bluuebunny/crossref_metadata_2025 huggingface dataset:
Co-Formulations as the First Injectable in Type 2 Diabetes: A Review of Efficacy, Safety, and Implications in Clinical Practice
Authors: John Mathew , Gopinath Deepa , Oommen Tittu
Published: August 2020

Background: Progression of type 2 diabetes will necessitate the use of injectable therapies in a significant number of people. Co-formulations of degludec with liraglutide (IDeg­Lira) and glargine with lixisenatide (IGlarLixi) are currently recommended for intensification in people with type 2 diabetes on basal insulin or glucagon-like peptide receptor agonist (GLP-1RA) alone or in people with type 2 diabetes who are naïve to insulin with very high glycated haemoglobin. Co-formulation of aspart with degludec (IDegAsp) is recommended as a substitute for premixed insulin. The aim of this article is to review the evidence in the use of co-formulations as the first injectable in type 2 diabetes and its clinical implications. Summary: In people with type 2 diabetes who are naïve to insulin or GLP-1RA, IDegLira and IGlarLixi achieved stable and durable glycaemic control over a wide range of baseline glycated haemoglobin (HbA1c) levels. People on IDegLira and IGlarLixi had lesser risk of hypoglycaemia and weight gain in studies compared to basal insulin and lesser gastrointestinal adverse effects in comparison to GLP-1RA. IDegAsp achieved similar glycaemic control to basal and premixed insulin with lesser risk of nocturnal hypoglycaemia. Key Messages: IDegLira, IGlarLixi, and IDegAsp can be used as the first injectable in people with type 2 diabetes with very high glycated haemoglobin on oral antidiabetic drugs. These co-formulations combine efficacy and durability with lesser injection burden. The components of these agents have proven cardiovascular and renal safety. Their limitations in flexibility of dosing, renal and cardiovascular considerations, and adverse effects are discussed.
A Proactive Mobile Health Application Program for Promoting Self-Care Health Management among Older Adults in the Community: Study Protocol of a Three-Arm Randomized Controlled Trial
Authors: Wong Arkers Kwan Ching , Wong Frances Kam Yuet , Chang Katherine Ka Pik
Published: August 2020

Background: The use of mobile health (mHealth) has become common in recent years and is regarded as one of the most effective interventions for developing disease-specific management skills and establishing confidence in making preventive health behavior changes and accomplishing health-related goals among community-dwelling older adults. Most mHealth designs adopt a reactive care approach whereby health care professionals do not respond until they receive abnormal assessment results from the database or a message or signal from the client. The purpose of this study is to determine the effectiveness of a proactive mobile health application program with the support of a community health-social care team for older adults dwelling in the community on improving their self-care health management. Methods: This is a three-armed, randomized controlled trial. The study will be conducted in 7 community centers with an estimated sample size of 282 participants. The participants will be randomly assigned to mHealth with interactivity, mHealth, and control groups when they are (1) aged 60 or above, (2) complaining chiefly of pain, hypertension, or diabetes mellitus, (3) living within the service areas, and (4) smartphone users. Subjects in the mHealth with interactivity group will receive 2 main elements, the mHealth application and nurse case management supported by a social service team. The mHealth group will receive the mHealth application only. The primary outcome measure will be self-efficacy, and secondary outcomes will include self-management outcomes (pain score, blood pressure, capillary blood glucose), client outcomes (quality of life, depression), and health service utilization outcomes (institutionalization and health service utilization [general practitioner, outpatient clinic, emergency room, hospital admission]). Data will be collected before intervention, after intervention, and 3 months after intervention. Discussion: The incremental benefits of adding interactivity in the mHealth program have not been confirmed. This present study will add valuable information to the knowledge gap of whether mHealth with nurse interaction supported by a health-social partnership can improve self-care management among community-dwelling older adults.
Melatonin Administered before or after a Cytotoxic Drug Increases Mammary Cancer Stabilization Rates in HER2/Neu Mice
Authors: Panchenko Andrey V. , Tyndyk Margarita L. , Maydin Mikhail A. , Baldueva Irina A. , Artemyeva Anna S. , Kruglov Stepan S. , Kireeva Galina S. , Golubev Alexey G. , Belyaev Alexey M. , Anisimov Vladimir N.
Published: August 2020

