bluuebunny/crossref_metadata_2025 huggingface dataset:
Simulation training on bedside veno-arterial extracorporeal membrane oxygenation decannulation
Authors: Au Shek Yin , Fong Ka Man , Chan Kwong Shun , Yung Sai Kwong , Leung Rowlina Pui Wah , Leung Avis Siu Ha , So Sze Sze , Ng George Wing Yiu
Published: April 2020

Veno-arterial extracorporeal membrane oxygenation is a form of mechanical circulatory support for patients with refractory decompensated heart failure. Blood is drawn from a large vein and pumped back to a large artery, usually a femoral artery through large bore catheters. When the heart recovers, the extracorporeal membrane oxygenation support can be terminated and the catheters are decannulated. The bleeding at the venous side can be controlled by prolonged compression; however, the arteriotomy wound needs to be repaired. Conventionally, the arteriotomy wounds require open vascular repair in the operating theater. The novel application of percutaneous vascular closure devices, which have been commonly used in vascular operations and percutaneous structural heart interventions, could be applied for closure of arteriotomy wounds at the bedside after extracorporeal membrane oxygenation support. The post-close ProGlide (Abbott Vascular) technique was shown to be safe and could potentially save time and manpower. The wounds are much smaller as compared with the conventional open repair and potentially, the chance of wound infection can be reduced. However, the success of percutaneous bedside closure requires careful prior planning and technique training. Backup plans with vascular surgeons’ standby are essential in case of failure of closure. Staffs in the extracorporeal membrane oxygenation centers need to be familiar with the preparation, the procedure as well as the device application technique for successful percutaneous closure. The long learning curve and the limited case load mean that such skills are best trained by simulation scenarios. This article described how this new technique and the team logistics can be trained by simulation.
Hemodialysis Reliable Outflow graft: A valid option in patients with central venous stenosis
Authors: Figueiredo Ana Carolina , Mira Filipe , Rodrigues Luís , Ferreira Emanuel , Oliveira Nuno , Fonseca Manuel , Anacleto Gabriel , Gonçalves Óscar , Sá Helena , Alves Rui
Published: April 2020

Introduction:

Central venous stenosis can be the main obstacle to the creation of an autologous vascular access in the upper limbs. The Hemodialysis Reliable Outflow graft was developed to provide an upper limb vascular access option to such patients, avoiding alternative, less advantageous options, such as lower limb vascular accesses or central venous catheters. Its advantages include catheter avoidance and, in case of lower limbs accesses, reduction of the ischemic risk and iliac vein thrombosis, potentially compromising a future kidney transplant.

Patients and methods:

Revision of the clinical files of the four patients who were placed a Hemodialysis Reliable Outflow device in our Center, including demographic variables, implantation technique characteristics, surgical complications, episodes of infection and thrombosis of the access, and need to place a transitory central venous catheter to undergo hemodialysis treatment.

Results:

Four Hemodialysis Reliable Outflow grafts were placed, which resulted in a significant improvement in the dialysis efficacy in all patients, with a median raise in the Kt/V of 36.7%. Two cases needed thrombectomy, one of which was unsuccessful. The actual time of patency varies between 3 and 28 months.

Conclusion:

Our experience with the Hemodialysis Reliable Outflow device showed that it was a safe option for patients with central venous stenosis and was associated with good clinical and analytic outcomes.
The many gendered faces of teachers’ views on schools and security
Authors: Holmberg Arita , Alvinius Aida
Published: April 2020

This article analyses the gendered nature of teachers’ views on schools and security. Current research on security emphasizes masculinity and the absence of femininity in relation to the security field – traditionally dominated by the military and emergency rescue services. However, there is a lack of knowledge on the areas of society that are new to the security field. Schools, pupils and teachers are gendered in many ways. What happens when security is added to this nexus? Existing, limited research suggests that this relationship may be both complicated and gendered. A qualitative content analysis is conducted based on interviews with teachers and principals from two municipalities in Sweden. It shows that teachers hold gendered views of their roles as security actors; of pupils in relation to security, as subjects of risks and sources of threats; and of external security threats. Men are embodied as positive or negative actors, whereas women are embodied mostly as powerless actors. Teachers give voice to a discourse focused on everyday insecurities. This is important, as the role of teachers (in particular women) as promoters of democratic citizens risks becoming undermined, and individual perspectives of security risk becoming replaced by national perspectives.
This is the real “death-line” AND I am still alive: A collaborative reflexivity about life trajectories
Authors: Lehmann Olga V. , Hansen Mixo , Hurme Helena
Published: April 2020

In this article, we, Olga Lehmann, Mixo Hansen and Helena Hurme, engage in a process of collaborative reflexivity upon living, aging, and dying as we attempt to make sense of the illnesses of the last author. The companionship that emerged between us in the plurality of our identities as friends, colleagues, coauthors, and women, encouraged us to revisit aspects of the theories in developmental-cultural psychology such as (a) the process of meaning-making, (b) the equifinality model in relation to aging and dying, and (c) the notion of personal life philosophies in relation to virtues. Based on our personal experiences as well as our collaborative reflexivity as scholars, we highlight that developmental-cultural psychology could more explicitly address existential transitions, such as dying and existential givens, such as uncertainty in its theories. We present as well some preliminary integrations between existential and cultural perspectives of meaning-making.
Gender differentiation in the family drawings of Israeli, Jewish-orthodox preschoolers
Authors: Karniol Rachel
Published: April 2020

