bluuebunny/crossref_metadata_2025 huggingface dataset:
Predictors of Deformity in Patients with Progressive Collapsing Foot Deformity and Valgus of the Ankle
Authors: Mansur Nacime S. , Lalevée Matthieu , Vivtcharenko Victoria , Carvalho Kepler , Dibbern Kevin N. , Deland Jonathan T. , Ellis Scott J. , Femino John E. , de Cesar Netto Cesar
Published: April 2022

Category:

Hindfoot; Ankle; Ankle Arthritis; Midfoot/Forefoot

Introduction/Purpose:

Markers used for diagnosis and severity grading are well studied in patients with Progressive Collapsing Foot Deformity (PCFD). Medial facet subluxation (MFS) in weight-bearing computerized tomography (WBCT) has been established as an early indicator of peritalar subluxation (PTS). When the disease affects the ankle leading to a valgus talar tilt (class E), structures distal to this topography may behave differently, trying to compensate for proximal deformity. The aim of this study is to assess predictors of deformity in PCFD patients with and without valgus of the ankle. Our hypothesis is that MFS cannot be used in Class E patients as an accurate marker for the evaluation and staging of PCFD.

Methods:

In this IRB-approved retrospective case-control study, we analyzed WBCT imaging of 21 consecutive patients with PCFD with valgus of the ankle and 64 controls (flexible PCFD without ankle involvement). MFS (defined by the percentage of uncoverage), middle facet incongruence angle, middle cuneiform-to-floor distance, forefoot arch angle, talonavicular uncoverage angle, hindfoot moment arm (HMA), Foot and Ankle Offset (FAO), and talar tilt angle (TTA) were obtained and compared between groups using one-way ANOVA. A multivariate regression analysis was performed to evaluate which of the measurements influenced the alignment. A partition prediction model was constructed to assess how the variables contributed to the deformity. P values <0.05 indicated statistical significance.

Results:

Differences between groups were found for MFS, HMA, FAO, and TTA, with a lower mean value of MFS in PCFD patients with valgus of the ankle. An inverse relation between MFS and TTA was found, which was demonstrated by an increase in the talar tilt and a decrease in middle facet uncoverage. FAO values were affected by MFS in the control group (R2: 0.25) but not in the ankle valgus group (R2: 0.001), which was influenced mainly by the TTA (R2: 0.53). Additionally, a FAO value higher than 12.14 was found to be a strong predictor of deformity at the ankle.

Conclusion:

Medial facet subluxation was lower in patients with PCFD and valgus of the ankle (Class E), which demonstrates that MFS is a weak predictor of deformity severity. Therefore, this suggests that talar tilt angle and Foot and Ankle Offset should be used as disease markers in this group of patients. Furthermore, a FAO value above 12.14 may be an indicator of ankle involvement in PCFD patients.
Chemoprophylaxis is Cost-Effective in Total Ankle Arthroplasty
Authors: Martinazzi Brandon J. , Kirchner Gregory , Bonaddio Vincenzo , Manto Kristen M. , Stauch Chris M. , Koroneos Zachary , Aynardi Michael C. , Juliano Paul J.
Published: April 2022

Category:

Ankle; Ankle Arthritis; Other

Introduction/Purpose:

The use of chemoprophylaxis to prevent thromboembolic complications following total ankle arthroplasty (TAA) is debated in the field of orthopaedics. The incidence of thromboembolic complications has been shown to vary within the literature, and some studies suggest that the incidence may be similar to what is seen following hip and knee arthroplasty. Therefore, some surgeons will prescribe chemoprophylaxis, such as aspirin 325mg or enoxaparin 40mg following surgery, especially in high-risk patients. To our knowledge, the cost-effectiveness of chemoprophylaxis in TAA has not been investigated. This article presents a break-even analysis for chemoprophylaxis in TAA for the prevention of thromboembolic complications.

Methods:

The estimated cost of treating a thromboembolic complication ($9,407.00) as well as the product cost of aspirin (325 mg) and enoxaparin (40 mg) were obtained from our institution's purchasing records. The high and low rates of thromboembolic complications were obtained from the literature. A break-even analysis was then performed to determine the absolute risk reduction (ARR) in thromboembolic complication rates to make chemoprophylaxis with aspirin 325mg and enoxaparin 40mg cost- effective.

Results:

The initial high rate of a thromboembolic complication following TAA was determined to be 9.8%. Costing $0.25, aspirin was considered cost-effective if the initial thromboembolic complication rate decreased by an ARR of 0.00266%, while enoxaparin (costing $131.73) was cost-effective if the initial rate decreased by an ARR of 1.40034%. For comparison, the initial low rate of thromboembolic complication following TAA was determined to be 0.45%. At this rate, aspirin was again considered to be cost- effective if the initial rate decreased by an ARR of 0.00266%. However, at this low rate, the ARR required to achieve cost- effectiveness for enoxaparin exceeds the initial thromboembolic complication rate.

