bluuebunny/crossref_metadata_2025 huggingface dataset:
Cost-effectiveness of CT perfusion for patients with acute ischemic stroke (CLEOPATRA)-Study protocol for a healthcare evaluation study
Authors: Koopman Miou S , Hoving Jan W , van Voorst Henk , Daems Jasper D , Peerlings Daan , Buskens Erik , Lingsma Hester F , Marquering Henk A , de Jong Hugo WAM , Berkhemer Olvert A , van Zwam Wim H , van Walderveen Marianne AA , van den Wijngaard Ido , van der Lugt Aad , Dippel Diederik WJ , Yoo Albert J , Campbell Bruce CV , Kunz Wolfgang G , Majoie Charles BLM , Emmer Bart J ,   for the CLEOPATRA Investigators
Published: April 2022

Introduction:

Computed tomography perfusion (CTP) is variably considered to assess eligibility for endovascular thrombectomy (EVT) in acute ischemic (AIS) stroke patients. Although CTP is recommended for patient selection in later (6–24 h) time window, it is currently not recommended in the earlier (0–6 h) time window and the costs and health effects of including CTP for EVT selection remain unknown. We aim to estimate the costs and health effects of using CTP for EVT selection in AIS patients compared to conventional selection.

Patients and methods:

CLEOPATRA is a healthcare evaluation study using clinical and imaging data from multiple, prospective EVT trials and registries in both the earlier and later time windows. To study the long-term health and cost effects, we will construct a (“Markov”) health state transition model simulating the clinical outcome over a 5-year follow-up period for CTP-based and conventional selection for EVT. Clinical data acquired within the current study and estimates from the literature will be used as input for probabilities of events, costs, and Quality-Adjusted Life Years (QALYs) per modified Rankin Scale (mRS) subscore. Primary outcome for the cost-effectiveness analysis will be the Incremental Cost-Effectiveness Ratio (ICER) in terms of costs per QALY gained over the simulated follow-up period.

Study outcomes:

Outcome measures will be reported as cumulative values over a 5-year follow-up period.

Discussion:

This study will provide preliminary insight into costs and health effects of including CTP in the selection for EVT for AIS patients, presenting between 0 and 24 h after time last known well. The results may be used to develop recommendations and inform further implementation projects and studies.
Creating Enterprise Ecosystem in Left Wing Extremism Affected Areas: A Case on Inclusive Entrepreneurship
Authors: Gupta Rajesh , Sahu Akash , Sinha Piyush Kumar
Published: April 2022

Rural development is a key component and main pillar of the approach towards the development of the nation. Inclusive entrepreneurship (IE) has been propounded to support development of enterprises for the disfranchised and underprivileged section of population. This article studies the IE framework, as developed by the Organisation for Economic Co-operation and Development (OECD) and implemented in many European countries, and applies the same to a village entrepreneurship development programme in left wing extremism affected rural areas of India. In the process it suggests an implementation framework for setting up and sustaining an IE ecosystem. The study is based on the implementation of SVEP programme in 12 blocks in 6 states which have been infested with Naxal extremities and have been classified as LWE by government of India. The learning brings out the importance of community ownership and the role of creating a team with members from the same localities. The role of capacity building and handholding of entrepreneurs comes up as a prime requirement of the sustainability of enterprises and the ecosystem.
The Role of the Diabetes Care and Education Specialist in the Hospital Setting
Authors:   The Association of Diabetes Care & Education Specialists
Published: April 2022

It is the position of Association of Diabetes Care & Education Specialists that all inpatient interdisciplinary teams include a diabetes care and education specialist to lead or support quality improvement initiatives that affect persons hospitalized with diabetes and/or hyperglycemia. This encompasses not only patient, family, and caregiver education but also education of interdisciplinary team members and achievement of diabetes-related organizational quality metrics and performance outcomes.
Cerebellar Mutism Syndrome in Children After Surgery for a Posterior Fossa Tumor: Patient Characteristics and Recovery
Authors: Hansen Melissa , Bendel Anne , Blabolil Julie Ann , Hooke Mary C.
Published: April 2022

Background: Cerebellar mutism syndrome (CMS) is a potential complication that may be experienced by children undergoing a resection of a posterior fossa tumor. Symptoms include mutism and emotional lability; additional symptoms may include hypotonia, difficulty swallowing, ataxia, and changes in cognition. The recovery of children experiencing CMS symptoms can be variable. In this retrospective chart review study, we identified the presenting characteristics of CMS in a cohort of children and compared them to matched-controls who did not develop CMS and examined recovery patterns during the year after diagnosis. Methods: Patients were identified through the program database. Children between ages 3 and 18 years who had a craniotomy for a posterior fossa tumor at our institution were included. For each CMS case, two control cases were selected to match the type of central nervous system tumor, sex, age group, and surgery date. Patient characteristics were abstracted from the patient's electronic medical record and the CMS survey was used to score CMS cases. Results: Seventeen children with CMS and 34 children without CMS were included in the review. Among children with CMS, 53% experienced mutism for less than 4 weeks; ataxia persisted beyond 4 weeks for more than 88% of the children and was still present in 71% 1 year after diagnosis. Clinical characteristics did not differ between the case and control groups. Discussion: CMS symptoms interfere with the child's quality of life and ongoing development. Study findings inform nurses providing anticipatory guidance and support to patients experiencing CMS and their families.
Understanding the wider social and economic context of post-earthquake cordons: A comparative case study between Christchurch, Aotearoa (New Zealand) and L’Aquila, Italy
Authors: Shrestha Shakti R , Orchiston Caroline HR , Elwood Kenneth J , Johnston David M , Becker Julia S , Tomassi Isabella
Published: April 2022

