bluuebunny/crossref_metadata_2025_split huggingface dataset:
Dysregulated NF-κB–Dependent ICOSL Expression in Human Dendritic Cell Vaccines Impairs T-cell Responses in Patients with Melanoma
Authors: Maurer Deena M. , Adamik Juraj , Santos Patricia M. , Shi Jian , Shurin Michael R. , Kirkwood John M. , Storkus Walter J. , Butterfield Lisa H. 
Published: October 2020

AbstractTherapeutic cancer vaccines targeting melanoma-associated antigens are commonly immunogenic but are rarely effective in promoting objective clinical responses. To identify critical molecules for activation of effective antitumor immunity, we have profiled autologous dendritic cell (DC) vaccines used to treat 35 patients with melanoma. We showed that checkpoint molecules induced by ex vivo maturation correlated with in vivo DC vaccine activity. Melanoma patient DCs had reduced expression of cell surface inducible T-cell costimulator ligand (ICOSL) and had defective intrinsic NF-κB signaling. Chromatin immunoprecipitation assays revealed NF-κB–dependent transcriptional regulation of ICOSL expression by DCs. Blockade of ICOSL on DCs reduced priming of antigen-specific CD8+ and CD4+ T cells from naïve donors in vitro. Concentration of extracellular/soluble ICOSL released from vaccine DCs positively correlated with patient clinical outcomes, which we showed to be partially regulated by ADAM10/17 sheddase activity. These data point to the critical role of canonical NF-κB signaling, the regulation of matrix metalloproteinases, and DC-derived ICOSL in the specific priming of cognate T-cell responses in the cancer setting. This study supports the implementation of targeted strategies to augment these pathways for improved immunotherapeutic outcomes in patients with cancer.
Subvertendo a ordem: os indocumentados e as estratégias de acesso à saúde na fronteira de Ponta Porã/BR e Pedro Juan Caballero/PY
Authors: Nascimento Valdir Aragão do 
Published: October 2020

O artigo discute, a partir das intersecções existentes entre os mecanismos de acesso à saúde – elaborados e acionados pelos indocumentados nas cidades de Pedro Juan Caballero (PY) e Ponta Porã (BR) –, categorias como segredo, confiança, família e amizade. A pesquisa que deu origem aos dados etnográficos aqui apresentados teve por objetivo descobrir e analisar como as pessoas indocumentadas, brasileiros e paraguaios, procediam – e procedem – para ter acesso aos serviços de saúde no Brasil por meio do Sistema Único de Saúde (SUS), visto que esse acesso só é franqueado diante da apresentação de documentação específica, tais como o Cartão do SUS e a Cédula de Identidade para Estrangeiros (RNE). Aos indocumentados resta apelar aos expedientes tidos pelas autoridades brasileiras como ilegais e, portanto, passíveis de sanções por parte do Estado. As estratégias dos indocumentados para acessar os serviços de saúde através do SUS envolvem complexas redes de solidariedade, nas quais se imiscuem e se confundem binômios como legal/ilegal e confiança/desconfiança.
Nature and Impact of Chinese and South African Engagement on the Development of the City of Lusaka
Authors: Li Hangwei , Siame Gilbert 
Published: October 2020

Abstract
As Zambia’s chief administrative centre and a major financial, transportation, and manufacturing hub for the country, the City of Lusaka has become one of the fasted growing cities in Southern Africa. Encouraged by the Chinese government’s ‘going out’ policy, Chinese investment and trade with Zambia have risen dramatically since the 2000s. Chinese investment is increasingly shaping the growth of Lusaka City and its hinterland in significant ways. On the other hand, South Africa as a regional geo-economic power has also amplified its strategic engagement with Lusaka. The paper explores how these two geo-economic powers have shaped the development of the City of Lusaka. Findings show that investments from South Africa into the City are private capital backed and are predominantly in the retail and real estate sectors. Chinese engagement in the city are dominated by large government-related construction projects, which have often been state-backed. Analysing the findings through the lens of urban assemblage and polarisation, the paper argues that the City is increasingly becoming more socio-spatially divided with the poor being more adversely affected by the nature and location of investments.
The Dragon’s March into the Indian Ocean: Implications for International Trade
Authors: Jonyo Fred , Mbutu Samuel 
Published: October 2020

