bluuebunny/crossref_metadata_2025 huggingface dataset:
In-Hospital Stroke Care: A Six-Year Community-Based Primary Stroke Center Experience
Authors: Chukwudelunzu Felix Ejike , Demaerschalk Bart M. , Fugoso Leonardo , Amadi Emeka , Dexter Donn , Gullicksrud Angela , Hagen Clinton
Published: May 2021

Background and purpose:

In-hospital stroke-onset assessment and management present numerous challenges, especially in community hospitals. Comprehensive analysis of key stroke care metrics in community-based primary stroke centers is under-studied.

Methods:

Medical records were reviewed for patients admitted to a community hospital for non-cerebrovascular indications and for whom a stroke alert was activated between 2013 and 2019. Demographic, clinical, radiologic and laboratory information were collected for each incident stroke. Descriptive statistical analysis was employed. When applicable, Kruskal-Wallis and Chi-Square tests were used to compare median values and categorical data between pre-specified groups. Statistical significance was set at alpha = 0.05.

Results:

There were 192 patients with in-hospital stroke-alert activation; mean age (SD) was 71.0 years (15.0), 49.5% female. 51.6% (99/192) had in-hospital ischemic and hemorrhagic stroke. The most frequent mechanism of stroke was cardioembolism. Upon stroke activation, 45.8% had ischemic stroke while 40.1% had stroke mimics. Stroke team response time from activation was 26 minutes for all in-hospital activations. Intravenous thrombolysis was utilized in 8% of those with ischemic stroke; 3.4% were transferred for consideration of endovascular thrombectomy. In-hospital mortality was 17.7%, and the proportion of patients discharged to home was 34.4% for all activations.

Conclusion:

The in-hospital stroke mortality was high, and the proportions of patients who either received or were considered for acute intervention were low. Quality improvement targeting increased use of acute stroke intervention in eligible patients and reducing hospital mortality in this patient cohort is needed.
Obstructive uropathy secondary to nasal type NK/T-cell lymphoma relapse: report of two cases
Authors: González-Nava Rosa Irene , Ñamendys-Silva Silvio A , Córdova-Sánchez Bertha M
Published: May 2021

Introduction:

Extranodal natural killer (NK)/T- cell represents only 0.3% of all non-Hodgkin lymphomas in North America and has a higher relative frequency in Southeast Asia and South America. NK/T- cell, nasal type lymphoma usually appears in the nasal cavity, but can also affect soft tissues, skin, gastrointestinal tract, and testes. Besides, most relapses are locoregional. Acute kidney injury (AKI) due to obstructive uropathy, as the initial presentation of relapsing NK/T- cell, nasal type lymphoma, has not been previously described.

Case description:

We present two cases of Mexican women with AKI due to obstructive uropathy caused by a relapsing NK/T-cell, nasal type lymphoma.

Conclusions:

In a patient with a history of NK/T- cell, nasal type lymphoma, presenting with AKI, we should rule out obstructive uropathy caused by a relapsing lymphoma. Relapse should be suspected even in the absence of oliguria and transvaginal bleeding.
Neutrophil extracellular traps and inflammasomes cooperatively promote venous thrombosis in mice
Authors: Campos Joana , Ponomaryov Tatyana , De Prendergast Alexandra , Whitworth Katharine , Smith Christopher W. , Khan Abdullah O. , Kavanagh Dean , Brill Alexander
Published: May 2021

Deep vein thrombosis (DVT) is linked to local inflammation. A role for both neutrophil extracellular traps (NETs) and the assembly of inflammasomes (leading to caspase-1–dependent interleukin-1β activation) in the development of DVT was recently suggested. However, no link between these 2 processes in the setting of thrombosis has been investigated. Here, we demonstrate that stimulation of neutrophils induced simultaneous formation of NETs and active caspase-1. Caspase-1 was largely associated with NETs, suggesting that secreted active caspase-1 requires NETs as an adhesive surface. NETs and their components, histones, promoted robust caspase-1 activation in platelets with the strongest effect exerted by histones 3/4. Murine DVT thrombi contained active caspase-1, which peaked at 6 hours when compared with 48-hour thrombi. Platelets constituted more than one-half of cells containing active caspase-1 in dissociated thrombi. Using intravital microscopy, we identified colocalized NETs and caspase-1 as well as platelet recruitment at the site of thrombosis. Pharmacological inhibition of caspase-1 strongly reduced DVT in mice, and thrombi that still formed contained no citrullinated histone 3, a marker of NETs. Taken together, these data demonstrate a cross-talk between NETs and inflammasomes both in vitro and in the DVT setting. This may be an important mechanism supporting thrombosis in veins.
Mesothelin is a novel cell surface disease marker and potential therapeutic target in acute myeloid leukemia
Authors: Kaeding Allison J. , Barwe Sonali P. , Gopalakrishnapillai Anilkumar , Ries Rhonda E. , Alonzo Todd A. , Gerbing Robert B. , Correnti Colin , Loken Michael R. , Broderson Lisa Eidenschink , Pardo Laura , Le Quy H. , Tang Thao , Leonti Amanda R. , Smith Jenny L. , Chou Cassie K. , Xu Min , Triche Tim , Kornblau Steven M. , Kolb E. Anders , Tarlock Katherine , Meshinchi Soheil
Published: May 2021

