bluuebunny/crossref_metadata_2025 huggingface dataset:
The Association of On-Admission Blood Hemoglobin, C-Reactive Protein, and Serum Creatinine With 2-Year Mortality of Patients With Femoral Neck Fractures
Authors: Sayed-Noor Arkan , Al-Amiry Bariq , Alwan Alan , Knutsson Björn , Barenius Björn
Published: August 2021

Introduction

The mortality of femoral neck fracture (FNF) is high and every effort should be made to identify and manage any possible risk factors. The aim of this study was to evaluate whether on-admission hemoglobin (Hb) level, C-reactive protein (CRP), and serum creatinine were associated with 2-year mortality after FNF.

Patients and Methods

In this retrospective observational cohort study, we considered for inclusion all displaced FNF patients 65 years and above treated with hemi-arthroplasty between February 2011 and May 2015. We documented the age, sex, cognitive status, and American Society of Anesthesiologists (ASA) classification. The Hb level, CRP, and serum creatinine were measured. The medical records were followed up for 2 years. We fitted different crude and adjusted Cox proportional hazards models to examine whether Hb level <100 g/L, CRP >20 mg/L, and serum creatinine >100 μmol/L were associated with the 2-year mortality, adjusted for age, sex, and ASA class.

Results

A total of 290 patients [208 females (72%), mean age 84 years] were included in the study. More than 50% of patients had impaired cognition and ASA class 3–4. Of the 290 patients, 38.3% ( n = 111) had died within 2 years after surgery. Mortality among males was 46.3% ( n = 38) while mortality among females was 35,1% ( n = 73), p = 0.07. We found that on-admission Hb level <100 g/L was associated with 2-year mortality (HR = 3.3, 95% CI: 1.3–8.3, p < 0.01) while CRP >20 mg/L and serum creatinine >100 μmol/L were not associated with 2-year mortality ( p = 0.89 and p = 0.31, respectively).

Conclusion

On-admission Hb level <100 g/L, but not CRP >20 mg/L and serum creatinine >100 μmol/L, was associated with 2-year mortality. These results can help healthcare providers identify high-risk FNF patients who probably would benefit from optimized perioperative medical management.
Linking CSR and Customer Engagement: The Role of Customer-Brand Identification and Customer Satisfaction
Authors: Agyei James , Sun Shaorong , Penney Emmanuel Kofi , Abrokwah Eugene , Ofori-Boafo Richmond
Published: August 2021

The study investigates how corporate social responsibility (CSR) impacts customer engagement and the mediating role of customer-brand identification and customer satisfaction. Survey data collected from 293 life insurance customers were analyzed using structural equation modeling. The findings reveal that CSR, customer-brand identification, and customer satisfaction are essential drivers of customer engagement. Furthermore, the findings show that CSR significantly influences customer-brand identification and customer satisfaction. The results also show that customer-brand identification and customer satisfaction play a key mediating effect in the relationship between CSR and customer engagement. The findings underscore the need for life insurance firms to consider CSR as a strategic instrument to stimulate and elicit favorable customer responses.
Paraspinal Muscle Degeneration as an Independent Risk for Loss of Local Alignment in Degenerative Lumbar Scoliosis Patients After Corrective Surgery
Authors: Han Gengyu , Wang Wei , Zhou Siyu , Li Wei , Zhang Bo , Sun Zhuoran , Li Weishi
Published: August 2021

Study Design:

Retrospective study.

Objectives:

To investigate the effect of paraspinal muscle degeneration on the maintenance of local and global alignment among degenerative lumbar scoliosis (DLS) patients after corrective surgery.

Methods:

98 DLS patients with a mean follow-up period of 38.3 months after corrective surgery were included. The T1 pelvic angle (TPA), lumbar lordosis (LL), pelvic incidence were measured preoperatively, immediate postoperatively and at last follow-up. All patients were divided into LL maintenance group (n = 21) and LL loss group (n = 77). For patients with well-aligned correction (immediate postoperative TPA ≤ 20°, n = 73), they were divided into TPA maintenance group (last follow-up TPA ≤ 20°) and TPA loss group (last follow-up TPA > 20°). The relative gross cross-sectional area (rGCSA) and fat infiltration (FI) of multifidus (MF) and erector spinae (ES), and the relative functional CSA (rFCSA) of psoas major (PS) were measured at L3, L4 and L5 on preoperative magnetic resonance imaging.

Results:

MF rGCSA were significantly smaller in LL loss group than in LL maintenance group. Both MF rGCSA and PS rFCSA were significantly smaller and MF FI was significantly higher in TPA loss group than in TPA maintenance group. Binary logistic regression revealed that the MF rGCSA was an independent factor of LL loss; Large immediate postoperative TPA was an independent risk factor of TPA loss, but not the parameters of paraspinal muscles.

