bluuebunny/crossref_metadata_2025 huggingface dataset:
The Safety Assessment of Irrigation Fluid Management for Shoulder Arthroscopy and Its Effect on Postoperative Efficacy
Authors: Zhuang Chengyu , Yang Renhao , Xu Yang , Song Yanyan , Zhang Yin , Liu Jingfeng , Yang Fan , Huang Xiaohong , Liu Jia , Wang Xiaoning , Wang Ying , Wang Lei
Published: December 2022

Objective

Fluid extravasation is a potentially dangerous complication associated with shoulder arthroscopy. Most relevant studies have involved respiratory system, while the primary purpose was to reveal the effects of the fluid extravasation on cardiovascular system and postoperative function.

Methods

The clinical data of 92 patients was retrospective analyzed, in which 84 cases with rotator cuff injury, three cases with shoulder instability, three cases with fractures of the greater tuberosity of the humerus, and two cases with frozen shoulder. All the patients were undergoing shoulder arthroscopy. The relationship between the basic information of the patients and cardiac index (CI) or pulse pressure variation (PPV) were evaluated by linear regression analysis. The change of CI or PPV at different states were evaluated by the one‐way analysis of variance. The liquid retention (TR) and postoperative clinical outcomes was analyzed using linear regression.

Results

The preoperative CI was affected by anesthesia status and body position, while PPV was not affected. Multivariate mixed‐effects model analysis of CI found that there was a statistically significant difference in groups of older than 55 years old and those with obesity (BMI > 24). After the operation, the retention of irrigation fluid significantly influenced the circumference of the deltoid (P < 0.001 (95%CI: [0.30, 1.00])), but not on the circumference of the deltoid, neck, and arm. The multivariate analysis of the American Shoulder and Elbow Surgery (ASES) scores at 3 and 6 months after surgery showed that the fluid retention volume was correlated with the ASES score at 3 months after surgery, especially when the retention volume was greater than 2 L (P = 0.001 (95%). %CI: [−12.49, −3.22]).

Conclusion

The retention of irrigation fluid after shoulder arthroscopic surgery causes swelling of local limbs, and has an effect on peripheral blood vessels, which is mainly reflected in its influence on PPV and the postoperative function. Therefore, surgeons need to improve their surgical technique, shorten the operation time and reduce fluid retention.
Combined Deflection Angle Classification: A Novel Typing System of Adult Femoral Neck Fracture
Authors: Zhang Ying , Yuan Qiang , Wei Qiushi , Dong Yiping , Liu Youwen , He Wei , Jing Zhenhao , Zhang Leilei , Wang Haibin , Li Wuyin
Published: December 2022

Objective

Femoral neck fracture (FNF) is a common clinical trauma with high mortality and disability rates. Furthermore, its incidence increases exponentially with increasing age. Existing classifications have some disadvantages. Thus, this study aimed to establish a novel typing system for FNF.

Methods

We retrospectively analyzed all adult patients with FNF admitted to our hospital between December 2015 and November 2017 for cannulated screw internal fixation. The study population was divided into the femoral varus offset group (VAR) and the valgus offset group (VAL). The data collected included sex, age, affected side, injury mode, body mass index, complications, pelvic incidence (PI), hip deflection angle (HDA), combined deflection angle (CDA), and neck shaft angle. Statistical analysis was conducted to determine the correlation between complications and deviation angles. A novel typing system was developed and compared with the Garden classification to detect its superiority.

Results

A total of 108 patients were recruited, with 59 patients in the VAR and 49 patients in the VAL groups. The incidence of complications in the VAR group was significantly higher than that in the VAL group (P < 0.05). Moreover, there were more male participants in the VAR group. Compared with the VAL group, the VAR group had significantly higher PI, HDA, and CDA (P < 0.05). The CDA classification (CDAC) was defined, with CDA as the main criterion and HDA as the supplementary criterion. Furthermore, there was a hierarchical correlation between the actual incidence of complications and the typing level, which was increased in CDAC but not in the Garden classification. This showed that CDAC was more accurate.

Conclusion

A novel typing system, CDAC, for FNF was established, which was more accurate than the Garden classification. We suggest combining CDAC and Garden classifications for the preoperative diagnosis, treatment selection, and prognostic evaluation for patients with FNF.
Tumor necrosis factor‐alpha inhibitors and acne fulminans: Friend or foe?
Authors: Barry Kelly K. , Neale Holly D. , Hawryluk Elena B.
Published: December 2022

Acne fulminans (AF) is an uncommon variant of inflammatory acne with abrupt eruption of painful nodules, pustules, and hemorrhagic ulcerations, often associated with systemic symptoms. Paradoxical adverse reactions to tumor necrosis (TNF)‐alpha inhibitors have been reported, and rare cutaneous complications include pyoderma gangrenosum, Sweet syndrome‐like hypersensitivity eruptions, and pustular folliculitis. We report an unusual case of AF in a patient with Crohn disease that worsened with doses of adalimumab, which is considered a second‐line treatment for AF. This case highlights that acneiform eruptions may be an underreported paradoxical adverse reaction to anti‐TNF alpha therapy.
Electing to Take Control: Political Identification and Personal Control
Authors: Greenaway Katharine H.
Published: December 2022

