bluuebunny/crossref_metadata_2025 huggingface dataset:
Hypothetical interventions on emergency ambulance and prehospital acetylsalicylic acid administration in myocardial infarction patients presenting without chest pain
Authors: Møller Amalie Lykkemark , Rytgaard Helene Charlotte Wiese , Mills Elisabeth Helen Anna , Christensen Helle Collatz , Blomberg Stig Nikolaj Fasmer , Folke Fredrik , Kragholm Kristian Hay , Lippert Freddy , Gislason Gunnar , Køber Lars , Gerds Thomas Alexander , Torp-Pedersen Christian
Published: December 2022

Background

Myocardial infarction (MI) patients presenting without chest pain are a diagnostic challenge. They receive suboptimal prehospital management and have high mortality. To elucidate potential benefits of improved management, we analysed expected outcome among non-chest pain MI patients if hypothetically they (1) received emergency ambulances/acetylsalicylic acid (ASA) as often as observed for chest pain patients, and (2) all received emergency ambulance/ASA.

Methods

We sampled calls to emergency and non-emergency medical services for patients hospitalized with MI within 24 h and categorized calls as chest pain/non-chest pain. Outcomes were 30-day mortality and a 1-year combined outcome of re-infarction, heart failure admission, and mortality. Targeted minimum loss-based estimation was used for all statistical analyses.

Results

Among 5418 calls regarding MI patients, 24% (1309) were recorded with non-chest pain. In total, 90% (3689/4109) of chest pain and 40% (525/1309) of non-chest pain patients received an emergency ambulance, and 73% (2668/3632) and 37% (192/518) of chest pain and non-chest pain patients received prehospital ASA. Providing ambulances to all non-chest pain patients was not associated with improved survival. Prehospital administration of ASA to all emergency ambulance transports of non-chest pain MI patients was expected to reduce 30-day mortality by 5.3% (CI 95%: [1.7%;9%]) from 12.8% to 7.4%. No significant reduction was found for the 1-year combined outcome (2.6% CI 95% [− 2.9%;8.1%]). In comparison, the observed 30-day mortality was 3% among ambulance-transported chest pain MI patients.

Conclusions

Our study found large differences in the prehospital management of MI patients with and without chest pain. Improved prehospital ASA administration to non-chest pain MI patients could possibly reduce 30-day mortality, but long-term effects appear limited. Non-chest pain MI patients are difficult to identify prehospital and possible unintended effects of ASA might outweigh the potential benefits of improving the prehospital management. Future research should investigate ways to improve the prehospital recognition of MI in the absence of chest pain.
Intervention effect estimates in randomised controlled trials conducted in primary care versus secondary or tertiary care settings: a meta-epidemiological study
Authors: Dugard Amandine , Tavernier Elsa , Caille Agnès , Dechartres Agnès , Hoang Adeline , Giraudeau Bruno , Dibao-Dina Clarisse
Published: December 2022

Background

Many clinical practice guidelines are based on randomised controlled trials conducted in secondary or tertiary care setting and general practitioners frequently question their relevance for primary care patients. Our aim was to compare the intervention effect estimates between primary care setting randomised controlled trials (PC-RCTs) and secondary or tertiary care setting randomised controlled trials (ST-RCTs).

Methods

Meta-epidemiological study of meta-analyses (MAs) of a binary outcome including at least one PC-RCT and one ST-RCT. PC-RCTs were defined as trials recruiting patients in general practices, primary care practices, family practices, community centers or community pharmacies. ST-RCTs were defined as trials recruiting in hospitals, including hospitalized patients, hospital outpatients and patients from emergency departments. For each MA, we estimated a ratio of odds ratio (ROR) by using random-effects meta-regression, with an ROR less than 1 indicating lower estimates of the intervention effect in PC-RCTs than ST-RCTs. Finally, we estimated a combined ROR across MAs by using a random-effects meta-analysis. We performed subgroup analyses considering the type of outcomes (objective vs subjective), type of experimental intervention (pharmacological vs non-pharmacological), and control group (active vs inactive) as well as analyses adjusted on items of the Cochrane Risk of Bias tool.

Results

Among 1765 screened reviews, 76 MAs with 230 PC-RCTs and 384 ST-RCTs were selected. The main medical fields were pneumology (13.2%) and psychiatry or addictology (38.2%). Intervention effect estimates did not significantly differ between PC-RCTs and ST-RCTs (ROR = 0.97, 95% confidence interval 0.88 to 1.08), with moderate heterogeneity across MAs (I2 = 45%). Subgroup and adjusted analyses led to consistent results.

Conclusion

We did not observe any significant difference in intervention effect estimates between PC-RCTs and ST-RCTs. Nevertheless, most of the medical fields in this meta-epidemiological study were not representative of the pathologies encountered in primary care. Further studies with pathologies more frequently encountered in primary care are needed.
Non-acute chest pain in primary care; referral rates, communication and guideline adherence: a cohort study using routinely collected health data
Authors: van den Bulk Simone , Spoelman Wouter A. , van Dijkman Paul R. M. , Numans Mattijs E. , Bonten Tobias N. ,   Leiden University Medical Center(LUMC)
Published: December 2022

Background

The prevalence of coronary artery disease is increasing due to the aging population and increasing prevalence of cardiovascular risk factors. Non-acute chest pain often is the first symptom of stable coronary artery disease. To optimise care for patients with non-acute chest pain and make efficient use of available resources, we need to know more about the current incidence, referral rate and management of these patients.

