bluuebunny/crossref_metadata_2025 huggingface dataset:
Self-expanding covered metallic stents as a transition to silicone stent implantation in management of severe post-tuberculosis bronchial stenosis
Authors: Zhou Zi-Qing , Feng Jia-Xin , Chen Yu , Su Zhu-Quan , Zhong Chang-Hao , Chen Xiao-Bo , Tang Chun-Li , Huang Jie-Rong , Li Shi-Yue
Published: May 2021

Background and aims:

Post-tuberculosis bronchial stenosis (PTBS) is one of the most common complications of tracheobronchial tuberculosis. Silicone stent serves as a major treatment for maintaining airway patency. However, silicone stent placement remains a large challenge in patients with severe cicatricial PTBS. Our objective was to evaluate the efficacy and safety of covered, self-expanding, metallic stents (SEMSs) as a transition to silicone stent implantation for treating severe PTBS.

Methods:

We retrospectively reviewed the data of patients with severe PTBS who received airway stenting in the First Affiliated Hospital of Guangdong Medical University between September 2015 and May 2019. The types of the stent, intervention procedures, bronchoscopic findings, clinical outcomes and related complications were collected and analyzed.

Results:

Fifty-eight cases with severe PTBS were included in this study. Thirteen (22.4%) of the patients received bronchial silicone stent implantation immediately after dilations. For the remaining 45 (77.6%) patients, silicone stents could not be deployed after dilations and SEMSs implantation was implemented as a bridge to silicone stenting. The SEMSs were placed for an interval of 28.4 ± 11.1 days. All of the silicone stents were inserted successfully following the removal of SEMSs. No SEMS-related complication occurred. The subgroup analysis showed that patients who received transitional SEMSs had less luminal caliber but fewer transbronchial dilations before silicone stent implantation ( p < 0.05).

Conclusion:

Covered SEMS placement as a transition to silicone stenting could serve as a feasible procedure to reduce complications and improve the success rate of silicone stent implantation in patients with severe PTBS. The reviews of this paper are available via the supplemental material section.
McArdle disease and pregnancy: A case report and scoping review of pregnancy outcomes
Authors: Nash Christopher M , Shetty Nabha , Miller Ashley , McCoy Kyle
Published: May 2021

McArdle disease is an autosomal recessive disorder affecting skeletal muscle glycogen metabolism. Limited data are available regarding pregnancy outcomes with this genetic condition. We present a recent case of a woman with McArdle disease, along with a scoping review of all published literature regarding pregnancy and delivery outcomes for women with McArdle disease. A total of 35 cases are summarised. Overall, pregnancy does not worsen or increase the risk for disease flare. Women can successfully deliver vaginally, with consideration of an assisted second stage recommended to reduce the risk of postpartum rhabdomyolysis.
A novel HBsAg-based model for predicting significant liver fibrosis among Chinese patients with immune-tolerant phase chronic hepatitis B: a multicenter retrospective study
Authors: Zeng Da-Wu , Huang Zu-Xiong , Lin Meng-Xin , Kang Na-Ling , Lin Xin , Li Ya-Nan , Zhu Yue-Yong , Liu Yu-Rui
Published: May 2021

Background:

Hepatitis B e antigen (HBeAg)-positive chronic hepatitis B (CHB) in the immune-tolerant (IT) phase is significantly associated with high risk for hepatocellular carcinoma, suggesting requirement for antiviral therapy, particularly for those with histological liver injury. This study aimed to establish a non-invasive panel to assess significant liver fibrosis in IT chronic hepatitis B.

Patients and methods:

One hundred and thirteen IT-phase CHB patients were retrospectively recruited and divided into two histopathological groups according to their histological profiles: necroinflammatory score <4 (N <4)/fibrosis score ⩽1 (F0-1), and necroinflammatory score ⩾4 (N ⩾4)/fibrosis score ⩾2 (F2-4). Multivariate analysis was conducted to assess the predictive value of the non-invasive model for significant liver fibrosis.

Results:

IT-phase CHB patients with N <4/F0-1 had significantly higher HBsAg levels than those with N ⩾4/F2-4. The optimal HBsAg level of log 4.44 IU/mL for significant liver fibrosis (F ⩾2) gave an area under the curve (AUC) of 0.83, sensitivity of 81.1%, specificity of 81.6%, positive predictive value (PPV) of 68.2%, and negative predictive value (NPV) of 89.9%. An IT model with HBsAg and gamma glutamyl transpeptidase (GGT) in combination was established, and it had an AUC of 0.86, sensitivity of 86.5%, specificity of 81.6%, PPV of 69.6, NPV of 92.5, and accuracy of 83.2% to predict F ⩾2 in the IT-phase CHB patients. Notably, the IT model exhibited higher predictive value than the existing aspartate aminotransferase-to-platelet ratio index, Fibrosis-4 score, and GGT to platelet ratio.

Conclusion:

The established IT model combining HBsAg and GGT has good performance in predicting significant liver fibrosis in IT-phase CHB patients.
Exercise-Induced Muscle Damage in Postmenopausal Well-Trained Women
Authors: Romero-Parra Nuria , Maestre-Cascales Cristina , Marín-Jiménez Nuria , Rael Beatriz , Alfaro-Magallanes Victor M. , Cupeiro Rocío , Peinado Ana B.
Published: May 2021

Background:

Sex hormone deprivation derived from menopause may affect exercise-induced muscle damage (EIMD). No studies have previously evaluated this response between postmpenopausal and premenopausal eumenorrheic women over the menstrual cycle.

