bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel biotechnological approaches for monitoring and immunization against resistant to antibiotics Escherichia coli and other pathogenic bacteria
Authors: Belizário José E. , Sircili Marcelo P.
Published: November 2020

The application of next-generation molecular, biochemical and immunological methods for developing new vaccines, antimicrobial compounds, probiotics and prebiotics for zoonotic infection control has been fundamental to the understanding and preservation of the symbiotic relationship between animals and humans. With increasing rates of antibiotic use, resistant bacterial infections have become more difficult to diagnose, treat, and eradicate, thereby elevating the importance of surveillance and prevention programs. Effective surveillance relies on the availability of rapid, cost-effective methods to monitor pathogenic bacterial isolates. In this opinion article, we summarize the results of some research program initiatives for the improvement of live vaccines against avian enterotoxigenic Escherichia coli using virulence factor gene deletion and engineered vaccine vectors based on probiotics. We also describe methods for the detection of pathogenic bacterial strains in eco-environmental headspace and aerosols, as well as samples of animal and human breath, based on the composition of volatile organic compounds and fatty acid methyl esters. We explain how the introduction of these low-cost biotechnologies and protocols will provide the opportunity to enhance co-operation between networks of resistance surveillance programs and integrated routine workflows of veterinary and clinical public health microbiology laboratories.
Barriers and enablers to source plasma donation by gay, bisexual and other men who have sex with men under revised eligibility criteria: protocol for a multiple stakeholder feasibility study
Authors: Vesnaver Elisabeth , Goldman Mindy , O’Brien Sheila , MacPherson Paul , Butler-Foster Terrie , Lapierre Don , Otis Joanne , Devine Dana V. , Germain Marc , Rosser Andrew , MacDonagh Richard , Randall Taylor , Osbourne-Sorrell William , Clement-Thorne Broderic , Al-Bakri Taim Bilal , Rubini Kyle A. , Hill Nolan E. , Presseau Justin
Published: November 2020

Background

Blood donation policy in Canada for gay, bisexual and other men who have had sex with men (gbMSM) has changed progressively in the last decade from indefinite deferral to 3-month deferral from last male-to-male sex. Driven by safety data and overseen by the national regulator, more inclusive policies continue to redress the disparity in donation for gbMSM. At the same time, the need for source plasma to prepare fractionated blood products is growing worldwide. The collection and processing of source plasma ensures greater safety compared to whole blood donation with respect to transfusion-transmitted infection. This greater safety offers an opportunity to evolve policies for gbMSM from time-based to behaviour-based deferral using revised eligibility criteria. However, changing policies does not in itself necessarily guarantee that gbMSM will donate or that staff in donor clinics are ready to support them to do so. In anticipation of a move to behaviour-based donation screening for gbMSM in Canada, we aim to assess the acceptability of and perceived barriers and enablers to source plasma donation using revised screening criteria for gbMSM among key stakeholders to inform policy implementation strategies.

Methods

This mixed-methods feasibility study will involve gbMSM and donor centre staff to understand modifiable barriers to implementing more inclusive eligibility criteria. Key informant interviews and surveys will be rooted in the Theoretical Domains Framework to identify modifiable factors associated with source plasma donation motives in gbMSM and training needs in donation centre staff. We will use an integrated knowledge translation approach involving a partnership between researchers, the national blood operator and gbMSM, situating knowledge users as key research team members to ensure their perspectives inform all aspects of the research.

Discussion

Our integrated knowledge translation approach will provide a more comprehensive and collaborative understanding of blood operator and gbMSM needs while accelerating the implementation of study findings. Given the historical backdrop of the decades of exclusion of sexually active gbMSM from blood donation, this study has the potential not only to inform a process and policy for gbMSM to donate source plasma, a blood product, but also offers opportunities for new relationships between these knowledge users.
Perioperative patient-specific factors-based nomograms predict short-term periprosthetic bone loss after total hip arthroplasty
Authors: Fu Guangtao , Li Mengyuan , Xue Yunlian , Li Qingtian , Deng Zhantao , Ma Yuanchen , Zheng Qiujian
Published: November 2020

Background

Although medical intervention of periprosthetic bone loss in the immediate postoperative period was recommended, not all the patients experienced periprosthetic bone loss after total hip arthroplasty (THA). Prediction tools that enrolled all potential risk factors to calculate an individualized prediction of postoperative periprosthetic bone loss were strongly needed for clinical decision-making.

Methods

Data of the patients who underwent primary unilateral cementless THA between April 2015 and October 2017 in our center were retrospectively collected. Candidate variables included demographic data and bone mineral density (BMD) in spine, hip, and periprosthetic regions that measured 1 week after THA. Outcomes of interest included the risk of postoperative periprosthetic bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year. Nomograms were presented based on multiple logistic regressions via R language. One thousand Bootstraps were used for internal validation.

Results

Five hundred sixty-three patients met the inclusion criteria were enrolled, and the final analysis was performed in 427 patients (195 male and 232 female) after the exclusion. The mean BMD of Gruen zone 1, 7, and total were decreased by 4.1%, 6.4%, and 1.7% at the 1st year after THA, respectively. 61.1% of the patients (261/427) experienced bone loss in Gruen zone 1 at the 1st postoperative year, while there were 58.1% (248/427) in Gruen zone 7 and 63.0% (269/427) in Gruen zone total. Bias-corrected C-index for risk of postoperative bone loss in Gruen zone 1, 7, and total zones in the 1st postoperative year were 0.700, 0.785, and 0.696, respectively. The most highly influential factors for the postoperative periprosthetic bone loss were primary diagnosis and BMD in the corresponding Gruen zones at the baseline.