Conclusion:

While the use of chemoprophylaxis following TAA is still being investigated, this break-even analysis demonstrates that aspirin is highly cost-effective for preventing thromboembolic complications. Furthermore, our results indicate that enoxaparin is cost-effective at the higher rates of thromboembolic complications, but cost-effectiveness is eliminated at a low rate. Not only does this break-even analysis demonstrate the cost-effectiveness of aspirin and, in some cases, enoxaparin, but the model can be easily applied to the values at any institution in order for orthopaedic surgeons to determine the cost-effectiveness of a therapeutic of their choice.
Effect of Prior Joint-sparing Surgery on Outcomes of First Metatarsophalangeal Joint Fusion for Treatment of Hallux Rigidus
Authors: Rajan Lavan , Fuller Robert , Zhu Jiaqi , Ellis Scott J.
Published: April 2022

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

Joint-sparing procedures such as cheilectomy are alternatives to first metatarsophalangeal fusion (MTPF) for treatment of hallux rigidus. These procedures have the proposed benefit of preserving joint motion and allowing for subsequent fusion if necessary. Despite the low incidence of revision after cheilectomy, some patients require subsequent MTPF due to arthritis progression or failure of symptom resolution. Prior studies have not compared outcomes between patients undergoing arthrodesis after cheilectomy and patients undergoing primary MTPF. The objective of this study was to determine if a history of a prior cheilectomy affected patient reported outcomes in patients treated with MPTF. We hypothesized that there would be no differences in outcomes between patients with and without history of prior cheilectomy.

Methods:

This retrospective cohort study included adult patients treated with MTPF for hallux rigidus with preoperative and minimum 1-year postoperative Patient-Reported Outcomes Measurement Information System (PROMIS) scores. Patients with no prior joint-sparing procedure (primary MTPF group) were assigned to one cohort, and patients with history of prior cheilectomy were assigned to another. Initial comparisons in preoperative PROMIS physical function (PF), pain interference (PI), pain intensity (Pint), global physical health (PH), global mental health (MH), and depression (D) scores were made using Mann-Whitney U tests. Postoperative PROMIS scores were compared using multivariable linear regression, controlling for age, BMI, gender, and preoperative scores. Wilcoxon signed rank tests were used to assess improvement in preoperative to postoperative scores in both groups.

Results:

A total of 127 patients (100 primary MTPF, 27 prior cheilectomy) with average follow-up of 19.6 months were included. Patient demographics including BMI, age, and gender distribution were similar between groups. Preoperative PF scores in the prior cheilectomy group were significantly worse than the primary MTPF group (median 40.5 vs 43.3, p<0.05). Table 1 illustrates the results of Wilcoxon signed rank tests demonstrating changes in scores in each PROMIS domain. There were no significant differences in postoperative PROMIS scores between the primary MTPF and prior cheilectomy groups.

Conclusion:

Patients undergoing MTPF for treatment of hallux rigidus both with and without a history of cheilectomy had no differences in postoperative outcomes as measured by PROMIS. Patients undergoing cheilectomy can be counseled that if the need to pursue MTPF arises due to arthritis progression or failure of symptom resolution, their postoperative function and pain after the fusion may not be affected by the cheilectomy.
The serum of COVID-19 asymptomatic patients up-regulates proteins related to endothelial dysfunction and viral response in circulating angiogenic cells ex-vivo
Authors: Beltrán-Camacho Lucía , Eslava-Alcón Sara , Rojas-Torres Marta , Sánchez-Morillo Daniel , Martinez-Nicolás Mª Pilar , Martín-Bermejo Victoria , de la Torre Inés García , Berrocoso Esther , Moreno Juan Antonio , Moreno-Luna Rafael , Durán-Ruiz Mª Carmen
Published: April 2022

Background

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has already caused 6 million deaths worldwide. While asymptomatic individuals are responsible of many potential transmissions, the difficulty to identify and isolate them at the high peak of infection constitutes still a real challenge. Moreover, SARS-CoV-2 provokes severe vascular damage and thromboembolic events in critical COVID-19 patients, deriving in many related deaths and long-hauler symptoms. Understanding how these processes are triggered as well as the potential long-term sequelae, even in asymptomatic individuals, becomes essential.

Methods

We have evaluated, by application of a proteomics-based quantitative approach, the effect of serum from COVID-19 asymptomatic individuals over circulating angiogenic cells (CACs).Healthy CACs were incubated ex-vivo with the serum of either COVID-19 negative (PCR −/IgG −, n:8) or COVID-19 positive asymptomatic donors, at different infective stages: PCR +/IgG − (n:8) and PCR −/IgG + (n:8). Also, a label free quantitative approach was applied to identify and quantify protein differences between these serums. Finally, machine learning algorithms were applied to validate the differential protein patterns in CACs.

Results

Our results confirmed that SARS-CoV-2 promotes changes at the protein level in the serum of infected asymptomatic individuals, mainly correlated with altered coagulation and inflammatory processes (Fibrinogen, Von Willebrand Factor, Thrombospondin-1). At the cellular level, proteins like ICAM-1, TLR2 or Ezrin/Radixin were only up-regulated in CACs treated with the serum of asymptomatic patients at the highest peak of infection (PCR + /IgG −), but not with the serum of PCR −/IgG + individuals. Several proteins stood out as significantly discriminating markers in CACs in response to PCR or IgG + serums. Many of these proteins particiArticle title: Kindly check and confirm the edit made in the article title.pate in the initial endothelial response against the virus.

