bluuebunny/crossref_metadata_2025 huggingface dataset:
Revision Arthrodesis of the Subtalar Joint
Authors: Tracey Joseph , Taghavi Cyrus , Li Shuyuan , Myerson Mark
Published: October 2019

Category:

Hindfoot

Introduction/Purpose:

Subtalar arthrodesis is an invaluable tool in managing arthritis, deformity, and muscular imbalance of the hindfoot. However, failed arthrodesis is complicated by bone necrosis, sclerosis with loss of bone, less than ideal biologic settings, and the literature reports a high rate of non-union. The aim of this study was to review all subtalar arthrodeses performed within a single institution, and specifically describe the management of non-union.

Methods:

492 consecutive subtalar arthrodesis cases were retrospectively analyzed between October 2001 and July 2013. From the primary arthrodesis group 91 (18%) were treated for subtalar coalition (100% arthrodesis), and were excluded to better depict the arthrodesis rate; the remaining 401 patients were treated primarily for post-traumatic arthritis. Pertinent demographics, comorbidities, and clinical notes were all retrieved through the electronic medical record and radiographs were reviewed through a PACS system.

Results:

49 patients with a mean age of 49 years (range 23 - 80) presented with subtalar non-union (overall rate 10%, adjusted rate 18%). 41 (84%) underwent revision at a mean of 16.2 months (range 2.8 - 57.1) from the index arthrodesis. The rate of revision arthrodesis was 78%, 21/30 (70%) in situ arthrodeses, 7/7 bone block arthrodesis (p=.028), and 4/4 triple arthrodesis (p=.028). Arthrodesis was present at a mean of 3.4 months (range 1.6 - 7.6). 4/9 (44%) of the recurrent nonunions elected to abstain from surgery. Of the 5 remaining patients, 2/5 had a successful third attempt at arthrodesis, 1/5 had an additional nonunion followed by a successful fourth attempt at arthrodesis, 1/5 had a successful tibiotalocalcaneal arthrodesis, and 1/5 required a below-knee amputation.

Conclusion:

Risk factors identified for non-union were post-traumatic arthritis, ipsilateral ankle arthrodesis, and individual patient factors (smoking, diabetes, and infection). Different methods of screw fixation were not found to be significantly different between the fused and nonunion groups. Despite directed management to obtain rigid fixation and adequate compression, the rates of subtalar arthrodesis from primary (82%), revision (78%) and secondary revision (60%) cases were very poor with the exception of the group which underwent a bone block arthrodesis (100%, p=.028).
The Impact of Metabolic Syndrome on 30-day Outcomes Following ORIF for Ankle Fractures
Authors: Xie Jack , Malik Azeem Tariq , Quatman Carmen E , Ly Thuan V. , Phieffer Laura , Khan Safdar N
Published: October 2019

Category:

Ankle, Trauma

Introduction/Purpose:

Metabolic syndrome (MetS) has been shown to be associated with significant post-operative morbidity. Despite an increasing prevalence of MetS in the US population, it’s impact on post-operative outcomes following ankle fractures remains limited.

Methods:

The 2012-2016 ACS-NSQIP database was used to query for patients undergoing ORIF for ankle fractures using Current Procedural Terminology (CPT) codes – 27766, 27769, 27792, 27814, 27822 and 27823. Patient undergoing surgery for polytrauma were excluded from the analysis. Records were further filtered to remove patients with missing data. The study cohort was divided into two groups – MetS vs. No MetS. MetS was identified using a pre-defined criteria, used previously in other studies, as the co-existence of 1) Diabetes Mellitus, 2) Hypertension and 3) BMI =30 kg/m2.

Results:

A total of 1,013 (6.7%) MetS underwent ORIF for ankle fractures. Following adjustment for differences in baseline demographic, co-morbidities, pre-operative and operative data, MetS was an independent predictor of experiencing any 30-day complication (OR 1.35 [95% CI 1.05 -1.74]; p=0.020), wound complications (OR 1.67 [95% CI 1.07-2.60]; p=0.024), renal complications (OR 3.54 [95% CI 1.20-10.48]; p=0.022), 30-day readmissions (OR 1.66 [95% CI 1.24-2.22]; p=0.001), 30-day unplanned re-operations (OR 1.69 [95% CI 1.14-2.51]; p=0.009). MetS was significantly associated with decreased odds of home discharge (OR 0.66 [95% CI 0.54-0.79]; p<0.001).

Conclusion:

Patients with MetS undergoing ORIF for ankle fractures are at an increased risk of experiencing adverse complications, re-admissions and re-operations within 30-days of the surgery. Providers should understand the need of appropriate post-operative surveillance in this high-risk group to minimize the risk of poor outcomes.
Reconstruction of Calcaneal Fracture Malunion with Osteotomy and Subtalar Joint Salvage
Authors: Zhang Mingzhu , Yu Guangrong
Published: October 2019

Category:

Hindfoot

Introduction/Purpose:

The goal of this study was to discuss the outcomes of treating calcaneal fracture malunion by restoring the subtalar joint with a reconstructive osteotomy.