Introduction: The effects of chemotherapy are known to depend on the time of administration. Circadian rhythms are disturbed in tumors and in tumor bearers. Agents involved in controlling the circadian rhythms (chronobiotics) potentially can modify the outcomes of chemotherapeutics administered at different times of the day. Pineal hormone melatonin (MT) is a prototypic chronobiotic. Objective: The aim of the study was to investigate if MT can affect efficacy or toxicity of chemotherapy drugs administered at the extreme time points of the working day of hospital personnel. Methods: Cyclophosphamide, adriamycin, and 5-fluorouracil (CAF) and adriamycin and docetaxel (AT) cytotoxic drug combinations were administered on day 0 at 11:00 a.m. or at 5:00 p.m. (UTC+03:00) to 6-month-old female HER2/neu transgenic FVB/N mice bearing mammary adenocarcinomas. Some mice were additionally provided with MT in drinking water (20 mg/L) at night 1 week before or 3 weeks after treatment or during both periods. Tumor node sizes, body weight, and blood cell counts were determined right before treatment and on days 2, 7, 14, and 21. Results: Significant decrease in the mean tumor node volume was found by days 14 and 21 upon all CAF and AT treatment schedules, except in animals treated with AT at 5:00 p.m. without supplementation with MT. In the latter case, mean tumor node volume on day 21 was the same as in the control. Supplementation of AT administered at 5:00 p.m. with MT improved the tumor response. CAF and AT regimens supplemented with MT also augmented the number of tumor nodes that did not increase by more than 20% by day 21 as compared to CAF or AT alone, respectively. This effect was significant in groups treated with AT at 5:00 p.m. and consistent upon other schedules. On day 7, leukopenia and anemia were registered in groups treated with CAF regimen; however, blood cell counts normalized by day 14. Both CAF and AT were associated with drop in the body weight registered on day 7. Supplementation with MT did not affect changes of the body weight and blood counts. Conclusions: MT supplementation to cytotoxic drugs can improve antitumor response, especially if it is blunted because of an inappropriate time of administration.
Cardiovascular Risk in Polycythemia Vera: Thrombotic Risk and Survival: Can Cytoreductive Therapy Be Useful in Patients with Low-Risk Polycythemia Vera with Cardiovascular Risk Factors?
Authors: Mancuso Salvatrice , Santoro Marco , Accurso Vincenzo , Agliastro Giuseppe , Raso Simona , Di Piazza Florinda , Perez Alessandro , Bono Marco , Russo Antonio , Siragusa Sergio
Published: August 2020

Background/Aims: Cardiovascular risk factors are not considered in the current scores for evaluation of the thrombotic risk in myeloproliferative neoplasms, and in polycythemia vera (PV) in particular. Cytoreduction is currently not indicated in low-risk patients with PV, despite the absence or presence of cardiovascular risk factors. Our purpose is to highlight how cardiovascular risk factors in patients with PV increase the thrombotic risk both in low- and high-risk patients. Methods: We collected and analyzed data from 165 consecutive patients with a diagnosis of PV followed at our institution and compared the frequency of thrombosis in subgroups of patients distinguished by the presence or absence of cardiovascular risk factors. The statistic tools used to obtain the results were the χ2 and the Kruskal-Wallis test for frequencies, and the Kaplan-Meyer method as well as the log-rank test for analysis of survival data. Results: The major result obtained is that the frequency of thrombotic events in our population is strictly linked with the cardiovascular risk, and it increases with the number of risk factors. Moreover, survival significantly worsens with the number of cardiovascular risk factors, despite the classical PV risk stratification. Conclusion: It should be useful to design perspective studies to determine the real influence of cardiovascular risk factors on the thrombotic risk for patients with PV and on survival in order to evaluate the opportunity to develop new specific therapeutic recommendations.
Potential Differences between Local and Systemic Allergic Rhinitis Induced by Birch Pollen
Authors: Bozek Andrzej , Zalejska Fiolka Jolanta , Krajewska Wojtys Anna , Galuszka Beata , Cudak Anna
Published: August 2020

Introduction: Different endotypes of rhinitis are known, but its pathomechanism has not been conclusively established. For example, the precise difference between systemic allergic rhinitis (SAR) and local allergic rhinitis (LAR) is still being checked. Comparison of patients with LAR and with allergies to birch of those with intermittent allergic rhinitis, same allergy, or with non-allergic rhinitis (NAR) was the purpose of this study. Methods: Twenty-six patients with LAR, 18 with SAR and allergy to birch, and 21 with NAR were included. Patients who met the inclusion criteria were selected to undergo the following procedures at baseline: medical examinations, nasal provocation test (NPT), detection of nasal-specific IgE to birch as well as basophil activation test (BAT). All immunological parameters were detected before and after NPT. Results: Concentration of nasal IgE to Bet v1 increased comparably in the LAR and SAR groups after NPT to birch as follows: in 21 (81%) patients with LAR, 14 (78%) with SAR, and in everyone in the NAR group. Serum concentration of allergen-specific IgE to Bet v1 increased significantly from a median of 20.7 (25–75% interval: 11.2–35.6) IU/mL to 29.9 (13.6–44.1) (p = 0.028) after NPT in patients with SAR. Allergen-specific IgE to Bet v1 was absent in all patients with LAR and NAR before and after NPT. BAT with Bet v1 was positive in 22 (85%) patients with LAR, in 14 (78%) with SAR, and 2 (9.5%) with NAR. Conclusion: These obtained data suggest there are no potential mechanisms that could explain LAR compared to SAR.
Prävalenz von okulärer Hypertension und Glaukom
Authors: Rohrschneider Klaus
Published: August 2020