Conclusions

To the best of our knowledge, our study represented the first time to use the nomograms in estimating the risk of postoperative periprosthetic bone loss with adequate predictive discrimination and calibration. Those predictive models would help surgeons to identify high-risk patients who may benefit from anti-bone-resorptive treatment in the early postoperative period effectively. It is also beneficial for patients, as they can choose the treatment options based on a reasonable expectation following surgery.
CXCL10 could drive longer duration of mechanical ventilation during COVID-19 ARDS
Authors: Blot Mathieu , Jacquier Marine , Aho Glele Ludwig-Serge , Beltramo Guillaume , Nguyen Maxime , Bonniaud Philippe , Prin Sebastien , Andreu Pascal , Bouhemad Belaid , Bour Jean-Baptiste , Binquet Christine , Piroth Lionel , Pais de Barros Jean-Paul , Masson David , Quenot Jean-Pierre , Charles Pierre-Emmanuel ,   Pneumochondrie study group, Aptel François , Dargent Auguste , Georges Marjolaine , Labruyère Marie , Lagrost Laurent , Large Audrey , Monier Serge , Roudaut Jean-Baptiste , Thomas Charles
Published: November 2020

Background

COVID-19-related ARDS has unique features when compared with ARDS from other origins, suggesting a distinctive inflammatory pathogenesis. Data regarding the host response within the lung are sparse. The objective is to compare alveolar and systemic inflammation response patterns, mitochondrial alarmin release, and outcomes according to ARDS etiology (i.e., COVID-19 vs. non-COVID-19).

Methods

Bronchoalveolar lavage fluid and plasma were obtained from 7 control, 7 non-COVID-19 ARDS, and 14 COVID-19 ARDS patients. Clinical data, plasma, and epithelial lining fluid (ELF) concentrations of 45 inflammatory mediators and cell-free mitochondrial DNA were measured and compared.

Results

COVID-19 ARDS patients required mechanical ventilation (MV) for significantly longer, even after adjustment for potential confounders. There was a trend toward higher concentrations of plasma CCL5, CXCL2, CXCL10, CD40 ligand, IL-10, and GM-CSF, and ELF concentrations of CXCL1, CXCL10, granzyme B, TRAIL, and EGF in the COVID-19 ARDS group compared with the non-COVID-19 ARDS group. Plasma and ELF CXCL10 concentrations were independently associated with the number of ventilator-free days, without correlation between ELF CXCL-10 and viral load. Mitochondrial DNA plasma and ELF concentrations were elevated in all ARDS patients, with no differences between the two groups. ELF concentrations of mitochondrial DNA were correlated with alveolar cell counts, as well as IL-8 and IL-1β concentrations.

Conclusion

CXCL10 could be one key mediator involved in the dysregulated immune response. It should be evaluated as a candidate biomarker that may predict the duration of MV in COVID-19 ARDS patients. Targeting the CXCL10-CXCR3 axis could also be considered as a new therapeutic approach.

Trial registration

ClinicalTrials.gov, NCT03955887
Impatiens wuyiensis (Balsaminaceae), a new species from Fujian of Southeast China, based on morphological and molecular evidences
Authors: Wang Jian-Sheng , Lu Yi-Fei , Xu Yue-Liang , Jin Shui-Hu , Jin Xiao-Feng
Published: November 2020

Background

Southeast Asia, together with tropical Africa, Madagascar, South India and Sri Lanka, and the eastern Himalayas, are the five primary hotspots of species diversity of Impatiens (Balsaminaceae). China is also rich in Impatiens species, especially in the limestone karsts or ‘Danxia’ landforms. With zygomorphic flowers and diverse corolla morphology and color, the species in Impatiens are well-known for their ornamental use, but they are also notorious in taxonomy. During the preparation of revision of Impatiens in Zhejiang and adjacent regions, an unknown species was collected from Mt. Wuyi in Fujian Province, Southeast China.

Results

Phylogenetic analyses based on nuclear ITS, chloroplast atpB-rbcL and trnL-F sequences, together with micromorphology of pollen grains and seed coats, strongly supported the close relationship of the new species with Impatiens platysepala Y.L.Chen and I. chloroxantha Y.L.Chen. In turn, both molecular data and morphological characters also were sufficient to distinguish the new species from the other two counterparts.

Conclusions

Our detailed morphological observations and molecular phylogenetic analyses support the recognition of Impatiens wuyiensis as a species new to science.
Pharmacy services during COVID-19 pandemic: experience from a tertiary care teaching hospital in Pakistan
Authors: Hussain Kashif , Ambreen Gul , Muzammil Mehreen , Raza Syed Shamim , Ali Umer
Published: November 2020

The coronavirus disease 19 (COVID-19) is rapidly spreading across the world. Pharmacy services play a vital role in public health in preventing and containing the COVID-19 pandemic. All over the world, especially in the developed countries pharmacists have responded smartly and speedily for public health, such as establishing professional protective and service guidance for pharmacy staff and services, creating and updating drug formularies, addressing the issues of drug shortages, providing public education for prevention and management of infection, contributing in drug evaluation and clinical trials. In this commentary, we review the exclusive demands from pharmacy services in Pakistan during coronavirus disease 2019 pandemic and sharing the responses of our hospital pharmacy to these demands and needs with the international pharmacy community, especially of the low and middle-income countries like Pakistan.
Prediction of the permeability of antineoplastic agents through nitrile medical gloves by zone classification based on their physicochemical properties
Authors: Oriyama Toyohito , Yamamoto Takehito , Nara Katsuhiko , Kawano Yohei , Nakajima Katsuyoshi , Suzuki Hiroshi , Aoyama Takao
Published: November 2020

Background

Permeability of antineoplastic agents through medical gloves is an important factor that must be considered for the appropriate selection of gloves. However, predicting the permeability of antineoplastic agents through medical gloves based on their physicochemical properties remains difficult. Thus, this study aimed to elucidate the relationship between the physicochemical properties and permeability of antineoplastic agents through medical gloves. Additionally, we tried to predict the risk of permeation of antineoplastic agents through medical gloves based on physicochemical parameters.

