bluuebunny/crossref_metadata_2025 huggingface dataset:
The application of evidence-based bundle approach to reduce surgical site infection in geriatric hip fracture patients: A single centre experience
Authors: Lok Chow Chun , Alexander Chan Pak Hin , Wah Hung Yuk , Ho Fan Jason Chi
Published: June 2020

Introduction:

Surgical site infection (SSI) is associated with increased morbidity and mortality, prolongation on length of hospital stay and cost of community healthcare. In 2010 and 2012, our centre experienced an unexpectedly high rate of SSI in geriatric hip fracture patients with hemiarthroplasty done. A multifaceted intervention programme – ‘bundle approach’ – consisting of preoperative microbiological screening, perioperative measures and postoperative wound care was implemented.

Method:

Preoperative methicillin-resistant Staphylococcus aureus (MRSA) screening was implemented. Intravenous vancomycin was given as prophylactic antibiotic of choice in those patients with positive MRSA screening. All patients will be bathed with chlorhexidine lotion 1 day before operation or on the day of operation. Standardized protocol of surgical site disinfection was implemented: a stringent first stage povidone-iodine disinfection, second stage waterproof extremity draping and sterile plastic sheet wrapping of non-surgical region and third stage ChloraPrep, followed by circumferential iodophor-impregnated plastic adhesive drape (‘Ioban’) covering the hip and thigh region. The surgical wound was dressed with Aquacel adhesive tape after wound closure.

Results:

The total numbers of infected cases were 17 from 2008 to 2012 and 9 from 2013 to 2018 (first quarter). The rates of infection were 7.02% from 2008 to 2012 and 3.16% from 2013 to 2018 (first quarter). There was a statistically significant reduction in the number of infected cases of hemiarthroplasty after the implementation of bundle approach ( p = 0.0411).

Discussion:

The bundle approach showed to achieve an effective and sustained decrease in SSI for the geriatric hip fracture patients.
Trigger Fingers After Open Carpal Tunnel Release
Authors: Ashmead Duffield , Okada Haruko , Macknin Jonathan , Naalt Steven Vander , Staff Ilene , Wollstein Ronit
Published: June 2020

Trigger finger (TF) and carpal tunnel syndrome (CTS) are common conditions often occurring together with an unclear relationship. While some studies conclude that TFs occur as a result of carpal tunnel release (CTR), others have not established a causal relationship. Our purpose was to evaluate the prevalence and timing of TF development in the same hand after open CTR in our population. This was a retrospective review of 497 patients undergoing open CTR by a single surgeon. Two hundred twenty-nine charts were analysed for age, gender, handedness, BMI, workers’ compensation status, and background disease. We analysed the specific digit involved and timing to development of triggering after CTR. Thirty-one patients developed triggering after CTR (13.5%). Mean age was 52.5 (14.0) years. Follow-up ranged from 1 to 53 months with a median follow-up of 6 months (interquartile range = 2-13). The thumb was the most common to trigger (42.22%), followed by the ring 24.44%, middle 22.22%, little 8.89%, and index fingers 2.22%. Trigger thumb occurred at 3.5 months (3.6) post-operatively, while other digits triggered at 7.5 months (4-10.25) after surgery ( P = .022). No risk factors were associated with TF development. Our results suggest that a trigger thumb develops more frequently and earlier than other trigger digits after an open CTR. Further study is needed to clarify the mechanisms involved and may enable specific treatment such as local anti-inflammatory medication following CTR. We suggest educating prospective carpal tunnel surgery patients to high risk of triggering following CTR.
Human Acellular Dermal Matrix Augmentation Phalloplasty Surgery
Authors: Zhang Huimin , Jin Chengyue , Zhang Peiyang , Wu Yuanyi , Zhang Min , Bai Wenjun , Li Qing , Xu Tao , Zhang Xiaowei
Published: June 2020

Introduction and Objective:

Many men often have the need to enlarge their penises for psychological gain and to satisfy or to impress their partners. Many surgical techniques have been reported. However, none is the gold standard.

Aim:

To evaluate the efficacy and safety of human acellular dermal matrix allograft in augmentation phalloplasty technique.

Methods:

From March 2015 to September 2017, a total of 182 patients were prospectively recruited into our cohort after complete physical and psychological evaluation that deemed suitable for penile enhancement. Penis circumference was measured at the mid-length of the penis. Mean was 7.03 cm (6.93 ± 1.00 cm) and 12.1 cm (10.59 ± 1.15 cm) during flaccid and erection, respectively. All patients received human acellular dermal matrix graft under spinal or local anesthesia. The allograft was preconditioned in normal saline for 20 minutes, and mesh incisions were made to optimize blood flow. The width was equal to the circumference of both corpus cavernosa but without corpus spongiosum. The length of the graft was determined by measuring the length between the tip of the coronary sulcus and the root of penis. A complete incision below the coronary sulcus to the depth of the Buck’s fascia was made. Then separate the dartos fascia from the Buck’s fascia. The prepared graft was then placed on top of the Buck’s fascia, with the blood-remained side facing the Buck’s fascia. The graft was sutured using 4-0 absorbable polyglycolic acid suture to the Buck’s fascia. Extra caution needed to be taken when fixing ventrally to avoid injuring the urethra. Once completed, the dartos fascia was restored, the dartos fascia and subcutaneous tissue were sutured with 4-0 absorbable suture, and skin closure is achieved subsequently.

