bluuebunny/crossref_metadata_2025 huggingface dataset:
Safety, Efficacy of an Accelerated Regimen of Low-Dose Recombinant Tissue-Type Plasminogen Activator for Reperfusion Therapy of Acute Pulmonary Embolism
Authors: Hoang Bui Hai , Do Phuc Giang , Le Lac Duy , Bui Thao Thi Huong , Bui Thinh Nghia , Nguyen Quan Minh , To Duong Hoang , Nguyen Anh Dat , Dinh Michael M. , Goldhaber Samuel Z. , Day Richard , Nguyen Hieu Lan
Published: September 2021

Controversy persists regarding the safety and efficacy of an accelerated low-dose recombinant tissue-type plasminogen activator (rt-PA) regimen for reperfusion therapy in acute pulmonary embolism. This study describes the outcomes of an accelerated low-dose rt-PA regimen for the treatment of acute pulmonary embolism in Vietnamese patients. This was a case series from October 2014 to October 2020 from 9 hospitals across Vietnam. Patients presenting with acute pulmonary embolism with high to intermediate mortality risk were administered alteplase 0.6 mg per kilogram (maximum of 50 mg) over 15 min. The main outcomes were the proportion who survived to hospital discharge and at 3 months as well as in-hospital hemorrhage (major and minor according to International Society of Thrombosis and Hemhorrage definitions). A total of 80 patients were enrolled: 48 (60%) with high risk for mortality and 32 patients (40%) with intermediate risk for mortality. A total of 7 (8.8%) died in hospital. All deaths occurred in the high-risk mortality group. The 73 patients who were discharged alive remained alive at 3 months follow up. During hospitalization, 1 patient (1.3%) suffered major bleeding, and 7 (8.8%) had minor bleeding. An accelerated thrombolytic regimen with alteplase 0.6 mg/kg (maximum of 50 mg) over 15 min for acute pulmonary embolism appeared be effective and safe in a case series of Vietnamese patients.
Bones, fire, and falcons: Loving things in medieval Europe
Authors: Jones Peter J. A.
Published: September 2021

In three loving encounters between humans and nonhumans, this article explores different approaches to material love in medieval Europe. Beginning with an English bishop who attempted to eat the bone relic of Saint Mary Magdalene, it first considers how a series of medieval thinkers imagined God's love as mediated primarily through the consumption of matter. Further, it shows how the medieval commercialization of relics enabled a subversive, quasi-mystical counter tradition that located loving experiences within the unmediated physicality, or thingness, of Christian artifacts themselves. Moving next to Saint Francis of Assisi (d.1226), the article explores a curious case of self-negating devotion to fire. While contextualizing the saint's love against a background of scholastic materialism and ecstatic mysticism, it explores how fire gained a unique onto-theological status as the material essence of both love and the heavens in the 1200s. Finally, turning to love for animals, the analysis explores the astonishing care shown to falcons by the Holy Roman Emperor, Frederick II (d.1250). While surveying a series of trends in medieval ways of loving creatures, the article stresses how the emperor's radical empathy for beasts allowed him temporarily to surrender his sovereignty, melding the interest of king and bird. Just like the mystical theology that underpinned much of medieval devotion, it argues, these three loving encounters were all essentially structured as self-annihilating journeys into a “oneness” with the material landscape. Considering the ongoing threads of this forgotten type of self-erasing love, these medieval encounters can have intriguing implications for debates in the environmental humanities today.
A question of justice: Critically researching suicide with Indigenous studies of affect, biosociality, and land-based relations
Authors: Ansloos Jeffrey , Peltier Shanna
Published: September 2021

This paper considers how Indigenous studies can inform the evolution of critical research on suicide. Aligned with critiques of mainstream suicidology, these methodological approaches provide a roadmap for structural analysis of complex systems and logics in which the phenomenon of suicide emerges. Moving beyond mere naming of social determinants of suicide and consistent with calls for a theory of justice within suicide research, Indigenous studies helps to advance conceptual knowledge of suicide in descriptive means and enhance ethical responses to suicide beyond psychocentric domains. Through centering Indigenous theories of affect, biosociality, and land-based relations, this article examines what new knowledge of suicide can emerge, as well as what ethical responses are possible to suicide and to a world where suicide exists. This new knowledge can inform practices for critical suicide studies which are invested in resisting structural violence, nourish agency, dignity and freedom for those living and dying in often-unlivable presents, and enhancing livability for individuals, communities, and the environment living under shadows of empire. Implications for theory, ethics, and suicide research and prevention practice are considered.
Experimental investigation and multi-objective optimization of multiple mechanical characteristics for chemically treated kenaf fibre reinforced epoxy composite using grey fuzzy logic
Authors: Gangwar Swati , Dubey Neelesh Kumar , Pathak Vimal Kumar
Published: September 2021

