bluuebunny/crossref_metadata_2025 huggingface dataset:
Opioid utilization after lower extremity amputation for peripheral vascular disease and discharge prescribing recommendations
Authors: Camazine Maraya N , Rountree Kaitlyn M , Smith Jamie B , Bath Jonathan , Vogel Todd R
Published: May 2022

Objectives

Opioids are commonly used for pain control after lower extremity amputations (LEA)—below the knee amputations (BKA) and above the knee amputations (AKA). Well-defined benchmarks for prescription requirements after amputation are deficient. This analysis evaluated opioid utilization after amputation to identify high-risk patients and provide recommendations for post-hospitalization opioid prescriptions at discharge.

Methods

Patients undergoing LEA (2008–2016) with identified peripheral vascular disease were selected from Cerner’s Health Facts® database using ICD-9 and 10 diagnosis and procedure codes. Patient demographics, disease severity, comorbidities, and hospital characteristics were evaluated. Post-operative opioid medications administered intravenously and orally during the hospital stay were identified from the data and converted to Morphine Milligram Equivalent per day (MME/d) for an evaluation and comparison during the index hospitalization. Descriptive statistics were used to report continuous and dichotomous variables. Dichotomous variables are reported as n (%) and continuous variables are reported as mean ± standard deviation (SD). Chi-square and T-tests were used as appropriate.

Results

2399 patients who underwent AKA or BKA with peripheral vascular disease were evaluated. Sixty-three percent of the cohort was male, 67% Caucasian, and 42% married, and 58% had a Charlson index >3. The majority of patients had an average length of hospital stay of 5.7 days (M = 5.72, SD = 4.56). Patient groups that used significantly higher MME/d in the early postop period included: BKA (29.2 vs 20.7, p = 0.006), males (62.6 vs 54.0, p < 0.0001), Caucasians (64.3 vs 44.7, p < 0.0001), younger patients (69.6 vs 54.0, p < 0.0001), and those at non-training institutions (66.7 vs 56.7, p < 0.0001). Patients whose hospital stay was greater than 6 days were found to have increased opioid utilization likely secondary to index complications. For those discharged by post-operative day 7, the mean MME utilized on postop day 1 was 59.5 and decreased to a mean MME/d utilization prior to discharge of 17.6.

Conclusions

This analysis demonstrates that younger patients, males, patients with BKAs, and those who receive amputations for vascular disease at non-training institutions have higher post-operative opioid utilization during the hospital stay. At the time of discharge, patients utilized an average of 17.6 MME/d which equates to approximately three hydrocodone/acetaminophen 5/325 mg tablets per day. Based on these findings, vascular surgeons are likely over prescribing opioids at discharge and must be cognizant of appropriate dosing quantities. Prescriptions at discharge should reflect the daily utilization described from this analysis and tapered to avoid chronic utilization, overdose, and possible death.
A narrative review of biparametric MRI (bpMRI) implementation on screening, detection, and the overall accuracy for prostate cancer
Authors: Greenberg Jacob W. , Koller Christopher R. , Casado Crystal , Triche Benjamin L. , Krane L. Spencer
Published: May 2022

Prostate cancer is the most common malignancy in American men following skin cancer, with approximately one in eight men being diagnosed during their lifetime. Over the past several decades, the treatment of prostate cancer has evolved rapidly, so too has screening. Since the mid-2010s, magnetic resonance imaging (MRI)–guided biopsies or ‘targeted biopsies’ has been a rapidly growing topic of clinical research within the field of urologic oncology. The aim of this publication is to provide a review of biparametric MRI (bpMRI) utilization for the diagnosis of prostate cancer and a comparison to multiparametric MRI (mpMRI). Through single-centered studies and meta-analysis across all identified pertinent published literature, bpMRI is an effective tool for the screening and diagnosis of prostate cancer. When compared with the diagnostic accuracy of mpMRI, bpMRI identifies prostate cancer at comparable rates. In addition, when omitting dynamic contrast-enhanced (DCE) protocol to the MRI, patients incur reduced costs and shorter imaging time while providers can offer more tests to their patient population.
Metastatic prostate carcinoma presenting as a gluteal soft tissue mass
Authors: John Jeff , Mngqi Noma , Aldera Alessandro Pietro
Published: May 2022

Metastatic lesions from prostate adenocarcinoma to the bone and lymph nodes and less frequently to the lungs, pleura, liver and adrenal glands are well documented. The presence of soft tissue metastases from a prostate adenocarcinoma is extremely rare. We report a case of a 56-year-old male who presented with a 2-year history of a painless buttock mass. MRI showed a well-defined, right gluteal intermuscular soft tissue mass and multifocal hypointense lesions of the pelvic bones and appendicular skeleton suggestive of secondary metastatic disease. Tru-cut biopsy of the gluteal mass demonstrated metastatic adenocarcinoma. Further workup showed an elevated prostate-specific antigen, and acinar adenocarcinoma of the prostate was confirmed on transrectal biopsy of the prostate. Androgen deprivation therapy with long-acting three monthly goserelin and short-term cover with bicalutamide was initiated as was systemic taxane-based chemotherapy. He has shown an excellent PSA response and remains asymptomatic with complete resolution of the size of the gluteal metastasis at the most recent follow-up 9 months later.
Getting past the gatekeeper: Cultural competence, field access and researching gender-based violence – Evidence from four countries
Authors: Miller Paul , Kirkman Gillian , Timmins Susan , Banerjee Rukmini , Panicker Anne , Nelson Kenisha , Jones Adele , Ochen Eric
Published: May 2022

