bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparing effects of continuous glucose monitoring systems (CGMs) and self-monitoring of blood glucose (SMBG) amongst adults with type 2 diabetes mellitus: a systematic review protocol
Authors: Zheng Mingyue , Luo Yunting , Lin Wei , Khoja Adeel , He Qian , Yang Shenqiao , Zhao Xuan , Hu Peng
Published: May 2020

Background

Continuous glucose monitorings (CGMs) have been used to manage diabetes with reasonable glucose control amongst patients with type 2 diabetes (T2D) in recent decades. CGMs measure interstitial fluid glucose levels to provide information about glucose levels, which identify fluctuation that would not have been identified with conventional self-monitoring. Self-monitoring of blood glucose (SMBG) is a classical tool to measure glycaemic changes. However, the effectiveness of glucose control, hypoglycemia, weight change, quality of life and user satisfaction, are needed to evaluate and compare CGMs and SMBG amongst adults with T2D.

Methods

The review will compare the various forms of CGM systems (i.e flash CGM, real-time CGM, retrospective CGM) versus SMBG or usual intervention regarding diabetes management amongst adults with T2D. The following databases will be searched: Cochrane Library, PubMed, EMBASE, CINAHL, PsycINFO, Scopus and grey literature (ClinicalTrials.gov, PsycEXTRA, ProQuest Dissertations, Google Scholar and Theses Global) for the identification of studies. The studies involving adults (aged ≥ 18 years old) will be included. We will only include and summarise randomised clinical trials (RCTs) with respect to authors, publication type, year, status and type of devices. Studies published in English between February 2010 and March 2020, will be included as the field of CGMs amongst T2D patients has emerged over the last decade. Primary outcomes will be HbA1c (glycosylated haemoglobin level) (mmol/L), body weight (kg), time spent with hypoglycaemia (< 70 mg/dl) or hyperglycaemia (≥ 180 mg/dl), blood pressure (< 140/90 mmHg is considered as good management) and quality of life (understanding and feeling of living situation based on culture and value system). Secondary outcome measures will be user satisfaction (patient or treatment/intervention satisfaction or satisfaction scale) and barriers (physical and mental difficulties or issues). Study selection, data extraction and risk of bias assessment will be conducted independently by at least two reviewers. A third reviewer will determine and resolve discrepancies. Moreover, the quality of the evidence of the review will be assessed according to the Grading of Recommendations Assessment, Development and Evaluation tool (GRADE).

Discussion

The review will synthesise evidence on the comparison between using CGMs and SMBG. The results will support researchers and health professionals to determine the most effective methods/technologies in the overall diabetes management.

Systematic review registration

PROSPERO CRD42020149212
Related Suzuki-type fixed point theorems in ordered metric space
Authors: Rida Outass , Karim Chaira , El Miloudi Marhrani
Published: May 2020

In this paper, we use Suzuki-type contraction to prove three fixed point theorems for generalized contractions in an ordered space equipped with two metrics; we obtain some generalizations of the Kannan fixed point theorem. Our results on partially ordered metric spaces generalize and extend some results of Ran and Reurings as well as of Nieto and Rodríguez-López. To illustrate the effectiveness of our main result, we give an application to matrix equations which involves monotone mappings.
COVID19, the pandemic which may exemplify a need for harm-reduction approaches to eating disorders: a reflection from a person living with an eating disorder
Authors: Janse van Rensburg Margaret
Published: May 2020

This reflective piece, written by a woman with an eating disorder aims to identify the impact of COVID-19 on persons living with eating disorders and provide a social justice approach as a resolution. The author identifies that eating disorder behaviors may be the only coping tool available for many persons with eating disorders during this time of uncertainty. While she acknowledges the risks associated with eating disorder behaviors, she identifies that this time of uncertainty may be a time to embrace harm-reduction in approaching the health and wellness of persons with eating disorders.
Treating winter depressive episodes in bipolar disorder: an open trial of light therapy
Authors: van Hout Lotte J. E. , Rops Lisette E. P. , Simons Claudia J. P.
Published: May 2020

Background

Light therapy has been used to treat winter depression in bipolar disorder, although the dose, duration, and timing of treatment have differed. The present study is an open trial of light therapy for depressive episodes in autumn/winter using a Dutch protocol specific for patients with a bipolar disorder.

Methods

Data were collected for the seasons September–April 2017–2018 and September–April 2018–2019. In total, 58 patients received light therapy for a minimum of 7 days and a maximum of 21 days; there was a follow-up measurement after two weeks. Outcomes were quick inventory of depressive symptomatology (QIDS) scores and side effects.

Results

QIDS scores were significantly lower at the last day of therapy (B = − 6.00, p < 0.001) and 2 weeks after the end of treatment (B = − 6.55, p < 0.001) compared with pre-intervention. Remission (QIDS ≤ 5) was reached in 55% of the treatments and response (50% symptom reduction) in 57% of the treatments. Side effects were mild; two hypomanic periods occurred.

Conclusions

The Dutch light therapy protocol for patients with a bipolar disorder may be effective in treating a seasonal depression and side effects are mild. Light therapy deserves a prominent place in the treatment because effects may be large and quick.
Modulation of CYP2E1 metabolic activity in a cohort of confirmed caffeine ingesting pregnant women with preterm offspring
Authors: Alcorta-García M. R. , López-Villaseñor C. N. , Sánchez-Ferrer G. , Flores-Mendoza H. , Castorena-Torres F. , Aguilar-Torres M. A. , Sepúlveda-Treviño C. M. , Hernández-Hernández J. A. , López-Sánchez R. C. , Lara-Díaz V. J.
Published: May 2020

Background

To ascertain interactions of caffeine ingestion, food, medications, and environmental exposures during preterm human gestation, under informed consent, we studied a cohort of Mexican women with further preterm offspring born at ≤ 34 completed weeks. At birth, blood samples were taken from mothers and umbilical cords to determine caffeine and metabolites concentrations and CYP1A2 (rs762551) and CYP2E1 (rs2031920, rs3813867) polymorphisms involved in caffeine metabolism.

