bluuebunny/crossref_metadata_2025 huggingface dataset:
Treatment Outcomes of Total Ankle Arthroplasty Using an Artificial Talus
Authors: Hirano Takaaki , Akiyama Yui , Karube Tomoko , Haraguchi Naoki , Niki Hisateru , Mitsui Hiroyuki
Published: November 2019

Category:

Ankle Arthritis

Introduction/Purpose:

Problems associated with mid- to long-term total ankle arthroplasty (TAA) include loosening and sinking of the talus implant. These problems arise due to a lack of stability compared with artificial joints such as knees and hips. In Japan, aluminum ceramic talus implants have been developed and are reported to result in good treatment outcomes. Here we investigated and report the treatment outcomes for combined TAA (cTAA), in which TAA is combined with a talus implant during the initial procedure.

Methods:

We assessed 15 cases involving 16 feet that underwent cTAA for which follow-up was available for at least 6 months. These cases comprised five feet with stage IIIb osteoarthritis and nine feet with stage IV osteoarthritis according to the Takakura classification as well as two feet with talus necrosis. The mean patient age was 73.5 years, and the mean follow-up period was 9.1 months. The talus implant was completely customized for all cases, and TNK Ankle (Kyocera, Japan) tibial components were used. Assessments were performed before and after surgery using the Japanese Society for Surgery of the Foot scale (JSSF scale) for physician-led objective evaluation and the Japanese Orthopaedic Association/Japanese Society for Surgery of the Foot and Self- Administered Foot Evaluation Questionnaire (SAFE-Q) subscales for patient-reported subjective evaluation. The validity and reliability of the JSSF scale and SAFE-Q have been verified by metering psychological verification. Scores were compared using paired t-tests.

Results:

The mean JSSF score improved significantly from 46.7 points preoperatively to 85.3 points postoperatively. For the SAFE-Q, pain and pain-related scores improved significantly from 40.5 points preoperatively to 75.8 points postoperatively (p < 0.001), physical function and daily lifestyle status improved significantly from 41.1 points preoperatively to 72.9 points postoperatively (p < 0.001), social lifestyle function improved significantly from 37.8 points preoperatively to 76.4 points postoperatively (p < 0.001), and overall sense of health improved significantly from 51.7 preoperatively to 80.7 postoperatively (p < 0.001). Shoe-related results improved from 50.0 points preoperatively to 69.4 points postoperatively (p = 0.038). Only one postoperative complication was noted, which was a case of deep wound infection.

Conclusion:

Short-term outcomes for cTAA were mostly good in our study population. The findings suggest that talus implants could be used as a treatment option for cases involving severe deformities, crushed talus injuries, and bone defects in which the use of TAA had previously been difficult, which can be handled with cTAA. These findings reveal new possibilities for expanded indications going forward. However, as these were short-term treatment outcomes, further follow-up is required in future studies.
Radiologic Recurrence of Hallux Valgus Deformity after Scarf and Akin Osteotomy in Patients with High Distal Metatarsal Articular Angle
Authors: Suh Jae Wan , Park Seung-Gwan , Kim Sung Hyun , Park Hyun-Woo
Published: November 2019

Category:

Bunion

Introduction/Purpose:

The most frequent complication after hallux valgus corrective surgery is recurrence of deformity. Many factors have been identified previously as risk factors for recurrence. Especially, inadequate correction of the distal metatarsal articular angle (DMAA) has been reported one of the surgical risk factors for recurrence. This study aimed to investigate the recurrence rate after hallux valgus correction using Scarf and Akin osteotomy and to identify the significance of postoperative DMAA as a risk factor of recurrence.

Methods:

We reviewed 87 hallux valgus patients (122 feet) who received Scarf and Akin osteotomy from January 2007 to August 2015. Clinical outcomes were evaluated using VAS and the AOFAS score. Radiological outcome measures included hallux valgus angle (HVA), intermetatarsal angle (IMA) and distal metatarsal articular angle (DMAA) in serial weight bearing radiograph. Recurrence was defined as more than 20 degrees of HVA in final follow-up radiograph. Radiological factors associated with recurrence including high DMAA were evaluated and analyzed.

Results:

Mean follow-up duration was 20.6 months (range, 12.0-46.5 months) and mean age was 44 years (13-80 years). The VAS and AOFAS scores were significantly improved at the final follow-up (7.0 to 2.0, p<0.001, 78.0 to 92.0, p<0.001). Significant corrections in the HVA, IMA and DMAA were obtained(p<0.001). Eleven (9.0%, 11/122) cases recurred hallux valgus deformity. Postoperative IMA, DMAA and HVA showed significant moderate to strong correlation with HVA at final follow-up (rho: Spearman correlation coefficient, 0.42, 0.71, 0.87, p<0.001). There was no recurrence in cases of postoperative DMAA less than 11.3 degree (fisher exact test, p<0.001).

