bluuebunny/crossref_metadata_2025 huggingface dataset:
Disrupting Biofilms From Titanium with a CHG Antimicrobial Irrigation System
Authors: Eberle Tanya , Sanders Jessica , Laubach Isabel , Manser Jak , Davis Troy , Peterson Marnie , Twomey Carolyn L.
Published: November 2022

Category:

Other

Introduction/Purpose:

Orthopedic device-related infections can be difficult to treat and decrease the success of surgical interventions. The implant provides a surface for bacterial attachment and biofilm formation, which decreases antimicrobial efficacy. This study was conducted to assess the ability of the Chlorhexidine Gluconate (CHG) Antimicrobial Irrigation System to disrupt biofilms from titanium coupons using an adapted ASTM E2871-19 method, 'Standard Test Method for Determining Disinfectant Efficacy Against Biofilm Grown in the CDC Biofilm Reactor Using the Single Tube Method.'

Methods:

CDC Biofilm Reactor was inoculated with Staphylococcus epidermidis (ATCC 14990TM), methicillin-resistant Staphylococcus aureus (ATCC 43300TM), Pseudomonas aeruginosa (ATCC 15442TM), or Escherichia coli (ATCC 25922TM). The reactors were run in a batch phase for 24 h, followed by continuous flow phase for an additional 24 h to produce single-species biofilms on titanium coupons. After coupons were washed with PBS to remove planktonic bacteria, growth control coupons were placed into standard sampling solution with 1% Tamol (SST) (neutralizer) or treated with CHG Antimicrobial Irrigation System according to Instructions for Use (IFU) followed by a 60 sec dwell or no dwell. Coupons were rinsed with normal saline following treatment and placed in SST. Then coupons were sonicated and vortexed to release bacteria and plated for enumeration. A coupon from each group was fixed for SEM imaging.

Results:

The CHG Antimicrobial Irrigation System disrupted biofilms of all organisms from titanium coupons with the greatest log reduction per coupon in the 60 sec dwell treatment group (log10 reduction 2.02 to 4.56 CFU/coupon from controls) (Table). Overall, S. epidermidis and E. coli biofilms had the greatest reductions in bacterial densities. SEM images confirmed biofilm disruption from the titanium surface.

Conclusion:

his study determined that the CHG Antimicrobial Irrigation System disrupted biofilms from titanium coupons when used according to the instructions for use.
Patients' Opinions on Critical Portions of Surgical Procedures in Foot and Ankle Surgery
Authors: Flaherty Alexandra , Mathur Vasundhara , Heyrani Nasser , Lubberts Bart , Waryasz Gregory R. , Guss Daniel , Ashkani-Esfahani Soheil , DiGiovanni Christopher W.
Published: November 2022

Category:

Other; Ankle

Introduction/Purpose:

Over the last decade, simultaneous or overlapping procedures in orthopedic surgery have come under increased media attention and public scrutiny. While little is known about what surgeons consider to be 'critical portions' of the myriad of foot and ankle procedures performed, even less is known about the expectations and opinions of patients themselves. In this study we aimed to elucidate patients' expectations of foot and ankle surgeons regarding their presence at different portions of a given surgery and what portions of a surgery they considered to be 'critical'.

Methods:

In this survey, data was collected using a questionnaire that was filled out by 49 patients presenting to an orthopedic foot and ankle tertiary referral clinic. The questions were designed around three common foot and ankle procedures: open reduction, internal fixation of fractures (ORIF), Achilles tendon repair, and ankle arthroscopy. For each procedure, the key steps were identified, and the responding patient was asked to characterize each step as 'Always Critical' 'Often Critical' 'Sometimes Critical' 'Rarely Critical' or 'Never Critical.' Additionally, demographics, education level, number of prior surgeries, and profession were also collected from the patients. Data were described using means, ranges, and percentages.

Results:

Of the 49 patients surveyed, the average age was 52.9 years old; 59% were female and 41% were male; 76% of respondents were college graduates, 8% completed some college, and 12% were high school graduates. Overall, 12% of respondents work in a healthcare related field. The average number of previous surgeries was 2.0, with a minimum of 0 and a maximum of 14. In all three procedures, the steps for which more than 50% of the patients identified as 'Always Critical' were discussion of risks, benefits, and alternatives, marking the surgical site, pre-operative time-out, skin incision for ORIF, soft tissue dissection, reduction of fracture, fracture fixation with hardware, repair of the tendon, and scoping the ankle. Across all three procedures, transferring the patient between operating table and bed, applying a sterile bandage, and applying a splint were categorized as the least critical portions of the procedure (Figure 1).

Conclusion:

The result of this study offers insight on what the most critical portion of three common foot and ankle procedures from the patient's perspective. Generally speaking, patients perceived initial dissection and even closure to be critical, in addition to procedural elements such as fracture reduction. Ongoing research aims to correlate these findings with the perceptions of foot and ankle surgeons themselves. Nonetheless, it highlights the potential discrepancy in perceptions between clinicians and patients as it pertains to 'critical portions' of a given procedure.
Does Severe Ankle Deformity Affect the Outcomes of a 4th Generation Total Ankle Prosthesis? A 2- Year Follow-Up
Authors: Gross Christopher E. , Friscia David A. , Doty Jesse F. , Vora Anand M. , Strasser Nicholas L.
Published: November 2022

Category:

Ankle Arthritis

Introduction/Purpose:

Fourth generation ankle replacements benefit from improved surgical technique, respect for bony preservation, and increased surgeon awareness of operative indications. In some studies, pre-operative degree of deformity has been reported to influence survivorship, pain, and functional outcomes. The purpose of this multi-institutional study was to evaluate whether pre- operative deformity affects prospectively collected patient reported outcome measures (PROMs) of a fourth-generation total ankle replacement.

