bluuebunny/crossref_metadata_2025 huggingface dataset:
CLINICAL FEATURES AND OUTCOMES OF LITTLE LEAGUE ELBOW IN YOUNG ATHLETES
Authors: Heyworth Benton E. , Zheng Evan T. , Bae Donald S.
Published: July 2021

Background:

As participation and specialization in youth sports has increased, so too has the incidence of overuse conditions, such as medial epicondyle apophysitis, or Little League Elbow (LLE). Hypothesis/ Purpose: The study purpose was to assess the demographic features, clinical presentation, management, and outcomes of a population of skeletally immature athletes with this increasingly common, but understudied, condition.

Methods:

A retrospective analysis was performed of patients diagnosed with LLE between 2003 and 2017 at a tertiary-care pediatric hospital. All patients had open apophyses with a clinical history of repetitive overhead athletic activity and radiographic and/or physical exam findings consistent with LLE. Study variables were derived from the electronic medical record.

Results:

Three hundred seventeen subjects (mean age: 12.8 years, range 8yrs – 16yrs; 310 males, 98%) were identified. The vast majority were baseball players (n=310, 98%), though there were several tennis players (n=4, 1%) and football quarterbacks (n=3, 1%). Two-hundred sixty-eight patients (85%) presented with apophysitis, while 49 (15%) presented with acute avulsion fractures from throwing (with 84% reporting preceding medial elbow pain). The acute fracture patients are the subject of a separate study. In the apophysitis cohort, all of whom presented with medial elbow pain, other presenting findings/symptoms included decreased elbow range of motion (16%) and concomitant ipsilateral shoulder pain (13%). Amongst those with documented shoulder exams, a majority (55%) demonstrated glenohumeral internal rotation deficit (GIRD) with a significantly longer time from diagnosis to resolution of symptoms (p=0.025). All apophysitis patients were treated with rest (complete cessation 75%, relative rest/position change 25%). Mean follow up was 32 months (sd 33 months). Return to sports occurred at a median of 12 weeks from diagnosis (IQR 7wks – 18wks). Recurrence of elbow pain occurred a median of 24 months (IQR 11mo - 43mo) following initial diagnosis in 13% of patients, a sub-cohort with significantly longer duration of symptoms prior to index presentation (p=0.024). One patient also suffered a subsequent medial epicondylar avulsion fracture while throwing in the setting of non-compliance with recommended rest.

Conclusion:

Little League Elbow is most commonly seen in adolescent and pre-adolescent male pitchers but may rarely be seen in other overhead athletic sub-populations. Careful evaluation of the entire kinetic chain is critical to identify concomitant pathology such as GIRD, which may portend a prolonged recovery. Proper treatment is necessary to minimize recurrence and development of epicondyle avulsion fractures, which represent a potentially preventable, but severe variant of LLE.
VARIATION IN TREATMENT APPROACHES TO ADOLESCENT MIDSHAFT CLAVICLE FRACTURES IN PEDIATRIC VERSUS ADULT HOSPITALS
Authors: Zhang Dafang , Heyworth Benton E. , Liotta Elizabeth S. , Hergott Katelyn A. , Earp Brandon E.
Published: July 2021

Background:

Optimal treatment of midshaft clavicle fractures in adolescents remains a topic of controversy. While adolescent midshaft clavicle fractures have historically been treated nonoperatively, recent randomized controlled trials of displaced midshaft clavicle fractures in the adult literature have raised the question of decreased symptomatic nonunion and malunion and improved functional outcomes with surgery. Consequently, the rates of surgical treatment of adolescent midshaft clavicle fractures, particularly in the older adolescent age group, has increased, despite a paucity of high-level evidence to justify this trend.

Hypothesis/Purpose:

To identify differences in treatment approach for isolated, displaced midshaft clavicle fractures in ‘older’ adolescent patients at adult versus pediatric hospitals. The secondary objective was to identify factors associated with surgery.

Methods:

Adolescents aged 15 to 18 years with isolated, displaced midshaft clavicle fractures treated at one of two adult tertiary care hospitals or one pediatric tertiary care hospital. Exclusion criteria included open fractures, skin tenting, nondisplaced fractures, medial third or distal third clavicle fractures, non-isolated injuries, and delay from injury to presentation of more than 2 weeks. Bivariate analysis and multivariable logistic regression analysis were used to identify factors associated with surgical treatment.

Results:

Two hundred and fourteen patients (median age: 16 years, mean BMI: 22.5, 85% male) were included. The cohort from the pediatric hospital was significantly younger, had lower BMI, had fewer comminuted fractures, and a higher proportion of angulated fractures (Table 1). One hundred six (50%) patients underwent surgical treatment. Bivariate analysis showed that older age (p = 0.004), higher BMI (p = 0.002), dominant upper extremity injury (p = 0.001), and treatment at an adult hospital (p < 0.0001) were associated with surgery. The fracture characteristics of comminution (p < 0.0001), greater displacement (p < 0.0001), and greater shortening (p < 0.0001) were associated with surgery. Multivariable logistic regression analysis showed superior-inferior fracture displacement (OR 1.13, 95% CI 1.06 to 1.20), dominant upper extremity injury (OR 2.60, 95% CI 1.19 to 5.67), and treatment at an adult hospital (OR 5.28, 95% CI 2.28 to 12.2) to be independently associated with surgery.