Methods

We used routinely collected health data from the STIZON data warehouse in the Netherlands between 2010 and 2016. Patients > 18 years, with no history of cardiovascular disease, seen by the general practitioner (GP) for non-acute chest pain with a suspected cardiac origin were included. Outcomes were (i) incidence of new non-acute chest pain in primary care, (ii) referral rates to the cardiologist, (iii) correspondence from the cardiologist to the GP, (iv) registration by GPs of received correspondence and; (v) pharmacological guideline adherence after newly diagnosed stable angina pectoris.

Results

In total 9029 patients were included during the study period, resulting in an incidence of new non-acute chest pain of 1.01/1000 patient-years. 2166 (24%) patients were referred to the cardiologist. In 857/2114 (41%) referred patients, correspondence from the cardiologist was not available in the GP’s electronic medical record. In 753/1257 (60%) patients with available correspondence, the GP did not code the conclusion in the electronic medical record. Despite guideline recommendations, 37/255 (15%) patients with angina pectoris were not prescribed antiplatelet therapy nor anticoagulation, 69/255 (27%) no statin and 67/255 (26%) no beta-blocker.

Conclusion

After referral, both communication from cardiologists and registration of the final diagnosis by GPs were suboptimal. Both cardiologists and GPs should make adequate communication and registration a priority, as it improves health outcomes. Secondary pharmacological prevention in patients with angina pectoris was below guideline standards. So, proactive attention needs to be given to optimise secondary prevention in this high-risk group in primary care.
Living and working in rural healthcare during the COVID-19 pandemic: a qualitative study of rural family physicians' lived experiences
Authors: Anaraki Nahid Rahimipour , Mukhopadhyay Meghraj , Karaivanov Yordan , Wilson Margo , Asghari Shabnam
Published: December 2022

Background

The COVID-19 pandemic has been pervasive in its impact on all aspects of Canadian society. Along with its pervasiveness, the disease provided unprecedented complexity to the Canadian healthcare infrastructure, eliciting varying responses from the afflicted healthcare systems in Canada. However, insights into the various parameters and complexities endured by Canadian rural physicians and rural healthcare institutions during the pandemic have been scarce.

Objective

This paper explores the conditions and complexity of living and working of Rural Family Physicians (RFPs) in rural healthcare in Canada during the pandemic.

Methods

Community-based participatory research was utilized as a collaborative and partnership approach, equitably engaged community members in all aspects of research, ranging from designing the research question to analyzing data. Participants of this study include RFPs with at least one year of experience working in rural Canada. Data were collected through telephone interviews and analyzed according to the six-phase guide for the data's inductive thematic analysis. Data collection halted upon saturation.

Results

Five significant compiled categories reflect the lived experiences of Rural Family Physicians. 1- virtual care as a challenge or forward progress; 2- canceling in-person visits and interrupting the routine; 3- shortage of health care providers and supporting staff; 4-ongoing coping process with the pandemic guidelines; 5-COVID-19 combat fatigue.

Discussion

The inception of COVID-19 has significantly impacted rural physicians across several interconnected issues. This study illuminates the lesser-known effects of the COVID-19 pandemic, which heavily impacts rural healthcare.
Hepatic venous pressure gradient after balloon-occluded retrograde transvenous obliteration and liver stiffness measurement predict the prognosis of patients with gastric varices
Authors: Shirane Yuki , Murakami Eisuke , Imamura Michio , Kosaka Masanari , Johira Yusuke , Miura Ryoichi , Murakami Serami , Yano Shigeki , Amioka Kei , Naruto Kensuke , Ando Yuwa , Uchikawa Shinsuke , Teraoka Yuji , Uchida Takuro , Fujino Hatsue , Ono Atsushi , Nakahara Takashi , Kawaoka Tomokazu , Miki Daiki , Yamauchi Masami , Okamoto Wataru , Tsuge Masataka , Chosa Keigo , Awai Kazuo , Aikata Hiroshi , Oka Shiro
Published: December 2022

Background

Balloon-occluded retrograde transvenous obliteration (BRTO) is a treatment option for patients with gastric varices (GVs). This study aimed to clarify the clinical significance of portal hypertension estimated by the hepatic venous pressure gradient (HVPG), subsequent exacerbation of esophageal varices (EVs), and prognosis of patients who underwent BRTO for GVs.

Methods

Thirty-six patients with GVs treated with BRTO were enrolled in this study, and their HVPG was measured before (pre-HVPG) and on the day after BRTO (post-HVPG). After BRTO, patients were followed-up for a median interval of 24.5 (3–140) months. Clinical factors related to EVs exacerbation and prognosis after BRTO were retrospectively analyzed.

Results

Post-HVPG increased compared to pre-HVPG in 21 out of 36 patients (58%), and post-HVPG was overall significantly higher compared to pre-HVPG (P = 0.009). During the observation period, 19 patients (53%) developed EVs exacerbation, and the cumulative EVs exacerbation rates at 1, 3 and 5 years after BRTO were 27%, 67%, and 73%, respectively. Pre-HVPG was not related to EVs exacerbation, although elevation of post-HVPG to ≥ 13 mmHg (P < 0.01) and high level of serum aspartate aminotransferase (P < 0.05) were significant independent risk factors for EVs exacerbation after BRTO. Fourteen patients (38.9%) died during the observation period. An elevated value of liver stiffness measurement (LSM) of ≥ 21 kPa was a significant independent risk factor for poor prognosis after BRTO (P < 0.05).

