bluuebunny/crossref_metadata_2025 huggingface dataset:
Adolescents With Inflammatory Bowel Disease Have Decreased Rates of Health Maintenance Visits
Authors: Moran Christopher J. , Aryee Emmanuel , Perrin James M.
Published: May 2021

Introduction:

Inflammatory bowel disease (IBD) commonly presents during adolescence and may affect health care utilization. This study aimed to assess rates of health maintenance examinations (HMEs) in adolescents with IBD with their primary care physicians (PCPs).

Methods:

This is a single center, case–control study of adolescents with IBD who received their IBD care and primary care within the same healthcare system. Adolescents diagnosed with IBD between 13 and 17 years of age were matched 1:1 by age, gender, race/ethnicity, and insurance status to healthy controls. Patient demographics, IBD characteristics, and health outcomes were extracted from the medical record. HME rate was defined as having one HME with a PCP during a 12‐month period.

Results:

This study included 150 IBD‐control matched pairs. HME rates were similar at baseline between cases and controls (83% vs 85%, P = 0.53) but approached significance in year 1 post‐diagnosis (77% vs 85%, P = 0.056). In year 2 post‐diagnosis, IBD patients had less frequent HME (62% vs 74%, P = 0.0486). Disease severity did not affect HME rates. IBD patients from under‐represented minority groups had lower rates than matched controls (46.2% vs 91.7%, P = 0.03). Meningococcal and human papilloma vaccination rates were lower in cases versus controls (79% vs 94%, P = 0.0005 and 60% vs 84%, P < 0.0001).

Conclusion:

Adolescents with IBD have less frequent HME and lower rates of certain vaccinations than their peers. Those from underrepresented minority groups are at particular risk. Given the important issues addressed at HMEs, gastroenterologists should recommend that adolescents with IBD have ongoing PCP engagement to optimize health outcomes.
Ultrasound Assessment of Gastric Emptying in Premature Infants Treated With Non‐Invasive Ventilatory Support
Authors: Hlaing Arkar Ye , Weinberger Barry , Schanler Richard , Cerise Jane , Kurepa Dalibor
Published: May 2021

Background:

Nasal continuous positive airway pressure (CPAP) introduces positive pressure of air into both the trachea and stomach, which may affect gastric emptying. The rate of gastric emptying can be estimated by ultrasound (US) in neonates by two validated techniques: “antral cross‐sectional area” (ACSA, two‐dimensional estimate of the surface area at the gastric antrum), and “spheroid gastric volume” (spheroid, three‐dimensional estimate of the stomach volume).

Objective:

To compare gastric emptying rates in neonates on machine‐derived nasal CPAP (MD‐nCPAP, Avea and RAM cannula) with those on bubble CPAP (bCPAP, Fisher Paykel and Babi.Plus nasal prongs).

Methods:

Ultrasound measurements of the amount of the milk in the stomach were performed before feeding and at 1, 2, and 3 hours after the start of feeding, using both the ACSA and spheroid methods. Rates of gastric emptying were calculated during the “early” (1–2 hours) and “late” (2–3 hours) phases after feeding.

Results:

We recruited 32 infants (25–34 weeks gestational age, full enteral tube feedings, on nasal CPAP). Seventeen infants were treated with MD‐nCPAP (median birth weight 1015 g [interquartile range (IQR): 870–1300], gestational age 28 weeks [IQR: 27–29], postnatal age 20 days [IQR: 14–28]), whereas 15 infants were treated with bCPAP (median birth weight 960 g [IQR: 855–1070], gestational age 27 weeks [IQR: 26–28], postnatal age 17 days [IQR: 15–25]). Gastric emptying rates (% emptied/min) were significantly faster in the “early” compared to the “late” phase for all infants. There were no significant differences in the rates of gastric emptying (either “early” or “late”) or volumes of gastric residuals between infants receiving MD‐nCPAP or bCPAP, measured by either method. Although no feeding intolerance was seen in either group, the volumes of residual gastric contents measured by both methods were higher than the volumes traditionally considered abnormal when obtained by gastric tube aspiration.

Conclusions:

Gastric emptying is faster during the “early” compared to the “late” phase. Gastric emptying rates are not different in infants receiving MD‐nCPAP versus bCPAP. The presence of large residual gastric contents in infants who are tolerating feedings challenges the value of traditional gastric aspiration for the assessment of feeding tolerance in infants.
Receptor‐binding Domain Severe Acute Respiratory Syndrome Coronavirus 2‐specific Antibodies in Human Milk From Mothers With Coronavirus Disease 2019 Polymerase Chain Reaction or With Symptoms Suggestive of Coronavirus Disease 2019
Authors: Demers‐Mathieu Veronique , DaPra Ciera , Fels Shawn , Medo Elena
Published: May 2021

This study aims to compare the receptor‐binding domain (RBD) severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2)‐specific antibody titers in human milk between mothers with a confirmed coronavirus disease 2019 (COVID‐19) polymerase chain reaction (PCR) test and mothers with viral symptoms suggestive of COVID‐19. The area under the curve (AUC) for RBD SARS‐CoV‐2‐specific secretory immunoglobulin A (SIgA)/immunoglobulin A (IgA), secretory immunoglobulin M (SIgM)/immunoglobulin M (IgM), immunoglobulin G (IgG), and free secretory components (fSC) in milk samples from eight mothers with a confirmed COVID‐19 PCR, eight mothers with viral symptoms (no PCR testing), and six unexposed mothers (pre‐pandemic 2018). AUCs of RBD SARS‐CoV‐2‐specific SIgA/IgA, SIgM/IgM, IgG, and fSC in milk samples were comparable between mothers with confirmed COVID‐19 PCR and mothers with viral symptoms of suggestive COVID‐19. AUCs of RBD‐specific SIgA/IgA, IgG, and fSC were higher in the COVID‐19‐exposed group than in the unexposed group, and SIgM/IgM tended to be higher in the exposed mothers. In conclusion, women with viral symptoms suggestive of COVID‐19 could secrete antibodies and fSC specific to SARS‐CoV‐2 in human milk.
The Association of Workload and Outcomes in the Pediatric Cardiac ICU*
Authors: Fundora Michael P. , Liu Jiayi , Calamaro Christina , Mahle William T. , KC Diwas
Published: May 2021