Background: Increasingly researchers are recognising the importance of including the perspectives of children and young people in research and in the development of interventions and innovations, in order to understand children's lives on their own terms. Purpose: This article reflects on the potential risks posed to children and young people in research and the role of gatekeepers in granting access and, in direct field activities, especially where the research could be deemed as ‘sensitive’. Research Design:Using a combined descriptive and autoethnographic research design, questionnaires and reflections were gathered from the field experiences of researchers in four countries (India, Jamaica, Uganda and the UK) conducting research on children's experiences of violence victimisation as part of a gender-based violence prevention project. Data was collected retrospectively and analysed thematically with the aid of QSR NVivo. Results: Based on the five themes that emerged: accessing schools; approach to access; accessing participants; lessons learnt; and advice for other researchers, the overall findings indicate that researching sensitive topics with children and young people is necessarily problematic in order to safeguard them. This is especially the case in contexts where discrimination and stigma relating to certain topics may be a significant barrier to children's participation. Conclusion: Research planning requires attention to gatekeeper power, safeguarding children and young people, and understanding how processes and attitudes concerning the status and rights of children at national and institutional levels might influence the research process.
Outcomes of a residential respite service for homeless people with tuberculosis in London, UK: a cross-sectional study
Authors: Crosby L , Lewer D , Appleby Y , Anderson C , Hayward A , Story A
Published: May 2022

Background:

Many countries are seeking to eliminate tuberculosis (TB), but incidence remains high in socially excluded groups such as people experiencing homelessness. There is limited research into the effectiveness of residential respite services (RRS), which provide accomodation and social and clinical support for homeless people with active TB.

Methods:

We used a register of all cases of TB diagnosed in London between 1 January 2010 and 3 October 2019 to compare characteristics and outcomes of patients treated in an RRS with patients receiving standard care. The primary outcome was successful treatment completion. We used logistic regression to compare likelihood of completing treatment, and simulation to estimate the absolute change in treatment completion resulting from this service.

Results:

A total of 78 homeless patients finished an episode of TB treatment at the RRS. Patients treated in the RRS were more likely than patients treated in standard care to have clinical and social risk factors including drug resistance, history of homelessness, drug or alcohol use, and need for directly observed therapy. After adjusting for these factors, patients treated in the RRS had 2.97 times the odds of completing treatment (95% CI = 1.44–6.96). Treatment ended in failure for 8/78 patients treated in the RRS (10%, 95% CI = 5%–20%). We estimated that in the absence of the RRS, treatment would have ended in failure for 17/78 patients (95% CI = 11–25).

Conclusion:

The residential respite service for homeless TB patients with complex social needs was associated with better treatment outcomes.
Novel suture/suture-anchor fixation versus tension band wiring for olecranon fractures: A systematic review
Authors: Dogramatzis Kostas , Kitridis Dimitrios , Bekoulis Theodosios , Craig Richard
Published: May 2022

Introduction

Tension Band Wiring (TBW) has traditionally been the cornerstone of operative management for simple displaced olecranon fractures but its success is limited by high complication rates, mainly related to metalwork irritation and fixation failure. Over the last twelve years, a number of novel fixation methods not involving metalwork have been described in case series (suture fixation, SF and suture-anchor fixation, SAF) with promising early results. In this systematic review, the outcomes of SF and SAF techniques are presented alongside those for TBW for the treatment of closed olecranon fractures without elbow instability.

Materials and methods

Five databases (Medline, Scholar, Scopus, Prospero and Cochrane) were searched for clinical studies involving TBW/SF/SAF for closed Mayo 1A/1B/2A/2B olecranon fractures from January 2010 onwards. Primary outcomes included overall complication and reoperation rates, as well as the rate of each specific complication. Elbow range of movement, surgeon and patient-reported outcome measures were defined as secondary outcomes.

Results

Eighteen studies were included, nine of which involved SF/SAF (99 patients) and nine TBW (382 patients). SF/SAF techniques were associated with lower rates of fracture/implant displacement (2% versus 9.7%, p = 0.01), implant irritation (1% versus 30.1%, p < 0.001) and overall complications (8% versus 46.1%, p < 0.001) when compared to TBW. Reoperation rates were lower for SF/SAF (3% versus 37.2%, p < 0.001). Total flexion/extension arc achieved was similar (130.16 ± 2.11 versus 129.45 ± 0.93 degrees). On average, patients regained a functional arc of flexion (135.21 ± 4.81 TBW versus 131.32 ± 12.99 SF/SAF) and extension (1.16 ± 7.54 SF/SAF versus 5.76 ± 7.98 TBW).

