bluuebunny/crossref_metadata_2025 huggingface dataset:
Toxoplasmosis chorioretinitis mimicking acute retinal necrosis associated with local corticosteroid
Authors: Crosson Jason N. , Kuthyar Sanjana , Shantha Jessica G. , Debiec Matthew R. , Laird Philip W. , Hwang Cindy S. , Grossniklaus Hans E. , Yeh Steven
Published: June 2020

Background

The cases discussed highlight the atypical presentation and diagnostic dilemmas of toxoplasmosis with fulminant retinal necrosis and the potentially devastating visual outcomes of toxoplasma chorioretinitis following local corticosteroid exposure.

Case presentation

We report a series of three patients who presented with toxoplasmosis mimicking severe acute retinal necrosis. Patients were between 59 and 77 years old and had been exposed to local corticosteroids preceding our evaluation. All patients demonstrated diffuse retinal whitening with severe vision loss on presentation. Polymerase chain reaction testing (PCR) was diagnostic in two patients, and histopathologic examination of a vitrectomy specimen was diagnostic in one patient. All cases of retinitis resolved with anti-parasitic medication; however, visual acuity failed to improve in all patients due to disease severity and presentation.

Conclusions

Local corticosteroid injection may trigger or exacerbate toxoplasmosis chorioretinitis, leading to fulminant retinal necrosis and severe vision loss. Toxoplasma chorioretinitis should be considered in the differential diagnosis of patients presenting with clinical features of acute retinal necrosis, particularly following local corticosteroid injection regardless of their baseline systemic immune status. Diagnostic vitrectomy may be helpful in patients in whom PCR testing is negative and ocular toxoplasmosis is suspected.
Evaluating diurnal variations in retinal perfusion using optical coherence tomography angiography
Authors: Rommel Felix , Rothe Matthias , Kurz Maximilian , Prasuhn Michelle , Grisanti Salvatore , Ranjbar Mahdy
Published: June 2020

Background

Optical coherence tomography angiography (OCTA) is a non-invasive tool for imaging and quantifying the retinal and choroidal vasculature as well as perfusion state in healthy eyes. Choroidal perfusion is subject to diurnal variation, showing lowest perfusion in the morning and highest in the afternoon. In this index study, OCTA was used to investigate diurnal changes of the retinal perfusion in healthy adult eyes and to identify impacting factors since retinal perfusion is known to be mainly determined by autoregulatory mechanisms.

Methods

A prospective study was conducted on healthy volunteers, each of whom underwent repeated measurements of mean arterial pressure (MAP), intraocular pressure (IOP), macular volume (MV), subfoveal choroidal thickness (SFCT), foveal avascular zone (FAZ) and retinal perfusion of the superficial capillary plexus (SCP), deep capillary plexus (DCP) and full retina (FR) slab at 7 a.m. and 4 p.m. Possible influence of MAP or IOP on the retinal perfusion was evaluated.

Results

A total of 22 eyes of 22 participants (mean age 55.91 ± 14.84) were analysed. Significant diurnal changes from 7 a.m. to 4 p.m. were observed for MAP (p < 0.001) and SFCT (p = 0.017). The perfusion of SCP, DCP and FR as well as the size of the FAZ and the MV did not show significant fluctuation during the day. No significant correlation between MAP or IOP and retinal perfusion values were detectable.

Conclusion

OCTA-based analysis of the retina in healthy adults demonstrated a steady perfusion of both plexus during the day, independently of changes in MAP. These findings support the theory of autoregulatory mechanisms of the retinal blood flow.
Logistic regression has similar performance to optimised machine learning algorithms in a clinical setting: application to the discrimination between type 1 and type 2 diabetes in young adults
Authors: Lynam Anita L. , Dennis John M. , Owen Katharine R. , Oram Richard A. , Jones Angus G. , Shields Beverley M. , Ferrat Lauric A.
Published: June 2020

Background

There is much interest in the use of prognostic and diagnostic prediction models in all areas of clinical medicine. The use of machine learning to improve prognostic and diagnostic accuracy in this area has been increasing at the expense of classic statistical models. Previous studies have compared performance between these two approaches but their findings are inconsistent and many have limitations. We aimed to compare the discrimination and calibration of seven models built using logistic regression and optimised machine learning algorithms in a clinical setting, where the number of potential predictors is often limited, and externally validate the models.

Methods

We trained models using logistic regression and six commonly used machine learning algorithms to predict if a patient diagnosed with diabetes has type 1 diabetes (versus type 2 diabetes). We used seven predictor variables (age, BMI, GADA islet-autoantibodies, sex, total cholesterol, HDL cholesterol and triglyceride) using a UK cohort of adult participants (aged 18–50 years) with clinically diagnosed diabetes recruited from primary and secondary care (n= 960, 14% with type 1 diabetes). Discrimination performance (ROC AUC), calibration and decision curve analysis of each approach was compared in a separate external validation dataset (n= 504, 21% with type 1 diabetes).

Results

Average performance obtained in internal validation was similar in all models (ROC AUC ≥ 0.94). In external validation, there were very modest reductions in discrimination with AUC ROC remaining ≥ 0.93 for all methods. Logistic regression had the numerically highest value in external validation (ROC AUC 0.95). Logistic regression had good performance in terms of calibration and decision curve analysis. Neural network and gradient boosting machine had the best calibration performance. Both logistic regression and support vector machine had good decision curve analysis for clinical useful threshold probabilities.

