bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Perioperative Opioid Use on Patients Undergoing Hip Arthroscopy
Authors: Rogers Miranda J. , LaBelle Mark W. , Kim Jaewhan , Adeyemi Temitope F. , Sciarretta Christopher E. , Bokat Christina E. , Maak Travis G.
Published: March 2022

Background:

Opioids are commonly used to treat postoperative pain; however, guidelines vary regarding safe opioid use after hip arthroscopy.

Purpose/Hypothesis:

The purposes were to (1) identify risk factors for persistent opioid use, (2) assess the effect of opioid use on outcomes, and (3) describe common opioid prescribing patterns after hip arthroscopy. It was hypothesized that preoperative opioid use would affect complication rates and result in greater postoperative opioid use.

Study Design:

Case-control study; Level of evidence 3.

Methods:

The Utah State All Payer Claims Database was queried for patients who underwent hip arthroscopy between January 2013 and December 2017. Included were patients ≥14 years of age at index surgery with continuous insurance. Patients were separated into acute (<3 months) and chronic (≥3 months) postoperative opioid use groups. Primary outcomes included revision surgery, complications (infection, pulmonary embolism/deep venous thrombosis, death), emergency department (ED) visits, and hospital admissions. Multivariate logistic regression was utilized to identify factors associated with the outcomes.

Results:

Included were 2835 patients (mean age, 47 years; range, 14-64 years), of whom 2544 were in the acute opioid use and 291 were in the chronic opioid use group. Notably, 91% of the patients in the chronic group took opioid medications preoperatively, and they were more than twice as likely to carry a mental health diagnosis ( P < .01). Patients in the acute group had a significantly shorter initial prescription duration, took fewer opioid pills, and had fewer refills than those in the chronic group ( P < .01 for all). Patients in the chronic group had a significantly higher risk of postoperative ED visits (odds ratio [OR], 2.76; P = .008), hospital admission (OR, 3.02; P = .002), and additional surgery ( P = .003), as well as infection (OR, 2.55; P < .001) and hematoma (OR, 2.43; P = .030). Patients who had used opioids before hip arthroscopy were more likely to need more refills ( P < .01). A formal opioid use disorder diagnosis correlated significantly with postoperative hospital admissions (OR, 3.83; P = .044) and revision hip arthroscopy (OR, 4.72; P = .003).

Conclusion:

Mental health and substance use disorders were more common in patients with chronic postoperative opioid use, and chronic postoperative opioid use was associated with greater likelihood of postoperative complications. Preoperative opioid use was significantly correlated with chronic postoperative opioid use and with increased refill requests after index arthroscopy.
What Are the Causes and Consequences of Delayed Surgery for Pediatric Tibial Spine Fractures? A Multicenter Study
Authors: Smith Haley E. , Cruz Aristides I. , Mistovich R. Justin , Leska Tomasina M. , Ganley Theodore J. , Aoyama Julien T. , Ellis Henry B. , Kushare Indranil , Lee Rushyuan J. , McKay Scott D. , Milbrandt Todd A. , Rhodes Jason T. , Sachleben Brant C. , Schmale Gregory A. , Patel Neeraj M.
Published: March 2022

Background:

The uncommon nature of tibial spine fractures (TSFs) may result in delayed diagnosis and treatment. The outcomes of delayed surgery are unknown.

Purpose:

To evaluate risk factors for, and outcomes of, delayed surgical treatment of pediatric TSFs.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The authors performed a retrospective cohort study of TSFs treated surgically at 10 institutions between 2000 and 2019. Patient characteristics and preoperative data were collected, as were intraoperative information and postoperative complications. Surgery ≥21 days after injury was considered delayed based on visualized trends in the data. Univariate analysis was followed by purposeful entry multivariate regression to adjust for confounders.

Results:

A total of 368 patients (mean age, 11.7 ± 2.9 years) were included, 21.2% of whom underwent surgery ≥21 days after injury. Patients who experienced delayed surgery had 3.8 times higher odds of being diagnosed with a TSF at ≥1 weeks after injury (95% CI, 1.1-14.3; P = .04), 2.1 times higher odds of having seen multiple clinicians before the treating surgeon (95% CI, 1.1-4.1; P = .03), 5.8 times higher odds of having magnetic resonance imaging (MRI) ≥1 weeks after injury (95% CI, 1.6-20.8; P < .007), and were 2.2 times more likely to have public insurance (95% CI, 1.3-3.9; P = .005). Meniscal injuries were encountered intraoperatively in 42.3% of patients with delayed surgery versus 21.0% of patients treated without delay ( P < .001), resulting in 2.8 times higher odds in multivariate analysis (95% CI, 1.6-5.0; P < .001). Delayed surgery was also a risk factor for procedure duration >2.5 hours (odds ratio, 3.3; 95% CI, 1.4-7.9; P = .006). Patients who experienced delayed surgery and also had an operation >2.5 hours had 3.7 times higher odds of developing arthrofibrosis (95% CI, 1.1-12.5; P = .03).

