bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability and validity of a quick test of cognitive speed (AQT) in screening for mild cognitive impairment and dementia
Authors: Afshar Pouya Farokhnezhad , Wiig Elisabeth H. , Malakouti Seyed Kazem , Shariati Behnam , Nejati Sara
Published: December 2021

Background

Cognitive disorders are one of the important issues in old age. There are many cognitive tests, but some variables affect their results (e.g., age and education). This study aimed to evaluate the reliability and validity of A Quick Test of Cognitive Speed (AQT) in screening for mild cognitive impairment (MCI) and dementia.

Methods

This is a psychometric properties study. 115 older adults participated in the study and were divided into three groups (46 with MCI, 24 with dementia, and 45 control) based on the diagnosis of two geriatric psychiatrists. Participants were assessed by AQT and Mini-Mental State Examination (MMSE). Data were analyzed using Pearson correlation, independent t-test, and ROC curve by SPSS v.23.

Results

There was no significant correlation between AQT subscales and age and no significant difference between the AQT subscales in sex, educational levels. The test-retest correlations ranges were 0.84 from 097. Concurrent validity was significant between MMSE and AQT. Its correlation was with Color − 0.78, Form − 0.71, and Color-Form − 0.72. The cut-off point for Color was 43.50 s, Form 52 s, and Color-Form 89 s were based on sensitivity and specificity for differentiating older patients with MCI with controls. The cut-off point for Color was 62.50 s, for Form 111 s, and Color-Form 197.50 s based on sensitivity and specificity measures for differentiating older patients with dementia and MCI.

Conclusion

The findings showed that AQT is a suitable tool for screening cognitive function in older adults.
Discharge after hip fracture surgery in relation to mobilisation timing by patient characteristics: linked secondary analysis of the UK National Hip Fracture Database
Authors: Sheehan Katie J. , Goubar Aicha , Martin Finbarr C. , Potter Chris , Jones Gareth D. , Sackley Catherine , Ayis Salma
Published: December 2021

Background

Early mobilisation leads to a two-fold increase in the adjusted odds of discharge by 30-days compared to late mobilisation. Whether this association varies by patient characteristics identified as reasons for delayed mobilisation is unknown.

Methods

Audit data was linked to hospitalisation records for 133,319 patients 60 years or older surgically treated for hip fracture in England or Wales between 2014 and 2016. Adjusted proportional odds regression models tested whether the cumulative incidences of discharge differed between those mobilised early and those mobilised late for subgroups defined by dementia, delirium, hypotension, prefracture ambulation, and prefracture residence, accounting for the competing risk of death.

Results

Overall, 34,253 patients presented with dementia, 9818 with delirium, and 10,123 with hypotension. Prefracture, 100,983 were ambulant outdoors, 30,834 were ambulant indoors only, 107,144 were admitted from home, and 23,588 from residential care. 1502 had incomplete data for ambulation and 2587 for prefracture residence. 10, 8, 8, 12, and 12% fewer patients with dementia, delirium, hypotension, ambulant indoors only prefracture, or admitted from residential care mobilised early when compared to those who presented without dementia, delirium, hypotension, with outdoor ambulation prefracture, or admitted from home. The adjusted odds ratios of discharge by 30-days postoperatively among those who mobilised early compared with those who mobilised late were 1.71 (95% CI 1.62–1.81) for those with dementia, 2.06 (95% CI 1.98–2.15) without dementia, 1.56 (95% CI 1.41–1.73) with delirium, 2.00 (95% CI 1.93–2.07) without delirium, 1.83 (95% CI, 1.66–2.02) with hypotension, 1.95 (95% CI, 1.89–2.02) without hypotension, 2.00 (95% CI 1.92–2.08) with outdoor ambulation prefracture, 1.80 (95% CI 1.70–1.91) with indoor ambulation only prefracture, 2.30 (95% CI 2.19–2.41) admitted from home, and 1.64 (95% CI 1.51–1.77) admitted from residential care, accounting for the competing risk of death.

Conclusion

Irrespective of dementia, delirium, hypotension, prefracture ambulation or residence, early compared to late mobilisation increased the likelihood of hospital discharge by 30-days postoperatively. However, fewer patients with dementia, delirium, or hypotension, poorer prefracture ambulation, or from residential care mobilised early. There is a need reduce this care gap by ensuring sufficient resource to enable all patients to benefit from early mobilisation.
Older adults who receive homecare are at increased risk of readmission and mortality following a short ED admission: a nationally register-based cohort study
Authors: Elkjær Mette , Wolff Donna Lykke , Primdahl Jette , Mogensen Christian Backer , Brabrand Mikkel , Gram Bibi
Published: December 2021

Background

Older adults admitted to an emergency department (ED) who are dependent on homecare may be especially challenged with respect to readmission and mortality. This study aimed to assess whether receiving homecare prior admission was associated with readmission or mortality within 30 days of a short ED admission and to explore whether the amount of homecare received was associated with an increased risk of readmission or mortality.

Methods

This nationwide register-based cohort study included patients aged 65 or above who were admitted to an ED at any Danish hospital from 1 December 2016 to 30 November 2017 and discharged within 48 h. Data were extracted from national registers through Statistics Denmark. Homecare was categorized into groups; patients without homecare and three groups according to the amount of homecare received per week. Logistic regression analyses were used to explore the association between the four homecare groups and outcomes, readmissions and mortality.

