bluuebunny/crossref_metadata_2025 huggingface dataset:
pCONUS 2 and pCONUS 2-HPC for the treatment of wide-necked intracranial aneurysms: Periprocedural, 6-month, and early 2-year follow-up outcomes
Authors: Yeomans J , Sastry A
Published: April 2021

Background/Purpose

pCONUS 2 and pCONUS 2-HPC are novel neck-bridging devices designed to support endovascular coil occlusion of wide-necked intracranial bifurcation aneurysms. This study summarises periprocedural outcomes, 6-month, and early 2-year follow-up results following its introduction in an interventional neuroradiology centre.

Materials/Methods

This prospective, single-arm study assessed 20 aneurysms treated over a 40 month time period from time of procedure to 2 years post-procedure. Data collected included patient demographics, aneurysm features, and intraprocedural, 6-month, and 2-year post-procedural complications and angiographic features.

Results

The mean age of the cohort was 59+-SD 7.7 years. 16 unruptured aneurysms were treated (pCONUS 2 13/16, pCONUS 2-HPC 3/16) and 4 ruptured aneurysms were treated with pCONUS 2-HPC. Unruptured cases received dual antiplatelet therapy pre- and post-procedure while ruptured cases received single antiplatelet therapy. 9/20 aneurysms were located at the MCA bifurcation and 7/20 at the basilar tip. The remaining 4 aneurysms were at various bifurcations in the anterior circulation. 11/20 were small (<10mm) and 9/20 were large (10–25mm). There was one periprocedural complication: a retroperitoneal bleed. There were no post-procedural intracranial complications or at 6-months follow-up. At 6 months, satisfactory occlusion was achieved in 94% of cases (15/16). There was one delayed death at 2-year follow-up from an unrelated cause.

Conclusion

pCONUS 2 and pCONUS 2-HPC have excellent short and medium-term safety profiles and clinical outcomes with no procedure-related mortality or morbidity and good occlusion rates at 6-month follow-up. The use of pCONUS 2-HPC with single antiplatelet therapy is feasible and did not cause any complications.
Scalable information-theoretic path planning for a rover-helicopter team in uncertain environments
Authors: Folsom Larkin , Ono Masahiro , Otsu Kyohei , Park Hyoshin
Published: April 2021

Mission-critical exploration of uncertain environments requires reliable and robust mechanisms for achieving information gain. Typical measures of information gain such as Shannon entropy and KL divergence are unable to distinguish between different bimodal probability distributions or introduce bias toward one mode of a bimodal probability distribution. The use of a standard deviation (SD) metric reduces bias while retaining the ability to distinguish between higher and lower risk distributions. Areas of high SD can be safely explored through observation with an autonomous Mars Helicopter allowing safer and faster path plans for ground-based rovers. First, this study presents a single-agent information-theoretic utility-based path planning method for a highly correlated uncertain environment. Then, an information-theoretic two-stage multiagent rapidly exploring random tree framework is presented, which guides Mars helicopter through regions of high SD to reduce uncertainty for the rover. In a Monte Carlo simulation, we compare our information-theoretic framework with a rover-only approach and a naive approach, in which the helicopter scouts ahead of the rover along its planned path. Finally, the model is demonstrated in a case study on the Jezero region of Mars. Results show that the information-theoretic helicopter improves the travel time for the rover on average when compared with the rover alone or with the helicopter scouting ahead along the rover’s initially planned route.
FUSIC HD. Comprehensive haemodynamic assessment with ultrasound
Authors: Miller Ashley , Peck Marcus , Clark Tom , Conway Hannah , Olusanya Segun , Fletcher Nick , Coleman Nick , Parulekar Prashant , Aron Jonathan , Kirk-Bayley Justin , Wilkinson Jonathan Nicholas , Wong Adrian , Stephens Jennie , Rubino Antonio , Attwood Ben , Walden Andrew , Breen Andrew , Waraich Manprit , Nix Catherine , Hayward Simon
Published: April 2021

FUSIC haemodynamics (HD) – the latest Focused Ultrasound in Intensive Care (FUSIC) module created by the Intensive Care Society (ICS) – describes a complete haemodynamic assessment with ultrasound based on ten key clinical questions: 1. Is stroke volume abnormal? 2. Is stroke volume responsive to fluid, vasopressors or inotropes? 3. Is the aorta abnormal? 4. Is the aortic valve, mitral valve or tricuspid valve severely abnormal? 5. Is there systolic anterior motion of the mitral valve? 6. Is there a regional wall motion abnormality? 7. Are there features of raised left atrial pressure? 8. Are there features of right ventricular impairment or raised pulmonary artery pressure? 9. Are there features of tamponade? 10. Is there venous congestion? FUSIC HD is the first system of its kind to interrogate major cardiac, arterial and venous structures to direct time-critical interventions in acutely unwell patients. This article explains the rationale for this accreditation, outlines the training pathway and summarises the ten clinical questions. Further details are included in an online supplementary appendix.
Giant cell tumour of hand bones: outcomes of treatment
Authors: Puri Ajay , Rajalbandi Rohit , Gulia Ashish
Published: April 2021

The purpose of this study was to report the incidence of giant cell tumour of the hand bones in an Asian population, document treatment options and report outcomes of treatment. Of 698 giant cell tumours of bone that underwent surgery between January 2011 and December 2020 at our institute, only 22 (3%) were in the hand. Fourteen occurred in the metacarpals, eight in the phalanges. Fifteen were primary tumours and seven had recurrent disease. Twenty lesions had an associated soft tissue component. Two patients treated for primary disease and one who had been treated for recurrence had local recurrence. Recurrence occurred in two of nine patients treated with curettage, one of three with resection and none of five with ray or digit amputation. Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control.