Conclusion:

The effect of paraspinal muscles in lower lumbar segments might be mainly focused on the maintenance of local alignment rather than the global alignment.
Hold the Chemo! Leukostasis, a Presentation of Brown Recluse Spider Bite: A Case Report
Authors: Hallak Ahmad , Mohanakrishnan Balaji Prasad E. , Dharmarpandi Jankikeerthika , Ivyanskiy Ilya , Patel Shrestha , Naguib Tarek
Published: August 2021

Brown recluse spiders, also known as Loxosceles reclusa, are endemic to the Southwest and Central Midwestern United States. A bite from this spider can cause a range of clinical manifestations, anywhere from a painless papular lesion to life-threatening reactions. We report a possible spider bite presenting as leukostasis initially suspected to be acute leukemia. A 22-year-old female patient presented to the emergency department with confusion and right upper arm pain, redness, and swelling after a suspected spider bite. Initial labs showed WBC count of 103.5x10e3/µL, hemoglobin of 3.3 g/dL, positive Direct Coombs’ test, creatinine of 1.8 mg/dL, transaminitis, and lactic acid of 20 mmol/L. Acute leukemia with leukostasis was suspected. She was started emergently on hydroxyurea in conjunction with prophylaxis for tumor lysis syndrome. However, peripheral smear showed left-shifted granulocytosis with lymphocytosis, monocytosis, and no blast cells or evidence of myelodysplasia. Bone marrow aspirate showed mildly hypercellular marrow with myeloid hyperplasia and no myelodysplasia. Flow cytometry analysis confirmed a left-shifted myeloid maturation pattern with 0.3% myeloblasts. BCR-ABL1 and JAK2 testing was negative. Hence, she had no evidence of leukemia but rather had leukostasis from a spider bite. Hydroxyurea was stopped and follow-up labs normalized. Sphingomyelinase D in the brown recluse spider venom is unique to Loxosceles and Sicarius and may be responsible for the unique clinical presentation of loxoscelism. The presentation of hyperleukocytosis complicated by shock with an unclear history poses a diagnostic challenge. In diagnostic uncertainty, consider delaying chemotherapy until a diagnosis can be confirmed to avoid potential harm.
Comparison of Bioabsorbable and Metallic Interference Screws for Graft Fixation During ACL Reconstruction: A Meta-analysis of Randomized Controlled Trials
Authors: Xu Baoyun , Yin Yuling , Zhu Yanling , Yin Yu , Fu Weili
Published: August 2021

Background:

Bioabsorbable interference screws and metallic interference screws are both widely used for graft fixation, but it remains unclear which screw type is superior.

Purpose:

To compare clinical outcomes and complications between bioabsorbable and metallic interference screws for anterior cruciate ligament reconstruction (ACLR).

Study Design:

Systematic review; Level of evidence, 1.

Methods:

The literature was searched for relevant randomized controlled trials published between 1966 and 2020. Two investigators independently assessed risk of bias in the included studies, and data were pooled to calculate mean differences (MDs) for continuous outcomes and risk ratios (RRs) for dichotomous outcomes, together with 95% CIs. Meta-analysis was performed using a random- or fixed-effects model, depending on the heterogeneity in the data.

Results:

Included were 14 randomized controlled trials involving 1032 patients who underwent ACLR: 528 patients with bioabsorbable screws and 504 patients with metallic screws. The 2 groups did not differ significantly in International Knee Documentation Committee score (RR, 1.04; 95% CI, 0.97 to 1.11), Lysholm score (MD, 0.59; 95% CI, –0.46 to 1.63), range of motion deficit (RR, 0.95; 95% CI, 0.67 to 1.34), positive pivot-shift test (RR, 0.87; 95% CI, 0.61 to 1.24), positive Lachman test (RR, 0.82; 95% CI, 0.48 to 1.39), or KT-1000 arthrometer value (MD, 0.01; 95% CI, –0.16 to 0.18). However, bioabsorbable screws were associated with a significantly higher risk of complications (RR, 1.70; 95% CI, 1.16 to 2.50), such as graft rupture, joint effusion, and infection.

Conclusion:

The results of this review showed that there was no difference between metallic and bioabsorbable screws for ACLR in terms of subjective knee function or knee laxity, but metallic interference screws had fewer complications.
Long-Term Sports Participation and Satisfaction After UCL Reconstruction in Amateur Baseball Players
Authors: Jack Robert A. , Rao Somnath , D’Amore Taylor , Willier Donald P. , Gallivan Robert , Cohen Steven B. , Dodson Christopher C. , Ciccotti Michael G.
Published: August 2021

Background:

While the incidence of ulnar collateral ligament reconstruction (UCLR) has increased across all levels of play, few studies have investigated the long-term outcomes in nonprofessional athletes.

Purpose:

To determine the rate of progression to higher levels of play, long-term patient-reported outcomes (PROs), and long-term patient satisfaction in nonprofessional baseball players after UCLR.

Study Design:

Case series; Level of evidence, 4.

Methods:

We evaluated UCLR patients who were nonprofessional baseball athletes aged <25 years at a minimum of 5 years postoperatively. Patients were assessed with the Kerlan-Jobe Orthopaedic Clinic Shoulder and Elbow Score (KJOC), the Timmerman-Andrews (T-A) Elbow score, the Mayo Elbow Performance Score (MEPS), and a custom return-to-play questionnaire.

Results:

A total of 91 baseball players met the inclusion criteria, and 67 (74%) patients were available to complete the follow-up surveys at a mean follow-up of 8.9 years (range, 5.5-13.9 years). At the time of the surgery, the mean age was 18.9 ± 1.9 years (range, 15-24 years). Return to play at any level was achieved in 57 (85%) players at a mean time of 12.6 months. Twenty-two (32.8%) of the initial cohort returned to play at the professional level. Also, 43 (79.1%) patients who initially returned to play after surgery reported not playing baseball at the final follow-up; of those patients, 12 reported their elbow as the main reason for eventual retirement. The overall KJOC, MEPS, and T-A scores were 82.8 ± 18.5 (range, 36-100), 96.7 ± 6.7 (range, 75-100), and 91.9 ± 11.4 (range, 50-100), respectively . There was an overall satisfaction score of 90.6 ± 21.5 out of 100, and 64 (95.5%) patients reported that they would undergo UCLR again.

