bluuebunny/crossref_metadata_2025 huggingface dataset:
Considerations for Integrating Advance Care Planning Into the Electronic Health Record: A Primer for Clinicians
Authors: Moses Adam , Dharod Ajay , Williamson Jeff , Pajewski Nicholas M. , Tuerff Daniel , Guo Jia , Gabbard Jennifer
Published: March 2020

Opportunities for expanding advance care planning (ACP) throughout the health-care system make it critical that primary care (PC) providers have a basic understanding of how the electronic health record (EHR) can aid promoting ACP discussions and documentation. This article will offer PC providers 5 useful tips for implementing ACP in outpatient settings utilizing the EHR.
To Block or Not: Updates in Neuromuscular Blockade in Acute Respiratory Distress Syndrome
Authors: Mefford Breanne , Donaldson J. Chris , Bissell Brittany D.
Published: February 2020

Objective: To review and evaluate neuromuscular blocking agents (NMBAs) in critically ill patients with acute respiratory distress syndrome (ARDS). Data Sources: A literature search utilizing PubMed was performed (January 1991 to January 2020) using the following search terms: ( neuromuscular blocking agents OR neuromuscular blockade OR cisatracurium OR rocuronium OR vecuronium OR pancuronium OR atracurium) AND * acute respiratory distress syndrome OR acute lung injury). Publications in English were evaluated. Study Selection and Data Extraction: Relevant clinical studies in humans were considered. Data Synthesis: Although NMBAs have been used for decades in the setting of ARDS, questions regarding mortality benefit remain. Early NMBA, within 48 hours of lung injury, have been historically used in critically ill patients with ARDS to aid in increasing alveolar recruitment, improving patient-ventilator synchrony, and promoting oxygenation by the prevention of contraction of respiratory muscles. Until recently, the literature showed an improvement in 90-day adjusted mortality. However, recent literature has demonstrated the lack of a mortality benefit. The continued receipt of NMBAs, with no clear benefit, could potentially lead to increased costs, skin breakdown, corneal abrasions, venous thromboembolisms, intensive care unit acquired weakness, and awareness with inappropriate sedation. Relevance to Patient Care and Clinical Practice: This review aims at discussing the preferred NMBA based on mechanism of action and reviews specific clinical trial data for the use of NMBAs in ARDS, clinical implications of these trial data, complications for the use of NMBAs, and needed future directions. Conclusions: The mortality benefit of NMBAs in ARDS has contradicting evidence with potentially serious adverse effects and notable controversies.
Neuroimaging of Narcolepsy and Primary Hypersomnias
Authors: Cavaliere Carlo , Longarzo Mariachiara , Fogel Stuart , Engström Maria , Soddu Andrea
Published: February 2020

Advances in neuroimaging open up the possibility for new powerful tools to be developed that potentially can be applied to clinical populations to improve the diagnosis of neurological disorders, including sleep disorders. At present, the diagnosis of narcolepsy and primary hypersomnias is largely limited to subjective assessments and objective measurements of behavior and sleep physiology. In this review, we focus on recent neuroimaging findings that provide insight into the neural basis of narcolepsy and the primary hypersomnias Kleine-Levin syndrome and idiopathic hypersomnia. We describe the role of neuroimaging in confirming previous genetic, neurochemical, and neurophysiological findings and highlight studies that permit a greater understanding of the symptoms of these sleep disorders. We conclude by considering some of the remaining challenges to overcome, the existing knowledge gaps, and the potential role for neuroimaging in understanding the pathogenesis and clinical features of narcolepsy and primary hypersomnias.
Crushable multiaxial behavior of sandwich foam cores: Pressure vessel experiments
Authors: Fatt Michelle S Hoo , Zhong Chong , Gadepalli Prasanna C , Tong Xiaolong
Published: March 2020

The objective of this study was to characterize the multiaxial, elastic-plastic and hysteresis behavior of Divinycell PVC H100 foam using a novel pressure vessel experiment. Cyclic, elastic and post-yield behavior of the foam under uniaxial compression and tension, shear, biaxial compression and shear, triaxial compression, triaxial compression-tension and triaxial compression and shear were obtained in both out-of-plane and in-plane directions of the foam. In all the above-mentioned modes, the foam exhibited elastic-plastic response followed by damage and viscoelastic hysteresis. The Tsai–Wu failure criterion was found to be superior in predicting yielding under triaxial stress states among all the anisotropic yield criteria considered. Based on the experimental results, an elastic-plastic, viscoelastic damage model was developed and used to obtain transversely isotropic, plastic strain hardening behavior as well as viscoelastic and damage properties associated with post-yield hysteresis.
What do I get? How do states’ negotiation alternatives influence the concessions they receive in multilateral negotiations?
Authors: McKibben Heather Elko
Published: February 2020