Methods:

From May 2005 to November 2016, 85 patients (88 feet) with calcaneal malunions after a displaced intraarticular calcaneal fracture were treated by osteotomy and autogenous bone graft. The subtalar joint was preserved. The mean time from initial injury to reconstructive operation was 8.9 months (95% confidence interval, 4.5-11.6 months). The displaced posterior facet was restored through a reconstructive osteotomy, whereas the bone defect in the calcaneus after reduction was filled with the lateral exostosis that had been removed, iliac bone graft was used if necessary. All patients were evaluated clinically and radiographically at a minimum of 24 months. Sixty two patients (63 feet) were followed for a mean of 45.4 months (29.0-52.3 months).

Results:

According to American Orthopaedic Foot & Ankle Society (AOFAS) ankle and hindfoot score, the average score was 81.6 points (95% confidence interval, 78.5-90.4 points), which was significantly higher than the preoperative assessment. Radiographs showed that Böhler’s angle, Gissane’s angle, talus declination angle, and width and height of calcaneus were improved to a great extent. Eight patients had wound edge necrosis, and 4 had superficial infection. Two patient required a subtalar fusion for subtalar arthritis at 2 years after surgery.

Conclusion:

Restoring the subtalar joint with a reconstructive osteotomy and autogenous bone graft was an effective treatment method for selected calcaneal fracture malunions. It reconstructed calcaneal morphology and preserved the subtalar joint.
Doctor YouTube: A Quality Analysis Of Medical Information Videos On The Video Platform YouTube On Ankle Sprain
Authors: Zyskowski Michael , Pesch Sebastian , Greve Frederik , Matthey Francesca von , Wurm Markus , Zapf Julian , Biberthaler Peter , Kirchhoff Chlodwig
Published: October 2019

Category:

Ankle, Sports, Trauma

Introduction/Purpose:

The video portal YouTube has evolved from pure entertainment to professional and semi-professional video tutorials and medical video channels in the recent past. As a result, YouTube today is a source of information that is widely used by patients and relatives. Ankle sprains are one of the most common musculoskeletal injuries, this study was designed to analyze the quality of informational videos available on YouTube and to identify potential hazards as well as content errors.

Methods:

In July 2016, YouTube was searched for the terms “ankle sprain”, “high ankle sprain”, “ankle pain” and “ankle pain distortion”. The analysis was limited to the first 5 result pages for each search term. Only English and German videos were included. The videos were found by 2 independent evaluators (MZ, SP) using a multi-dimensional score checklist for the sections anatomy, risk factors and symptoms (max 8 pts), biomechanics (max 3 pts), imaging (max 2 pts), clinical examination (max 6 pts), treatment (max 5 pts), rehabilitation measures (max 2 pts) and prevention (max 2 pts) with a maximum scores per contribution of 31 pts evaluated.

Results:

The mean score of the video quality was 11.5 ± 4.5 pts. Distribution of points by subgroup: anatomy, risk factors and symptoms 3.7 ± 1.4, biomechanics 1,8 ± 1.2, imaging 0.9 ± 0.8, clinical examination 1.3 ± 1.2, treatment 2 ± 1.3, rehabilitation 1.1 ± 0.9, prevention 0.6 ± 1. No evaluated contribution achieved “very good” Quality Assessment Score of 25-31 pts, one video was rated ”good” with 21-26 pts, 2 videos were “satisfactory” (20-16 pts), 14 videos ”sufficient” (15-10 pts.). 7 videos were rated as “insufficient” (9-4 pts). One clip (2.5 pts) was rated as a promotional video. A slight correlation between views by videos and score (r = 0.11) and a small correlation between the total score and Likes occured (r = 0.15).

Conclusion:

Patients watching online video tutorials on ankle injuries are seeking valid information. YouTube gives an extensive video footage of low quality. The defective and incorrect information analyzed by us must be corrected by medical advice. Furthermore, the presented investigation shows an average to bad quality so that the introduction of a seal of approval by the AOFAS for digital content, based on an evidence-based quality control should be discussed in the future.
Network inference with ensembles of bi-clustering trees
Authors: Pliakos Konstantinos , Vens Celine
Published: October 2019

Background

Network inference is crucial for biomedicine and systems biology. Biological entities and their associations are often modeled as interaction networks. Examples include drug protein interaction or gene regulatory networks. Studying and elucidating such networks can lead to the comprehension of complex biological processes. However, usually we have only partial knowledge of those networks and the experimental identification of all the existing associations between biological entities is very time consuming and particularly expensive. Many computational approaches have been proposed over the years for network inference, nonetheless, efficiency and accuracy are still persisting open problems. Here, we propose bi-clustering tree ensembles as a new machine learning method for network inference, extending the traditional tree-ensemble models to the global network setting. The proposed approach addresses the network inference problem as a multi-label classification task. More specifically, the nodes of a network (e.g., drugs or proteins in a drug-protein interaction network) are modelled as samples described by features (e.g., chemical structure similarities or protein sequence similarities). The labels in our setting represent the presence or absence of links connecting the nodes of the interaction network (e.g., drug-protein interactions in a drug-protein interaction network).

Results

We extended traditional tree-ensemble methods, such as extremely randomized trees (ERT) and random forests (RF) to ensembles of bi-clustering trees, integrating background information from both node sets of a heterogeneous network into the same learning framework. We performed an empirical evaluation, comparing the proposed approach to currently used tree-ensemble based approaches as well as other approaches from the literature. We demonstrated the effectiveness of our approach in different interaction prediction (network inference) settings. For evaluation purposes, we used several benchmark datasets that represent drug-protein and gene regulatory networks. We also applied our proposed method to two versions of a chemical-protein association network extracted from the STITCH database, demonstrating the potential of our model in predicting non-reported interactions.

