bluuebunny/crossref_metadata_2025 huggingface dataset:
Breast prosthetic implant-associated Squamous Cell Carcinoma: A case report and Literature Review
Authors: Liu Zhaoyun , Liu Chenyu , Zhao Chenglong , Yu Qian , Zhang Guanyu , Wang Xinzhao , Yu Zhi-yong
Published: January 2021

BackgroundBreast reconstruction is widely used for women undergoing mastectomy. Prosthetic implants have become a common technique performed for these women because of their safety, flexibility and adjustable size. There are few reports of implant-associated squamous cell carcinoma. In addition to this report, only 8 reports including 11 cases have been reported in the English literature.Case presentationWe report the case of a patient with breast prosthetic implant-associated squamous cell carcinoma who received mastectomy and prosthetic implants 10 years ago. She was recently hospitalized with unilateral breast enlargement. Surgical pathology showed squamous cell carcinoma around the breast implant. There was no evidence of primary squamous cell carcinoma at any other anatomic site. We analysed all 11 patients with breast implant-derived squamous cell carcinoma (SCC) from a thorough literature search to identify studies. The median age of patients at SCC diagnosis was 56.8 years old. The average time from initial breast augmentation until SCC diagnosis was 21.9 years. The prognosis was poor; 4 of the 11 patients eventually progressed or died within 1 year, 3 of the 11 patients were disease free during the follow-up period, and 4 of the 11 patients were lost to follow-up. The most widespread opinion is that chronic inflammation from breast implants plays a substantial role in the disease progression of SCC.ConclusionsWe reported the rare complications associated with breast prosthetic implants and reviewed the literature. This malignancy should be taken into account in patients with breast prosthetic implants who have acute breast pain and enlargement.
Measuring Concern over Coronavirus in an Iranian non-clinical sample using the Coronavirus Disease Concern Scale (COVID-19CS)
Authors: Dadfar Mahboubeh , Lester David
Published: January 2021

BackgroundThe Coronavirus Disease-2019 (COVID-19) outbreak is a public health problem and a great challenge in the world, including Iran. The aims of the present study were: (a) to investigate the psychometric properties and the factorial structure of the Coronavirus Disease (COVID-19) Concern Scale (COVID-19CS), (b) to explore correlations of the COVID-19CS scores with the Fear of COVID-19 Scale (FCV-19S), and (c) to examine gender differences. MethodsThis was a descriptive cross-sectional study. A convenience sample of 125 medical students was recruited. The COVID-19CS and FCV-19S were administered to the students. The data were analyzed with descriptive statistics, t-tests, Pearson correlation coefficients, and a Principal Components factor analysis.ResultsCronbach's α was .94. Three factors were extracted labeled “Infection/Unsafety”, “Instability/Fear of Social Isolation”, and “Insecurity/Death Fear.” The COVID-19CS score was positively correlated with the FCV-19S score. There was no sex difference in the COVID-19CS score.ConclusionsThe COVID-19CS is a multidimensional scale. Just over half (56.3%) of students reported concern of COVID-19 and, therefore, appropriate policy-making and evidence-based psycho educational training are necessary to reduce their concern over COVID-19.
Case ReportDouble Valve Replacement in a Patient with Maroteaux – Lamy syndrome. An Ultimate Team Challenge.
Authors: Demis Alexandros Agron , Oiconomidou Stella , Daglis Fotios , Polymenakos Spyridon , Panagiotou Matthew
Published: January 2021

BackgroundThe Maroteaux-Lamy syndrome (Mucopolysaccharidosis type VI) is a rare, inherited metabolic disease that results in progressive tissue accumulation of dermatan-sulfated glycosaminoglycans and inflammatory consequences that almost always affects the heart valves. From the anesthesia point of view, these rare cases are a serious challenge since the features of the syndrome entail difficulties in airway management and ventilation. It’s more than possible that the surgical team will perform a non-straightforward procedure.Case presentationA 42 year old male with Maroteaux-Lamy syndrome was referred to our department with shortness of breath, due to severe aortic stenosis, and at least moderate mitral valve regurgitation.The patient was initially scheduled for aortic valve replacement. After multiple attempts with video assisted laryngoscopy, the endotracheal intubation was achieved with the aid of fiberoptic bronchoscopy, while the ventilation succeeded only with laryngeal mask. The somatic features of the syndrome that made the anesthesia induction extremely difficult, also affected the surgical procedure. Suboptimal exposure of the mitral valve, patch enlargement of the aortic root to host the bigger possible prosthesis, and the hard decision to replace the mitral valve even with a marginal indication were the intraoperative difficulties for the surgical team.Finally, the patient underwent a successful double valve replacement with aortic root enlargement and after 18 months remains improved.ConclusionPatients with Maroteaux-Lamy syndrome represent a challenge for both anesthesiologists and cardiac surgeons. The whole team should be well prepared to deal with difficulties in airway management, ventilation and surgical valve exposure. The cardiac surgeon should be ready to offer additional procedures and even replace “prematurely” a moderately diseased valve in order to avoid a dangerous reoperation. The limited knowledges on the natural history and progression of the Maroteaux-Lamy syndrome valvulopathy and the difficulties in anesthesia induction support this approach.
Comparative Study of the Intravenous Infusion of Umbilical Cord Mesenchymal Stem Cells and A Modified Sub-Tenon’s Capsule Injection of Triamcinolone Acetonide in Retinitis Pigmentosa Combined with Macular Edema
Authors: Zhao Tongtao , Lie Hongxuan , Wang Fang , Liu Yong , Meng Xiaohong , Yin Zhengqin , Li Shiying
Published: January 2021

