bluuebunny/crossref_metadata_2025 huggingface dataset:
Arthroscopic Ankle Arthrodesis with Circular External Fixator: Case Report
Authors: Araujo Caio A. , Pereira Vinícius F. , Mansur Nacime SB
Published: November 2022

Category:

Ankle Arthritis; Arthroscopy; Trauma

Introduction/Purpose:

One of the options for the surgical treatment of tibial pilon fracture is the circular external fixator. Similar results are found in the literature, with good outcomes in relation to a low incidence of infection, osteomyelitis and soft tissue injuries compared to open reduction and internal fixation. Even so, evolution to a probable arthrodesis occurs in 3-27% of cases, showing that the prognosis for this type of fracture is dismal. Options for performing joint fusion include open arthrotomy with joint decortication and internal fixation (plates and/or screws), in addition to arthroscopic joint preparation, a method that has been gaining popularity since 1983, in its first description. Fusion through circular external fixation is an excellent option that has shown good results in the literature.

Methods:

Patient with left tibial pilon fracture. Uniplanar external fixation was performed in the emergency room, with subsequent conversion to transarticular circular external fixation. After 4 months of review, the patient has evidence of tibiotarsal arthrosis. It was decided to perform arthrodesis using the arthroscopic technique, performing joint compression with circular external fixation, already installed in the patient. Spinal anesthesia was performed on the patient and the Smarch tourniquet was used. First, access to the anteromedial portal, trocar and optic passage was obtained, and the intermediate dorsal cutaneous branch of the superficial peroneal nerve was identified laterally, and the anterolateral portal was constructed. Through these portals, a 4.5mm Shaver blade was used to perform curettage and joint debridement, in addition to curettes and osteotomes. In addition to arthroscopic control, fluoroscopic observation was also performed for adequate joint preparation.Finally, joint compression was performed with the device already installed.

Results:

The patient presented complete consolidation of the tibio-tarsal arthrodesis. At the moment (2 years and 10 months postoperatively) the patient does not use crutches/gait accessories, does not limit his daily activities due to foot problems, does not have difficulty going down and up stairs, has good ankle alignment, plantigrade foot, has no joint pain and can walk long distances.

Conclusion:

This work showed a technique rarely reported or cited in the orthopedic literature, not presenting any article as an original description. Supported by the description of the procedure by the robust final functional results of the patient in question, this report establishes the basis for the widespread method and new works to emerge to enrich the debate and study around arthroscopic ankle arthrodesis using the Ilizarov method.
Surgical Repair of the Achilles Tendon using the Three Transverse Incision Technique
Authors: Araujo Caio A. , Maciel Eduardo S. , Mansur Nacime SB
Published: November 2022

Category:

Sports

Introduction/Purpose:

Acute rupture of the Achilles tendon is a frequent injury in our country, being the most common rupture of the tendon of the lower limbs(1), especially in men aged between 40-50 years(2). The main complication of the surgical treatment is the care of the soft tissue. To minimize this risk, the technique of three transverse incisions has shown good results and low postoperative complications. We believe that this surgical technique is a good alternative, especially with regard to soft tissue complications. Therefore, the objective of this work is to describe this surgical technique and demonstrate the benefits of its performance, since special materials are not required, and can be performed in any orthopedic service, in addition to the risk of soft tissue involvement.

Methods:

The proximal and distal stumps are palpated and a demarcation is performed 2 cm proximal to the proximal stump and 2 cm distal to the distal stump. A third demarcation is performed in the center of the gap. The first incision is performed proximally, opening the paratenon and exposing the proximal stump; the suture used is of the Krackow type and Vycril 2 was used. The same procedure is performed on the distal stump. After that, the third incision is made to allow suturing of the extremities and tendon approximation. Procedure performed with the foot in maximum plantar flexion. The planes (paratendon, subcutaneous and skin) are sutured and the limb is immobilized in plantar flexion. The patient remains immobilized in plantar flexion (1 week). The immobilization is exchanged for an orthopedic boot with 4 shims of 1.5 cm each and weight bearing is released with the aid of crutches.

Results:

Follow-up is performed in the first week for dressing evaluation and in the third week for stitch removal. After that, the patient returns at 6, 12, 24 and 48 weeks after surgery. To date, this technique has been used in 24 patients. There were no re- ruptures, sural nerve neuropraxia/axonotmesis or deep infection. There was 1 case with a superficial infection, which was quickly treated with oral antibiotic therapy. To date, 6 patients have completed the 48-week postoperative follow-up.

Conclusion:

New studies should be carried out for the best decision on the treatment to be followed in the event of an acute rupture of the Achilles tendon, as well as studies demonstrating, it is hoped, a decrease in the rate of complications with the use of less invasive techniques. Due to the low follow-up (6 patients) we have, it is difficult to make a comparison between the percutaneous and minimally invasive techniques currently described in the literature. documentation of the effectiveness and benefit of this technique.
Use of a Lightweight Portable Fluoroscopy Device for Obtaining Weightbearing Ankle Images
Authors: Ashkani-Esfahani Soheil , Schermann Haggai , Zhao John Z. , Lubberts Bart , Kaiser Philip , Waryasz Gregory R.
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Portable fluoroscopy devices provide point-of-care imaging in emergency and out-patient clinics. In patients suffering from ankle syndesmosis injuries, imaging under physiologic load can lead to more accurate diagnosis, particularly in subtle cases. In this study, we compared weightbearing images obtained using a novel lightweight portable battery-powered fluoroscopy device with a conventional radiography device regarding syndesmosis examination measurements.

