bluuebunny/crossref_metadata_2025 huggingface dataset:
Field validity and spatial accuracy of Food Standards Agency Food Hygiene Rating scheme data for England
Authors: Kirkman Scott , Hollingsworth Bruce , Lake Amelia , Hinke Stephanie , Sorrell Stewart , Burgoine Thomas , Brown Heather
Published: September 2020

Background

The study aimed to evaluate the validity and spatial accuracy of the Food Standards Agency Food Hygiene Rating online data through a field audit.

Methods

A field audit was conducted in five Lower Layer Super Output Areas (LSOAs) in the North East of England. LSOAs were purposively selected from the top and bottom quintiles of the Index of Multiple Deprivation and from urban and rural areas. The FHRS data validity against the field data was measured as Positive Predictive Values (PPV) and sensitivity. Spatial accuracy was evaluated via mean difference in straight line distances between the FHRS coordinates and the field coordinates.

Results

In all, 182 premises were present in the field, of which 162 were in the FHRS data giving a sensitivity of 89%. Eight outlets recorded in the FHRS data were absent in the field, giving a PPV of 95%.The mean difference in the geographical coordinates of the field audit compared to the FHRS was 110 m, and <100 m for 77% of outlets.

Conclusions

After an evaluation of the validity and spatial accuracy of the FHRS data, the results suggest that it is a useful dataset for surveillance of the food environment and for intervention evaluation.
Clinical features, treatments and outcomes of calcinosis in adult patients with dermatomyositis: a single cohort study
Authors: Jiang Wei , Yang Hanbo , Li Sizhao , Tian Xiaolan , Wang Guochun
Published: August 2020

Objective

The occurrence of calcinosis cutis as a clinical feature of dermatomyositis in adult patients is not well understood. Cohort studies of adult patients with calcinosis are rare. We systematically describe the clinical features, treatments and outcomes of adult patients with calcinosis.

Methods

We initially enrolled 627 adult DM patients. Of those enrolled, 35 (5.6%) were found to have calcinosis. We analysed the clinical features associated with calcinosis in this subgroup. The risk factors associated with calcinosis were analysed using the Poisson regression model.

Results

Multivariate analysis showed that a younger age at disease onset [odds ratio (OR) = 0.945, 95% CI 0.925, 0.966, P < 0.001], dysphagia (OR = 2.609, 95% CI 1.189, 5.728, P = 0.017), skin ulcer (OR = 5.705, 95% CI 3.041, 10.705, P < 0.001) and the presence of anti-nuclear matrix protein 2 antibody (OR = 5.917, 95% CI 2.754, 12.714, P < 0.001) were independently associated with calcinosis. In both the low- and high-dose prednisone treatment groups, no difference in treatment response was seen between the bisphosphonate treatment group and the group not receiving bisphosphonate treatment (P = 1.000 and P = 0.375, respectively). A follow-up study revealed that the mortality rate of the calcinosis group was 5.7%. Additionally, 60.6% of the cases had a chronic polycyclic disease course and 17.1% had mild complications secondary to calcinosis.

Conclusion

Calcinosis is an uncommon, but significant clinical feature in adult patients with DM. Bisphosphonates were not found to effectively treat calcinosis, however, the overall health outcomes of adult DM patients with calcinosis were favourable.
Were the Italian policy reforms to contrast favoritism and foster effectiveness in faculty recruitment successful?
Authors: Abramo Giovanni , D’Angelo Ciriaco Andrea
Published: September 2020

In this work, we assess whether and to what extent the latest Italian national policy initiatives intended, among others, to contrast favoritism and foster recruitment effectiveness have resulted in the desired effects. To answer the question, we propose two related analyses. One compares the research performance ratings of recruits in two subsequent five-year periods, before and after the introduction of the above policy measures. The second analysis compares the effectiveness of recruitment by all Italian universities, in the above two subsequent five-year periods. The results from the comparisons show a decline of both unproductive and high-performing recruits, and no overall improvement in the effectiveness of recruitment.
Policy options for green regional development: Adopting a production and application perspective
Authors: Tödtling Franz , Trippl Michaela , Frangenheim Alexandra
Published: September 2020

Green and sustainable developments have received increasing attention in recent years due to challenges emanating from climate change and worsening environmental conditions. Although these are problems of global nature, actions have to be taken often at lower spatial scales. We focus on innovation and industrial policies and on the regional level since green development often can be supported here by respective policies. However, effective policies have to consider that individual regions face different kinds of challenges for moving towards a ‘greener’ future. This article develops a framework that allows taking such differences into account. We distinguish between the production side of ‘green technologies’ (i.e. the industries that develop and produce such technologies) and the application side (i.e. the adoption of such technologies by firms and the wider society), and we investigate what challenges might prevail on both sides and explore the potential role of policies for different types of regions.
Modified Lateral Approach of the Elbow for Surgical Release and Synovectomy
Authors: Roulet Steven , Charruau Bertille , Mazaleyrat Matthieu , Ferembach Benjamin , Marteau Emilie , Laulan Jacky , Bacle Guillaume
Published: August 2020