Preschool children from Israeli, Jewish-Orthodox families with an average of four children per family drew their families. Three aspects of gender differentiation in children’s drawings were assessed in relation to children’s gender and number of siblings: size of figures, colour use, and inclusion of gender-associated characteristics. Size of drawings reflected gender differentiation, with fathers being drawn larger than mothers. Boys, and children with more siblings, drew both their mothers and their fathers larger. Colour use did not differ by children’s gender or number of siblings. Girls evidenced greater gender differentiation in their drawings, including more gender-associated characteristics than boys, both in their drawings of children, and in their drawings of adults. Finally, children who showed no differentiation between parents in terms of gender-associated characteristics drew both mothers and fathers smaller than children who showed such gender differentiation, and boys who did not use a variety of colours in their drawings drew their fathers larger than their mothers, whereas those who used a variety of colours, drew their parents the same size, indicating that the measures of gender differentiation are related. The results were discussed in terms of children’s emerging gender differentiation of self and others in large families.
Reflections on combining action research and actor-network theory
Authors: Piovesan Federico
Published: April 2020

In this paper, I address two questions: do their dissimilarities prevent action research and actor-network theory from being used together? If not, how can they complement each other? To do so, I discuss literature from each approach, the only two studies I found that combine action research and actor-network theory (both from organization management) and anecdotes from my field-work experience on the participatory management of urban spaces. On one hand, combining action research and actor-network theory helped me deal with the unpredictability of collaborative research projects by (1) helping me adapt to circumstances while remaining aware of my agency and (2) report systematically on diverse interactions while also letting a shared vocabulary and narrative emerge. On the other, my adherence to the principles of each approach and the comparability of my experience were affected by a lack of both time and control over the processes in which I was involved. I hope to support a debate that crosses disciplinary and methodological boundaries about the realities of doing collaborative inquiry, not by seeking normative statements about research practice, but by emphasizing how the latter cannot exist without a complex network of relations that inevitably affect its validity.
Evaluation and prediction of fused fabric composites properties – A review
Authors: Sudhakar R , Renjini G
Published: April 2020

Garment parts are fused with an interlining for achieving a specific handle, form and fall. Fusing helps in ease of construction of garment parts enabling pucker-free and clean look in finished products. The properties of the fused components are considered essential for enhancing garment aesthetics and functionality. The main objective of this review is to elaborate the factors affecting the properties of fused fabric composites, the methods to evaluate the same and explore the models that aid in better selection of interlinings for a specific hand and functionality. Interlinings are available in a variety of fibre content, base fabric structure, weight, finish, resin type and resin content. These attributes influence the characteristics of fused fabric composites. They are essential criteria in interlining selection for a given application. Mechanical properties used to evaluate and predict the fused fabric behaviour objectively are discussed. The most important mechanical properties that describe the characteristics of fused fabric composites are bending rigidity, shear rigidity, tensile properties, drape and dimensional stability of the component fabrics. Objective and subjective methods used to evaluate these properties are elaborated. The methods employed in determining the optimum fusing conditions and fused composite quality include theoretical, statistical, numerical, and computational modelling. A better understanding of the properties of fused fabric composites leads to optimisation in the interlining selection and fusing process for a given hand feel and application.
Impact of early division of the middle cerebral artery on outcome following mechanical thrombectomy
Authors: Styczen Hanna , Maus Volker , Hesse Amélie C , Goertz Lukas , Fischer Sebastian , Riedel Christian , Forsting Michael , Radbruch Alexander , Behme Daniel
Published: April 2020

Background

Mechanical thrombectomy has become the standard care for acute ischemic stroke caused by large vessel occlusion. However, complete reperfusion cannot be achieved in all cases, and several factors influencing the results of mechanical thrombectomy have been investigated. Among others, a tortuous anatomy is associated with lower rates of complete reperfusion. We aimed to investigate whether an early division of the middle cerebral artery has an impact on reperfusion results in mechanical thrombectomy.

Methods

Retrospective review of consecutive patients with M1 occlusion treated endovascularly between January 2016 and December 2019 at three tertiary care centers. The study group was dichotomized based on the length of the M1 segment. Early division of the middle cerebral artery was defined as a maximum length of 10 mm of the M1 segment. Primary endpoints were first-pass mTICI scores of 3, ≥2c, and ≥2b. Secondary endpoints contained final reperfusion, number of device-passes, time interval from groin puncture to reperfusion, rate of postinterventional symptomatic intracranial hemorrhage, and frequency of emboli of new territory.

Results

Among 284 included patients, 70 presented with an early division of the M1 segment (25%). Reperfusion results did not differ significantly between early and late division of M1. A higher rate of symptomatic intracranial hemorrhage was found in the group with an early M1 division treated with aspiration only (14.3% vs. 0%; p = 0.013). Patients with late M1 division had a significantly higher rate of large artery sclerosis (19.2% vs. 8.6%, p = 0.039).