Conclusions

The ex vivo incubation of CACs with the serum of asymptomatic COVID-19 donors at different stages of infection promoted protein changes representative of the endothelial dysfunction and inflammatory response after viral infection, together with activation of the coagulation process. The current approach constitutes an optimal model to study the response of vascular cells to SARS-CoV-2 infection, and an alternative platform to test potential inhibitors targeting either the virus entry pathway or the immune responses following SARS-CoV-2 infection.
Rail Roughness Acceptance Criterion Based on Metro Interior Noise
Authors: Liu Xiaolong , Han Jian , Liu Moukai , Wang Jianuo , Xiao Xinbiao , Wen Zefeng
Published: April 2022

Severe rail roughness leads to a series of problems in metro systems, particularly the vehicle noise problem. To ensure a better acoustic environment, rail roughness control is therefore one of the main concerns for the metro operators. But the existing roughness acceptance criteria are not suitable for metro interior noise control. It is an appropriate method to determine the rail roughness limit based on interior noise. A rail roughness acceptance criterion based on metro interior noise is accordingly proposed in this paper. The relationship between rail roughness and interior noise can be derived with wheel-rail noise as link. With this objective, a combined test and simulation method is adopted. A validated wheel-rfigil noise prediction model is thus established to determine the relationship between rail roughness and wheel-rail noise. Moreover, the transfer function of wheel-rail noise to interior noise is developed based on extensive field test. Using this method, the noise sensitivity to roughness wavelength and acceptance criteria at different speeds and track structures are investigated. Finally, an eclectic rail corrugation acceptance criterion on curved track is suggested in consideration of practical application.
A Review of Smart Materials for the Boost of Soft Actuators, Soft Sensors, and Robotics Applications
Authors: Hao Yufei , Zhang Shixin , Fang Bin , Sun Fuchun , Liu Huaping , Li Haiyuan
Published: April 2022

With the advance of smart material science, robotics is evolving from rigid robots to soft robots. Compared to rigid robots, soft robots can safely interact with the environment, easily navigate in unstructured fields, and be minimized to operate in narrow spaces, owning to the new actuation and sensing technologies developed by the smart materials. In the review, different actuation and sensing technologies based on different smart materials are analyzed and summarized. According to the driving or feedback signals, actuators are categorized into electrically responsive actuators, thermally responsive actuators, magnetically responsive actuators, and photoresponsive actuators; sensors are categorized into resistive sensors, capacitive sensors, magnetic sensors, and optical waveguide sensors. After introducing the principle and several robotic prototypes of some typical materials in each category of the actuators and sensors. The advantages and disadvantages of the actuators and sensors are compared based on the categories, and their potential applications in robotics are also presented.
Anti-cancer peptide-based therapeutic strategies in solid tumors
Authors: Karami Fath Mohsen , Babakhaniyan Kimiya , Zokaei Maryam , Yaghoubian Azadeh , Akbari Sadaf , Khorsandi Mahdieh , Soofi Asma , Nabi-Afjadi Mohsen , Zalpoor Hamidreza , Jalalifar Fateme , Azargoonjahromi Ali , Payandeh Zahra , Alagheband Bahrami Armina
Published: April 2022

Background

Nowadays, conventional medical treatments such as surgery, radiotherapy, and chemotherapy cannot cure all types of cancer. A promising approach to treat solid tumors is the use of tumor-targeting peptides to deliver drugs or active agents selectively.

Result

Introducing beneficial therapeutic approaches, such as therapeutic peptides and their varied methods of action against tumor cells, can aid researchers in the discovery of novel peptides for cancer treatment. The biomedical applications of therapeutic peptides are highly interesting. These peptides, owing to their high selectivity, specificity, small dimensions, high biocompatibility, and easy modification, provide good opportunities for targeted drug delivery. In recent years, peptides have shown considerable promise as therapeutics or targeting ligands in cancer research and nanotechnology.

Conclusion

 This study reviews a variety of therapeutic peptides and targeting ligands in cancer therapy. Initially, three types of tumor-homing and cell-penetrating peptides (CPPs) are described, and then their applications in breast, glioma, colorectal, and melanoma cancer research are discussed.
Selection of scenarios for landscape-level risk assessment of chemicals: case studies for mammals
Authors: Wang Magnus , Park Su-Yeong , Dietrich Christian , Kleinmann Joachim
Published: April 2022

Background

For landscape-level risk assessments of pesticides, the choice of the scenario is a key question, since it determines the outcome of a risk assessment. Typically, the aim is to select a realistic worst-case scenario. In the present study, landscapes from an area with a high proportion of cereal fields in France were analysed and simulations with population models for wood mouse, common vole, brown hare and European rabbit were conducted to understand if the worst-case character regarding pesticide exposure and population survival can be determined based on landscape features alone. Furthermore, it was analysed which landscape features relate with population survival and the magnitude of effects due to pesticide application. Answers to these question may help to decide whether landscape scenarios can be selected based on expert decision and whether the same scenarios may be used for different species or not.

Results

There were species-specific landscape features relating to long-term population survival. A landscape that is worst-case for one species, was not necessarily worst-case for another. Furthermore, landscapes that were worst-case regarding population survival were often not worst-case regarding the magnitude of effects resulting from pesticide application. We also found that small landscapes were sometimes, but not always worst-case compared to larger landscapes. When small landscapes were worst-case, this was typical because of the artificial borders of the digitised landscape.