Methods:

Patients presenting for a total ankle replacement at 9 institutions were prospectively enrolled and implanted in a variety of academic and private settings. Each patient received an INFINITY ankle prosthesis. (Styker, Memphis, TN, USA). The degree of deformity was radiographically classified pre-operatively as severe if ankle varus or valgus was greater than 10° in the coronal plane. PROMs were recorded pre-operatively and at 6 months, 12 months, and 24-month intervals. The following PROMs were collected: Ankle Osteoarthritis Score (AOS), PROMIS Global Physical Health, and Foot and Ankle Outcome Score (FAOS). The preoperative and latest follow-up scores for patients with two years of follow-up were analyzed.

Results:

A total of 147 patients were enrolled in the study. Fifty-two patients exhibited a pre-operative ankle deformity of greater than 10° varus or valgus. Eighty-eight patients had 24 months of follow-up. All patients with severe deformity had significant improvements in all domains of the AOS, PROMIS, and FAOS Scores (p<0001). The degree of deformity, ankle instability, or hindfoot arthritis did not impact the PROMs (AOA p=.2661, PROMIS p=.543, FAOS p=.684) in those with 2-year follow-up.There were three revisions with varying degrees of deformity. Two patients had revisions for aseptic loosening (6o valgus and 10o varus). One patient had a revision for tibial subsidence (11o varus).

Conclusion:

Severe pre-operative deformity did not impact PROMs in patients undergoing implantation with a 4th generation total ankle replacement. In carefully selected patients, greater deformity did not necessarily correlate with an increased need for revision surgery.
The Statistical Fragility of Platelet-Rich Plasma as Treatment for Plantar Fasciitis: A Systematic Review and Meta-Analysis
Authors: Gupta Arjun , Ortiz-Babilonia Carlos D. , Xu Amy L. , Rogers Davis L. , Vulcano Ettore , Aiyer Amiethab A.
Published: November 2022

Category:

Basic Sciences/Biologics; Hindfoot; Sports

Introduction/Purpose:

Plantar fasciitis (PF) is estimated to account for 8% of all running-related injuries, affecting nearly 1 out of every 10 adults aged 50 and older. Recent randomized controlled trials (RCTs) suggest platelet-rich plasma (PRP) injection may be an effective non-operative treatment option for chronic, refractory PF. However, RCTs in general have come under scrutiny due to a frequent lack of reproducibility, which is largely attributable to shortcomings of the commonly used p<0.05 threshold for significance. Fragility indices may be an appropriate tool to gauge the clinical importance of RCT findings in these situations. In this study, we utilize the continuous fragility index (CFI) and continuous fragility quotient (CFQ) to determine the statistical robustness of data from RCTs evaluating PRP for PF.

Methods:

RCTs comparing outcomes after PRP injection versus other conservative treatment in chronic PF patients were evaluated. Representative datasets were generated for each reported outcome event using summary statistics. The CFI was determined by manipulating each dataset until reversal of significance (a=0.05) was achieved. The corresponding CFQ was calculated by dividing the CFI by the sample size.

Results:

Of 259 studies screened, 27 studies (59 outcome events) were included in this analysis. The median CFI for all events was 9 (CFQ=0.177), suggesting that altering the treatment of only 9 patients (or 17.7 out of 100) would be sufficient to reverse trial significance (Table 1). Of the 36 outcome events reporting lost to follow-up data, 10 events (27.8%) lost >=9 patients. Outcome events that were originally reported as significant (p<0.05) were considerably more fragile (CFI=5; CFQ=0.122) than events that were reported as nonsignificant (CFI=10; CFQ=0.179).

Conclusion:

Fragility indices are a useful adjunct to p-values and provide an assessment of how easily statistical significance can be overturned. While there is some preliminary evidence supporting the clinical efficacy of PRP, our fragility analysis suggests that RCT findings may be underpowered in some cases. Over 27% of outcome events may have experienced a reversal of significance if the studies had simply maintained follow-up. Given the importance of RCTs in clinical decision-making, fragility indices should be reported alongside p-values to indicate the strength of statistical findings.
No Association Between Cavovarus Alignment and Risk of Non-Union or Delayed Union in Jones Fractures
Authors: Holmes Scott , Webb Alexander R. , Manz Wesley J. , Jacobson Joseph E. , Coleman Michelle M. , Kadakia Rishin J. , Bariteau Jason T.
Published: November 2022

Category:

Midfoot/Forefoot; Other

Introduction/Purpose:

It has been well documented in the literature that fractures of the base of the fifth metatarsal are often associated with varus hindfoot alignment. Zone two fractures at the metaphyseal-diaphyseal junction, commonly referred to as Jones fractures, have specifically been noted to have a higher incidence of delayed union and nonunion. This has historically been attributed to the tenuous blood supply in this region. Although it is known that hindfoot varus may predispose to these fractures, there is little information on whether a cavovarus alignment may also contribute to the increased risk of nonunion. The purpose of this study is to determine whether cavovarus foot alignment is associated with delayed union or nonunion in Jones fractures.

