bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics and biomarkers of coronary microvascular dysfunction and obstructive coronary artery disease
Authors: Mayala Henry Anselmo , Yan Wang , Jing Hu , Shuang-ye Liu , Gui-wen Yi , Chun-xia Qin , Ya Wang , Xiao-li Lan , Zhao-hui Wang
Published: August 2019

Objective

The purpose of this study was to determine the clinical characteristics and biomarkers in patients with coronary microvascular dysfunction (CMVD) and to compare them with patients with obstructive coronary artery disease (OCAD).

Methods

We conducted a single-center, hospital-based, observational, descriptive, comparative, clinical study of 40 patients, including 20 patients with CMVD and 20 with OCAD. We assessed laboratory biomarkers (low-density lipoprotein [LDL], high-density lipoprotein [HDL], red blood cell distribution width [RDW], brain natriuretic protein [BNP], troponin I), and PET/CT coronary flow reserve was performed.

Results

The mean coronary flow reserve (CFR) in patients with CMVD was 1.96±0.55. Mean low-density lipoprotein cholesterol (LDL-C) levels were significantly higher in the CMVD subgroup (2.53±0.63 mmol/L) compared with the OCAD subgroup (1.76±0.97 mmol/L). Logistic regression analysis identified LDL-C as a predictor for the development of CMVD (odds ratio, 5.24).

Conclusion

It is difficult to differentiate between OCAD and CMVD based on the patient’s medical history, clinical characteristics, and coronary angiography results. Further investigations may be needed to allow an accurate diagnosis. CFR measurements based on non-invasive positron emission tomography/computed tomography may aid the diagnosis of CMVD. We also identified LDL-C as a predictor for the development of CMVD.
Phase I studies: a test bench for Italian clinical research
Authors: Cagnazzo Celeste , Nanni Oriana , Arizio Francesca , Franchina Veronica , Cenna Rosita , Tabaro Gianna , Vannini Francesca , Procopio Giuseppe , Gori Stefania , Di Costanzo Alessandro
Published: August 2019

Background:

The Agenzia Italiana del Farmaco (AIFA) Determination 809/2015 sets all the requirements that clinical units and laboratories must meet in order to conduct phase I studies. Requirements include buildings, equipment, personnel, emergency management, as well as quality requirements defined in a set of standard operating procedures.

Methods:

In September 2018, the Italian Association of Medical Oncology working group, Clinical Research Coordinator, created an anonymous survey addressed to 51 medical directors of oncologic/hematologic clinical phase I units and all medical directors of generic and transversal units located in Italy and listed at the AIFA website.

Results:

Questionnaires from 24 institutions were collected, 9 previously inspected by competent authorities. All surveyed structures are certified to conduct profit studies and 1 is authorized to include healthy volunteers; 15 units implemented a Clinical Trial Quality Team in order to conduct nonprofit studies. At the time of data collection, a total of 398 proposals for phase I trials have been received, more than 50% coming from 3 institutes. A total of 144 phase I studies were active, with a median of 2.5 (Q1–Q3=0–6) studies for each center and asymmetric distribution of proposals.

Conclusion:

The considerable number of proposals received from the interviewed centers indicates that Italy plays an important role in the international pharmaceutical scene, despite bureaucratic procedures that threaten exclusion from decision-making. The AIFA Determination will be an important opportunity to acquire a competitive working approach.
Vestibular migraine: An update on current understanding and future directions
Authors: Huang Tzu-Chou , Wang Shuu-Jiun , Kheradmand Amir
Published: August 2019

Background

Vestibular migraine is among the most common causes of recurrent vertigo in the general population. Despite its prevalence and high impact on healthcare cost and utilization, it has remained an under-recognized condition with largely unknown pathophysiology. In the present article, we aim to provide an overview of the current understanding of vestibular migraine.

Methods

We undertook a narrative literature review on the epidemiology, presentations, clinical and laboratory findings, pathophysiology, and treatments of vestibular migraine.

Results

Currently, the diagnosis of vestibular migraine relies solely on clinical symptoms since clinical tests of vestibular function are typically normal, or difficult to interpret based on inconsistent results reported in earlier studies. The challenges related to diagnosis of vestibular migraine lie in its relatively broad spectrum of manifestations, the absence of typical migraine headaches with vestibular symptoms, and its very recent definition as a distinct entity. Here, we highlight these challenges, discuss common vestibular symptoms and clinical presentations in vestibular migraine, and review the current aspects of its clinical diagnosis and evaluation. The concepts related to the pathophysiology and treatment of vestibular migraine are also discussed.

Conclusion

Vestibular migraine is still underdiagnosed clinically. Future studies are needed to address the pathophysiological mechanisms and investigate effective treatment regimens.
Deinking sludge compost stability and maturity assessment using Fourier transform infrared spectroscopy and thermal analysis
Authors: Marouani Emna , Benzina Naïma Kolsi , Ziadi Noura , Bouslimi Besma , Abouda Amani , Koubaa Ahmed
Published: August 2019

