bluuebunny/crossref_metadata_2025 huggingface dataset:
The Pathologic Achilles Insertion Angle (PAIA): A Novel Angular Measurement to Guide Both Evaluation and Treatment of Insertional Achilles Tendinopathy
Authors: Gu Wanjun , Zhu Mingjie , Carpenter Melissa L. , Hunt Kenneth J. , Myerson Mark S. , Li Shuyuan
Published: November 2022

Category:

Hindfoot; Sports

Introduction/Purpose:

Insertional Achilles tendinopathy (IAT) refers to calcified enlargement of the Achilles insertion. Recently, the Zadek osteotomy has been proven to be an effective and minimally invasive procedure for IAT with a dorsal-based closing wedge osteotomy on the posterior tuberosity of the calcaneus. However, determining the wedge size and location to determine the exact enlargement of the tuberosity remains clinically challenging. The goal of this study was to examine the morphology of the calcaneus in both normal control and IAT groups, and to propose a novel algorithm to determine the angular measurement to guide treatment with a Zadek osteotomy.

Methods:

Lateral weightbearing images of 40 control feet were used to determine the size of the calcaneus and contour of the tuberosity. The shape of the calcaneus was mapped onto part of a circle the Standard Circle (SC) whose center and radius were statistically fitted and scaled in relation to the height and width of the calcaneus. The diseased tuberosity of 40 patients with IAT was outlined and compared to their respective SC's. An angle was calculated by which the diseased calcaneus curve was rotated around the weightbearing point to fit the SC. We defined this angular measurement as the Pathologic Achilles Insertion Angle (PAIA). The size of the PAIA should be the exact size of the Zadek osteotomy if the apex of the osteotomy is chosen at the weightbearing point of the calcaneus. The effect of moving the apex of the osteotomy anteriorly on the calcaneal pitch angle was calculated.

Results:

From the morphology of the 40 normal calcanei, the equation of the Standard Curve, R^2=(x+a)^2+(y+b)^2 was created to calculate the SC. The offsets of the center of SC and the radius of SC (a, b, and R) were scaled in relation to the width and height of the calcaneus. From the morphology of the 40 enlarged tuberosities in the IAT group, an algorithm was created to automate the calculation of PAIA. This represented the extent of the enlarged Achilles insertion, which also determined the size and location of the wedge to normalize the contour of the enlarged posterior tuberosity. Using the weightbearing point of the calcaneus as the apex of the osteotomy did not change the pitch angle of the calcaneus, but moving the apex of the osteotomy anteriorly reduced the calcaneal pitch angle determined by both the original PAIA and the calcaneal pitch angle of each specific foot.

Conclusion:

Based on mechanism of mapping and curve fitting, the newly developed PAIA, will not only guide evaluation of the enlarged tuberosity in IAT, but also calculate the size of the Zadek osteotomy taking the patient's calcaneus size, IAT enlargement size, and pitch angle in consideration.
Conservative Management of Lisfranc Injury: A Systematic Review
Authors: Guerreiro Fransiska , Abdelaziz Ahmed , Ponugoti Nikhil , Marsland Daniel
Published: November 2022

Category:

Trauma; Midfoot/Forefoot

Introduction/Purpose:

Lisfranc injuries range from sprains to fracture-dislocations of the tarsometatarsal joints which include injury to the Lisfranc ligament complex. Most require surgical intervention. However, apparently stable injuries can be managed nonoperatively. The aims of the current study were to perform a systematic review of outcomes following nonoperative treatment of Lisfranc injuries.

Methods:

Following PRISMA guidelines and PROSPERO registered, a review was performed of the literature (2000 - 2021) reporting Lisfranc injuries considered to be stable and initially managed nonoperatively. Following exclusions, 8 papers were identified; 1 prospective and 7 retrospective studies. A total of 220 patients were studied with a mean age of 39.8 years and mean follow up of 4.3 years. Outcomes included function, displacement, rates of surgery and secondary osteoarthritis.

Results:

Four papers reported good outcomes, with adjusted functional scores ranging from of 82.6 to 100 (out of 100). However, poor outcomes were frequently reported. One paper reported that late displacement occurred in 54% of patients. Surgical intervention was required in 12.2 to 55.6% of patients. Rates of secondary osteoarthritis were 4.9 to 37.5%. Two papers directly compared operative to non-operative treatment. In an injury matched cohort, superior outcomes were reported in the surgical arm. Numerous limitations were identified, including a lack of consensus on what constitutes a stable injury. Furthermore, wide heterogeneity was identified due to use of different classification systems, PROMS, investigation modalities and treatment protocols.

Conclusion:

Reported outcomes following nonoperative treatment of Lisfranc injuries vary widely, including high rates of conversion to surgery. There is no agreed definition of what a stable Lisfranc injury is, and no agreed treatment protocol. With the advantage of modern imaging techniques, prospective research is needed to determine which Lisfranc injuries can be safely treated nonoperatively.
Comparison of Arthroscopic, X-ray and MRI T2 Mapping Findings for Varus Ankle Osteoarthritis
Authors: Hio Naohiro , Taki Masanori
Published: November 2022

Category:

Ankle Arthritis; Arthroscopy

Introduction/Purpose:

We have previously reported the indication criteria for supramalleolar osteotomy for varus ankle osteoarthritis using our arthroscopic classification. However arthroscopy is invasive, MRI T2 mapping (T2M) is also useful for noninvasive preoperative assessment of articular cartilage condition. The purpose of this study is to investigate the relationship among these.

