bluuebunny/crossref_metadata_2025 huggingface dataset:
Lessons Learned From the First Pilot Study of the Compensatory Reserve Index After Congenital Heart Surgery Requiring Cardiopulmonary Bypass
Authors: Ehrmann Daniel E. , Leopold David K. , Campbell Kristen , Silveira Lori , Gist Katja M. , Phillips Ryan , Shahi Niti , Moulton Steven L. , Kim John S.
Published: March 2021

Background:

Early warning systems that utilize dense physiologic data and machine learning may aid prediction of decompensation after congenital heart surgery (CHS). The Compensatory Reserve Index (CRI) analyzes changing features of the pulse waveform to predict hemodynamic decompensation in adults, but it has never been studied after CHS. This study sought to understand the feasibility, safety, and potential utility of CRI monitoring after CHS with cardiopulmonary bypass (CPB).

Methods:

A single-center prospective pilot cohort of patients undergoing pulmonary valve replacement was studied. Compensatory Reserve Index was continuously measured from preoperative baseline through the first 24 postoperative hours. Average CRI values during selected procedural phases were compared between patients with an intensive care unit (ICU) length of stay (LOS) <3 days versus LOS ≥3 days.

Results:

Twenty-three patients were enrolled. On average, 17,445 (±3,152) CRI data points were collected and 0.33% (±0.40) of data were missing per patient. There were no adverse events related to monitoring. Five (21.7%) patients had an ICU LOS ≥3 days. Compared to the ICU LOS <3 days group, the ICU LOS ≥3 days group had a greater decrease in CRI from baseline to immediately after CPB (−0.3 ± 0.1 vs −0.1 ± 0.2, P = .003) and were less likely to recover to baseline CRI during the monitoring period (20% vs 83%, P = .017).

Conclusions:

Compensatory Reserve Index monitoring after CHS with CPB seems feasible and safe. Early changes in CRI may precede meaningful clinical outcomes, but this requires further study.
Decreased Quality of Life in Children With Anomalous Aortic Origin of a Coronary Artery
Authors: Agrawal Hitesh , Mery Carlos M. , Sami Sarah A. , Qureshi Athar M. , Noel Cory V. , Cutitta Katherine , Masand Prakash , Tejtel S. Kristen Sexson , Wang Yunfei , Molossi Silvana
Published: March 2021

Background:

Anomalous aortic origin of a coronary artery (AAOCA) is associated with sudden death in the young. We sought to determine quality of life (QOL) in patients/families affected by AAOCA.

Methods:

Patients with AAOCA (8-18 years) were prospectively included from January 2016 to May 2017. Parent proxy and patient Pediatric Cardiac Quality of Life Inventory (PCQLI) were used to evaluate QOL and Pediatric Quality of Life Inventory (PedsQL) Family Impact Module to assess the impact of AAOCA on families, as primary outcomes. Secondary outcomes included peer relationship, anxiety, and depression assessed using patient-reported outcomes measurement information system. Patients deemed high-risk were offered surgery/exercise restriction. Generalized linear mixed regression models were used to determine significant predictors of outcomes.

Results:

Fifty-three patients, the majority (n = 31, 59%) unrepaired, and 49 caregivers were included. Using PCQLI, patient and parent proxy QOL scores were similar to published scores for children with long-QT syndrome. Patients’ QOL score was associated with exertional symptoms, perceived chronic disease, and altered parent’s concentration ability. Likewise, parent proxy QOL scores were associated with mother’s living situation, exertional symptoms, parent missing work for ≥1 day, and disturbed parental functioning at work. Family impact scores were associated with lower maternal education, among other measures. Risk categories or surgical status did not impact patient, parent proxy reported, or family impact QOL.

Conclusion:

Anomalous aortic origin of a coronary artery is associated with decreased QOL as perceived by patients and caregiver and is associated with numerous facets of family functioning. These findings are independent of risk categorization or surgical status.
Staged Repair of Van Praagh Truncus Type A3
Authors: Ganta Srujan , Duster Nicole , El-Said Howaida , Artrip John , Rao Rohit , Golding Ian , Dummer Kirsten , Nigro John J.
Published: March 2021

Van Praagh (VP) A3 variant of truncus arteriosus (or common arterial trunk) is defined by only one pulmonary artery (usually the right) originating from the common trunk, while the other lung is supplied either by collaterals or a pulmonary artery arising from the aortic arch. This report describes a staged approach to manage a VP-A3 variant truncus arteriosus with ductal origin of the left pulmonary artery (LPA), a hypoplastic right pulmonary artery, and cyanosis. Initially, the ductal portion of the proximal LPA was stented with a Resolute Onyx drug-eluting stent. The pulmonary arteries grew and at four months of age had an acceptable McGoon ratio and Nakata index. The patient then underwent repair which included unifocalization of the branch pulmonary arteries, closure of the ventricular septal defect, and placement of a right ventricle-to-pulmonary artery homograft conduit.
Interference Screw Versus Suture Anchors for Femoral Fixation in Medial Patellofemoral Ligament Reconstruction: A Biomechanical Study
Authors: Gould Heath P. , Delaney Nicholas R. , Parks Brent G. , Melvani Roshan T. , Hinton Richard Y.
Published: March 2021

Background:

Femoral-sided graft fixation in medial patellofemoral ligament (MPFL) reconstruction is commonly performed using an interference screw (IS). However, the IS method is associated with several clinical disadvantages that may be ameliorated by the use of suture anchors (SAs) for femoral fixation.