Conclusion:

High DMAA is one of numerous risk factor for hallux valgus recurrence after scarf and akin osteotomy. To avoid recurrence, we suggest that surgical correctional goal of DMAA should be considered less than 11.3 degrees.
The primacy of gastrointestinal tract antigen-presenting cells in lethal graft-versus-host disease
Authors: Koyama Motoko , Hill Geoffrey R.
Published: November 2019

Koyama and Hill review the role of the gut microbiome interaction with pretransplant conditioning injury in stimulating graft-versus-host disease.
Behavioural interventions targeting physical activity improve psychocognitive outcomes in COPD
Authors: Lavoie Kim L. , Sedeno Maria , Hamilton Alan , Li Pei-Zhi , De Sousa Dorothy , Troosters Thierry , Maltais François , Bourbeau Jean
Published: November 2019

This study explored the impact of a self-management behaviour modification (SMBM) programme with/without bronchodilators and with/without exercise training (ExT) to improve daily physical activity on psychological and cognitive outcomes in COPD patients as a secondary analysis of the PHYSACTO trial.

A 12-week, four-group, randomised, partially double-blind, placebo-controlled, parallel-group trial of SMBM in addition to tiotropium 5 µg, tiotropium/olodaterol 5/5 µg, tiotropium/olodaterol 5/5 µg plus ExT, or placebo was conducted in 304 patients. Outcomes included anxiety (Hospital Anxiety and Depression Scale (HADS)-A), depression (HADS-D and Patient-Health Questionnaire (PHQ)-9) and cognitive function (Montreal Cognitive Assessment (MoCA)).

All outcomes showed statistically and clinically significant improvements after 12 weeks independent of treatment group. However, greater improvements in HADS-A and MoCA were seen in patients who exhibited greater increases in physical activity and exercise capacity, respectively, whereas greater improvements in HADS-D and PHQ-9 were seen in patients who exhibited increases in either physical activity or exercise capacity.

The results indicate that SMBM with/without bronchodilators or ExT was associated with improved psychological and cognitive functioning. Anxiety reduced with increased physical activity, cognitive function improved with increased exercise capacity, and depression reduced with increases in either physical activity or exercise capacity. Interventions that increase daily physical activity or exercise capacity may improve psychological and cognitive outcomes in COPD.
Clinical effectiveness of once-daily fluticasone furoate/umeclidinium/vilanterol in usual practice: the COPD INTREPID study design
Authors: Worsley Sally , Snowise Neil , Halpin David M.G. , Midwinter Dawn , Ismaila Afisi S. , Irving Elaine , Sansbury Leah , Tabberer Maggie , Leather David , Compton Chris
Published: November 2019

Effectiveness studies complement conventional randomised controlled trials by providing a holistic view of treatments in the setting of usual clinical practice. We present the protocol for the ongoing INTREPID (INvestigation of TRelegy Effectiveness: usual PractIce Design; ClinicalTrials.gov identifier:NCT03467425) study, a randomised, open-label, 24-week effectiveness study of once-daily fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI; Trelegy) delivered by the ELLIPTA inhalerversusnon-ELLIPTA multiple-inhaler triple therapy in patients with chronic obstructive pulmonary disease (COPD) in usual practice settings. INTREPID was designed to provide evidence of FF/UMEC/VI effectiveness in patients with COPD managed in routine healthcare systems across multiple European countries. Between study initiation and end-of-study visits, patients will receive their medication and care as they would ordinarily receive it, from their usual healthcare provider at their usual healthcare centre. Study-specific intervention will be minimal. The primary end-point will be the proportion of COPD assessment test (CAT) responders, defined as a clinically meaningful improvement from baseline of ≥2 units, at week 24. The CAT was chosen as it provides health status information relevant to patients, physicians, health technology agencies and payers. Lung function (forced expiratory volume in 1 s) and critical inhaler errors will also be assessed in a subgroup of patients. The strengths and weaknesses of the protocol and some of the challenges associated with conducting this multicountry study, such as differences in healthcare systems and treatment practices across sites, will also be discussed.
Changing epidemiology of nontuberculous mycobacterial lung disease over the last two decades in a region of the Basque country
Authors: Pedrero Sandra , Tabernero Eva , Arana-Arri Eunate , Urra Elena , Larrea Maialen , Zalacain Rafael
Published: November 2019

Recent studies suggest an increasing prevalence of nontuberculous mycobacteria (NTM) lung disease. The aim of the present study was to describe incidence rates of NTM lung disease and trends therein in our area over a 20-year period.

This was a retrospective study of all cases of NTM lung disease between 1997 and 2016 that met the 2007 American Thoracic Society criteria. We analysed the annual incidence rates, species of mycobacteria isolated, trends over time and annual mortality in 327 patients.

Mycobacterium kansasiiwas the most common mycobacterium isolated (84%), followed byMycobacterium aviumcomplex (MAC) (13%). We compared two periods: 1997–2006 (257 cases, 79%) and 2007–2016 (70 cases, 21%). The incidence rates tended to decrease across these years, with a peak of incidence in 2000 with 10.6 cases per 100 000. There was a clearly decreasing trend inM. kansasiiinfection, not only in the first period (incident rate ratio (IRR) 0.915, 95% CI 0.88–0.90; p<0.0001) but also in the second (IRR 0.869, 95% CI 0.780–1.014; p=0.080), reaching 1.8 per 100 000 in 2016. In contrast, MAC infection tended to increase across the two periods (IRR 1.251, 95% CI 1.081–1.447; p=0.003).