In the present work, chemically treated kenaf fibre (10, 20 and 30 wt. %) reinforced epoxy resin composite formulations were fabricated using hand lay-up technique. The prepared composites were mechanically characterized using Taguchi L27 experimental design to examine the influence of varying kenaf fibre wt. %, NaOH concentration % for chemical treatment, and fibre immersion duration. The grey-fuzzy optimization approach was utilized for optimizing prepared formulations mechanical properties such as tensile strength, impact strength and flexural strength. Further, analysis of variance (ANOVA) tests and response graphs were utilized for delivering model significance and determining the percentage contribution of input variables. The NaOH concentration % was found to be most significant parameter followed by kenaf wt. % in providing best mechanical properties of chemically treated kenaf fibre reinforced epoxy composites.
Learning outcomes: The long goodbye: Vocational qualifications in the 21st century
Authors: Winch Christopher
Published: September 2021

This article describes the origins of learning outcomes-based qualifications in England in the 1980s. It describes the design philosophy and evolution of National Vocational Qualifications (NVQs) which are contrasted with content-led frameworks and qualifications such as the English National Curriculum. The design flaws of the NVQ are noted and some policy implications of the NVQ experience are remarked on. It goes on to consider the adoption of learning outcomes approaches to qualifications in the European Union, first through the introduction of the European Qualification Framework (EQF) and then of European Skills, Competences, Qualifications and Occupations (ESCO). First, it is argued that the EQF serves as an umbrella for qualifications fundamentally incompatible with each other. Second, it is maintained that although ESCO has certain design features that liken it to the NVQ, it is also compatible with non-learning outcomes-based qualifications. Its assumptions about qualification design, based on task analysis, render it unsuitable as a template for the development of advanced vocational qualifications. The decline and fall of the NVQ and its replacement by standards-based qualification in England is described and some lessons that can be learned by policymakers are outlined. Learning outcomes-based qualifications are not fit for purpose.
Effects of Childhood Maltreatment on Self-Compassion: A Systematic Review and Meta-Analysis
Authors: Zhang Huiping , Li Jiming , Sun Bingyi , Wei Qingong
Published: September 2021

Background:

This systematic review aims to estimate the extent to which childhood maltreatment influences self-compassion in later life.

Method:

Four English databases (Web of Science, PsycINFO, PubMed, and PsycARTICLES) and three Chinese databases (China National Knowledge Infrastructure, Wanfang, and Weipu) were systematically searched. We extracted data related to the associations between child maltreatment and self-compassion and pooled them using random effect models.

Findings:

A total of 20 eligible studies were included involving 6,877 participants in the analyses. Overall child maltreatment was negatively related to self-compassion ( r = −.28, p < .001); emotional abuse and neglect were negatively related to self-compassion ( r = −.28, p < .01; r = −.31, p < .01, respectively) at a moderate level; and physical abuse, sexual abuse, and physical neglect were negatively related to self-compassion ( r = −.12, p < .01; r = −.10, p < .01; and r = −.22, p < .001, respectively) at a small level.

Conclusion:

The results indicate that overall and subtypes of maltreatment are associated with decreased self-compassion, and child intervention programs focused on self-compassion should be designed to protect the well-being of individuals with a history of childhood maltreatment.
Modeling a high-speed pin-on-disk experiment
Authors: Wing Aron , Liu Tony , Palazotto Anthony
Published: September 2021

The purpose of this work is to analyze the heat transfer characteristics of Vascomax®C300 during high-speed sliding. This work extends previous research that is intended to help predict the wear-rate of connecting shoes for a hypersonic rail system at Holloman Air Force Base to prevent critical failure of the system. Solutions were generated using finite element analysis and spectral methods. The frictional heat generated by the pin-on-disk is assumed to flow uniformly and normal to the face of the pin and the pin is assumed to be a perfect cylinder resulting in two-dimensional heat flow. Displacement data obtained from the experiment is used to define the moving boundary. The distribution of temperature resulting from transient finite element analysis is used to justify a one-dimensional model. Spectral methods are then employed to calculate the spatial derivatives improving the approximation of the function which represents the data. It is concluded that a one-dimensional approach with constant heat transfer parameters sufficiently models the high-speed pin-on-disk experiment.
A Systematic Literature Review of Ethical Challenges Related to Medical and Public Health Data Sharing in China
Authors: Li Xiaojie , Cong Yali
Published: September 2021

Although stakeholders in China have begun promoting medical and public health data sharing, a large portion of data cannot flow freely across research teams and borders and be converted into “big data.” To identify the ethical challenges that are considered to hinder medical and public health data sharing, we performed a systematic literature review pertaining to medical and health data sharing in China. A total of 2959 unique records were retrieved through the database search, 61 of which were included in the final synthesis after full-text screening. This review provides an overview of the current ethical challenges and barriers involved in data sharing for healthcare purposes in China. Through the systematic review of evidence from peer-reviewed literature and dissertations, we identified barriers and ethical challenges grouped in a taxonomy of capacity building needs, balancing different stakeholders’ interests, scientific and social value, and the data subjects’ rights, public trust and engagement. Best practices and educational implications were suggested based on our findings.
Delayed neurological improvement is predictive to long-term clinical outcome on endovascular thrombectomy patients
Authors: Cai Haodi , Han Yunfei , Sun Wen , Zha Mingming , Shi Xuan , Huang Kangmo , Yang Qingwen , Wang Xiaoke , Liu Rui , Liu Xinfeng
Published: September 2021

Objectives

This study aims at exploring the 3-month outcome predicting ability of delayed neurological improvement and the cause of delayed neurological improvement.

