bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of inferior oblique myectomy on primary position when combined with lateral rectus recession for intermittent exotropia
Authors: Scelfo Christina , Elhusseiny Abdelrahman M , Alkharashi Maan
Published: March 2021

Purpose:

To evaluate the surgical success and need for adjustment due to overcorrection in patients who undergo inferior oblique myectomy (IOM) combined with lateral rectus recession (LRc) for intermittent exotropia in the setting of inferior oblique overaction.

Methods:

A retrospective chart review was conducted of patients with intermittent exotropia who underwent LRc using adjustable sutures alone versus LRc combined with IOM between January 2010 and July 2018 at our institution. Binocular alignment was recorded before and within one week of surgery. Evaluation measures noted were surgical success (defined as distance alignment of ⩽10 prism diopters) and need for postoperative adjustment due to overcorrection.

Results:

Of 48 patients, 24 underwent LRc alone and 24 underwent LRc combined with IOM; all 48 patients had adjustable sutures. Surgical success was significantly higher in the LRc alone group (91.6%) compared with the LRc with IOM group (62.5%) ( p = 0.036). The need for postoperative adjustment due to overcorrection was also significantly higher in the LRc with IOM group (20.8%) compared with the LRc alone group (0%) ( p = 0.049).

Conclusions:

In this study, more patients needed adjustment for overcorrection after undergoing LRc combined with IOM versus LRc alone. Since the tertiary action of the inferior oblique is abduction it is possible that, in patients with inferior oblique overaction, surgically weakening the inferior oblique causes more esodeviation and overcorrection. Thus, surgical correction of exotropia and inferior oblique overaction using LRc combined with IOM may lead to overcorrection and increased need for postoperative adjustment.
Impact of clinical parameters and vascular haemodynamics on arterio-venous fistula maturation in patients with end stage renal disease: A prospective study on Indian patients
Authors: Ghosh Nalini Kanta , Bhattacharjee Hemanga Kumar , Prajapati Omprakash , Krishna Asuri , Kumar Atin , Mahajan Sandeep , Bansal Virinder Kumar
Published: March 2021

Background:

About 18%–65% of Arterio-Venous fistula (AVF) made to facilitate haemodialysis in end stage renal disease patient fail to mature. This study was designed to evaluate the impact of clinical parameters and vascular haemodynamics on maturation of AVF on Indian patients.

Material and methods:

This was a prospective observational study. Eligible patients’ clinical profiles and vascular haemodynamics by Doppler ultrasonography were noted. All patients underwent radio-cephalic AVF on the non-dominant arm under local anaesthesia. Clinical definition was used to assess success rate of AVFs which is defined as successful six settings of satisfactory dialysis. Data were analysed using Stata/12.0 software. Independent t-test, chi-square test, logistic regression analysis and multivariate analysis were used. The p-value of <0.05 was considered significant.

Results:

A total of 205 patients were enrolled and analysed. Among clinical factors, age, sex, serum creatinine, hypertension had no significant association with failure (p = 0.5, 0.08, 0.76 and 0.74). Patient’s BMI and presence of diabetes had significant impact on outcome ( p < 0.001 and 0.02 respectively). Among vascular haemodynamics, radial vein diameter of >2.5 mm and radial artery flow rate >40 ml/min had no significant association with failure ( p = 0.12 and 0.28). Diameter of radial artery (>2 mm) and intra-operatively immediate thrill were independent predictor of success (p = 0.002 and <0.001).

Conclusion:

In the present study rate of fistula, maturation was 73.2% without any post-operative radiological intervention. Radial artery diameter >2 mm and presence of immediate thrill post-operatively were significantly associated with successful cannulation.
Structural fire design of SHS, RHS and CHS high strength steel columns
Authors: Mohammed Asif , Cashell Katherine A
Published: March 2021

Despite substantial progress in recent years to improve the design guidance for high strength steel (HSS) structural elements, this has mainly been for ambient conditions with their fire response still in need of further research. Accordingly, this paper reports on an investigation into the structural performance of unprotected HSS hollow section columns in fire. Finite element models of columns made from square, circular and rectangular hollow sections are developed and are validated against test data at ambient and elevated temperature. The validated models are employed to perform parametric studies to assess the influence of a range of variables such as the grades of HSS, levels of temperature exposure and cross-sectional geometry. The structural fire design resistance method for a column given in the Eurocode is assessed based on the FE results. Consequently, new buckling curves are proposed, which provide a more accurate prediction of the real capacity and reliability analysis is also performed on the new proposed design formulations.
When Things Get Real: (Re)Considering the Challenges to Cultural Industries Research
Authors: Elavsky C. Michael , Jansová Iveta
Published: March 2021

This article considers the practical methodological challenges and variances related to doing research in the cultural industries. More specifically, it seeks to illuminate how considering the specific proclivities of prescribed, historically inflected, fields of study and concomitant sites therein (e.g., in our case study, the infrastructural/cultural dynamics of media organizations in a small, central-European media market) force methodological (re)considerations which can enhance doing practical research in this realm.
An Affordable and Easily Recreated Ultrasound Phantom for Deep Vein Thrombosis
Authors: Rathbun Kimberly M. , Zweig Aaron
Published: March 2021

