bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Achieving the Patient Acceptable Symptomatic State at Minimum 5-Year Follow-up Following Primary Hip Arthroscopy in the Adolescent Athlete
Authors: Jimenez Andrew E. , Glein Rachel M. , Owens Jade S. , Lee Michael S. , Maldonado David R. , Saks Benjamin R. , Lall Ajay C. , Domb Benjamin G.
Published: December 2021

Background:

Predictors of outcomes in adolescent athletes undergoing hip arthroscopy have not been established. The purpose of this study was to identify factors correlated with achieving the Patient Acceptable Symptomatic State (PASS) for the Hip Outcome Score-Sports Specific Subscale (HOS-SSS) at a minimum 5-year follow-up in adolescent athletes undergoing primary hip arthroscopy.

Methods:

Data were reviewed on adolescent (below 18 y old) athletes who underwent primary hip arthroscopy for femoroacetabular impingement syndrome between March 2008 and October 2015. Patients were included if they participated in sport within 1 year before surgery and had preoperative, 2-year, and minimum 5-year postoperative patient-reported outcome (PRO) scores for the modified Harris Hip Score, HOS-SSS, Visual Analog Scale for pain (VAS), and Non-Arthritic Hip Score (NAHS). Patients were divided into 2 groups based on whether they achieved PASS for HOS-SSS. Demographics, intraoperative findings, radiographic variables, surgical treatments, and PRO were compared. Multivariate logistic regression with corresponding odds ratios (ORs) quantified the correlation between variables and achievement of the PASS.

Results:

A total of 123 athletes with a mean age of 16.2±1.1 years were included. These athletes demonstrated significant imrpovement from preoperative to minimum 5-year follow-up for all recorded PROs (P<0.001). The multivariate logistic regression model identified preoperative NAHS (P=0.019, OR: 1.033), 2-year postoperative HOS-SSS (P=0.014, OR: 1.037), and 2-year postoperative VAS (P=0.003, OR: 0.590) as statistically significantly correlated with achieving the PASS. Athletes with a 2-year postoperative VAS pain score ≤2 achieved PASS at a rate of 81.9%, while those with a score >2 achieved PASS at a rate of 24.1% (P<0.001, OR: 14.2, 95% confidence interval: 5.23-38.7).

Conclusions:

Favorable outcome were achieved at mid-term follow-up in adolescent athletes undergoing primary hip arthroscopy. Preoperative NAHS, 2-year postoperative HOS-SSS, and 2-year postoperative VAS pain scores were correlated with achieving the PASS for HOS-SSS at a minimum 5-year follow-up. Patients with 2-year postoperative VAS ≤2 were significantly more likely to achieve the PASS at 5-year follow-up than those with scores >2.

Level of Evidence:

Level III—case-control study.
Retrograde Application of Humerus Fassier-Duval Rod in Osteogenesis Imperfecta: A New Surgical Technique
Authors: Marwan Yousef , Abu Dalu Khaled , Hamdy Reggie C. , Janelle Chantal , Fassier Francois
Published: December 2021

Background:

The aim of this study is to describe the technique of retrograde application of Fassier-Duval (FD) rod for the humerus in patients with osteogenesis imperfecta (OI). This technique was developed to overcome the downsides of the previously used techniques of humerus rodding.

Methods:

The study was done at a tertiary care pediatric orthopaedic hospital from April 2014 to August 2021. Skeletally immature patients with OI who underwent retrograde FD rodding were included. This surgery was performed for humeral shaft fractures/bowing limited to the distal half of the bone to ensure appropriate stability of the fixation. Surgical technique of the procedure is described in detail.

Results:

Six patients with OI, of which 2 (33.3%) had FD rodding bilaterally, were included. The mean age at rodding was 7.6±3.5 (range: 3 to 14) years. The mean duration of postoperative follow-up was 45.5±18.0 (range: 24 to 75) months. All patients had full healing of the fracture/osteotomy, with functional alignment of their humeri. No surgical complications were observed; however, 1 (12.5%) segment only had a traumatic humerus fracture following a fall that was associated with rod migration, occurring 60 months postoperatively. This was treated with a retrograde FD rodding again, with fracture augmentation with plate and screws.

Conclusions:

The retrograde FD rodding technique of the humerus in OI patients is relatively simple and preserves the soft tissue surrounding the shoulder joint, with favorable outcomes. Studies with larger sample size and long-term follow-up duration are needed.

Level of Evidence:

Level IV—case series.
Novel Uses of Traditional Algorithms for Septic Arthritis
Authors: Nickel Amanda J. , Bretscher Brianna S. , Truong Walter H. , Laine Jennifer C. , Kharbanda Anupam B.
Published: December 2021

Background:

Pediatric musculoskeletal infection (MSKI) is a bacterial infection of the bone, joint, and/or muscle that can be difficult to diagnose. The Kocher and Caird algorithms were developed to distinguish septic arthritis (SA) from transient synovitis (TS) in the hip. These algorithms have been applied to all patients presenting with painful, swollen monoarticular joints regardless of suspicion for SA. The aim of this analysis was to assess the test performance of Kocher and Caird to distinguish MSKI among all pediatric patients presenting with monoarticular joint pain. A secondary aim was to validate the original algorithms.