Conclusion:

Patients who underwent delayed surgery for TSFs were found to have a higher rate of concomitant meniscal injury, longer procedure duration, and more postoperative arthrofibrosis when the surgery length was >2.5 hours. Those who experienced delays in diagnosis or MRI, saw multiple clinicians, and had public insurance were more likely to have a delay to surgery.
Culture’s Gendered Consequences: The Relationship Between Local Cultural Conditions and the Gender Wage Gap
Authors: Scarborough William J. , Moeder Jessica
Published: March 2022

Local economic conditions have been found to be highly influential in shaping patterns of gender inequality across the United States. Less attention, however, has been directed toward exploring the role of cultural characteristics, such as gender norms toward women’s leadership and family divisions of labor. Using data from the American Community Survey and the General Social Survey, we examine the relationship between local gender norms and levels of the gender wage gap across US commuting zones. Results indicate that gender egalitarian family norms predict lower gender wage gaps, while norms toward women’s suitability for leadership are unrelated to wage inequality between women and men. Investigating the mechanisms by which local norms relate to gender wage gaps, we find that family gender norms are unrelated to occupational gender segregation. Instead, egalitarian gender norms toward the family division of labor are associated with greater within-occupation wage equality, indicating that women and men in the same occupations have more equitable opportunities and compensation in contexts where family expectations are shared equally.
Occupational Fatigue and Associated Factors among Saudi Nurses Working 8-Hour Shifts at Public Hospitals
Authors: Alsayed Sharifah Abdulmuttalib , Abou Hashish Ebtsam Aly , Alshammari Farhan
Published: March 2022

Introduction

Shift work and demanding work schedules contribute to occupational fatigue, negatively affecting patient safety and nurses’ well-being, consequently placing nurses and patients at risk for injury and adverse health outcomes. For preventing fatigue and minimizing its negative consequences, information about its characteristics and associated factors is required.

Objectives

This study aimed to assess occupational fatigue “acute fatigue, chronic fatigue, and inter-shift recovery” among Saudi nurses working 8-h shifts. Further, we explored factors associated with fatigue from nurses’ perspectives.

Methods

We conducted a mixed-method study with a convenience sample of Saudi nurses ( N = 282) working in four public hospitals in Saudi Arabia. Data were collected using the nurses’ profile form; the occupational fatigue exhaustion recovery (OFER) scale, for relevant quantitative data; and open-ended questions for qualitative data. We used descriptive and inferential statistics for analysing the quantitative data and content analysis of the qualitative data.

Results

The results showed that Saudi nurses rated themselves moderately fatigued with working 8-h shifts. The inter-shift recovery subscale showed a negative correlation with chronic fatigue and acute fatigue ( r = −0.518, r = −0.356, P < 0.001). Sleeping problems, meals per day, and frequency of exercise showed significant relations with chronic fatigue among nurses ( p < 0.05). In addition, three categories were derived from the qualitative content analysis. Saudi nurses reported work-related, psychosocial, and individual factors as major contributors to fatigue and recovery.

Conclusion

Occupational fatigue is a multidimensional issue, and nurses and nurse managers are challenged with reducing its prevalence and negative impact on nurses and patients. Our quantitative and qualitative findings suggest the need for a comprehensive approach to fatigue management and mitigation, including organizational support, creative workforce planning, flexible work schedules, and psychosocial support. Fatigue reduction and prevention policies and educational programs are vital strategies to improve nurses’ well-being and inter-shift recovery.
Health Literacy in Patients’ Clinical Records of Hospital Settings: A Systematic Review
Authors: Cristofori Elena , Zeffiro Valentina , Alvaro Rosaria , D’Agostino Fabio , Zega Maurizio , Cocchieri Antonello
Published: March 2022

Introduction

Health literacy (HL) can be defined as the individual's ability to understand and process health information. A low level of HL can be viewed as a stronger predictor of a person's health status than age, education level, and race. Although HL is an important determinant of health, it is often underestimated. This systematic review investigates the evidence on HL assessment in hospital settings.

Methods

PubMed Medline, CINAHL, Scopus, Web of Science and Educational Resources Information Centre databases were searched, with the date last searched being 16 March 2020. The PRISMA guidelines were applied, and the protocol of the study was registered with PROSPERO (CRD42021236029). The quality of the included studies was appraised using the STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE) guidelines for cross-sectional studies.

Results

Five studies reported HL assessments in hospital patients’ clinical records. Four main strategies were used to implement HL routine assessment in hospitals: multidisciplinary teams, stakeholders, training, and monitoring. Different performance measures were used to monitor the feasibility of incorporating HL assessment into electronic health records (EHRs).

Conclusion

This review examined how inpatients’ HL is recorded in hospital settings. HL is poorly measured in a hospital setting. These results guide hospital leadership in involving nurses in HL assessment implementation in hospitals and support nurses in creating a specific performance measure dashboard to monitor effective HL assessments in hospitals.
Designing a 3D Printed Model of the Skull-Base: A Collaboration Between Clinicians and Industry
Authors: Saleh Youssuf , Piper Rory , Richard Michael , Jeyaretna Sanjeeva , Cosker Thomas
Published: March 2022

Introduction

The role of three dimensional (3D) printing in neurosurgical education is becoming increasingly common. Notably, 3D printing can simulate complex anatomical pathways that may be difficult to regularly and accurately reproduce in cadavers. One such example is the course of the facial nerve within the temporal bone and its relation to the labyrinth. This can aid pre-surgical planning and minimise surgical complications. Here we aim to develop a novel anatomically accurate model of the skull base which demonstrates key neuro vascular components and the course of the facial nerve within the temporal bone by developing a 3D printed model of the skull-base that can be used for medical education and pre-surgical planning.

