bluuebunny/crossref_metadata_2025 huggingface dataset:
Intersectional Stigma, Identity, and Culture: A Grounded Theory of Female Escort Perspectives from Brazil and Pakistan
Authors: Brooks-Gordon Belinda , Poli Nasra
Published: September 2020

Intersectional experiences, socio-cultural meanings, ethnic traditions and morals compound stigma-related stress (Jackson et al., 2020; Schmitz 2019). Sex workers are subject to various stigmatizing forces which can lead to secrecy, isolation and lack of social and cultural support (Koken 2012). Stigmatizing forces include structural humanitarian governance and aid interventions that conflate migration and sex work with insidious constraints and coercion. This study explored how migrant female sex workers from distinctive ethnic cultures manage their identity on a day to day basis in relation to the separation of work and home life. Methods: The perspectives of female sex workers were collected via a series of in-depth semi-structured interviews. The inclusion criteria were that the women had worked in sex work for over 18months, defined their involvement in sex work as voluntary, and were over 18yrs of age. The perspectives of seven women from South Asian (Pakistani), Brazilian, and British backgrounds were analyzed using Grounded Theory (Glaser and Strauss, 1967). Ethnicity was considered to explore how the women experienced stigma, how it impacted on the management of their identity, and how the process of change occurred. Results: The women used a variety of methods to maintain work and home life boundaries, processes they used switch into a role and all experienced stigma and tried to deal with it in ways such as concealment from friends and family. Two core categories and properties emerged from the data as participants felt guilt and/or shame but only the South Asian participants spoke of this with reference to their culture and religion. Conclusion: It was not migration per se but rather the relationship of migration to culture that was key to identity management. Participants reflected that as their country was considered collectivist country with interdependent thought, that any negativity felt could not only be reflected on the individual, but also the entire family. For these reasons Pakistani sex workers were subject to more complex stigmatizing forces, shame and guilt as regards risk and exposure. Discussion focusses on the processes and management strategies used to extend social and cultural support.
Integrated Impact Assessment of Active Travel: Expanding the Scope of the Health Economic Assessment Tool (HEAT) for Walking and Cycling
Authors: Götschi Thomas , Kahlmeier Sonja , Castro Fernandez Alberto , Brand Christian , Cavill Nick , Kelly Paul , Lieb Christoph , Rojas Rueda David , Woodcock James , Racioppi Francesca
Published: September 2020

The World Health Organization’s Health Economic Assessment Tool (HEAT) for walking and cycling is a user-friendly web-based tool to assess health impacts of active travel. HEAT, developed over 10 years ago, has been used by researchers, planners and policymakers alike in appraisals of walking and cycling policies of both national and more local scales. HEAT has undergone regular upgrades adopting the latest scientific evidence. This article presents the most recent upgrades of the tool. Health impacts of walking and/or cycling in a specified population are quantified in terms of premature deaths avoided (or caused). In addition to the calculation of benefits from physical activity, HEAT was recently expanded to include assessments of the burden associated with air pollution exposure and crash risks while walking or cycling. Further, impacts on carbon emissions from mode shift to active travel modes can now be assessed. Monetization of impacts using Value of Statistical Life and Social Costs of Carbon now uses country-specific values. As active travel inherently results in often substantial health benefits as well as not always negligible risks, assessments of active travel behaviour or policies are incomplete without considering health implications. The recent developments of HEAT make it easier than ever to obtain ballpark estimates of health impacts and carbon emissions related to walking and cycling.
Outcome of Sacropelvic Resection and Reconstruction Based on a Novel Classification System
Authors: Houdek Matthew T. , Wellings Elizabeth P. , Moran Steven L. , Bakri Karim , Dozois Eric J. , Mathis Kellie L. , Yaszemski Michael J. , Sim Franklin H. , Rose Peter S.
Published: September 2020

Background:

Sacral tumor resections require a multidisciplinary approach to achieve a cure and a functional outcome. Currently, there is no accepted classification system that provides a means to communicate among the multidisciplinary teams in terms of approach, osseous resection, reconstruction, and acceptable functional outcome. The purpose of this study was to report the outcome of sacral tumor resection based on our classification system.

Methods:

In this study, 196 patients (71 female and 125 male) undergoing an oncologic en bloc sacrectomy were reviewed. The mean age (and standard deviation) was 49 ± 16 years, and the mean body mass index was 27.2 ± 6.4 kg/m2. The resections included 130 sarcomas (66%). The mean follow-up was 7 ± 5 years.

Results:

Resections included total sacrectomy (Type 1A: 20 patients [10%]) requiring reconstruction, subtotal sacrectomy (Type 1B: 5 patients [3%]) requiring reconstruction, subtotal sacrectomy (Type 1C: 104 patients [53%]) not requiring reconstruction, hemisacrectomy (Type 2: 29 patients [15%]), external hemipelvectomy and hemisacrectomy (Type 3: 32 patients [16%]), total sacrectomy and external hemipelvectomy (Type 4: 5 patients [3%]), and hemicorporectomy (Type 5: 1 patient [1%]). The disease-specific survival was 66% at 5 years and 52% at 10 years. Based on the classification, the 5-year disease-specific survival was 34% for Type 1A, 100% for Type 1B, 71% for Type 1C, 65% for Type 2, 57% for Type 3, 100% for Type 4, and 100% for Type 5 (p < 0.001). Tumor recurrence occurred in 67 patients, including isolated local recurrence (14 patients), isolated metastatic disease (31 patients), and combined local and metastatic disease (22 patients). At 5 years, the local recurrence-free survival was 77% and the metastasis-free survival was 68%. Complications occurred in 153 patients (78%), most commonly wound complications (95 patients [48%]). Following the procedure, 154 patients (79%) were ambulatory, and the mean Musculoskeletal Tumor Society (MSTS93) score was 60% ± 23%.