Conclusion

Logistic regression performed as well as optimised machine algorithms to classify patients with type 1 and type 2 diabetes. This study highlights the utility of comparing traditional regression modelling to machine learning, particularly when using a small number of well understood, strong predictor variables.
Comparative evaluation of efficacy, pharmacodynamics, and safety of Hetero’s adalimumab (Mabura®, Hetero Biopharma Ltd.) and reference adalimumab (Humira®, Abbvie Inc.) in patients with active rheumatoid arthritis on concomitant methotrexate therapy
Authors: Sinha Shubhadeep , Ghosh Biswadip , Bandyopadhyay Syamasis , Fatima Firdaus , Bandi Vamsi Krishna , Thakur Pankaj , Reddy Bala , Chary Sreenivasa , Talluri Leela , Gupta Ajay , Kale Amit Ramchandra , Gupta Anil Kumar , P Ashok Kumar , Reddy Diwakar , Mohammed Younus , Shekar Soma , T Sudheer , Goni Vijay G. , Sharma Vishnu , Yeligod Vishwanath
Published: June 2020

Background

Our study aimed to compare efficacy and safety of Hetero’s adalimumab (Mabura®, Hetero Biopharma Limited) versus reference adalimumab (Humira®, Abbvie Inc.) in Indian patients with active rheumatoid arthritis (RA) concomitant on methotrexate (MTX) therapy.

Methods

Patients (n = 168) were randomized (2:1) to receive either test or reference product for 24 weeks with concomitant MTX. Proportion of patients achieving American College of Rheumatology 20 (ACR20) criteria at week 12 was the primary endpoint. Changes in Disease Activity Score of 28 joints–C-reactive protein (DAS28-CRP), Health Assessment Questionnaire–Disability Index (HAQ-DI), and patients achieving ACR20 at week 24, ACR50/70 at weeks 12 and 24 were secondary endpoints.

Results

Patients achieving ACR20 responses with test (96.43%) were similar to reference (96.43%) in intention-to-treat (ITT) analysis at week 12. Proportional difference (PD) between groups (PD [95% CI] 0.0 [− 6.0, 6.0], p = 1.000) for ACR20 at week 12 for ITT analysis showed lower limit of the two-sided 95% CI was above the pre-specified noninferiority margin of − 15%. Similar trend in PP analysis (PD [95% CI] 0.0 [− 0.03, 0.07], p = 1.000), confirmed therapeutic equivalence. No significant difference was noted between arms for patients attaining ACR20 at week 24 and ACR50/70 at weeks 12 and 24 (all p > 0.05). DAS28-CRP and HAQ-DI were similar between groups. Total of 54 patients reported 88 AEs during the study. Out of these, 60 AEs were reported in 34 patients with Hetero-Adalimumab and 28 AEs were reported in 20 patients with Reference-Adalimumab. Total two patients, one in each group reported two serious adverse events (Sinusitis and Viral infection) during the study and resolved completely. No deaths and no life threatening AEs were reported.

Conclusion

Results demonstrated Hetero’s adalimumab is as effective and well tolerated as reference adalimumab in patients with active RA concomitantly on MTX therapy.

Trial registration

CTRI/2016/04/006884, Registered on 28/04/2016.
Endovascular stenting of medically refractory intracranial arterial stenotic (ICAS) disease (clinical and sonographic study)
Authors: Nassef Ayman Mohamed , Awad Eman Mahmoud , El-bassiouny Ahmed Ali , Afify Hossam Eldin Mahmoud , Yousef Romany Adly , Shafik Mohamed Ahmed
Published: June 2020

Background

Atherosclerotic intracranial arterial stenosis (ICAS) is one of the most common causes of stroke worldwide and is associated with a high risk of recurrent stroke. Patients with a recent transient ischemic attack (TIA) or stroke and severe stenosis (70 to 99% of the diameter of a major intracranial artery) are at particularly high risk for recurrent stroke in the territory of the stenotic artery (approximately 23% at 1 year) despite medical treatment. Therefore, alternative therapies are urgently needed for these patients.

Objective

To determine the efficacy and safety of angioplasty with stenting in medically refractory ICAS and to compare its effectiveness with optimal medical treatment.

Subjects and methods

Fifty patients with symptomatic ICAS despite medical treatment (i.e, recurrent stroke or TIA) were enrolled and equally randomized in a prospective study where twenty-five patients underwent angioplasty with stenting and twenty-five patients received optimal medical treatment. Clinical assessment with NIHSS and mRS were done at 0, 3, and 6 months, and transracial Doppler (TCD) assessment of ICAS was done at 0 and 3 months after treatment.

Results

The interventional group had a better clinical outcome with mean NIHSS scores (5.2 ± 4.2, 4.43 ± 4.28 and 3.9 ± 4.7) at baseline, 3 and 6 months, respectively, in comparison to the medical group with mean NIHSS (4.5 ± 4.2, 11.42 ± 6.3, and 8.5 ± 5.1) and better functional outcome with mean mRS scores (1.3 ± 0.96, 1.2 ± 1.13, and 1.0 ± 1.13) at baseline, 3 and 6 months, respectively, in comparison to the medical group (0.84 ± 0.75, 2.28 ± 1.2, and 2 ± 1.24). TCD assessment of ICAS showed a marked reduction of the percentage of stenosis on 3 months of follow-up among the interventional groups (only 5.6% had > 70% stenosis) in comparison to the medical group (85.7% had > 70% stenosis). Recurrent ischemic events on 6 months of follow-up were 16% among interventional groups in comparison to 84% among medical groups. The mortality rate was 8% among interventional groups due to subarachnoid hemorrhages (SAH) related to procedure in comparison to 28% among medical groups secondary to ischemic events. The intraoperative success rate was 96% with the failure of stent deployment in 1 patient due to the tortuous anatomy of vessels. Early post interventional complication rate, i.e, SAH was 8%. Late post interventional restenosis and occlusion rates were 8% on 3 months of follow-up.

