bluuebunny/crossref_metadata_2025 huggingface dataset:
Closed-Incision and Surrounding Soft Tissue Negative Pressure Dressings in Post-Mastectomy Pre-Pectoral Direct-to-Implant Breast Reconstruction: A Pilot Study
Authors: Sibia Udai S. , Singh Devinder , Sidrow Kathryn M. , Holton Luther H.
Published: May 2021

Background: Closed-incision and surrounding soft tissue negative pressure therapy (cistNPT) is theorized to decrease infection, reduce tissue edema, and promote healing of the mastectomy skin flap. We report our early experience with this dressing in pre-pectoral direct-to-implant (pDTI) breast reconstruction. Methods: We retrospectively reviewed all patients who underwent post-mastectomy pDTI breast reconstruction with cistNPT between July 2019 and February 2020. All reconstructions utilized smooth round silicone gel implants and human acellular dermal matrix. Results: Thirty-five female patients underwent 58 mastectomies. Mean age and body mass index were 49.9 years and 28.9 kg/m2, respectively. Eleven (31.4%) patients had neoadjuvant chemotherapy. The mean sternal notch-to-nipple distance was 27.0 cm. The median specimen weight was 483 g, while the median implant volume was 495 cc. The mean implant-to-specimen ratio was 1.4 for nipple-sparing, 1.1 for skin-sparing, and 0.7 for skin-reducing mastectomy. Total drain volume was 483.1 cc from each breast. Post-operative complications included seroma (5.2%), peri-incisional necrosis (8.6%), and superficial skin epidermolysis (13.8%). There were no cases of surgical site infection, dehiscence, or hematoma. Rate of return to the operative room was 3.4%. Mean follow-up was 90 days. Conclusions: In our series of pDTI breast reconstructions with cistNPT, no patients experienced hematoma, dehiscence, or infection complications. Rates of seroma, skin necrosis requiring operative debridement, and total drain volumes were lower than those reported in literature.
Development, Implementation, and Outcomes of a Global Infectious Disease Training Course
Authors: Caniza Miguela A , Homsi Maysam , Gonzalez Miriam , Moreira Daniel C , Tang Li , Adderson Elisabeth , Rodriguez-Galindo Carlos
Published: May 2021

Background:

Skilled healthcare professionals are critical for providing quality healthcare for children with cancer globally. Training curricula addressing the knowledge needs in infection care and prevention (ICP) in cancer are scarce.

Program description:

We implemented a 10-week blended course in ICP. The distance learning had four 2-week modules: Infectious Complications, Quality in Infection Care, Quality in Infection Prevention, and Sustainability, Research, and Dissemination. Each module had pre- and post-tests and weekly webinars. The 2-week in-person learning had lectures, group exercises, clinical observations, hospital and laboratory tours, and ended in an annual conference. An individual project developed during the distance learning was presented in the in-person workshop. Course attendance criteria were English language proficiency and participants’ role in ICP at their institutions.

Program evaluation and results:

Twenty-two students from 17 hospitals in 10 countries completed the course, developed a project, and answered surveys covering knowledge assessments and satisfaction, and 6-month course and 1-year project follow-ups. Pretest and post-test scores revealed knowledge improvement ( P < .001). Participants rated the distance learning as outstanding (63%) or good (28%); and the in-person as outstanding (87%). In the follow-up survey, graduates felt more comfortable at managing infections and participated more in quality improvement and academics at their institutions. Seventeen participants (77%) took steps to implement their study projects, and 9 were successful. Collaboration and networking of trainees were notable outcomes.

Discussion:

The ICP course is a resource to improve knowledge, engage graduates in network collaborations, and a reliable model to develop other thematic healthcare global training programs.
Long-term participation in community group exercise improves lower extremity muscle strength and delays age-related declines in walking speed and physical function in older adults
Authors: Hayashi Chisato , Ogata Soshiro , Okano Tadashi , Toyoda Hiromitsu , Mashino Sonoe
Published: May 2021

Background

The effects of group exercise on the physical function of community-dwelling older adults remain unclear. The changes in lower extremity muscle strength, timed up and go (TUG) time, and the motor fitness scale (MFS), over time, among older adults who expressed a willingness to participate in community-based physical exercise groups, were determined using multilevel modelling.

Methods

We analyzed data of 2407 older adults between April 2010 and December 2019 from the registry of physical tests of community-based physical exercise groups. We conducted a retrospective cohort study to assess the effect of physical exercise on lower extremity muscle strength, TUG time, and MFS scores. The durations of the exercises were evaluated by frequency of physical test’s participate.

Results

A deterioration in lower extremity muscle strength was found in the short-term participant group only. However, in the mid-term and long-term participation groups, lower extremity muscle strength showed a trend of improvement. The TUG time and the MFS score were negatively correlated with increasing age in both groups divided by the duration of participation. However, there was a slower rate of deterioration in the long-term participation group.

Discussion

Lower extremity muscle strength, TUG time, and MFS scores decline with increasing age and there were differences in the slope of deterioration that depended on the duration of participation in community-based group exercise.

