bluuebunny/crossref_metadata_2025 huggingface dataset:
Catastrophic antiphospholipid syndrome after pregnancy complicated by hemolysis, elevated liver enzymes and low platelets syndrome
Authors: Saini Aashna , Wilkie Gianna , Dumont Tina
Published: November 2022

Background

Antiphospholipid syndrome (APLS) is rarely complicated by catastrophic antiphospholipid syndrome (CAPS). Peripartum CAPS is rarer still and can masquerade as other obstetric disorders. A high degree of suspicion is critical for early diagnosis and specific management given the significant morbidity and mortality associated with this disorder.

Case

We report a case of a 27-year-old at 22 week's gestation with a history of APLS found to have severe hemolysis, elevated liver enzymes and low platelets (HELLP) syndrome, resulting in termination of pregnancy. Further workup revealed the diagnosis of CAPS followed by prompt treatment with triple therapy leading to clinical improvement.

Conclusion

CAPS should be considered within the differential in an obstetric patient with a history of APLS who has evidence of multiorgan involvement with macro- or microvascular thrombosis. Although this may mimic alternative disorders, prompt diagnosis is imperative for appropriate therapy and reduction in maternal morbidity and mortality.
The United Kingdom's Psychoactive Substances Act 2016. Where are we now?
Authors: Humphries Christopher
Published: November 2022

This narrative review describes the background to the introduction of the UK Psychoactive Substances Act 2016, and developments since the Home Office review of the Act in 2018. It discusses the challenges when measuring illicit drug proliferation, and triangulates the impact of the Act by using data from multiple public sources. It looks at both the direct impacts of the Act, and indirect impacts on other forms of drug use, and identifies the discrepancy between politically expedient legislation and real-world harm reduction.
Influencing Factors of Online Course Learning Intention of Undergraduates Majoring in Art and Design: Mediating Effect of Flow Experience
Authors: Hewei Tian , Youngsook Lee
Published: November 2022

Using technology to support learning is a major trend in the development of modern education. In the face of COVID-19, online courses play an important role. During the COVID-19 pandemic, a large number of online art design courses have been developed in China. Art design courses involve many practical investigation and skill operation links, which is a challenge of online learning. In order to explore the influencing factors of online course learning intention of art and design majors, this study compiled a questionnaire, conducted an online survey on 1,057 Chinese art and design majors through the Wenjuanxing questionnaire survey platform, and conducted structural equation analysis and hierarchical regression analysis on the sample data by using SPSS and AMOS analysis software. Based on Information Technology Acceptance Model and immersion theory, this study focuses on the relationship between information characteristics, immersion experience and learning intention of art and design online courses. The results show that the antecedent variables such as professionalism, interactivity, interest, and ease of use of online courses have a positive impact on College Students’ user immersion experience and learning intention; Immersion experience positively affects learning intention; Immersion experience plays a mediating role between online course information characteristics and learning intention.
3D Analysis of the Hindfoot Following Total Ankle Replacement for Varus Ankle Osteoarthritis
Authors: Kvarda Peter , Siegler Lena , Horn-Lang Tamar , Susdorf Roman , Ruiz Roxa , Hintermann Beat
Published: November 2022

Category:

Hindfoot; Ankle; Ankle Arthritis

Introduction/Purpose:

In advanced stages of varus ankle osteoarthritis (OA) progressive destabilization of the peritalar structures is common. Total ankle replacement (TAR) is a viable treatment option although data, particularly on changes in the subtalar joint position following TAR, is scarce. Therefore, we evaluated the subtalar joint using semi-automated measurements based on weightbearing cone-beam CT scans (WBCT) before and after TAR.

Methods:

14 patients (15 ankles) who received TAR without additional bony procedures for varus ankle OA were analyzed using semi-automated measurements of the hindfoot based on pre-and postoperative WBCT. Pain on visual analog scale (VAS) and American Orthopedic Foot and Ankle Society Hindfoot Score (AOFAS) were assessed.

Results:

Five of 6 measurements showed a significant improvement including sagittal and axial talocalcaneal angle, talar horizontal inclination angle, hindfoot angle, and talar tilt.

Conclusion:

Besides ankle joint realignment, TAR for varus ankle OA without additional bony procedures achieved significant correction of the subtalar joint based on WBCT.
Midfoot Joint Arthrodesis using Compression Plate with Lag Screw Augmenting with Highly Porous β- Tricalcium Phosphate (β-TCP) and Bone Marrow Aspirate Concentrate (BMAC)
Authors: Lee Wonyong , MacDonald Justin , Prat Dan , Chao Wen , Farber Daniel C. , Wapner Keith L.
Published: November 2022

Category:

Midfoot/Forefoot

Introduction/Purpose:

There is still a controversy regarding the most optimal fixation instruments and bone graft materials for midfoot joint arthrodesis. We present the results of midfoot joint arthrodesis using compression plate highly porous β-tricalcium phosphate (β-TCP) and bone marrow aspirate concentrate (BMAC).

