bluuebunny/crossref_metadata_2025 huggingface dataset:
Contrast sensitivity and binocular reading speed best correlating with near distance vision‐related quality of life in bilateral nAMD
Authors: Rossouw Petra , Guichard Maria M , Hatz Katja
Published: September 2020

Purpose

Bilateral neovascular age‐related macular degeneration (nAMD) causes difficulties in daily life, especially with regard to near‐vision tasks, despite well preserved Early Treatment of Diabetic Retinopathy Study (ETDRS) best corrected visual acuity (BCVA) at distance. Therefore, alternative visual function measures were evaluated in terms of their correlation with vision‐related quality of life scores (QoL).

Methods

A prospective cross‐sectional pilot study including patients with a diagnosis of bilateral nAMD having lesions within the central 1 mm ETDRS grid subfield. Standardised testing included a vision‐related QoL assessment (NEI‐VFQ25), best corrected visual acuity (BCVA), low luminance visual acuity (LLVA), Radner maximum reading speed and Pelli‐Robson contrast sensitivity (CS).

Results

N = 54. The mean better eye (range) BCVA was 79 (55–96) letters, median (range) LLVA 79.5 (58–97) letters and median (range) CS 1.35 (0–1.65) log units. Mean binocular maximum reading speed was 117.33 ± 28.42 wpm. The best correlations with the near subscale score were found for CS followed by binocular maximum reading speed (r = 0.59, p = 0.0001; r = 0.36, p = 0.008, respectively). A weaker correlation was observed for the BCVA in the better eye (r = 0.33, p = 0.02). The correlation between the NEI‐VFQ25 distance subscale and BCVA was weaker (r = 0.37, p = 0.005) than the correlations with CS (r = 0.67, p = 0.0001) and LLVA (r = 0.40, p = 0.003).

Conclusions

For patients with a bilateral centre‐involving nAMD, the best correlation with near QoL was the better eye CS followed by maximum binocular reading speed. These measures could be valuable in quantifying vision‐related QoL outcomes in AMD clinical trials.
The ligament of Marshall and arrhythmias: A review
Authors: He Bo , Wang Xiaoying , Zhao Fang , Guo Tao , Po Sunny S. , Lu Zhibing
Published: September 2020

The ligament of Marshall (LOM) is a remnant of the embryonic sinus venosus and left cardinal vein, and contains fat and fibrous tissues, blood vessels, muscle bundles, nerve fibers, and ganglia. The complexity of LOM's structure makes it as a source of triggers and drivers as well as substrates of re‐entry for atrial arrhythmias, especially for atrial fibrillation (AF). LOM also serves as a portion of left atrial macro‐re‐entrant circuit, especially peri‐mitral isthmus re‐entrant circuit. Experimental studies demonstrate that the LOM acts as a sympathetic conduit between the left stellate ganglion and the ventricles, and participates in the initiation and maintenance of ventricular arrhythmias. Endocardial or epicardial catheter ablation or ethanol infusion into the vein of Marshall may serve as an important adjunct therapy to pulmonary vein isolation in patients with advanced stage of AF, and may help alleviate ventricular arrhythmias as well.
Interrelations of nutrient and water transporters in plants under abiotic stress
Authors: Barzana Gloria , Rios Juan J. , Lopez‐Zaplana Alvaro , Nicolas‐Espinosa Juan , Yepes‐Molina Lucía , Garcia‐Ibañez Paula , Carvajal Micaela
Published: September 2020

Environmental changes cause abiotic stress in plants, primarily through alterations in the uptake of the nutrients and water they require for their metabolism and growth and to maintain their cellular homeostasis. The plasma membranes of cells contain transporter proteins, encoded by their specific genes, responsible for the uptake of nutrients and water (aquaporins). However, their interregulation has rarely been taken into account. Therefore, in this review we identify how the plant genome responds to abiotic stresses such as nutrient deficiency, drought, salinity and low temperature, in relation to both nutrient transporters and aquaporins. Some general responses or regulation mechanisms can be observed under each abiotic stress such as the induction of plasma membrane transporter expression during macronutrient deficiency, the induction of tonoplast transporters and reduction of aquaporins during micronutrients deficiency. However, drought, salinity and low temperatures generally cause an increase in expression of nutrient transporters and aquaporins in tolerant plants. We propose that both types of transporters (nutrients and water) should be considered jointly in order to better understand plant tolerance of stresses.
Automatic extraction of sophisticated qualitative trajectory relationships between two moving objects in space‐time
Authors: Vahidnia Mohammad H.
Published: September 2020

A comparison of moving objects’ trajectories in space‐time based on descriptive and qualitative interpretations is useful in many GIS‐related studies. Qualitative relationships help to answer questions such as “Do the objects meet each other?” or “Do the objects move towards or away from each other?” Questions about moving objects can be efficiently addressed using quantitative and computational techniques such as data mining of trajectory datasets but expressed in terms of qualitative relationships. It is, however, difficult to recognize these qualitative relationships when the trajectories are large and consist of many parts, where a sophisticated qualitative relationship can be formed from the aggregation of simple ones. For this reason, this study introduces two classes of trajectory relationships: initial qualitative trajectory relationships (IQTR) and combinatory qualitative trajectory relationships (CQTR). It also suggests effective algorithmic approaches to automatically retrieve them. The proposed algorithm for IQTR using min‐heap and linked‐list data structure could effectively reduce the time complexity from O(n2) to O(n log n). For CQTRs, a divide‐and‐conquer and recursive technique and a linked‐path structure again managed to reduce the time complexity from O(n2) to O(n log n). Finally, experiments on large datasets suggest the capability of the proposed methods in terms of performance and stability.
A novel labeling strategy reveals that myosin Va and myosin Vb bind the same dendritically polarized vesicle population
Authors: Frank Madeline , Citarella Clara G. , Quinones Geraldine B. , Bentley Marvin
Published: September 2020