Methods:

The subjects were 19 patients with 19 joints, 3 males and 16 females, mean age 65.2 years (45-78), 3 joints in stage 2, 8 joints in stage 3a, and 8 joints in stage 3b according to radiographic classification by Takakura et al. Measurements were taken on the coronal section of the talar dome. To evaluate the arthroscopic findings, we used our five grades classification, which is based on the percentage of eburnation areas on the articular surface, we measured the percentage of the area of the missing joint space to the width of the talar dome in X-rays and the ratio of the area of cartilage signal loss to the width of the talar dome in T2M. We determined how well the radiographic and T2M findings match the arthroscopic findings.

Results:

The results showed that there were 2 joints in grade 2, 15 joints in grade 3, and 2 joints in grade 4 in arthroscopic classification. The concordance rate between arthroscopy and X-rays measurements was 100% (2 joints/2 joints) for grade 2, 46.7% (7/15) for grade 3, and 0% (0/2) for grade 4. In all 10 unmatched joints, X-rays underestimated the condition of the articular cartilage compared to arthroscopic findings. The concordance rate between arthroscopy and T2M measurements was 50% (1/2) for grade 2, 80% (12/15) for grade 3, and 100% (2/2) for grade 4. Two joints were underestimated and two were overestimated by T2M compared to the arthroscopic findings.

Conclusion:

Compared to arthroscopic findings, X-rays tended to underestimate the condition of articular cartilage, while T2M tended to overestimate it, but in general, T2M showed a higher concordance rate with the arthroscopic findings than X-rays. T2M is more useful than X-rays as a tool for cartilage evaluation to determine the operative method for varus ankle osteoarthritis.
Outcomes of Lisfranc Injuries Treated with Arthrex Internalbrace
Authors: Hoskins Meloria , Staub Jacob R. , Koroneos Zachary , Aynardi Michael C.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Surgical treatment options for Lisfranc injuries include open reduction and internal fixation (ORIF) and primary arthrodesis. To date, various options of ORIF exist, including transarticular screws, dorsal plates, and more recently, flexible fixation methods such as suture button and InternalBrace (Arthrex Inc, Naples, FL).1-4 Flexible fixation techniques attempt to minimize post-surgical joint immobilization and prevent the articular cartilage damage seen with transarticular screws.4-6 Unlike other flexible fixation techniques, the InternalBrace avoids placement of a suture button on the medial cuneiform and prevents disruption of the tibialis anterior tendon.4,7 Patient outcomes have been reported for suture button and transarticular screw fixation; however, there is a lack of clinical data reported utilizing InternalBrace in Lisfranc injuries due to its recent FDA approval in 2019.1,2,4

Methods:

A retrospective chart review was performed as part of a case study investigation of 9 patients who underwent ORIF with InternalBrace fixation by a single surgeon. Patients over 18 years of age were included.

Results:

The average follow-up time was 6.6 months (SD = 5.1 months). The average time to weight-bearing as tolerated was 6.8 weeks (n=9), while the average time to return to work/sport as tolerated was 14.3 weeks (n=7). The only complication noted at follow-up was hypersensitivity along the foot [1 (11%)] (Table 3). No hardware complications were noted at either 6-week and 12-week post-operative x-rays.

Conclusion:

In this retrospective chart review, the time to return to work/sport as tolerated was comparable to that of return to sport after ORIF with screws and combined bridge-plating (19.6 weeks) and suture button (19.4 weeks).8 Future research involving a larger cohort of patients is required and is currently being performed by our institution to further evaluate outcomes after use of the InternalBrace for Lisfranc injuries.
The Lateral Fibular Stress Test: High Variability of Force Applied May Lead to Under-Detection of Syndesmotic Instability
Authors: Ingall Eitan M. , Kaiser Philip , Ashkani-Esfahani Soheil , Zhao John Z. , Kwon John Y.
Published: November 2022

Category:

Ankle

Introduction/Purpose:

The lateral fibular stress test (LFST), also known as the hook or Cotton test, is commonly performed to assess syndesmotic instability intraoperatively. Several studies have determined that 100 Newtons (N) is the required force applied when performing the LFST to detect syndesmotic instability. We hypothesize that surgeons do not uniformly nor consistently apply 100N of force when performing the LFST and that substantial variation exists. Fundamentally, this could lead to under-detection of syndesmotic instability as surgeons may not be applying the requisite force in a consistent manner.

Methods:

A biomechanical SawBones lower leg model including simulated soft tissue envelope (SawBones inc., Vashon Island, Washington) was mounted to a board and a 1cm diameter hole was drilled across the tibia and fibula in the area of the syndesmosis. An industrial force gauge (Nidec-Shimpo, Kyoto, Japan) was then mounted. A metal extension piece was passed from the force gauge through the hole and positioned so that the tip was exposed on the lateral side of the model. A commonly utilized reduction clamp was affixed to the force gauge. Orthopaedic attending surgeons and trainees were asked to perform a series of LFSTs and to simulate the force they typically apply intra-operatively and this force was recorded in Newtons (N). Basic demographic data was collected on each participant.

Results:

33 surgeons participated in the study, including 18 trainees. The median (IQR) force applied during the LFST was 96.42(71.42-126.33), 87.49 (69.19-117.40), 99.99(79.91-137.49), for the pooled group, attendings, and trainees respectively. Over half (54.5%) of all trials were less than 100N (57.8% of surgeons, 51.8% trainees). The distribution of pulls is shown in Figure 1. Intraobserver correlation was excellent within the overall cohort (0.92, p<0.001), trainees (0.90, p<0.001) and attendings (0.94, p<0.001), respectively. Inter-observer reliability was fair among the overall cohort (Kappa =0.28, p=0.49), and poor between the attendings (Kappa=0.11, p=0.69), and the trainees (Kappa=0.05, p=0.82), respectively.

