bluuebunny/crossref_metadata_2025 huggingface dataset:
Fascia Temporalis as Tympanic Graft: A Swedish and German Story
Authors: Mudry Albert
Published: July 2021

Fascia temporalis is the most widely used graft for reconstruction of the tympanic membrane. Its story began at the turn of the 1960s. Some historical reports credit the American otolaryngologist Lloyd A. Storrs (1922–1989), to be the first user of this material in tympanoplasty in 1961. In fact, this is not quite exact. Based only on primary sources, this study demonstrates that Urban Örtegren (1921–1991), a Swedish otolaryngologist in Lund, began using fascia temporalis to reconstruct the tympanic membrane already in 1957. He was followed by Hans Heermann (1900–1996), a German otologist of Essen in 1958. Fascia temporalis as a tympanic graft is thus a Swedish and German story.
Perioperative Outcomes Following Kidney-Pancreas Transplantation in Alberta, Canada: Research Letter
Authors: Fox Danielle E. , Quinn Robert R. , Ronksley Paul E. , Harrison Tyrone G. , Quan Hude , Bigam David , Shapiro A. M. James , Jeong Rachel , Lam Ngan N.
Published: July 2021

Background:

Simultaneous kidney-pancreas transplantation (SPK) has benefits for patients with kidney failure and type I diabetes mellitus, but is associated with greater perioperative risk compared with kidney-alone transplantation. Postoperative care settings for SPK recipients vary across Canada and may have implications for patient outcomes and hospital resource use.

Objective:

To compare outcomes following SPK transplantation between patients receiving postoperative care in the intensive care unit (ICU) compared with the ward.

Design:

Retrospective cohort study using administrative health data.

Setting:

In Alberta, the 2 transplant centers (Calgary and Edmonton) have different protocols for routine postoperative care of SPK recipients. In Edmonton, SPK recipients are routinely transferred to the ICU, whereas in Calgary, SPK recipients are transferred to the ward.

Patients:

129 adult SPK recipients (2002-2019).

Measurements:

Data from the Canadian Institute for Health Information Discharge Abstract Database (CIHI-DAD) were used to identify SPK recipients (procedure codes) and the outcomes of inpatient mortality, length of initial hospital stay (LOS), and the occurrence of 16 different patient safety indicators (PSIs).

Methods:

We followed SPK recipients from the admission date of their transplant hospitalization until the first of hospital discharge or death. Unadjusted quantile regression was used to determine differences in LOS, and age- and sex-adjusted marginal probabilities were used to determine differences in PSIs between centers.

Results:

There were no perioperative deaths and no major differences in the demographic characteristics between the centers. The majority of the SPK transplants were performed in Edmonton (n = 82, 64%). All SPK recipients in Edmonton were admitted to the ICU postoperatively, compared with only 11% in Calgary. There was no statistically significant difference in the LOS or probability of a PSI between the 2 centers (LOS for Edmonton vs Calgary:16 vs 13 days, P = .12; PSIs for Edmonton vs Calgary: 60%, 95% confidence interval [CI] = 0.50-0.71 vs 44%, 95% CI = 0.29-0.59, P = .08).

Limitations:

This study was conducted using administrative data and is limited by variable availability. The small sample size limited precision of estimated differences between type of postoperative care.

Conclusions:

Following SPK transplantation, we found no difference in inpatient outcomes for recipients who received routine postoperative ICU care compared with ward care. Further research using larger data sets and interventional study designs is needed to better understand the implications of postoperative care settings on patient outcomes and health care resource utilization.
Screening for Cognitive Impairment among Community-Dwelling Older Adults: A Comparison of 2 Screening Instruments
Authors: Hobden Breanne , Bryant Jamie , Freund Megan , Clapham Matthew , Sanson-Fisher Rob
Published: July 2021

Introduction

Community aged care services provide support to older adults living in their own homes. Cognitive impairment may increase the complexity of the support required. There is a need to ensure suitable brief screening tools are available to community aged care providers to assess possible cognitive impairment. This study aimed to examine the agreement between 2 validated cognitive impairment screening tools, the Mini-Cog, and Abbreviated Mental Test Score (AMTS), and the perceptions the individuals case manager of Case Manager’s.

Methods

A cross-sectional survey study was undertaken with clients of a community aged care provider. Clients were administered both the screening tools via an electronic survey by their Case Manager.

Results

In total, 158 (54%) eligible participants consented to participate. There was a 70% agreement between the Mini-Cog and AMTS measures, indicating a moderate agreement which was not statistically different from chance (Kappa 0.08, 95% CI −0.04-0.19). Case Managers identified 37% (n = 48/130) of participants as possibly having cognitive impairment, of which, 15% (n = 20) were also identified via a screening tool.

