bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-high-density lipoprotein cholesterol and treatment targets in vascular surgery patients
Authors: Braet Drew J , Pourak Kian , Mouli Vibav , Palmon Itai , Dinh Dan , Osborne Nicholas H , Vemuri Chandu , Brandt Eric J
Published: September 2022

Introduction

Low-density lipoprotein cholesterol (LDL) is a known contributing factor to atherosclerotic cardiovascular disease (ASCVD) and a primary therapeutic target for medical management of ASCVD. Non-high-density lipoprotein cholesterol (non-HDL) has recently been identified as a secondary therapeutic target but is not yet widely used in vascular surgery patients. We sought to assess if vascular surgery patients were undertreated per non-HDL therapeutic guidelines.

Methods

This was an observational study that used a single-center database to identify a cohort of adult patients who received care from a vascular surgery provider from 01/2001 to 07/2021. ICD-9/10-CM codes were used to identify patients with a medical history of hyperlipidemia (HLD), coronary artery disease (CAD), cerebrovascular occlusive disease (CVOD), peripheral artery disease (PAD), hypertension (HTN), or diabetes mellitus (DM). Patient smoking status and medications were also identified. Lab values were obtained from the first and last patient encounter within our system. Primary outcomes were serum concentrations of LDL and non-HDL, with therapeutic thresholds defined as 70 mg/dL and 100 mg/dL, respectively.

Results

The cohort included 2465 patients. At first encounter, average age was 59.3 years old, 21.4% were on statins, 8.4% were on a high-intensity statin, 25.7% were diagnosed with HLD, 5.2% with CAD, 15.3% with PAD, 26.3% with DM, 18.6% with HTN, and 2.1% with CVOD. At final encounter, mean age was 64.8 years, 23.5% were on statins with 10.1% on high-intensity statin. Diagnoses frequency did not change at final encounter. At first encounter, nearly two-thirds of patients were not at an LDL <70 mg/dL (62.3%) or non-HDL <100 mg/dL (66.0%) with improvement at final encounter to 45.2 and 40.5% of patients not at these LDL or non-HDL treatment thresholds, respectively. Patients on statins exhibited similar trends with 51.1 and 50.1% of patients not at LDL or non-HDL treatment thresholds at first encounter and 39.9 and 35.4% not at LDL or non-HDL treatment thresholds at last encounter. Importantly, 6.9% of patients were at LDL but not non-HDL treatment thresholds.

Discussion

Among vascular surgery patients, over half did not meet non-HDL targets. These results suggest that we may be vastly under-performing adequate medical optimization with only about one-fourth of patients on a statin at their final encounter and approximately one-tenth of patients being treated with a high-intensity statin. With recent evidence supporting non-HDL as a valuable measurement for atherosclerotic risk, there is potential to optimize medical management beyond current high-intensity statin therapy. Further investigation is needed regarding the risk of adverse events between patients treated with these varied therapeutic targets.
Arterial diameter ratio as a reliable predictor for upper limb steal syndrome in patients with arteriovenous fistula for hemodialysis
Authors: Alsaadi Mohammed J.
Published: September 2022

Objectives

The aim of this study is to assess the association between the anastomosis diameter enlargement and steal syndrome incidence in patients with upper limb arteriovenous fistula using ratios as reliable predictors.

Material and Methods

An analytical cross-sectional prospective study was conducted. A total of 49 patients with AVF hemodialysis access were recruited. Twenty-four participants with positive steal syndrome and 25 control were enrolled in the study. Anastomosis diameter, anastomosis diameter ratio, and volume flow ratio were measured ultrasonographically by two expert vascular sonographers. These clinical parameters were recorded and analyzed to assess the difference and association. Patient risk factors and steal syndrome association were emphasized.

Results

The study analysis indicates a strong association in the anastomosis diameter and anastomosis diameter ratio between steal and non-steal patients with a p-value ≤0.05. Additionally, there was a significant increase in the volume flow ratio in the patients with steal syndrome compared to the control group ( p-value ≤0.05). There was a strong relationship between steal syndrome and the presence of peripheral arterial disease (73.9%, p = 0.001). The ICC index of absolute agreement between the two observers was ICC= 0.99 (95% CI 0.99–0.99, n = 10), indicating excellent agreement between observers.

Conclusion

Anastomosis diameter and volume flow ratio strongly suggest that steal syndrome is associated with the increased diameter of anastomosis. Patients with a≥1.05 anastomosis diameter ratio have a greater risk of developing steal syndrome than those with an anastomosis ratio of ≤0.8. In addition, patients with a volume flow ratio ≥0.98 have an increased risk of developing steal syndrome than those with a volume flow ratio of ≤0.75.
Tuberculosis in elderly: Epidemiological profile, prognosis factors and chronological trends in Southern Tunisia, 1995–2016
Authors: Trigui Maroua , Ben Ayed Houda , Koubaa Makram , Ben Hmida Mariem , Ben Jmaa Maissa , Yaich Sourour , Ben Jmaa Tarek , Hammami Fatma , Fki Habib , Damak Jamel , Ben Jemaa Mounir
Published: September 2022

Background

Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy.

