bluuebunny/crossref_metadata_2025 huggingface dataset:
Platelet-Rich Plasma for Knee Osteoarthritis: Internet Marketing and Patient Education—An Appraisal of Content for Websites with the Greatest Search Engine Visibility
Authors: Shai Shemesh S. , Shay Ribenzaft Z. , Pretell-Mazzini Juan , Tal Frenkel Rutenberg , Nir Cohen , Barak Haviv , Steven Velkes
Published: February 2020

Objective

The internet is increasingly being used as a resource for health-related information by the general public. We sought to establish the authorship, content, and accuracy of the information available online regarding platelet-rich plasma (PRP) therapy for knee osteoarthritis.

Design

Top 200 search results from each of the 3 leading search engines available online (Google, Yahoo!, Bing) were screened, and 181 websites were finally reviewed for content with emphasis on specific claims, comparing between websites authored by private physicians/groups and other authorship types.

Results

Nearly 80% of the websites claimed that PRP injections for osteoarthritis of the knee improve patients’ pain. A total of 42.8% of the private websites and 27.6% of nonprivate websites have stated that the procedure can delay or eliminate the need for future surgery. Costs were only mentioned by few (11.6%), and mainly by the nonprivate websites. Both website groups were unlikely to mention that PRP therapy is not the treatment of choice for end-stage knee osteoarthritis (7.9% of private and 17.2% of the nonprivate sites), or to state that patients with less advanced disease may benefit more from the treatment (11.8% and 20.6%, respectively). Private websites were less likely to refer to peer-reviewed literature (18.4% vs. 41.4%) and were more than 3 times less likely to mention lack of adequate evidence (13.2% vs. 48.2%).

Conclusions

Patients seeking online information regarding PRP therapy are vulnerable to websites presenting a narrow viewpoint of this treatment modality, putting emphasis on unsubstantiated benefits while disregarding potential drawbacks and concerns.
Article 47 CFR and the effective enforcement of EU labour law: Teeth for paper tigers?
Authors: Adams-Prassl Jeremias
Published: February 2020

‘Social rights’, the late Professor Sir Bob Hepple warned in 2007 ‘are like paper tigers, fierce in appearance but missing in tooth and claw.’ This note sets out to explore the potential of the right to an effective remedy in Article 47 of the European Union’s Charter of Fundamental Rights (‘CFR’) in equipping the Union’s social acquis with credible remedies. Article 47 CFR is one of the most-litigated and important Articles in the Charter. At the same time, however, it has received surprisingly little attention in the context of EU employment law.

Discussion is structured as follows: section one explores the rise of the principle of effectiveness, from the early case law of the Court of Justice to the Charter’s entry into force in 2009. Section two sketches the powerful potential of Article 47 CFR, highlighting its utility both in tackling domestic obstacles to effective enforcement, and expanding the horizontal applicability of EU employment law. Section three briefly highlights some of the limitations litigants might encounter, including a general emphasis on broad regulatory discretion for Member States, and the difficult of crafting (positive) duties out of (negative) restraints. A brief concluding section turns to EU law more broadly, as well as the European Convention of Human Rights, for inspirations guiding the potential future development of Article 47 CFR.
Pancreatic cancer‐derived organoids – a disease modeling tool to predict drug response
Authors: Frappart Pierre‐Olivier , Walter Karolin , Gout Johann , Beutel Alica K , Morawe Mareen , Arnold Frank , Breunig Markus , Barth Thomas FE , Marienfeld Ralf , Schulte Lucas , Ettrich Thomas , Hackert Thilo , Svinarenko Michael , Rösler Reinhild , Wiese Sebastian , Wiese Heike , Perkhofer Lukas , Müller Martin , Lechel André , Sainz Bruno , Hermann Patrick C , Seufferlein Thomas , Kleger Alexander
Published: February 2020

Background

Organotypic cultures derived from pancreatic ductal adenocarcinoma (PDAC) termed pancreatic ductal cancer organoids (PDOs) recapitulate the primary cancer and can be derived from primary or metastatic biopsies. Although isolation and culture of patient‐derived pancreatic organoids were established several years ago, pros and cons for individualized medicine have not been comprehensively investigated to date.

Methods

We conducted a feasibility study, systematically comparing head‐to‐head patient‐derived xenograft tumor (PDX) and PDX‐derived organoids by rigorous immunohistochemical and molecular characterization. Subsequently, a drug testing platform was set up and validated in vivo. Patient‐derived organoids were investigated as well.

Results

First, PDOs faithfully recapitulated the morphology and marker protein expression patterns of the PDXs. Second, quantitative proteomes from the PDX as well as from corresponding organoid cultures showed high concordance. Third, genomic alterations, as assessed by array‐based comparative genomic hybridization, revealed similar results in both groups. Fourth, we established a small‐scale pharmacotyping platform adjusted to operate in parallel considering potential obstacles such as culture conditions, timing, drug dosing, and interpretation of the results. In vitro predictions were successfully validated in an in vivo xenograft trial. Translational proof‐of‐concept is exemplified in a patient with PDAC receiving palliative chemotherapy.