Thermal composting is an important and useful way to transfer raw organic matter into value-added product rich in humic substances. Furthermore, thermal composting is a very promising way to reduce deinking paper sludge pollutions, which are difficult to remove. The objective of this study was to investigate the behaviour of the composting process of deinking paper sludge with poultry manure over 14 months. Two composts were used: C1 (70/30: deinking paper sludge/poultry manure) and C2 (50/50: deinking paper sludge/poultry manure). The compost stability and maturity were assessed via physico–chemical and thermal analyses: thermogravimetric analysis, differential thermal analysis and diffuse reflectance infrared Fourier transform spectroscopy. Diffuse reflectance infrared Fourier transform spectroscopy analysis provided chemical information for the presence of aromatic, phenolic, aliphatic and polysaccharidic structures. Thermogravimetry analyses revealed that both deinking paper sludge composts were rich in humic acids. The ratio E4/E6 (fulvic acids/humic acids) was also carried out to characterise the maturity index of composts. After 14 months, the compost C2 is more stable, mature and rich in humic acids than compost C1. Furthermore, the addition of poultry manure to the deinking paper sludge-based composts enhanced the formation of humic substances. From 0 to 14 months of composting, the concentration of polychlorinated biphenyls decreased from 0.2 to 0.1 mg kg−1 and from 0.6 to 0.2 mg kg−1 for C1 and C2, respectively.
Raising the ghosts of justice: Staging time and the memory of Empire in The Trial of Governor Eyre
Authors: Allen-Paisant Jason
Published: August 2019

I examine the staging of time, justice and performance in The Trial of Governor Eyre, investigating what this site-specific performance reveals about the experience of time in the context of colonial violence. In doing so, I show that the work’s discourse on temporality reflects a vital sense of performativity within an Afro-diasporic context. The work’s use of temporality, besides reflecting a cultural adaptation, allows for a remoulding of forms, coupling law and theatre in confronting Eyre’s mass executions of 1865. This remoulding of forms (law as theatre, theatre as law) provides a potential for postcolonial witnessing not available when either performance protocol is used on its own. Using Blazevic’s and Cale Feldman’s concept of ‘misperformance’, I argue that this play-trial arises out of a Benjaminian sense of historicity, providing an experience of inchoate justice that finds fulfilment in the present. The Trial of Governor Eyre points, more broadly, to a new ‘problem-space’ in African diaspora political theory, where resistance against colonial structures of oppression is increasingly mounted on the ground of justice itself and through which the legal apparatuses of colonialism become a site of critical memory. Through the play’s deployment of ritual and its plastic moulding of time, 1865 is enlisted as a key historical conjuncture for thinking through the cultural disenchantment of race, but also of the formalist, creative resources that can be mobilised for reimagining humanness in the contemporary moment.
Evidence of Modeling Impact in Development of Policies for Controlling the Opioid Epidemic and Improving Public Health: A Scoping Review
Authors: Sharareh Nasser , Sabounchi Shabnam S , McFarland Mary , Hess Rachel
Published: August 2019

Background:

Opioid addiction and overdose rates are reaching unprecedented levels in the U.S., with around 47,736 overdose deaths in 2017. Many stakeholders affect the opioid epidemic, including government entities, healthcare providers and policymakers, and opioid users. Simulation and conceptual modeling can help us understand the dynamics of the opioid epidemic by simplifying the real world and informing policymakers about different health interventions that could reduce the deaths caused by opioid overdose in the United States every year.

Objectives:

To conduct a scoping review of simulation and conceptual models that propose policies capable of controlling the opioid epidemic. We demonstrate the strengths and limitations of these models and provide a framework for further improvement of future decision support tools.

Methods:

Using the methodology of a scoping review, we identified articles published after 2000 from eight electronic databases to map the literature that uses simulation and conceptual modeling in developing public health policies to address the opioid epidemic.

Results:

We reviewed 472 papers of which 14 were appropriate for inclusion. Each used either system dynamics simulation modeling, mathematical modeling, conceptual modeling, or agent-based modeling. All included studies tested and proposed strategies to improve health outcomes related to the opioid epidemic. Factors considered in the models included physicians prescribing opioids, trafficking, users recruiting new users, and doctor shopping; no model investigated the impact of age and spatial factors on the dynamics of the epidemic. Key findings from these studies were (1) prevention of opioid initiation is better than treatment of opioid addiction, (2) the analysis of an intervention’s impact should include both benefits and harms, and (3) interventions with short-term benefits might have a counterproductive impact on the epidemic in long run.

Conclusions:

While most studies examined the role of prescription opioids and trafficking on this epidemic, the transition of patients from prescription opioid use to nonprescription use including heroin and synthetic opioids such as fentanyl impacts the system significantly and results in an epidemic with quite different characteristics than what it had a decade ago. We recommend including the impact of age and geographic location on the opioid epidemic using modeling methods.
Patterns of Mutation Enrichment in Metastatic Triple-Negative Breast Cancer
Authors: Saravia César H , Flores Claudio , Schwarz Luis J , Bravo Leny , Zavaleta Jenny , Araujo Jhajaira , Neciosup Silvia , Pinto Joseph A
Published: August 2019

Background:

Triple-negative breast cancer (TNBC) is a heterogeneous disease with aggressive biology and complex tumor evolution. Our purpose was to identify enrichment patterns of genomic alterations in metastatic triple-negative breast cancer (mTNBC).

Methods:

Genomic data were retrieved (mutations and copy number variations) from 550 primary TNBC tumors from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and The Cancer Genome Atlas (TCGA) data sets and 58 mTNBC tumors from “Mutational Profile of Metastatic Breast Cancers” and “The Metastatic Breast Cancer Project.” Statistical analysis of microarray data between primary and metastatic tumors was performed using a chi-square test, and the percentage of mutation enrichment in mTNBC cases was estimated. P-values were adjusted for multiple testing with Benjamini-Hochberg method with a false-discovery rate (FDR) <.05. In addition, we identified dominant hallmarks of cancer in mTNBC.

