bluuebunny/crossref_metadata_2025 huggingface dataset:
Baricitinib in severe and refractory peripheral ulcerative keratitis: a case report and literature review
Authors: Calvo-Río Vanesa , Sánchez-Bilbao Lara , Álvarez-Reguera Carmen , Castañeda Santos , González-Mazón Iñigo , Demetrio-Pablo Rosalía , González-Gay Miguel A. , Blanco Ricardo
Published: November 2022

Ocular disease, such as scleritis and peripheral ulcerative keratitis (PUK), may be a serious ocular complication. We present a patient with severe and refractory PUK treated with baricitinib. A review of the literature on Janus kinase inhibitors (JAKINIB) in refractory ocular surface pathology was also performed. For the literature review, the search in PubMed, Embase, and the Cochrane library was carried out from inception until 31 May 2021, including conference proceedings from four major rheumatology congresses. All original research articles studying JAKINIB treatment in patients with inflammatory eye disease were included. We present an 85-year-old woman with rheumatoid arthritis (RA) and secondary Sjögren’s syndrome refractory to methotrexate, leflunomide, certolizumab pegol, adalimumab, and tocilizumab (TCZ). However, 10 months after starting TCZ, the patient suffered a perforation secondary to PUK, requiring urgent surgical intervention. In the absence of infection, she was treated with boluses of intravenous methylprednisolone followed by oral prednisone at high doses in a decreasing pattern together with baricitinib at a dose of 2 mg/day with a very rapid and persistent favorable response to eye and joint symptoms. After 18 months of treatment, the patient had not presented serious side effects or signs of reactivation of her disease. In addition to this report, three other studies including one PUK associated with RA and two non-infectious scleritis treated with tofacitinib were included in this literature review. All three patients had experienced an insufficient response to conventional treatment, including biologic agents, before being switched to JAKINIB, leading to a complete or partial recovery in all of them without significant adverse effects so far. JAKINIBs (baricitinib and tofacitinib) may be an effective and safe therapy in patients with severe autoimmune and refractory ocular surface pathology, such as scleritis and PUK.
Health disparities in rheumatoid arthritis
Authors: Ciofoaia Elena I. , Pillarisetty Anjani , Constantinescu Florina
Published: November 2022

Rheumatoid arthritis (RA) is an autoimmune disease characterized by joint inflammation that involves symmetric polyarthritis of small and large joints. Autoimmune rheumatic diseases represent a significant socioeconomic burden as they are among the leading causes of death and morbidity due to increased risk of cardiovascular disease. Health disparities in patients with rheumatoid arthritis affect outcomes, prognosis, and management of the disease.
Central Bank Independence: A Pseudo de Facto Case of Reserve Bank of India
Authors: Bhat Aijaz Ahmad , Khan Javaid Iqbal
Published: November 2022

The trend of studies dealing with the correlation between central bank independence and inflation rose to prominence in the last twentieth century, 1980’s. These phenomena lead to development of certain empirical indices for measuring CBI across the countries. This study tries to evaluate the central bank independence in India using the index modelled on the lines of Jasmine Mona and Talla with minor modification regarding price stability objective. The study covers the time period from 1990–1991 till 2018–2019. The results found were that CBI has in India has more or less increased but improved significantly since the adoption of inflation targeting and formation of monetary policy committee post 2016.
Reconceptualization of Trochlear Dysplasia in Patients With Recurrent Patellar Dislocation Using 3-Dimensional Models
Authors: Yu Kristin E. , Cooperman Daniel R. , Schneble Christopher A. , McLaughlin William , Beitler Brian , Kaliney Ryan , Wang Annie , Fulkerson John P.
Published: November 2022

Background:

Common classification schemes, measurements, and surgical planning for trochlear dysplasia are predicated on 2-dimensional imaging views.

Purpose:

To investigate patellofemoral joint osseous anatomy using 3-dimensional (3D) printed models to describe osseous anatomic trochlear variations in patients with recurrent patellar dislocation.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Computed tomography scans were obtained from 20 patients with recurrent patellar dislocation and 10 healthy control knees, and 3D prints generated from these computed tomography scans were studied with respect to mediolateral positioning of the proximal trochlear groove and groove obliquity as well as changes in the appearance, height, and orientation of the medial and lateral trochlear ridges. Each trochlea was centered with respect to a vertical line perpendicular to the distal femoral condyles and through the central intercondylar notch roof, with the 3D models resting on their posterior femoral condyles. A novel 3D measurement method was devised to assess groove obliquity, termed the entry point–transition point (EP-TP) angle. The EP was defined as the midpoint of the flattened region of the proximal trochlea where the lateral and medial ridges of the proximal trochlea meet, and the TP was the point along the trochlear groove at which the groove shape changes from an oblique orientation proximally to one more vertical distally. Measurements were obtained by 3 reviewers, and reliability analyses were performed.

Results:

With the dysplastic knees arranged according to flattening of the trochleas, increased obliquity of the trochlear grooves was observed, as reflected by increased EP-TP angles as well as more lateral patellar EPs into the proximal trochleas of these recurrent patellar dislocation knees when compared with the control knees. The degree of trochlear dysplasia (according to the Dejour classification and trochlear flatness in the frontal and axial planes) was associated with diminished prominence of the lateral trochlear convexity, increasingly lateralized proximal trochlear EPs, increased trochlear groove obliquity, lateral trochlear curvature, and progressive medial ridge deformity.