Introduction: The rate of unknown glaucoma is around 50% in industrialized countries. The purpose of our study was to estimate the prevalence of unknown cases of ocular hypertension, glaucoma suspects, and glaucoma in patients consulting for refractive disorders in France. Methods: A retrospective study in the Point Vision ophthalmology center was led in Toulouse, France. All participants consulting for refractive disorders between June 2015 and June 2017 in the ophthalmology center were included. The cases were identified by the assessment of intraocular pressure, optic nerve head structure, and visual field. Ocular hypertension was defined as an intraocular pressure >21 mm Hg. Glaucoma was defined as the association of a glaucomatous papilla and two successive pathological visual fields. Glaucoma suspect was defined as the association of a glaucomatous papilla without visual field defect. The primary endpoint was the prevalence of unknown ocular hypertension, glaucoma suspects, and glaucoma in patients seen in an ophthalmology center. Results: A total of 66,068 patients (mean age = 37 years) consulted for a refraction visual assessment during the study period. Among them, 234 had a visual field and a retinal nerve fiber layer assessment for ocular hypertension and/or suspicious papilla. The prevalence of unknown cases of ocular hypertension, glaucoma suspect, and glaucoma was 2.6, 0.8, and 0.5 per 1,000 consultants, respectively. Median age at diagnosis of ocular hypertension, glaucoma suspect, and glaucoma was 52, 53, and 65 years, respectively. Conclusion: The present study highlights the importance of glaucoma screening in people over 40 years old with the measurement of intraocular pressure and an optic nerve head assessment.
Stress Alters the Neural Context for Building New Memories
Authors: Meier Jacqueline Katharina , Weymar Mathias , Schwabe Lars
Published: August 2020

Stressful events affect mnemonic processing, in particular for emotionally arousing events. Previous research on the mechanisms underlying stress effects on human memory focused on stress-induced changes in the neural activity elicited by a stimulus. We tested an alternative mechanism and hypothesized that stress may already alter the neural context for successful memory formation, reflected in the neural activity preceding a stimulus. Therefore, 69 participants underwent a stress or control procedure before encoding neutral and negative pictures. During encoding, we recorded high-density EEG and analyzed—based on multivariate searchlight analyses—oscillatory activity and cross-frequency coupling patterns before stimulus onset that were predictive of memory tested 24 hr later. Prestimulus theta predicted subsequent memory in controls but not in stressed participants. Instead, prestimulus gamma predicted successful memory formation after stress, specifically for emotional material. Likewise, stress altered the patterns of prestimulus theta–beta and theta–gamma phase–amplitude coupling predictive of subsequent memory, again depending on the emotionality of the presented material. Our data suggest that stress changes the neural context for building new memories, tuning this neural context specifically to the encoding of emotionally salient events. These findings point to a yet unknown mechanism through which stressful events may change (emotional) memory formation.
Avoiding Opioid Misuse After Surgery in the Era of the Opioid Epidemic
Authors: Petersen Michael J. , Adams Kathryne W. , Siparsky Nicole F.
Published: August 2020

Background

Chronic pain patients at risk of addiction can be identified through pre-prescription screening with the opioid risk tool (ORT); there is no equivalent for surgical patients. Our aims were to validate the ORT in the surgical population and assess the impact of patient education on compliance with proper storage and disposal (S&D) of unused opioid therapy (UOT).

Methods

Each subject completed the ORT, prevideo and postvideo surveys, educational video viewing, and compliance survey. Aberrant behavior was assessed by questionnaire, chart review, and Illinois Prescription Monitoring Program review.

Results

We recruited 24 subjects who underwent emergency surgery; 18 (of 24) were prescribed an opioid on discharge and 15 (of 18) were followed for 1 month. Before education, 38% (n = 9 of 24) of subjects identified proper UOT disposal and 63% (n = 15 of 24) identified safe handling of opioids. After education, 75% (n = 18 of 24) identified proper S&D. On ORT, 9 of 24 subjects (38%) scored moderate-risk to high-risk for opioid misuse. Half of subjects who demonstrated aberrant behavior (n = 7 of 12, 58%) scored in the low-risk range on ORT; 67% of subjects (n = 10 of 15) retained UOT, and 67% (n = 10 of 15) safely stored UOT. Few subjects (30%; n = 3 of 10) who stored their UOT reported proper disposal of UOT.

Discussion

The ORT is not useful in identifying acute pain surgical patients at risk for aberrant behavior. An educational video increased awareness of, but not compliance with, safe S&D of UOT. Opioid overprescription continues to contribute to opioid misuse.
Patient Contact Time and Prehospital Interventions in Hypotensive Trauma Patients: Should We Reconsider the “ABC” Algorithm When Time Is of the Essence?
Authors: Ninokawa Scott , Friedman Jessica , Tatum Danielle , Smith Alison , Taghavi Sharven , McGrew Patrick , Duchesne Juan
Published: August 2020

Introduction

There is disagreement in the trauma community concerning the extent to which emergency medical services (EMS) should perform on-scene interventions. Additionally, in recent years the “ABC” algorithm has been questioned in hypotensive patients. The objective of this study was to quantify the delay introduced by different on-scene interventions.

Methods

A retrospective analysis of hypotensive trauma patients brought to an urban level 1 trauma center by EMS from 2007 to 2018 was performed, and patients were stratified by mechanism of injury and new injury severity score (NISS). Independent samples median tests were used to compare median on-scene times.

Results

Among 982 trauma patients, median on-scene time was 5 minutes (interquartile range 3-8). In penetrating trauma patients ( n = 488) with NISS of 16-25, intubation significantly increased scene time from 4 to 6 minutes ( P < .05). In penetrating trauma patients with NISS of 10-15, wound care significantly increased scene time from 3 to 6 minutes ( P < .05). Tourniquet use, interosseous (IO) access, intravenous (IV) access, and needle decompression did not significantly increase scene time.

