bluuebunny/crossref_metadata_2025 huggingface dataset:
THE INFLUENCE OF DURATION OF BREASTFEEDING ON BONE MASS IN POSTMENOPAUSAL WOMEN OF DIFFERENT AGE GROUPS
Authors: Gur A , Cevik R , Nas K , Sarac AJ , Ataoglu S , Karakoc M , Can A , Gurkan F
Published: April 2023

This study examines the influence of duration of breastfeeding on bone mineral density (BMD) and investigates the relationship between duration of breastfeeding and bone mass at four sites in postmenopausal women of different ages. A total of 509 postmenopausal women aged 45–86 years were included in the study. Patients were divided into three groups: never breastfed (n=67), <96 months (n=157) and ≥96 months (n=285); they were further classified into two age groups, 40–59 years (n=233) and 60–80 years (n=276). In all patients and in the 40–59 year age group, BMD of the spine was found to be significantly lower in the never‐breastfed group, while BMD of the trochanter was significantly lower in the ≥96 month breastfeeding group. BMD of the spine and femur tended to decrease with longer breastfeeding in all groups, while BMD of the spine and trochanter tended to decrease with longer breastfeeding in the 40–59 year group. Of patients in the 60–80 year group who had never breastfed, spinal BMD was significantly higher than that of the ≥=96 month group, while in the ≥96 month group trochanter BMD was significantly lower than in other groups. In the never‐breastfed group, ward's triangle BMD was significantly higher than that of other groups. There was a significant correlation between duration of breastfeeding and BMD of the spine, neck, trochanter and ward's triangle. The study suggests that duration of breastfeeding has an effect on BMD, and extended breastfeeding leads to lower BMD.
CASPOFUNGIN IN THE TREATMENT OF OROPHARYNGEAL CANDIDIASIS
Authors: Garbino J , Lew D , Hirschel B , Rohner P
Published: April 2023

A patient with AIDS developed oropharyngeal candidiasis. Candida albicans and C. glabrata were isolated from the patient and found to be resistant to fluconazole and itraconazole in vitro. Voriconazole therapy was initiated, but discontinued when the C. albicans strain isolated from the patient was found to be resistant to it. The patient failed to respond to subsequent therapy with a combination of amphotericin B and 5‐flucytosine. Therapy with caspofungin was then initiated (70 mg loading dose, followed by 50 mg/day). The patient responded favourably to caspofungin, with complete resolution of signs and symptoms.
TREATMENT OF CARBIMAZOLE‐INDUCED AGRANULOCYTOSIS AND SEPSIS WITH GRANULOCYTE COLONY STIMULATING FACTOR
Authors: Joseph F , Younis N , Bowen‐Jones D
Published: April 2023

We present the management of agranulocytosis and neutropenic sepsis secondary to carbimazole with recombinant human granulocyte colony stimulating factor (G‐CSF). A 72‐year‐old woman with a history of thyrotoxicosis presented with sore throat and fever two weeks after starting carbimazole. Investigations confirmed a leucopenia and neutropenia. G‐CSF was used as an adjunctive therapy with discontinuation of carbimazole, barrier nursing and a broad‐spectrum antibiotic regimen to treat her neutropenic sepsis. Total white cell count and neutrophil count returned to normal and she made an uneventful recovery. She was subsequently rendered euthyroid with radioiodine treatment.
AN UNUSUAL CASE OF PNEUMONIA
Authors: Mangoni AA , Desai SR , Shaikh H , Barker RD , Mufti GJ , Jackson SHD
Published: April 2023

A previously healthy 37‐year‐old man was admitted with a two‐month history of increasing shortness of breath and high temperature. A chest X‐ray demonstrated bibasal shadowing and small bilateral pleural effusions; arterial blood gases demonstrated low pO2. Despite intravenous antibiotics no significant improvement was observed. A high‐resolution chest computed tomography showed diffuse ground‐glass opacification with segmental and subsegmental airways opacification, indicating fine fibrosis. Subsequently, open lung biopsy showed diffuse alveolar damage and a histopathological diagnosis of acute interstitial pneumonia (Hamman‐Rich syndrome) was made. Antibiotics were stopped and high intravenous doses of steroids were given with a dramatic improvement in the patient's breathing and radiographic findings. The pathophysiological mechanisms of acute interstitial pneumonia and current therapeutic options are discussed.
SARCOIDOSIS EMERGING AFTER ADRENALECTOMY FOR CUSHING'S SYNDROME
Authors: Holiday S , Goldsmith DJA
Published: April 2023

Cushing's syndrome is characterised by circulating steroid excess; the mainstay of treatment of systemic sarcoidosis is steroid therapy. We describe a case of sarcoidosis emerging after treatment for Cushing's syndrome.
ACCURACY OF INTRA‐ARTICULAR INJECTIONS FOR OSTEOARTHRITIS OF THE TRAPEZIOMETACARPAL JOINT
Authors: Helm AT , Higgins G , Raj Kumar P , Redfern M
Published: April 2023

