bluuebunny/crossref_metadata_2025_split huggingface dataset:
Perineural and intravenous dexamethasone and dexmedetomidine: network meta‐analysis of adjunctive effects on supraclavicular brachial plexus block
Authors: Sehmbi H. , Brull R. , Ceballos K. R. , Shah U. J. , Martin J. , Tobias A. , Solo K. , Abdallah F. W. 
Published: October 2020

SummaryBoth perineural and intravenous dexamethasone and dexmedetomidine are used as local anaesthetic adjuncts to enhance peripheral nerve block characteristics. However, the effects of dexamethasone and dexmedetomidine based on their administration routes have not been directly compared, and the relative extent to which each adjunct prolongs sensory blockade remains unclear. This network meta‐analysis sought to compare and rank the effects of perineural and intravenous dexamethasone and dexmedetomidine as supraclavicular block adjuncts. We sought randomised trials investigating the effects of adding perineural and intravenous dexamethasone or dexmedetomidine to long‐acting local anaesthetics on supraclavicular block characteristics, including time to block onset and durations of sensory, motor and analgesic blockade. Data were compared and ranked according to relative effectiveness for each outcome. Our primary outcome was sensory block duration, with a 2‐h difference considered clinically important. We performed a frequentist analysis, using the GRADE framework to appraise evidence. One‐hundred trials (5728 patients) were included. Expressed as mean (95%CI), the control group (local anaesthetic alone) had a duration of sensory block of 401 (366–435) min, motor block duration of 369 (330–408) min and analgesic duration of 435 (386‐483) min. Compared with control, sensory block was prolonged most by intravenous dexamethasone [mean difference (95%CI) 477 (160–795) min], followed by perineural dexamethasone [411 (343–480) min] and perineural dexmedetomidine [284 (235–333) min]. Motor block was prolonged most by perineural dexamethasone [mean difference (95%CI) 294 (236–352) min], followed by intravenous dexamethasone [289 (129–448)min] and perineural dexmedetomidine [258 (212–304)min]. Analgesic duration was prolonged most by perineural dexamethasone [mean difference (95%CI) 518 (448–589) min], followed by intravenous dexamethasone [478 (277–679) min] and perineural dexmedetomidine [318 (266–371) min]. Intravenous dexmedetomidine did not prolong sensory, motor or analgesic block durations. No major network inconsistencies were found. The quality of evidence for intravenous dexamethasone, perineural dexamethasone and perineural dexmedetomidine for prolongation of supraclavicular sensory block duration was 'low', 'very low' and 'low', respectively. Regardless of route, dexamethasone as an adjunct prolonged the durations of sensory and analgesic blockade to a greater extent than dexmedetomidine. Differences in block characteristics between perineural and intravenous dexamethasone were not clinically important. Intravenous dexmedetomidine did not affect block characteristics.
Sentinel node occult lesion localization technique for impalpable breast cancer
Authors: Hubley Shelley , Barton Ryan , Snook Kylie L. , Spillane Andrew 
Published: October 2020

AbstractBackgroundMammographic screening has enabled earlier detection of breast cancer, with 25–35% of malignancies being non‐palpable at diagnosis. Accurate removal and sentinel node biopsy for staging these lesions are crucial to successful management. Both these aspects are achieved by peritumoural localization with radioisotope and lymphoscintigraphy for sentinel lymph node (SN) mapping using the sentinel node and occult lesion localization (SNOLL) technique. This study reports SNOLL outcomes in a large cohort of women with non‐palpable breast cancers to assess its performance and promote its logistic advantages.MethodsThis retrospective cohort study used data from BreastSurgANZ Quality Audit supplemented with private case notes. Inclusion criteria were females >18 years, with invasive breast cancer that was asymptomatic and non‐palpable at presentation, who underwent SNOLL (n = 450). Primary outcomes were proportion of successful lesion localization, proportion of patients requiring re‐excision and volume of tissue excised. Secondary outcomes focused on lymphoscintigraphy success rate in detecting sentinel nodes and SN positivity rates.ResultsTumours were successfully removed with the initial SNOLL procedure in 449 cases (99.8%). The re‐excision rate was 15.1% (n = 68). The mean total excision volume was 54.69 cm3 (95% CI 51.49–57.88 cm3; range 2.75–195.33 cm3), with a mean closest circumferential margin of 7.05 mm (95% CI 6.60–7.49 mm; range 0 to ≥10 mm). Lymphoscintigraphy was successful in 96.9% (n = 436) of cases. Sentinel nodes were successfully identified and removed in 99.6% (n = 448) of cases. SN positivity rate was 18.4%.ConclusionSNOLL is an efficient and effective technique for localizing non‐palpable invasive breast lesions while simultaneously identifying sentinel nodes.
Flying baby optical coherence tomography alters the staging and management of advanced retinopathy of prematurity
Authors: Cehajic‐Kapetanovic Jasmina , Xue Kanmin , Purohit Ravi , Patel Chetan K. 
Published: October 2020

