bluuebunny/crossref_metadata_2025 huggingface dataset:
Lab-based feasibility and acceptability of neuromuscular electrical stimulation in hip osteoarthritis rehabilitation
Authors: Burgess Louise C , Taylor Paul , Wainwright Thomas W , Swain Ian D
Published: March 2021

Introduction

Neuromuscular electrical stimulation (NMES) could provide an alternative or adjunct treatment modality to induce muscle hypertrophy in the hip osteoarthritis population. This preliminary study evaluates the feasibility and acceptability of NMES to evoke involuntary muscle contractions in adults with advanced hip osteoarthritis.

Methods

Thirteen adults with moderate-to-severe hip osteoarthritis and fifteen healthy, older adults were invited to a lab-based testing session. NMES was applied unilaterally to the knee extensors and hip abductors for one continuous, five-minute testing session. Data were collected on device acceptability, tolerability and muscle contractile force, and compared between groups.

Results

Electrical stimulation of the knee extensors elicited a visible muscular contraction in 11 participants (85%) with hip osteoarthritis and 15 controls (100%) at an intensity acceptable to the participant. Electrical stimulation of the hip abductors elicited a muscular contraction in eight participants (62%) with osteoarthritis, and ten controls (67%). Muscle contractile force, pain, discomfort and acceptability did not differ between groups, however NMES of the knee extensors was favoured across all measures of assessment when compared to the hip abductors.

Conclusions

Electrical stimulation of the knee extensors may be a feasible and acceptable treatment modality to address muscle atrophy in adults with advanced hip osteoarthritis.
Impact on radiological practice of active guideline implementation of musculoskeletal guideline, as measured over a 12-month period
Authors: Gransjøen Ann M , Thorsen Kjetil , Lysdahl Kristin B , Wiig Siri , Hofmann Bjørn M
Published: March 2021

Background

An ever-increasing technological development in the field of radiology urges a need for guidelines to provide predictable and just health services. A musculoskeletal guideline was developed in Norway in 2014, without active implementation.

Purpose

To investigate the impact of active guideline implementation on the use of musculoskeletal diagnostic imaging most frequently encountered in general practice (pain in the neck, shoulders, lower back, and knees).

Material and Methods

The total number of outpatient radiological examinations across modalities registered at the Norwegian Health Economics Administration between January 2013 and February 2019 was assessed using an interrupted time series design.

Results

A 12% reduction in the total examination of Magnetic Resonance Imaging shoulder and knee, and x-ray lower back and shoulder was found at a significant level ( p = 0.05). Stratified analysis (Magnetic Resonance Imaging examination as one group and x-ray examinations as the other) showed that this reduction mainly was due to the reduction in the use of Magnetic Resonance Imaging examinations (shoulder and knee) which was reduced by 24% at a significant level ( p = 0.002), while x-ray examinations had no significant level change ( p = 0.71). No other statistically significant changes were found.

Conclusion

The impact of the implementation on the use of imaging of the neck, shoulder, lower back, and knee is uncertain. Significant reductions were demonstrated in the use of some examinations in the intervention county, but similar effects were not seen when including a control group in the analysis. This indicates a diffusion of the implementation, or other interventions or events that affected both counties and occurred in the intervention period.
Analysis of pathogenic distribution and drug resistance of catheter-related blood stream infection in hemodialysis patients with vein tunneled cuffed catheter
Authors: Ren Wei , Jiang Jun , Wang Yan , Jin Yan , Fang Yuan , Zhao Chen
Published: March 2021

The catheter related blood stream infections (CRBSI) in hemodialysis (HD) patients with vein tunneled cuffed catheter (TCC) and misuse of antibiotic in clinical practice seriously affected the prognosis of MHD patients. The present study aimed to investigate the pathogen distribution and drug resistance of CRBSI in HD patients with TCC to guide clinical empirical pharmacy. The clinical data of 75 HD patients with TCC diagnosed with CRBSI between January 2011 and March 2015 were retrospectively collected, and the distribution and drug resistance of pathogens were analyzed. In 75 HD patients with TCC diagnosed with CRBSI, there were 33 patients with positive blood culture, and the positive rate of blood culture was 44%. The majority of the 33 pathogens were Gram-positive bacteria (22 strains, accounting for 66.7%). Gram-positive cocci hardly resisted to vancomycin and linezolid, while the resistance rate to penicillin G nearly reached to 100%. Gram-negative bacilli had low resistance rates to carbapenems and quinolone antibiotics, and the resistance rate to cephalosporins antibioticsexceeding 50%. The positive rate of blood culture in 75 HD patients with TCC diagnosed with CRBSI is low. The pathogens resulting in CRBSI in HD patients are mainly Gram-positive bacteria which are significantly resistant to penicillin G, and have a low resistance rate to methicillin. Gram-negative bacteria have high resistance rates to commonly used antibiotics. The pathogen examination should be performed as early as possible and effective antibiotics should be chosen according to drug sensitivity test results in CRBSI in HD patients.
The Effect of Statistics on Enjoyment and Perceived Credibility in Sports Media
Authors: Hahn Dustin
Published: March 2021