Elbow stiffness is a common reason for consultation. In recent years, arthroscopic techniques in elbow surgery have progressed, but there are still some contraindications to performance of arthroscopic synovectomy and release in this joint (elbows with anatomic deformity after multiple procedures, malunion, presence of osteosynthesis material, severe stiffness of >80 degrees, instability, or previous transposition of the ulnar nerve). Therefore, knowledge of a safe and reliable open approach to achieve elbow release and/or synovectomy is essential. We report the technical details of the modified lateral approach between extensor carpi radialis brevis and longus muscles, as well as the clinical results of 43 elbow release and/or synovectomy procedures, illustrating its feasibility. The modified lateral approach, providing visual control of the radial nerve and good anterior exposure of the elbow joint, is detailed. From 1994 to 2016, this approach was used in 43 release and/or synovectomy procedures of the elbow in 41 patients, 30 men and 11 women, with a mean age of 40.56 years (range, 17 to 84 y). Using this procedure, 38 elbows (93%) recovered full extension and 5 subtotal extension with an average deficit of 11 degrees (range, 5 to 20 degrees). All elbows were stable. No neurological complications were reported. The modified lateral approach preserves the insertion of the lateral epicondyle muscles that are major dynamic stabilizers and reduces the risk of instability. Initially described for the treatment of radial tunnel syndrome, it should also be recommended for elbow release and synovectomy.
Analysis of related factors of optical quality in healthy Chinese adults: a community-based population study
Authors: Zhang Xi-Fang , Qiao Li-Ya , Cai Xiao-Gu , Li Xiao-Xia , Tan Jia-Xuan , Guan Zheng , Zhang Ye , Cao Kai , Wang Ning-Li
Published: August 2020

Background:

In recent years, visual quality has been extensively investigated in various conditions. In this community-based population study, we analyzed the effects of aging, refraction, and Lens Opacification Classification System III (LOCSIII) score on retinal imaging quality in healthy Chinese adults.

Methods:

This cross-sectional study was conducted on sub-group subjects from The Handan Eye Study between October 2012 and January 2013. Healthy subjects over 30-years-old with logarithm of the minimal angle of resolution (logMAR) best-corrected visual acuity (BCVA) less than 0 were included. Retinal image quality was measured by optical quality analysis system (OQAS) and recorded as modulation transfer function cutoff frequency (MTFcutoff), OQAS value (OV) 100%, OV20%, OV9%, Strehl ratio (SR), and objective scatter index (OSI). The correlation between age, spherical equivalent refraction (SE), LOCSIII score, and optical quality parameters were investigated by multivariate analysis.

Results:

Among 1108 verified subjects, 690 subjects (1380 eyes) met the inclusion criteria. Their age ranged from 30 to 76 years, SE ranged from −4.75 to 2.75 D. They were divided into five age groups (30–39, 40–49, 50–59, 60–69, and ≥70 years) for further analysis. After multivariate analysis by mixed-effect linear model, SR (t =  −3.03, P = 0.002), OV20% (t = −2.39, P = 0.017), and OV9% (t = −3.16, P = 0.001) significantly decreased with the increasing age, whereas logMAR BCVA (t = 4.42, P < 0.001) and OSI (t = 4.46, P < 0.001) significantly increased with age. As SE increased, SR (t = 2.74, P = 0.01), OV20% (t = 2.31, P = 0.02), and OV9% (t = 2.79, P = 0.005) significantly elevated, and OSI (t = −3.38, P < 0.001) significantly decreased. With the increase in cortical opacity score, all optical quality parameters except for SR significantly decreased, including MTFcutoff (t = −2.78, P = 0.01), OV100% (t = −2.78, P = 0.005), OV20% (t = −2.60, P = 0.009), and OV9% (t = −2.05, P = 0.040). As posterior sub capsular opacity score increased, MTFcutoff (t = −2.40, P = 0.02) and OV100% (t = −2.40, P = 0.01) significantly decreased, while OSI (t = 7.56, P < 0.001) significantly increased.

Conclusions:

In healthy Chinese adult population, optical quality-related parameters significantly decrease with the increasing age, and OSI significantly increases with age. In normal BCVA subjects, optical quality is significantly impacted by cortical and posterior sub capsular opacity rather than by nuclear opacity.
Eligibility for Second-line Therapy in Patients With Advanced Hepatocellular Carcinoma
Authors: Tsang Erica S. , Davies Janine M. , Loree Jonathan M. , Lim Howard J. , Renouf Daniel J. , Gill Sharlene
Published: August 2020

Introduction:

With an increasing number of systemic therapy options for hepatocellular carcinoma (HCC), optimal sequencing is an important consideration. There remains limited real-world data about the eligibility of patients for second-line therapies in advanced HCC. We characterized real-world eligibility and use of second-line therapies post sorafenib.

Materials and Methods:

We identified all patients with advanced HCC who received ≥1 cycle of first-line sorafenib between January 1, 2014 and December 31, 2017 in British Columbia, Canada. All patients were Child-Pugh class A for initiation of sorafenib. Baseline characteristics and clinical outcomes were reviewed. Eligibility for second-line therapy was determined using the RESORCE and CELESTIAL study entry criteria.

Results:

Of 144 patients with advanced HCC who received ≥1 cycle of first-line sorafenib, median age was 65.3 years (range, 32.2 to 83.4 y) and 85% were male. Median duration of sorafenib was 2.6 months. Twelve patients (8%) received second-line treatment but 37 patients (26%) were eligible for second-line therapies based on inclusion criteria from recent registration trials. Primary reasons for ineligibility included ECOG ≥2 (58%), and deterioration to Child-Pugh status B (28%). On Cox regression, improved survival was associated with better ECOG and recurrent disease after initial locoregional therapy. Eligibility for second-line treatment was associated with improved median overall survival from end of first-line treatment (8.5 vs. 5.1 mo; P<0.01).