Aim/Objective

This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia.

Methods

A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant.

Results

Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024).

Discussion

A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.
Influence of Government Expenditure on Economic Growth: An Empirical Retrospection Based on ARDL Approach
Authors: Javed Sarfaraz , Husain Uvesh
Published: September 2022

The study investigates the influence of government expenditure (GE) on Oman’s economic growth by examining different government-spending dimensions as predictors of economic progression based on collected time-series data of Oman for 30 years. The study uses ‘Auto-Regressive Distributed Lag’ (ARDL) to assess the short-range and long-term effects of the dimensions on economic growth. GE, personal consumption expenditure and public debt are significant negative predictors of Oman’s economic progress in the long run. However, government and private consumption expenditures (PCEs) are significantly negative in the short run. Gross domestic investment is not a significant predictor in the long run, whereas public debt is a substantial positive predictor of Oman’s economic growth in the short run. The study will help policymakers recognize GE in Oman’s economic progression and development.
Boys don’t cry: Trauma, trauma narrative and masculine practice among young male who engaged in harmful sexual behaviour
Authors: Zaniewski Bartosz , Dallos Rudi , Stedmon Jacqui , Welbourne Penelope
Published: September 2022

Compelling evidence suggests that majority of young men who engaged in harmful sexual behaviour (HSB) were subjected to various forms of trauma and adverse childhood experiences. This research explores lived experience of a group of young men who engaged in HSB, what sense they made of it and how their positioned themselves towards these events including HSB, so they are able to maintain their self-integrity. It also explores impact of lived experience with consideration for broader family and cultural discourses. Transition to Adulthood Attachment Interview and Semi-structured interview were employed and Dynamic- Maturation Model of attachment were utilised for this research since it differentiates for dismissed and pre-occupied trauma spectrums. Findings highlighted that all of the young men presented mainly with complex unresolved dismissed trauma or loss and some with both types of trauma. Furthermore, they employed dominant hegemonic culturally shared discourses of masculinity to make sense of their lived experience. The ways in which experiences of trauma shaped the HSB pathway that developed is discussed.
Supporting Students With Specific Learning Disabilities: Strategies for the General Music Classroom
Authors: Draper Ellary A.
Published: September 2022

Of the more than 6 million students with disabilities ages 6 through 21 receiving services under the Individuals With Disabilities Education Act (IDEA), 37.1% (more than 2 million) of students have specific learning disabilities. Given the large number of students with specific learning disabilities, it is likely that these students are attending music classes alongside their same-aged peers. This article provides general information about specific learning disabilities, as well as strategies teachers can use when including students with specific learning disabilities in their inclusive classrooms.
Foreign Bodies Caused by Dental Treatment in the Head and Neck - A Surgical Challenge
Authors: Wüster Jonas , Raguse Jan D. , Kreutzer Kilian , Nahles Susanne , Voß Jan
Published: September 2022

Study Design

Case series

Objective

By reporting several cases of dislocated foreign bodies, we aim to make dentists/surgeons aware of possible severe and potentially life-threatening complications. In case of dislocation, the appropriate radiological assessment depending on the foreign body is required if direct removal fails.

Material and Methods

Electronic and paper record of patients suffering from various dental foreign bodies were analysed. Analysis included history of dislocation, type of foreign object, anatomical region of dislocation, related dental treatment and approach to surgical removal.

Results

In total, 5 patients with various dental foreign body objects, including fractured root canal instruments (n = 2), a broken dental injection needle (n = 1), a broken Lindemann bur (n = 1) and root filling material (n = 1) are reported. Patient ages ranged from 14 to 54 years. In 4 cases, the foreign body could be salvaged successfully, and one patient refused the surgical therapy. General anaesthesia was required in 4 patients. Intraoperatively, a 3D C-arm was used in 3 cases to ensure the successful recovery of the foreign bodies. In 1 case, the foreign body could be removed with endoscopical assistance.

Conclusion

The management of dental materials and instruments requires diligent care by the practitioner, and prevention techniques should be used at all times to minimise the patients’ risk. In the case of foreign body dislocation, appropriate radiological assessment and determination of further medical treatment (if necessary) should take place. During surgical procedures, intraoperative 3D-imaging, as well as endoscopic techniques, are helpful tools to ensure the recovery of foreign bodies.
Genome-wide CRISPR/Cas9 screen identifies etoposide response modulators associated with clinical outcomes in pediatric AML
Authors: Nguyen Nam H. K. , Rafiee Roya , Tagmount Abderrahmane , Sobh Amin , Loguinov Alex , de Jesus Sosa Angelica K. , Elsayed Abdelrahman H. , Gbadamosi Mohammed , Seligson Nathan , Cogle Christopher R. , Rubnitz Jeffery , Ribeiro Raul , Downing James , Cao Xueyuan , Pounds Stanley B. , Vulpe Christopher D. , Lamba Jatinder K.
Published: September 2022