Methods:

We performed a retrospective review of patients undergoing midfoot joint arthrodesis using compression plate with lag screw augmenting with highly porous β - tricalcium phosphate (β - TCP) and bone marrow aspirate concentrate (BMAC) from January 2014 to May 2019. The radiographic bony union rate was investigated. Postoperative complications and reoperations were also noted. A total of 36 patients (37 feet) including 75 joints were available in this study.

Results:

A high bony union rate was achieved as of 97.3% in 73 out of 75 joints. Nonunion was seen in two patients including two joints: one for 1st TMT joint and the other for medial NC joint. There was no delayed union in this study. Time to radiographic union was 10.5 +- 1.9 (range, 7-15) weeks. A total of five postoperative complications were noted. All of them were related to hardware irritation, and all five patients underwent removal of hardware procedure. There was no major complication such as infection during the follow-up period. Of the two nonunion patients, only one with medial NC joint nonunion underwent a revision arthrodesis surgery.

Conclusion:

Based on our results, the fixation construct of compression plate with lag screw augmenting with highly porous β - tricalcium phosphate (β - TCP) and bone marrow aspirate concentrate (BMAC) is safe and effective for midfoot joint arthrodesis with an excellent union rate and a low complication rate.
Isokinetic Evaluation in a Large Cohort of Normal Ankles
Authors: Maciel Eduardo S. , Fonseca Lucas , Inojossa Thiago R. , Netto Cesar de Cesar , Raduan Fernando C. , Mansur Nacime SB , Astur Diego C.
Published: November 2022

Category:

Ankle; Sports; Other

Introduction/Purpose:

The isokinetic test has been used diffusely as a way to evaluate the functional results after the rehabilitation of musculoskeletal injuries. In the ankle, in particular, most studies are related to lateral ligament injuries and Achilles tendon's injuries. However, different protocols are used and a lack of normative values is observed in the literature. The aim of this work is to perform a global isokinetic evaluation on healthy ankles in order to propose reference values for future patients.

Methods:

We evaluated 100 participants (200 ankles) using the Biodex 3 System for the eversion, inversion, dorsiflexion and plantar flexion movements of the ankle. The sample consisted of individuals aged 20-60 years, with an active life and practice of recreational physical activity (non-athlete) and without previous injuries. Five repetitions for strength (N / m) and work (J) at a speed of 30o / sec and 10 repetitions for power (W) at a speed of 120o / sec were performed in our protocol. Agonist / antagonist ratio and the Muscle Deficiency Index, which globally assesses the balance between the sides for each movement, were also evaluated, as well as the demographic variables. Different statistical analyzes were performed for each parameter.

Results:

The mean age was 38.5 years and BMI 25.8 (CI 2.7 and 0.8 respectively) in 69 men and 31 women. In 78% of participants, the dominant ankle was the right one. The non-dominant side was consistently stronger (higher peak torque) in all movements (p<0.001 - Wilcoxon Test). The mean values obtained for force in each movement were 29.9N/m for eversion, 34.8N/m (CI 1.6) for inversion, 48.6N/m (2.0) for dorsiflexion and 140.2 N/m for plantar flexion. Such parameters for men and women were also obtained (p<0.001) and there was no correlation between age or BMI with the maximum torque (N/m) through Spearman's Correlation. The ratio of eversors / inverters was 88.8% (CI 3.1) and that of dorsiflexors / plantar flexors was 36.1% (1.3). Limb symmetry Index were >= 90% between sides in all four moviments (91,99% for eversion, 98,57% for inversion, 96,96% for dorsiflexion and 94,72% for plantarflexion).

Conclusion:

The non-dominant side was stronger in this evaluation of the two hundred healthy ankles. However, this difference was within the expected range for the limb symmetry index and for the MDI, showing that limb dominance is not relevant for the isokinetic assessment of the ankle. In the studied sample, the demographic variables (except gender) did not show any correlation with the evaluated parameters, especially with the maximum torque. Normative values of torque forces and agonist/antagonist balances were proposed. The results have implications for rehabilitation protocols and criteria for returning to sports.
Association of Bleeding Disorders and Risk of Complications Following Open Reduction and Internal Fixation of the Ankle
Authors: Malyavko Alisa , Quan Theodore , Stoll William T. , Manzi Joseph E. , Gu Alex , Tabaie Sean , Stein Benjamin E.
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

Open reduction and internal fixation (ORIF) of the ankle is a common procedure performed to correct ankle fractures in many different patient populations. Diabetes, peripheral vascular disease, and osteoporosis have been identified as risk factors for postoperative complications following surgery for ankle fractures. To date, there have not been any studies evaluating postoperative outcomes in patients with bleeding disorders undergoing operative treatment for ankle fractures. The aim of this study was to determine the postoperative complication rate following ORIF of the ankle in patients with a bleeding disorder versus those without a bleeding disorder.

Methods:

From 2006 to 2018, patients undergoing operative treatment for ankle fracture were identified in the National Surgical Quality Improvement Program database. Two patient cohorts were defined: patients with a bleeding disorder and patients without a bleeding disorder. Patients who underwent either inpatient or outpatient ORIF of the ankle were included in this study. In this analysis, demographics, medical comorbidities, and postoperative complications variables were assessed between the two cohorts. Bivariate and multivariate analyses were performed.