Level of evidence: IV
Early high dose corticosteroid therapy in hematopoietic stem cell transplantation patients with acute respiratory distress syndrome: a propensity score matched study
Authors: Hu Yan , Shen Jiawei , An Youzhong , Liu Shuang
Published: April 2021

Background:

Acute respiratory distress syndrome (ARDS) is one of the pulmonary complications after hematopoietic cell transplantation (HSCT) with a poor prognosis. The effects of corticosteroid therapy in HSCT patients with ARDS have never been described. In this study, we aim to evaluate the effect of corticosteroid on hospital mortality and other outcomes in patients with HSCT and ARDS.

Methods:

In this bicenter retrospective study, data were collected from patients diagnosed with ARDS and HSCT. Patients were divided into an early high dose steroids group (receiving a cumulative dose ⩾480 mg of methylprednisolone or its equivalent within the first 3 days after ARDS onset) and a no early high dose steroids group. Univariate and multivariate analyses were used to determine the risk factors of hospital mortality. Cox regression was performed to assess the effect of early high dose steroids on patient survival. A propensity score matched cohort was built to validate the results from the original study cohort.

Results:

Two hundred and sixty-four patients were included in the original study cohort; 89 (33.71%) patients received early high dose steroids; these patients had higher ventilator free days at day 28 (7.68 ± 4.32 versus 6.48 ± 4.76, p = 0.046); there was no difference in hospital mortality (64.04% versus 53.14%, p = 0.091). Patients with early high dose steroids had a higher incidence of new onset bacteremia (17.98% versus 4%, p < 0.001) and viremia (13.48% versus 3.43%, p = 0.002). The results were further confirmed in the propensity score matched cohort, except for the improvement of ventilator free days (6.02 ± 5.51 versus 5.57 ± 5.54, p = 0.643).

Conclusion:

In this cohort of HSCT patients with ARDS, early high dose coticosteroids had no effect on hospital mortality. In addition, the incidences of new onset bacteremia and viremia were increased after early high dose steroids. The reviews of this paper are available via the supplemental material section.
Cell therapies in ovarian cancer
Authors: Sarivalasis Apostolos , Morotti Matteo , Mulvey Arthur , Imbimbo Martina , Coukos George
Published: April 2021

Epithelial ovarian cancer (EOC) is the most important cause of gynecological cancer-related mortality. Despite improvements in medical therapies, particularly with the incorporation of drugs targeting homologous recombination deficiency, EOC survival rates remain low. Adoptive cell therapy (ACT) is a personalized form of immunotherapy in which autologous lymphocytes are expanded, manipulated ex vivo, and re-infused into patients to mediate cancer rejection. This highly promising novel approach with curative potential encompasses multiple strategies, including the adoptive transfer of tumor-infiltrating lymphocytes, natural killer cells, or engineered immune components such as chimeric antigen receptor (CAR) constructs and engineered T-cell receptors. Technical advances in genomics and immuno-engineering have made possible neoantigen-based ACT strategies, as well as CAR-T cells with increased cell persistence and intratumoral trafficking, which have the potential to broaden the opportunity for patients with EOC. Furthermore, dendritic cell-based immunotherapies have been tested in patients with EOC with modest but encouraging results, while the combination of DC-based vaccination as a priming modality for other cancer therapies has shown encouraging results. In this manuscript, we provide a clinically oriented historical overview of various forms of cell therapies for the treatment of EOC, with an emphasis on T-cell therapy.
Analysis of factors that drives arthrocentesis for suspected septic joint
Authors: Roth Cameron A. , Da Lomba Tony , Dadwani Rahul , Dahm James , Strelzow Jason
Published: April 2021

Introduction:

This study aims to develop a simple diagnostic criterion that could be used to justify arthrocentesis in adults with suspected septic arthritis. Our hypothesis is that no single factor will be predictive for a decision to aspirate a questionable septic joint.

Methods:

A prospective observational cohort study was performed at a Level 1 Trauma institution including all patients over the age of 18 years referred to Orthopaedics through the Emergency Department or inpatient orthopaedic consultations for a suspected septic joint. Patient information recorded was age, laboratory markers (white blood cell count, erythrocyte sedimentation rate, C-reactive protein, physical exam findings (fever, pain with range-of-motion), and presence of smoking, diabetes, end-stage renal disease (ESRD) on dialysis, and body mass index > 30. Continuous data was analyzed using logistic regression, and nominal data was analyzed using a two-tailed Fisher’s exact test.

Results:

A total of 128 patients met inclusion criteria for this study; 71 patients underwent arthrocentesis for suspected septic joint. On analysis of risk factors, the demographics, laboratory markers, physical exam and comorbidities were not significant between the two groups. On subset analysis of the septic joints, we found the only risk factor to be significantly predictive of whether a joint was septic was the presence of ESRD on dialysis ( p = 0.042).

