bluuebunny/crossref_metadata_2025 huggingface dataset:
Reference intervals for radiographic, echocardiographic and N-terminal pro B-type natriuretic peptide values in healthy kittens
Authors: Gunther-Harrington Catherine T , Sharpe Ashley N , Vernau Karen M , Ueda Yu , Montgomery Elizabeth A , Surmick Jennifer D , Fernandez Nicole , Ontiveros Eric , Walker Ashley L , Stern Joshua A
Published: August 2020

Objectives

Assessment of heart size in kittens is important, and there is a need for reference intervals (RIs) to prevent misinterpretation of cardiomegaly in this patient population. The purpose of this study was to generate RIs for echocardiographic and radiographic quantification of cardiac size in healthy kittens.

Methods

In total, 88 kittens aged 6–16 weeks were enrolled in this study. Physical examination, and radiographic and echocardiographic evaluations were performed without sedation. Thoracic radiographs and echocardiographic images were measured to establish RIs for vertebral heart score (VHS), cardiac thoracic ratio (CTR) and multiple echocardiographic variables. N-terminal pro B-type natriuretic peptide (NT-proBNP) was measured. Statistical correlations between echocardiographic parameters and age, body weight and sex were all evaluated and RIs were generated.

Results

Low-grade heart murmurs were appreciated in 26/88 kittens (29.5%). Kittens had a median VHS of 9.5 vertebrae (95% RI 8.0–10.9) and a median CTR of 67.2% (95% RI 54.4–79.8%). Measured NT-proBNP levels were comparable to healthy adult cats with a median of 31 pmol/l (upper reference limit 75 pmol/l). Multiple moderate-to-strong correlations between body weight and age with various echocardiographic parameters were observed and allometric scaling was performed for body weight. RIs for echocardiographic parameters were generated based on patient weight using allometric scaling formulas. Tricuspid valve regurgitation was a common finding and was present in 37.5% (n = 33) of the kittens.

Conclusions and relevance

This study establishes RIs for thoracic radiograph assessment, echocardiography and cardiac biomarkers in kittens, which fills a critical gap in the veterinary literature. The VHS reported in this study is higher than previously reported for adult cats.
Social Functioning in Individuals With Post-Traumatic Stress Disorder: A Systematic Review
Authors: Scoglio Arielle A. J. , Reilly Erin D. , Girouard Caitlin , Quigley Karen S. , Carnes Sarah , Kelly Megan M.
Published: August 2020

Post-traumatic stress disorder (PTSD) can lead to multiple deleterious outcomes and has negative, sometimes debilitating, impacts on general functioning of those affected. This systematic review of 26 articles evaluates the existing literature on social functioning outcomes used in PTSD research, the association between PTSD and social functioning, and the impact of interventions for PTSD on social functioning. A review of 26 articles using the preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines for systematic reviews showed that PTSD was associated with significant impairment in global social functioning. This review also reveals the need for both standardized definitions and better assessment methods to operationalize social functioning and improve our ability to compare findings across studies. The literature also suggests that some evidence-based treatments for PTSD improve social functioning despite not explicitly targeting social functioning in the treatment. The findings of this review suggest that there are ample opportunities for improving both research and interventions to improve global social functioning in PTSD.
Capacity Building Together: Shifting Roles for Research and Implementation in Health Resilience Among American Indians in Arizona
Authors: Hardy Lisa J. , shaw kevin l. , Hughes Amy , Hulen Elizabeth , Sanderson Priscilla , Corrales Candi , Pinn Travis , Begay R. Cruz
Published: August 2020

Community engagement has become a leading framework for supporting health equity. The process of engagement includes groups working together to continually identify and erode existing inequalities to promote a justice-oriented approach to health and wellness for all. Missing from the literature is a fine-grained study of processes that occur between and among project partners building the foundation for ongoing trust and reciprocity. Our project, Health Resilience among American Indians in Arizona, brought new and seasoned researchers together to collect and analyze data on healthcare provider knowledge and American Indian resilience. Four years after the conclusion of the project, central members of the team developed a postproject self-assessment to investigate lasting impacts of project participation using what we call an “Iterative Poly-knowledge Evaluation Cycle approach.” Results highlight the value of flexibility of roles and organic change within projects, the importance of a focus on strengths rather than deficits, and the identification of lasting change on project team members at all levels to build and bolster multisectoral scaffolding for partnerships for health. We present this case study to contribute to an understanding of impacts of community-engaged, Indigenous research projects on people who work together toward challenging existing systems of inequality for better community health.
Assessing Diabetic Foot Infections With the ThermoScale: A Comparative Thermometry Device Designed as a Patient Self-Screening Tool
Authors: Arts Laure , De Neve Johan , Baharlou Samira , Denecker Nathalie , Kerselaers Laura , Aerden Dimitri
Published: August 2020

