bluuebunny/crossref_metadata_2025 huggingface dataset:
Percutaneous cholecystostomy as a definitive treatment for moderate and severe acute acalculous cholecystitis: a retrospective observational study
Authors: Chen Bai-Qing , Chen Guo-Dong , Xie Feng , Li Xue , Mao Xue , Jia Bao
Published: December 2021

Background

In this study, we aimed to investigate risk factors for the relapse of moderate and severe acute acalculous cholecystitis (AAC) patients after initial percutaneous cholecystostomy (PC) and to identify the predictors of patient outcomes when choosing PC as a definitive treatment for AAC.

Materials and methods

The study population comprised 44 patients (median age 76 years; range 31–94 years) with moderate or severe AAC who underwent PC without subsequent cholecystectomy. According to the results of follow-up (followed for a median period of 17 months), the data of patients with recurrence versus no recurrence were compared. Patients were divided into the death and non-death groups based on patient status within 60 days after PC.

Results

Twenty-one (47.7%) had no recurrence of cholecystitis during the follow-up period after catheter removal (61–1348 days), six (13.6%) experienced recurrence of cholecystitis after PC, and 17 (38.6%) patients died during the indwelling tube period (5–60 days). The multivariate analysis showed that coronary heart disease (CHD) or congestive heart failure (odds ratio [OR] 26.50; 95% confidence interval [CI] 1.21–582.06; P = 0.038) was positively correlated with recurrence. The age-adjusted Charlson comorbidity index (OR 1.53; 95% CI 1.08–2.17; P = 0.018) was independently associated with 60-day mortality after PC.

Conclusions

Our results suggest that CHD or congestive heart failure was an independent risk factor for relapse in moderate and severe AAC patients after initial PC. AAC patients with more comorbidities had worse outcomes.
Oral health-related quality of life and parental anxiety in chinese children undergoing Dental General Anesthesia: a prospective study
Authors: Gou Ce , Wang Yan , Yang Ran , Huang Ruijie , Zhang Qiong , Zou Jing
Published: December 2021

Dental general anesthesia (DGA) is an effective treatment for very young children or those who have severe dental fear and mental or physical disabilities. However, the long-term impacts of DGA on oral health-related quality of life (OHRQoL) and parents’ anxiety in China are still questionable. This study aimed to assess the influence of DGA on OHRQoL in Chinese children and their parents’ psychological status. A total of 204 children and their parents participated in this study. The ECOHIS was applied to evaluate OHRQoL in children. The parents’ anxiety was analyzed using the Chinese version of the Kessler 10 scale. The internal consistency was evaluated with Cronbach’s alpha coefficient, and Wilcoxon signed-rank test was used for statistical analyses. The scores of each section of ECOHIS decreased one month after the procedure except for the self-image and social sections (P < 0.05). The scores of the Kessler 10 scale decreased one month after DGA and kept decreasing six months later (P < 0.05). The parents’ Kessler 10 scores exhibited a moderately positive correlation with the children’s ECOHIS scores (r = 0.480, P < 0.05). After DGA, the OHRQoL of Chinese children and their parents’ mental health continued to improve. And they exhibited positive correlation.
NT-pro BNP in AECOPD-PH: old biomarker, new insights-based on a large retrospective case-controlled study
Authors: Tian Fengming , Song Wen , Wang Liang , Zeng Qiang , Zhao Zhenyu , Feng Ning , Fan Jiahui , Wang Yue , Wang Jing , Ma Xiumin
Published: December 2021

Background

Pulmonary hypertension (PH) is one of the common complications in chronic obstructive pulmonary disease (COPD). The study aimed to evaluate the predicting ability of N-terminal pro brain natriuretic peptide (NT-pro BNP) in patients with AECOPD-PH and its relationship with the severity of PH.

Methods

A large retrospective case-controlled study (n = 1072) was performed in the First Affiliated Hospital of Xinjiang Medical University from January 2018 to December 2020, and patients were divided into stable COPD (n = 178), AECOPD (n = 688) and AECOPD-PH group (n = 206). Different statistical models were used to screen for reliable and stable biomarkers.

Results

In unadjusted analysis and PSM (model 1, 2, 3), red cell distribution width (RDW), total bilirubin (TBIL), and NT-pro BNP were higher in patients with AECOPD-PH than those in AECOPD group. Logistic regression analysis showed, when the range of NT-proBNP was 271–1165 pg/mL (OR: 0.293; 95%CI: 0.184–0.467; P < 0.001) and NT-proBNP > 1165 pg/mL (OR: 0.559; 95%CI: 0.338–0.926; P = 0.024), the morbidity risk of PH in AECOPD patients was increased, so did TBIL. In receiver operating characteristic (ROC) curves, at the cut-off value of NT-proBNP was 175.14 pg/mL, AUC was 0.651 (P < 0.001), which was better than TBIL (AUC: 0.590, P < 0.001). As for the results of rank correlation analysis, NT-proBNP had a weak correlation with severity of PH with AECOPD (rs = 0.299, P = 0.001) and its relative relevance with other biomarkers (RDW was 0.359 and TBIL was 0.238, P < 0.001).

Conclusions

Our findings suggest that NT-proBNP has a diagnostic efficacy in AECOPD-PH and NT-proBNP has a weak correlation with severity of PH with AECOPD.
Citrullinated myelin induces microglial TNFα and inhibits endogenous repair in the cuprizone model of demyelination
Authors: Standiford Miranda M. , Grund Ethan M. , Howe Charles L.
Published: December 2021

Background

Microglia are the primary phagocytes of the central nervous system and are responsible for removing damaged myelin following demyelination. Previous investigations exploring the consequences of myelin phagocytosis on microglial activation overlooked the biochemical modifications present on myelin debris. Such modifications, including citrullination, are increased within the inflammatory environment of multiple sclerosis lesions.

