bluuebunny/crossref_metadata_2025 huggingface dataset:
Diabetic Foot Osteomyelitis: Is it all the Same?
Authors: Carro Gabriela Verónica , de Jesus Fermín Martinez , Ricci Anahí
Published: March 2023

Diabetic foot osteomyelitis (OM) requires a longer duration of therapy, a greater need for surgery and implies a higher rate of recidivism, a higher amputation risk, and lower treatment success. But do all bone infections behave the same way, require the same treatment, or imply the same prognosis? Actually, in clinical practice we can verify there are different clinical presentations of OM. The first one is that associated with the infected diabetic foot attack. It requires urgent surgery and debridement since “time is tissue.” Clinical features and radiographs are enough for the diagnosis, and treatment should not be delayed. The second one is related to a sausage toe. It affects phalanges and it can be treated with a 6- or 8-week antibiotic course with a high rate of success. Clinical features and radiographs are sufficient for the diagnosis in this case. The third presentation is OM superimposed to Charcot's neuroarthropathy, which mainly comprises midfoot or hindfoot. It starts with a plantar ulcer in a foot that has developed a deformity. The treatment is based on an accurate diagnosis that often includes magnetic resonance, and requires a complex surgery to preserve the midfoot and to avoid recurrent ulcers or foot instability. The final presentation is that of an OM without large soft tissue compromise secondary to a chronic ulcer or a previous unsuccessful surgery secondary to minor amputation or debridement. There is often a small ulcer with a positive probe to bone test over a bony prominence. Diagnosis is made by clinical features, radiographs, and laboratory tests. Treatment includes antibiotic therapy guided by surgical or transcutaneous biopsy, but this presentation often requires surgery. Different presentations of OM mentioned above need to be recognized because the diagnosis, type of culture, antibiotic treatment, surgical treatment, and prognosis are different upon the presentation.
Customizing foam sclerotherapy of the great saphenous vein: A proposed algorithm to enhance technical efficacy
Authors: Georgakarakos Efstratios , Dimitriadis Konstantinos , Tasopoulou Kalliopi-Maria , Doukas Damianos , Argyriou Christos , Georgiadis George S
Published: March 2023

Objectives

The catheter-directed foam sclerotherapy (FS) and the suggested perivenous tumescent application for great saphenous vein (GSV) diameter reduction are suggested to improve technical and clinical results; yet, their use is reported rather indiscriminately. Our aim is to introduce an algorithm categorising the use of technical modalities accompanying ultrasound-guided FS of the GSV and present the technical efficacy of FS through a 5 F × 11  cm sheath placed at the knee level.

Methods

Representative cases of GSV insufficiency were chosen to describe our methodology.

Results

Sole sheath-directed FS can achieve complete GSV occlusion proximally at a level comparable to the catheter-directed technique. We apply perivenous 4°C cold tumescent to GSV >6 mm even in the standing position to ensure diameter reduction of the proximal GSV as close to the saphenofemoral junction. We use long catheters only to overcome large varicosities above the knee level that could otherwise compromise the adequate foam infusion from the sheath tip. When GSV insufficiency extends along the entire limb and severe skin lesions preclude the antegrade distal catheterisation, the sheath-directed FS in the thigh can be concomitantly combined with retrograde FS from catheterisation just below the knee.

Conclusions

A topology-oriented methodology with sheath-directed FS is technically feasible and avoids indiscriminate use of more complex modalities.
Amputation and advance care plans: An observational study exploring decision making and long-term outcomes in a vascular centre
Authors: Grange Robert , Carter Ben , Chamberlain Charlotte , Brooks Marcus , Nitharsan Ramya , Twine Christopher , Braude Philip
Published: March 2023

Background

Half of those undergoing major lower limb amputation for peripheral arterial disease die within 1 year. Advance care planning reduces days in hospital and increases the chance of dying in a preferred place.

Aim

To investigate the prevalence and content of advance care planning for people having a lower limb amputation due to acute or chronic limb-threatening ischaemia or diabetes. Secondary aims were to explore its association with mortality, and length of hospital stay.

Design

A retrospective observational cohort study. The intervention was advance care planning.

Setting/participants

Patients admitted to the South West England Major Arterial Centre between 1 January 2019 and 1 January 2021 who received unilateral or bilateral below, above, or through knee amputation due to acute or chronic limb-threatening ischaemia or diabetes.

Results

116 patients were included in the study. 20.7% ( n = 24) died within 1 year. 40.5% ( n = 47) had an advance care planning discussion of which all included cardiopulmonary resuscitation decisions with few exploring other options. Patients who were more likely to have advance care planning discussions were ≥75 years (aOR = 5.58, 95%CI 1.56–20.0), female (aOR = 3.24, 95%CI 1.21–8.69), and had multimorbidity (Charlson Comorbidity Index ≥5, aOR = 2.97, 95%CI 1.11–7.92). Discussions occurred more often in the emergency pathway and were predominantly initiated by physicians. Advance care planning was associated with increased mortality (aHR = 2.63, 95%CI 1.01, 5.02) and longer hospital stay (aHR = 0.52, 95%CI 0.32–0.83).