Conclusion

Small‐scale drug screening in organoids appears to be a feasible, robust and easy‐to‐handle disease modeling method to allow response predictions in parallel to daily clinical routine. Therefore, our fast and cost‐efficient assay is a reasonable approach in a predictive clinical setting.
Impact of therapies on bowel damage in Crohn’s disease
Authors: Fiorino Gionata , Bonifacio Cristiana , Allocca Mariangela , Danese Silvio
Published: February 2020

Crohn’s disease (CD) is a chronic inflammatory bowel disease that usually progresses to bowel damage, defined as strictures, fistulas and abscesses. These complications require intestinal resection and lead to further irreversible structural damage. Cross‐sectional imaging, such as magnetic resonance imaging, computed tomography and ultrasound, are accurate in assessing intestinal damage at a definite time point and the progression of damage over time. Recently, an imaging‐based index, the Lémann Index, has been proposed and developed in order to quantify bowel damage in CD patients; emerging data confirm that this Index can measure the structural damage with good sensitivity to change. One challenge remains to understand whether existing or future treatments might be able to stop bowel‐damage progression or even reverse intestinal damage, improving the prognosis and changing the natural history of CD. We reviewed the current data available in the literature focused on the measure of structural damage in CD patients, mainly focusing on the impact on therapies in reversing bowel damage. We also explored some further perspectives on measuring and targeting intestinal damage in clinical research and in clinical practice as an ultimate therapeutic target.
Censorship’s Effect on Incidental Exposure to Information: Evidence From Wikipedia
Authors: Pan Jennifer , Roberts Margaret E.
Published: February 2020

The fast-growing body of research on internet censorship has examined the effects of censoring selective pieces of political information and the unintended consequences of censorship of entertainment. However, we know very little about the broader consequences of coarse censorship or censorship that affects a large array of information such as an entire website or search engine. In this study, we use China’s complete block of Chinese language Wikipedia ( zh.wikipedia.org ) on May 19, 2015, to disaggregate the effects of coarse censorship on proactive consumption of information—information users seek out—and on incidental consumption of information—information users are not actively seeking but consume when they happen to come across it. We quantify the effects of censorship of Wikipedia not only on proactive information consumption but also on opportunities for exploration and incidental consumption of information. We find that users from mainland China were much more likely to consume information on Wikipedia about politics and history incidentally rather than proactively, suggesting that the effects of censorship on incidental information access may be politically significant.
Gender-Specific Differences in Presentation and Management of Spinal Infection: A Single-Center Retrospective Study of 159 Cases
Authors: Lener Sara , Wipplinger Christoph , Hartmann Sebastian , Rietzler Andreas , Thomé Claudius , Tschugg Anja
Published: February 2020

Study Design:

A retrospective single-center analysis of 159 cases.

Objective:

To investigate differences between male and female patients, as spinal infection (SI) represents a life-threatening condition and numerous factors may facilitate the course and outcome of SI, including patients’ age and comorbidities, as well as gender. To date, no comparative data investigating sex differences in SI is available. Thus, the purpose of the present retrospective trial was to investigate differences between male and female patients.

Methods:

A total of 159 patients who were treated for a spinal infection between 2010 and 2016 at our department were included in the analysis. The patients were categorized into 2 groups based on gender. Evaluation included magnetic resonance imaging, laboratory values, clinical outcome, and conservative/operative management.

Results:

Male patients suffered from SI significantly more often than female patients (n = 101, 63.5% vs n = 58, 36.5%, P = .001). However, female patients were initially affected more severely, as infection parameters were significantly higher ( P = .032) and vertebral destruction was more serious ( P = .018). Furthermore, women suffered from intraoperative complications more often ( P = .024) and received erythrocyte concentrates more frequently ( P = .01). Nevertheless, mortality rates and outcome were comparable. Pain scales were significantly higher in female patients at 12-month follow-up ( P = .042).

Conclusion:

Although male patients show a higher incidence for SI, the course of disease and the management is more challenging in female patients. Nevertheless, outcome after 12 months is comparably good. Underlying mechanisms may include a better immune response and dissimilar effects of antibiotic treatment in women. Pain management in female patients is still unsatisfactory after 12 months.
Survival analysis of osteosarcoma patients: A 15-year experience
Authors: Yasin Nor Faissal , Abdul Rashid Muhammad Lutfi , Ajit Singh Vivek
Published: February 2020

Introduction:

Management of osteosarcoma has evolved considerably for the past two decades and there have been changes of practices especially pertaining to chemotherapy regime. This is a review of our cases in the past 15 years.

Method:

This is a retrospective survival analysis study of 128 patients treated at University Malaya Medical Centre (UMMC) from 1997 to 2011.

Results:

There were 80 (62.5%) male and 48 (37.5%) female patients with the median age being 15 (5–59). Majority had osteosarcoma of extremities (94.5%). More than 60% patients developed metastasis throughout the course of treatment with 39% presenting with lung metastasis. Osteoblastic osteosarcoma was the commonest subtype (65.6%). Of the 109 patients treated surgically, 84 patients (65.6%) underwent limb salvage surgery while the rest underwent amputation. Seventy-one per cent of patients completed treatment with local recurrence rate of 22.7%. The 5-year and 10-year survival rates were 56.31% (95% CI: 46.20, 65.24) and 22.33% (95% CI: 14.86, 30.76), respectively. The 5-year event-free survival was 52.94% (95% CI: 41.83, 62.87). In multivariate analysis, the independent prognostic factors were presence of metastasis and completion of treatment for both 5-year and 10-year overall survival. Good histological response was only significant for multivariate analysis at 5 years. Patients with metastasis had a hazard ratio of 20.4 at 5 years and 3.26 at 10 years.