Evaluating a patient for a deep vein thrombosis (DVT) using ultrasound is a common procedure in the emergency department. Teaching a clinician to identify a DVT on ultrasound is often done on a phantom, which is a synthetic model intended to simulate a clinical condition. Traditional commercial ultrasound phantoms modeling a DVT exist, but can be prohibitively expensive. We have created a DVT phantom by embedding a water-filled balloon containing a smaller balloon filled with water and an acrylic polymer in a gelatin-psyllium hydrophilic mucilloid fiber mixture. This phantom is durable, easily created, and affordable. It provides clinicians the ability to learn to identify a DVT on a phantom prior to performing the procedure on a patient.
Robust trajectory tracking control of a 6-DOF robotic crusher based on dynamic compensation
Authors: Li Guoguang , Shi Boqiang , Liu Ruiyue , Gu Jie
Published: March 2021

A robust controller is developed for the trajectory tracking control of a 6-DOF robotic crusher in task space. Firstly, the dynamic model including the mantle assembly and actuators is derived by Lagrange method according to the virtual work principle. In order to simulate the crushing behavior of cone crusher in the crushing chamber, the trajectory model of the mantle assembly is achieved by ADAMS. Then, a robust controller which contains the dynamic compensation is designed, and the convergence stability of the 6-DOF robotic crusher is strictly proved based on Lyapunov stability theory. Finally, the co-simulation is used to verify that the proposed controller can solve the problem of model uncertainties and external disturbances well. Meanwhile, numerical simulation results of the 6-DOF robotic crusher illustrate the proposed controller is able to effectively reduce the trajectory tracking errors compared with the computed torque controller.
The Clinical Utility of High-Resolution Vessel Wall Imaging in Screening for Meningovascular Neurosyphilis
Authors: Kayyali Mohammad N. , Momii Austin , Xiao Jiayu , Fan Zhaoyang , Dumitrascu Oana M.
Published: March 2021

Meningovascular neurosyphilis is a common cause of stroke in young adults, particularly when HIV co-infection is present. Contemporary screening for neurosyphilis relies on invasive testing. High resolution vessel wall imaging (HR-VW) is an emerging non-invasive tool to detect intracranial vessel wall inflammation. We report a case of multifocal acute cerebral infarctions from meningovascular neurosyphillis in which HR-VWI was instrumental in leading to the etiological diagnosis. A 32-year-old man with history of untreated HIV and polysubstance abuse presented with sudden onset vertigo. CT angiogram of the head and neck showed non-dominant left extracranial vertebral artery occlusion in the V1 segment, and multifocal areas of stenoses in V2 through V4 segments. Non-contrast brain MRI demonstrated multiple small acute infarcts in the left cerebellum, left brachium pontis, medulla and occipital lobe. Rapid plasma reagin was reactive. 3D whole-brain HR-VWI revealed concentric vessel wall contrast enhancement in the left V4 segment, suggestive of inflammation. This HR-VWI finding prompted further investigation with cerebrospinal fluid analysis that revealed reactive fluorescent treponemal antibody absorption test. The patient received high-dose intravenous Penicillin G, was restarted on highly active antiretroviral therapy, and remained neurologically stable to-date. With high spatial resolution and signal-to-noise ratio, HR-VWI allows for visualization of vessel wall inflammation in co-morbid HIV and neurosyphilis.
Prevalence of multidrug-resistant Acinetobacter baumannii in a critical care setting: A tertiary teaching hospital experience
Authors: Alotaibi Thabit , Abuhaimed Abdulrhman , Alshahrani Mohammed , Albdelhady Ahmed , Almubarak Yousef , Almasari Osama
Published: March 2021

Background:

The management of Acinetobacter baumannii infection is considered a challenge especially in an intensive care setting. The resistance rate makes it difficult to manage and is believed to lead to higher mortality. We aim to investigate the prevalence of Acinetobacter baumannii and explore how different antibiotic regimens could impact patient outcomes as there are no available published data to reflect our population in our region.

Methods:

We conducted a retrospective review of all infected adult patients admitted to the intensive care unit at King Fahad University Hospital with a confirmed laboratory diagnosis of Acinetobacter baumannii from 1 January 2013 until 31 December 2017. Positive cultures were obtained from the microbiology department and those meeting the inclusive criteria were selected. Variables were analyzed using descriptive analysis and cross-tabulation. Results were further reviewed and audited by blinded co-authors.

Results:

A comprehensive review of data identified 198 patients with Acinetobacter baumannii. The prevalence of Acinetobacter baumannii is 3.37%, and the overall mortality rate is 40.81%. Our sample consisted mainly of male patients, that is, 68.7%, with a mean age of 49 years, and the mean age of female patients was 56 years. The mean age of survivors was less than that of non-survivors, that is, 44.95 years of age. We observed that prior antibiotic use was higher in non-survivors compared to survivors. From the review of treatment provided for patients infected with Acinetobacter baumannii, 65 were treated with colistin alone, 18 were treated with carbapenems, and 22 were treated with a combination of both carbapenems and colistin. The mean length of stay of Acinetobacter baumannii–infected patients was 20.25 days. We found that the survival rates among patients who received carbapenems were higher compared to those who received colistin. Conclusion: We believe that multidrug-resistant Acinetobacter baumannii is prevalent and associated with a higher mortality rate and represents a challenging case for every intensive care unit physician. Further prospective studies are needed.
The Surgical Outcomes of Unstable Ankle Fractures in Patients Aged >65 Years
Authors: Sahin Adem , Agar Anıl , Gulabi Deniz , Erturk Cemil
Published: March 2021

Aim:

To evaluate the surgical outcomes and complications of patients over 65 years of age, with unstable ankle fractures.