Results:

Seven genes with mutations were enriched in mTNBC after correcting for multiple testing. These included TTN, HMCN1, RELN, PKHD1L1, DMD, FRAS1, and RYR3. Only RPS6KB2 amplification was statistically significant in mTNBC; on the contrary, deletion of the genes TET1, RHOA, EPHA5, SET, KCNJ5, ABCG4, NKX3-1, SDHB, IGF2, and BRCA1 were the most frequent. The molecular alterations related to the hallmark of “genetic instability and mutation” were predominant in mTNBC. Interestingly, the hallmark of “activating immune destruction” was the least represented in mTNBC.

Conclusion:

Despite the study limitations, we identified recurrent patterns of genomic alterations with potential contribution to tumor evolution. Deletions were the aberrations more commonly found in mTNBC. Several molecular alterations are potentially targetable.
Risk of secondary progressive multiple sclerosis: A longitudinal study
Authors: Fambiatos Adam , Jokubaitis Vilija , Horakova Dana , Kubala Havrdova Eva , Trojano Maria , Prat Alexandre , Girard Marc , Duquette Pierre , Lugaresi Alessandra , Izquierdo Guillermo , Grand’Maison Francois , Grammond Pierre , Sola Patrizia , Ferraro Diana , Alroughani Raed , Terzi Murat , Hupperts Raymond , Boz Cavit , Lechner-Scott Jeannette , Pucci Eugenio , Bergamaschi Roberto , Van Pesch Vincent , Ozakbas Serkan , Granella Franco , Turkoglu Recai , Iuliano Gerardo , Spitaleri Daniele , McCombe Pamela , Solaro Claudio , Slee Mark , Ampapa Radek , Soysal Aysun , Petersen Thor , Sanchez-Menoyo Jose Luis , Verheul Freek , Prevost Julie , Sidhom Youssef , Van Wijmeersch Bart , Vucic Steve , Cristiano Edgardo , Saladino Maria Laura , Deri Norma , Barnett Michael , Olascoaga Javier , Moore Fraser , Skibina Olga , Gray Orla , Fragoso Yara , Yamout Bassem , Shaw Cameron , Singhal Bhim , Shuey Neil , Hodgkinson Suzanne , Altintas Ayse , Al-Harbi Talal , Csepany Tunde , Taylor Bruce , Hughes Jordana , Jun Jae-Kwan , van der Walt Anneke , Spelman Tim , Butzkueven Helmut , Kalincik Tomas
Published: August 2019

Background:

The risk factors for conversion from relapsing-remitting to secondary progressive multiple sclerosis remain highly contested.

Objective:

The aim of this study was to determine the demographic, clinical and paraclinical features that influence the risk of conversion to secondary progressive multiple sclerosis.

Methods:

Patients with adult-onset relapsing–remitting multiple sclerosis and at least four recorded disability scores were selected from MSBase, a global observational cohort. The risk of conversion to objectively defined secondary progressive multiple sclerosis was evaluated at multiple time points per patient using multivariable marginal Cox regression models. Sensitivity analyses were performed.

Results:

A total of 15,717 patients were included in the primary analysis. Older age (hazard ratio (HR) = 1.02, p < 0.001), longer disease duration (HR = 1.01, p = 0.038), a higher Expanded Disability Status Scale score (HR = 1.30, p < 0.001), more rapid disability trajectory (HR = 2.82, p < 0.001) and greater number of relapses in the previous year (HR = 1.07, p = 0.010) were independently associated with an increased risk of secondary progressive multiple sclerosis. Improving disability (HR = 0.62, p = 0.039) and disease-modifying therapy exposure (HR = 0.71, p = 0.007) were associated with a lower risk. Recent cerebral magnetic resonance imaging activity, evidence of spinal cord lesions and oligoclonal bands in the cerebrospinal fluid were not associated with the risk of conversion.

Conclusion:

Risk of secondary progressive multiple sclerosis increases with age, duration of illness and worsening disability and decreases with improving disability. Therapy may delay the onset of secondary progression.
Development and mechanical evaluation of a new interlocking earth masonry block
Authors: Ma Hongwang , Ma Qi , Gaire Prakash
Published: August 2019

An innovative interlocking compressed earth block, called interlocking compressed earth block developed at Shanghai Jiao Tong University, was developed for structural masonry. The locking mechanism of the interlocking compressed earth block developed at Shanghai Jiao Tong University completely depends on the grout in the vertical holes. Therefore, there is no gap between the interlocking key and the blocks, which increases the wall stability and reduces the block manufacturing costs. Experimental studies on the mechanical behavior of the unit (the block) and the masonry (prism constructed with a dry interface) were performed in accordance with the related standards. Soil samples from the northern Gansu Province of China were collected and studied. Small cylindrical samples were tested to determine the compressive and splitting tensile strength. Subsequently, the compressive strength of the prisms with three dry-stack blocks and the shear behavior of the masonry through the triplet test were investigated. The results show that the compressive and shear strengths meet the related standards. This work may provide a valuable structural system for low-cost, eco-friendly dwelling in developing countries.
The fundamental right of social assistance: A global, a regional (Europe and Africa) and a national perspective (Germany, the Netherlands and South Africa)
Authors: Vonk Gijsbert , Olivier Marius
Published: August 2019

