bluuebunny/crossref_metadata_2025_split huggingface dataset:
Non-Hodgkin’s lymphoma in an elderly patient with renal dysfunction: a case report
Authors: Ma Cong , Yu Bingxiang , Zhang Haomin , Yang Bo , Li Dongwan , Li Rong , Lu Xuechun 
Published: August 2020

Objective This study was performed to examine the treatment regimen used for an elderly patient with diffuse large B-cell lymphoma (DLBCL) complicated with renal dysfunction. Case report An 85-year-old man presented with nasal and sinus disorders in May 2018. He was also found to have renal insufficiency caused by long-term consumption of compound aminopyrine phenacetin tablets. Physical examination revealed irritation of the nasal mucous membrane on the right side and dark red nasal passages with a smooth surface. The right side of the neck contained several small peanut-sized lymph nodes. A biopsy of the right nasal neoplasm revealed germinal center type DLBCL. The mini–rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone regimen (mini-R-CHOP) was administered as the main chemotherapy regimen. Additionally, the use of thrombopoietin prevented further deterioration in renal function. This individualized treatment program helped the patient to achieve complete remission. The creatinine level decreased and was well maintained. Conclusion The mini-R-CHOP and rituximab cross-use regimen was found to be safe in an elderly patient with chronic renal insufficiency. Thrombopoietin exerted a protective effect on renal function.
Andrographolide enhanced radiosensitivity by downregulating glycolysis via the inhibition of the PI3K-Akt-mTOR signaling pathway in HCT116 colorectal cancer cells
Authors: Li Xiaofei , Tian Ruifang , Liu Lan , Wang Lihui , He Dong , Cao Ke , Ma John K. , Huang Chenghui 
Published: August 2020

Objective Radiotherapy plays an important role in the treatment of colorectal cancer (CRC). However, some patients benefit minimally from radiotherapy because of radioresistance. This study investigated the effects of andrographolide on radiosensitivity in HCT116 CRC cells and examined its mechanism of action. Methods Cell survival, proliferation, apoptosis, and migration were evaluated using MTT, colony formation, flow cytometry, and Transwell cell invasion assays, respectively. Glycolysis-related indicators were measured to examine cell glycolytic activity. The expression of related proteins was detected by western blotting. Results After andrographolide treatment, the expression of phosphoinositide 3-kinase (PI3K)-Akt-mammalian target of rapamycin (mTOR) signaling pathway-related proteins, glycolytic activity, and cell survival and invasion rates were decreased in HCT116 cells. Andrographolide plus irradiation increased apoptosis and decreased survival, invasion, and colony formation compared with the effects of irradiation alone. Conclusion Andrographolide enhanced radiosensitivity by downregulating glycolysis via inhibition of the PI3K-Akt-mTOR signaling pathway in HCT116 cells.
Neonatal Adverse Outcomes, Neonatal Birth Risks, and Socioeconomic Status: Combined Influence on Preterm Infants’ Cognitive, Language, and Motor Development in Brazil
Authors: Panceri Carolina , Valentini Nadia Cristina , Silveira Rita C. , Smith Beth A. , Procianoy Renato S. 
Published: August 2020

Background: This study extended previous research by investigating the combined effects of neonatal birth risks, neonatal adverse outcomes, and socioeconomic status on preterm neurodevelopment. Method: A total of 184 preterm infants were assessed using the Bayley Scales of Infant Development III in a follow-up clinic in southern Brazil. Structural equation modeling was conducted with 3 latent variables (neonatal birth risks, neonatal adverse outcomes, and socioeconomic status) and 3 outcomes (cognitive, language, and motor development). Results: The analyses showed that neonatal adverse outcomes were associated with infants’ cognitive (b = –0.45, P < .001), language (b = –0.23, P = .001), and motor (b = –0.51, P < .001) development. Socioeconomic status also explained the variances (cognitive: b = 0.20, P = .006; language: b = 0.28, P = .001; and motor: b = 0.21, P = .004), whereas neonatal birth risks remained significant only in the motor development (b = 0.15, P = .040). Conclusion: This study suggests that the most evident contributors to poor neurodevelopment were adverse outcomes and socioeconomic risk factors.
Tracking hydration status changes by bioimpedance spectroscopy in children on peritoneal dialysis
Authors: Karava Vasiliki , Stabouli Stella , Dotis John , Liakopoulos Vassilios , Papachristou Fotios , Printza Nikoleta 
Published: August 2020