In our region, the incidence of NTM lung disease has notably decreased in recent years.M. kansasiihad high incidence rates in the first decade but clearly decreased in the second decade.
Association of atypical antipsychotics and mortality for patients hospitalised with pneumonia
Authors: Boivin Zachary , Perez Mario F. , Atuegwu Nkiruka C. , Metersky Mark , Alvarez Carlos A. , Anzueto Antonio , Mortensen Eric M.
Published: November 2019

Introduction

Atypical antipsychotics are commonly used in patients with psychiatric conditions and dementia. They are also frequently used in patients being admitted with pneumonia; however, there are few safety data. The purpose of this study was to examine whether atypical antipsychotic use prior to admission is associated with increased mortality in patients with pneumonia.

Methods

We conducted a retrospective cohort study of hospitalised patients with pneumonia over a 10-year period. We included patients 65 years or older and hospitalised with pneumonia. For our primary analysis, we used propensity score matching to balance confounders between atypical antipsychotic users and nonusers.

Results

There were 102 897 patients and 5977 were taking atypical antipsychotics. After matching there were 5513 users and 5513 nonusers. Atypical antipsychotic use was associated with increased odds of 30-day (OR 1.20, 95% CI 1.11–1.31) and 90-day mortality (1.19, 1.09–1.30).

Conclusion

In patients 65 years or older that are hospitalised with pneumonia, we found an association between atypical antipsychotic use and increased odds of mortality. This was particularly pronounced for patients with pre-existing psychiatric or cardiac conditions. We suggest closely monitoring patients who use these medications and minimising their use in older adult patients.
Time to diagnosis of tuberculosis is greater in older patients: a retrospective cohort review
Authors: Abbara Aula , Collin Simon M. , Kon Onn M. , Buell Kevin , Sullivan Adam , Barrett Jessica , Corrah Tumena , McGregor Alastair , Hansel Trevor , John Laurence , Davidson Robert N.
Published: November 2019

Introduction

Age-related immunosenescence influences the presentation of tuberculosis (TB) in older patients. Here, we explore the clinical and radiological presentation of TB in the elderly and the factors associated with time to treatment for TB.

Methods

This is a retrospective cohort study comparing the clinical, radiological and demographic characteristics of TB patients aged ≥65 years with TB patients aged 18–64 years in a large cohort of TB patients in the UK. Factors associated with the time to presentation and time to treatment were identified using a multivariable analysis model.

Results

1023 patients were included in the analyses: 679 patients aged 18–64 years and 344 patients aged ≥65 years. “Classical” symptoms of TB (cough, haemoptysis, fever, nights sweats and weight loss) were less common among older patients with pulmonary TB (PTB) (p<0.05), but dyspnoea was more common among older patients (p=0.001). Time from presenting in secondary care to starting treatment was shorter in younger compared with older patients: 3versus15 days (p=0.001). When adjusted for age, factors associated with shorter time to treatment from symptom onset include sex (maleversusfemale) (hazard ratio (HR) 1.23 (95% CI 1.05–1.46)), UK born (HR 1.23 (95% CI 1.05–1.46)) and HIV (HR 2.07 (95% CI 1.30–3.29)). Only age remained an independent predictor of time to treatment in a multivariable model (HR 0.98 (95% CI 0.98–0.99)). For those with PTB, chest radiography findings showed that cavitation and lymphadenopathy were more common among younger patients (p=0.001).

Conclusions

Older patients aged ≥65 years with TB had fewer “classical” clinical and radiological presentations of TB, which may explain longer times to starting treatment from symptom onset compared with younger patients aged <65 years.
Corner Transition Toolpath Generation Based on Velocity-Blending Algorithm for Glass Edge Grinding
Authors: Ren Kun , Pan Yujia , Jiang Danyan , Pan Jun , Chen Wenhua , Hu Xuxiao
Published: November 2019

Sharp corners usually are used on glass contours to meet the highly increasing demand for personalized products, but they result in a broken wheel center toolpath in edge grinding. To ensure that the whole wheel center toolpath is of G1 continuity and that the grinding depth is controllable at the corners, a transition toolpath generation method based on a velocity-blending algorithm is proposed. Taking the grinding depth into consideration, the sharp-corner grinding process is planned, and a velocity-blending algorithm is introduced. With the constraints, such as traverse displacement and grinding depth, the sharp-corner transition toolpath is generated with a three-phase motion arrangement and with confirmations of the acceleration/deceleration positions. A piece of glass with three sharp corners is ground on a three-axis numerical-control glass grinding equipment. The experimental results demonstrate that the proposed algorithm can protect the sharp corners from breakage efficiently and achieve satisfactory shape accuracy. This research proposed a toolpath generation method based on a velocity-blending algorithm for the manufacturing of personalized glass products, which generates the transition toolpath as needed around a sharp corner in real time.
Train Vehicle Structure Design from the Perspective of Evacuation
Authors: Qiu Hanzhao , Fang Weining
Published: November 2019