Conclusions

Bi-clustering trees outperform existing tree-based strategies as well as machine learning methods based on other algorithms. Since our approach is based on tree-ensembles it inherits the advantages of tree-ensemble learning, such as handling of missing values, scalability and interpretability.
CLINE: a web-tool for the comparison of biological dendrogram structures
Authors: Allendes Osorio Rodolfo S. , Tripathi Lokesh P. , Mizuguchi Kenji
Published: October 2019

Background

When visually comparing the results of hierarchical clustering, the differences in the arrangements of components are of special interest. However, in a biological setting, identifying such differences becomes less straightforward, as the changes in the dendrogram structure caused by permuting biological replicates, do not necessarily imply a different biological interpretation. Here, we introduce a visualization tool to help identify biologically similar topologies across different clustering results, even in the presence of replicates.

Results

Here we introduce CLINE, an open-access web application that allows users to visualize and compare multiple dendrogram structures, by visually displaying the links between areas of similarity across multiple structures. Through the use of a single page and a simple user interface, the user is able to load and remove structures form the visualization, change some aspects of their display and set the parameters used to match cluster topology across consecutive pairs of dendrograms.

Conclusions

We have implemented a web-tool that allows the users to visualize different dendrogram structures, showing not only the structures themselves, but also linking areas of similarity across multiple structures. The software is freely available at http://mizuguchilab.org/tools/cline/. Also, the source code, documentation and installation instructions are available on GitHub at https://github.com/RodolfoAllendes/cline/.
Legofit: estimating population history from genetic data
Authors: Rogers Alan R.
Published: October 2019

Background

Our current understanding of archaic admixture in humans relies on statistical methods with large biases, whose magnitudes depend on the sizes and separation times of ancestral populations. To avoid these biases, it is necessary to estimate these parameters simultaneously with those describing admixture. Genetic estimates of population histories also confront problems of statistical identifiability: different models or different combinations of parameter values may fit the data equally well. To deal with this problem, we need methods of model selection and model averaging, which are lacking from most existing software.

Results

The Legofit software package allows simultaneous estimation of parameters describing admixture, and the sizes and separation times of ancestral populations. It includes facilities for data manipulation, estimation, analysis of residuals, model selection, and model averaging.

Conclusions

Legofit uses genetic data to study the history of a subdivided population. It is unaffected by recent history and can therefore focus on the deep history of population size, subdivision, and admixture. It outperforms several statistical methods that have been widely used to study population history and should be useful in any species for which DNA sequence data is available from several populations.
Dynamic transcriptome sequencing and analysis during early development in the bighead carp (Hypophthalmichthys nobilis)
Authors: Fu Jianjun , Zhu Wenbin , Wang Lanmei , Luo Mingkun , Song Feibiao , Dong Zaijie
Published: October 2019

Background

Early development is a key process of the life history of fish. However, the relationship between the transcriptome and the dynamic regulation of early development is still uncharacterized in the bighead carp (Hypophthalmichthys nobilis). In the present study, we performed transcriptome analysis of six development stages inH. nobilis, aiming to understand the dynamic molecular regulation of early development in this fish.

Results

A total of 76,573 unigenes were assembled from clean sequence reads, with an average length of 1768 base. Among which, 41,742 (54.54%) unigenes were annotated to public protein databases, and an additional 59,014 simple sequence repeat (SSR) loci were identified among the unigenes. Furthermore, 30,199 differentially expressed transcripts (DETs) (fold change > 4 or < 0.25, and the false discovery rate FDR < 0.01) were observed in comparisons between the adjacent developmental stages, and nine expression patterns (profiles) were simulated using series-cluster analysis across six developmental stages. The unigenes expression level markedly increased after the DS1 stage (early blastula), and the numbers of DETs gradually decreased during subsequent development. The largest transcriptomic change (up- or down-regulated) was detected during the period from DS1 to DS2 (6-somite stage), which was enriched for many biological processes and metabolic pathways related to maternal to zygotic transition (MZT). Distinctly protein-protein interaction (PPI) networks were plotted for DETs during the period from DS1 to DS2. The genes (or proteins) from the same pathways were integrated together, and showed with obvious co-regulation patterns. In the series-cluster analysis, a remarkable profile of gene expression (profile_48) was identified that is probably related to the hatching duringH. nobilisdevelopment, and the strict co-expression of a hatching enzyme gene (hce1) with 33 other annotated genes was identified from this profile.

Conclusions

The results indicated that strict dynamic regulation occurs during the early development inH. nobilis, especially in embryogenesis before hatching. This study provides valuable new information and transcriptomic resources related toH. nobilisearly development, and for certain events such as MZT and hatching.
Correction to: QTL mapping of flowering time and biomass yield in tetraploid alfalfa (Medicago sativa L.)
Authors: Adhikari Laxman , Makaju Shiva Om , Missaoui Ali M.
Published: October 2019

In the article [1], in ‘Methods’ section and ‘G x E and heritability’ subsection, there is an error in the formula of heritability (H2).
Direct-from-blood RNA sequencing identifies the cause of post-bronchoscopy fever
Authors: Ko Emily R. , Philipson Casandra W. , Burke Thomas W. , Cer Regina Z. , Bishop-Lilly Kimberly A. , Voegtly Logan J. , Tsalik Ephraim L. , Woods Christopher W. , Clark Danielle V. , Schully Kevin L.
Published: October 2019

Background

Antibiotic resistance is rising at disturbing rates and contributes to the deaths of millions of people yearly. Antibiotic resistant infections disproportionately affect those with immunocompromising conditions, chronic colonization, and frequent antibiotic use such as transplant patients or those with cystic fibrosis. However, clinicians lack the diagnostic tools to confidently diagnose and treat infections, leading to widespread use of empiric broad spectrum antimicrobials, often for prolonged duration.