Conclusions:

Although resections of sacral malignancies are associated with complications, they can be curative in a majority of patients, with a majority of patients ambulatory with an acceptable functional outcome considering the extent of the resection. At our institution, this classification allows for communication between surgical teams and implies a surgical approach, staging, reconstruction, and potential functional outcomes.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Determining Diagnostic Thresholds for Acute Postoperative Periprosthetic Joint Infection
Authors: Sukhonthamarn Kamolsak , Tan Timothy L. , Xu Chi , Kuo Feng-Chih , Lee Mel S. , Citak Mustafa , Gehrke Thorsten , Goswami Karan , Parvizi Javad
Published: September 2020

Background:

The diagnosis of periprosthetic joint infection (PJI) in the early postoperative period remains a challenge. Although studies have established that serum C-reactive protein (CRP) and synovial markers may be useful, recent studies have suggested that the current thresholds used may lack sensitivity. The purpose of this study was to examine the role of serum CRP, erythrocyte sedimentation rate (ESR), synovial fluid white blood-cell (WBC) count, and polymorphonuclear neutrophil (PMN) percentage in the diagnosis of acute postoperative PJI and to identify the optimal threshold.

Methods:

This multicenter study included patients who were investigated for possible PJI within 90 days of an index arthroplasty. This study included 197 patients from 4 institutions who underwent total joint arthroplasty from 2000 to 2017. Of these patients, 123 were confirmed to have PJI, and 74 were ruled out as not having PJI (non-infected group). Analyses of receiver operating characteristic (ROC) curves and the area under the curve were performed to determine the value of each test and optimal cutoff values.

Results:

The optimal cutoff value was 6,130 cells/μL for synovial fluid WBC count (91% sensitivity and 83% specificity), 39.8 mg/L for serum CRP (91% sensitivity and 87% specificity), 39.5 mm/hr for ESR (76% sensitivity and 67% specificity), and 79.5% for PMN percentage (95% sensitivity and 59% specificity). Reducing the acute period from 90 days to 30 days or 45 days made little difference in most threshold values. However, the optimal cutoff for synovial fluid WBC count was almost twice as high (10,170 cells/μL) when using a 30-day definition instead of a 90-day definition.

Conclusions:

The calculated cutoffs in our study were substantially lower than the thresholds used by the Musculoskeletal Infection Society. The calculated values of this study should be used, as previous cutoffs may be too high and lack sensitivity. In addition, it appears that the threshold values, at least for some of the tests, change as the duration since the index arthroplasty lengthens. A continuum of threshold values that is dependent on the number of days since the index arthroplasty may need to be used for the diagnosis of acute PJI.

Level of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Assessment of Mitochondrial Dysfunction in a Murine Model of Supraspinatus Tendinopathy
Authors: Zhang Xueying , Wada Susumu , Zhang Ying , Chen Daoyun , Deng Xiang-Hua , Rodeo Scott A.
Published: September 2020

Background:

The purpose of this study was to assess mitochondrial dysfunction in a murine model of supraspinatus tendinopathy.

Methods:

Eighty-four mice (168 limbs) were included in the study. Supraspinatus tendinopathy was induced by inserting a microsurgical clip in the subacromial space of 63 mice bilaterally (126 limbs). Forty-two of these limbs were harvested at 4 weeks postoperatively, 42 underwent clip removal at 4 weeks after the initial procedure and were harvested at 2 weeks, and 42 underwent clip removal at 4 weeks and were harvested at 4 weeks. Forty-two limbs in the remaining 21 mice did not undergo surgical intervention and were utilized as the control group. Outcomes included biomechanical, histological, gene expression, superoxide dismutase (SOD) activity, and transmission electron microscopy (TEM) analyses.

Results:

Radiographs confirmed stable clip position in the subacromial space at 4 weeks. Biomechanical testing demonstrated a 60% decrease in failure force of the supraspinatus tendons at 4 weeks compared with the control group. The failure force gradually increased at 2 and 4 weeks after clip removal. Histological analysis demonstrated inflammation surrounding the tendon with higher modified Bonar scores at 4 weeks after clip placement followed by gradual improvement following clip removal. The expression of mitochondrial-related genes was decreased at 4 weeks after clip placement and then significantly increased after clip removal. SOD activity decreased significantly at 4 weeks after clip placement but increased following clip removal. TEM images demonstrated alterations in morphology and the number of mitochondria and cristae at 4 weeks after clip placement with improvement after clip removal.

Conclusions:

Mitochondrial dysfunction appears to be associated with the development of tendinopathy.