Conclusion:

Our study demonstrates that the amount of lateral force applied by surgeons in a biomechanical ankle model when performing the LFST is variable and often less than 100N. Inadequate force application when performing the LFST may lead to under-detection of syndesmotic instability which may portend a poorer outcome. Either the intraoperative use of force gauges and/or specific practice outside of the operating theatre (to become familiarized with the proprioceptive feel of generating the requisite force) may permit surgeons to consistently apply the test in a manner that is clinically reproducible.
Anatomical and Radiological Description of the Spring Ligament Articular Facet (SLAF)
Authors: Kasture Sarang P. , Mistry Alpesh , Low Samantha , Fisher Andrew , Bond Alistair P. , Lambert Laura-Ann , Jayatilaka Lara , Philpott Matthew , Fisher Lauren , Mason Lyndon W. , Molloy Andrew P.
Published: November 2022

Category:

Basic Sciences/Biologics; Midfoot/Forefoot

Introduction/Purpose:

Spring ligament is a principle static stabilizer of the medial longitudinal arch. There is a triangular facet of fibrocartilage in its superomedial bundle that articulates with the talar head which is poorly described in the literature. The aim of this study was to carry out a formal anatomical and radiological description of the spring ligament articular facet (SLAF).

Methods:

Anatomically, we dissected 10 normally aligned cadaveric lower limbs. The spring ligament was approached from the superior direction. The talus was disarticulated and high-resolution images were taken of the ligament complex. ImageJ and Tracker software was used to calculate the surface area and the maximum linear measurements of the spring ligament articular facet (SLAF). 22 normally aligned feet were analysed on reformatted PD space sequences on MRI using PACS.

Results:

The meniscus was consistently trapezoid in shape in all specimens. The mean area of the SLAF was 203.31 mm2. The average longest proximal to distal length was 11.93 mm and at the shortest plantar and lateral margin was 5.34 mm. The attachment of the SLAF with calcaneum and navicular articular surface was defined by a distinct thick fibrous ligamentous structure that measured 3.67 and 1.69 mm at its medial and lateral margin on the calcaneal side and 2.72 and 2.87 mm respectively on the navicular side. SLAF was visible on MRI but it was not possible to differentiate between SLAF and its investing ligaments. MRI measurements showed a mean surface area of 354 mm2 with mean thickness of 2.7 - 4.3 mm throughout its course.

Conclusion:

The paper describes the anatomical and radiological parameters of SLAF, a constant fibrocartilaginous structure within the superomedial portion of the spring ligament, as well as its ligamentous attachments.
Novel Techniques for Acute Lengthening of Metatarsal for Treatment of Brachymetatarsia with 2cm and More Shortening
Authors: Khosroabadi Alireza
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

Previous acute lengthening of metatarsal for the treatment of brachymetatarsia has been limited to 1cm. The success of acute lengthening has not been as predictable. I have successfully been able to acutely lengthen up to 2.2 cm with the use of allograft. I have successfully done this in 10 patients for the last 2 years.

Methods:

The method involves acute lengthening and transfer of the extensor longus and Brevis. A complete release of the MPJ which involves the entire capsule as well as the lumbricles and interosseus medial and lateral. Also I have created a 'joint spacer ' by using a fiber tape (Arthrex) which is made in to a donut shape and placed in the joint and held in placed with a k wire that is passed through the digit then through the spacer and further advanced to the metatarsal. This k wire is removed 6 weeks post op. I also use a temporary external fixator to distract the metatarsal segments after doing an Osteotomy at the base or the metatarsal. Once the appropriate length is achieved the allograft is cut to size and placed and secured with screws and an 8 hole plate. Then the temporary ex fix is removed. Tendons sutured and secured. Skin is closed. The only hardware that is exposed is the .062 k wire. 6 weeks post op. The k wire is removed and a Stab incision is made at the level of the MPJ and the spacer is removed. This will keep the joint space maintained which make the digit be able to move after such a large acute lengthening. Part of the Peotocol is to have the foot in good compression by using a 3M 2 layer compression system. Which keeps the incision from opening.

Results:

For the past 2 years I have performed 10 acute metatarsal lengthening successfully with minimal complications. This method is reproducible by any foot and ankle surgeon

Conclusion:

Using this step by step technique has resulted in a predictable and successful outcome. Previously the lengthening of a short metatarsal has been limited to 1cm and below if you wanted to outcome to be good and without major complications such as MPJ subluxation and digital deformity and most importantly not being able to lengthen the metatarsal to its appropriate length. This novel technique can be done in any ambulatory surgical setting. It also uses allograft which makes its less painful for the patient and decreases the complication rate when compared to using autograft
Personalized assessment: Applying higher-order cognitive diagnosis models in secondary mathematics
Authors: Zhang Ying , Jin Yi , Xiong Zhenrong , Leung Shing On , Chen Gaowei , Li Na , Li Bo
Published: November 2022