Conclusions

Landscape analyses can help to obtain an approximate impression of the worst-case character of a landscape scenario. However, since it was difficult to consistently and reliably do this for single landscapes, it may be advisable to use a set of different landscapes for each risk assessment, which covers the natural variability. Depending on whether population survival shall be ensured or the magnitude of effects due to pesticides, different landscape structure and composition needs to be considered to establish a worst-case landscape scenario.
Functional R2R3-MYB transcription factor NsMYB1, regulating anthocyanin biosynthesis, was relative to the fruit color differentiation in Nitraria sibirica Pall.
Authors: Bao Xuemei , Zong Yuan , Hu Na , Li Shiming , Liu Baolong , Wang Honglun
Published: April 2022

Background

Nitraria sibirica Pall. is an economic plant with two kinds of fruit color, widely spreads in the Qinghai Tibet Plateau. The chemical analysis and pharmacological evaluation had been carried out for several tens of years, the mechanism behind the fruit color differentiation is still unclear.

Results

In this manuscript, the chemical analysis of the extractions showed that the chemical composition of fruit color was anthocyanin, and two kind of Nitraria sibirica Pall. were caused by the content differentiation with the same anthocyanin kinds. Cyanidin-3-[2”-(6′”-coumaroyl)-glucosyl]-glucoside (C3G) was the major anthocyanin. Transcriptome analysis and the qRT-PCR revealed that the structural genes relative to anthocyanin biosynthesis except CHS, F3’5’H and ANS were up-regulated in the peels of BF (Black fruit) compared with the peels of RF (Red fruit), which indicated that transcript factor should be the reason for the expression difference of the structure genes. In the unigenes of the transcript factor MYB and bHLH, relative to anthocyanin, only NsMYB1 (Cluster 8422.10600), was high-expression and up-expression in the peels of BF. NsMYB1 encoded the same length protein with four amino acid differences in the RF and BF, and both contained the intact DNA, HTH-MYB and SANT domains. NsMYB1 was close to the AtMYB114, AtMYB113 and AtPAP1, regulating anthocyanin biosynthesis, in phylogenetic relationship. Both NsMYB1r and NsMYB1b could promote the transcript of the structural genes, and induced the anthocyanin accumulation in all tissues of transgenic tobacco. The insertion of ‘TATA’ in the promoter of NsMYB1r gave one more promoter region, and was the reason for higher transcripts in black fruit possibly.

Conclusions

Cyanidin-3-[2′’-(6′”-coumaroyl)-glucosyl]-glucoside was the major anthocyanin in black fruit of Nitraria sibirica Pall.. NsMYB1 was a functional R2R3-MYB transcription factor, regulated the anthocyanin biosynthesis, and led to the fruit color differentiation in Nitraria sibirica Pall.
Interaction between photoperiod and variation in circadian rhythms in tomato
Authors: Xiang Yanli , Sapir Thomas , Rouillard Pauline , Ferrand Marina , Jiménez-Gómez José M.
Published: April 2022

Background

Many biological processes follow circadian rhythmicity and are controlled by the circadian clock. Predictable environmental changes such as seasonal variation in photoperiod can modulate circadian rhythms, allowing organisms to adjust the timing of their biological processes to the time of the year. In some crops such as rice, barley or soybean, mutations in circadian clock genes have altered photoperiod sensitivity, enhancing their cultivability in specific seasons and latitudes. However, how changes in circadian rhythms interact with the perception of photoperiod in crops remain poorly studied. In tomato, the appearance during domestication of mutations in EMPFINDLICHER IM DUNKELROTEN LICHT 1 (EID1, Solyc09g075080) and NIGHT LIGHT-INDUCIBLE AND CLOCK-REGULATED GENE 2 (LNK2, Solyc01g068560) delayed both the phase and period of its circadian rhythms. The fact that variation in period and phase are separated in tomato provides an optimal tool to study how these factors affect the perception of photoperiod.

Results

Here we develop tomato near isogenic lines carrying combinations of wild alleles of EID1 and LNK2 and show that they recreate the changes in phase and period that occurred during its domestication. We perform transcriptomic profiling of these near isogenic lines under two different photoperiods, and observe that EID1, but not LNK2, has a large effect on how the tomato transcriptome responds to photoperiod. This large effect of EID1 is likely a consequence of the global phase shift elicited by this gene in tomato's circadian rhythms.

Conclusions

Our study shows that changes in phase that occurred during tomato domestication determine photoperiod perception in this species, while changes in period have little effect.
Pulmonary valve perforation with multiple cardiac anomalies: a case report
Authors: Chen Yan , Gao Huanhuan , Mou Yun , Zheng Zhelan
Published: April 2022

Background

Large pulmonary valve perforation, which is rarely seen with infective endocarditis, general atrophy, or congenital fenestration, often leads to potentially fatal outcomes, including heart failure.

Case presentation

Transthoracic and transesophageal echocardiographic evaluation of a 69-year-old woman revealed a severely eccentric pulmonary regurgitation with concomitant pulmonary valve stenosis, patent ductus arteriosus, patent foramen ovale, and pulmonary artery aneurysm. In the operation, a large perforation was found in the pulmonary valve leaflet. She underwent complicated surgery that involved closure of the congenital heart defects and replacement of a pulmonary valve with successful results. But the cause of her pulmonary valve perforation remained undetermined.

