bluuebunny/crossref_metadata_2025 huggingface dataset:
Postoperative Disposal of Unused Opioids: A Systematic Review
Authors: Lamplot Joseph D. , Premkumar Ajay , James Evan W. , Lawton Cort D. , Pearle Andrew D.
Published: April 2021

Introduction: Opioid misuse and overprescription have contributed to a national public health crisis in the United States. Postoperatively, patients are often left with unused opioids, which pose a risk for diversion if not appropriately disposed of. Patients are infrequently provided instructions on safe disposal methods of surplus opioids. Purpose: We sought to determine the current rates of disposal of unused opioids and the reported disposal mechanisms for unused opioids that were prescribed for acute postoperative pain control. Methods: A systematic review was performed of the PubMed, Cochrane, and Embase databases for relevant articles from their earliest entries through October 2, 2019. We used the search terms “opioid” or “narcotic” and “disposal” and “surgery.” Studies were considered for inclusion if they reported the rate of disposal of unused opioids following surgery. A screening strategy was used to identify relevant articles using Covidence. For studies meeting inclusion criteria, relevant information was extracted. Results: Sixteen studies met inclusion criteria. We found that surplus opioid disposal rates varied widely, from 4.9% to 87.0%. Among studies with no intervention (opioid disposal education or drug disposal kit/bag), rates of opioid disposal ranged from 4.9% to 46.5%. While 7 studies used opioid disposal education as an intervention, only 3 showed a significant increase in surplus opioid disposal compared with standard care. All 3 studies that used an opioid disposal kit or bag as an intervention demonstrated significant increases in opioid disposal. Conclusions: Baseline rates of surplus opioid disposal are relatively low in the postoperative setting. Our findings suggest that opioid disposal kits significantly increase rates of surplus opioid disposal postoperatively. Further research, including a large-scale cost-benefit analysis, will be necessary prior to recommending widespread implementation of drug disposal kits or bags.
Barriers and Facilitators of Outcome Collection During Hand Surgery Outreach: A Quality Improvement Study
Authors: Shapiro Lauren M. , Đình Mừng Phan , Fox Paige M. , Richard Marc J. , Eppler Sara L. , Kamal Robin N.
Published: April 2021

Background

Surgical outreach trips to low- and middle-income countries have been increasing. Outcome collection on these trips, however, has been inconsistent and often incomplete. We conducted a qualitative study of surgeons, administrators, and patients to identify the barriers and facilitators to outcome collection on hand surgery outreach trips to Hospital 175 in Ho Chi Minh City, Vietnam.

Methods

A purposive sample of surgeons, administrators, and patients from Hospital 175 were interviewed about their beliefs regarding outcome collection. We used a semi-structured interview guide based on the Theoretical Domains Framework to systematically explore barriers and facilitators. Interviews were recorded, transcribed, and analyzed using content analysis. Beliefs underlying similar responses were identified and aggregated to describe barriers and facilitators of outcome measurement.

Results

Twelve surgeons and administrative staff (3 visiting and 9 local) and 5 patients were interviewed before saturation was achieved. All stakeholders believed outcome collection on hand surgery outreach trips is important. Barriers identified were primarily related to environmental context and resources (eg, cost of returning) and memory, attention, and decision process (eg, difficulty in remembering patient follow-up intervals). The most commonly identified barriers address the distance patients live from the hospital/clinic, the resources required for them to return, and the lack of an organized system to assist in follow-up.

Conclusions

Multiple barriers to outcome collection exist at Hospital 175 in Vietnam. Understanding these barriers informs context-specific implementation approaches to collect outcomes on hand surgery outreach trips, which may improve the safety and quality of care provided.
Distal Radius Fracture Treatment Outcomes in Patients With Ipsilateral Hemiplegia or Hemiparesis
Authors: Munaretto Nicholas , Tagliero Adam , Patel Raahil , Rhee Peter C.
Published: April 2021

Background

Little information exists to guide decision-making with regard to distal radius fractures in the setting of ipsilateral hemiparesis or hemiplegia.

Methods

Patients who sustained a distal radius fracture in the setting of ipsilateral hemiparesis or hemiplegia secondary to brain injury were evaluated. Investigated variables included perioperative pain, preinjury House functional classification score, length of immobilization, radiographic outcome measurements, and time to union.

Results

There were 15 patients with distal radius fractures with a mean age of 65.9 years. The mean clinical and radiographic follow-up was 2.8 and 2.9 years, respectively. Wrists were placed into the nonoperative group (NOG, n = 10) and operative group (OG, n = 5). Pain significantly decreased at final follow-up for both groups. Baseline House functional classification scores averaged 1.3 and 1.6 for the NOG and OG, respectively, and were maintained at final follow-up. Length of immobilization for the NOG was 46 days and OG was 37 days, P = .15. Radiographic outcomes at final follow-up in the NOG and OG, respectively, were a mean radial height of 9.3 versus. 11.6 mm, radial inclination of 18.3° versus 22.3°, 4.2° dorsal tilt versus 5.3° volar tilt, and tear drop angle of 45.6° versus 44.5°. There were no significant differences in these measurements. Time to radiographic union averaged 58 days for the NOG and 67 days for the OG, P = .42. There were no revision surgeries.