OBJECTIVES:

Healthcare workload has emerged as an important metric associated with poor outcomes. To measure workload, studies have used bed occupancy as a surrogate. However, few studies have examined frontline provider (fellows, nurse practitioners, physician assistants) workload and outcomes. We hypothesize frontline provider workload, measured by bed occupancy and staffing, is associated with poor outcomes and unnecessary testing.

DESIGN:

A retrospective single-center, time-stamped orders, ordering provider identifiers, and patient data were collected. Regression was performed to study the influence of occupancy on orders, length of stay, and mortality, controlling for age, weight, admission type, Society of Thoracic Surgery-European Association for Cardio-Thoracic Surgery Congenital Heart Surgery Mortality score, diagnosis, number of surgeries, orders, provider staffing, attending experience, and time fixed effects.

SETTING:

Twenty-seven bed tertiary cardiac ICU in a free-standing children’s hospital.

PATIENTS:

Patients (0–18 yr) admitted to the pediatric cardiac ICU, January 2018 to December 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

There were 16,500 imaging and 73,113 laboratory orders among 1,468 patient admissions. Median age 6 months (12 d to 5 yr), weight 6.2 kg (3.7–16.2 kg); 840 (57.2%) surgical and 628 (42.8%) medical patients. ICU teams consisted of 16 attendings and 31 frontline providers. Mortality 4.4%, median stay 5 days (2–11 d), and median bed occupancy 89% (78–93%). Every 10% increase in bed occupancy had 7.2% increase in imaging orders per patient (p < 0.01), 3% longer laboratory turn-around time (p = 0.015), and 3 additional days (p < 0.01). Higher staffing (> 3 providers) was associated with 6% less imaging (p = 0.03) and 3% less laboratory orders (p = 0.04). The number of “busy days” (bed occupancy > 89%) was associated with longer stays (p < 0.01), and increased mortality (p < 0.01).

CONCLUSIONS:

Increased bed occupancy and lower staffing were associated with increased mortality, length of stay, imaging orders, and laboratory turn-around time. The data demonstrate performance of the cardiac ICU system is exacerbated during high occupancy and low staffing.
Isolated Eosinophilic Myometritis: A Case Report of an Extremely Rare Phenomenon
Authors: Mohammad Ghayeb , Rustom Fairouz , Albinsson Sofie , Wennerås Christine , Akyürek Levent M.
Published: May 2021

Increased number of eosinophils in the uterus has been reported under physiological and pathologic conditions. However, eosinophilic infiltration limited to the myometrium is very unusual. A rare finding of isolated eosinophilic infiltration in the myometrium without involvement of endometrium or pathologies in the cervix or ovaries was observed in a 31-yr-old woman seeking medical attention for unexplained infertility, abnormal uterine bleeding, and dysmenorrhea. The patient had no allergies, parasitic disease, or other systemic disorders. This rare manifestation of eosinophilic infiltration expands the differential diagnosis of inflammatory conditions of the myometrium in patients with gynecological issues.
The Influence of Race, Sex, and Social Disadvantage on Self-reported Health in Patients Presenting With Chronic Musculoskeletal Pain
Authors: Cheng Abby L. , Bradley Ethan C. , Brady Brian K. , Calfee Ryan P. , Klesges Lisa M. , Colditz Graham A. , Prather Heidi
Published: May 2021

Objective

The aim of the study was to better address sociodemographic-related health disparities. This study examined which sociodemographic variables most strongly correlate with self-reported health in patients with chronic musculoskeletal pain.

Design

This single-center, cross-sectional study examined adult patients, followed by a physiatrist for chronic (≥4 yrs) musculoskeletal pain. Sociodemographic variables considered were race, sex, and disparate social disadvantage (measured as residential address in the worst vs. best Area Deprivation Index national quartile). The primary comparison was the adjusted effect size of each variable on physical and behavioral health (measured by Patient-Reported Outcomes Measurement Information System [PROMIS]).

Results

In 1193 patients (age = 56.3 ± 13.0 yrs), disparate social disadvantage was associated with worse health in all domains assessed (PROMIS Physical Function Β = −2.4 points [95% confidence interval = −3.8 to −1.0], Pain Interference = 3.3 [2.0 to 4.6], Anxiety = 4.0 [1.8 to 6.2], and Depression = 3.7 [1.7 to 5.6]). Black race was associated with greater anxiety than white race (3.2 [1.1 to 5.3]), and female sex was associated with worse physical function than male sex (−2.5 [−3.5 to −1.5]).

Conclusions

Compared with race and sex, social disadvantage is more consistently associated with worse physical and behavioral health in patients with chronic musculoskeletal pain. Investment to ameliorate disadvantage in geographically defined communities may improve health in sociodemographically at-risk populations.
Digitally Assisted Versus Conventional Home-Based Rehabilitation After Arthroscopic Rotator Cuff Repair
Authors: Correia Fernando Dias , Molinos Maria , Luís Sara , Carvalho Diana , Carvalho Carlos , Costa Pedro , Seabra Rosmaninho , Francisco Gerard , Bento Virgílio , Lains Jorge
Published: May 2021

Objective

The aim of this study was to evaluate the clinical impact of a 12-wk home-based digitally assisted rehabilitation program after arthroscopic rotator cuff repair against conventional home-based rehabilitation.

