bluuebunny/crossref_metadata_2025 huggingface dataset:
Ustekinumab is associated with superior treatment persistence but not with higher remission rates versus vedolizumab in patients with refractory Crohn’s disease: results from a multicentre cohort study
Authors: Bacsur Péter , Matuz Mária , Resál Tamás , Miheller Pál , Szamosi Tamás , Schäfer Eszter , Sarlós Patrícia , Iliás Ákos , Szántó Kata , Rutka Mariann , Bálint Anita , Milassin Ágnes , Fábián Anna , Bor Renáta , Szepes Zoltán , Molnár Tamás , Farkas Klaudia
Published: December 2022

Background:

Treatment with antitumor necrosis factor alpha (anti-TNF-α) is safe and effective as first-line therapy; however, its efficacy is limited due to primary nonresponse (PNR) and secondary loss of response (LOR), resulting in treatment discontinuation in approximately 40%–50% of cases. Vedolizumab (VDZ) and ustekinumab (UST) therapies could be good alternatives in patient with anti-TNF failure; however, no head-to-head randomized comparison of these drugs as second- or third-line treatments has been made.

Objectives:

This study aimed to assess the treatment persistence and comparative effectiveness of UST and VDZ in patients with refractory Crohn’s disease (CD).

Design:

In this nationwide retrospective study, patients with CD on UST or VDZ maintenance therapy were enrolled. Clinical data at baseline, after induction, and at week 52 were obtained.

Methods:

Clinical and biochemical activities as well as corticosteroid-free remission (SFR) rates were assessed, while concomitant medications, comorbidities, hospitalizations, and surgeries were recorded during the follow-up to detect any predictors.

Results:

A total of 161 UST- and 65 VDZ-treated patients completed the follow-up. No significant difference in clinical or biochemical remission rates was observed after induction between the two treatment groups; however, clinical remission rate at week 52 was higher in UST group. UST showed superior drug persistence than VDZ (86.5%, 57.9%, p < 0.0001). The drug type was predictive of clinical SFR at week 52 [ p = 0.011, odds ratio (OR) = 2.39 with UST]. Drug failure rates were higher for VDZ than those for UST (PNR rates: 21.54% and 4.97%, respectively, p < 0.001, OR = 8.267, p = 0.001). LOR and escalations were more common during UST treatment (61.5% versus 36.9%, p < 0.001; 64.2% versus 23.1%, p < 0.001). Hospital and surgical admission rates did not differ significantly. Only one adverse event occurred with VDZ at week 20, which led to drug cessation.

Conclusions:

VDZ and UST were safe and effective for treating patients with CD in whom anti-TNF therapy failed. UST showed superior drug persistence than VDZ, but dose escalation was more frequent. Biologicals used in lower treatment lines resulted in better drug persistence.
Cytotoxic corpus callosum lesion and mild CSF pleocytosis during hantavirus infection: a case report
Authors: Straeten Frederike A. , Meyer zu Hörste Gerd
Published: December 2022

A middle-aged, previously healthy male patient presented with high fever, headache, and aching limbs for 3 days. Laboratory results showed signs of acute kidney injury, elevated procalcitonin, and mild thrombocytopenia. On neurological examination, he had no focal neurological deficits, especially no meningism or visual disturbances. Cerebrospinal fluid (CSF) examination showed mild lymphocytic pleocytosis, and magnetic resonance imaging (MRI) revealed a lesion of the splenium corporis callosum. The patient received anti-infective treatment with acyclovir and ceftriaxone until laboratory results returned positive hantavirus IgM and IgG antibodies in the serum indicating an active hantavirus infection. The renal retention parameters and thrombocytopenia receded following treatment with intravenous fluids, analgesic, and antipyretic agents. MRI follow-up 10 days later showed a residual small FLAIR-positive lesion without any persistent callosal diffusion abnormality. The patient was discharged symptom-free after 8 days and had recovered fully 2 months later. The source of infection in this patient remained unclear. Cytotoxic lesions of the corpus callosum (CLCC) are secondary lesions usually with a good prognosis but require further investigation regarding their underlying etiology and should not be confounded with primary callosal lesions, such as ischemia or lymphoma.
Eltrombopag increases the hematopoietic supporting ability of mesenchymal stem/stromal cells
Authors: Muntión Sandra , Preciado Silvia , Sánchez-Luis Elena , Corchete Luis , Díez-Campelo María , Osugui Lika , Martí-Chillón Gerardo-Javier , Vidriales María-Belén , Navarro-Bailón Almudena , De Las Rivas Javier , Sánchez-Guijo Fermín
Published: December 2022

Background:

Eltrombopag (EP) is a small molecule that acts directly on hematopoietic stem cells (HSCs) and megakaryocytes to stimulate the hematopoietic process. Mesenchymal stem/stromal cells (MSCs) are key hematopoietic niche regulators.

Objectives:

We aimed to determine whether EP has any effect on MSC function and properties (especially on their hematopoietic-supporting ability) and if so, what changes (e.g. genome-wide transcriptomic alterations) are induced in MSC after EP treatment.

Design/Methods:

MSCs were isolated from 12 healthy donors and treated with 15 µM and 50 µM of EP for 24 h. The toxicity of the drug on MSCs and their differentiation ability were analyzed, as well as the transcriptomic profile, reactive oxygen species (ROS) and DNA damage and the changes induced in the clonogenic capacity of HSCs.