Results

In 90 pregnant women who gave birth to 98 preterm neonates, self-informed caffeine ingestion rate was 97%, laboratory confirmed rate was 93 %. Theobromine was the predominant metabolite found. Consumption of acetaminophen correlated significantly with changes in caffeine metabolism (acetaminophen R2 = 0.637, p = 0.01) due to activation of CYP2E1 alternate pathways. The main caffeine source was cola soft drinks.

Conclusion

Environmental exposures, especially acetaminophen ingestion during human preterm pregnancy, can modulate CYP2E1 metabolic activity.
Orthodontic bonding procedures significantly influence biofilm composition
Authors: Jeon Da-Mi , An Jung-Sub , Lim Bum-Soon , Ahn Sug-Joon
Published: May 2020

Background

Because changes in surface properties affect bacterial adhesion, orthodontic bonding procedures may significantly influence biofilm formation and composition around orthodontic appliances. However, most studies used a mono-species biofilm model under static conditions, which does not simulate the intraoral environment and complex interactions of oral microflora because the oral cavity is a diverse and changeable environment. In this study, a multi-species biofilm model was used under dynamic culture conditions to assess the effects of the orthodontic bonding procedure on biofilm formation and compositional changes in two main oral pathogens, Streptococcus mutans and Porphyromonas gingivalis.

Methods

Four specimens were prepared with bovine incisors and bonding adhesive: untreated enamel surface (BI), enamel surface etched with 37% phosphoric acid (ET), primed enamel surface after etching (PR), and adhesive surface (AD). Surface roughness (SR), surface wettability (SW), and surface texture were evaluated. A multi-species biofilm was developed on each surface and adhesion amounts of Streptococcus mutans, Porphyromonas gingivalis, and total bacteria were analyzed at day 1 and day 4 using real-time polymerase chain reaction. After determining the differences in biofilm formation, SR, and SW between the four surfaces, relationships between bacteria levels and surface properties were analyzed.

Results

The order of SR was AD < PR < BI < ET, as BI and ET showed more irregular surface texture than PR and AD. For SW, ET had the greatest value followed by PR, BI, and AD. S. mutans and P. gingivalis showed greater adhesion to BI and ET with rougher and more wettable surfaces than to AD with smoother and less wettable surfaces. The adhesion of total bacteria and S. mutans significantly increased over time, but the amount of P. gingivalis decreased. The adhesion amounts of all bacteria were positively correlated with SR and SW, irrespective of incubation time.

Conclusions

Within the limitations of this study, changes in SR and SW associated with orthodontic bonding had significant effects on biofilm formation and composition of S. mutans and P. gingivalis.
A nationwide study of asthma correlates among adolescents in Saudi Arabia
Authors: Musharrafieh Umayya , Tamim Hani , Houry Rana , AlBuhairan Fadia
Published: May 2020

Background

Asthma is a chronic airway inflammation disease that is frequently found in children and adolescents with an increasing prevalence. Several studies are linking its presence to many lifestyle and health correlates. The objective of this study was to explore these correlates and find characteristics of self-reported asthmatics among adolescents in Saudi Arabia.

Methods

This is a cross-sectional, school-based study carried out in all 13 regions of Saudi Arabia. Sampling was randomly done from intermediate and secondary school students. Data in our study consisted of demographic characteristics, health conditions and lifestyle patterns and were compared between the two groups: asthmatics versus non-asthmatics. Comparison between the two groups was done by analyzing our data using Statistical Analysis Software SURVEYFREQ procedure (SAS Version 9; SAS Institute, Cary, NC).

Results

Among a sample of 11,348 participants, the prevalence of self-reported asthma was found to be 8.2%. Various characteristics were found significantly different between the 2 groups including the gender, the weight, the family’s education, and dietary patterns. Self –reported asthmatic were more likely to be males, overweight or obese, with a lower father’s level of education and a higher consumption of milk and power drinks.

Conclusion

Asthma disease remains prevalent among adolescents in Saudi Arabia and requires higher awareness and better guidance for its prevention and treatment. Further efforts should focus on health promotion and lifestyle wellness to support preventive efforts of this chronic disease condition.
Ibuprofen gargle for chemo- or Chemoradiotherapy-induced Oral Mucositis: a feasibility study
Authors: Ioroi Takeshi , Kiyota Naomi , Imamura Yoshinori , Tanda Masaaki , Aoki Shiori , Okuno Mamoru , Yamamoto Kazuhiro , Sasaki Ryohei , Nibu Ken-ichi , Minami Hironobu , Hirai Midori , Yano Ikuko
Published: May 2020

Background

Oral mucositis frequently occurs in cancer patients treated with chemotherapy and chemoradiotherapy (CRT). This study examined the safety and efficacy of ibuprofen gargle in healthy volunteers and patients with chemotherapy- and concomitant CRT-induced oral mucositis.

Methods

We enrolled healthy volunteers and patients with chemotherapy- and CRT-induced oral mucositis. In cohort I, single and multiple doses of ibuprofen gargle (0.6% or 1.0%) were administered to healthy volunteers on day 1 and days 4–10. In cohort II, multiple doses of ibuprofen gargle (0.6%) were administered to patients with complicated grade 2–3 oral mucositis based on the Common Terminology Criteria for Adverse Events (CTCAE) version 4.0. The primary endpoint of cohort I was the treatment-related adverse events (TRAEs) as defined by CTCAE version 4.0. The primary endpoint of cohort II was the change in the visual analogue scale (VAS) pain score from before to 15 min after gargle use on day 3. The incidence and severity of TRAEs were assessed based on the CTCAE version 4.0 and a subjective rating scale completed by healthy volunteers and patients.