Methods:

In this prospective study, eleven healthy participants underwent bilateral three-view weightbearing imaging of both ankles using a radiography (X-ray group) device and a portable fluoroscopy system (Smart-C group). Radiographic measurements were done by two observers on anteroposterior, mortise, and lateral views were compared between the two techniques. These measurements included talar tilt, tibiofibular clear space, tibiofibular overlap, plafond malleolar angle, medial distal tibial angle, medial clear space, lateral distal tibial angle, anterior and posterior tibiofibular distance were measured using the appropriate view. Data were compared between the two techniques; the interobserver agreement was calculated within each group. P<0.05 was considered statistically significant.

Results:

Comparing the two imaging modalities, there was no significant difference between the measurements in Smart-C and X- ray groups except plafond malleolar angle. The overall interobserver agreement was excellent between the two observers. There was no significant difference between the measures by the two observers and between the bilateral ankles.

Conclusion:

Our results support the use of weightbearing images using portable fluoroscopy device as an alternative for the conventional radiography systems, particularly in limited-resource settings.
Secreted mutant calreticulins as rogue cytokines in myeloproliferative neoplasms
Authors: Pecquet Christian , Papadopoulos Nicolas , Balligand Thomas , Chachoua Ilyas , Tisserand Amandine , Vertenoeil Gaëlle , Nédélec Audrey , Vertommen Didier , Roy Anita , Marty Caroline , Nivarthi Harini , Defour Jean-Philippe , El-Khoury Mira , Hug Eva , Majoros Andrea , Xu Erica , Zagrijtschuk Oleh , Fertig Tudor E. , Marta Daciana S. , Gisslinger Heinz , Gisslinger Bettina , Schalling Martin , Casetti Ilaria , Rumi Elisa , Pietra Daniela , Cavalloni Chiara , Arcaini Luca , Cazzola Mario , Komatsu Norio , Kihara Yoshihiko , Sunami Yoshitaka , Edahiro Yoko , Araki Marito , Lesyk Roman , Buxhofer-Ausch Veronika , Heibl Sonja , Pasquier Florence , Havelange Violaine , Plo Isabelle , Vainchenker William , Kralovics Robert , Constantinescu Stefan N.
Published: November 2022

Mutant calreticulin (CALR) proteins resulting from a −1/+2 frameshifting mutation of the CALR exon 9 carry a novel C-terminal amino acid sequence and drive the development of myeloproliferative neoplasms (MPNs). Mutant CALRs were shown to interact with and activate the thrombopoietin receptor (TpoR/MPL) in the same cell. We report that mutant CALR proteins are secreted and can be found in patient plasma at levels up to 160 ng/mL, with a mean of 25.64 ng/mL. Plasma mutant CALR is found in complex with soluble transferrin receptor 1 (sTFR1) that acts as a carrier protein and increases mutant CALR half-life. Recombinant mutant CALR proteins bound and activated the TpoR in cell lines and primary megakaryocytic progenitors from patients with mutated CALR in which they drive thrombopoietin-independent colony formation. Importantly, the CALR-sTFR1 complex remains functional for TpoR activation. By bioluminescence resonance energy transfer assay, we show that mutant CALR proteins produced in 1 cell can specifically interact in trans with the TpoR on a target cell. In comparison with cells that only carry TpoR, cells that carry both TpoR and mutant CALR are hypersensitive to exogenous mutant CALR proteins and respond to levels of mutant CALR proteins similar to those in patient plasma. This is consistent with CALR-mutated cells that expose TpoR carrying immature N-linked sugars at the cell surface. Thus, secreted mutant CALR proteins will act more specifically on the MPN clone. In conclusion, a chaperone, CALR, can turn into a rogue cytokine through somatic mutation of its encoding gene.
Frosted branch angiitis presenting after a SARS-CoV-2 infection
Authors: Alapati Akhila , Cameron Nathaniel , Gratton Sean , Stahl Erin , Champion Mary
Published: November 2022

Purpose

To report a case of frosted branch angiitis presenting in a pediatric patient with unremarkable laboratory work-up apart from SARS-CoV-2 IgG antibodies.

Observations

Less than four weeks after a SARS-CoV-2 infection, a 10 year-old female presented to the emergency department with severe headache and intermittent fevers. During her hospital admission, the ophthalmology service was consulted for blurry vision. Subsequent eye examination revealed frosted branch angiitis. The patient initially received intravenous corticosteroids but was escalated to plasmapheresis to achieve resolution of her symptoms. Outpatient maintenance therapy consisted of an oral Prednisone taper and Infliximab infusion.

