bluuebunny/crossref_metadata_2025 huggingface dataset:
Multivariate joint modeling to identify markers of growth and lung function decline that predict cystic fibrosis pulmonary exacerbation onset
Authors: Andrinopoulou Eleni-Rosalina , Clancy John Paul , Szczesniak Rhonda
Published: January 2020

Background: Attenuated decreases in lung function can signal the onset of acute respiratory events known as pulmonary exacerbations (PEs) in children and adolescents with cystic fibrosis (CF). Univariate joint modeling facilitates dynamic risk prediction of PE onset and accounts for measurement error of the lung function marker. However, CF is a multi-system disease and the extent to which simultaneously modeling growth and nutrition markers improves PE predictive accuracy is unknown. Furthermore, it is unclear which routinely collected clinical indicators of growth and nutrition in early life predict PE onset in CF. Methods: Using a longitudinal cohort of 17,100 patients aged 6-20 years (US Cystic Fibrosis Foundation Patient Registry; 2003-2015), we fit a univariate joint model of lung-function decline and PE onset and contrasted its predictive performance with a class of multivariate joint models that included combinations of growth markers as additional submodels. Outcomes were longitudinal lung function (forced expiratory volume in 1 s of % predicted), percentiles of body mass index, weight-for-age and height-for-age and PE onset. Relevant demographic/clinical covariates were included in submodels. We implemented a univariate joint model of lung function and time-to-PE and four multivariate joint models including growth outcomes. Results: All five joint models showed that declining lung function corresponded to slightly increased risk of PE onset (hazard ratio from univariate joint model: 0.97, P < 0.0001), and all had reasonable predictive accuracy (cross-validated area under the receiver-operator characteristic curve > 0.70). None of the growth markers alongside lung function as outcomes in multivariate joint modeling appeared to have an association with hazard of PE. Jointly modeling only lung function and PE onset yielded the most accurate (area under the receiver-operator characteristic curve = 0.75) and precise (narrowest interquartile range) predictions. Dynamic predictions were accurate across forecast horizons (0.5, 1 and 2 years) and precision improved with age. Conclusions: Including growth markers via multivariate joint models did not yield gains in prediction performance, compared to a univariate joint model with lung function. Individualized dynamic predictions from joint modeling could enhance physician monitoring of CF disease progression by providing PE risk assessment over a patient’s clinical course.
Does urethral length affect continence outcomes following robot assisted laparoscopic radical prostatectomy (RALP)?
Authors: Lin Diwei , O'Callaghan Michael E , David Rowan , Fuller Andrew , Wells Richard , Sutherland Peter , Foreman Darren
Published: January 2020

Background : Post-operative urinary incontinence is a significant concern for patients choosing to undergo a radical prostatectomy (RP) for treatment of prostate cancer. The aim of our study was to determine the effect of pre-operative MUL on 12 month continence outcomes in men having robot-assisted laparoscopic prostatectomy (RALP). Methods : We use the South Australian Prostate Cancer Clinical Outcomes Collaborative (SA-PCCOC) database, to identify 602 patients who had undergone RALP by a high volume surgeon. Only patients who received an assessment and education by a specialist pelvic floor physiotherapist, had completed EPIC questionnaires before treatment and did not have radiotherapy treatment within 12 months of surgery were included. MUL measurements were taken from pre-operative magnetic resonance imaging (MRI) scans. The short-form version of the Expanded Prostate Cancer Index Composite (EPIC-26) was used to measure continence outcomes. Continence was defined as 100/100 in the EPIC-26 Urinary Continence domain score. Results : The observed median MUL in this study was 14.6mm. There was no association between MUL and baseline continence. MUL was associated with continence at 12 months post RALP (OR 1.13, 95% CI 1.03-1.21, p=0.0098). In men who were continent before surgery, MUL was associated with return to continence at 12 months after RALP (OR 1.15, 1.05-1.28, p=0.006). MUL was also associated with change in continence after surgery (β=1.22, p=0.002). Conclusions : MUL had no effect on baseline continence but had a positive and significant association with continence outcomes over 12 months post RALP.
The Effect of the Mobile ‘Blood Pressure Management Application’ on Hypertension Self-Management Enhancement: A Randomized Controlled Trial
Authors: Bozorgi Ali , Hosseini Hamed , Eftekhar Hassan , Majdzadeh Reza , Yoonessi Ali , Ramezankhani Ali , Mansouri Mehdi , Ashoorkhani Mahnaz
Published: January 2020

Background: Self-management of hypertension is of great significance given its increasing incidence and its associated disabilities. With the increased use of mobile health in medicine, the present study evaluated the effect of a self-management application on patient adherence to hypertension treatment. Methods: This clinical trial was performed on 120 hypertensive patients who were provided with a mobile intervention for 8 weeks and followed-up until the24th week. Data on the primary outcome (adherence to treatment) and secondary outcomes(adherence to the DASH diet, regular monitoring of blood pressure, and physical activity) were collected using a questionnaire and a mobile application, respectively. The inter-group change difference over time was analyzed using repeated measures ANOVA (General Linear Model). Results: The treatment adherence score increased by an average of 5.9 (95% CI: 5.0-6.7) in the intervention group compared to the control group. Scores of 'adherence to the low-fat and low-salt diet plans' were 1.7 (95% CI: 1.3-2.1) and 1.5 (95% CI: 1.2-1.9), respectively. Moreover, moderate physical activity increased to 100.0 minutes (95% CI: 61.7-138.3) per week in the intervention group. Conclusion: The treatment and control of blood pressure require a multifaceted approach given its complexity and multifactorial nature. Considering the widespread use of smartphones, mHealth interventions can be effective in self-management and better patient adherence to treatments. Our results showed that this application can be used as a successful tool for hypertension self-management in patients attending public hospitals in developing countries. Trial registration: This study was registered in the Iran Randomized Clinical Trial Center under the number IRCT2015111712211N2 on January 1st2016.
Identification of the Differences in Olfactory System Between Male and Female Oriental Tobacco Budworm Helicoverpa assulta 
Authors: Li Haichao , Li Weizheng , Miao Changjian , Wang Gaoping , Zhao Man , Yuan Guohui , Guo Xianru
Published: January 2020

