bluuebunny/crossref_metadata_2025 huggingface dataset:
A Systematic Review of Cervical Ganglioneuromas
Authors: Saadat Saad , Fritz Christian , Tran Deanna , Parry Nathan , Yuhan Brian T. , Bolduan Alyssa , Thorpe Eric
Published: June 2022

Objective

To perform a systematic review of the literature evaluating clinical characteristics and management of cervical ganglioneuromas (CGNs).

Data Sources

PubMed, Embase, and Cochrane Library databases were searched. Data such as patient demographics, imaging, and treatments were obtained.

Review Methods

Pertinent studies were downloaded, and the full text was reviewed by 4 authors (N.P., S.S., C.F., D.T.). Results were reported via the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta‐analyses).

Results

Fifty‐two studies with 58 patients were identified in the literature. Of the 58 patients, 22 were adults and 36 were pediatric. The most common reported location of CGN was within the parapharyngeal space (76%), followed by the retropharyngeal (19%) and paravertebral/prevertebral (7%) spaces. The most common presenting symptoms included a nontender mass (29.3%), dysphagia (17.2%), and hoarseness (10.3%). Interestingly, the average tumor volume for patients with postoperative Horner’s syndrome was 183 mm3 (n = 21, 47.7%) vs 946 mm3 in patients without Horner’s syndrome (n = 23, 52.3%). This represents a statistically significant finding (P =. 018). There exists no significant difference in tumor volumes between adult and pediatric patients with Horner’s syndrome (P =. 645).

Conclusion

CGN is a rare tumor of the sympathetic nervous system. Management should involve complete surgical excision with biopsy. We found that patients with small‐volume CGNs are significantly more likely to experience postoperative Horner’s syndrome. This finding is independent of age and should therefore be taken into consideration in any patient with suspected CGN.
Management of biliary stones in bariatric surgery
Authors: Tustumi Francisco , Pinheiro Filho João Emílio Lemos , Stolzemburg Lucas Cata Preta , Serigiolle Leonardo Carvalho , Costa Thiago Nogueira , Pajecki Denis , Santo Marco Aurélio , Nahas Sérgio Carlos
Published: June 2022

Morbidly obese and post-bariatric surgery patients are at increased risk for biliary stones formation. The complications related to biliary stones may impose complexity on their management. This study aimed to review the management of biliary conditions in obese and bariatric patients. In this study, a narrative review was performed of the medical, surgical, and endoscopic procedures for the management of biliary stones and their related complications. Knowing the main prophylactic and therapeutic interventions options is essential for clinicians to properly manage the biliary stones in patients candidates or submitted to bariatric surgery.

Plain Language Summary

Management of biliary stones in bariatric surgery The complications related to biliary stones may impose complexity on their management. Knowing the main prophylactic and therapeutic intervention options is essential for clinicians to properly manage the biliary stones in patient candidates or submitted to bariatric surgery. This study reviewed the main tools clinicians can handle to properly manage candidates for bariatric surgery or patients submitted to bariatric surgery.
Motivators and impediments to seismic retrofit implementation for wood-frame soft-story buildings: A case study in California
Authors: Zhang Yating , Fung Juan F , Johnson Katherine J , Sattar Siamak
Published: June 2022

Motivating property owners to mitigate seismic risks for existing buildings is a major challenge for many earthquake-prone regions. This article identifies primary factors that may affect the adoption of seismic retrofit by owners of commercial and residential buildings, assesses the influence of economic, social, regulatory, and individual factors on retrofit implementation in three California cities, and discusses potential approaches to promoting seismic retrofits. Data for three retrofit programs are utilized to create predictive models for retrofit probability. The results suggest that retrofit probability for multifamily residential buildings may increase with building height, median housing value, educational attainment, and population density in the neighborhood, but may decrease with building age, building size, land value, and housing vacancy rate in the neighborhood. The retrofit decision for commercial buildings is strongly correlated with the number of stories and rooms, land value, vacancy rate, and population density, while the retrofit decision for residential buildings is highly associated with building age, number of rooms, land value, median housing value, median contract rent, and educational attainment. Overall, promoting seismic retrofits requires careful consideration of different motivators and impediments to owner’s retrofit actions for commercial and residential buildings, and for older, taller, larger buildings, which tend to be more vulnerable but are associated with higher retrofit costs. In addition, neighborhood characteristics including median housing value and vacancy rate may be strong indicators of the retrofit probability among building clusters.
Measuring evolution learning: impacts of student participation incentives and test timing
Authors: Sbeglia Gena C. , Nehm Ross H.
Published: June 2022

Background

Policy documents likeVision and Changeand theNext Generation Science Standardsemphasize the importance of using constructed-response assessments to measure student learning, but little work has examined the extent to which administration conditions (e.g., participation incentives, end-of-course timing) bias inferences about learning using such instruments. This study investigates potential biases in the measurement of evolution understanding (one time point) and learning (pre-post) using a constructed-response instrument.

Methods

The constructed-response ACORNS instrument (Assessment of COntextual Reasoning about Natural Selection) was administered at the beginning of the semester, during the final exam, and at end of the semester to large samples of North American undergraduates (N = 488–1379, 68–96% participation rate). Three ACORNS scores were studied: number of evolutionary core concepts (CC), presence of evolutionary misconceptions (MIS), and presence of normative scientific reasoning across contexts (MODC). Hierarchical logistic and linear models (HLMs) were used to study the impact of participation incentives (regular credit vs. extra credit) and end-of-course timing (final exam vs. post-test) on inferences about evolution understanding (single time point) and learning (pre-post) derived from the three ACORNS scores. The analyses also explored whether results were generalizable across race/ethnicity and gender.