Methods

Ten antineoplastic agents (carboplatin, carmustine, cisplatin, cyclophosphamide, doxorubicin, etoposide, fluorouracil, ifosfamide, oxaliplatin, and paclitaxel) with varying physicochemical properties were investigated, and their permeation rates (PRs) through nitrile medical gloves of varying thicknesses (0.05, 0.07, and 0.1 mm) were measured using a continuous flow in-line cell device. We also determined the apparent permeation clearance (CLP,app) values of the antineoplastic agents based on their PRs at 240 min (PR240) and assessed the relationship between CLP,app and physicochemical parameters [molecular weight (MW) and logarithm of octanol-water partition coefficient (LogP)].

Results

The CLP,app values of the 10 antineoplastic agents through nitrile medical gloves (0.05 mm thickness) were significantly correlated with their MWs, but not their LogP values (P = 0.026 and 0.39, respectively; Spearman’s rank correlation). This finding indicated that the rates of diffusion of the antineoplastic agents in the glove material showed greater effects on CLP,app than the rates of absorption into the glove surfaces within 240 min of exposure. We then classified the 10 antineoplastic agents into 3 zones (Zone A, high LogP/low MW drugs; Zone B, high LogP/high MW drugs; and Zone C, low LogP) and found that Zones A, B, and C corresponded to high (PR240 > 10 ng/min/cm2), moderate (PR240 < 10 ng/min/cm2), and low (no detectable permeation) permeation risk, respectively.

Conclusions

The permeation risk of antineoplastic agents through nitrile medical gloves within the actual continuous wearing time in clinical settings could be predicted using MW and LogP values. We believe that the proposed zone classification of antineoplastic agents will be a useful tool for predicting the permeation risk of antineoplastic agents through medical gloves.
Increased calcium intake is associated lower serum 25-hydroxyvitamin D levels in subjects with adequate vitamin D intake: a population-based observational study
Authors: Jorde Rolf , Grimnes Guri
Published: November 2020

Background

There are indications that an increased intake of calcium has a vitamin D sparing effect, which might be explained by a decreased catabolism of 25-hydroxyvitamin D (25(OH)D). However, there are only a few studies where this has been examined.

Method

In the seventh survey of the Tromsø study, serum 25(OH)D and parathyroid hormone were measured, and questionnaires on calcium and vitamin D intakes filled in.

Results

There were significant interactions between sex, calcium and vitamin D intakes regarding serum 25(OH)D level. The analyses were therefore done stratified. In males there was, regardless of vitamin D intake, a significant decrease in serum 25(OH)D with increasing calcium intake. The difference in serum 25(OH)D between those with the highest and lowest calcium intakes was approximately 10%. In the females, there was in subjects with low vitamin D intake (< 7 μg/d) a significant increase in serum 25(OH)D with increasing calcium intake, which could not be explained by secondary hyperparathyroidism. In females with higher vitamin D intakes, increasing calcium intake was associated with lower serum 25(OH)D levels.

Conclusions

There is, at least in subjects with an adequate vitamin D intake, a negative association between calcium intake and serum 25(OH)D.
Big data in education: a state of the art, limitations, and future research directions
Authors: Baig Maria Ijaz , Shuib Liyana , Yadegaridehkordi Elaheh
Published: November 2020

Big data is an essential aspect of innovation which has recently gained major attention from both academics and practitioners. Considering the importance of the education sector, the current tendency is moving towards examining the role of big data in this sector. So far, many studies have been conducted to comprehend the application of big data in different fields for various purposes. However, a comprehensive review is still lacking in big data in education. Thus, this study aims to conduct a systematic review on big data in education in order to explore the trends, classify the research themes, and highlight the limitations and provide possible future directions in the domain. Following a systematic review procedure, 40 primary studies published from 2014 to 2019 were utilized and related information extracted. The findings showed that there is an increase in the number of studies that address big data in education during the last 2 years. It has been found that the current studies covered four main research themes under big data in education, mainly, learner’s behavior and performance, modelling and educational data warehouse, improvement in the educational system, and integration of big data into the curriculum. Most of the big data educational researches have focused on learner’s behavior and performances. Moreover, this study highlights research limitations and portrays the future directions. This study provides a guideline for future studies and highlights new insights and directions for the successful utilization of big data in education.
Texture indices of 4′-[methyl-11C]-thiothymidine uptake predict p16 status in patients with newly diagnosed oropharyngeal squamous cell carcinoma: comparison with 18F-FDG uptake
Authors: Ihara-Nishishita Ayumi , Norikane Takashi , Mitamura Katsuya , Yamamoto Yuka , Fujimoto Kengo , Takami Yasukage , Ibuki Emi , Kudomi Nobuyuki , Hoshikawa Hiroshi , Toyohara Jun , Nishiyama Yoshihiro
Published: November 2020

Background

In oropharyngeal squamous cell carcinoma (OPSCC), human papillomavirus (HPV)/p16 status is important as a prognostic biomarker.

