bluuebunny/crossref_metadata_2025 huggingface dataset:
Retrospective Review of Long-term Outcomes of Patients Undergoing CMC Arthroplasty With Interposition Scaffold
Authors: Marcuzzi Augusto , Colzani Giulia , Acciaro Andrea Leti , Rosa Norman Della , Landi Antonio
Published: June 2020

Background: The treatment of rhizarthritis involves several surgical techniques; among them, bioabsorbable scaffolds have begun to be proposed to avoid the use of other biological tissues or artificial permanent devices. Methods: In this study, we evaluated the long-term outcomes of poly-ld-lactic acid scaffold in interposition arthroplasty in a series of patients treated in our department. Results: Strength, range of motion, and pain improved after the intervention and lasted over the years; nonetheless, most of the radiographs showed a progressive collapse of the first metacarpal. Conclusions: Despite radiological findings, we believe that poly-ld-lactic acid scaffold can be considered a good alternative to traditional trapeziectomy with tendon interposition and suspensionplasty, with long-lasting satisfactory clinical results.
Trends in the Incidence and Treatment of Distal Radius Fractures in the United States in Privately Insured and Medicare Advantage Enrollees
Authors: Kakar Sanjeev , Noureldin Mohamed , Van Houten Holly K. , Mwangi Raphael , Sangaralingham Lindsey R.
Published: June 2020

Background: This study aims to determine the trends in the treatment of distal radius fractures (DRFs) in patients aged 18 years and older. Methods: An administrative claims database of more than 100 million patients was used to identify patients aged 18 years and older with a DRF between 2005 and 2014. A total of 137 130 DRFs were identified in 135 128 patients. Results: The proportion and rate of fractures were more predominant in those aged 55 years and older compared with a decreasing incidence in patients younger than 55 years. Age-adjusted rates of surgical treatment have significantly increased in both women and men by 15.9% (absolute change, 4.8%) and 5.0% (absolute change, 1.7%) change over time, respectively. Conversely, age-adjusted rates of nonsurgical treatment have significantly decreased overtime in both women and men by 6.9% and 2.6%, respectively. Conclusions: These data provide better understanding of the epidemiology of DRF, which is important to develop preventive strategies targeting high-risk populations and to develop effective treatment strategies.
Impact of Patient-Reported Allergies on Early Postoperative Opioid Use and Outcomes Following Ambulatory Hand Surgery
Authors: Coxe Francesca R. , Wessel Lauren E. , Verret Claire I. , Stepan Jeffrey G. , Nguyen Joseph T. , Fufa Duretti T.
Published: June 2020

Background: Patient-reported allergies (PRAs) are associated with suboptimal orthopaedic surgery outcomes and may serve as a proxy for mental health. While mental health disorders are known risk factors for increased opioid use, less is known about how PRAs impact opioid use after orthopedic surgery. The purpose of this study was to investigate the association between PRAs and postoperative opioid use, pain, and satisfaction following hand surgery. Methods: Patients who underwent ambulatory hand surgery at a single institution from May 2017 to March 2019 were retrospectively reviewed. Various scores, including the Mindfulness Attention Awareness Scale (MAAS), were collected preoperatively. Postoperatively, patients completed a 2-week pain diary, satisfaction, and visual analog scale (VAS) pain scores. Opioid consumption was converted to oral morphine equivalents (OMEs) using standard conversions. Results: A total of 137 patients were divided into 2 groups based on presence (≥1) (n = 73) or absence (0) (n = 64) of PRAs. At baseline, the ≥ 1 PRA group had significantly higher female composition ( P < .001) and pain ( P < .001) and lower PROMIS mental health scores ( P = .044). Postoperative OME consumption averaged 42.5 (range 0-416) in the entire cohort, with no differences between groups. Among patients with ≥ 1 PRA, increasing number of allergies significantly correlated with increasing OME consumption across all time points (week 1, P = .016; week 2, P = .001; total, P = .005). Conclusions: The presence of PRAs did not impact postoperative narcotic usage, pain, or satisfaction. Increasing numbers of PRAs did, however, significantly correlate with higher narcotic use. These results may have implications for postoperative pain management in this population.
p64 flow diverter: Results in 108 patients from a single center
Authors: De Beule Tom , Boulanger T , Heye S , van Rooij WJ , van Zwam WH , Stockx L
Published: June 2020

Background and purpose

Flow diverters are increasingly used to treat intracranial aneurysms. We report the safety and efficacy of the p64 flow diverter, a resheathable and detachable device for intracranial aneurysms.

Materials and methods

We retrospectively reviewed 108 patients with 109 aneurysms treated with the p64 between March 2014 and July 2019. There were 87 women and 21 men, mean age 57 years. Of 109 aneurysms, 74 were discovered incidentally, 12 were symptomatic, 18 were previously treated, and five were ruptured dissection aneurysms. A total of 10 aneurysms were located in the posterior circulation. The mean aneurysm or remnant size was 8.1 mm.

