bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Patient-Surgeon Relationship on Patient’s Return to Work
Authors: Dubert Thierry , Girault Cédric , Rozenblat Marc , Dorey Julie , Dubert-Khalifa Heba , Katz Gregory
Published: August 2019

Background:

Upper-limb injuries and musculoskeletal disorders represent a major economic burden for both patients and society, largely due to limitations in returning to work. We hypothesized that a positive patient-surgeon relationship may facilitate patients’ recovery and lead to a faster return to work.

Methods:

This longitudinal observational study comprised 219 patients, from 8 French hand trauma centers, who were 18 to 55 years of age and were on sick leave from work because of an injury or musculoskeletal disorder of the upper limb. In addition to instruments measuring patients’ functional scores and quality of life, the quality of the patient-surgeon relationship was assessed at enrollment using a specific questionnaire (Q-PASREL [Quality of PAtient-Surgeon RELationship]). Six months after enrollment, the return-to-work status was assessed. Logistic and Cox regression models were developed to identify predictors of return to work (yes/no) and the time off from work in days.

Results:

Overall, 74% of the patients who returned to work within 6 months after enrollment had a high or medium-high Q-PASREL score, whereas 64% of the patients who were still on sick leave had a low or medium-low Q-PASREL score. The odds of patients with a low or medium-low Q-PASREL score returning to work were, respectively, 95% and 71% lower than the odds of patients with a high score doing so, with a percent difference of 56% (95% confidence interval [CI] = 40% to 71%) for low versus high (odds ratio [OR] = 0.05 [95% CI = 0.02 to 0.13]) and 25% (95% CI = 6% to 44%) for medium-low versus high (OR = 0.29 [95% CI = 0.11 to 0.76]). All Q-PASREL items and scores were significantly associated with return to work.

Conclusions:

Patients with a lower Q-PASREL score and more severe disability were less likely to return to work within 6 months and had a longer time off from work. Efforts to improve the quality of patient-surgeon relationships may minimize the duration of sick leaves and accelerate patient recovery.

Level of Evidence:

Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
Pediatric Gartland Type-IV Supracondylar Humeral Fractures Have Substantial Overlap with Flexion-Type Fractures
Authors: Mitchell Stuart L. , Sullivan Brian T. , Ho Christine A. , Abzug Joshua M. , Raad Micheal , Sponseller Paul D.
Published: August 2019

Background:

Knowledge is limited about the diagnosis and treatment of modified Gartland type-IV supracondylar humeral fractures. We determined the prevalence of type-IV fractures, identified preoperative characteristics associated with these injuries, and assessed operative treatment characteristics.

Methods:

We retrospectively identified patients <16 years of age who underwent operative treatment of a supracondylar humeral fracture at 2 centers between 2008 and 2016. We compared patient, injury, and treatment characteristics between type-IV and type-III fracture groups (1:4, cases:controls). Preoperative radiographs were assessed by 4 pediatric orthopaedists blinded to fracture type. The odds of a fracture being type IV were assessed using univariate logistic regression for individual radiographic parameters. Significance was set at alpha = 0.05.

Results:

Type-IV fractures accounted for 39 (1.3%) of the supracondylar humeral fractures treated operatively during the study period. A type-IV fracture was associated with the following radiographic parameters: flexion angulation (odds ratio [OR] = 17; 95% confidence interval [CI] = 4.9 to 59), valgus angulation (OR = 5.6; 95% CI = 1.6 to 20), and lateral translation (OR = 4.1; 95% CI = 1.6 to 11) of the distal fragment; osseous apposition between the proximal and distal fragments (OR = 4.0; 95% CI = 1.8 to 9.0); and propagation of the fracture line toward the diaphysis of the proximal segment (OR = 9.2; 95% CI = 1.6 to 53). We found no significant differences in patient or injury characteristics between the groups. Compared with type-III fractures, type-IV fractures were treated more frequently with open reduction and percutaneous pinning (13% compared with 3.8%; p = 0.04) and were associated with longer mean operative time (82 ± 42 compared with 63 ± 28 minutes; p = 0.001).

Conclusions:

We identified 5 preoperative radiographic parameters associated with greater odds of a supracondylar humeral fracture being type IV rather than type III. No patient or injury characteristic differed significantly between the groups. Substantial overlap likely exists between type-IV and flexion-type fractures. Type-IV fractures were associated with longer operative time and were treated with open reduction more frequently than were type-III fractures.

Level of Evidence:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
An Estimation of Lifetime Fatal Carcinogenesis Risk Attributable to Radiation Exposure in the First Year Following Polytrauma
Authors: Howard Anthony , West Robert , Iball Gareth , Panteli Michalis , Pandit Hemant , Giannoudis Peter V.
Published: August 2019

Background:

The utilization of medical imaging continues to rise, including routine use in major trauma centers. The aims of this study were to estimate the amount of radiation exposure from radiographic imaging and the associated fatal carcinogenesis risk among patients treated for polytrauma at 1 institution.

Methods:

Included were patients who were admitted to our institution with an Injury Severity Score (ISS) of ≥16 during the period of January 2007 to December 2016. Records of patients were reviewed to assess exposures to radiation (excluding fluoroscopy) in the 12 months following injury. The risk of developing a fatal cancer of any type was modeled using patient age and sex, on the basis of the International Commission on Radiological Protection (ICRP) recommendations. Estimates of cancer risk were based on the exposure received and then imported into previously developed models.