Materials and methods

Early neurological improvement and delayed neurological improvement were calculated to represent the neurological improvements. Good functional outcome was defined as a 90-day modified Rankin Scale score 0–2. We used multivariant logistic regression to explore the influential factors of good functional outcome as well as delayed neurological improvement. We applied net reclassification improvement and integrated discrimination improvement to assess the quantitative improvement of the predictive model.

Results

Early neurological improvement was observed in 50 (23%) patients and delayed neurological improvement exhibited in 67 (30%) patients. Early neurological improvement and delayed neurological improvement were both independent predictive factors to good functional outcome. In the basic model (adjusted for age, admission glucose level, baseline National Institute of Health Stroke Scale, and complications and number of retrieval attempts), early neurological improvement and delayed neurological improvement statistically improved the predictive ability (early neurological improvement: net reclassification improvement = 0.34, 95% confidence interval, 95% confidential interval (0.06, 0.69); integrated discrimination improvement = 0.05, p < 0.001; delayed neurological improvement: net reclassification improvement = 0.79, 95% confidential interval (0.47, 1.12); integrated discrimination improvement = 0.14, p < 0.001) delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement (early neurological improvement vs. delayed neurological improvement: integrated discrimination improvement = 0.09, p < 0.001). Moreover, delayed neurological improvement was affected by hypertension (odds ratio  = 0.40, 95% CI (0.18, 0.88), p = 0.02), early neurological improvement (odds ratio  = 20.10, 95% confidential interval (8.24, 19.02), p < 0.001), number of retrieval attempts (odds ratio  = 0.39, 95% confidential interval (0.24, 0.66), p < 0.001), and complication (odds ratio  = 0.25, 95% confidential interval (0.12, 0.54), p < 0.001).

Conclusions

Delayed neurological improvement could predict clinical outcomes more accurately than early neurological improvement. Hypertension, early neurological improvement, numbers of retrieval attempts, and complications were all predicting factors to delayed neurological improvement.
Aortic arch anomalies, embryology and their relevance in neuro-interventional surgery and stroke: A review
Authors: Mantri Shilpa S , Raju Bharath , Jumah Fareed , Rallo Michael S , Nagaraj Anmol , Khandelwal Priyank , Roychowdhury Sudipta , Kung David , Nanda Anil , Gupta Gaurav
Published: September 2021

Background

Congenital aortic arch anomalies are commonly encountered during neurointerventional procedures. While some anomalies are identified at an early age, many are incidentally discovered later in adulthood during endovascular evaluations or interventions. Proper understanding of the normal arch anatomy and its variants is pivotal to safely navigate normal aortic arch branches and to negotiate the catheter through anomalies during neurointerventional procedures. This is particularly relevant in the increasingly “transradial first” culture of neurointerventional surgery. Moreover, some of these anomalies have a peculiar predilection for complications including aneurysm formation, dissection, and rupture during the procedure. Therefore, an understanding of these anomalies, their underlying embryological basis and associations, and pattern of circulation will help endovascular neurosurgeons and interventional radiologists navigate with confidence and consider relevant pathologic associations that may inform risk of cerebrovascular disease.

Methods

Here, we present a brief review of the basic embryology of the common anomalies of the aortic arch along with their neurological significances and discuss, through illustrative cases, the association of aortic arch anomalies with cerebral vascular pathology.

Conclusions

Understanding the aortic arch anomalies and its embryological basis is essential to safely navigate the cerebral vascular system during neurointerventional surgeries.
Long-term follow-up of the pCONus device for the treatment of wide-neck bifurcation aneurysms
Authors: Guenego Adrien , Mine Benjamin , Bonnet Thomas , Elens Stephanie , Vazquez Suarez Juan , Jodaitis Lise , Ligot Noémie , Naeije Gilles , Lubicz Boris
Published: September 2021

Purpose

Wide-neck bifurcation aneurysms remain challenging for the neurointerventionist and/or neurosurgeon despite many recent advances. The pCONus (Phenox, Bochum, Germany) is an emerging device for endovascular neck protection, we report the first long-term results of this device.

Methods

We performed a retrospective analysis of all consecutive intracranial wide-neck bifurcation aneurysms treated with the pCONus. Patients' characteristics were reviewed, procedural complications, angiographic (Roy-Raymond scale) and clinical outcomes were documented.

Results

Between January 2016 and September 2019, 43 patients (74% female, median age 56 [49–66] years) with 43 wide-neck bifurcation aneurysms (mean width of 6.8 ± 2.1 mm, dome/neck ratio of 1.3 ± 0.2 and neck of 5.2 ± 1.3 mm) were included. A procedural angiographic complication was reported in five patients (12%), no patient presented a post-operative neurological deficit or long-term complication, mortality rate was 0%. At last follow-up (median of 46.5 months [38.3–51.7]), an adequate occlusion (complete and neck remnant) was observed in 37/43 patients (86%) and an aneurysm remnant in 6/43 (14%). Four patients (9%) needed retreatment. No in-stent stenosis or branch occlusion was depicted.