Background: Retinitis pigmentosa (RP) is a hereditary retinal degenerative disease leading to eventual blindness. Macular edema (ME) is a frequent complication in RP. When RP is combined with ME, the visual impairment further worsens. Well controlled ME is crucial to prevent RP from advancing. We compared the intravenous infusion of umbilical cord mesenchymal stem cells (UCMSCs) and a modified sub-Tenon’s capsule injection of triamcinolone acetonide (TA) in the treatment of RP combined with ME to assess their safety and efficacy in eliminating macular edema. Methods: A phase I/II clinical trial enrolled 20 patients was conducted. Patients in the UCMSCs infusion group received a single intravenous infusion of 3 × 106 UCMSCs, and patients in the TA injection group received a modified sub-Tenon’s capsule injection of 20 mg of TA. All patients were followed up for 6 months. Systemic and ophthalmological investigations were performed to assess the safety and efficacy.Results: There were no severe adverse effects in both groups. At 2nd month follow up, the thickness of the central fovea in TA injection group was significantly lower than that in UCMSCs infusion group (P<0.05). The gradient of decrease of average macular thickness in TA injection group was significantly higher than that in UCMSCs group (P<0.05). At 6th month follow up, the central fovea thickness was higher in the TA injection group than that in UCMSCs infusion group (P<0.05). The average amplitude/latency (A/L) of the P2 wave in the flash visual evoked potential (FVEP) in UCMSCs infusion group was significantly higher at 6th month follow up than that in TA injection group (P<0.05). Conclusions: This study suggests TA injection is more effective at reducing ME in a short term. UCMSC intravenous infusion exerts slow but persistent action in reducing ME, and can maintain the visual function for a longer time. These approaches can be applied separately or jointly depending on the disease condition for patients to benefit maximumly. Trial registration: chictr.org.cn: ChiCTR-ONC-16008839. Registered on July 14, 2016.
Costs and Cost-Effectiveness of Artesunate Against Quinine Treatment Therapy for Severe Malaria in Children Under 14 Years in Zambia.
Authors: Mtalimanja Michael , Mtalimanja James Lamon , Xu Zhengyuan , Du Wenwen , Xu Wei
Published: January 2021

BackgroundMalaria exerts a significant economic burden on health care providers and households. Also, the cost of inpatient care for a case of severe malaria further exerts a heavy financial burden on most countries with already limited recourses. Therefore, it is essential to provide policy makers with relevant economic evidence on economic benefits of health care control, preventive and curative strategies.MethodsCost-effectiveness analysis of severe malaria treatment was conducted from a healthcare provider perspective using a decision tree. Standard costing was performed for the identification, measurement and assessment phases, with data from Zambia annual quantification reports for anti-malaria commodities. The data was collected from Health Management information system, and meta-analysis. Average and incremental cost-effectiveness ratio were estimated. The uncertainties were assessed through probabilistic sensitivity analysis.ResultsSevere Malaria in Children has been shown to account for over 45% of the total monthly curative healthcare costs incurred by households compared to the mean per capita monthly income. The cost of treating severe malaria depleted 7.67% of the monthly average household income. In addition, the cost attributed to loss of income in taking care of a sick child is the highest contributor $10.5 of total cost followed by direct medical costs $7.75. According, to the cost effectiveness analysis the of Artesunate with quinine the ICER was $105 per death averted.ConclusionThe use of Artesunate over Quinine in the treatment of severe malaria in children under 14years is a highly cost-effective strategy for the healthcare provider in Zambia.
Combination Strategy of Dynamic Obstacle-Avoidance and Autonomous Tracking for Hazardous Gases Inspection Robot in Man-Machine Environment
Authors: Zhang Qing-fang , Gao Xueshan , Lan Bing-Qing , Fu Xiao-Long , Li Jing-Ye
Published: January 2021

A variety of toxic and hazardous gases exist in many working or storage environments, and once a leak occurs, it will cause a wide range of casualties and immeasurable economic losses. To improve the timeliness and flexibility of the inspection equipment in a man-machine hybrid environment, this research provides an effective and practical method to improving the autonomous behavior strategy of robots in complex environments. The team designs a mobile inspection robot used to inspect hazardous gas which can be controlled remotely or inspect dangerous gas independently first, the robot is controlled by a host computer through a hybrid architecture control system mainly composed by Micro Controller Unit (MCU), Raspberry Pi based on Wi-Fi formed by a wireless router. The robot uses the hub motors as the driving wheels, equipped with multiple sensors and cameras to complete forward and backward, turning, possesses target tracking, obstacle avoidance and real-time image transmission functions softly. Based on the robot kinematic model built, this paper studies the interfering objects four typical behavior patterns, establishes a social force model to guide the robot behavioral decision-making under dynamic obstacles. To verify the effectiveness of the combination motion strategy, Matlab is used to establish a shared environment space, trajectory simulation of the state of human crossing behavior and encounter behavior, and the speed change trend of the mobile robot is recorded. Combines the dynamic obstacle avoidance strategy presented based on fuzzy thinking, an autonomous tracking strategy by adopting Fuzzy-PID controller is proposed, the experiments under fixed trajectory indoors verifies that when the robot deviates from the predetermined trajectory during inspection operations, the Fuzzy-PID control system can effectively help the robot return to the target trajectory, which the PTZ is stable and the video image is clear and the frame rate is more than 10 frames per second shows the good inspection performance. The results of simulation and test are similar, and the robot position error up to 10mm, the angle error up to 0.1 rad, which draws the reliability and accuracy of the inspection method,. And the robot can fast responsive, the small-scale time delay of the speed change does not affect the obstacle avoidance effectiveness, the robot and human will always maintain a sufficient safety distance to reduce the "sense of crisis" that humans towards to the robot.
Evaluation of Strength Properties of In-Service X80 Pipeline Steel Using Small Punch Test and Backpropagation Neural Network
Authors: Song Ming , Li Xuyang , Jiang Wenchun , Zhong Jiru , Guan Kaishu
Published: January 2021