Conclusions:

After controlling for relevant demographic and fracture characteristics, adolescent patients treated at adult hospitals for displaced midshaft clavicle fractures have more than 5 times the odds of surgical treatment than those treated at a pediatric hospital. Significant practice variation across institutions reflects ongoing controversy in surgical indications and underscores the need for high quality prospective outcomes studies.

[Table: see text]
BORDERLINE ACETABULAR DYSPLASIA: THREE-DIMENSIONAL DEFORMITY PREDICTORS OF THE DIAGNOSIS OF SYMPTOMATIC INSTABILITY TREATED WITH PERIACETABULAR OSTEOTOMY
Authors: Graesser Elizabeth , Schwabe Maria , Garrido Cecilia Pascual , Clohisy John C. , Nepple Jeffrey J.
Published: July 2021

Introduction:

Borderline acetabular dysplasia is classically defined as a lateral center edge angle (LCEA) of 20-25 degrees. The optimal treatment strategy in this patient group remains controversial, with some patients having primarily hip instability-based symptoms, while others have primarily impingement-based symptoms (non-instability). The purpose of the current study was to define the 3D characteristics on low-dose CT that differentiate patients with instability symptoms from those without instability in the setting of borderline acetabular dysplasia.

Methods:

Seventy consecutive hips with borderline acetabular dysplasia undergoing surgical treatment were included in the current study. All patients underwent low-dose pelvic CT with femoral version assessment for preoperative planning. CT measurements included alpha angle and radial acetabular coverage (RAC) at standardized clockface positions (9:00-posterior to 3:00-anterior), central and cranial acetabular version. RAC was assessed in three sectors (anterior, superior, and posterior) and defined (relative to published normative data) as normal (-1 SD, +1 SD), undercoverage (<-1 SD), or overcoverage (>+1 SD). Statistical analysis was performed to compare the CT characteristics of the symptomatic instability and non-instability groups.

Results:

Of the 70 hips, 62.9% had the diagnosis of symptomatic instability, while 37.1% had no instability symptoms. Hips with instability (compared to non-instability) had significantly lower alpha angle (maximal difference at 1:00 - 47.0° vs. 59.4°), increased femoral version (22.3° vs. 15.3°), and decreased radial acetabular coverage (maximal difference at 1:00 – 59.9% vs. 62.2%) (all p<0.001). Multivariate analysis identified femoral version (OR 1.1, p=0.02), alpha angle at 1:00 (OR 0.91, p=0.02), and RAC at 1:00 (OR 0.46, p=0.003) as independent predictors of the presence of instability. The model combining these three factors had excellent predictive probability with a c-statistic 0.92.

Conclusion:

We found significant differences in the 3D hip morphology of the symptomatic instability and non-instability subgroups within the borderline dysplasia cohort. In the setting of borderline dysplasia, three-dimensional deformity characterization with low-dose CT allowed for differentiation of patients diagnosed with underlying instability vs. non-instability. Femoral version, alpha angle at 1:00, and radial acetabular coverage at 1:00 were identified as independent predictors of diagnosis in borderline acetabular dysplasia.

This study attempts to define 3D CT characteristics to help distinguish between patients with impingement-based vs instability-based symptoms of borderline acetabular dysplasia.
PATIENTS WHO ATTEND FORMAL PHYSICAL THERAPY FOR THE ENTIRE DURATION OF RECOVERY AFTER ACLR DEMONSTRATE EXCELLENT FUNCTIONAL OUTCOMES
Authors: Link Meredith , Greenberg Elliot
Published: July 2021

Background:

Limitations in insurance coverage and higher out-of-pocket expenses create challenges for physical therapists rehabilitating pediatric athletes after anterior cruciate ligament reconstruction (ACLR). While recovery may last 9-12 months, rehabilitation typically lasts <7 months. Unfortunately, research indicates many pediatric athletes have poor functional performance at the time of returning to sports. This may indicate incomplete rehabilitation within our current model of treatment. Understanding how rehabilitation utilization relates to functional outcomes may help optimize physical therapy (PT) treatment for pediatric patients post-ACLR.

Purpose:

To report the pattern of visit usage and functional outcomes of ACLR patients who were cared for within a large, pediatric specialty care network.

Methods:

A retrospective study of ACLR patients ≤18 years-old who underwent surgery between December 2016 and August 2019. All subjects must have completed rehabilitation within the sponsoring institutions PT centers and completed a functional hop testing battery, consisting of four single leg hop tests, prior to 10 months post-operative. The frequency of subjects able to achieve ≥90% limb symmetry (LS) on all hop tests was calculated and served as the main outcome of interest.

Results:

Out of 120 potential subjects, 53 were excluded for missing data, treatment at other facilities or care extending outside the designated time-frame, leaving 67 subjects (mean age 14.6 ± 1.5 SD, 38% female) for analysis. On average, PT began 14 days (range 5-33) post-operatively and subjects attended a mean of 40 visits (range 16-64) throughout 9 months of rehabilitation. The mean (range) number of sessions attended during rehabilitation was as follows: 0-6 weeks: 6 sessions (1-12), 7-12 weeks 10 sessions (2-15), 3 to 6 months 14 sessions (1-25), 6 to 9 months 9 sessions (0-23). Hop testing was completed 8 months post-surgery (range 5-10) with 85% of subjects achieving >90% LS on all tests.