Conclusions

The findings indicate poor agreement across the 3 measures. To ensure adequate supports are offered to those with cognitive impairment, the use of validated tools that can be administered by non-medical staff in a community setting is a priority. This study highlights a need for further work to determine the most suitable tool for use by community-based aged care services.
Color in Context: Three Angles on Contemporary Colorism
Authors: strmic-pawl hephzibah v. , Gonlin Vanessa , Garner Steve
Published: July 2021

Colorism is a form of discrimination based on skin tone wherein people with light(er) complexions are advantaged over those with dark(er) ones. In this review, we define key terms, explore colorism as an individual and structural phenomenon, and identify some predominant themes in the existing scholarship on colorism. We review three case studies of contemporary uses and ramifications of colorism in order to encourage scholars to engage with this important field. These case studies are skin tone’s impact on U.S. politics, “transraciality,” the appropriation of skin tone, and finally, the global skin lightening industry. While the first two are mostly focused on the United States, the third enables an appreciation of the global dynamics of colorism, and links back to the national and regional contextual politics of skin tone.
Teacher’s Reasons for Trust and Distrust in Scientific Evidence: Reflecting a “Smart But Evil” Stereotype?
Authors: Rosman Tom , Merk Samuel
Published: July 2021

We investigate in-service teachers’ reasons for trust and distrust in educational research compared to research in general. Building on previous research on a so-called “smart but evil” stereotype regarding educational researchers, three sets of confirmatory hypotheses were preregistered. First, we expected that teachers would emphasize expertise—as compared with benevolence and integrity—as a stronger reason for trust in educational researchers. Moreover, we expected that this pattern would not only apply to educational researchers, but that it would generalize to researchers in general. Furthermore, we hypothesized that the pattern could also be found in the general population. Following a pilot study aiming to establish the validity of our measures (German general population sample; N = 504), hypotheses were tested in an online study with N = 414 randomly sampled German in-service teachers. Using the Bayesian informative hypothesis evaluation framework, we found empirical support for five of our six preregistered hypotheses.
Characterisation of the clinical phenotype in Phelan-McDermid syndrome
Authors: Burdeus-Olavarrieta Mónica , San José-Cáceres Antonia , García-Alcón Alicia , González-Peñas Javier , Hernández-Jusdado Patricia , Parellada-Redondo Mara
Published: July 2021

Background

Phelan-McDermid syndrome (PMS) is a rare genetic disorder compromising the 22q13 terminal region and affecting SHANK3, a gene crucial to the neurobehavioural phenotype and strongly linked to autism (ASD) and intellectual disability (ID). The condition is characterised by global developmental delay, ID, speech impairments, hypotonia and autistic behaviours, although its presentation and symptom severity vary widely. In this study, we provide a thorough description of the behavioural profile in PMS and explore differences related to deletion size and language ability.

Methods

We used standard clinical assessment instruments to measure altered behaviour, adaptive skills and autistic symptomatology in sixty participants with PMS (30 females, median age 8.5 years, SD=7.1). We recorded background information and other clinical manifestations and explored associations with deletion size. We performed descriptive and inferential analyses for group comparison.

Results

We found delayed gross and fine motor development, delayed and impaired language (~70% of participants non or minimally verbal), ID of different degrees and adaptive functioning ranging from severe to borderline impairment. Approximately 40% of participants experienced developmental regression, and half of those regained skills. Autistic symptoms were frequent and variable in severity, with a median ADOS-2 CSS score of 6 for every domain. Sensory processing anomalies, hyperactivity, attentional problems and medical comorbidities were commonplace. The degree of language and motor development appeared to be associated with deletion size.

Conclusions

This study adds to previous research on the clinical descriptions of PMS and supports results suggesting wide variability of symptom severity and its association with deletion size. It makes the case for suitable psychotherapeutic and pharmacological approaches, for longitudinal studies to strengthen our understanding of possible clinical courses and for more precise genomic analysis.
WGS based analysis of acquired antimicrobial resistance in human and non-human Acinetobacter baumannii isolates from a German perspective
Authors: Wareth Gamal , Brandt Christian , Sprague Lisa D. , Neubauer Heinrich , Pletz Mathias W.
Published: July 2021

Background

Acinetobacter baumanniiability to develop and acquire resistance makes it one of the most critical nosocomial pathogens globally. Whole-genome sequencing (WGS) was applied to identify the acquired or mutational variants of antimicrobial resistance (AMR) genes in 85 GermanA. baumanniistrains utilizing Illumina technology. Additionally, the whole genome of 104 German isolates deposited in the NCBI database was investigated.

Results

In-silicoanalysis of WGS data revealed wide varieties of acquired AMR genes mediating resistance mostly to aminoglycosides, cephalosporins, carbapenems, sulfonamides, tetracyclines and macrolides. In the 189 analyzed genomes, theant(3″)-IIa conferring resistance to aminoglycosides was the most frequent (55%), followed byblaADC.25(38.6%) conferring resistance to cephalosporin,blaOXA-23(29%) and theblaOXA-66variant of the intrinsicblaOXA-51-likes(26.5%) conferring resistance to carbapenems, thesul2 (26%) conferring resistance to sulfonamides, thetet.B (19.5%) conferring resistance to tetracycline, andmph. E andmsr.E (19%) conferring resistance to macrolides.blaTEMvariants conferring resistance to cephalosporins were found in 12% of genomes. Thirteen variants of the intrinsicblaOXA-51carbapenemase gene,blaOXA-510andblaADC-25genes were found in isolates obtained from dried milk samples.