Design

The digital therapy group performed independent technology-assisted sessions complemented with 13 face-to-face sessions, and the conventional therapy group had conventional face-to-face physical therapy (30 sessions). Primary outcome was functional change between baseline and 12 wks, measured through the Constant-Murley score. Secondary outcomes were the change in the QuickDASH Scale and shoulder range of motion.

Results

Fifty participants enrolled; 41 completed the 12-wk program (23 digital therapy group vs. 18 conventional therapy group), and 32 (15 vs. 17) were available for the 12-mo follow-up assessment. No differences were found between groups regarding study endpoints at the end of the 12-wk program. However, follow-up results revealed the superiority of the digital therapy group for QuickDASH (P = 0.043), as well as an interaction between time and group in the Constant-Murley score (P = 0.047) in favor of the digital therapy group.

Conclusions

The results demonstrate that digital therapeutics can be used to achieve similar, if not superior, short- and long-term outcomes as conventional approaches after arthroscopic rotator cuff repair, while being far less human resource intensive than conventional care.

Level of evidence: II.
Theranostic Approach in Breast Cancer
Authors: Jokar Narges , Velikyan Irina , Ahmadzadehfar Hojjat , Rekabpour Seyed Javad , Jafari Esmail , Ting Hong Hoi , Biersack Hans-Jürgen , Assadi Majid
Published: May 2021

Breast cancer is the most frequent invasive malignancy and the second major cause of cancer death in female subjects mostly due to the considerable diagnostic delay and failure of therapeutic strategies. Thus, early diagnosis and possibility to monitor response to the treatment are of utmost importance. Identification of valid biomarkers, in particular new molecular therapeutic targets, that would allow screening, early patient identification, prediction of disease aggressiveness, and monitoring response to the therapeutic regimen has been in the focus of breast cancer research during recent decades. One of the intensively developing fields is nuclear medicine combining molecular diagnostic imaging and subsequent (radio)therapy in the light of theranostics. This review aimed to survey the current status of preclinical and clinical research using theranostic approach in breast cancer patients with potential to translate into conventional treatment strategies alone or in combination with other common treatments, especially in aggressive and resistant types of breast cancer. In addition, we present 5 patients with breast cancer who were refractory or relapsed after conventional therapy while presumably responded to the molecular radiotherapy with177Lu-trastuzumab (Herceptin),177Lu-DOTATATE, and177Lu-FAPI-46.
Reconstruction of Cutaneous Nasal Alar Defects Following Melanocytic Nevus Resection
Authors: Gu Chuan , Lu Lin , Jin Rui , Luo Xusong , Sun Di
Published: May 2021

Objective:

The reconstruction of nasal alar defects after resection of a melanocytic nevus becomes one of the most challenging procedures for surgeons. Choosing the most appropriate technique is still difficult sometimes. The authors reviewed our cases and published experience on choosing optimal surgical methods to repair different types of nasal alar defect following melanocytic nevus resection.

Methods:

A total of 152 patients who were treated between 2016 and 2019 in Shanghai Ninth People's Hospital were evaluated. The surgical methods included primary closure, full-thickness skin graft, composite auricular graft, interpolated melolabial flap, paramedian forehead flap including hair-bearing paramedian forehead flap.

Results:

Among the 152 patients with a melanocytic nevus, 49 underwent primary closure, 38 were treated with a full-thickness skin graft, 16 composite auricular graft, 28 were treated with interpolated melolabial flap, and 21were treated with paramedian forehead flap including 14 with hair-bearing paramedian forehead flap. Most skin graft, composite auricular graft, and flaps were survived. Patients who completed follow-up were satisfied with the contour of the nasal ala.

Conclusions:

After resection of the melanocytic nevus, the surgeon should choose the most appropriate surgical method for alar reconstruction according to the characteristics of the defect and personal desire of patient or the guardian.
Comparison of General, Epidural, and Spinal Anesthesia in Laparoscopic TEP (Total Extraperitoneal Repair) for Inguinal Hernia
Authors: Ferahman Sina , Donmez Turgut , Surek Ahmet , Akarsu Cevher , Aydin Husnu , Cayirci Can E. , Emir Nalan S. , Karabulut Mehmet
Published: May 2021

Purpose:

Laparoscopic total extraperitoneal repair (TEP) is one of the most preferred minimally invasive methods for inguinal hernia repair. In our study, we aimed to compare the advantages and disadvantages of general anesthesia (GA), spinal anesthesia (SA), and epidural anesthesia (EA) for TEP operations.

Materials and Methods:

This is a retrospective study involving 221 patients who underwent TEP surgery for inguinal hernia between January 2018 and July 2020. Patients were divided into 3 groups as GA (n=77), SA (n=70), and EA (n=74). Demographic data of the patients, duration of anesthesia and surgery, perioperative and postoperative complications, postoperative pain, anatomical delineation, hospital stay and quality of life were evaluated.

Results:

Anesthesia time was the longest in the EA group (23.1±2.32 min) and significantly prolonged the operation time (P<0.001). When the visual analog scale scores were compared, it was observed that the patients in the GA group felt significantly more pain (P<0.001). While the rates of hypotension and headache were higher in regional anesthesia (P<0.001 and P<0.002), there was no significant difference in urinary retention, postoperative nausea/vomiting, and shoulder pain (P=0.274, 0.262, and 0.314, respectively). SA and EA groups were found to be superior compared with the GA group in terms of patient satisfaction (P<0.001).