Clinical Relevance:

Mitochondrial protection may offer a potential strategy for delaying the development of tendinopathy and promoting tendon healing.
Interpreting Patient-Reported Outcome Measures in Orthopaedic Surgery
Authors: Docter Shgufta , Fathalla Zina , Lukacs Michael J. , Khan Michaela C.M. , Jennings Morgan , Liu Shu-Hsuan , Dong Susan , Getgood Alan , Bryant Dianne M.
Published: September 2020

Background:

The Consolidated Standards of Reporting Trials (CONSORT) Statement recommends that studies report results beyond p values and include treatment effect(s) and measures of precision (e.g., confidence intervals [CIs]) to facilitate the interpretation of results. The objective of this systematic review was to assess the reporting and interpretation of patient-reported outcome measure (PROM) results in clinical studies from high-impact orthopaedic journals, to determine the proportion of studies that (1) only reported a p value; (2) reported a treatment effect, CI, or minimal clinically important difference (MCID); and (3) offered an interpretation of the results beyond interpreting a p value.

Methods:

We included studies from 5 high-impact-factor orthopaedic journals published in 2017 and 2019 that compared at least 2 intervention groups using PROMs.

Results:

A total of 228 studies were analyzed, including 126 randomized controlled trials, 35 prospective cohort studies, 61 retrospective cohort studies, 1 mixed cohort study, and 5 case-control studies. Seventy-six percent of studies (174) reported p values exclusively to express and interpret between-group differences, and only 22.4% (51) reported a treatment effect (mean difference, mean change, or odds ratio) with 95% CI. Of the 54 studies reporting a treatment effect, 31 interpreted the results using an important threshold (MCID, margin, or Cohen d), but only 3 interpreted the CIs. We found an absolute improvement of 35.5% (95% CI, 20.8% to 48.4%) in the reporting of the MCID between 2017 and 2019.

Conclusions:

The majority of interventional studies reporting PROMs do not report CIs around between-group differences in outcome and do not define a clinically meaningful difference. A p value cannot effectively communicate the readiness for implementation in a clinical setting and may be misleading. Thus, reporting requirements should be expanded to require authors to define and provide a rationale for between-group clinically important difference thresholds, and study findings should be communicated by comparing CIs with these thresholds.
Anterior Cruciate Ligament Repair: The Current Status
Authors: Hughes Jonathan D. , Lawton Cort D. , Nawabi Danyal H. , Pearle Andrew D. , Musahl Volker
Published: September 2020

Update

This article was updated on December 31, 2020, because of a previous error. On page 1911, in the section entitled “Short-Term Clinical Results,” the sentence that had read “An ongoing, nonrandomized cohort study has been comparing the BEAR procedure with ACL reconstruction using hamstring autograft14,67.” now reads “An ongoing, nonrandomized cohort study has been comparing the BEAR procedure with ACL reconstruction using hamstring autograft14.”

An erratum has been published: J Bone Joint Surg Am. 2021 Feb 3;103(3):e14.

➤ Failure rates for anterior cruciate ligament (ACL) repair are greater than those for ACL reconstruction.

➤ There are no long-term outcome studies for ACL repairs, as far as we know, and postoperative protocols including physical therapy progression and return-to-play criteria following ACL repair have not been established.

➤ There are currently insufficient data to support utilization of ACL repair in all patients and tear types.

➤ ACL reconstruction remains the gold standard surgical option for patients with ACL tears.
ANALISIS EKONOMI DAN KELAYAKAN LINGKUNGAN PENERAPAN GREEN SUPPLY CHAIN MANAGEMENT (GSCM) PADA PRODUKSI SUSU
Authors: Suryaningrat Ida Bagus , Novita Elida , Kurniaputeri Rika Dwi
Published: September 2020

In milk processing, supply chain activities were started fromthe procurement of raw materials, milking cows, milkprocessing, marketing of dairy products, and wastemanagement. The purposes of this study were to analyzeeconomical aspect, and to study environmental aspect onGSCM implementation in CV. MUER. Direct survey anddisccussion, environmetal indicators and economicalanalysis were implemented in this study. The results of studyfound that the use of water for cage cleansing was 3600liters, number of feeding was 2265.57kg, milking productionwas 550 liters, the water usage for washing tools was 250liters. The assessment of environmental indicators using 13indicators found that this unit has score of 30 means thatCV. MUER has implemented most of the GSCM conceptsalong the supply chain of milk production. Other resultshowed that the amount of contamination (COD and BODvalue) in the milk processing was higher than govermentregulation standard. In term of economical analysis shownthat NPV value was Rp.2.723.162.185, IRR 36.99%, and B /C ratio was 1.48. This means that the value of NPV wasgreater than zero, IRR was greater than the bank interestrate (equal to 10%), and B/C ratio was greater than 1, thisindicated that based on environmental and economicalaspect, GSCM has a high feasibility to be implemented inCV. MUER.In milk processing, supply chain activities were started fromthe procurement of raw materials, milking cows, milkprocessing, marketing of dairy products, and wastemanagement. The purposes of this study were to analyzeeconomical aspect, and to study environmental aspect onGSCM implementation in CV. MUER. Direct survey anddisccussion, environmetal indicators and economicalanalysis were implemented in this study. The results of studyfound that the use of water for cage cleansing was 3600liters, number of feeding was 2265.57kg, milking productionwas 550 liters, the water usage for washing tools was 250liters. The assessment of environmental indicators using 13indicators found that this unit has score of 30 means thatCV. MUER has implemented most of the GSCM conceptsalong the supply chain of milk production. Other resultshowed that the amount of contamination (COD and BODvalue) in the milk processing was higher than govermentregulation standard. In term of economical analysis shownthat NPV value was Rp.2.723.162.185, IRR 36.99%, and B /C ratio was 1.48. This means that the value of NPV wasgreater than zero, IRR was greater than the bank interestrate (equal to 10%), and B/C ratio was greater than 1, thisindicated that based on environmental and economicalaspect, GSCM has a high feasibility to be implemented inCV. MUER.
KARAKTERISTIK PENGERINGAN KELAPA PARUT MENGGUNAKAN ALAT PENGERING SILINDER TIPE RAK
Authors: Kurniawan Hary , Muiz Abdul , Mbele Muhamad Ikhsan Febriyanto , Dini Rizka Okta , Baskara Zulhan Widya
Published: September 2020