Methods:

We conducted a secondary analysis of a prospective cohort study evaluating the test performance of procalcitonin for suspected SA in a pediatric emergency department. Patients aged 0 to 16 years old who presented with a painful or swollen monoarticular joint were considered for enrollment. We compared the test performance of the traditional algorithms in an expanded population of MSKI versus alternate joint pain using sensitivity, specificity, and area under the curve (AUC). As a sensitivity analysis, missing data for predictors like temperature, erythrocyte sedimentation rate, C-reactive protein, and inability to bear weight were multiply imputed using the Stata program, mi impute, for changed equations.

Results:

The Caird algorithm had better test performance compared to the Kocher in all populations. Both algorithms were most discriminative in comparing SA to TS in all joints (AUC: 0.84 Caird and 0.75 Kocher). However, the Caird criteria performed almost as well discriminating MSKI from other causes of monoarticular joint pain in all joints (AUC: 0.79; 95% confidence interval: 0.72, 0.85) and nonhip joints (AUC: 0.80; 95% confidence interval: 0.71, 0.88).

Conclusion:

Based on the findings of this study, it is clinically reasonable to apply the Caird algorithm to pediatric patients presenting with monoarticular joint pain of medium and large joints such as the knee, ankle, shoulder, elbow, and wrist, in addition to the hip.

Level of Evidence:

Level III—retrospective study of novel applications of SA algorithms.
Pediatric Back Pain: A Scoring System to Guide Use of Magnetic Resonance Imaging
Authors: Nolte Michael T. , Harada Garrett K. , LeDuc Ryan , Sayari Arash J. , Basques Bryce A. , Louie Philip K. , Colman Matthew W. , Goldberg Edward J. , DeWald Christopher J. , Phillips Frank M. , Kogan Monica , An Howard S. , Samartzis Dino
Published: December 2021

Background:

The prevalence of back pain in the pediatric population is increasing, and the workup of these patients presents a clinical challenge. Many cases are selflimited, but failure to diagnose a pathology that requires clinical intervention can carry severe repercussions. Magnetic resonance imaging (MRI) carries a high cost to the patient and health care system, and may even require procedural sedation in the pediatric population. The aim of this study was to develop a scoring system based on pediatric patient factors to help determine when an MRI will change clinical management.

Methods:

This is a retrospective cohort analysis of consecutive pediatric patients who presented to clinic with a chief complaint of back pain between 2010 and 2018 at single orthopaedic surgery practice. Comprehensive demographic and presentation variables were collected. A predictive model of factors that influence whether MRI results in a change in management was then generated using cross-validation least absolute shrinkage and selection operator logistic regression analysis.

Results:

A total of 729 patients were included, with a mean age of 15.1 years (range: 3 to 20 y). Of these, 344 (47.2%) had an MRI. A predictive model was generated, with nocturnal symptoms (5 points), neurological deficit (10 points), age (0.7 points per year), lumbar pain (2 points), sudden onset of pain (3.25 points), and leg pain (3.75 points) identified as significant predictors. A combined score of greater than 9.5 points for a given patient is highly suggestive that an MRI will result in a change in clinical management (specificity: 0.93; positive predictive value: 0.92).

Conclusions:

A predictive model was generated to help determine when ordering an MRI may result in a change in clinical management for workup of back pain in the pediatric population. The main factors included the presence of a neurological deficit, nocturnal symptoms, sudden onset, leg pain, lumbar pain, and age. Care providers can use these findings to better determine if and when an MRI might be appropriate.

Level of Evidence:

Level III—diagnostic study.
Faith Community Nurses as Health Leaders During a Pandemic
Authors: Hellman Ann N.
Published: December 2021

In the face of a public health emergency, nurses, particularly those serving faith communities, need to understand and live out their roles in adhering to evidence-based practice while demonstrating grace and obedience to Scripture. Serving as public health role models and advocates, nurses in faith communities can inform and support church leaders in following government directives for the common good. Applicable Scripture, ethical, and research considerations are presented.
Together in Christ
Authors: Roney Linda , Merino Samantha , Murray Rev. John P. , Kazer Meredith
Published: December 2021

The StagsCare program at a Christian university offered support to recent nursing graduates and other alumni during the early days of the COVID-19 pandemic. Faculty of the Egan School of Nursing and Health Studies created the StagsCare program, providing opportunity for alumni spanning over 20 class years to join in community for prayer, reflection, and shared experience. Both new and seasoned nurses, most of whom did not know one another, offered support to one another and strengthened their spiritual foundations as they served on the frontlines of the pandemic across the United States.
Human exposome assessment platform
Authors: Merino Martinez Roxana , Müller Heimo , Negru Stefan , Ormenisan Alex , Arroyo Mühr Laila Sara , Zhang Xinyue , Trier Møller Frederik , Clements Mark S. , Kozlakidis Zisis , Pimenoff Ville N. , Wilkowski Bartlomiej , Boeckhout Martin , Öhman Hanna , Chong Steven , Holzinger Andreas , Lehtinen Matti , van Veen Evert-Ben , Bała Piotr , Widschwendter Martin , Dowling Jim , Törnroos Juha , Snyder Michael P. , Dillner Joakim
Published: December 2021