A study was conducted to determine the accuracy of intra‐articular injections for osteoarthritis (OA) of the trapeziometacarpal joint (TMCJ). Over a period of 12 months intra‐articular injections on 60 TMCJs (12 males and 48 females) were carried out. All the injections were performed in the operating theatre. The operator inserted the needle into the position clinically assessed to be the TMCJ and the position was assessed using biplanar fluoroscopy. In 42% of cases, the needle was incorrectly placed and its position had to be adjusted, using fluoroscopy, to ensure correct intra‐articular placement. Entry into an osteoarthritic TMCJ with a blind passage of the needle is not straightforward. A proper injection technique must be employed to enter the correct joint. Using an image intensifier greatly facilitates accurate needle placement. (Int J Clin Pract 2003; 57(4): 265–266)
SAFETY AND EFFECTIVENESS OF REPLACING STANDARD DOXAZOSIN WITH DOXAZOSIN IN THE GASTROINTESTINAL THERAPEUTIC SYSTEM (GITS) FORMULATION IN ELDERLY HYPERTENSIVE PATIENTS
Authors: Jiménez‐Garía R , Anegón M , Esteban J , Carrasco P , Apaolaza* I , Gil A
Published: April 2023

The objective of this paper is to evaluate the safety and effectiveness of using doxazosin standard formulation in elderly hypertensive patients who were either uncontrolled or newly diagnosed, and replacing standard doxazosin with doxazosin in the gastrointestinal therapeutic system (GITS) formulation. We designed a postmarketing surveillance, open‐label non‐comparative, multicentre, clinical study covering primary care patients aged 65 years or older diagnosed with essential uncontrolled arterial hypertension. The study covered a period of 6–9 months, divided into two phases. Phase I involved a minimum of three and maximum of six months in treatment with standard doxazosin; phase II began with the changeover from standard doxazosin to the GITS formulation and lasted 12 weeks. Of the 1705 patients initially enrolled, 1292 (75.8%) completed the study. Reduction in systolic blood pressure was 22.3 mmHg (13.7%) in phase I, and 3.9 mmHg (2.77%) in phase II; reduction in diastolic blood pressure was 12.4 mmHg (13.2%) in phase I, and 2.4 mmHg (2.9%) in phase II. The percentage of controlled patients was 40.5% (691/1705) by the end of phase I and 45.3% (776/1705) by the end of phase II. A total of 154 patients suffered adverse events (AE), 127 during phase I and 27 in phase II. We conclude that doxazosin in its two formulations is effective and safe for the purpose of lowering blood pressure in elderly patients.
IBANDRONATE: A POTENT NEW BISPHOSPHONATE IN THE MANAGEMENT OF POSTMENOPAUSAL OSTEOPOROSIS
Authors: Papapoulos SE
Published: April 2023

Osteoporosis is a serious, common skeletal disease. Oral bisphosphonates are among the most effective therapeutics available to manage this condition. Currently, bisphosphonates are administered orally either daily or once weekly. Less frequent dosing, while retaining efficacy, may provide greater convenience, thereby promoting long‐term adherence to treatment and maximising therapeutic outcomes. Ibandronate is a highly potent nitrogen‐containing bisphosphonate that has been given orally or intravenously at variable dosing intervals for the prevention and treatment of osteoporosis. Recent studies with oral ibandronate, given daily or intermittently with a between‐dose interval longer than two months to women with postmenopausal osteoporosis, demonstrated significant and sustained antifracture efficacy. Additional studies showed that ibandronate given as a convenient intravenous injection every three months induces significant increases in bone mineral density and suppression of bone turnover. Ongoing studies aim to determine the optimal therapeutic regimen of this promising new bisphosphonate in clinical practice.
VENOUS THROMBOEMBOLIC RISK AND PREVENTION IN ACUTE MEDICAL ILLNESS
Authors: Hampton KK
Published: April 2023

We describe a case in which an elderly woman is hospitalised for acute medical illness and ask how this patient's risk of venous thromboembolism should be assessed and managed. Venous thromboembolism was previously regarded as a surgical problem, but occurs at least as frequently among medical patients. The risk of venous thromboembolism varies, but recent studies have provided detailed data on the risk in patients with acute medical illness, in particular those patients with acute heart failure, respiratory failure and acute infectious disease. As the evidence has accumulated, specific guidelines recommend provision of thromboprophylaxis to patients at risk. An approach to venous thromboembolic risk assessment and prevention in acutely ill medical patients is presented.
CHURG‐STRAUSS SYNDROME IN AN HCV SEROPOSITIVE PATIENT
Authors: Dikensoy O , Bayram NG , Erbagci Z , Namiduru M , Filiz A , Ekinci E
Published: April 2023

Churg‐Strauss syndrome was considered rare until leukotriene modifiers were introduced into medical practice in 1996. Since then, an increasing number of reports considering a possible relationship between leukotriene receptor antagonists and the Churg‐Strauss syndrome have been published. Hepatitis C virus (HCV) is a blood‐borne infection and a major health problem with an increasing prevalence worldwide. Previously, numerous reports suggested a relationship between HCV and certain autoimmune disorders such as cryoglobulinaemia and polyarteritis nodosa. We present a patient with HCV seropositive Churg‐Strauss syndrome and a history of systemic corticosteroid and leukotriene receptor antagonist use, and discuss the possible risk factors in the aetiology of Churg‐Strauss syndrome.
BLOODY DIARRHOEA: A RARE PRESENTATION OF A SYSTEMIC DISEASE
Authors: Mann SD , Young* A , Barrison IG , Catnach SM
Published: April 2023