Materials and Methods

We utilised a combination of Computed Tomography (CT) and angiography scans to reconstruct the skull base and its vascular contents. Neural components were digitally incorporated under the guidance of the Oxford neurosurgical team and the anatomy department. The model was integrated and printed using polymer jetting.

Results

The model was successfully printed, with all neurovascular components included. Notably we were able to highlight the intra-temporal course of the facial nerve by creating a bony window within the temporal bone.

Conclusion

Through a collaboration with industry and a multidisciplinary team, we were able to reproduce the base of the skull from patient neuro-imaging. Our model is both cost-effective, reproducible and can aid both medical students and neurosurgical trainees in their training/education.
An intersectional approach to neoliberal environmentality: Women's engagement with ecotourism at Corbett Tiger Reserve, India
Authors: Pandya Revati
Published: March 2022

Research in environmentality has provided an analysis of environmentally friendly subject formation through the influence of conservation governance. Within this research, examination of subject formation from the local community perspective is also gaining attention. However, a gender perspective in environmentality research remains marginal. This study thus contributes to environmentality research by drawing on intersectional feminist political ecology to examine women's engagement with ecotourism in the context of India's Corbett Tiger Reserve. Ecotourism as a form of market-based conservation has been commonly framed as an expression of neoliberal environmentality. Neoliberal environmentality is reflected in market-centred incentives used to promote conservation and support for local people via employment in conservation-based work - a supposedly ‘win-win’ dynamic. Through ethnographic research, I provide insights into different forms of women's engagement with tourism. The analysis reveals that this engagement does not necessarily produce the environmentally friendly subject that environmentality analysis predicts. Rather, women's engagement is shaped by intersecting dynamics of caste and class and motivated by factors including but not limited to monetary benefits. This study thus questions the dominant approach to investigating neoliberal environmentality in particular, that tends to emphasise the influence of monetary incentives in producing environmentally friendly subjects.
The Heterogeneity of Organizational Resilience: Exploring functional, operational and strategic resilience
Authors: Hepfer Manuel , Lawrence Thomas B.
Published: March 2022

Research on organizational resilience has grown significantly over the past three decades – but it has done so in an increasingly disorganized fashion. In this article, we present an integrative review of the organizational resilience literature. We synthesize existing research to provide a compelling and generative conceptual foundation for future work in this scholarly area. Our review shows that current research tends to treat organizational resilience as a relatively homogeneous concept. We present an alternative formulation that conceives of organizational resilience as a heterogeneous phenomenon with three main forms – functional resilience, operational resilience and strategic resilience – each with distinctive foundations, dynamics and outcomes. Based on this conceptualization, we develop a cyclical model of organizational resilience that incorporates its heterogeneity and thus allows for more nuanced and precise applications to a variety of contexts and forms of adversity.
Gene therapy of yeast NDI1 on mitochondrial complex I dysfunction in rotenone-induced Parkinson’s disease models in vitro and vivo
Authors: Li Hongzhi , Sun Bohao , Huang Yuting , Zhang Jing , Xu Xuejing , Shen Yuqi , Chen Zhuo , Yang Jifeng , Shen Luxi , Hu Yongwu , Gu Haihua
Published: March 2022

Purpose

Parkinson's disease (PD) is the second most common neurodegenerative disease without cure or effective treatment. This study explores whether the yeast internal NADH-quinone oxidoreductase (NDI1) can functionally replace the defective mammalian mitochondrial complex I, which may provide a gene therapy strategy for treating sporadic PD caused by mitochondrial complex I dysfunction.

Method

Recombinant lentivirus expressing NDI1 was transduced into SH-SY5Y cells, or recombinant adeno-associated virus type 5 expressing NDI1 was transduced into the right substantia nigra pars compacta (SNpc) of mouse. PD cell and mouse models were established by rotenone treatment. The therapeutic effects of NDI1 on rotenone-induced PD models in vitro and vivo were assessed in neurobehavior, neuropathology, and mitochondrial functions, by using the apomorphine-induced rotation test, immunohistochemistry, immunofluorescence, western blot, complex I enzyme activity determination, oxygen consumption detection, ATP content determination and ROS measurement.

Results

NDI1 was expressed and localized in mitochondria in SH-SY5Y cells. NDI1 resisted rotenone-induced changes in cell morphology, loss of cell viability, accumulation of α-synuclein and pS129 α-synuclein, mitochondrial ROS production and mitochondria-mediated apoptosis. The basal and maximal oxygen consumption, mitochondrial coupling efficiency, basal and oligomycin-sensitive ATP and complex I activity in cell model were significantly increased in rotenone + NDI1 group compared to rotenone + vector group. NDI1 was efficiently expressed in dopaminergic neurons in the right SNpc without obvious adverse effects. The rotation number to the right side (NDI1-treated side) was significantly increased compared to that to the left side (untreated side) in mouse model. The number of viable dopaminergic neurons, the expression of tyrosine hydroxylase, total and maximal oxygen consumption, mitochondrial coupling efficiency and complex I enzyme activity in right substantia nigra, and the content of dopamine in right striatum were significantly increased in rotenone + NDI1 group compared to rotenone + vector group.