Results:

Overall, 2,394 patients, with a mean ISS of 28.66 (range, 17 to 66), were included in our analysis. The mean total radiation dose received was 30.45 mSv and the median dose was 18.46 mSv. One hundred and fifteen patients (4.8% of the cohort) received ≥100 mSv of radiation. The total patient group had a 3.56% mean risk of fatal carcinogenesis of any type that related solely to medical exposure of radiation as a result of their injuries. In their lifetime, 85 patients would be expected to develop cancer as a result of medical imaging that they had undergone in the year following their accident. The ISS and the body region of injury contributing to the ISS were predictive of the level of radiation exposure.

Conclusions:

Those involved in trauma care can use the ISS and body region to predict radiation exposure and the risk of fatal carcinogenesis of any type. We found that, for injuries to the limb and pelvis, the greater the severity of injury, the greater the radiation exposure and fatal carcinogenesis risk. However, this study does not provide an actuarial analysis. It is unknown how many patients in the study went on to develop cancer.

Level of Evidence:

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Role of Ligament Stabilizers of the Proximal Carpal Row in Preventing Dorsal Intercalated Segment Instability
Authors: Pérez Alfonso J. , Jethanandani Rishabh G. , Vutescu Emil S. , Meyers Kathleen N. , Lee Steve K. , Wolfe Scott W.
Published: August 2019

Background:

Isolated injuries of the scapholunate interosseous ligament (SLIL) are insufficient to produce dorsal intercalated segment instability. There is no consensus about which additional ligamentous stabilizers are critical determinants of dorsal intercalated segment instability. The aim of this study was to evaluate the role of the long radiolunate (LRL), scaphotrapeziotrapezoid (STT), and dorsal intercarpal (DIC) ligaments in preventing dorsal intercalated segment instability.

Methods:

Thirty fresh-frozen forearms were randomized to 5 ligament section sequences to study the SLIL, LRL, STT, and DIC ligaments. The DIC-lunate insertion (DICL) and scaphoid insertion (DICS) were studied separately; the DIC insertions on the trapezium and triquetrum were left intact. Loaded posteroanterior and lateral fluoroscopic images were obtained at baseline and repeated after each ligament was sectioned. After each sequence, the wrists were loaded cyclically (71 N). The radiolunate angle was measured with load. Dorsal intercalated segment instability was defined as an increase of >15° in the radiolunate angle compared with baseline.

Results:

Division of the SLIL did not increase the radiolunate angle. Section of the SLIL+LRL or SLIL+DICL significantly increased the radiolunate angle but did not produce dorsal intercalated segment instability. Section of the SLIL+STT or SLIL+DICL+DICS produced dorsal intercalated segment instability.

Conclusions:

In order to produce dorsal intercalated segment instability, complete scapholunate injuries require the disruption of at least 1 critical ligament stabilizer of the scaphoid or lunate (the STT or DICL+DICS).

Clinical Relevance:

When treating SLIL tears with dorsal intercalated segment instability, techniques to evaluate the volar and dorsal critical stabilizers of the proximal carpal row should be considered.
Preferred Single-Vendor Program for Total Joint Arthroplasty Implants
Authors: Boylan Matthew R. , Chadda Anisha , Slover James D. , Zuckerman Joseph D. , Iorio Richard , Bosco Joseph A.
Published: August 2019

Background:

In total joint arthroplasty, variation in implant use can be driven by vendor relationships, surgeon preference, and technological advancements. Our institution developed a preferred single-vendor program for primary hip and knee arthroplasty. We hypothesized that this initiative would decrease implant costs without compromising performance on quality metrics.

Methods:

The utilization of implants from the preferred vendor was evaluated for the first 12 months of the contract (September 1, 2017, to August 31, 2018; n = 4,246 cases) compared with the prior year (September 1, 2016, to August 31, 2017; n = 3,586 cases). Per-case implant costs were compared using means and independent-samples t tests. Performance on quality metrics, including 30-day readmission, 30-day surgical site infection (SSI), and length of stay (LOS), was compared using multivariable-adjusted regression models.

Results:

The utilization of implants from the preferred vendor increased from 50% to 69% (p < 0.001), with greater use of knee implants than hip implants from the preferred vendor, although significant growth was seen for both (from 62% to 81% for knee, p < 0.001; and from 38% to 58% for hip, p < 0.001). Adoption of the preferred-vendor initiative was greatest among low-volume surgeons (from 22% to 87%; p < 0.001) and lowest among very high-volume surgeons (from 61% to 62%; p = 0.573). For cases in which implants from the preferred vendor were utilized, the mean cost per case decreased by 23% in the program’s first year (p < 0.001), with an associated 11% decrease in the standard deviation. Among all cases, there were no significant changes with respect to 30-day readmission (p = 0.449) or SSI (p = 0.059), while mean LOS decreased in the program’s first year (p < 0.001).