Etoposide is used to treat a wide range of malignant cancers, including acute myeloid leukemia (AML) in children. Despite the use of intensive chemotherapeutic regimens containing etoposide, a significant proportion of pediatric patients with AML become resistant to treatment and relapse, leading to poor survival. This poses a pressing clinical challenge to identify mechanisms underlying drug resistance to enable effective pharmacologic targeting. We performed a genome-wide CRISPR/Cas9 synthetic-lethal screening to identify functional modulators of etoposide response in leukemic cell line and integrated results from CRISPR-screen with gene expression and clinical outcomes in pediatric patients with AML treated with etoposide-containing regimen. Our results confirmed the involvement of well-characterized genes, including TOP2A and ABCC1, as well as identified novel genes such as RAD54L2, PRKDC, and ZNF451 that have potential to be novel drug targets. This study demonstrates the ability for leveraging CRISPR/Cas9 screening in conjunction with clinically relevant endpoints to make meaningful discoveries for the identification of prognostic biomarkers and novel therapeutic targets to overcome treatment resistance.
Focused lung ultrasound to predict respiratory failure in patients with symptoms of COVID-19: a multicentre prospective cohort study
Authors: Skaarup Søren Helbo , Aagaard Rasmus , Ovesen Stig Holm , Weile Jesper , Kirkegaard Hans , Espersen Caroline , Lassen Mats Christian Højbjerg , Skaarup Kristoffer Grundtvig , Posth Stefan , Laursen Christian B. , Bock Ask , Dan Arvig Michael , Biering-Sørensen Tor
Published: September 2022

Background

In this study we aimed to assess if a focused lung ultrasound examination predicts the need for mechanical ventilation, admission to an intensive care unit, high-flow oxygen treatment, death from COVID-19 within 30 days and 30-day all-cause mortality in patients with clinical suspicion of COVID-19 or PCR-verified SARS-CoV-2 infection.

Methods

A multicentre prospective cohort trial was performed. Film clips from focused lung ultrasound examinations were recorded and rated by blinded observers using different scoring systems. A prediction model was built and used to test relationship between lung ultrasound scores and clinical outcomes. Diagnostic performance of scoring systems was analysed.

Results

A total of 3889 film clips of 398 patients were analysed. Patients who had any of the outcomes of interest had a significantly higher ultrasound score than those who did not. Multivariable logistic regression analyses showed that lung ultrasound predicts mechanical ventilation (relative risk 2.44, 95% CI 1.32–5.52), admission to intensive care (relative risk 2.55, 95% CI 1.41–54.59) and high-flow oxygen treatment (relative risk 1.95, 95% CI 1.5–2.53) but not survival when adjusting for sex, age and relevant comorbidity. There was no diagnostic difference in area under the receiver operating characteristic curve between a scoring system using only anterolateral thorax zones and a scoring system that also included dorsal zones.

Conclusion

Focused lung ultrasound in patients with clinical suspicion of COVID-19 predicts respiratory failure requiring mechanical ventilation, admission to intensive care units and the need for high-flow oxygen treatment. Thus, focused lung ultrasound may be used to risk stratify patients with COVID-19 symptoms.
A systematic review of economic evaluations of pharmacological treatments for adults with chronic migraine
Authors: Khanal Saval , Underwood Martin , Naghdi Seyran , Brown Anna , Duncan Callum , Matharu Manjit , Mistry Hema
Published: September 2022

Background and aims

Chronic migraine is a common neurovascular brain disorder with substantial economic costs. We performed a systematic review to identify economic evaluations of pharmacological treatments for adults with chronic migraine.

Methods

We undertook systematic literature searches using terms for migraine/headache and prophylactic drug interventions, combined with economic/cost terms where appropriate. Using inclusion and exclusion criteria, two reviewers independently assessed the citations and abstracts, and full-text articles were retrieved. A review of study characteristics and methodological quality was assessed.

Results

Sixteen citations met the inclusion criteria and were model-based cost-utility studies evaluating: Botox (n = 6); Erenumab (n = 8); Fremanezumab (n = 2); and Galcanezumab (n = 1) as the main treatment. They varied in their use of comparators, perspective, and model type. Botox was cost-effective compared to placebo with an incremental cost-effectiveness ratio (ICER) ranging between £15,028 (€17,720) and £16,598 (€19,572). Erenumab, Fremanezumab and Galcanezumab when compared to Botox, was associated with ICERs ranging between £59,712 ($81,080) and £182,128 (€218,870), with the ICERs above the most common willingness-to-pay thresholds (WTPs). But they were cost-effective within the commonly used WTPs among the population for whom the previous treatments including Botox were failed. Three studies compared the cost-effectiveness of Erenumab against the placebo and found that Erenumab was dominant. All studies performed sensitivity analyses to check the robustness of their results. None of the findings from the included articles were generalisable and none of the included studies fulfilled all the criteria mentioned in the CHEERS 2022 reporting checklist and Phillips’s checklist for economic models.

