bluuebunny/crossref_metadata_2025_split huggingface dataset:
Informing diversion strategy: A comparison of parent and general practitioner‐referred paediatric patients presenting to a metropolitan hospital
Authors: Millar Robert , Palmer Bethany , Chiappazzo Amelia 
Published: March 2020

AbstractObjectiveTo determine whether the characteristics and outcomes of parent‐referred children differ substantially from general practitioner (GP)‐referred children attending a metropolitan ED.MethodsProspective cross‐sectional observational study of consecutive patients aged less than 16 years of age attending a mixed adult and paediatric metropolitan teaching hospital ED in Melbourne. Data collected included patient characteristics (age, sex, arrival mode and triage category) and outcomes (admission, specialty consultation, treatment time >1 h, intravenous or nasogastric therapy, procedural sedation, procedures, imaging studies and pathology collection).ResultsThe outcome data of 4580 patients was analysed. Patients brought by parents directly to the ED did not differ from patients referred by their GP in age, sex, or triage category, but were more likely to arrive by ambulance (13%vs2%,P < 0.01). Low‐urgency GP‐referred children were more likely to require a procedure (22%vs15%, risk difference [RD] 0.07, 95% confidence interval [CI] 0.02–0.13) and pathology tests (13%vs8%, RD 0.05, 95% CI 0.01–0.1) than parent‐referred children, but were similar for other outcomes. The proportion of low‐urgency children who had no ED‐specific care interventions was not significantly different between the groups (27%vs32%, RD −0.06, 95% CI −0.11 to 0).ConclusionsChildren brought to ED directly by their parents or carers did not differ substantially from GP‐referred children in their characteristics or outcomes. The use of referral source and triage categories to determine patient suitability for diversion to general practice may need to be reconsidered.
Circ_0038467 regulates lipopolysaccharide‐induced inflammatory injury in human bronchial epithelial cells through sponging miR‐338‐3p
Authors: Liu Guangming , Wan Qiufeng , Li Jingwen , Hu Xinying , Gu Xingli , Xu Sicheng 
Published: March 2020

BackgroundPneumonia is a common acute lower respiratory infection in children and elders. Circular RNAs (circRNAs) have recently been uncovered to play important roles in pneumonia. However, the function and mechanism of circ_0038467 in pneumonia remain elusive.MethodsCell viability and apoptosis were determined using the Cell Counting Kit‐8 (CCK‐8) assay and flow cytometry, respectively. The levels of interleukin 6 (IL‐6), IL‐8 and IL‐1β were detected by enzyme‐linked immunosorbent assay (ELISA). Western blot analysis was performed to assess the expression of related proteins. Circ_0038467 was characterized by Ribonuclease R (RNase) digestion and subcellular localization assays. The levels of circ_0038467 and miR‐338‐3p were evaluated by quantitative real‐time polymerase chain reaction (qRT‐PCR). The direct interaction between circ_0038467 and miR‐338‐3p was validated by the dual‐luciferase reporter and RNA immunoprecipitation (RIP) assays.ResultsOur data indicated that lipopolysaccharide (LPS) induced an inflammatory injury in 16HBE cells by repressing cell viability and enhancing cell apoptosis and proinflammatory cytokines production. Circ_0038467 was upregulated and miR‐338‐3p was downregulated in LPS‐treated 16HBE cells. Circ_0038467 knockdown or miR‐338‐3p overexpression attenuated LPS‐induced 16HBE cell inflammatory injury. Moreover, circ_0038467 acted as a sponge of miR‐338‐3p in 16HBE cells. MiR‐338‐3p mediated the alleviated effect of circ_0038467 knockdown on LPS‐induced 16HBE cell inflammatory injury. Additionally, the Janus kinase/ signal transducer and activator of transcription 3 (JAK/STAT3) signaling pathway was involved in the circ_0038467/miR‐338‐3p axis‐mediated regulation in LPS‐induced 16HBE cell inflammatory injury.ConclusionsThe current work had led to the identification of circ_0038467 knockdown that alleviated LPS‐induced inflammatory injury in 16HBE cells at least partly through sponging miR‐338‐3p and regulating JAK/STAT3 pathway, highlighting novel molecular targets for the treatment of pneumonia.
Pericardial tamponade during pembrolizumab treatment in a patient with advanced lung adenocarcinoma: A case report and review of the literature
Authors: Harada Kazuaki , Ogasawara Makoto , Shido Akane , Meno Akimitsu , Oda Soichiro , Yoshida Shota , Yoshida Sonoe , Yoshikawa Ayumu , Ebata Ko , Abiko Satoshi , Kawagishi Naoki , Sano Itsuki , Oda Hisashi , Miyagishima Takuto 
Published: March 2020