Results

In total, 80,517 patients (51% female, median age 75 years) were included in the study. Overall, 64,886 patients without homecare, 15,631 (19%) patients received homecare (64% female, median age 83 years), of which 4938 patients received homecare ≤30 min, 4033 received > 30 min to ≤120 min and 6660 received > 120 min per week. The risk of readmission and mortality increased concurrently with the minutes of homecare received: Patients receiving homecare > 120 min per week had the highest odds ratios (ORs) for readmission within 30 days (OR 1.8 95% CI: 1.7–1.9) and mortality within 30 days (OR 4.5 95% CI: 4.1–4.9) compared with patients without homecare.

Conclusion

Receiving homecare was associated with an increased risk of readmission and death following a short ED admission. Collaboration between the ED and primary health care sector in relation to rehabilitation and end-of-life care is essential to improve quality of care for older adults who receive homecare, particularly those receiving homecare > 2 h a week, because of their increased risk of readmission and mortality.
Effects of physician visit frequency for Parkinson’s disease treatment on mortality, hospitalization, and costs: a retrospective cohort study
Authors: Fujita Takako , Babazono Akira , Kim Sung-a , Jamal Aziz , Li Yunfei
Published: December 2021

Background

The number of patients with Parkinson’s disease among older adults is rapidly increasing. Such patients mostly take medication and require regular physician visits. However, the effect of physician visit frequency for the treatment for Parkinson’s disease has not been evaluated. This study aimed to evaluate the impact of physician visit frequency for Parkinson’s disease treatment on mortality, healthcare days, and healthcare and long-term care costs among older adults.

Methods

This study employed a retrospective cohort design utilizing claims data from the Fukuoka Prefecture Wide-Area Association of Latter-Stage Elderly Healthcare Insurance and Long-Term Care Insurance. Patients aged ≥75 years who were newly diagnosed with Parkinson’s disease in 2014 were included in this study, following the onset of Parkinson’s disease to March 31, 2019. We calculated the restricted mean survival time to evaluate mortality, focusing on the frequency of physician visits for Parkinson’s disease treatment. Inpatient days, outpatient days, and healthcare and long-term care costs per month were calculated using a generalized linear model.

Results

There were 2224 participants, with 46.5% mortality among those with a higher frequency of physician visits and 56.4% among those with a lower frequency of physician visits. A higher frequency of physician visits was associated with a significant increase in survival time (1.57 months at 24 months and 5.00 months at 60 months) after the onset of Parkinson’s disease and a decrease in inpatient days and healthcare costs compared to a lower frequency of physician visits.

Conclusions

A higher frequency of physician visits was significantly associated with longer survival time, fewer inpatient days, and lower healthcare costs. Caregivers should support patients with Parkinson’s disease to visit physicians regularly for their treatment.
Trends and predictive factors for treatment failure following artemisinin-based combination therapy among children with uncomplicated malaria in Ghana: 2005–2018
Authors: Abuaku Benjamin , Duah-Quashie Nancy Odurowah , Quashie Neils , Gyasi Akosua , Afriyie Patricia Opoku , Owusu-Antwi Felicia , Ghansah Anita , Malm Keziah Laurencia , Bart-Plange Constance , Koram Kwadwo Ansah
Published: December 2021

Background

Since the introduction of artemisinin-based combination therapy (ACT) in Ghana in 2005 there has been a surveillance system by the National Malaria Control Programme (NMCP) and the University of Ghana Noguchi Memorial Institute for Medical Research (UG-NMIMR) to monitor the therapeutic efficacy of ACTs for the treatment of uncomplicated malaria in the country. We report trends and determinants of failure following treatment of Ghanaian children with artesunate-amodiaquine (ASAQ) and artemether-lumefantrine (AL) combinations.

Methods

Per protocol analyses as well as cumulative incidence of day 28 treatment failure from Kaplan Meier survival analyses were used to describe trends of failure over the surveillance period of 2005–2018. Univariable and multivariable cox regression analyses were used to assess the determinants of treatment failure over the period.

Results

Day 28 PCR-corrected failure, following treatment with ASAQ, significantly increased from 0.0% in 2005 to 2.0% (95% CI: 1.1–3.6) in 2015 (p = 0.013) but significantly decreased to 0.4% (95% CI: 0.1–1.6) in 2018 (p = 0.039). Failure, following treatment with AL, decreased from 4.5% (95% CI: 2.0–9.4) in 2010 to 2.7% (95% CI: 1.4–5.1) in 2018, though not statistically significant (p = 0.426). Risk of treatment failure, from multivariable cox regression analyses, was significantly lower among children receiving ASAQ compared with those receiving AL (HR = 0.24; 95% CI: 0.11–0.53; p < 0.001); lower among children with no parasitaemia on day 3 compared with those with parasitaemia on day 3 (HR = 0.02; 95% CI: 0.01–0.13; p < 0.001); and higher among children who received ASAQ and had axillary temperature ≥ 37.5 °C on day 1 compared with those with axillary temperature < 37.5 °C (HR = 3.96; 95% CI: 1.61–9.75; p = 0.003).

Conclusions

Treatment failures for both ASAQ and AL have remained less than 5% (below WHO’s threshold of 10%) in Ghana since 2005. Predictors of treatment failure that need to be considered in the management of uncomplicated malaria in the country should include type of ACT, day 3 parasitaemia, and day 1 axillary temperature of patients being treated.
Imaging features of sentinel lymph node mapped by multidetector-row computed tomography lymphography in predicting axillary lymph node metastasis
Authors: Ou Xiaochan , Zhu Jianbin , Qu Yaoming , Wang Chengmei , Wang Baiye , Xu Xirui , Wang Yanyu , Wen Haitao , Ma Andong , Liu Xinzi , Zou Xia , Wen Zhibo
Published: December 2021

Introduction

Accurately assessing axillary lymph node (ALN) status in breast cancer is vital for clinical decision making and prognosis. The purpose of this study was to evaluate the predictive value of sentinel lymph node (SLN) mapped by multidetector-row computed tomography lymphography (MDCT-LG) for ALN metastasis in breast cancer patients.