This article gives a broad overview of the fundamental right of social assistance. The central question is to what extent the fundamental right to social assistance can count on universal recognition and what legal consequences are drawn from this right when it is invoked in national courts. In order to answer this question, we have looked at this right from a global, a regional (Europe and Africa) and a national perspective (Germany, the Netherlands and South Africa). On the basis of this study we discern a broad synergy in the normative context, not only transgressing through but also operating above the national constitutional jurisdictions. It is observed that from a legal perspective the added value of this right lies in the possibility for an individual to address structural shortcomings in the existing architecture of social assistance schemes. This possibility places courts in the position to critically review the system in the light of human rights requirements.
Understanding social work-force satisfaction
Authors: Pithouse Andrew , Rees Alyson , Brookfield Charlotte , Djupvik Alf
Published: August 2019

A Guardian Newspaper survey of social workers in the UK published in 2015 suggested that ‘The happiest social workers are in Wales’. In exploring why this may be so, the authors undertook an in-depth national online survey in 2017 of all social workers in Wales registered ( n = 5564) as employed at that point and from which some 997 responded. The survey sought a wide field of information about the occupational experience, and this article reports on selected aspects of knowledge, evidence-base, aims, competence and quality as perceived by respondents.

Findings

The workforce, durable, mostly white, aging and female, consider their services of good quality despite insufficiencies in staff capacities and material resources. While most acknowledged the influence on their practice of psycho-social, cognitive and systems paradigms, they also cited as major sources of knowledge, their clients, work experience, colleagues, case-procedures and in-house training. There seemed much less affirmation of evidence-based techniques and relatively little use of social work journals, books and professional magazines once qualified and in practice.

Applications

The emphasis by many upon the bureau or department as both ‘habitus’ and heuristic for much everyday practice raises important questions for how we understand and enhance practitioner knowledge and ensure equivalent social worker competence across the workforce.
An Experimental Pilot Study of Global Postural Reeducation Concerning the Cognitive Approach of Patients With Alzheimer’s Disease
Authors: Todri Jasemin , Lena Orges , Martínez Gil José Luis
Published: August 2019

Background:

Several recent studies have examined the positive effects of physical exercise and equilibrium on individuals with neurodegenerative diseases.

Objectives:

In this sense, this study based on an experimental design, tested whether global postural reeducation (GPR) can affect equilibrium and cognition, life quality, and psychological symptoms of patients with Alzheimer’s disease (AD).

Methods:

One hundred thirty-five participants with mild and moderate AD diagnosis were assigned to 2 groups: experimental group (EG, n = 90) and control group (CG, n = 45). The GPR therapy was implemented in the EG for 6 months, while both groups underwent neuropsychological assessments prior and after the 6-month period.

Results:

According to the repeated measures of analysis of variance, significant differences between groups were found at the 6-month follow-up period, in benefit of the EG such as Mini-Mental State Examination ( P = .000), Geriatric Depression Scale ( P = .000), Neuropsychiatric Inventory ( P = .000), quality of life in AD/patient ( P = .000), quality of life in AD/caregivers ( P = .000), Barthel index ( P = .000), and Tinetti Scale ( P = .000), while the CG showed a low performance in the neuropsychological tests.

Conclusions:

We suggest that GPR is a therapeutic option, which can improve the psychological, physical, and cognitive aspects of patients with AD.
Full Robotic Distal Pancreatectomy: Safety and Feasibility Analysis of a Multicenter Cohort of 236 Patients
Authors: Alfieri Sergio , Boggi Ugo , Butturini Giovanni , Pietrabissa Andrea , Morelli Luca , Di Sebastiano Pierluigi , Vistoli Fabio , Damoli Isacco , Peri Andrea , Lapergola Alfonso , Fiorillo Claudio , Panaccio Paolo , Pugliese Luigi , Ramera Marco , De Lio Nelide , Di Franco Gregorio , Rosa Fausto , Menghi Roberta , Doglietto Giovanni Battista , Quero Giuseppe
Published: August 2019

Introduction. Despite the widespread use of the robotic technology, only a few studies with small sample sizes report its application to pancreatic diseases treatment. Our aim is to present the results of a multicenter study on the safety and feasibility of robot-assisted distal pancreatectomy (RDP). Materials and Methods. All RDPs for benign, borderline, and malignant diseases performed in 5 referral centers from 2008 to 2016 were included. Perioperative outcomes were evaluated. Results. Two hundred thirty-six patients were included. Spleen preservation was performed in 114 cases (48.3%). Operative time was 277.8 ± 93.6 minutes. Progressive improvement in operative time was observed over the study period. Conversion rate was 6.3%. Morbidity occurred in 102 cases (43.2%), mainly due to grade A fistulas. Reoperation was required in 10 patients. Postoperatively, 2 patients died of sepsis due to a grade C fistula. Hospital readmission was necessary in 11 cases. A R0 resection was always achieved, with a mean number of 16.2 ± 15 harvested lymph nodes. Conclusion. To our knowledge, this is one of the largest RDP series. Safety and feasibility including the low conversion rate, the high spleen preservation rate, the adequate operative time, and the acceptable morbidity and mortality rates confirm the validity of this technique. Appropriate oncological outcomes have been also obtained.
Beyond a Court of Law: Holocaust Film and the Tensions in Primo Levi’s ‘Grey Zone’
Authors: Brown Adam
Published: August 2019