Purpose:

To compare the load to failure and stiffness of SAs versus an IS for the femoral fixation of a semitendinosus autograft in MPFL reconstruction.

Study Design:

Controlled laboratory study.

Methods:

Based on a priori power analysis, a total of 6 matched pairs of cadaveric knees were included. Specimens in each pair were randomly assigned to receive either SA or IS fixation. After an appropriate reconstruction procedure, the looped end of the MPFL graft was pulled laterally at a rate of 6 mm/s until construct failure. The best-fit slope of the load-displacement curve was then used to calculate the stiffness (N/mm) in a post hoc fashion. A paired t test was used to compare the mean load to failure and the mean stiffness between groups.

Results:

No significant difference in load to failure was observed between the IS and the SA fixation groups (294.0 ± 61.1 vs 250.0 ± 55.9; P = .352), although the mean stiffness was significantly higher in IS specimens (34.5 ± 9.6 vs 14.7 ± 1.2; P = .004). All IS reconstructions failed by graft pullout from the femoral tunnel, whereas 5 of the 6 SA reconstructions failed by anchor pullout.

Conclusion:

In this biomechanical study using a cadaveric model of MPFL reconstruction, SA femoral fixation was not significantly different from IS fixation in terms of load to failure. The mean load-to-failure values for both reconstruction techniques were greater than the literature-reported values for the native MPFL.

Clinical Relevance:

These results suggest that SAs are a biomechanically viable alternative for femoral-sided graft fixation in MPFL reconstruction.
Different Levels of Physical Activity, Physical Health, Happiness, and Depression among Older Adults with Diabetes
Authors: Lee Jungjoo , Kim Junhyoung , Chow Angela , Piatt Jennifer A.
Published: March 2021

The purpose of this study was to investigate the relationship between different levels of physical activity (light, moderate, and vigorous), physical health, happiness, and depression among older adults with diabetes. Using data from the National Social Life, Health and Aging Project (NSHAP) Wave 3, the results indicate that moderate and/or vigorous physical activity is more effective than light physical activity for promoting physical health and happiness and lowering depression of older adults with diabetes. This study suggests that activity professionals and therapists working with older adults with diabetes need to encourage their participation in physical activity as well as adjust a level of physical activity intensity that is tailored to participants’ needs and expectations.
Developing Actionable Survey Questions to Improve Patient Experience
Authors: Millstein Jeffrey , Agarwal Anish
Published: March 2021

Patient experience surveys should be concise, with questions that give us the most insight into our patients’ needs and how successfully they were addressed during visits. Survey questions are most valuable if answers are actionable, connect more clearly with skill sets and identify issues which improve care.
Cost savings of paper analytical devices (PADs) to detect substandard and falsified antibiotics: Kenya case study
Authors: Chen Hui-Han , Higgins Colleen , Laing Sarah K. , Bliese Sarah L. , Lieberman Marya , Ozawa Sachiko
Published: March 2021

Background:

Over 10% of antibiotics in low- and middle-income countries (LMICs) are substandard or falsified. Detection of poor-quality antibiotics via the gold standard method, high-performance liquid chromatography (HPLC), is slow and costly. Paper analytical devices (PADs) and antibiotic paper analytical devices (aPADs) have been developed as an inexpensive way to estimate antibiotic quality in LMICs.

Aim:

To model the impact of using a rapid screening tools, PADs/aPADs, to improve the quality of amoxicillin used for treatment of childhood pneumonia in Kenya.

Methods:

We developed an agent-based model, ESTEEM (Examining Screening Technologies with Economic Evaluations for Medicines), to estimate the effectiveness and cost savings of incorporating PADs and aPADs in amoxicillin quality surveillance in Kenya. We compared the current testing scenario (batches of entire samples tested by HPLC) with an expedited HPLC scenario (testing smaller batches at a time), as well as a screening scenario using PADs/aPADs to identify poor-quality amoxicillin followed by confirmatory analysis with HPLC.

Results:

Scenarios using PADs/aPADs or expedited HPLC yielded greater incremental benefits than the current testing scenario by annually averting 586 (90% uncertainty range (UR) 364–874) and 221 (90% UR 126–332) child pneumonia deaths, respectively. The PADs/aPADs screening scenario identified and removed poor-quality antibiotics faster than the expedited or regular HPLC scenarios, and reduced costs significantly. The PADs/aPADs scenario resulted in an incremental return of $14.9 million annually compared with the reference scenario of only using HPLC.