Conclusion:

The 3D reproductions enabled unique conceptualization of trochlear deformity associated with recurrent patellar dislocation.
The Image of Nurses and Midwives in Ghana: Patient and Family Perspectives
Authors: Ohene Lillian Akorfa , Acheampong Angela Kwartemaa , Dzansi Gladys , Kyei Josephine , Adjei Charles Ampong , Adjorlolo Samuel , Asante Isabella Naana Akyaa , Woolley Philomena , Nyante Felix , Aziato Lydia
Published: November 2022

This study aims to explore the perceptions of patients and family caregivers on the image of nurses and midwives in Ghana. The study adopted a qualitative exploratory descriptive approach. A total of 25 participants were interviewed during data collection. Content and thematic analysis were applied in the data analysis to develop themes. The findings are captured under two major themes that describe the primary influences on participant images of nurses: Thus, (1) nurses’ and midwives’ attributes with four subthemes; staff appearance, communication strategies and behaviors, work attitudes, and professional competence and (2) patients’ status and subthemes were; uneducated poor and educated rich. We conclude that patients and families in Ghana recognize the professional attributes of the nurse and midwife, which reflect in their personality, grooming, communication, competencies, and attitudes. However, low publicity of the professional roles of nurses and midwives may have negative repercussions for their professional image. A policy to perform a regular public audit on the image of the Nurse/Midwife is important for professional advancement.
Nephroblastoma of the Big Child, a Rare Entity: About a Case
Authors: Cherraqi Amine , El Haddad Siham , Iraqi Houssaini Zaynab , Messaoud Ola , El Mohtarim Rihane , Lamalmi Najat , Elkababr Maria , Chat Latifa , Allali Nazik
Published: November 2022

Nephroblastoma is a renal blast tumor, the most common malignant renal tumor in children between 1 and 5 years of age. The average age of onset is 3.5 years, rarely occurring in children over 10 years of age. Its treatment is a model of medical-surgical collaboration. The prognostic factors are mainly the stage but recent studies have also shown that the advanced age of the child is a negative prognostic factor. We report a case of a 14-year-old child who presented with pain with swelling of the right hypochondrium, ultrasound showed a heterogeneous right retroperitoneal mass, MRI showed a large retroperitoneal tumor process with a right renal origin, in heterogeneous T2 signal, in T1 hyposignal, diffusion restricted, containing necrotic areas and heterogeneously enhancing after injection, responsible for pyelocalic dilatation and right renal venous thrombosis, extended to the IVC and the right atrium, with adenopathies, suggesting first a sarcoma. The extension workup showed pulmonary nodules of secondary appearance. An echo-guided biopsy was performed and the anatomopathological study confirmed the diagnosis of nephroblastoma.
Prolonged cardiac monitoring for stroke prevention: A systematic review and meta-analysis of randomized-controlled clinical trials
Authors: Tsivgoulis Georgios , Palaiodimou Lina , Triantafyllou Sokratis , Köhrmann Martin , Dilaveris Polychronis , Tsioufis Konstantinos , Magiorkinis Gkikas , Krogias Christos , Schellinger Peter D , Caso Valeria , Paciaroni Maurizio , Sharma Mukul , Lemmens Robin , Gladstone David J , Sanna Tommaso , Wachter Rolf , Filippatos Gerasimos , Katsanos Aristeidis H
Published: November 2022

Introduction:

Prolonged cardiac monitoring (PCM) substantially improves the detection of subclinical atrial fibrillation (AF) among patients with history of ischemic stroke (IS), leading to prompt initiation of anticoagulants. However, whether PCM may lead to IS prevention remains equivocal.

Patients and methods:

In this systematic review and meta-analysis, randomized-controlled clinical trials (RCTs) reporting IS rates among patients with known cardiovascular risk factors, including but not limited to history of IS, who received PCM for more than 7 days versus more conservative cardiac rhythm monitoring methods were pooled.

Results:

Seven RCTs were included comprising a total of 9048 patients with at least one known cardiovascular risk factor that underwent cardiac rhythm monitoring. PCM was associated with reduction of IS occurrence compared to conventional monitoring (Risk Ratio: 0.76; 95% CI: 0.59–0.96; I2 = 0%). This association was also significant in the subgroup of RCTs investigating implantable cardiac monitoring (Risk Ratio: 0.75; 95% CI: 0.58–0.97; I2 = 0%). However, when RCTs assessing PCM in both primary and secondary prevention settings were excluded or when RCTs investigating PCM with a duration of 7 days or less were included, the association between PCM and reduction of IS did not retain its statistical significance. Regarding the secondary outcomes, PCM was related to higher likelihood for AF detection and anticoagulant initiation. No association was documented between PCM and IS/transient ischemic attack occurrence, all-cause mortality, intracranial hemorrhage, or major bleeding.