Conclusions:

The creation of a preferred single-vendor model for hip and knee arthroplasty implants led to significant cost savings and decreased cost variability within the program’s first year. Higher-volume surgeons were less likely to modify their implant choice than were lower-volume surgeons. Despite the potential learning curve associated with changes in surgical implants, there was no difference in short-term quality metrics.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Spatio-temporal characterization of S- and M/L-cone degeneration in the Rd1 mouse model of retinitis pigmentosa
Authors: Narayan Daniel S. , Ao Jack , Wood John P. M. , Casson Robert J. , Chidlow Glyn
Published: August 2019

Background
The Pde6brd1 (Rd1) mouse is widely used as a murine model for human retinitis pigmentosa. Understanding the spatio-temporal patterns of cone degeneration is important for evaluating potential treatments. In the present study we performed a systematic characterization of the spatio-temporal patterns of S- and M/L-opsin + cone outer segment and cell body degeneration in Rd1 mice, described the distribution and proportion of dual cones in Rd1 retinas, and examined the kinetics of microglial activation during the period of cone degeneration.

Results
Outer segments of S- and M/L-cones degenerated far more rapidly than their somas. Loss of both S- and M/L-opsin + outer segments was fundamentally complete by P21 in the central retina, and 90% complete by P45 in the peripheral retina. In comparison, degeneration of S- and M/L-opsin + cell bodies proceeded at a slower rate. There was a marked hemispheric asymmetry in the rate of S-opsin + and M/L-opsin + cell body degeneration. M/L-opsin + cones were more resilient to degeneration in the superior retina, whilst S-opsin + cones were relatively preserved in the inferior retina. In addition, cone outer segment and cell body degeneration occurred far more rapidly in the central than the peripheral retina. At P14, the superior retina comprised a minority of genuine S-cones with a much greater complement of genuine M/L-opsin cones and dual cones, whilst the other three retinal quadrants had broadly similar numbers of genuine S-cones, genuine M/L-cones and dual cones. At P60, approximately 50% of surviving cones in the superior, nasal and temporal quadrants were dual cones. In contrast, the inferior peripheral retina at P60 contained almost exclusively genuine S-cones with a tiny minority of dual cones. Microglial number and activity were stimulated during rod breakdown, remained relatively high during cone outer segment degeneration and loss of cone somas in the central retina, and decreased thereafter in the period coincident with slow degeneration of cone cell bodies in the peripheral retina.

Conclusion
The results of the present study provide valuable insights into cone degeneration in the Rd1 mouse, substantiating and extending conclusions drawn from earlier studies.
Accuracy of the lower third molar radiographic imaging to estimate age among Ugandan young people
Authors: Mwesigwa Catherine Lutalo , Kutesa Annet Mutebi , Munabi Ian Guyton , Kabenge Catherine Ann , Buwembo William
Published: August 2019

Objective: Dental development is a useful method for age estimation. Although third molar eruption is commonly used to estimate age in Uganda, it is reported to be unreliable because of external influences. The more reliable radiographic techniques have inter-ethnic differences but data from sub-Saharan Africa are limited regarding estimating age in young adults. This study, therefore, aimed at determining the accuracy of Demirjian’s classification of the lower third molar, a common dental age estimation method, in estimating key ages in a Ugandan population using Ugandan references. Dental records of 1021 Ugandans aged 10-22 years were assigned to two groups; reference and test. The reference data was retrieved from a database of a previous bigger research project.
Results: The overall sample population comprised of 514/1021 (50.3%) males. The mean age was 15.8 (3.6) years. No significant sex differences in dental age were established in the reference sample (520 records). Accuracy values (area under the curve) at the 12-, 14-, 16- and 18-year-cut-offs were between 0.83 and 0.90 using the test sample (501 records). The results suggest that Demirjian’s classification of the lower third molars is a useful method for age estimation in the young urban Ugandan population in the 10-22-year age-group.
An assessment for Diagnostic and Therapeutic Modalities for Management of Pediatric Iron Defficiency Anemia in Saudi Arabia: a Crossectional Study
Authors: Sulayyim Hadi J Al , Omari Ali Al , Badri Motasim
Published: August 2019

Background: Iron deficiency anemia (IDA) is a global public health issue that affect more than 2 billion individuals worldwide. However evidence for optimal management of IDA is lacking. Objectives: To assess the diagnostic criteria and therapeutic modalities for pediatric IDA employed by physicians in a major public healthcare facility in Riyadh. Methodology: A validated questionnaire including demographic data and patient case-scenarios related to diagnosis and treatment of IDA was employed. Robust regression analysis was used to identify factors associated with overall score of participants. Results: Of the 166 physicians surveyed 147(88.6%) were included in the study. Wide variability was observed in IDA diagnosis and therapy practises. For nutritional IDA, only 15.6% recommended no other laboratory tests in addition to CBC. The majority preferred treatment with ferrous sulfate (77.6%) divided into two doses (57.1%), but the total daily elemental iron doses varied widely from 2 to 6 mg/kg. For intravenous iron, 42.9% recommended iron dextran, 32.7% iron sucrose, and 13.4% would continue oral iron. Of all assessed factors, median score was significantly highest in pediatric hematologists compared with pediatricians, family medicine specialists and GPs; p=0.007, and those work in tertiary care compared with those in primary care; p=0.043. However, in multivariate robust regression analysis, overall score was only significantly associated with professional qualification pediatric hematologist β=13.71,95%CI 2.48-24.95, p=0.017; pediatrician β=1.77,95%C (-6.05-9.59, p=0.66; family medicine β=2.66,95%CI-4.30-9.58, p=0.45 compared with general practitioner. Conclusion: Wide variations exist among physicians in diagnosis and treatment of pediatric IDA. Intervention programs and national guidelines are urgently needed.
Continuing evolution of H6N2 influenza A virus in South African chickens and the implications for diagnosis and control
Authors: Abolnik Celia , Strydom Christine , Rauff Dionne Linda , Wandrag Daniel Barend Rudolph , Petty Deryn
Published: August 2019