Engaging in the political process is one way that individuals can exert control over society in general. Yet, emerging research suggests that engaging with political groups also helps people feel more in control of the course of their own lives. The present research examined whether this is always the case, using the natural experiment afforded by political events to probe the psychological mechanisms underpinning the relationship between group identification and personal control. Two cross‐sectional studies conducted immediately after the 2016 Presidential election (total N = 752) and one longitudinal study conducted immediately before and after the 2020 Presidential election (N = 743) investigated the relationship between political group identification and personal control. Together, the studies tested whether this relationship is weakened under conditions of low agency (i.e., in a group that lost the election) and low predictability (i.e., immediately following a surprise election outcome). The results suggest that the relationship between political identification and personal control is robust except in the case of low agency and low predictability. The studies contribute to understanding the processes that link group‐level political factors with individual‐level psychological outcomes.
Effects of time delay and blood storage methods on analysis of canine venous blood samples with an Element point‐of‐care analyzer
Authors: Rincon Angie A. , Wurlod Virginie A. , Liu Chin‐Chi , Smith M. Ryan
Published: December 2022

Background

Manufacturers of point‐of‐care (POC) analyzers recommend immediate processing and anaerobic collection of blood samples. However, it is not uncommon for clinical scenarios to result in delayed sample processing or room air exposure that could impact the test results.

Objective

To investigate the effect of time delay and sample storage method on key POC analytes in canine venous blood samples processed with an Element POC analyzer.

Methods

Blood gas analysis was performed on venous blood samples at times 0 (T0), 15, 30, and 60 minutes after sampling using three different storage methods: preheparinized plastic syringes and two different lithium heparin tubes. To determine clinical relevance, results were compared with allowable total error of the respective parameter. Significance was set at P < 0.05.

Results

Significant differences between the three storage methods at baseline were found for partial pressure of carbon dioxide (PCO2), partial pressure of oxygen (PO2), base excess, and total hemoglobin. No significant differences up to T60 were found within collection methods for actual bicarbonate (HCO3−), base excess, sodium, potassium, chloride, ionized calcium (iCa), glucose, and BUN. Significant differences within collection methods were found after T0 for creatinine, after 15 minutes for lactate, and after 30 minutes for pH and hematocrit. No significant differences were found for PO2 in samples stored in preheparinized plastic syringes at any time point.

Conclusions

These results suggest that HCO3−, sodium, potassium, chloride, iCa, glucose, and BUN are comparable within the three storage methods for up to 60 minutes after sampling without resulting in clinically relevant changes.
A Review of Demand Side Management Strategies and Electricity Tariffs in Distributed Grids
Authors: Dahiru Ahmed Tijjani , Tan Chee Wei , Salisu Sani , Lau Kwan Yiew , Toh Chuen Ling , Bukar Abba Lawan
Published: December 2022

A major challenge in renewable energy planning and integration with existing systems is the management of intermittence of the renewable resources and customer demand uncertainties. In emerging distributed grids, state-of-the-art optimization techniques were used for cost and reliability objectives. In the existing literature, power dispatch and demand side management schemes were implemented for various techno-economic objectives. In renewable energy-based distributed grids, power dispatch is strategic to distributed grid operations. However, demand side management is preferred, as it allows more options for customer participation. Moreover, the demand side management can simply follow supplies. This paper investigates the functions of demand side management as it affects the planning and operations of renewable energy-based distributed grids. The traditional demand side management strategies were inflexible and affect customer comforts. The time-of-use methods on the other hand are utility-centered and do not allow customer participation. Hence, integration of demand side management with tariff regimes through hybridizations such as time-of-use based real-time pricing were conceptualized for improved economic performance, reliability enhancement, and mitigation of environmental implications.
Formality of cochains on BG$BG$
Authors: Benson David J. , Greenlees John
Published: December 2022

Let be a compact Lie group with maximal torus . If is invertible in the field , then the algebra of cochains is formal as an algebra, or equivalently as a differential graded algebra.
Lenguaje figurado y educación : creencias implícitas, usos e implicaciones prácticas
Authors: Belinchón Carmona Mercedes , Marulanza Páez Elena , Gómez-Hernández Félix Antonio , Igoa González José Manuel , Pérez Jiménez Miguel Ángel , González-Tobón Juanita
Published: December 2022

Este libro condensa los hallazgos más importantes de tres proyectos de investigación que indagaron cuáles eran las creencias y actitudes de los maestros en cuanto al lenguaje figurado y su presencia en escenarios educativos; cómo procesan metáforas, modismos e ironías jóvenes con síndrome de Asperger/autismo de alto funcionamiento y lectores con dificultades de comprensión de textos, y cómo ayudar a potenciar la que denominamos competencia figurativa a través de herramientas pedagógicas como el juego.
La piel del conflicto: voces de Vista Hermosa
Authors: Cuellar Isabel Cristina , Matallana Eslava Diana L. , Gómez-Restrepo Carlos
Published: December 2022

Este texto es la voz de la piel de la guerra. Cada diálogo de entrevistador y entrevistado llega hasta la herida y se mete en ella. Muestra los guerreros, embravecidos en el combate, concentrados en conseguir la muerte del enemigo; los instantes humanos, de cuidado del otro, de amor de pareja en las noches que amanece en batalla; el fragor de balas que pegan sin dolor como golpes brutales; el sufrimiento y silencio y aislamiento cuando paran las explosiones; el campo de muertos; el quedar inconscientes y despertar en hospitales de cambuche, en enfermerías enemigas; el encontrarse perplejos ante el futuro, con la marca en la piel, con el órgano destruido o desaparecido para siempre. Así, surge la pregunta de si vale la pena seguir viviendo cuando los compañeros pasaron al otro lado, con el interrogante ¿para qué sirvió esto?
Interaction of Two Coaxial Penny-Shaped Cracks Near an Arbitrarily Graded Interface in Functionally Graded Materials: Exact and Approximate Solutions
Authors: Chen X. W. , Yue Z. Q.
Published: December 2022