Hypothesis:

Postmenopausal women will present higher EIMD markers than premenopausal women, especially in comparison with the menstrual cycle phases where sex hormone concentrations are higher.

Study Design:

Cross-sectional study.

Level of Evidence:

Level 3.

Methods:

Thirteen postmenopausal and 19 eumenorrheic women, all of them resistance-trained, performed an eccentric squat-based exercise. The postmenopausal group performed 1 bout of exercise, while the eumenorrheic group performed 3 bouts coinciding with the early follicular, late follicular, and mid-luteal phases ot their menstrual cycle. Muscle soreness, countermovement jump, creatine kinase (CK), myoglobin, lactate dehydrogenase, interleukin-6, tumor necrosis factor-α, and C-reactive protein were evaluated before and postexercise.

Results:

The expected differences in sex hormones were observed between groups ( P < 0.001) according to their reproductive status. Postexercise increases in CK, myoglobin, and muscle soreness (168.2 ± 45.5 U/L, 123.1 ± 41.5 µg/L, and 20.7 ± 21.3 mm, respectively) were observed in comparison with baseline (136.2 ± 45.5 U/L, 76.9 ± 13.8 µg/L, and 2.7 ± 4.2 mm, respectively). Myoglobin values at baseline in postmenopausal women were higher compared with premenopausal women in the aforementioned menstrual cycle phases, respectively (62.8 ± 8.2, 60.4 ± 7.2, and 60.1 ± 10.6 µg/L; P < 0.001 for all comparisons), which was supported by large effect sizes (0.72-1.08 standardized d units). No postexercise differences were observed between groups in any markers ( P > 0.05).

Conclusion:

Despite higher resting levels of myoglobin and lower strength values in postmenopausal than in premenopausal women, EIMD was similar between both reproductive profiles. This suggests a potential benefit of being physically active despite aging and sex hormone deprivation.

Clinical Relevance:

Sex hormone deprivation derived from menopause seems not to influence muscle damage reponse to eccentric exercise in resistance-trained postmenopausal women.
Effects of Clenching Strength on Exercise Performance: Verification Using Spinal Function Assessments
Authors: Hirabayashi Ryo , Edama Mutsuaki , Saito Arisa , Yamada Yuki , Nawa Ryohei , Onishi Hideaki
Published: May 2021

Background:

This study aimed to determine the relationship between exercise performance and spinal function based on clenching strength.

Hypothesis:

Low-intensity clenching contributes to joint movement, whereas high-intensity clenching contributes to joint fixation.

Study Design:

Randomized crossover trial.

Level of Evidence:

Level 3.

Methods:

Two experiments were conducted using 2 groups of 20 healthy adults. The 4 clenching conditions in experiment 1 were 0%, 12.5%, 25%, and 50% of the maximum voluntary contraction (MVC) of the masseter muscle. Experiment 2 consisted of 3 conditions: no-bite condition, moderate effort, and maximum effort (max condition). In experiment 1, spinal function and ankle dorsiflexion tasks were measured for each clenching condition, and the ankle dorsiflexion task was measured in experiment 2. Regarding spinal function, we measured spinal reciprocal inhibition (RI) and excitability of spinal anterior horn cells. For the ankle dorsiflexion task, ankle dorsiflexion MVC was performed for 3 seconds under each clenching condition. The items analyzed were reaction time, peak ankle dorsiflexion torque, and soleus (Sol)/tibialis anterior (TA) electromyography (EMG) ratio.

Results:

The results of experiment 1 illustrated that RI was significantly attenuated or eliminated with increasing clenching strength (>25% MVC). Spinal anterior horn cell excitability increased significantly with increasing clenching strength. The peak torque was significantly higher at 50% MVC than that at 0% MVC. In experiment 2, the peak torque was significantly higher under moderate and max conditions than no-bite condition, and the Sol/TA EMG ratio was significantly higher under max condition than that under moderate condition.

Conclusion/Clinical Relevance:

The results illustrated that during high-strength clenching (≥50% MVC), antagonist muscles are activated simultaneously to increase muscle strength. High-strength clenching improved kinetic performance (joint fixation), whereas low-strength clenching (<50% MVC) enhanced exercise performance (joint movement).
Intraarticular Hyaluronic Acid Preparations for Knee Osteoarthritis: Are Some Better Than Others?
Authors: Webner David , Huang Yili , Hummer Charles D.
Published: May 2021

Objective

This literature review summarizes evidence on the safety and efficacy of intraarticular hyaluronic acid (IAHA) preparations approved in the United States for the treatment of osteoarthritis of the knee.

Design

A systematic literature search was performed in PubMed, Ovid MEDLINE, and SCOPUS databases. Only studies in which clinical outcomes of individual IAHA preparations alone could be assessed when compared to placebo, no treatment, other standard knee osteoarthritis treatments, and IAHA head-to-head studies were selected.

Results

One hundred nine articles meeting our inclusion criteria were identified, including 59 randomized and 50 observational studies. Hylan G-F 20 has been the most extensively studied preparation, with consistent results confirming efficacy in placebo-controlled studies. Efficacy is also consistently reported for Supartz, Monovisc, and Euflexxa, but not for Hyalgan, Orthovisc, and Durolane. In the head-to-head trials, high-molecular-weight (MW) Hylan G-F 20 was consistently superior to low MW sodium hyaluronate preparations (Hyalgan, Supartz) up to 20 weeks, whereas one study reported that Durolane was noninferior to Supartz. Head-to-head trials comparing high versus medium MW preparations all used Hylan G-F 20 as the high MW preparation. Of the IAHA preparations with strong evidence of efficacy in placebo-controlled studies, Euflexxa was found to be noninferior to Hylan G-F 20. There are no direct comparisons to Monovisc. One additional IAHA preparation (ie, Synovial), which has not been assessed in placebo-controlled studies, was also noninferior to Hylan G-F 20.