Conclusions

Despite a high risk of death for all patients in the months following amputation, advance care planning occurred in fewer than half of people and mostly focused on resuscitation.
Generic drugs use during the COVID-19 pandemic among Lebanese patients using psychotropics: An opportunity for generic drug promotion
Authors: Hatem Georges , Ankouni Ali , Salhab Sethrida , Kteich Walaa , Awada Sanaa
Published: March 2023

Introduction

The Coronavirus disease of 2019 (COVID-19) pandemic has imposed several challenges leading to the shortage of medications due to the disruption of their supply chains. Among others, patients using psychotropics encountered difficulties finding their medication despite the efforts of investing in local production. Encouraging patients to use generic drugs can be an effective strategy to ensure sustainable access to medication.

Objectives

This study aimed to describe the consumption of psychotropic medications during the COVID-19 pandemic and the willingness together with the reasons for using generic drugs. It also assessed the association between generic drugs and the general characteristics of the patients.

Design

A cross-sectional study was performed over a period of 4 months (July–October 2021) targeting 128 patients using psychotropic drugs.

Results

The sample included more women than men with a mean age of 38 years. Antidepressants were the psychotropic medications mostly consumed followed by anti-anxiety medications. Almost 13% of the patients started using psychotropics either through self-prescription or a friend’s advice and 73.4% used generic drugs. Fear of dependence, unavailability of the brand drug, and pharmacist’s recommendation were the main reported reasons for using generic drugs.

Conclusion

During the COVID-19 pandemic, the consumption of psychotropics increased due to new prescriptions and self-medication. No differences were noted between using generics and the characteristics of the patients in contrast to previous studies which support the implementation of generic prescription and substitution policies.
Exploring Eurasian integration through the lenses of Carl Schmitt: The Eurasian Economic Union as an example of Schmittian “Great Space”
Authors: Pizzolo Paolo
Published: March 2023

The Eurasian Economic Union (EAEU) embodies Russia’s latest attempt to restore interconnections among former Soviet countries through economic means rather than military might. The literature on the EAEU views the initiative as a geopolitical tool, a post-imperial escamotage, a platform to enhance reforms, or a counterhegemonic strategy. This article wishes to understand the EAEU as an example of Carl Schmitt’s theorizations, especially in relation to the concept of Great Space. The EAEU resembles the Schmittian Great Space in four main respects: the existence of a regional hegemon with spheres of interest beyond its fixed borders, the expression of an “imperial” community of cultural and historical affinity, the overcome of the rigid Westphalian state model expressed by the jus publicum Europeaum in favor of a large space, and the manifestation of the nomos of the Earth, that is a telluric civilization within the Schmittian contraposition between Land and Sea. The application of the Schmittian Great Space paradigm to the EAEU—in tandem with the proliferation of other regional integration initiatives and organizations—confirms the ongoing global shift from rigid Westphalian nation-states to highly integrated political-economic blocs based on civilizational identity in the frame of a multipolar world.
Flame Transfer Functions of the Lean Burnout Zone of an RQL Combustion Chamber - Dynamic Response to Primary Zone and Mixing Port Velocity Fluctuations
Authors: Renner Julian , March Martin , Do Thuy An , Merk Moritz , Hirsch Christoph , Sattelmayer Thomas
Published: March 2023

This article describes an experimental investigation of thermoacoustic flame transfer functions of the lean burnout zone of an rich–quench–lean combustion chamber. With spatial separation of the rich primary from the lean secondary dilution zone, the latter is independently examined. The multi-microphone-method was employed to characterize the combustor acoustic velocity response to acoustic forcing coming from the primary zone and the mixing ports. The lean secondary zone is then treated as a pure acoustic 3-port network element connected to a 2-port Rankine-Hugoniot flame element. Focusing only on heat release fluctuations due to velocity fluctuations, the former are described by two linear superimposed flame transfer functions as a function of the velocity fluctuations coming from the primary zone and the mixing ports, respectively. Based on a non-reacting and a reacting measurement the two flame transfer functions could be extracted from the experimental data. Within this research, flame transfer functions from the new acoustical approach are presented and compared with ones measured using chemiluminescence and a photomultiplier tube. It is found that the inverse diffusion flame in the burnout zone reacts to velocity fluctuations from the primary zone in the low frequency range and a clear low pass behavior is observed. The mixing port velocity fluctuations create a more broadband response. In the presented cases, the flame transfer functions calculated from chemiluminescence match those from the acoustic method very well.
Three New Antioxidative Phenolics From Phyllanthus emblica L. Fruit
Authors: Sun Hai-feng , Lv Qiao , Ji Xiong , Fang Cheng , Fei Jia-xiang , Liu Xian-jun , Liu Jing-xun , Liu Xiao-hui
Published: March 2023

Objective: The present study aimed to investigate the potential bioactive compounds from Phyllanthus emblica L. fruit. Methods: Acetone extracts (60%) of P emblica fruit were dissolved in water and fractionated sequentially with light petroleum and ethyl acetate (EtOAc). The water fraction was separated using Sephadex LH-20 and the isolated compounds were purified by preparative high-performance liquid chromatography. The structures of the isolated compounds were determined through HR-ESI-MS and spectroscopic methods, including 1D- and 2D-NMR, and the antioxidant abilities of the isolates were evaluated by 1,1-diphenyl-2-picrylhydrazyl (DPPH), 2,2′-azino-bis (3-ethylbenzothiazoline-6-sulfonic acid) (ABTS), and ferric reducing antioxidant power (FRAP) assays. Results: Three new phenolic compounds, mucic acid 1-ethyl ester 3- O-gallate (1), mucic acid 6-methyl ester 3- O-gallate (2), and mucic acid 6-ethyl ester 2- O-gallate (3), together with 4 known compounds (4-7), were isolated from P emblica fruit. All phenolics exhibited potent antioxidant abilities (DPPH: IC50 7.5-13.2 µM; ABTS: 1.12-2.84 µM Trolox/µM; FRAP: 1.11-2.26 µM Fe2+/µM). Conclusions: Our research contributes to the growing body of evidence demonstrating the benefits of P emblica for health and supports the functional food and nutraceutical applications of the fruit.
A survey to evaluate parameters governing the selection and application of extracellular vesicle isolation methods
Authors: Williams Soraya , Jalal Aveen R , Lewis Mark P , Davies Owen G
Published: March 2023