Post-earthquake cordons have been used after seismic events around the world. However, there is limited understanding of cordons and how contextual information such as geography, sociocultural characteristics, economy, and institutional and governance structures affects decisions and operational procedures, including aspects related to spatial and temporal attributes of cordon establishment. This research aims to fill the gap in cordon knowledge through a qualitative comparative case study of two cities: Christchurch, New Zealand (Mw 6.2 earthquake, February 2011) and L’Aquila, Italy (Mw 6.3 earthquake, 2009). Both cities suffered comprehensive damage to their city centers and had cordons established for extended periods of time. Data collection was done through purposive and snowball sampling whereby 23 key informants were interviewed in total. Research participants held expert knowledge in their roles and responsibilities, that is, council members, emergency managers, politicians, business/insurance representatives, academics, and police. Results illustrate that cordons were primarily established to ensure safety of people and to maintain security. The extent and duration of the cordons were affected by the recovery approaches taken in respective cities, that is, in Christchurch demolition was widely undertaken which supported recovery and allowed for faster removal of cordons. In contrast, authorities in L’Aquila placed high value on heritage buildings which led to recovery strategy based on preserving and restoring most of the buildings which extended the duration of cordon. Extended cordons have many similarities but evolve overtime. This evolution of cordons is affected by site-specific needs; thus, cordons should be understood and planned based on contextual realities.
ERS International Congress 2021: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly
Authors: Bal Christina , Falster Casper , Carvalho Andre , Hersch Nicole , Brock Judith , Laursen Christian B. , Walsh Simon , Annema Jouke , Gompelmann Daniela
Published: April 2022

This article summarises the highlights from the European Respiratory Society's “Clinical techniques, imaging and endoscopy” Assembly 14 presented at the virtual 2021 European Respiratory Society International Congress. Cutting-edge innovative developments in both diagnostic approaches and therapeutic strategies in patients with lung cancer, interstitial lung disease, obstructive airway disorders and infectious diseases were presented on this year's interactive congress platform. In this article, the Assembly 14 subgroups summarise the key take home messages given new research outcomes and place them in the context of the current knowledge.
Developing a conceptual model of symptoms and impacts in progressive fibrosing interstitial lung disease to evaluate patient-reported outcome measures
Authors: Wijsenbeek Marlies , Molina-Molina Maria , Chassany Olivier , Fox John , Galvin Liam , Geissler Klaus , Hammitt Katherine M. , Kreuter Michael , Moua Teng , O'Brien Emily C. , Slagle Ashley F. , Krasnow Anna , Reaney Matthew , Baldwin Michael , Male Natalia , Rohr Klaus B. , Swigris Jeff , Antoniou Katerina
Published: April 2022

Background

An understanding of the experience of patients with progressive fibrosing interstitial lung disease (PF-ILD) is needed to select appropriate patient-reported outcome measures (PROMs) to evaluate treatment effect in clinical trials.

Methods

A systematic literature review was conducted to develop a preliminary conceptual model of the symptoms experienced by patients with PF-ILD and the impacts the disease has on them. An online survey and consensus meetings were then conducted with 12–14 stakeholders (patients, clinicians, regulatory and payer advisors) to refine the conceptual model and critically appraise how key concepts should be measured by PROMs. PROMs assessed included Living with Idiopathic Pulmonary Fibrosis, Living with Pulmonary Fibrosis, the King's Brief Interstitial Lung Disease questionnaire, Cough and Sputum Assessment Questionnaire, Evaluating Respiratory Symptoms, Leicester Cough Questionnaire, Functional Assessment of Chronic Illness Therapy (Dyspnoea/Fatigue) and St George's Respiratory Questionnaire for Idiopathic Pulmonary Fibrosis.

Results

The literature review identified 36 signs/symptoms and 43 impacts directly or indirectly related to pulmonary aspects of PF-ILD. The most relevant symptoms identified by participants included shortness of breath on exertion, fatigue and cough; relevant impacts included effects on physical functioning, activities of daily living and emotional wellbeing. These are presented in a conceptual model. Consensus opinion was that existing PROMs need further modification and validation before use in clinical trials.

Conclusions

The conceptual model improves understanding of the symptoms and impacts that living with PF-ILD has on patients’ wellbeing. It can help to inform the choice of PROMs in clinical trials and highlight aspects to assess in the clinical care of patients with PF-ILD.
Potential use of beneficial fungal microorganisms and C-phycocyanin extract for enhancing seed germination, seedling growth and biochemical traits of Solanum lycopersicum L.
Authors: Metwally Rabab A. , Abdelhameed Reda E. , Soliman Shereen A. , Al-Badwy Asmaa H.
Published: April 2022

Background

Biopriming as a new technique of seed treatment involves the application of beneficial microorganisms on the seed surface to stimulate seed germination, plant growth, and protect the seed from soil and seed-borne pathogens. The present investigation was carried out on seed germination, seedling vigor and biochemical traits of one of the most important vegetable crops (Tomato, Solanum lycopersicum L.). The treatments comprised viz. T1: Non primed seeds (Control), T2: Hydropriming, T3: Biopriming with C-phycocyanin (C-PC) (Spirulina platensis extract), T4: Biopriming with Trichoderma asperellum, T5: Biopriming with T. viride, T6: Biopriming with Beauveria bassiana.