Conclusions

HVPG increases after BRTO. HVPG after BRTO has greater predictive ability for subsequent EVs exacerbation than HVPG before BRTO. LSM is a potential prognostic parameter in patients who undergo BRTO.
Trochanteric fracture pattern is associated with increased risk for nonunion independent of open or closed reduction technique
Authors: Berk Till , Halvachizadeh Sascha , Martin David Paul , Hierholzer Christian , Müller Dominik , Pfeifer Roman , Jukema Gerrolt Nico , Gueorguiev Boyko , Pape Hans-Christoph
Published: December 2022

Purpose

Soft tissue injury and soft tissue injury as risk factors for nonunion following trochanteric femur fractures (TFF) are marginally investigated. The aim of this study was to identify risk factors for impaired fracture healing in geriatric trauma patients with TFF following surgical treatment with a femoral nail.

Methods

This retrospective cohort study included geriatric trauma patients (aged > 70 years) with TFF who were treated with femoral nailing. Fractures were classified according to AO/OTA. Nonunion was defined as lack of callus-formation after 6 months, material breakage, and requirement of revision surgery. Risk factors for nonunion included variables of clinical interest (injury pattern, demographics, comorbidities), as well as type of approach (open versus closed) and were assessed with uni- and multivariate regression analyses.

Results

This study included 225 geriatric trauma patients. Nonunion was significantly more frequently following AO/OTA 31A3 fractures (N = 10, 23.3%) compared with AO/OTA type 31A2 (N = 6, 6.9%) or AO/OTA 31A1 (N = 3, 3.2%, p < 0.001). Type 31A3 fractures had an increased risk for nonunion compared with type 31A1 (OR 10.3 95%CI 2.2 to 48.9, p = 0.003). Open reduction was not associated with increased risk for nonunion (OR 0.9, 95%CI 0.1 to 6.1. p = 0.942) as was not the use of cerclage (OR 1.0, 95%CI 0.2 to 6.5, p = 0.995). Factors such as osteoporosis, polytrauma or diabetes were not associated with delayed union or nonunion.

Conclusion

The fracture morphology of TFF is an independent risk factor for nonunion in geriatric patients. The reduction technique is not associated with increased risk for nonunion, despite increased soft tissue damage following open reduction.
Midwife empathy and its association with the childbirth experience: a cross-sectional study
Authors: Jin Yuhua , Wu Yanpeng , Li Jing
Published: December 2022

Background

Although pregnancy and childbirth comprise a life-course that most midwives experience, whether their own experiences of childbirth resonate with other women during childbirth remains to be determined. In this study, we therefore characterized midwives’ empathic capabilities and defined their underlying factors.

Method

We conducted a cross-sectional study with data from 464 midwives in Guangdong, China, that were collected through the “Chinese version of the Jefferson Scale of Empathy for Health Professionals (JSE-HP).” This questionnaire contains sections related to midwife demographics and delivery characteristics. We then implemented multivariate logistic regression analysis to identify empathy-related factors.

Results

Our analysis revealed 303 (65.3%) participants in the high-empathy group while 161 (34.7%) were in the middle-empathy group. Compared with the reference groups, these results indicated that higher empathy was associated with an elevated educational level (OR, 1.83; 95% CI, 1.04–3.25), high monthly salary (OR, 2.30; 95% CI, 1.11–4.80), and no shift work (OR, 2.89; 95% CI, 1.09–7.63). The odds of a high empathy score were higher for midwives who experienced two childbirths (2.27, 1.11–4.66) and for those who had children under the age of 3 years (2.81, 1.34–5.92).

Conclusion

Midwives possess a moderate-to-high level of empathy, and the greater the number of childbirths they experienced and the younger their children, the higher their reported empathy score. This study contributes novel information regarding the empathic behavior of midwives toward women who give birth in China.
Mild blurry vision as the initial presentation of central nervous system relapses of acute lymphoblastic leukemia: a case report
Authors: Zhang Yuehong , Zhang Zhimeng , Mo Wenjian
Published: December 2022

Background

Leukemia relapses after hematopoietic stem cell transplantation can sometimes occur from the central nervous system prior to relapse from the bone marrow, and manifestations varied.

Case report

We present a case of mild blurry vision as the initial symptom of central nervous system relapse of adult acute lymphoblastic leukemia. A 30-year-old man presented with a 1 week history of painless visual loss in both eyes. At that time there were no headaches or other systemic features. The neurological examination was without positive findings except bilateral optic nerve edema. He had a history of acute lymphoblastic leukemia and hematopoietic stem cell transplantation, which had been in clinical remission post-transplant for 1 year. Lumbar puncture revealed relapsed disease within the central nervous system, confirmed with cerebrospinal fluid leukemic blasts.

Conclusions

It highlights the need for ophthalmologists to be aware of the possibility of central nervous system involvement in patients with the setting of leukemia when visual symptoms as the initial manifestation.
Early outcomes of preterm neonates with respiratory distress syndrome admitted at Muhimbili National Hospital, a prospective study
Authors: Bulimba Maria , Cosmas Judith , Abdallah Yaser , Massawe Augustine , Manji Karim
Published: December 2022

Background

Respiratory distress syndrome (RDS) is one of the commonest complication preterm neonates suffer and accounts for a significant morbidity and mortality in low and middle income countries (LMICs). Addressing RDS is therefore crucial in reducing the under 5 mortality in LMICs. This study aimed at describing early outcomes (death/survival) of preterm neonates with RDS and identify factors associated with the outcomes among neonates admitted at Muhimbili national hospital, Tanzania.