Extracellular vesicles (EVs) continue to gain interest across the scientific community for diagnostic and therapeutic applications. As EV applications diversify, it is essential that researchers are aware of challenges, in particular the compatibility of EV isolation methods with downstream applications and their clinical translation. We report outcomes of the first cross-comparison study looking to determine parameters (EV source, starting volume, operator experience, application and implementation parameters such as cost and scalability) governing the selection of popular EV isolation methods across disciplines. Our findings highlighted an increased clinical focus, with 36% of respondents applying EVs in therapeutics and diagnostics. Data indicated preferential selection of ultracentrifugation for therapeutic applications, precipitation reagents in clinical settings and size exclusion chromatography for diagnostic applications utilising biofluids. Method selection was influenced by operator experience, with increased method diversity when EV research was not the respondents primary focus. Application and implementation criteria were indicated to be major influencers in method selection, with UC and SEC chosen for their abilities to process large and small volumes, respectively. Overall, we identified parameters influencing method selection across the breadth of EV science, providing a valuable overview of practical considerations for the effective translation of research outcomes.
Women bureaucrats and petty corruption. Experimental evidence from Ghana
Authors: Brierley Sarah , Pereira Miguel M.
Published: March 2023

More women in public institutions are correlated with lower levels of corruption. However, this relationship is thought to be context specific, and the mechanisms that underlie it remain unclear. We conduct two survey experiments to investigate whether and why end-users expect women bureaucrats to be less corrupt in Ghana. Our results show that citizens do not expect women bureaucrats to be less likely to solicit bribes than men. This result holds across bureaucrats with different levels of experience in the public sector and respondents who have and have not paid a bribe. Our second experiment shows that citizens expect men and women bureaucrats to distribute equal shares of their salaries with their extended families. We argue that equality in financial pressures explains why bribe-taking rates may be similar across genders. Our results cast doubt on the idea that women bureaucrats will reduce petty corruption in countries where corruption is pervasive.
Collision metastasis from prostate adenocarcinoma and pancreatic ductal adenocarcinoma to a lung nodule
Authors: Mohamed Ahmed , Yao Mark , Saw Sonia , Clark Amanda , Madaan Sanjeev
Published: March 2023

Introduction

Prostate cancer and pancreatic cancer are often complex pathologies that affect millions of patients worldwide. However, the incidence of a distant collision metastasis of both malignancies remains a rare and often poorly documented incidence.

Case presentation

A 75-year-old male patient with past history of prostate cancer on maximal androgen blockade was recently diagnosed with pancreatic cancer for which he underwent radical surgical resection of pancreas with curative intent. A metastatic lung nodule was noted on surveillance CT imaging and, subsequently, biopsied. A diagnosis of collision metastasis from two distinct primary malignancies was histopathologically confirmed following immunohistochemical evaluation.

Conclusion

We report the first case of collision metastasis of prostate and pancreatic adenocarcinomata to a lung nodule to the best of our knowledge.
Pericardial Effusions After the Arterial Switch Operation: A PHIS Database Review
Authors: Mikulski Matthew F , Well Andrew , Subramanian Sujata , Colman Kathleen , Fraser Charles D , Mery Carlos M , Lion Richard P
Published: March 2023

Background: Pericardial effusion (PCE) is a significant complication after pediatric cardiac surgery. This study investigates PCE development after the arterial switch operation (ASO) and its short-term and longitudinal impacts. Methods: A retrospective review of the Pediatric Health Information System database. Patients with dextro-transposition of the great arteries who underwent ASO from January 1, 2004, to March 31, 2022, were identified. Patients with and without PCE were analyzed with descriptive, univariate, and multivariable regression statistics. Results: There were 4896 patients identified with 300 (6.1%) diagnosed with PCE. Thirty-five (11.7%) with PCE underwent pericardiocentesis. There were no differences in background demographics or concomitant procedures between those who developed PCE and those who did not. Patients who developed PCE more frequently had acute renal failure (N = 56 (18.7%) vs N = 603(13.1%), P = .006), pleural effusions (N = 46 (15.3%) vs N = 441 (9.6%), P = .001), mechanical circulatory support (N = 26 (8.7%) vs N = 199 (4.3%), P < .001), and had longer postoperative length of stay (15 [11-24.5] vs 13 [IQR: 9-20] days). After adjustment for additional factors, pleural effusions (OR = 1.7 [95% CI: 1.2-2.4]), and mechanical circulatory support (OR = 1.81 [95% CI: 1.15-2.85]) conferred higher odds of PCE. There were 2298 total readmissions, of which 46 (2%) had PCE, with no difference in median readmission rate for patients diagnosed with PCE at index hospitalization (median 0 [IQR: 0-1] vs 0 [IQR: 0-0], P = .208). Conclusions: PCE occurred after 6.1% of ASO and was associated with pleural effusions and mechanical circulatory support. PCE is associated with morbidity and prolonged length of stay; however, there was no association with in-hospital mortality or readmissions.
A Transcendental Phenomenology of School Counselors’ Lived Experiences Transforming Remote Counseling Services During the COVID-19 Pandemic
Authors: Greenidge Taneshia , Smith-Adcock Sondra , Cakmakci Huzeyfe , Su Yi-Wen
Published: March 2023