Results

Hemorrhage by perforation with the distal guidewire occurred in two patients with permanent neurological deficits in one. In one patient, acute in-stent occlusion caused infarction with a permanent deficit. Permanent morbidity was 1.9% (2 of 108, 95%CI 0.1–6.9%); there was no mortality. During follow-up, three in-stent occlusions occurred, all asymptomatic. There were no delayed hemorrhagic complications. At six months, 77 of 96 aneurysms (80.2%) were completely occluded, and at last follow-up, this increased to 93 of 96 aneurysms (96.9%). In-stent stenosis at any degree occurred in 11 patients, progressing to asymptomatic complete occlusion in one. In the other patients, stenosis resolved or improved at further follow-up.

Conclusion

The p64 offers an effective and safe treatment option. Aneurysm occlusion rate was 97% at last follow-up, mostly achieved with a single device. There were no delayed hemorrhagic complications. Delayed in-stent stenosis infrequently progresses to occlusion but remains a matter of concern.
Was there a socialist Rechtsstaat in late communist East Central Europe? The Czechoslovak case in a regional context
Authors: Kopeček Michal
Published: June 2020

In contrast to most existing literature, the author claims that there were palpable ‘rudiments’ of authoritarian socialist Rechtsstaat in some communist countries of East Central Europe in the late 1980s. The first part of the article examines the existing terminology with regard to the functioning of law in communist dictatorships and authoritarian regimes in general. By using the example of communist countries such as Poland and in particular Czechoslovakia, the author strives to show not only how rule by law was an increasingly important ruling instrument in state socialism but also how that gradually changed the nature of the dictatorial regimes. He argues that the late communist leaderships in these countries haphazardly set out towards an authoritarian socialist Rechtsstaat in an effort to safe their grip on power by strengthening the socialist normative state. They never arrived at the envisioned optimal stage in this respect, yet they opened a fateful path inside the dictatorships towards the legalist and negotiated revolutions of 1989.
National temporal trends and determinants of cost of abdominal aortic aneurysm repair
Authors: Jayarajan Senthil Nathan , Vlada Claudiu Adrian , Sanchez Luis Arturo , Jim Jeffrey
Published: June 2020

Introduction

In recent decades, there has been a shift in the management of aortic abdominal aneurysm from open intervention (open aortic aneurysm repair) to an endovascular approach (endovascular aortic aneurysm repair). This shift has yielded clinical as well as socioeconomic reverberations. In our current study, we aim to analyze these effects brought about by the switch to endovascular treatment and to scrutinize the determinants of cost variations between the two treatment modalities.

Methods

The National (Nationwide) Inpatient Sample database was queried for clinical data ranging from 2001 to 2013 using International Classification of Disease, 9th Revision (ICD-9) codes for open and endovascular aortic repair. Clinical parameters and financial data related to the two treatment modalities were analyzed. Temporal trends of index hospitalization costs were determined. Multivariate linear regression was used to characterize determinants of cost for endovascular aneurysm repair and open abdominal aortic aneurysm repair.

Results

A total of 128,154 aortic repairs were captured in our analysis, including 62,871 open repairs and 65,283 endovascular repairs. Over the assessed time period, there has been a decrease in the cost of elective endovascular aortic aneurysm repair from $34,975.62 to $31,384.90, a $3,590.72 difference ( p < 0.01), while the cost of open aortic repair has increased from $37,427.77 to $43,640.79 by 2013, a $6,212.79 increase ( p < 0.01). The cost of open aortic aneurysm repair disproportionately increased at urban teaching hospitals, where by 2013, it costs $50,205.59, compared to $34,676.46 at urban nonteaching hospitals, and $34,696.97 at rural institutions. Urban teaching hospitals were found to perform an increasing proportion of complex open aneurysm repairs, involving concomitant renal and visceral bypass procedures. On multivariate analysis, strong determinants of cost increase for both endovascular aortic aneurysm repair and open aortic aneurysm repair are rupture status, prolonged length of stay, occurrence of complications, and the need for disposition to a nursing facility or another acute care institution.

Conclusion

As the vascular community has shifted from an open repair of abdominal aortic aneurysm to an endovascular approach, a number of unforeseen clinical and economic effects were noted. We have characterized these ramifications to help guide further clinical decision and resource allocation.
Introduction of a specialized consultation prior to insertion of totally implantable access venous devices: Impact on cancellation rate and patient satisfaction
Authors: Colucci Nicola , Gregoris Adrien , Meyer Jeremy , Naiken Surennaidoo Perumal , Staszewicz Wojciech , Gialamas Eleftherios , Toso Christian , Abbassi Ziad
Published: June 2020

Objectives

Preoperative consultation is usually not performed before insertion of a totally implantable venous access device (TIVAD). In our experience, an incomplete preoperative assessment, a predictable medical condition contraindicating surgery, or no-show patients the day of surgery led to several surgery cancellations. Therefore, we introduced a specific preoperative surgical consultation for TIVAD that took place shortly before surgery. The aim of the present study is to evaluate the patients’ satisfaction and to establish the rate of cancellation after the adoption of this strategy.

Methods

Two-hundred and four patients who benefited from the preoperative consultation before TIVAD insertion from August 2014 to August 2016 were included. Satisfaction of patients and cancellation rate were documented.