Conclusion:

PCM may represent an effective stroke prevention strategy in selected patients. Additional RCTs are warranted to validate the robustness of the reported associations.
Sesamoid View X-ray vs Weightbearing Computed Tomography in the Measurement of Metatarsal Pronation Angle
Authors: Steadman Jesse , Siebert Matthew , Saltzman Charles L.
Published: November 2022

Category:

Bunion; Midfoot/Forefoot

Introduction/Purpose:

First metatarsal (M1) axial rotation as measured by the metatarsal pronation angle (MPA) has increasingly become recognized as a clinically relevant component of hallux valgus deformity and methods to realign the M1 in 3 dimensions have been developed. Preoperative imaging with weightbearing computed tomography (WBCT) is considered the best way to image and measure the MPA, however WBCT is not available to many foot and ankle surgeons. The aim of this project is to investigate if the MPA measured on sesamoid view weight bearing radiographs is similar to that measured on WBCT.

Methods:

A retrospective analysis of patient imaging studies was performed. We identified 25 feet with both sesamoid WBR and WBCT images from a consecutive patient database. Included subjects had no trauma or foot and ankle operation between acquisition of the two scans. MPA of the WBCT for each patient was initially measured. After an appropriate washout period, the observer then measured MPA of the WBR for the cohort. Demographic statistics were calculated, a paired t-test was performed to evaluate for any significant difference in angular measurement between the two scans.

Results:

Patient characteristics: mean age 53 +- 16 years, mean BMI 32 +- 8 kg/m2, 13 right and 12 left feet, 19 females and 6 males. Average time between sesamoid view WBR and WBCT was 5.7 +- 9.5 months. Mean difference in MPA between WBR and WBCT = 0.6 +- 3.9 degrees (p= 0.444, t=0.777).

Conclusion:

Among the cohort assessed, we found no significant difference present in the measurement of the metatarsal pronation angle as evaluated on sesamoid view weightbearing radiography compared with weightbearing computed tomography (Figure 1). Routine acquisition of a sesamoid view weightbearing radiograph may be considered as an appropriate substitute for weightbearing computed tomography in the preoperative evaluation of M1 rotation in the coronal plane. These findings may benefit physicians who do not have access to weightbearing computed tomography in their clinics.
A Clinical and Economic Evaluation of ORIF Management for Calcaneal Fractures with and without Adjunctive Umbilical Cord
Authors: Stewart Chris
Published: November 2022

Category:

Hindfoot

Introduction/Purpose:

The number of calcaneus fractures per year continues to increase in the United States, resulting in an increased number of open reduction and internal fixation (ORIF)procedures to repair these injuries. These surgeries are notorious for post-operative complications, including post-surgical wound healing problems that occur in 16 to 43% of patients. Umbilical cord (UC) allograft has anti-inflammatory and anti-scarring properties and has been shown to promote healing of cutaneous wounds. The objective of this study was to evaluate the clinical and economic outcomes related to wound complications after ORIF management of calcaneal fractures with and without adjunctive UC.

Methods:

A clinical and economic evaluation was performed based on information pertaining to ORIF management obtained from the published literature and our previous clinical data of ORIF for calcaneal fractures with (n=20) and without adjunctive UC (n=20).

Results:

After ORIF for calcaneal fractures, 10% of patients that received adjunctive UC required wound care compared to 35% of patients didn't receive the adjunctive treatment. Similarly, the readmission and reoperation rate were higher in the control group compared to the UC treatment group (30% vs 10%, respectively). Available cost-effectiveness data demonstrated that treatment with UC results in an average cost-savings of $2,775.50 per person over a five-year period (total cost of $330, 500 vs. $386,010 in the UC and control group, respectively). Using available data that includes costs incurred from time off work, adjunctive UC allograft treatment resulted in an average cost-savings of $14,377.50 per patient over a four-year period (total cost of $704,260 vs. $991,810 in the UC and control group, respectively).

Conclusion:

Wound complications remain a significant burden to patient recovery and an economic burden to payors and providers. Based on our observed complications rates, adjunctive use of UC during ORIF management of calcaneal fractures may not only decrease wound complications but also reduce socioeconomic costs.
Sequence Analysis and Structural Predictions of Lipid Transfer Bridges in the Repeating Beta Groove (RBG) Superfamily Reveal Past and Present Domain Variations Affecting Form, Function and Interactions of VPS13, ATG2, SHIP164, Hobbit and Tweek
Authors: Levine Tim P
Published: November 2022

Lipid transfer between organelles requires proteins that shield the hydrophobic portions of lipids as they cross the cytoplasm. In the last decade a new structural form of lipid transfer protein (LTP) has been found: long hydrophobic grooves made of beta-sheet that bridge between organelles at membrane contact sites. Eukaryotes have five families of bridge-like LTPs: VPS13, ATG2, SHIP164, Hobbit and Tweek. These are unified into a single superfamily through their bridges being composed of just one domain, called the repeating beta groove (RBG) domain, which builds into rod shaped multimers with a hydrophobic-lined groove and hydrophilic exterior. Here, sequences and predicted structures of the RBG superfamily were analyzed in depth. Phylogenetics showed that the last eukaryotic common ancestor contained all five RBG proteins, with duplicated VPS13s. The current set of long RBG protein appears to have arisen in even earlier ancestors from shorter forms with 4 RBG domains. The extreme ends of most RBG proteins have amphipathic helices that might be an adaptation for direct or indirect bilayer interaction, although this has yet to be tested. The one exception to this is the C-terminus of SHIP164, which instead has a coiled-coil. Finally, the exterior surfaces of the RBG bridges are shown to have conserved residues along most of their length, indicating sites for partner interactions almost all of which are unknown. These findings can inform future cell biological and biochemical experiments.
Multi-criteria optimization of micro-hole on glass using developed µ-abrasive jet machine set-up
Authors: Vanmore Vinod V. , Dabade Uday A.
Published: November 2022