Results:

The post-operative course was without complications. At the follow-up after 1 year, the mean flaccid girth increased to 8.07 ± 1.06 cm ( P < .05), while the mean erect girth increased to 12.79 ± 1.23 cm ( P < .05). Sexual activity was allowed after 8 weeks of surgery. The majority reported that sexual self-esteem and functioning significantly improved. In addition, 59 patients reported alleviation of premature ejaculation.

Conclusions:

Compared to autologous dermis-fat graft and xenograft, augmentation phalloplasty using human acellular dermal matrix has several advantages: (1) it avoids harm harvesting site of the autograft; (2) the effects of dermis allograft can last at least 1 year; and (3) acellular dermal matrix is more likely to be accepted by people.
Women and Partners’ Information Need, Emotional Adjustment, and Breast Reconstruction Decision-Making Before Mastectomy
Authors: Lamore Kristopher , Flahault Cécile , Untas Aurélie
Published: June 2020

Objective:

Our aim was to explore the differences between women and their partners on information need, emotional adjustment, and breast reconstruction (BR) decision-making after breast cancer diagnosis. A second aim was to explore these differences regarding surgery type (mastectomy vs immediate BR).

Methods:

Women newly diagnosed with a first nonmetastatic breast cancer and having a mastectomy were invited to fill out online questionnaires, in conjunction with their partners, before mastectomy. Questionnaires assessed their information need (Patient Information Need Questionnaire), emotional adjustment (Profile of Mood States), motivations to have BR or not, shared decision-making (Shared Decision-Making Questionnaire), and partner influence in BR decision-making.

Results:

Thirty (15 women and their partners) people took part in the study. Women and partners had similar levels of information need, emotional adjustment, and shared decision-making. However, partners did not entirely perceive why BR is wished or not by the women. Furthermore, partners of women having a mastectomy alone had higher scores of mood disturbance and a greater need for information, compared to partners of women having an immediate BR ( P < .05). Likewise, men expressed a greater need for disease-oriented information than their loved ones ( P < .05).

Conclusions:

This is the first study to highlight differences in couples’ experiences of breast cancer diagnosis and BR decision-making before mastectomy. Partners express an important need for information and do not entirely perceive why BR is wished or not by their loved ones. An online tool providing information to both women and partners could help them in breast cancer care pathway and BR decision-making.
Investing the Time: Group Differences in Cultural Capital Development Among U.S. Adolescents
Authors: Hwang Karam
Published: June 2020

This study examines the extent of class and racial inequalities in cultural capital development among recent adolescent cohorts in the United States. Informed by several decades of cultural capital research, I compare participation in four dimensions of cultural capital proposed by prior scholarship—highbrow consumption, omnivorous consumption, technical capacity, and social competence—by using nationally representative time-diary data to test for group differences in time-use patterns. Time investment has been long theorized but seldom tested as the means through which individuals develop cultural capital. Activities associated with technical capacity appear to have the greatest potential as the bases for both class and racial exclusions, as group differences are evident in both the prevalence and duration of participation. Smaller race and class differences are evident for omnivorous consumption, and low participation in highbrow activities is evident across all groups. Distinct patterns of time-use among Asian American adolescents suggest they are simultaneously advantaged and disadvantaged in their cultural capital acquisition, speaking to debates regarding their relative status in the United States.
An Analysis of the Perception of Psoriasis Symptoms and the Impact on Willingness to Seek Medical Attention
Authors: Bray Jeremy K. , Feldman Steven R.
Published: June 2020

Background:

Most people with psoriasis do not have a medical visit for psoriasis within a given year.

Objective:

To assess individuals’ perceptions of the impact of psoriasis symptoms and how this impact affects willingness to seek medical attention.

Methods:

A total of 302 subjects with self-reported psoriasis were recruited through Amazon Mechanical Turk and surveyed via Qualtrics to assess the impact of psoriasis on their daily lives and willingness to seek medical care. Comparisons were made between subjects presented with either an image of mild psoriasis or severe psoriasis. Outcome measures were evaluated on a 10-point Likert scale and compared using 1-way analysis of variance and 2-group t tests.

Results:

In the mild and severe psoriasis groups, those who rated the impact on their daily life ≥8 (1-10 scale) reported a greater willingness to seek medical attention for their psoriasis ( M = 9.1, SD = 1.5) compared to those who rated the impact between 6 and 7 ( M = 7.5, SD = 1.9, P < .01) and between 1 and 5 ( M = 6.4, SD = 2.4, P < .01). Those who rated the impact between 6 and 7 ( M = 7.5, SD = 1.9) reported a greater willingness to seek medical attention compared to those who rated the impact between 1 and 5 ( M = 6.4, SD = 2.4, P < .01).

Conclusion:

Patients with psoriasis may not visit a dermatologist in part due to not viewing their symptoms as severe enough to seek medical attention.
Playing the Bullshit Game: How Empty and Misleading Communication Takes Over Organizations
Authors: Spicer André
Published: June 2020

Why is bullshit so common in some organizations? Existing explanations focus on the characteristics of bullshitters, the nature of the audience, and social structural factors which encourage bullshitting. In this paper, I offer an alternative explanation: bullshitting is a social practice that organizational members engage with to become part of a speech community, to get things done in that community, and to reinforce their identity. When the practice of bullshitting works, it can gradually expand from a small group to take over an entire organization and industry. When bullshitting backfires, previously sacred concepts can become seen as empty and misleading talk.
The effect of Ti on the microstructure and mechanical properties of (Ti + Mg3Sb2)/Mg composites
Authors: Li Bo , Long Wei , Zhou Xiaoping
Published: June 2020

