bluuebunny/crossref_metadata_2025 huggingface dataset:
Efficacy of a Standalone Microporous Ceramic Versus Autograft in Instrumented Posterolateral Spinal Fusion
Authors: Lehr A. Mechteld , Oner F. Cumhur , Delawi Diyar , Stellato Rebecca K. , Hoebink Eric A. , Kempen Diederik H.R. , van Susante Job L.C. , Castelein René M. , Kruyt Moyo C.
Published: February 2020

Study Design.

in the rest of the article written as patient- and observer-blinded, multicenter, randomized, intrapatient controlled, noninferiority trial.

Objective.

The aim of this study was to determine noninferiority of a biphasic calcium-phosphate (AttraX® Putty) as a bone graft substitute for autograft in instrumented posterolateral fusion (PLF).

Summary of Background Data.

Spinal fusion with autologous bone graft is a frequently performed surgical treatment. Several drawbacks of autografting have driven the development of numerous alternatives including synthetic ceramics. However, clinical evidence for the standalone use of these materials is limited.

Methods.

This study included 100 nontraumatic adults who underwent a primary, single- or multilevel, thoracolumbar, instrumented PLF. After instrumentation and preparation for grafting, the randomized allocation side of AttraX® Putty was disclosed. Autograft was applied to the contralateral side of the fusion trajectory, so each patient served as his/her own control. For the primary efficacy outcome, PLF was assessed at 1-year follow-up on computed tomography scans. Each segment and side was scored as fused, doubtful fusion, or nonunion. After correction for multilevel fusions, resulting in a single score per side, the fusion performance of AttraX® Putty was tested with a noninferiority margin of 15% using a 90% confidence interval (CI).

Results.

There were 49 males and 51 females with a mean age of 55.4 ± 12.0 (range 27–79) years. Two-third of the patients underwent a single-level fusion and 62% an additional interbody fusion procedure. The primary analysis was based on 87 patients, including 146 instrumented segments. The fusion rate of AttraX® Putty was 55% versus 52% at the autograft side, with an overall fusion rate of 71%. The 90% CI around the difference in fusion performance excluded the noninferiority margin (difference = 2.3%, 90% CI = −9.1% to +13.7%).

Conclusion.

The results of this noninferiority trial support the use of AttraX® Putty as a standalone bone graft substitute for autograft in instrumented thoracolumbar PLF.

Level of Evidence: 1
Asymptomatic ACDF Nonunions Underestimate the True Prevalence of Radiographic Pseudarthrosis
Authors: Crawford Charles H. , Carreon Leah Y. , Mummaneni Praveen , Dryer Randall F. , Glassman Steven D.
Published: February 2020

Study Design.

Secondary analysis of subjects in the control anterior cervical discectomy and fusion (ACDF) arm of Medtronic Investigational Device Exemption (IDE) trials for cervical disc arthroplasty (CDA).

Objectives.

To compare patient-reported outcomes (PROs) in patients with radiographic nonunion to patients with a solid fusion.

Summary of Background Data.

The true prevalence of nonunion after ACDF is unknown. Nonunion may be under-reported, as some patients are not symptomatic enough to justify radiographic evaluation.

Methods.

Three hundred forty-five subjects enrolled in the control arm of IDE trials for CDA who had single-level ACDF with allograft and plate with 24 month data formed the study cohort. Using the 24-month postop evaluation, subjects were divided into those who had radiographic fusion and those who did not using strict study criteria. SF-36, NDI, Neck and Arm pain NRS scores were reported at 12, 24, 36, 60, and 84 months postop. For subjects who had secondary surgery failures, the last observations before the secondary surgery were carried forward to future visits for the analysis.

Results.

Forty-four (13%) patients had radiographic nonunion and 301 (87%) were fused at 24 months postop. At 24 months, PROs were similar between the two groups. Seven patients in the Nonunion group (16%) and 10 (3%) in the Fused group had additional surgery at the index level prior to the 24 follow-up (P = 0.003). Over the 84-month follow-up a total of 9 patients in the Nonunion group (21%) and 22 (7%) in the Fused group had additional surgery at the index level (P = 0.009).

Conclusion.

While the radiographic nonunion rate at 24 months was 13%, PROs show that many of the radiographic nonunions were asymptomatic. Although the majority of patients with radiographic nonunion did not undergo additional surgery, the rate of secondary surgeries at the index level was significantly higher in the radiographic nonunion group.

Level of Evidence: 2
Multidirectional Y-V Flap Capsulorrhaphy in Hallux Valgus Surgery
Authors: Renehan John R. , Dean Daniel M. , Cascells Nicholas D. , Cooper Paul S.
Published: February 2020

Although there are a number of techniques to address osseous deformity in hallux valgus surgery, the lateral soft tissue release and medial capsulorrhaphy are also important to a successful correction. Rebalancing the deforming forces is integral to a durable correction. We describe a new technique of multidirectional medial capsulorrhaphy that allows the surgeon to balance the soft tissue reliably in the coronal, sagittal, and axial planes. This described technique utilizes a Y-V flap configuration with multiple anchor points that can be tailored to the optimal tension and rotation to suit the individual deformity. Proper tensioning of the flap produces soft tissue balance and reduction of the sesamoids that is readily apparent with fluoroscopy. The technique is simple to perform and reproduce, and can be easily adopted and applied to any open hallux valgus procedure.