Conclusion

IAHA efficacy varies widely across preparations. High-quality studies are required to assess and compare the safety and efficacy of IAHA preparations.
Maintenance therapy for untreated diffuse large B-cell lymphoma: a systematic review and network meta-analysis
Authors: Yuan Ting , Zhang Feng , Yao Qingmin , Liu Yanxia , Zhu Xiaojuan , Chen Peng
Published: May 2021

Background:

Several clinical trials have been conducted to evaluate the role of maintenance therapy in untreated diffuse large B-cell lymphoma (DLBCL) patients with complete response or partial response following standard immunochemotherapy; however, the effect of maintenance therapy remains uncertain, and a suitable maintenance strategy has not been determined because of the lack of direct/indirect comparisons.

Methods:

We performed a systematic review and Bayesian network meta-analysis (NMA) to analyze and compare the effectiveness of different maintenance regimens in newly diagnosed DLBCL patients. We searched the PubMed Medline, Embase, Web of Science, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials for relevant papers from inception to 18 March 2021. Our study was prospectively registered in the International Prospective Register of Systematic Reviews (CRD42020168864). Data on overall survival (OS) were extracted and the treatments were ranked using the surface under the cumulative ranking (SUCRA) curve.

Results:

Eight trials and seven treatments involving 3525 patients were analyzed. OS analysis indicated that none of the drugs showed any benefit compared with non-maintenance therapy. Maintenance therapy with lenalidomide (SUCRA 69.3%) was ranked first in terms of OS.

Conclusion:

Based on the OS results observed in this NMA, we do not recommend maintenance therapy in patients with newly diagnosed DLBLC after first-line therapy.
Prescription attitudes and practices regarding clozapine among Serbian psychiatrists: results of a nationwide survey
Authors: Ignjatovic Ristic Dragana , Cohen Dan , Ristic Ivan
Published: May 2021

Objective:

Despite clozapine being the most effective treatment for treatment-resistant schizophrenia (TRS), a clear explanation as to why it is underutilized and why its initiation is delayed remains unclear. The first aim of the study was to conduct a nation-wide assessment of both the psychiatrists’ attitudes of the obstacles for prescribing clozapine as well as their prescription practices. The second aim was to make recommendations, based on the results obtained, for improving the Serbian clozapine guidelines.

Methods:

A questionnaire was conducted consisting of two parts. One regarded the clinical characteristics of the psychiatrists, while the second contained questions about indications for clozapine initiation, clozapine prescribing tendencies, and barriers to clozapine use. The questionnaire was sent to 302 Serbian psychiatrists.

Results:

With 161 out of the 302 psychiatrists returning the questionnaires, the response rate was 53.3%. Nearly 60% of the psychiatrists treated 10 or more patients with clozapine, with TRS being the most common indication. Only four psychiatrists (2.5%) had no patients currently on clozapine. Psychiatrists indicated that their fear of agranulocytosis (68%) constituted the greatest obstacle for clozapine prescription, followed closely by weight gain (56%), and sedation (39%). Despite their fear of agranulocytosis, only 83.9% of the psychiatrists monitored leukocytes regularly.

Conclusion:

In general, psychiatrists in Serbia seem to be confident in prescribing clozapine, even in the absence of clear monitoring guidelines and the possibility of therapeutic drug monitoring. In order to reduce obstacles for clozapine prescription, monitoring laxity, and an overreliance on personal experience, we recommend three modifications of the existing clozapine guideline.
Parental surveillance and parenting styles: Toward a model of familial surveillance climates
Authors: Marciano Avi
Published: May 2021

This study examines parental surveillance of preadolescents based on location-tracking applications installed on their smartphones. Applying reflexive thematic analysis to 24 semi-structured, in-depth interviews with mothers of middle-school children, the study asks how mothers with different parenting styles describe their surveillance ideologies and practices, and what are the sociocultural imageries that motivate their use of location-tracking applications. The findings offer six criteria for evaluating different familial surveillance climates, organizing them in a three-tier model that demonstrates the multidimensionality of digital parental surveillance. Consequently, the study challenges the presumed link between parental surveillance and strict parenting styles (e.g., authoritarian, helicopter). Acknowledging the increasing normalization of digital parental surveillance, the study advances a balanced and pragmatic view of this trend while illuminating participatory methods of implementing what is often considered a suppressive practice.
Initial experience in the treatment of Peyronie’s disease using testicular vaginal tunica graft
Authors: Rico Luis , Villasante Nicolás , Blas Leandro , Bonnano Nicolás , Ameri Carlos
Published: May 2021

Background:

Peyronie’s disease (PD) is a progressive disorder of the connective tissue of the tunica albuginea of the penis that produces an abnormal curvature, painful erections and different degrees of erectile dysfunction (ED). The aim of this study is to evaluate our initial experience in the surgical treatment of PD using an autologous graft of testicular vaginal tunica.

Materials and methods:

A retrospective study of 23 patients was carried out between 2015 and 2019. The successful surgical stretching rate was defined as a functional 20 degrees of curvature or less. Postoperative sexual function and complications rate were evaluated as secondary objectives. We used the abbreviated IIEF-5 questionnaire and evaluated the sexual function before and after the surgical procedure. Wilcoxon signed-rank test for paired samples (U test) was used, considering a value of p<0.05 to be statistically significant.