Results:

The results show that EP also modifies MSC functions, decreasing their adipogenic differentiation, increasing the expression of genes involved in hypoxia and other pathways related to oxygen homeostasis, and enhancing their ability to support hematopoiesis in vitro.

Conclusion:

Our findings support the use of EP in cases where hematopoiesis is defective, despite its well-known direct effects on hematopoietic cells. Our findings suggest that further studies on the effects of EP on MSCs from patients with aplastic anemia are warranted.
Biomaterials delivery strategies to repair spinal cord injury by modulating macrophage phenotypes
Authors: Xia Yuanliang , Yang Ruohan , Wang Hengyi , Hou Yulin , Li Yuehong , Zhu Jianshu , Xu Feng , Fu Changfeng
Published: December 2022

Spinal cord injury (SCI) causes tremendous harm to a patient’s physical, mental, and financial health. Moreover, recovery of SCI is affected by many factors, inflammation is one of the most important as it engulfs necrotic tissue and cells during the early stages of injury. However, excessive inflammation is not conducive to damage repair. Macrophages are classified into either blood-derived macrophages or resident microglia based on their origin, their effects on SCI being two-sided. Microglia first activate and recruit blood-derived macrophages at the site of injury—blood-borne macrophages being divided into pro-inflammatory M1 phenotypes and anti-inflammatory M2 phenotypes. Among them, M1 macrophages secrete inflammatory factors such as interleukin-β (IL-β), tumor necrosis factor-α (TNF-α), IL-6, and interferon-γ (IFN-γ) at the injury site, which aggravates SCIs. M2 macrophages secrete IL-4, IL-10, IL-13, and neurotrophic factors to inhibit the inflammatory response and inhibit neuronal apoptosis. Consequently, modulating phenotypic differentiation of macrophages appears to be a meaningful therapeutic target for the treatment of SCI. Biomaterials are widely used in regenerative medicine and tissue engineering due to their targeting and bio-histocompatibility. In this review, we describe the effects of biomaterials applied to modulate macrophage phenotypes on SCI recovery and provide an outlook.
Introducing a Clinical Summary Template From the Adult Day Center to Support Decision Making by Primary Care Providers
Authors: Zhong Jie , Boafo Jonelle , Sadarangani Tina R.
Published: December 2022

Introduction:

CareMOBI (Mhealth for Organizations to Bolster Interconnectedness) is a mobile application designed to facilitate information exchange between primary care providers (PCPs) and adult day centers (ADCs). A key function of CareMOBI is to synthesize information collected outside of the provider’s office (ie,: in the ADC or at home) and distill the most relevant data points into an exportable clinical summary that can help inform clinical decision making by the PCP with information from outside providers who are not formally embedded within health systems. In this study, we used a qualitative approach to understand the acceptability and utility of the clinical summary template within CareMOBI.

Methods:

Purposive sampling, followed by snowball sampling, was used to recruit PCPs from a variety of primary care practice settings (i.e. home-based, academic). Semi-structured interviews were conducted virtually to elicit feedback on the user-experience after interaction with a prototype template. Interviews were recorded, transcribed, and analyzed using content analysis.

Results:

Our sample (n = 10) consisted of physicians and nurse practitioners in a variety of settings. Feedback suggested that the summary template facilitates interdisciplinary, bidirectional, succinct, and relevant information exchange across care teams. The summary template effectively integrates observations and assessments from team members, centralizes them, and allows PCPs to hone in on the most salient components to inform clinical decision making for the geriatric patient. The summary gave PCPs “live texture” about what was happening outside the office and represented a significant improvement over other methodologies of information exchange. Prior to implementation into clinical practice, several refinements are necessary based on feedback including integration into the PCP’s workflow.

Conclusions:

The template was viewed by PCPs as a concise and actionable record, in contrast to current communication which is characterized as “bloated”—containing too many pages on nonessential information. The summary could potentially save PCP’s time in locating and analyzing historical data to enable rapid patient assessment and prompt more ready and informed action.
The Effects of the 2021 Monthly Child Tax Credit on Child and Family Well-Being: Evidence from New York City
Authors: Collyer Sophie , Gandhi Jill , Garfinkel Irwin , Ross Schuyler , Waldfogel Jane , Wimer Christopher
Published: December 2022

The temporary monthly child tax credit implemented in 2021 had the potential to affect many aspects of child and family well-being, including poverty, hardship, use of food pantries, spending on child-related items, and parents’ mental health and employment. The authors assess these effects using data from two longitudinal studies of well-being in New York City. They find that the monthly child tax credit led to significant declines in the risk for facing material hardship, multiple hardships, running out of money, and using food pantries. The authors do not find evidence of significant changes in parents’ mental health, employment, or spending on childcare or enrichment activities.
Perceptions of School Quality and Student Learning During the Pandemic: Exploring the Role of Students, Families, Schools, and Neighborhoods
Authors: Jabbari Jason , Chun Yung , Johnson Odis , Grinstein-Weiss Michal , McDermott Laura
Published: December 2022

Given the inequitable distribution of resources across school, neighborhood, and home contexts in the United States, lower resourced students may have had fewer opportunities to learn during the coronavirus disease 2019 pandemic, which may have caused previous disadvantages to accumulate during the pandemic. Nevertheless, research has yet to comprehensively explore how school, neighborhood, and home contexts— together—relate to perceptions of school quality and, ultimately, learning outcomes during the pandemic. To fill this gap, the authors leverage a unique multiwave survey of households across 47 states. Using multinomial modeling, the authors find that previous disadvantages were not always accumulated during the pandemic and that in some cases, perceptions of school quality and student learning improved for students who had struggled before the pandemic. The results also suggest stratification across race/ethnicity, parental education levels, school types, learning modes, and a range of learning resources.
Self-esteem moderates the impact of perceived social support on the life satisfaction of adults with autism spectrum disorder
Authors: Tsermentseli Stella
Published: December 2022

Background and aims

Although social resources and self-esteem are well-known predictors of subjective well-being in the general population, the relations among these factors have not yet been investigated in autism spectrum disorder (ASD). The present preliminary study sought to compare the levels of life satisfaction, self-esteem and perceived social support between adults with ASD and typically developing volunteers (TYP). It also examined whether self-esteem would moderate the effect of perceived social support on life satisfaction in adults with ASD.