Results

With that strategy, no TIVAD insertion was either delayed or cancelled. The overall level of satisfaction was high (91.8%); 184 patients (90.2%) judged the consultation useful in preparation for the surgery. The surgical procedure met their expectations in 92.2% of cases. Patients known for a psychiatric comorbidity were more likely to express dissatisfaction.

Conclusions

The introduction of a specific preoperative surgical consultation for TIVAD insertion led to a high level of patients’ satisfaction. After the preoperative consultation, no cancellation was recorded. Special approaches have to be considered for patients with a psychiatric comorbidity.
Information seeking and communication during forced migration: An empirical analysis of refugees’ digital media use and its effects on their perceptions of Germany as their target country
Authors: Emmer Martin , Kunst Marlene , Richter Carola
Published: June 2020

There is a common perception that ‘every refugee carries a smartphone’, but research on this phenomenon is limited. We conducted a representative survey of 400 refugees to Germany which provides insight into their use of digital media in preparation for and during forced migration. We also asked whether digital media shaped images of and expectations about the refugees’ target country Germany. The data show that refugees are not a homogeneous group and that usage patterns depend on regional origins. Internet use also contributed to a positively biased perception of Germany, but the effect of traditional media use was stronger.
Understanding the characteristics of broadcast media policy in Iran: A thematic policy analysis
Authors: Talebian Sara
Published: June 2020

This article aims to explore the characteristics of broadcasting media policy in Iran. Ratified laws and regulatory documents concerning broadcast media in Iran are collected and analysed using qualitative content analysis and thematic coding. The results indicate that rigid state ownership, promoting political and cultural discourses, unification, using state-secured budgets, focussing on mass audience and developing air broadcasting technology have been the core themes of the broadcast media policy paradigm in Iran in the past four decades. In the given time horizon, the Iranian government has always reinforced regulatory policies for broadcast media to impose limitations on possible broadcasting activities of individuals, groups and commercial parties.
Nordic walking multibody analysis and experimental identification
Authors: Russo Caterina , Mocera Francesco , Somà Aurelio
Published: June 2020

The widespread diffusion of Nordic walking as a trending sport discipline has increased the need for a tool to study the movement, both at the beginner and professional level. This article presents a methodology for the analysis of the body motion during Nordic walking. The main goal was to design a numerical tool able to replicate human body behaviour when performing this sport. With this approach, it is possible to study several biomechanical aspects, like the kinematics of each body segment, estimating loads applied to the joints for given tasks. Results can be used to compare the user movements with a standard technique implemented in the virtual environment. In fact, using a specific monitoring device developed in previous works, different parameters like the pole angle, arms cycle frequency and synchronization, as well as the pushing force applied to the ground, can be measured during the activity. This acquisition system can be used to save data to be compared with results from the standard numerical model, evaluating the user performance. In this work, numerical results were compared and discussed with measurements from the aforementioned device in terms of pole force and pole angle. The ground reaction force obtained with the multi-body model during Nordic walking was then compared with results from the literature.
Diagnosis and management of tendinopathies in primary care
Authors: Fitzpatrick Daniel
Published: June 2020

Tendinopathy describes a common overuse injury occurring in tendons around the body. Due to the high incidence and prevalence, patients with tendinopathy will often present in primary care, and it is important that GPs recognise and manage these patients appropriately.
Acute mental health service use is increased in rheumatoid arthritis and ankylosing spondylitis: a population-based cohort study
Authors: Kuriya Bindee , Tia Vivian , Luo Jin , Widdifield Jessica , Vigod Simone , Haroon Nigil
Published: June 2020

Background:

Rheumatoid arthritis (RA) and ankylosing spondylitis (AS) are associated with mental illness. Whether acute mental health (MH) service utilization (i.e. emergency visits or hospitalizations) is increased in RA or AS is not known.

Methods:

Two population-based cohorts were created where individuals with RA ( n = 53,240) or AS ( n = 13,964) were each matched by age, sex, and year to unaffected comparators (2002–2016). Incidence rates per 1000 person-years (PY) were calculated for a first MH emergency department (ED) presentation or MH hospitalization. Hazard ratios (HR) and 95% confidence intervals (CI) were calculated, adjusting for demographic, clinical, and health service use variables.

Results:

Individuals with RA had higher rates of ED visits [6.59/1000 person-years (PY) versus 4.39/1000 PY in comparators] and hospitalizations for MH (3.11/1000 PY versus 1.80/1000 PY in comparators). Higher rates of ED visits (7.92/1000 PY versus 5.62/1000 PY in comparators) and hospitalizations (3.03/1000 PY versus 1.94/1000 PY in comparators) were also observed in AS. Overall, RA was associated with a 34% increased risk for MH hospitalization (HR 1.34, 95% CI 1.22–1.47) and AS was associated with a 36% increased risk of hospitalization (HR 1.36, 95% CI 1.12–1.63). The risk of ED presentation was attenuated, but remained significant, after adjustment in both RA (HR 1.08, 95% CI 1.01–1.15) and AS (HR 1.14, 95% CI 1.02–1.28).