Conclusion:

In nonprofessional baseball players after UCLR, there was a high rate of progression to higher levels of play. Long-term PRO scores and patient satisfaction were high. The large majority of patients who underwent UCLR would undergo surgery again at long-term follow-up, regardless of career advancement.
Evaluation of the Responsiveness of the Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) Scale
Authors: Webster Kate E. , Feller Julian A.
Published: August 2021

Background:

The Anterior Cruciate Ligament Return to Sport After Injury (ACL-RSI) scale is a reliable and valid tool for evaluation of psychological readiness to return to sport after ACL injury, but its responsiveness to change has not been extensively evaluated.

Purpose:

To determine the responsiveness of the ACL-RSI scale.

Study Design:

Cohort study (diagnosis); Level of evidence, 2.

Methods:

The ACL-RSI scale and the knee confidence question from the Knee injury and Osteoarthritis Outcome Score–Quality of Life subscale was completed at 6 and 12 months after ACL reconstruction surgery. Responsiveness was assessed using distribution and anchor-based methods for the full- and short-form versions of the scale and subgroup analyzed for sex. From distribution statistics, the standardized response mean (SRM) and the smallest detectable change (SDC) were calculated. Using the anchor-based method, the minimally important change (MIC) that was associated with an improvement in knee confidence was determined using receiver operating characteristic analysis.

Results:

A total of 441 patients (257 men, 184 women; mean age of 25 years) were included in this study. An SRM of 0.7 was found for both versions, indicating a moderate level of responsiveness. The MIC was 13.4 points for the full-form version and 15.1 points for the short-form version. These values were larger than SDC values at the group level but not at the individual patient level. Responsiveness was similar between male and female patients.

Conclusion:

The ACL-RSI scale had sufficient responsiveness to investigate the efficacy of an intervention at a group level, but it may be more limited at an individual patient level.
Variability in Preschool CLASS Scores and Children’s School Readiness
Authors: Finders Jennifer K. , Budrevich Adassa , Duncan Robert J. , Purpura David J. , Elicker James , Schmitt Sara A.
Published: August 2021

The Classroom Assessment Scoring System (CLASS) is a widely administered measure of classroom quality that assesses teacher-child interactions in the domains of Emotional Support, Classroom Organization, and Instructional Support. We use data from an evaluation of state-funded prekindergarten provided to 684 children from families with low incomes (Mage = 57.56 months, 48% female) to examine the extent to which CLASS scores vary over the course of an observational period within a single day and investigate whether this variability is related to children’s school readiness at the end of the preschool year, holding constant two additional measures of quality. Teacher-child interactions in all three domains were moderately stable. Mean Classroom Organization was positively related to math, and variability in Classroom Organization was negatively related to literacy. Mean Instructional Support was negatively associated with language. Findings have implications for programs that utilize the CLASS to make high-stakes decision and inform professional development.
Boundary Matters: Uncovering the Hidden History of New York City’s School Subdistrict Lines
Authors: Kafka Judith , Matheny Cici
Published: August 2021

This article traces the spatial history of New York City’s geographic school subdistrict boundaries throughout the 20th century, exploring the historical relationship between race, space, and schooling in New York City and beyond. It seeks to both make the case for studying the spatial history of within-district education boundaries and put the results of our historical mapping project into the public domain. Ultimately, we hope that researchers will use our data to explore their own questions about the history of New York City, its neighborhoods, and its schools, and that some may embark on similar boundary-mapping projects for other cities, counties, and school systems.
Undernutrition and Its Associated Factors Among Human Immunodeficiency Virus Infected Children on Follow Up in Amhara Region Referral Hospitals, Ethiopia, 2020
Authors: Dessalegn Nigatu , Birhanu Shiferaw , Birhanu Minyichil , Kassaw Amare , Kindie Kassa , Adugna Amanual
Published: August 2021

Background. Undernutrition is a global problem and the biggest threat to human life and economic progress. It is the main cause of child morbidity and mortality especially in sub-Saharan Africa including Ethiopia. The severity of the problem is even worse when children are infected with human immunodeficiency virus. However the seriousness of the problem, there were limited studies conducted in the study area. Therefore, this study was conducted to assess the magnitude of undernutrition and its associated factors among HIV-infected children on follow up in Amhara Region Referral Hospitals. Methods. A facility-based cross-sectional study was conducted from February to April 2020. The data were collected through an interviewer-administered questionnaire. The collected data were coded and entered into Epi data 3.1 and exported to SPSS 26.0 for analysis. P-value <.05 was considered as statically significant. Results. The magnitude of undernutrition in this study was 30.3%. Dietary diversity (AOR = 1.73; CI 1.07-2.81), nutritional counseling (AOR = 2.42; CI 1.45-4.04), family size (AOR = 0.50; CI 0.27-0.93), WHO staging (AOR = 1.77; CI 1.08-2.88), and adherence to antiretroviral therapy (AOR = 1.75; CI 1.06-2.87) were predictors of undernutrition. Conclusions. Nearly one-third of the children included in this study had undernutrition. Poor dietary diversity, adherence to ART, nutritional counseling, family size, and WHO staging were factors significantly associated with undernutrition. Early screening and treatment of opportunistic infections, close attention to dietary counseling for caregivers and proper feeding habits will alleviate the problem.
The Early Sonographic Prediction of Gestational Diabetes in Women From India
Authors: Gupta Shivani , Gupta Arjun , Swarnakar C. P. , Rathore Monika , Beniwal Ramesh , Meena Kiran , Simlot Anita , Gupta Nidhi
Published: August 2021

Objective:

The purpose of this study was to look for the earliest, cost -effective method that can be added to the routine antenatal screening for identifying patients who might develop gestational diabetes mellitus (GDM) in a proactive manner, as opposed to the current reactive approach of screening and treating GDM, during the second trimester of pregnancy.