Conclusion

Understanding that intubation increases scene time in penetrating trauma, while IV and IO access do not, alterations to the traditional “ABC” algorithm may be warranted. Further investigation of prehospital interventions is needed to determine which are appropriate on-scene.
Lithium Isotope Measurement Using Laser-Induced Breakdown Spectroscopy and Chemometrics
Authors: Wood Jason C. , Shattan Michael B.
Published: August 2020

Laser-induced breakdown spectroscopy (LIBS) is a technique capable of portable, quantitative elemental analysis; however, quantitative isotopic determination of samples in situ has not yet been demonstrated. This research demonstrates the ability of LIBS to quantitatively determine concentrations of 6Li in solid samples of lithium hydroxide monohydrate in a nominally 40 mTorr argon environment using chemometrics. Three chemometric analysis techniques (principal component regression, partial least squares regression, and neural networks analysis) are applied to spectra collected using a spectrometer with modest resolving power (λ/Δλ ≈ 27 000). This analysis suggests that bulk lithium isotopic assay can be determined using LIBS to within a 95% confidence interval in minutes to an hour for enrichment levels ranging from 3% to 85%. This has direct applications for the nuclear safeguards and geological exploration communities and others that desire a portable, stable isotope analytical technique. Additionally, isotope-specific self-absorption of atomic emission in a laser-produced plasma is observed for the first time.
The Rise and Fall of Marcha Verde in the Dominican Republic
Authors: Betances Emelio
Published: August 2020

The Marcha Verde movement emerged in 2017 to protest bribery on the part of the Brazilian transnational Odebrecht. It conducted 25 protests in the provinces and large marches in July 2017 and August 2018 but ultimately failed to force the government to try those responsible. As a movement for the democratization of democracy through the construction of citizens’ rights, it was a watershed moment in Dominican political history. However, it did not have time to build the social base that would have allowed it to challenge the authorities. The political parties that supported it were only interested in weakening the official party, and the electoral race intervened as the way to channel the movements’ demands, leaving the radicals alone in calling for a transformation of the political sphere.

El movimiento Marcha Verde surgió en 2017 en protesta contra los sobornos efectuados por la transnacional brasileña Odebrecht. Aunque organizó 25 protestas en las provincias y grandes marchas en julio de 2017 y agosto de 2018, no logró forzar al gobierno a enjuiciar a los responsables. En tanto se trata de un movimiento para la democratización de la democracia a través de la construcción de los derechos ciudadanos, este fue un momento decisivo en la historia política dominicana. Sin embargo, no tuvo tiempo de construir la base social que le hubiera permitido desafiar a las autoridades. Los partidos políticos que lo apoyaron sólo estaban interesados en debilitar al partido oficial, y las elecciones que intervinieron en el proceso se convirtieron en la vía de canalización para las demandas del movimiento, dejando a los elementos radicales solos en su exigencia por una genuina transformación de la esfera política.
Do Pensions Matter for Recruiting State and Local Workers?
Authors: Quinby Laura D. , Sanzenbacher Geoffrey T.
Published: August 2020

Many state and local governments have responded to financial challenges facing their pension systems by cutting benefits or by shifting costs to employees. Will these changes make it harder for state and local governments to recruit highly skilled workers? This study explores this question by linking individual-level data from the Current Population Survey on worker transitions between the private and public sectors to measures of state and local pension generosity from the Public Plans Database. The results suggest that state and local employers with relatively generous pensions are better able to recruit high-wage workers from the private sector, but that this advantage is lost as workers are asked to contribute more from current paychecks to prefund those benefits. The findings help inform an ongoing debate over the role that state and local pensions play in shaping the public workforce.
Increasing Engagement in Regulatory Science: Reflections from the Field of Risk Assessment
Authors: Dendler Leonie , Böl Gaby-Fleur
Published: August 2020

While the demands for greater engagement in science in general and regulatory science in particular have been steadily increasing, we still face limited understanding of the empirical resonance of these demands. Against this context, this paper presents findings from a recent study of a potential participatory opening of the German Federal Institute for Risk Assessment (“Bundesinstitut für Riskobewertung” [BfR]), a prominent regulatory scientific organization in the field of risk governance. Drawing upon quantitative surveys of the public and selected professional experts as well as in-depth qualitative expert interviews, we identify a general support for greater engagement in science-based risk assessment. However, we also find significant contestation concerning its potential enactment and its normative and strategic merit. Underlying these contestations, we identify the persistence of a normal view of science and decisionist understanding of risk assessment, which create conflicting legitimacy demands for BfR and other regulatory scientific organizations. Together with concerns about imbalances in the power to participate, especially in highly specialized engagement processes, these pose significant challenges for the institutionalization of more participatory practices.
Documenting Dictatorship: Writing and Resistance in Chile's Vicaría de la Solidaridad
Authors: Bell Vikki
Published: August 2020