Conclusions:

Only a minority of real-world patients with advanced HCC were eligible for second-line therapies based on trial criteria. Given the high rate of attrition, improved first-line treatment options are urgently needed.
The Development and Implementation of a Transfer Follow-up Program at a Level I Pediatric Trauma Center
Authors: Colson Cindy D. , Alberto Emily C. , Fritzeen Jennifer L.
Published: September 2020

Background:

Inconsistent trauma patient referral feedback limits trauma system growth and may perpetuate suboptimal care. Trauma and burn patients are transferred to our Level I pediatric trauma center from hospitals in the surrounding metropolitan area. In the past, we had no consistent method to address performance improvement opportunities or provide information on patient outcomes to the referring facilities. The purpose of this study is to describe the implementation and evaluation of a formal electronic transfer follow-up program.

Methods:

This was a before-and-after quality improvement study of pediatric trauma patients comparing prefeedback program implementation (2018) to postfeedback program implementation (2019). A new transfer patient feedback program was designed to address low rates of feedback provided to referring hospitals. Our center worked with a software developer to create a program that stored outside hospital contacts, automated follow-up letters, and tracked the number of letters sent, and opened, to enhance communication between trauma center and referring facilities.

Results:

A total of 383 preprogram (2018) patients and 369 postprogram (2019) patients were evaluated. Since program implementation, an average of 70% follow-up per referral and an average return rate of 45% have been maintained.

Conclusion:

As we continue to use the system and make changes, we fully expect to exceed our goal in providing essential feedback on the care of pediatric trauma and burn patients to our referring facilities.
SMARTphone-based, early cardiac REHABilitation in patients with acute coronary syndromes: a randomized controlled trial
Authors: Yudi Matias B. , Clark David J. , Tsang David , Jelinek Michael , Kalten Katie , Joshi Subodh B. , Phan Khoa , Ramchand Jay , Nasis Arthur , Amerena John , Koshy Anoop N. , Murphy Alexandra C. , Arunothayaraj Sandeep , Si Si , Reid Christopher M. , Farouque Omar
Published: August 2020

Background

There are well-documented treatment gaps in secondary prevention of coronary heart disease with a lack of clearly defined strategies to assist early physical activity after acute coronary syndromes (ACS). Smartphone technology may provide an innovative platform to close these gaps.

Objectives

The primary goal of this study was to assess whether a smartphone-based, early cardiac rehabilitation program improved exercise capacity in patients with ACS.

Methods

A total of 206 patients with ACS across six tertiary Australian hospitals were included in this randomized controlled trial. Participants were randomized to usual care (UC; including referral to traditional cardiac rehabilitation), with or without an adjunctive smartphone-based cardiac rehabilitation program (S-CRP) upon hospital discharge. The primary endpoint was change in exercise capacity, measured by the change in 6-minute walk test distance at 8 weeks when compared to baseline, between groups. Secondary endpoints included uptake and adherence to cardiac rehabilitation, changes in cardiac risk factors, psychological well-being and quality of life status.

Results

Of the 168 patients with complete follow-up (age 56 ± 10 years; 16% females), 83 were in the S-CRP. At 8-week follow-up, the S-CRP group had a clinically significant improvement in 6-minute walk test distance (Δ117 ± 76 vs. Δ91 ± 110 m; P = 0.02). Patients in the S-CRP were more likely to participate (87% vs. 51%, P < 0.001) and adhere (72% vs. 22%, P < 0.001) to a cardiac rehabilitation program. Compared to UC, patients receiving S-CRP had similar smoking cessation rates, LDL-cholesterol levels, blood pressure reduction, depression, anxiety and quality of life measures (all P = NS).

Conclusion

In patients with ACS, a S-CRP, as an adjunct to UC improved exercise capacity at 8 weeks in addition to participation and adherence to cardiac rehabilitation (Australian New Zealand Clinical Trials Registry; ACTRN12616000426482).
Endoscopic therapy + β-blocker vs. covered transjugular intrahepatic portosystemic shunt for prevention of variceal rebleeding in cirrhotic patients with hepatic venous pressure gradient ≥16 mmHg
Authors: Guo Huiwen , Zhang Feng , Yin Xiaochun , Zhang Ming , Xiao Jiangqiang , Wang Yi , Zhang Bin , Zhang Wei , Zou Xiaoping , Zhuge Yuzheng
Published: August 2020

Background and objective

Currently, monitoring hepatic venous pressure gradient (HVPG) have been proved to be the best predictor for the risk of variceal bleeding. We performed the study to evaluate the effect of endoscopic therapy + β-blocker vs. covered transjugular intrahepatic portosystemic shunt (TIPS) for the prevention of variceal rebleeding in cirrhotic patients with HVPG ≥16 mmHg.

Methods

Consecutive cirrhotic patients with HVPG ≥16 mmHg treated with endoscopic therapy + β-blocker or covered TIPS for variceal bleeding were retrospectively gathered between April 2013 and December 2018. The variceal rebleeding rate, survival, and incidence of overt hepatic encephalopathy (OHE) were compared.

Results

A total of 83 patients were analyzed, of which 46 received endoscopic therapy + β-blocker and 37 covered TIPS. During a median follow-up of 12.0 months, the rebleeding rate (32.6 vs. 10.8%, P = 0.017) and rate of OHE (2.2 vs. 27.0%, P = 0.001) showed significant differences between the two groups, while liver transplantation-free survival (93.5 vs. 94.6%, P = 0.801) was similar. Preoperative and postoperative Child-Turcotte-Pugh scores were similar in either group. In addition, no significant differences of rebleeding rate (25.0 vs. 21.3%, P = 0.484) and survival (97.2 vs. 91.5%, P = 0.282) were observed between patients with 16 mmHg ≤ HVPG < 20 mmHg and HVPG ≥ 20 mmHg.