Results

Variation in participation incentives and end-of-course ACORNS administration timing did not meaningfully impact inferences about evolution understanding (i.e., interpretations of CC, MIS, and MODC magnitudes at a single time point); all comparisons were either insignificant or, if significant, considered to be small effect sizes. Furthermore, participation incentives and end-of-course timing did not meaningfully impact inferences about evolutionlearning(i.e., interpretations of CC, MIS, and MODC changes through time). These findings were consistent across race/ethnicity and gender groups.

Conclusion

Inferences about evolution understanding and learning derived from ACORNS scores were in most cases robust to variations in participation incentives and end-of-course timing, suggesting that educators may have some flexibility in terms of when and how they deploy the ACORNS instrument.
Acute multifocal retinitis in a patient with Q fever (Coxiella Burnetii infection) with endocarditis
Authors: Mahmoud Anis , Abid Fatma , Khairallah Molka , Affes Sofien , Mbarek Sameh , Amor Hassen Ibn Hadj , Khalifa Anis Ben Hadj , Mesaoud Riadh , Khairallah Moncef
Published: June 2022

Objective

To report acute multifocal retinitis in association with serologically-proven Coxiella (C) Burnetii infection (Q fever) with endocarditis.

Material and methods

A single case report documented with multimodal imaging.

Results

A 67-year-old cattle breeder presented with a 2-week history of persistent fever, headache, and floaters in both eyes. On examination, his best-corrected visual acuity was 20/20, and there was 1+ vitreous cells in both eyes. Bilateral fundus examination showed multiple small superficial white retinal lesions scattered in the posterior pole and midperiphery associated with a few retinal hemorrhages. These retinal lesions did not stain on fluorescein angiography (FA) and showed focal hyperreflectivity and thickening primarily involving the inner retinal layers on optical coherence tomography (OCT). There also was a band-like hyper-reflective area in the middle retina consistent with paramacular acute middle maculopathy. Transthoracic echocardiogram (TTE) showed a mobile echodensity on the anterior aortic leaflet consistent with a diagnosis of endocarditis. Elisa assays performed on paired serum samples collected 2 weeks apart showed increase in antibodies against C burnetii from 60 IU/ml to 255 IU/ml. The patient was treated with doxycycline 100 mg twice a day for 18 months, with subsequent resolution of the endocarditis. Sequential ocular examinations showed gradual resolution of all acute retinal findings without visible scars.

Conclusion

Acute Q fever, caused by C burnetii infection, should be considered in the differential diagnosis of acute multifocal retinitis. A systematic cardiac assessment with echocardiography is essential for early diagnosis of associated endocarditis and for prompt administration of appropriate antibiotic treatment to improve clinical outcomes.
A novel role for CFTR interaction with LH and FGF in azoospermia and epididymal maldevelopment caused by cryptorchidism
Authors: Hadziselimovic Faruk , Verkauskas Gilvydas , Stadler Michael
Published: June 2022

Cryptorchidism occurs frequently in children with cystic fibrosis. Among boys with cryptorchidism and abrogated mini-puberty, the development of the epididymis and the vas deferens is frequently impaired. This finding suggests that a common cause underlies the abnormal development of Ad spermatogonia and the epididymis. The cystic fibrosis transmembrane conductance regulator (CFTR) is an ATP-binding cassette transporter protein that acts as a chloride channel. The CFTR gene has been associated with spermatogenesis and male fertility. In boys with cryptorchidism, prepubertal hypogonadotropic hypogonadism induces suboptimal expression of the ankyrin-like protein gene, ASZ1, the P-element induced wimpy testis-like gene, PIWIL, and CFTR. The abrogated expression of these gene leads to transposon reactivation, and ultimately, infertility. Curative gonadotropin-releasing hormone agonist (GnRHa) treatment stimulates the expression of CFTR and PIWIL3, which play important roles in the development of Ad spermatogonia and fertility. Furthermore, GnRHa stimulates the expression of the epididymal androgen-sensitive genes, CRISP1, WFDC8, SPINK13, and PAX2, which thereby promotes epididymal development. This review focuses on molecular evidence that favors a role for CFTR in cryptorchidism-induced infertility. Based on information available in the literature, we interpreted our RNA-Seq expression data obtained from samples before and after randomized GnRHa treatment in boys with bilateral cryptorchidism. We propose that, in boys with cryptorchidism, CFTR expression is controlled by luteinizing hormone and testosterone. Moreover, CFTR regulates the activities of genes that are important for fertility and Wolffian duct differentiation.
Identification, characterization and functional analysis of gonadal long noncoding RNAs in a protogynous hermaphroditic teleost fish, the ricefield eel (Monopterus albus)
Authors: He Zhi , Ye Lijuan , Yang Deying , Ma Zhijun , Deng Faqiang , He Zhide , Hu Jiaxiang , Chen Hongjun , Zheng Li , Pu Yong , Jiao Yuanyuan , Chen Qiqi , Gao Kuo , Xiong Jinxin , Lai Bolin , Gu Xiaobin , Huang Xiaoli , Yang Shiyong , Zhang Mingwang , Yan Taiming
Published: June 2022

Background

An increasing number of long noncoding RNAs (lncRNAs) have been found to play important roles in sex differentiation and gonad development by regulating gene expression at the epigenetic, transcriptional and posttranscriptional levels. The ricefield eel, Monopterus albus, is a protogynous hermaphroditic fish that undergoes a sequential sex change from female to male. However, the roles of lncRNA in the sex change is unclear.

