bluuebunny/crossref_metadata_2025 huggingface dataset:
Acute Renal Infarction Due to Symptomatic Isolated Spontaneous Renal Artery Dissection: A Rare and Fatal Disease
Authors: He Yangyan , Hu Yujian , Tian Lu , Qiu Chenyang , Li Donglin , Xiang Yilang , Wang Xiaohui , He Yunjun , Wang Xun , Shang Tao , Zhu Qianqian , Chen Tianchi , Li Zhenjiang , Zeng Qinglong , Wu Ziheng , Zhang Hongkun
Published: May 2023

Objective:

To report demographics and clinical, laboratory, and imaging features of acute renal infarction (ARI) due to symptomatic isolated spontaneous renal artery dissection (SISRAD) and to analyze outcomes after the initial therapy for SISRAD.

Methods:

Thirteen patients with ARI due to SISRAD between January 2016 and March 2021 were enrolled in this retrospective study. We reviewed the demographics, clinical, laboratory, and imaging features (location of the infarct kidney, the branch artery involved by dissection, true lumen stenosis, false lumen thrombosis, and aneurysm), treatment modalities, and follow-up results; analyzed the difference between SISRAD and other causes of ARI; and propose an appropriate therapy strategy for SISRAD based on our data and literature.

Result:

Patients with ARI due to SISRAD were mostly young men (43 [24–53] years; 12/13 [92%]). No patients had atrial fibrillation or acute kidney injury at admission (0/13). All 13 patients received conservative treatment as the initial treatment. Sixty-two percent (8/13) of patients progressed, and 88% (7/8) of them had dissection aneurysm on the admission computed tomographic angiography (CTA) image. Seventy-five percent (6/8) of patients underwent endovascular intervention as follows, stent placement in 1 patient, renal artery embolization in 1, and stent placement with embolization in 4. Two patients with disease progression died: 1 during the conservative treatment period and 1 after the stent placement. Thirty-eight percent (5/13) of patients in remission continued to receive conservative treatment, none of whom had dissection aneurysm on the admission CTA.

Conclusion:

Symptomatic isolated spontaneous renal artery dissection is a rare and fatal disease. For young ARI patients with no previous history of tumors and cardiogenic diseases, CTA examination is recommended to exclude SISRAD. Dissection aneurysm seems to be a risk of progression for SISRAD in this series. Conservative treatment, a recognized initial treatment, has a good effect on patients without dissection aneurysm, and we recommend endovascular intervention as the initial treatment for the patient with dissection aneurysm at admission. Multicenter clinical studies are needed to explore a more-appropriate treatment for patients with SISRAD.

Clinical Impact

This article report the related factors, risks, demographics and laboratory data of Acute renal infarction (ARI) due to Symptomatic isolated spontaneous renal artery dissection (SISRAD) and explore a better initial therapy strategy for SISRAD. It will help improve the effectiveness of SISRAD treatment and reduce the mortality rate from this rare but lethal disease.
Abdominal Aortic Endograft Implantation Immediately Induces Vascular Stiffness Gradients That May Promote Adverse Aortic Neck Dilatation: Results of A Porcine Ex Vivo Study
Authors: Schellinger Isabel N. , Naumann Jörg , Hoffmann Annett , Barnard Sarah-Jane , Düsing Sandra , Wagenhäuser Markus U. , Haunschild Josephina , Scheinert Dierk , Hasenfuß Gerd , Etz Christian D. , Raaz Uwe
Published: May 2023

Purpose:

Endovascular aortic repair (EVAR) is the method of choice for most abdominal aortic aneurysm (AAA) patients requiring intervention. However, chronic aortic neck dilatation (AND) following EVAR progressively weakens the structural seal between vessel and endograft and compromises long-term results of the therapy. This experimental ex vivo study seeks to investigate mechanisms of AND.

Materials and Methods:

Porcine abdominal aortas (n=20) were harvested from slaughterhouse pigs and connected to a mock circulation. A commercially available endograft was implanted (n=10) or aortas were left untreated as controls (n=10). Vascular circumferential strain was assessed via ultrasound in defined aortic segments as a parameter of aortic stiffness. Histology and aortic gene expression analysis were performed to investigate potential changes of aortic wall structure and molecular differences due to endograft implantation.

Results:

We found that endograft implantation acutely induces a significant stiffness gradient directly at the interface between stented and unstented aortic segments under pulsatile pressure. Comparing stented aortas with unstented controls, we detected increased aortic expression levels of inflammatory cytokines ( Il6 and Ccl2) and matrix metalloproteinases ( Mmp2 and Mmp9) after 6 hours of pulsatile pressurization. This effect, however, was abolished when repeating the same experiment under 6 hours of static pressure.

Conclusions:

We identified endograft-induced aortic stiffness gradients as an early trigger of inflammatory aortic remodeling processes that might promote AND. These results highlight the importance of adequate endograft designs to minimize vascular stiffness gradients and forestall late complications, such as AND.