Background: This 6-month prospective longitudinal study investigates the association between hydration status changes using bioimpedance spectroscopy (BIS) and systolic blood pressure (SBP), pulse pressure (PP), and serum albumin (sAlb) changes in children on peritoneal dialysis (PD). Methods: Thirteen patients (median age: 12.58 years) were enrolled. Normal hydration, moderate hydration, severe overhydration, and dehydration were defined as −7% ≤ relative overhydration (Re-OH) < +7%, +7% ≤ Re-OH < +15%, Re-OH ≥ +15%, and Re-OH < −7%, respectively. Automated office blood pressure z-score, sAlb, and weight z-score were recorded. Results: Fifty-two Re-OH measurements were recorded: three in five, four in five, five in two, and seven in one patient, respectively. SBP was higher and sAlb lower in cases with severe overhydration (9 readings) ( p < 0.001, p < 0.001), but distribution of these parameters did not differ between normal hydration/dehydration (28 readings) and moderate overhydration (15 readings) cases. In patients with hydration status change, SBP and PP were higher while sAlb lower in cases with higher hydration status level ( p = 0.026, p = 0.05, and p = 0.109, respectively). In all patients, visit-to-visit SBP, PP, and sAlb changes were correlated to Re-OH changes ( rs = 0.693, p < 0.001; rs = 0.643, p < 0.001; rs = −0.444, p = 0.008, respectively) but not to weight changes ( rs = 0.052, p = 0.754; rs = 0.034, p = 0.838; rs = −0.156, p = 0.378, respectively). Visit-to-visit Re-OH changes, which were >+4% or <−4%, were linearly correlated to SBP ( r = 0.858, p < 0.001), PP ( r = 0.757, p < 0.001), and sAlb ( r = −0.699, p = 0.002) changes. Conclusion: In children on PD, longitudinal Re-OH changes are superior to weight changes in assessing volume-dependent variations of SBP, PP, and sAlb. Routine BIS application, rather than single BIS measurements, seems useful in the intra-patient monitoring of hydration status.
Impact of Pharmacist Intervention in Response to Automated Molecular Diagnostic Tests of Blood Culture Results
Authors: McCarthy Lauren , Colley Peter , Nguyen Hoa L. , Berhe Mezgebe 
Published: August 2020

Background: Rapid molecular diagnostic tests can aid in deescalating antimicrobial therapy prior to final culture and susceptibility reports. Objective: The purpose of this study was to determine whether a new workflow that incorporated pharmacist review of these results reduced time to change in antimicrobial therapy. Methods: This retrospective study analyzed pre- and post-implementation of pharmacist review of positive blood cultures analyzed by rapid diagnostics with clinical recommendations paged to providers. Patients 18 years of age or older initiated on empiric antibiotics were included. The primary outcome was the time to change to targeted antimicrobials. Other outcomes evaluated were rates of Clostridioides difficile (C difficile) infection, inpatient mortality, and intensive care unit and hospital lengths of stay. Results: A total of 199 patients were included, with 98 and 101 patients in the pre- and post-implementation groups, respectively. The median time to change to targeted antimicrobials was significantly reduced with pharmacist intervention from 18.35 to 8.43 hours ( P = 0.042). The groups had similar rates of C difficile infection (1% vs 0%, P = 0.492) and mortality (7.1% vs 5%, P = 0.564). The post-group also had significant reductions in antibiotic days of therapy (10.5 vs 9 days, P = 0.014) and intensive care unit length of stay (3.04 vs 1.44 days, P = 0.046). Median hospital length of stay was similar between the pre- and post-groups (8.5 vs 8 days, P = 0.106), respectively. Conclusion: Incorporating pharmacist review of rapid molecular results of blood cultures decreased time to change to targeted antimicrobials and reduced inpatient antibiotic days of therapy.
Pilot study of anti-mitochondrial antibodies in antiphospholipid syndrome
Authors: Becker Yann LC , Julien Anne-Sophie , Godbout Alexandra , Boilard Éric , Fortin Paul R 
Published: August 2020