Case presentation

A 22 year-old Caucasian female with cystic fibrosis received a bilateral orthotopic lung transplantation 5 months prior to the index hospitalization. She underwent routine surveillance bronchoscopy and was admitted for post-procedure fever. A clear cause of infection was not identified by routine methods. Imaging and bronchoscopic lung biopsy did not identify an infectious agent or rejection. She was treated with a prolonged course of antimicrobials targeting known colonizing organisms from prior bronchoalveolar lavage cultures (Pseudomonas, Staphylococcus aureus, and Aspergillus). However, we identified Stenotrophomonas maltophilia in two independent whole blood samples using direct-pathogen sequencing, which was not identified by other methods.

Conclusions

This case represents a common clinical conundrum: identification of infection in a high-risk, complex patient. Here, direct-pathogen sequencing identified a pathogen that would not otherwise have been identified by common techniques. Had results been clinically available, treatment could have been customized, avoiding a prolonged course of broad spectrum antimicrobials that would only exacerbate resistance. Direct-pathogen sequencing is poised to fill a diagnostic gap for pathogen identification, allowing early identification and customization of treatment in a culture-independent, pathogen-agnostic manner.
Correction to: Public health impact and cost effectiveness of routine childhood vaccination for hepatitis a in Jordan: a dynamic model approach
Authors: Hayajneh Wail A. , Daniels Vincent J. , James Cerise K. , Kanıbir Muhammet Nabi , Pilsbury Matthew , Marks Morgan , Goveia Michelle G. , Elbasha Elamin H. , Dasbach Erik , Acosta Camilo J.
Published: October 2019

Following publication of the original article1, the authors noted the following:
Bayesian modeling of spatiotemporal patterns of TB-HIV co-infection risk in Kenya
Authors: Otiende Verrah , Achia Thomas , Mwambi Henry
Published: October 2019

Background

Tuberculosis (TB) and Human Immunodeficiency Virus (HIV) diseases are globally acknowledged as a public health challenge that exhibits adverse bidirectional relations due to the co-epidemic overlap. To understand the co-infection burden we used the case notification data to generate spatiotemporal maps that described the distribution and exposure hypotheses for further epidemiologic investigations in areas with unusual case notification levels.

Methods

We analyzed the TB and TB-HIV case notification data from the Kenya national TB control program aggregated for forty-seven counties over a seven-year period (2012–2018). Using spatiotemporal poisson regression models within the Integrated Nested Laplace Approach (INLA) paradygm, we modeled the risk of TB-HIV co-infection. Six competing models with varying space-time formulations were compared to determine the best fit model. We then assessed the geographic patterns and temporal trends of coinfection risk by mapping the posterior marginal from the best fit model.

Results

Of the total 608,312 TB case notifications, 194,129 were HIV co-infected. The proportion of TB-HIV co-infection was higher in females (39.7%) than in males (27.0%). A significant share of the co-infection was among adults aged 35 to 44 years (46.7%) and 45 to 54 years (42.1%). Based on the Bayesian Defiance Information (DIC) and the effective number of parameters (pD) comparisons, the spatiotemporal model allowing space-time interaction was the best in explaining the geographical variations in TB-HIV coinfection. The model results suggested that the risk of TB-HIV coinfection was influenced by infrastructure index (Relative risk (RR) = 5.75, Credible Interval (Cr.I) = (1.65, 19.89)) and gender ratio (RR = 5.81e−04, Cr. I = (1.06e−04, 3.18e−03). The lowest and highest temporal relative risks were in the years 2016 at 0.9 and 2012 at 1.07 respectively. The spatial pattern presented an increased co-infection risk in a number of counties. For the spatiotemporal interaction, only a few counties had a relative risk greater than 1 that varied in different years.

Conclusions

We identified elevated risk areas for TB/HIV co-infection and fluctuating temporal trends which could be because of improved TB case detection or surveillance bias caused by spatial heterogeneity in the co-infection dynamics. Focused interventions and continuous TB-HIV surveillance will ensure adequate resource allocation and significant reduction of HIV burden amongst TB patients.
Active immunoprophyilaxis with uromune® decreases the recurrence of urinary tract infections at three and six months after treatment without relevant secondary effects
Authors: Ramírez Sevilla Cristóbal , Gómez Lanza Esther , Manzanera Juan Llopis , Martín Jose Antonio Romero , Sanz Miguel Ángel Barranco
Published: October 2019

Background

To prospectively analyze the efficacy of uromune® in the prevention of uncomplicated recurrent urinary tract infections at 3 and 6 months, and according to gender and menopause.

Methods

From September 2011 to December 2017 uromune® was administered sublingually every 24 h along 3 months to 784 patients with history of three or more uncomplicated urinary tract infections in the 12 months prior to the first visit.