Methods:

We identified patients who sustained a proximal fifth metatarsal fracture between the years 2016-2021 at a single academic institution. Weightbearing foot radiographs were then reviewed to identify zone 2 fractures. Talo-first metatarsal, talonavicular coverage, and talocalcaneal angles were then measured on the AP view and calcaneal pitch, talocalcaneal, and talo- first metatarsal angles were measured on the lateral view to assess foot alignment. The primary outcome measure was the presence of a nonunion or delayed union. T-tests, Mann Whitney U tests, and ANOVA analyses were conducted to assess for differences.

Results:

We identified a total of 117 patients with 118 zone 2 proximal fifth metatarsal fractures. Of those fractures, there were 23 of which were considered either delayed union (n=8) or nonunion (n=15). Similar rates of nonunion and delayed union were observed between patients undergoing nonoperative and operative management of their Jones fractures (p=0.514, p=0.200, respectively). For all patients with a nonunion or delayed union, no differences in anteroposterior (AP) talo-first metatarsal angle, AP talonavicular coverage angle, AP talocalcaneal angle, lateral calcaneal pitch, lateral talo-first metatarsal angle, or lateral talocalcaneal angle from those with expected healing were observed (p = 0.773, p = 0.084, p = 0.874, p = 0.751, p = 0.471, and p = 0.386 - respectively).

Conclusion:

Overall, no measured foot alignment values (talo-first metatarsal angle, talonavicular coverage, talocalcaneal angle, or calcaneal pitch) were statistically associated with increased risk of delayed union or non-union among patients with Jones fractures undergoing either operative or non-operative treatment. Furthermore, there was no measured difference in these foot alignment parameters between those patients undergoing operative treatment and those undergoing non-operative treatment. In conclusion, cavovarus alignment is not associated with an increased risk of non-union or delayed union in the operative or non-operative treatment of Jones fractures.
Can Patient Reported Outcomes be Used to Eliminate Unnecessary Follow Up Clinic Visits after Surgery?
Authors: Hunter Jefferson , Ramirez Gabriel A. , Thirukumaran Caroline , Baumhauer Judith F.
Published: November 2022

Category:

Other; Ankle; Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

Patient reported outcomes (PROs) have been a powerful tool to inform clinicians on the success or failure of various treatments including surgery. Patient-Reported Outcome Measurement Information System (PROMIS) is a suite of validated symptom-based questions designed to be asked and answered directly by the patient to track treatment progress quickly and accurately. This study uses PROMIS to determine the duration between foot and ankle surgery and assessment of a successful outcome. Additionally, we retrospectively calculate the savings that would be realized by eliminating unnecessary office visits if this model was implemented in clinical practice.

Methods:

Retrospective PROMIS Pain Interference (PI) data were obtained for common elective foot (n=832) and ankle (n=851) surgical procedures. Patients were categorized into quartiles of their pre-operative PI score - quartile 1 (Q1) being 25% of patients with the lowest PI scores. Minimal clinically important difference (MCID) was defined by the ½ standard-deviation of the pre- operative pain interference t-scores. A patient was considered recovered after observing two consecutive MCID decreases in post-operative pain interference t-scores. A cox proportional hazards model stratified by preoperative PI score quartile was used to predict probability patient recovery after adjusting for age, race, ethnicity, gender, and primary payor. The average and total potential savings for the cohort was derived using the number of patient-visits post-recovery.

Results:

Two consecutive decreases in MCID measured by PI PROMIS t-scores were achieved 90 days post-operatively by 16%, 16%, 17%, and 23% of post-operative ankle patients in quartiles 1-4 respectively; post-operative foot patients achieved 18%, 11%, 20%, and 26% in quartiles 1-4 respectively (see Figure 1). Days 30-60 recorded the greatest rate of improvement across quartiles with Q4 showing the greatest improvement. The least improvement occurred between days 90-120 across all quartiles. Patients were seen by the orthopedics departments on average 2.84 times after achieving two consecutive MCID improvements, totaling to $243.63 in expenses to institutional payers per patient. Avoiding these excess visits even after MCID achievement could result in savings ranging from $38,593 to $122,002.

Conclusion:

PI PROMIS t-scores can be used to assess the need for ongoing follow up for surgical patients. If there is evidence that the patient has improved a clinically meaningful amount on two successive visits additionally follow-up may not be needed. Using PROs in clinical decision-making pathways as suggested in this research will eliminate unnecessary visits and save healthcare dollars and valuable resources
Understanding “flow”: A multimodal reading of political economy and capitalist erotics in hip hop
Authors: Maxwell Kate , Greenaway Jonathan
Published: November 2022