Clinical Impact

AND may compromise the long-term results following endovascular aortic repair. However, the mechanisms behind the underlying detrimental aortic remodeling are still unclear. In this study we find that endograft-induced aortic stiffness gradients induce an inflammatory aortic remodeling response consistent with AND. This novel pathomechanistic insight may guide the design of new aortic endografts that minimize vascular stiffness gradients and forestall late complications such as AND.
Old Wine in new Bottles: Silver Sulfadiazine Nanotherapeutics for Burn Wound Management
Authors: Abul Barkat Harshita , Abul Barkat Muhammad , Ali Raisuddin , Hadi Hazrina , Kasmuri Abdul Razak
Published: May 2023

According to the World Health Organization (WHO), ∼180,000 casualties are recorded every year due to burns, majorly from low- and middle-income countries that require medical attention. For the last 5 decades, silver sulfadiazine (SSD) 1% cream has been the most widely used topical antimicrobial agent for managing burn wound infections. Although SSD is considered the gold standard therapy in burn wound management, however in the last 10 years, several studies have reported the negative impact of SSD on the wound healing process. The therapeutic potential of SSD is restricted by its poor solubility, and antimicrobial action appears only after the dissociation of SSD into silver ions (Ag+) and sulfadiazine (SD). Pharmaceutical researchers and industries are looking for alternative strategies to overcome the challenges and limitations of the available SSD formulation due to rising costs, extensive time commitment, and the high risk of failure associated with the de novo development of new antimicrobial drugs. Recent advances in drug delivery systems nanotechnology-based strategies have had a colossal impact on them, particularly in burn wound management. Nanoparticulate systems and nanotools could be considered as potential drug delivery approaches for burn management. This contemporary review provides an abridgment of the literature on advanced SSD nanotherapeutics and their importance in managing burns.
A Transfiguration Paradigm for Quest Design
Authors: Harris Steven , Caldwell Nicholas
Published: May 2023

Quest design is an important design aspect of video games. The current approach to quest design is dominated by a task-orientated paradigm in which a quest is viewed as a series of tasks to be completed as part of the narrative structure of the game. This paper presents an alternative paradigm that shifts away from the predominant task-based approach to quest design. Based on a study of existing quest models, a dual quest framework of singular and synergy quests is proposed. Within the frameworks, tasks become an intermediary step within the quest which is now focused on the transfiguration of the player character. This approach offers a practical design structure for both procedural and manual quest design.
Does complete blood count have a role in the prediction of deep vein thrombosis?
Authors: Beyazal Osman Fehmi
Published: May 2023

The aim of this study is to evaluate the importance of complete blood count parameters for predicting deep vein thrombosis.

Methods

It was planned as a retrospective case–control study in which 1,527 patients between January 2022 and September 2022 were evaluated. After the eligibility criteria, systematic sampling was performed and analyzed in the case group (103) and the control group (179) patients. The predictive significance of Hb, NLR, PLR, MPV, PLT, MPV/PLT, monocytes, lymphocytes, eosinophils, RDW, LMR, and PDW parameters for the development of DVT was investigated. Then, logistic regression analysis was performed with these parameters to analyze the predictive value. The cutoff point was determined by performing ROC analysis for the statistically significant parameters.

Results

Neutrophil, RDW, PDW, NLR, and MPV/platelet values were statistically higher in the DVT group than the control group. Lymphocyte, PLT, and LMR values were statistically lower in the DVT group than the control group. There was no statistical difference between the two groups in terms of neutrophils, monocytes, eosinophils, Hb, MPV, and PLR values. RDW and PDW values were statistically significant for DVT prediction ( p < 0.001, OR = 1.183 and p < 0.001, OR = 1.304, respectively). According to ROC analysis, 45.5 fL for RDW and 14.3 fL for PDW were determined as the cutoff points for DVT prediction.

Conclusion

We found RDW and PDW to be significant in terms of DVT prediction in our study. We found the NLR and MPV/PLT to be higher in the DVT group, and the LMR to be lower in the DVT group, but we found that there was no statistically significant predictive value. CBC can be used as an inexpensive and easily accessible test that has predictive significance for DVT. In addition, these findings need to be supported by prospective studies in the future.
Correlation between circulating myeloid-derived suppressor cells and serum miRNA21 in non-small cell lung cancer and its clinical significance
Authors: Chen Zhengzheng , Zhong Linyan , Jiang Yanyan , Xiao Long , Lai Lei , Cao Jun
Published: May 2023

Objective: To investigate the effect and clinical significance of myeloid-derived suppressor cells (MDSCs) levels and serum miRNA-21 expression in advanced non-small cell lung cancer (NSCLC) patients. Methods: Advanced NSCLC patients treated at the First People’s Hospital of Tongxiang City, Zhejiang Province, between July 2021 and June 2022 were included in this study. MDSCs in the peripheral circulation were assessed by flow cytometry, and serum miRNA-21 expression was assessed by q-PCR. The effects of miRNA-21 on MDSC proliferation and ARG-1 and inducible nitric oxide synthase (iNOS) secretion from MDSCs were examined using in vitro cell experiments. In addition, the correlation between MDSC and CEA, CRP and Ki67 was analyzed. Results: Compared with those in the peripheral circulation of individuals in the control group, the expression levels of polymorphonuclear-MDSCs (PMN-MDSCs) and miRNA-21 in the peripheral circulation of NSCLC patients were significantly higher, and the two groups were significantly positively correlated. In in vitro cell experiments, miRNA-21 mimics promoted MDSC proliferation and increased ARG-1 and iNOS secretion and miRNA-21 inhibtor has an opposite result. In addition, PMN-MDSCs in the peripheral circulation of NSCLC patients were significantly positively correlated with carcinoembryonic antigen (CEA), C-reactive protein (CRP), and Ki67. Conclusion: The blood of advanced NSCLC patients contains high levels of MDSCs and miRNA-21, and the two may interact to impact on NSCLC.
People with diabetes who read their clinicians’ visit notes: Behaviors and attitudes
Authors: Dong Zhiyong , Leveille Suzanne , Lewis Dana , Walker Jan
Published: May 2023

Objectives

To understand behaviors and attitudes of adults with diabetes who read their clinicians’ visit notes.