Methods

Fifty-seven adults with ASD without intellectual disability and 60 age-matched TYP in the United Kingdom (UK) completed self-reported measures of perceived social support, global self-esteem, and life satisfaction.

Results

Results indicated that adults with ASD reported significantly lower levels of life satisfaction and self-esteem (but not social support) than TYP. Hierarchical regressions revealed that both social support and self-esteem were significant predictors of life satisfaction in adults with ASD. Self-esteem buffered the effect of perceived social support on life satisfaction.

Conclusions

This study corroborated a growing body of evidence that suggests that adults with ASD report lower levels of self-esteem and life satisfaction than TYP. In addition, it reported for the first time that global self-esteem influences the association between social support and life satisfaction in adults with ASD.

Implications

The present findings suggest that interventions aimed at enhancing self-esteem and cultivating social relationships could be important areas for intervention to improve the well-being of adults with ASD.
Substandard and falsified medical product recalls in Zambia from 2018 to 2021 and implications on the quality surveillance systems
Authors: Chabalenge Billy , Jere Elimas , Nanyangwe Namuchindo , Hikaambo Christabel , Mudenda Steward , Banda Michelo , Kalungia Aubrey , Matafwali Scott
Published: December 2022

Background:

Substandard and falsified (SF) medical products are removed from circulation through a process called ‘product recall’ by medicines regulatory agencies. In Zambia, the Zambia Medicines Regulatory Authority (ZAMRA) is responsible for recalling SF medical products from the Zambian market through passive and active surveillance methods. This study aimed to describe the prevalence of recalls of SF medical products and to analyse the frequently recalled therapeutic categories, dosage forms, categories of defects that led to the recalls and their sources with respect to the country of the marketing authorisation holder (MAH) or manufacturer.

Methods:

We conducted a descriptive cross-sectional review of the product recalls issued by ZAMRA between January 2018 and December 2021. A search for all medical product alerts and recalls issued by ZAMRA was carried out by reviewing the internal post-marketing surveillance database kept at ZAMRA headquarters. Data were extracted using a structured Excel database and analysed using Microsoft Excel.

Results:

A total of 119 alerts were received during the review period, of which 83 (69.7%) were product recalls. Oral solid dosage forms were the most recalled dosage form (53%). Furthermore, the number of recalls increased in 2020 (44.6%) and 2021 (22.9%), with the majority (20.5%) of the recalled products being substandard products classified as antiseptics and disinfectants and were attributed to the high demand during the COVID-19 pandemic. Manufacturing laboratory control issues were the reason for product recall in almost half (47.4%) of the cases. Most of the products recalled originated from India (38.6%), followed by Zambia (25.3%). Only one suspected falsified product was recalled between 2018 and 2021. A total of 66 recalls of the 83 products were initiated by ZAMRA, with only 17 voluntarily by foreign MAHs. No product recall was initiated by the local representatives of foreign manufacturers or MAH.

Conclusion:

The majority of the pharmaceutical product recalls in Zambia were substandard products. Manufacturing laboratory control issues lead to most recalls and require investigation of the root causes, preventive action, and strict compliance with the good manufacturing practices guidelines by manufacturers.
Proximal Focal Femoral Deficiency: Prenatal Diagnosis of a Rare Congenital Skeletal Anomaly
Authors: Awowole Ibraheem O. , Ugowe Osagie Joseph , Afeniforo Bode Lewis , Ayodele Sidikat Abiola , Abdur-rahim Zainab Foyeke
Published: December 2022

A rare case of proximal focal femoral deficiency (PFFD) is presented due to concerns for a short fetal femur. A 32-year-old patient (G3P2002) was reviewed at 37 weeks of gestation. Sonography revealed an appropriately maturing female fetus, with a left femoral diaphyseal length of 36.1 mm (<1st percentile), while the right measured 71.4 mm (35th percentile). The proximal epiphysis, head, and trochanter of the left fetal femur were absent on 3D sonography, with significant overlap of the femur on the pubic bone. At delivery, the baby weighed 3240 g, with a lower limb-length discrepancy of 56 mm. A radiograph confirmed left-sided hypoplastic proximal femur, absent femoral head, and a poorly formed acetabulum. The baby was conservatively managed, with plans for possible surgery and limb prosthesis. A high index of suspicion and capacity building to facilitate prenatal diagnosis are essential for optimal care of babies with PFFD.
Function and return to sports after proximal humeral replacement in patients with primary bone sarcoma
Authors: Ellerbrock Moritz , Theil Christoph , Gosheger Georg , Deventer Niklas , Klingebiel Sebastian , Rickert Carolin , Schneider Kristian Nikolaus
Published: December 2022

Background

Improved patient and limb survival rates have led to an increased interest in the functional outcome and return to sports of patients undergoing megaprosthetic reconstruction in musculoskeletal oncology. This study evaluates the functional outcome and postoperatively performed level of sports in patients undergoing proximal humeral replacement (PHR) following resection of a primary bone sarcoma and identifies potential beneficial and limiting factors.

