bluuebunny/crossref_metadata_2025 huggingface dataset:
The test–retest reliability of the retrieval practice effect
Authors: Lima Marcos Felipe Rodrigues de , Buratto Luciano Grüdtner
Published: November 2022

Retrieving information from memory, compared with different control conditions, improves subsequent retention of that information. Given the ubiquitous demonstration of this retrieval practice effect, researchers have asked whether such benefit is moderated by individual-difference variables. An implicit assumption in individual-difference research is that the retrieval practice effect at the participant level is reliable across participants. In this study, we tested this reliability assumption. In two sessions, 54 participants studied foreign–native word pairs, repeatedly restudied half of the word pairs, repeatedly retrieval-practised the other half, and, finally, took a final test for all pairs. Different word pairs were used in each session. We replicated the retrieval practice effect at the group level in Sessions 1 ( d = 0.54, 95% confidence interval [CI] = [0.27, 0.80]) and 2 ( d = 0.79 [0.53, 1.05]). In addition, we found that the retrieval practice effect at the participant level was reliable over a 1-week span both for absolute agreement, intraclass correlation coefficient (ICC) = .33 [.12, .51], and for consistency estimates, ICC = .35 [.14, .53]. The result bridges a gap in the literature of individual differences on the retrieval practice effect. We suggest that future studies identify whether, and under which experimental conditions, the retrieval practice effect at the participant level may show even greater reliability estimates than the ones reported here. The finding may also pave the way for studies assessing whether the magnitude of the retrieval practice effect is domain-general or paradigm-specific.
Physical therapy intervention versus corticosteroid injection for lateral elbow tendinopathy. Does slow and steady win the race? – A systematic review
Authors: Sharma Shivam , Berwal Prerana , Verma Nishank , Pandey Avaneesh Kumar , Saxena Somya , Gamad Nanda
Published: November 2022

Background

Lateral elbow tendinopathy is one of the most common chronic and degenerative diseases which significantly affects quality of life and the activities of daily living of a person. The following is a systematic review reporting a comparison between physical therapy intervention and corticosteroid injection for the treatment of lateral elbow tendinopathy.

Method

PubMed, Web of Science, and Embase were searched using headings related to treatment options for Lateral elbow tendinopathy. The following keywords were used: lateral epicondylitis, physical therapy, and corticosteroid injection.

Result

We descriptively analyzed and reviewed a total of 12 studies including a total of 1253 patients for lateral elbow tendinopathy. The physical therapy intervention included interventions like electrotherapy, manual therapy, and exercise. The studies included had an overall low to unknown risk of bias.

Conclusion

Our review suggests corticosteroid injection provides beneficial short-term effects and physical therapy interventions provide intermediate to long-term effects, less additional treatment and low recurrence rate in patients with lateral elbow tendinopathy. Although high-quality randomized control trials are required in order to have a better understanding of both intervention types.
Beyond the EU’s democratic deficit: From union of states to European democracy
Authors: Hoeksma Jaap
Published: November 2022

The democratisation of the EU is a historic achievement, which poses great challenges. This article argues that the EU has overcome its democratic deficit and that the nature of the Union has been defined in unambiguous terms. It will be demonstrated that the 2007 Lisbon Treaty defines the EU as a democratic union of democratic states. Moreover, the European Court of Justice has elaborated this concept in its jurisprudence with sound legal reasoning. The implication of this analysis for political theorists and constitutional lawyers is that the EU has outgrown its democratic deficit. Taking this approach enables politicians to refute the claim that the EU is not a real democracy and to present it as a union of states and citizens which works as a European democracy. The immediate challenges for the Union are to improve its democracies and to defend them against both erosion from within and foreign aggression.
Incivility Diminishes Interest in What Politicians Have to Say
Authors: Feinberg Matthew , Frimer Jeremy A.
Published: November 2022

Incivility is prevalent in society suggesting a potential benefit. Within politics, theorists and strategists often claim incivility grabs attention and stokes interest in what a politician has to say. In contrast, we propose incivility diminishes overall interest in what a politician has to say because people find the incivility morally distasteful. Studies 1a and 1b examined the relationship between uncivil language and followership in the Twitter feeds of Presidents Donald Trump and Joe Biden, finding incivility reduced their following on the platform. In Studies 2–3, we manipulated how uncivil a number of politicians were and found that incivility consistently depressed interest in what they had to say. These effects of incivility are generalized to both political allies and opponents. Observers’ moral disapproval of the incivility mediated the diminished interest, suppressing the attention-grabbing nature of incivility. Altogether, our findings indicate that the public reacts more negatively to political incivility than previously thought.
The slime hand illusion: Nonproprioceptive ownership distortion specific to the skin region
Authors: Kodaka Kenri , Sato Yutaro , Imai Kento
Published: November 2022

The “slime hand illusion” is a simple and robust technique that uses mirror-visual feedback to produce a nonproprioceptive ownership distortion. The illusion can be easily evoked by the participant watching the experimenter pinching and pulling a chunk of slime in a mirror while the participant's hand, hidden behind the mirror, is similarly manipulated. This procedure produces a feeling of one of their fingers or the skin of their whole hand being stretched or deformed in a similar way to the visible slime. A public experiment found that more than 90% of participants reported a strong sense of skin or finger stretching. This report details a laboratory experiment performed to characterize the mechanisms behind the illusion more robustly. It reproduced this result and found that participants experienced a drift in their sense of skin location of approximately 30 cm on average, which is beyond the conventionally accepted range of proprioceptive drift.
Facilitating Role Understanding and Collaboration Between Aspiring School Counselors and Principals
Authors: Gonzales Shelby K. , Limberg Dodie , Cunningham Kathleen M. W.
Published: November 2022

