bluuebunny/crossref_metadata_2025 huggingface dataset:
Prevalence of malpractice claims after arthroscopic shoulder surgery: analysis of 69,097 procedures from a national registry in Norway
Authors: Lian Ola Midtsaether , Randsborg Per-Henrik , Jakobsen Rune Bruhn , Khan Bukholm Ida Rashida , Aae Tommy Frøseth
Published: October 2023

Background

Systematic analysis of compensation claims following patient injuries is helpful in improving patient safety. The objective of the current study was to assess compensation claims after arthroscopic treatment of rotator cuff ruptures, impingement, and acromioclavicular joint osteoarthritis reported to the Norwegian System of Patient Injury Compensation and evaluate if there was regional variation on the risk of patient injuries leading to an accepted compensation claim.

Methods

Data from the Norwegian System of Patient Injury Compensation and the Norwegian Patient Registry (NPR) from 2008 to 2018 were collected. Demographics (age and sex) and type of claim and reasons for accepted claims were obtained from the Norwegian System of Patient Injury Compensation, while the number of arthroscopic procedures was collected from NPR. The treating institutions were grouped on geography according to Norway’s four regional Health Trusts and private institutions and the effect of geography on the probability of an accepted claim was estimated.

Results

NPR registered 69,097 shoulder arthroscopies during the study period, of which 216 (0.3%) compensation claims were filed for patient injury. A total of 38% of the claims were accepted, representing 0.1% of the arthroscopic procedures. Infection (37.8%) was the most common reason for accepted claim, followed by no surgical indication (15.9%) and wrong surgical technique (12.2%). We found a statistically significantly increased odds ratio for a claim being accepted in both the smallest and largest regional Health Trusts compared to the other regional Health Trusts and private institutions.

Conclusions

Compensation claims due to patient injury following shoulder arthroscopy are rare (0.3% of patients file a claim, of which a third is accepted (0.1% of all shoulder arthroscopy patients)). The most common reason for accepted claim was infection followed by lack of indication.
Circulation of Anaplasma phagocytophilum among invasive and native carnivore species living in sympatry in Poland
Authors: Lesiczka Paulina Maria , Myśliwy Izabella , Buńkowska-Gawlik Katarzyna , Modrý David , Hrazdilová Kristýna , Hildebrand Joanna , Perec-Matysiak Agnieszka
Published: October 2023

Background

Anaplasma phagocytophilum is characterized by a worldwide distribution and distinguished from other Anaplasmataceae by the broadest range of mammalian hosts and high genetic diversity. The role carnivores play in the life cycle of A. phagocytophilum in Europe is uncertain. Currently, only the red fox is considered a suitable reservoir host. In this study, we focused on native and invasive medium-sized carnivore species that live in sympatry and represent the most abundant species of wild carnivores in Poland.

Methods

A total of 275 individual spleen samples from six carnivore species (Vulpes vulpes, Meles meles, Procyon lotor, Nyctereutes procyonoides and Martes spp.) were screened combining nested PCR and sequencing for A. phagocytophilum targeting a partial groEL gene with subsequent phylogenetic analysis inferred by the maximum likelihood method.

Results

The DNA of A. phagocytophilum was detected in 16 of 275 individuals (5.8%). Eight unique genetic variants of A. phagocytophilum were obtained. All detected haplotypes clustered in the clade representing European ecotype I. Three variants belonged to the subclade with European human cases together with strains from dogs, foxes, cats, and wild boars.

Conclusions

While carnivores might have a restricted role in the dissemination of A. phagocytophilum due to their relatively low to moderate infection rates, they hold significance as hosts for ticks. Consequently, they could contribute to the transmission of tick-borne infections to humans indirectly, primarily through tick infection. This underscores the potential risk of urbanization for the A. phagocytophilum life cycle, further emphasizing the need for comprehensive understanding of its ecological dynamics﻿.

Graphical Abstract
Utility of a penile compression device for the quality of life in male patients with urinary incontinence after prostatectomy (the MORE study): a randomized prospective study
Authors: Gotoh Daisuke , Torimoto Kazumasa , Onishi Kenta , Morizawa Yosuke , Hori Shunta , Nakai Yasushi , Miyake Makito , Fujimoto Kiyohide
Published: October 2023

Objectives

To verify the effects of penile clamping on the degree of stress urinary incontinence and quality of life in post-radical prostatectomy patients.

Results

Thirty-seven patients suffering from stress urinary incontinence after undergoing radical prostatectomy were enrolled. A total of 19 and 18 patients were analyzed in the non-clamp and clamp groups, respectively. The mean ages of the patients in non-clamp and clamp groups were 68.3 ± 7.1 years and 71.2 ± 4.8 years, respectively; the mean time after radical prostatectomy was 28.9 ± 44.0 months and 26.2 ± 39.0 months, respectively. The penile clamp used was the CLAMPMED® (URINE CONTROL CLAMP) size M (MURANAKA MEDICAL INSTRUMENTS Co., Ltd.). Specific urinary care pads (Sawayaka Pad for Men, Small Quantity®, Unicharm Corporation), were provided; the average daily usage was monitored for four weeks. The quality of life was evaluated using the King’s Health Questionnaire. The average daily use of urinary care pads was significantly reduced in the clamp group than in the non-clamp group (-0.83 ± 1.51 vs. -0.16 ± 0.69, P = 0.0071). King’s Health Questionnaire scores did not change significantly in either group. Wearing the CLAMPMED® reduced the amount of urinary incontinence but did not improve the quality of life.