The variables analyzed with statistical package system for science version 15.0 were age, gender, number of urinary tract infections with positive urine culture in the first consultation, and 3 and 6 months after the end of treatment.

The results with positive urine culture were registered at 3 and 6 months after the end of the treatment according to gender and also in the menopausal group with respect to pre-menopausal women.

Results

Mean age was 73.5 years. 82.7% were women and 94.3% menopausal.

The number of episodes of urinary tract infections in the 12 months prior to uromune® were 3 in 37.2%, 4 in 28.1%, 5 in 19.5%, 6 in 9.6%, 7 in 4%, 8 in 1.4%, 9 in 0.1% and 10 in 0.1%.

Three months after uromune® 44.1% had 0 urinary tract infections and 27.6% had 1. After 6 months the results were 0 urinary tract infections in 32.3% and 1 in 32.4%.

Women had 0 urinary tract infections after 3 months in 45.4% and 1 in 28.5%. At 6 months the female had 0 episodes in 32.7% and 1 in 33.2%.

Menopausal women had 0 urinary tract infections at 3 months in 46.5% and 1 in 28% and at 6 months scored 0 episodes in 33.6% and 1 in 32.9%.

Conclusions

Uromune® was highly effective to reduce the number of episodes of urinary tract infections at three and six months of follow-up. Uromune® reduced the number of episodes to zero or one in 71.7 and 64.7% at three and six months with minimal side effects.

The best results were observed in women over 50 years old.

Sublingual immunoprophylaxis with uromune® could be the treatment of first choice in the prevention of uncomplicated recurrent urinary tract infections according to the sample analyzed.
Death due to delirium: a case of a self-cut hemodialysis dialysis catheter - a case report
Authors: Brown Pierre Antoine , Magner Peter O. , Hiremath Swapnil , Clark Edward G.
Published: October 2019

Background

Neuropsychiatric conditions such as depression, delirium and cognitive impairment are common in patients with end-stage kidney disease (ESKD) and individuals suffering from ESKD are more likely to commit suicide than members of the general population. Self-harm gestures are not infrequent for ESKD patients suffering from depression, but not well described in other conditions.

Case presentation

We present a case of self-harm in a patient with ESKD suffering from acute delirium. A man in his mid-seventies was admitted with fungal peritoneal dialysis (PD) associated peritonitis. On the first day post operatively, he was found with absent vital signs due to exsanguination from newly inserted central catheter which he which had self-severed. He died a few days later as a result of the self-harm gesture.

Conclusion

This case highlights that delirium may lead to self-harm events in ESKD and identifies a few strategies to help reduce the risk of self-harm events.
Correlation between significant asymptomatic carotid artery stenosis and severity of peripheral arterial occlusive disease in the lower limb: a retrospective study on 200 patients
Authors: Pan Zhongjie , Wang Ruitao , Li Li , Zhang Hua
Published: October 2019

Background

The aim of this study was to evaluate the correlation between significant asymptomatic carotid artery stenosis (ACAS) and severity of peripheral arterial occlusive disease (PAOD) in the lower limb, and to investigate the risk factors for significant ACAS in patients with lower limb PAOD.

Methods

Two hundred patients with lower limb PAOD were retrospectively reviewed. Baseline data, medical history and potential risk factors were collected. Lower limb PAOD was classified as stage IIA, stage IIB, stage III and stage IV. The carotid artery stenosis was classified as significant ACAS and non-significant ACAS. Multiple logistic regression estimated odds ratio of the risk factors.

Results

Compared to patients with non-significant ACAS, the patients with significant ACAS were significantly older in age and had greater percentage of cigarette-smoking andalcohol beverage consumption, and higher levels of total cholesterol and fibrinogen. There was no significant difference in sex, diabetes, hypertension, coronary heart disease and triglyceride between the two groups. The prevalence rate of significant ACAS increased with the stage of lower limb PAOD and with age. Advanced age and hypercholesteremia were risk factors for significant ACAS in this cohort. The prevalence rate of stroke increased with ACAS stage.

Conclusion

The results suggested that the prevalence rate of significant ACAS was positively correlated with the severity of lower limb PAOD and age. Advanced age and hypercholesteremia appeared to be potential risk factors for significant ACAS in patients with lower limb PAOD.
Dynamic interaction of genetic risk factors and cocaine abuse in the background of Parkinsonism – a case report
Authors: Illés Anett , Balicza Péter , Molnár Viktor , Bencsik Renáta , Szilvási István , Molnar Maria Judit
Published: October 2019

Background

Parkinsonism is a complex multifactorial neurodegenerative disorder, in which genetic and environmental risk factors may both play a role. Among environmental risk factors cocaine was earlier ambiguously linked to Parkinsonism. Former single case reports described Parkinsonism in chronic cocaine users, but an epidemiological study did not confirm an increased risk of Parkinson’s disease. Here we report a patient, who developed Parkinsonism in young age after chronic cocaine use, in whom a homozygous LRRK2 risk variant was also detected.

Case presentation

The patient was investigated because of hand tremor, which started after a 1.5-year period of cocaine abuse. Neurological examination suggested Parkinsonism, and asymmetrical pathology was confirmed by the dopamine transporter imaging study. The genetic investigations revealed a homozygous risk allele in the LRRK2 gene. After a period of cocaine abstinence, the patient’s symptoms spontaneously regressed, and the dopamine transporter imaging also returned to near-normal.