Conclusions:

RA and AS are both independently associated with a higher rate and risk of acute ED presentations and hospitalizations for mental health conditions. These findings underscore the need for routine evaluation of MH as part of the management of chronic inflammatory arthritis. Additional research is needed to identify the underlying individual characteristics, as well as system-level variation, which may explain these differences, and to help plan interventions to make MH service use more responsive to the needs of individuals living with RA and AS.
Engineered scaffolds based on mesenchymal stem cells/preosteoclasts extracellular matrix promote bone regeneration
Authors: Dong Rui , Bai Yun , Dai Jingjin , Deng Moyuan , Zhao Chunrong , Tian Zhansong , Zeng Fanchun , Liang Wanyuan , Liu Lanyi , Dong Shiwu
Published: June 2020

Recently, extracellular matrix-based tissue-engineered bone is a promising approach to repairing bone defects, and the seed cells are mostly mesenchymal stem cells. However, bone remodelling is a complex biological process, in which osteoclasts perform bone resorption and osteoblasts dominate bone formation. The interaction and coupling of these two kinds of cells is the key to bone repair. Therefore, the extracellular matrix secreted by the mesenchymal stem cells alone cannot mimic a complex bone regeneration microenvironment, and the addition of extracellular matrix by preosteoclasts may contribute as an effective strategy for bone regeneration. Here, we established the mesenchymal stem cell/preosteoclast extracellular matrix -based tissue-engineered bones and demonstrated that engineered-scaffolds based on mesenchymal stem cell/ preosteoclast extracellular matrix significantly enhanced osteogenesis in a 3 mm rat femur defect model compared with mesenchymal stem cell alone. The bioactive proteins released from the mesenchymal stem cell/ preosteoclast extracellular matrix based tissue-engineered bones also promoted the migration, adhesion, and osteogenic differentiation of mesenchymal stem cells in vitro. As for the mechanisms, the iTRAQ-labeled mass spectrometry was performed, and 608 differentially expressed proteins were found, including the IGFBP5 and CXCL12. Through in vitro studies, we proved that CXCL12 and IGFBP5 proteins, mainly released from the preosteoclasts, contributed to mesenchymal stem cells migration and osteogenic differentiation, respectively. Overall, our research, for the first time, introduce pre-osteoclast into the tissue engineering of bone and optimize the strategy of constructing extracellular matrix–based tissue-engineered bone using different cells to simulate the natural bone regeneration environment, which provides new sight for bone tissue engineering.
Routine use of the Bath Adolescent Pain Questionnaire in a paediatric pain clinic
Authors: Goddard John M , Robinson Jane , Hiscock Rachel
Published: June 2020

Introduction:

Assessment of outcomes from health interventions are of increasing importance, primarily to identify effective and safe treatment, but also to justify funding decisions. The Bath Adolescent Pain Questionnaire (BAPQ) is a self-report questionnaire, validated in 11–18 year olds, assessing the impact of pain in multiple domains of adolescent life. The similarly validated Bath Adolescent Pain Questionnaire for Parents (BAPQ-P) uses the same domains as the BAPQ, assessing the functioning and development of the adolescent from the parents’ perspective.

Methods:

We conducted a prospective study, planning to routinely collect BAPQ/BAPQ-P data at initial assessment and 6 months later. All patients aged between 5 and 19 attending our chronic pain clinic for the first time between December 2009 and December 2014 were mailed BAPQ and BAPQ-P questionnaires before the first appointment and 6 months after the first appointment.

Results:

In total, 376 of 386 families returned questionnaires at time 0 and 96 after 6 months, 26% of those responded at time 0. We found statistically significant differences on patients’ BAPQ questionnaires from 0 to 6 months showing improvement in all domains. A different result was found on parents’ questionnaires where we only found a statistically significant difference on daily and emotional functioning. When comparing patient and parent questionnaires at 0 and 6 months, we found statistically significant differences between patients’ and parents’ questionnaires in the daily functioning and development domains.

Conclusion:

We believe BAPQ and BAPQ-P measurement proved useful tools to assess response to pain management input in adolescents over a 6-month period. Our experience and results suggest that these tools can, with appropriate administrative support, be used in routine clinical practice to assess patient outcomes. We also believe that BAPQ and BAPQ-P measurements have a utility to audit pain clinic activity and potentially a use in demonstrating beneficial outcomes to commissioners.
Dissolution of metastatic thymic carcinoma–associated right atrial thrombus with rivaroxaban
Authors: Nimblette Curlene , Seecheran Rajeev , Kawall Jessica , Seecheran Valmiki , Persad Sangeeta , Ramsaroop Koomatie , Seecheran Naveen Anand
Published: June 2020

Thymic carcinoma typically exhibits more clinically aggressive behavior and portends a worse prognosis as compared to thymoma. Venous thromboembolism is a significant cause of morbidity and mortality in oncologic patients. Traditionally, the standard-of-care management of cancer-associated venous thromboembolism has been therapeutic anticoagulation with low molecular weight heparins; however, with the advent of direct oral anticoagulants, there is an ongoing paradigm shift to transition to these novel agents in an attempt to attenuate cancer-associated venous thromboembolism events. We describe an exceedingly rare case of metastatic thymic carcinoma–associated right atrial thrombus with high-risk embolic features, which subsequently underwent near-complete dissolution with rivaroxaban after 3 months.
Use of a three-dimensional printed anatomical model for tumor management in a pediatric patient
Authors: Salazar David , Huff Trevor J. , Cramer Justin , Wong Lincoln , Linke Gabe , Zuniga Jorge
Published: June 2020