Conclusion

Participation in group exercise improved lower extremity muscle strength, TUG time, and MFS scores of older adults living in a community. The positive effects of group exercise were dependent on long-term participation.
Early differences in auditory processing relate to Autism Spectrum Disorder traits in infants with Neurofibromatosis Type I
Authors:   the STAARS and EDEN Teams, Begum-Ali Jannath , Kolesnik-Taylor Anna , Quiroz Isabel , Mason Luke , Garg Shruti , Green Jonathan , Johnson Mark H. , Jones Emily J. H.
Published: May 2021

Background

Sensory modulation difficulties are common in children with conditions such as Autism Spectrum Disorder (ASD) and could contribute to other social and non-social symptoms. Positing a causal role for sensory processing differences requires observing atypical sensory reactivity prior to the emergence of other symptoms, which can be achieved through prospective studies.

Methods

In this longitudinal study, we examined auditory repetition suppression and change detection at 5 and 10 months in infants with and without Neurofibromatosis Type 1 (NF1), a condition associated with higher likelihood of developing ASD.

Results

In typically developing infants, suppression to vowel repetition and enhanced responses to vowel/pitch change decreased with age over posterior regions, becoming more frontally specific; age-related change was diminished in the NF1 group. Whilst both groups detected changes in vowel and pitch, the NF1 group were largely slower to show a differentiated neural response. Auditory responses did not relate to later language, but were related to later ASD traits.

Conclusions

These findings represent the first demonstration of atypical brain responses to sounds in infants with NF1 and suggest they may relate to the likelihood of later ASD.
Virtual reality in biology: could we become virtual naturalists?
Authors: Morimoto Juliano , Ponton Fleur
Published: May 2021

The technological revolution of past decades has led teaching and learning of evolutionary biology to move away from its naturalist origins. As a result, students’ learning experiences and training on the science of natural history—which entails careful observations and meticulous data curation to generate insight—have been compromised compared with the times of the pioneers in the field. But will technology cause the extinction of natural history in its traditional form? In this essay, we provide a visionary—albeit not yet possible—perspective of the future of natural history in the technological era. We review the main concepts and applications of key state-state-of-the-art technologies to the teaching and learning of Biology including Virtual and Mixed Reality (VMR). Next, we review the current knowledge in artificial life, and describe our visionary model for the future of natural history voyages—the BioVR—which is an immersive world where students can experience evolution in action, and also shape how evolution can occur in virtual worlds. We finish the essay with a cautionary tale as to the known negative sides of using VMR technologies, and why future applications should be designed with care to protect the intended learning outcomes and students’ experience. Our aim is to stimulate debates on how new technologies can revolutionise teaching and learning across scenarios, which can be useful for improving learning outcomes of biological concepts in face-to-face, blended, and distance learning programmes.
Association between doctor-patient familiarity and patient-centred care during general practitioner's consultations: a direct observational study in Chinese primary care practice
Authors: Zhong Chenwen , Zhou Mengping , Luo Zhuojun , Liang Cuiying , Li Lina , Kuang Li
Published: May 2021

Background

Patient-centred care is a core attribute of primary care. Not much is known about the relationship between patient-centred care and doctor-patient familiarity. This study aimed to explore the association between general practitioner (GP) perceived doctor-patient familiarity and the provision of patient-centred care during GP consultations.

Methods

This is a direct observational study conducted in eight community health centres in China. Level of familiarity was rated by GPs using a dichotomized variable (Yes/No). The provision of patient-centred care during GP consultations was measured by coding audiotapes using a modified Davis Observation Code (DOC) interactional instrument. Eight individual codes in the modified DOC were selected for measuring the provision of patient-centred care, including ‘family information’, ‘treatment effects’, ‘nutrition guidance’, ‘exercise guidance’, ‘health knowledge’, ‘patient question’, ‘chatting’, and ‘counseling’. Multivariate analyses of covariance were adopted to evaluate the association between GP perceived doctor-patient familiarity and patient-centred care.

Results

A total of 445 audiotaped consultations were collected, with 243 in the familiar group and 202 in the unfamiliar group. No significant difference was detected in overall patient-centred care between the two groups. For components of patient-centred care, the number of intervals (1.36 vs 0.88,p = 0.026) and time length (7.26 vs. 4.40 s,p = 0.030) that GPs spent in ‘health knowledge’, as well as time length (13.0 vs. 8.34 s,p = 0.019) spent in ‘patient question’ were significantly higher in unfamiliar group. The percentage of ‘chatting’ (11.9% vs. 7.34%,p = 0.012) was significantly higher in the familiar group.

Conclusions

This study suggested that GP perceived doctor-patient familiarity may not be associated with GPs’ provision of patient-centred care during consultations in the context of China. Not unexpectedly, patients would show more health knowledge and ask more questions when GPs were not familiar with them. Further research is needed to confirm and expand on these findings.
Knowledge, attitudes and practices on African tick bite fever of rural livestock communities living in a livestock-wildlife interface area in the Eastern Cape Province of South Africa
Authors: Katswara Tandiwe , Mukaratirwa Samson
Published: May 2021

Background

African tick bite fever (ATBF) caused byRickettsia africaeand transmitted byAmblyommaspp. ticks is one of the zoonotic tick-borne fevers from the spotted fever group (SFG) of rickettsiae, which is an emerging global health concern. There is paucity of information regarding the occurrence and awareness of the disease in endemic rural livestock farming communities living in livestock-wildlife interface areas in South Africa.

