bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and type of adverse events in patients taking vonoprazan: A systematic review and meta-analysis
Authors: Xu Wentao , Bai Zhaohui , Shang Yiyang , Wang Jing , Wong Yujun , Qi Xingshun
Published: April 2023

Background:

Vonoprazan, a novel acid-suppressive drug, is non-inferior to proton pump inhibitors (PPIs) for the management of gastric acid-related diseases. However, the safety of vonoprazan has not been systematically evaluated yet.

Objectives:

To elucidate the incidence and type of adverse events (AEs) in patients taking vonoprazan.

Design:

Systematic review and meta-analysis.

Data sources and methods:

PubMed, EMBASE, and Cochrane Library databases were searched for all studies reporting the safety of vonoprazan. The incidences of any AEs, drug-related AEs, serious AEs, AEs leading to drug discontinuation, and common AEs were pooled. Odds ratios (ORs) were calculated to compare the incidence of AEs between patients taking vonoprazan and PPIs.

Results:

Seventy-seven studies were included. The pooled incidences of any AEs, drug-related AEs, serious AEs, and AEs leading to drug discontinuation were 20, 7, 1, and 1%, respectively. The incidences of any AEs (OR = 0.96, p = 0.66), drug-related AEs (OR = 1.10, p = 0.44), serious AEs (OR = 1.14, p = 0.36), and AEs leading to drug discontinuation (OR = 1.09, p = 0.55) were not significantly different between patients taking vonoprazan and PPIs. In subgroup analyses, patients with peptic ulcer disease (PUD) had higher incidences of any AEs, serious AEs, and AEs leading to drug discontinuation than those with gastroesophageal reflux disease (GERD), Helicobacter pylori ( H. pylori) infection, and artificial ulcer after gastric endoscopic submucosal dissection (ESD), but patients with H. pylori infection had a higher incidence of drug-related AEs than those with PUD, GERD, and artificial ulcer after gastric ESD. The incidence of AEs was higher in patients taking long-term use of vonoprazan than those taking short-term use of vonoprazan.

Conclusion:

Vonoprazan is well tolerated and shows similar safety compared to PPIs. The safety of vonoprazan may be primarily influenced by its indications and duration.

Registration:

PROSPERO CRD42022314982.
Antiviral and Possible Prophylactic Significance of Myricetin for COVID-19
Authors: Agrawal Pawan K. , Agrawal Chandan , Blunden Gerald
Published: April 2023

Myricetin (3,5,7,3′,4′,5′ -hexahydroxyflavone), a common dietary flavonoid, has been reported for its roles in improving health due to various pharmacological activities, such as antioxidant, antimicrobial, anti-inflammatory, analgesic, antitumor, hepatoprotective, and antidiabetic. Myricetin has also been shown to have a broad spectrum of antiviral effects against a variety of viruses including Rauscher murine leukemia virus (RLV), human immunodeficiency virus (HIV), Coxsackie virus, Ebolavirus, Zika virus, herpes simplex virus (HSV-1 and HSV-2), dengue virus, murine norovirus, infectious bronchitis virus, African swine fever virus, and both DNA polymerase α and DNA polymerase I. Intensive research suggests that the remarkable potential of myricetin in promoting either the prevention or overcoming of SARS-CoV-2 infection is due to the wide range of its effects on SARS-COV-2 proteases, including modulation of inflammatory processes and immune responses. In silico and in vitro studies demonstrated that myricetin can effectively interfere at various stages of viral infection, including the coronavirus entry and replication cycle due to its high-binding affinity with S-protein, ACE2 receptor, PLpro, Mpro, RdRp, exonuclease, and endoribonuclease. Based on the findings discussed in this review, myricetin, its glycosides, and dihydromyricetin, can be considered as multi-targeted agents having beneficial effects in combatting COVID-19.
Kaempferol Protects Against Apoptosis in PC12 Cells Exposed to Hydrogen Peroxide by Activating Akt1
Authors: Li Erliang , Yan Kang , Zhang Rui , Zou Peng , Li Shuang , Ma Qiong , Liao Bo
Published: April 2023

Objective

Spinal cord injury (SCI) is a debilitating disease that cannot be cured at present. Kaempferol (KPL) has proven neuroprotective, antioxidant, and antibacterial properties. However, the neuroprotective effect of KPL on SCI and its potential mechanism are still unclear.

Methods

Network pharmacology and molecular docking were used to determine the potential mechanisms of KPL on SCI. In vitro studies were used to validate the results. Hydrogen peroxide (H2O2)-exposed PC12 cells were pretreated with or without KPL. The safe concentrations of KPL, H2O2, and MK2206 in PC12 cells were determined via cell counting kit-8 assays. Then, terminal deoxynucleotidyl transferase dUTP nick end labeling staining and Annexin V-FITC/PI double staining were used to detect apoptotic cells. In addition, Western blotting was utilized to measure apoptosis-related gene and protein expression levels.

Results

Network pharmacology and molecular docking data demonstrated an interaction between KPL and Akt1 and identified apoptosis as a potential target of the KPL/Akt1 complex. The data verified that KPL could inhibit mitochondrial apoptosis in vivo by inducing Akt1 phosphorylation. Subsequently, MK2206, a pharmacological Akt1 inhibitor, was used to assess the role of Akt1 in this process, and we found that MK2206 attenuated the antiapoptotic effect of KPL on PC12 cells.