Evolving media landscapes toward increasingly diverse and competitive environments in both traditional and new media requires producers regularly examine the quality of their productions. One growing line of research identifies the increasing presence and significance of statistics in sports media programming. This experiment measures the effect of statistics on enjoyment and perceived credibility by sport consumers while considering level of fanship, media source, and variations in placement within Instagram posts. Results uncover evidence that validates previous observations about statistics in media while contradicting others. Specifically, findings reveal that statistics enhance enjoyment and improve perceived credibility. Observations were consistent across fanship level. However, additional findings also suggest media source and placement of statistics influences both enjoyment and credibility as well. For both dependent variables, statistics in both the Instagram caption and image yielded significantly greater enjoyment and credibility than some other conditions including posts without statistics at all. The impact of these and other findings on sports media industry and scholarship, along with limitations and directions for future research, are discussed.
Effectiveness of Print Media Marketing in Digital Age: A Study on Indian Telecommunication Industry
Authors: Mathai Shaji , Jeswani Saket
Published: March 2021

In today’s era, business is Internet-driven that embarked on the evolution of the digital era. We are in the digital age with complete technology-driven activities facilitated by the Internet. This has certainly opened many new options for businesses to plug themselves. A gamut of studies has reported a positive influence of print media marketing on business. However, this study examines the effectiveness of print media marketing in today’s highly competitive digital era for the Indian telecommunication industry. A model was proposed to gauge the effectiveness of print media on customer retention for the telecom industry. The study was conducted with 200 customers from various telecom service providers, using a survey questionnaire which was administered to them. Research findings indicate that the migration to online sources is inevitable although print media has not become obsolete. It is also revealed that the print media alone is not effective and hence is unable to retain the consumers. The integration of print media marketing with digital and social media marketing is the recommendation of this study. This bundle is often effectively utilized to reinforce awareness and retention. The study also presents implications, limitations and future research direction within the context.
Clinical, Radiographic, and Arthroscopic Outcomes of Surgical Repair for Radial and Avulsed Lesions on the Lateral Meniscus Posterior Root During ACL Reconstruction: A Systematic Review
Authors: Zheng Tong , Song Guanyang , Li Yue , Zhang Zhijun , Ni Qiankun , Cao Yanwei , Feng Zheng , Zhang Hui , Feng Hua
Published: March 2021

Background:

Clinical outcomes of surgical repairs for tears of the lateral meniscus posterior root (LMPR) in patients undergoing anterior cruciate ligament (ACL) reconstruction (ACLR) have not been comprehensively investigated.

Purpose:

To systematically review the clinical, radiographic, and arthroscopic results of surgical repairs for tears of the LMPR in patients undergoing ACLR.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic electronic search of the PubMed and Embase databases was performed to identify studies reporting clinical, radiographic, or arthroscopic results of surgical repairs for tears of the LMPR in patients undergoing ACLR. Each included study was abstracted regarding study characteristics, patient characteristics, surgical technique, and outcome measures. The methodological quality of the included studies was analyzed according to the Methodological Index for Non-Randomized Studies (MINORS) criteria.

Results:

Nine studies were included in this systematic review, representing a total of 215 knees in 215 patients. Overall, 123 side-to-side repairs and 89 pullout repairs were performed for tears of the LMPR during ACLR. After a mean follow-up of 33.9 months, significant improvements ( P < .05) were found in the mean Lysholm score (from 58.3 to 91.4) as well as the mean International Knee Documentation Committee subjective score (from 61.1 to 87.2). Weightbearing anteroposterior radiographs of 41 patients showed no significant narrowing of lateral joint space width. On magnetic resonance imaging scans, 31 patients demonstrated no significant progression of chondral lesions, and no significant decreases in meniscal extrusion on coronal planes were reported in another 76 patients. The complete/partial healing was 93.6% on second-look arthroscopy after side-to-side repairs for radial tears of the LMPR. The MINORS value showed a high risk of bias for all 9 studies.

Conclusion:

Patients with tears of the LMPR associated with ACL injuries achieved favorable functional scores after ACLR and LMPR repairs, and the side-to-side repair for radial tears of the LMPR succeeded in a high meniscal healing rate of >90%. However, the authors of this review were unable to definitively conclude whether LMPR repairs fully restore the hoop stress of the lateral meniscus.
Transvestic Disorder, Obsessive Compulsive Disorder, and Bipolar Disorder in an Adolescent Male: Diagnostic Conundrums and Management Difficulties
Authors: Panda Tushar Kant , Aneja Jitender , Swami Mukesh
Published: March 2021

Transvestic disorder with comorbid obsessive-compulsive disorder and bipolar disorder (BD) is a rare presentation, with only 1 case report in available literature. It may be an arduous task to differentiate between the phenomenology of transvestic disorder and obsessive-compulsive disorder. We, herein, report the case of a 17-year-old boy who presented with complaints of cross-dressing which was difficult to be differentiated from sexual obsessions. He also suffered from BD that complicated the management.
Single-cell analysis can define distinct evolution of tumor sites in follicular lymphoma
Authors: Haebe Sarah , Shree Tanaya , Sathe Anuja , Day Grady , Czerwinski Debra K. , Grimes Susan M. , Lee HoJoon , Binkley Michael S. , Long Steven R. , Martin Brock , Ji Hanlee P. , Levy Ronald
Published: March 2021

