bluuebunny/crossref_metadata_2025 huggingface dataset:
Early Surgical Fixation for Hip Fractures in Patients Taking Direct Oral Anticoagulation: A Retrospective Cohort Study
Authors: King Kieran , Polischuk Michael , Lynch Genni , Gergis Anthony , Rajesh Ashwin , Shelfoon Christopher , Kattar Nrusheel , Sriselvakumar Sajan , Cooke Cameron
Published: July 2020

Introduction:

Currently, evidence-based guidelines regarding delay to theatre for urgent surgical intervention in patients taking direct oral anticoagulants (DOACs) are lacking. Therefore, this study aims to investigate the effect of DOACs on patient outcomes receiving early (<48 hours) versus delayed (>48 hours) surgery for neck of femur fractures.

Methods:

A retrospective cohort study was conducted at a tertiary teaching hospital. Treatment groups were hip fracture patients taking DOACs on admission and receiving surgery in <48 hours (n = 17) and >48 hours (n = 11). A control cohort of hip fracture patients not taking DOACs (n = 56) was matched to the <48 hours treatment group for comparison. Patient demographics were recorded and key outcome measures included perioperative hemoglobin levels, transfusion rates, time to surgery, 90-day mortality, hematoma rates, and length of stay in hospital.

Results:

There was no significant difference in perioperative hemoglobin levels, transfusion rates, or hematoma between groups. Patients taking DOACs and receiving early surgery had significantly longer time to surgery compared to the non-DOAC control (32.21 ± 7.83 vs 25.98 ± 11.4, P = .01). No deaths were recorded in the early DOAC group at 90 days, compared to 4 (36%) in the late DOAC group ( P = .04).

Discussion and Conclusions:

Our study suggests hip fracture patients taking DOACs on admission is not a reason to delay surgery. However, given the lack of literature in this area, further prospective research with larger patient numbers is required to definitively guide clinical practice.
Knowledge of Heat-Related Illness First Aid and Self-Reported Hydration and Heat-Related Illness Symptoms in Migrant Farmworkers
Authors: Smith Daniel J. , Ferranti Erin P. , Hertzberg Vicki S. , Mac Valerie
Published: July 2020

Background: Outdoor workers are exposed to hot work environments and are at risk of heat-related morbidity and mortality. The purpose of this study was to evaluate the knowledge of migrant farmworkers about first aid for heat-related illness (HRI) symptoms. Methods: The authors recruited 60 migrant farmworkers out of 66 who were approached from vegetable farms in Georgia. They were workers who participated in the 2018 Farmworker Family Health Program (FWFHP). The authors surveyed the workers to assess demographics, prevalence of HRI symptoms, hydration practices, and knowledge of HRI first aid. Descriptive statistics for worker demographics, HRI symptoms, and hydration data were calculated, as were the percentages of correctly answered pilot questions. Findings: Of the 60 workers who chose to participate in this study, more than 50% incorrectly answered pilot questions related to their knowledge of HRI first aid. The two most common HRI symptoms reported were heavy sweating and muscle cramps. More than two thirds reported experiencing at least one HRI symptom during the workday. Mean liquid consumption within this sample was 72.95 oz per day, which is much less than the recommended 32 oz per hour. Conclusion/Application to Practice: Until larger structural change can occur to protect farmworkers, farm owners can prevent morbidity and mortality from inadequate hydration practices and working in high-heat conditions by providing migrant farmworkers with training in heat-related first aid. Appropriate heat-illness interventions should focus on first aid measures to reduce morbidity and mortality related to heat illness in farmworkers.
The value of sub-national data: The dynamics of contentious politics in Nepal
Authors: González Belén , Vüllers Johannes
Published: July 2020

Over the last decade, a renewed interest in the empirical analysis of contentious politics has led to significant improvements in the quality and quantity of data. The related wave of research has thus turned to analysis of the dynamics of contentious politics from a comparative perspective. Unfortunately, these studies use country level datasets for their analysis, creating a mismatch between the original actor-based theoretical framework and the empirical conceptualization of contentious collective action. We discuss the conceptual challenges this theoretical-empirical gap generates and highlight how contentious dynamics can be studied with a bottom-up sub-national approach. To do so, we present a new fine-grained dataset of contentious collective action in post-conflict Nepal (2007 to 2010). We descriptively show how this type of data can help us improve our understanding of repertoires of contentious politics. This paper highlights the relevance of gathering information on active organizations to study the inherent dynamics of contentious politics.
Spontaneous Tumor Lysis Syndrome in Blastoid-Variant Mantle Cell Lymphoma: Considerations for the General Internist
Authors: Patel Vishal , Case Robert
Published: July 2020