Conclusion

Endovascular stenting of medically refractory ICAS is more efficacious and effective with better clinical and functional outcomes than optimal medical treatment; however, its safety is still debatable.

Trial registration

Done at ClinicalTrials.gov. Trial ID (NCT Number) NCT04393025.
Comparison of bupivacaine versus bupivacaine-dexamethasone infiltration for postoperative analgesia in skin graft donor sites: a randomized trial
Authors: Mahrose Ramy , Elsayed Ahmed Mohammed , Sabry Asmaa Adel
Published: June 2020

Background

Skin grafting, both partial and complete thickness, is frequently used in reconstruction of traumatic soft tissue defects. It is of great value not only for functional and anesthetic purposes in the field of plastic surgery, but also for other surgical specialties.

Of all the problems in the early postoperative period, pain is considered the most important, ameliorating it can lead to significant reduction in postoperative morbidity and faster recovery of the skin donor site.

Objective

To evaluate use of dexamethasone as adjuvant for bupivacaine in subcutaneous local anesthesia infiltration for skin graft donor sites, on quality of pain relief and total dose of analgesic requirements in the early hours postoperatively.

Methods

Ninety-five patients were randomly allocated to receive local bupivacaine infiltration (group LB) (48 patients), or dexamethasone plus bupivacaine (group LB + D) (47 patients) in skin donor site after skin harvesting. In addition to basic demographic data, patients were compared for numerical rating scale (NRS), total dose of morphine including morphine equivalents, time to 1st breakthrough pain (over an observational period during the first 12 h postoperatively) and duration of surgery.

Results

Numerical rating scale figures were significantly better (P< 0.05) in group (LB + D) than group (LB) in the first 7 h postoperatively. Likewise, consumption of morphine or its equivalents was considerably less, as well as time to first breakthrough pain. Duration of surgery was not significantly different between both groups.

Conclusion

Addition of dexamethasone to bupivacaine provided effective analgesia for patients undergoing skin grafting surgery, with less need for rescue analgesia in the early postoperative period to bupivacaine alone.
Diagnostic accuracy of serum endothelin-1 in patients with HCC on top of liver cirrhosis
Authors: Elbadry Mohammad M. , Tharwat Mina , Mohammad Emad F. , Abdo Ehab F.
Published: June 2020

Background

Hepatocellular carcinoma (HCC) is one of the most common cancers and one of the main causes of cancer-related deaths. As the overall survival of patients with cirrhosis has improved and the global incidence of HCC has continued to increase, strategies for the early detection of HCC are urgently needed for better prognosis. In this study, we aimed to assess the accuracy of endothelin-1 in the diagnosis of HCC in cirrhotic patients in comparison with alpha-fetoprotein (AFP) and whether it could predict its vascular spread. This is a case–control study that included 70 cirrhotic patients with or without hepatocellular carcinoma. Patients were subjected to complete medical history taking, clinical examination and laboratory investigations including serum endothelin-1, alpha-fetoprotein, abdominal ultrasound and Triphasic multi-slice computed tomography (CT; abdomen and pelvis). The outcome results obtained for endothelin-1 were used to assess its diagnostic accuracy in HCC diagnosis and the prediction of presence of vascular spread.

Results

There was a statistically significant increase in serum endothelin-1 in HCC in comparison to cirrhotic patients and normal persons (P value < 0.001). Sensitivity, specificity, and positive and negative predictive values at cut-off point of 5.2 pg/ml for HCC were 90%, 100%, 100%, and 90.9% respectively. There was no statistically significant association between serum endothelin-1 level and portal vein thrombosis in HCC (P value = 0.547).

Conclusion

Endothelin-1 has high sensitivity and specificity for diagnosis of hepatocellular carcinoma. However, it has little value for prediction of its vascular spread.
Robust control of a multi-bus DC microgrid based on adaptive Lyapunov function method
Authors: Rezaei Mohammad Mahdi , Shojaeian Shahrokh , Rouhollahi Rasoul
Published: June 2020

Due to the development of power electronic devices, the DC microgrids are competing AC microgrids, and even in some areas, such as efficiency, reliability, stability, DC microgrids are superior. In spite of mentioned advantages, the main technical challenge related to operation of the DC microgrids is to provide a fast and stable voltage regulation. In this paper, a robust control structure is proposed for multi-bus DC microgrids. Adopting master–slave control strategy, an adaptive voltage control scheme is proposed to robustly maintain the master unit voltage at the nominal value. In addition, an adaptive current controller is designed to robustly regulate the current of all the DG units in the grid-connected mode, as well as the slave units in the islanded mode of operation. All of the controllers are designed based on local measurements and are independent with respect to parameters, dynamic, and topology of the DCMG loads. The control scheme is shown to be stable and robust subject to parametric uncertainties and various types of disturbances. The consistent and effectiveness of the proposed control scheme is demonstrated through simulation studies in MATLAB®software environment.
Experience of transfer from child to adult mental health services of young people with autism spectrum disorder
Authors: Merrick Hannah , King Chris , McConachie Helen , Parr Jeremy R. , Le Couteur Ann
Published: June 2020

Background

Transition from child-centred to adult mental health services has been reported as challenging for young people. It can be especially difficult for young people with autism spectrum disorder (ASD) as they manage the challenges of adolescence and navigate leaving child and adolescent mental health services (CAMHS).