Multiple cracks interaction is an important topic in fracture mechanics. The related solutions are helpful to understand the failure process and the toughening mechanism of brittle materials. Previous works on the topic were most for homogenous material. In this paper, we extend the analysis and examine the problem of interaction of two coaxial penny-shaped cracks near an arbitrarily graded interface in functionally graded materials (FGMs). The cracks are modelled as circular edge dislocation loops. An efficient dislocation solution for FGMs and Fredholm integral equation technique are used to solve the crack problem. Both exact solution using a system of integral equations and approximate solution by virtue of Kachanov’s method are presented. Unlike most existing analytical treatments to the crack problems in FGMs with the assumption of special gradation, i.e., graded shear modulus according to special functions and constant Poisson’s ratio, the present method is more flexible since it can consider arbitrarily graded shear modulus and Poisson’s ratio. The validity of the present solutions is checked by comparing to existing results in literatures for two stacked penny-shaped cracks in homogenous material and a penny-shaped crack near a graded interface with exponentially graded shear modulus. Finally, a practical example of double cracks interaction in a real epoxy-glass FGM with measured data of material properties is considered. The error due to the assumption of special gradation is also discussed.
The Effects of Hub Profile on the Aerodynamics of Integrated Intermediate Turbine Ducts
Authors: Hou Jiangdong , Zhou Chao
Published: December 2022

The integration design of the intermediate turbine ducts (ITDs) with the first row of the low-pressure turbine vane can significantly reduce the length of the turbine section, thus reducing the weight and drag of the aero-engine. This paper investigates the effects of the hub profile on the aerodynamic performance of integrated ITDs (IITDs). The flow features and loss mechanism of four IITDs are studied by experimental, numerical, and theoretical methods. In the baseline case, an open corner separation occurs near the hub-suction surface corner, which results in a significant loss. The loss is broken down into the parts generated by the mean vortex and turbulence theoretically. The open corner separation causes significant turbulence loss. To reduce the size of the separation zone, the positive radial/spanwise pressure gradient near hub is increased by moving the hub profile near the vane rear part slightly downward. As a result, a small closed corner separation with three-dimensional topology occurs instead of the open corner separation in the baseline case. The corner shape factor is defined to quantitatively describe the closed corner separation. When the hub profile moves further downward, the loss due to the corner separation reduces, but the loss generated in the vane passage away from hub increases mainly due to the mixing as the low-momentum flow near the hub transports toward the mid span. The change of the overall loss is subject to the combination of the two effects, and should be balanced during the design process.
Silbido profundo: An open source package for the use of deep learning to detect odontocete whistles
Authors: Conant Peter C. , Li Pu , Liu Xiaobai , Klinck Holger , Fleishman Erica , Gillespie Douglas , Nosal Eva-Marie , Roch Marie A.
Published: December 2022

This work presents an open-source matlab software package for exploiting recent advances in extracting tonal signals from large acoustic data sets. A whistle extraction algorithm published by Li, Liu, Palmer, Fleishman, Gillespie, Nosal, Shiu, Klinck, Cholewiak, Helble, and Roch [(2020). Proceedings of the International Joint Conference on Neural Networks, July 19–24, Glasgow, Scotland, p. 10] is incorporated into silbido, an established software package for extraction of cetacean tonal calls. The precision and recall of the new system were over 96% and nearly 80%, respectively, when applied to a whistle extraction task on a challenging two-species subset of a conference-benchmark data set. A second data set was examined to assess whether the algorithm generalized to data that were collected across different recording devices and locations. These data included 487 h of weakly labeled, towed array data collected in the Pacific Ocean on two National Oceanographic and Atmospheric Administration (NOAA) cruises. Labels for these data consisted of regions of toothed whale presence for at least 15 species that were based on visual and acoustic observations and not limited to whistles. Although the lack of per whistle-level annotations prevented measurement of precision and recall, there was strong concurrence of automatic detections and the NOAA annotations, suggesting that the algorithm generalizes well to new data.
Retrieval-extinction of drug memory requires AMPA receptor trafficking
Authors: Lv Xinyou , Zhang Junjie , Yuan Ti-Fei
Published: December 2022

Disruption of drug-associated memory reduces relapse. Transient memory retrieval facilitates the upcoming extinction of addiction memory, while the neural basis for this beneficial outcome remains unelucidated. Here, we report that AMPA receptor trafficking acts as the central component for retrieval-extinction–based drug memory intervention. Drug memory retrieval transiently reduces AMPA receptor–mediated synaptic transmission in prefrontal cortical neurons (lasting for 2 to 4 hours) through rapid removal of calcium-permeable AMPA receptors from the synapse, which returned to basal state level after 6 hours. The receptor trafficking is orchestrated by dopamine D1 but not D2 receptor signaling. Blocking AMPA receptor trafficking abolishes retrieval-extinction–mediated addiction memory degradation. These results reveal the molecular mechanism underlying the efficacy of transient memory retrieval on helping to erase addiction memory and support targeting the prefrontal cortex to reduce relapse (e.g., with noninvasive brain stimulation).
Ionic-electronic halide perovskite memdiodes enabling neuromorphic computing with a second-order complexity
Authors: John Rohit Abraham , Milozzi Alessandro , Tsarev Sergey , Brönnimann Rolf , Boehme Simon C. , Wu Erfu , Shorubalko Ivan , Kovalenko Maksym V. , Ielmini Daniele
Published: December 2022