Spontaneous tumor lysis syndrome (SPTLS) is a rare phenomenon that can manifest in rapidly proliferating hematological malignancies and solid tumors prior to initiating cytotoxic therapy. We encountered a patient who originally presented with diffuse lymphadenopathy, abdominal distention, and dyspnea, who had laboratory abnormalities suggestive of SPTLS. His peripheral flow cytometry and lymph node biopsy revealed blastoid-variant mantle cell lymphoma. Prior to initiating chemotherapy, acute kidney injury (AKI) and uric acid had improved with intravenous fluids and the initiation of allopurinol. However, after beginning chemotherapy, the patient developed a second AKI concerning for tumor lysis syndrome (TLS). He went on to have renal recovery and did not require renal replacement therapy. With the exception of case reports, there is limited evidence to guide general medicine clinicians who encounter cases of SPTLS. Expert-based guidelines are available to guide use of rasburicase, an uricase enzyme, before initiation of chemotherapy for certain malignancies when risk for TLS is considered high. Despite these guidelines, the role of rasburicase in preventing AKI remains controversial after inconclusive results in a meta-analysis. The causative relationship between uric acid and AKI in TLS is based on a mechanism of tubular obstruction. There are also mechanisms by which uric acid may cause AKI without tubular obstruction related to acute hyperuricemic nephropathy. Further characterization of the role of uric acid in causing AKI in patients without tubular obstruction may identify new mechanisms of injury and offer insight into new treatment strategies.
Does Anterior Cruciate Ligament Reconstruction Protect the Meniscus and Its Repair? A Systematic Review
Authors: Korpershoek Jasmijn V. , de Windt Tommy S. , Vonk Lucienne A. , Krych Aaron J. , Saris Daniel B.F.
Published: July 2020

Background:

Anterior cruciate ligament (ACL) tear and meniscal injury often co-occur. The protective effect of early ACL reconstruction (ACLR) on meniscal injury and its repair is not clear. Critical literature review can support or change clinical strategies and identify gaps in the available evidence.

Purpose:

To assess the protective effect of ACLR on the meniscus and provide clinical guidelines for managing ACL tears and subsequent meniscal injury. We aimed to answer the following questions: (1) Does ACLR protect the meniscus from subsequent injury? (2) Does early ACLR reduce secondary meniscal injury compared with delayed ACLR? (3) Does ACLR protect the repaired meniscus?

Study Design:

Systematic review; Level of evidence, 4.

Methods:

A systematic review was performed through use of MEDLINE and Embase electronic databases according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Search terms included ACL, reconstruction, and meniscus. Studies describing primary ACLR and nonoperative treatment in adult patients were included, as well as studies indicating timing of ACLR. The included articles were assessed individually for risk of bias through use of the modified Cochrane Risk of Bias and MINORS (Methodological Index for Nonrandomized Studies) tools.

Results:

One level 2 randomized controlled trial and several level 3 and 4 studies indicated a protective effect of ACLR on meniscal injury compared with nonoperative treatment. There was weak (level 3) evidence of the protective effect of early ACLR on the meniscus. Meniscal repair failure was less frequent in patients with ACL reconstruction than in patients with ACL deficiency (level 4).

Conclusion:

The evidence collected in this review suggests a protective effect of ACLR for subsequent meniscal injury (level 2 evidence). ACLR should be performed within 3 months of injury (level 3 evidence). Meniscal injury requiring surgical repair in the ACL-deficient knee should be treated with repair accompanied by ACLR (level 3 evidence). The paucity of level 2 studies prevents the formation of guidelines based on level 1 evidence. There is a strong clinical need for randomized or prospective trials to provide guidelines on timing of ACLR and meniscal repair.
Role of Communication, Professionalism, and Clinical Care Skills of Postgraduate Students on Patients Recall Visits in Dental School—An Observational Study
Authors: Pasupuleti Mohan Kumar , Subhadra Penmetsa Gautami , Gangolu Meghana , Ramesh Konathala Santosh Venkata , Naga Venkata Satya Sruthima
Published: July 2020

Preservation of periodontal health after periodontal therapy is paramount for the complete elimination of periodontal diseases. In most of the Dental Schools, recall appointments are considerably low, and in particular, to the Department of Periodontics, the compliance to recall visits by the patients diagnosed with periodontal disease is still inadequate. Faculty from the Department of Periodontics framed new criteria to follow in the comprehensive clinics by the postgraduate students. The criteria include communication, intraoral examination skills, and professionalism toward dental patients. Faculty in each comprehensive dental clinic observed the clinical encounters of postgraduate students with patients and provided the feedback. The study conducted from May 2018 to April 2019, and the patients attended were 1164 of 1544. Unattended patients were 380 of 1544. Effective evaluation of the feedback provided by faculty and communication with both the postgraduate students and unattended patients resulted in further improvement in recall, that is, 151 of 380 patients. Reframed criteria, direct observation of the postgraduate students by faculty during patients interaction, assessment of feedback forms, and immediately modifying the student’s way of communication allowed maximum recall visits to the Department of Periodontics.
Gingival Thickness and Outcome of Periodontal Plastic Surgery Procedures: A Meta-regression Analysis
Authors: Holtzman L. Paternò , Blasi G. , Rivera E. , Herrero F. , Downton K. , Oates T.
Published: July 2020

Objective:

To evaluate the impact of soft tissue thickness (STT) on root coverage achieved with different periodontal plastic surgery procedures.

Background:

Gingival recession has been managed successfully through various surgical approaches, with great variability in outcomes. Anatomic characteristics of the recipient site and selected technique account in part for this variability. Gingival flap thickness is one of the most critical site-related characteristics.

Methods:

An electronic search was conducted on the major databases (PubMed, Embase, Web of Science). Human prospective studies with at least 6 mo of follow-up and with a numeric baseline measurement for gingival thickness were eligible. Only studies including nonsmoking patients were considered. Variables included surgical approach, participant characteristics, local anatomic factors, and follow-up time. Primary outcome was mean percentage root coverage (%RC) achieved, and complete root coverage was a secondary outcome.