Results:

Only one patient presented a recurrence of the penile curvature, resulting in a 95.6% success rate of functional stretching. We observed a 1.6 and 0.9 difference between pre- and postoperative total score and satisfaction ( p = 0.002 and p = 0.003 respectively)

Conclusion:

In this series, the use of testicular vaginal tunic was found to be safe and effective with a significant change in the quality of sexual life, especially reflected in the overall satisfaction after the procedure and a low rate of complications.

Level of evidence:

Not applicable for this multicentre audit.
Initial and Recurrent Hyperkalemia Events in Patients With CKD in Older Adults: A Population-Based Cohort Study
Authors: Sriperumbuduri Sriram , McArthur Eric , Hundemer Gregory L. , Canney Mark , Tangri Navdeep , Leon Silvia J. , Bota Sara , Bugeja Ann , Akbari Ayub , Knoll Greg , Sood Manish M.
Published: May 2021

Background:

The risk of hyperkalemia is elevated in chronic kidney disease (CKD); however, the initial and recurrent risk among older individuals is less clear.

Objectives:

We set out to examine the initial and 1-year recurrent risk of hyperkalemia by level of kidney function (estimated glomerular filtration rate, eGFR) in older adults (≥66 years old).

Design:

Population-based, retrospective cohort study

Settings:

Ontario, Canada

Participants:

905 167 individuals (≥66 years old) from 2008 to 2015.

Measurements:

Serum potassium values

Methods:

Individuals were stratified by eGFR (≥90, 60-89, 30-59, 15-29 mL/min/1.73 m2) and examined for the risk of incident hyperkalemia (K ≥ 5.5 mEq/L) using adjusted Cox proportional hazards models. The 1-year risk of recurrent hyperkalemia was examined using multivariable Andersen-Gill models.

Results:

Among a population of 905 167 individuals (15% eGFR ≥ 90, 58% eGFR 60-89, 25% eGFR 30-59, 3% eGFR 15-29) with a potassium measurement, there were a total of 18 979 (2.1%) individuals with hyperkalemia identified. The event rate (per 1000 person-years) and adjusted hazard ratio (HR) of hyperkalemia was inversely associated with eGFR (mL/min; eGFR >90 mL/min: 8.8, referent, 60-89 mL/min: 11.8 HR 1.41; eGFR 30-59: 39.8, HR 4.37; eGFR 15-29: 133.6, 13.65) and with an increasing urine albumin-to-creatinine ratio (ACR, mg/mmol; ACR< 3: 14, referent, ACR 3-30: 35.1, HR 1.98; ACR >30: 93.7, 4.71). The 1-year event rate and adjusted risk of recurrent hyperkalemia was similarly inversely associated with eGFR (eGFR ≥ 90: 10.1, referent, eGFR 60-89: 14.4, HR 1.47; eGFR 30-59: 54.8, HR 4.90; eGFR 15-29: 208.0, HR 12.98). Among individuals with a baseline eGFR of 30 to 59 and 15 to 29, 0.9 and 3.8% had greater than 2 hyperkalemia events. The relative risk of initial and recurrent hyperkalemia was marginally higher with RAAS blockade. Roughly 1 in 4 individuals with hyperkalemia required hospitalization the day of or within 30 days after their hyperkalemia event.

Limitations:

Limited to individuals aged 66 years and above.

Conclusions:

Patients with low eGFR are at a high risk of initial and recurrent hyperkalemia.

Trial registration:

N/A
Body talk in the digital age: A controlled evaluation of a classroom-based intervention to reduce appearance commentary and improve body image
Authors: Bell Beth T , Taylor Caitlin , Paddock Danielle L. , Bates Adam , Orange Samuel T
Published: May 2021

This research evaluates the efficacy of a classroom-based intervention – Body Talk in the Digital Age (BTIDA) – in reducing adolescents’ appearance commentary and improving body image. British adolescents ( N = 314; Age Range = 12–14) were cluster randomised to intervention or waiting-list control groups. Measures of appearance commentary, appearance ideal internalisation, self-objectification and body satisfaction were completed at baseline (T1), then one-week (T2) and eight-week (T3) post-intervention. Multi-level modelling showed girls who received BTIDA reported less appearance commentary engagement and thin ideal internalisation at T2 and T3, than the control, supporting the partial efficacy of BTIDA for girls. No intervention effects were found among boys.
Effective dispute prevention and resolution through proactive contract design
Authors: Hietanen-Kunwald Petra , Haapio Helena
Published: May 2021

Research shows that strategic dispute resolution and early intervention reduce direct and indirect costs of conflicts. Minimal costs are involved in preventing and de-escalating disputes, compared with the costs of arbitration and litigation, for example. In this context, the traditional view of contracts as legal documents or reactive enforcement mechanisms is too narrow. Contracts can be used proactively, ex ante, too, enhancing the parties’ chances of success and preventing unnecessary problems. In Europe, this is part of what is known as Proactive Law; in the US, Preventive Law. On both sides of the Atlantic, it can also be framed as practicing proactive contracting or proactive contract design. Well-designed contracting processes and documents can prevent misaligned expectations and disappointments so that unnecessary disputes can be avoided. Early intervention methods of dispute resolution, such as mediation, can be used to de-escalate the dispute and promote cooperation. Along with other crucial elements, contracts can provide pre-agreed procedures and resolution mechanisms if changes, delays, or disturbances occur or a conflict situation arises. Building on our previous work on civil and commercial mediation and a managerial-legal view on contracts and their design we illustrate, with examples, how proactive contract design, combined with early intervention procedures and monitoring systems as well as post-award management processes can be used to better deal with the commercial, legal and human elements of a dispute. With a focus on commercial business-to-business contracts and related conflicts we explore how design methods can be used to address the root causes of legal disputes and to operationalize an effective dispute prevention and resolution system.
Portfolio Returns of Islamic Indices and Stock Prices in GCC Countries: Empirical Evidence From the ARDL Model
Authors: Alshubiri Faris
Published: May 2021