Methods

112 patients with breast cancer who underwent preoperative MDCT-LG examination were included in the study. Long-axis diameter, short-axis diameter, ratio of long-/short-axis and cortical thickness were measured. Logistic regression analysis was performed to evaluate independent predictors associated with ALN metastasis. The prediction of ALN metastasis was determined with related variables of SLN using receiver operating characteristic (ROC) curve analysis.

Results

Among the 112 cases, 35 (30.8%) cases had ALN metastasis. The cortical thickness in metastatic ALN group was significantly thicker than that in non-metastatic ALN group (4.0 ± 1.2 mm vs. 2.4 ± 0.7 mm, P < 0.001). Multi-logistic regression analysis indicated that cortical thickness of > 3.3 mm (OR 24.53, 95% CI 6.58–91.48, P < 0.001) had higher risk for ALN metastasis. The best sensitivity, specificity, negative predictive value(NPV) and AUC of MDCT-LG for ALN metastasis prediction based on the single variable of cortical thickness were 76.2%, 88.5%, 90.2% and 0.872 (95% CI 0.773–0.939, P < 0.001), respectively.

Conclusion

ALN status can be predicted using the imaging features of SLN which was mapped on MDCT-LG in breast cancer patients. Besides, it may be helpful to select true negative lymph nodes in patients with early breast cancer, and SLN biopsy can be avoided in clinically and radiographically negative axilla.
Primary extraosseous dural chondrosarcoma: a case report
Authors: Garay Buitron Francis , Pons-Escoda Albert , Vidal Noemí , Torres Alberto , Camins Angels
Published: December 2021

Background

Dural chondrosarcoma is a very rare intracranial tumor, given that meninges do not normally contain cartilaginous tissue from which it can originate. We present a case of primary extraosseous dural chondrosarcoma.

Case presentation

A 48-year-old woman presented to our tertiary center neurosurgery consultation with progressive headache, vomiting, vertigo, and gait instability of 5 months’ duration.

An initial brain CT revealed a large parietal mass with gross calcifications and subtle hyperostosis of the inner table. Subsequent brain MRI showed a heterogeneous expansive lesion with a honey-comb enhancement.

Discussion of intra- or extra-axial location was warranted, and finally, initial presurgical suspicion of meningioma arose although some atypical imaging features were detected. The differential diagnosis included solitary fibrous tumor–hemangiopericytoma and dural metastasis.

Total resection of the lesion was performed, extra-axial origin was confirmed, and pathology resulted in a primary dural chondrosarcoma.

Conclusion

The importance of this case presentation lies in the unusual nature of the final diagnosis, the brief literature review and differential diagnosis with emphasis on imaging pearls, as well as the useful reminder for physicians to consider less frequent diseases when key findings do not unambiguously lead to the usual suspects.
Socio-demographic and environmental risk factors associated with multiple under-five child loss among mothers in Bangladesh
Authors: Kabir Rasel , Farag Marwa , Lim Hyun Ja , Geda Nigatu , Feng Cindy
Published: December 2021

Background

Despite the substantial decline in child mortality globally over the last decade, reducing neonatal and under-five mortality in Bangladesh remains a challenge. Mothers who experienced multiple child losses could have substantial adverse personal and public health consequences. Hence, prevention of child loss would be extremely desirable during women’s reproductive years. The main objective of this study was to determine the risk factors associated with multiple under-five child loss from the same mother in Bangladesh.

Methods

In this study, a total of 15,877 eligible women who had given birth at least once were identified from the 2014 Bangladesh Demographic and Health Survey. A variety of count regression models were considered for identifying socio-demographic and environmental factors associated with multiple child loss measured as the number of lifetime under-five child mortality (U5M) experienced per woman.

Results

Of the total sample, approximately one-fifth (18.9%, n = 3003) of mothers experienced at least one child’s death during their reproductive period. The regression analysis results revealed that women in non-Muslim families, with smaller household sizes, with lower education, who were more advanced in their childbearing years, and from an unhygienic environment were at significantly higher risk of experiencing offspring mortality. This study also identified the J-shaped effect of age at first birth on the risk of U5M.

Conclusions

This study documented that low education, poor socio-economic status, extremely young or old age at first birth, and an unhygienic environment significantly contributed to U5M per mother. Therefore, improving women’s educational attainment and socio-economic status, prompting appropriate timing of pregnancy during reproductive life span, and increasing access to healthy sanitation are recommended as possible interventions for reducing under-five child mortality from a mother. Our findings point to the need for health policy decision-makers to target interventions for socio-economically vulnerable women in Bangladesh.
An exploratory study of two-dimensional shear-wave elastography in the diagnosis of acute compartment syndrome
Authors: Zhang Jun , Zhang Wanfu , Zhou Huihui , Sang Lin , Liu Lina , Sun Yuanyuan , Gong Xue , Guan Hao , Yu Ming
Published: December 2021

Background

Two-dimensional shear-wave elastography (2D-SWE) is an ultrasound elastography technique that uses shear waves to quantitatively measure tissue stiffness and it has recently been developed as a safe, real-time, and noninvasive imaging technique. The purpose of this study was to investigate the value of 2D-SWE in the diagnosis and treatment of acute compartment syndrome (ACS).