Neurons are specialized cells with a polarized geometry and several distinct subdomains that require specific complements of proteins. Delivery of transmembrane proteins requires vesicle transport, which is mediated by molecular motor proteins. The myosin V family of motor proteins mediates transport to the barbed end of actin filaments, and little is known about the vesicles bound by myosin V in neurons. We developed a novel strategy to visualize myosin V‐labeled vesicles in cultured hippocampal neurons and systematically characterized the vesicle populations labeled by myosin Va and Vb. We find that both myosins bind vesicles that are polarized to the somatodendritic domain where they undergo bidirectional long‐range transport. A series of two‐color imaging experiments showed that myosin V specifically colocalized with two different vesicle populations: vesicles labeled with the transferrin receptor and vesicles labeled by low‐density lipoprotein receptor. Finally, coexpression with Kinesin‐3 family members found that myosin V binds vesicles concurrently with KIF13A or KIF13B, supporting the hypothesis that coregulation of kinesins and myosin V on vesicles is likely to play an important role in neuronal vesicle transport. We anticipate that this new assay will be applicable in a broad range of cell types to determine the function of myosin V motor proteins.
Assessment of biomarkers influencing treatment success on small intestinal lymphoma in dogs
Authors: Yamazaki Hiroki , Sasai Hiroshi , Tanaka Miyuu , Tanaka Toshiyuki , Nishida Hidetaka , Noguchi Shunsuke , Kuwamura Mitsuru , Akiyoshi Hideo
Published: September 2020

This study aimed to determine a reliable therapeutic biomarker for localized small intestinal lymphoma (SIL) in dogs based on clinical and histopathological features. We retrospectively investigated 84 dogs with localized SIL, including 36 dogs receiving surgery and 48 dogs receiving chemotherapy. The dogs receiving surgery were divided into two subgroups: 18 dogs (group 1) with overall survival (OS) <120 days (median OS) and 18 dogs (group 2) with OS ≥120 days. Correspondingly, the dogs receiving chemotherapy were divided into 24 dogs (group 3) with OS <98 days (median OS) and 24 dogs (group 4) with OS ≥98 days. Clinical, haematological, histopathological and immunohistochemical analyses were comparatively evaluated among the four subgroups. There was no significant difference in OS between the surgery and chemotherapy groups. In dogs receiving surgery, the rate of Ki67‐positive cells was significantly increased in group 1 compared to group 2 and showed no significant difference between groups 3 and 4. In dogs receiving chemotherapy, the rate of O6‐methylguanine‐DNA methyltransferase (MGMT) was significantly higher in group 3 than in group 4 and showed no significant difference between groups 1 and 2. Additionally, our data showed that OS in dogs with higher Ki67 expression might be significantly increased by chemotherapy than by surgery, that of those with higher MGMT expression might be significantly increased by surgery than by chemotherapy, and Ki67 and MGMT were independent of each other. Indices of Ki67 and MGMT are suggested therapeutic biomarkers to determine the optimal first‐line treatment for localized SIL in dogs.
PROTECTIVE EFFECTS OF VIRGIN COCONUT OIL AND TOCOTRIENOL-RICH FRACTION ON BONE BIOMECHANICS
Authors: Abdul Malik Mohd Maaruf , Che Ab Ghani Dina Fariha , Uzaimi A'isyah Nabila , Shuid Ahmad Nazrun
Published: September 2020

Osteoporosis is a metabolic disease characterized by low bone mineral density. Both virgin coconut oil (VCO) and tocotrienol-rich fraction (TRF) are known to have higher antioxidant activity. The study aimed to determine the effect of combined therapy of VCO and TRF on biomechanical bone strength parameters of the ovariectomised rat model fed with high fat diet and heated palm oil. Thirty-six female Sprague-Dawley rats were divided into; Sham-operated (SHAM), ovariectomised control (OVX), ovariectomised and given Premarin 64.5 µg/kg (OVX+P), ovariectomised and given VCO 1.43 ml/kg (OVX+V), ovariectomised and given TRF 30 mg/kg (OVX+T) and ovariectomised and given combined therapy of VCO and TRF (OVX+VT). Following 24 weeks, the rats were sacrificed and the right femora were analyzed for three-point bending test using Shimadzu machine (AG-X 500 N). The parameters were divided into two classes: extrinsic (load, displacement and stiffness) and intrinsic (stress, strain and Young modulus). The statistical tests used were analysis of variance (ANOVA), followed by Tukey’s HSD test. The Young modulus value of OVX+VT group was significantly higher than OVX+V and OVX+T groups (p<0.05). Combined therapy of VCO and TRF have offered better bone protective effects than single dose of VCO or TRF in preventing bone loss of osteoporotic rat model.
A SYNCHRONIZATION LOSS DETECTION METHOD FOR PMSM SPEED SENSORLESS CONTROL
Authors: Harini Bernadeta Wuri , Husnayain Faiz , Subiantoro Aries , Yusivar Feri
Published: September 2020