Tumor heterogeneity complicates biomarker development and fosters drug resistance in solid malignancies. In lymphoma, our knowledge of site-to-site heterogeneity and its clinical implications is still limited. Here, we profiled 2 nodal, synchronously acquired tumor samples from 10 patients with follicular lymphoma (FL) using single-cell RNA, B-cell receptor (BCR) and T-cell receptor sequencing, and flow cytometry. By following the rapidly mutating tumor immunoglobulin genes, we discovered that BCR subclones were shared between the 2 tumor sites in some patients, but in many patients, the disease had evolved separately with limited tumor cell migration between the sites. Patients exhibiting divergent BCR evolution also exhibited divergent tumor gene-expression and cell-surface protein profiles. While the overall composition of the tumor microenvironment did not differ significantly between sites, we did detect a specific correlation between site-to-site tumor heterogeneity and T follicular helper (Tfh) cell abundance. We further observed enrichment of particular ligand-receptor pairs between tumor and Tfh cells, including CD40 and CD40LG, and a significant correlation between tumor CD40 expression and Tfh proliferation. Our study may explain discordant responses to systemic therapies, underscores the difficulty of capturing a patient’s disease with a single biopsy, and furthers our understanding of tumor-immune networks in FL.
A composite single-nucleotide polymorphism prediction signature for extranodal natural killer/T-cell lymphoma
Authors: Tian Xiao-Peng , Ma Shu-Yun , Young Ken H. , Ong Choon Kiat , Liu Yan-Hui , Li Zhi-Hua , Zhai Qiong-Li , Huang Hui-Qiang , Lin Tong-Yu , Li Zhi-Ming , Xia Zhong-Jun , Zhong Li-Ye , Rao Hui-Lan , Li Mei , Cai Jun , Zhang Yu-Chen , Zhang Fen , Su Ning , Li Peng-Fei , Zhu Feng , Xu-Monette Zijun Y. , Wong Esther Kam Yin , Ha Jeslin Chian Hung , Khoo Lay Poh , Ai Le , Cheng Run-Fen , Lim Jing Quan , de Mel Sanjay , Ng Siok-Bian , Lim Soon Thye , Cai Qing-Qing
Published: March 2021

Current prognostic scoring systems based on clinicopathologic variables are inadequate in predicting the survival and treatment response of extranodal natural killer/T-cell lymphoma (ENKTL) patients undergoing nonanthracyline-based treatment. We aimed to construct a classifier based on single-nucleotide polymorphisms (SNPs) for improving predictive accuracy and guiding clinical decision making. Data from 722 patients with ENKTL from international centers were analyzed. A 7-SNP–based classifier was constructed using LASSO Cox regression in the training cohort (n = 336) and further validated in the internal testing cohort (n = 144) and in 2 external validation cohorts (n = 142 and n = 100). The 7-SNP–based classifier showed good prognostic predictive efficacy in the training cohort and the 3 validation cohorts. Patients with high- and low-risk scores calculated by the classifier exhibited significantly different progression-free survival (PFS) and overall survival (OS) (all P < .001). The 7-SNP–based classifier was further proved to be an independent prognostic factor by multivariate analysis, and its predictive accuracy was significantly better than clinicopathological risk variables. Application of the 7-SNP–based classifier was not affected by sample types. Notably, chemotherapy combined with radiotherapy significantly improved PFS and OS vs radiotherapy alone in high-risk Ann Arbor stage I patients, whereas there was no statistical difference between the 2 therapeutic modalities among low-risk patients. A nomogram was constructed comprising the classifier and clinicopathological variables; it showed remarkably better predictive accuracy than either variable alone. The 7-SNP–based classifier is a complement to existing risk-stratification systems in ENKTL, which could have significant implications for clinical decision making for patients with ENKTL.
Current evidence for COVID-19 therapies: a systematic literature review
Authors: Welte Tobias , Ambrose Lucy J. , Sibbring Gillian C. , Sheikh Shehla , Müllerová Hana , Sabir Ian
Published: March 2021

Effective therapeutic interventions for the treatment and prevention of coronavirus disease 2019 (COVID-19) are urgently needed. A systematic review was conducted to identify clinical trials of pharmacological interventions for COVID-19 published between 1 December 2019 and 14 October 2020. Data regarding efficacy of interventions, in terms of mortality, hospitalisation and need for ventilation, were extracted from identified studies and synthesised qualitatively.

In total, 42 clinical trials were included. Interventions assessed included antiviral, mucolytic, antimalarial, anti-inflammatory and immunomodulatory therapies. Some reductions in mortality, hospitalisation and need for ventilation were seen with interferons and remdesivir, particularly when administered early, and with the mucolytic drug, bromhexine. Most studies of lopinavir/ritonavir and hydroxychloroquine did not show significant efficacy over standard care/placebo. Dexamethasone significantly reduced mortality, hospitalisation and need for ventilationversusstandard care, particularly in patients with severe disease. Evidence for other classes of interventions was limited. Many trials had a moderate-to-high risk of bias, particularly in terms of blinding; most were short-term and some included low patient numbers.

This review highlights the need for well-designed clinical trials of therapeutic interventions for COVID-19 to increase the quality of available evidence. It also emphasises the importance of tailoring interventions to disease stage and severity for maximum efficacy.
Clinical and radiological outcomes of total hip arthroplasty in patients affected by Paget’s disease: a combined registry and single-institution retrospective observational study
Authors: Di Martino Alberto , Coppola Maria Antonietta Rita , Bordini Barbara , Stefanini Niccolò , Geraci Giuseppe , Pilla Federico , Traina Francesco , Faldini Cesare
Published: March 2021

Background

Total hip arthroplasty (THA) in patients with Paget’s disease can be associated with technical difficulties related to deformities and altered mechanical bone properties, and hypervascularity leads to significative intra-operative bleeding. The purpose of this registry and single-institution study was to investigate overall survival and causes of failure of THA in pagetic patients, together with an analysis of the clinical and radiological complications.

Material and methods

Registry-based survival and complication analysis, type of fixation, intra- and post-operative complications, clinical (pharmacological history, blood transfusions, Harris hip score [HHS]) and radiographic (cup orientation, stem axial alignment, osteolysis around the cup and the stem and heterotopic ossification [HO]) data were reviewed.