When will states receive concessions in multilateral negotiations? And on which issues are those concessions likely to be received? I highlight two factors that influence the likelihood a state will receive concessions on an issue in multilateral negotiations: (1) the degree to which the issues linked together in the negotiation are “differently valued” by the negotiating states, and (2) the costliness of states’ “best alternative to a negotiated agreement” on each individual issue. The former creates the opportunity for an exchange of concessions; the latter creates the incentive for that exchange to occur. It is the interaction of having more differently valued issues on the table and having a more costly best alternative to a negotiated agreement on an issue that makes a state more likely to receive concessions on that issue. This argument stands in contrast to the standard negotiation literature, which has shown that having a more beneficial best alternative to a negotiated agreement will yield greater concessions. I argue that these contradictory assertions exist because there are two types of best alternatives to a negotiated agreement that must be taken into account – one at the negotiation level and those at the issue-specific level. The current literature has tended to focus on the former while I focus on the latter. I test my argument on an originally constructed dataset of concessions states received in the Uruguay Round trade negotiations of the General Agreement on Tariffs and Trade. For each issue in the Round, I coded the costliness of each state's issue-specific best alternative to a negotiated agreement and the level of concessions it received on that issue. The results provide insights into the workings of multilateral negotiations.
‘The enemy within’: Campaign attention and motivated reasoning in voter perceptions of intra-party conflict
Authors: Plescia Carolina , Kritzinger Sylvia , Eberl Jakob-Moritz
Published: March 2020

In spite of broad interest in internal party dynamics, with previous literature relatedly demonstrating that voters are not oblivious to party infighting, very little attention has been paid to the antecedents of voter perceptions of intra-party conflict. This article addresses this research deficit with the support of empirical evidence gathered over the course of the 2017 Austrian national election campaign. The study examines variations in perceived intra-party conflict over time, both across parties and within the same party. We find that although voter perceptions largely mirror actual distinctions in intra-party fighting, conspicuous individual-level variations can also be identified owing to attention to the election campaign and motivated reasoning in information processing. These results have important consequences for our understanding of voter perceptions of intra-party conflict and the role of election campaigns, with potential implications for party strategies during election campaigns.
Racial minorities’ attitudes toward interracial couples: An intersection of race and gender
Authors: Chuang Roxie , Wilkins Clara , Tan Mingxuan , Mead Caroline
Published: March 2020

Four studies examined racial minorities’ attitudes toward interracial couples. Overall, Asian and Black Americans indicated lower warmth towards interracial than same-race couples. We hypothesized that perceived competition for same-race partners would predict attitudes toward particular pairings. Consistent with predictions, attitudes towards interracial couples varied based on the societal prevalence of particular types of couples. Black American women (but not men) indicated more negative attitudes toward the more common Black male–White female pairing than toward White male–Black female couples. Asian American men (but not women) reported more negative attitudes toward White male–Asian female couples than toward Asian male–White female couples. Furthermore, perceived competition with White men predicted Asian American men’s attitudes toward White male–Asian female couples. Perceived competition with White women drove Black women’s attitudes toward Black male–White female couples. This research highlights the importance of adopting an intersectional approach (examining both race and gender) to understand attitudes toward interracial couples.
Management of progressive facial asymmetry owing to a rare temporomandibular joint tumour: A case report
Authors: Sharma Geetanjali , Shorafa Mohammad , Hans Gurdeep
Published: March 2020

Osteochondroma of the condyle is a rare, slow-growing, benign tumour of the temporomandibular joint that can result in facial asymmetry, limited mouth opening, temporomandibular joint dysfunction and malocclusion. The large majority of osteochondromas occur at the distal metaphysis of the femur and the proximal metaphysis of the tibia, whereas only 0.6% of osteochondromas have been reported as occurring in the craniofacial region. We discuss the diagnosis and treatment of a 56-year-old fit and well male patient who presented to the Orthodontic Department at Wexham Park Hospital with a four-year history of progressive facial asymmetry and functional concerns, owing to a rare osteochondroma of the condyle.
Evaluation of temporomandibular joint function after orthognathic surgery using a jaw tracker
Authors: Aslanidou Katarina , Xie Rongbing , Christou Terpsithea , Lamani Ejvis , Kau Chung H
Published: March 2020

Objective:

It has been reported that temporomandibular joint (TMJ) function after orthognathic surgery differs from normal patients. Dysfunction of the joints occurs often even in the general public, with an incidence in the range of 20%–25%. Population-based studies among adults report that approximately 10%–15% have symptoms of pain and 5% of them had a perceived need for treatment. To date, no studies have reported on the evaluation of TMJ function after orthognathic surgery through the use of four-dimensional jaw tracking.

Design and setting:

This study evaluated TMJ function using such a device and information from a TMJ questionnaire. Sixteen orthognathic surgery patients and 17 controls were included in this study. Four-dimensional jaw tracking information was obtained using the SiCAT JMT device. Clinical signs and jaw function were evaluated.

Results:

Within the limitations of the study, the following results were seen using the SICAT JMT+ jaw tracking device: (1) no significant differences were found in any of the millimetric measurements between the surgery patients and controls; (2) no significant difference was found in subjective reported symptoms of pain, clicking, crepitation, locking, stiffness, headaches and migraines between the groups; and (3)there was a significant difference in the popping of the joints for surgery and non-surgery groups.