The Human Exposome Assessment Platform (HEAP) is a research resource for the integrated and efficient management and analysis of human exposome data. The project will provide the complete workflow for obtaining exposome actionable knowledge from population-based cohorts. HEAP is a state-of-the-science service composed of computational resources from partner institutions, accessed through a software framework that provides the world’s fastest Hadoop platform for data warehousing and applied artificial intelligence (AI). The software, will provide a decision support system for researchers and policymakers. All the data managed and processed by HEAP, together with the analysis pipelines, will be available for future research. In addition, the platform enables adding new data and analysis pipelines. HEAP’s final product can be deployed in multiple instances to create a network of shareable and reusable knowledge on the impact of exposures on public health.
Pre-operative fasting in children
Authors: Frykholm Peter , Disma Nicola , Andersson Hanna , Beck Christiane , Bouvet Lionel , Cercueil Eloise , Elliott Elizabeth , Hofmann Jan , Isserman Rebecca , Klaucane Anna , Kuhn Fabian , de Queiroz Siqueira Mathilde , Rosen David , Rudolph Diana , Schmidt Alexander R. , Schmitz Achim , Stocki Daniel , Sümpelmann Robert , Stricker Paul A. , Thomas Mark , Veyckemans Francis , Afshari Arash
Published: December 2021

Current paediatric anaesthetic fasting guidelines have recommended conservative fasting regimes for many years and have not altered much in the last decades. Recent publications have employed more liberal fasting regimes with no evidence of increased aspiration or regurgitation rates. In this first solely paediatric European Society of Anaesthesiology and Intensive Care (ESAIC) pre-operative fasting guideline, we aim to present aggregated and evidence-based summary recommendations to assist clinicians, healthcare providers, patients and parents.

We identified six main topics for the literature search: studies comparing liberal with conservative regimens; impact of food composition; impact of comorbidity; the use of gastric ultrasound as a clinical tool; validation of gastric ultrasound for gastric content and gastric emptying studies; and early postoperative feeding. The literature search was performed by a professional librarian in collaboration with the ESAIC task force.

Recommendations for reducing clear fluid fasting to 1 h, reducing breast milk fasting to 3 h, and allowing early postoperative feeding were the main results, with GRADE 1C or 1B evidence. The available evidence suggests that gastric ultrasound may be useful for clinical decision-making, and that allowing a ‘light breakfast’ may be well tolerated if the intake is well controlled. More research is needed in these areas as well as evaluation of how specific patient or treatment-related factors influence gastric emptying.
Facilitators and barriers for the implementation of resuscitation training programmes for schoolchildren
Authors: Wingen Sabine , Jeck Julia , Schroeder Daniel C. , Wingen-Heimann Sebastian M. , Drost Ruben M.W.A. , Böttiger Bernd W.
Published: December 2021

BACKGROUND

Training schoolchildren in resuscitation seems to improve rates of resuscitation by bystanders. Leading medical societies recommend comprehensive resuscitation education in schools. To date, no widespread implementation within the European Union has happened.

OBJECTIVE

The study aim was to identify facilitators and barriers for the implementation of cardiopulmonary resuscitation training for schoolchildren within the European Union.

DESIGN

Systematic review.

DATA SOURCES

A literature search in PubMed was conducted between 1 January 1999 and 30 June 2020 in accordance with the PRISMA statement. The search terms ‘resuscitation’, ‘children’ and ‘Europe’ were combined with the Boolean Operator ‘AND’ and ‘OR’. Medical subject heading terms were used in order to include relevant articles.

ELIGIBILITY CRITERIA

Articles were included if cardiopulmonary resuscitation training specifically tailored for schoolchildren aged 12 to 18 years was considered in countries of the European Union. Articles that fulfilled the following criteria were excluded: duplicates, training methods only for specific patient groups, articles not accessible in the English language, and articles that did not include original data.

Findings were structured by an evidence-based six-level approach to examine barriers and facilitators in healthcare.

RESULTS

Thirty out of 2005 articles were identified. Large variations in cardiopulmonary resuscitation training approaches ranging from conventional to innovative training methods can be observed. Schoolteachers as resuscitation instructors act either as barrier or facilitator depending on their personal attitude and their exposure to training in resuscitation. Cardiopulmonary resuscitation training in schoolchildren is effective. The uncoordinated interplay between the generally motivated schools and the political orientation towards resuscitation training for schoolchildren serve as barrier. The lack of financial support, absent systematic organisation, and standardisation of training create major barriers.

CONCLUSION

Training schoolchildren in cardiopulmonary resuscitation is effective. More financial support and political guidance is needed. Until then, local initiatives, motivated teachers, and dedicated principles combined with innovative and low-cost training methods facilitate cardiopulmonary resuscitation training in schools.
Severe Ocular Complications Associated With Wearing of Contact Lens in Japan
Authors: Shigeyasu Chika , Yamada Masakazu , Fukuda Masahiko , Koh Shizuka , Suzuki Takashi , Toshida Hiroshi , Oie Yoshinori , Nejima Ryohei , Eguchi Hiroshi , Kawasaki Ryo , Nishida Kohji ,   for the Research Group of Severe Contact Lens-associated Ocular Complications
Published: December 2021

Objectives:

To examine the severe ocular complications associated with contact lens wearing in Japan.

Method:

A questionnaire was sent to 964 ophthalmologist training facilities inquiring for cases of contact lens–associated complications from April 2016 to March 2018. The inclusion criteria were as follows: (1) corrected distance visual acuity ≤0.1 decimal after treatment for 3 months, (2) corneal perforation observed during follow-up, and (3) requiring surgery. A secondary analysis was conducted, inquiring for further information on the type of contact lens, clinical manifestations, and course of treatment.

Results:

Forty-two patients with infectious keratitis met the inclusion criteria. Eight patients were users of rigid gas-permeable contact lens, and 34 were users of soft contact lens. Microbiological tests were positive in 73.0%. The organisms isolated in microbiological culture were bacteria in 11 patients (Pseudomonas aeruginosa in 9 patients), fungi in 2 patients, and Acanthamoeba in 14 patients. Ten patients were treated with local antibiotics, 11 with a combination of systemic antibiotics, and 21 with a combination of surgical approaches, including 13 with corneal transplantation.