Conclusion and importance

This case represents a unique ocular manifestation of COVID-19, as recent SARS-CoV-2 was the sole identifiable cause of the patient’s frosted branch angiitis. Additionally, this patient required plasmapheresis to control disease progression.
Involvement of kynurenine pathway between inflammation and glutamate in the underlying etiopathology of CUMS-induced depression mouse model
Authors: Wu Xingying , Chen Bowen , Di Zhong , Jiang Shuo , Xu Haipeng , Shi Mengting , Hu Rong , Sun Shaopeng , Song Zhujin , Liu Jiapeng , Ma Ruijie , Guo Qin
Published: November 2022

Inflammation and glutamate (GLU) are widely thought to participate in the pathogenesis of depression, and current evidence suggests that the development of depression is associated with the activation of the kynurenine pathway (KP). However, the exact mechanism of KP among the inflammation, GLU and depression remain poorly understood. In this study, we examined the involvement of KP, inflammation and GLU in depressive phenotype induced by chronic unpredictable mild stress (CUMS) in C57B/6 J mice. Our results showed that CUMS caused depressive like-behavior in the sucrose preference test, tail suspension test and forced swimming test. From a molecular perspective, CUMS upregulated the peripheral and central inflammatory response and activated indoleamine 2,3-dioxygenase (IDO), the rate-limiting enzyme of KP, which converts tryptophan (TRP) into kynurenine (KYN). KYN is a precursor for QA in microglia, which could activate the N-methyl-D-aspartate receptor (NMDAR), increasing the GLU release, mirrored by increased IDO activity, quinolinic acid and GLU levels in the hippocampus, prefrontal cortex and serum. However, intervention with IDO inhibitor 1-methyl-DL-tryptophan (50 mg/kg/s.c.) and 1-methyl-L-tryptophan (15 mg/kg/i.p.) reversed the depressive-like behaviors and adjusted central and peripheral KP’s metabolisms levels as well as GLU content, but the inflammation levels were not completely affected. These results provide certain evidence that KP may be a vital pathway mediated by IDO linking inflammation and glutamate, contributing to depression.
Minimal important difference and patient acceptable symptom state for common outcome instruments in patients with a closed humeral shaft fracture - analysis of the FISH randomised clinical trial data
Authors: Ibounig Thomas , Juurakko Joona , Lähdeoja Tuomas , Sumrein Bakir O. , Järvinen Teppo L. N. , Paavola Mika , Ardern Clare L. , Karjalainen Teemu , Taimela Simo , Rämö Lasse
Published: November 2022

Background

Two common ways of assessing the clinical relevance of treatment outcomes are the minimal important difference (MID) and the patient acceptable symptom state (PASS). The former represents the smallest change in the given outcome that makes people feel better, while the latter is the symptom level at which patients feel well.

Methods

We recruited 124 patients with a humeral shaft fracture to a randomised controlled trial comparing surgery to nonsurgical care. Outcome instruments included the Disabilities of Arm, Shoulder, and Hand (DASH) score, the Constant-Murley score, and two numerical rating scales (NRS) for pain (at rest and on activities). A reduction in DASH and pain scores, and increase in the Constant-Murley score represents improvement. We used four methods (receiver operating characteristic [ROC] curve, the mean difference of change, the mean change, and predictive modelling methods) to determine the MID, and two methods (the ROC and 75th percentile) for the PASS. As an anchor for the analyses, we assessed patients’ satisfaction regarding the injured arm using a 7-item Likert-scale.

Results

The change in the anchor question was strongly correlated with the change in DASH, moderately correlated with the change of the Constant-Murley score and pain on activities, and poorly correlated with the change in pain at rest (Spearman’s rho 0.51, -0.40, 0.36, and 0.15, respectively).

Depending on the method, the MID estimates for DASH ranged from -6.7 to -11.2, pain on activities from -0.5 to -1.3, and the Constant-Murley score from 6.3 to 13.5.

The ROC method provided reliable estimates for DASH (-6.7 points, Area Under Curve [AUC] 0.77), the Constant-Murley Score (7.6 points, AUC 0.71), and pain on activities (-0.5 points, AUC 0.68).

The PASS estimates were 14 and 10 for DASH, 2.5 and 2 for pain on activities, and 68 and 74 for the Constant-Murley score with the ROC and 75th percentile methods, respectively.

Conclusion

Our study provides credible estimates for the MID and PASS values of DASH, pain on activities and the Constant-Murley score, but not for pain at rest. The suggested cut-offs can be used in future studies and for assessing treatment success in patients with humeral shaft fracture.

Trial registration

ClinicalTrials.gov NCT01719887, first registration 01/11/2012.
Chimeric forecasting: combining probabilistic predictions from computational models and human judgment
Authors: McAndrew Thomas , Codi Allison , Cambeiro Juan , Besiroglu Tamay , Braun David , Chen Eva , De Cèsaris Luis Enrique Urtubey , Luk Damon
Published: November 2022

Forecasts of the trajectory of an infectious agent can help guide public health decision making. A traditional approach to forecasting fits a computational model to structured data and generates a predictive distribution. However, human judgment has access to the same data as computational models plus experience, intuition, and subjective data. We propose a chimeric ensemble—a combination of computational and human judgment forecasts—as a novel approach to predicting the trajectory of an infectious agent. Each month from January, 2021 to June, 2021 we asked two generalist crowds, using the same criteria as the COVID-19 Forecast Hub, to submit a predictive distribution over incident cases and deaths at the US national level either two or three weeks into the future and combined these human judgment forecasts with forecasts from computational models submitted to the COVID-19 Forecasthub into a chimeric ensemble. We find a chimeric ensemble compared to an ensemble including only computational models improves predictions of incident cases and shows similar performance for predictions of incident deaths. A chimeric ensemble is a flexible, supportive public health tool and shows promising results for predictions of the spread of an infectious agent.
The clinicopathological characteristics of POLE-mutated/ultramutated endometrial carcinoma and prognostic value of POLE status: a meta-analysis based on 49 articles incorporating 12,120 patients
Authors: Wu Qing , Zhang Nianhai , Xie Xianhe
Published: November 2022

Objective

This study was designed to investigate the frequency and clinicopathological characteristics of POLE-mutated/ultramutated (POLEmut) in endometrial carcinoma (EC) and assess the prognostic values of POLE status.