Conclusion

The presence of strains harboring acquired AMR genes in dried milk raises safety concerns and highlights the need for changes in producing dried milk. Acquired resistance genes and chromosomal gene mutation are successful routes for disseminating AMR determinants amongA. baumannii.Identification of chromosomal and plasmid-encoded AMR in the genome ofA. baumanniimay help understand the mechanism behind the genetic mobilization and spread of AMR genes.
Exogenous melatonin improves the salt tolerance of cotton by removing active oxygen and protecting photosynthetic organs
Authors: Jiang Dan , Lu Bin , Liu Liantao , Duan Wenjing , Meng Yanjun , Li Jin , Zhang Ke , Sun Hongchun , Zhang Yongjiang , Dong Hezhong , Bai Zhiying , Li Cundong
Published: July 2021

Background

As damage to the ecological environment continues to increase amid unreasonable amounts of irrigation, soil salinization has become a major challenge to agricultural development. Melatonin (MT) is a pleiotropic signal molecule and indole hormone, which alleviates the damage of abiotic stress to plants. MT has been confirmed to eliminate reactive oxygen species (ROS) by improving the antioxidant system and reducing oxidative damage under adversity. However, the mechanism by which exogenous MT mediates salt tolerance by regulating the photosynthetic capacity and ion balance of cotton seedlings still remains unknown. In this study, the regulatory effects of MT on the photosynthetic system, osmotic modulators, chloroplast, and anatomical structure of cotton seedlings were determined under 0–500 μM MT treatments with salt stress induced by treatment with 150 mM NaCl.

Results

Salt stress reduces the chlorophyll content, net photosynthetic rate, stomatal conductance, intercellular CO2 concentration, transpiration rate, PSII photochemical efficiency, PSII actual photochemical quantum yield, the apparent electron transfer efficiency, stomata opening, and biomass. In addition, it increases non-photochemical quenching. All of these responses were effectively alleviated by exogenous treatment with MT. Exogenous MT reduces oxidative damage and lipid peroxidation by reducing salt-induced ROS and protects the plasma membrane from oxidative toxicity. MT also reduces the osmotic pressure by reducing the salt-induced accumulation of Na+ and increasing the contents of K+ and proline. Exogenous MT can facilitate stomatal opening and protect the integrity of cotton chloroplast grana lamella structure and mitochondria under salt stress, protect the photosynthetic system of plants, and improve their biomass. An anatomical analysis of leaves and stems showed that MT can improve xylem and phloem and other properties and aides in the transportation of water, inorganic salts, and organic substances. Therefore, the application of MT attenuates salt-induced stress damage to plants. Treatment with exogenous MT positively increased the salt tolerance of cotton seedlings by improving their photosynthetic capacity, stomatal characteristics, ion balance, osmotic substance biosynthetic pathways, and chloroplast and anatomical structures (xylem vessels and phloem vessels).

Conclusions

Our study attributes help to protect the structural stability of photosynthetic organs and increase the amount of material accumulation, thereby reducing salt-induced secondary stress. The mechanisms of MT-induced plant tolerance to salt stress provide a theoretical basis for the use of MT to alleviate salt stress caused by unreasonable irrigation, fertilization, and climate change.
Ten-year risk of fatal cardiovascular disease and its association with metabolic risk factors among waste pickers in South Africa
Authors: Made Felix , Nonterah Engelbert A. , Tlotleng Nonhlanhla , Ntlebi Vusi , Naicker Nisha
Published: July 2021

Background

Cardiovascular disease (CVD) is the leading cause of death among non-communicable diseases in South Africa. Several metabolic risk factors contribute to the development of CVD. Informal workers such as waste pickers could be unhealthy lifestyle naive, and most public health research on CVD does not include this understudied population. This study estimated the 10-year risk of fatal CVD and its association with metabolic risk factors in an understudied study population of waste pickers in Johannesburg, South Africa.

Methods

A cross-sectional survey was conducted among waste pickers in two landfill sites in Johannesburg. We used the Systematic Coronary Risk Evaluation (SCORE) risk charts to estimate the 10-year risk of fatal CVD. We then employed ordinary least squares regression to assess the association between the 10-year risk of fatal CVD with metabolic risk factors. Other variables adjusted in the regression model were HIV status, education, income, injuries from work, clinic visits in the previous 12 months, and alcohol consumption.

Results

A total of 370 waste pickers were included in this analysis, 265 (73.41%) were males. The mean age of the participants was 34 years. The majority were between the age of 20 and 39 years. More than 55% of the waste pickers did not visit a clinic in the previous 12 months, and 68.57% were smoking. The 10-year survival probability from CVD was more than 99% for both males and females. In the multivariable regression model, elevated blood glucose showed a non-significant increase in the mean percentage of 10-year risk of fatal CVD. Waste pickers who were overweight/obese, and hypertensive had high statistically significant mean percentages of the 10-year risk of fatal CVD compared to those who did not have the metabolic risk factors.