Diabetic foot infection (DFI) is an important risk factor for amputation, and late diagnosis or referral is often incriminated for poor outcome. To enable an earlier diagnosis of DFI, comparative foot thermometry has been suggested as a self-screening method for patients in a home setting. We validated the efficacy of the ThermoScale, a weighing scale outfitted with temperature sensors that allows accurate temperature measurement in both feet. Temperature differentials in DFI patients (n = 52) were compared with a control group of similar diabetic patients (n = 45) without any foot wounds. Based on these findings, we drafted a receiver operating characteristic curve to determine an area-under-the-curve of 0.8455. This value suggests that the ThermoScale, as a diagnostic test, is reasonably accurate. A cutoff value of 2.15 °C temperature difference corresponded with a sensitivity of 88.9% and a specificity of 61.5%. As wearables, portable health electronics, and telemedicine become increasingly popular, we think that comparative temperature measurement technology is valuable in improving early diagnosis of DFIs.
A scale for measuring teacher leadership in early childhood education in China: Development and validation
Authors: Wang Mo , Xia Jing
Published: August 2020

This article describes the development of a teacher leadership scale (TLS) that can be utilized in early childhood education in China. A mixed methods research design was developed to meet the research aim, and both qualitative and quantitative data on the perceptions of teacher leadership from both middle leaders (i.e. vice-principal, key stage coordinator, subject leader) and classroom teachers were collected. In the qualitative study, semi-structured interviews with seven middle leaders and seven classroom teachers were conducted. The qualitative findings were then used for item pool generation in a quantitative study to create the TLS in four stages of development. The TLS questionnaire was distributed to 175 respondents and then to a further 419 respondents for exploratory factor analysis. The scale was further validated by confirmatory factor analysis with another 597 respondents. Its concurrent validity was also examined: teacher leadership was found to be positively associated with job satisfaction and the principal’s authority openness. The article demonstrates that a four-factor model of teacher leadership as follows is psychometrically sound: (a) leading teaching and professional development; (b) characteristics of teacher leaders; (c) participating in school-wide decision-making; and (d) diversity and continuous improvement.
Serum Gamma Glutamyl transferase is a predictor of recurrence after R0 hepatectomy for patients with colorectal cancer liver metastases
Authors: Xiao Binyi , Peng Jianhong , Tang Jinghua , Deng Yuxiang , Zhao Yujie , Wu Xiaojun , Ding Peirong , Lin Junzhong , Pan Zhizhong
Published: August 2020

Objectives:

Gamma glutamyl-transpeptidase (GGT) has been shown as a prognostic marker in many cancers. The aim of this study was to explore whether serum GGT could predict tumor recurrence in patients with liver-confined colorectal cancer liver metastases (CRCLM) undergoing R0 resection.

Methods:

We reviewed patients who had underwent liver surgery for CRCLM. Patients with liver-only metastases that underwent R0 resection were included. Pre-operative serum GGT were classified into either high or low using a cut-off value of 33 U/L for female and 51 U/L for male. Relapse-free survival (RFS) was compared in relation to GGT and other clinicopathological factors.

Results:

Of the 350 patients included, 108 (30.9%) had a high serum GGT. Patients with metachronous liver metastases, number of metastases ⩾2, size of the largest metastasis ⩾3 cm, or a history of neoadjuvant chemotherapy had a higher GGT level ( p = 0.001, 0.027, 0.001, and 0.002, respectively). In survival analyses, patients with a high GGT had a shorter RFS than those with a low GGT, with a median RFS of 11.8 versus 30.3 months ( p < 0.001). RFS was also associated with the number of metastases, size of the largest metastasis and the delivery of neoadjuvant chemotherapy. In multivariate analysis, GGT remained an independent prognostic factor of RFS.

Conclusions:

Our study demonstrates that the serum GGT level before liver surgery is an adverse prognostic factor of RFS for patients with liver-confined CRCLM.
Translating Kyrios in the Gospel of John
Authors: Riley Paul C. J.
Published: August 2020

This article is a practical guide for translating kyrios in the Gospel of John. It considers the context of those translating into minority languages and vernaculars, especially when their language communities have access to a pre-existing translation in a language of wider communication. It takes into account the importance of textual criticism, semantics, acceptability, narrative, and paratext when trying to address challenges in Bible translation.
Towards a New Proposal for Translating the Conjunction כי‎ in Deuteronomy 4.29
Authors: Goeman Peter
Published: August 2020

English translations almost universally understand the phrase כי תדרשׁנו בכל־לבבך ובכל־נפשׁך‎ in Deut 4.29 as a conditional statement: “if you seek him with all your heart and all your soul.” This article challenges the typical translation and argues that instead of expressing a condition, Deut 4.29 should be understood as the reason Israel will repent and turn to Yahweh. This argument is supported by the near context of Deut 4, as well as the remote context of Deut 29–30. In addition, the typical usage of כי‎ clauses in Hebrew grammar provides positive evidence for a causal understanding of Deut 4.29. In addition to the contextual and grammatical evidence, the LXX of Deut 4.29 and Jer 29.11 (36.13 LXX) demonstrates that the first translators of the text likely did not view this text as conditional. Thus, Deut 4.29 is best read as the reason for Israel’s latter-day return to Yahweh—Israel will find Yahweh because they will seek him with their whole heart.
Optimization of pulse sequences in ultrafast magnetic resonance imaging for the diagnosis of acute abdominal pain caused by gastrointestinal disease
Authors: Inoue Akitoshi , Furukawa Akira , Nitta Norihisa , Takaki Kai , Ohta Shinichi , Murata Kiyoshi
Published: August 2020

Background

Magnetic resonance imaging (MRI) is widely used to diagnose acute abdominal pain; however, it remains unclear which pulse sequence has priority in acute abdominal pain.