Methods

Electronic databases were screened to identify relevant studies. Meta-analysis was used to yield the pooled frequency of POLEmut and prognostic parameters by 95% confidence interval (CI), odd ratio (OR), and hazard ratio (HR).

Results

Totally, 12,120 EC patients from 49 studies were included. The pooled frequency of POLEmut was 7.95% (95% CI: 6.52–9.51%) in EC, 7.95% (95% CI: 6.55–9.46%) in endometrioid endometrial carcinoma, and 4.45% (95% CI: 2.63–6.61%) in nonendometrioid endometrial carcinoma. A higher expression occurred in grade 3 (OR = 0.51, 95% CI: 0.36–0.73, P = 0.0002), FIGO stage I-II (OR = 1.91, 95% CI: 1.29–2.83, P = 0.0013), and myometrial invasion< 50% (OR = 0.66, 95% CI: 0.50–0.86, P = 0.0025). Survival analyses revealed favorable OS (HR = 0.68, 95% CI: 0.55–0.85, P = 0.0008), PFS (HR = 0.74, 95% CI: 0.59–0.93, P = 0.0085), DSS (HR = 0.61, 95% CI: 0.44–0.83, P = 0.0016), and RFS (HR = 0.47, 95% CI: 0.35–0.61, P <  0.0001) for POLEmut ECs. Additionally, the clinical outcomes of POLEmut group were the best, but those of p53-abnormal/mutated (p53abn) group were the worst, while those of microsatellite-instable (MSI)/hypermutated group and p53-wild-type (p53wt) group were medium.

Conclusions

The POLEmut emergered higher expression in ECs with grade 3, FIGO stage I-II, and myometrial invasion< 50%; it might serve as a highly favorable prognostic marker in EC; the clinical outcomes of POLEmut group were the best one among the four molecular subtypes.
Efficacy and safety of adjuvant chemotherapy in T1N0M0 intrahepatic cholangiocarcinoma after radical resection
Authors: Li Xiao-hui , Zhao Chong-yu , Zhou En-liang , Lin Xiao-jun
Published: November 2022

Objective

Adjuvant chemotherapy is necessary for radical resection of intrahepatic cholangiocarcinoma (ICC) with a high risk of recurrence (T2–4, N1). However, its use in the treatment of early-stage ICC remains controversial. This study aimed to investigate the role of adjuvant chemotherapy after radical resection in patients with early-stage ICC (T1N0M0).

Data and methods

The data of 148 patients with pathologically diagnosed ICC (T1N0M0) who underwent radical resection from January 2012 to January 2018 at the Sun Yat-sen University Cancer Center were retrospectively analyzed. Using consistent baseline data, Kaplan–Meier survival curves were constructed to compare relapse-free survival (RFS) and overall survival (OS) between patients who received postoperative adjuvant chemotherapy (AC group) and those who received only surgical treatment (non-AC group). Univariate and multivariate Cox regression analyses were used to screen for independent prognostic factors affecting survival. The RFS and OS of patients were analyzed after the administration of three adjuvant chemotherapy regimens (gemcitabine + capecitabine [GX], gemcitabine + cisplatin [GP], and capecitabine monotherapy [X]). Finally, the safety of adjuvant chemotherapy was evaluated based on the incidence of grade 1–4 adverse events.

Results

The median RFS was 18 months in the non-AC group and 25 months in the AC group. The median OS was 34 months in the non-AC group; however, it was not reached in the AC group. The OS of the AC group was significantly higher than that of the non-AC group (P = 0.005). Multivariate Cox analysis demonstrated that nerve invasion (P = 0.001), preoperative elevation of cancer antigen 19–9 (CA 19–9) levels (P = 0.009), and postoperative adjuvant chemotherapy (P = 0.009) were independent prognostic factors for early-stage ICC after radical resection. The OS rates of the GX, GP, X, and non-AC groups were significantly different (P = 0.023) and were higher in the GX group than in the non-AC group (P = 0.0052). Among patients with elevated preoperative CA 19–9 levels, the OS rate was higher in the AC group than in the non-AC group (P = 0.022). In terms of safety, the incidence of grade 3 or 4 adverse reactions was < 18.2% in the GX, GP, and X groups, without the occurrence of death owing to such reactions.

Conclusion

Adjuvant chemotherapy can prolong OS among patients with early-stage ICC who have undergone radical resection. Preoperative elevation of CA 19–9 levels and nerve invasion are independent prognostic factors for poor survival outcomes for early-stage ICC after radical resection. All chemotherapy regimens used in the study are safe.
Is there variation in utilization of preoperative tests among patients undergoing total hip and knee replacement in the US, and does it affect outcomes? A population-based analysis
Authors: Hasan Mohamed Mosaad , Kang Raymond , Lee Jungwha , Beal Matthew D. , Ahmed Abdalrahman G. , Tian Yao , Ghomrawi Hassan M. K.
Published: November 2022

Study objective

To describe recent practice patterns of preoperative tests and to examine their association with 90-day all-cause readmissions and length of stay.