Results:

Of 10,306 patients undergoing operative treatment for ankle fracture, 9,909 patients (96.1%) had no bleeding disorder whereas 397 patients (3.9%) had a bleeding disorder. Following adjustment on multivariate analysis, compared to patients who did not have a bleeding disorder, those with a bleeding disorder had an increased risk of any postoperative complications (OR 1.479; p=0.024), requirement for postoperative blood transfusion (OR 2.863; p=0.001), and extended length of hospital stay greater than 5 days (OR 1.455; p=0.010) (Table 1).

Conclusion:

Patients with bleeding disorders are at an increased risk of postoperative complications following ORIF for ankle fractures. Our study found that patients with bleeding disorders had greater odds of postoperative complications following ORIF of the ankle. Determining patient risk factors and creating optimal preoperative and perioperative management plans in patients with bleeding disorders undergoing ORIF can be beneficial in reducing postoperative complications, improving patient outcomes, and reducing overall cost.
Investigating areas for improvement in the transition from hospital-to-home for frail older adults: A mixed methods study
Authors: Skerry Leanne , Kervin Emily , Hanson Natasha , Jarrett Pamela , McCloskey Rose
Published: November 2022

Background

The planning and execution of discharge plans to successfully transition frail older adults from hospital-to-home can be a complicated endeavour.

Objective

To identify areas for improvement in the transitional process of frail older adults who were discharged from hospital based, geriatric units to their homes in the community.

Method

A prospective multi-phased mixed methods design was used, and cross-case thematic analysis of Phase 2 data were triangulated with Phase 1 findings.

Results

Thematic analysis findings indicated several related areas of importance within the transitional process: 1) Coordination of discharge; 2) Transition-to-home planning; 3) Home and community care; 4) Following of recommendations; and, 5) Medical follow-up.

Conclusions

Strengthening communication between stakeholders, as well as the implementation of harmonized policies and guidelines are needed to facilitate more consistent care delivery and provide patients and families with information on what to expect during the transitional process.
Quiescent Bilateral Internal Carotid Artery Dissection Following Strangulation
Authors: Dalton Bryan , Coyle Mark , Tansey Paul , Fallon Clare , Raman Vivek , Healy Ultan
Published: November 2022

Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events.

Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause.

Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.
Integrating novel agents into the treatment of advanced mycosis fungoides and Sézary syndrome
Authors: Khodadoust Michael S. , Mou Eric , Kim Youn H.
Published: November 2022

Agents targeting the unique biology of mycosis fungoides and Sézary syndrome are quickly being incorporated into clinical management. With these new therapies, we are now capable of inducing more durable responses and even complete remissions in advanced disease, outcomes which were exceedingly rare with prior therapies. Yet, even this new generation of therapies typically produce objective responses in only a minority of patients. As our therapeutic options increase, we are now challenged with selecting treatments from a growing list of options. To gain the full benefit of these novel agents, we must develop strategies to match treatments for the patients most likely to benefit from them. Here, we consider both the current approaches to treatment selection based on clinical features and the future of molecular biomarker-guided therapy for patients with this heterogeneous disease.
Aging drives Tet2
+/− clonal hematopoiesis via IL-1 signaling
Authors: Caiado Francisco , Kovtonyuk Larisa V. , Gonullu Nagihan G. , Fullin Jonas , Boettcher Steffen , Manz Markus G.
Published: November 2022

Clonal hematopoiesis of indeterminate potential (CHIP), also referred to as aging-related clonal hematopoiesis, is defined as an asymptomatic clonal expansion of mutant mature hematopoietic cells in ≥4% of blood leukocytes. CHIP associates with advanced age and increased risk for hematological malignancy, cardiovascular disease, and all-cause mortality. Loss-of-function somatic mutations in TET2 are frequent drivers of CHIP. However, the contribution of aging-associated cooperating cell-extrinsic drivers, like inflammation, remains underexplored. Using bone marrow (BM) transplantation and newly developed genetic mosaicism (HSC-SCL-Cre-ERT; Tet2+/flox; R26+/tm6[CAG-ZsGreen1]Hze) mouse models of Tet2+/−driven CHIP, we observed an association between increased Tet2+/− clonal expansion and higher BM levels of the inflammatory cytokine interleukin-1 (IL-1) upon aging. Administration of IL-1 to mice carrying CHIP led to an IL-1 receptor 1 (IL-1R1)–dependent expansion of Tet2+/− hematopoietic stem and progenitor cells (HSPCs) and mature blood cells. This expansion was caused by increased Tet2+/− HSPC cell cycle progression, increased multilineage differentiation, and higher repopulation capacity compared with their wild-type counterparts. In agreement, IL-1α–treated Tet2+/− hematopoietic stem cells showed increased DNA replication and repair transcriptomic signatures and reduced susceptibility to IL-1α–mediated downregulation of self-renewal genes. More important, genetic deletion of IL-1R1 in Tet2+/− HPSCs or pharmacologic inhibition of IL-1 signaling impaired Tet2+/− clonal expansion, establishing the IL-1 pathway as a relevant and therapeutically targetable driver of Tet2+/− CHIP progression during aging.
Quality standards for managing children and adolescents with bronchiectasis: an international consensus
Authors: Chang Anne B. , Boyd Jeanette , Bush Andrew , Hill Adam T. , Powell Zena , Zacharasiewicz Angela , Alexopoulou Efthymia , Chalmers James D. , Collaro Andrew J. , Constant Carolina , Douros Konstantinos , Fortescue Rebecca , Griese Matthias , Grigg Jonathan , Hector Andreas , Karadag Bulent , Mazulov Oleksandr , Midulla Fabio , Moeller Alexander , Proesmans Marijke , Wilson Christine , Yerkovich Stephanie T. , Kantar Ahmad , Grimwood Keith
Published: November 2022