In Documentality (2013), Maurizio Ferraris argues that documents are at the heart of social institutions. Taking this notion as a cue, this piece considers a key organisation in the resistance to state violence and Pinochet's dictatorship in Chile, the Vicaría de la Solidaridad, and focuses on the remarkable document where the desperate stories of people detained, disappeared and murdered following the coup in 1973 were recorded. This process of registration adopted an overtly rational, administrative response akin to the ‘bio-political’ modes of governing life that Foucault described. As such, it was also built upon a refusal to allow the lives of a section of the population to be cast as without value. Moreover, it ‘deferred’ to a future, in which such documentation would be an invaluable record of injustice. Its legacy is not confined to legal forums, however; academic work and Nicolás Franco's artwork La Sábana (The Sheet, 2017) have also emerged.
Proximal hyper-intense vessel sign on initial FLAIR MRI in hyper-acute middle cerebral artery ischemic stroke: a retrospective observational study
Authors: Shin Dong Hyuk , Han Sang Kuk , Lee Jang Hee , Choi Pil Cho , Park Sang O , Lee Young Hwan , Ung Na Ji
Published: August 2020

Background

A hyper-intense vessel sign on fluid attenuated inversion recovery magnetic resonance imaging (FHV) represents slow blood flow in the cerebral arteries.

Purpose

To investigate the relationship between the proximal FHV (pFHV) on initial magnetic resonance imaging (MRI) and the status of the culprit vessel (stenosis, obstruction) in hyper-acute strokes affecting the territory of the middle cerebral artery (MCA).

Material and Methods

The study participants consisted of 105 patients presenting to the emergency department (ED) with acute MCA infarction within 4.5 h of onset of symptoms. Patients underwent brain MRI within 45 min of arrival at the ED and angiography within 2 h of arrival. Culprit vessel status and presence of a pFHV on initial MRI were investigated retrospectively.

Results

The pFHV was observed in 71/105 (67.6%) patients who presented with a hyper-acute MCA infarction. All patients with hyper-acute MCA infarction caused by internal carotid artery (90.6% caused by M1 occlusion, 92.9% caused by M2 occlusion) showed a pFHV on initial MRI. After logistic regression analysis, the presence of a pFHV showed significant positive correlation with large vessel occlusion (adjusted odds ratio [OR] 34.533, 95% confidence interval [CI] 9.781–121.926; P < 0.001). A pFHV was not associated with severe large vessel stenosis.

Conclusion

A pFHV is independently representative of the acute occlusion of intervention-eligible proximal arteries within the territory of the MCA. If a patient with a hyper-acute MCA infarction shows a pFHV, aggressive flow augmentation strategies and early activation of intervention team should be warranted for best patient outcome.
Drug-coated balloons used in peripheral artery disease: experience from a single center
Authors: Liu Jinbo , Li Tianrun , Huang Wei , Zhao Na , Liu Huan , Zhao Hongwei , Xu Jiufeng , Wang Hongyu
Published: August 2020

Objective

This retrospective single-center study aimed to analyze immediate and follow-up results of using drug-coated balloons (DCBs) for treating peripheral arterial disease.

Methods

In this study, we identified a total of 75 patients who underwent DCB therapy at our institution. The ankle–brachial index (ABI) was measured before and after intervention. Intermittent claudication and whether there was healing of ulcers were determined by telephone.

Results

The cohort consisted of 56 men and 19 women aged 38 to 87 years (68 ± 12 years). Twenty-three patients had Rutherford grade III, 15 had Rutherford grade IV, and 37 had Rutherford grade V. Seventeen patients had stents and 18 had the Rotarex system used. The postoperative ABI was significantly greater than the preoperative ABI (0.911 ± 0.173 vs 0.686 ± 0.249). Good results for treatment were obtained. Intermittent claudication and rest pain did not occur in subjects with Rutherford grades III and IV during follow-up. The amputation rate was 4.1% among all patients using DCB therapy during follow-up.

Conclusions

DCB therapy is safe and effective for treating peripheral arterial disease in real-world patients. Future prospective studies on this issue are recommended.
Advanced pneumonic type of lung adenocarcinoma: survival predictors and treatment efficacy of the tumor
Authors: Zong Qiu , Zhu Feng , Wu Shimin , Peng Li , Mou Yong , Miao Kang , Wang Qi , Zhao Jianping , Xu Yongjian , Zhou Min
Published: August 2020

Purpose:

To retrospectively explore the survival predictors and treatment efficacy of advanced pneumonic-type lung adenocarcinoma (P-ADC).

Methods:

Retrospective analysis of clinical data and survival follow-up was undertaken on 41 patients with advanced P-ADC from January 1, 2009, to April 30, 2019. Analysis on tumor biomarkers such as carcinoembryonic antigen (CEA), neuron-specific enolase (NSE), and the cytokeratin-19-fragment (Cyfra21-1) were undertaken. The patients in this study were divided into three groups based on usage of tyrosine kinase inhibitor (TKI): TKI therapy group (including combination with chemotherapy), non-TKI therapy group (chemotherapy alone), and palliative care group.

Results:

More than half of the patients had higher levels of tumor biomarkers and the incidence of NSE was highest (81.8%), followed by CEA (74.4%) and Cyfra21-1 (74.1%). All patients had abnormal findings on chest computed tomography and with adenocarcinoma pathology. The overall survival (OS) time was 10.4 months in TKI group, 8.8 months in the non-TKI group, and 2.1 months in the palliative care group. Patients with higher level of serum Cyfra21-1 had insignificantly shorter survival time compared to those with normal Cyfra21-1 ( p = 0.067). TKI therapy and non-TKI therapy provided a better prognosis prediction compared to palliative care. TKI therapy improved prognosis compared to non-TKI therapy. The comprehensive based TKI therapy provided improved OS vs the non-TKI therapy.