Conclusions

Prevention of 10-year risk of fatal CVD in this understudied population of waste pickers should target the control of obesity, hypertension, and diabetes. Health awareness and education for waste pickers will be an important step in reducing the burden of these metabolic risk factors. We further recommend that health systems should recognize waste pickers as a high-risk group and consider extensive CVDs surveillance.
A mixed methods study on medicines information needs and challenges in New Zealand general practice
Authors: Campbell Chloë , Braund Rhiannon , Morris Caroline
Published: July 2021

Background

Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners.

Methods

A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method.

Results

Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners’ medicines information needs were identified from the qualitative data: a ‘common core’ related to medicine dose, side effects and interactions and a ‘perplexing periphery’. Challenges in the perplexing periphery were the variation in information needs, complexity, ‘known unknowns’ and ‘unknown unknowns’. Key factors affecting general practitioners’ strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility.

Conclusions

General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.
Combination of tumor markers predicts progression and pathological response in patients with locally advanced gastric cancer after neoadjuvant chemotherapy treatment
Authors: Liu Zining , Wang Yinkui , Shan Fei , Ying Xiangji , Zhang Yan , Li Shuangxi , Jia Yongning , Miao Rulin , Xue Kan , Li Zhemin , Li Ziyu , Ji Jiafu
Published: July 2021

Background

The prognostic values of preoperative tumor markers (TMs) remain elusive in patients with locally advanced gastric cancer (LAGC) after neoadjuvant chemotherapy treatment (NACT). This study aimed to assess and establish a novel scoring system incorporating carcinoembryonic antigen (CEA), carbohydrate antigen 19-9 (CA19-9), carbohydrate antigen 72-4 (CA72-4) to enhance prognostic accuracy for progression-free survival (PFS) and pathological response (pCR).

Methods

Patients' data were retrospectively analyzed from December 2006 to December 2017 in our center. The cutoff value of TMs was determined using the time-dependent receiver operating test characteristics method. These three TMs were allocated 1 point each for the post neoadjuvant chemotherapy combination of tumor markers (post-NACT CTM) scores. The training group comprised 533 patients, responsible for full analysis, and the validation group comprised 137 patients based on the selection protocol.

Results

Of 533 enrolled patients, 138, 233, 117, and 45 patients scored 0, 1, 2, 3 respectively. The 3-year PFS rate Multivariate analysis revealed that post-NACT CTM score was an independent predictor of PFS (0 vs. 1, HR: 1.34, 95% CI: 0.92–1.96, P = 0.128; 0 vs. 2, HR: 2.03, 95% CI: 1.35–3.05, P = 0.001; 0 vs. 3, HR: 2.98, 95% CI: 1.83–4.86, P < 0.001). The time-dependent area under curve (AUC) revealed a consistent highest level for post-NACT CTM than other three single TMs. Lower post-NACT CTM score significantly correlated with higher pCR rate based on multivariate logistic regression (2/3 vs. 1, OR: 2.77, 95% CI: 0.90–8.53, P = 0.077; 2/3 vs. 0, OR: 4.33, 95% CI: 1.38–13.61, P = 0.012). A nomogram was formed with both internal and external validation.

Conclusions

The post-NACT CTM score system served as a strong independent predictor for PFS and pCR in LAGC patients who received NACT. Further population-based studies are required to confirm our results.
Continuous Blood purification on Influenza-Associated Neurological Disease in children: a retrospective cohort study
Authors: Ni Jingwen , Fang Kenan , Zhao Zhe , Wang Zhiyuan , Huang Qian , Li Lele , Yang Guiying , Guo Huizi , Hong Xiaoyang , Li Shujun
Published: July 2021

Background

Due to lack of proven therapies, we evaluated the effect of CBP on Influenza-Associated Neurological Disease in children.

Methods

A single-center, retrospective, cohort study was conducted in Luoyang, Henan province, China from January 2018 to January 2020. Children (<18 years) with influenza-associated neurological disease were enrolled in the study. Children with indications for CBP and parental consent received CBP (Continuous Blood purification), while others received maximal intensive care treatment because of the absence of parental consent. The outcomes of the CBP and non-CBP groups were compared. Categorical variables were presented as percentage and compared by Chi-square test. Continuous variables were expressed as median (interquartile ranges) and compared with non-parametric independent sample test. Statistical analyses were carried out by SPSS (version 26.0) and p < 0.05 (2 tailed) was considered to be statistically significant.

Results

30 children with influenza-associated neurological disease were recruited to the study. 18 received CBP and the other 12 received maximal intensive care. There were no differences between CBP and non-CBP children in age, sex, body weight, type of influenza virus, neurological complications, Glasgow score, PIM-2 score and PCIS at admission (p > 0.05). The inflammatory factors (CRP, PCT and IL-6) of 30 cases were tested at admission and after 3 days of admission. In the CBP group, there was a significant decrease in IL-6 levels at 3 days of admission (p = 0.003) and a decrease in CRP and PCT levels, but no significant difference (p > 0.05). In the non-CBP group, there were no significant difference on levels of CRP, PCT and IL-6 at admission and 3-day of admission (p > 0.05). The 28-day mortality was significantly lower in the CBP group compared with the non-CBP group (11.11% vs. 50%, p = 0.034).