Methods

Mouse cortical myelin isolated by ultracentrifugation was citrullinated ex vivo by incubation with the calcium-dependent peptidyl arginine deiminase PAD2. Demyelination was induced by 6 weeks of cuprizone (0.3%) treatment and spontaneous repair was initiated by reversion to normal chow. Citrullinated or unmodified myelin was injected into the primary motor cortex above the cingulum bundle at the time of reversion to normal chow and the consequent impact on remyelination was assessed by measuring the surface area of myelin basic protein-positive fibers in the cortex 3 weeks later. Microglial responses to myelin were characterized by measuring cytokine release, assessing flow cytometric markers of microglial activation, and RNAseq profiling of transcriptional changes.

Results

Citrullinated myelin induced a unique microglial response marked by increased tumor necrosis factor α (TNFα) production both in vitro and in vivo. This response was not induced by unmodified myelin. Injection of citrullinated myelin but not unmodified myelin into the cortex of cuprizone-demyelinated mice significantly inhibited spontaneous remyelination. Antibody-mediated neutralization of TNFα blocked this effect and restored remyelination to normal levels.

Conclusions

These findings highlight the role of post-translation modifications such as citrullination in the determination of microglial activation in response to myelin during demyelination. The inhibition of endogenous repair induced by citrullinated myelin and the reversal of this effect by neutralization of TNFα may have implications for therapeutic approaches to patients with inflammatory demyelinating disorders.
Human-machine-human interaction in motor control and rehabilitation: a review
Authors: Küçüktabak Emek Barış , Kim Sangjoon J. , Wen Yue , Lynch Kevin , Pons Jose L.
Published: December 2021

Background

Human-human (HH) interaction mediated by machines (e.g., robots or passive sensorized devices), which we call human-machine-human (HMH) interaction, has been studied with increasing interest in the last decade. The use of machines allows the implementation of different forms of audiovisual and/or physical interaction in dyadic tasks. HMH interaction between two partners can improve the dyad’s ability to accomplish a joint motor task (task performance) beyond either partner’s ability to perform the task solo. It can also be used to more efficiently train an individual to improve their solo task performance (individual motor learning). We review recent research on the impact of HMH interaction on task performance and individual motor learning in the context of motor control and rehabilitation, and we propose future research directions in this area.

Methods

A systematic search was performed on the Scopus, IEEE Xplore, and PubMed databases. The search query was designed to find studies that involve HMH interaction in motor control and rehabilitation settings. Studies that do not investigate the effect of changing the interaction conditions were filtered out. Thirty-one studies met our inclusion criteria and were used in the qualitative synthesis.

Results

Studies are analyzed based on their results related to the effects of interaction type (e.g., audiovisual communication and/or physical interaction), interaction mode (collaborative, cooperative, co-active, and competitive), and partner characteristics. Visuo-physical interaction generally results in better dyadic task performance than visual interaction alone. In cases where the physical interaction between humans is described by a spring, there are conflicting results as to the effect of the stiffness of the spring. In terms of partner characteristics, having a more skilled partner improves dyadic task performance more than having a less skilled partner. However, conflicting results were observed in terms of individual motor learning.

Conclusions

Although it is difficult to draw clear conclusions as to which interaction type, mode, or partner characteristic may lead to optimal task performance or individual motor learning, these results show the possibility for improved outcomes through HMH interaction. Future work that focuses on selecting the optimal personalized interaction conditions and exploring their impact on rehabilitation settings may facilitate the transition of HMH training protocols to clinical implementations.
Converging rapid deployment prostheses with minimal access surgery: analysis of early outcomes
Authors: Salmasi M. Yousuf , Papa Kristo , Mozalbat David , Ashraf Muhammad , Zientara Alicja , Chauhan Ishaan , Karadatkou Nikoleta , Athanasiou Thanos , Roussin Isabelle , Quarto Cesare , Asimakopoulos George
Published: December 2021

Background

Sutureless prostheses may have added benefit when combined with minimal access surgery, although this has not been fully assessed in the literature. This study aims to provide a comparative analysis of the Perceval valve comparing median sternotomy (MS) with mini-sternotomy (MIS).

Methods

A retrospective analysis of prospectively collected data was conducted for all isolated aortic valve replacement (AVR), using the Perceval valve, for severe aortic stenosis cases in the period 2014 to 2019. Patients undergoing concomitant valve or revascularisation surgery were excluded.

Results

A total of 78 patients were included: MS group 41; MIS group 37. Operatively, bypass times were comparable between MS and MIS groups (mean 89.3 vs 83.4, p = 0.307), as were aortic cross clamp times (58.4 vs 55.9, p = 0.434). There were no operative deaths or new onset post-operative neurology. MIS was a predictor of reduced stay in the intensive care unit (coef − 3.25, 95% CI [− 4.93, − 0.59], p = 0.036) and hospital stay overall (p = 0.004). Blood transfusion units were comparable as were the incidence of heart block (n = 5 vs n = 3, p = 0.429) and new onset atrial fibrillation (n = 15 vs n = 9, p = 0.250). Follow-up echocardiography found a significant improvement in effective orifice area, left ventricular dimension and volume indices, and LVEF (p > 0.05) for all patients. Multivariate analysis found mini-sternotomy to be a predictor for reduced LV diastolic volume (coef − 0.35, 95% CI [− 1.02, − 0.05], p = 0.05).