Background Mitochondria are intracellular organelles of bacterial origin capable of stimulating the immune system when released into the extracellular milieu. We previously reported the expression of anti-mitochondrial antibodies (AMA) targeting whole organelles (AwMA), mitochondrial DNA (AmtDNA) or mitochondrial RNA (AmtRNA) in patients with systemic lupus erythematosus (SLE). Antiphospholipid syndrome (APS) is an autoimmune condition that may be independent of, or associated with, other diseases, usually SLE. This study aimed to detect AMA in patients with APS and to explore the association with clinical features of APS. Methods AwMA-, AmtDNA- and AmtRNA-IgG and -IgM were detected in a pilot study (healthy controls n = 30 and APS patients n = 24) by direct ELISA, and their levels were associated with demographic and disease characteristics. Results AmtDNA-IgM and AmtRNA-IgG and IgM were elevated in APS compared to healthy controls ( p = 0.009, p = 0.0005 and p = 0.01, respectively). AwMA-IgG were increased in patients positive for lupus anticoagulant (median ± interquartile range = 0.36 ± 0.31 vs. 0.14 ± 0.08, p = 0.008), and optical density values for AwMA-IgM were correlated with titres of IgM against cardiolipin ( rs = 0.51, p = 0.01). An increment of 0.1 unit of AmtDNA-IgM levels was associated with reduced prior reporting of arterial events (odds ratio = 0.86; 95% confidence interval 0.74–1.00; p = 0.047). Conclusion Our pilot study suggests that AMA are represented within the autoantibody repertoire in APS and may display different associations with the clinical manifestations of the disease. Further studies should focus on reproducing these preliminary results by following AMA levels through time in larger prospective cohorts.
What do you Need to Get Started in your Own Counselling Practice?
Authors: Abramson Rachel 
Published: August 2020

Picture this; You are sitting in your office, seeing lots of clients. They come to you from far and wide to seek your advice. You feel good, knowing you can help them. You know that if you tell them they have to come back and see you again, they will readily accept your advice. If you are sick for a week or two, you know they will wait until you are better. You can charge what you like and you are earning a tidy sum of money. You know you will be around in the business world for a long, long, time. You look at the long list of bookings. You reach for the telephone and ring a trusted colleague. “Can you come in for a couple of days,” you ask. “I've got a backlog of clients to get through.” Your colleague wonders how you do it. Your colleague is struggling to make ends meet. If your colleague was to ask: “How did you do it?” what would your response be? Would you be talking about marketing strategies? Perhaps you would be talking about business plans? Or perhaps you had another strategy up your sleeve that works well for you? Take the time to reflect on your own strategies for a while. Then write down your own ideas for later use.
A Career Advisory System for Australia?
Authors: McCowan Col , Hyndman Ken 
Published: August 2020

This article presents a review of career activity, in particular as it relates to vocational education and training, and proposes a model for a system that incorporates an understanding of: • the transition to the changing world of work; • the range and variety of types of employment; and • the best means of utilising available pathways between employment, on- and off-the-job vocational education and training, and university study. In order to maximise the benefits to be gained from recent reforms in the education and training system, an improved career advisory system is needed to enable students to make informed choices regarding further study and employment. The continual demands for retraining, skills development, work restructuring and continuous improvement mean that the individual's need for ongoing opportunities for career information, counselling and advice can no longer be limited to the formal years of education. The Career Pathways project team, with the assistance of a reference group, undertook a range of tasks to collect data for the report. These included interviews, visits, focus groups, literature and policy reviews, and detailed analysis of practices of six countries: France, Germany, New Zealand, Canada the United States and the United Kingdom. This article represents a summary of the report, highlighting key findings and recommendations.
Applying the VPI and the 16PF in a Case of Mismatched Occupations
Authors: Abramson Rachel 
Published: August 2020