The influence of Primo Levi’s writing on the ‘grey zone’ has only sharpened over the last decade, not only in terms of its broader application to human rights contexts beyond the Holocaust, but also through a greater focus on the question of how to understand the behaviour of so-called ‘privileged’ prisoners in the Nazi camps and ghettos. History has shown a court of law to be an inadequate setting for negotiating the complexities of the ethical dilemmas forced on victims in extremis, and substantial problems of judgement and representation have plagued efforts to understand these liminal figures elsewhere. This article examines the tensions within Levi’s writings and maps these onto attempts to represent the ‘grey zone’ in Holocaust films. Engaging in particular with Margarethe von Trotta’s critically acclaimed feature film Hannah Arendt (2012) and Tor Ben-Mayor’s lesser known documentary Kapo (1999), I highlight how these distinct approaches to depicting ‘privileged’ Jews expose the fraught nature of portraying victim complicity on screen.
Returning from study abroad and transitioning as a scholar: Stories of foreign PhD holders from Kazakhstan
Authors: Kuzhabekova Aliya , Sparks Jason , Temerbayeva Aizhan
Published: August 2019

The article reports the results of an interview-based study exploring how international PhD holders re-integrate into the research environment in Kazakhstan. One of the main results consistent with prior studies is that returning scholars face poor access to international and domestic scholarly societies. Interaction with external peers is problematic due to insufficient funding available for conference participation. Lack of communication with the domestic scholarly community is related to its inaccessibility for junior researchers, as well as to its propensity to operate as an informal network of senior scholars controlling the protectionist distribution of funding and exerting influence on administrative and policy decision-making in academia. To counteract the informal networks, returning scholars get organized into alternative informal networks aimed at information exchange, mutual support and lobbying of interests. This transformative activity of junior scholars cannot be explained with the dominant structural theories in the existing research. An alternative Agency Theory interpretation is considered.
Robotic sacrocolpopexy for the management of pelvic organ prolapse: quality of life outcomes
Authors: Vollstedt Annah , Meeks William , Triaca Veronica
Published: August 2019

Background:

Our aim was to investigate longer-term surgical and quality of life (QOL) outcomes in a cohort of women undergoing robotic-assisted laparoscopic sacrocolpopexy (RALS) for pelvic organ prolapse (POP).

Methods:

We performed a retrospective cohort study at a single institution of female patients undergoing RALS with and without concomitant robotic-assisted laparoscopic hysterectomy, urethral sling, and rectocele repair. Scores from the Pelvic Floor Distress Inventory (PFDI) and Pelvic Floor Impact Questionnaire (PFIQ) surveys were used to evaluate QOL outcomes. Clinical improvement was defined by a decrease in a patient’s PFDI and PFIQ postoperative score by ⩾70%.

Results:

Clinical improvement was seen in 62.6% by the PFIQ and in 64% by the PFDI survey. Younger patient age (OR 0.92, p = 0.011) and worse preoperative American Urological Association (AUA) Quality of Life score (OR 1.42, p = 0.046) were associated with clinical improvement. Within the PFIQ, 35.6% of patients saw clinical improvement with their bowel symptoms, compared with bladder (54.1%, p < 0.001) and prolapse (45.6%, p = 0.053) symptoms. Within the PFDI, 45.5% of patients reached clinical improvement with their bowel symptoms, compared with bladder (56.7%, p = 0.035) and prolapse (62.6%, p < 0.001) symptoms. Of the patients who had a rectocele repair, 46.3% reached clinical improvement in their CRADI-8 score, and 51% saw clinical improvement in the bowel portion of the PDFI.

Conclusions:

Significantly fewer patients reached clinical improvement within the portions of the surveys that focus on bowel symptoms, compared with symptoms related to urination and POP. Of those that had a concomitant rectocele repair, approximately half reached clinical improvement with their bowel symptoms.
Effectiveness of drug-eluting bead transarterial chemoembolization versus conventional transarterial chemoembolization for small hepatocellular carcinoma in Child-Pugh class A patients
Authors: Lee In Joon , Lee Jeong-Hoon , Lee Yun Bin , Kim Yoon Jun , Yoon Jung-Hwan , Yin Yong Hu , Lee Myungsu , Hur Saebeom , Kim Hyo-Cheol , Jae Hwan Jun , Chung Jin Wook
Published: August 2019

Background:

This study aimed to compare the therapeutic effectiveness including progression-free survival (PFS), overall survival (OS), and safety of conventional transarterial chemoembolization (cTACE) and drug-eluting bead transarterial chemoembolization (DEB-TACE) in a superselective fashion for the patients with nodular hepatocellular carcinoma (HCC) ( n ⩽ 5) and Child–Pugh class A.

Methods:

A total of 198 consecutive patients with nodular HCCs ( n ⩽ 5) and Child–Pugh class A liver function who were initially treated with cTACE ( n = 125) or DEB-TACE ( n = 57) were included retrospectively. The primary endpoint was PFS. Secondary endpoints included time-to-target lesion progression (TTTLP), OS, and safety.

Results:

The median follow up was 62 months (range, 1–87 months). The PFS was significantly longer in the cTACE group than in the DEB-TACE group (median, 18 months versus 7 months; hazard ratio [HR] = 0.658, log-rank p = 0.031), whereas OS was comparable (log-rank p = 0.299). TTTLP was significantly longer in the cTACE group than in the DEB-TACE group (median, 34 months versus 11 months; log-rank p < 0.001). In the stratification analysis based on tumor size, the cTACE group showed significantly longer TTTLP than the DEB-TACE group in the 1.0–2.0 cm and 2.1–3.0 cm subgroups (HR = 0.188, log-rank p < 0.001 and HR = 0.410, p = 0.015, respectively) but not in the 3.1–5.0 cm and 5.1–10.0 cm subgroups (all p > 0.05). Postembolization syndrome occurred more frequently in the cTACE group than in the DEB-TACE group ( p = 0.006).

