bluuebunny/crossref_metadata_2025 huggingface dataset:
Laser-Aided Enamel Conditioning: A Comparison of Microleakage Under Brackets Following Different Aging Procedures
Authors: Ok Ufuk , Yilmaz Berza Sen , Ramoglu Sabri Ilhan
Published: November 2019

Objective:

To evaluate microleakage under the orthodontic adhesives applied following two version of erbium:yttrium aluminum garnet (Er:YAG) laser-aided enamel conditioning after thermal and thermomechanical simulators.

Materials and Methods:

A comparative analytical study based on metal braces bonded on the enamel of extracted teeth ( n = 160) etched with acid, Er:YAG laser and Er:YAG laser with an X-Runner handpiece, and self-etch adhesives. An arch wire was ligatured to samples which were embedded in acrylic blocks by two with periodontal ligaments. The specimens were subdivided into two groups: those aged with thermal cycling and thermomechanical aging procedures. The samples were immersed in basic fuchsin solution (0.5%) for 24 h. Buccolingual sections were performed on the mesial and distal wings of the braces. The color penetration at the gingival and occlusal margins of the adhesive-bracket and enamel-adhesive was evaluated under a stereomicroscope. The median and mean values of microleakage in both groups were evaluated with Kruskal–Wallis and Mann–Whitney U tests ( P < .05).

Results:

The highest microleakage was recorded in the gingival part of the samples aged with the thermomechanical aging procedure ( P = .001). The amount of microleakage generally increased in the samples subjected to thermomechanical loading, but the only significant difference was recorded in the gingival part in each four different conditioning methods.

Conclusion:

Microleakage of the phosphoric acid-etched groups was recorded with lower values for both aging methods. Thermomechanical aging should be included to microleakage studies due to increased microleakage on gingival side for all etching groups.
Lingual Orthodontic Treatment: Efficacy and Complications
Authors: Behnaz Mohammad , Farahnaki Arash , Rahimipour Kasra , Mousavi Reza , Davoodi Nima Sheikh
Published: November 2019

Aims and Objectives:

The high esthetic demands led to the promotion of various esthetic appliances like lingual orthodontics. This study aimed to review clinical outcome and potential complications of lingual orthodontics to achieve an evidence-based decision for orthodontic therapies.

Materials and Methods:

A comprehensive electronic search was conducted from January 1975 to March 2019 which was limited to English language and administrations of lingual orthodontics treatment which evaluated its efficacy and potential complications. Data extraction was performed according to the PRISMA statement.

Results:

49 studies were selected and analyzed in this systematic review. The pain of lingual appliances starts a little earlier and lasts longer, and patients with lingual appliances experience more tongue discomfort and less cheek and lip pain and greater eating difficulties especially after placement and take a longer time to adapt to appliances. Lingual appliances generally cause more plaque accumulation and gingivitis especially in lingual anterior teeth; however, labial appliances are associated with high frequency in posterior maxillary teeth.

Conclusion:

This systematic review shows that despite the drawbacks of these appliances such as pain and eating difficulties, they can accomplish treatment goals with the same outcomes in comparison with conventional approaches, within the same duration and even lesser anchorage loss.
Influence of Graft Bending Angle on Graft Maturation, the Femoral Tunnel, and Functional Outcomes by 12 Months After Anterior Cruciate Ligament Reconstruction
Authors: Li Hong , Liu Shaohua , Sun Yaying , Li Hongyun , Chen Shiyi , Chen Jiwu
Published: November 2019

Background:

The graft bending angle (GBA), the angle between the femoral bone tunnel and the line connecting the femoral and tibial tunnel apertures, has been proven to influence stress within the graft and could be an important factor in graft healing within the joint and bone tunnel. However, the influence of the GBA on functional outcomes, particularly on return to sports (RTS), is rarely reported.

Purpose/Hypothesis:

The purpose of this study was to investigate the influence of the GBA on graft maturation, the femoral tunnel, and functional outcomes at 12 months after anterior cruciate ligament reconstruction (ACLR). We hypothesized that a greater GBA might be related to bone tunnel widening, poor graft healing, and inferior functional outcomes after ACLR.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 43 consecutive patients who underwent unilateral ACLR with hamstring tendon autografts participated in this study. Their knees were evaluated using functional scores (International Knee Documentation Committee [IKDC] score, Lysholm knee activity score, Tegner activity scale, RTS) and the anterior tibial translation side-to-side difference (ATTD), as measured using a KT-1000 arthrometer and 3.0-T magnetic resonance imaging (MRI), at 12 months after surgery. Based on MRI, the signal/noise quotient (SNQ) of the graft, the GBA, and the femoral tunnel diameter were measured.

Results:

The mean GBA was 56° (range, 41°-69°). The GBA had a significant positive correlation with the SNQ (rho, 0.45; P = .003) and bone tunnel diameter (rho, 0.35; P = .02), but it had no significant correlation with any functional scores. Patients were divided into 3 groups based on GBA values: low GBA (LGBA; 40° < GBA ≤ 50°), middle GBA (MGBA; 50° < GBA ≤ 60°), and high GBA (HGBA; 60° < GBA ≤ 70°). The HGBA group had a significantly higher mean SNQ than both the LGBA ( P = .01) and MGBA groups ( P = .02). It also had a greater mean tunnel diameter than the LGBA group ( P = .04). There was no significant difference in IKDC scores, Lysholm scores, ATTD, Tegner scores, or rates of RTS among groups.