Conclusions

Based on this small case series, patients with distal radius fracture and ipsilateral hemiparesis or hemiplegia may have similar clinical, functional, and radiographic outcomes, regardless of nonoperative or operative treatment.
A quality analysis method for three-dimensional model in aircraft structural parts design
Authors: Wang Kai , Zhao Ning , He Qiang , Xu Jianxin
Published: April 2021

To analyze the quality of three-dimensional (3D) model for aircraft structural parts designed by model-based definition (MBD) technology, an approach combining analytic hierarchy process (AHP), hesitant fuzzy linguistic term set (HFLTS), and fuzzy synthetic evaluation is proposed. According to all levels of quality standards and part specification-tree elements, a quality assessment index system is constructed from four sub-models of parts 3D model: design model, process model, tooling model, and test model. In addition, the weight of each index is calculated using the AHP. Then the assessment model is established by using a configurable index system model, HFLTS, fuzzy synthetic evaluation, and assigning uniformly and quantitatively the index system through quality grade division rules of indexes and triangular fuzzy numbers. Finally, a case application is used to illustrate the proposed method. The application of this method can make the quality analysis of parts 3D model more effective, accurate, and efficient. This paper can not only help enterprises identify higher-weight and error-prone design factors, but also guide designers in modeling.
A network meta-analysis of direct factor Xa inhibitors for the treatment of cancer-associated venous thromboembolism
Authors: Brandão Gustavo Muçouçah Sampaio , Malgor Rafael D , Vieceli Tarsila , Cândido Raissa Carolina Fonseca , Inácio José Francisco Secorun , Rodrigues Clarissa Garcia , Malgor Emily A , Sobreira Marcone Lima
Published: April 2021

Introduction

Treatment of cancer-associated venous thromboembolism (CAVTE) remains challenging. The aim of this study was to assess the outcomes of direct acting oral anticoagulants (DOAs) for the treatment of CAVTE.

Materials and methods

A network meta-analysis of randomized clinical trials comparing DOAs (Apixaban, Rivaroxaban, and Edoxaban) versus Dalteparin for the treatment of CAVTE was performed. Outcomes of interest included, VTE recurrence, all-cause mortality, event-free survival, major bleeding, and clinically relevant non-major bleeding (CRNMB). Analysis was based on a random effects model and Bayesian Markov-chain Monte Carlo method was used for indirect comparisons.

Results

Four RCTs involving 2894 patients were included. Overall certainty of evidence was moderate regarding all outcomes. DOAs exhibited lower risk of VTE (RR 0.62; 95% CI 0.44, 0.87; P = 0.007), similar risk of major bleeding (RR 1.33; 95% CI 0.84, 2.11; P = 0.23), and higher risk of CRNMB (RR 1.66, 95% CI 1.08, 2.56; P = 0.02), compared with Dalteparin. Risk of all-cause mortality and event-free survival were similar between groups with RR 0.99 (95% CI 0.84, 1.16) and RR 1.03 (95% CI 0.94, 1.13), respectively. Apixaban ranked first for recurrent VTE (42.4%) and major bleeding (62.3%) and Dalteparin ranked first for CRNMB (54.7%). Rivaroxaban ranked best considering all-cause mortality (58.7%); Apixaban ranked best for event-free survival (83.6%).

Conclusions

DOAs presented a reduced risk of recurrent VTE with similar risk of major bleeding compared to Dalteparin. However, a higher risk of CRNMB is expected when this cohort of patients are treated with DOAs instead of Dalteparin.
Identification of cluster of differentiation molecule-associated microRNAs as potential therapeutic targets for gastrointestinal cancer immunotherapy
Authors: Zhang Hanyu , Li Mingxing , Kaboli Parham Jabbarzadeh , Ji Huijiao , Du Fukuan , Wu Xu , Zhao Yueshui , Shen Jing , Wan Lin , Yi Tao , Wen Qinglian , Li Xiang , Cho Chi Hin , Li Jing , Xiao Zhangang
Published: April 2021

Background:

Cluster of differentiation molecules are markers of immune cells that have been identified as a potential immunotherapeutic target for cancer treatment. MicroRNAs are small non-coding RNAs that act as tumor suppressors or oncogenes whose importance in diagnosis, prognosis, and treatment of gastric and colorectal cancers has been widely reported. However, their association with cluster of differentiation molecules in gastrointestinal cancers has not been well studied. Therefore, our study aimed to analyze the relationship between microRNAs and cluster of differentiation molecules in gastrointestinal cancers, and to identify cluster of differentiation molecule-associated microRNAs as prognostic biomarkers for gastrointestinal cancer patients.

Methods:

Targetscan, Starbase, DIANA microT, and miRDB were used to investigate microRNA profiles that might be correlated with cluster of differentiation molecules in gastrointestinal cancers. Moreover, The Cancer Genome Atlas data analysis was used to investigate the association between cluster of differentiation molecules and microRNA expression in patients with gastric, colon, rectal, pancreatic, and esophageal cancers. The Kaplan–Meier plotter was used to identify the association between overall survival and cluster of differentiation molecule-associated microRNA expression in gastrointestinal cancer patients.

Results:

miR-200a, miR-559, and miR-1236 were negatively associated with CD86, CD81, and CD160, respectively, in almost all types of gastrointestinal cancers, which were further verified in the in vitro studies by transfecting microRNA mimics in gastric cancer, colon cancer, pancreatic, and esophageal cell lines.