Conclusions

CBP definitely reduces IL-6 levels significantly. We did find that the survival rate of patients in the CBP group was improved. But we don’t know if there is a relationship between the reduction of IL-6 levels and the survival rate. Trial registration: http://www.chictr.org.cn/index.aspx(ChiCTR2000031754).
Atypical histological abnormalities in an adult patient with nephronophthisis harboring NPHP1 deletion: a case report
Authors: Akira Maiko , Suzuki Hitoshi , Ikeda Arisa , Iwasaki Masako , Honda Daisuke , Takahara Hisatsugu , Rinno Hisaki , Tomita Shigeki , Suzuki Yusuke
Published: July 2021

Background

Nephronophthisis (NPHP) is a chronic tubular interstitial disorder that exhibits an autosomal recessive genetic form and causes progressive renal failure in children. Patients with NPHP rarely show urinary abnormalities, edema, or hypertension. Thus, NPHP is often detected only when renal failure becomes advanced. NPHP can be divided into three types based on the age of end-stage renal failure, i.e., infant type (approximately 5 years old), juvenile type (approximately 13–14 years old), and adolescent type (approximately 19 years old). Here, we report a case of NPHP diagnosed by genetic analysis at 26 years of age with atypical histological abnormalities.

Case presentation

A 26-year-old woman showed no growth disorders or urinary abnormalities in annual school physical examinations. However, at a check-up at 26 years old, she exhibited renal dysfunction (eGFR 26 mL/min/1.73 m2). Urine tests indicated low specific gravity of urine, but not proteinuria or microscopic hematuria. Urinary β2-microglobulin was high (805 μg/L), and renal biopsy was performed for definitive diagnosis. Histological findings showed no significant findings in glomeruli. However, moderate fibrosis was observed in the interstitial area, and moderate atrophy was observed in the tubules. There were no significant findings in immunofluorescence analysis, and no electron dense deposits were detected by electron microscopy. Although cyst-like expansion of the tubules was unclear, tubular atrophy was dominantly found in the distal tubule by cytokeratin 7 staining. Genetic analysis of the NPHP1 gene showed complete deletion of this gene, leading to a definitive diagnosis of NPHP.

Conclusions

NPHP is not merely a pediatric disease and is relatively high incidence in patients with adult onset end-stage of renal disease. In this case, typical histological abnormalities, such as cyst-like expansion of the tubular lesion, were not observed, and diagnosis was achieved by genetic analysis of the NPHP1 gene, which is responsible for the onset of NPHP. In patients with renal failure with tubular interstitial disease dominantly in the distal tubules, it is necessary to discriminate NPHP, even in adult cases.
Exploring the malnutrition status and impact of total parenteral nutrition on the outcome of patients with advanced stage ovarian cancer
Authors: Yan Xin , Zhang Sanyuan , Jia Junmei , Yang Jiaolin , Song Yilai , Duan Haoran
Published: July 2021

Background

Ovarian cancer is a common cancer type in women and is often associated with onset of malnutrition. Total parenteral nutrition (TPN) is a nutritional intervention method that has been reported to have controversial effect on cancer patients. In the present retrospective study, we sought to explore the prevalence of malnutrition assessed by the Nutritional Risk Index (NRI) and its association with survival in advanced stage ovarian cancer patients. We also compared the post-operative outcome of the malnourished patients treated with either TPN or conservative management.

Results

A total of 415 patients with advanced stage ovarian cancer were separated into 4 nutrition groups based on the NRI scores. We found that a number of factors were significantly different among the 4 nutrition groups, including age, serum albumin level, BMI and NRI; among which serum albumin level and NRI were identified to be independent predictors of progression-free and overall survival. In the moderately and severely malnourished patients, those who were treated with TPN had significantly shorter hospitalization period, lower serum albumin level and lower BMI after surgery. In addition, serum albumin level, use of TPN and number of patients with complications were closely related to the hospital stay duration.

Conclusion

Malnutrition status is closely associated with survival of advanced stage ovarian cancer patients. These patients may benefit from TPN treatment for reduced hospitalization, especially with the onset of hypoalbuminemia.
PreserFlo MicroShunt® exposure: a case series
Authors: Bunod Roxane , Robin Mathieu , Buffault Juliette , Keilani Chafik , Labbé Antoine , Baudouin Christophe
Published: July 2021

Background

PreserFlo® MicroShunt (PM) (also known as InnFocus® MicroShunt) is a subconjunctival stent implanted ab externo via a minimally invasive surgical procedure. The current indication is progressive, mild to moderate, open angle glaucoma uncontrolled on topical medications. According to the literature, adverse events are rare, mild and transient.

Case presentation

Two cases of stand-alone PreserFlo MicroShunt® implantation in patients with uncontrolled open-angle glaucoma are reported. Exposure occurred 7 days and 3 months respectively after implantation. These cases shared common features including preexisting blepharitis and the lack of a Tenon’s flap. In both cases, removal of the device was required after several attempts at repair.