Purpose

To investigate the diagnostic accuracy of MRI and to assess the conspicuity of each pulse sequence for the diagnosis of acute abdominal pain due to gastrointestinal diseases

Material and Methods

We retrospectively enrolled 60 patients with acute abdominal pain who underwent MRI for axial and coronal T2-weighted (T2W) imaging, fat-suppressed (FS)-T2W imaging, and true-fast imaging with steady-state precession (True-FISP) and axial T1-weighted (T1W) imaging and investigated the diagnosis with endoscopy, surgery, histopathology, computed tomography, and clinical follow-up as standard references. Two radiologists determined the diagnosis with MRI and rated scores of the respective sequences in assessing intraluminal, intramural, and extramural abnormality using a 5-point scale after one month. Diagnostic accuracy was calculated and scores were compared by Wilcoxon-signed rank test with Bonferroni correction.

Results

Diagnostic accuracy was 90.0% and 93.3% for readers 1 and 2, respectively. Regarding intraluminal abnormality, T2W, FS-T2W, and True-FISP imaging were superior to T1W imaging in both readers. FS-T2W imaging was superior to True-FISP in reader 2 ( P < 0.0083). For intramural findings, there was no significant difference in reader 1, whereas T2W, FS-T2W, and True-FISP imaging were superior to T1W imaging in reader 2 ( P < 0.0083). For extramural findings, FS-T2W imaging was superior to T2W, T1W, and True-FISP imaging in both readers ( P < 0.0083).

Conclusion

T2W and FS-T2W imaging are pivotal pulse sequences and should be obtained before T1W and True-FISP imaging.
“Not a Woman-Question, But a Power-Question”: A Qualitative Study of Third Parties on Psychological Violence in Academic Medicine
Authors: Siller Dr. Heidi , Beck-Rabanser Claudia , Hochleitner Prof. Dr. Margarethe , Exenberger Dr. Silvia
Published: August 2020

Background

Psychological violence is a persistent issue in academic medicine and affects the health and safety of health care workers. This violence is also debated as part of medical culture. Third parties, persons learning about violations after it happened, may provide an understanding of the interplay between gender and psychological violence. Perspectives on research on psychological violence in academic medicine are currently lacking.

Methods

In this qualitative exploratory study, interviews were conducted with women from a working group on equal treatment at one medical university in Austria. This group monitors discrimination and harassment and consists of medical doctors, natural scientists, administrative staff, and students. To recruit participants, an email invitation was sent to members of the working group. Of 20 eligible persons, 12 women participated. After written consent from participants, individual interviews were conducted face-to-face, audio-recorded, and transcribed verbatim. Data were analyzed with grounded theory.

Findings

Participants described a firm organizational culture with persistent, historically grown gendered structures. Potential threat of psychological violence affected mostly “weaker,” less powerful persons, and often women. Descriptions of violence indicated harm to those affected, but intent to harm was doubted. Interventions strengthened the individual, but some participants demanded collective responsibility.

Conclusion/application to practice

Few descriptions could be classified as psychological violence. Findings indicated a need to change organizational cultures where lower positions pose a potential threat to experiencing harm. Occupational health practice should include training in sensitization to psychological violence, protection of those targeted, deconstructing power accumulation, and promoting diversity in career patterns and working styles.
The Role of Orientation Programs to Prepare Students for Online Learning: A Case Study From an Executive MPH Program
Authors: Alperin Melissa , Gaydos Laura , Phillips Julia
Published: August 2020

The coronavirus pandemic has caused many colleges and universities throughout the United States to pivot from in-person teaching to distance-based instruction, and while this form of education offers many advantages, one challenge facing institutions of higher education is how to best prepare their students for success in the online environment. This article describes the approach used by a hybrid executive Master of Public Health (MPH) program to orient its students, who are all working professionals, to the online environment. In addition to a description of the online orientation course, quantitative and qualitative evaluation findings are shared. The article includes recommendations for establishing an online orientation program. Although the orientation described was developed for working professionals earning an MPH degree, the approach can be applied or adapted to other online programs as they face the need to prepare students for online delivery, whether during a time of emergency like the coronavirus pandemic or during a period of natural programmatic growth.
Artificial intelligence in thoracic surgery: past, present, perspective and limits
Authors: Etienne Harry , Hamdi Sarah , Le Roux Marielle , Camuset Juliette , Khalife-Hocquemiller Theresa , Giol Mihaela , Debrosse Denis , Assouad Jalal
Published: August 2020