AbstractPurposeTo report the use of flying baby spectral domain optical coherence tomography (SD‐OCT) on infants with advanced retinopathy of prematurity (ROP), where clinical findings alone failed to differentiate between retinoschisis and retinal detachment.MethodsProspective, non‐interventional case‐series study of three premature infants with advanced ROP of clinically uncertain stage, after examination by indirect ophthalmoscopy. To confirm the diagnosis, table‐mounted SD‐OCT retinal imaging was performed with the infant held in the flying baby position under topical ocular anaesthesia only. Spectral domain optical coherence tomography (SD‐OCT) findings were correlated with clinical examination and ultra‐widefield scanning laser ophthalmoscopy to determine disease stage and appropriate management.ResultsThe flying baby position was well tolerated, and SD‐OCT images of central and peripheral retina were successfully obtained in all three cases. Additional information provided by the SD‐OCT changed the ROP staging from 3 to 4 in one case, which subsequently required surgical treatment. In two other cases, clinical suspicion of stage 4 ROP was overruled as SD‐OCT revealed tractional retinoschisis rather than full‐thickness retinal detachment, thereby avoiding the need for immediate surgical intervention.ConclusionsIn this case‐series study, flying baby SD‐OCT provided a rapid and widely accessible imaging approach that overruled clinical findings and altered classification and management of infants with advanced ROP. The methodology was suitable for outpatient settings with no risks associated with systemic anaesthesia. The increased use of OCT imaging will make apparent how structural information is useful in management of ROP and may influence future classification of the disease.
Long‐term longitudinal changes in axial length in the Caucasian myopic and hyperopic population with a phakic intraocular lens
Authors: Gaurisankar Zoraida S. , van Rijn Gwyneth A. , Haasnoot Geert W. , Verhoeven Virginie J. M. , Klaver Caroline C. W. , Luyten Gregorius P. M. , Beenakker Jan‐Willem M. 
Published: October 2020

AbstractPurposeTo determine the long‐term longitudinal axial length changes in myopic and hyperopic adults with an iris‐fixated phakic intraocular lens (pIOL).MethodsThe medical records of patients aged ≥18 years with myopia or hyperopia who were treated with pIOL implantation between 1996 and 2011 for refractive correction with a minimum follow‐up of 5 years after pIOL implantation were analyzed. The main outcome measure was change in ocular axial length over time.Results149 eyes of 149 myopic patients and 27 hyperopic eyes of 27 patients were included in this study. Mean patient age was 37.1 ± 10.4 years (35% male) in the myopic group and 39.4 ± 9.4 years (4% male) in the hyperopic group. The eyes of the myopic patients showed a significant mean increase in axial length of 0.45 ± 0.61 mm after a mean follow‐up time of 144 ± 38 months (p < 0.001). In 26 eyes (17%), the axial length had increased by ≥1 mm. The mean annual axial length increase was 0.04 ± 0.06 mm. Axial elongation was associated with a higher degree of myopia (p < 0.001) and younger age (p = 0.02). The eyes of the hyperopic patients showed no change in axial length over time.ConclusionsMyopic eyes corrected with an iris‐fixated pIOL show continuous increase in axial length at an adult age. Although this study is limited to subjects with a pIOL, this is the first time myopization in Caucasian adults has been reported in a large long‐term longitudinal study.
Do socially motivated self‐help groups perform better? Exploring determinants of micro‐credit groups’ performance in Eastern India
Authors: Pal Anirban , Singh Piyush Kumar 
Published: October 2020