One of the essential elements of a rapper’s art is “flow”: the delivery of text against beat. Hip hop, with its linguistic dominance and street origins, is traditionally male-orientated, with women often depicted in terms of (sexual) subordination. However, when considered through a female gaze, the discourses conjured by “flow” take on different meanings. From the flow of desire to monthly visits from Aunt Flo, “flow” is integral to female sexuality. As a commercial art form in a capitalist society, the flow of capital is another meaning that has been largely overlooked in hip hop studies. In this article we broaden the understanding of “flow” to include that of the libido, menstruation, capital, and social media. We analyse five hip hop songs (with videos) using a methodology that builds on Van Leeuwen’s (1999) multimodal analysis of sound, together with a tripartite division of “mode” into cultural practices, semiotic resources, and elements (Maxwell, 2015), underpinned by close readings of the Marxist philosophers Deleuze and Guattari. We show that the dominant flow in hip hop is inevitably that of capital – the Deleuzian great flow – and that even this self-consciously subversive music style is governed by the insatiable drive of the market.
A ‘drift’ in the Anthropocene: A case study of urban maritime materiality
Authors: Turnbull Daisy KE
Published: November 2022

This study reviews our understanding of the materiality of the coastline, considering it as a function of post-modern ecology and drawing from it narratives of the Anthropocene. It redresses the theoretical and ontological understandings of archaeologists, geographers, historians and creative artists at a unique urban coastal setting. In doing so, it responds to the work of Ϸóra Pétursdóttir in her 2018 work analysing ‘Drift’ and the tensions found within the inter-tidal zone between human and non-human actors in a remote setting. This study aims to challenge Pétursdóttir’s work within an urban setting. This is achieved through photographic survey of Eastney Spit, to the east of Portsea Island on the south coast of England, and the lived experience of its environment and history. It argues that exploration of materials at the maritime borderland can enable re-evaluation of our relationship with the coast as a lived, urban environment. Through the manipulation of material, historically, artistically or unconsciously, the land and seascape of Eastney have been forever altered by both tangible and intangible cultural forces. As such, the concept of 'drift' is applied to evaluate the corruption of maritime forces and the entangled manipulation of materials that forms unique connections between matter and ontology along contemporary urban coastlines.
Incentivizing Relationship Investment for Project Performance Improvement
Authors: Zhu Liuying , Cheung Sai On
Published: November 2022

Collaboration between developers and contractors is pivotal to the efficient completion of construction projects. Relational contracting practice has been used to promote working partnerships. Construction incentivization can be a valuable contractual tool to build relationships. This study proposes that incentivization can serve as an instrumental means to forge interorganizational relationships and corresponding project performance improvements. With data collected from experienced construction professionals, the hypotheses are empirically supported by structural equation modeling. It is therefore concluded that in addition to its conventional uses, incentivization can be innovatively designed to develop and manage interorganizational relationships and engender project performance improvement.
A gravimetric assessment of the Gotthard Base Tunnel geological model: insights from a novel gravity terrain-adaptation correction and rock physics data
Authors: Scarponi M. , Hetényi G. , Baron L. , Marti U.
Published: November 2022

The Gotthard Base Tunnel (GBT) is a 57 km long railway tunnel, constructed in the Central Alps in Switzerland and extending mainly North–South across numerous geological units. We acquired 80 new gravity data points at the surface along the GBT profile and used 77 gravity measurements in the tunnel to test and constrain the shallow crustal, km-scale geological model established during the tunnel construction. To this end, we developed a novel processing scheme, which computes a fully 3D, density-dependent gravity terrain-adaptation correction (TAC), to consistently compare the gravity observations with the 2D geological model structure; the latter converted into a density model. This approach allowed to explore and quantify candidate rock density distributions along the GBT modelled profile in a computationally-efficient manner, and to test whether a reasonable fit can be found without structural modification of the geological model. The tested density data for the various lithologies were compiled from the SAPHYR rock physical property database. The tested models were evaluated both in terms of misfit between observed and synthetic gravity data, and also in terms of correlation between misfit trend and topography of the target profile. The results indicate that the locally sampled densities provide a better fit to the data for the considered lithologies, rather than density data averaged over a wider set of Alpine rock samples for the same lithology. Furthermore, using one homogeneous and constant density value for all the topographic corrections does not provide an optimal fit to the data, which instead confirms density variations along the profile. Structurally, a satisfactory fit could be found without modifying the 2D geological model, which thus can be considered gravimetry-proof. From a more general perspective, the gravity data processing routines and the density-dependent corrections developed in this case study represent a remarkable potential for further high-resolution gravity investigations of geological structures.
High levels of follicular fluid testosterone could impair oocyte developmental competency via affecting aryl hydrocarbon receptor pathway in PCOS patients
Authors: Eini Fatemeh , kutenaei Maryam Azizi , Foroutan Tahereh , Salehi Ensieh
Published: November 2022

Background

Although hormonal and metabolic dysfunction have been recognized as a possible cause of polycystic ovarian syndrome (PCOS), the associations between hyperandrogenism and aryl hydrocarbon receptor (Ahr) signaling pathway remains controversial. The current study aimed to investigate the effect of hyperandrogenism on oocyte developmental competency via regarding Ahr signaling downstream pathway in granulosa cells.

Materials and methods

Granulosa cells were collected from 45 PCOS patients under assisted reproductive technique (ART). Gene expression of Ahr downstream pathway was evaluated based on Reverse Transcription Q-PCR assay. Moreover the correlation was investigated between gene expression and hyperandrogenism, and oocyte developmental competency in PCOS.