Artificial intelligence (AI) technology is becoming prevalent in many areas of everyday life. The healthcare industry is concerned by it even though its widespread use is still limited. Thoracic surgeons should be aware of the new opportunities that could affect their daily practice, by direct use of AI technology or indirect useviarelated medical fields (radiology, pathology and respiratory medicine). The objective of this article is to review applications of AI related to thoracic surgery and discuss the limits of its application in the European Union. Key aspects of AI will be developed through clinical pathways, beginning with diagnostics for lung cancer, a prognostic-aided programme for decision making, then robotic surgery, and finishing with the limitations of AI, the legal and ethical issues relevant to medicine. It is important for physicians and surgeons to have a basic knowledge of AI to understand how it impacts healthcare, and to consider ways in which they may interact with this technology. Indeed, synergy across related medical specialties and synergistic relationships between machines and surgeons will likely accelerate the capabilities of AI in augmenting surgical care.
Lung complications of Sjogren syndrome
Authors: Luppi Fabrizio , Sebastiani Marco , Sverzellati Nicola , Cavazza Alberto , Salvarani Carlo , Manfredi Andreina
Published: August 2020

Primary Sjogren syndrome (pSS) is a systemic autoimmune disease characterised by lymphocytic infiltration of exocrine glands and by a number of systemic manifestations, including those regarding the lung. Pulmonary involvement in pSS includes interstitial lung disease (ILD) and airway disease, together with lymphoproliferative disorders.

Patients with pSS-ILD report impaired health-related quality of life and a higher risk of death, suggesting the importance of early diagnosis and treatment of this type of pulmonary involvement. In contrast, airway disease usually has little effect on respiratory function and is rarely the cause of death in these patients.

More rare disorders can be also identified, such as pleural effusion, cysts or bullae.

Up to date, available data do not allow us to establish an evidence-based treatment strategy in pSS-ILD. No data are available regarding which patients should be treated, the timing to start therapy and better therapeutic options. The lack of knowledge about the natural history and prognosis of pSS-ILD is the main limitation to the development of clinical trials or shared recommendations on this topic. However, a recent trial showed the efficacy of the antifibrotic drug nintedanib in slowing progression of various ILDs, including those in pSS patients.
Fibrotic interstitial lung diseases and air pollution: a systematic literature review
Authors: Harari Sergio , Raghu Ganesh , Caminati Antonella , Cruciani Mario , Franchini Massimo , Mannucci Piermannuccio
Published: August 2020

Background

Air pollution is hypothesised to be a risk factor for interstitial lung diseases (ILD). This study systematically reviewed the literature regarding the impact of air pollution on idiopathic pulmonary fibrosis (IPF) and fibrotic interstitial lung diseases (ILD).

Methods

A computer-assisted literature search of electronic databases was performed to identify studies focused on the association between ILDs and air pollution. Other inclusion criteria required that the article had to be: 1) original; 2) a prospective or retrospective study; and 3) fully published in English. Both randomised clinical trials and observational studies were considered.

Results

Only seven studies met the inclusion criteria. All studies investigated the relationship between pollution and IPF, except one that dealt with the relationship between pollution and hypersensitivity pneumonitis. Outcome measures included exacerbation of IPF, mortality, disease severity, prevalence of hypersensitivity pneumonitis, progression and incidence of IPF. On the whole, air pollution levels were negatively associated with outcomes in patients with IPF and fibrotic ILD outcome. The heterogeneity in the measurement and reporting of the end-points limited the performance of a quantitative synthesis of data.

Conclusions

This systematic review provides supporting evidence linking exposure to air pollution to poor outcomes in patients with IPF and fibrotic ILD.
Financial reimbursement - irrelevant for GPs’ readiness to implement brief intervention to reduce alcohol consumption? A cross-sectional vignette study
Authors: Fankhaenel Thomas , Schulz Katrin , Petersen Lars-Eric , Klement Andreas , Frese Thomas
Published: August 2020

Background

General Practitioners’ (GPs) readiness to implement screening and brief intervention (SBI) to treat patients with excessive alcohol consumption is low. Several studies identified crucial barriers such as insufficient financial reimbursement. In contrast to the barriers-account, we assume that low implementation readiness of GPs may be less attributed to external barriers but rather more so to inherent characteristics of SBI. To test our assumption, we conducted a vignette study assessing the GPs’ readiness to implement SBI in comparison to a pharmacological intervention also designed for the treatment of excessive drinkers in relation to standard or above-standard financial reimbursement. According to our hypothesis GPs should be less ready to implement SBI regardless of financial reimbursement.

Methods

A convenience sample of GPs was recruited to answer the questionnaire. To assess the GPs’ implementation readiness a 4-item 6-point Likert scale was developed and pretested.

Results

One hundred forty GPs completed the questionnaire. GPs were more ready to implement the pharmacological intervention than SBI, F(1,132) = 27.58, p < .001 (main effect).

We found no effect for financial reimbursement, F(1,132) = 3.60, ns, and no interaction effect, F(1,132) = 2.20, ns.

Conclusions

Further research should investigate more thoroughly the crucial characteristics of SBI to initiate a modification process finally leading to more effective primary care dependency prevention.
The global prevalence ptxP3 lineage of Bordetella pertussis was rare in young children with the co-purified aPV vaccination: a 5 years retrospective study
Authors: Wang Zengguo , Luan Yang , Du Quanli , Shu Chang , Peng Xiaokang , Wei Huijing , Hou Tiejun , Liu Ying , Liu Xiaoguai , Li Yarong
Published: August 2020

Background

The global prevalent ptxP3 strains varies from about 10% to about 50% of circulating B. pertussis population in different areas of China.