Personalized assessment is an essential component in education. Although many cognitive diagnosis models (CDMs) have been developed for this purpose, few studies have applied them in secondary mathematical contexts. Using a sample of 391 Grade 11 students from a secondary school in China, the findings indicated that the higher-order generalized deterministic inputs, noisy, “and” gate (higher-order GDINA) model with one-parameter logistic (1PL) best fit the data, and the Q matrix validation process achieved acceptable results. At the grade level, most of the participants mastered attributes B1 (i.e., basic concept development of derivatives: simple equations, zero or extreme points, and function range problems), B2 (complex inductive contextualization of derivatives: induction from the known to solve the unknown problems), and B3 (basic routine problem solving of derivatives: graphs that pass through a fixed point or quantitative inequalities). However, less than half of the students mastered attribute B4 (complex transformative contextualization of derivatives: transformation by the combination of numbers and graphs). At the individual level, we selected four representative students with high, medium, and low levels of achievement to examine their individual skill profiles and provide personalized remedial and enhanced feedback. Implications for personalized assessments are discussed.
Changes in Central Line–Associated Bloodstream Infection (CLABSI) Rates Following Implementation of Levofloxacin Prophylaxis for Children and Adolescents With High-Risk Leukemia
Authors: Linder Lauri A. , Gerdy Cheryl , Jo Yeonjung , Stark Crystal , Wilson Andrew
Published: November 2022

Background: Despite initiatives to reduce central line–associated bloodstream infection (CLABSI), children and adolescents with hematologic malignancies, as well as those with relapsed disease, remain at the greatest risk for infection. This single-institution project evaluated changes in CLABSI rates following implementation of antibacterial prophylaxis with levofloxacin for patients with high-risk hematologic malignancies. Methods: Positive blood culture events meeting National Health Safety Network surveillance criteria to be classified as CLABSIs from January 1, 2006, to December 31, 2019, were included. Data were organized into four time periods for comparison based on implementation of CLABSI-reduction interventions. Conditional Poisson regression models were used to evaluate the effect of time (intervention period) on CLABSI rates with post hoc Tukey pairwise comparisons between each of the four time periods. Results: From 2006 and 2019, 227 patients experienced 310 CLABSIs. Clinically important decreases in CLABSI rates from baseline (4.84 per 1,000 line days) occurred with implementation of Children's Hospital Association (CHA) bundles (3.29 per 1,000 line days); however, this difference was not significant ( p  =  .16). CLABSI rates decreased from baseline with the addition of formalized supportive cares (2.66 per 1,000 line days; incidence rate ratio [IRR]  =  0.60; p < .01), and with the use of antibacterial prophylaxis (1.66 per 1,000 line days; IRR  =  0.35; p < .01). Post hoc comparisons indicated decreased CLABSI rates with the use of antibacterial prophylaxis compared with CHA bundles alone (IRR  =  0.49; p  =  .011) and CHA bundles plus formalized supportive cares (IRR  =  0.58; p  =  .046). Discussion: Results demonstrate sustained success using a practice-based evidence approach to guide CLABSI-reduction interventions. Follow-up research, applying machine learning algorithms, may identify additional risk factors and inform future interventions.
Propylthiouracil-induced alveolar haemorrhage associated with antineutrophil cytoplasmic antibody
Authors: Ohtsuka M , Yamashita Y , Doi M , Hasegawa S
Published: November 2022

Propylthiouracil (PTU) is known to cause vasculitis as a rare complication. We report the case of a patient who developed alveolar haemorrhage and haematuria whilst treated with PTU. The serum was positive for antineutrophil cytoplasmic antibody (ANCA) with myeloperoxidase (MPO) specificity (MPO-ANCA). All symptoms resolved completely after discontinuation of PTU. Alveolar haemorrhage or pulmonary-renal syndrome associated with antineutrophil cytoplasmic antibody with myeloperoxidase specificity may be a new complication of propylthiouracil therapy.
Inactivation of the MSTN gene expression changes the composition and function of the gut microbiome in sheep
Authors: Du Chenchen , Zhou Xianhui , Zhang Ke , Huang Shuhong , Wang Xiaolong , Zhou Shiwei , Chen Yulin
Published: November 2022

Background

Myostatin (MSTN) negatively regulates the muscle growth in animals and MSTN deficient sheep have been widely reported previously. The goal of this study was to explore how MSTN inactivation influences their gut microbiota composition and potential functions.

Results

We compared the slaughter parameters and meat quality of 3 MSTN-edited male sheep and 3 wild-type male sheep, and analyzed the gut microbiome of the MSTN-edited sheep (8 female and 8 male sheep) and wild-type sheep (8 female and 8 male sheep) through metagenomic sequencing. The results showed that the body weight, carcass weight and eye muscle area of MSTN-edited sheep were significantly higher, but there were no significant differences in the meat quality indexes. At the microbial level, the alpha diversity was significantly higher in the MSTN-edited sheep (P < 0.05), and the microbial composition was significantly different by PCoA analysis in the MSTN-edited and wild-type sheep. The abundance of Firmicutes significantly increased and Bacteroidota significantly decreased in the MSTN-edited sheep. At genus level, the abundance of Flavonifractor, Subdoligranulum, Ruthenibacterium, Agathobaculum, Anaerotignum, Oribacterium and Lactobacillus were significantly increased in the MSTN-edited sheep (P < 0.05). Further analysis of functional differences was found that the carotenoid biosynthesis was significantly increased and the peroxisome, apoptosis, ferroptosis, N-glycan biosynthesis, thermogenesis, and adipocytokines pathways were decreased in the MSTN-edited sheep (P < 0.05). Moreover, carbohydrate-active enzymes (CAZymes) results certified the abundance of the GH13_39, GH4, GH137, GH71 and PL17 were upregulated, and the GT41 and CBM20 were downregulated in the MSTN-edited sheep (P < 0.05).