Conclusion:

Regional anesthesia (SA and EA) can be safely performed in TEP surgeries, gives results similar to the anatomical delineation satisfactory and complication rates of GA, and results in less postoperative pain.
Outcomes of 601 Colorectal Endoscopic Submucosal Dissections in a Single Western Center: Is Right Colon Location Still a Major Concern?
Authors: Spychalski Michał , Włodarczyk Marcin , Winter Katarzyna , Włodarczyk Jakub , Dąbrowski Igor , Dziki Adam
Published: May 2021

Background:

Endoscopic submucosal dissection (ESD), as a minimally invasive procedure for removal of early gastrointestinal neoplasms, is a standard approach in Asian countries. Outcomes of ESD in Western European countries significantly differ, which makes it more difficult to apply this procedure to daily-basis clinical routine. The aim of this study is to analyze the safety and efficiency of colorectal ESD based on a large series of cases performed by a single operator after finishing the learning curve period in a western referral center.

Materials and Methods:

We retrospectively studied 601 patients who underwent ESD procedure for colorectal neoplasm from January 2016 to December 2019 in a tertiary colorectal ESD center in Poland.

Results:

The overall en bloc resection was achieved in 88.02%. Complete histologic resection rate (R0) was reported at a level of 86.36%. Lesions located in the right colon were characterized by statistically lower en bloc, R0 resection, and success rate (73.95%, 71.43%, 69.75%, respectively). In 9.82% (n=59) of cases, the ESD procedure-related complications have been observed. Post-ESD bleeding occurred in 23 patients (3.83%) and perforation in 32 patients (5.32%). Twenty-seven patients were treated endoscopically (4.49%) and 5 required surgery (0.83%). Analysis of complications showed that tumors located within the right colon were characterized by the highest perforation rate at 10.92%. Within the rectum there were minimal number of perforations (2.69%), whereas the bleeding rate was 4.48%.

Conclusions:

Our results represent the largest material concerning ESD of colorectal lesions in the West and show that ESD is characterized by a high rate of successful resections with a low risk of complications. Thus, confirming that it is possible to obtain results similar to Asian centers and that colorectal ESD procedures can be implemented in clinical routine in western countries. Nevertheless, ESD in the right colon is still related with high rate of complications, so qualification for the ESD procedure should be very careful and discussed with the patient and should be performed by an experienced endoscopist after the learning curve.
Laparoscopic Versus Open Appendectomy for Appendicitis in Pregnancy: Systematic Review and Meta-Analysis
Authors: Zeng Qi , Aierken Amina , Gu Shen-Sen , Yao Gang , Apaer Shadike , Anweier Nuerzhatijiang , Wu Jing , Zhao Jin-Ming , Li Tao , Tuxun Tuerhongjiang
Published: May 2021

Objectives:

The clinical safety, efficacy and feasibility of laparoscopic appendectomy (LA) compared with open appendectomy (OA) in pregnancy are still controversial. Herein, we are aiming to compare the clinical outcomes of LA and OA in patients with acute appendicitis during their pregnancy.

Materials and Methods:

This was a systematic review and meta-analysis of studies comparing laparoscopic and OA in pregnancy identifying using PubMed, Web of science, Embase, The Cochrane Library, Ovid and Scopus. Two independent reviewers extracted data on surgical complication, fetal loss, preterm delivery, hospital stay, Apgar score in both groups.

Results:

Twenty-seven studies with total of 6497 patients (4464 in open and 2031 in laparoscopic group) were included. LA was associated with lower rate of wound infection [odds risk (OR)=3.13, 95% confidence interval (CI): 1.77-5.56, P<0.0001] overall complications (OR=2.15, 95% CI: 1.47-3.14, P<0.0001) and shorter hospitalization (mean difference=0.72, 95% CI: 0.43-1.02, P<0.00001) compared with open group. LA was in a lower risk for 5-minute Apgar score (mean difference=0.09, 95% CI: 0.02-0.17, P=0.01) group than open group. No difference was found regarding preterm delivery between 2 groups. LA was associated with higher fetal loss (OR=0.57, 95% CI: 0.41-0.79, P=0.0007) compared with open surgery. However, laparoscopy was not associated with increased fetal loss after 2010 (OR=0.74, 95% CI: 0.44-1.24, P=0.26) compared with open group.

Conclusions:

LA in pregnancy seems to be feasible with acceptable outcome, especially in patients with early and mid-trimester period, with sophisticated hands and experienced centers.
Comparison of Pelvic Floor Physical Therapy Attendance Based on Referring Provider Specialty
Authors: Fullerton Morgan E. , Mwesigwa Patricia J. , Tandel Megha D. , Kwan Lorna , Grisales Tamara , Tarnay Christopher M.
Published: May 2021

Objective

The objective of this study was to determine whether pelvic floor physical therapy (PFPT) attendance differs based on referring provider specialty and identify factors related to PFPT initiation and completion.

Methods

This was an institutional review board-approved retrospective cohort study examining referrals from female pelvic medicine and reconstructive surgery (FPMRS) and non-FPMRS providers at a single academic medical center to affiliated PFPT clinics over a 12-month period. Demographics, referring specialty and diagnoses, prior treatment, and details regarding PFPT attendance were collected. Characteristics between FPMRS and non-FPMRS referrals were compared and multivariate logistic regression analyses were performed to identify factors associated with PFPT initiation and completion.