Methods

To investigate the difference of vaccination status between different genotypes in the circulating B. pertussis after 10 years of acellular pertussis vaccine (aPV) used in China. The nasopharyngeal swabs and isolates of B. pertussis from these patients were used to perform genotyping of antigen genes. We use antibiotic susceptibility test against erythromycin and sequencing methods for site 2047 of 23S rRNA to determine the resistance status.

Results

The ptxP1 allele with erythromycin resistant (ER) B. pertussis infection (total of 449 subjects) consisted of 84.70 to 96.70% from 2012 to 2016 in this study. Vaccinated with co-purified aPV was found in 133(133/403,33.0%), 1(1/9,11.1%) and 2(2/21,9.5%) in ptxP1/fhaB3-ER, ptxP1/fhaB2-ES and ptxP3/fhaB2-ES B. pertussis infected children each, which showed a significant difference (χ2 = 6.87, P = 0.032).

Conclusions

The ptxP3-ES B. pertussis was rare while the ptxP1-ER B. pertussis was steadily increased in Xi’an, China from 2012 to 2016, where co-purified aPV was prevalent used. This pose a hypothesis that the co-purified aPV might protect against ptxP3 strains more efficient, which generated a rare chance for ptxP3 strains to be under the antibiotic pressure and further developed to be erythromycin resistance. A further cohort study and the mechanisms of the additional antigen proteins of co-purified aPV protected against B. pertussis should be consideration.
Correction to: Sonographic follow-up after endoscopic carpal tunnel release for severe carpal tunnel syndrome: a one-year neuroanatomical prospective observational study
Authors: Li Miao , Jiang Jue , Zhou Qi , Zhang Chen
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Meta-analysis of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) versus abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectal tumors
Authors: He Jun , Yao Hai-Bo , Wang Chang-Jian , Yang Qin-Yan , Qiu Jian-Ming , Chen Jin-Ming , Shen Zhong , Yang Guan-Gen
Published: August 2020

Background

Natural orifice specimen extraction surgery is a novel technique of minimally invasive surgery. The purpose of this study was to compare the safety of laparoscopic anterior resection with natural orifice specimen extraction (NOSE-LAR) and abdominal incision specimen extraction (AISE-LAR) for sigmoid or rectum tumors.

Methods

MEDLINE (PubMed), Embase, CENTRAL (Cochrane Central Register of Controlled Trials), Scopus, and ClinicalTrials databases were systematically searched for related articles up to August 2019. The primary outcomes included postoperative complications (overall postoperative complication, incision-related complication, anastomotic fistula, and severe complication) and pathologic results (lymph nodes harvested, proximal resection margin, and distal resection edge). The statistical analysis was performed on STATA 12.0 software.

Results

Ten studies comprising 1787 patients were used for meta-analysis. Compared with AISE-LAR, NOSE-LAR had more advantages in terms of overall postoperative complication (odds ratio (OR) = 0.65 (95% CI, 0.46 to 0.90; P = 0.01)), incision-related complication (OR = 0.13 (95% CI, 0.05 to 0.35; P < 0.01)), distal resection edge (weighted mean difference (WMD) = 0.17 cm (95% CI, 0.02 to 0.33 cm; P = 0.02)), recovery of gastrointestinal function (WMD = − 0.38 day (95% CI, − 0.70 to − 0.06 day; P = 0.02 )), pain scores in postoperative day 1 (WMD = − 1.64 (95% CI, − 2.31 to − 0.98; P < 0.01)), additional analgesics usage (OR = 0.21 (95% CI, 0.11 to 0.40; P < 0.01)) and hospital stay (WMD = − 0.71 day (95% CI, − 1.10 to − 0.32 day; P < 0.01)), while the operation time of NOSE-LAR was prolonged (WMD = 7.4 min (95% CI, 0.17 to 14.64 min; P = 0.04)). The anastomotic fistula, severe complication, lymph nodes harvested, proximal resection margin, intraoperative blood loss, and long-term outcomes in NOSE-LAR were comparable with AISE-LAR.

Conclusions

The safety of NOSE-LAR was demonstrated, and it could be an alternative to conventional surgery in laparoscopic anterior resection for sigmoid and rectal tumors. However, further randomized and multi-center trials are required.
Bladder perforation during transurethral resection of bladder tumour is not a result of a deficient structure of the bladder wall
Authors: Poletajew Sławomir , Ilczuk Tomasz , Krajewski Wojciech , Niemczyk Grzegorz , Cyran Agata , Białek Łukasz , Radziszewski Piotr , Górnicka Barbara , Kryst Piotr
Published: August 2020

Background

Transurethral resection of the bladder tumour (TUR) is associated with a risk of bladder perforation. The underlying mechanisms and risk factors are not fully understood. The aim of this study was to determine if the bladder wall structure affects the risk of bladder perforation during TUR.

Methods

Fifteen patients who underwent TUR complicated by a bladder perforation (group 1) and fifteen matched controls who underwent uncomplicated TUR (group 2) were retrospectively enrolled in this morphological analysis. Surgical specimens were collected from all participating patients to describe the quality and architecture of urothelium and bladder submucosa. Immunohistochemical studies were performed with primary mouse anti-human E-cadherin, beta-catenin, type IV collagen, cytokeratin 20 and epithelial membrane antigen antibodies. The intensity of the immunohistochemical reaction was assessed using an immunoreactive score (IRS). Ultrastructural examinations were performed by transmission electron microscopy. The microscopic assessment was focused on the intensity of fibrosis in the bladder submucosa and the presence of degenerative changes in the urothelium.