Conclusion:

Overall survival rate for osteosarcoma patients at our centre was comparably higher than other centres in the region. Two independent risk factors for survival are metastatic status and completion of treatment. A standardized chemotherapy regime is essential for long-term survival.
Second Anterior Cruciate Ligament Injuries After Anterior Cruciate Ligament Reconstruction in Professional Sumo Wrestlers: A Case Series
Authors: Shimizu Sadanori , Nagase Tsuyoshi , Tateishi Tomohiko , Nakagawa Teruhiko , Tsuchiya Masamitsu
Published: February 2020

Background:

Anterior cruciate ligament (ACL) injury is one of the most common traumatic injuries in professional sumo wrestlers. Further, ipsilateral reinjuries or contralateral ACL injuries after ACL reconstruction can occur in sumo wrestlers. The incidence of ipsilateral reinjury and contralateral ACL injury after ACL reconstruction ranges from 3% to 13% in a healthy athletic population.

Purpose:

To investigate the current status of second ACL injuries after ACL reconstruction in sumo wrestlers.

Study Design:

Case series; Level of evidence, 4.

Methods:

Between 1988 and 2015, a total of 139 primary ACL reconstructions were performed in professional sumo wrestlers at our hospital. After exclusion of cases of multiple ligament knee reconstruction and patients in whom the contralateral ACL had been injured previously, 110 cases were included in this study. We investigated the number of second injuries, time from primary reconstruction to second injury, treatment method, and change in official sumo ranking after second injuries. The chi-square test, Student t test, and Fisher exact text were used for statistical analysis.

Results:

Among 110 wrestlers who underwent ACL reconstruction, second injuries after primary ACL reconstruction occurred in 22 cases (20.0%). Among them, 14 cases (12.7%) entailed ipsilateral reinjury, 11 (10.0%) entailed contralateral injury, and 3 involved combined rerupture and contralateral injury. As for surgical treatment, 5 revision ACL reconstructions were performed for ipsilateral reinjury (35.7%), and 7 ACL reconstructions were performed for contralateral injury (63.6%). Surgical treatment was not performed for the remaining cases. Wrestlers who were treated by revision or contralateral ACL reconstruction after the second injury were demoted in rank for 3 to 4 tournaments but overtook the nonoperative treatment group in ranking by 2 years postoperatively; all athletes initially were demoted in rank after the second injury.

Conclusion:

This study is the first to investigate instances of ipsilateral reinjuries and contralateral ACL injuries after ACL reconstruction in professional athletes in heavyweight combat sports. The incidences of ipsilateral reinjury and contralateral ACL injury after ACL reconstruction in professional sumo wrestlers were relatively higher than those reported in previous studies.
Five-year Survival Rate of Bonded Dental Restorations in Frail Older Adults
Authors: Tong N. , Wyatt C.C.L.
Published: February 2020

Introduction:

Frail older adults residing in long-term care (LTC) facilities are among the most vulnerable to dental caries due to poor oral hygiene (OH), medication-related salivary hypofunction, carbohydrate-rich diets, and limited access to dental care. Providing dental restorations for LTC patients is challenging, and there are few studies investigating the longevity of restorations in this cohort. Multiple restorative materials have been used to restore tooth anatomy as well as address caries prevention using fluoride-based materials.

Objectives:

This study examined the longevity of bonded direct restorations placed in LTC patients. Specifically, we examined whether a difference in survival exists between resin composite (RC) and glass ionomer cement (GIC) direct restorations in frail older adults residing in LTC.

Methods:

Tooth-colored restorations placed in LTC patients between 2007 and 2012, within the University of British Columbia Geriatric Dentistry Program, were followed annually up to 5 y or until they incurred an event (i.e., re-restoration or tooth extraction) or the patient was lost to follow-up or deceased. Restoration status was documented within the Clinical Oral Disorder in Elders (CODE) Index annual oral health assessments. Mixed-effect logistic regression was calculated to determine hazard ratios, address within-patient correlation, and measure the effect size of multiple covariates.

Results:

A total of 3,201 dental restorations placed in 846 LTC patients were followed. This cohort of patients had a mean age of 86 y and high levels of oral and systemic disease. Over half were wheelchair bound and had compromised ability to perform OH. The overall 5-y survival rate was 60.3%, and there was no statistically significant difference in survival between RC and GIC.

Conclusion:

Tooth-colored restorations had reasonable longevity in LTC patients and had comparable survival to restorations placed in functionally independent, community-dwelling geriatric populations. No difference between RC and GIC was found with regards to restoration longevity in this population.