The safety of trains, a highly efficient mode of transportation, has attracted significant attention. In the vehicle structure design of a train, the evaluation of the passenger evacuation time is necessary. The establishment of a simulation model is the fastest, most convenient, and practical way to achieve this goal. However, few scholars have focused on the reliability of a passenger train evacuation simulation model. This paper proposes a new validation method based on dynamic time warping and multidimensional scaling. The proposed method validates the dynamic process of a simulation model, provides statistical results, and can be used for small-sample scenarios such as a train evacuation scenario. The results of a case study indicate that the proposed method is an effective and quantitative approach to the validation of simulation models in a dynamic process. Thus, this paper describes the influence of the train structure size on an evacuation based on the results of simulation experiments. The structural size factors include the door width, aisle width, and seat pitch. The experiment results indicate that a wide aisle and reasonable seat pitch can promote a proper evacuation. In addition, a normal train door width has no effect on an evacuation.
Linking biological toxicity and the spectral characteristics of contamination in seriously polluted urban rivers
Authors: Chen Zhongli , Zhu Zihan , Song Jiyu , Liao Ruiyan , Wang Yufan , Luo Xi , Nie Dongya , Lei Yumeng , Shao Ying , Yang Wei
Published: November 2019

Background

Urban river pollution risks to environments and human health are emerging as a serious concern worldwide. With the aim to achieve the health of urban river ecosystem, numerous monitoring programs have been implemented to investigate the spectral characteristics of contamination. While due to the complexity of aquatic pollutants, the linkages between harmful effects and the spectral characteristics of contamination are still a major challenge for capturing main threats to urban aquatic environments. To establish these linkages, surface water (SW), sediment pore water (SDPW), and riparian soil pore water (SPW) were collected from five sites of the seriously polluted Qingshui Stream, China. The water-dissolved organic carbon (DOC), total nitrogen (TN), total phosphate (TP), fluorescence excitation–emission matrix, and specific ultraviolet absorbance were applied to analyze the spectral characteristics of urban river contamination. The Photobacterium phosphorem 502 was used to test the acute toxicity of the samples. Finally, the correlations between acute toxicity and concentrations of DOC, TN, TP, and the spectral characteristics were explored.

Results

The concentrations of DOC, TN, and TP in various samples amounted from 11.41 ± 2.31 to 3844.67 ± 87.80 mg/L, from 1.96 ± 0.06 to 906.23 ± 26.01 mg/L and from 0.06 ± 0.01 to 101.00 ± 8.29 mg/L, respectively. The florescence index (FI) amounted from 1.54 to 3.14, the biological index (BIX) were between 0.94 and 1.57. The distribution patterns of specific ultraviolet absorbance at 254 nm (SUVA254) showed that the highest aromaticity and hydrophobicity were found in SDPW and the lowest ones were in SW. All samples showed significantly inhibition on luminescent bacteria. Particularly, the highest acute toxicity was found in site 1 with an EC50 value of 6.023-fold dilution for the raw SDPW sample. In addition, the highest fluorescence intensity was also observed from SDPW of site 1.

Conclusions

Tryptophan-like and protein-like substances could be important DOC fractions contributing remarkably to the acute toxicity in the seriously polluted river. In addition, the significant reduction on acute toxicity was found with the treatment of surface water flow constructed wetland, revealing that constructed wetland could be an effective approach for toxicant degradation. These observations are useful for water treatments, and meaningful for urban sustainable development.
Manipulating osa-MIR156f Expression by D18 Promoter to Regulate Plant Architecture and Yield Traits both in Seasonal and Ratooning Rice
Authors: Liu Qing , Su Yi , Zhu Yunhua , Peng Keqin , Hong Bin , Wang Ruozhong , Gaballah Mahmoud , Xiao Langtao
Published: November 2019

Background

Rice (Oryza sativa L.) feeds more than half of the world’s population. Ratooning rice is an economical alternative to the second seasonal rice, thus increasing the yield of ratooning rice is highly important.

Results

Here we report an applicable transgenic line constructed through the manipulation of osa-MIR156f expression in rice shoot using the OsGA3ox2 (D18) promoter. In seasonal rice, the D18–11 transgenic line showed moderate height and more effective tillers with normal panicle. In ratooning rice, axillary buds outgrew from the basal node of the D18–11 transgenic line before the harvest of seasonal rice. More effective tillers produced by the outgrowth of axillary buds contributed to the plant architecture improvement and yield increase. Additionally, it was found that osa-miR156f down-regulated the expression of tillering regulators, such as TEOSINTE BRANCHED1 (TB1) and LAX PANICLE 1 (LAX1). The expression of DWARF10, DWARF27 and DWARF53, three genes being involved in the biosynthesis and signaling of strigolactone (SL), decreased in the stem of the D18–11 transgenic line.

Conclusion

Our results indicated that the manipulation of osa-MIR156f expression may have application significance in rice genetic breeding. This study developed a novel strategy to regulate plant architecture and grain yield potential both in the seasonal and ratooning rice.
A comparative study of topology-based pathway enrichment analysis methods
Authors: Ma Jing , Shojaie Ali , Michailidis George
Published: November 2019

Background

Pathway enrichment extensively used in the analysis of Omics data for gaining biological insights into the functional roles of pre-defined subsets of genes, proteins and metabolites. A large number of methods have been proposed in the literature for this task. The vast majority of these methods use as input expression levels of the biomolecules under study together with their membership in pathways of interest. The latest generation of pathway enrichment methods also leverages information on the topology of the underlying pathways, which as evidence from their evaluation reveals, lead to improved sensitivity and specificity. Nevertheless, a systematic empirical comparison of such methods is still lacking, making selection of the most suitable method for a specific experimental setting challenging. This comparative study of nine network-based methods for pathway enrichment analysis aims to provide a systematic evaluation of their performance based on three real data sets with different number of features (genes/metabolites) and number of samples.