Results

Extraction and purification of C-phycocyanin (C-PC) from the dry S. platensis powder using various methods was performed. The purity after dialyses was 0.49 and its ultimate purity (A620/A280) after ion-exchange chromatography was 4.64. The results on tomato seedlings revealed that the maximum germination percentage (100%), germination index (15.46 and 15.12), seedling length (10.67 cm), seedling dry weight (1.73 and 1.97 mg) and seedling length vigor index (1066.7) were recorded for tomato biopriming with T. viride, and B. bassiana (T5 and T6). Moreover, the quantitative estimation of total carbohydrates and total free amino acids contents in bioprimed tomato seedlings indicated a significantly higher amount with T. viride, followed by those bioprimed with T. asperellum, B. bassiana and C-PC extract.

Conclusion

Thus, our results indicated that biopriming of tomato seeds with beneficial fungal inoculants and C-PC was very effective. The most operative biostimulants were those bioprimed with T. viride and B. bassiana compared to other biostimulants (T. asperellum and C-PC). Therefore, to ensure sustainable agriculture, this study offers new possibilities for the biopriming application as an alternative and ecological management strategy to chemical treatment and provides a valuable basis for improving seed germination.
Comprehensive evaluation of Chinese peanut mini-mini core collection and QTL mapping for aflatoxin resistance
Authors: Ding Yingbin , Qiu Xike , Luo Huaiyong , Huang Li , Guo Jianbin , Yu Bolun , Sudini Hari , Pandey Manish , Kang Yanping , Liu Nian , Zhou Xiaojing , Chen Weigang , Chen Yuning , Wang Xin , Huai Dongxin , Yan Liying , Lei Yong , Jiang Huifang , Varshney Rajeev , Liu Kede , Liao Boshou
Published: April 2022

Background

Aflatoxin contamination caused by Aspergillus fungi has been a serious factor affecting food safety of peanut (Arachis hypogaea L.) because aflatoxins are highly harmful for human and animal health. As three mechanisms of resistance to aflatoxin in peanut including shell infection resistance, seed infection resistance and aflatoxin production resistance exist among naturally evolved germplasm stocks, it is highly crucial to pyramid these three resistances for promoting peanut industry development and protecting consumers’ health. However, less research effort has been made yet to investigate the differentiation and genetic relationship among the three resistances in diversified peanut germplasm collections.

Results

In this study, the Chinese peanut mini-mini core collection selected from a large basic collection was systematically evaluated for the three resistances against A. flavus for the first time. The research revealed a wide variation among the diversified peanut accessions for all the three resistances. Totally, 14 resistant accessions were identified, including three with shell infection resistance, seven with seed infection resistance and five with aflatoxin production resistance. A special accession, Zh.h1312, was identified with both seed infection and aflatoxin production resistance. Among the five botanic types of A. hypogaea, the var. vulgaris (Spanish type) belonging to subspecies fastigiata is the only one which possessed all the three resistances. There was no close correlation between shell infection resistance and other two resistances, while there was a significant positive correlation between seed infection and toxin production resistance. All the three resistances had a significant negative correlation with pod or seed size. A total of 16 SNPs/InDels associated with the three resistances were identified through genome-wide association study (GWAS). Through comparative analysis, Zh.h1312 with seed infection resistance and aflatoxin production resistance was also revealed to possess all the resistance alleles of associated loci for seed infection index and aflatoxin content.

Conclusions

This study provided the first comprehensive understanding of differentiation of aflatoxin resistance in diversified peanut germplasm collection, and would further contribute to the genetic enhancement for resistance to aflatoxin contamination.
Hemodynamic and antiemetic effects of prophylactic hyoscine butyl-bromide during cesarean section under spinal anesthesia: a randomized controlled trial
Authors: Abbas Mostafa Samy , Hassan Shimaa Abbas , Abbas Ahmed Mohamed , Thabet Amr Mohamed , Thabet Ahmed Mostafa , Mahdy Magdy Mohammed
Published: April 2022

Background

Abrupt bradycardia and hemodynamic instability during spinal anesthesia for cesarean section are not uncommon and are considered as one of the primary causes of intraoperative nausea and vomiting (IONV). We hypothesized that prophylactic use of hyoscine butyl-bromide (HBB) could improve hemodynamics and reduce IONV in parturients undergoing cesarean section.

Methods

A randomized, double-blind placebo-controlled trial was carried out in a tertiary university hospital, patients scheduled for elective cesarean section were equally randomized to receive either IV HBB 20 mg in 1 ml (Hyoscine group) or the same volume of 0.9% saline (Control group), one minute after spinal anesthesia. The primary endpoint was the incidence of intraoperative bradycardia (HR < 50 beats min−1). Secondary endpoints included changes in mean arterial blood pressure (MAP), the incidence of Intraoperative and Postoperative nausea or vomiting (IONV & PONV), the fetal heart rate and, Apgar score.