The global burden of bronchiectasis in children and adolescents is being recognised increasingly. However, marked inequity exists between, and within, settings and countries for resources and standards of care afforded to children and adolescents with bronchiectasis compared with those with other chronic lung diseases. The European Respiratory Society (ERS) clinical practice guideline for the management of bronchiectasis in children and adolescents was published recently. Here we present an international consensus of quality standards of care for children and adolescents with bronchiectasis based upon this guideline.

The panel used a standardised approach that included a Delphi process with 201 respondents from the parents and patients’ survey, and 299 physicians (across 54 countries) who care for children and adolescents with bronchiectasis.

The seven quality standards of care statements developed by the panel address the current absence of quality standards for clinical care related to paediatric bronchiectasis. These internationally derived, clinician-, parent- and patient-informed, consensus-based quality standards statements can be used by parents and patients to access and advocate for quality care for their children and themselves, respectively. They can also be used by healthcare professionals to advocate for their patients, and by health services as a monitoring tool, to help optimise health outcomes.
Same degree but different outcomes: an analysis of labour market outcomes for native and international PhD students in Australia
Authors: Tani Massimiliano
Published: November 2022

This paper used data on career destinations over the period 1999–2015 to study the labour market outcomes of native and foreign PhD graduates staying on in Australia as skilled migrants. Natives with an English-speaking background emerge as benefiting from positive employer ‘discrimination’ (a wage premium unrelated to observed characteristics such as gender, age, and previous work experience). The premium is field-specific and applies to graduates in Science, Technology, Engineering and Mathematics (STEM). In contrast, foreign PhD graduates with a non-English speaking background experience inferior labour market outcomes, especially if they work in the university sector. Against expectations to the contrary, completing the highest degree of education in the host country and staying on in the same sector where one acquired human capital does not appear to eliminate lesser labour market outcomes for the foreign-born.
Identification of key gene networks related to the freezing resistance of apricot kernel pistils by integrating hormone phenotypes and transcriptome profiles
Authors: Liu Xiaojuan , Xu Huihui , Yu Dan , Bi Quanxin , Yu Haiyan , Wang Libing
Published: November 2022

Background

Apricot kernel, a woody oil tree species, is known for the high oil content of its almond that can be used as an ideal feedstock for biodiesel production. However, apricot kernel is vulnerable to spring frost, resulting in reduced or even no yield. There are no effective countermeasures in production, and the molecular mechanisms underlying freezing resistance are not well understood.

Results

We used transcriptome and hormone profiles to investigate differentially responsive hormones and their associated co-expression patterns of gene networks in the pistils of two apricot kernel cultivars with different cold resistances under freezing stress. The levels of auxin (IAA and ICA), cytokinin (IP and tZ), salicylic acid (SA) and jasmonic acid (JA and ILE-JA) were regulated differently, especially IAA between two cultivars, and external application of an IAA inhibitor and SA increased the spring frost resistance of the pistils of apricot kernels. We identified one gene network containing 65 hub genes highly correlated with IAA. Among these genes, three genes in auxin signaling pathway and three genes in brassinosteroid biosynthesis were identified. Moreover, some hub genes in this network showed a strong correlation such as protein kinases (PKs)-hormone related genes (HRGs), HRGs-HRGs and PKs-Ca2+ related genes.

Conclusions

Ca2+, brassinosteroid and some regulators (such as PKs) may be involved in an auxin-mediated freezing response of apricot kernels. These findings add to our knowledge of the freezing response of apricot kernels and may provide new ideas for frost prevention measures and high cold–resistant apricot breeding.
Service readiness and availability of perinatal care in public hospitals - a multi-centric baseline study in Nepal
Authors: Chaulagain Dipak Raj , Malqvist Mats , Wrammert Johan , Gurung Rejina , Brunell Olivia , Basnet Omkar , KC Ashish
Published: November 2022

Background

Poor quality of maternal and newborn care contributes to nearly two million deaths of mothers and their newborns worldwide annually. Assessment of readiness and availability of perinatal care services in health facilities provides evidence to underlying bottlenecks for improving quality of care. This study aimed to evaluate the readiness and availability of perinatal care services in public hospitals of Nepal using WHO’s health system framework.