Results

Herein, we performed RNA sequencing to analyse lncRNA expression patterns in five different stages of M. albus development to investigate the roles of lncRNAs in the sex change process. A total of 12,746 lncRNAs (1503 known lncRNAs and 11,243 new lncRNAs) and 2901 differentially expressed lncRNAs (DE-lncRNAs) were identified in the gonads. The target genes of the DE-lncRNAs included foxo1, foxm1, smad3, foxr1, camk4, ar and tgfb3, which were mainly enriched in signalling pathways related to gonadal development, such as the insulin signalling pathway, MAPK signalling pathway, and calcium signalling pathway. We selected 5 highly expressed DE-lncRNAs (LOC109952131, LOC109953466, LOC109954337, LOC109954360 and LOC109958454) for full length amplification and expression pattern verification. They were all expressed at higher levels in ovaries and intersex gonads than in testes, and exhibited specific time-dependent expression in ovarian tissue incubated with follicle-stimulating hormone (FSH) and human chorionic gonadotropin (hCG). The results of quantitative real-time PCR (qRT-PCR) analysis and a dual-luciferase assay showed that znf207, as the gene targeted by LOC109958454, was expressed in multiple tissues and gonadal developmental stages of M. albus, and its expression was also inhibited by the hormones FSH and hCG.

Conclusions

These results provide new insights into the role of lncRNAs in gonad development, especially regarding natural sex changes in fish, which will be useful for enhancing our understanding of sequential hermaphroditism and sex changes in the ricefield eel (M. albus) and other teleosts.
Transcriptional changes in the peripheral blood leukocytes from Brangus cattle before and after tick challenge with Rhipicephalus australis
Authors: Mantilla Valdivieso Emily F. , Ross Elizabeth M. , Raza Ali , Naseem Muhammad Noman , Kamran Muhammad , Hayes Ben J. , Jonsson Nicholas N. , James Peter , Tabor Ala E.
Published: June 2022

Background

Disease emergence and production loss caused by cattle tick infestations have focused attention on genetic selection strategies to breed beef cattle with increased tick resistance. However, the mechanisms behind host responses to tick infestation have not been fully characterised. Hence, this study examined gene expression profiles of peripheral blood leukocytes from tick-naive Brangus steers (Bos taurus x Bos indicus) at 0, 3, and 12 weeks following artificial tick challenge experiments with Rhipicephalus australis larvae. The aim of the study was to investigate the effect of tick infestation on host leukocyte response to explore genes associated with the expression of high and low host resistance to ticks.

Results

Animals with high (HR, n = 5) and low (LR, n = 5) host resistance were identified after repeated tick challenge. A total of 3644 unique differentially expressed genes (FDR < 0.05) were identified in the comparison of tick-exposed (both HR and LR) and tick-naive steers for the 3-week and 12-week infestation period. Enrichment analyses showed genes were involved in leukocyte chemotaxis, coagulation, and inflammatory response. The IL-17 signalling, and cytokine-cytokine interactions pathways appeared to be relevant in protection and immunopathology to tick challenge. Comparison of HR and LR phenotypes at timepoints of weeks 0, 3, and 12 showed there were 69, 8, and 4 differentially expressed genes, respectively. Most of these genes were related to immune, tissue remodelling, and angiogenesis functions, suggesting this is relevant in the development of resistance or susceptibility to tick challenge.

Conclusions

This study showed the effect of tick infestation on Brangus cattle with variable phenotypes of host resistance to R. australis ticks. Steers responded to infestation by expressing leukocyte genes related to chemotaxis, cytokine secretion, and inflammatory response. The altered expression of genes from the bovine MHC complex in highly resistant animals at pre- and post- infestation stages also supports the relevance of this genomic region for disease resilience. Overall, this study offers a resource of leukocyte gene expression data on matched tick-naive and tick-infested steers relevant for the improvement of tick resistance in composite cattle.
HLA-E restricted cytomegalovirus UL40 peptide polymorphism may represent a risk factor following congenital infection
Authors: Tarragó David , González Irene , González-Escribano Maria Francisca
Published: June 2022

Background

Congenital cytomegalovirus immunopathogenesis is largely unknown and multifactorial due to the complex interactions between viral, maternal, placental, and child factors. Polymorphisms in the HLA-E binding UL4015-23peptide mimics HLA-E complexed peptides from certain HLA-A, -B, -C and -G alleles, which regulate the cellular immune response driven by natural killer-cells (NK) and CD8 + T cells. The aim of this study was to compare UL4015-23peptides distribution in congenital CMV and the counterpart HLA Class I peptides in a healthy cohort to investigate risk factors and markers for cCMV disease. In this 10-year retrospective study, theUL40 genewas directly sequenced from 242 clinical samples from 199 cases of congenital CMV (166 children and 33 pregnant or breast feeding women). Distribution of HLA-E binding UL4015-23peptides was analyzed and compared to those of HLA Class I observed in a cohort of 444 healthy individuals.