Background: The threat of poultry-origin H6 avian influenza viruses to human health emphasizes the importance of monitoring their evolution. South Africa’s H6N2 epidemic in chickens began in 2001 and two co-circulating antigenic sub-lineages of H6N2 could be distinguished from the outset. The true incidence and prevalence of H6N2 in the country has been difficult to determine, partly due to the continued use of an inactivated whole virus H6N2 vaccine and the inability to distinguish vaccinated from non-vaccinated birds on serology tests. In the present study, the complete genomes of twelve H6N2 viruses isolated from various farming systems between September 2015 and February 2019 in three major chicken-producing regions were analysed and a serological experiment was used to demonstrate the effects of antigenic mismatch in diagnostic tests.
Results: Genetic drift in H6N2 continued and antigenic diversity in sub-lineage I is increasing; no sub-lineage II viruses were detected. Reassortment patterns indicated epidemiological connections between provinces as well as different farming systems, but there was no reassortment with wild bird or ostrich influenza viruses. The sequence mismatch between the official antigens used for hemagglutination inhibition (HI) testing and circulating field strains has increased steadily, and we demonstrated that these antigens are likely to miss H6N2 field infections. More concerning, sub-lineage I H6N2 viruses have acquired three of the nine HA mutations associated with human receptor-binding preference (A13S, V187D and A193N) since 2002. Most sub-lineage I viruses isolated since 2015 have acquired the K702R mutation in PB2 associated with the ability to infect humans, whereas prior to 2015 most viruses in sub-lineages I and II contained the avian lysine marker. All strains had an unusual HA0 motif of PQVETRGIF or PQVGTRGIF.
Conclusions: The H6N2 viruses in South African chickens are mutating and reassorting amongst themselves but have remained a genetically pure lineage since they emerged more than 18 years ago. Greater efforts must be made by government and industry in the continuous isolation and characterization of field strains for use as HI antigens, new vaccine seed strains and to monitor the zoonotic threat of H6N2 viruses.
Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia, 2018: Community based cross-sectional survey
Authors: Zena Dereje , Asrat Anemaw , Fentahun Agumas
Published: August 2019

IIntroduction: Modern Contraceptive use allows people to attain their desired number of children and determine the spacing of pregnancies. Objective: The main objective of this study is to assess the Prevalence of modern contraceptive utilization and associated factors among women of reproductive age from 36-49 years in Ethiopia. Methodology: A community based, cross-sectional study was employed from January 1 to June 30, 2016, among women of reproductive age from 36-49 years in all regions of Ethiopia. A bivariate, multivariable logistic regression model was fit and statistical significance was determined with odds ratios and 95 % confidence level. Result: The overall modern contraceptive prevalence rate was found to be 17%. Being wealthy (Adjusted Odds Ratio=4.120 95%CI (2.853, 5.949), higher educated (Adjusted Odds Ratio =3.329, 95%CI (2.065, 5.368) and having more numbers of living children (Adjusted Odds Ratio =1.714, 95% (1.328, 2.212) was significantly associated with use of modern contraceptive methods. Conclusion: The utilization of modern contraceptive method was low. Contraceptive utilization was associated with some socio-economic and socio-demographic factors like age, educational status, women wealth index and number of children. Keywords: modern Contraceptives use, Associated Factors and Women
Identification of quantitative trait loci and the exploration of candidate genes for the tolerance to Zn deficiency in maize
Authors: Xu Jianqin , Zhu Xiaoyang , Fu Xiuyi , Yu Futong
Published: August 2019

Background

Zn is essential for plants and Zn deficiency leads to great reduction in quality and quantity of crops. Maize, as one of the most important main staple crops worldwide, is more susceptible to Zn deficiency than any other cereal crops. Therefore, understanding the functional mechanisms in tolerance to Zn deficiency in maize is urgent but is still lacking. In this study, quantitative trait loci (QTL) analysis in K22 and By815 RIL population with high-density bin map was conducted to investigate genetic basis of the mechanisms in maize to tolerate Zn deficiency, subsequently some candidate genes were identified and considered as being associated with Zn metabolisms in plants.

Results

21 QTLs were detected and accounted for 5.9% - 16.6% of phenotypic variations. Based on the co-localization in this study and the comparisons with previous studies in different RIL and GWAS populations, 223 candidate genes were identified inside the reduced QTL peak intervals on chromosome 1, 2, 6, 7 and 9. Furthermore, 9 genes detected within the peak bins of valuable genomic regions are suggested to be associated with ions transportation and some redox processes affected by Zn deficiency. Additionally, 5 genes, including ZmIRT1, ZmNRAMP6, ZmEIN2 and ZmHMAs, whose homologous gene have been studied and considered to be responsible for metal cations transportation and ethylene-signaling pathway requiring a transition metal were discovered in 5 loci we mapped.