In the present research work, (titanium (Ti) + magnesium antimonide (Mg3Sb2)/magnesium (Mg) composites with Ti contents of 0, 5%, 10%, and 15% (mass fraction, %) were fabricated by powder metallurgy. The effect of different Ti contents on the microstructure and mechanical properties of (Ti + Mg3Sb2)/Mg composites was investigated. The results show that the volume of Mg3Sb2 compounds can be significantly refined and the distribution uniformity of Mg3Sb2 compounds can be improved by adding an appropriate amount of Ti. Part of Sb reacts with Ti in situ to form TiSb2 compounds at the periphery of Ti particles. However, the reaction is not sufficient, and there is still the remaining Ti distribution in composites. Both Ti particles and TiSb2 compounds form (Ti + TiSb2) microstructures, which have different degrees of agglomeration with the increase of Ti contents in composites. The appropriate amount of Ti can improve the mechanical properties of the composite, but excessive Ti can reduce the tensile strength of the composite.
Comparing low-molecular-weight heparin dosing for treatment of venous thromboembolism in patients with obesity (RIETE registry)
Authors: Mirza Reza , Nieuwlaat Robby , López-Núñez Juan J. , Barba Raquel , Agarwal Arnav , Font Carme , Ciammaichella Maurizio , Grandone Elvira , Ikesaka Rick , Crowther Mark , Monreal Manuel ,   the RIETE Investigators
Published: June 2020

Because of the absence of comparative evidence, current guidelines and product monographs diverge in the dosing of low-molecular-weight heparin (LMWH) for obese patients with venous thromboembolism (VTE). We used the RIETE registry to compare the primary composite outcomes (VTE recurrence, major bleeding, or death) in patients with VTE who weighed >100 kg during LMWH therapy with capped doses of LMWH (18 000 IU/d) vs uncapped doses (>18 000 IU/d). Multivariable logistic regression analysis was used to account for possible confounders. A total of 2846 patients who weighed >100 kg were included: 454 (16%) received capped doses of LMWH, and the remaining 2392 received uncapped doses. Mean (standard deviation) LMWH treatment duration was 14.8 (20.6) and 14.3 (32.3) days, respectively. Thirty-one patients (1.9%) had VTE recurrences, 38 (1.3%) had bleeding episodes, 65 (2.3%) died, and 122 (4.3%) had at least 1 of the composite outcomes. Unadjusted outcome rates revealed that capped dosing was associated with a decrease in the composite outcome (rate ratio, 0.22; 95% confidence interval [CI], 0.04-0.75). Multivariable analysis confirmed that patients who received capped doses had significantly lower rates of the composite outcome (odds ratio, 0.16; 95% CI, 0.04-0.68) while receiving LMWH. These retrospective observational data suggest that capped dosing of LMWH is an acceptable alternative to uncapped dosing based on body weight, given the significantly lower composite event rate of VTE recurrence, major bleeding, and all-cause death.
Sputum neutrophil elastase associates with microbiota andPseudomonas aeruginosain bronchiectasis
Authors: Oriano Martina , Gramegna Andrea , Terranova Leonardo , Sotgiu Giovanni , Sulaiman Imran , Ruggiero Luca , Saderi Laura , Wu Benjamin , Chalmers James D. , Segal Leopoldo N. , Marchisio Paola , Blasi Francesco , Aliberti Stefano
Published: June 2020

Introduction

Neutrophilic inflammation is a major driver of bronchiectasis pathophysiology, and neutrophil elastase activity is the most promising biomarker evaluated in sputum to date. How active neutrophil elastase correlates with the lung microbiome in bronchiectasis is still unexplored. We aimed to understand whether active neutrophil elastase is associated with low microbial diversity and distinct microbiome characteristics.

Methods

An observational, cross-sectional study was conducted at the bronchiectasis programme of the Policlinico Hospital in Milan, Italy, where adults with bronchiectasis were enrolled between March 2017 and March 2019. Active neutrophil elastase was measured on sputum collected during stable state, microbiota analysed through 16S rRNA gene sequencing, molecular assessment of respiratory pathogens carried out through real-time PCR and clinical data collected.

Results

Among 185 patients enrolled, decreasing α-diversity, evaluated through the Shannon entropy (ρ −0.37, p<0.00001) and Pielou's evenness (ρ −0.36, p<0.00001) and richness (ρ −0.33, p<0.00001), was significantly correlated with increasing elastase. A significant difference in median levels of Shannon entropy as detected between patients with neutrophil elastase ≥20 µg·mL−1(median 3.82, interquartile range 2.20–4.96)versusneutrophil elastase <20 µg·mL−1(4.88, 3.68–5.80; p<0.0001). A distinct microbiome was found in these two groups, mainly characterised by enrichment withPseudomonasin the high-elastase group and withStreptococcusin the low-elastase group. Further confirmation of the association ofPseudomonas aeruginosawith elevated active neutrophil elastase was found based on standard culture and targeted real-time PCR.