Results:

A total of 42 studies were included (35 randomized controlled trials, 5 case series, 1 prospective cohort study, and 1 controlled clinical trial). Across studies, the pooled %RC was 81.9% (95% CI, 79.1% to 84.7%). The %RC was not significantly associated ( P = 0.267) with baseline soft tissue thickness; however there was a significant ( P = 0.031) inverse relationship between STT and %RC after 12-mo follow-up. Subgroup analysis showed that for no graft, there was a significant ( P = 0.025) positive relationship between STT and %RC with the exclusion of the single outlier study based on STT.

Conclusions:

STT plays a limited role in predicting root coverage across all approaches; when flaps are performed with no graft, the effect of STT is most critical. The length of time following surgery appears to influence outcomes, with 12-mo follow-up offering greater insight.

Knowledge Transfer Statement:

The results of this study can suggest to clinicians which periodontal plastic surgery technique to employ when treating challenging cases. In particular, it can be helpful when selecting the treatment approach to treat thin phenotype sites. This study could help clinicians provide a more appropriate treatment decision in such cases.
Cystic Fibrosis and Genotype-Dependent Therapy: Is There a Need for a Sex-Specific Therapy?
Authors: Bradbury Neil A.
Published: July 2020

Cystic fibrosis (CF) is an autosomal recessive genetic disease caused by mutations in the cystic fibrosis transmembrane conductance regulation (CFTR) anion channel. Loss of CFTR protein and/or function disrupts chloride, bicarbonate, and fluid transport and also impacts epithelial sodium transport. Such altered ion and fluid transport produces mucus obstruction, inflammation, pulmonary infection, and damage to multiple organs. Although an autosomal disease, it is apparent that gender differences in life expectancy and quality of life do exist. Conventionally established therapies have treated the downstream sequelae of CFTR dysfunction and have led to a steady increase in life expectancy. Physicians now have access to medications that treat the basic defect in CF, in the form of CFTR modulators. These drugs target the trafficking and/or function of CFTR to improve clinical outcomes for patients. This review summarizes the science behind CFTR modulators and shows how these drugs have dramatically changed how patients with CF are treated. Surprisingly, although the drug target(s) are identical in males and females, CF females seem to display a greater improvement than their male counterparts.
Intra-articular Calcaneus Fractures: Current Concepts Review
Authors: Allegra Paul R. , Rivera Sebastian , Desai Sohil S. , Aiyer Amiethab , Kaplan Jonathan , Gross Christopher Edward
Published: July 2020

Calcaneal fractures are the most common fracture of the tarsal bones and represent 1% to 2% of all fractures. Roughly 75% of these fractures include intra-articular involvement of the posterior facet of the calcaneus. Intra-articular calcaneal fractures are challenging injuries to manage for both patients and surgeons given their association with both early and late complications. This article aims to review the management, classification systems, surgical approaches, and care regarding intra-articular calcaneal fractures. A review of the current literature yielded treatment strategies that aim to reduce complications such as soft tissue injury or loss of articular reduction while maintaining satisfactory clinical outcomes. The purpose of this article is to review these current concepts in the management of intra-articular calcaneal fractures.

Level of Evidence: Level V, expert opinion.
Trends in Publication and Levels of Evidence in Foot & Ankle International From 2000 to 2015
Authors: Griffith Matthew , Han Edward , Hattaway Joshua , Huh Jeannie
Published: July 2020

Background:

As the movement toward evidence-based medicine grows and publication rates rise each year, critical analysis of the orthopedic literature has become increasingly important. To aid readers in assessing the scientific quality of published research, Foot & Ankle International ( FAI) began assigning levels of evidence to all clinical articles in 2008. The purpose of this study was to analyze trends in the characteristics and levels of evidence of articles published in FAI between 2000 and 2015.

Methods:

All articles published in FAI from the years 2000, 2005, 2010, and 2015 were reviewed and categorized into article type (clinical, basic science, review, or technical tip). Each clinical article was assigned a level of evidence (I-V) and study type (prognostic, therapeutic, economic, or diagnostic). Descriptive information was gathered pertaining to country of origin, author credentials, and funding. Statistical analysis was performed using chi-squared tests to detect any trends in levels of evidence and publication characteristics.

Results:

A total of 647 articles were reviewed. From 2000 to 2015, there was a statistically significant increase in the publication of clinical research articles (70% to 83%; P = .013), while the number of basic science articles decreased (29% to 17%; P = .013). Of the clinical articles, there was a significant increase in therapeutic studies (41% to 58%; P = .003). During the study period, the publication of Level I and II evidence significantly increased (2% to 14%; P = .002). Although Level III and V evidence also increased (65% to 71%, P > .99), this was not found to be statistically significant. Publications originated from a total of 39 countries, with a significant increase in the proportion of international papers (33% to 48%; P = .007) over the study period. The proportion of articles authored by Doctors of Podiatric Medicine (DPMs) during the study period significantly decreased (4% to 2%, P = .035). Finally, the percentage of studies that disclosed the use of outside funding increased during the study period, with reported funding from grants or professional groups rising from 3% to 16% ( P < .001) and reported funding from commercial sources rising from 0% to 9% ( P = .002).