Aims

This study examines the predictors of transfer to adult mental health services, and using a qualitative analysis, explores the young people’s experiences of transition.

Method

A UK sample of 118 young people aged 14–21 years, with ASD and additional mental health problems, recruited from four National Health Service trusts were followed up every 12 months over 3 years, as they were discharged from CAMHS. Measures of mental health and rich additional contextual information (clinical, family, social, educational) were used to capture their experiences. Regression and framework analyses were used.

Results

Regression analysis showed having an attention-deficit hyperactivity disorder diagnosis and taking medication were predictors of transfer from child to adult mental health services. Several features of young people's transition experience were found to be associated with positive outcomes and ongoing problems, including family factors, education transitions and levels of engagement with services.

Conclusions

The findings show the importance of monitoring and identifying those young people that might be particularly at risk of negative outcomes and crisis presentations. Although some young people were able to successfully manage their mental health following discharge from CAMHS, others reported levels of unmet need and negative experiences of transition.
Effect of Vitamin D Supplementation on the Incidence of Diabetes Mellitus
Authors: Barbarawi Mahmoud , Zayed Yazan , Barbarawi Owais , Bala Areeg , Alabdouh Ahmad , Gakhal Inderdeep , Rizk Fatima , Alkasasbeh Mariam , Bachuwa Ghassan , Manson JoAnn E
Published: June 2020

Context

The effect of vitamin D supplementation on the risk of type 2 diabetes mellitus (T2DM) remains controversial because most randomized controlled trials (RCTs) have been small or have reported low doses of vitamin D.

Objective

To conduct a meta-analysis of RCTs testing vitamin D supplementation in the prevention of T2DM.

Data Sources

Database search of PubMed/MEDLINE, EMBASE, and the Cochrane Library was performed by 2 reviewers from inception through September 15, 2019.

Study Selection

We included RCTs that reported the effect of vitamin D supplementation for at least 1 year on T2DM prevention.

Data Extraction

Two independent reviewers extracted the data. The risk ratios (RRs) and 95% confidence intervals (CIs) were reported. Primary outcome of the meta-analysis was the incidence of T2DM.

Data Synthesis

Nine RCTs were included (43 559 participants). The mean age (standard deviation) was 63.5 (6.7) years. The RR for vitamin D compared with placebo was 0.96 (95% CI, 0.90-1.03); P = 0.30. In trials testing moderate to high doses of supplementation (≥1000 IU/day), all conducted among participants with prediabetes, the RR for vitamin D compared with placebo was 0.88 (95% CI, 0.79-0.99). In contrast, the trials testing lower doses, which were conducted in general population samples, showed no risk reduction (RR, 1.02; 95% CI, 0.94-1.10; P, interaction by dose = 0.04).

Conclusion

In patients with prediabetes, vitamin D supplementation at moderate to high doses (≥1000 IU/day), significantly reduced the incidence risk of T2DM, compared with placebo.
Insulin Sensitizers for Improving the Endocrine and Metabolic Profile in Overweight Women With PCOS
Authors: Xing Chuan , Li Chunzhu , He Bing
Published: June 2020

Objective

To evaluate the efficacy of insulin sensitizers on menstrual frequency, sex hormone, and metabolic parameters in overweight women with polycystic ovary syndrome (PCOS).

Methods

We searched multiple databases from inception to September 2019 for randomized controlled trials. Network meta-analysis was conducted using multivariate random effects method.

Results

Fourteen trials reporting on 619 women were included. Compared with metformin, metformin + thiazolidinediones (TZDs) was more superior in menstrual recovery (weighted mean difference [WMD] 3.68; 95% credibility interval [CrI], 1.65 to 8.20), metformin +  glucagon-like peptide-1 (GLP-1) receptor agonists was more effective in decreasing androstenedione (WMD −2.53; 95% CrI, −3.96 to −1.09), both metformin + GLP-1 receptor agonists (WMD 9.22; 95% CrI, 5.46 to 12.98) and metformin + TZDs (WMD 4.30; 95% CrI, 0.78 to 7.82) were more effective in increasing sex hormone–binding globulin (SHBG), while TZDs were less effective in decreasing body mass index (BMI) (WMD 1.69; 95% CrI, 0.72 to 2.66). Compared with GLP-1 receptor agonists, metformin + GLP-1 receptor agonists was associated with higher SHBG (WMD 7.80; 95% CrI, 4.75 to 10.85), lower free testosterone (WMD −1.77; 95% CrI, −3.25 to −0.29), lower androstenedione (WMD −2.70; 95% CrI, −3.91 to −1.50) and lower fasting blood glucose (WMD −0.41; 95% CrI, −0.73 to −0.08).

Conclusion

For overweight women with PCOS, both metformin combined with GLP-1 receptor agonists and metformin combined with TZDs appear superior to monotherapy in improving hyperandrogenemia. Metformin combined with TZDs could be particularly effective in promoting the recovery of menstruation. Metformin combined with GLP-1 receptor agonists has the additional advantage of improving fasting glucose when compared with GLP-1 receptor agonists alone. TZDs are inferior to metformin in decreasing BMI.
Association Between Exposure to Ambient Air Pollution and Thyroid Function in Korean Adults
Authors: Kim Hyun-Jin , Kwon Hyuktae , Yun Jae Moon , Cho Belong , Park Jin-Ho
Published: June 2020

Context

Although a significant relationship has been reported between air pollution and thyroid function in limited samples or regions, few studies have addressed this association in the general population.