Conclusion:

The GBA did not affect functional outcomes at 12 months after ACLR, although it affected the SNQ of the graft and the femoral tunnel diameter.
Functional and Radiographic Outcomes After Anatomic Coracoclavicular Ligament Reconstruction for Type III/V Acromioclavicular Joint Injuries
Authors: Muench Lukas N. , Kia Cameron , Jerliu Aulon , Murphy Matthew , Berthold Daniel P. , Cote Mark P. , Arciero Robert A. , Mazzocca Augustus D.
Published: November 2019

Background:

Acromioclavicular (AC) joint separation is a common injury. The anatomic coracoclavicular ligament reconstruction (ACCR) technique is a viable treatment option, designed to restore the native joint anatomy.

Purpose:

To evaluate the clinical and radiographic outcomes of patients undergoing ACCR for the treatment of type III and V AC joint injuries with a minimum 2-year follow-up.

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective chart review was performed on prospectively collected data. Patients who underwent ACCR for type III or V AC joint injuries between January 2003 and December 2015 were analyzed. Clinical outcome measures included the American Shoulder and Elbow Surgeons (ASES) score, Rowe score, Simple Shoulder Test (SST), and Constant-Murley (CM) score. To determine the clinical relevance of the ASES score, the minimal clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptomatic state (PASS) were used. The pre- and postoperative coracoclavicular distance (CCD) and side-to-side difference in the CCD were measured for radiographic analysis.

Results:

A total of 43 patients (22 acute, 21 chronic) were included in the study. The mean patient age was 43.4 ± 11.4 years, with a mean follow-up of 3.4 years (range, 2.0-7.5 years). With regard to the ASES score, 92% of patients achieved the MCID, 81% achieved the SCB, and 49% reached or exceeded the PASS. There was no significant difference when stratifying by type (III vs V) or chronicity (acute vs chronic) of injury (both P > .05). The Rowe score improved from 66.6 ± 15.9 preoperatively to 88.6 ± 12.3 postoperatively, the CM score from 61.6 ± 18.8 to 87.4 ± 15.1, and the SST score from 6.2 ± 3.6 to 9.4 ± 3.7 (all P < .001). The postoperative side-to-side difference in the CCD was 3.1 ± 2.7 mm, with type III injuries (2.4 ± 1.9 mm) showing significantly lower measurements compared with type V (4.2 ± 3.4 mm) ( P = .02). No significant trend was found between joint reduction and the improvement in clinical outcomes ( P > .05).

Conclusion:

Patients undergoing ACCR for acute and chronic type III and V AC joint injuries maintained significant improvement in clinical and radiographic outcomes at a minimum 2-year follow-up. Additionally, 81% of patients reached the SCB after surgical reconstruction.
Online Consent Enables a Randomized, Controlled Trial Testing a Patient-Centered Online Decision-Aid for Medicare Beneficiaries to Meet Recruitment Goal in Short Time Frame
Authors: Meehan Amy , Bundorf Mary Kate , Klimke Roman , Stults Cheryl D. , Chan Albert S , Pun Ting , Tai-Seale Ming
Published: November 2019

Online consenting allows potential participants of research projects to deliberate their participation at their own pace and may be more cost-effective than conventional approaches. Yet, online consenting is not widespread in health services research due partly to concerns about security, confidentiality, and lack of established processes. We report our use of online consenting to successfully enroll over 1185 Medicare beneficiaries in a short 9-week time frame for a research study.
Managing the competing risks of thrombosis, bleeding, and anticoagulation in patients with malignancy
Authors: Al-Samkari Hanny , Connors Jean M.
Published: November 2019

The association between malignancy and thrombosis has been recognized for over a century and a half. Patients with cancer have an elevated risk of both initial and recurrent venous thromboembolism (VTE) compared with patients without cancer owing to cancer- and patient-specific factors. Recurrent VTE is common despite anticoagulation, presenting additional management challenges. Patients with cancer also have an increased risk of bleeding when on anticoagulants compared with patients without cancer. This bleeding risk is heightened by the thrombocytopenia common in patients with hematologic malignancies and those treated with intensive myelosuppressive chemotherapy regimens. Despite the advancements in cancer-directed therapy made over the past 15 years, numerous large studies have confirmed that bleeding and VTE recurrence rates remain high in cancer patients. Balancing the increased and competing risks of clotting and bleeding in these patients can be difficult, because management of cancer-associated thrombosis requires anticoagulation despite known increased risks for bleeding. In the context of challenging illustrative cases, this review will describe management approaches to clinical scenarios in which data are sparse: cancer patients with recurrent VTE despite anticoagulation and cancer patients with a new VTE in the setting of severe thrombocytopenia.
The ParaHox gene Cdx4 induces acute erythroid leukemia in mice
Authors: Thoene Silvia , Mandal Tamoghna , Vegi Naidu M. , Quintanilla-Martinez Leticia , Rösler Reinhild , Wiese Sebastian , Metzeler Klaus H. , Herold Tobias , Haferlach Torsten , Döhner Konstanze , Döhner Hartmut , Schwarzmüller Luisa , Klingmüller Ursula , Buske Christian , Rawat Vijay P. S. , Feuring-Buske Michaela
Published: November 2019