Purpose

We evaluated the relationship between 4′-[methyl-11C]-thiothymidine (11C-4DST) and 18F-FDG PET texture indices and p16 status in patients with newly diagnosed OPSCC.

Methods

We retrospectively reviewed the collected data of 256 consecutive, previously untreated patients with primary head and neck tumors enrolled between November 2011 and October 2019. Complete data on both 11C-4DST and 18F-FDG PET/CT studies before therapy, patients with OPSCC, and p16 status were available for 34 patients. Six of them were excluded because they did not exhibit sufficient 11C-4DST and/or 18F-FDG tumor uptake to perform textural analysis. Finally, 28 patients with newly diagnosed OPSCC were investigated. The maximum standardized uptake value (SUVmax) and 6 texture indices (homogeneity, entropy, short-run emphasis, long-run emphasis, low gray-level zone emphasis, and high gray-level zone emphasis) were derived from PET images. The presence of p16 expression in tumor specimens was examined by immunohistochemistry and compared with the PET parameters.

Results

Using 11C-4DST, the expression of p16 was associated with a higher homogeneity (P = 0.012), lower short-run emphasis (P = 0.005), higher long-run emphasis (P = 0.009), and lower high-gray-level-zone emphasis (P = 0.042) values. There was no significant difference between 18F-FDG PET parameters and p16 status.

Conclusion

Texture indices of the primary tumor on 11C-4DST PET, but not 18F-FDG PET, may be of value in predicting the condition’s p16 status in patients with newly diagnosed OPSCC.
A systematic review of CXCL13 as a biomarker of disease and treatment response in rheumatoid arthritis
Authors: Bechman Katie , Dalrymple Anthony , Southey-Bassols Charles , Cope Andrew P. , Galloway James B.
Published: November 2020

Background

The B cell chemoattractant CXCL13 is a promising biomarker in rheumatoid arthritis (RA), with a plausible role in supporting diagnosis, monitoring disease activity and as a prognostic value. It is a key chemokine driving the formation of lymphoid follicles within the inflamed synovium. The objective of this systematic review was to evaluate the role of CXCL13 as a viable biomarker in RA.

Methods

We conducted a systematic literature review of all published cohort and randomised controlled trials evaluating the role of CXCL13 in RA. The primary outcomes were; i) CXCL13 levels in RA patients compared to healthy controls, ii) the correlation between CXCL13 and markers of disease activity, and iii) the association between CXCL13 and treatment response.

Results

The search produced 278 articles, of which 31 met the inclusion criteria. Of the 12 studies evaluating CXCL13 expression in early or established RA, all reported higher levels than that seen in healthy controls. Twelve of sixteen studies reported a weakly positive correlation between CXCL13 and markers of disease activity including DAS28 and swollen joint count, with rho values between 0.20–0.67. In 2 studies, CXCL13 levels correlated with ultrasonographic evidence of synovitis. Eighteen studies assessed CXCL13 in response to therapeutic intervention. The majority signified a fall in levels in response to treatment including biologics and Janus kinase (JAK) inhibition. In some, this reduction was only seen in treatment responders. High CXCL13 levels predicted failure to achieve disease remission with csDMARDs. The evidence for treatment prediction with biologics was conflicting.

Conclusion

Despite evidence to suggest a role in diagnosing RA and in detecting synovitis, the heterogeneity of studies included in this review limit our ability to draw robust conclusions. At present there are inadequate results to justify the routine use of CXCL13 as a biomarker in RA routine clinical practice.
Temporal insular glioma–rare case report for a venous air embolism
Authors: Jain Swati , Kumar Dinesh , Chandra Nikhilesh , Kakkar Mahak
Published: November 2020

Background

Venous air embolism (VAE) is a well-known entity in the field of neuroanesthesia, with established surgeries and positions where its occurrence is high. The insular cortex is a deep area within the lateral sulcus, and surgeries in this area are not reported to develop VAE.

Case presentation

A young male being operated on the insular cortex developed VAE, had cardiac arrest, was revived, and was extubated with no residual deficit due to the untoward event.

Conclusions

An anesthesiologist should always be prepared for this complication due to its rapid presentation and fatal consequences.
Predictors of postoperative atrial fibrillation after coronary artery bypass grafting: a prospective observational cohort study
Authors: El-Gendy Hanaa A. , Dabsha Mohamed H. , Elewa Gamal M. , Ali Amr H.
Published: November 2020

Background

This study was conducted to determine the effect of certain predictors on the incidence of postoperative atrial fibrillation (POAF) during ICU stay after coronary artery bypass graft (CABG) surgery.

Results

We enrolled 123 patients in this study. The mean age was 57.4 ± 8.7 years, and the mean left atrial diameter was 4.1 ± 0.52 cm with male preponderance (76.4%). The incidence of POAF following CABG was 33.3%. There was no statistically significant association between POAF and smoking (P = 0.123). However, POAF was significantly associated with higher CHA2DS2-VASc score (P = 0.002), valve replacement (P < 0.001), and inotropic support (P = 0.005). Moreover, patients with POAF had significantly higher mean age (P = 0.031) and left atrial (LA) diameter (P < 0.001). Logistic regression showed that LA diameter (P < 0.001), potassium level at 36 h (P = 0.016), and female gender (P = 0.001) were independent predictors of POAF.