In an effort to identify acute myeloid leukemia (AML)-restricted targets for therapeutic development in AML, we analyzed the transcriptomes of 2051 children and young adults with AML and compared the expression profile with normal marrow specimens. This analysis identified a large cohort of AML-restricted genes with high expression in AML, but low to no expression in normal hematopoiesis. Mesothelin (MSLN), a known therapeutic target in solid tumors, was shown to be highly overexpressed in 36% of the AML cohort (range, 5-1077.6 transcripts per million [TPM]) and virtually absent in normal marrow (range, 0.1-10.7 TPM). We verified MSLN transcript expression by quantitative reverse transcription polymerase chain reaction, confirmed cell surface protein expression on leukemic blasts by multidimensional flow cytometry, and demonstrated that MSLN expression was associated with promoter hypomethylation. MSLN was highly expressed in patients with KMT2A rearrangements (P < .001), core-binding factor fusions [inv(16)/t(16;16), P < .001; t(8;21), P < .001], and extramedullary disease (P = .001). We also demonstrated the presence of soluble MSLN in diagnostic serum specimens using an MSLN-directed enzyme-linked immunosorbent assay. In vitro and in vivo preclinical efficacy of the MSLN-directed antibody-drug conjugates (ADCs) anetumab ravtansine and anti-MSLN–DGN462 were evaluated in MSLN+ leukemia cell lines in vitro and in vivo, as well as in patient-derived xenografts. Treatment with ADCs resulted in potent target-dependent cytotoxicity in MSLN+ AML. In this study, we demonstrate that MSLN is expressed in a significant proportion of patients with AML and holds significant promise as a diagnostic and therapeutic target in AML, and that MSLN-directed therapeutic strategies, including ADCs, warrant further clinical investigation.
The value of genomic relationship matrices to estimate levels of inbreeding
Authors: Villanueva Beatriz , Fernández Almudena , Saura María , Caballero Armando , Fernández Jesús , Morales-González Elisabeth , Toro Miguel A. , Pong-Wong Ricardo
Published: May 2021

Background

Genomic relationship matrices are used to obtain genomic inbreeding coefficients. However, there are several methodologies to compute these matrices and there is still an unresolved debate on which one provides the best estimate of inbreeding. In this study, we investigated measures of inbreeding obtained from five genomic matrices, including the Nejati-Javaremi allelic relationship matrix (FNEJ), the Li and Horvitz matrix based on excess of homozygosity (FL&H), and the VanRaden (methods 1, FVR1, and 2, FVR2) and Yang (FYAN) genomic relationship matrices. We derived expectations for each inbreeding coefficient, assuming a single locus model, and used these expectations to explain the patterns of the coefficients that were computed from thousands of single nucleotide polymorphism genotypes in a population of Iberian pigs.

Results

Except for FNEJ, the evaluated measures of inbreeding do not match with the original definitions of inbreeding coefficient of Wright (correlation) or Malécot (probability). When inbreeding coefficients are interpreted as indicators of variability (heterozygosity) that was gained or lost relative to a base population, both FNEJ and FL&H led to sensible results but this was not the case for FVR1, FVR2 and FYAN. When variability has increased relative to the base, FVR1, FVR2 and FYAN can indicate that it decreased. In fact, based on FYAN, variability is not expected to increase. When variability has decreased, FVR1 and FVR2 can indicate that it has increased. Finally, these three coefficients can indicate that more variability than that present in the base population can be lost, which is also unreasonable. The patterns for these coefficients observed in the pig population were very different, following the derived expectations. As a consequence, the rate of inbreeding depression estimated based on these inbreeding coefficients differed not only in magnitude but also in sign.

Conclusions

Genomic inbreeding coefficients obtained from the diagonal elements of genomic matrices can lead to inconsistent results in terms of gain and loss of genetic variability and inbreeding depression estimates, and thus to misleading interpretations. Although these matrices have proven to be very efficient in increasing the accuracy of genomic predictions, they do not always provide a useful measure of inbreeding.
Untrained birds’ ability to recognise predators with changed body size and colouration in a field experiment
Authors: Antonová Kateřina , Veselý Petr , Fuchs Roman
Published: May 2021

Background

During recognition process, multiple parameters of the encountered stimulus may play a role. Previous studies with wild birds identified the importance of several salient features (e.g., eyes, beak, prominent elements of colouration) which birds use to recognise other bird species, such as predators or nest parasites. In the present study, we observed the responses of passerines visiting winter feeders to stimuli in the form of dummies of Eurasian sparrowhawk which were modified in body size and/or colouration but always carried the salient features of raptors (hooked beak, talons) and one species-specific feature of the sparrowhawk (yellow eyes). In the vicinity of a feeder, we placed a dummy of an unmodified sparrowhawk, life-sized sparrowhawk with pigeon, great tit, or robin colouration, a small, great tit-sized sparrowhawk dummy with unmodified or pigeon colouration, or an unmodified pigeon dummy, which functioned as a harmless control. Then we measured how it affected the number of visits.