Knowledge Transfer Statement:

Direct restorations provided to frail older adults residing in LTC have reasonable longevity and should be expected to survive for the remainder of the patient’s life. As no detectable difference exists in survival rates between RC and GIC, operators should select appropriate restorative materials based on clinical conditions, patient factors, physical properties, and personal preference.
A new ranking of IHRM journals: What type of quantitative research do they publish?
Authors: Redondo Raquel , Fabra Maria Eugenia , Martín Gloria
Published: February 2020

By analyzing content, this paper aims to map empirical quantitative research on International Human Resource Management. Our filters will be “when, where, what, and how.” “When” indicates the time span we use to analyze the evolution of International Human Resource Management, “where” refers to the influential journals chosen for publication; “what” covers the different topics dealt with in IHRM, and “how” is linked to the various methodologies and statistical techniques applied. Using the “when, where, what, and how” of empirical quantitative, International Human Resource Management studies allows us to identify how different topics have been investigated and so may lead us to suggest methodological refinements to improve the analysis and knowledge of topics in International Human Resource Management. It will allow us to detect trends and research gaps and point to the most prominent journals for publication and dissemination of results.
Permissible progress: Sexual(ities that) progress in and beyond English primary schools
Authors: Hall Joseph J
Published: February 2020

This paper examines what is permissible sexual progress in English primary schools by exploring the possibilities – but also the limitations – of the introduction of familial sexualities. In recent years, Stonewall (a prominent and politically mainstream Lesbian, Gay, Bisexual, and Trans charity) have increasingly utilised ‘the family’ as a ‘child-friendly’ topic to encourage primary educators to broach same-sex relationships by incorporating their ‘inclusive’ range of Different Families resources into lessons. This strategic manoeuvre emerges in a socio-political and spatiotemporal context dominated by neoliberal sexual politics and follows ‘moral panics’ surrounding queer progressive politics inspired initiatives, most notably No Outsiders (2006–2009) which previously unsettled institutionalised discourses of ‘childhood (sexual) innocence’ in pursuing radical, but arguably necessary approaches for disrupting and undoing heteronormativity. In spite of this, Stonewall’s Different Families, Same Love initiative is now the dominant approach for introducing lesbian and gay sexualities in English primary schools; yet, little is known about how primary-aged children respond to this intervention. Focusing on a leading exponent of Stonewall’s initiative, I explore 4–9 year olds dis/engagements with gay and lesbian sexualities when introduced in a familial context. Reflecting on mixed ethnographic and focus group data, I question not only which gay and lesbian sexualities ‘progress’ in contemporary English primary schools, but also how well. To this end, recommendations are made for improving families’ curricula without losing sight of the limits of this approach.
Broiler Poultry Feed Cost Optimization Using Linear Programming Technique
Authors: Mallick Priyaranjan , Muduli Kamalakanta , Biswal Jitendra Narayan , Pumwa John
Published: February 2020

Demand for poultry meat and eggs is increasing at a faster pace due to its good quality, nutritive values, and reasonable price. With the growing demand for egg and poultry meat, the demand for poultry feed is also increasing. Most of the feed ingredients which are used in poultry feed are also used for human nutrition. So these major feed ingredients and cumulatively poultry feed are facing market competition with increased cost. This study proposed linear programming (LP) technique to minimize the feed cost for small scale poultry farms. It employs locally available feed ingredients to formulate the broiler starter and finisher feed mix. The dietary nutrient requirement for broiler starter and finisher stage were determined from the prescribed standard specifications by Indian standard institutes and National Research Centers, Indian Council of Agricultural Research (ICAR). Sixteen feed ingredients were selected to formulate the optimal feed mix to minimize the total cost of feed mix subject to the essential nutrient constraints. Microsoft excel solver was used for the formulation of liner programming model and optimal feed mix for broiler starter and finisher were obtained.
Simulating the shake table response of unreinforced masonry cavity wall structures tested to collapse or near-collapse conditions
Authors: Malomo Daniele , Pinho Rui , Penna Andrea
Published: February 2020

The seismic performance of existing unreinforced masonry (URM) buildings is considerably affected by typology and level of effectiveness of both construction details and structural components, especially if not originally designed for resisting earthquakes. Within this framework, the use of advanced numerical approaches that are capable of duly accounting for such aspects might improve significantly the assessment of the global response of URM structures. In this article, the applied element method is thus employed for simulating the shake table response of a number of full-scale building specimens representative of cavity wall terraced house construction, used in a number of countries exposed to tectonic or induced seismicity, accounting explicitly for the influence of the presence of both rigid and flexible diaphragms, degree of connections among structural members, and interaction between in- and out-of-plane mechanisms. Although the models slightly underestimated the energy dissipation in some specific cycles prior to collapse, the predicted crack patterns, failure modes, and hysteretic behaviors have shown a good agreement with their experimental counterparts.
Numerical implementation of variable friction sliding base isolators and preliminary experimental results
Authors: Yang Tianye , Calvi Paolo M , Wiebe Richard
Published: February 2020

The development of variable friction base isolation systems (VFSs) is the object of an ongoing international research project that involves extensive numerical and experimental activities. This article presents some of the recent numerical developments carried out as part of this project. More specifically, a three-dimensional (3D) variable friction (VF) element is formulated and implemented into OpenSees, providing the foundation for studying structural response in the context of nonlinear time history (NLTH) analysis. The element implementation captures the bearing bidirectional horizontal response along with horizontal–vertical coupling effects. Response predictions obtained using this newly implemented element are compared with the experimental results obtained from testing a full-scale VFS prototype, showing promising results. Finally, a demonstrative numerical study is carried out in which a steel moment resisting frame (MRF) structure, isolated using VFSs, is analyzed via NLTH analyses.
Recognition of PF4-VWF complexes by heparin-induced thrombocytopenia antibodies contributes to thrombus propagation
Authors: Johnston Ian , Sarkar Amrita , Hayes Vincent , Koma Gavin T. , Arepally Gowthami M. , Chen Junmei , Chung Dominic W. , López José A. , Cines Douglas B. , Rauova Lubica , Poncz Mortimer
Published: February 2020