Background: The olfactory system of insects facilitates their search for host and mates, hence it plays an essential role for insect survival and reproduction. Insects recognize odor substances through olfactory neurons and olfactory genes. Previous studies showed that there are significant sex-specific differences in how insects identify odorant substances, especially sex pheromones. However, whether the sex-specific recognition of odorant substances is caused by differences in the expression of olfaction-related genes between males and females remains unclear. Results: In order to clarify this problem, the whole transcriptome sequence of the adult Helicoverpa assulta, an important agricultural pest of tobacco and other Solanaceae plants, was obtained using PacBio sequencing. RNA-seq analysis showed that there were 27 odorant binding proteins (OBPs), 24 chemosensory proteins (CSPs), 4 pheromone-binding proteins (PBPs), 68 odorant receptors (OR) and 2 sensory neuron membrane proteins (SNMPs) genes that were expressed in the antennae of male and female H. assulta. Females had significantly higher expression of GOBP1-like, OBP, OBP3, PBP3 and SNMP1 than males, while males had significantly higher expression of GOBP1, OBP7, OBP13, PBP2 and SNMP2. Conclusions: Our findings improve our understanding of olfactory genes in H. assulta, and can be used to further study pheromone identification, mate search, and sex differences in an insect’s ability to search for hosts. These results improve our understanding of mate search and host differentiation in H. assulta.
Access to Oral Health Care: A Focus on Dental Caries Treatment Provision in Enugu Nigeria
Authors: Uguru Nkolika , Onwujekwe Obinna , Udochukwu Ogu Ugochukwu , Uguru Chibuzo
Published: January 2020

Background Dental caries, despite improvement in oral health across the globe, is still a large contributor to the global burden of oral diseases and a major public health concern. In Enugu state Nigeria, there is minimal access to adequate and proper oral health care. This study examined the determinants of dental caries treatment provision and the challenges of providing equitable access to oral health care. Method This was a descriptive cross-sectional study conducted in three local government areas in Enugu state Nigeria. The study was conducted using both qualitative and quantitative research methods. The determinants of supply of dental caries treatment services were explored with a focus on provider behaviour, cost of dental services, human resource availability and availability of dental equipment. Results Five factors determine what dental caries treatment service is provided viz: cost of raw materials (100%), human resources (98.1%), geographical location (98.1), Government policies (88%) and price of other goods (80.8%). Inadequate awareness and knowledge, high cost of treatment services, inadequately skilled staff, poor government funding and policy for oral health, limited primary healthcare facilities offering dental treatment services and poor knowledge of dental caries treatment options are factors that determine dental service provision and equally influence access to oral health care. There are still a limited number of dental facilities in the country with a growing need for dental caries treatment/services and other dental issues. Conclusion Adequate access to oral health care services is a major concern that affects all aspects of healthcare and a determining factor in the country’s drive to achieve universal health coverage. In order to address this, there is a need to incorporate oral health into the general health care system. Dental health facilities need to be strategically located and properly equipped with materials, equipment and adequate skilled staff.
Performance of IRS on malaria prevalence and incidence using pirimiphos-methyl in the context of pyrethroids resistance in Koulikoro region, Mali
Authors: Kané Fousseyni , Keïta Moussa , Traoré Boïssé , Diawara Sory Ibrahim , Bane Sidy , Diarra Souleymane , Sogoba Nafomon , Doumbia Seydou
Published: January 2020

Background: Koulikoro Health District is one of three districts of Mali where the indoor residual spray (IRS) has been implemented from 2008 to 2016. With widespread of resistance to pyrothroide, IRS was shifted from pyrethroid to pirimiphos-methyl in 2014 -2016. We assessed the added value of IRS to LLINs on the prevalence of parasitemia and malaria incidence among children under 10 years old. Methods: We compare these outcomes in two health zones: one where IRS intervention was deployed (zone test, district of Koulikoro) and the neighboring health zone where no IRS was applied (control zone, district of Banamba). In both settings we carried out two cross-sectional surveys at the beginning of the rainy season (June) and the end of the rainy season (October) to assess the effect of IRS on seasonal changes in malaria parasitemia. Results: The incidence of malaria was measured through passive case detection (PCD) from the health facilities. A 50 % increase was observed in malaria parasitemia from June to October in control villages (14.0% to 42.3%) compared to IRS villages 17.9% (9.2% vs 13.2%). The overall malaria incidence rate was 2.7 per 100 person-months in IRS area and 6.8 per 100 person-month in control areas. The Kaplan Meier survival analysis showed that children living in IRS area remain much longer free from malaria than children of the control area (P < 0.001). IRS using pirimiphos-methyl has been successful in reducing substantially the prevalence and the incidence of malaria in children under 10 years old in area of pyrethroids resistance of Koulikoro. Conclusions: As IRS intervention was ended after 2016 campaign, further studies are needed to determine the rebound effect and monitor potential emergence of organophasphate resistance for better management of insecticide resistance
Performance of Indoor Residual Spray on entomological parameters of malaria transmission using pirimiphos-methyl in the context of pyrethroids resistance in Koulikoro region, Mali.
Authors: KEITA Moussa , SOGOBA Nafomon , Traoré Boïssé , Kané Fousseyni , Coulibaly Boubacar , Traoré Sekou Fantamady , Doumbia Seydou
Published: January 2020