Patients and methods

Between 2007 and 2020, a total of 606 patients underwent resection of a primary bone sarcoma and reconstruction with a single-design modular implant. For 112 (18%) patients, the location of the tumour was the proximal humerus. Exclusion criteria were death (n = 65), patients living overseas (n = 8), and subsequent amputation (n = 1), leaving 38 patients for evaluation, of whom 32 were available for the study (13 women, median age 42 years). Clinical data regarding oncological and surgical treatment as well as subsequent complications were obtained from the patients’ electronic medical records. Functional outcome was determined using the Musculoskeletal Tumor Society Score (MSTS) and Toronto Extremity Salvage Score (TESS) as well as the Subjective Shoulder Value (SSV). Return to sports was assessed using the Tegner Activity Score (TS) and the modified Weighted Activity Score (WAS).

Results

At the last follow-up after a median of 30 months (IQR 22–58), median MSTS was 18 (IQR 12–24), median TESS was 80% (IQR 69–87), median SSV was 35% (IQR 10–58), median TS was 5 (IQR 4–6) and median WAS was 5 (IQR 0–10). Preservation of the axillary nerve, a reverse shoulder reconstruction and a WAS of > 10 prior to surgery were associated with better functional outcome and return to sports activity scores.

Conclusion

Following PHR, good to excellent functional outcomes are possible, and patients regularly return to participate in sports activities—most commonly in low-impact types of sports, but some individuals are even able to participate in high-impact sports activities.

Level of evidence

IV.
Longitudinal trajectory of acidosis and mortality in acute kidney injury requiring continuous renal replacement therapy
Authors: Lee Jinwoo , Kim Seong Geun , Yun Donghwan , Kang Min Woo , Kim Yong Chul , Kim Dong Ki , Oh Kook-Hwan , Joo Kwon Wook , Kim Yon Su , Koo Ho Seok , Han Seung Seok
Published: December 2022

Background

Acidosis frequently occurs in severe acute kidney injury (AKI), and continuous renal replacement therapy (CRRT) can control this pathologic condition. Nevertheless, acidosis may be aggravated; thus, monitoring is essential after starting CRRT. Herein, we addressed the longitudinal trajectory of acidosis on CRRT and its relationship with worse outcomes.

Methods

The latent growth mixture model was applied to classify the trajectories of pH during the first 24 hours and those of C-reactive protein (CRP) after 24 hours on CRRT due to AKI (n = 1815). Cox proportional hazard models were used to calculate hazard ratios of all-cause mortality after adjusting multiple variables or matching their propensity scores.

Results

The patients could be classified into 5 clusters, including the normally maintained groups (1st cluster, pH = 7.4; and 2nd cluster, pH = 7.3), recovering group (3rd cluster with pH values from 7.2 to 7.3), aggravating group (4th cluster with pH values from 7.3 to 7.2), and ill-being group (5th cluster, pH < 7.2). The pH clusters had different trends of C-reactive protein (CRP) after 24 hours; the 1st and 2nd pH clusters had lower levels, but the 3rd to 5th pH clusters had an increasing trend of CRP. The 1st pH cluster had the best survival rates, and the 3rd to 5th pH clusters had the worst survival rates. This survival difference was significant despite adjusting for other variables or matching propensity scores.

Conclusions

Initial trajectories of acidosis determine subsequent worse outcomes, such as mortality and inflammation, in patients undergoing CRRT due to AKI.
CD97 expression level and its effect on cell adhesion in Preeclampsia
Authors: Atigan Ayhan , Tan Semih , Cetin Hulya , Guler Omer Tolga , Ozdamar Saim , Karakaya Yeliz Arman
Published: December 2022

Objectives

Cellular interactions and cell adhesion underlie preeclampsia (PE). The aim of the current study is to investigate the role of cell adhesion molecules such as CD97, neural (N)-cadherin, epithelial (E) -cadherin and integrin beta-4 in PE.

Methods

This prospective study included 20 pregnant women with PE and a control group of 16 healthy pregnant women who were matched for age, gestational age, gravida and parity. Standard blood tests and placental cell adhesion molecule immunohistochemical staining were examined.

Results

The creatinine, uric acid and lactate dehydrogenase (LDH) levels from standard blood tests were found to be statistically higher in the PE group (p = 0.002, p = 0.000, p = 0.001; respectively). In the PE group, the CD97 maternal serum level was statistically significantly lower, as was its immunohistochemical expression in placental sections (p = 0.028, p = 0.000; respectively). The E-cadherin expression score was statistically higher in the PE group compared to the control group (3,65 ± 1,84 vs 2,06 ± 1,76 respectively; p = 0.003). The N-cadherin expression score was statistically lower in the PE group compared to the control group (1,50 ± 0,82 vs 2,43 ± 1,59 respectively; p = 0.049). Integrin beta-4 was not statistically different between groups.