Results

Of the 160 subjects randomized, 80 received HBB and 80 received placebo. There was a significant reduction in the incidence of the primary endpoint of intraoperative bradycardia (HR < 50 beats min−1) in the Hyoscine group (0% vs 10%; OR = 0.05, 95% CI = [0.003, 0.93]; P = 0.004) compared with placebo. MAP showed an insignificant difference between groups over time. HBB significantly decreased incidences of IONV and PONV (p = 0.002 & 0.004) respectively.

Conclusions

In parturients undergoing cesarean section under spinal anesthesia, pretreatment with intravenous HBB was a safe measure for both the mother and the baby to reduce the risk of severe intraoperative bradycardia, but not hypotension. Furthermore, it was associated with less incidence of both IONV and PONV.

Trial registration

https://clinicaltrials.gov/ct2/show/NCT04069078
Ustekinumab trough levels predicting laboratory and endoscopic remission in patients with Crohn’s disease
Authors: Hirayama Hisashi , Morita Yasuhiro , Imai Takayuki , Takahashi Kenichiro , Yoshida Atsushi , Bamba Shigeki , Inatomi Osamu , Andoh Akira
Published: April 2022

Backgrounds

Optimal concentration of ustekinumab (UST) predicting endoscopic remission has not been fully investigated in Crohn’s disease (CD). We aimed to identify the optimal UST trough levels predicting clinical, laboratory and endoscopic remission in CD patients.

Methods

Twenty-eight patients with CD were enrolled and investigated (27 patients by enteroscopy and 1 by colonoscopy). The endoscopic activity was assessed using the scoring system that applied the Rutgeerts score to observed intestine. Serum UST trough levels and anti-UST antibodies (AUAs) levels were determined by in-house immunoassays.

Results

Endoscopic activity was negatively correlated with serum UST trough levels (Spearman’s rank correlation coefficient (ρ) = − 0.66, P = 0.0001) and serum albumin levels (ρ = − 0.60, P = 0.0007). The endoscopic activity was positively and significantly correlated with CRP (ρ = 0.59, P = 0.0009) and ESR (ρ = 0.44, P = 0.033). There was no significant association between the endoscopic score and AUA levels and/or Crohn’s disease activity index (CDAI). Serum UST trough levels and albumin levels were significantly higher in the endoscopic remission group (scores of 0 and 1) than in the non-endoscopic remission group (UST trough, mean 3.3 vs. 1.8 μg/mL). No significant difference was observed in AUAs between the endoscopic remission and non-remission groups. Receiver operation curve (ROC) analysis revealed that the optimal cutoff value of UST trough levels predicting normal CRP and serum albumin levels was 1.7 μg/mL for each, and the optimal cutoff value predicting endoscopic remission was 2.0 μg/mL (AUC: 0.80, 95% CI 0.64–0.96).

Conclusion

Achievement of endoscopic remission requires higher UST trough levels than required for normalization of CRP and serum albumin levels.
Long delay in diagnosis of a case with MEN1 due to concomitant presence of AIMAH with insulinoma: a case report and literature review
Authors: Chavoshi Vajihe , Tamehri Zadeh Seyed Saeed , Khalili Shayesteh , Rabbani Amirhassan , Matini Seyed Amir Hassan , Mohsenifar Zhaleh , Hadaegh Farzad
Published: April 2022

Background

ACTH-independent macronodular hyperplasia (AIMAH) is an uncommon disorder characterized by massive enlargement of both adrenal glands and hypersecretion of cortisol. Concomitant AIMAH and multiple endocrine neoplasia type1 (MEN1) is rare to our knowledge.

Case presentation

Herein, we describe a 32 year old woman with long history of prolactinoma and secondary ammonhrea presented with not-severe manifestation of hypoglycemia due to concomitant presence of insulinoma with AIMAH leading to 12 years delay of MEN1 diagnosis. Laboratory tests showed severe hypoglycemia associated with hyper insulinemia (non-fasting blood sugar = 43 mg/dl, insulin = 80.6 μIU /ml, C-peptide = 9.3 ng/ml) hyperparathyroidism (calcium = 10.3 mg/dl, phosphor = 3.1 mg/dl, PTH = 280 pg/ml) and chemical evidence of an ACTH-independent hypercortisolism (serum cortisol value of 3.5, after 1 mg dexamethasone suppression test serum ACTH value of 17 pg/ml, and high urinary cortisol level). Abdominal CT scan demonstrated two enhancing well-defined masses 27*20 mm and 37*30 mm in the tail and body of the pancreas, respectively, and a 36*15 mm mass in left adrenal gland (seven Hounsfield units). Dynamic pituitary MRI revealed a partial empty sella. The physical examination of the patient was unremarkable. Distal pancreatectomy and a left adrenalectomy were performed. After the surgery, we observed clinical and biochemical remission of hyper insulinemia and gradual decrease in urinary cortisol. The histological features of the removed left adrenal gland were consistent with AIMAH. Histological examination of the pancreatic lesions revealed well differentiated neuroendocrine tumors. Genetic abnormalities in the MEN1, heterozygote for pathogenic variant chr11; 645,773,330-64577333AGAC, c.249-252delGTCT, p. (11e85Serfs Ter33) in exon 2 were found. It was recommended the patient undergoes parathyroidectomy as soon as possible.