Conclusions

PreserFlo MicroShunt® exposure is a potentially vision-threatening complication because of the risk of endophthalmitis. Potential risk factors include the absence of a Tenon’s flap and pre-existing ocular surface inflammation. Ocular surface inflammation should be detected and treated prior to PM implantation. If a deficiency in Tenon’s capsule is noted intraoperatively, close monitoring should be performed because of the higher risk of PM exposure.
Effect of socioeconomic characteristics and lifestyle on BMI distribution in the Chinese population: a population-based cross-sectional study
Authors: Wang Weihua , Qiu Lin , Sa Rina , Dang Shaonong , Liu Feng , Xiao Xiang
Published: July 2021

Background

Body mass index (BMI) is an accepted measurement that is widely used to quantify overweight and obesity at the population level. Previous studies have described the distribution variation of BMI through applying common statistical approaches, such as multiple linear or logistic regression analyses. This study proposed that associations between BMI and socioeconomic characteristics, diet, and lifestyle factors varied across the conditional BMI distribution.

Methods

This study was based on a sample of 10,023 Chinese adults who participated in the monitoring of chronic diseases and associated risk factors in Shaanxi Province, Northwest China, in 2013. Cross-quantile factors were observed in the relationships between major risk factors and BMI through quantile regression (QR) and ordinary least squares (OLS) regression.

Results

Participants’ mean BMI was 24.19 ± 3.51 kg/m2 (range 14.33–52.82 kg/m2). The QR results showed that living in urban areas was associated with BMI in the low and central quantiles (10th–60th). Participants with 6–9 years of education were 0.23–0.38 BMI units higher in the first half of the BMI quantiles compared with those with ≤6 years of education. There was a positive association between consumption of red meat and BMI; however, the association diminished from the 10th to the 50th quantile. Intake of oil and alcohol were positively associated with all BMI quantiles. Cigarette smoking per day was negatively associated with BMI, which showed a U-shaped distribution. The above results were also observed in the OLS.

Conclusion

This study implies that in addition to socioeconomic characteristics, limiting oil and alcohol intake may decrease BMI score. Consuming more red meat could be a strategy to increase BMI.
Quality of life during the epidemic of COVID-19 and its associated factors among enterprise workers in East China
Authors: Chen Xiaoxiao , Xu Qian , Lin Haijiang , Zhu Jianfu , Chen Yue , Zhao Qi , Fu Chaowei , Wang Na
Published: July 2021

Background

The COVID-19 related lockdown and home confinement might have an important impact on the quality of life in enterprise workers. We investigated the quality of life during the epidemic in enterprise workers who just returned to work, and assessed its potential influencing factors to have a better understanding of the impact of COVID-19 epidemic lockdown and home confinement.

Methods

This was a cross-sectional study of enterprise workers conducted in Deqing and Taizhou, Zhejiang Province, China. The Chinese version of EQ5D was used to assess life quality, and information about general characteristics and COVID-19 related factors was collected by a structured questionnaire, which was distributed through the social application “WeChat”. Multiple liner regression was used to investigate potential influencing factors.

Results

A total of 2420 participants were enrolled, 59.5% of which worked in Deqing. About 50% of the participants reported worries about the COVID-2019 epidemic and 40.2% had a centralized or home quarantine during the epidemic. The mean EQ-5D score and VAS were 0.990 and 93.5. Multiple liner regression showed that the quality of life measures was related to physical activities (β = 0.006) and keeping home ventilation (β = 0.063) in Deqing, and were related to wearing a mask when going out (β = 0.014), keeping home ventilation (β = 0.061), other marital status (β = − 0.011), worry about the epidemic (β = − 0.005) and having a centralized or home quarantine (β = − 0.005) in Taizhou.

Conclusions

The quality of life for returning enterprise workers in areas with different risks of COVID-19 was affected by different factors. Associated factors identified from this study would help develop proper intervention measures for enterprise workers to reduce the impact of large-scale public health events like the COVID-19 on their quality of life.
Mental health impact among hospital staff in the aftermath of the Nice 2016 terror attack: the ECHOS de Nice study
Authors: Bentz Laurence , Vandentorren Stéphanie , Fabre Roxane , Bride Jeremy , Pirard Philippe , Doulet Nadège , Baubet Thierry , Motreff Yvon , Pradier Christian
Published: July 2021

Background

The Nice terror attack of July 14, 2016 resulted in 84 deaths and 434 injured, with many hospital staff exposed to the attack, either as bystanders on site at the time of the attack (‘bystander exposure’) who may or may not have provided care to attack victims subsequently, or as care providers to victims only (‘professional exposure only’). The objective of this study is to describe the impact on mental health among hospital staff by category of exposure with a particular focus on those with ‘professional exposure only’, and to assess their use of psychological support resources.

Method

An observational, cross-sectional, multicenter study conducted from 06/20/2017 to 10/31/2017 among all staff of two healthcare institutions in Nice, using a web questionnaire. Collected data included social, demographic and professional characteristics; trauma exposure category (‘bystanders to the attack’; ‘professional exposure only’; ‘unexposed’); indicators of psychological impact (Hospital Anxiety and Depression Scale); PTSD (PCL-5) level; support sought. Responders could enter open comments in each section of the questionnaire, which were processed by inductive analysis.