Methods

The purpose of the study was to assess the level of knowledge, attitudes and practices on ticks and ATBF infection from a community living in livestock-wildlife interface areas in South Africa. A focus group discussion (FGD) was carried out followed by verbal administration of a standardized semi-structured questionnaire a month later to 38 rural livestock farmers (23 from Caquba area and 15 from Lucingweni area whereA. hebraeumwas absent). An FGD was conducted in Caquba (situated at the livestock-wildlife interface whereAmblyomma hebraeumwas prevalent on cattle and infected withRickettsia africae) in the O.R. Tambo district of the Eastern Cape province of South Africa.

Results

Results from the FGD and questionnaire survey showed that participants from the two rural communities were not aware of ATBF and were not aware that ticks are vectors of the disease. Respondents from Caquba reported of having frequent exposure to tick bites (91.3%, 21/23) specifically from the anthropophilicA. hebrauemwhich they were able to identify asQwelagqibein IsiXhosa (their vernacular). Thirteen out of 15 (86.7%) of respondents from Lucingweni reported that they had never been bitten by ticks, which corresponded with the absence ofA. hebraeumfrom their locality as evidenced from results of a concurrent study on prevalence of ticks on livestock in the area. Both communities confirmed to being “very concerned” of tick bites and we presume this was more related to the localized wounds from the bites than to the diseases transmitted by the ticks.

Conclusions

We recommend future studies encompassing seroprevalence of ATBF in Caquba and other communities at risk in South Africa including establishing surveillance systems to monitor the seasonal infection rates in ticks, cattle and humans.
Metastatic colo-rectal cancer: real life experience from an Indian tertiary care center
Authors: Sharma Vinod , Sharma Atul , Raina Vinod , Dabkara Deepak , Mohanti Bidhu Kalyan , Shukla N. K. , Pathy Sushmita , Thulkar Sanjay , Deo S. V. S. , Kumar Sunil , Sahoo Ranjit Kumar
Published: May 2021

Background

No data exist for the long-term outcome of metastatic colorectal cancer (mCRC) from the Southern part of Asia. The primary objective of the study is to evaluate the survival outcome of mCRC from an Indian tertiary care center. The study also aims to highlight the treatment pattern practiced and the unique clinico-pathologic characteristics.

Methods

This is a single-center retrospective observational study done at a large referral tertiary care center in North India. All patients with synchronous or metachronous mCRC who received at least one dose of chemotherapy for metastatic disease, registered between 2003 to 2017 were included. Primary outcome measures were overall survival and progression-free survival and prognostic factors of overall survival. Descriptive analysis was done for the clinicopathological characteristics and treatment patterns. Kaplan Meier method for overall survival and progression-free survival. Cox regression analysis was performed for the determination of the prognostic factors for overall survival.

Result

Out of 377 eligible patients, 256 patients (68%) had de novo metastatic disease and the remaining 121 (32%) progressed to metastatic disease after initial treatment. The cohort was young (median age, 46 years) with the most common primary site being the rectum. A higher proportion of signet (9%) and mucinous histology (24%). The three common sites of metastasis were the liver, peritoneum, and lung. In the first line, most patients received oxaliplatin-based chemotherapy (70%). Only 12.5% of patients received biologicals in the first-line setting. The median follow-up and median overall survival of study cohort were 17 months and 18.5 months. The factors associated with poor outcome for overall survival on multivariate analysis were ECOG performance status of > 1, high CEA, low albumin, and the number of lines of chemotherapy received (< 2).

Conclusion

The outcome of mCRC is inferior to the published literature. We found a relatively higher proportion of patients with the following characteristics; younger, rectum as primary tumor location, the signet, and mucinous histology, higher incidence of peritoneum involvement. The routine use of targeted therapies is limited. Government schemes (inclusion of targeted therapies in the Ayushman scheme), NGO assistance, and availability of generic low-cost targeted drugs may increase the availability.
Health indicators on adolescents reveal disparity and inequality on regional and national levels
Authors: Wang Mengqiao
Published: May 2021

Background

Health status in adolescents is difficult to evaluate and compare horizontally, vertically and longitudinally among different regions and nations of the world.

Methods

With repeated surveys conducted with relatively uniformed standards, the UNICEF Data warehouse compiles and publishes a wide spectrum of health indicators, of which data analysis and visualization would reveal the underlying statuses and trends on global, regional and national levels.

Results

Apparent geographic disparity is present in that sub-Saharan African countries lag far behind their counterparts in other regions with regard to most health indicators on adolescents. Education attendance rates sequentially drop from primary to secondary school levels, and display correlation with youth literacy. Harmful practices of early marriage, early childbearing and female genital mutilation have decreased but the presences of peer violence and sexual violence are worthy of attentions. Although incidence and mortality rates of HIV/AIDS have dropped (most notably in sub-Saharan Africa), adolescents’ HIV/AIDS awareness remains suboptimal in selected countries. Cumulative COVID-19 cases and deaths in the adolescents are comparable to the children but relatively lower than the adult and senior groups.