Conclusion

Given the history and presentation of our case, we recommend that the clinicians consider the possibility of autonomous cortisol production in MEN1 patients who do not show severe symptoms of hypoglycemia in the presence of insulinoma.
The variables associated with dental anxiety and their management in primary care dental clinics in Bahrain: a cross-sectional study
Authors: Sivaramakrishnan Gowri , Makki Hawra , AlDallal Samar , Alaswad Zahra , Sultan Eman , Ahmed Sara , AlBanna Haifa , Alsobaiei Muneera , AlSalihi Leena
Published: April 2022

Background

20–80% of adults presenting to a dental clinic experience anxiety. Negative past dental experiences and environmental factors such as the waiting area of a dental clinic or sound of a drill are commonly considered triggering factors for anxiety. Anxiety management strategies are considered a part of routine dental procedure, due to increased prevalence and compromised patient care. Hence the aim of the present study is to identify the prevalence and variables associated with dental anxiety and their management in patients visiting the primary care dental clinics in Bahrain.

Method

Four hundred and eighty participants were included. A 3-part questionnaire deciphered the demographic characteristics of the participants, the dental procedure undertaken, the level of anxiety, and the management strategy used by the dentist. The pre and post-treatment MDAS scores were recorded. Paired t test, ANOVA and Wilcoxon signed rank test was used to test the level of significance between the variables and the mean MDAS scores. The p ≤ 0.05 was considered statistically significant.

Results

The prevalence of dental anxiety was 23.7% with moderate anxiety, and 11.4% with high anxiety. Females presented with a higher mean MDAS both pre and post-treatment compared with males. A statistically significant difference between the pre and post-treatment MDAS scores were observed in educated patients less than 50 years of age. Those with unpleasant previous dental experience showed statistically significant difference. Analyses of anxiety management techniques showed that single techniques worked better than combination techniques. Rest and breaks combined with any other technique of choice showed significant reduction in the MDAS scores post treatment.

Conclusion

To conclude, all patients attending the dental clinic present with some level of anxiety that necessitates the dentist to use anxiety management strategies. Non-pharmacological methods that are non-invasive must be the first choice. Rests and breaks, with any technique of choice provides the best possible anxiety management. It is possible to achieve the desired anxiety reduction in single visit to complete the planned dental intervention, other than in patients who are dental phobic.
Conducting a prospective evaluation of the development of a complex psycho-oncological care programme (isPO) in Germany
Authors: Salm Sandra , Cecon Natalia , Jenniches Imke , Pfaff Holger , Scholten Nadine , Dresen Antje , Krieger Theresia
Published: April 2022

Background

Evaluating the development phase of a complex intervention programme can be challenging. A prospective evaluation approach is presented based on the example of the new complex psycho-oncological care programme isPO (integrated, cross-sectoral Psycho-Oncology). Prior to programme implementation, we examined (1) if isPO was developed as intended, and (2) if it was relevant and transferable into the newly developed psycho-oncological care networks in North-Rhine Westphalia, Germany. Further, we investigated which implementation facilitators and barriers were anticipated and which implementation strategies were planned by the programme designers (multidisciplinary professionals and cancer supporting organizations who developed the isPO programme components and the networks).

Methods

A mixed-methods approach was applied. Qualitative data were collected by quarterly progress reports, interviews and a focus group with the programme designers. Evaluation criteria for document analyses of the quarterly progress reports were developed and applied. Content analysis was applied for analysing interviews and focus group. Quantitative data were gained from evaluating the programme training for the isPO service providers by short written questionnaires that were analysed descriptively.

Results

An implementable prototype of the isPO programme has been developed within 15 months, however no piloting was conducted. The programme’s complexity proved to be challenging with regard to coordination and communication of the numerous programme designers. This was intensified by existing interdependencies between the designers. Further, there was little communication and participation between the programme designers and the prospective users (patients and service providers). Due to these challenges, only context-unspecific implementation strategies were planned.

Conclusion

The required resources for developing a new complex care programme and the need of a mature implementation strategy should be sufficiently addressed. Programmes may benefit from prospective evaluation by gaining insightful knowledge concerning the programme’s maturity and anticipating implementation facilitators and barriers. A mixed-methods evaluation design was crucial for achieving profound insight into the development process.

Trial registration

The study has been registered in the German Clinical Trials Register (No.DRKS00015326) on 30.10.2018.
Quality assessment of point-of-care ultrasound reports for patients at the emergency department treated by internists
Authors: van Essen Larissa , Olgers Tycho J. , van Heel Moritz , ter Maaten Jan C.
Published: April 2022

Background

POCUS (point-of-care ultrasound) is an important diagnostic tool for several medical specialties. To provide safe patient care, the quality of this exam should be as high as possible. This includes solid documentation with a written report and the availability of images for review. However, international guidelines or publications about this quality assessment and its application in clinical practice are scarce.

Methods

We designed a criteria-checklist to evaluate the quality of POCUS examinations. This checklist was made based on international guidelines and protocols and was validated by a Dutch expert group using the nominal group technique (NGT). All POCUS exams in general internal medicine patients documented between August 2019 and November 2020 in our ED were evaluated using this checklist.

Results

A total of 169 exams were included. In general, the compliance for most important criteria was high, but not optimal. A clinical question or indication for the POCUS exam was stated in 75.7% of cases. The completeness of all standard views differed per indication, but was lower when more than one standard view was required. Labels were provided in 83.5% of the saved images, while 90.8% of all examinations showed a written conclusion.