Methods

By linking a large 2017 patient survey involving three institutions with administrative and portal use data, we identified patients with diabetes mellitus from outpatient records and examined reading behaviors related to eligible notes—initial, follow-up, history and physical, and progress notes. We analyzed patients’ perceived benefits of reading notes.

Results

2104 respondents had diagnoses of diabetes mellitus and had read ≥1 note in the 12-month period. Patients had an average of 8.7 eligible notes available and read 59% of them. The strongest predictor of reading more notes was having more notes available; the specialties of the authoring clinicians were not correlated with note reading rates. Patients reported understanding notes by primary care clinicians and specialists equally well; more than 90% of patients reported understanding everything or almost everything in a self-selected note. Across visit types, 73–80% of patients reported that note reading was extremely important for taking care of their health.

Discussion

People with diabetes want to read their clinicians’ notes, are accessing them at high rates, and report understanding the notes and benefiting from reading them.
Comparing word recognition in simplified and traditional Chinese: A megastudy approach
Authors: Tsang Yiu-Kei , Huang Jian , Wang Suiping , Wang Jie , Wong Andus Wing-Kuen
Published: May 2023

Although it is well established that the visual complexity of a written word can influence processing, it is far less clear from a cross-script perspective, whether the overall visual complexity of the entire written lexicon also affects word recognition. This question can be answered with the data in megastudy of lexical decision in Chinese (MELD-CH), which was developed with over 800 participants responding to 12,587 simplified and traditional Chinese words. The results showed that lexical decision was slower but more accurate in simplified Chinese, which has about 22.5% less strokes, than traditional Chinese. This pattern could not be explained by a speed–accuracy trade-off. Moderate correlations were found in response times and error rates between the two scripts, indicating considerable overlap in processing despite the script difference. In addition, (generalised) linear mixed-effects modelling was used to examine whether the simplified and traditional Chinese groups differed in sensitivity towards linguistic variables. The results showed that the effects of word frequency, word length, and number of strokes were stronger in recognising simplified Chinese words, whereas the effects of number of words formed and number of meanings of the constituent characters were stronger in traditional Chinese. These results suggested that the visual-perceptual processing demands of simplified Chinese might force readers to focus more on local properties of the words, making them less sensitive to global properties that are defined over the entire lexicon. Finally, limitations and alternative explanations of the results were discussed.
Preventing depression in aphasia: A cluster randomized control trial of the Aphasia Action Success Knowledge (ASK) program
Authors: Ryan Brooke , Kneebone Ian , Rose Miranda L. , Togher Leanne , Power Emma , Hoffmann Tammy , Khan Asaduzzaman , Simmons-Mackie Nina , Carragher Marcella , Worrall Linda
Published: May 2023

Background:

Stroke patients with aphasia and their caregivers have higher incidence of depression than those without aphasia.

Aims:

The objective of the study is to determine whether a tailored intervention program (Action Success Knowledge; ASK) led to better mood and quality of life (QoL) outcomes than an attention control with a 12-month end point at cluster and individual participant level.

Methods:

A multi-site, pragmatic, two-level single-blind cluster randomized controlled trial compared ASK to an attention control (secondary stroke prevention program). Ten metropolitan and 10 non-metropolitan health regions were randomized. People with aphasia and their family members were recruited within 6 months post-stroke who scored ⩽12 on the Stroke Aphasic Depression Questionnaire Hospital Version–10 at screening. Each arm received manualized intervention over 6–8 weeks followed by monthly telephone calls. Blinded assessments of QoL and depression were taken at 12 months post-onset.

Results:

Twenty clusters (health regions) were randomized. Trained speech pathologists screened 1744 people with aphasia and 373 participants consented to intervention (n = 231 people with aphasia and 142 family members). The attrition rate after consent was 26% with 86 and 85 participants with aphasia in the ASK arm and attention control arm, respectively, receiving intervention. Of those 171 who did receive treatment, only 41 met the prescribed minimum dose. Multilevel mixed effects modeling under the intention-to-treat protocol showed a significant difference on the Stroke and Aphasia Depression Questionnaire–21 (SADQ-21, N = 122, 17 clusters) in favor of the attention control (β = –2.74, 95% confidence interval (CI) = –4.76 to –0.73, p = 0.008). Individual data analysis using a minimal detectable change score for the SADQ-21 showed the difference was not meaningful.

Conclusion:

ASK showed no benefit over attention control in improving mood and preventing depression in people with aphasia or their family members.
Coach-created motivational climate ratings differentiate between dropout and continuation in Australian youth swimming
Authors: Moulds Kylie , Fraser Kotryna K. , Karp Josh , Kapocius Olivia , Heathcote Mark , Appleton Paul R. , Cobley Stephen
Published: May 2023

Objectives

Applying Bronfenbrenner's Bio-Ecological Systems Theory and PPCT model recommendations, this study examined whether specific or multiple factors were associated with participation status in Australian youth swimming; a context known for high dropout rates.

Methods

Participants were continuing ( N = 99) and former ( N = 104) swimmers, aged 8–18 years, who competed at club-national level in New South Wales, Australia. Participants completed an online survey, examining socio-demographic, participation history, and coach-created motivational climate characteristics (using the EDMCQ-C). To identify influential factors, a combination of T-tests, Odds Ratios, and MANOVA analyses were used. To confirm the presence of coach-motivational climate types and their association with participant status, cluster analyses with follow-up Odds Ratios were used.