Conclusions:

The major cause of serious contact lens–associated ocular complications was microbial keratitis, and P. aeruginosa and Acanthamoeba were the major pathogens in Japan.
Faculty Perceptions on Use of the Clinical Reasoning Assessment Tool to Support Learning in Physical Therapist Students: A Qualitative Study
Authors: McDevitt Amy , Rapport Mary Jane , Rodriguez Jenny , Miller Matthew
Published: December 2021

Introduction.

The clinical reasoning assessment tool (CRAT) is a patient-centered tool that was developed to assess students' progress in the development of clinical reasoning. The purpose of this qualitative study was to explore how academic and clinical faculty in a physical therapist curriculum use the CRAT to support the development and assessment of clinical reasoning in physical therapist student learners.

Review of Literature.

Clinical reasoning is a multifaceted process crucial to optimal patient care. The ability to teach, learn, and assess the development of clinical reasoning skills continues to be challenging due to the complexity of this necessary skill.

Methods.

A qualitative, thematic analysis approach was used to achieve the study objective. Qualitative data were collected from 3 focus group sessions, transcribed, and analyzed to identify, summarize, and interpret entry-level physical therapist educators' perceptions and experiences using the CRAT with physical therapist students.

Results.

Physical therapist educator participants (N = 13) reported using the CRAT as a guide for learning and assessment. Three qualitative themes were identified: 1) fostering understanding of clinical reasoning through organization and structure; 2) facilitating clinical reasoning through dialogue and self-reflection; and 3) assessment of clinical reasoning in the learner through benchmarking.

Discussion and Conclusion.

Study findings suggest that the structure and organization of the CRAT facilitated dialogue, student self-reflection, and assessment of clinical reasoning through benchmarking. The CRAT may support faculty in their work to further the learners' acquisition of clinical reasoning skills.
The fatter, the better in old age: the current understanding of a difficult relationship
Authors: Fonseca Guilherme Wesley Peixoto da , von Haehling Stephan
Published: December 2021

Purpose of review

Obesity has shown a protective effect on mortality in older adults, also known as the obesity paradox, but there are still controversies about this relationship.

Recent findings

Recent studies have shown a J or U-shaped relationship between BMI and mortality, wherein an optimal range is described between 22 and 37 kg/m2 depending on the condition. Many mechanisms can explain this protective effect of higher BMI, fat/muscle mass storage, more aggressive treatment in obese individuals, loss of bone mineral content and selection bias. However, BMI must be used with caution due to its limitations to determine body composition and fat distribution.

Although BMI is an easy tool to evaluate obesity, its protective effect may be present to certain extend, from normal range to class I obesity (BMI 30–34.9 kg/m2), but then it becomes detrimental. Skeletal muscle mass and muscle function associated with adipose tissue assessment can add valuable information in the risk stratification. Further studies should be performed prospectively, adjust BMI for cofounding variable and consider other elderly subpopulations. To promote healthy ageing, excessive fat mass should be avoided and maintenance or improvement of skeletal muscle mass and muscle function should be stimulated in older adults.
The association between polymorphism of the long noncoding RNA, Plasmacytoma variant translocation 1, and the risk of gastric cancer
Authors: Park Jae Ho , Jin Eun-Heui , Hong Jang Hee , Lee Sang-Il , Sung Jae Kyu
Published: December 2021

Genetic polymorphisms of plasmacytoma variant translocation 1 can affect various tumors including gastro-intestinal, sexual hormone sensitive cancers and lymphoma. Accumulated evidence have shown that plasmacytoma variant translocation 1 acts as an oncogene and tumor suppressor in various cancers. In fact, the rs13255292 and rs2608053 single nucleotide polymorphisms of plasmacytoma variant translocation 1are known to affect lymphoma; however, their effects on gastric cancer are primarily unknown. In this study, we evaluated the association between these plasmacytoma variant translocation 1 polymorphisms and the risk of gastric cancer.

In the present study, 462 patients diagnosed with gastric cancer and 377 cancer-free controls were enrolled. The TaqMan genotyping assay was used to analyze the association between rs13255292 and rs2608053 single nucleotide polymorphisms and the risk of gastric cancer.

The rs2608053 dominant model (CT + TT) was associated with a decreased risk of gastric cancer in T3 + T4 (odds ratio [OR] = 0.61, confidence interval (CI) = 0.41 – 0.92, P = .019), and stage III Gastric cancer subgroups (OR = 0.59, 95% CI = 0.38 – 0.91, P = .017) compared to the CC genotype. When stratified analysis by sex was carried out, the rs13255292 dominant model (CT + TT) had a significant association with an increased risk of gastric cancer in the female negative lymph node metastasis gastric cancer subgroup, compared to the CC genotype (OR = 1.96, 95% CI = 1.16 – 3.30, P = .012). The recessive model (TT) of rs13255292 was associated with an increased risk of gastric cancer in the male T3 + T4 gastric cancer subgroups compared to the CC + CT genotype (OR = 3.82, 95% CI = 1.02 – 14.33, P = .047). The dominant model (CT + TT) of rs2608053 was related to a decreased risk of gastric cancer in male T3 + T4 (OR = 0.57, 95% CI = 0.33 – 0.98, P = .042) and stage III gastric cancer subgroups (OR = 0.49, 95% CI = 0.27 – 0.89, P = .020) compared to the CC genotype.