Conclusion

This case highlights two important points: the need for timely management of congenital heart disease and being aware of the possibility of pulmonary valve perforation, which in this case was indicated by an eccentric pulmonary regurgitant jet seen on echocardiography.
Retrospective analysis of patterns of opioid overdose and interventions delivered at a tertiary hospital emergency department: impact of COVID-19
Authors: Potaka Katherine L. , Freeman Rebecca , Soo Danny , Nguyen Nam-Anh , Sim Tin Fei , Moullin Joanna C.
Published: April 2022

Background

Opioid-related overdoses cause substantial numbers of preventable deaths. Naloxone is an opioid antagonist available in take-home naloxone (THN) kits as a lifesaving measure for opioid overdose. As the emergency department (ED) is a primary point of contact for patients with high-risk opioid use, evidence-based recommendations from the Society of Hospital Pharmacists of Australia THN practice guidelines include the provision of THN, accompanied by psychosocial interventions. However, implementation of these guidelines in practice is unknown. This study investigated ED opioid-related overdose presentations, concordance of post-overdose interventions with the THN practice guidelines, and the impact, if any, of the SARS-CoV-2 (COVID-19) pandemic on case presentations.

Methods

A single-centre retrospective audit was conducted at a major tertiary hospital of patients presenting with overdoses involving opioids and non-opioids between March to August 2019 and March to August 2020. Patient presentations and interventions delivered by the paramedics, ED and upon discharge from the ED were collated from medical records and analysed using descriptive statistics, chi square and independent T-tests.

Results

The majority (66.2%) of patients presented to hospital with mixed drug overdoses involving opioids and non-opioids. Pharmaceutical opioids were implicated in a greater proportion (72.1%) of overdoses than illicit opioids. Fewer patients presented in March to August 2020 as compared with 2019 (26 vs. 42), and mixed drug overdoses were more frequent in 2020 than 2019 (80.8% vs. 57.1%). Referral to outpatient psychology (22.0%) and drug and alcohol services (20.3%) were amongst the most common post-discharge interventions. Naloxone was provided to 28 patients (41.2%) by the paramedics and/or ED. No patients received THN upon discharge.

Conclusions

This study highlights opportunities to improve ED provision of THN and other interventions post-opioid overdose. Large-scale multi-centre studies are required to ascertain the capacity of EDs to provide THN and the impact of COVID-19 on opioid overdose presentations.
Establishing the content validity of a new emergency department patient-reported experience measure (ED PREM): a Delphi study
Authors: Bull Claudia , Crilly Julia , Latimer Sharon , Gillespie Brigid M.
Published: April 2022

Background

Patient-reported experience measures aim to capture the patient’s perspective of what happened during a care encounter and how it happened. However, due to a lack of guidance to support patient-reported experience measure development and reporting, the content validity of many instruments is unclear and ambiguous. Thus, the aim of this study was to establish the content validity of a newly developed Emergency Department Patient-Reported Experience Measure (ED PREM).

Methods

ED PREM items were developed based on the findings of a systematic mixed studies review, and qualitative interviews with Emergency Department patients that occurred during September and October, 2020. Individuals who participated in the qualitative interviews were approached again during August 2021 to participate in the ED PREM content validation study. The preliminary ED PREM comprised 37 items. A two-round modified, online Delphi study was undertaken where patient participants were asked to rate the clarity, relevance, and importance of ED PREM items on a 4-point content validity index scale. Each round lasted for two-weeks, with 1 week in between for analysis. Consensus was a priori defined as item-level content validity index scores of ≥0.80. A scale-level content validity index score was also calculated.

Results

Fifteen patients participated in both rounds of the online Delphi study. At the completion of the study, two items were dropped and 13 were revised, resulting in a 35-item ED PREM. The scale-level content validity index score for the final 35-item instrument was 0.95.

Conclusions

The newly developed ED PREM demonstrates good content validity and aligns strongly with the concept of Emergency Department patient experience as described in the literature. The ED PREM will next be administered in a larger study to establish its’ construct validity and reliability. There is an imperative for clear guidance on PREM content validation methodologies. Thus, this study may inform the efforts of other researchers undertaking PREM content validation.
Emergency cricothyroidotomy in difficult airway simulation – a national observational study of Air Ambulance crew performance
Authors: Andresen Åke Erling L. , Kramer-Johansen Jo , Kristiansen Thomas
Published: April 2022

Background

Advanced prehospital airway management includes complex procedures carried out in challenging environments, necessitating a high level of technical and non-technical skills. We aimed to describe Norwegian Air Ambulance-crews’ performance in a difficult airway scenario simulation, ending with a “cannot intubate, cannot oxygenate”-situation.

Methods

The study describes Air Ambulance crews’ management of a simulated difficult airway scenario. We used video-observation to assess time expenditure according to pre-defined time intervals and technical and non-technical performance was evaluated according to a structured evaluation-form.

Results

Thirty-six crews successfully completed the emergency cricothyroidotomy with mean procedural time 118 (SD: ±70) seconds. There was variation among the crews in terms of completed procedural steps, including preparation of equipment, patient- monitoring and management. The participants demonstrated uniform and appropriate situational awareness, and effective communication and resource utilization within the crews was evident.