Conclusion

The anatomic variant of an early division of the middle cerebral artery was not a predictor for incomplete reperfusion.
Numerical study of the greenhouse solar drying of olive mill wastewater under different conditions
Authors: Bouraoui Chaima , Ben Nejma Fayçal
Published: April 2020

The aim of this work is to develop thermal modeling of the olive mill wastewater drying process in a greenhouse solar dryer. A configuration was thus proposed and simulated using the commercial software COMSOL Multiphysics in order to solve the conservation equations governing our problem. The resulting simulations are used to evaluate the temperature, velocity, and vapor mass fraction distributions after hours of sunshine and to provide a quantification of the drying process. The influence of the greenhouse effect on the drying kinetics is highlighted by comparing to open sun-drying results. The effect of some greenhouse geometric characteristics and external meteorological conditions are studied.
Effects of Low Molecular Weight Fucoidan on the Proliferation and Apoptosis of Dysplastic Oral Keratinocyte and Oral Squamous Cell Carcinoma Cells
Authors: Li Lulu , Xu Yingjie , Wang Yixue , Liu Mengjia , Deng Songsong , Yu Xixi , Cong Beibei , Wang Wanchun
Published: April 2020

Oral squamous cell carcinoma (OSCC) is one of the most common malignant tumors with high incidence, rapid progress, and high mortality. There are still some defects in the treatments of OSCC, which seriously affect the quality of patients’ life. Therefore, it is urgent to find a safer and more effective treatment for OSCC. Low molecular weight fucoidan (LMWF) has various biological activities, such as antitumor, anti-inflammatory, and antithrombotic, and has no obvious side effects, but the effect of LMWF on OSCC has not been reported. In this study, the effects of LMWF on dysplastic oral keratinocyte (DOK) and OSCC cells SCC-9 and SCC-25 were detected by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide assay, flow cytometry, TUNEL, colony formation, and wound healing assay, and the expression levels of Notch-1 and Jagged-1 treated with LMWF were detected by RT-qPCR. The results showed that LMWF could inhibit the proliferation and migration of DOK and SCC-9, and promote apoptosis. Low molecular weight fucoidan upregulated the expression of Notch-1 and Jagged-1 in DOK and SCC-9 cells. It indicated that LMWF might promote the apoptosis of DOK and SCC-9 by upregulating the Notch signal pathway, thereby inhibiting cell proliferation and playing an antitumor role. It provided theoretical basis to develop LMWF as a novel therapeutic drug for oral cancer.
Dysbiosis of Fecal Microbiota in Allergic Rhinitis Patients
Authors: Liu Xiang , Tao Jing , Li Jing , Cao Xiaolin , Li Yong , Gao Xuefeng , Fu Yong
Published: April 2020

Background

The gut microbiota plays an important role in shaping the immune system and may be closely connected to the development of allergic diseases.

Objective

This study aimed to determine the gut microbiota composition in Chinese allergic rhinitis (AR) patients as compared with healthy controls (HCs).

Methods

We collected stool samples from 93 AR patients and 72 age- and sex-matched HCs. Gut microbiota composition was analyzed using QIIME targeting the 16S rRNA gene. Functional pathways were predicted using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States. Statistical analysis was performed using the R program, linear discriminant analysis effect size (LefSe), analysis of QIIME, and statistical analysis of metagenomic profiles, among other tests.

Results

Compared with HCs, AR patients had significantly lower gut-microbiota α-diversity ( P < .001). The gut microbiota composition significantly differed between the 2 study groups. At the phylum level, the relative abundance of Bacteroidetes was higher while those of Actinobacteria and Proteobacteria were lower in the AR group than in the HC group ( P < .001, q < 0.001). At the genus level, Escherichia-Shigella, Prevotella, and Parabacteroides ( P < .001, q < 0.001) had significantly higher relative abundances in the AR group than in the HC group. LefSe analysis indicated that Escherichia-Shigella, Lachnoclostridium, Parabacteroides, and Dialister were potential biomarkers for AR. In addition, predictive metagenome functional analysis showed that pyruvate, porphyrin, chlorophyll, purine metabolism, and peptidoglycan biosynthesis significantly differed between the AR and HC groups.

Conclusion

A comparison of the gut microbiota of AR patients and HCs suggested that dysbiosis of the fecal microbiota is involved in the development of AR. The present results may reveal key differences and identify targets for preventive or therapeutic intervention.
Increase in Free and Total Plasma TGF-β1 Following Physical Activity
Authors: Han Ashley J. , Alexander Louie C. , Huebner Janet L. , Reed Alexander B. , Kraus Virginia B.
Published: April 2020

Objective

To evaluate effects of physical activity and food consumption on plasma concentrations of free and total transforming growth factor beta-1 (TGF-β1), beta-2 (TGF-β2), and beta-3 (TGF-β3) in individuals with knee osteoarthritis (OA).