Results

Except athlete age and sex, other socio-demographic, participation history, and family sport history participation were not associated with dropout. Meanwhile, EDMCQ-C analyses identified three cluster types of coach-created climate (empowering, disempowering, and neutral), with disempowering and empowering types, respectively, associated with dropout and continuation. The neutral climate was associated with low-moderate EDMCQ-C sub-scale scoring and was neither associated with dropout nor continuation.

Conclusion

Findings identify the influence of coach-created motivational climates and not athlete-related factors on continued Australian youth swimming participation, highlighting coaching implications.
The therapeutic potential of quercetin for cigarette smoking–induced chronic obstructive pulmonary disease: a narrative review
Authors: Ding Kaixi , Jiang Wei , Zhan Wenling , Xiong Chunping , Chen Jieling , Wang Yu , Jia Huanan , Lei Ming
Published: May 2023

Quercetin is a flavonoid with antioxidant and anti-inflammatory properties. Quercetin has potentially beneficial therapeutic effects for several diseases, including cigarette smoking–induced chronic obstructive pulmonary disease (CS-COPD). Many studies have shown that quercetin’s antioxidant and anti-inflammatory properties have positive therapeutic potential for CS-COPD. In addition, quercetin’s immunomodulatory, anti-cellular senescence, mitochondrial autophagy–modulating, and gut microbiota–modulating effects may also have therapeutic value for CS-COPD. However, there appears to be no review of the possible mechanisms of quercetin for treating CS-COPD. Moreover, the combination of quercetin with common therapeutic drugs for CS-COPD needs further refinement. Therefore, in this article, after introducing the definition and metabolism of quercetin, and its safety, we comprehensively presented the pathogenesis of CS-COPD related to oxidative stress, inflammation, immunity, cellular senescence, mitochondrial autophagy, and gut microbiota. We then reviewed quercetin’s anti-CS-COPD effects, performed by influencing these mechanisms. Finally, we explored the possibility of using quercetin with commonly used drugs for treating CS-COPD, providing a basis for future screening of excellent drug combinations for treating CS-COPD. This review has provided meaningful information on quercetin’s mechanisms and clinical use in treating CS-COPD.
Interactions of Different Urolithins With Bovine Serum Albumin
Authors: Zelenovic Nevena , Kojadinovic Milica , Filipovic Lidija , Vucic Vesna , Milcic Milos , Arsic Aleksndra , Popovic Milica
Published: May 2023

Backgound/Objectives

Urolithins (UROs) are the metabolites derived from the gut microbial action on ellagitannins and ellagic acid-rich foods. Following their absorption in the intestine, UROs are transported through the systemic circulation to various tissues where they can express their biological function as antimicrobial, anti-inflammatory, and anticancer agents. In addition to blood plasma, where they can be found as glucuronide and sulfate conjugates, they are also found in urine. Therefore, the interactions of UROs with serum proteins are of great clinical interest.

Methods

A powerful technique for examining these urolithin-serum protein interactions is fluorescence spectroscopy. Bovine serum albumin (BSA) is a particularly suitable model protein because it is readily available, affordable, and similar to human serum albumin. This work aimed to study the binding of UROs (urolithin A, UROA and urolithin B, UROB) and their glucuronide conjugates (UROAG and UROBG) to BSA by quenching the intrinsic fluorescence of protein.

Results

The spectra obtained showed that the binding process is influenced by the polyphenol's structure and the conjugation process with the glucuronide. The calculated Stern Vollmer binding constants (Ksv): UROA and UROB Ksv were 59236   ±   5706 and 69653   ±   14922, respectively, while for UROAG and UROBG, these values were 15179   ±   2770 and 9462   ±   1955, respectively, which showed that the binding affinity decreased with glucuronidation. Molecular docking studies confirmed that all of the studied molecules will bind favorably to BSA. The preferential binding site for both UROs and UROGs is Sudlow I, while UROs will also bind to Sudlow II. URO-Gs can bind to BSA in the cleft region with lower binding scores than for the Sudlow I binding site.

Conclusion

The aglycone's higher hydrophobicity increases the binding affinity to BSA, thus reducing its bioavailability in the blood.
Hallux Valgus Bunion Splint: Surgical Dressing Technique
Authors: Lewis Lauren K. , Chen Jie , Johnson Connor S. , Adams Samuel B.
Published: May 2023

Background

Hallux valgus is a common condition with a complex etiology resulting in numerous treatment options. Recurrence of the deformity can occur following correction. Surgical technique and possibly also postoperative care play a role in reducing recurrence rates. This article highlights a postoperative surgical dressing technique which allows for semirigid support during the immediate postoperative period.

Methods

A wooden tongue depressor placed along the medial border of the hallux comprises the primary support for the dressing. The rigidity of the tongue depressor allows for the hallux to be drawn toward the depressor, encouraging neutral alignment of the hallux. Dressings are removed 2 weeks postoperatively, with new dressings applied in similar fashion and maintained in place until 6 weeks postoperatively.

Results

Based upon our observations, our surgical dressing technique provides sufficient support following hallux valgus correction surgery while being straightforward to replicate without the need for frequent dressing changes. The dressing materials are of negligible cost and are typically readily available. No associated wound complications have been observed.

Conclusions

We present an easily replicable and affordable option for postoperative hallux valgus correction surgical dressings.