Conclusions

Evidence to support the cost-effectiveness of pharmacological treatments of chronic migraine in the adult population using Botox and Erenumab were identified. Our findings suggest that both Botox and Erenumab, are cost-effective compared to placebo; although Erenumab had more incremental economic benefits compared to Botox, the ICERs were above the most common willingness-to-pay thresholds. Hence, Erenumab might be an acceptable treatment for chronic migraine for patients whom other treatments such as Botox do not work. Further research is needed to help characterise the data to adequately structure and parameterise an economic model to support decision-making for chronic migraine therapies.
Palliative care team in a Brazilian tertiary emergency department
Authors: Lourençato Frederica Montanari , Miranda Carlos Henrique , de Carvalho Borges Marcos , Pazin-Filho Antonio
Published: September 2022

Objectives

To describe the process of implementing a palliative care team (PCT) in a Brazilian public tertiary university hospital and compare this intervention as an active in-hospital search (strategy I) with the Emergency Department (strategy II).

Methods

We described the development of a complex Palliative Care Team (PCT). We evaluated the following primary outcomes: hospital discharge, death (in-hospital and follow-up mortality) or transfer, and performance outcomes-Perception Index (difference in days between hospitalization and the evaluation by the PTC), follow-up index (difference in days between the PTC evaluation and the primary outcome), and the in-hospital stay.

Results

We included 1203 patients—strategy I (587; 48.8%) and strategy II (616; 51.2%). In both strategies, male and elderly patients were prevalent. Most came from internal medicine I (39.3%) and II (57.9%), p <  0.01. General clinical conditions (40%) and Oncology I (27.7%) and II (32.4%) represented the majority of the population. Over 70% of all patients had PPS 10 and ECOG 4 above 85%. There was a reduction of patients identified in ICU from I (20.9%) to II (9.2%), p <  0.01, reduction in the ward from I (60.8%) to II (42.5%), p <  0.01 and a significant increase from I (18.2%) to II (48.2%) in the emergency department, p <  0.01. Regarding in-hospital mortality, 50% of patients remained alive within 35 days of hospitalization (strategy I), while for strategy II, 50% were alive within 20 days of hospitalization (p <  0.01). As for post-discharge mortality, in strategy II, 50% of patients died 10 days after hospital discharge, while in strategy I, this number was 40 days (p <  0.01). In the Cox multivariate regression model, adjusting for possible confounding factors, strategy II increased 30% the chance of death. The perception index decreased from 10.9 days to 9.1 days, there was no change in follow-up (12 days), and the duration of in-hospital stay dropped from 24.3 to 20.7 days, p <  0.01. The primary demand was the definition of prognosis (56.7%).

Conclusion

The present work showed that early intervention by an elaborate and complex PCT in the ED was associated with a faster perception of the need for palliative care and influenced a reduction in the length of hospital stay in a very dependent and compromised old population.
Probabilistic quotient’s work and pharmacokinetics’ contribution: countering size effect in metabolic time series measurements
Authors: Gotsmy Mathias , Brunmair Julia , Büschl Christoph , Gerner Christopher , Zanghellini Jürgen
Published: September 2022

Metabolomic time course analyses of biofluids are highly relevant for clinical diagnostics. However, many sampling methods suffer from unknown sample sizes, commonly known as size effects. This prevents absolute quantification of biomarkers. Recently, several mathematical post acquisition normalization methods have been developed to overcome these problems either by exploiting already known pharmacokinetic information or by statistical means. Here we present an improved normalization method, MIX, that combines the advantages of both approaches. It couples two normalization terms, one based on a pharmacokinetic model (PKM) and the other representing a popular statistical approach, probabilistic quotient normalization (PQN), in a single model. To test the performance of MIX, we generated synthetic data closely resembling real finger sweat metabolome measurements. We show that MIX normalization successfully tackles key weaknesses of the individual strategies: it (i) reduces the risk of overfitting with PKM, and (ii), contrary to PQN, it allows to compute sample volumes. Finally, we validate MIX by using real finger sweat as well as blood plasma metabolome data and demonstrate that MIX allows to better and more robustly correct for size effects. In conclusion, the MIX method improves the reliability and robustness of quantitative biomarker detection in finger sweat and other biofluids, paving the way for biomarker discovery and hypothesis generation from metabolomic time course data.
Filtering ASVs/OTUs via mutual information-based microbiome network analysis
Authors: Mokhtari Elham Bayat , Ridenhour Benjamin Jerry
Published: September 2022

Microbial communities are widely studied using high-throughput sequencing techniques, such as 16S rRNA gene sequencing. These techniques have attracted biologists as they offer powerful tools to explore microbial communities and investigate their patterns of diversity in biological and biomedical samples at remarkable resolution. However, the accuracy of these methods can negatively affected by the presence of contamination. Several studies have recognized that contamination is a common problem in microbial studies and have offered promising computational and laboratory-based approaches to assess and remove contaminants. Here we propose a novel strategy, MI-based (mutual information based) filtering method, which uses information theoretic functionals and graph theory to identify and remove contaminants. We applied MI-based filtering method to a mock community data set and evaluated the amount of information loss due to filtering taxa. We also compared our method to commonly practice traditional filtering methods. In a mock community data set, MI-based filtering approach maintained the true bacteria in the community without significant loss of information. Our results indicate that MI-based filtering method effectively identifies and removes contaminants in microbial communities and hence it can be beneficial as a filtering method to microbiome studies. We believe our filtering method has two advantages over traditional filtering methods. First, it does not required an arbitrary choice of threshold and second, it is able to detect true taxa with low abundance.
Pharmacist-led medication reviews in primary healthcare for adult community-dwelling patients – a descriptive study charting a new target group
Authors: Wickman Katarina , Dobszai Annika , Modig Sara , Bolmsjö Beata Borgström , Caleres Gabriella , Lenander Cecilia
Published: September 2022