Methods

Participants ( n = 40 in 2 cohorts of 20; mean age 70 years) with radiographic knee OA were admitted overnight for serial blood sampling. Cohorts 1 and 2 assessed the impacts of food intake and activity, respectively, on TGF-β concentrations. Cohort 1 blood draws included 2 hours postprandial the evening of day 1 (T3), fasting before rising on day 2 (T0), nonfasting 1 hour after rising (T1B), and 4 hours after rising (T2). Cohort 2 blood draws included T3, T0, fasting 1 hour after rising and performing activities of daily living (T1A), and nonfasting 2 hours after rising (T1B). By sandwich ELISAs, we quantified plasma free and total TGF-β1 concentrations in all samples, and plasma total TGF-β2 and TGF-β3 in cohort 2.

Results

Free TGF-β1 represented a small fraction of the total systemic concentration (mean 0.026%). In cohort 2, free and total TGF-β1 and total TGF-β2 concentration significantly increased in fasting samples collected after an hour (T1A) of activities of daily living (free TGF-β1: P = 0.006; total TGF-β1: P < 0.001; total TGF-β2: P = 0.001). Total TGF-β3 increased nonsignificantly following activity ( P = 0.590) and decreased ( P = 0.035) after food consumption while resting (T1B).

Conclusions

Increased plasma concentrations of TGF-β with physical activity suggests activity should be standardized prior to TGF-β1 analyses.
The role of romiplostim for pediatric patients with immune thrombocytopenia
Authors: Al-Samkari Hanny , Grace Rachael F. , Kuter David J.
Published: April 2020

The thrombopoietin receptor agonists (TPO-RAs) are a class of platelet growth factors used to treat immune thrombocytopenia (ITP) in children and adults. Romiplostim is a peptide TPO-RA approved for over a decade to treat adults with ITP but was just recently US Food and Drug Administration approved to manage ITP in children 1 year of age and older who have had an inadequate response to corticosteroids, intravenous immunoglobulin, or splenectomy. Like the small molecule TPO-RA eltrombopag, romiplostim offers a high clinical response rate in pediatric patients with ITP, but requires use over an extended, and possibly indefinite, duration. This review is a critical appraisal of the role of romiplostim in pediatric ITP, discussing the safety and efficacy of this agent in clinical trials of children and adults and defining the patients most likely to benefit from romiplostim treatment. The treating hematologist is additionally provided guidance with treatment goals, dosing strategies, toxicity management, and indications for discontinuation.
Spinal surgery and urinary retention: A review of the literature
Authors: Kopel Jonathan , Sharma Dr Pranav
Published: April 2020

Objective:

Postoperative urinary retention is a common complication for patients recovering from general anesthesia or invasive surgery near the spinal column. However, no study has systematically reviewed the incidence of postoperative urinary retention for spinal surgeries performed at the cervical, thoracic, or lumbar spinal regions. In this review, we critically analyze and summarize the known literature on the incidence and risk factors associated with postoperative urinary retention after spinal surgery.

Methods:

A comprehensive literature review was performed at the end of September 2019 within the PubMed database.

Results:

The average incidence of postoperative urinary retention from nine of the 10 studies was 17.2% with one paper that did not report on postoperative urinary retention incidence. Furthermore, age, male gender, location and history of spinal surgery, duration of surgery, benign prostatic hypertrophy, and Foley catheter were reported as major risk factors for postoperative urinary retention and spinal surgery.

Conclusion:

Overall, spinal cord and postoperative urinary retention remains a poorly understood area requiring further investigation into the incidence, risk factors, and surgical methods influence postoperative urinary retention and post-operative outcomes. We believe an overview of such data can help revise guidelines for the management of postoperative urinary retention and raise awareness of its prevalence in elderly patients undergoing spinal surgery.

Level of evidence:

Not applicable for this multicentre audit.
#selfharn on Instagram: understanding online communities surrounding non-suicidal self-injury through conversations and common properties among authors
Authors: Fulcher Jory A. , Dunbar Sarah , Orlando Elizabeth , Woodruff Sarah J. , Santarossa Sara
Published: April 2020

Objectives

#selfharm has been blocked by Instagram, but manoeuvring hashtags (e.g. #selfharn) are beginning to appear in order for secret non-suicidal self-injury (NSSI) communities to communicate. The purpose of this study was to (a) determine the nature of the #selfharn conversation on Instagram, (b) analyze common properties of the visual content (i.e. images and videos; n = 93) tagged with #selfharn, and (c) discover what kind of environment the authors ( n = 50) of #selfharn were creating.

Methods

A multi-method approach was utilized for this study. Netlytic was used to generate a text and content analysis to examine the authors’ captions and comments ( n = 8772) associated with #selfharn (collected over a seven-day period).

Results

After removing #selfharn from the dataset, the text analysis revealed that #depression ( n = 3081) and #suicide ( n = 2270) were the most commonly used terms associated with #selfharn. Overall, 52% ( n = 4386) of the popular words/phrases related with #selfharn posts were categorized as ‘bad feelings’. Through manual coding, it was determined that the majority of #selfharn visual content ( n = 92; 99%) did not generate an advisory warning but did contain a wound ( n = 70; 75%). The #selfharn author analysis suggests that most were women ( n = 18; 36%) with a dark-coloured profile aesthetic ( n = 37; 74%) determined by an overwhelming amount of grey, black, blue, red, or purple colours.