Conclusion

Current evidence suggests that SF/SAF of simple olecranon fractures is a safe and effective alternative to the current gold standard TBW fixation, with preliminary evidence suggestive of lower complication and reoperation rates. Firm conclusions of equivalence or superiority are not possible based on the current poor quality of literature available. Until the outcomes of high-quality prospective studies are available, patients should be carefully counselled that suture methods remain novel and outcomes should be regularly audited.
Increased Arthrodesis Rates in Charcot Neuroarthropathy Utilizing Distal Tibial Distraction Osteogenesis Principles
Authors: Siddiqui Noman A. , Millonig Kelsey J. , Mayer Brittany E. , Fink Jessica N. , McClure Philip K. , Bibbo Christopher
Published: May 2022

Charcot neuroarthropathy of the hindfoot and ankle poses substantial challenges due to deformity, segmental bone loss, chronic infection, and difficulty with bracing. Hindfoot or ankle arthrodesis is often employed at high rates of complications and nonunion. This study reports 15 consecutive patients with Charcot neuroarthropathy who underwent tibiotalocalcaneal or tibiocalcaneal fusion with simultaneous distal tibial distraction osteogenesis with a mean follow-up period of 20.2 ± 5.66 months. Arthrodesis rate was 93.3% (14 patients) with mean time to fusion of 4.75 ± 3.4 months. One hypertrophic nonunion occurred at the arthrodesis site. Complete consolidation of 4 cortices was achieved at the distraction site in 93.3% of patients (14 patients) with a mean duration to consolidation of 9.8 ± 3.3 months. One patient experienced hypertrophic nonunion at the regeneration site. The authors report a technique to enhance arthrodesis rates in Charcot neuroarthropathy by combining distal tibial distraction osteogenesis with simultaneous tibiotalocalcaneal or tibiocalcaneal arthrodesis for hindfoot fusion and salvage. Distraction osteogenesis supports enhanced vascularity to the arthrodesis site.

Level of Clinical Evidence: Level 4
Religious nationalism, racism, and raza hispánica (“Hispanic race”) in Constantino Bayle’s, S.J. (1882–1953) missiology (A publication history approach)
Authors: Roldán-Figueroa Rady
Published: May 2022

This article focuses on the career of the Jesuit priest, Constantino Bayle, as a historian of Spanish Catholic missions and promoter of state-sponsored arrangements that institutionalized nationalist religious historiography. He encoded religious nationalism and racist categories in academic discourse and terminology, elevating in this way racist assumptions and renewed imperialist aspirations to the level of official historiography. The article traces Bayle’s early career as an Americanista at the Spanish Catholic periodical, Razón y Fe. Bayle was an ardent supporter of Francisco Franco’s military uprising of 1936. He was an apologist for Falange Española who defended its Catholic character. Alongside other Jesuits, he was responsible for forging a Spanish school of missiology that was predicated upon the tenets of Spanish national Catholicism and that was meant to rival analogous Protestant and Roman Catholic historiographic projects. Central to this culturalist endeavor were the notions of Hispanidad and Raza Hispanica.
Completed Surgical Repair of Common Arterial Trunk Type I at 16 Years old Without Pulmonary Protection
Authors: Bui Minh Thanh , Nguyen Khanh
Published: May 2022

We report a successful surgical repair of type I common arterial trunk in a 16-year-old male patient without pulmonary stenosis, nor any previous palliative interventions.
Establishment and Validation of a Nomogram for the Risk of New Vertebral Compression Fractures After Percutaneous Vertebroplasty in Patients With Osteoporotic Vertebral Compression Fractures: A Retrospective Study
Authors: Bian FuCheng , Bian GuangYu , An YongSheng , Wang DaYong , Fang JinHui
Published: May 2022

Purpose

New vertebral compression fractures(NVCFs) after minimally invasive surgery in patients with osteoporotic vertebral compression fracture (OVCF) is a challenging issue worldwide. Predicting the occurrence of NVCFs is key to addressing such questions. Therefore, we aimed to investigate the risk factors for patients who developed NVCFs after undergoing surgical treatment and establish a nomogram model to reduce the occurrence of NVCFs.

Methods

This study is a retrospective analysis that collected the general characteristics and surgical features of patients who underwent surgical treatment at 2 central institutions between January 2017 and December 2020. Patients were divided into training and testing sets based on the presence or absence of NVCFs. Independent risk factors for NVCFs were obtained in the training set of patients, and then a nomogram model was constructed. Internal and external validation of the nomogram model was performed using the consistency index (C index), receiver operating characteristic curve(ROC), calibration curves, and decision curve analysis (DCA).

Results

A total of 562 patients were included in this study. Patients from the first center were used for nomogram construction and internal validation, and patients from the second center were used as an external validation population. Multivariate regression analysis showed that age, Hounsfield unit (Hu) value, cement leakage, and thoracolumbar (TL) junction fracture were independent risk factors for NVCFs after minimally invasive surgery. The C index was .85, and the validation of internal and external validation shows that the predicted values of the established model is in good agreement with the actual values.

Conclusions

In this study, 4 independent risk factors were obtained by regression analysis, and a nomogram model was constructed to guide clinical work. The application of this model can help surgeons to make more accurate judgments to prevent the occurrence of NVCFs.
Use of the Locking Attachment Plate for Internal Fixation of Periprosthetic Femur Fractures
Authors: Wall Bryce , Stambough Jeffrey B , Cherney Steven M. , Mears Simon C
Published: May 2022

Introduction

The locking attachment plate (LAP) can be added to a locking compression plate (LCP) to allow the fixation of locking screws bicortically around a femoral implant. We aimed to examine surgical and fracture characteristics associated with healing for periprosthetic femur fractures (PPFFx) treated with constructs employing LAP fixation. We hypothesize that the addition of an LAP provides stable peri-implant fixation.