This study aimed to analyze four portfolio returns of Islamic indices to determine the potential of attracting investments in the Islamic Stock Price Index of the six Gulf Cooperation Council (GCC) countries. Monthly data were collected from S&P Dow Jones Indices LLC reports covering the period from December 31, 2010 to December 31, 2019. The study applied the autoregressive distributed lag (ARDL) method for estimation. The findings show that the S&P GCC Composite Shariah, the S&P GCC Composite Shariah Dividend, and the S&P Shariah Domestic Total Return Index are positively related in the long run to the Islamic Stock Price Index but S&P GCC Investable Shariah is negatively related to the Islamic Stock Price Index. The error correction model (ECM) results for the short-run ARDL model indicate that the S&P GCC Composite Shariah and the S&P GCC Investable Shariah are positively related to the Islamic Stock Price Index but S&P Shariah Domestic Total Return Index is negatively related to the Islamic Stock Price Index. The main conclusion is that positive growth in the price of Islamic stocks depends on diversifying the Islamic investment portfolio to hedge against unexpected risks.
Decoupling of Obsessions and Compulsions During Cognitive Behavioral Therapy for Youths With Obsessive Compulsive Disorder
Authors: Olatunji Bunmi O. , Cole David , McGuire Joseph F. , Schneider Sophie C. , Small Brent J. , Murphy Tanya K. , Wilhelm Sabine , Geller Daniel A. , Storch Eric A.
Published: May 2021

Although exposure and response prevention (ERP) is an effective treatment for obsessive compulsive disorder (OCD), it is unclear whether the decoupling of obsessions and compulsions is associated with treatment response. Accordingly, the present study examined change in the association between obsessions and compulsions during ERP for OCD as well as the association between decoupling of obsessions and compulsions and treatment outcome. The sample consisted of 140 youths with OCD who received 10 sessions of cognitive behavioral therapy with an emphasis on ERP. The findings show that the correlation and covariance of obsessions and compulsions increased during treatment. However, for participants that did not show improvement, the association between obsessions and compulsions strengthened over the course of treatment. In contrast, the association between obsessions and compulsions weakened over the course of ERP for treatment responders. These findings highlight the importance of the relationship between obsessions and compulsions in the treatment of OCD.
Differentiating Kinds of Systemic Stressors With Relation to Psychotic-Like Experiences in Late Childhood and Early Adolescence: The Stimulation, Discrepancy, and Deprivation Model of Psychosis
Authors: Vargas Teresa , Damme Katherine S. F. , Osborne K. Juston , Mittal Vijay A.
Published: May 2021

Conceptualizations that distinguish systems-level stress exposures are lacking; the stimulation (lack of safety and high attentional demands), discrepancy (social exclusion and lack of belonging), and deprivation (SDD; lack of environmental enrichment) theory of psychosis and stressors occurring at the systems level has not been directly tested. Exploratory factor analysis was conducted on 3,207 youths, and associations with psychotic-like experiences (PLEs) were explored. Although model fit was suboptimal, five factors were defined, and four were consistent with the SDD theory and related to PLEs. Objective and subjective or self-report exposures for deprivation showed significantly stronger PLE associations compared with discrepancy and objective stimulation factors. Objective and subjective or self-report measures converged overall, although self-report stimulation exhibited a significantly stronger association with PLEs compared with objective stimulation. Considering distinct systems-level exposures could help clarify putative mechanisms and psychosis vulnerability. The preliminary approach potentially informs health policy efforts aimed at psychopathology prevention and intervention.
Outcomes of Surgery for Sacral Chordoma and Impact of Complications: A Report of 50 Consecutive Patients With Long-Term Follow-Up
Authors: Zuckerman Scott L. , Lee Sun-Ho , Chang George J. , Walsh Garrett L. , Mehran Reza J. , Gokaslan Ziya L. , Rao Ganesh , Tatsui Claudio E. , Rhines Laurence D.
Published: May 2021

Study Design:

Retrospective case series.

Objective:

To determine predictive factors of overall survival (OS) and local recurrence (LR), report complications, and assess the impact of complications on survival, recurrence, and function in patients undergoing en bloc resection of sacral chordoma.

Methods:

This retrospective case series was obtained from a prospective database (1995-2016). All patients underwent en bloc resection of sacral chordoma. Demographic, perioperative, and complication data were collected. Outcomes included: overall survival(OS), local recurrence(LR), and complications. Survival analysis with multivariable cox regression was performed.