Conclusion:

Past data have looked solely at predictive risk factors for septic arthritis; however, this study aims to predict what drives physicians towards aspirating a joint even before it is determined to be septic. We found no single factor was predictive of joint aspiration. Only ESRD on dialysis is predictive of whether a joint with concern for septic arthritis would ultimately be septic in our institution. The decision to aspirate continues to be best determined by clinician judgment in light of experience and available clinical information.
Ultrasonography predicts the results of labial salivary gland biopsy in patients with suspected Sjögren’s syndrome: a matrix risk model
Authors: Mo Ying-Qian , Hao Shao-Yun , Li Qian-Hua , Liang Jin-Jian , Luo Yi , Lan Yu-Qing , Zhong Jiang-Long , Wang Jun-Wei , Zhang Xue-Pei , Huang Wen-Ke , Dai Lie
Published: April 2021

Objective:

Although a positive result of labial salivary gland biopsy (LSGB) is critical for the diagnosis of Sjögren’s syndrome, rheumatologists prefer assessing the non-invasive objective items and hope to learn the predicted probability of positive LSGB before referring patients with suspected Sjögren’s syndrome to receive biopsy. This study aimed to explore the predictive value of combined B-mode ultrasonography (US) and shear-wave elastography (SWE) examination on LSGB results.

Methods:

A derivation cohort and later a validation cohort of patients with suspected Sjögren’s syndrome were recruited. All participants received clinical assessments, B-mode US and SWE examination on bilateral parotid and submandibular glands before LSGB. Positive LSGB was defined by a focus score ⩾1 per 4 mm2 of glandular tissue.

Results:

In the derivation cohort of 91 participants, either the total US scores or the total SWE values of four glands significantly distinguished patients with positive LSGB from those with negative results (area under the curve (AUC) = 0.956, 0.825, both p < 0.001). The positive predictive value (PPV) was 100% in patients with total US scores ⩾9 or with total SWE values ⩾33 kPa. The negative predictive value (NPV) was 100% in patients with total US scores <5, but 68% in patients with total SWE values <27 kPa. A matrix risk model was derived based on the combination of total US scores and total SWE values. Patients can be stratified into high, moderate, and low risk of positive LSGB. In the validation cohort of 52 participants, the PPV was 94% in the high-risk subpopulation and the NPV was 93% in the low-risk subpopulation.

Conclusion:

A novel matrix risk model based on the combined B-mode US and SWE examination can help rheumatologists to make a shared decision with suspected Sjögren’s syndrome patients on whether the invasive procedure of LSGB should be performed.
Should denosumab treatment for osteoporosis be continued indefinitely?
Authors: Noble Jane A. , McKenna Malachi J. , Crowley Rachel K.
Published: April 2021

Denosumab was approved for the treatment of postmenopausal osteoporosis in 2010, based on the FREEDOM study, which indicated a benefit in terms of increased bone mineral density and reduced risk of major osteoporotic fracture. In the initial clinical studies it was noted that discontinuation of denosumab can lead to a rebound of bone turnover markers and loss of accrued bone mineral density. An increased risk of fractures (multiple vertebral fractures in particular) associated with discontinuation was noted after approval and marketing of denosumab. For many patients experiencing gain in bone mineral density and fracture prevention while taking denosumab, there is no reason to stop therapy. However, discontinuation of denosumab may happen due to non-adherence; potential lack of efficacy in an individual; where reimbursement for therapy is limited to those with bone mineral density in the osteoporosis range, when assessment reveals this has been exceeded; or patient or physician concern regarding side effects. This review paper aims to discuss these concerns and to summarize the data available to date regarding sequential osteoporosis therapy following denosumab cessation to reduce the risk of multiple vertebral fracture.
Economic Evaluation of Water Resource Management in South Korea Based on Benefit–Cost Analysis
Authors: Kim Hyun No
Published: April 2021

The economic evaluation of the government policy is useful to identify the effectiveness of its financial management and the achievement of its goal. Based on valuation studies of water quality improvement from the Environmental Valuation Information System database provided by Korea Environment Institute, this study employed a meta-regression to measure the benefits of water quality improvement in three major river basins in South Korea. The empirical model is specified to capture the differentiated impact of water quality improvement by each river basin and the regression results showed that the increase in water quality grade has an impact on willingness-to-pay values. The total benefits provided by Han, Nakdong, and Geum River are estimated to be about US$490 million, about US$173 million, and about US$50 million per year, respectively. The estimated benefits were then compared with the costs, namely river management funds (RMFs) which are financial resources to support a variety of projects for water quality improvement. Based on benefit–cost comparison, this study explores the economic evaluation of water resource management in South Korea. This study also provides policy options including the equity of imposing water use charges, operational efficiency of RMFs, and stakeholder engagement for inclusive water governance that are helpful to maintain the sustainability of water resource in the long run.
Bundled Payment Models in Spine Surgery
Authors: Hines Kevin , Mouchtouris Nikolaos , Getz Charles , Gonzalez Glenn , Montenegro Thiago , Leibold Adam , Harrop James
Published: April 2021

Study Design:

The following is a narrative discussion of bundled payments in spine surgery.

Objective:

The cost of healthcare in the United States has continued to increase. To lower the cost of healthcare, reimbursement models are being investigated as potential cost saving interventions by driving incentives and quality improvement in fields such a spine surgery.

Methods:

Narrative overview of literature pertaining to bundled payments in spine surgery synthesizing findings from computerized databases and authoritative texts.

