bluuebunny/crossref_metadata_2025 huggingface dataset:
Effectiveness of geriatric rehabilitation in inpatient and day hospital settings: a systematic review and meta-analysis
Authors: Wong Eric K. C. , Hoang Peter M. , Kouri Andrew , Gill Sandeep , Huang Yu Qing , Lee Janice C. , Weiss Sophie M. , Daniel Raymond , McGowan Jessie , Amog Krystle , Sale Joanna E. M. , Isaranuwatchai Wanrudee , Naimark David M. J. , Tricco Andrea C. , Straus Sharon E.
Published: November 2024

Background

Geriatric rehabilitation is a multidisciplinary intervention that promotes functional recovery in older adults. Our objective was to assess the efficacy of geriatric rehabilitation in inpatient and geriatric day hospital settings.

Methods

We searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, PsycINFO, PEDro and AgeLine from inception to September 30, 2022 for randomized controlled trials (RCTs) including older adults (age ≥ 65 years) undergoing geriatric rehabilitation (inpatient or day hospital) with a usual care comparator group. Primary outcome measures included mortality, long-term care home (LTCH) admission, and functional status. Secondary outcomes included discharge/remaining at home, functional improvement, length of stay, cognition, mood, and quality of life. Records were screened, abstracted and assessed for risk of bias (Cochrane Risk of Bias [RoB] 2) by two reviewers independently. We conducted a random effects meta-analysis to summarize risk ratios (RR, dichotomous outcomes) and standardized mean differences (SMD, continuous outcomes).

Results

Of the 5304 records screened, 29 studies (7999 patients) met eligibility criteria. There were 23 RCTs of inpatient geriatric rehabilitation (6428 patients) and six of geriatric day hospital (1571 patients) reporting outcomes of mortality (26 studies), LTCH admission (22 studies), functional status (19 studies), length of stay (18 studies), cognition (5 studies), mood (5 studies) and quality of life (6 studies). The primary outcome of mortality at longest follow up was lower in the rehabilitation group (RR 0.84, 95% confidence interval [CI] 0.76 to 0.93, I2 = 0%). LTCH admission was lower in the rehabilitation group at longest follow up (RR 0.86, 95% CI 0.75 to 0.98, I2 = 8%). Functional status was better in the rehabilitation group at longest follow up (SMD 0.09, 95% CI 0.02 to 0.16, I2 = 24%). Cognition was improved in the rehabilitation group (mean difference of mini-mental status exam score 0.97, 95% CI 0.35 to 1.60, I2 = 0%). No difference was found for patient length of stay, mood, or quality of life.

Conclusions

Geriatric rehabilitation in inpatient and day hospital settings reduced mortality, LTCH admission, and functional impairment. Future studies should explore implementation of this intervention for older adults.

Review registration

PROSPERO: CRD42022345078.
Evaluating effects of meal delivery on the ability of homebound older adults to remain in the community via a pragmatic, two-arm, randomized comparative effectiveness trial: study protocol for the Deliver-EE trial
Authors: Thomas Kali S. , Bernard Kimberly P. , Clark Melissa , Dionne Laura , Fisher Alison , Gadbois Emily , Harrison Jill , Juckett Lisa , Locher Julie , Risica Patricia , Sequeira Tamara , Theilheimer Lucy , Gutman Roee
Published: November 2024

Background

As food insecurity and healthcare costs are linked, healthcare entities (i.e., providers, healthcare systems, insurers) are increasingly interested in identifying and providing solutions to address food insecurity among their patients. Home-delivered meals are one long-standing solution to address food insecurity among homebound older adults. However, there is limited evidence about what mode of delivery is most effective in promoting community independence, reducing healthcare utilization, and improving quality of life as well as how these outcomes may vary as a function of people’s preferences for how meals are delivered to them.

Methods

With extensive stakeholder input, we designed and implemented a pragmatic randomized comparative effectiveness study in which we will enroll 2300 older adults on waiting lists at home-delivered meals programs across the country and randomize them to receive for 6 months, either (1) weekday lunchtime meals delivered by a local volunteer or driver who also provides socialization and wellness checks or (2) biweekly delivery of 10 frozen meals to participants’ homes. Participant data will be combined with Centers for Medicare and Medicaid Services (CMS) data to calculate post-randomization institutional vs. community days. Baseline and 3-month surveys will evaluate secondary outcomes (e.g., food insecurity, loneliness, quality of life) and exploratory outcomes (e.g., nutritional risk). To examine heterogeneity of treatment effects, we will test for interactions between the two types of meal delivery and participants’ preferred mode of meal delivery as well as participants’ living arrangements.

Discussion

This research will be the first to prospectively evaluate the comparative effectiveness of the two predominant meal delivery options. The knowledge generated from this research will be of value to healthcare providers, health systems, payers, community-based organizations, older adults, and their families, because it will identify the mode of meal delivery that best meets homebound older adults’ needs and promotes community independence. In addition, the experience of working closely with stakeholders in designing and conducting this trial will be useful to researchers seeking to engage with stakeholders in the development and evaluation of complex social service interventions while balancing regulatory, resource, and human subjects research considerations.