Heparin-induced thrombocytopenia (HIT) is a prothrombotic disorder mediated by complexes between platelet factor 4 (PF4) and heparin or other polyanions, but the risk of thrombosis extends beyond exposure to heparin implicating other PF4 partners. We recently reported that peri-thrombus endothelium is targeted by HIT antibodies, but the binding site(s) has not been identified. We now show that PF4 binds at multiple discrete sites along the surface of extended strings of von Willebrand factor (VWF) released from the endothelium following photochemical injury in an endothelialized microfluidic system under flow. The HIT-like monoclonal antibody KKO and HIT patient antibodies recognize PF4-VWF complexes, promoting platelet adhesion and enlargement of thrombi within the microfluidic channels. Platelet adhesion to the PF4-VWF-HIT antibody complexes is inhibited by antibodies that block FcγRIIA or the glycoprotein Ib-IX complex on platelets. Disruption of PF4-VWF-HIT antibody complexes by drugs that prevent or block VWF oligomerization attenuate thrombus formation in a murine model of HIT. Together, these studies demonstrate assembly of HIT immune complexes along VWF strings released by injured endothelium that might propagate the risk of thrombosis in HIT. Disruption of PF4-VWF complex formation may provide a new therapeutic approach to HIT.
The efficacy and safety of direct oral anticoagulants in noncirrhotic portal vein thrombosis
Authors: Naymagon Leonard , Tremblay Douglas , Zubizarreta Nicole , Moshier Erin , Troy Kevin , Schiano Thomas , Mascarenhas John
Published: February 2020

Guidelines currently favor vitamin K antagonists or low-molecular-weight heparins for treatment of noncirrhotic portal vein thrombosis (ncPVT). Use of direct oral anticoagulants (DOACs) in PVT has been met with concern because of the lack of data. We conducted a retrospective study to investigate the efficacy and safety of DOACs for the treatment of ncPVT, and to compare them with standard therapies: 330 patients with ncPVT, followed-up for a mean 41.6 months, received warfarin (n = 108), enoxaparin (n = 70), rivaroxaban (n = 65), apixaban (n = 20), dabigatran (n = 8), fondaparinux (n = 2), or no anticoagulation (n = 57). The primary outcome was complete radiographic resolution (CRR) of PVT. Secondary outcomes included recanalization of occlusive PVT, cavernous transformation of the PV, development of chronic portal hypertensive symptoms (cPHS), and major bleeding. DOACs were associated with the highest CRR rates (dabigatran, 6/8 [75%]; apixaban, 13/20 [65%]; rivaroxaban, 42/65 [65%]). Enoxaparin was associated with a CRR rate similar to that of the DOACs (40/70 = 57%). Warfarin was associated with worse outcomes in this regard (CRR rate, 31% [33/108]; hazard ratio [HR] DOACs:warfarin, 2.91; 95% confidence interval [CI], 1.87-4.52; P < .0001). DOACs were associated with recanalization rates similar to enoxaparin and greater than warfarin (HR DOACs:warfarin, 3.45; 95% CI, 1.93-6.18; P < .0001). DOACs were associated with lower rates of cPHS, although this did not attain significance (DOACs, 8/93 [9%]; enoxaparin, 13/70 [19%]; warfarin, 31/108 [29%]). DOACs were associated with less major bleeding relative to warfarin (HR DOACs:warfarin, 0.20; 95% CI, 0.05-0.86; P = .0307). Patients harboring JAK2V617F, those with no evident predisposing factor for PVT, and those with occlusive thrombus demonstrated worse outcomes. DOACs appear effective and safe for the treatment of ncPVT.
Obstructive sleep apnoea treatment and blood pressure: which phenotypes predict a response? A systematic review and meta-analysis
Authors: Pengo Martino F. , Soranna Davide , Giontella Alice , Perger Elisa , Mattaliano Paola , Schwarz Esther Irene , Lombardi Carolina , Bilo Grzegorz , Zambon Antonella , Steier Joerg , Parati Gianfranco , Minuz Pietro , Fava Cristiano
Published: February 2020

The treatment for obstructive sleep apnoea (OSA) with continuous positive airway pressure (CPAP) or mandibular advancement devices (MADs) is associated with blood pressure (BP) reduction; however, the overall effect is modest. The aim of this systematic review and meta-analysis of randomised controlled trials (RCTs) comparing the effect of such treatments on BP was to identify subgroups of patients who respond best to treatment.

The article search was performed in three different databases with specific search terms and selection criteria. From 2289 articles, we included 68 RCTs that compared CPAP or MADs with either passive or active treatment. When all the studies were pooled together, CPAP and MADs were associated with a mean BP reduction of −2.09 (95% CI −2.78– −1.40) mmHg for systolic BP and −1.92 (95% CI −2.40– −1.43) mmHg for diastolic BP and −1.27 (95% CI −2.34– −0.20) mmHg for systolic BP and −1.11 (95% CI −1.82– −0.41) mmHg for diastolic BP, respectively. The subgroups of patients who showed a greater response were those aged <60 years (systolic BP −2.93 mmHg), with uncontrolled BP at baseline (systolic BP −4.14 mmHg) and with severe oxygen desaturations (minimum arterial oxygen saturation measured by pulse oximetry <77%) at baseline (24-h systolic BP −7.57 mmHg).