The rs13255292 and rs2608053 single nucleotide polymorphisms in plasmacytoma variant translocation 1 may contribute to susceptibility of gastric cancer. Further studies with more subjects and different ethnic groups are needed to validate our results.
The effect of remimazolam on postoperative memory retention and delayed regeneration in breast surgery patients
Authors: Shirozu Kazuhiro , Nobukuni Keiko , Funakoshi Kouta , Nakamura Taizo , Sumie Makoto , Higashi Midoriko , Yamaura Ken
Published: December 2021

Background:

Remimazolam, a benzodiazepine ultra-short-acting sedative, has been used in general anesthesia since August 2020. It is used in awake surgeries that require awakening the patient in the middle of the surgery because of its rapid awakening effect as well as antagonistic interactions. If remimazolam has associated anterograde amnesia similar to benzodiazepines, it will have a positive effect on preventing psychological trauma. However, to our knowledge, the effect of remimazolam on anterograde amnesia has not been previously examined.

Methods/design:

The aim of this exploratory, open, propofol-controlled, single-center, randomized clinical trial is to examine the effect of remimazolam on postoperative memory retention and delayed regeneration. Seventy patients undergoing breast surgery will be included in the study. The patients will be randomly assigned to receive propofol or remimazolam as sedatives during surgery. The primary endpoint is the number of posters patients remember 24 hours after surgery (among 4 posters shown after awakening from anesthesia) as an assessment of anterograde amnesia. Secondary endpoints are retrograde amnesia, dose of analgesic given from the time the patient returns to the ward until 24 hours after surgery, immediate postoperative pain numerical rating scale scores, and pain numerical rating scale scores 24 hours after leaving the operating room. Recruitment will take place between October 2021 and March 2022 to achieve the target sample size.

Discussion:

To our knowledge, this is the first trial designed to examine the effects of remimazolam on postoperative memory retention and delayed regeneration in patients undergoing breast surgery.

Trial registration:

This clinical trial was registered at the University Hospital Medical Information Network (UMIN) Center on September 28, 2021 (UMIN-CTR: UMIN000045593).
Acupuncture for oligospermia and asthenozoospermia
Authors: Jia Wen , Wang Chuan , Yin Ying
Published: December 2021

Background:

Acupuncture is widely used for oligospermia and asthenozoospermia in China, but its effect is unclear. We aimed to determine the effectiveness and safety of acupuncture in treating oligospermia and asthenozoospermia.

Methods:

An electronic search for randomized controlled trials evaluating acupuncture treatment in patients with oligospermia and asthenozoospermia published from database inception to October 2018 was conducted in PubMed, EMBASE, the Chinese Biomedical Literature Database, the Chinese Scientific Journal Database (VIP Database), the Wan-Fang Database, the China National Knowledge Infrastructure and the Cochrane Library. We established search terms related to 3 areas (oligospermia, asthenozoospermia, and acupuncture). Two authors independently screened all identified citations and extracted the data. The methodological quality of the included trials was assessed using the Cochrane criteria.

Results:

Seven studies with a total of 527 subjects were screened according to inclusion and exclusion standards, and most of the studies had significant methodological weaknesses. Seven randomized controlled trials tested the effects of acupuncture compared with placebo acupuncture and conventional medications in patients with oligospermia and asthenozoospermia. The results of this study suggest that acupuncture alone has no clear superiority in improving sperm motility (standard mean difference [SMD] = 1.13, 95% confidence interval [CI]: −0.64 to 2.89), the sperm concentration (SMD = 0.32, 95% CI: 0.27–0.92) or semen volume compared with placebo acupuncture. No significant difference was found between acupuncture alone and conventional medications in improving sperm motility (SMD = −0.53, 95% CI: −2.54 to 1.48), the sperm concentration (SMD = −1.10, 95% CI: −1.48 to −0.72) or semen volume. However, adjuvant acupuncture may enhance the effect of medications on improving sperm motility (SMD = 4.10, 95% CI: 1.09–7.12) and the sperm concentration (SMD = 1.07, 95% CI: 0.739–1.40), but the study heterogeneity was too high to establish robust conclusions.

Conclusion:

These results suggest that the current evidence does not support acupuncture as an effective treatment for oligospermia and asthenozoospermia; therefore, acupuncture is not currently recommended as a treatment for these conditions. However, owing to the high risk of bias among the included studies, the evidence is limited, and more large-scale, high-quality clinical trials are needed in the future.

Trial registration number:

PROSPERO CRD42018083885
The efficacy of aquatic therapy in stroke rehabilitation
Authors: Li Yumei , Zheng Gang
Published: December 2021

Background:

Few studies have reported the clinical effect of aquatic therapy in stroke rehabilitation. Therefore, we performed a protocol for systematic review and meta-analysis to assess the effectiveness of aquatic therapy for individuals affected by strokes.

Methods:

This protocol of systematic review and meta-analysis has been drafted under the guidance of the preferred reporting items for systematic reviews and meta-analyses protocols. This study will use the Cochrane Library, Web of Science, PubMed, Embase, Allied and Complementary Medicine Database (AMED), China Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), China Science and Technology Journal Database (VIP), Wanfang Database, and Ongoing Clinical Trials Database. Quality assessment of the included studies was evaluated using the Cochrane risk of bias assessment tool. We performed the meta-analysis by RevMan 5.4 software.

Results:

The results of this systematic review and meta-analysis will be published in a peer-reviewed journal.