Key Points

CDX4 induces AEL in mice and suppresses expression of genes associated with erythroid differentiation. Mutations detectable in the Cdx4-induced AEL model occur in genes reported mutated in patients with AEL.
Comparative genome analyses reveal the unique genetic composition and selection signals underlying the phenotypic characteristics of three Chinese domestic goat breeds
Authors: Guo Jiazhong , Zhong Jie , Li Li , Zhong Tao , Wang Linjie , Song Tianzeng , Zhang Hongping
Published: November 2019

Background

As one of the important livestock species around the world, goats provide abundant meat, milk, and fiber to fulfill basic human needs. However, the genetic loci that underlie phenotypic variations in domestic goats are largely unknown, particularly for economically important traits. In this study, we sequenced the whole genome of 38 goats from three Chinese breeds (Chengdu Brown, Jintang Black, and Tibetan Cashmere) and downloaded the genome sequence data of 30 goats from five other breeds (four non-Chinese and one Chinese breed) and 21 Bezoar ibexes to investigate the genetic composition and selection signatures of the Chinese goat breeds after domestication.

Results

Based on population structure analysis andFSTvalues (averageFST = 0.22), the genetic composition of Chengdu Brown goats differs considerably from that of Bezoar ibexes as a result of geographic isolation. Strikingly, the genes under selection that we identified in Tibetan Cashmere goats were significantly enriched in the categories hair growth and bone and nervous system development, possibly because they are involved in adaptation to high-altitude. In particular, we found a large difference in allele frequency of one novel SNP (c.-253G>A) in the 5′-UTR ofFGF5between Cashmere goats and goat breeds with short hair. The mutation at this site introduces a start codon that results in the occurrence of a premature FGF5 protein and is likely a natural causal variant that is involved in the long hair phenotype of cashmere goats. The haplotype tagged with the AGG-allele in exon 12 ofDSG3, which encodes a cell adhesion molecule that is expressed mainly in the skin, was almost fixed in Tibetan Cashmere goats, whereas this locus still segregates in the lowland goat breeds. The pigmentation geneKITLGshowed a strong signature of selection in Tibetan Cashmere goats. The genesASIPandLCORLwere identified as being under positive selection in Jintang Black goats.

Conclusions

After domestication, geographic isolation of some goat breeds has resulted in distinct genetic structures. Furthermore, our work highlights several positively selected genes that likely contributed to breed-related traits in domestic goats.
Unusual interplay of contrasting selective pressures on β-defensin genes implicated in male fertility of the Buffalo (Bubalus bubalis)
Authors: Batra Vipul , Maheshwarappa Avinash , Dagar Komal , Kumar Sandeep , Soni Apoorva , Kumaresan A. , Kumar Rakesh , Datta T. K.
Published: November 2019

Background

The buffalo, despite its superior milk-producing ability, suffers from reproductive limitations that constrain its lifetime productivity. Male sub-fertility, manifested as low conception rates (CRs), is a major concern in buffaloes. The epididymal sperm surface-binding proteins which participate in the sperm surface remodelling (SSR) events affect the survival and performance of the spermatozoa in the female reproductive tract (FRT). A mutation in an epididymal secreted protein, beta-defensin 126 (DEFB-126/BD-126), a class-A beta-defensin (CA-BD), resulted in decreased CRs in human cohorts across the globe. To better understand the role of CA-BDs in buffalo reproduction, this study aimed to identify the BD genes for characterization of the selection pressure(s) acting on them, and to identify the most abundant CA-BD transcript in the buffalo male reproductive tract (MRT) for predicting its reproductive functional significance.

Results

Despite the low protein sequence homology with their orthologs, the CA-BDs have maintained the molecular framework and the structural core vital to their biological functions. Their coding-sequences in ruminants revealed evidence of pervasive purifying and episodic diversifying selection pressures. The buffalo CA-BD genes were expressed in the major reproductive and non-reproductive tissues exhibiting spatial variations. The Buffalo BD-129 (BuBD-129) was the most abundant and the longest CA-BD in the distal-MRT segments and was predicted to be heavily O-glycosylated.

Conclusions

The maintenance of the structural core, despite the sequence divergence, indicated the conservation of the molecular functions of the CA-BDs. The expression of the buffalo CA-BDs in both the distal-MRT segments and non-reproductive tissues indicate the retention the primordial microbicidal activity, which was also predicted by in silico sequence analyses. However, the observed spatial variations in their expression across the MRT hint at their region-specific roles. Their comparison across mammalian species revealed a pattern in which the various CA-BDs appeared to follow dissimilar evolutionary paths. This pattern appears to maintain only the highly efficacious CA-BD alleles and diversify their functional repertoire in the ruminants. Our preliminary results and analyses indicated that BuBD-129 could be the functional ortholog of the primate DEFB-126. Further studies are warranted to assess its molecular functions to elucidate its role in immunity, reproduction and fertility.
High-density linkage map construction and QTL analyses for fiber quality, yield and morphological traits using CottonSNP63K array in upland cotton (Gossypium hirsutum L.)
Authors: Zhang Kuang , Kuraparthy Vasu , Fang Hui , Zhu Linglong , Sood Shilpa , Jones Don C.
Published: November 2019

Background

Improving fiber quality and yield are the primary research objectives in cotton breeding for enhancing the economic viability and sustainability of Upland cotton production. Identifying the quantitative trait loci (QTL) for fiber quality and yield traits using the high-density SNP-based genetic maps allows for bridging genomics with cotton breeding through marker assisted and genomic selection. In this study, a recombinant inbred line (RIL) population, derived from cross between two parental accessions, which represent broad allele diversity in Upland cotton, was used to construct high-density SNP-based linkage maps and to map the QTLs controlling important cotton traits.