Conclusion:

Our study showed that miR-200a, miR-1236, and miR-559 are identified as cluster of differentiation-associated microRNAs in gastrointestinal cancers, providing a novel perspective to identify new therapeutic targets for cancer immunotherapy in gastrointestinal cancer patients.
SUR1, newly expressed in astrocytes, mediates neuropathic pain in a mouse model of peripheral nerve injury
Authors: Tsymbalyuk Orest , Gerzanich Volodymyr , Mumtaz Aaida , Andhavarapu Sanketh , Ivanova Svetlana , Makar Tapas K , Sansur Charles A , Keller Asaf , Nakamura Yumiko , Bryan Joseph , Simard J Marc
Published: April 2021

Background

Neuropathic pain following peripheral nerve injury (PNI) is linked to neuroinflammation in the spinal cord marked by astrocyte activation and upregulation of interleukin 6 (IL -6 ), chemokine (C-C motif) ligand 2 (CCL2) and chemokine (C-X-C motif) ligand 1 (CXCL1), with inhibition of each individually being beneficial in pain models.

Methods

Wild type (WT) mice and mice with global or pGfap-cre- or pGFAP-cre/ERT2-driven Abcc8/SUR1 deletion or global Trpm4 deletion underwent unilateral sciatic nerve cuffing. WT mice received prophylactic (starting on post-operative day [pod]-0) or therapeutic (starting on pod-21) administration of the SUR1 antagonist, glibenclamide (10 µg IP) daily. We measured mechanical and thermal sensitivity using von Frey filaments and an automated Hargreaves method. Spinal cord tissues were evaluated for SUR1-TRPM4, IL-6, CCL2 and CXCL1.

Results

Sciatic nerve cuffing in WT mice resulted in pain behaviors (mechanical allodynia, thermal hyperalgesia) and newly upregulated SUR1-TRPM4 in dorsal horn astrocytes. Global and pGfap-cre-driven Abcc8 deletion and global Trpm4 deletion prevented development of pain behaviors. In mice with Abcc8 deletion regulated by pGFAP-cre/ERT2, after pain behaviors were established, delayed silencing of Abcc8 by tamoxifen resulted in gradual improvement over the next 14 days. After PNI, leakage of the blood-spinal barrier allowed entry of glibenclamide into the affected dorsal horn. Daily repeated administration of glibenclamide, both prophylactically and after allodynia was established, prevented or reduced allodynia. The salutary effects of glibenclamide on pain behaviors correlated with reduced expression of IL-6, CCL2 and CXCL1 by dorsal horn astrocytes.

Conclusion

SUR1-TRPM4 may represent a novel non-addicting target for neuropathic pain.
A fault diagnostic system based on Petri nets and gray relational analysis for train–ground wireless communication systems
Authors: Zeng Yining , Duan Rongxing , Feng Tao , Huang Shujuan , He Jiejun
Published: April 2021

The system structure of train–ground wireless communication systems (TWCSs) is extremely complicated due to the use of fault tolerant technology to improve their performance. This complex structure raises several challenges in fault diagnosis for TWCSs, such as epistemic uncertainty, dynamic fault behaviors, and common cause failure (CCF). A fault diagnostic system is proposed to deal with these challenges based on Petri nets and gray relational analysis in this paper. Specifically, the fuzzy analytic hierarchy process is used to evaluate the failure data of components to handle epistemic uncertainty. Furthermore, the dynamic fault tree of TWCSs is established and converted into a generalized stochastic Petri net to calculate several reliability parameters used for fault diagnosis. Besides, a β factor model is employed to resolve the problem of CCF in TWCSs. In addition, Birnbaum importance measure (BIM), risk achievement worth (RAW) and test cost are considered comprehensively to obtain the optimal diagnostic sequence using an improved gray relational analysis. Finally, a numerical example is presented to demonstrate the efficiency of the proposed fault diagnostic system.
Global assessment of pollicization outcomes: an analysis in 27 patients
Authors: Bachy Manon , Victoria Christian , Martinot-Lagarde Coline , Romana Claudia , Vialle Raphael , Fitoussi Franck
Published: April 2021

Outcomes measurements after pollicization remains difficult due to the lack of a standardized assessment protocol. This study reports our experience of a global assessment of pollicized thumbs that includes a specific questionnaire for subjective evaluation, a detailed clinical assessment focused on functional outcomes incorporating function and usage of the pollicized thumb. Twenty-seven patients completed the questionnaire, and nine hands were clinically evaluated by a multidisciplinary team composed of hand surgeons and occupational therapists. Subjective evaluations revealed that 24 patients would recommend pollicization. Clinical evaluations revealed that only four out of nine patients properly integrated their pollicized thumb during bimanual activities; however, occupational therapy input allowed the children to compensate for the lack of strength and other difficulties. We propose the use of this global assessment package to analyse function and usage at various capacities, which can be useful for the surgeon, child and parents.