Conclusions:

DEB-TACE is followed by significantly shorter PFS than cTACE in patients with nodular HCCs ( n ⩽ 5) and Child–Pugh class A, although OS is comparable. Postembolization syndrome occurs more frequently in cTACE than in DEB-TACE.
Considerations for an Alternative Site of Islet Cell Transplantation
Authors: Addison Poppy , Fatakhova Karina , Rodriguez Rilo Horacio L.
Published: August 2019

Islet cell transplantation has been limited most by poor graft survival. Optimizing the site of transplantation could improve clinical outcomes by minimizing required donor cells, increasing graft integration, and simplifying the transplantation and monitoring process. In this article, we review the history and significant human and animal data for clinically relevant sites, including the liver, spleen, and kidney subcapsule, and identify promising new sites for further research. While the liver was the first studied site and has been used the most in clinical practice, the majority of transplanted islets become necrotic. We review the potential causes for graft death, including the instant blood-mediated inflammatory reaction, exposure to immunosuppressive agents, and low oxygen tension. Significant research exists on alternative sites for islet cell transplantation, suggesting a promising future for patients undergoing pancreatectomy.
Secondary membranous nephropathy in a patient with myasthenia gravis without thymic disease, and partial remission induced by adrenocorticotropic hormone therapy
Authors: Hanna Ramy M , Arman Farid , Selamet Umut , Wallace William D , Barsoum Marina , Rastogi Anjay , Nobakht Niloofar , Shieh Perry
Published: August 2019

Membranous glomerulonephritis is the most common glomerular disease in adults. Its primary form has been characterized with formation of phospholipase A2 receptor antibodies. Malignancy, infections, and autoimmune disorders are the most common causes of secondary membranous glomerulonephritis. We present a case of a 55-year-old African American female who presented with nephrotic range proteinuria and diagnosed with secondary membranous glomerulonephritis based on distinct pathological features on kidney biopsy and absence of serum phospholipase A2 receptor antibodies. She initially underwent extensive workup for malignancies, infections, and common autoimmune disorders which were all negative. Her proteinuria remained resistant to steroid treatment and she was treated with subcutaneous adrenocorticotropic hormone injections. Meanwhile, she was also diagnosed with the anti-muscle specific kinase antibody variant of myasthenia gravis. In literature, there are few case reports of myasthenia gravis as a cause of secondary membranous glomerulonephritis. In our case, the lack of other inciting factors also suggested this association.
Female Care-Leavers’ Experiences of Aftercare in Ethiopia
Authors: Takele Anduamlak Molla , Kotecho Messay Gebremariam
Published: August 2019

The phenomenon of care-leavers’ experience of aftercare in Ethiopia has not yet been recognized. A qualitative research design was used to uncover female care-leavers’ experience of aftercare in 2017. Participants in the study were recruited via a snowball sampling technique, and data were collected through in-depth interviews and a review of documents. The generated data were analyzed using thematic analysis. The study found that participants are faced with different adversities, such as job searching, homelessness, the inability to pay housing rent, being betrayed, and not reconnecting with living biological family members. Female care-leavers have expected to receive support from the institution to cope with aftercare challenges. However, their aftercare experience is characterized by negative outcomes, which implies that they need continued aftercare support until they can find their feet. Female care-leavers view aftercare support as strengthening them in their attempt to navigate the adult world on their own. Such support offers them the opportunity to find attractive jobs and so save them from having to emigrate. This article sheds light on the issue of aftercare support for female emerging adults who are transitioning from care to adulthood in Ethiopia.
Reducing Surgical Site Infection in Pediatric Scoliosis Surgery: A Multidisciplinary Improvement Program and Prospective 4-Year Audit
Authors: Tipper Geoffrey A. , Chiwera Lillian , Lucas Jonathan
Published: August 2019

Study Design:

Single-center prospective cohort.

Objectives:

To evaluate a multidisciplinary led, structured protocol for reducing surgical site infections (SSIs) in pediatric scoliosis surgery.

Methods:

Following a spike to 8.6% in local annual infection rate, a multidisciplinary team was convened to identify interventions. The team consisted of spinal surgeons, infectious diseases consultants, physiotherapists, specialist nurses, and theatre managers. A protocol was initiated, including preoperative skin decontamination; standardized operative site prepreparation; betadine-soaked swabs sutured to wound edges; blood loss minimization; 3 L0.9% saline pulsed-lavage; defined protocol of glove changes; antibiotic regime of preoperative gentamicin, intraoperative subfascial vancomycin powder, 48-hour cefuroxime; and intraoperative normothermia. A 4-year audit was initiated of all patients aged ≤18 years undergoing corrective spinal deformity surgery. Institutional board review was not required.

Results:

Between January 1, 2014 and January 1, 2018, 414 operations were performed on 355 patients: male:female = 1:2.2, mean age 13.7 years (range 2.5-17.9), 233 idiopathic (mean operated vertebral levels 12), 122 neuromuscular (mean operated vertebral levels 14), 66 growing rod procedures, 41 multistage procedures. The mean number of operated vertebral levels both overall and in infected cases was 13 (range 2-17). Nine SSIs occurred in 8 patients at 3 months (4 neuromuscular), resulting in an overall SSI per operation of 2.2%.

