bluuebunny/crossref_metadata_2025 huggingface dataset:
The clinical outcomes of mechanical thrombectomy for proximal M1 occlusion involving lenticulostriate perforators
Authors: Ko Hak Cheol
Published: August 2021

Although the success rate of recanalization in acute intracranial artery occlusion is high, there is a poor rate of improvement in functional clinical outcome. The purpose of this study was to assess the functional outcome of mechanical thrombectomy for proximal M1 occlusion involving lenticulostriate arteries (LSAs) compared with distal M1 occlusion-sparing the LSAs.

A retrospective analysis was conducted in patients with middle cerebral artery (MCA) M1 occlusions who had a successful recanalization subsequent to mechanical thrombectomy. The recanalization results were estimated using the thrombolysis in cerebral infarction grade assessed by digital subtraction angiography. To confirm the ischemic change resulting from the lenticulostriate artery occlusion, we reviewed the neuroimaging findings from magnetic resonance imaging 1 day after mechanical thrombectomy. The functional outcomes were then evaluated using the modified Rankin scale at 90 days.

In total, 28 patients with MCA M1 occlusion had successful recanalization outcomes with thrombolysis in cerebral infarction grades IIa, IIb, and III. Among the 28 patients, 17 had proximal M1 occlusions and 11 had distal M1 occlusions. Demographic factors, including initial National Institutes of Health Stroke Scale score, time from symptom to recanalization, and recanalization rate did not differ considerably between patients with proximal and distal M1 occlusions. Regarding infarctions in the basal ganglia, internal capsule, and corona radiata, there were statistically significant differences between the proximal and distal M1 occlusions. However, there were no significant differences in good functional outcome (modified Rankin scale ≤2) observed between the groups at 90 days after mechanical thrombectomy.

Although proximal M1 occlusion had more frequent infarctions associated with the LSA territories, these were not related to poor functional outcomes. Both proximal and distal M1 occlusion demonstrated comparably good outcomes.
Association between higher pericoronary adipose tissue attenuation measured by coronary computed tomography angiography and nonalcoholic fatty liver disease
Authors: Ichikawa Keishi , Miyoshi Toru , Osawa Kazuhiro , Miki Takashi , Morimitsu Yusuke , Akagi Noriaki , Nakashima Mitsutaka , Ito Hiroshi
Published: August 2021

Non-alcoholic fatty liver disease (NAFLD) is a risk factor for cardiac mortality. Pericoronary adipose tissue (PCAT) attenuation, expressed by the fat attenuation index on coronary computed tomography angiography, reflects pericoronary inflammation. We aimed to investigate the association between PCAT attenuation and NAFLD.

This is a single-center cohort study comprising of patients who underwent coronary computed tomography angiography for suspected stable coronary artery disease between January and December 2020. Patient characteristics and coronary computed tomography angiography findings were analyzed between patients with NAFLD (n = 78) and a propensity score-matched cohort of patients without NAFLD (n = 78). PCAT attenuation was assessed in Hounsfield units (HU) of proximal 40-mm segments of the left anterior descending artery (LAD) and right coronary artery.

The mean PCAT attenuation in LAD and right coronary artery were significantly higher in patients with NAFLD than those without NAFLD. When patients were divided into 2 groups using the median LAD-PCAT attenuation of −72.5 HU, the high PCAT attenuation group had more males (82% vs 67%, P = .028) and NAFLD patients (63% vs 37%, P = .001) compared to the low PCAT attenuation group. No differences in age, body mass index, conventional cardiovascular risk factors, or the presence of high-risk plaque were observed between the 2 groups. In the multivariate logistic analysis, NAFLD was independently associated with high PCAT attenuation (odds ratio 2.912, 95% confidence interval 1.386 to 6.118, P = .005).

NAFLD is associated with high PCAT attenuation on coronary computed tomography angiography. This finding suggests that pericoronary inflammation is involved in the increased cardiac mortality in NAFLD patients.
Gut-flora metabolites is not associated with synchronous carotid artery plaque and non-alcoholic fatty liver disease in asymptomatic adults
Authors: Lin Ying-Chun , Wang Horng-Yuan , Kuo Yang-Che , Chen Ming-Jen , Wu Ming-Shiang , Liu Chun-Jen , Yang Horng Woei , Shih Shou-Chuan , Yu Lo-Yip , Ko Hung-Ju , Yeh Hung-I , Hu Kuang-Chun
Published: August 2021

Synchronous non-alcoholic fatty liver disease (NAFLD) and carotid artery plaque formation increase the risk of mortality in patients with cardiovascular disease (CVD). Metabolic status and host gut flora are associated with NAFLD and CVD, but the risk factors require further evaluation.

To evaluate the risk factors associated with NAFLD and CVD, including gut-flora-related examinations.

This cross-sectional study included 235 subjects aged over 40 years who underwent abdominal ultrasound examination and carotid artery ultrasound examination on the same day or within 12 months of abdominal ultrasound between January 2018 and December 2019. All subjects underwent blood tests, including endotoxin and trimethylamine-N-oxide.

The synchronous NAFLD and carotid artery plaque subjects had a higher proportion of men and increased age compared with those without NAFLD and no carotid artery plaque. The synchronous NAFLD and carotid artery plaque group had increased body mass index (BMI), blood pressure, hemoglobin A1C (5.71% vs 5.42%), triglyceride (TG) (164.61 mg/dL vs 102.61 mg/dL), and low-density lipoprotein (135.27 mg/dL vs 121.42 mg/dL). In multiple logistic regression analysis, increased BMI, mean systolic blood pressure, and TG > 110 mg/dL were independent risk factors for synchronous NAFLD and carotid artery plaque formation. Endotoxin and trimethylamine-N-oxide levels were not significantly different between the 2 groups.

