bluuebunny/crossref_metadata_2025 huggingface dataset:
Contribution of Excessive Gestational Weight Gain to the Increased Risk of Autism Spectrum Disorder Occurrence in Offspring
Authors: Kheirouri Sorayya , Farazkhah Tohid
Published: July 2022

Background:

According to epidemiological studies, the number of children affected by autism spectrum disorder (ASD) has elevated notably in recent years, which increases the importance of identifying and controlling modifiable risk factors of ASD.

Aim:

We aim to explore the association of maternal gestational weight gain (GWG) with the risk of ASD in offspring.

Methods:

This case-control study was conducted in Tabriz, Iran, from October 2019 to July 2020. Data of 426 children (208 with ASD and 218 healthy) were collected using medical records and face-to-face interviews with their mothers.

Results:

Maternal GWG was significantly higher in the ASD group ( P = .002). The percentage of inadequate (3.4% vs 0.5%) and excess (85.6% vs 56.0%) GWG was significantly higher in the ASD group ( P < .001). Maternal ( P < .001) and paternal ( P = .004) ages were significantly lower in the ASD group compared with the healthy group. Boys were shown to be more affected by ASD than girls ( P < .001). Results of multivariate regression indicated that maternal GWG [OR (95% CI): 1.10 (1.03, 1.19), P = .005], gestational age [OR (95% CI): 1.21 (1.05, 1.41), P= .009], maternal age [OR (95% CI): 0.82 (0.73, 0.91), P < .001], child male sex [OR (95% CI): 3.82 (2.31, 6.30), P < .001], and low education of father [OR (95% CI): 4.96 (1.56, 15.72), P = .006] were independently associated with increased risk of ASD.

Conclusion:

The results indicate that maternal excessive GWG, maternal and gestational age, parental low education level, and male sex of infant may independently increase the risk of ASD in offspring.
The Addition of Chemoradiation to Adjuvant Chemotherapy is Associated With Improved Survival Following Upfront Surgical Resection for Pancreatic Cancer With Nodal Metastases
Authors: Altman Ariella M. , White McKenzie J. , Marmor Schelomo , Shukla Dip , Chang Katherine , Lou Emil , LaRocca Christopher J. , Hui Jane Y.C. , Tuttle Todd M. , Jensen Eric H. , Denbo Jason W.
Published: July 2022

Background

It is unclear whether the addition of chemoradiation (CRT) to adjuvant chemotherapy (CT) following upfront resection of pancreatic ductal adenocarcinoma (PDAC) provides any benefit. While some studies have suggested a benefit to combined modality therapy (CMT) (adjuvant CT plus CRT), it is not clear if this benefit was related to increased CT usage in patients who received CMT. We sought to clarify the use of CMT in patients who underwent upfront resection of PDAC.

Methods

Patients with non-metastatic PDAC were retrospectively identified from the linked SEER-Medicare database. Those who underwent upfront resection were identified and divided into two cohorts – patients who received adjuvant CT and patients who received adjuvant CMT. Cohorts were compared. Univariate analysis described patient characteristics. Kaplan-Meier and multivariable Cox proportional hazards modeling were used to estimate overall survival (OS).

Results

3555 patients were identified; 856 (24%) received CT and 573 (16%) received CMT. The median number of CT doses was 11 for both groups. Patients who received CMT were younger, diagnosed in the earlier time frame, and had fewer comorbidities. The median OS was 21 months and 18 months for those treated with CMT and CT ( P < .0001), respectively, but when stratified by nodal status, the association with improved OS in the CMT cohort was only observed in node-positive patients. On multivariable analysis, receipt of CMT and removal of >15 lymph nodes decreased the risk of death ( P < .05).

Discussion

Receipt of CMT following upfront resection for PDAC was associated with improved survival, which was confined to node-positive patients. The role of adjuvant CMT in PDAC with nodal metastases warrants further study.
Smartphone ophthalmoscopy versus slit-lamp biomicroscopy for optic nerve head evaluation: A digital apparatus into medical education
Authors: Muhsen Sana , Roto Allaa , Al-Sabbagh Mohammed Qussay , Al-Huneidy Leen , AlRamahi Nura , Alhalaybeh Naja , Kotkot Duaa , Alkiswani Somaya , Al-Ani Abdallah , Abu-Yaghi Nakhleh
Published: July 2022

Objective

Th aim of this study is to explore the diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy in the diagnosis of optic nerve head (ONH) abnormalities and screening for glaucoma.

Methods

This is a prospective clinical-based validation study performed on 90 patients recruited from a tertiary teaching hospital. Patients underwent dilated fundus examination by slit-lamp and smartphone-based D-EYE fundoscopy operated by two experienced ophthalmologists.

Results

The diagnostic accuracy of smartphone-based D-EYE ophthalmoscopy of normal vertical cup-to-disc ratio (VCDR) was acceptable (sensitivity 85.8%–96.4%; specificity 51.4%–96.4%). The D-EYE would often underestimate VCDR values as mean VCDR was significantly lower among overall and glaucoma cohorts (all p-value <0.001) for D-EYE in comparison with slit-lamp. In terms of ONH abnormalities, the D-EYE adequately demonstrated high sensitivity in the identification of only margins-related abnormalities (sensitivity 92.5%–96.6%). Overall, the diagnostic accuracy and agreement between expert ophthalmologists using the D-EYE and the reference slit-lamp examination were significantly poor.