Conclusions

This case report suggests that cocaine abuse indeed might be linked to secondary Parkinsonism and serves as an example of a potential gene-environmental interaction between the detected LRRK2 risk variant and cocaine abuse. The reversible nature of the DaTscan pathology is a unique feature of this case, and needs further evaluation, whether this is incidental or can be a feature of cocaine related Parkinsonism.
A prospective study of maternal postnatal depressive symptoms with infant-feeding practices in a Chinese birth cohort
Authors: Sha Tingting , Gao Xiao , Chen Cheng , Li Ling , Cheng Gang , Wu Xialing , Tian Qianling , Yang Fan , He Qiong , Yan Yan
Published: October 2019

Background

The first few weeks after childbirth are critical, as women may encounter lactation problems and postpartum depression during this period. However, it is still unclear whether early breastfeeding behaviours are related to the symptoms of postnatal depression (PND) in Chinese populations. Therefore, the current study aimed to investigate the association between symptoms of PND and infant feeding practices based on a large-scale Chinese cohort.

Methods

A prospective study of the community-based cohort was conducted from January 2015 to December 2016. Infant feeding outcomes, including exclusive/partial breastfeeding and formula feeding, were assessed according to the WHO guidelines. Symptoms of PND were assessed by the Edinburgh Postnatal Depression Scale at 4 weeks postpartum. Multivariate generalized estimating equation models were applied to investigate the associations between depressive symptoms and infant feeding behaviours.

Results

A total of 956 mother-infant pairs were included. Fifty-six mothers presented screen-positive symptoms of PND with a cut-off ≥10. The percentage of early breastfeeding initiation was 75.8%, while the average duration of exclusive breastfeeding was 3.90 ± 2.33 months. Postnatal depressive symptoms were associated with a shorter breastfeeding duration (8.02 vs. 6.32 months, P < 0.05) and earlier formula introduction (4.98 vs. 3.60 months, P < 0.05). After adjustments were made for covariates, postnatal depressive symptoms were associated with an increased risk of the discontinuation of exclusive and partial breastfeeding (β = − 0.049, P = 0.047 and β = − 0.082, P = 0.006, respectively). Compared to mothers without symptoms of PND, mothers with depressive symptoms were more likely to supplement formula for their infants in the first year of life (β =0.074, P = 0.016). These associations were still significant in the sensitivity analyses, using an EPDS cut-off of ≥13.

Conclusions

Our findings indicate that depressive symptoms at 4 weeks postpartum are associated with the cessation of exclusive and partial breastfeeding duration and the introduction of formula in the 12 months of delivery. Early psychosocial assessment and social support should be offered to mothers in the early postpartum period to indirectly prevent adverse breastfeeding outcomes.
Diabetes care in remote Australia: the antenatal, postpartum and inter-pregnancy period
Authors:   On behalf of the NT Diabetes in Pregnancy Partnership, Kirkham R. , Trap-Jensen N. , Boyle J. A. , Barzi F. , Barr E. L. M. , Whitbread C. , Van Dokkum P. , Kirkwood M. , Connors C. , Moore E. , Zimmet P. , Corpus S. , Hanley A. J. , O’Dea K. , Oats J. , McIntyre H. D. , Brown A. , Shaw J. E. , Maple-Brown L.
Published: October 2019

Background

Aboriginal and Torres Strait Islander women experience high rates of diabetes in pregnancy (DIP), contributing to health risks for mother and infant, and the intergenerational cycle of diabetes. By enhancing diabetes management during pregnancy, postpartum and the interval between pregnancies, the DIP Partnership aims to improve health outcomes and reduce risks early in the life-course. We describe a mixed methods formative study of health professional’s perspectives of antenatal and post-partum diabetes screening and management, including enablers and barriers to care.

Methods

Health professionals involved in providing diabetes care in pregnancy, from a range of health services across the Northern Territory, completed the survey (n = 82) and/or took part in interviews and/or focus groups (n = 62).

Results

Qualitative findings highlighted factors influencing the delivery of care as reported by health professionals, including: whose responsibility it is, access to care, the baby is the focus and pre-conception care. The main challenges were related to: disjointed systems and confusion around whose role it is to provide follow-up care beyond six weeks post-partum. Quantitative findings indicated that the majority of health professionals reported confidence in their own skills to manage women in the antenatal period (62%, 40/79) and slightly lower rates of confidence in the postpartum interval (57%, 33/58).

Conclusion

These findings regarding whose role it is to provide postpartum care, along with opportunities to improve communication pathways and follow up care have informed the design of a complex health intervention to improve health systems and the provision of DIP related care.
Flemish breast cancer screening programme: 15 years of key performance indicators (2002–2016)
Authors: Goossens M. , De Brabander I. , De Grève J. , Van Ongeval C. , Martens P. , Van Limbergen E. , Kellen E.
Published: October 2019

Background

We examined 15 years of key performance indicators (KPIs) of the population-based mammography screening programme (PMSP) in Flanders, Belgium.

Methods

Individual screening data were linked to the national cancer registry to obtain oncological follow-up. We benchmarked crude KPI results against KPI-targets set by the European guidelines and KPI results of other national screening programmes. Temporal trends were examined by plotting age-standardised KPIs against the year of screening and estimating the Average Annual Percentage Change (AAPC).