Permanent Magnet Synchronous Motor (PMSM) is an AC motor in which the rotor must operate at synchronous speed in all load conditions. If the motor mechanical load increases, the motor can lose synchronization, stopping the motor. In sensorless control systems, i.e., those without speed sensors, the speed is estimated from the stator current using the Model Reference Adaptive System (MRAS) algorithm.   Because such systems therefore cannot detect the loss of synchronization, it is necessary to design a synchronization loss detection system.  Here, another speed estimation calculated from the stator currents and voltages is introduced.  The speed is called a calculated speed.  In the normal condition (synchronous condition), estimated speed and calculated speed will be approximately equal.  However, when synchronization loss occurs, these two speed values diverge.  On the basis of this phenomenon, a synchronization loss detection algorithm and method are developed.  The algorithm’s speed-delta boundary values and detection period must be determined. The greater the setpoint speed, the higher the speed-delta boundary values but the smaller the detection period. The experiments confirm that the proposed algorithm is able to effectively detect the occurrence of synchronization loss.
A Novel Method for Transient Heat Conduction in a Quasi-Periodic Structure With Nonlinear Defects
Authors: Cui Haichao , Gao Qiang , Li Xiaolan , Ouyang Huajiang
Published: September 2020

This paper proposes an efficient numerical method for transient heat conduction in a quasi-periodic structure with nonlinear defects. According to the physical features of transient heat conduction, a quasi-superposition principle for transient heat conduction in a quasi-periodic structure with nonlinear defects is presented, and then a new method is developed to separate the above nonlinear problem to be solved into a linear problem of a perfect periodic structure and nonlinear problems of some small-scale structures with defects. As the scale of nonlinear problem to be solved is significantly reduced and low computational resource is required, outstanding efficiency is achieved. Finally, a numerical example shows that the proposed method is effective and accurate.
Effect of Non-Newtonian Dynamics on the Clearance of Mucus From Bifurcating Lung Airway Models
Authors: Rajendran Rahul R. , Banerjee Arindam
Published: September 2020

Mucus hypersecretion is a common pathophysiological manifestation of several obstructive airway diseases in which the mucociliary clearance is impaired, and the airflow generated by a cough or a forced expiratory maneuver called the huff is primarily responsible for clearing mucus. This airflow driven clearance of mucus is a complex process that is affected by the mucus rheology, airflow rate, airway geometry, and gravity. This study examines the role of mucus rheology in the transport and distribution of mucus in idealized 3D airway geometries. The complex air-mucus interface was tracked by the volume-of-fluid (VOF) model, and the turbulence in the core airflow was modeled using the k–ω shear stress transport (SST) model. Mucus was modeled as a shear-thinning liquid by using a power-law model. The computational model was validated using in vitro experimental data available in the literature. Gravity-dominated eccentric core-annular flow was observed with the core biased toward the outer wall in the inclined daughter branches of the bifurcation models, which transitions into concentric core-annular flow in the trachea. The increase in tangential shear at the interface due to the secondary flow structures developed in the flow divider location resulted in a region of enhanced mucus clearance with reduced mucus layer thickness. Secondary flow developed due to the curvature in the airway geometry resulted in a local redistribution of mucus that reduced the eccentricity. The accumulation of mucus around the carinal ridges and the regions with reduced clearance are sites with the potential for microbial growth.
Methodology for Measurement of Density of Liquid Oxides
Authors: Hrbek Jan , Mészáros Bence , Paukov Mykhaylo , Kudláč Martin
Published: September 2020

Measurement of physical properties of materials in extreme conditions, such as high temperature, is limited by technological challenges. Nevertheless, modeling of several phenomena relies on the existence of experimental data for their validation. In this study, a method suitable for determination of density in a liquid phase at high temperature is proposed and tested on Al2O3–ZrO2 system. A methodology for acquiring the temperature dependence of density for radioactive materials is proposed and is aimed to refine severe nuclear accidents modeling. The oxide was melted in an induction furnace with a cold crucible. The measurement was based on evaluation of the volume of the melt at different temperatures, in a range from 2100 to 2400 °C. The densities of the oxide in the solid-state and the skull-layer were measured using a pycnometer. A temperature dependence of the density was established and the results were compared with literature. The difference between existing data and the measured values in this work was less than 5%. Thus, the proposed methodology provides reliable density values in extreme conditions.
Wind Turbine Multivariate Power Modeling Techniques for Control and Monitoring Purposes
Authors: Astolfi Davide , Castellani Francesco , Natili Francesco
Published: September 2020

Wind turbine performance monitoring is a complex task because the power has a multivariate dependence on ambient conditions and working parameters. Furthermore, wind turbine nacelle anemometers are placed behind the rotor span and the control system estimates the upwind flow through a nacelle transfer function: this introduces a data quality issue. This study is devoted to the analysis of data-driven techniques for wind turbine performance control and monitoring: operation data of six 850 kW wind turbines sited in Italy have been employed. The objective of this study is an assessment of several easily implementable techniques and input variables selections for data-driven models whose target is the power of a wind turbine. Three model types are selected: one is linear (Principal Component Regression) and two are nonlinear (Support Vector Regression with Gaussian Kernel and Feedforward Artificial Neural Network). The models' validation provides meaningful indications: the linear model in general has lower performance because it cannot reproduce properly the nonlinear pitch behavior when approaching rated power. Therefore, it is concluded that a nonlinear model should be employed and the achieved mean absolute error is of the order of 1.3% of the rated power. Furthermore, the errors are kept at the order of 2% of the rated power for the models whose input is the rotor speed instead that wind speed: this observation supports that, in case it is needed because of nacelle anemometer biases, the power monitoring can be acceptably implemented using the rotor speed.
Surface preparation of porous Si-graphene nanocomposites for heteroepitaxy
Authors: Jellite Mourad , Darnon Maxime , Arvinte Roxana , Aziziyan Mohammad Reza , Machon Denis , Boucherif Abderraouf , Arès Richard
Published: September 2020