Conclusions

Findings on the health indicators of adolescents until 2019 reveal the most recent status quo for reference right before the hit of ongoing COVID-19 pandemic. Progresses made on the various health indicators as well as the associated disparity and inequality underlie the remaining gaps to fill for the achievement of the Sustainable Development Goals by 2030.
The association between frequency of eating out with overweight and obesity among children aged 6–17 in China: a National Cross-sectional Study
Authors: Ma Yanning , Gong Weiyan , Ding Caicui , Song Chao , Yuan Fan , Fan Jing , Feng Ganyu , Chen Zheng , Liu Ailing
Published: May 2021

Background

In parallel with the increased prevalence of childhood overweight and obesity, the proportion of eating out in China has increased dramatically in recent years. The purpose of the study was to explore the association between frequency of eating out with overweight and obesity among Chinese children.

Methods

The representative sample was recruited from Chinese National Nutrition and Health Survey (CNNHS) in 2010–2012, which included Chinese children aged 6–17 years (7685 boys and 7576 girls). Frequency of eating out was collected by interview-administered questionnaire and categorized as: 0, 1–2 and ≥ 3 times per week. Height and weight were measured, consequently body mass index was calculated.

Results

The prevalence of eating out among Chinese children aged 6–17 years old was 23.2%. Children who ate out 0, 1–2, ≥3 times per week were accounted for 76.8, 10.9 and 12.3% respectively. Findings revealed that eating out three times per week or more was statistically significant associated with higher prevalence of overweight and obesity among boys (OR = 1.20,95CI:1.04–1.38) compared with those ate out less than three times per week. However, no significantly association was observed among girls (OR = 0.91, 95CI:0.78–1.01). In additional, Younger children, rural children, children from low income family, those with leisure exercises (certain physical activities regularly carried out such as swimming, walking, running, equipment fitness), leisure time sedentary behaviors (LTSB)(> 2 h/d) were relatively more likely to eat out.

Conclusions

The results illustrated that eating out three times or more had a significantly positive effect on overweight and obesity among boys in China.
Duloxetine reduces pain after Total hip arthroplasty: a prospective, randomized controlled study
Authors: Li Hao , Zeng Wei-Nan , Ding Zi-Chuan , Yuan Ming-Cheng , Cai Yong-Rui , Zhou Zong-Ke
Published: May 2021

Background

Previous studies have demonstrated the efficacy of duloxetine in reducing postoperative pain and opioid consumption. However, the effect of duloxetine on total hip arthroplasty (THA) remains unclear. The objective of this study was to assess the efficacy of oral duloxetine in THA.

Methods

We enrolled 96 patients in this randomized controlled trial. These patients were randomized (1,1) to either the duloxetine group or the placebo group and received daily doses of 60 mg duloxetine or placebo, respectively, from 2 d pre-operation to 14 d after surgery. The primary outcome was pain severity upon movement measured by a visual analogue scale (VAS). The secondary outcomes included VAS scores for resting pain, morphine consumption, Harris Hip Score, patient satisfaction at discharge, length of postoperative hospital stay, and adverse events.

Results

Patients in the duloxetine group had significantly lower pain severity scores upon movement within 3 postoperative weeks (p < 0.05) while none of the differences met the minimum clinically important difference (MCID). Moreover, patients in the duloxetine group performed better in terms of resting pain (in 3 weeks after surgery), morphine requirements, and satisfaction level at discharge (all p < 0.05). There was no difference between groups in the prevalence of adverse events.

Conclusions

Although it did not result in a clinically meaning reduction in pain after total hip arthroplasty, perioperative administration of 60 mg of duloxetine daily significantly alleviated pain in the postoperative 3 weeks and morphine requirements during the postoperative 48 h. Therefore, duloxetine still shows promise in optimizing the multimodal pain-management protocols in total hip arthroplasty.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2000033606, 06/06/2020.
Efficacy of the “Eiffel tower” double titanium elastic nailing in combined management of congenital pseudarthrosis of the tibia: preliminary outcomes of 17 cases with review of literature
Authors: Wang Xiaoyu , Shi Li , Zhang Rui , Wang Wenbo , Wang Feng , Wang Mengwei , Xu Ze , Zuo Rongtai , Xu Jia , Kang Qinglin
Published: May 2021

Background

Difficulty in obtaining union, recurrent fractures, and residual deformities remain the problems challenging the management of congenital pseudarthrosis of the tibia (CPT). We applied the “Eiffel Tower” double titanium elastic nails (TENs) in the existing combined approach, which takes advantages of TEN’s mechanical stability with the protection against refracture, Ilizarov’s high fusion rate with alignment control and the biologic environment provided by bone grafting for bony union. The results of this procedure are presented and discussed.

Methods

Seventeen patients with CPT treated by combined surgery including pseudarthrosis resection, the “Eiffel Tower” double TENs technique, autogenous iliac bone grafting, and Ilizarov fixation between 2013 and 2019 were retrospectively investigated. Signs of bone union, limb length discrepancy (LLD), rate of refracture, and degree of residual deformities were reviewed. The AOFAS Ankle Hindfoot scale and measurement of ankle motion were used to evaluate ankle function. The mean follow-up time was 40.5 (11 to 91) months.