Conclusions

Our study suggested that MSTN inactivation remarkably influenced the composition and potential function of hindgut microbial communities of the sheep, and significantly promoted growth performance without affecting meat quality.
Life-threatening hypotension in the immediate postoperative period of cataract surgery under topical anesthesia: a report of two cases
Authors: Fostier Michele , Januleviciute Gintare , Fauconnier Fabrice , Collard Edith , Dubois Virginie
Published: November 2022

Background

Cataract surgery is one of the most frequent surgeries in the world. It is a very safe procedure mostly performed under topical anesthesia in outpatients centers. Due to the growing lack of anesthesiologists, cataract surgeries are more frequently performed without an anesthesiologist present in the operating room. Although extremely rare, life-threatening complications may occur.

Cases presentation

We report two cases of cataract surgery complicated by severe hypotension that required emergency resuscitation in the immediate postoperative period and hospitalization in intensive care unit. Anaphylactic shock was confirmed in the first case and suspected in the second.

Conclusions and importance

Even though cataract surgery is a very safe procedure, it is essential to ensure the presence of an anesthesiologist to manage potential, though extremely rare, life-threatening complications such as anaphylactic reactions.
Predictors of hypotension during anesthesia induction in patients with hypertension on medication: a retrospective observational study
Authors: Hojo Takayuki , Kimura Yukifumi , Shibuya Makiko , Fujisawa Toshiaki
Published: November 2022

Background

Hypotension during anesthesia induction is a common event, and occurs more frequently in patients with hypertension than in healthy individuals. Intraoperative hypotension in non-cardiac surgery is reportedly associated with various postoperative complications. However, the predictors of hypotension during anesthesia induction in patients with hypertension have not yet been ascertained. Therefore, we aimed to determine the predictors of hypotension during anesthesia induction in patients with hypertension on medication focusing on the half-life of the medication used.

Methods

In this retrospective observational study, we enrolled patients with hypertension on medication who underwent general anesthesia for oral and maxillofacial surgery between January 1, 2013, and December 31, 2019. Multivariable logistic regression analysis was conducted to test for associations between clinical factors and hypotension during anesthesia induction in patients with hypertension on medication.

Results

A total of 395 patients were included in this study. The risk factors for hypotension during anesthesia induction in patients with hypertension on medication were pre-induction mean arterial blood pressure (adjusted unit odds ratio, 0.96 [95% confidence interval, 0.94 to 0.98]), female sex (adjusted odds ratio [aOR], 1.63 [1.03 to 2.57]), regular use of angiotensin receptor blockers (ARBs)/angiotensin-converting enzyme inhibitors (ACE-Is) with a long half-life (vs. no regular use of ARBs/ACE-Is aOR, 4.02 [1.77 to 9.12]; vs. regular use of ARBs/ACE-Is with a short-to-middle half-life aOR, 3.17 [1.46 to 6.85]), and regular use of beta blockers (aOR, 2.45 [1.19 to 5.04]). Regular use of calcium channel blockers (aOR, 0.44 [0.25 to 0.77]) was a suppressive factor for hypotension during anesthesia induction in patients with hypertension.

Conclusions

In patients with hypertension on medication, regular use of ARBs/ACE-Is with a long half-life, regular use of beta blockers, low pre-induction mean arterial blood pressure, and female sex were risk factors for hypotension during anesthesia induction. Notably, regular use of ARBs/ACE-Is with a long half-life was a high-risk factor for hypotension during anesthesia induction in patients with hypertension on medication even after a 24-h preoperative withdrawal period.
Implementation of a medicine management plan (MMP) to reduce medication-related harm (MRH) in older people post-hospital discharge: a randomised controlled trial
Authors: Ali Khalid , Mensah Ekow A. , McDermott Eugene Ace , Kirkham Frances A. , Stevenson Jennifer , Hamer Victoria , Parekh Nikesh , Schiff Rebekah , Van Der Cammen Tischa , Nyangoma Stephen , Fowler-Davis Sally , Davies Graham , Gage Heather , Rajkumar Chakravarthi
Published: November 2022

Background

Medication-related harm (MRH) is an escalating global challenge especially among older adults. The period following hospital discharge carries high-risk for MRH due to medication discrepancies, limited patient/carer education and support, and poor communication between hospital and community professionals. Discharge Medical Service (DMS), a newly introduced NHS scheme, aims to reduce post-discharge MRH through an electronic communication between hospital and community pharmacists. Our study team has previously developed a risk-prediction tool (RPT) for MRH in the 8-weeks period post discharge from a UK hospital cohort of 1280 patients. In this study, we aim to find out if a Medicines Management Plan (MMP) linked to the DMS is more effective than the DMS alone in reducing rates of MRH.

Method

Using a randomized control trial design, 682 older adults ≥ 65 years due to be discharged from hospital will be recruited from 4 sites. Participants will be randomized to an intervention arm (individualised medicine management plan (MMP) plus DMS) or a control arm (DMS only) using a 1:1 ratio stratification. Baseline data will include patients’ clinical and social demographics, and admission and discharge medications. At 8-weeks post-discharge, a telephone interview and review of GP records by the study pharmacist will verify MRH in both arms. An economic and process evaluation will assess the cost and acceptability of the study methods.

Data analysis

Univariate analysis will be done for baseline variables comparing the intervention and control arms. A multivariate logistic regression will be done incorporating these variables. Economic evaluation will compare the cost-of-service use among the study arms and modelled to provide national estimates. Qualitative data from focus-group interviews will explore practitioners’ understanding, and acceptance of the MMP, DMS and the RPT.