Conclusion:

The proportion of Level I and II studies published in FAI significantly increased from 2000 to 2015. The publication of clinical research rose, with a majority being therapeutic studies. There was a significant increase in articles published by international authors and a significant decrease in articles published by DPMs. During the same time period, there was a rise in the proportion of articles reporting the use of outside funding, both professional and commercial.
Rapidly expanded partially HLA DRB1–matched fungus-specific T cells mediate in vitro and in vivo antifungal activity
Authors: Castellano-González Gloria , McGuire Helen M. , Luciani Fabio , Clancy Leighton E. , Li Ziduo , Avdic Selmir , Hughes Brendan , Singh Mandeep , Fazekas de St Groth Barbara , Renga Giorgia , Pariano Marilena , Bellet Marina M. , Romani Luigina , Gottlieb David J.
Published: July 2020

Invasive fungal infections are a major cause of disease and death in immunocompromised hosts, including patients undergoing allogeneic hematopoietic stem cell transplant (HSCT). Recovery of adaptive immunity after HSCT correlates strongly with recovery from fungal infection. Using initial selection of lymphocytes expressing the activation marker CD137 after fungal stimulation, we rapidly expanded a population of mainly CD4+ T cells with potent antifungal characteristics, including production of tumor necrosis factor α, interferon γ, interleukin-17, and granulocyte-macrophage colony stimulating factor. Cells were manufactured using a fully good manufacturing practice–compliant process. In vitro, the T cells responded to fungal antigens presented on fully and partially HLA-DRB1 antigen–matched presenting cells, including when the single common DRB1 antigen was allelically mismatched. Administration of antifungal T cells lead to reduction in the severity of pulmonary and cerebral infection in an experimental mouse model of Aspergillus. These data support the establishment of a bank of cryopreserved fungus-specific T cells using normal donors with common HLA DRB1 molecules and testing of partially HLA-matched third-party donor fungus-specific T cells as a potential therapeutic in patients with invasive fungal infection after HSCT.
T-cell lymphoblastic lymphoma and leukemia: different diseases from a common premalignant progenitor?
Authors: Kroeze Emma , Loeffen Jan L. C. , Poort Vera M. , Meijerink Jules P. P.
Published: July 2020

T-cell lymphoblastic lymphoma (T-LBL) and lymphoblastic leukemia (T-ALL) represent malignancies that arise from the transformation of immature precursor T cells. Similarities in T-LBL and T-ALL have raised the question whether these entities represent 1 disease or reflect 2 different diseases. The genetic profiles of T-ALL have been thoroughly investigated over the last 2 decades, whereas fairly little is known about genetic driver mutations in T-LBL. Nevertheless, the comparison of clinical, immunophenotypic, and molecular observations from independent T-LBL and T-ALL studies lent strength to the theory that T-LBL and T-ALL reflect different presentations of the same disease. Alternatively, T-LBL and T-ALL may simultaneously evolve from a common malignant precursor cell, each having their own specific pathogenic requirements or cellular dependencies that differ among stroma-embedded blasts in lymphoid tissues compared with solitary leukemia cells. This review aims to cluster recent findings with regard to clinical presentation, genetic predisposition, and the acquisition of additional mutations that may give rise to differences in gene expression signatures among T-LBL and T-ALL patients. Improved insight in T-LBL in relation to T-ALL may further help to apply confirmed T-ALL therapies to T-LBL patients.
Noncanonical type 2B von Willebrand disease associated with mutations in the VWF D′D3 and D4 domains
Authors: Sacco Monica , Lancellotti Stefano , Ferrarese Mattia , Bernardi Francesco , Pinotti Mirko , Tardugno Maira , De Candia Erica , Di Gennaro Leonardo , Basso Maria , Giusti Betti , Papi Massimiliano , Perini Giordano , Castaman Giancarlo , De Cristofaro Raimondo
Published: July 2020

We observed a 55-year-old Italian man who presented with mucosal and cutaneous bleeding. Results of his blood analysis showed low levels of von Willebrand factor (VWF) antigen and VWF activity (both VWF ristocetin cofactor and VWF collagen binding), mild thrombocytopenia, increased ristocetin-induced platelet aggregation, and a deficiency of high-molecular-weight multimers, all typical phenotypic hallmarks of type 2B von Willebrand disease (VWD). The analysis of the VWF gene sequence revealed heterozygous in cis mutations: (1) c.2771G>A and (2) c.6532G>T substitutions in the exons 21 and 37, respectively. The first mutation causes the substitution of an Arg residue with a Gln at position 924, in the D′D3 domain. The second mutation causes an Ala to Ser substitution at position 2178 in the D4 domain. The patient’s daughter did not present the same fatherly mutations but showed only the heterozygous polymorphic c.3379C>T mutation in exon 25 of the VWF gene causing the p.P1127S substitution, inherited from her mother. The in vitro expression of the heterozygous in cis VWF mutant rVWFWT/rVWF924Q-2178S confirmed and recapitulated the ex vivo VWF findings. Molecular modeling showed that these in cis mutations stabilize a partially stretched and open conformation of the VWF monomer. Transmission electron microscopy and atomic force microscopy showed in the heterozygous recombinant form rVWFWT/rVWF924Q-2178S a stretched conformation, forming strings even under static conditions. Thus, the heterozygous in cis mutations 924Q/2178S promote conformational transitions in the VWF molecule, causing a type 2B–like VWD phenotype, despite the absence of typical mutations in the A1 domain of VWF.
Essential role of Salmonella Enteritidis DNA adenine methylase in modulating inflammasome activation
Authors: Guo Yaxin , Gu Dan , Huang Tingting , Cao Liyan , Zhu Xinyu , Zhou Yi , Wang Kangru , Kang Xilong , Meng Chuang , Jiao Xinan , Pan Zhiming
Published: July 2020

Background

Salmonella Enteritidis (SE) is one of the major foodborne zoonotic pathogens of worldwide importance which can induce activation of NLRC4 and NLRP3 inflammasomes during infection. Given that the inflammasomes play an essential role in resisting bacterial infection, Salmonella has evolved various strategies to regulate activation of the inflammasome, most of which largely remain unclear.