Levels of Evidence:

Level V: Expert Opinion
Subacute Brachial Plexopathy due to Intraneural Epithelioid Hemangioma: A Case Report
Authors: Nakhate Vihang , McInnis Robert P. , Sy Albert , Matiello Marcelo
Published: May 2023

Brachial plexopathy is a common consideration in the differential diagnosis of upper extremity sensory and motor deficits, and neoplasms signify one possible etiology of brachial plexopathy. Of the neoplastic brachial plexopathies, hemangiomas involving the brachial plexus are rare. Most reported cases describe extraneural brachial plexus hemangiomas that present as a palpable, tender neck mass associated with pain and sensory disturbance, with minimal motor deficits. Here we share the case of a 48 year-old man with intraneural epithelioid hemangioma of the brachial plexus who presented with prominent motor weakness and no palpable mass. The patient presented with subacute onset of left arm pain, numbness and progressive weakness. Neurologic exam revealed lower motor neuron signs and weakness spanning multiple nerve root and peripheral nerve distributions. Dedicated brachial plexus MRI showed two mass lesions involving the cords of the brachial plexus, with corresponding FDG-avidity on PET/CT. Biopsy revealed intraneural atypical epithelioid hemangioma. After nerve transfer surgery, he had moderate improvement in left arm strength. This case serves to: emphasize the importance of both clinical localization and dedicated brachial plexus imaging in the evaluation of brachial plexopathy; introduce to the literature a new clinical presentation of brachial plexus hemangiomas; encourage consideration of neoplastic brachial plexopathy even when faced with an illness script resembling Parsonage-Turner Syndrome, to avoid delays in diagnosis and treatment.
Lymphoplasmacytic lymphoma relapse presenting as isolated multifocal subcutaneous adipose tissue infiltrates on 18F-FDG PET/CT
Authors: Anžej Doma Saša , Doma Andrej
Published: May 2023

Lymphoplasmacytic lymphoma (LPL)/Waldenström macroglobulinemia (WM) is an uncommon mature B cell lymphoma usually involving the bone marrow and, less commonly, the spleen and/or lymph nodes. This case presents a pathology-confirmed isolated extramedullary relapse of LPL, located in subcutaneous adipose tissue, 5 years after successful treatment of WM.
Loneliness and Maladjustment in Young Adults: The Protective Effects of High Respiratory Sinus Arrhythmia and Sleep Quality
Authors: Philbrook Lauren E. , Chen Grace Jia-Xin , Decker Riley A. , Khaner Lucy B.
Published: May 2023

Loneliness is a pervasive concern among young adults that has been exacerbated by the COVID-19 pandemic. Identifying factors that mitigate the negative impact of loneliness is important for protecting young adults’ mental health and well-being. Among 188 undergraduates (71.8% women; 77.1% White), the present study examined physiological regulation and sleep quality as moderators of the association between loneliness and adjustment. Physiological regulation was assessed via resting respiratory sinus arrhythmia (RSA), a measure of parasympathetic activity. Participants self-reported loneliness, sleep quality, mental health symptoms, and positive affect/well-being. Three-way interactions were significant, such that at higher levels of loneliness, the combination of high resting RSA and high sleep quality was protective against elevated anxiety and depressive symptoms and low positive affect/well-being. Multi-pronged, tailored interventions that target improvement in loneliness, physiological regulation, and sleep quality based on an individual’s unique risk factors may best promote young adults’ adjustment.
Matched Cohort Study Comparing Arthroscopic-Assisted Versus Full-Arthroscopic Latissimus Dorsi Tendon Transfer for Irreparable Massive Rotator Cuff Tears
Authors: Kany Jean , Meirlaen Stéphanie , Werthel Jean David , van Rooij Floris , Saffarini Mo , Grimberg Jean
Published: May 2023

Background:

Latissimus dorsi tendon transfer (LDTT) is increasingly performed with arthroscopic assistance, requiring an open axillary incision, which could increase risks of infection, hematoma, and lymphoedema. Technological advancements now enable LDTT to be fully arthroscopic, but its benefits and safety have not yet been confirmed.

Purpose:

To compare the clinical outcomes and complication rates of arthroscopic-assisted versus full-arthroscopic LDTT for irreparable posterosuperior massive rotator cuff tears in shoulders with no surgical antecedents.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The study included 90 patients who had undergone LDTT over 4 consecutive years by the same surgeon and did not have prior surgery. During the first 2 study years, all procedures were arthroscopically assisted (n = 52), while during the last 2 years, all procedures were fully arthroscopic (n = 38). Procedure duration and all complications were recorded, as well as clinical scores and range of motion at minimum 24-month follow-up. To enable direct comparison between the techniques, propensity score matching was used to obtain 2 groups with equivalent age, sex, and follow-up.

Results:

From the initial cohort of 52 patients who underwent arthroscopic-assisted LDTT, 8 had complications (15.4%), of which 3 (5.7%) required conversion to reverse shoulder arthroplasty and 2 (3.8%) required drainage or lavage. From the initial cohort of 38 patients who had full-arthroscopic LDTT, 5 had complications (13.2%), of which 2 (5.2%) required conversion to reverse shoulder arthroplasty but no patients (0%) required other procedures. Propensity score matching resulted in 2 groups, each comprising 31 patients, with similar outcomes in terms of clinical scores and range of motion. The procedure time was about 18 minutes shorter for full-arthroscopic LDTT, which had different complications (2 axillary nerve pareses) as compared with arthroscopic-assisted LDTT (1 hematoma and 2 infections).