Background

Medication treatment can reduce morbidity but can also cause drug-related problems (DRPs). One method to identify and solve DRPs is medication reviews (MRs) that are aimed at increased patient safety and quality in drug treatment. In Skåne county, Sweden, a well-established multi-professional model for MRs in nursing homes is practiced. However, a demand for MRs regarding community-dwelling patients has emerged. These patients may be extra vulnerable since they have less supervision from healthcare personnel.

AIM: To describe the community-dwelling patients in primary healthcare considered in need of an MR, as well as the outcomes of these pharmacist-led MRs.

Methods

Personnel from 14 primary healthcare centers selected patients for the MRs. Based on electronic medical records, the symptom assessment tool PHASE-20 (PHArmacotherapeutical Symptom Evaluation 20 questions) and medication lists, pharmacists conducted MRs and communicated adjustment suggestions via the medical record to the general practitioners (GPs).

Results

A total of 109 patients were included in the study and 90.8% (n = 99) of the patients were exposed to at least one DRP, with an average of 3.9 DRPs per patient. Patients with impaired renal function (glomerular filtration rate, GFR < 45 ml/min) or ≥ 10 medications were exposed to a significantly higher number of DRPs per patient, 5.1 DRP and 5.3 respectively. The most frequent DRP-categories were Unnecessary drug therapy and Adverse drug reaction, which represented 23.0% respectively 22.9% of the total amount of DRPs.

Conclusions

Our results indicate a prioritized need for MRs for community-dwelling patients, specifically with impaired renal function or polypharmacy.
Three-year weight change and risk of all-cause, cardiovascular, and cancer mortality among Iranian adults: over a decade of follow-up in the Tehran Lipid and Glucose Study
Authors: Deravi Niloofar , Moazzeni Seyyed Saeed , Hasheminia Mitra , Hizomi Arani Reyhane , Azizi Fereidoun , Hadaegh Farzad
Published: September 2022

Background

We investigated the impact of weight change on mortality in a population-based cohort setting.

Methods

We conducted two weight measurements for 5436 participants aged ≥ 30 years with an approximate 3-year interval. Based on their weight change, we categorized participants to: > 5% weight loss, 3–5% weight loss, stable weight (± < 3%), 3–5% weight gain, > 5% weight gain. We followed participants for mortality annually up to March 20th 2018. We applied the multivariable Cox proportional hazard models to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of weight change categories for all-cause, cardiovascular (CV), and cancer mortality, considering stable weight as reference. The Cox models was adjusted for age, sex, educational level, body mass index, smoking status, hypertension, hypercholesterolemia, diabetes, and cardiovascular disease (CVD) at baseline.

Results

During a median follow-up of 14.4 years, 629 deaths (247 CV and 126 cancer deaths) have occurred. Over 5% weight loss and gain were associated with increased risk of all-cause mortality in multivariable analysis with HRs of 1.47 [95% CI: 1.17–1.85] and 1.27 [1.02–1.57], respectively; however, a 3–5% loss or gain did not alter the risk of all-cause mortality significantly. These significant risks for wight change > 5% were not modified by the presence of diabetes, obesity, and smoking status; however, the unfavorable impact of weight change on mortality events was more prominent in those older than > 65 years (P-value for interaction: 0.042). After excluding those with history of CVD, diabetes, and cancer during the weight measurements period, these associations significantly attenuated (HR: 1.29 [0.89–1.87] for > 5% weight loss and 1.12 [0.84–1.50] for > 5% weight gain). Additionally, a > 5% weight loss was also associated with about 60% higher risk for CV mortality (HR: 1.62 [1.15–2.28]), and a 3–5% weight loss was associated with about 95% higher risk of cancer mortality (HR: 1.95 [1.13–3.38]).

Conclusions

Our findings showed a U-shaped association across weight change categories for all-cause mortality risk with over 5% weight gain and loss causing higher risk. Moreover, weight loss can have adverse impact on CV and cancer mortality events.
Market survey of disposable e-cigarette nicotine content and e-liquid volume
Authors: Appleton Scott , Cyrus-Miller Helen , Seltzer Ryan , Gilligan Karin , McKinney Willie
Published: September 2022