Desiccated coconut is one of the diversification of coconut products which is cut into pieces or grated into small pieces and dried, white, sweet taste and distinctive odor. The purpose of this study was to determine the drying characteristics of desiccated coconut using a cylindrical dryer. Eight trays, each containing 350 grams of grated coconut, were arranged on a tray and measured the air temperature in the drying chamber, the temperature of the material, as well as the moisture content of the material during drying both on the top rack, middle rack and bottom rack. The results showed that the air temperature in the drying chamber and the temperature of the material were significant, and moisture content during drying of materials both on the top rack, middle rack and bottom are relatively significant. The constant rate of drying of grated coconut on the upper rack, middle rack and lower rack is 0.1306 - 1338 minutes-1. The predicted value of grated coconut water content shows that it is almost close to the observed water content value, which is marked by a coefficient of determination that is close to 1.
Proportion of unplanned pregnancies, their determinants and health outcomes of women delivering at a teaching hospital in Sri Lanka
Authors: Ranatunga Jayani Chalindra , Jayaratne Kapila
Published: September 2020

Background Unplanned pregnancy is a significant public health issue in both low- and high-income countries. The burden of unplanned pregnancy is reflected in women opting for pregnancy terminations and it can be detrimental to the women and her family as well as the health system and society. Solid data on the proportion of unplanned pregnancies are using more specific tools such as the London Measure of Unplanned Pregnancy (LMUP) needed to address the issue in Sri Lankan contexts. The objective was to describe the proportion of unplanned pregnancies, their determinants and the health outcomes of women delivering at Colombo North Teaching Hospital-Ragama (CNTH). Methods A cross-sectional study was carried out among 494 consecutive pregnant women selected by non-probability consecutive sampling who were admitted for the confinement at CNTH. A pre-tested structured interviewer-administered questionnaire was used to collect data on antenatal women and intentionality measured by self-administered six-item LMUP. Maternal and newborn health outcomes were ascertained in each post-partum women before discharge. Data were analyzed with the Mann-Whitney U tests, Kruskal-Wallis tests and spearman rank correlation. We also evaluated the psychometric properties of the Sinhalese version of LMUP. Results The response rate was 97.8% and 17.2% of pregnancies ending at birth were unplanned, 12.7% were ambivalent and 70.1% were planned.Associated factor profile of women with unplanned pregnancies includes; not married women (p=0.001), educated up to the passing of GCE ordinary level by women (p<0.001) and spouse (p<0.001), primiparity (p=0.002) and inadequate knowledge on emergency contraceptives (p=0.037). Less planned pregnancies were also significantly associated with anemia (p=0.004), low mood for last two weeks (p<0.001), having a partner with problematic alcohol consumption (p<0.001), presence of Gender-Based Violence (GBV) (p<0.001), poor relationship satisfaction with partner (p<0.001) and family (p<0.001). Inadequate pre-pregnancy preparation and antenatal care were associated with an unplanned pregnancy. No differences were found in neonatal outcomes. Sinhalese version of the LMUP scale was found to be accepted, valid and reliable with the Cronbach's alpha of 0.936. Conclusions A sizeable proportion of pregnancies were unplanned. Teenage pregnancies, non-marital relationships and inadequate knowledge on emergency contraceptives, maternal anemia, low mood, and GBV were modifiable associated factors which could be prevented by evidence-based locally applicable approaches.
Container-aided Integrative QTL and RNA-seq Analysis of Collaborative Cross Mice Supports Distinct Sex-Oriented Molecular Modes of Response in Obesity
Authors: Binenbaum Ilona , Atamni Hanifa Abu-Toamih , Fotakis Georgios , Kontogianni Georgia , Koutsandreas Theodoros , Pilalis Eleftherios , Mott Richard , Himmelbauer Heinz , Iraqi Fuad A. , Chatziioannou Aristotelis
Published: September 2020

Background: The CC mouse population is a valuable resource to study the genetic basis of complex traits, such as obesity. Although the development of obesity is influenced by environmental factors, the underlying genetic mechanisms play a crucial role in the response to these factors. The interplay between the genetic background and the gene expression pattern can provide further insight into this response, but we lack robust and easily reproducible workflows to integrate genomic and transcriptomic information in the CC mouse population. Results: We established an automated and reproducible integrative workﬂow to analyse complex traits in the CC mouse genetic reference panel at the genomic and transcriptomic levels. We implemented the analytical workﬂow to assess the underlying genetic mechanisms of host susceptibility to diet induced obesity and integrate these results with diet induced changes in the hepatic gene expression of susceptible and resistant mice. Hepatic gene expression diﬀers signiﬁcantly between obese and non-obese mice, with a signiﬁcant sex eﬀect, where male and female mice exhibit diﬀerent responses and coping mechanisms. Conclusion: Integration of the data showed that diﬀerent genes but similar pathways are involved in the genetic susceptibility and disturbed in diet induced obesity. Genetic mechanisms underlying susceptibility to high-fat diet induced obesity diﬀer in female and male mice. The clear distinction we observe in the systemic response to the high-fat diet challenge and to obesity between male and female mice points to the need for further research into distinct sex-related mechanisms in metabolic disease.
Breastfeeding support at an Australian Breastfeeding Association drop-in service: a descriptive survey
Authors: Burns Elaine , Duursma Louise , Triandafilidis Zoi
Published: September 2020