Results

Nineteen different HLA-E binding UL4015-23peptides were found. Three of them (VMAPRTLIL, VMAPRTLLL, VMAPRTLVL) were found in 88.3% of UL40 and 100% of HLA Class I of healthy individuals. In contrast, 15 of them (10.7%) were not found in HLA Class I. The VMAPRTLFL peptide was found in 1% of UL40 and all HLA-G alleles. Significant differences in peptide (VMAPRTLIL, VMAPRTLLL, VMAPRTLVL, other UL4015-23peptides, other HLA Class I peptides) distribution between UL4015-23from congenital CMV and HLA-A, -B, -C and –G from healthy individuals were found.

Conclusions

Our findings suggest that a mismatch between UL4015-23peptides and HLA Class I peptides between children and mothers might play a role in congenital CMV disease, and it may account for differences in outcome, morbidity and sequelae.
Characteristics and outcomes of unplanned intensive care unit admission after general anesthesia
Authors: Katori Nobuyuki , Yamakawa Kentaro , Yagi Kosuke , Kimura Yoshihiro , Doi Mayuko , Uezono Shoichi
Published: June 2022

Background

Unplanned ICU admission after surgery has been validated as a measure of a quality indicator of perioperative management because it may put surgical patients at risk of increased morbidity and mortality. Postoperative unscheduled admission to the ICU is usually determined either in the post-anesthesia care unit (PACU) or in the general surgical ward; however, it could be expected patient outcomes after ICU admission would be affected by the circumstances. The purpose of this retrospective observational study was to investigate the clinical characteristics and the outcome of unplanned admission to the ICU directly from the PACU or from the ward within 7 days after PACU discharge.

Methods

Forty-three thousand, five hundred fifty-three patients admitted to the PACU after general anesthesia were included in the study. Unplanned ICU admission was defined as the admission which was not anticipated preoperatively but was due to adverse events in the PACU (PACU group) or the ward after discharge from the PACU (Ward group). The following parameters were compared between the groups: patient characteristics, surgical characteristics, length of ICU and hospital stay, the principal adverse event for ICU admission, treatments in the ICU, and in-hospital mortality. The primary outcome was in-hospital mortality and the second was the length of ICU and hospital stay.

Results

Among 43,553 patients, 109 patients underwent unplanned ICU admission directly from the PACU (n= 73, 0.17%) or subsequently from the ward (n= 36, 0.08%). The length of both ICU and hospital stay was significantly longer in the Ward group than in the PACU group (1.4 and 19 days vs. 2.5 and 39 days, respectively). There was no significant difference in in-hospital mortality between the groups (4.1% vs. 8.3%, respectively).

Conclusions

The incidence of unplanned ICU admission after PACU stay was low, however, delayed admission to the ICU from the ward may prolong the length of both ICU and hospital stay compared to those directly from the PACU.
Association of body mass index with left ventricular diastolic dysfunction among ambulatory individuals with diabetes mellitus in rural Uganda: a cross-sectional study
Authors: Lumori Boniface Amanee Elias , Nuwagira Edwin , Abeya Fardous Charles , Araye Abdirahman Ali , Masette Godfrey , Mondo Charles K. , Okello Samson , Muzoora Conrad , Muyingo Anthony
Published: June 2022

Background

Left ventricular diastolic dysfunction (LVDD) is a recognized complication of diabetes mellitus that precedes and is a risk factor for heart failure. We aimed to determine the prevalence of LVDD and its association with body mass index in ambulatory adults with diabetes mellitus in rural Uganda.

Methods

We conducted a cross-sectional study, over 5 months, to enroll 195 ambulatory Ugandan adults living with diabetes mellitus for at least five years at Mbarara Regional Referral Hospital. We collected demographic, and clinical data and measured body mass index (BMI). Echocardiography was performed to determine LVDD by assessing the mitral inflow ventricular filling velocities (E/A and E/è ratios), tricuspid regurgitant jet peak velocity, and left atrium maximum volume index. We used logistic regression to estimate the odds ratio for the association of LVDD with BMI and evaluated the variation of associations by age and hypertension status.

Results

Of the 195 participants, 141 (72.31%) were female, the mean age was 62 [standard deviation, 11.50] years, and the median duration of diabetes diagnosis was 10 [interquartile range, 7, 15] years. Eighty-six percent (n = 168) had LVDD with the majority (n = 127, 65.1%) of participants in the grade 1 category of LVDD. In the adjusted model, the odds of LVDD for each 1 kg/m2 increase in BMI was 1.11 [95% confidence interval 1.00, 1.25, p = 0.04]. The adjusted odds of LVDD among individuals aged ≥ 50 years with BMI ≥ 25 kg/m2 was 13.82 times the odds of LVDD in individuals aged < 50 years with BMI < 25 kg/m2.