Material and Method:

The study included 111 patients (73F/38 M) operated on between January 2015 and February 2019 and followed up for a mean of 21.2 months (range, 6-62 months).Demographic characteristics, comorbidities, fracture type, and mechanisms of injury were evaluated. Relationships between postoperative complications and comorbidities were examined. In the postoperative functional evaluations, the AOFAS score was used and pre and postoperative mobilization (eg, use of assistive devices) was assessed.

Results:

The mean age of the patients was 70.5 ± 6.1 years (range, 65-90 years). The mechanism of trauma was low-energy trauma in 90.1% of the fractures and high-energy trauma in 9.9%. The fractures were formed with a SER injury (supination external rotation) in 83.7% of cases and bimalleolar fractures were seen most frequently (85/111, 76%).Complications developed in 16 (14.4%) patients and a second operation was performed in 11 (9.9%) patients with complications. Plate was removed and debridement was performed in 5 of 6 patients due to wound problems. Nonunion was developed in the medial malleolus in 4 patients. Revision surgery was performed because of implant irritation in 2 patients and early fixation loss in the medial malleolus fracture in one patient. Calcaneotibial arthrodesis was performed in 3 patients because of implant failure and ankle luxation associated with non-union. A correlation was determined between ASA score and DM and complications, but not with osteoporosis. The mean follow-up AOFAS score was 86.7 ± 12.5 (range, 36-100).A total of 94 (84.7%) patients could walk without assistance postoperatively and 92 (82.9%) were able to regain the preoperative level of mobilization.

Conclusion:

Although surgery can be considered an appropriate treatment option for ankle fractures in patients aged >65 years, care must be taken to prevent potential complications and the necessary precautions must be taken against correctable comorbidities.
Symptoms as Black Boxes: Time to Look Inside the Box
Authors: Wilshire Carolyn E. , Ward Tony , Clack Samuel
Published: March 2021

In our original article (this issue, p. 323), we argued that focusing research on individual symptoms of psychopathology might provide valuable information about their underlying nature and result in better classification systems, explanations, and treatment. To this end, we formulated five core questions that were intended to guide subsequent research and symptom conceptualizations in the psychopathology domain. In this article, we respond to two commentaries on our article. We conclude that it is time to open the black box of symptoms and to take seriously their status as complex constructs.
CD70-specific CAR T cells have potent activity against acute myeloid leukemia without HSC toxicity
Authors: Sauer Tim , Parikh Kathan , Sharma Sandhya , Omer Bilal , Sedloev David , Chen Qian , Angenendt Linus , Schliemann Christoph , Schmitt Michael , Müller-Tidow Carsten , Gottschalk Stephen , Rooney Cliona M.
Published: March 2021

The prognosis of patients with acute myeloid leukemia (AML) remains dismal, highlighting the need for novel innovative treatment strategies. The application of chimeric antigen receptor (CAR) T-cell therapy to patients with AML has been limited, in particular by the lack of a tumor-specific target antigen. CD70 is a promising antigen to target AML, as it is expressed on most leukemic blasts, whereas little or no expression is detectable in normal bone marrow samples. To target CD70 on AML cells, we generated a panel of CD70-CAR T cells that contained a common single-chain variable fragment (scFv) for antigen detection, but differed in size and flexibility of the extracellular spacer and in the transmembrane and the costimulatory domains. These CD70scFv CAR T cells were compared with a CAR construct that contained human CD27, the ligand of CD70 fused to the CD3ζ chain (CD27z). The structural composition of the CAR strongly influenced expression levels, viability, expansion, and cytotoxic capacities of CD70scFv-based CAR T cells, but CD27z-CAR T cells demonstrated superior proliferation and antitumor activity in vitro and in vivo, compared with all CD70scFv-CAR T cells. Although CD70-CAR T cells recognized activated virus-specific T cells (VSTs) that expressed CD70, they did not prevent colony formation by normal hematopoietic stem cells. Thus, CD70-targeted immunotherapy is a promising new treatment strategy for patients with CD70-positive AML that does not affect normal hematopoiesis but will require monitoring of virus-specific T-cell responses.
Glioblastoma cell populations with distinct oncogenic programs release podoplanin as procoagulant extracellular vesicles
Authors: Tawil Nadim , Bassawon Rayhaan , Meehan Brian , Nehme Ali , Montermini Laura , Gayden Tenzin , De Jay Nicolas , Spinelli Cristiana , Chennakrishnaiah Shilpa , Choi Dongsic , Adnani Lata , Zeinieh Michele , Jabado Nada , Kleinman Claudia L. , Witcher Michael , Riazalhosseini Yasser , Key Nigel S. , Schiff David , Grover Steven P. , Mackman Nigel , Couturier Charles P. , Petrecca Kevin , Suvà Mario L. , Patel Anoop , Tirosh Itay , Najafabadi Hamed , Rak Janusz
Published: March 2021