Level of Evidence: Diagnostic Level V.
Upregulated LEPRE1 correlates with poor outcome and its knockdown attenuates cells proliferation, migration and invasion in osteosarcoma
Authors: Huang Zhanguo , Wang Qiang , Wang Yingying , Zhao Lei , Cao Zhong , Cui Cunbao , Yu Dapeng , Liu Bo
Published: February 2020

Leucine proline-enriched proteoglycan 1 has been extensively explored because of its protective function in cell homeostasis and correlation with osteogenesis imperfect. Human osteosarcoma is the most common primary malignant tumor of bone with multiple and complex genomic aberrations. However, the functional role of leucine proline-enriched proteoglycan 1 is still unknown in osteosarcoma. Thus we performed this study to explain the leucine proline-enriched proteoglycan 1 effect in osteosarcoma. Gene arrays of human osteosarcoma were downloaded from the Gene Expression Omnibus database. Quantitative real-time PCR was conducted to assess the expression of leucine proline-enriched proteoglycan 1 in osteosarcoma cell lines. Then we attenuated leucine proline-enriched proteoglycan 1 expression in MG63 cells by siRNA strategy and assessed the effect of leucine proline-enriched proteoglycan 1 on cell proliferation, migration and invasion through in-vitro experiments. Additionally, we detected the role of leucine proline-enriched proteoglycan 1 knockdown on PI3K/AKT pathway-related proteins using western blotting. Leucine proline-enriched proteoglycan 1 was increased in osteosarcoma tissues and cells. The overall survival curve demonstrated that high-regulated leucine proline-enriched proteoglycan 1 was linked with poor prognosis of patients with osteosarcoma. The capabilities of proliferation, migration and invasion were all inhibited in MG63 cell because of the downregulation of leucine proline-enriched proteoglycan 1. Furthermore, the expression of phosphorylated PI3K and AKT was impaired after knockdown the leucine proline-enriched proteoglycan 1 as well as P70S6K. In conclusion, leucine proline-enriched proteoglycan 1 might function as an important therapeutic factor in human osteosarcoma through regulating the PI3K/AKT signaling pathway.
Investigation of the cytotoxic activity of two novel digitoxigenin analogues on H460 lung cancer cells
Authors: Boff Laurita , Persich Lara , Brambila Paula , Ottoni Flaviano Melo , Munkert Jennifer , Ramos Gabriela Silva , Soares Viana Adhônis Rodrigues , Kreis Wolfgang , Braga Fernão Castro , Alves Ricardo José , Maia de Pádua Rodrigo , Schneider Naira Fernanda Zanchett , Oliveira Simões Cláudia Maria
Published: February 2020

Cardiac glycosides (CGs) are natural compounds traditionally used for the treatment of heart disorders, and recently new therapeutic possibilities were proposed. Their antitumor reports and clinical trials have notably enhanced, including those targeted for lung cancer, the most lethal type that lacks of new treatment agents, instigating the research of these molecules. The CGs studied here, named C10 {3β-[(N-(2-hydroxyethyl)aminoacetyl]amino-3-deoxydigitoxigenin} and C18 (3β-(aminoacetyl)amino-3-deoxydigitoxigenin), are semisynthetic derivatives prepared from digitoxigenin scaffold. Both compounds demonstrated high cytotoxicity for different cancer cell lines, especially H460 lung cancer cells, and their cytotoxic effects were deeply investigated using different methodological approaches. C10 induced cell death at lower concentrations and during shorter periods of treatment than C18, and increased the number of small and irregular nuclei, which are characteristics of apoptosis. This type of cell death was confirmed by caspase-3/7 assay. Both compounds reduced H460 cells proliferative potential by long-term action, and C10 showed the strongest potential. Moreover, these compounds induced a significant decrease of the area and viability of H460 spheroids providing preclinical favorable profiles to develop new chemotherapeutic agents.
A 3D screening approach identifies the compound epitajixanthone hydrate as a new inhibitor of cancer cell growth and invasion
Authors: Yang Sheng-Xiang , Xiao Jing-Fang , Liu Ting-Kai , Huang Ze-Diao , Li Xiang , Chen Ye-Miao , Yang Xiao-Long
Published: February 2020

With unique advantages, the small-molecule anticancer drugs have recently gained growing attention. Particular strategies, exemplified by high-throughput screening, fragment-based drug discovery, virtual screening and knowledge-based design, have been developed to identify active compounds. However, such screens generally rely on sophisticated and expensive instrumentations. Herein, we developed a simple spheroids 3D culture system to enable direct screening of small molecules with reliable results. Using this system, we screened 27 fungal natural products and three fungal crude extracts for their inhibitory effects on cancer cell growth, and invasion. We identified that the compound M23 (epitajixanthone hydrate, a derivative of prenylxanthone) and the crude extracts (MPT-191) from the fungi Taxus chinensis showed potential anticancer activity. The effect of epitajixanthone hydrate on cancer cell growth and invasion were further confirmed by the assays of cells viability, trans-well migration and invasion, colony formation and cells reattachment. Overall, Epitajixanthone hydrate was identified as an effective inhibitor of cancer cell growth and invasion by our simple and fast screening platform.
Pembrolizumab Treatment and Pathologic Therapeutic Evaluation for Granulocyte Colony-stimulating Factor-producing Bladder Cancer: A Case Report and Literature Review
Authors: Muramatsu-Maekawa Yuka , Taniguchi Tomoki , Ito Hiroki , Nakane Keita , Kato Taku , Tsuchiya Tomohiro , Miyazaki Tatsuhiko , Koie Takuya , Mizutani Kosuke
Published: February 2020