Abstract
This article reviews China’s engagement in the Indian Ocean Region, implications for international trade and strategies to mitigate its vulnerabilities. Premised on maritime theory, it argues that China’s interests in the Indian Ocean will influence its relations with India, extra-regional powers and African states. China is likely to leverage on its presence in the Indian Ocean to boost its levels of international trade volumes, while at the same time forge alternative strategies such as string of pearls, Maritime Silk Road and access through Myanmar to mitigate its vulnerabilities in the region.
International Human Rights Law and the Response to the covid-19 Pandemic
Authors: Joseph Sarah 
Published: October 2020

Abstract
States have duties under Article 12(2)(c) of the International Covenant on Economic, Social and Cultural Rights and Article 6 of the International Covenant on Civil and Political Rights to prevent, control and treat covid-19. Implementation of these three obligations is analysed, taking account of countervailing human rights considerations. Regarding prevention, lockdowns designed to stop the spread of the virus are examined. Control measures are then discussed, namely transparency measures, quarantine, testing and tracing. The human rights compatibility of treatment measures, namely the provision of adequate medical and hospital care (or the failure to do so), are then examined. Finally, derogations from human rights treaties in times of pubic emergency are discussed.
Characterization of depressed bipolar patients with current suicidal ideation
Authors: Nobile Bénédicte , Dubois Jonathan , Aouizerate Bruno , Aubin Valerie , Loftus Joséphine , Bellivier Frank , Belzeaux Raoul , Dubertret Caroline , Gard Sebastien , Haffen Emmanuel , Schwan Raymund , Llorca Pierre-Michel , Passerieux Christine , Roux Paul , Polosan Mircea , Etain Bruno , Leboyer Marion ,   FondaMental Advanced Centres of Expertise in Bipolar Disorders (FACE-BD) Collaborators, Courtet Philippe , Olié Emilie 
Published: October 2020

Objective: Bipolar disorder is one of the most frequent psychiatric disorders among suicidal patients. A large part of patients with bipolar disorder (30–50%) will attempt suicide. Suicidal ideation being a major risk factor of suicidal act, it is crucial to better characterize patients with suicidal bipolar depression (i.e. depression with current suicidal ideation). The aim of this study was to characterize suicidal bipolar depressed patients in comparison with non-suicidal depressed patients in terms of clinical characteristics, evolution of depression and suicidal ideation course over time, and risk of suicide attempt during follow-up. Methods: Among patients with bipolar disorder recruited from the network of FondaMental expert centres for bipolar disorder between 2009 and 2017, we selected patients with at least mild depression (Montgomery–Åsberg Depression Rating Scale total score >11) and without current manic symptomatology (Young Mania Rating Scale total score <7) at baseline ( N = 938). Suicidal depression was defined by a baseline score ⩾2 for item 12 of the Quick Inventory of Depressive Symptomatology–Self Report ( N = 271, 28.9%). Non-suicidal depression was defined by a baseline item 12 of the Quick Inventory of Depressive Symptomatology–Self Report score <2 ( N = 667, 71.1%). A subsample of about 300 patients (with or without suicidal ideation at baseline) was followed up for 2 years. Results: Baseline clinical features (e.g. depression severity, childhood trauma, global functioning) were more severe in patients with than without suicidal depression. Suicidal patients tended to remain more suicidal throughout the follow-up than patients without suicidal ideation at baseline (3.4-fold higher risk of persistent suicidal ideation at the 2-year visit despite an improvement in depressive symptomatology). Conclusions: Depressed bipolar disorder patients reporting suicidal ideation had more severe clinical features at baseline and were more prone to report persistent suicidal ideation during the follow-up, independently of thymic state. Clinicians should closely monitor this subgroup of patients.
Intoxication and overdose should not preclude veno-venous extracorporeal membrane oxygenation
Authors: Radowsky Jason S , Mazzeffi Michael M , Deatrick K Barry , Galvagno Samuel M , Parker Brandon M , Tabatabai Ali , Madathil Ronson J , Kaczorowski David J , Rabinowitz Ronald P , Herr Daniel L , Scalea Thomas , Menaker Jay 
Published: October 2020