Conclusion:

This analysis shows the significant value of PADs/aPADs as a medicine quality screening and testing tool in LMICs with limited resources.
Counter-hegemonic struggle and the framing practices of the anti-nuclear platform in Turkey (2002–2018)
Authors: Balkan Şahin Sevgi , Bodur Ün Marella
Published: March 2021

Since winning its first electoral victory in 2002, the Justice and Development Party (AKP) has promoted nuclear energy as crucial for satisfying rising energy needs, triggering economic development and increasing competitiveness of Turkey. This hegemonic discourse has been challenged by the anti-nuclear platform (ANP) that has framed nuclear energy as posing a threat to human life and the nature. Based on an engagement between the framing perspective and the Gramscian approach, this study considers the framing activities of the ANP as a counter-hegemonic strategy to challenge the hegemonic discourses articulated by AKP on nuclear energy over the past 15 years. Analyzing the data from primary sources, such as reports, bulletins, pamphlets, and press releases produced by the ANP and interviews with ANP representatives, this study reveals the ways the platform exercises power through their framing practices and counter-hegemonic discourses to delegitimize the official frame promoting nuclear energy in Turkey.
Resilience assessment tool for port planning
Authors: Dhanak Manhar , Parr Scott , Kaisar Evangelos I , Goulianou Panagiota , Russell Hannah , Kristiansson Fanny
Published: March 2021

US ports and container/intermodal terminals are critical links in the marine transportation system. Disruption at a port can have a crippling economic effect in the coastal zone as well as the rest of the nation. Port stakeholders have a vested interest in the long-term function and viability of ports, but no standardized measures for performance or resilience exist for ports. The goal of this research is to demonstrate the utility of a predictive port resilience assessment tool. The developed tool encompasses a microscopic traffic simulation model (VISSIM) based hybrid multimodal analyzes of port operations and provides a quantifiable assessment of resilience. The application of this tool is shown on six ports in the Southeast US. The waterside port simulation models were developed using vessel automatic identification system data and programed within a VISSIM simulation of landside operations. This hybrid modeling approach was used to visualize vessels and allow them to interact in both time and space with each other and landside infrastructure. Local and regional resilience was quantified through the analysis of time-dependent resilience plots and used as a performance measure in this study. The utility of the predictive port resilience assessment was demonstrated in response to Hurricane Matthew (2016). However, the novel procedure described herein can be applied to any port hazard. This research grows the understanding of the regional consequences of hurricane events and enhances the knowledge in the development of a stakeholder-focused tool to assess resilience.
The relationship between breast density, age, and mammographic lesion type among Chinese breast cancer patients from a large clinical dataset
Authors: Ji Yu , Li Boxin , Zhao Rui , Zhang Ying , Liu Junjun , Lu Hong
Published: March 2021

Background

The purpose of this study was to investigate the relationship between breast density, age, and mammographic lesion type among Chinese breast cancer patients included in a large clinical dataset.

Methods

A review of mammographic images acquired between July 2014 and June 2017 from a total of 9716 retrospectively registered breast cancer patients was conducted. Mammographic breast density was defined according to the American College of Radiology Breast Imaging Reporting and Data System (ACR BI-RADS) 4-class density rating. Mammographic lesion types were defined according to the ACR BI-RADS, including mass, mass with calcifications, calcifications, architectural distortion/asymmetries, and architectural distortion/asymmetries with calcifications. Three experienced breast radiologists interpreted all mammograms. The chi-square (χ2) test and Pearson correlation analyses were performed to assess the relationship between breast density, age, and mammographic lesion type.

Results

A significant inverse relationship was observed between the BI-RADS breast density rating given by radiologists and patient age (r = − 0.521, p < 0.01). The breast density distribution in breast cancer patients from China reversed at the age of 55 years, and exhibited one age peak in the age 55–59 year group. The percentage of lesions with calcifications decreased with increasing age (p < 0.01), and increased with increasing breast density (p < 0.01).

Conclusions

In general, we identified a relationship between patient breast density, age, and mammographic lesion type. This finding may provide a basis for clinical diagnoses and support development of breast cancer screening programs in China.
Identification of tumor antigens and immune subtypes of cholangiocarcinoma for mRNA vaccine development
Authors: Huang Xing , Tang Tianyu , Zhang Gang , Liang Tingbo
Published: March 2021

Background

The mRNA-based cancer vaccine has been considered a promising strategy and the next hotspot in cancer immunotherapy. However, its application on cholangiocarcinoma remains largely uncharacterized. This study aimed to identify potential antigens of cholangiocarcinoma for development of anti-cholangiocarcinoma mRNA vaccine, and determine immune subtypes of cholangiocarcinoma for selection of suitable patients from an extremely heterogeneous population.

Methods

Gene expression profiles and corresponding clinical information were collected from GEO and TCGA, respectively. cBioPortal was used to visualize and compare genetic alterations. GEPIA2 was used to calculate the prognostic index of the selected antigens. TIMER was used to visualize the correlation between the infiltration of antigen-presenting cells and the expression of the identified antigens. Consensus clustering analysis was performed to identify the immune subtypes. Graph learning-based dimensionality reduction analysis was conducted to visualize the immune landscape of cholangiocarcinoma.

Results

Three tumor antigens, such as CD247, FCGR1A, and TRRAP, correlated with superior prognoses and infiltration of antigen-presenting cells were identified in cholangiocarcinoma. Cholangiocarcinoma patients were stratified into two immune subtypes characterized by differential molecular, cellular and clinical features. Patients with the IS1 tumor had immune “hot” and immunosuppressive phenotype, whereas those with the IS2 tumor had immune “cold” phenotype. Interestingly, patients with the IS2 tumor had a superior survival than those with the IS1 tumor. Furthermore, distinct expression of immune checkpoints and immunogenic cell death modulators was observed between different immune subtype tumors. Finally, the immune landscape of cholangiocarcinoma revealed immune cell components in individual patient.