The purpose of this study is to explore school counselors' experiences migrating counseling services online during the COVID-19 pandemic. Using a transcendental phenomenological approach, we conducted in-depth interviews with 14 school counselors with a focus on the use of technology and transformative practices. Findings of the study included five composite themes: (a) changes in school counseling services using technology; (b) reaching families for equity; (c) changes in relationship with stakeholders; (d) school counselors’ adjustment to grief, loss, and role confusion; and (e) positive outcomes for the future. We discuss the essence of the lived experience and implications for school counselors.
Do Preoperative Supine Radiographs Predict Postoperative Residual Lumbar Curvatures in Adolescent Idiopathic Scoliosis? A Retrospective Cohort Study
Authors: Rajan Prashant V. , Steiner Richard , Ritzman Todd F. , Moberly Trey , Floccari Lorena V.
Published: March 2023

Study Design

Retrospective comparative study.

Objectives

This study compares supine vs bending flexibility radiographs and evaluates their ability to predict residual postoperative lumbar curvature after selective thoracic fusion for Lenke 1 and 2 curves across different lumbar modifiers (A, B, and C) in adolescent idiopathic scoliosis (AIS).

Methods

This was a retrospective review of AIS Lenke 1 and 2 patients who underwent posterior fusion. All patients had preoperative flexibility radiographs including side-bending and supine posteroanterior (PA) films, in addition to pre- and post-operative standing PA and lateral radiographs. We used SurgiMap 2.0 software for all radiographic measurements. Pearson correlations and linear regression models were developed in SAS.

Results

A total of 86 patients were included mean age 14.9 years and follow-up 72.3 months. Preoperative supine lumbar Cobb angle and preoperative side-bending Cobb angles had similar, positive correlations with postoperative lumbar Cobb angle, r = .55 ( P < .001) and r = .54 ( P < .001), respectively. Three regression models were built to predict postoperative lumbar Cobb angles from preoperative information: Model S (R2 = .39) uses preoperative supine lumbar curve; Model B (R2 = .44) uses preoperative side-bending lumbar curve; Model SB (R2 = .49) uses both preoperative supine and side-bending lumbar curves. Model S and B performed just as well as Model SB.

Conclusion

Either supine or side-bending radiographs alone may be used to estimate mean residual postoperative lumbar curvature after selective posterior thoracic fusion, but little is to be gained by taking both supine and side-bending radiographs.
Exploring Oral Function, Protein Intake, and Risk of Sarcopenia: A Scoping Review
Authors: Moynihan P.J. , Teo J-L.
Published: March 2023

Introduction:

Sarcopenia is loss of both muscle mass and function with age and is associated with inadequate protein intake. However, evidence to suggest an association with oral health is less clear.

Objective:

To scope peer-reviewed published evidence (2000–2022) pertaining to oral function in relation to sarcopenia and/or protein intake in older people.

Methods:

CINAHL, Embase, PubMed, and Scopus were searched. Included were peer-reviewed studies measuring oral function (e.g., tooth loss, salivary flow masticatory function, strength of muscles of mastication, and tongue pressure) and a measure of protein intake and/or a measure of sarcopenia (appendicular muscle mass and function). Full article screening was conducted by 1 reviewer with a random 10% screened in duplicate by a second reviewer. Relevant content pertaining to study type, country of origin, measures of exposure, and outcomes and key findings was mapped and the balance of data showing a positive versus null association of oral health with outcomes charted.

Results:

Of 376 studies identified, 126 were screened in full, yielding 32 included texts, of which 29 were original articles. Seven reported intake of protein and 22 reported measures of sarcopenia. Nine distinct oral health exposures were identified, with ≤4 studies relating to any one of these measures. Most data were cross-sectional in nature (27 studies) and from Japan (20 studies). The balance of data showed associations between tooth loss and measures of sarcopenia and protein intake. However, the balance of data pertaining to any association between chewing function, tongue pressure, or indices of oral hypofunction and sarcopenia was mixed.

Conclusion:

A broad range of oral health measures have been studied in relation to sarcopenia. The balance of data suggests that tooth loss is associated with risk, but data pertaining to the oral musculature and indices of oral hypofunction are mixed.

Knowledge Transfer Statement:

The findings of this research will increase awareness among clinicians of the amount and nature of evidence pertaining to the relationship between oral health and risk of compromised muscle mass and function, including data showing that loss of teeth is associated with increased risk of sarcopenia in older people. The findings highlight to researchers the gaps in the evidence and where further research and clarification of the relationship between oral health and risk of sarcopenia is warranted.
The formation of the Chinese territorial spatial planning system and international comparison
Authors: Hu Gangyu , Huang Jianzhong , Shi Jianing , Chen Siling
Published: March 2023