Granulocyte colony-stimulating factor (G-CSF)-producing bladder cancer is a rare variant subtype of bladder cancer with a poor prognosis. Pembrolizumab has improved overall survival in bladder cancer and is widely used as a standard second-line treatment. However, no reports on G-CSF-producing cancer treated by pembrolizumab are available. We report a case of the pathologically evaluated antitumor effect of pembrolizumab, a programmed death-1 immune checkpoint inhibitor antibody, in G-CSF-producing bladder cancer. A 53-year-old male patient underwent 4 courses chemotherapy with a combination of gemcitabine and carboplatin before a radical cystectomy with ileal neobladder. Four months after the surgery, local recurrence was detected in the pelvis and therefore pembrolizumab was used. One week after its administration, the patient showed increased mucus in his urine. A computed tomography scan and cystoscopy revealed a fistula between the ileum and the neobladder. He subsequently underwent partial ileectomy and repair of the neobladder-ileum fistula. Pathology-diagnosed tumor response to pembrolizumab in the metastatic tumor showed predominant infiltration by lymphocytes, unlike that in the primary bladder cancer. The patient has shown complete response and no recurrence at 1 year after the beginning of treatment, and therapy is still continuing. Although many questions still remain regarding the treatment of G-CSF-producing bladder cancer, pathologic evaluation of the present case suggests that treatment with pembrolizumab may be one option for G-CSF-producing bladder cancer that has failed chemotherapy treatment, similar to non-G-CSF-producing bladder cancer.
Brief Communication: Immune Checkpoint Inhibitor-induced Diaphragmatic Dysfunction: A Case Series
Authors: Archibald William J. , Anderson Dagny K. , Breen Thomas J. , Sorenson Karl R. , Markovic Svetomir N. , Blauwet Lori A.
Published: February 2020

Diaphragmatic dysfunction is a rare cause of dyspnea that can lead to hypercapnic respiratory failure. A variety of causes of diaphragmatic dysfunction have been identified, including myopathies and neuropathies, the latter of which can be further subdivided into infectious, idiopathic, demyelinating, malignant, and iatrogenic etiologies. Now, in the era of immune checkpoint inhibitors (ICIs), case reports of immune-mediated phrenic nerve palsies have been described. This diagnosis can be challenging to make, as dyspnea is a common presenting complaint and immune-mediated palsy of the phrenic nerve is a rarely described complication of ICI therapy. At Mayo Clinic, 3 patients with diaphragmatic dysfunction in the setting of ICI therapy were successfully treated without mortality. This case series describes the presentation, diagnoses, and management of these patients and their clinical outcomes.
Application of Cannabinoids in Neurosciences
Authors: Owusu Kent A. , Saliba Lina , Ammar Abdalla A. , Ammar Mahmoud A. , Mucksavage Jeffrey
Published: February 2020

Medicinal cannabinoid use continues to evolve across the United States, although legitimate federal recognition for medicinal purpose is lacking. Variability exists across states within the United States with respect to legislation, and health care institutions encounter challenges when patients present with a history of medicinal cannabinoid use. Emerging evidence in the field of neurosciences suggests a role of cannabinoids for neurologic medical conditions such as Parkinson disease, multiple sclerosis, and epilepsy. We aim to provide an overview of cannabinoids including a historical perspective, pharmacology, applications in neurosciences, and challenges in health care and academia. Knowledge of the appropriate role of cannabinoids in the clinical setting is essential for all health care practitioners including nursing.
Opiate Dependence
Authors: Khouzam Nour , Gelberg Lillian , Guo Rong , Tseng Chi-Hong , Bhattacharya Debika
Published: February 2020

The prevalence of hepatitis B virus (HBV) in the homeless population is underestimated despite multiple behavioral risks. Data from a sample of 534 homeless adults from downtown Los Angeles were analyzed to examine the prevalence and predictors of HBV infection in this community. The prevalence of HBV was 7 to 10 times higher than in the US general population rate. Opiate dependence, injection and noninjection use, was an independent predictor of HBV exposure. Testing and counseling occurred at significantly lower rates for HBV than for human immunodeficiency virus. Findings emphasize the need to enhance screening and counseling in homeless communities and other populations with opiate use.
Case Management and Capacity Building to Enhance Hepatitis C Treatment Uptake at Community Health Centers in a Large Urban Setting
Authors: Boodram Basmattee , Kaufmann Maggie , Aronsohn Andrew , Hamlish Tamara , Peregrine Antalis Erin , Kim Kristine , Wolf Jill , Rodriguez Isa , Millman Alexander J. , Johnson Daniel
Published: February 2020

An estimated 4.1 million people in the United States are infected with hepatitis C virus (HCV). In 2014, the Hepatitis C Community Alliance to Test and Treat (HepCCATT) collaborative was formed to address hepatitis C in Chicago. From 2014 to 2017, the HepCCATT Case Management Program case managed 181 HCV-infected people and performed on-site capacity building at a 6-site community health center (CHC) that produced codified protocols, which were translated into a telehealth program to build capacity within CHCs to deliver hepatitis C care. HepCCATT's innovative approach to addressing multilevel barriers is a potential model for increasing access to hepatitis C care and treatment.
Case–Control Study on the Interaction Effects of rs10757278 Polymorphisms at 9p21 Locus and Traditional Risk Factors on Coronary Heart Disease in Xinjiang, China
Authors: Lu Wu-Hong , Zhang Wen-Qian , Zhao Yun-Juan , Gao Ya-Ting , Tao Ning , Ma Yi-Tong , Liu Ji-Wen , Wulasihan Muhuyati
Published: February 2020

Objective:

To study the interaction effects of rs10757278 polymorphisms at 9p21 locus and traditional risk factors on coronary heart disease (CHD) in Xinjiang, China.