Methods

This was a mixed methods study conducted in 12 public hospitals in Nepal. A cross-sectional study design was used to assess the readiness and availability of perinatal care services. Three different data collection tools were developed. The tools were pretested in a tertiary maternity hospital and the discrepancies in the tools were corrected before administering in the study hospitals. The data were collected between July 2017 to July 2018.

Results

Only five out of 12 hospitals had the availability of all the basic newborn care services under assessment. Kangaroo mother care (KMC) service was lacking in most of the hospitals (7 out of 12). Only two hospitals had all health workers involved in perinatal care services trained in neonatal resuscitation. All of the hospitals were found not to have all the required equipment for newborn care services. Overall, only 60% of the health workers had received neonatal resuscitation training. A small proportion (3.2%) of the newborn infants with APGAR < 7 at one minute received bag and mask ventilation. Only 8.2% of the mothers initiated breastfeeding to newborn infants before transfer to the post-natal ward, 73.4% of the mothers received counseling on breastfeeding, and 40.8% of the mothers kept their newborns in skin-to-skin contact immediately after birth.

Conclusion

The assessment reflected the gaps in the availability of neonatal care services, neonatal resuscitation training, availability of equipment, infrastructure, information system, and governance. Rapid scale-up of neonatal resuscitation training and increased availability of equipment is needed for improving the quality of neonatal care services.
Vault differences in eyes implanted with spherical and toric implantable collamer lenses: an inter-eye analysis
Authors: Sánchez Trancón Angel , Cerpa Manito Santiago , Torrado Sierra Oscar , Baptista António Manuel , Serra Pedro Miguel
Published: November 2022

Purpose

To determine the influence of implantable collamer lenses (ICL) geometry, i.e. spherical and toric on the vault, and report the refractive and visual outcomes of patients bilaterally implanted with the two ICL geometries.

Methods

This retrospective case series analysed 41 patients implanted with a spherical ICL (sICL) in one eye and an equal sized toric ICL (tICL) in the fellow eye. The anatomical and ICL-related parameters were assessed using anterior-segment optical coherence tomography (AS-OCT Visante, Zeiss Meditec AG) and optical tomography (Pentacam, OCULUS). The influence of the anatomical and ICL-related parameters on the vault was determined using generalised estimating equations (GEE) to incorporate inter-eye correlations.

Results

Postoperative spherical equivalent was within ± 0.50D in 66% and 83% of the eyes, respectively implanted with sICL and tICL. The efficacy index in the sICL group was 1.06 and 1.14 in the tICL group. The mean inter-eye vault difference was -1.46 µm, anatomical and ICL-related parameters showed similar associations with the vault for sICL and tICL. The GEE identified the ICL size minus the anterior chamber width, the ICL spherical power and ICL central thickness as significant factors influencing the vault.

Conclusions

Spherical and toric ICL showed good efficacy for the correction of myopia and astigmatism. Patients implanted bilaterally with sICL and tICL tend to present similar vaults. The vault produced by both types of ICL was mainly regulated by the oversizing of the ICL. This suggests that the ICL geometry (spherical vs toric) is a factor with limited influence on the vault, thus the sizing method of a sICL and tICL should be similar.
Assessing infant sleep practices and other risk factors of SIDS in Zambia: a cross-sectional survey of mothers in Lusaka, Zambia
Authors: Osei-Poku Godwin K. , Mwananyanda Lawrence , Elliot Patricia A. , MacLeod William B. , Somwe Somwe Wa , Pieciak Rachel C. , Gill Christopher J.
Published: November 2022

Background

Having infants sleep with their parents and sleeping face down or on their sides are the two most proximate and modifiable risk factors for sudden infant death syndrome (SIDS). Little is known about the burden of SIDS or the prevalence of these risk factors in Africa. Our primary objective was to determine the prevalence of modifiable risk factors of SIDS in Lusaka, Zambia.

Methods

We conducted cross-sectional surveys with recent mothers of infants aged < 1 year across two busy urban clinic sites in Lusaka, Zambia. We used log-binomial regression analysis to identify factors predictive of bedsharing and prone sleeping.

Results

Surveys were conducted with 478 mothers between April-May 2021. The sleep-related risk factors, bedsharing and side sleeping, were widely prevalent. 89.5% of respondents indicated that they share a bed with the infant during sleep, 73.0% preferred putting their baby on its side, and 19.9% preferred the prone position. Only 6.7% of respondents described using the safer, supine position. Age of infant was the only factor which was predictive of prone sleeping. Infants > 2 months old were twice as likely to be put to sleep in a prone position compared to infants aged less than 2 months old. Mothers reported that they rarely (24.1%) received advice from medical caregivers to use the supine position. Maternal use of alcohol (12.0%) and tobacco (0.8%) during pregnancy were uncommon.