Results

We found that birds were less afraid of small dummies regardless of their colouration than they were of life-sized raptor dummies or even the pigeon dummy. This contrasts with the results of a previous laboratory experiment where great tits’ reaction to small dummies was comparably fearful to their response to life-size dummies. In our experiment, birds were also not afraid of life-sized dummies with modified colouration except for a robin-coloured dummy, which caused an equally significant fear reaction as an unmodified sparrowhawk dummy. It is likely that this dummy resembled the colouration of a male sparrowhawk closely enough to cause this effect.

Conclusions

Based on our observations, we conclude that birds use contextual features to evaluate the size of other birds. Distance and familiar reference points seem to play an important part in this process.
Management of prosthetic joint infections in France: a national audit to identify key situations requiring innovation and homogenization
Authors: Le Maréchal Marion , Cavalli Zoé , Batailler Cécile , Gonzalez Jean-François , Ferreira André , Lustig Sébastien , Ferry Tristan , Courjon Johan
Published: May 2021

Background

Prosthetic joint infections (PJI) are one of the most serious complication of arthroplasty. The management of PJI needs a multidisciplinary collaboration between orthopaedic surgeon, infectious disease specialist and microbiologist. In France, the management of PJI is organized around reference centres (CRIOACs). Our main objective was to perform an audit through a questionnaire survey based on clinical cases, to evaluate how French physicians manage PJI. Eligible participants were all physicians involved in care of patients presenting a PJI. Physicians could answer individually, or collectively during a multidisciplinary team meeting dedicated to PJI. The survey consisted as three questionnaires organized in a total of six clinical cases.

Results

Answers from the CRIOACs to the three questionnaires were 92, 77, and 53%. Between 32 and 39% of respondents did not administer antibiotic prophylaxis despite positive S. aureus pre-operative documentation. One-stage exchange strategy was widely preferred in all clinical cases, with no difference between CRIOACs and other centres. Rifampicin was prescribed for S. aureus PJI, in a situation with (90–92%) or without any prosthesis (70%). There was no consensus for the total antibiotic regimen duration, with prescriptions from six to 12 weeks for a majority of respondents.

Conclusions

Surgical strategy for the management of PJI was homogenous with a preference for a one-stage exchange strategy. Medical management was more heterogenous, which reflects the heterogeneity of those infections and difficulties to perform studies with strong conclusions.
Struma ovarii and peritoneal strumosis during pregnancy
Authors: Li Zheng , Wang Jingxue , Chen Qian
Published: May 2021

Background

Struma ovarii is a special type of ovarian dermoid cyst and accounts for approximately 2–3 % of all dermoid tumours. Benign struma ovarii may manifest as distant metastasis, called peritoneal strumosis, which makes it biologically similar to malignancy, and has been reported in limited cases but never discovered during pregnancy.

Case presentation

We report a patient with a history of right struma ovarii cystectomy. During pregnancy, pelvic masses with non-specific clinical presentation were found again. During the caesarean section, contralateral struma ovarii with dissemination of nodules in the peritoneal cavity was found, and pathology revealed that the masses were thyroid follicle ovarian goitres.

Discussion and conclusions

Recurrent benign struma ovarii with extraovarian dissemination is a rare aggressive clinical manifestation different from malignancy. It is emphasized that adequate assessment and complete resection of suspicious masses are of great importance.
Temporal trends in annual incidence rates for psychiatric disorders and self-harm among children and adolescents in the UK, 2003–2018
Authors: Cybulski Lukasz , Ashcroft Darren M. , Carr Matthew J. , Garg Shruti , Chew-Graham Carolyn A. , Kapur Nav , Webb Roger T.
Published: May 2021

Background

There has been growing concern in the UK over recent years that a perceived mental health crisis is affecting children and adolescents, although published epidemiological evidence is limited.

Methods

Two population-based UK primary care cohorts were delineated in the Aurum and GOLD datasets of the Clinical Practice Research Datalink (CPRD). We included data from 9,133,246 individuals aged 1–20 who contributed 117,682,651 person-years of observation time. Sex- and age-stratified annual incidence rates were estimated for attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) (age groups: 1–5, 6–9, 10–12, 13–16, 17–19), depression, anxiety disorders (6–9, 10–12, 13–16, 17–19), eating disorders and self-harm (10–12, 13–16, 17–19) during 2003–2018. We fitted negative binomial regressions to estimate incidence rate ratios (IRRs) to examine change in incidence between the first (2003) and final year (2018) year of observation and to examine sex-specific incidence.

Results

The results indicated that the overall incidence has increased substantially in both boys and girls in between 2003 and 2018 for anxiety disorders (IRR 3.51 95% CI 3.18–3.89), depression (2.37; 2.03–2.77), ASD (2.36; 1.72–3.26), ADHD (2.3; 1.73–3.25), and self-harm (2.25; 1.82–2.79). The incidence for eating disorders also increased (IRR 1.3 95% CI 1.06–1.61), but less sharply. The incidence of anxiety disorders, depression, self-harm and eating disorders was in absolute terms higher in girls, whereas the opposite was true for the incidence of ADHD and ASD, which were higher among boys. The largest relative increases in incidence were observed for neurodevelopmental disorders, particularly among girls diagnosed with ADHD or ASD. However, in absolute terms, the incidence was much higher for depression and anxiety disorders.