Host metabolic status, such as elevated BMI, TG, and systolic blood pressure, are associated with synchronous NAFLD and carotid artery plaque in asymptomatic adults. Aggressive TG control, blood pressure control, and weight reduction are indicated in patients with NAFLD.
Prognostic values and clinical relationship of TYK2 in laryngeal squamous cell cancer
Authors: Fang Lucheng , Wang Wen , Shi Licai , Chen Qinjuan , Rao Xingwang
Published: August 2021

Laryngeal squamous cell cancer (LSCC) is the second most common head and neck cancer with the increasing mortality. The tyrosine kinase 2 (TYK2) has previously been reported to play an important role in various cancers excepting LSCC. We used available data from the cancer genome atlas program (TCGA), gene expression omnibus, and gene expression profiling interactive analysis (GEPIA) to evaluate the role of TYK2 in LSCC.

The difference of TYK2 expression level between normal and tumor samples was analyzed based on TCGA, gene expression omnibus, and GEPIA databases. The relationship between clinical features and TYK2 were analyzed using the Wilcoxon signed-rank test. We applied Cox regression and the Kaplan–Meier method to finding which clinical characteristics is associated with overall survival. Also, we used GEPIA database to validate the relationship between TYK2 and overall survival. At last, we performed gene set enrichment analysis based on TCGA data set.

The expression level of TYK2 in LSCC was significantly associated with gender, lymph node status and metastasis (P-values <.05). Kaplan–Meier survival analysis, as same as GEPIA validation, demonstrated that LSCC with TYK2-low had a worse prognosis than that with TYK2-high. The univariate analysis showed that TYK2-high correlated significantly with a better overall survival (hazard ratio: 0.351, 95% confidence interval: 0.194–0.637, P < .001). The multivariate analysis revealed that TYK2 remained independently associated with overall survival (hazard ratio: 0.36, 95% confidence interval: 0.185–0.699, P = .003). Gene set enrichment analysis shows that Janus kinases–STAT signaling pathway, p53 signalling pathway and natural killer cell mediated cytotoxicity, etc are enriched in TYK2 high expression phenotype.

Gene TYK2 may be a potential prognostic molecular marker for LSCC. Moreover, the Janus kinases–STAT signaling pathway and p53 signaling pathway are probably the key pathway associated with TYK2 in LC.
Comparing the effects of dexmedetomidine and dexamethasone as perineural adjuvants on peripheral nerve block
Authors: Xiong Chang , Han Cheng-peng , Zhao Dong , Tang Zhi-hao , Zhang Yu-fan , Wang Jian
Published: August 2021

Background:

Dexmedetomidine (Dexm), a selective alpha-2 adrenoceptor agonist, and dexamethasone (Dexa), a very potent and highly selective glucocorticoid, have both been proven effectively to prolong the duration of local anesthetics (LA) in regional anesthesia. However, data comparing the efficacy of Dexm and Dexa as perineural adjuvants are inconsistent. Therefore, this systematic review and meta-analysis of randomized and quasi-randomized controlled trials (RCTs) was conducted to compare the effects of Dexm and Dexa when used as LA adjuvants on peripheral nerve block (PNB).

Methods:

We systematically searched PubMed, Cochrane Library, EMBASE, Web of Science, and ScienceDirect databases up to October, 2020. The primary outcome was the duration of analgesia. Secondary outcomes included incidence of rescue analgesia, cumulative opioid consumption, time required for onset of sensory and motor blockades, duration of sensory and motor blockades, incidence of postoperative nausea and vomiting (PONV), and side effect-associated outcomes (e.g., bradycardia, sedation, hypotension, rates of infection, and neurological complications). The study was registered on PROSPERO, number CRD42020188796.

Results:

After screening of full-text relevant articles, 13 RCTs that met the inclusion criteria were retrieved for this systematic review. It was revealed that perineural Dexm provided equivalent analgesic duration to perineural Dexa. Besides, the intake of Dexm increased the incidence of rescue analgesia in limbs surgery, as well as the cumulative opioid consumption, and decreased the time required for onset of sensory and motor blockades for long-acting LA (all P < .05). Other analysis revealed insignificant difference between the 2 groups in terms of the incidence of PONV (P > .05). Additionally, 2 studies demonstrated that Dexm possesses more sedative properties than Dexa (P < .05).

Conclusions:

This meta-analysis indicated that the analgesic duration of Dexm and Dexa as LA adjuvants in PNB is the same. Meanwhile, the effects of perineural Dexm and Dexa on some secondary outcomes, including the incidence of rescue analgesia, cumulative opioid consumption, and time required for onset of sensory and motor blockades, are associated with the surgical site and type of LA.
Predictors for survival in patients with bone metastasis of small cell lung cancer
Authors: Xue MingFeng , Chen Gang , Chen XingGuang , Hu JunYu
Published: August 2021

The objective of the current study is to analyze the clinical and demographic characteristics of patients with bone metastasis of small cell lung cancer (SCLC) and explore their survival predictors.

We retrospectively extracted patients with bone metastasis of SCLC from the Surveillance, Epidemiology, and End Results database. We applied Cox regression analyses to identify independent survival predictor of overall survival (OS) and cancer-specific survival (CSS). Only significant predictors from univariable analysis were included for multivariable Cox analysis. Kaplan–Meier method was used to evaluate survival differences between groups by the log–rank test.