Results

From the 45 PCOS patients, 26 (64.44%) had a high level of follicular fluid testosterone (FFT). Based on the FFT level, two groups of PCOS: HFT (high level of FFT) and non-HFT, were shown significant differences in oocyte and embryo quality, and fertilization and cleavage rates. Moreover, the mean relative expressions of Ahr and Arnt genes were significantly higher in HFT –PCOS group (p < 0.01 and p < 0.01) respectively. Also, the significant positive correlations were obtained for Ahr, Arnt, Cyp1A1, and Cyp1B1 with incidence of clinical hyperandrogenism and FFT level. Besides, our results showed that Ahr, Cyp1A1, and Cyp1B1 gene expression was correlated significantly with fertilization rate.

Conclusion

The present study suggested that hyperandrogenism could impair oocyte developmental competency via affecting Ahr signaling downstream pathway.
Multiomics analyses reveals Anaplasma phagocytophilum Ats-1 induces anti-apoptosis and energy metabolism by upregulating the respiratory chain-mPTP axis in eukaryotic mitochondria
Authors: Li Ruirui , Ma Zhongchen , Zheng Wei , Wang Zhen , Yi Jihai , Xiao Yangyang , Wang Yong , Chen Chuangfu
Published: November 2022

Background

Anaplasma translocated substrate 1 (Ats-1) is an effector of type 4 secretory systems (T4SS) and the main virulence factor of Anaplasma phagocytophilum. Ats-1 is involved in the regulation of host cell biological processes, but the specific molecular mechanism of its action is unclear.

Results

In this study, we identified Ats-1 as involved in mitochondrial respiratory regulation of HEK293T cells by multi-omics analysis. After intracellular expression of Ats-1, adenosine triphosphate levels and the proliferation of HEK293T cells were both up-regulated, while HEK293T cells apoptosis was inhibited. Ats-1 targeted translocation to the mitochondria where it up-regulated the expression of NDUFB5, NDUFB3, NDUFS7, COX6C, and SLC25A5, thereby enhancing energy production and inhibiting HEK293T cells apoptosis while enhancing HEK293T cells proliferation, and ultimately facilitating Anaplasma phagocytophilum replication in HEK293T cells.

Conclusions

This study demonstrated that Anaplasma phagocytophilum Ats-1 induces anti-apoptosis and energy metabolism by upregulating the respiratory chain-mPTP axis in eukaryotic mitochondria. These results provide a better understanding of the pathogenic mechanism of Anaplasma phagocytophilum within host cells.
Effect of conditioned media from Aeromonas caviae on the transcriptomic changes of the porcine isolates of Pasteurella multocida
Authors: Hanchanachai Nonzee , Chumnanpuen Pramote , E-kobon Teerasak
Published: November 2022

Background

Pasteurella multocidais an opportunistic pathogen causing porcine respiratory diseases by co-infections with other bacterial and viral pathogens. Various bacterial genera isolated from porcine respiratory tracts were shown to inhibit the growth of the porcine isolates ofP. multocida. However, molecular mechanisms during the interaction betweenP. multocidaand these commensal bacteria had not been examined. 

Methods

This study aimed to investigate the interaction between two porcine isolates ofP. multocida(PM2 for type D and PM7 for type A) withAeromonas caviaeselected from the previously published work by co-culturingP. multocidain the conditioned media prepared fromA. caviaegrowth and examining transcriptomic changes using RNA sequencing and bioinformatics analysis. 

Results

In total, 629 differentially expressed genes were observed in the isolate with capsular type D, while 110 genes were significantly shown in type A. High expression of genes required for energy metabolisms, nutrient uptakes, and quorum sensing were keys to the growth and adaptation to the conditioned media, together with the decreased expression of those in the unurgent pathways, including translation and antibacterial resistance.

Conclusion

This transcriptomic analysis also displayed the distinct capability of the two isolates ofP. multocidaand the preference of the capsular type A isolate in response to the tough environment of theA. caviaeconditioned media. Therefore, controlling the environmental sensing and nutrient acquisition mechanisms ofP. multocidawould possibly prevent the overpopulation of these bacteria and reduce the chance of becoming opportunistic pathogens.
The impact of ABCB1 and CES1 polymorphisms on the safety of dabigatran in patients with non-valvular atrial fibrillation
Authors: Zhu Zhu , Qian Chenyue , Su Cunjing , Tao Hong , Mao Jiaojiao , Guo Zhening , Zhu Xinyi , Pan Jie
Published: November 2022

Background

This study aimed to analyze associations between genetic variants and plasma concentrations along with clinical outcomes in dabigatran in patients with non-valvular atrial fibrillation (NVAF).

Methods

We conducted a prospective study and enrolled NVAF patients treated with dabigatran in the real world. A total of 86 patients treated with 110 mg DE twice daily were recruited for this study. Blood samples were obtained from each patient and used for genotyping and determination of plasma dabigatran concentration. All bleeding and thromboembolic complications were recorded during the 1.5 years of follow-up.