Vascular anomalies, including local and peripheral thrombosis, are a hallmark of glioblastoma (GBM) and an aftermath of deregulation of the cancer cell genome and epigenome. Although the molecular effectors of these changes are poorly understood, the upregulation of podoplanin (PDPN) by cancer cells has recently been linked to an increased risk for venous thromboembolism (VTE) in GBM patients. Therefore, regulation of this platelet-activating protein by transforming events in cancer cells is of considerable interest. We used single-cell and bulk transcriptome data mining, as well as cellular and xenograft models in mice, to analyze the nature of cells expressing PDPN, as well as their impact on the activation of the coagulation system and platelets. We report that PDPN is expressed by distinct (mesenchymal) GBM cell subpopulations and downregulated by oncogenic mutations of EGFR and IDH1 genes, along with changes in chromatin modifications (enhancer of zeste homolog 2) and DNA methylation. Glioma cells exteriorize their PDPN and/or tissue factor (TF) as cargo of exosome-like extracellular vesicles (EVs) shed from cells in vitro and in vivo. Injection of glioma-derived podoplanin carrying extracelluar vesicles (PDPN-EVs) activates platelets, whereas tissue factor carrying extracellular vesicles (TF-EVs) activate the clotting cascade. Similarly, an increase in platelet activation (platelet factor 4) or coagulation (D-dimer) markers occurs in mice harboring the corresponding glioma xenografts expressing PDPN or TF, respectively. Coexpression of PDPN and TF by GBM cells cooperatively affects tumor microthrombosis. Thus, in GBM, distinct cellular subsets drive multiple facets of cancer-associated thrombosis and may represent targets for phenotype- and cell type–based diagnosis and antithrombotic intervention.
Characteristics and outcomes of KSHV-associated multicentric Castleman disease with or without other KSHV diseases
Authors: Ramaswami Ramya , Lurain Kathryn , Polizzotto Mark N. , Ekwede Irene , Waldon Kirsta , Steinberg Seth M. , Mangusan Ralph , Widell Anaida , Rupert Adam , George Jomy , Gonçalves Priscila H. , Marshall Vickie A. , Whitby Denise , Wang Hao-Wei , Pittaluga Stefania , Jaffe Elaine S. , Little Richard F. , Uldrick Thomas S. , Yarchoan Robert
Published: March 2021

Kaposi sarcoma (KS)-associated herpesvirus (KSHV)–associated multicentric Castleman disease (MCD) is a relapsing and remitting systemic lymphoproliferative disorder characterized by severe inflammatory symptoms most common among people living with HIV (PLWH). Patients with KSHV-MCD may present with concurrent KSHV-associated diseases, such as KS and/or primary effusion lymphoma (PEL). We evaluated clinical and immunologic characteristics, the effects of concurrent KSHV malignancies, and treatments from the largest prospective natural history study of participants with KSHV-MCD within the United States. Treatment options administered at investigator discretion included high-dose zidovudine with valganciclovir (AZT/VGC), rituximab, or rituximab with liposomal doxorubicin (R-Dox) during KSHV-MCD flares. Survival analyses and prognostic factors were explored for all participants. Sixty-two participants with HIV were enrolled, including 20 with KSHV-MCD alone, 34 with KSHV-MCD and KS, 1 with KSHV-MCD and PEL, and 7 with all KSHV-associated diseases. Forty-four percent of KSHV-MCD diagnoses were made at our institution. Forty-four participants received rituximab-based therapies, 20 of whom had maintenance AZT/VGC or interferon. Participants receiving R-Dox and then maintenance AZT/VGC had the highest 5-year progression-free survival (89%). Cytokine profiles during KSHV-MCD flares did not differ by the presence of concurrent KSHV-associated diseases. The 10-year survival was 71% (95% confidence interval [CI], 56% to 82%) for all participants. A concurrent diagnosis of PEL negatively impacted survival (PEL hazard ratio, 5.4; 95% CI, 1.8 to 16.8). KSHV-MCD is an underdiagnosed condition among PLWH, including those with KS. KSHV-MCD has an excellent prognosis with appropriate treatment. Physicians should be alert for patients with multiple KSHV diseases, which impact optimal treatment and survival outcomes. This study was registered at www.clinicaltrials.gov as #NCT00099073.
Proteomics and Metabolomics Studies on the Biotic Stress Responses of Rice: an Update
Authors: Vo Kieu Thi Xuan , Rahman Md Mizanor , Rahman Md Mustafizur , Trinh Kieu Thi Thuy , Kim Sun Tae , Jeon Jong-Seong
Published: March 2021