Conclusion

LVDD is prevalent and positively associated with BMI among ambulatory Ugandan adults living with diabetes mellitus for at least five years. The association was higher for older overweight/obese than younger individuals with normal weight. Future studies should focus on the effect of weight loss on LVDD as a possible target for the prevention of heart failure.
Fasting blood glucose-to-glycated hemoglobin ratio and all-cause mortality among Chinese in-hospital patients with acute stroke: a 12-month follow-up study
Authors: Cai Zhong-ming , Zhang Man-man , Feng Ren-qian , Zhou Xu-dong , Chen Hao-man , Liu Zhi-peng , Wu Yan-zhi , Lin Qun-li , Ye Sheng-lie , Liao Cheng-wei , Huang Xue-rong , Sun Le-qiu , Yang Bo , Zhu Bei-lei
Published: June 2022

Background

Stroke is a leading cause of death and functional impairment in older people. To assess the prospective association between fasting blood glucose-to-glycated hemoglobin ratio and all-cause mortality and poor prognosis in stroke patients.

Methods

A total of 971 Chinese inpatients with acute stroke (mean age of 65.7) were consecutively enrolled in the prospective clinical study and followed up for 12 months after discharge. Stress hyperglycemia was measured using the ratio of fasting blood glucose (FBG, mmol/L)/glycated hemoglobin (HbA1c, %). The primary outcome was all-cause mortality, and secondary outcomes were poor prognosis defined as infectious complications, a National Institutes of Health Stroke Scale (NIHSS) score ≥ 6, a Barthel Index score ≤ 60, or a modified Rankin Scale (mRS) score of 3–6, presented as multivariate-adjusted odds ratios (ORs) with 95% confidence intervals (CIs) across the quartiles of the FBG/HbA1c ratio.

Results

There were 35 (4.1%) all-cause deaths at 3 months and 85 (11.4%) at 12 months. The inpatients with the highest quartile of the FBG/HbA1c ratio had a higher risk of all-cause death at 3 months (adjusted OR: 5.16, 95% CI: 1.03–25.74) and at 12 months (adjusted OR: 2.59, 95% CI: 1.14–5.89)) and a higher risk of infectious complications (adjusted OR 2.37, 95% CI 1.27–4.43) and dysfunction (adjusted OR 1.79, 95% CI 1.06–3.01) during hospitalization than inpatients with the lowest quartile.

Conclusions

Stress hyperglycemia, measured by the FBG/HbA1c ratio, was associated with an increased risk of adverse outcomes, including all-cause death, infectious complications, and dysfunction after stroke.
Efficacy and safety of caspofungin for patients with hepatic insufficiency
Authors: Ran Xiaoyun , Wang Pengfei , Zhang An , Tang Binfei
Published: June 2022

Background

To observe the changes of hepatic function and efficacy of conventional dosage of caspofungin in the treatment of patients with different Child–Pugh scores.

Methods

In total, 200 patients (Child–Pugh A group: 66 patients, Child–Pugh B group: 83 patients, Child–Pugh C group: 51 patients) treated with caspofungin from May 2018 to March 2021 in the Second Affiliated Hospital of Chongqing Medical University were enrolled. Main investigation items were as follows: sex, age, weight, duration of treatment, dosage, department, underlying diseases, risk factors for fungal infection, albumin, liver enzyme, total bilirubin, serum creatinine, estimated glomerular filtration rate. To investigate the changes of liver, kidney function tests and efficacy during the treatments of caspofungin. Patients were divided into three groups according to the duration of treatment of caspofungin:1-week group, 2-week group and 3-week group, respectively.

Results

In the three groups, albumin, liver enzyme levels, total bilirubin and serum creatinine, estimated glomerular filtration rate had no significant difference (P > 0.05). The efficacy of different Child–Pugh scores and different duration of treatment was also significantly different (P > 0.05).

Conclusions

Caspofungin is well tolerated and highly effective. And it will not exacerbate the hepatic and renal function when administered with the not-reducing dose, which indicate the clinical application value of caspofungin. Besides, extending the treatment duration has little effect on improving the efficacy of caspofungin. The drug should be withdrawn timely according to the patients’ clinical condition in order to reduce the adverse reactions and economic burden.
Maternal septicemia caused by Streptococcus mitis: a possible link between intra-amniotic infection and periodontitis. Case report and literature review
Authors: Chaemsaithong Piya , Lertrut Waranyu , Kamlungkuea Threebhorn , Santanirand Pitak , Singsaneh Arunee , Jaovisidha Adithep , Pakdeeto Sasikarn , Mongkolsuk Paninee , Pongchaikul Pisut
Published: June 2022

Background

Intra-amniotic infection has a strong causal association with spontaneous preterm birth and preterm prelabor rupture of membranes (PPROM). The most common route of intra-amniotic infection is the ascending pathway in which microorganisms from the vagina gain access to the amniotic cavity. Distant microorganisms such as those from the oral cavity have been reported in intra-amniotic infection through hematogenous spreading.

Case presentation

A 31-year-old gravida 1, para 0 Thai woman at 33+6 weeks’ gestation presented with leakage of vaginal fluid and irregular uterine contraction. She developed fever at 4 h after admission and was later diagnosed with acute chorioamnionitis. A Cesarean section was performed to terminate pregnancy. In addition to a blood culture, the cultures of amniotic fluid, vaginal and chorioamniotic membrane swabs were positive forStreptococcus mitiswith identical susceptibility profiles. After the delivery and antibiotic prescription, oral examination showed dental caries and chronic periodontitis.