Results

804 staff members’ questionnaires were analysed. Among responding staff, 488 were exposed (61%): 203 were ‘bystanders to the attack’, 285 had ‘professional exposure only’. The staff with ‘professional exposure only’ reported anxiety (13.2%), depression (4.6%), suicidal thoughts (5.5%); rates of full PTSD was 9.4% and of partial PTSD, 17.7%. Multivariate analysis in the ‘professional exposure only’ category showed that the following characteristics were associated with full or partial PTSD: female gender (OR = 2.79; 95% CI = 1.19–6.56, p = 0.019); social isolation (OR = 3.80; 95% CI = 1.30–11.16, p = 0.015); having been confronted with an unfamiliar task (OR = 3.04; 95% CI = 1.18–7.85; p = 0.022). Lastly, 70.6% of the staff with ‘professional exposure only’ with full PTSD did not seek psychological support.

Conclusion

Despite a significant impact on mental health, few staff with ‘professional exposure only’ sought psychological support. Robust prevention and follow-up programs must be developed for hospital staff, in order to manage the health hazards they face when exposed to exceptional health-related events such as mass terror attacks.

Study registration

Ethical approval for the trial was obtained from the National Ethics Committee for Human Research (RCBID N° 2017-A00812–51).
Efficacy of early antifibrotic treatment for idiopathic pulmonary fibrosis
Authors: Sugino Keishi , Ono Hirotaka , Watanabe Natsumi , Ando Masahiro , Tsuboi Eiyasu , Homma Sakae , Kishi Kazuma
Published: July 2021

Background

Although antifibrotic drugs, including nintedanib and pirfenidone, slow the progression of idiopathic pulmonary fibrosis (IPF), there is little data about the timing of start of antifibrotic treatment in real-world clinical practice. The present study aimed to clarify the efficacy of nintedanib and pirfenidone in patients with early-stage IPF.

Methods

We compared survival and disease progression between patients with IPF with Japanese Respiratory Society (JRS) disease severity system stage I with and without oxygen desaturation on the 6-min walk test (6MWT) and increased the gender–age–physiology (GAP) staging. We examined the efficacy of antifibrotic drugs in patients with early-stage IPF.

Results

The severity of stage I IPF (n = 179) according to the JRS criteria consisted of the following GAP staging criteria: stage I, 111 cases; stage II, 58 cases; stage III, 10 cases. The duration from the initial visit to disease progression and survival time was significantly shorter in JRS stage I patients with oxygen desaturation on the 6MWT or with increased GAP staging (unfavorable group) compared with patients without those factors. In the unfavorable group, the relative decline in percentage predicted forced vital capacity (%FVC) over 6 months was significantly lower in patients undergoing antifibrotic treatment compared with non-treated patients.

Conclusion

Antifibrotic drugs have a beneficial effect on the decline in %FVC in Japanese patients with early-stage IPF who have oxygen desaturation on the 6MWT or increased GAP staging.
IL-6 expression helps distinguish Castleman’s disease from IgG4-related disease in the lung
Authors: Kinugawa Yasuhiro , Uehara Takeshi , Iwaya Mai , Asaka Shiho , Kobayashi Shota , Nakajima Tomoyuki , Komatsu Masamichi , Yasuo Masanori , Yamamoto Hiroshi , Ota Hiroyoshi
Published: July 2021

Background

It is difficult to distinguish between multicentric Castleman’s disease (MCD) and IgG4-related lung disease (IgG4-LD), an IgG4-related disease (IgG4-RD) in the lung.

Methods

We focused on IL-6, which is elevated in MCD, to distinguish between MCD and IgG4-LD by RNAscope, a highly sensitive RNA in situ method. Six cases of MCD and four cases of IgG4-LD were selected.

Results

In all cases of MCD and IgG4-LD, 10 or more IgG4-positive cells were found in one high-power field. All MCD cases were inconsistent with the pathological IgG4-related comprehensive diagnostic criteria, but 2 of 6 cases had an IgG4/IgG ratio greater than 40%. In all IgG4-LD cases, histological features were consistent with the pathological IgG4-RD comprehensive diagnostic criteria. IL-6 expression was observed in all MCD and IgG4-LD cases except for one IgG4-LD biopsy. IL-6-expressing cells were mainly identified in the stroma. Sites of IL-6 expression were not characteristic and were sparse. IL-6 expression tended to be higher in MCD compared with IgG4-LD. A positive correlation was found between the IL-6 H-score and serum IL-6 level.

Conclusion

Differences in IL-6 expression may help distinguish between MCD and IgG4-LD. In addition, the presence of high IL-6 levels may help elucidate the pathological mechanisms of IgG4-LD.
Reoperations after fusion surgeries for degenerative spinal diseases depending on cervical and lumbar regions: a national database study
Authors: Park Moon Soo , Ju Young-Su , Moon Seong-Hwan , Kim Young-Woo , Jung Jong Ho , Oh Jung Hyun , Kim Chi Heon , Chung Chun Kee
Published: July 2021

Background

Reoperation is one of the key factors affecting postoperative clinical outcomes. The reoperation rates of cervical surgeries might be different from those of lumbar surgeries due to the anatomical and biomechanical differences. However, there has been no study to compare the reoperation rate between them. The purpose is to compare reoperation rates after fusion surgeries for degenerative spinal diseases depending on the anatomic region of cervical and lumbar spines.