The purpose of this study was to investigate the usage of an anatomical model to improve surgical planning of a complex schwannoma resection. As advancements in additive manufacturing continue to prosper, new applications of this valuable technology are being implemented in the medical field. One of the most recent applications has been in the development of patient-specific anatomical models for unique clinical education as well as for preoperative planning. In this case, a multidisciplinary team with expertise in research, three-dimensional printing, and medicine was formed to develop a three-dimensional printed model that could be used to help plan the reduction of a tumor from the cervical spine of a pediatric patient. Image segmentation and stereolithography creation were accomplished using Mimics and 3-matic, respectively. Models were developed on two different printer types to view different aspects of the region of interest. Reports from the operating surgeon indicated that the model was instrumental in the planning procedures of the operation and reducing operation time.
Successful rechallenge with paliperidone after clozapine treatment for a patient with dopamine supersensitivity psychosis
Authors: Kobayashi Remiko , Oda Yasunori , Hayatsu Ryunosuke , Ohki Nozomi , Akutsu Misa , Oiwa Takahiro , Komatsu Hideki , Niitsu Tomihisa , Sasaki Tsuyoshi , Iyo Masaomi
Published: June 2020

We describe the case of a 49-year-old Japanese male patient successfully treated with a paliperidone rechallenge following 2-year treatment with clozapine for treatment-resistant schizophrenia. He had responded well to conventional antipsychotic treatment for the initial psychotic episode but gradually developed dopamine supersensitivity; even treatment with paliperidone and another antipsychotic medication (a total up to 1700 mg in chlorpromazine-equivalent dose) had not improved his psychotic symptoms. Clozapine treatment produced temporary symptomatic relief, but the clozapine dose could not be increased to > 150 mg due to the patient’s intolerance. Following low-dose clozapine treatment for 2 years, a rechallenge with paliperidone monotherapy ameliorated his psychotic symptoms. This suggests that clozapine may have the potential to release the dopamine supersensitivity state. Our patient’s case indicates that for patients with dopamine supersensitivity psychosis, a rechallenge with a previously ineffective antipsychotic after clozapine treatment may be successful.
Treatment of post-menopausal acne with tretinoin lotion 0.05% delivers rapid results and concomitant benefits
Authors: Sangha Archana M
Published: June 2020

We describe a case of comedonal acne in a post-menopausal female treated with a novel tretinoin lotion 0.05%. The patient also had some actinic keratoses, which are hyperkeratotic, scaly lesions caused by prolonged exposure to ultraviolet radiation. These lesions have the ability to progress into squamous cell carcinoma. Actinic keratoses can occur in patients as young as 20 years, but are more common in patients aged 50 years and older. Topical retinoids are recommended as monotherapy in comedonal acne but despite their documented clinical efficacy are underutilized due to concerns about cutaneous tolerability. Topical tretinoin is currently not recommended as first-line therapy in the treatment of actinic keratosis as its efficacy is not comparable to that of other modalities. In this patient, a novel tretinoin lotion 0.05% resulted in rapid in and sustained improvement of acne. The investigator also observed improvement in actinic keratoses and photodamage. If these results can be confirmed in a larger patient population this may be an attractive area of investigation for the treatment of patients with adult acne and photodamaged skin.
A unique surgical case of giant invasive intracystic carcinoma of the male breast focusing on cytological findings
Authors: Shioya Akihiro , Kadoguchi Rie , Guo Xin , Ukihashi Mayumi , Noguchi Miki , Inokuchi Masafumi , Yamada Sohsuke
Published: June 2020

A 60-year-old male presented with a history of a relatively hard and cystic right chest mass that had gradually increased in size, with subsequent skin erosion, exudate and hemorrhage. The cytologic specimens from a cyst fluid contained a large number of sheet-like or papillary clusters of atypical cuboidal to columnar epithelial cells with loss of myoepithelial components, in a severely inflammatory background with scattered siderophages. We first interpreted it as a carcinoma, but could not completely exclude out the possibilities of benign. Tumor extirpation was performed, and a gross examination of the neoplasm revealed a giant, cystic and partly solid papillary-projected tumor lesion, with a gray-whitish cut surface, associated focally with skin invasion, measuring approximately 9 × 7 cm with a 6 × 4 cm solid area in diameter. On a microscopic examination, solid parts of the tumor were predominantly composed of the intracystic proliferation of mildly atypical epithelial cells with absence of two-cell patterns in a papillary or papillotubular growth fashion, only partly involving the dermis to epidermis. Immunohistochemistry showed that the carcinoma cells were specifically positive for estrogen and progesterone receptors, whereas negative for p63, S-100 protein and several neuroendocrine markers. Therefore, we finally made a diagnosis of invasive intracystic carcinoma of the male breast. We should be aware that owing to its characteristic cytological features, cytopathologists might be able to make a correct diagnosis of that, based on multiple and adequate samplings, even though a core biopsy would be the absolute minimum assessment.
The expression of Kruppel-like factor 2 in mice with collagen-induced arthritis and its role in the induction of nitric oxide synthase production
Authors: Wu Donglei , Wang Xinye , Xu Shuaijun , Zhang Wanjun , Zeng Shiyi , Ni Chenghong , Luo Xinjing , Lv Guoju
Published: June 2020