A total of 5120 patients with bone metastasis of SCLC were identified and included for survival analysis. The 1-year OS and CSS rates of bone metastasis of SCLC were 19.8% and 21.4%, respectively. On multivariable analysis, gender, age, radiotherapy, chemotherapy, liver metastasis, brain metastasis, insurance status, and marital status independently predicted OS and CSS. There was no significant difference of OS and CSS in terms of race and tumor size.

Independent predictors of survival were identified among patients with bone metastasis of SCLC, which could be valuable to clinicians in treatment decision. Patients with bone metastasis of SCLC may benefit from radiotherapy and chemotherapy.
Correlational analysis of bone health status and vitamin D-related biomarkers in women working in agriculture
Authors: Cho Min-Chul , Park Ki Soo , Shin Jeong Kyu , Lee Soon Ae , Cho In Ae , Jo Hyen Chul , Kim Seung Chan , Choi Won Jun
Published: August 2021

The purpose of this study was to investigate the status of bone health in women working in agriculture and analyze the associations between bone health and various vitamin D-related biomarkers.

This observational study enrolled women working in agriculture (n = 210) and control occupations (n = 180). The concentration of serum total 25-hydroxy vitamin D [25(OH)D] was measured using the Elecsys Vitamin D Total Kit, and serum vitamin D-binding protein (VDBP) was measured by enzyme-linked immunosorbent assay. Along with albumin, 25(OH)D and VDBP were used to calculate the concentrations of bioavailable and free 25(OH)D. Bone mineral density (BMD) and T-score were measured at lumbar 1 to 4 and the femur neck using dual-energy X-ray absorptiometry. To identify factors affecting BMD, log-linear model and linear regression analysis were performed for statistical analysis.

Agricultural women workers showed higher serum concentrations of bioavailable 25(OH)D (12.8 ± 3.7 vs 8.7 ± 5.1 ng/mL) and lower VDBP concentrations (201.8 ± 45.0 vs 216.0 ± 68.2 μg/mL) than control women. The association between these 2 vitamin D related-biomarkers and femur neck BMD were confirmed through univariable and multivariable linear model analysis. Although lumbar BMD did not differ between groups, the agricultural group displayed a lower femur BMD and a 4.3-fold increase in the risk of osteoporosis compared with the control group.

Women working in agriculture showed lower femur BMD than the control group. Of the vitamin D-related biomarkers tested, bioavailable 25(OH)D and VDBP were associated with BMD. As bioavailable 25(OH)D levels are affected mainly by VDBP levels, VDBP may play a role in the lower femur neck BMD values observed in the agricultural group. Thus, the measurement of VDBP concentration might be considered a simple and non-invasive method for measuring bone health status.
Polypharmacy is associated with malnutrition and activities of daily living disability among daycare facility users
Authors: Nakamura Tomiyo , Itoh Takashi , Yabe Aiko , Imai Shoko , Nakamura Yoshimi , Mizokami Yasuko , Okouchi Yuki , Ikeshita Akito , Kominato Hidenori
Published: August 2021

Polypharmacy influences malnutrition and activities of daily living (ADL) in older individuals owing to side effects such as anorexia. This study aimed to examine whether polypharmacy (5 or more drugs) is associated with malnutrition and ADL disability among daycare facility users.

This cross-sectional study was performed in a daycare facility specializing in rehabilitation. Malnutrition was defined according to the Global Leadership Initiative on Malnutrition criteria and ADL disability according to the “criteria for determination of the daily life independence level (bedridden level) of elderly with disabilities.”

In total, 103 of the 134 included individuals were analyzed. Thirty-three (32.0%) participants were malnourished, 46 (44.7%) had ADL disability, 58 (56.3%) qualified as cases of polypharmacy, and 9 (8.7%) experienced loss of appetite. Multivariable logistic regression analysis showed that polypharmacy was independently associated with malnutrition and ADL disability. Separate analyses of each type of drug revealed that proton pump inhibitors (that impair protein absorption and assimilation), anticonstipation drugs, and antihypertensive drugs were associated with malnutrition, whereas proton pump inhibitors, anticonstipation drugs, antidyslipidemia drugs, and antidiabetic drugs were associated with ADL disability. The only factor related to anorexia was the loss of pleasure of eating, which in turn was related to psychological stress.

The side effects of polypharmacy among individuals with malnutrition and ADL disability may include impaired protein absorption and assimilation caused by proton pump inhibitors, but not anorexia. Further multicenter prospective studies are required to confirm these findings.
Association between self-reported physical activity and indicators of cardiovascular risk in community-dwelling older adults with hypertension in Korea
Authors: Ahn Jeong-Ah , Min Deulle
Published: August 2021

The prevalence of hypertension has increased with the rise in the elderly population, and high blood pressure is a major cause of cardiovascular disease. Physical activity is an important strategy for preventing cardiovascular disease. The study aimed to explore the association between physical activity and cardiovascular risk indicators in community-dwelling older adults with hypertension.

This study is a secondary data analysis of a prospective longitudinal study using data from the Elderly Cohort Database of the National Health Insurance Service in South Korea between 2002 and 2013. Participants included 10,588 older adults (≥60 years) with hypertension. Data assessing self-reported physical activity and directly measured blood pressure, fasting blood glucose, body mass index, and total cholesterol levels throughout the 12-year study were extracted from the original database and analyzed. Participants were categorized into 4 groups based on the reported changes in physical activity over time: Group I (Maintaining No Physical Activity Group), II (Changing from No Physical Activity to Physical Activity Group), III (Changing from Physical Activity to No Physical Activity Group), and IV (Maintaining Physical Activity Group). Cox proportional hazard model was used to confirm the risk of cardiovascular indicators over time in each group.