Trial registration

ClinicalTrials.gov. NCT05357261. Registered on May 02, 2022
Optimal battery management in PV + WT micro-grid using MSMA on fuzzy-PID controller: a real-time study
Authors: Behera Sadasiva , Dev Choudhury Nalin B.
Published: November 2024

In modern energy systems, managing energy within a microgrid (MG) poses significant challenges due to the unpredictable nature of renewable energy sources. This article introduces a novel approach for optimal battery management in a photovoltaic–wind microgrid using a Modified Slime Mould Algorithm (MSMA) combined with a fuzzy-PID controller. The microgrid comprises a wind turbine (WT) generator, solar photovoltaic (PV) generator, and a battery energy storage system (BESS). The BESS plays a crucial role in meeting high power demand during outages, while the fuzzy-PID controller ensures accurate prediction of the battery’s state of charge (SOC). The proposed method’s performance is evaluated by comparing the MSMA-based fuzzy-PID controller with a PSO-based fuzzy-PID controller to establish its effectiveness. The optimal energy management of the BESS in the microgrid is achieved by fine-tuning the fuzzy-PID controller using the MSMA algorithm. Simulation results demonstrate that the battery management system (BMS) effectively optimizes charging and discharging based on renewable energy availability and load demand. The fuzzy-PID controller adjusts battery operation by minimizing the error between the desired and actual battery voltage. Performance validation has been conducted in RTS-lab using five distinct load scenarios—45 kW, 35 kW, 75 kW, 4.5 kW, and 12.5 kW, which confirming the effectiveness of the proposed control strategy for energy management.
Insights into geometric deviations of medical 3d-printing: a phantom study utilizing error propagation analysis
Authors: Juergensen Lukas , Rischen Robert , Hasselmann Julian , Toennemann Max , Pollmanns Arne , Gosheger Georg , Schulze Martin
Published: November 2024

Background

The use of 3D-printing in medicine requires a context-specific quality assurance program to ensure patient safety. The process of medical 3D-printing involves several steps, each of which might be prone to its own set of errors. The segmentation error (SegE), the digital editing error (DEE) and the printing error (PrE) are the most important partial errors. Approaches to evaluate these have not yet been implemented in a joint concept. Consequently, information on the stability of the overall process is often lacking and possible process optimizations are difficult to implement. In this study, SegE, DEE, and PrE are evaluated individually, and error propagation is used to examine the cumulative effect of the partial errors.

Methods

The partial errors were analyzed employing surface deviation analyses. The effects of slice thickness, kernel, threshold, software and printers were investigated. The total error was calculated as the sum of SegE, DEE and PrE.

Results

The higher the threshold value was chosen, the smaller were the segmentation results. The deviation values varied more when the CT slices were thicker and when the threshold was more distant from a value of around -400 HU. Bone kernel-based segmentations were prone to artifact formation. The relative reduction in STL file size [as a proy for model complexity] was greater for higher levels of smoothing and thinner slice thickness of the DICOM datasets. The slice thickness had a minor effect on the surface deviation caused by smoothing, but it was affected by the level of smoothing. The PrE was mainly influenced by the adhesion of the printed part to the build plate. Based on the experiments, the total error was calculated for an optimal and a worst-case parameter configuration. Deviations of 0.0093 mm ± 0.2265 mm and 0.3494 mm ± 0.8001 mm were calculated for the total error.

Conclusions

Various parameters affecting geometric deviations in medical 3D-printing were analyzed. Especially, soft reconstruction kernels seem to be advantageous for segmentation. The concept of error propagation can contribute to a better understanding of the process specific errors and enable future analytical approaches to calculate the total error based on process parameters.
Scaling laws of urban heavy truck mobility
Authors: Pang Xiao-Zhe , Lin Xu-Jie , Yang Yitao , Liu Erjian , Jia Xiang-Yu , Lv Ying-Yue , Guo Zile , Wang Yang , Yan Xiao-Yong
Published: November 2024

Heavy truck mobility is crucial in serving urban freight supply and demand, but it can also lead to traffic accidents, high energy consumption and pollutant emissions. Exploring the statistical characteristics of heavy truck mobility is highly important for efficiently managing cities and enhancing sustainable urban development. In this paper, we review some scaling laws of urban heavy truck mobility, including the allometry of urban heavy truck mobility and some scaling laws observed in collective mobility networks and individual mobility trajectories of urban heavy trucks. We also introduce models that explain the underlying mechanisms of these scaling laws. We further provide an outlook for future research on urban heavy truck mobility.
Escaping Impossibility
Authors: Young Thelathia “Nikki”
Published: November 2024

This article forwards the idea that to be human is to be free and possible, without limiting predetermination or signification. Such a claim is ontological, establishing freedom as both a divine enterprise and an ethical aim for humanity, and recognizable in God, our neighbors, and ourselves. This article also asserts that colonization—particularly the colonial gaze—along with economies of slavery pervert the recognition of ontological freedom and establish an epistemic frame of Blackness that renders Black lives and being unlivable, impossible. However, Black queer ethics—in its construction and use of virtues, values, and practices from Black queer folks—reframes freedom by turning back to the fundamental idea of what it means to be. This article ultimately suggests that Black queer ethics makes use of the processes of creative resistance, fugitivity, and un/making to reestablish freedom for human beings who have been especially unrecognized as livable and oppressed through signification.
The sclerotome is the source of the dorsal and anal fin skeleton and its expansion is required for median fin development
Authors: Bailon-Zambrano Raisa , Keating Margaret K. , Sales Emily C. , Nichols Abigail R. , Gustafson Grace E. , Hopkins Colette A. , Kocha Katrinka M. , Huang Peng , Barske Lindsey , Nichols James T.
Published: November 2024