China is currently carrying out the reform of territorial spatial planning. With the method of literature review, this paper gives a brief introduction to the development course of spatial planning in the United States, the United Kingdom, the Netherlands, Germany, France, and Japan. After that, the four stages of China’s spatial planning development and the main contents of the current territorial spatial planning are introduced in detail. Then this paper explores the important factors affecting the development of spatial planning and the coping strategies of various countries through international comparison and discusses the enlightenments of the coping strategies of other countries to China. The study indicates that Chinese spatial planning has gone through the multi-planning stage, which comprises major functional zone planning, regional planning, territorial planning, urban and rural planning, and eco-environmental protection planning. Additionally, under the influence of multiple factors such as spatial resources, social factors, international events, environmental crises, and urban problems, China has formed the territorial spatial planning system with ecological civilization as its core concept and high-level governance, high-quality development, and high-quality life as its main planning objectives.
Combinatorial targeting of epigenome-modifying enzymes with decitabine and RN-1 synergistically increases HbF
Authors: Ibanez Vinzon , Vaitkus Kestis , Zhang Xu , Ramasamy Jagadeesh , Rivers Angela E. , Saunthararajah Yogen , Molokie Robert , Lavelle Donald
Published: March 2023

Increased fetal hemoglobin (HbF) levels reduce the symptoms of sickle cell disease (SCD) and increase the lifespan of patients. Because curative strategies for bone marrow transplantation and gene therapy technologies remain unavailable to a large number of patients, the development of a safe and effective pharmacological therapy that increases HbF offers the greatest potential for disease intervention. Although hydroxyurea increases HbF, a substantial proportion of patients fail to demonstrate an adequate response. Pharmacological inhibitors of DNA methyltransferase (DNMT1) and lysine-specific demethylase 1A (LSD1), 2 epigenome-modifying enzymes associated with the multiprotein corepressor complex recruited to the repressed γ-globin gene, are powerful in vivo inducers of HbF. The hematological side effects of these inhibitors limit feasible clinical exposures. We evaluated whether administering these drugs in combination could reduce the dose and/or time of exposure to any single agent to minimize adverse effects, while achieving additive or synergistic increases in HbF. The DNMT1 inhibitor decitabine (0.5 mg/kg per day) and the LSD1 inhibitor RN-1 (0.25 mg/kg per day) administered in combination 2 days per week produced synergistic increases in F-cells, F-reticulocytes, and γ-globin messenger RNA in healthy baboons. Large increases in HbF and F-cells were observed in healthy, nonanemic, and anemic (phlebotomized) baboons. Combinatorial therapy targeting epigenome-modifying enzymes could thus be a useful strategy for producing larger increases in HbF to modify the clinical course of SCD.
Positive airway pressure therapy for post-stroke sleep disordered breathing: a systematic review, meta-analysis and meta-regression
Authors: Toh Zheng An , Cheng Ling Jie , Wu Xi Vivien , De Silva Deidre Anne , Oh Hui Xian , Ng Si Xian , He Hong-Gu , Pikkarainen Minna
Published: March 2023

Background

Sleep disordered breathing (SDB) is an under-recognised independent risk factor and a potential consequence of stroke. We systematically reviewed and meta-analysed the effectiveness of positive airway pressure (PAP) therapy in improving post-stroke outcomes.

Methods

We searched CENTRAL, Embase, PubMed, CINAHL, PsycINFO, Scopus, ProQuest, Web of Science and CNKI (China National Knowledge Infrastructure) for randomised controlled trials comparing PAP therapy against a control or placebo group. We evaluated the pooled effects of PAP therapy on recurrent vascular events, neurological deficit, cognition, functional independence, daytime sleepiness and depression using random effects meta-analyses.

Results

We identified 24 studies. Our meta-analyses showed that PAP therapy reduced recurrent vascular events (risk ratio 0.47, 95% CI 0.28–0.78), and showed significant beneficial effects on neurological deficit (Hedges’ g= −0.79, 95% CI −1.19– −0.39), cognition (g=0.85, 95% CI 0.04–1.65), functional independence (g=0.45, 95% CI 0.01–0.88) and daytime sleepiness (g= −0.96, 95% CI −1.56– −0.37). However, there was insignificant reduction in depression (g= −0.56, 95% CI −2.15–1.02). No publication bias was detected.

Conclusions

Post-stroke patients with SDB benefited from PAP therapy. Prospective trials are needed to determine the ideal initiation period and the minimum effective therapeutic dose.
The role of smoking in COVID-19 progression: a comprehensive meta-analysis
Authors: Gallus Silvano , Scala Marco , Possenti Irene , Jarach Carlotta Micaela , Clancy Luke , Fernandez Esteve , Gorini Giuseppe , Carreras Giulia , Malevolti Maria Chiara , Commar Alison , Fayokun Ranti , Gouda Hebe N. , Prasad Vinayak M. , Lugo Alessandra
Published: March 2023