Design

Retrospective cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS).

Setting

SPARCS from March 1, 2016, to July 1, 2017.

Participants

Adults undergoing Total Hip Replacement (THR) or Total Knee Replacement (TKR) had a preoperative screening outpatient visit within two months before their surgery.

Interventions

Electrocardiogram (EKG), chest X-ray, and seven preoperative laboratory tests (RBCs antibody screen, Prothrombin time (PT) and Thromboplastin time, Metabolic Panel, Complete Blood Count (CBC), Methicillin Resistance Staphylococcus Aureus (MRSA) Nasal DNA probe, Urinalysis, Urine culture) were identified.

Primary and secondary outcome measures

Regression analyses were utilized to determine the association between each preoperative test and two postoperative outcomes (90-day all-cause readmission and length of stay). Regression models adjusted for hospital-level random effects, patient demographics, insurance, hospital TKR, THR surgical volume, and comorbidities. Sensitivity analysis was conducted using the subset of patients with no comorbidities.

Results

Fifty-five thousand ninety-nine patients (60% Female, mean age 66.1+/− 9.8 SD) were included. The most common tests were metabolic panel (74.5%), CBC (66.8%), and RBC antibody screen (58.8%). The least common tests were MRSA Nasal DNA probe (13.0%), EKG (11.7%), urine culture (10.7%), and chest X-ray (7.9%). Carrying out MRSA testing, urine culture, and EKG was associated with a lower likelihood of 90-day all-cause readmissions. The length of hospital stay was not associated with carrying out any preoperative tests. Results were similar in the subset with no comorbidities.

Conclusions

Wide variation exists in preoperative tests before THR and TKR. We identified three preoperative tests that may play a role in reducing readmissions. Further investigation is needed to evaluate these findings using more granular clinical data.
Successful management of ectopic kidney stones in a patient with situs inversus totalis: a rare case report
Authors: Mansour Marah , Naksho Abdulmonem , Ouerdane Yassamine , Alsuliman Tamim , Almozawer Hani , Alrebdawi Khaled
Published: November 2022

Background

Situs inversus totalis is a very rare congenital anatomical variation, in which all thoracic and abdominal organs are right-left inverted. This condition is associated with an increased risk of organ malformations including ectopic kidney, which is a very rare combination.

Case presentation

A 56-year-old male presented with colicky left iliac pain associated with nausea, vomiting, and irritative lower urinary symptoms. The patient has a medical history of recurrent lower urinary infections and a family history of situs inversus totalis. Radiological images demonstrated dextrocardia, situs inversus totalis of all the abdominal organs, and an ectopic pelvic kidney on the left side, with 4 stones inside it. Left nephrectomy was performed due to extensive renal damage. At discharge and during follow-up, the patient's condition was satisfactory and stable.

Conclusions

The ectopic kidney may present diagnostic and therapeutic challenges when associated with situs inversus.
Association of lipid, inflammatory, and metabolic biomarkers with age at onset for incident cardiovascular disease
Authors: Tian Xue , Chen Shuohua , Zuo Yingting , Zhang Yijun , Zhang Xiaoli , Xu Qin , Luo Yanxia , Wu Shouling , Wang Anxin
Published: November 2022

Background

Risk profiles for premature cardiovascular disease (CVD) are unclear. This study aimed to examine baseline risk profiles for incident CVD by age at onset in Chinese population.

Methods

A total of 97,841 participants without CVD were enrolled from the Kailuan cohort study. Four age groups were examined (< 55, 55 to < 65, 65 to < 75, and ≥ 75 years) for CVD onset. Risk profiles included clinical, lipid, metabolic, and inflammatory risk factors and biomarkers.

Results

Of the clinical factors, diabetes was associated with the highest relative risk for incident CVD in participants younger than 55 years (sub-distributional hazard ratio [sHR], 4.08; 95% confidence interval [CI], 3.47–4.80). Risk factors that were also noted for CVD onset in participants younger than 55 years included hypertension, metabolism syndrome, overweight or obese, dyslipidemia, and smoking. Among the biomarkers, insulin resistance measured by triglyceride-glucose index had the highest sHR (1.42; 95% CI, 1.35–1.49) for CVD in participants younger than 55 years. In comparison, weaker but significant associations with CVD in participants younger than 55 years were noted for most lipids, metabolic biomarkers, and inflammatory biomarkers. Most risk factors and biomarkers had associations that attenuated with increasing age at onset. Some biomarkers had similar CVD age association, while a few had no association with CVD onset at any age.

Conclusions

These findings showed that diabetes and insulin resistance, in addition to hypertension, metabolism syndrome, overweight or obese, dyslipidemia, and smoking, appeared to be the strongest risk factors for premature onset of CVD, and most risk factors had attenuated relative rates at older ages.
Facial expression recognition is linked to clinical and neurofunctional differences in autism
Authors: Meyer-Lindenberg Hannah , Moessnang Carolin , Oakley Bethany , Ahmad Jumana , Mason Luke , Jones Emily J. H. , Hayward Hannah L. , Cooke Jennifer , Crawley Daisy , Holt Rosemary , Tillmann Julian , Charman Tony , Baron-Cohen Simon , Banaschewski Tobias , Beckmann Christian , Tost Heike , Meyer-Lindenberg Andreas , Buitelaar Jan K. , Murphy Declan G. , Brammer Michael J. , Loth Eva
Published: November 2022

Background

Difficulties in social communication are a defining clinical feature of autism. However, the underlying neurobiological heterogeneity has impeded targeted therapies and requires new approaches to identifying clinically relevant bio-behavioural subgroups. In the largest autism cohort to date, we comprehensively examined difficulties in facial expression recognition, a key process in social communication, as a bio-behavioural stratification biomarker, and validated them against clinical features and neurofunctional responses.