Conclusion:

Equivalent outcomes at minimum 24-month follow-up were found for arthroscopic-assisted and full-arthroscopic LDTT in terms of complications rates (15.4% and 13.2%, respectively), conversion to reverse shoulder arthroplasty (5.7% and 5.2%), clinical scores, and range of motion.
Role of EDPs in Harnessing Local Resources—with Special Reference to Hyderabad and Rangareddy Districts
Authors: Kandukuri Vinutha , Samunnatha V.
Published: May 2023

This study focuses on the programmes conducted for entrepreneurial development towards sustainability and value creation from the locally available resources, which in turn contribute to the performance of SMEs. Various programmes, such as employment generation activities and entrepreneurial development efforts, are conducted by the government and NGOs to uplift the economic status of individuals. The key opportunities and solutions for harnessing natural resources under sustainable entrepreneurship development programmes conducted by institutions based in Hyderabad and Rangareddy districts have been discussed. Secondary data collected has been adequately presented with the help of tables and graphs as and where applicable.
Klebsiella Endogenous Endophthalmitis During the COVID-19 Pandemic
Authors: Agi Nathan , Zarbin Marco A. , Bhagat Neelakshi
Published: May 2023

Purpose: To describe the characteristics of Klebsiella pneumoniae endogenous endophthalmitis (KEE) encountered during the COVID-19 pandemic. Methods: This retrospective consecutive case series evaluated eyes that presented with KEE between March 2020 and July 2022. Results: Seven eyes of 5 patients developed KEE. Between January 2020 and July 2022, KEE was observed in 42% of consecutive EE cases compared with 7.8% during the preceding 13 years. COVID-19 was positive in 4 of 5 patients before they developed KEE. Only 1 patient presented with a VA better than hand motions (20/400). All eyes were treated with urgent vitrectomy and intravitreal and systemic antibiotics. No improvement in vision occurred in any patient; VA remained light perception to no light perception in 60% of eyes. Conclusions: The visual prognosis in KEE is extremely poor. The presence of a preceding COVID-19 infection in 80% of patients may signal a new risk factor for KEE. Patients with a hypervirulent Klebsiella syndrome should be routinely screened for EE.
Modified Endolaser Instrument for Chandelier Scleral Buckling
Authors: Raval Nilesh , Li Yafeng , Pinhas Alexander , Landa Gennady , Deobhakta Avnish , Rosen Richard B.
Published: May 2023

Purpose: To report a new modification of an illuminated endolaser to facilitate safe endophotocoagulation during chandelier-assisted scleral buckling surgery. Methods: This case series comprised phakic patients with rhegmatogenous retinal detachments (RRDs) who had primary scleral buckling with chandelier endoillumination, external drainage, and endophotocoagulation using the modified endolaser instrument. Results: All 6 patients had successful outcomes after primary scleral buckling for RD repair without significant intraoperative or postoperative complications. Conclusions: The new modified endolaser instrument can be safely used in a nonvitrectomized eye during chandelier scleral buckling.
A novel “7 sutures and 8 knots” surgical technique in reverse shoulder arthroplasty for proximal humeral fractures: tuberosity healing improves short-term clinical results
Authors: Troiano Elisa , Peri Giacomo , Calò Irene , Colasanti Giovanni Battista , Mondanelli Nicola , Giannotti Stefano
Published: May 2023

Background

Complex proximal humeral fractures (cPHFs) represent an important public health concern, and reverse shoulder arthroplasty (RSA) has emerged as a feasible treatment option in the elderly with high functional demands. Recent studies have shown that tuberosity healing leads to better clinical outcomes and an improved range of motion. However, the best surgical technique for the management of the tuberosities is still a topic of debate. The purpose of this retrospective observational study is to report the radiographic and clinical outcomes of a consecutive series of patients who underwent RSA for cPHFs using a novel “7 sutures and 8 knots” technique.

Materials and methods

A consecutive series of 32 patients (33 shoulders) were treated with this technique by a single surgeon from January 2017 to September 2021. Results at a minimum follow-up of 12 months and a mean ± SD follow-up of 35.9 ± 16.2 (range 12–64) months are reported.

Results

The tuberosity union rate was 87.9% (29 out of 33 shoulders), the mean Constant score was 66.7 ± 20.5 (range 29–100) points, and the mean DASH score was 33.4 ± 22.6 (range 2–85) points.

Conclusions

The “7 sutures and 8 knots” technique, which relies on three sutures around the implant and five bridging sutures between the tuberosities, is a relatively simple procedure which provides a reliable means for anatomic restoration of the tuberosities and allows functional recovery of the shoulder in elderly patients with cPHFs treated with RSA.

Level of evidence: IV; retrospective atudy.

Trial registration: At our institution, no institutional review board nor ethical committee approval is necessary for retrospective studies.
Atypical drug-induced hypersensitivity syndrome with multiple organ failure rescued by combined acute blood purification therapy: a case report
Authors: Oiwa Hideaki , Yoshida Shozo , Okada Hideshi , Yasunishi Masahiro , Kamidani Ryo , Suzuki Kodai , Miyake Takahito , Doi Tomoaki , Shimohata Takayoshi , Ogura Shinji
Published: May 2023

Background

Drug-induced hypersensitivity syndrome (DIHS), including Stevens-Johnson syndrome (SJS), is a severe rash that often develops 2–6 weeks after the intake of the causative drug; however, its diagnosis is sometimes difficult. This article describes a case in which a patient with DIHS-induced multiple organ failure was successfully treated with blood purification therapy.