Paired locomotion appendages are hypothesized to have redeployed the developmental program of median appendages, such as the dorsal and anal fins. Compared with paired fins, and limbs, median appendages remain surprisingly understudied. Here, we report that a dominant zebrafish mutant, smoothback (smb), fails to develop a dorsal fin. Moreover, the anal fin is reduced along the antero-posterior axis, and spine defects develop. Mechanistically, the smb mutation is caused by an insertion of a sox10:Gal4VP16 transgenic construct into a non-coding region. The first step in fin, and limb, induction is aggregation of undifferentiated mesenchyme at the appendage development site. In smb, this dorsal fin mesenchyme is absent. Lineage tracing demonstrates the previously unknown developmental origin of the mesenchyme, the sclerotome, which also gives rise to the spine. Strikingly, we find that there is significantly less sclerotome in smb than in wild type. Our results give insight into the origin and modularity of understudied median fins, which have changed position, number, size, and even disappeared, across evolutionary time.
Short-range Fgf signalling patterns hindbrain progenitors to induce the neurogenesis-to-oligodendrogenesis switch
Authors: Yeung Tim J. , Wilkinson David G.
Published: November 2024

In the vertebrate nervous system, neurogenesis generally precedes gliogenesis. The mechanisms driving the switch in cell type production and generation of the correct proportion of cell types remain unclear. Here, we show that Fgf20 signalling patterns progenitors to induce the switch from neurogenesis to oligodendrogenesis in the zebrafish hindbrain. Fgf20 emanating from earlier-born neurons signals at a short range to downregulate proneural gene expression in the segment centre with high spatial precision along both anterior-posterior and dorsal-ventral axes. This signal induces oligodendrocytes in the segment centre by upregulating olig2 and sox10 expression in pre-patterned competent progenitors. We show that the magnitude of proneural gene downregulation and the quantity of oligodendrocyte precursor cells specified is dependent on the extent of Fgf20 signalling. Overexpression of fgf20a induces precocious specification and differentiation of oligodendrocytes among olig2+ progenitors, resulting in an increase in oligodendrocytes at the expense of neurogenesis. Thus, Fgf20 signalling defines the proportion of each cell type produced. Taken together, Fgf20 signalling from earlier-born neurons patterns hindbrain segments spatially and temporally to induce the neurogenesis-to-oligodendrogenesis switch.
Impact of Social Determinants of Health on Melanoma Nodal Surveillance in a Multi-institutional Cohort
Authors: Montgomery Kelsey B. , McLeod M. Chandler , DePalo Danielle K. , Dugan Michelle M. , Zager Jonathan S. , Elleson Kelly M. , Sabel Michael S. , Hieken Tina J. , Kottschade Lisa A. , Ollila David W. , Pham Veronica , Archer Dion , Berman Russell S. , Lee Ann Y. , Cintolo-Gonzalez Jessica A. , McDonald Hannah G. , Winchester Sydney , Burke Erin E. , Rhodin Kristen E. , Beasley Georgia M. , Broman Kristy K.
Published: November 2024

Background

Nodal surveillance (NS) has overtaken completion lymphadenectomy as the preferred management for sentinel node-positive (SLN+) melanoma, but requires frequent exams and nodal ultrasound (US). Social determinants of health (SDoH) may affect US adherence in real-world populations, and evaluation of these potential impacts is needed.

Methods

Adults with SLN+ melanoma diagnosed from July 2017 to December 2019 who received NS at nine cancer centers were identified retrospectively. Exposures included insurance status, travel distance, and Centers for Disease Control and Prevention (CDC) Social Vulnerability Index (SVI), a validated measure of area-level SDoH, indicated as 0 (low) to 1 (high) vulnerability. The primary outcome was US adherence (≥ 1 study per 6-month follow-up interval). The secondary outcomes were combined-modality adherence [US, computed tomography (CT), or positron emission tomography (PET)] and loss to follow-up (LTFU). Bivariate analyses and mixed-effects multivariable logistic regression were performed.

Results

Most of the 519 patients were male (57%), non-Hispanic white (94.4%), and insured privately (45.3%) or by Medicare (43.5%). The median travel distance was 63.3 miles (interquartile range [IQR], 31.2–111.0 miles), and the median SVI was 0.426 (IQR, 0.253–0.610). The surveillance adherence rates were 41.6% for US and 75.1% for combined modalities. No significant differences in US adherence were observed based on sociodemographic covariates in regression analysis. Medicaid (odds ratio [OR], 3.12; p = 0.02) and uninsured (OR 4.48; p = 0.01) patients had increased likelihood of LTFU.