Results

Molecular genetic mapping using RIL population produced a genetic map of 3129 SNPs, mapped at a density of 1.41 cM. Genetic maps of the individual chromosomes showed good collinearity with the sequence based physical map. A total of 106 QTLs were identified which included 59 QTLs for six fiber quality traits, 38 QTLs for four yield traits and 9 QTLs for two morphological traits. Sub-genome wide, 57 QTLs were mapped in A sub-genome and 49 were mapped in D sub-genome. More than 75% of the QTLs with favorable alleles were contributed by the parental accession NC05AZ06. Forty-six mapped QTLs each explained more than 10% of the phenotypic variation. Further, we identified 21 QTL clusters where 12 QTL clusters were mapped in the A sub-genome and 9 were mapped in the D sub-genome. Candidate gene analyses of the 11 stable QTL harboring genomic regions identified 19 putative genes which had functional role in cotton fiber development.

Conclusion

We constructed a high-density genetic map of SNPs in Upland cotton. Collinearity between genetic and physical maps indicated no major structural changes in the genetic mapping populations. Most traits showed high broad-sense heritability. One hundred and six QTLs were identified for the fiber quality, yield and morphological traits. Majority of the QTLs with favorable alleles were contributed by improved parental accession. More than 70% of the mapped QTLs shared the similar map position with previously reported QTLs which suggest the genetic relatedness of Upland cotton germplasm. Identification of QTL clusters could explain the correlation among some fiber quality traits in cotton. Stable and major QTLs and QTL clusters of traits identified in the current study could be the targets for map-based cloning and marker assisted selection (MAS) in cotton breeding. The genomic region on D12 containing the major stable QTLs for micronaire, fiber strength and lint percentage could be potential targets for MAS and gene cloning of fiber quality traits in cotton.
Genome-wide identification and characterization of the GDP-L-galactose phosphorylase gene family in bread wheat
Authors: Broad Ronan C. , Bonneau Julien P. , Beasley Jesse T. , Roden Sally , Philips Joshua G. , Baumann Ute , Hellens Roger P. , Johnson Alexander A. T.
Published: November 2019

Background

Ascorbate is a powerful antioxidant in plants and an essential micronutrient for humans. TheGDP-L-galactose phosphorylase(GGP) gene encodes the rate-limiting enzyme of the L-galactose pathway—the dominant ascorbate biosynthetic pathway in plants—and is a promising gene candidate for increasing ascorbate in crops. In addition to transcriptional regulation, GGP production is regulated at the translational level through an upstream open reading frame (uORF) in the long 5′-untranslated region (5’UTR). TheGGPgenes have yet to be identified in bread wheat (Triticum aestivumL.), one of the most important food grain sources for humans.

Results

Bread wheat chromosomal groups 4 and 5 were found to each contain three homoeologousTaGGPgenes on the A, B, and D subgenomes (TaGGP2-A/B/DandTaGGP1-A/B/D, respectively) and a highly conserved uORF was present in the long 5’UTR of all six genes. Phylogenetic analyses demonstrated that theTaGGPgenes separate into two distinct groups and identified a duplication event of theGGPgene in the ancestor of theBrachypodium/Triticeae lineage. A microsynteny analysis revealed that theTaGGP1andTaGGP2subchromosomal regions have no shared synteny suggesting thatTaGGP2may have been duplicated via a transposable element. The two groups ofTaGGPgenes have distinct expression patterns with theTaGGP1homoeologs broadly expressed across different tissues and developmental stages and theTaGGP2homoeologs highly expressed in anthers. Transient transformation of theTaGGPcoding sequences inNicotiana benthamianaleaf tissue increased ascorbate concentrations more than five-fold, confirming their functional role in ascorbate biosynthesisin planta.

Conclusions

We have identified sixTaGGPgenes in the bread wheat genome, each with a highly conserved uORF. Phylogenetic and microsynteny analyses highlight that a transposable element may have been responsible for the duplication and specialized expression ofGGP2in anthers in theBrachypodium/Triticeae lineage. Transient transformation of theTaGGPcoding sequences inN. benthamianademonstrated their activityin planta. The sixTaGGPgenes and uORFs identified in this study provide a valuable genetic resource for increasing ascorbate concentrations in bread wheat.
Effects of regional anesthesia techniques on local anesthetic plasma levels and complications in carotid surgery: a randomized controlled pilot trial
Authors: Rössel Thomas , Uhlig Christopher , Pietsch Jörg , Ludwig Stefan , Koch Thea , Richter Torsten , Spieth Peter Markus , Kersting Stephan
Published: November 2019

Background

The ultrasound guided intermediate cervical plexus block with perivascular infiltration of the internal carotid artery (PVB) is a new technique for regional anesthesia in carotid endarterectomy (CEA). We conducted a pilot study investigating the effects of deep cervical block (DCB), intermediate cervical block alone (ICB) and PVB on perioperative complications in patients undergoing elective CEA. We hypothesized, that the ropivacaine plasma concentration is higher in patients receiving DCB compared to PVB and ICB.