Conclusion

pCONus device provides a safe and efficient alternative for endovascular wide-neck bifurcation aneurysms management, with long-term stability.
Fatigue self-management led by occupational therapists and/or physiotherapists for chronic conditions: A systematic review and meta-analysis
Authors: Kim Sungha , Xu Ying , Dore Kelly , Gewurtz Rebecca , Larivière Nadine , Letts Lori
Published: September 2021

Objective

The aim of this study was to investigate the effectiveness of occupational therapist-/physiotherapist-guided fatigue self-management for individuals with chronic conditions.

Methods

Eight databases, including MEDLINE and EMBASE, were searched until September 2019 to identify relevant studies. Randomised controlled trials and quasi-experimental studies of self-management interventions specifically developed or delivered by occupational therapists/physiotherapists to improve fatigue symptoms of individuals with chronic conditions were included. A narrative synthesis and meta-analysis were conducted to determine the effectiveness of fatigue self-management.

Results

Thirty-eight studies were included, and fatigue self-management approaches led by occupational therapists/physiotherapists were divided into six categories based on the intervention focus: exercise, energy conservation, multimodal programmes, activity pacing, cognitive-behavioural therapy, and comprehensive fatigue management. While all exercise programmes reported significant improvement in fatigue, other categories showed both significant improvement and no improvement in fatigue. Meta-analysis yielded a standardised mean difference of the overall 13 studies: 0.42 (95% confidence interval:−0.62 to − 0.21); standardised mean difference of the seven exercise studies was −0.55 (95% confidence interval: −0.78 to −0.31).

Discussion

Physical exercises inspired by the self-management principles may have positive impacts on fatigue symptoms, quality of life, and other functional abilities.
Following the recipe: Producing The Great British Bake Off in Flanders
Authors: van Keulen Jolien
Published: September 2021

TV formats provide an excellent lens to study the transnationalisation of television, but actual format production has rarely been examined. This article discusses three interrelated limitations of current format scholarship: (1) a gap between industrial and textual studies; (2) a selective focus on localisation; and (3) a lack of insight into daily practices of format production. Using the Flemish adaptation of The Great British Bake Off ( 2010 –2016, 2017–present) as a case study and drawing on participant observations, this article analyses transnational power dynamics in the TV industry and the meaning of the format on the micro-level of TV production.
Being Moved by Nature in the Anthropocene: On the Limits of the Ecological Sublime
Authors: Caracciolo Marco
Published: September 2021

According to recent accounts, we experience the emotion of “being moved” when a situation brings into play our core values. What are the core values evoked by nonhuman landscapes, however, particularly as the distinction between man-made and natural environments becomes increasingly blurry in the so-called Anthropocene? That is the central question tackled by this article. I start by rethinking the sublime as an affect that, since Romanticism, has shaped Western attitudes toward nature. I argue that today's climate crisis calls for an expansion of our affective engagement with the nonhuman: the sublime can be part of our emotional repertoire, but only if it is complicated by feelings that point to constitutive human–nonhuman entanglement.
Effects of Simulated Adverse Environmental Conditions Related to Actual Conditions at Health Promoting Hospitals on the Performance of Blood Glucose Testing by Glucose Meters
Authors: Apiratmateekul Napaporn , Duanginta Wanutchaya , Phetree Methawadee , Kongros Kunchit , Treebuphachatsakul Wanvisa
Published: September 2021

Background:

Annual peaks in temperature and humidity exceed manufacturers’ specifications for blood glucose test strip storage in Thailand. Health Promoting Hospitals (HPH) do not always provide the same level of health services that hospitals do since they often only turn on air-conditioning units during working hours.

Methods:

The blood glucose testing performance of 4 glucose meters were investigated for short and long terms stress at 5 simulated conditions. Temperature and relative humidity (RH) at 5 HPHs in different regions of Thailand were monitored for 9 weeks during April to July 2019. The use of air conditioning in storage rooms for storing test strips was surveyed at 131 HPHs using questionnaires.

Results:

Median-paired differences of glucose measurements with stressed test strips in 5 simulated conditions significantly differed ( P < 0.05) both in the short term (3 days) and in the long term (30 days) with 4 glucose meters when compared to unstressed test strips. The average temperature of all HPHs exceeded 30°C (86°F). The average RH was 84%. There was only one HPH that occasionally turned on its air conditioners. Most HPHs kept both opened and unopened vials of test strips in rooms without air conditioners. Further, 21.4-32.0% of HPHs kept test strips at room with air conditioners.

Conclusions:

This study provides evidence for poor performance of blood glucose testing by glucose meters that are affected by adverse environmental conditions. The environmental for test strips storage at HPHs should be considered to prevent analytical errors of glucose measurement.
Comparing User Perceptions of Surgical Environments: Simulations in a High-Fidelity Physical Mock-Up Versus a Postoccupancy Evaluation
Authors: Joseph Anjali , Mihandoust Sahar , Wingler Deborah , Machry Herminia , Allison David , Reeves Scott T.
Published: September 2021

Objective:

The purpose of this study was to compare perceptions and behaviors of end users participating in simulations in a high-fidelity physical mock-up of an operating room (OR) prototype with the perceptions and behaviors of end users in the built out ORs postoccupancy.