Results

Patients’ age, sex distribution, tumour diameters, surgeon experience or cancer stage did not differ between study groups. The immunohistochemical analysis did not reveal statistically significant differences between group 1 and group 2. From a clinical point of view, ultrastructural analysis by electron microscopy showed a higher rate of severe fibrosis in group 1 (63.6% vs. 38.5%), with no differences in the rate and degree of urothelial changes. However, these differences were not statistically significant (p = 0.32).

Conclusions

Bladder perforation during TUR is not a result of a deficient structure of the bladder wall. Based on available evidence, the surgical technique seems to play the most important role in its prevention.
Correction to: Microencapsulation of cellular aggregates composed of differentiated insulin and glucagon-producing cells from human mesenchymal stem cells derived from adipose tissue
Authors: Jara Claudia , Oyarzun-Ampuero Felipe , Carrión Flavio , González-Echeverría Esteban , Cappelli Claudio , Caviedes Pablo
Published: August 2020

An amendment to this paper has been published and can be accessed via the original article.
Numerical study and stability of the Lengyel–Epstein chemical model with diffusion
Authors: Zafar Zain Ul Abadin , Shah Zahir , Ali Nigar , Kumam Poom , Alzahrani Ebraheem O.
Published: August 2020

In this paper, a nonlinear mathematical model with diffusion is taken into account to review the dynamics of Lengyel–Epstein chemical reaction model to describe the oscillating chemical reactions. For this purpose, the dimensionless Lengyel–Epstein model with diffusion and homogeneous boundary condition is considered. The steady states with and without diffusion of the Lengyel–Epstein model are studied. The basic reproductive number is computed and the global steady states for the system are calculated. Numerical results are offered for two systems using three well known techniques to validate the main outcomes. The consequences established from this qualitative study are supported by numerical simulations characterized by distinct programs, adopting forward Euler method, Crank–Nicolson method, and nonstandard finite difference method.
Pain and haemorrhage are the most common reasons for emergency department use and hospital admission in adults following ambulatory surgery: results of a population-based cohort study
Authors: Sawhney Monakshi , Goldstein David H. , Wei Xuejiao , Pare Genevieve C. , Wang Louie , VanDenKerkhof Elizabeth G.
Published: August 2020

Background

Advances in healthcare delivery have allowed for the increase in the number of ambulatory surgery procedures performed in Canada. Despite these advances, patients return to hospital following discharge. However, the reason for unplanned healthcare use after ambulatory surgery in Canada is not well understood.

Aims

To examine unplanned healthcare use, specifically emergency department visit and hospital admissions, in the 3 days after ambulatory surgery in Ontario, Canada.

Methods

This population-based retrospective cohort study was conducted using de-identified administrative databases. Participants were residents in the province of Ontario, Canada; 18 years and older; and underwent common ambulatory surgical procedures between 2014 and 2018. The outcomes included emergency department (ED) visit and hospital admission. Incidence rates were calculated for the total cohort, for each patient characteristic and for surgical category. The odds ratios and 95% confidence intervals were calculated for each outcome using bivariate and multivariate logistic regression.

Results

484,670 adults underwent select common surgical procedures during the study period. Patients had healthcare use in the first 3 days after surgery, with 14,950 (3.1%) ED visits and 14,236 (2.9%) admissions. The incidence of ED use was highest after tonsillectomy (8.1%), cholecystectomy (4.2%) and appendectomy (4.0%). Incidence of admissions was highest after appendectomy (21%). Acute pain (19.7%) and haemorrhage (14.2%) were the most frequent reasons for an ED visit and “convalescence following surgery” (49.2%) followed by acute pain (6.2%) and haemorrhage (4.5%) were the main reasons for admission.

Conclusions

These findings can assist clinicians in identifying and intervening with patients at risk of healthcare use after ambulatory surgery. Pain management strategies that can be tailored to the patient, and earlier follow-up for some patients may be required. In addition, administrative decision-makers could use the results to estimate the impact of specific ambulatory procedures on hospital resources for planning and allocation of resources.
Evaluating the effectiveness of learning ear anatomy using holographic models
Authors: Gnanasegaram Joshua J. , Leung Regina , Beyea Jason A.
Published: August 2020

Background

Computer-assisted learning has been shown to be an effective means of teaching anatomy, with 3-D visualization technology more successfully improving participants’ factual and spatial knowledge in comparison to traditional methods. To date, however, the effectiveness of teaching ear anatomy using 3-D holographic technology has not been studied. The present study aimed to evaluate the feasibility and effectiveness of learning ear anatomy using a holographic (HG) anatomic model in comparison to didactic lecture (DL) and a computer module (CM).

Methods

A 3-D anatomic model of the middle and inner ear was created and displayed using presentation slides in a lecture, computer module, or via the Microsoft HoloLens. Twenty-nine medical students were randomized to one of the three interventions. All participants underwent assessment of baseline knowledge of ear anatomy. Immediately following each intervention, testing was repeated along with completion of a satisfaction survey.