Conclusion

We demonstrated that the D-EYE is a highly specific tool for VCDR within the normal range but not in patients with glaucoma. Despite being an easy and portable tool to measure VCDR, it is limited in terms of diagnosing ONH and blood vessel abnormalities.
Complications and predictors of morbidity for hip fracture surgery in patients with chronic liver disease
Authors: Szapary Hannah J , Monárrez Rubén , Varady Nathan H , Hanna Philip , Chen Antonia F , Rodriguez Edward K
Published: July 2022

Background:

Despite the fact that patients with chronic liver disease (CLD) are at increased risk of complications after a fracture of the hip, there remains little information about the risk factors for acute postoperative complications and their overall outcome. The aim of this study was to describe inpatient postoperative complications and identify predictors of postoperative morbidity.

Methods:

Patients with CLD who had been treated for a fracture of the hip between April 2005 and August 2019 were identified from a retrospective search of an intramural trauma registry based in the Northeastern United States. Medical records were reviewed for baseline demographics, preoperative laboratory investigations, and outcomes.

Results:

The trauma registry contained 110 patients with CLD who had undergone surgery for a fracture of the hip. Of these, patients with a platelet-count of ⩽100,000/µL were 3.81 (95% CI, 1.59–9.12) times more likely to receive a transfusion than those with a platelet-count of >100,000/µL. Those with a Model for End-stage Liver Disease (MELD) score of >9 were 5.54 (2.33–13.16) times more likely to receive a transfusion and 3.97 (1.06–14.81) times more likely to develop postoperative delirium than those with a MELD score of ⩽9. Of patients without chronic kidney disease, those with a creatinine of ⩾1.2 mg/dL were 6.80 (1.79–25.87) times more likely to develop acute renal failure (ARF) than those with a creatinine of <1.2 mg/dL. In a multivariable model, as MELD score was increased, the odds of developing a composite postoperative complication, which included transfusion, ARF, delirium, or deep wound infection, were 1.29 (1.01–1.66). Other tools used to assess surgical risks, Charlson Comorbidity Index, Elixhauser, and American Society of Anesthesiologist scores, were not predictive.

Conclusions:

Patients with CLD who undergo surgery for a hip fracture have a high rate of postoperative complications which can be predicted by the preoperative laboratory investigations identified in this study and MELD scores, but not by other common comorbidity indices.
What’s in a name? Gender equality and the European Conservatives and Reformists’ group in the European Parliament
Authors: Gaweda Barbara , Siddi Marco , Miller Cherry
Published: July 2022

Far-right and populist right-wing political parties have garnered significant scholarly attention in recent years. They have acquired importance also in European political institutions such as the European Parliament (EP). We explore this issue by focusing on the European Conservatives and Reformists’ (ECR) group in the EP. We analyse its current and former main national party delegations – the British Conservative Party, the Polish Law and Justice Party, and the Brothers of Italy – and unpack the ideological underpinnings of ‘conservative’ positions of the ECR group. How is ‘conservatism’ constructed in the EP? What role does gender play in these constructions? Significantly, we locate gender equality as a key area, crucial to the identity of what it means to be a conservative party in Europe today. We combine the analysis of ECR political programs with interview and ethnographic data. The article contributes to both the study of European Union (EU) politics and to research on national conservative parties.
Investigating why guests choose to use (or not to use) peer-to-peer hospitality services through the behavioral perspective model
Authors: FB Teixeira Otávio
Published: July 2022

This study aimed to combine and systematise the reasons why guests opt to use (or reject) peer-to-peer hospitality services according to recent literature, thus providing practical solutions to strengthen this industry. In this regard, this study performed a comprehensive literature review of 24 studies in the field of tourism and hospitality by (i) applying their findings (Nreasons = 115) to a broad model of predicted consumption (behavioural perspective model), (ii) recognising the incidence of utilitarian and informational outcomes in the industry, (iii) identifying a pattern of reinforcement attached to it, and (iv) implementing the marketing mix structure to develop growth strategies. The results show that guests opt for these services primarily for utilitarian reasons, such as feeling welcomed by their host and comfortable in the neighbourhood (interaction), and that the level of security introduced by these services (safety) either attracts or turns away consumers. Furthermore, the high utilitarian/low informational pattern of reinforcements attached to these services reveals opportunities to develop the industry, which may be covered by extending accommodation that prompts individuals’ need for self-promotion and uniqueness (place strategy). This study contributes to past peer-to-peer hospitality research focussed on guests’ perspectives by linking their findings and providing a broad-theme overview. It also extends the behavioural perspective model literature to hospitality analysis, providing managers with a further consumer predictive tool.
Moral distress during COVID-19: The importance of perceived organizational support for hospital nurses
Authors: Latimer Abigail L , Otis Melanie D , Mudd- Martin Gia , Moser Debra K
Published: July 2022

Moral distress, or the inability to act congruent with moral beliefs, has been of concern for healthcare professionals especially since the COVID-19 pandemic. Hospital nurses are particularly affected in their roles with mounting administrative pressures and demands. We examined whether general and COVID-specific support in employing healthcare organizations predicted moral distress in a sample of inpatient hospital nurses. A total of 248 nurses completed the Measure of Moral Distress for Healthcare Professionals, Survey of Perceived Organizational Support, COVID Organizational Support survey, and the Hospital Ethical Climate Scale. We found that general and COVID-related organizational support were predictors of moral distress after controlling for age, gender, working in an intensive care unit setting, and ethical climate. Findings support the need for a comprehensive strategy to address moral distress, including institutional efforts to convey support and commitment. Strategies moral distress may be experienced differently based on gender identity.
A queer kind of dwelling: Digital throwness and existential security among sexual minorities in Russia
Authors: Tudor Matilda
Published: July 2022