Conclusions

We had several significant epidemiological, clinical, and operative variables that were significantly associated with post-CABG AF, including older age, female gender, large LA diameter, valve replacement, higher CHA2DS2-VASc score, and postoperative inotropic support. However, only LA diameter, female gender, and potassium level at 36 h were independent predictors of POAF. Nevertheless, further large-scale studies are needed to confirm our findings.
Intraoperative infusion of lidocaine 2% reduces postoperative fentanyl requirements for pain control in renal transplantation surgery
Authors: Abdellatif Mostafa K. , Ibrahim Tamer H.
Published: November 2020

Background

Intravenous lidocaine has been shown to be an analgesic and anti-inflammatory medication with modulation of excessive inflammatory response.

We investigated the efficacy of intraoperative lidocaine 2% infusion in reducing the postoperative Fentanyl requirements for analgesia in renal transplant recipients. Patients were assigned equally into two groups by computer-generated list compiled before the start of the study. Control group: fentanyl (F) group and study group: lidocaine 2% (L) group. Medication used is either lidocaine in the dose of 2 mg/kg/h and the other syringe contained saline both have been infused by rate of 10 ml/h. Fentanyl induction dose given for the two groups was 1.5 mcg/kg. Both groups have received extra fentanyl according to their intraoperative analgesic requirements, patients in the lidocaine group received the fentanyl induction dose accompanied by lidocaine 2% 1.5 mg/kg as loading dose, followed by maintenance dose of lidocaine 2% infusion 2 mg/kg/h. After transfer to the PACU nursing staff administered fentanyl 0.5 mcg/kg boluses for postoperative pain relief every 10 min up to 2 mcg/kg, the recovery nurse used the pain numerical score to assess pain. The recovery nurse referred the patient to the responsible anesthesiologist covering the recovery unit if he required more than 2 mcg/kg of fentanyl to control postoperative pain. Patient was then transferred to the RTU (renal transplant unit), postoperative pain and fentanyl PCA consumption were followed up during the first 24 h.

Results

Our study detected increased fentanyl consumption in the recovery for the fentanyl group more than the lidocaine group. The request of the first dose of analgesic was significantly longer in lidocaine group than in fentanyl group.

Conclusion

The usage of intraoperative lidocaine infusion decreased postoperative fentanyl requirements as analgesic in patients undergoing renal transplantation.

Trial registration

Registration on ANZCTR number ACTRN12618001335280, REGISTERED 08 August 2018.
Reductive regulation of BECN1 gene in adult Egyptian patients with do novo AML
Authors: Ghozlan Manal Fawzy , Farweez Botheina Ahmed Thabet , Safwat Nesma Ahmed , Hassan Noha Bassiouny , Elsalakawy Walaa Ali
Published: November 2020

Background

Acute myeloid leukaemia (AML) is a clonal haematopoietic disease characterized by the proliferation of immature blast cells in the bone marrow and peripheral blood. Autophagy is an inherent cellular route by which waste macromolecules are engulfed within autophagosomes prior to their fusion with cytoplasmic lysosomes for degradation. The BECN1 gene encodes the Beclin-1 protein, which regulates autophagy. Few reports have investigated BECN1 gene expression and its value in AML patients.

Results

This randomized case-control study included 50 newly diagnosed AML patients, in addition to 20 subjects as a control group. BECN1 gene expression was assessed using real-time quantitative polymerase chain reaction (qRT-PCR).

The median level of BECN1 gene expression in AML patients was 0.41 (IQR 0.29–1.03) in comparison to 1.12 (IQR 0.93–1.26) in the control group (P = 0.000). Seventy-two percent of AML patients showed reduced BECN1 gene expression, which was highly significantly associated with intermediate and adverse cytogenetic risk. Reduced BECN1 gene expression was associated with older age, higher total leukocyte counts, the presence of peripheral blood blast cells, a higher percentage of bone marrow blast cells, and higher expression of CD34 and CD117. FLT3-ITD mutation was detected in 14 patients (38.9%), all of whom showed reduced BECN1 gene expression (P = 0.006). BECN1 gene expression was also reduced in non-responder AML patients, with a highly statistically significant difference (P = 0.002).

Conclusion

A reduction in BECN1 gene expression might indicate a poor prognosis in adult Egyptian patients with de novo AML. Decreased BECN1 gene expression is associated with a higher risk of resistance to treatment. Targeting autophagy pathways may help in the treatment of AML patients.
Comparison of cognitive function, socioeconomic level, and the health-related quality of life between epileptic patients with attention deficit hyperactivity disorder and without
Authors: Ahmed Gellan K. , Darwish Alaa M. , Khalifa Hossam , Khashbah Mohamed A.
Published: November 2020

Background

Epilepsy is one of the most common neurological conditions. Attention deficit hyperactivity disorder (ADHD) in children with epilepsy proves to be very common. Both epilepsy and ADHD impair quality of life. We aimed to evaluate cognitive function, socioeconomic level, and quality of life (QOL) among children with ADHD and epilepsy. A total of 100 children were divided into 5 groups (20 children/group) as (I) epilepsy, (II) ADHD with epilepsy, (III) ADHD with EEG changes, (IV) ADHD without EEG changes, and (V) control. Children aged between 6 and 11 years were recruited for this study. Early Childhood Epilepsy Severity Scale (E-Chess), Conners’ Parent Rating Scale (CPRS), Wechsler Intelligence Scale for Children-3rd edition (WISC-III), socioeconomic scale for assessment of social burden and socioeconomic classes, and PedsQL (quality of life measure) assessed.