Results

Baseline test scores did not differ across intervention groups. All groups showed an improvement in anatomic knowledge post-intervention ( p < 0.001); the improvement was equal across all interventions ( p = 0.06). Participants rated the interventions equally for delivery of factual content ( p = 0.96), but rated the HG higher than the DL and CM for overall effectiveness, ability to convey spatial relationships, and for learner engagement and motivation ( p < 0.001).

Conclusions

These results suggest that 3-D holographic technology is an effective method of teaching ear anatomy as compared to DLs and CMs. Furthermore, it is better at engaging and motivating learners compared to traditional methods, meriting its inclusion as a tool in undergraduate medical education curriculum.
Structural basis for the multimerization of nonstructural protein nsp9 from SARS-CoV-2
Authors: Zhang Changhui , Chen Yiping , Li Li , Yang Yan , He Jun , Chen Cheng , Su Dan
Published: August 2020

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the causative agent of a potentially fatal disease named coronavirus disease 2019 (COVID-19), has raised significant public health concerns globally. To date, the COVID-19 pandemic has caused millions of people to be infected with SARS-CoV-2 worldwide. It has been known since the 2003 SARS epidemic that coronaviruses (CoVs) have large RNA genomes, the replication of which requires an RNA-dependent RNA replication/transcription complex. CoV nonstructural proteins (Nsps) play pivotal roles in the assembly of this complex and associated enzymatic functions in virus genomic replication. Several smaller nonenzymatic Nsps assist with RNA-dependent RNA polymerase function. In this study, we determined the structure of SARS-CoV-2 nonstructural protein 9 (nsp9), an RNA-binding protein that is essential for CoV replication. Its homotetrameric structure with two stable dimeric interfaces provids a structural basis for understanding the mechanisms of RNA-binding protein self-assembly, which may be essential for the regulation of viral RNA replication and transcription.
Model for ethical triaging of electroconvulsive therapy patients during the COVID-19 pandemic
Authors: Tor Phern-Chern , Tan Jacinta , Loo Colleen
Published: August 2020

Electroconvulsive therapy (ECT) is an essential treatment for severe mental illnesses such as depression with suicidality and catatonia. However, its availability is being threatened by resource limitations and infection concerns due to the COVID-19 pandemic. This may necessitate the triage of patients for ECT but there is no established ethical framework to prioritise patients. We offer an application of an ethical framework for use of scare medical resources in the ECT setting.
Natural Language Processing of Serum Protein Electrophoresis Reports in the Veterans Affairs Health Care System
Authors: Ryu Justine H. , Zimolzak Andrew J.
Published: August 2020

PURPOSE

Serum protein electrophoresis (SPEP) is a clinical tool used to screen for monoclonal gammopathy, thus it is a critical tool in the evaluation of patients with multiple myeloma. However, SPEP laboratory results are usually returned as short text reports, which are not amenable to simple computerized processing for large-scale studies. We applied natural language processing (NLP) to detect monoclonal gammopathy in SPEP laboratory results and compared its performance at multiple hospitals using both a rules-based manual system and a machine-learning algorithm.

METHODS

We used the data from the VA Corporate Data Warehouse, which comprises data from 20 million unique individuals. SPEP reports were collected from July to December 2015 at 5 Veterans Affairs Medical Centers. Of these reports, we annotated the presence or absence of monoclonal gammopathy in 300 reports. We applied a machine learning–based NLP and a manual rules-based NLP to detect monoclonal gammopathy in SPEP reports at each of the hospitals, then applied the model from 1 hospital to each of the other hospitals.

RESULTS

The learning system achieved an area under the receiver operating characteristic curve of 0.997, and the rules-based system achieved an accuracy of 0.99. When a model trained on 1 hospital’s data was applied to a different hospital, however, accuracy varied greatly, and the learning-based models performed better than the rules-based model.

CONCLUSION

Binary classification of short clinical texts such as SPEP reports may be a particularly attractive target on which to train highly accurate NLP systems.
Perdas visuais agudas: uma revisão dos últimos 10 anos de causas não infecciosas e não maculares
Authors: Queiroz Kenya Vitória Aguiar , Gomes Mariana Studart Mendonça , Ribeiro João Crispim Moraes Lima
Published: August 2020