Conclusion

According to the text and content analyses, #selfharn on Instagram may be contributing negatively to an online community of mental-health issues. More resources should be provided by Instagram to those who are involved in the NSSI Instagram community.
Thinking Outside the Black-Box: The Case for “Algorithmic Sovereignty” in Social Media
Authors: Reviglio Urbano , Agosti Claudio
Published: April 2020

This article is an interdisciplinary critical analysis of personalization systems and the gatekeeping role of current mainstream social media. The first section presents a literature review of data-driven personalization and its challenges in social media. The second section sheds light on increasing concerns regarding algorithms’ ability to overtly persuade—and covertly manipulate—users for the sake of engagement, introducing the emergence of the exclusive ownership of behavioral modification through hyper-nudging techniques. The third section empirically analyzes users’ expectations and behaviors regarding such data-driven personalization to frame a conceptualization of users’ agency. The fourth section introduces the concept of “algorithmic sovereignty.” Current projects that aim to grant this algorithmic sovereignty highlight some potential applications. Together this novel theoretical framework and empirical applications suggest that, to preserve trust, social media should open their personalization algorithms to a social negotiation as the first step toward a more sustainable social media landscape. To decentralize the immense power of mainstream social media, guarantee a democratic oversight, and mitigate the unintended undesirable consequences of their algorithmic curation, public institutions and civil society could help in developing and researching public algorithms, fostering a collective awareness so as to eventually ensure a fair and accountable “algorithmic sovereignty.”
Reproducibility of calcium scoring of the coronary arteries: comparison between different vendors and iterative reconstructions
Authors: Choi Kyu Sung , Lee Whal , Jung Joon Hyung , Park Eun-Ah
Published: April 2020

Background

The coronary artery calcium scoring (CCS) has been widely used for cardiac risk stratification for asymptomatic patients.

Purpose

To assess the reproducibility of CCS performed on four different computed tomography (CT) scanners, and compare the variability between two reconstruction algorithms, filtered back projection (FBP), and iterative reconstruction (IR).

Material and Methods

A CCS phantom was made from agar and contained 23 pieces of chicken bones. The phantom was repeatedly scanned using four different CT scanners: Toshiba; GE; Philips; and Siemens. Images were reconstructed using FBP and IR. Agatston and volume scores of total bone fragments were calculated and the overall differences between the instruments were evaluated using the Friedman test. Comparison of the Agatston and volume scores between the two reconstruction algorithms, for each instrument, was evaluated using the Wilcoxon signed rank test.

Results

The difference in the Agatston scores was significantly different between the four machines ( P = 0.001). The Toshiba scanner yielded the highest score followed by Philips, GE, and Siemens scanners. There was no difference in the CCS evaluated using the two reconstruction algorithms, except in case of the Siemens scanner ( P = 0.032).

Conclusion

CCS performed on different scanners varied significantly. In the Toshiba, Philips, and GE scanners, there was no significant difference in the CCS determined using either an IR or the FBP algorithm. In the Siemens scanner, applying the IR algorithm resulted in a slightly different scores, which might not be clinically significant.
Increasing the Signal-to-Noise Ratio: COVID-19 Clinical Synopsis for Outpatient Providers
Authors: Sartor Zach , Hess Burritt
Published: April 2020

The novel coronavirus (SARS-CoV-2), which is the cause of coronavirus disease (COVID-19 formally 2019-nCoV), has received widespread attention from the medical community. Despite the rapid publication of research on the virus and the disease it causes, there is a lack of concise and relevant material to help busy medical providers navigate recognition and management of the disease in the ambulatory setting. This review article aims to bridge this gap by briefly reviewing the key points of the evaluation and treatment of patients with COVID-19 in the ambulatory clinic environment.
Increasing Diagnostic Emphasis on Negative Affective Dysfunction: Potentially Negative Consequences for Psychiatric Classification and Diagnosis
Authors: Stanton Kasey
Published: April 2020

Maladaptive experiences of negative mood states and difficulties regulating them, collectively referred to here as negative affective dysfunction, are linked robustly to many disorders. Despite negative affective dysfunction being a nonspecific psychopathology feature, the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders ( DSM–5) introduced new (a) disorders and (b) features to existing disorders intended to capture manifestations of negative affective dysfunction. This theoretical article highlights why these additions may exacerbate issues concerning disorder overlap and differential diagnosis. Specific examples are provided to support this viewpoint, including potential consequences of emphasizing negative affective dysfunction within the diagnostic criteria for attention-deficit/hyperactivity disorder. Although researchers likely will continue to disagree about how to best classify negative affective dysfunction (e.g., using dimensions vs. categories), I argue that we can reach common ground as a field by recognizing that caution is needed when proposing new DSM–5 additions to capture nonspecific psychopathology features.
Understanding Patient Expectations of Health Care: A Qualitative Study
Authors: El-Haddad Carlos , Hegazi Iman , Hu Wendy
Published: April 2020