Conclusions

Bedsharing and placing the infant to sleep on the side were commonly reported among the mothers we interviewed. Whether this represents an opportunity to reduce SIDS in Zambia is unclear since accurate data on the burden of SIDS in Zambia is not available. There is a need for increased awareness of SIDS and more prospective data collection on its burden and related risk factors in these African populations.
Psychotropic medication use in people living with severe and persistent mental illness in the Australian community: a cross-sectional study
Authors: Hu Jie , McMillan Sara S , Theodoros Theo , Collins Jack C , El-Den Sarira , O’Reilly Claire L , Wheeler Amanda J
Published: November 2022

Background

Psychotropic polypharmacy and high-dose prescribing may play a role in therapy, however, with associated risks. The aim of this study was to describe current prescribing practices and use of four psychotropic medication groups (antipsychotics, antidepressants, mood stabilisers and benzodiazepines), focusing on polypharmacy (across and within groups) and high-dose prescribing in adults experiencing severe and persistent mental illness (SPMI) in the Australian community.

Methods

318 people taking psychotropic medication for SPMI had a medication review undertaken by a community pharmacist. Participants were recruited as part of an RCT from three Australian states/territories between September 2020-July 2021. All psychotropic medication and daily doses were recorded and reviewed for alignment with current clinical guidelines. Univariate and multiple logistic regression models investigated factors associated with antipsychotic, antidepressant, and mood stabiliser polypharmacy, and antipsychotic and antidepressant high-dose therapy. Variables included age, gender, geographic location, self- reported mental illness(es), hospital admission(s) in previous 6-months and prescriber type.

Results

806 psychotropic medications were prescribed for the 318 participants. Mood stabiliser polypharmacy was recorded in 19.0% of participants prescribed mood stabilisers; antipsychotic polypharmacy in 18.4% of participants prescribed antipsychotics; antidepressant polypharmacy in 11.3% of those prescribed antidepressants; and three participants (5.1%) were prescribed two benzodiazepines concurrently. Almost 18.6% of the cohort was receiving high-dose treatment; 18 participants were prescribed high-dose antipsychotics and 39 high-dose antidepressants, with two participants prescribed both. Adjusted logistic regression for polypharmacy found male gender, psychiatrist as sole prescriber, or multiple prescribers, were associated with antipsychotic polypharmacy. The adjusted model for high-dose therapy found psychiatrist as sole prescriber was significantly associated with antipsychotic and antidepressant high-dose prescribing.

Conclusion

Psychotropic polypharmacy was common in this community cohort experiencing SPMI. Whilst polypharmacy is not always inappropriate, it is a complex construct with potential benefits alongside potential risks. Benefits and harms need to be balanced however this practice is not supported by clear guidance to assist health practitioners. This study highlights the important need for regular medication reviews and strengthened communication between consumers and all healthcare professionals involved in community mental health care, to support safe and effective use of psychotropic medications.
The predictive role of coping styles and sense of coherence in the post-traumatic growth of mothers with disabled children: a cross-sectional study
Authors: Farhadi Akram , Bahreini Masoud , Moradi Ainaz , Mirzaei Kamran , Nemati Reza
Published: November 2022

Background

Coping and accepting stressful events can lead to positive psychological changes, growth, and excellence. In this regard, the present study was conducted to determine the relationship between coping styles and sense of coherence with post-traumatic growth in mothers with disabled children in Bushehr (a southern city in Iran).

Methods

The present cross-sectional study was performed on 260 mothers with children with disabilities who were filed in the rehabilitation centers covered by the Welfare Department of Bushehr in 2018. Demographic information form, Tedeschi and Calhoun post-traumatic growth questionnaire, Antonovsky sense of coherence, and Billings and Moos coping styles were employed to collect data. Data were analyzed by SPSS software using Pearson correlation coefficient and linear regression analysis at a significance level of less than 0.05.

Results

The mean age and standard deviation were 35.83 ± 7.41 for the mothers, and 7.20 ± 4.05 for the children. The mean and standard deviation of post-traumatic growth was 64.88 ± 14.90, sense of coherence was 116.36 ± 22.65 and coping styles was 30.59 ± 6.39. The results of linear regression show that only the two dimensions of meaningfulness (p = 0.013 and β = 0.170) and manageability from the sense of coherence (p = 0.001 and β = 0.432) can predict post-traumatic growth in mothers with disabled children in Bushehr. Also, from the coping style dimensions, only the emotion-focused variable (p = 0.001 and β = 0.353) is a predictor of post-traumatic growth.

Conclusion

Considering the role of sense of coherence and coping style in predicting post-traumatic growth, to implement rehabilitation programs and support the families of these children, it is essential to plan for the development of social and psychological support for mothers with disabled children.
A simple method for restoring the femoral head center in hip arthroplasty: a 3-dimensional analysis in the Chinese population
Authors: Tian Zui , Mao Xingjia , Gao Zhenzhong , Chen Bohong , Wang Zehua , Yin Zhiwen , Guo Zijian , Gao Ze , Xiang Chuan
Published: November 2022

Background

Various authors have successfully demonstrated that the distance from the greater trochanter to the femoral head center (GTFHC) and the distance from the lesser trochanter to the femoral head center (LTFHC) can be used as parameters to determine the recovery of the femoral head center (FHC) during hip arthroplasty. It is necessary to undertake an anatomical study concerning the correlations between the greater trochanter (GT), the lesser trochanter (LT), and the FHC using data obtained from the 3D-CT reconstruction method.