In non-traditional machining, micro-abrasive jet machining (MAJM) is a cost-effective machining process. MAJM has been used for fabricating electronic devices and microfluidic channels. This work has made an effort to utilize MAJM for glass. A new design and fabrication of the Laval type of nozzle have been proposed to improve machining accuracy. A nozzle is conceived to ensure specific characteristics of the mixture (compressed air and abrasive particles) pass through it. The abrasive particle force is converted to kinetic energy, increasing the mixture’s velocity. The cross-sectional area of the nozzle can be circular, rectangular, square, or oval. A circular cross-sectional nozzle has been developed for high velocity, precise etching, and patterning on difficult-to-machine materials such as steel alloys. A circular cross-sectional micro-nozzle with a large aspect ratio is proposed, and the flow characteristics and cutting performance are examined precisely by the experiment. Efforts are being made to make machining processes sustainable, productive, and efficient. Here, the Taguchi-grey relational analysis integration approach has been used to analyze the machining parameters such as air pressure, stand-off distance, and abrasive mesh size (AMS). The top hole diameter, bottom hole diameter, material removal rate, and radial overcut are the response variables in this investigation. Analysis of variance (ANOVA) results showed that the AMS was the most efficient parameter, which followed the processing condition on the total input of the multi-purpose function. The reported optimized process parameters are air pressure of 8 bar, stand-off distance of 2 mm, and AMS mix (50%+100%) micron, which significantly affects the top and bottom micro-hole diameters.
From the Henderson Poverty Inquiry to the Cashless Debit Card: Alternatives to the Reframing of Poverty as Welfare Dependency in Australia
Authors: Mendes Philip
Published: November 2022

The recent announcement of a Senate inquiry into the ‘extent and nature of poverty in Australia’ reminds us that poverty policy in Australia has long been a contested concept in terms of identification of causes and potential solutions. The 1972–1975 Henderson Commission of Inquiry into Poverty led by Ronald Henderson arguably represented the high point of Australian poverty research and policy discourse. That inquiry established a framework for measuring poverty based on a link to the minimum wage, and incorporating housing costs which has informed all subsequent research.
Reactive Arthritis after BCG Therapy in Bladder Carcinoma
Authors: Anwar Saajid , Agarwal Anoushka , Velammal P. , Menon Sujaya
Published: November 2022

Bladder cancer is a common malignancy in women and is the fourth most common malignancy in men. Bladder cancer ranges from nonaggressive and usually noninvasive tumors that recur and require long-term invasive follow-up to aggressive and invasive tumors with high disease-specific mortality. Bacillus Calmette Guerin (BCG) intravesical immunotherapy, a vaccine derived from attenuated Mycobacterium strains - Bovis is one of the most effective bladder cancer therapies currently available. Reactive arthritis has occurred in between 0.5% and 1% of bladder cancer patients treated with intravesical BCG immunotherapy. Here, we present a 66-year-old man diagnosed with urothelial carcinoma undergoing intravesical BCG therapy with high-grade fever and polyarthralgia.
Synovial fluid pH is as specific as synovial leukocyte count but less sensitive for the diagnosis of chronic prosthetic joint infection
Authors: Theil Christoph , Ackmann Thomas , Gosheger Georg , Puetzler Jan , Moellenbeck Burkhard , Schwarze Jan , Schulze Martin , Klingebiel Sebastian
Published: November 2022

Background

Synovial fluid markers (synovial leukocyte count and differential) have been shown to be most accurate in diagnosing prosthetic joint infection (PJI). An inverse correlation for synovial leukocyte count and synovial pH is known assuming that leukocyte metabolism causes synovial fluid acidosis. This study’s purpose is to analyze the use of synovial pH as a potential diagnostic marker for PJI.

Materials and methods

92 patients who presented with painful total joint arthroplasty (TJA) of the hip (THA; n = 25) or knee (TKA, n = 67) were prospectively investigated. In our cohort 33% (30/92) had PJI and 67% (62/92) were diagnosed non-infected based on the modified Musculoskeletal Infection Society (MSIS) criteria of 2018. Receiver operating curves and the Youden’s index were used to define an ideal cut-off value for synovial pH and the sensitivity and specificity were calculated using cross-tables. Additionally, the sensitivity and specificity were calculated for synovial white blood cell (WBC) count (cut-off > 3000 leukocytes) and percentage of neutrophils (PMN%, cut-off > 80%).

Results

The median synovial pH level was significantly lower in the group with chronic PJI compared to implants with aseptic failure (7.09 vs. 7.27; p < 0.001). The calculated optimal cut-off value was 7.11 (AUC 0.771) with a sensitivity of 53% and specificity of 89%. However, the sensitivity and specificity of synovial WBC count were 90% and 88% and for synovial PMN% 73% and 98%, respectively.