With increasing computing demands, serial processing in von Neumann architectures built with zeroth-order complexity digital circuits is saturating in computational capacity and power, entailing research into alternative paradigms. Brain-inspired systems built with memristors are attractive owing to their large parallelism, low energy consumption, and high error tolerance. However, most demonstrations have thus far only mimicked primitive lower-order biological complexities using devices with first-order dynamics. Memristors with higher-order complexities are predicted to solve problems that would otherwise require increasingly elaborate circuits, but no generic design rules exist. Here, we present second-order dynamics in halide perovskite memristive diodes (memdiodes) that enable Bienenstock-Cooper-Munro learning rules capturing both timing- and rate-based plasticity. A triplet spike timing–dependent plasticity scheme exploiting ion migration, back diffusion, and modulable Schottky barriers establishes general design rules for realizing higher-order memristors. This higher order enables complex binocular orientation selectivity in neural networks exploiting the intrinsic physics of the devices, without the need for complicated circuitry.
π-Stacks of radical-anionic naphthalenediimides in a metal-organic framework
Authors: Kim Bongkyeom , Lee Juhyung , Chen Ying-Pin , Wu Xue-Qian , Kang Joongoo , Jeong Hwakyeung , Bae Sang-Eun , Li Jian-Rong , Sung Jooyoung , Park Jinhee
Published: December 2022

Radical-ionic metal-organic frameworks (MOFs) have unique optical, magnetic, and electronic properties. These radical ions, forcibly formed by external stimulus-induced redox processes, are structurally unstable and have short radical lifetimes. Here, we report two naphthalenediimide-based (NDI-based) Ca-MOFs: DGIST-6 and DGIST-7. Neutral DGIST-6, which is generated first during solvothermal synthesis, decomposes and is converted into radical-anionic DGIST-7. Cofacial (NDI)
2
•−
and (NDI)
2
2−
dimers are effectively stabilized in DGIST-7 by electron delocalization and spin-pairing as well as dimethylammonium counter cations in their pores. Single-crystal x-ray diffractometry was used to visualize redox-associated structural transformations, such as changes in centroid-to-centroid distance. Moreover, the unusual rapid reduction of oxidized DGIST-7 into the radical anion upon infrared irradiation results in effective and reproducible photothermal conversion. This study successfully illustrated the strategic use of in situ prepared cofacial ligand dimers in MOFs that facilitate the stabilization of radical ions.
Highly efficient charge transport across carbon nanobelts
Authors: Lin Junfeng , Wang Shengda , Zhang Fan , Yang Bowen , Du Pingwu , Chen Chuanfeng , Zang Yaping , Zhu Daoben
Published: December 2022

Carbon nanobelts (CNBs) are a new form of nanocarbon that has promising applications in optoelectronics due to their unique belt-shaped π-conjugated systems. Recent synthetic breakthrough has led to the access to various CNBs, but their optoelectronic properties have not been explored yet. In this work, we study the electronic transport performance of a series of CNBs by incorporating them into molecular devices using the scanning tunneling microscope break junction technique. We show that, by tuning the bridging groups between the adjacent benzenes in the CNBs, we can achieve remarkably high conductance close to 0.1 
G
0
, nearly one order of magnitude higher than their nanoring counterpart cycloparaphenylene. Density functional theory–based calculations further elucidate the crucial role of the structural distortion played in facilitating the unique radial π-electron delocalization and charge transport across the belt-shaped carbon skeletons. These results develop a basic understanding of electronic transport properties of CNBs and lay the foundation for further exploration of CNB-based optoelectronic applications.
Neutrophils and macrophages drive TNF-induced lethality via TRIF/CD14-mediated responses
Authors: Muendlein Hayley I. , Connolly Wilson M. , Cameron James , Jetton David , Magri Zoie , Smirnova Irina , Vannier Edouard , Li Xudong , Martinot Amanda J. , Batorsky Rebecca , Poltorak Alexander
Published: December 2022

TNF mediates a variety of biological processes including cellular proliferation, inflammatory responses, and cell death and is therefore associated with numerous pathologies including autoinflammatory diseases and septic shock. The inflammatory and cell death responses to TNF have been studied extensively downstream of TNF-R1 and are believed to rely on the formation of proinflammatory complex I and prodeath complex II, respectively. We recently identified a similar multimeric complex downstream of TLR4, termed the TRIFosome, that regulates inflammation and cell death in response to LPS or
Yersinia pseudotuberculosis
. We present evidence of a role for the TRIFosome downstream of TNF-R1, independent of TLR3 or TLR4 engagement. Specifically, TNF-induced cell death and inflammation in murine macrophages were driven by the TLR4 adaptor TRIF and the LPS co-receptor CD14, highlighting an important role for these proteins beyond TLR-mediated immune responses. Via immunoprecipitation and visualization of TRIF-specific puncta, we demonstrated TRIF- and CD14-dependent formation of prodeath and proinflammatory complexes in response to TNF. Extending these findings, in a murine TNF–induced sepsis model, TRIF and CD14 deficiency decreased systemic inflammation, reduced organ pathology, and improved survival. The outcome of TRIF activation was cell specific, because TNF-induced lethality was mediated by neutrophils and macrophages responding to TNF in a TRIF-dependent manner. Our findings suggest that in addition to their crucial role in TNF production, myeloid cells are central to TNF toxicity and position TRIF and CD14 as universal components of receptor-mediated immune responses.
Penetration of a Heating Electromagnetic Pulse into Plasma in Magnetic Field
Authors: Grigorovich D. A. , Ovchinnikov K. N. , Uryupin S. A.
Published: December 2022