Conclusions

This is the first case report demonstrating maternal septicemia and intra-amniotic infection caused byS. mitiswhich might be attributed to periodontitis in women presenting with preterm PROM. We highlighted the association of periodontal disease and preterm labor/PROM syndrome. Oral cavity examination should be included in the prenatal care to ensure good dental hygiene.
Facilitators and barriers to point-of-care testing for sexually transmitted infections in low- and middle-income countries: a scoping review
Authors: Martin Kevin , Wenlock Rhys , Roper Tom , Butler Ceri , Vera Jaime H.
Published: June 2022

Background

Sexually transmitted infections (STIs) in low- and middle-income countries (LMICs) are predominantly managed by syndromic management. However, most STIs are asymptomatic. These untreated STIs cause individual morbidity, and lead to high STI prevalences.

There is increasing interest in the use of point-of-care tests (POCTs) for STIs in LMICs, which could facilitate same day testing and treatment. To best utilise these tests, we must understand the facilitators and barriers to their implementation. The aim of this review is to explore how point-of-care testing for STIs has been implemented into healthcare systems in LMIC and the facilitators and barriers to doing so.

Methods

A scoping review was conducted by searching MEDLINE, Embase, Emcare, CINAHL, Scopus, LILACS, the Cochrane Library, and ProQuest Dissertations and Theses for studies published between 1st January 1998 and 5th June 2020. Abstracts and full articles were screened independently by two reviewers. Studies were considered for inclusion if they assessed the acceptability, feasibility, facilitators, or barriers to implementation of point-of-care testing for chlamydia, gonorrhoea, trichomoniasis or syphilis in LMICs. Thematic analysis was used to analyse and present the facilitators and barriers to point-of-care STI testing.

Results

The literature search revealed 82 articles suitable for inclusion; 44 (53.7%) from sub-Saharan Africa; 21 (25.6%) from Latin American and the Caribbean; 10 (12.2%) from East Asia and the Pacific; 6 (7.3%) from South Asia; and one (1.2%) multi-regional study. Thematic analysis revealed seven overarching themes related to the implementation of POCTs in LMICs, namely (i) Ideal test characteristics, (ii) Client factors, (iii) Healthcare provision factors, (iv) Policy, infrastructure and health system factors, (v) Training, audit, and feedback, (vi) Reaching new testing environments, and (vii) Dual testing.

Conclusion

Implementation of POCTs in LMICs is complex, with many of the barriers due to wider health system weakness. In addition to pressing for broader structural change to facilitate basic healthcare delivery, these themes may also be used as a basis on which to develop future interventions. The literature was heavily skewed towards syphilis testing, and so more research needs to be conducted assessing chlamydia, gonorrhoea, and trichomoniasis testing, as well as home or self-testing.
A randomized controlled trial for evaluating pain response in patients with spinal metastases following local versus whole vertebral radiotherapy: study protocol for phase II clinical trial
Authors: Yuan Li , Geng Lidan , Wu Danfeng , Dai Tangzhi , Feng Gang , Du Xiaobo
Published: June 2022

Background

Patients with bone metastasis often experience severe pain that is difficult to control and seriously affects quality of life. Radiotherapy is an effective way to relieve pain in these patients. Currently, there is no standard recommended range of radiotherapy targets for vertebral metastasis. The effect of radiotherapy on pain relief varies among patients, and some patients with metastases have serious side effects.

Methods

This study aims to verify whether reducing the radiotherapy range for vertebral metastases can achieve the same effect as whole vertebral radiotherapy while minimizing side effects. Sixty-six patients with pain caused by vertebral metastasis were randomly divided into two groups. The study group is receiving partial vertebrae body radiotherapy at the regions of abnormal signal, suspected invasion, and adjacent subclinical focus of vertebral metastasis, and the control group is receiving the same dose of radiotherapy on whole vertebrae body where metastasis occurred. After radiotherapy, along-term follow-up of patients will determine pain relief and side effects.

Discussion

The expected results of this study are that local irradiation of vertebral metastases can achieve a palliative effect of pain control not less than total vertebral irradiation with fewer side effects.

Trial registration

This study was registered in the Chinese Clinical Trial Registry (No: ChiCTR1900023401).
Preconception reproductive tract infections status and adverse pregnancy outcomes: a population-based retrospective cohort study
Authors: Zeng Mengyao , Yang Liu , Mao Yanyan , He Yang , Li Min , Liu Jun , Zhu Qianxi , Chen Liang , Zhou Weijin
Published: June 2022

Background

Reproductive tract infections can cause serious adverse outcomes for pregnant women such as spontaneous abortion and preterm birth. However, it is unclear whether maternal reproductive tract infection before pregnancy would also be related to any adverse pregnancy outcomes. This study aims to investigate the association of maternal preconception reproductive tract infections with subsequent adverse pregnancy outcomes.

Methods

A retrospective cohort study was conducted in the Chongqing Municipality of China between April 2010 and December 2016. A total of 57,586 women (57,708 pregnancies) from all 39 counties of Chongqing who participated in the National Free Preconception Health Examination Project were included. They all took preconception examinations for gonorrhea, chlamydia, trichomoniasis, syphilis, bacterial vaginosis and candidiasis before pregnancy within one year. Primary outcomes included spontaneous abortion (< 28 weeks gestation), preterm birth (< 37 weeks gestation), macrosomia and low birthweight.