Conclusion:

TKI-based therapy could improve the prognosis and OS for advanced P-ADC. This study recommends the analysis of EGFR mutations for all patients with advanced P-ADC.
The socioeconomic burden of migraine: An evaluation of productivity losses due to migraine headaches based on a population study in Germany
Authors: Seddik Ahmed H , Branner Jennifer C , Ostwald Dennis A , Schramm Sara H , Bierbaum Martin , Katsarava Zaza
Published: August 2020

Background

This study estimates the socioeconomic impact of migraine headaches on paid and unpaid work productivity in the adult German population in 1 year.

Methods

We used data on headache frequency (days per month) from a longitudinal population-based study. Prevalence estimates of migraine were derived from the Global Burden of Disease Collaborative Network. Demography data were derived from official statistics in 2017. Aggregate headache days in 1 year were translated to losses in paid and unpaid productive hours based on estimates of presenteeism and absenteeism along with other socioeconomic parameters. Paid hours lost were distributed across the industry sectors. In this way, an age-, gender- and industry sector-specific monetary value was calculated for paid hours lost. Unpaid hours lost were valued by assigning the unpaid activities to their nearest market substitute. In a last step, value-added multipliers derived from input-output tables were used to calculate the economic value chain effects.

Results

A total of 15.5 million persons (20 years or older) suffer from migraine in Germany. Our analysis shows that 60% of those have three or fewer headache days per month, while patients suffering chronic migraine (15+ headache days per month) account for 5.4% of the adult migraine population. Females bear 65% of the total 836 million headache days per year. The socioeconomic losses due to migraine amount to €100.4 billion (€6493 on average per patient) in one year.

Conclusion

In addition to time losses in paid work, migraine causes substantial socioeconomic losses to unpaid work activities due to its disproportionate prevalence among females. Economic value chain effects provide a novel perspective on losses beyond a patient’s time loss. Overall, the elements of socioeconomic burden provide a strong rationale that innovative migraine therapies could be of high value to society.
Combination Approach to Tear Trough Deformities and Under Eye Appearance Using Microfocused Ultrasound With Visualization and Hyaluronic Acid Filler
Authors: Barbarino Sheila C.
Published: August 2020

Filler for tear trough deformities and improved under eye appearance has become a well-accepted procedure to treat fine lines, wrinkles, shadowing, darkness, and hollowness. Microfocused ultrasound with visualization–induced skin tightening can be a powerful modality to treat periocular laxity on its own. There is also considerable rationale for combining these 2 modalities for synergistic rejuvenation of the entire periocular area. This case series recruited participants with mild-to-moderate skin laxity in the periocular area and tear trough deformities. Participants received microfocused ultrasound with visualization therapy followed 3 months later by injection with Cohesive Polydensified Matrix hyaluronic acid gel. Photographs were taken at baseline, 3 months after microfocused ultrasound with visualization therapy, and 1 month after Cohesive Polydensified Matrix hyaluronic acid injection for rating by physicians and participants using the Global Aesthetic Improvement Scale. All participants also completed a satisfaction questionnaire. This pilot study enrolled 10 participants ranging in age from 35 to 55 years. After microfocused ultrasound with visualization alone, physicians rated 4 participants “much improved,” 5 “improved,” and 1 with “no change.” After participants had received both treatment modalities, physicians rated 9 participants as “very much improved” and 1 as “much improved.” Participant satisfaction was high with microfocused ultrasound with visualization alone and even higher with the combined treatment approach with all 10 participants reporting their periocular appearance “very much improved” at the end of the study. No treatment complications were observed. In conclusion, microfocused ultrasound with visualization in combination with Cohesive Polydensified Matrix hyaluronic acid gel was effective at improving appearance of the eye area in participants with periocular skin laxity and tear trough deformities.
Sleep Architecture in Valproate-Induced Nocturnal Enuresis in Primary School and Preschool Children
Authors: Esmael Ahmed , Elsherief Mohammed , Abdelsalam Mohamed , Bendary Lotfy , Egila Hossam
Published: August 2020

Nocturnal enuresis is one of the side effects of valproic acid treatment, and generally underdiagnosed by clinicians. Studies reported that a variable incidence of valproic acid–induced nocturnal enuresis is 2.2% to 24% with unclear explanations of the reasons behind valproic acid–induced nocturnal enuresis. A retrospective study was carried out on 260 children (aged 5-12 years) diagnosed with idiopathic epilepsy, treated with valproic acid to evaluate the nocturnal enuresis secondary to valproic acid, and to discuss the characteristics of their sleep architecture. Nocturnal enuresis was reported in 28 (10.7%) patients after a mean exposure time to valproate of 18.78±8.4 days. Nocturnal enuresis was significantly associated with younger age and serum level of valproate ( P = .05). The polysomnographic study suggested that the underlying mechanism may be related to impaired sleep efficiency, frequent arousals, prolonged sleep latency, snoring, or increased sleep depth which may impair a child’s ability to awaken to the sense of bladder fullness or contractions.