Trial registration

The Japan Registry of Clinical Trials (jRCT1052230083). Registered 2 August, 2023.
An edge server deployment method based on optimal benefit and genetic algorithm
Authors: Ye Hongfan , Cao Buqing , Liu Jianxun , Li Pei , Tang Bing , Peng Zhenlian
Published: October 2023

With the speedy advancement and accelerated popularization of 5G networks, the provision and request of services through mobile smart terminals have become a hot topic in the development of mobile service computing. In this scenario, an efficient and reasonable edge server deployment solution can effectively reduce the deployment cost and communication latency of mobile smart terminals, while significantly improving investment efficiency and resource utilization. Focusing on the issue of edge server placement in mobile service computing environment, this paper proposes an edge server deployment method based on optimal benefit quantity and genetic algorithm. This method is firstly, based on a channel selection strategy for optimal communication impact benefits, it calculates the quantity of edge servers which can achieve optimal benefit. Then, the issue of edge server deployment is converted to a dual-objective optimization problem under three constraints to find the best locations to deploy edge servers, according to balancing the workload of edge servers and minimizing the communication delay among clients and edge servers. Finally, the genetic algorithm is utilized to iteratively optimize for finding the optimal resolution of edge server deployment. A series of experiments are performed on the Mobile Communication Base Station Data Set of Shanghai Telecom, and the experimental results verify that beneath the limit of the optimal benefit quantity of edge servers, the proposed method outperforms MIP, K-means, ESPHA, Top-K, and Random in terms of effectively reducing communication delays and balancing workloads.
Quantitative 177Lu SPECT/CT imaging for personalized dosimetry using a ring-shaped CZT-based camera
Authors: Danieli Rachele , Stella Martina , Leube Julian , Tran-Gia Johannes , Marin Clementine , Uribe Carlos F. , Vanderlinden Bruno , Reynaert Nick , Flamen Patrick , Levillain Hugo
Published: October 2023

Background

Dosimetry after radiopharmaceutical therapy with 177Lu (177Lu-RPT) relies on quantitative SPECT/CT imaging, for which suitable reconstruction protocols are required. In this study, we characterized for the first time the quantitative performance of a ring-shaped CZT-based camera using two different reconstruction algorithms: an ordered subset expectation maximization (OSEM) and a block sequential regularized expectation maximization (BSREM) combined with noise reduction regularization. This study lays the foundations for the definition of a reconstruction protocol enabling accurate dosimetry for patients treated with 177Lu-RPT.

Methods

A series of 177Lu-filled phantoms were acquired on a StarGuide™ (GE HealthCare), with energy and scatter windows centred at 208 (± 6%) keV and 185 (± 5%) keV, respectively. Images were reconstructed with the manufacturer implementations of OSEM (GE-OSEM) and BSREM (Q.Clear) algorithms, and various combinations of iterations and subsets. Additionally, the manufacturer-recommended Q.Clear-based reconstruction protocol was evaluated. Quantification accuracy, measured as the difference between the SPECT-based and the radionuclide calibrator-based activity, and noise were evaluated in a large cylinder. Recovery coefficients (RCs) and spatial resolution were assessed in a NEMA IEC phantom with sphere inserts. The reconstruction protocols considered suitable for clinical applications were tested on a cohort of patients treated with [177Lu]Lu-PSMA-I&T.

Results

The accuracy of the activity from the cylinder, although affected by septal penetration, was < 10% for all reconstructions. Both algorithms featured improved spatial resolution and higher RCs with increasing updates at the cost of noise build-up, but Q.Clear outperformed GE-OSEM in reducing noise accumulation. When the reconstruction parameters were carefully selected, similar values for noise (~0.15), spatial resolution (~1 cm) and RCs were found, irrespective of the reconstruction algorithm. Analogue results were found in patients.

Conclusions

Accurate activity quantification is possible when imaging 177Lu with StarGuide™. However, the impact of septal penetration requires further investigations. GE-OSEM is a valid alternative to the recommended Q.Clear reconstruction algorithm, featuring comparable performances assessed on phantoms and patients.
Restoring vertebral height in the treatment of multilevel vertebral compression fractures with vertebroplasty
Authors: Encarnacion-Santos Daniel , Nurmukhametov Renat , Bozkurt Ismail , Dosanov Medet , Volovish Alexander , Chaurasia Bipin
Published: October 2023

Background

Osteoporosis (OP) is the fourth leading cause of disability in the elderly. The challenges presented by OP fractures are complex. Vertebral body fractures (VCF) are frequently encountered in osteoporotic patients. Due to the predominant age group of osteoporotic VCF along with co-morbidities, restoring the vertebral body height and the correction of kyphosis via minimally invasive methods are preferred. Vertebroplasty continues to be the most commonly employed method in this selection. The purpose of this study is to provide evidence for the combined employment of vertebroplasty with other minimally invasive techniques in the treatment of osteoporotic VCF. A retrospective analysis of patients treated for multilevel thoracolumbar osteoporotic VCF was performed. The patients were treated with percutaneous vertebroplasty (PVP), transforaminal lumbar interbody fusion supplemented by vertebroplasty (TLIF-VP) and minimally invasive transpedicular screw fixation supplemented by vertebroplasty (TP-VP). They were followed up for at least a year and VAS and ODI scores along with the degree of kyphotic correction and restoration of vertebral body height have been evaluated.