Conclusion

Covered TIPS was more effective than endoscopic therapy + β-blocker in preventing rebleeding in patients with HVPG ≥16 mmHg but did not improve survival. TIPS also induce more OHE.
Platelet transfusion for patients with platelet dysfunction: effectiveness, mechanisms, and unanswered questions
Authors: Lee Robert H. , Kasthuri Raj S. , Bergmeier Wolfgang
Published: August 2020

Purpose of review

In this review, we discuss current clinical guidelines and potential underlying mechanisms regarding platelet transfusion therapy in patients at risk of bleeding, comparing management of patients with thrombocytopenia versus those with qualitative platelet disorders.

Recent findings

Platelet transfusion therapy is highly effective in managing bleeding in patients with hypoproliferative thrombocytopenia. Clinical trials have demonstrated that platelet transfusion can be used at a lower trigger threshold and reduced platelet doses, and may be used therapeutically rather than prophylactically in some situations, although additional data are needed. In patients with inherited platelet disorders such as Glanzmann's Thrombasthenia or those with RASGRP2 mutations, platelet transfusion may be ineffective because of competition between transfused and endogenous platelets at the site of vascular injury. Successful management of these patients may require transfusion of additional platelet units, or mechanism-driven combination therapy with other pro-hemostatic agents. In patients on antiplatelet therapy, timing of transfusion and inhibitor mechanism-of-action are key in determining therapeutic success.

Expanding our understanding of the mechanisms by which transfused platelets exert their pro-hemostatic function in various bleeding disorders will improve the appropriate use of platelet transfusion.
An update on the pathophysiology of immune thrombocytopenia
Authors: Semple John W. , Rebetz Johan , Maouia Amal , Kapur Rick
Published: August 2020

Immune thrombocytopenia (ITP) is an autoimmune bleeding disorder mediated by antiplatelet autoantibodies and antigen-specific T cells that either destroy platelets peripherally in the spleen or impair platelet production in the bone marrow. There have been a plethora of publications relating to the pathophysiology of ITP and since January of 2019, at least 50 papers have been published on ITP pathophysiology.

Purpose of review

To summarize the literature relating to the pathophysiology of ITP including the working mechanisms of therapies, T-cell and B-cell physiology, protein/RNA/DNA biochemistry, and animal models in an attempt to unify the perceived abnormal immune processes.

Recent findings

The most recent pathophysiologic irregularities associated with ITP relate to abnormal T-cell responses, particularly, defective T regulatory cell activity and how therapeutics can restore these responses. The robust literature on T cells in ITP points to the notion that ITP is a disease initiated by faulty self-tolerance mechanisms very much like that of other organ-specific autoimmune diseases. There is also a large literature on new and existing animal models of ITP and these will be discussed. It appears that understanding how to specifically modulate T cells in patients with ITP will undoubtedly lead to effective antigen-specific therapeutics.

Conclusions

ITP is predominately a T cell disorder which leads to a breakdown in self tolerance mechanisms and allows for the generation of anti-platelet autoantibodies and T cells. Novel therapeutics that target T cells may be the most effective way to perhaps cure this disorder.
Pattern of Suicide Methods and Postmortem Toxicological Findings in Suicide-Related Deaths
Authors: Valipour Rooholah , Shekari Ahmad , Setareh Mehrdad , Soltaninejad Kambiz
Published: August 2020

Suicide is a public health threat that leads to morbidity and mortality worldwide. In this study, we evaluated postmortem toxicological finding among forensic autopsies on suicidal deaths from 2010 to 2016 at the Legal Medicine Center of Zanjan Province (northwest of Iran). All suicide fatal cases were investigated to define the cause and manner of death. Toxicological analyses were performed using thin-layer chromatography, high-performance liquid chromatography, gas chromatography/mass spectrometry, headspace gas chromatography, and gas chromatography equipped with nitrogen phosphorus detector. Demographic data (age, sex, educational level, residential location, and marital status), cause of death, and postmortem toxicological findings were extracted from forensic reports and were entered into the designed questioners. During this period, a total of 181 cases of suicide deaths were investigated. Among them, 74% were male. The most often used suicide method was hanging, followed by self-poisoning in young people. Aluminum phosphide was the most frequent poison detected in the fatal suicidal cases (33 cases), followed by opioids. Hanging and self-poisoning were the frequent suicidal method in young male population. It seems that psychological and social supports in young people along with restriction to easy access to drugs and poisons should be considered by policy making and healthcare authorities.
Fetal Autopsy—Categories and Causes of Death at a Tertiary Care Center
Authors: Bhale Chandrashekhar Prasad , Vare Anil , Gupta Akshi
Published: August 2020

Background

A fetus is defined from 8 weeks after conception until term while in the uterus. Fetal death is defined as death of the fetus before the complete expulsion or extraction from the mother, irrespective of the duration of pregnancy that is not an induced termination of pregnancy. The causes of fetal death determined after fetal autopsy can be categorized according to the classification proposed by Cunningham and Hollier as fetal, placental, and maternal.

Methods

All fetuses dying in utero, that is, prior to birth, regardless of the gestational age, to the mothers admitted in the Department of Obstetrics and Gynecology along with the respective placentas were received in the Department of Pathology, MGM Medical College, Aurangabad, after an informed and written consent from October 26, 2017, to October 30, 2019, and were included in this study. Clinical details along with obstetric history and antenatal ultrasonographic findings were also recorded. Anthropometric examination of the fetus was performed and evisceration was then done using the Rokitansky technique. Representative sections from each of the organs were taken and kept in tissue cassettes and processed for routine hematoxylin and eosin staining.