Career counsellors have long known that occupational interests are often linked with abilities. We also know that if one has the ability, but not the interest, that ability will not be used. What happens, however, when one has an interest but not the right temperament or personality? I recently had the pleasure of seeing someone for career counselling who fell in this latter category. This individual (let us call her Ms S) came to my rooms with one burning question on her lips: “What's wrong with me? Why can't I keep a job? I was in my past job for 4 weeks and the one before that for 3 weeks. How do I hang on to a job?” Ms S had a secretarial background. She had been fired from her previous positions and was concerned whether she had the capacity to continue working in this field or whether she had somehow become too slow. After obtaining some background information, I asked Ms S to complete a battery of career counselling tests. Of special interest to this case was the results from both the Vocational Preference Indicator (VPI) and the 16 Personality Factor Questionnaire (16PF), which I shall discuss below.
Case Discussions in Advanced Care Planning
Authors: Krechowicz Regine , Gupta Melini , Gratton Valerie , Hickey Carly , Thompson Laura H. , Kyeremanteng Kwadwo 
Published: August 2020

Background: Advanced care planning (ACP) provides an opportunity for individuals to explore and document their values concerning medical care decisions prior to an acute event. This manuscript explores the value of ACP and compares and contrasts 2 ACP models currently in practice. Methods: This hypothetical case describes an elderly, frail patient with end-stage chronic obstructive pulmonary disease who is also a high user of health care resources. A new palliative care-led outpatient ACP clinic model is described using this example. Results: Using the ACP clinic model in this case reveals how different a patient’s end of life experience may be when proper, proactive planning measures are in place. With proper education and discussion around this patient and family’s wishes pertaining to the end of his life, this man was able to change his plan of care from aggressive resuscitation treatment in hospital to a peaceful palliative experience at home. Conclusions: In this case description, the valuable role of ACP in preserving quality of life for patients, increasing satisfaction with care, and decreasing distress among family members during a medical event is demonstrated.
Surgical Repair of Orofacial Clefts in North Kivu Province of Eastern Democratic Republic of Congo (DRC)
Authors: Kalisya Luc Malemo , Bake Jacques Fadhili , Elisee Bake , Nyavandu Kavira , Perry Robert , Rothstein David H. , Cairo Sarah B. 
Published: August 2020

Background: There is a high prevalence of orofacial clefts in low- and middle-income countries with significant unmet need, despite having 50% of the population younger than 18 years in countries such as the Democratic Republic of Congo (DRC). The purpose of this article is to report on the experience of general surgeons with orofacial clefts at a single institution. Methods: This is a retrospective study of patients treated for cleft lip/palate in the province of North Kivu, DRC between 2008 and 2017. Results: A total of 1112 procedures (122/year) were performed. All procedures were performed by general surgeons following training by an international nongovernmental aid organization. A total of 59.2% of patients were male and the median age was 3.4 years (interquartile range: 0.7-13 years). Average distance from surgical center to patient location was 242.6 km (range: 2-1375 km) with outreach performed for distances >200 kms. A majority (82.1%) of patients received general anesthesia (GA) with significant differences in use of GA, age, weight, and length of stay by major orofacial cleft category. Of the 1112 patients, 86.1% were reported to have cleft lip alone, 10.5% had cleft lip and palate, and 3.4% cleft palate alone. Despite this, only 5.3% of patients underwent surgical repair of cleft palate. Conclusions: Multiple factors including malnutrition, risk of bleeding, procedural complexity, and cosmetic results may contribute to the distribution of procedures performed where most cleft palates are not treated. Based on previously published estimates, unmet needs and social burden of cleft lip and palate are high in the DRC.
The Cleft Nurse Specialist: A Key Building Block in the Cleft Multidisciplinary Team
Authors: Martin Serena , Slevin Emma , Hill Chris 
Published: August 2020