Conclusions

CD247, FCGR1A, and TRRAP are potential antigens for mRNA vaccine development against cholangiocarcinoma, specifically for patients with IS2 tumors. Therefore, this study provides a theoretical basis for the anti-cholangiocarcinoma mRNA vaccine and defines suitable patients for vaccination.
Correction to: The dysregulated innate immune response in severe COVID-19 pneumonia that could drive poorer outcome
Authors:   for the LYMPHONIE Study Group, Blot Mathieu , Bour Jean-Baptiste , Quenot Jean Pierre , Bourredjem Abderrahmane , Nguyen Maxime , Guy Julien , Monier Serge , Georges Marjolaine , Large Audrey , Dargent Auguste , Guilhem Alexandre , Mouries-Martin Suzanne , Barben Jeremy , Bouhemad Belaid , Charles Pierre‑Emmanuel , Chavanet Pascal , Binquet Christine , Piroth Lionel
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article.
Pexidartinib treatment in Alexander disease model mice reduces macrophage numbers and increases glial fibrillary acidic protein levels, yet has minimal impact on other disease phenotypes
Authors: Boyd Michelle M. , Litscher Suzanne J. , Seitz Laura L. , Messing Albee , Hagemann Tracy L. , Collier Lara S.
Published: March 2021

Background

Alexander disease (AxD) is a rare neurodegenerative disorder that is caused by dominant mutations in the gene encoding glial fibrillary acidic protein (GFAP), an intermediate filament that is primarily expressed by astrocytes. In AxD, mutant GFAP in combination with increased GFAP expression result in astrocyte dysfunction and the accumulation of Rosenthal fibers. A neuroinflammatory environment consisting primarily of macrophage lineage cells has been observed in AxD patients and mouse models.

Methods

To examine if macrophage lineage cells could serve as a therapeutic target in AxD, GFAP knock-in mutant AxD model mice were treated with a colony-stimulating factor 1 receptor (CSF1R) inhibitor, pexidartinib. The effects of pexidartinib treatment on disease phenotypes were assessed.

Results

In AxD model mice, pexidartinib administration depleted macrophages in the CNS and caused elevation of GFAP transcript and protein levels with minimal impacts on other phenotypes including body weight, stress response activation, chemokine/cytokine expression, and T cell infiltration.

Conclusions

Together, these results highlight the complicated role that macrophages can play in neurological diseases and do not support the use of pexidartinib as a therapy for AxD.
Osteoid osteoma: the great mimicker
Authors: Carneiro Bruno C. , Da Cruz Isabela A. N. , Ormond Filho Alípio G. , Silva Igor P. , Guimarães Júlio B. , Silva Flávio D. , Nico Marcelo A. C. , Stump Xavier M. G. R. G.
Published: March 2021

Osteoid osteoma is a painful, benign and common bone tumor that is prevalent in young adults. The typical clinical presentation consists of pain that becomes worse at night and is relieved by nonsteroidal anti-inflammatory drugs. The most common imaging finding is a lytic lesion, known as a nidus, with variable intralesional mineralization, accompanied by bone sclerosis, cortical thickening and surrounding bone marrow edema, as well as marked enhancement with intravenous contrast injection. When the lesion is located in typical locations (intracortical bone and the diaphyses of long bones), both characteristic clinical and radiological features are diagnostic. However, osteoid osteoma is a multifaceted pathology that can have unusual presentations, such as intraarticular osteoid osteoma, epiphyseal location, lesions at the extremities and multicentric nidi, and frequently present atypical clinical and radiological manifestations. In addition, many conditions may mimic osteoid osteoma and vice versa, leading to misdiagnosis. Therefore, it is essential to understand these musculoskeletal diseases and their imaging findings to increase diagnostic accuracy, enable early treatment and prevent poor prognosis.
Thyroid hormone: sex-dependent role in nervous system regulation and disease
Authors: Baksi Shounak , Pradhan Ajay
Published: March 2021

Thyroid hormone (TH) regulates many functions including metabolism, cell differentiation, and nervous system development. Alteration of thyroid hormone level in the body can lead to nervous system-related problems linked to cognition, visual attention, visual processing, motor skills, language, and memory skills. TH has also been associated with neuropsychiatric disorders including schizophrenia, bipolar disorder, anxiety, and depression. Males and females display sex-specific differences in neuronal signaling. Steroid hormones including testosterone and estrogen are considered to be the prime regulators for programing the neuronal signaling in a male- and female-specific manner. However, other than steroid hormones, TH could also be one of the key signaling molecules to regulate different brain signaling in a male- and female-specific manner. Thyroid-related diseases and neurological diseases show sex-specific incidence; however, the molecular mechanisms behind this are not clear. Hence, it will be very beneficial to understand how TH acts in male and female brains and what are the critical genes and signaling networks. In this review, we have highlighted the role of TH in nervous system regulation and disease outcome and given special emphasis on its sex-specific role in male and female brains. A network model is also presented that provides critical information on TH-regulated genes, signaling, and disease.
Empowering large chemical knowledge bases for exposomics: PubChemLite meets MetFrag
Authors: Schymanski Emma L. , Kondić Todor , Neumann Steffen , Thiessen Paul A. , Zhang Jian , Bolton Evan E.
Published: March 2021