Conclusion

This study demonstrates that KPL could inhibit mitochondrial apoptosis by inducing the phosphorylation of Akt1, suggesting that KPL is a very promising candidate for SCI treatment.
Matrixmidface Preformed Orbital Implants for Three-Dimensional Reconstruction of Orbital Floor and Medial Wall Fractures: A Prospective Clinical Study
Authors: Chodankar Neha Umakant , Dhupar Vikas , Akkara Francis , Vijay Vathsalya
Published: April 2023

Study Design

Prospective Interventional study

Objective

To evaluate the efficiency of Matrixmidface preformed Orbital plates for three-dimensional reconstruction of orbital floor and medial wall fractures.

Methods

This prospective institutional clinical study was conducted on a group of 14 patients who underwent repair of orbital floor and medial wall fracture defects using Matrixmidface Preformed Orbital plates and open reduction and internal fixation of associated fractures. The following parameters were studied preoperative and postoperative enophthalmos, hypoglobus, orbital volume; correction of diplopia, intraoperative and postoperative complications.

Results

All 14 patients were males aged between 19 and 42 years. The most common mode of injury was found to be road traffic accidents (RTAs) followed by self-fall and trauma at workplace. Orbital fractures were associated with other concomitant maxillofacial fractures in 12 patients (85.7%) while 2 patients (14.3%) had pure blowout fractures. Significant improvement of enophthalmos was noted from preoperative period to 1 week, 6 weeks, and 6 months postoperatively ( P value .02, .01, and .01, respectively). Out of 11 patients with preoperative hypoglobus, 5 patients (45.45%) had persistent hypoglobus in the immediate postoperative period which reduced to 4 patients (36.36%) at 6 weeks postoperatively (p value .00). The postoperative orbital volume of fractured side ranged from 20.3 cm3 to 26.76 cm3 with a mean of 23.50 cm3 ± 1.74. The mean difference between the volumes of the repaired and uninjured sides was found to be .27 cm3 ± .39 ( P value .02) denoting that the reconstruction of the orbit closely approximated that of the uninjured side.

Conclusions

The Matrixmidface Preformed Orbital plate provides exceptional reconstruction of the orbital blowout fracture defects and ensures satisfactory results clinically and radiographically. The plate ensures an approximate recreation of topographical anatomy of the orbit and adequately restores the orbital volume. It provides adequate correction of asymmetry, hypoglobus, enophthalmos and attempts to restore eye movements, without causing any significant postoperative complication.
Bilateral eagle syndrome: A rare entity
Authors: Al-Abrar Ahmad Kailani Abdul Azim , Sobani Muhammad Ariff , Mat Barhan Noor Shairah , Rahim Norazila Abdul , Mansor Masaany , Lazim Norhafiza Mat
Published: April 2023

Elongated styloid process or Eagle syndrome is a rare condition presenting with a wide range of symptoms including throat pain, foreign body sensation, neck pain, and ear pain. Establishing a diagnosis requires a high index of suspicion and understanding of this entity by the physician. Computed tomography (CT) is the gold standard to diagnose Eagle syndrome. Conservative medical treatment with analgesics, oral steroids, and anticonvulsants are offered in patients who refused surgery. The mainstay of treatment is surgical resection through transoral or transcervical approaches. We describe a rare case of bilateral Eagle syndrome which presented with chronic foreign body sensation in the throat but aggravated by fish bone ingestion. Flexible nasopharyngolaryngoscopy (FNPLS) and cervical x-ray did not reveal any foreign body but showed an incidental finding of elongated styloid process bilaterally. Contrast-enhanced CT scan of the neck confirmed the finding of the elongated styloid process bilaterally. The patient underwent transoral endoscopic assisted bilateral styloidectomy following tonsillectomy. There was complete resolution of the symptoms during postoperative follow-up. This approach is recommended to avoid external scarring, minimize postoperative pain, and shorter hospital stay.
Cosmohistories and pluriversal dialogues: The future of the history of geography
Authors: Ferretti Federico , Barrera de la Torre Geronimo
Published: April 2023

When it comes to the ‘History of Geography’, many still think of something descriptive and conservative, which has virtually no links with the ‘future’, a metaphorical place where ‘progress’ and ‘advancements’ are usually located. The existence of such feelings exposes how some lingering positivistic views still remain in parts of the discipline that claimed to have got rid of positivism. In this commentary, we contend that the history of geography can play an important role in re-imagining the future of the discipline. First, drawing upon our own research experience and extending recent literature on ‘geographical futures’, we expose why the history of geography is making increasingly important contributions to key discussions in a plural and evolving discipline. We especially focus on the ongoing pluralistic and multilingual rediscovery of ‘other geographical traditions’ that is enriching critical, radical, and feminist approaches to geography. Next, we propose to enrich the field of geography and its prevailing ‘Western’ origin stories by engaging in pluriversal dialogues with Indigenous knowledge and practices, focusing on Latin America and on decolonial notions such as cosmohistory, which show that there are many histories of geography, and they all matter for the futures of the discipline.
Laparoscopic cholecystectomy after transcatheter arterial embolisation for haemobilia due to a pseudoaneurysm in the gallbladder: A case report
Authors: Itagaki Yuki , Yamamoto Kazuyuki , Kikuchi Tomoki , Takano Hironobu , Nishigami Kohei , Fukunaga Akira , Ichimura Tatsunosuke , Manase Hiroto , Hirano Satoshi
Published: April 2023