Conclusion:

Physical therapy at a pediatric specialized center resulted in superior functional performance compared to existing literature. Interestingly, visit frequency was maintained throughout a 9-month period, which is not typical practice. Treatment during this latter phase of rehabilitation, involves advanced plyometric and sports conditioning, which may explain the high level of performance seen. Sampling bias and limitations is sample size, warrant caution in interpreting these results; however this data demonstrates that PT within a specialized setting, encompassing the entire duration of recovery after ACLR, yields excellent functional outcomes. Future investigations, within a larger and diverse sample are necessary to more fully understand these factors.
The Impact of COVID-19 Related School Closures and SPORT CANCELLATIONS on the Health of Adolescent Athletes
Authors: McGuine Timothy , Biese Kevin , Hetzel Scott , Kliethermes Stephanie , Reardon Claudia , Bell David , Brooks M Alison , Watson Andrew
Published: July 2021

Background:

In March 2020, schools were closed to in-person teaching and interscholastic sports cancelled in an attempt to slow the spread of the COVID-19. Child health experts have stated that school closures may have profound psychosocial consequences for students and need further study.

Hypothesis/Purpose:

To identify how COVID-19 related school closures and sport cancellations impacted the health of adolescent athletes.

Methods:

Adolescent athletes in Wisconsin were recruited via social media to complete an online survey in May 2020 while schools were closed to in-person teaching and interscholastic and club sports were cancelled. Assessments included the: General Anxiety Disorder-7 Item (GAD-7) for anxiety, Patient Health Questionnaire-9 Item (PHQ-9) for depression, the Pediatric Functional Activity Brief Scale (PFABS) for physical activity, and the Pediatric Quality of Life Inventory 4.0 (PedsQL) for quality of life. PHQ-9, PFABS and PedsQL scores were compared with historical data (HD) of Wisconsin adolescent athletes (N = 5,231) collected during normal school and sport operations in the years 2016–2018.

Results:

A total of 3,243 (58% female, Age = 16.1+1.2 yrs., grades 9 – 12) participated in the study. May 2020 participants reported higher (worse) PHQ-9 scores than the HD participants (mean: 8.0 (95%CI: 7.8, 8.2) vs 3.3 (3.1, 3.5), p < 0.001) as well as a higher prevalence of moderate to severe levels of depression (32.9% vs 9.7%, p < 0.001). May 2020 Participants also reported lower (worse) PFABS scores (mean: 12.2 (95%CI: 11.9, 12.5) vs 24.7 (24.5, 24.9) p < 0.001) and lower (worse) PedsQL total scores compared to athletes in the HD group (78.4 (78.0, 78.8) vs. 90.9 (90.5, 91.3) p < 0.001). Females in May 2020 reported increased moderate and severe anxiety percentages than the males in May 2020 (27.7% vs 22.3%, p < 0.001).

Conclusions:

COVID-19 related school closures and sport cancellations in Wisconsin were associated with increased anxiety and depression as well as decreased physical activity and quality of life in adolescent athletes. The potential negative health impacts of prolonged school closures and sport cancellations should be taken into account when evaluating steps to limit the spread of COVID-19.
PRE-OPERATIVE EXPECTATIONS FOR RETURN TO SPORTS AND OUTCOMES FOLLOWING ACL RECONSTRUCTION: A SURVEY OF ADOLESCENT PATIENTS AND THEIR PARENTS
Authors: Varakitsomboon Shing , Saper Michael
Published: July 2021

Background:

There is limited data regarding patient and parent expectations regarding return to sport (RTS) and outcomes following anterior cruciate ligament reconstruction (ACLR) in adolescent athletes.

Purpose:

To investigate RTS and outcome expectations of adolescent patients and their parents before ACLR and determine any differences between groups.

Methods:

For this cross-sectional study, sets of patients (aged 10 to 18 years) and parents were separately asked to complete the same questionnaire relating to knowledge and expectations regarding the patient’s upcoming ACLR. The custom survey consisted of 12 questions and was administered before being seen by a single sports medicine surgeon in the clinical setting of a tertiary care referral center from June 2019 through June 2020. Statistical analysis was performed to compare differences between patient and parent/guardian responses.

Results:

28 sets of patients (53.6% female) and parents (64.3% female) completed the survey with average ages of 14.5 ± 2.0 years and 45.6 ± 7.0 years, respectively. 75% of families were Caucasian and 85.2% had private insurance. The most common sports played were basketball (25%) and soccer (17.9%). Overall, nearly 68% of consults were for a second opinion. 50% of patients and 82.1% of parents researched or read of ACL injuries and/or surgery prior to the visit. Most patients (46.4%) and parents (51.9%) expected the surgeon to consider full, unrestricted RTS/activities at 9 months. Only 7.1% of patients and 3.7% of parents believed full RTS would occur >12 months. 50% of patients and 67.9% of parents expected RTS at the same level. Both patients (53.6%) and parents (64.3%) believed fear of re-injury was the most common reason for not returning to sport or returning at a decreased level. There were no statistically significant differences in RTS expectations between patients and parents ( p>0.05). Most patients (38.5%) believed the risk of graft rupture in adolescent athletes was 5%, whereas most parents (37%) believed the risk to be at 25%, but the difference was not statistically significant ( p>0.05). Both patients and parents believed the risk of graft rupture was highest within the first 6 months (77.8% vs. 50%, respectively). More parents felt the risk of graft rupture was highest within the first year (39.3% vs. 22.2%), but the difference was not statistically significant ( p>0.05).