Background:

Simulation-based evaluations of high-fidelity physical mock-ups of proposed layouts are increasingly being conducted during the facility design process to understand impacts on workflow and potential adverse patient safety outcomes. Nevertheless, it is unclear to what extent user experiences in these simulated healthcare spaces are similar to those in built and occupied healthcare environments.

Methods:

Using interviews, surveys, and observations, this study compared user evaluations in a high-fidelity physical mock-up of an OR with user evaluations of the built and occupied OR postoccupancy. Workflow disruptions were also analyzed using video recordings for a simulated pediatric surgery and five pediatric surgeries in the actual OR.

Results:

This study found that user perceptions and behavior in the two types of environments were mostly similar with regard to perceived support for the location of surgeon workstation, perceived space and task performance, perceived access to storage locations, boom setup, and OR cleanability. Participant’s ratings differed for supportiveness of the mobile Circulating Nurse (CN) workstation, maneuvering booms, and environmental disruptions.

Conclusion:

Simulation-based evaluations are extremely beneficial during the design process and can provide valuable input to design teams as well as clinical teams about workflow and safety issues that allow design issues to be addressed before construction.
EVL is a novel focal adhesion protein involved in the regulation of cytoskeletal dynamics and vascular permeability
Authors: Mascarenhas Joseph B. , Gaber Amir A. , Larrinaga Tania M. , Mayfield Rachel , Novak Stefanie , Camp Sara M. , Gregorio Carol , Jacobson Jeffrey R. , Cress Anne E. , Dudek Steven M. , Garcia Joe G.N.
Published: September 2021

Increases in lung vascular permeability is a cardinal feature of inflammatory disease and represents an imbalance in vascular contractile forces and barrier‐restorative forces, with both forces highly dependent upon the actin cytoskeleton. The current study investigates the role of Ena‐VASP‐like (EVL), a member of the Ena‐VASP family known to regulate the actin cytoskeleton, in regulating vascular permeability responses and lung endothelial cell barrier integrity. Utilizing changes in transendothelial electricial resistance (TEER) to measure endothelial cell barrier responses, we demonstrate that EVL expression regulates endothelial cell responses to both sphingosine‐1‐phospate (S1P), a vascular barrier‐enhancing agonist, and to thrombin, a barrier‐disrupting stimulus. Total internal reflection fluorescence demonstrates that EVL is present in endothelial cell focal adhesions and impacts focal adhesion size, distribution, and the number of focal adhesions generated in response to S1P and thrombin challenge, with the focal adhesion kinase (FAK) a key contributor in S1P‐stimulated EVL‐transduced endothelial cell but a limited role in thrombin‐induced focal adhesion rearrangements. In summary, these data indicate that EVL is a focal adhesion protein intimately involved in regulation of cytoskeletal responses to endothelial cell barrier‐altering stimuli.

Keywords: cytoskeleton, vascular barrier, sphingosine‐1‐phosphate, thrombin, focal adhesion kinase (FAK), Ena‐VASP like protein (EVL), cytoskeletal regulatory protein
Do News Actually “Find Me”? Using Digital Behavioral Data to Study the News-Finds-Me Phenomenon
Authors: Haim Mario , Breuer Johannes , Stier Sebastian
Published: September 2021

Research on news exposure has shown that while political knowledge and interest largely determine the degree of active engagement with online news, some people are generally less willing to invest into actively staying informed. Instead, these people report to pursue a passive mode of relying on specific sources, such as social media, based on the belief that “news finds me” (NFM). Notably, the three dimensions of NFM—feeling informed, relying on peers, and not actively seeking news—combine intentions and perceptions related to news use. Understanding NFM perceptions, hence, requires an analytical distinction between active and passive modes of news use as well as reliable measures of (different types of) news exposure. We contribute to this field by combining a survey, tracked web-browsing data, and tracked Facebook data to investigate the relationship between NFM perceptions and exposure to online news, also taking into account political knowledge and interest as traditional predictors of active news use. Our results show that both political knowledge and interest are associated with more news exposure via web browsers and that political knowledge—but not political interest—is also associated with more news in people’s Facebook feeds. Compared with the NFM dimensions, political knowledge and interest are stronger predictors of online news exposure in our study. Taken together, the novel combination of Facebook and web tracking data provides evidence that online news exposure is shaped by a confluence of traditional factors and more diffuse interpersonal processes.
Adaptation of the Teaching Students With Disabilities Self-Efficacy Scale
Authors: Boulden Rawn
Published: September 2021

This study aimed to adapt the Teaching Students With Disabilities Self-Efficacy Scale for contemporary school counseling practice. The adaptation, titled the Students With Learning Disabilities School Counselor Self-Efficacy Scale, is a resource that assesses school counselors’ belief in their ability to counsel and support students identified as having learning disabilities. The findings suggest that the scale has sound validity and reliability metrics, with a few considerations. This article also discusses implications.
Surgical Outcomes of Inguinal-, Pubic-, and Adductor-Related Chronic Pain in Athletes: A Systematic Review Based on Surgical Technique
Authors: Hatem Munif , Martin RobRoy L. , Bharam Srino
Published: September 2021

Background:

Controversies remain regarding the surgical treatment of inguinal-, pubic-, and adductor-related chronic groin pain (CGP) in athletes.