We have investigated the fabrication process of an alternative approach for a direct integration of epitaxial structures onto a foreign substrate. Our approach is based on the synthesis of a nanocomposite made of graphenelike carbon and porous silicon. The nanocomposite was produced by anodization etching of a silicon substrate followed by a thermal carbonization step. The main study focused on the preparation of the nanocomposite surface for subsequent epitaxial deposition. While the nanocomposite must retain its carbon content for thermal stability at epitaxial temperatures, the surface must be stripped of its residual carbon to expose the silicon crystal and support layer nucleation. Our results show that the porous silicon substrate, carbonized at 750°C and subjected to an O2 plasma treatment of 20 W during 12 s, presented a carbon-free surface, while the bulk porous structure retained its carbon coating. Subsequent growth of a crystalline GaAs thin film demonstrated the substrate’s ability to support epitaxy.
Connecting field and intensity correlations: The Siegert relation and how to test it
Authors: Ferreira Dilleys , Bachelard Romain , Guerin William , Kaiser Robin , Fouché Mathilde
Published: September 2020

The Siegert relation relates electric field and intensity correlations of light, under given assumptions. After a brief derivation of the relation, we present an experimental setup that can be implemented in a student laboratory: it allows measuring both field and intensity correlations at the same time, thus providing a direct test of the Siegert relation. Some experimental results are presented when the scattering medium corresponds to a cold atomic cloud. As a conclusion, we discuss typical situations where the relation fails.
Comparing Elements of Study Abroad Among Sport Management Students
Authors: LeCrom Carrie , Dwyer Brendan , Greenhalgh Gregory , Goebert Chad , Gellock Jennifer
Published: September 2020

A globalized curriculum has the potential to prepare students in a way that equips them for whatever sport looks like in the future. Study abroad programs are one way to achieve this. The current study looked at two short-term study abroad programs (one to western Europe, one to South Africa), offered during the same semester at the same institution, comparing learning outcomes between students on the two trips. Utilizing a mixed methods design, students completed quantitative pre/post surveys and responded to qualitative, open-ended daily prompts while on the trips. Findings indicate that knowledge acquisition occurs in both programs; however, students traveling on a sport-focused service-based trip to South Africa had a more transformational learning experience than those traveling on a sport-business-focused trip to western Europe.
Zika and ubiquitin
Authors: Foley John F.
Published: September 2020

Ubiquitylation of the Zika virus envelope protein drives viral entry and pathogenesis.
Successful Development of Bacteriocins into Therapeutic Formulation for Treatment of MRSA Skin Infection in a Murine Model
Authors: Ovchinnikov Kirill V. , Kranjec Christian , Thorstensen Tage , Carlsen Harald , Diep Dzung B.
Published: September 2020

The emergence of antibiotic-resistant pathogens has caused a serious worldwide problem in infection treatment in recent years. One of the pathogens is methicillin-resistant
Staphylococcus aureus
(MRSA), which is a major cause of skin and soft tissue infections. Alternative strategies and novel sources of antimicrobials to solve antibiotic resistance problems are urgently needed. In this study, we explored the potential of two broad-spectrum bacteriocins, garvicin KS and micrococcin P1, in skin infection treatments.
Role of DNA Methylation and CpG Sites in the Viral Telomerase RNA Promoter during Gallid Herpesvirus 2 Pathogenesis
Authors: Pejaković Srđan , Mbouombouo Mfossa André Claude , Wiggers Laëtitia , Kheimar Ahmed , Coupeau Damien , Kaufer Benedikt B. , Muylkens Benoît
Published: September 2020

Previous studies demonstrated that telomerase RNAs possess functions that promote tumor development independent of the telomerase complex. vTR is a herpesvirus-encoded telomerase RNA subunit that plays a crucial role in virus-induced tumorigenesis and is expressed by a robust viral promoter that is highly regulated by the c-Myc oncoprotein binding to the E-boxes. Here, we demonstrated that the DNA methylation patterns in the functional c-Myc response elements of the vTR promoter change upon reactivation from latency, and that demethylation strongly increases telomerase activity in virus-infected cells. Moreover, the introduction of mutation in the CpG dinucleotides of the c-Myc binding sites resulted in decreased vTR expression and complete abrogation of tumor formation. Our study provides further confirmation of the involvement of specific DNA methylation patterns in the regulation of vTR expression and vTR importance for virus-induced tumorigenesis.
Interferon Regulatory Factor 7 Attenuates Chronic Gammaherpesvirus Infection
Authors: Johnson K. E. , Aurubin C. A. , Jondle C. N. , Lange P. T. , Tarakanova V. L.
Published: September 2020