Conclusion

The number of young people seeking help for psychological distress appears to have increased in recent years. Changes to diagnostic criteria, reduced stigma, and increased awareness may partly explain our results, but we cannot rule out true increases in incidence occurring in the population. Whatever the explanation, the marked rise in demand for healthcare services means that it may be more challenging for affected young people to promptly access the care and support that they need.
Changes in physical activity and rest-activity circadian rhythm among Hong Kong community aged population before and during COVID-19
Authors: LEE Priscilla Ming Yi , Huang Bixia , Liao Gengze , Chan Chi Kuen , Tai Lai-bun , Tsang Chun Yuk Jason , Leung Chi Chiu , Kwan Mei-Po , Tse Lap Ah.
Published: May 2021

Background

This study aims to determine the changes in physical activity and actigraphy-measured rest-activity circadian rhythm among Hong Kong community aged population before and during the outbreak of COVID-19.

Methods

This is a three repeated measure population-based cross-sectional study. We recruited community older men aged > 60 years in three periods of the COVID-19 outbreak in Hong Kong, i.e., before the COVID-19 outbreak (2 July 2019–8 January 2020), between the 2nd and 3rd waves of COVID-19 (23 June 2020–9 July 2020), and during the 3rd wave of COVID-19 (15 September 2020–29 September 2020). Participants reported detailed information on their physical activity habits using the International Physical Activity Questionnaire and wore actigraphs continuously for 7 days (168 h). The actigraph data were then transferred to four rest-activity circadian rhythm parameters: midline statistic of rhythm (MESOR), amplitude, acrophase and percent rhythm. Multivariate logistic regression was performed to estimate the association of period effect of COVID-19 on physical activity and rest-activity circadian rhythm parameters.

Results

Among the 242 community older men, 106 (43.8%) of them were recruited before the COVID-19 outbreak, 66 (27.3%) were recruited between the 2nd and 3rd waves of COVID-19, and 70 (28.9%) were recruited during the late phase of the 3rd wave of COVID-19. Compared with those recruited before COVID-19, participants recruited between the 2nd and 3rd waves of COVID-19 had lower physical activity (adjusted odds ratio (AOR) = 2.03, 95% confidence interval (95%CI) =1.05–3.93), MESOR (AOR = 2.05, 95%CI = 1.01–4.18), and amplitude (AOR = 1.91, 95%CI = 0.95–3.83). There was no difference in physical activity or circadian rhythm parameters between subjects recruited before and during the late phase of the 3rd wave.

Conclusions

This study found that the effect of COVID-19 on physical activity and rest-activity circadian rhythm for the community people may be short-term, indicating strong resilience of the community population. Although maintaining physical activity are encouraged for the older adults to sustain good health, a rebound in their physical activity may be a sign for the next wave of outbreak if insufficient social distancing and population protection are facilitated.
Economic abuse and its associations with symptoms of common mental disorders among women in a cross-sectional survey in informal settlements in Mumbai, India
Authors: Kanougiya Suman , Daruwalla Nayreen , Gram Lu , Gupta Apoorwa Deepak , Sivakami Muthusamy , Osrin David
Published: May 2021

Background

Domestic violence takes a range of interconnected forms, of which economic abuse is common, but less studied than others. We examine the prevalence of economic abuse, its determinants, and its association with symptoms of depression, anxiety, and suicidal ideation.

Methods

Our cross-sectional survey in informal settlement areas in Mumbai, India, asked women aged 18–49 years 15 questions about acquisition, use, and maintenance of economic resources, demographic and socioeconomic factors, and physical, sexual, and emotional violence. We administered the Patient Health Questionnaire 9 (PHQ-9) and Generalised Anxiety Disorder 7 (GAD-7) scales and asked about suicidal thinking. Determinants of economic abuse and its associations with positive screens for depression and anxiety were explored in univariable and multivariable logistic regression models.

Results

Of 4906 ever-married women respondents, 23% reported at least one form of economic abuse by either an intimate partner or another family member. The commonest were denial of property rights (10%), not being trusted with money (8%), and coercive appropriation of belongings (7%). Economic abuse was more commonly reported by widowed, separated, or divorced women than by married women (aOR 12.4; 95% CI 6.4, 24.1), and when their partners used alcohol or drugs (aOR 1.4; 95% CI 1.2–1.7). Women had greater odds of reporting economic abuse if they had suffered emotional (aOR 6.3; 95% CI 5.0–7.9), physical (aOR 1.9; 95% CI 1.4–2.6), or sexual violence (aOR 5.4; 95% CI 3.6–8.1) in the preceding 12 months. Economic abuse was independently associated with positive screens for moderate-severe depression (aOR 2.6; 95% CI 2.0–3.4), anxiety (aOR 2.7; 95% CI 1.9–3.8), and suicidal ideation (aOR 2.2; 95% CI 1.5–3.1). The odds of anxiety and depression increased with each additional form of economic abuse.