Methods:

This case–control study consecutively enrolled 310 unrelated consecutive CHD patients aged 18–70 years old. All study participants were recruited between January and December 2017 from The Heart Center of The First Affiliated Hospital of Xinjiang Medical University. CHD patients were confirmed by coronary angiography (≥50% diameter stenosis in at least one of the major coronary arteries) according to the American Heart Association criteria for the confirmation of CHD. Healthy subjects were randomly selected from the occupational population, who received physical examination in our hospital and matched to cases on the basis of age (±3 years) and sex, those without medical history of cardiovascular diseases, and 536 subjects were selected as the control group after medical history inquiry, physical examination, cardiac ultrasound, electrocardiogram, and other blood biochemical examinations in the hospital. The occupational stress was evaluated by an effort-reward imbalance questionnaire. An epidemiological survey was conducted to collect clinical data. Chi-squared test, analysis of variance, and binary logistic regression analysis were adopted.

Results:

Both the case and the control groups showed significant difference in smoking, drinking, physical activity, hypertension, diabetes mellitus, family history of CHD, and body mass index (BMI) (all P < 0.05); prevalence of CHD was not related to occupational stress. There was no significant difference in occupational stress level between the 2 groups (P > 0.05); Differences in rs10757278 genotype between the case group and the control groups were statistically significant; binary logistic regression analysis was used to evaluate the risk factors of CHD. After adjustment for age and sex, significant increased risk effects for CHD were found to be associated with smoking [odds ratio (OR) = 2.311; 95% confidence interval (CI): 1.04–2.499; P < 0.001], physical exercise (OR = 1.365; 95% CI: 1.137–1.639; P < 0.001), hypertension (OR = 4.627; 95% CI: 2.165–10.764; P < 0.001), family history of CHD (OR = 4.103; 95% CI: 3.169–6.892; P < 0.001), BMI (OR = 2.484; 95% CI: 2.036–3.03; P < 0.001), and GG genotype at rs10757278 (OR = 1.978; 95% CI: 1.413–2.769; P < 0.001); We noted that a significant interaction association between GG genotype at rs10757278 and CHD differs across categories of smoking, hypertension, family history of CHD, and BMI.

Conclusion:

GG genotype at rs10757278 may be a risk factor for CHD. And there are interaction effects between GG genotype of rs10757278 in region 9p21 gene and traditional risk factors.
Quantification of 3-Hydroxypropyl Mercapturic Acid in the Urine of Patients with Breast Cancer to Monitor Cyclophosphamide Toxicity
Authors: Harahap Yahdiana , Yanuar Arry , Muhammad Cyril , Melhan Madeline , Purwanto Denni Joko
Published: February 2020

Background:

The alkylating agent cyclophosphamide is used in chemotherapy regimens for various type of cancer. However, cyclophosphamide may lead to toxic side effects on the bladder, namely hemorrhagic cystitis, which can cause hematuria, and, potentially, bladder cancer. These effects are caused by acrolein, a byproduct of cyclophosphamide metabolism. In this study, a method to quantify 3-hydroxypropyl mercapturic acid (3-HPMA) in urine was developed. 3-HPMA is a stable metabolite of acrolein that serves as biomarker of acrolein.

Methods:

Urine samples were collected 4 hours after cyclophosphamide administration and analyzed to determine the risk of hematuria. 3-HPMA was analyzed by reverse-phase LC-MS/MS using a triple quadrupole electrospray ionization mass spectrometer in the positive-ion mode. The mobile phase was a 90:10 (vol/vol) mixture of 0.1% formic acid in water and 0.1% formic acid in acetonitrile. Multiple reaction monitoring mode was used, with m/z 222.10 → 90.97 for 3-HPMA and 164.10 → 122.02 for the internal standard N-acetyl cysteine (NAC). Samples were prepared by acidification and dilution.

Results:

The analytical method produced a linear response within the concentration range of 40–10,000 ng/mL. The method was validated in accordance with 2018 FDA guidelines and applied to quantify 3-HPMA in the urine of 40 patients with breast cancer. The measured concentrations ranged from 820.3 to 5596.1 ng/mg creatinine. Seven patients identified with hematuria had low 3-HPMA concentrations of 4445.824 ± 411.17 ng/mg creatinine, and 33 patients without hematuria had low 3-HPMA concentrations of 2419.4 ± 1171.8 ng/mg creatinine.