Conclusion:

Jaw tracking did not detect significant differences in jaw function, but some clinical symptoms were present.
Ethnography of young people in confinement: on subjectivity, positionality and situated ethics in closed space
Authors: Henriksen Ann-Karina , Schliehe Anna
Published: February 2020

This article explores the strengths and limitations of doing ethnographic research with young people in confinement. The article draws on two studies from Scotland and Denmark, and reflects on critical issues such as getting access, obtaining informed and voluntary consent, emotional challenges, safety, positionality and situated ethics. While a substantial body of literature addresses the methodological challenges of doing ethnographic research in prisons, the literature on doing qualitative research with young people confined in locked residential institutions and youth remand centres is very limited. The article demonstrates the continued importance of doing ethnographic research in penal institutions, by showing how sensory data and lived experience of penal practice and materiality, contributes to our understanding of how young people experience confinement. By drawing on fieldnotes and interviews, this article aims to inspire and lay the grounds for new researchers in the field.
In search of healthy policy ecologies for education in relation to sustainability: Beyond evidence-based policy and post-truth politics
Authors: Stratford Robert , Wals Arjen E
Published: March 2020

There is a rational assumption built into some research projects that policy contexts are influenced by the quality of the evidence. This is, at best, only somewhat true some of the time. Through policy ethnographies, two education researchers working in the context of sustainability discuss their experiences with evidence-based policy. Central to both accounts is how critical messages about such issues as race, wellbeing and sustainability can become diluted and even lost. In the existing ‘politics of unsustainability’, and at a time of ‘post-truth’ politics, these accounts also show the limits of evidence-based policy.

We argue that those working with ‘the evidence’ need to be open about how evidence-based approaches can end up supporting the ‘status quo’. Moreover, while approaches such as knowledge mobilisation emphasise the relational qualities of policy contexts, and the importance of simple compelling narratives for decision-makers, they, like many other practices, do not sufficiently theorise the power structures surrounding knowledge and the policy context. In addition to the careful use of evidence, we argue that there needs to be greater emphasis on building healthy policy ecologies – including far more emphasis on building critical and creative policy alternatives, especially in areas like sustainability and education.
Recanalization following Endovascular treatment and imaging of PErfusion, Regional inFarction and atrophy to Understand Stroke Evolution—NA1 (REPERFUSE-NA1)
Authors: Tariq Sana , Sah Rani Gupta , Chan Leona , Rajashekar Deepthi , McTaggart Ryan , Butcher Kenneth , Aviv Richard , Swartz Rick , Field Thalia , Tarpley Jason , Shah Ruchir , Hill Michael , Demchuk Andrew , Goyal Mayank , d’Esterre Christopher D , Barber Philip A
Published: March 2020

Rationale

Following endovascular treatment, poor clinical outcomes are more frequent if the initial infarct core or volume of irreversible brain damage is large. Clinical outcomes may be improved using neuroprotective agents that reduce stroke volume and improve recovery.

Aim

The aim of the REPERFUSE NA1 was to replicate the preclinical neuroprotection study that significantly reduced infarct volume in a primate model of ischemia reperfusion. Specifically, REPERFUSE NA1 will determine if administration of the neuroprotectant NA1 prior to endovascular therapy can significantly reduce early (Day 2 subtract Day 1 diffusion-weighted imaging volume) and delayed secondary infarct (90-day whole brain atrophy plus FLAIR volume—Day 1 diffusion-weighted imaging volume) growth, as measured by magnetic resonance imaging.

Methods and design

REPERFUSE-NA1 is a magnetic resonance imaging observational substudy of ESCAPE-NA1 (ClinicalTrialGov NCT02930018). A total of 150 acute stroke patients will be recruited (including 20% attrition) that have been randomized to either NA1 or placebo in the ESCAPE-NA1 trial.

Study outcomes

Primary—Early infarct growth measured using diffusion-weighted imaging will be at least 30% smaller in patients receiving NA1 compared to placebo. Secondary—Delayed secondary stroke injury at 90 days will be significantly reduced in patients receiving NA1 compared to placebo, as well as delayed secondary growth at 90 days.

Conclusion

REPERFUSE-NA1 will demonstrate the effect of NA1 neuroprotection on reducing the early and delayed stroke injury after reperfusion treatment.
Timing of Early Complications Following Open Reduction and Internal Fixation of Closed Ankle Fractures
Authors: Bohl Daniel D. , Idarraga Alexander J. P. , Lee Simon , Hamid Kamran S. , Lin Johnny , Holmes George B.
Published: March 2020

Introduction: There is increasing interest in the early identification and treatment of adverse medical events following orthopaedic procedures. The purpose of this study is to characterize the timing of 8 early adverse events following open reduction and internal fixation of closed fractures of the ankle. Methods: A retrospective cohort study was conducted using the American College of Surgeons National Surgical Quality Improvement Program. A total of 17 318 patients undergoing open reduction and internal fixation of closed ankle fractures were identified. 48.4% of patients were discharged on the day of surgery. For each of 8 different early adverse events, the median postoperative day of diagnosis, interquartile range for day of diagnosis, and middle 80% for day of diagnosis were determined. Timing was compared between unimalleolar and bi-/trimalleolar fractures and between inpatient and outpatient procedures. Results: The median day of diagnosis (and interquartile range; middle 80%) for myocardial infarction was 2 (1-5; 0-17), pneumonia 3 (2-7; 1-19), acute kidney injury 6.5 (2-18; 2-20), urinary tract infection 7 (2-14; 0-24), pulmonary embolism 10 (3-21; 0-27), sepsis 15 (4-22; 1-28), deep vein thrombosis 17 (10-22; 3-27), and surgical site infection 19 (14-25; 8-28). Patients with bi-/trimalleolar fractures had earlier occurrence of myocardial infarction (day 2 vs 10), urinary tract infection (day 6.5 vs 9.5), and sepsis (day 10 vs 20.5). Inpatients had later occurrence of acute kidney injury (day 7 vs 3), but earlier occurrence of urinary tract infection (day 6 vs 15). Conclusions: These precisely described time periods for occurrence of specific adverse events enable heightened awareness among orthopaedic surgeons during the first month following open reduction and internal fixation of the ankle. Orthopaedic surgeons should have the lowest threshold for testing for each adverse event during the time period of greatest risk.