Materials and Methods:

190 singleton pregnant women in the age group 18-35 years were selected for the study. On these women two step assessment was done. The current project was carried out to utilize sonography as an early, cost-effective method which could be added to routine antenatal screening for identifying patients, at risk for developing GDM.

Results:

Body mass index was found to have a significant association in those patients with GDM with a P < .001. There was a significant association between subcutaneous adipose tissue (SAT) depth and occurrence of GDM, with a P-value of <.001. Also, in the present study, the occurrence of GDM significantly increased with a rise in visceral adipose tissue (VAT), and there was a significant association between the two, with P < .001. It was noted that there were greater incidences of GDM as VAT depth increased. The existence of GDM greatly increased with a rise in total abdominal tissue (TAT), and there was a significant association between the two, with P < .001

Conclusion:

The sonographic measurement of SAT, VAT, and TAT, could be potential marker to identify probable events for the development of GDM, among Asian Indian women who tend to have T2DM, due to differential distribution of fat.
Inferring the dynamics of mutated hematopoietic stem and progenitor cells induced by IFNα in myeloproliferative neoplasms
Authors: Mosca Matthieu , Hermange Gurvan , Tisserand Amandine , Noble Robert , Marzac Christophe , Marty Caroline , Le Sueur Cécile , Campario Hugo , Vertenoeil Gaëlle , El-Khoury Mira , Catelain Cyril , Rameau Philippe , Gella Cyril , Lenglet Julien , Casadevall Nicole , Favier Rémi , Solary Eric , Cassinat Bruno , Kiladjian Jean-Jacques , Constantinescu Stefan N. , Pasquier Florence , Hochberg Michael E. , Raslova Hana , Villeval Jean-Luc , Girodon François , Vainchenker William , Cournède Paul-Henry , Plo Isabelle
Published: August 2021

Classical BCR-ABL–negative myeloproliferative neoplasms (MPNs) are clonal disorders of hematopoietic stem cells (HSCs) caused mainly by recurrent mutations in genes encoding JAK2 (JAK2), calreticulin (CALR), or the thrombopoietin receptor (MPL). Interferon α (IFNα) has demonstrated some efficacy in inducing molecular remission in MPNs. To determine factors that influence molecular response rate, we evaluated the long-term molecular efficacy of IFNα in patients with MPN by monitoring the fate of cells carrying driver mutations in a prospective observational and longitudinal study of 48 patients over more than 5 years. We measured the clonal architecture of early and late hematopoietic progenitors (84 845 measurements) and the global variant allele frequency in mature cells (409 measurements) several times per year. Using mathematical modeling and hierarchical Bayesian inference, we further inferred the dynamics of IFNα-targeted mutated HSCs. Our data support the hypothesis that IFNα targets JAK2V617F HSCs by inducing their exit from quiescence and differentiation into progenitors. Our observations indicate that treatment efficacy is higher in homozygous than heterozygous JAK2V617F HSCs and increases with high IFNα dose in heterozygous JAK2V617F HSCs. We also found that the molecular responses of CALRm HSCs to IFNα were heterogeneous, varying between type 1 and type 2 CALRm, and a high dose of IFNα correlates with worse outcomes. Our work indicates that the long-term molecular efficacy of IFNα implies an HSC exhaustion mechanism and depends on both the driver mutation type and IFNα dose.
Genome-wide analysis of R2R3-MYB transcription factors family in the autopolyploid Saccharum spontaneum: an exploration of dominance expression and stress response
Authors: Yuan Yuan , Yang Xiping , Feng Mengfan , Ding Hongyan , Khan Muhammad Tahir , Zhang Jisen , Zhang Muqing
Published: August 2021

Background

Sugarcane (Saccharum) is the most critical sugar crop worldwide. As one of the most enriched transcription factor families in plants, MYB genes display a great potential to contribute to sugarcane improvement by trait modification. We have identified the sugarcane MYB gene family at a whole-genome level through systematic evolution analyses and expression profiling.R2R3-MYBis a large subfamily involved in many plant-specific processes.

Results

A total of 202R2R3-MYBgenes (356 alleles) were identified in the polyploidSaccharum spontaneumgenomic sequence and classified into 15 subgroups by phylogenetic analysis. The sugarcane MYB family had more members by a comparative analysis in sorghum and significant advantages among most plants, especially grasses. Collinearity analysis revealed that 70% of theSsR2R3-MYBgenes had experienced duplication events, logically suggesting the contributors to the MYB gene family expansion. Functional characterization was performed to identify 56SsR2R3-MYBgenes involved in various plant bioprocesses with expression profiling analysis on 60 RNA-seq databases. We identified 22 MYB genes specifically expressed in the stem, of whichRT-qPCR validated MYB43,MYB53,MYB65,MYB78, andMYB99. Allelic expression dominance analysis implied the differential expression of alleles might be responsible for the high expression of MYB in the stem.MYB169,MYB181,MYB192were identified as candidate C4photosynthetic regulators by C4expression pattern and robust circadian oscillations. Furthermore, stress expression analysis showed thatMYB36,MYB48,MYB54,MYB61 actively responded to drought treatment; 19 and 10 MYB genes were involved in response to the sugarcane pokkah boeng and mosaic disease, respectively.