Results

This study was done on 33 cases of fetal death. Most fetal deaths occurred in the gestational age between 15 and 19 weeks (14 cases [42.42%]) and the least amount during 35 to 39 weeks (2 cases [6.06%]). The cause of death could not be ascertained in 6 cases (18.18%), whereas the maximum cases had fetal factor as the cause of death (15 cases [45.45%]). Maternal causes were seen in only 4 cases (12.12%). Gestational hypertension was seen to be the most common maternal factor associated with fetal death, which comprised 24.24% of cases (8 of 33). Thirteen of the total 33 cases did not have any associated obstetric complication. Of the total 33 fetal deaths, only 7 had associated placental defects on gross examination. Twenty-six placentas did not show any gross abnormality. Of these 7 cases, 5 were seen to have placental infarction.

Conclusions

Fetal autopsy is a valuable and cost-effective modality for the confirmation of cause of fetal death. Fetal autopsy can also prove beneficial to the parents in planning for future pregnancies. Fetal autopsy can serve as the ultimate tool in diagnosing cause of fetal death in cases where no other diagnostic clue is available. Therefore, it should be encouraged and couples to be counseled regarding its importance and clinical utility.
Clinicopathologic Significance of EGFR Mutation and HPV Infection in Sinonasal Squamous Cell Carcinoma
Authors: Hongo Takahiro , Yamamoto Hidetaka , Jiromaru Rina , Nozaki Yui , Yasumatsu Ryuji , Hashimoto Kazuki , Yoneda Reiko , Sugii Azusa , Taguchi Kenichi , Masuda Muneyuki , Nakagawa Takashi , Oda Yoshinao
Published: August 2020

Sinonasal squamous cell carcinoma (SNSCC) is sometimes associated with high-risk human papillomavirus (HR-HPV) infection and inverted sinonasal papilloma or oncocytic sinonasal papilloma. Frequent mutations of EGFR and KRAS are reported in inverted sinonasal papilloma–related sinonasal squamous cell carcinoma (ISP-SCC) and oncocytic sinonasal papilloma–related SNSCC, respectively. Here, we attempted to determine the prevalence and the prognostic significances of these alterations in SNSCC. We retrospectively collected 146 SNSCCs, including 14 ISP-SCCs, and comprehensively analyzed the HR-HPV infection by human papillomavirus (HPV)-RNA in situ hybridization, EGFR gene copy number gain (CNG) by chromogenic in situ hybridization, and gene mutations in EGFR and KRAS by Sanger sequencing. HR-HPV was detected in 11 cases (7.5%), whereas all 14 ISP-SCCs were negative. EGFR mutations were present in 21 (14.7%) of 143 SNSCCs, including 13/14 (92.9%) ISP-SCCs and 8/129 (6.2%) non–ISP-SCCs (P<0.0001). The majority of EGFR mutations were exon 20 insertions, with the remainder composed of deletions and single-nucleotide substitutions in exons 19 and 20. All of 142 SNSCCs harbored no KRAS mutation. EGFR CNG was detected in 41 (28.1%) of 146 SNSCCs; all of them were HPV negative and 3 had EGFR mutations. Collectively, EGFR mutation, EGFR CNG, and HR-HPV were essentially mutually exclusive, and each subgroup had distinct clinicopathologic features. The HPV-negative/EGFR-mutant group, the HPV-negative/EGFR CNG-positive group, and the triple-negative group had significantly worse prognoses than the HPV-positive group (P=0.0265, 0.0264, and 0.0394, respectively). In conclusion, EGFR mutation may play a pathogenetically important role in some populations of SNSCCs, especially ISP-SCCs. The molecular subclassification of SNSCCs may contribute to prognostic prediction and molecular-targeted precision medicine.
AKT1 Mutations in Peripheral Bronchiolar Papilloma
Authors: Sasaki Eiichi , Masago Katsuhiro , Fujita Shiro , Iwakoshi Akari , Kuroda Hiroaki , Hosoda Waki
Published: August 2020

Glandular papilloma (GP) and mixed squamous cell and glandular papilloma (MP) are rare benign pulmonary tumors occurring in the bronchi. Bronchiolar adenoma (BA) was recently characterized as a pulmonary tumor exhibiting alveolar spread. Both GP/MP and BA are composed of a mixture of glandular, ciliated, squamous, and basal cells. We aimed to clarify whether GP/MP and BA represent the same tumor. We evaluated the detailed histologic characteristics of 11 cases involving pulmonary peripheral tumors that exhibited histologic features of GP/MP or BA, and performed genetic analyses using targeted panel sequencing, allele-specific polymerase chain reaction, and digital polymerase chain reaction. Histologically, 4 and 7 tumors were classified as GP/MP and BA, respectively. GP/MP showed endobronchiolar papillary growth with a pseudostratified or stratified epithelium. In contrast, 5 BAs showed a predominant flat structure with a bilayered or pseudostratified epithelium, whereas 2 BAs showed a GP/MP-like papillary architecture. The mean epithelial thickness in each tumor was significantly larger in GP/MPs and BAs with a GP/MP-like morphology (103 to 242 μm) than in flat-predominant BA (23 to 47 μm, P=0.0010). AKT1 E17K mutations were detected in all GP/MPs and BAs with GP/MP-like morphology but were absent in the 5 flat-predominant BAs. AKT1 mutations were always concurrent with BRAF or HRAS mutations, and the variant allele frequency or percentage of mutant copies of AKT1 mutations was equal to those of BRAF or HRAS mutations. GP/MPs are characterized by AKT1 mutations concurrent with BRAF or HRAS mutations. Peribronchiolar papillary tumors with AKT1 mutations may also be classified as GP/MP.
HIV stigma by association among Australian gay and bisexual men
Authors: Broady Timothy R. , Brener Loren , Hopwood Max , Cama Elena , Treloar Carla , Holt Martin
Published: September 2020

Objective:

The negative effects of HIV stigma may extend beyond those who are HIV-positive, to people who are perceived to be at risk of HIV. This article examines HIV stigma by association among Australian gay and bisexual men (GBM).