Results

Children with ADHD and epilepsy had the lowest PedsQL total scores and lower scores than other groups especially in performance IQ score. The highest percentage of low socioeconomic class (25%) was observed in the group of ADHD with epilepsy and the group of epilepsy.

Conclusion

ADHD with epilepsy is associated with low performance IQ, poor socioeconomic level, and quality of life. Pediatric Quality of Life Inventory scores show significant correlation with total IQ score in the group of ADHD with epilepsy.
Reviews
Authors: Sandham William A.
Published: November 2020

Deep Learning, by Ian Goodfellow, Yoshua Bengio, and Aaron Courville, ISBN 978-0-262-03561-3, 2016, MIT Press, US$80.00 (print).
Memorial
Authors: Robinson Enders , Moser Tijmen Jan
Published: November 2020

Virgil Bardan was known for his contributions to seismic data acquisition and digital data processing related to inversion, sampling, and multiple attenuation. His numerous publications and erudite presentations, in a career that extended for more than 45 years, established him as a leader in exploration geophysics.
PsychStart: a novel mentoring scheme for supporting and valuing medical students interested in psychiatry
Authors: Hewson Thomas , Thomas Nikki , Lovett Kate , Bruce Helen , Tracy Derek K.
Published: November 2020

We describe the establishment and evaluation of a career-based mentoring scheme (PsychStart) for medical students interested in psychiatry. Medical students reported multiple benefits of mentoring, including enhanced personal and professional development, increased career and clinical knowledge, and broadened exposure to psychiatry. The mentoring scheme was also found to promote and sustain interest in the specialty. Further evaluation is required to determine the long-term effects of mentoring and how this may compare with other undergraduate enrichment activities. We conclude that mentoring in psychiatry could offer innovative solutions for improving recruitment and retention, and for supporting and valuing medical students who demonstrate an early interest in the specialty.
Brown Fat–Activating Lipokine 12,13-diHOME in Human Milk Is Associated With Infant Adiposity
Authors: Wolfs Danielle , Lynes Matthew D , Tseng Yu-Hua , Pierce Stephanie , Bussberg Valerie , Darkwah Abena , Tolstikov Vladimir , Narain Niven R , Rudolph Michael C , Kiebish Michael A , Demerath Ellen W , Fields David A , Isganaitis Elvira
Published: November 2020

Context

Little is known about the specific breastmilk components responsible for protective effects on infant obesity. Whether 12,13-dihydroxy-9Z-octadecenoic acid (12,13-diHOME), an oxidized linoleic acid metabolite and activator of brown fat metabolism, is present in human milk, or linked to infant adiposity, is unknown.

Objective

To examine associations between concentrations of 12,13-diHOME in human milk and infant adiposity.

Design

Prospective cohort study from 2015 to 2019, following participants from birth to 6 months of age.

Setting

Academic medical centers.

Participants

Volunteer sample of 58 exclusively breastfeeding mother-infant pairs; exclusion criteria included smoking, gestational diabetes, and health conditions with the potential to influence maternal or infant weight gain.

Main Outcome Measures

Infant anthropometric measures including weight, length, body mass index (BMI), and body composition at birth and at 1, 3, and 6 months postpartum.

Results

We report for the first time that 12,13-diHOME is present in human milk. Higher milk 12,13-diHOME level was associated with increased weight-for-length Z-score at birth (β = 0.5742, P = 0.0008), lower infant fat mass at 1 month (P = 0.021), and reduced gain in BMI Z-score from 0 to 6 months (β = −0.3997, P = 0.025). We observed similar associations between infant adiposity and milk abundance of related oxidized linoleic acid metabolites 12,13-Epoxy-9(Z)-octadecenoic acid (12,13-epOME) and 9,10-Dihydroxy-12-octadecenoic acid (9,10-diHOME), and metabolites linked to thermogenesis including succinate and lyso-phosphatidylglycerol 18:0. Milk abundance of 12,13-diHOME was not associated with maternal BMI, but was positively associated with maternal height, milk glucose concentration, and was significantly increased after a bout of moderate exercise.

Conclusions

We report novel associations between milk abundance of 12,13-diHOME and adiposity during infancy.
The Management of Neuroendocrine Tumors of the Lung in MEN1: Results From the Dutch MEN1 Study Group
Authors: van den Broek Medard F M , de Laat Joanne M , van Leeuwaarde Rachel S , van de Ven Annenienke C , de Herder Wouter W , Dekkers Olaf M , Drent Madeleine L , Kerstens Michiel N , Bisschop Peter H , Havekes Bas , Hackeng Wenzel M , Brosens Lodewijk A A , Vriens Menno R , Buikhuisen Wieneke A , Valk Gerlof D
Published: November 2020

Introduction

Multiple endocrine neoplasia type 1 (MEN1)-related neuroendocrine tumors (NETs) of the lung are mostly indolent, with a good prognosis. Nevertheless, cases of aggressive lung NET do occur, and therefore the management of individual patients is challenging.

Aim

To assess tumor growth and the survival of patients with MEN1-related lung NETs at long-term follow-up.

Methods

The population-based Dutch MEN1 Study Group database (n = 446) was used to identify lung NETs by histopathological and radiological examinations. Tumor diameter was assessed. Linear mixed models and the Kaplan-Meier method were used for analyzing tumor growth and survival. Molecular analyses were performed on a lung NET showing particularly aggressive behavior.