Results

The findings highlight both methodological and empirical differences across the nine methods. In particular, certain methods assess pathway enrichment due to differences both across expression levels and in the strength of the interconnectedness of the members of the pathway, while others only leverage differential expression levels. In the more challenging setting involving a metabolomics data set, the results show that methods that utilize both pieces of information (with NetGSA being a prototypical one) exhibit superior statistical power in detecting pathway enrichment.

Conclusion

The analysis reveals that a number of methods perform equally well when testing large size pathways, which is the case with genomic data. On the other hand, NetGSA that takes into consideration both differential expression of the biomolecules in the pathway, as well as changes in the topology exhibits a superior performance when testing small size pathways, which is usually the case for metabolomics data.
Trusting the hand that feeds: microbes evolve to anticipate a serial transfer protocol as individuals or collectives
Authors: van Dijk Bram , Meijer Jeroen , Cuypers Thomas D. , Hogeweg Paulien
Published: November 2019

Background

Experimental evolution of microbes often involves a serial transfer protocol, where microbes are repeatedly diluted by transfer to a fresh medium, starting a new growth cycle. This has revealed that evolution can be remarkably reproducible, where microbes show parallel adaptations both on the level of the phenotype as well as the genotype. However, these studies also reveal a strong potential for divergent evolution, leading to diversity both between and within replicate populations. We here study how in silico evolved Virtual Microbe “wild types” (WTs) adapt to a serial transfer protocol to investigate generic evolutionary adaptations, and how these adaptations can be manifested by a variety of different mechanisms.

Results

We show that all WTs evolve to anticipate the regularity of the serial transfer protocol by adopting a fine-tuned balance of growth and survival. This anticipation is done by evolving either a high yield mode, or a high growth rate mode. We find that both modes of anticipation can be achieved by individual lineages and by collectives of microbes. Moreover, these different outcomes can be achieved with or without regulation, although the individual-based anticipation without regulation is less well adapted in the high growth rate mode.

Conclusions

All our in silico WTs evolve to trust the hand that feeds by evolving to anticipate the periodicity of a serial transfer protocol, but can do so by evolving two distinct growth strategies. Furthermore, both these growth strategies can be accomplished by gene regulation, a variety of different polymorphisms, and combinations thereof. Our work reveals that, even under controlled conditions like those in the lab, it may not be possible to predict individual evolutionary trajectories, but repeated experiments may well result in only a limited number of possible outcomes.
Nutritional value of Sesamum indicum L. was improved by Azospirillum and Azotobacter under low input of NP fertilizers
Authors: Nosheen Asia , Bano Asghari , Naz Rabia , Yasmin Humaira , Hussain Ishtiaq , Ullah Faizan , Keyani Rumana , Hassan Muhammad Nadeem , Tahir Ayesha T.
Published: November 2019

Background

Sesame (Sesame indicumL.) is well-known as a versatile industrial crop having various usages and contains 50–55% oil, 20% protein, 14–20% carbohydrate and 2–3% fiber. Several environmental factors are known to adversely affect yield and productivity of sesame. Our overall aim was to improve the growth, yield and quality of sesame cv. TS-3 using plant growth promoting rhizobacteria (PGPR) and saving the nitrogen and phosphate fertilizers (NP) by 50%. Field experiment (randomized complete block design) was conducted during the months of July to October of two consecutive years 2012–2013.Azospirillum(AL) andAzotobacter(AV) were applied as seed inoculation alone as well as along with half of the recommended dose of nitrogen (N) and phosphate (P) fertilizers (urea and diammonium phosphate) at the rate of 25 kg/ha and 30 kg/ha respectively.

Results

Here we report thatA. lipoferumalong with half dose of NP fertilizers (ALCF) were highly effective in increasing the agronomic and yield traits of sesame as compared to the control.A. vinelandiiplus NP fertilizers (AVCF) exhibited higher seed oil content. Minimum acid value, optimum specific gravity and modified fatty acid composition were observed in ALCF treatment. Increase in oleic acid by ALCF is directly linked with improved oil quality for health benefits as oleic acid is the fatty acid which creates a balance between saturation and unsaturation of oil and for the hypotensive (blood pressure reducing) effects.

Conclusion

It is inferred that ALCF treatment improved plant growth, seed yield and oil quality of sesame pertaining to good quality edible oil production.
The effect of intraoperative lidocaine versus esmolol infusion on postoperative analgesia in laparoscopic cholecystectomy: a randomized clinical trial
Authors: Bajracharya Joshan Lal , Subedi Asish , Pokharel Krishna , Bhattarai Balkrishna
Published: November 2019

Background

As a part of multimodal analgesia for laparoscopic cholecystectomy, both intraoperative lidocaine and esmolol facilitate postoperative analgesia. Our objective was to compare these two emerging strategies that challenge the use of intraoperative opioids. We aimed to assess if intraoperative esmolol infusion is not inferior to lidocaine infusion for opioid consumption after laparoscopic cholecystectomy.