Conclusions

Our research showed that the overall quality of documentation varies with regard to several important criteria. Suboptimal compliance of documentation may have adverse effects on patient safety. We have developed a checklist which can be used to improve POCUS documentation.
The retinal ganglion cell layer reflects neurodegenerative changes in cognitively unimpaired individuals
Authors: López-de-Eguileta Alicia , López-García Sara , Lage Carmen , Pozueta Ana , García-Martínez María , Kazimierczak Martha , Bravo María , Irure Juan , López-Hoyos Marcos , Muñoz-Cacho Pedro , Rodríguez-Perez Noelia , Tordesillas-Gutiérrez Diana , Goikoetxea Alexander , Nebot Claudia , Rodríguez-Rodríguez Eloy , Casado Alfonso , Sánchez-Juan Pascual
Published: April 2022

Background

To evaluate a wide range of optical coherence tomography (OCT) parameters for possible application as a screening tool for cognitively healthy individuals at risk of Alzheimer’s disease (AD), assessing the potential relationship with established cerebrospinal fluid (CSF) core AD biomarkers and magnetic resonance imaging (MRI).

Methods

We studied 99 participants from the Valdecilla Study for Memory and Brain Aging. This is a prospective cohort for multimodal biomarker discovery and validation that includes participants older than 55 years without dementia. Participants received a comprehensive neuropsychological battery and underwent structural 3-T brain MRI, lumbar puncture for CSF biomarkers (phosphorylated-181-Tau (pTau), total Tau (tTau), beta-amyloid 1–42 (Aβ 1–42), and beta-amyloid 1–40 (Aβ 1–40)). All individuals underwent OCT to measure the retinal ganglion cell layer (GCL), the retinal nerve fiber layer (RFNL), the Bruch’s membrane opening-minimum rim width (BMO-MRW), and choroidal thickness (CT). In the first stage, we performed a univariate analysis, using Student’st-test. In the second stage, we performed a multivariate analysis including only those OCT parameters that discriminated at a nominal level, between positive/negative biomarkers in stage 1.

Results

We found significant differences between the OCT measurements of pTau- and tTau-positive individuals compared with those who were negative for these markers, most notably that the GCL and the RNFL were thinner in the former. In stage 2, our dependent variables were the quantitative values of CSF markers and the hippocampal volume. The Aβ 1–42/40 ratio did not show a significant correlation with OCT measurements while the associations between pTau and tTau with GCL were statistically significant, especially in the temporal region of the macula. Besides, the multivariate analysis showed a significant correlation between hippocampal volume with GCL and RNFL. However, after false discovery rate correction, only the associations with hippocampal volume remained significant.

Conclusions

We found a significant correlation between Tau (pTau) and neurodegeneration biomarkers (tTau and hippocampus volume) with GCL degeneration and, to a lesser degree, with damage in RFNL. OCT analysis constitutes a non-invasive and unexpensive biomarker that allows the detection of neurodegeneration in cognitively asymptomatic individuals.
Ionospheric disturbances observed over Japan following the eruption of Hunga Tonga-Hunga Ha’apai on 15 January 2022
Authors: Saito Susumu
Published: April 2022

Traveling ionospheric disturbances (TIDs) were observed over Japan by using Global Navigation Satellite System (GNSS) receiver network data after the eruption of Hunga Tonga-Hunga Ha’apai in Tonga on 15 January 2022. Two types of TIDs with different characteristics were observed as perturbation in the total electron content (TEC). The first one arrived at Japan which are located about 7800 km away from Hunga Tonga-Hunga Ha’apai about 3 h after the eruption. The amplitude was about ± 0.5 TECU. The wavefronts was in the NNE–SSW direction and propagated in the WNW direction (– 69$$^\circ$$

∘

counter-clockwise from the north) at 250 m s$$^{-1}$$

-
1

. The wavelength was estimated as 400 km. The second one arrived at Japan about 7 h after the eruption. The amplitude was about ± 1.0 TECU. The wavefronts was in the NE–SW direction and propagated in the NW direction (– 53$$^\circ$$

∘

counter-clockwise from the north) at 270 m s$$^{-1}$$

-
1

. The wavelength was longer than the first one and was estimated as 800 km. The first one were associated with ionospheric irregularities represented by the rate of TEC index (ROTI). In contrast, the second one did not have irregularities all over the TIDs, but in only a limited region. The arrival of the first TID was too early for the atmospheric acoustic waves to arrive, while the arrival of the second TIDs approximately coincided with the arrival of surface pressure enhancement. To understand the mechanisms of the TIDs, further studies with wide-area observations as well as numerical calculations are necessary. TIDs and ionospheric irregularities after volcanic eruption could be threats to GNSS-based systems especially for those which utilize carrier-phase measurements.