Using a convergent mixed-methods design, we investigated role understanding and collaboration between school counselors and principals. Specifically, this study situated aspiring school counselors and principals in a curriculum intervention on the role of their counterpart and then brought the two professions together in a collaborative powerful learning experience. The results of our pilot study demonstrate that both school counselor and educational leadership graduate students benefit from and value a presentation on roles of their opposite counterpart and the opportunity to practice collaboration in their graduate preparation programs.
Long segment versus short segment stabilization in thoracolumbar spine fracture: A retrospective clinical and radiological analysis
Authors: Mak Suk-Ying Jodhy , Siu Yuk-Cheun , Chau Wai-Wang , Lo Cho-Yau , Ma Chun-Man
Published: November 2022

Introduction: Thoracolumbar spine fracture is one of the commonest spinal fractures. The treatment of choice of surgery is still controversial. This is a retrospective analysis of clinical and radiological outcomes of long and short segment stabilization for patients admitted with thoracolumbar fracture in our hospitals. Material and Method: Inclusion criteria included a single level of thoracolumbar fracture, excluding pre-existing deformity or spinal surgery, osteoporosis, and pathological fracture. Clinical parameters included visual analogue scale (VAS), operative time, intraoperative blood loss, and postoperative length of stay. Radiological parameters included wedge angle and anterior and posterior vertebral height ratio. Results: From June 2007 to May 2020, 56 patients (male = 31, female = 25) were recruited. There were 25 patients in the short segment group (open = 11, minimal invasive surgery (MIS) = 14) and 31 patients in the long segment group. Clinically, significantly better VAS at 6 months (1 vs. 1.96; p = 0.041), shorter post-op length of stay (16 days vs. 25 days; p = 0.01), and less blood loss (178 ml vs. 824 ml; p < 0.01) were found in the short segment group. Radiologically, the short segment group showed significantly better wedge angle at immediate (5° vs. 9.23°; p = 0.002) and long-term follow-up (7.41° vs. 11.43°; p = 0.01). Moreover, the short segment group has significantly better post-op anterior and posterior vertebral height ratios. Within the short segment group, the MIS group showed significantly less blood loss (82 ml vs. 303 ml; p < 0.01). However radiological parameters favour the open group. Discussion and Conclusion: For single-level thoracolumbar fracture, both long and short stabilizations were effective in reducing and stabilizing the fracture. However, the short segment group showed significantly superior results. Moreover, a minimally invasive technique in short segment stabilization showed even less blood loss but less optimal radiological results. Therefore, short segment stabilization could be the treatment of choice for traumatic thoracolumbar spine fractures.
May an incidental finding on chest CT be a predictor of access in intensive care unit? Role of hepatic steatosis in patients affected by SARS-CoV-2
Authors: Danna Pietro S.C. , Buoni Giada Francesca , Bor Simone , Coda Carolina , Abruzzese Flavia , Bertoli Matteo , Giaivia Valentina , Airoldi Chiara , Castello Luigi Mario , Saba Luca , Carriero Alessandro
Published: November 2022

Background:

Due to the high prevalence of hepatic steatosis (HS), the aim of the study is to verify the frequency of HS incidentally detected in chest computed tomography (CT) imaging in our population affected by SARS-CoV-2 and to investigate its association with the severity of the infection and outcome in terms of hospitalization.

Design and methods:

We retrospectively analyzed 500 patients with flu syndrome and clinically suspected of having Sars-CoV-2 infection who underwent unenhanced chest CT and have positive RT-PCR tests for Sars-CoV-2 RNA. Two radiologists both with >5 years of thoracic imaging experience, evaluated the images in consensus, without knowing the RT-PCR results. Liver density was measured by a region of interest (ROI), using a liver attenuation value ≤40 Hounsfield units (HU).

Results:

On 480 patients, 23.1% (111/480) had an incidental findings of HS on chest CT. The steatosis group, included 83 (74.7%) males and 28 (25.3%) females. Patients with HS were more likely to be hospitalized in the intensive care unit (ICU). On univariate analysis, there is a correlation between probability to be intubate (access in the ICU) and HS: patients with HS are twice as likely to be intubated (OR 2.04, CI 95% 1.11–3.73).

Conclusion:

Chest CT is an important diagnostic tool for COVID-19 and can provide information about the prognosis of the disease. HS can easily be detected on chest CT taken for the diagnosis of the COVID-19 disease, is an important sign for a poor prognosis and possible predictor of admission in ICU.
Vitamin D Deficiency is Associated with Charcot Neuroarthropathy: A Case-Control Study
Authors: Martinazzi Brandon J. , Lorenz F. Jeffrey , Nam Hannah , Dopke Kelly , Ptasinski Anna , Mansfield Kirsten N. , Kirchner Gregory , Aynardi Michael C.
Published: November 2022

Category:

Diabetes; Trauma; Other

Introduction/Purpose:

Charcot Neuroarthropathy can be a challenging condition for the foot and ankle surgeon. Prior studies have reported Vitamin D deficiency to be associated with several lower extremity complications. However, the relationship between vitamin D deficiency and Charcot is not well defined. Therefore, the purpose of this study was to determine if patients with Charcot were more likely to be vitamin D deficient than patients with diabetes alone.

Methods:

A large online database from 2011-2021 was retrospectively queried using CTP and ICD codes. Patients were separated into two groups. Group A consisted of patients with diabetes and Charcot Neuroarthropathy. Group B consisted of patients with only diabetes. Statistical analysis was then run to determine if there was an association between Vitamin D deficiency in patients with Charcot compared to patients with diabetes alone. Demographics including age, sex, and race were also recorded.