Clinical trial registration: ClinicalTrials.gov identifiers: NCT04191863
Design and experimental study of novel multi-stage gearbox
Authors: Dong Peng , Wang Yongfei , Zhao Shengdun , Gao Zhuoneng , Zhao Yongqiang , Cao Yangfeng , Zhang Peng
Published: August 2020

Automatic transmission has been widely used in the automotive industry, and novel automatic transmissions with simple structure and reliable operation are a research hotspot. This paper proposes an automatic transmission with multi-stage gears to simplify its working process. The automatic transmission comprises a case and a driving transmission shaft and driven shaft which are mounted on the case. The transmission gear pairs are superimposed on the driving and driven shafts similar to a tower. The gear pairs on the driving and driven shafts are always engaged. All the driving gears are connected to the driven shaft via a flat key, and the driven gear and the driven shaft are connected by a join key, which is used to connect or disconnect the gear and the driven shaft, and are controlled by a hydraulic shifting mechanism and have been designed in detail. Numerical simulation is adopted to verify the strength of the core components. In addition, the transmission performance of the gearbox is experimentally tested. The results indicate that the novel gearbox can achieve variable speed and work smoothly. The gearbox has a novel structure, the driving and driven shafts are simple and installed friendly, and the transmission gear meshes are reliable.
Improved K-medoids algorithm-based clustering analysis for handle driving force in automotive manual sliding door closing process
Authors: Gao Yunkai , Duan Yuexing , Yang James , Liu Zhe , Ma Chao
Published: August 2020

Handle driving forces are the input of the automotive sliding door dynamic system and play an important role for ensuring a smooth closing process during manual sliding door mechanism design. It is important to provide a reliable and accurate input for the manual sliding door mechanism during the design and analysis stage. This paper aims to present an improved K-medoids clustering algorithm to investigate the characteristic of handle driving forces in manually closing an automotive sliding door based on experimental data. The improved K-medoids clustering algorithm includes two stages: observation-based clustering stage and traditional K-medoids clustering stage. In all, 134 subjects have been recruited to manually close the sliding door in the lab and the handle driving force data are collected and processed. The handle driving forces are described in the sliding door coordinate system (XYZ) fixed on the door. This study mainly focuses on the X direction force component clustering analysis. The first stage of the improved algorithm classifies the X direction force components into three clusters based on force curve shapes. Then, each of the above identified three clusters is clustered with the traditional K-medoids clustering algorithm. Results show that the X direction force component has three different shapes: Shape 1—only one crest in the curve, Shape 2—two crests in the curve, and Shape 3—one crest and one trough in the curve. The forces with three different shapes are finally divided into six clusters and the amplitude and time duration are similar for X direction forces within the same cluster and are different in the different clusters. The medoids of these clusters are the mined representative prototypes. Compared to the pure traditional K-medoids algorithm, the improved algorithm can provide much better results that give insights on subjects’ door closing behaviors.
Identification of Workload Measurement Indicators for School Nursing Practice
Authors: Jameson Beth E. , Anderson Lori S. , Endsley Patricia
Published: August 2020

Many school districts rely on caseload or student to school nurse ratios that are not grounded in evidence-based research. There is a need for a comprehensive workload instrument to describe the work of school nurses that incorporates the complexities of the role and includes acuity, care processes, and social determinants of health. The purpose of this qualitative study was to identify workload activities from a previous Delphi study that can be empirically measured as items for a workload instrument. A nationally representative sample of 27 school nurses participated in four focus groups, describing activities important to the measurement of workload. Focus group input resulted in identification and confirmation of workload activities that impact school nurse workload. Use of the National Association of School Nurses’ Framework for 21st Century School Nursing Practice™ was integral in capturing gaps and important workload activities for a potential workload instrument.
Outcomes Following Revision Surgery After Failed Kidner Procedure for Painful Accessory Navicular
Authors: Kim Jaeyoung , Day Jonathan , Seilern und Aspang Jesse
Published: August 2020

Background:

The Kidner procedure is performed to treat painful accessory navicular syndrome, with varying results. Recurrent pain remains a complication, and to date, there is a paucity of literature regarding the causes of recurrent pain and surgical outcomes of revision.

Methods:

Twenty-one patients who underwent revision surgery for recurrent pain after the Kidner procedure were identified. All patients had their tendon inspected and treated, and all had a medial displacement calcaneal osteotomy. Revision was indicated after 6 months of failed conservative therapy. Pre- and postrevision radiographic measurements included lateral talo–first metatarsal angle (Meary’s angle), talonavicular coverage angle, calcaneal pitch, and hindfoot moment arm (HMA). Meary’s angle >4 degrees was considered a planus deformity and HMA >9.1 mm was considered a hindfoot valgus deformity; patients fulfilling both criteria were categorized as having planovalgus deformity. Measurements in the contralateral foot were performed to determine whether alignment of the involved side was attributed to failed treatment or a preexisting deformity. Visual analog scale and Foot and Ankle Outcome Scores were compared and average follow-up was 20.1 months (range, 14-26).