Results:

Among 50 patients, median follow-up was 5.3 years (range = 1.3-17.2). The majority (82%) underwent a negative margin resection. Survival: 17 patients died (34%) with a median OS of 10.0 years (range = 1.3-17.2). Multivariable cox regression revealed that a negative margin resection was not significantly associated with improved survival (HR = 3.35, 95%CI 0.87-12.80, P = .078). Recurrence: 20 patients (40%) experienced LR with a median time of 6.2 years (range = 0-16.9). Multivariable cox regression revealed that a negative margin resection was associated with a significant decreased risk of LR (HR = 4.96, 95%CI 1.84-13.34, P = 0.002,). A 62% overall complication rate was seen (42% major), with 26% reoperation rate. Of the reoperations, 54% were delayed (>6 weeks after the index surgery). Multivariable cox regression demonstrated that neither major complication nor reoperation significantly impacted OS (HR = 0.62, 95%CI 0.22-1.79, P = 0.380), LR (HR = 1.28, 95%CI 0.49-3.36, P = 0.611), or functional outcomes (OR = 2.94, 95%CI 0.25-34.8, P = 0.393).

Conclusions:

Negative margin resection was associated with decreased LR. Neither major complication nor reoperation significantly impacted OS, LR, or functional outcome. Though additional studies are needed, it appears that despite the morbidity associated with sacral chordoma resection, the long-term clinical outcomes are favorable.
Altered eutopic endometrial T-regulatory and T-helper 17 lymphocyte ratio in women with unexplained subfertility
Authors: Adur Malavika K , Braundmeier-Fleming Andrea G , Lessey Bruce A , Nowak Romana A
Published: May 2021

Problem:

Perturbations in T-helper lymphocyte profiles have previously been associated with endometriosis related subfertility and conception failure. Hence a retrospective in vitro study was conducted to evaluate the relationship between T-regulatory (Treg) and T-helper 17 (Th17) lymphocytes in the eutopic endometrium of women with unexplained subfertility and correlate these profiles to their conception status.

Method of study:

Eutopic endometrial biopsies were collected during the mid-secretory phase of the menstrual cycle, from women with unexplained subfertility. These samples were evaluated immunohistochemically for Treg and Th17 lymphocytes as well as the related proinflammatory cytokine, Interleukin-17 (IL-17). These eutopic endometrial T lymphocyte subpopulations were compared to the patients’ conception status in subsequent cycles.

Results:

Though Treg cells were not indicative of conception success in subsequent cycles, patients who maintained their subfertile (no conception) status were observed to have a higher Th17 cell count in their eutopic endometrium. The ratio of Treg:Th17 cell counts was significantly correlated to patient conception status as well. These trends stayed consistent irrespective of concurrent endometriosis.

Conclusion:

Patients with a high proinflammatory Th17 lymphocyte profile and low Treg:Th17 ratio in their eutopic endometrium during the secretory phase of their menstrual cycle are more likely to not conceive in subsequent cycles.
Effectiveness of the Reverse Sural Flap in Covering Diabetic Foot Ulcers: A Systematic Review and Meta-Analysis
Authors: Yammine Kaissar , Eric Mirela , Nasser Jason , Chahine ASSI
Published: May 2021

Background: The reverse sural fasciocutaneous flap (RSFCF) has been used with success to cover noncomplicated foot and ankle soft tissue defects. However, there are some controversies when it is used in patients having chronic diabetic foot ulcers. This aim of this meta-analysis was to evaluate the efficacy of RSFCF in covering diabetic foot and ankle ulcers. Methods: A systematic review was undertaken from MEDLINE, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Only diabetic foot and ankle ulcers were accepted for inclusion and all study designs were included. Proximally based flaps, nondiabetic ulcers, and assisted negative pressure therapy were excluded. Suitability for inclusion was assessed by 2 reviewers. The random-effect estimate was reported for the set outcomes whenever high heterogeneity was present. Metaregression analysis was performed to identify independent risk factors for failure. Results: The search identified 33 relevant studies comprising 187 patients and flap interventions; all but 1 were case-series. The weighted outcomes were as follows: (1) the flap healing rate was 93.3% while 6.6% resulted in total necrosis, (2) the rate of partial flap necrosis was 12%, (3) venous congestion was reported in 6.6% of cases, (4) the infection rate was 8.3%, and (5) the donor site morbidity was 4.6%. No association was found between pedicle width or presence of a subcutaneous pedicle tunnel and the primary outcome of total loss. Conclusions: This review demonstrated excellent results of the flap when covering complicated or large diabetic foot and ankle ulcers. When compared to those published in the literature, our results found RSFCF to be relatively less successful in diabetic wounds than in trauma patients but more successful than in those having associated osteomyelitis and those who were treated with random local flaps.
Reduction of Anastomotic Time Through the Use of Cyanoacrylate in Microvascular Procedures
Authors: Orădan Alex V. , Dindelegan George C. , Vinaşi Ramona C. , Muntean Maximilian V. , Dindelegan Maximilian G. , Chiriac Liviu , Volovici Victor
Published: May 2021

Background: Ever since the description of the first microvascular anastomosis, numerous alternative methods have been described to the classical approach. Tissue adhesive has shown promising result in previous studies and can be a fast and efficient alternative which still requires more studies to allow its clinical implementation. Methods: A randomized comparative experimental study was conducted on rats’ femoral arteries and an end-to-end anastomosis was performed in order to compare 2 anastomosis techniques. In one group, a simple interrupted suture was utilized, whereas in the second group a combination between fewer sutures and tissue adhesive was used. The anastomotic time, total operative time, blood flow velocity before, immediately after and 48 hours after the procedure, as well as an independent grading of the anastomosis immediately after the procedure were performed. Magnetic resonance imaging (MRI) was performed in order to assess the degree of stenosis. After euthanasia, histology and scanning electron microscopy (SEM) were performed on the vessels in order to assess possible complications. Results: A total of 24 anastomoses were performed, of which 12 with a classic technique and 12 with an adhesive technique. All the anastomoses were patent with a significant reduction of anastomotic and total operative time. The grading of the anastomoses showed better results in the classic suture group. The blood flow velocities were not statistically significant between the 2 groups. On MRI there was one stenotic anastomosis, whereas histology and SEM showed more complications on the adhesive group. Conclusion: Anastomotic times were significantly lower with a non-significant trend toward more thrombotic complications in the adhesive group. Further improvement of the glue properties and refinement of the technique will likely make it a viable alternative to interrupted suturing in the future.
Spondylodiscitis treated with freeze-dried bone allograft alone or combined with autograft: A randomized and blinded trial
Authors: Martínez-Gutiérrez Oscar , Peña-Martínez Victor , Camacho-Ortiz Adrián , Vilchez-Cavazos Felix , Simental-Mendía Mario , Tamez-Mata Yadira , Acosta-Olivo Carlos
Published: May 2021