Introduction Acute intoxication (AI) related morbidity and mortality are increasing in the United States. For patients with severe respiratory failure in the setting of an acute ingestion, veno-venous extracorporeal membrane oxygenation (VV ECMO) can provide salvage therapy. The purpose of this study was to evaluate outcomes in patients with overdose-related need for VV ECMO. Methods: We performed a retrospective review of all patients admitted to a specialty VV ECMO unit between August 2014 and August 2018. Patients were stratified by those whose indication for VV ECMO was directly related to an acute ingestion (alcohol, illicit drug, or prescription drug overdose) and those with unrelated diagnoses. Demographics, pre-cannulation clinical characteristics, ECMO parameters, and outcomes data was collected and analyzed with parametric and non-parametric statistics as indicated. Results: 189 patients were enrolled with 27 (14%) diagnosed with AI. Patients requiring VV ECMO for an AI were younger, had lower median BMI and PaO2/FiO2, and higher RESP scores than non-AI patients (p = 0.002, 0.01, 0.03 and 0.01). There was no difference in pre-cannulation pH, lactate, or SOFA scores between the two groups (p = 0.24, 0.5, 0.6). There was no difference in survival to discharge (p = 0.95). Among survivors, there was no difference in ECMO time or hospital stay (p = 0.24, 0.07). Conclusion: We demonstrate no survival difference for patients with and without an AI-related need for VV ECMO. AI patients should be supported with VV ECMO when traditional therapies fail despite potential stigma against acceptance on referral.
Continuous improvement on the rationality of prophylactic injectable PPIs usage by a clinical pharmacist-led guidance team at a Chinese tertiary teaching hospital
Authors: Hong Yun , Ye Ziqi , Gao Zhe , Rao Yuefeng 
Published: October 2020

Objective We aimed to evaluate the effects of a clinical pharmacist-led-guidance-team (CPGT) on improving rational prophylactic injectable proton pump inhibitor use (PIPU) and to explore the application of the Plan–Do–Check–Act (PDCA) method in promoting rational PIPU. Methods We conducted a retrospective study among 814 patients at a Chinese tertiary teaching hospital from January 2017 to December 2018. We enrolled 98 patients before the PDCA; 297 and 419 patients were included in first- and second-round PDCA cycles, respectively. The CPGT established the criteria for PIPU and conducted interventions, including medical record reviews, provision of feedback, clinician education, and outcome analysis. We analyzed the appropriateness and costs of PIPU before and after establishment of the PDCA cycle. Results Implementation of continuous CPGT-led intervention and a PDCA cycle significantly decreased the rate of irrational PIPU (53.06% vs. 8.57%), including duration, administration route, indication, and dosing frequency. Costs of total (USD 211.28 ± 162.33 vs. 53.17 ± 22.32) and inappropriate (USD 76.70 ± 59.78 vs. 2.25 ± 3.86) PIPU per patient were significantly reduced. The target compliance rate was 107.56%. Conclusion A CPGT can have an effective role in improving rational PIPU and optimizing administration through a PDCA cycle, to attain improved clinical and economic outcomes.
Does radical prostatectomy result in lower urinary tract symptom improvement in high-risk and locally advanced prostate cancer? A Single-center experience
Authors: Papadopoulos Georgios , Fragkoulis Charalampos , Stasinopoulos Konstantinos , Stathouros Georgios , Glykas Ioannis , Theocharis Georgios , Lamprou Stavros , Ntoumas Konstantinos 
Published: October 2020