Results:

Preoperatively, 20 of 21 (95%) patients had a form of valgus heel alignment (planovalgus, n = 11; hindfoot valgus only, n = 9), and 1 had an isolated planus deformity. The contralateral side revealed similar deformity, with 17 of 21 (81%) patients having a form of valgus heel alignment (planovalgus, n = 13; hindfoot valgus only, n = 4) and 4 patients with an isolated planus deformity. All patients underwent realignment surgery with medial displacement calcaneal osteotomy. All radiographic parameters except Meary’s angle ( P = .885) significantly improved postoperatively along with significantly improved clinical outcomes.

Conclusion:

Recurrent pain following the Kidner procedure was associated with valgus heel alignment. Revision surgery including realignment procedure alleviated pain and improved functional outcomes with minimal complications. Therefore, we recommend assessing heel alignment in patients presenting with recurrent pain following the Kidner procedure.

Level of Evidence:

Level IV, case series.
Toward Reduced Burden in Evidence-Based Assessment of PTSD: A Machine Learning Study
Authors: Jiang Tammy , Dutra Sunny , Lee Daniel J. , Rosellini Anthony J. , Gauthier Gabrielle M. , Keane Terence M. , Gradus Jaimie L. , Marx Brian P.
Published: August 2020

Structured diagnostic interviews involve significant respondent burden and clinician administration time. This study examined whether we can maintain diagnostic accuracy using fewer posttraumatic stress disorder (PTSD) assessment questions. Our study included 1,265 U.S. veterans of the Afghanistan and Iraq conflicts who were assessed for PTSD using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (SCID-5). We used random forests to assess the importance of each diagnostic item in predicting a SCID-5 PTSD diagnosis. We used variable importance to rank each item and removed the lowest ranking items while maintaining ≥90% accuracy (i.e., efficiency), sensitivity, and other metrics. We eliminated six diagnostic items among the overall sample, four items among male veterans, and six items among female veterans. Our findings demonstrate that we may shorten the SCID-5 PTSD module while maintaining excellent diagnostic performance. These findings have implications for potentially reducing patient and provider burden of PTSD diagnostic assessment.
Insights From the Ecology of Information to Cancer Control
Authors: Whelan Christopher J. , Avdieiev Stanislav S. , Gatenby Robert A.
Published: August 2020

Uniquely in nature, living systems must acquire, store, and act upon information. The survival and replicative fate of each normal cell in a multicellular organism is determined solely by information obtained from its surrounding tissue. In contrast, cancer cells as single-cell eukaryotes live in a disrupted, heterogeneous environment with opportunities and hazards. Thus, cancer cells, unlike normal somatic cells, must constantly obtain information from their environment to ensure survival and proliferation. In this study, we build upon a simple mathematical modeling framework developed to predict (1) how information promotes population persistence in a highly heterogeneous environment and (2) how disruption of information resulting from habitat fragmentation increases the probability of population extinction. Because (1) tumors grow in a highly heterogeneous microenvironment and (2) many cancer therapies fragment tumors into isolated, small cancer cell populations, we identify parallels between these 2 systems and develop ideas for cancer cure based on lessons gleaned from Anthropocene extinctions. In many Anthropocene extinctions, such as that of the North American heath hen ( Tympanuchus cupido cupido), a large and widespread population was initially reduced and fragmented owing to overexploitation by humans (a “first strike”). After this, the small surviving populations are vulnerable to extinction from environmental or demographic stochastic disturbances (a “second strike”). Following this analogy, after a tumor is fragmented into small populations of isolated cancer cells by an initial therapy, additional treatment can be applied with the intent of extinction (cure). Disrupting a cancer cell’s ability to acquire and use information in a heterogeneous environment may be an important tactic for causing extinction following an effective initial therapy. Thus, information, from the scale of cells within tumors to that of species within ecosystems, can be used to identify vulnerabilities to extinction and opportunities for novel treatment strategies.
The effect of a pre-existing nanovoid on martensite formation and interface propagation: a phase field study
Authors: Javanbakht Mahdi , Ghaedi Mohammad Sadegh , Barchiesi Emilio , Ciallella Alessandro
Published: August 2020

In the present work, the effect of a pre-existing nanovoid on martensitic phase transformation (PT) is investigated using the phase field approach. The nanovoid is created as a solution of the coupled Cahn–Hilliard and elasticity equations. The coupled Ginzburg–Landau and elasticity equations are solved to capture the martensitic nanostructure. The above systems of equations are solved using the finite element method and COMSOL code. The austenite ( A)–martensite ( M) interface propagation is investigated without the nanovoid and with it for different nanovoid misfit strains and different temperatures. With the nanovoid, the evolution of the moving interface is changed even before it reaches the nanovoid surface due to the nanovoid stress concentration. It is also found that for small misfit strains, pre-transformation occurs near the nanovoid. For larger misfit strains, martensite nucleates and grows near the nanovoid surface and coalesces with the moving interface. The nanovoid shows a promotive effect on the PT with an increase in the rate of transformation, which is discussed based on the transformation work distribution. The effect of the nanovoid is more pronounced on a curved interface. The nanovoid-induced martensitic growth is mainly dependent on the transformation strain tensor. Examples for different transformation strains are presented where a stable non-complete transformed sample with no void becomes unstable in the presence of the nanovoid. The presented model and results will help to develop an interaction model between nanovoids and multiphase structures at the nanoscale.