Results:

Spine surgery is challenging to define payment modes because of high cost variability and surgical decision-making nuances. While implementing bundled care payments in spine surgery, it is important to understand concepts such as value-based purchasing, episodes of care, prospective versus retrospective payment models, one versus two-sided risk, risk adjustment, and outlier protection. Strategies for implementation underscore the importance of risk stratification and modeling, adoption of evidence based clinical pathways, and data collection and dissemination. While bundled care models have been successfully implemented, challenges facing institutions adopting bundled care payment models include financial stressors during adoption of the model, distribution of risks, incentivization of treating only low risk patients, and nuanced variation in procedures leading to variation in costs.

Conclusion:

An alternative for fee for service payments, bundled care payments may lead to higher cost savings and surgeon accountability in a patient’s care.
Pharyngo-Esophageal Perforation Following Anterior Cervical Spine Surgery: A Single Center Experience and a Systematic Review of the Literature
Authors: Moletta Lucia , Pierobon Elisa Sefora , Salvador Renato , Volpin Francesco , Finocchiaro Francesco Massimiliano , Capovilla Giovanni , Piangerelli Alfredo , Ciccioli Eleonora , Zanchettin Gianpietro , Costantini Mario , Merigliano Stefano , Valmasoni Michele
Published: April 2021

Study Design:

Case series and systematic review of the Literature.

Objectives:

Pharyngo-esophageal perforation (PEP) is a rare, life-threatening complication of anterior cervical spine surgery (ACSS). Best management of these patients remains poorly defined. The aim of this study is to present our experience with this entity and to perform a systematic Literature review to better clarify the appropriate treatment of these patients.

Methods:

Patients referred to our center for PEP following ACSS (January 2002-December 2018) were identified from our database. Moreover, an extensive review of the English Literature was conducted according to the 2009 PRISMA guidelines.

Results:

Twelve patients were referred to our Institution for PEP following ACSS. Indications for ACSS were trauma (n = 10), vertebral metastases (n = 1) and disc herniation (n = 1). All patients underwent hardware placement at the time of ACSS. There were 6 early and 6 delayed PEP. Surgical treatment was performed in 11 patients with total or partial removal of spine fixation devices, autologous bone graft insertion or plate/cage replacement, anatomical suture of the fistula and suture line reinforcement with myoplasty. Complete resolution of PEP was observed in 6 patients. Five patients experienced PEP persistence, requiring further surgical management in 2 cases. At a median follow-up of 18.8 months, all patients exhibited permanent resolution of the perforation.

Conclusions:

PEP following ACSS is a rare but dreadful complication. Partial or total removal of the fixation devices, direct suture of the esophageal defect and coverage with tissue flaps seems to be an effective surgical approach in these patients
Assessment of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, and mean platelet volume in patients with idiopathic epiretinal membrane
Authors: Demir Gokhan , Topcu Husna , Cakmak Semih , Aksoy Funda Ebru , Sucu Mehmet Emin , Gunes Hasan , Yasa Dilek , Alkın Zeynep
Published: April 2021

Purpose:

To assess the role of inflammation in the pathogenesis of idiopathic epiretinal membrane (iERM) using the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and mean platelet volume (MPV) as indicators of inflammation and to compare these parameter levels between iERM and control subjects.

Methods:

We retrospectively analyzed the medical records of 36 patients who underwent vitrectomy-ERM peeling and 39 patients who had cataract surgery. We obtained blood samples from all individuals who participated in the study to investigate these parameters.

Results:

Seventy-five subjects were included in this study: 36 in the iERM group and 39 in the control group. The mean neutrophil and MPV levels were significantly higher in iERM subjects than in control subjects. The mean lymphocyte level was lower in the iERM group. The mean NLR, PLR, and MPV levels were higher in iERM subjects than in control subjects.

Conclusion:

The higher NLR, PLR, and MPV levels found in patients with iERM may indicate that subclinical systemic inflammation may associate with iERM.
Elementary General Music Performances and Teachers’ Perceptions of Stress
Authors: Potter Jennifer
Published: April 2021

The purpose of investigation was to examine the perceptions of elementary music teachers concerning the preparation of elementary music performances and the impact on their perceived stress. Participants were practicing elementary general music teachers ( N = 3) representing three different elementary schools from a metropolitan area in the Midwest. All participants were interviewed twice over a period of two months via Zoom. Data were analyzed through an open coding process (Gibbs, 2007), which yielded three themes: time management, control, and isolation. Facets of time management included strategic planning, organizational techniques, and instructional time; control concerned scheduling, repertoire selection, equipment, and performance venues; and isolation pertained to relationships with colleagues and administrators and an overwhelming amount of responsibility. These findings indicate the importance of acknowledging various stressors affecting music educators and how those might positively and negatively affect teachers and students.
Online biophysical predictions for SARS-CoV-2 proteins
Authors: Kagami Luciano , Roca-Martínez Joel , Gavaldá-García Jose , Ramasamy Pathmanaban , Feenstra K. Anton , Vranken Wim F.
Published: April 2021

Background

The SARS-CoV-2 virus, the causative agent of COVID-19, consists of an assembly of proteins that determine its infectious and immunological behavior, as well as its response to therapeutics. Major structural biology efforts on these proteins have already provided essential insights into the mode of action of the virus, as well as avenues for structure-based drug design. However, not all of the SARS-CoV-2 proteins, or regions thereof, have a well-defined three-dimensional structure, and as such might exhibit ambiguous, dynamic behaviour that is not evident from static structure representations, nor from molecular dynamics simulations using these structures.