Conclusions

This is the first report on genome-wide analysis of the MYB gene family in sugarcane. SsMYBs probably played an essential role in stem development and the adaptation of various stress conditions. The results will provide detailed insights and rich resources to understand the functional diversity of MYB transcription factors and facilitate the breeding of essential traits in sugarcane.
Comparison of targeted metagenomics and IS-Pro methods for analysing the lung microbiome
Authors: Goolam Mahomed T , Peters RPH , Pretorius GHJ , Goolam Mahomed A , Ueckermann V , Kock MM , Ehlers MM
Published: August 2021

Background

Targeted metagenomics and IS-Pro method are two of the many methods that have been used to study the microbiome. The two methods target different regions of the 16 S rRNA gene. The aim of this study was to compare targeted metagenomics and IS-Pro methods for the ability to discern the microbial composition of the lung microbiome of COPD patients.

Methods

Spontaneously expectorated sputum specimens were collected from COPD patients. Bacterial DNA was extracted and used for targeted metagenomics and IS-Pro method. The analysis was performed using QIIME2 (targeted metagenomics) and IS-Pro software (IS-Pro method). Additionally, a laboratory cost per isolate and time analysis was performed for each method.

Results

Statistically significant differences were observed in alpha diversity when targeted metagenomics and IS-Pro methods’ data were compared using the Shannon diversity measure (p-value = 0.0006) but not with the Simpson diversity measure (p-value = 0.84). Distinct clusters with no overlap between the two technologies were observed for beta diversity. Targeted metagenomics had a lower relative abundance of phyla, such as theProteobacteria, and higher relative abundance of phyla, such asFirmicuteswhen compared to the IS-Pro method.Haemophilus,PrevotellaandStreptococcuswere most prevalent genera across both methods. Targeted metagenomics classified 23 % (144/631) of OTUs to a species level, whereas IS-Pro method classified 86 % (55/64) of OTUs to a species level. However, unclassified OTUs accounted for a higher relative abundance when using the IS-Pro method (35 %) compared to targeted metagenomics (5 %). The two methods performed comparably in terms of cost and time; however, the IS-Pro method was more user-friendly.

Conclusions

It is essential to understand the value of different methods for characterisation of the microbiome. Targeted metagenomics and IS-Pro methods showed differences in ability in identifying and characterising OTUs, diversity and microbial composition of the lung microbiome. The IS-Pro method might miss relevant species and could inflate the abundance ofProteobacteria.However, the IS-Pro kit identified most of the important lung pathogens, such asBurkholderiaandPseudomonasand may work in a more diagnostics-orientated setting. Both methods were comparable in terms of cost and time; however, the IS-Pro method was easier to use.
Experiences of ethnic minority patients who are living with a primary chronic bowel condition: a systematic scoping review with narrative synthesis
Authors: Ahmed Salina , Newton Paul D. , Ojo Omorogieva , Dibley Lesley
Published: August 2021

Background

Prevalence of chronic gastrointestinal diseases has been rising amongst ethnic minority populations in Western countries, despite the first-generation migrants originating from countries of low prevalence. Differences caused by genetic, environmental, cultural, and religious factors in each context may contribute towards shaping experiences of ethnic minority individuals living with primary bowel conditions. This review aimed to explore the experiences of ethnic minority patients living with chronic bowel conditions.

Methods

We conducted a systematic scoping review to retrieve qualitative, quantitative, and mixed methods studies from eight electronic databases, and manually searched reference lists of frequently cited papers.

Results

Fourteen papers met the inclusion criteria: focussing on inflammatory bowel disease, irritable bowel syndrome, and coeliac disease. Core themes were narratively analysed. South Asians had limited understanding of inflammatory bowel disease and coeliac disease, hindered by language and literacy barriers, particularly for older generations, suggesting that culturally relevant information is needed. Family support was limited, and Muslim South Asians referred to religion to understand and self-manage inflammatory bowel disease. Ethnic minority groups across countries experienced: poor dietary intake for coeliac disease and inflammatory bowel disease, cultural conflict in self-managing diet for inflammatory bowel disease which increased anxiety, and there was a need for better quality of, and access to, healthcare services. British ethnic minority groups experienced difficulties with IBD diagnosis/misdiagnosis.

Conclusions

Cultural, religious, and social contexts, together with language barriers and limited health literacy influenced experiences of health inequalities for ethnic minority patients living with chronic bowel diseases.
Autoimmune neutropenia associated with influenza virus infection in childhood: a case report
Authors: Callejas Caballero Ignacio , Illán Ramos Marta , Berzosa Sánchez Arantxa , Anguita Eduardo , Ramos Amador José Tomás
Published: August 2021

Background

Although neutropenia is relatively frequent in infants and children and is mostly a benign condition with a self-limited course, it can lead to life-threatening severe infections.

Autoimmune neutropenia is a relatively uncommon hematological disorder characterized by the autoantibody-induced destruction of neutrophils. It is usually triggered by viral infections with very few documented cases after influenza virus.

Case presentation

An 8-month-old male infant presented at the emergency room with a 5-days history of fever up to 39.7 °C, cough and runny nose.

In the blood test performed, severe neutropenia was diagnosed (neutrophils 109/μL). A nasopharyngeal aspirate revealed a positive rapid test for Influenza A.

Serum antineutrophil antibodies were determined with positive results. Neutropenia targeted panel showed no mutations. Despite maintenance of severe neutropenia for 9 months the course was uneventful without treatment.