Kruppel-like factor 2 (KLF2) is associated with acute and chronic inflammation. However, the role of KLF2 in rheumatoid arthritis (RA) remains unknown. Here, we investigated the expression of KLF2 in mice with collagen-induced arthritis (CIA) to determine whether KLF2 levels correlate with inducible nitric oxide synthase (iNOS) production in vitro. Hematoxylin and eosin staining was used to assess the synovitis and bone destruction in mice. The concentration of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and nitric oxide (NO) in synovial fluid was determined by enzyme-linked immunosorbent assay, while western blot (WB) analysis was employed to detect the expression of KLF2 and iNOS in the synovium, heart, and kidneys. The expression of iNOS in MH7A cells was analyzed by quantitative polymerase chain reaction (PCR) and WB. The expression of KLF2 and iNOS was significantly elevated in the synovium, heart, and kidneys of CIA mice. This was correlated to an increase in the severity of arthritis and the concentration of inflammatory mediators including TNF-α, IL-6, and NO in joint fluid. KLF2 and iNOS expression in vitro was induced by TNF-α and KLF2 knockdown significantly reduced the TNF-α-induced iNOS expression. These findings indicate that KLF2 influences synovial inflammation in CIA mice by regulating iNOS production in synoviocytes.
A young woman from an Echinococcus-endemic area with progressive abdominal distension: a case report
Authors: Boehlig Albrecht , Blank Valentin , Karlas Thomas , Trawinski Henning , Hau Hans-Michael , Lederer Andri Arnosson , Berg Thomas
Published: June 2020

Background

Cystic echinococcosis is a zoonotic infection caused by Echinococcus granulosus. This case report shows the difficulty in differential diagnosis in a patient with highly suspected hydatid disease.

Case presentation

A 29-year-old Chinese woman presented with progressive abdominal distension. Imaging results revealed a large multicystic tumor with typical features of hydatid disease. There was no clear relationship between the cystic tumor and the liver, which led to the assumption of primary extrahepatic cystic echinococcosis. After albendazole therapy was initiated, a laparotomy was performed and a huge ovarian cystadenoma was diagnosed.

Conclusions

This case highlights the possible challenges of differential diagnosis in patients with suspicion of hydatid cysts.
Degenerate Hopf bifurcation in a Leslie–Gower predator–prey model with predator harvest
Authors: Su Juan
Published: June 2020

In this paper, we investigate the degenerate Hopf bifurcation of a Leslie–Gower predator–prey system with predator harvest. The known work discussed the Hopf bifurcation of this system when the first Lyapunov number does not vanish and gave an example of a stable weak focus with order 2. However, the thorough discussion of center-type equilibrium for all possible parameters has not been completed. In this paper, by computing the first two focal values, we decompose the variety with resultant and prove that the center-type equilibrium is a weak focus with order at most 2 for all the possible parameter values. Moreover, numerical simulations are employed to show the appearance of two limit cycles from degenerate Hopf bifurcation. Our results finish the study of Hopf bifurcation in this system.
An at-sea assessment of Argos location accuracy for three species of large whales, and the effect of deep-diving behavior on location error
Authors: Irvine Ladd M. , Winsor Martha H. , Follett Tomas M. , Mate Bruce R. , Palacios Daniel M.
Published: June 2020

Background

Argos satellite telemetry is used globally to track terrestrial and aquatic megafauna, yet the accuracy of this system has been described empirically only for a limited number of species. We used Argos-linked archival tags with Fastloc GPS deployed on free-ranging sperm (Physeter macrocephalus), blue (Balaenoptera musculus), and fin (B. physalus) whales to derive empirical estimates of Argos location errors for these species, examine possible behavior-related differences, and test the effect of incorporating species-specific error parameters on performance of a commonly used movement model.

Results

Argos location errors for blue and fin whale tags were similar and were combined (n = 1712 locations) for comparison against sperm whale tags (n = 1206 locations). Location error magnitudes for tags attached to sperm whales were significantly larger than blue/fin whale tags for almost all Argos location classes (LC), ranging from 964 m versus 647 m for LC 3, respectively, to 10,569 m versus 5589 m for LC B, respectively. However, these differences were not seen while tags floated at the surface after release. Sperm whale tags were significantly colder than ambient temperature when surfacing from a dive, compared to blue/fin whale tags (16.9 °C versus 1.3 °C, respectively) leading to larger changes in tag temperature during post-dive intervals. The increased rate of tag temperature change while at the surface was correlated to increased error magnitude for sperm whales but not blue/fin whales. Movement model performance was not significantly improved by incorporating species-specific error parameters.