Results

In total, 66 patients (27 males and 39 females, mean age at surgery 71.1 years for males and 74.8 years for female) from the registry study presented a 10-year survival of 89.5%. In the institutional study, involving 26 patients (14 males and 12 females, 69 years average) and 29 THAs, hip function improved significantly. Average cup orientation was 40.5°, while varus stem alignment was 13.8%. In total, 52% of hips had heterotopic ossifications. Peri-acetabular osteolysis was in 13.8% of implants and in 45% of hips was found around the stem. Allogenic and autologous blood transfusion rate were 68.2% and 31.8%, respectively, with an average transfusion of 2 units of blood (range 1–6 units). HHS improved by an average of 34 points, with excellent result in 64.3% of patients. Two implants failed, one due to traumatic ceramic head fracture 64 months after surgery, and one due to mobilization of the cup on the second post-operative day.

Conclusion

THA surgery in Paget’s patients is a safe procedure, and implant survival is only partly affected by bone remodelling and choice of fixation. The post-operative functional outcome is largely similar to that of other patients. Bleeding-related complications are the main complications; a careful pharmacological strategy should be recommended to decrease the risk of transfusions and of HO development.

Level of evidence

Level III
An In-Situ Reaction Route to Molecular Level Dispersed Bisimide and ZnO Nanorod Hybrids with Efficient Photo-Induced Charge Transfer
Authors: Lv Chunzheng , He Lirong , Tang Jiahong , Yang Feng , Zhang Chuhong
Published: March 2021

As an important photoconductive hybrid material, perylene/ZnO has attracted tremendous attention for photovoltaic-related applications, but generally faces a great challenge to design molecular level dispersed perylenes/ZnO nanohybrids due to easy phase separation between perylenes and ZnO nanocrystals. In this work, we reported an in-situ reaction method to prepare molecular level dispersed H-aggregates of perylene bisimide/ZnO nanorod hybrids. Surface photovoltage and electric field-induced surface photovoltage spectrum show that the photovoltage intensities of nanorod hybrids increased dramatically for 100 times compared with that of pristine perylene bisimide. The enhancement of photovoltage intensities resulting from two aspects: (1) the photo-generated electrons transfer from perylene bisimide to ZnO nanorod due to the electric field formed on the interface of perylene bisimide/ZnO; (2) the H-aggregates of perylene bisimide in ZnO nanorod composites, which is beneficial for photo-generated charge separation and transportation. The introduction of ordered self-assembly thiol-functionalized perylene-3,4,9,10-tetracarboxylic diimide (T-PTCDI)/ ZnO nanorod composites induces a significant improvement in incident photo-to-electron conversion efficiency. This work provides a novel mentality to boost photo-induced charge transfer efficiency, which brings new inspiration for the preparation of the highly efficient solar cell.
Immune-related genes of the larval Holotrichia parallela in response to entomopathogenic nematodes Heterorhabditis beicherriana LF
Authors: Li Ertao , Qin Jianhui , Feng Honglin , Li Jinqiao , Li Xiaofeng , Nyamwasa Innocent , Cao Yazhong , Ruan Weibin , Li Kebin , Yin Jiao
Published: March 2021

Background

Entomopathogenic nematodes (EPNs) emerge as compatible alternatives to conventional insecticides in controlling Holotrichia parallela larvae (Coleoptera: Scarabaeidae). However, the immune responses of H. parallela against EPNs infection remain unclear.

Results

In present research, RNA-Seq was firstly performed. A total of 89,427 and 85,741 unigenes were achieved from the midgut of H. parallela larvae treated with Heterorhabditis beicherriana LF for 24 and 72 h, respectively; 2545 and 3156 unigenes were differentially regulated, respectively. Among those differentially expressed genes (DEGs), 74 were identified potentially related to the immune response. Notably, some immune-related genes, such as peptidoglycan recognition protein SC1 (PGRP-SC1), pro-phenoloxidase activating enzyme-I (PPAE-I) and glutathione s-transferase (GST), were induced at both treatment points. Bioinformatics analysis showed that PGRP-SC1, PPAE-I and GST were all involved in anti-parasitic immune process. Quantitative real-time PCR (qRT-PCR) results showed that the three immune-related genes were expressed in all developmental stages; PGRP-SC1 and PPAE-I had higher expressions in midgut and fat body, respectively, while GST exhibited high expression in both of them. Moreover, in vivo silencing of them resulted in increased susceptibility of H. parallela larvae to H. beicherriana LF.

Conclusion

These results suggest that H. parallela PGRP-SC1, PPAE-I and GST are involved in the immune responses to resist H. beicherriana LF infection. This study provides the first comprehensive transcriptome resource of H. parallela exposure to nematode challenge that will help to support further comparative studies on host-EPN interactions.
Structural and functional analysis of tomato sterol C22 desaturase
Authors: Gutiérrez-García Laura , Arró Montserrat , Altabella Teresa , Ferrer Albert , Boronat Albert
Published: March 2021

Background

Sterols are structural and functional components of eukaryotic cell membranes. Plants produce a complex mixture of sterols, among which β-sitosterol, stigmasterol, campesterol, and cholesterol in some Solanaceae, are the most abundant species. Many reports have shown that the stigmasterol to β-sitosterol ratio changes during plant development and in response to stresses, suggesting that it may play a role in the regulation of these processes. In tomato (Solanum lycopersicum), changes in the stigmasterol to β-sitosterol ratio correlate with the induction of the only gene encoding sterol C22-desaturase (C22DES), the enzyme specifically involved in the conversion of β-sitosterol to stigmasterol. However, despite the biological interest of this enzyme, there is still a lack of knowledge about several relevant aspects related to its structure and function.