Conclusions

High levels of active neutrophil elastase are associated to low microbiome diversity and specifically toP. aeruginosainfection.
Correction to: Genome-wide SNP data unveils the globalization of domesticated pigs
Authors: Yang Bin , Cui Leilei , Perez-Enciso Miguel , Traspov Aleksei , Crooijmans Richard P. M. A. , Zinovieva Natalia , Schook Lawrence B. , Archibald Alan , Gatphayak Kesinee , Knorr Christophe , Triantafyllidis Alex , Alexandri Panoraia , Semiadi Gono , Hanotte Olivier , Dias Deodália , Dovč Peter , Uimari Pekka , Iacolina Laura , Scandura Massimo , Groenen Martien A. M. , Huang Lusheng , Megens Hendrik-Jan
Published: June 2020

An amendment to this paper has been published and can be accessed via the original article.
The impact of time from injury to surgery in functional recovery of traumatic acute subdural hematoma
Authors: Chen Shih-Han , Sun Jui-Ming , Fang Wen-Kuei
Published: June 2020

Background

The time from injury to surgery (TIS) is critical in the functional recovery of individuals with traumatic acute subdural hematoma (TASDH). However, only few studies have confirmed such notion.

Methods

The data of TASDH patients who were surgically treated in Chia-Yi Christian Hospital between January 2008 and December 2015 were collected. The significance of variables, including age, sex, traumatic mechanism, coma scale, midline shift on brain computed tomography (CT) scan, and TIS, in functional recovery was assessed using the student’s t-test, Mann-Whitney U test, chi-square test, univariate and multivariate models, and receiver operating characteristic (ROC) curve.

Results

A total of 37 patients achieved functional recovery (outcome scale score of 4 or 5) and 33 patients had poor recovery (outcome scale score of 1–3) after at least 1 year of follow-up. No significant difference was observed in terms of age, sex, coma scale score, traumatic mechanism, or midline shift on brain CT scan between the functional and poor recovery groups. TIS was found to be significantly shorter in the functional recovery group than in the poor recovery group (145.5 ± 27.0 vs. 181.9 ± 54.5 min, P-value = 0.002). TIS was a significant factor for functional outcomes in the univariate and multivariate regression models. The analysis of TIS with the ROC curve between these two groups showed that the threshold time for functional recovery in comatose patients and those with TASDH who were surgically treated was 2 h and 57.5 min.

Conclusions

TIS is an important factor l for the functional recovery of comatose TASDH patients who underwent surgery.
Polycystic subdural hygroma associated with immunoglobulin G4-related intracranial hypertrophic pachymeningitis: a case report
Authors: Ota Kazumichi , Nakazato Yoshihiko , Okuda Risa , Yokoyama Ryu , Kawasaki Hitoshi , Tamura Naotoshi , Yamamoto Toshimasa
Published: June 2020

Background

Recent studies have examined hypertrophic pachymeningitis as an IgG4-RD. However, there are no reports of immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis with polycystic subdural hygroma.

Case presentation

A 56-year-old man presented to the hospital with complaints of a persistent, pulsatile, occipital headache and general malaise. Magnetic resonance imaging of the brain revealed hypertrophic pachymeningitis with polycystic subdural hygroma and hematoma. Based on the dural biopsy findings and exclusion of other diseases, the patient was diagnosed with immunoglobulin G4 (IgG4)-related hypertrophic pachymeningitis. IgG4-related diseases may cause subdural hygroma more commonly than other diseases that cause hypertrophic pachymeningitis.

Conclusions

This is the first case report discussing polycystic subdural hygroma and hematoma with IgG4-related hypertrophic pachymeningitis.
Outcomes and potential mechanism of a protocol to optimize foot orthoses in patients with rheumatoid arthritis
Authors: Tenten-Diepenmaat Marloes , Dekker Joost , Twisk Jos W. R. , Huijbrechts Elleke , Roorda Leo D. , van der Leeden Marike
Published: June 2020

Background

Foot problems are highly prevalent in patients with rheumatoid arthritis. Treatment of foot problems related to rheumatoid arthritis often consists of custom made foot orthoses. One of the assumed working mechanisms of foot orthoses is redistribution of plantar pressure by creating a larger weight bearing area. Overall, the reported treatment effect of foot orthoses on foot pain in rheumatoid arthritis is small to medium. Therefore, we developed a foot orthoses optimization protocol for evaluation and adaptation of foot orthoses by using the feedback of in-shoe plantar pressure measurements. The objectives of the present study were: 1) to evaluate the 3-months outcomes of foot orthoses developed according to the protocol on pain, physical functioning and forefoot plantar pressure in patients with foot problems related to rheumatoid arthritis, and 2) to determine the relationship between change in forefoot plantar pressure and change in pain and physical functioning.

Methods

Forty-five patients with foot problems related to rheumatoid arthritis were included and received foot orthoses developed according to the protocol. Outcome measures were assessed at baseline and after three months of wearing foot orthoses in 38 patients. Change scores and effect sizes (ES) were calculated for pain, physical functioning and plantar pressure. In a subgroup of patients with combined forefoot pain and high plantar pressure, the relationship between change in plantar pressure and change in pain and physical functioning was analyzed.

Results

In the total group of 38 patients, statistically significant changes in pain (ES 0.69), physical functioning (ES 0.82) and forefoot plantar pressure (ES 0.35) were found. In the subgroup (n = 23) no statistically significant relationships were found between change in plantar pressure and change in pain or physical functioning.

Conclusion

Foot orthoses developed according to a protocol for improving the plantar pressure redistribution properties lead to medium to large improvements in pain and physical functioning. The hypothesis that more pressure reduction would lead to better clinical outcomes could not be proven.
Follow-up after surgical treatment for intermittent claudication (FASTIC): a study protocol for a multicentre randomised controlled clinical trial
Authors: Haile Sara , Linné Anneli , Johansson Unn-Britt , Joelsson-Alm Eva
Published: June 2020

Background

Intermittent claudication (IC) is a classic symptom of peripheral arterial disease, and strongly associated with coronary heart disease and cerebrovascular disease. Treatment of IC and secondary prevention of vascular events include best medical treatment (BMT), changes in lifestyle, most importantly smoking cessation and increased physical exercise, and in appropriate cases surgery. A person-centred and health promotion approach might facilitate breaking barriers to lifestyle changes and increasing adherence to secondary prevention therapy. The FASTIC study aims to evaluate a nurse-led, person-centred, health-promoting follow-up programme compared with standard follow-up by a vascular surgeon after surgical treatment for IC.