Understanding and measuring patient expectations of health care is central to improving patient satisfaction and delivering patient-centered care. However, most empiric research in this field has focused on measuring patient expectations for specific diseases only. Patient expectations common to a variety of settings and clinical contexts need to be better understood to design measures with wider utility. We aimed to understand how patients express and conceptualize their expectations of health care across a range of clinical contexts and conditions. Semi-structured interviews were conducted with patients presenting to a major metropolitan hospital, informed by interpretive phenomenological analysis. Sampling continued until thematic saturation. Interview topics explored the illness experience, interactions with clinicians, how patients communicated and conceptualized their expectations of health care, and the nature of these expectations. The 26 participants conceptualized and described their expectations in 3 distinct domains: (1) health outcomes, (2) individual clinicians, and (3) the health-care system. Importantly, these domains were consistent across a variety of clinical contexts, participant demographics, and medical conditions. Despite variation in expectations due to individual patient circumstances, we identified 3 conceptual domains within which expectations consistently lie. When designing measurement tools for patient expectations, we suggest incorporating questions specifically addressing the 3 domains we have identified. With such measures, clinicians and health-care providers can be empowered to provide and monitor patient-centered care with outcomes tailored to what patients desire.
Bendamustine-induced immune hemolytic anemia: a case report and systematic review of the literature
Authors: Chan Maverick , Silverstein William K. , Nikonova Anna , Pavenski Katerina , Hicks Lisa K.
Published: April 2020

Key Points

Bendamustine can cause severe autoimmune hemolytic anemia (AIHA), which may require plasma exchange and aggressive immunosuppression. Bendamustine-induced AIHA can be delayed, and many, but not all, cases report prior exposure to fludarabine.
Haploidentical BMT for severe aplastic anemia with intensive GVHD prophylaxis including posttransplant cyclophosphamide
Authors: DeZern Amy E. , Zahurak Marianna L. , Symons Heather J. , Cooke Kenneth R. , Rosner Gary L. , Gladstone Douglas E. , Huff Carol Ann , Swinnen Lode J. , Imus Philip , Borrello Ivan , Wagner-Johnston Nina , Ambinder Richard F. , Luznik Leo , Bolaños-Meade Javier , Fuchs Ephraim J. , Jones Richard J. , Brodsky Robert A.
Published: April 2020

Severe aplastic anemia (SAA) is a stem cell disorder often treated with bone marrow transplantation (BMT) to reconstitute hematopoiesis. Outcomes of related HLA-haploidentical (haplo) donors after reduced-intensity conditioning with intensive graft-versus-host disease (GVHD) prophylaxis including posttransplantation cyclophosphamide are presented here from 37 SAA, 20 relapsed/refractory (R/R), and 17 treatment-naïve (TN) SAA patients. Median follow-up is 32 months (90% confidence interval [CI], 29-44). The median age was 25 (range, 4-69) years. The median time to neutrophil recovery was 17 days (range, 15-88). Four of 37 patients (11%) experienced graft failure (GF). There was 1 primary GF of 20 patients in the R/R group and 3 of 17 in the TN group at 200 cGy (1 primary, 2 secondary), but none in the 10 patients who received 400 cGy total body irradiation. Two patients with GF succumbed to infection and 2 were rescued with second haplo BMT. The overall survival for all patients is 94% (90% CI, 88-100) at 1 and 2 years. The cumulative incidence of grade II-IV acute GVHD at day 100 is 11%. The cumulative index of chronic GVHD at 2 years is 8%. Similar results were seen in 10 SAA patients who received the identical nonmyeloablative regimen with posttransplant cyclophosphamide but matched donor transplants. Haplo BMT with posttransplant cyclophosphamide represents a potential cure in SAA, with all 20 R/R currently alive, disease-free, and with no evidence of active GVHD. Extending this approach to TN patients was associated with higher GF rates, but an increase in total body irradiation dose to 400 cGy was associated with durable engraftment without greater early toxicity. Nonmyeloablative haplo BMT in TN SAA could lead to a paradigm shift, such that essentially all patients can proceed quickly to safe, curative BMT. These trials were registered at www.cincialtrials.gov as #NCT02224872) and #NCT02833805.
Transcriptome profiling of developing testes and spermatogenesis in the Mongolian horse
Authors: Li Bei , He Xiaolong , Zhao Yiping , Bai Dongyi , Du Ming , Song Lianjie , Liu Zhuang , Yin Zhenchen , Manglai Dugarjaviin
Published: April 2020

Background

Horse testis development and spermatogenesis are complex physiological processes.

Methods

To study these processes, three immature and three mature testes were collected from the Mongolian horse, and six libraries were established using high-throughput RNA sequencing technology (RNA-Seq) to screen for genes related to testis development and spermatogenesis.

Results

A total of 16,237 upregulated genes and 8,641 downregulated genes were detected in the testis of the Mongolian horse. These genes play important roles in different developmental stages of spermatogenesis and testicular development. Five genes with alternative splicing events that may influence spermatogenesis and development of the testis were detected. GO (Gene ontology) and KEGG (Kyoto Encyclopedia of Genes and Genomes) pathway analyses were performed for functional annotation of the differentially expressed genes. Pathways related to “spermatogenesis,” male gamete generation,” “spermatid development” and “oocyte meiosis” were significantly involved in different stages of testis development and spermatogenesis.