Results

A total of 497 referrals were placed for PFPT. Compared with non-FPMRS referrals, FPMRS referrals were for patients who were older (54.7 years vs 35.6 years), and had higher parity; more were postmenopausal (56% vs 18%) and had Medicare insurance (22% vs 10%) (all P < 0.001). Most FPMRS referrals were for patients with urinary incontinence (69% vs 31%), whereas non-FPMRS referrals were for patients with pelvic pain (70% vs 27%) (both P < 0.0001). Pelvic floor physical therapy attendance was similar in both groups when comparing rates of initiation (47% vs 45%) and completion (13% vs 16%). In multivariate analysis, factors associated with initiation were age 65 years or older, additional therapy provided at referring visit, private insurance, Asian race, pregnant or postpartum at time of referral, and more than 1 referring diagnosis (all P < 0.05). No factors were associated with completion.

Conclusions

Less than half of the patients referred to PFPT initiate therapy, and only 15% complete PFPT. The populations referred by FPMRS and non-FPMRS providers are different, but ultimately PFPT utilization is similar.
Management of blunt traumatic abdominal wall hernias: A Western Trauma Association multicenter study
Authors: Harrell Kevin N. , Grimes Arthur D. , Albrecht Roxie M. , Reynolds Jessica K. , Ueland Walker R. , Sciarretta Jason D. , Todd Samual R. , Trust Marc D. , Ngoue Marielle , Thomas Bradley W. , Ayuso Sullivan A. , LaRiccia Aimee , Spalding M. Chance , Collins Michael J. , Collier Bryan R. , Karam Basil S. , de Moya Marc A. , Lieser Mark J. , Chipko John M. , Haan James M. , Lightwine Kelly L. , Cullinane Daniel C. , Falank Carolyne R. , Phillips Ryan C. , Kemp Michael T. , Alam Hasan B. , Udekwu Pascal O. , Sanin Gloria D. , Hildreth Amy N. , Biffl Walter L. , Schaffer Kathryn B. , Marshall Gary , Muttalib Omaer , Nahmias Jeffry , Shahi Niti , Moulton Steven L. , Maxwell Robert A.
Published: May 2021

BACKGROUND

Blunt traumatic abdominal wall hernias (TAWH) occur in approximately 15,000 patients per year. Limited data are available to guide the timing of surgical intervention or the feasibility of nonoperative management.

METHODS

A retrospective study of patients presenting with blunt TAWH from January 2012 through December 2018 was conducted. Patient demographic, surgical, and outcomes data were collected from 20 institutions through the Western Trauma Association Multicenter Trials Committee.

RESULTS

Two hundred and eighty-one patients with TAWH were identified. One hundred and seventy-six (62.6%) patients underwent operative hernia repair, and 105 (37.4%) patients underwent nonoperative management. Of those undergoing surgical intervention, 157 (89.3%) were repaired during the index hospitalization, and 19 (10.7%) underwent delayed repair. Bowel injury was identified in 95 (33.8%) patients with the majority occurring with rectus and flank hernias (82.1%) as compared with lumbar hernias (15.8%). Overall hernia recurrence rate was 12.0% (n = 21). Nonoperative patients had a higher Injury Severity Score (24.4 vs. 19.4, p = 0.010), head Abbreviated Injury Scale score (1.1 vs. 0.6, p = 0.006), and mortality rate (11.4% vs. 4.0%, p = 0.031). Patients who underwent late repair had lower rates of primary fascial repair (46.4% vs. 77.1%, p = 0.012) and higher rates of mesh use (78.9% vs. 32.5%, p < 0.001). Recurrence rate was not statistically different between the late and early repair groups (15.8% vs. 11.5%, p = 0.869).

CONCLUSION

This report is the largest series and first multicenter study to investigate TAWHs. Bowel injury was identified in over 30% of TAWH cases indicating a significant need for immediate laparotomy. In other cases, operative management may be deferred in specific patients with other life-threatening injuries, or in stable patients with concern for bowel injury. Hernia recurrence was not different between the late and early repair groups.

LEVEL OF EVIDENCE

Therapeutic/care management, Level IV.
Postinjury treatments to make early tactical aeromedical evacuation practical for the brain after TBI
Authors: Singer Kathleen E. , Wallen Taylor E. , Morris Mackenzie C. , McGlone Emily , Stevens-Topie Sabre , Earnest Ryan , Goodman Michael D.
Published: May 2021

BACKGROUND

Traumatic brain injury (TBI) is common in civilians and military personnel. No potential therapeutics have been evaluated to prevent secondary injury induced by the hypobaric hypoxia (HH) environment integral to postinjury aeromedical evacuation (AE). We examined the role of allopurinol, propranolol, adenosine/lidocaine/magnesium (ALM), or amitriptyline administration prior to simulated flight following murine TBI.

METHODS

Mice underwent TBI and were given allopurinol, propranolol, amitriptyline, or ALM prior to simulated AE or normobaric normoxia (NN) control. Heart rate (HR), respiratory rate, and oxygen saturation (Spo
2) were recorded throughout simulated AE. Mice were sacrificed at 24 hours, 7 days, or 30 days. Serum and cerebral cytokines were assessed by enzyme-linked immunosorbent assay. Motor function testing was performed with Rotarod ambulation. Immunohistochemistry was conducted to examine phosphorylated tau (p-tau) accumulation in the hippocampus at 30 days.