Results

Sixty patients with 132 levels of VCF treated were evaluated. PVP was superior in terms of shortened operative period, decreased blood loss, earlier ambulation and not requiring general anesthesia. Both TLIF-VP and TP-VP required general anesthesia, with longer operative period and increased blood loss, however it provided greater kyphotic correction. Restoration of vertebral body height was the highest in the PVP and TP-VP group. All patients benefited clinically from the interventions in regard to VAS pain and ODI scores.

Conclusions

VP continues to be the choice for minimally invasive correction of osteoporotic VCF. VP can be employed with other techniques as seen in this study in selected patients with sufficient symptomology. TLIF implantation allowed for discectomy and sufficient root decompression while transpedicular screw fixation allowed for greater correction especially in the chronic fractures.
Effect of elevated HbA1c on outcomes in on-pump versus off-pump coronary artery bypass grafting
Authors: Cooke Brett , Williams Lamario , Delay T. Kurt , Xie Rongbing , Cornelius Katherine , Davies James E. , Vardas Panos N.
Published: October 2023

Background

Diabetic patients are at an increased risk of cardiovascular morbidities. We aimed to examine if elevated pre-operative glycosylated hemoglobin (HbA1c) levels are associated with higher likelihood of experiencing adverse events in on-pump (ONCAB) versus off-pump (OPCAB) coronary artery bypass graft (CABG) procedures. We examined characteristics of patients undergoing CABG using our institutional STS Adult Cardiac Surgery Database (ACSD) from 2014 to 2020. Descriptive statistics and univariate analyses were used to compare postoperative outcomes between ONCAB and OPCAB based on preoperative HbA1c levels: (1) HbA1c ≤ 6.0%, (2) 6.0% < HbA1c ≤ 7.0%, (3) 7.0% < HbA1c ≤ 8.5%, (4) HbA1c > 8.5%. Multivariable models were built to assess risk factors associated with adverse events. Primary outcomes were operative mortality and stroke.

Results

For ONCAB, statistically significant associations were found between increasing HbA1c and new post-operative dialysis (p=0.01), rates of readmission (p=0.003) and greater lengths of stay (p=0.002). For OPCAB, statistically significant associations were found between increasing HbA1c and rates of operative mortality (p=0.04), post-operative renal failure (p=0.0001), new post-operative dialysis (p=0.0001), sternal wound infection (p=0.01), and greater lengths of stay (p=0.03). No significant relationship was noted between HbA1c and stroke, reoperation due to bleeding, or post-operative transfusion.

Conclusions

Increasing HbA1c positively correlated with numerous adverse patient outcomes in both ONCAB and OPCAB, and differences were noted in which outcomes were most impacted between the two techniques. Pre-operative medical optimization from a diabetes standpoint is paramount to improve CABG outcomes in both on-pump or off-pump techniques.
Relationship of functional movement screening with balance and flexibility in adult nonathletes—an observational study
Authors: Mahapatra Charuhasini , Alexander Joseph Oliver Raj
Published: October 2023

Background

The functional movement screening (FMS), Flamingo balance, Y balance, and sit and reach tests are the screening tools for fundamental movement patterns, balance, and flexibility, respectively; the latter three tests are components of quantifying fitness levels. Functional movement screening is used to measure the quality of movement, and it is an injury risk predictor. There are several studies done to find the correlation between functional movement screening and fitness parameters in athletes but has not been studied much in non-athlete population. The aim of this study is to determine the correlation between functional movement screening with static and dynamic balance and flexibility in healthy adult nonathletes, and to find gender differences, if any.

Method

A total of 65 healthy nonathletes in the age group 18 to 27 years were included in the study based on the selection criteria. The functional movement screening, Y-balance test, Flamingo balance test, and sit and reach test were done for all participants.

Results

Pearson’s correlation was used to analyze the collected data. The results indicated a poor correlation between FMS and fitness parameters. These are FMS and Y-balance test left and right side (r = 0.216, 0.144, p = 0.084, 0.251), FMS with Flamingo balance test left and right side (r = 0.071, 0.197 p = 0.575, 0.115), and FMS with sit and reach test (r = 0.006, p = 0.961).

Conclusion

The results showed that functional movement screening and balance (Flamingo and Y balance) and sit and reach cannot be used interchangeably as they do not have any strong correlation. The results of the study also indicate that using only one of the tools cannot predict injury risk in healthy individuals. They have to be used in conjunction with each other.
Knowledge, attitude, and perception of Nigerian-based physiotherapists on the utilization of musculoskeletal ultrasound imaging in the clinical management of musculoskeletal conditions
Authors: Ojukwu Chidiebele Petronilla , Anekwu Emelie Moris , Ude-Bassey Zimuzor , Onuchukwu Chioma Linda , Ede Stephen Sunday , Chukwu Sylvester Caesar , Okemuo Adaora Justina , Eze Joseph C. , Okafor Chinelo Jennifer
Published: October 2023

Background

Musculoskeletal ultrasound imaging (MSUI) is an efficient monitoring and re-evaluation tool used for the management of musculoskeletal conditions in several clinical domains. Its utilization among physiotherapists, particularly in African countries, is yet to be explored.

Objective

This study investigated the knowledge, attitude, and perception of physiotherapists on the utilization of MSUI in the clinical management of musculoskeletal conditions.

Methods

One hundred and ninety-two consenting Nigerian-based physiotherapists practicing in public and private health institutions participated in this cross-sectional survey. They responded to a three-sectioned structured questionnaire, investigating socio-demographic and occupational characteristics, knowledge, attitude, and utilization of MSUI for the management of musculoskeletal conditions. Data were analyzed with descriptive statistics and Pearson’s chi-square test at a significant level of 0.05.