Bloody diarrhoea in adolescents is usually due to enteric infection or inflammatory bowel disease. We describe a patient with bloody diarrhoea and endoscopic features of colitis in association with a systemic vasculitis. Positive anti‐proteinase‐3 antineutrophil cytoplasmic antibodies and cutaneous vasculitis on biopsy confirmed the diagnosis of Wegener's granulomatosis. He was started on high dose steroids and cyclophosphamide but required plasmapheresis for a declining renal function. The case highlights the need for vigilance with common clinical problems, because a life‐threatening condition may be averted by prompt recognition and urgent therapy with immunosuppressants.
TELITHROMYCIN: THE FIRST KETOLIDE ANTIBACTERIAL FOR THE TREATMENT OF COMMUNITY‐ACQUIRED RESPIRATORY TRACT INFECTIONS
Authors: Lorenz J
Published: April 2023

Telithromycin is the first ketolide antibacterial to be approved for clinical use. The ketolides represent a novel class of antibacterial agents structurally related to the macrolides, which has been developed specifically to offer an optimal spectrum for the treatment of upper and lower respiratory tract infections (RTIs) caused by common and atypical pathogens, including strains that are resistant to currently used antibiotics. The innovative structural changes that distinguish telithromycin from macrolides contribute to its unique microbiological profile. Its well‐balanced spectrum of antibacterial activity is highly appropriate for the empirical treatment of upper and lower community‐acquired RTIs, offering activity against common, including resistant, and atypical/intracellular pathogens. Furthermore, telithromycin demonstrates a low propensity to select for or induce resistance to macrolide‐lincosamide‐streptogramin antibacterials. A once‐daily dose of telithromycin 800 mg rapidly achieves high concentrations in both plasma and respiratory tissues and fluids and is maintained at effective levels throughout the 24‐hour dosing period. In clinical trials, telithromycin has demonstrated high clinical and bacteriological efficacy in the treatment of community‐acquired pneumonia, acute exacerbations of chronic bronchitis, acute sinusitis and group A β‐haemolytic streptococcal tonsillitis/pharyngitis. High efficacy was maintained in those patient groups considered to be at high risk of complications and those with infections caused by penicillin and/or macrolide (erythromycin) resistant Streptococcus pneumoniae. Together with its favourable tolerability profile and short course of once‐daily therapy, these properties indicate that telithromycin will be a valuable new antibacterial for the empirical treatment of community‐acquired RTIs.
THE SKATE STUDY: INTERIM ANALYSIS
Authors: Elger Christian , Sander Ley , Owen Olwen Glynn
Published: April 2023

The Safety of Keppra as Adjunctive Therapy in Epilepsy (SKATE) study is a continuing phase IV open‐label evaluation of the antiepileptic drug levetiracetam (Keppra) as an adjunctive therapy in adult patients with uncontrolled partial seizures. The study, which began in April 2000, is scheduled to include 1400 patients from 300 centres in 16 countries. An interim analysis of the first 731 patients from 117 centres in nine countries treated over a 16‐week period showed that seizure frequency was reduced by half or more in 49% of patients across all seizure types. A substantial 17.2% of patients achieved complete freedom from seizures. Levetiracetam was well tolerated overall. Adverse events were predominantly mild to moderate and rarely led to discontinuation. The most commonly reported symptoms were asthenia, somnolence, headache and dizziness.
HYPERKALAEMIA IN A PATIENT WITH GRAVES' DISEASE
Authors: Ng CW , Chan NN , So WY , Chan WB , Chow CC
Published: April 2023

A case of hyporeninaemic hypoaldosteronism in a young girl with treated Graves' disease presenting as hyperkalaemia is described. The possible autoimmune link of these two conditions is discussed.
A SPINAL NEURENTERIC CYST PRESENTING AS BURNING FEET SYNDROME
Authors: Jain RS
Published: April 2023

Spinal neurenteric cysts are rare congenital cysts of endodermal origin. A 34‐year‐old man presented with burning feet syndrome lasting two years. Magnetic resonance imaging (MRI) revealed an intradural extramedullar cystic mass extending from l_2 to L5 causing severe compression of the terminal portion of the conus medullaris and the filum terminale with displacement to the right side. A tethered cord and filar lipoma were also present. The cystic mass and filar lipoma were resected and the tethered cord released. Histopathology confirmed a neurenteric cyst. This case is reported in view of its peculiar presentation.
ENFUVIRTIDE (FUZEON®): THE FIRST FUSION INHIBITOR
Authors: Williams IG
Published: April 2023

With the number of people living with HIV infection increasing and the problems of drug resistance and long‐term toxicity associated with current antiretroviral agents continuing, there is a growing need for new therapy options. Enfuvirtide is the first fusion inhibitor, a new class of drug, to be licensed for the treatment of HIV infection and is a welcome addition to the arsenal of antiretrovirals. This paper, which is the result of a multidisciplinary discussion meeting, reviews current practice in treating HIV infection, the clinical data available on enfuvirtide and discusses its introduction into clinical practice. Data available to date indicate that enfuvirtide is appropriate for use in patients who have previously taken nucleoside reverse transcriptase inhibitor (NRTI), non‐NRTI and protease inhibitor containing regimens and are either intolerant of them or have experienced virological failure. Enfuvirtide should ideally be used while the patient still has other active drug options available to them to combine with enfuvirtide in an effective therapy regimen.
Chylothorax associated with pulmonary compressive atelectasis in an emperor tamarin (Saguinus imperator)
Authors: Santana Clarissa Helena , da Silva Laice Alves , de Paula Nayara Ferreira , dos Reis de Souza Lucas , Oliveira Ayisa Rodrigues , dos Santos Daniel Oliveira , Tinoco Herlandes Penha , Coelho Carlyle Mendes , Gonçalves Ângela Tinoco Pessanha Ribeiro , Silva Rodrigo Otávio Silveira , da Paixão Tatiane Alves , Santos Renato Lima
Published: April 2023