Conclusions

We found that Norwegian Air Ambulance crews managed a prehospital “cannot intubate, cannot oxygenate”-situation with an emergency cricothyroidotomy under stressful conditions with effective communication and resource utilization, and within a reasonable timeframe. Some discrepancies between standard operating procedures and performance are observed. Further studies to assess the impact of check lists on procedural aspects of airway management in the prehospital environment are warranted.
Computed tomography features and clinicopathological characteristics of gastric glomus tumor
Authors: Xing Jing-jing , Huang Wen-peng , Wang Fang , Chai Ya-ru , Gao Jian-bo
Published: April 2022

Background

Gastric glomus tumor (GGT) is a rare neoplasm that is difficult to distinguish from other gastric submucosal tumors due to a lack of diagnostic experience. The goal of this study was to better understand GGT by looking at its clinicopathological features, computed tomography (CT) features, and differential diagnosis.

Methods

The clinical data and CT findings of 21 pathologically confirmed GGT patients were examined. The clinical characteristics and CT findings of benign GGT were compared to gastric stromal tumors (GST) (n = 30) and heterotopic pancreas (n = 30).

Results

The 21 cases included six males and fifteen females ranging in age from 42 to 64 years. The lesions were found in the gastric body in four cases and the antrum in seventeen. GGT was diagnosed as benign in 20 cases and malignant in one. In benign cases, the glomus cells were small, uniform, showed perivascular hemangiopericytoma‑like or solid nest‑like structures. Obvious mitotic figures were observed in the malignant case. SMA staining was positive in the tumor cells. A quasi-round or round solid mass protruded into the gastric cavity in 20 benign cases, with a clear and smooth edge. The long to short diameter ratio was 1.01 ± 0.15. All of the benign cases had obvious enhancement, with homogeneous enhancement in ten cases and heterogeneous enhancement in ten cases, as well as central filling enhancement in 12 cases. The ratio of CT value of lesion to abdominal aorta in arterial phase and venous phase were (0.41 ± 0.11) and (0.81 ± 0.20), which were significantly higher than GST and heterotopic pancreas. The irregular mass broke through the gastric wall and invaded liver with poorly defined boundary and internal necrosis, heterogeneous persistent moderate enhancement with thickening blood supply arteries was seen in one malignant case with a long diameter of 150 mm and a thick diameter of 30 mm.

Conclusions

CT enhancement usually shows persistent obvious enhancement, especially in arterial phase, which provides important value for the diagnosis. CT findings can help in the differential diagnosis of GGT and other submucosal tumors.
Determine the impact of a structured pharmacist-led medication review - a controlled intervention study to optimise medication safety for residents in long-term care facilities
Authors: Lexow M. , Wernecke K. , Sultzer R. , Bertsche T. , Schiek S.
Published: April 2022

Background

Medication reviews contribute to protecting long-term care (LTC) residents from drug related problems (DRPs). However, few controlled studies have examined the impact on patient-relevant outcomes so far.

Objective

We examined the impact of a one-time, pharmacist-led medication review on medication changes (primary endpoint) including discontinued medication, the number of chronic medications, hospital admissions, falls, and deaths (secondary endpoints).

Methods

A prospective, controlled intervention study was performed in three LTC facilities. In the intervention group (IG), after performing a medication review, a pharmacist gave recommendations for resolving DRPs to physicians, nurses and community pharmacists. The control group (CG) received usual care without a medication review. (i) We assessed the number of medication changes and the secondary endpoints in both groups before (t0) and after (t1, t2) the intervention. (ii) Additionally, the medication review was evaluated in the IG with regard to identified DRPs, the healthcare professional’s feedback on the forwarded pharmacist recommendations and whether DRPs were finally resolved.

Results

107 (IG) and 104 (CG) residents were enrolled. (i) More medication changes were identified in the IG than in the CG at t1 (p = 0.001). However, no significant difference was identified at t2 (p = 0.680). Mainly, medication was discontinued in those medication changes. Chronic medications increased in the CG (p = 0.005) at t2 while hospital admissions, falls, and deaths showed no differences. (ii) Overall, 1252 DRPs (median: 10; minimum-maximum: 2–39) were identified. Recommendations for 82% of relevant DRPs were forwarded to healthcare professionals, of which 61% were accepted or clarified. 22% were not accepted, 12% required further review and 6% remained without feedback. 51% of forwarded DRPs were finally resolved.

Conclusions

We found more medication changes in the IG compared to controls. Mostly, medication was discontinued. This suggests that our intervention was successful in discontinuing unnecessary medication. Other clinical outcomes such as falls, hospitalisations, and deaths were not improved due to the one-time intervention. The medication review further identified a high prevalence of DRPs in the IG, half of which were finally resolved.

Trial registration

German Clinical Trials Register, DRKS00026120 (www.drks.de, retrospectively registered 07/09/2021).
Association between age at initial diagnosis and post-metastasis mortality among women with recurrent metastatic breast cancer in China
Authors: Xie Yuxin , Gou Qiheng , Zhang Yingjie , Xie Keqi , Zheng Dan , Luo Chuanxu , Suo Jiaojiao , Zhong Xiaorong , Luo Ting
Published: April 2022

Background

Little is known about whether age at initial diagnosis influences the prognosis of recurrent metastatic breast cancer (rMBC). Here, we analyzed the association between age at initial diagnosis and rMBC mortality in China.