Results

In cohort I, 9 of 10 healthy volunteers were evaluable for safety. All 9 healthy volunteers reported the TRAE of oral irritation with single or multiple use of the gargle. In cohort II, 10 patients were enrolled and evaluable for safety and 7 of 10 patients were evaluable for efficacy. The mean change in the VAS pain score from before to 15 min after using the gargle on day 3 was − 1.28 (95% confidence interval: − 2.06, − 0.51), and all patients experienced some degree of pain relief (range: − 0.2 to − 2.5). All 10 patients reported the TRAE of oral irritation. No other TRAEs of ibuprofen gargle were observed in the healthy volunteers and patients.

Conclusion

Despite oral irritation, the ibuprofen gargle appeared to be safe and effective for the pain related to chemo- or CRT-induced oral mucositis. However, ibuprofen-related oral irritation warrants further formulation improvement.

Trial registration

This study was registered with the University Hospital Medical Information Network Clinical Trials Registry (UMIN000014433).
Trends and factors associated with the utilisation of antenatal care services during the Millennium Development Goals era in Tanzania
Authors: Rwabilimbo Abdon Gregory , Ahmed Kedir Y. , Page Andrew , Ogbo Felix Akpojene
Published: June 2020

Background

A detailed understanding of trends, as well as what act as enablers and/or barriers to the utilisation of antenatal care (ANC) among Tanzanian women, is essential to policymakers and health practitioners to guide maternal health efforts. We investigated the trends and factors associated with ANC service use during the Millennium Development Goals (MDG) era in Tanzania between 1999 and 2016.

Methods

The study used the Tanzania Demographic and Health Survey (TDHS) data for the years 1999 (n = 2095), 2004–2005 (n = 5576), 2010 (n = 6903) and 2015–2016 (n = 5392). Multivariate multinomial logistic regression models were used to investigate the association between predisposing, enabling, need and community-level factors and frequency of ANC (1–3 and ≥ 4) visits in Tanzania.

Results

The proportion of women who made one to three ANC visits improved significantly from 26.4% in 1999 to 47.0% in 2016. The percentage of women who make four or more ANC visits declined from 71.1% in 1999 to 51.0% in 2016. Higher maternal education, belonging to wealthier households, being informally employed and listening to the radio were associated with four or more ANC visits. Women who did not desire pregnancy had a lower likelihood to attend four or more ANC visits. Women who had primary or higher education, those who resided in wealthier households and those who were informally employed were more likely to make between one and three ANC visits.

Conclusion

The study showed that there was an improvement in the proportion of Tanzanian women who made one to three ANC visits, but it also indicated a concurrent decrease in the prevalence of four or more ANC visits. Improving uptake of ANC among Tanzanian women is achievable if national health policies and programmes also focus on key amenable maternal factors of education, household wealth and employment.
Biomarker testing for advanced lung cancer by next-generation sequencing; a valid method to achieve a comprehensive glimpse at mutational landscape
Authors: Mehta Anurag , Vasudevan Smreti , Sharma Sanjeev Kumar , Panigrahi Manoj , Suryavanshi Moushumi , Saifi Mumtaz , Batra Ullas
Published: May 2020

Background

Next-generation sequencing (NGS) based assay for finding an actionable driver in non-small-cell lung cancer is a less used modality in clinical practice. With a long list of actionable targets, limited tissue, arduous single-gene assays, the alternative of NGS for broad testing in one experiment looks attractive. We report here our experience with NGS for biomarker testing in hundred advanced lung cancer patients.

Methods

Predictive biomarker testing was performed using the Ion AmpliSeq™ Cancer Hotspot Panel V2 (30 tumors) and Oncomine™ Solid Tumor DNA and Oncomine™ Solid Tumor Fusion Transcript kit (70 tumors) on Ion-Torrent sequencing platform.

Results

One-seventeen distinct aberrations were detected across 29 genes in eighty-six tumors. The most commonly mutated genes were TP53 (43% cases), EGFR (23% cases) and KRAS (17% cases). Thirty-four patients presented an actionable genetic variant for which targeted therapy is presently available, and fifty-two cases harbored non-actionable variants with the possibility of recruitment in clinical trials. NGS results were validated by individual tests for detecting EGFR mutation, ALK1 rearrangement, ROS1 fusion, and c-MET amplification. Compared to single test, NGS exhibited good agreement for detecting EGFR mutations and ALK1 fusion (sensitivity- 88.89%, specificity- 100%, Kappa-score 0.92 and sensitivity- 80%, specificity- 100%, Kappa-score 0.88; respectively). Further, the response of patients harboring tyrosine kinase inhibitor (TKI) sensitizing EGFR mutations was assessed. The progression-free-survival of EGFR positive patients on TKI therapy, harboring a concomitant mutation in PIK3CA-mTOR and/or RAS-RAF-MAPK pathway gene and/or TP53 gene was inferior to those with sole-sensitizing EGFR mutation (2 months vs. 9.5 months, P = 0.015).

Conclusions

This is the first study from South Asia looking into the analytical validity of NGS and describing the mutational landscape of lung cancer patients to study the impact of co-mutations on cancer biology and treatment outcome. Our study demonstrates the clinical utility of NGS testing for identifying actionable variants and making treatment decisions in advanced lung cancer.
Methodological framework for radiomics applications in Hodgkin’s lymphoma
Authors: Sollini Martina , Kirienko Margarita , Cavinato Lara , Ricci Francesca , Biroli Matteo , Ieva Francesca , Calderoni Letizia , Tabacchi Elena , Nanni Cristina , Zinzani Pier Luigi , Fanti Stefano , Guidetti Anna , Alessi Alessandra , Corradini Paolo , Seregni Ettore , Carlo-Stella Carmelo , Chiti Arturo
Published: May 2020

Background

According to published data, radiomics features differ between lesions of refractory/relapsing HL patients from those of long-term responders. However, several methodological aspects have not been elucidated yet.