Purpose:

To investigate the outcomes of surgery for CGP in athletes based on surgical technique and anatomic area addressed.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

The PubMed and Embase databases were searched for articles reporting surgical treatment of inguinal-, pubic-, or adductor-related CGP in athletes. Inclusion criteria were level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or MINORS (Methodological Index for Non-randomized Studies) criteria. Techniques were grouped as inguinal, adductor origin, pubic symphysis, combined inguinal and adductor, combined pubic symphysis and adductor, or mixed.

Results:

Overall, 47 studies published between 1991 and 2020 were included. There were 2737 patients (94% male) with a mean age at surgery of 27.8 years (range, 12-65 years). The mean duration of symptoms was 13.1 months (range, 0.3-144 months). The most frequent sport involved was soccer (71%), followed by rugby (7%), Australian football (5%), and ice hockey (4%). Of the 47 articles reviewed, 44 were classified as level 4 evidence, 1 study was classified as level 3, and 2 randomized controlled trials were classified as level 1b. The quality of the observational studies improved modestly with time, with a mean MINORS score of 6 for articles published between 1991 and 2000, 6.53 for articles published from 2001 to 2010, and 6.9 for articles published from 2011 to 2020. Return to play at preinjury or higher level was observed in 92% (95% CI, 88%-95%) of the athletes after surgery to the inguinal area, 75% (95% CI, 57%-89%) after surgery to the adductor origin, 84% (95% CI, 47%-100%) after surgery to the pubic symphysis, and 89% (95% CI, 70%-99%) after combined surgery in the inguinal and adductor origin.

Conclusion:

Return to play at preinjury or higher level was more likely after surgery for inguinal-related CGP (92%) versus adductor-related CGP (75%). However, the majority of studies reviewed were methodologically of low quality owing to the lack of comparison groups.
Impact of Early Weightbearing After Ankle Arthroscopy and Bone Marrow Stimulation for Osteochondral Lesions of the Talus
Authors: Danilkowicz Richard M. , Grimm Nathan L. , Zhang Gloria X. , Lefebvre Thomas A. , Lau Brian , Adams Samuel B. , Amendola Annunziato
Published: September 2021

Background:

Osteochondral lesion of the talus (OLT) may be caused by osteochondritis dissecans, osteochondral fractures, avascular necrosis, or focal arthritic changes. For certain focal cartilage defects, bone marrow stimulation (BMS) has been a widely used technique to restore a fibrocartilage substitute overlying the defect. There are various postoperative weightbearing protocols for this procedure, with no single gold standard method.

Purpose:

To retrospectively review the outcomes of patients undergoing ankle arthroscopy with concomitant BMS to determine outcomes based on postoperative weightbearing status.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

We retrospectively reviewed the records of patients who underwent ankle arthroscopy with BMS for OLTs between 2015 and 2018. Patients were placed into 2 cohorts based on postoperative immobilization status: the nonweightbearing (NWB) group and the weightbearing-as-tolerated (WBAT) group. Patient characteristics obtained included age, sex, comorbidities, and etiology of talar pathology. Outcomes included the pain visual analog scale (VAS), range of motion (ROM), complications, time to first weightbearing, and the method and length of immobilization. Patients who were lost to follow-up before 30 days were excluded. The chi-square test was used to compare categorical variables between cohorts, and the t test was used for continuous variables.

Results:

A total of 69 patients met the inclusion criteria for this study, 18 in the WBAT group and 51 in the NWB group. The mean lesion size was 9.48 × 9.21 mm (range, 3-15 mm × 2-20 mm) for the NWB group and 9.36 × 9.72 mm (range, 5-14 mm × 6-20 mm) for the WBAT group ( P > .05). The VAS scores improved from 4.40 to 0.67 for the WBAT group and from 6.33 to 2.55 for the NWB group, with the difference in final values reaching statistical significance ( P = .0002). Postoperative ROM was not significantly different between the groups. There were 4 repeat operations within the NWB cohort.

Conclusion:

The surgical management of OLTs can be challenging, and the postoperative weightbearing protocol can be an extra obstacle for the patient to navigate. We found no difference in pain, ROM, or complications when allowing immediate, full WBAT.
The effect of amblyopia on clinical outcomes of children with astigmatism
Authors: Çakır Burçin , Aksoy Nilgün Özkan , Özmen Sedat , Bursalı Özlem
Published: September 2021

Background:

Amblyopia is more common in children with high astigmatism, but factors contributing to development of amblyopia and visual outcomes are not fully understood.

Objective:

To evaluate the effect of amblyopia on the clinical outcomes in children with ⩾1.75 diopter (D) astigmatism.

Methods:

We reviewed the medical records of children with ⩾1.75 D astigmatism with and without amblyopia (amblyopes group and non-amblyopes group). The mean age, gender, amount and type of ocular deviation, presence of convergence insufficiency (CI), stereopsis, time of initial spectacle use and follow-up time, differences in best-corrected visual acuity (VoD) and spherical equivalent (SE) between eyes were assessed and compared between the groups. Best-corrected visual acuity (BCVA), mean SE, astigmatism measurements were assessed and compared between amblyopic, fellow, and non-amblyopic eyes.