Conclusion

Yeast NDI1 can rescue the defect of oxidative phosphorylation in rotenone-induced PD cell and mouse models, and ameliorate neurobehavioral and neuropathological damages. The results may provide a basis for the yeast NDI1 gene therapy of sporadic PD caused by mitochondrial complex I dysfunction.
The long-term effects of genomic selection: 1. Response to selection, additive genetic variance, and genetic architecture
Authors: Wientjes Yvonne C. J. , Bijma Piter , Calus Mario P. L. , Zwaan Bas J. , Vitezica Zulma G. , van den Heuvel Joost
Published: March 2022

Background

Genomic selection has revolutionized genetic improvement in animals and plants, but little is known about its long-term effects. Here, we investigated the long-term effects of genomic selection on response to selection, genetic variance, and the genetic architecture of traits using stochastic simulations. We defined the genetic architecture as the set of causal loci underlying each trait, their allele frequencies, and their statistical additive effects. We simulated a livestock population under 50 generations of phenotypic, pedigree, or genomic selection for a single trait, controlled by either only additive, additive and dominance, or additive, dominance, and epistatic effects. The simulated epistasis was based on yeast data.

Results

Short-term response was always greatest with genomic selection, while response after 50 generations was greater with phenotypic selection than with genomic selection when epistasis was present, and was always greater than with pedigree selection. This was mainly because loss of genetic variance and of segregating loci was much greater with genomic and pedigree selection than with phenotypic selection. Compared to pedigree selection, selection response was always greater with genomic selection. Pedigree and genomic selection lost a similar amount of genetic variance after 50 generations of selection, but genomic selection maintained more segregating loci, which on average had lower minor allele frequencies than with pedigree selection. Based on this result, genomic selection is expected to better maintain genetic gain after 50 generations than pedigree selection. The amount of change in the genetic architecture of traits was considerable across generations and was similar for genomic and pedigree selection, but slightly less for phenotypic selection. Presence of epistasis resulted in smaller changes in allele frequencies and less fixation of causal loci, but resulted in substantial changes in statistical additive effects across generations.

Conclusions

Our results show that genomic selection outperforms pedigree selection in terms of long-term genetic gain, but results in a similar reduction of genetic variance. The genetic architecture of traits changed considerably across generations, especially under selection and when non-additive effects were present. In conclusion, non-additive effects had a substantial impact on the accuracy of selection and long-term response to selection, especially when selection was accurate.
A 1-bp deletion in bovine QRICH2 causes low sperm count and immotile sperm with multiple morphological abnormalities
Authors: Hiltpold Maya , Janett Fredi , Mapel Xena Marie , Kadri Naveen Kumar , Fang Zih-Hua , Schwarzenbacher Hermann , Seefried Franz R. , Spengeler Mirjam , Witschi Ulrich , Pausch Hubert
Published: March 2022

Background

Semen quality and insemination success are monitored in artificial insemination bulls to ensure high male fertility rates. Only ejaculates that fulfill minimum quality requirements are processed and eventually used for artificial inseminations. We examined 70,990 ejaculates from 1343 Brown Swiss bulls to identify bulls from which all ejaculates were rejected due to low semen quality. This procedure identified a bull that produced 12 ejaculates with an aberrantly small number of sperm (0.2 ± 0.2 × 109 sperm per mL) which were mostly immotile due to multiple morphological abnormalities.

Results

The genome of this bull was sequenced at a 12× coverage to investigate a possible genetic cause. Comparing the sequence variant genotypes of this bull with those from 397 fertile bulls revealed a 1-bp deletion in the coding sequence of the QRICH2 gene which encodes the glutamine rich 2 protein, as a compelling candidate causal variant. This 1-bp deletion causes a frameshift in translation and a premature termination codon (ENSBTAP00000018337.1:p.Cys1644AlafsTer52). The analysis of testis transcriptomes from 76 bulls showed that the transcript with the premature termination codon is subject to nonsense-mediated mRNA decay. The 1-bp deletion resides in a 675-kb haplotype that includes 181 single nucleotide polymorphisms (SNPs) from the Illumina BovineHD Bead chip. This haplotype segregates at a frequency of 5% in the Brown Swiss cattle population. Our analysis also identified another bull that carried the 1-bp deletion in the homozygous state. Semen analyses from the second bull confirmed low sperm concentration and immotile sperm with multiple morphological abnormalities that primarily affect the sperm flagellum and, to a lesser extent, the sperm head.

Conclusions

A recessive loss-of-function allele of the bovine QRICH2 gene likely causes low sperm concentration and immotile sperm with multiple morphological abnormalities. Routine sperm analyses unambiguously identify homozygous bulls for this allele. A direct gene test can be implemented to monitor the frequency of the undesired allele in cattle populations.
ROS1-mediated decrease in DNA methylation and increase in expression of defense genes and stress response genes in Arabidopsis thaliana due to abiotic stresses
Authors: Yang Liping , Lang Chenjing , Wu Yanju , Meng Dawei , Yang Tianbo , Li Danqi , Jin Taicheng , Zhou Xiaofu
Published: March 2022

Background

Small interfering RNAs (siRNAs) target homologous genomic DNA sequences for cytosine methylation, known as RNA-directed DNA methylation (RdDM), plays an important role in transposon control and regulation of gene expression in plants. Repressor of silencing 1 (ROS1) can negatively regulate the RdDM pathway.