Conclusions

Less than half of the patients in this multicenter cohort achieved US adherence, although the rates improved with combined modalities. Medicaid or non-insurance were social risk factors for LTFU. Optimizing surveillance practices for socially vulnerable groups will be crucial for the ongoing real-world implementation of NS.
A variation in the origin, course and blood supply of the posterior circumflex humeral artery
Authors: Tikk Tiina , Rahu Madis , Kolts Ivo , Weyers Imke , Põldoja Elle
Published: November 2024

Learning ordinary anatomy is an essential part of medical training. New knowledge about anatomical variations helps surgeons to improve their surgical techniques and avoid complications. The posterior circumflex humeral artery usually arises from the axillary artery and passes through the quadrilateral space along with the axillary nerve. In our study, we introduce a human cadaver specimen with unusual arterial variation. In this case, instead of passing through the quadrilateral space, the posterior circumflex humeral artery coursed along the lower edge of the teres major muscle to the surgical neck of the humerus. In our data, the posterior circumflex humeral artery arose from brachial artery and the branches of this artery supplied the deltoid muscle, teres minor and infraspinatus tendons, and the lower part of the long head of the triceps brachii muscle.
Assessment of nutritional status, energy intake and energy requirement: a cross-sectional study among sabar males of West Bengal, India
Authors: Das Kaustav , Basu Souradip , Mukherjee Koel , Ganguli Sayak , Bagchi Subrata Sankar
Published: November 2024

Malnutrition, particularly undernutrition, is a major problem for most low and middle-income countries. For several years, health professionals have recommended improving daily diets and continuous nutritional education as the solution to malnutrition and maximising a healthy life. More specifically, malnutrition is often reversible to a certain extent if the balance between energy intake (EI) and energy requirement (ER) can be measured accurately and maintained accordingly. The present study tries to assess the nutritional status and evaluate the EI and ER among the Sabar males living in the Purulia district of West Bengal, India. For this cross-sectional study, 400 Sabar men aged 18–60 years were selected. To assess their nutritional status, the anthropometric measurements of height (cm) and weight (kg) were taken following a standard procedure. Body mass index (BMI) was calculated, and the classification proposed by World Health Organization (WHO) for the South Asian population was considered. Body composition variables like Percent Body Fat (PBF), Fat Mass (FM), Fat- Free Mass (FFM), Fat Mass Index (FMI) and Fat-Free Mass Index (FFMI) were also calculated. The 24-hour dietary recall method was used to assess the nutrient intake (i.e., EI). ER was derived from the estimated total energy expenditure (TEE) calculated from the predictive equation proposed by the Indian Council of Medical Research (ICMR) for the Indian population. The study protocol was approved by the institutional ethical committee. Data were collected after getting consent from the study participants. The rate of undernutrition increased with age and was found to be highest (56.9%) among the aged individuals (41–50 years) with an overall prevalence of 48.5%. A gradual decrease in FFM, FFMI and a steady increase in PBF, FM, and FMI was seen with the increase in age. Differences were observed in EI and TEE across different age groups and nutritional categories. A negative energy flow was identified where TEE exceeded EI in each age and nutritional category. The high prevalence of undernutrition demands immediate nutritional intervention. This is probably the first report on the assessment of EI and TEE among any indigenous community living in West Bengal, so further studies are required among other communities living in similar or different ecological conditions for a better understanding and formulation of nutritional policies with special emphasis on elderly people.
The role of hemostatic changes in the pathogenesis of diabetic retinopathy
Authors: Preys Nataliya , Savytskyi Ivan
Published: November 2024

Introduction: The paper presents the results of the hemostasis system of rats with experimental diabetic retinopathy.
Material and methods: Experimental studies were performed on white Wistar rats, which were divided into 2 groups: 1st group – intact animals; 2nd group – 60 animals with modelling of diabetic retinopathy without correction (control pathology). Аnalysis of the hemostasis system was performed according to the following indicators: plasma recalcification time, activated partial thromboplastin time, prothrombin time, thrombin time, heparin time, thermostable thromboplastin inhibitor, thermolabile thromboplastin inhibitor and fibrinogen level.
Results: Under the conditions of simulated diabetic retinopathy, the time of plasma recalcification was significantly reduced by 1.2 times (p<0.05) compared to intact rats; prothrombin time – 1.4 times (p<0.05); thrombin time – 1.1 times; heparin time – 1.1 times; thermostable thromboplastin inhibitor – 1.0 times; thermolabile thromboplastin inhibitor – 1.5 times (p<0.05), respectively. There was also a significant increase in the level of activated partial thromboplastin time by 1.3 times (p<0.05) compared to the intact group of animals and the level of fibrinogen by 4.9 times (p<0.05), respectively. Such violations of hemostasis at the initial stage of the development of diabetic retinopathy R are associated with inhibition of anticoagulation mechanisms, since the contact phase of hemocoagulation did not change significantly.
On the 120th day of the experimental studies, the plasma recalcification time decreased by 1.3 times (p<0.05) compared to intact rats; prothrombin time - 1.5 times (р<0.05); thrombin time – 1.3 times (p<0.05); heparin time – 1.2 times (p<0.05); thermostable thromboplastin inhibitor - 1.1 times; thermolabile thromboplastin inhibitor - 2.0 times (p<0.05), respectively. It was established that the activated partial thromboplastin time also increased significantly by 1.4 times (p<0.05) compared to intact rats; there was a 4.0-fold increase in the concentration of fibrinogen (p<0.05), respectively, in intact animals.
Conclusions: DM is characterized by a number of changes in the hemostasis system, which determine the risk of thrombotic complications. One of the main reasons for these changes is: insulin resistance, hyperinsulinemia and insufficient compensation of carbohydrate metabolism. Hypercoagulation in DR conditions is manifested by an increase in the concentration and activity of factors VII and fibrinogen.
The Impact of prolonged antibiotic use on the development of bacterial resistance - a literature review
Authors: Nojek Paweł , Zimonczyk Mariusz , Zawół Monika , Pawlik Wiktoria , Błaszczyński Gustaw , Nowotarska Agnieszka
Published: November 2024