Evaluating the strength properties of materials of an in-service pipeline without shutting down transportation has been always a challenge. A novel and non-destructive method for determining the true stress-strain curve of pipeline steel based on backpropagation artificial neural network and small punch test is proposed in this study. The elastoplastic mechanical properties of the pipeline steels could be obtained by this method. The load-displacement curves of 2261 groups of different hypothetical materials were obtained by the finite element model of small punch test within Gurson-Tvergaard-Needleman (GTN) damage parameters and used to train the neural network. The relationship between the load-displacement curve of small punch test and the true stress-strain curve of the conventional uniaxial tensile test was established based on the trained neural network. The accuracy and wide applicability of the trained neural network were verified by the experimental data of four types of materials obtained by small punch test and standard tensile test, respectively. The established relationship can be used to predict the true stress-strain curve of the pipeline steels to determine the elastoplastic mechanical properties only by the load-displacement curve of the small punch test without performing the conventional tensile test.
Challenges of Online Teaching During the COVID-19 Pandemic in an English as a Foreign Language Context: A Process Tracing Approach
Authors: Shahnama Mojdeh , Yazdanmehr Elham , Shirvan Majid Elahi
Published: January 2021

The prevalence of COVID-19 pandemic worldwide has affected educational systems around the world and has forced education systems to shift to online learning. The present study was motivated to explore the challenges (common technology-driven and content-specific challenges) facing an English as a foreign language teacher throughout an online English course in Iran. The main participant of this study was a female teacher, with 17 years of experience in teaching English to children, teenagers, and adults. To this aim, a process-tracing approach was employed in an online English class with 10 female students, all teenagers, to unravel the causal mechanisms involved in the beginning, middle and end of the English course. The results showed that the greatest challenges throughout the course especially in initial and mid sessions were caused by deficient technological resources. The two other causal categories, human and content resources, were at their peak early in the course and then reduced significantly by the end. The most troublesome challenges the teacher faced were platform limitations, internet connection and human resources’ unpreparedness for online education. Though the teacher’s as well as most students’ technological knowledge and media literacy showed an increase by the end of the course, some students’ slow adaptation challenged the teacher until the end. As for the content-based challenges, teaching vocabulary and speaking was considered the most challenging one due to lack of teacher’s physical contact with students.
Current Status of Genetically Modified Crops in Iran and the world: Overview of Production and Consumption Challenges
Authors: Baghbani-Arani Abolfazl , Poureisa Mona , Alekajbaf Hossein , Abad Rezvan Karami Borz- , Khodadadi-Dashtaki Khodadad
Published: January 2021

Transgenic technologies expanded in many countries regarding the nutritional needs of the increasing population. There are, however, some concerns about possible risks in growing genetically modified (GM) food such as threats of biodiversity and food allergies making it a challenge. This study aimed at examining the economic effects and political scopes of GM food in the production sector and policies made by different countries in the world and Iran. Moreover, essential (practical and legal) solutions and guidelines for GM food production and consumption are provided, which are useful for governmental entities and Iranian politicians and consumers' rights. transgenic technology has been accepted by high-rank farmers to produce genetically modified crops due to an increase in net profit caused by improved yield in spite of the high cost of transgenic seeds. Among 11 countries producing GM crops in the world in 2018, the USA is the first country followed by Brazil and Argentina at second and third ranks. In 2018, 78, 76, 30 and 29% of soybean, cotton, corn and canola production areas respectively were under cultivation of GM varieties. Although Iran has been one of the leading Asian countries not only in the field of transfer of technical knowledge of genetic engineering, but also in the development of specialized knowledge of biosafety, and despite the production of several transgenic plant lines by Iranian researchers, no GM crop has obtained release and cultivation license except for genetically modified rice that its growing process was banned after government change. This study implies that GM crops growing and production process does not follow the global trend owing to scientific and legal infrastructures.
Real Time Surveillance of COVID-19 Space and Time Clusters During the Summer 2020 in Spain
Authors: Rosillo Nicolás , del-Águila-Mejía Javier , Rojas-Benedicto Ayelén , Guerrero-Vadillo María , Peñuelas Marina , Mazagatos Clara , Segú-Tell Jordi , Ramis Rebeca , Gómez-Barroso Diana
Published: January 2021