Design:

Cross-sectional, online survey of 1280 Australian gay and bisexual men. This article focuses on HIV stigma from within a larger study that investigated stigma related to sexual identity.

Methods:

Bivariate and multivariable comparisons were made between men who experienced HIV stigma by association and those who did not. A serial mediation model was tested to investigate relationships between GBM community attachment, sexual identity stigma, HIV testing frequency, HIV stigma by association, psychological distress, and rejection of sex partners.

Results:

Results found that 5% of participants were HIV-positive, yet over 70% reported that they had been stigmatized by others for their perceived risk of acquiring HIV. Multivariable analysis indicated that HIV stigma by association was associated with more frequent HIV testing, greater GBM community attachment, experiencing stigma related to sexual identity and psychological distress. Our results suggest flow-on effects of HIV stigma by association, such as being more likely to reject other GBM on the basis of their HIV status or not testing for HIV.

Conclusion:

Our results underscore the notion that HIV stigma can have broader, negative effects on HIV-affected populations. There is a need to address HIV stigma within GBM communities and society more broadly in order to encourage HIV testing and prevention among GBM.
The People Living with HIV Stigma Index 2.0: generating critical evidence for change worldwide
Authors: Friedland Barbara A. , Gottert Ann , Hows Julian , Baral Stefan D. , Sprague Laurel , Nyblade Laura , McClair Tracy L. , Anam Florence , Geibel Scott , Kentutsi Stella , Tamoufe Ubald , Diof Daouda , Amenyeiwe Ugo , Mallouris Christoforos , Pulerwitz Julie
Published: September 2020

Objective(s):

To describe the process of updating the People Living with HIV (PLHIV) Stigma Index (Stigma Index) to reflect current global treatment guidelines and to better measure intersecting stigmas and resilience.

Design:

Through an iterative process driven by PLHIV, the Stigma Index was revised, pretested, and formally evaluated in three cross-sectional studies.

Methods:

Between March and October 2017, 1153 surveys (n = 377, Cameroon; n = 390, Senegal; n = 391, Uganda) were conducted with PLHIV at least 18 years old who had known their status for at least 1 year. PLHIV interviewers administered the survey on tablet computers or mobile phones to a diverse group of purposively sampled respondents recruited through PLHIV networks, community-based organizations, HIV clinics, and snowball sampling. Sixty respondents participated in cognitive interviews (20 per country) to assess if questions were understood as intended, and eight focus groups (Uganda only) assessed relevance of the survey, overall.

Results:

The Stigma Index 2.0 performed well and was relevant to PLHIV in all three countries. HIV-related stigma was experienced by more than one-third of respondents, including in HIV care settings. High rates of stigma experienced by key populations (such as MSM and sex workers) impeded access to HIV services. Many PLHIV also demonstrated resilience per the new PLHIV Resilience Scale.

Conclusion:

The Stigma Index 2.0 is now more relevant to the current context of the HIV/AIDS epidemic and response. Results will be critical for addressing gaps in program design and policies that must be overcome to support PLHIV engaging in services, adhering to antiretroviral therapy, being virally suppressed, and leading healthy, stigma-free lives.
Skull Base Sphenoid Bone: A Potential Route of Brain Abscesses Induced by Odontogenic Infection
Authors: Lou Yiting , Feng Bin , Hong Hui , Ying Binbin , Yu Mengfei , Wang Huiming
Published: August 2020

Odontogenic foci are rarely linked with brain abscesses. The lack of an effective approach to match the causative origin with the infection can lead to late medical response of patients. Here we present a case of a 53-year-old man with brain abscesses that was probably caused by odontogenic foci. The imaging examinations clearly showed the periodontitis of mandibular left second molar and the destruction of greater sphenoid wing. Therefore, possible routes of extension through masticator space abscesses were indicated. For early infection of the maxillofacial space caused by potential odontogenic lesions, oral surgeons should eliminate the potentially odontogenic foci and use computerized tomography imaging to determine the existence of bone destruction around the oral cavity such as the skull to prevent further bone defect complications such as brain abscesses.
Sphenoid Bone Structure and Its Influence on the Cranium in Syndromic Versus Nonsyndromic Craniosynostosis
Authors: Lu Xiaona , Forte Antonio Jorge , Park Kitae Eric , Allam Omar , Mozaffari Mohammad Ali , Alperovich Michael , Steinbacher Derek M. , Alonso Nivaldo , Persing John A.
Published: August 2020

Background:

Little is known about the detailed growth of the sphenoidal and temporal bones, even though they contribute significantly to the cranial base and cranial fossa skeletons. They also serve to connect the cranial vault with facial structure. This study details their morphologic development in isolated bicoronal synostosis and associated syndromes.

Methods:

Eighty-one CT scans were included (nonsyndromic bicoronal synostosis, n = 28; Apert syndrome associated with bicoronal synostosis, n = 19; Crouzon syndrome associated with bicoronal synostosis, n = 8; and controls, n = 26), and measured using Materialize software.