Results

In this study we report the subcellular localization of tomato C22DES in the endoplasmic reticulum (ER) based on confocal fluorescence microscopy and cell fractionation analyses. Modeling studies have also revealed that C22DES consists of two well-differentiated domains: a single N-terminal transmembrane-helix domain (TMH) anchored in the ER-membrane and a globular (or catalytic) domain that is oriented towards the cytosol. Although TMH is sufficient for the targeting and retention of the enzyme in the ER, the globular domain may also interact and be retained in the ER in the absence of the N-terminal transmembrane domain. The observation that a truncated version of C22DES lacking the TMH is enzymatically inactive revealed that the N-terminal membrane domain is essential for enzyme activity. The in silico analysis of the TMH region of plant C22DES revealed several structural features that could be involved in substrate recognition and binding.

Conclusions

Overall, this study contributes to expand the current knowledge on the structure and function of plant C22DES and to unveil novel aspects related to plant sterol metabolism.
TNF-α - mediated peripheral and central inflammation are associated with increased incidence of PND in acute postoperative pain
Authors: Zhao Yu-fan , Yang Hui-wen , Yang Ting-shun , Xie Wenxiu , Hu Zhong-hua
Published: March 2021

Background

Acute postoperative pain plays an important role in the perioperative neurocognitive disorders (PND). The pathogenesis of PND is still unknown, but it is generally believed that peripheral and central nervous system inflammation play an important role, and acute postoperative pain is also thought to aggravate postoperative inflammatory response. The aim of the present study is to explore the effect of acute postoperative pain on peripheral and central nervous system inflammation and related cognitive impairment behaviour in elderly rats after surgery.

Methods

Rats were assigned into four groups: control, surgery for internal fixation for tibial fracture, surgery with analgesia using intraperitoneal morphine, and morphine without surgery. Pain was assessed by the Subjective Pain Scale. The spatial memory of rats was assessed by the Morris water maze (delayed matching task) from the second day to the seventh day after surgery (POD2-POD7). In part of the rats, the pro-inflammatory cytokines TNF-α in plasma, the medial prefrontal cortex (mPFC), and the hippocampus were determined by ELISA on the POD2. The activation of microglia and the expression of c-Fos in the hippocampal CA1 regions and mPFC were detected by the immunohistochemical method on the POD2.

Results

Acute postoperative pain and spatial memory impairment occurred after operation, and postoperative analgesia could significantly improve the both parameters. Additionally, on the POD2, the levels of TNF-α in plasma, hippocampus and mPFC were significantly increased, while the activation of microglia cells and the expression c-Fos in the hippocampal CA1 regions and mPFC were significantly increased. And postoperative analgesia with morphine significantly inhibited the above reactions.

Conclusion

Our data suggest that acute postoperative pain increases the incidence of perioperative neurocognitive disorders. Peripheral and central nervous system inflammation may be involved in this cognitive impairment. And reducing the intensity of acute postoperative pain may be one of the main preventive strategies for PND.
Acute cannabis intoxication in the emergency department: the effect of legalization
Authors: Baraniecki Robert , Panchal Puru , Malhotra Danya Deepsee , Aliferis Alexandra , Zia Zaka
Published: March 2021

Background

On October 17, 2018, the Cannabis Act decriminalized the recreational use of cannabis in Canada. This study seeks to determine how legalization of cannabis has impacted emergency department (ED) visits for acute cannabis intoxication.

Methods

We conducted a retrospective chart review at an academic ED in Hamilton, Ontario. We assessed all visits with a cannabis-related ICD-10 discharge code 6 months before and after legalization (October 17, 2018) to determine cases of acute cannabis intoxication. The primary outcome was the rate of ED visits. Secondary outcomes included number of visits distributed by age, length of stay, co-ingestions, and clinical course in the emergency department (investigations and treatment).

Results

There was no difference in the overall rate of ED visits following legalization (2.44 vs. 2.94 visits/1000, p = 0.27). However, we noted a 56% increase in visits among adults aged 18–29 (p = 0.03). Following legalization, a larger portion of patients required observation without interventions (25% vs 48%, p < 0.05). Bloodwork and imaging studies decreased (53% vs. 12%, p < 0.05; 29% vs. 2%, p < 0.05); however, treatment with benzodiazepines increased (24% vs. 51%, p < 0.05).

Conclusions

Legalization was not associated with a change in the rate of cannabis-related ED visits in our study. More research is needed regarding changing methods of cannabis ingestion and trends among specific age groups.
Understanding patient journey in ulcerative colitis prior to biologic initiation: a 5-year exploration
Authors: Wang Yiting , Makadia Rupa , Knoll Christopher , Hardin Jill , Voss Erica A. , Fife Daniel , Davis Kourtney , Sloan Sheldon
Published: March 2021

Background

There has been a more pronounced shift toward earlier, more aggressive therapies in Crohn’s disease than in ulcerative colitis (UC). The aim of this study was to describe the pre-biologic treatment and health care experience, including co-morbidities and overall health care utilization, for UC patients who initiated biologic therapies, in the 5 years prior to the initiation of the first biologic agent.