Conclusions:

The method was applicable for the quantification of 3-HPMA in human urine. Large variations in 3-HPMA concentrations were found in 40 patients with breast cancer treated with cyclophosphamide, with a significant difference (P < 0.05) observed between patients with hematuria and those without hematuria.
Patient-specific instruments in the treatment of ilium intraosseous lipoma: a case report
Authors: Wang Yin , Wang XingBo , Song JianMin
Published: February 2020

Introduction:

Intraosseous lipoma is one of the rarest primary bone tumors, the most commonly involved site are the calcaneus and the metaphysis of long bone. This study reports a very rare symptomatic intraosseous lipoma of the ilium. First, we performed a pathologic examination and found an intraosseous lipoma. Then, we made a 3-dimensional model of the pelvis and a patient-specific instruments (PSIs). We removed the tumor on the basis of PSIs. The tumor was precisely excised.

Conclusions:

Surgical treatment is recommended for symptomatic intraosseous lipomas. PSIs technology can be used for better preoperative planning, providing a new method for individualized treatment of patients with bone tumors.
Foot Salvage with Selective Arterialization of Pedal Venosomes
Authors: Effendi Maleeh , Ha Austin Y. , Felder John M.
Published: February 2020

Background:

Lower extremity salvage using microvascular flaps can be considered in high-functioning patients, but indications for salvage are often restricted by distal microvascular disease that may threaten the foot as a whole. Selective arterialization of specific pedal venosomes is a novel potential solution to this problem.

Methods:

A 48-year-old man with a chronic left plantar forefoot wound, osteomyelitis of the second and third metatarsal heads, and critical limb ischemia was evaluated for foot salvage. Despite a patent popliteal to posterior tibial bypass graft, residual ischemia was present in the first and second toes due to severe microvascular disease. This wound was reconstructed with a free partial medial rectus abdominis flow-through flap based on the medial branch of the deep inferior epigastric artery. The lateral branch was used as a flow-through vessel to arterialize the dorsal veins of the first webspace.

Results:

Arterialization of the first webspace veins resulted in an immediate intraoperative improvement of the color of the first and second toes, along with creation of an arterial Doppler signal. The flap effectively covered the wound. The patient went on to heal completely and return to unrestricted ambulation. Transcutaneous oxygen measurement values of the dorsal foot improved from 35.8 mm Hg preoperatively to 48.3 mm Hg postoperatively.

Conclusions:

In patients with focal areas of critical ischemia, selective arterialization of the venous system may be an effective method of preventing tissue loss and improving wound healing. A flow-through flap can be used to accomplish this in tandem with wound reconstruction.
Comparative Severity of Influenza A and B Infections in Hospitalized Children
Authors: Mattila Janna-Maija , Vuorinen Tytti , Heikkinen Terho
Published: February 2020

Background:

Influenza A viruses are conventionally thought to cause more severe illnesses than B viruses, but few studies with long observation periods have compared the clinical severity of A and B infections in hospitalized children.

Methods:

We analyzed the clinical presentation, outcomes and management of all children <16 years of age admitted to Turku University Hospital, Finland, with virologically confirmed influenza A or B infection during the 14-year period of 1 July 2004 to 30 June 2018. All comparisons between influenza A and B were performed both within predefined age groups (0–2, 3–9 and 10–15 years) and in all age groups combined.

Results:

Among 391 children hospitalized with influenza A or B infection, influenza A was diagnosed in 279 (71.4%) and influenza B in 112 (28.6%) children. Overall, there were no significant differences in any clinical features or outcomes, management, treatment at intensive care unit or length of stay between children with influenza A and B, whether analyzed by age group or among all children. As indicators of the most severe clinical presentations, blood cultures were obtained from 101 (36.2%) children with influenza A and 39 (34.8%) with influenza B (P = 0.80), and lumbar puncture was performed to 16 (5.7%) children with influenza A and 11 (9.8%) children with influenza B (P = 0.15).

Conclusions:

The clinical severity of influenza A and B infections is similar in children. For optimal protection against severe influenza illnesses, the use of quadrivalent vaccines containing both lineages of B viruses seems warranted in children.
Assessment of the Urinary Microbiome in Children Younger Than 48 Months
Authors: Kinneman Lauren , Zhu Wei , Wong Wendy S.W. , Clemency Nicole , Provenzano Marina , Vilboux Thierry , Jane’t Keary , Seo-Mayer Patricia , Levorson Rebecca , Kou Maybelle , Ascher David , Niederhuber John E. , Hourigan Suchitra K.
Published: February 2020

Background:

The urinary tract was once thought to be sterile, and little is known about the urinary microbiome in children. This study aimed to examine the urinary microbiome of young children across demographic and clinical factors.

Methods:

Children <48 months, undergoing a urinary catheterization for clinical purposes in the Pediatric Emergency Department were recruited and urine samples collected. Detailed demographic and clinical information were recorded. Urine samples underwent DNA extraction and 16S ribosomal RNA gene sequencing, urinalysis and urine culture.

Results:

Eighty-five children were included; a urinary microbiome was identified in every child. Nine children had Escherichia coli urinary tract infections (UTIs) identified. Those with UTIs had a significantly decreased alpha diversity (t test, P < 0.001) and the composition of the microbiome clustered separately (P = 0.001) compared with those without UTIs.

Conclusions:

A urinary microbiome was identified in every child, even neonates. Differences in microbiome diversity and composition were observed in patients with a standard culture positive UTI. The urinary microbiome has just begun to be explored, and the implications on long-term disease processes deserve further investigation.
Microarray Analysis of Group B Streptococci Causing Invasive Neonatal Early- and Late-onset Infection
Authors: Zürn Katharina , Lander Fabian , Hufnagel Markus , Monecke Stefan , Berner Reinhard
Published: February 2020

Background:

Group B Streptococcus is the leading cause of meningitis and sepsis in newborns. Until now, there is no data of fast and simple typing of group B Streptococcus virulence factors using a genetic microarray and comparing these data to clinical manifestations.