Results

The mean age at index surgery was 6.2 (2.5 to 15) years. Union of the pseudarthrosis was achieved in 100% of cases. Among them, 15 (88.2%) patients obtained union of the pseudarthrosis on the first attempt (primary union). The average time to primary union was 3.8 (2 to 6) months. The rest 2 cases achieved union after additional surgeries (secondary union). In terms of complications, refracture occurred in 2 patients (11.8%) and 4 patients (23.5%) developed pin infection. The mean limb length discrepancy at the final follow up was 33.4 (6–141) mm. The average AOFAS score improved from 38.2 (27 to 51) pre-operatively to 77 (63 to 87) post-operatively (p < 0.01).

Conclusions

The “Eiffel Tower” double TENs technique is an ideal intramedullary fixation method in the surgical treatment of CPT. The combination of TENs technique with bone grafting and Ilizarov fixation has the advantages of early bone union, less injury on metaphysis, and early functional recovery.

Level of evidence

Level IV.
Hip arthroscopy has good clinical outcomes in the treatment of osteoid osteoma of the acetabulum
Authors: Gao Guanying , Wu Ruiqi , Liu Rongge , Ao Yingfang , Wang Jianquan , Xu Yan
Published: May 2021

Background

Osteoid osteoma (OO) of the acetabulum is a relatively rare disease. However, the the clinical outcomes of hip arthroscopy for treatment of OO of the acetabulum are still uncertain.

Methods

We evaluated consecutive patients who were diagnosed with OO of the acetabulum and who underwent hip arthroscopy at our hospital between January 2013 and March 2020. All patients underwent a preoperative physical examination. Preoperative supine anteroposterior hip radiography, cross-table lateral radiographs, computed tomography (CT), and magnetic resonance imaging were performed in all patients. The alpha angle and lateral center-edge angle were measured before surgery. Supine anteroposterior hip radiography and CT were performed in all patients postoperatively. Preoperative patient-reported outcomes (PROs), including Visual Analog Scale (VAS), the International Hip Outcome Tool-12 (iHOT-12) and modified Harris Hip Score (mHHS), and PROs at final follow-up were evaluated.

Results

A total of 6 patients (mean age, 18.7 years; age range, 6–31 years; 5 males and 1 females) were included in this study. The average follow-up period after surgery was 28.3 months (range, 6–90 months). Before surgery, the mean mHHS was 45.2 ± 10.5 (range, 33–56), the mean iHOT-12 was 33.3 ± 14.5 (range, 13–49), and mean VAS was 8.2 ± 1.0 (range, 7–9). At one month after surgery, mean mHHS was 78.7 ± 1.9 (range, 77–81), iHOT-12 was 71.0 ± 4.5 (range, 68–80), and mean VAS was 0. At the final post-operative follow-up, mean mHHS was 89.2 ± 2.1 (range, 86–91), iHOT-12 was 93.5 ± 5.0 (range, 88–98), and mean VAS was 0. All results, except VAS between one month after surgery and at final follow-up, demonstrated statistically significant improvement (P < 0.05). One patient underwent revision surgery.

Conclusions

Hip arthroscopy has good clinical outcomes in the treatment of OO of the acetabulum. Further study on the mechanism of secondary femoroacetabular impingement (FAI) caused by OO of the acetabulum is needed. More cases of arthroscopic excision and longer follow-up are also needed to better prove the clinical outcomes of hip arthroscopy for OO of the acetabulum.
Auxiliary two-staged partial resection liver transplantation
Authors: Line Pål-Dag , Nadalin Silvio , Balci Deniz
Published: May 2021

A case report of two patients who underwent auxiliary liver transplantation and two staged hepatectomy was recently published in BMC Surgery. The surgical technique utilised is described as novel but has been published previously also in the setting of chronic liver disease. A new name for this surgical approach therefore seems redundant. The importance of careful hemodynamic monitoring of pressure and flow in the portal vein and artery of the auxiliary graft as well as optimizing venous outflow is paramount to ensure graft regeneration and avoid small for size syndrome. The relevant surgical considerations to ensure optimal safety has also been reported in previous literature. This brief letter to the editor of BMC Surgery gives an overview that put the article content in context with published literature on this transplant surgical technique.
A novel mutation in TNFRSF11A gene causes pediatric osteopetrosis: case report
Authors: Xu You , Yu Xiaoyan , Huang Mengjie
Published: May 2021

Background

Osteopetrosis is a rare inherited bone disorder affected individual by osteoclast disfunction and increasing bone density. Surgery was taken for histological examination of the specimen and evidence of malignancy was not found. Finally, X-ray and gene detection lead to the diagnosis.

Case presentation

We report a 10-year-old girl with two years history of pus rhinorrhea, nasal obstruction and smelly nose. She was diagnosed and treated as sinusitis. But the symptoms were recurrent. Ten months ago, she was afflicted with persistent swelling and broken skin on the right cheek. All the laboratory findings showed normal. During surgery, we resected the right gingiva, the right nasal mucosa and the right facial tissue for biopsies. Histological examination showed proliferation of granulation tissue in chronic inflammatory mucosa. X-rays showed generalized sclerosis. Genetic analysis strongly supported a novel mutation of TNFRSF11A gene which caused osteoporosis. We found a novel mutation of the c.1196C > G (p.S399X) in exon 9 of TNFRSF11A. The TNFRSF11A gene encodes RANK, which is fundamental for osteoclast formation.