Methods

In this prospective, randomized, double-blind, non-inferiority clinical trial, 90 female patients scheduled for elective laparoscopic cholecystectomy received either intravenous (IV) lidocaine bolus 1.5 mg/kg at induction followed by an infusion (1.5 mg/ kg/h) or IV bolus of esmolol 0.5 mg/kg at induction followed by an infusion (5–15 μg/kg/min) till the end of surgery. Remaining aspect of anesthesia followed a standard protocol apart from no intraoperative opioid supplementation. Postoperatively, patients received either morphine or tramadol IV to maintain visual analogue scale (VAS) scores ≤3. The primary outcome was opioid consumption (in morphine equivalents) during the first 24 postoperative hours. Pain and sedation scores, time to first perception of pain and void, and occurrence of nausea/vomiting were secondary outcomes measured up to 24 h postoperatively.

Results

Two patients in each group were excluded from the analysis. The postoperative median (IQR) morphine equivalent consumption in patients receiving esmolol was 1 (0–1.5) mg compared to 1.5 (1–2) mg in lidocaine group (p = 0.27). The median pain scores at various time points were similar between the two groups (p > 0.05). More patients receiving lidocaine were sedated in the post-anesthesia care unit (PACU) than those receiving esmolol (p < 0.05); however, no difference was detected later.

Conclusion

Infusion of esmolol is not inferior to lidocaine in terms of opioid requirement and pain severity in the first 24 h after surgery. Patients receiving lidocaine were more sedated during their stay in PACU than those receiving esmolol.

Trial registration

ClinicalTrials.gov- NCT02327923. Date of registration: December 31, 2014.
Evaluation of tools to assess psychological distress: how to measure psychological stress reactions in citizen responders– a systematic review
Authors: Kragh Astrid Rolin , Folke Fredrik , Andelius Linn , Ries Emma Slebsager , Rasmussen Rasmus Vedby , Hansen Carolina Malta
Published: November 2019

Background

Dispatched citizen responders are increasingly involved in out-of-hospital cardiac arrest (OHCA) resuscitation which can lead to severe stress. It is unknown which psychological assessment tools are most appropriate to evaluate psychological distress in this population.

The aim of this systematic review was to identify and evaluate existing assessment tools used to measure psychological distress with emphasis on citizen responders who attempted resuscitation.

Methods

A systematic literature search conducted by two reviewers was carried out in March 2018 and revised in July 2018. Four databases were searched: PubMed, PsycInfo, Scopus, and The Social Sciences Citation Index. A total of 504 studies examining assessment tools to measure psychological distress reactions after acute traumatic events were identified, and 9 fulfilled the inclusion criteria for further analysis. The selected studies were assessed for methodological quality using the Scottish Intercollegiate Guidelines Network.

Results

The Impact of Event Scale (IES) and The Impact of Event Scale-Revised (IES-R) were the preferred assessment tools, and were used on diverse populations exposed to various traumatic events. One study included lay rescuers performing bystander cardiopulmonary resuscitation and this study used the IES. The IES and the IES-R also have proven a high validity in various other populations. The Clinical administered PTSD scale (CAPS) was applied in two studies. Though the CAPS is comparable to both the IES-R and the IES, the CAPS assess PTSD symptoms in general and not in relation to a specific experienced event, which makes the scale less suitable when measuring stress due to a specific resuscitation attempt.

Conclusions

The IES and the IES-R seem to be solid measures for psychological distress among people experiencing an acute psychological traumatic event. However, only one study has assessed psychological distress among citizen responders in OHCA for which the IES-R scale was used, and therefore, further research on this topic is warranted.
Definition of a systematic review used in overviews of systematic reviews, meta-epidemiological studies and textbooks
Authors: Krnic Martinic Marina , Pieper Dawid , Glatt Angelina , Puljak Livia
Published: November 2019

Background

A standard or consensus definition of a systematic review does not exist. Therefore, if there is no definition about a systematic review in secondary studies that analyse them or the definition is too broad, inappropriate studies might be included in such evidence synthesis. The aim of this study was to analyse the definition of a systematic review (SR) in health care literature, elements of the definitions that are used and to propose a starting point for an explicit and non-ambiguous SR definition.

Methods

We included overviews of systematic reviews (OSRs), meta-epidemiological studies and epidemiology textbooks. We extracted the definitions of SRs, as well as the inclusion and exclusion criteria that could indicate which definition of a SR the authors used. We extracted individual elements of SR definitions, categorised and quantified them.

Results

Among the 535 analysed sources of information, 188 (35%) provided a definition of a SR. The most commonly used reference points for the definitions of SRs were Cochrane and the PRISMA statement. We found 188 different elements of SR definitions and divided them into 14 categories. The highest number of SR definition elements was found in categories related to searching (N = 51), analysis/synthesis (N = 23), overall methods (N = 22), quality/bias/appraisal/validity (N = 22) and aim/question (N = 13). The same five categories were also the most commonly used combination of categories in the SR definitions.