Conclusion:

A multidisciplinary approach with standardized measures significantly reduced SSIs in the unit’s pediatric scoliosis surgery.
Attracting Students to the Classroom With Innovative Pedagogies
Authors: Dutta Nirankush , Bhat Anil , Bhattacharya Kumar Sankar , Mahesh Jayashree
Published: August 2019

One of the significant challenges of teaching Master’s in Business Administration (MBA) courses lies in the dynamic nature of the programme itself where the only constant is the change. Hence, the main pedagogical aim in such a programme is teaching students how to continuously learn, unlearn and relearn in a lifelong fashion. There are multiple factors that hinder the learning outcomes of many offered courses in an MBA programme. At Birla Institute of Technology and Sciences (BITS) Pilani, the challenge is enhanced somewhat as the student population pursuing an MBA degree is mostly from an engineering background. Moreover, the institutional regulations do not disqualify students from appearing in any evaluation based on their attendance in the class. Thus, teachers have to incorporate an innovative approach to their teaching style for attracting students to the classrooms.
Artery of Percheron Infarction: A Short Review
Authors: Kichloo Asim , Jamal Shakeel M. , Zain El-Amir , Wani Farah , Vipparala Navya
Published: August 2019

One uncommon type of ischemic stroke is occlusion of the artery of Percheron (AOP) leading to infarction of the paramedian thalami and mesencephalon. There are several variants of thalamic blood supply, and identifying the potential presence and infarction of an AOP is important in diagnosis and treatment of ischemic strokes affecting the thalami and mesencephalon, especially because of the unusual and variable presentation of these forms of ischemic strokes. This short review includes and discusses the case of a 58-year-old woman with an AOP infarct and indicates the importance of recognizing an AOP infarct early despite its clinical variations in order to treat the stroke in a timely fashion. This short review also includes a discussion of imaging modalities in such cases and clinical differential diagnoses to consider with management strategies.
Fixing extraction through conservation: On crises, fixes and the production of shared value and threat
Authors: Enns Charis , Bersaglio Brock , Sneyd Adam
Published: August 2019

We are currently witnessing a global trend of intensifying and deepening relationships between extractive companies and biodiversity conservation organisations that warrants closer scrutiny. Although existing literature has established that these two sectors often share the same space and rely on similar logics, it is increasingly common to find biodiversity conservation being carried out through partnerships between extractive and conservation actors. In this article, we explore what this cooperation achieves for both sectors. Using illustrative examples of extractive-conservation collaboration across sub-Saharan Africa, we argue that new entanglements between extractive and conservation actors are motivated by multiple purposes. First, partnering with conservation actors serves as a spatial and socio-ecological fix for extractive companies in response to multiple crises that threaten the sector's productivity. Second, new forms of collaboration between extractive and conservation actors create pathways for both sectors to produce new value from nature. For the extractive sector, creating new value from nature works as a further fix to capitalist crises whereas, for the conservation sector, producing value through nature amounts to new opportunities for capital accumulation. Importantly, working together to produce shared value from nature within and beyond extractive concessions secures both sectors' control over the means of production. Theoretically, our analysis links literature on value in capitalist nature with that on spatial and socio-ecological fixes.
Yoga for People With Chronic Pain in a Community-Based Setting: A Feasibility and Pilot RCT
Authors: Schmid Arlene A. , Fruhauf Christine A. , Sharp Julia L. , Van Puymbroeck Marieke , Bair Matthew J. , Portz Jennifer Dickman
Published: August 2019

The purpose of this feasibility pilot study was to assess benefits of 8 weeks of yoga in people with chronic pain. Participants completed baseline assessments and were randomized to yoga or usual care. Yoga was offered twice a week for 8 weeks. We assessed feasibility and the Brief Pain Inventory (BPI) was the primary outcome, assessing pain-severity and pain interference on daily activities. Eighty-three people were recruited; 67 people completed the study and were included in the analyses. Average age of participants was 50.78 ± 10.43 years and most participants had pain >10 years. The intervention appeared feasible and there were significant improvements ( P < .05) in multiple measures for the yoga group, including a decrease in BPI interference scores from 7.15 ± 1.70 to 6.14 ± 2.21 ( P = .007). There was a significant difference in body responsiveness and pain management scores between groups at 8 weeks. It appears that yoga was feasible and positively influenced multiple outcome measures for people with chronic pain.
The Wound Healing Property of N-Methyl-(2S,4R)-trans-4-Hydroxy-L-Proline from Sideroxylon obtusifolium is Related to its Anti-Inflammatory and Antioxidant Actions
Authors: de Aquino Pedro Everson Alexandre , de Souza Tamiris de Fátima Goebel , Santos Flávia Almeida , Viana Ana Flávia Seraine Custódio , Louchard Bianca Oliveira , Leal Luzia Kalyne Almeida Moreira , Rocha Talita Magalhães , Evangelista Janaina Serra Azul Monteiro , de Aquino Nayara Coriolano , de Alencar Nylane Maria Nunes , Silveira Edilberto da Rocha , Viana Glauce Socorro de Barros
Published: August 2019