BackgroundIn Australia, during the early establishment phase of breastfeeding, women can access telephone peer support counselling provided by the Australian Breastfeeding Association (ABA) however options for face-to-face peer support are limited. The known factors which improve ongoing and exclusive breastfeeding include face-to-face support, peer and/or professional support, and trained personnel. This study aimed to examine women’s experiences of accessing one breastfeeding drop-in peer support service provided by trained peer support volunteer counsellors from the ABA.MethodsWomen who accessed the service were invited, in 2014, to participate in an anonymous online survey which collected both quantitative and qualitative data. Participants were asked about their experiences of breastfeeding support, as well as their experiences of the drop-in service. In total, 53 women completed the online survey, and subsequent analysis generated descriptive statistics and qualitative themes.ResultsResponses to the survey revealed that women attended the drop-in service with infants ranging in age from less than 1 week through to 12 months of age. Most women reported attending with infants aged 0-8 weeks of age (72%). The predominant presenting problems identified were sore/damaged nipples, difficulties with infant latching to the breast, or concerns about using nipple shields. Analysis of the open text qualitative responses revealed one overarching theme ‘Support to continue breastfeeding’ and four subthemes: ‘feeling listened to and not judged’; ‘emotional support and confidence building’; ‘the importance of face-to-face, practical support'; and ‘the need for ongoing, free access’.DiscussionIn this study many women were seeking support for ongoing breastfeeding difficulties. Health professionals who had limited breastfeeding knowledge and skills were identified as most unhelpful in providing support with ongoing breastfeeding difficulties. Women valued having access to trained peer counsellors, who had the capacity to provide non-judgemental, face-to-face support; who could sit through a feed; in a space that was ‘safe’; and who could enhance a woman’s confidence with breastfeeding over the course of her full breastfeeding journey. ConclusionReactive peer support, provided in response to need, at an Australian Breastfeeding Association drop-in service, was described by participants as pivotal to enabling their ongoing breastfeeding.
Learning curve of digital intraoral scanning – an in vivo study
Authors: Róth Ivett , Czigola Alexandra , Joós-Kovács Gellért Levente , Dalos Magdolna , Hermann Péter , Borbély Judit
Published: September 2020

Background: The spread of digital technology in dentistry poses new challenges and goals for dentists. It is important to involve new methods and devices in university education. The aim of the present in vivo study was to determine the learning curve of IOS described by (1) scanning time and (2) image number (count of images made by intraoral scanner during scanning process). Methods: Ten dental students of Semmelweis University took part in the study. Dental students took digital study impressions using 3Shape Trios 3® (Copenhagen, Denmark) IOS device. Each student took 10 digital impressions on volunteers (for standardization the first and the last patients was the same for each student). The inclusion criteria of patients were full dentition (except missing third molar) and no prosthetic- restorative treatment. Digital impression taking was preceded by a lecture consisting of two parts: education and training. For standardization, the scanning device was calibrated before impression taking, followed by the registration of patient data. Digital impressions were taken of the upper and lower arches, and the bite was recorded according to the manufacturer's instructions. Total scanning time and image number of intraoral scanning were recorded. Results: The difference of scanning time between the first and the tenth digital impressions was significant (p=0.007). The average scanning time of first impressions was 23min 9sec, for tenth impressions it was 15min 28sec. The difference between scanning time of the first and the tenth impressions was 7min 41sec. The average image number of the first impressions was 1964.5, for the tenth impressions it was 1468.6. The difference between number of images of the first and the tenth impressions was 495,9. The curve of image number show decreasing tendency first, then has a trough around the sixth measurement, and rises. Conclusion: The learning curve of IOS can be described with scanning time and image number of digital impression. Scanning time decreases as result of practice. Shorter scanning times are accompanied by poorer coverage quality, the operator has to correct by adding extra images represented by the curve of image numbers which turning into increasing tendency after the sixth measurement.
Combination Therapy with Pemafibrate (K-877) and Pitavastatin Improves Vascular Endothelial Dysfunction in Dahl/Salt-sensitive Rats Fed a High-salt and High-fat Diet​
Authors: Yoshida Masatoki , Nakamura Kazufumi , Miyoshi Toru , Yoshida Masashi , Kondo Megumi , Akazawa Kaoru , Kimura Tomonari , Ohtsuka Hiroaki , Ohno Yuko , Miura Daiji , Ito Hiroshi
Published: September 2020