Results

In this paper, we investigated the molecular mechanisms by which an upstream regulator ACD6 in the salicylic acid (SA) defense pathway, an ABA pathway-related gene ACO3, and GSTF14, an endogenous gene of the glutathione S-transferase superfamily, were induced by various abiotic stresses. The results demonstrated that abiotic stresses, including water deficit, cold, and salt stresses, induced demethylation of the repeats in the promoters of ACD6, ACO3, and GSTF14 and transcriptionally activated their expression. Furthermore, our results revealed that ROS1-mediated DNA demethylation plays an important role in the process of transcriptional activation of ACD6 and GSTF14 when Arabidopsis plants are subjected to cold stress.

Conclusions

This study revealed that ROS1 plays an important role in the molecular mechanisms associated with genes involved in defense pathways in response to abiotic stresses.
Are gastrointestinal symptoms associated with higher risk of Mortality in COVID-19 patients? A systematic review and meta-analysis
Authors: Wang Yang , Li Yimin , Zhang Yifan , Liu Yun , Liu  Yulan
Published: March 2022

Background

Gastrointestinal symptoms have been reported in patients with COVID-19. Several clinical investigations suggested that gastrointestinal symptoms were associated with disease severity of COVID-19. However, the relevance of gastrointestinal symptoms and mortality of COVID-19 remains largely unknown. We aim to investigate the relationship between gastrointestinal symptoms and COVID-19 mortality.

Methods

We searched the PubMed, Embase, Web of science and Cochrane for studies published between Dec 1, 2019 and May 1, 2021, that had data on gastrointestinal symptoms in COVID-19 patients. Additional literatures were obtained by screening the citations of included studies and recent reviews. Only studies that reported the mortality of COVID-19 patients with/without gastrointestinal symptoms were included. Raw data were pooled to calculate OR (Odds Ratio). The mortality was compared between patients with and without gastrointestinal symptoms, as well as between patients with and without individual symptoms (diarrhea, nausea/vomiting, abdominal pain).

Results

Fifty-three literatures with 55,245 COVID-19 patients (4955 non-survivors and 50,290 survivors) were included. The presence of GI symptoms was not associated with the mortality of COVID-19 patients (OR=0.88; 95% CI 0.71–1.09;P=0.23). As for individual symptoms, diarrhea (OR=1.01; 95% CI 0.72–1.41;P=0.96), nausea/vomiting (OR=1.16; 95% CI 0.78–1.71;P=0.46) and abdominal pain (OR=1.55; 95% CI 0.68–3.54;P=0.3) also showed non-relevance with the death of COVID-19 patients.

Conclusions

Gastrointestinal symptoms are not associated with higher mortality of COVID-19 patients. The prognostic value of gastrointestinal symptoms in COVID-19 requires further investigation.
Long-term survival of a patient with liver metastases from clear cell gastric adenocarcinoma after multimodality treatment including interventional oncology techniques: case report
Authors: Jugovec Vesna , Benedik Jernej , Jeruc Jera , Popovic Peter
Published: March 2022

Background

Gastric cancer (GC) is the fourth most common cancer and the third leading cancer-related cause of death worldwide since most patients are diagnosed at an advanced stage. The majority of GCs are adenocarcinomas (ACs), and the poorly characterized clear cell AC represents a unique subgroup of GCs and is an independent marker of poor prognosis. Even though the prognosis for patients with advanced GC is poor we present a report of a patient with long-term survival despite having liver metastases from clear cell gastric AC.

Case presentation

A 45-year-old male with clear cell gastric AC underwent subtotal gastrectomy and postoperative chemoradiation. Only a year and a half after his initial treatment the disease spread to his liver. He received two lines of chemotherapy treatment within the next two years before a right hepatectomy was suggested. Due to an initially insufficient future liver remnant (FLR), transarterial chemoembolization (TACE) and portal vein embolization (PVE) were performed, which made the surgical procedure possible. Shortly after a disease progression in the remaining liver was detected. In the following three years the patient was treated with a carefully planned combination of systemic therapy and different interventional oncology techniques including selective internal radiation therapy (SIRT) and TACE. And as illustrated, an attentive, patient-tailored, multimodality treatment approach can sometimes greatly benefit our patients as he had an overall survival of 88 months despite the poor prognosis of his disease.

Conclusion

To the best of our knowledge, this report is the first to describe a patient with liver metastases from clear cell gastric AC treated with interventional oncology techniques (PVE, TACE, and SIRT) in combination with other locoregional and systemic therapies thereby presenting that these interventional oncology techniques can be successfully integrated into long-term management of non-conventional liver tumors.
A novel duodenal-release formulation of caraway oil and L-menthol is a safe, effective and well tolerated therapy for functional dyspepsia
Authors: Lacy Brian E. , Chey William D. , Epstein Michael S. , Shah Syed M. , Corsino Patrick , Zeitzoff Linda R. , Cash Brooks D.
Published: March 2022

Background

A randomized, placebo-controlled clinical trial (FDREST) of a novel formulation of caraway oil and L-menthol (COLM-SST) demonstrated symptom relief in patients with functional dyspepsia (FD). Two follow-up studies were conducted to evaluate patient satisfaction, self-regulated dosing, and long-term safety data: FDACT, Functional Dyspepsia Adherence and Compliance Trial, and FDSU36, Functional Dyspepsia Safety Update at 36 months.

Methods

A patient reported outcomes (PRO) questionnaire was designed and distributed online to assess real-world satisfaction and dosing frequency of open-label COLM-SST in patients with FD. A separate study analyzing voluntary safety surveillance data evaluated the frequency and severity of reported adverse events (AEs).