Wound healing involves the interaction of blood cells, proteins, proteases, growth factors, and extracellular matrix components. Inflammation is one of the first events occurring during this process. Previously, we showed that the N-Methyl-(2S,4R)-trans-4-Hydroxy-L-Proline (NMP) from Sideroxylon obtusifolium leaves (a Brazilian medicinal species) presents an anti-inflammatory action. Considering inflammation as an important event in the wound healing process, the objectives were to investigate the topical effects of the NMP gel on a mice wound-induced model. Male Swiss mice were divided into 4 groups: Sham (surgical procedure only), Control (gel-base treated), and 3% or 10% NMP gel-treated groups. Measurements of wound areas and microscopic analyses (HE [hematoxylin-eosin] and PSR [picrosirius red] stainings) were carried out, at the 7th and 12th, days after the wound induction. Furthermore, immunohistochemical assays for iNOS (inducible nitric oxide synthase) and COX-2 (cyclooxygenase-2) and biochemical measurements for TBARS (thiobarbituric acid reactive substances), GSH (glutathione), and myeloperoxidase (MPO) were also performed, at the second day after the wound induction. The work showed that NMP decreases the wound areas, after topical application, relatively to the Sham and Control groups. In addition, microscopic alterations were reduced and collagen deposition was increased, at the 7th and 12th days, in the 10% NMP group. While iNOS and COX-2 immunostainings and GSH contents increased, in relation to the Sham and Control groups, TBARS and MPO decreased. Altogether, the results showed NMP to improve the wound healing process, by upregulating iNOS and COX-2 activities, reducing lipid peroxidation and MPO activity, and increasing GSH contents. In addition, NMP certainly contributes to the increased collagen deposition. These data may stimulate translational studies dealing with the possible use of NMP from Sideroxylon obtusifolium or from other sources for the management of wound healing.
Combined deficiency of RAB32 and RAB38 in the mouse mimics Hermansky-Pudlak syndrome and critically impairs thrombosis
Authors: Aguilar Alicia , Weber Josiane , Boscher Julie , Freund Monique , Ziessel Catherine , Eckly Anita , Magnenat Stéphanie , Bourdon Catherine , Hechler Béatrice , Mangin Pierre H. , Gachet Christian , Lanza François , Léon Catherine
Published: August 2019

The biogenesis of lysosome related organelles is defective in Hermansky-Pudlak syndrome (HPS), a disorder characterized by oculocutaneous albinism and platelet dense granule (DG) defects. The first animal model of HPS was the fawn-hooded rat, harboring a spontaneous mutation inactivating the small guanosine triphosphatase Rab38. This leads to coat color dilution associated with the absence of DGs and lung morphological defects. Another RAB38 mutant, the cht mouse, has normal DGs, which has raised controversy about the role of RAB38 in DG biogenesis. We show here that murine and human, but not rat, platelets also express the closely related RAB32. To elucidate the parts played by RAB32 and RAB38 in the biogenesis of DGs in vivo and their effects on platelet functions, we generated mice inactivated for Rab32, Rab38, and both genes. Single Rab38 inactivation mimicked cht mice, whereas single Rab32 inactivation had no effect in DGs, coat color, or lung morphology. By contrast, Rab32/38 double inactivation mimicked severe HPS, with strong coat and eye pigment dilution, some enlarged lung multilamellar bodies associated with a decrease in the number of DGs. These organelles were morphologically abnormal, decreased in number, and devoid of 5-hydroxytryptamine content. In line with the storage pool defect, platelet activation was affected, resulting in severely impaired thrombus growth and prolongation of the bleeding time. Overall, our study demonstrates the absence of impact of RAB38 or RAB32 single deficiency in platelet biogenesis and function resulting from full redundancy, and characterized a new mouse model mimicking HPS devoid of DG content.
Hypothalamic-Pituitary Disorders in Childhood Cancer Survivors: Prevalence, Risk Factors and Long-Term Health Outcomes
Authors: van Iersel Laura , Li Zhenghong , Srivastava Deo Kumar , Brinkman Tara M , Bjornard Kari L , Wilson Carmen L , Green Daniel M , Merchant Thomas E , Pui Ching-Hon , Howell Rebecca M , Smith Susan A , Armstrong Gregory T , Hudson Melissa M , Robison Leslie L , Ness Kirsten K , Gajjar Amar , Krull Kevin R , Sklar Charles A , van Santen Hanneke M , Chemaitilly Wassim
Published: August 2019

Context

Data on hypothalamic-pituitary (HP) disorders in systematically evaluated childhood cancer survivors are limited.

Objective

To describe prevalence, risk factors, and associated adverse health outcomes of deficiencies in GH deficiency (GHD), TSH deficiency (TSHD), LH/FSH deficiency (LH/FSHD), and ACTH deficiency (ACTHD), and central precocious puberty (CPP).

Design

Retrospective with cross-sectional health outcomes analysis.

Setting

Established cohort; tertiary care center.

Patients

Participants (N = 3141; median age, 31.7 years) were followed for a median 24.1 years.

Main Outcome Measure

Multivariable logistic regression was used to calculate ORs and 95% CIs for associations among HP disorders, tumor- and treatment-related risk factors, and health outcomes.

Results

The estimated prevalence was 40.2% for GHD, 11.1% for TSHD, 10.6% for LH/FSHD, 3.2% for ACTHD, and 0.9% for CPP among participants treated with HP radiotherapy (n = 1089), and 6.2% for GHD, and <1% for other HP disorders without HP radiotherapy. Clinical factors independently associated with HP disorders included HP radiotherapy (at any dose for GHD, TSHD, LH/FSHD, >30 Gy for ACTHD), alkylating agents (GHD, LH/FSHD), intrathecal chemotherapy (GHD), hydrocephalus with shunt placement (GHD, LH/FSHD), seizures (TSHD, ACTHD), and stroke (GHD, TSHD, LH/FSHD, ACTHD). Adverse health outcomes independently associated with HP disorders included short stature (GHD, TSHD), severe bone mineral density deficit (GHD, LH/FSHD), obesity (LH/FSHD), frailty (GHD), impaired physical health-related quality of life (TSHD), sexual dysfunction (LH/FSHD), impaired memory, and processing speed (GHD, TSHD).

Conclusion

HP radiotherapy, central nervous system injury, and, to a lesser extent, chemotherapy are associated with HP disorders, which are associated with adverse health outcomes.