Conclusions

14 target genes identified in 9 loci we mapped in this work were explored to elucidate the potential functions in Zn homeostasis and the direct or indirect effects on mechanisms in Zn deficiency tolerance in maize. It is the first time that ZmIRT1, ZmNRAMP6, ZmHMAs were identified using linkage analysis under Zn deficiency in maize, providing genetic evidence and foundation for further gene functional characterization. Our findings have assisted us untangling the genetic basis of possible mechanisms in response to Zn deficiency in maize.
Phylogenomics, biogeography, and clade diversification of Paris (Melanthiaceae)
Authors: Ji Yunheng , Yang Lifang , Chase Mark W. , Liu Changkun , Yang Zhenyan , Yang Jin , Yang Jun-Bo , Yi Ting-Shuang
Published: August 2019

Background

Paris (Melanthiaceae) is an economically important but taxonomically difficult genus, which is unique in angiosperms because some species have extremely large nuclear genomes. Phylogenetic relationships within Paris have long been controversial. Based on complete plastomes and nuclear ribosomal DNA (nrDNA) sequences, this study aims to reconstruct a robust phylogenetic tree and explore historical biogeography and clade diversification in the genus.

Results

All 29 species currently recognized in Paris were sampled. Complete plastomes and nrDNA sequences were generated by the genome skimming approach. Phylogenetic relationships were reconstructed using the maximum likelihood and Bayesian inference methods. Based on the phylogenetic framework and molecular dating, biogeographic scenarios and historical diversification of Paris were explored. Significant conflicts between plastid and nuclear datasets were identified, and the plastome tree is highly congruent with past interpretations of the morphology. Ancestral area reconstruction indicated that Paris may have originated in northeastern Asia and northern China, and has experienced multiple dispersal and vicariance events during its diversification. The rate of clade diversification has sharply accelerated since the late Miocene.

Conclusions

Our results provide important insights for clarifying some of the long-standing taxonomic debates in Paris. Cytonuclear discordance may have been caused by ancient and recent hybridizations in the genus. The climatic and geological changes since the late Miocene, such as the intensification of Asian monsoon and the rapid uplift of Qinghai-Tibet Plateau, as well as the climatic fluctuations during the Pleistocene, played essential roles in driving range expansion and radiative diversification in Paris. Our findings challenge the theoretical prediction that large genome sizes may limit speciation.
AMBN gene polymorphism Alters the Caries Susceptibility of Adolescents in South China
Authors: Wang Ketian , Pang Liangyue , Yin Luoping , Li Xia , Zhang Jianming , Cui Tianqiang , Tao Ye , Lin Huan Cai
Published: August 2019

The aim of this study was to identify genetic factors under additive and dominance models that contribute to caries susceptibility, and to investigate into the interactions between these genes. A cross-sectional study was conducted among 1055 adolescents in Foshan, South China. The International Caries Detection and Assessment System (ICDAS) was used to identify caries. Demographic and environmental variables were analyzed. Twenty-three single nucleotide polymorphisms (SNPs) in 14 genes were identified from saliva samples. Regression analysis was used for the evaluation of direct and epistasis of genes under the hypothesis of an additive model and using the minor allele as the reference allele. After the adjustment by environmental factors, the G allele in AMBN (rs13115627) was a protective factor for caries under both additive model (P=0.007; OR=0.728; 95% CI, 0.579-0.916) and dominance model (P=0.021; OR=0.728; 95% CI, 0.556-0.953). No interactions between selected genes met the Bonferroni correction significance cutoff for multiple testing. Our results suggests that gender, one-child family, Cariostat score and Plaque Index have independent protective effects on dental caries. The polymorphisms in AMBN (rs13115627), under both additive and dominance models alters caries susceptibility of Adolescents in South China. No epistatic effect has been found between selected genes.
Prevalence, infection intensity and associated risk factors of Intestinal Schistosomiasis among primary school Children in Lira District, Northern Uganda
Authors: Byagamy John Paul , Malinga Geoffrey Maxwell , Angwech Harriet , Opiro Robert , Echodu Richard , Odongo-Aginya Emmanuel
Published: August 2019

Objective: The aim of this cross-sectional study was to determine the prevalence, infection intensity and associated risk factors of intestinal schistosomiasis among primary school children in Lira district, Uganda. The study was conducted among 532 primary school pupils aged 6-16 years from eight randomly selected primary schools (March-May 2017). Stool samples were collected and examined for schistosomiasis using Odongo-Aginya method. Data on socio-demographic characteristics and risk factors were obtained using questionnaires.
Results: The overall prevalence of Schistosoma mansoni was 35.7% indicating a moderate infection. Both males and females were equally affected with S. mansoni . Ogur sub county had highest prevalence (42.1%) than others. Akangi and Akano primary schools both had highest (21.1%) prevalence compared to the others. Individuals aged 14-16 and 10-14 years had heavy infections (mean epg) of 600 and 565 eggs, respectively than those aged 6-9 years. With regard to risk factors, source of drinking water, sub-county location and primary school were associated with infection. Participants who fetch water from spring (85,44.7%) had higher infection than those who fetch from other sources. The study recommends provision of safe water, periodic treatment of school-aged children with praziquantel and public health education to reduce prevalence of S. mansoni .
A blended eHealth intervention for insomnia following acquired brain injury study protocol for a randomized controlled trial
Authors: Ford Marthe , Geurtsen Gert J. , Groet Erny , Bennekom Coen A.M. Van , Someren Eus J.W. Van
Published: August 2019