The innate immune system of the host is critical for the restriction of acute viral infections. In contrast, the role of the innate immune network during chronic herpesvirus infection remains poorly defined. Interferon regulatory factor 7 (IRF-7) is a transcription factor with many target genes, including type I interferons (IFNs). In this study, we show that the antiviral role of IRF-7 continues into the chronic phase of gammaherpesvirus infection, wherein IRF-7 restricts the establishment of viral latency and viral reactivation. This study is, to our knowledge, the first to define the role of IRF-7 in chronic virus infection.
OASL Triggered by Novel Goose Astrovirus via ORF2 Restricts Its Replication
Authors: Ren Dan , Li Tuofan , Zhang Xinyu , Yao Xiaohui , Gao Wei , Xie Quan , Zhang Jianjun , Shao Hongxia , Wan Zhimin , Qin Aijian , Ye Jianqiang
Published: September 2020

Astroviruses cause gastroenteritis and encephalitis in human, and nephritis, hepatitis, and gout disease in poultry. However, the host immune response activated by astrovirus is mostly unknown. Here, we found that a novel goose astrovirus, GAstV-GD, and its ORF2 protein could efficiently induce a high level of OASL
in vitro
and
in vivo,
which could feed back to restrict the replication of GAstV-GD, revealing novel innate molecules triggered by astroviruses and highlighting that the ORF2 of GAstV-GD and OASL can be potential antiviral targets for astroviruses.
Supplemental Material: Modeling glacier extents and equilibrium line altitudes in the Rwenzori Mountains, Uganda, over the last 31,000 yr
Authors: Doughty Alice , al. et
Published: September 2020

Explanation of the modeling methods, climate input data, and a comparison between glacierized sites in East Africa
Neonatal videolaryngoscopy as a teaching aid: the trainees’ perspective
Authors: O'Shea Joyce E , Kirolos Sandy , Thio Marta , Kamlin C Omar Farouk , Davis Peter G
Published: September 2020

Introduction

Neonatal intubation is a challenging skill to acquire. A randomised controlled trial (RCT) found junior trainees had higher intubation success rates if their supervisor shared their airway view on a videolaryngoscope screen compared with intubations where the supervisor could not see the videolaryngoscope screen. The intubations in the trial were supervised by a group of experienced neonatologists who developed an intubation teaching package that aimed to be informative, consistent and supportive. We surveyed the trainees to assess their experiences of the intubation attempts.

Methods

Trainees participating in the RCT completed questionnaires anonymously after each intubation attempt. Questionnaires used 5-point Likert scales and free comment sections. Quantitative analysis was performed using descriptive statistics. In a qualitative analysis, free comments were coded to identify central recurring themes.

Results

Two hundred and six questionnaires were completed by 36 trainees. The majority reported that the guidance received during intubation was helpful, the postprocedure feedback was educational and their confidence levels were increased. Trainees appreciated a controlled environment and calm, consistent guidance. They found intubations in the delivery room, those involving unstable infants, large audiences and parental presence more stressful. Responses were positive whether the videolaryngoscope screen was visible or covered, emphasising the importance of consistent guidance. Overall, 16% of intubations were reported as intimidating.

Conclusion

The shared airway view offered by videolaryngoscopy was well received. In addition, taking measures to control the setting, with standardised guidance and feedback, improved confidence and created a more positive learning experience.
Solitary extramedullary plasmacytoma of the larynx: a rare cause of dysphonia
Authors: Brandt Hannes Hermann , Brockmeier Steffi Johanna , Tetter Nora
Published: September 2020

Solitary extramedullary plasmacytoma (SEP) of the larynx is a rare haematological malignancy and an infrequent cause of persisting dysphonia. We present the case of a 54-year-old woman with a long-standing history of dysphonia. While clinical examination showed a rather inconspicuous prominent right vestibular fold, an MRI revealed a laryngeal mass with erosion of the thyroid cartilage. A biopsy taken during rigid endoscopy demonstrated plasma cell infiltration with light chain restriction amidst amyloid deposits. After exclusion of systemic involvement, the diagnosis of an SEP of the larynx with secondary amyloidosis was made. The patient received primary radiation therapy. Another biopsy taken 3 months after the end of therapy did not show any signs of ongoing neoplastic plasma cell disease. The patient was therefore considered to be in remission. She is currently receiving regular follow-up and has not shown signs of persistent or progressive disease for the past 18 months.
Adrenal medullary hyperplasia mimicking pheochromocytoma
Authors: Montebello Annalisa , Ceci Michelle Ann , Vella Sandro
Published: September 2020

A 59-year-old woman, a known case of hypertension, was incidentally diagnosed with a large right-sided adrenal mass. Investigations for a functional adrenal lesion resulted in very high preoperative norepinephrine levels. A right adrenalectomy was performed. Histology showed adrenal medullary hyperplasia (AMH). AMH is a rare diagnosis and its incidence is poorly documented in the literature. This is a benign entity which resembles pheochromocytoma (PCC) in both clinical and biochemical manner. AMH is usually bilateral and may occur in isolation or in association with PCC. In fact, some authors consider it to be a precursor to PCC. Thus, these patients need long-term follow-up in view of the risk of development of PCC later.
Multicentre study of 4626 patients assesses the effectiveness, safety and burden of two categories of treatments for central retinal vein occlusion: intravitreal anti-vascular endothelial growth factor injections and intravitreal Ozurdex injections
Authors: Gale Richard , Gill Claire , Pikoula Maria , Lee Aaron Y , Hanson Rachel L W , Denaxas Spiros , Egan Catherine , Tufail Adnan , Taylor Paul ,   UK EMR Database Users Group
Published: September 2020

Background/Aims

To assess the effectiveness, burden and safety of two categories of treatment for central retinal vein occlusion (CRVO): intravitreal injections of anti-vascular endothelial growth factor (anti-VEGF) and dexamethasone (Ozurdex).