Levels of Evidence: Therapeutic, Level III: Retrospective cohort study
Computed tomography assessment of anterior ethmoidal canal dehiscence: An interobserver agreement study and review of the literature
Authors: Guarnizo Angela , Nguyen Thanh B , Glikstein Rafael , Zakhari Nader
Published: March 2020

Purpose

The anterior ethmoidal artery can be injured in functional endoscopic sinus surgery. The ability of computed tomography (CT) to identify dehiscence of the anterior ethmoidal canal (AEC) has not been widely evaluated. The aim of this study was to evaluate the interobserver agreement in the CT assessment of AEC dehiscence.

Methods

We conducted a retrospective review of consecutive CT scans of the paranasal sinuses (PNS) between January 1, 2012, and December 31, 2012. Two neuroradiologists separately assessed the presence of AEC dehiscence, the presence of PNS opacification, and the best CT plane to evaluate the AEC. Statistical analysis included descriptive analysis and interobserver agreement (kappa coefficient).

Results

The AEC was below the skull base in 199 (22.3%) cases. Dehiscence of the AEC was found in 13.2% for reader 1 and in 7.3% for reader 2. The interobserver agreement for identification of AEC dehiscence was only fair (κ = 0.246). The interobserver agreement for the AEC dehiscence in cases with opacification of ethmoidal air cells was substantial (κ = 0.754).

Conclusion

The suboptimal interobserver agreement could potentially limit the usefulness of CT scans for routine assessment of AEC dehiscence. In patients with PNS opacification, CT scans could still add valuable information regarding AEC dehiscence.
Acute Cardiovascular Care Association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: A document of the Acute Cardiovascular Care Association of the European Society of Cardiology
Authors: Zeymer Uwe , Bueno Hector , Granger Christopher B , Hochman Judith , Huber Kurt , Lettino Maddalena , Price Susanna , Schiele Francois , Tubaro Marco , Vranckx Pascal , Zahger Doron , Thiele Holger
Published: March 2020

Most of the guideline-recommended treatment strategies for patients with acute coronary syndromes have been tested in large randomised clinical trials. Still, a major challenge is represented by patients with acute myocardial infarction admitted with impending or established cardiogenic shock. Despite early revascularization the mortality of cardiogenic shock remains high and roughly half of patients do not survive until hospital discharge or 30-day follow-up. However, there is only limited evidence-based scientific knowledge in the cardiogenic shock setting. Therefore, recommendations and actual treatments are often based on retrospective or prospective registry data and extrapolations from randomised clinical trials in acute myocardial infarction patients without cardiogenic shock. This position statement will summarise the current consensus of the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock based on current evidence and will provide advice for clinical practice.
A portable pneumatic compression device to prevent venous thromboembolism in orthopedic patients with the highest risks of both venous thrombosis and bleeding: A case series study
Authors: Takahashi Yoshiki , Takahira Naonobu , Shibuya Manaka , Uchiyama Katsufumi , Fukushima Kensuke , Iwase Dai , Kawamura Tadashi , Miyagi Masayuki , Higashiyama Reiji , Moriya Mitsutoshi , Sakai Kenta , Tsuda Kouji , Sakamoto Miki , Akamine Akihiko , Takaso Masashi
Published: March 2020

Purpose:

There is a pressing need for safe venous thromboembolism (VTE) prophylaxis in orthopedic patients with the highest risks of both venous thrombosis and bleeding. Portable intermittent pneumatic compression device (IPCD) has proven to be effective and safe in patients with a high risk of venous thrombosis and low bleeding risk. Therefore, this study examined the effectiveness, safety, and wearing compliance of portable IPCD for postoperative VTE prophylaxis in patients with the highest risks of both venous thrombosis and bleeding.

Methods:

The cases consisted of 38 patients who had used a portable IPCD and had the highest risks of both venous thrombosis and bleeding. We examined the incidence of VTE to assess the effectiveness of the portable IPCD, the presence of hemorrhagic adverse events to assess safety, and the wearing rate to assess wearing compliance.

Results:

The incidences of asymptomatic and symptomatic deep vein thrombosis were 5.3% and 2.6%, respectively. The incidence of hemorrhagic adverse events was 21.1% in patients who received anticoagulants and wore an IPCD simultaneously and 0% in patients who wore an IPCD but did not receive anticoagulants. The wearing rate (i.e. ≥18 h/day) was 100%.

Conclusion:

Portable IPCD has the potential for safe VTE prophylaxis in patients at high risks for both venous thrombosis and bleeding. Therefore, we suggest that such patients use a portable IPCD for VTE prophylaxis.
Arthroscopic procedures could delay the need for a subsequent knee arthroplasty in older patients with end-stage osteoarthritis
Authors: Phua Jonathan Kia-Sheng , Razak Hamid Rahmatullah Bin Abd , Mitra Amit Kanta
Published: March 2020

Background/objective:

Arthroscopic surgery in knee osteoarthritis is controversial with many studies refuting its efficacy in recent literature. This study aims to evaluate the mean duration to knee arthroplasty, and the effect of microfracture on the need for subsequent knee arthroplasty in patients above the age of 55 undergoing arthroscopic procedures for osteoarthritis.