Results

A transposon mutant library in SE strain C50336 was screened for the identification of the potential factors that regulate inflammasome activation. We found that T3SS-associated genes invC, prgH, and spaN were required for inflammasome activation in vitro. Interestingly, C50336 strains with deletion or overexpression of Dam were both defective in activation of caspase-1, secretion of IL-1β and phosphorylation of c-Jun N-terminal kinase (Jnk). Transcriptome sequencing (RNA-seq) results showed that most of the differentially expressed genes and enriched KEGG pathways between the C50336-VS-C50336Δdam and C50336-VS-C50336::dam groups overlapped, which includes multiple signaling pathways related to the inflammasome. C50336Δdam and C50336::dam were both found to be defective in suppressing the expression of several anti-inflammasome factors. Moreover, overexpression of Dam in macrophages by lentiviral infection could specifically enhance the activation of NLRP3 inflammasome independently via promoting the Jnk pathway.

Conclusions

These data indicated that Dam was essential for modulating inflammasome activation during SE infection, there were complex and dynamic interplays between Dam and the inflammasome under different conditions. New insights were provided about the battle between SE and host innate immunological mechanisms.
Interaction between lipoprotein (a) levels and body mass index in first incident acute myocardial infarction
Authors: Teng Ruo-Ling , Wang Heng , Sun Bei-Chen , Cai Dong-Ping , He Yong-Ming
Published: July 2020

Background

Possible interaction between Lipoprotein (a) (Lp(a)) and body mass index (BMI) was investigated with regard to the risk of first incident acute myocardial infarction (AMI).

Methods

Cross-sectional study of 1522 cases with initial AMI and 1691 controls without coronary artery disease (CAD) were retrospectively analyzed using logistic regression model. Subjects were categorized based on Lp(a) and BMI and compared with regard to occurrence of AMI by calculating odds ratios (ORs) with 95% confidence intervals (CIs). A potential interaction between Lp(a) and BMI was evaluated by the measures of effect modification on both additive (Relative excess risk due to interaction, RERI) and multiplicative scales.

Results

Compared with reference group (BMI < 24 kg/m2 and in the first quintile of Lp(a)), multivariable-adjusted analysis revealed that ORs(95%CI) of AMI were 2.27(1.46–3.52) for higher BMI alone; 1.79(1.11–2.90), 1.65(1.05–2.60), 1.96(1.20–3.20) and 2.34(1.47–3.71) for higher Lp(a) alone across its quintiles; and 2.86(1.85–4.40), 3.30(2.14–5.11), 4.43(2.76–7.09) and 5.98(3.72–9.60) for both higher BMI and higher Lp(a), greater than the sum of the both risks each. Prominent interaction was found between Lp(a) and BMI on additive scale (RERI = 2.45 (0.36–4.54) at the fifth quintile of Lp(a)) but not on multiplicative scale.

Conclusions

This study demonstrates that BMI and Lp(a) levels are important factors affecting the risk of AMI. Significant interaction is found between Lp(a) and BMI in initial AMI on additive scale, indicating that Lp(a) confers greater risk for initial AMI when BMI is elevated. For those whose BMIs are inadequately controlled, Lp(a) lowering may be an option.

Trial registration

This clinical study was not registered in a publicly available registry because this study was a retrospective study first started in 2015. Data are available via the correspondent.
Multimorbidity and consultation time: a systematic review
Authors: Tadeu Ana Carolina Reis , e Silva Caetano Inês Rosendo Carvalho , de Figueiredo Inês Jorge , Santiago Luiz Miguel
Published: July 2020

Background

Multimorbidity (MM) is one of the major challenges health systems currently face. Management of time length of a medical consultation with a patient with MM is a matter of concern for doctors.

Methods

A systematic review was performed to describe the impact of MM on the average time of a medical consultation considering the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. The systematic online searches of the Embase and PubMed databases were undertaken, from January 2000 to August 2018. The studies were independently screened by two reviewers to decide which ones met the inclusion criteria. (Kappa = 0.84 and Kappa = 0.82). Differing opinions were solved by a third person. This systematic review included people with MM criteria as participants (two or more chronic conditions in the same individual). The type of outcome included was explicitly defined – the length of medical appointments with patients with MM. Any strategies aiming to analyse the impact of MM on the average consultation time were considered. The length of time of medical appointment for patients without MM was the comparator criteria. Experimental and observational studies were included.

Results

Of 85 articles identified, only 1 observational study was included, showing a clear trend for patients with MM to have longer consultations than patients without MM criteria (p < 0.001).

Conclusions

More studies are required to better assess allocation length-time for patients with MM and to measure other characteristics like doctors’ workload.
Sarcopenia is associated with insomnia in Japanese older adults: a cross-sectional study of data from the Nagasaki Islands study
Authors: Nagaura Yuki , Kondo Hideaki , Nagayoshi Mako , Maeda Takahiro
Published: July 2020

Background

Sarcopenia is associated with increased mortality among older adults. Sleep-related problems have been studied as factors related to sarcopenia. This study was conducted to determine the relationship between sleep-related problems and sarcopenia among Japanese community-dwelling older adults using data from the Nagasaki Islands Study.