Conclusion

Osteopetrosis is a rare genetic bone disease characterized by increased bone density because of bone resorption failure. Diagnosis is based on X-ray and gene analyze. Osteoclasts are bone-related cells derived from hematopoietic cell lines. Since osteoclasts arise from a hematopoietic progenitor cell of the monocytic lineage, the defect can be corrected by hematopoietic stem cell transplantation (HSCT). Better understanding of this pathological situation and pathogenesis is so important to plan appropriate immunotherapy to benefit.
How do women living with HIV experience menopause? Menopausal symptoms, anxiety and depression according to reproductive age in a multicenter cohort
Authors:   CoRIS Cohort, Suarez-García Ines , Alejos Belén , Pérez-Elías Maria-Jesús , Iribarren Jose-Antonio , Hernando Asunción , Ramírez Margarita , Tasias María , Pascual Mario , Jarrin Inma , Hernando Victoria
Published: May 2021

Background

To estimate the prevalence and severity of menopausal symptoms and anxiety/depression and to assess the differences according to menopausal status among women living with HIV aged 45–60 years from the cohort of Spanish HIV/AIDS Research Network (CoRIS).

Methods

Women were interviewed by phone between September 2017 and December 2018 to determine whether they had experienced menopausal symptoms and anxiety/depression. The Menopause Rating Scale was used to evaluate the prevalence and severity of symptoms related to menopause in three subscales: somatic, psychologic and urogenital; and the 4-item Patient Health Questionnaire was used for anxiety/depression. Logistic regression models were used to estimate odds ratios (ORs) of association between menopausal status, and other potential risk factors, the presence and severity of somatic, psychological and urogenital symptoms and of anxiety/depression.

Results

Of 251 women included, 137 (54.6%) were post-, 70 (27.9%) peri- and 44 (17.5%) pre-menopausal, respectively. Median age of onset menopause was 48 years (IQR 45–50). The proportions of pre-, peri- and post-menopausal women who had experienced any menopausal symptoms were 45.5%, 60.0% and 66.4%, respectively. Both peri- and post-menopause were associated with a higher likelihood of having somatic symptoms (aOR 3.01; 95% CI 1.38–6.55 and 2.63; 1.44–4.81, respectively), while post-menopause increased the likelihood of having psychological (2.16; 1.13–4.14) and urogenital symptoms (2.54; 1.42–4.85). By other hand, post-menopausal women had a statistically significant five-fold increase in the likelihood of presenting severe urogenital symptoms than pre-menopausal women (4.90; 1.74–13.84). No significant differences by menopausal status were found for anxiety/depression. Joint/muscle problems, exhaustion and sleeping disorders were the most commonly reported symptoms among all women. Differences in the prevalences of vaginal dryness (p = 0.002), joint/muscle complaints (p = 0.032), and sweating/flush (p = 0.032) were found among the three groups.

Conclusions

Women living with HIV experienced a wide variety of menopausal symptoms, some of them initiated before women had any menstrual irregularity. We found a higher likelihood of somatic symptoms in peri- and post-menopausal women, while a higher likelihood of psychological and urogenital symptoms was found in post-menopausal women. Most somatic symptoms were of low or moderate severity, probably due to the good clinical and immunological situation of these women.
State medical malpractice laws and utilization of surgical treatment for rotator cuff tear and proximal humerus fracture: an observational cohort study
Authors: Chen Brian , Chapman Cole , Bauer Floyd Sarah , Mobley John , Brooks John
Published: May 2021

Background

How much does the medical malpractice system affect treatment decisions in orthopaedics? To further this inquiry, we sought to assess whether malpractice liability is associated with differences in surgery rates among elderly orthopaedic patients.

Methods

Medicare data were obtained for patients with a rotator cuff tear or proximal humerus fracture in 2011. Multivariate regressions were used to assess whether the probability of surgery is associated with various state-level rules that increase or decrease malpractice liability risks.

Results

Study results indicate that lower liability is associated with higher surgery rates. States with joint and several liability, caps on punitive damages, and punitive evidence rule had surgery rates that were respectively 5%-, 1%-, and 1%-point higher for rotator cuff tears, and 2%-, 2%- and 1%-point higher for proximal humerus fractures. Conversely, greater liability is associated with lower surgery rates, respectively 6%- and 9%-points lower for rotator cuff patients in states with comparative negligence and pure comparative negligence.

Conclusions

Medical malpractice liability is associated with orthopaedic treatment choices. Future research should investigate whether treatment differences result in health outcome changes to assess the costs and benefits of the medical liability system.
Measuring the impact of an acute visiting scheme on emergency department attendances – a pre-post cohort design
Authors: Kaehne Axel , Keating Paula
Published: May 2021

Background

Emergency department (ED) attendances are contributing to rising costs of the National Health Service (NHS) in England. Critically assessing the impact of new services to reduce emergency department use can be difficult as new services may create additional access points, unlocking latent demand. The study evaluated an Acute Visiting Scheme (AVS) in a primary care context. We asked if AVS reduces overall ED demand and whether or not it changed utilisation patterns for frequent attenders.