Background: Following vectors resistance to both pyrethroid and carbamates, organophosphate (pirimiphos-methyl) was used in the Indoor Residual Spray campaigns of 2015 to 2016 in the district of Koulikoro. In this context, we assessed the effect of IRS on malaria transmission by comparing entomological indices in two localities: Koulikoro (LLINs+IRS), and Banamba (LLINs -only) districts. Methods: The study was conducted in two villages of each of Koulikoro and Banamba in 2016. Pyrethroid spray catch and entry window trapping where used to collect mosquitoes monthly WHO bioassay test was used to assess mosquito’s susceptibility to insecticides. Mosquitoes were identified into species by PCR and the infection rate using ELISA. Results: An. coluzii was by far the most frequent species. Its density was rainfall dependent in no-IRS area, and almost independent in IRS area. The IR in the no-IRS area was 1.24%, while in the IRS area, we could not detect infection. In the no-IRS area, the EIR was 0.21 infective bites /person month with the peak in September. High resistance to pyrethroids and carbamates and susceptibility to organophosphates was observed in all sites. Conclusion: A big randomized study is needed to better estimate the added value of the IRS in an integrated malaria control strategy. Key words: Mali, IRS, Long-lasting insecticidal nets, insecticide resistance, transmission.
The role of community leaders on adolescent HIV and Sexual Reproductive Health and Rights in Mulanje, Malawi
Authors: Chimatiro Chancy Skenard , Hajison Precious , Muula Adamson S.
Published: January 2020

Background: We conducted this study to understand roles of community leaders on adolescents HIV and Sexual and Reproductive Health (SRH) rights in Mulanje-Malawi. We assessed how each role influence health seeking behaviour and improve SRH rights among adolescents from the local perspective. Methods: A qualitative study approach was used. We conducted 12 Focus Group Discussions (FGDs) and 17 Key Informant Interviews (KIIs) with community leaders. Purposive sampling technique was used to select study participants for both KIIs and FGDs. Random sampling technique was used to identify one Traditional Authority (TA) and 12 villages where FGDs were conducted. Inductive thematic content analysis was done guided by the study objectives to generate emerging themes. Results: Community leaders have many roles on adolescents HIV and SRH. These roles include advisory, encouragement, regulating and restricting cultural practices, formulating bye-laws and handling sexual abuse complaints. However, community leaders with religious affiliation have shown to have different views with those representing other institutions not affiliated to religion. In addition, the majority of community leaders indicated low level of knowledge on adolescent’s SRH rights. Conclusion: We suggest that the roles of community leaders differ depending on the position held and institution represented. Those community leaders not affiliated to religious can encourage certain behaviour in adolescents while those from religious background are discouraging it. Stakeholders involved in the fight against HIV and SRH rights should invest more on capacity building among the community leaders.
More than meets the eye: A shift in the gastropod and trematode communities in Lake Kariba, Zimbabwe
Authors: Muzarabani Kudzai Collete , Carolus Hans , Hammoud Cyril , Schols Ruben , Barson Maxwell , Huyse Tine
Published: January 2020

Background: Freshwater gastropod-borne trematodes pose a great public health burden and cause major economic losses in the livestock and fish industries. Knowledge on the composition, diversity and ecology of both gastropods and trematodes communities is key to understand disease transmission dynamics and control trematodiases of economic significance. The objective of this study is to investigate the diversity and spatio-temporal ecological trends of gastropod and trematode communities on the Northern shore of Lake Kariba in Zimbabwe, the largest artificial lake in volume worldwide. Methods: A sampling campaign was undertaken at 16 sites along the lake shoreline of Kariba town. Gastropods and water samples were collected monthly during one year. All 2477 specimens were identified, counted and subjected to shedding experiments; infection status was confirmed by the use of a Rapid Diagnostic PCR (RD-PCR). To explain spatio-temporal trends in gastropod and trematode occurrence, water samples were analysed for different physico-chemical parameters including pH, temperature, nitrates and phosphates. Results: Gastropod species collected include Bulinus truncatus, Bulinus forskalii, Gyraulus sp., Pseudosuccinea columella, Radix sp, Physella acuta, Bellamya sp. and Melanoides tuberculata. Bulinus truncatus was found to be infected with trematode species belonging to the families Notocotylidae, Psilostomstidae, Paramphistomidae and Diplostomatidae. A species of the latter family was also found to infect B. forskalii. As previously reported, lymnaeid species P. columella and Radix sp. were both infected with a species belonging to the Fasciolidae family, while Radix sp. was also infected with amphistomes. Conclusions: We confirm the occurrence of new species of gastropods in Lake Kariba and the absence of the previously reported B. pfeifferi and B. globosus. This explains the absence of human schistosome species, but we report the presence of other trematode families that have not been reported in Lake Kariba or Zimbabwe before. Compared to the latest study in 2001, there is a remarkable shift in the gastropod community, which is likely driven by the introduction of exotic gastropod species that are now abundant in the lake.
Copeptin assessment to predict vasoplegia after cardiopulmonary by-pass. An observational cohort study.
Authors: Pasero Daniela , Berton Alessandro Maria , Motta Giovanna , Raffaldi Riccardo , Fornaro Giancarlo , Costamagna Andrea , Trompeo Anna Chiara , Filippini Claudia , Mengozzi Giulio , Prencipe Nunzia , Zavattaro Marco , Settanni Fabio , Ghigo Ezio , Brazzi Luca , Benso Andrea Silvio
Published: January 2020