Methods

This cross-sectional study analyzed data collected from 2017 to 2018. A total of 1592 older adults (575 men, 36.1%) aged 65 years or older participated. Sarcopenia was evaluated using the skeletal muscle mass index and grasp powers based on the criteria of the Asian Working Group for Sarcopenia. Odds ratios for sarcopenia were calculated using logistic regression analysis. Furthermore, subgroup analysis was performed based on the following tertiles of age: 65–70 years, 71–78 years, and 79–98 years.

Results

The number of participants with sarcopenia was 238 (14.9%). The median age of participants in the sarcopenia group (80 years; interquartile range: 74–84) was significantly higher than in the non-sarcopenia group (73 years; interquartile range 69–79; P <  0.001). In the sarcopenia group, 70.9% of participants had difficulty initiating and/or maintaining sleep, sleep duration tended to be longer (P <  0.001), and 33.3% of participants’ sleep duration was over 9 h. In a logistic regression analysis for sarcopenia, advancing age was the most prominent factor, and the adjusted odds ratio (95% confidence interval) of facing difficulty initiating and/or maintaining sleep was 1.60 (1.14–2.25). Despite longer sleep duration being a significant factor in the univariable analysis, it was not significant in the multivariable analysis. In the logistic regression analysis for sarcopenia among older adults aged 79–98 years, the odds ratio (95% confidence interval) among women was significantly low at 0.53 (0.33–0.83).

Conclusions

Sarcopenia is associated with difficulty initiating and/or maintaining sleep among Japanese older adults. In sarcopenia control measures, sleep/wake disorders related to insomnia are required to be evaluated in detail to help inform nursing and medical policy.
Is adiposity associated with objectively measured physical activity and sedentary behaviors in older adults?
Authors: Zhu Wenfei , Cheng Zhiwei , Howard Virginia J. , Judd Suzanne E. , Blair Steven N. , Sun Yuliang , Hooker Steven P.
Published: July 2020

Background

Many older adults in the U.S. do not achieve the recommended amount of physical activity (PA) to fully realize a myriad of health benefits. Adiposity is one of those important correlates of PA and sedentary behaviors. However, the full extent to which adiposity is associated with PA and stationary time (STA) is uncertain. Therefore, we examined the association of adiposity with objectively measured PA and STA in black and white older adults.

Methods

We conducted a cross-sectional study of older adults enrolled in the REasons for Geographic and Racial Differences in Stroke (REGARDS) Study 2003–2007 who participated in an ancillary accelerometer study 2009–2013. Assessment of body mass index (BMI) and waist circumference (WC) was completed during an in-home visit in the parent study. PA was measured by Actical™ accelerometers, which provided estimates of moderate-to-vigorous-intensity PA (MVPA), light-intensity PA (LPA), and STA for 4–7 consecutive days. Data from accelerometers were standardized to square root percentages of total wear time per day (SqrtMVPA%, SqrtLPA%, and SqrtSTA%). Interactions were tested for BMI and WC by race and sex, separately.

Results

Data were available for 7873 participants (69.8 ± 8.7 yr, 54.2% women, 31.5% African American). In mixed linear regression models, significant interactions existed in BMI by race and sex for the SqrtMVPA%, WC by race and sex for the SqrtMVPA% and the SqrtLPA% model(p < 0.05). No interaction was significant for the logistic model of meeting the PA guideline or not. In subgroup analyses, BMI was inversely associated with SqrtMVPA%, SqrtLPA%, and positively related to SqrtSTA% in black women, white men and white women after adjustments. Similar patterns were observed between WC and SqrtMVPA%, SqrtLPA%, and SqrtSTA% in all groups, respectively. However, BMI was not associated with SqrtMVPA% in black men. Those with higher BMI or WC were less likely to meet the PA guideline in all groups.

Conclusions

Adiposity was inversely associated with higher levels of MVPA/LPA and positively associated with higher levels of STA among black and white older adults. Prevention efforts aimed at promoting weight control may be beneficial to prevent physical inactivity and sedentary lifestyle among older adults.
Renal expression of cytokines and chemokines in diabetic nephropathy
Authors: Araújo Liliane Silvano , Torquato Bianca Gonçalves Silva , da Silva Crislaine Aparecida , dos Reis Monteiro Maria Luíza Gonçalves , dos Santos Martins Ana Luisa Monteiro , da Silva Marcos Vinícius , dos Reis Marlene Antônia , Machado Juliana Reis
Published: July 2020

Background

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease worldwide. Inflammatory mediators have been implicated in the pathogenesis of DN, thus considered an inflammatory disease. However, further studies are required to assess the renal damage caused by the action of these molecules. Therefore, the objective of this study was to analyze the expression of cytokines and chemokines in renal biopsies from patients with DN and to correlate it with interstitial inflammation and decreased renal function.

Methods

Forty-four native renal biopsies from patients with DN and 23 control cases were selected. In situ expression of eotaxin, MIP-1α (macrophage inflammatory protein-1α), IL-8 (interleukin-8), IL-4, IL-10, TNF-α (tumor necrosis factor-α), TNFR1 (tumor necrosis factor receptor-1), IL-1β, and IL-6 were evaluated by immunohistochemistry.