Although this meta-analysis shows that the expected reduction of BP by CPAP/MADs is modest, it identifies specific characteristics that may predict a pronounced benefit from CPAP in terms of BP control. These findings should be interpreted with caution; however, they are particularly important in identifying potential phenotypes associated with BP reduction in patients treated for OSA.
Predictors of progression in systemic sclerosis patients with interstitial lung disease
Authors: Distler Oliver , Assassi Shervin , Cottin Vincent , Cutolo Maurizio , Danoff Sonye K. , Denton Christopher P. , Distler Jörg H.W. , Hoffmann-Vold Anna-Maria , Johnson Sindhu R. , Müller Ladner Ulf , Smith Vanessa , Volkmann Elizabeth R. , Maher Toby M.
Published: February 2020

Systemic sclerosis (SSc) is a systemic autoimmune disease affecting multiple organ systems, including the lungs. Interstitial lung disease (ILD) is the leading cause of death in SSc.

There are no valid biomarkers to predict the occurrence of SSc-ILD, although auto-antibodies against anti-topoisomerase I and several inflammatory markers are candidate biomarkers that need further evaluation. Chest auscultation, presence of shortness of breath and pulmonary function testing are important diagnostic tools, but lack sensitivity to detect early ILD. Baseline screening with high-resolution computed tomography (HRCT) is therefore necessary to confirm an SSc-ILD diagnosis. Once diagnosed with SSc-ILD, patients' clinical courses are variable and difficult to predict, although certain patient characteristics and biomarkers are associated with disease progression. It is important to monitor patients with SSc-ILD for signs of disease progression, although there is no consensus about which diagnostic tools to use or how often monitoring should occur. In this article, we review methods used to define and predict disease progression in SSc-ILD.

There is no valid definition of SSc-ILD disease progression, but we suggest that either a decline in forced vital capacity (FVC) from baseline of ≥10%, or a decline in FVC of 5–9% in association with a decline in diffusing capacity of the lung for carbon monoxide of ≥15% represents progression. An increase in the radiographic extent of ILD on HRCT imaging would also signify progression. A time period of 1–2 years is generally used for this definition, but a decline over a longer time period may also reflect clinically relevant disease progression.
Acceptability of screening for pregnancy intention in general practice: a population survey of people of reproductive age
Authors: Hammarberg Karin , Hassard Julie , de Silva Renee , Johnson Louise
Published: February 2020

Background

Optimal parental preconception health benefits reproductive outcomes. However, preconception health promotion is not routinely offered in primary health care settings to people of reproductive age. The aim was to gauge the planned preconception health behaviours and attitudes towards being asked about pregnancy intention by a general practitioner (GP) among people of reproductive age in Australia.

Method

The research was conducted on a single wave of Australia’s first and only probability-based online panel, Life in Australia™. Members of the Life in Australia™ panel are Australian residents aged 18 years or over. All active members between the ages of 18 and 45 years were eligible to participate. Eligible panel members were invited to complete a survey about fertility and childbearing. Data were collected from 18 February to 4 March 2019.

Results

In all 965 female and male members of Life in Australia™ aged between 18 and 45 years were invited to complete the survey. Of these, 716 (74.2%) agreed. Most respondents indicated that if they were planning to have a child they would try to optimise their preconception health by adopting a healthier diet (80%), seeing a GP for a health check-up (78%), reducing alcohol consumption (78% of those consuming alcohol), getting fitter (73%), and stopping smoking (70% of smokers). Three in four (74%) stated that they would not mind if their GP asked them about their pregnancy intentions.

Conclusion

Findings suggests that routinely asking people of reproductive age about their pregnancy intentions and advising those who are planning pregnancy about what they can do to ensure optimal preconception health would be acceptable to most people and may improve reproductive outcomes.
A case of multiple Vertebrobasilar artery fenestration misdiagnosed as vertebral artery dissection
Authors: Wang Feng , Wang Xiaokai , Li Xiaohua , Zheng Huifeng , Zhang Zhiyong
Published: February 2020

Background

Fenestration of vertebra-basilar artery is an uncommon congenital vascular anomaly, which is identified by incidental findings on imaging in patients presented without related symptoms or in patients with intracerebral hemorrhage secondary to concomitant artery aneurysm or arteriovenous malformations. Yet, cases of fenestration being misdiagnosed as cerebral artery dissection have never been reported.

Case presentation

We present a patient of 66-year-old female with acute onset of dizziness after chiropractic manipulation of the neck. Neck computed tomography angiography (CTA) showed ‘double lumen’ sign and ‘intimal flap’ of the V1 segment of the vertebral artery, which led to the initial diagnosis of vertebral artery dissection (VAD). However, vertebral artery fenestration at V1 segment was eventually identified by multi-directional digital subtraction angiography (DSA). Interestingly, concomitant vertebral fenestration at V3 segment, basilar fenestration and basilar artery tip aneurysm was also revealed by DSA.