Discussion

To our knowledge, this is the first community-based study in India of the prevalence of economic abuse and its associations with symptoms of common mental disorders. It provides empirical support for the idea that economic abuse is at least as harmful to women’s mental health as physical violence. Surveys should include questions on economic abuse and prevention and intervention strategies need to help survivors to understand its forms.
Knowledge, health beliefs and attitudes towards dementia and dementia risk reduction among the Dutch general population: a cross-sectional study
Authors: Vrijsen J. , Matulessij T. F. , Joxhorst T. , de Rooij S. E. , Smidt N.
Published: May 2021

Background

Positive health beliefs and attitudes towards dementia and dementia risk reduction may encourage adopting a healthy behaviour. Therefore, we aimed to investigate the knowledge, health beliefs and attitudes towards dementia and dementia risk reduction among the Dutch general population and its association with the intention to change health behaviours.

Methods

A random sample of Dutch residents (30 to 80 years) was invited to complete an online survey. We collected data on knowledge, health beliefs and attitudes towards dementia (risk reduction) and the intention to change health behaviours. Multivariable logistic regression analyses were used to obtain effect estimates.

Results

Six hundred fifty-five participants completed the survey. In general, participants had insufficient knowledge about dementia and dementia risk reduction. Participants had relatively high scores on general health motivation and perceived benefits, but low scores on perceived susceptibility, perceived severity, perceived barriers, cues to action and self-efficacy. Individuals with higher scores on perceived benefits and cues to action had more often the intention to change their behaviour with regard to physical activity (OR = 1.33, 95%-CI:1.11–1.58; OR = 1.13, 95%-CI:1.03–1.24, respectively) and alcohol consumption (OR = 1.30, 95%-CI:1.00–1.69; OR = 1.17, 95%-CI:1.02–1.35, respectively). Younger excessive alcohol consumers with higher perceived severity scores had more often the intention to change their alcohol consumption behaviour (OR = 2.70, 95%-CI:1.04–6.97) compared to older excessive alcohol consumers. Opposite results were found for middle-aged excessive alcohol consumers (OR = 0.81, 95%-CI:0.67–0.99). Individuals who perceived more barriers had more often the intention to change their diet (OR = 1.10, 95%-CI:1.01–1.21), but less often the intention to change their smoking behaviour (OR = 0.78, 95%-CI:0.63–0.98). Moreover, less educated individuals with higher perceived benefits scores had less often the intention to change their diet (OR = 0.78, 95%-CI:0.60–0.99), while highly educated individuals with higher perceived benefits scores had more often the intention to change their diet (OR = 1.41, 95%-CI:1.12–1.78).

Conclusions

The knowledge, beliefs and attitudes towards dementia and dementia risk reduction among the Dutch general population is insufficient to support dementia risk reduction. More education about dementia and dementia risk reduction is needed to improve health beliefs and attitudes towards dementia and dementia risk reduction in order to change health behaviour.
Risk factors associated with cervical spine lesions in patients with rheumatoid arthritis: an observational study
Authors: Uchino Yosuke , Higashi Takayuki , Kobayashi Naomi , Inoue Tetsuhiko , Mochida Yuichi , Inaba Yutaka
Published: May 2021

Background

Few reports have described the association between rheumatoid arthritis (RA) cervical lesions and osteoporosis, especially in patients with vertical subluxation (VS) that could be induced by the collapse of lateral masses in the upper cervical spine. Therefore, this study aimed to investigate the prevalence and risk factors for cervical lesions in patients with RA under current pharmacological treatments with biological agents, and to investigate the relationship between osteoporosis and VS development.

Methods

One hundred eighty-five consecutive patients with RA who underwent both cervical plain radiography and bone mineral density (BMD) scanning were enrolled. RA cervical lesions included atlantoaxial subluxation (AAS), VS, and subaxial subluxation (SAS). We assigned patients with AAS, VS, or SAS to the cervical-lesion group, and all other patients to the non-cervical-lesion group. Radiological findings, BMD, and clinical data on RA were collected. We used multivariate logistic regression analyses to assess the risk factors for cervical lesions in patients with RA.

Results

The cervical-lesion and non-cervical-lesion groups included 106 and 79 patients, respectively. There were 79 patients with AAS, 31 with VS, and 41 with SAS. The cervical-lesion group had a younger age of RA onset, longer RA disease duration, higher RA stage, and lower femoral neck BMD than the non-cervical-lesion group. Multivariate analyses showed that the risk factors for RA cervical lesions were prednisolone usage, biological agent usage, and higher RA stage. Prednisolone usage and femoral neck BMD were the risk factors for VS.

Conclusions

Cervical lesions were confirmed in 57 % of the patients. Prednisolone usage, biological agent usage, and higher RA stage were significant risk factors for cervical lesions in patients with RA. The general status of osteoporosis might contribute to the development of VS.
Effectiveness of brushing teeth in patients with reduced oral hygiene by laypeople: a randomized, controlled study
Authors: Barbe Anna Greta , Al-Barwari Aya , Hamacher Stefanie , Deinzer Renate , Weik Ulrike , Noack Michael J.
Published: May 2021

Background

To evaluate the success of plaque reduction after external toothbrushing by instructed laypeople versus dental professionals using either a manual or powered toothbrush. Longitudinal, randomized, parallel-group intervention study in periodontitis patients with reduced oral hygiene quality undergoing anti-infective therapy. Patients were randomly and equally assigned to one of four groups: laypeople using a manual or powered toothbrush or dental professionals using a manual or powered toothbrush. Plaque reduction (Quigley–Hein-Index (QHI), Marginal Plaque Index (MPI)), gingivitis (papilla bleeding index), and cleaning time (seconds) were investigated.