Methods

A retrospective analysis of Medisoft electronic medical record (EMR) data from 27 National Health Service sites in the UK identified 4626 treatment-naive patients with a single mode of treatment for macular oedema secondary to CRVO. Statistics describing the overall CRVO patient cohort and individual patient subpopulations stratified by treatment type were generated. Mean age at baseline, gender, ethnicity, social deprivation and visual acuity (VA) follow-up was reported. Absolute and change in VA using ETDRS are used to describe treatment effectiveness, the number of injections and visits used to describe treatment burden and endophthalmitis rates as a marker of treatment safety.

Results

Mean VA was 47.9 and 45.3 EDTRS letters in the anti-VEGF and Ozurdex groups, respectively. This changed to 57.9/53.7 at 12 months, 58.3/46.9 at 18 months and 59.4/51.0 at 36 months. Mean number of injections were 5.6/1.6 at 12 months, 6.0/1.7 at 18 months and 7.0/1.8 at 36 months. Endophthalmitis rates were 0.003% (n=4) for the anti-VEGF group and 0.09% (n=1) for the Ozurdex group.

Conclusions

VA improvements were greater and more sustained with anti-VEGF treatment. Lower starting acuity resulted in bigger gains in both groups, while higher starting acuity resulted in higher VA at 36 months. Although treatment burden was greater with anti-VEGF, Ozurdex was associated with higher rates of endophthalmitis.
Potential epidemiological impact of the 2017 American College of Cardiology/American Heart Association high blood pressure guideline on the Chinese population: a cross-sectional study in rural areas of Liaoning Province
Authors: Dong Yuanyuan , Sun Zhaoqing , Li Zhao , Guo Xiaofan , Sun Guozhe , Xie Yanxia , Zheng Jia , Dai Yue , Wang Yali , Guo Rongrong , Zheng Liqiang , Sun Yingxian
Published: September 2020

Objectives

The present study estimated the percentage of rural Chinese adults with hypertension and recommended pharmacological antihypertensive treatment according to the 2017 American College of Cardiology/American Heart Association (ACC/AHA) guideline compared with the 2010 Chinese Guideline for the Management of Hypertension.

Design

Cross-sectional study.

Setting

Three counties in rural areas of northeastern China.

Participants

A total of 11 747 eligible individuals aged ≥35 years from rural areas of northeastern China were selected for the present analysis.

Main outcome measures

The percentage of rural Chinese adults with hypertension and recommended pharmacological antihypertensive treatment according to the 2017 ACC/AHA guideline and the 2010 Chinese Guideline for the Management of Hypertension, and the proportion of rural Chinese adults taking antihypertensive medication with blood pressure (BP) above the 2017 ACC/AHA guideline and the 2010 Chinese guideline treatment goal.

Results

The mean age of the study population was 53.9±10.8 years and 53.7% of the participants were women. According to the 2017 ACC/AHA guideline and the 2010 Chinese guideline, the crude prevalence of hypertension was 72.2% and 49.8%, respectively, and the percentage of recommended antihypertensive medications for rural Chinese adults was 56.4% and 51.4%, respectively. Among these rural Chinese adults taking antihypertensive medications, 96.7% had above goal BP according to the 2017 ACC/AHA guideline compared with 86.1% with above goal BP according to the 2010 Chinese guideline.

Conclusion

The present analysis demonstrated that compared with the 2010 Chinese guideline, the 2017 ACC/AHA hypertension guideline will result in a substantial increase in the percentage of rural Chinese adults defined as having hypertension and a small increase in the percentage of adults who are recommended antihypertensive medications. More intensive management is suggested to improve the control rate of hypertension among rural Chinese adults.
Viral respiratory infections in very low birthweight infants at neonatal intensive care unit: prospective observational study
Authors: Sánchez García Laura , Calvo Cristina , Casas Inmaculada , Pozo Francisco , Pellicer Adelina
Published: September 2020

Background and objective

Very low birthweight (VLBW) infants are highly susceptible to respiratory infections. Information about prevalence of viral respiratory infections (VRIs) in neonatal intensive care unit (NICU) is scarce. Recent evidence suggests short-term and long-term impact of VRI in morbidity of VLBW infants. The goal of this study is to conduct a VRI surveillance in VLBW infants during NICU admission to address the prevalence, type of viruses and associated clinical features.

Methods

Prospective observational cohort study on infants below 32 gestational weeks admitted to a tertiary NICU during a 2-year period. Respiratory virus detection (influenza, parainfluenza, rhinovirus (hRV), enterovirus, respiratory syncytial virus, metapneumovirus, coronavirus, bocavirus and adenovirus) was performed by real time multiplex PCR assays in nasopharyngeal aspirates (NPAs), within the first 72 hours after birth and weekly, until discharge. Additional samples were taken if clinically indicated.