Conclusion

This study will inform the use of an objective, validated RPT for MRH among older adults after hospital discharge, and provide a clinical, economic, and service evaluation of a specific medicines management plan alongside the DMS in the National Health Service (UK).
Clinical course of pharyngotonsillitis with group A streptococcus treated with different penicillin V strategies, divided in groups of Centor Score 3 and 4: a prospective study in primary care
Authors: Tell David , Tyrstrup Mia , Edlund Charlotta , Rystedt Karin , Skoog Ståhlgren Gunilla , Sundvall Pär-Daniel , Hedin Katarina
Published: November 2022

Background

Sore throat is a common reason for prescribing antibiotics in primary care, and 10 days of treatment is recommended for patients with pharyngotonsillitis with group A streptococcus (GAS). Our group recently showed that penicillin V (PcV) four times daily for 5 days was non-inferior in clinical outcome to PcV three times daily for 10 days. This study compares duration, intensity of symptoms, and side effects in patients with a Centor Score (CS) of 3 or 4 respectively, after treatment with PcV for 5 or 10 days and evaluates whether all patients with pharyngotonsillitis with a CS of 3 or 4 should be treated for 5 days or if severity of symptoms or CS suggest a longer treatment period.

Method

Data on symptoms and recovery from patient diaries from 433 patients included in a RCT comparing PcV 800 mg × 4 for 5 days or PcV 1 g × 3 for 10 days was used. Patients six years and older with CS-3 or CS-4 and positive rapid antigen detection test for GAS-infection were grouped based on CS and randomized treatment. Comparisons for categorical variables were made with Pearson’s chi-squared test or Fisher’s exact test. Continuous variables were compared with the Mann–Whitney U test.

Results

Patients with CS-3 as well as patients with CS-4 who received PcV 800 mg × 4 for 5 days self-reported that they recovered earlier compared to patients with CS-3 or CS-4 who received treatment with PcV 1 g × 3 for 10 days. In addition, the throat pain as single symptom was relieved 1 day earlier in patients with CS-4 and 5 days of treatment compared to patients with CS-4 and 10 days of treatment. No differences in side effects between the groups were found.

Conclusion

Intense treatment with PcV four times a day for 5 days seems clinically beneficial and strengthens the suggestion that the 4-dose regimen with 800 mg PcV for 5 days may be the future treatment strategy for GAS positive pharyngotonsillitis irrespectively of CS-3 or CS-4.

Trail registration ClinicalTrials.gov ID: NCT02712307 (3 April 2016).
Circulating levels of IL-6 and TGF-β1 in patients with prostate cancer undergoing radiotherapy: associations with acute radiotoxicity and fatigue symptoms
Authors: Kopčalić Katarina , Matić Ivana Z. , Besu Irina , Stanković Vesna , Bukumirić Zoran , Stanojković Tatjana P. , Stepanović Aleksandar , Nikitović Marina
Published: November 2022

Background

The goal of research was to investigate the possible relations between serum concentrations of IL-6 and TGF-β1, individual and clinical characteristics, and adverse effects of radiotherapy in patients with prostate cancer: acute and late genitourinary and gastrointestinal toxicity, and fatigue.

Methods

Thirty-nine patients with localized or locally advanced prostate cancer who were treated with radiotherapy were enrolled in this study. The acute radiotoxicity grades and fatigue levels were assessed during the radiotherapy and 1 month after the radiotherapy. Estimation of the late radiotoxicity was performed every three months in the first year, every four months in the second year, and then every six months. Serum levels of IL-6 and TGF-β1 were determined before radiotherapy and after the 25th radiotherapy fraction by ELISA.

Results

The significant positive association between diabetes mellitus and changes in acute genitourinary toxicity grades during the radiotherapy was observed in prostate cancer patients. In addition, patients who were smokers had significantly higher maximum fatigue levels in comparison with patients who were non-smokers. The circulating IL-6 levels were significantly higher after the 25th radiotherapy fraction in comparison with levels determined before radiotherapy. The significant positive correlations between pretreatment TGF-β1 levels and maximum genitourinary toxicity grades and between TGF-β1 levels after the 25th fraction and genitourinary toxicity grades after the 25th fraction, were found. The pretreatment IL-6 concentrations and TGF-β1 concentrations after the 25th fraction were positively correlated with maximum genitourinary toxicity grades. The IL-6 levels after the 25th fraction were positively associated with genitourinary toxicity grades after this fraction. The pretreatment IL-6 concentrations were significantly positively correlated with maximum fatigue scores. The significant positive correlation between IL-6 concentrations and fatigue scores after the 25th fraction was determined. The positive correlations between IL-6 and TGF-β1 concentrations measured after the 25th fraction and maximum fatigue scores were observed.

Conclusions

Our results suggest that serum levels of IL-6 and TGF-β1 might influence the severity of acute genitourinary radiotoxicity and fatigue in patients with prostate cancer. Combining clinical parameters and circulating cytokine levels might be useful for the prediction of adverse reactions to radiotherapy.
Beta zone parapapillary atrophy in elderly Chinese
Authors: Zhou Ling Xiao , Shao Lei , Da Zhou Wen , Xu Liang , Li Rong , Wei Wen Bin
Published: November 2022

Purpose

Assess the beta zone parapapillary atrophy in elderly Chinese.