Methods

A total of 1636 women diagnosed with rMBC between 1989 and 2020 at West China Hospital, Sichuan University were included in this study. The age at initial diagnosis was categorized as young (≤ 40 years), middle-aged (41–64 years) and elderly (≥ 65 years). Post-metastasis mortality was the primary outcome and its associated factors were analyzed by Cox proportional hazards models.

Results

During a median follow-up of 5.2 years after initial diagnosis of breast cancer, 620 deaths were identified. Compared with middle-aged patients, elderly patients had a 70% increased risk of post-metastasis mortality (95%CI, 1.24–2.33) after adjusting for demographics, tumor characteristics and treatment modes. Similarly, elderly patients were associated with a 75% increased risk of post-metastasis mortality (95%CI, 1.19–2.59) compared with young patients. Subgroup analyses also showed similar trends.

Conclusion

Our findings suggest that in breast cancer, elderly patients at initial diagnosis face a higher risk of post-metastasis mortality.
Tivozanib in renal cell carcinoma: a systematic review of the evidence and its dissemination in the scientific literature
Authors: Caquelin Laura , Gewily Mohamed , Mottais Wendy , Tebaldi Chloé , Laviolle Bruno , Naudet Florian , Locher Clara
Published: April 2022

Background

Tivozanib (Fotivda) is an anti-angiogenic tyrosine kinase inhibitor that was denied access to the US market by the Food and Drug Administration (FDA). In contrast, it was granted approval by the European Medicines Agency (EMA) for the treatment of Renal Cell Carcinoma in adults. Given the conflicting decisions from these regulatory agencies, the objectives of the following study are (i) to critically review the evidence supporting the approval of tivozanib; (ii) to analyse the dissemination of this evidence in the literature by way of a citation analysis.

Methods

Pivotal trials were searched by two independent reviewers using Medline, Cochrane Library, ClinicalTrials.gov and the European Public Assessment Report. The risk of bias for each trial was then inductively assessed. Articles citing any of these trials were identified using Web of Sciences. Finally, the quality of the citations was evaluated by two independent reviewers according to standard data extraction methods.

Results

The search for primary evidence identified two pivotal studies: TIVO-1 upon which the FDA and the EMA decisions were based, and TIVO-3 which was conducted after the agencies’ decisions had been issued. The TIVO-1 trial presented several limitations that compromised causal inference, in relation to (i) design (absence of blinding, inappropriate comparator, and one-way crossover), (ii) poor internal consistency in the results for the primary endpoint, (iii) a discrepancy between a benefit observed for progression-free survival (HR: 0.80, 95% CI [0.64–0.99]) and the absence of difference for overall survival (HR: 1.25, 95% CI [0.95 – 1.62]). Our citation search protocol identified 229 articles that cited TIVO-1 in the 7 years following its publication, among which 151 (65.9%) citing articles discussing efficacy. Presence of spin was identified in 64 (42.4%) of these 151 citing articles, and 39 (25.8%) additional articles citing results without providing enough elements to interpret the TIVO-1 results.

Conclusion

EMA’s approval was based on a single pivotal trial presenting critical limitations, rendering the results from the trial potentially inconclusive. The broad dissemination of TIVO-1 results in the scientific literature may have been affected by spin or results were presented in an inadequate critical manner.
A multicenter noninferior randomized controlled study comparing the efficacy of laparoscopic versus abdominal radical hysterectomy for cervical cancer (stage IA1 with LVSI, IA2): study protocol of the LAUNCH 1 trial
Authors: Wu Xin , Feng Hao , Gao Shujun , Feng Hua , Diao Wenjing , Zhang Hongwei , Du Ming , Lou Weihua , Wang Xipeng , Zhu Tao , Zhang Yuyang , Hu Weiguo , Xue Xiaohong , Zhu Zhiling , Xiang Libing , Li Jiarui , Fang Xuhong , Bai Yongrui , Hou Yanli , Yan Weili , Qiu Ling , Yu Hailin , Zhu Shurong , Du Yan , Jiang Hua
Published: April 2022

Background

A retrospective study and a randomized controlled trial published in a high quality journal in late 2018 have shown that laparoscopic radical hysterectomy (RH) was associated with worse survival than abdominal RH among patients with early stage cervical cancer. Radical hysterectomy in cervical cancer has been a classic landmark surgery in gynecology, therefore this conclusion is pivotal. The current trial is designed to reconfirm whether there is a difference between laparoscopic RH and abdominal RH in cervical cancer (stage IA1 with LVSI, IA2) patient survival under stringent operation standards and consistent tumor-free technique. This paper reports the rationale, design, and implementation of the trial.

Methods

This is an investigator-initiated, prospective, randomized, open, blinded endpoint (PROBE) controlled trial. A total of 690 patients with stage IA1 (with intravascular), and IA2 cervical cancer will be enrolled over a period of three years. Patients are randomized (1:1) to either the laparoscopic RH or the abdominal RH group. Patients will then be followed-up for at least five years. The primary endpoint will be 5-year progression-free survival. Secondary endpoints will include 5-year overall survival rates, recurrence rates, operation time, intraoperative blood loss, surgery-related complications, and quality of life.

Discussion

The results of the trial will provide valuable evidence for guiding clinical decision of choosing appropriate treatment strategies for stage IA1 (LVSI) and stage IA2 cervical cancer patients.