Participants’ mean age was 64.2 years in the initial year of 2002. The number of participants in Groups I, II, III, and IV was 4032, 2697, 1919, and 1940, respectively. Group IV showed a significant decline in risk for uncontrolled hypertension compared to Group I (hazard ratio = 0.87, 95% confidence interval [0.800–0.948]). Group II showed a significant decrease in risk for uncontrolled diabetes compared to Group I (hazard ratio = 0.94, 95% confidence interval [0.888–0.999]).

The findings indicated that physical activity is a significant factor associated with indicators of cardiovascular risk in older people with high blood pressure. Healthcare providers should be aware of the importance of older adults’ physical activity and encourage them to perform and maintain it steadily for better long-term cardio-metabolic outcomes.
Application of ex vivo liver resection and autotransplantation in treating Budd-Chiari syndrome secondary to end-stage hepatic alveolar echinococcosis
Authors: Wang Cong , Qiu Yiwen , Wang WenTao
Published: August 2021

Background:

Secondary Budd-Chiari syndrome (BCS) occurs due to a blockage in the liver caused by invasion or compression by a large lesion. Conventional treatments for BCS do not solve practical problems, wherease liver transplantation has been only applied as a last-resort therapy and as the only opportunity for a radical cure. We explored the feasibility of applying ex vivo liver resection and autotransplantation (ELRA) for the new indications of treating patients with end-stage hepatic alveolar echinococcosis (HAE). Our center has firstly proposed the idea and successfully treated the 49 patients with HAE. This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE.

Methods:

According to the degree of lesion invasion and surgical options, 11 patients were divided into 4 types. These 11 patients had large lesions that invaded the second and third hilum of the caudate lobe and involved the confluence of the hepatic vein and the inferior vena cava, suprahepatic vena cava, or at least 2 hepatic veins and led to secondary BCS. The aim of the present work was to report 11 patients with life-threatening diseases who underwent ELRA (ex vivo liver resection and autotransplantation) for secondary BCS, to propose a classification system for secondary BCS, and to suggest that secondary BCS is an indication for ELRA.

Results:

Eleven patients successfully underwent ELRA without intraoperative mortality. The median autograft weight was 690 g (440–950 g); operative time was 12.5 hours (9.4–16.5 hours); Postoperative hospital stay was 15 days (7–21 days). Clavien-Dindo grade IIIa or higher postoperative complications occurred in only 5 patients.

Conclusions:

This article for the first time reports the application of ELRA in treating patients with BCS secondary to HAE, not only provides new ideas for alternative treatments of secondary BCS, but also provides a classification system for secondary BCS. This article describes the technical process of outflow tract reconstruction and the experience for expanding the indications for ELRA. Our study demonstrated that ELRA is well feasible for treatment of BCS secondary to advanced HAE.
Peripartum cardiomyopathy and acute heart failure associated with prolonged tocolytic therapy in pregnancy
Authors: Li Pei-Chen , Chang Huai-Ren , Kao Sheng-Po
Published: August 2021

Rationale:

Peripartum cardiomyopathy (PPCM) is a rare and sometimes fatal systolic heart failure that affects women during late pregnancy or the early postpartum period. Heart failure symptoms can mimic the physiological changes of normal pregnancy, and the diagnosis is based on echocardiography.

Patient concerns:

A 38-year-old multiparous woman with a history of cervical incompetence underwent cervical cerclage and received tocolysis for 100 days.

Diagnoses:

She delivered vaginally at 37 weeks of gestation but developed postpartum decompensated acute heart failure with low left ventricular ejection fraction (LVEF: 34%) and was diagnosed with PPCM.

Interventions:

She received standard therapy for acute heart failure.

Outcomes:

The patient's pulmonary edema cleared, and she was fully ambulatory 6 days after admission. A follow-up echocardiogram 3 months later demonstrated recovery of LVEF to 66%.

Lessons:

Prolonged tocolysis may contribute to cardiomyopathy and should be used with caution. PPCM management requires standard treatments for acute heart failure with modifications for fetal safety.
Role of geospatial mapping in the planning of HIV programs
Authors: Prabhu Sandeep , Mehta Shruti H. , McFall Allison M. , Srikrishnan Aylur K. , Vasudevan Canjeevaram K. , Lucas Gregory M. , Celentano David D. , Solomon Sunil S.
Published: August 2021

Geographic information systems (GIS) tools can be used to understand the spatial distribution of local HIV epidemics but are often underutilized, especially in low-middle income countries. We present characteristics of an HIV epidemic within Hyderabad, a large city in southern India, as a case study to highlight the utility of such data in program planning.

Cross-sectional sample recruited using respondent-driven sampling in a cluster-randomized trial.

We analyzed data from 2 cross-sectional respondent-driven sampling surveys of MSM in Hyderabad, which were conducted as part of a cluster-randomized trial. All participants were tested for HIV and those positive underwent viral load quantification. ArcGIS was used to create heat maps of MSM distribution using self-reported postal code of residence and combined into larger zones containing at least 200 MSM.

Postal code data was available for 661 MSM (66.2%) in the baseline and 978 MSM (97.8%) in the follow-up survey. The proportion of HIV-positive MSM (12.7–15.7%) and prevalence of virally suppressed persons (2.6–8.2%) increased between the 2 surveys. The distribution of all MSM, HIV-positive MSM, and HIV-viremic MSM differed significantly by geographic zone with several zones having higher numbers of HIV-positive and viremic individuals than would be expected based on the distribution of all MSM.