Conclusions

Location accuracy estimates for blue/fin whales were within the range estimated for other marine megafauna, but were higher for sperm whales. Thermal inertia from deep, long-duration dives likely caused transmission frequency drift and greater Argos location error in sperm whales, as tags warmed at the surface during post-dive intervals. Thus, tracks of deep-diving species may be less accurate than for other species. However, differences in calculated error magnitude between species were less than typical scales of movement and had limited effect on movement model performance. Therefore, broad-scale interpretation of Argos tracking data will likely be unaffected, although fine-scale interpretation should be made with more caution for deep-diving species inhabiting warm regions.
Educational achievement and youth homicide mortality: a City-wide, neighborhood-based analysis
Authors: Bray Michael J. C. , Boulos Mary E. , Shi Galen , MacKrell Kevin , Nestadt Paul S.
Published: June 2020

Background and objective

Educational achievement, particularly among youth, may mitigate risk of exposure to violence and negative related health outcomes such as crime and gang activity. Few studies to date have examined relationships between education and youth homicide. The authors hypothesized association between educational achievement in grades 3 and 8 and youth homicide mortality.

Methods

Neighborhood-based, city-wide analysis was conducted of cross-sectional data regardingN = 55 neighborhoods in Baltimore, MD, extracted from Baltimore 2017 Neighborhood Health Profiles.

Results

Higher educational achievement (operationalized by reading proficiency) in third, but not eighth, grade was associated with reduced neighborhood youth homicide mortality rates in hierarchical linear regression, controlling for demographic and socioeconomic factors (ß = − 0.5082,p = 0.03), such that each 1.97% increase in proportion of students reading at an acceptable level was associated with one fewer neighborhood youth homicide per 100,000. Neighborhoods within the highest tertile of youth homicide mortality differed from those in the lowest tertile with fewer males (45% vs. 48%,p = 0.002), greater unemployment (17% vs. 8%,p < 0.001), familial poverty (35% vs. 16%,p < 0.001), and residents identifying as black or African-American (88% vs. 25%,p < 0.001). Causal mediation analysis demonstrated mediation effects of familial poverty and eighth grade educational achievement through third grade educational achievement (ACME = 0.151,p = 0.04; ACME = − 0.300,p = 0.03, respectively) with no significant direct effects.

Conclusions

Higher educational achievement (operationalized by reading proficiency) predicts reduced homicide mortality among Baltimore youth and appears to mediate effects of familial poverty on homicide mortality as well. This converges with literature highlighting the importance of education as a determinant of social capital and violence. Future policy-based interventions should target inequalities in educational achievement to mitigate homicide risk among youth in communities facing disparities in violent crime.
Pattern of liver injury in adult patients with COVID-19: a retrospective analysis of 105 patients
Authors: Wang Qi , Zhao Hong , Liu Li-Gai , Wang Yan-Bin , Zhang Ting , Li Ming-Hui , Xu Yan-Li , Gao Gui-Ju , Xiong Hao-Feng , Fan Ying , Cao Ying , Ding Rui , Wang Jing-Jing , Cheng Cheng , Xie Wen
Published: June 2020

Background

Recent studies reported that patients with coronavirus disease-2019 (COVID-19) might have liver injury. However, few data on the combined analysis and change patterns of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBil) have been shown.

Methods

This is a single-center retrospective study. A total of 105 adult patients hospitalized for confirmed COVID-19 in Beijing Ditan Hospital between January 12, and March 17, 2020 were included, and divided into mild group (n = 79) and severe group(n = 26). We compared liver functional test results between the two groups. Category of ALT change during the disease course was also examined.

Results

56.2% (59/105) of the patients had unnormal ALT, AST, or total TBil throughout the course of the disease, but in 91.4% (96/105) cases the level of ALT, AST or TBil ≤3 fold of the upper limit of normal reference range (ULN). The overall distribution of ALT, AST, and TBil were all significantly difference between mild and severe group (P <  0.05). The percentage of the patients with elevated both ALT and AST was 12.7% (10/79) in mild cases vs. 46.2% (12/26) in severe cases (P = 0.001). 34.6% (9/26) severe group patients started to have abnormal ALT after admission, and 73.3% (77/105) of all patients had normal ALT before discharge.

Conclusions

Elevated liver function index is very common in patients with COVID-19 infection, and the level were less than 3 × ULN, but most are reversible. The abnormality of 2 or more indexes is low in the patients with COVID-19, but it is more likely to occur in the severe group.
Magnitude of iodine deficiency disorder and associated factors in Dawro zone, Southwest Ethiopia; the hidden hunger: a cross-sectional study
Authors: Asfaw Agize , Belachew Tefera
Published: June 2020

Background

Iodine deficiency disorder (IDD) is continued to be a major public health problem in Ethiopia. The problem is worse but the data is scarce in some pocket areas of the country. This study was aimed to assess the magnitude of IDD and associated factors in southwest Ethiopia by using different biochemical and clinical indicators.

Methods

Both community and school based cross- sectional study was conducted on school age children (6–12 years) from March 1 to 24, 2017. Simple random and systematic sampling techniques were applied to select districts and eligible children respectively. Household data was collected from children’s primary care takers by using structured questionnaire. A trained surgeon examined all children (n = 652) for goiter. Urine sample was collected from 20% of children (n = 130).

Results

A total of 652 school children were participated in the study. Total goiter rate and median urinary iodine concentration (UIC) was 54.8% and 96.12 μg/l respectively. In multivariable logistic regression analyses student’s age was significantly (P < 0 05) associated with both goiter and median UIC. However; sex of students and family income were significantly (P < 0.001) associated with goiter and cassava consumption was significantly (P < 0.001) associated with UIC.