Results

Eighty-three patients provided samples at the trough plasma level of dabigatran, and 58 patients provided samples at the peak plasma level of dabigatran. There was a significant association between the CES1 SNP rs8192935 and trough plasma concentrations of dabigatran (P = 0.013). Our results showed that the CES1 SNP rs8192935 significantly influenced dabigatran trough concentrations in the Chinese population, and carriers of the G allele had increased trough plasma concentrations of dabigatran compared to noncarriers. The ABCB1 SNP c.2482-2236G > A (rs4148738) was associated with major bleeding events in the addictive model (P = 0.046, OR = 3.29) and dominant model (P = 0.040, OR = 8.17). Additionally, the ABCB1 SNP c.3435 C > T (rs1045642) was associated with the incidence of major bleeding events in the addictive model (P = 0.043, OR = 3.34) and dominant model (P = 0.046, OR = 7.77). However, no significant associations were found between all the SNPs and the incidence of minor bleeding events.

Conclusion

Our results indicated that the CES1 polymorphism rs8192935 was associated with trough plasma concentrations of dabigatran. Carriers of the G allele had increased trough plasma concentrations of dabigatran compared to noncarriers. The ABCB1 polymorphisms rs4148738 and rs1045642 were associated with an increased risk for major bleeding events for the first time in a Chinese population.
Latent profile analysis for quality of life in older patients
Authors: Băjenaru Lidia , Balog Alexandru , Dobre Ciprian , Drăghici Rozeta , Prada Gabriel-Ioan
Published: November 2022

Background

Quality of life (QOL) is a complex concept known for being influenced by socio-demographic characteristics, individual needs, perceptions and expectations. The study investigates influences of such heterogeneous variables and aims to identify and describe subgroups of older patients who share similar response patterns for the four domains (physical health, psychological health, social relationships and environment) of World Health Organization Quality of Life instrument, Short Form (WHOQOL-BREF).

Methods

The sample used included older Romanian patients (N = 60; equal numbers of men and women; mean age was 71.95, SD = 5.98). Latent Profile Analysis (LPA) was conducted to explore quality of life profiles with the four WHOQOL-BREF domains as input variables. Differences between profiles were analysed by MANOVA and ANOVAs as a follow-up.

Results

The LPA results showed that the three-profile model was the most suitable and supported the existence of three distinct QOL profiles: low and very low (28.3%), moderate (63.3%) and high (8.4%). The relative entropy value was high (0.86), results pointed to a good profile solution and the three profiles differed significantly from one another.

Conclusion

Our results reveal heterogeneity within the older adult sample and provide meaningful information to better tailor QOL improvement programs to the needs of older patient groups, especially those designed for patients of profiles related to poorer QOL in different domains.
Risk factors for multidrug resistance in tuberculosis patients with diabetes mellitus
Authors: Li Shuangping , Liang Yalin , Hu Xinjun
Published: November 2022

Objective

To study the risk factors and prediction models of multidrug resistance in patients with tuberculosis and diabetes and those with a history of tuberculosis treatment.

Methods

A total of 256 tuberculosis patients with diabetes who were registered in Luoyang city, Henan Province, from January 2018 to December 2021. Logistic regression analysis was performed to analyse the risk factors for multidrug resistance. ROC curves were used to analyse the predictive model for multidrug resistance.

Results

Age < 65 years old, HbA1c, and a history of tuberculosis treatment were independent risk factors for multidrug resistance in patients with tuberculosis and diabetes (P < 0.05). The area under the ROC curve of predictive model for MDR was 0.878 (95% CI (0.824, 0.932)). Age < 65 years old and HbA1c were independent risk factors for MDR in patients with TB and diabetes with a history of TB treatment. The area under the ROC curve of predictive model for MDR was 0.920 [95% CI (0.831, 0.999)].

Conclusion

The predictive model had certain prediction value for the risk of multidrug resistance in patients with tuberculosis and diabetes.
Case report: Meningoencephalocele and recurrent bacterial meningitis in chronic idiopathic intracranial hypertension
Authors: Zhang Jinru , Wu Jianchao , Wu Yue , Wang Yaye , Han Jingzhe
Published: November 2022

Background

Meningoencephalocele is a rare malformation caused by congenital and acquired lesions. The association between recurrent bacterial meningitis and meningoencephaloceles with cerebrospinal fluid (CSF) leak is reported in the literature. We report a rare case of meningoencephalocele secondary to chronic idiopathic intracranial hypertension as a result of hospitalization repeatedly for meningitis due to the lack of CSF leak.

Case presentation

This study presents a case of a patient with a decade of recurrent meningitis. With clinical symptoms and imaging examination with chronic idiopathic intracranial hypertension, this patient was diagnosed with meningoencephalocele. With the treatment of acetazolamide to decrease CSF product, the patient had no recurrence of meningitis over the 6-months follow-up period.

Conclusion

In patients with recurrent intracranial infections but no history of immunodeficiency, cranial trauma, or neurosurgery, the possibility of meningitis should be considered appropriately, even in the absence of CSF otorrhea or rhinorrhea.
Socio-cultural factors influencing adolescent pregnancy in Ghana: a scoping review
Authors: Amoadu Mustapha , Ansah Edward Wilson , Assopiah Patricia , Acquah Philomina , Ansah Joyce Evelyn , Berchie Eunice , Hagan Doris , Amoah Elsie
Published: November 2022

Background

Adolescent pregnancy is a public health challenge that has well-defined causes, associated health risks, and social and economic consequences for adolescent, their families, communities, and society. The purpose of this scoping review is to summarize studies published on socio-cultural determinants of adolescent pregnancy in Ghana.