Methods

Between 255 and 488 participants aged 6–30 years with autism, typical development and/or mild intellectual disability completed the Karolinska Directed Emotional Faces task, the Reading the Mind in the Eyes Task and/or the Films Expression Task. We first examined mean-group differences on each test. Then, we used a novel intersection approach that compares two centroid and connectivity-based clustering methods to derive subgroups based on the combined performance across the three tasks. Measures and subgroups were then related to clinical features and neurofunctional differences measured using fMRI during a fearful face-matching task.

Results

We found significant mean-group differences on each expression recognition test. However, cluster analyses showed that these were driven by a low-performing autistic subgroup (~ 30% of autistic individuals who performed below 2SDs of the neurotypical mean on at least one test), while a larger subgroup (~ 70%) performed within 1SD on at least 2 tests. The low-performing subgroup also had on average significantly more social communication difficulties and lower activation in the amygdala and fusiform gyrus than the high-performing subgroup.

Limitations

Findings of autism expression recognition subgroups and their characteristics require independent replication. This is currently not possible, as there is no other existing dataset that includes all relevant measures. However, we demonstrated high internal robustness (91.6%) of findings between two clustering methods with fundamentally different assumptions, which is a critical pre-condition for independent replication.

Conclusions

We identified a subgroup of autistic individuals with expression recognition difficulties and showed that this related to clinical and neurobiological characteristics. If replicated, expression recognition may serve as bio-behavioural stratification biomarker and aid in the development of targeted interventions for a subgroup of autistic individuals.
On some new generalized fractional Bullen-type inequalities with applications
Authors: Hussain Sabir , Rafeeq Sobia , Chu Yu-Ming , Khalid Saba , Saleem Sahar
Published: November 2022

In this paper, we establish a Bullen-type generalized fractional integral identity for the differentiable functions and derive some new estimates for the Bullen-type fractional integral inequalities via the Raina fractional integrals. Further examples are given to indicate the validity of obtained results. Lastly, some error estimates for the quadrature rules are provided, and to find applications for our results to information theory, we proved a new generalization based on f-divergence measure.
COVID-19 and aerobic exercise: possible role of angiotensin converting enzyme 2
Authors: Djemai Haidar , Hammad Rami , Dabayebeh Ibrahim M. , Hammad Saleh , Merzouk Abdellah , Coumoul Xavier , Noirez Philippe
Published: November 2022

The emergence and circulation of a novel coronavirus (2019-nCoV)—Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)—set off a global health crisis. SARS-CoV-2 spreads faster than its two ancestors, SARS-CoV and MERS-CoV. Several modes of transmission have been identified: via respiratory droplets, contact with infected people or contaminated surfaces, and potentially, bioaerosols. Various countries have taken preventive measures that may include partial or total lockdowns lasting weeks. The physical inactivity associated with lockdowns may promote cardiometabolic or other diseases, while physical activity may play a critical role in preventing them. Here we develop the hypothesis of the involvement of aerosols in the contamination process, the role of angiotensin converting enzyme 2 (ACE2), the potential benefits and harm of physical activity during lockdowns, and we suggest directions for future research.
Determinants of change in unintended pregnancy in Ethiopia using the 2005 and 2016 EDHS: non-linear multivariable decomposition analysis
Authors: Tareke Abiyu Abadi , Enyew Ermias Bekele , Dubale Abiy Tasew , Shimie Aynadis Worku , Kasaye Mulugeta Desalegn , Eshetu Habitu Birhan
Published: November 2022

Background

Unintended pregnancy is a pregnancy either mistimed or unwanted. The main consequence of unintended pregnancy is inducing abortion. In Ethiopia, more than half of unintended pregnancies end up in abortion.

Objective

This study aims to measure the change in unintended pregnancy among women of reproductive age between survey years 2005 and 2016 and to identify the socio-demographic factors that most significantly contributed to the change.

Methods

Data from the two most recent Ethiopian Demographic and Health Surveys (EDHS) were analyzed. We quantified the contribution of socio-demographic factors in the change of unintended pregnancy, using Oaxaca-Blinder decomposition for non-linear regression models by applying the STATA command ‘mvdcmp’.

Result

Unintended pregnancy decreased from 37% in 2005 to 27% in 2016 in Ethiopia. Both changes in population characteristics and coefficient were the contributing elements to the observed change in unintended pregnancy. Among population characteristics factors, being a partial decision-maker and being a slum in the Somali region contributed 10 and 14% to the change of unintended pregnancy between the 2005 and 2016. Of the coefficient factors, knowledge of modern family planning, being a partial decision-maker, media exposure, distance to health facilities, and health facility visits contributed to the change by 93, 43, 17, and 10% respectively.