The association between current smoking and coronavirus disease 2019 (COVID-19) progression remains uncertain. We aim to provide up-to-date evidence of the role of cigarette smoking in COVID-19 hospitalisation, severity and mortality. On 23 February 2022 we conducted an umbrella review and a traditional systematic reviewviaPubMed/Medline and Web of Science. We used random-effects meta-analyses to derive pooled odds ratios of COVID-19 outcomes for smokers in cohorts of severe acute respiratory syndrome coronavirus 2 infected individuals or COVID-19 patients. We followed the Meta-analysis of Observational Studies in Epidemiology reporting guidelines. PROSPERO: CRD42020207003. 320 publications were included. The pooled odds ratio for currentversusnever or nonsmokers was 1.08 (95% CI 0.98–1.19; 37 studies) for hospitalisation, 1.34 (95% CI 1.22–1.48; 124 studies) for severity and 1.32 (95% CI 1.20–1.45; 119 studies) for mortality. Estimates for formerversusnever-smokers were 1.16 (95% CI 1.03–1.31; 22 studies), 1.41 (95% CI: 1.25–1.59; 44 studies) and 1.46 (95% CI 1.31–1.62; 44 studies), respectively. Estimates for ever-versusnever-smokers were 1.16 (95% CI 1.05–1.27; 33 studies), 1.44 (95% CI 1.31–1.58; 110 studies) and 1.39 (95% CI 1.29–1.50; 109 studies), respectively. We found a 30–50% excess risk of COVID-19 progression for current and former smokers compared with never-smokers. Preventing serious COVID-19 outcomes, including death, seems the newest compelling argument against smoking.
Prevalence, imaging patterns and risk factors of interstitial lung disease in connective tissue disease: a systematic review and meta-analysis
Authors: Joy Greta M. , Arbiv Omri A. , Wong Carmen K. , Lok Stacey D. , Adderley Nicola A. , Dobosz Krzysztof M. , Johannson Kerri A. , Ryerson Christopher J.
Published: March 2023

Introduction

Interstitial lung disease (ILD) is a frequent manifestation of connective tissue disease (CTD) with substantial variability in prevalence and outcomes reported across CTD subtypes. This systematic review summarises the prevalence, risk factors and ILD patterns on chest computed tomography of CTD-ILD.

Methods

A comprehensive search was performed in Medline and Embase to identify eligible studies. Meta-analyses were completed using a random effects model to determine the pooled prevalence of CTD-ILD and ILD patterns.

Results

11 582 unique citations were identified with 237 articles included. Pooled prevalence of ILD was 11% in rheumatoid arthritis (95% CI 7–15%), 47% in systemic sclerosis (44–50%), 41% in idiopathic inflammatory myositis (33–50%), 17% in primary Sjögren's syndrome (12–21%), 56% in mixed connective tissue disease (39–72%) and 6% in systemic lupus erythematosus (3–10%). Usual interstitial pneumonia was the most prevalent ILD pattern in rheumatoid arthritis (pooled prevalence of 46%), while nonspecific interstitial pneumonia was the most common ILD pattern in all other CTD subtypes (pooled prevalence range 27–76%). Across all CTDs with available data, positive serology and higher inflammatory markers were risk factors for development of ILD.

Discussion

We identified substantial variability in ILD across CTD subtypes suggesting that CTD-ILD is too heterogenous to be considered a single entity.
Comprehensive analysis of metabolome and transcriptome reveals the mechanism of color formation in different leave of Loropetalum Chinense var. Rubrum
Authors: Zhang Xia , Zhang Li , Zhang Damao , Su Dingding , Li Weidong , Wang Xiangfei , Chen Qianru , Cai Wenqi , Xu Lu , Cao Fuxiang , Zhang Dongling , Yu Xiaoying , Li Yanlin
Published: March 2023

Background

Loropetalum chinense var. rubrum (L. chinense var. rubrum) is a precious, coloured-leaf native ornamental plant in the Hunan Province. We found an L. chinense var. rubrum tree with three different leaf colours: GL (green leaf), ML (mosaic leaf), and PL (purple leaf). The mechanism of leaf coloration in this plant is still unclear. Therefore, this study aimed to identify the metabolites and genes involved in determining the colour composition of L. chinense var. rubrum leaves, using phenotypic/anatomic observations, pigment content detection, and comparative metabolomics and transcriptomics.

Results

We observed that the mesophyll cells in PL were purple, while those in GL were green and those in ML were a mix of purple-green. The contents of chlorophyll a, b, carotenoids, and total chlorophyll in PL and ML were significantly lower than those in GL. While the anthocyanin content in PL and ML was significantly higher than that in GL. The metabolomics results showed the differences in the content of cyanidin 3-O-glucoside, delphinidin 3-O-glucoside, cyanidin 3,5-O-diglucoside, pelargonidin, and petunidin 3,5-diglucoside in ML, GL, and PL were significant. Considering that the change trend of anthocyanin content change was consistent with the leaf colour difference, we speculated that these compounds might influence the colour of L. chinense var. rubrum leaves. Using transcriptomics, we finally identified nine differentially expressed structural genes (one ANR (ANR1217); four CYP75As (CYP75A1815, CYP75A2846, CYP75A2909, and CYP75A1716); four UFGTs (UFGT1876, UFGT1649, UFGT1839, and UFGT3273) and nine transcription factors (two MYBs (MYB1057 and MYB1211), one MADS-box (MADS1235), two AP2-likes (AP2-like1779 and AP2-like2234), one bZIP (bZIP3720), two WD40s (WD2173 and WD1867) and one bHLH (bHLH1631) that might be related to flavonoid biosynthesis and then impacted the appearance of colour in L. chinense var. rubrum leaves.

Conclusion

This study revealed potential molecular mechanisms associated with leaf coloration in L. chinense var. rubrum by analyzing differential metabolites and genes related to the anthocyanin biosynthesis pathway. It also provided a reference for research on leaf colour variation in other ornamental plants.
Ecological distribution and genetic diversity of Azolla in Uganda
Authors: Lydia Nabyonga , Basamba Twaha A. , Nyakoojo Clement , Mustafa Abubakar Sadik , Saidi Ntambi , Mutumba Gerald M. , Ssenku Jamilu E.
Published: March 2023

Background

Azolla is an important aquatic fern whose agronomic potential has not been fully exploited in Uganda. This study aimed at determining the genetic variation in the Azolla species existing in Uganda and the factors influencing their distribution in the different agro-ecological zones of Uganda. Molecular characterization was preferred in this study because of its efficiency in detecting variations among closely related species.