Results

The majority (79.2%) of the respondents had positive knowledge of MSUI and its benefits as a clinical modality for managing MSCs. However, only 4.2% had utilized MSUI in clinical practice. Non-utilization of MSUI was commonly attributed to a lack of access to MSUI (60.3%) and its unavailability in most diagnostic centers (42.9%). Almost all (99.0%) of them agreed to the necessity for increased availability of MSUI to physiotherapists for enhancement of physiotherapy interventions in the management of MSCs.

Conclusion

Knowledge of MSUI among Nigerian-based physiotherapists is adequate, but its utilization as a clinical tool is poor. Improved availability of MSUI to physiotherapists is necessary as well as specialty training on the utilization and interpretation of MSUI.
The athlete’s heart: insights from echocardiography
Authors: Flanagan Harry , Cooper Robert , George Keith P. , Augustine Daniel X. , Malhotra Aneil , Paton Maria F. , Robinson Shaun , Oxborough David
Published: October 2023

The manifestations of the athlete’s heart can create diagnostic challenges during an echocardiographic assessment. The classifications of the morphological and functional changes induced by sport participation are often beyond ‘normal limits’ making it imperative to identify any overlap between pathology and normal physiology. The phenotype of the athlete’s heart is not exclusive to one chamber or function. Therefore, in this narrative review, we consider the effects of sporting discipline and training volume on the holistic athlete’s heart, as well as demographic factors including ethnicity, body size, sex, and age.
Effect of Neck-Deep Immersion in Cool or Thermoneutral Water on Blood Glucose Levels in Individuals With Type 1 Diabetes
Authors: Abramoff Kristina J , De Souza Lauren L , Maloney Shane K , Davis Elizabeth A , Jones Timothy W , Fournier Paul A
Published: October 2023

Context

It is unclear whether immersion in cool water, typical of many beaches, increases the concentration of blood glucose in individuals with type 1 diabetes mellitus (T1DM).

Objective

To test the hypothesis in individuals with T1DM that immersion neck-deep in cool water (COOL) causes an increase in blood glucose concentration, but not exposure to thermoneutral water (THERMO) or thermoneutral air.

Methods

Eight overnight-fasted participants with T1DM were exposed for 60 minutes on separate days to 3 experimental conditions: cool water (COOL, 23 °C); thermoneutral water (THERMO, 33.5 °C); or thermoneutral air (24 °C). They then recovered for 60 minutes on land at 24 °C. At time intervals, we measured: blood glucose and plasma insulin concentration, rate of carbohydrate and fat oxidation, skin and core temperature, subcutaneous blood flow, and shivering via electromyography.

Results

There was no change in blood glucose concentration during the 3 experimental conditions (P > .05). During recovery after COOL, blood glucose increased (P < .05) but did not change in the other 2 conditions. The rate of carbohydrate oxidation during and early after COOL was higher than in the other 2 conditions (P < .05), and COOL led to a decrease in subcutaneous blood flow and the concentration of plasma insulin (P < .05).

Conclusion

Cool or thermoneutral neck-deep immersion in water does not cause a change in the concentration of blood glucose in people with T1DM, but on-land recovery from COOL causes an increase in blood glucose that may be due, at least in part, to the accompanying decrease in plasma insulin.
Nutritional Neuropathies
Authors: Kumar Neeraj
Published: October 2023

OBJECTIVE

This article reviews the etiologies, presentations, and management of neuropathies related to nutritional deficiencies.

LATEST DEVELOPMENTS

Peripheral neuropathy can be the predominant or only manifestation of certain nutrient deficiencies. Cognitive difficulties or involvement of other parts of the central nervous system, such as the optic nerve and spinal cord, may accompany nutritional peripheral neuropathies. In most patients, the nutritional deficiency may have a single predominant cause, but in some cases, multiple causes may coexist. Obesity, for unclear reasons, can be associated with nutrient deficiencies. The rising rates of bariatric surgery and the incidence of nutrient deficiencies following bariatric surgery make this a particularly relevant topic for neurologists.

ESSENTIAL POINTS

Neuropathies caused by nutrient deficiencies are preventable with appropriate supplementation in high-risk situations. Early recognition and prompt treatment are essential to ensure an optimal outcome and minimize neurologic morbidity.
Infectious Neuropathies
Authors: Boegle Aimee K. , Narayanaswami Pushpa
Published: October 2023

Objective

This article discusses the clinical manifestations and management of infectious peripheral neuropathies.

Latest Developments

Several infectious etiologies of peripheral neuropathy are well-recognized and their treatments are firmly established. The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is associated with several central and peripheral nervous system manifestations, including peripheral neuropathies. Additionally, some COVID-19 vaccines have been associated with Guillain-Barré syndrome. These disorders are an active area of surveillance and research. Recent evidence-based guidelines have provided updated recommendations for the diagnosis and treatment of Lyme disease.

Essential Points

Infectious agents of many types (primarily bacteria and viruses) can affect the peripheral nerves, resulting in various clinical syndromes such as mononeuropathy or mononeuropathy multiplex, distal symmetric polyneuropathy, radiculopathy, inflammatory demyelinating polyradiculoneuropathy, and motor neuronopathy. Knowledge of these infections and the spectrum of peripheral nervous system disorders associated with them is essential because many have curative treatments. Furthermore, understanding the neuropathic presentations of these disorders may assist in diagnosing the underlying infection.
Hereditary Neuropathies
Authors: Hayes Leslie H. , Sadjadi Reza
Published: October 2023

OBJECTIVE

This article provides an overview of hereditary neuropathies, describes the different hereditary neuropathy subtypes and the clinical approach to differentiating between them, and summarizes their clinical management.