Results

A total of 600 FD patients were enrolled in the PRO study. Ninety five percent of respondents reported a major or moderate improvement in their FD symptoms and 91.7% indicated a major or moderate improvement in quality of life (QOL) using COLM-SST. Between 1 and 4 capsules were consumed daily by 91.2% of respondents, with 56.2% taking them before meals. Symptom relief was rapid, with 86.4% of respondents indicating relief within 2 h of taking COLM-SST. Few adverse events (AEs) were reported (0.0187%) by patients using COLM-SST. No serious AEs were identified.

Conclusion

COLM-SST is safe, well tolerated, and provides rapid relief of FD symptoms. These findings, demonstrated in the FDREST trial, were further supported by a large prospective PRO study evaluating self-regulated dosing frequency, symptom improvement, and QOL. COLM-SST was well-tolerated based on review of AE data at 36 months.
Past dynamics of HIV transmission among men who have sex with men in Montréal, Canada: a mathematical modeling study
Authors: Milwid Rachael M. , Xia Yiqing , Doyle Carla M. , Cox Joseph , Lambert Gilles , Thomas Réjean , Mishra Sharmistha , Grace Daniel , Lachowsky Nathan J. , Hart Trevor A. , Boily Marie-Claude , Maheu-Giroux Mathieu
Published: March 2022

Background

Gay, bisexual, and other men who have sex with men (gbMSM) experience disproportionate risks of HIV acquisition and transmission. In 2017, Montréal became the first Canadian Fast-Track City, setting the 2030 goal of zero new HIV infections. To inform local elimination efforts, we estimate the evolving role of prevention and sexual behaviours on HIV transmission dynamics among gbMSM in Montréal between 1975 and 2019.

Methods

Data from local bio-behavioural surveys were analyzed to develop, parameterize, and calibrate an agent-based model of sexual HIV transmission. Partnership dynamics, HIV’s natural history, and treatment and prevention strategies were considered. The model simulations were analyzed to estimate the fraction of HIV acquisitions and transmissions attributable to specific groups, with a focus on age, sexual partnering level, and gaps in the HIV care-continuum.

Results

The model-estimated HIV incidence peaked in 1985 (2.3 per 100 person years (PY); 90% CrI: 1.4–2.9 per 100 PY) and decreased to 0.1 per 100 PY (90% CrI: 0.04–0.3 per 100 PY) in 2019. Between 2000–2017, the majority of HIV acquisitions and transmissions occurred among men aged 25–44 years, and men aged 35–44 thereafter. The unmet prevention needs of men with > 10 annual anal sex partners contributed 90–93% of transmissions and 67–73% of acquisitions annually. The primary stage of HIV played an increasing role over time, contributing to 11–22% of annual transmissions over 2000–2019. In 2019, approximately 70% of transmission events occurred from men who had discontinued, or never initiated antiretroviral therapy.

Conclusions

The evolving HIV landscape has contributed to the declining HIV incidence among gbMSM in Montréal. The shifting dynamics identified in this study highlight the need for continued population-level surveillance to identify gaps in the HIV care continuum and core groups on which to prioritize elimination efforts.
Importance of early diagnosis and surgical treatment of calcified amorphous tumor-related native valve endocarditis caused by Escherichia coli: a case report
Authors: Koito Shu , Unoki Yuto , Yoshida Keimei , Takemoto Sho , Uchida Takayuki , Matono Takashi
Published: March 2022

Background

Unlike Escherichia coli bacteremia, which is common, E. coli endocarditis is uncommon, particularly in patients with native valve, leading to its delayed diagnosis.

Case presentation

We present a case of infective endocarditis caused by E. coli in a 78-year-old Japanese man with type 2 diabetes, involving persistent bacteremia and vegetation on the mitral valve (measuring 18 × 4.2 mm in diameter). He presented with recurrent fever after antimicrobial treatment for pyelonephritis. He received antibiotic therapy for 6 weeks and required surgical removal of a calcified amorphous tumor and vegetation with mitral valvuloplasty 7 days after admission. Despite an episode of multiple cerebral infarctions, he recovered fully from the infection.

Conclusions

Follow-up blood cultures should be performed for Gram-negative bacilli bacteremia among patients with unknown focus and an atypical clinical course after treatment. Early diagnosis and aggressive surgical intervention are paramount to achieving good clinical outcomes.
Epstein-Barr virus infection associated polymyositis and coronary artery dilation
Authors: Teng Liping , Shen Chencong , Gu Weizhong , Wu Jianqiang , Lu Meiping , Xu Xuefeng
Published: March 2022

Background

Epstein-Barr virus (EBV) infects more than 90% of the population worldwide. However, chronic active EBV infection (CAEBV) is one of the EBV-positive T- or NK-lymphoproliferative diseases with high morbidity and mortality. Here, we report a case of a 9-year girl with CAEBV, successively presenting with polymyositis and coronary artery dilation (CAD).