AbstractSeveral studies have demonstrated increased pericardial effusion during anti‐PD‐1 immunotherapy, and treatment in patients who have developed pericardial tamponade is controversial. In this study, we describe a 63‐year‐old woman with stage IVA lung adenocarcinoma given pembrolizumab as a first‐line therapy. After four cycles of pembrolizumab treatment, the patient suddenly developed a pericardial tamponade. Although pericardial effusion was increased, her tumor lesions were reduced. After an emergency pericardiocentesis, she continued the pembrolizumab therapy without recurrent pericardial effusions for three months until the primary tumor and lymph node metastasis progressed. Nine months after the pericardiocentesis, the patient died of progressive lung cancer, but pericardial effusion did not recur throughout the treatment course. This case study suggests that pembrolizumab therapy can be continued with a strict follow‐up in some patients with pembrolizumab‐induced pericardial tamponade.Key points• Significant findings of the studyOur patient developed pericardial tamponade during pembrolizumab treatment but continued pembrolizumab treatment after emergency pericardiocentesis without recurrent pericardial effusions.• What this study addsPembrolizumab treatments may be resumed with a strict follow‐up in some patients with treatment‐related pericardial tamponade.
Rewiring of gene networks underlying mite allergen‐induced CD4 + Th‐cell responses during immunotherapy
Authors: Jones Anya C. , Anderson Denise , Troy Niamh M. , Mallon Dominic , Hartmann Rochelle , Serralha Michael , Holt Barbara , Bosco Anthony , Holt Patrick G. 
Published: March 2020

AbstractBackgroundMultiple regulatory mechanisms have been identified employing conventional hypothesis‐driven approaches as contributing to allergen‐specific immunotherapy outcomes, but understanding of how these integrate to maintain immunological homeostasis is incomplete.ObjectiveTo explore the potential for unbiased systems‐level gene co‐expression network analysis to advance understanding of immunotherapy mechanisms.MethodsWe profiled genome‐wide allergen‐induced Th‐cell responses prospectively during 24 months subcutaneous immunotherapy (SCIT) in 25 rhinitis, documenting changes in immunoinflammatory pathways and associated co‐expression networks and their relationships to symptom scores out to 36 months.ResultsPrior to immunotherapy, mite‐induced Th‐cell response networks involved multiple discrete co‐expression modules including those related to Th2‐, type1 IFN‐, inflammation‐ and FOXP3/IL2‐associated signalling. A signature comprising 109 genes correlated with symptom scores, and these mapped to cytokine signalling/T‐cell activation‐associated pathways, with upstream drivers including hallmark Th1/Th2‐ and inflammation‐associated genes. Reanalysis after 3.5 months SCIT updosing detected minimal changes to pathway/upstream regulator profiles despite 32.5% symptom reduction; however, network analysis revealed underlying merging of FOXP3/IL2—with inflammation—and Th2‐associated modules. By 12 months SCIT, symptoms had reduced by 41% without further significant changes to pathway/upstream regulator or network profiles. Continuing SCIT to 24 months stabilized symptoms at 47% of baseline, accompanied by upregulation of the type1 IFN‐associated network module and its merging into the Th2/FOXP3/IL2/inflammation module.ConclusionsSubcutaneous immunotherapy stimulates progressive integration of mite‐induced Th cell–associated Th2‐, FOXP3/IL2‐, inflammation‐ and finally type1 IFN‐signalling subnetworks, forming a single highly integrated co‐expression network module, maximizing potential for stable homeostatic control of allergen‐induced Th2 responses via cross‐regulation. Th2‐antagonistic type1 IFN signalling may play a key role in stabilizing clinical effects of SCIT.
Transfer and loss of allergen‐specific responses via stem cell transplantation: A prospective observational study
Authors: Debiasi Markus , Pichler Herbert , Klinglmüller Florian , Boztug Heidrun , Schmidthaler Klara , Rech Jonas , Scherer David , Lupinek Christian , Valenta Rudolf , Kacinska‐Pfaller Ewa , Geyeregger Rene , Fritsch Gerhard , Haas Oskar A. , Peters Christina , Lion Thomas , Akdis Mübeccel , Matthes Susanne , Akdis Cezmi A. , Szépfalusi Zsolt , Eiwegger Thomas 
Published: March 2020