Conclusion:

Aquatic therapy may be a valid means for the rehabilitation of people affected by stroke.

Open Science Framework registration number: https://doi.org/10.17605/OSF.IO/ZKE3Y10.17605/OSF.IO/8UDV9.
Lung adenocarcinoma with eosinophilic pleural effusion
Authors: Zhou Xiangxiang , Wan Jingxuan , Gan Xin
Published: December 2021

Rationale:

Eosinophilic pleural effusion (EPE) is a rare phenomenon in which the etiological diagnosis remains a challenging issue; here, we present a patient who was eventually diagnosed with malignant EPE by parietal pleural biopsy.

Patient concerns:

The patient was a 73-year-old man with pulmonary tuberculosis who was taking isoniazid and rifampin; after 6 months, he had right-sided eosinophilic pleura, and histopathological examination of the parietal pleura revealed malignant cells from the lung.

Diagnosis:

Based on the parietal pleural biopsy, the patient was diagnosed with lung adenocarcinoma with ipsilateral pleural metastasis stage IVA.

Interventions:

The patient received a first-line systemic chemotherapy regimen (premetrexed and carboplatin).

Outcomes:

The patient received 2 cycles of chemotherapy, and based on the response evaluation criteria for solid tumors, he achieved partial response and the effusion disappeared.

Lessons:

This case presents a patient with tuberculosis who was suffering from an EPE, which was eventually diagnosed as malignant EPE based on histopathological examination through medical thoracoscopy, although multiple Thinprep cytology tests showed no evidence of malignancy, pleural biopsy is necessary to obtain an accurate etiology diagnosis.
Reconstruction of large bone defect using autogenous fibular strut and iliac bone graft for revision total elbow arthroplasty
Authors: Lee Yoon Min , Son Soo Hun , Sur Yoo Joon , Song Seok Whan
Published: December 2021

The stability and longevity of the prosthesis after revision total elbow arthroplasty (TEA) are greatly influenced by the reconstruction of bone defects around the distal humerus and proximal ulna. This study evaluated the clinical and radiological results of reconstruction of a large bone defect using an autogenous fibular strut and iliac bone graft in revision TEA.

This retrospective study reviewed 10 patients who underwent revision TEA with autogenous fibular strut and iliac corticocancellous bone graft between March 2007 and May 2016. Range of motion (ROM), Visual Analog Scale (VAS), and Mayo Elbow Performance Score were used to evaluate clinical outcomes at the final follow-up. Plain radiographs were reviewed for bone union and the presence of re-loosening or for the presence of peri-prosthetic fractures.

At the final follow-up, the ROMs of the elbow was 102.5° (range, 90–120°) from extension to flexion, 60.0° (range, 40–80°) in pronation, and 58.5° (range, 35–80°) in supination. The mean preoperative VAS and Mayo Elbow Performance Score were 5.1 and 46.5, and theses scores were improved to 2.6 and 79.0, at the final follow-up (P < .05). Union of the grafted bone with the distal humerus was achieved at an average of 4.5 months (range, 3–6 months). Re-osteolysis recurred in 2 cases, and additional surgery for bone grafting was performed in 1 case.

Autogenous fibular strut bone grafting is an effective technique when revision TEA has large bone defects around the prosthesis resulting in a relatively stable prosthesis fixation and good union rate with a satisfactory clinical outcome after TEA revision.
A novel risk signature with 6 RNA binding proteins for prognosis prediction in patients with glioblastoma
Authors: Huang Qian-Rong , Li Jian-Wen , Pan Xin-Bin
Published: December 2021

Recent studies suggested that RNA binding proteins (RBPs) were related to the tumorigenesis and progression of glioma. This study was conducted to identify prognostic RBPs of glioblastoma (GBM) and construct an RBP signature to predict the prognosis of GBM.

Univariate Cox regression analysis was carried out to identify the RBPs associated with overall survival of GBM in the The Cancer Genome Atlas (TCGA), GSE16011, and Repository for Molecular Brain Neoplasia data (Rembrandt) datasets, respectively. Overlapping RBPs from the TCGA, GSE16011, and Rembrandt datasets were selected. The biological role of prognostic RBPs was assessed by Gene Ontology, Kyoto Encyclopedia of Genes and Genomes, and protein–protein interaction analyses. Least absolute shrinkage and selection operator regression analysis and multivariate Cox regression analysis were used to construct an RBP-related risk signature. The prognostic value of RBP signature was measured by Kaplan–Meier method and time-dependent receiver operating characteristic curve. A nomogram based on independent prognostic factors was established to predict survival for GBM. The CGGA cohort was used as the validation cohort for external validation.

This study identified 27 RBPs associated with the prognosis of GBM and constructed a 6-RPBs signature. Kaplan–Meier curves suggested that high-risk score was associated with a poor prognosis. Area under the curve of 1-, 3-, and 5-year overall survival was 0.618, 0.728, and 0.833 for TCGA cohort, 0.655, 0.909, and 0.911 for GSE16011 cohort, and 0.665, 0.792, and 0.781 for Rembrandt cohort, respectively. A nomogram with 4 parameters (age, chemotherapy, O6-methylguanine-DNA methyltransferase promoter status, and risk score) was constructed. The calibration curve showed that the nomogram prediction was in good agreement with the actual observation.