Conclusion

Synovial pH may be a useful adjunct parameter in the diagnosis of chronic PJI after hip or knee arthroplasty, but showed low sensitivity in this preliminary cohort. Future studies with larger numbers are needed.

Level of evidence

2a, diagnostic study.

Trial registration German Clinical Trials Register (Registration number: DRKS00021038).
H3AGWAS: a portable workflow for genome wide association studies
Authors: Brandenburg Jean-Tristan , Clark Lindsay , Botha Gerrit , Panji Sumir , Baichoo Shakuntala , Fields Christopher , Hazelhurst Scott
Published: November 2022

Background

Genome-wide association studies (GWAS) are a powerful method to detect associations between variants and phenotypes. A GWAS requires several complex computations with large data sets, and many steps may need to be repeated with varying parameters. Manual running of these analyses can be tedious, error-prone and hard to reproduce.

Results

The H3AGWAS workflow from the Pan-African Bioinformatics Network for H3Africa is a powerful, scalable and portable workflow implementing pre-association analysis, implementation of various association testing methods and post-association analysis of results.

Conclusions

The workflow is scalable—laptop to cluster to cloud (e.g., SLURM, AWS Batch, Azure). All required software is containerised and can run under Docker or Singularity.
Comprehensive analysis of TCGA data reveals correlation between DNA methylation and alternative splicing
Authors: Lin Shuting , Yi Soojin , Qiu Peng
Published: November 2022

The effect of DNA methylation on the regulation of gene expression has been extensively discussed in the literature. However, the potential association between DNA methylation and alternative splicing is not understood well. In this study, we integrated multiple omics data types from The Cancer Genome Atlas (TCGA) and systematically examined the relationship between DNA methylation and alternative splicing. Using the methylation data and exon expression data, we identified many CpG sites significantly associated with exon expression in various types of cancers. We further observed that the direction and strength of significant CpG-exon correlation tended to be consistent across different cancer contexts, indicating that some CpG-exon correlation patterns reflect fundamental biological mechanisms that transcend tissue- and cancer- types. We also discovered that CpG sites correlated with exon expressions were more likely to be associated with patient survival outcomes compared to CpG sites that did not correlate with exon expressions. Furthermore, we found that CpG sites were more strongly correlated with exon expression than expression of isoforms harboring the corresponding exons. This observation suggests that a major effect of CpG methylation on alternative splicing may be related to the inclusion or exclusion of exons, which subsequently impacts the relative usage of various isoforms. Overall, our study revealed correlation patterns between DNA methylation and alternative splicing, which provides new insights into the role of methylation in the transcriptional process.
Genome-wide association study and genetic mapping of BhWAX conferring mature fruit cuticular wax in wax gourd
Authors: Yan Jinqiang , Chen Feng , Sun Piaoyun , Liu Wenrui , Xie Dasen , Qian Yulei , Jiang Biao
Published: November 2022

Background

Wax gourd [Benincasa hispida (Thunb) Cogn. (2n = 2x = 24)] is an economically important vegetable crop of genus Benincasa in the Cucurbitaceae family. Fruit is the main consumption organ of wax gourd. The mature fruit cuticular wax (MFCW) is an important trait in breeding programs, which is also of evolutionary significance in wax gourd. However, the genetic architecture of this valuable trait remains unrevealed.

Results

In this study, genetic analysis revealed that the inheritance of MFCW was controlled by a single gene, with MFCW dominant over non-MFCW, and the gene was primarily named as BhWAX. Genome-wide association study (GWAS) highlighted a 1.1 Mb interval on chromosome 9 associated with MFCW in wax gourd germplasm resources. Traditional fine genetic mapping delimited BhWAX to a 0.5 Mb region containing 12 genes. Based on the gene annotation, expression analysis and co-segregation analysis, Bhi09G001428 that encodes a membrane bound O-acyltransferase (MBOAT) was proposed as the candidate gene for BhWAX. Moreover, it was demonstrated that the efficiency of a cleaved amplified polymorphic sequences (CAPS) marker in the determination of MFCW in wax gourd reached 80%.

Conclusions

In closing, the study identified the candidate gene controlling MFCW and provided an efficient molecular marker for the trait in wax gourd for the first time, which will not only be beneficial for functional validation of the gene and marker-assisted breeding of wax gourd, but also lay a foundation for analysis of its evolutionary meaning among cucurbits.
The association between dietary total antioxidant capacity and odds and severity of irritable bowel syndrome among Iranian adults: a cross-sectional study
Authors: Saneie Solaleh , Aminianfar Azadeh , Shidfar Farzad , Keshteli Ammar Hassanzadeh , Esmaillzadeh Ahmad , Adibi Peyman
Published: November 2022

Background

Little evidence is available in terms of the role of dietary antioxidants in the management of irritable bowel syndrome (IBS) disease. This study aimed to examine the association between dietary total antioxidant capacity (dTAC) and odds of IBS and its severity.