Materials &Methods

We retrospectively reviewed a consecutive series of 28 PPFFx surgically treated with LCP-LAP constructs by 4 surgeons from 2015-2020. Fractures were classified and grouped using the Vancouver Classification System and included 12 B1, 2 B2, 11 C fractures, and 3 fractures around other stemmed implants. Primary outcome measures included hardware failure such as screw pullout, broken screws, and plate fracture. Clinical complications including infection, non-union, malunion, and reoperation were recorded.

Results

No LAP failures, screw pullout, or broken screws were observed. Two fractured plates (7.1%) occurred in patients with Vancouver C fracture types. Overall complication rate was 17.9% and included 3 non-unions, 1 deep infection, and 1 implant loosening with painful hardware, each requiring reoperation. Differences were observed between unions and nonunions for total number of screws (12.4 vs 14.7, P = .005) and number of locking screws used (8.04 vs 11.3, P = .03).

Conclusion

The LAP provides adequate fixation and low failure rates where fixation is required around a well-fixed stem. When failures occur, it is from plate breakage and not due to failure of fixation at the area of plate-stem overlap.
Exploring Multilevel Workplace Tobacco Control Interventions: A Scoping Review
Authors: Parkinson Reilly , Jessiman-Perreault Geneviève , Frenette Nicole , Allen Scott Lisa K.
Published: May 2022

Background:

The workplace provides a unique opportunity to intervene on tobacco use, by implementing multilevel interventions engaging diverse employees. Using the social ecological model (SEM), this scoping review aimed to synthesize descriptions of multilevel workplace tobacco control programs to create a health equity informed framework for intervention planning.

Methods:

Multiple databases were searched for articles published from January 2010 to December 2020 meeting inclusion criteria (i.e., discussed multilevel tobacco cessation interventions that intervene, target, or incorporate two or more levels of influence, and one of the levels must be the workplace). Articles were screened by two independent researchers and included if they discussed multilevel tobacco cessation interventions that intervened, targeted, or incorporated two or more levels of influence. To integrate the extracted information into the SEM, we utilized the McLeroy et al. model and definitions to describe potential multilevel interventions and their determinants.

Results:

Nine articles were included in this review. No studies intervened across all five levels (individual, interpersonal, institutional, community, and policy), and the most common levels of intervention were individual (e.g., individual counseling), interpersonal (e.g., group therapy), and institutional (e.g., interventions during work hours). Participation rates varied by key social determinants of health (SDOHs) such as age, gender, education and income. Barriers including cost and sustainability influenced successful implementation, while leadership endorsement and accessibility facilitated successful implementation.

Discussion/Application to Practice:

Multilevel interventions targeting at least two SEM levels may reduce persistent health inequities if they address how SDOHs influence individual health behaviors. Employee characteristics impacted the success of tobacco cessation interventions, but more research is needed to understand the barriers and facilitators related to workplace characteristics.
This Means More: Branded Solidarity at Liverpool’s Soccer Clubs
Authors: Henderson Chris W. , Oates Thomas P.
Published: May 2022

Liverpool’s elite soccer clubs are at once carefully managed global brands and local institutions infused with community values. As billion-dollar companies, Liverpool FC and Everton FC deploy a tactic we call “branded solidarity”: leveraging the historical enactment of leftist politics in the city to appeal to a broader, global audience through value-laden marketing campaigns that frame the clubs as authentic representations of working-class solidarity. By reducing local traditions to marketable symbols of community, the clubs encounter resistance from fans, who periodically place limits on the capitalist endeavors of the clubs. In this paper, we offer a conjunctural analysis that focuses on the tensions and contradictions of branded solidarity through a close reading of each club’s marketing campaigns and discusses how these tensions played a role in the demise of the short-lived European Super League.
Association of Postoperative Lateral Meniscal Extrusion With Cartilage Degeneration on Magnetic Resonance Imaging After Discoid Lateral Meniscus Reshaping Surgery
Authors: Nishino Kazuya , Hashimoto Yusuke , Iida Ken , Nishida Yohei , Yamasaki Shinya , Nakamura Hiroaki
Published: May 2022

Background:

Although arthroscopic reshaping surgery for a discoid lateral meniscus (DLM) has good clinical results, it cannot completely prevent degeneration. The degree of DLM extrusion associated with degenerative changes is unclear.

Purpose/Hypothesis:

To measure meniscal extrusion preoperatively and postoperatively in patients who underwent DLM-reshaping surgery and examine factors associated with knee articular cartilage degeneration. It was hypothesized that meniscal extrusion existed preoperatively, progressed postoperatively, and was related to knee joint degeneration.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

We retrospectively reviewed the medical records of patients who underwent DLM-reshaping surgery and attended ≥2 years of follow-up. Magnetic resonance imaging (MRI) was performed preoperatively and at 24 months postoperatively, and residual midbody meniscal extrusion was measured. Cartilage degeneration was detected when the Whole-Organ Magnetic Resonance Imaging Score (WORMS) of the lateral compartment was grade ≥3 at 2 years postoperatively. Factors associated with MRI cartilage degeneration were evaluated.

Results:

Included in this study were 48 knees in 39 patients; the mean patient age at the time of surgery was 12.0 years. The mean midbody meniscal extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 24 months postoperatively ( P < .001). According to the WORMS cartilage score, 16 patients were categorized as having MRI cartilage degeneration. Multivariate logistic analysis showed that an inferior preoperative Lysholm score (odds ratio, 0.89; P = .024) and postoperative extrusion (odds ratio, 6.18; P = .010) significantly increased the risk of cartilage degeneration. The receiver operating characteristic curve showed that a residual meniscal extrusion of 2.0 mm was the cutoff value indicating cartilage degeneration (sensitivity, 87.5%; specificity, 78.1%).