The prevalence of HIV and HIV viremia among MSM differed by geographic zones within a city and evolved over time. Such data could be critical to improving program implementation efficiency by accurately targeting resources to population characteristics.
Normal pancreatic volume assessment using abdominal computed tomography volumetry
Authors: Li Lu , Wang Shuang , Wang Fei , Huang Guo-ning , Zhang Dong , Wang Guang-xian
Published: August 2021

To determine the normal range of pancreatic volume (PV) in Chinese adults using computed tomography (CT) volumetry. To assess the relationships of PV with patient demographics and clinical parameters. To analyze the degree of correlation between PV values determined by manual segmentation and those calculated by formulas.

A total of 240 adults (120 women, 120 men) between the ages of 18 and 79 years were reviewed. There were 6 groups of patients, with 40 patients in each decade regarding age. PV was segmented manually on computed tomography images slice by slice for each patient, and 2 formulas were used to calculate PV∗ and PV#.

The mean PV was 77.44 ± 19.11 cm3 (range from 28.55–138.15 cm3). PV was significantly correlated with height (r = 0.427, P < .001), weight (r = 0.525, P < .001), body mass index (r = 0.377, P < .001), the width of the first lumbar vertebral body (r = 0.166, P = .01), the transverse abdominal diameter (r = 0.455, P < .001), and the sagittal abdominal diameter (r = 0.456, P < .001). There was a negative correlation between PV and age (r = –0.209, P = .001). The correlation coefficients between PV and PV∗ and PV# were 0.676 and 0.376, respectively, with both P < .001.

PV associated with patient demographics and clinical parameters. A more accurate and simpler formula should be used in the future to calculate and monitor changes in PV.
Efficacy and safety of Naoxintong capsule for acute ischemic stroke
Authors: Li Na , Yang Fan , Zhao Zhilong , Jiang Juan , Lei Yi
Published: August 2021

Background:

Acute ischemic stroke (AIS) is one of the most common causes of mortality and disability worldwide, which has become a global health concern due to the high prevalence, mortality, and disability rate. Naoxintong capsule is an oral Chinese patent preparation used extensively to treat AIS in China. However, the systematic evaluation on the clinical efficacy and safety of Naoxintong capsule is still absent. Therefore, we attempt to perform a systematic review and meta-analysis based on the existing evidence, in order to provide solid support for the clinical practice of Naoxintong capsule in the treatment of AIS.

Methods:

We will search both English and Chinese databases, including Scopus, EMBASE, PubMed, Cochrane library, Google Scholar, Web of Science, CNKI, VIP, Wanfang, and Chinese Biomedical Literature Database, for randomized controlled trials which focus on Naoxintong capsule treating AIS. The retrieving time was from inception to August 2021. According to eligibility criteria, 2 researchers will independently screen information and assess the quality of selected articles. The RevMan 5.3 (Copenhagen, The Nordic Cochrane Centre, The Cochrane Collaboration) software will be used for meta-analysis.

Results:

The clinical efficacy and safety of Naoxintong capsule in the treatment of AIS will be systematically evaluated or descriptive analyzed.

Conclusion:

The study will provide rigorous evidence to identify whether the application of Naoxintong capsule for treating AIS appeared to be adequate reliability regarding on the efficacy and safety.

INPLASY registration number:

INPLASY202180052
Effect and safety of topical application of tranexamic acid to reduce perioperative blood loss in elderly patients with intertrochanteric fracture undergoing PFNA
Authors: Wei Huiping , Xiao Qiuping , He Jianfeng , Huang Tianji , Xu Wantang , Xian Siping , Xia Menghong
Published: August 2021

The specific method and dose of tranexamic acid (TXA) topically applied for intertrochanteric fractures have not been well established. The aim of this study is to investigate the efficacy and safety of TXA topically administered via our protocol for perioperative bleeding management in elderly patients with intertrochanteric fractures who underwent proximal femoral nail anti-rotation (PFNA).

A retrospective comparative analysis was performed. The TXA group was composed of 82 patients with topical use of TXA, and the control group was composed of 82 patients without TXA use during the PFNA procedure. Intraoperative, total and hidden amounts of blood loss, drainage volumes, postoperative blood transfusion volumes and complications were compared between the 2 groups.

The intraoperative, total and hidden amounts of blood loss and the drainage volumes were significantly lower in the TXA group than in the control group (P = .012, P < .01, P < .01, P = .014, respectively). The volume and rate of blood transfusion in the TXA group were significantly lower than those in the control group (P < .01). There were no significant differences in complications between the 2 groups (P > .05).

Topical application of TXA offers an effective and safe option for reducing perioperative blood loss and transfusion in elderly patients with intertrochanteric fractures undergoing PFNA.
Comparing Methods of Identifying Outlying Nurses in Audits of Low-Risk Cesarean Delivery Rates
Authors: Edmonds Joyce K. , Woodbury Samuel R. , Lipsitz Stuart R. , Weiseth Amber , Farrell Maureen E. , Shah Neel T. , Greene Naomi , Gregory Kimberly D.
Published: August 2021

Background:

The low-risk cesarean delivery (CD) rate is an established performance indicator for providers in maternity care for quality improvement purposes.

Purpose:

Our objectives were to assess nurse performance using adjusted nurse-level CD rates and to compare methods of identifying nurse outliers.