Methods

UC patients who initiated a biologic agent approved for UC between 9/15/2005 and 1/30/2018 were identified from the IBM® MarketScan® Commercial Database, a large US database. The date of the first recorded UC biologic exposure was defined as the index date, and ≥ 5 years of pre-index records were required to evaluate patients’ treatment, disease progression and overall health care utilization prior to initiating biologic agents.

Results

Among the 1891 eligible patients, treatment with oral corticosteroids, 5-aminosalicylates, and other non-biologic immunomodulators, all increased progressively across the 5 years prior to the index. From within year-five to within year-one prior to the index, the median duration of oral corticosteroid treatment increased from 34 to 88 days per year and the proportion of patients who experienced more extensive/pancolitis disease increased from 16 to 59%. Overall, the frequency of all-cause health care visits also increased.

Conclusions

Patients with UC experienced increasing morbidity and treatment burden in the 5 years prior to initiating biologic therapy. To achieve reduced corticosteroids in UC management, better risk stratification is needed to help identify patients for more timely biologic treatment.
Increased mucosal IL-12 expression is associated with relapse of ulcerative colitis
Authors: Uchiyama Kazuhiko , Takagi Tomohisa , Mizushima Katsura , Kajiwara-Kubota Mariko , Kashiwagi Saori , Toyokawa Yuki , Tanaka Makoto , Hotta Yuma , Kamada Kazuhiro , Ishikawa Takeshi , Konishi Hideyuki , Kishimoto Mitsuo , Naito Yuji , Itoh Yoshito
Published: March 2021

Background

The role of IL-12/23 in the pathogenesis of ulcerative colitis (UC) is unclear. We analyzed mucosal IL-12/23 expression and its relationship with endoscopic severity, histological activity, and UC relapse.

Methods

Rectal biopsies were collected from 70 UC patients with clinical remission. IL-12, IL-23, IFN-γ, IL-17A, and IL-17F mRNA expression was measured by real-time PCR. Endoscopic severity and histological activity were evaluated using the Mayo endoscopic subscore (MES) and the Geboes score, respectively.

Results

The longest follow-up period was 51 months. Thirty-four patients relapsed during the study period. Samples from these subsequently relapsed patients formed the “relapse” group, while those from patients that did not relapse formed the “remission” group. IL-12 (P = 0.0003) and IL-23 (P = 0.014) mRNA expression was significantly higher in the relapse than the remission group. Expression of IL-23 (P = 0.015) but not IL-12 (P = 0.374) was correlated with MES. However, in patients with an MES of 0 and 1, IL-12 expression was statistically higher in the relapse than the remission group (P = 0.0015,P = 0.0342). IL-12 and IL-23 expression did not vary significantly between histologically active and inactive mucosa; both were higher in histologically inactive patients in the remission group (IL-12:P = 0.0002, IL-23:P = 0.046).

Conclusions

Rectal IL-12 and IL-23 expression was elevated in the relapse group, but IL-12 was more strongly associated with UC relapse, irrespective of endoscopic severity and histological activity. Mucosal IL-12 was elevated in patients with deep mucosal healing. Our results suggest an important role of IL-12 in UC pathogenesis and the molecular mechanism of UC relapse.
First-line oral antiviral therapies showed similar efficacies in suppression of serum HBcrAg in chronic hepatitis B patients
Authors: Mak Lung-Yi , Wong Danny Ka-Ho , Cheung Ka-Shing , Seto Wai-Kay , Fung James , Yuen Man-Fung
Published: March 2021

Background

Serum hepatitis B core-related antigen (HBcrAg) is a potential surrogate marker for intra-hepatic covalently-closed circular DNA in chronic hepatitis B (CHB). We aimed to study the profiles of serum HBcrAg in CHB patients treated with first-line nucleos(t)ide analogues (NA): entecavir (ETV), tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide (TAF).

Method

Serum HBcrAg was measured in 120 treatment-naïve CHB patients receiving one of the 3 NAs (ETV: TDF: TAF = 60: 26: 34) using the Lumipulse G HBcrAg assay in a Lumipulse G1200 analyzer (Fujirebio Inc, Toyko, Japan). Serum HBcrAg levels were measured at week 0, week 48 and week 96 of NA therapy.

Results

Among the 120 patients, 67 (55.8%) were hepatitis B e antigen (HBeAg) positive. Both tenofovir and ETV led to significantly lower serum HBcrAg at week 48 and week 96 compared to week 0. There were no significant differences for the magnitude of median HBcrAg decline at week 96 between tenofovir and ETV in HBeAg-positive (2.28 vs. 1.65 log U/mL, p > 0.05) and HBeAg-negative (0.83 vs. 0.54 log U/mL, p > 0.05) patients. TDF and TAF produced no significant differences in the magnitude of median HBcrAg decline at week 96 (HBeAg-positive: 2.63 vs. 1.83, respectively; HBeAg-negative: 1.04 vs. 0.40, respectively; both p > 0.05).

Conclusion

Magnitude of reduction of HBcrAg levels after 2-year first-line treatment did not differ statistically among the current first-line NAs, although HBcrAg reduction was numerically greater in tenofovir-treated group. More long-term studies are essential to determine whether tenofovir exerts a more pronounced effect on HBcrAg.
Characteristics of patients with Coronavirus Disease 2019 (COVID-19) and seasonal influenza at time of hospital admission: a single center comparative study
Authors: Sieber Pablo , Flury Domenica , Güsewell Sabine , Albrich Werner C. , Boggian Katia , Gardiol Céline , Schlegel Matthias , Sieber Robert , Vernazza Pietro , Kohler Philipp
Published: March 2021

Background

In the future, co-circulation of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza viruses A/B is likely. From a clinical point of view, differentiation of the two disease entities is crucial for patient management. We therefore aim to detect clinical differences between Coronavirus Disease 2019 (COVID-19) and seasonal influenza patients at time of hospital admission.