This article asks what it means to habituate a queer orientation in a world permeated by digital connectivity. In doing so, it takes media phenomenology away from the mundane towards the momentous, drawing on queer phenomenology, and existential media studies. Using life-narrative interviews with sexual minorities in Russia, the article sheds light on the “work of queer habituation” in a straight world, and the contemporary significance of digital media technologies within this process. Digital media’s ability to multiply space is defined a key feature which offers sites to “stay with” the disorienting experience of queer dispositions. Through longer periods of discrete “queer digital dwelling,” individuals who have been associating their queer desires with ontological threats are able to find space for existence and existential security. By locating others in close proximity, some are also allowed to appropriate local territory in ways that make it more livable.
Something in the air: Toxic pollution in and around U.S. prisons
Authors: Toman Elisa L.
Published: July 2022

Toxic chemicals are released into land, air, and waterways daily. Exposure to such chemicals, however, is not equally distributed across the U.S. It is well documented that communities without agency and capital, typically economically and socially disadvantaged, are those that suffer the brunt of the impacts of a polluted environment. These impacts can have both acute and chronic health consequences, leading to lower life expectancy, higher cancer rates, and compromised immune systems. Emerging qualitative work indicates that incarcerated persons – individuals who have no agency to leave their environment – are disproportionately affected by our polluting practices. This study argues that environmental regulations across the country allow polluting industries to poison confined populations. Nationwide data from the Environmental Protection Agency's Toxic Release Inventory is used to examine if industries geographically closer to correctional facilities emit greater amounts of toxic chemicals. Regional differences are examined as well. Results identify a pattern of harm – incarcerated persons who already have compromised health are also exposed to high levels of toxic chemicals.
A circle grid-based approach for obstacle avoidance motion planning of unmanned surface vehicles
Authors: Zhu Man , Xiao Changshi , Gu Shangding , Du Zhe , Wen Yuanqiao
Published: July 2022

Aiming at an obstacle avoidance problem with dynamic constraints for Unmanned Surface Vehicle (USV), a method based on Circle Grid Trajectory Cell (CGTC) is proposed. Firstly, the ship model and standardization rules are constructed to develop and constrain the trajectory, respectively. Secondly, by analyzing the properties of the circle grid, the circle grid tree is produced to guide the motion of the USV. Then, the kinematics and dynamics of the USV are considered through the on-line trajectory generator by designing a relational function that links the rudder angle, the heading angle, and the central angle of the circle grid. Finally, obstacle avoidance is achieved by utilizing the on-line trajectory generator to choose a safe, smooth, and efficient path for the USV. The experimental results indicate that the proposed method can avoid both static and dynamic obstacles, showing better performance in terms of distance cost and steering cost comparing with the related methods, and our method only takes 50% steering cost of the grid-based method; the collision avoidance path not only conforms to the USV dynamic characteristics but also provides a reference of steering command.
Irish social policy to family carers of adults with an intellectual disability: A critical analysis
Authors: Brennan Damien , D’eath Maureen , Dunne Nikki , O’Donovan Mary-Ann , McCallion Philip , McCarron Mary
Published: July 2022

This paper explores contemporary Irish social policy for family caregivers with specific focus on the dynamic between the individual, the family and the state in terms of the social contract for care provision for people with intellectual disability. Drawing from Bacchi’s analytical framework (Bacchi, 2009), the Irish National Carers’ Strategy is interrogated specifically with regards to how it frames and assumes the social contract for family care provision for adults with an intellectual disability. We suggest that Irish social policy constructs family caregiving as the assumed natural and neutral point of departure for providing care within society, and this constructed identify is subsequently reinforced through the provisions contained with the policies themselves that seek to support such caregivers. A fundamental reconsideration of the social contract for such care provision and support with society would appear warranted.
In-hospital outcomes and recurrence of stroke during pregnancy and puerperium
Authors: Garg Aayushi , Roeder Hannah , Leira Enrique C
Published: July 2022

Background:

There are limited data regarding the best management and outcomes of acute stroke during pregnancy and the puerperium.

Methods:

Pregnancy-related hospitalizations with age > 18 years were identified from the Nationwide Readmissions Database 2016–2018. The study cohort consisted of all patients with acute stroke and a 5% random sample of the remaining non-stroke hospitalizations. Logistic regression and survival analyses were used to compare the in-hospital outcomes and readmissions in patients with and without acute stroke.

Results:

There were 11,829,044 pregnancy-related hospitalizations, of which 4057 had acute stroke. The mean ± SD age of the study cohort was 29.0 ± 5.7 years. Among patients with acute ischemic stroke, 60 (3.7%) patients received intravenous thrombolysis and 112 (6.8%) patients underwent endovascular thrombectomy. Among patients with intracranial hemorrhage, 205 (10.5%) patients underwent ventriculostomy and 18 (0.9%) patients underwent decompressive craniotomy. Patients with stroke had longer length of stay (mean: 10.7 vs 2.7 days), higher in-hospital mortality (4.6% vs 0.0001%) and were less likely to discharge home (73.0% vs 98.6%). Non-elective readmission within 90 days of discharge occurred in 14.8% of patients with stroke versus in 3.9% of patients without stroke. Readmissions due to cerebrovascular events occurred in 2.3% of patients with stroke versus in 0.007% of patients without stroke within 1 year of discharge, with mean ± SD time to readmission 66.2 ± 78.0 days.