Conclusion

The majority of the change in unintended pregnancy from 2005 to 2016 survey was due to differences in coefficients (85%). The principal contributing factors to the change of unintended pregnancy were FP knowledge, decision making, media exposure and health facility visits. Therefore, an interventional plan will be efficient, better, and more effective if focused on the larger contributing factors.
Temperature-dependent modal analysis of the InSight lander on Mars
Authors: Zhang Lei , Gao Fei , Liu Zai , Cao Peng , Zhang Jinhai
Published: November 2022

The first high-performance seismometer on Mars, deployed by InSight, has been working for nearly two Martian years. However, the recorded seismic data are substantially affected by the natural frequencies of the lander. To analyze the effect of the natural frequencies of the lander on specific components of the seismic data, we have built a simplified finite-element model of the lander to conduct modal analyses. Three natural frequencies are modeled by comparing them with those identified from the observed data. These natural frequencies are nonconstant and temperature dependent, which can be explained as an elastic modulus reduction of the solar panels (35% at most) and/or the property changes of the ground media beneath the lander due to a daily air temperature variation of approximately 100 K on Mars. Compared with the previous studies based on the empirical models before the launch, our results can quantitatively evaluate natural modes and their temperature dependency. Thus, these analyses are helpful in avoiding the potential interference of natural frequencies and improving the reliability of seismic data applications.
Medicare Advantage: A Disadvantage for Complex Cancer Surgery Patients
Authors: Raoof Mustafa , Ituarte Philip H.G. , Haye Sidra , Jacobson Gretchen , Sullivan Kevin M. , Eng Oliver , Kim Jae , Fong Yuman
Published: November 2022

PURPOSE

Nearly half of all Medicare beneficiaries are enrolled in privatized Medicare insurance plans (Medicare Advantage [MA]). Little comparative information is available about access, outcomes, and cost of inpatient cancer surgery between MA and Traditional Medicare (TM) beneficiaries. We set out to assess and compare access, postoperative outcomes, and estimated cost of inpatient cancer surgery among MA and TM beneficiaries.

METHODS

Retrospective cohort analysis of MA or TM beneficiaries undergoing elective inpatient cancer surgery (for cancers located in lung, esophagus, stomach, pancreas, liver, colon, or rectum) was performed using the Office of Statewide Health Planning Inpatient Database linked to California Cancer Registry from 2000 to 2020. For each cancer site, risk-standardized access to high-volume hospitals, postoperative 30-day mortality, complications, failure to rescue, and surgery-specific estimated costs were compared between MA and TM beneficiaries.

RESULTS

This analysis of 76,655 Medicare beneficiaries (median age 74 years, 51% female, 39% MA) included 31,913 colectomies, 10,358 proctectomies, 4,604 hepatectomies, 2,895 pancreatectomies, 3,639 gastrectomies, 1,555 esophagectomies, and 21,691 lung resections. Except for colon surgery, MA beneficiaries were less likely to receive care at a high-volume hospital. Mortality was significantly higher among MA beneficiaries ( v TM) for gastrectomy (adjusted risk difference [ARD], 1.5%; 95% CI, 0.01 to 2.9; P = .036), pancreatectomy (ARD, 2.0%; CI, 0.80 to 3.3; P = .002), and hepatectomy (ARD, 1.4%; 95% CI, 0.1 to 2.9; P = .04). By contrast, compared with TM, MA beneficiaries incurred lower estimated hospital costs.

CONCLUSION

Enrollment in MA plan is associated with lower estimated hospital costs. However, compared with TM, MA beneficiaries had lower access to high-volume hospitals and increased 30-day mortality for stomach, pancreas, or liver surgery.
Making Every Meeting Count: A Qualitative Investigation of Multiteam Meeting Events and Their Role in Supporting Coordinated Cancer Care Delivery
Authors: Wolf Annamaria V. , Hedrick Katelyn N. , Begerowski Sydney R. , Wiper Donald W. , Carter Dorothy R. , Shuffler Marissa L.
Published: November 2022

PURPOSE:

This research considers how cross-disciplinary cancer care meetings can facilitate coordination within the multiteam systems (MTSs) that provide inpatient hospital care. We conducted a series of interviews and observations with members of a single cancer care MTS to address the following research questions: (1) what are the key characteristics of MTS cancer care meetings (with regard to composition, focus, and structure)? and (2) how is cross-team coordination acknowledged and addressed during these meetings?

METHODS:

In this single-site case study of a MTS operating to provide gynecologic oncology care within a teaching hospital, two types of meetings, called rounds and huddles, were held consistently. We used qualitative methods, including interviews with health care professional subject matter experts and 30 hours of observations of cancer care meetings, and analyzed the data in three stages of qualitative coding.

RESULTS:

Our analyses resulted in a thematic framework detailing key processes, and subprocesses, identified as central to the activities of observed cancer care meetings. Key processes include information sharing, gaining clarity, strategizing, and pedagogy. Discussions and explanations of this framework showcase the ways in which MTS meetings can bolster cross-team coordination and facilitate MTS activities.

CONCLUSION:

Inpatient cancer care meetings provide opportunities to facilitate MTS coordination in several ways, yet doing so does not come without challenges. Considering these results together with insights from meeting science and MTS research, this article concludes by putting forward practical recommendations for leveraging opportunities and overcoming challenges to use cancer care meetings as tools to support cross-team coordination.
The HACKD Score—Predicting Extent of Resection of Pituitary Macroadenomas Through an Endoscopic Endonasal Transsphenoidal Approach
Authors: Castle-Kirszbaum Mendel , Wang Yi Yuen , King James , Kam Jeremy , Goldschlager Tony
Published: November 2022

BACKGROUND:

Predicting extent of resection before pituitary surgery is imperative for operative planning and patient counseling. In the era of endoscopic endonasal transsphenoidal surgery (EEA), a specific, reliable tool for predicting resection of macroadenomas would have widespread applications.