Level of evidence: IV
Scaphoid fracture displacement is not correlated with the fracture angle
Authors: Aruse Ophir , Immerman Igor , Badir Omar , Haj Madi El , Volk Ido , Luria Shai
Published: April 2021

Classifications of scaphoid fractures associate the angle of the fracture with its stability. To examine this assumption, we measured acute scaphoid fracture angles and inclinations in relation to different scaphoid axes, using fracture displacement as an indicator of instability. We examined the effect of using different axes on the measurements of angles. CT scans of 133 scaphoid fractures were classified according to the location of the fractures. Using a three-dimensional computer model, we computed four scaphoid axes. For each fracture, we then measured the fracture angle and the direction of the fracture inclination in relation to each one of the axes. We found a correlation between displacement and the angles of proximal fractures using one of these axes (the surface principal component analysis axis). No such correlations were found for waist fractures, which were the majority of fractures. There were significant differences between the measurements made with different axes. The findings indicate that the angle of the fracture and the direction of the fracture inclination are minor factors in the displacement of most scaphoid fractures.

Level of evidence: III
The role of gastrointestinal pathogens in inflammatory bowel disease: a systematic review
Authors: Axelrad Jordan E. , Cadwell Ken H. , Colombel Jean-Frederic , Shah Shailja C.
Published: April 2021

The inflammatory bowel diseases (IBD), comprising Crohn’s disease (CD) and ulcerative colitis (UC), are chronic, progressive, inflammatory conditions of the gastrointestinal tract. Imbalance in the gut microbial community, or dysbiosis, and the subsequent immune response, represent the critical relationship between genetic susceptibility, microbes, and environment factors, that result in IBD. Gastrointestinal pathogens – a common cause of dysbiosis – have been implicated as an environmental trigger in new onset IBD, as well as flare of existing IBD. In this article, we systematically review clinical data regarding the association between specific gastrointestinal pathogens and IBD. Numerous bacteria, viruses, fungi, and parasites have been implicated in the pathogenesis of IBD, and exacerbations of existing disease. In this article, we will also specifically discuss the less recognized microbes that have an inverse association with IBD, including certain bacterial pathogens, such as Helicobacter pylori, and parasites, such as Trichuris species. Future prospective and experimental studies are required to establish causality and clarify potential mechanisms of enteric pathogens in modifying the risk and course of IBD.
Conceptualizing dimensions and a model for digital pedagogy
Authors: Väätäjä Janne Olavi , Ruokamo Heli
Published: April 2021

The global COVID-19 pandemic has caused a rising interest in the use of digital pedagogies and the need to teach remotely. This article aims to conceptualize the dimensions described below and offer a model for digital pedagogy to provide tools for using digital technologies in teaching. The model for digital pedagogy is discussed in terms of three dimensions: 1) pedagogical orientation; 2) pedagogical practices; and 3) the digital pedagogical competencies it provides for the teacher. This study examines how the dimensions of digital pedagogy are presented in the current research literature. The research is conducted through a systematic literature review surveying articles published in the years 2014 to 2019; a total of 12 articles are included in the review. The findings suggest that, first, in many cases, pedagogical orientation is labeled as socio-constructivist and student-centered. Second, pedagogical practices are the methods used to promote students’ learning; they involve, for example, collaboration and social knowledge construction. Finally, in addition to technological, pedagogical, and content knowledge, teachers’ success in blending digital technologies into their teaching is improved by high self-efficacy and strong peer-collaboration skills.
Safety and Feasibility Evaluation of Step Count Informed Meal Boluses in Type 1 Diabetes: A Pilot Study
Authors: Ozaslan Basak , Brown Sue A. , Pinnata Jennifer , Barnett Charlotte L. , Carr Kelly , Wakeman Christian A. , Clancy-Oliveri Mary , Breton Marc D.
Published: April 2021

Background:

Physical activity can cause glucose fluctuations both during and after it is performed, leading to hurdles in optimal insulin dosing in people with type 1 diabetes (T1D). We conducted a pilot clinical trial assessing the safety and feasibility of a physical activity-informed mealtime insulin bolus advisor that adjusts the meal bolus according to previous physical activity, based on step count data collected through an off-the-shelf physical activity tracker.

Methods:

Fifteen adults with T1D, each using a continuous glucose monitor (CGM) and an insulin pump with carbohydrate counting, completed two randomized crossover daily visits. Participants performed a 30 to 45-minute brisk walk before lunch and lunchtime insulin boluses were calculated based on either their standard therapy (ST) or the physical activity-informed bolus method. Post-lunch glycemic excursions were assessed using CGM readings.

Results:

There was no significant difference between visits in the time spent in hypoglycemia in the post-lunch period (median [IQR] standard: 0 [0]% vs physical activity-informed: 0 [0]%, P = NS). Standard therapy bolus yielded a higher time spent in 70 to 180 mg/dL target range (mean ± standard: 77% ± 27% vs physical activity-informed: 59% ± 31%, P = .03) yet, it was associated with a steeper negative slope in the early postprandial phase ( P = .032).

Conclusions:

Use of step count to adjust mealtime insulin following a walking bout has proved to be safe and feasible in a cohort of 15 T1D subjects. Physical activity-informed insulin dosing of meals eaten soon after a walking bout has a potential of mitigating physical activity related glucose reduction in the early postprandial phase.
Isokinetic Strength After ACL Reconstruction: Influence of Concomitant Anterolateral Ligament Reconstruction
Authors: Gillet Benoit , Blache Yoann , Rogowski Isabelle , Vigne Grégory , Capel Olivier , Sonnery-Cottet Bertrand , Fayard Jean-Marie , Thaunat Mathieu
Published: April 2021

Background:

To reduce the rate of anterior cruciate ligament (ACL) graft rupture, recent surgeries have involved anterolateral ligament reconstruction (ALLR). This reconstruction procedure harvests more knee flexor muscle tendons than isolated ACL reconstruction (ACLR), but its influence on knee muscle strength recovery remains unknown. This study aimed to assess the influence of ALLR with a gracilis graft on the strength of the knee extensor and flexor muscles at 6 months postoperatively.