Conclusions

The combination of minimal access surgery and sutureless AVR may enhance patient recovery and provide early LV remodelling.
Immunomodulatory and immunosuppressive drug protocols in the treatment of canine primary immune thrombocytopenia, a scoping review
Authors: Kristiansen Peter Spanner , Nielsen Lise Nikolic
Published: December 2021

Primary immune thrombocytopenia (ITP) is a cause of severe thrombocytopenia in dogs. Immunosuppressive corticosteroid drugs are frequently used in the management of ITP, but treatment failure may occur. Immunomodulatory and non-corticosteroid immunosuppressive drugs might improve outcomes from therapy either alone or in combination with corticosteroids. The objectives of this scoping review were (1) to evaluate the current evidence relating to immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP, and (2) to answer the clinical question, whether or not therapy with immunomodulatory or non-corticosteroid immunosuppressive drugs alone or in combination with corticosteroids could improve outcome, compared to therapy with corticosteroids alone. A literature search was performed in the electronic databases of Agricola, CAB Abstracts, Embase, Medline and Web of Science for publications in November 2019 and again February 1, 2021. Selection criteria were relatively strict and included peer-reviewed research papers reporting outcome measures from immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP with a pre-therapeutic mean or median platelet count < 50,000/µL as a strict criterion for inclusion. Studies were evaluated if they had an appropriate diagnostic work up to exclude underlying conditions. Outcome measures and adverse events were compared between drug protocols both within studies and between studies. The search identified 456 studies, with six studies being eligible for inclusion. The studies were mostly case series while two were randomized controlled trials. Level of evidence varied with an overall uncertain subject enrollment, small groups, inadequate description and variable use of drug protocols or outcome measures. For outcomes such as platelet recovery time and duration of hospitalization, an improvement was observed using adjunctive therapy (human intravenous immunoglobulin) compared to therapy with corticosteroids alone. For outcomes of complete platelet recovery time, survival (6-month), mortality and relapse, no improvement was observed using adjunctive drugs compared to corticosteroids alone. Specifically, therapy with mycophenolate mofetil alone and adjunctive azathioprine were associated with more severe adverse events compared to other drug protocols. Evidence relating to immunomodulatory and immunosuppressive drug protocols in the treatment of canine ITP was of variable quality. Future larger case-controlled trials are required for determination of optimal treatment protocols in canine ITP.
Protocol for the Metformin Aneurysm Trial (MAT): a placebo-controlled randomised trial testing whether metformin reduces the risk of serious complications of abdominal aortic aneurysm
Authors: Golledge Jonathan , Arnott Clare , Moxon Joseph , Monaghan Helen , Norman Richard , Morris Dylan , Li Qiang , Jones Greg , Roake Justin , Bown Matt , Neal Bruce
Published: December 2021

Background

Multiple observational studies have associated metformin prescription with reduced progression of abdominal aortic aneurysm (AAA). The Metformin Aneurysm Trial (MAT) will test whether metformin reduces the risk of AAA rupture-related mortality or requirement for AAA surgery (AAA events) in people with asymptomatic aneurysms.

Methods

MAT is an international, multi-centre, prospective, parallel-group, randomised, placebo-controlled trial. Participants must have an asymptomatic AAA measuring at least 35 mm in maximum diameter, no diabetes, no contraindication to metformin and no current plans for surgical repair. The double-blind period is preceded by a 6-week, single-blind, active run-in phase in which all potential participants receive metformin. Only patients tolerating metformin by taking at least 80% of allocated medication will enter the trial and be randomised to 1500 mg of metformin XR or an identical placebo. The primary outcome is the proportion of AAA events defined as rupture-related mortality or need for surgical repair. Secondary outcomes include AAA growth, major adverse cardiovascular events and health-related quality of life. In order to test if metformin reduced the risk of AAA events by at least 25%, 616 primary outcome events will be required (power 90%, alpha 0.05).

Discussion

Currently, there is no drug therapy for AAA. Past trials have found no convincing evidence of the benefit of multiple blood pressure lowering, antibiotics, a mast cell inhibitor, an anti-platelet drug and a lipid-lowering medication on AAA growth. MAT is one of a number of trials now ongoing testing metformin for AAA. MAT, unlike these other trials, is designed to test the effect of metformin on AAA events. The international collaboration needed for MAT will be challenging to achieve given the current COVID-19 pandemic. If this challenge can be overcome, MAT will represent a trial unique within the AAA field in its large size and design.

Trial registration

Australian Clinical Trials ACTRN12618001707257. Registered on 16 October 2018
Robotic versus Open Pancreatoduodenectomy for Pancreatic and Periampullary Tumors (PORTAL): a study protocol for a multicenter phase III non-inferiority randomized controlled trial
Authors: Jin Jiabin , Shi Yusheng , Chen Mengmin , Qian Jianfeng , Qin Kai , Wang Zhen , Chen Wei , Jin Weiwei , Lu Fengchun , Li Zheyong , Wu Zehua , Jian Li , Han Bing , Liang Xiao , Sun Chuandong , Wu Zheng , Mou Yiping , Yin Xiaoyu , Huang Heguang , Chen Hao , Gemenetzis Georgios , Deng Xiaxing , Peng Chenghong , Shen Baiyong
Published: December 2021

Background

Pancreatoduodenectomy is a complex and challenging procedure that requires meticulous tissue dissection and proficient suturing skills. Minimally invasive surgery with the utilization of robotic platforms has demonstrated advantages in perioperative patient outcomes in retrospective studies. The development of robotic pancreatoduodenectomy (RPD) in specific has progressed significantly, since first reported in 2003, and high-volume centers in pancreatic surgery are reporting large patient series with improved pain management and reduced length of stay. However, prospective studies to assess objectively the feasibility and safety of RPD compared to open pancreatoduodenectomy (OPD) are currently lacking.

Methods/design

The PORTAL trial is a multicenter randomized controlled, patient-blinded, parallel-group, phase III non-inferiority trial performed in seven high-volume centers for pancreatic and robotic surgery in China (> 20 RPD and > 100 OPD annually in each participating center). The trial is designed to enroll and randomly assign 244 patients with an indication for elective pancreatoduodenectomy for malignant periampullary and pancreatic lesions, as well as premalignant and symptomatic benign periampullary and pancreatic disease. The primary outcome is time to functional recovery postoperatively, measured in days. Secondary outcomes include postoperative morbidity and mortality, as well as perioperative costs. A sub-cohort of 128 patients with pancreatic adenocarcinoma (PDAC) will also be compared to assess the percentage of patients who undergo postoperative adjuvant chemotherapy within 8 weeks, in each arm. Secondary outcomes in this cohort will include patterns of disease recurrence, recurrence-free survival, and overall survival.