Background Post-cardiotomy vasoplegic syndrome is a vasodilatory shock characterized by a decrease of vascular tone with a normal or increased cardiac output. A relative deficit in vasopressin secretion in the postoperative was hypothesized. Copeptin is secreted in equimolar ratio with vasopressin but it is more stable and easier to measure. The aim of the present study was to investigate whether perioperative copeptin was associated with post-cardiotomy vasoplegic syndrome. Methods All patients scheduled for cardiac surgery were evaluated. Exclusion criteria were age < 18 years old, corticosteroids therapy, heart transplantation, extra-circulatory life support, sepsis, preoperative use of vasoactive drugs, off-pump surgery, chronic hepatic and renal failure, paraneoplastic syndrome, lack of informed consent. Post-cardiotomy vasoplegic syndrome was defined as a mean arterial pressure < 60 mmHg, a reduction of systemic vascular resistances < 1200 dyn*s/cm 5 *m 2 and/or the need of nor-epinephrine ³ 0.1 µg/kg/min. All patients underwent a preoperative evaluation of the corticotropin stimulation test; then, before surgery (T0), on day one after surgery (T1) and after 7 days (T2) copeptin and NT-proBNP concentration were measured. Results Among 55 enrolled patients, 9 (16.3%) developed post-cardiac surgery vasoplegia. Patients with vasoplegia had higher preoperative level of copeptin (19.2 pmol/L, IQR 17.89 – 21.29 vs 11.39 pmol/L, IQR 6.33 - 14.78; p < 0.001) and NT-proBNP (1435 pg/ml, IQR 721.75 – 1836.25 vs 365.5 pg/ml, IQR 141 - 977); p = 0.006) compared to the control group. At the multivariable analysis, preoperative copeptin resulted a significant predictor of vasoplegia (OR 1.56, 95% CI 1.002-1.33) and the ROC analysis showed an accurate copeptin cut off able to identify vasoplegic patients (> 16.9 pmol/L, AUC = 0.86, 95% CI 0.73-0.94). Otherwise, a lack of response to the low dose corticotropin test was not a predictor of PCVS; no patient presented a pathological response to the standard dose test. ConclusionsIncreased preoperative copeptin and NT-proBNP levels might be associated with an increased risk to develop post-cardiotomy vasoplegic syndrome. Our results suggest that patients with a decompensated neuroendocrine control of cardiovascular function are more prone to develop postoperative vasoplegia.
Comparison of Japanese and German nursing homes: Implications of demographic and policy differences
Authors: Karmann Alexander , Sugawara Shinya
Published: January 2020

Background This research provides a comparative study of Japanese and German nursing homes. Although these two aging countries share similar long-term care policies based on social insurance, descriptive statistics show the existence of a large difference in the outcomes of their nursing home sectors. This research pursues the reason behind these observations, looking at demographic and policy differences between the two countries. Methods To shed light from multiple angles, we conduct empirical analysis using three methods: regression, the Blinder-Oaxaca decomposition, and data envelopment analysis using regional data from the past decade. Results Our empirical results find that different outcomes are driven by both demographic and policy differences.Conclusions The results from the demographic elements indicate that the process of ageing will have a severer consequence for Germany than for Japan when Germany would catch up with the age profile of Japan. Among the policy elements, our result is consistent to the existence of moral hazard in Germany due to a generous welfare program.
Monitoring process barriers and enables towards universal health coverage within the Sustainable Development Goals
Authors: Derakhshani Naser , Doshmangir leila , Ahmadi Ayat , Fakhri Ali , Sadeghi-Bazarghani Homayuon , Gordeev Vladimir S
Published: January 2020

Background This study builds on previous successes of using tracer indicators in tracking progress towards UHC and complements them by offering a more detailed framework that would allow to identify potential factors that impede or advance such progress. This tool was designed accounting for possibly available data in low and middle income counties.Methods A systematic review of relevant studies was carried out using PubMed, ISI Web of Science, Embase, Scopus and ProQuest databases with no time period restriction. The search was complemented by a scoping review of grey literature, using the World Bank and WHO official reports depositories. Next, an inductive content analysis identified determinants influencing the progress towards UHC and its relevant indicators. The conceptual proximity between indicators and categorized themes were explored through three focus group discussion with 18 experts in UHC. Finally, a comprehensive list of indicators was converted into an assessment tool and refined following three consecutive expert panel discussions and two rounds of email surveys.Results 416 themes (including indicators and determinants factors) were extracted from 170 eligible articles and documents. Based on conceptual proximity, the number of factors was reduced to 119. These were grouped into seven domains: social infrastructure and social sustainability, financial and economic infrastructures, population health status, service delivery, coverage, stewardship/governance and global movements. The final assessment tool included 20 identified subcategories and 88 relevant indicators.Conclusion All identified factors in progress towards UHC are interrelated. The developed tool can be adapted and used in whole or in part in any country. Periodical use of the tool to understand progress towards UHC is recommended.
Barriers to vaccine uptake in the fishing and island communities of Uganda: a qualitative study
Authors: Bakibinga Pauline , Kisia Lyagamula , Lodda Charles Clarke , Namwanja Paul , Ibembe John Daniel
Published: January 2020