Results

Of the 57,708 pregnancies, 2438 (4.22%) had at least one type of reproductive tract infections. Compared with women who were not infected with any reproductive tract infection before pregnancy, women with reproductive tract infections had a higher rate of spontaneous abortion (7.88% vs. 5.62%, p < 0.001). After analyzing by each infection, there were few significant associations between pre-pregnancy infections and adverse outcomes. Preconception syphilis infection was significantly associated with increased odds of spontaneous abortion (aOR = 2.07, 95%CI 1.50–2.85), induced abortion/labour due to medical reasons (aOR = 1.60, 95%CI 1.01–2.54) and preterm birth (aOR = 1.60, 95%CI 1.12–2.30) after adjusting for potential confounders. Preconception trichomoniasis was intended to relate to a higher risk of spontaneous abortion (aOR = 1.65, 95%CI 1.01–2.71), but its impact seemed to be attributed to its co-infection with other RTIs. Women who were chlamydia or bacterial vaginosis positive before pregnancy showed higher odds of macrosomia (aOR = 2.00, 95% CI 1.07–3.74 for chlamydia; aOR = 1.58, 95% CI 1.06–2.34 for bacterial vaginosis). Preconception bacterial vaginosis might also be associated with higher risks of very preterm birth (aOR = 2.16, 95%CI 1.23–3.78) and large for gestational age (aOR = 1.36, 95%CI 1.02–1.81).

Conclusions

Women with infections of the genital tract before pregnancy might also have increased risks of subsequent adverse outcomes including spontaneous abortion, preterm birth and macrosomia.
Outcomes of prophylactic abdominal aortic balloon occlusion in patients with placenta previa accreta: a propensity score matching analysis
Authors: Yin Huifen , Hu Rong
Published: June 2022

Background

Placenta previa accreta is a life-threatening pregnancy complication, and reducing blood loss during operative treatment remains a major challenge. The aim of our study was to investigate the effect of prophylactic abdominal aortic balloon occlusion (AABO) during caesarean section in women with placenta previa accreta.

Methods

A retrospective study of women with placenta previa accreta was conducted in a tertiary hospital from January 1, 2015, to December 31, 2020. Women were divided into balloon and control groups by whether AABO was performed. Baseline characteristics and pregnancy outcomes were compared in the two groups. A propensity score analysis was applied to minimise the indication bias. The primary outcome was composite, including estimated blood loss (EBL) ≥ 2.0 L, massive transfusion and hysterectomy.

Results

A total of 156 patients participated in this study, with 68 in the balloon group and 88 in the control group. Propensity score analysis showed that women in the balloon group had less EBL (1590.36 ± 1567.57 vs. 2830.36 ± 2285.58 mL, P = 0.02) as well as a lower proportion of EBL ≥ 1.0 L (50.00% vs. 78.57%, P = 0.03), EBL ≥ 2.0 L (21.43% vs. 50.00%, P = 0.03) and EBL ≥ 3.0 L (14.29% vs. 42.86%, P = 0.04). In addition, women in the control group received more red blood cell transfusions (8.43 U ± 9.96 vs. 3.43 U ± 6.27, P = 0.03), and the proportion of massive transfusions was higher (35.71% vs. 7.14%, P = 0.02). The proportions of disseminated intravascular coagulation (0% vs. 28.57%, P < 0.01), haemorrhagic shock (3.57% vs. 32.14%, P = 0.02) and hysterectomy (10.71% vs. 39.29%, P = 0.03) were significantly lower in the balloon group. Sutures were performed more often in the balloon group (64.29% vs. 17.86%, P < 0.01). Multivariate logistic regression analysis showed that AABO was associated with the primary outcome (adjusted odds ratio 0.46, 95% confidence interval 0.23 ~ 0.96, P = 0.04). No serious balloon catheter-related complications occurred in the balloon group.

Conclusion

AABO was an effective and safe approach to improve maternal outcomes for patients with placenta previa accreta.
A novel carbon-fibre adjustable reusable accessory (CARA) for supine breast positioning to reduce toxicity in breast adjuvant radiotherapy: a study protocol for a multicentre phase III randomized controlled trial
Authors: Duzenli Cheryl , Chan Elisa K. , Bergman Alanah M. , Grahame Sheri , Singer Joel , Burns Levi , Olson Robert A.
Published: June 2022

Background

A novel device for supine positioning in breast radiotherapy for patients with large or pendulous breasts has been developed and tested in phase II studies. This trial is designed to assess the efficacy of the device to reduce skin toxicity and unwanted normal tissue dose in comparison to the current clinical standard for supine breast support during breast radiotherapy.

Methods

Patients at high risk for moist desquamation, having infra-mammary fold or lateral ptosis, will be randomized into two arms. Patients in the control arm will receive breast radiotherapy with supine positioning using current standard of care. Patients in the experimental arm will be positioned supine with the novel device. The primary endpoint is the incidence of moist desquamation in the infra-mammary fold. We hypothesize a 20% reduction (from 50 to 30%) in the rate of moist desquamation in the study arm versus the control arm. For 80% power, two-tailed α = 0.05 and 10% loss to follow up, 110 patients will be assigned to each arm. The proportion of patients experiencing moist desquamation in the two arms will be compared using logistic regression adjusting for brassiere cup size, skin fold size, body mass index, smoking status, and dose fractionation schedule. An unadjusted comparison will also be made using the chi-square test, or Fisher’s exact test, if appropriate. Secondary endpoints include dose-volume statistics for the lung and heart, skin dose and clinical parameters including setup time, reproducibility, and staff experience with setup procedures. Patient-reported pain, skin condition interference with sleep and daily activities, and comfort during treatment are also secondary endpoints.