Methods

The FASTIC-study is a multicentre randomised controlled clinical trial. Patients will be recruited from two hospitals in Stockholm, Sweden after surgical treatment of IC through open and/or endovascular revascularisation and will be randomly assigned into two groups. The intervention group is offered a nurse-led, person-centred, health-promoting programme, which includes two telephone calls and three visits to a vascular nurse the first year after surgical treatment. The control group is offered standard care, which consists of a visit to a vascular surgeon 4–8 weeks after surgery and a visit to the outpatient clinic 1 year after surgical treatment. The primary outcome is adherence to BMT 1 year after surgical treatment and will be measured using The Swedish Prescribed Drug Registry. Clinical assessments, biomarkers, and questionnaires will be used to evaluate several secondary outcomes, such as predicted 10-year risk of cardiovascular and cerebrovascular events, health-related quality of life, and patients’ perceptions of care quality.

Discussion

The FASTIC study will provide important information about interventions aimed at improving adherence to medication, which is an unexplored field among patients with IC. The study will also contribute to knowledge on how to implement person-centred care in a clinical context.

Trial registration

ClinicalTrials.govNCT03283358, registration date 06/13/2016.
The role of testosterone in chronic kidney disease and kidney function in men and women: a bi-directional Mendelian randomization study in the UK Biobank
Authors: Zhao Jie V. , Schooling C. Mary
Published: June 2020

Background

Chronic kidney disease (CKD) has an apparent sex disparity, with a more rapid progress in men than in women. Whether the well-established sex-specific evolutionary biology trade-off between reproduction and longevity might inform CKD has not previously been considered. Relevant evidence from randomized controlled trials (RCTs) is not available.

Methods

We used a bi-directional Mendelian randomization study to obtain unconfounded estimates using the UK Biobank. Single nucleotide polymorphisms (SNPs) that strongly (p value < 5 × 10−8) predicted testosterone in a sex-specific manner were applied to 179,916 white British men (6016 CKD cases) and 212,079 white British women (5958 CKD cases) to obtain sex-specific associations with CKD, albuminuria, and estimated glomerular filtration rate (eGFR). We also used multivariable MR to control for sex hormone binding globulin (SHBG). For validation, we similarly examined their role in hemoglobin and high-density lipoprotein cholesterol (HDL-c). We also assessed the role of kidney function in serum testosterone, by applying eGFR-related SNPs to testosterone in the UK Biobank.

Results

Genetically predicted testosterone was associated with CKD in men (odds ratio (OR) for bioavailable testosterone 1.17 per standard deviation, 95% confidence interval (CI) 1.03 to 1.33) based on 125 SNPs but not in women (OR 1.02, 95% CI 0.92 to 1.14 for total testosterone) based on 254 SNPs. Multivariable MR allowing for SHBG showed consistent patterns. Genetically predicted bioavailable testosterone in men and women and genetically predicted total testosterone in women increased hemoglobin and lowered HDL-c, as seen in RCTs. Genetically predicted eGFR was not related to serum testosterone in men or in women.

Conclusions

Genetically predicted testosterone was associated with CKD and worse kidney function in men, whilst not affected by kidney function. Identifying drivers of testosterone and the underlying pathways could provide new insights into CKD prevention and treatment.
Alogliptin after acute coronary syndrome in patients with type 2 diabetes: a renal function stratified analysis of the EXAMINE trial
Authors: Ferreira João Pedro , Mehta Cyrus , Sharma Abhinav , Nissen Steven E. , Rossignol Patrick , Zannad Faiez
Published: June 2020

Background

The EXAMINE trial tested the efficacy and safety of alogliptin, an inhibitor of dipeptidyl peptidase 4, compared with placebo in 5380 patients with type 2 diabetes and a recent acute coronary syndrome. Because alogliptin is cleared by the kidney, patients were stratified according to screening renal function within two independently randomized strata: (1) estimated glomerular filtration rate (eGFR) ≥ 60 ml/min/1.73m2 and (2) eGFR < 60 ml/min/1.73m2. We aim to assess the efficacy and safety of alogliptin vs. placebo according to the renal function strata.

Methods

Cox-proportional hazard models with an interaction term by renal function strata were used. The primary endpoint was a composite of cardiovascular death, nonfatal myocardial infarction (MI), or nonfatal stroke.

Results

Patient characteristics were balanced within each renal function strata. In total, 3946 patients were randomized within the eGFR ≥ 60 stratum, and 1434 patients within the eGFR < 60 stratum. The effect of alogliptin was modified by the renal function strata. Primary outcome: eGFR ≥ 60 HR = 0.81, 95%CI, 0.65–0.99, and eGFR < 60 HR = 1.20, 95%CI, 0.95–1.53; interactionp = 0.014. Cardiovascular death: eGFR ≥ 60 HR = 0.61, 95%CI, 0.42–0.88, and eGFR < 60 HR = 1.16, 95%CI, 0.82–1.65; interactionp = 0.013. Non-fatal MI: eGFR ≥ 60 HR = 0.86, 95%CI, 0.66–1.13, and eGFR < 60 HR = 1.48, 95%CI, 1.07–2.06; interactionp = 0.013.