Method

The study used a pre post single cohort design. The impact of AVS on all-cause ED attendances was hypothesised as a substitution effect, where AVS duty doctor visits would replace emergency department visits. Primary outcome was frequency of ED attendances. End points were reduction of frequency of service use and increase of intervals between attendances by frequent attenders.

Results

ED attendances for AVS users rose by 47.6%. If AVS use was included, there was a more than fourfold increase of total service utilisation, amounting to 438.3%. It shows that AVS unlocked significant latent demand. However, there was some reduction in the frequency of ED attendances for some patients and an increase in time intervals between ED attendances for others.

Conclusion

The study demonstrates that careful analysis of patient utilisation can detect a differential impact of AVS on the use of ED. As the new service created additional access points for patients and hence introduces an element of choice, the new service is likely to unlock latent demand. This study illustrates that AVS may be most useful if targeted at specific patient groups who are most likely to benefit from the new service.
Community-based molecular and serological surveillance of subclinical malaria in Myanmar
Authors: O’Flaherty Katherine , Oo Win Han , Zaloumis Sophie G. , Cutts Julia C. , Aung Kyaw Zayar , Thein Myat Mon , Drew Damien R. , Razook Zahra , Barry Alyssa E. , Parischa Naanki , Zaw Nyi Nyi , Thu Htin Kyaw , Thi Aung , Htay Wai Yan Min , Soe Aung Paing , Simpson Julie A. , Beeson James G. , Agius Paul A. , Fowkes Freya J. I.
Published: May 2021

Background

In the Greater Mekong Subregion (GMS), current malaria surveillance strategies rely on a network of village health volunteers (VHVs) reporting the results of rapid diagnostic tests (RDTs), known to miss many asymptomatic infections. Integration of more sensitive diagnostic molecular and serological measures into the VHV network may improve surveillance of residual malaria transmission in hard-to-reach areas in the region and inform targeted interventions and elimination responses. However, data on residual malaria transmission that would be captured by these measures in the VHV-led testing and treatment surveillance network in the GMS is unknown.

Methods

A total of 114 VHVs were trained to collect dried blood spots from villagers undergoing routine RDTs as part of VHV-led active and passive case detection from April 2015 to June 2016. Samples were subjected to molecular testing (quantitative polymerase chain reaction [qPCR]) to determine Plasmodium falciparum and P. vivax infection and serological testing (against P. falciparum and P. vivax antigens) to determine exposure to P. falciparum and P. vivax.

Results

Over 15 months, 114 VHVs performed 32,194 RDTs and collected samples for molecular (n = 13,157) and serological (n = 14,128) testing. The prevalence of molecular-detectable P. falciparum and P. vivax infection was 3.2% compared to the 0.16% prevalence of Plasmodium spp. by RDT, highlighting the large burden of infections undetected by standard surveillance. Peaks in anti-P. falciparum, but not P. vivax, merozoite IgG seroprevalence coincided with seasonal P. falciparum transmission peaks, even in those with no molecularly detectable parasites. At the individual level, antibody seropositivity was associated with reduced odds of contemporaneous P. falciparum (OR for PfCSP 0.51 [95%CI 0.35, 0.76], p = 0.001, PfAMA1 0.70 [95%CI 0.52, 0.93], p = 0.01, and PfMSP2 0.81 [95%CI 0.61, 1.08], p = 0.15), but not P. vivax infection (OR PvAMA1 1.02 [95%CI 0.73, 1.43], p = 0.89) indicating a potential role of immunity in protection against molecular-detectable P. falciparum parasitaemia.

Conclusions

We demonstrated that integration and implementation of sample collection for molecular and serological surveillance into networks of VHV servicing hard-to-reach populations in the GMS is feasible, can capture significant levels of ongoing undetected seasonal malaria transmission and has the potential to supplement current routine RDT testing. Improving malaria surveillance by advancing the integration of molecular and serological techniques, through centralised testing approaches or novel point-of-contact tests, will advance progress, and tracking, towards malaria elimination goals in the GMS.
Genome-based selection and application of food-grade microbes for chickpea milk fermentation towards increased l-lysine content, elimination of indigestible sugars, and improved flavour
Authors: Tangyu Muzi , Fritz Michel , Aragao-Börner Rosa , Ye Lijuan , Bogicevic Biljana , Bolten Christoph J. , Wittmann Christoph
Published: May 2021

Background

Plant-based milk alternatives are more popular than ever, and chickpea-based milks are among the most commercially relevant products. Unfortunately, limited nutritional value because of low levels of the essential amino acid l-lysine, low digestibility and unpleasant taste are challenges that must be addressed to improve product quality and meet consumer expectations.

Results

Using in-silico screening and food safety classifications, 31 strains were selected as potential l-lysine producers from approximately 2,500 potential candidates. Beneficially, 30% of the isolates significantly accumulated amino acids (up to 1.4 mM) during chickpea milk fermentation, increasing the natural level by up to 43%. The best-performing strains, B. amyloliquefaciens NCC 156 and L. paracasei subsp. paracasei NCC 2511, were tested further. De novo lysine biosynthesis was demonstrated in both strains by 13C metabolic pathway analysis. Spiking small amounts of citrate into the fermentation significantly activated l-lysine biosynthesis in NCC 156 and stimulated growth. Both microbes revealed additional benefits in eliminating indigestible sugars such as stachyose and raffinose and converting off-flavour aldehydes into the corresponding alcohols and acids with fruity and sweet notes.