Pseudoaneurysms of the cystic artery are a rare but significant complication of acute cholecystitis. Laparoscopic cholecystectomy may be a safe alternative to open cholecystectomy in such cases. We report the case of a female patient in her seventies, who presented with anaemia, jaundice, and hepatic dysfunction during hospitalisation for right knee pyogenic arthritis. The patient had no pain in the right upper quadrant. Her serum haemoglobin level was 6.5 g/dL, and upper gastrointestinal endoscopy revealed no abnormalities. Six days later, jaundice worsened, and endoscopic retrograde cholangiopancreatography revealed bloody bile. An endoscopic biliary drainage tube was inserted at the discretion of the gastroenterology department. Contrast-enhanced computed tomography revealed a haematoma in the gallbladder and a pseudoaneurysm in the lateral wall of the gallbladder. On the same day, the endoscopic biliary drainage tube was replaced with an endoscopic nasobiliary drainage tube, which indicated the degree of haemorrhage and enabled lavage of the lumen in cases of obstruction. The next day, angiography revealed a pseudoaneurysm of the deep branch of the cystic artery and coil embolisation was performed at the periphery of the cystic artery. Uninterrupted laparoscopic cholecystectomy was performed. Although laparoscopic cholecystectomy is difficult when bleeding is uncontrolled, it was safely performed following haemostasis using transcatheter arterial embolisation. Laparoscopic cholecystectomy is feasible in haemodynamically stable patients with cystic artery pseudoaneurysms after transcatheter arterial embolisation.
Painful tonic spasms in a patient with neuromyelitis optica spectrum disorder: A case report
Authors: Aryal Roshan , Homagian Sushan , Shrestha Suraj , Gajurel Bikram Prasad , Karn Ragesh , Rajbhandari Reema , Gautam Niraj , Shrestha Ashish , Shahi Sumit , Ojha Rajeev
Published: April 2023

Painful tonic spasms initially described in association with multiple sclerosis are actually more common in patients with neuromyelitis optica spectrum disorder. Characterized by fierce pain and tonic posture of limbs, painful tonic spasms are common in patients during the recovery phase after the first episode of myelitis. A 68-year-old man presented with painful tonic spasm after 2 months of diagnosis of neuromyelitis optica spectrum disorder. Eventual use of eslicarbazepine resulted in significant control of spasms. Early recognition of painful tonic spasms and appropriate therapeutic medications can significantly decrease the impact it can have on the quality of life among neuromyelitis optica spectrum disorder patients.
Medicinal Cannabis and Implications for Workplace Health and Safety: Scoping Review of Systematic Reviews
Authors: O’Neill Veronica , Karanikas Nektarios , Sav Adem , Murphy Patricia
Published: April 2023

Purpose:

Although medicinal cannabis is prescribed for conditions such as pain, epilepsy, nausea and vomiting during cancer treatment, evidence about associated adverse side effects is still evolving. Because adverse events (AEs) might impact the performance of workers, it is important to consider their implications on workplace health and safety (WHS). This study aimed to map the types and prevalence of the AEs associated with medical cannabis and articulate how those events could impact WHS.

Methods:

A scoping review of systematic reviews and/or meta-analyses published between 2015 and March 2021 was performed to identify the AEs of medicinal cannabis in adults. Publications in English and full text available online were collected from Embase, MEDLINE, PsychINFO, PubMed, Scopus, and Web of Science.

Results:

Of 1,326 papers identified from the initial search, 31 met the inclusion criteria and were analyzed. The studies reported various AEs with the most predominant being sedation, nausea/vomiting, dizziness, and euphoria. Acute and chronic pain was the most prevalent disorder under review.

Conclusions:

Adverse events associated with the use of medicinal cannabis could increase workplace risks, including decreased alertness and reaction times, increased absenteeism, reduced ability to safely drive or operate machinery and an increased probability of falling. Focused research into the risk to workers and workplaces from the use of medical cannabis and related human performance impairment is urgently warranted.
Serial Quantitative Assessment of Load Redistribution After Medial Open-Wedge High Tibial Osteotomy
Authors: Jeong Ho Won , Song Yoo Sung , Kim Joo Sung , Nam Hee Seung , Lee Won Woo , Lee Yong Seuk
Published: April 2023

Background:

The maximum standardized uptake value (SUVmax), as determined on combined single-photon emission computed tomography and conventional computed tomography (SPECT/CT), can be an indicator of biomechanical changes due to the load redistribution effect after medial open-wedge high tibial osteotomy (MOW-HTO).

Purpose/Hypothesis:

The purposes of this study were to (1) analyze serial changes in the SUVmax in the medial, lateral, and patellofemoral compartments after MOW-HTO and (2) identify the contributing factors that affect changes in the SUVmax. The hypotheses were that (1) an elevated SUVmax in the medial compartment would be transferred to the lateral compartment because of the load redistribution effect and (2) there would be contributing factors that cause SUVmax changes.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included were 67 knees that were treated with biplanar MOW-HTO between March 2019 and December 2020. SPECT/CT was performed immediately after surgery and at 3 months and 1 year postoperatively to determine the serial load redistribution effect of MOW-HTO. The Pearson correlation coefficient was used to evaluate the relationship between SUVmax and radiological parameters, and subgroup analyses were conducted to compare the SUVmax according to associated cartilage procedures and the weightbearing line ratio (WBLR).

Results:

The SUVmax in the medial and lateral compartments increased at 3 months but decreased at 1 year postoperatively. The load redistribution effect was most prominent in the anterior zones of the femur (medial: P = .041; lateral: P = .012). In the patella, the SUVmax decreased in both the medial and the lateral zones at all follow-up times ( P < .001 for all). The SUVmax in the anterolateral and posterolateral articular zones of the femur increased with a greater preoperative WBLR ( r = 0.256, P = .039; and r = 0.261, P = .036, respectively). Patients who underwent an associated cartilage procedure had a significantly higher SUVmax in the anteromedial and posteromedial articular zones of both the femur and the tibia at 1 year postoperatively ( P ≤ .002 for all).