Hypothesis:

The additional amount of knee flexor harvest for ALLR would result in impairment in knee flexor muscle strength at 6 months postoperatively.

Study Design:

Retrospective cohort study.

Level of Evidence:

Level 2.

Methods:

A total of 186 patients were assigned to 2 groups according to the type of surgery: ACL + ALLR (graft: semitendinosus + gracilis, n = 119) or isolated ACLR (graft: semitendinosus, n = 67). The strength of the knee extensor and flexor muscles was assessed using an isokinetic dynamometer at 90, 180, and 240 deg/s for concentric and 30 deg/s for eccentric contractions and compared between groups using analysis of variance statistical parametric mapping.

Results:

Regardless of the surgery and the muscle, the injured leg produced significantly less strength than the uninjured leg throughout knee flexion and extension from 30° to 90° for each angular velocity (30, 90, 180, and 240 deg/s). However, the knee muscle strength was similar between the ACL + ALLR and ACLR groups.

Conclusion:

The addition of ALLR using the gracilis tendon during ACLR does not alter the muscle recovery observed at 6 months postoperatively.

Clinical Relevance:

Although more knee flexor muscle tendons were harvested in ACL + ALLR, the postoperative strength recovery was similar to that of isolated ACLR.
Socio-ecological contradictions and the future of food
Authors: Mikati Mizhar
Published: April 2021

The COVID-19 pandemic has heightened the contradictions and crisis tendencies of capitalist development. The responses likewise are reflective of these contradictions and tendencies. This article will reflect on the social relations this form of development takes in light of ‘labour-saving’ technologies within the agrarian sector. Primarily as a socio-theoretical reflection, this article highlights the societal and environmental contradictions arising out of precision agriculture. This commentary assesses the contradictions associated with labour-saving technological development and whether approaches such as eco-modernism are suitable for critically analyzing the social and environmental conditions of food production. This commentary takes a critical stance from a historical materialist perspective.
Doppler waveform analysis during provocative manoeuvres in the assessment for arterial thoracic outlet syndrome results in high false-positive rates; a cross-sectional study
Authors: Bishop Lily , Bartlett Matthew
Published: April 2021

Objectives

There is a high rate of false-positive arterial Thoracic Outlet Syndrome (ATOS) diagnoses due to limited research into the optimal use of ultrasound. To improve future diagnostic efficiency, we aimed to characterise the haemodynamic effects of different provocative positions and estimate the prevalence of compression in the healthy population.

Design

In this cross-sectional, observational study, the effect of varying degrees of arm abduction on discomfort levels and/or changes in subclavian artery Doppler waveform was analysed in the healthy population; the peak systolic velocity (PSV), systolic rise time (SRT), phasicity and extent of turbulence were recorded.

Setting

Department of the Vascular Studies, Royal Free Hospital.

Participants

19 participants (11 females, 27.4 ± 5.2 years) were recruited for bilateral scans.

Main outcome measures

Seven positions were investigated; the primary outcome was an occlusion or monophasic waveform indicating significant compression and this was compared with the secondary outcome; any physiological discomfort.

Results

28.9% experienced significant arterial compression in at least one position; 120° abduction was the position with the greatest level of abduction that did not result in significant waveform changes or symptoms. The PSV and SRT were difficult to accurately measure and bore no correlation to the level of compression.

Conclusion

Ultrasound testing in isolation would result in a false indication of TOS in almost 30% of our normal population. With further research, the 120° abduction position may have a lower false-positive rate. The PSV and SRT must be interpreted with caution due to their variability even within the healthy population.
Urosepsis and hydronephrosis secondary to vaginal vault prolapse: A case report
Authors: John Athul , Ting Ying Yang , Shepherd Andrew , Lloyd Mark , Kuan Li Lian
Published: April 2021

Pelvic organ prolapse (POP) is a common condition affecting older women. POP can cause hydronephrosis in some patients. Although rare, especially in the subset of patients with vaginal vault prolapse, unrecognized obstructive hydronephrosis can result in renal impairment and urosepsis. We present a case of a 69-year-old female with obstructive urosepsis on a background of vaginal vault prolapse. The case highlights the importance of early recognition and intervention of obstructive urosepsis in patients with severe POP disease.

Level of evidence: Not applicable for this multicentre audit.
Prophylactic or Early Use of Eculizumab and Graft Survival in Kidney Transplant Recipients With Atypical Hemolytic Uremic Syndrome in the United States: Research Letter
Authors: Plasse Richard A. , Olson Stephen W. , Yuan Christina M. , Agodoa Lawrence Y. , Abbott Kevin C. , Nee Robert
Published: April 2021

Introduction:

Among kidney transplant recipients (KTRs) with end-stage kidney disease (ESKD) due to atypical hemolytic uremic syndrome (aHUS), recurrence is associated with poor allograft outcomes. We compared graft and patient survival of aHUS KTRs with and without prophylactic/early use of eculizumab, a monoclonal antibody that binds complement protein C5, at the time of transplantation.