Methods

Between October 2019 and January 2020 we conducted a prospective study on 246 preterm neonates with RDS at Muhimbili National Hospital. These were followed up for 7 days. We generated Kaplan–Meier survival curve to demonstrate time to death. We performed a cox regression analysis to ascertain factors associated with outcomes. The risk of mortality was analyzed and presented with hazard ratio. Confidence interval of 95% and P-value less than 0.05 were considered as significant.

Results

Of the 246 study participants 51.6% were male. The median birth weight and gestational age of participants (Inter-Quartile range) was 1.3 kg (1.0, 1.7) and 31 weeks (29, 32) respectively. Majority (60%) of study participants were inborn. Only 11.4% of mothers of study participants received steroids. Of the study participants 49 (20%) received surfactant. By day 7 of age 77/246 (31.3%) study participants had died while the majority of those alive 109/169 (64.5%) continued to need some respiratory support. Factors independently associated with mortality by day 7 included birth weight of < 1500 g (AHR = 2.11 (1.16–3.85), CI95%; p = 0.015), lack of antenatal steroids (AHR = 4.59 (1.11–18.9), CI95%; p = 0.035), 5th minute APGAR score of < 7 (AHR = 2.18 (1.33–3.56), CI95%; p = 0.002) and oxygen saturation < 90% at 6 hours post admission (AHR = 4.45 (1.68–11.7), CI95%; p = 0.003).

Conclusion

Our study reports that there was high mortality among preterm neonates admitted with RDS mainly occurring within the first week of life. Preterm neonates with very low birth weight (VLBW), whose mother did not receive antenatal steroid, who scored < 7 at 5th minute and whose saturation was < 90% at 6 hours were at higher risk of dying. There is need to scale up antenatal corticosteroids, neonatal resuscitation training and saturation monitoring among preterm neonates with RDS.
Bleeding in neonates with severe thrombocytopenia: a retrospective cohort study
Authors: Peng Ting , Shan Yuanyuan , Zhang Peng , Cheng Guoqiang
Published: December 2022

Background

Severe neonatal thrombocytopenia is a rare disease with multiple etiologies. Severe thrombocytopenia with bleeding is life-threatening and has attracted significant attention from clinicians. However, only a few studies have focused on the association between severe thrombocytopenia and bleeding. Thus, this study aimed to describe the neonates’ postnatal age at which severe thrombocytopenia was first recognized, clinical characteristics, bleeding patterns, and outcomes and to evaluate the association between minimum platelet count and bleeding.

Methods

A single-center retrospective cohort study for neonates with severe thrombocytopenia (platelet count ≤ 50 × 109/L) was conducted. Neonates who were admitted to our neonatal intensive care unit between October 2016 and February 2021 and developed severe thrombocytopenia were analyzed. Data were collected retrospectively until the patients were referred to other hospitals, discharged, or deceased.

Results

Among the 5819 neonatal inpatients, 170 with severe thrombocytopenia were included in this study. More than 30% of the patients had severe thrombocytopenia in the first 3 days of life. Among the 118 neonates with bleeding, 47 had more than one type of pathological bleeding. Neonates with very severe thrombocytopenia (point estimate: 53.7%, 95% confidence interval [CI]: 44.2%–63.1%) had a higher incidence rate of cutaneous bleeding than those with severe thrombocytopenia (point estimate: 23.4%, 95% CI: 12.3%–34.4%). The gestational age (median: 36.2 [interquartile range [IQR]: 31.4–39.0] weeks) and birth weight (median: 2310 [IQR: 1213–3210] g) of the major bleeding group were the lowest among no bleeding, minor bleeding, and major bleeding groups. Regression analysis controlled for confounders and confirmed that a lower platelet count (odds ratio [OR]: 2.504 [95% CI: 1.180–5.314], P = 0.017) was associated with a significant increase in the rate of bleeding. Very severe thrombocytopenia (point estimate: 49.1%, 95% CI: 39.6%–58.6%) had a higher rate of platelet transfusion than severe thrombocytopenia (point estimate: 5.7%, 95% CI: 0.7%–10.7%). The mortality rate was higher in neonates with bleeding than in those without bleeding (point estimates with 95% CI: 33.1% [24.4%–41.7%] vs. 7.7% [0.2%–15.2%]).

Conclusions

These findings describe the incidence of severe thrombocytopenia and demonstrate that a lower platelet count is associated with an increased bleeding rate in patients with severe thrombocytopenia.
Exploring risk factors for re-hospitalization in a psychiatric inpatient setting: a retrospective naturalistic study
Authors: Berardelli Isabella , Sarubbi Salvatore , Rogante Elena , Erbuto Denise , Cifrodelli Mariarosaria , Giuliani Carlotta , Calabrò Giuseppa , Lester David , Innamorati Marco , Pompili Maurizio
Published: December 2022

Background

The reduction of multiple psychiatric hospitalizations is an important clinical challenge in mental health care. In fact, psychiatric re-hospitalization negatively affects the quality of life and the life expectancy of patients with psychiatric disorders. For these reasons, identifying predictors of re-hospitalization is important for better managing psychiatric patients. The first purpose of the present study was to examine the readmission rate in a large sample of inpatients with a psychiatric disorder. Second, we investigated the role of several demographical and clinical features impacting re-hospitalization. 