Discussion

The PORTAL trial is designed to assess the feasibility and safety of RPD compared to OPD, in terms of functional recovery as described previously. Additionally, this trial will explore whether RPD allows increased access to postoperative adjuvant chemotherapy, in a sub-cohort of patients with PDAC.

Trial registration

ClinicalTrials.govNCT04400357. Registered on May 22, 2020
A mechanism-based proof of concept study on the effects of duloxetine in patients with painful knee osteoarthritis
Authors: Ammitzbøll Nadia , Arendt-Nielsen Lars , Bertoli Davide , Brock Christina , Olesen Anne Estrup , Kappel Andreas , Drewes Asbjørn Mohr , Petersen Kristian Kjær
Published: December 2021

Background

The global burden of osteoarthritis (OA) is steadily increasing due to demographic and lifestyle changes. The nervous system can undergo peripheral and central neuroplastic changes (sensitization) in patients with OA impacting the options to manage the pain adequately. As a result of sensitization, patients with OA show lower pressure pain thresholds (PPTs), facilitated temporal summation of pain (TSP), and impaired conditioned pain modulation (CPM). As traditional analgesics (acetaminophen and non-steroidal anti-inflammatory drugs) are not recommended for long-term use in OA, more fundamental knowledge related to other possible management regimes are needed. Duloxetine is a serotonin-noradrenalin reuptake inhibitor, and analgesic effects are documented in patients with OA although the underlying fundamental mechanisms remain unclear. The descending pain inhibitory control system is believed to be dependent on serotonin and noradrenalin. We hypothesized that the analgesic effect of duloxetine could act through these pathways and consequently indirectly reduce pain and sensitization. The aim of this mechanistic study is to investigate if PPTs, TSP, CPM, and clinical pain parameters are modulated by duloxetine.

Methods

This proof of concept study is a randomized, placebo-controlled, double-blinded, crossover trial, which compares PPTs, TSP, and CPM before and after 18 weeks of duloxetine and placebo in forty patients with knee OA. The intervention periods include a titration period (2 weeks), treatment period (60 mg daily for 14 weeks), and a discontinuation period (2 weeks). Intervention periods are separated by 2 weeks.

Discussion

Duloxetine is recommended for the treatment of chronic pain, but the underlying mechanisms of the analgesic effects are currently unknown. This study will investigate if duloxetine can modify central pain mechanisms and thereby provide insights into the underlying mechanisms of the analgesic effect.

Trial registration

ClinicalTrials.govNCT04224584. Registered on January 6, 2020. EudraCT 2019-003437-42. Registered on October 22, 2019. The North Denmark Region Committee on Health Research Ethics N-20190055. Registered on October 31, 2019.
Microbial degradation and community structure analysis of hydroxyl-terminated polybutadiene (HTPB)
Authors: Zhang Ying , Zou Min , Lodhi Adil Farooq , Deng Yu-lin
Published: December 2021

Hydroxyl-terminated polybutadiene (HTPB) is a curing adhesive that is commonly used in the production of ammunition, and it emerged during the time of war. After entering the peaceful era, several countries around the globe have focused on the destruction of expired ammunition using safe and economical methods in terms of consumption of energy. Microorganisms exhibit a highly efficient and environment friendly degradation capability for variety of refractory substances. Therefore, in this study we screened five strains of microorganisms from five environmental soil samples for their ability to degrade HTPB. These microorganisms were identified as Microbacterium trichothecenolyticum, Microbacterium esteraromaticum, Arthrobacter pascens, Pseudonocardia carboxydivorans and Ochrobactrum anthropic based on 16S rRNA gene similarity index. We observed the uncorroded and corroded HTPB sample through scanning electron microscopy and observed the formation of lot of holes and gullies in HTPB after corrosion. An 18S rRNA gene clone library was constructed for HTPB-degrading fungi. Based on the results of library evaluation, it was found that the structure of the HTPB-degrading fungi community was relatively simple. A total of 54 positive clones were obtained. These clones represented some uncultured microorganisms that were closely related to Scytalidium lignicola, Pseudokahliella and Gonostomum strenuum. This study will help in the implementation of environment friendly degradation strategies for HTPB degradation.
Modular control of multiple pathways of Corynebacterium glutamicum for 5-aminolevulinic acid production
Authors: Ge Fanglan , Li Xiaokun , Ge Qingrong , Zhu Di , Li Wei , Shi Fenghui , Chen Hongjin
Published: December 2021

5-aminolevulinic acid (ALA) has broad potential applications in the medical, agricultural and food industries. Several strategies have been implemented successfully to try to improve ALA synthesis. Nonetheless, the low yield has got in the way of large-scale bio-manufacture of 5-ALA. In this study, we explored strain engineering strategies for high‐level 5‐ALA production in Corynebacterium glutamicum F343 using the C4 pathway. Initially, the glutamate dehydrogenase-encoding gene gdhA was deleted to reduce glutamate yield. Then the C4 pathway was introduced in the gdhA mutant strain F2-A (∆gdhA + hemA), resulting in a 5-ALA yield of up to 3.2 g/L. Furthermore, the accumulations of downstream metabolites such as heme, porphobilinogen, and protoporphyrin IX, were decreased. After evaluating the mechanisms of this synthetic pathway by RNA-Seq, the results showed that genes involved in both the C5 pathway and heme pathways were down-regulated in strain F2-A (∆gdhA + hemA). Interestingly, upstream genes of succinyl-CoA in the tricarboxylic acid (TCA) cycle, such as icd, lpdA, were up-regulated, while its downstream genes, including sucC, sucD, sdhB, sdhA, sdhCD, were down-regulated. These changes amplify the sources of succinyl-CoA and reduce its expenditure, before pulling the carbon flux to produce 5-ALA. Furthermore, the down-regulation of most genes of the heme pathway could reduce the drainage of 5‐ALA, which further enhance its accumulation. To alleviate competition between glyoxylate and the TCA cycle, the isocitrate dehydrogenase-encoding gene aceA was also knocked out, resulting in 3.86 g/L of 5‐ALA. Finally, the fermentation conditions were optimized, resulting in a maximum 5-ALA yield of 5.6 g/L. Overall, the blocking of the glutamate synthesis pathway could be a powerful strategy to re-allocate the carbon flux to produce 5-ALA. It could also enable the efficient synthesis of other TCA derivatives in C. glutamicum.
Vitamin D and its association with symptom severity in knee osteoarthritis: a cross sectional study at a national referral hospital in Uganda
Authors: Namutebi Fiona , Kayima James , Kaddumukasa Mark
Published: December 2021