Results:

From 2011-2021, a total of 5,428,806 were identified. Group A consisted of 13,519 patients with a mean age of 59 +- 11.6 years. Of these patients, 60% were male (8,064), 40% were female (5,455), 72% were white (9,725), 14% were Black or African American (1,913), 1% were Asian (89), 13% were unknown (1,730), <1% were American Indian (49), and <1% were Native Hawaiian (13). Group B consisted of 5,415,287 patients with a mean age of 59.6 +- 15.4. Of these patients, 50% were male (2,693,118), 50% were female (2,720,313), <1% were unknown (1,856), 59% were white (3,214,4058), 19% were black or African American (995,514), 3% were Asian (139,732), 19% were unknown (1,035,894), <1% were American Indian (20,681), and <1% were Native Hawaiian (13). Patients with Charcot were more likely to have Vitamin D deficiency than diabetic patients alone (OR: 1.687; 95% CI: 1.616, 1.761).

Conclusion:

In our cohort, patients with Charcot Neuroarthropathy were more likely to be Vitamin D deficient than patients with diabetes alone. Given that Vitamin D deficiency has been found to be associated with lower extremity complications, further investigation is warranted.
Lateral Column Midfoot Injury: Do They All Need Fixation?
Authors: Mason Lyndon W. , Airey Grace L. , Mangwani Jitendra , Tanaka Hiro , Chapman James , Elbannan Mamdouh M.
Published: November 2022

Category:

Trauma; Midfoot/Forefoot

Introduction/Purpose:

Research on midfoot injuries have primarily concentrated on the central column and the Lisfranc ligament without amassing evidence on lateral column injuries. Lateral column injuries have historically been treated with Kirschner wire fixation when encountered. Our aim in this study was to analyse lateral column injuries to the midfoot and their treatment.

Methods:

Setting: Multicentre observational study Methods: Data was retrospectively collected from three centres on surgically treated midfoot fracture dislocations between 2011 and 2021. Radiographs were analysed using departmental PACS. All statistics was performed using SPSS 26.

Results:

A total of 113 cases were diagnosed as having a lateral column injury out of the 242 cases included. On cross tabulation, there was a significant association with having a central column injury (112/113, p<.001) and 70% of cases also had an additional medial column injury. Of the 113 lateral column injuries which underwent fixation of the central column, only 13 had undergone Kirschner wire fixation of the lateral column. There were no reported loss of lateral column alignment in either the temporary fixation or no fixation groups in this study.

Conclusion:

Lateral column injury occurs in almost half of midfoot fractures in this study. It rarely occurs alone and is most commonly related to three column injuries. Nevertheless, following stabilisation of the central column, injuries to the lateral column are unlikely to require any further stabilisation with no reported loss of alignment in our study without lateral column fixation.
Tibial Nerve Branches in Relation to the Tarsal Tunnel: A Cadaveric Study
Authors: Mattos Ivan , Ubillus Hugo A. , Campos Gustavo , Soares Sérgio , Azam Mohammad T. , Kennedy John G.
Published: November 2022

Category:

Hindfoot; Ankle

Introduction/Purpose:

Tarsal tunnel syndrome (TTS) is typically caused by an anatomical variant or mechanical compression of the tibial nerve (TN). It is critical then to understand the anatomy of the TN in relation to the tarsal tunnel to understand this condition more fully.

Methods:

40 lower-leg specimens were obtained. Dissection started 20 centimeters proximal to the DellonMcKinnon (DM) line towards the medial aspect of the naviculo-cuneiform joint distally. Anteriorly, dissection began at the tibio-talar medial gutter until the medial aspect of the Achilles tendon posteriorly. The plantar aspect extended from medial to lateral within the parameters previously described, ending at the level of the second metatarsal.

Results:

The flexor retinaculum had a denser consistency in 22.5% of the cases and the average length was 51.9 mm. The flexor retinaculum as an independent structure was absent and 77.2% of cases as an undistinguished extension of the crural fascia. The lateral plantar nerve (LPN) and abductor digiti minimi (ADM) nerve shared the same origin in 80% of cases, 34.5% bifurcated proximal to the DM line, 31.2% distally and 34.3% at the same level. The medial calcaneal nerve (MCN) emerged proximal to the DM line in 100% of specimens. The medial plantar nerve (MPN) has its origin proximal to the DM line in 95% of cases.

Conclusion:

The flexor retinaculum is an extension of the crural fascia and not an independent structure. The LPN and ADM have the same origin in most cases and this presents as an important finding that must be studied in detail for clinical correlations between the motor ADM and sensory LPN affections. Finally, the branches of the MCN and MPN are the most constant in their distribution and proximal origin in relation to the DellonMcKinnon line.
Hallux Valgus Multiplanar Correction Surgery Through a Minimally Invasive Technique: Our First 100 Patients Experience
Authors: Mocoçain Mac-iver Pablo E. , Elgueta Stephane , Díaz Andres Keller , Radkievich Ruben D. , Valderrama Carlos
Published: November 2022

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

Recently, minimally invasive surgery for hallux valgus correction has regained popularity. The minimally invasive Chevron and Akin (MICA), has been proved to be as satisfactory for patients as conventional open techniques. However, due to its design, it is difficult to correct the coronal plane malalignment, which could lead to the recurrence of the deformity. Instead, a Bösch-type osteotomy allows multiplanar correction, and with an upgrade in its fixation we can create a stable third- generation percutaneous osteotomy. We report our first 100 patients results using the minimally invasive Bösch and Akin osteotomy (MIBA).