Background: Despite global and local initiatives to increase vaccine uptake, timeliness of vaccinations and vaccine uptake remain low among residents of islands and fishing communities in Uganda. Vaccine coverage (all vaccines) among island communities stands at 37.1% compared to 55%, the national level. This qualitative study was conducted to (i) understand key barriers to vaccine uptake among residents of islands and fishing communities of Lake Victoria, Buganda sub-region, Uganda and (ii) identify specific needs of the communities; ahead of implementation of a mobile health intervention to promote vaccine uptake. Methods: Explorator y qualitative. Data were collected through focus group discussions with women of reproductive age and village health teams (VHT) and key informant interviews with the health coordinators and health service providers. Data were analysed through content analysis, by coding pre-established and recurrent themes.Results: Under the barriers, seven themes were identified: Opportunity cost of seeking vaccines versus making a living, Distance/Cost to health facility, Availability of service provider, Attitudes towards vaccines, Decision making regarding the use of vaccines, Knowledge of availability of services, and Attitudes of service providers. Participants suggested strategies to improve uptake: 1) more health education and regular reminders using VHTs, public address systems and mobile technology; 2) bring services closer to people through scheduled vaccination campaigns to reduce on cost of seeking services; and 3) strengthening public-private partnerships in the health sector for delivery of vaccine services. Conclusion: In light of the current barriers to vaccine uptake, innovations to increase the utilisation of vaccination services in remote underserved settings need to be multi-pronged, responding to user, structural and supply-side factors. The use of mobile technology and public-private partnerships for health have the potential to bridge existing vaccine delivery and uptake gaps.
An Integrated Inclusion Health Service for Homeless Adults in Dublin: An Observational, Descriptive Study
Authors: Siersbaek Rikke , Lawlee Ann-Marie , Dowds Joanne , Molamphy Aoife , O’Rourke Niamh , Kennedy Una , Geary Una , Moughty Adrian , Sears Jess , Sandys Vicky , Macken Lilly , Sweeney Ann-Marie , Rooney Claire , Cheallaigh Clíona Ní
Published: January 2020

Background: The pilot Inclusion Health Service was a multi-component intervention designed to improve outcomes for adults experiencing homelessness accessing hospital care. The objectives of this report are to describe the development and evaluation of the Inclusion Health Service. Method: Observational study reporting on a multi-component intervention including comprehensive assessment and case management of homeless adult inpatients, case management advice to emergency department- and community-based health, and social care providers and education sessions for hospital and community-based staff. Results: The Inclusion Health Service assessed and developed a comprehensive discharge plan for 262 patients admitted to the hospital. 51 weekly interagency case management meetings took place during the one-year pilot. Additional interventions included education sessions for hospital and community-based health and social care providers; case management advice to ED and community-based health providers and provision of clothes and personal hygiene items to homeless inpatients. During the intervention, declines in the rate of ED presentations and admissions for homeless adults, compared with the prior year, were observed in the participating hospital. Lengths of stay remained the same. Conclusion: An Inclusion Health assessment and integrated discharge plan are feasible and acceptable and may have reduced the need for unscheduled healthcare.
Outcomes after the conversion of metal-on-metal hip resurfacing arthroplasty to ceramic-on-ceramic total hip arthroplasty: A retrospective observational study with a mean 10-year follow-up
Authors: Yu Weiguang , Shuai Mao , Lin Jinluan , Chen Baomin , Zhao Mingdong , Zhang Chao Xin , Chen Wenli , Han Guowei
Published: January 2020

Background The purpose of this retrospective study was to assess clinical outcomes following failed metal-on-metal hip resurfacing arthroplasty (MoM-HRA) revised using ceramic-on-ceramic total hip arthroplasty (CoC-THA) via the direct anterior approach (DAA).Methods Data involving 112 patients (112 hips) with failed primary MoM-HRA that was revised using CoC-THA via the DAA during 2006 - 2018 were retrospectively analysed. The mean age was 54.6 years (45–63 years). Frequent surgical indications for conversion were aseptic loosening and femoral neck fracture. The primary endpoint was the Postel-Merle d’Aubigne functional score (PMA). Secondary endpoints were the major orthopaedic complication rate and serum metal ion levels (chromium and cobalt).Results The mean follow-up time was 10 years (range, 4 - 13 years). The mean PMA improved from 9 (4-14) to 16 (13-18) (p = 0.001). Six patients had undergone a re-revision intervention. Fourteen incidents of aseptic loosening and four periprosthetic fractures were observed. A consistent decline in mean serum metal ion levels was detected [chromium decreased from 36.6 μg/L (12.5-76.5 μg/L) prior to conversion to 2.6 μg/L (0.1-13.5 μg/L) at final follow-up (p = 0.001), cobalt decreased from 37.5 μg/L (6.7-93.2 μg/L) to 2.2 μg/L (1.2-18.4 μg/L) (p =0.003)].Conclusion Failed primary MoM-HRA converted to CoC-THA using the DAA yielded acceptable clinical outcomes.
Polylactide pins can effectively fix severely comminuted and unsalvageable radial head fracture: a retrospective study of 40 patients
Authors: Guo Liang , li 睿夫 , Yang Xuhui , Yu Chao , Gui Fei
Published: January 2020