Conclusions

Cellular interaction may be responsible for PE as in cancer. A balance in intercellular communication, as researched in cancer therapy, may offer the solution in PE.
Rates of confirmatory HIV testing, linkage to HIV services, and rapid initiation of antiretroviral treatment among newly diagnosed children living with HIV in Ethiopia: perspectives from caregivers and healthcare workers
Authors: Bekele Alemayehu , Hrapcak Susan , Mohammed Jelaludin Ahmed , Yimam Jemal Ayalew , Tilahun Tsegaye , Antefe Tenagnework , Kumssa Hanna , Kassa Desta , Mengistu Semegnew , Mirkovic Kelsey , Dziuban Eric J. , Belay Zena , Ross Christine , Teferi Wondimu
Published: December 2022

Background

Successful linkage to HIV services and initiation of antiretroviral treatment (ART) for children living with HIV (CLHIV) is critical to improve pediatric ART coverage. We aimed to assess confirmatory testing, linkage, and rapid ART initiation among newly diagnosed CLHIV in Ethiopia from the perspectives of caregivers and healthcare workers (HCWs).

Methods

We conducted standardized surveys with HCWs and caregivers of children 2–14 years who were diagnosed with HIV but not yet on ART who had been identified during a cross-sectional study in Ethiopia from May 2017–March 2018. Eight health facilities based on their HIV caseload and testing volume and 21 extension sites were included. Forty-one children, 34 care givers and 40 healthcare workers were included in this study. Three months after study enrollment, caregivers were surveyed about timing and experiences with HIV service enrollment, confirmatory testing, and ART initiation. Data collected from HCWs included perceptions of confirmatory testing in CLHIV before ART initiation. SPSS was used to conduct descriptive statistics.

Results

The majority of the 41 CLHIV were enrolled to HIV services (n = 34, 83%) and initiated ART by three months (n = 32, 94%). Median time from diagnosis to ART initiation was 12 days (interquartile range 5–18). Five children died before the follow-up interview. Confirmatory HIV testing was conducted in 34 children and found no discordant results; the majority (n = 23, 68%) received it within one week of HIV diagnosis. Almost all HCWs (n = 39/40, 98%) and caregivers (n = 31/34, 91%) felt better/the same about test results after conducting confirmatory testing.

Conclusion

Opportunities remain to strengthen linkage for newly diagnosed CLHIV in Ethiopia through intensifying early follow-up to ensure prompt confirmatory testing and rapid ART initiation. Additional services could help caregivers with decision-making around treatment initiation for their children.
Randomly controlled drivers using minimally invasive sampling: assessment of drug prevalence in Western Switzerland over two time periods
Authors: Joye Timothée , Déglon Julien , Donzé Nicolas , Gilardi Federica , Sidibé Jonathan , Favrat Bernard , Augsburger Marc , Thomas Aurélien
Published: December 2022

Background

According to the World Health Organization, road traffic injuries lead to 1.3 million deaths each year and represent the leading cause of death for young adults under 30 years old. The use of psychoactive substances, including alcohol, drugs and pharmaceuticals, is a well-known risk factor for road traffic injuries. Our study aims to assess the prevalence of substances consumed by drivers in western Switzerland. Such studies are pivotal to improving prevention and developing public awareness campaigns.

Methods

To assess the prevalence of psychoactive substances among drivers, roadside controls were performed in collaboration with local police, using their classical sampling procedures to detect drivers under the influence of drugs or alcohol over two time periods (P1: 2006-2008, P2: 2017-2020). When impaired driving was not suspected by the police, minimally invasive sampling strategies (i.e., oral fluids during P1 and dried blood spots during P2) were performed on volunteer drivers after a road safety survey. A posteriori analyses and statistical interpretation were then performed.

Results

Among the 1605 drivers included in the study, 1048 volunteers provided an oral fluid sample, while 299 provided a dried blood spot sample. The percentage of drivers testing positive for at least one substance that can impact driving abilities was stable over time, with a rate of 10.5% positivity measured over both periods. Considering the different categories of substances, a slight variation was observed between both periods, with 7.6 and 6.3% of pharmaceuticals and 3.6 and 4.9% of illicit drugs for P1 and P2, respectively. Regarding the consumption of illicit drugs, the highest percentage of positivity was measured in biological fluids of drivers under the age of 35, during nights and week-ends, periods which are considered particularly prone to fatal accidents for this age group. Disturbingly, the road safety survey highlighted that drivers’ perception of the risk of getting positively controlled while driving after drug consumption is low (3.3 on a 1-to-10 scale,N = 299).

Conclusion

The number of positive cases measured in voluntary drivers who passed the preliminary police check demonstrates the importance of systematic biofluid sampling strategies regarding driving under the influence of psychoactive substances. Although the number of fatal road accidents globally has decreased over time, the results of this study reveal the need for both better prevention and deterrent processes that could potentially reduce the risk of fatal road accidents associated with drug consumption.
Incidence, costs and post-operative complications following ankle fracture – A US claims database analysis
Authors: Vanderkarr Mari F. , Ruppenkamp Jill W. , Vanderkarr Mollie , Parikh Anjani , Holy Chantal E. , Putnam Matthew
Published: December 2022

Background

The epidemiology and payer costs for ankle fractures are not well documented. This study evaluated: (1) the incidence of ankle fracture and ankle surgery following fracture in the US population; and (2) the clinical presentation of patients presenting with ankle fractures requiring surgery, their complication rates, and payer costs.