Background Up to a third of stroke patients and patients with traumatic brain injury suffer from insomnia, including problems to fall asleep or stay asleep at night. Insomnia may exacerbate other brain damage-related problems, for example regarding cognitive functioning and emotional well-being, may lead to poorer quality of life, and may complicate recovery processes. Cognitive behavioural therapy for insomnia, delivered face-to-face or online, is found to be effective in the general population. However, despite the high prevalence and serious consequences of insomnia following acquired brain injury, studies on the efficacy of face-to-face cognitive behavioural treatment in this population are scarce, and this applies even more for studies on online cognitive behavioural therapy. Therefore, this study aims to evaluate the efficacy of a newly developed guided online cognitive behavioural therapy for insomnia following acquired brain injury. Methods A multicenter randomized controlled trial will be conducted, in which 48 patients diagnosed with stroke or traumatic brain injury, and insomnia will be randomly allocated to the online cognitive behavioural therapy for insomnia treatment group or the treatment as usual group. The treatment consists of 6 online cognitive behavioural therapy sessions given on a weekly basis and personalized feedback after each session, combined with face-to-face sessions. Outcomes will be assessed at baseline, immediately after the intervention period and at 6 week follow up. The primary outcome is the insomnia severity assessed with the insomnia severity index. Secondary outcome measures include sleep quality, sleep features derived from the sleep diary, fatigue, anxiety and depression, subjective cognitive functioning and societal participation. Discussion This study will provide insight on the efficacy of online cognitive behavioural therapy for insomnia following stroke and traumatic brain injury. Trial Register Netherlands Trial Register, NTR7082, 12 March 2018
eNACT: A protocol for a randomised placebo-controlled trial investigating the efficacy and mechanisms of action of adjunctive N-acetylcysteine for first episode psychosis
Authors: Cotton Sue , Berk Michael , Watson Amity , Wood Stephen , Allott Kelly , Bartholomeusz Cali , Bortolasci Chiara , Walder Ken , O'Donoghue Brian , Dean Olivia , Chanen Andrew , Amminger Paul , McGorry Patrick , Ratheesh Aswin , Dodd Seetal
Published: August 2019

Background First episode psychosis (FEP) may lead to a progressive, potentially disabling and lifelong chronic illness; however, evidence suggests that the illness course can be improved if appropriate treatments are given at the early stages. Nonetheless, the efficacy of antipsychotic medications is suboptimal, particularly for negative and cognitive symptoms, and more efficacious and benign treatments are needed. Previous studies have shown the antioxidant amino acid N-acetyl cysteine (NAC) reduces negative symptoms and improves functioning in chronic schizophrenia and bipolar disorder. Research is scarce as to whether NAC is beneficial earlier in the course of illness. The primary aim of this study is to determine the efficacy of treatment with adjunctive NAC (2g/day for 26 weeks) compared with placebo to improve psychiatric symptoms in young people experiencing FEP. Secondary aims are to explore the neurobiological mechanisms underpinning NAC and how they relate to various clinical and functional outcomes at 26- and 52-week follow-up. Methods ENACT is a 26-week randomised controlled trial of adjunctive NAC versus placebo, with a 26-week non-treatment follow-up period, for FEP. We will be recruiting 162 young people aged 15-25 years who have recently presented to, and are being treated at, the Early Psychosis Prevention and Intervention Centre, Melbourne, Australia. The primary outcome is the Total Score on the Positive and Negative Syndrome Scale which will be administered at baseline, and weeks 4, 8, 12, 26 (primary endpoint), and 52 (end of study). Secondary outcomes include: symptomatology, functioning, quality of life, neurocognition, blood-derived measures of; inflammation, oxidative and nitrosative stress, and magnetic resonance spectroscopy measures of glutathione concentration. Discussion Targeted drug development for FEP to date has generally not involved the exploration of neuroprotective agents. This study has the potential to offer a new, safe, and efficacious treatment for people with FEP, leading to better treatment outcomes. Additionally, the neuroprotective dimension of this study may lead to a better long-term prognosis for people with FEP. It has the potential to uncover a novel treatment that targets the neurobiological mechanisms of FEP and, if successful, will be a major advance for psychiatry.
Enhancement of de novo sequencing, assembly and annotation of the Mongolian gerbil genome with transcriptome sequencing and assembly from several different tissues
Authors: Cheng Shifeng , Fu Yuan , Zhang Yaolei , Xian Wenfei , Wang Hongli , Grothe Benedikt , Lu Xin , Xu Xun , Klug Achim , McCullagh Elizabeth
Published: August 2019