Background The treatment of comminuted unsalvageable radial head fracture remains controversial. Open reduction and internal fixation are hard to achieve. Common techniques include radial head resection and arthroplasty. Both methods have characteristic complications. The present study aims to demonstrate the feasibility of treating unreducible radial head fractures with absorbable polylactide pins. Methods A total of 17 patients with severely comminuted Mason type III radial head fractures were treated with open reduction and internal fixation using polylactide pins and 23 with metallic implants. Patients receiving both modalities were followed-up for a mean of 15 months (standard deviation [SD]: 2.6). Radiographic analysis was conducted 2, 30, 60 and 120 days after surgery. Measurements of range of motion (ROM), disability of arm shoulder and hands, Mayo elbow performance score and Broberg and Morrey elbow score were recorded, with treatments compared using a Mann-Whitney U test. Result All fractures healed successfully. The data shows no statistical difference between the polylactide and metallic implant groups. Complications were infrequent and did not cause disability. All patients were satisfied with the surgical outcomes. Conclusion Polylactide pins can feasibly treat severely comminuted radial head fractures which are normally considered unreducible. The outcomes were similar to those of metallic implants. This technique provides an optional treatment plan in addition to resection and arthroplasty, especially for young patients that refuse that form of treatment.
Clinical and radiographic outcomes of oblique lateral lumbar interbody fusion and minimally-invasive transforaminal lumbar interbody fusion in patients with grade-1 degenerative spondylolisthesis
Authors: He Da , He Wei , Liu Yajun , Sun Yuqing , Xing Yonggang , Lang Zhao , Tian Wei
Published: January 2020

Background: The most effective lumbar interbody fusion (LIF) technique for degenerative spondylolisthesis remains controversial. Methods: This is a retrospective study. This comparative analysis included consecutive patients with grade-1 degenerative spondylolisthesis who underwent oblique LIF (OLIF) or minimally-invasive transforaminal LIF (MI-TLIF) at the Department of Spine Surgery, our hospital(January 2016 to August 2017). Patient satisfaction (Japanese Orthopaedic Association score), visual analog scale (VAS) scores for back and leg pain, Oswestry disability index (ODI), radiographic outcomes including anterior/posterior disc heights (ADH/PDH), foraminal height (FH), foraminal width (FW), cage subsidence, cage retropulsion and fusion rate were assessed during a 2-year follow-up. Results: The OLIF and MI-TLIF groups comprised 36 patients (age, 52.1±7.2 years; 27 women) and 45 patients (age, 48.4±14.4 years; 24 women) respectively. Satisfaction rates at 2 years exceeded 90% in both groups. The OLIF group had less intraoperative blood loss (140±36 vs. 233±62 mL), lower back pain VAS score (2.42±0.81 vs. 3.38±0.47) and ODI score (20.47±2.53 vs. 27.31±3.71) at 3 months (with trends toward lower values at 2 years), but higher leg pain VAS scores at all postoperative time points than the MI-TLIF group (all P<0.001). ADH, PDH, FD and FW improved in both groups after surgery. At 2 years, the OLIF group had a higher rate of Bridwell grade-I fusion (100% vs. 88.9%, P=0.046) and lower incidences of cage subsidence (8.33% vs. 46.67%, P<0.001) and retropulsion (0% vs. 6.67%, P=0.046). Conclusions: In patients with grade-I spondylolisthesis, OLIF was associated with less blood loss and better improvements in some clinical(VAS for back pain and ODI) and radiologic outcomes than MI-TLIF, although patients in the OLIF group had higher leg pain VAS scores than patients in the MI-TLIF group.
Polymorphisms in endoplasmic reticulum aminopeptidase genes are associated with cervical cancer risk in a Chinese Han population
Authors: Li Chuanyin , Li Yaheng , Yan Zhiling , Dai Shuying , Liu Shuyuan , Wang Xia , Wang Jun , Zhang Xinwen , Shi Li , Yao Yufeng
Published: January 2020