Case presentation

A male patient in his 60s was admitted to our hospital with autoimmune encephalitis. The patient was treated with steroid pulse therapy, acyclovir, levetiracetam, and phenytoin. From the 25th day, he presented with fever (≥ 38 °C) as well as miliary-sized erythema on the extremities and trunk, followed by erosions. DIHS and SJS were suspected; accordingly, levetiracetam, phenytoin, and acyclovir were discontinued. On the 30th day, his condition further deteriorated, and he was admitted to the intensive care unit for ventilatory management. The next day, he developed multi-organ failure and was started on hemodiafiltration (HDF) for acute kidney injury. Although he presented with hepatic dysfunction and the appearance of atypical lymphocytes, he did not meet the diagnostic criteria for DIHS or SJS/toxic epidermal necrolysis. Therefore, he was diagnosed with multi-organ failure caused by severe drug eruption and underwent a 3-day treatment with plasma exchange (PE) in addition to HDF. Accordingly, the patient was diagnosed with atypical DIHS. After being started on blood purification therapy, the skin rash began to disappear; moreover, the organ damage improved, with a gradual increase in urine output. Eventually, the patient was weaned off the ventilator and transferred to the hospital on the 101st day.

Conclusions

HDF + PE could effectively treat multi-organ failure caused by atypical DIHS, which is difficult to diagnose.
Trends and predictors of incidence of hypospadias in a tertiary hospital in South Africa
Authors: Udatinya Daniel , Ahmad Ahsan , Kabera Gaetan , Nel Marietha
Published: May 2023

Background

Hypospadias is a penile congenital abnormality characterized by an ectopic urethral opening, ventral curvature and incomplete foreskin closure with a dorsal hooded prepuce. Management of the outcome demands high cost. The aim of this study was to determine the trends and predictors of hypospadias among babies born at Charlotte Maxeke Johannesburg Academic Hospital between 01 January 2014 and 31 December 2016.

Methods

Mothers’ files from the transfer unit of the labour ward were reviewed. A case–control study compared boys with hypospadias and those without born approximately at the same time. Data were retrospectively collected on data collection forms. EpiData version 3.1 and STATA version 15.1 were used for statistical analysis. The Mantel Haenszel method determined combined odds ratios for hypospadias outcome on boys whose mothers were exposed to certain conditions versus boys of unexposed mothers. Woolf’s method was used to compute confidence intervals of the odds ratios. Logistic regression analysis was used to assess the independent contributing maternal factors to the risk of hypospadias.

Results

Records of 221 male babies were collected of which 73 were cases and 148 controls in the ratio of 1:2. Hypospadias was more frequent in boys born by Caesarean Section (p < 0.001), those with low birth weight (p < 0.001) and those small for gestational age (p < 0.002). Alcohol use (odds ratio 3.1), smoking (odds ratio 1.54), herbal use (odds ratio 2.05), medical history (odds ratio 2.8), multiple pregnancies (odds ratio 1.69) and maternal congenital abnormalities (odds ratio 3.03) indicated an increased risk of hypospadias. Surgical history (odds ratio 1.29), pre-natal vaccination (odds ratio 0.92), employment (odds ratio 0.85), and education (odds ratio 0.48) were not associated with the risk of hypospadias.

Conclusions

Mothers older than 36 years presented a stratifying effect on disease outcome. Our findings did not indicate major changes in trends of incidence of hypospadias. The years assessed did not have a significant effect on the number of cases.
The plastome reveals new insights into the evolutionary and domestication history of peonies in East Asia
Authors: Chen Qihang , Chen Le , Teixeira da Silva Jaime A. , Yu Xiaonan
Published: May 2023

Backgroud

Paeonia holds considerable value in medicinal, ornamental horticultural, and edible oil industries, but the incomplete state of phylogenetic research in this genus poses a challenge to the effective conservation and development of wild germplasm, and also impedes the practical utilization of existing cultivars. Due to its uniparental inheritance and lack of recombination, the plastome (i.e., plastid genome), which is a valuable molecular marker for phylogenetic analyses, is characterized by an appropriate rate of nucleotide evolution.

Methods

In this study, 10 newly assembled data and available reported data were combined to perform a comparative genomics and phylogenetics analysis of 63 plastomes of 16 Paeonia species, primarily from East Asia, which is the origin and diversity center of Paeonia.

Results

Ranging between 152,153 and 154,405 bp, most plastomes displayed a conserved structure and relatively low nucleotide diversity, except for six plastomes, which showed obvious IR construction or expansion. A total of 111 genes were annotated in the Paeonia plastomes. Four genes (rpl22, rps3, rps19 and ycf1) showed different copy numbers among accessions while five genes (rpl36, petN, psbI, rpl33 and psbJ) showed strong codon usage biases (ENC < 35). Additional selection analysis revealed that no genes were under positive selection during the domestication of tree peony cultivars whereas four core photosynthesis-related genes (petA, psaA, psaB and rbcL) were under positive selection in herbaceous peony cultivars. This discovery might contribute to the wide adaption of these cultivars. Two types of molecular markers (SSR and SNP) were generated from the 63 plastomes. Even though SSR was more diverse than SNP, it had a weaker ability to delimit Paeonia species than SNP. The reconstruction of a phylogenetic backbone of Paeonia in East Asia revealed significant genetic divergence within the P. ostii groups. Evidence also indicated that the majority of P. suffruticosa cultivars had a maternal origin, from P. ostii. The results of this research also suggest that P. delavayi var. lutea, which likely resulted from hybridization with P. ludlowii, should be classified as a lineage within the broader P. delavayi group.