RESULTS

While all treatments improved oxygen saturation, propranolol, amitriptyline, and allopurinol improved AE-induced tachycardia. At 24 hours, both propranolol and amitriptyline reduced tumor necrosis factor alpha levels while allopurinol and ALM reduced tumor necrosis factor alpha levels only in NN mice. Propranolol, amitriptyline, and ALM demonstrated lower serum monocyte chemoattractant protein-1 7 days after AE. Both amitriptyline and allopurinol improved Rotarod times for AE mice while only allopurinol improved Rotarod times for NN mice. Propranolol was able to reduce p-tau accumulation under both HH and NN conditions while ALM only reduced p-tau in hypobaric hypoxic conditions.

CONCLUSION

Propranolol lowered post-TBI HR with reduced proinflammatory effects, including p-tau reduction. Amitriptyline-induced lower post-TBI HR and improved functional outcomes without affecting inflammatory response. Allopurinol did not affect vital signs but improved late post-TBI systemic inflammation and functional outcomes. Adenosine/lidocaine/magnesium provided no short-term improvements but reduced p-tau accumulation at 30 days in the HH cohort. Allopurinol may be the best of the four treatments to help prevent short-term functional deficits while propranolol may address long-term effects.

LEVEL OF EVIDENCE

Basic science article.
Early cognitive impairment is common in pediatric patients following mild traumatic brain injury
Authors: Keys Megan Elizabeth , Delaplain Patrick , Kirby Katharine A. , Boudreau Kate Irene , Rosenbaum Kathryn , Inaba Kenji , Lekawa Michael , Nahmias Jeffry
Published: May 2021

INTRODUCTION

The incidence and factors related to early cognitive impairment (ECI) after mild traumatic brain injury (mTBI) in pediatric trauma patients (PTPs) are unknown. Prior data in the adult population demonstrated an ECI incidence of 51% after mTBI and strong correlation with initial Glasgow Coma Scale (GCS) and Brain Injury Guidelines (BIG) category. Therefore, we hypothesized that ECI is common after mTBI in PTPs and associated with initial GCS and BIG category.

METHODS

A single-center, retrospective review of PTPs (age, 8–17 years) from 2015 to 2019 with intracranial hemorrhage and mTBI (GCS score, 13–15) was performed. Primary outcome was ECI, defined as Ranchos Los Amigos score less than 8. Comparisons between ECI and non-ECI groups regarding Injury Severity Score (ISS), demographics, and cognitive and clinical outcomes were evaluated using χ2 statistics and Wilcoxon rank sum tests. Odds of ECI were evaluated using multivariable logistic regression.

RESULTS

From 47 PTPs with mTBI, 18 (38.3%) had ECI. Early cognitive impairment patients had a higher ISS than non-ECI patients (19.7 vs. 12.6, p = 0.003). Injuries involving motor vehicles were more often related to ECI than non-auto-involved mechanisms (55% vs. 15%, p = 0.005). Lower GCS score (odds ratio [OR], 6.60; 95% confidence interval [CI], 1.34–32.51, p = 0.02), higher ISS (OR, 1.12; 95% CI, 1.01–1.24; p = 0.030), and auto-involved injuries (OR, 6.06; 95% CI, 1.15–31.94; p = 0.030) were all associated with increased risk of ECI. There was no association between BIG category and risk of ECI (p > 0.05).

CONCLUSION

Nearly 40% of PTPs with mTBI suffer from ECI. Lower initial GCS score, higher ISS, and autoinvolved mechanism of injury were associated with increased risk of ECI. Brain Injury Guidelines category was not associated with ECI in pediatric patients.

LEVEL OF EVIDENCE

Prognostic study, Level III.
Perinatal depression in migrant and refugee women on the Thai–Myanmar border: does social support matter?
Authors: Fellmeth Gracia , Plugge Emma , Fazel Mina , Nosten Suphak , Oo May May , Pimanpanarak Mupawjay , Phichitpadungtham Yuwapha , Fitzpatrick Raymond , McGready Rose
Published: May 2021

Migrant and refugee women are at risk of perinatal depression due to stressors experienced before, during and after migration. This study assesses the associations between social support and perinatal depression among migrant and refugee women on the Thai–Myanmar border. We conducted a cohort study of pregnant and post-partum women. Depression status was assessed using a structured clinical interview. Received support, perceived support and partner support were measured in the third trimester. Logistic regression was used to calculate associations between social support measures and perinatal depression controlling for demographic, socio-economic, migration, obstetric and psychosocial factors. Four hundred and fifty-one women (233 migrants; 218 refugees) were included. The prevalence of perinatal depression was 38.6% in migrants and 47.3% in refugees. Migrants had higher levels of received, perceived and partner support than refugees. After controlling for all other variables, higher levels of received support remained significantly associated with a lower likelihood of perinatal depression in migrants (adjusted odds ratio 0.82; 95% CI 0.68–0.99). In both groups, depression history and trauma were strongly associated with perinatal depression. Our study highlights the importance of received social support to perinatal depression in migrant women on the Thailand–Myanmar border. The perinatal period offers a valuable opportunity to ask women about their support and offer community-level or public policy interventions to nurture support networks in current locations and resettlement destinations.