Conclusion:

DLM extrusion significantly increased from 0.8 mm preoperatively to 1.6 mm at 2 years postoperatively. Postoperative extrusion and a lower preoperative Lysholm score were factors related to MRI cartilage degeneration postoperatively. A postoperative extrusion of 2.0 mm was the cutoff value for MRI cartilage degeneration.
Single-Channel Focused Thresholds Relate to Vowel Identification in Pediatric and Adult Cochlear Implant Listeners
Authors: Arjmandi Meisam K. , Jahn Kelly N. , Arenberg Julie G.
Published: May 2022

Speech recognition outcomes are highly variable among pediatric and adult cochlear implant (CI) listeners. Although there is some evidence that the quality of the electrode-neuron interface (ENI) contributes to this large variability in auditory perception, its relationship with speech outcomes is not well understood. Single-channel auditory detection thresholds measured in response to focused electrical fields (i.e., focused thresholds) are sensitive to properties of ENI quality, including electrode-neuron distance, intracochlear resistance, and neural health. In the present study, focused thresholds and speech perception abilities were assessed in 15 children and 21 adult CI listeners. Focused thresholds were measured for all active electrodes using a fast sweep procedure. Speech perception performance was evaluated by assessing listeners’ ability to identify vowels presented in /h-vowel-d/ context. Consistent with prior literature, focused thresholds were lower for children than for adults, but vowel identification did not differ significantly across age groups. Higher across-array average focused thresholds, which may indicate a relatively poor ENI quality, were associated with poorer vowel identification scores in both children and adults. Adult CI listeners with longer durations of deafness had higher focused thresholds. Findings from this study demonstrate that poor-quality ENIs may contribute to reduced speech outcomes for pediatric and adult CI listeners. Estimates of ENI quality (e.g., focused thresholds) may assist in developing customized programming interventions that serve to improve the transmission of spectral cues that are important in vowel identification.
“What Is the Matter With Me?” or a “Badge of Honor”: Nurses’ Constructions of Resilience During Covid-19
Authors: Conolly Anna , Abrams Ruth , Rowland Emma , Harris Ruth , Couper Keith , Kelly Daniel , Kent Bridie , Maben Jill
Published: May 2022

It has long been known that nursing work is challenging and has the potential for negative impacts. During the COVID-19 pandemic most nurses’ working landscapes altered dramatically and many faced unprecedented challenges. Resilience is a contested term that has been used with increasing prevalence in healthcare with health professionals encouraging a “tool-box” of stress management techniques and resilience-building skills. Drawing on narrative interview data ( n = 27) from the Impact of Covid on Nurses (ICON) qualitative study we examine how nurses conceptualized resilience during COVID-19 and the impacts this had on their mental wellbeing. We argue here that it is paramount that nurses are not blamed for experiencing workplace stress when perceived not to be resilient “enough,” particularly when expressing what may be deemed to be normal and appropriate reactions given the extreme circumstances and context of the COVID-19 pandemic.
Effectiveness of Weekend Physiotherapy on Geriatric In-Patients’ Physical Function
Authors: Rajendran Venkadesan , Jeevanantham Deepa , Falk Dylan
Published: May 2022

Purpose

Hospital-associated disability (HAD) is significant among geriatric patients admitted to acute care hospitals. The objective of the study is to evaluate the effectiveness of additional weekend physiotherapy on mobility impairments of high-risk older patients admitted to the acute medical unit.

Methods

A prospective, non-randomized controlled trial was conducted in one of the medical units in a northern Ontario hospital. A total of 41 patients were recruited using a consecutive sampling method and assigned to a control group ( n = 19) and an experimental group ( n = 22). The de Morton Mobility Index (DEMMI) and the Barthel Index (BI) were the outcome measures.

Results

A Mann-Whitney U test was used to analyze the group differences, and it showed that there was a statistically significant difference ( p < .05) between the experimental and control groups on the DEMMI and the BI.

Conclusion

Additional weekend physiotherapy significantly improves elderly patients’ physical function and gets them physically ready for discharge when medically stable. This may significantly reduce the alternate level of care for patients.
Overestimation of COVID-19 Vaccination Coverage in Population Surveys Due to Social Desirability Bias: Results of an Experimental Methods Study in Germany
Authors: Wolter Felix , Mayerl Jochen , Andersen Henrik K. , Wieland Theresa , Junkermann Justus
Published: May 2022

In Germany, studies have shown that official coronavirus disease 2019 (COVID-19) vaccination coverage estimated using data collected directly from vaccination centers, hospitals, and physicians is lower than that calculated using surveys of the general population. Public debate has since centered on whether the official statistics are failing to capture the actual vaccination coverage. The authors argue that the topic of one’s COVID-19 vaccination status is sensitive in times of a pandemic and that estimates based on surveys are biased by social desirability. The authors investigate this conjecture using an experimental method called the item count technique, which provides respondents with the opportunity to answer in an anonymous setting. Estimates obtained using the item count technique are compared with those obtained using the conventional method of asking directly. Results show that social desirability bias leads some unvaccinated individuals to claim they are vaccinated. Conventional survey studies thus likely overestimate vaccination coverage because of misreporting by survey respondents.
Personal-professional Development Program Fosters Resilience During COVID-Pandemic
Authors: van de Pol M.H.J. , van Gurp P.J.M. , van Ede A.E. , Terlouw A.J. , Hameleers R.J.M.G. , Laan R.F.J.M.
Published: May 2022

Problem

Epidemiological data throughout the academic world show an upswing in mental health concerns among students, even more significant during the ongoing COVID-pandemic. Many universities have recognized these problems and started counseling programs. However, currently reported stress levels and mental health problems at many universities remain substantial.