Results

PMSP coverage increased significantly over the period of 15 years (+ 7.5% AAPC), but the increase fell to + 1.6% after invitation coverage was maximised. In 2016, PMSP coverage was at 50.0% and opportunistic coverage was at 14.1%, resulting in a total coverage by screening of 64.2%. The response to the invitations was 49.8% in 2016, without a trend. Recall rate decreased significantly (AAPC -1.5% & -5.0% in initial and subsequent regular screenings respectively) while cancer detection remained stable (AAPC 0.0%). The result was an increased positive predictive value (AAPC + 3.8%). Overall programme sensitivity was stable and was at 65.1% in 2014.

In initial screens of 2015, the proportion of DCIS, tumours stage II+, and node negative invasive cancers was 18.2, 31.2, and 61.6% respectively. In subsequent regular screens of 2015, those proportions were 14.0, 24.8, and 65.4% respectively. Trends were not significant.

Conclusion

Besides a suboptimal attendance rate, most KPIs in the Flemish PMSP meet EU benchmark targets. Nonetheless, there are several priorities for further investigation such as a critical evaluation of strategies to increase screening participation, organising a biennial radiological review of interval cancers, analysing the effect that preceding opportunistic screening has on the KPI for initial screenings, and efforts to estimate the impact on breast cancer mortality.
Effect of skill drills on neonatal ventilation performance in a simulated setting- observation study in Nepal
Authors: Gurung Rejina , Gurung Abhishek , Sunny Avinash K. , Basnet Omkar , Shrestha Shree Krishna , Gomo Øystein Herwig , Myklebust Helge , Girnary Sakina , KC Ashish
Published: October 2019

Aim

Maintaining neonatal resuscitation skills among health workers in low resource settings will require continuous quality improvement efforts. We aimed to evaluate the effect of skill drills and feedback on neonatal resuscitation and the optimal number of skill drills required to maintain the ventilation skill in a simulated setting.

Methods

An observational study was conducted for a period of 3 months in a referral hospital of Nepal. Sixty nursing staffs were trained on Helping Babies Breathe (HBB) 2.0 and daily skill drills using a high-fidelity manikin. The high-fidelity manikin had different clinical case scenarios and provided feedback as “well done” or “improvement required” based on the ventilation performance. Adequate ventilation was defined as bag-and-mask ventilation at the rate of 40–60 breaths per minute. The effective ventilation was defined as adequate ventilation with a “well done” feedback. We assessed the correlation of number skill drills and clinical case scenario with adequate ventilation rate using pearson’s correlation. We assessed the correlation of number of skill dills performed by each participant with effective ventilation using Mann Whitney test.

Results

Among the total of 60 nursing staffs, all of them were competent with an average score of 12.73 ± 1.09 out of 14 (p < 0.001) on bag-and-mask ventilation skill checklist. Among the trained staff, 47 staffs participated in daily skill drills who performed a total of 331 skill drills and 68.9% of the ventilations were done adequately. Among the 47 nursing staffs who performed the skill drills, 228 (68.9%) drills were conducted at a ventilation rate of 40–60 breathes per minute. There was no correlation of the adequate ventilation with skill drill category (p = 0.88) and the level of skill performed (p = 0.28). Out of 47 participants performing the skill drills, 74.5% of them had done effective ventilation with a mean average of 8 skill drills (SD ± 4.78) (p-value- 0.032).

Conclusion

In a simulated setting, participants who had an average skill drill of 8 in 3 months had effective ventilation. We demonstrated optimal skill drill sessions for maintain the neonatal resuscitation competency. Further evaluation will be required to validate the findings in a scale up setting.
Later achievement of infant motor milestones is related to lower levels of physical activity during childhood: the GECKO Drenthe cohort
Authors: Brouwer Silvia I. , Stolk Ronald P. , Corpeleijn Eva
Published: October 2019

Background

The aim of this study is to investigate whether age of infant motor milestone achievement is related to levels of physical activity (PA), weight status and blood pressure at age 4–7 years of age.

Methods

In the Dutch GECKO (Groningen Expert Center of Kids with Obesity) Drenthe cohort, the age of achieving the motor milestone ‘walking without support’ was reported by parents. Weight status and blood pressure were assessed by trained health nurses and PA was measured using the Actigraph GT3X between age 4 and 7 years.

Results

Adjusted for children’s age, sex and the mother’s education level, infants who achieved walking without support at a later age, spent more time in sedentary behaviour during childhood and less time in moderate-to-vigorous PA. Later motor milestones achievement was not related to higher BMI Z-score, waist circumference Z-score, diastolic or systolic blood pressure.

Conclusion

The results of this study indicate that a later age of achieving motor milestone within the normal range have a weak relation to lower PA levels at later age. It is not likely that this will have consequences for weight status or blood pressure at 4–7 years of age.
Fetal alcohol spectrum disorder: neurodevelopmentally and behaviorally indistinguishable from other neurodevelopmental disorders
Authors: Lange Shannon , Shield Kevin , Rehm Jürgen , Anagnostou Evdokia , Popova Svetlana
Published: October 2019

Background

The lack of universally accepted diagnostic criteria and the high rate of psychiatric comorbidity make it difficult to diagnose Fetal Alcohol Spectrum Disorder (FASD). In an effort to improve the diagnosis of FASD, the current study aimed to identify a neurodevelopmental profile that is both sensitive and specific to FASD.