Background:On June 21st de-escalation measures and state-of-alarm ended in Spain after the COVID-19 first wave. New surveillance and control strategy was set up to detect emerging outbreaks.Aim:To detect and describe the evolution of COVID-19 clusters and cases during the 2020 summer in Spain.Methods:A near-real time surveillance system to detect active clusters of COVID-19 was developed based on Kulldorf´s prospective space-time scan statistic (STSS) to detect daily emerging active clusters. Results:Analysis were performed daily during the summer 2020 (June 21st – August 31st) in Spain, showing an increase of active clusters and municipalities affected. Spread happened in the study period from a few, low-cases, regional-located clusters in June to a nationwide distribution of bigger clusters encompassing a higher average number of municipalities and total cases by end-August.Conclusion:STSS-based surveillance of COVID-19 can be of utility in a low-incidence scenario to help tackle emerging outbreaks that could potentially drive a widespread transmission. If that happens, spatial trends and disease distribution can be followed with this method. Finally, cluster aggregation in space and time, as observed in our results, could suggest the occurrence of community transmission.
Large-size intramuscular nodular fasciitis, a challenging histopathologic diagnosis confirmed by molecular detection of USP6 gene rearrangement: A case report and literature review
Authors: Wang Changrong , Wang Wei , Xu Rujun , Xiang Jingjing
Published: January 2021

Background: The intramuscular subtype of nodular fasciitis (NF) is rare with lesions normally not more than 2 cm in size and characterized by pseudosarcomatous morphology. Case presentation: Here, we report a case of a 27-year-old man presenting with a chief complaint of an increasingly enlarged mass of the left upper arm for 4 months. Magnetic resonance imaging confirmed the presence of a well-defined tumor measuring 5 cm within the outer edge of the middle humerus. Microscopically, the neoplasm was highly cellular with focally discohesive and myxoid features. In more cellular areas, cells grew in bundles with an interlaced pattern. The mitotic index was high and multinuclear giant cells were evident. The stroma contained collagen with erythrocyte extravasation. The tumor border was infiltrative. Immunohistochemically, the tumor cells were positive for SMA and negative for CK, desmin, CD34, S100, ALK, and β-catenin. Molecular detection demonstrated evidence of USP6 gene rearrangement in this tumor. Based on the findings, we diagnose this case as intramuscular NF. At 48 months after the initial surgery, the patient had recovered well with no evidence of recurrence or metastasis. Conclusions: In this study, the diagnosis of intramuscular NF with a relatively large tumor was confirmed by molecular detection of USP6 gene rearrangement.
Primary High-grade Serous Carcinoma of Fallopian Tube, an Incidental Intraoperative Finding: A Case Report 
Authors: Shokouhi Nasim , Saeedi Sara , Sarmadi Soheila , Moradi Behnaz , Feizabad Elham
Published: January 2021

Background: Primary carcinoma of fallopian tube is a rare but deadly gynecologic cancer, In addition, its preoperative diagnosis is strict due to the lack of specific symptoms and signs and in most patients, it is an intraoperative finding.Case presentation: A 55-year-old patient, G3Ab1P2 referred to urogynecology clinic of our hospital with chief complaint about heavy, prolonged menstrual bleeding and a permanently abnormal yellow discharge that could not be distinguished from its urinary or vaginal source.After complete diagnostic work-up, the patient became a candidate for hysterectomy due to the drug (Megestrol Acetate) -resistant abnormal vaginal bleeding, her abnormal vaginal bleeding, positive family history of malignancy, and abnormal vaginal discharge.Laparotomy revealed unusual left fallopian tube feature (Large, bulky, and vegetative feature), suspected to malignancy. Intraoperative frozen-section analysis of the left fallopian tube and ovary specimens detected the mass as a high-grade serous carcinoma of fallopian tube. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, and partial omentectomy were performed. The definitive histopathological diagnosis was high-grade serous carcinoma of the left fallopian tube stage 2b with omental involvement without any evidence of lymph-vascular invasion.Conclusions: High-grade serous carcinoma of fallopian tube is likely to present nonspecific symptoms, which may cause considerable delay in diagnosis and treatment. This consequently, affects the prognosis and survival of the patient.
NDRG1 Inhibition of Tumor Progression in Caco2 Cells
Authors: He Yixiao , Ji Yuzhu , Hua Hairong , Zhu Yu , Yu Peng , Zeng Xiangfei , Wang Kaixin , Wang Fang
Published: January 2021

Background: Colorectal cancer (CRC) is a leading cause of cancer death worldwide. Invasiveness and migration are the main cause of death, and so there is a need to find a sensitive, reliable molecular marker that can predict the migration of colorectal cancer at an early stage. NDRG1 (N-myc Downstream Regulated Gene 1) has been reported to be a multifunctional gene that has a strong relationship with tumor invasion and migration, but theories about the current role of NDRG1 in colorectal cancer remains to be conclusively determined. Methods and Results: Through lentivirus infection and CRISPR/Cas9 methods, respectively, we established that NDRG1 stably overexpressed and knocked out Caco2 cell lines. CCK8(Cell Counting kit 8) data showed that NDRG1 inhibited Caco2 proliferation. Flow cytometry further confirmed that the cell cycle can be arrested at the G1/S phase when NDRG1 overexpresses, while the number of G2 phase cells significantly increased after NDRG1 was knocked out. This means that NDRG1 inhibited the proliferation of Caco2 cells by arresting the cell cycle in the G1/S phase. Our data also demonstrated that NDRG1 promotes early cell apoptosis. The strength of invasion and migration was decreased when NDRG1 overexpressed. Conclusions: Our results underline that NDRG1 inhibits tumor progression in Caco2 cells. These findings may provide a new potential therapeutic strategy for the treatment of CRC.
Rhinocerebral Mucormycosis Secondary to Severe Acute Pancreatitis and Diabetic Ketoacidosis: A Case Report
Authors: Wang Jinjing , Li Yao , Luo Shuai , Zheng Hong
Published: January 2021