Purpose:

To compare the bone fusion of freeze-dried allograft alone versus freeze-dried allograft combined autograft in spinal instrumentation due to spondylodiscitis.

Methods:

A randomized prospective trial of patients with spondylodiscitis treated with surgical debridement and spinal fixation with freeze-dried bone allograft and autograft (Group 1) or freeze-dried bone allograft alone (Group 2) was performed. Patient follow-up was assessed with a CT-scan for bone fusion; consecutive serum inflammatory marker detection (C-reactive protein, [CRP], and erythrocyte sedimentation rate, [ESR]) and clinical assessment (pain, functional disability, and spinal cord injury recovery) were other outcome parameters. The primary outcome was the grade of bone allograft integration with the scale of Tan (which ranges from 1 to 4, with lower scores indicating a better fusion rate) at 1 year after surgery.

Results:

A total of 20 patients were evaluated, 13 (65%) men and 7 (35%) women with a mean age of 47.2 (±14.3) years. Homogeneous distribution of demographic data was observed. A similar satisfactory bone graft fusion grade was observed in both graft groups at 1 year after surgery (p = 1.0000). Serum inflammatory markers gradually decreased in both groups after surgical intervention (CRP, p < 0.001; ESR, p < 0.01). At one-year follow-up, gradual improvement of pain, functional disability, and neurological spinal injury recovery in both graft groups were achieved.

Conclusion:

Freeze-dried allograft alone could be a therapeutic option for spinal fixation surgery due to spondylodiscitis since it achieves a satisfactory graft fusion rate and clinical improvement.

Level of Evidence:

Level 1. Treatment

register:

NCT03265561
Book Review: Jason Keith Fernandes, Citizenship in a Caste Polity: Religion, Language and Belonging in Goa
Authors: Jha Mithilesh Kumar
Published: May 2021

Jason Keith Fernandes, Citizenship in a Caste Polity: Religion, Language and Belonging in Goa. Hyderabad: Orient BlackSwan. Co-published by New India Foundation. 2020. 380 pages. ₹975.
Book Review: Madhav Khosla. India’s Founding Moment: The Constitution of a Most Surprising Democracy
Authors: Dhingra Alisha
Published: May 2021

Madhav Khosla. India’s Founding Moment: The Constitution of a Most Surprising Democracy. Cambridge: Harvard University Press. 2020. 219 pages. ₹599.
Arthroscopic Bankart Repair and Open Bristow Procedure in the Treatment of Anterior Shoulder Instability With Osseous Glenoid Lesions in Collision Athletes
Authors: Tasaki Atsushi , Morita Wataru , Nozaki Taiki , Yonekura Yuki , Saito Masayoshi , Phillips Barry B. , Kitamura Nobuto
Published: May 2021

Background:

Traumatic anterior shoulder instability in collision sports athletes often involves osseous glenoid lesions, which make surgical treatment challenging. High redislocation rates have been seen in collision sports athletes treated using arthroscopic Bankart repair.

Purpose:

To investigate the effectiveness of a combined arthroscopic Bankart repair and open Bristow procedure for the treatment of traumatic anterior shoulder instability in collision sports athletes, with a focus on osseous glenoid lesions.

Study Design:

Case series; Level of evidence, 4.

Methods:

We reviewed 149 shoulders in 141 competitive collision sports athletes (mean ± standard deviation age, 20.1 ± 4.1 years; 8 bilateral cases) who underwent a combined arthroscopic Bankart repair and open Bristow procedure with minimum 2 years of follow-up. Osseous Bankart lesions were arthroscopically reduced and fixed using a coracoid graft.

Results:

Clinical outcomes as indicated by mean Rowe score improved significantly from 50.0 preoperatively to 98.9 postoperatively ( P < .001) at a median follow-up of 3.4 years (range, 2.5-7 years). There were 2 recurrent dislocations (1.3%), both of which had nonunion of the transferred coracoid. Osseous Bankart lesions were observed in 85 shoulders, and osseous glenoid lesions ≥10% of the diameter of the nonoperative side were found in 58 shoulders, including 24 off-track cases. Clinical outcomes were not significantly different between patients with a glenoid defect ≥10% and <10%. Nonunion of the transferred coracoid was observed in 16 shoulders (10.7%), which had inferior Rowe scores; however, we could not define any risk factors for nonunion, including patient characteristics or bone morphology. Postoperative computed tomography performed in 29 patients >1 year after surgery showed successful repair of the osseous glenoid lesions, with a restored glenoid articular surface in all cases. Significant pre- to postoperative increases were seen in glenoid diameter (mean, 13.1% [95% CI, 9.9%-16.3%]; P < .001) and area (mean, 10.6% [95% CI, 8.5%-12.7%]; P < .001).