Patients and methods

The Beijing Eye Study 2011 is a population-based cross-sectional study, which includes 3468 patients with the average age of 64.5 ± 9.8 years. The beta zone of parapapillary atrophy was captured and analyzed morphometrically by using colour optic disc photographs.

Results

The beta zone was found in 1358 (39.9%) eyes, measuring 0.37 ± 0.84 mm2 in size, 203.5 ± 81.8° in circumferential angle, 0.36 ± 0.27 mm in the maximum radial extent, the most often and longest in the temporal peripapillary region, followed by the temporal inferior region and the temporal superior region, the nasal region at least. Beta zone has statistically significant association with male gender (P = 0.001), myopic refractive error (P = 0.003), thinner retinal nerve fiber layer thickness (P<0.001), thinner subfoveal choroidal thickness (P<0.001), bigger size of optic disc size (P<0.001). The size of beta zone has statistically significant association with longer axial length (P = 0.004)，increasing age (P<0.001), urban (P = 0.025), cardiovascular disease history (P = 0.025), with age related macular degeneration (P = 0.038), myopic ametropia (P<0.001), thinner retinal nerve fiber layer thickness (P = 0.001), thinner subfoveal choroidal thickness (P<0.001), bigger size of optic disc size (P = 0.001).

Conclusion

The population prevalence of beta zone was 39.9% in elderly Chinese. The area of the beta zone has statistically significant association with age, urban, the thickness of retinal nerve fiber layer, age related macular degeneration, cardiovascular disease history, axial length, myopic refractive error, size of optic disc size, the thickness of subfoveal choroid.
The relationship between depression symptoms and academic performance among first-year undergraduate students at a South African university: a cross-sectional study
Authors: Wagner F , Wagner RG , Kolanisi U , Makuapane LP , Masango M , Gómez-Olivé FX
Published: November 2022

Background:

South African universities face a challenge of low throughput rates, with most students failing to complete their studies within the minimum regulatory time. Literature has begun to investigate the contribution of well-being, including mental health, with depression among students being one of the most common mental disorders explored. However, locally relevant research exploring associations between depression and academic performance has been limited. This research hypothesizes that the presence of depression symptoms, when controlling for key socio-demographic factors, has an adverse impact on student academic outcomes and contributes to the delay in the academic progression of students.

Methods:

The study used a cross-sectional design. Data were collected in 2019 from first-time, first-year undergraduate students using a self-administered online questionnaire. In total, 1,642 students completed the survey. The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression symptoms. Data on students’ academic performance were obtained from institutional records. Bivariate and multivariate regression analyses were used to examine associations between depression symptoms and academic performance.

Results:

Most participants (76%) successfully progressed (meeting the requirements to proceed to the second year of university study). Of the participants, 10% displayed symptoms of severe depression. The likelihood of progression delay (not meeting the academic requirements to proceed to the second year of university study) increased with the severity of depression symptoms. Moderate depression symptoms nearly doubled the adjusted odds of progression delay (aOR = 1.98, 95% CI: 1.30-3.00, p = 0.001). The likelihood of progression delay was nearly tripled by moderate severe depression symptoms (aOR = 2.70, 95% CI:1.70–4.36, p < 0.001) and severe depression symptoms (aOR = 2.59, 95% CI:1.54–4.36, p < 0.001). The model controlled for field of study, financial aid support as well as sex and race.

Conclusion:

Higher levels of depression symptoms among first-year university students are associated with a greater likelihood of progression delay and may contribute to the low throughput rates currently seen in South African universities. It is important for students, universities and government departments to recognize student mental wellness needs and how these can be met.
Comparison of the clinical manifestations and chest CT findings of pulmonary cryptococcosis in immunocompetent and immunocompromised patients: a systematic review and meta-analysis
Authors: Xiong Chunlin , Lu Jianguo , Chen Ting , Xu Rui
Published: November 2022

Objective

The purpose of our study was to perform a meta-analysis and systematic review to compare differences in clinical manifestations and chest computed tomography (CT) findings between immunocompetent and immunocompromised pulmonary cryptococcosis (PC) patients.

Methods

An extensive search for relevant studies was performed using the PubMed, EMBASE, Cochrane Library, and Web of Sciences databases from inception to September 30, 2021. We included studies that compared the clinical manifestations and chest CT findings between immunocompetent and immunocompromised PC patients. Study bias and quality assessment were performed using the Newcastle–Ottawa Scale (NOS).

Results

Nine studies involving 248 immunocompromised and 276 immunocompetent PC patients were included in our analysis. The NOS score of each eligible study was above 5, indicating moderate bias. The proportion of elderly patients (> = 60 years old) in the immunosuppressed group was significantly higher than that in the immunocompetent group (OR = 2.90, 95% CI (1.31–6.43), Z = 2.63, p = 0.01). Fever (OR = 7.10, 95% CI (3.84–13.12), Z = 6.25, p < 0.000) and headache (OR = 6.92, 95% CI (2.95–16.26), Z = 4.44, p < 0.000) were more common in immunosuppressed patients. According to thin-section CT findings, lesions were more frequently distributed in the upper lobe (OR = 1.90, 95% CI (1.07–3.37), Z = 2.2, p = 0.028) in immunocompromised individuals. The proportions of patients with cavity sign (OR = 5.11, 95% CI (2.96–8.83), Z = 5.86, p = 0.00), ground-glass attenuation (OR = 5.27, 95% CI (1.60–17.35), Z = 2.73, p = 0.01), and mediastinal lymph node enlargement (OR = 2.41, 95% CI (1.12–5.20), Z = 2.24, p = 0.03) were significantly higher in immunocompromised patients.