Purpose

The study aimed at setting up a methodological framework in radiomics applications in Hodgkin’s lymphoma (HL), especially at (a) developing a novel feature selection approach, (b) evaluating radiomic intra-patient lesions’ similarity, and (c) classifying relapsing refractory (R/R) vs non-(R/R) patients.

Methods

We retrospectively included 85 patients (male:female = 52:33; median age 35 years, range 19–74). LIFEx (www.lifexsoft.org) was used for [18F]FDG-PET/CT segmentation and feature extraction. Features were a-priori selected if they were highly correlated or uncorrelated to the volume. Principal component analysis-transformed features were used to build the fingerprints that were tested to assess lesions’ similarity, using the silhouette. For intra-patient similarity analysis, we used patients having multiple lesions only. To classify patients as non-R/R and R/R, the fingerprint considering one single lesion (fingerprint_One) and all lesions (fingerprint_All) was tested using Random Undersampling Boosting of Tree Ensemble (RUBTE).

Results

HL fingerprints included up to 15 features. Intra-patient lesion similarity analysis resulted in mean/median silhouette values below 0.5 (low similarity especially in the non-R/R group). In the test set, the fingerprint_One classification accuracy was 62% (78% sensitivity and 53% specificity); the classification by RUBTE using fingerprint_All resulted in 82% accuracy (70% sensitivity and 88% specificity).

Conclusions

Lesion similarity analysis was developed, and it allowed to demonstrate that HL lesions were not homogeneous within patients in terms of radiomics signature. Therefore, a random target lesion selection should not be adopted for radiomics applications. Moreover, the classifier to predict R/R vs non-R/R performed the best when all the lesions were used.
Acute kidney injury following percutaneous mechanical thrombectomy of subclavian artery stent graft thrombosis: a case report
Authors: Turk Tajana , Blaskovic Darko , Smiljanic Ranko , Vidjak Vinko
Published: May 2020

Background

Percutaneous mechanical thrombectomy (PMT) is a well-established technique for treatment of acute arterial and venous thrombosis which inevitably leads to intravascular erythrocyte hemolysis, resulting in hemoglobinuria.

Case presentation

We present a case of 66-year-old Caucasian female with subclavian artery aneurysm causing distal embolization and hand ischemia. The aneurysm was treated with stent graft, but with a subsequent graft thrombosis 3 months later. After graft recanalisation, AngioJet PMT was performed which resulted in dialysis-requiring acute kidney injury.

Conslusion

Only several cases of acute kidney injury following AngioJet PMT have been published in literature. To our knowledge, this is the first reported case of dialysis-requiring AKI after PMT for peripheral arterial thrombosis. Until there is sufficient evidence and recommendation on preventing AKI in this setting, we believe that by being aware of the risk and by monitoring of patient, one might minimize the damage in case it occurs.
VITamin D and OmegA-3 TriaL (VITAL): Effects of Vitamin D Supplements on Risk of Falls in the US Population
Authors: LeBoff Meryl S , Murata Elle M , Cook Nancy R , Cawthon Peggy , Chou Sharon H , Kotler Gregory , Bubes Vadim , Buring Julie E , Manson JoAnn E
Published: June 2020

Context

It is unclear whether vitamin D supplementation reduces risk of falls, and results from randomized controlled trials (RCTs) are conflicting.

Objective

The objective of this work is to determine whether 2000 IU/day of supplemental vitamin D3 decreases fall risk.

Design

VITamin D and OmegA-3 TriaL (VITAL) is a double-blind, placebo-controlled RCT including 25 871 adults, randomly assigned November 2011 to March 2014 and treated for 5.3 years (median).

Setting

This is a nationwide study.

Participants

Men 50 years or older and women 55 years or older (mean age, 67.1 years) without cancer or cardiovascular disease at baseline participated in this study.

Interventions

Interventions included vitamin D3 (cholecalciferol; 2000 IU/day) and/or omega-3 fatty acids (1 g/day) or respective placebos in a 2 × 2 factorial design.

Main Outcome Measures

Main outcome measures include 2 or more falls and falls resulting in a doctor or hospital visit.

Results

Baseline serum total 25-hydroxyvitamin D (25[OH]D) level was 77 nmol/L; characteristics were well-balanced between groups. Numbers of participants with 2 or more falls were similar between active and placebo groups (9.8% vs 9.4%). Over 5 years, there were no differences in the proportion having 2 or more falls (odds ratio [OR] = 0.97; 95% CI, 0.90-1.05, P = .50), falls resulting in a doctor visit (OR = 1.03; 95% CI, 0.94-1.13, P = .46), or resulting in a hospital visit (OR = 1.04; 95% CI, 0.90-1.19, P = .61) between groups. Results did not differ between those with baseline 25(OH)D less than 50 vs 50 nmol/L or greater or other cut points.

Conclusion

Daily supplemental vitamin D3 vs placebo did not decrease fall risk in generally healthy adults not selected for vitamin D insufficiency. This large RCT does not indicate that supplemental vitamin D should be used for primary prevention of falls in the US population.
Brn3a/Pou4f1 Functions as a Tumor Suppressor by Targeting c-MET/STAT3 Signaling in Thyroid Cancer
Authors: Jung Seung-Nam , Kang Yea Eun , Lee Gun Ho , Liu Lihua , Oh Chan , Jin Yan Li , Lim Mi Ae , Lee Kyungmin , Oh Taejeong , Won Ho-Ryun , Chang Jae Won , Koo Bon Seok
Published: May 2020

Background

Brn3a/Pou4f1 is a class IV POU domain-containing transcription factor and has been found to be expressed in a variety of cancers. However, the mechanism and action of Brn3a in thyroid cancer has not been investigated.