Compound (or chemical) databases are an invaluable resource for many scientific disciplines. Exposomics researchers need to find and identify relevant chemicals that cover the entirety of potential (chemical and other) exposures over entire lifetimes. This daunting task, with over 100 million chemicals in the largest chemical databases, coupled with broadly acknowledged knowledge gaps in these resources, leaves researchers faced with too much—yet not enough—information at the same time to perform comprehensive exposomics research. Furthermore, the improvements in analytical technologies and computational mass spectrometry workflows coupled with the rapid growth in databases and increasing demand for high throughput “big data” services from the research community present significant challenges for both data hosts and workflow developers. This article explores how to reduce candidate search spaces in non-target small molecule identification workflows, while increasing content usability in the context of environmental and exposomics analyses, so as to profit from the increasing size and information content of large compound databases, while increasing efficiency at the same time. In this article, these methods are explored using PubChem, the NORMAN Network Suspect List Exchange and the in silico fragmentation approach MetFrag. A subset of the PubChem database relevant for exposomics, PubChemLite, is presented as a database resource that can be (and has been) integrated into current workflows for high resolution mass spectrometry. Benchmarking datasets from earlier publications are used to show how experimental knowledge and existing datasets can be used to detect and fill gaps in compound databases to progressively improve large resources such as PubChem, and topic-specific subsets such as PubChemLite. PubChemLite is a living collection, updating as annotation content in PubChem is updated, and exported to allow direct integration into existing workflows such as MetFrag. The source code and files necessary to recreate or adjust this are jointly hosted between the research parties (see data availability statement). This effort shows that enhancing the FAIRness (Findability, Accessibility, Interoperability and Reusability) of open resources can mutually enhance several resources for whole community benefit. The authors explicitly welcome additional community input on ideas for future developments.
Energy-efficient time and energy resource allocation in non-selfish symbiotic cognitive relaying sensor network with privacy preserving for smart city
Authors: Li Ping , Liu Yu , Gao Xiang , Li Huibo , Gong Peng
Published: March 2021

Energy efficiency and privacy preserving have become essential for the wireless sensor networks. In this paper, a joint energy and time resource allocation problem for the cognitive users (CUs) in a non-selfish symbiotic cognitive relaying scheme (NSCRS) is considered. We aim to maximize the total energy efficiency (EE) of the primary user and CUs with the consideration of information privacy under the total energy constraints of CUs. With full channel state information (CSI), an optimal energy and time resource allocation algorithm is proposed based on the exhaustive searching. Besides, in order to reduce the overhead of CSI feedback, a suboptimal algorithm, in which only the partial instantaneous CSI is required, is additionally proposed. Simulation results demonstrate the EE of primary and CUs in the NSCRS with consideration of information privacy can be greatly improved by the proposed algorithms.
Legislation and current developments in adverse drug reaction reporting in Mongolia: how far are we?
Authors: Zulzaga Zuzaan , Myagmarsuren Erdenetuya , Woerdenbag Herman J. , van Puijenbroek Eugene P.
Published: March 2021

Monitoring adverse drug reactions is a vital issue to ensure drug safety and to protect the general public from medication-related harmful effects. In order to properly monitor drug safety, a regulatory system needs to be in place as well as an infrastructure that allows for analyzing national and international safety data. In Mongolia, adverse drug reaction (ADR) reporting activities have been implemented in the past decade. During this period, the basic structure and legal basis of an adverse drug reaction monitoring system was established. Because of the fragmented but growing healthcare system and the complexity of pharmaceutical issues in Mongolia, a sustainable process for the development of the adverse drug reaction reporting system is a key issue. The aim of this article is to disclose the Mongolian situation for the rest of the world and to share experiences on how an ADR reporting system can be developed towards a higher and more advanced level to contribute to both national and international drug safety issues. In this article, we review the features of the Mongolian health care and pharmaceutical systems, as well as the current development of the adverse drug reaction reporting system.
Toxoplasma gondii seroprevalence among pregnant women in Rabat, Morocco
Authors: Laboudi Majda , Taghy Zoubida , Duieb Oussama , Peyron François , Sadak Abderrahim
Published: March 2021

Background

Toxoplasmosis is an infectious disease caused by a protozoan parasite named Toxoplasma gondii (T.gondii). Pregnant women are considered one of the risk groups. The objective of this retrospective study is to provide an updated estimate of the seroprevalence of anti-T. gondii antibodies among a group of Moroccan pregnant women monitored at the Parasitology Laboratory of the National Institute of Hygiene in Rabat in Morocco.

Methods

Serum samples were tested for the presence of specific anti-T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) antibodies using indirect enzyme-linked immunosorbent assay (ELISA). Anti-Toxoplasma IgM- and IgG-positive cases were also evaluated with the anti-Toxoplasma IgG avidity test. All cases were evaluated according to the age, parity, and historical of abortion.

Results

Among 677 pregnant women, 94.1% (637/677) were serologically screened for the first time and therefore had no knowledge of their serological status, and only 5.9% (40/677) were screened for the second or third time. The overall anti-T. gondii IgG and IgM seropositivity among the 637 pregnant women included in the study analysis was 43% (274/637) and 3.9% (25/637), respectively. The use of the IgG avidity test allowed excluding recent infection among 83% of cases with IgG and IgM positive sera. The mean age was 29.4 ± 6.3 years. The result of the bivariate analysis revealed that the age influenced significantly the seroprevalence rate, while the parity and the existence of previous spontaneous abortion did not have any significant statistical correlation with seropositivity to T. gondii.