Conclusion:

Adolescent patients and their parents had similar knowledge and expectations regarding RTS and outcomes following ACLR. Further study is needed to better understand factors affecting those expectations.
Knee arthroscopy in patients over 64 years suffering from primary gonarthrosis
Authors: Lopez Alejandro Alvarez
Published: July 2021

Objectives:

to evaluate the results of the arthroscopic surgical techniques in patients with primary gonarthrosis older than 64 years.

Methods:

an analytical observational study was carried out in 40 patients older than 64 years treated arthroscopically with the diagnosis of primary gonarthrosis, at the Manuel Ascunce Domenech University Hospital in the city of Camagüey from October 2012 to May 2019. The research has a level of evidence IV recommendation D.

Results:

the average age of the 40 patients studied was 69,6 years, with a predominance of female to male, with a ratio of 3 to 1. Tricompartmental disease predominated in most patients as well as grade IV according to the Outerbridge RE classification. The cartilage and associated meniscus injuries predominate. Grades III and IV of the Kellgram JH and Lawrence JS classification were the most found. The most commonly used arthroscopic treatments were debridement and partial meniscectomy. Statistical significance between a before and after was detected.

Conclusion:

the results of the investigation show that the procedures performed through the arthroscopic route for patients with primary gonarthrosis over 64 years of age are effective in more than half of the patients.
Field Experiments and Job Posting Sources: The Consequences of Job Database Selection for Estimates of Racial Discrimination
Authors: Pedulla David S. , Muñoz John , Wullert Katherine E. , Dias Felipe A.
Published: July 2021

Field experiments have proliferated throughout the social sciences and have become a mainstay for identifying racial discrimination during the hiring process. To date, field experiments of labor market discrimination have generally drawn their sample of job postings from limited sources, often from a single major online job posting website. While providing a large pool of job postings across labor markets, this narrow sampling procedure leaves open questions about the generalizability of the findings from field experiments of racial discrimination in the extant literature. In this paper, we present evidence from a field experiment examining racial discrimination in the hiring process that draws its sample from two sources: (1) a national online job posting website that aligns with previous research, and (2) a job aggregator service that scrapes the web daily in an effort to obtain all online job postings in the United States. While differing in the types of information they collect, we find the job postings drawn from the two sources result in similar estimates of discrimination against Black applicants. In other words, we do not find evidence that racial discrimination varies by the source of the job posting. We conclude by discussing the implications of these findings for studies of racial discrimination, discrimination along other axes of social difference, as well as field-experimental methods more broadly.
Family Perceptions of Palliative Care and Communication in the Surgical Intensive Care Unit
Authors: Paré Kristina , Grudziak Joanna , Lavin Kyle , Sten May-Britt , Huegerich Anneka , Umble Karl , Twer Emma , Reid Trista
Published: July 2021

Few data exist on palliative care for trauma and acute care surgery patients. This pilot study evaluated family perceptions and experiences around palliative care in a surgical intensive care unit (SICU) via mixed methods interviews conducted from February 1, 2020, to March 5, 2020, with 5 families of patients in the SICU. Families emphasized the importance of clear, honest communication, and inclusiveness in decision-making. Many interviewees were unable to recall whether goals-of-care discussions had occurred, and most lacked understanding of the patients’ illnesses. This study highlights the significance of frequent communication and goals-of-care discussions in the SICU.
Senior Citizen Homes: Search for a Viable Business Model
Authors: Agrawal Gautam , Chhabra Sakhhi , Chhikara Ritu , Garg Ruchi
Published: July 2021

The case pertains to the decision regarding business model to be decided by the developer of a proposed senior citizen homes. Due to a number of reasons, enumerated in the study, the elderly people prefer to live in community living projects.

The protagonist Mr Pankaj Pawa, MD, Pawa Group, wants a scalable Old Age Home (OAH) concept, which can be replicated across India. Accordingly, he has identified upper-middle-class senior citizens as the potential segment. As per his surveys, this segment is neglected till date. The project will need to be planned as a community project, where the residents become part of the community by sharing common resources.

The developer’s main concern is selecting the best business model, which allows him to expand. Simultaneously, the project should not lead to his capital blockage as the real estate market has faced liquidity crisis. Furthermore, he needs to be convinced that the senior citizens are a financially viable customer segment, and an exclusive project for them will be self-sustaining in the long term.
Cough symptom severity in patients with refractory or unexplained chronic cough: a systematic survey and conceptual framework
Authors: Kum Elena , Guyatt Gordon H. , Devji Tahira , Wang Yuting , Bakaa Layla , Lan Lucy , Liu Eva , Mastrolonardo Alexander , Couban Rachel , O'Byrne Paul M. , Satia Imran
Published: July 2021

Background

Cough severity represents an important subjective endpoint in assessing the effectiveness of therapies for patients with chronic cough. Although cough-specific quality of life questionnaires exist, a widely available cough severity instrument with established measurement properties remains unavailable.

Aims

To identify and summarise the results of studies reporting on the experience of patients with chronic cough and, in the process, develop a conceptual framework to inform development of a patient-reported outcome measurement (PROM) addressing cough severity.

Results

We identified 61 eligible studies reporting on patient experience with chronic cough. Studies provided 82 potential items, of which 43 proved unique and relevant to cough severity. The urge-to-cough sensation and the cough symptom itself represented broad domains of cough severity. Two subdomains under urge-to-cough included frequency (1 item) and intensity (1 item). Five subdomains under cough symptoms included control (2 items), frequency (6 items), bout duration (1 item), intensity (8 items), and associated features/sequelae (24 items).