Results

The DN group showed a significant increase in IL-6 (p < 0.0001), IL-1β (p < 0.0001), IL-4 (p < 0.0001) and eotaxin (p = 0.0012) expression, and a decrease in TNFR1 (p = 0.0107) and IL-8 (p = 0.0262) expression compared to the control group. However, there were no significant differences in IL-10 (p = 0.4951), TNF-α (p = 0.7534), and MIP-1α (p = 0.3816) expression among groups. Regarding interstitial inflammation, there was a significant increase in IL-6 in scores 0 and 1 compared to score 2 (p = 0.0035), in IL-10 in score 2 compared to score 0 (p = 0.0479), and in eotaxin in score 2 compared to scores 0 and 1 (p < 0.0001), whereas IL-8 (p = 0.0513) and MIP-1α (p = 0.1801) showed no significant differences. There was a tendency for negative correlation between eotaxin and estimated glomerular filtration rate (eGFR) (p = 0.0566).

Conclusions

Our results indicated an increased in situ production of cytokines and chemokines in DN, including IL-6, IL-1β, IL-4, and eotaxin. It was observed that, possibly, eotaxin may have an important role in the progression of interstitial inflammation in DN and in eGFR decrease of these patients.
Barriers and associated factors for adequate antenatal care among Afghan women in Iran; findings from a community-based survey
Authors: Dadras Omid , Dadras Fateme , Taghizade Ziba , Seyedalinaghi Seyedahmad , Ono-Kihara Masako , Kihara Masahiro , Nakayama Takeo
Published: July 2020

Background

Almost a third of Afghan women living in Iran are at childbearing age. Antenatal care (ANC) is an inextricable part of healthy pregnancy and could prevent the adverse birth outcomes. Almost 97% of Iranian expectant women are receiving adequate ANC (4 or more visits). However, the situation for pregnant Afghan women is unclear. Some studies indicated low access to ANC among Afghan women. In the present study, we aimed to explore the sociodemographic factors and potential barriers associated with adequate ANC among Afghan women in Iran.

Methods

A cross sectional study was conducted between June 2019 and August 2019. Using time location sampling (TLS), we recruited 424 Afghan women aged 18–45 years old at three health centers in south region of Tehran. The data were collected on sociodemographic characteristics and the reported reasons for inadequate ANC using a questionnaire and analyzed applying bivariate, and multivariate analyses. Factor analysis was performed to reduce the number of potential reasons for inadequate ANC in order to improve the precision of regression analysis.

Results

Almost a third of Afghan women in this study had adequate ANC (≥ 8 visits). The women in older age group, those with higher education and family income, women with longer length of stay, those of legal status were more likely to have adequate ANC. In multivariate analysis, the poor knowledge and attitude toward ANC (AOR = 0.06; 95% CI [0.03–0.15]), the poor quality of services (AOR = 0.17 95% CI [0.07–0.41]); and to some extent, the difficulties in access (AOR = 0.33; 95% CI [0.11–1.00]) were the main obstacles toward adequate ANC among the study population.

Conclusion

Our study emphasized the important role of the personal knowledge and attitude toward ANC with adequate antenatal care among Afghan women in Iran. This could be addressed by well-oriented interventions and health education for Afghan women. The collaboration between central government with international agencies should be directed toward enhancing the social support, promoting the awareness and knowledge, and expanding the safety net services to improve the access and quality care among Afghan women in Iran.
Albumin-bound paclitaxel and gemcitabine combination therapy in soft tissue sarcoma
Authors: Tian Zhichao , Zhang Fan , Li Po , Wang Jiaqiang , Yang Jinpo , Zhang Peng , Yao Weitao , Wang Xin
Published: July 2020

Background

The evidence that albumin-bound paclitaxel (nab-paclitaxel) is safe and efficacious for the treatment of many types of malignant tumors is continuously increasing. However, the evidence and clinical data of nab-paclitaxel and gemcitabine in metastatic soft tissue sarcoma (STS) treatment are rare.

Methods

The clinical data of metastatic STS patients who received nab-paclitaxel/ gemcitabine chemotherapy between January 2019 and February 2020 were retrospectively analysed. All these patients were treated with nab-paclitaxel/ gemcitabine only after doxorubicin-based chemotherapy had failed. We evaluated the effectiveness and safety of nab-paclitaxel and gemcitabine in these patients.

Results

A total of 17 patients treated with nab-paclitaxel/ gemcitabine were enrolled in this study. One patient with angiosarcoma achieved complete response, 6 patients had partial response, 5 patients achieved stable disease, and 5 patients had progressive disease. The average diameter change in target lesion from baseline was − 19.06 ± 45.74%. And median progression free survival was 6 months (95% CI, 2–9 months). Grade 3 / 4 adverse events were not common, included neutropenia (17.6%), fatigue (11.8%), anemia (11.8%), leukopenia (11.8%), nausea (5.9%), peripheral neuropathy (5.9%), diarrhea (5.9%), and thrombocytopenia (5.9%). No treatment-related deaths occurred.