Results

Thirty-nine patients participated in the study. Neither the choice of toothbrush (p = 0.399) nor the use of a dental professional (p = 0.790) had a significant influence on plaque levels achieved. However, multivariate modeling indicated statistically significant differences in the external cleaning time between brushing groups, with longer time required by laypeople (p = 0.002) and longer use of the powered toothbrush (p = 0.024).

Conclusion

When the ability to carry out personal oral hygiene is reduced, external brushing by dental professionals or instructed laypeople who meet previously defined criteria such as sufficient personal oral hygiene at home could help to fill the emerging dental care gap. A combination of oral hygiene approaches adapted to the individual needs of the patients in need of external help is necessary for optimum oral hygiene.

Trial registration: German Clinical Trials register (https://www.germanctr.de; number DRKS00018779; date of registration 04/11/2019).
Implicit gender-career bias in postgraduate medical training still exists, mainly in residents and in females
Authors: Kramer Maud , Heyligers Ide C. , Könings Karen D.
Published: May 2021

Background

More and more female residents enter postgraduate medical training (PGMT). Meanwhile, women are still underrepresented in academic medicine, in leadership positions and in most surgical specialties. This suggests that female residents’ career development may still be negatively impacted by subtle, often unconscious stereotype associations regarding gender and career-ambition, called implicit gender-career bias. This study explored the existence and strength of implicit gender-career bias in doctors who currently work in PGMT, i.e. in attending physicians who act as clinical trainers and in their residents.

Methods

We tested implicit gender-career bias in doctors working in PGMT by means of an online questionnaire and an online Implicit Association Test (IAT). We used standard IAT analysis to calculate participants’ IAT D scores, which indicate the direction and strength of bias. Linear regression analyses were used to test whether the strength of bias was related to gender, position (resident or clinical trainer) or specialty (non-surgical or surgical specialty).

Results

The mean IAT D score among 403 participants significantly differed from zero (D-score = 0.36 (SD = 0.39), indicating bias associating male with career and female with family. Stronger gender-career bias was found in women (βfemale =0 .11; CI 0.02; 0.19; p = 0.01) and in residents (βresident 0.12; CI 0.01; 0.23; p = 0.03).

Conclusions

This study may provide a solid basis for explicitly addressing implicit gender-career bias in PGMT. The general understanding in the medical field is that gender bias is strongest among male doctors’ in male-dominated surgical specialties. Contrary to this view, this study demonstrated that the strongest bias is held by females themselves and by residents, independently of their specialty. Apparently, the influx of female doctors in the medical field has not yet reduced implicit gender-career bias in the next generation of doctors, i.e. in today’s residents, and in females.
Factors affecting the performance of brain arteriovenous malformation rupture prediction models
Authors: Tao Wengui , Yan Langchao , Zeng Ming , Chen Fenghua
Published: May 2021

Background

In many cases, both the rupture rate of cerebral arteriovenous malformation (bAVM) in patients and the risk of endovascular or surgical treatment (when radiosurgery is not appropriate) are not low, it is important to assess the risk of rupture more cautiously before treatment. Based on the current high-risk predictors and clinical data, different sample sizes, sampling times and algorithms were used to build prediction models for the risk of hemorrhage in bAVM, and the accuracy and stability of the models were investigated. Our purpose was to remind researchers that there may be some pitfalls in developing similar prediction models.

Methods

The clinical data of 353 patients with bAVMs were collected. During the creation of prediction models for bAVM rupture, we changed the ratio of the training dataset to the test dataset, increased the number of sampling times, and built models for predicting bAVM rupture by the logistic regression (LR) algorithm and random forest (RF) algorithm. The area under the curve (AUC) was used to evaluate the predictive performances of those models.

Results

The performances of the prediction models built by both algorithms were not ideal (AUCs: 0.7 or less). The AUCs from the models built by the LR algorithm with different sample sizes were better than those built by the RF algorithm (0.70 vs 0.68, p < 0.001). The standard deviations (SDs) of the AUCs from both prediction models with different sample sizes displayed wide ranges (max range > 0.1).

Conclusions

Based on the current risk predictors, it may be difficult to build a stable and accurate prediction model for the hemorrhagic risk of bAVMs. Compared with sample size and algorithms, meaningful predictors are more important in establishing an accurate and stable prediction model.
Commissioner, clinician, and patient experiences of a pre‐surgical health optimisation programme – a qualitative study
Authors: McLaughlin Joanna , Palmer Cecily , Redwood Sabi , Kipping Ruth , Owens Lucie , Reynolds Rebecca , Scott Lauren J , Hill Elizabeth M , Donovan Jenny L , Jago Russell , Owen-Smith Amanda
Published: May 2021

Background

Health optimisation programmes are an increasingly popular policy intervention that aim to support patients to lose weight or stop smoking ahead of surgery. There is little evidence about their impact and the experience of their use. The aim of this study was to investigate the experiences and perspectives of commissioners, clinicians and patients involved in a locality’s health optimisation programme in the United Kingdom. The programme alters access to elective orthopaedic surgery for patients who smoke or are obese (body mass index ≥ 30 kg/m2), diverting them to a 12-week programme of behavioural change interventions prior to assessment for surgical referral.