Penetration of a heating pulse of quasistationary electromagnetic field into plasma in constant magnetic field directed along its surface was studied. Weakening of electron heat transfer across the magnetic field leads to more efficient heating of electrons near the plasma surface. As a result, the penetration of the field into the plasma decreases, which is accompanied by suppression of the “inverse” skin effect. Inhomogeneous heating of electrons across the magnetic field leads to generation of an electric field strength component orthogonal to both the magnetic field and the direction of temperature gradient. Appearance of the additional field strength component leads to a change in polarization of the reflected pulse. In a sufficiently strong magnetic field, due to suppression of the electron heat flux and less significant effect of the magnetic field on the ion heat flux, a state with large difference of electron and ion temperatures occurs.
Comparative Analysis of the Parameters of the Normal and Abnormal DC Glow Discharges
Authors: Surzhikov S. T.
Published: December 2022

A comparative numerical study of the parameters of normal and abnormal direct current glow discharges between two flat disk electrodes with a radius of 3 cm in a 1-cm-high electric discharge gap is performed. A two-dimensional axisymmetric drift-diffusion model of the glow discharge is used for the numerical simulation, including equations for the transfer of electrons and molecular nitrogen ions, and the Poisson equation for finding the electric potential in the discharge gap taking into account the regions of the space charge and the positive column. Abnormal discharges are obtained when the radius of the cathode decreases. A numerical procedure is proposed for smoothing local maxima of the electric field strength near the boundaries of the abnormal glow discharge cathode, which ensures the stability of the solution and the weak effect on the calculated data. The numerical simulation results of the electrodynamic structure of normal and abnormal glow discharges are presented.
Erratum to: Prospects for the Use of Marine Sulfated Fucose-Rich Polysaccharides in Treatment and Prevention of COVID-19 and Post-COVID-19 Syndrome
Authors: Kiselevskiy M. V. , Anisimova N. Yu. , Bilan M. I. , Usov A. I. , Ustyuzhanina N. E. , Petkevich A. A. , Shubina I. Zh. , Morozevich G. E. , Nifantiev N. E.
Published: December 2022

An Erratum to this paper has been published: https://doi.org/10.1134/S1068162022340015
Ethnic differences in urinary monocyte chemoattractant protein-1 and heparanase-1 levels in individuals with type 2 diabetes: the HELIUS study
Authors: van der Velden Anouk I M , van den Berg Bernard M , van den Born B J , Galenkamp Henrike , Ijpelaar Daphne H T , Rabelink Ton J
Published: December 2022

Introduction

We aimed to investigate ethnic differences in two urinary inflammatory markers in participants with type 2 diabetes mellitus (T2DM).

Research design and methods

We included 55 Dutch, 127 South-Asian Surinamese, 92 African Surinamese, 62 Ghanaian, 74 Turkish and 88 Moroccan origin participants with T2DM from the HEalthy LIfe in an Urban Setting study. Using linear regression analyses, we investigated differences in urinary monocyte chemoattractant protein-1 (MCP-1) and heparanase-1 (HPSE-1) levels across ethnic minorities compared with Dutch. Associations between the urinary markers and albuminuria (albumin:creatinine ratio (ACR)) was investigated per ethnicity.

Results

Urinary MCP-1 levels were higher in the Moroccan participants (0.15 log ng/mmol, 95% CI 0.05 to 0.26) compared with Dutch after multiple adjustments. Urinary HPSE-1 levels were lower in the African Surinamese and Ghanaian participants compared with the Dutch, with a difference of −0.16 log mU/mmol (95% CI −0.29 to −0.02) in African Surinamese and −0.16 log mU/mmol (95% CI −0.31 to −0.00) in Ghanaian after multiple adjustments. In all ethnic groups except the Dutch and Ghanaian participants, MCP-1 was associated with ACR. This association remained strongest after multiple adjustment in South-Asian and African Surinamese participants, with an increase in log ACR of 1.03% (95% CI 0.58 to 1.47) and 1.23% (95% CI 0.52 to 1.94) if log MCP-1 increased 1%. Only in the Dutch participants, an association between HPSE-1 and ACR was found, with increase in log ACR of 0.40% (95% CI 0.04 to 0.76) if log HPSE-1 increased 1%.

Conclusions

We found ethnic differences in urinary MCP-1 and HPSE-1 levels, in a multi-ethnic cohort of participants with T2DM. In addition, we found ethnic differences in the association of MCP-1 and HPSE-1 levels with albuminuria. These findings suggest differences in renal inflammation across ethnic groups.
Development of a new version of the Bristol Stool Form Scale: translation, content validity, face validity, and reliability of the Persian version
Authors: Shokouhi Nasim , Mohammadi Samira , Ghanbari Zeenat , Montazeri Ali
Published: December 2022

Objectives

The Bristol Stool Form Scale (BSFS) is the most widely used scale for stool form assessment. This study aimed to translate the BSFS into the Persian version and determine its content validity, face validity, and reliability.