Methods

2D-SWE was used to measure the elasticity values of the main muscles in the superficial compartments of the calf in 212 healthy volunteers, and the difference in the muscle elasticity values between different gender and age groups were analyzed. Nine patients with clinical suspicion of ACS were included in this study and 2D-SWE was used to measure the elasticity values of the muscles on the affected and unaffected sides, and a comparative analysis was performed.

Results

The mean elasticity values of the tibialis anterior (TA), peroneus longus (PL), and gastrocnemius medialis (GA) muscles in the relaxed state of the 212 healthy volunteers were 25.4 ± 3.2 kPa, 15.7 ± 1.5 kPa, and 12.1 ± 2.1 kPa, respectively. No statistically significant differences was observed in the elasticity values of the same muscle under the state of relaxation in different gender and age groups (p > 0.05). A statistically significant difference in the elasticity values of the muscle between the affected and unaffected sides in the fasciotomy group (p < 0.05, n = 5) was observed. In contrast, no difference in the elasticity values of the muscle between the affected and unaffected sides in the conservative group (p > 0.05, n = 4) was observed. There was a statistically significant difference in the elasticity values of the muscle on the affected side in the two treatment groups (p < 0.05).

Conclusions

When the ACS occurs, the muscle elasticity of the affected limb increases significantly. 2D-SWE is expected to be a new noninvasive technique for the assessment of ACS and may provide a potential basis for clinical diagnosis and treatment.
What is the impact of the COVID-19 pandemic on residency training: a systematic review and analysis
Authors: Chen Shou-Yen , Lo Hsiang-Yun , Hung Shang-Kai
Published: December 2021

Background

The coronavirus disease 2019 (COVID-19) pandemic has greatly affected medical education in addition to clinical systems. Residency training has probably been the most affected aspect of medical education during the pandemic, and research on this topic is crucial for educators and clinical teachers. The aim of this study was to understand the effect of the COVID-19 pandemic comprehensively through a systematic review and analysis of related published articles.

Methods

A systematic review was conducted based on a predesigned protocol. We searched MEDLINE and EMBASE databases until November 30, 2020, for eligible articles. Two independent reviewers extracted data by using a customized form to record crucial information, and any conflicts between the two reviewers were resolved through discussion with another independent reviewer. The aggregated data were summarized and analyzed.

Results

In total, 53 original articles that investigated the effect of the COVID-19 pandemic on residency training were included. Studies from various regions were included in the research, with the largest percentage from the United States (n = 25, 47.2%). Most of these original articles were questionnaire-based studies (n = 44, 83%), and the research target groups included residents (79.55%), program directors (13.64%), or both (6.82%). The majority of the articles (n = 37, 84.0%) were published in countries severely affected by the pandemic. Surgery (n = 36, 67.92%) was the most commonly studied field.

Conclusions

The COVID-19 pandemic has greatly affected residency training globally, particularly surgical and interventional medical fields. Decreased clinical experience, reduced case volume, and disrupted education activities are major concerns. Further studies should be conducted with a focus on the learning outcomes of residency training during the pandemic and the effectiveness of assisted teaching methods.
Oral GLP-1 analogue: perspectives and impact on atherosclerosis in type 2 diabetic patients
Authors: Saraiva José Francisco Kerr , Franco Denise
Published: December 2021

Cardiovascular events related to atherosclerosis are responsible for high morbidity and mortality among patients with type 2 diabetes. Improvement in care, especially in early stages, is crucial. Oral semaglutide, a glucagon-like peptide 1 analogue, controls blood glucose and results in significant body weight loss in patients with type 2 diabetes. Beyond these well-known effects, an interesting aspect of this drug is its antiatherogenic activity, which should be further explored in clinical practice. This paper reviews the evidence related to oral semaglutide decreasing cardiovascular risk in patients with type 2 diabetes, focusing on the drug’s antiatherosclerotic properties. The glucagon-like peptide 1 analogue restores endothelial dysfunction, induces vasodilatation, and reduces plasma lipids. Oral semaglutide showed cardiovascular safety profile, with significant reduced risk of death from cardiovascular events. Based on current data, clinicians should consider oral semaglutide for type 2 diabetes management.
Reprogramming of RNA silencing triggered by cucumber mosaic virus infection in Arabidopsis
Authors: Annacondia Maria Luz , Martinez German
Published: December 2021

Background

RNA silencing has an important role mediating sequence-specific virus resistance in plants. The complex interaction of viruses with RNA silencing involves the loading of viral small interfering RNAs (vsiRNAs) into its host ARGONAUTE (AGO) proteins. As a side effect of their antiviral activity, vsiRNAs loading into AGO proteins can also mediate the silencing of endogenous genes. Here, we analyze at the genome-wide level both aspects of the interference of cucumber mosaic virus (CMV) with the RNA silencing machinery of Arabidopsis thaliana.

Results

We observe CMV-derived vsiRNAs affect the levels of endogenous sRNA classes. Furthermore, we analyze the incorporation of vsiRNAs into AGO proteins with a described antiviral role and the viral suppressor of RNA silencing (VSR) 2b, by combining protein immunoprecipitation with sRNA high-throughput sequencing. Interestingly, vsiRNAs represent a substantial percentage of AGO-loaded sRNAs and displace other endogenous sRNAs. As a countermeasure, the VSR 2b loaded vsiRNAs and mRNA-derived siRNAs, which affect the expression of the genes they derive from. Additionally, we analyze how vsiRNAs incorporate into the endogenous RNA silencing pathways by exploring their target mRNAs using parallel analysis of RNA end (PARE) sequencing, which allow us to identify vsiRNA-targeted genes genome-wide.