LATEST DEVELOPMENTS

Increasingly available clinical genetic testing has broadened the clinical spectrum of hereditary neuropathy subtypes and demonstrated a significant overlap of phenotypes associated with a single gene. New subtypes such as SORD-related neuropathy and CANVAS (cerebellar ataxia, neuropathy, vestibular areflexia syndrome) have emerged. The optimization of clinical management has improved gait and motor function in the adult and pediatric populations. Novel therapeutic approaches are entering clinical trials.

ESSENTIAL POINTS

Hereditary neuropathies constitute a spectrum of peripheral nerve disorders with variable degrees of motor and sensory symptoms, patterns of involvement, and clinical courses.
Multidisciplinary Clinics in Neuromuscular Medicine
Authors: Gwathmey Kelly , Heiman-Patterson Terry D.
Published: October 2023

Multidisciplinary care is comprehensive, coordinated clinical care across medical disciplines and allied health professions. Neuromuscular disorders, such as amyotrophic lateral sclerosis and muscular dystrophies, are often associated with disabling weakness and extramuscular symptoms and may benefit from care in a model that consolidates numerous clinic visits into a single more efficient multidisciplinary clinic visit. The goal of the neuromuscular multidisciplinary care model is to improve patient outcomes, patient satisfaction, quality of life, access to medications and equipment, and survival. Although the costs of running a multidisciplinary clinic are high, they are likely associated with cost savings from the patient's perspective. Several barriers to acceptance of multidisciplinary clinics include the distance needed to travel to the clinic and the duration of the clinic visit. Telehealth multidisciplinary clinic visits may address some of these concerns. Further study is needed to understand the value of multidisciplinary clinics and is a necessary step toward creating a sustainable model.
Association Between Intraoperative Landiolol Use and In-Hospital Mortality After Coronary Artery Bypass Grafting: A Nationwide Observational Study in Japan
Authors: Iwasaki Yudai , Ohbe Hiroyuki , Nakajima Mikio , Sasabuchi Yusuke , Ikumi Saori , Kaiho Yu , Yamauchi Masanori , Fushimi Kiyohide , Yasunaga Hideo
Published: October 2023

BACKGROUND:

Ischemic heart disease is a leading cause of death worldwide, and coronary artery bypass grafting (CABG) is a major treatment. Landiolol is an ultra–short-acting beta-antagonist known to prevent postoperative atrial fibrillation. However, the effectiveness of intraoperative landiolol on mortality remains unknown. This study aimed to evaluate the association between intraoperative landiolol use and the in-hospital mortality in patients undergoing CABG.

METHODS:

To conduct this retrospective cohort study, we used data from the Japanese Diagnosis Procedure Combination inpatient database. All patients who underwent CABG during hospitalization between July 1, 2010, and March 31, 2020, were included. Patients who received intraoperative landiolol were defined as the landiolol group, whereas the other patients were defined as the control group. The primary outcome was in-hospital mortality. Propensity score matching was used to compare the landiolol and control groups.

RESULTS:

In total, 118,506 patients were eligible for this study, including 25,219 (21%) in the landiolol group and 93,287 (79%) in the control group. One-to-one propensity score matching created 24,893 pairs. After propensity score matching, the in-hospital mortality was significantly lower in the landiolol group than that in the control group (3.7% vs 4.3%; odds ratio 0.85; 95% confidence interval 0.78 to 0.94; P = .010).

CONCLUSIONS:

Intraoperative landiolol use was associated with decreased in-hospital mortality in patients undergoing CABG. Further randomized controlled trials are required to confirm these findings.
Postdischarge Survival After Sepsis: A Cohort Study
Authors: Engoren Milo , Maile Michael D. , Seelhammer Troy , Freundlich Robert E. , Schwann Thomas A.
Published: October 2023

BACKGROUND:

After hospital discharge, patients who had sepsis have increased mortality. We sought to estimate factors associated with postdischarge mortality and how they vary with time after discharge.

METHODS:

This was a retrospective study of hospital survivors of sepsis using time-varying Cox proportional hazard models, which produce a baseline hazard ratio (HR) and a second number (δHR) that reflects the amount by which the baseline HR changes with time.

RESULTS:

Of the 32,244 patients who survived sepsis at hospital discharge, 13,565 patients (42%) died (mean ± standard deviation: 1.41 ± 1.87 years) after discharge from the index hospitalization, while 18,679 patients were still alive at follow-up (4.98 ± 2.86 years). The mortality rate decreased with time after discharge: approximately 8.7% of patients died during the first month after discharge, 1.1% of patients died during the 12th month after discharge, and 0.3%% died during the 60th month; after Kaplan-Meier analysis, survival was 91% (95% confidence interval [CI], 91%–92%) at 1 month, 76% (95% CI, 76%–77%) at 1 year, 57% (95% CI, 56%–58%) at 5 years, and 48% (95% CI, 47%–48%) at 10 years after discharge. Organ dysfunction at discharge was associated with worse survival. In particular, elevated urea nitrogen at discharge (HR, 1.10 per 10 mg/dL, 95% CI, 1.08–1.12, P < .001) was associated with increased mortality, but the HR decreased with time from discharge (δHR, 0.98 per 10 mg/dL per year, 95% CI, 0.98–0.99, P < .001). Higher hemoglobin levels were associated with lower mortality (HR, 0.92 per g/dL, 95% CI, 0.91–0.93, P < .001), but this association increased with increasing time after discharge (δHR, 1.02 per g/dL per year, 95% CI, 1.01–1.02, P < .001). Older age was associated with an increased risk of mortality (HR, 1.29 per decade of age, 95% CI, 1.27–1.31, P < .001) that grew with increasing time after discharge (δHR, 1.01 per year of follow-up per decade of age, 95% CI, 1.00–1.02, P < .001). Compared to private insurances Medicaid as primary insurance was associated with an increased risk of mortality (HR, 1.17, 95% CI, 1.10–1.25, P < .001) that did not change with time after discharge. In contrast, Medicare status was initially associated with a similar risk of mortality as private insurance at discharge (HR, 1), but was associated with greater risk as time after discharge increased (δHR, 1.04 per year of follow-up, 95% CI, 1.03–1.05, P < .001).

CONCLUSIONS:

Acute physiologic derangements and organ dysfunction were associated with postdischarge mortality with the associations decreasing over time.
Association of Central Nervous System–Affecting Medications With Occurrence and Short-Term Mortality of Traumatic Brain Injury
Authors: Cajanus Kristiina , Kytö Ville , Ruuskanen Jori O. , Luoto Teemu M. , Rautava Päivi , Tornio Aleksi , Posti Jussi P.
Published: October 2023

BACKGROUND AND OBJECTIVES:

The use of medications commonly prescribed after traumatic brain injury (TBI) has been little studied before TBI. This study examined the association between the use of medications that affect the central nervous system (CNS) and the occurrence and short-term mortality of TBI.

METHODS:

Mandatory Finnish registries were used to identify TBI admissions, fatal TBIs, and drug purchases during 2005–2018. Patients with TBI were 1:1 matched to nontrauma control patients to investigate the association between medications and the occurrence of TBI and 30-day mortality after TBI. Number needed to harm (NNH) was calculated for all medications.

RESULTS:

The cohort included 59 606 patients with TBI and a similar number of control patients. CNS-affecting drugs were more common in patients with TBI than in controls [odds ratio = 2.07 (2.02-2.13), P < .001)]. Benzodiazepines were the most common type of medications in patients with TBI (17%) and in controls (11%). The lowest NNH for the occurrence of TBI was associated with benzodiazepines (15.4), selective serotonin uptake inhibitors (18.5), and second-generation antipsychotics (25.8). Eight percent of the patients with TBI died within 30 days. The highest hazard ratios (HR) and lowest NNHs associated with short-term mortality were observed with strong opioids [HR = 1.41 (1.26-1.59), NNH = 33.1], second-generation antipsychotics [HR = 1.36 (1.23-1.50), NNH = 37.1], and atypical antidepressants [HR = 1.17 (1.04-1.31), NNH = 77.7].

CONCLUSION:

Thirty-seven percent of patients with TBI used at least 1 CNS-affecting drug. This proportion was significantly higher than in the control population (24%). The highest risk and lowest NNH for short-term mortality were observed with strong opioids, second-generation antipsychotics, and atypical antidepressants. The current risks underscore the importance of weighing the benefits and risks before prescribing CNS-affecting drugs in patients at risk of head injury.
Mitochondrial metabolism in Drosophila macrophage-like cells regulates body growth via modulation of cytokine and insulin signaling
Authors: Sriskanthadevan-Pirahas Shrivani , Tinwala Abdul Qadeer , Turingan Michael J. , Khan Shahoon , Grewal Savraj S.
Published: October 2023

Macrophages play critical roles in regulating and maintaining tissue and whole-body metabolism in normal and disease states. While the cell–cell signaling pathways that underlie these functions are becoming clear, less is known about how alterations in macrophage metabolism influence their roles as regulators of systemic physiology. Here, we investigate this by examining Drosophila macrophage-like cells called hemocytes. We used knockdown of TFAM, a mitochondrial genome transcription factor, to reduce mitochondrial OxPhos activity specifically in larval hemocytes. We find that this reduction in hemocyte OxPhos leads to a decrease in larval growth and body size. These effects are associated with a suppression of systemic insulin, the main endocrine stimulator of body growth. We also find that TFAM knockdown leads to decreased hemocyte JNK signaling and decreased expression of the TNF alpha homolog, Eiger in hemocytes. Furthermore, we show that genetic knockdown of hemocyte JNK signaling or Eiger expression mimics the effects of TFAM knockdown and leads to a non-autonomous suppression of body size without altering hemocyte numbers. Our data suggest that modulation of hemocyte mitochondrial metabolism can determine their non-autonomous effects on organismal growth by altering cytokine and systemic insulin signaling. Given that nutrient availability can control mitochondrial metabolism, our findings may explain how macrophages function as nutrient-responsive regulators of tissue and whole-body physiology and homeostasis.
Analysis of the chromatin landscape and RNA polymerase II binding at SIN3-regulated genes
Authors: Soukar Imad , Mitra Anindita , Pile Lori A.
Published: October 2023