Methods:

We conducted a retrospective, cohort study of 6970 births attended by 181 registered nurses in one hospital's maternity unit. Adjusted and unadjusted nurse-level CD rates were compared and agreement between 3 definitions (statistical, top decile, over a benchmark) of outliers calculated.

Results:

Adjusted nurse-level CD rates varied from 5.5% to 53.2%, and the unadjusted rates varied from 5% to 50%. Risk adjustment had little impact on the ranking of nurses, and outliers were consistently identified by 3 definitions.

Conclusions:

Trade-offs between statistical certainty and feasibility need to be considered when classifying nurse outliers. Findings can help target interventions to improve nurse performance.
Leveraging Partnerships to Reduce Insulin Needlestick Injuries
Authors: Friel Beth Ann , Sieradzan Ray , Jones Chris , Katz Rachael A. , Smith Cole M. , Trenery Alyssa , Gee Julie
Published: August 2021

Background:

Percutaneous injuries from needlesticks are a major occupational hazard for nurses.

Local Problem:

Reducing subcutaneous insulin-related needlestick injuries was part of a nurse-led comprehensive sharps injury-reduction program at an integrated, not-for-profit health system.

Methods:

The incident rate of needlestick injuries was compared between 1 year before and 1 year after introducing this quality improvement project.

Interventions:

A system-wide educational program instituting changes in subcutaneous insulin administration practices was combined with supply chain standardization using a single type of safety-engineered insulin syringe.

Results:

The average monthly incidence of needlestick injuries per 10 000 subcutaneous insulin injections fell significantly from year to year (incidence rate ratio, 0.49; 95% CI, 0.30-0.80; Poisson regression P = .004). One-year cost savings for supplies totaled $3500; additional annual median savings were $24 875 (2019 US dollars) in estimated costs of needlestick injuries averted.

Conclusions:

The effectiveness of this multifaceted project provides a practical template to reduce subcutaneous insulin-related needlestick injuries.
Change of the Inclination Angle in a Pediatric Bilateral Condylar Fracture Treated With Intermaxillary Fixation and an Occlusal Stop
Authors: Wu XiaJing , Ma Sung Hwan , Hwang Kun
Published: August 2021

This paper presents the outcomes of a pediatric bilateral condylar fracture treated with intermaxillary fixation (IMF) and an occlusal stop.

A 6-year-old girl presented with the complaint of pain on her chin. She had fallen down, whereas riding a bicycle and her face hit the road. She had limited mouth-opening (10 mm). Panoramic radiography and computed tomography confirmed a bilateral con-dylar fracture. The inclination of the fractured condyle (IFC) was 39.2° and 42.4° on the left and right sides, respectively. On the third post-trauma day, arch bars were applied and IMF was performed with a prefabricated wafer (occlusal stop) and rubber bands. The rubber bands were changed to wires on post-IMF day (PMF) 4.

Immediately after IMF, the IFCs increased (left: 50.1° and right: 68.1°). On PMF 1, the IFCs had improved (44.5° and 46.9°, respectively). On PMF 3, 12, 28, and 35, the left and right IFCs were 46.9° and 70.7°,38.9° and 72.0°,38.0° and 56.5°, and 36.4° and 44.6°, respectively. On PMF 42, the IFCs had changed to 34.5° and 36.1 °, and wires were changed to rubber bands. On PMF 49, the IFCs were 34.0° and 36.5°, and rubber bands were applied at night only. On PMF 56, the IFCs had improved to 35.0° and 34.8°, and the arch bars were removed. The changes of IFC were fitted to an exponential regression model (left: y = 44.134e0.005xand right: y = 11.378e0.043x).

This case shows that pediatric bilateral mandibular condyle fractures can be treated by vertical lengthening using an occlusal stop and IMF.
Skilled maneuvering: Evaluation of a young driver advanced training program
Authors: Slinkard-Barnum Samantha A. , Gryder-Culver Laura K. , Batra Kavita , Chestovich Paul J. , Kuhls Deborah A.
Published: August 2021

BACKGROUND

Young drivers (YDs) are disproportionately injured and killed in motor vehicle crashes throughout the United States. Nationally, YDs aged 16 to 20 years constituted nearly 9% of all traffic-related fatalities in 2018. A Nevada Advanced Driver Training (ADT) program for YDs aims to reduce YD traffic injuries and fatalities through four modules taught by professional drivers. The program modules include classroom-based didactic lessons and hands-on driving exercises intended to improve safe driving knowledge and behaviors. The overarching purpose of this study was to determine if the Nevada ADT program achieved its objectives for improving safe driving knowledge and behaviors based on program-provided data. A secondary purpose of this study was to provide recommendations to improve program efficiency, delivery, and evaluation. The findings of this study would serve as a basis to develop and evaluate future ADT interventions.

METHODS

The exploratory mixed methods outcome evaluation used secondary data collected during three weekend events in December 2018 and March 2019. The study population consisted of high school students with a driver’s license or learner’s permit. Pretests/posttests and preevent questionnaires on student driving history were matched and linked via personal identifiers. The pretests/posttests measured changes in knowledge of safe driving behaviors. This study used descriptive statistics, dependent samples t test, Pearson’s r correlation coefficient, and χ2 (McNemar’s test) with significance set at p = 0.05, 95% confidence interval. Statistical analysis was conducted using IBM SPSS version 24 (Armonk, NY). Qualitative data analysis consisted of content and thematic analysis.

RESULTS

Responses from YD participants (N = 649) were provided for analysis. Aggregate YD participant knowledge of safe driving behaviors increased from a mean of 43.9% (pretest) to 74.9% (posttest).

CONCLUSION

The program achieved its intended outcomes of improving safe driving knowledge and behaviors among its target population.