Methods

This cross-sectional study was conducted on 3,362 Iranian adults who were referred to health centers in Isfahan province, Iran. Participants' dietary intakes were collected using a semi-quantitative validated food frequency questionnaire (DS-FFQ). The dTAC was measured by the ferric-reducing antioxidant power (FRAP) method. Multivariable binary or ordinal logistic regression analyses were performed to estimate any associations between dTAC and odds of IBS, IBS severity, and IBS subtypes.

Results

The average age and BMI of the participants and dTAC score were 36.3 ± 7.87 year, 24.9 ± 3.82 kg/m2. The prevalence of IBS, IBS with constipation (IBS-C), IBS with diarrhoea (IBS-D), mixed IBS (IBS-M), and un-subtyped IBS (IBS-U) were 22.2, 7.5, 4.6, 3.8, and 6.2%, respectively. In crude and adjusted models, the results did not show any significant association between dTAC and odds of IBS among whole and gender-age stratified populations. Being in the third compared with the first tertile of dTAC was not also significantly associated with odds of IBS severity. Besides, there were no significant associations between dTAC and odds of IBS-C, IBS-D, IBS-M, and IBS-U.

Conclusion

This study indicates that dTAC may not be associated with the odds of IBS and its severity even after stratification for gender and body mass index.
Adverse outcomes after non-hepatic surgeries in patients with alcoholic liver diseases: a propensity-score matched study
Authors: Wu Hsin-Yun , Chang Chuen-Chau , Yeh Chun-Chieh , Chen Ming-Yao , Cherng Yih-Giun , Chen Ta-Liang , Liao Chien-Chang
Published: November 2022

Background

The influence of alcoholic liver disease (ALD) on the postoperative outcomes is not completely understood. Our purpose is to evaluate the complications and mortality after nonhepatic surgeries in patients with ALD.

Methods

We conducted a retrospective cohort study included adults aged 20 years and older who underwent nonhepatic elective surgeries using data of Taiwan’s National Health Insurance, 2008–2013. Using a propensity-score matching procedure, we selected surgical patients with ALD (n = 26,802); or surgical patients without ALD (n = 26,802) for comparison. Logistic regression was used to calculate the odds ratios (ORs) and 95% confidence intervals (CIs) of postoperative complications and in-hospital mortality associated with ALD.

Results

Patients with ALD had higher risks of acute renal failure (OR 2.74, 95% CI 2.28–3.28), postoperative bleeding (OR 1.64, 95% CI 1.34–2.01), stroke (OR 1.51, 95% CI 1.34–1.70) septicemia (OR 1.47, 95% CI 1.36–1.58), pneumonia (OR 1.43, 95% CI 1.29–1.58), and in-hospital mortality (OR 2.64, 95% CI 2.24–3.11) than non-ALD patients. Patients with ALD also had longer hospital stays and higher medical expenditures after nonhepatic surgical procedures than the non-ALD patients. Compared with patients without ALD, patients with ALD who had jaundice (OR 4.82, 95% CI 3.68–6.32), ascites (OR 4.57, 95% CI 3.64–5.74), hepatic coma (OR 4.41, 95% CI 3.44–5.67), gastrointestinal hemorrhage (OR 3.84, 95% CI 3.09–4.79), and alcohol dependence syndrome (OR 3.07, 95% CI 2.39–3.94) were more likely to have increased postoperative mortality.

Conclusion

Surgical patients with ALD had more adverse events and a risk of in-hospital mortality after nonhepatic surgeries that was approximately 2.6-fold higher than that for non-ALD patients. These findings suggest the urgent need to revise the protocols for peri-operative care for this population.
Efficacy and safety of heparin plus dexamethasone after partial splenic embolization for liver cirrhosis with massive splenomegaly
Authors: Lu Haohao , Zheng Chuansheng , Xiong Bin , Xia Xiangwen
Published: November 2022

Purpose

The aim of this study was to investigate the efficacy and safety of the combination of low-molecular-weight heparin + dexamethasone after partial splenic embolization in cirrhotic patients with massive splenomegaly.

Methods

This study included 116 patients with liver cirrhosis complicated with massive splenomegaly who underwent PSE in Union Hospital from January 2016 to December 2019, and they met the criteria. They were divided into two groups: PSE + Hep + Dex group (N = 54) and PSE group (N = 62). We conducted a retrospective study to analyze the efficacy and safety of the two groups of patients.

Results

The volume of splenic embolization was 622.34 ± 157.06 cm3 in the PSE + Hep + DEX group and 587.62 ± 175.33 cm3 in the PSE group (P = 0.306). There was no statistically difference in the embolization rate of the spleen between the two groups (P = 0.573). WBC peaked 1 week after PSE and PLT peaked 1 month after PSE in both groups; it gradually decreased later, but was significantly higher than the preoperative level during the 12-month follow-up period. The incidences of abdominal pain (46.3% vs 66.1%, P = 0.039), fever (38.9% vs 75.8%, P < 0.001), PVT (1.9% vs 12.9%, P = 0.026), refractory ascites (5.6% vs 19.4%, P = 0.027) were lower in the PSE + Hep + DEX group than in the PSE group. The VAS score of abdominal pain in PSE group was higher than that in PSE + Hep + DEX group on postoperative days 2–8 (P < 0.05). Splenic abscess occurred in 1(1.6%) patient in the PSE group and none (0.0%) in the PSE + Hep + DEX group (P = 0.349).