Conclusion:

After MOW-HTO, the unloading effect in the anteromedial articular zone of the femur was the most significant. A greater SUVmax in the lateral zones of the femur was observed in cases of overcorrection. The SUVmax in the medial zones was higher postoperatively in patients with associated cartilage procedures.
PsyCalibrator: An Open-Source Package for Display Gamma Calibration and Luminance and Color Measurement
Authors: Lin Zhicheng , Ma Qi , Zhang Yang
Published: April 2023

Studies in vision, psychology, and neuroscience often present visual stimuli on digital screens. Crucially, the appearance of visual stimuli depends on properties such as luminance and color, making it critical to measure them. Yet conventional luminance-measuring equipment is not only expensive but also onerous to operate (particularly for novices). Building on previous work, here we present an open-source integrated software package—PsyCalibrator ( https://github.com/yangzhangpsy/PsyCalibrator )—that takes advantage of consumer hardware (SpyderX, Spyder5) and makes luminance/color measurement and gamma calibration accessible and flexible. Gamma calibration based on visual methods (without photometers) is also implemented. PsyCalibrator requires MATLAB (or its free alternative, GNU Octave) and works in Windows, macOS, and Linux. We first validated measurements from SpyderX and Spyder5 by comparing them with professional, high-cost photometers (ColorCAL MKII Colorimeter and Photo Research PR-670 SpectraScan). Validation results show (a) excellent accuracy in linear correction and luminance/color measurement and (b) for practical purposes, low measurement variances. We offer a detailed tutorial on using PsyCalibrator to measure luminance/color and calibrate displays. Finally, we recommend reporting templates to describe simple (e.g., computer-generated shapes) and complex (e.g., naturalistic images and videos) visual stimuli.
Esophageal Perforation Etiologies, Management, and Outcomes at a Tertiary Academic Medical Center
Authors: Nguyen Madison , Clayton Steven
Published: April 2023

Background:

Esophageal perforations can occur spontaneously, but most are iatrogenic and related to procedures. The literature reports death rates from 10% to 26%. Our goals were to summarize demographics, comorbidities, managing services, perforation sites, outcomes, and complications of esophageal perforations at a tertiary academic medical center.

Methods:

This was a retrospective chart review. ICD and CPT codes were used to identify 89 subjects who experienced esophageal perforation from 2008 to 2020. Patients under age 18 were excluded from the study.

Results:

Patients diagnosed with esophageal perforation averaged 67 years. Perforations affected more males than females. Most perforations were contained and referred from outside hospitals. Thoracic esophageal perforations predominated followed by cervical and abdominal. Iatrogenic causes were identified in 56% of cases. The most common underlying diseases were gastrointestinal, cardiac, and cancer. Most patients were managed by a multidisciplinary team. The most common complication was empyema managed with chest tubes.

Conclusions:

We report an esophageal perforation mortality rate of 9%. Approximately 1% of perforations directly led to death. All uncontained thoracic perforations were complicated by empyema and managed with chest tubes. We observed more contained versus uncontained perforations, which may have contributed to higher survival rate. Our institution’s multidisciplinary approach to managing perforations potentially contributed to better outcomes and increased survival. Esophageal perforation remains a medical emergency, but perhaps with prompt recognition and interdisciplinary management, outcomes may not be as dreadful as previously reported.
Residual risk identified in routine noninvasive follow-up assessments in pulmonary arterial hypertension
Authors: Ostermann Jonna , Pott Julian , Hennigs Jan K. , Roedl Kevin , Sinning Christoph , Harbaum Lars , Klose Hans
Published: April 2023

Background

The 2022 ESC/ERS guidelines on pulmonary hypertension recommend noninvasive risk assessments based on three clinical variables during follow-up in patients with pulmonary arterial hypertension (PAH). We set out to test whether residual risk can be captured from routinely measured noninvasive clinical variables during follow-up in PAH.

Methods

We retrospectively studied 298 incident PAH patients from a German pulmonary hypertension centre who underwent routine noninvasive follow-up assessments including exercise testing, echocardiography, electrocardiography, pulmonary function testing and biochemistry. To select variables, we used least absolute shrinkage and selection operator (LASSO)-regularised Cox regression models. Outcome was defined as mortality or lung transplant after first follow-up assessment.

Results

12 noninvasive variables that were associated with outcomes in a training sub-cohort (n=208) after correction for multiple testing entered LASSO modelling. A model combining seven variables discriminated 1-year (area under the curve (AUC) 0.83, 95% confidence interval (CI) 0.68–0.99, p=8.4×10−6) and 3-year (AUC 0.81, 95% CI 0.70–0.92, p=2.9×10−8) outcome status in a replication sub-cohort (n=90). The model's discriminatory ability was comparable to that of the guideline approach in the replication sub-cohort. From the individual model components, World Health Organization functional class, 6-min walking distance and the tricuspid annular plane systolic excursion to systolic pulmonary arterial pressure (TAPSE/sPAP) ratio were sensitive to treatment initiation. Addition of TAPSE/sPAP ratio to the guideline approach numerically increased its ability to discriminate outcome status.