Methods:

We conducted a retrospective cohort study using the United States Renal Data System. Out of 123 624 ESKD patients transplanted between January 1, 2008, and June 1, 2016, we identified 348 (0.28%) patients who had “hemolytic uremic syndrome” as the primary cause of ESKD. We then linked these patients to datasets containing the Healthcare Common Procedure Coding System (HCPCS) code for eculizumab infusion. Patients who received eculizumab prior to or within 30 days of transplant represented the exposure group. We calculated crude incidence rates and conducted exact logistic regression, adjusted for recipient age and sex, for the study outcomes of graft loss, death-censored graft loss, and mortality. We also estimated the average treatment effect (ATE) by propensity-score matching, to reduce the bias in the estimated treatment effect on graft loss.

Results:

Our final study cohort included 335 aHUS KTRs (23 received eculizumab, 312 did not), with a mean duration of follow-up of 5.8 ± 2.7 years. There were no significant differences in baseline demographic and clinical characteristics between the eculizumab versus non-eculizumab group. Patients who received prophylactic/early eculizumab were less likely to experience graft loss compared with those who did not receive eculizumab (0% vs 20%, P = .02), with an adjusted odds ratio of 0.13 ( P = .02). In the propensity-score-matched sample, the ATE (eculizumab vs non-eculizumab) was −0.20 (95% confidence interval [CI] = −0.25 to −0.15, P < .001); thus, treatment was associated with an average of 20% reduction in graft loss. There was no significant difference in the risk of death between the 2 groups.

Conclusions:

Although there was no significant difference in the risk of death, prophylactic/early use of eculizumab was significantly associated with improved graft survival among aHUS KTRs. Given the high cost of eculizumab, randomized controlled trials are much needed to guide prophylactic strategies to prevent graft loss.
Immuno-modulation by heat-killed Lacticaseibacillus paracasei MCC1849 and its application to food products
Authors: Maehata Hazuki , Arai Satoshi , Iwabuchi Noriyuki , Abe Fumiaki
Published: April 2021

Probiotics are microorganisms that confer health benefits to host. Well-known examples include Bifidobacterium and Lactobacillus species. In recent years, interest in promoting our health with probiotics has grown as life expectancy and health awareness has increased. However, some concerns for safety and stability exist for these live organisms. Thus, “postbiotics” and “paraprobiotics,” non-viable heat-killed microbial cells or cell fractions that retain health benefits, are increasingly favored. Unfortunately, little information on clinical efficacy and mechanisms of action is available compared with many available probiotics. Lacticaseibacillus (previous name Lactobacillus) paracasei MCC1849 is a commonly used lactic acid bacterial strain in Japan that displays immuno-modulatory effects in humans in non-viable heat-killed form. This review discusses health benefits of heat-killed L. paracasei MCC1849 immune modulation and offers a theoretical basis for its mechanisms of action. We also discuss the feasibility of using heat-killed probiotics for application in food products.
The efficacy and safety of bronchoscopy for treating transluminal broncholiths
Authors: Wang Hong , Zhang Li , Li Fangwei , Wan Yixin
Published: April 2021

We aim to reveal the clinical features of transluminal broncholiths and to evaluate the efficacy and safety of bronchoscopy for treating transluminal broncholiths. Patients with transluminal broncholiths were enrolled in this retrospective study in Lanzhou University Second Hospital between January 2010 and December 2018. Then age, gender, symptoms, and signs, imaging characteristics, treatment methods, outcomes as well as complications were retrospectively analyzed. Twenty-eight patients with 36 pieces of transluminal broncholiths were diagnosed using chest CT and bronchoscopy, of which two patients underwent broncholiths removal via an elective surgical procedure and six patients were treated with one-time removal of broncholiths by bronchoscopy. Among the six patients who received one-time removal of stones by bronchoscopy, two underwent massive hemorrhage and one suffered from bronchial wall laceration in the process of broncholiths removal, all of the three patients received surgical treatment eventually. No serious complications occurred in the other 20 patients who underwent broncholiths removal via repeated bronchoscopy. Removal of transluminal broncholiths by bronchoscopy are effective and safe with less complications. When it is difficult to remove the transluminal broncholith completely at one time, repeated bronchoscopy could be chosen: First, to remove the portion which causes airway obstruction; and then to remove the remaining part by repeated bronchoscopy during the follow-up period. In case that severe distal lung tissue injury, massive hemoptysis or bronchial wall laceration occurs or the diagnosis of broncholiths is unclear, surgical treatment is required.
Perioperative Hidden Blood Loss in Elderly Cervical Spondylosis Patients With Anterior Cervical Discectomy Fusion and Influencing Factors
Authors: Cai Tongchuan , Chen Dong , Wang Shuguang , Shi Pengzhi , Wang Junwu , Wang Pingchuan , Feng Xinmin , Zhang Wenjie , Zhang Liang
Published: April 2021

Introduction:

To analyze the perioperative hidden blood loss (HBL) and its influencing factors in elderly cervical spondylosis patients treated with anterior cervical discectomy fusion (ACDF).