Methods

In this single-center observational study, we included all consecutive patients hospitalized for COVID-19 or influenza between November 2019 and May 2020. Data were extracted from a nationwide surveillance program and from electronic health records. COVID-19 and influenza patients were compared in terms of baseline characteristics, clinical presentation and outcome. We used recursive partitioning to generate a classification tree to discriminate COVID-19 from influenza patients.

Results

We included 96 COVID-19 and 96 influenza patients. Median age was 68 vs. 70 years (p = 0.90), 72% vs. 56% (p = 0.024) were males, and median Charlson Comorbidity Index (CCI) was 1 vs. 2 (p = 0.027) in COVID-19 and influenza patients, respectively. Time from symptom onset to hospital admission was longer for COVID-19 (median 7 days, IQR 3–10) than for influenza patients (median 3 days, IQR 2–5, p < 0.001). Other variables favoring a diagnosis of COVID-19 in the classification tree were higher systolic blood pressure, lack of productive sputum, and lack of headache. The tree classified 86/192 patients (45%) into two subsets with ≥80% of patients having influenza or COVID-19, respectively. In-hospital mortality was higher for COVID-19 patients (16% vs. 5%, p = 0.018).

Conclusion

Discriminating COVID-19 from influenza patients based on clinical presentation is challenging. Time from symptom onset to hospital admission is considerably longer in COVID-19 than in influenza patients and showed the strongest discriminatory power in our classification tree. Although they had fewer comorbidities, in-hospital mortality was higher for COVID-19 patients.
Surveillance of the major pathogenic arboviruses of public health concern in Gabon, Central Africa: increased risk of West Nile virus and dengue virus infections
Authors: Ushijima Yuri , Abe Haruka , Nguema Ondo Georgelin , Bikangui Rodrigue , Massinga Loembé Marguerite , Zadeh Vahid R. , Essimengane Joseph G. E. , Mbouna Armel V. N. , Bache Emmanuel B. , Agnandji Selidji T. , Lell Bertrand , Yasuda Jiro
Published: March 2021

Background

Increasing arbovirus infections have been a global burden in recent decades. Many countries have experienced the periodic emergence of arbovirus diseases. However, information on the prevalence of arboviruses is largely unknown or infrequently updated because of the lack of surveillance studies, especially in Africa.

Methods

A surveillance study was conducted in Gabon, Central Africa, on arboviruses, which are a major public health concern in Africa, including: West Nile virus (WNV), dengue virus (DENV), Zika virus (ZIKV), yellow fever virus (YFV), chikungunya virus (CHIKV), and Rift Valley fever virus (RVFV). Serological and molecular assays were performed to investigate past infection history and the current status of infection, using serum samples collected from healthy individuals and febrile patients, respectively.

Results

The overall seroprevalence during 2014˗2017 was estimated to be 25.3% for WNV, 20.4% for DENV, 40.3% for ZIKV, 60.7% for YFV, 61.2% for CHIKV, and 14.3% for RVFV. No significant differences were found in the seroprevalence of any of the viruses between the male and female populations. However, a focus on the mean age in each arbovirus-seropositive individual showed a significantly younger age in WNV- and DENV-seropositive individuals than in CHIKV-seropositive individuals, indicating that WNV and DENV caused a relatively recent epidemic in the region, whereas CHIKV had actively circulated before. Of note, this indication was supported by the detection of both WNV and DENV genomes in serum samples collected from febrile patients after 2016.

Conclusions

This study revealed the recent re-emergence of WNV and DENV in Gabon as well as the latest seroprevalence state of the major arboviruses, which indicated the different potential risks of virus infections and virus-specific circulation patterns. This information will be helpful for public health organizations and will enable a rapid response towards these arbovirus infections, thereby preventing future spread in the country.
Acute pancreatitis associated with hemorrhagic fever with renal syndrome: a cohort study of 346 patients
Authors: Guo Qinyue , Xu Jing , Shi Qindong , Du Bin
Published: March 2021

Background

To assess the prevalence, risk factors, clinical characteristics, and outcomes of acute pancreatitis (AP) in patients with hemorrhagic fever with renal syndrome (HFRS).

Methods

All patients diagnosed with HFRS admitted to the First Affiliated Hospital of Xi’an Jiaotong University from January 2013 to July 2020 were enrolled. Patients with and without AP were compared by two risk stratification models: (1) a multivariate regression analysis using propensity score to adjust for confounding and (2) a propensity-matched nested case-control study.

Results

A total of 346 patients were enrolled in the cohort study, 29 of whom (8.4%) were diagnosed as AP. There was no significant difference between patients with and without AP with regards to common risk factors and presenting signs/symptoms other than gastrointestinal symptoms (p < 0.01). The patients with AP had a significantly higher 90-day mortality rate (24.1% vs. 3.5%, OR 8.9, 95% CI 1.3 to 103.4,p = 0.045), and significantly shorter duration of therapy free-days to 28 day such as RRT and mechanical ventilation free days (p < 0.05, respectively).

Conclusions

Our study indicated that AP was independently associated with higher mortality in HFRS patients. While considering the difficulty of early recognition of AP among HFRS patients with similar signs and/or symptoms, further laboratory and imaging studies might help identify these patients at risk of poor clinical prognosis.
Neonatal Ureaplasma parvum meningitis complicated with subdural hematoma: a case report and literature review
Authors: Zhan Canyang , Chen Lihua , Hu Lingling
Published: March 2021

Background

Neonatal meningitis is a severe infectious disease of the central nervous system with high morbidity and mortality. Ureaplasma parvum is extremely rare in neonatal central nervous system infection.