Results

In 102 patients (22.9% of the total MEN1 cohort), 164 lesions suspected of lung NETs were identified and followed for a median of 6.6 years. Tumor diameter increased 6.0% per year. The overall 15-year survival rate was 78.0% (95% confidence interval: 64.6–94.2%) without lung NET-related death. No prognostic factors for tumor growth or survival could be identified. A somatic c.3127A > G (p.Met1043Val) PIK3CA driver mutation was found in a case of rapid growing lung NET after 6 years of indolent disease, presumably explaining the sudden change in course.

Conclusion

MEN1-related lung NETs are slow growing and have a good prognosis. No accurate risk factors for tumor growth could be identified. Lung NET screening should therefore be based on well-informed, shared decision-making, balancing between the low absolute risk of an aggressive tumor in individuals and the potential harms of frequent thoracic imaging.
Identification and Metabolic Profiling of a Novel Human Gut-derived LEAP2 Fragment
Authors: Hagemann Christoffer A , Zhang Chen , Hansen Henrik H , Jorsal Tina , Rigbolt Kristoffer T G , Madsen Martin R , Bergmann Natasha C , Heimbürger Sebastian M N , Falkenhahn Mechthilde , Theis Stefan , Breitschopf Kristin , Holm Stephanie , Hedegaard Morten A , Christensen Mikkel B , Vilsbøll Tina , Holst Birgitte , Vrang Niels , Jelsing Jacob , Knop Filip K
Published: November 2020

Context

The mechanisms underlying Roux-en-Y gastric bypass (RYGB) surgery-induced weight loss and the immediate postoperative beneficial metabolic effects associated with the operation remain uncertain. Enteroendocrine cell (EEC) secretory function has been proposed as a key factor in the marked metabolic benefits from RYGB surgery.

Objective

To identify novel gut-derived peptides with therapeutic potential in obesity and/or diabetes by profiling EEC-specific molecular changes in obese patients following RYGB-induced weight loss.

Subjects and Methods

Genome-wide expression analysis was performed in isolated human small intestinal EECs obtained from 20 gut-biopsied obese subjects before and after RYGB. Targets of interest were profiled for preclinical and clinical metabolic effects.

Results

Roux-en-Y gastric bypass consistently increased expression levels of the inverse ghrelin receptor agonist, liver-expressed antimicrobial peptide 2 (LEAP2). A secreted endogenous LEAP2 fragment (LEAP238-47) demonstrated robust insulinotropic properties, stimulating insulin release in human pancreatic islets comparable to the gut hormone glucagon-like peptide-1. LEAP238-47 showed reciprocal effects on growth hormone secretagogue receptor (GHSR) activity, suggesting that the insulinotropic action of the peptide may be directly linked to attenuation of tonic GHSR activity. The fragment was infused in healthy human individuals (n = 10), but no glucoregulatory effect was observed in the chosen dose as compared to placebo.

Conclusions

Small intestinal LEAP2 expression was upregulated after RYGB. The corresponding circulating LEAP238-47 fragment demonstrated strong insulinotropic action in vitro but failed to elicit glucoregulatory effects in healthy human subjects.
Apparent Reversal of a Successful Peripheral Neural Blockade With Intravenous Lipid Emulsion After Treatment for Local Anesthetic Systemic Toxicity: A Case Report
Authors: Torrie Arissa M. , Dunitz Jackson , Brookman Jason C.
Published: November 2020

The use of local anesthetics for improved pain management is well established. However, significant morbidity may be caused by local anesthetic systemic toxicity (LAST) from inadvertent intravascular injection or excessive dosing of local anesthetics. Despite incomplete understanding of the mechanism of action of intravenous lipid emulsions (ILE), their use has become a first-line therapy for treating LAST. We present a case report of LAST, successfully treated with ILE with a secondary effect of complete reversal of a successful peripheral nerve block as quickly as the LAST symptoms resolved.
Angus Fletcher’s Precious Idiosyncrasy
Authors: Gross Kenneth
Published: November 2020

The essay describes Angus Fletcher’s ambitious, often uncanny ways of mapping the nature of literary form and literary knowing. The essay describes how Fletcher himself describes our crucial metaphors of order and disorder, our “cosmic” (sometimes cosmetic) images, how he explores their conditions of possibility. The focus is on three words, three figures of thought in Fletcher’s work: daemon, central to his picture of allegorical agency, its compulsive, almost supernatural character; gnome, or the gnomic, a name for what’s most secret, most difficult, and yet most fundamental in literary expression; and horizon, a mark of how human thought, in collaboration with nature or the given world, shapes an image of space, direction, and limit, an imaginary line that also helps to frame ideas of transcendence. Taken together, these three words offer coordinates by which one can start to map the unfolding labyrinth of Fletcher’s conceptual world.
Artificial selection for schooling behaviour and its effects on associative learning abilities
Authors: Vega-Trejo Regina , Boussard Annika , Wallander Lotta , Estival Elisa , Buechel Séverine D. , Kotrschal Alexander , Kolm Niclas
Published: November 2020