Objective

Using a nationwide sample of Korean adults, we investigated the association between exposure to air pollution and thyroid function, and whether this association differed between subgroups stratified according to age or body mass index (BMI).

Methods

We included 4704 adults in the final analysis and used each person’s annual average exposure to 4 air pollutants, namely, particulate matter with an aerodynamic diameter less than or equal to 10 μm (PM10), nitrogen dioxide (NO2), sulfur dioxide, and carbon monoxide (CO). We measured serum thyrotropin (TSH) and free thyroxine (FT4) concentrations as indicators of thyroid function according to age and BMI.

Results

The annual average exposure to NO2 and CO was significantly associated with an elevated TSH and reduced FT4 concentration after adjusting for possible confounding factors (all P < .05). In men, in addition to these 2 pollutants, PM10 exposure was positively associated with TSH level (P = .03). Age-stratified analysis showed stronger effects of NO2 and CO exposure in older than in younger adults. Exposure to these air pollutants was related to serum TSH and FT4 concentrations in people with overweight or obesity but not in those of normal weight.

Conclusions

This study provides the first evidence that air pollution exposure is linked to thyroid function in the general population and that this association may be stronger in older or overweight or obese adults.
Circulating Myeloid-derived Suppressor Cells Facilitate Invasion of Thyroid Cancer Cells by Repressing miR-486-3p
Authors: Chen Li , Xiong Li , Hong Shubing , Li Jin , Huo Zijun , Li Yudong , Chen Shuwei , Zhang Quan , Zhao Ruiying , Gingold Julian A , Zhu Xiaonan , Lv Weiming , Li Yanbing , Yu Shuang , Xiao Haipeng
Published: June 2020

Background

Myeloid-derived suppressor cells (MDSCs) have become increasingly recognized as facilitators of tumor development. However, the role of MDSCs in papillary thyroid carcinoma (PTC) progression has not been clearly explored.

Objective

We aimed to evaluate the levels and function of circulating MDSCs in PTC.

Methods

The proportion of circulating polymorphonuclear (PMN)-MDSCs and mononuclear-MDSCs from patients with PTC or benign thyroid nodules and healthy controls was measured using flow cytometry. For immunosuppressive activity analysis, sorted circulating MDSCs were cocultured with CD3/CD28-costimulated T lymphocytes and the proliferation of T cells was determined. PTC cell lines (TPC-1 and BC-PAP) were cocultured with PMN-MDSCs, and the effects on cell migration, invasion, proliferation, and apoptosis were evaluated. The differential expressed microribonucleic acids (RNAs) and messenger RNAs and their function were also explored in TPC-1 cells cocultured with or without PMN-MDSCs.

Results

PMN-MDSCs were increased in peripheral blood mononuclear cells of patients with PTC. Circulating PMN-MDSCs displayed strong T cell suppressive activity. PTC cells demonstrated enhanced invasive capabilities in vitro and in vivo when cocultured with sorted PMN-MDSCs. PMN-MDSCs decreased expression of miR-486-3p and activated nuclear factor kappa B2 (NF-κB2), a direct target of miR-486-3p. Rescue of miR-486-3p diminished the cell migration and invasion induced by PMN-MDSCs.

Conclusion

Collectively, our work indicates that circulating PMN-MDSCs promote PTC progression. By suppressing miR-486-3p, PMN-MDSCs promote the activity of the NF-κB2 signaling pathway, resulting in accelerated invasion of PTC cells, which may provide new therapeutic strategies for treatment of thyroid cancer.
Vein patterning by tissue-specific auxin transport
Authors: Govindaraju Priyanka , Verna Carla , Zhu Tongbo , Scarpella Enrico
Published: June 2020

Unlike in animals, in plants vein patterning does not rely on direct cell-cell interaction and cell migration; instead, it depends on the transport of the plant hormone auxin, which in turn depends on the activity of the PIN-FORMED1 (PIN1) auxin transporter. The current hypotheses of vein patterning by auxin transport propose that in the epidermis of the developing leaf PIN1-mediated auxin transport converges to peaks of auxin level. From those convergence points of epidermal PIN1 polarity, auxin would be transported in the inner tissues where it would give rise to major veins. Here we tested predictions of this hypothesis and found them unsupported: epidermal PIN1 expression is neither required nor sufficient for auxin-transport-dependent vein patterning, whereas inner-tissue PIN1 expression turns out to be both required and sufficient for auxin-transport-dependent vein patterning. Our results refute all vein patterning hypotheses based on auxin transport from the epidermis and suggest alternatives for future tests.
Estimating the Prevalence of Pseudomyxoma Peritonei in Europe Using a Novel Statistical Method
Authors: Patrick-Brown Thale Dawn J. H. , Carr Norman John , Swanson David M. , Larsen Stein , Mohamed Faheez , Flatmark Kjersti
Published: June 2020

Background

The determination of the incidence and prevalence of rare diseases is important for economists and health-care providers. Pseudomyxoma peritonei (PMP) is a rare, slow-growing abdominal cancer that represents a substantial burden on both patients and health-care systems. The incidence rate was previously approximated at 1–2 people per million per year; this incidence has never been challenged, and the prevalence has not been estimated.