Inaccurate labels on some e-cigarette products have prompted calls for routine testing to monitor product label integrity. The objective of this study was to compare label statements of commercial disposable/non-chargeable e-cigarette products for nicotine concentration and e-liquid volume with analytically verified levels. Commercial e-cigarette samples were analyzed for nicotine concentration (N = 51), e-liquid volume and total nicotine content (N = 39). Twenty-three of the 51 samples analyzed for nicotine deviated from their label statements by more than ± 10%. Deviations ranged from -50.1% to + 13.9%. Thirty of the 39 samples analyzed for e-liquid volume deviated from their label statements by more than ± 10%. Deviations ranged from -62.1% to + 13.3%. Only one brand listed total nicotine on the label. In thirty-one of the 39 samples, calculated total nicotine amount in e-liquid deviated from the amounts calculated from the label metrics by more than ± 10%. Deviations ranged from -66.8% to -1.43%. These findings underscore the need for regulatory enforcement of manufacturing quality control and product labeling practices to optimize the harm reduction potential and consumer experience associated with the use of e-cigarette products.
Clinical evaluation of S1 alar screws application in short-segment lumbosacral fixation and fusion for spine infection with severe S1 vertebral body loss
Authors: Fang Weizhi , Liu Weijun , Li Qingbo , Cai Lei , Wang Wei , Yi Xincheng , Jiao Hongbo , Yao Zhi
Published: September 2022

Background

The one-stage posterior approach for treating spinal infection has recently been generally accepted. However, severe vertebral body loss caused by infection remains a major challenge in posterior surgery. This study was conducted to evaluate the clinical application and outcomes of S1 alar screws used in the one-stage posterior surgery of short-segment lumbosacral fixation and fusion after debridement for infection with severe S1 vertebral body loss.

Methods

The clinical features and treatment outcomes of 7 patients with spinal infections from August 2016 to August 2021 who were treated with one-stage posterior surgery using S1 alar screws were retrospectively analyzed. The clinical data, including patient data, visual analogue scale (VAS), Oswestry Disability Index (ODI), fusion time and complications of the patients, were recorded.

Results

All 7 patients were followed up for an average duration of 14.57 months (range, 12—18 months). The VAS score decreased significantly from 7.3 preoperatively (range, 6—8) to 2.6 postoperatively (range, 2—3). The ODI score demonstrated a steady and gradual increase from 73.8 preoperatively (range, 68—75) to 33.6 postoperatively (range, 30—37). Bony fusion time was observed approximately 6.8 months after surgery. Two patients in our study experienced the postoperative local pain, which could be relieved by analgesics and disappeared 3 months after the operation. There were no complications of intraoperative fracture, posterior wound infection or neurovascular injury.

Conclusions

S1 alar screws are suitable for use in the operation and could be an alternative option to S1 pedicle screws for short-segment lumbosacral fixation and fusion with severe S1 vertebral body loss caused by spinal infection, which could provide satisfactory clinical outcomes.
Long-term survival of hybrid total hip replacement for prior failed proximal femoral nail antirotation: a retrospective study with a median 10-year follow-up
Authors: Wang Lin , Yu Minji , Zhang Yaodong , Wang Shuxin , Zhao Mingdong , Yu Mingliang , Li Si , Gao Songtao , Xiong Min , Yu Weiguang
Published: September 2022

Background

Hybrid total hip replacement (THR) is commonly used in the management of proximal femur fractures in elderly individuals. However, in the context of the revision, the literature on hybrid THR is limited, and differences in the long-term survival outcomes reported in the literature are obvious. This retrospective study aimed to evaluate the long-term survival of hybrid THR for failed proximal femoral nail antirotation (PFNA) in elderly individuals aged ≥ 75 years.

Methods

An observational cohort of 227 consecutive individuals aged ≥ 75 years who experienced hybrid THRs following prior primary PFNAs was retrospectively identified from the Joint Surgery Centre, the First Affiliated Hospital, Sun Yat-sen University. Implant survival was estimated using the Kaplan–Meier method. The primary end point was the implant survivorship calculated using the Kaplan–Meier method with revision for any reason as the end point; secondary end points were the function score measured using the modified Harris Hip Score (mHHS) and the incidence of main orthopaedic complications.

Results

In total, 118 individuals (118 THRs) were assessed as available. The median follow-up was 10 (3–11) years. The 10-year survivorship with revision for any reason as the endpoint was 0.914 (95% confidence interval [CI], 0.843–0.960). The most common indication for revision was aseptic loosening (70.0%), followed by periprosthetic fracture (30.0%). At the final follow-up, the median functional score was 83.6 (79.0–94.0). Among the 118 patients included in this study, 16 experienced 26 implant-related complications. The overall incidence of key orthopaedic complications was 13.5% (16/118).

Conclusion

For patients aged ≥ 75 years old with prior failed PFNAs, hybrid THR may yield satisfactory long-term survival, with good functional outcomes and a low rate of key orthopaedic complications.
Online student tutorials for effective peer teaching in digital times: a longitudinal quantitative study
Authors: Festl-Wietek Teresa , Kern Nils , Erschens Rebecca , Griewatz Jan , Zipfel Stephan , Herrmann-Werner Anne
Published: September 2022

Background

Peer-assisted learning represents a favoured method of teaching in universities. The COVID-19 pandemic has necessitated transferring medical education to digital formats, and subsequently, the question has arisen of whether online tutorials might be effective. This study, thus, investigated the efficacy of online tutorials in a communication course by assessing the interaction, verbal communication, and nonverbal communication of tutors and students.