BACKGROUND: The Mongolian gerbil (Meriones unguiculatus) has historically been used as a model organism for the auditory and visual systems, stroke/ischemia, epilepsy and aging related research since 1935 when laboratory gerbils were separated from their wild counterparts. In this study we report genome sequencing, assembly, and annotation further supported by transcriptome sequencing and assembly from 27 different tissues samples. RESULTS: The genome was assembled using Illumina HiSeq 2000 and resulted in a final genome size of 2.54 Gbp with contig and scaffold N50 values of 31.4 Kbp and 500.0 Kbp, respectively. Based on the k-mer estimated genome size of 2.48 Gbp, the assembly appears to be complete. The genome annotation was supported by transcriptome data that identified 31 769 (>2000bp) predicted protein-coding genes across 27 tissue samples. A BUSCO search of 3023 mammalian groups resulted in 86% of curated single copy orthologs present among predicted genes, indicating a high level of completeness of the genome. CONCLUSIONS: We report a de novo assembly of the Mongolian gerbil genome that was further enhanced by assembly of transcriptome data from several tissues. Sequencing of this genome increases the utility of the gerbil as a model organism, opening the availability of now widely used genetic tools.
Pancreatic neck thickness: A possible key to stump closure technique selection after distal pancreatectomy
Authors: Nikov Andrej , Záruba Pavel , Bělina František , Ryska Miroslav
Published: August 2019

Background

To date, no stump closure technique has been shown to be superior in lowering the risk of postoperative pancreatic fistula (POPF) after pancreatectomy. The aims our study were to investigate the possibility to influence POPF risk by selection of stump closure technique according to pancreatic parenchyma thickness and to establish a thickness cut-off value for selection of a hand-sewn and stapled closure technique.

Methods

A retrospective analysis of consecutive patients who underwent distal pancreatectomy at a single centre was performed. Anatomical determination of the transection site (pancreatic neck, body, or tail) was based on operative report and postoperative follow-up computed tomography (CT), with the thickness measured on the most recent CT image before surgery. Patients were classified by the thickness of the transection site, and sub-classified according to stump closure technique. POPF incidence, morbidity, mortality, and baseline-characteristics were investigated between groups.

Results

Among the 115 cases included in the analysis, the incidence of POPF was 33%, with no difference between stapled (29.9%) and hand-sewn (37.5%) closure techniques (p=0.426), regardless of transection site thickness. Among those with a transection site <13 mm, the incidence of POPF was 4.6% in the stapler subgroup versus 45.5% in the hand-sewn subgroup (p=0.0002). Among patients with a transection site ≥13 mm, the incidence of POPF was 75% in the stapler subgroup versus 30.8% in the hand-sewn subgroup (p=0.007).

Conclusions

Transection in the pancreatic neck, stapler closure of thin parenchyma, and hand-sewn closure of thick parenchyma were associated with significantly lower risk of POPF.
Can a community-led intervention offering social support and health education improve maternal health?: a repeated measures evaluation of the PACT project run in a socially deprived London borough at 6 month follow-up
Authors: Brown June S.L. , Luderowski Ana Lucia , Namusisi-Riley Josephine , Moore-Shelley Imogen , Bolton Matthew David , Bolton Derek
Published: August 2019

Background
Social adversity can significantly influence the wellbeing of mothers and their children. Maternal health may be improved through strengthened support networks and better health literacy. Population level health improvement requires the optimizing of the collaboration between statutory services (e.g. midwifery and health visiting services), civic organisations (e.g. churches, schools) as well as community groups and parents themselves. Key elements in improving community engagement are co-production and community control. This study evaluates a co-produced and community-led intervention developed for ante-natal and post-natal mothers, offering social support and health education. The intervention was based in a deprived south London borough.
Methods
A pre-post design was used to assess changes in the maternal health of mothers before and 6 months after attending a weekly intervention offering two key elements: social support for mothers and children (called Mumspace), and health education for mothers (called Parent University). Measures used included depression (PHQ-9), anxiety (GAD-7), health literacy (New Vital Signs), social capital (ASSIS) and a satisfaction measure.
Results
Sixty-one mothers were recruited at baseline and 58 mothers (95.1%) followed up after 6 months. The PACT intervention attracted some “difficult to engage” mothers, specifically Nigerian (26.2%) and Latin American (9.8%) mothers, the proportion of which was 5.8% and 3.6% above that in census records. Significant improvements were found on depression and anxiety for all the mothers, but particularly significant changes were found for those with more severe problems at baseline. There were also improvements in health literacy for those with poor literacy at baseline, overall social capital as well as 4 out of the 8 specific aspects. Satisfaction with the service was high.
Conclusions
This community-led social support and health education intervention has engaged “difficult to engage” mothers, as well as found very positive outcomes from a 6 month follow-up of mothers. Improvements were found on mental health, with particularly marked changes in depression and anxiety of mothers with more severe problems. Improvements in health literacy and social capital were also found. This is a promising intervention for the maternal mental health of mothers. A more rigorous controlled trial is recommended to further examine its effectiveness.
Modified Hardinge approach is an alternative to trochanteric flip osteotomy for Pipkin type IV femoral head fracture
Authors: Chen I-Jung , Chou Ying-Chao , Hsu Yung-Heng , Yu Yi-Hsun
Published: August 2019

Background
Pipkin type IV femoral head (FH) fractures generally have poor prognoses. Although several surgical approaches are used, the optimal procedure is still under debate. The purposes of this study were to compare two approaches, the modified Hardinge approach and trochanteric flip osteotomy, for the treatment of Pipkin type IV FH fractures.