Objetivo: o conhecimento das principais causas de perda visual aguda possibilita o diagnóstico precoce do paciente, o que favorece o tratamento mais rápido e eficaz, a fim de preservar a acuidade visual. Neste artigo de revisão, as principais causas não infeciosas e não oriundas da mácula são abordadas, a fim de buscar e revisar os tópicos mais pertinentes sobre cada tema, como as manifestações clínicas e os tratamentos mais utilizados. Métodos: trata-se de uma revisão de literatura, com 30 artigos selecionados e revisados da plataforma MEDLINE. Resultados: as causas de perda visual aguda discutidas são cinco. Primeiro, as por baixa acuidade visual, súbita, unilateral, sem dor e sem hiperemia: hemorragia vítrea, descolamento de retina, oclusão vascular de retina e neuropatia óptica isquêmica anterior. Posteriormente, por baixa acuidade visual, súbita, unilateral, com dor e sem hiperemia: neurite óptica. Por meio deste estudo, alguns fatores de risco podem ser evidenciados e os principais tratamentos destacados. Conclusão: o diagnóstico precoce das perdas visuais agudas deve ser realizado, com os exames físicos adequados, como a fundoscopia e os exames complementares necessários solicitados. Além disso, o encaminhamento ao oftalmologista é de extrema importância para minimizar sequelas e evitar complicações.
Are side effects of cannabidiol (CBD) products caused by tetrahydrocannabinol (THC) contamination?
Authors: Lachenmeier Dirk W. , Habel Stephanie , Fischer Berit , Herbi Frauke , Zerbe Yvonne , Bock Verena , Rajcic de Rezende Tabata , Walch Stephan G. , Sproll Constanze
Published: August 2020

Cannabidiol (CBD)-containing products are widely marketed as over the counter products, mostly as food supplements, to avoid the strict rules of medicinal products. Side-effects reported in anecdotal consumer reports or during clinical studies were first assumed to be due to hydrolytic conversion of CBD to psychotropic Δ9-tetrahydrocannabinol (Δ9-THC) in the stomach after oral consumption. However, research of pure CBD solutions stored in simulated gastric juice or subjected to various storage conditions such as heat and light with specific liquid chromatographic/tandem mass spectrometric (LC/MS/MS) and ultra-high pressure liquid chromatographic/quadrupole time-of-flight mass spectrometric (UPLC-QTOF) analyses was unable to confirm THC formation. Another hypothesis for the side-effects of CBD products may be residual Δ9-THC concentrations in the products as contamination, because most of them are based on crude hemp extracts containing the full spectrum of cannabinoids besides CBD. Analyses of 67 food products of the German market (mostly CBD oils) confirmed this hypothesis: 17 products (25%) contained Δ9-THC above the lowest observed adverse effects level (2.5 mg/day). Inversely, CBD was present in the products below the no observed adverse effect level. Hence, it may be assumed that the adverse effects of some commercial CBD products are based on a low-dose effect of Δ9-THC and not due to effects of CBD itself. The safety, efficacy and purity of commercial CBD products is highly questionable, and all of the products in our sample collection showed various non-conformities to European food law such as unsafe Δ9-THC levels, full-spectrum hemp extracts as non-approved novel food ingredients, non-approved health claims, and deficits in mandatory food labelling requirements. In view of the growing market for such lifestyle products, the effectiveness of the instrument of food business operators' own responsibility for product safety must obviously be challenged.
Hypertension management in older adults
Authors: Bilen Ozlem , Wenger Nanette K.
Published: August 2020

Vascular aging leads to arterial hypertension, which is the leading cause of cardiovascular mortality and morbidity in older adults. Blood pressure reduction is effective in reducing the cardiovascular risk and is safe in ambulatory older adults. It is important to note that blood pressure control in this group of patients is challenging because of comorbidities, polypharmacy, and frailty. Choice of pharmacotherapy is not simple and should be individualized.
Effects of paracetamol (acetaminophen) on gene expression and permeability properties of the rat placenta and fetal brain
Authors: Koehn Liam M. , Huang Yifan , Habgood Mark D , Kysenius Kai , Crouch Peter J. , Dziegielewska Katarzyna M , Saunders Norman R
Published: August 2020

Background:Paracetamol (acetaminophen) is widely used in pregnancy and generally regarded as “safe” by regulatory authorities.

Methods:Clinically relevant doses of paracetamol were administered intraperitoneally to pregnant rats twice daily from embryonic day E15 to 19 (chronic) or as a single dose at E19 (acute). Control samples were from un-treated age-matched animals. At E19, rats were anaesthetised, administered a final paracetamol dose, uteruses were opened and fetuses exposed for sample collection. For RNA sequencing, placentas and fetal brains were removed and flash frozen. Fetal and maternal plasma and cerebrospinal fluid were assayed for α-fetoprotein and interleukin 1β (IL1β). Brains were fixed and examined (immunohistochemistry) for plasma protein distribution. Placental permeability to a small molecule (14C-sucrose) was tested by injection into either mother or individual fetuses; fetal and maternal blood was sampled at regular intervals to 90 minutes.

Results:RNA sequencing revealed a large number of genes up- or down-regulated in placentas from acutely or chronically treated animals compared to controls. Most notable was down-regulation of three acute phase plasma proteins (α-fetoprotein, transferrin, transthyretin) in acute and especially chronic experiments and marked up-regulation of immune-related genes, particularly cytokines, again especially in chronically treated dams. IL1β increased in plasma of most fetuses from treated dams but to variable levels and no IL1β was detectable in plasma of control fetuses or any of the dams. Increased placental permeability appeared to be only from fetus to mother for both14C-sucrose and α-fetoprotein, but not in the reverse direction. In the fetal brain, gene regulatory changes were less prominent than in the placenta of treated fetuses and did not involve inflammatory-related genes; there was no evidence of increased blood-brain barrier permeability.

Conclusion:Results suggest that paracetamol may induce an immune-inflammatory-like response in placenta and more caution should be exercised in use of paracetamol in pregnancy.