Method

This retrospective study enrolled 1001 adult inpatients (510 men and 491 women) consecutively admitted to the University Psychiatric Clinic, Sant'Andrea Hospital, Sapienza University of Rome between January 2018 and January 2022. To identify risk factors for psychiatric re-hospitalization, we divided the sample into 3 subgroups: the Zero-Re group which had no readmission after the index hospitalization, the One-Re group with patients re-admitted only once, and the Two-Re with at least two re-admissions. 

Results

The groups differed according to previous hospitalizations, a history of suicide attempts, age at onset, and length of stay. Furthermore, the results of the regression model demonstrated that the Two-Re group was more likely to have a history of suicide attempts and previous hospitalizations.

Discussion

These results indicate the importance of assessing risk factors in psychiatric hospitalized patients and implementing ad hoc prevention strategies for reducing subsequent re-hospitalizations.
Variations in lower limb alignments indicate pelvic tilt after total hip arthroplasty
Authors: Chen Kangming , Wu Jinyan , Huang Gangyong , Liu Changquan , Shen Chao , Zhu Junfeng , Li Yang , Li Tao , Xiao Fei , Peng Jianping , Han Xiuguo , Zhang Xinhai , Xia Jun , Chen Xiaodong
Published: December 2022

Objective

We sought to correlate various spinopelvic and lower limb alignments, and to examine the current spinopelvic theories on a Chinese cohort.

Methods

We retrospectively reviewed 166 patients undergoing THA. Among them, 138 patients with unilateral THA met the inclusion criteria. Sagittal alignments and cup orientations were measured on standing and sitting lateral EOS images. Patients were categorized into two groups with a scoring system for lumbar spine degeneration. Patients’ demographics including age, sex, lumbar spine degeneration and radiographic measurements were studied.

Results

PT, SS, LL and TK differed significantly between standing and sitting within each group except for TK in degenerative group (32.8 ± 13.9 vs. 32.9 ± 14.2, p = 0.905). Compared with degenerative spine group, non-degenerative spine patients have great pelvic mobility (ΔPT, -24.4 ± 12.5° vs. -17.6 ± 10.7, p = 0.0008), greater lumbar mobility (ΔLL, -34.8 ± 15.2 vs. -21.7 ± 12.2, p = < 0.0001) and compensatory cup orientation changes (ΔRA, -15.5 ± 11.1 vs. -12.0 ± 8.4, p = 0.00920; ΔRI, -10.8 ± 11.5 vs. -5.6 ± 7.5, p = 0.0055). Standing PT and ankle dorsiflexion angle correlated positively (R2 = 0.236, p = 0.005).

Conclusion

THA patients in this cohort showed a spinopelvic motion paradigm similar to that from previous studies on Caucasians. Ankle dorsiflexion indicate greater posterior pelvic tilt on standing. Surgeons should beware of risks of instability in patients with lower limb compensations.

Advances in knowledge

This study provides new insights into the clinical relevance of lower limb alignments to spinopelvic motion after THA in a relatively young Chinese population.
The value of contrast-enhanced ultrasonography in the diagnosis of primary testicular non-neoplastic and neoplastic lesions in adults
Authors: Xue Nianyu , Zhang Shengmin , Wang Guoyao
Published: December 2022

Background

Different pathological types of testicular tumors are treated differently. Malignant germ cell tumors require radical orchiectomy, while benign tumors may only need mass enucleation. Contrast-enhanced ultrasonography (CEUS) is more sensitive than conventional ultrasonography in displaying tumor microvessels, which helps distinguish between benign and malignant tumors.

Methods

This was a retrospective analysis of 35 patients with pathological-confirmed primary testicular non-neoplastic and neoplastic lesions in our hospital from February 2017 to February 2022. Conventional ultrasonography and CEUS imaging findings of included lesions were retrospectively analyzed and their diagnostic values were compared with the pathological results.

Results

There were 13 cases of benign testicular lesions (including 1 case of spontaneous hematoma, 2 cases of segmental infarctions, 5 cases of epidermoid cysts, 2 cases of Sertoli cell tumors, and 3 cases of Leydig cell tumors) and 23 cases of malignant testicular lesions (including 10 cases of seminomas, 1 case of embryonal carcinoma, 2 cases of mixed germ cell tumors, 2 cases of spermatocytic tumors, and 8 cases of lymphomas). The sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates of conventional ultrasound in diagnosing benign testicular tumors by "onion skin-like" echo (epidermoid cysts) and peripheral annular blood flow were 30.8%, 100.0%, 100.0%, 71.9% and 75.0%, respectively. All testicular non-neoplastic lesions and epidermoid cysts showed no enhancement by CEUS. All Sertoli-Leydig cell tumors (SLCTs)’ CEUS imaging showed uniform high enhancement (no necrosis area), fast forward, and slow backward. 80.0% (12/15) malignant germ cell tumors showed heterogeneous enhancement and fast forward and fast backward in CEUS. All lymphomas showed fast forward and fast backward, and 87.5% (7/8) of them showed uniform high levels of enhancement in CEUS. According to CEUS without enhancement (non-neoplastic lesions and epidermoid cysts) and uniform high enhancement with fast forward and slow backward (SLCT), the sensitivity, specificity, positive predictive value, negative predictive value and accuracy rates for diagnosing benign testicular tumors were all 100.0%. Compared with conventional ultrasound, the difference was statistically significant (p = 0.004).