Chylothorax is the accumulation of lymph in the thoracic cavity, and it has never been reported in neotropical primates. An emperor tamarin died and at necropsy chylothorax associated with pulmonary compressive atelectasis was diagnosed. Idiopathic chylothorax can be a cause of respiratory insufficiency and death in tamarins.
Niraparib as a therapeutic agent for the treatment of ovarian cancer meningeal dissemination with BRCA1 mutation
Authors: Nei Takashi , Tamauchi Satoshi , Ikeda Yoshiki , Yoshikawa Nobuhisa , Niimi Kaoru , Kajiyama Hiroaki
Published: April 2023

This study analyzed a 63‐year‐old woman with hereditary BRCA1 mutation. She underwent interval debulking surgery after neoadjuvant chemotherapy for high‐grade serous ovarian carcinoma (HGSOC). After 2 years of postoperative chemotherapy, she developed headache and dizziness, and a suspected metastatic cerebellar mass in left ovary was detected. Pathological analysis of the mass revealed HGSOC, which was removed surgically. Eight months and another 6 months after the surgery, local recurrence was noted; hence, she underwent CyberKnife treatment. After 3 months, cervical spinal cord metastasis was found, evidenced by left shoulder pain. Moreover, meningeal dissemination was present around the cauda equina. Chemotherapy treatment, including bevacizumab, was ineffective and increased lesions were observed. After CyberKnife treatment for the cervical spinal cord metastasis, niraparib was initiated for the meningeal dissemination. The cerebellar lesions and meningeal dissemination improved within 8 months of niraparib treatment. Although meningeal dissemination is challenging to treat, niraparib may be useful in BRCA‐mutated HGSOC.
Characterising approaches to steroid therapy in paediatric multisystem inflammatory syndrome temporally associated with SARS‐CoV‐2
Authors: McGlacken‐Byrne Sinéad M , Johnson Mae , Penner Justin , du Pré Pascale , Katugampola Harshini
Published: April 2023

Aim

We describe approaches to steroid therapy use in paediatric multisystem inflammatory syndrome temporally associated with SARS‐CoV‐2 (PIMS‐TS) and examine the association between steroid therapy and key clinical markers of severity.

Methods

We conducted a retrospective review of children (<18 years) admitted to a tertiary paediatric hospital in the UK with PIMS‐TS. We collected data on if and why steroid therapy was used; the duration, type and dosing of steroids prescribed; and approaches to hypothalamo‐pituitary‐adrenal (HPA) axis monitoring, if performed. We examined associations between steroid exposure/total steroid dose (mg/m2/day) and paediatric intensive care unit admission, mechanical ventilation and inotropic support.

Results

Steroid therapy was commenced in most children (84.9%, n = 104) with a median total daily steroid dose (hydrocortisone equivalent) of 271.0 mg/m2/day (interquartile range 232.5–355.5) and treatment length of 26.0 days (interquartile range 19.0–32.0). Dosing regimens predominantly involved a short course of high‐dose methylprednisolone followed by tapering oral prednisolone. Basal and/or dynamic testing of the HPA axis was conducted in a minority (11.8%, n = 15) and was normal. Duration of steroid therapy correlated positively with durations of paediatric intensive care unit admission (r = 0.407, P < 0.001) and mechanical ventilation (r = 0.797, P < 0.001). A greater proportion of children receiving steroid therapy also received inotropic support compared to those that did not receive steroid therapy (71.4% vs. 45.5%, P = 0.025).

Conclusion

Prolonged, high‐dose steroid therapy is often used in the management of severe PIMS‐TS with the potential for HPA axis suppression and should be withdrawn carefully.
Post‐operative pain in children: Comparison of pain scores between parents and children
Authors: Niu Tianchen , Liu Mengjie , Fang Yu , Liu Yuping , Zhang Xiaoman
Published: April 2023

Aim

To compare the relationship between parent–child postoperative pain scores and explore the factors that led to the difference in the score.

Methods

Convenience sampling was used to select children and their parents who were 5–14 years old and scheduled for elective surgery as study subjects. When the child returned to the ward after surgery, the parent and child used the pain assessment tool to score the child's postoperative pain, respectively.

Results

A total of 214 children and their parents were included in the study. The results showed that the postoperative pain scores of parents and children were 3.69 ± 2.47 and 4.05 ± 2.90, respectively, and there were differences between the scores (P < 0.05). The results of multiple linear regression indicated that whether the child used Patient‐Controlled Analgesia, different types of surgery and parents' pre‐operative anxiety may be the reasons for the differences in parent–child scores.

Conclusion

The parents' pain scores differed from their children's pain scores. If health‐care professionals wanted to use the parents' pain score to replace the child's pain score, consideration should be given to whether children used patient‐controlled analgesia, different types of surgery and the parents' pre‐operative anxiety on the parents' pain score.
Effectiveness of AI‐driven remote monitoring technology in improving oral hygiene during orthodontic treatment
Authors: Snider Vivian , Homsi Karen , Kusnoto Budi , Atsawasuwan Phimon , Viana Grace , Allareddy Veerasathpurush , Gajendrareddy Praveen , Elnagar Mohammed H.
Published: April 2023

Objective

This study aimed to evaluate the effectiveness of Dental Monitoring™ (DM™) Artificial Intelligence Driven Remote Monitoring Technology (AIDRM) technology in improving the patient's oral hygiene during orthodontic treatment through AI‐based personalized active notifications.