Graphical Abstract
Refining the contribution of riverine particulate release to the global marine Nd budget
Authors: Che Hong , Zhang Jing , Liu Qian , He Huijun , Zhao Zhi-Qi
Published: April 2022

The release of neodymium (Nd) from particles along continental margins may contribute to losses in the global of Nd budget. The Changjiang River, which carries a heavy load of total suspended matter, empties into the East China Sea, and a strong particulate–seawater interaction process occurs along the salinity gradient. In the low-salinity region (S < 2.0), strong removal of dissolved rare earth elements (dREEs) occurs, but the Nd isotope values are uniform. At mid- and high-salinity (S = 2.0–28.0 and S > 28.0) areas, the dREE concentrations increase slightly. An Nd isotope mass balance indicates that the release of particulate matter is a source of dREEs in the Changjiang estuary. The release rate of particulate Nd (NdSPM) to the dissolved Nd pool in Changjiang estuary is higher than other estuaries, such as Amazon estuary. Composite all river data available from the previous studies indicate that 5800–9200 Mg per year of Nd is released to global marine waters from riverine particles. This estimated quantity is on the same order of magnitude as the calculated global Nd release flux based on the case study in the Amazon estuary. Our study indicates that to better constrain the global Nd budget, it is required to consider the release rate of NdSPM in different rivers due to the significant difference among various rivers, but with very limited available data as of now.
Back-transformation processes in high-pressure minerals: implications for planetary collisions and diamond transportation from the deep Earth
Authors: Kubo Tomoaki , Kamura Ko , Imamura Masahiro , Tange Yoshinori , Higo Yuji , Miyahara Masaaki
Published: April 2022

We conducted back-transformation experiments in ringwoodite, bridgmanite, and lingunite at 0.47–8.1 GPa and 310–920 °C by in situ X-ray observation method. Ringwoodite back-transformed to olivine by grain-boundary nucleation and growth mechanism. The site saturation occurred at the early stage under the conditions far from the equilibrium boundary, and we observed the growth-controlled back-transformation kinetics in ringwoodite. The growth kinetics determined in the present study is largely different from that in the previous study (Reynard et al. in Am Min 81:585–594, 1996), which may be due to the effects of water. Bridgmanite did not directly back-transform to the stable phase orthoenstatite at ~ 1–4 GPa, but first becomes amorphous with increasing temperatures. We observed kinetics of the orthoenstatite crystallization from amorphous bridgmanite that was controlled by both nucleation and growth processes. The temperature range in the amorphous state became narrow with increasing pressures, and the direct back-transformation to high-P clinoenstatite without amorphization eventually occurred at 8 GPa. Amorphization was also observed in lingunite when increasing temperature at ~ 1.5 GPa; however, the plagioclase crystallization proceeded before the complete amorphization. The back-transformation in ringwoodite variedly occurs in shocked meteorites depending on the degree of the post-shock annealing, which can be reasonably interpreted based on the growth kinetics. On the other hand, the presence of hydrous ringwoodite in diamond inclusions cannot be explained without the help of residual stress. The present study also indicates that complete amorphization or the back-transformation to enstatite is unavoidable in bridgmanite during the post-shock annealing. This is inconsistent with the presence of crystalline bridgmanite in shocked meteorites, still requiring further investigations of kinetic behaviors in shorter timescales.
Forward modelling and identification of shallow gas in the Bohai Bay seabed
Authors: Yang Xiao-Di , Chun Ming-Hao , Luo Xiao-Qiao , Yao Zhi-Guang
Published: April 2022

The accumulation of shallow gas in the seabed reduces the strength of strata or forms a high-pressure air sac, endangering ocean engineering construction. Therefore, it is important to identify the distribution of shallow gas in the seabed within the study area. Shallow gas increases the soil mass porosity and reduces the acoustic wave velocity, causing attenuation by absorbing to high-frequency components in the acoustic waves. Based on the geological drilling data in the area surrounding an oil platform in Bohai Bay, a stratigraphic model was established for forward analysis, and the results suggest the presence of the phase inversion of reflective waves at the interface between shallow gas and strata and sunken events for the lower shallow gas. According to a survey of stratigraphic profiles surrounding the platform, a seismic attribute analysis of acoustic stratigraphic profile data concerning amplitude, instantaneous phase, and instantaneous frequency was carried out, and characteristics such as disordered weak amplitude reflection, phase inversion, sunken events and indicators, including high-frequency loss and shallow gas reflection, were identified. Given that the shallow gas reflection is columnar and ended at the top clay strata of the seabed, the shallow gas was probably produced from deep depths.
A comparative study between the efficacy of bupivacaine plus nalbuphine versus bupivacaine alone in pectoral nerve block for management of postoperative pain in patients undergoing breast fibroadenoma excision
Authors: Mohammed Mostafa Salaheldeen , Abdel Latif Samia Abdelmohsen , Nasr Dalia Abdelhamid , Serry Mostafa Mohamed
Published: April 2022

Background

Breast surgeries, even the relatively minor ones, can be associated with significant postoperative pain affecting patients’ physical and psychological well-being. As a result, regional anaesthetic approaches have been used for breast surgery anaesthesia and analgesia. PECS I and II blocks have been proven to be relatively easy and safe in such regards. Moreover, using adjuvants, such as nalbuphine, have been proposed by many studies to intensify the block and decrease postoperative analgesic intake.

This current study aims to assess the effects of using nalbuphine (20 mg) as a bupivacaine 0.25% (10 ml) adjuvant in PECS I block compared to injecting bupivacaine 0.25% (10 ml) alone in fibroadenoma excision patients.