Methods

A thematic analysis of semi-structured interviews (n = 20) with National Health Service and Local Authority commissioners and planners, healthcare professionals, and patients using the pathway.

Results

Health optimisation was broadly acceptable to professionals and patients in our sample and offered a chance to trigger both short term pre-surgical weight loss/smoking cessation and longer-term sustained changes to lifestyle intentions post-surgery. Communicating the nature and purpose of the programme to patients was challenging and consequently the quality of the explanation received and understanding gained by patients was generally low. Insight into the successful implementation of health optimisation for the hip and knee pathway, but failure in roll-out to other surgical specialities, suggests placement of health optimisation interventions into the ‘usual waiting time’ for surgical referral may be of greatest acceptability to professionals and patients.

Conclusions

Patients and professionals supported the continuation of health optimisation in this context and recognised likely health and wellbeing benefits for a majority of patients. However, the clinicians’ communication to patients about health optimisation needs to improve to prepare patients and optimise their engagement.
Intrauterine midgut volvulus as a rare cause of intestinal obstruction: a case report
Authors: Gerçel Gonca , Anadolulu Ali İhsan
Published: May 2021

Background

Intrauterine midgut volvulus is a very rare, life-threatening condition, and prenatal diagnosis is difficult. In this article, we present a case of midgut volvulus followed by a pre-diagnosis of antenatal jejunal atresia.

Case presentation

A 1-day-old Turkish male baby, who was followed with a diagnosis of antenatal jejunal atresia, with a birth weight of 3600 g, delivered by cesarean section at 38 weeks of gestation from a 19-year-old mother in her fourth pregnancy, was taken to the newborn intensive care unit. The patient underwent surgery on the postnatal first day with a preliminary diagnosis of jejunal atresia. It was observed that the small intestine was rotated two full cycles from the mesenteric root. Bowel blood circulation was good. Volvulus was untwisted. There was malrotation. Ladd's procedure was performed. The baby was discharged on the seventh postoperative day with full oral feeding. The patient is still in the first postoperative year and follow-up has been uneventful.

Conclusion

Intrauterine midgut volvulus has been associated with high mortality in the literature. Differential diagnosis of midgut volvulus in patients with antenatal intestinal obstruction, close prenatal follow-up, appropriate delivery and timing of surgical intervention may significantly reduce morbidity and mortality.
Bilateral secondary testicular, epididymal and spermatic cords carcinoma of prostatic origin: a case report and review of the literature
Authors: Olorunsola Ifeoluwa S. , Etonyeaku Amarachukwu C. , Lekwa Blessing O. , Ojo Olusegun S.
Published: May 2021

Background

Prostatic carcinoma is emerging as the most common male malignancy in Nigeria and the second most common male cancer worldwide. Patients often present with locally advances stages, and common sites of metastasis are the spine, pelvis, chest, and long bones. Metastases to the testes and spermatic cords are reputed to be rare and may be indicative of a worse outcome, when they occur. We recently encountered a clinical case of bilateral testicular, epididymal and spermatic cords prostatic cancer metastases.

Case presentation

A 71-year-old Nigerian man, who presented at our hospital with 1-month-old complaints of inability to walk together with low back and bilateral thigh pains. This presentation had been preceded by a 5-month history of lower urinary tract symptoms. On examination, the prostate was hard and nodular as were the left testis and spermatic cord. On histological assessment of a needle biopsy, prostatic adenocarcinoma (Gleason score 5 + 5 = 10) was diagnosed. A subsequent therapeutic bilateral total orchidectomy specimen was found to contain metastatic prostatic carcinoma deposits, in the testes, epididymides, and spermatic cords. Although our patient is currently doing well postoperatively on zoledronic acid, ketoconazole, bicalutamide, and tamsulosin, he is being re-evaluated periodically for any feature of recurrence.

Conclusion

Since it has implications for eventual outcome, every clinically suspicious therapeutic orchidectomy specimen should be subjected to a detailed histopathological examination in order to exclude secondaries from the primary prostatic malignancy.
Comparison of one versus two maxillary molars distalization with iPanda: a finite element analysis
Authors: Sujaritwanid Kamontip , Suzuki Boonsiva , Suzuki Eduardo Yugo
Published: May 2021

Background

The purpose of this study was to compare the stress distribution and displacement patterns of the one versus two maxillary molars distalization with iPanda and to evaluate the biomechanical effect of distalization on the iPanda using the finite element method.

Methods

The finite element models of a maxillary arch with complete dentition, periodontal ligament, palatal and alveolar bone, and an iPanda connected to a pair of midpalatal miniscrews were created. Two models were created to simulate maxillary molar distalization. In the first model, the iPanda was connected to the second molar to simulate a single molar distalization. In the second model, the iPanda was connected to the first molar to simulate “en-masse” first and second molar distalization. A varying force from 50 to 200 g was applied. The stress distribution and displacement patterns were analyzed.