Abstract
Introduction and Objective. Antimicrobial resistance (AMR) arises when pathogens no longer respond to antimicrobials, including antibiotics, making infections harder to treat and increasing the risks of severe illness and death. Although AMR is a natural evolutionary process, human activities, especially the misuse of antimicrobials in healthcare, agriculture, and animal care, accelerate its spread. This review examines the impact of prolonged antibiotic use on bacterial resistance and analyzes global trends and strategies to combat AMR.
Methods. A literature review was conducted using PubMed and Google Scholar with search terms like "antimicrobial resistance," "antibiotic-resistant bacteria," and "overuse of antibiotics." Articles from the last five years were prioritized.
State of Knowledge. AMR poses a major global health threat due to excessive and improper antibiotic use, resulting in resistant infections and higher healthcare costs. Addressing AMR requires limiting antibiotic use, implementing rapid diagnostics, and exploring alternatives like bacteriophage therapy.
Conclusions. Innovative treatments, such as bacteriophages, and rapid diagnostics show promise, while public education on responsible antibiotic use is essential. Combating AMR will require coordinated international efforts, research support, and global standards to maintain effective treatments in the future.
Virtual reality based apps are the future of patient: Counseling
Authors: Behera Ranjan K , Morya Arvind K , Gupta Parul C , Singh Arshi
Published: November 2024

The use of virtual reality to educate preoperative patients has a positive impact on nurses as well as patients undergoing treatment. It can help improve patient satisfaction and improve favorable outcomes by reducing patient anxiety and proving adequate knowledge about the procedure and possible outcomes to the patient. It also reduces burden on nursing staff and counsellors. Larger and more diverse cohort studies will help us understand the wider application of this tool on the patient population. It may be difficult to apply this tool on elderly patients with failing eyesight, multiple physical comorbidities. Also, there may be reduced acceptance of this modality by older nursing staff and practitioners who may prefer the traditional verbal version for counselling. We will benefit from a combined approach of using virtual reality apps with tradition one-on-one counselling to help alleviate patient concerns and improve patient and healthcare professional satisfaction.
Enhancing postoperative pain control by surgically-initiated rectus sheath block in abdominal aortic aneurysm open repair: A case report
Authors: Chen Kuan-Hua , Kang Ming-Yuan , Chang Yi-Ting , Huang Sheng-Yang , Wu Yung-Szu
Published: November 2024

BACKGROUND

Abdominal aortic aneurysm (AAA) repair often involves significant postoperative pain, traditionally managed with systemic opioids, which can cause undesirable side effects. This case report explores the novel use of a surgically-initiated rectus sheath block with a catheter-over-needle assembly for pain management in AAA repair.

CASE SUMMARY

A 67-year-old female with hypertension and previous aortic dissection underwent elective open repair of an infrarenal AAA, which had grown from 3.4 cm to 4.3 cm over 14 months. A rectus sheath block was initiated surgically for postoperative pain control. The patient reported low pain scores and did not require systemic intravenous opioids, enabling early ambulation and discharge on postoperative day seven without complications. By preventing complications of systemic opioids, the method indicating a promising direction for postoperative pain management in major vascular surgeries.

CONCLUSION

Surgically-initiated rectus sheath block as a valuable tool for managing postoperative pain in AAA repair.
Anlotinib-induced sick sinus syndrome: Two case reports
Authors: Fu Cheng-Feng , Yang Li-Fen , Tian Lei , Deng Song , Zhang Qi , Yao Biao
Published: November 2024

BACKGROUND

This manuscript describes the first known cases of sick sinus syndrome (SSS) associated with the use of anlotinib in non-small cell lung cancer patients, highlighting the need for increased vigilance and cardiac monitoring.

CASE SUMMARY

Two patients with non-small cell lung cancer developed SSS after 15 months and 5 months of anlotinib treatment, respectively, presenting with syncope and palpitations. Electrocardiogram confirmed SSS, and different treatment approaches were taken for each patient. One patient received a dual-chamber permanent pacemaker, while the other discontinued the medication and experienced symptom resolution.

CONCLUSION

Anlotinib can induce SSS, suggesting that cardiac monitoring is crucial during anlotinib treatment. Individualized management strategies are necessary for affected individuals.
Saccharomyces boulardii as a single trigger of food protein-induced enterocolitis syndrome: Seven case reports
Authors: Hwang Jin-Bok , Jang Hyo-Jeong
Published: November 2024

BACKGROUND

Food protein-induced enterocolitis syndrome (FPIES) is the most serious type of non-immunoglobulin E (IgE)-mediated food allergic reaction manifesting as sepsis-like symptom, which can lead to shock. Saccharomyces boulardii (S. boulardii ), a probiotic prescribed frequently in clinical settings, has been reported to trigger FPIES in an infant with soy-triggered FPIES. In this report, we describe a new clinical FPIES in which S. boulardii was the sole triggering factor of acute FPIES adverse reaction in seven healthy infants.