Methods

In a randomized controlled pilot study thirty patients scheduled for elective CEA were randomly assigned into three groups: DCB receiving 20 mL ropivacaine 0.5% (n = 10), ICB receiving 20 mL ropivacaine 0.5% (n = 10) and PVB receiving 20 mL ropivacaine 0.5% and 10 mL ropivacaine 0,3% (n = 10). As primary outcome, plasma levels of ropivacaine were measured with high performance liquid chromatography before, 5, 10, 20, 60, and 180 min after the injection of ropivacaine. Secondary outcomes were vascular and neurological complications as well as patients’ and surgeons’ satisfaction. All analyses were performed on an intention-to-treat basis. Statistical significance was accepted atp < 0.05.

Results

No conversion to general anesthesia was necessary and we observed no signs of local anesthetic intoxication or accidental vascular puncture. Plasma concentration of ropivacaine was significantly higher in the DCB group compared to PVB and ICB (p < 0.001) and in the PVB group compared to ICB (p = 0.008). Surgeons’ satisfaction was higher in the PVB group compared to ICB (p = 0.003) and patients’ satisfaction was higher in the PVB group compared to ICB (p = 0.010) and DCB group (p = 0.029). Phrenic nerve paralysis was observed frequently in the DCB group (p < 0.05). None of these patients with hemi-diaphragmatic paralysis showed signs of respiratory distress.

Conclusion

The ultrasound guided PVB is a safe and effective technique for CEA which is associated with lower plasma levels of local anesthetic than the standard DCB. Considering the low rate of complications in all types of regional anesthesia for CEA, larger randomized controlled trials are warranted to assess potential side effects among the blocks.

Trial registration

The trial was registered at German Clinical Trials Register (DRKS) on 04/05/2019 (DRKS00016705, retrospectively registered).
Comparison of transesophageal echocardiography findings after different anticoagulation strategies in patients with atrial fibrillation: a systematic review and meta-analysis
Authors: Yang Jian , Zhang Xuan , Wang Xi-ying , Zhang Chi , Chen Song-zan , Hu Shen-Jiang
Published: November 2019

Background

High risk of embolic events exists in both patients with chronic atrial fibrillation (AF) and patients in the perioperative period of ablation (effective treatment for AF). Therefore, anticoagulant therapy is important. Oral anticoagulants can be divided into two major categories: vitamin K antagonists (VKAs) and non-vitamin K antagonist oral anticoagulants (NOACs). VKAs, represented by warfarin, have been widely used as traditional anticoagulants, whereas NOACs have been used in clinical practice, but their anticoagulant effects and side effects are still the focus of research. We used a meta-analysis to compare the incidence of left atrial thrombi (LAT) between different anticoagulants.

Methods

We searched PubMed, EMBASE, Web of Science, and the Cochrane Library databases for observational studies that compared the transesophageal echocardiography (TEE) findings for patients treated with NOACs and VKAs. The incidence of LAT and dense spontaneous echocardiographic contrast (dense SEC) were extracted as the basis of the meta-analysis.

Results

Fifteen studies were included in the meta-analysis. We found that patients anticoagulated with NOACs and VKAs had similar incidence of LAT (OR = 0.74, 95%CI: 0.55–1.00). After excluding the heterogeneous article by sensitivity analysis, we found the incidence of LAT in patients anticoagulated with NOACs is lower than VKAs (OR = 0.59, 95%CI: 0.42–0.84). The results of subgroup analysis showed that the incidence of LAT among three types of NOACs have no significant difference (dabigatran vs. rivaroxaban, OR = 1.16 [0.75, 1.81]; rivaroxaban vs. apixaban, OR = 0.97 [0.54, 1.74]; dabigatran vs. apixaban, OR = 1.09 [0.55, 2.16]).

Conclusion

Patients anticoagulated with NOACs may have lower incidence of LAT than VKAs. The incidence of LAT among different type of NOACs are similar.
Comparison of standard and over-the-head method of chest compressions during cardiopulmonary resuscitation - a simulation study
Authors: Ćwiertnia Michał , Kawecki Marek , Ilczak Tomasz , Mikulska Monika , Dutka Mieczysław , Bobiński Rafał
Published: November 2019

Background

Maintaining highly effective cardiopulmonary resuscitation (CPR) can be particularly difficult when artificial ventilation using a bag-valve-mask device, combined with chest compression have to be carried out by one person. The aim of the study is to compare the quality of CPR conducted by one paramedic using chest compression from the patient’s side with compression conducted from the ‘over-the-head’ position.

Methods

The subject of the study were two methods of CPR – ‘standard’ (STD) and ‘over-the-head’ (OTH). The STD method consisted of cycles of 30 chest compressions from the patient’s side, and two attempts at artificial ventilation after moving round to behind the patient’s head. In the OTH method, both compressions and ventilations were conducted from behind the patient’s head.

Results

Both CPR methods were conducted by 38 paramedics working in medical response teams. Statistical analysis was conducted on the data collected, giving the following results: the average time of the interruptions between compression cycles (STD 9.184 s, OTH 7.316 s, p < 0.001); the depth of compression 50–60 mm (STD 50.65%, OTH 60.22%, p < 0.001); the rate of compression 100–120/min. (STD 46.39%, OTH 53.78%, p < 0.001); complete chest wall recoil (STD 84.54%, OTH 91.46%, p < 0.001); correct hand position (STD 99.32%, OTH method 99.66%, p < 0.001). A statistically significant difference was demonstrated in the results to the benefit of the OTH method in the above parameters. The remaining parameters showed no significant differences in comparison to reference values.