Conclusion:

Stroke is a serious complication of pregnancy, associated with high morbidity and mortality. Recurrence of stroke occurs in a small proportion of patients, and the risk is highest during the initial 3 months.
Neurotoxicity and Structure-Activity Relationships of Resveratrol and its two Natural Analogs, 4,4′-Dihydroxystilbene and Pinosylvin
Authors: Shi Jianwu , Li Tingting , Dong Jin , Wu Yuanyuan , Wang Wenran , Wang Chengniu
Published: July 2022

Resveratrol (RES) and its two natural analogues, 4,4′-dihydroxystilbene (DHS) and pinosylvin (PIN), are very important polyphenols and have attracted considerable pharmaceutical interest because of their diverse biological activities. However, their adverse effects on motor nerves and glioma cells have not been properly assessed. Herein, we surveyed the toxicity and analyzed the structure-activity relationship of these three polyphenols using transgenic zebrafish ( Danio rerio) and U87. Results indicated that, in zebrafish embryos, both DHS (1 and 10 μg/mL) with hydroxyl groups at the 4 and 4′ positions, and PIN (1 and 10 μg/mL) with hydroxyl groups at the 3 and 5 positions inhibited motor neuron growth more effectively than RES (1 and 10 μg/mL) with hydroxyl groups at the 3, 4′, and 5 positions, although their appearance is normal. Both the DHS- (10 μg/mL) and PIN (10 μg/mL) -treated groups significantly reduced the swimming distance of zebrafish compared with the RES (10 μg/mL) -treated group. In addition, DHS with the hydroxyl groups at the 4 and 4′ positions (0.002, 0.02, 0.2, 2, and 20 μM) inhibited U87 cell aggregation in a concentration-dependent manner; PIN with the hydroxyl groups at the 3 and 5 positions (0.002, 0.02, 0.2, 2, and 20 μM) promoted U87 cell aggregation in a concentration-dependent manner, while RES with three hydroxyl groups promoted U87 cell aggregation at concentrations from 0.2 to 2 μM. Taken together, DHS and PIN are more neurotoxic than RES. The position and number of hydroxyl groups significantly affected the ability of the polyphenols to aggregate into tumors in the U87 cell.
Efficacy and Safety of Dupilumab Versus Omalizumab in Chronic Rhinosinusitis With Nasal Polyps and Asthma: EVEREST Trial Design
Authors: De Prado Gomez, PharmD, MSc Lucia , Khan, MBBS, MPH Asif H. , Peters, MD Anju T. , Bachert, MD, PhD Claus , Wagenmann, MD Martin , Heffler, MD, PhD Enrico , Hopkins, BMBCh Claire , Hellings, MD, PhD Peter W. , Zhang, PhD Mei , Xing, PhD Jun , Rowe, MD Paul , Jacob-Nara, MD, MPH, DHSc Juby A.
Published: July 2022

Background

Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma are chronic type 2 inflammatory diseases that are frequently associated with each other. Dupilumab inhibits the dual signaling pathways of interleukin (IL)-4 and IL-13, which are key and central drivers of type 2 inflammation in CRSwNP. Omalizumab blocks the action of immunoglobulin E. Head-to-head studies are required to investigate the comparative efficacy and safety of these interventions. EVEREST (EValuating trEatment RESponses of dupilumab vs omalizumab in Type 2 patients) trial is designed to evaluate whether the efficacy of dupilumab is superior to omalizumab in treating patients with CRSwNP and comorbid asthma (ClinicalTrials.gov Identifiers: NCT04998604).

Objective

Here, we describe the EVEREST study design to compare the efficacy and safety of dupilumab compared to omalizumab over 24 weeks of treatment in patients with severe CRSwNP and comorbid asthma.

Methods

EVEREST is a global, phase 4 multicenter, randomized (1:1), double-blind, active-controlled trial. Approximately 422 adult patients with severe CRSwNP, symptoms of nasal congestion and loss of smell, and coexisting asthma will be recruited across 15 countries. The primary objective is to assess the efficacy of dupilumab compared to omalizumab in reducing the nasal polyp size and improving the sense of smell. The key secondary objectives are to evaluate the comparative efficacy in improving CRSwNP symptoms (eg, nasal congestion) and lung function. The safety will be evaluated in terms of treatment-emergent adverse events (AEs), serious AEs, and AEs of special interest.

Conclusions

EVEREST is the first head-to-head trial assessing the comparative efficacy and safety of 2 biologics in patients with severe CRSwNP and comorbid asthma. The study will provide evidence to help optimize treatment plans for patients that suffer from severe CRSwNP and comorbid asthma.
Exploring green areas in Polish cities in context of anthropogenic land use changes
Authors: Noszczyk Tomasz , Cegielska Katarzyna , Rogatka Krzysztof , Starczewski Tomasz
Published: July 2022