Background: antigen-processing machinery molecules play crucial roles in infectious diseases and cancers. Studies have shown that variants in endoplasmic reticulum aminopeptidase (ERAP) genes can influence the enzymatic activity of ERAP proteins and are associated with the risk of cancers. In the current study, we evaluated the influence of ERAP gene (ERAP1 and ERAP2) variants on susceptibility to cervical intraepithelial neoplasia (CIN) and cervical cancer.Methods: Six single nucleotide polymorphisms (SNPs) in ERAP1 and 5 SNPs in ERAP2 were selected and genotyped in 556 CIN patients, 1072 cervical cancer patients, and 1262 healthy control individuals. Candidate SNPs were genotyped using SNaPshot assay. And the association of these SNPs with CIN and cervical cancer was analysed.Results: the results showed that allelic and genotypic frequencies of rs26653 in ERAP1 were significantly different between cervical cancer and control groups (P=0.001 and 0.004). The allelic frequencies of rs27044 in ERAP1 and rs2287988 in ERAP2 were also significantly different between control and cervical cancer groups (P=0.003 and 0.004). Inheritance model analysis showed that genotypes at rs26618, rs26653, rs27044, and rs2287988 SNPs may be associated with the risk of cervical cancer (P=0.004, 0.001, 0.003, and 0.002). Additionally, haplotype analysis results showed that the ERAP1 haplotype, rs26618T-rs26653G-rs27044C-rs30187T-rs3734016C, was associated with a lower risk of cervical cancer (P=0.001; OR=0.804, 95%CI:0.711-0.910). The ERAP2 haplotypes rs2248374A-rs2549782G-rs2287988G-rs2548538A-rs1056893T might be the risk factor of cervical cancer (P=0.009; OR=1.592, 95%CI:1.122-2.258). Haplotype rs2248374G-rs2549782T-rs2287988A-rs2548538T-rs1056893T of ERAP2 might be associated with lower risk of cervical cancer (P=0.003; OR=0.835,95%CI:0.740-0.942). Conclusion: Our results indicated that rs26653 and rs27044 in ERAP1 and rs2287988 in ERAP2 influenced susceptibility to cervical cancer.
Effect of microwave ablation treatment against hepatic malignance on serum cytokine level.
Authors: Zhao Jing , Li Qiang , Muktiali Merlin , Ren Bingjie , Hu Yingxi , Li Dapeng , Li Zhi , Li Daoming , Xie Yufeng , Tao Min , Liang Rongrui
Published: January 2020

BackgroundMicrowave ablation (MWA) is widely used to treat unresectable primary and secondary malignancies of the liver, and a limited number of studies indicate that ablation can cause not only necrosis at the in situ site but also an immunoreaction of the whole body. This study aimed to investigate the effects of MWA on cytokines in patients who underwent MWA against a hepatic malignancy.MethodsPatients admitted to the Oncology Department in the First Affiliated Hospital of Soochow University between June 2015 and February 2019 were selected. Peripheral blood was collected from patients with a hepatic malignancy treated with MWA. The levels of cytokines (IL-2, IFN-γ, TNF-α, IL-12 p40, IL-12 p70, IL-4, IL-6, IL-8, IL-10, and vascular endothelial growth factor (VEGF)) were detected with a MILLIPLEX® MAP Kit. The comparison times were as follows: before ablation, 24 hours after ablation, 15 days after ablation, and 30 days after ablation. Data were analyzed using a paired sample t-test and Spearman’s correlation analysis.ResultsA total of 43 patients with hepatic malignancies were recorded. There were significant differences in IL-2, IL-12 p40, IL-12 p70, IL-1β, IL-8, and TNF-α at 24 hours after MWA. Significant increases (>2-fold vs. before ablation) were observed in IL-2, IL-1β, IL-6, IL-8, IL-10, and TNF-α after MWA. Elevated IL-2 and IL-6 levels after ablation were positively correlated with energy output during the MWA procedure.ConclusionsMWA treatment for hepatic malignancies can alter the serum levels of several cytokines and affect the tumor status.
Ethnobotany of Bajiru (Chrysobalanus Icaco L.) In a Coastal Vegetation of Southeastern Brazil
Authors: Fonseca-Kruel Viviane Stern , Neves Maria Eduarda Rodrigues , Araujo Dorothy Sue Dunn de , Prance Ghillean T.
Published: January 2020

Background: Chrysobalanus icaco L. (Chrysobalanaceae) is a native but not endemic shrub species from Brazil. It is known as: abajirú, ajuru, bajirú, guajurú. There are ancient reports of edible fruits and leaves used in traditional medicine, mainly by the artisanal fishing communities of the Brazilian coast. It occurs especially in the coastal sand plains, situated between the Atlantic Ocean and the rainforest. However, in the last two decades this vegetation has been suffering strong anthropic pressures, which has led to the suppression of vegetation cover. This fact has impacted both the maintenance of plants and cultural diversity associated with it. Our study aimed to investigate current ethnobotanical knowledge about bajiru, an important species for the treatment of diabetes and recognized in the artisanal fishing communities of Southeastern Brazil to support conservation actions and sustainable management plan.Methods: This study was conducted with the artisanal fishermen community, near the Restinga de Massambaba, Brazilian costal vegetation and was supported by the signature and consent of all the fishermen involved. The collection of ethnobotanical information was performed using snowball technique, seeking artisanal fishermen who hold local knowledge, conversations and informal interviews based on rapport, semi-structured interviews and free listing. The Anthropac 4.0 software was used to calculate the highest citation frequency and highest salience among the repertoire of useful species indicated in the free listing. Complementary techniques were used: free walking with local experts for information triangulation and to collect botanical material. We used the Informant Consensus Factor (ICF) and Fidelity level (FL). Results: Interviews were conducted with 42 artisanal fishermens and bajiru was a preferred and useful species of current relevance (indicated by 32 of 42 fishermen). Its leaves are still used for diabetes treatments and with representative value of the informants' consensus in the studied sample (IFC = 0.78) and the level of fidelity of this use information (FL = 1).Conclusions: In our discussion we highlight the importance of bajiru as a potential for future studies for diabetes. Should the use of bajiru increase comercially greater plans for the conservation and possible cultivation of this specie will be needed.
Two-stage total hip arthroplasty for primary advanced septic arthritis of the hip in adults: comparison of debridement versus femoral head resection with spacer implantation
Authors: Li Zhenzhong , Wei Congcong , Li Xiangke , Yao Mengxuan , Li Huijie
Published: January 2020