Purpose

To investigate the role of Brn3a in thyroid cancer progression and its clinical implication.

Methods

We examined Brn3a expression status in patients with thyroid cancer and analyzed relationships between Brn3a expression and clinicopathological findings using The Cancer Genome Atlas (TCGA) database. For functional in vitro analysis, proliferation, migration, invasion assay, and Western blotting were performed after overexpression or suppression of Brn3a.

Results

The promoter hypermethylation of Brn3a was found in patients with aggressive thyroid cancer and Brn3a was downregulated in tissues of patients with thyroid cancer. In TCGA database, the low-Brn3a-expression group revealed a more aggressive phenotype, including T stage and extrathyroid extension when compared with the high-Brn3a-expression group. Overexpression of Brn3a suppressed cell migration and invasion via regulation of epithelial-mesenchymal transition (EMT)-associated proteins in thyroid cancer cell lines. Brn3a overexpression also downregulated signal transducer and activator of transcription 3 (STAT3) signaling through suppression of tyrosine-protein kinase Met (c-MET). In contrast, knockdown of Brn3a by small interfering ribonucleic acid (siRNA) significantly increased cell migration and invasion through upregulation of c-MET/STAT3. These results imply that Brn3a suppresses tumor metastasis via c-MET/STAT3 inhibition and EMT suppression in thyroid cancer.

Conclusions

Our findings show that Brn3a is a potential tumor suppressor that leads to reduced cancer cell migration and invasion in thyroid cancer. Elucidation of the Brn3a-regulated cancer pathways may therefore provide novel therapeutic strategies to control thyroid cancer metastasis.
Biomarkers of Bone Turnover Identify Subsets of Chronic Kidney Disease Patients at Higher Risk for Fracture
Authors: Hughes-Austin Jan M , Katz Ronit , Semba Richard D , Kritchevsky Stephen B , Bauer Douglas C , Sarnak Mark J , Ginsberg Charles , Shlipak Michael G , Lima Florence , Malluche Hartmut H , Ix Joachim H
Published: May 2020

Background

We sought to identify biomarkers that indicate low turnover on bone histomorphometry in chronic kidney disease (CKD) patients, and subsequently determined whether this panel identified differential risk for fractures in community-dwelling older adults.

Methods

Among CKD patients who underwent iliac crest bone biopsies and histomorphometry, we evaluated candidate biomarkers to differentiate low turnover from other bone disease. We applied this biomarker panel to 641 participants in the Health Aging and Body Composition Study (Health ABC) study with estimated glomerular filtration rate (eGFR) less than 60 mL/min/1.73 m2 who were followed for fracture. Cox proportional hazards models evaluated the association of bone mineral density (BMD) with fracture risk and determined whether biomarker-defined low bone turnover modified fracture risk at any level of BMD.

Results

In 39 CKD patients age 64 ± 13 years, 85% female, with mean eGFR 37 ± 14 mL/min/1.73 m2 who underwent bone biopsy, lower fibroblast growth factor (FGF)-23, higher ɑ-Klotho, and lower parathyroid hormone (PTH) indicated low bone turnover in accordance with bone histomorphometry parameters (individual area under the curve = 0.62, 0.73, and 0.55 respectively; sensitivity = 22%, specificity = 100%). In Health ABC, 641 participants with CKD were age 75 ± 3 years , 49% female, with mean eGFR 48 ± 10 mL/min/1.73 m2. For every SD lower hip BMD at baseline, there was an 8-fold higher fracture risk in individuals with biomarker-defined low turnover (hazard ratio 8.10 [95% CI, 3.40-19.30]) vs a 2-fold higher risk in the remaining individuals (hazard ratio 2.28 [95% CI, 1.69-3.08]) (Pinteraction = .082).

Conclusions

In CKD patients who underwent bone biopsy, lower FGF-23, higher ɑ-Klotho, and lower PTH together had high specificity for identifying low bone turnover. When applied to older individuals with CKD, BMD was more strongly associated with fracture risk in those with biomarker-defined low turnover.
Contemporary Thyroid Nodule Evaluation and Management
Authors: Grani Giorgio , Sponziello Marialuisa , Pecce Valeria , Ramundo Valeria , Durante Cosimo
Published: June 2020

Context

Approximately 60% of adults harbor 1 or more thyroid nodules. The possibility of cancer is the overriding concern, but only about 5% prove to be malignant. The widespread use of diagnostic imaging and improved access to health care favor the discovery of small, subclinical nodules and small papillary cancers. Overdiagnosis and overtreatment is associated with potentially excessive costs and nonnegligible morbidity for patients.

Evidence Acquisition

We conducted a PubMed search for the recent English-language articles dealing with thyroid nodule management.

Evidence Synthesis

The initial assessment includes an evaluation of clinical risk factors and sonographic examination of the neck. Sonographic risk-stratification systems (e.g., Thyroid Imaging Reporting and Data Systems) can be used to estimate the risk of malignancy and the need for biopsy based on nodule features and size. When cytology findings are indeterminate, molecular analysis of the aspirate may obviate the need for diagnostic surgery. Many nodules will not require biopsy. These nodules and those that are cytologically benign can be managed with long-term follow-up alone. If malignancy is suspected, options include surgery (increasingly less extensive), active surveillance or, in selected cases, minimally invasive techniques.