Recent decades saw a global degradation of ecosystems and climate change caused by rapid anthropogenic socio-economic growth. The paper investigates spatio-temporal changes in green areas in Polish cities. The study involved two levels: macro (all 936 towns and cities in Poland) and micro (zooming in on Kraków and Toruń) from 2006 to 2018. The authors analysed 64,312 records of statistical data and 32,317 polygons representing areas of specific land use categories in the Urban Atlas with GIS tools and algorithms. Results for the entire country (a macro level) indicate that the area of forests in cities is in decline, but the total share of green urban areas is increasing slightly. Polish towns and cities also exhibit a positive balance of shrub count and a negative balance of tree count. At a micro level, land use analysis indicates a slight decrease in green urban areas, but an increase in the forest area. Moreover, an analysis of the spatial distributions of changes in green areas in Kraków and Toruń demonstrated specific trends. Sites exhibiting a significant decrease in green urban areas were found mainly along main transport routes. Moreover, incomplete green belts around highly urbanised zones turned out to be a characteristic component. The slight differences in results at a micro and macro level are due to a more significant generalisation at a macro level. Micro-level research focuses on an individual case. Hence, it should be used mainly to juxtapose cities, while the macro-level perspective is adequate for cross-country analyses, for example. The results are relevant to urban policies deployed by local and regional authorities, the European Green Deal and climate neutrality.
Virtual Hospitalization at Home After the Covid-19 Pandemic: Time to Consider Our Future Community Healthcare Options
Authors: Boone Emily J. , Shammash Jonathan B.
Published: July 2022

The concept of acute hospitalization at home has been described for over 3 decades. Its scope, however, was largely limited to small experimental trials and pilot studies. The Covid-19 pandemic changed these circumstances. The convergence of the critical need for acute hospital beds along with the growing sophistication and comfort in virtual monitoring facilitated the rapid deployment of hospitalization at home throughout many communities in the United States. Now in the waning times of the pandemic, community health leaders and health systems are questioning what the future role of home virtual hospitalization might be. Might this concept be relegated to only future times of critical bed shortage, or might it be part of a true change in community healthcare delivery.
The untold story of the modernization thesis: Urbanization and corruption in developing countries
Authors: Adou Kouakou Donatien
Published: July 2022

How does urbanization affect corruption? Modernization theory suggests a negative relationship. Existing empirical studies tend to confirm this hypothesis, showing that urbanization is inversely associated with corruption. In this paper, I provide an alternative perspective on corruption, focusing especially on Sub-Saharan Africa. I argue that the modernization process, ironically, can exacerbate rather than ameliorate corruption. Urbanization is conducive to corruption in an African context because urbanization is characterized by a more individualistic lifestyle reducing thus the cost of being corrupt as there are fewer social sanctions and peer pressure compared to community-based traditional life. A time-series cross-sectional analysis (1972−2015) shows across several regression models and estimators that urbanization is directly associated with corruption in a sample of African countries, but it has mixed effects on a global sample. Re-conceptualizing how urbanization shapes political culture in Africa is important for a continent that is rapidly urbanizing, working to control corruption, and in need of further development.
Outcomes of Biceps Tenotomy Versus Tenodesis During Arthroscopic Rotator Cuff Repair: An Analysis of Patients From a Large Multicenter Database
Authors: Srinivasan Ramesh C. , Hao Kevin A. , Wright Thomas W. , Farmer Kevin W. , Wright Jonathan O. , Roach Ryan P. , Moser Michael W. , Freidl Michael C. , Pazik Marissa , King Joseph J.
Published: July 2022

Background:

Studies to date evaluating biceps tenotomy versus tenodesis in the setting of concomitant rotator cuff repair (RCR) have demonstrated relatively equivalent pain and functional outcomes.

Hypothesis:

It was hypothesized that a significant difference could be demonstrated for pain and functional outcome scores comparing biceps tenotomy versus tenodesis in the setting of RCR if the study was adequately powered.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

The Arthrex Surgical Outcomes System database was queried for patients who underwent arthroscopic biceps tenotomy or tenodesis and concomitant RCR between 2013 and 2021; included patients had a minimum of 2 years of follow-up. Outcomes between treatment types were assessed using the American Shoulder and Elbow Surgeons Shoulder (ASES), Single Assessment Numeric Evaluation (SANE), visual analog scale (VAS) for pain, and Veterans RAND 12-Item Health Survey (VR-12) scores preoperatively and at 3 months, 6 months, 1 year, and 2 years postoperatively. Results were stratified by age at surgery (3 groups: <55, 55-65, >65 years) and sex.

Results:

Overall, 1936 primary RCRs were included for analysis (1537 biceps tenodesis and 399 biceps tenotomy patients). Patients who underwent tenotomy were older and more likely to be female. A greater proportion of female patients aged <55 years and 55 to 65 years received a biceps tenotomy compared with tenodesis ( P = .012 and .026, respectively). All scores were comparable between the treatment types preoperatively and at 3 months, 6 months, and 1 year postoperatively. At 2-year follow-up, patients who received a biceps tenodesis had statistically more favorable ASES, SANE, VAS pain, and VR-12 scores ( P ≤ .031); however, the differences did not exceed the minimal clinically important difference (MCID) for these measures.