This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.
Who actually cares for children in slums? Why we need to think, and do, more about paid childcare in urbanizing sub-Saharan Africa
Authors: Hughes Robert C. , Kitsao-Wekulo Patricia , Muendo Ruth , Bhopal Sunil S. , Kimani-Murage Elizabeth , Hill Zelee , Kirkwood Betty R.
Published: May 2021

The early years are critical and inform the developmental trajectory of children. This is justifiably attracting growing policy attention. Much of this attention is focused on interventions and policies directed at parents, especially mothers. Yet emerging evidence suggests that increasing numbers of children in rapidly urbanizing low- and middle-income countries are now spending much of their day with other formal and informal childcare providers, including largely unregulated paid childcare providers. This paper summarizes the limited literature about the use of such paid childcare in low- and middle-income countries in sub-Saharan Africa, before considering possible reasons behind the lack of research evidence. Finally, key research gaps and their implications for public health practice are explored, with reference to the ongoing British Academy funded Nairobi Early Childcare in Slums research programme in Nairobi, Kenya. We argue that improving childcare may be an under-explored strategy to help some of the world's most disadvantaged children in the most important period of their lives, and that interventions in this largely informal market should be built on a rigorous research base.

This article is part of the theme issue ‘Multidisciplinary perspectives on social support and maternal–child health’.
Performance of Adenosine Deaminase assay in diagnosis of pulmonary & extrapulmonary tuberculosis
Authors: Kawle Anuja , Mishra Arti , Hutke Vinita , Shekhawat Seema , Nayak Amit , Biswas Rima , Chandak Nitin , Agrawal Vijay , Daginawala Hatim , Singh Lokendra , Kashyap Rajpal S.
Published: May 2021

There has been a lot of debate about the use of the Adenosine Deaminase (ADA) for tuberculosis (TB) diagnosis. In the present study, to overcome this debate, we have planned a large scale study in all forms of TB to access the performance of ADA for diagnosis of TB. we have also studied the performance of the ADA in the Tb prognosis. ADA activity was evaluated using Guisti and Galanti method. The sensitivity of the ADA test is impressive in all forms of TB clinical samples analysed for the study (PTB [82%], TBM [85%] TBAR [85%]), and (ATB) [84%]. However, the specificity was variable in pulmonary TB, but satisfactory in extrapulmonary TB (EPTB) cases (i.e TBM [89%], (ATB) [88%], TBAR [88%]). In the follow-up samples, ADA value declined drastically after the anti TB medication (ATT). Our study, which consists of a large number of samples, suggests that the ADA has very limited value in the diagnosis of PTB, and hence it is not recommended for PTB diagnosis. We recommend, ADA test is quite useful for EPTB diagnosis along with other clinical correlations and in absence of other advanced diagnostic tests. However, on the other ADA can be used as a prognostic test for all forms of TB.
A theory of direction selectivity for Macaque primary visual cortex
Authors: Chariker Logan , Shapley Robert , Hawken Michael , Young Lai-Sang
Published: May 2021

This paper offers a new theory for the origin ofdirection selectivityin the Macaque primary visual cortex, V1. Direction selectivity (DS) is essential for the perception of motion and control of pursuit eye movements. In the Macaque visual pathway, DS neurons first appear in V1, in the Simple cell population of the Magnocellular input layer 4Cα. The LGN cells that project to these cortical neurons, however, are not direction-selective. We hypothesize that DS is initiated in feedforward LGN input, in the summed responses of LGN cells afferent to a cortical cell, and it is achieved through the interplay of (a) different visual response dynamics of ON and OFF LGN cells, and (b) the wiring of ON and OFF LGN neurons to cortex. We identify specific temporal differences in the ON/OFF pathways that together with (b) produce distinct response time-courses in separated subregions; analysis and simulations confirm the efficacy of the mechanisms proposed. To constrain the theory, we present data on Simple cells in layer 4Cα in response to drifting gratings. About half of the cells were found to have high DS, and the DS was broad-band in spatial and temporal frequency (SF and TF). The proposed theory includes a complete analysis of how stimulus features such as SF and TF interact with ON/OFF dynamics and LGN-to-cortex wiring to determine the preferred direction and magnitude of DS.

Significance Statement

Motion perception is important for primates, and direction selectivity (DS), the ability to perceive the direction a target is moving, is an essential part of motion perception. Yet no satisfactory mechanistic explanation has been proposed for the origin of DS in primate visual cortex up until now. In this paper, we hypothesize that DS is initiated in feedforward LGN input as a result of the dynamic differences between the ON/OFF pathways. The mechanisms we propose are biology-based, and our theory explains experimental data for all spatial and temporal frequencies in visual stimuli. Exploiting temporal biases in parallel pathways is relevant beyond visual neuroscience; similar ideas likely apply to other types of neural signal processing.g
In vivoadministration of anti-HIV hyper-immune eggs induces anti-anti-idiotypic antibodies against HIV gp120 peptides (fragments 308-331 and 421-438) and against HIV gp41 peptide (fragment 579-601) which have demonstrable protective capacity
Authors: Justiz-Vaillant Angel , Ferrer-Cosme Belkis , Smikle Monica Fisher , Pérez Oliver
Published: May 2021

Isolation of antibodies from the egg yolk of chickens is of particular interest as a source of specific antibodies for oral administration to prevent infections and use them as immunodiagnostic reagents. The use of birds in antibody production results in a reduction in the use of laboratory animals. Immunized chickens produce larger quantities of antibodies (2000 mg IgY/month) than rodents (200 mg IgG/month) in the laboratory. According to Jerne’s network theory, it is possible to produce an antibody against the antigen-binding site of another antibody. This study assessed the hypothesis that immunization with viral peptides (immunogens) could provide a potent immune response that could be evaluated in chicken eggs. Human immunodeficiency virus 1(HIV-1) is used as an immunogen. The second hypothesis was that an orally administered antibody stimulates the production of a complementary antibody, the so-called anti-idiotypic antibody, which can potentially be therapeutical. This study reports and analyzes the use of eggs as therapeutic agents. We wanted to test the hypothesis that feeding chicks with hyperimmune eggs stimulates the production of anti-anti-idiotypic antibodies that neutralize the original HIV antigen fragments 308-331 or 421-438 of gp120 or fragment 579-601 of gp41. Future research could entail an anti-idiotype strategy for prophylactic vaccines. It is vital to note that it may need an anti-idiotype response to prime immunity against an HIV viral epitope, which may be used as a secondary element. The use of anti-idiotype immune responses in infected individuals may shift the balance of the immune system, allowing the organism to manage HIV infection. Therefore, it may be an avenue for immunotherapy to improve the fight against HIV infections. However, more studies and clinical trials are required to demonstrate similar human immune responses as observed in birds.
Mapping RNA
Authors: Green Michael R. , Sambrook Joseph
Published: May 2021