Methods:

This was a prospective case series of our first 100 patients (137 feet) undergoing MIBA procedure. Outcome measures included the Manchester-Oxford Foot Questionnaire (MOXFQ), the AOFAS Forefoot Score, and the visual analog scale (VAS) for pain assessment. There was also a significant improvement in all radiographic parameters (p < 0.05). Mean HVA decreased from 30.5° to 7.8°, mean IMA decreased from 13° to 4.5°, and the mean DMAA decreased from 13.8° to 4.0° (p<0.05). All complications and emitted radiation dosage were reported as well.

Results:

At 12 months MOXFQ and AOFAS improved from 57.3 to 0.73 (p=0.00) and 45.2 to 99.2 (p=0.00), respectively. The mean preoperative VAS was 4.6, and improved during the first week to 1.3 (p<0.05). There was also a significant improvement in all radiographic parameters. We had three significant and 13 minor complications.

Conclusion:

The MIBA procedure is a safe and effective option to achieve a multiplanar hallux valgus correction.
‘Our humanism cannot be captured in the bylaws’: How moral ecological rationalities and care shape a smallholder irrigation scheme in Zimbabwe
Authors: Chitata Tavengwa , Kemerink-Seyoum Jeltsje , Cleaver Frances
Published: November 2022

In this article, we bring concepts of institutional bricolage, moral ecological rationalities and care into engagement, to explain the everyday management of an irrigation scheme in Zimbabwe. In doing this we: (a) emphasise the constant processes of bricolage through which irrigators adapt to changing circumstances and dynamically enact irrigation management; (b) illustrate some of the key features of the contemporary, hybridised moral-ecological rationalities that shape these processes of bricolage; (c) show how motivations to care (for people, the environment and infrastructure) as well as to control shape the bricolaged management arrangements. Through this approach, we aim to contribute to expanding ways of thinking about rationalities, including those that express the aspiration to live well together with human and non-human others, including water and infrastructure. The focus on moral-ecological rationalities is central to our contribution to critical water studies. This sheds light on actual practices of governing water and relationships between society-water/people and the environment. In so doing it helps us to understand the possibilities of caring for natural resources.
Pohlite, a new lead iodate hydroxide chloride from Sierra Gorda, Chile
Authors: Kampf Anthony R. , Harlow George E. , Ma Chi
Published: November 2022

The new mineral pohlite (IMA2022–043), Pb7(IO3)(OH)4Cl9, was found at La Compania mine, Sierra Gorda, Antofagasta Province, Antofagasta, Chile, where it occurs in cavities in an oxidised portion of a quartz vein in association with massive aragonite and anhydrite. Pohlite crystals are transparent, colourless to pale grey blades, up to 4 mm in length. The mineral has a white streak, adamantine lustre and is nonfluorescent. It is brittle with irregular, conchoidal fracture. The Mohs hardness is ~2½ and it has no cleavage. The calculated density is 5.838(2) g cm–3. Optically, the mineral is biaxial (+) with α < 2.01(est.), β = 2.02 (calc.), γ = 2.05 (calc.); 2V = 60(5)°; moderate r > v dispersion; orientation: Y∧a ≈ 20°, Z∧b ≈ 30°; and is nonpleochroic. The Raman spectrum exhibits bands consistent with IO3– and O–H. Electron microprobe analysis provided the empirical formula Pb6.74I1.00Cl9.29O6.71H4.23. The five strongest powder X-ray diffraction lines are [dobs Å(I)(hkl)]: 3.818(91)(023, 122, 1$\bar{2}$1), 3.674(85)($\bar{1}\bar{2}$1, $\bar{1}$22, 200, 104), 3.399(47)($\bar{2}$10, 210, $\bar{1}$04), 2.378(100)(302, 041, $\bar{2}$24) and 1.9943(45)(multiple). Pohlite is triclinic, P$\bar{1}$, a = 7.3366(5), b = 9.5130(9), c = 16.2434(15) Å, α = 81.592(7), β = 84.955(7), γ = 89.565(6)°, V = 1117.13(17) Å3 and Z = 2. The structure of pohlite (R1 = 0.0328 for 3394 I > 2σI) contains two types of clusters, a [Pb4(OH)3]5+ cluster formed by short Pb–O bonds and a [Pb3(OH)(IO3)]28+ ‘double cluster’ formed by short I–O bonds and short- to medium-length Pb–O bonds. Long Pb–Cl and I–Cl bonds link the clusters together in three dimensions.
Identification of the cuproptosis-related molecular subtypes and an immunotherapy prognostic model in hepatocellular carcinoma
Authors: Zhang Li , Xu Jingwei , Chu Xiufeng , Zhang Hongqiao , Yao Xueyuan , Zhang Jian , Guo Yanwei
Published: November 2022

Background

Cuproptosis, a newly discovered mode of cell death, has been less studied in hepatocellular carcinoma (HCC). Exploring the molecular characteristics of different subtypes of HCC based on cuproptosis-related genes (CRGs) is meaningful to HCC. In addition, immunotherapy plays a pivotal role in treating HCC. Exploring the sensitivity of immunotherapy and building predictive models are critical for HCC.