Methods

Patients in the IBM® MarketScan® Commercial and Medicare Supplemental databases with an inpatient/outpatient diagnosis of ankle fracture from 2016 to 2019 were stratified by age group and gender, and rates of fracture per 10,000 enrollees were estimated. Surgically-treated patients between January 2016 – October 2021 were further analyzed. One-year post-surgical outcomes evaluated complication rates (e.g., infection, residual pain), reoperations, and 1-year payments. Standard descriptive statistics were calculated for all variables and outcomes. Generalized linear models were designed to estimate payments for surgical care and incremental payments associated with postoperative complications.

Results

Fracture cases affected 0.14% of the population; 23.4% of fractures required surgery. Pediatric and elderly patients were at increased risk. From 3 weeks to 12 months following index ankle surgery, 5.5% (5.3% - 5.7%) of commercially insured and 5.9% (5.1% - 6.8%) of Medicare patients required a new surgery. Infection was observed in 4.4% (4.2% - 4.6%) commercially insured and 9.8% (8.8% - 10.9%) Medicare patients, and residual pain 3 months post-surgery was observed in 29.5% (28.7% - 30.3%) commercially-insured and 39.3% (36.0% - 42.6%) Medicare patients. Commercial payments for index surgery ranged from $9,821 (95% CI: $9,697 - $9,945) in the ambulatory surgical center to $28,169 (95% CI: $27,780 - $28,559) in the hospital inpatient setting, and from $16,775 (95% CI: $16,668 - $16,882) in patients with closed fractures, to $41,206 (95% CI: $38,795 - $43,617) in patients with Gustilo III fractures. Incremental commercial payments for pain and infection averaged $5,200 (95% CI: $4,261 - $6,139) and $27,510 (95% CI: $21,759 - $33,261), respectively.

Conclusion

Ankle fracture has a high incidence and complication rate. Residual pain affects more than one-third of all patients. Ankle fracture thus presents a significant societal impact in terms of patient outcomes and payer burden.
Residual cancer is a strong predictor of survival in T3 incidental gallbladder cancer
Authors: You Chuan , Xie Mengyi , Ling Meng , Yang Facai , Qiu Yinghe , Li Jingdong
Published: December 2022

Background and purpose

Index cholecystectomy is insufficient for curing T3 incidental gallbladder cancer (IGC), and once residual cancer (RC) is found, the prognosis is often poor. The purpose of this study was to investigate the effect of RC on the prognosis and the optimal choice of adjuvant therapy for R0 reresection patients with T3 IGC.

Methods

We retrospectively reviewed data from patients with T3 IGC who underwent radical reresection from January 2013 to December 2018. RC was defined as histologically proven cancer at reresection. Demographics and tumour treatment-related variables were analysed in correlation with RC and survival. Adjuvant (Adj) chemoradiotherapy (CRT) was correlated with overall survival (OS) and disease-free survival (DFS).

Results

Of the 167 patients with IGC who underwent surgery, 102 underwent radical extended resection. Thirty-two (31.4%) RCs were found. Hepatic side tumours (T3h) and both side tumours (T3h + T3p) were associated with the presence of RC. In multivariate analysis, RC and lymph node metastasis were independent prognostic factors for DFS and OS (P < 0.05). RC was associated with a significantly shorter median OS (20 vs. 53 months; P < 0.01) and DFS (11 vs. 40 months; P < 0.001) despite R0 resection. For R0 reresection patients with RC and/or lymph node metastasis, Adj CRT significantly improved OS (P = 0.024).

Conclusion

Residual cancer and lymphatic metastasis are important factors for the poor prognosis of T3 IGC despite R0 resection, and these patients should actively receive adjuvant therapy.
Outcomes of delayed versus early endoscopic intervention for acute biliary pancreatitis with non-severe acute cholangitis
Authors: Lyu Yunxiao , Ye Shenjian , Wang Bin
Published: December 2022

Background

Despite previous studies on endoscopic interventions in patients with acute biliary pancreatitis (ABP), the optimal time to perform endoscopic retrograde cholangiopancreatography (ERCP) for ABP with non-severe acute cholangitis (AC) remains controversial.

Methods

We performed a retrospective cohort analysis of patients with concurrent ABP and non-severe AC. The patients were divided into two groups: those who underwent ERCP ≤ 72 h after admission (early ERCP group) and those who underwent ERCP > 72 h after admission (delayed ERCP group). The primary outcomes were the technical success rate and ERCP-related complications.

Results

The study involved 164 patients (early ERCP, n = 70; delayed ERCP, n = 94) who were treated from 1 December 2 to 2016 to 12 December 2021. The patients’ baseline characteristics were not significantly different between the two groups. The technical success rate of ERCP was similar between the two groups (94.29% vs. 97.87%, p = 0.43). Morbidity was also similar between the two groups (p = 0.83). There was no significant difference in the total hospital stay (p = 0.13). However, the early ERCP group had a longer post-ERCP hospital stay (p < 0.001).

Conclusion

This retrospective analysis showed that delayed ERCP performed > 72 h after admission has economic and safety outcomes similar to those of early ERCP for patients with concurrent ABP and non-severe AC.
Comparison of five single-file systems in the preparation of severely curved root canals: an ex vivo study
Authors: Liu Yina , Chen Meizhi , Tang Weilong , Liu Chang , Du Minquan
Published: December 2022

Background

The ex vivo study is to compare the root canal preparation outcomes achieved by five nickel–titanium single-file instrumentation systems (M3-L, Reciproc Blue, V-Taper 2H, WaveOne Gold, XP-endo Shaper) in severely curved molar root canals.