Conclusion

This study shows that 43% of pregnant women were positive and 57% of them had no antibody against the T. gondii infection. However, the pregnancy follow-up and the counseling of pregnant women remain essential for the prevention of congenital toxoplasmosis.
Application of 3D printing and distributed manufacturing during the first-wave of COVID-19 pandemic. Our experience at a third-level university hospital
Authors: Perez-Mañanes Rubén , José Sonia García-de San , Desco-Menéndez Manuel , Sánchez-Arcilla Ignacio , González-Fernández Esmeralda , Vaquero-Martín Javier , González-Garzón Javier Pascau , Mediavilla-Santos Lydia , Trapero-Moreno Diego , Calvo-Haro José Antonio
Published: March 2021

Background

3D printing and distributed manufacturing represent a paradigm shift in the health system that is becoming critical during the COVID-19 pandemic. University hospitals are also taking on the role of manufacturers of custom-made solutions thanks to 3D printing technology.

Case Presentation

We present a monocentric observational case study regarding the distributed manufacturing of three groups of products during the period of the COVID-19 pandemic from 14 March to 10 May 2020: personal protective equipment, ventilatory support, and diagnostic and consumable products. Networking during this period has enabled the delivery of a total of 17,276 units of products manufactured using 3D printing technology. The most manufactured product was the face shields and ear savers, while the one that achieved the greatest clinical impact was the mechanical ventilation adapters and swabs. The products were manufactured by individuals in 57.3% of the cases, and our hospital acted as the main delivery node in a hub with 10 other hospitals. The main advantage of this production model is the fast response to stock needs, being able to adapt almost in real time.

Conclusions

The role of 3D printing in the hospital environment allows the reconciliation of in-house and distributed manufacturing with traditional production, providing custom-made adaptation of the specifications, as well as maximum efficiency in the working and availability of resources, which is of special importance at critical times for health systems such as the current COVID-19 pandemic.
Comparative study between medial canthus episcleral block versus peribulbar block in intracapsular cataract surgery
Authors: Abd el raof Elsayed Ahmed Fayez , Zaghlol Mohammed Ali Ahmed , Allah Sherif Samir Wahba Rizk , Mohamed Ahmed Moustafa Mohamed
Published: March 2021

Background

Ophthalmic regional anesthesia is now the most common anesthetic technique used for eye surgeries. There are various modes of needle-based ophthalmic anesthesia which are retrobulbar, peribulbar, and episcleral. The sub-Tenon episcleral anesthesia technique became a potential alternative to the retrobulbar and peribulbar anesthesia in most of the anterior and posterior segment eye surgeries; this is due to its better safety profile and tolerability than the other blocks. The aim of this study was to compare between medial episcleral block and peribulbar block in intracapsular cataract surgery as regards anesthesia and akinesia of the eye, the need of supplementation of local anesthetic, and finally the safety profile of each block. This was a prospective, comparative, randomized, double-blinded clinical study. It was carried out on 60 patients that were scheduled for intracapsular cataract surgery in ophthalmic surgery unit. The patients were randomly allocated into two equal groups; group A received medial canthus episcleral block technique and group B received peribulbar block technique.

Results

Results of this prospective, comparative, randomized, double-blinded study showed no statistical difference between the two groups as regards demographic and vital data. As regards Akinesia score, the ESA group had better akinesia score at 1, 5, and 10 min and at the end of surgery than PBA group (P value, 0.001). No patient in the ESA group received supplemental injection via inferotemporal peribulbar block technique, while 66.7% of PBA group was in need of supplementation. Regarding time to onset of acceptable akinesia score; ESA group had a faster onset with high statistical significance (P value, 0.001). Numeric pain scale was better in ESA group than PBA group with high statistical significance. There were chemosis after injection in two of the ESA group (6.6%). On the other hand, slight pricking pain at the end pf surgery developed in two cases in the PBA group.

Conclusion

Medial canthal episcleral technique proved to be superior in motor akinesia score, time to onset of acceptable akinesia score, and numeric pain scale in comparison to peribulbar anesthesia with high statistical significance between the two groups. Both techniques proved to be safe with no incidence of major complications.
Palliative Nerve Block for Penile Calciphylaxis: A Case Report on Ultrasound-Guided Phenol Neurolysis
Authors: Mach Steven , Collie Mark A. , Pesce Michael B.
Published: March 2021

A 78-year-old man with uncontrolled diabetes, heart failure, and hemodialysis-dependent end-stage renal disease presented with intractable penile pain secondary to calciphylaxis and necrosis of his glans penis. Given pain refractory to pharmacologic management and refusal of surgery, treatment entailed an ultrasound-guided dorsal penile nerve block with 5 mL of aqueous 4% phenol bilaterally. The patient reported immediate relief and died pain-free 3 months later. While phenol nerve blocks are increasingly uncommon due to local tissue toxicity, the precision of ultrasound leverages phenol’s denaturing and axonal demyelinating properties to facilitate long-term targeted neurolysis to palliate chronic nonmalignant pain.
Reconstituting C-Centered Hexagold(I) Clusters with N-Heterocyclic Carbene Ligands
Authors: Lei Zhen , Pei Xiao-Li , Ube Hitoshi , Shionoya Mitsuhiko
Published: March 2021