Case presentation

We herein report a case of U. parvum meningitis in a full-term neonate who presented with fever and seizure complicated with subdural hematoma. After hematoma evacuation, the seizure disappeared, though the fever remained. Cerebrospinal fluid (CSF) analysis showed inflammation with CSF pleocytosis (1135–1319 leukocytes/μl, mainly lymphocytes), elevated CSF protein levels (1.36–2.259 g/l) and decreased CSF glucose (0.45–1.21 mmol/l). However, no bacterial or viral pathogens in either CSF or blood were detected by routine culture or serology. Additionally, PCR for enteroviruses and herpes simplex virus was negative. Furthermore, the CSF findings did not improve with empirical antibiotics, and the baby experienced repeated fever. Thus, we performed metagenomic next-generation sequencing (mNGS) to identify the etiology of the infection. U. parvum was identified by mNGS in CSF samples and confirmed by culture incubation on mycoplasma identification medium. The patient’s condition improved after treatment with erythromycin for approximately 5 weeks.

Conclusions

Considering the difficulty of etiological diagnosis in neonatal U. parvum meningitis, mNGS might offer a new strategy for diagnosing neurological infections.
Neonatal prophylaxis with antibiotic containing ointments does not reduce incidence of chlamydial conjunctivitis in newborns
Authors: Smith-Norowitz Tamar A. , Ukaegbu Crystal , Kohlhoff Stephan , Hammerschlag Margaret R.
Published: March 2021

Background

Neonatal ocular prophylaxis with silver nitrate does not prevent neonatal conjunctivitis due toChlamydia trachomatis. The efficacy of antibiotic containing preparations for prevention of neonatal chlamydial conjunctivitis (NCC) has not been established.

Objective

To examine published literature to determine whether antibiotic containing preparation are efficacious for prevention of NCC andC. trachomatisin the nasopharynx.

Methods

A literature search of MEDLINE and EMBASE. Articles were selected for review if their content included 4 key criteria: (1) Prospective/comparative study. (2) Prenatal screening of mothers forC. trachomatiswith results reported. (3) Follow-up of infants born to chlamydia-positive women. (4) Infants prospectively followed at regular intervals and tested forC. trachomatisin the eye/ nasopharynx (NP).

Results

The search yielded 159 studies; 11 were selected for full reviews, eight were excluded; three addressed the four criteria. Rates ofC. trachomatisconjunctivitis in infants in included studies who received silver nitrate was 20–33%; positive NP, 1–28% and pneumonia, 3–8%. Rates ofC. trachomatisconjunctivitis in neonates who received erythromycin or tetracycline prophylaxis did not differ from silver nitrate; 0–15 and 11%, respectively, who received erythromycin or tetracycline developed NCC. Similarly, 4–33 and 5% of infants who received erythromycin or tetracycline, respectively, had positive NP cultures; 0–4% developed chlamydial pneumonia.

Conclusion

Neonatal ocular prophylaxis with erythromycin or tetracycline ophthalmic ointments does not reduce incidence of neonatal chlamydial conjunctivitis or respiratory infection in infants born to mothers withC. trachomatisinfection compared to silver nitrate.
An MRI study of the tibial nerve in the ankle canal and its branches: a method of multiplanar reformation with 3D-FIESTA-C sequences
Authors: Zhang Yan , He Xucheng , Li Juan , Ye Ju , Han Wenjuan , Zhou Shanshan , Zhu Jianzhong , Wang Guisheng , Chen Xiaoxia
Published: March 2021

Background

The visualization of the tibial nerve and its branches in the ankle canal is helpful for the diagnosis of local lesions and compression, and it is also useful for clinical observation and surgical planning. The aim of this study was to investigate the feasibility of three-dimensional dual-excitation balanced steady-state free precession sequence (3D-FIESTA-C) multiplanar reformation (MPR) display of the tibial nerve and its branches in the ankle canal.

Methods

The subjects were 20 healthy volunteers (40 ankles), aged 22–50 years, with no history of ankle joint disease. The 3D-FIESTA-C sequence was used in the 3.0 T magnetic resonance equipment for imaging. During scanning, each foot was at an angle of 90° to the tibia. The tibial nerve of the ankle canal and its branches were displayed and measured at the same level through MPR.

Results

Most of the tibial nerve bifurcation points were located in the ankle canal (57.5%), few bifurcation points (42.5%) were located at the proximal end of the ankle canal, and none of them were found away from the distal end. The bifurcation between the medial plantar nerve and the lateral plantar nerve was on the line between the tip of the medial malleolus and the calcaneus, and it’s angle ranged between 6° and 35°. In MPR images, the display rates of both the medial calcaneal nerve and the subcalcaneal nerve were 100%, and the starting point of the subcalcaneal nerve was always at the distal end of the starting point of the medial calcaneal nerve. In 55% of cases, there were more than two medial calcaneal nerve innervations.

Conclusion

The 3D-FIESTA-C MPR can display the morphological features and positions of the tibial nerve and its branches and the bifurcation point’s projection position can be marked on the body surface. This method not only benefited the imaging diagnosis of the tibial nerve and branch-related lesions in the ankle canal, but it also provided a good imaging basis to plan a clinical operation of the ankle canal and avoid surgical injury.