Conclusions

CEUS could accurately distinguish between benign and malignant testicular tumors, as well as differentiate specific pathological types (testicular focal infarction, epidermoid cysts, spermatocytic tumors, SLTC and lymphoma). Accurate preoperative diagnosis is critical for guiding the selection of appropriate treatment plans for different pathological types of testicular tumors.
Efficacy of tooth brushing via a three-dimensional motion tracking system for dental plaque control in school children: a randomized controlled clinical trial
Authors: Jeong Jin-Sun , Kim Kyeong-Seop , Lee Jeong-Whan , Kim Kee-Deog , Park Wonse
Published: December 2022

Background

School children are in a developmental period in which permanent teeth replace primary dentition. It is also a period with a high incidence of gingivitis and caries, which can be improved with adequate tooth brushing. Advances in information technology have led to the development of smart health devices that assist in tooth brushing. We compared the effectiveness of computer-assisted toothbrushing using a toothbrushing instruction (TBI) method called the smart toothbrush and smart mirror (STM) system with that of conventional TBI (verbal instructions) for plaque control in school children.

Methods

This randomized controlled clinical trial analyzed and compared the reduction of the modified Quigley-Hein plaque index between the two methods in 42 school children. The participants were randomly assigned to the STM system group (n = 21) or conventional-TBI group (n = 21). The plaque indices were evaluated at baseline, immediately after TBI (day 0), and 1 week and 1 month after TBI.

Results

The STM system and conventional TBI led to an average reduction of 40.50% and 40.57%, respectively, in whole mouth plaque. Reductions in the plaque indices within each tested time period were observed in both groups (P < 0.001), and the mean plaque reduction did not differ between the two groups (P = 0.44).

Conclusions

The present study tested a computer assisted system for TBI, more studies are needed to confirm its usefulness in different objectives.

Clinical relevance The computer-assisted STM system may be an alternative of TBI for children.

Trial registration ClinicalTrials.gov (NCT04627324) Registered 13/11/2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04627324.
Early osseointegration of micro-arc oxidation coated titanium alloy implants containing Ag: a histomorphometric study
Authors: Ding Mingchao , Shi Jin , Wang Weiqi , Li Dechao , Tian Lei
Published: December 2022

Background

This study aimed to evaluate bone response to micro-arc oxidation coated titanium alloy implants containing Ag.

Methods

144 titanium alloy implants were prepared by machine grinding and divided into three treatment groups as following, SLA group: sand-blasting and acid-etched coating; MAO group: micro-arc oxidation without Ag coating; MAO + Ag group: micro-arc oxidation containing Ag coating. Surface characterization of three kind of implants were observed by X-ray diffraction, energy dispersive X-ray spectrometer, scanning electron microscopy, High Resolution Transmission Electron Microscope and roughness analysis. The implants were inserted into dog femurs. 4, 8 and 12 weeks after operation, the bone response to the implant to the bone was evaluated by push-out experiment, histological and fluorescent labeling analysis.

Results

MAO + Ag group consisted of a mixture of anatase and rutile. Ag was found in the form of Ag2O on the surface. The surface morphology of MAO + Ag group seemed more like a circular crater with upheaved edges and holes than the other two groups. The surface roughness of MAO and MAO + Ag groups were higher than SLA group, but no statistical difference between MAO and MAO + Ag groups. The contact angles in MAO + Ag group was smallest and the surface free energy was the highest among three groups. The maximum push-out strength of MAO and MAO + Ag groups were higher than SLA group at all time point, the value of MAO + Ag group was higher than MAO group at 4 and 8 weeks. Scanning electron microscopy examination for the surface and cross-section of the bone segments and fluorescent labeling analysis showed that the ability of bone formation and osseointegration in MAO + Ag group was higher than that of the other two groups.

Conclusion

The micro-arc oxidation combination with Ag coating is an excellent surface modification technique to posse porous surface structure and hydrophilicity on the titanium alloy implants surface and exhibits desirable ability of osseointegration.
Natural language processing and network analysis in patients withdrawing from life-sustaining treatments: a retrospective cohort study
Authors: Tsai Wei-Chin , Tsai Yun-Cheng , Kuo Kuang-Cheng , Cheng Shao-Yi , Tsai Jaw-Shiun , Chiu Tai-Yuan , Huang Hsien-Liang
Published: December 2022

Background

Providing palliative care to patients who withdraw from life-sustaining treatments is crucial; however, delays or the absence of such services are prevalent. This study used natural language processing and network analysis to identify the role of medications as early palliative care referral triggers.

Methods

We conducted a retrospective observational study of 119 adult patients receiving specialized palliative care after endotracheal tube withdrawal in intensive care units of a Taiwan-based medical center between July 2016 and June 2018. Patients were categorized into early integration and late referral groups based on the median survival time. Using natural language processing, we analyzed free texts from electronic health records. The Palliative trigger index was also calculated for comparison, and network analysis was performed to determine the co-occurrence of terms between the two groups.

Results

Broad-spectrum antibiotics, antifungal agents, diuretics, and opioids had high Palliative trigger index. The most common co-occurrences in the early integration group were micafungin and voriconazole (co-correlation = 0.75). However, in the late referral group, piperacillin and penicillin were the most common co-occurrences (co-correlation = 0.843).