The evolution of collective behaviour has been proposed to have important effects on individual cognitive abilities. Yet, in what way they are related remains enigmatic. In this context, the ‘distributed cognition’ hypothesis suggests that reliance on other group members relaxes selection for individual cognitive abilities. Here, we test how cognitive processes respond to evolutionary changes in collective motion using replicate lines of guppies (Poecilia reticulata) artificially selected for the degree of schooling behaviour (group polarization) with >15% difference in schooling propensity. We assessed associative learning in females of these selection lines in a series of cognitive assays: colour associative learning, reversal-learning, social associative learning, and individual and collective spatial associative learning. We found that control females were faster than polarization selected females at fulfilling a learning criterion only in the colour associative learning assay, but they were also less likely to reach a learning criterion in the individual spatial associative learning assay. Hence, although testing several cognitive domains, we found weak support for the distributed cognition hypothesis. We propose that any cognitive implications of selection for collective behaviour lie outside of the cognitive abilities included in food-motivated associative learning for visual and spatial cues.
The marginalisation of midwifery in medicalised pregnancy and childbirth: a qualitative study
Authors: Najmabadi Khadijeh Mirzaie , Tabatabaie Mahmoud Ghazi , Vedadhir Abou Ali , Mobarakabadi Sedigheh Sedigh
Published: November 2020

Introduction

The role of midwives has changed in providing care for low-risk pregnancies and childbirth. This study explores the perceptions of perinatal care providers and recipients regarding midwifery services.

Methods

This study used a qualitative content analysis approach. Data were collected through 49 semi-structured in-depth interviews, and analysed with qualitative content analysis.

Results

The medicalisation of pregnancy and childbirth has marginalised midwifery. Midwifery, which should be at the heart of all low-risk pregnancies and childbirth, has deteriorated such that it has become disempowered in interdisciplinary relations.

Conclusions

Midwifery is at risk of being totally excluded from low-risk pregnancy care and childbirth.
Improving physical health in people with severe mental illness
Authors: Hardy Sheila
Published: November 2020

People with severe mental illness have a higher mortality than the general population. Sheila Hardy explains how nurses can address the health disparities that people with severe mental illness face

People with severe mental illness have a higher mortality than the general population, with the main cause of early death being from a physical condition. Practice nurses are well placed to address the health disparities that people with severe mental illness face. This article describes the reasonable adjustments that can be made to increase engagement with patients.
Olecranon fixation with two bicortical screws
Authors: Gill James R. , Vermuyten Lieven , Schenk Sophie A. , Ong Josh C. Y. , Schenk Willem
Published: November 2020

Aims

The aim of this study is to report the results of a case series of olecranon fractures and olecranon osteotomies treated with two bicortical screws.

Methods

Data was collected retrospectively for all olecranon fractures and osteotomies fixed with two bicortical screws between January 2008 and December 2019 at our institution. The following outcome measures were assessed; re-operation, complications, radiological loss of reduction, and elbow range of flexion-extension.

Results

Bicortical screw fixation was used to treat 17 olecranon fractures and ten osteotomies. The mean age of patients being treated for olecranon fracture and osteotomy were 48.6 years and 52.7 years respectively. Overall, 18% of olecranon fractures were classified as Mayo type I, 71% type II, and 12% type III. No cases of fracture or osteotomy required operative re-intervention. There were two cases of loss of fracture reduction which occurred in female patients ≥ 75 years of age with osteoporotic bone. In both cases, active extension and a functional range of movement was maintained and so the loss of reduction was managed non-operatively. For the fracture fixation cohort, at final follow-up mean elbow extension and flexion were -5° ± 5° and 136° ± 7°, with a mean arc of motion of 131° ± 11°.

Conclusion

This series has shown that patients regain near full range of elbow flexion-extension and complication rates are low following bicortical screw fixation of olecranon fractures and osteotomy. Cite this article: Bone Joint Open 2020;1-7:376–382.
30-day mortality following trauma and orthopaedic surgery during the peak of the COVID-19 pandemic
Authors: Karayiannis Paul N. , Roberts Veronica , Cassidy Roslyn , Mayne Alistair I. W. , McAuley Daryl , Milligan David J. , Diamond Owen
Published: November 2020

Aims

Now that we are in the deceleration phase of the COVID-19 pandemic, the focus has shifted to how to safely reinstate elective operating. Regional and speciality specific data is important to guide this decision-making process. This study aimed to review 30-day mortality for all patients undergoing orthopaedic surgery during the peak of the pandemic within our region.

Methods

This multicentre study reviewed data on all patients undergoing trauma and orthopaedic surgery in a region from 18 March 2020 to 27 April 2020. Information was collated from regional databases. Patients were COVID-19-positive if they had positive laboratory testing and/or imaging consistent with the infection. 30-day mortality was assessed for all patients. Secondly, 30-day mortality in fracture neck of femur patients was compared to the same time period in 2019.

Results

Overall, 496 operations were carried out in 484 patients. The overall 30-day mortality was 1.9%. Seven out of nine deceased patients underwent surgery for a fractured neck of femur. In all, 27 patients contracted COVID-19 in the peri-operative period; of these, four patients died within 30 days (14.8%). In addition, 21 of the 27 patients in this group had a fractured neck of femur, 22 were over the age of 70 years (81.5%). Patients with American Society of Anesthesiologists (ASA) grade > 3 and/or age > 75 years were at significantly higher risk of death if they contracted COVID-19 within the study period.

Conclusion

Overall 30-day postoperative mortality in trauma and orthopaedic surgery patients remains low at 1.9%. There was no 30-day mortality in patients ASA 1 or 2. Patients with significant comorbidities, increasing age, and ASA 3 or above remain at the highest risk. For patients with COVID-19 infection, postoperative 30-day mortality was 14.8%. The reintroduction of elective services should consider individual patient risk profile (including for ASA grade). Effective postoperative strategies should also be employed to try and reduce postoperative exposure to the virus. Cite this article: Bone Joint Open 2020;1-7:392–397.