Methods:

A prospective active surveillance study was conducted via 2 independent and nationwide reporting systems, the German Pediatric Surveillance Unit (ESPED) and the Laboratory Sentinel Group at Robert Koch-Institute. Surveillance was performed between 2001 and 2003 and between 2008 and 2010. Typing of virulence factors, serotypes, pilus islands and alpha-like proteins was done by means of a newly developed microarray method.

Results:

We evaluated 475 isolates of invasive neonatal infections. Predominant virulence factors were serotype III (63%), pilus island 2b and pilus island 1 (50%) and alp rib (64%) (alp - alpha-like protein, rib -resistance to proteases, immunity, group B). There was no significant change over time or geographically within Germany. Serotype III, pilus island 2b + 1 and alp rib showed significant associations with late-onset disease and meningitis, whereas alp 5 had a significant association with early-onset disease. Based on serotypes, pilus islands and alpha-like proteins, it was possible to cluster 86% of all isolates into 5 genetic groups.

Conclusions:

The molecular epidemiology of a large collection of invasive neonatal infections showed similar distributions, as shown in smaller cohorts before. The microarray used proved to be a fast and reliable technique. Using this new tool, we were able to cluster the isolates according to their virulence factors. The clusters showed a better association with clinical data than single virulence factors.
Recurrent intraocular inflammation after cataract surgery associated with retained lint fiber
Authors: Athota Prashanth Kumar , Yekollu Srinivasulu Reddy , Raju Vadrevu K. , Kheirkhah Ahmad
Published: February 2020

A 65-year-old woman had manual small-incision cataract surgery. Postoperatively, she developed 2 episodes of significant postoperative intraocular inflammation involving the anterior chamber and vitreous. The vitreous biopsy was negative for infectious etiology in both episodes. She later was found to have a retained lint fiber in the eye located over the posterior capsule. After removing the fiber, there was no recurrence of the inflammation. This case report suggested that retained lint, most often cotton fiber, which is introduced into the eye during cataract surgery, may be associated with postoperative intraocular inflammation. Therefore, measures should be taken before and during surgery to avoid the fibers entering the eye.
Development of Fertility Preparedness Scale for Women Receiving Fertility Treatment
Authors: FATA Sevcan , ALUŞ TOKAT Merlinda
Published: February 2020

Background

Stress has a negative impact on fertility by suppressing the secretion of fertility hormones. Although it is known that stress reduces the probability of conception and affects fertility negatively, scales that are now widely used to evaluate fertility preparedness include negative items. Positive statements are crucial to relieving stress in women. Using positive items in assessments of fertility preparedness in women may help reduce related stress.

Purpose

This study was designed to develop the Fertility Preparedness Scale for women receiving fertility treatments.

Methods

A methodological study was conducted in four fertility clinics between December 2015 and March 2016. Two hundred thirty women who had been diagnosed with primary or secondary infertility were enrolled as participants. A personal information form and the Fertility Preparedness Scale were used to collect data.

Results

The Cronbach's alpha was .84 for the total scale and .76–.79 for the subscales. Factor analysis extracted three subscales that explained 52.93% of the total variance. The confirmatory factor analysis found a goodness of fit index of .80, a comparative fit index of .95, and a nonnormed fit index of .94.

Conclusions/Implications for Practice

This scale is valid and reliable for measuring the fertility preparedness of women who receive fertility treatment.
Spinal fusion in facioscapulohumeral dystrophy for hyperlordosis
Authors: Eren İlker , Abay Berk , Günerbüyük Caner , Çakmak Özgür Öztop , Şar Cüneyt , Demirhan Mehmet
Published: February 2020

Rationale:

Facioscapulohumeral muscular dystrophy (FSHD) is the third most common muscular dystrophy, which is associated with facial, shoulder girdle, and paraspinal muscle atrophy. Most of the patients develop hypokyphosis and hyperlordosis in the course of the disease, to preserve standing posture. Corrective fusion is contraindicated in these patients as the surgery results with loss of compensatory hyperlordosis and leads to loss of trunk balance while standing. Although spinal fusion in neuromuscular scoliosis is a known treatment option, there are no studies in the literature on the spinal fusion of this specific patient group.

Patient concerns:

In this case report we have presented a 66-year-old woman, who was admitted with back and abdominal pain, inability to sit straight, abdominal discomfort, and numbness in the lower extremities after prolonged sitting.

Diagnoses:

The patient developed severe hyperlordosis causing intra-abdominal disorders, radicular symptoms, and sitting discomfort due to FSHD.

Interventions:

The patient underwent T2–S1 fusion and successful fusion was achieved.

Outcomes:

Individualized Neuromuscular Quality of Life Questionnaire (INQoL) was used to assess preoperative and 3 years postoperative functional outcomes. All domains and total score improved at the end of the follow-up period and successful fusion was verified radiologically.

Lessons:

This case suggests that spinal fusion may provide functional improvement in carefully selected patient groups. Patient stratification considering spinal disability is required for further studies in this specific indication.
Cemented versus uncemented hemi-arthroplasty for femoral neck fractures in elderly patients
Authors: Li Na , Zhong Lei , Wang Chang , Xu Meng , Li Wei
Published: February 2020

Aim:

To compare the efficacy and safety of cemented and uncemented hemiarthroplasty in elderly patients with femoral neck fracture.