Conclusions

When severe neutropenia is diagnosed and confirmed, it is essential to rule out some potential etiologies and underlying conditions, since the appropriate subsequent management will depend on it.

Although autoimmune neutropenia triggered by viral infections has been widely reported, it has seldom been reported after influenza infection.

The benign course of the disease allows a conservative management in most cases.
Modified arteriosclerosis score predicts the outcomes of diabetic kidney disease
Authors: Zhang Yifan , Jiang Qifeng , Xie Jianteng , Qi Chunfang , Li Sheng , Wang Yanhui , Him Yau Hok , Chen Zujiao , Zhang Shaogui , Li Qiuling , Zhu Yuan , Li Ruizhao , Liang Xinling , Bai Xiaoyan , Wang Wenjian
Published: August 2021

Background

The significance of renal arteriosclerosis in the prediction of the renal outcomes of diabetic kidney disease (DKD) remains undetermined.

Methods

We enrolled 174 patients with DKD from three centres from January 2010 to July 2017. The severity and extent of arteriosclerosis were analysed on sections based on dual immunohistochemical staining of CD31 and α-smooth muscle actin. An X-tile plot was used to determine the optimal cut-off value. The primary endpoint was renal survival (RS), defined as the duration from renal biopsy to end-stage renal disease or death.

Results

The baseline estimated glomerular filtration rate (eGFR) of 135 qualified patients was 45 (29 ~ 70) ml/min per 1.73 m2, and the average 24-h urine protein was 4.52 (2.45 ~ 7.66) g/24 h. The number of glomeruli in the biopsy specimens was 21.07 ± 9.7. The proportion of severe arteriosclerosis in the kidney positively correlated with the Renal Pathology Society glomerular classification (r = 0.28, P < 0.012), interstitial fibrosis and tubular atrophy (IFTA) (r = 0.39, P < 0.001), urine protein (r = 0.213, P = 0.013), systolic BP (r = 0.305, P = 0.000), and age (r = 0.220, P = 0.010) and significantly negatively correlated with baseline eGFR (r = − 0.285, P = 0.001). In the multivariable model, the primary outcomes were significantly correlated with glomerular class (HR: 1.72, CI: 1.15 ~ 2.57), IFTA (HR: 1.96, CI: 1.26 ~ 3.06) and the modified arteriosclerosis score (HR: 2.21, CI: 1.18 ~ 4.13). After risk adjustment, RS was independently associated with the baseline eGFR (HR: 0.97, CI: 0.96 ~ 0.98), urine proteinuria (HR: 1.10, CI: 1.04 ~ 1.17) and the modified arteriosclerosis score (HR: 2.01, CI: 1.10 ~ 3.67), and the nomogram exhibited good calibration and acceptable discrimination (C-index = 0.82, CI: 0.75 ~ 0.87).

Conclusions

The severity and proportion of arteriosclerosis may be helpful prognostic indicators for DKD.
Obstetric anal sphincter injury in adolescent mothers
Authors: Chill Henry H. , Lipschuetz Michal , Atias Eyal , Shimonovitz Tzvika , Shveiky David , Karavani Gilad
Published: August 2021

Background

Obstetric anal sphincter injury (OASI) is a debilitating complication of vaginal delivery which has yet to receive ample attention in adolescents. The aim of this study was to describe risk for OASI in adolescent mothers compared to adults. We further attempted to compare risk factors for OASI between these two age groups.

Methods

We performed a retrospective cohort study between 2003 and 2019. Primiparous women who delivered vaginally, 21 years and younger were compared to women ages 26–35. Excluded were preterm, multifetal, non-vertex, cesarean deliveries as well as intrauterine fetal death. Rate of OASI as well as obstetric and labor characteristics of women with OASI, were compared between groups. Finally, risk factors were assessed for each group separately. Univariate and multivariate logistic regression model were performed.

Results

Final analysis was performed on 5113 nulliparous adolescents and 13,845 nulliparous in the 26–35 age group. Allocation to study groups was according to OASI – Sixty-seven adolescents (1.3%) had a 3rd or 4th degree perineal tear and were defined as the OASI group, while 5046 patients (98.7%) did not have such a tear. In the adult group, 199 out of 13,845 patients (1.4%) were diagnosed with OASI. Occurrence of OASI did not differ between groups (p = 0.510). Comparison of women with OASI in the adolescent group vs. adult group found differences with regard to operative vaginal delivery, (20.9% vs. 36.2%, respectively; p = 0.023) and meconium stained amniotic fluid (9.1% vs. 21.3%, respectively; p = 0.027).

Following multivariate analysis the only parameter independently associated with OASI in the adolescent age group was head circumference ≥ 90th percentile with an adjusted odds ratio of 3.08 (CI 1.48–6.38, p = 0.003). In the adult group the similar analysis revealed operative vaginal delivery (OR = 2.44, CI 1.72–3.47, p < 0.001) and a birthweight≥90th percentile (OR = 2.23, CI 1.19–4.18, p = 0.012) to be independent risk factors for OASI.

Conclusion

Adolescents have similar risk for OASI compared to adults but differ in risk factors leading to OASI. Head circumference ≥ 90th percentile was found to be associated with OASI in this age group.
Influence of Epstein–Barr virus and human papillomavirus infection on macrophage migration inhibitory factor and macrophage polarization in nasopharyngeal carcinoma
Authors: Feng Guofei , Xu Yifei , Ma Ning , Midorikawa Kaoru , Oikawa Shinji , Kobayashi Hatasu , Nakamura Satoshi , Ishinaga Hajime , Zhang Zhe , Huang Guangwu , Takeuchi Kazuhiko , Murata Mariko
Published: August 2021

Background

To assess the effects of Epstein–Barr virus (EBV) and human papillomavirus (HPV) infection on the tumor microenvironment, we examined the relationship between viral infection status, macrophage migration inhibitory factor (MIF), and tumor-associated macrophages in nasopharyngeal carcinoma (NPC).