Approach

Our medical faculty features an evidence informed longitudinal program on personal-professional development (LPPD) integrated into the core curriculum to strengthen wellbeing and support the student as a whole.

Outcomes

With our LPPD program we show that it is possible to successfully enable personal-professional development and well-being, especially in unexpected times when resilience is needed. The safe learning environment the teacher-coaches created has proven to be an important condition in this regard.

Next steps

The LPPD program will be further evaluated and both results and program materials will be shared with the academic community through web-pages, online material and research papers.
Daratumumab in AL amyloidosis
Authors: Wechalekar Ashutosh D. , Sanchorawala Vaishali
Published: May 2022

Light-chain amyloidosis has come far, with the first treatment getting regulatory approval in 2021. Daratumumab-based regimens achieve deep hematologic and organ responses, offering a new therapeutic backbone. Early identification, correct fibril typing, challenges of the very advanced patient, and lack of therapies to remove amyloid deposits remain under study, but are, as yet, elusive. We review the progress of treatment in AL amyloidosis, the impact of daratumumab, and the next steps after treatment.
Approval of brexucabtagene autoleucel for adults with relapsed and refractory acute lymphocytic leukemia
Authors: Frey Noelle V.
Published: May 2022

In October 2021, brexucabtagene autoleucel became the first anti-CD19 chimeric antigen receptor T-cell product to receive approval from the Food and Drug Administration to treat adults with relapsed and refractory B-cell acute lymphoblastic leukemia. The approval is based on results from the Zuma-3 trial and significantly widens treatment options for this patient population. In this article, we review outcomes from this study and its implications.
Alterations in B- and circulating T-follicular helper cell subsets in immune thrombotic thrombocytopenic purpura
Authors: Shin Jin-Sup , Subhan Maryam Owais , Cambridge Geraldine , Guo Yanping , de Groot Rens , Scully Marie , Thomas Mari
Published: May 2022

T follicular helper (Tfh) cells regulate development of antigen-specific B-cell immunity. We prospectively investigated B-cell and circulating Tfh (cTfh) cell subsets in 45 patients with immune thrombotic thrombocytopenic purpura (iTTP) at presentation and longitudinally after rituximab (RTX). B-cell phenotype was altered at acute iTTP presentation with decreased transitional cells and post–germinal center (post-GC) memory B cells and increased plasmablasts compared with healthy controls. A higher percentage of plasmablasts was associated with higher anti-ADAMTS13 IgG and lower ADAMTS13 antigen levels. In asymptomatic patients with ADAMTS13 relapse, there were increased naïve B cells and a global decrease in memory subsets, with a trend to increased plasmablasts. Total circulating Tfh (CD4+CXCR5+) and PD1+ Tfh cells were decreased at iTTP presentation. CD80 expression was decreased on IgD+ memory cells and double-negative memory cells in acute iTTP. At repopulation after B-cell depletion in de novo iTTP, post-GC and double-negative memory B cells were reduced compared with pre-RTX. RTX did not cause alteration in cTfh cell frequency. The subsequent kinetics of naïve, transitional, memory B cells and plasmablasts did not differ significantly between patients who went on to relapse vs those who remained in remission. In summary, acute iTTP is characterized by dysregulation of B- and cTfh cell homeostasis with depletion of post-GC memory cells and cTfh cells and increased plasmablasts. Changes in CD80 expression on B cells further suggest altered interactions with T cells.
The impact of long-acting muscarinic antagonists on mucus hypersecretion and cough in chronic obstructive pulmonary disease: a systematic review
Authors: Calzetta Luigino , Ritondo Beatrice Ludovica , Zappa Maria Cristina , Manzetti Gian Marco , Perduno Andrea , Shute Janis , Rogliani Paola
Published: May 2022

Patients suffering from chronic obstructive pulmonary disease (COPD) clinically manifest airway mucus hypersecretion as sputum expectoration and cough. Evidence accumulated in the past decade has shown that the cholinergic system not only regulates airway smooth muscle contraction but also the activity of inflammatory and airway epithelial cells, including goblet cells, and submucosal gland activity. Long-acting muscarinic antagonists (LAMAs) with the most favourable M3/M2muscarinic acetylcholine (ACh) receptors residency properties are not only excellent bronchodilators but potentially also mucus-modifying agents, able to positively impact on mucus hypersecretion and cough. The aim of this systematic review was to investigate the impact of LAMAs on mucus hypersecretion and cough in COPD patients. The evidence confirmed that LAMAs, mainly tiotropium and aclidinium, improved sputum production and cough in moderate to severe COPD. Thus, LAMAs not only antagonise the ACh-induced bronchoconstriction of the airways but also appear to limit the production of mucus secreted in response to ACh by airway goblet cells and/or submucosal glands. Further clinical studies are necessary to evaluate the impact of LAMAs exclusively on sputum symptoms and cough as primary end-points and to investigate whether LAMAs have a modulatory action on the rheological properties of mucus.
Toll-like receptor-agonist-based therapies for respiratory viral diseases: thinking outside the cell
Authors: Girkin Jason L.N. , Maltby Steven , Bartlett Nathan W.
Published: May 2022