Conclusion

Treatments for severe infections, chronic illnesses, and analgesics are possible triggers for specialized palliative care consultations. The Palliative trigger index and network analysis indicated the need for palliative care in patients withdrawing from life-sustaining treatments. This study recommends establishing a therapeutic control system based on computerized order entry and integrating it into a shared-decision model.
Women’s independent decision-making power and determinants on not to use contraceptives among currently married women in Ethiopia using demographic and Health Survey data: Multilevel Analysis
Authors: Tesfa Desalegn , Azanaw Melkalem Mamuye , Gebremariam Alemayehu Digssie , Engidaw Melaku Tadege , Tiruneh Mulu , Zemene Melkamu Aderajew , Anley Denekew Tenaw , Dessie Anteneh Mengist
Published: December 2022

Background

Evidence suggests that couples frequently dispute regarding the desirability of pregnancy, as well as whether or not to employ family planning measures. There are numerous unmet needs owing to partner or family objections, according to a scares study that illustrates women’s independent decision-making capacity on whether or not to use a contraceptive. As a result, the purpose of this study was to analyze women’s independent decision-making power and determinants of not using contraceptives.

Methods

Reproductive age group women aged (15–49 years) currently married who are not pregnant and are currently not using family planning preceding five years the survey was included from the individual record (IR file) file using standard demographic and health survey datasets of Ethiopia. Using multilevel logistic regression models, we investigated the relationship between several independent factors and women’s independent decision-making not to use contraception. The adjusted odds ratios were evaluated using 95% confidence intervals.

Results

A total of 5,598 currently married women were included in this study. Individual level factors significantly associated with women independent decision making on not to use contraceptive were female-led households (AOR = 2.11; 95% CI = 1.60–2.78), being orthodox ( AOR = 1.84; 95% CI = 1.39–2.44 ) and protestant ( AOR = 1.62; 95% CI = 1.17–2.23), and belonging to more than one union (AOR = 1.48; 95% CI = 1.12–1.95). Whereas, low community education (AOR = 1.19; 95%= 1.00-1.49) and regions: in Tigray (AOR = 2.19; 95%CI = 1.51–3.16), Afar (AOR = 1.74; 95% CI = 1.14–2.64), Amhara (AOR = 2.45; 95% CI = 1.71–3.500), South Nations Nationality (AOR = 1.87; 95% CI = 1.32–2.65), Gambela (AOR = 2.58; 95% CI = 1.73–3.84), Hareri (AOR = 3.93; 95% CI = 2.62–5.88), and Dre DDewa (AOR = 1.66; 95% CI = 1.12–2.45) were community-level factors.

Conclusion

Women’s independent decision-making power not to use contraceptives was low and greatly affected by both individual and community-level factors. Therefore, it is necessary to develop policies and create programs that promote women’s empowerment by incorporating their partners in each region of the nation to encourage women’s independent decision-making authority to use or not to use a contraceptive.
Does asset ownership influence sexual risk-taking behaviors among women engaged in sex work in Southern Uganda? A mediation analysis
Authors: Nabayinda Josephine , Kiyingi Joshua , Kizito Samuel , Nsubuga Edward , Nabunya Proscovia , Bahar Ozge Sensoy , Magorokosho Natasja , Nattabi Jennifer , Witte Susan , Fred Melch Ssewamala
Published: December 2022

Background

Economic vulnerability influences women engaged in commercial sex work (WESW) to further engage in sexual risk behaviors, as they often have multiple customers and engage in unprotected sex for financial gains. This study examined asset ownership’s direct and indirect impact on sexual risk-taking behaviors among WESW in Southern Uganda, a very vulnerable group of women at high risk for contracting HIV and other STIs.

Methodology

We used baseline data from theKyaterekerastudy, an NIH-funded study among WESW aged 18–55 across 19 HIV hotspots in Southern Uganda. Structural equation modeling was used to examine the direct, indirect, and total effects of assets—defined as ownership of physical and financial resources—on sexual risk-taking behaviors among WESW.

Results

Results showed that asset ownership was associated with a decrease in depression (β =  − 0.096 [95% CI − 0.191, − 0.001],p = 0.050) and increased access to medical care (β = 0.174 [95% CI 0.072, 0.275],p = 0.001).We also found that an increase in access to medical care was associated with decreased sexual risk-taking behaviors (β =  − 0.107 [95% CI − 0.210, − 0.004],p = 0.041). We observed a specific indirect effect between assets and sexual risk-taking behaviors through access to medical care (β =  − 0.019 [95% CI − 0.040, − 0.002],p = 0.05). Mediation contributed 31% of the total effects of asset ownership on sexual risk-taking behaviors.

Conclusion

To our knowledge, this is among the few studies to examine the impact of asset ownership on sexual risk-taking behaviors among WESW in Southern Uganda.Findings from this study indicate that increasing access to economic resources may reduce the risk of WESW engaging in unprotected sex for higher income, which limits the spread of HIV among this population. The results also indicate that asset ownership may allow women to access healthcare services.
Attitudes and values among the Swedish general public to using human embryonic stem cells for medical treatment
Authors: Grauman Åsa , Hansson Mats , Nyholm Dag , Jiltsova Elena , Widner Håkan , van Vliet Trinette , Drevin Jennifer
Published: December 2022

Background

The use of human embryonic stem cells (ES cells) for the development of medical therapies is surrounded with moral concerns. The aim of this study was to assess the public’s attitudes toward the use of ES cells for treatment of Parkinson’s disease (PD) and other diseases, what factors are most important to consider when using ES cells for drug development, and if there is an association between religious beliefs and attitudes toward using ES cells for medical treatment.