Introduction: Rhinocerebral mucormycosis is a rare and severe form of opportunistic fungal infection that can develop rapidly and cause significant mortality, particularly among diabetic patients suffering from ketoacidosis. Diagnosing rhinocerebral mucormycosis during the early stages of infection is challenging. Case presentation：We describe a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis. In this case, the condition was not diagnosed during the optimal treatment window. we therefore provide a thorough overview of related clinical findings and histopathological characteristics, and we discuss potential differential diagnoses.Conclusions: In summary, we described a case of rhinocerebral mucormycosis secondary to severe acute pancreatitis in a patient suffering from diabetic ketoacidosis, with the optimal treatment window for this condition having been missed. This report suggests that a definitive mucormycosis diagnosis can be made based upon tissue biopsy that reveals the presence of characteristic hyphae. Early diagnosis and treatment are essential in order to improve patient prognosis.
Hot Spot Mapping and Size Estimation of Illicit Drug Users in Iran: A Pilot Study
Authors: Khodadost Mahmoud , Ghalehkhani Nima , Hajebi Ahmad , Gouya Mohammad Mahdi , Kazerooni Parvin Afsar , Ghodusi Ebrahim , Fathi Hamid R , Bojnordi Toktam Khojasteh , Sarvi Fatemeh , Vashani Jamshid , Kokie Fatima Zare Banad , Hashemvarzi Mahmoud Reza , Davasazirani Reza , Sharifi Hamid , Motevalian Seyed Abbas
Published: January 2021

Background: Mapping and size estimation of people who use (PWUD) or inject drugs (PWID) are important issues for control of drug use. The aim of this pilot study is to mapping and estimate the number of PWUD and PWID in Iran.Methods: We used the hotspot mapping and size estimation method to estimate the number of illicit drug users in four cities of Iran from December 2017 to January 2019. We identified hotspots by local knowledge of key informants. For size estimation in each hotspot, three estimates were made during hotspot visit: a) KAP-KI (Key Affected Population Key Informant) estimate (drug users met in the hotspot), b) Non-KAP KI estimate (e.g. taxi drivers, shopkeepers nearby the hotspot); c) estimation made by field observers. Locations of hotspots were recorded by the field team and ArcGIS software was used for mapping. Results: A total number of 335 hot spots were identified in four cities of them, 70 (20.9%) were in Ahvaz, 90 (26.9%) in Sari, 67 (20%) in Yazd and 108(32.2%) in district 2 of Tehran metropolitan. We identified nine high-density areas for PWUDs of them three were in Ahvaz, one in the south of Sari, two in district 2 of Tehran and three in Yazd. The total numbers of 1524 key informants were interviewed by the field team in 335 identified hot spots. Based on the median estimated number of PWUD, Ahvaz had the highest estimated number of PWUD (1242, range, 606-1285), followed by Sari (788, range, 373-1044), district 2 of Tehran (684, range, 642-728) and Yazd (123, range, 76-316). The median estimated number of PWID indicated that Ahvaz had the highest estimated number of PWID (843, range, 703-887), followed by Sari (346, range, 307-666), Yazd (228, range, 221-471) and Tehran (18, range, 18-34). Conclusions: Findings highlight the importance of geographical targeting of illicit drug users to provide harm reduction programs with a broader reach in Iran.
Pitfalls and Remedial Technique of Intramedullary Nail for Subtrochanteric Femur Fractures: A Case Series
Authors: Chen Botao , Fan Xiaohong
Published: January 2021