Design

Following permission, a forward–backward translation procedure was applied to translate the scale from English into Persian. A cross-sectional study was conducted on a sample of 210 participants from the general and gastrointestinal clinics of a teaching hospital affiliated with the Tehran University of Medical Sciences, Tehran, Iran, from January 2020 to August 2020. The samples were selected using convenience sampling. A group of 10 experts and 10 adults assessed content and face validity, respectively. The kappa index evaluated the reliability of the instruments.

Results

Participants’ mean (±SD) age was 37.62 (±8.87) years. Most of the participants (65.7%) were women. The highest percentage of concordance was 100% for stool type 7, and stool type 5 had the lowest concordance percentage (78.1%). The overall kappa index was 0.79.

Conclusion

The Persian version of the BSFS is a valid and reliable measure for assessing stool form, and now it can be used in research and clinical practice.
Sarcopenia and coexistent risk factors detected using the ‘Yubi-wakka’ (finger-ring) test in adults aged over 65 years in the public annual health check-up in Tama City, Tokyo: a cross-sectional study
Authors: Fujii Hitomi , Kodani Eitaro , Kaneko Tomohiro , Nakamura Hiroyuki , Sasabe Hajime , Tamura Yutaka
Published: December 2022

Objectives

To examine the positive rate of sarcopenia using the ‘Yubi-wakka’ (finger-ring) test and associated risk factors among adults aged 65 years and older.

Design

Cross-sectional study.

Setting

We used the Yubi-wakka test, which has been developed and validated as a predictor of sarcopenia, frailty, disability and mortality. A positive test result is indicated by a smaller calf circumference than the finger-ring. The test was administered during annual health check-ups among residents of Tama City, Japan.

Participants

During the 2019 fiscal year, 12 894 individuals aged 65 years and older underwent the Yubi-wakka test at primary care clinics.

Interventions

Examinees conducted the test themselves in a seated position. They formed a ring around their calf using both thumbs and index fingers and judged whether their calf was larger, the same or smaller than their finger-ring.

Primary and secondary outcome measures

We compared anthropometric and serological data between the positive (smaller calf) and negative (larger calf) test result groups.

Results

The positive rate was 15.4% among men and 18.5% among women. The prevalence of a positive result was higher in those aged ≥80 years than in younger age groups in both sexes (men: 22.8%; women: 28.8%). Multivariate logistic regression analysis showed that a diagnosis of metabolic syndrome was a risk factor for detecting a positive test result in women aged 65–74 years (OR 3.445; 95% CI 1.44 to 8.29) and ≥75 years (OR 3.37; 95% CI 1.97 to 5.78).

Conclusions

Because the Japanese population is healthy and lives long, interventions against sarcopenia are important, especially for older adults aged >75 years. The presence of metabolic syndrome may be a risk factor for sarcopenia (as detected by the Yubi-wakka test) and future frailty, and requires closer attention, especially among women.
Risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation: results from the contact tracing strategy of the CoVIDA epidemiological surveillance study in Bogotá, Colombia, in 2020–2021
Authors: Ramírez Varela Andrea , Contreras-Arrieta Sandra , Tamayo-Cabeza Guillermo , Salas Zapata Leonardo , Caballero-Díaz Yuldor , Hernández Florez Luis Jorge , Benavidez Andrés Patiño , Laajaj Rachid , De la Hoz Fernando , Buitrago Gutierrez Giancarlo , Restrepo Silvia , Behrentz Eduardo
Published: December 2022

Objectives

To estimate the risk factors for SARS-CoV-2 transmission in close contacts of adults at high risk of infection due to occupation, participants of the CoVIDA study, in Bogotá D.C., Colombia.

Setting

The CoVIDA study was the largest COVID-19 intensified sentinel epidemiological surveillance study in Colombia thus far, performing over 60 000 RT-PCR tests for SARS-CoV-2 infection. The study implemented a contact tracing strategy (via telephone call) to support traditional surveillance actions performed by the local health authority.

Participants

Close contacts of participants from the CoVIDA study.

Primary and secondary outcome measures

SARS-CoV-2 testing results were obtained (RT-PCR with CoVIDA or self-reported results). The secondary attack rate (SAR) was calculated using contacts and primary cases features.

Results

The CoVIDA study performed 1257 contact tracing procedures on primary cases. A total of 5551 close contacts were identified and 1050 secondary cases (21.1%) were found. The highest SAR was found in close contacts: (1) who were spouses (SAR=32.7%; 95% CI 29.1% to 36.4%), (2) of informally employed or unemployed primary cases (SAR=29.1%; 95% CI 25.5% to 32.8%), (3) of symptomatic primary cases (SAR of 25.9%; 95% CI 24.0% to 27.9%) and (4) living in households with more than three people (SAR=22.2%; 95% CI 20.7% to 23.8%). The spouses (OR 3.85; 95% CI 2.60 to 5.70), relatives (OR 1.89; 95% CI 1.33 to 2.70) and close contacts of a symptomatic primary case (OR 1.48; 95% CI 1.24 to 1.77) had an increased risk of being secondary cases compared with non-relatives and close contacts of an asymptomatic index case, respectively.