Conclusions

Alogliptin may benefit patients with eGFR ≥ 60, but may be detrimental to patients with eGFR < 60 ml/min/1.73m2. These hypothesis-generating findings require further validation to assess the potential benefit and risk of alogliptin across the renal function spectrum among patients with type 2 diabetes and a recent acute coronary syndrome.

Trial registration

ClinicalTrials.gov, NCT00968708
Seven-day services in surgery and the “weekend effect” at a Japanese teaching hospital: a retrospective cohort study
Authors: Matoba Masaaki , Suzuki Takashi , Ochiai Hirotaka , Shirasawa Takako , Yoshimoto Takahiko , Minoura Akira , Sano Hitomi , Ishii Mizue , Kokaze Akatsuki , Otake Hiroshi , Kasama Tsuyoshi , Kamijo Yumi
Published: June 2020

Background

Hospitals deliver 24-h, 7-day care on a 5-day workweek model, as fewer resources are available on weekends. In prior studies, poorer outcomes have been observed with weekend admission or surgery. The purpose of this study was to investigate the effect of 7-day service at a hospital, including outpatient consultations, diagnostic examinations and elective surgeries, on the likelihood of the “weekend effect” in surgery.

Methods

This was a retrospective cohort study of patients who underwent surgery between April 2014 and October 2016 at an academic medical centre in Tokyo, Japan. The main outcome measure was 30-day in-hospital mortality from the index surgery. The characteristics of the participants were compared using the Mann–Whitney U test or the chi-squared test as appropriate. Logistic regression was used to test for differences in the mortality rate between the two groups, and propensity score adjustments were made.

Results

A total of 7442 surgeries were identified, of which, 1386 (19%) took place on the weekend. Of the 947 emergency surgeries, 25% (235) were performed on the weekend. The mortality following emergency weekday surgery was 21‰ (15/712), compared with 55‰ (13/235) following weekend surgery. Of the 6495 elective surgeries, 18% (1151) were performed on the weekend. The mortality following elective weekday surgery was 2.3‰ (12/5344), compared with 0.87‰ (1/1151) following weekend surgery. After adjustment, weekend surgeries were associated with an increased risk of death, especially in the emergency setting (emergency odds ratio: 2.7, 95% confidence interval: 1.2–6.5 vs. elective odds ratio: 0.4, 95% confidence interval: 0.05–3.2).

Conclusions

Patients undergoing emergency surgery on the weekend had higher 30-day mortality, but showed no difference in elective surgery mortality. These findings have potential implications for health administrators and policy makers who may try to restructure the hospital workweek or consider weekend elective surgery.
The clinical and cost effectiveness of surgical interventions for stones in the lower pole of the kidney: the percutaneous nephrolithotomy, flexible ureterorenoscopy and extracorporeal shockwave lithotripsy for lower pole kidney stones randomised controlled trial (PUrE RCT) protocol
Authors: McClinton Sam , Starr Kathryn , Thomas Ruth , MacLennan Graeme , Lam Thomas , Hernandez Rodolfo , Pickard Robert , Anson Ken , Clark Terry , MacLennan Steven , Thomas David , Smith Daron , Turney Ben , McDonald Alison , Cameron Sarah , Wiseman Oliver
Published: June 2020

Introduction

Renal stones are common, with a lifetime prevalence of 10% in adults. Global incidence is increasing due to increases in obesity and diabetes, with these patient populations being more likely to suffer renal stone disease. Flank pain from stones (renal colic) is the most common cause of emergency admission to UK urology departments. Stones most commonly develop in the lower pole of the kidney (in ~35% of cases) and here are least likely to pass without intervention. Currently there are three technologies available within the UK National Health Service to remove lower pole kidney stones: extracorporeal shockwave lithotripsy (ESWL), percutaneous nephrolithotomy (PCNL) and flexible ureterorenoscopy (FURS) with laser lithotripsy. Current evidence indicates there is uncertainty regarding the management of lower pole stones, and each treatment has advantages and disadvantages. The aim of this trial is to determine the clinical and cost effectiveness of FURS compared with ESWL or PCNL in the treatment of lower pole kidney stones.

Methods

The PUrE (PCNL, FURS and ESWL for lower pole kidney stones) trial is a multi-centre, randomised controlled trial (RCT) evaluating FURS versus ESWL or PCNL for lower pole kidney stones. Patients aged ≥16 years with a stone(s) in the lower pole of either kidney confirmed by non-contrast computed tomography of the kidney, ureter and bladder (CTKUB) and requiring treatment for a stone ≤10 mm will be randomised to receive FURS or ESWL (RCT1), and those requiring treatment for a stone >10 mm to ≤25 mm will be randomised to receive FURS or PCNL (RCT2). Participants will undergo follow-up by questionnaires every week up to 12 weeks post-intervention and at 12 months post-randomisation. The primary clinical outcome is health status measured by the area under the curve calculated from multiple measurements of the EuroQol five dimensions five-level version (EQ-5D-5L) questionnaire up to 12 weeks post-intervention. The primary economic outcome is the incremental cost per quality-adjusted life year gained at 12 months post-randomisation.

Discussion

The PUrE trial aims to provide robust evidence on health status, quality of life, clinical outcomes and resource use to directly inform choice and National Health Service provision of the three treatment options.