Conclusions

The higher quality of CPR in the simulated research using the OTH method by a single person justifies the use of this method in a wider range of emergency interventions.
Compositional alterations of gut microbiota in children with primary nephrotic syndrome after initial therapy
Authors: Kang Yulin , Feng Dan , Law Helen Ka-wai , Qu Wei , Wu Ying , Zhu Guang-hua , Huang Wen-yan
Published: November 2019

Background

Primary nephrotic syndrome (PNS) is a common glomerular disease in children. T cell dysfunction plays a crucial role in the pathogenesis of PNS. Moreover, dysbiosis of gut microbiota contributes to immunological disorders. Whether the initial therapy of PNS affects gut microbiota remains an important question. Our study investigated compositional changes of gut microbiota after initial therapy.

Methods

Fecal samples of 20 children with PNS were collected before and after 4-week initial therapy. Total bacteria DNA were extracted and the V3-V4 regions of bacteria 16S ribosomal RNA gene were sequenced. The composition of gut microbiota before and after initial therapy was analyzed by bioinformatics methods. The function of altered gut microbiota was predicted with PICRUSt method.

Results

The richness and diversity of gut microbiota were similar before and after 4-week initial therapy. Gut microbiota at the phylum level was dominated by four phyla including Firmicutes, Proteobacteria, Bacteroidetes and Actinobacteria, but the increased relative abundance after initial therapy was found in Deinococcus-Thermus and Acidobacteria. At the genus level, the increased abundance of gut microbiota after initial therapy was observed in short chain fat acids (SCFA)-producing bacteria including Romboutsia, Stomatobaculum and Cloacibacillus (p < 0.05). Moreover, the predicted functional profile of gut microbiota showed that selenocompound metabolism, isoflavonoid biosynthesis and phosphatidylinositol signaling system weakened after initial therapy of PNS.

Conclusions

Initial therapy of PNS increased SCFA-producing gut microbiota, but might diminish selenocompound metabolism, isoflavonoid biosynthesis and phosphatidylinositol signaling system in children.
Co-producing childbirth knowledge: a qualitative study of birth stories in antenatal sessions
Authors: de Quattro Leah
Published: November 2019

Background

Birth stories surround pregnant women. Existing research on childbirth knowledge suggests that personal accounts from family and friends play a foundational role upon which other information builds. However, among the handful of studies that specifically address the educational role of birth stories, stories appeared to have little impact on knowledge creation. This paper engages with this discussion by exploring how birth stories contributed to the co-construction of birth knowledge within the specific context of antenatal sessions. Findings draw from the pilot study of a project which seeks to understand how women use collective approaches to co-produce birth knowledge.

Method

Research data drew from participant observation of group-led Homebirth sessions (25 participants) and teacher-led National Childbirth Trust classes (18 participants). The researcher analysed transcripts using template analysis, a form of thematic content analysis, with principles from feminist ethnography and narrative analysis.

Results

Storytelling proved central to mother-to-mother antenatal group practices, providing not only information, but also a means for understanding. This educational work took place through various mechanisms: Stories (re)shaped expectations, shared practical techniques, navigated different truth claims and approaches to knowledge, and helped build supportive communities of parents. These findings emerged more prominently in group-led sessions compared to teacher-led sessions.

Conclusion

Compared to teacher-led norms, storytelling and other collective approaches to antenatal education provide additional resources to childbearing women. As dialogic, complex and flexible learning tools, stories offer uniquely diverse, credible and supportive messages. The next phase of this project will further investigate these findings, explore informal collective practices, and seek to evaluate the impact of collective knowledge on childbirth experiences.
IgA vasculitis (Henoch – Schönlein Purpura) as the first manifestation of juvenile Systemic Lupus Erythematosus: Case-control study and systematic review
Authors: Murata Chiharu , Rodríguez-Lozano Ana Luisa , Hernández-Huirache Hayde Guadalupe , Martínez-Pérez Miriam , Rincón-Arenas Laura Andrea , Jiménez-Polvo Esmeralda Nancy , Rivas-Larrauri Francisco Eduardo , Solís-Galicia Cecilia
Published: November 2019

Background

We have recognized 15 children with jSLE and the antecedent of IgA vasculitis (HSP). This association is not broadly present in the literature.

Aim

To know the age and gender distribution of children with IgA vasculitis (HSP), compare it to our IgA vasculitis (HSP) + jSLE cases, and identify prognostic factors to develop jSLE within our case series, IgA vasculitis (HSP) vs. IgA vasculitis (HSP) + jSLE.

Methods

A systematic review was carried out to know the age and gender distribution of children with IgA vasculitis (HSP). The information obtained plus data from 110 children with IgA vasculitis (HSP) from the Instituto Nacional de Pediatría were used to compare groups and identify prognostic factors. We performed a case-control study in patients < 18 years, consisting of 15 cases retrospectively identified with IgA vasculitis (HSP) + jSLE, and 110 IgA vasculitis (HSP) control subjects.

Results

The information of 12,819 IgA vasculitis (HSP) subjects from the systematic review and 110 IgA vasculitis (HSP) controls was obtained and compared to our 15 IgA vasculitis (HSP) + jSLE cases. The mean age of IgA vasculitis (HSP) was 7.1-years vs. 10.4-years of IgA vasculitis (HSP) + jSLE at the HSP diagnosis. Female to male ratio of IgA vasculitis (HSP) was 1:1.33 vs. 1:0.25 of IgA vasculitis (HSP) + jSLE. Patients with IgA vasculitis (HSP) + jSLE had lower levels of Hemoglobin (Hb) compared to patients with IgA vasculitis (HSP) 109 g/L vs. 141 g/L. For the development of jSLE, we found older age and lower levels of Hb as prognostic factors with OR [95% CI]: 1.37 [1.06, 1.89] and 5.39 [2.69, 15.25], respectively.