Methods
This retrospective study included 20 patients who underwent surgical treatment for Pipkin type IV FH fractures between January 2011 and September 2017 at a level 1 trauma center. Thirteen were treated using the modified Hardinge approach (group A) and seven with trochanteric flip osteotomy (group B). All patients completed at least 1 year of follow-up. The clinical outcome of the Merle d’Aubigné-Postel score; and radiological outcomes including the quality of the fracture reduction, the osteonecrosis of the FH (ONFH), the hip joint osteoarthritis (OA), and heterotopic ossification (HO); were compared between the two groups. Conversion to THR was also recorded as an outcome measure, analyzed by Kaplan–Meier curve and log-rank test.

Results
The mean operative time was similar in the two groups. The estimated blood loss of group B (435.7 ± 307.8 ml) was nearly double that of group A (233.1 ± 116.8 ml), although not statistically significant (P = 0.135). Radiographic outcomes including the quality of fracture reduction, ONFH, hip joint OA, and HO did not differ significantly between the two groups. There were also no significant differences between the two groups in terms of mean Merle d’Aubigné-Postel score at 1 year after injury and the log rank test of conversion to THR. One patient in group A had recurrent dislocation and underwent revision surgery, while one patient in group B requested removal of the trochanteric screws due to discomfort.

Conclusions
For the management of Pipkin type IV FH fractures, the modified Hardinge approach results in reduced blood loss, similar clinical and radiological outcomes compared with trochanteric osteotomy. The modified Hardinge approach appears to be an acceptable alternative to trochanteric flip osteotomy.
Costs analysis of Staged Versus Simultaneous Bilateral Total Knee and Hip Arthroplasty：a university affiliated hospital survey of 1579 Chinese patients
Authors: Hou Ji-Fei , Hu Chuan , Liu Yan-Zheng , Zhang Chi , Li Jing , Wang Yue , Li Cheng-Cheng , Zhang Yun
Published: August 2019

Background
Total knee arthroplasty (TKA) and total hip arthroplasty (THA) are required for many patients. No recent studies that concentrate on the costs for each of the payment items both for TKA and THA when comparing simultaneous bilateral procedures with staged arthroplasty. This study aimed to evaluate the medical costs, length of stay(LOS), blood transfusion, and in-hospital complications in patients undergoing simultaneous TKA or THA and staged TKA or THA.

Methods
A retrospective cohort study was conducted by analyzing 1,579 patients from a single institution. All patients who underwent primary bilateral TKA or THA from 2013 to 2018 were divided into simultaneous bilateral and staged bilateral groups. These two sub-groups were compared between three groups(TKA, THA, and pooled groups).

Results
All categories of medical costs, except for materials fees which were higher in the simultaneous bilateral THA and pooled groups but with no statistical significance, were lower in the simultaneous TKA, THA and pooled simultaneous groups. The total average medical costs in simultaneous and staged bilateral TKA groups were $15,535.621($12,362.542,$16,450.131)and $16,747.192($14,670.273, $18,036.289), (p <0.001), respectively; THA groups were $15,046.210 ($12,838.230, $17,026.529) and $16,126.808 ($14,575.031, $18,867.963), (p=0.003), respectively; pooled groups were $16,506.971 ($14,618.267, $18,185.414) and $15,467.561 ($12,432.783, $16,494.155), (p <0.001), respectively. The highest and lowest costs were materials fees and nursing care fees. No significant differences were found for complications between the two sub-groups in three groups. The simultaneous groups had a shorter LOS, a higher incidence of blood transfusion than staged groups whether it is TKA groups or THA or pooled groups.

Conclusions
These results indicate that simultaneous bilateral TKA and THA with a shorter LOS is more cost-effective than staged bilateral TKA and THA. Counts of complications were not affected by the choice for staged or simultaneous bilateral total arthroplasty. But blood transfusion was more prevalent in the simultaneous groups both for TKA and THA.
Two-year outcome of an eye that underwent hyperopic LASIK following inadvertent myopic SMILE lenticule in situ implantation
Authors: Zhao Jing , Shang Jianmin , Niu Lingling , Xu Haipeng , Yang Dong , Zhao Yu , Fu Dan , Zhou Xingtao
Published: August 2019

Background: This report describes a case in which hyperopic femtosecond laser-assisted in situ keratomileusis (FS-LASIK) was performed following small incision lenticule extraction (SMILE) lenticule in situ implantation.
Case presentation: The hyperopic left eye of a 46-year-old patient with refraction of +7.75 diopters sphere (DS)/-1.25 diopters cylinder (DC)  5° and corrected distance visual acuity (CDVA) of 20/50 mistakenly underwent the SMILE procedure for myopic astigmatism (-8.50 DS/-1.50 DC  175°) due to medical negligence. The extracted lenticule was subsequently re-implanted in situ. After 8 months, the left eye underwent FS-LASIK to correct hyperopia and astigmatism (+5.0 DS/-0.75 DC × 100°). Two years after FS-LASIK, corneal tomography showed no ectasia and microscopy revealed transparent cornea. The left eye exhibited CDVA of 20/50 with refraction of -0.75 DS/-0.25 DC × 165°.
Conclusions: SMILE lenticule in situ implantation offers a solution for corneal volume and thickness restoration. FS-LASIK provides feasible correction of refractive error following lenticule re-implantation. Future studies are needed for determining the effectiveness of the treatment.