Methods

A prospective clinical study was conducted on two groups of orthodontic patients. DM Group: (n = 24) monitored by DM weekly scans and received personalized notifications on the DM smartphone application regarding their oral hygiene status. Control Group (n = 25) not monitored by DM. Both groups were clinically assessed using Plaque Index (OPI) and the Modified Gingival Index (MGI). DM Group was followed for 13 months and the Control Group was followed for 5 months. Student‐independent t test and paired t tests were used to investigate the mean differences between study groups and between time points for each group respectively.

Results

At all time points, the mean differences indicated that the DM group had lower OPI and MGI values than the control group. The mean value for OPI and MGI were statistically significantly lower in the DM group (OPI = 1.96, MGI = 1.56) than in the control group (OPI = 2.41, MGI = 2.17) after 5 months. A rapid increase in mean OPI and MGI values was found between T0 and T1 for both study groups. A plateau effect for OPI scores appeared to occur from T1 to T5 for both study groups, but the plateau effect seemed to be more pronounced for the DM group than the study group. The MGI values for both study groups also increased dramatically from baseline to T5, however, a plateau effect was not observed.

Conclusions

The oral hygiene of orthodontic patients rapidly worsens over the first 3 months and plateaus after about 5 months of treatment. AIDRM by weekly DM scans and personalized active notifications may improve oral hygiene over time in orthodontic patients.
Longevity and potential reusability of cardiac implantable electronic devices explanted in funeral homesPublisher
Authors: Lorenzo Ruiz Iñigo
Published: April 2023

Background

While in high‐income countries (HICs) the implantation of cardiac implantable electronic devices (CIEDs) is common, in certain low‐ and middle‐income countries (LMICs) access to devices is limited and insufficient to meet the demand. Between 17% and 30% of CIEDs explanted post‐mortem in HICs appears to have enough battery life to be reused but devices are not routinely programmed to no pacing output and continue to consume battery after the patient's death. Therefore, we conducted a prospective analysis of CIEDs collected from funeral homes, controlling variables such as the date of explantation and limiting the time until the date of interrogation to 6 months. The objective was to perform an accurate analysis of the reusability of post‐mortem explanted CIEDs to assess the possibility of implementing a local effort of CIED reuse in LMICs.

Methods

A descriptive study of post‐mortem explanted CIEDs in funeral homes was conducted. Participating centers stored all devices explanted between December 2020 to December 2021 for collection and interrogation.

Results

The participating centers attended 6472 deaths (28.05% of total deaths registered in the region). Two hundred fourteen CIEDs were collected (90.2% pacemakers and 9.8% defibrillators). Of the 214 collected devices, 100 CIEDs (46.7%) had >4 years or >75% battery remaining, preserved external integrity, and no evidence of malfunction and therefore were considered reusable.

Conclusions

Based on stablished criteria 46.7% of recovered devices were considered reusable. Therefore, recovery from funeral homes of HICs comprises a potential source of reusable devices for LMICs.
High‐frequency ultrasound biomicroscopy findings of the skin of dogs with atopic dermatitis
Authors: Mantis Panagiotis , Sofou Evangelia I. , Aleksandrova Svetlina , Badulescu Elisabeta , Church David , Lloyd David , Koutsouvelis Panagiotis , Mpairamoglou Stathis , Chatzis Manolis , Saridomichelakis Manolis
Published: April 2023

Background

The high‐frequency ultrasonographic appearance of skin of dogs with atopic dermatitis (cAD) has not been described.

Objectives

To compare high‐frequency ultrasonographic findings among lesional, macroscopically nonlesional skin of dogs with cAD, and the macroscopically nonlesional skin of healthy dogs. Additionally, to determine whether there is any correlation between the ultrasonographic findings in lesional skin and local Canine Atopic Dermatitis Extent and Severity Index, 4th iteration (CADESI‐04) or its domains (erythema, lichenification, excoriations/alopecia). As a secondary aim, six cAD dogs were re‐evaluated after management intervention.

Animals

Twenty dogs with cAD (six were re‐examined after treatment) and six healthy dogs.

Materials and Methods

In all dogs, ultrasonographic examination was performed on the same 10 skin sites, using a 50 MHz transducer. Wrinkling of skin surface, presence/width of subepidermal low echogenic band, hypoechogenicity of dermis and thickness of the skin were evaluated and scored/measured blindly.

Results

Dermal hypoechogenicity was more common and severe in lesional compared to macroscopically nonlesional skin of dogs with cAD. In lesional skin, presence/severity of wrinkling of skin surface and of dermal hypoechogenicity were positively correlated with presence/severity of lichenification, while severity of dermal hypoechogenicity was positively correlated with local CADESI‐04. A positive correlation between the change in skin thickness and the change in the severity of erythema during treatment was noted.

Conclusions and Clinical Relevance

High‐frequency ultrasound biomicroscopy may be useful for the evaluation of skin of dogs with cAD and for evaluating the progression of skin lesions during treatment.
Bilateral corneal dermoids associated with bilateral choroido–scleral colobomas in a cat: retinographic and optical coherence tomography study with surgical outcome and follow–up
Authors: Cognard Sophie Andree , Cassagnes Charles , Chaudieu Gilles , Manning Heather
Published: April 2023

Purpose

To report a case of feline bilateral corneal dermoids, associated with unilateral iris coloboma and bilateral choroido‐scleral colobomas in the same dorsolateral position, to describe retinographic and optical coherence tomography (OCT) characteristics, surgical outcome, and follow‐up.