Conclusions

Our systematic survey and conceptual framework identified items and domains of cough severity in patients with refractory or unexplained chronic cough. The results support item generation and content validity for a PROM assessing cough severity.
Anti-tuberculosis chemotherapy alters TNFR2 expression on CD4+ lymphocytes in both drug-sensitive and -resistant tuberculosis: however, only drug-resistant tuberculosis maintains a pro-inflammatory profile after a long time
Authors: Téllez-Navarrete Norma A. , Ramon-Luing Lucero A. , Muñoz-Torrico Marcela , Preciado-García Mario , Medina-Quero Karen , Hernandez-Pando Rogelio , Chavez-Galan Leslie
Published: July 2021

Background

Tuberculosis (TB) is an infectious disease. During TB, regulatory T cells (Treg) are related to poor prognosis. However, information about conventional and unconventional Treg (cTreg and uTreg, respectively) is limited. The tumour necrosis factor (TNF) and its receptors (TNFR1 and TNFR2) are necessary for mycobacterial infection, and TNFR2 signalling is required to maintain Treg.

Methods

A blood sample of drug-susceptible (DS-TB) and drug-resistant tuberculosis (DR-TB) patients was obtained before (basal) and after 2 and 6 months of anti-TB therapy. Expression of TNF, TNFR1, and TNFR2 (transmembrane form, tm) on cTreg, uTreg, activated CD4+ (actCD4+), and CD4+ CD25− (CD4+) T cell subpopulations were evaluated. The main objective was to identify immunological changes associated with sensitive/resistant Mtb strains and with the use of anti-TB therapy.

Results

We found that after 6 months of anti-TB therapy, both DS- and DR-TB patients have decreased the frequency of cTreg tmTNF+, CD4+ tmTNFR1+ and CD4+ tmTNFR2+. Nevertheless, after 6 months of therapy, only DR-TB patients decreased the frequency of actCD4+ tmTNF+ and actCD4+ tmTNFR2+, exhibited a systemic inflammatory status (high levels of TNF, IFN-γ and IL-12), and their purified CD4+ T cells showed that TNF and TNFR2 are up-regulated at the transcriptional level. Moreover, DS- and DR-TB down-regulated TNFR1 and other proteins associated with Treg (FOXP3 and TGFβ1) in response to the anti-TB therapy.

Conclusion

These results partially explain the differences in the immune response of DS-TB vs DR-TB. The frequency of actCD4+ tmTNFR2+ cells and inflammatory status should be considered in the follow-up of therapy in DR-TB patients.
Study on flexural performance of prestressed glulam continuous beams under control influence
Authors: Mei Lidan , Guo Nan , Li Ling , Zuo Hongliang , Zhao Yan
Published: July 2021

Traditional glulam beam connection mode has a weak ability to transfer bending moment, leading to insufficient joint stiffness and mostly in the form of simply supported beams. To make full use of material strength, a novel prestressed glulam continuous beam was proposed. On this basis, this paper put forward a new method to further improve the mechanical performance of the beams by controlling prestress. According to the estimated ultimate loads of the beams, six different control range values were formulated, and 12 continuous beams were tested for flexural performance. The effects of prestressing control on the failure modes, ultimate load capacity, and load versus deformation relationships of the glulam continuous beams were analyzed. The test results indicated that the flexural performance of the beams with prestressed control was significantly improved compared to the uncontrolled beams, the ultimate load was enhanced by 13.60%–45.11%, and the average steel wire stress at failure was increased from 70% of the designed tensile strength to 94%. Combined with the finite element analysis (FEA), the reasonable control range of the prestressed control continuous beams was18%–30% of the estimated ultimate load. The research in this paper can provide references for the theoretical analysis and engineering application of similar structures.
The effectiveness of vibration therapy for muscle peak torque and postural control in individuals with anterior cruciate ligament reconstruction: a systematic review and meta-analysis of clinical trials
Authors: Maghbouli Nastaran , Khodadost Mahmoud , Pourhassan Saeed
Published: July 2021

Objective

This study aimed to review and summarize the existing evidence on the effectiveness of vibration therapy (VT) in comparison with conventional rehabilitation in anterior cruciate ligament (ACL)-reconstructed patients considering muscle peak torque and postural control.

Methods

We searched available online databases for relevant studies published up to February 2020. All randomized clinical trials investigating the effect of VT on quadriceps peak torque, hamstring peak torque, and postural control (closed-eye and open-eye) were included. Overall, 13 clinical trials with a total sample size of 407 participants were included for the meta-analysis. We used the pooled mean difference with random effects model for meta-analyses. We assessed the heterogeneity of the studies using the I2 and Cochran’s Q test. Meta-regression analysis was used to assess the source of heterogeneity.

Results

We found that VT significantly improved hamstring peak torque [weighted mean difference (WMD) 12.67, 95% CI 4.51–20.83] and quadriceps peak torque (WMD 0.11, 95% CI −0.06 to 0.29). However, subgroup analysis showed a significant increase in mentioned muscles’ peak torque in studies employing interventions including both local muscle vibration (LMV) and vibration frequency higher than 100 Hz (WMD 20.84, 95% CI 11.75–29.93). With regard to postural control, we observed a significant improvement only in open-eye mediolateral postural control (WMD 0.26, 95% CI −1.26 to 1.77).