Conclusions

This work exemplifies the complex relationship of RNA viruses with the endogenous RNA silencing machinery and the multiple aspects of virus resistance and virulence that this interaction induces.
An important new health policy voice
Authors: Saltman Richard B.
Published: December 2021

In the 10 years since its founding, the Israel Journal of Health Policy Research has established itself as an important voice in Israeli and international health policy. The Journal’s ability to combine national and international perspectives on key issues in health services delivery and health systems analysis has developed a valuable new arena for academic research about the increasingly complex post-COVID future of health care systems.
Intravenous albumin for the prevention of hemodynamic instability during sustained low-efficiency dialysis: a randomized controlled feasibility trial (The SAFER-SLED Study)
Authors: Clark Edward G. , McIntyre Lauralyn , Watpool Irene , Kong Jennifer W. Y. , Ramsay Tim , Sabri Elham , Canney Mark , Hundemer Gregory L. , Brown Pierre-Antoine , Sood Manish M. , Hiremath Swapnil
Published: December 2021

Background

Hemodynamic instability is a frequent complication of sustained low-efficiency dialysis (SLED) treatments in the ICU. Intravenous hyperoncotic albumin may prevent hypotension and facilitate ultrafiltration. In this feasibility trial, we sought to determine if a future trial, powered to evaluate clinically relevant outcomes, is feasible.

Methods

This single-center, blinded, placebo-controlled, randomized feasibility trial included patients with acute kidney injury who started SLED in the ICU. Patients were randomized to receive 25% albumin versus 0.9% saline (control) as 100 mL boluses at the start and midway through SLED, for up to 10 sessions. The recruitment rate and other feasibility outcomes were determined. Secondary exploratory outcomes included ultrafiltration volumes and metrics of hemodynamic instability.

Results

Sixty patients (271 SLED sessions) were recruited over 10 months. Age and severity of illness were similar between study groups. Most had septic shock and required vasopressor support at baseline. Protocol adherence occurred for 244 sessions (90%); no patients were lost to follow-up; no study-related adverse events were observed; open label albumin use was 9% and 15% in the albumin and saline arms, respectively. Ultrafiltration volumes were not significantly different. Compared to the saline group, the albumin group experienced less hemodynamic instability across all definitions assessed including a smaller absolute decrease in systolic blood pressure (mean difference 10.0 mmHg, 95% confidence interval 5.2–14.8); however, there were significant baseline differences in the groups with respect to vasopressor use prior to SLED sessions (80% vs 61% for albumin and saline groups, respectively).

Conclusions

The efficacy of using hyperoncotic albumin to prevent hemodynamic instability in critically ill patients receiving SLED remains unclear. A larger trial to evaluate its impact in this setting, including evaluating clinically relevant outcomes, is feasible.

Trial registration ClinicalTrials.gov (NCT03665311); First Posted: Sept 11th, 2018. https://clinicaltrials.gov/ct2/show/NCT03665311?term=NCT03665311&draw=2&rank=1
The CT assessment of uncovertebral joints degeneration in a healthy population
Authors: Huang Tianji , Qin Jie , Zhong Weiyang , Tang Ke , Quan Zhengxue
Published: December 2021

Background

A retrospective study investigated the degeneration trend of uncovertebral joints in a healthy population based on CT assessment.

Methods

A total of 200 males and 160 females, aged 21–79 years old (50.82 ± 17.06), who underwent CT examination in our hospital from September 2020 to March 2021 were enrolled. Sixty patients were included in each age group. According to the Kellgren and Lawrence classification and CT was used to evaluate the uncovertebral joints degeneration in different groups.

Results

With the increase of age, the degeneration of each segment was gradually aggravated. The uncovertebral joints started degenerating in the 20 s, and the C5–6 is the most degenerative segment, followed by the C4–5 and C6–7. Significant degeneration occurred in each segment between the 40 s and 60 s and became more severe after the 70 s.

Conclusions

The modified Kellgren and Lawrence classification based on CT scan could provide a quantitative assessment of uncovertebral joints degeneration in a healthy population and could provide more details for artificial cervical arthroplasty.
Migration velocity analysis based on focusing diffractions generated from CRS wavefront attributes: Application to real land data
Authors: Garabito German , dos Santos Silva José Silas , Lima Williams
Published: December 2021

In land seismic data processing, the prestack time migration (PSTM) image remains the standard imaging output, but a reliable migrated image of the subsurface depends on the accuracy of the migration velocity model. We have adopted two new algorithms for time-domain migration velocity analysis based on wavefield attributes of the common-reflection-surface (CRS) stack method. These attributes, extracted from multicoverage data, were successfully applied to build the velocity model in the depth domain through tomographic inversion of the normal-incidence-point (NIP) wave. However, there is no practical and reliable method for determining an accurate and geologically consistent time-migration velocity model from these CRS attributes. We introduce an interactive method to determine the migration velocity model in the time domain based on the application of NIP wave attributes and the CRS stacking operator for diffractions, to generate synthetic diffractions on the reflection events of the zero-offset (ZO) CRS stacked section. In the ZO data with diffractions, the poststack time migration is applied with a set of constant velocities, and the migration velocities are then selected through a focusing analysis of the simulated diffractions. We also introduce an algorithm to automatically calculate the migration velocity model from the CRS attributes picked for the main reflection events in the ZO data. We determine the precision of our diffraction focusing velocity analysis and the automatic velocity calculation algorithms using two synthetic models. We also applied them to real 2D land data with low quality and low fold to estimate the time-domain migration velocity model. The velocity models obtained through our methods were validated by applying them in the Kirchhoff PSTM of real data, in which the velocity model from the diffraction focusing analysis provided significant improvements in the quality of the migrated image compared to the legacy image and to the migrated image obtained using the automatically calculated velocity model.
Joint inversion of gravity and gravity gradient data: A systematic evaluation
Authors: Capriotti Joseph , Li Yaoguo
Published: December 2021