Methods

Second-year medical students were invited to participate in this longitudinal quantitative study. Validated and self-developed questionnaires (e.g., Jefferson Empathy Scale) including 39 questions (rated on a 7- or 5-point Likert scale) were used to assess the different variables including interaction, verbal and nonverbal communication and students’ learning success.

Results

Out of 165 medical students, 128 took part in the study. The students as well as tutors reported that they found each other likeable (Mstudents = 4.60±0.71; Mtutors = 4.38±0.53; p > .05). Learning success increased throughout the communication course (Cohen’s d = 0.36–0.74). The nonverbal and verbal communication in the simulated patient (SP) encounter was also rated as high by all three groups (Mnonverbal = 3.90±0.83; Mverbal = 4.88±0.35).

Conclusions

Interaction as well as nonverbal and verbal communication occurred in the online format, indicating that online tutorials can be effective. The implementation of SPs increases the efficiency of synchronous online learning as it enhances the simulation of a real patient–physician encounter. Thus, online tutorials are a valuable amendment to medical education.
Assessing equity of access and affordability of care among South Sudanese refugees and host communities in two districts in Uganda: a cross-sectional survey
Authors: King Jessica , Prabhakar Pallavi , Singh Neha , Sulaiman Munshi , Greco Giulia , Mounier-Jack Sandra , Borghi Josephine
Published: September 2022

Background

The vast majority of refugees are hosted in low and middle income countries (LMICs), which are already struggling to finance and achieve universal health coverage for their own populations. While there is mounting evidence of barriers to health care access facing refugees, there is more limited evidence on equity in access to and affordability of care across refugee and host populations. The objective of this study was to examine equity in terms of health needs, service utilisation, and health care payments both within and between South Sudanese refugees and hosts communities (Ugandan nationals), in two districts of Uganda.

Methods

Participants were recruited from host and refugee villages from Arua and Kiryandongo districts. Twenty host villages and 20 refugee villages were randomly selected from each district, and 30 households were sampled from each village, with a target sample size of 2400 households. The survey measured condition incidence, health care seeking and health care expenditure outcomes related to acute and chronic illness and maternal care. Equity was assessed descriptively in relation to household consumption expenditure quintiles, and using concentration indices and Kakwani indices (for expenditure outcomes). We also measured the incidence of catastrophic health expenditure- payments for healthcare and impoverishment effects of expenditure across wealth quintiles.

Results

There was higher health need for acute and chronic conditions in wealthier groups, while maternal care need was greater among poorer groups for refugees and hosts. Service coverage for acute, chronic and antenatal care was similar among hosts and refugee communities. However, lower levels of delivery care access for hosts remain. Although maternal care services are now largely affordable in Uganda among the studied communities, and service access is generally pro-poor, the costs of acute and chronic care can be substantial and regressive and are largely responsible for catastrophic expenditures, with service access benefiting wealthier groups.

Conclusions

Efforts are needed to enhance access among the poorest for acute and chronic care and reduce associated out-of-pocket payments and their impoverishing effects. Further research examining cost drivers and potential financing arrangements to offset these will be important.
Congenital tremor and splay leg in piglets – insights into the virome, local cytokine response, and histology
Authors: Stenberg Hedvig , Hellman Stina , Lindström Lisa , Jacobson Magdalena , Fossum Caroline , Hayer Juliette , Malmberg Maja
Published: September 2022

Background

Atypical porcine pestivirus (APPV) is a neurotropic virus associated with congenital tremor type A-II. A few experimental studies also indicate an association between APPV and splay leg. The overarching aim of the present study was to provide insights into the virome, local cytokine response, and histology of the CNS in piglets with signs of congenital tremor or splay leg.

Results

Characterization of the cytokine profile and virome of the brain in piglets with signs of congenital tremor revealed an APPV-associated upregulation of Stimulator of interferon genes (STING). The upregulation of STING was associated with an increased expression of the gene encoding IFN-α but no differential expression was recorded for the genes encoding CXCL8, IFN-β, IFN-γ, IL-1β, IL-6, or IL-10. No viral agents or cytokine upregulation could be detected in the spinal cord of piglets with signs of splay leg or in the brain of piglets without an APPV-infection. The histopathological examination showed no lesions in the CNS that could be attributed to the APPV-infection, as no difference between sick and healthy piglets could be seen.

Conclusion

The results from this study provide evidence of an APPV-induced antiviral cytokine response but found no lesions related to the infection nor any support for a common causative agent.
Relationships of serum CC16 levels with smoking status and lung function in COPD
Authors: Gribben Kelli C. , Poole Jill A. , Nelson Amy J. , Farazi Paraskevi A. , Wichman Christopher S. , Heires Art J. , Romberger Debra J. , LeVan Tricia D.
Published: September 2022

Background

The club cell secretory protein (CC16) has anti-inflammatory and antioxidant effects, and low CC16 serum levels have been associated with both risk and progression of COPD, yet the interaction between smoking and CC16 on lung function outcomes remains unknown.