Methods

A secondary analysis was conducted on data obtained from the Canadian component of the World Health Organization International Study on the Prevalence of FASD. Data on neurodevelopmental status and behavior were derived from a battery of standardized tests and the Child Behavior Checklist for 21 children with FASD, 28 children with other neurodevelopmental disorders, and 37 typically developing control children, aged 7 to 11 years. Two latent profile analyses were performed to derive discriminative profiles: i) children with FASD compared with typically developing control children, and ii) children with FASD compared with typically developing control children and children with other neurodevelopmental disorders. The classification function of the resulting profiles was evaluated using the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Confidence intervals (CIs) were approximated using 10,000 bootstrapped samples.

Results

The neurodevelopmental profile of FASD tested consisted of impairments in perceptual reasoning, verbal comprehension, visual-motor speed and motor coordination, processing speed (nonverbal information), attention and executive function, visuospatial processing, and language, in combination with rule-breaking behavior and attention problems. When children with FASD were compared with typically developing control children, a 2-class model fit the data best and resulted in a sensitivity of 95.2% (95% CI: 84.2–100.0%), specificity of 89.2% (95% CI: 78.4–97.5%), PPV of 83.3% (95% CI: 66.7–96.2%), and NPV of 97.1% (95% CI: 90.3–100.0%). When children with FASD were compared with typically developing control children and children with other neurodevelopmental disorders, the neurodevelopmental profile correctly identified only 56.9% (95% CI: 45.1–69.2%) of typically developing children and children with other neurodevelopmental disorders as not having FASD, and thus the profile was found not to be specific to children with FASD.

Conclusion

The findings question the uniqueness of children with FASD with respect to their neurodevelopmental impairments and behavioral manifestations.
Risk factors for suicidal thoughts in informal caregivers: results from the population-based Netherlands mental health survey and incidence Study-2 (NEMESIS-2)
Authors: Joling Karlijn J. , ten Have Margreet , de Graaf Ron , O’Dwyer Siobhan T.
Published: October 2019

Background

Previous research suggests that family caregivers contemplate suicide at a higher rate than the general population. Much of this research has been disease specific and in relatively small samples. This study aimed to compare suicidal thoughts between non-caregivers and informal caregivers of people with a variety of conditions, in a large representative sample, and to identify significant risk factors.

Methods

The general population study NEMESIS-2 (N at baseline = 6646) included 1582 adult caregivers at the second wave (2010–2012) who also participated at the third wave (2013–2015). Suicidal thoughts were assessed over 4 years, with the Suicidality Module of the Composite International Diagnostic Interview 3.0. The presence of suicidal thoughts was estimated and risk factors for suicidal thoughts were assessed with logistic regression analyses adjusted for age and gender.

Results

Thirty-six informal caregivers (2.9%) reported suicidal thoughts during the 4 year study period. The difference between caregivers and non-caregivers (3.0%) was not significant. Among caregivers, significant risk factors for suicidal thoughts included being unemployed, living without a partner, having lower levels of social support, having a chronic physical disorder, a mood disorder or an anxiety disorder, and having impaired social, physical and emotional functioning. These risk factors were also found in non-caregivers. No caregiving-related characteristics were associated with suicidal thoughts.

Conclusion

There was no elevated rate of suicidal thoughts in caregivers and risk factors for suicidal thoughts in caregivers were consistent with risk factors in non-caregivers. No association between caregiving characteristics and suicidal thoughts was found. Caregivers with limited resources and in poorer health might still benefit from prevention and intervention efforts.
Mortality of site-specific cancer in patients with schizophrenia: a systematic review and meta-analysis
Authors: Ni Liwei , Wu Jian , Long Yuming , Tao Jialong , Xu Jianhao , Yuan Xuya , Yu Na , Wu Runhong , Zhang Yusong
Published: October 2019

Background

Numerous studies have reported contradicting results on the relationship between cancer mortality and schizophrenia. Our aim is to quantify the mortality rate of common site-specific cancers among patients with schizophrenia and to synthesize the available research evidence.

Methods

We performed a systemic search of the PubMed, EMBASE and Web of Science databases. Studies reporting the mortality rate of different cancer in patients with schizophrenia were included. A random-effects model was applied to calculate the pooled relative risks (RRs) with 95% confidence intervals (95%CIs).

Results

Seven studies consisting of 1,162,971 participants with schizophrenia were included in this meta-analysis. Data regarding mortality risk of breast, colon, lung and prostate cancer among schizophrenia patients were subjected to quantitative analysis. Pooled results showed significant increases in mortality risk of breast cancer (RR = 1.97, 95%CI 1.38–2.83), lung cancer (RR = 1.93, 95%CI 1.46–2.54) and colon cancer (RR = 1.69, 95%CI 1.60–1.80) in patients with schizophrenia compared with those in the general population or control group. The mortality risk of prostate cancer increased in male patients, although no significant difference was detected (RR = 1.58, 95% CI 0.79–3.15). Increased risks of mortality from lung and colon cancer were observed in female patients (RR = 2.49, 95%CI 2.40–2.59 and RR = 2.42, 95%CI 1.39–4.22, respectively) and elevated risks of mortality from lung and colon cancer in male patients (RR = 2.40, 95%CI 2.30–2.50 and RR = 1.90, 95%CI 1.71–2.11, respectively) were detected.

Conclusions

Individuals with schizophrenia have a significantly high risk of mortality from breast, colon, and lung cancer.