Gravity and gravity gradiometry measurements are commonly used to map density variations in the subsurface. Gravity measurements can characterize gravitational anomalies at long and short wavelengths effectively, but the cost of collecting a sufficiently spatially dense survey to characterize the short wavelengths can be prohibitive. Gravity gradient data can be quickly collected with short-wavelength information at a low noise level, but they have decreasing sensitivity to longer wavelengths. We have described a method to jointly invert gravity and gravity gradient data that takes advantage of the differing frequency contents and noise levels of the two methods to create an improved image of the subsurface. Previous work treated the inversion as a multiple component gravity inversion; however, this can cause unintended errors in the recovered models because each data set is not guaranteed to be fit within its noise level. Our joint inversion methodology ensures that the gravity and gravity gradient data sets are fit within their individual noise levels by incorporating a relative weighting parameter, and we describe how to find that parameter. This method can also be used to create an improved broadband gravity anomaly map that has a reduced noise level at long wavelengths using a joint equivalent source reconstruction. We first build a synthetic model using a Minecraft world editor that has different wavelength anomalies, and find the improvement with joint inversion. These results are also confirmed using a real-world example at the R. J. Smith test range in Kauring, Australia.
Evidence-based complementary medicine for palliative cancer care: does it make sense?
Authors: Ernst E , Filshie J , Hardy Janet
Published: December 2021

Complementary medicine is fast becoming an integral part of palliative cancer care. There is considerable debate as to whether such treatments require proof of effectiveness through randomized clinical trials or whether it may suffice that patients adopt them with apparent appreciation. We attempt to raise some of the arguments on both sides. The arguments include the logistical problems of conducting research in palliative care, ethical problems of placebo controls, methodological difficulties of standardizing treatments or quantifying subtle effects and the, often considerable, costs of clinical trials. We feel that neither those who argue against nor those who argue in favour of rigorous clinical trials are entirely wrong or entirely right. However, our final verdict is that an absence of rigorous science will critically hinder progress. This, in turn, would be to the detriment of future patients. Through discussing the strengths and weaknesses of both sets of arguments, both sides might learn valuable lessons.
Opioids and the immune system
Authors: Sacerdote Paola
Published: December 2021

Opioid compounds such as morphine produce powerful analgesia that is effective in treating various types of pain. In addition to their therapeutic efficacy, opioids can produce several well known adverse events, and, as has recently been recognized, can interfere with the immune response. The immunomodulatory activities of morphine have been characterized in animal and human studies. Morphine can decrease the effectiveness of several functions of both natural and adaptive immunity, and significantly reduces cellular immunity. Indeed, in animal studies morphine is consistently associated with increased morbidity and mortality due to infection and worsening of cancer. However, from several animal studies it emerges that not all opioids induce the same immunosuppressive effects, and evaluating each opioid’s profile is important for appropriate analgesic selection. Buprenorphine is a potent opioid that is frequently prescribed for chronic pain. Acute intracerebroventricular administration of buprenorphine has been shown in rats not to affect cellular immune responses, while a statistically significant inhibition of the immune response was observed with morphine. In mouse studies, chronic administration of buprenorphine led to immune parameters important for antimicrobial responses or for anti-tumour surveillance (lymphoproliferation, natural killer (NK)-lymphocyte activity, cytokine production, lymphocyte number) being unaffected. In contrast, levels of these immune markers were significantly reduced when the potent μ-agonist fentanyl was administered, but recovered after longer periods as tolerance developed. Because the intrinsic immunosuppressive activity varies between individual opioids, predicting the outcome on immunity can be difficult. To study this, the effects of morphine, fentanyl and buprenorphine on NK-lymphocyte activity depressed by experimental surgery were examined in rats. Treating animals immediately after surgery with equianalgesic doses of morphine and buprenorphine significantly reduced surgery-induced immunosuppression. However, buprenorphine reverted NK-lymphocyte activity to preoperative levels, while in morphine-treated rats NK-lymphocyte activity was ameliorated, although not completely. In contrast, fentanyl did not prevent immunosuppression induced by surgery. Overall, from several animal studies it emerges that buprenorphine has the more favourable profile, being a potent analgesic devoid of intrinsic immunosuppressive activity.
Trends in Breast Cancer Mortality Between 2001 and 2017: An Observational Study in the European Union and the United Kingdom
Authors: Jani Chinmay , Salciccioli Ingrid , Rupal Arashdeep , Al Omari Omar , Goodall Richard , Salciccioli Justin D. , Marshall Dominic C. , Hanbury Georgina , Singh Harpreet , Weissmann Lisa , Shalhoub Joseph
Published: December 2021

PURPOSE

Breast cancer is the most common cancer in women worldwide, representing 25.4% of the newly diagnosed cases in 2018. The past two decades have seen advancements in screening technologies, guidelines, and newer modalities of treatment. Our study reports and compares trends in breast cancer mortality in the European Union and the United Kingdom.

MATERIALS AND METHODS

We used the WHO Mortality Database. We extracted breast cancer mortality data from 2001 to 2017 on the basis of the International Classification of Diseases, 10th revision system. Crude mortality rates were dichotomized by sex and reported by year. We computed age-standardized death rates (ASDRs) per 100,000 population using the world standard population. Breast cancer mortality trends were compared using joinpoint regression analysis.