Background To compare the outcomes of debridement and antibiotic-loaded spacer implantation in primary advanced septic arthritis (SA) of the hip in adults treated with two-stage total hip arthroplasty (THA). Methods In the first stage, 9 patients were treated with debridement and 11 patients were treated with antibiotic-loaded spacer implantation. Then, THA was conducted in all patients in the second stage. Patients were evaluated based on the recurrence of infection, Harris hip score, visual analogue scale (VAS) pain score and leg-length discrepancy. Results No cases of infection, deep vein thrombosis, death, and loosening of hip prosthesis were observed during follow-up. The mean follow-up time was 29.09 ± 10.80 months in the debridement with THA group, and 28.22 ± 14.80 months in the spacer implantation with THA group. Before the THA surgery, the mean leg-length discrepancy was 2.80 ± 2.03 cm in the debridement with THA group, and 0.50 ± 0.23 cm in the spacer implantation with THA group (P < 0.05). In the latest follow-up, The Harris hip scores of patients was 90.33 ± 4.85 in the debridement with THA group and 94.36 ± 2.34 in the spacer implantation with THA group (P < 0.05), respectively. There was no statistical significant difference in VAS pain score of the hip between the two groups (P > 0.05).Conclusions Two-stage THA using antibiotic-loaded spacer implantation is an effective method for the treatment of advanced SA of the hip in adults due to it can control infection and significantly improve functional hip.
Effect of different attributes of the mimic human lumbar spine biomechanics material structure change by finite element analysis
Authors: Da-ping Qin , Zhang Xiao-gang , Son Ming , Zhang Hua , Cao Lin-zhong , Zhao Wen-tao , Zhang Hong-wei , Zhao Xi-yun , Wang Zhi-peng , Xu Shi-wei
Published: January 2020

Background In this study, we compared stress changes and quantity effect relationships from 3D finite element models of normal and degenerative lumbar segments. We further defined the mechanisms causing alterations in mechanical stability the control of normal and degenerative lumbar segments using traditional Chinese medicine. Objective The characteristics of the stress change and the quantity effect relationships of the three-dimensional finite element model of normal and degenerative lumbar segments were compared. The mechanism(s) leading to changes in mechanical stability and the intervention and balance between normal and degenerative lumbar segments of the traditional Chinese medicine was analyzed. Methods A 3D-FEM of degenerative lumbar segments L4~5 of the human spine was established to simulate the physiological and pathological changes of the lumbar spine in response to flexion, extension, lateral bending and torsion. The stress changes in the normal and degenerative lumbar vertebrae were assessed through external force interventions and the response to TCM. Stress in the degenerative lumbar vertebrae changed according the external load. Stress and strain were compared in the FEM model under a range of motion states. Results Components of the human lumbar vertebrae including the cortical vertebrae, cancellous bone, endplates, fibrous rings, and facet articular processes were investigated. The elastic modulus of the nerve roots and the posterior marginal structures of the vertebral body increased with lumbar degeneration. The stress distribution in the intervertebral discs were influenced by TCM, and the space in the spinal canal enlarged so that nerve root stress decreased, vertebral body stress increased, and facet processes and pedicle stress in the posterior regions exceeded those of the anterior flexion position. The internal stress of the intervertebral disc increased in the flexion compared to the extension position, gradually increasing from top to bottom. Conclusion TCM can improve and treat lumbar disc disease through its ability to regulate the mechanical environment of degenerative lumbar vertebrae. Compared to the FEM models of the lumbar vertebrae, lumbar degenerative changes could be assessed in response to alterations in the biomechanical environment. These findings provide a scientific basis for the popularization and application of TCM to prevent and treat spinal degenerative disease.
Metabolic syndrome in haemodialysis patients: Prevalence, determinants and association to cardiovascular outcomes
Authors: Delautre Arnaud , Chantrel François , Dimitrov Yves , Klein Alexandre , Imhoff Olivier , Muller Clotilde , Schauder Nicole , Hannedouche Thierry , Krummel Thierry
Published: January 2020

Background In the general population, the metabolic syndrome (MetS) has been identified as predictive of major adverse cardiovascular events (MACE). Waist circumference (WC), a component of the MetS criteria, is linked to visceral obesity, which in turn is correlated with MACE. However, in haemodialysis (HD) patients, the association between MetS, WC and MACE is unclear.Methods In a cross-sectional study of 1000 HD patients, we evaluated the prevalence and characterised the clinical predictors of MetS. The relationship between MetS and its components, alone or in combination, and MACE, as defined by comorbidity among coronary diseases, peripheral arteriopathy, stroke or cardiac failure, was further studied using receiver operating characteristics (ROC) curves and logistic regression.Results A total of 753 patients were included between October 2011 and April 2013. The prevalence of MetS was 68.5%. Waist circumference (> 88 cm in women, 102 cm in men) was the best predictor of MetS (sensitivity 80.2; specificity 82.3; AUC 0.80; p < 0.05). In multivariate analysis, MetS was associated with MACE (OR: 1.85; 95CI 1.24-2.75; p < 0.01), but not WC alone. There was a stronger association between the combination of abdominal obesity, hypertriglyceridaemia and low high-density lipoprotein cholesterol with MACE after exclusion of impaired fasting glucose and hypertension.ConclusionsMetS is frequent and associated with MACE in HD patients in our region and probably in other European dialysis populations. In HD patients, a new simplified definition could be proposed, in keeping with the concept of hypertriglyceridaemic waist.