Background: Statins suppress the progression of atherosclerosis by reducing low-density lipoprotein (LDL) cholesterol levels. Pemafibrate (K-877), a novel selective peroxisome proliferator-activated receptor α modulator, is expected to reduce residual risk factors including high triglycerides (TGs) and low high-density lipoprotein (HDL) cholesterol during statin treatment. However, it is not known if statin therapy with add-on pemafibrate improves the progression of atherosclerosis. The aim of this study was to assess the effect of combination therapy with pitavastatin and pemafibrate on lipid profiles and endothelial dysfunction in hypertension and insulin resistance model rats.Methods: Seven-week-old male Dahl salt-sensitive (DS) rats were divided into the following five treatment groups (normal diet (ND) plus vehicle, high-salt and high-fat diet (HD) plus vehicle, HD plus pitavastatin (0.3 mg/kg/day), HD plus pemafibrate (K-877) (0.5 mg/kg/day), and HD plus combination of pitavastatin and pemafibrate) and treated for 12 weeks. At 19 weeks, endothelium-dependent relaxation of the thoracic aorta in response to acetylcholine was evaluated.Results: After feeding for 12 weeks, systolic blood pressure and plasma levels of total cholesterol were significantly higher in the HD-vehicle group compared with the ND-vehicle group. Combination therapy with pitavastatin and pemafibrate significantly reduced systolic blood pressure, TG levels, including total, chylomicron (CM), very LDL (VLDL), HDL-TG, and cholesterol levels, including total, CM, VLDL, and LDL-cholesterol, compared with vehicle treatment. Acetylcholine caused concentration-dependent relaxation of thoracic aorta rings that were pre-contracted with phenylephrine in all rats. Relaxation rates in the HD-vehicle group were significantly lower compared with the ND-vehicle group. Relaxation rates in the HD-combination of pitavastatin and pemafibrate group significantly increased compared with the HD-vehicle group, although neither medication alone ameliorated relaxation rates significantly. Western blotting experiments showed increased phosphorylated endothelial nitric oxide synthase protein expression in aortas from rats in the HD-pemafibrate group and the HD-combination group compared with the HD-vehicle group. However, the expression levels did not respond significantly to pitavastatin alone.Conclusions: Combination therapy with pitavastatin and pemafibrate improved lipid profiles and endothelial dysfunction in hypertension and insulin resistance model rats. Pemafibrate as an add-on strategy to statins may be useful for preventing atherosclerosis progression.
Risk-adapted treatment reduced chemotherapy exposure for clinical stage 1 pediatric testicular cancer
Authors: ye yunlin , Chen Zhuang-fei , Bian Jun , Liang Hai-tao , Qin Zi-ke
Published: September 2020

Background: Different from adult clinical stage I (CS1) testicular cancer, surveillance was recommended for CS1 pediatric testicular cancer. For high-risk children, greater than 50% of them suffered relapse and progress during surveillance and adjuvant chemotherapy was administrated. Risk-adapted treatment might reduce chemotherapy exposure for those children.Methods: The decision model was designed and calculated using TreeAge Pro 2011 software. Clinical utilities such as relapse rates of different groups during surveillance or after chemotherapy were collected from literatures. And a survey to urologist was performed to evaluate the toxicity of the first-line and second-line chemotherapy. Using decision analysis model, chemotherapy exposure between risk-adapted treatment and surveillance were compared based on this series of clinical utilities. One-way and two-way tests were administrated to check the feasibility.Results: In base case decision analysis of CS1 pediatric testicular cancer, risk-adapted treatment preferred lower exposure of chemotherapy than surveillance (average: 0.7965 cycle verse 1.3419 cycles). The sensitivity analysis demonstrated that when relapse rate after primary chemotherapy ≤0.10 and the relapse rate of high-risk group ≥0.40, risk-adapted treatment would expose lower chemotherapy, without association of the proportion of low-risk patients, the relapse rate of low-risk group, relapse rate after salvage chemotherapy and toxicity utility of second-line chemotherapy compared to first-line chemotherapy.Conclusions: Using decision analysis, risk-adapted treatment might decrease chemotherapy exposure for these high-risk patients and precious evaluation after orchiectomy was critical to this process. Further clinical study was needed to validate this statement.
Identification of a novel mutation in the KITLG gene in a Chinese family with familial progressive hyper- and hypopigmentation
Authors: Wang Jianbo , Li Weisheng , Zhou Naihui , Liu Jingliu , Zhang Shoumin , Li Xueli , Li Zhenlu , Yang Ziliang , Sun Miao , Li Min
Published: September 2020

Background: Familial progressive hyper- and hypopigmentation (FPHH, MIM 145250) is a rare hereditary skin disorder that is predominantly characterized by progressive, diffuse, partly blotchy hyperpigmented lesions intermingled with scattered hypopigmented spots, lentigines and sometimes Cafe-au-lait spots (CALs). Heterozygous mutations of KIT ligand (KITLG, MIM 184745) gene is responsible for FPHH. To date, only eight KITLG mutations were reported to be associated with FPHH and no clear genotype-phenotype correlations had been well established. This study aimed to identify the causative mutations of the KITLG gene in two Chinese FPHH cases.Methods: Directly sequencing of the coding regions of KITLG was performed. The pathogenicity prediction was assessed using bioinformatics tools including SIFT, Polyphen2, and SWISS-MODEL, and further evaluated following the American College of Medical Genetics and Genomics (ACMG) guideline 2015.Results: A novel mutation c.104A>T (p.Asn35Ile) and a recurrent mutation c.101C>T (p.Thr34Ile) in KITLG were identified. As SIFT and Polyphen-2 softwares showed, both mutations identified in this study were predicted to be detrimental variations. Three-dimensional protein structures modeling indicated the mutant KITLG proteins might affect KITLG affinity to its receptor c-KIT. According to the ACMG guideline 2015, the novel mutation c.104A>T was ‘Likely Pathogenic’.Conclusions: So far, most of the KITLG mutations are clustered within the conserved VTNNV motif (amino acid 33-37) in exon 2. The known mutations are only involved in 33V, 34T, 36N, 37V but not 35N. We have now identified a novel mutation c.104A>T of KITLG, which was first reported in FPHH located within the conserved 35N of the motif. These results strengthen our understanding of FPHH and expand the mutational spectrum of the KITLG gene.
Heterogeneity of antidiabetic treatment effect on the risk of major adverse cardiovascular events in type 2 diabetes: a systematic review and meta-analysis
Authors: D'Andrea Elvira , Kesselheim Aaron S. , Franklin Jessica M. , Jung Emily , Hey Spencer Phillips , Patorno Elisabetta
Published: September 2020