Methods:

One hundred and nine consecutive patients with diagnosed osteoarthritis who underwent arthroscopic surgery performed from January 2000 to December 2012 on patients aged 55 years and above by a single surgeon were reviewed retrospectively. Demographic data, age at operation, comorbidities, perioperative details and information of subsequent total knee arthroplasty were collected and analysed.

Results:

There were 38 males and 71 females in our study group. The group was predominantly Chinese (51.38%), with hypertension and hyperlipidaemia being the most common comorbidities, each affecting 57.8% of our study cohort. All patients had a preoperative radiograph and a magnetic resonance imaging confirming the diagnosis of osteoarthritis associated with meniscal tears. Fifty-eight knees underwent microfracture along with arthroscopic meniscectomy. The mean follow-up duration was 127.5 months (10.5 years, range: 67–212 months). Twenty three patients (20.91%) underwent knee arthroplasties subsequently, with the mean duration to arthroplasty being 65.0 months (5.5 years, range: 7–166 months). The odds ratio of avoiding knee arthroplasty with microfracture was 1.03 (95% CI = 0.410–2.581).

Conclusion:

Arthroscopic procedures could possibly delay the need for subsequent knee arthroplasty for approximately 65 months in older patients with osteoarthritis. However, microfracture does not affect the duration between therapeutic arthroscopy and subsequent arthroplasty. Our long-term retrospective study provides an additional step in the understanding of the impact of arthroscopic procedures and a prospective case–control study would be an ideal follow-up to fully justify the application of arthroscopic procedures to delay knee arthroplasty.
Neutrophil activation and neutrophil derived neutrophil extracellular trap formation in patients with coronary artery ectasia
Authors: Guo Yuchao , Liu Ruifeng , Chen Lianfeng , Wu Wei , Zhang Shuyang
Published: March 2020

Background

This study investigated neutrophil activation and neutrophil-derived extracellular traps formation in coronary artery ectasia.

Methods

We enrolled 90 patients who underwent coronary angiography, and included 30 patients with coronary artery ectasia (CAE), 30 patients with obstructive coronary artery disease (CAD) and 30 patients with normal coronary arteries (CON). Intra-neutrophil mean myeloperoxidase index (MPXI) was determined using an automated blood cell counter (ADVIA2120 Hematology System). Serum concentrations of plasma adhesion molecules, cytokines, and neutrophil-derived extracellular traps were quantified.

Results

The intra-neutrophil mean myeloperoxidase index was reduced in CAE patients compared to CAD and CON patients (1.02 ± 3.01, 3.22 ± 3.03, 3.52 ± 4.25, respectively; CAE vs CAD, p = 0.016 and CAE vs CON, p = 0.007). Multiple logistic regression analysis showed that MPXI and dsDNA were independent factors that predicted the presence of CAE. CAE patients had higher levels of plasma adhesion molecules (P-selectin glycoprotein ligand-1, E-selectin, L-selectin) and interleukin 1 beta levels. Neutrophil extracellular trap concentrations were significantly higher in the CAE group compared to CAD and CON patients (284.31(258.33–449.91) ng/mL, 225.12(203.34–257.13) ng/mL, and 247.37(231.04–273.01) ng/mL, respectively; CAE vs CAD, p = 0.000 and CAE vs CON, p = 0.001).

Conclusions

Peripheral neutrophils from CAE patients were activated and neutrophil extracellular traps were elevated in the plasma. IL-1β and soluble adhesion molecules may be the causal factors for neutrophil activation.
Distorted body weight perception and its gender differences in middle-aged adults: population based study
Authors: Song Youngshin , Kwon Myoungjin , Kim Sun Ae
Published: March 2020

Background

Increasing interest in appearance and the growing preference for a beautiful body can lead to physical and psychological problems due to an inappropriate body image perception. As such, there is a need to identify what factors may contribute to an inappropriate body image. The purpose of this study was to examine the presence of distorted body weight perception among middle-aged Koreans and identify gender differences and other factors that contribute to a distorted body image regarding body weight.

Methods

Data on 8363 middle-aged adults (aged 45–64 years) from the Korea National Health and Nutrition Examination Survey were analyzed using complex samples analysis considering weight, stratification variables, and cluster variables. The difference between perceived body image regarding body weight and actual body mass index was used to assess distorted body weight perception. Socioeconomic status, health behaviors, daily energy consumption, and psychological status (depression and stress) were assessed for their relationship to distorted body weight perception.

Results

Results showed that a distorted body image regarding body weight was more prevalent among middle-aged men (45.3%) than women (25.7%). Age, income, perceived health status, and health behaviors were significantly associated with distorted body weight perception in middle-aged men, whereas psychological factors were associated with distorted body weight perception in middle-aged women.

Conclusions

Further research on distorted body weight perception is needed to gain understanding of the gender differences between middle-aged men and women in Korea. Furthermore, to the results of the study can be used as a basis for developing various education, health mediation, and public health promotion interventions and programs to address body weight perception in middle-aged adults.
Jaw reconstruction with vascularized fibular flap: The 11-year experience among 104 patients
Authors: Shao Shengjie , Wang Weihong , Xu Biao , Liu Yu , Zhang Zhe
Published: February 2020

Background

A vascularized fibular osteomyocutaneous flap with severe vascular crisis often results in serious consequences. This study aims to examine the clinical effect of non-vascularized fibular graft on patients with severe vascular crisis after reconstruction of the defect jaw with vascularized fibular osteomyocutaneous flap.