Main

We present a website (https://bio2byte.be/sars2/) that provides protein sequence-based predictions of the backbone and side-chain dynamics and conformational propensities of these proteins, as well as derived early folding, disorder, β-sheet aggregation, protein-protein interaction and epitope propensities. These predictions attempt to capture the inherent biophysical propensities encoded in the sequence, rather than context-dependent behaviour such as the final folded state. In addition, we provide the biophysical variation that is observed in homologous proteins, which gives an indication of the limits of their functionally relevant biophysical behaviour.

Conclusion

The https://bio2byte.be/sars2/ website provides a range of protein sequence-based predictions for 27 SARS-CoV-2 proteins, enabling researchers to form hypotheses about their possible functional modes of action.
A buffered media system for yeast batch culture growth
Authors: Prins Rianne C. , Billerbeck Sonja
Published: April 2021

Background

Fungi are premier hosts for the high-yield secretion of proteins for biomedical and industrial applications. The stability and activity of these secreted proteins is often dependent on the culture pH. As yeast acidifies the commonly used synthetic complete drop-out (SD) media that contains ammonium sulfate, the pH of the media needs to be buffered in order to maintain a desired extracellular pH during biomass production. At the same time, many buffering agents affect growth at the concentrations needed to support a stable pH. Although the standard for biotechnological research and development is shaken batch cultures or microtiter plate cultures that cannot be easily automatically pH-adjusted during growth, there is no comparative study that evaluates the buffering capacity and growth effects of different media types across pH-values in order to develop a pH-stable batch culture system.

Results

We systematically test the buffering capacity and growth effects of a citrate-phosphate buffer (CPB) from acidic to neutral pH across different media types. These media types differ in their nitrogen source (ammonium sulfate, urea or both). We find that the widely used synthetic drop-out media that uses ammonium sulfate as nitrogen source can only be effectively buffered at buffer concentrations that also affect growth. At lower concentrations, yeast biomass production still acidifies the media. When replacing the ammonium sulfate with urea, the media alkalizes. We then develop a medium combining ammonium sulfate and urea which can be buffered at low CPB concentrations that do not affect growth. In addition, we show that a buffer based on Tris/HCl is not effective in maintaining any of our media types at neutral pH even at relatively high concentrations.

Conclusion

Here we show that the buffering of yeast batch cultures is not straight-forward and addition of a buffering agent to set a desired starting pH does not guarantee pH-maintenance during growth. In response, we present a buffered media system based on an ammonium sulfate/urea medium that enables relatively stable pH-maintenance across a wide pH-range without affecting growth. This buffering system is useful for protein-secretion-screenings, antifungal activity assays, as well as for other pH-dependent basic biology or biotechnology projects.
Risk of major bleeding by ethnicity and socioeconomic deprivation among 488,107 people in primary care: a cohort study
Authors: Tse Wai Chung , Grey Corina , Harwood Matire , Jackson Rod , Kerr Andrew , Mehta Suneela , Poppe Katrina , Pylypchuk Romana , Wells Sue , Selak Vanessa
Published: April 2021

Background

Antithrombotic medications (antiplatelets and anticoagulants) reduce the risk of cardiovascular disease (CVD), but with the disadvantage of increasing bleeding risk. Ethnicity and socioeconomic deprivation are independent predictors of major bleeds among patients without CVD, but it is unclear whether they are also predictors of major bleeds among patients with CVD or atrial fibrillation (AF) after adjustment for clinical variables.

Methods

Prospective cohort study of 488,107 people in New Zealand Primary Care (including 64,420 Māori, the indigenous people of New Zealand) aged 30–79 years who had their CVD risk assessed between 2007 and 2016. Participants were divided into three mutually exclusive subgroups: (1) AF with or without CVD (n = 15,212), (2) CVD and no AF (n = 43,790), (3) no CVD or AF (n = 429,105). Adjusted hazards ratios (adjHRs) were estimated from Cox proportional hazards models predicting major bleeding risk for each of the three subgroups to determine whether ethnicity and socioeconomic deprivation are independent predictors of major bleeds in different cardiovascular risk groups.

Results

In all three subgroups (AF, CVD, no CVD/AF), Māori (adjHR 1.63 [1.39–1.91], 1.24 [1.09–1.42], 1.57 [95% CI 1.45–1.70], respectively), Pacific people (adjHR 1.90 [1.58–2.28], 1.30 [1.12–1.51], 1.62 [95% CI 1.49–1.75], respectively) and Chinese people (adjHR 1.53 [1.08–2.16], 1.15 [0.90–1.47], 1.13 [95% CI 1.01–1.26], respectively) were at increased risk of a major bleed compared to Europeans, although for Chinese people the effect did not reach statistical significance in the CVD subgroup. Compared to Europeans, Māori and Pacific peoples were generally at increased risk of all bleed types (gastrointestinal, intracranial and other bleeds). An increased risk of intracranial bleeds was observed among Chinese and Other Asian people and, in the CVD and no CVD/AF subgroups, among Indian people. Increasing socioeconomic deprivation was also associated with increased risk of a major bleed in all three subgroups (adjHR 1.07 [1.02–1.12], 1.07 [1.03–1.10], 1.10 [95% CI 1.08–1.12], respectively, for each increase in socioeconomic deprivation quintile).