The 6-RBPs signature could effectively predict the prognosis of GBM, and our findings supplemented the prognostic index of GBM to a certain extent.
Pancreatic Enzyme Replacement Therapy for Patients Diagnosed With Pancreaticobiliary Cancer
Authors: Carnie Lindsay E. , Farrell Kelly , Barratt Natalie , Abraham Marc , Gillespie Loraine , Satyadas Thomas , McNamara Mairéad G. , Hubner Richard A. , Geraghty Joe , Bibby Neil , Valle Juan W. , Lamarca Angela
Published: December 2021

Objective

An algorithm was designed aiming to provide consistency of pancreatic enzyme replacement therapy (PERT) dosing/titration across healthcare professionals in pancreaticobiliary cancers (PBCs). This prospective observational study aimed to validate this algorithm.

Methods

Consecutive patients with inoperable or postoperative PBC with pancreatic exocrine insufficiency (PEI) symptoms, not taking PERT, or taking below the algorithm “starting dose,” were eligible. A dietitian or clinical nurse specialist reviewed patients for up to 3 weeks, titrating PERT as per the algorithm. Feasibility of algorithm deliverability was assessed by the percentage of patients with successful completion (primary objective).

Results

Twenty-five patients were eligible (N = 25): at baseline, 22 took PERT (100% on suboptimal doses, 54.5% taking incorrectly) and 3 initiated PERT because of PEI symptoms. Algorithm completion (20 of 25, 80%) confirming deliverability by dietitians (11 of 12, 92%) and clinical nurse specialists (9 of 13, 69%). Symptom resolution occurred in 8 of 19 (42%), 3 of 7 (43%), and 1 of 3 (33%) patients at first, second, and third reviews, respectively; advice compliance was between 63% and 86%.

Conclusions

This algorithm provides a structured method to titrate PERT. At diagnosis, all patients with PBC should be assessed for PEI and adequate PERT initiated. Regular reviews are required for timely symptom resolution and adequate escalation, facilitating differential diagnosis if refractory symptoms exist.
Survival of Patients With Gastroenteropancreatic Neuroendocrine Tumors and Diabetes Mellitus
Authors: Thapi Sahityasri , Baeg Kiwoon , Kim Michelle K. , Gallagher Emily J.
Published: December 2021

Objectives

Diabetes mellitus (DM) is associated with an increased risk of gastroenteropancreatic neuroendocrine tumors (GEP-NETs), but the association between DM and GEP-NET survival is unknown. We evaluated disease characteristics and survival in individuals with DM and GEP-NETs.

Methods

Using the Surveillance, Epidemiology, and End Results registry linked to Medicare (SEER-Medicare) claims database, we examined sociodemographics, GEP-NET characteristics, and treatment in patients with and without DM before GEP-NET diagnosis. We compared survival using univariate and multivariate analyses.

Results

We identified 1858 individuals with GEP-NETs: 478 (25.7%) with DM and 1380 (74.3%) without. Significant differences in race (P = 0.002) were found between the DM and non-DM groups. Compared with individuals without DM, those with DM had more gastric (9.7% vs 14.9%), duodenal (6.5% vs 10.0%), and pancreatic (17.0% vs 21.8%), and less jejunal/ileal (18.1% vs 12.8%) NETs (P < 0.0001). Patients with DM had earlier stages (stage I, 37.0%; stage IV, 30.8%) than those without (stage I, 30.6%; stage IV, 36.4%; P = 0.0012). We found no difference in survival (multivariate hazard ratio, 0.97; 95% confidence interval, 0.76–1.23) between groups.

Conclusions

Among patients with and without DM before GEP-NET diagnosis, we found differences in tumor location and stage, but not survival.
Rationale for and Development of the Pancreatic Quantitative Sensory Testing Consortium to Study Pain in Chronic Pancreatitis
Authors: Phillips Anna Evans , Faghih Mahya , Singh Vikesh K. , Olesen Søren Schou , Kuhlmann Louise , Novovic Srdan , Bick Benjamin , Hart Philip A. , Ramsey Mitchell L. , Talukdar Rupjyoti , Garg Pramod K. , Yadav Dhiraj , Drewes Asbjørn Mohr
Published: December 2021

Objectives

Abdominal pain is the primary symptom of chronic pancreatitis (CP), but pain is difficult to assess, and objective methods for pain assessment are lacking. The characterization of the sensory component of pain as a surrogate for nociception can be achieved by sensory testing using standardized stimuli. Herein, we describe the rationale for and development of an international consortium to better understand and characterize CP pain.

Methods

A collaboration was initially formed between the University of Aalborg, Johns Hopkins University, and the University of Pittsburgh. This group refined the protocol for pancreatic quantitative sensory testing (P-QST) and then expanded the collaboration with plans for incorporating P-QST into prospective studies.

Results

The collaboration has successfully developed a P-QST nomogram. Chronic pancreatitis patients identified with P-QST as having widespread hyperalgesia had higher pain intensity scores, higher prevalence of constant pain, and decreased quality of life. Psychiatric comorbidities were independent of pain phenotypes. Multiple studies are underway to validate these findings and evaluate their utility in clinical trials.

Conclusions

Development of the P-QST Consortium will facilitate collaborative efforts to use P-QST as a means for evaluation and characterization of pain in CP patients, and optimize methods to guide individualized pain management approaches.
Intraoperative Allogeneic Red Blood Cell Transfusion Negatively Influences Prognosis After Radical Surgery for Pancreatic Cancer
Authors: Kanda Taishu , Wakiya Taiichi , Ishido Keinosuke , Kimura Norihisa , Nagase Hayato , Kubota Shunsuke , Fujita Hiroaki , Hagiwara Yusuke , Hakamada Kenichi
Published: December 2021

Objective

We aimed to investigate the real impact of allogeneic red blood cell transfusion (ABT) on postoperative outcomes in resectable pancreatic ductal adenocarcinoma (PDAC) patients.