Conclusion:

Our findings indicate that surgeons are more likely to perform a biceps tenotomy in female and older patients. Biceps tenodesis provided improved pain and functional scores compared with tenotomy at 2-year follow-up; however, the benefit did not exceed previously reported MCID for the outcome scores. Both procedures provided improvement in outcomes; thus, the choice of procedure should be a shared decision between the surgeon and patient.
Formation of the Valmiki Heritage: Making Sense of Dalit Cultural Assertion in Punjab
Authors: Kumar Yogesh
Published: July 2022

This article seeks to understand the agenda of the government of Punjab behind the recent construction of the cultural heritage of sant/guru Valmiki which is attracting a sizable population of the Dalit community known as Balmikis in the state. In this context, the article explores the historical role of the Adi-Dharam Samaj, an anti-caste reformist movement by the Balmiki community. This movement has adopted various new modes and strategies to mobilize the community. It also subscribes to the philosophy of Ad Dharm to define a separate religious identity for Dalits, especially the Balmiki community separate from Hindus and Sikhs. It has also adopted a distinct path of ensuring Dalit social mobility without following the dominant modes like Sanskritization and conversion. The making of Dalit cultural heritage is a significant development in a realm that explores the extremely marginalized community within Dalits, and their attempt at identity articulation and assertion in contemporary Punjab.
Book review: Akhila Naik, Bheda (Translated by Raj Kumar)
Authors: Nag Kuber
Published: July 2022

Akhila Naik, Bheda (Translated by Raj Kumar) (Oxford University Press, 2017), 108 pp. ₹495 (paperback). ISBN-13:978-0-19-947607-7
Epigenetic regulator genes direct lineage switching in MLL/AF4 leukemia
Authors: Tirtakusuma Ricky , Szoltysek Katarzyna , Milne Paul , Grinev Vasily V. , Ptasinska Anetta , Chin Paulynn S. , Meyer Claus , Nakjang Sirintra , Hehir-Kwa Jayne Y. , Williamson Daniel , Cauchy Pierre , Keane Peter , Assi Salam A. , Ashtiani Minoo , Kellaway Sophie G. , Imperato Maria R. , Vogiatzi Fotini , Schweighart Elizabeth K. , Lin Shan , Wunderlich Mark , Stutterheim Janine , Komkov Alexander , Zerkalenkova Elena , Evans Paul , McNeill Hesta , Elder Alex , Martinez-Soria Natalia , Fordham Sarah E. , Shi Yuzhe , Russell Lisa J. , Pal Deepali , Smith Alex , Kingsbury Zoya , Becq Jennifer , Eckert Cornelia , Haas Oskar A. , Carey Peter , Bailey Simon , Skinner Roderick , Miakova Natalia , Collin Matthew , Bigley Venetia , Haniffa Muzlifah , Marschalek Rolf , Harrison Christine J. , Cargo Catherine A. , Schewe Denis , Olshanskaya Yulia , Thirman Michael J. , Cockerill Peter N. , Mulloy James C. , Blair Helen J. , Vormoor Josef , Allan James M. , Bonifer Constanze , Heidenreich Olaf , Bomken Simon
Published: July 2022

The fusion gene MLL/AF4 defines a high-risk subtype of pro-B acute lymphoblastic leukemia. Relapse can be associated with a lineage switch from acute lymphoblastic to acute myeloid leukemia, resulting in poor clinical outcomes caused by resistance to chemotherapies and immunotherapies. In this study, the myeloid relapses shared oncogene fusion breakpoints with their matched lymphoid presentations and originated from various differentiation stages from immature progenitors through to committed B-cell precursors. Lineage switching is linked to substantial changes in chromatin accessibility and rewiring of transcriptional programs, including alternative splicing. These findings indicate that the execution and maintenance of lymphoid lineage differentiation is impaired. The relapsed myeloid phenotype is recurrently associated with the altered expression, splicing, or mutation of chromatin modifiers, including CHD4 coding for the ATPase/helicase of the nucleosome remodelling and deacetylation complex. Perturbation of CHD4 alone or in combination with other mutated epigenetic modifiers induces myeloid gene expression in MLL/AF4+ cell models, indicating that lineage switching in MLL/AF4 leukemia is driven and maintained by disrupted epigenetic regulation.
Which stem in total hip arthroplasty for developmental hip dysplasia? A comparative study using a 3D CT-based software for pre-operative surgical planning
Authors: Castagnini Francesco , Lucchini Stefano , Bordini Barbara , Cosentino Monica , Pardo Francesco , Traina Francesco
Published: July 2022

Background

Stem choice in total hip arthroplasty (THA) for hip dysplasia is still controversial. The aims of the study were to evaluate (1) which stem design provided the highest percentage of adequate reconstructions in THA for dysplasia and (2) any correlation between the reconstructions provided by the stems and the native femoral morphology.

Materials and methods

150 CT scans including 200 adult dysplastic hips were randomly selected. Using the 3D CT-based software Hip-Op for surgical planning, the native hip anatomy was studied. Then, a single wedge tapered stem, an anatomical stem and a conical tapered stem were simulated in every hip. An adequate reconstruction of hip biomechanics was obtained when combined anteversion, offset restoration, coronal and sagittal tilt, canal filling and leg lengthening were inside the normal ranges.

Results

Conical stems achieved the highest percentage of adequate reconstructions (87%, p < 0.0001). The anatomical stem was the worst performer. Single wedge and anatomical stem acceptability was mainly influenced by the combined anteversion. Stem anteversion was correlated with the femoral anteversion (fair correlation), the calcar femorale (fair) and the mediolateral femoral diameter at isthmus (poor). When the femoral anteversion was ≥ 25°, combined anteversion was very acceptable for the conical stem (99.2%), whereas the rate of acceptable combined anteversion for the single wedge tapered stem was 71.4%, and that for the anatomical stem was 51.6% (p < 0.0001).

Conclusions

Stem choice in developmental hip dysplasia is mainly driven by appropriate combined anteversion, which is dependent on the coronal and axial femoral morphologies. As a rule of thumb, tapered stems are adequate when femoral anteversion is < 25°; conical stems should be adopted for higher anteversions.