OBJECTIVE:

To identify factors that predict resection of pituitary macroadenomas through the EEA.

METHODS:

A prospectively maintained, multicenter database of 277 consecutive macroadenomas resected through the EEA was analyzed. Multivariate logistic regression identified predictors of gross total resection (GTR). A simple scoring system, the Hardy, Age, Clival, Knosp, Depth (HACKD) Score, was developed and tested.

RESULTS:

GTR was achieved in 82.3% (228/277) of cases. Older than 50 years (odds ratio [OR] 2.96, P = .01), clival extension (OR 5.87, P < .01), Hardy grade C or D suprasellar extension (OR 3.91, P = .01), Knosp grade 3 or 4 cavernous sinus invasion (OR 7.62, P < .01), and tumor depth >20 mm (OR 5.14, P < .01) were all associated with subtotal resection. The HACKD score, awarding 1 point each for Hardy grade C or D, and older than 50 years, and 2 points each for clival extension, Knosp grades 3 or 4, and tumor depth >20 mm, demonstrated excellent discriminative ability (AUROC 0.887, 95% CI: 0.839-0.934). The rate of GTR progressively decreased with a higher HACKD score. Rates of GTR were 95.8% (182/190) for low (HACKD ≤2), 59.5% (44/74) for moderate (HACKD 3-5), and 15.4% (2/13) for high (HACKD 6+) HACKD scores.

CONCLUSION:

The HACKD score is a simple and accurate tool based on the largest study analyzing predictors of GTR in pituitary macroadenomas operated through the EEA.
A method for stabilising the XX karyotype in female mESC cultures
Authors: Keniry Andrew , Jansz Natasha , Hickey Peter F. , Breslin Kelsey A. , Iminitoff Megan , Beck Tamara , Gouil Quentin , Ritchie Matthew E. , Blewitt Marnie E.
Published: November 2022

Female mouse embryonic stem cells (mESCs) present differently from male mESCs in several fundamental ways; however, complications with their in vitro culture have resulted in an under-representation of female mESCs in the literature. Recent studies show that the second X chromosome in female, and more specifically the transcriptional activity from both of these chromosomes due to absent X chromosome inactivation, sets female and male mESCs apart. To avoid this undesirable state, female mESCs in culture preferentially adopt an XO karyotype, with this adaption leading to loss of their unique properties in favour of a state that is near indistinguishable from male mESCs. If female pluripotency is to be studied effectively in this system, it is crucial that high-quality cultures of XX mESCs are available. Here, we report a method for better maintaining XX female mESCs in culture that also stabilises the male karyotype and makes study of female-specific pluripotency more feasible.
Prognostication of overall survival in patients with brain metastases using diffusion tensor imaging and dynamic susceptibility contrast-enhanced MRI
Authors: de Godoy Laiz Laura , Chen Yin Jie , Chawla Sanjeev , Viaene Angela N , Wang Sumei , Loevner Laurie A , Alonso-Basanta Michelle , Poptani Harish , Mohan Suyash
Published: November 2022

Objectives:

To investigate the prognostic utility of DTI and DSC-PWI perfusion-derived parameters in brain metastases patients.

Methods:

Retrospective analyses of DTI-derived parameters (MD, FA, CL, CP, and CS) and DSC-perfusion PWI-derived rCBVmaxfrom 101 patients diagnosed with brain metastases prior to treatment were performed. Using semi-automated segmentation, DTI metrics and rCBVmaxwere quantified from enhancing areas of the dominant metastatic lesion. For each metric, patients were classified as short- and long-term survivors based on analysis of the best coefficient for each parameter and percentile to separate the groups. Kaplan-Meier analysis was used to compare mOS between these groups. Multivariate survival analysis was subsequently conducted. A correlative histopathologic analysis was performed in a subcohort (n = 10) with DTI metrics and rCBVmaxon opposite ends of the spectrum.

Results:

Significant differences in mOS were observed for MDmin(p < 0.05), FA (p < 0.01), CL (p < 0.05), and CP (p < 0.01) and trend toward significance for rCBVmax(p = 0.07) between the two risk groups, in the univariate analysis. On multivariate analysis, the best predictive survival model was comprised of MDmin(p = 0.05), rCBVmax(p < 0.05), RPA (p < 0.0001), and number of lesions (p = 0.07). On histopathology, metastatic tumors showed significant differences in the amount of stroma depending on the combination of DTI metrics and rCBVmax values. Patients with high stromal content demonstrated poorer mOS.

Conclusion:

Pretreatment DTI-derived parameters, notably MDminand rCBVmax, are promising imaging markers for prognostication of OS in patients with brain metastases. Stromal cellularity may be a contributing factor to these differences.

Advances in knowledge:

The correlation of DTI-derived metrics and perfusion MRI with patient outcomes has not been investigated in patients with treatment naïve brain metastasis. DTI and DSC-PWI can aid in therapeutic decision-making by providing additional clinical guidance.