Conclusion

Our real-world data suggest that residual risk can be captured by noninvasive clinical procedures during routine follow-up assessments in patients with PAH and highlights the potential use of echocardiographic imaging to refine risk assessment.
Comprehensive analysis and expression profiles of the AP2/ERF gene family during spring bud break in tea plant (Camellia sinensis)
Authors: Liu Yujie , Chen Si , Chen Jiedan , Wang Junyu , Wei Mengyuan , Tian Xiaomiao , Chen Liang , Ma Jianqiang
Published: April 2023

Background

AP2/ERF transcription factors (AP2/ERFs) are important regulators of plant physiological and biochemical metabolism. Evidence suggests that AP2/ERFs may be involved in the regulation of bud break in woody perennials. Green tea is economically vital in China, and its production value is significantly affected by the time of spring bud break of tea plant. However, the relationship between AP2/ERFs in tea plant and spring bud break remains largely unknown.

Results

A total of 178 AP2/ERF genes (CsAP2/ERFs) were identified in the genome of tea plant. Based on the phylogenetic analysis, these genes could be classified into five subfamilies. The analysis of gene duplication events demonstrated that whole genome duplication (WGD) or segmental duplication was the primary way of CsAP2/ERFs amplification. According to the result of the Ka/Ks value calculation, purification selection dominated the evolution of CsAP2/ERFs. Furthermore, gene composition and structure analyses of CsAP2/ERFs indicated that different subfamilies contained a variety of gene structures and conserved motifs, potentially resulting in functional differences among five subfamilies. The promoters of CsAP2/ERFs also contained various signal-sensing elements, such as abscisic acid responsive elements, light responsive elements and low temperature responsive elements. The evidence presented here offers a theoretical foundation for the diverse functions of CsAP2/ERFs. Additionally, the expressions of CsAP2/ERFs during spring bud break of tea plant were analyzed by RNA-seq and grouped into clusters A-F according to their expression patterns. The gene expression changes in clusters A and B were more synchronized with the spring bud break of tea plant. Moreover, several potential correlation genes, such as D-type cyclin genes, were screened out through weighted correlation network analysis (WGCNA). Temperature and light treatment experiments individually identified nine candidate CsAP2/ERFs that may be related to the spring bud break of tea plant.

Conclusions

This study provides new evidence for role of the CsAP2/ERFs in the spring bud break of tea plant, establishes a theoretical foundation for analyzing the molecular mechanism of the spring bud break of tea plant, and contributes to the improvement of tea cultivars.
Postoperative pulmonary complications after sugammadex reversal of neuromuscular blockade: a systematic review and meta-analysis with trial sequential analysis
Authors: Liu Hong-Mei , Yu Hong , Zuo Yi-Ding , Liang Peng
Published: April 2023

Background

Sugammadex has been reported to lower the incidence of postoperative residual neuromuscular blockade. Despite the advantages, until recently the effects of sugammadex on postoperative pulmonary complications (PPCs) were controversial. We conducted a systematic review and meta-analysis to determine whether reversal with sugammadex was associated with a lower risk of PPCs compared with neostigmine.

Methods

PubMed, Embase, and Cochrane Central Register of Controlled Trials were searched from inception to May 2022. Randomized controlled trials (RCTs) and observational studies comparing PPCs in patients receiving sugammadex or neostigmine as reversal agent at the end of surgery were included. The primary outcomes focused on PPCs including desaturation, pneumonia, atelectasis, noninvasive ventilation (NIV) and reintubation. Trial sequential analysis was performed on the primary outcomes to confirm whether firm evidence was reached.

Results

Meta-analysis of included studies showed that the rate of desaturation (43.2% vs 45.0%, RR = 0.82; 95% CI 0.63 to 1.05; p = 0.11) were comparable between the two groups. When looking at other primary outcomes, significantly lower risk of pneumonia (1.37% vs 2.45%, RR = 0.65; 95% CI 0.49 to 0.85; p = 0.002), atelectasis (24.6% vs 30.4%, RR = 0.64; 95% CI 0.42 to 0.98; p = 0.04), NIV (1.37% vs 2.33%, RR = 0.65; 95% CI 0.43 to 0.98; p = 0.04) and reintubation (0.99% vs 1.65%, RR = 0.62; 95% CI 0.43 to 0.91; p = 0.01) in the sugammadex group were detected compared with the neostigmine group.

Conclusions

We concluded that sugammadex is more effective at reducing the incidence of PPCs including pneumonia, atelectasis, NIV and reintubation compared with neostigmine. Further evidence, preferably from RCTs, is required to confirm these findings.
Predicting hypertension by obesity- and lipid-related indices in mid-aged and elderly Chinese: a nationwide cohort study from the China Health and Retirement Longitudinal Study
Authors: Li Yuqing , Gui Jiaofeng , Zhang Xiaoyun , Wang Ying , Mei Yujin , Yang Xue , Liu Haiyang , Guo Lei-lei , Li Jinlong , Lei Yunxiao , Li Xiaoping , Sun Lu , Yang Liu , Yuan Ting , Wang Congzhi , Zhang Dongmei , Wei Huanhuan , Li Jing , Liu Mingming , Hua Ying , Zhang Lin
Published: April 2023

Background

Currently, the study outcomes of anthropometric markers to predict the risk of hypertension are still inconsistent due to the effect of racial disparities. This study aims to investigate the most effective predictors for screening and prediction of hypertension (HTN) in the Chinese middle-aged and more elderly adult population and to predict hypertension using obesity and lipid-related markers in Chinese middle-aged and older people.