Respiratory virus infections initiate in the upper respiratory tract (URT). Innate immunity is critical for initial control of infection at this site, particularly in the absence of mucosal virus-neutralising antibodies. If the innate immune response is inadequate, infection can spread to the lower respiratory tract (LRT) causing community-acquired pneumonia (as exemplified by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)/coronavirus disease 2019). Vaccines for respiratory viruses (influenza and SARS-CoV-2) leverage systemic adaptive immunity to protect from severe lung disease. However, the URT remains vulnerable to infection, enabling viral transmission and posing an ongoing risk of severe disease in populations that lack effective adaptive immunity.

Innate immunity is triggered by host cell recognition of viral pathogen-associated molecular patternsviamolecular sensors such as Toll-like receptors (TLRs). Here we review the role of TLRs in respiratory viral infections and the potential of TLR-targeted treatments to enhance airway antiviral immunity to limit progression to severe LRT disease and reduce person-to-person viral transmission. By considering cellular localisation and antiviral mechanisms of action and treatment route/timing, we propose that cell surface TLR agonist therapies are a viable strategy for preventing respiratory viral diseases by providing immediate, durable pan-viral protection within the URT.
Pan-cancer analysis reveals RIPK2 predicts prognosis and promotes immune therapy resistance via triggering cytotoxic T lymphocytes dysfunction
Authors: Song Junquan , Yang Runyu , Wei Rongyuan , Du Yue , He Pengcheng , Liu Xiaowen
Published: May 2022

Background

Receptor-interacting protein kinase 2 (RIPK2, also known as RIP2) was reported to be associated with bacterial infections as well as inflammatory responses. However, the role of RIPK2 in prognosis and immunotherapy response is yet to be elucidated in human pan-cancer.

Methods

In this study, we investigated the expression, gene alteration landscape and prognostic value of RIPK2 in 33 cancers through various databases including Ualcan, cBioportal and Gene Expression Profiling Interactive Analysis 2 (GEPIA2). Then, the correlation between RIPK2 and immune infiltration, immune score, stromal score, and ESTIMATE score was investigated in the Cancer Genome Atlas (TCGA) and tumor immune estimation resource (TIMER) databases. Independent cohorts were utilized to explore the role of RIPK2 in tumor immunotherapy response. Furthermore, Gene set enrichment analysis (GSEA) was conducted to explore the mechanisms by which RIPK2 regulates immune therapy resistance. Single-cell RNA-seq datasets were used to analyze the expression level of RIPK2 on different immune cells. Moreover, CellMiner database was used to explore the relationship between RIPK2 expression with drug response.

Result

Compared with normal tissue, tumor tissue had a higher expression level of RIPK2 in various cancers. Survival analysis showed that high expression of RIPK2 associated with poor prognosis in numerous cancers. RIPK2 was found to promote a series of immune cell infiltration and B cells, macrophages, and neutrophils were significantly positively correlated with the expression of RIPK2. Moreover, RIPK2 affected immune score, stromal score and ESTIMATE score for a wide range of cancers. In the vast majority of 33 cancers, gene co-expression analysis showed that RIPK2 was positively correlated with the expression of immune checkpoint markers, such as PDCD1 (PD-1), CD274 (PD-L1), CTLA4 and TIGIT. RIPK2 aggravated cytotoxic T lymphocyte (CTL) dysfunction and related to the poor efficacy of immune checkpoint blockade in skin cutaneous melanoma (SKCM) and kidney renal clear cell carcinoma (KIRC). High expression of RIPK2 promoted innate immunotherapy resistance and adaptive immunotherapy resistance through IL-6/JAK/STAT3 signaling, interferon-gamma response, and interferon-alpha response pathway.

Conclusions

These results confirmed that RIPK2 could serve as a prognostic biomarker and promoted immune therapy resistance via triggering cytotoxic T lymphocytes dysfunction.
NDR1 increases NOTCH1 signaling activity by impairing Fbw7 mediated NICD degradation to enhance breast cancer stem cell properties
Authors: Wang Ling-Ling , Wan Xiao-Yun , Liu Chun-Qi , Zheng Fei-Meng
Published: May 2022

Background

The existence of breast cancer stem cells (BCSCs) causes tumor relapses, metastasis and resistance to conventional therapy in breast cancer. NDR1 kinase, a component of the Hippo pathway, plays important roles in multiple biological processes. However, its role in cancer stem cells has not been explored. The purpose of this study was to investigate the roles of NDR1 in modulating BCSCs.

Methods

The apoptosis was detected by Annexin V/Propidium Iodide staining and analyzed by flow cytometry. BCSCs were detected by CD24/44 or ALDEFLUOR staining and analyzed by flow cytometry. The proliferation ability of BCSCs was evaluated by sphere formation assay. The expression of interested proteins was detected by western blot analysis. The expression of HES-1 and c-MYC was detected by real-time PCR. Notch1 signaling activation was detected by luciferase reporter assay. Protein interaction was evaluated by immunoprecipitation. Protein degradation was evaluated by ubiquitination analysis. The clinical relevance of NDR1 was analyzed by Kaplan–Meier Plotter.