Conclusion

Thyroid nodule evaluation is no longer a 1-size-fits-all proposition. For most nodules, the likelihood of malignancy can be confidently estimated without resorting to cytology or molecular testing, and low-frequency surveillance is sufficient for most patients. When there are multiple options for diagnosis and/or treatment, they should be discussed with patients as frankly as possible to identify an approach that best meets their needs.
АЛГОРИТМИЗАЦИЯ УПРАВЛЕНИЯ НЕКОТОРЫМИ РЕСУРСАМИ В СИСТЕМЕ ПЕРЕВОЗОК
Authors: Lvovich Yakov Yevseevich , Preobrazhenskiy Andrey Petrovich , Choporov Oleg Nikolaevich
Published: May 2020

В статье рассматривается задача, связанная с созданием оптимизационной модели для интеллектуального управления ресурсами в системе перевозок. Приведена структура системы, позволяющей осуществлять рейтинговое управление. Предлагается применение игрового подхода для алгоритма интеллектуальной поддержки.
ПРОБЛЕМЫ ПОСТАВОК ЗАПАСНЫХ ЧАСТЕЙ ОТОПИТЕЛЬНОГО ОБОРУДОВАНИЯ
Authors: Preobrazhenskiy Andrey Petrovich , Pitolin Mikhail Vladimirovich
Published: May 2020

В статье рассматривается задача, связанная с поставками запасных частей. Решение ее базируется на статистическом подходе. Приведены результаты проведенного моделирования.
ПОВЫШЕНИЕ БЕЗОПАСНОСТИ ПРИ ЭКСПЛУАТАЦИИ АВТОМОБИЛЬНОГО ТРАНСПОРТА
Authors: Tukhvatullin Bulat Talirovich , Korsakov Alexey Sergeyevich , Leontiev Vladimir Victorovich
Published: May 2020

В работе рассмотрен вопрос повышения безопасности на автотранспорте. Начинающие водители, как правило, не всегда способны самостоятельно определить причину неисправности, возникшей в ходе эксплуатации транспортного средства. Одним из вариантов повышения безопасности эксплуатации транспортных средств является внедрение системы диагностирования транспортного средства, которая позволит как начинающему, так и опытному водителю самостоятельно и без затруднений проводить диагностику и постоянный контроль технического состояния сложных систем транспортного средства.
ПОВЫШЕНИЕ ПРОХОДИМОСТИ АВТОМОБИЛЬНОЙ ТЕХНИКИ (БОЕВЫХ КОЛЁСНЫХ МАШИН)
Authors: Tukhvatullin Bulat Talirovich , Levchenko Dmitry Vladimirovich , Khodorkin Oleg Leonidovich , Zolnikov Igor Vladimirovich
Published: May 2020

В работе рассматриваются некоторые аспекты проходимости как одного из основных эксплуатационно-технических свойств, оказывающих влияние на боевую эффективность применения боевых колёсных машин. Раскрываются основные параметры и показатели проходимости, пути повышения проходимости, конструкционные решения обеспечивающие высокую проходимость боевых колёсных машин.
Fixation of the short global tissue-sparing hip stem
Authors: Nieuwenhuijse Marc J. , Vehmeijer Stephan B. W. , Mathijsen Nina M. C. , Keizer Stefan B.
Published: May 2020

Aims

Short, bone-conserving femoral components are increasingly used in total hip arthroplasty (THA). They are expected to allow tissue-conserving implantation and to render future revision surgery more straightforward but the long-term data on such components is limited. One such component is the global tissue-sparing (GTS) stem. Following the model for stepwise introduction of new orthopaedic implants, we evaluated early implant fixation and clinical outcome of this novel short-stem THA and compared it to that of a component with established good long-term clinical outcome.

Methods

In total, 50 consecutive patients ≤ 70 years old with end-stage symptomatic osteo-arthritis were randomized to receive THA with the GTS stem or the conventional Taperloc stem using the anterior supine intermuscular approach by two experienced hip surgeons in two hospitals in the Netherlands. Primary outcome was implant migration. Patients were followed using routine clinical examination, patient reported outcome using Harris Hip Score (HHS), Hip Disability And Osteoarthritis Outcome Score (HOOS), EuroQol five-dimension questionnaire (EQ5D), and Roentgen Stereophotogrammetric Analysis (RSA) at three, six, 12, and 24 months. This study evaluated the two-year follow-up results.

Results

In addition to the initial migration pattern of distal migration (subsidence, Y-translation) and retroversion (Y-rotation) also exhibited by the Taperloc stem, the GTS stem showed an initial migration pattern of varization (X-translation combined with Z-rotation) and posterior translation (Z-translation). However, all components stabilized aside from one Taperloc stem which became loose secondary to malposition and was later revised. Clinical outcomes and complications were not statistically significantly different with the numbers available.

Conclusion

A substantially different and more extensive initial migration pattern was seen for the GTS stem compared to the Taperloc stem. Although implant stabilization was achieved, excellent long-term survival similar to that of the Taperloc stem should not be inferred. Especially in the absence of clinically proven relevant improvement, widespread usage should be postponed until long-term safety has been established. Cite this article: Bone Joint J 2020;102-B(6):699–708.
Impact of chemotherapy-induced necrosis on event-free and overall survival after preoperative MAP chemotherapy in patients with primary high-grade localized osteosarcoma
Authors: Tsuda Yusuke , Tsoi Kim , Parry Michael C. , Stevenson Jonathan D. , Fujiwara Tomohiro , Sumathi Vaiyapuri , Jeys Lee M.
Published: May 2020

Aims

To assess the correlation between the histological response to preoperative chemotherapy and event-free survival (EFS) or overall survival (OS) in patients with high-grade localized osteosarcoma.