Conclusion:

A combined arthroscopic Bankart repair and open Bristow procedure improved bone morphology and was a reliable surgical method for treating collision sports athletes with traumatic anterior shoulder instability involving osseous glenoid lesions.
Conceptual Model of Hearing Health Inequalities (HHI Model): A Critical Interpretive Synthesis
Authors: Tsimpida Dialechti , Kontopantelis Evangelos , Ashcroft Darren M. , Panagioti Maria
Published: May 2021

Hearing loss is a major health challenge that can have severe physical, social, cognitive, economic, and emotional consequences on people’s quality of life. Currently, the modifiable factors linked to socioeconomic inequalities in hearing health are poorly understood. Therefore, an online database search (PubMed, Scopus, and Psych) was conducted to identify literature that relates hearing loss to health inequalities as a determinant or health outcome. A total of 53 studies were selected to thematically summarize the existing literature, using a critical interpretive synthesis method, where the subjectivity of the researcher is intimately involved in providing new insights with explanatory power. The evidence provided by the literature can be summarized under four key themes: (a) There might be a vicious cycle between hearing loss and socioeconomic inequalities and lifestyle factors, (b) socioeconomic position may interact with less healthy lifestyles, which are harmful to hearing ability, (c) increasing health literacy could improve the diagnosis and prognosis of hearing loss and prevent the adverse consequences of hearing loss on people’s health, and (d) people with hearing loss might be vulnerable to receiving low-quality and less safe health care. This study uses elements from theoretical models of health inequalities to formulate a highly interpretive conceptual model for examining hearing health inequalities. This model depicts the specific mechanisms of hearing health and their evolution over time. There are many modifiable determinants of hearing loss, in several stages across an individual’s life span; tackling socioeconomic inequalities throughout the life-course could improve the population’s health, maximizing the opportunity for healthy aging.
A pilot study of dimethyl fumarate in pulmonary arterial hypertension associated with systemic sclerosis
Authors: Kong Kristi , Koontz Diane , Morse Christina , Roth Eileen , Domsic Robyn T , Simon Marc A , Stratton Eric , Buchholz Connor , Tobin-Finch Kimberly , Simms Robert , George M Patricia , Hassoun Paul M , Farber Harrison , Lafyatis Robert
Published: May 2021

Introduction:

Given the poor treatment options for pulmonary arterial hypertension–associated systemic sclerosis patients, we sought to determine clinical safety and efficacy of dimethyl fumarate, an Nrf2 agonist, and the effects on biomarkers of oxidative stress on pulmonary arterial hypertension–associated systemic sclerosis in an exploratory interventional clinical trial.

Objectives:

The primary objectives were to assess the safety and efficacy of treatment with dimethyl fumarate in patients with pulmonary arterial hypertension–associated systemic sclerosis.

Methods:

This was an investigator-initiated, double-blind, randomized, placebo-controlled trial conducted at two sites in the United States. The primary safety endpoint was the incidence of serious adverse events and all adverse events in dimethyl fumarate compared to placebo-treated patients. The primary efficacy endpoint was the change in 6-min walk distance from baseline to the end of treatment at Week 24 in dimethyl fumarate compared to placebo-treated patients.

Results:

Six participants were randomized to either placebo (n = 2) or dimethyl fumarate (n = 4). Baseline demographics were similar in both groups. A total of 25 adverse events occurred in 6 subjects, with 14 adverse events (56.0%) having occurred in dimethyl fumarate-treated subjects. Three occurrences were identified as nausea adverse events, and two participants withdrew due to nausea. One participant in the placebo group was withdrawn after a hospitalization serious adverse event due to worsening of heart failure and shortness of breath secondary to anemia. One participant in each group completed protocol. Subjects in the dimethyl fumarate-treated group showed a non-significant reduced decline in 6-min walk distance (relative mean change of −7.07%) from baseline to Week 24 as compared to placebo-treated subjects (relative mean change of −14.97%).

Conclusion:

Patients treated for pulmonary arterial hypertension–associated systemic sclerosis with 2- and 3-drug regimens, as is now typical for these patients, tolerate dimethyl fumarate poorly. Our small sample size did not provide power to suggest efficacy. We suggest that Nrf2 is still a valid therapeutic target for future trials, using better tolerated Nrf2 agonists.
How to govern a sustainable supply chain: Standards, standardizers, and the political ecology of (in)advertence
Authors: Archer Matthew
Published: May 2021

There is an ambivalence within political ecology about whether the unequal power relations that emerge from many development projects are intended or unintended. This ambivalence is a result of an empirical focus on the effects of these programs on target communities, as opposed to an empirical focus on the people who are responsible for developing those programs. Drawing on qualitative fieldwork among people tasked with designing, promoting, and enforcing sustainability standards in global agricultural supply chains, I argue that the empowerment of multinational corporations and well-funded environmental NGOs that characterizes market-oriented sustainability programs is, in fact, intentional. This intention reflects the belief among sustainability professionals that the intersection of western scientific expertise with the dynamics of “the market” is the most effective way to promote sustainability in global supply chains, and to generate global sustainability in a more general sense. Concepts like “stakeholder engagement” and a commitment to flexibility and accommodation in the development and adoption of social and environmental standards are examples of what I call euphemistic sustainability, which shifts critical attention away from a balance of power that is increasingly tilted toward private interests, even as that imbalance remains an intended outcome of non-state market-driven governance systems like ostensibly voluntary sustainability standards.