Background

Vitamin D deficiency is highly prevalent among patients with osteoarthritis. It is associated with joint pain, stiffness and worse physical function. Whether vitamin D deficiency is associated with osteoarthritis is controversial. We investigated serum vitamin D levels and its association with symptom severity in patients with knee osteoarthritis.

Methods

Between January 2020 to March and May 2020, we conducted a cross sectional study at a national referral hospital in Uganda. Using the American College of Rheumatology clinical criteria, 107 consenting adults were diagnosed with knee osteoarthritis. A questionnaire captured patient demographics and clinical characteristics. Joint pain, stiffness and physical function severity were assessed and graded based on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). We determined serum vitamin D levels by electrochemilumniscence immunoassay. The data were analysed and adjusted for age, sex, education, occupation, family history, body mass index (BMI) and calcium supplementation.

Results

Of the 107 patients, 92 (86%) patients were females, mean (SD) age was 58.1 (12.6) years. Nearly 65% of the patients had suboptimal serum vitamin D levels < 30 ng/ml. The median (Q1, Q3) WOMAC joint scores were as follows: pain 8.0 (5, 11), stiffness 1 (0, 2), physical function 29.0 (16, 41) and total WOMAC 39.0 (21, 54). Spearman correlations between serum vitamin D levels with symptom severity were as follows: joint pain (r = 0.18, p = 0.06), stiffness (r = 0.13, p = 0.17), physical function (r = 0.09, p = 0.36) and total WOMAC (r = 0.13, p = 0.19).

Conclusion

Serum vitamin D levels are not associated with joint pain, stiffness and physical function severity. Older age and higher BMI are associated with vitamin D deficiency in patients with knee osteoarthritis attending a national referral hospital rheumatology clinic in Uganda. Suboptimal vitamin D is an independent risk factor for total mortality in the general population. Clinical guidelines and further studies to determine age and BMI ranges required for vitamin D screening are needed in patients with osteoarthritis in Uganda. Patients are advised to keep a normal BMI.
Brain tumors in the first two years of life
Authors: Enayet Abdelrhman
Published: December 2021

Background

Brain tumors in the first years of life are frequently encountered recently with the advancement in neuroimaging, neurosurgery and neuroanethesia where early diagnosis of these lesions became available even before birth. Their management is challenging where the surgery is technically demanding, radiotherapy is omitted in this age because of its late sequelae and chemotherapy role may be beneficial, but it is limited also by its side effects and neurotoxicity. The aim of this article is to review the current literature about the brain tumors in the first two years of life, their diagnosis and treatment.

Main body

Brain tumors in the first two years of life encompass mainly fetal/congenital tumors and infantile tumors. They account for 1.4–18% of cases of pediatric brain tumor, and most of them are diagnosed in the first year of life. The main histopathologies diagnosed are glial tumors, choroid plexus tumors, medulloblastoma and other embryonal tumors, teratoma and ependymoma. They are mainly supratentorial. Large head and bulging fontanelles are the main presenting symptoms and signs secondary to increased intracranial pressure secondary to large tumors or associated hydrocephalus. Prenatal and postnatal ultrasonography represents the initial imaging step in the diagnosis that should be complemented by MRI and CT brain. The main and first line of treatment of infantile brain tumors is surgical excision as the prognosis is directly related to the extent of resection besides surgery offers specimens for histopathological diagnosis and adjuvant chemotherapy is given for residual irresectable cases and malignant tumors with the main aim to delay radiotherapy beyond the age of three years.

Conclusion

Brain tumors in the first two years of life are a challenging group of different histopathological entities with underlying specific molecular characterization and genetic predispositions. They have aggressive behavior and general poor prognosis with limited options of management. Individualized multidisciplinary management for each case is needed, and future studies for therapeutic medications targeting underlying molecular biology may improve their outcome.
Simultaneous Quantification of Aromatase Inhibitors and Estrogens in Postmenopausal Breast Cancer Patients
Authors: Bertelsen Bjørn-Erik , Viste Kristin , Helland Thomas , Hagland Magnus , Søiland Håvard , Geisler Jürgen , Lende Tone Hoel , Lønning Per Eystein , Sagen Jørn V , Mellgren Gunnar , Almås Bjørg
Published: December 2021

Context

Currently there are no assays that can simultaneously quantify serum levels of the third-generation aromatase inhibitors (AIs): letrozole, anastrozole, and exemestane, and the ultra-low levels of estrogens in postmenopausal breast cancer patients on AI treatment. Such measurements may be pivotal for the determination of optimal and individualized treatment regimens. We aimed at developing a liquid chromatography–tandem mass spectrometry (MS/MS) method for simultaneous assessment of letrozole, anastrozole, exemestane, and 17-hydroxyexemestane as well as subpicomolar levels of estradiol and estrone.

Methods

Internal standards, calibrators, serum samples, and quality controls were in fully automated steps transferred to a deep-well plate for a 2-step liquid-liquid extraction. The extracts were reconstituted and analytes were separated chromatographically using 2 serially coupled columns, then subject to MS/MS in electrospray ionization mode. The method was thoroughly validated and is traceable to 2 accredited estrogen methods.