Case presentation

The girl complained of fatigue for more than 1 month. Muscle strength examinations had no abnormal findings. Blood chemistries showed elevated alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine kinase (CK). Magnetic resonance imaging (MRI) showed spotty high-intensity signals in thigh muscles, and electromyogram suggested myogenic damage. The significant findings were positive EBV antibodies (EBVEA-IgG, EBVCA-IgG, and EBVNA-IgG), increased EBV DNA copies in B, T, and NK cells, and positive EBV-encoded small RNA in biopsy muscle specimen. The girl received ganciclovir, intravenous immunoglobulin, and methylprednisolone, and her symptoms improved. On the 45th day of hospitalization, echocardiograph revealed CAD. She received additional anticoagulants and Tocilizumab. Her condition improved and continued to be followed up at the clinic preparing for hematopoietic stem cell transplantation.

Conclusions

This is the first reported case of CAEBV successively with polymyositis and CAD. This case makes the diagnoses of autoimmune diseases in children more complicated. Careful investigation of hidden CAEBV should be recommended in children with atypical polymyositis or CAD.
Exploring the mechanisms behind HIV drug resistance in sub-Saharan Africa: conceptual mapping of a complex adaptive system based on multi-disciplinary expert insights
Authors: Kiekens Anneleen , Dierckx de Casterlé Bernadette , Pellizzer Giampietro , Mosha Idda H. , Mosha Fausta , Rinke de Wit Tobias F. , Sangeda Raphael Z. , Surian Alessio , Vandaele Nico , Vranken Liesbet , Killewo Japhet , Jordan Michael , Vandamme Anne-Mieke
Published: March 2022

Background

HIV drug resistance (HIVDR) continues to threaten the effectiveness of worldwide antiretroviral therapy (ART). Emergence and transmission of HIVDR are driven by several interconnected factors. Though much has been done to uncover factors influencing HIVDR, overall interconnectedness between these factors remains unclear and African policy makers encounter difficulties setting priorities combating HIVDR. By viewing HIVDR as a complex adaptive system, through the eyes of multi-disciplinary HIVDR experts, we aimed to make a first attempt to linking different influencing factors and gaining a deeper understanding of the complexity of the system.

Methods

We designed a detailed systems map of factors influencing HIVDR based on semi-structured interviews with 15 international HIVDR experts from or with experience in sub-Saharan Africa, from different disciplinary backgrounds and affiliated with different types of institutions. The resulting detailed system map was conceptualized into three main HIVDR feedback loops and further strengthened with literature evidence.

Results

Factors influencing HIVDR in sub-Saharan Africa and their interactions were sorted in five categories: biology, individual, social context, healthcare system and ‘overarching’. We identified three causal loops cross-cutting these layers, which relate to three interconnected subsystems of mechanisms influencing HIVDR. The ‘adherence motivation’ subsystem concerns the interplay of factors influencing people living with HIV to alternate between adherence and non-adherence. The ‘healthcare burden’ subsystem is a reinforcing loop leading to an increase in HIVDR at local population level. The ‘ART overreliance’ subsystem is a balancing feedback loop leading to complacency among program managers when there is overreliance on ART with a perceived low risk to drug resistance. The three subsystems are interconnected at different levels.

Conclusions

Interconnectedness of the three subsystems underlines the need to act on the entire system of factors surrounding HIVDR in sub-Saharan Africa in order to target interventions and to prevent unwanted effects on other parts of the system. The three theories that emerged while studying HIVDR as a complex adaptive system form a starting point for further qualitative and quantitative investigation.
The identification of pregnant women with renal colic who may need surgical intervention
Authors: He Maomao , Lin Xiaoting , Lei Ming , Xu Xiaolan , He Zhihui
Published: March 2022

Background

Renal colic is a surgical emergency in pregnancy that is caused by a range of non-obstetric factors and known to occur more frequently during the second and third trimesters. Several studies have reported that up to 70–80% of stones pass spontaneously during pregnancy. There are some patients will not pass their stones and will ultimately require surgical intervention. Through retrospective analysis of the clinical data of 212 pregnant women with renal colic, the predictive factors of pregnant women with renal colic in need of surgical intervention were determined.

Methods

We conducted a retrospective review of 212 pregnant women presenting with renal colic between 1st January 2009 and 31st December 2020. Univariate and multivariate analyses identified a range of predictive variables for surgical intervention. In addition, we used receiver operating characteristic curve analysis to evaluate the predictive power of our model and created a nomogram for clinical application.

Results

Of the 212 patients presenting with acute renal colic in pregnancy, 100 patients (47.2%) underwent surgical intervention and 112 patients (52.8%) were treated conservatively. Univariate analysis identified significant differences between the two groups with regards to fever, the duration of pain, white blood cells, C-reactive protein, ureteral stone size, hydronephrosis, and stone location. Multivariate analysis further identified a number of independent predictors for surgical intervention, including fever, a duration of pain ≥ 4 days, a ureteral stone size ≥ 8 mm, and moderate or severe hydronephrosis.

Conclusions

We identified several independent predictors for surgical intervention for renal colic in pregnancy. Fever, a duration of pain ≥ 4 days, a ureteral stone size ≥ 8 mm, and moderate/severe hydronephrosis, play significant roles in predicting surgical intervention. Our nomogram can help to calculate the probability of surgical intervention in a simple and efficient manner. Prospective studies are now required to validate our model.
Coexisting CLT in PTC is an independent predictor of tumor aggressiveness for patients aged under 55: a retrospective analysis of 635 patients
Authors: Ma Bing’e , Chen Xiyi , Zhao Zhengping , Yin Xiaoyang , Ji Qin , Zhou Yifan , Ma Chaoqun , Wang Jianhua
Published: March 2022

Background

The study was aimed at investigating the potential role of chronic lymphocytic thyroiditis (CLT) in papillary thyroid cancer (PTC) aggressiveness for patients aged below 55, as well as to figure out factors influencing potential recurrence risk in different age groups.