Methods

Epidemiological data from Norway and England were obtained and analysed to calculate a minimum incidence rate based on the number of patients having a first surgical intervention for PMP. A novel method was then used to determine a prevalence rate for PMP, incorporating incidence, death, and cure rates in a multi-year analysis that accounted for the increasing population of Europe over a 10-year period.

Results

An incidence rate of 3.2 people per million per year was calculated, with a corresponding estimated prevalence rate of 22 people per million per year. By this calculation, 11,736 people in Europe were estimated to be living with PMP in 2018.

Conclusion

Incidence and prevalence are essential tools for assessment of the financial and human cost of a disease. For rare diseases, such as PMP, the lack of accurate registries presents a particular challenge in determining such health-related statistical parameters. Based on our calculations, a significant number of people are living with PMP in Europe, underlining the need for appropriate resource allocation to ensure that adequate health-care measures are provided.
Surgery for Gastric Remnant Cancer Results in Similar Overall Survival Rates Compared with Primary Gastric Cancer: A Propensity Score-Matched Analysis
Authors: Galata Christian , Ronellenfitsch Ulrich , Weiß Christel , Blank Susanne , Reißfelder Christoph , Hardt Julia
Published: June 2020

Background

The purpose of this study was to investigate clinical features, prognostic factors, and overall survival (OS) in surgical patients with gastric remnant cancer (GRC).

Methods

A retrospective analysis of patients with gastrectomy for pT1–4 gastric cancer between October 1972 and February 2014 at our institution was performed. Clinical characteristics were compared between patients with GRC and those with primary gastric cancer (PGC). Multivariable Cox regression analysis was performed to determine the prognostic factors for OS in patients with GRC. A propensity score-matched cohort was used to investigate OS between the GRC and PGC groups.

Results

Of a baseline cohort of 1440 patients, 95 patients with GRC were identified. Patients with GRC underwent more multivisceral resections (p < 0.001) than patients with PGC despite lower tumor stages (p = 0.018); however, R0 resection rates were not significantly different (p = 0.211). The postoperative overall (p = 0.032) and major surgical (p = 0.021) complication rates and the 30-day (p = 0.003) and in-hospital (p = 0.008) mortality rates were higher in patients with GRC. In multivariable analysis, the only prognostic factors for worse OS in GRC were higher tumor stage (p < 0.001) and the occurrence of postoperative complications (p < 0.001). OS between propensity score-matched GRC and PGC groups was not significantly different (p = 0.772).

Conclusions

GRC required more invasive surgery than PGC; however, the feasibility of R0 resection was similar. The prognostic factors of GRC were similar to those of PGC, and OS was not significantly different between both groups. Patients with GRC benefit from extensive surgery when performed with low morbidity and mortality.
The Influence of Prolonged Running and Footwear on Lower Extremity Joint Stiffness
Authors: WEIR GILLIAN , WILLWACHER STEFFEN , TRUDEAU MATTHIEU B. , WYATT HANNAH , HAMILL JOSEPH
Published: June 2020

Introduction

The purpose of this study was to compare leg, sagittal plane knee and ankle, and frontal plane ankle stiffness over the course of a prolonged treadmill run in neutral and stability footwear.

Methods

Thirteen male habitual rearfoot runners completed two biomechanical testing sessions in which they ran for 21 min at their preferred running speed in a neutral shoe, then changed either into the same neutral shoe or a stability shoe and ran a further 21 min on a force-instrumented treadmill. Three-dimensional kinematics and kinetics were recorded at the beginning and end of each 21-min interval.

Results

No differences were observed in leg stiffness between footwear conditions throughout the run (P> 0.05). Knee stiffness increased during the first 21 min (P= 0.009), whereas ankle stiffness reduced at minute 21 (P= 0.004) and minute 44 (P= 0.006). These changes were modulated by an increase in ankle joint compliance and knee joint moments. No differences were observed between footwear conditions for leg and sagittal plane lower extremity joint stiffness (P> 0.05). During the second half of the run, frontal plane ankle stiffness increased in the stability shoe but decreased in the neutral shoe (P= 0.019), attributed to reduced eversion range of motion caused by the added medial post.

Conclusions

These results suggest that over the course of a prolonged treadmill run, shock attenuation strategies change, which may affect the knee joint.
FORMAÇÃO JURÍDICA E NOVAS TECNOLOGIAS: RELATO DE UMA APRENDIZAGEM EXPERIENCIAL EM DIREITO
Authors: Feferbaum Marina , Lima Stephane H. B.
Published: June 2020

O objetivo deste artigo é investigar a contribuição do ensino experiencial no campo do ensino jurídico enquanto instrumento adequado à formação das competências identificadas como importantes aos novos profissionais de Direito. Variadas transformações tecnológicas estão sendo vivenciadas nas profissões jurídicas, com a crescente inserção da automação e da inteligência artificial no mercado de Direito. Nesse cenário, buscou-se identificar as competências necessárias a esses novos profissionais para, a partir da utilização da teoria da experiência de ensino, ser proposto um novo método de formação jurídica com base na aprendizagem experiencial do Direito. Foi utilizada, portanto, como metodologia, especialmente, a análise de doutrina, de acordo com referenciais teóricos da Educação (Kolb e Moon), em consonância com conclusões de pesquisas jurídicas sobre o perfil dos novos profissionais de Direito (CEPI); então, idealizou-se uma nova disciplina para o curso de graduação da FGV Direito SP, cujos resultados foram avaliados e se encontram presentes neste artigo. Concluiu-se, por meio da análise dos diários de bordo produzidos pelos alunos ao longo do semestre e de observação, que o método utilizado foi importante para o desenvolvimento das competências identificadas como relevantes à formação dos novos profissionais de Direito, quais sejam: desenvolver a capacidade de apresentar soluções criativas e rápidas de problemas; trabalhar colaborativamente em grupos diversos; e idealizar, executar e conduzir novos projetos.
RELEITURA DO REGIME JURÍDICO-ADMINISTRATIVO E A TEORIA DO MELHOR DIREITO: IMPACTOS DA CONVENCIONALIDADE NO SISTEMA INTERAMERICANO DE DIREITOS HUMANOS
Authors: Gussoli Felipe Klein
Published: June 2020