Animal studied

A 9‐month‐old domestic shorthaired cat in which a full ophthalmoscopic examination was performed for evaluation of dermoids resulting in a diagnosis of associated iris coloboma in one eye and posterior colobomas in both eyes.

Procedures

Retinographies and OCT were performed under anesthesia to characterize the lesions of both fundi and allow surgical excision of the corneal dermoids.

Results

Ophthalmoscopy and retinographies revealed oval lesions in the dorsolateral fundi of both eyes. The lesions precisely mirrored their respective dermoids' (10‐11 h OD and 1‐2 h OS) clock positions, lacked a tapetum lucidum and choroidal vessels, and featured thin retinal vessels plunging to a posterior plane of the fundus. OCT crossline scans demonstrated preservation of retinal thickness and morphological layering in the fundic colobomas leading to the conclusion that the colobomas were purely choroido‐scleral. The outcome of the surgical excision of the dermoids was satisfactory without hair recurrence and with acceptable corneal clarity making it possible to visualize the unilateral associated iris coloboma. Follow‐ups did not reveal any fundic evolution nor retinal detachment.

Conclusions

Retinographies and OCT made possible the characterization of choroido‐scleral colobomas associated with corneal dermoids in this first reported case in a cat. We hypothesize that the recently described superior ocular sulcus might be the embryological link between these anomalies.
Verbal Encouragement Improves Game Intensity, Technical Aspects, and Psychological Responses During Soccer-Specific Training
Authors: Selmi Okba , Levitt Danielle E. , Aydi Bilel , Ferhi Waad , Bouassida Anissa
Published: April 2023

Background: Soccer match outcomes rely on technical accuracy, intensity of play, and athlete motivation, and these parameters can be developed during sport-specific practice such as during small-sided games (SSGs). Verbal encouragement as a coaching technique improves exercise intensity and athlete enjoyment (indicative of motivation), but the impact on technical performance alongside these critical parameters remains unknown. Purpose: To examine the effects of verbal encouragement on technical performance, exercise intensity, and enjoyment during SSGs. Methods: Sixteen male youth soccer players (mean [SD]; age: 17.2 [0.4] y; height: 176.3 [7.0] cm; body mass: 68.0 [4.1] kg; body fat: 11.9% [2.2%]) completed 4 sessions of 4-per-side SSG without a goalkeeper. Two sessions were conducted as SSGs with verbal encouragement and 2 without verbal encouragement. Each SSG lasted 25 minutes (4 × 4-min work, 3-min passive recovery between bouts) on a 25 × 35-m pitch. Heart rate (HR) was continuously recorded, and rating of perceived exertion was collected after each SSG. Video analysis was used to quantify technical actions during SSG. Enjoyment was assessed after each SSG using the Physical Activity Enjoyment Scale. Results: Paired t tests revealed that SSGs with verbal encouragement induced higher HR (% maximum HR and mean HR), rating of perceived exertion, and Physical Activity Enjoyment Scale score than SSGs without verbal encouragement (all P < .001, all d ≥ 0.92, large). Compared with SSGs without verbal encouragement, SSGs with verbal encouragement resulted in an increased percentage of successful passes (P < .001, d = 0.73, medium) and number of interceptions (P < .001, d = 0.89, large) and fewer lost balls (P < .001, d = 0.68, medium). Conclusions: Coaches should use verbal encouragement during SSGs to improve physical effort, technical performance, and psychological status in soccer players.
An excavate root for the eukaryote tree of life
Authors: Al Jewari Caesar , Baldauf Sandra L.
Published: April 2023

Much of the higher-order phylogeny of eukaryotes is well resolved, but the root remains elusive. We assembled a dataset of 183 eukaryotic proteins of archaeal ancestry to test this root. The resulting phylogeny identifies four lineages of eukaryotes currently classified as “Excavata” branching separately at the base of the tree. Thus, Parabasalia appear as the first major branch of eukaryotes followed sequentially by Fornicata, Preaxostyla, and Discoba. All four excavate branch points receive full statistical support from analyses with commonly used evolutionary models, a protein structure partition model that we introduce here, and various controls for deep phylogeny artifacts. The absence of aerobic mitochondria in Parabasalia, Fornicata, and Preaxostyla suggests that modern eukaryotes arose under anoxic conditions, probably much earlier than expected, and without the benefit of mitochondrial respiration.
Synthetic neutrophil extracellular traps dissect bactericidal contribution of NETs under regulation of α-1-antitrypsin
Authors: Yang Ting , Yu Jinlong , Ahmed Tasdiq , Nguyen Katherine , Nie Fang , Zan Rui , Li Zhiwei , Han Pei , Shen Hao , Zhang Xiaonong , Takayama Shuichi , Song Yang
Published: April 2023