Background We explored whether clinically relevant baseline characteristics of patients with type 2 diabetes can modify the effect of glucagon-like peptide-1 receptor agonists (GLP-1 RA) or sodium-glucose cotransporter-2 inhibitors (SGLT-2i) on the risk of major adverse cardiovascular events (MACE). Methods We investigated Medline and EMBASE through June 2019. We included randomized clinical trials reporting the effect of GLP-1 RA or SGLT-2i on MACE in subgroups of patients with type 2 diabetes, identified through key baseline factors: established cardiovascular disease; heart failure; chronic kidney disease; uncontrolled diabetes; duration of diabetes; hypertension; obesity; age; gender and race. Hazard ratios (HRs) and 95% confidence intervals (CIs) from trials were meta-analyzed using random-effects models. Results Nine trials enrolling 87,143 patients were included in the analyses. Subgroup meta-analyses showed a 14% risk reduction of MACE in patients with established cardiovascular disease [GLP1-RA: HR, 0.86 (95% CI, 0.79-0.94); SGLT-2i: 0.86 (0.80-0.93)], and no effect in at-risk patients without history of cardiovascular events [GLP1-RA: 0.95 (0.83-1.08); SGLT-2i: 1.00 (0.87-1.16)]. We observed a trend toward larger treatment benefits with SGLT-2i among patients with chronic kidney disease [0.82 (0.69-0.97)], and patients with uncontrolled diabetes for both GLP1-RA or SGLT-2i [GLP1-RA: 0.82 (0.71-0.95); SGLT-2i: 0.84 (0.75-0.95)]. Uncontrolled hypertension, obesity, gender, age and race did not appear to modify the effect of these drugs. Conclusions In this exploratory analysis, history of cardiovascular disease appeared to modify the treatment effect of SGLT2i or GLP1-RA on MACE. Chronic kidney disease and uncontrolled diabetes should be further investigated as potential effect modifiers.
Assessment of the simultaneous effect of hypothyroidism and thyroid autoimmunity with gestational diabetes on the incidence of type 2 diabetes
Authors: zahedi Maryam , Kazemian Elham , Tehrani Fahimeh Ramezani , tohidi Maryam , azizi Fereidoun , Khalili Davood , Rahmati maryam , Amouzegar Atieh
Published: September 2020

Introduction: Despite the evidence available on the adverse impact of gestational diabetes (GDM) and thyroid disorders on developing type 2 diabetes (T2DM), the concurrent influence of these disorders on the incidence of T2DM has not been reported yet. Methods: In this prospective study, 1894 non-diabetic women aged 20 to 60 years, with a history of at least one term delivery, without diagnosed hyperthyroidism were selected at the initiation of the Tehran Thyroid Study (TTS). Pooled logistic regression analyses were used to investigate the association of GDM, thyroid disorders i.e., hypothyroidism and/or thyroid peroxidase antibody (TPOAb) positivity and interaction between GDM and thyroid disorders with the risk of incident T2DM. Results: Of the 1894 participants of the present study, 346 (18.3%) had a history of GDM, and 832 (43.9%) had thyroid disorders. The total cumulative incidence rate of T2DM at the median follow-up time of ~ 12 years was overall 12/1000 person-years (95% confidence interval (CI): 10/1000–13/1000), with an incidence rate of 16/1000 (95%CI: 13/1000–20/1000) in women with GDM; and 11/100,000 (95%CI: 9/100,000–12/1000) among those without GDM. After adjustment for age, the risk of incident T2DM increased among individuals with the previous GDM compared to women without a history of GDM (odds ratio (OR): 1.54, 95%CI: 1.06, 2.25). No significant associations were found between either thyroid disorders or the interaction between GDM and thyroid disorders with the development of T2DM; (OR: 1.14, 95%CI: 0.82, 1.58) and (OR: 1.27, 95%CI: 0.66, 2.43), respectively.Conclusion: GDM and thyroid disorders have no concurrent impacts on the incidence of T2DM.
Psychological Investigation on Pregnant Women during the Outbreak of COVID-19
Authors: Chen Shaoqi , Zhuang Jiamian , Chen Qingzi , Tan Xuerui
Published: September 2020