Conclusions

The combined use of dexamethasone and low-molecular-weight heparin after PSE is a safe and effective treatment strategy that can significantly reduce the incidence of complications after PSE (such as post-embolization syndrome, PVT, refractory ascites).
Nurses’ competence in recognition and management of delirium in older patients: development and piloting of a self-assessment tool
Authors: Hoch Jonas , Bauer Jürgen M. , Bizer Martin , Arnold Christine , Benzinger Petra
Published: November 2022

Background

Delirium is a common condition in elderly inpatients. Health care professionals play a crucial role in recognizing delirium, initiating preventive measures and implementing a multicomponent treatment strategy. Yet, delirium often goes unrecognized in clinical routine. Nurses take an important role in preventing and managing delirium. This study assesses clinical reasoning of nurses using case vignettes to explore their competences in recognizing, preventing and managing delirium.

Methods

The study was conducted as an online survey. The questionnaire was based on five case vignettes presenting cases of acutely ill older patients with different subtypes of delirium or diseases with overlapping symptoms. In a first step, case vignettes were developed and validated through a multidisciplinary expert panel. Scoring of response options were summed up to a Geriatric Delirium Competence Questionnaire (GDCQ) score including recognition and management tasks The questionnaire was made available online. Descriptive analyses and group comparisons explores differences between nurses from different settings. Factors explaining variance in participants’ score were evaluated using correlations and linear regression models.

Results

The questionnaire demonstrated good content validity and high reliability (kappa = 0.79). The final sample consisted of 115 nurses. Five hundred seventy-five case vignettes with an accuracy of 0.71 for the correct recognition of delirium presence or absence were solved. Nurses recognized delirium best in cases describing hyperactive delirium (79%) while hypoactive delirium was recognized least (44%). Nurses from geriatric and internal medicine departments had significantly higher GDCQ-score than the other subgroups. Management tasks were correctly identified by most participants.

Conclusions

Overall, nurses’ competence regarding hypoactive delirium should be strengthened. The online questionnaire might facilitate targeting training opportunities to nurses’ competence.
Cross-cultural adaptation of the Taiwan Chinese version of the Falls Efficacy Scale-International for community-dwelling elderly individuals
Authors: Chang Kai-Chieh , Chen Hsin-Shui , Horng Yi-Shiung , Liou Horng-Hui , Liang Huey-Wen
Published: November 2022

Background

The Falls Efficacy Scale-International (FES-I) is a commonly used questionnaire to evaluate concerns about falling. We adapted a Taiwan Chinese version (FES-ITC) and evaluated its reliability and validity in community-dwelling elderly individuals. The discriminative validity was tested in relation to several known risk factors for fear of falling (FOF).

Methods

The questionnaire was adapted through translation, back-translation, and expert review processes. A convenience sample of 135 community-dwelling elderly individuals (at least 60 years old) completed the adapted questionnaire, and 31 of them had a retest within 7–10 days. Cronbach’s α and an intraclass correlation coefficient (ICC) were used to evaluate the internal consistency and test–retest reliability. Principal component factor analysis was performed to assess the factor-construct validity. The discriminative validity was tested in relation to demographic features, fall-related history and performances on three functional tests: timed up and go, four-stage balance and 30-s chair stand tests. Effect sizes were computed. Correlation coefficients between physical functional performance and FES-ITC scores were computed. Receiver operating characteristic curves were used to determine the cutoff point for the score to differentiate high and low concern of falling.

Results

The FES-ITC questionnaire had high internal consistency (Cronbach’s α = 0.94) and excellent test–retest reliability (ICC = 0.94). Principal component factor analysis yielded a two-factor model, with several items requiring high demand on postural control loading on factor 2. FES-ITC scores discriminated individuals with different ages, reporting FOF, reporting falls in the past year and using walking aids. However, FES-ITC scores did not differ between the participants who were at risk of falling and those who were not at risk based on functional test performance and there was no correlation found between them.

Conclusion

The FES-ITC was highly reliable and had adequate construct and discriminative validity. The lack of correlation between FES-ITC scores and functional test performance implied the presence of FOF even in individuals with good functional performance. Further follow up studies are warranted to verify the predictive validity of the FES-ITC.
Carotid artery corrected flow time and respiratory variations of peak blood flow velocity for prediction of hypotension after induction of general anesthesia in elderly patients
Authors: Wang Ji , Li Yulan , Su Hang , Zhao Juan , Tu Faping
Published: November 2022

Background

Postinduction hypotension is closely related to postoperative complications. Elderly patients with compromised cardiovascular compensatory reserve are more susceptible to hypotension after induction of general anesthesia. This study investigated whether the carotid artery corrected flow time (FTc) and respiratory variation of peak blood flow velocity in the common carotid artery (ΔVpeak) could predict postinduction hypotension in elderly patients.

Methods

This prospective observational study included elderly patients aged 65 to 75 who were scheduled for elective surgery under general anesthesia with ASA physical status class of I-II, without cardiovascular disease, hypertension, diabetes, or obesity. Anesthesia was induced by midazolam, sufentanil, and etomidate and was maintained by sevoflurane. The carotid artery FTc and ΔVpeak were measured by ultrasound before induction of anesthesia. Hemodynamic data were recorded before induction and then during the first 10 min after induction.