Conclusion

Currently used definitions of SRs are vague and ambiguous, often using terms such as clear, explicit and systematic, without further elaboration. In this manuscript we propose a more specific definition of a systematic review, with the ultimate aim of motivating the research community to establish a clear and unambiguous definition of this type of research.
Advanced glycation end products and their ratio to soluble receptor are associated with limitations in physical functioning only in women: results from the CARLA cohort
Authors: Ebert Helen , Lacruz Maria Elena , Kluttig Alexander , Simm Andreas , Greiser Karin Halina , Tiller Daniel , Kartschmit Nadja , Mikolajczyk Rafael
Published: November 2019

Background

Advanced glycation end products (AGEs), modifications of proteins or amino acids, are increasingly produced and accumulated with age-related diseases. Recent studies suggested that the ratio of AGEs and their soluble receptor (sRAGE) is a more accurate biomarker for age-related diseases than each separately. We aim to investigate whether this also applies for physical functioning in a broad age-spectrum.

Methods

AGE and sRAGE levels, and physical functioning (SF-12 questionnaire) of 967 men and 812 women (45–83 years) were measured in the CARLA study. We used ordinal logistic regression to examine associations between AGEs, sRAGE, and AGE/sRAGE ratio with physical functioning in sex- and age-stratified models.

Results

Higher levels of AGEs and AGE/sRAGE ratio were associated with lower physical functioning only in women, even after consideration of classical lifestyle and age-related factors (education, BMI, smoking, alcohol consumption, diet, creatinine clearance, diabetes mellitus, lipid lowering and antihypertensive drugs) (odds ratio (OR) =0.86, 95%confidence interval = 0.74–0.98 and OR = 0.86, 95%CI = 0.75–0.98 for AGEs and AGE/sRAGE ratio respectively). We could not demonstrate a significant difference across age.

Conclusions

We showed a sex-specific association between physical functioning and AGEs and AGE/sRAGE, but no stronger associations of the latter with physical functioning. Further investigation is needed in the pathophysiology of this association.
Infective endocarditis caused by Capnocytophaga canimorsus; a case report
Authors: Sakai Jun , Imanaka Kazuhito , Kodana Masahiro , Ohgane Kana , Sekine Susumu , Yamamoto Kei , Nishida Yusuke , Kawamura Toru , Matsuoka Takahiro , Maesaki Shigefumi , Oka Hideaki , Ohno Hideaki
Published: November 2019

Background

Capnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce β-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test.

Case presentation

A 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for β-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery.

Conclusions

We diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.
Modification of both functional neurological symptoms and neuroimaging patterns with a good anatomoclinical concordance: a case report
Authors: Galli Silvio , Aybek Selma , Chokron Sylvie , Moulin Thierry , Magnin Eloi
Published: November 2019

Background

In the nineteenth century, Jean Martin Charcot explained functional neurological disorder (formerly called conversion disorder) as a “psychodynamic” lesion. Numerous advances in neuroimaging have permitted identification of the neural underpinnings of this disorder.

Case presentation

Herein we describe a case of functional neurological disorder (FND) with initial left sensorimotor deficit, in-coordinated limb movements, neglect, clouded consciousness, slurred speech and a semiology of visual impairment. A single photon emission computed tomography (SPECT) showed a right thalamic hypoperfusion, which is rather concordant with the initial semiology. Later, the semiology changed, presenting with a predominantly neurovisual complex presentation. The second SPECT showed no more thalamic abnormalities but an hypoperfusion in the right temporo-occipital junction, right inferior parietal lobe and left superior frontal lobe, which is also rather concordant with the changing semiology.

Conclusions

This case illustrates the evolving neuroimaging patterns of FND but also the concordance between semiology and neuroimaging findings in FND supporting Charcot's theory of “dynamic lesion”.
Parenchymal central nervous system involvement in aggressive B-cell lymphoma: retrospective analysis of clinical and MRI features in a Chinese population
Authors: Wu Yuchen , Wang Yaming , Sun Xuefei , Bai Xueyan , Qian Jun , Zhu Hong , Cui Qu , Xing Ruixian , Chen Yuedan , Liu Qing , Guo Jiayuan , Ji Nan , Sun Shengjun , Liu Yuanbo
Published: November 2019

Background

Secondary central nervous system lymphoma (SCNSL) is defined as secondary central nervous system (CNS) involvement in patients with systemic lymphoma. It is considered a profoundly adverse complication with inferior clinical outcome. Parenchymal involvement in the CNS in aggressive B-cell lymphoma is not frequently seen and remains a diagnostic dilemma.

Methods

In our study, we retrospectively analyzed the clinical and magnetic resonance imaging (MRI) features of 26 parenchymal SCNSL patients. In addition, we compared MRI features of SCNSL and primary CNS lymphoma (PCNSL) patients after 1:1 propensity score matching. Also we presented two SCNSL cases with atypical MRI appearance.

Results

Among SCNSL patients, the median CNS relapse time was 3 months, and multiple lesions were found in 76.9% of the cases. In PCNSL, this percentage was 42.3% (p = 0.011). None of the SCNSL patients and 23.1% of the PCNSL patients had solitary infratentorial lesions (p = 0.003).

Conclusions

The majority of parenchymal involvement occurred within the first year of systemic lymphoma, in which mostly cases presenting with multiple and supratentorial locations, unlike what was found in PCNSL.
Determinants of extended door-to-needle time in acute ischemic stroke and its influence on in-hospital mortality: results of a nationwide Dutch clinical audit
Authors:   on behalf of the Dutch Acute Stroke Audit consortium, Kuhrij Laurien S. , Marang-van de Mheen Perla J. , van den Berg-Vos Renske M. , de Leeuw Frank-Erik , Nederkoorn Paul J.
Published: November 2019

Background

Intravenous thrombolysis (IVT) plays a prominent role in the treatment of acute ischemic stroke (AIS). The sooner IVT is administered, the higher the odds of a good outcome. Therefore, registering the in-hospital time to treatment with IVT, i.e. the door-to-needle time (DNT), is a powerful way to measure quality improvement. The aim of this study was to identify determinants that are associated with extended DNT.