Conclusion

Ethnicity and socioeconomic status should be considered in bleeding risk assessments to guide the use of antithrombotic medication for the management of AF and CVD.
Mortality rates and risk factors in 1412 Japanese patients with decompensated hepatitis C virus-related cirrhosis: a retrospective long-term cohort study
Authors: Fujiyama Shunichiro , Akuta Norio , Sezaki Hitomi , Kobayashi Mariko , Kawamura Yusuke , Hosaka Tetsuya , Kobayashi Masahiro , Saitoh Satoshi , Suzuki Fumitaka , Suzuki Yoshiyuki , Arase Yasuji , Ikeda Kenji , Kumada Hiromitsu
Published: April 2021

Background

Hepatitis C virus is the leading cause of liver cirrhosis and hepatocellular carcinoma in Japan. We aimed to examine the long-term (> 20 years) mortality and hepatocellular carcinoma rates and associated risk factors in 1412 Japanese patients with decompensated hepatitis C virus-related cirrhosis (Child–Pugh B or C).

Methods

Cumulative survival and hepatocellular carcinoma rates were determined using Kaplan–Meier analysis. Independent risk factors were identified by multivariate analysis. A two-tailed P-value of < 0.05 was considered significant.

Results

The patients were followed up for a median of 2 years (range 0.5–24.2 years). In total, 62.3%, 41.7%, 4.7%, and 68.3% of the patients had a history of hepatocellular carcinoma, ascites, hepatic encephalopathy, and esophageal varices, respectively. The 1-, 5-, 10-, and 20-year cumulative overall survival rates in the total cohort was 74.9%, 29.0%, 9.1%, and 1.4%, respectively. The 1-, 3-, 5-, and 10-year cumulative survival rates for patients without hepatocellular carcinoma were 93.1%, 54.4%, 18.2%, and 4.0%, respectively, and the corresponding cumulative post-decompensation hepatocellular carcinoma rates were 14.0%, 31.6%, 46.1%, and 66.2%, respectively. The independent risk factors for mortality were older age, Child–Pugh C cirrhosis, the presence of hepatocellular carcinoma, low estimated glomerular filtration rate, low serum sodium level, low platelet count, and high γ-glutamyl transferase and α-fetoprotein levels for all patients and older age, Child–Pugh C cirrhosis, and low estimated glomerular filtration rate for patients without hepatocellular carcinoma. Overall, 1035 patients (73.3%) died; the causes of death were liver failure with/without hepatocellular carcinoma, pneumonia, sepsis, cardiovascular disease, and non-hepatocellular carcinoma malignancies. The corresponding morality rates per person-year were 133.4, 59.9, 10.9, 10.6, 9.0, and 5.2, respectively.

Conclusions

Among Japanese patients with decompensated hepatitis C virus-related cirrhosis, hepatocellular carcinoma is associated with poor prognosis. Our results highlight the importance of managing liver-related events, including hepatocellular carcinoma, in these patients.
The profile of older adults seeking chiropractic care: a secondary analysis
Authors: de Luca Katie , Hogg-Johnson Sheilah , Funabashi Martha , Mior Silvano , French Simon D.
Published: April 2021

Background

Musculoskeletal conditions are the primary reason older adults seek general medical care, resulting in older adults as the highest consumers of health care services. While there is high use of chiropractic care by older adults, there is no recent, specific data on why older adults seek chiropractic care and how chiropractors manage conditions. Therefore, the purpose of this study was to describe the demographic characteristics of older adults seeking chiropractic care, and to report problems diagnosed by chiropractors and the treatment provided to older adults who seek chiropractic care.

Methods

A secondary data analysis from two, large cross-sectional observational studies conducted in Australia (COAST) and Canada (O-COAST). Patient encounter and diagnoses were classified using the International Classification of Primary Care, 2nd edition (ICPC-2), using the Australian ICPC-2 PLUS general practice terminology and the ICPC-2 PLUS Chiro terminology. Descriptive statistics were used to summarize chiropractor, patient and encounter characteristics. Encounter and patient characteristics were compared between younger (< 65 years old) and older (≥65 years old) adults using χ2 tests or t-tests, accounting for the clustering of patients and encounters within chiropractors.

Results

A total of 6781 chiropractor–adult patient encounters were recorded. Of these, 1067 encounters were for persons aged > 65 years (16%), from 897 unique older patients. The most common diagnosis within older adult encounters was a back problem (56%), followed by neck problems (10%). Soft tissue techniques were most frequently used for older patients (85 in every 100 encounters) and in 29 of every 100 encounters, chiropractors recommended exercise to older patients as a part of their treatment.

Conclusions

From 6781 chiropractor–adult patient encounters across two countries, one in seven adult chiropractic patients were > 65 years. Of these, nearly 60% presented with a back problem, with neck pain and lower limb problems the next most common presentation to chiropractors. Musculoskeletal conditions have a significant burden in terms of disability in older adults and are the most commonly treated conditions in chiropractic practice. Future research should explore the clinical course of back pain in older patients seeking chiropractic care and compare the provision of care to older adults across healthcare professions.
Practice variation in the treatment of patients with renal hyperparathyroidism: a survey-based study in the Netherlands
Authors: Zhang Jaimie L. H. , Appelman-Dijkstra Natasha M. , Fu Edouard L. , Rotmans Joris I. , Schepers Abbey
Published: April 2021

Background

Renal hyperparathyroidism is a disease entity that is complex and poorly understood. Although there are guidelines regarding how to manage this patient group, evidence is scarce. Therefore, this survey-based study aims to map the physicians’ attitude in terms of preference for management of renal hyperparathyroidism and the influence of patient and respondent factors.