Methods

The study comprised 293 patients (151 males and 142 females), with an average age of 65.06 years. The femoral head diameter(FHD), the linear distance from FHC to GT (GTFHC), and the linear distance from FHC to LT(LTFHC) were all measured and recorded data. The correlation between FHD with LTFHC and GTFHC was assessed using Pearson correlation coefficients, and the ratio of LTFHC and GTFHC to FHD was calculated from this ratio. All measured parameters were compared between the left and right sides and the sexes of the participants.

Results

The average ratios of GTFHC/FHD and LTFHC/FHD were 0.99 and 0.95, respectively .96% of the LTFHC had absolute lateral differences of < 4 mm . 92% of the GTFHC had absolute lateral differences of < 4 mm.

Conclusion

LTFHC and GTFHC are reliable reference parameters for preoperative planning and reconstruction of FHC of hip arthroplasty. The ratio displayed in this research may yield insight into a practical and straightforward method for orthopedic surgeons to perform hip arthroplasty in patients with femoral neck fractures. Ratios from studies based on the same race may be desirable for future work.
Identifying the key genes regulating mesenchymal stem cells chondrogenic differentiation: an in vitro study
Authors: Liang Tongzhou , Li Pengfei , Liang Anjing , Zhu Yuanxin , Qiu Xianjian , Qiu Jincheng , Peng Yan , Huang Dongsheng , Gao Wenjie , Gao Bo
Published: November 2022

Background

Mesenchymal stem cells (MSCs) possess the potential to differentiate into chondrocytes, which makes them an ideal source for healing cartilage defects. Here, we seek to identify the essential genes participating in MSCs chondrogenesis.

Methods

Human MSCs were induced for chondrogenesis for 7, 14, and 21 days using a high-density micromass culture system, and RNA was extracted for RNA-seq.

Results

A total of 6247 differentially expressed genes (DEGs) were identified on day 7, and 85 DEGs were identified on day 14. However, no significant DEGs was identified on day 21. The top 30 DEGs at day 7, including COL9A3, COL10A1, and CILP2, are closely related to extracellular matrix organization. While the top 30 DEGs at day 14 revealed that inflammation-related genes were enriched, including CXCL8, TLR2, and CCL20. We also conducted protein–protein interaction (PPI) networks analysis using the search tool for the retrieval of interacting genes (STRING) database and identified key hub genes, including CXCL8, TLR2, CCL20, and MMP3. The transcriptional factors were also analyzed, identifying the top 5 TFs: LEF1, FOXO1, RORA, BHLHE41, and SOX5. We demonstrated one particular TF, RORA, in promoting early MSCs chondrogenesis.

Conclusions

Taken together, our results suggested that these DEGs may have a complex effect on MSCs chondrogenesis both synergistically and solitarily.
The original and two new derivative versions of the COMPERA 2.0 risk assessment model: useful tools for guiding balloon pulmonary angioplasty
Authors: Zhang Yi , Li Xin , Jin Qi , Luo Qin , Zhao Qing , Yang Tao , Zeng Qixian , Yan Lu , Duan Anqi , Huang Zhihua , Hu Meixi , Xiong Changming , Zhao Zhihui , Liu Zhihong
Published: November 2022

Background

The COMPERA 2.0 4-stratum (4-S) risk score has been demonstrated superior over the 3-stratum (3-S) one in patients with pulmonary arterial hypertension and medically managed patients with chronic thromboembolic pulmonary hypertension (CTEPH). We aimed to determine the prognostic value of the original 4-S and 3-S COMPERA 2.0 risk score and two new derivative versions in CTEPH patients who underwent balloon pulmonary angioplasty (BPA).

Methods

We retrospectively enrolled 175 BPA-treated patients with CTEPH. We assessed the risk stratification before and after each BPA session of CTEPH patients by the original 4-S and 3-S COMPERA 2.0 risk score (by rounding decimal to the nearest integer) and two new proposed derivative versions: the modified version (by rounding decimal to the next integer) and a hybrid version that fuses the original and modified versions. The primary endpoint was clinical worsening events. The secondary outcomes were achieving low-risk profile and mean pulmonary arterial pressure (mPAP) < 30 mmHg at follow-up. We used the Kaplan–Meier curve analysis to assess the survival differences between stratified patients. The comparative model’s performance was evaluated in terms of discrimination by Harrell’s C-index.

Results

All versions of COMPERA 2.0 4-S model outperformed the 3-S one in discriminating the differences in echocardiographic and hemodynamic parameters and clinical worsening-free survival rates. The original and hybrid 4-S model could independently predict the primary and secondary endpoints, and the hybrid version seemed to perform better. The first BPA session could significantly improve risk profiles, and these changes were associated with the likelihood of experiencing clinical worsening events, achieving a low-risk profile and mPAP < 30 mmHg at follow-up. The number of BPA sessions required to achieve low risk/mPAP < 30 mmHg increased as the baseline risk score escalated.