This trial enrolled 60 patients, 30 of whom received bupivacaine plus nalbuphine (group BN) and 30 in the bupivacaine only (group B). Postoperative VAS, SpO2 and vital signs at 0, 1, 2, 4, 6, 12 and 24 h as well as the amount of morphine consumed, the time it took for the first analgesic to be administered and adverse effects were both recorded and compared.

Results

Regarding postoperative outcomes, a statistically significant difference between the two groups was not detected regarding VAS, SpO2, vital signs and adverse effects. Similarly, there was no statistically significant difference in total morphine intake in the 24 h following surgery between the two groups (p-value = 0.65). Only 9 out of 60 patients needed analgesia, 5 in the BN group and 4 in the B group, and time to the first analgesic was not of statistically significant difference between BN and B groups (211.8 ± 71.29 and 183.5 ± 29.872 min respectively) (p-value = 0.73). In terms of postoperative complications, there was no statistically significant difference between the two groups.

Conclusions

Adding nalbuphine (20 mg) to bupivacaine in PECS I block in fibroadenoma patients undergoing excision is not accompanied by a difference with statistical significance in postoperative VAS, morphine consumption and duration to the first analgesia when compared to bupivacaine alone.
Appendicitis and COVID: cause or effect?
Authors: Raju Abdus Salam , Benjamin Aditya Thomas , Rutland Tristan , Liu Luke , Lambrakis Paul
Published: April 2022

Background

Vasculitis and phlebitis with vascular occlusion within appendix specimen is rare. Several authors have reported COVID-19 related veno-occlusive disease in hepatic pathology, but lymphoid aggregation with phlebitis is unusual in appendix specimen. We present a case with medium size venule phlebitis in an appendix of a patient recovered from COVID-19 infection.

Case presentation

A 27-year-old who recently recovered from COVID-19 infection 12 weeks prior, presented with acute appendicitis, confirmed on computed tomography and operative findings. He underwent an uneventful laparoscopic appendicectomy. Histopathology showed veno-occlusive vasculitis within the appendix specimen.

Conclusions

Veno-occlusive disease within the appendix is uncommon. Emerging data suggest COVID-19 infection can cause systemic vascular complications. We herein report a case of healthy patient with no past medical history with an unusual findings of medium vessels phlebitis within the appendix post COVID-19 infection.
Dynamics of Long-Term Patient-Reported Quality of Life and Health Behaviors After Adjuvant Breast Cancer Chemotherapy
Authors: Di Meglio Antonio , Havas Julie , Gbenou Arnauld S. , Martin Elise , El-Mouhebb Mayssam , Pistilli Barbara , Menvielle Gwenn , Dumas Agnes , Everhard Sibille , Martin Anne-Laure , Cottu Paul H. , Lerebours Florence , Coutant Charles , Lesur Anne , Tredan Olivier , Soulie Patrick , Vanlemmens Laurence , Joly Florence , Delaloge Suzette , Ganz Patricia A. , André Fabrice , Partridge Ann H. , Jones Lee W. , Michiels Stefan , Vaz-Luis Ines
Published: April 2022

PURPOSE

We aimed to characterize long-term quality of life (QOL) trajectories among patients with breast cancer treated with adjuvant chemotherapy and to identify related patterns of health behaviors.

METHODS

Female stage I-III breast cancer patients receiving chemotherapy in CANTO (CANcer TOxicity; ClinicalTrials.gov identifier: NCT01993498 ) were included. Trajectories of QOL (European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire–C30 Summary Score) and associations with trajectory group membership were identified by iterative estimations of group-based trajectory models and multivariable multinomial logistic regression, respectively.

RESULTS

Four trajectory groups were identified (N = 4,131): excellent (51.7%), very good (31.7%), deteriorating (10.0%), and poor (6.6%) QOL. The deteriorating trajectory group reported fairly good baseline QOL (mean [95% CI], 78.3/100 [76.2 to 80.5]), which significantly worsened at year-1 (58.1/100 [56.4 to 59.9]) and never recovered to pretreatment values through year-4 (61.1/100 [59.0 to 63.3]) postdiagnosis. Healthy behaviors were associated with better performing trajectory groups. Obesity (adjusted odds ratio [aOR] v lean, 1.51 [95% CI, 1.28 to 1.79]; P < .0001) and current smoking (aOR v never, 1.52 [95% CI, 1.27 to 1.82]; P < .0001) at diagnosis were associated with membership to the deteriorating group, which was also characterized by a higher prevalence of patients with excess body weight and insufficient physical activity through year-4 and by frequent exposure to tobacco smoking during chemotherapy. Additional factors associated with membership to the deteriorating group included younger age (aOR, 1-year decrement 1.01 [95% CI, 1.01 to 1.02]; P = .043), comorbidities (aOR v no, 1.22 [95% CI, 1.06 to 1.40]; P = .005), lower income (aOR v wealthier households, 1.21 [95% CI, 1.07 to 1.37]; P = .002), and endocrine therapy (aOR v no, 1.14 [95% CI, 1.01 to 1.30]; P = .047).

CONCLUSION

This latent-class analysis identified some patients with upfront poor QOL and a high-risk cluster with severe, persistent postchemotherapy QOL deterioration. Screening relevant patient-level characteristics may inform tailored interventions to mitigate the detrimental impact of chemotherapy and preserve QOL, including early addressal of behavioral concerns and provision of healthy lifestyle support programs.