Conclusion

Genes, pathways and alternative splicing events were identified with inferred functions in the process of spermatogenesis in the Mongolian horse. The identification of these differentially expressed genetic signatures improves our understanding of horse testis development and spermatogenesis.
Extensively drug-resistant Haemophilus influenzae – emergence, epidemiology, risk factors, and regimen
Authors: Su Pei-Yi , Huang Ay-Huey , Lai Chung-Hsu , Lin Hsiu-Fang , Lin Tsun-Mei , Ho Cheng-Hsun
Published: April 2020

Background

Concern about Haemophilus influenzae infection has been increasing over recent decades. Given the emergence of H. influenzae with severe drug resistance, we assessed the prevalence of as well as risk factors and potential therapies for extensively drug-resistant (XDR) H. influenzae infection in Taiwan.

Results

In total, 2091 H. influenzae isolates with disk diffusion-based antibiotic susceptibility testing from 2007 to 2018 were enrolled. H. influenzae strains resistant to ampicillin, chloramphenicol, levofloxacin, and trimethoprim-sulfamethoxazole tended to be isolated from patient wards (≧41%), whereas those resistant to amoxicillin-clavulanate, cefotaxime, and cefuroxime were more likely to be isolated from intensive care units (approximately 50%). XDR H. influenzae was first identified in 2007, and its incidence did not significantly change thereafter. Overall prevalence of single, multiple, and extensively drug-resistant H. influenzae over 2007–2018 was 21.5% (n = 450), 26.6% (n = 557), and 2.5% (n = 52), respectively. A stepwise logistic regression analysis revealed that blood culture (odds ratio: 4.069, 95% confidence intervals: 1.339–12.365, P = 0.013) was an independent risk factor for XDR H. influenzae infection. No nosocomial transmission of XDR H. influenzae observed. Antibiotic susceptibility testing results demonstrated that cefotaxime was effective against 78.8% (n = 41) of the XDR strains.

Conclusions

The presence of XDR H. influenzae strains was identified in Taiwan, and cefotaxime was efficacious against most of these strains.
Identification of the Eutrema salsugineum EsMYB90 gene important for anthocyanin biosynthesis
Authors: Qi Yuting , Gu Caihong , Wang Xingjun , Gao Shiqing , Li Changsheng , Zhao Chuanzhi , Li Chuanshun , Ma Changle , Zhang Quan
Published: April 2020

Background

Anthocyanins contribute to coloration and antioxidation effects in different plant tissues. MYB transcription factors have been demonstrated to be a key regulator for anthocyanin synthesis in many plants. However, little information was available about the MYB genes in the halophyte species Eutrema salsugineum.

Result

Here we report the identification of an important anthocyanin biosynthesis regulator EsMYB90 from Eutrema salsugineum, which is a halophyte tolerant to multiple abiotic stresses. Our phylogenetic and localization analyses supported that EsMYB90 is an R2R3 type of MYB transcription factor. Ectopic expression of EsMYB90 in tobacco and Arabidopsis enhanced pigmentation and anthocyanin accumulation in various organs. The transcriptome analysis revealed that 42 genes upregulated by EsMYB90 in 35S:EsMYB90 tobacco transgenic plants are required for anthocyanin biosynthesis. Moreover, our qRT-PCR results showed that EsMYB90 promoted expression of early (PAL, CHS, and CHI) and late (DFR, ANS, and UFGT) anthocyanin biosynthesis genes in stems, leaves, and flowers of 35S:EsMYB90 tobacco transgenic plants.

Conclusions

Our results indicated that EsMYB90 is a MYB transcription factor, which regulates anthocyanin biosynthesis genes to control anthocyanin biosynthesis. Our work provides a new tool to enhance anthocyanin production in various plants.
Higher fatty liver index is associated with increased risk of new onset heart failure in healthy adults: a nationwide population-based study in Korea
Authors: Roh Jae-Hyung , Park Jae-Hyeong , Lee Hanbyul , Yoon Yong-Hoon , Kim Minsu , Kim Yong-Giun , Park Gyung-Min , Lee Jae-Hwan , Seong In-Whan
Published: April 2020

Background

Heart failure (HF) is relatively common cardiovascular disease with high mortality and morbidity. Although it is associated with many cardiovascular risk factors, the association between nonalcoholic fatty liver disease (NAFLD), the most common chronic liver disease, and HF has not been evaluated in a large-scale cohort study. Thus, we evaluated the ability of the fatty liver Index (FLI), a surrogate marker of NAFLD, to predict the development of HF in healthy individuals.

Methods

We analyzed the association between the FLI and new-onset HF with multivariate Cox proportional-hazards models in 308,578 healthy persons without comorbidities who underwent the National Health check-ups in the republic of Korea from 2009 to 2014.