Results

The measurement range for estrone and estradiol was 0.2 to 12 000 pmol/L and 0.8 to 13 000 pmol/L, and covered the expected therapeutic range for the AIs. All analytes had a precision of less than or equal to 13%, and accuracies within 100 ± 8%. As proof of concept, AI and estrogen levels were determined in serum samples from postmenopausal breast cancer patients under treatment.

Conclusion

We present here an assay suitable for the simultaneous measurement of serum levels of all third-generation AIs and ultra-low levels of estrogens, providing a powerful new tool to study drug efficacy and compliance. The method is highly valuable for postmenopausal patients whose pretreatment estradiol levels are below the threshold of detection for most routine assays, but still require suppression.
Association Between Frailty and Clinical Outcomes and Quality of Life in Older Adults Following Hip Fracture Surgery: A Retrospective Cohort Study
Authors: Zhao Hong , Wei Peiyao , Feng Yi
Published: December 2021

BACKGROUND:

Hip fracture is a serious event in the older population and is associated with morbidity, mortality, and disability among those who survive. Emerging evidence suggests that frailty is pertinent to the clinical outcomes of older patients with hip fracture.

METHODS:

We conducted a retrospective cohort study on older patients (aged ≥65 years) who underwent orthopedic repair with hip fracture under spinal or general anesthesia between June 1, 2019 and May 31, 2020. Demographic, surgical, and anesthetic features; chart-derived frailty index (CFI); occurrence of complications; and length of stay were retrospectively collected by reviewing patients’ anesthesia records and medical charts. Patients were divided into 2 groups according to their CFI: high CFI group (CFI, 3–5) and low CFI group (CFI, 0–2). The CFI was calculated as the addition of the patient’s conditions, including age >70 years, preoperative body mass index <18.5 kg/m2, hematocrit <35%, albumin <34 g/L, and serum creatinine >176.8 mol/L (2.0 mg/dL). The EuroQol 5-dimensional questionnaire (EQ-5D) was obtained through telephone interviews 12 months after surgery to assess mortality and long-term quality of life.

RESULTS:

During the study period, 381 patients met the inclusion criteria. Patients in the high CFI group had an increased incidence of delirium by 13.80% (95% confidence interval [CI], 6.31–21.29) (17 [16.6%] vs 8 [2.8%]; P < .001) compared to patients in the low CFI group. More patients in the high CFI group had pneumonia with an increased incidence of 17.71% (95% CI, 7.08–23.34) (40 [39.2%] vs 60 [21.5%]; P < .001) than patients in the low CFI group. Postoperative hospital stay was significantly longer in the high CFI group (8 [6–12] vs 7 [5–10] days; P = .0222) than in the low CFI group. More patients died in the high CFI group 1 year after surgery with an increased mortality of 19.33% (95% CI, 9.47–29.18) (26.4% [23/87] vs 7.1% [16/225]; P < .001) than patients in the low CFI group. A total of 64 patients in the high CFI group and 209 patients in the low CFI group completed the EQ-5D survey 1 year after surgery. The EQ-5D score in the high CFI group was significantly lower than that in the low CFI group (0.63 ± 0.22 vs 0.72 ± 0.22; P = .002).

CONCLUSIONS:

Frailty status is associated with adverse postoperative outcomes, mortality, and low quality of life 12 months after hip fracture surgery in older patients.
Preoperative Assessment of Anxiety and Depression Using Computerized Adaptive Screening Tools: A Pilot Prospective Cohort Study
Authors: Bass Victoria , Brown Frank , Beiser David G. , Peterson Tarren , Gibbons Robert D. , Nagele Peter
Published: December 2021

BACKGROUND:

Serious mental health conditions (eg, anxiety and depression) are common in surgical patients, yet likely underassessed due to the time-consuming and cumbersome traditional screening process. A recently developed computerized adaptive mental health assessment tool (computerized adaptive test-mental health [CAT-MH]) allows rapid, precise, and accurate assessment of numerous mental health disorders, including anxiety and depression, without the need for a trained interviewer. The goal of this investigation was to determine the feasibility of administering CAT-MH for anxiety and depression in the preoperative setting and to obtain preliminary evidence of the prevalence of anxiety and depression in preoperative patients.

METHODS:

In this prospective cohort study, 100 adult patients scheduled for elective surgery were enrolled and asked to complete the CAT-MH in the preoperative clinic. Urgent and emergency surgeries were excluded as were pregnant patients. Primary feasibility outcomes were completion rate and time to completion. Secondary outcomes were prevalence estimates of anxiety and depression.

RESULTS:

All 100 enrolled patients completed the study. All patients were able to complete the mental health assessment (mean time: 3.6 ± 1.8 minutes standard deviation). Sixteen patients (16%) screened positive for anxiety (severity: mild, n = 7 [7%]; moderate, n = 7 [7%]); severe, n = 2 [2%]); 12 of 16 (75%) did not have a previous diagnosis of anxiety disorder. Twenty-eight (28%) patients screened positive for depression (severity: mild, n = 26 [26%]; moderate and severe, n = 1 each [1%]); 23 of 28 (82%) had no previous diagnosis of depressive disorder. Nineteen patients (19%) met the screening criteria for major depressive disorder; 14 of 19 (74%) of which had no previous diagnosis of major depressive disorder.

CONCLUSIONS:

The results of this pilot study support the feasibility of using CAT-MH in a preoperative evaluation and indicate that there is a substantial prevalence of undiagnosed anxiety and depression in surgical patients.
Robotic Nerve Sheath Tumor Resection With Intraoperative Neuromonitoring: Case Series and Systematic Review
Authors: Curry Brian P. , Alvarez Reinier , Widemann Brigitte C. , Johnson Matthew , Agarwal Piyush K. , Lehky Tanya , Valera Vladimir , Chittiboina Prashant
Published: December 2021

BACKGROUND:

Retroperitoneal nerve sheath tumors present a surgical challenge. Despite potential advantages, robotic surgery for these tumors has been limited. Identifying and sparing functional nerve fascicles during resection can be difficult, increasing the risk of neurological morbidity.