Conclusion

This study suggests that VT, especially LMV type with vibration frequency higher than 100 Hz, can be effective in rehabilitation of ACL-reconstructed patients. Although improvement in the peak torque of hamstring and quadriceps muscles was seen, there was no significant improvement in postural control, especially closed-eye, in comparison with conventional rehabilitation.

Level of evidence

1.

Highlights

Vibration therapy can increase hamstring peak torque in individuals with ACL reconstruction.

Local muscle vibration type in comparison with whole-body vibration is recommended for ACL-reconstructed patients.

Vibration frequency higher than 100 Hz is preferred in ACL-reconstructed rehabilitation.
Whole genome sequencing and phylogenetic analysis of six SARS-CoV-2 strains isolated during COVID-19 pandemic in Tunisia, North Africa
Authors: Fares Wasfi , Chouikha Anissa , Ghedira Kais , Gdoura Meriam , Rezig Dorra , Boubaker Sondes Haddad , Dhifallah Imen Ben , Touzi Henda , Hammami Walid , Meddeb Zina , Sadraoui Amel , Hogga Nahed , Abouda Imen , Kwasiborski Aurélia , Hourdel Véronique , Mikaty Guillain , Caro Valérie , Manuguerra Jean-Claude , Alaya Nissaf Ben , Triki Henda
Published: July 2021

Background

In Tunisia a first SARS-CoV-2 confirmed case was reported in March 03, 2020. Since then, an increase of cases number was observed from either imported or local cases. The aim of this preliminary study was to better understand the molecular epidemiology and genetic variability of SARS-CoV-2 viruses circulating in Tunisia and worldwide.

Methods

Whole genome sequencing was performed using NGS approach on six SARS.

CoV-2 highly positive samples detected during the early phase of the outbreak.

Results

Full genomes sequences of six Tunisian SARS-CoV-2 strains were obtained from imported and locally transmission cases during the COVID-19 outbreak. Reported sequences were non-identical with 0.1% nucleotide divergence rate and clustered into 6 different clades with worldwide sequences. SNPs results favor the distribution of the reported Tunisian sequences into 3 major genotypes. These SNP mutations are critical for diagnosis and vaccine development.

Conclusions

These results indicate multiple introductions of the virus in Tunisia and add new genomic data on SARS-CoV-2 at the international level.
Peridermal fruit skin formation in Actinidia sp. (kiwifruit) is associated with genetic loci controlling russeting and cuticle formation
Authors: Macnee Nikolai , Hilario Elena , Tahir Jibran , Currie Alastair , Warren Ben , Rebstock Ria , Hallett Ian C. , Chagné David , Schaffer Robert J. , Bulley Sean M.
Published: July 2021

Background

The skin (exocarp) of fleshy fruit is hugely diverse across species. Most fruit types have a live epidermal skin covered by a layer of cuticle made up of cutin while a few create an outermost layer of dead cells (peridermal layer).

Results

In this study we undertook crosses between epidermal and peridermal skinned kiwifruit, and showed that epidermal skin is a semi-dominant trait. Furthermore, backcrossing these epidermal skinned hybrids to a peridermal skinned fruit created a diverse range of phenotypes ranging from epidermal skinned fruit, through fruit with varying degrees of patches of periderm (russeting), to fruit with a complete periderm. Quantitative trait locus (QTL) analysis of this population suggested that periderm formation was associated with four loci. These QTLs were aligned either to ones associated with russet formation on chromosome 19 and 24, or cuticle integrity and coverage located on chromosomes 3, 11 and 24.

Conclusion

From the segregation of skin type and QTL analysis, it appears that skin development in kiwifruit is controlled by two competing factors, cuticle strength and propensity to russet. A strong cuticle will inhibit russeting while a strong propensity to russet can create a continuous dead skinned periderm.
Hahn-PCNN-CNN: an end-to-end multi-modal brain medical image fusion framework useful for clinical diagnosis
Authors: Guo Kai , Li Xiongfei , Hu Xiaohan , Liu Jichen , Fan Tiehu
Published: July 2021

Background

In medical diagnosis of brain, the role of multi-modal medical image fusion is becoming more prominent. Among them, there is no lack of filtering layered fusion and newly emerging deep learning algorithms. The former has a fast fusion speed but the fusion image texture is blurred; the latter has a better fusion effect but requires higher machine computing capabilities. Therefore, how to find a balanced algorithm in terms of image quality, speed and computing power is still the focus of all scholars.

Methods

We built an end-to-end Hahn-PCNN-CNN. The network is composed of feature extraction module, feature fusion module and image reconstruction module. We selected 8000 multi-modal brain medical images downloaded from the Harvard Medical School website to train the feature extraction layer and image reconstruction layer to enhance the network’s ability to reconstruct brain medical images. In the feature fusion module, we use the moments of the feature map combined with the pulse-coupled neural network to reduce the information loss caused by convolution in the previous fusion module and save time.

Results

We choose eight sets of registered multi-modal brain medical images in four diease to verify our model. The anatomical structure images are from MRI and the functional metabolism images are SPECT and 18F-FDG. At the same time, we also selected eight representative fusion models as comparative experiments. In terms of objective quality evaluation, we select six evaluation metrics in five categories to evaluate our model.