Conclusion

Nab-paclitaxel/ gemcitabine combination chemotherapy is comparatively effective in the treatment of STS, demonstrates low toxicity, and is worthy of further study.
Is thyroid excision mandatory with laryngectomy in carcinoma larynx?
Authors: Baghel Surendra Singh , Singhal Pawan , Verma Namita , Sehra Ritu , Yadav Rajeev , Agarwal Sunita , Sharma Man Prakash , Gupta D. P.
Published: July 2020

Background

Advanced stage operable cancers of larynx are treated with total laryngectomy including thyroid resection in most of the cases, which may expose patient to hypothyroidism and hypoparathyroidism. The requirement of thyroidectomy during Total Laryngectomy is controversial.

Methods

A cross sectional observational study was set out to review preoperative clinical and radiological assessment; intraoperative and histopathological findings; and follow-up data to predict thyroid gland invasion in the setting of squamous cell carcinoma of the Larynx.

Results

11 (16%) out of 69 patients had thyroid gland involvement on histopathological examination with mean age 63 years. Out of these 11 cases, 8 (72%) underwent primary total laryngectomy. 90% patients with thyroid gland involvement were male. 9 cases with thyroid gland involvement were staged as T4a preoperatively.

Conclusion

Invasion of thyroid gland by laryngeal cancer is uncommon. Unnecessary hemithyroidectomies lead to hypothyroidism and hypoparathyroidism. The study points out the clear indications of thyroid excision in patients undergoing total laryngectomy. We can suggest that total thyroidectomy should be done with total laryngectomy in cases which have gross clinical, radiological or intraoperative thyroid gland involvement, subglottic extension and thyroid cartilage invasion. This can save the patients from the brunt of unnecessary morbid hypothyroidism and hypoparathyroidism.
Potential metabolic monitoring indicators of suicide attempts in first episode and drug naive young patients with major depressive disorder: a cross-sectional study
Authors: Zhao Ke , Zhou Siyao , Shi Xiang , Chen Jianjun , Zhang Yaoyao , Fan Kaili , Zhang Xiangyang , Wang Wei , Tang Wei
Published: July 2020

Backgrounds

Major depressive disorder is an ordinary mental disorder, and suicide is considered to be a major concern among patients with MDD. Previous studies focused on the relationship between suicide attempts and metabolism in elderly patients with MDD, while ignore the young people. The aim of this study is to find the potential relationship between suicide attempts and metabolism in young patients with MDD to find a way to prevent and ultimately reduce suicide in young patients with MDD.

Methods

Cross-sectional design was employed in the study.740 patients aged between 18 and 45 years old with MDD had been consecutively recruited in this study between 2011 and 2017, 128 of whom had suicide attempts. Their serum samples used to monitor fasting blood glucose, serum lipids as well as socio-demographic characteristics were collected. Besides, some clinical scales were also employed to measure symptoms of anxiety, depression and other conditions.

Results

This study indicated that compared with non-suicide attempters, suicide attempters in young patients with MDD showed higher levels of FBG, TC, LDL-C (allp <  0.05) and lower levels of HDL-C(p <  0.001). Further logistic regression analysis suggested that suicide attempts were associated with increased FBG, decreased HDL-C, the course of disease, HAMD scores and obvious anxiety.

Conclusions

Suicide attempts in young patients with MDD may be predicted by metabolic levels in the future. And our findings suggested that the level of FBG and HDL-C can be promising biomarkers to predict the occurrence of this event.
MANTRA: development and localization of a mobile educational health game targeting low literacy players in low and middle income countries
Authors: Mueller Sonja , Soriano Delphine , Boscor Andrei , Saville Naomi , Arjyal Abriti , Baral Sushil , Fordham Maureen , Hearn Gareth , Le Masson Virginie , Kayastha Rachya , Kostkova Patty
Published: July 2020

Background

Mobile technology is increasingly important for delivering public health interventions to remote populations. This research study developed, piloted, and assessed a serious game for mobile devices that teaches geohazard, maternal, and neonatal health messages. This unique mHealth intervention aimed at low-literacy audiences in low resource settings is part of the Maternal and Neonatal Technologies in Rural Areas (MANTRA) project: Increasing maternal and child health resilience before, during, and after disasters using mobile technology in Nepal.

Methods

The serious game was developed through a co-creation process between London and Kathmandu based researchers by email and video-calling, and face-to-face with local stakeholders in Nepal. The process identified core needs, developed appropriate pictograms and mechanics, and tailored the pilot serious game to the local cultural context. Evaluations and feedback from end users took place in rural villages and suburban Kathmandu in Province Three. Field evaluation sessions used mixed methods. Researchers observed game play and held focus group discussions to elicit qualitative feedback and understand engagement, motivation, and usability, and conducted a paired pre- and post-game knowledge assessment.

Results

The MANTRA serious game is contextualized to rural Nepal. The game teaches 28 learning objectives in three modules: maternal health, neonatal health, and geohazards, through picture matching with immediate audio and visual feedback. User feedback from focus groups demonstrated high engagement, motivation, and usability of the game.

Conclusions

This MANTRA study is a unique mHealth intervention of a serious game to teach core health and geohazards messages to low-literacy audiences in rural Nepal. Although the mobile game is tailored for this specific context, the developmental process and insights could be transferable to the development of other games-based interventions and contextualized for any part of the world. Successfully targeting this low-literacy and illiterate audience makes the MANTRA development process the first of its kind and a novel research endeavor with potential for widespread impact and adoption following further game development.

Trial registration

This project was approved by the University College London Ethics Committee in London, United Kingdom [10547/001], and the Nepal Health Research Council in Kathmandu, Nepal [Reg. No. 105/2017]. All participants provided informed written consent.