Results:

Sphenoidal and temporal bone volumes in nonsyndromic bicoronal synostosis are reduced 23% (P = 0.005) and 24%(P = 0.003) at 6 months of age, compared to controls. Apert and Crouzon syndrome patients developed similar reduced volumes. The greater wing of the sphenoid and pterygoid processes in nonsyndromic bicoronal synostosis are initially inferiorly rotated at 2 months of age, by 9.60° (P = 0.002) and 4.33° (P = 0.023), respectively. In Apert syndrome, these rotations were reduced by 4.82° (P = 0.003) and 12.60° (P < 0.001), (like Crouzon syndrome). However, in Apert syndrome, the length of pterygoid processes is shortened by 11% (P = 0.018) compared to nonsyndromic bicoronal synostosis. Crouzon syndrome skulls did not develop a statistically significant shortening relative to nonsyndromic bicoronal synostosis. Mediolateral expansion of the sphenoid in nonsyndromic bicoronal synostosis was less than normal (P = 0.023), and it was further reduced in syndromic skulls.

Conclusion:

Isolated bicoronal synostosis tends to reduce the volume of sphenoidal and temporal bones, and inferior and posterior rotation of the entire sphenoid. Syndromic conditions restrict sphenoidal rotation, and limit the expansion of sphenoidal greater wing and pterygoid plate.
A Technique for Minimizing the Need for Hemotransfusion in Non-Syndromic Craniosynostosis Surgery
Authors: Furtado Leopoldo Mandic Ferreira , da Costa Val Filho José Aloysio , Hon Yang Pol , Sandes Bruno Lacerda , Brandão Vianna Bruna Silviano , Valadares Friederike Wolff , dos Santos Andre Ribeiro
Published: August 2020

Surgery for craniosynostosis is associated with excessive blood loss, as well as morbidity and mortality risks. This study investigated the effectiveness of a surgical technique for nonsyndromic craniosynostosis intervention in controlling bleeding, assessed based on the volume of blood transfused. The cohort included 73 children who underwent nonsyndromic craniosynostosis surgery during a 3-year period. Retrospective evaluation of patient parameters included sex, weight, and age at the time of surgery; type of craniosynostosis; duration of surgery; hemoglobin concentration before and after surgery; rate of transfusion; and volume of transfused blood (mL/kg). The surgical technique involved skin incision and subgaleal dissection using electrocautery with a Colorado needle tip. The pericranium was not removed but instead kept in situ, and orbiectomy was performed using piezosurgery. Of the 73 children in the cohort, 75.3% underwent fronto-orbital advancement and were included in the analysis. The average age was 10.9 months (range: 4–96 months), with 68.5% boys and 31.5% girls (P < 0.001). The most common type of craniosynostosis was trigonocephaly (57.5%), followed by scaphocephaly (19.2%). The mean duration of the surgery was 2 hours and 55 minutes. Blood transfusion was needed in 56.2% of patients, with a mean volume of 8.7 mL/kg body weight transfused intraoperatively. No complications or fatalities were observed. These results suggested that meticulous, continuous control of homeostasis is paramount in minimizing blood loss during surgical repair of nonsyndromic craniosynostosis.
Primary Palatoplasty With Intravelar Veloplasty Using Acellular Dermal Matrix Interpositional Graft
Authors: Yi Chang Ryul , Jeon Dong-Nyeok , Choi Jong-Woo , Oh Tae Suk
Published: August 2020

The aim of this study was to analyze the effect of acellular dermal matrix (ADM) on fistula formation after primary palatoplasty using intravelar veloplasty for levator veli palatini muscle repair.

This single-center retrospective study included patients who underwent primary palatoplasty with intravelar veloplasty for reorientation of the levator veli palatini muscles between April 2014 and March 2018. In the control group (group A) conventional intravelar veloplasty was performed, while in the ADM group (group B) intravelar veloplasty using ADM was performed. The study sample was composed of 162 patients, 81 in each of the 2 groups (A and B). In group B, securely dissected muscles were overlapped, and a pentagon-shaped ADM (AlloDerm, LifeCell Corp., Branchburg, NJ) of 1.6 mm mean thickness, 11.3 mm mean width, and 14.4 mm mean length was designed, and placed under the repaired levator muscle sling. The outcome variable was the occurrence of oronasal fistula within the first 6 months after surgery.

Postoperative fistula formation was reported in 6 patients in group A (7.4%) and in 5 patients in group B (6.2%). There was no statistically significant difference between the 2 groups (P = 0.755). There were 7 cases of ADM exposure and 2 cases of wound dehiscence in group B.

The results of this study demonstrated that ADM use did not have any disadvantage with respect to oronasal fistula complications after intravelar veloplasty for levator veli palatini muscle repair.
Mild Cognitive Impairment in Retired Professional Football Players With a History of Mild Traumatic Brain Injury: A Pilot Investigation
Authors: Didehbani Nyaz , Fields Lindy M. , Wilmoth Kristin , LoBue Christian , Hart John , Cullum C. Munro
Published: September 2020

Background:

Traumatic brain injury (TBI) is a known risk factor for neurodegenerative dementias such as Alzheimer disease (AD); however, the potential risk of mild cases of TBI, such as concussions, remains unclear.

Objective:

To explore whether a small sample of retired professional athletes with a diagnosis of mild cognitive impairment (MCI)—the prodromal stage of AD—and a history of multiple mild TBIs exhibit greater neuropsychological impairment than age-matched nonathletes with MCI and no history of TBI.

Method:

Ten retired National Football League players diagnosed with MCI and reporting multiple mild TBIs, and 10 nonathletes, also diagnosed with MCI but with no history of TBI, completed a standard neurologic examination and neuropsychological testing. Independent samples t tests were conducted to examine differences in neuropsychological performance between the two groups.