Results

Ninety-nine patients were included in the final analysis, of whom 63 developed postinduction hypotension. The area under the receiver operating characteristic curves was 0.87 (0.78 to 0.93) for carotid artery FTc and 0.67 (0.56 to 0.76) for ΔVpeak, respectively. The optimal cutoff value for predicting postinduction hypotension was 379.1 ms for carotid artery FTc, with sensitivity and specificity of 72.2 and 93.7%, respectively. The best cutoff value was 7.5% for ΔVpeak, with sensitivity and specificity of 55.6 and 75.0%, respectively.

Conclusions

The carotid artery FTc is a reliable predictor of postinduction hypotension in elderly patients with ASA status of I or II, without cardiovascular disease, hypertension, diabetes, or obesity. Elderly patients with a carotid artery FTc less than 379.1 ms before anesthesia have a higher risk of postinduction hypotension.

Trial registration

Clinical Trial Registry on August 2nd, 2020 (www.chictr.org.cn; ChiCTR2000035190).
The effect of calcineurin inhibitors on anthropometric measurements in kidney transplant recipients
Authors: Sayilar Emel Isiktas , Ersoy Alparslan , Ersoy Canan , Oruc Aysegul , Ayar Yavuz , Sigirli Deniz
Published: November 2022

Background

This study was designed to investigate the effect of calcineurin inhibitors (CNIs), cyclosporine (CsA), and tacrolimus (Tac) on anthropometrics in kidney transplant recipients.

Methods

111 of 128 adult kidney transplant recipients who received post-transplant CNIs were included in this retrospective study. Anthropometrics were recorded in the pre-transplant and post-transplant 4-year follow-up periods (1st, 3rd, 6th, 12th, 24th, 36th and 48th months).

Results

Compared to pre-transplant values, significant increases in body weight and body mass index (between 3rd and 48th months), waist and hip circumferences (between 1st and 48th months), waist-to-hip ratio (between 1st and 3rd or 6th months) and neck circumference (between 1st and 12th or 24th months) were observed in both CsA and Tac groups. A significant increase was noted in post-transplant body fat percentage values for the 3rd to 24th months in the CsA group, whereas for the 24th to 48th months in both CsA and Tac groups. Hip circumferences percentage changes from the pre-transplant period to the 1st, 12th and 24th months were significantly higher in CsA than in the Tac group. At each time point, there was no significant difference in percentage changes for other anthropometric parameters between the CsA and Tac groups. De novo diabetes mellitus developed in 8.3% of the CsA group and 19.1% of the Tac group.

Conclusions

After a successful kidney transplant, anthropometric measurements increase in most recipients. Although the effect of calcineurin inhibitor type on weight gain is unclear, a regression analysis showed that CNI type was not a risk factor for the development of obesity in the 48th month. However, it is helpful to be cautious about its dyslipidemic effect in patients using CsA and the potential hazards of using Tac in patients with a diabetic predisposition.
The effectiveness of skilled breathing and relaxation techniques during antenatal education on maternal and neonatal outcomes: a systematic review
Authors: Leutenegger Vanessa , Grylka-Baeschlin Susanne , Wieber Frank , Daly Deirdre , Pehlke-Milde Jessica
Published: November 2022

Background

Several studies have investigated the relationship between antenatal education classes and pregnancy outcomes. These studies have shown positive effects on mothers, such as a lower epidural rate in the intervention groups. However, until now, the impact on outcomes for mothers and newborns of antenatal education classes that focus on breathing and relaxation techniques has not been examined.

Aim

Investigate the effects of skilled breathing and relaxation techniques provided in antenatal education classes on maternal and neonatal birth outcomes.

Methods

The protocol for this study was registered with PROSPERO (ID: CRD42020192289). A systematic literature search was undertaken and completed in January 2022, using the databases MEDLINE, CINAHL, clinicalTrials.gov, Cochrane Library, Embase and MIDIRS according to a priori formulated PICO criteria: population (pregnant women), intervention (antenatal education classes with integrated breathing and relaxation techniques), comparison (antenatal education classes that do not include skilled breathing and relaxation techniques), and outcome (maternal and neonatal outcomes). The quality of the studies was assessed by two reviewers using the standardised instruments RoB 2 and ROBINS-I.

Results

Ten studies were included in this review, nine randomised controlled trials and one quasi-experimental study. The results indicate that skilled breathing and relaxation techniques may positively influence self-efficacy, the need for pharmacological support, specifically the use of epidural anaesthesia, and the memory of labour pain. No effects were found in relation to predefined neonatal outcomes. The quality of evidence on maternal and neonatal outcomes is inconsistent across studies, as different antenatal education classes with varying interventions, including breathing and relaxation techniques, were offered in the studies.

Conclusions

Women who attended an antenatal education class with breathing and relaxation techniques appear to benefit from the intervention. This applies to the practical implementation and use of breathing and relaxation techniques during labour, increased self-confidence and self-efficacy, and a increased feeling of being in control during labour. This demonstrates the importance of information provision and a focus on breathing and relaxation techniques in antenatal education.