Methods

Out of 625 patients aged ≤ 40 years treated for primary high-grade osteosarcoma between 1997 and 2016, 232 patients without clinically detectable metastases at the time of diagnosis and treated with preoperative high-dose methotrexate, adriamycin and cisplatin (MAP) chemotherapy and surgery were included. Associations of chemotherapy-induced necrosis in the resected specimen and EFS or OS were assessed using Cox model and the Pearson’s correlation coefficients (r). Time-dependent receiver operating characteristic analysis was applied to determine the optimal cut-off value of chemotherapy-induced necrosis for EFS and OS.

Results

OS was 74% (95% confidence interval (CI) 67 to 79) at five years. Median chemotherapy-induced necrosis was 85% (interquartile range (IQR) 50% to 97%). In multivariate Cox model, chemotherapy-induced necrosis was significantly associated with EFS and OS (hazard ratio (HR) = 0.99 (95% CI 0.98 to 0.99); p < 0.001 and HR = 0.98 (95% CI 0.97 to 0.99); p < 0.001, respectively). Positive correlation was observed between chemotherapy-induced necrosis and five-year EFS and five-year OS (r = 0.91; p < 0.001, and r = 0.85; p < 0.001, respectively). The optimal cut-off value of chemotherapy-induced necrosis for five-year EFS and five-year OS was 85% and 72%, respectively.

Conclusion

Chemotherapy-induced necrosis in the resected specimen showed positive correlation with EFS and OS in patients with high-grade localized osteosarcoma after MAP chemotherapy. In our analysis, optimal cut-off values of MAP chemotherapy-induced necrosis in EFS and OS were lower than the commonly used 90%, suggesting the need for re-evaluation of the optimal cut-off value through larger, international collaborative research. Cite this article: Bone Joint J 2020;102-B(6):795–803.
Outcomes of modular femoral revision implants and the effect of component design on subsidence
Authors: Abdelsamie Karam R. , Elhawary Ibrahim , Ali Hesham , Ali Mohamed , EL-Shafie Mohamed , Dominic Meek R. M.
Published: May 2020

Aims

Femoral revision component subsidence has been identified as predicting early failure in revision hip surgery. This comparative cohort study assessed the potential risk factors of subsidence in two commonly used femoral implant designs.

Methods

A comparative cohort study was undertaken, analyzing a consecutive series of patients following revision total hip arthroplasties using either a tapered-modular (TM) fluted titanium or a porous-coated cylindrical modular (PCM) titanium femoral component, between April 2006 and May 2018. Clinical and radiological assessment was compared for both treatment cohorts. Risk factors for subsidence were assessed and compared.

Results

In total, 65 TM and 35 PCM cases were included. At mean follow-up of seven years (1 to 13), subsidence was noted in both cohorts during the initial three months postoperatively (p < 0.001) then implants stabilized. Subsidence noted in 58.7% (38/65 cases) of the TM cohort (mean 2.3 mm, SD 3.5 mm) compared to 48.8% (17/35) of PCM cohort (mean 1.9 mm, SD 2.6 mm; p = 0.344). Subsidence of PCM cohort were significantly associated with extended trochanteric osteotomy (ETO) (p < 0.041). Although the ETO was used less frequently in PCM stem cohort (7/35), subsidence was noted in 85% (6/7) of them. Significant improvement of the final mean Oxford Hip Score (OHS) was reported in both treatment groups (p < 0.001).

Conclusion

Both modular TM and PCM revision femoral components subsided within the femur. TM implants subsided more frequently than PCM components if the femur was intact but with no difference in clinical outcomes. However, if an ETO is performed then a PCM component will subside significantly more and suggests the use of a TM implant may be advisable. Cite this article: Bone Joint J 2020;102-B(6):709–715.
2020 John N. Insall Award: Removal of total knee arthroplasty from the inpatient-only list adversely affects bundled payment programmes
Authors: Yayac Michael , Schiller Nicholas , Austin Matthew S. , Courtney P. Maxwell
Published: May 2020

Aims

The purpose of this study was to determine the impact of the removal of total knee arthroplasty (TKA) from the Medicare Inpatient Only (IPO) list on our Bundled Payments for Care Improvement (BPCI) Initiative in 2018.

Methods

We examined our institutional database to identify all Medicare patients who underwent primary TKA from 2017 to 2018. Hospital inpatient or outpatient status was cross-referenced with Centers for Medicare & Medicaid Services (CMS) claims data. Demographics, comorbidities, and outcomes were compared between patients classified as ‘outpatient’ and ‘inpatient’ TKA. Episode-of-care BPCI costs were then compared from 2017 to 2018.

Results

Of the 2,135 primary TKA patients in 2018, 908 (43%) were classified as an outpatient and were excluded from BPCI. Inpatient classified patients had longer mean length of stay (1.9 (SD 1.4) vs 1.4 (SD 1.7) days, p < 0.001) and higher rates of discharge to rehabilitation (17% vs 3%, p < 0.001). Post-acute care costs increased when comparing the BPCI patients from 2017 to 2018, ($5,037 (SD $7,792) vs $5793 (SD $8,311), p = 0.010). The removal of TKA from the IPO list turned a net savings of $53,805 in 2017 into a loss of $219,747 in 2018 for our BPCI programme.

Conclusions

Following the removal of TKA from the IPO list, nearly half of the patients at our institution were inappropriately classified as an outpatient. Our target price was increased and our institution realized a substantial loss in 2018 BPCI despite strong quality metrics. CMS should address its negative implications on bundled payment programmes. Cite this article: Bone Joint J 2020;102-B(6 Supple A):19–23.
Reflecting on and managing the emotional impact of prosthetic joint infections on orthopaedic surgeons—a qualitative study
Authors: Svensson Karin , Rolfson Ola , Mohaddes Maziar , Malchau Henrik , Erichsen Andersson Annette
Published: May 2020

Aims

To investigate the experience and emotional impact of prosthetic joint infection (PJI) on orthopaedic surgeons and identify holistic strategies to improve the management of PJI and protect surgeons’ wellbeing.