Biotic stresses represent a serious threat to rice production to meet global food demand and thus pose a major challenge for scientists, who need to understand the intricate defense mechanisms. Proteomics and metabolomics studies have found global changes in proteins and metabolites during defense responses of rice exposed to biotic stressors, and also reported the production of specific secondary metabolites (SMs) in some cultivars that may vary depending on the type of biotic stress and the time at which the stress is imposed. The most common changes were seen in photosynthesis which is modified differently by rice plants to conserve energy, disrupt food supply for biotic stress agent, and initiate defense mechanisms or by biotic stressors to facilitate invasion and acquire nutrients, depending on their feeding style. Studies also provide evidence for the correlation between reactive oxygen species (ROS) and photorespiration and photosynthesis which can broaden our understanding on the balance of ROS production and scavenging in rice-pathogen interaction. Variation in the generation of phytohormones is also a key response exploited by rice and pathogens for their own benefit. Proteomics and metabolomics studies in resistant and susceptible rice cultivars upon pathogen attack have helped to identify the proteins and metabolites related to specific defense mechanisms, where choosing of an appropriate method to identify characterized or novel proteins and metabolites is essential, considering the outcomes of host-pathogen interactions. Despites the limitation in identifying the whole repertoire of responsive metabolites, some studies have shed light on functions of resistant-specific SMs. Lastly, we illustrate the potent metabolites responsible for resistance to different biotic stressors to provide valuable targets for further investigation and application.
Evaluation of direct and maternal responses in reproduction traits based on different selection strategies for postnatal piglet survival in a selection experiment
Authors: Nguyen Tuan Q. , Knap Pieter W. , Simm Geoff , Edwards Sandra A. , Roehe Rainer
Published: March 2021

Background

Postnatal piglet survival is important both in economic and animal welfare terms. It is influenced by the piglet’s own direct genetic effects and by maternal genetic effects of the dam, associated with milk production and mothering abilities. These genetic effects might be correlated, affected by other non-genetic factors and unfavourably associated with other reproduction traits such as litter size, which makes the development of optimal breeding strategies a challenge. To identify the optimum selection strategy for piglet survival, a selection experiment was carried out to compare responses in survival and reproduction traits to selection on only direct, only maternal, or both genetic effects of postnatal survival. The data of the experiment were recorded from outdoor reared pigs, with first- and second-generation sires selected based on their estimated breeding values for maternal and direct effects of postnatal survival of indoor reared offspring, respectively, with the opportunity to identify potential genotype-by-environment interaction.

Results

A Bayesian multivariate threshold-linear model that was fitted to data on 22,483 piglets resulted in significant (Pr(h2 > 0) = 1.00) estimates of maternal and direct heritabilities between 0.12 and 0.18 for survival traits and between 0.29 and 0.36 for birth weight, respectively. Selection for direct genetic effects resulted in direct and maternal responses in postnatal survival of 1.11% ± 0.17 and − 0.49% ± 0.10, respectively, while selection for maternal genetic effects led to greater direct and maternal responses, of 5.20% ± 0.34 and 1.29% ± 0.20, respectively, in part due to unintentional within-litter selection. Selection for both direct and maternal effects revealed a significant lower direct response (− 1.04% ± 0.12) in comparison to its expected response from single-effect selection, caused by interactions between direct and maternal effects.

Conclusions

Selection successfully improved post- and perinatal survival and birth weight, which indicates that they are genetically determined and that genotype-by-environment interactions between outdoor (experimental data) and indoor (selection data) housed pigs were not important for these traits. A substantially increased overall (direct plus maternal) response was obtained using selection for maternalversusdirect or both direct and maternal effects, suggesting that the maternal genetic effects are the main limiting factor for improving piglet survival on which selection pressure should be emphasized.
stochprofML: stochastic profiling using maximum likelihood estimation in R
Authors: Amrhein Lisa , Fuchs Christiane
Published: March 2021

Background

Tissues are often heterogeneous in their single-cell molecular expression, and this can govern the regulation of cell fate. For the understanding of development and disease, it is important to quantify heterogeneity in a given tissue.

Results

We present the R package stochprofML which uses the maximum likelihood principle to parameterize heterogeneity from the cumulative expression of small random pools of cells. We evaluate the algorithm’s performance in simulation studies and present further application opportunities.

Conclusion

Stochastic profiling outweighs the necessary demixing of mixed samples with a saving in experimental cost and effort and less measurement error. It offers possibilities for parameterizing heterogeneity, estimating underlying pool compositions and detecting differences between cell populations between samples.
Early mobility after fragility hip fracture: a mixed methods embedded case study
Authors: Haslam-Larmer Lynn , Donnelly Catherine , Auais Mohammad , Woo Kevin , DePaul Vincent
Published: March 2021

Background

Following a hip fracture up to 60% of patients are unable to regain their pre-fracture level of mobility. For hospitalized older adults, the deconditioning effect of bedrest and functional decline has been identified as the most preventable cause of ambulation loss. Recent studies demonstrate that this older adult population spends greater than 80% of their time in bed during hospitalization, despite being ambulatory before their fracture. We do not fully understand why there continues to be such high rates of sedentary times, given that evidence demonstrates functional decline is preventable and early mobility recommendations have been available for over a decade.

Methods

A descriptive mixed method embedded case study was selected to understand the phenomenon of early mobility after fragility hip fracture surgery. In this study, the main case was one post-operative unit with a history of recommendation implementation, and the embedded units were patients recovering from hip fracture repair. Data from multiple sources provided an understanding of mobility activity initiation and patient participation.

Results

Activity monitor data from eighteen participants demonstrated a mean sedentary time of 23.18 h. Median upright time was 24 min, and median number of steps taken was 30. Qualitative interviews from healthcare providers and patients identified two main categories of themes; themes external to the person and themes unique to the person. We identified four factors that can influence mobility; a patient’s pre-fracture functional status, cognitive status, medical unpredictability, and preconceived notions held by healthcare providers and patients.