Methods

A total of 635 adult patients were retrospectively analyzed. 188 patients were diagnosed with coexistent CLT and the remaining 447 were classified as non-CLT. Then the characteristics of CLT-coexisted patients and non-CLT ones were compared respectively when patients were aged ≥ 55 years or below. The association among postoperative clinicopathological features were also analyzed using multivariate regression. In addition, the prognostic value of several variables relating to high-risk recurrence were estimated within different age groups.

Results

When divided in two age groups (55 years as the borderline), non-CLT group (aged below 55 years) had a remarkable frequency of small size lesion (Dmax ≤ 1 cm) compared with CLT-coexisted patients (54.6% to 43.0%,p = 0.02). In addition, non-CLT patients tended to have intrathyroidal extension as opposed to those with coexistent CLT (20.2% to 28.2%,p = 0.05). In multivariate analysis, CLT still significantly acted as an independent risk factor of greater lesion size (Dmin > 1 cm) (OR = 1.7,p = 0.02) and mildly promoted gross extrathyroidal extension (ETE) (OR = 1.4,p = 0.06). However, associations didn’t emerge in the characteristics mentioned above with CLT when patients were ≥ 55 years old. The prognostic value of CLT in high-risk recurrence was evident only in patients aged 35–44 years. (OR = 2.4, 95%CI:1.2–5.4,p = 0.02). Greater lesion size independently promoted gross ETE, no matter patients were aged above 55 years or not. Its prognostic value of high-risk recurrence was significant throughout all age groups.

Conclusion

These findings revealed that CLT coexistence might be the unfavorable factor of PTC aggressiveness in patients aged below 55 years. Its role as well as greater tumor size may potentially predict higher recurrence risk according to results figured out in the prediction model.
Alternative medicine: therapeutic effects on gastric original signet ring carcinoma via ascorbate and combination with sodium alpha lipoate
Authors: Chen Weiyu , Xu Lingyun , Chang Edwin , Gowrishankar Gayatri , Ferrara Katherine W. , Gambhir Sanjiv Sam
Published: March 2022

Background

Gastric signet ring cell carcinoma (SRCC) is an aggressive gastric adenocarcinoma with a poor prognosis when diagnosed at an advanced stage. As alternative medicine, two natural supplements (ascorbate (AA) and sodium alpha lipoate (LA)) have been shown to inhibit various cancers with mild side effects.

Methods

These two natural supplements and a series of combinations (AA&LA, AA+LA and LA + AA) were incubated with non-SRCC cells (GPM-1), patient-derived gastric origin SRCC (GPM-2), gastric-origin SRCCs (HSC-39 and KATO-3), human pancreatic (MIA PaCa-2) and ovarian (SKOV-3) cells for evaluating their therapeutic effects. Moreover, these treatments were applied in 3D-cultured organoids to reveal the feasibility of these approaches for in vivo study.

Results

Analyzing their antioxidant capabilities and dose-response curves, we observed that all four gastric cell lines, including three patient-derived cell lines were sensitive to ascorbate (~ 10 mM). The influence of ascorbate incubation time was studied, with a 16-h incubation found to be optimal for in vitro studies. Moreover, a simultaneous combination of AA and LA (AA&LA) did not significantly inhibit cell proliferation, while prior LA treatment increased the growth inhibition of AA therapy (LA + AA). Anti-cancer efficacy of AA was further confirmed in 3D-cultured SRCC (KATO-3) organoids.

Conclusions

This study highlights the potential of AA and LA + AA in treating gastric origin SRCC, and demonstrates the influence of order in which the drugs are administered.
Formulation of teaching strategies for graduation internship based on the experiential learning styles of nursing undergraduates: a non-randomized controlled trial
Authors: Li Cong , Yang Yu , Jing Yancui
Published: March 2022

Purpose

To formulate scientific and effective teaching strategies for the graduation internship of nursing undergraduates, in order to improve their holistic clinical competence.

Method

A before-after self-controlled study with cluster sampling was performed on the 78 senior nursing undergraduates that underwent a graduation internship at the department. Students were required to fill in the Kolb’s Learning Style Questionnaire and Holistic Clinical Assessment Tool on the date of admission to assess their learning style characteristics and holistic clinical competence, according to which targeted teaching strategies for their graduation internship were formulated. When leaving the department, the students were required to fill in the Holistic Clinical Assessment Tool again to assess the changes in their learning skills after rotation.

Results

In terms of learning methods, nursing students scored 23.87 ± 6.11, 29.57 ± 5.03, 37.85 ± 6.87, and 28.73 ± 6.70 in Concrete Experience, Reflective Observation, Abstract Conceptualisation, and Active Experimentation, respectively. When the learning styles were ranked by composition ratio, 46 students (58.9%) were assimilators, 18 (23.1%) were convergers, 9 (11.5%) were divergers, and 5 (6.4%) were accommodators. The holistic clinical competence of students after rotation was significantly improved compared to before rotation (P < 0.01).

Conclusion

Clinical teaching strategies for graduation internship that are formulated according to the experiential learning style of nursing undergraduates can effectively improve their learning skills and holistic clinical competence.