Results

For one molar, the stress was concentrated at the furcation and along the distal surface in all roots with a large amount of distalization and distobuccal crown tipping. For two molars, the stress in the first molar was 10 times higher than in the second molar with a great tendency for buccal tipping and a minimal amount of distalization. Moreover, the stress concentration on the distal miniscrew was six times higher than in the mesial miniscrew with an extrusive and intrusive vector, respectively.

Conclusions

Individual molar distalization provides the most effective stress distribution and displacement patterns with reduced force levels. In contrast, the en-masse distalization of two molars results in increased force levels with undesirable effects in the transverse and vertical direction.
School-level inequality measurement based categorical data: a novel approach applied to PISA
Authors: Sempé Lucas
Published: May 2021

This paper introduces a new method to measure school-level inequality based on Item Response Theory (IRT) models. Categorical data collected by large-scale assessments poses diverse methodological challenges hinder measuring inequality due to data truncation and asymmetric intervals between categories. I use family possessions data from PISA 2015 to exemplify the process of computing the measurement and develop a set of country-level mixed-effects linear regression models comparing the predictive performance of the novel inequality measure with school-level Gini coefficients. I find school-level inequality is negatively associated with learning outcomes across many non-European countries.
Public and private sectors collective response to combat COVID-19 in Malaysia
Authors: Tan Ching Siang , Lokman Saim , Rao Yao , Kok Szu Hua , Ming Long Chiau
Published: May 2021

Over the last year, the dangerous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly around the world. Malaysia has not been excluded from this COVID-19 pandemic. The resurgence of COVID-19 cases has overwhelmed the public healthcare system and overloaded the healthcare resources. Ministry of Health (MOH) Malaysia has adopted an Emergency Ordinance (EO) to instruct private hospitals to receive both COVID-19 and non-COVID-19 patients to reduce the strain on public facilities. The treatment of COVID-19 patients at private hospitals could help to boost the bed and critical care occupancy. However, with the absence of insurance coverage because COVID-19 is categorised as pandemic-related diseases, there are some challenges and opportunities posed by the treatment fees management. Another major issue in the collaboration between public and private hospitals is the willingness of private medical consultants to participate in the management of COVID-19 patients, because medical consultants in private hospitals in Malaysia are not hospital employees, but what are termed “private contractors” who provide patient care services to the hospitals. Other collaborative measures with private healthcare providers, e.g. tele-conferencing by private medical clinics to monitor COVID-19 patients and the rollout of national vaccination programme. The public and private healthcare partnership must be enhanced, and continue to find effective ways to collaborate further to combat the pandemic. The MOH, private healthcare sectors and insurance providers need to have a synergistic COVID-19 treatment plans to ensure public as well as insurance policy holders have equal opportunities for COVID-19 screening tests, vaccinations and treatment.
The Advancing Understanding of Transportation Options (AUTO) study: design and methods of a multi-center study of decision aid for older drivers
Authors:   on behalf of the AUTO Research Team, Betz Marian E. , Omeragic Faris , Meador Lauren , DiGuiseppi Carolyn G. , Fowler Nicole R. , Han S. Duke , Hill Linda , Johnson Rachel L. , Knoepke Christopher E. , Matlock Daniel D. , Moran Ryan
Published: May 2021

Background

Decision-making about when to stop driving for older adults involves assessment of driving risk, availability of support or resources, and strong emotions about loss of independence. Although the risk of being involved in a fatal crash increases with age, driving cessation can negatively impact an older adult’s health and well-being. Decision aids can enhance the decision-making process by increasing knowledge of the risks and benefits of driving cessation and improve decision quality. The impact of decision aids regarding driving cessation for older adults is unknown.

Methods

The Advancing Understanding of Transportation Options (AUTO) study is a multi-site, two-armed randomized controlled trial that will test the impact of a decision aid on older adults’ decisions about changes in driving behaviors and cessation. AUTO will enroll 300 drivers age ≥ 70 years with a study partner (identified by each driver); the dyads will be randomized into two groups (n = 150/group). The decision aid group will view the web-based decision aid created by Healthwise at baseline and the control group will review information about driving that does not include evidence-based elements on risks and benefits and values clarification about driving decisions. The AUTO trial will compare the effect of the decision aid, versus control, on a) immediate decision quality (measured by the Decisional Conflict Scale; primary outcome); b) longitudinal psychosocial outcomes at 12 and 24 months (secondary outcomes); and c) longitudinal driving behaviors (including reduction or cessation) at 12 and 24 months (secondary outcomes). Planned stratified analyses will examine the effects in subgroups defined by cognitive function, decisional capacity, and readiness to stop driving.

Discussion

The AUTO study is the first large-scale randomized trial of a driving decision aid for older adults. Results from this study will directly inform clinical practice about how best to support older adults in decision-making about driving.

Trial registration

ClinicalTrials.gov: NCT04141891. Registered on October 28, 2019. Located at https://clinicaltrials.gov/ct2/show/NCT04141891