Method

We used the Korean Health Insurance Review & Assessment Service national database. Subjects were included if they had any of the primary procedures of fusion combined with the procedure of decompression procedures under the diagnosis of degenerative diseases (n = 42,060). We assigned the patients into two groups based on anatomical regions: cervical and lumbar fusion group (n = 11,784 vs 30,276). The primary endpoint of reoperation was the repeat of any aforementioned fusion procedures. Age, gender, presence of diabetes, associated comorbidities, and hospital types were considered potential confounding factors.

Results

The reoperation rate was higher in the patients who underwent lumbar fusion surgery than in the patients who underwent cervical fusion surgery during the entire follow up period (p = 0.0275). A similar pattern was found during the late period (p = 0.0468). However, in the early period, there was no difference in reoperation rates between the two groups. Associated comorbidities and hospital type were noted to be risk factors for reoperation.

Conclusions

The incidence of reoperation was higher in the patients who underwent lumbar fusion surgery than those who underwent cervical fusion surgery for degenerative spinal diseases.
TELD with limited foraminoplasty has potential biomechanical advantages over TELD with large annuloplasty: an in-silico study
Authors: Li Jingchi , Xu Chen , Zhang Xiaoyu , Xi Zhipeng , Liu Mengnan , Fang Zhongxin , Wang Nan , Xie Lin , Song Yueming
Published: July 2021

Background

Facetectomy, an important procedure in the in–out and out–in techniques of transforaminal endoscopic lumbar discectomy (TELD), is related to the deterioration of the postoperative biomechanical environment and poor prognosis. Facetectomy may be avoided in TELD with large annuloplasty, but iatrogenic injury of the annulus and a high grade of nucleotomy have been reported as risk factors influencing poor prognosis. These risk factors may be alleviated in TELD with limited foraminoplasty, and the grade of facetectomy in this surgery can be reduced by using an endoscopic dynamic drill.

Methods

An intact lumbo-sacral finite element (FE) model and the corresponding model with adjacent segment degeneration were constructed and validated to evaluate the risk of biomechanical deterioration and related postoperative complications of TELD with large annuloplasty and TELD with limited foraminoplasty. Changes in various biomechanical indicators were then computed to evaluate the risk of postoperative complications in the surgical segment.

Results

Compared with the intact FE models, the model of TELD with limited foraminoplasty demonstrated slight biomechanical deterioration, whereas the model of TELD with large annuloplasty revealed obvious biomechanical deterioration. Degenerative changes in adjacent segments magnified, rather than altered, the overall trends of biomechanical change.

Conclusions

TELD with limited foraminoplasty presents potential biomechanical advantages over TELD with large annuloplasty. Iatrogenic injury of the annulus and a high grade of nucleotomy are risk factors for postoperative biomechanical deterioration and complications of the surgical segment.
Effects of non-surgical periodontal therapy on periodontal clinical data in periodontitis patients with rheumatoid arthritis: a meta-analysis
Authors: Huang Yu , Zhang Zheng , Zheng Youli , Zhao Zhulan , Zhong Yang , Zhang Qingyu , Xia Degeng , Ma Ning , Zhang Li
Published: July 2021

Backgrounds

To date, there is still no consensus about the clinical efficacy of non-surgical periodontal therapy in rheumatoid arthritis (RA) patients with periodontitis. Therefore, the aim of this study was to summarize clinical data regarding the efficacy of scaling and root planing (SRP) in patients with RA and periodontitis compared to non-RA periodontitis patients.

Methods

We selected randomized controlled trials (RCTs) that compared periodontal clinical data in RA as compared to non-RA periodontitis patients by searching Embase, PubMed and Cochrane Central Register of Controlled Trials and by manually retrieving from the earliest records to March 8, 2021. The overall effect size of plaque index (PI), gingival index (GI), attachment loss (AL), probing depth (PD) and bleeding on probing (BOP) were calculated by either a fixed or random-effect model, and subgroup analyses were conducted according to the different time points of follow-up. Two investigators extracted the data and assess the accuracy of the obtained results with 95% of Confidence Intervals (CI). Cochrane Collaboration's tool was responsible for the evaluation of the literature quality and the inter-study heterogeneity was evaluated by Q test and I2 statistic. Sensitivity analyses were applied for results with heterogeneity. Publication bias was determined by Begg's test, Egger's test and the trim-and-fill method.

Results

Seven RCTs including 212 patients eventually met the inclusion criteria for the study. As the primary results, the change of PD was not statistically significant and in the secondary results changes of PI, GI, AL and BOP were also not statistically significant in RA patients with periodontitis compared to non-RA periodontitis patients. In subgroup analysis, a larger BOP reduction at 3 months, PI and AL reduction at 6 months were observed in patients with RA and periodontitis group. The results of sensitivity analyses had no significant effect. No evidence of potential publication bias was tested. There were some limitations due to the small number of eligible RCTs.

Conclusions

SRP is equally effective in RA as compared to non-RA periodontitis patients. It suggests RA does not affect the clinical efficacy of non-surgical periodontal therapy. These results could serve evidence-based practice.