CASE SUMMARY

Seven FPIES cases triggered by only S. boulardii were gathered from 2011 to the present. None of the patients had previously experienced any allergic reaction to cow’s milk, soy, or complementary food. The age of the patients was 4-10-months old, and the symptoms of FPIES developed after ingestion of S. boulardii , which is mostly prescribed for the treatment of gastroenteritis or antibiotic-associated diarrhea. All patients experienced severe repetitive vomiting 1-3 hours after S. boulardii ingestion. Extreme lethargy, marked pallor, and cyanosis were also observed. No IgE-mediated hypersensitivity developed in any patient. Diarrhea was followed by initial intense vomiting in approximately 5-10 hours after S. boulardii ingestion, and only one case showed bloody, purulent, and foul-smelling diarrhea. The patients stabilized quickly, mostly within 6 hours. Symptoms got all improved within 24 hours after discontinuation of S. boulardii .

CONCLUSION

S. boulardii can be the sole trigger of acute FPIES and be prescribed cautiously even in healthy children without FPIES.
ANTIMICROBIAL BIOACTIVE GLASS FOR TREATMENT OF TRAUMATIC OR PATHOLOGICAL BONE DEFECTS
Authors: Samuel Bolaji John , Horbert Victoria , Jin Zhaorui , Brauer Delia S. , Matziolis Georg
Published: November 2024

Aim

Biomaterial-associated infections (BAI) present a formidable clinical challenge. Bioactive glasses (BG) have proven highly successful in diverse clinical applications, especially in dentistry and orthopaedics. In this study, we aimed to determine the effect of three commonly used BG composition and particle sizes on cell and bacterial attachment and growth. Our focus is on understanding the changes in pH and osmotic pressure in the surrounding environment during glass degradation.

Method

First, three different melt-derived glasses were characterized by analyzing particle size and glass network structure using Raman and NMR. The different glasses were then tested in vitro by seeding 4x 104 cells/well (SaOS Cell line) in a 48 well plate. After a pre-incubation period of 72 hours, the different BGs and particle sizes were added to the cells and the pH value, ion release and live/dead staining was measured every hour. The effect of BG against bacteria (S. epidermidis) was analyzed after 24 and 72 hours of treatment by using XTT viability assay and CFU counting by plating out the treated aliquot agar to estimate the viable bacteria cells.

Results

All three BG compositions tested showed a significant increase in pH, which was highest in BG composition 45S5 with a value of 11 compared to the other BG compositions 10 and 9 in S53P4 and 13-93 respectively. This strong increase in the pH in all BG samples tested results in a strongly reduced cell viability rate of more than 75% compared to the untreated control and 6-fold reduction in bacterial viability compared to the untreated control. The live/ dead assay also showed an increased cell viability with increasing glass particle size (i. e smallest glass particle < 25% viable cell and largest glass particle> 65% viable cell). The ion release concentration over 50 h showed an increase in sodium ions to 0.25 mol/L, calcium to 0.003 mol/L and a decrease in phosphorus.

Conclusions

These results show that the composition of the bioactive glass and the choice of particle size have a major influence on subsequent applications. In addition to the different compositions of the BG, particle size and additional medium change also influence the pH and ion release, and therefore also on cells or bacteria viability. The sizes of the bioactive glass particle are inversely proportional to it. Further tests are necessary to develop custom design BG compositions, which simultaneously stimulate osteoblasts proliferation and prevent microbial adhesion.
THE MANAGEMENT OF UNHEALED FRACTURE-RELATED INFECTIONS WITH A SINGLE-STAGE PROTOCOL AND WITHOUT BONE GRAFT
Authors: Frank Florian , Hotchen Andrew , Valand Poonam , Stubbs David , Ferguson Jamie , McNally Martin
Published: November 2024

Aim

This retrospective study evaluated the outcome of treatment for unhealed fracture-related infections (FRI).

Methods

We identified a consecutive, single-centre cohort of patients having treatment for an FRI Consensus confirmed FRI. All fractures were unhealed at the time of treatment. Patients were followed up for at least one year. Successful outcome was a healed fracture without recurrent infection. Lack of union, persistent infection and/or unplanned reoperation defined failure.

Results

Demographics: 183 patients (184 FRIs) with mean age 52.1 years (range 17-96) were treated and followed up for a mean of 2.8 years (range 1-9.4). Mean duration of FRI was 1.1 years with 65 (35.5 %) presenting within 6 months of injury. 118 patients had established infected non-union. FRI was most frequent in the tibia (74), femur (48) and humerus (24). 171 patients were BACH Complex.

75.5% of FRIs were culture positive, with Staph. aureus being the most frequent organism. Polymicrobial infection and Gram negative cultures were common (25.5% and 33.6%).

Treatment: 98.3% of surgeries were performed in one stage with just 3 planned 2-stage procedures (2 endoprosthetic replacements and 1 free fibular flap). No bone graft was used in any surgery and all wounds were closed at first operation. 48 cases (26%) required flap coverage (29 free flaps and 19 local flaps). Local antibiotics were used in 124 cases (67.4%) of primary surgeries.