Introduction: The cleft nurse specialist (CNS) plays a key role in counselling and supporting parents from the diagnosis onward. The CNS started in 2012 and we aimed to perform a qualitative study to determine the benefits this brought to the cleft community from the parents’ perspective. Methods: The cleft database was used to locate babies born in 2010/2011 and 2013/2014. Parents were contacted by phone by 2 authors and completed a questionnaire on the care and support they received following the diagnosis, in the early days and around the time of surgery. Results: Parents of 38 babies completed the survey. In 2010/2011, only 21% had an antenatal diagnosis compared to 47% in 2013/2014. 2011/2012: 3 unilateral cleft lip and palate (UCLP), 3 bilateral cleft lip and palate (BCLP), 4 CLO, 9 cleft palate only (CPO). 2013/2014: 5 UCLP, 7 BCLP, 7 CPO. 2011/2012: 68% were counselled by a surgeon, 42% were seen >1 week after birth, with some over a month. 2013/2014: 84% were counselled by the CNS, 53% were seen within 48 hours, and 100% within 7 days. Parents in 2013/2014 felt more supported by the cleft team throughout pregnancy and the early days, with home visits being particularly advantageous. Conclusion: The introduction of the CNS to the cleft multidisciplinary team has significantly improved the pathway for parents and is a key link with the wider cleft team. With the improvement in antenatal diagnosis, counselling occurs at an earlier stage and prepares parents for the difficulties commonly experienced in the early days. Key themes included; home visits and direct contact with the CNS.
Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Instrumental Outcomes of Velopharyngeal Function
Authors: Pereira Valerie J. , Tuomainen Jyrki , Hay Norman , Mars Michael , Suchak Archna , Sell Debbie A. 
Published: August 2020

Objective: To investigate the effect of maxillary osteotomy on velopharyngeal function in cleft lip and palate (CLP) using instrumental measures. Design: A prospective study. Participants: A consecutive series of 20 patients with CLP undergoing maxillary osteotomy by a single surgeon were seen at 0 to 3 months presurgery (T1), 3 months (T2), and 12 months (T3) post-surgery. Interventions: Nasalance was measured on the Nasometer II 6400. For videofluoroscopy and nasendoscopy data, visual perceptual ratings, for example, palatal lift angle (PLAn), and quantitative ratiometric measurements, for example, closure ratio (CRa), were made using a validated methodology and computer software. Reliability studies were undertaken for all instrumental measures. Main Outcome Measures: Repeated measures analysis of variance (with time at 3 levels) for nasalance and each velar parameter. Planned comparisons across pairs of time points (T1-T2, T1-T3, and T2-T3) including effect sizes. Results: A significant difference over time was found for nasalance ( P = .001) and planned comparisons across pairs of time points were significant between T1 and T2 ( P = .008), T1 and T3 ( P = .002), but not between T2 and T3 ( P = .459) providing evidence that maxillary osteotomy can impact on nasalance adversely and that the changes seen are permanent and stable. There were also significant differences over time for PLAn ( P = .012) and CRa ( P = −.059) and planned comparisons for both velar parameters reflected similar findings to those of nasalance. Conclusions: Maxillary osteotomy can adversely affect velopharyngeal function in patients with CLP. The study provides evidence for a much earlier post-surgery review even as early as 3 months after surgery.
Sociodemographic Predictors of Patient Age at Time of Cleft Lip and Palate Repair
Authors: Lynn Jeremy V. , Ranganathan Kavitha , Bageris Matthew H. , Luby Alexandra O. , Tursak Hailey R. , Hart-Johnson Tami , Blackwood R. Alexander , Buchman Steven R. 
Published: August 2020

Objective: To identify the impact of sociodemographic and health variables on the age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Design: A retrospective, noninterventional quality assessment, and quality improvement study was designed. Setting: This institutional study was performed at Michigan Medicine in Ann Arbor, MI. Patients: All patients born between 2011 and 2014 who received surgical cleft repair, excluded those who were adopted (n = 165). Main Outcome Measure: The age at which patients undergo cleft lip repair, cleft palate repair, and primary speech evaluation. Results: Cleft lip repair was performed significantly later for patients identifying as Asian (18 weeks, P = .01), patients with Child Protective Services contact (19 weeks, P = .01), patients with a significant comorbidity (14 weeks, P = .02), and patients who underwent preliminary lip adhesion surgery (19 weeks, P < .01). Cleft palate repair was performed significantly later for patients identifying racially as Asian (19 weeks, P = .03) and other (22 weeks, P = .03). Preliminary speech and language evaluation were performed significantly later for patients identifying as black (55 weeks, P = .03) and patients diagnosed with an isolated cleft lip (71 weeks, P < .01). Conclusions: Timing of cleft lip, cleft palate repair, and primary speech and language evaluation are subject to variation which may be predicted by clinically accessible factors. By identifying race, Child Protective Services contact, and care variables as significant predictors of increased patient age at time of intervention, multidisciplinary cleft care teams can proactively allocate patient support resources.