Conclusion

IgA vasculitis (HSP) + jSLE patients are older and have lower levels of Hb than patients with IgA vasculitis (HSP). It is necessary to confirm these findings through a prospective study.
Combining technical and expert-by-experience knowledge in the quest for personal recovery from bipolar disorder: a qualitative study
Authors: Tse Samson , Yuen Winnie W. Y. , Murray Greg , Davidson Larry , Lai Queenie , Kan Alice
Published: November 2019

Background

Knowledge construction is a form of communication in which people can work individually or collaboratively. Peer support services have been adopted by the public psychiatric and social welfare service as a regular form of intervention since 2015 in Hong Kong. Peer-based services can help people with bipolar disorder (BD) deal with the implications of the diagnosis, the way in which individuals with BD receive treatment, and the lifestyle changes that take place as a result of the diagnosis. Through a qualitative paradigm, this study aims to examine how individuals with BD use technical and expert-by-experience knowledge.

Methods

A total of 32 clients of mental health services were recruited from hospitals, Integrated Community Centers for Mental Wellness, and non-governmental organizations. They participated in semi-structured individual interviews. All interviews were recorded, transcribed verbatim, and analyzed using thematic analysis with the aid of NVivo. The findings were verified by peer researchers.

Results

Three main themes are presented in this article, including how clients made sense of the knowledge provided by mental health professionals and peer support workers (PSWs), critical perspectives about peer support services, and the way in which the services are more than knowledge transfer alone. Participants generally indicated that knowledge sharing revolved around three experiences: mood changes, medications, and sense of hope. Nevertheless, an empathic understanding of the clients’ experience was more important than the sharing of knowledge. Some clients perceived medication as the chief means to recovery, so PSWs were not useful for them. However, PSW role models had an effect beyond mere knowledge transmission, as they could promote clients’ pursuit of functional recovery goals.

Conclusions

The present study has improved our understanding of knowledge sharing between clients with BD and health professionals or PSWs, which should take place in an empathic and hope-instilling manner. It has also emphasized the value of the presence of a role model who can speak convincingly with clients to facilitate recovery. The present findings can be used to improve the care of people with BD by generating important guidance with regard to enhancing the knowledge exchange between clients and health practitioners.
Static plantar pressure and functional capacity in children with femoral shaft fractures treated by titanium elastic nailing
Authors: Amăricăi Elena , Suciu Oana , Onofrei Roxana Ramona , Iacob Emil Radu , Iacob Daniela , Popoiu Călin Marius , Negru Marius , Belei Oana , Bădițoiu Luminița , Boia Eugen
Published: November 2019

Background

Femoral shaft fractures represent common fractures of the lower limb in the paediatric population. The objectives of our study were to analyse the static plantar pressure and functional capacity in children with surgically treated unilateral femoral shaft fractures, 1 month after the metallic implant removal.

Methods

Our study included 24 children with unilateral femoral shaft fracture (fracture site contralateral to the dominant leg) treated by titanium elastic nailing (TEN) implants, with the removal of the implant 6 months after initial surgery. The patients were divided into two groups: Group 1 (12 patients without inpatient rehabilitation) and Group 2 (12 patients who attended inpatient rehabilitation). The patients and 12 gender and age-matched healthy controls performed plantar pressure analysis and functional capacity testing (6-min walk test: 6MWT). For patients in Group 1 and 2 the assessments were performed 1 month after the TEN implant removal. Paired t-tests were used to compare the intragroup data. A one-way ANOVA test for independent measures was performed to assess the differences for plantar pressure, and 6MWT among study groups and controls.

Results

All study patients had left femoral shaft fractures (affected limb). The patients and controls were all right leg dominant. In both Group 1 and Group 2 total foot loading was significantly higher on the non-affected limb compared with the affected limb. When compared to the non-affected limb, the loadings on the affected limb were significantly increased on the first and fifth metatarsal in Group 1, and on the fifth metatarsal in Group 2, with a significantly smaller heel loading. When compared with the controls we found significant differences for all pressure parameters, except for the right foot load for the rehabilitation group. Although the functional capacity values were higher in the rehabilitation group the two patients groups had significantly lower 6MWT values.

Conclusions

When compared to healthy controls children with surgically treated unilateral femoral shaft fractures, although assessed after 7 months, had a different weight distribution on the feet and a decreased functional capacity. A rehabilitation programme included in the management of these patients is important for regaining their functional level.
Effectiveness of spiritual care training to enhance spiritual health and spiritual care competency among oncology nurses
Authors: Hu Yanli , Jiao Miaorui , Li Fan
Published: November 2019

Background

Although spiritual care is a basic element of holistic nursing, nurses’ spiritual care knowledge and abilities are often unable to satisfy patients’ spiritual care needs. Therefore, nurses are in urgent need of relevant training to enhance their abilities to provide patients with spiritual care.

Design

A nonrandomized controlled trial.

Objective

To establish a spiritual care training protocol and verify its effectiveness.

Methods

This study recruited 92 nurses at a cancer treatment hospital in a single province via voluntary sign-up. The nurses were divided into two groups—the study group (45 people) and the control (wait-listed) group (47 people)—using a coin-toss method. The study group received one spiritual care group training session every six months based on their routine nursing education; this training chiefly consisted of lectures by experts, group interventions, clinical practice, and case sharing. The control group participated in monthly nursing education sessions organized by the hospital for 12 continuous months.