Discussion

Based on results from earlier phase II studies, it is expected that the device-enabled elimination of infra-mammary fold should reduce toxicity and improve quality of life for this patient population. Earlier studies showed reduction in dose to organs at risk including lung and heart, indicating potential for other long-term benefits for patients using the device. This study is limited to acute skin toxicity, patient-reported outcomes, and clinical factors to inform integration of the device into standard breast radiotherapy procedures.

Trial registration

Clinicaltrials.gov identifier: NCT04257396. Registered February 6 2020.
Exploring complement-dependent cytotoxicity by rituximab isotypes in 2D and 3D-cultured B-cell lymphoma
Authors: Lara Sandra , Heilig Juliane , Virtanen Alexander , Kleinau Sandra
Published: June 2022

Background

The therapeutic IgG1 anti-CD20 antibody, rituximab (RTX), has greatly improved prognosis of many B-cell malignancies. Despite its success, resistance has been reported and detailed knowledge of RTX mechanisms are lacking. Complement-dependent cytotoxicity (CDC) is one important mode of action of RTX. The aim of this study was to systematically evaluate factors influencing complement-mediated tumor cell killing by RTX.

Methods

Different RTX isotypes, IgG1, IgG3, IgA1 and IgA2 were evaluated and administered on four human CD20+ B-cell lymphoma cell lines, displaying diverse expression of CD20 and complement-regulatory protein CD59. Complement activation was assessed on lymphoma cells grown in 2 and 3-dimensional (3D) culture systems by trypan blue exclusion. CDC in 3D spheroids was additionally analyzed by Annexin V and propidium iodide staining by flow cytometry, and confocal imaging. Anti-CD59 antibody was used to evaluate influence of CD59 in RTX-mediated CDC responses. Statistical differences were determined by one-way ANOVA and Tukey post hoc test.

Results

We found that 3 out of 4 lymphomas were sensitive to RTX-mediated CDC when cultured in 2D, while 2 out of 4 when grown in 3D. RTX-IgG3 had the greatest CDC potential, followed by clinical standard RTX-IgG1 and RTX-IgA2, whereas RTX-IgA1 displayed no complement activation. Although the pattern of different RTX isotypes to induce CDC were similar in the sensitive lymphomas, the degree of cell killing differed. A greater CDC activity was seen in lymphoma cells with a higher CD20/CD59 expression ratio. These lymphomas were also sensitive to RTX when grown in 3D spheroids, although the CDC activity was substantially reduced compared to 2D cultures. Analysis of RTX-treated spheroids demonstrated apoptosis and necrosis essentially in the outer cell-layers. Neutralization of CD59 overcame resistance to RTX-mediated CDC in 2D-cultured lymphoma cells, but not in spheroids.

Conclusions

The results demonstrate that CDC outcome in CD20+ B-cell lymphoma is synergistically influenced by choice of RTX isotype, antigen density, tumor structure, and degree of CD59 expression. Assessment of tumor signatures, such as CD20/CD59 ratio, can be advantageous to predict CDC efficiency of RTX in vivo and may help to develop rational mAbs to raise response rates in patients.
Optical coherence tomographic angiography in children with anisometropic amblyopia
Authors: Liu Chenchen , Zhang Yanzhen , Gu Xiaopeng , Wei Puying , Zhu Dehai
Published: June 2022

Objectives

To observe and compare the difference in retinal perfusion using optical coherence tomography angiography (OCTA) between anisometropic amblyopia in children and fellow eyes as well as age-matched controls.

Methods

A total of 16 children with anisometropic amblyopia and 19 age-matched healthy subjects were enrolled. All participants underwent OCTA examination, with 3 mm × 3 mm and 6 mm × 6 mm scans in the macular region. Perfusion parameters of the superficial retinal layer were measured by built-in software, including the macular foveal avascular zone (FAZ) area, perimeter and circularity, as well as the vessel length density (VLD) and perfusion density (PD) of the foveal, parafoveal and perifoveal regions.

Results

Among the 16 patients with anisometropic amblyopia, the FAZ area was significantly higher in diseased eyes (P = 0.027) than in fellow eyes. The VLD and PD of the foveal average and the VLD of the nasal quadrant of the perifoveal region in anisometropic amblyopic eyes were significantly lower than those in fellow eyes (P < 0.05). The VLD of the parafoveal average, the superior, temporal, inferior and nasal quadrants of the parafoveal region, and the nasal quadrant of the perifoveal region in anisometropic amblyopic eyes were significantly lower than those in healthy controls (P < 0.05). The PD of the parafoveal average, and the inferior quadrant of the parafoveal region in anisometropic amblyopic eyes were significantly lower than those in healthy controls (P < 0.05). The VLD of the parafoveal average, the superior, inferior and nasal quadrants of the parafoveal region, and the nasal quadrant of the perifoveal region in fellow eyes were significantly lower than those in healthy controls (P < 0.05). The PD of the parafoveal average, and the inferior quadrant of the parafoveal region in fellow eyes were significantly lower than those in healthy controls (P < 0.05).

Conclusions

The macular vessel density of the superficial capillary plexus is lower in anisometropic amblyopic children than in age-matched healthy children. Compared with the fellow eye, the perfusion of the amblyopic eye in children with anisometropic amblyopia also decreases.