AbstractGroup‐based micro‐credit initiatives, as part of the broader social and solidarity‐based finance initiatives, have gained prominence over the past decade, especially in developing economies like India. Lending to the poor, especially women, through micro‐credit groups, are significantly associated with the utilization of commons. Apart from their financial operations, self‐help groups promote social empowerment activities and collective action following a dual bottom‐line approach. However, the causal role of the group's motivation towards pursuing social objectives has not been explored in the past. The present study, therefore, investigates the interlinkages between the group's intrinsic motivation and efficiency using an innovative two‐stage double bootstrapped DEA‐based methodology. Results from the study affirm that apart from traditional factors like maturity, accessibility and group management, the motivation of the group is a crucial determinant of social efficiency. Additionally, the group's loan‐to‐savings ratio and receipt of cash payments significantly affect its long‐term financial sustainability. Micro‐credit groups cannot contribute sustainably as a viable alternative to traditional means of access to credit if it merely offers innovative forms of financing and consumption. They need to be socially aligned to serve the community better and contribute to the group's overall performance and galvanize community‐based resource management.
Impact of CYP2D6 on serum concentrations of flupentixol, haloperidol, perphenazine and zuclopenthixol
Authors: Waade Ragnhild Birkeland , Solhaug Vigdis , Høiseth Gudrun 
Published: October 2020

AimsTo investigate the impact of cytochrome P450 2D6 (CYP2D6) on dose‐adjusted serum concentrations of flupentixol, haloperidol, perphenazine and zuclopenthixol in a therapeutic drug monitoring (TDM) cohort of psychiatric patients. We also studied the functional impact of CYP2D6*41 on dose‐adjusted serum concentrations in the perphenazine‐treated patients.MethodsSerum concentrations of flupentixol, haloperidol, perphenazine and zuclopenthixol from CYP‐genotyped patients were extracted retrospectively from a routine TDM database in the period March 2005 to May 2019. Samples were divided into three CYP2D6 phenotype subgroups according to genotype; normal metabolizers (NMs), intermediate metabolizers (IMs) and poor metabolizers (PMs). The effect of CYP2D6 phenotype on dose‐adjusted serum concentrations of the four antipsychotics was evaluated by multivariable mixed model analyses.ResultsMean dose‐adjusted serum concentrations of perphenazine (564 samples) were 3.9‐fold and 1.6‐fold higher in CYP2D6 PMs and IMs, respectively, compared with NMs (P < .001 and P < .01). For zuclopenthixol (658 samples), mean dose‐adjusted serum concentrations were about 1.5‐fold and 1.3‐fold higher in CYP2D6 PMs and IMs, respectively, compared with NMs (P < .01 and P < .001). CYP2D6 was of minor or no importance to haloperidol (320 samples) and flupentixol (115 samples). In our data material, the genotype CYP2D6 *1/*41 appears to have a similar impact on dose‐adjusted serum concentrations of perphenazine as *1/null (null = variant allele encoding no enzyme function).ConclusionsThis study shows that CYP2D6 is important for the metabolism of perphenazine and zuclopenthixol, but not for haloperidol and flupentixol. The CYP2D6*41 allele appears to have a reduced function close to nonfunctional variant alleles.
Dendrobine attenuates gestational diabetes mellitus in mice by inhibiting Th17 cells
Authors: Feng Yan , Jia Bei , Feng Qi , Zhang Yinghong , Chen Yangyang , Meng Jun 
Published: October 2020