Results:

The records included 68 eyes of 34 children with amblyopia and 56 eyes of 28 children without amblyopia. The mean age, gender, amount and type of ocular deviation, presence of CI, stereopsis, time of initial spectacle use, follow-up time, and the difference in SE did not differ between groups. In amblyopes, exodeviation was more common and statistically greater in near (33 cm) than at distance (6 m) (p = 0.005). The mean BCVA and astigmatism values were statistically different between amblyopic, fellow, and non-amblyopic eyes.

Conclusion:

A greater near than distance exodeviation and higher mean astigmatism value were found in amblyopic children with astigmatism.
The impact of poverty and deprivation at the end of life: a critical review
Authors: Rowley Jane , Richards Naomi , Carduff Emma , Gott Merryn
Published: September 2021

This critical review interrogates what we know about how poverty and deprivation impact people at the end of life and what more we need to uncover. While we know that people in economically resource-rich countries who experience poverty and deprivation over the life course are likely to die younger, with increased co-morbidities, palliative care researchers are beginning to establish a full picture of the disproportionate impact of poverty on how, when and where we die. This is something the Covid-19 pandemic has further illustrated. Our article uses a critical social science lens to investigate an eclectic range of literature addressing health inequities and is focused on poverty and deprivation at the end of life. Our aim was to see if we could shed new light on the myriad ways in which experiences of poverty shape the end of people’s lives. We start by exploring the definitions and language of poverty while acknowledging the multiple intersecting identities that produce privilege. We then discuss poverty and deprivation as a context for the nature of palliative care need and overall end-of-life circumstances. In particular, we explore: total pain; choice at the end of life; access to palliative care; and family caregiving. Overall, we argue that in addressing the effects of poverty and deprivation on end-of-life experiences, there is a need to recognise not just socio-economic injustice but also cultural and symbolic injustice. Too often, a deficit-based approach is adopted which both ‘Others’ those living with poverty and renders invisible the strategies and resilience they develop to support themselves, their families and communities. We conclude with some recommendations for future research, highlighting in particular the need to amplify the voices of people with lived experience of poverty regarding palliative and end-of-life care.
Prognostic impact of DNMT3A mutation in acute myeloid leukemia with mutated NPM1
Authors: Oñate Guadalupe , Bataller Alex , Garrido Ana , Hoyos Montserrat , Arnan Montserrat , Vives Susana , Coll Rosa , Tormo Mar , Sampol Antònia , Escoda Lourdes , Salamero Olga , Garcia Antoni , Bargay Joan , Aljarilla Alba , Nomdedeu Josep F. , Esteve Jordi , Sierra Jorge , Pratcorona Marta
Published: September 2021

The negative prognostic impact of internal tandem duplication of FLT3 (FLT3-ITD) in patients with acute myeloid leukemia with mutated NPM1 (AML-NPM1) is restricted to those with a higher FLT3-ITD allelic ratio (FLT3high; ≥0.5) and considered negligible in those with a wild-type (FLT3WT)/low ITD ratio (FLT3low). Because the comutation of DNMT3A (DNMT3Amut) has been suggested to negatively influence prognosis in AML-NPM1, we analyzed the impact of DNMT3Amut in FLT3-ITD subsets (absent, low, and high ratios). A total of 164 patients diagnosed with AML-NPM1 included in 2 consecutive CETLAM protocols and with DNMT3A and FLT3 status available were studied. Overall, DNMT3Amut status did not have a prognostic impact, with comparable overall survival (P = .2). Prognostic stratification established by FLT3-ITD (FLT3WT = FLT3low > FLT3high) was independent of DNMT3Amut status. Measurable residual disease (MRD) based on NPM1 quantitative polymerase chain reaction was available for 94 patients. DNMT3Amut was associated with a higher number of mutated NPM1 transcripts after induction (P = .012) and first consolidation (C1; P < .001). All DNMT3Amut patients were MRD+ after C1 (P < .001) and exhibited significant MRD persistence after C2 and C3 (MRD+ vs MRD−; P = .027 and P = .001, respectively). Finally, DNMT3Amut patients exhibited a trend toward greater risk of molecular relapse (P = .054). In conclusion, DNMT3Amut did not modify the overall prognosis exerted by FLT3-ITD in AML-NPM1 despite delayed MRD clearance, possibly because of MRD-driven preemptive intervention.
Complete genome sequence and identification of polyunsaturated fatty acid biosynthesis genes of the myxobacterium Minicystis rosea DSM 24000T
Authors: Pal Shilpee , Sharma Gaurav , Subramanian Srikrishna
Published: September 2021

Background

Myxobacteria harbor numerous biosynthetic gene clusters that can produce a diverse range of secondary metabolites. Minicystis rosea DSM 24000T is a soil-dwelling myxobacterium belonging to the suborderSorangiineae and family Polyangiaceae and is known to produce various secondary metabolites as well as polyunsaturated fatty acids (PUFAs). Here, we use whole-genome sequencing to explore the diversity of biosynthetic gene clusters in M. rosea.