Materials and methods

From December 2007 to December 2018, a total of 104 patients with jaw neoplasms that underwent reconstruction with free vascularized fibular flap were retrospectively analyzed; seven of these cases had postoperative vascular crisis during mandibular reconstruction.

Results

Of the seven cases with postoperative vascular crisis, the vascularized fibular flaps in three patients survived completely, thanks to early detection; two cases were completely necrotic and removed in the end, and the remaining two cases had severe vascular crisis after the removal of the soft tissue attached to the fibular flap. The non-vascular fibular grafts were retained regardless of the severe absorption after follow-ups for 25 and 69 months, respectively.

Conclusions

If vascular crisis occurs following jaw reconstruction with a vascularized fibular osteomyocutaneous flap, early re-surgical exploration effectively improves the salvage rate. In addition, when a severe vascular crisis occurs, the vascularized fibular flap can be changed to a non-vascular fibular graft to reconstruct the mandibular defect, thus avoiding the serious consequences resulting from the complete failure of fibular graft.
Damage to the eye and optic nerve in seriously traumatized patients with concomitant head injury: analysis of 84,627 cases from the TraumaRegister DGU® between 2002 and 2015
Authors: Huckhagel Torge , Regelsberger Jan , Westphal Manfred , Nüchtern Jakob , Lefering Rolf
Published: March 2020

Background

To determine the prevalence and characteristics of prechiasmatic visual system injuries (VSI) among seriously injured patients with concomitant head trauma in Europe by means of a multinational trauma registry.

Methods

The TraumaRegister DGU® was searched for patients suffering from serious trauma with a Maximum Abbreviated Injury Scale (AIS) ≥ 3 between 2002 and 2015 in Europe. After excluding cases without significant head injury defined by an AIS ≥ 2, groups were built regarding the existence of a concomitant damage to the prechiasmatic optic system comprising globe and optic nerve. Group comparisons were performed with respect to demographic, etiological, clinical and outcome characteristics.

Results

2.2% (1901/84,627) of seriously injured patients with concomitant head trauma presented with additional VSI. These subjects tended to be younger (mean age 44.7 versus 50.9 years) and were more likely of male gender (74.8% versus 70.0%) compared to their counterparts without VSI. The most frequent trauma etiologies were car accidents in VSI patients (28.5%) and falls in the control group (43.2%). VSI cases were prone to additional soft tissue trauma of the head, skull and orbit fractures as well as pneumocephalus. Primary treatment duration was significantly longer in the VSI cohort (mean 23.3 versus 20.5 days) along with higher treatment costs and a larger proportion of patients with moderate or severe impairment at hospital discharge despite there being a similar average injury severity at admission in both groups.

Conclusions

A substantial proportion of patients with head injury suffers from additional VSI. The correlation between VSI and prolonged hospitalization, increased direct treatment expenditures, and having a higher probability of posttraumatic impairment demonstrates the substantial socioeconomic relevance of these types of injuries.
Vascular wall injury and inflammation are key pathogenic mechanisms responsible for early testicular degeneration during acute besnoitiosis in bulls
Authors: González-Barrio David , Diezma-Díaz Carlos , Tabanera Enrique , Aguado-Criado Elena , Pizarro Manuel , González-Huecas Marta , Ferre Ignacio , Jiménez-Meléndez Alejandro , Criado Fernando , Gutiérrez-Expósito Daniel , Ortega-Mora Luis Miguel , Álvarez-García Gema
Published: March 2020

Background

Bovine besnoitiosis, caused by the apicomplexan parasite Besnoitia besnoiti, is a chronic and debilitating cattle disease that notably impairs fertility. Acutely infected bulls may develop respiratory signs and orchitis, and sterility has been reported in chronic infections. However, the pathogenesis of acute disease and its impact on reproductive function remain unknown.

Methods

Herein, we studied the microscopic lesions as well as parasite presence and load in the testis (pampiniform plexus, testicular parenchyma and scrotal skin) of seven bulls with an acute B. besnoiti infection. Acute infection was confirmed by serological techniques (IgM seropositive results and IgG seronegative results) and subsequent parasite detection by PCR and histological techniques.

Results

The most parasitized tissue was the scrotal skin. Moreover, the presence of tachyzoites, as shown by immunohistochemistry, was associated with vasculitis, and three bulls had already developed juvenile tissue cysts. In all animals, severe endothelial injury was evidenced by marked congestion, thrombosis, necrotizing vasculitis and angiogenesis, among others, in the pampiniform plexus, testicular parenchyma and scrotal skin. Vascular lesions coexisted with lesions characteristic of a chronic infection in the majority of bulls: hyperkeratosis, acanthosis and a marked diffuse fibroplasia in the dermis of the scrotum. An intense inflammatory infiltrate was also observed in the testicular parenchyma accompanied by different degrees of germline atrophy in the seminiferous tubules with the disappearance of various strata of germ cells in four bulls.