Methods

The data for the cohort study came from the China Health and Retirement Longitudinal Study (CHARLS), including 4423 middle-aged and elderly people aged 45 years or above. We examined 13 obesity- and lipid-related indices, including waist circumference (WC), body mass index (BMI), waist-height ratio (WHtR), visceral adiposity index (VAI), a body shape index (ABSI), body roundness index (BRI), lipid accumulation product index (LAP), conicity index (CI), Chinese visceral adiposity index (CVAI), triglyceride-glucose index (TyG-index) and their combined indices (TyG-BMI, TyG-WC, TyG-WHtR). To compare the capacity of each measure to forecast the probability of developing HTN, the receiver operating characteristic curve (ROC) was used to determine the usefulness of anthropometric indices for screening for HTN in the elderly and determining their cut-off value, sensitivity, specificity, and area under the curve (AUC). Association analysis of 13 obesity-related anthropometric indicators with HTN was performed using binary logistic regression analysis.

Results

During the four years, the incident rates of HTN in middle-aged and elderly men and women in China were 22.08% and 17.82%, respectively. All the above 13 indicators show a modest predictive power (AUC > 0.5), which is significant for predicting HTN in adults (middle-aged and elderly people) in China (P < 0.05). In addition, when WHtR = 0.501 (with an AUC of 0.593, and sensitivity and specificity of 63.60% and 52.60% respectively) or TYg-WHtR = 4.335 (with an AUC of 0.601, and sensitivity and specificity of 58.20% and 59.30% respectively), the effect of predicting the incidence risk of men is the best. And when WHtR = 0.548 (with an AUC of 0.609, and sensitivity and specificity of 59.50% and 56.50% respectively) or TYg-WHtR = 4.781(with an AUC of 0.617, and sensitivity and specificity of 58.10% and 60.80% respectively), the effect of predicting the incidence risk of women is the best.

Conclusions

The 13 obesity- and lipid-related indices in this study have modest significance for predicting HTN in Chinese middle-aged and elderly patients. WHtR and Tyg-WHtR are the most cost-effective indicators with moderate predictive value of the development of HTN.
Determinants of vitamin B12 deficiency in patients with type-2 diabetes mellitus — A primary-care retrospective cohort study
Authors: Wee Andrew Kien Han , Sultana Rehena
Published: April 2023

Background

Like many developed nations, the prevalence of both older people and type-2 diabetes mellitus (T2DM) in Singapore is rising. This demographic shift predisposes the population to greater risks of both frailty and its complications that can be further aggravated by vitamin B12 deficiency —a highly prevalent associated variable that is potentially modifiable.

Indeed, B12 deficiency adversely impacts the neuro-cognitive, haematological, and even the immune systems; jeopardizing our aspirations for successful aging. Despite this, many patients with T2DM in primary care remain unscreened due to a lack of clear guidelines for regular B12 screening. We therefore investigated the determinants of B12 deficiency in community-dwelling patients with T2DM, with the aim of profiling patients most in need of B12-deficiency screening.

Methods

B12 deficiency was evaluated using a retrospective cross-sectional cohort of 592 primary-care patients with T2DM, recruited from 2008 to 2011 from a Polyclinic in Singapore.

Results

B12 deficiency (serum B12 < 150 pmol/L) was present in 164 (27.7%) patients and was associated with a higher “metformin daily dose” (OR = 2.79; 95% CI, 2.22–3.48, P < 0.001); “age ≥ 80 years” (OR = 2.86; 95% CI, 1.31–6.25, P = 0.008); “vegetarianism” (OR = 21.61; 95% CI, 4.47–104.44, P < 0.001); and “folate deficiency” (OR = 2.04; 95% CI, 1.27–3.28, P = 0.003). Conversely, “Prescribed B12 supplementation” was associated with a lower odds of B12 deficiency (OR = 0.37; 95% CI: 0.22–0.61, P < 0.001). The area under the receiver operating characteristic curve was 0.803 (95% CI: 0.765–0.842).

“Metformin daily dose” correlated interchangeably with “Metformin 1-year cumulative dose” (r = 0.960; P < 0.01), and also associated linearly with “duration of diabetes” (B = 0.113, P < 0.0001).

Independent of the duration of T2DM, 29.3% of the B12-deficient patients needed > 1 screening test before the detection of B12 deficiency.

Conclusions

Primary-care screening for B12 deficiency should be part of the annual laboratory review of patients with T2DM regardless of the duration of T2DM —especially when they are prescribed ≥ 1.5 g/day of metformin; ≥ 80 years old; vegetarian; and not prescribed B12 supplementation. Concurrent evaluation for associated folate (vitamin B9) deficiency is essential when addressing T2DM-associated B12 deficiencies.

Current “Metformin daily dose” is an accurate proxy of both cumulative metformin exposure and duration of T2DM.
Research on layout model and construction planning of aged care institutions for disabled elders in China: based on Nanjing city data
Authors: Guo Xiaojun , Shen Houxue , Wen Qinglan , Liu Sifeng , Yang Yingjie , Zhang Hui
Published: April 2023

Background

To meet the needs of diversified pension services and the construction of aged care institutions is one of the urgent livelihood issues in China. Under the major national needs of pension and care for the elderly, it is necessary to optimize the allocation of pension and care for the elderly resources, and formulate operational coping strategies and optimization plans. It is of great significance to deal with the urgent problem of population aging in a timely and scientific way.

Methods

The economic benefits and social costs of aged care institutions are regarded as objective functions. To satisfy the economic benefits, it is necessary to reduce the social costs, and its construction quantity can only be an integer. The multi-objective genetic algorithm is improved with integer programming, and the global optimal solution is achieved after several times of searching. Under the multi-objective optimization model, the improved genetic algorithm was combined with the superior and inferior solution distance method to solve the genetic algorithm, and the corresponding objective function value was obtained after rounding. Finally, Pareto optimal solution set is selected by multi-objective decision, and the result of construction planning is obtained.