Results

147 out of 224 eligible infants were enrolled. At least one positive NPA was found in 38% of the study cohort. Main viruses identified were hRV (58%) and adenovirus (31%). Among the 56 infants with positive NPA, 26 showed non-specific respiratory features in 58% (increased respiratory workload, tachypnoea, apnoea) or typical cold features in 38% (rhinorrhea, cough, fever), at least in one episode. Antibiotics were prescribed in 29% of cases. Positive infants showed higher rates of bronchopulmonary dysplasia (BPD), need for supplemental oxygen and mechanical ventilation, and had longer hospital stay. Cox regression analysis found BPD as an independent risk factor for viral infection (p<0.001) and symptomatic VRI (p<0.04).

Conclusions

Systematic surveillance in VLBW infants reports VRI is frequent, particularly by hRV. Asymptomatic infection is highly prevalent which is critical in the face of establishing appropriate preventive strategies. Infants with BPD are especially vulnerable to such infections.
How boys and testicles wander to surgery: a nationwide cohort study of surgical delay in Sweden
Authors: Omling Erik , Bergbrant Sanna , Persson Andreas , Björk Jonas , Hagander Lars
Published: September 2020

Background

Early orchidopexy is recommended for cryptorchidism and the surgery is increasingly centralised. The objectives were to determine the incidence, risk factors and if distance to treating hospital impacted on timely treatment of cryptorchidism.

Methods

In this observational study, all boys born in Sweden from 2001 to 2014 were followed in national registers to determine the incidence of cryptorchidism by levels of birth-related risk factors and social determinants. Travel time to hospital was used as the primary exposure in multivariable survival analysis, with age at surgery as main outcome.

Results

Of 748 678 boys at risk for cryptorchidism, 7351 were treated and evaluated for timing of surgery (cumulative childhood incidence 1.4%, 95% CI 1.3% to 1.5%). The incidence was clearly associated with prematurity and overdue pregnancy (HR for <32 weeks 2.77 (95% CI 2.39 to 3.21); 32–36 weeks HR 1.36 (95% CI 1.24 to 1.49); >41 weeks HR 1.19 (95% CI 1.10 to 1.29)), low birth weight (<1000 g HR 3.94 (95% CI 3.15 to 4.92); 1000–1499 g HR 3.70 (95% CI 3.07 to 4.46); 1500–2500 g HR 1.69 (95% CI 1.52 to 1.88)) and intrauterine growth restriction (small for gestational age HR 2.38 (95% CI 2.14 to 2.65); large for gestational age HR 1.26 (95% CI 1.13 to 1.42)), but not with smoking or maternal age. Each 30 min increase in travel time was associated with a reduced probability of timely treatment (HR for being treated by age 3 adjusted for risk factors and socioeconomic determinants: 0.91 (95% CI 0.88 to 0.95)). Lower income and financial support were also associated with treatment delays (adjusted HR for lowest income quintile 0.82 (95% CI 0.72 to 0.93) and for families with financial support 0.85 (95% CI 0.73 to 0.97)).

Conclusions

Travel distance to treating hospital was associated with delayed treatment. ‘Not all those who wander are lost’, but these findings suggest a trade-off between centralisation benefits and barriers of geography also in elective paediatric surgery.
Cross-sectional study of paediatric case mix presenting to an emergency centre in Cape Town, South Africa, during COVID-19
Authors: Akuaake Lembi Magano , Hendrikse Clint , Spittal Graeme , Evans Katya , van Hoving Daniël Jacobus
Published: September 2020

Objective

To describe and compare the effect of level 5 lockdown measures on the workload and case mix of paediatric patients presenting to a district-level emergency centre in Cape Town, South Africa.

Methods

Paediatric patients (<13 years) presenting to Mitchells Plain Hospital were included. The level 5 lockdown period (27 March 2020–30 April 2020) was compared with similar 5-week periods immediately before (21 February 2020–26 March 2020) and after the lockdown (1 May 2020–4 June 2020), and to similar time periods during 2018 and 2019. Patient demographics, characteristics, International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) diagnosis, disposition and process times were collected from an electronic patient tracking and registration database. The χ2 test and the independent samples median test were used for comparisons.

Results

Emergency centre visits during the lockdown period (n=592) decreased by 58% compared with 2019 (n=1413) and by 56% compared with the 2020 prelockdown period (n=1342). The proportion of under 1 year olds increased by 10.4% (p<0.001), with a 7.4% increase in self-referrals (p<0.001) and a 6.9% reduction in referrals from clinics (p<0.001). Proportionally more children were referred to inpatient disciplines (5.6%, p=0.001) and to a higher level of care (3.9%, p=0.004). Significant reductions occurred in respiratory diseases (66.9%, p<0.001), injuries (36.1%, p<0.001) and infectious diseases (34.1%, p<0.001). All process times were significantly different between the various study periods.

Conclusion

Significantly less children presented to the emergency centre since the implementation of the COVID-19 lockdown, with marked reductions in respiratory and infectious-related diseases and in injuries.
International recommendations for a vascular access minimum dataset: a Delphi consensus-building study
Authors: Schults Jessica , Kleidon Tricia , Chopra Vineet , Cooke Marie , Paterson Rebecca , Ullman Amanda J , Marsh Nicole , Ray-Barruel Gillian , Hill Jocelyn , Devrim İlker , Hammarskjold Fredrik , Pedreira Mavilde L , Bertoglio Sergio , Egan Gail , Mimoz Olivier , van Boxtel Ton , DeVries Michelle , Magalhaes Maria , Hallam Carole , Oakley Suzanne , Rickard Claire M
Published: September 2020

Background

Data regarding vascular access device use and outcomes are limited. In part, this gap reflects the absence of guidance on what variables should be collected to assess patient outcomes. We sought to derive international consensus on a vascular access minimum dataset.