Deciphering the complex interplay of neutrophil extracellular traps (NETs) with the surrounding environment is a challenge with notable clinical implications. To bridge the gap in knowledge, we report our findings on the antibacterial activity against
Pseudomonas aeruginosa
of synthetic NET-mimetic materials composed of nanofibrillated DNA-protein complexes. Our synthetic system makes component-by-component bottom-up analysis of NET protein effects possible. When the antimicrobial enzyme neutrophil elastase (NE) is incorporated into the bactericidal DNA-histone complexes, the resulting synthetic NET-like structure exhibits an unexpected reduction in antimicrobial activity. This critical immune function is rescued upon treatment with alpha-1-antitrypsin (AAT), a physiological tissue-protective protease inhibitor. This suggests a direct causal link between AAT inhibition of NE and preservation of histone-mediated antimicrobial activity. These results help better understand the complex and, at times, contradictory observations of in vivo antimicrobial effects of NETs and AAT by excluding neutrophil, cytokine, and chemoattractant contributions.
ZFP750 affects the cutaneous barrier through regulating lipid metabolism
Authors: Butera Alessio , Agostini Massimiliano , Cassandri Matteo , De Nicola Francesca , Fanciulli Maurizio , D’Ambrosio Lorenzo , Falasca Laura , Nardacci Roberta , Wang Lu , Piacentini Mauro , Knight Richard A. , Jia Wei , Sun Qiang , Shi Yufang , Wang Ying , Candi Eleonora , Melino Gerry
Published: April 2023

An essential function of the epidermis is to provide a physical barrier that prevents the loss of water. Essential mediators of this barrier function include ceramides, cholesterol, and very long chain fatty acids, and their alteration causes human pathologies, including psoriasis and atopic dermatitis. A frameshift mutation in the human
ZNF750
gene, which encodes a zinc finger transcription factor, has been shown to cause a seborrhea-like dermatitis. Here, we show that genetic deletion of the mouse homolog ZFP750 results in loss of epidermal barrier function, which is associated with a substantial reduction of ceramides, nonpolar lipids. The alteration of epidermal lipid homeostasis is directly linked to the transcriptional activity of ZFP750. ZFP750 directly and/or indirectly regulates the expression of crucial enzymes primarily involved in the biosynthesis of ceramides. Overall, our study identifies the transcription factor ZFP750 as a master regulator epidermal homeostasis through lipid biosynthesis and thus contributing to our understanding of the pathogenesis of several human skin diseases.
Treatment of medial tibial stress syndrome using an investigational lower leg brace. A pilot for a randomised controlled trial.
Authors: McNamara William , Longworth Thomas , Sunwoo Joo Y , Rizvi Syed MT , Knee Christopha J , Cole Brandi F
Published: April 2023

Objective

Medial tibial stress syndrome (MTSS) is common and often difficult to treat. The purpose of this study was to examine the effect of a lower leg brace on MTSS symptoms compared to a placebo.

Methods

A pilot of a prospective double-blinded randomised placebo-controlled trial conducted in two private sports medicine practices. Included were those with symptomatic MTSS lasting 6 weeks or more. Excluded were those with other lower limb pathologies. Fourteen participants formed the study cohort who wore the brace or placebo. The brace applied counterforce pressure to the musculotendinous junctions of the soleus, compressed periosteum at the distal third of the posteromedial tibia and applied inferomedial torsion to the soleus muscle. Additional treatment modalities were recorded. Participants completed a standardised MTSS Severity Score at 0–6, 8, 12 and 24 weeks and recorded return to full activity.

Results

The brace group demonstrated a significantly reduced MTSS severity score from 5 to 24 weeks (p<0.03) and had returned to full activity within 5 weeks. MTSS score in the placebo group remained unchanged (p >0.05), all participants experienced MTSS recurrence and none returned to full activity over 24 weeks.

Conclusion

The lower leg brace demonstrated a reduction in MTSS symptoms from 5 weeks that was sustained over 6 months with a lower rate of MTSS recurrence compared with the placebo. If similar results are seen in a larger cohort, it has potential to benefit patients with MTSS as an adjunct to current treatment modalities. Further investigation regarding efficacy is needed.

Trial registration number

ACTRN12620000906954.
Inclusion of adults with conditions that have the potential to affect capacity and or communication in research: triangulation from a mixed-methods study of current practice and values across multiple stakeholders
Authors: Killett Anne , Langdon Peter E , Ryan Hayley , Shiggins Ciara , Heywood Rob , Jimoh Oluseyi F , Redley Marcus , Bunning Karen
Published: April 2023

Objectives

We aimed to: (A) describe researcher decision-making when including or excluding adults with conditions that have the potential to affect capacity and/or communication in research and (B) explore the underlying values and reasoning of stakeholders in research which falls under the provisions of the Mental Capacity Act, 2005.

Design

The mixed-methods design included semistructured interviews with adults with conditions that have the potential to affect capacity and/or communication, supporters, researchers, research ethics committee members and an online survey with researchers. Triangulation was used to integrate the data and examine the complementarity of the findings.

Setting

England and Wales.

Participants

There were 61 participants who took part in semistructured interviews, of which 39 were adults with conditions with potential to affect capacity and/or communication, 6 were in support roles for adults with conditions with potential to affect capacity and/or communication (including family members and professionals in advocacy organisations), 8 were members of research ethics committees flagged under the Mental Capacity Act to review research where there could be issues of mental capacity and 8 were researchers with experience of working with adults with conditions that have the potential to affect capacity and/or communication. The online survey had 128 participants, researchers with experience of working with adults with conditions that have the potential to affect capacity and/or communication.

Results

All stakeholders were supportive of the genuine inclusion of adults with conditions that have the potential to affect capacity and/or communication in research, and exclusion was seen as a form of discrimination. Many researchers were daunted by meeting the threshold within the legislation for including participants who may lack capacity.