Materials and Methods:

From January 2017 to December 2018, 128 elderly cervical spondylosis patients (age > 65 y) treated with ACDF were selected. The patients’ height, weight, duration of symptoms, previous medical history and other basic information were routinely recorded. The hemoglobin (Hb), hematocrit (Hct) and blood coagulation function preoperative and the next day postoperative were recorded. The operation time, surgical bleeding, ASA classification, fixation method, total drainage and the time for extraction of drainage tube were recorded. The total blood loss (TBL) was calculated according to the Gross’s formula, and HBL was calculated based on TBL, total drainage and surgical bleeding. The statistical analysis of HBL was performed, and then influential factors were further analyzed by multivariate linear regression analysis and t test.

Results:

The mean surgical bleeding was 102.70 ± 46.78 mL and HBL was 487.98 ± 255.96 mL. HBL accounted for 67.61 ± 5.20% of TBL. According to the multiple linear regression analysis, the gender (P = 0.047), operation time (P = 0.000), fixation method (P = 0.014) and international normalized ratio (INR) (P = 0.003) influenced the amount of HBL. Body mass index (BMI) (P = 0.624), hypertension (P = 0.977), diabetes (P = 0.528), blood type (P = 0.577), ASA classification (P = 0.711), duration of symptoms (P = 0.661), preoperative cobb angle (P = 0.152), number of surgical level (P = 0.709), intramedullary hyperintensity (P = 0.967), drainage time (P = 0.294), postoperative drainage volume (P = 0.599), prothrombin time (PT) (P = 0.674), activated partial thromboplastin time (APTT) (P = 0.544) and thrombin time (TT) (P = 0.680) had no correlation with the amount of HBL.

Conclusions:

There was obvious HBL during the perioperative period of ACDF in elderly cervical spondylosis patients. The male patients, longer operation time, fusion with titanium plate and cage and high INR were independent risk factors for HBL.
The Emotional and Cognitive Scale of the Human–Nature Relationship (ECS-HNR)
Authors: Mundaca Enrique A. , Lazzaro-Salazar Mariana , Pujol-Cols Lucas , Muñoz-Quezada María Teresa
Published: April 2021

A bidimensional (cognitive–emotional) novel survey, the Emotional and Cognitive Scale of the Human–Nature Relationship (ECS-HNR), was designed and validated to measure Ecological Awareness (EAW) and Ecological Affectiveness (EAF) as vital aspects of the human–nature relationship. Data were collected in Chile between July and October 2019 from 474 participants ranging between 6 and 85 years old, using the snowball sampling technique. To examine the properties of the ECS-HNR we analyzed the results in terms of its content validity, reliability, factor structure, convergent validity, and discriminant validity. The ECS-HNR comprises 24 items divided into two subscales with three subscales each (EAF: Empathy, Enjoyment, and Connectedness; EAW: Understanding, Appreciation, and Perception). The results demonstrated that the ECS-HNR is a reliable instrument, as items (the two scales and their subscales) exhibited an acceptable internal consistency. Our findings demonstrate that the ECS-HNR allows the integration of both dimensions of the human–nature relationship and is appropriate to evaluate attitudes and feelings toward nature.
Depression and the Adoption of Faux Depression Symptoms: Novel Evidence for a Self-Verification Perspective
Authors: Hart William , Breeden Christopher J. , Richardson Kyle , Kinrade Charlotte
Published: April 2021

Research suggests that individuals who are more depressed are prone to behaviors that reinforce their depressive symptoms. We performed a novel test of the self-verification perspective of this phenomenon. In two experiments, nonclinical participants completed a sham color-gazing task in which depressed people ostensibly see colors become less intense (less-intense condition) or more intense (more-intense condition) while gazing at them. Depression related to perceiving colors as turning less intense in the less-intense condition and more intense in the more-intense condition. These effects of depression (a) persisted after controlling for proneness for nondepressive negative affect or gender, (b) likely occurred without awareness, and (c) were not attributable to accuracy goals or opportunistic self-presentation goals. Depression also related to self-reported increased likelihood of possessing depression characteristics and rating them as more tolerable, and mediation evidence suggested that responses on the color-gazing task partly drove these reports.
Hyperprogression in a Patient With Hepatocellular Cancer Treated With Atezolizumab and Bevacizumab: A Case Report and Review of Literature
Authors: Singh Balraj , Kaur Parminder , Maroules Michael
Published: April 2021

Immune checkpoint inhibitors have emerged as a novel treatment in a wide variety of malignancies; however, it is associated with a distinctive array of side effects known as immune-related adverse events. Hyperprogression is defined as an accelerated growth of disease burden in patients treated with immunotherapy. Limited literature is available regarding hyperprogression in hepatocellular cancer. We report a case of a 36-year-old male with no past medical history who presented with nausea, vomiting, and abdominal pain and was diagnosed with unresectable hepatocellular cancer and thereby started on atezolizumab and bevacizumab. The patient got only 1 cycle of treatment and unfortunately had hyperprogression of disease.
The Evaluation of Trochlear Osseous Morphology: An Epidemiologic Study
Authors: Onor Gabriel I. , Yalcin Sercan , Kaar Scott G. , Pace J. Lee , Ferrua Paolo , Farrow Lutul D.
Published: April 2021

Background:

The femoral trochlea is considered the most significant osseous factor affecting stability in the patellofemoral joint. The true prevalence of trochlear dysplasia in the general population is largely unknown.