Ubiquitous intramolecular aurophilic interactions in gold clusters have usually been assigned as the main determinants of their molecular geometry and various properties. By utilizing N-heterocyclic carbene (NHC) ligands instead of phosphine ligands which have been exclusively used, we have developed ligand-specific photophysical properties of C-centered hexagold(I) (C@Au6) clusters. This account describes the recent development of carbene-protected C@Au6 clusters. First of all, a strong intramolecular C–H⋯Au interaction was found as a key structural feature of these clusters. These are also present in the newly emerged NHC-gold nanoclusters, but are negligible in the phosphine counterparts. Interestingly, the use of NHC ligands also produces clusters with a nearly identical metal kernel, but their luminescence changes significantly. In addition, a simple extension of the π-conjugated system of NHCs from imidazolylidene to benzimidazolylidene is expected to produce significant changes in both absorption coefficient and emission wavelength. These results show the promising potential of carbene ligands in character modulation of metal clusters, and may help in the rational design of carbene ligands for constructing functional metal clusters.
John Fletcher’s Collaborator on The Noble Gentleman
Authors: Freebury-Jones Darren
Published: March 2021

Although John Fletcher is recognized as one of the most influential dramatists of the early modern period, many of the theories concerning the divisions of authorship in his collaborative plays continue to present insoluble difficulties. For instance, according to the soundly based chronology developed by Martin Wiggins, many plays attributed in part to Francis Beaumont appear to have been written after Beaumont had ceased writing (c. 1613), or even after he died in 1616. A prime example would be The Noble Gentleman (1626), which E. H. C. Oliphant and Cyrus Hoy attributed in part to Beaumont. Modern scholarship holds that this was Fletcher’s last play and that it was completed by another hand after Fletcher died in 1625. This article offers the most comprehensive analysis yet undertaken of the stylistic qualities of the “non-Fletcher” portions in this play in relation to dramatists writing for the King’s Men at the time, thereby opening up several new lines of enquiry for co-authored plays of the period. Seeking to broaden our understanding of the collaborative practices in plays produced by that company in or around 1626, through a combination of literary-historical and quantitative analysis, the article puts forth a new candidate for Fletcher’s posthumous collaborator: John Ford.
Annika Mikkel, Rütmilised lauselõpud 14. sajandi ladinakeelsetes ning itaalia rahvakeelsetes proosateostes
Authors: Grünthal Satu
Published: March 2021

Annika Mikkel, Rütmilised lauselõpud 14. sajandi ladinakeelsetes ning itaalia rahvakeelsetes proosateostes (Rhythmic clausulae in the 14th-century Latin and Italian vernacular prose texts)
Women in the Inner Circle: Gender and Director Networks After the Fracturing of the Corporate Elite
Authors: Benton Richard A.
Published: March 2021

Over the past two decades, women have increased their representation among multiboard directors—corporate directors who simultaneously hold seats on two or more firms. Traditionally, multiboard directors exercised greater power and influence in corporate governance. As a consequence, women’s increased representation among this “inner circle” could signal women’s increased influence in corporate governance. However, women’s access to these elite positions comes at a time when multiboard holding has declined. This paper investigates gendered patterns in access to and outcomes of multiboard holding. I argue that these patterns reflect gendered logics in director appointment practices such that firms increasingly recruit and appoint highly boarded female directors, but multiboard women continue to lag in substantive influence in the boardroom. Analyses of nearly two decades of data on S&P 1500 boards demonstrate female directors’ increased access to the corporate inner-circle, but this access is decoupled from increased participation in board committees and interorganizational social influence. I discuss implications for theory on gender tokenism, corporate networks, and board processes.
Prognosis of papillary thyroid carcinoma in relation to preoperative subclinical hypothyroidism
Authors: Kang SY , Ahn HR , Youn HJ , Jung SH
Published: March 2021

Introduction

It has been established that thyroid-stimulating hormone (TSH) stimulates the growth and development of thyroid malignancy, and a higher serum TSH level is associated with the incidence of thyroid cancer and an advanced tumour stage. This study aimed to evaluate the association of preoperative subclinical hypothyroidism with the prognosis of papillary thyroid cancer (PTC).

Methods

A total of 466 patients who underwent surgery for PTC between December 2006 and June 2009 were enrolled. Among them, 44 patients had subclinical hypothyroidism, while 422 did not have subclinical hypothyroidism, as diagnosed using the preoperative thyroid function test. We compared the recurrence rate and association with clinicopathological features in the two groups.

Results

The median patient age was 46.9 years (17–74 years). There were 420 female and 46 male patients. The median follow-up duration was 81.4 months. There were no statistical differences between the two groups with respect to age, sex, tumour size, extrathyroidal extension, multifocality, lymph node metastasis, TNM stages, recurrence and disease-free survival, despite a significant difference in the average TSH concentrations of the two groups.

Conclusions

Our results suggest that preoperative subclinical hypothyroidism was not associated with tumour aggressiveness and recurrence in PTC.
Laparoscopic vs open surgery during the COVID-19 pandemic: what are the risks?
Authors: Hadjittofi C , Seraj SS , Uddin A , Ali ZJ , Antonas PL , Fisher RJ , Parekh KP , Lovett B , Ahmad A
Published: March 2021

Introduction

The initial intercollegiate surgical guidance from the UK during the COVID-19 pandemic resulted in significant changes to practice. Avoidance of laparoscopy was recommended, to reduce aerosol generation and risk of virus transmission. Evidence on the safety profile of laparoscopy during the pandemic is lacking. This study compares patient outcomes and risk to staff from laparoscopic and open gastrointestinal operations during the COVID-19 pandemic.