Level of evidence

IV.
Genome-wide analyses of the mung bean NAC gene family reveals orthologs, co-expression networking and expression profiling under abiotic and biotic stresses
Authors: Tariq Rezwan , Hussain Ammara , Tariq Arslan , Khalid Muhammad Hayder Bin , Khan Imran , Basim Huseyin , Ingvarsson Pär K.
Published: July 2022

Background

Mung bean is a short-duration and essential food crop owing to its cash prominence in Asia. Mung bean seeds are rich in protein, fiber, antioxidants, and phytonutrients. The NAC transcription factors (TFs) family is a large plant-specific family, participating in tissue development regulation and abiotic and biotic stresses.

Results

In this study, we perform genome-wide comparisons of VrNAC with their homologs from Arabidopsis. We identified 81 NAC transcription factors (TFs) in mung bean genome and named as per their chromosome location. A phylogenetic analysis revealed that VrNACs are broadly distributed in nine groups. Moreover, we identified 20 conserved motifs across the VrNACs highlighting their roles in different biological process. Based on the gene structure of the putative VrNAC and segmental duplication events might be playing a vital role in the expansion of mung bean genome. A comparative phylogenetic analysis of mung bean NAC together with homologs from Arabidopsis allowed us to classify NAC genes into 13 groups, each containing several orthologs and paralogs. Gene ontology (GO) analysis categorized the VrNACs into biological process, cellular components and molecular functions, explaining the functions in different plant physiology processes. A gene co-expression network analysis identified 173 genes involved in the transcriptional network of putative VrNAC genes. We also investigated how miRNAs potentially target VrNACs and shape their interactions with proteins. VrNAC1.4 (Vradi01g03390.1) was targeted by the Vra-miR165 family, including 9 miRNAs. Vra-miR165 contributes to leaf development and drought tolerance. We also performed qRT-PCR on 22 randomly selected VrNAC genes to assess their expression patterns in the NM-98 genotype, widely known for being tolerant to drought and bacterial leaf spot disease.

Conclusions

This genome-wide investigation of VrNACs provides a unique resource for further detailed investigations aimed at predicting orthologs functions and what role the play under abiotic and biotic stress, with the ultimate aim to improve mung bean production under diverse environmental conditions.
Mitral and aortic valve regurgitation following surgical and transcatheter perimembranous ventricular septal defect closure in children and adolescents: midterm outcomes
Authors: Edraki Mohammadreza , Nobakhti Mohammadjavad , Naghshzan Amir , Amoozgar Hamid , Amirghofran Ahmadali , Ghasemzadeh Bahram , Nirooie Elahe , Mehdizadegan Nima , Mohammadi Hamid , Keshavarz Kambiz
Published: July 2022

Background

Closure of perimembranous ventricular septal defects (pmVSD), either surgical or percutaneous, might improve or cause new-onset mitral regurgitation (MR) and aortic regurgitation (AR). We aimed to evaluate the changes in MR and AR after pmVSD closure by these two methods.

Material and method

We performed a comparative retrospective data review of all pediatric patients with pmVSDs treated at our institution with surgical or antegrade percutaneous methods from 2014 to 2019 and 146 consecutive patients under 18 years were enrolled. We closely looked at the mitral and aortic valve function after repair. Included patients had no or lower than moderate aortic valve prolapse and baseline normal mitral or aortic valve function or less than moderate MR or AR.

Results

Out of 146 patients, 83 (57%) pmVSDs were closed percutaneously, and 63 (43%) pmVSDs were closed surgically. 80 and 62 patients were included for MR evaluation, and 81 and 62 patients for AR evaluation in percutaneous and surgical groups. The mean follow-up time was 40.48 ± 21.59 months in the surgery group and 20.44 ± 18.66 months in the transcatheter group. Mild to moderate degrees of MR and AR did not change or decreased in most patients. In detail, MR of 70% and AR of 50% of the valves were resolved or decreased in both groups. 13% of patients with no MR developed trivial to mild MR, and 10% of patients with no AR showed mild to moderate AR after pmVSD closure in both methods. There was no significant difference between the two methods regarding emerging new regurgitation or change in the severity of the previous regurgitation.

Conclusion

pmVSD closure usually improves mild to moderate MR and AR to a nearly similar extent in both percutaneous and surgical methods among children and adolescents. It might lead to the onset of new MR or AR in cases with no regurgitation.
Endoscopic ultrasonography guided cutting scar of esophageal stricture after endoscopic injection sclerotherapy
Authors: Zhang Fulong , Xu Jing , Zhu Yuandong , Shi Yan , Wu Bo , Wang Hai , Huang Chaojun
Published: July 2022

Objective

To investigate efficacy and safety of endoscopic ultrasonography (EUS) guiding to cut the scar of esophageal stricture after endoscopic injection sclerotherapy (EIS).

Methods

The data of 10 patients with oesophageal stricture after esophageal varices EIS in our hospital from September 1, 2021 to December 31, 2021 treated by cutting the scar guided by ultrasonic endoscopy were retrospective, and the efficacy was evaluated.

Results

The dysphagia was obviously relieved in 9 patients during follow-up, and 1 patient suffered dysphagia again after the treatment. There was no complications of perforation, bleeding and infection among the paitents.