Methods

The 357 HCC samples from the TCGA database were classified into three subtypes, Cluster 1, Cluster 2, and Cluster 3, based on the expression levels of ten CRGs genes using consensus clustering. Six machine learning algorithms were used to build models that identified the three subtypes. The molecular features of the three subtypes were analyzed and compared from some perspectives. Moreover, based on the differentially expressed genes (DEGs) between Cluster 1 and Cluster 3, a prognostic scoring model was constructed using LASSO regression and Cox regression, and the scoring model was used to predict the efficacy of immunotherapy in the IMvigor210 cohort.

Results

Cluster 3 had the worst overall survival compared to Cluster 1 and Cluster 2 (P = 0.0048). The AUC of the Catboost model used to identify Cluster 3 was 0.959. Cluster 3 was significantly different from the other two subtypes in gene mutation, tumor mutation burden, tumor microenvironment, the expression of immune checkpoint inhibitor genes and N6-methyladenosine regulatory genes, and the sensitivity to sorafenib. We believe Cluster 3 is more sensitive to immunotherapy from the above analysis results. Therefore, based on the DEGs between Cluster 1 and Cluster 3, we obtained a 7-gene scoring prognostic model, which achieved meaningful results in predicting immunotherapy efficacy in the IMvigor210 cohort (P = 0.013).

Conclusions

Our study provides new ideas for molecular characterization and immunotherapy of HCC from machine learning and bioinformatics. Moreover, we successfully constructed a prognostic model of immunotherapy.
Albumin alleviated esketamine-induced neuronal apoptosis of rat retina through downregulation of Zn2+-dependent matrix metalloproteinase 9 during the early development
Authors: Zhang Kan , Ma Ruijing , Feng Luping , Liu Peiwen , Cai Shuang , Tong Chaoyang , Zheng Jijian
Published: November 2022

Aims

Esketamine upregulates Zn2+-dependent matrix metalloproteinase 9 (MMP9) and increases the neuronal apoptosis in retinal ganglion cell layer during the early development. We aimed to test whether albumin can alleviate esketamine-induced apoptosis through downregulating Zn2+-dependent MMP9.

Methods

We investigate the role of Zn2+ in esketamine-induced neuronal apoptosis by immunofluorescence. MMP9 protein expression and enzyme activity were investigated by zymography in situ., western blot and immunofluorescence. Whole-mount retinas from P7 Sprague-Dawley rats were used.

Results

We demonstrated that esketamine exposure increased Zn2+ in the retinal GCL during the early development. Zn2+-dependent MMP9 expression and enzyme activity up-regulated, which eventually aggravated apoptosis. Albumin effectively down-regulated MMP9 expression and activity via binding of free zinc, ultimately protected neurons from apoptosis. Meanwhile albumin treatment promoted activated microglia into multi-nucleated macrophagocytes and decreased the inflammation.

Conclusion

Albumin alleviates esketamine-induced neuronal apoptosis through decreasing Zn2+ accumulation in GCL and downregulating Zn2+-dependent MMP9.
Opioid-reduced anesthesia based on esketamine in gynecological day surgery: a randomized double-blind controlled study
Authors: Zhu Teng , Zhao Xiaoyong , Sun Meiyan , An Yan , Kong Wenwen , Ji Fanceng , Wang Guizhi
Published: November 2022

Background

Opioid-reduced anesthesia may accelerate postoperative rehabilitation by reducing opioid-related side effects. The objective was to investigate the feasibility of opioid-reduced general anesthesia based on esketamine and to observe postoperative nausea and vomiting (PONV), postoperative pain, hemodynamics and other adverse reactions in gynecological day surgery compared with the traditional opioid-based anesthesia program.

Method

This study was conducted as a prospective parallel-group randomized controlled trial. A total of 141 adult women undergoing gynecological day surgery were included. Patients were randomly assigned to receive traditional opioid-based anesthesia (Group C) with alfentanil, or opioid-reduced anesthesia (a moderate-opioid group (Group MO) and low-opioid group (Group LO) with esketamine and alfentanil). For anesthesia induction, the three groups received 20, 20, 10 μg/kg alfentanil respectively and Group LO received an additional 0.2 mg/kg esketamine. For maintenance of anesthesia, the patients in Group C received 40 μg/kg/h alfentanil, and those in Group MO and Group LO received 0.5 mg/kg/h esketamine.

Results

Patients in the three groups had comparable clinical and surgical data. A total of 33.3% of patients in Group C, 18.4% of patients in Group MO and 43.2% of patients in Group LO met the primary endpoint (p = 0.033), and the incidence of nausea within 24 hours after surgery in Group MO was lower than in Group LO (p < 0.05). The extubation time, median length of stay in the hospital after surgery and visual analog scale (VAS) of postoperative pain were equivalent in the three groups. The frequencies of adverse hemodynamic events in the MO 1(0, 2) and LO 0(0, 1) groups were significantly decreased (p < 0.05). Compared with Group C, the median length of stay in the postanesthesia care unit (PACU) in Group LO was increased, 60.0 (36.25, 88.75) vs. 42.5 (25, 73.75) minutes (p < 0.05).

Conclusions

Opioid-reduced anesthesia based on esketamine is feasible and provides effective analgesia for patients. Esketamine provided a positive analgesic effect and the opioid-reduced groups showed more stable hemodynamics. However, less or no use of opioids did not result in a more comfortable prognosis.

Trial registration

This study was registered at Chictr.org.cn (NO. ChiCTR2100053153); November 13, 2021.
Differential diagnosis of Crohn’s disease and intestinal tuberculosis: development and assessment of a nomogram prediction model
Authors: Zeng Shaoxiong , Lin Ying , Guo Jiaxiang , Chen Xi , Liang Qiong , Zhai Xiaoming , Tao Jin
Published: November 2022

Background

China is a region with a high incidence of tuberculosis, and the incidence of IBD has also been rising rapidly in recent years. Differentiating Crohn’s disease(CD) from intestinal tuberculosis (ITB) has become a very challenging issue. We aimed to develop and assess a diagnostic nomogram to differentiate between CD and ITB to improve the accuracy and practicability of the model.