Methods

Single-centre retrospective study of gastrointestinal operations performed during the peak of the COVID-19 pandemic. Demographic, comorbidity, perioperative and survival data were collected from electronic medical records and supplemented with patient symptoms reported at telephone follow up. Outcomes assessed were: patient mortality, illness among staff, patient COVID-19 rates, length of hospital stay and postdischarge symptomatology.

Results

A total of 73 patients with median age of 56 years were included; 55 (75%) and 18 (25%) underwent laparoscopic and open surgery, respectively. All-cause mortality was 5% (4/73), was related to COVID-19 in all cases, with no mortality after laparoscopic surgery. A total of 14 staff members developed COVID-19 symptoms within 2 weeks, with no significant difference between laparoscopic and open surgery (10 vs 4; p=0.331). Median length of stay was shorter in the laparoscopic versus the open group (4.5 vs 9.9 days; p=0.011), and postdischarge symptomatology across 15 symptoms was similar between groups (p=0.135–0.814).

Conclusions

With appropriate protective measures, laparoscopic surgery is safe for patients and staff during the COVID-19 pandemic. The laparoscopic approach maintains an advantage of shorter length of hospital stay compared with open surgery.
Managing breast gangrene during the COVID-19 pandemic
Authors: Abbas A , Turner N , MacNeill F
Published: March 2021

At the onset of the COVID-19 crisis, a 63-year-old woman with multiple life-limiting comorbidities was referred with a necrotic infected left breast mass on a background of breast cancer treated with conservation surgery and radiotherapy 22 years previously. The clinical diagnosis was locally advanced breast cancer, but four separate biopsies were non-diagnostic. Deteriorating renal function and incipient sepsis and endocarditis resulted in urgent salvage mastectomy during the peak of the COVID19 pandemic. The final diagnosis was infected ischaemic/infarcted breast (wet gangrene) secondary to vascular insufficiency related to diabetes, cardiac revascularisation surgery and breast radiotherapy.
The role of self-expanding vascular stent in superior vena cava syndrome for advanced tumours
Authors: Irace L , Martinelli O , Gattuso R , Mingoli A , Fiori E , Alunno A , Di Girolamo A , Crocetti D , Sapienza P
Published: March 2021

Introduction

Superior vena cava (SVC) syndrome (SVCS) is a life-threatening occurrence that necessitates prompt treatment. At present, endovascular stenting is proposed as a first-line treatment to relieve symptoms. We assessed the effectiveness, safety and outcome of SVC stent positioning in patients affected with advanced cancer.

Methods

Forty-two patients undergoing stent positioning in the SVC for neoplasms from January 2002 to December 2018 form the basis of this retrospective study. Demographic data, risk factors, associated diseases, symptoms at presentation according to the score proposed by Kishi and the type of SVCS according to Sanford and Doty were collected. Minor and major complications were recorded. Suspected stent occlusion was confirmed by means of recurrence of symptoms followed by a confirmatory computed tomography (CT).

Results

Thirty-four (81%) patients had a nonresectable lung tumour invading or compressing the SVC. Five (12%) patients had a non-Hodgkin's lymphoma, and three (7%) had metastatic lymphadenopathies. Nitinol stents (Memotherm®) were employed in 19 (45%) patients, and steel stents (Wallstent™) in the remaining 23 (55%) patients. Thirty-five (85%) patients died during follow up for disease progression and the overall survival rate at 24 months was 11% (standard error (SE)=0.058). Thirteen patients (32%) had a recurrence of SVCS because of stent thrombosis in three (23%) and extrinsic compression from uncontrolled cancer progression in ten (77%). The overall symptom-free interval at 24 months was 57% (SE=0.095).

Conclusions

We recommend the use of the endovascular procedure as a first-line treatment in locally advanced or metastatic tumour in the presence of SVCS.
Photoacoustic tomography reconstruction using lag-based delay multiply and sum with a coherence factor improves in vivo ovarian cancer diagnosis
Authors: Yang Guang , Amidi Eghbal , Zhu Quing
Published: March 2021

Ovarian cancer is the fifth most common cause of death due to cancer, and it is the deadliest of all gynecological cancers. Diagnosing ovarian cancer via conventional photoacoustic delay-and-sum beamforming (DAS) presents several challenges, such as poor image resolution and low lesion to background tissue contrast. To address these concerns, we propose an improved beamformer named lag-based delay multiply and sum combined with coherence factor (DMAS-LAG-CF). Simulations and phantom experiments demonstrate that compared with the conventional DAS, the proposed algorithm can provide 1.39 times better resolution and 10.77 dB higher contrast. For patient data, similar performance on contrast ratios has been observed. However, since the diagnostic accuracy between cancer and benign/normal groups is a significant measure, we have extracted photoacoustic histogram features of mean, kurtosis and skewness. DMAS-LAG-CF can improve cancer diagnosis with an AUC of 0.91 for distinguishing malignant vs. benign ovarian lesions when mean and skewness are used as features.