Methods

Utilizing cross-sectional data on United States veterans, CC16 serum concentrations were measured by ELISA and log transformed for analyses. Spirometry was conducted and COPD status was defined by post-bronchodilator FEV1/FVC ratio < 0.7. Smoking measures were self-reported on questionnaire. Multivariable logistic and linear regression were employed to examine associations between CC16 levels and COPD, and lung function with adjustment for covariates. Unadjusted Pearson correlations described relationships between CC16 level and lung function measures, pack-years smoked, and years since smoking cessation.

Results

The study population (N = 351) was mostly male, white, with an average age over 60 years. An interaction between CC16 and smoking status on FEV1/FVC ratio was demonstrated among subjects with COPD (N = 245, p = 0.01). There was a positive correlation among former smokers and negative correlation among current or never smokers with COPD. Among former smokers with COPD, CC16 levels were also positively correlated with years since smoking cessation, and inversely related with pack-years smoked. Increasing CC16 levels were associated with lower odds of COPD (ORadj = 0.36, 95% CI 0.22–0.57, Padj < 0.0001).

Conclusions

Smoking status is an important effect modifier of CC16 relationships with lung function. Increasing serum CC16 corresponded to increases in FEV1/FVC ratio in former smokers with COPD versus opposite relationships in current or never smokers. Additional longitudinal studies may be warranted to assess relationship of CC16 with smoking cessation on lung function among subjects with COPD.
Peroxisome proliferator-activated receptor gamma gene variants modify human airway and systemic responses to indoor dibutyl phthalate exposure
Authors: Leung Clarus , Ryu Min Hyung , Bølling Anette Kocbach , Maestre-Batlle Danay , Rider Christopher F. , Hüls Anke , Urtatiz Oscar , MacIsaac Julie L. , Lau Kevin Soon-Keen , Lin David Tse Shen , Kobor Michael S. , Carlsten Chris
Published: September 2022

Background

Single nucleotide polymorphisms (SNPs) of peroxisome proliferator-activated receptor gamma (PPAR-γ; gene: PPARG) and oxidative stress genes are associated with asthma risk. However, whether such variants modulate responses to dibutyl phthalate (DBP), a common plasticizer associated with increased asthma development, remains unknown. The purpose of this study is to investigate how SNPs in PPARG and oxidative stress genes, as represented by two separate genetic risk scores, modify the impact of DBP exposure on lung function and the airway and systemic response after an inhaled allergen challenge.

Methods

We conducted a double-blinded human crossover study with sixteen allergen-sensitized participants exposed for three hours to DBP and control air on distinct occasions separated by a 4-week washout. Each exposure was followed by an allergen inhalation challenge; subsequently, lung function was measured, and blood and bronchoalveolar lavage (BAL) were collected and analyzed for cell counts and allergen-specific immunoglobulin E (IgE). Genetic risk scores for PPAR-γ (P-GRS; weighted sum of PPARG SNPs rs10865710, rs709158, and rs3856806) and oxidative stress (OS-GRS; unweighted sum of 16 SNPs across multiple genes) were developed, and their ability to modify DBP effects were assessed using linear mixed-effects models.

Results

P-GRS and OS-GRS modified DBP effects on allergen-specific IgE in blood at 20 h (interaction effect [95% CI]: 1.43 [1.13 to 1.80], p = 0.005) and 3 h (0.99 [0.98 to 1], p = 0.03), respectively. P-GRS also modified DBP effects on Th2 cells in blood at 3 h (− 25.2 [− 47.7 to − 2.70], p = 0.03) and 20 h (− 39.1 [− 57.9 to − 20.3], p = 0.0005), and Th2 cells in BAL at 24 h (− 4.99 [− 8.97 to − 1.01], p = 0.02). An increasing P-GRS associated with reduced DBP effect on Th2 cells. Neither GRS significantly modified DBP effects on lung function parameters.

Conclusions

PPAR-γ variants modulated several airway and systemic immune responses to the ubiquitous chemical plasticizer DBP. Our results suggest that PPAR-γ variants may play a greater role than those in oxidative stress-related genes in airway allergic responses to DBP.

Trial registration: This study reports results from The Phthalate-Allergen Immune Response Study that was registered on ClinicalTrials.gov with identification NCT02688478.
A review on the role of MEG8 lncRNA in human disorders
Authors: Ghafouri-Fard Soudeh , Khoshbakht Tayyebeh , Hussen Bashdar Mahmud , Taheri Mohammad , Shojaei Seyedpouzhia
Published: September 2022

Maternally expressed 8 (MEG8) is a long non-coding RNA which is expressed in the nucleus. It is highly expressed in adrenal, placenta and brain. Recent studies have shown contribution of MEG8 in different disorders ranging from neoplastic ones to diabetic nephropathy, atherosclerosis, ischemic stroke, trophoblast dysfunction and abortion, Henoch-Schonlein purpura and osteoarthritis. It has an oncogenic role in the development of lung, pancreatic and liver cancer. In the current review, we summarize the role of this lncRNA in mentioned disorders, based on the evidence obtained from in vitro, in vivo and human studies.