Conclusion

The triple fenestration at vertebrobasilar artery with basilar tip artery aneurysm is extremely rare, and the fenestration at the V1 segment of vertebral artery was easily misdiagnosed as VAD due to the similar imaging morphology.
Weight before and after a diagnosis of breast cancer or ductal carcinoma in situ: a national Australian survey
Authors: Ee Carolyn , Cave Adele Elizabeth , Naidoo Dhevaksha , Bilinski Kellie , Boyages John
Published: February 2020

Background

Overweight/obesity are strongly implicated in breast cancer development, and weight gain post-diagnosis is associated with greater morbidity and all-cause mortality. The aim of this study was to describe the prevalence of overweight/obesity and the pattern of weight gain after diagnosis of breast cancer amongst Australian women.

Methods

We collected sociodemographic, medical, weight and lifestyle data using an anonymous, self-administered online cross-sectional survey between November 2017 and January 2018 from women with breast cancer living in Australia. The sample consisted mainly of members of the Breast Cancer Network Australia Review and Survey Group.

Results

From 309 responses we obtained complete pre/post diagnosis weight data in 277 women, and calculated pre/post Body Mass Index (BMI) for 270 women. The proportion of women with overweight/obesity rose from 48.5% at diagnosis to 67.4% at time of survey. Most women were Caucasian with stage I-III breast cancer (n = 254) or ductal carcinoma in situ (DCIS) (n = 33) and mean age was 59.1 years. The majority of women (63.7%) reported they had gained weight after diagnosis with an average increase of 9.07 kg in this group. Of the women who provided complete weight data, half gained 5 kg or more, 17.0% gained > 20 kg, and 60.7% experienced an increase in BMI of >1 kg/m2. Over half of the women rated their concern about weight as high. Of those women who gained weight, more than half reported that this occurred during the first year after diagnosis. Two-thirds (69.1%) of women aged 35–74 years gained, on average, 0.48 kg more weight per year than age-matched controls.

Conclusions

Although the findings from this survey should be interpreted cautiously due to a limited response rate and self-report nature, they suggest that women in Australia gain a considerable amount of weight after a diagnosis of breast cancer/DCIS (in excess of age-matched data for weight gain) and report high levels of concern about their weight. Because weight gain after breast cancer may lead to poorer outcomes, efforts to prevent and manage weight gain must be prioritized and accelerated particularly in the first year after diagnosis.
The risk of morbidity and mortality following recurrent malaria in Papua, Indonesia: a retrospective cohort study
Authors: Dini Saber , Douglas Nicholas M. , Poespoprodjo Jeanne Rini , Kenangalem Enny , Sugiarto Paulus , Plumb Ian D. , Price Ric N. , Simpson Julie A.
Published: February 2020

Background

An acute episode of malaria can be followed by multiple recurrent episodes either due to re-infection, recrudescence of a partially treated parasite or, in the case of Plasmodium vivax or P. ovale, relapse from the dormant liver stage of the parasite. The aim of this study was to quantify the impact of recurrent malaria episodes on morbidity and mortality in Papua, Indonesia.

Methods

We undertook a retrospective analysis of routinely collected data from malaria patients attending the primary referral hospital in Papua, Indonesia, between April 2004 and December 2013. Multi-state modelling was used to estimate the effect of recurring malaria episodes on re-presentation and admission to hospital and death. The risks of early (≤ 14 days) and late (15 to 365 days) hospital admission and death were estimated separately in our study to distinguish between the direct and indirect effects of malaria recurrence on adverse outcomes.

Results

A total of 68,361 patients were included in the analysis, of whom 37,168 (54.4%) presented initially with P. falciparum, 22,209 (32.5%) with P. vivax, and 8984 (13.1%) with other species. During 12 months of follow-up after each of the first four malaria episodes, 10,868 (15.9%) patients were admitted to hospital and 897 (1.3%) died. The risk of re-presenting to the hospital with malaria increased from 34.7% (95% CI 34.4%, 35.1%) at first episode to 58.6% (57.5%, 59.6%) following the third episode of malaria. After adjusting for co-factors, infection with P. vivax was a significant risk factor for re-presentation (hazard ratio (HR) = 1.48 (95% CI 1.44, 1.51)) and late admission to hospital (HR = 1.17 (1.11, 1.22)). Patients infected with P. falciparum had a greater overall rate of mortality within 14 days (HR = 1.54 (1.25, 1.92)), but after multiple episodes of malaria, there was a trend towards a higher rate of early death in patients infected with P. vivax compared to P. falciparum (HR = 1.91 (0.73, 4.97)).