Trial registration

ClinicalTrials.gov (NCT04934982, Registered on 22 June 2021).
Retrospective analysis of secondary enucleation for uveal melanoma after plaque radiotherapy
Authors: Wang Heng , Zhang Ruiheng , Wang Yining , Chen Rongtian , Liu Yueming , Li Yang , Wei Wenbin
Published: April 2022

Background

Uveal melanoma (UM) is the most common primary intraocular malignancy in adults. Plaque brachytherapy (PRT) is widely accepted as an effective globe-conserving treatment modality for UM. However, local treatment failure and complications lead to the enucleation of irradiated eyes. We conducted this study to explore the causes and long-term prognosis for UM patients who accepted secondary enucleation after plaque radiotherapy.

Methods

This was a retrospective cohort study. Data of patients who underwent secondary enucleation for UM after plaque radiotherapy, from July 2007 to July 2019, at Beijing Tongren Hospital were analyzed. Kaplan–Meier analysis was performed to assess the probability of indications, metastasis, and metastasis-related death. Cox regression analysis was used to analyze associations of the prognostic factors.

Results

Eight hundred and eighty patients were clinically diagnosed with uveal melanoma and initially treated by iodine-125 plaque radiotherapy, 132 of whom underwent secondary enucleation and pathological examination in the same hospital. Fifty-two (39.4%) eyes were enucleated simply because of uncontrollable neovascular glaucoma (NVG). Forty-four (33.3%) patients suffered from tumor recurrence. Tumor non-response occurred in 18 (13.6%) cases. Ten (7.6%) eyes received enucleation entirely due to other types of glaucoma. Failure to preserve the eyes for other reasons occurred in eight (6.1%) patients. At a median follow-up of 58.1 [IQR: 40.9–90.5] months, the systemic spread was detected in 45 (34.1%) patients, and 38 of them died. On multivariate analysis, tumor largest basal diameter (HR 1.15 [95% CI: 1.01, 1.31]), tumor non-response (HR 7.22 [95% CI: 2.63, 19.82]), and recurrence (HR 3.29 [95% CI: 1.54, 7.07]) were risk factors for metastasis. Increased age (HR 1.54 [95% CI: 1.07, 2.23]), tumor non-response (HR 7.91 [95% CI: 2.79, 22.48]), and recurrence (HR 3.08 [95% CI: 1.13, 7.23]) were risk factors for metastasis-related death.

Conclusions

NVG was the major reason for secondary enucleation for Chinese UM patients after PRT. Tumor non-response and recurrence were associated with a significantly higher risk of long-term metastasis and metastasis-related death.
Endogenous endophthalmitis caused by Streptococcus suis infection: a case report
Authors: Li Zhe , Xu Min , Hua Xin
Published: April 2022

Background

Streptococcus suis (S. suis) is an emerging zoonotic human pathogen, which commonly causes meningitis and sepsis. Ocular infections associated with S. suis infection are very rare. Herein, we reported a rare case of a man who developed endophthalmitis complicated by meningitis following S. suis infection.

Case presentation

A 48-year-old male with a fever, loss of vision in the right eye, slight headache, and hearing loss in the right ear was admitted to our hospital. A comprehensive ophthalmological examination suggested endophthalmitis. The metagenomics next-generation sequencing (mNGS) results of pathogenic microorganisms from vitreous and cerebrospinal fluid samples revealed that the causative pathogen was S. suis, which was further confirmed by the bacterial culture of the vitreous sample. Subsequently, the patient received phacoemulsification and vitrectomy, combined with silicone oil tamponade, as well as local and systemic anti-infective therapy, after which his condition significantly improved.

Conclusions

Despite the low incidence rate of endophthalmitis caused by S. suis, clinicians should be aware of relevant clinical manifestations, especially for patients with neurological symptoms and risk factors for S. suis infection. The next-generation sequencing is efficient for etiological diagnosis of pathogenic microorganisms.
Community violence and internalizing mental health symptoms in adolescents: A systematic review.
Authors: Miliauskas Claudia Reis , Faus Daniela Porto , da Cruz Valéria Lima , do Nascimento Vallaperde João Gabriel Rega , Junger Washington , Lopes Claudia Souza
Published: April 2022

Purposes

Mental disorders are responsible for 16% of the global burden of disease in adolescents. This review focuses on one contextual factor called community violence that can contribute to the development of mental disorders

Objective

To evaluate the impact of community violence on internalizing mental health symptoms in adolescents, to investigate whether different proximity to community violence (witness or victim) is associated with different risks and to identify whether gender, age, and race moderate this association.

Methods

systematic review of observational studies. The population includes adolescents (10-24 years), exposition involves individuals exposed to community violence and outcomes consist of internalizing mental health symptoms. Selection, extraction and quality assessment were performed independently by two researchers.

Results

A total of 2987 works were identified; after selection and extraction, 42 works remained. Higher exposure to community violence was positively associated with internalizing mental health symptoms. Being a witnessing is less harmful for mental health than being a victim. Age and race did not appear in the results as modifiers, but male gender and family support appear to be protective factors in some studies.

Conclusion

This review confirms the positive relationship between community violence and internalizing mental health symptoms in adolescents and provides relevant information that can direct public efforts to build policies in the prevention of both problems.