Conclusions

There are multi-level factors that require consideration with implementation of best practice interventions, namely, systemic, healthcare provider related, and patient related. An increased risk of poor outcomes occurs with compounding multiple factors, such as a patient with low pre-fracture functional mobility, cognitive impairment, and a mismatch of expectations. The study reports several variables to be important considerations for facilitating early mobility. Communicating mobility expectations and addressing physical and psychological readiness are essential. Our findings can be used to develop meaningful healthcare provider and patient-centred interventions to address the risks of poor outcomes.
Renin-angiotensin system inhibitors and susceptibility to COVID-19 in patients with hypertension: a propensity score-matched cohort study in primary care
Authors: Haroon Shamil , Subramanian Anuradhaa , Cooper Jennifer , Anand Astha , Gokhale Krishna , Byne Nathan , Dhalla Samir , Acosta-Mena Dionisio , Taverner Thomas , Okoth Kelvin , Wang Jingya , Chandan Joht Singh , Sainsbury Christopher , Zemedikun Dawit Tefra , Thomas G. Neil , Parekh Dhruv , Marshall Tom , Sapey Elizabeth , Adderley Nicola J. , Nirantharakumar Krishnarajah
Published: March 2021

Introduction

Renin-angiotensin system (RAS) inhibitors have been postulated to influence susceptibility to Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2). This study investigated whether there is an association between their prescription and the incidence of COVID-19 and all-cause mortality.

Methods

We conducted a propensity-score matched cohort study comparing the incidence of COVID-19 among patients with hypertension prescribed angiotensin-converting enzyme I (ACE) inhibitors or angiotensin II type-1 receptor blockers (ARBs) to those treated with calcium channel blockers (CCBs) in a large UK-based primary care database (The Health Improvement Network). We estimated crude incidence rates for confirmed/suspected COVID-19 in each drug exposure group. We used Cox proportional hazards models to produce adjusted hazard ratios for COVID-19. We assessed all-cause mortality as a secondary outcome.

Results

The incidence rate of COVID-19 among users of ACE inhibitors and CCBs was 9.3 per 1000 person-years (83 of 18,895 users [0.44%]) and 9.5 per 1000 person-years (85 of 18,895 [0.45%]), respectively. The adjusted hazard ratio was 0.92 (95% CI 0.68 to 1.26). The incidence rate among users of ARBs was 15.8 per 1000 person-years (79 out of 10,623 users [0.74%]). The adjusted hazard ratio was 1.38 (95% CI 0.98 to 1.95). There were no significant associations between use of RAS inhibitors and all-cause mortality.

Conclusion

Use of ACE inhibitors was not associated with the risk of COVID-19 whereas use of ARBs was associated with a statistically non-significant increase compared to the use of CCBs. However, no significant associations were observed between prescription of either ACE inhibitors or ARBs and all-cause mortality.
Kidney transplant dysfunction in a patient with COVID − 19 infection: role of concurrent Sars-Cov 2 nephropathy, chronic rejection and vitamin C-mediated hyperoxalosis: case report
Authors: Anandh Urmila , Gowrishankar Swarnalata , Sharma Alok , Salama Alan , Dasgupta Indranil
Published: March 2021

Background

COVID-19 infection in kidney transplant recipients often lead to allograft dysfunction. The allograft injury has various histopathological manifestations. Our case illustrates the unusual combination of allograft rejection, acute kidney injury secondary to oxalate nephropathy and SARS CoV-2 nephropathy as the cause of irreversible allograft failure.

Case presentation

A 56 year old renal allograft recipient presented with a history of fever and diarrhoea for the preceding 4 weeks, tested positive for Sars-CoV2 on nasal swab and was found to have severe allograft dysfunction, necessitating haemodialysis. He subsequently underwent an allograft biopsy, which demonstrated antibody mediated rejection along with the presence of extensive oxalate deposition in the tubules. Ultrastructural examination demonstrated spherical spiked particles in the glomerular capillary endothelium and the presence of tubulo-reticular inclusions suggestive of an active COVID-19 infection within the kidney. The intra-tubular oxalate deposition was considered to be the result of high dose, supplemental Vitamin C used as an immune booster in many patients with COVID − 19 infection in India.

Conclusions

This case highlights the complex pathology that may be seen in following COVID-19 disease and the need for kidney biopsies in these patients to better understand the aetiology of disease.
Family meal participation is associated with dietary intake among 12-month-olds in Southern Norway
Authors: Hillesund Elisabet R. , Sagedal Linda R. , Bere Elling , Øverby Nina C.
Published: March 2021

Background

Family meal participation is associated with healthier eating among children and adolescents. Less is known about family meal participation among infants and toddlers. The objective of the present study was to explore whether family meal participation at 12 months of age is associated with dietary intake and whether a potential relationship differs according to maternal education or child sex.

Methods

Follow-up data from children born to mothers participating in the Norwegian Fit for Delivery (NFFD) trial during pregnancy were used to assess the frequency of intake of 11 dietary items according to frequency of participating in the respective family meals. Dietary differences according to seldom (0–3 times/week) or often (4–7 times/week) participating in each respective meal category were assessed in linear regression models. Potential dose-response associations with frequency of participation in all family meal categories combined were also estimated. Models were adjusted for maternal randomization status, education, and child sex.