All patients had sampling, debridement, systemic antibiotics and wound closure. 40 (21.7%) had DAIR, 31 (16.8%) had new internal fixation and 105 (57.1%) had external fixation (including 79 Ilizarov fixators).

Outcomes: After primary surgery, 84.6% of all patients were infection-free and 77.2% had united. After further surgery, 98.8% were infection-free and 98.1% had united. External fixation techniques achieved infection eradication in 89.1% compared to 71.7% with any internal fixation (p=0.005). Primary internal fixation achieved union in 81.7% compared to 74.3% with external fixation (p=0.27). Secondary surgery after external fixation was mainly docking site fixation.

Conclusion

Unhealed FRIs present a difficult challenge for treatment. This large series demonstrated that single-stage treatment, without bone grafting, gave acceptable results with few reoperations. Primary external fixation gave more certainty of infection eradication but required more reoperations to secure union. However, this difference in reoperation was not statistically significant. We strongly advocate managing these patients with a multidisciplinary team which can treat all aspects of the condition.
A CLINICAL EVALUATION OF THE SAFETY AND TOLERABILITY OF A NOVEL ANTIMICROBIAL PEPTIDE IN PERIPROSTHETIC JOINT INFECTION OF THE KNEE TREATED BY DEBRIDEMENT, ANTIMICROBIALS AND IMPLANT RETENTION (DAIR)
Authors: McNally Martin , Dietz Matthew , Piuzzi Nicolas , Chen Antonia , Parvizi Javad , Stolarski Edward , Pelt Christopher , Rodriguez-Quintana David , Trautner Barbara , Dobbins Despina
Published: November 2024

Aim

Antimicrobial peptides occur naturally in our intrinsic immune system. PLG0206 is a novel, engineered, 24-amino acid peptide which has broad-spectrum antimicrobial activity, including in biofilm and against multi-drug resistant pathogens (1,2). This is the first clinical study to evaluate the safety and tolerability of PLG0206 when administered via an irrigation solution in patients with periprosthetic joint infections (PJI) following total knee arthroplasty (TKA) during debridement, antibiotics, and implant retention (DAIR). Secondary objectives were to evaluate pharmacokinetics (PK), biomarkers and initial clinical efficacy at one year post-DAIR procedure.

Method

This prospective, multicenter, open-label, interventional study assessed two dose levels of PLG0206. Fourteen patients underwent revision for PJI after TKA. At the end of debridement, they received a single intra-articular irrigation of PLG0206 into the wound cavity lasting 15 minutes at concentrations of 3 mg/mL (n=7) or 10 mg/mL (n=7). Patients received post-operative care and intravenous/oral antimicrobial therapy as per their institutional guidelines. Patients were monitored for safety and signs of relapse or persistent infection for 12 months post study drug administration and PK and blood biomarkers were assessed.

Results

All patients completed their final study assessment at Day 365. Over the 1-year follow-up, only one recurrence (7%) was noted at Day 169 in the low-dose cohort. Following dosing, nine patients (64.3%) had limited systemic exposure; maximum plasma concentration occurred 1-hour post-administration and declined rapidly to undetectable levels by 24 hours following treatment in all patients. The incidence of drug related treatment-emergent adverse events (TEAEs) was low. Two patients, both in the higher dose cohort, experienced a transient drug related TEAE; one of hypertransaminasaemia and one of neuralgia. Both events were moderate in severity and resolved within two weeks of onset.

Conclusions

A single 15-minute irrigation of PLG0206 into the wound cavity of patients undergoing a DAIR procedure for PJI following TKA, is safe and well tolerated by patients. This new antimicrobial peptide offers a promising therapeutic option in musculoskeletal infection. The initial clinical efficacy is encouraging but now needs to be investigated in a much larger clinical trial.
IS THE PRESENCE OF A POSITIVE BLOOD CULTURE A RISK FACTOR FOR DAIR FAILURE IN HAEMATOGENOUS TOTAL KNEE ARTHROPLASTY INFECTION?
Authors: Pedemonte Gloria , Reynaga Esteban , López Vicente , de los Rios Javier Diez , Molinos Sònia , Larraza Ainhoa Vivero , Hermoso Jose Antonio Hernandez
Published: November 2024

Aim

Haematogenous prosthetic joint infections account for 20-35% of total prosthetic infections. Debridement, antibiotics and implant retention (DAIR) is a well-accepted treatment for these infections and probably the most desired by surgeons, since it tries to maintain a functional and stable implant. However, the risk of DAIR failure is not negligible and some risk factors have been described, and also, different scores, such as CRIME80.

Nonetheless, less is known about the impact of positive blood cultures may have on DAIR treatment. The aim of our study is to analyze whether the presence of a positive culture is a risk factor for DAIR failure.

Method

A retrospective cohort study of 50 late acute haematogenous TKA infections was performed from 2015 to 2023. DAIR failure was defined as the need of a subsequent intervention either a new DAIR or a revision surgery. So, patients were divided into two groups depending on the surgical outcome: successful (SG) vs failure (FG).