Purpose: Radical prostatectomy represents the most popular method of prostate cancer treatment, including cases with high-risk and locally advanced cancer. Besides, men with this disease often experience lower urinary tract symptoms (LUTS) and report high International Prostate Symptom Scores (IPSS), pathological post-void residual (PVR) urine volumes and low levels of maximum urinary flow rates (Qmax). In this study we assessed the effect of radical prostatectomy on the above parameters in patients with high-risk and locally advanced disease. Methods: A number of 240 individuals were enrolled in the study. Patients that required any post-operative manipulation up to the completion of 12 months after surgery were excluded. All patients were assessed pre- and post-operatively at 3, 6 and 12 months. Evaluation included IPSS, Qmax and PVR. Results: Mean age was 66.8 years. Mean PSA value was 12.7 ng/ml and mean Gleason score was 7.9. At baseline 41.3% of the patients had Qmax ⩽10 and 42.5% had IPSS >8. There was a significant increase in Qmax during the follow-up (median value was 12 at baseline and increased to 21 at 12 months). Also, IPSS and PVR decreased significantly during the follow-up. IPSS median value decreased from 9 at baseline to 5 at 12 months. Improvement was observed in all grades of symptoms.
Multidisciplinary collaborative approach for management of adrenal tumors: Outcomes of minimally invasive adrenalectomy at a single center
Authors: Mahajan Rahul , Kotwal Suman , Mahajan Arti , Anjali  , Manhas Amit 
Published: October 2020

Introduction: Laparoscopy is currently the gold standard for the management of adrenal tumors as it is associated with less morbidity. Owing to technological advances, even large adrenal tumors are currently amenable to laparoscopic removal. In this work, we describe our multidisciplinary collaborative approach for management of adrenal tumors at a single center. Material and methods: Between January 2017 and January 2020, 18 patients with adrenal lesions were operated at our center. Five of these patients had incidentalomas. All patients were evaluated in coordination with endocrinologists and anesthetists. All patients underwent transperitoneal laparoscopic adrenalectomy. The surgical complications were classified as per Clavein-Dindo system. All patients with pheochromocytoma and Cushing syndrome were followed up by the endocrinologist for further evaluation and titration of glucocorticoids and antihypertensive medication. Results: Two out of the 18 patients had American Society of Anesthesiologists (ASA) physical status III. Out of the 18 patients, only one required conversion to open surgery. Five patients developed intraoperative hypertensive crisis while three patients developed hypotensive crisis. All patients were ambulated on the first postoperative day and were discharged on the third post operative day. None of the patients developed any major (Clavein-Dindo III–V) intra operative or post operative complications. Conclusion: Laparoscopic adrenalectomy is the procedure of choice for adrenal tumors. A multi-disciplinary approach involving the endocrinologist, anesthesiologist, and laparoscopic surgeon can help achieve favorable outcomes.
Feasibility of Rapid Development and Deployment of a Telemedicine Program in a Foot and Ankle Orthopedic Practice
Authors: Manz Wesley J. , Goel Rahul , Fakunle Omolola P. , Labib Sameh A. , Bariteau Jason T. 
Published: October 2020

Background: A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared with in-office appointments for all nonemergency visit types. Methods: Telemedicine satisfaction was assessed via phone survey with a modified 1 to 5 Likert scale. Patients who had completed a telemedicine visit between April 13, 2020, and June 19, 2020, were eligible to participate. Patient demographics were recorded, and data were analyzed using paired and independent t tests for parametric continuous data and Fisher’s exact and chi-square tests for noncontinuous data. A total of 216 patients completed the telemedicine questionnaire. Results: The overall mean satisfaction for telemedicine visits (4.7) was significantly lower than that for in-office visits (4.9) ( P < .001). However, the majority (90.3%) of patients reported they would use telemedicine again in the future. When compared, patients seeking fracture care had significantly higher telemedicine satisfaction (4.9, n = 38) than those receiving nonfracture care (4.6, n = 178) ( P = .001), and those greater than 50 miles from the clinic had higher satisfaction (5.0, n = 14) than patients living within 50 miles of the clinic (4.7, n = 202) ( P < .001). Conclusion: Patients were more satisfied with their in-office clinic visit than telemedicine, although the vast majority of patients endorsed a willingness to utilize telemedicine in the future. Patients with trauma and greater barriers to foot and ankle care were more satisfied with their telemedicine visits. Level of Evidence: Level III, retrospective cohort study.
Mental Imagery as a Rehabilitative Therapy for Neuropathic Pain in People With Spinal Cord Injury: A Randomized Controlled Trial
Authors: Kaur Jaskirat , Ghosh Shampa , Sahani Asish Kumar , Sinha Jitendra Kumar 
Published: October 2020