Methods

A tissue microarray containing 150 cores from 90 patients with NPC and six with chronic inflammation was used. EBV and HPV status were detected using in situ hybridization with commercial EBER1 and HPV16/18 probes. Immunofluorescence double staining of MIF, pan-macrophage marker CD68, M1 macrophage marker CD11c, and M2 macrophage marker CD163 were analyzed using the same tissue microarray. The levels of these markers between NPC and inflammation cases and between tumor nests and stroma were compared. Correlations among these markers were analyzed.

Results

We found EBER1(+) cases in 90% of NPC patients, including 10% EBV/HPV co-infection. M1 macrophages mainly infiltrated the tumor nest, while M2 macrophages infiltrated the tumor stroma. We found a significant positive correlation between EBER1 levels and MIF levels in tumor nests and a significant positive correlation between HPV16/18 and CD11c(+) cell levels in NPC tissues.

Conclusions

It is suggested that MIF is associated with EBV, and M1 macrophage infiltration is affected by HPV status in NPC.
Scrutinize of healthy school canteen policy in Iran’s primary schools: a mixed method study
Authors: Babashahi Mina , Omidvar Nasrin , Joulaei Hassan , Zargaraan Azizollaah , Zayeri Farid , Veisi Elnaz , Doustmohammadian Azam , Kelishadi Roya
Published: August 2021

Background

Schools provide an opportunity for developing strategies to create healthy food environments for children. The present study aimed to analyze the Healthy School Canteen (HSC) policy and identify challenges of its implementation to improve the school food environment in Iran.

Methods

This mixed method study included two qualitative and quantitative phases. In the qualitative phase, triangulation approach was applied by using semi-structured interviews with key informants, documents review and direct observation. Data content analysis was conducted through policy analysis triangle framework. In the quantitative phase, food items available in 64 canteens of primary schools of Tehran province were gathered. The food’s nutrient data were evaluated using their nutrition facts label. The number and proportion of foods that met the criteria based on Iran’s HSC guideline and the World Health Organization nutrient profile model for the Eastern Mediterranean Region (WHO-EMR) were determined.

Results

The main contextual factors that affected adoption of HSC policy included health (nutritional transition, high prevalence of non-communicable diseases and unhealthy food environment in and around the schools), political (upstream supportive policies and joint memorandums about health children between the Ministry of Health and Medical Education and Ministry of Education), structural (the lack of unified stewardship, inadequate human resource capacity, poor inter-sectional cooperation), economic (school financial problems, poor fiscal supportive of food policies), and socio-cultural (mothers working outside the home, the role of children’s peer group, low nutrition knowledge of school principals) factors. Assessment of the school canteens showed that a large proportion of available foods did not comply with the national guidelines (54.7 ± 2.54%) and WHO-EMR model (85.6 ± 2.34%). The main reasons identified for incomplete implementation of the policy were inadequate physical and economic infrastructure to set up standard school canteens, lack of scientific criteria for food categorization, poor monitoring, high price of healthy foods, and conflict of interest among the actors.

Conclusion

The majority of foods and beverages available in the school canteens did not comply with national and regional standards. Iran HSC policy needs to be improved by using an evidence-based approach and active interaction between all key actors.
Similar outcomes in computer-assisted and conventional total knee arthroplasty: ten-year results of a prospective randomized study
Authors: Beyer Franziska , Pape Alexander , Lützner Cornelia , Kirschner Stephan , Lützner Jörg
Published: August 2021

Background

Computer-assisted navigation (CAS) was developed to improve the surgical accuracy and precision. Many studies demonstrated better alignment in the coronal plane in CAS TKA compared to conventional technique. The influence on the functional outcome is still unclear. Only few studies report long-term results of CAS TKA. This study was initiated to investigate 10-year patient-reported outcome of CAS and conventional TKA.

Methods

From initially 80 patients of a randomized study of CAS and conventional TKA a total of 50 patients could be evaluated at the 10-year follow-up. The Knee Society Score and EuroQuol Questionnaire were assessed. For all patients a competing risk analysis for revision was performed.

Results

The patient-reported outcome measures demonstrated similar values for both groups. The 10-year risk for revision was 2.5% for conventional TKA and 7.5% for CAS TKA (p=0.237).

Conclusions

There was no difference between CAS and conventional TKA with regard to patient-reported outcome and revision risk ten years after surgery.

Trial registration

This study was registered at clinicaltrials.gov on 11/30/2009, ID:NCT01022099.
Long-term results of type B aortic dissection patients with tumor after endovascular repair or optimal medical therapy: a single—center and retrospective cohort study
Authors: Liang Taiping , Zhu Hongqiao , Zhang Lei , Li Shuangshuang , He Xiaomin , Zhao Kaiwen , Jing Zaiping , Zhou Jian
Published: August 2021

Background

The effect of thoracic endovascular aortic repair (TEVAR) for acute Type B aortic has been confirmed, However, when patients with malignant disease suffer from acute type B aortic dissection (ATBAD), the effect of TEVAR intervention is still unclear.