Background: Intraoperative technical complications are occasionally encountered while implanting intramedullary nails for subtrochanteric fractures. Surgeons must pay attention to the pitfalls and remedial technique of this operation.Methods: We report on three cases in which intraoperative difficulties occurred during the implantation of an intramedullary nail among Han Chinese patients from mainland China. In Case 1, during an operation on a 57-year-old man, a seinsheimer type V in a right subtrochanteric fracture was not fully realized, and the dislocation of intertrochanteric fracture was aggravated after reduction of the subtrochanteric fracture. The intramedullary nail fixation was completed with the aid of an additional anterolateral plate. Case 2 involved a transverse subtrochanteric fracture. The surgeon neglected the coronal dislocation when considering good sagittal reduction. Although an auxiliary reduction device was used during the operation, there was unacceptable coronal dislocation after the intramedullary nail was inserted. A temporary anterolateral locking plate fixation was used to complete the intramedullary nail fixation. Case 3 involved an old trochanteric fracture combined with a new subtrochanteric fracture in an 81-year-old woman. After reducing the subtrochanteric fractures, the intramedullary nail fixation was successfully completed by releasing the poorly healed intertrochanteric fractures and fixing the anterior lateral plate.Results: With the development of techniques, reliable results can be obtained with fewer complications. Of the various internal fixation methods, we favor using a trochanteric start intramedullary nail.Conclusions: The treatment of subtrochanteric fractures presents challenges. Good reduction and reliable temporary fixation are key to completing the intramedullary nailing. If percutaneous joysticks, finger reduction tools, blocking screws, clamps, and Schanz pins cannot be used for effective auxiliary reduction or temporary reliable fixation, reduction after intramedullary nailing will not be satisfactory. The temporary addition of a reconstruction locking plate can achieve good reduction and temporary stability, and an extra reconstruction locking plate should be retained when the temporary fixation device is removed to reduce the risk of internal fixation failure during fracture healing.
Impact of Diabetes Mellitus on Early Postoperative Outcomes After Hip Fracture Surgery in Geriatric Patients: A Retrospective, Propensity Score Matching Study
Authors: Li Ruibo , Yuan Xingyue , Liu Yuehong , Liu Shuping , Zhou Yu , Chen Xi , Zhou Qing , Wang Zhicong
Published: January 2021

Background：The impact of diabetes mellitus (DM) on hip fracture (HF) is still controversial. The primary aim of this study was to examine the influence of DM on perioperative transfusion， the secondary aims were to evaluate 1-year mortality, length of stay，and total charges in individuals with hip fracture.Methods: All patients with initial HF aged 60 years or older admitted to our hospital from January 2014 to January 2018 were eligible for this study. After excluding some patients who did not meet the experimental requirements, 326 HF patients aged 60 years and above were admitted to the study institution, and were divided into DM group (n=71) and non-diabetes mellitus (non-DM) group (n=255). Sex, age, American Society of Anesthesiologists (ASA) classification, anesthesia type and surgery type were matched in the two groups (DM group vs. non-DM group) using propensity score matching (PSM) without any statistical differences. Then，perioperative transfusion，length of stay，direct total charges and 1-year mortality in individuals with HF were compared between two groups.Results: Following PSM, 62 patients in the DM group and 62 patients in the non-DM group were included in the study. Twenty-eight patients had received blood transfusion during the perioperative period, the difference in blood transfusion rate between two groups was statistically significant (p=0.032). There were no statistical differences in 1-year mortality, length of stay and direct hospital costs between two groups.Conclusions: This study showed that DM patients with hip fractures have a higher probability of receiving transfusions compared to patients without DM. Higher blood transfusion rates may be associated with lower hemoglobin and hematocrit levels at admission. However, there was no significant increase in 1-year mortality, length of hospital stay, and direct hospital costs after hip fracture surgery due to diabetes.
Expression of The Factors Associated With Wnt/β-Catenin, BMP-2/Runx2/Osterix, OPG/RANKL and LGR4/RANKL Pathways in Postmenopausal Osteoporosis Fracture
Authors: Mai Caiyuan , Luo Xiping , Cao Yanming , Wang Zhizhong , Li Xinxu , Wang Bin
Published: January 2021

Objective Detect and analyse the correlation between factors of related pathways (Wnt/β-catenin, BMP-2/Runx2/Osterix, OPG/RANKL and LGR4/RANKL) and postmenopausal osteoporotic fracture (PMOPF). Methods The postmenopausal patients with tibial fracture were divided into control group (36 cases) and PMOPF group (36 cases). Using RNAiso Plus method to extract total RNA of bone tissue, RT-qPCR method was used to detect the expression of each factor. Detected the levels of serum of factors by ELISA method in control group. PMOPF group was divided into group A-F according to the blood collection time interval (at different time period), use ELISA method to detect each factor’s level. Compared the changes between control group and PMOPF group, and the subdivided groups of PMOPF group. Results (1) RT-qPCR detected the expressions of LRP5, β-catenin, Runx2, C-myc, Osterix, OPG and LGR4 in PMOPF group were lower than control group (P<0.05), but the expression of RANKL was increased (P<0.05). (2) ELISA detected the serum levels of LRP5, β-catenin, Runx2, C-myc, Osterix, OPG and LGR4 decreased significantly (P<0.05), and RANKL increased significantly (P<0.05). LRP5 and Runx2 appeared the lowest in Group B (2-3 days after fracture); β-catenin and C-myc appeared the lowest in Group C (4-7 days after fracture); RANKL appeared the highest in Group C; Osterix appeared the lowest in Group D (8-14 days after fracture); OPG and LGR4 appeared the lowest in Group E (15-28 days after fracture). Conclusion The related factors of Wnt/β-catenin, BMP-2/Runx2/Osterix, OPG/RANKL and LGR4/RANKL pathway are closely related to the occurrence of PMOPF. LRP5 and Runx2 decreased to the lowest level within 3 days after fracture, β-catenin and C-myc decreased to the lowest level within 7 days after fracture, the results showed that these changes in Wnt/β-catenin osteogenesis pathway were consistent; Osterix decreased to the lowest level within 14 days after fracture, OPG and LGR4 decreased to the lowest level within 28 days after fracture, which may be related to the difficulty of short-term healing of PMOPF; RANKL increased to the highest level within 7 days after fracture, which may be associated with the increase in bone formation after PMOPF. According to the changes and characteristics of these factors in above pathways, we can regulate or intervene the occurrence and progression of PMOPF.
Response Rate of Patient Reported Outcomes: the Delivery Method Matters
Authors: Neve Olaf , Benthem Peter Paul G. Van , Stiggelbout Anne M. , Hensen Erik F.
Published: January 2021