Trial registration

ISRCTN: ISRCTN98970319. Registered on 11 November 2015.
Immediate and long-term consequences of COVID-19 infections for the development of neurological disease
Authors: Heneka Michael T. , Golenbock Douglas , Latz Eicke , Morgan Dave , Brown Robert
Published: June 2020

Increasing evidence suggests that infection with Sars-CoV-2 causes neurological deficits in a substantial proportion of affected patients. While these symptoms arise acutely during the course of infection, less is known about the possible long-term consequences for the brain. Severely affected COVID-19 cases experience high levels of proinflammatory cytokines and acute respiratory dysfunction and often require assisted ventilation. All these factors have been suggested to cause cognitive decline. Pathogenetically, this may result from direct negative effects of the immune reaction, acceleration or aggravation of pre-existing cognitive deficits, or de novo induction of a neurodegenerative disease. This article summarizes the current understanding of neurological symptoms of COVID-19 and hypothesizes that affected patients may be at higher risk of developing cognitive decline after overcoming the primary COVID-19 infection. A structured prospective evaluation should analyze the likelihood, time course, and severity of cognitive impairment following the COVID-19 pandemic.
COVID-19 preclinical models: human angiotensin-converting enzyme 2 transgenic mice
Authors: Lutz Cathleen , Maher Leigh , Lee Charles , Kang Wonyoung
Published: June 2020

Coronavirus disease 2019 (COVID-19) is a declared pandemic that is spreading all over the world at a dreadfully fast rate. Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), the pathogen of COVID-19, infects the human body using angiotensin-converting enzyme 2 (ACE2) as a receptor identical to the severe acute respiratory syndrome (SARS) pandemic that occurred in 2002–2003. SARS-CoV-2 has a higher binding affinity to human ACE2 than to that of other species. Animal models that mimic the human disease are highly essential to develop therapeutics and vaccines against COVID-19. Here, we review transgenic mice that express human ACE2 in the airway and other epithelia and have shown to develop a rapidly lethal infection after intranasal inoculation with SARS-CoV, the pathogen of SARS. This literature review aims to present the importance of utilizing the human ACE2 transgenic mouse model to better understand the pathogenesis of COVID-19 and develop both therapeutics and vaccines.
Performance of a high-frequency (180 kHz) acoustic array for tracking juvenile Pacific salmon in the coastal ocean
Authors: Rechisky Erin L. , Porter Aswea D. , Winchell Paul M. , Welch David W.
Published: June 2020

Background

Acoustic telemetry is now a key research tool used to quantify juvenile salmon survival, but transmitter size has limited past studies to larger smolts (> 130 mm fork length). New, smaller, higher-frequency transmitters (“tags”) allow studies on a larger fraction of the smolt size spectrum (> 95 mm); however, detection range and study duration are also reduced, introducing new challenges. The potential cost implications are not trivial. With these new transmitters in mind, we designed, deployed, and tested the performance of a dual-frequency receiver array design in the Discovery Islands region of British Columbia, Canada. We double-tagged 50 juvenile steelhead (Oncorhynchus mykiss) with large 69-kHz tags (VEMCO model V9-1H) and small 180-kHz tags (model V4-1H). The more powerful 69-kHz tags were used to determine fish presence in order to estimate the detection efficiency (DE) of the 180-kHz tags. We then compared the standard error of the survival estimate produced from the tracking data using the two tag types which has important implications for array performance and hypothesis testing in the sea.

Results

Perfect detection of the 69-kHz tags allowed us to determine the DE of the 180-kHz tags. Although the 180-kHz tags began to expire during the study, the estimated DE was acceptable at 76% (SE = 9%) when we include single detections. However, 95% confidence intervals on steelhead survival (64%) were 1.5 × larger for the 180-kHz tags (47–85% vs. 51–77% for 69 kHz) because of the reduced DE.

Conclusions

The array design performed well; however, single detections of the 180-kHz tags indicates that under slightly different circumstances the DE could have been compromised, emphasizing the need to carefully consider the interaction of animal migration characteristics, study design, and tag programming when designing telemetry arrays. To increase DE and improve the precision of 180 kHz-based survival estimates presented here requires either an increase in receiver density, an increase in tag sample size (and modified transmitter programming), or both. The optimal solution depends on transmitter costs, array infrastructure costs, annual maintenance costs, and array use (i.e., contributors). Importantly, the use of smaller tags reduces potential tag burden effects and allows early marine migration studies to be extended to Pacific salmon populations that have been previously impossible to study.
A rare case of epidermal inclusion cyst: an unusual complication of ear surgery
Authors: Mogre Dilesh A. , Ahmed M. D. Fazal , Banu T. Parvathi
Published: June 2020

Background

Epidermal inclusion cysts are common tumours of the hand in industrial workers caused by entrapment of epidermal elements within the dermis. They are unusual in the head and neck region more so in the temporal region.

Case presentation

We present a 27-year-old man with a 3-month history of a slow-growing swelling in the left temporal region. He had a history of chronic otitis media and underwent an end-aural tympanomastoid surgery 5 years earlier. Physical examination revealed a 5 × 3 × 2.5 cm cystic globular minimally tender mass in the temporal fossa along with squamous active otitis media with bony erosion of the outer attic wall. High-resolution computed tomography of the left temporal bone revealed otomastoiditis with erosion of the scutum; ossicles were not identified. We hereby describe the diagnostic challenge and the plan of management of this lesion.