Results

NDR1 regulates apoptosis and drug resistance in breast cancer cells. The upregulation of NDR1 increases CD24low/CD44high or ALDEFLUORhigh population and sphere-forming ability in SUM149 and MCF-7 cells, while downregulation of NDR1 induces opposite effects. NDR1 increased the expression of the Notch1 intracellular domain (NICD) and activated the transcription of its downstream target (HES-1 and c-MYC). Critically, both suppression of Notch pathway activation by DAPT treatment or downregulation of Notch1 expression by shRNA reverses NDR1 enhanced BCSC properties. Mechanically, NDR1 interactes with both NICD or Fbw7 in a kinase activity-independent manner. NDR1 reduces the proteolytic turnover of NICD by competing with Fbw7 for NICD binding, thereby leading to Notch pathway activation. Furthermore, NDR1 might function as a hub to modulate IL-6, TNF-α or Wnt3a induced activation of Notch1 signaling pathway and enrichment of breast cancer stem cells. Moreover, we find that the elevation of NDR1 expression predictes poor survival (OS, RFS, DMFS and PPS) in breast cancer.

Conclusion

Our study revealed a novel function of NDR1 in regulating BCSC properties by activating the Notch pathway. These data might provide a potential strategy for eradicating BCSC to overcome tumor relapses, metastasis and drug resistance.
An Experimental Validation Study on Ferrofluid Evaporation
Authors: Yu Wenjuan , Li Decai , Niu Sifang
Published: May 2022

The current research on the evaporation of ferrofluids mainly focuses on the characterization of ultra-low vapor pressure ferrofluids in vacuum and the theoretical analysis of the evaporation process. Few studies have focused on the experimental validation of the proposed evaporation rate equations and on the comparison of the differences in ferrofluid evaporation. In this study, based on the Bolotov’s model, an evaporation rate equation is deduced from the experimental model. The experimental study included a comparison of the evaporation, magnetic particle volume fraction, temperature, height of the fluid surface from the outlet, and magnetic field of a kerosene-based ferrofluid and its base carrier liquid. The prepared sample was evaporated in a test tube, and the evaporation rate was calculated by measuring the weight loss of the sample. The experimental results show that the evaporation rate of the base carrier liquid is higher than that of the ferrofluid. The smaller the volume fraction of the magnetic particles, the greater the evaporation rate. The magnetic particles play a key role in preventing evaporation of the base liquid. The higher the temperature, the smaller the deviation of the evaporation rate from the predicted value. The evaporation rates obtained by the two control groups at the height of the fluid surface from the outlet were lower than the predict value. The magnetic field had a certain promotional effect on the evaporation of the ferrofluid. The experimental results were consistent with the results obtained using Bolotov’s model. This research validates Bolotov’s model and shows that the model is somewhat biased but still responds well to different variables.
Rotator cuff repair with single row technique provides satisfying clinical results despite consistent MRI retear rate
Authors: Vecchini Eugenio , Ricci Matteo , Elena Nicholas , Gasperotti Luca , Cochetti Andrea , Magnan Bruno
Published: May 2022

Background

The number of shoulder arthroscopies is steadily increasing to treat glenohumeral joint disorders, among which the rotator cuff tear is the most common. The prevalence of this condition ranges from 13% to 37% in the general population without considering the number of asymptomatic patients. The gold standard procedure for rotator cuff repair is still undefined. The purpose of this study is to evaluate a population who underwent a single row (SR) rotator cuff repair and correlate their clinical results with MRI findings.

Materials and methods

Sixty-seven consecutive rotator cuff procedures were retrospectively selected. All patients were diagnosed with a full-thickness rotator cuff tear and subsequently treated with an arthroscopic SR repair technique. Each patient was clinically assessed with the DASH questionnaire and the Constant–Murley Score to grade their satisfaction. Moreover, rotator cuff repair integrity was evaluated by MRI and graded using the Sugaya score.

Results

Mean follow-up was 19.5 ± 5.7 months. The mean Constant score was 82.8 ± 13.0 points, with 55 patients reporting excellent results. No patient scored less than 30 points, which could be deemed as unsatisfying. Meanwhile, on the DASH questionnaire, 6.1% of our patients rated their clinical outcome as unsatisfying, whereas 75.8% rated their outcome as excellent. Postoperative MRI classified 45 patients (83.3%) as either Sugaya type I, II, or III, whereas 9 patients (16.7%) presented a Sugaya type IV consistent with a full-thickness cuff retear. Of these nine patients, five (55.6%) and three (33.3%) reported excellent results for the Constant score and DASH questionnaire, respectively. The Mann–Whitney test reported that the retear group had worse scores than the intact repaired cuff group for pain (8.3 ± 5.0 versus 13.1 ± 3.4), Constant Score (68.8 ± 18.5 versus 83.1 ± 11.6), and DASH (66.2 ± 22.1 versus 44.2 ± 14.9). Still, range of motion (ROM) differences were not significant, except for better forward flexion in the intact group (p < 0.039).

Conclusions

Both groups with intact repaired and retorn cuffs showed improvement in their condition, but unexpectedly, there is no significant  correlation between patient satisfaction and rotator cuff integrity.

Level of evidence

IV