Conclusions

The COMPERA 2.0 4-S model outperformed the 3-S one in BPA-treated patients with CTEPH. The 4-S model, especially its hybrid version, could be used to predict clinical outcome before the initiation of BPA and monitor treatment response.
Prediction and prognosis of adverse maternal and foetal/neonatal outcomes in pulmonary hypertension: an observational study and nomogram construction
Authors: Chen Yuqin , Zhou Dansha , Xiong Mingmei , Xi Xin , Zhang Wenni , Zhang Ruifeng , Chen Lishi , Jiang Qian , Lai Ning , Li Xiang , Luo Jieer , Li Xuanyi , Feng Weici , Gao Chuhui , Chen Jiyuan , Fu Xin , Hong Wei , Jiang Mei , Yang Kai , Lu Wenju , Luo Yiping , Zhang Jun , Cheng Zhe , Liu Chunli , Wang Jian
Published: November 2022

Background

Pregnant women with pulmonary hypertension (PH) have higher mortality rates and poor foetal/neonatal outcomes. Tools to assess these risk factors are not well established.

Methods

Predictive and prognostic nomograms were constructed using data from a “Development” cohort of 420 pregnant patients with PH, recorded between January 2009 and December 2018. Logistic regression analysis established models to predict the probability of adverse maternal and foetal/neonatal events and overall survival by Cox analysis. An independent “Validation” cohort comprised data of 273 consecutive patients assessed from January 2019 until May 2022. Nomogram performance was evaluated internally and implemented with online software to increase the ease of use.

Results

Type I respiratory failure, New York Heart Association functional class, N-terminal pro-brain natriuretic peptide $$\ge$$
≥
1400 ng/L, arrhythmia, and eclampsia with pre-existing hypertension were independent risk factors for maternal mortality or heart failure. Type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, New York Heart Association functional class, and N-terminal pro-brain natriuretic peptide $$\ge$$
≥
1400 ng/L were independent predictors of pulmonary hypertension survival during pregnancy. For foetal/neonatal adverse clinical events, type I respiratory failure, arrhythmia, general anaesthesia for caesarean section, parity, platelet count, fibrinogen, and left ventricular systolic diameter were important predictors. Nomogram application for the Development and Validation cohorts showed good discrimination and calibration; decision curve analysis demonstrated their clinical utility.

Conclusions

The nomogram and its online software can be used to analyse individual mortality, heart failure risk, overall survival prediction, and adverse foetal/neonatal clinical events, which may be useful to facilitate early intervention and better survival rates.
Enhancement of fatty acid degradation pathway promoted glucoamylase synthesis in Aspergillus niger
Authors: Qi Jie , Xiao Xianzun , Ouyang Liming , Yang Chenghan , Zhuang Yingping , Zhang Lixin
Published: November 2022

Background

Our recent multi-omics analyses of glucoamylase biosynthesis inAspergillus niger(A. niger) suggested that lipid catabolism was significantly up-regulated during high-yield period under oxygen limitation. Since the catabolism of fatty acids can provide energy compounds such as ATP and important precursors such as acetyl-CoA, we speculated that enhancement of this pathway might be beneficial to glucoamylase overproduction.

Results

Based on previous transcriptome data, we selected and individually overexpressed five candidate genes involved in fatty acid degradation under the control of the Tet-on gene switch inA. niger. Overexpression of thefadE,fadAandcypgenes increased the final specific enzyme activity and total secreted protein on shake flask by 21.3 ~ 31.3% and 16.0 ~ 24.2%, respectively. And a better inducible effect by doxycycline was obtained from early logarithmic growth phase (18 h) than stationary phase (42 h). Similar with flask-level results, the glucoamylase content and total extracellular protein in engineered strains OE-fadE(overexpressingfadE) and OE-fadA(overexpressingfadA) on maltose-limited chemostat cultivation were improved by 31.2 ~ 34.1% and 35.1 ~ 38.8% compared to parental strain B36. Meanwhile, intracellular free fatty acids were correspondingly decreased by 41.6 ~ 44.6%. The metabolomic analysis demonstrated intracellular amino acids pools increased 24.86% and 18.49% in two engineered strains OE-fadEand OE-fadAcompared to B36. Flux simulationrevealed that increased ATP, acetyl-CoA and NADH was supplied into TCA cycle to improve amino acids synthesis for glucoamylase overproduction.

Conclusion

This study suggested for the first time that glucoamylase production was significantly improved inA. nigerby overexpression of genesfadEandfadAinvolved in fatty acids degradation pathway. Harnessing the intracellular fatty acids could be a strategy to improve enzyme production inAspergillus nigercell factory.
New strategy for antimetastatic treatment of lung cancer: a hypothesis based on circulating tumour cells
Authors: Que Zujun , Tian Jianhui
Published: November 2022

Metastasis is the primary cause of death in lung cancer patients. However, until now, effective drugs and intervention strategies for treating lung cancer metastasis have been lacking. This hypothesis focuses on circulating tumour cells (CTCs) to develop a new antimetastatic therapeutic strategy for lung cancer. Here, we outline the role of CTCs in tumour metastasis and their functional effects during the treatment of lung cancer patients. Additionally, we hypothesized the possibility of CTCs as a novel biomarker and therapeutic target in preventing and treating metastasis in patients with early-stage lung cancer. We hope that the realization of this hypothesis will improve the overall survival of lung cancer.