Methods

Patients receiving IVT in 2015 and 2016 registered in the Dutch Acute Stroke Audit were included. DNT and onset-to-door time (ODT) were dichotomized using the median (i.e. extended DNT) and the 90th percentile (i.e. severely extended DNT). Logistic regression was performed to identify determinants associated with (severely) extended DNT/ODT and its effect on in-hospital mortality. A linear model with natural spline was used to investigate the association between ODT and DNT.

Results

Included were 9518 IVT treated patients from 75 hospitals. Median DNT was 26 min (IQR 20–37). Determinants associated with a higher likelihood of extended DNT were female sex (OR 1.17, 95% CI 1.05–1.31) and admission during off-hours (OR 1.12, 95% CI 1.01–1.25). Short ODT correlated with longer DNT, whereas longer ODT correlated with shorter DNT. Young age (OR 1.38, 95% CI 1.07–1.76) and admission to a comprehensive stroke center (OR 1.26, 1.10–1.45) were associated with severely extended DNT, which was associated with in-hospital mortality (OR 1.54, 95%CI 1.19–1.98).

Conclusions

Even though DNT in the Netherlands is short compared to other countries, lowering the DNT may be achievable by focusing on specific subgroups.
Angiographic features of drug-induced bilateral angle closure and transient myopia with Ciliochoroidal effusion
Authors: Kang Yong Koo , Son Byeong Jae , Park Dong Ho , Shin Jae Pil
Published: November 2019

Background

To report five cases of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion and to analyze angiographic findings of these cases.

Methods

This study is an observational case series. Five patients with acute drug-induced angle closure and transient myopia with ciliochoroidal effusion were examined by fluorescein angiography, indocyanine green angiography (ICGA) and ultrasound biomicroscopy (UBM).

Results

Five patients presented with bilateral visual loss and ocular pain after intake of topiramate, methazolamide, phendimetrazine tartrate or mefenamic acid. All patients showed elevated intraocular pressure (IOP) with shallow anterior chamber and myopic shift from − 0.5 to − 17.0 diopters (D). UBM showed ciliochoroidal effusions with diffuse thickening of the ciliary body in all cases. Rapid normalization of IOP and decrease of myopic shift occurred in all patients after discontinuing the suspected drugs. We classified the ICGA findings into 2 major signs (hypofluorescent dark spots, hyperfluorescent pinpoints) and 3 minor signs (diffuse choroidal hyperfluorescence, early hyperfluorescence of choroidal stromal vessel, and leakage and dilated retinal vessels).

Conclusions

The pathogenesis of acute drug-induced angle closure and transient myopia with ciliochoroidal effusion may be idiosyncratic reaction of uveal tissue to systemic drugs. Accumulation of extravascular fluid in the ciliochoroidal layer had a major role in the pathogenesis. ICGA could be a useful method to examine the pathophysiology of this condition by imaging of the choroidal layer.
Primary immunodeficiency disease: a retrospective study of 112 Chinese children in a single tertiary care center
Authors: Wu Jinhong , Zhong Wenwei , Yin Yong , Zhang Hao
Published: November 2019

Background

Primary immunodeficiency disease (PID) is a disorder caused by an inherited flaw in the immune system that increases the susceptibility to infections.

Methods

In this study, 112 children with PID were diagnosed and classified based on the 2017 criteria presented by the International Union of Immunological Societies (IUIC) in a single tertiary care center from January 2013 to November 2018. We retrospectively studied the clinical features of those PID children and followed-up them as well.

Results

It was revealed that male/female ratio was 6:1. The most frequent diagnosed PID was severe combined immunodeficiency (SCID) (28.6%) and hyper-IgM (HIGM) syndrome (24.1%), followed by predominantly antibody deficiencies (17.8%). Combined immunodeficiencies with associated or syndromic features (12.5%) and congenital defects of phagocyte number, function, or both (10.7%) were less common in our center compared with SCID and HIGM syndrome. Besides, we found that 20 children (17.8%) had a positive family history of PID, and almost all cases (97.3%) had a history of recurrent infection. Recurrent respiratory tract infection was among the most common symptoms, followed by the bacterial infection of the skin and mucous membranes and diarrhea. Additionally, adverse event following immunization (AEFI) was found in 20.5% of the patients, and immune disorder was commonly observed in PID patients. In the present study, 47 patients underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT), and 2-year overall survival (OS) rate for these patients was 78.7% (37/47). It is noteworthy that OS widely differed among PID patients with different phenotypes who underwent allo-HSCT. The 2-year OS rate for SCID, HIGM syndrome, and the remaining of PID patients who underwent allo-HSCT was 14.3, 83.3, and 100%, respectively.

Conclusions

PID typically emerges at early age. Recurrent infection and serious infection were the most common clinical manifestations. Allo-HSCT is a relatively effective therapeutic strategy for PID patients.