Results

After 12 months of intervention, the nurses in the study group had significantly higher overall spiritual health and spiritual care competency scores as well as significantly higher scores on all individual dimensions compared with those in the control group (P < 0.01).

Conclusions

A spiritual care training protocol for nurses based on the concept of mutual growth with patients enhances nurses’ spiritual well-being and spiritual care competencies.
Clinical pilot study to evaluate the neovaginal PACIENA prosthesis® for vaginoplasty without skin grafts in women with vaginal agenesis
Authors: Acién Pedro , Nohales-Alfonso Francisco J. , Sánchez-Ferrer Maria-Luisa , Sánchez-Lozano Miguel , Navarro-Lillo Victoria , Acién Maribel
Published: November 2019

Background

To evaluate the feasibility and clinical outcomes of vaginoplasties using a neovaginal polylactic acid prosthesis made with 3-dimensional (3D) printing technology as an intraneovaginal mould.

Methods

This was an interventionist, prospective, and multicentre clinical pilot investigation of a sanitary product (PACIENA prosthesis®) aiming to recruit and operate on 8 patients over 6 months with a follow-up period of 6 months. Only six patients with Rokitansky syndrome and one patient with Morris syndrome (7 patients in total) were operated on in two university hospitals: “La Fe”, Valencia (H1) and “Arrixaca”, Murcia (H2). Interventions: Extensive surgical dissection of a defined space between the urethra and bladder in the front and of the rectum in the back as well as insertion of the PACIENA prosthesis® covered with Interceed® were performed. After 12 days, the prosthesis was changed to the silicone-covered version for daily application.

Results

In the 6 patients with Rokitansky syndrome (86%), the primary endpoint (satisfactory vaginal outcome in terms of appearance, function, and sensation without relevant additional morbidity) was achieved, although only 2 patients (28%) were sexually active at the end of 6 months of follow-up. The patient with Morris syndrome withdrew from the study after 1 month. Patients without bacterial colonization showed positive Schiller tests at 1 month, and subsequent biopsies showed adequate keratinization and epidermization. Epithelization and iodopositivity were delayed in the patients who developed inflammatory granulomas.

Conclusions

Good anatomical and functional results can be achieved with the PACIENA prosthesis® for vaginoplasties without skin grafts. However, adequate patient selection and education, good surgical techniques and haemostasis, postoperative support, and prevention of bacterial colonization are important.

Trial registration

This clinical study was approved by the Ethical Clinical Investigation Committee of San Juan University Hospital on September 27, 2016, to be conducted in the participating centres; it was authorized by the Spanish Agency of Medicines and Health Products (AEMPS) on April 24, 2017 (exp. no. 585/16/EC), to be carried out in that hospitals.
Cost-related medication nonadherence among over-indebted individuals enrolled in statutory health insurance in Germany: a cross-sectional population study
Authors: Warth Jacqueline , Puth Marie-Therese , Tillmann Judith , Beckmann Niklas , Porz Johannes , Zier Ulrike , Weckbecker Klaus , Weltermann Birgitta , Münster Eva
Published: November 2019

Background

Millions of citizens in high-income countries face over-indebtedness that implies being unable to cover payment obligations with available income and assets on an ongoing basis. Studies have shown an association between over-indebtedness and health outcomes, independent of standard socioeconomic status measures. Patterns of cost-related medication nonadherence (CRN) among over-indebted individuals are yet unclear. The aim of this study was to examine the frequency of nonadherence to prescribed medications due to cost, and to identify risk factors for CRN among over-indebted individuals in Germany.

Methods

In 2017, we conducted a cross-sectional survey among over-indebted individuals recruited in 70 debt advice agencies in North Rhine-Westphalia, Germany. Data on CRN in the last 12 months (i.e. not filling prescriptions, skipping or decreasing doses of prescribed medication due to financial problems) were collected by a survey using a self-administered written questionnaire that was returned by 699 individuals with a response rate of 50.2%. Prevalence of CRN was assessed using descriptive statistics. Multiple logistic regression analysis was performed to examine risk factors of CRN, including participants enrolled in statutory health insurance with complete data (n = 521).

Results

The prevalence of CRN was 33.6%. The chronically ill had significantly greater odds of cost-related medication nonadherence (aOR 1.96; 95% CI 1.27–3.03) than individuals without a chronic illness. CRN was more likely to occur in individuals who had discussed financial problems with their general practitioner (aOR 1.58; 95% CI 1.01–2.47). There was no association between CRN and other sociodemographic factors or socioeconomic status.

Conclusions

Medication nonadherence due to financial pressures is common among over-indebted citizens enrolled in statutory health insurance in Germany. Stakeholders in social policy, research and health care need to address over-indebtedness to develop strategies to safeguard access to relevant medications, especially among those with high morbidity.

Trial registration

Arzneimittelkonsum, insbesondere Selbstmedikation bei überschuldeten Bürgerinnen und Bürgern in Nordrhein-Westfalen (ArSemü), (engl. ‘Medication use, particularly self-medication among over-indebted citizens in North Rhine-Westphalia’), German Clinical Trials Register: DRKS00013100. Date of registration: 23.10.2017. Date of enrolment of the first participant: 18.07.2017, retrospectively registered.