The chromatin environment has a significant impact on gene expression. Chromatin structure is highly regulated by histone modifications and RNA polymerase II binding dynamics. The SIN3 histone modifying complex regulates the chromatin environment leading to changes in gene expression. In Drosophila melanogaster, the Sin3A gene is alternatively spliced to produce different protein isoforms, two of which include SIN3 220 and SIN3 187. Both SIN3 isoforms are scaffolding proteins that interact with several other factors to regulate the chromatin landscape. The mechanism through which the SIN3 isoforms regulate chromatin is not well understood. Here, we analyze publicly available data sets to allow us to ask specific questions on how SIN3 isoforms regulate chromatin and gene activity. We determined that genes repressed by the SIN3 isoforms exhibited enrichment in histone H3K4me2, H3K4me3, H3K14ac and H3K27ac near the transcription start site. We observed an increase in the amount of paused RNA polymerase II on the promoter of genes repressed by the isoforms as compared to genes that require SIN3 for maximum activation. Furthermore, we analyzed a subset of genes regulated by SIN3 187 that suggest a mechanism in which SIN3 187 might exhibit hard regulation as well as soft regulation. Data presented here expand our knowledge of how the SIN3 isoforms regulate the chromatin environment and RNA polymerase II binding dynamics.
A Novel Custom Cycle Ergometer Protocol to Determine V̇O2max: Validation with ACSM’s Cycle Ergometry Metabolic Equation
Authors: Lankford Dianne M. , Cummings Donald M.
Published: October 2023

Introduction

Protocols for determination of maximal oxygen consumption (V̇O2max) on a cycle ergometer should be easily administered while maximizing physiological efficiency and minimizing premature local muscle fatigue for individuals of variable fitness levels. Current protocols typically increase workload by adding resistance to the flywheel; however, increasing pedal rate later in the test, rather than resistance, may provide increased physiological efficiency, yielding a more valid determination of V̇O2max.

Purpose

The purpose of this study was to design and validate a novel V̇O2max cycle ergometer protocol that can be used for measuring and predicting submaximal oxygen consumption (V̇O2) and V̇O2max during exercise testing in healthy, asymptomatic adults.

Methods

Subjects (n = 60, 19–60 yr old) performed a V̇O2max test using the new cycle ergometer protocol. Workload increases were based on predetermined incremental target heart rates (ITHR) using heart rate reserve. Stages commenced at a workload of 150 kg·m·min−1 (0.5 kg, 50 rpm) and increased every 2 min by adding 0.5 or 1.0 kg resistance based on ITHR. When an ITHR representing ≥60% heart rate reserve was achieved, workloads increased by 10 rpm for subsequent stages. Pearson’s r was used to examine relationships between predicted (American College of Sports Medicine cycle equation) and measured V̇O2 at workload intensities representing moderate, vigorous, and maximal exercise. Bland–Altman plots were used to display predicted and measured V̇O2 at all exercise intensities and heart rate values at maximal exercise.

Results

There was a strong and statistically significant correlation between predicted and measured V̇O2 at moderate (r = 0.92, P < 0.001), vigorous (r = 0.94, P < 0.001), and maximal (r = 0.90, P < 0.001) exercise intensities. All subjects reached ≥90% of age-predicted maximum heart rate.

Conclusion

This novel cycle ergometer protocol was demonstrated to be a viable tool to predict and/or measure submaximal V̇O2 and V̇O2max in a population of healthy, asymptomatic adults.
Characteristics of bibliometric analyses of the complementary, alternative, and integrative medicine literature: A scoping review protocol
Authors: Ng Jeremy Y. , Liu Henry , Shah Aimun Qadeer , Wieland L. Susan , Moher David
Published: October 2023

Background: There is a growing body of literature on complementary, alternative, and integrative medicine (CAIM), which offers a holistic approach to health and the maintenance of social and cultural values. Bibliometric analyses are an increasingly commonly used method employing quantitative statistical techniques to understand trends in a particular scientific field. The objective of this scoping review is to investigate the quantity and characteristics of evidence in relation to bibliometric analyses of CAIM literature. Methods: The following bibliographic databases will be searched: MEDLINE, EMBASE, PsycINFO, AMED, CINAHL, Scopus and Web of Science. Studies published in English, conducting any type of bibliometric analysis involving any CAIM therapies, as detailed by an operational definition of CAIM adopted by Cochrane Complementary Medicine, will be included. Conference abstracts and study protocols will be excluded. The following variables will be extracted from included studies: title, author, year, country, study objective, type of CAIM, health condition targeted, databases searched in the bibliometric analysis, the type of bibliometric variables assessed, how bibliometric information was reported, main findings, conclusions, and limitations. Findings will be summarized narratively, as well as in tabular and graphical format. Conclusions: To the best of our knowledge, this scoping review will be the first to investigate the characteristics of evidence in relation to bibliometric analyses on CAIM literature. The findings of this review may be useful to identify variations in the objectives, methods, and results of bibliometric analyses of CAIM research literature.
Impact of COVID-19 on Mobile Technology use in adults in the United States
Authors: Lin Yi , Rowles Graham D. , Stromberg Arnold J. , Zeidan Rola S. , Mankowski Robert T.
Published: October 2023

Background: Mobile technology (MT) has become essential in receiving information and services during the COVID-19 pandemic. Imposed quarantines could have led to varying adaptations of MT use. This study explored how COVID-19 impacted behavior, perception, and attitudes toward MT use in the United States.

Methods: We distributed a pilot-tested survey online. Participants were MT users ≥ 35 years old. All participants responded based on their recalled experience of using MT before COVID-19 and their recent experience during COVID-19. Data analysis involved descriptive statistics and the Wilcoxon signed-rank test.