Background: Patient Reported Outcomes (PROs) are subjective outcomes of disease and/or treatment in clinical research. For effective evaluations of PROs, high response rates are crucial. This study assessed the impact of the delivery method on the patients’ response rate.Methods: A cohort of patients with a unilateral vestibular schwannoma (a condition with substantial impact on quality of life, requiring prolonged follow-up) was assigned to three delivery methods: email, regular mail, and hybrid. Patients were matched for age and time since the last visit to the outpatient clinic. The primary outcome was the response rate, determinants other than delivery mode were age, education and time since the last consultation. In addition, the effect of a second reminder by phone was evaluated. Results: In total 602 patients participated in this study. The response rates for delivery by email, hybrid, and mail were 45%, 58% and 60%, respectively. The response rates increased after a reminder by phone to 62%, 67% and 64%, respectively. A lower response rate was seen in association with a low level of education and longer time interval since last outpatient clinic visit.Conclusion: The response rate for PRO surveys is influenced by the delivery method. PRO surveys by regular mail yield the highest response rate, followed by hybrid and email delivery methods. Hybrid delivery combines good response rates with the ease of digitally returned questionnaires.
Characteristics and patient-reported outcomes associated to dropout in severely affected oncological patients
Authors: Gebert Pimrapat , Schindel Daniel , Frick Johann , Schenk Liane , Grittner Ulrike
Published: January 2021

BackgroundPatient-reported outcome measures (PROMs) are commonly used and are surrogates for clinical outcomes in cancer research. In the research setting of very severe diseases such as cancer, it is difficult to avoid the problem of incomplete questionnaires from drop-out or missing data due to patients who deceased during observation period. We aimed to explore patient characteristics and patient-reported outcomes associated with the time-to-dropout. MethodsIn the Oncological Social Care Project (OSCAR) study the condition of participants was assessed four times within 12 months (t0: baseline, t1: 3 months, t2: 6 months, and t3: 12 months) by validated PROMs. We performed competing-risks regression based on Fine and Gray’s proportional sub-distribution hazards model for exploring factors associated with time-to-dropout. Death was considered as competing risk. ResultsThree hundred sixty-two participants were analyzed in the study. 193 (53.3%) completed follow-up at 12 months, 67 (18.5%) patients dropped out, and 102 patients (28.2%) died during the study period. Poor subjective social support was related to higher risk for drop-out (SHR=2.10; 95%CI: 1.01 – 4.35). Lower values in health-related quality of life were related to drop-out and death. The subscales global health status/QoL, role functioning, physical functioning, and fatigue symptom in the EORTC QLQ-C30 were key characteristics associated with early drop-out.ConclusionSeverely affected cancer patients with poor social support and poor quality of life seem more likely to drop out of studies compared to patients with higher levels of social support and quality of life. This should be considered when planning studies assessing cancer patients. Methods to monitor drop-outs timely and handle missing outcomes might be used. Results of such studies have to be interpreted with caution in light of the particular drop-out mechanisms.
Highly Accurate Coiflet wavelet-Homotopy Solution of Jeffery-Hamel Problem at Extreme Parameters
Authors: Ahmed Sohail , Xu Hang , Wang An-Yang , Chen Qing-Bo
Published: January 2021

The magnetised Jeffery-Hamel flow due to a point sink or source in convergent and divergent channels is studied. The simplified governing equation ruled by the Reynolds number, the Hartmann number and the divergent-convergent angle with appropriate boundary conditions are solved by the newly proposed Coiflet wavelet-homotopy method. Highly accurate solutions are obtained, whose accuracy is rigidly checked. As compared with the traditional homotopy analysis method, our proposed technique has higher computational efficiency and larger applicable range of physical parameters. Results show that our proposed technique is very convenient to handle strong nonlinear problems without special treatment. It is expected that this technique can be further applied to study complex nonlinear problems in science and engineering involving into extreme physical parameters. Besides, the influence of physically important quantities on the flow is discussed. It is found that wall stretching and shrinking exhibits totally different roles on the flow development. The enhanced Lorenz force affects the flow behaviours significantly for both convergent and divergent cases.
Candida Species in Community-Acquired Pneumonia in Patients With Chronic Aspiration
Authors: Moss Benjamin Joseph , Musher Daniel M.
Published: January 2021