Purpose/Hypothesis:

To investigate the prevalence of trochlear dysplasia in the general population. Our hypothesis was that, while trochlear dysplasia is not uncommon, there is a low prevalence of severe dysplasia in the general population.

Study Design:

Descriptive epidemiology study.

Methods:

Five observers were asked to evaluate 692 skeletally mature femoral specimens from 359 skeletons for trochlear dysplasia at 2 time points. We further subclassified the dysplastic trochlea in 62 femora with the highest rated degree of dysplasia.

Results:

Sex ( P = .11) and race ( P = .2) had no effect on the severity of dysplasia. Interobserver reliability was excellent (0.906 and 0.904), and intraobserver reliability was good to excellent (0.686 to 0.808). The percentages of trochlea graded as normal, mildly dysplastic, moderately dysplastic, and severely dysplastic were 61.5%, 21.4%, 12.7%, and 4.4%, respectively, in the first evaluation, and 58.5%, 23.7%, 12.7%, and 5.1% in the second evaluation. Of the 62 trochlea with the highest scores for dysplasia, 36 had trochlear dysplasia without a supratrochlear spur, 8 had trochlear dysplasia with medial femoral condyle hypoplasia, and 18 had trochlear dysplasia with a supratrochlear spur.

Conclusion:

Observers with differing degrees of clinical experience had similar opinions on the degree of trochlear dysplasia. Also, our cohort showed that moderate to severe dysplasia is not uncommon, as it is present in approximately 17% of knees in our cohort. Our findings also suggest that clinicians are speaking the same language when identifying and describing trochlear dysplasia on gross inspection.
Individual Hearing Aid Benefit in Real Life Evaluated Using Ecological Momentary Assessment
Authors: von Gablenz Petra , Kowalk Ulrik , Bitzer Jörg , Meis Markus , Holube Inga
Published: April 2021

Ecological momentary assessment (EMA) was used in 24 adults with mild-to-moderate hearing loss who were seeking first hearing-aid (HA) fitting or HA renewal. At two stages in the aural rehabilitation process, just before HA fitting and after an average 3-month HA adjustment period, the participants used a smartphone-based EMA system for 3 to 4 days. A questionnaire app allowed for the description of the environmental context as well as assessments of various hearing-related dimensions and of well-being. In total, 2,042 surveys were collected. The main objectives of the analysis were threefold: First, describing the “auditory reality” of future and experienced HA users; second, examining the effects of HA fitting for individual participants, as well as for the subgroup of first-time HA-users; and third, reviewing whether the EMA data collected in the unaided condition predicted who ultimately decided for or against permanent HA use. The participants reported hearing-related disabilities across the full range of daily listening tasks, but communication events took the largest share. The effect of the HA intervention was small in experienced HA users. Generally, much larger changes and larger interindividual differences were observed in first-time compared with experienced HA users in all hearing-related dimensions. Changes were not correlated with hearing loss or with the duration of the HA adjustment period. EMA data collected in the unaided condition did not predict the cancelation of HA fitting. The study showed that EMA is feasible in a general population of HA candidates for establishing individual and multidimensional profiles of real-life hearing experiences.
Does Dental Caries Increase Risk of Undernutrition in Children?
Authors: Tanner L. , Craig D. , Holmes R. , Catinella L. , Moynihan P.
Published: April 2021

Introduction:

A systematic review of the evidence on the impact of dental caries on malnutrition risk in children was conducted.

Objectives:

To systematically review published evidence pertaining to the effect of dental caries severity and prevalence on risk of wasting or stunting in children.

Methods:

Four questions relating to caries of the permanent dentition, primary dentition, early childhood caries (ECC), and severe ECC as a risk factor for undernutrition were set. The target population was children aged 0 to 18 y from any country. Data sources included MEDLINE and Embase. All human epidemiological studies were included. Quality assessment excluded lowest-quality studies. Evidence synthesis by vote counting was depicted using harvest plots. A best available evidence approach was applied to narrative synthesis. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results:

Of the 2,690 studies identified, 447 were screened in duplicate; of these, 117 underwent quality assessment, resulting in 46 included studies, of which 38 were included in vote counting (3 quasi-experimental, 1 cohort, 1 case control, and 33 cross-sectional studies). For the permanent dentition, findings were mixed; the balance of data showed no association between caries prevalence (7/11 studies) or severity (8/17 studies) with wasting. For the primary dentition, the balance of data showed a positive association between caries prevalence (10/15 studies) and severity (12/15 studies) with wasting, as well as between-caries prevalence (4/5 studies) and severity (6/6 studies) with stunting. Considering ECC only did not alter this pattern of findings.

Conclusion:

The balance of evidence suggests that dental caries in the primary dentition is associated with undernutrition. There is a need for well-designed trials on the impact of caries rehabilitation on growth trajectories of children from low- and middle-income countries and for prospective studies of the impact of caries severity on both stunting and wasting to confirm causality.

Knowledge Transfer Statement:

The results of this study can be used by policy makers when considering the importance of oral health in addressing the United Nations Sustainable Development Goal to end all forms of malnutrition. The findings suggest that dental caries in the primary dentition may impair children’s healthy weight gain. The findings indicate that higher-quality data are required to confirm a causal relationship and thus inform funding bodies of the need for research, especially in low- and middle-income countries, to substantiate the current knowledge and inform clear and accurate policy statements.