Results: The average age of the 1212 participants was 56.1±12.2 years (55% female). Daily use frequency (from ≤3 to ≥4 hours/day) and perceived necessity (from some need to a strong need) during COVID-19 significantly increased (p<0.001) compared to before COVID-19. There was a significant increase (p<0.001) in video calls/meetings, online education, grocery/food delivery, and ordering taxi/car during COVID-19 compared to before. Participants increased (p≤0.001) their attention to the physical, social, and emotional benefits of using MT during the pandemic. COVID-19 increased MT use and acceptance in the United States.

Conclusion: The knowledge gained from this study will help remove barriers to using and accepting MT and provide directions for MT development in middle-aged and older populations.
Effect of extrusion cooking on the chemical and nutritional properties of instant flours: a review
Authors: Pismag Remigio Yamid , Polo María Paula , Hoyos José Luis , Bravo Jesús Eduardo , Roa Diego Fernando
Published: October 2023

Satisfying the nutritional requirements of consumers has made food industries focus on the development of safe, innocuous, easy-to-prepare products with high nutritional quality through efficient processing technologies. Extrusion cooking has emerged as a prominent technology associated with the nutritional and functional attributes of food products. This review aims to establish a theoretical framework concerning the influence of extrusion parameters on the functional and nutritional properties of precooked or instant flours, both as end-products and ingredients. It highlights the pivotal role of process parameters within the extruder, including temperature, screw speed, and raw materials moisture content, among others, and elucidates their correlation with the modifications observed in the structural composition of these materials. Such modifications subsequently induce notable changes in the ultimate characteristics of the food product. Detailed insights into these transformations are provided within the subsequent sections, emphasizing their associations with critical phenomena such as nutrient availability, starch gelatinization, protein denaturation, enhanced in vitro digestibility, reduction in the content of antinutritional factors (ANFs), and the occurrence of Maillard reactions during specific processing stages. Drawing upon insights from available literature, it is concluded that these effects represent key attributes intertwined with the nutritional properties of the end-product during the production of instant flours.
Association of the CD28 markers with the disease activity in systemic lupus erythematosus patients
Authors: Pratama Mirza Zaka , Handono Kusworini , Kalim Handono , Susianti Hani
Published: October 2023

Background: Systemic Lupus Erythematosus (SLE) is a complex autoimmune disease with diverse manifestations and unpredictable activity. CD28 markers, particularly sCD28, is a promising biomarker for evaluating SLE disease activity. This study aimed to investigate the significance of CD28 markers in evaluating disease activity in SLE and the role of sCD28 in various clinical manifestations.

Methods: A total of 40 female subjects, aged between 18 and 45 years, who fulfilled the 2019 EULAR/ACR classification criteria for SLE were recruited in this study. Twenty healthy matched individuals were also recruited as control. Comprehensive data on demographic information, clinical manifestations, laboratory test findings, and treatment history were collected from all participants. The Indonesian version of SLEDAI-2K score was utilized to assess disease activity, categorizing patients into active SLE and lupus low disease activity (LLDAS). Collected data were analyzed on SPSS for Windows version 25.0.

Results: Patients with SLE in LLDAS category had significantly lower SLEDAI scores (1.8 ± 1.4 vs 11.7 ± 4.9, p<0.001) with mild clinical manifestation. Active SLE patients had the lowest percentages of CD4+CD28+ cells (5.7 ± 4.1%) and the highest sCD28 concentration (26.2 ± 11.3 ng/ml) compared to other groups. Moreover, sCD28 concentration demonstrated a moderate positive correlation with SLE disease activity. In most cases, higher sCD28 concentrations were associated with clinical manifestations, particularly in neuropsychiatric lupus (OR 7.1 [1.8 – 67.9], p=0.047), nephritis (OR 14.5 [1.6 – 131.9], p=0.017), and mucocutaneous manifestations (OR 3.4 [1.9 – 12.8], p=0.035).

Conclusions: Our study establishes the link between CD28 markers and disease activity, including certain clinical manifestations in SLE. We suggest that CD28 has a potential role in predicting disease activity. However, further research through longitudinal studies is required to strengthen these findings.
Factors contributing to online child sexual abuse in Bangladesh: A qualitative inquiry
Authors: Islam Md Redwanul , Towhid Muhammad Ibrahim Ibne , Salwa Merium , Tasnim Anika , Mroy Wai Wai , Khan Md Maruf Haque , Haque Md Atiqul
Published: October 2023

Background: Children globally, including in Bangladesh, are facing various forms of online sexual abuse including sextortion, exploitation, body shaming, and blackmail. They are also coerced into engaging in intimate activities, harassed through the sending of sexual content, among other forms of abuse. We aimed to explore the root cause of online child sexual abuse (OCSA) in Bangladesh. Methods: This qualitative research design utilized in-depth interviews (IDIs) and key informant interviews (KIIs) between February and April 2022. The study sample comprised 21 school-going children aged 13−17 years, selected from two different geographical settings (10 from rural areas and 11 from urban areas) in Bangladesh using purposive sampling techniques. They participated in in-depth interviews (IDIs) while additional data was obtained through key informant interviews (KIIs) with 11 multidisciplinary stakeholders. Results: Children from both rural and urban areas reported facing abuse in various ways, such as being asked to send naked photos, being invited to be naked in video calls, and being invited to have virtual sex, among others, over the internet. Conclusions: We found inadequate internet literacy is a leading cause of OCSA. The causes of OCSA reported in this study is a serious public health concern in Bangladesh.