Methods

A total of 133 patients (CD 90 and ITB 43) were analyzed retrospectively. Univariate and multivariate logistic regression analysis was included to determine the independent predictive factors and establish the regression equation. On this basis, the nomogram prediction model was constructed. The discrimination, calibration and clinical efficiency of the nomogram were assessed using area under the curve(AUC), C-index, calibration curve, decision curve analysis (DCA) and clinical impact curve.

Results

T-SPOT positive, cobblestone appearance, comb sign and granuloma were significant predictors in differentiating CD from ITB. Base on the above independent predictors, a diagnostic nomogram was successfully established. The sensitivity, specificity, accuracy of the prediction model are 94.4%, 93.0%, 94.0% respectively. The AUC and the C-index of the prediction model are both 0.988, which suggest that the model had a good discrimination power. The calibration curve indicated a high calibration degree of the prediction model. The DCA and clinical impact curve indicated a good clinical efficiency of the prediction model which could bring clinical benefits.

Conclusion

A nomogram prediction model for distinguishing CD from ITB was developed and assessed, with high discrimination, calibration and clinical efficiency. It can be used as an accurate and convenient diagnostic tool to distinguish CD from ITB, facilitating clinical decision-making.
Prediction of long-term remission in patients following discontinuation of anti-TNF therapy in ulcerative colitis: a 10 year follow up study
Authors: Johnsen Kay-Martin , Florholmen Jon , Moe Øystein K. , Gundersen Mona , Beilfuss Julia , Kileng Hege , Sørbye Sveinung W. , Goll Rasmus
Published: November 2022

Background

The long-term outcomes of Ulcerative colitis (UC) after discontinuation of biological therapy are largely unknown. There is also a lack of accurate and validated markers that can predict outcome after withdrawal accurately. The aims of this study were to describe the long-term outcomes in UC patients following cessation of anti-TNF therapy and explore potential biomarkers as an approach towards precision medicine.

Methods

Seventy-five patients with moderate to severe UC treated to remission with anti-tumor necrosis factor (TNF) were included in the study. This is a follow-up of previously reported UC outcomes. The patients were categorized as either “Remission” or “Relapse”. The “Relapse” group was divided into subgroups determined by the highest treatment level needed to obtain remission the last 3 years of observation: non-biological therapy, biological therapy or colectomy. Remission were divided in long term remission (LTR), those using immunomodulating drugs (LTR + imids) and those using only 5-amino-salicylate (5-ASA) treatment (LTR) for the past 3 years. Analyses of mucosal gene expression by real-time PCR were performed.

Results

The median (IQR) observation time of all patients included was 121 (111–137) months. Of the 75 patients, 46 (61%) did not receive biological therapy, including 23 (31%) in LTR ± imids. Of these 23 patients, 16 (21%) were defined as LTR with a median observation time of (IQR) 95 (77–113) months. In total 14 patients (19%) underwent colectomy during the 10 years after first remission. Mucosal TNF copies/µg mRNA < 10 000 at anti-TNF discontinuation predicted long-term remission, biological free remission and lower risk of colectomy with a HR 0.36 (0.14–0.92) for long-term remission, HR 0.17 (0.04–0.78) for biological free remission and HR 0.12 (0.01–0.91) for colectomy. IL1RL1 was normalized in LTR phenotype and higher in relapsing UC.

Conclusion

In this 10-year follow-up of UC of patients with moderate to severe disease, 61% of patients experience an altered phenotype to a milder disease course without need of biological therapy. Twenty-one percent of the patients were LTR without any medication except of 5-ASA. Mucosal TNF gene expression and IL1RL1- transcripts may be of clinical utility for long term prognosis in development of precision medicine in UC.
Epidemiology and prognostic analysis of patients with pancreatic signet ring cell carcinoma: a population-based study
Authors: Nie Duorui , Lan Qingxia , Huang Yue , Fang Chongkai , Cao Yang , Chen Yao
Published: November 2022

Background

Pancreatic signet ring cell carcinoma (PSRCC) is a rare tumour subtype with poorly understood epidemiological characteristics and prognosis. We attempted to comprehensively characterise the epidemiology and survival outcomes of PSRCC.

Methods

Patients diagnosed with PSRCC between 2000 and 2018 were identified using Surveillance, Epidemiology and End Results Stat 8.3.9.2 software. Age-adjusted incidence and survival were calculated. Survival curves were plotted using the Kaplan–Meier method, and the differences between survival curves were compared using the log-rank test. Cox proportional hazards models were used to evaluate factors that independently predict overall survival. The primary analysis was a complete case analysis; multiple imputations were employed in a sensitivity analysis.

Results

We identified 585 eligible patients with PSRCC. The overall annual incidence from 2000 to 2018 was 0.349 (95% CI, 0.321–0.379) per million population. The incidence increased significantly in patients over 55 years of age and peaked at about 80 years of age (2.12 per million). Males and Black patients had the highest incidence. The observed survival rates at 1, 2 and 5 years were 20.1, 8.3 and 3.4%, respectively. Survival analysis revealed that primary surgery and chemotherapy are effective treatments for patients with PSRCC (P < 0.05). According to multivariate Cox regression analysis, early stage and receiving surgery and chemotherapy were favourable factors (P < 0.05). Similar conclusions were drawn from the interpolated data.