AbstractBackgroundCurrently, no estimates can be made on the impact of hematopoietic stem cell transplantation on allergy transfer or cure of the disease. By using component‐resolved diagnosis, we prospectively investigated 50 donor‐recipient pairs undergoing allogeneic stem cell transplantation. This allowed calculating the rate of transfer or maintenance of allergen‐specific responses in the context of stem cell transplantation.MethodsAllergen‐specific IgE and IgG to 156 allergens was measured pretransplantation in 50 donors and recipients and at 6, 12 and 24 months in recipients post‐transplantation by allergen microarray. Based on a mixed effects model, we determined risks of transfer of allergen‐specific IgE or IgG responses 24 months post‐transplantation.ResultsAfter undergoing stem cell transplantation, 94% of allergen‐specific IgE responses were lost. Two years post‐transplantation, recipients' allergen‐specific IgE was significantly linked to the pretransplantation donor or recipient status. The estimated risk to transfer and maintain individual IgE responses to allergens by stem cell transplantation was 1.7% and 2.3%, respectively. Allergen‐specific IgG, which served as a surrogate marker of maintaining protective IgG responses, was highly associated with the donor's (31.6%) or the recipient's (28%) pretransplantation response.ConclusionHematopoietic stem cell transplantation profoundly reduces allergen‐specific IgE responses but also comes with a considerable risk to transfer allergen‐specific immune responses. These findings facilitate clinical decision‐making regarding allergic diseases in the context of hematopoietic stem cell transplantation. In addition, it provides prospective data to estimate the risk of transmitting allergen‐specific responses via hematopoietic stem cell transplantation.
The Political Aesthetics of Middle Class Housing in (not so) Neoliberal Mozambique
Authors: Sumich Jason , Nielsen Morten 
Published: March 2020

AbstractThis article explores the social and material repercussions of middle class aspirations in a system that is still infused by socialist aesthetics in Maputo, Mozambique. We argue the activation of “middle classness” reproduces ingrained inequalities and boundaries. This is demonstrated through two ethnographic case studies of urban housing, long central to imaginaries of prosperity. First, fearing downward mobility, members of the upper middle class seek to embody a liberal ideology of “autonomy”, while simultaneously being dependent on state structures. Second, members of the lower middle class attempt to create enclaves to experiment with forms of privatisation normally only accessible to a privileged elite. Through this examination of the ways in which a spectrum of privileged urbanites attempts to secure their position in the face of a precarious future, the article outlines middle classness under contemporary capitalist conditions and how this is shaped by the legacies of the past.
Sitting in the driver's seat: Manipulation of mammalian cell Rab GTPase functions by apicomplexan parasites
Authors: Coppens Isabelle , Romano Julia D. 
Published: March 2020

AbstractMany intracellular microbial pathogens subvert, disrupt or otherwise modulate host membrane trafficking pathways to establish a successful infection. Among them, bacteria that are trapped in a phagosome during mammalian cell invasion, disengage the programmed degradation process by altering the identity of their replicative niche through the exclusion or recruitment of specific Rab GTPases to their vacuole. Many viruses co‐opt essential cellular trafficking pathways to perform key steps in their lifecycles. Among protozoan parasites, Apicomplexa are obligate intracellular microbes that invade mammalian cells by creating a unique, nonfusogenic membrane‐bound compartment that protects the parasites straightaway from lysosomal degradation. Recent compelling evidence demonstrates that apicomplexan parasites are master manipulators of mammalian Rab GTPase proteins, and benefit or antagonise Rab functions for development within host cells. This review covers the exploitation of mammalian Rab proteins and vesicles by Apicomplexa, focusing on Toxoplasma, Neospora, Plasmodium and Theileria parasites.
Alcohol misuse among adolescents with BPD symptoms: exploring the moderating role of reasons for drinking and perceived coping skills in a clinical adolescent sample
Authors: Folk Johanna B. , Williams Caitlin A. , Esposito‐Smythers Christianne 
Published: March 2020