Methods

Search for records was done in four major databases, including PubMed CENTRAL, Science Direct and JSTOR. Records from Google and Google Scholar were also added, and results and findings from published and unpublished studies were included. All the 22 studies that met the eligibility criteria, were critically appraised. The guidelines for conducting scoping reviews by Arksey and O’Malley were followed.

Results

The result revealed that poverty, peer influence, low level of education, dysfunctional family, lack of communication between parents and their daughters, lack of sexual and reproductive health education, child marriage, coerced sex, misconception and non-usage of contraceptives, and decline in cultural values such as puberty rites and virginity inspection are some of the determinants of adolescent pregnancy in Ghana. The study also showed that there is a lack of high-quality observational studies that adjust for confounding variables.

Conclusion

Interventions and policies should be designed to take into consideration the needs, context, and background of adolescents. Programmes to enhance adolescent reproductive health need to consider multilevel factors such as person, family, community, institutions, national, and global issues that affect such programmes.
Secular trends of morbidity and mortality of prostate, bladder, and kidney cancers in China, 1990 to 2019 and their predictions to 2030
Authors: Huang Qiao , Zi Hao , Luo Lisha , Li Xuhui , Zhu Cong , Zeng Xiantao
Published: November 2022

Background

Prostate, bladder and kidney cancers are common age-related genitourinary cancers. China's population is aging at an increasing rate, so predicting the morbidity and mortality of prostate, bladder, and kidney cancer in China is of great significance to provide epidemiological evidence for forward planning and implementation of national health policies.

Methods

Numbers of incidences and deaths by cancer (prostate, bladder and kidney), sex (male and female) and age groups from 1990 to 2019 were extracted from the Global Burden of Disease (GBD) Study. We applied Bayesian age-period-cohort models to predict incidences and deaths to 2030. We also calculated Age-standardized incidence rate (ASIR) and mortality rate (ASMR), their trends were quantified by estimated average percentage change (EAPC) and 95% confidence interval (CI).

Results

Predictions suggest that by 2030, there will be 315,310 prostate cancer cases, 192,390 bladder cancer cases and 126,980 kidney cancer cases. The ASIRs will increase to 25.54/100,000 for prostate cancer (EAPC: 2.88, 95% CI, 2.84, 2.93), 7.54/100,000 for bladder cancer (EAPC: 2.58, 95% CI, 2.54, 2.61) and 5.63/100,000 for kidney cancer (EAPC: 4.78, 95% CI, 4.54, 5.02). Number of deaths in 2030 will be 81,540, 61,220, and 41,940, respectively. Different ASMR changes are observed, the ASMR for prostate cancer will drop to 7.69/100,000 (EAPC: -0.29, 95% CI, -0.31, -0.27), the ASMR for bladder cancer will stabilize at 2.49/100,000 (EAPC: 0.00, 95% CI, -0.02, 0.03), the ASMR of kidney cancer will increase to 1.84/100,000 (EAPC: 3.45, 95% CI, 3.22, 3.67). From 1990 to 2030, higher numbers of cases and rates are reported among males and in the 60 plus age group, both ASIR and ASMR of bladder and kidney cancers presents progressively widening differences between both males and females and between the < 60 and the ≥ 60 age groups.

Conclusion

Morbidity and mortality of the three genitourinary cancers are predicted to increase further over the next decade. It highlights the need for timely development and implementation of optimal health policies to curb the epidemic trends.
Effects of vitamin D supplementation on depression and some selected pro-inflammatory biomarkers: a double-blind randomized clinical trial
Authors: Kaviani Mina , Nikooyeh Bahareh , Etesam Farnaz , Behnagh Siroos Jahangiri , Kangarani Hamed Mohammadi , Arefi Mohammad , Yaghmaei Parichehreh , Neyestani Tirang R.
Published: November 2022

Background

Both augmented inflammatory reaction and low vitamin D status are associated with depression but the magnitude of their relationships is unclear. This study was, therefore, conducted to evaluate the effects of vitamin D supplementation on serum 25(OH)D concentration, depression severity and some pro-inflammatory biomarkers in patients with mild to moderate depression.

Methods

An 8-week double-blind randomized clinical trial (RCT) was performed on 56 (18–60 yrs) patients with mild to moderate depression, randomly assigned to intervention (50,000 IU cholecalciferol 2wks−1) and control (placebo) groups. Serum 25(OH)D, intact parathyroid hormone (iPTH), interlukin (IL)-1β, IL-6, high-sensitivity C-reactive protein (hs-CRP) and depression severity (Beck Depression Inventory-II) (BDI-II)) were initially and finally assessed.

Results

At the end point, statistically significant changes were observed only in intervention group as compared with controls including increased 25(OH)D concentration (+ 40.83 ± 28.57 vs. + 5.14 ± 23.44 nmol L−1, P < 0.001) and decreased depression severity (-11.75 ± 6.40 vs. -3.61 ± 10.40, P = 0.003). No significant within- or between group differences were observed in serum IL-1β, IL-6 and hs-CRP concentrations.

Conclusion

Increased circulating 25(OH)D concentrations following 8-week vitamin D supplementation (50,000 IU 2wks−1) resulted in a significant decrease in BDI-II scores in patients with mild to moderate depression. However, this effect was independent of the serum concentrations of the studied inflammatory biomarkers.