Background: COVID-19(Corona Virus Disease 2019) outbreaks around the world and is highly infectious, which may cause people prone to anxiety and depression. Pregnant women, as a particular group, need more attention. The aim of this study is to investigate the mental health status of pregnant women during the outbreak of COVID-19, to analyze factors affecting their mental health status, to get wise to their cognition, behavioral responses and to provide solution guidance for psychological problems.Methods: Using a self-designed questionnaire, self-rated anxiety scale(SAS), self-rated depression scale (SDS), we conducted a web-based survey on 1160 pregnant women during the outbreak of COVID-19.Results: Compared with general adults in some regions of China during the outbreak of COVID-19, the scores of SAS and SDS of pregnant women were both significantly higher (P<0.05). The results of multivariate regression analysis unveiled that age, levels of education, and duration of pregnancy were factors influencing pregnant women’s psychological status. In terms of psychological problems, compared with pregnant women aged < 30 years old, the risk of psychological problems in pregnant women aged ≥ 30 years old was 0.646 times (95% CI:0.486-0.858). Besides, compared with women with a level of high school or below, those with a junior college degree or above had a poor mental health risk of 0.551 times (95%CI: 0.416-0.731). Compared with women in early pregnancy, women in middle pregnancy and in last pregnancy had a risk of 0.543 times (95% CI:0.398-0.739) and 0.636 times (95% CI: 0.466-0.867) in poor mental health.Conclusions: During the outbreak of COVID-19, pregnant women are prone to anxiety or depression, highlighting the necessity of further attention to mental health. It is of great significance to provide timely psychological counseling and intervention for pregnant women with poor mental health during the COVID-19 outbreak.
Assessing burden, risk factors, and perceived impact of uterine fibroids on women’s lives in rural Haiti: implications for advancing a health equity agenda, a mixed methods study
Authors: Millien Christophe , Manzi Anatole , Katz Arlene M. , Gilbert Hannah , Fawzi Mary C. Smith , Farmer Paul E. , Mukherjee Joia
Published: September 2020

Background Uterine fibroids, the most common cause of gynecologic surgery, have a reported cumulative incidence of 59% among Black women in the U.S. Uterine fibroids negatively impact the quality of women’s lives. No study has been found in the literature about fibroids in Haiti. We conducted a mixed methods study to assess the burden and risk factors of uterine fibroids, as well as their effects on women’s quality of life. Methods A convergent mixed methods study was conducted between October 1, 2019 and January 31, 2020 at MUH’s (Mirebalais University Hospital) OB-GYN outpatient department. Quantitatively, in a cross-sectional study 211 women completed consecutively a structured questionnaire. In-depth interviews with 17 women with fibroids and 7 family members were implemented for the qualitative component. Descriptive statistics were calculated for clinical and social demographic variables. Logistic regression was performed to examine associations between fibroids and related risk factors. An inductive thematic process was used to analyze the qualitative data. A joint display technique was used to integrate the results. Results Of 193 women analyzed 116 had fibroids (60.1%). The mean age was 41.3 . Anemia was the most frequent complication— 61 (52.6%). Compared to women without uterine fibroids, factors associated with uterine fibroids included income decline (AOR = 4.7, 95% CI: 2.1-10.9, p=<0.001), excessive expenses for transport (AOR = 4.4, 95% CI: 1.6-12.4, p=0.005), and family history with uterine fibroids (AOR = 4.6, 95% CI: 1.6-13.6, p=0.005). In contrast, higher level of education and micro polycystic ovarian syndrome were associated with lower prevalence (AOR= 0.3, 95% CI: 0.1-0.9, p=0.021) and (AOR= 0.2, 95% CI: 0.1-0.97, p=0.044), respectively . The qualitative findings delineate how contextual factors such as health system failures, long wait times, gender inequality and poverty negatively affect the quality of women’s lives. The poverty cycle of uterine fibroids emerged. Conclusions A vicious cycle of poverty negatively impacts access to care for uterine fibroids in Haiti. Health insurance, social support, and income generating activities may be keys to promote social justice through access to adequate care for women with uterine fibroids in Haiti.
Influence of enhanced recovery after surgery (ERAS) on patients receiving lung resection: a retrospective study of 1,749 cases
Authors: Wang Chunmei , Lai Yutian , Li Pengfei , Su Jianhua , Che Guowei
Published: September 2020

Background The study aimed to evaluate the outcomes following the implementation of enhanced recovery after surgery (ERAS) for patients undergoing lung cancer surgery.Method A retrospective cohort study involving 1,749 patients with lung cancer undergoing pulmonary resection was conducted. The patients were divided into two time period groups for analysis(routine pathway and ERAS pathway). Logistic regression analysis was performed to assess the risks of developing postoperative pulmonary complications.Results Among the 1,749 patients, 691 were stratified into the ERAS group, and 1,058 in to the routine group. The ERAS group presented with shorter postoperative in-hospital length of stay (LOS) (4.0 vs 6.0, P<0.001), total LOS (10.0 VS. 13.0 days, P<0.001), and lower total in-hospital costs (P<0.001), including material (P<0.001) and drug expenses (P<0.001). Furthermore, the ERAS group also presented with a lower occurrence of postoperative pulmonary complications (PPCs) than the routine group (15.2% vs. 19.5%, P=0.022). Likewise, a significantly lower occurrence of pneumonia (8.4% vs. 14.2%, P<0.001) and atelectasis (5.9% vs. 9.8%, P=0.004) was found in the ERAS group. Regarding the binary logistic regression, the ERAS intervention was the sole independent factor for the occurrence of PPCs (OR: 0.601, 95% CI: 0.434-0.824, P=0.002). In addition, age (OR: 1.032, 95% CI: 1.018-1.046), COPD (OR: 1.792, 95% CI: 1.196-2.686), and FEV1(OR: 0.205, 95% CI: 0.125-0.339) were also independent predictors of PPCs. Conclusion Implementation of an ERAS pathway shows improved postoperative outcomes, including shortened LOS, lower in-hospital costs, and reduced occurrence of PPCs, providing benefits to the postoperative recovery of patients with lung cancer undergoing surgical treatment.