Conclusions

B. amyloliquefaciens NCC 156 and L. paracasei subsp. paracasei NCC 2511 emerged as multi-benefit microbes for chickpea milk fermentation with strong potential for industrial processing of the plant material. Given the high number of l-lysine-producing isolates identified in silico, this concept appears promising to support strain selection for food fermentation.
Evaluation of the EQ-5D-3L and 5L versions in low back pain patients
Authors: Garratt A. M. , Furunes H. , Hellum C. , Solberg T. , Brox J. I. , Storheim K. , Johnsen L. G.
Published: May 2021

Background

The EuroQol EQ-5D is one of the most widely researched and applied patient-reported outcome measures worldwide. The original EQ-5D-3L and more recent EQ-5D-5L include three and five response categories respectively. Evidence from healthy and sick populations shows that the additional two response categories improve measurement properties but there has not been a concurrent comparison of the two versions in patients with low back pain (LBP).

Methods

LBP patients taking part in a multicenter randomized controlled trial of lumbar total disc replacement and conservative treatment completed the EQ-5D-3L and 5L in an eight-year follow-up questionnaire. The 3L and 5L were assessed for aspects of data quality including missing data, floor and ceiling effects, response consistency, and based on a priori hypotheses, associations with the Oswestry Disability Index (ODI), Pain-Visual Analogue Scales and Hopkins Symptom Checklist (HSCL-25).

Results

At the eight-year follow-up, 151 (87%) patients were available and 146 completed both the 3L and 5L. Levels of missing data were the same for the two versions. Compared to the EQ-5D-5L, the 3L had significantly higher floor (pain discomfort) and ceiling effects (mobility, self-care, pain/discomfort, anxiety/depression). For these patients the EQ-5D-5L described 73 health states compared to 28 for the 3L. Shannon’s indices showed the 5L outperformed the 3L in tests of classification efficiency. Correlations with the ODI, Pain-VAS and HSCL-25 were largely as hypothesized, the 5L having slightly higher correlations than the 3L.

Conclusion

The EQ-5D assesses important aspect of health in LBP patients and the 5L improves upon the 3L in this respect. The EQ-5D-5L is recommended in preference to the 3L version, however, further testing in other back pain populations together with additional measurement properties, including responsiveness to change, is recommended.

Trial registration: retrospectively registered: https://clinicaltrials.gov/ct2/show/NCT01704677.
Identification of circRNA–miRNA–mRNA networks contributes to explore underlying pathogenesis and therapy strategy of gastric cancer
Authors: Dong Zhijie , Liu Zhaoyu , Liang Min , Pan Jinhui , Lin Mingzhen , Lin Hai , Luo Yuanwei , Zhou Xinke , Yao Wenxia
Published: May 2021

Background

Circular RNAs (circRNAs) are a new class of noncoding RNAs that have gained increased attention in human tumor research. However, the identification and function of circRNAs are largely unknown in the context of gastric cancer (GC). This study aims to identify novel circRNAs and determine their action networks in GC.

Methods

A comprehensive strategy of data mining, reverse transcription-quantitative polymerase chain reaction (RT-qPCR) and computational biology were conducted to discover novel circRNAs and to explore their potential mechanisms in GC. Promising therapeutic drugs for GC were determined by connectivity map (CMap) analysis.

Results

Six overlapped differentially expressed circRNAs (DECs) were screened from selected microarray and RNA-Seq datasets of GC, and the six DECs were then validated by sanger sequencing and RNase R treatment. Subsequent RT-qPCR analysis of GC samples confirmed decreased expressions of the six DECs (hsa_circ_0000390, hsa_circ_0000615, hsa_circ_0001438, hsa_circ_0002190, hsa_circ_0002449 and hsa_circ_0003120), all of which accumulated preferentially in the cytoplasm. MiRNA binding sites and AGO2 occupation of the six circRNAs were predicted using online databases, and circRNA–miRNA interactions including the six circRNAs and 33 miRNAs were determined. Then, 5320 target genes of the above 33 miRNAs and 1492 differently expressed genes (DEGs) from The Cancer Genome Atlas (TCGA) database were identified. After intersecting the miRNA target genes and the 889 downregulated DEGs, 320 overlapped target genes were acquired. The Kyoto Encyclopedia of Genes and Genomes enrichment analysis indicated that these target genes were related to two critical tumor-associated signaling pathways. A protein–protein interaction network with the 320 target genes was constructed using STRING, and fifteen hubgenes (ATF3, BTG2, DUSP1, EGR1, FGF2, FOSB, GNAO1, GNAI1, GNAZ, GNG7, ITPR1, ITPKB, JUND, NR4A3, PRKCB) in the network were identified. Finally, bioactive chemicals (including vorinostat, trichostatin A and astemizole) based on the fifteen hubgenes were identifed as therapeutic agents for GC through the CMap analysis.

Conclusions

This study provides a novel insight for further exploration of the pathogenesis and therapy of GC from the circRNA-miRNA-mRNA network perspective.