Materials and methods:

We searched PubMed, EMBASE, and Cochrane Library databases for published randomized clinical trials comparing cemented hemiarthroplasty with uncemented hemiarthroplasty in elderly patients with a femoral neck fracture. The search was not limited to language, time, or other factors. The quality of each study was assessed using the revised Jadad scale. Two researchers independently extracted data from all selected studies, including the following base line data: study period, fracture stage, number of patients, male female ratio, average age, and per-protocol (PP) or intent-to-treat (ITT), and the interest outcomes: the mortality at 12 months, operative time, hospital stay, common complications, prosthetic-related complications, blood loss and Harris Hip Score (HHS). Fixed-effects or random-effects models with mean differences and odds ratios were used to pool the continuous and dichotomous variables to determine heterogeneity of the included studies.

Results:

A total of 8 studies involving 1577 hips (782 uncemented and 795 cemented) were included in this meta-analysis. The meta-analysis is indicated that the operation time of cemented hemiarthroplasty was longer than uncemented hemiarthroplasty and there was statistical significance between two groups (OR = −7.30, 95%CI, −13.13, −1.46; P = .01). However, there was no significant difference between the two methods of fixation in mortality at 12 months (OR = 1.22, 95%CI, 0.94–1.59; P = .14), hospital stay (OR = 0.26, 95%CI, −0.41, 0.93; P = .44), blood loss (OR = −17.94, 95%CI, −65.83, 29.95; P = .46), and HHS score. There were significant differences in the common complications of pulmonary embolism between the two groups, but there were no differences in the other five common complications. The results showed that uncemented hemiarthroplasty could reduce the incidence of pulmonary embolism after operation. Moreover, the outcomes of prosthetic-related complications showed that there were significant differences between the two groups in periprosthetic fracture (OR = 8.32, 95%CI, 3.85–17.98; P < .00001) and prosthetic subsidence and loosening (OR = 5.33, 95%CI, 2.18–13.00; P = .0002).

Conclusions:

Our study shows that uncemented prosthesis can shorten the operation time and reduce the incidence of pulmonary embolism, but it does not reduce mortality, blood loss, and hospital stay. Most importantly, the incidence of prosthetic-related complications was higher in uncemented patients.
Efficacy and safety of acupuncture on relieving abdominal pain and distension for acute pancreatitis
Authors: Zhu Xinyun , Yang Lijie , Li Xianglei , Zhu Fengya , Li Zimeng , Craemer Andrea , Xiong Yueheng , Lan Ying , Zhao Yuemeng , Wu Jie
Published: February 2020

Introduction:

The purpose of this study is to evaluate the efficacy and safety of acupuncture on relieving abdominal pain and distension in acute pancreatitis.

Methods and analysis:

We will electronically search PubMed, MEDLINE, Embase, Web of Science, the Cochrane Central Register of Controlled Trial, China National Knowledge Infrastructure, China Biomedical Literature Database, China Science Journal Database, and Wanfang Database from their inception. Furthermore, we will manually retrieve other resources, including reference lists of identified publications, conference articles, and gray literature. The clinical randomized controlled trials or quasi-randomized controlled trials related to acupuncture treating acute pancreatitis will be included in the study. The language is limited to Chinese and English. Research selection, data extraction, and research quality assessment will be independently completed by 2 researchers. Data will be synthesized using a fixed effects model or random effects model depending on the heterogeneity test. The overall response rate and the visual analog scale score will be the primary outcomes. The time of first bowel sound, the time of first defecation, the length of hospitalization, acute physiology and chronic health evaluation II score, and the adverse events will also be assessed as secondary outcomes. RevMan 5 (version 5.3) statistical software will be used for meta-analysis, and the level of evidence will be assessed by Grading of Recommendations Assessment, Development, and Evaluation. Continuous data will be expressed in the form of weighted mean difference or standardized mean difference with 95% confidence intervals, whereas dichotomous data will be expressed in the form of risk ratios with 95% confidence intervals.

Ethics and dissemination:

The protocol of this systematic review does not require ethical approval because it does not involve humans. We will publish this article in peer-reviewed journals and present at relevant conferences.

PROSPERO registration number:

CRD42019147503.
Therapeutic management of stroke-like episodes varies from that of encephalitis
Authors: Finsterer Josef
Published: February 2020

Introduction:

Stroke-like episodes (SLEs) are typical cerebral manifestations of certain mitochondrial disorders (MIDs). They are characterised by a vasogenic edema in a non-vascular distribution.

Patients concerns:

none

Diagnosis:

SLEs show up on cerebral MRI as stroke-like lesions (SLLs), characterised by vasogenic edema in a non-vascular distribution. SLLs expand in the acute stage and regress during the chronic stage. They show hyperperfusion in the acute stage and hypoperfusion in the chronic stage.

Interventions:

SLLs respond favorably to antiseizure drugs, to No-precursors, steroids, the ketogenic diet, and antioxidants.

Outcome:

SLLs end up as normal tissue, white matter lesion, grey matter lesion, cyst, laminar cortical necrosis, or the toenail sign.