Conclusion

Further training, expertise and resources are required to promote the successful inclusion in research of adults with conditions that have the potential to affect capacity and/or communication.
Association between BUN/creatinine ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome: a single-centre retrospective cohort from the MIMIC database
Authors: Ma Huayi , Lin Song , Xie You , Mo Song , Huang Qiang , Ge Hongfei , Shi Zhanying , Li Sixing , Zhou Dan
Published: April 2023

Objective

Recent studies have shown that blood urea nitrogen to creatinine (BUN/Cr) ratio might be an effective marker for the prognosis of patients with respiratory diseases. Herein, we aimed to assess the association between BUN/Cr ratio and the risk of in-hospital mortality in patients with trauma-related acute respiratory distress syndrome (ARDS).

Design

A retrospective cohort study.

Setting and participants

1034 patients were extracted from the Medical Information Mart for Intensive Care-III (MIMIC-III) database.

Primary and secondary outcome measures

The primary outcome of the study was in-hospital mortality, defined by the vital status at the time of hospital discharge (ie, survivors and non-survivors).

Results

Of the total patients, 191 (18.5%) died in hospital. The median follow-up duration was 16.0 (8.3–26.6) days. The results showed that high level of BUN/Cr ratio was significantly associated with an increased risk of in-hospital mortality (15.54–21.43: HR=2.00, 95% CI: (1.18 to 3.38); >21.43: HR=1.76, 95% CI: (1.04 to 2.99)) of patients with trauma-related ARDS. In patients with trauma-related ARDS that aged ≥65 years old, male and female, Onychomycosis Severity Index (OSI)>98, Revised Trauma Score (RTS)>11, Simplified Acute Physiology Score II (SAPS-II)>37 and sequential organ failure assessment (SOFA) scores≤7, BUN/Cr ratio was also related to the increased risk of in-hospital mortality (all p<0.05). The predictive performance of BUN/Cr ratio for in-hospital mortality was superior to BUN or Cr, respectively, with the area under the curve of receiver operator characteristic curve at 0.6, and that association was observed in age, gender, OSI, RTS, SAPS-II and SOFA score subgroups.

Conclusion

BUN/Cr ratio may be a potential biomarker for the risk of in-hospital mortality of trauma-related ARDS, which may help the clinicians to identify high-risk individuals and to implement clinical interventions.
Association of preoperative spirometry tests with postoperative pulmonary complications after mediastinal mass resection: protocol for a retrospective cohort study
Authors: Zhang Zhiyuan , Fu Yu , Zhang Nan , Yu Jing , Wen Zongmei
Published: April 2023

Introduction

Patients with a mediastinal mass are at risk of pulmonary complications in the perioperative period. Preoperative spirometry tests are recommended in patients scheduled for thoracic surgery. Our objective is to investigate the association between preoperative spirometry results and the incidence of postoperative pulmonary complications in patients following mediastinal mass resection, which may determine the usefulness of spirometry tests in the prediction of the perioperative respiratory risk.

Methods and analysis

This protocol describes a retrospective cohort study of patients with mediastinal masses in Shanghai Pulmonary Hospital between 1 September 2021 and 1 September 2022, with a planned sample size of 660 patients. The primary aim of this study is to explore the association between preoperative spirometry results and the occurrence of postoperative pulmonary complications after mediastinal mass resection. Logistic regression analysis will be used to calculate the adjusted incidence rate difference and incidence rate ratios (with 95% CIs).

Ethics and dissemination

The study was approved by the ethics committee of Shanghai Pulmonary Hospital (K21-372Y). The results of the study will be submitted to a peer-reviewed biomedical journal for publication and presented at relevant conferences.
Impact evaluation of the TAMANI project to improve maternal and child health in Tanzania
Authors: Hetherington Erin , Harper Sam , Davidson Rebecca , Festo Charles , Lampkin Nadia , Mtenga Sally , Teixeira Clarissa , Vincent Ilona , Nandi Arijit
Published: April 2023

Background

The Tabora Maternal and Newborn Health Initiative project was a multicomponent intervention to improve maternal and newborn health in the Tabora region of Tanzania. Components included training healthcare providers and community health workers, infrastructure upgrades, and improvements to health management. This study aimed to examine the impact of trainings on four key outcomes: skilled birth attendance, antenatal care, respectful maternity care and patient–provider communication.

Methods

Trainings were delivered sequentially at four time points between 2018 and 2019 in eight districts (two districts at a time). Cross-sectional surveys were administered to a random sample of households in all districts at baseline and after each training wave. Due to practical necessities, the original stepped wedge cluster randomised design of the evaluation was altered mid-programme. Therefore, a difference-in-differences for multiple groups in multiple periods was adopted to compare outcomes in treated districts to not yet treated districts. Risk differences were estimated for the overall average treatment effect on the treated and group/time dynamic effects.

Results

Respondents reported 3895 deliveries over the course of the study. The intervention was associated with a 12.9 percentage point increase in skilled birth attendance (95% CI 0.4 to 25.4), which began to increase 4 months after the end of training in each district. There was little evidence of impact on antenatal care visits, respectful treatment during delivery and patient–provider communication.

Conclusion

Interventions to train local healthcare workers in basic and comprehensive emergency obstetric and newborn care increased skilled birth attendance but had limited impact on other pregnancy-related outcomes.