RESULTS

We analyzed data from 24 EU countries, including the United Kingdom. For women, breast cancer mortality was observed to be downtrending in all countries except Croatia, France, and Poland. For the most recent female data, the highest ASDR for breast cancer was identified in Croatia (19.29 per 100,000), and the lowest ASDR was noted in Spain (12.8 per 100,000). Denmark had the highest change in ASDR and the highest estimated annual percentage change of −3.2%. For men, breast cancer mortality decreased in 18 countries, with the largest relative reduction observed in Denmark with an estimated annual percentage change of −27.5%. For the most recent male data, the highest ASDR for breast cancer was identified in Latvia (0.54 per 100,000).

CONCLUSION

Breast cancer mortality rates have down trended in most EU countries between 2001 and 2017 for both men and women. Given the observational nature of this study, causality to the observed trends cannot be reliably ascribed. However, possible contributing factors should be considered and subject to further study.
Pro–Con Debate: Viscoelastic Hemostatic Assays Should Replace Fixed Ratio Massive Transfusion Protocols in Trauma
Authors: Blaine Kevin P. , Dudaryk Roman
Published: December 2021

Major trauma patients at risk of traumatic coagulopathy are commonly treated with early clotting factor replacement to maintain hemostasis and prevent microvascular bleeding. In the United States, trauma transfusions are often dosed by empiric, low-ratio massive transfusion protocols, which pair plasma and platelets in some ratio relative to the red cells, such as the “1:1:1” combination of 1 units of red cells, 1 unit of plasma, and 1 donor’s worth of pooled platelets. Empiric transfusion increases the rate of overtransfusion when unnecessary blood products are administered based on a formula and not on at patient’s hemostatic profile. Viscoelastic hemostatic assays (VHAs) are point-of-care hemostatic assays that provided detailed information about abnormal clotting pathways. VHAs are used at many centers to better target hemostatic therapies in trauma. This Pro/Con section will address whether VHA guidance should replace empiric fixed ratio protocols in major trauma.
Simulation Analysis of Flow Rate Variability During Microinfusions: The Effect of Vertical Displacement and Multidrug Infusion in Conventional Infusion Pumps Versus New Cylinder-Type Infusion Pumps
Authors: Oh Eun Jung , Hong Kwan Young , Lee Jong-Hwan , Kim Duk Kyung , Cho Joongbum , Min Jeong-Jin
Published: December 2021

BACKGROUND:

Medication dosing errors can occur during microinfusions when there is vertical pump displacement or multidrug infusion through a single intravenous path. We compared flow rate variability between new-generation cylinder-type infusion pumps and conventional infusion pumps under simulated conditions.

METHODS:

We evaluated the flow rates during microinfusions using different infusion pumps (syringe pump with 10/30/50-mL syringes, peristaltic pump, and cylinder pump). Two visible dyes were used as model drugs. The study samples were quantified using spectrophotometry. For vertical displacement, the infusion pumps were moved up and down by 60 cm during microinfusions at 0.5 mL·h−1 and 2 mL·h−1. In the multi-infusion study, the second drug flow was added through 4 linearly connected stopcocks either upstream or downstream of the first drug. We compared the total error dose between the cylinder pump and the syringe pump with a Mann-Whitney U test and additionally estimated the effects of the infusion pumps on total error doses by linear regression analysis.

RESULTS:

There were repetitive patterns of temporary flow increases when the pump was displaced upward and flow decreases when the pump was displaced downward in all settings. However, the amount of flow irregularities was more pronounced at the lower infusion rate and in the syringe-type pump using larger volume syringes. The total error dose increased in the syringe pump loaded with a 50-mL syringe compared to that of the new cylinder pump (regression coefficient [β] = 4.66 [95% confidence interval {CI}, 1.60–7.72]; P = .008). The initiation and cessation of a new drug during multidrug microinfusion in the same intravenous path affected the lower rate first drug leading to a transient flow rate increase and decrease, respectively. The change in flow rate was observed regardless of the port selected for addition of the second drug, and the total error dose of the first drug did not significantly vary when an upstream or a downstream port was selected.

CONCLUSIONS:

In the microinfusion settings, attention must be paid to the use of the syringe pump loaded with large-volume syringes. The novel cylinder pump could be considered as a practical alternative to syringe pumps with small syringes given its flow stability without the need for frequent drug replacement.
As bases da excelência científica
Authors: Fleck Mario , Schmit Daniel
Published: December 2021

O Instituto Weizmann mostra que ciência de ponta se faz com pesquisadores bem formados, livres para criar, em conexão com a prática e de todas as partes do mundo, inclusive do Brasil.
Pontos nevrálgicos da estratégia
Authors: Carneiro Jorge , Perini Luis
Published: December 2021

A crise causada pela Covid-19 tornou evidente como a gestão de riscos, gestão de crises e o engajamento das pessoas devem complementar os modelos analíticos tradicionais.
Dilemas do retorno ao presencial
Authors: Maria Braga Beatriz
Published: December 2021

Fomos penosamente forçados a nos adaptar a um novo modo de trabalhar que, ao final de tantos meses, tornou-se um “novo normal” − como tantos gostam de dizer −, e agora parece ser difícil voltar ao “antigo normal”.
Η διαγνωστική εγκυρότητα της νευροψυχολογικής εκτίμησης σε ηλικιωμένα αναλφάβητα άτομα
Authors: Μανδυλά Μαρία-Αικατερίνη
Published: December 2021