Conclusions

Overall, this study’s research findings suggest that the Paeonia plastome is highly informative for phylogenetic and comparative genomic analyses, and could be useful in future research related to taxonomy, evolution, and domestication.
Respiratory support with nasal high flow without supplemental oxygen in patients undergoing endoscopic retrograde cholangiopancreatography under moderate sedation: a prospective, randomized, single-center clinical trial
Authors: Sawase Hironori , Ozawa Eisuke , Yano Hiroshi , Ichinomiya Taiga , Yano Rintaro , Miyaaki Hisamitsu , Komatsu Naohiro , Ayuse Takao , Kurata Shinji , Sato Shuntaro , Pinkham Maximilian Ichabod , Tatkov Stanislav , Ashizawa Kazuto , Nagata Kazuyoshi , Nakao Kazuhiko
Published: May 2023

Background

Nasal high flow (NHF) may reduce hypoxia and hypercapnia during an endoscopic retrograde cholangiopancreatography (ERCP) procedure under sedation. The authors tested a hypothesis that NHF with room air during ERCP may prevent intraoperative hypercapnia and hypoxemia.

Methods

In the prospective, open-label, single-center, clinical trial, 75 patients undergoing ERCP performed with moderate sedation were randomized to receive NHF with room air (40 to 60 L/min,n = 37) or low-flow O2via a nasal cannula (1 to 2 L/min,n = 38) during the procedure. Transcutaneous CO2, peripheral arterial O2saturation, a dose of administered sedative and analgesics were measured.

Results

The primary outcome was the incidence of marked hypercapnia during an ERCP procedure under sedation observed in 1 patient (2.7%) in the NHF group and in 7 patients (18.4%) in the LFO group; statistical significance was found in the risk difference (-15.7%, 95% CI -29.1 – -2.4,p = 0.021) but not in the risk ratio (0.15, 95% CI 0.02 – 1.13,p = 0.066).

In secondary outcome analysis, the mean time-weighted total PtcCO2was 47.2 mmHg in the NHF group and 48.2 mmHg in the LFO group, with no significant difference (-0.97, 95% CI -3.35 – 1.41,p = 0.421). The duration of hypercapnia did not differ markedly between the two groups either [median (range) in the NHF group: 7 (0 – 99); median (range) in the LFO group: 14.5 (0 – 206);p = 0.313] and the occurrence of hypoxemia during an ERCP procedure under sedation was observed in 3 patients (8.1%) in the NHF group and 2 patients (5.3%) in the LFO group, with no significant difference (p = 0.674).

Conclusions

Respiratory support by NHF with room air did not reduce marked hypercapnia during ERCP under sedation relative to LFO. There was no significant difference in the occurrence of hypoxemia between the groups that may indicate an improvement of gas exchanges by NHF.

Trial registration

jRCTs072190021.

The full date of first registration on jRCT: August 26, 2019.
HIV and AIDS prevention: knowledge, attitudes, practices and health literacy of older persons in the Western Cape and KwaZulu-Natal Provinces, South Africa and in Lesotho
Authors: Kalula Sebastiana Zimba , Blouws Tarryn , Ramathebane Maseabata , Sayed Abdul-Rauf
Published: May 2023

Background

Population ageing and access to anti-retroviral therapies in South Africa have resulted in ageing of the HIV/AIDS epidemic, which has implications for policy, planning and practice. Impactful interventions on HIV/AIDS for older persons require knowledge on effects of the pandemic on this population. A study was undertaken to assess knowledge, attitudes, and practices (KAP) of HIV/AIDS, as well as health literacy (HL) level of a population aged ≥ 50 years.

Methods

A cross-sectional survey was conducted at three sites in South Africa and two sites in Lesotho with an educational intervention at the South African sites. At baseline, data were collected for assessment of KAP of HIV/AIDS and HL levels. The pre- and post-intervention comprised participants at South African sites being familiarised with the contents of a specially constructed HIV/AIDS educational booklet. Participants’ KAP was reassessed six weeks later. A composite score of ≥ 75% was considered adequate KAP and an adequate HL level.

Results

The baseline survey comprised 1163 participants. The median age was 63 years (range 50–98 years); 70% were female, and 69% had ≤ 8 years’ education. HL was inadequate in 56% and the KAP score was inadequate in 64%. A high KAP score was associated with female gender (AOR = 1.6, 95% CI = 1.2–2.1), age < 65 years (AOR = 1.9, 95% CI = 1.5–2.5) and education level (Primary school: AOR = 2.2; 95% CI = 1.4–3.4); (High school: AOR = 4.4; 95% CI = 2.7–7.0); (University/college: AOR = 9.6; 95% CI = 4.7–19.7). HL was positively associated with education but no association with age or gender. The educational intervention comprised 614 (69%) participants. KAP scores increased post intervention: 65.2% of participants had adequate knowledge, versus 36% pre-intervention. Overall, younger age, being female and higher education level were associated with having adequate knowledge about HIV/AIDS, both pre- and post-intervention.

Conclusions

The study population had low HL, and KAP scores regarding HIV/AIDS were poor but improved following an educational intervention. A tailored educational programme can place older people centrally in the fight against the epidemic, even in the presence of low HL. Policy and educational programmes are indicated to meet the information needs of older persons, which are commensurate with the low HL level of a large section of that population.