Results

Using PacBio sequencing technology, we assembled the 16.04 Mbp complete genome of M. rosea DSM 24000T, the largest bacterial genome sequenced to date. About 44% of its coding potential represents paralogous genes predominantly associated with signal transduction, transcriptional regulation, and protein folding. These genes are involved in various essential functions such as cellular organization, diverse niche adaptation, and bacterial cooperation, and enable social behavior like gliding motility, sporulation, and predation, typical of myxobacteria. A profusion of eukaryotic-like kinases (353) and an elevated ratio of phosphatases (8.2/1) in M. rosea as compared to other myxobacteria suggest gene duplication as one of the primary modes of genome expansion. About 7.7% of the genes are involved in the biosynthesis of a diverse array of secondary metabolites such as polyketides, terpenes, and bacteriocins. Phylogeny of the genes involved in PUFA biosynthesis (pfa) together with the conserved synteny of the complete pfa gene cluster suggests acquisition via horizontal gene transfer from Actinobacteria.

Conclusion

Overall, this study describes the complete genome sequence of M. rosea, comparative genomic analysis to explore the putative reasons for its large genome size, and explores the secondary metabolite potential, including the biosynthesis of polyunsaturated fatty acids.
Phenotypic and immune functional profiling of patients with suspected Mendelian Susceptibility to Mycobacterial Disease in South Africa
Authors: van Coller Ansia , Glanzmann Brigitte , Cornelissen Helena , Möller Marlo , Kinnear Craig , Esser Monika , Glashoff Richard
Published: September 2021

Background

Mendelian Susceptibility to Mycobacterial Disease (MSMD) is a primary immunodeficiency (PID) characterised by a predisposition to infection by weakly-pathogenic mycobacteria. In countries with a high prevalence of tuberculosis (TB), individuals with MSMD are also prone to infections by Mycobacterium tuberculosis. Several MSMD-associated genes have been described, all resulting in a disruption of IL-12 and IFN-γ cytokine axis, which is essential for control of mycobacterial infections. An accurate molecular diagnosis, confirmed by phenotypic and functional immune investigations, is essential to ensure that the patient receives optimal treatment and prophylaxis for infections. The aim of this study was to implement a set of functional assays to assess the integrity of the IL-12-IFN-γ cytokine pathways in patients presenting with severe, persistent, unusual and/or recurrent TB, mycobacterial infections or other clinical MSMD-defining infections such as Salmonella.

Methods

Blood was collected for subsequent PBMC isolation from 16 participants with MSMD-like clinical phenotypes. A set of flow cytometry (phenotype and signalling integrity) and ELISA-based (cytokine production) functional assays were implemented to assess the integrity of the IL-12-IFN-γ pathway.

Results

The combination of the three assays for the assessment of the integrity of the IL-12-IFN-γ pathway was successful in identifying immune deficits in the IL-12-IFN-γ pathway in all of the participants included in this study.

Conclusions

The data presented here emphasise the importance of investigating PID and TB susceptibility in TB endemic regions such as South Africa as MSMD and other previously described PIDs relating to TB susceptibility may present differently in such regions. It is therefore important to have access to in vitro functional investigations to better understand the immune function of these individuals. Although functional assays alone are unlikely to always provide a clear diagnosis, they do give an overview of the integrity of the IL-12-IFN-γ pathway. It would be beneficial to apply these assays routinely to patients with suspected PID relating to mycobacterial susceptibility. A molecular diagnosis with confirmed functional impairment paves the way for targeted treatment and improved disease management options for these patients.
Neuromuscular block in patients 80 years and older: a prospective, controlled study
Authors: Schmartz Denis , Sghaier Raouf , Bernard Paul , Fils Jean François , Fuchs-Buder Thomas
Published: September 2021

Background

An increasing number of patients older than 80 years are undergoing anesthesia, but little information is available regarding pharmacodynamic effects of myorelaxants in this population. This study aims to compare the time course of rocuronium neuromuscular block in patients ≥ 80 years with those of younger adults.

Methods

Under total intravenous anesthesia with propofol and sufentanil, time course of a bolus of rocuronium 0.6 mg/kg neuromuscular block was assessed with acceleromyography in patients ≥ 80 and in patients 20–50 years old. Onset time, clinical duration, duration until 90% and 100% recovery of baseline were determined.

Results

Data from 32 patients were analyzed, 16 were ≥ 80 years and 16 were 20–50 years old. Demographic data are shown in Table 1. In the group ≥ 80, onset time was 190 s ± 46 s compared to 123 s ± 40 s in the group 20–50, P < 0.001 and the clinical duration was 52 [48–69.5] min and 36 [34–41] min, respectively, P < 0.001. Duration to 90% recovery of baseline was 77.5 [71–88.5] min and duration to 100% recovery of baseline was 91.2 [82.2–98] min in patients ≥ 80 years and the corresponding values in the patients 20–50 years old were 53.5 [49–55.5] min and 59.5 [56.5–70.25] min, respectively, P < 0.001.

Conclusion

Compared to younger adults rocuronium shifted in patients ≥ 80 years from a rapid onset, intermediate acting compound to a slower onset, long-acting compound.

Trial registration

ClinicalTrials.gov identifier: NCT03551652 (29/05/2018).