Conclusions:

SLLs are a frequent manifestation of MIDs. They undergo dynamic changes in the acute and chronic stage. They need to be differentiated from ischemic stroke as they are differentially treated.
Neuromuscular electrical stimulation and shortwave diathermy in unrecovered Bell palsy
Authors: Marotta Nicola , Demeco Andrea , Inzitari Maria Teresa , Caruso Maria Giovanna , Ammendolia Antonio
Published: February 2020

Background:

Unrecovered Bell palsy is difficult to treat, because until now in literature there is not a gold standard. This study aimed to evaluate the effectiveness of neuromuscular electrical stimulation (NMES) and shortwave diathermy (SWD) therapy for chronic Bell palsy.

Methods:

After 5 months of conventional therapy, this 2-arm randomized controlled trial enrolled and randomly allocated 20 patients to a treatment group with NMES+SWD and supervised exercises (n = 10) or a sham group with supervised exercise alone (n = 10). The administration of NMES or sham NMES, as intervention, was performed 30 min/session, 5 sessions/wk, for 4 weeks. The primary outcome was assessed by Sunnybrook scale. The secondary outcomes were evaluated by the Kinovea©, a movement analysis software. All primary and secondary outcomes were measured at baseline (T0), at the end of 4-week treatment (T1).

Results:

At the end of 4-week treatment, the patients in the treatment group did not achieve better outcomes in resting symmetry, but we observed an increase of the perceived a significant improvement (P < .05) for symmetry of voluntary movements by the Sunnybrook subscale, with a score of 55.4 ± 9 compared to 46.4 ± 3.7 to control group and an increase in zygomatic muscle movement symmetry ratio (P < .05) by Kinovea©. No adverse events occurred in either group.

Conclusion:

The improvements in the symmetry of voluntary movements demonstrated that combining diathermy with neuromuscular electrostimulation is valid and reliable in the treatment of chronic Bell palsy.
Variants in the 8q24 region associated with risk of breast cancer
Authors: Wang Xuedong , He Xian , Guo Hui , Tong Yu
Published: February 2020

Breast cancer is a molecularly heterogeneous disorder associated with high lethal malignant tumors among women worldwide. Genetic factors play an important role in breast cancer development. Several single nucleotide polymorphisms in the 8q24 region associated with risk of breast cancer have been identified. Fifteen studies including 32,955 cases and 43,716 controls were collected to conduct a meta-analysis to evaluate the associations between variants in 8q24 region and risk of breast cancer. Our study showed that only rs13281615 is associated with breast cancer risk in this large-scale research synopsis and meta-analysis. Further studies are needed to explore the role of the 8q24 variants in the development of breast cancer.
The effectiveness of high-intensity interval training on body composition, cardiorespiratory fitness, and cardiovascular risk factors in children
Authors: Solera-Martínez Montserrat , Díez-Fernández Ana , González-García Alberto , Manzanares-Domínguez Ismael , Martínez-Vizcaíno Vicente , Pozuelo-Carrascosa Diana P.
Published: February 2020

Background:

No previous systematic review has examined the effect of high-intensity interval training (HIIT) interventions on body composition, cardiometabolic risk factors and cardiorespiratory fitness (CRF) in healthy schoolchildren from 5 to 12 years old.

Methods:

This study will be conducted by following the guideline of the preferred reporting items for systematic review and meta-analysis protocols. An electronic search in MEDLINE (via PubMed), EMBASE (via Scopus), SPORTDiscus, Cochrane Library and Web of Science databases of all dates from inception will be conducted. We will include randomized controlled trials aimed to assess the effectiveness of HIIT to improve cardiometabolic risk factors, body composition, and CRF in children. Two authors will perform the study selection and data collection; disagreements will be solved by a third reviewer. The methodological quality of studies will be assessed by the Cochrane Collaboration's tool for assessing risk of bias (RoB2). Data analysis and synthesis will be performed by Comprehensive Meta-analysis Software and StataSE software, version 15.

Conclusion:

The results should be disseminated through publication in a peer-reviewed journal. Since the data used in systematic reviews of this type will be extracted exclusively from published studies, approval form and ethics committee will not be required.
Low ambient temperatures correlate with increased risk of hypoglycemia in patients with type 2 diabetes
Authors: Lai Shih-Wei , Chang Wan-Chi , Lin Cheng-Li , Chou I-Ching , Tsai Fuu-Jen , Lai Yen-Jen
Published: February 2020

Little evidence is available about the relationship between ambient temperatures and hypoglycemia in Taiwan. The purpose of the present paper is to investigate whether there is an association between ambient temperatures and hypoglycemia in patients with type 2 diabetes.

An ecological study was conducted to analyze the type 2 diabetes dataset of the Taiwan National Health Insurance Program. Every episode of hypoglycemia diagnosed at emergency department among subjects with type 2 diabetes was identified monthly between 2006 and 2013. Average monthly ambient temperatures in Celsius between 2006 and 2013 were measured according to the database of the Central Weather Bureau in Taiwan.

The incidence rates of hypoglycemia were higher during the period of cold ambient temperatures (from December to March) than the period of warm ambient temperatures (from April to November). The peak period of hypoglycemia always occurred in winter months (January and February).

Patients with type 2 diabetes in Taiwan are more susceptible to hypoglycemia during the period of cold ambient temperatures, particularly in winter months. Clinicians in Taiwan should remind patients to make a preventive strategy for hypoglycemia during the periods of cold ambient temperatures.