Methods

ATBAD patients were identified from electronic medical records between 2009 and 2019. The 5 year overall and aortic-disease free survival rates were analyzed and compared between the two groups.

Results

Of the 40 enrolled patients, 27 (67.5%) received TEVAR and 13 (32.5%) received OMT. The baseline characteristics of the two groups were not significantly different. Kaplan‒Meier survival curve showed that the 5 year overall survival and 5 year aortic-disease free survival of the TEVAR group were better than those of the OMT group. The Cox proportional hazard model with unadjusted risk showed an 83.0% decrease in 5 year overall mortality (HR, 0.17; 95% CI, 0.05–0.56) and a lower aortic-disease related risk (HR, 0.08; 95% CI, 0.02–0.39) in TEVAR group compared to OMT group. After adjusted for age, gender, smoking, drinking and comorbidities (diabetes mellitus, hypertension and coronary artery diseases), the hazard ratio of 5 year overall mortality was 78.0% lower (HR, 0.22; 95% CI, 0.06.0.81) and the risk of aortic-disease related mortality was 93.0% lower (HR, 0.07; 95% CI, 0.01–0.61) in TEVAR group compared to OMT group. In the cohort stratified by age, sex, the risk of the 5 year overall or aortic-disease related mortality in TEVAR group was relatively reduced compared to OMT group.

Conclusions

Compared to OMT, TEVAR improves the 5 year overall and aortic-disease free survival rates in the cohort of ATBAD patients with a single type of malignant tumors.
Acute myocardial infarction and arterial embolism in a patient with newly diagnosed renal mass: management dilemmas! A case report
Authors: Martin Benedikt , Greinacher Andreas , Bülow Robin , Hammer Fabian , Hoene Andreas , Burchardt Martin , Zimmermann Uwe
Published: August 2021

Background

Cancer is often associated with a hypercoagulable state and new thrombosis is often the first clinical manifestation of cancer. Surgical treatment of the primary tumor is crucial since it provides the only curative approach in most cases, but management of patients is highly complex, especially in the presence of new antiplatelet drugs and/or anticoagulants. Paraneoplastic syndromes (PNS) represent a frequent complication of renal cell carcinomas (RCC) and include different hematological symptoms in patients, whilst occlusion of arterial blood vessels displays a rare form of PNS accompanying renal tumors.

Case presentation

We report the case of a 62-year old man who was initially hospitalized due to acute coronary syndrome. He subsequently underwent coronary angioplasty treatment including multiple stenting and treatment with ticagrelor and aspirin. Post-interventional, acute arterial thrombotic emboli of several limb arteries required thrombectomy. By computer tomography we identified a renal lesion suspicious for an RCC and suspected a PNS as underlying cause of the thrombotic complications. Triple anticoagulant therapy was maintained with therapeutic dose low molecular weight heparin (LMWH), aspirin, and clopidogrel, by which we replaced ticagrelor. Surgery was postponed for 4 weeks. We paused LMWH, aspirin and clopidogrel only at the day of surgery and perioperatively restored hemostasis by transfusion of two platelet concentrates. Laparoscopic nephrectomy was uneventful. Pathology confirmed a clear cell RCC. The patient fully recovered whilst slowly reducing anticoagulation dose.

Conclusions

A multidisciplinary team approach of experts in urology, cardiology and hemostasis was key in managing this patient since a personalized thrombosis consult was needed to minimize the risk of reinfarction due to in-stent thrombosis. We report a therapeutic protocol that may be helpful for the management of similar cases. Furthermore, the finding of thrombotic arterial occlusions in larger blood vessels represents a novel complication of PNS in RCC and adds to the varied possible manifestations of this clinical chameleon.
Effects of iRoot SP on osteogenic differentiation of human stem cells from apical papilla
Authors: Wu Laidi , Xue Kaiyang , Hu Guang , Du Hanman , Gan Kang , Zhu Juanfang , Du Tianfeng
Published: August 2021

Background

Research shows that nano-bioceramics can modulate the differentiation of dental stem cells. The novel ready-to-use calcium-silicate-based root-canal sealer iRoot SP is widely used in root filling. Accordingly, the aim of this study was to evaluate the effects of iRoot SP on proliferation and osteogenic differentiation in human stem cells from the apical papilla (hSCAPs).

Methods

hSCAPs were isolated and characterized in vitro, then cultured with various concentrations of iRoot SP extract. Cell proliferation was assessed by CCK-8 assay, and scratch-wound-healing assays were performed to evaluate cell-migration capacity. hSCAPs were then cultured in osteogenic medium supplemented with iRoot SP extracts. Alkaline phosphatase (ALP) activity assay was used to evaluate ALP enzyme levels. Alizarin red staining and cetylpyridinium chloride (CPC) assays were performed to assess calcified-nodule formation and matrix-calcium accumulation of hSCAPs. The mRNA and protein expression levels of the osteogenic markers OCN, OSX, Runx2, and DSPP were determined by qRT-PCR and Western blotting. The data were analyzed using one-way ANOVA and LSD-t tests.

Results

iRoot SP at low concentrations (2, 0.2, and 0.02 mg/mL) is nontoxic to hSCAPs. iRoot SP at concentrations of 0.02 and 0.2 mg/mL significantly increases cell-migration capacity. In terms of osteogenic differentiation, 0.2 mg/mL iRoot SP promotes intracellular ALP activity and the formation of mineralized nodules. Moreover, the expression of osteogenic markers at the mRNA and protein levels are upregulated by iRoot SP.

Conclusion

iRoot SP is an effective filling material for periapical bone regeneration.