Results

Based on multi-attribute decision analysis and taking three years as the construction cycle, the planning scheme of aged care institutions construction in each district of Nanjing in the next 15 years was proposed. In addition, considering the intelligent trend of future pension, the proportion of home-based pension is increasing year by year, and the model is promoted to meet the needs of diversified pension services. With the gradual increase of the elderly population in Nanjing, the proportion of intelligent home-based care has been increasing year by year since 2027, and the construction demand of aged care institutions has also increased. The number of construction at all levels rises gradually in each cycle, and the increase is more obvious after 2027.

Conclusions

The layout and planning of aged care institutions proposed in this paper not only considers economic and environmental benefits, but also combines the current situation of aged care institutions in various districts of Nanjing. The model is reasonable and effective, and has practical application value. It will help China optimize the allocation of elderly care resources under the target of active aging, and scientifically and comprehensively deal with the problem of population aging.
Predicting norovirus and rotavirus resurgence in the United States following the COVID-19 pandemic: a mathematical modelling study
Authors: Lappe Brooke L. , Wikswo Mary E. , Kambhampati Anita K. , Mirza Sara A. , Tate Jacqueline E. , Kraay Alicia N. M. , Lopman Ben A.
Published: April 2023

Background

To reduce the burden from the COVID-19 pandemic in the United States, federal and state local governments implemented restrictions such as limitations on gatherings, restaurant dining, and travel, and recommended non-pharmaceutical interventions including physical distancing, mask-wearing, surface disinfection, and increased hand hygiene. Resulting behavioral changes impacted other infectious diseases including enteropathogens such as norovirus and rotavirus, which had fairly regular seasonal patterns prior to the COVID-19 pandemic. The study objective was to project future incidence of norovirus and rotavirus gastroenteritis as contacts resumed and other NPIs are relaxed.

Methods

We fitted compartmental mathematical models to pre-pandemic U.S. surveillance data (2012–2019) for norovirus and rotavirus using maximum likelihood estimation. Then, we projected incidence for 2022–2030 under scenarios where the number of contacts a person has per day varies from70%, 80%, 90%, and full resumption (100%) of pre-pandemic levels.

Results

We found that the population susceptibility to both viruses increased between March 2020 and November 2021. The 70–90% contact resumption scenarios led to lower incidence than observed pre-pandemic for both viruses. However, we found a greater than two-fold increase in community incidence relative to the pre-pandemic period under the 100% contact scenarios for both viruses. With rotavirus, for which population immunity is driven partially by vaccination, patterns settled into a new steady state quickly in 2022 under the 70–90% scenarios. For norovirus, for which immunity is relatively short-lasting and only acquired through infection, surged under the 100% contact scenario projection.

Conclusions

These results, which quantify the consequences of population susceptibility build-up, can help public health agencies prepare for potential resurgence of enteric viruses.
Automated classification of polyps using deep learning architectures and few-shot learning
Authors: Krenzer Adrian , Heil Stefan , Fitting Daniel , Matti Safa , Zoller Wolfram G. , Hann Alexander , Puppe Frank
Published: April 2023

Background

Colorectal cancer is a leading cause of cancer-related deaths worldwide. The best method to prevent CRC is a colonoscopy. However, not all colon polyps have the risk of becoming cancerous. Therefore, polyps are classified using different classification systems. After the classification, further treatment and procedures are based on the classification of the polyp. Nevertheless, classification is not easy. Therefore, we suggest two novel automated classifications system assisting gastroenterologists in classifying polyps based on the NICE and Paris classification.

Methods

We build two classification systems. One is classifying polyps based on their shape (Paris). The other classifies polyps based on their texture and surface patterns (NICE). A two-step process for the Paris classification is introduced: First, detecting and cropping the polyp on the image, and secondly, classifying the polyp based on the cropped area with a transformer network. For the NICE classification, we design a few-shot learning algorithm based on the Deep Metric Learning approach. The algorithm creates an embedding space for polyps, which allows classification from a few examples to account for the data scarcity of NICE annotated images in our database.

Results

For the Paris classification, we achieve an accuracy of 89.35 %, surpassing all papers in the literature and establishing a new state-of-the-art and baseline accuracy for other publications on a public data set. For the NICE classification, we achieve a competitive accuracy of 81.13 % and demonstrate thereby the viability of the few-shot learning paradigm in polyp classification in data-scarce environments. Additionally, we show different ablations of the algorithms. Finally, we further elaborate on the explainability of the system by showing heat maps of the neural network explaining neural activations.

Conclusion

Overall we introduce two polyp classification systems to assist gastroenterologists. We achieve state-of-the-art performance in the Paris classification and demonstrate the viability of the few-shot learning paradigm in the NICE classification, addressing the prevalent data scarcity issues faced in medical machine learning.
Prevalence of pituitary dysfunction after aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis
Authors: Song Xiaowei , Cong Shengnan , Zhang Ming , Gan Xiaokui , Meng Fan , Huang Baosheng
Published: April 2023

Background

Pituitary dysfunction (PD) is a common complication after aneurysmal subarachnoid hemorrhage (aSAH). The prevalence of PD varies widely at a global level and no recent meta-analysis is available. Therefore, the aim of our systematic review and meta-analysis was to summarize the updated estimates of worldwide prevalence of PD after aSAH.