O trabalho descreve os impactos da convencionalidade no regime jurídico de Direito Administrativo nos ordenamentos dos países integrantes do Sistema Interamericano de Direitos Humanos (SIDH). Explora os reflexos dos tratados internacionais de Direitos Humanos, decisões e Opiniões Consultivas da Corte Interamericana de Direitos Humanos na interpretação e aplicação de princípios comuns do Direito Administrativo da região latino-americana. Para tanto, discorre sobre alterações cabíveis, em tese, na organização das Administrações Públicas nacionais a partir da teoria do melhor direito formulada pelo jurista argentino Jorge Luis Salomoni. Busca, em suma, possibilitar diálogos entre os Estados integrantes do Sistema Interamericano em torno da construção de melhores patamares de proteção dos direitos humanos na região.
OBSERVÂNCIA DE PRECEDENTES E GESTÃO DE DEMANDAS REPETITIVAS POR MEIO DO APRENDIZADO DE MÁQUINA
Authors: Sabo Isabela Cristina , Rover Aires José
Published: June 2020

O Poder Judiciário se apresenta como um dos focos de debate sobre a implementação de tecnologias relacionadas à Inteligência Artificial (IA), de onde advém a técnica de aprendizado de máquina (ML - machine learning). Nesse contexto, apresenta-se o problema de pesquisa: é possível que o aprendizado de máquina contribua para o funcionamento do sistema de precedentes? Partindo-se de uma hipótese inicial positiva e empregando-se o método indutivo, o artigo expõe um estudo de dois casos, com o levantamento de dados referentes a dois institutos processuais: um relacionado à não observância dos precedentes, a Reclamação; e outro pertinente às técnicas para julgamento de casos repetitivos, o Incidente de Resolução de Demandas Repetitivas (IRDR). A fim de contextualizar o tema e os objetivos do estudo, a pesquisa apresenta a evolução do conceito de jurisdição, reportando-se às alterações trazidas pelo Código de Processo Civil (CPC) de 2015; e, ainda, as noções de E-Judiciário e E-Jurisdição combinadas com as funcionalidades da IA, bem como trabalhos relacionados utilizando a técnica de ML. Com isso, a proposta de possíveis aplicações envolvendo a técnica de ML se fundamenta na identificação desses dois institutos relacionados ao funcionamento do sistema de precedentes, que podem ser aperfeiçoados com a implementação da tecnologia, no intuito de atingir um modelo de jurisdição inteligente.
Case Report: Management of rectal squamous cell carcinoma - a treatment dilemma
Authors: Parker Nathaniel A. , Hussein Agha Yasmine , Buess Charles Scott , Lalich Daniel , Deutsch Jeremy M.
Published: June 2020

Primary rectal squamous cell carcinoma is rare compared to adenocarcinoma, which is the predominant histologic type most commonly discovered at the time of colorectal carcinoma diagnosis. Due to the infrequent nature of this malignancy, data on tumor pathogenesis and risk factors remains sparse. Moreover, no standardized therapeutic regimen exists. This report describes a case of advanced rectal squamous cell carcinoma diagnosed in a 46-year-old female who initially presented with abdominal pain. Her clinical course was uncomplicated and she responded well to the selected therapy. Much work remains to be accomplished for patients with rectal squamous cell carcinoma.
Ethical challenges in pathogen sequencing: a systematic scoping review
Authors: Johnson Stephanie , Parker Michael
Published: June 2020

Background: Going forward, the routine implementation of genomic surveillance activities and outbreak investigation is to be expected. We sought to systematically identify the emerging ethical challenges; and to systematically assess the gaps in ethical frameworks or thinking and identify where further work is needed to solve practical challenges.

Methods: We systematically searched indexed academic literature from PubMed, Google Scholar, and Web of Science from 2000 to April 2019 for peer-reviewed articles that substantively engaged in discussion of ethical issues in the use of pathogen genome sequencing technologies for diagnostic, surveillance and outbreak investigation.

Results: 28 articles were identified; nine United States, five United Kingdom, five The Netherlands, three Canada, two Switzerland, one Australia, two South Africa, and one Italy. Eight articles were specifically about the use of sequencing in HIV. Eleven were not specific to a particular disease. Results were organized into four themes: tensions between public and private interests; difficulties with translation from research to clinical and public health practice; the importance of community trust and support; equity and global partnerships; and the importance of context.