AbstractGestational diabetes mellitus (GDM) is a common disease in pregnant women with a prevalence from 1.4% to 14% based on the population studied. The number of patients with GDM is increasing annually, and yet, the treatment for GDM remains limited. In this study, we aimed to explore the potential of dendrobine against GDM. For this purpose, a genetic mouse model of GDM was established. GDM mice were orally administered with 20 mg/kg dendrobine daily from the beginning of pregnancy to delivery. It was found that dendrobine significantly ameliorated the symptoms of GDM, as evidenced by reduced maternal body‐weight and blood glucose levels, as well as increased insulin levels and insulin sensitivity in GDM mice. Dendrobine also remarkably attenuated the impairments to offspring, such as decreased birth‐weight and birth size. Moreover, dendrobine reduced the secretion of inflammatory cytokines by T helper 17 (Th17) cells, including interleukin‐1β, interleukin‐6, tumour necrosis factor‐α and interleukin‐17. Furthermore, we found that dendrobine also reduced the population of Th17 cells in GDM mice. In conclusion, dendrobine could effectively alleviate GDM in mice and might serve as a potential therapeutic drug candidate for GDM patients.
The Importance of Political Systems for Trade Union Membership, Coverage and Influence: Theory and Comparative Evidence
Authors: Budd John W. , Lamare J. Ryan 
Published: October 2020

AbstractIdeological connections between the state, political systems and industrial relations have long been important. But the influence of the structural nature of a country's political system on trade union membership, coverage and influence has been largely overlooked. We uniquely theorize three channels through which a political system can shape unionization in the workplace independent of ideology: incentives for inclusionary governance, legislative body composition and policy enactment. Empirically, we use multiple European datasets to test the relationship between political and employee representation using multivariate analyses across more than 25 countries. We find that increased political representativeness, measured by lower disproportionality and the presence of multiparty coalitions, is a statistically significant predictor of a greater likelihood of individual trade union membership, coverage and influence, while competitive fragmentation, measured by greater numbers of political parties, is associated with weakened collective voice.
Treatment and relapse of interstitial lung disease in nivolumab‐treated patients with non–small cell lung cancer
Authors: Sata Masafumi , Sasaki Shinichi , Oikado Katsunori , Saito Yoshinobu , Tominaga Junya , Sakai Fumikazu , Kato Terufumi , Iwasawa Tae , Kenmotsu Hirotsugu , Kusumoto Masahiko , Baba Tomohisa , Endo Masahiro , Fujiwara Yutaka , Sugiura Hiroaki , Yanagawa Noriyo , Ito Yoshihiko , Sakamoto Takahiko , Ohe Yuichiro , Kuwano Kazuyoshi 
Published: October 2020

AbstractNivolumab, a human monoclonal antibody against programmed death‐1, is approved for the treatment of non–small cell lung cancer (NSCLC). Although nivolumab is generally well tolerated, it can cause interstitial lung disease (ILD), a rare but potentially fatal immune‐related adverse event. Currently, there are limited data available on the treatment of nivolumab‐induced ILD and its outcome. This retrospective cohort study based on a post–marketing study described the treatment of nivolumab‐induced ILD and its outcome in NSCLC patients in Japan through the assessment of clinical and chest imaging findings by an expert central review committee. Treatment details for patients who experienced a relapse of ILD were also analyzed. Of the 238 patients identified as having nivolumab‐induced ILD, 37 patients died of ILD. Corticosteroids were used in 207 (87.0%) patients. Of those, 172 (83.1%) patients responded well and survived and 35 (16.9%) died (most died during corticosteroid treatment). A total of nine patients experienced a relapse; at the time of relapse, four patients were taking nivolumab. Of those who were receiving corticosteroids at the time of relapse, three of four patients were taking low doses or had nearly completed dose tapering. All patients (except one, whose treatment was unknown) received corticosteroids for the treatment of relapse, but one patient died. Patients with NSCLC who experience nivolumab‐induced ILD are treated effectively with corticosteroids, and providing extra care when ceasing or reducing the corticosteroid dose may prevent relapse of ILD.
Limited versus extended cocaine intravenous self‐administration: Behavioral effects and electrophysiological changes in insular cortex
Authors: Luo Yi‐Xiao , Huang Donald , Guo Changyong , Ma Yao‐Ying 
Published: October 2020