Conclusions

Contact tracing strategies must focus on households with socioeconomic vulnerabilities to guarantee isolation and testing to stop the spread of the disease.
Effect of vaccination on the case fatality rate for COVID-19 infections 2020–2021: multivariate modelling of data from the US Department of Veterans Affairs
Authors: Murata Glen H , Murata Allison E , Perkins Douglas J , Campbell Heather M , Mao Jenny T , Wagner Brent , McMahon Benjamin H , Hagedorn Curt H
Published: December 2022

Objectives

To evaluate the benefits of vaccination on the case fatality rate (CFR) for COVID-19 infections.

Design, setting and participants

The US Department of Veterans Affairs has 130 medical centres. We created multivariate models from these data—339 772 patients with COVID-19—as of 30 September 2021.

Outcome measures

The primary outcome for all models was death within 60 days of the diagnosis. Logistic regression was used to derive adjusted ORs for vaccination and infection with Delta versus earlier variants. Models were adjusted for confounding factors, including demographics, comorbidity indices and novel parameters representing prior diagnoses, vital signs/baseline laboratory tests and outpatient treatments. Patients with a Delta infection were divided into eight cohorts based on the time from vaccination to diagnosis. A common model was used to estimate the odds of death associated with vaccination for each cohort relative to that of unvaccinated patients.

Results

9.1% of subjects were vaccinated. 21.5% had the Delta variant. 18 120 patients (5.33%) died within 60 days of their diagnoses. The adjusted OR for a Delta infection was 1.87±0.05, which corresponds to a relative risk (RR) of 1.78. The overall adjusted OR for prior vaccination was 0.280±0.011 corresponding to an RR of 0.291. Raw CFR rose steadily after 10–14 weeks. The OR for vaccination remained stable for 10–34 weeks.

Conclusions

Our CFR model controls for the severity of confounding factors and priority of vaccination, rather than solely using the presence of comorbidities. Our results confirm that Delta was more lethal than earlier variants and that vaccination is an effective means of preventing death. After adjusting for major selection biases, we found no evidence that the benefits of vaccination on CFR declined over 34 weeks. We suggest that this model can be used to evaluate vaccines designed for emerging variants.
Experience of suffering in patients with hypertension: a qualitative analysis of in-depth interview of patients in a university hospital in Seoul, Republic of Korea
Authors: Sung Jidong , Paik Young-gyung
Published: December 2022

Objective

To describe the suffering experienced by patients with hypertension, not only regarding symptoms, but also suffering in a social context.

Design

A qualitative analysis of semi-structured interview data. Interviews were audio-recorded and transcribed verbatim. A descriptive approach was taken by exploring patient accounts and presenting their experiences and perspectives.

Setting

Cardiology clinic in a university hospital (Samsung Medical Center, Seoul, Republic of Korea).

Participants

Patients with hypertension and without serious comorbidities who had been followed-up at a cardiology clinic of a training university hospital.

Results

Nineteen men and women (male:female=12:7) were interviewed. The mean age was 44 years, and the average hypertension duration was 4 years. All 19 patients reported symptoms allegedly to be associated with hypertension. Anxiety about blood pressure fluctuation and hypertension complications, dislike of antihypertensive medication and associated labelling effect, family stress and refusal to be enrolled in life insurance were commonly found among patients’ interviews. Relatively younger (≤50 years of age), actively working patients experienced stigmatisation and discrimination in the workplace.

Conclusion

The illness experience of patients with hypertension consists of suffering associated with threatened or damaged self-identity at the individual and social level. Medical professionals should have more awareness of the suffering of these patients to improve the quality of care. An education programme with proper focus on the elements of patients’ suffering may help to alleviate it.
UK recommendations for HER2 assessment in breast cancer: an update
Authors: Rakha Emad A , Tan Puay Hoon , Quinn Cecily , Provenzano Elena , Shaaban Abeer M , Deb Rahul , Callagy Grace , Starczynski Jane , Lee Andrew H S , Ellis Ian O , Pinder Sarah E
Published: December 2022

The last UK breast cancer (BC) human epidermal growth factor receptor 2 (HER2) testing guideline recommendations were published in 2015. Since then, new data and therapeutic strategies have emerged. The American Society of Clinical Oncology (ASCO)/College of American Pathologists (CAP) published a focused update in 2018 that reclassified in situ hybridisation (ISH) Group 2 (immunohistochemistry (IHC) score 2+andHER2/chromosome enumeration probe 17 (CEP17) ratio ≥2.0 andHER2 copy number <4.0 signals/cell), as well as addressed other concerns raised by previous guidelines. The present article further refines UK guidelines, with specific attention to definitions of HER2 status focusing on eight key areas: (1) HER2 equivocal (IHC 2+) and assignment of the ASCO/CAP ISH group 2 tumours; (2) the definition of the group of BCs with low IHC scores for HER2 with emphasis on the distinction between IHC score 1+ (HER2-Low) from HER2 IHC score 0 (HER2 negative); (3) reporting cases showing HER2 heterogeneity; (4) HER2 testing in specific settings, including on cytological material; (5) repeat HER2 testing, (6) HER2 testing turnaround time targets; (7) the potential role of next generation sequencing and other diagnostic molecular assays for routine testing of HER2 status in BC and (8) use of image analysis to score HER2 IHC. The two tiered system of HER2 assessment remains unchanged, with first line IHC and then ISH limited to IHC equivocal cases (IHC score 2+) but emerging data on the relationship between IHC scores and levels of response to anti-HER2 therapy are considered. Here, we present the latest UK recommendations for HER2 status evaluation in BC, and where relevant, the differences from other published guidelines.
Mechanical thrombectomy is cost-effective versus medical management alone around Europe in patients with low ASPECTS
Authors: Moreu Manuel , Scarica Raffaele , Pérez-García Carlos , Rosati Santiago , López-Frías Alfonso , Egido José A , Gómez-Escalonilla Carlos , Simal Patricia , Arrazola Juan , Bocquet Anne-Laure , Barthe Thomas
Published: December 2022

Objective

To demonstrate, by a cost-effectiveness analysis, the efficiency of mechanical thrombectomy (MT) versus medical management (MM) in patients with a low Alberta Stroke Program Early CT Score (ASPECTS) from the RESCUE Study.