Conclusions

This study confirmed that severe acute besnoitiosis leads to early sterility that might be permanent, which is supported by the severe lesions observed. Consequently, we hypothesized that testicular degeneration might be a consequence of (i) thermoregulation failure induced by vascular lesions in pampiniform plexus and scrotal skin lesions; (ii) severe vascular wall injury induced by the inflammatory response in the testis; and (iii) blood-testis barrier damage and alteration of spermatogenesis by immunoresponse.
Expression of d-psicose-3-epimerase from Clostridium bolteae and Dorea sp. and whole-cell production of d-psicose in Bacillus subtilis
Authors: Wei Hongbei , Zhang Ruoxuan , Wang Leyi , Li Donglong , Hang Fangxue , Liu Jidong
Published: March 2020

Purpose

d-psicose-3-epimerase (DPEase) catalyses the isomerisation of d-fructose to d-psicose, a rare sugar in nature with unique nutritional and biological functions. An effective industrial-scale method is needed for d-psicose production. Herein, the expression of a neutral and a slightly acidic pH DPEase in Bacillus subtilis was evaluated.

Methods

Two DPEase genes from Clostridium bolteae and Dorea sp. were separately expressed in B. subtilis via plasmid pSTOP1622, and an extra P43 promoter was employed to the expression cassette. The fermentation conditions of the engineered B. subtilis strains were also optimised, to facilitate both cell growth and enzyme production.

Result

The introduction of P43 promoter to the two DPEase genes increased enzyme production by about 20%. Optimisation of fermentation conditions increased DPEase production to 21.90 U/g at 55 °C and 24.01 U/g at 70 °C in B. subtilis expressing C. bolteae or Dorea sp. DPEase, equating to a 94.67% and 369.94% increase, respectively, relative to controls.

Conclusion

Enhanced DPEase production was achieved in B. subtilis expressing C. bolteae or Dorea sp. DPEase genes.
Hoffmann’s syndrome necessitating forearm fasciotomy: a case report
Authors: Aarsæther Erling , Joakimsen Ragnar , Halvorsen Hanne , Sildnes Trude , Sivertsen Olav , Due Jan
Published: March 2020

Background

Hoffmann’s syndrome is a rare form of hypothyroid myopathy. Only a few cases of fasciotomy in this setting have previously been reported.

Case presentation

A 41-year-old Caucasian man under treatment for hypothyroidism presented with acute-onset severe pain in his forearm for no obvious reason and was admitted to our emergency room. He eventually developed compartment syndrome which necessitated surgical decompression. Soon after surgery he complained of similar symptoms in his calves. By the time his hypothyroid status was confirmed, conservative treatment and orally administered levothyroxine gradually made the pain from his calves disappear, without further surgical treatment.

Conclusion

Hoffmann’s syndrome may precipitate a compartment syndrome in the absence of trauma.
Fecal non-aureus Staphylococci are a potential cause of bovine intramammary infection
Authors: Wuytack Ameline , De Visscher Anneleen , Piepers Sofie , Haesebrouck Freddy , De Vliegher Sarne
Published: March 2020

The presence of non-aureus staphylococci (NAS) in bovine rectal feces has recently been described. Similar to other mastitis causing pathogens, shedding of NAS in the environment could result in intramammary infection. The objective of this study was to investigate whether NAS strains present in feces can cause intramammary infection, likely via teat apex colonization. During a cross-sectional study in 5 dairy herds, samples were collected from the habitats quarter milk, teat apices, and rectal feces from 25%, 10%, and 25% of the lactating cows, respectively, with a cow serving as the source of one type of sample only. Samples from clinical mastitis cases were continuously collected during the 1-year study period as well. The 6 most prevalent NAS species, Staphylococcus (S.) chromogenes, S. cohnii, S. devriesei, S. equorum, S. haemolyticus, and S. hominis, were further subtyped by random amplification of polymorphic deoxyribonucleic acid polymerase chain reaction (RAPD-PCR), when the same NAS species was present in the same herd in the three habitats. For S. chromogenes, S. cohnii, S. devriesei, and S. haemolyticus, the same RAPD type was found in rectal feces, teat apices, and quarter milk, indicating that fecal NAS can infect the mammary gland. For S. hominis and S. equorum, we were unable to confirm the presence of the same RAPD types in the three habitats.
Impacts of drainage beds covered with sand and wood shavings on the comfort behaviour of dairy buffalo in a temperate climate
Authors: Li Lin , Liu Ping , Guo Lulu , Zhang Fulan , Pu Jinhui , Mao Huaming , Gu Zhaobing
Published: March 2020

Background

Comfortable beds play an important role in increasing the ruminant and milk production efficiency of dairy buffalo. In loose housing systems, cow lying comfort depends on both the bedding materials and bed base.

Results

Buffaloes spent more lying time on sand beds at depth of 15 and 20 cm (S-15 and S-20) than on beds of 10 cm (S-10a) beds or in the feed alley in Exp1 (P < 0.01). No significant difference in the cow comfort index (CCI) was detected between S-10a and S-15; however, both showed higher CCI than that of the S-20 bed. In Exp2, buffaloes spent more time lying on the wood shavings at depth of 15 cm (WS-15) bed followed by the WS-20 and S-10b beds, respectively (P < 0.01), and CCI was greater in the WS-15 bed than in the S-10b and WS-20 beds (P < 0.05).

Conclusion

A depth of sand or wood shavings at 15 cm can meet the lying comfort requirements of dairy buffaloes when bedding materials are used above drainage beds.
Prevalence, risk factors, phenotypic and molecular characteristics for Staphylococcus aureus carriage in community-based drug users in Guangzhou, China
Authors: Wang Yingying , Lin Jialing , Zhou Junli , Han Zhigang , Yao Zhenjiang
Published: March 2020

Background

Staphylococcus aureus (S. aureus), particularly methicillin-resistant Staphylococcus aureus (MRSA), remains the predominant cause of infections in drug users. This cross-sectional study aims to elucidate the prevalence, risk factors, phenotypic and molecular characteristics of S. aureus carriage among community-based drug users.