Conclusion: While pathogen sequencing has the potential to be transformative for public health, there are a number of key ethical issues that must be addressed, particularly around the conditions of use for pathogen sequence data. Ethical standards should be informed by public values, and further empirical work investigating stakeholders’ views are required. Development in the field should also be under-pinned by a strong commitment to values of justice, in particular global health equity.
Introduction to the Special Issue on Marketing Science and Health
Authors: Ailawadi Kusum , Chan Tat , Manchanda Puneet , Sudhir K.
Published: June 2020

This editorial introduces the special issue on marketing science and health. We begin by describing the healthcare ecosystem and its many distinguishing features relative to other markets. With its large share of U.S. and world gross domestic product; rapid changes on the demand, supply, and regulatory sides; and a complex ecosystem with many types of participants, healthcare markets provide a rich canvas of novel research opportunities for marketing scholars. We then describe the special issue process and the papers published in the special issue. We summarize key themes that emerge from these papers and conclude with a discussion of future research opportunities in the area.
When and Why Consumers “Accidentally” Endanger Their Products
Authors: Shani Yaniv , Appel Gil , Danziger Shai , Shachar Ron
Published: June 2020

In this article, we examine whether consumers may “accidentally” endanger a product they own when a new version of the product is introduced. We propose that owners endanger their product when they want to upgrade to a new version but have difficulty justifying the upgrade and that owners find justification more difficult when a new version offers an improved design but does not offer a significant technological improvement. Owners endanger their product hoping that it will be fortuitously damaged. Product damage provides owners with a good reason to upgrade. Focusing on iPhone as a case study, field data and experiments provide evidence for product endangering, and they support the role of justification in three ways. First, as hypothesized, endangering occurs when the new product offers an improved design but does not offer a significant technological improvement. Second, owners are less likely to endanger a product that is under warranty; therefore, damage to it will not enable upgrading. Third, owners are more likely to endanger their product when their justification concerns are heightened.

This paper was accepted by Yan Chen, decision analysis.
Supporting women with breast cancer during pregnancy
Authors: Brauten-Smith Grete
Published: June 2020

While offering specialist support, Breast Cancer Now is continuing to share the breast awareness message
Against the grain: midwives' experiences of facilitating home birth outside of guidelines
Authors: Larner Lisa , Hooks Claire
Published: June 2020

Background

Midwifery standards promote autonomous decision-making and informed choice, resulting in maternal home birth choices which may contravene guidelines. There is a paucity of evidence exploring midwives' experiences of managing these choices.

Aims

To explore the lived experiences of midwives facilitating home birth outside of guidelines.

Methods

A qualitative design using an interpretive hermeneutic cycle to analyse semi-structured interviews.

Findings

Participants reported confidence in supporting maternal choices, identifying barriers including other birth supporters. Perceived levels of risk, previous experience and safety concerns impacted on confidence. Peer, unit and professional midwifery advocate (PMA) support were identified as being beneficial to midwives.

Recommendations

Expansion of birth choices clinics; implementation of dedicated home birth teams; guideline review for midwife led birthing units; expansion of the PMA role; implementation of a structured debriefing service and further research looking at women's choices, and the impact of the loss of midwifery supervision.
Supporting childbearing women who are at risk of having their baby removed at birth
Authors: Tantawi-Basra Tabitha , Pezaro Sally
Published: June 2020

Background

Applications for babies to be taken in to care at birth are at a national high. This results in significantly impaired life outcomes.

Aims

To identify therapeutic mechanisms and interventions to support those at risk of having their baby removed from them at birth and explore the literature in this area.

Findings

Overall, eight articles including a total of 2 539 participants were selected for inclusion, reporting outcomes from Canada, Australia, England, the Netherlands and US. Findings were categorised into three overarching themes and seven subthemes.

Conclusion

A cycle of maltreatment model is presented. Social stigma, distrust of services and inequalities remain significant barriers to help-seeking. The development of trusting professional relationships, goal setting and early and sustained interventions may be key in developing effective future interventions of support.
Adjusting our focus
Authors: Allingham Sue
Published: June 2020

While there has been a lot of coverage in the media about lockdown having placed children in ‘education poverty’, it is their health and well-being that must be the priority as they return to school, says Sue Allingham.
Your best investment
Authors: Dubiel Jan
Published: June 2020

‘Continuous provision’ can imply that a well resourced environment is enough to support learning without an adult being present. But the adult is always the most precious resource, says Jan Dubiel.
See the big picture
Authors: Baker Charlotte
Published: June 2020

Last month Charlotte Baker explored what motivates and drives early years research forward. Here she looks at the barriers to carrying it out effectively and how these can be overcome.
Listen carefully
Authors: Thom Jamie
Published: June 2020

The art of listening has an important role to play in raising the quality of classroom dialogue and the learning that goes with it. Jamie Thom offers strategies to ensure that all children – whether they are naturally quiet or extrovert – derive maximum benefit.
Get smart with CPD
Authors: Hardy-King Annabel
Published: June 2020

With professional development now more important than ever, PACEY's online learning platform is designed to inspire its users and encourage them to share, reflect and extend best practice. And the good news is, it's free.
Left to go it alone
Authors: Leitch Neil
Published: June 2020

As the sector moves towards a phased reopening, it is imperative that the Government steps in to provide financial support for those who are facing a fall in demand for places – and for those who cannot afford to open at all.
Roma adventure
Authors: Hewson Claire
Published: June 2020

The Lost Homework is a great book to link creative activities such as junk modelling and cooking while helping children to understand a chain of events.
Safe in the water
Authors: Hewson Claire
Published: June 2020

At this time of year it is important that children understand the risks around different bodies of water – including paddling pools, ponds and swimming pools.