Details of the fine structure of a particular transcript may be assessed by S1 mapping or ribonuclease protection. The use of either of these techniques allows the detection of the 5′ and 3′ ends of a particular mRNA, as well as the splice junctions, precursors, and processing intermediates of mRNA. Primer extension provides a measure of the amount of a particular mRNA species and allows an exact determination of the 5′ end of the mRNA. These three methods are introduced here.
Emotional and behavioural responses to the 19 September 2017 earthquake: the case of the occupants of three multi-storey buildings
Authors: Santos-Reyes Jaime , Gouzeva Tatiana
Published: May 2021

Purpose

Studies on human behaviour during a seismic emergency in tall buildings are scant. During such emergencies, occupants need to reach a safe place. The purpose of this paper is to address some of the emotional and behavioural responses of the occupants of three multi-storey buildings during the 19 September earthquake that hit Mexico City in 2017.

Design/methodology/approach

A cross-sectional and non-probability study was conducted using a questionnaire-based survey; the sample size wasn = 352, and the study was conducted from 4 October to 20 November 2017.

Findings

(1) In the 11 storey-building, women, age (18–49 years old [yo]) and participants with higher education exhibited flight behaviour, and those of the six storey-building within the age category 18–49 yo also exhibited a similar behaviour; (2) Women and age (18–49 yo) in the six and 11-storey buildings were significantly associated with fear of the earthquake; (3) Women were significantly more fearful and felt more intense the tremors than men in the 11-storey building; (4) Women were significantly more fearful of the 11-storey building collapsing; (5) The taller the building, the more fearful were the occupants of the building collapsing.

Research limitations/implications

First, the sample considered in the study was no probability; consequently, the results should not be generalised to the existing high-rising buildings in Mexico City. Second, some of the variables considered herein were of the Likert-type scale but have been assumed as continuous; in fact, some future work could be the design of a valid and reliable questionnaire to address human behaviour during earthquakes in tall buildings.

Practical implications

The presented results may be the great value to key decision-makers on how to address the lack of earthquake preparedness during a seismic emergency. Further, the results have shed light on the negative emotions (fear) experienced by the occupants of tall buildings.

Social implications

Gaining a better understanding of human behavioural in tall buildings is essential in devising measures to mitigate the impact of earthquake disasters.

Originality/value

Research on human behaviour during a seismic emergency in high-rise buildings is scant. To gain a better understanding of human emotional and behavioural response to earthquakes in tall buildings, it becomes necessary to conduct research such as the present case study. This may help decision-makers to devise measures so that the impact of earthquake disasters may be limited.
Establishing the synergy between the perceptions of construction professionals and the phases of value management
Authors: Thneibat Mujahed , Thneibat Motasem , Al-Tamimi Bader
Published: May 2021

Purpose

This study aims to lay the groundwork for the potential application of value management (VM) in construction projects. This paper presents a critical review on the status of VM in a developing country and highlights the role of perceptions on critical success factors (CSFs) for the phases of VM studies, as the participants in a VM study should consider CSFs tailored to the local context.

Design/methodology/approach

A series of interviews and a questionnaire were conducted to understand the drivers, perceptions, barriers, and CSFs of VM in the Jordanian construction industry. Although descriptive statistics were used to analyze the status of VM, a structural equation modeling (SEM) approach was adopted to highlight the interrelationships between perceptions and the CSFs of the three phases of VM (i.e. pre-workshop, workshop, and implementation).

Findings

The descriptive analysis revealed conflicting viewpoints for perceptions and drivers. Most practitioners acknowledged little awareness of VM phases, and the SEM results indicated that perceptions of VM, in terms of its capacity in improving the scope and objectives of the project, and reducing overall costs, most strongly influenced the CSFs of the implementation phase in terms of support and clear plan for implementation, and had the least influence on the pre-workshop phase. Further, the perceptions had a moderate effect on the CSFs of the workshop phase and it tended to be positive, highlighting the importance of function analysis in this phase.

Originality/value

This is the first study to reveal the status of VM in Jordan in terms of adoption, drivers, perceptions, barriers and CSFs; no prior studies have investigated how perceptions can affect the CSFs of each phase of VM and the endorsement of VM by the construction industry. The contributions of this study include linking the perceptions of construction professionals with the CSFs of VM.
Dual innovation: the road to sustainable development of enterprises
Authors: Zhao Jie
Published: May 2021

Purpose

This paper aims to provide policy suggestions for enterprises to carry out dual innovation.

Design/methodology/approach

This paper studies the practical examples of dual innovation and the development cases of dual innovation of typical Chinese enterprises.

Findings

This paper demonstrates the mutually promoting relationship between dual innovation and sustainable development of enterprises and puts forward suggestions on how to effectively develop dual innovation in terms of corporate governance, resource access, market orientation and business model.

Originality/value

The research results of this paper are helpful for enterprises to better carry out dual innovation, so as to achieve sustainable development.