OBJECTIVE:

To review the literature regarding robotic resection of retroperitoneal nerve sheath tumors and retrospectively analyze our experience with robotic resection of these tumors using a manual electromyographic probe to identify and preserve functional nerve fascicles.

METHODS:

We retrospectively analyzed the clinical courses of 3 patients with retroperitoneal tumors treated at the National Institutes of Health by a multidisciplinary team using the da Vinci Xi system. Parent motor nerve fascicles were identified intraoperatively with a bipolar neurostimulation probe inserted through a manual port, permitting tumor resection with motor fascicle preservation.

RESULTS:

Two patients with neurofibromatosis type 1 underwent surgery for retroperitoneal neurofibromas located within the iliopsoas muscle, and 1 patient underwent surgery for a pelvic sporadic schwannoma. All tumors were successfully resected, with no complications or postoperative neurological deficits. Preoperative symptoms were improved or resolved in all patients.

CONCLUSION:

Resection of retroperitoneal nerve sheath tumors confers an excellent prognosis, although their deep location and proximity to vital structures present unique challenges. Robotic surgery with intraoperative neurostimulation mapping is safe and effective for marginal resection of histologically benign or atypical retroperitoneal nerve sheath tumors, providing excellent visibility, increased dexterity and precision, and reduced risk of neurological morbidity.
Posterior Cervical Decompression and Fusion With Exoscope: 2-Dimensional Operative Video
Authors: Srinivasan Ethan S. , Crutcher Clifford L. , Shaffrey Christopher I. , Gottfried Oren N. , Than Khoi D.
Published: December 2021

Posterior cervical decompression and fusion is an effective strategy for correction of cervical spondylotic myelopathy. Here, we highlight the operative treatment of a 63-yr-old man entailing a 4-level posterior cervical laminectomy and fusion, with the use of an exoscope throughout. The patient initially presented with symptoms of gait dysfunction and loss of fine motor control in the upper extremities, without neck pain or radiculopathy. His imaging demonstrated a congenitally narrowed spinal canal with cervical stenosis at C3-C4, C5-C6, and C6-C7. The patient consented to the procedure and publication of his image, along with other participants and any identifiable individuals. The operation proceeded with the patient in a prone position with midline dissection to the posterior elements of C3-C6. Pilot holes were drilled in the lateral masses and C3-C4, C4-C5, C5-C6, and C6-C7 laminectomies performed using a high-speed drill, with removal of the laminae en bloc. Lateral mass screws were inserted and precontoured rods secured, with morselized autograft and allograft bone chips placed for arthrodesis. Postoperatively, the patient reported noted improvement in his symptoms.
Corrupção e retorno de ações de empresas listadas na B3
Authors: Fonseca Machado Beling Dias Vitor , Fernandes Malaquias Rodrigo
Published: December 2021

O objetivo do presente artigo foi identificar o efeito da divulgação de notícias sobre um possível envolvimento em corrupção das empresas no retorno de suas ações em períodos próximos à divulgação dessas notícias. Foi utilizada a metodologia do estudo de evento, considerando o período entre 2012 e 2019, com uma amostra de 83 empresas brasileiras listadas na B3 e 236 reportagens. A principal hipótese da pesquisa foi confirmada, pois os resultados indicaram que o fenômeno estudado está relacionado a uma diminuição no retorno das ações, principalmente na data da divulgação do evento. O estudo se mostrou alinhado à perspectiva sand the wheels, evidenciou ajustes nos preços dos títulos coerentes com a teoria sobre eficiência de mercado, e pode ser usado por investidores na tomada de decisão.
Strategies of portfolio investment with estimates of bull and bear markets
Authors: Valls Pereira Pedro L. , Oliveira André Barbosa
Published: December 2021

The financial market has non-linear patterns, with different return behavior in bull versus bear markets. This article uses multivariate model estimates to study portfolios in changing conditions, and develops investment strategies for portfolios in light of uncertainty about the bear or bull status of the stock market. Portfolios were optimized for the main stocks listed on the Brazilian market index Ibovespa. The portfolios proposed with estimates of changing market status outperformed others over the analyzed period, with rebalancing adjustments made either weekly or monthly.
Θεωρίες και πρακτικές για την εννοιολόγηση και τη διδακτική εννοιών της μαθηματικής ανάλυσης με χρήση τεχνολογιών πληροφορίας και επικοινωνιών
Authors: Ρεμούνδου Δήμητρα
Published: December 2021