Methods

A total of 60 root canals were selected from extracted human molar teeth with curvatures ranging from 25° to 50° and divided into five groups based on the instrumentation system employed (n = 12). Before and after root canal preparation, a Micro-CT scan was taken, and pre- and post-operative data were analyzed to evaluate the following parameters: volume increment of root canals (VI), untouched root canal areas (UTA), and canal transportation (CT). Apically extruded debris (AD) was collected during preparation. After that, all samples were separated into two parts and examined respectively by scanning electron microscope (SEM) to assess cleaning ability. Data were statistically analyzed with ANOVA (UTA, AD, VI) or Kruskal–Wallis test (CT, SEM-score), the level of significance was set at α = 0.05.

Results

There were no significant differences between the five systems regarding the AD, VI, and UTA parameters (P > 0.05). In terms of CT, no significant difference was noted at the straight section of canal and apical levels, while XP-endo Shaper showed less canal transportation than M3-L at the level of curved vertex (P < 0.05), and the centering ability of V-Taper 2H was significantly better than WaveOne Gold at the initial point of bending (P < 0.05). Debris and smear layers were present on the canal walls of all specimens, the apical thirds of the canal presented higher SEM scores than the coronal thirds in all groups (P < 0.05). Reciproc Blue and XP-endo Shaper showed fewer smear scores than WaveOne Gold in the apical thirds (P < 0.01 and P < 0.05, respectively), and no statistical difference was found between other groups in the middle and coronal thirds.

Conclusion

The five single-file systems evaluated performed equally in apically debris extrusion, dentin removal, and untouched root canal areas, while XP-endo Shaper and V-Taper 2H resulted in less canal transportation compared to M3-L and WaveOne Gold. Regarding cleaning ability, Reciproc Blue and XP-endo Shaper were associated with less smear layer than WaveOne Gold in the apical thirds.
The radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars
Authors: Li Kuncai , Xu Wei , Zhou Tiejun , Chen Junliang , He Yun
Published: December 2022

Objectives

The indication for removal of asymptomatic fully impacted third molars is still controversial. In this study, radiological and histological investigation of the dental follicle of asymptomatic impacted mandibular third molars was performed, aiming to provide a reference for clinical prophylactic extraction of these teeth.

Methods

Patients with impacted mandibular third molars were included and the maximum width of the dental follicle around the crown was measured in horizontal, sagittal and coronal sections by cone beam computed tomography. The dental follicles were stained with haematoxylin-eosin, analysed by a pathologist and classified as normal, inflammatory or cystic. A Chi-squared test was used to analyse the association of the incidence of inflammation and cysts with the clinical variables of the impacted mandibular third molars.

Results

Thirty-seven samples were normal dental follicles; 52 samples showed inflammatory infiltration with an incidence of 57.14%; 2 samples with a maximum dental follicle width of 2–3 mm were diagnosed as odontogenic cysts, and the incidence was 2.20%. There was no significant difference in the incidence of inflammatory and cystic dental follicles between males and females, or between different age groups (P > 0.05). With an increase of the maximum width of the dental follicle, there was a rise in the incidence and degree of infiltration of chronic nonspecific inflammation.

Conclusion

Asymptomatic impacted mandibular third molars tend to be extracted, especially for teeth with a 2–3 mm maximum width of the dental follicle on radiological examination.
Adenomatoid tumors of ovary mimicking malignancy: report of 2 cases and literature review
Authors: Sun Lili , Zhao Zehua , Qu Ning , Zhu Yanmei
Published: December 2022

Background

Adenomatoid tumors (ATs) are benign tumors originating from the mesothelium. ATs of the ovary are rare, and can easily be confused with malignancy due to the histomorphological diversity. Thus, it is difficult in histopathological and differential diagnosis, especially during intraoperative frozen pathological diagnosis, which directly affects the resection scope of surgery.

Case presentation

In this study, we reported two patients (58 and 41 year old) with ovarian ATs. AT of patient 1 occurred in both ovaries at different time points and she had been diagnosed with Hashimoto's thyroiditis. AT of patient 2 occurred in right ovary. Intraoperative frozen pathological diagnosis was performed in both cases and laparoscopic salpingo-oophorectomy was undergone on the lesion side according to benign freezing diagnostic result. Ovarian ATs, the final diagnoses of the 2 cases were concluded after histological, extensive immunohistochemical (IHC), histochemical, and fluorescence in situ hybridization analyses.

Conclusions

Our results show that ovarian ATs may not be related to BAP1 or CDKN2A/p16 mutations. In addition, the case 1 suggests that ATs may be associated with immune dysregulation. When encountering such similar lessions, we recommend that a series of immunohistochemical, histochemical and molecular biological techniques should be used for diagnosis and differential diagnosis to avoid misdiagnosis. Improving understanding of the rare ovarian ATs which mimic malignancy is necessary to prevent overresection.
Magnitude and associated factors of intimate partner violence among youth women in Ethiopia: multilevel analysis based on 2016 Ethiopian Demographic and Health Survey
Authors: Tsega Nuhamin Tesfa , Belay Daniel Gashaneh , Aragaw Fantu Mamo , Asratie Melaku Hunie , Gashaw Moges , Endalew Mastewal
Published: December 2022

Background

The period of youth is important for the foundation of healthy and stable relationships, women’s health and well-being. Youth women face a higher risk of experiencing violence than older women. Intimate partner violence (IPV) against youth women is a significant public health concern. Despite paramount negative health consequences of IPV for the survivor, as per our knowledge, research study on IPV and associated factors among youth women in Ethiopia is scarce. Therefore, this study aimed to assess the magnitude and associated factors of IPV among youth women in Ethiopia.