Background Pain of neuropathic origin in spinal cord injury (SCI) is unbearable and challenging to treat. Research studies conducted in the past have shown that mental imagery (MI) techniques have a significant impact on the reduction of symptoms of central neuropathic pain in people with SCI. Objectives The objective of this study was to evaluate the effect of MI training on pain intensity, neuropathic pain symptoms, and interference of pain with function in SCI. Methods A total of 42 SCI participants with central neuropathic pain (duration 6-12 months) were recruited and randomly allocated to MI or control groups. A MI training protocol was administered to MI group and for 30 min/d for 5 days. Outcome measures were assessed at baseline and at the end of 4 weeks. Results There was significant reduction in differences of mean [95% CI] scores of numeric rating scale (−2.1 [CI −2.78 to −1.41]; P < .001) between groups. Mean [95% CI] total scores of Neuropathic Pain Symptom Inventory declined in MI group as compared with control group (−4.52 [CI −5.86 to −3.18]; P < .001). Similarly, Brief Pain Inventory interference scale total dropped significantly ( P < .001) in MI group. Majority of participants in the MI group (55%) reported improvement in scores of Patients’ Global Impression of Change scale as compared with control group where most of the participants (52%) reported no change. Conclusions This study shows the effectiveness of the MI protocol developed as a rehabilitative approach in improving central neuropathic pain in SCI. Trial Registration. Clinical Trials Registry–India under Indian Council of Medical Research; CTRI/2018/07/014884. Registered July 16, 2018.
Prevalence of patent foramen ovale in the Greek population is high and impacts on the interpretation of the risk of paradoxical embolism (RoPE) score
Authors: Koutroulou Ioanna , Tsivgoulis Georgios , Karacostas Dimitris , Ikonomidis Ignatios , Grigoriadis Nikolaos , Karapanayiotides Theodoros 
Published: October 2020

Background: The risk of paradoxical embolism (RoPE) score calculates the probability that patent foramen ovale (PFO) is causally related to stroke (PFO attributable fraction, PFOAF), based on PFO prevalence in patients with cryptogenic stroke (CS) compared with that in the general population. The latter has been estimated at 25%; however, PFO prevalence in nonselected populations varies widely. Methods: Since PFO prevalence in Greece remains unknown, we evaluated it and we calculated PFOAF stratified by RoPE score in a cohort of patients with CS ⩽55 years old. PFO was detected according to the international consensus transcranial Doppler (TCD) criteria in 124 healthy subjects (H), in 102 patients with CS, and in 56 patients with stroke of known cause (nonCS). Each subject underwent unilateral middle cerebral artery recording after infusion of agitated saline, at rest, and after a controlled Valsalva maneuver. We characterized PFO as large (>20 microbubbles or curtain), moderate (11–20), and small (⩽10). Results: PFO was detected in 42.7% of H, 49% of CS, and 25% of nonCS ( p = 0.013). Large PFOs were numerically higher in CS [28.4% (29/102)] compared with H [19.3% (24/124); p = 0.1] and to nonCS [7.1% (4/56), p = 0.04]. The median RoPE score in patients with CS and PFO was seven. Even patients with very high RoPE score (9–10) had moderate PFOAF (57%). For any individual stratum up to RopE score 8, PFOAF was <33%. Conclusions: PFO prevalence in the Greek population is much higher than the widely accepted 25%. PFO may be the cause of stroke in one out of nine Greek patients with CS. Among Greek CS patients who harbor a PFO, the latter is causal in one out of five. The established RoPE score cutoff of ⩾7 for having a probable PFO-associated stroke may overestimate the probability in patients deriving from populations with high PFO prevalence.