Methods

A randomly selected sample of the Swedish public, aged 18–87-years-old, completed an online survey (n = 467). The survey assessed socio-demographics, religious views, perceived moral status of the embryo, and attitudes toward using ES cells for medical treatment of PD and other diseases. Adjusted odds ratios (ORs) and 95% confidence intervals (CI) for positive vs. negative attitude toward using ES cells for drug development were computed using logistic regression.

Results

The respondents were positive about using ES for treatment; specifically, 70% totally agreed that it is acceptable to use ES cells for treatment of PD, while 40% totally agreed that it is acceptable to use ES cells for treatment but induced pluripotent cells is just as efficient. Religion being of little importance in one’s life was associated with a positive attitude toward using ES cells for treatment of PD (adjusted OR 6.39, 95% CI 2.78–14.71). The importance of being able “to access new, effective treatments against diseases that do not have any treatment available” was ranked as the most important factor to consider when using ES cells for drug development.

Conclusion

Most respondents are positive about using ES cells for drug development, and making effective treatments accessible to those who do not have any. However, these attitudes are influenced by the specific disorder that the drug development is intended for, as well as the religious views and perceived moral status of the early embryo.
Evolutionary plasticity of zoonotic porcine Deltacoronavirus (PDCoV): genetic characteristics and geographic distribution
Authors: Bahoussi Amina Nawal , Wang Pei-Hua , Shah Pir Tariq , Bu Hongli , Wu Changxin , Xing Li
Published: December 2022

The emergence and rapid spread of the acute respiratory syndrome coronavirus-2 have confirmed that animal coronaviruses represent a potential zoonotic source. Porcine deltacoronavirus is a worldwide evolving enteropathogen of swine, detected first in Hong Kong, China, before its global identification. Following the recent detection of PDCoV in humans, we attempted in this report to re-examine the status of PDCoV phylogenetic classification and evolutionary characteristics. A dataset of 166 complete PDCoV genomes was analyzed using the Maximum Likelihood method in IQ-TREE with the best-fitting model GTR + F + I + G4, revealing two major genogroups (GI and GII), with further seven and two sub-genogroups, (GI a-g) and (GII a-b), respectively. PDCoV strains collected in China exhibited the broadest genetic diversity, distributed in all subgenotypes. Thirty-one potential natural recombination events were identified, 19 of which occurred between China strains, and seven involved at least one China strain as a parental sequence. Importantly, we identified a human Haiti PDCoV strain as recombinant, alarming a possible future spillover that could become a critical threat to human health. The similarity and recombination analysis showed that PDCoV spike ORF is highly variable compared to ORFs encoding other structural proteins. Prediction of linear B cell epitopes of the spike glycoprotein and the 3D structural mapping of amino acid variations of two representative strains of GI and GII showed that the receptor-binding domain (RBD) of spike glycoprotein underwent a significant antigenic drift, suggesting its contribution in the genetic diversity and the wider spread of PDCoV.
Medium-long term prognosis prediction for idiopathic pulmonary fibrosis patients based on quantitative analysis of fibrotic lung volume
Authors: Du Kaifeng , Zhu Yichun , Mao Ruolin , Qu Yubei , Cui Bo , Ma Yuan , Zhang Xin , Chen Zhihong
Published: December 2022

Purpose

To investigate the prognostic value of quantitative analysis of CT among patients with idiopathic pulmonary fibrosis (IPF) by quantifying the fibrosis extent and to attempt to provide precise medium-long term prognostic predictions for individual patients.

Methods

This was a retrospective cohort study that included 95 IPF patients in Zhongshan Hospital, Fudan University. 64 patients firstly diagnosed with IPF from 2009 to 2015 was included as the derivation cohort. Information regarding sex, age, the Gender-Age-Physiology (GAP) index, high-resolution computed tomography (HRCT) images, survival status, and pulmonary function parameters including forced vital capacity (FVC), FVC percent predicted (FVC%pred), diffusing capacity of carbon monoxide (DLCO), DLCO percent predicted (DLCO%pred), carbon monoxide transfer coefficient (KCO), KCO percent predicted (KCO%pred) were collected. 31 patients were included in the validation cohort. The Synapse 3D software was used to quantify the fibrotic lung volume (FLV) and total lung volume (TLV). The ratio of FLV to TLV was calculated and labeled CTFLV/TLV%, reflecting the extent of fibrosis. All the physiological variants and CTFLV/TLV% were analyzed for the dimension of survival through both univariate analysis and multivariate analysis. Formulas for predicting the probability of death based on the baseline CTFLV/TLV% were calculated by logistic regression, and validated by the validation cohort.

Results

The univariate analysis indicated that CTFLV/TLV% along with DLCO%pred, KCO%pred and GAP index were significantly correlated with survival. However, only CTFLV/TLV% was meaningful in the multivariate analysis for prognostic prediction (HR 1.114, 95% CI 1.047–1.184, P = 0.0006), and the best cutoff was 11%, based on receiver operating characteristic (ROC) curve analysis. The survival times for the CTFLV/TLV% ≤ 11% and CTFLV/TLV% > 11% groups were significantly different. Given the CTFLV/TLV% data, the death probability of a patient at 1 year, 3 years and 5 years could be calculated by using a particular formula. The formulas were tested by the validation cohort, showed high sensitivity (88.2%), specificity (92.8%) and accuracy (90.3%).

Conclusion

Quantitative volume analysis of CT might be useful for evaluating the extent of fibrosis in the lung. The CTFLV/TLV% could be a valuable biomarker for precisely predicting the medium-long term prognosis of individual patients with IPF.