Στην παρούσα εργασία διερευνήθηκε η επίδοση σε νευροψυχολογικές δοκιμασίες γνωστικά υγιών (χωρίς άνοια) αναλφάβητων ατόμων σε σύγκριση με γνωστικά υγιή εγγράμματα άτομα και εγγράμματα άτομα με γνωστική έκπτωση, ώστε να αναδειχθούν οι δοκιμασίες οι οποίες αποτελούν χρήσιμα εργαλεία στην κλινική διάγνωση αναλφάβητου πληθυσμού. Ο βασικός σκοπός της μελέτης ήταν να διερευνηθεί η καταλληλότητα των νευροψυχολογικών δοκιμασιών για τη διαγνωστική εκτίμηση ηλικιωμένων αναλφάβητων ατόμων. Το δείγμα της συγχρονικής μελέτης αποτέλεσαν 1794 ηλικιωμένοι (65 ετών και άνω), όλοι συμμετέχοντες του ερευνητικού προγράμματος Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) που διεξάγεται στην Ελλάδα. Οι συμμετέχοντες χωρίστηκαν σε ομάδες (γνωστικά υγιείς ή με γνωστική έκπτωση) σύμφωνα με το επίπεδο λειτουργικότητάς τους (υψηλή ή χαμηλή), καθώς επίσης, σύμφωνα με το αν έχουν φοιτήσει ή όχι στην τυπική εκπαίδευση. Στους συμμετέχοντες χορηγήθηκε μια πλήρης συστοιχία νευροψυχολογικών δοκιμασιών με την οποία εξετάστηκαν η μνήμη (λεκτική και οπτική), η οπτικοχωρική αντίληψη, η προσοχή/ταχύτητα επεξεργασίας πληροφοριών, οι εκτελεστικές λειτουργίες (εναλλαγή, αναστολή και νοητική ευελιξία) και οι λεκτικές ικανότητες. Οι δοκιμασίες οι οποίες ανέδειξαν ομοιότητες στην επίδοση των υγιών εγγράμματων και αναλφάβητων ατόμων είναι η λεκτική μνήμη αναγνώρισης και ο δείκτης ελλείμματος της παγίωσης, ο Κινητικός Προγραμματισμός Μέρος Α και ο αριθμός ομαδοποιήσεων στη Φωνολογική Ευχέρεια (όλα τα p > .002), ενώ στις υπόλοιπες δοκιμασίες που εξετάστηκαν οι αναλφάβητοι συμμετέχοντες είχαν χαμηλότερη επίδοση από τους εγγράμματους (όλα τα p < .002). Επίσης, όλες οι δοκιμασίες που εξετάστηκαν δεν ανέδειξαν διαφορές στην επίδοση μεταξύ των γνωστικά υγιών αναλφάβητων και των εγγράμματων ατόμων με γνωστική έκπτωση (όλα τα p > .002), με εξαίρεση την άμεση και καθυστερημένη ελεύθερη ανάκληση και την καθυστερημένη ανάκληση με υποδείξεις λίστας λέξεων (όλα τα p < .002), στις οποίες υπερτερούσαν τα υγιή αναλφάβητα άτομα. Με βάση τα παρόντα ευρήματα, η επίδοση σε ορισμένες μεταβλητές σε έργο λεκτικής μνήμης υποδεικνύει την ύπαρξη ή μη γνωστικού ελλείμματος ανεξάρτητα από το εκπαιδευτικό επίπεδο, ενώ με βάση τις υπόλοιπες μεταβλητές που εξετάστηκαν υποτιμάται η επίδοση των γνωστικά υγιών αναλφάβητων ατόμων, γεγονός το οποίο μπορεί να οδηγήσει σε εσφαλμένη διάγνωση νοητικής έκπτωσης κατά την κλινική εκτίμηση σε αυτή την ομάδα. Επομένως, αναδεικνύεται η ανάγκη δημιουργίας διαφορετικού τρόπου εξέτασης με μεγαλύτερη οικολογική εγκυρότητα, καθώς και κανονιστικών τιμών για την εκτίμηση της νοητικής κατάστασης των ηλικιωμένων αναλφάβητων ατόμων.
Frequency of parasitic infections in Arachishypogaea L (groundnuts), Citrulluslanatus seeds (watermelon seeds), and Ziziphusspina-christi (nabag) sold by street vendors in Khartoum State, Sudan: a cross-sectional study
Authors: Suleiman Mohammed Arwa , Abd Alla Ahmed , Galander Ahmed , Elfaki Tayseer , Ibrahim Hashim Ahmed , N. Altayb Hisham
Published: December 2021

Background: Plant products, including seeds are an important source of vitamins, minerals, proteins, and energy. This study aimed to assess parasitic contaminations in roasted groundnuts,

nabag, and tasali (watermelon seeds) sold by street vendors in Khartoum State, Sudan.

Methods: The frequency of parasitic contaminations among all crop products was detected by washing the plants with saline, and then conducting an examination using a formal ether

concentration technique (FECT), followed by a saturated sugar floatation technique.

Results: The detected parasites belonged to two species: Entamoeba histolytica (33.3%) and Giardia lamblia (15.6%). No helminthic parasites were detected. Mixed contamination of the mentioned parasites was also observed (11.1%). The most contaminated crop was nabag, followed by groundnut, and finally tasali.

Conclusion: No relation was established between the positivity of samples for parasites and crop type, Khartoum State city, or  seller sex. FECT was more sensitive than the saturated sugar floatation technique as a detection method.