Results

The sample comprised 408 children. A total of 74, 53 and 74% had breakfast, lunch, and dinner with family ≥4 times/week, respectively, while 39% had supper and 27% between-meal snacks with family ≥4 times/week. Having family dinner ≥4 times/week was associated with more frequent intake of vegetables, homemade infant cereal, milk, and water, and less frequent intake of commercial infant foods while the other family meal categories were associated with fewer dietary outcomes. For each additional meal category eaten with family ≥4 times/week, frequency of vegetable intake (β = 0.45), water (β = 0.17), and milk (β = 0.09) per day increased, while commercial infant cereal was eaten less frequently (β = − 0.18). The inverse association between family meals and commercial infant cereal was only evident in children born to mothers in the intervention group. Several associations with diet were stronger and only significant among boys.

Conclusions

Being fed in the context of family meals at 12 months of age was associated with a more favorable diet. Including the infant in family meals has potential in the promotion of early nutritional health.
Clinical characteristics of severe neonatal enterovirus infection: a systematic review
Authors: Zhang Meng , Wang Haoran , Tang Jun , He Yang , Xiong Tao , Li Wenxing , Qu Yi , Mu Dezhi
Published: March 2021

Background

Enterovirus (EV) is a common cause of infection in neonates. Neonates are at high risk of enterovirus infection with serious clinical manifestations and high lethality. This review systematically summarized the clinical characteristics of neonates with severe enteroviral infection to provide evidence for the identification and treatment of severe neonatal EV infection.

Methods

PubMed, Embase, and Web of Science were searched for original studies on neonates with severe EV infections from January 1, 2000, to November 27, 2020. Two reviewers independently screened the literature, extracted the data, and performed a descriptive analysis.

Results

In total, 66 articles with 237 cases of severe neonatal enterovirus infection were included. All neonates developed severe complications. Among them, 46.0% neonates had hepatitis or coagulopathy, 37.1% had myocarditis, 11.0% had meningoencephalitis, and 5.9% had other complications such as hemophagocytic lymphohistiocytosis and pulmonary hemorrhage. The lethality rate of neonates with severe infection was 30.4%. The highest lethality rate was 38.6%, which was observed in neonates with myocarditis. In 70.5% neonates, the age at the onset of symptoms was less than 7 days. Coxsackievirus B infection was seen in 52.3% neonates. The most common symptoms included temperature abnormalities (127, 53.6%), rash (88, 37.1%), poor feeding (58, 24.5%), and respiratory symptoms (52, 21.9%). The main treatment included transfusion of empirical antibiotics (127, 53.6%), blood components (100, 42.2%), intravenous immunoglobulin (IVIG; 97, 40.9%), mechanical ventilation (51, 21.5%), and extracorporeal membrane oxygenation (ECMO; 43, 18.1%). Additionally, antiviral medications pleconaril (14, 5.9%) and pocapavir (3, 1.3%) were administered.

Conclusions

Lethality was high in neonates with severe enterovirus infection, especially in those complicated with myocarditis. The most common symptoms included temperature abnormalities, rash, and poor feeding. The chief supportive treatment consisted of transfusion of blood components, mechanical ventilation, and ECMO. Empirical antibiotics and IVIG were widely used. Antiviral medications included pocapavir and pleconaril; however, more clinical evidence regarding their efficacy is needed.
Early public adherence with and support for stay-at-home COVID-19 mitigation strategies despite adverse life impact: a transnational cross-sectional survey study in the United States and Australia
Authors: Czeisler Mark É. , Howard Mark E. , Robbins Rebecca , Barger Laura K. , Facer-Childs Elise R. , Rajaratnam Shantha M. W. , Czeisler Charles A.
Published: March 2021

Background

Governments worldwide recommended unprecedented measures to contain the coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As pressure mounted to scale back measures, understanding public priorities was critical. We assessed initial public adherence with and support for stay-at-home orders in nations and cities with different SARS-CoV-2 infection and COVID-19 death rates.

Methods

Cross-sectional surveys were administered to representative samples of adults aged ≥18 years from regions with different SARS-CoV-2 prevalences from April 2–8, 2020. Regions included two nations [the United States (US—high prevalence) and Australia (AU—low prevalence)] and two US cities [New York City (NY—high prevalence) and Los Angeles (LA—low prevalence)]. Regional SARS-CoV-2 and COVID-19 prevalence (cumulative SARS-CoV-2 infections, COVID-19 deaths) as of April 8, 2020: US (363,321, 10,845), AU (5956, 45), NY (81,803, 4571), LA (7530, 198). Of 8718 eligible potential respondents, 5573 (response rate, 63.9%) completed surveys. Median age was 47 years (range, 18–89); 3039 (54.5%) were female.

Results

Of 5573 total respondents, 4560 (81.8%) reported adherence with recommended quarantine or stay-at-home policies (range of samples, 75.5–88.2%). Additionally, 29.1% of respondents screened positive for anxiety or depression symptoms (range of samples, 28.6–32.0%), with higher prevalences among those of younger age, female gender, and those in quarantine or staying at home most of the time versus those who did not report these behaviours. Despite elevated prevalences of adverse mental health symptoms and significant life disruptions, 5022 respondents (90.1%) supported government-imposed stay-at-home orders (range of samples, 88.9–93.1%). Of these, 90.8% believed orders should last at least three more weeks or until public health or government officials recommended, with support spanning the political spectrum.