LEVEL OF EVIDENCE

Prognostic/Epidemiologic, Level V.
Twenty years review of probiotic meta-analyses articles: Effects on disease prevention and treatment
Authors: Farahmandi Kajal , Sulaimany Sadegh , Kalhor Kambiz
Published: August 2021

The study of the probiotic effect in the prevention or treatment of diseases has long attracted the attention of many researchers. Here, we collected close to 300 meta-analysis articles for 20 years, investigating the effect of probiotics in the prevention and treatment of diseases. The goal of this study is to provide an overview of all meta-analysis articles of the effects of probiotics on various human diseases. For this purpose, different online databases, Pubmed, ScienceDirect, and Google Scholar, were searched with the keywords “probiotics” + “disease” + “meta-analysis” in the title, abstract, and keywords. Papers studied and categorized and investigated in order to present valuable insights for researchers in the field. Some of main categories are based on publication year, publishing journals, gender, age, effect type, disease type, contradicting reports and etc. According to the results, most meta-analyses indicated probiotics were 79% effective in preventing or treating the diseases. Some articles have also reported no positive effects, but there is not any paper in our study confirming the detrimental influence of probiotic effect on human health. For the future works, Cochrane reviews, meta-analysis including dozens of articles (as e.g. for NEC and AAD) may be investigated.
A quantitative evaluation of aerosol generation during manual facemask ventilation
Authors: Shrimpton A. J. , Brown J. M. , Gregson F. K. A. , Cook T. M. , Scott D.A. , McGain F. , Humphries R. S. , Dhillon R. S. , Bzdek B. R. , Hamilton F. , Reid J. P. , Pickering A. E.
Published: August 2021

Manual facemask ventilation, a core component of elective and emergency airway management, is classified as an aerosol generating procedure. This designation is based on a single epidemiological study suggesting an association between facemask ventilation and transmission from the SARS 2003 outbreak. There is no direct evidence to indicate whether facemask ventilation is a high-risk procedure for aerosol generation. We conducted aerosol monitoring during routine facemask ventilation, and facemask ventilation with an intentionally generated leak, in anaesthetised patients with neuromuscular blockade. Recordings were made in ultraclean theatres and compared against the aerosol generated by the patient’s own tidal breathing and coughs. Respiratory aerosol from tidal breathing was reliably detected above the very low background particle concentrations (191 (77-486 [3.8-1313]) versus 2.1 (0.7-4.6 [0-12.9] particles.l-1 median(IQR)[range], n=11, p=0.002). The average aerosol concentration detected during facemask ventilation both without a leak (3.0 particles.l-1 (0 – 9 [0-43])) and with an intentional leak (11 particles.l-1 (7.0 – 26 [1-62])) was 64-fold and 17-fold lower than that of tidal breathing (p=0.001 and p=0.002 respectively). The peak particle concentration during facemask ventilation both without a leak (60 particles.l-1 (0 – 60 [0-120])) and with a leak (120 particles.l-1 (60 – 180 [60-480]) were respectively 20-fold and 10-fold lower than a cough (1260 particles (800 – 3242 [100-3682]), p=0.002 and p=0.001 respectively). This study demonstrates that facemask ventilation, even performed with an intentional leak, does not generate high levels of bioaerosol. On the basis of this evidence, facemask ventilation should not be considered an aerosol generating procedure.
Prospective cohort study reveals unexpected aetiologies of livestock abortion in northern Tanzania
Authors: Thomas Kate M. , Kibona Tito , Claxton John R. , de Glanville William A. , Lankester Felix , Amani Nelson , Buza Joram J. , Carter Ryan W. , Chapman Gail E. , Crump John A. , Dagleish Mark P. , Halliday Jo E. B. , Hamilton Clare M. , Innes Elisabeth A. , Katzer Frank , Livingstone Morag , Longbottom David , Millins Caroline , Mmbaga Blandina T. , Mosha Victor , Nyarobi James , Nyasebwa Obed M. , Russell George C. , Sanka Paul N. , Semango George , Wheelhouse Nick , Willett Brian J. , Cleaveland Sarah , Allan Kathryn J.
Published: August 2021

Livestock abortion is an important cause of productivity losses worldwide and many infectious causes of abortion are zoonotic pathogens that impact on human health. Little is known about the relative importance of infectious causes of livestock abortion in Africa, including in subsistence farming communities that are critically dependent on livestock for food, income, and wellbeing. We conducted a prospective cohort study of livestock abortion, supported by cross-sectional serosurveillance, to determine aetiologies of livestock abortions in livestock in Tanzania. This approach generated several important findings including detection of a Rift Valley fever virus outbreak in cattle; high prevalence of C. burnetii infection in livestock; and the first report of Neospora caninum, Toxoplasma gondii, and pestiviruses associated with livestock abortion in Tanzania. Our approach provides a model for abortion surveillance in resource-limited settings. Our findings add substantially to current knowledge in sub-Saharan Africa, providing important evidence from which to prioritise disease interventions.
Data Preparation of the nuMoM2b Dataset
Authors: Goretsky Anton , Dmitrienko Anastasia , Tang Irene , Lari Nicolae , Kunhardt Owen , Khan Raiyan Rashid , Marcussen Cassandra , Catto Adam , Mallia Daniel , Leshchenko Alisa , Lin Adam (Yun Chao) , Raja Anita , Salleb-Aouissi Ansaf , Pe’er Itsik , Wapner Ronald , Gyamfi-Bannerman Cynthia
Published: August 2021