Conclusion

As indicated by the median UIC, there was mild iodine deficiency in this study community. However; chronic iodine deficiency was still a severe public health problem (high goiter prevalence). In addition, there was low concentration of iodine in the salt and increased cassava cultivation and consumption indicating the potential risk in the area. Therefore, it is necessary to intensify IDD elimination activities along with teaching communities on techniques of cassava processing for household consumption.

Trial registration

PACTR201809544276357. Retrospectively registered on 14, Sept 2018.
Visual and anatomic outcomes of sustained single agent anti-VEGF treatment versus double anti-VEGF switching in the treatment of persistent diabetic macular edema
Authors: Sorour Osama A. , Liu Keke , Mehta Nihaal , Braun Phillip , Gendelman Isaac , Nassar Elsayed , Baumal Caroline R. , Witkin Andre J. , Duker Jay S. , Waheed Nadia K.
Published: June 2020

Background

To compare the anatomical and visual outcomes in eyes with persistent diabetic macular edema (DME) after initial anti-VEGF therapy that were retreated continuously with the same anti-VEGF drug versus those that underwent two successive cycles of medication change in anti-VEGF drugs (double anti-VEGF switch).

Methods

Retrospective review of eyes with persistent DME after 3 initial consecutive monthly anti-VEGF injections. This cohort was divided into two groups: Group 1 continued to receive the same initial anti-VEGF drug for at least 18 months while group 2 eyes were switched to different anti-VEGF medications twice. Group 1 was further subdivided into: Group 1A composed of eyes with less than 20% reduction in central subfield thickness (CRT) at month 3; and group 1B eyes with greater than or equal to 20% reduction in CRT. The percentage of eyes that achieved greater than 10 letters visual acuity (VA) gain or loss was recorded as the primary end point (through month 18 in group 1 and month 6 after 2nd switch in group 2).

Results

Group 1A, 1B and group 2 were composed of 24, 18, and 14 eyes respectively. 34.7%, 56.2% and 36.3% of eyes achieved > 10 letters gain, while 4.3%, 6.2% and 27.2% of eyes lost > 10 letters in groups 1A, 1B, and 2, respectively. Analysis of the visual acuity (VA) letter change in this time interval revealed no significant difference between all groups (p = 0.11). Mean VA and CRT measurements at the primary endpoint in all groups were 0.5, 0.39, and 0.47 logMAR (p = 0.44), and 369.7, 279.9, 321 µm, (p = 0.01) respectively.

Conclusions

There was no difference in the visual outcomes between the two treatment strategies in eyes with persistent DME after 3 consecutive anti-VEGF injections. This may indicate that anti-VEGF switching—even if it is done twice—may have comparable clinical outcomes to sustained treatment with one agent.
Percutaneous treatment of vascular access-site complications: a ten years’ experience in two centres
Authors: Minici Roberto , Paone Sara , Talarico Marisa , Zappia Lorenzo , Abdalla Karim , Petullà Maria , Laganà Domenico
Published: June 2020

Background

The spread of percutaneous arterial catheterization in diagnostic and therapeutic procedures has led to a parallel increase of vascular access site complications. The incidence of these events is between 0.2–1%. A detailed analysis of injuries by type of procedure shows a higher incidence of injuries after therapeutic procedures (3%) than those observed for diagnostic ones (1%), due to the greater size of the vascular devices used and the necessity to frequently administer anticoagulant and antiplatelet therapy during procedures. The iatrogenic arterial injuries requiring treatment are the pseudoaneurysm, arteriovenous fistula, arterial rupture and dissection. Less frequent complications include distal embolization of the limbs, nerve damage, abscess and lymphocele.

Moreover, the use of percutaneous vascular closure devices (VCD) has further expanded the types of complications, with an increased risk of stenosis, thrombosis, distal embolism and infection. Our work aims to bring the personal 10 years’ experience in the percutaneous treatment of vascular access-site complications.

Results

Ninety-two pseudoaneurysms (PSA), 12 arteriovenous fistulas (AVF), 15 retrograde dissections (RD) and 11 retroperitoneal bleedings (RB) have been selected and treated. In 120/130 cases there were no periprocedural complications with immediate technical success (92.3%). Nine femoral PSA, treated with percutaneous ultrasound-guided thrombin injection, showed a failure to close the sac and therefore they were treated by PTA balloon inflation with a contralateral approach and cross-over technique. Only one case of brachial dissection, in which the prolonged inflation of the balloon has not led to a full reimbursement of the dissection flap, was then surgically repaired. At the 7 days follow-up, complications were two abscesses in retroperitoneal bleedings, treated by percutaneous drainage. At 3 months, acute occlusion of 3 covered femoral stents occurred, then treated by loco-regional thrombolysis and PTA. A total of 18 major complications was recorded at 2 years, with a complication rate at 2 years of 13.8%.

Conclusions

The percutaneous treatment of vascular access-site complications is the first-choice treatment. It represents a safe and effective option, validated by a high technical success rate and a low long-term complication rate, that allows avoiding the surgical approach in most cases.