Methods

All eligible drug users, with both injection and non-injection route of drug administration, were asked to complete questionnaires and collect nasal swabs by trained personal during the period between May and December 2017 in Guangzhou, China. Swabs were processed for identification of S. aureus. Antimicrobial susceptibility test and polymerase chain reaction assays were used to detect phenotypic and molecular characteristics for identified isolates. Univariate and multivariate logistic regression analyses were used to assess risk factors for S. aureus carriage.

Results

Overall, 353 drug users were included in the study and the prevalence of S. aureus carriage was 15.01% (53/353). The prevalence of MRSA carriage was 6.80% (24/353). Cohabitation was a risk factor for S. aureus (adjusted OR = 8.80, 95% CI: 1.89–40.99). The proportion of multidrug resistance was 54.72% for S. aureus isolates and most of these isolates were resistant to penicillin, erythromycin and clindamycin. Seventeen MRSA isolates were multidrug resistant. The results of clonal complexes (CCs) and sequence types (STs) for S. aureus were diverse. The three predominant types for CCs were CC5 (64.15%, 34/53), CC59 (11.32%, 6/53), and CC7 (7.55%, 4/53); and for STs were ST188 (20.75%, 11/53), ST5 (11.32%, 6/53), and ST59 (11.32%, 6/53).

Conclusion

The prevalence of S. aureus nasal carriage was lower while the prevalence of MRSA carriage was moderate compared to previous studies. Phenotypic and molecular characteristics of S. aureus isolates, particularly MRSA isolates, revealed high proportions of antibiotic resistance, indicating the existence of cross-circulation, and implying high opportunity of virulence-related diseases. Decolonization and antibiotic stewardship might be implemented for drug users with MRSA carriage.
The portal of Neviaser: a valid option for antegrade nailing of humerus fractures
Authors: Gerich Torsten , Mouton Caroline , Jabbarian Lea , Weydert Jean-Paul , Hoffmann Alexander , Pape Dietrich , Seil Romain
Published: February 2020

Introduction

The objective of this retrospective non-randomized study was to evaluate the portal of Neviaser (PN) as an alternative approach in antegrade humeral nailing.

Methods

The surgical approach for the straight antegrade intramedullary nail (SAIN) was either the anterolateral delta-split (group 2, n = 79) or the portal of Neviaser (group 3, n = 27). Length of surgery and time of radiation were extracted from charts. Patients stabilized using the PN were followed for a clinical and radiological exam. At follow-up we evaluated the DASH (Disability of the Arm, Shoulder and Hand) and CMS (Constant-Murley Score).

Results

Between 10.2015 and 12.2018 191 proximal and diaphyseal humeral fractures were operated using either an angular stable extramedullary device (group 1, PHILOS®, n = 85) or a straight humeral nail (MultiLoc®, n = 106). Time of radiation and intervention followed a normal distribution. The mean length of surgery was 172.9 min (SD 91.5) in group 1, 121.5 min (SD 54.1) in group 2 and 96.4 min (SD 33.7) in group 3 (p < 0.01). Time of radiation was significantly different with 1.1 min (SD 0.6: group 1), 3.1 min (SD 1.6: group 2) and 2.9 min (SD 1.7: group 3) (p < 0.01). After a mean interval of 21.5 months (range 6–43 months) 14 / 27 patients of group 3 were available for a clinical and radiological follow-up. The mean DASH in group 3 was 25, the CMS reached 70. The age and sex weighted CMS mean value was 96%. Forward flexion was 131°, abduction 125°. The ratio of strength affected versus non-affected side was 4.4: 6.2 kg.

Conclusions

The portal of Neviaser is a feasible and safe approach and is an alternative to the anterolateral delta-split. Length of surgery and time of radiation were significantly shorter.

Level of evidence

IV
Methodological quality (risk of bias) assessment tools for primary and secondary medical studies: what are they and which is better?
Authors: Ma Lin-Lu , Wang Yun-Yun , Yang Zhi-Hua , Huang Di , Weng Hong , Zeng Xian-Tao
Published: February 2020

Methodological quality (risk of bias) assessment is an important step before study initiation usage. Therefore, accurately judging study type is the first priority, and the choosing proper tool is also important. In this review, we introduced methodological quality assessment tools for randomized controlled trial (including individual and cluster), animal study, non-randomized interventional studies (including follow-up study, controlled before-and-after study, before-after/ pre-post study, uncontrolled longitudinal study, interrupted time series study), cohort study, case-control study, cross-sectional study (including analytical and descriptive), observational case series and case reports, comparative effectiveness research, diagnostic study, health economic evaluation, prediction study (including predictor finding study, prediction model impact study, prognostic prediction model study), qualitative study, outcome measurement instruments (including patient - reported outcome measure development, content validity, structural validity, internal consistency, cross-cultural validity/ measurement invariance, reliability, measurement error, criterion validity, hypotheses testing for construct validity, and responsiveness), systematic review and meta-analysis, and clinical practice guideline. The readers of our review can distinguish the types of medical studies and choose appropriate tools. In one word, comprehensively mastering relevant knowledge and implementing more practices are basic requirements for correctly assessing the methodological quality.