In 2010, the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) started the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b), a prospective cohort study of a racially/ethnically/geographically diverse population of nulliparous women with singleton gestation. The nuMoM2b is a very large dataset, consisting of data for 10,038 patients with over 4,600 features per patient, spread out over 80 files. In this report, we share our experience preparing and working with this dataset. We present our data preprocessing of the nuMoM2b dataset to get a deeper understanding of the data, extract the most relevant features, make the fewest assumptions when filling in unknown values, and reducing the dimensionality of the data. We hope this report is useful to researchers interested in building machine learning and statistical models from the nuMoM2b dataset.
The relationship between autoantibodies targeting GPCRs and the renin-angiotensin system associates with COVID-19 severity
Authors: Cabral-Marques Otavio , Halpert Gilad , Schimke Lena F. , Ostrinski Yuri , Zyskind Israel , Lattin Miriam T. , Tran Florian , Schreiber Stefan , Marques Alexandre H.C. , Filgueiras Igor Salerno , Plaça Desirée Rodrigues , Baiocchi Gabriela Crispim , Freire Paula Paccielli , Fonseca Dennyson Leandro M. , Humrich Jens Y. , Lange Tanja , Müller Antje , Giil Lasse M. , Graßhoff Hanna , Schumann Anja , Hackel Alexander Maximilian , Junker Juliane , Meyer Carlotta , Ochs Hans D. , Lavi Yael Bublil , Schulze-Forster Kai , Silvergerg Jonathan I. , Amital Howard , Zimmerman Jason , Heidecke Harry , Rosenberg Avi Z , Riemekasten Gabriela , Shoenfeld Yehuda
Published: August 2021

The coronavirus disease 2019 (COVID-19) can evolve to clinical manifestations resembling systemic autoimmune diseases, with the presence of autoantibodies that are still poorly characterized. To address this issue, we performed a cross-sectional study of 246 individuals to determine whether autoantibodies targeting G protein-coupled receptors (GPCRs) and renin-angiotensin system (RAS)-related molecules were associated with COVID-19-related clinical outcomes. Moderate and severe patients exhibited the highest autoantibody levels, relative to both healthy controls and patients with mild COVID-19 symptoms. Random Forest, a machine learning model, ranked anti-GPCR autoantibodies targeting downstream molecules in the RAS signaling pathway such as the angiotensin II type 1 and Mas receptor, and the chemokine receptor CXCR3 as the three strongest predictors of severe disease. Moreover, while the autoantibody network signatures were relatively conserved in patients with mild COVID-19 compared to healthy controls, they were disrupted in moderate and most perturbed in severe patients. Our data indicate that the relationship between autoantibodies targeting GPCRs and RAS-related molecules associates with the clinical severity of COVID-19, suggesting novel molecular pathways for therapeutic interventions.
PRMT5 promotes symmetric dimethylation of RNA processing proteins and modulates activated T cell alternative splicing and Ca2+/NFAT signaling
Authors: Sengupta Shouvonik , West Kelsi O. , Sanghvi Shridhar , Laliotis Georgios , Agosto Laura M. , Lynch Kristen , Tsichlis Philip , Singh Harpreet , Patrick Kristin , Guerau-de-Arellano Mireia
Published: August 2021

Protein Arginine Methyltransferase (PRMT) 5 is the major type 2 methyltransferase catalyzing symmetric dimethylation (SDM) of arginine. PRMT5 inhibition or deletion in CD4 Th cells reduces TcR engagement-induced IL-2 production and Th cell expansion and confers protection against experimental autoimmune encephalomyelitis (EAE), the animal model of Multiple Sclerosis. However, the mechanisms by which PRMT5 modulates T helper (Th) cell proliferation are still not completely understood and neither are the methylation targets in T cells. In this manuscript, we uncover the role of PRMT5 on alternative splicing (AS) in activated T cells and identify several targets of PRMT5 SDM involved in splicing. In addition, we find a possible link between PRMT5 mediated AS of Trpm4 (Transient Receptor Potential Cation Channel Subfamily M Member 4) and TcR/NFAT signaling/IL-2 production. This understanding may guide development of drugs targeting these processes to benefit patients with T cell-mediated diseases.
Deficiency of the lysosomal protein CLN5 alters lysosomal function and movement
Authors: Basak Indranil , Hansen Rachel A. , Ward Michael E. , Hughes Stephanie M.
Published: August 2021

Batten disease is a devastating childhood rare neurodegenerative disease characterized by rapid deterioration of cognition and movement, leading to death within ten to thirty years of age. One of the thirteen Batten disease forms, CLN5 Batten disease, is caused by mutations in the CLN5 gene leading to motor deficits, mental deterioration, cognitive impairment, visual impairment, and epileptic seizures in children. A characteristic pathology in CLN5 Batten disease is the defects in lysosomes, leading to neuronal dysfunction. In this study, we aimed to investigate the lysosomal changes in CLN5-deficient human neurons. We used an induced pluripotent stem cell system, which generates pure human cortical-like glutamatergic neurons. Using CRISPRi, we inhibited the expression of CLN5 in human neurons. The CLN5-deficient human neurons showed neutralised lysosomal acidity and reduced lysosomal enzyme activity measured by microscopy and flow cytometry. Furthermore, the CLN5-deficient human neurons also showed impaired lysosomal movement – a phenotype that has never been reported in CLN5 Batten disease. Lysosomal trafficking is key to maintain local degradation of cellular wastes, especially in long neuronal projections and our results from the human neuronal model present a key finding to understand the underlying lysosomal pathology in neurodegenerative diseases.