BackgroundAdolescents who experience symptoms of borderline personality disorder (BPD) are at high risk for alcohol misuse, yet little is known about why these adolescents drink and what factors heighten or mitigate this risk. The current study explores factors that may impact risk for alcohol misuse among youth with BPD symptoms: using alcohol to self‐medicate or to rebel and perceived coping skills.MethodA sample of 181 psychiatrically hospitalized adolescents (Mage = 15.04 years, SD = 1.31 years; 71.8% female, 83.4% White) was recruited as part of a larger study from the northeastern United States. Assessments and diagnostic interviews were administered to adolescents.ResultsUse of alcohol for self‐medication and perceived coping skills, but not using alcohol for rebellion, moderated the relationship between BPD symptoms and alcohol misuse. A significant positive relationship between BPD symptoms and alcohol frequency and/or problems was only found among adolescents who reported lower use of alcohol for self‐medication purposes or higher perceived coping skills.ConclusionsYouth with more BPD symptoms are at high risk for alcohol misuse. Moderation effects for self‐medication motives and perceived coping skills were counter to hypotheses; lower levels of self‐medication motives contributed to greater alcohol problems, as did higher levels of perceived coping skills. Results suggest the importance of assessing how much youth are drinking or experiencing consequences, as well as why they are using alcohol. It is possible adolescents with more BPD symptoms may be reporting more coping skills, but actually exhibiting the phenomenon of apparent competence (i.e., present as ‘in control’, but actually experiencing extreme distress and lacking sufficient coping skills); collateral reports of adolescents’ coping skills may provide a more objective measure of actual skill level.Key Practitioner MessageWhat is known?

Adolescents who experience symptoms of borderline personality disorder (BPD) are at high risk for alcohol misuse, yet little is known about why these adolescents drink and what factors heighten or mitigate this risk.

What is new?

Adolescents who use alcohol to self‐medicate or rebel are at high risk for alcohol problems, regardless of presence of BPD symptoms.

Contrary to expectations, higher perceived coping skills strengthened the relation between BPD and alcohol misuse. Apparent competence (i.e., present as ‘in control’ but lack sufficient skills) may be at play.

What is significant for clinical practice?

Clinicians are encouraged to assess why adolescents are using alcohol and teach alternative coping strategies when self‐medication and/or rebellion is an identified use.

Clinicians are encouraged to collect collateral reports of adolescent’s coping abilities rather than relying solely on self‐report.
Surveillance of succinate dehydrogenase gene mutation carriers: Insights from a nationwide cohort
Authors: Martins Raquel G. , Cunha Nuno , Simões Helder , Matos Maria João , Silva João , Torres Isabel , Rodrigues Fernando , Leite Valeriano , Teixeira Manuel R. , Bugalho Maria João 
Published: March 2020

AbstractObjectiveMutations in the genes coding for succinate dehydrogenase (SDHx) are the most frequent germline alterations in pheochromocytomas and paragangliomas. Evidence for the advantages associated with presymptomatic screening for SDHx mutation carriers is scarce. This study describes a nationwide cohort of these mutation carriers and aims to compare patients with clinical manifestations of the disease and those diagnosed through genetic screening. DESIGN: Cross‐sectional study.PatientsSDHx mutation carriers (n = 118) followed through the Portuguese Oncology referral centres: 41 probands and 77 nonprobands.MeasurementsAll participants were subjected to biochemical and body imaging examinations for a complete assessment of the extent and spread of disease. Clinical data obtained this way were further analysed.ResultsThe mean age of this cohort was 44.5 ± 17.4 years, and more than half carried the same founder SDHB mutation. About 50.8% of the mutation carriers developed pheochromocytomas or paragangliomas. Compared to patients diagnosed through genetic screening, those diagnosed clinically were characterized by larger tumours (P < .001), more frequent metastases (P = .024), were more frequently subjected to surgery (P = .011) and radiotherapy (P = .013), and had worse outcomes, such as macroscopic positive margins (P = .034). Persistent and/or unresectable disease and disease‐related mortality were also more frequent in symptomatic patients compared to those diagnosed through genetic screening (P = .014).ConclusionsIn this nationwide cohort study, a large proportion of mutation carriers were found to develop SDHx‐related neoplasia. Genetic testing and subsequent follow‐up resulted in the diagnosis of smaller and nonmetastatic tumours, fewer treatment procedures, fewer complications and greater number of disease‐free patients.
Implementation of an easy in‐hospital educational stoma pathway results in decrease of home nursing care services after discharge
Authors: van Loon Y.T. , Clermonts S. H. E. M. , Belt R. , Nagle D. , Wasowicz D. K. , Zimmerman D. D. E. 
Published: March 2020