BackgroundWhen Candida is found in a sputum culture, clinicians generally dismiss it as a contaminant. We sought to identify cases of community-acquired pneumonia (CAP) in which Candida might play a contributory etiologic role.MethodsIn a convenience sample of patients hospitalized for CAP, we screened for “high-quality sputum” by Gram stain (>20 WBC/epithelial cell) and performed quantitative sputum cultures. Criteria for a potential etiologic role for Candida included the observation of large numbers of yeast forms on Gram stain and the finding of >106 CFU/ml Candida in sputum. We gathered clinical information on cases that met these criteria for possible Candida infection.ResultsSputum from 6 of 154 consecutive CAP patients had large numbers of extra- and intracellular yeast forms on Gram stain, with >106 CFU/ml Candida albicans, glabrata, or tropicalis on quantitative culture. In all 6 patients, the clinical diagnoses at admission included chronic aspiration. Greater than 105 CFU/ml of a recognized bacterial pathogen (Streptococcus pneumoniae, Staphylococcus aureus, or Pseudomonas) or >106 CFU/ml of other ‘normal respiratory flora’ (Lactobacillus species) were present together with Candida in every case. Blood cultures yielded Candida in 1 case, and 1,3-beta-D glucan was >500 ng/mL in 3 of 3 cases in which it was assayed. Since all patients were treated with anti-bacterial and anti-fungal drugs, no inference about etiology can be derived from therapeutic response.Conclusions﻿Candida species, together with a recognized bacterial pathogen or normal respiratory flora, may contribute to the cause of CAP in patients who chronically aspirate.
The Influence of Caffeine and Genistein Ingestion on Plasma Triglycerides Status in Male Soccer Players
Authors: Danielik Karol Mateusz , Łoźna Karolina , Bronkowska Monika
Published: January 2021

Background Scientific literature provides more and more information on compounds supporting fat metabolism. More research is needed to fully characterize the effects of compounds that increase concentration triglycerides. The aim of our study was to test the influence of caffeine and genistein consumption on triglyceride status in athletes.Methods Fourteen Polish adult sub-elite soccer players (23.1 ± 2.1 years; 179.6 ± 8.5 cm; 74.1 ± 8.5 kg; 12.4 ± 3.8% body fat) were accepted for research. The athletes for this randomized, double-blind study were joining fasted. After consuming a standardized milk meal, participants took caffeine (400 mg), genistein (120 mg), or placebo (400 mg of vitamin C). Athletes ate the compound if it saw a sequentially increase and decrease in triglyceride concentration after eating the test meal. Participants had their glucose levels measured every 15 minutes with a glucometer (Accu-Chek Active) and their triglyceride levels with CardioChek PA. The subject was terminating the study when he had sequentially increased and decreased triglyceride concentration after the compound. If no such reaction occurred, measurements were taken for up to 90 minutes. In order to determine statistically significant differences between the variables, non-parametric Kruskal-Wallis and U Mann-Whitney tests were used. The significance level of α = 0.05 was adopted for both of these tests. The relationships between the variables were determined using the Spearman R correlation. The correlations were statistically significant at p ≤ 0.100.Results A statistically significant difference was demonstrated between the initial and maximum triglyceride concentration after caffeine consumption compared to placebo (p = 0.049). After consuming caffeine, the athletes had a significant difference in trigliceride concentration at 30 min (p = 0.018) and 60 min (p = 0.036) compared to placebo. In the group taking genistein, only a statistically significant difference was noticed compared to placebo only in 60 min (p = 0.029).Conclusion Our research results show that after acute caffeine and genistein supplementation, triglyceride concentration increase in soccer players.
A Study Based on CASIA2: What the Subtle Changes Has Taken Place in the Shape of the Crystalline Lens After Cycloplegia?
Authors: Dai Cheng , Liu Meng , Lv Xiaodong , Li Binzhong
Published: January 2021

Background: To evaluate the shape of the crystalline lens biometry and the diopter before and after cycloplegia using the CASIA2 swept-source (SS) optical coherence tomography (OCT) system on the anterior segment.Methods: This is a retrospective study. Children and adolescents (26 males and 29 females, aged 4–21 years) with simple ametropia were selected for optometry and CASIA2 imaging at 2 separate visits before and after cycloplegia. Diopter is derived from the spherical power (S) obtained by optometry. The Biometric parameters of the crystalline lens, including anterior chamber depth (ACD), anterior and posterior curvature of the lens (ACL and PCL), lens thickness (LTH), lens decentration(LD), lens tilt(LT), and the equivalent diameter of the lens (LED), were measured by CASIA2. The differences of these parameters before and after cycloplegia were compared, and the relationship between them was analyzed.Results: Fifty-five participants (106 eyes) were initially enrolled. The differences were statistically significant(P<0.05) in S (t=-7.026, P=0.000), ACD (t=-8.796, P=0.000), ACL (t=-13.263, P=0.000) and LTH（t=7.363, P=0.000）before and after cycloplegia. The change of PCL (t=1.557,P=0.122), LD (t=0.876, P=0.383), LT (t=0.440, P=0.661) and LED（t=-0.351, P=0.726） was not statistically significant (P>0.05). There was a significant (P<0.05) correlation between the change in S and ACL(r=0.466, P=0.000),LTH (r=-0.592, P=0.000),and LED (r=0.223, P=0.021) but not between the PCL(r=0.19, P=0.051), LD (r=-0.048, P=0.0628) and LT (r=-0.022, P=0.822). Furthermore, the change of ACD is closely related to the change of crystal morphology. However, in children and adolescents, we found that the change of crystal morphology will not have anything to do with age.Conclusion: The morphological changes of the lens before and after cycloplegia are mainly the ACL and LTH, but there is no difference in the PCL, LD, LT, and LED. In the adolescent population, the change of S is related to the change of ACL, LED and LTH. However, age gets nothing to do with the shape of the crystalline lens. For different refractive states (myopia, hyperopia, emmetropia), whether groups of different ages can reach the same conclusion needs further research.