Conclusion

No significant differences in nonspecific respiratory symptoms were found between immunocompromised and immunocompetent PC patients. Nevertheless, fever and headache were more common in immunocompromised patients. Among the CT findings, cavity, ground-glass attenuation, and mediastinal lymph node enlargement were more common in immunocompromised individuals.
From laparoscopic to robotic-assisted Heller myotomy for achalasia in a single high-volume visceral surgery center: postoperative outcomes and quality of life
Authors: Gass Jörn-Markus , Cron Lucien , Mongelli Francesco , Tartanus Justyna , Angehrn Fiorenzo Valente , Neuschütz Kerstin , von Flüe Markus , Fourie Lana , Steinemann Daniel , Bolli Martin
Published: November 2022

Background

Laparoscopic (LSC) Heller myotomy (HM) is considered the standard procedure for the treatment of achalasia. Robotic platforms, established over the last years, provide important advantages to surgeons, such as binocular 3-dimensional vision and improvement of fine motor control. However, whether perioperative outcomes and long-term results of robotic-assisted laparoscopic (RAL) HM are similar or even superior to LSC technique, especially concerning long-term follow-up, is still debated. Therefore, the aim of the present study was to evaluate intra- and postoperative results as well as long-term quality of life after RAL compared to LSC surgery for achalasia in a single high-volume visceral surgery center.

Methods

Between August 2007 and April 2020, 43 patients undergoing minimally invasive HM for achalasia in a single high-volume Swiss visceral surgery center, were included in the present study. Intra- and postoperative outcome parameters were collected and evaluated, and a long-term follow-up was performed using the gastroesophageal-reflux disease health-related quality of life (GERD-Hr-QuoL) questionnaire.

Results

A total of 11 patients undergoing RAL and 32 undergoing LSC HM were analyzed. Baseline demographics and clinical characteristics were similar. A trend (p = 0.052) towards a higher number of patients with ASA III score treated with RAL was detectable. Operation time was marginally, but significantly, shorter in LSC (140 min, IQR: 136–150) than in RAL (150 min, IQR: 150–187, p = 0.047). Postoperative complications graded Clavien-Dindo ≥ 3 were only observed in one patient in each group. Length of hospital stay was similar in both groups (LSC: 11 days, IQR: 10–13 vs. RAL: 11 days, IQR: 10–14, p = 0.712). Long-term follow-up (LSC: median 89 months, vs. RAL: median 28 months, p = 0.001) showed comparable results and patients from both groups expressed similar levels of satisfaction (p = 0.181).

Conclusions

LSC and RAL HM show similar peri- and postoperative results and a high quality of life, even in long-term (> 24 months) follow-up. Prospective, randomized, controlled multicenter trials are needed to overcome difficulties associated to small sample sizes in a rare condition and to confirm the equality or demonstrate the superiority of robotic-assisted procedures for achalasia. Meanwhile, the choice of the treatment technique could be left to the operating surgeon’s preferences.
Outcomes and risks in palliative pancreatic surgery: an analysis of the German StuDoQ|Pancreas registry
Authors: Hofmann Felix O. , Miksch Rainer C. , Weniger Maximilian , Keck Tobias , Anthuber Matthias , Witzigmann Helmut , Nuessler Natascha C. , Reissfelder Christoph , Köninger Jörg , Ghadimi Michael , Bartsch Detlef K. , Hartwig Werner , Angele Martin K. , D’Haese Jan G. , Werner Jens
Published: November 2022

Background

Non-resectability is common in patients with pancreatic ductal adenocarcinoma (PDAC) due to local invasion or distant metastases. Then, biliary or gastroenteric bypasses or both are often established despite associated morbidity and mortality. The current study explores outcomes after palliative bypass surgery in patients with non-resectable PDAC.

Methods

From the prospectively maintained German StuDoQ|Pancreas registry, all patients with histopathologically confirmed PDAC who underwent non-resective pancreatic surgery between 2013 and 2018 were retrospectively identified, and the influence of the surgical procedure on morbidity and mortality was analyzed.

Results

Of 389 included patients, 127 (32.6%) underwent explorative surgery only, and a biliary, gastroenteric or double bypass was established in 92 (23.7%), 65 (16.7%) and 105 (27.0%). After exploration only, patients had a significantly shorter stay in the intensive care unit (mean 0.5 days [SD 1.7] vs. 1.9 [3.6], 2.0 [2.8] or 2.1 [2.8]; P < 0.0001) and in the hospital (median 7 days [IQR 4–11] vs. 12 [10–18], 12 [8–19] or 12 [9–17]; P < 0.0001), and complications occurred less frequently (22/127 [17.3%] vs. 37/92 [40.2%], 29/65 [44.6%] or 48/105 [45.7%]; P < 0.0001). In multivariable logistic regression, biliary stents were associated with less major (Clavien–Dindo grade ≥ IIIa) complications (OR 0.49 [95% CI 0.25–0.96], P = 0.037), whereas—compared to exploration only—biliary, gastroenteric, and double bypass were associated with more major complications (OR 3.58 [1.48–8.64], P = 0.005; 3.50 [1.39–8.81], P = 0.008; 4.96 [2.15–11.43], P < 0.001).

Conclusions

In patients with non-resectable PDAC, biliary, gastroenteric or double bypass surgery is associated with relevant morbidity and mortality. Although surgical palliation is indicated if interventional alternatives are inapplicable, or life expectancy is high, less invasive options should be considered.