Results

Four species of Azolla were identified in Uganda with 100, 93.36, 99.22 and 99.39% sequence identities to the reference database sequences of; Azolla mexicana, Azolla microphylla, Azolla filiculoides and Azolla cristata, respectively. These different species were distributed in four out of the ten agro-ecological zones of Uganda which are situated in close vicinity to large water masses. The principal component analysis (PCA) results revealed that maximum rainfall and altitude significantly accounted for the variations in the distribution of Azolla with factor loadings of 0.921 and 0.922, respectively.

Conclusion

Massive destruction coupled with prolonged disturbance of Azolla’s habitat negatively affected its growth, survival and distribution in the country. Therefore, there is a need to develop standard methods that can preserve the various species of Azolla, so as to salvage them for future use, research and reference.
Provision of information by midwives for pregnant women in England on guidance on foods/drinks to avoid or limit
Authors: Beasant Lucy , Ingram Jenny , Tonks Rachel , Taylor Caroline M.
Published: March 2023

Background

The National Health Service (NHS) website gives guidance for pregnant women in England on foods/drinks to avoid or limit because of microbiological, toxicological or teratogenic hazards. These include, for example, some types of soft cheeses, fish/seafood and meat products. This website and midwives are trusted sources of information for pregnant women, but the ways in which midwives can be supported to provide clear and accurate information are unknown.

Aims

The aims were to: (1) determine midwives’ accuracy of recall of information and confidence in delivering the guidance to women; (2) identify barriers to provision; (3) identify the ways in which midwives provide this information to women.

Methods

Registered Midwives practicing in England completed an online questionnaire. Questions included those on what information they provided and their confidence in delivering it, the ways they provided information on foods to avoid/limit, their recall of some of the guidance, and what resources they used. Ethics approval was given by the University of Bristol.

Results

More than 10% of midwives (n = 122) were ‘Not at all confident/Don't know’ in providing advice about ten items, including game meat/gamebirds (42% and 43%, respectively), herbal teas (14%) and cured meats (12%). Only 32% correctly recalled overall advice on eating fish, and only 38% the advice on tinned tuna. The main barriers to provision were lack of time in appointments and lack of training. The most usual methods of disseminating information were verbal (79%) and signposting to websites (55%).

Conclusion

Midwives were often unconfident about their ability to provide accurate guidance, and recall on items tested was frequently mistaken. Delivery of guidance by midwives on foods to avoid or limit needs to be supported by appropriate training and access to resources, and sufficient time in appointments. Further research on barriers to the delivery and implementation of the NHS guidance is needed.
Pregnancy outcomes among Indian women: increased prevalence of miscarriage and stillbirth during 2015–2021
Authors: Kuppusamy Periyasamy , Prusty Ranjan K , Chaaithanya Itta K , Gajbhiye Rahul K , Sachdeva Geetanjali
Published: March 2023

Background

Pregnancy outcome is an important health indicator of the quality of maternal health. Adverse pregnancy outcomes is a major public health problem, which can lead to poor maternal and neonatal outcomes. This study investigates the trends in pregnancy outcomes prevalent during 2015–2021 in Indian women.

Methods

The study analysed the data presented in the fourth (2015-16) and fifth (2019-21) rounds of National Family Health Survey (NFHS). The absolute and relative changes in the birth outcomes of last pregnancy during the five years preceding the surveys were estimated using data collected from 195,470 women in NFHS-4 and from 255,549 women in NFHS-5.

Results

Livebirth decreased by 1.3 points (90.2% vs. 88.9%), and nearly half of the Indian states/UTs (n = 17/36) had lower than the national average of livebirth (88.9%) reported during 2019-21. A higher proportion of pregnancy loss was noted, particularly miscarriages increased in both urban (6.4% vs. 8.5%) and rural areas (5.3% vs. 6.9%), and stillbirth increased by 28.6% (0.7% vs. 0.9%). The number of abortions decreased (3.4% vs. 2.9%) among Indian women. Nearly half of the abortions were due to unplanned pregnancies (47.6%) and more than one-fourth (26.9%) of abortions were performed by self. Abortions among adolescent women in Telangana was eleven times higher during 2019-21 as compared to 2015-16 (8.0% vs. 0.7%).

Conclusion

Our study presents evidence of a decrease in the livebirth and an increase in the frequency of miscarriage and stillbirth among Indian women during 2015–2021. This study emphasises that there is a need of regional-specific, comprehensive and quality maternal healthcare programs for improving livebirth among Indian women.
Evaluating prognostic value and stage migration effects using a positive lymph node ratio in adenocarcinoma of the esophagogastric junction
Authors: Kamiya Hajime , Komatsu Shuhei , Nishibeppu Keiji , Ohashi Takuma , Konishi Hirotaka , Shiozaki Atsushi , Kubota Takeshi , Fujiwara Hitoshi , Okamoto Kazuma , Otsuji Eigo
Published: March 2023

Background

Adenocarcinoma of the esophagogastric junction (AEG) is increasing worldwide. Lymph node metastasis is an important clinical issue in AEG patients. This study investigated the usefulness of a positive lymph node ratio (PLNR) to stratify prognosis and evaluate stage migration.