Results:

The retired athletes with a history of mild TBI obtained generally similar scores to the nonathlete controls on measures of verbal learning and memory, verbal fluency, and processing speed. However, the retired athletes scored lower than the controls on tests of confrontation naming and speeded visual attention.

Conclusion:

Retired athletes with MCI and a history of mild TBI demonstrated similar neuropsychological profiles as nonathlete controls despite lower scores on measures of confrontation naming and speeded visual attention. These findings suggest that a history of multiple mild TBIs does not significantly alter the overall neuropsychological profile of individuals with MCI; confirmation of this will require longitudinal research with larger sample sizes.
Vision Loss From Giant Cell Arteritis in Patients With Other Ocular Diagnoses
Authors: Nichani Prem , Biousse Valérie , Newman Nancy J. , Micieli Jonathan A.
Published: August 2020

Vision problems from giant cell arteritis (GCA) can be difficult to diagnose as patients may present with vision loss in the absence of systemic symptoms, have other comorbidities that affect inflammatory blood markers, or have other ocular diagnoses. We present 3 cases illustrating this point including a patient with advanced glaucoma with worsening vision from posterior ischemic optic neuropathy from GCA, a patient with arteritic anterior ischemic optic neuropathy (AAION) erroneously diagnosed as optic neuritis without elevated inflammatory blood markers due to corticosteroid use, and a patient with AAION and a history of nonarteritic anterior ischemic optic neuropathy in her fellow eye and untreated obstructive sleep apnea. GCA should be kept in the differential diagnosis for patients over 50 years of age even if they carry other ocular diagnoses. Temporal artery biopsy remains the gold standard for GCA diagnosis and is often required in equivocal cases.
Periodic Discharges: How to Approach, When to Treat
Authors: Husari Khalil S. , Johnson Emily L.
Published: September 2020

The use of continuous EEG monitoring has expanded in the last decade, allowing the recognition not only of nonconvulsive seizures but also of the relatively high prevalence of periodic and rhythmic EEG patterns. Periodic discharges are a fairly common EEG pattern and often present a therapeutic challenge when encountered. We will consider five associations of these periodic discharges: ictal, acute seizures, epileptogenic, injurious, and epiphenomenal. We present the challenges and unanswered questions pertaining to periodic discharges, along with several next steps and future directions to help enhance our understanding of periodic discharges. We also present an algorithmic approach to management centered on clinicoelectrographic and clinicoradiologic data.
The association between left ventricular mass index and serum sirtuin 3 level in patients with hypertension
Authors: Karayiğit Orhan , Çelik Muhammet Cihat , Kiziltunç Emrullah , Çiçekçioğlu Hülya , Topçuoğlu Canan , Doğanay Birsen , Çetin Mustafa
Published: August 2020

Objectives

Sirtuin 3 (SIRT3) can protect cardiomyocytes from oxidative stress-mediated cell damage and prevent cardiac hypertrophy development. The aim of this study was to evaluate whether a relationship existed between left ventricular mass index (LVMI) and serum SIRT3 levels in patients with hypertension.

Patients and methods

This study was conducted as a cross-sectional study of 83 patients between April 2018 and October 2018. The LVMI of all patients was calculated using the formula of the American Echocardiography Association and patients were divided into two groups according to results (increased LVMI and normal LVMI).

Results

Increased LVMI was determined in 37.3% of patients, whereas 62.7% had normal LVMI. There was no significant difference between serum SIRT3 levels between those with increased LVMI and normal LVMI (5.8 versus 5.4 ng/ml; P = 0.914). Serum pro-brain natriuretic peptide levels (69 versus 41 ng/ml; P = 0.019) were found to be higher in patients with increased LVMI than in those with normal LVMI. A positive correlation between SIRT3 levels and Sm (myocardial systolic) velocity was also determined (r = 0.338; P = 0.002).

Conclusion

The serum levels of SIRT3, a molecule which has been proposed to have protective properties against myocardial hypertrophy, were not found to be correlated with LVMI values; however, SIRT3 levels were found to be correlated with Sm velocity, which is accepted to be an indicator of myocardial early diastolic dysfunction.
Interference of feral radish (Raphanus sativus) resistant to AHAS-inhibiting herbicides in oilseed rape, wheat and sunflower crops
Authors: Vercellino Roman B. , Pandolfo Claudio E. , Cantamutto Miguel , Presotto Alejandro
Published: August 2020

Raphanus sativus(feral radish), a cosmopolitan weed, has developed resistance to acetohydroxyacid synthase (AHAS) inhibitor herbicides in several countries of South America. This study reports the effects of season-long interference of several feral radish densities on grain yield and yield components of oilseed rape, wheat and sunflower, and on feral radish traits under field conditions. Feral radish density treatments consisted of 0, 2, 4, 8 and 16 plants m−2in oilseed rape, 0, 4 and 12 plants m−2in wheat, and 0, 1.6, 4, 8 and 16 plants m−2in sunflower. The number of inflorescences per area, seeds per inflorescence and the seed biomass of crops were reduced with increasing feral radish densities. The rectangular hyperbola model revealed yield losses by up to 100 %, 74.4 % and 12.2 % in oilseed rape, wheat and sunflower, respectively. Feral radish seed production ranged from 4,300 to 31,200, and 1000 to 4,700 seeds m−2in winter crops and sunflower, respectively. Season-long feral radish interference can result in serious economic losses in oilseed rape, wheat and sunflower. The adverse impact of feral radish on the yield of winter and summer crops and the high feral radish seed and pods production suggests the need for the development and implementation of diverse and effective long-term weed management practices.