Trial registration

The clinical trial registration code was obtained from the Iranian Registry of Clinical Trials (date of registration: 17/09/2018, registration number: IRCT20170926036425N1) and ClinicalTrials.gov (date of registration: 04/12/2018, registration number: NCT03766074)
The impact of the COVID-19 pandemic on individuals with generalized anxiety disorder: assessing COVID-19 media source exposure and behaviour changes
Authors: Alphonsus K. B. , Abayateye F.
Published: November 2022

Background

The COVID-19 pandemic that has resulted in social distancing, lockdowns, and increase in media posts has taken a toll on the mental health of many people especially those living with Generalized Anxiety Disorder (GAD). The main objective of this study is to understand whether the source of information people use to receive information about COVID-19 and increase or decrease in personal weekly habits during the pandemic were associated with severity of GAD. 

Methods

This study was a cross sectional design and was based on data from Canada. The Canadian Perspective Survey Series (CPSS) 4, 2020: Information Sourced Consulted During the Pandemic was used for the study. The outcome variable was severity of GAD. Multivariate logistic regression was carried out using STATA IC 13.

Results

Severity of GAD was significantly associated with being a female, the type of information source used to find out about COVID-19 and change in weekly habits (consuming alcohol, consuming cannabis spending time on the internet and eating junk foods or sweets).

Conclusion

The results indicate that getting information from credible sources about the pandemic, staying connected with family and friends, seeking virtual mental health services, and learning positive coping strategies can help reduce the severity of GAD.
Identifying vertebral fractures in the Japanese population using the trabecular bone score: a cross-sectional study
Authors: Omichi Yasuyuki , Mima Noriaki , Okada Ryo , Wada Keizo , Morimoto Masatoshi , Sairyo Koichi
Published: November 2022

Background

The trabecular bone score (TBS) is reported to be an independent predictor of fracture risk in patients with primary or secondary osteoporosis. However, there have been few reports on its use in the Japanese population. This study aimed to investigate the risk factors for vertebral fracture in the Japanese population and to evaluate the usefulness of TBS.

Methods

This cross-sectional study involved 279 patients aged 60–90 years in whom bone mineral density (BMD) was measured by dual-energy X-ray absorptiometry (DXA). TBS was calculated based on the DXA scans. The presence or absence of vertebral fractures was assessed from T11 to L5. The patients were divided into those with vertebral fractures (VF group, n = 104) and those without vertebral fractures (non-VF group, n = 175).

Results

Of the 104 patients in the VF group, 75 had 1 vertebral fracture and 29 had 2 or more fractures. The mean TBS was 1.28 in the VF group and 1.35 in the non-VF group (p < 0.001). The mean BMD values at the lumbar spine and femoral neck were lower in the VF group (p < 0.001). The areas under the receiver-operating characteristic curve for incidence of vertebral fractures were 0.700, 0.737, and 0.689 for TBS, lumbar spine BMD, and femoral neck BMD, respectively. Multiple logistic regression analysis identified lumbar spine BMD, TBS, and female sex as significant risk factors for vertebral fractures. The proportion of patients in the group with osteoporosis or osteopenia who had vertebral fractures was higher in those with a low TBS (≤ 1.23) than in those with a non-low TBS (> 1.23).

Conclusion

TBS was a significant indicator of vertebral fractures in the Japanese population and might contribute to identifying patients with vertebral fractures, particularly those with osteopenia who need pharmacologic therapy.
The effect of combined maxillary pad movable appliance and FR-III functional appliance in the treatment of skeletal Class III malocclusion of deciduous teeth
Authors: Lyu Lihua , Lin Huidong , Huang Hua
Published: November 2022

Background

To evaluate the therapeutic effect of maxillary pad movable appliance combined with FR-III functional appliance in treating skeletal Class III malocclusion of deciduous teeth and provide a reference for optimizing clinical treatment methods.

Methods

A total of 30 pediatric patients were randomly selected between April 2012 and April 2019. They were in stage IIA osseous skeletal Class III malocclusion, treated with maxillary pad movable appliance to relieve the reverse, combined with FR-III functional appliance to maintain a median relationship to stage IIIA. A self-control study of children before and after treatment was used, and paired t-test was used to evaluate the changes in the measurement indexes of the IIA and IIIA stage X-rays and changes in the bone and soft tissue profiles.

Results

After 3 years of treatment, SNA, ANB, and NA-PA in the sagittal osteofacial index of the jawbones increased, SNB decreased, and the Y-axis angle in the vertical index of the jawbones increased. U1-SN, U1-NA, U1-NA distance, L1-MP, L1-NB, and L1-NB distance in the index of labial inclination of upper and lower central incisors increased, while U1-L1 decreased. The sagittal anomalies of the jawbones were improved, and there were significant differences before and after treatment (P < 0.05). FCA, ULP, and UL-EP increased, soft-tissue facial prominence and facial height increased, and the relationship between the upper lip and the aesthetic plane was harmonious. None of the 30 children with skeletal Class III malocclusion in the deciduous stage experienced recurrence in stage IIIA.

Conclusions

Combined treatment with the maxillary pad movable appliance and the FR-III functional appliance is suitable for children with skeletal Class III malocclusion in the deciduous stage.