Methods

Of 128 patients undergoing resectable PDAC surgery at our facility, 24 (18.8%) received ABT. Recurrence-free survival (RFS) and disease-specific survival (DSS), before and after propensity score matching (PSM), were compared among patients who did and did not receive ABT.

Results

In the entire cohort, ABT was significantly associated with decreased RFS (P = 0.002) and DSS (P = 0.014) before PSM. Cox regression analysis identified ABT (risk ratio, 1.884; 95% confidence interval, 1.015–3.497; P = 0.045) as an independent prognostic factor for RFS. Univariate and multivariate analysis identified preoperative hemoglobin value, preoperative total bilirubin value, and intraoperative blood loss as significant independent risk factors for ABT. Using these 3 variables, PSM analysis created 16 pairs of patients. After PSM, the ABT group had significantly poorer RFS rates than the non-ABT group (median, 9.8 vs 15.8 months, P = 0.022). Similar tendencies were found in DSS rates (median, 19.4 vs 40.0 months, P = 0.071).

Conclusions

This study revealed certain negative effects of intraoperative ABT on postoperative survival outcomes in patients with resectable PDAC.
Noninvasive Models Screen New-Onset Diabetics at Low Risk of Early-Onset Pancreatic Cancer
Authors: Khan Salman , Al Heraki Samee , Kupec Justin T.
Published: December 2021

Objectives

Several noninvasive models have been developed to identify new-onset diabetics at higher risk of developing pancreatic ductal adenocarcinoma (PDAC). However, they need external validation before implementation.

Methods

This study validated one such model (Boursi model) among a cohort of new-onset diabetics. A bivariate analysis of the model's components was done between patients who developed PDAC and type 2 diabetics. The model performance was assessed through receiver-operative characteristic curve analysis.

Results

Patients with PDAC had significantly lower total cholesterol and alkaline phosphatase at diagnosis of diabetes (P < 0.01). They were observed losing body mass index (BMI) preceding diagnosis (ΔBMI = −0.42 kg/m2, P < 0.01). The model's area under the curve was 0.83 (95% confidence interval, 0.79–0.88). The cutoff that maximized the Youden index was at 0.8%. At this cutoff, the sensitivity was 75%, specificity was 80%, and the prevalence of pancreatic cancer increased from 0.19% at baseline to 0.69%.

Conclusions

Boursi model enriches the prevalence of PDAC among new-onset diabetics.
Estrogen Receptor Expression in Pancreatic Adenocarcinoma
Authors: Lykoudis Panagis M. , Contis John
Published: December 2021

Pancreatic adenocarcinoma remains a chemotherapy-resistant and refractory malignancy with high mortality, unaffected by recent progress in anticancer treatment. Expression of estrogen receptors was detected almost 50 years ago, in both benign and malignant pancreatic cells. However, early preclinical studies in pancreatic cancer led to contradictory findings, and most clinical studies failed to demonstrate an effect with tamoxifen treatment. The identification of a second form of estrogen receptor seems to provide some explanation for these discrepancies. Predominantly expressed in malignant cells and structurally different from what was considered the only estrogen receptor, estrogen receptor β was recognized as a negative prognostic factor and a possible therapeutic target in pancreatic ductal adenocarcinoma. Therefore, findings of research before the identification of estrogen receptor β should be reconsidered, and further studies should be designed to reassess the expression and effect of this specific estrogen receptor type in pancreatic cancer.
Analysis of Outcomes in COVID-19 Patients With Varying Degrees of Hyperlipasemia
Authors: Benias Petros C. , Inamdar Sumant , Wee Diana , Liu Yan , Buscaglia Jonathan M. , Satapathy Sanjaya K. , Trindade Arvind J.
Published: December 2021

Objectives

Coronavirus disease 2019 (COVID-19) patients may have varying degrees of hyperlipasemia. The aim was to compare outcomes among different levels of hyperlipasemia in patients with COVID-19.

Methods

This is a retrospective study examining outcomes among hospitalized COVID-19 patients with a lipase <3× upper limit of normal (ULN), asymptomatic hyperlipasemia (>3× ULN), secondary pancreatitis (typical respiratory COVID-19 symptoms and found to have pancreatitis), and primary pancreatitis (presenting with pancreatitis).

Results

Of 11,883 patients admitted with COVID-19, 1560 patients were included: 1155 patients had normal serum lipase (control group), 270 had elevated lipase <3× ULN, 46 patients had asymptomatic hyperlipasemia with lipase >3× ULN, 57 patients had secondary pancreatitis, and 32 patients had primary pancreatitis. On adjusted multivariate analysis, the elevated lipase <3× ULN and asymptomatic hyperlipasemia groups had worse outcomes with higher mortality (odds ratio [OR], 1.6 [95% confidence interval [CI], 1.2–2.2) and 1.1 [95% CI, 0.5–2.3], respectively), higher need for mechanical ventilation (OR, 2.8 [95% CI, 1.2–2.1] and 2.8 [95% CI, 1.5–5.2], respectively), and longer length of stay (OR, 1.5 [95% CI, 1.1–2.0] and 3.16 [95% CI, 1.5–6.5], respectively).

Conclusions

Patients with COVID-19 with elevated lipase <3× ULN and asymptomatic hyperlipasemia have generally worse outcomes than those with pancreatitis.