Results

A total of 2532 subjects (0.8%) were newly diagnosed with HF during the study period (a median of 5.4 years). We categorized our subjects into quartile groups according to FLI (Q1, 0–4.9; Q2, 5.0–12.5; Q3, 12.6–31.0; and Q4, > 31.0). The cumulative incidence of HF was significantly higher in the highest FLI group than in the lowest FLI group (Q1, 307 [0.4%] and Q4, 890 [1.2%]; P < 0.001). Adjusted hazard ratio (HRs) indicated that the highest FLI group was independently associated with an increased risk for HF (HR between Q4 and Q1, 2.709; 95% confidence interval = 2.380–3.085; P < 0.001). FLI was significantly associated with an increased risk of new-onset HF regardless of their baseline characteristics.

Conclusions

Higher FLI was independently associated with increased risk of HF in a healthy Korean population.
Brazilian cardio-oncology: the 10-year experience of the Instituto do Cancer do Estado de Sao Paulo
Authors: Costa Isabela B. S. da S. , Bittar Cristina S. , Fonseca Silvia M. R. , e Silva Carolina M. P. D. , dos Santos Rehder Marilia H. H. , Rizk Stéphanie I. , Cruz Cecilia B. B. V. , Figueiredo Clara S. , de A. Andrade Fernanda T. , Barberino Ludmila de A. , de S. Costa Fernanda A. , Machado Letticya P. , González Thalita B. , Almeida Marcel P. C. , Fukushima Julia T. , Kalil Filho Roberto , Hajjar Ludhmila Abrahao
Published: April 2020

Background

In recent years, the field of cardio-oncology has grown worldwide, bringing benefits to cancer patients in terms of survival and quality of life. This study reports the experience of a pioneer cardio-oncology programme at University Cancer Hospital in Brazil over a period of 10 years, describing the clinical profile of patients and the clinical outcomes.

Methods

A retrospective study was conducted on a cohort of patients treated at the cardio-oncology programme from April 2009 to February 2019. We analysed the characteristics of patients and outcomes, including mortality, according to the type of clinical indication for outpatient care (general cardiology, perioperative evaluation and follow-up and treatment cardiotoxicity).

Results

From a total of 26,435 medical consultations, we obtained the data of 4535 individuals among the medical care outpatients. When we analysed the clinical characteristics of patients considering the clinical indication - general cardiology, perioperative evaluation and cardiotoxicity outpatient clinics, differences were observed with respect to age (59 [48–66], 66 [58–74] and 69 [62–76], p < 0.001), diabetes (67 [15%], 635 [22.6%] and 379 [29.8%]; p < 0.001), hypertension (196 [43.8%], 1649 [58.7%] and 890 [70.1%], p < 0.001) and dyslipidaemia (87 [19.7%), 735 [26.2%] and 459 [36.2%], p < 0.001). A similar overall mortality rate was observed in the groups (47.5% vs. 45.7% vs. 44.9% [p = 0.650]).

Conclusion

The number of oncologic patients in the Cardio-Oncology Programme has grown in the last decade. A well-structured cardio-oncology programme is the key to achieving the true essence of this area, namely, ongoing care for cancer patients throughout the disease treatment process, optimizing their cardiovascular status to ensure they can receive the best therapy against cancer.
“Midwives do not appreciate pregnant women who come to the maternity with torn and dirty clothing”: institutional delivery and postnatal care in Torit County, South Sudan: a mixed method study
Authors: Bayo Pontius , Belaid Loubna , Tahir Elijo Omoro , Ochola Emmanuel , Dimiti Alexander , Greco Donato , Zarowsky Christina
Published: April 2020

Background

South Sudan has one of the highest maternal mortality ratios in the world, at 789 deaths per 100,000 live births. The majority of these deaths are due to complications during labor and delivery. Institutional delivery under the care of skilled attendants is a proven, effective intervention to avert some deaths. The aim was to determine the prevalence and explore the factors that affect utilization of health facilities for routine delivery and postnatal care in Torit County, South Sudan.

Methods

A convergent parallel mixed method design combined a community survey among women who had delivered in the previous 12 months selected through a multistage sampling technique (n = 418) with an exploratory descriptive qualitative study. Interviews (n = 19) were conducted with policymakers, staff from non-governmental organizations and health workers. Focus group discussions (n = 12) were conducted among men and women within the communities. Bivariate and multivariate logistic regression were conducted to determine independent factors associated with institutional delivery. Thematic analysis was undertaken for the qualitative data.

Results

Of 418 participants who had delivered in the previous 12 months, 27.7% had institutional deliveries and 22.5% attended postnatal care at least once within 42 days following delivery. Four or more antenatal care visits increased institutional delivery 5 times (p < 0.001). The participants who had an institutional delivery were younger (mean age 23.3 years old) than those who had home deliveries (mean age 25.6 years). Any previous payments made for delivery in the health facility doubled the risk of home delivery (p = 0.021). Women were more likely to plan and prepare for home delivery than for institutional delivery and sought institutional delivery when complications arose. Perceived poor quality of care due to absence of health staff and lack of supplies was reported as a major barrier to institutional delivery. Women emphasized fear of discrimination based on social and economic status. Unofficial payments such as soap and sweets were reported as routine expectations and another major barrier to institutional delivery.

Conclusion

Interventions to stop unofficial payments and discrimination based on socio-economic status and to increase access to ANC, delivery services and PNC are needed.