Methods

We retrospectively analysed 117 consecutive AEG patients (Siewert type I or II) who received a lymphadenectomy between 2000 and 2016.

Results

A PLNR cut-off value of 0.1 most effectively stratified patient prognosis into two groups (P < 0.001). Also, prognosis could be clearly stratified into four groups: PLNR = 0, 0 < PLNR < 0.1, 0.1 ≤ PLNR < 0.2, and 0.2 ≤ PLNR (P < 0.001, 5-year survival rates (88.6%, 61.1%, 34.3%, 10.7%)). A PLNR ≥ 0.1 significantly correlated with tumour diameter ≥ 4 cm (P < 0.001), tumour depth (P < 0.001), greater pathological N-status (P < 0.001), greater pathological Stage (P < 0.001), and oesophageal invasion length ≥ 2 cm (P = 0.002). A PLNR ≥ 0.1 was a poor independent prognostic factor (hazard ratio 6.47, P < 0.001). The PLNR could stratify prognosis if at least 11 lymph nodes were retrieved. A 0.2 PLNR cut-off value discriminated a stage migration effect in pN3 and pStage IV (P = 0.041, P = 0.015) patients; PLNR ≥ 0.2 might potentially diagnose a worse prognosis and need meticulous follow-up post-surgery.

Conclusion

Using PLNR, we can evaluate the prognosis and detect higher malignant cases who need meticulous treatments and follow-up in the same pStage.
Pediatric sleep-disordered breathing in Shanghai: characteristics, independent risk factors and its association with malocclusion
Authors: Li Yuanyuan , Tong Xianqin , Wang Shuai , Yu Liming , Yang Gang , Feng Jinqiu , Liu Yuehua
Published: March 2023

Objectives

This study aimed to determine the prevalence and independent risk factors of SDB, and explore its association with malocclusion among 6–11-year-old children in Shanghai, China.

Methods

A cluster sampling procedure was adopted in this cross-sectional study. Pediatric Sleep Questionnaire (PSQ) was applied to evaluate the presence of SDB. Questionnaires including PSQ, medical history, family history, and daily habits/environment were completed by parents under instruction, and oral examinations were implemented by well-trained orthodontists. Multivariable logistic regression was applied to identify independent risk factors for SDB. Chi-square tests and Spearman's Rank Correlation were used to estimate the relationship between SDB and malocclusion.

Results

A total of 3433 subjects (1788 males and 1645 females) were included in the study. The SDB prevalence was about 17.7%. Allergic rhinitis (OR 1.39, 95% CI 1.09–1.79), adenotonsillar hypertrophy (OR 2.39, 95% CI 1.82–3.19), paternal snoring (OR 1.97, 95% CI 1.53–2.53), and maternal snoring (OR 1.35, 95% CI 1.05–1.73) were independent risk factors for SDB. The SDB prevalence was higher in children with retrusive mandibles than in proper or excessive ones. No significant difference was observed in the correlation between SDB and lateral facial profile, mandible plane angle, constricted dental arch form, the severity of anterior overjet and overbite, degree of crowding and spacing, and the presence of crossbite and open bite.

Conclusions

The prevalence of SDB in primary students in the Chinese urban population was high and highly associated with mandible retrusion. The independent risk factors included Allergic rhinitis, adenotonsillar hypertrophy, paternal snoring, and maternal snoring. More efforts should be made to enhance public education about SDB and related dental-maxillofacial abnormalities.
Does intra-articular injection of tenoxicam after arthrocentesis heal outcomes of temporomandibular joint osteoarthritis? A randomized clinical trial
Authors: Bayramoglu Zeynep , Yavuz Günay Yapici , Keskinruzgar Aydın , Koparal Mahmut , Kaya Göksel Simsek
Published: March 2023

Background

Temporomandibular joint osteoarthritis (TMJ-OA) is a degenerative disease and manifests itself with pain and limitation of movement in the jaws. Arthrocentesis alone or in combination with intraarticular injections is one of the most commonly used treatment methods in these patients. The aim of the study is to examine the effectiveness of arthrocentesis plus tenoxicam injection and to compare it with arthrocentesis alone in patients with TMJ-OA.

Methods

Thirty patients with TMJ-OA who were treated randomly with either arthrocentesis plus tenoxicam injection (TX group) or arthrocentesis alone (control group) were examined. Maximum mouth opening (MMO), visual analog scale (VAS) pain values, and joint sounds were the outcome variables, which were evaluated at pre-treatment and at 1, 4, 12, and 24 weeks after treatment. Statistical significance was set at p < 0.05.

Results

The gender distribution and mean age were not significantly different between the two groups. Pain values (p < 0.001), MMO (p < 0.001), and joint sounds (p < 0.001) improved significantly in both groups. However, there was no significant difference between the groups in terms of outcome variables [pain (p = 0.085), MMO (p = 0.174), joint sounds (p = 0.131)].

Conclusions

Arthrocentesis plus tenoxicam injection showed no better outcomes in terms of MMO, pain, and joint sounds compared with arthrocentesis alone in patients with TMJ-OA.

Trial registration

Injection of Tenoxicam Versus Arthrocentesis Alone in the Treatment of Temporomandibular Joint Osteoarthritis, NCT05497570. Registered 11 May 2022.

Retrospectively registered, https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000CD7A&selectaction=Edit&uid=U0006FC4&ts=6&cx=f3anuq