Conclusions

The fusion image obtained by our model can retain the effective information in source images to the greatest extent. In terms of image fusion evaluation metrics, our model is superior to other comparison algorithms. In terms of time computational efficiency, our model also performs well. In terms of robustness, our model is very stable and can be generalized to multi-modal image fusion of other organs.
Challenging the status quo: results of an acceptability and feasibility study of hypertensive disorders of pregnancy (HDP) management pathways in Indonesian primary care
Authors: Ekawati Fitriana Murriya , Emilia Ova , Gunn Jane , Licqurish Sharon , Lau Phyllis
Published: July 2021

Background

Hypertensive disorders of pregnancy (HDP) are the leading cause of maternal mortality in Indonesia. Focused HDP management pathways for Indonesian primary care practice have been developed from a consensus development process. However, the acceptability and feasibility of the pathways in practice have not been explored. This study reports on the implementation process of the pathways to determine their acceptability and feasibility in Indonesian practice.

Methods

The pathways were implemented in three public primary care clinics (Puskesmas) in Yogyakarta province for a month, guided by implementation science frameworks of Medical Research Council (MRC) and the Practical Robust Implementation and Sustainability Model (PRISM). The participating providers (general practitioners (GPs), midwives, and nurses) were asked to use recommendations in the pathways for a month. The pathway implementation evaluations were then conducted using clinical audits and a triangulation of observations, focus groups (FGs), and interviews with all of the participants. Clinical audit data were analysed descriptively, and qualitative data were analysed using a mix of the inductive-deductive approach of thematic analysis.

Results

A total of 50 primary care providers, four obstetricians, a maternal division officer in the local health office and 61 patients agreed to participate, and 48 of the recruited participants participated in evaluation FGs or interviews. All of the providers in the Puskesmas attempted to apply recommendations from the pathways to various degrees, mainly adopting preeclampsia risk factor screenings and HDP monitoring. The participants expressed that the recommendations empowered their practice when it came to HDP management. However, their practices were challenged by professional boundaries and hierarchical barriers among health care professionals, limited clinical resources, and regulations from the local health office. Suggestions for future scale-up studies were also mentioned, such as involving champion obstetricians and providing more patient education toolkits.

Conclusion

The HDP management pathways are acceptable and feasible in Indonesian primary care. A further scale-up study is desired and can be initiated with investigations to minimise the implementation challenges and enhance the pathways’ value in primary care practice.
Association between gestational weight gain in women with gestational diabetes mellitus and adverse pregnancy outcomes: a retrospective cohort study
Authors: Shi Ping , Liu Aimin , Yin Xiaoyan
Published: July 2021

Background

To examine association between gestational weight gain (GWG) in women with gestational diabetes mellitus (GDM) and adverse pregnancy outcomes (APOs).

Methods

This retrospective cohort study enrolled women with GDM who delivered at 2010–2020 in Changzhou, Jiangsu. Total GWG, rates of GWG in second trimester and third trimesters were stratified into three categories according to IOM guidelines: within, below, and above IOM guidelines. Univariable and multivariable logistic regression analyses were used.

Results

Overall, 1606 women with GDM fulfilled inclusion criteria. Compared with within IOM guidelines and after adjusting for confounders, total GWG above IOM guidelines in pregnancy was associated with an increased odds of caesarean delivery [adjusted odds ratio (aOR) = 1.34, 95% confidence interval (CI): 1.04–1.72], hypertensive disorders of pregnancy (HDP) (aOR = 2.00, 1.28–3.12), preeclampsia (aOR = 2.06, 1.01–3.12), macrosomia (aOR = 1.55, 1.13–2.13) and large for gestational age (LGA) (aOR = 2.82, 1.94–3.23), and a decreased odds of premature rupture of membrane (PROM) (aOR = 0.46, 0.36–0.60) and preterm birth (aOR = 0.35, 0.26–0.44); total GWG below IOM guidelines in pregnancy was associated with an increased risk of preterm birth (aOR = 1.96, 1.44–2.66), small for gestational age (SGA) (aOR = 1.32, 1.11–1.50) and a decreased odds of macrosomia (aOR = 0.35, 0.23–0.53) and LGA (aOR = 0.54, 0.42–0.72). Further, in both second and third trimesters of pregnancy, rates of GWG above IOM guidelines was found to be associated with a high odds of HDP (aOR = 2.55, 1.86–3.38; aOR = 1.93, 1.08–2.98), preeclampsia (aOR = 2.28, 1.21–3.81; aOR = 2.17, 1.35–4.37), macrosomia (aOR = 1.20, 1.02–1.82; aOR = 2.02, 1.51–2.64) and LGA (aOR = 1.42, 1.24–1.97; aOR = 1.79, 1.51–2.54). Rates of GWG above IOM guidelines in third trimester of pregnancy also increased odds of caesarean delivery (aOR = 1.48, 1.16–2.34) when compared with within IOM guidelines. While rates of GWG below IOM guidelines in both second and third trimesters of pregnancy was associated with a decreased odds of macrosomia (aOR = 0.66, 95% CI: 0.52–0.78; aOR = 0.52, 0.39–0.63) and LGA(aOR = 0.71, 0.51–0.82; aOR = 0.67, 0.55–0.79). In addition, rate of GWG below IOM guidelines in third trimester of pregnancy was associated with an increased odds of preterm birth (aOR = 1.52, 1.12–2.05) and SGA (aOR = 1.21, 1.10–1.69).