AbstractAimNew stoma patients often rely heavily on the assistance of the ward nursing staff during the hospital stay and on the availability of home nursing care services (HNCS) after discharge. An easily executable 4‐day in‐hospital educational stoma pathway was developed and implemented. The aim was to increase their level of independence (LOI) in order to reduce the need for HNCS after discharge.Method All new stoma patients on the gastrointestinal surgery ward, physically and psychologically capable of performing independent stoma care (SC), were enrolled in this pathway. They were compared to a retrospective control group of new stoma patients before the onset of the stoma pathway. The primary outcome is the need and frequency of HNCS for SC at the moment of discharge. Secondary outcome is the LOI in SC at discharge.ResultsA total of 145 patients [m:f = 102:43, median age 67 (range 27–90) years] were included in the present study. Patients requiring daily HNCS for SC decreased from 80% to 50%, P < 0.001; patients discharged without HNCS for SC increased from 5% to 27%. Patients’ independence in SC at discharge increased from 8% to 68%, P < 0.001.ConclusionThis study shows that a clinical 4‐day in‐hospital educational stoma pathway is feasible and effective in increasing the LOI in SC of new stoma patients and significantly reducing their need for HNCS. Cost–benefit analysis and applicability of this pathway in multicentre settings are currently being investigated.
Patient‐reported and physician‐recorded bowel dysfunction following colorectal resection and radical cystectomy: a prospective, comparative study
Authors: Ng K.‐S. , Gladman M. A. 
Published: March 2020

AbstractAimBowel dysfunction following anterior resection (AR) is termed low anterior resection syndrome. It is unclear whether such dysfunction occurs following other bowel/pelvic operations as well. This study aimed to characterize and compare bowel dysfunction following AR, right hemicolectomy (RH) and radical cystectomy (RC).MethodA prospective study of consecutive patients undergoing AR, RH and RC (2002–2012) was performed at a tertiary referral centre in Sydney, Australia. Outcome measures included (i) patient‐reported satisfaction with bowel function, self‐described bowel function and self‐reported change in bowel function; (ii) objective assessment of bowel function using validated criteria to identify symptoms and stratify patients into those with constipation and/or faecal incontinence (FI); and (iii) health‐related quality of life (SF‐36v2 Health Survey).ResultsOf 743 eligible patients, 70% participated [AR, n = 338, mean age 69.6 years (SD 11.9), 59% men; RH, n = 150, 75.8 years (SD 10.5), 54% men; RC, n = 34, 71.1 years (SD 14.1), 71% men]. AR patients were three times more likely to report change in bowel function post‐surgery and self‐judged their bowel function as abnormal more frequently (64%) than RH patients (35%) and RC patients (35%) (P < 0.01). AR patients were four times more likely to meet criteria for concomitant constipation and FI. Patients with concomitant constipation and FI had lower physical and mental SF‐36v2 scores (P < 0.001).ConclusionBowel dysfunction occurred after RH and RC but rates were higher following AR. This suggests that low anterior resection syndrome occurs due to a direct impact of partial/complete loss of the rectum rather than just due to loss of bowel length and/or the consequence(s) of pelvic dissection.
On the ‘Arab Inequality Puzzle’: The Case of Egypt
Authors: Achcar Gilbert 
Published: March 2020

ABSTRACTThis article surveys and discusses prominent protagonists of the debate on socio‐economic inequality in the Arab region, with a special focus on the World Bank and Egypt. According to official data, the region holds remarkably low Gini coefficients in a context of declining inequality. This contradicts the popular perception of high social inequality as a major cause of regional protests since the Arab Spring; hence the reference to a ‘puzzle’ in mainstream literature. The debate about the reality of social inequality in the region has developed since 2011 — particularly in regard to Egypt, where income and consumption data are periodically collected by means of household surveys. Inequality measures based on this method alone, while income taxation data are inaccessible, are highly questionable and conflict with various observations and calculations based on other indicators such as national accounts, executive income or house prices. Yet, the World Bank upholds official inequality findings in portraying the Arab upheaval as the revolt of a ‘middle class’ that aspires to greater business freedom, in consonance with the neoliberal worldview.