Methods

A cost-effectiveness model was designed to project both direct medical costs and quality-adjusted life-years (QALYs) of MT versus MM in eight European countries (Spain, UK, France, Italy, Belgium, Germany, Sweden, and the Netherlands). Our model was created based on previously published health-economic data in those countries. Procedure costs, acute, mid-term, and long-term care costs were projected based on expected modified Rankin Scale (mRS) scores as reported in the RESCUE-Japan LIMIT trial.

Results

MT was found to be a cost-effective option in eight different countries across Europe (Spain, Italy, UK, France, Belgium, Germany, the Netherlands, and Sweden). with a lifetime incremental cost-effectiveness ratio varying from US$2 875 to US$11 202/QALY depending on the country. A cost-effectiveness acceptability curve showed 100% acceptability of MT at the willingness to pay (WTP) of US$40 000 for the eight countries.

Conclusions

MT is efficient versus MM alone for patients with low ASPECTS in eight countries across Europe. Patients with a large ischemic core could be treated with MT because it is both clinically beneficial and economically sustainable.
Comorbidities and treatment patterns in early rheumatoid arthritis: a nationwide Swedish study
Authors: Tidblad Liselotte , Westerlind Helga , Delcoigne Benedicte , Askling Johan , Saevarsdottir Saedis
Published: December 2022

Objective

To examine how comorbidities in patients with early rheumatoid arthritis (RA) associate with use of different disease-modifying antirheumatic drugs (DMARDs).

Methods

We used Swedish nationwide clinical and quality registers to collect comorbidity data for patients diagnosed with RA during 2006–2019 (n=13 505). We compared the use of DMARDs at diagnosis and after 1 year, in relation to comorbidity categories 5 years prior to RA diagnosis and overall comorbidity burden. For each comorbidity category, we also calculated adjusted ORs of being on treatment with other (or no) DMARDs compared with methotrexate (MTX) monotherapy 1 year after RA diagnosis.

Results

At RA diagnosis, 68% (n=9178) of all patients were treated with MTX monotherapy, with the lowest proportion in patients with chronic kidney (CKD, 48%, n=50) and respiratory diseases (57%, n=413). At 1 year, most patients still received MTX monotherapy (<11% decrease, across all comorbidity categories). At 1 year, 13% received biological/targeted synthetic DMARDs, with the lowest proportion among patients with malignant diseases (OR=0.69, 95% CI=0.51 to 0.95). Being without DMARD at 1 year was more common among patients with CKD (OR=3.25, 95% CI=2.20 to 4.81), respiratory diseases (OR=1.83, 95% CI=1.32 to 2.53) or a history of hospitalisation due to infection (OR=1.47, 95% CI=1.23 to 1.75), and among patients with higher comorbidity burden and older age.

Conclusion

In a nationwide setting with universal healthcare, most comorbid conditions do not limit the initiation or continuation of MTX or other DMARDs in early RA, although patients with certain comorbid conditions, higher comorbidity burden and higher age were somewhat less intensively treated.
Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma
Authors: Heatley Heath , Tran Trung N , Bourdin Arnaud , Menzies-Gow Andrew , Jackson David J , Maslova Ekaterina , Chapaneri Jatin , Skinner Derek , Carter Victoria , Chan Jeffrey Shi Kai , Ariti Con , Haughney John , Price David B
Published: December 2022

Introduction

Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (adverse outcomes); no previous study has focused exclusively on intermittent OCS use.

Methods

This historical (2008–2019) UK cohort study using primary care medical records from two anonymised, real-life databases (OPCRD and CPRD) included patients aged≥4 years with asthma receiving only intermittent OCS. Patients were indexed on their first recorded intermittent OCS prescription for asthma and categorised by OCS prescribing patterns: one-off (single), less frequent (≥90 day gap) and frequent (<90 day gap). Non-OCS patients matched 1:1 on gender, age and index date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, Global Initiative for Asthma (GINA) 2020 treatment step, and pre index inhaled corticosteroid (ICS) and short-acting β2-agonist (SABA) prescriptions using a multivariable Cox-proportional hazard model.

Findings

Of 476 167 eligible patients, 41.7%, 26.8% and 31.6% had one-off, less frequent and frequent intermittent OCS prescribing patterns, respectively. Risk of any AO increased with increasingly frequent patterns of intermittent OCS versus non-OCS (HR; 95% CI: one-off 1.19 (1.18 to 1.20), less frequent 1.35 (1.34 to 1.36), frequent 1.42 (1.42 to 1.43)), and was consistent across age, GINA treatment step and ICS and SABA subgroups. The highest risks of individual OCS-related adverse outcomes with increasingly frequent OCS were for pneumonia and sleep apnoea.

Conclusion

A considerable proportion of patients with asthma receiving intermittent OCS experienced a frequent prescribing pattern. Increasingly frequent OCS prescribing patterns were associated with higher risk of OCS-related adverse outcomes. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.