Methods

The data was accessed from 2016 Ethiopia demographic and health survey (EDHS) which was a cross sectional population based household survey. It was also conducted using a multi-stage stratified random cluster sampling approach. The data were cleaned, weighted, and analyzed using STATA Version 14 software. The total weighted sample of 1077 youth women were used in this study. Multilevel logistic regression modeling was used to determine factors associated with IPV among youth women. Adjusted odds ratio (AOR) with 95% confidence interval (CI) and p value < 0.05 were used to declare the significant variables.

Results

Among the total participants, 30.27% (95% CI 27.59, 33.09) of youth women experienced IPV. Individual level variables such as: Being widowed/divorced/separated (AOR = 2.28; 95% CI 1.33, 3.91), having a partner who drinks alcohol (AOR = 5.76; 95% CI 3.42, 9.69), witnessing inter-parental violence during childhood (AOR = 3.45; 95% CI 2.21, 5.37), being afraid of partners (AOR = 7.09; 95% CI 4.30, 11.68), and from community level variables, youth women residing in communities with a low proportion of educated youth women (AOR = 0.31; 95% CI 0.13, 0.78) were significantly associated with having experience of IPV.

Conclusion

The magnitude of intimate partner violence among youth women in Ethiopia was relatively high as compared to the global estimate of IPV. Individual and community level variables such as currently widowed/divorced/separated women, having a partner who drinks alcohol, witnessing inter-parental violence, being afraid of partner, and women from a low proportion of community level youth women's education were significantly associated with intimate partner violence. To decrease this public health problem, it is better to strengthen legislation on the purchase and sale of alcohol, provide legal protection for separated/divorced women, establish effective legal response services for IPV, promote gender equality, and provide psychological support for those who witnessed inter-parental violence during childhood to reduce IPV.
Family presence during invasive procedures: a pilot study to test a tool
Authors: de Mingo-Fernández Eva , Belzunegui-Eraso Ángel , Medina-Martín Guillermina , Cuesta-Martínez Roser , Tejada-Musté Raquel , Jiménez-Herrera María
Published: December 2022

Background

Family Presence During Invasive Procedures (FPDI) generates controversy among healthcare professionals. Twibell and her team designed an instrument that measured nurses’ Risk-Benefit and Self-Confidence perceptions regarding family presence during resuscitation and was used in numerous studies.

Objectives

Evaluate the new tool for Family Presence Risk-Benefit and Family Presence Self-Confidence during invasive procedures and find out the opinions of the medical and nursing staff on FPDIP.

Method

Cross-sectional methodological pilot study. Online and paper questionnaires modified from a previous translation. A factor analysis was performed for the validity of the indices and bivariate analysis for all the variables. Ethical approvals and research permissions were obtained according to national standards.

Results

One hundred twenty healthcare professionals (22.18%) answered the survey. Cronbach’s α on the Family Presence Risk-Benefit scale was 0.877. Cronbach’s α on the Family Presence Self-Confidence scale was 0.937. The correlation between the Risk-Benefit and Self-confidence variables is significant and with a moderate intensity of the relationship. A lower predisposition to Family Presence During Invasive Procedures is observed. Physicians are more reluctant than nurses.

Conclusions

The FPDI generates controversy as it alters health professionals’ routines when they decide whether to allow it or not. There is a tendency for younger professionals to support FPDI. In general, health professionals, mainly physicians, do not favor FPDI. Health workers who perceive fewer risks and more benefits in FPDI and have greater self-confidence are more in favor of FPDI. The psychometric properties and internal consistency of the questionnaire indicate the validity and reliability of this tool.
Effects of computerized decision support on maternal and neonatal health-worker performance in the context of combined implementation with performance-based incentivisation in Upper East Region, Ghana: a qualitative study of professional perspectives
Authors: Aninanya Gifty Apiung , Williams John E , Williams Afua , Otupiri Easmon , Howard Natasha
Published: December 2022

Background

Computerized decision support systems (CDSS) and performance-based incentives (PBIs) can improve health-worker performance. However, there is minimal evidence on the combined effects of these interventions or perceived effects among maternal and child healthcare providers in low-resource settings. We thus aimed to explore the perceptions of maternal and child healthcare providers of CDSS support in the context of a combined CDSS-PBI intervention on performance in twelve primary care facilities in Ghana’s Upper East Region.

Methods

We conducted a qualitative study drawing on semi-structured key informant interviews with 24 nurses and midwives, 12 health facility managers, and 6 district-level staff familiar with the intervention. We analysed data thematically using deductive and inductive coding in NVivo 10 software.

Results

Interviewees suggested the combined CDSS-PBI intervention improved their performance, through enhancing knowledge of maternal health issues, facilitating diagnoses and prescribing, prompting actions for complications, and improving management. Some interviewees reported improved morbidity and mortality. However, challenges described in patient care included CDSS software inflexibility (e.g. requiring administration of only one intermittent preventive malaria treatment to pregnant women), faulty electronic partograph leading to unnecessary referrals, increased workload for nurses and midwives who still had to complete facility forms, and power fluctuations affecting software.

Conclusion

Combining CDSS and PBI interventions has potential to improve maternal and child healthcare provision in low-income settings. However, user perspectives and context must be considered, along with allowance for revisions, when designing and implementing CDSS and PBIs interventions.