Methods

A survey was sent to Dutch societies of nephrology, endocrinology, and surgeons with interest in endocrine surgery. The survey consisted of eight case vignettes of renal hyperparathyroidism patients who were on hemodialysis and suitable for kidney transplantation, and varied in one of three patient variables import for decision making: age (40 vs. 65 years), parathyroid hormone (40 vs. 90 pmol/L), and serum calcium level (2.25 vs. 2.8 mmol/L). For each case, respondents could choose between maintaining conservative treatment (active vitamin D metabolites), calcimimetics, or subtotal parathyroidectomy as their treatment of choice. Categorical multilevel logistic models were used to investigate the association of patient and respondent variables with treatment preference. The influence of patient variables was determined independently of each other and by means of logistic regression the probabilities of treatment choice were calculated.

Results

In total, 115 surveys were included in the analysis. In 6 out of 8 cases, less than two-thirds of respondents agreed on the most favoured treatment. Among patient characteristics, the main disincentive for respondents not to choose conservative therapy was an elevated serum calcium level (subtotal parathyroidectomy vs conservative OR 93.1, 95%-CI: 48.39–179.07 and calcimimetics vs conservative OR 31.2 95%-CI: 18.58–52.30). Additionally, the most significant treatment differences were found between medical specialties and the experience of the respondents, expressed as the amount of cases the physician was involved in during the past year.

Conclusions

Elevated serum calcium levels were widely recognized and the prime reason for respondents to abandon conservative treatment. However, considerable disagreement in treatment preferences remained throughout the cases, demonstrating the current literature available being inconclusive in guiding physicians. Therefore, a high-quality trial comparing subtotal parathyroidectomy to medical treatment is needed to determine optimal treatment.
Ovarian cyst elevation using a metreurynter for laparoscopic cystectomy of a benign ovarian cyst during pregnancy
Authors: Kotani Yasushi , Murakami Kosuke , Yamamoto Kiko , Fujishima Risa , Yahata Tamaki , Yo Yoshie , Shimaoka Masao , Matsumura Noriomi
Published: April 2021

Background

A uterine manipulator cannot be used to elevate the ovary in benign ovarian surgery during pregnancy. This report describes our method of elevation of the ovary using a metreurynter with the success rate of the procedure and a comparison of surgical results and pregnancy outcomes between the successful and unsuccessful cases.

Methods

Between August 2003 and February 2020, 11 pregnant patients with a tumor found sunk in the Cul-de-sac underwent laparoscopic cystectomy for a benign ovarian cyst with a metreurynter. The surgical results, success and failure of the elevation by a metreurynter, pregnancy outcomes, and fetal status at delivery were evaluated.

Results

Elevation of ovarian tumors with a metreurynter was successful in nine cases. However, it was unsuccessful in the remaining two cases wherein the ovary was lifted with forceps while the uterus was in a compressed state. The operative time was also longer in these cases. The pregnancy prognosis, however, was good for both, successful and unsuccessful cases.

Conclusions

The metreurynter is an inexpensive and practical obstetric device, and its optimal use allows the performance of a procedure with minimal burden on a pregnant uterus. Therefore, we recommend the appropriate use of this method to enable effective laparoscopic cystectomy of ovarian tumors during pregnancy.
Atopic diseases in children and adolescents are associated with behavioural difficulties
Authors: Keller Wiebke , Vogel Mandy , Prenzel Freerk , Genuneit Jon , Jurkutat Anne , Hilbert Cornelia , Hiemisch Andreas , Kiess Wieland , Poulain Tanja
Published: April 2021

Background

Atopic diseases and behavioural difficulties in children have both been on the rise in recent decades. This study seeks to assess associations between atopic diseases and behavioural difficulties, examining the differences considering child age and how behavioural difficulties were reported (via self-report or parent-report).

Methods

Data on behavioural difficulties, assessed through the Strengths and Difficulties Questionnaire (SDQ), and on atopic diseases, assessed through the participant’s medical history, were available for 2701 study participants aged 3 to 18 years. Associations between atopic diseases and behavioural difficulties were evaluated using linear regression analyses. We split the study sample into two groups. I: 3-to 10-year-olds/parent-reported SDQ (n = 1764), II: 11- to 18-year-olds/parent-reported SDQ (n = 937) and self-reported SDQ (n = 915). All analyses were adjusted for age, gender, and socioeconomic status.

Results

In younger children, atopic dermatitis was strongly associated with higher total difficulties scores, more emotional problems and conduct problems, and more symptoms of hyperactivity/inattention. Parents reported higher total difficulties scores, more emotional problems, and more peer-relationship problems for adolescents with bronchial asthma and other allergies, whereas the adolescents themselves reported more peer relationship problems.