Conclusions

Compared to patients initially infected with P. falciparum, those infected with P. vivax had significantly more re-presentations to hospital with malaria, and this contributed to a high risk of inpatient admission and death. These findings highlight the importance of radical cure of P. vivax to eliminate the dormant liver stages that trigger relapses.
Health intersectoralism in the Sustainable Development Goal era: from theory to practice
Authors: Hussain Sameera , Javadi Dena , Andrey Jean , Ghaffar Abdul , Labonté Ronald
Published: February 2020

In 2015, the United Nations’ (UN) Member States adopted a bold and holistic agenda of the Sustainable Development Goals (SDGs), integrating a vision of peace and prosperity for people and planet. Extensive work within, between, across sectors is required for this bold and holistic agenda to be implemented. It is in this context that this special article collection showcases multisectoral approaches to achieving SDG 3—Good Health and Well-Being—which, though focused explicitly on health, is connected to almost all other goals. A confluence of social and health inequities, within a context of widespread environmental degradation demands systems thinking and intersectoral action. Articles in this issue focus on the SDGs as a stimulus for renewed multisectoral action: processes, policies, and programs primarily outside the health sector, that have health implications through social, commercial, economic, environmental, and political determinants of health. Case studies offer critical lessons on effectively engaging other sectors to enhance their health outputs, identifying co-benefits and ‘win-wins’ that enhance human health.
Hospital volume-outcome relationship in total knee arthroplasty: protocol for a systematic review and non-linear dose-response meta-analysis
Authors: Rombey Tanja , Goossen Käthe , Breuing Jessica , Mathes Tim , Hess Simone , Burchard Rene , Pieper Dawid
Published: February 2020

Background

Knee osteoarthritis is a common, chronic condition and main contributor to global disability. Total knee arthroplasty (TKA) is the most successful treatment for end-stage knee osteoarthritis. It is assumed that in the field of surgery, there is a relationship between hospital volume and health outcomes and that higher hospital volume results in better health outcomes. As a consequence, minimum volume thresholds have been implemented in Germany for various procedures, including TKA (50 procedures per year). To date, it is unclear whether minimum volume thresholds truly result in better outcomes.

The objective of this study will be to quantify the relationship between hospital volume and patient-relevant outcomes in patients undergoing TKA.

Methods

We will include published or unpublished (cluster-) randomized controlled trials and prospective or retrospective cohort studies that involve patients with primary and/or revision TKA, report at least two different hospital volumes and report at least one patient-relevant outcome. To identify studies, we will systematically search (from inception onwards) PubMed/MEDLINE, Embase, CENTRAL, and CINAHL, as well as trial registers, conference proceedings, and reference lists. We will also contact experts in the field. Study selection and data extraction will be performed by two reviewers independently. The primary outcome will be rate of early revision. Secondary outcomes will include rate of revision > 1 year, mortality, length of stay, readmission rate, surgical complications, adverse events and health-related quality of life. We will assess the risk of bias of the included studies using ROBINS-I or the Cochrane risk of bias tool. Both a linear and a non-linear dose-response meta-analyses will be performed. We will use the GRADE approach to evaluate our confidence in the cumulative evidence. We will incorporate patients’ needs, goals and preferences into our recommendations by consulting three focus groups, each consisting of eight participants.

Discussion

The findings of our systematic review will probably be limited by the design of the included studies. We do not expect to identify any (cluster-) randomized controlled trials that meet our inclusion criteria. Therefore, the best available evidence included in our systematic review will most likely consist of cohort studies only. We anticipate that the results of this study will inform future health policy decisions in Germany regarding the minimum volume threshold for TKA.

Systematic review registration: PROSPERO CRD42019131209
Mental wellbeing among Hispanic female domestic cleaners
Authors: Ish Jennifer , Gimeno Ruiz de Porras David , Whitworth Kristina W.
Published: February 2020

Background

The purpose of this study was to examine the mental wellbeing of self-employed, Hispanic female domestic cleaners in San Antonio, Texas.

Methods

We conducted a cross-sectional pilot study and administered a short questionnaire to 56 participants. Mental wellbeing was assessed using The World Health Organization Well-Being Index (WHO-5). We calculated the age-adjusted prevalence of poor mental wellbeing, both overall and stratified by socioeconomic, neighborhood, and health characteristics.

Results

Almost half of the participants screened positive for poor mental wellbeing (47.3%) with a mean WHO-5 score of 68.9 [standard error (SE) = 3.1]. We observed a high prevalence of poor mental wellbeing among participants with less than a high school education (56.0%), who worked less than 30 h per week (57.0%) and who sometimes or always felt unsafe at her cleaning job (69.1%).

Conclusions

Female domestic cleaners, particularly those who work in the informal sector, are an overburdened and understudied population. This is particularly true regarding their mental wellbeing, which has largely been considered as an afterthought in epidemiologic studies of cleaning workers in general. Our results suggest that this group of domestic cleaners faces several psychosocial stressors, both in and outside of the workplace, and may have a high risk of poor mental health outcomes.
Clostridium species as probiotics: potentials and challenges
Authors: Guo Pingting , Zhang Ke , Ma Xi , He Pingli
Published: February 2020

Clostridium species, as a predominant cluster of commensal bacteria in our gut, exert lots of salutary effects on our intestinal homeostasis. Up to now, Clostridium species have been reported to attenuate inflammation and allergic diseases effectively owing to their distinctive biological activities. Their cellular components and metabolites, like butyrate, secondary bile acids and indolepropionic acid, play a probiotic role primarily through energizing intestinal epithelial cells, strengthening intestinal barrier and interacting with immune system. In turn, our diets and physical state of body can shape unique pattern of Clostridium species in gut. In view of their salutary performances, Clostridium species have a huge potential as probiotics. However, there are still some nonnegligible risks and challenges in approaching application of them. Given this, this review summarized the researches involved in benefits and potential risks of Clostridium species to our health, in order to develop Clostridium species as novel probiotics for human health and animal production.