Η σημασία της έννοιας της 'μεταβολής' (change) και του 'ρυθμού μεταβολής' (rate of change) στη μαθηματική εκπαίδευση έχει αναδειχτεί τα τελευταία χρόνια, τόσο λόγω της σχέσης τους με έννοιες της Μαθηματικής Ανάλυσης όπως το όριο, η παράγωγος και το ολοκλήρωμα, όσο και του μεγάλου αριθμού εφαρμογών τους σε διάφορους κλάδους των επιστημών. Έρευνες σε διεθνές επίπεδο έχουν αναδείξει τις δυσκολίες που αντιμετωπίζουν μαθητές αλλά και φοιτητές στην εννοιολόγηση και στην εφαρμογή αυτών των εννοιών. Παρατηρείται αποσπασματική κατανόηση της συμμεταβολής (covariation) και του ρυθμού μεταβολής, εξαρτημένη από την αναπαράσταση και το πλαίσιο στο οποίο αναφέρονται. Στην παρούσα διδακτορική διατριβή μελετήθηκε η θέση της έννοιας του ρυθμού μεταβολής στο ελληνικό πρόγραμμα σπουδών και η εννοιολόγηση του ρυθμού μεταβολής από φοιτητές. Για τη διερεύνηση της θέσης της έννοιας του ρυθμού μεταβολής στο ελληνικό εκπαιδευτικό σύστημα, εξετάστηκε ο τρόπος που δομείται σταδιακά η έννοια, μέσα από αναφορές στο πρόγραμμα σπουδών και στα σχολικά εγχειρίδια, σε σύγκριση με άλλες χώρες. Επιπλέον, εξετάστηκαν οι απόψεις εν ενεργεία εκπαιδευτικών μαθηματικών σε σχέση με τη διδασκαλία της έννοιας. Συγκεκριμένα, οι καθηγητές ρωτήθηκαν για τη σημαντικότητα του ρυθμού μεταβολής, τη θέση του στην υποχρεωτική εκπαίδευση, τις δυσκολίες που εντοπίζουν στους μαθητές και τους τρόπους που θα επέλεγαν για να διδάξουν το θέμα. Στη συνέχεια, διερευνήθηκε ο τρόπος εννοιολόγησης του ρυθμού μεταβολής από φοιτητές. Για τον σκοπό αυτό διαμοιράστηκε ένα ερωτηματολόγιο με έργα γύρω από τον ρυθμό μεταβολής με διάφορες αναπαραστάσεις και ένα ερωτηματολόγιο με έργα που αφορούν στον ρυθμό μεταβολής και σχετικές έννοιες, όπως η κλίση. Για την εννοιολόγηση του ρυθμού μεταβολής, εντοπίστηκαν βασικές έννοιες που απαιτούνται, όπως ο λόγος και οι αναλογίες, η κλίση και η παράγωγος. Παρατηρήθηκε ότι κάποιες από τις έννοιες αυτές διδάσκονται στην υποχρεωτική εκπαίδευση, αλλά δεν αναδυκνείεται η σύνδεση μεταξύ τους. Η εννοιολόγηση του ρυθμού μεταβολής που υπερισχύει σύμφωνα με τον τρόπο που δομείται η έννοια στην υποχρεωτική εκπαίδευση, αλλά και τις απαντήσεις των φοιτητών είναι κυρίως διαδικασιακή και σχετίζεται με την παράγωγο. Με βάση τα ευρήματα των παραπάνω ερευνών και τη διεθνή βιβλιογραφία, προτείνονται προσαρμογές στο πρόγραμμα σπουδών, στις οποίες συγκαταλέγεται η έμφαση στη συμμεταβολή και η διαισθητική προσέγγιση ποσοτήτων που συμμεταβάλλονται από μικρότερη ηλικία. Βασικές συνιστώσες της προσπάθειας αυτής αποτελούν οι αναπαραστάσεις, οι εφαρμογές σε ρεαλιστικά πλαίσια και η εκπαιδευτική αξιοποίηση τεχνολογιών πληροφορίας και επικοινωνιών. Στο πλαίσιο αυτό, αναπτύχθηκαν και παρουσιάζονται ενδεικτικές δραστηριότητες για την ενίσχυση της εννοιολογικής κατανόησης του ρυθμού μεταβολής και βασικών εννοιών που σχετίζονται με αυτόν.
H σχέση με τον/την μέντορα και η αυτο-αποτελεσματικότητα των φοιτητών/φοιτητριών του Τμήματος Θεολογίας Αθήνας στην πρακτική άσκηση στο σχολείο
Authors: Κουκουνάρας Λιάγκης Μάριος , Παπαϊωάννου Μανώλης , Αποστολάκη Ελένη-Άννα
Published: December 2021

Στο άρθρο διερευνώνται οι αντιλήψεις Υποψήφιων Εκπαιδευτικών (ΥΕ), φοιτητών/τριών του Τμ. Θεολογίας ΕΚΠΑ, για τους παράγοντες που επηρεάζουν την αυτο-αποτελεσματικότητά τους στη Πρακτική Άσκηση (ΠΑ) στο σχολείο, στο πλαίσιο της απόκτησης της Παιδαγωγικής και Διδακτικής Επάρκειας. Συμμετείχαν 83 ΥΕ, τη χρονιά 2019-20. Μελετήθηκαν ξεχωριστά τέσσερεις διαστάσεις της μεντορικής καθοδήγησης και συγκεκριμένα: α) η ποιότητα σχέσης Μέντορα και ΥΕ, β) η μεντορική υποστήριξη, γ) η διάρκεια και ο χαρακτήρας της ανατροφοδότησης, δ) η αυτονομία των ΥΕ στην επιλογή και δοκιμασία διδακτικών δραστηριοτήτων, σε συσχέτιση με τις αντιλήψεις των ΥΕ για την αποτελεσματικότητά τους στη διδασκαλία (διδακτική αυτο-αποτελεσματικότητα). Από την ανάλυση δεδομένων προκύπτει ότι η καλή σχέση και η υποστήριξη που δέχονται οι ΥΕ από τους/τις Μέντορες σχετίζεται σε ένα βαθμό θετικά με την αυτο-αποτελεσματικότητά τους στη διδασκαλία. Επίσης, όταν η ανατροφοδότηση λειτουργεί θετικά σε πρακτικό εκπαιδευτικό επίπεδο για τους/τις ΥΕ, αυτό σχετίζεται με την αυτο-αποτελεσματικότητά τους στη διδασκαλία, κάτι που δεν συμβαίνει αντίστοιχα με τη διάρκειά της. Τέλος, όσο μειώνεται η συνεισφορά των Μεντόρων Εκπαιδευτικών (ΜΕ) στην επιλογή και την εφαρμογή των διδακτικών δραστηριοτήτων των ΥΕ, τόσο περισσότερο οι ΥΕ αισθάνονται μεγαλύτερη αυτο-αποτελεσματικότητα στη διδασκαλία. Η έρευνα αναδεικνύει σημαντικά κριτήρια για τον μελλοντικό σχεδιασμό προγραμμάτων ΠΑ φοιτητών/τριών ή εκπαίδευσης Μεντόρων.