Conclusion

In younger children, atopic dermatitis is associated with internalizing and externalizing problems. In adolescents, bronchial asthma and other allergies are associated with a greater level of internalizing problems only. The findings further suggest that parents of adolescents are more likely to perceive associations between atopic diseases and behavioural difficulties than the adolescents themselves.
The development of a reliable and valid instrument to measure the osteoporosis-related knowledge: validation of the Hungarian version of Osteoporosis Knowledge Assessment Tool (OKAT)
Authors: Tardi Peter , Szilagyi Brigitta , Makai Alexandra , Gyuro Monika , Acs Pongrac , Jaromi Melinda , Molics Balint , Hock Marta
Published: April 2021

Background

Osteoporosis is one of the most common chronic musculoskeletal diseases. Osteoporosis-related knowledge is an important contributor in to prevent osteoporosis. There is no validated reliable questionnaire to measure the knowledge in Hungary. The aim of the study was to validate the Osteoporosis Knowledge Assessment Tool (OKAT) Hungarian version.

Methods

The research was a randomized validation study of a new Hungarian language instrument. The questionnaire was administered to 557 randomly selected healthy women (age between 25 and 44 years) from December 2018 to July 2019 in Baranya county, Hungary. The reliability was examined by the Flesch reading ease and McNemar’s test. We examined item discrimination and item-total correlations, inter-item consistency (Cronbach’s alpha coefficient) and principal component factor analysis.

Results

Significant differences (p <  0.001) were reported between total scores and the age categories. Significant (p <  0.001) correlation (r = 0.25) was found between the education level and the knowledge. Significantly (p <  0.001) higher knowledge were found in health care profession (14.53 ± 3.58) than the non-health care profession (9.99 ± 4.04). Participants with osteoporosis or fracture in family history had better knowledge (p <  0.001). Flesch reading ease was 44, the questionnaire had a Ferguson’s sigma of 0.94 and a Cronbach’s alpha of 0.81. There were no negative inter-item correlations psychometric properties of the OKAT, all items had more than 70% of correlations (p <  0.001).

Conclusions

The Hungarian version of the Osteoporosis Knowledge Assessment Tool is a reliable and objective questionnaire to measure women’s knowledge in Hungary.
Cumulative radiation dose incurred during the management of complex pleural space infection
Authors: Gilbert Christopher R. , Jackson Anee S. , Wilshire Candice L. , Horslen Leah C. , Chang Shu-Ching , Bograd Adam J. , Vallieres Eric , Gorden Jed A.
Published: April 2021

Background

Complex pleural space infections are commonly managed with antibiotics, pleural drainage, intrapleural fibrinolytic therapy, and surgery. These strategies often utilize radiographic imaging during management, however little data is available on cumulative radiation exposure received during inpatient management. We aimed to identify the type and quantity of radiographic studies along with the resultant radiation exposure during the management of complex pleural space infections.

Methods

Retrospective review of community network healthcare system from January 2015 to July 2018. Patients were identified through billing databases as receiving intrapleural fibrinolytic therapy and/or surgical intervention. Patient demographics, clinical outcomes, and inpatient radiographic imaging was collected to calculate cumulative effective dose.

Results

A total of 566 patients were identified with 7275 total radiographic studies performed and a median cumulative effective dose of 16.9 (IQR 9.9–26.3) mSv. Multivariable linear regression analysis revealed computed tomography use was associated with increased cumulative dose, whereas increased age was associated with lower cumulative dose. Over 74% of patients received more than 10 mSv, with 7.4% receiving more than 40 mSv.

Conclusions

The number of radiographic studies and overall cumulative effective dose in patients hospitalized for complex pleural space infection was high with the median cumulative effective dose > 5 times normal yearly exposure. Ionizing radiation and modern radiology techniques have revolutionized medical care, but are likely not without risk. Additional study is warranted to identify the frequency and imaging type needed during complex pleural space infection management, attempting to keep ionizing radiation exposure as low as reasonably possible.
A modified intrafocal pinning technique with three‐dimensional planning to facilitate volar plating in dorsally comminuted AO/OTA C2 and C3 distal radius fractures
Authors: Gui Xue-yang , Shi Hong-fei , Xiong Jin , Chen Yi-xin , Wang Jun-fei , Huang Jie , Qiu Xu-sheng , Wang Yin-he
Published: April 2021

Backgrounds

Theaim of this study was to assess the efficacy of a modified intrafocal pinningtechnique with three-dimensional (3D) planning to facilitate volar plating in dorsally comminuted intra-articular distal radius fractures.

Methods

Intotal 35 AO/OTA type C2 and C3 fractures were finally included.The 3D digital model of the fracture was reconstructed based on preoperative computedtomographic (CT) images, with the displacement of the comminuted dorsalfragment and the intra-articular fragment analyzed for preoperative planning. During operation, amodified intrafocal pinning technique was applied percutaneously from thedorsal aspect of the radius to reduce the collapsed intra-articular fragmentfollowing volar plating. Adequate reduction was confirmed in all of patientsconsidering radial height, radial inclination and volar tilt in postoperativeradiographs.

Results

No significant fracture re-displacement wasobserved in most of the cases during a mean follow-up period of 17.4 months, exceptfor two patients withthe C3 fracture. All of the patients achieved adequate clinicalROMs at 12 months postoperatively, with a mean DASH score of 12.0. Most of the patients achievedan excellent (n = 21) or good (n = 12) Gartland and Werley wrist score.

Conclusions

Ourmodified intrafocal pinning technique with 3D planning contributes to a satisfactoryclinical and radiological outcome in dorsally comminuted intra-articular distalradius fractures fixed with a volar locking plate.

Trialregistration

Notapplicable because the design of the study is retrospective.