Methods

In total, 18 prosthetic joint surgeons in Sweden were recruited using a purposive sampling strategy. Content analysis was performed on transcripts of individual in-person interviews conducted between December 2017 and February 2018.

Results

PJI had a negative emotional impact on Swedish surgeons. Many felt guilt, stress, and a sense of failure, and several aspects of PJI management were associated with psychosocial challenges. Peer support was reported as the most important coping strategy as was collaborating with infectious disease specialists.

Conclusion

Our study affirms that there is a negative emotional impact of PJI on surgeons which can be minimized by improved peer support and working in multidisciplinary teams. Based on the surgeons’ experiences we have identified desired improvements that may facilitate the management of PJI. These may also be applicable within other surgical specialties dealing with postoperative infections, but need to be evaluated for their efficacy. Cite this article: Bone Joint J 2020;102-B(6):736–743.
Is a full component revision necessary for isolated tibial loosening?
Authors: Martin J. Ryan , Geary Michael B. , Ransone Michael , Macknet David , Fehring Keith , Fehring Thomas
Published: May 2020

Aims

Aseptic loosening of the tibial component is a frequent cause of failure in primary total knee arthroplasty (TKA). Management options include an isolated tibial revision or full component revision. A full component revision is frequently selected by surgeons unfamiliar with the existing implant or who simply wish to “start again”. This option adds morbidity compared with an isolated tibial revision. While isolated tibial revision has a lower morbidity, it is technically more challenging due to difficulties with exposure and maintaining prosthetic stability. This study was designed to compare these two reconstructive options.

Methods

Patients undergoing revision TKA for isolated aseptic tibial loosening between 2012 and 2017 were identified. Those with revision implants or revised for infection, instability, osteolysis, or femoral component loosening were excluded. A total of 164 patients were included; 88 had an isolated tibial revision and 76 had revision of both components despite only having a loose tibial component. The demographics and clinical and radiological outcomes were recorded.

Results

The patient demographics were statistically similar in the two cohorts. The median follow-up was 3.5 years (interquartile range (IQR) 1 to 12.5). Supplementary femoral metaphyseal fixation was required in five patients in the full revision cohort. There was a higher incidence of radiological tibial loosening in the full component revision cohort at the final follow-up (8 (10.5%) vs 5 (5.7%); p = 0.269). Three patients in the full component revision cohort developed instability while only one in the isolated tibial cohort did. Three patients in the full revision cohort developed a flexion contracture greater than 5° while none in the isolated tibial cohort did.

Conclusion

Isolated tibial revision for aseptic tibial loosening has statistically similar clinical and radiological outcomes at a median follow-up of 3.5 years, when compared with full component revision. Substantial bone loss can occur when removing a well-fixed femoral component necessitating a cone or sleeve. Femoral component revision for isolated tibial loosening can frequently be avoided provided adequate ligamentous stability can be obtained. Cite this article: Bone Joint J 2020;102-B(6 Supple A):123–128.
Patterns of cartilage loss and anterior cruciate ligament status in end-stage osteoarthritis of the knee
Authors: Scott Chloe E. H. , Holland George , Krahelski Oliver , Murray Iain R. , Keating John F. , Keenan Oisin J. F.
Published: May 2020

Aims

This study aims to determine the proportion of patients with end-stage knee osteoarthritis (OA) possibly suitable for partial (PKA) or combined partial knee arthroplasty (CPKA) according to patterns of full-thickness cartilage loss and anterior cruciate ligament (ACL) status.

Methods

A cross-sectional analysis of 300 consecutive patients (mean age 69 years (SD 9.5, 44 to 91), mean body mass index (BMI) 30.6 (SD 5.5, 20 to 53), 178 female (59.3%)) undergoing total knee arthroplasty (TKA) for Kellgren-Lawrence grade ≥ 3 knee OA was conducted. The point of maximal tibial bone loss on preoperative lateral radiographs was determined as a percentage of the tibial diameter. At surgery, Lachman’s test and ACL status were recorded. The presence of full-thickness cartilage loss within 16 articular surface regions (two patella, eight femoral, six tibial) was recorded.

Results

According to articular cartilage loss and ACL status, 195/293 (67%) were suitable for PKA or CPKA: medial unicompartmental knee arthroplasty (UKA) 97/293 (33%); lateral UKA 25 (9%); medial bicompartmental arthroplasty 31 (11%); lateral bicompartmental arthroplasty 12 (4%); bicondylar-UKA 23 (8%); and patellofemoral arthroplasty (PFA) seven (2%). The ACL was intact in 166 (55%), frayed in 82 (27%), disrupted in 12 (4%), and absent in 33 (11%). Lachman testing was specific (97%) but poorly sensitive (38%) for disrupted/absent ACLs. The point of maximal tibial bone loss showed good interclass correlation (ICC 0.797, 0.73 to 0.85 95% confidence interval (CI); p < 0.001) and was more posterior when the ACL was absent. Maximum tibial bone loss occurring at > 55% of the anterior to posterior distance predicted ACL absence with 93% sensitivity and 91% specificity (area under the curve 0.97 (0.94 to 0.99 95% CI; p < 0.001).

Conclusion

ACL status can be reliably determined from a lateral radiograph using the location of maximal tibial bone loss. According to regions of cartilage loss and ACL status, two-thirds of patients with end-stage knee OA could potentially be treated with PKA or CPKA. Cite this article: Bone Joint J 2020;102-B(6):716–726.