Conclusions

Epidermal inclusion cyst must be considered in the differential diagnosis of temporal fossa lesions especially in patients with a prior history of ipsilateral tympanomastoid surgery.
The developed Arabic version of the Hearing Handicap Inventory for the Elderly
Authors: Ismail N. , Shalaby A. , Behairy R , Khodary H. , Ashraf M.
Published: June 2020

Background

Hearing impairment ranks third on the list of chronic health conditions of the elderly, after arthritis and hypertension. As average lifespans increase, it is likely that the proportion of people with hearing loss will also increase. The purpose of the study was to develop, standardize, and apply an Arabic version of the Hearing Handicap Inventory for the Elderly (HHIE).

Results

The mean age of the 100 subjects included in the pretest was 64.92 ± 5.937 with age ranged from 60 to 84 years. The average score for each item (simple, clear, and relevant) for each separate question obtained more than 80% which is considered valid. One hundred percent of the participants reported that the entire inventory appeared simple, clear, and relevant, we further implied the jury opinion; the total score average of our jury for the entire inventory was calculated to determine the face validity of the questionnaire and found to be 89.81%. Responses of all participants for each question were collected and showed questions 8, 21, 6, 7, and 14 obtained the highest response results for both yes and sometimes. The HHIE showed high reliability (p value < 0.001) for all questions. The demographic data of the forty participants showed no statistically significant difference between the complaining group of hearing loss and the non-complaining group as regards age and gender. There was a highly statistically significant difference between the complaining group and the non-complaining group regarding the HHIE. The sensitivity of the HHIE was 79% for severe auditory handicapping and only 24% for mild-to-moderate auditory handicapping.

Conclusion

The developed Arabic version of the HHIE has high reliability, validity, simplicity, and clarity which found consistent with the original English questionnaire and it performed well in the detection of hearing loss in elderly Egyptians. It can be applied in a large population and for use in surveys.
A trimeric metazoan Rab7 GEF complex is crucial for endocytosis and scavenger function
Authors: Dehnen Lena , Janz Maren , Verma Jitender Kumar , Psathaki Olympia Ekaterini , Langemeyer Lars , Fröhlich Florian , Heinisch Jürgen J. , Meyer Heiko , Ungermann Christian , Paululat Achim
Published: June 2020

Endosome biogenesis in eukaryotic cells is critical for nutrient uptake and plasma membrane integrity. Early endosomes initially contain Rab5, which is replaced by Rab7 on late endosomes prior to their fusion with lysosomes. Recruitment of Rab7 to endosomes requires the Mon1–Ccz1 guanine-nucleotide-exchange factor (GEF). Here, we show that full function of the Drosophila Mon1–Ccz1 complex requires a third stoichiometric subunit, termed Bulli (encoded by CG8270). Bulli localises to Rab7-positive endosomes, in agreement with its function in the GEF complex. Using Drosophila nephrocytes as a model system, we observe that absence of Bulli results in (i) reduced endocytosis, (ii) Rab5 accumulation within non-acidified enlarged endosomes, (iii) defective Rab7 localisation and (iv) impaired endosomal maturation. Moreover, longevity of animals lacking bulli is affected. Both the Mon1–Ccz1 dimer and a Bulli-containing trimer display Rab7 GEF activity. In summary, this suggests a key role for Bulli in the Rab5 to Rab7 transition during endosomal maturation rather than a direct influence on the GEF activity of Mon1–Ccz1.
Functionalization of Primary C–H Bonds in Picolines toward Pyridylthioamides
Authors: Ho Tuan H , Le Ha H K , To Tuong A , Nguyen Tung T , Phan Nam T S
Published: June 2020

We report a method for coupling of nitroarenes, 2- or 4-methylazaarenes, and elemental sulfur to afford (2-pyridyl)aryl thioamides. Good tolerance of functionalities was observed, including primary and secondary amines, bromo, iodo, ester, and boronic ester groups. Thioamides derived from pyrazole, thiazole, quinoline, quinoxalines, and azoles were obtained in good yields, showing the compatibility of heterocycles. This appears to be a general method to obtain pyridyl thioamides in one step from commercial, simple substrates.
Asymmetric Synthesis of 1-Tetralones Bearing a Remote Quaternary Stereocenter through Rh-Catalyzed C–C Activation of Cyclopentanones
Authors: Ochi Shusuke , Xia Ying , Dong Guangbin
Published: June 2020

Herein, we describe the preparation of 1-tetralones bearing a remote quaternary stereocenter in a highly enantioselective manner. A sequence of Pd-catalyzed asymmetric 1,4-addition and Rh-catalyzed enantiospecific C–C/C–H activation delivers diverse 1-tetralones with a C4 quaternary stereocenter, which are prepared in good overall yields and high enantioselectivity.
Evolution of radiation protection for medical workers
Authors: Boice John , Dauer Lawrence T , Kase Kenneth R. , Mettler Fred A , Vetter Richard J
Published: June 2020

Within a few months of discovery, X-rays were being used worldwide for diagnosis and within a year or two for therapy. It became clear very quickly that while there were immense benefits, there were significant associated hazards, not only for the patients, but also for the operators of the equipment. Simple radiation protection measures were implemented within a decade or two and radiation protection for physicians and other operators has continued to evolve over the last century driven by cycles of widening uses, new technologies, realization of previously unidentified effects, development of recommendations and regulations, along with the rise of related societies and professional organizations. Today, the continue acceleration of medical radiation uses in diagnostic imaging and in therapeutic modalities not imagined at the turn of this century, such as positron emission tomography, calls for constant vigilance and flexibility to provide adequate protection for the growing numbers of medical radiation workers.