Methods

Scopus, Embase, Web of Science, and PubMed databases were used to comprehensively search the appropriate literature and a random-effects meta-analysis on the results of the available studies was performed. The heterogeneity in the prevalence estimates was evaluated by subgroup analysis in terms of types of PD, and acute and chronic phases of aSAH. The onset of PD within 6 months after aSAH was considered as acute, while that after 6 months was considered as chronic.

Results

Twenty-seven studies with 1848 patients were included in this analysis. The pooled prevalence of PD in the acute phase was 49.6% (95% CI, 32.4-66.8%), and 30.4% (95% CI, 21.4-39.4%) in the chronic phase. Among the hormonal deficiencies, growth hormone dysfunction was the most prevalent in the acute phase, being 36.0% (95% CI, 21.0-51.0%), while hypoadrenalism was the most prevalent in the chronic phase, being 21.0% (95% CI, 12.0-29.0%). Among the six World Health Organization regions, the South-East Asia Region has the highest prevalence of PD in the acute phase (81.0%, 95%CI, 77.0-86.0%, P < 0.001), while the European Region had the highest prevalence of PD in the chronic phase (33.0%, 95%CI, 24.0-43.0%, P < 0.001). Moreover, single pituitary hormonal dysfunction occurred more frequently than the multiple one, regardless of acute or chronic phase.

Conclusions

Almost half (49.6%) of the included patients with aSAH developed PD complication in the acute phase, while 30.4% of the patients developed them in the chronic phase. Although prevalence varies globally, the high healthcare burden, morbidity and mortality require greater awareness among clinicians.
Relationship between mean blood pressure during hospitalization and clinical outcome after acute ischemic stroke
Authors: Hu Manyan , Zhu Yuan , Chen Zhaoyao , Li Wenlei , Li Li , Li Yunze , Xia Yangjingyi , Zhang Tianrui , Feng Qinghua , Wu Jiacheng , Wu Minghua
Published: April 2023

Objective

The optimal blood pressure (BP) targets for acute ischemic stroke are unclear. We aimed to assess the relationship between Mean BP and clinical outcomes during hospitalization.

Materials and methods

We included 649 patients with Acute ischemic stroke (AIS) from December 2020 to July 2021. BP was measured daily, and mean blood pressure was calculated. Clinical events recorded within 90 days of randomization were: recurrent ischemic stroke, symptomatic intracranial hemorrhage, and death. The modified Rankin Scale (mRS) was used to measure primary outcomes 3 months after AIS. Logistic multiple regression analysis was performed by statistical software R.

Result

There is a nonlinear U-shaped relationship between SBP and poor outcomes. This means higher SBP and lower SBP will increase the incidence of poor outcomes. The optimal mean SBP during hospitalization was 135-150 mmHg, and patients with SBP < 135mmhg OR 2.4 [95% Cl, (1.16 ~ 4.97)], P = 0.018; and > 150mmhg OR 2.04 [95% Cl, 1.02 ~ 4.08], p = 0.045 had a higher probability of poor outcomes.

Conclusion

Our study shows that the optimal SBP of patients with AIS during hospitalization was 135-150 mmHg. The findings suggest that the relationship between mean SBP and 3-month functional outcome after AIS was U-shaped. Both higher SBP and lower SBP lead to poor prognosis in AIS patients.
Intensive Neurophysiological Rehabilitation System for children with cerebral palsy: a quasi-randomized controlled trial
Authors: Kushnir A , Kachmar O
Published: April 2023

Background

Recent research indicates that intensive rehabilitation tends to be effective for children with cerebral palsy (CP). Intensive Neurophysiological Rehabilitation System (INRS) is a multi-component approach that combines various interventions and addresses different functional goals.. This study aimed to examine the effectiveness of the INRS treatment in children with bilateral CP.

Methods

In this quasi-randomized controlled study, 48 children with spastic bilateral CP (age 5–12 years, GMFCS Levels I-IV, MACS Levels I-IV) were assigned to an experimental or control group in order they have been enrolled. The experimental group underwent INRS treatment in the tertiary care facility for about four hours daily for ten days and continued routine home treatment for four weeks. After the first evaluation, participants from the control group stayed on the waiting list for four weeks receiving home treatment and then starting the INRS treatment. Thereby, all participants were assessed three times. The primary outcome measure was a Gross Motor Function Measure 66 Item Set (GMFM). The secondary outcome measures included the Jebsen-Taylor Hand Function test, Box and Blocks test, ABILHAND-Kids Questionnaire, Self-care and Mobility domain of the Pediatric Evaluation of Disability Inventory, and the ankle dorsiflexion passive range of motion.

Results

There was a statistically significant increase in the GMFM score after the INRS treatment in both the experimental group (mean difference (MD) 2.0, P < 0.01) and control group (MD 1.5, P < 0.05), with a large size effect (partial eta squared (η2) = 0.21 and η2 = 0.14). The mean difference between groups during the first study period was 2.89 points (p < 0.01) in the GMFM score with a medium effect size (η2 = 0.12). Statistically significant superiority of the INRS treatment over home treatment was also obtained by Jebsen-Taylor Hand Function Test and the Box and Blocks Test in both dominant and non-dominant hands.

Conclusions

The study indicates that the INRS treatment can be beneficial for improving both gross motor functions and hand function in children with bilateral CP. Further longitudinal studies are required to evaluate the effects of the INRS treatment on the participation level of children with CP.

Trial registration

The study protocol was registered on ClinicalTrials.gov under the identifier: NCT04093180 on 17/09/2019.