Conclusions

PSRCC is a highly malignant tumour that predominates in elderly, male and Black patients. The prognosis is poor with a 5-year survival rate of 3.4%; however, multivariate analysis and adjusted models accounting for missing data revealed that early diagnosis, surgery and chemotherapy are effective in improving the prognosis.
A pragmatic randomized controlled trial of rapid on-site influenza and respiratory syncytial virus PCR testing in paediatric and adult populations
Authors: Bibby Helen L. , de Koning Lawrence , Seiden-Long Isolde , Zelyas Nathan , Church Deirdre L. , Berenger Byron M.
Published: November 2022

Background

Rapid/point-of-care respiratory virus nucleic acid tests (NAT) may improve oseltamivir, antibiotic, diagnostic test, and hospital bed utilization. Previous randomized controlled trials (RCT) on this topic have not used standard procedures of an accredited healthcare and laboratory system.

Methods

We conducted a parallel RCT at two hospitals [paediatric = Alberta Children’s Hospital (ACH); primarily adult = Peter Lougheed Centre (PLC)]. Patients with a respiratory viral testing order were randomized to testing at either a central accredited laboratory (standard arm) or with a rapid polymerase chain reaction test at an on-site accredited laboratory followed by standard testing [rapid on-site test (ROST) arm] based on day of specimen receipt at the laboratory. Patients and clinicians were blinded to assignment.

The primary outcome for ACH was inpatient length of stay (LOS) and for PLC was the proportion of inpatients prescribed oseltamivir.

Results

706 patient encounters were included at ACH; 322 assigned to ROST (181 inpatients) and 384 to the standard arm (194 inpatients). 422 patient encounters were included at PLC; 200 assigned to ROST (157 inpatients) and 222 to the standard arm (175 inpatients).

The rate of oseltamivir prescription and number of doses given was reduced in PLC inpatients negative for influenza in the ROST arm compared to standard arm [mean 14.9% (95% CI 9.87–21.9) vs. 27.5% (21.0–35.2), p = 0.0135; mean 2.85 doses (SEM 2.39–3.32) vs. 4.17 doses (3.85–4.49) p = 0.022, respectively]. ROST also significantly reduced oseltamivir use at ACH, reduced chest radiographs (ACH), and laboratory test ordering (PLC), but not antibiotic prescriptions. ROST also reduced the median turnaround time by > 24 h (ACH and PLC).

The LOS at ACH was not significantly different between the ROST and standard arms [median 4.05 days (SEM 1.79–18.2) vs 4.89 days (2.07–22.9), p = 0.062, respectively].

No adverse events were reported.

Conclusions

In a RCT representing implementation of ROST in an accredited laboratory system, we found that a ROST improved oseltamivir utilization and is the first RCT to show reduced ancillary testing in both paediatric and adult populations. A larger study is required to assess reduction in paediatric LOS as ACH was underpowered. These findings help justify the implementation of rapid on-site respiratory virus testing for inpatients.

Trial registration ISRCTN, number 10110119, Retrospectively Registered, 01/12/2021.
Granulomatous interstitial nephritis with CTLA-4 haploinsufficiency: a case report
Authors: Kohatsu Kaori , Suzuki Tomo , Takimoto Madoka , Matsui Katsuomi , Hashiguchi Akinori , Koike Junki , Shirai Sayuri
Published: November 2022

Background

Cytotoxic T lymphocyte antigen-4 (CTLA-4) is an essential inhibitory regulator of immune activation. CTLA-4 haploinsufficiency is known to be associated with dysregulation of FOXP3+ regulatory T cells, hyperactivation of effector T cells, and lymphocytic infiltration of multiple organs. However, there have only been a few reports of renal involvement with CTLA-4. Herein, we present a case of acute granulomatous tubulointerstitial nephritis (TIN) in a patient with CTLA-4 haploinsufficiency.

Case presentation

A 44-year-old man presented with a 3-week history of fever and malaise, and subsequently developed acute kidney injury (AKI) a few days after treatment with levofloxacin (LVFX). A kidney biopsy and immunohistochemical staining revealed granulomatous TIN with dominantly infiltrating CD4+ T cells. General symptoms and renal impairment showed improvement after discontinuation of LVFX and initiation of oral steroids. However, they worsened following steroid tapering. Further, a colon biopsy analysis showed similar findings to the renal tissue analysis. We suspected that granulomatous TIN was possibly associated with CTLA-4 haploinsufficiency. Therefore, the patient was transferred to another hospital for further treatment of CTLA-4 haploinsufficiency using immunosuppressive agents.

Conclusions

There have been few reports regarding renal involvement of CTLA-4 haploinsufficiency. In the present case, granulomatous TIN could have arisen due to instability of immune regulatory functions, such as CTLA-4 haploinsufficiency, and treatment with LVFX could have triggered immunologic activation and severe inflammation as well as renal dysfunction.
Analysis of cellular and cell free mitochondrial DNA content and reactive oxygen species levels in maternal blood during normal pregnancy: a pilot study
Authors: Srivastava Anubhav , Srivastava Pransu , Mathur Shashank , Mishra Suman , Abbas Sabiya , Gupta Amrit , Mishra Prabhaker , Tiwari Meenakshi , Sharma Lokendra Kumar
Published: November 2022

Background

Alterations in mitochondrial signatures such as mitochondrial DNA (mtDNA) content in maternal blood have been linked to pregnancy-related complications. However, changes in maternal mtDNA content, their distribution and associated signaling during normal pregnancies are not clear; which could suggest their physiological role in maternal adaptation to pregnancy related changes and a reference threshold. The aim of this study: to assess the distribution of mtDNA in peripheral blood and their association with circulatory ROS levels across different trimesters of healthy pregnancy.