Methods

A modified Delphi study with three rounds (two electronic surveys and a face-to-face consensus panel) was conducted involving international vascular access specialists. In Rounds 1 and 2, electronic surveys were distributed to healthcare professionals specialising in vascular access. Survey respondents were asked to rate the importance of variables, feasibility of data collection and acceptability of items, definitions and response options. In Round 3, a purposive expert panel met to review Round 1 and 2 ratings and reach consensus (defined as ≥70% agreement) on the final items to be included in a minimum dataset for vascular access devices.

Results

A total of 64 of 225 interdisciplinary healthcare professionals from 11 countries responded to Round 1 and 2 surveys (response rate of 34% and 29%, respectively). From the original 52 items, 50 items across five domains emerged from the Delphi procedure.Items related to demographic and clinical characteristics (n=5; eg, age), device characteristics (n=5; eg, device type), insertion (n=16; eg, indication), management (n=9; eg, dressing and securement), and complication and removal (n=15, eg, occlusion) were identified as requirements for a minimum dataset to track and evaluate vascular access device use and outcomes.

Conclusion

We developed and internally validated a minimum dataset for vascular access device research. This study generated new knowledge to enable healthcare systems to collect relevant, useful and meaningful vascular access data. Use of this standardised approach can help benchmark clinical practice and target improvements worldwide.
Palliative care from the perspective of cancer physicians: a qualitative semistructured interviews study
Authors: Economos Guillaume , Bonneville-Levard Alice , Djebari Ines , Van Thuynes Kevin , Tricou Colombe , Perceau-Chambard Élise , Filbet Marilene
Published: September 2020

Objective

Integrated palliative care for populations with cancer is now highly recommended. However, numerous physicians working in cancer care are still reluctant to refer patients to specialist palliative care teams. This study explores their perceptions of palliative care and factors influencing reasons to refer to specialist palliative care.

Methods

We used a qualitative methodology based on semistructured interviews with physicians working in cancer care, in two tertiary hospitals and one comprehensive cancer centre with access to a specialist palliative care team. Forty-six physicians were invited and 18 interviews were performed until data saturation. Participants were mainly men, licensed in cancer care, 37.9 years old on average and had 13 years of professional experience. The length of interviews was on average 34 min (SD=3). Analysis was performed accordingly with the thematic analysis.

Results

The data analysis found four themes: symptom management as a trigger, psychosocial support, mediation provided by interventions, and the association with terminal care or death. Palliative care integrated interventions were mainly perceived as holistic approaches that offered symptom management expertise and time. They were valued for helping in consolidating decision-making from a different or external perspective, or an ‘outside look’. Several barriers were identified, often due to the confusion between terminal care and palliative care. This was further highlighted by the avoidance of the words ‘palliative care’, which were associated with death.

Conclusions

National policies for promoting palliative care seemed to have failed in switching oncologists' perception of palliative care, which they still consider as terminal care.
Cultural adaptation and content validity of a Chinese translation of the ‘Person-Centered Primary Care Measure’: findings from cognitive debriefing
Authors: Tse Emily Tsui Yee , Lam Cindy Lo Kuen , Wong Carlos King Ho , Chin Weng Yee , Etz Rebecca S , Zyzanski Stephen J , Stange Kurt C
Published: September 2020

Objectives

To develop an equivalent Chinese translation of the Person-Centered Primary Care Measure (PCPCM) and to establish its cultural adaptability and content validity through cognitive debriefing.

Design

The original English PCPCM was first translated into Chinese by double forward-translation by professional translators. The reconciliated Chinese version was then doubly back-translated into English by two other professional translators blinded to the forward-translation. On affirmation on its linguistic equivalence with the developers of the original English PCPCM, the reconciliated Chinese PCPCM was sent for cognitive debriefing with 20 Chinese-speaking primary care subjects by a trained interviewer using structured probing questions to collect their opinions on the clarity, comprehensibility and relevance of each item and response option in the Measure.

Setting

Subjects were invited from a primary care clinic in Hong Kong to undergo the cognitive debriefing interviews. The interviews were divided into four groups chronologically to allow revision of the items to be made in between.

Participants

Ten males and 10 females above the age of 18 completed the cognitive interviews. They were all Cantonese-speaking Chinese recruited by convenience sampling. Subjects with cognitive impairment, could not read Chinese, too old or too sick to complete the interviews were excluded from the study.

Results

An average of 3.3 min (range 3–4 min) was required for the subjects to self-complete the Measure. All items were generally perceived to be easily understood and relevant. Modifications were made to items with the content validity index (CVI) on clarity or understanding <0.8 in each round of the interviews or if a majority of the subjects suggested rewording. Revisions were made to two items in the Chinese PCPCM throughout the whole cognitive debriefing process before the final version was confirmed. The average CVI on clarity of the Chinese PCPCM items ranged from 0.75 to 1. The average CVI on understanding ranged from 0.7 to 1. The average CVI on relevance ranged from 0.55 to 1.

Conclusions

The content validity of the PCPCM was ascertained in terms of its clarity, understandability and relevance to allow further testing of its psychometric properties in a larger Chinese population.