Conclusions

Public adherence with COVID-19 mitigation policies was highly prevalent, in both highly-affected (US, NY) and minimally-affected regions (AU, LA). Despite disruption of respondents’ lives, the vast majority supported continuation of extended stay-at-home orders. Despite common support, these two countries diverged in stringent mitigation implementation, which may have contributed to subsequent outcomes. These results reveal the importance of surveillance of public support for and adherence with such policies during the COVID-19 pandemic and for future infectious disease outbreaks.
Response to ‘Systematic reviews do not always capture context of real-world intervention programmes for childhood obesity’ by Wild et al., 2021 in BMC Public Health
Authors: Littlewood Robyn , Canfell Oliver J. , Walker Jacqueline L.
Published: March 2021

In a correspondence to BMC Public Health, Wild et al. respond to our systematic review that synthesised results of interventions to prevent or treat childhood obesity in Māori and Pacific Islanders. Our review included the Whānau Pakari study as one of six included studies – a multidisciplinary intervention for Māori children and adolescents living with obesity led by their research team. Our review suggested that future research can incorporate stronger co-design principles when designing culturally-tailored interventions to maximise cultural specificity, enhance engagement, facilitate program ownership and contribute to improved health and weight-related outcomes. We commend Whānau Pakari and the team of Wild et al. on their sustained commitment to addressing obesity in priority populations and agree that systematic reviews struggle to capture real-world context of interventions for complex diseases such as obesity. In this article, we respond sequentially to the comments made by Wild et al. and (1) clarify the scope of our review article (2) reiterate our commendation of mixed-methods approaches that capture real-world context (3) explain a referencing error that caused a misinterpretation of our results (4) clarify our interpretation of some Whānau Pakari characteristics (5) welcome partnership to facilitate shared learning with Wild et al.
A biomechanical analysis of four anterior cervical techniques to treating multilevel cervical spondylotic myelopathy: a finite element study
Authors: Li Zhonghai , Liu Hui , Yang Ming , Zhang Wentao
Published: March 2021

Background

The decision to treat multilevel cervical spondylotic myelopathy (MCSM) remains controversial. The purpose of this study is to compare the biomechanical characteristics of the intervertebral discs at the adjacent segments and internal fixation, and to provide scientific experimental evidence for surgical treatment of MCSM.

Methods

An intact C2-C7 cervical spine model was developed and validated. Four additional models were developed from the fusion model, including multilevel anterior cervical discectomy and fusion (mACDF), anterior cervical corpectomy and fusion (ACCF), hybrid decompression and fusion (HDF), and mACDF with cage alone (mACDF-CA). Biomechanical characteristics on the plate and the disc of adjacent levels (C2/3, C6/7) were comparatively analyzed.

Results

Of the four models, stress on the upper (C2/3) adjacent intervertebral disc was the lowest in the mACDF-CA group and highest in the ACCF group. Stress on the intervertebral discs at adjacent segments was higher for the upper C2/3 than the lower C6/7 intervertebral disc. In all models, the mACDF-CA group had the lowest stress on the intervertebral disc, while the ACCF group had the highest stress. In the three surgical models with titanium plate fixation (mACDF, ACCF, and HDF), the ACCF group had the highest stress at the titanium plate-screw interface, while the mACDF group had the lowest stress.

Conclusion

Among the four anterior cervical reconstructive techniques for MCSM, mACDF-CA makes little effect on the adjacent disc stress, which might reduce the incidence of adjacent segment degeneration (ASD) after fusion. However, the accompanying risk of the increased incidence of cage subsidence should never be neglected.
When to resume bariatric surgery after COVID-19 pandemic?: results of patients’ and surgeons’ survey
Authors: Dudek Alicja , Wysocki Michał , Walędziak Maciej , Szeliga Jacek , Proczko-Stepaniak Monika , Pędziwiatr Michał , Major Piotr
Published: March 2021

Background

Coronavirus Disease 2019 is affecting most countries around the world, including Poland. In response, all elective surgeries have been postponed. We asked patients and surgeons when they want bariatric surgery to resume after pandemic. The main aim of the study was to determine patients’ and surgeons’ expectations about when to resume bariatric surgery regarding COVID-19 pandemic state.

Methods

The study was conducted in two groups: Group 1—bariatric patients; Group 2—bariatric surgeons. Two online surveys were distributed.

Results

A total of 895 patients, 299 before, 596 after surgery and 32 surgeons took part in survey. All patients and surgeons declared willingness to resume bariatric surgeries after pandemic and responded that they should be resumed immediately the World Health Organization announces end of pandemic (42%). The majority of patients before surgery answered that bariatric procedures should be resumed immediately the number of daily incidents begins to decrease (53%). In the patient group, current body mass index (p < 0.001) and contact with COVID+/quarantined persons (p < 0.001) had impact on the response to resumption of bariatric procedures.

Conclusions

Patients opted to wait for bariatric surgery until the oncological queue has become shorter. Surgeons presented a readiness to resume both procedures in parallel.