Methods

In this pilot cross sectional study, blood samples of normal pregnant women from each trimester (total = 60) and age-matched non-pregnant (NP) women as control group (n = 20) were analyzed for a) the relative distribution of mtDNA content in cellular and cell free (plasma) fractions using relative quantitative polymerase chain reaction (qPCR) and b) the levels of circulating reactive oxygen species (ROS) by measurement of plasma H2O2. The results were compared between pregnant and NP groups and within trimesters for significant differences, and were also analyzed for their correlation between groups using statistical methods.

Results

While, we observed a significant decline in cellular mtDNA; plasma mtDNA was significant increased across all trimesters compared to NP. However, from comparisons within trimesters; only cellular mtDNA content in 3rd trimester was significantly reduced compared to 1st trimester, and plasma mtDNA did not differ significantly among different trimesters. A significantly higher level of plasma H2O2 was also observed during 3rd trimester compared to NP and to 1st trimester. Correlation analysis showed that, while cellular mtDNA content was negatively correlated to plasma mtDNA and to plasma H2O2 levels; plasma mtDNA was positively correlated with plasma H2O2 content.

Conclusions

This study suggested that normal pregnancy is associated with an opposing trend of reduced cellular mtDNA with increased circulatory mtDNA and H2O2 levels, which may contribute to maternal adaptation, required during different stages of pregnancy. Estimation of mtDNA distribution and ROS level in maternal blood could show mitochondrial functionality during normal pregnancy, and could be exploited to identify their prognostic/ diagnostic potential in pregnancy complications.
The prognostic significance of the circumferential resection margin in esophageal squamous cell carcinoma patients without neoadjuvant treatment
Authors: Yang Zhaoyang , Lin Hua , Wang Zhen , Rong Lulu , Zhang Xuchen , Wang Lin , Qin Jianjun , Xue Xuemin , Li Yin , Xue Liyan
Published: November 2022

Background

Circumferential resection margin (CRM) is very important in esophageal cancer, but its diagnostic criteria has not been unified. The College of American Pathologists (CAP) and the Royal College of Pathologists (RCP) provide two different criteria. The aim of this study is to evaluate the long-term prognostic significance of CRM status with different CRM criteria in esophageal squamous cell carcinoma (ESCC).

Methods

Influence of CRM status according to the CAP and RCP criteria on long-term survival of 838 patients with resected pT3 tumors and without neoadjuvant therapy was analyzed. Patients stratified into three groups on the basis of tumor distance from the CRM (CRM > 1 mm, 0-1 mm, and 0 mm) were also analysed.

Results

Positive CRM was found in 59 (7%) patients according to the CAP criteria and 317 (37.8%) patients according to the RCP criteria. Univariate and multivariate survival analysis showed that CRM status, according to three different criteria, was independent prognostic factor. However, subgroup analysis showed that the prognostic value of CRM status was limited to certain metastatic lymph node load. In pN0 subgroup, patients with CRM > 1 mm had better prognosis than patients with CRM 0-1 mm. Patients with CRM 0 mm had worse outcome than patients with CRM > 0 mm in pN1-2 subgroup. But CRM status had no prognosis value in pN3 subgroup.

Conclusions

The CRM status is an important prognostic factor in ESCC patients, but this effect was limited to patients without or with less lymph node metastasis (pN0-2). In clinical practice, we recommend the 1 mm-three-tier criteria as it provides more prognostic value than the traditional two-tier criteria.
Impact of GTF2H1 and RAD54L2 polymorphisms on the risk of lung cancer in the Chinese Han population
Authors: Geng Tingting , Li Miao , Chen Rong , Yang Shuangyu , Jin Guoquan , Jin Tinabo , Chen Fulin
Published: November 2022

Background

Repair pathway genes play an important role in the development of lung cancer. The study aimed to assess the correlation between single nucleotide polymorphisms (SNPs) in DNA repair gene (GTF2H1 and RAD54L2) and the risk of lung cancer.

Methods

Five SNPs in GTF2H1 and four SNPs in RAD54L2 in 506 patients with lung cancer and 510 age-and gender-matched healthy controls were genotyped via the Agena MassARRAY platform. The influence of GTF2H1 and RAD54L2 polymorphisms on lung cancer susceptibility was assessed using logistic regression analysis by calculating odds ratios (ORs) and their corresponding 95% confidence intervals (CIs).

Results

RAD54L2 rs9864693 GC genotype increased the risk of lung cancer (OR = 1.33, 95%CI: 1.01–1.77, p = 0.045). Stratified analysis found that associations of RAD54L2 rs11720298, RAD54L2 rs4687592, RAD54L2 rs9864693 and GTF2H1 rs4150667 with lung cancer risk were found in subjects aged ≤ 59 years. Precisely, a protective effect of RAD54L2 rs11720298 on the occurrence of lung cancer was observed in non-smokers and drinkers. GTF2H1 rs4150667 was associated with a decreased risk of lung cancer in subjects with BMI ≤ 24 kg/m2. RAD54L2 rs4687592 was associated with an increased risk of lung cancer in drinkers. In addition, GTF2H1 rs3802967 was associated with a reduced risk of lung squamous cell carcinoma.

Conclusion

Our study first revealed that RAD54L2 rs9864693 was associated with an increased risk of lung cancer in the Chinese Han population. This study may increase the understanding of the effect of RAD54L2 and GTF2H1 polymorphisms on lung cancer occurrence.