Conclusion

EUS guiding to cut the scar of esophageal stricture after EIS was safe and reliable.
Edmonton frailty scale score predicts postoperative delirium: a retrospective cohort analysis
Authors: Sieber Frederick , Gearhart Susan , Bettick Dianne , Wang Nae-Yuh
Published: July 2022

Background

Frailty has been associated with postoperative delirium (POD). Studies suggest that the Fried phenotype has a stronger association with POD than the Edmonton Frailty Scale (EFS) criteria. Although phenotypic frailty is recognized as a good predictor of delirium, the EFS has higher ratings for feasibility in the surgical setting. Thus, our aim was to determine the association between EFS-assessed vulnerability and POD in an elective surgical population of older adults. A secondary aim was to determine which domains assessed by the EFS were closely associated with POD.

Methods

After IRB approval was received, electronic medical records of surgical patients at our institution were downloaded from 12/1/2018 to 3/1/2020. Inclusion criteria included age ≥ 65 years, preoperative EFS assessment within 6 months of surgery, elective surgery not scheduled for intensive care unit (ICU) stay but followed by at least 1 day postoperative stay, and at least two in-hospital evaluations with the 4 A’s test (arousal, attention, abbreviated mental test-4, acute change [4AT]) on the surgical ward. Vulnerability was determined by EFS score ≥ 6. Patients were stratified into two groups according to highest postoperative 4AT score: 0–3 (no POD) and ≥ 4 (POD). Odds of POD associated with EFS score ≥ 6 were evaluated by using logistic regression adjusted for potential confounders.

Results

The dataset included 324 patients. Vulnerability was associated with higher incidence of POD (p = 0.0007, Fisher’s exact). EFS ≥6 was consistently associated with POD in all bivariate models. Vulnerability predicted POD in multivariable modeling (OR = 3.5, 95% CI 1.1 to 11.5). Multivariable analysis of EFS domains revealed an overall trend in which higher scores per domain had a higher odds for POD. The strongest association occurred with presence of incontinence (OR = 3.8, 95% CI 1.2 to 11.0).

Conclusions

EFS criteria for vulnerability predict POD in older, non-ICU patients undergoing elective surgery.
Infectious shock after liposuction
Authors: Lu Jinqiang , Jiang Xiao , Huang Hongyin , Tang Lingzhi , Zou Xinhui , Mao Haoran , Liu Hongwei
Published: July 2022

Background

Liposuction has become one of the most popular cosmetic surgeries in China. However, few studies have discussed infectious shock caused by C. perfringens as one of the causes of death after liposuction.

Case presentation

A 24-year-old woman was brought to the emergency department (ED) of Guangzhou Chinese Overseas Hospital for treatment. The patient had undergone liposuction in her bilateral lower limbs two days prior. At the ED, the patient was unconscious, and had bilateral equal-sized (diameter, 6 mm) round pupils, no light reflex, a blood pressure (BP) of 71/33 mmHg, a heart rate of 133 bpm, and an SpO2 of 70%. She had bilateral limb swelling, extensive ecchymoses in her lower abdomen and bilateral thighs, local crepitus, blisters, weak pulses on her femoral artery and dorsalis pedis, high skin tension, and hemoglobin of 32 g/L. The patient was diagnosed with Clostridium perfringens infection, and she underwent debridement surgery and supportive treatment. But the patient’s BP could not improve. At 8:28 pm on the day of admission, the patient was declared clinically dead after the electrocardiograph showed a horizontal line and spontaneous respiration ceased.

Conclusions

Failure to meet surgical disinfection and environmental standards may be the cause of infection of C. perfringens through wounds. Therefore, it is necessary to strengthen the environmental disinfection of the operating room, and standardize the sterile conditions of the operation staff and patients before and during operation. Liposuction surgery necrotizing fasciitis is a rare but fatal complications, especially if diagnosis delay, therefore it is critical for early diagnosis and treatment of gas gangrene.
A case of Streptococcus canis bacteremia, osteomyelitis, sacroiliitis, myositis, and abscess
Authors: Van Tol A. L. , Tang B. , Mackie I. D.
Published: July 2022

Background

Streptococcus canis is a group G beta-hemolytic Streptococcus species which normally resides on the skin and mucosal surfaces of dogs. Although it rarely causes infection in humans, our case and review of relevant literature demonstrate that this multi-host pathogen may be responsible for metastatic infection. We present an appropriate management strategy in such cases.

Case presentation

A previously healthy 26-year-old male presented to the emergency department with a 2-day history of erythema, pain, and swelling of the left ankle and foot, consistent with acute cellulitis. The patient was initially discharged home with a plan to complete a course of IV cefazolin as an outpatient, but later recalled after two sets of blood cultures grew gram positive cocci. Blood cultures speciated as Streptococcus canis. This was performed by identifying beta hemolytic strep on blood agar, then typed as Lancefield group G, followed by MALDI-TOF which distinguished S. canis. History was unremarkable except for a 2-week history of lower back pain precipitated by a wrestling injury. There was no canine bite or scratch wound, although the patient lives with a dog. CT spine was obtained which demonstrated right piriformis myositis and S1 osteomyelitis. MRI additionally demonstrated right erector spinae myositis, right sacroiliitis, and multiple collections in the right posterior paraspinal soft tissues. Transthoracic echocardiogram did not demonstrate valvular vegetations. The S. canis isolate was pan-susceptible and the patient was ultimately discharged home and completed a 8-week course of IV penicillin G. After completion of therapy, his symptoms, repeat imaging, and biochemical markers suggested resolution of infection on follow-up.

Conclusions

We suggest that management of S. canis bacteremia should involve consideration of screening for metastatic infection and infectious diseases consultation. However, despite its potential for systemic involvement, S. canis is often susceptible to narrow spectrum antibiotics, and may be treated with penicillins.