AbstractAimsLimited vs extended drug exposure has been proposed as one of the key factors in determining the risk of relapse, which is the primary characteristic of addiction behaviors. The current studies were designed to explore the related behavioral effects and neuronal alterations in the insular cortex (IC), an important brain region involved in addiction.MethodsExperiments started with rats at the age of 35 days, a typical adolescent stage when initial drug exposure occurs often in humans. The drug‐seeking/taking behaviors, and membrane properties and intrinsic excitability of IC pyramidal neurons were measured on withdrawal day (WD) 1 and WD 45‐48 after limited vs extended cocaine intravenous self‐administration (IVSA).ResultsWe found higher cocaine‐taking behaviors at the late withdrawal period after limited vs extended cocaine IVSA. We also found minor but significant effects of limited but not extended cocaine exposure on the kinetics and amplitude of action potentials on WD 45, in IC pyramidal neurons.ConclusionOur results indicate potential high risks of relapse in young rats with limited but not extended drug exposure, although the adaptations detected in the IC may not be sufficient to explain the neural changes of higher drug‐taking behaviors induced by limited cocaine IVSA.
Superoxide dismutase C affects Dictyostelium contractile vacuole biogenesis and function
Authors: Kabra Adwait , Kim Lou W. 
Published: October 2020

AbstractDictyostelium cells cope with hypo‐osmotic stress with a contractile vacuole (CV) system, which consists of one or two vacuoles that cyclically charge and discharge. Uniquely, a F‐Actin remodeling dependent minimal mixing of the CV membrane components with the target plasmalemma during the fusion and the dischargement warrants the integrity of the CV bladder for an efficient next CV cycle. The effect of hypo‐osmotic stress on F‐Actin remodeling activity, however, is currently not well understood. Dictyostelium cells increase the level of intracellular superoxide level in response to hypo‐osmotic stress, which in turn activates redox‐sensitive Ras proteins, but not Akt, which is one of the Ras downstream targets and a major regulator of F‐Actin remodeling. However, Akt is not insulated from the active Ras in cells lacking Superoxide dismutase C (SodC). We report here that sodC‐ cells were compromised in the CV structure and function and the attenuation of Ras/PI3K/Akt signaling in several independent means significantly improved the compromised CV structure but not the function. Interestingly, when sodC‐ cells were treated with 5‐(N,N‐Dimethyl) amiloride hydrochloride (EIPA), an inhibitor of sodium proton exchanger (NHE), both the structure and the function of the CV improved. Thus, a proper CV biogenesis in sodC‐ cells was insufficient to restore their CV function, which in turn indicates the presence of an additional target for SodC and EIPA that modulates CV function.
What drives gallers and parasitoids interacting on a host plant? A network approach revealing morphological coupling as the main factor
Authors: Luz Fernando Albuquerque , Goetz Ana Paula Moraes , Mendonça Milton de Souza 
Published: October 2020

1. Ecological interaction networks, those built from linking interacting species in a biological community, can be structured according to neutral factors, like abundance, or depend on species distribution in space, time, or functional aspects of interacting species.2. Gall inducers are a specialized guild of herbivores producing a structure serving as shelter, food, and defence against natural enemies. Interactions between galling insects and their parasitoids can become complex; studies analysing processes influencing how these interactions occur are uncommon.3. We tested for ecological processes predictive of network structure: neutral (abundance), temporal, or morphological coupling factors.4. We used a single host plant, and six Cecidomyiidae species from subtropical forests of southern Brazil. There were 14 samples across two years; out of 1762 galls, 741 parasitoids emerged (45 species). The network had high specialization (39 exclusive parasitoid species) and low connectance (21%).5. Gall‐parasitoid morphological coupling (gall thickness vs. parasitoid ovipositor length) was the best factor explaining network structure, with little effect for time, or abundances. Modularity was significant, with two modules, one with only Pisphondylia brasiliensis and its parasitoids. This insect induces thick multichambered galls with the lowest parasitism rate, attacked by parasitoids with longer ovipositors. Thinner galls had higher parasitism rates and more attacking parasitoid species, implying an important adaptive role for gall shape/size in natural enemy interactions.6. Interaction networks are important tools to help understand how ecological function impacts community structure, but higher‐scale studies may be needed to reach more encompassing conclusions about galler‐parasitoid interactions.