Conclusion

GWG, outside IOM guidelines has increased risks of APOs among women with GDM, implying that careful surveillance for GWG during different stages of pregnancy is warranted.
Assessing the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with PCOS in Iran: a field trial study
Authors: Hajivandi Leila , Noroozi Mahnaz , Mostafavi Firoozeh , Ekramzadeh Maryam
Published: July 2021

Background

Polycystic ovary syndrome is the most common endocrine disorder among adolescents and adults. Given the importance of healthy nutritional behaviors in management of this disease, the present study was conducted to determine the impact of an educational intervention program based on the theory of planned behavior on the nutritional behaviors of adolescents and young adults with polycystic ovary syndrome.

Methods

In this field trial study, 72 participants aged between 15 and 21 years old from four gynecology clinics in Shiraz, Iran, were assigned into the intervention and control groups. Educational intervention program was implemented based on the theory of planned behavior over 4 sessions during two weeks. The data collection tools were researcher-made questionnaires of demographic information, knowledge assessment, and assessment of theory of planned behavior constructs, as well as a questionnaire for assessing consumption of food groups, fast food, and snacks. The data were collected at two stages (once at baseline and once three months after the intervention), and then the changes in knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior were analyzed using descriptive and inferential statistical methods (t-test, Chi-square, Mann- Whitney U, and Wilcoxon tests; as well as one- way ANOVA, repeated measures ANOVA, and ANCOVA, respectively).

Results

Statistically significant increases were observed in the mean scores of knowledge, attitude, subjective norms, the perceived behavioral control, behavioral intention, and nutritional behavior in the intervention group by passing three months from the intervention compared to the scores before the intervention (P < 0.001). However, these differences were not statistically significant in the control group (P > 0.05). Moreover, the mean scores of knowledge, attitude, subjective norms, perceived behavioral control, behavioral intention, and nutritional behavior had no statistically significant difference before the intervention between the two groups; however, this was statistically significant by passing three months from the intervention (P < 0.001).

Conclusion

Considering the effect of an educational intervention program based on the theory of planned behavior on creating healthy nutritional behaviors in adolescents and young adults with polycystic ovary syndrome, it is recommended to use it in order to improve the nutritional health of them.

Trial registration: IRCT, IRCT20160224026756N6. Registered 18 Aug 2018, https://en.irct.ir/user/trial/32693/view
Evaluating effort-reward imbalance among nurses in emergency departments: a cross-sectional study in China
Authors: Tian Mengge , Yang Heping , Yin Xiaoxv , Wu Yafei , Zhang Guopeng , Lv Chuanzhu , Mu Ketao , Gong Yanhong
Published: July 2021

Background

Effort-reward imbalance is an adverse psychological response to working conditions that has several negative effects on nurses. However, there is little research on effort-reward imbalance and its influencing factors among nurses in emergency departments. This study aimed to understand the current situation of effort-reward imbalance and explore its influencing factors among emergency department nurses in China.

Methods

From July to August 2018, a structured online questionnaire survey was conducted among emergency department nurses in China. Data were collected from emergency department nurses employed in hospitals providing pre-hospital care in China. The questionnaire consisted of sociodemographic characteristics, work-related factors and effort-reward imbalance. A descriptive analysis and a binary logistic regression were conducted to explore the effort-reward imbalance and its influencing factors among emergency department nurses.

Results

The study involved 17,582 emergency department nurses; notably, the prevalence of effort-reward imbalance was 59.66%. The participating nurses who were males, aged 25 to 34 years, whose educational level was a bachelor degree or above, who had a junior or above title, who had longer years of service, and who had suffered verbal or physical violence in the past year had a higher risk of effort-reward imbalance. Furthermore, the nurses with a high monthly income, who believed that the number of nurses met the department’s demand had a lower risk of effort-reward imbalance.

Conclusions

Effort-reward imbalance was prevalent among emergency department nurses in China. Measures such as adjusting the night shift frequency, increasing the number of nurses, raising salaries and reducing workplace violence should be considered to reduce the level of effort-reward imbalance.
What intensity of exercise is most suitable for the elderly in China? A propensity score matching analysis
Authors: Chen Xinlin , Su Dai , Chen Xinlan , Chen Yingchun
Published: July 2021

Background

The strategy of successful ageing is an important means to deal with the challenges of the current ageing society. This paper aims to explore the effects of different intensities of physical activity on the successful ageing of the elderly.

Methods

Our data were from wave 4 of the China Health and Retirement Longitudinal Survey (CHARLS), involving 9026 residents aged 60 years and older. The intensity of physical activity was divided into three levels: vigorous, moderate and mild. The concept of successful ageing adopted a four-dimensional model of life satisfaction added to the theoretical model of Rowe and Kahn’s. Propensity score matching (PSM) with controlling nine confounding factors were used to analyse the effects of different intensities of physical activity.

Results

The percentage of successful ageing was 1.88% among all subjects. Among them, 30.26, 29.57 and 29.40% of the elderly often participated in vigorous, moderate and mild physical activity, respectively. The results of PSM showed that participation in moderate activity increased the probability of successful ageing of the elderly by 0.76–0.78% (P < 0.001), while participation in vigorous and mild physical activity had no significant effect on successful ageing (P > 0.05). Moderate physical activity had statistically significant effects on four components of successful aging, including major disease, physical function, life satisfaction, and social participation (P < 0.05).

Conclusion

Moderate-intensity physical activity was most beneficial to the successful ageing of the elderly and should be promoted in the elderly population.