Demographic variables including age, gender, affected side and body mass index were collected. Patient's comorbidities were also collected including chronic obstructive pulmonary disease (COPD), diabetes, rheumatoid arthritis (RA), cirrhosis and chronic renal failure, etc. Other variables, such as ones included in CRIME80 (C-reactive protein (CRP) >150mg/dl and polyethylene exchange), were also collected.

Results

30 patients had a successful DAIR outcome (60%). Age and sex do not act as risk factors [OR 0.7 (0.2-2.6) and OR 0.4 (0.1-1.3)]. Neither do COPD [OR 3.3 (0.5-2.0), p=0.2]; RA [OR 0.8 (0.2-3.1), p=0.7]; CRP value [3.2 (0.9-11.2), p=0.06]; and polyethylene exchange [OR 0.4 (0.1-2.5), p= 0.3].

Thirty-five blood cultures (70%) were obtained before surgery (20 SG and 15 FG). Nine of the obtained blood cultures were positive (25.7%), being 7 from FG (46.7%) [OR 7.6 (1.3-4.8), p=0.02].

A logistic regression was performed where positive blood cultures were the only significant variable to predict DAIR failure (OR 12, 95% CI 1.1−18, p=0.049), after adjusting for all CRIME80 variables.

Skin and soft tissue origin was described in 5 of the nine positive blood cultures (55.6%). Cardiovascular system was the second most common spread (22.2%), and then followed by urogenital and digestive tract. The most common microorganism in FG was Staphylococcus aureus (57.1%) [OR 6.4 (0.2-18.0), p=0.2].

Conclusions

Positive blood cultures may be another risk factor for DAIR failure. This can be important in diagnosis and it may be taken into account in antibiotic and surgical treatment strategies.
HOW DOES SMOKING AFFECT QUALITY OF LIFE AFTER SURGERY FOR BONE AND JOINT INFECTION?
Authors: Dudareva Maria , Lama Shristi , Scarborough Claire , Miyazaki Keiko , Wijendra Asanka , Tissingh Elizabeth , Kumin Michelle , Scarborough Matthew , McNally Martin
Published: November 2024

Aim

People awaiting surgery for bone and joint infection may be recommended to stop smoking to improve anaesthetic and surgical outcomes. However, restricting curative surgical treatment to non-smokers on the basis of potentially worse surgical outcomes is not validated for functional outcomes or quality of life differences between patients who do and do not smoke.

This study used secondary analysis of trial data to ask: do peri-operative non-smokers have a greater improvement in their quality of life 12 months after surgery for bone and joint infection, compared with non-smokers?

Method

Participants in the SOLARIO and OVIVA clinical trials who had complete baseline and 12 month EQ-5D-5L or EQ-5D-3L scores were included. Smoking status was ascertained at baseline study enrolment from participant self-report. Normalised quality of life scores were calculated for participants at baseline and 12 months, based on contemporaneous health state scores for England. Baseline and 12 month scores were compared to calculate a post-operative increment in quality of life.

Results

Mean quality of life increment over 12 months was +0.17 for people who reported smoking peri-operatively (95% confidence interval −0.55 to +0.89), compared to +0.23 for people who did not report smoking peri-operatively (95% confidence interval −0.48 to +0.94). Linear regression analysis found no significant difference between the improvement in quality of life for smokers and non-smokers (p>0.1). Mean increments for both groups were greater than estimates of Minimal Clinically Important Difference in quality of life in musculoskeletal conditions. [1,2]

Conclusions

People who smoke peri-operatively still experience an improvement in quality of life after surgery for orthopaedic infections, commensurate with the improvement experienced by non-smokers. Surgery should not be denied to people on the basis of reported smoking status alone.
WHAT IS THE BEST SURGICAL OPTION FOR PERIPROSTHETIC JOINT INFECTION (PJI) DUE TO CANDIDA SPECIES?
Authors: McNally Martin , Lora-Tamayo Jaime , Oustau Cecile Ronde , Salles Mauro , Morata Laura , Mancheño-Losa Mikel , Giordano Gerard , Frank Bernhard J.H. , Hofstaetter Jochen , Dinh Aurélien
Published: November 2024

Aim

Candida species are uncommon pathogens causing prosthetic joint infection (PJI). This study evaluated the surgical management and outcome of Candida PJI.

Methods

Patients with EBJIS Definition confirmed PJI, due to Candida species, from 19 medical centres were assessed. Demographic, diagnostic, medical and surgical treatment and outcome data were collected.

Results

269 patients were recruited with follow-up for at least one year. Mean age was 70.2 years (+/- 12.4) with 10.8% being immunocompromised. The most common fungal species were C. albicans (55.8%), C. parapsilosis (29.4%), C. glabrata (7.8%) and C. tropicalis (5.6%). Co-infection with bacteria occurred in 138 (51.3%) cases.

DAIR was performed in 96 (36.2%) cases, with 169 (63.8%) having implant exchange or removal (76 one-stage, 78 two-stage, 11 removal/Girdlestone arthroplasty, 2 amputation). Patient demographics and antifungal therapy were similar in all surgical groups.

Overall, treatment was successful in 156 (58%) cases. Failure was more likely in older patients (>70 years; p=0.008) and those who had DAIR (OR 1.945; 1.156-3.279; p=0.004). Failure was less likely with C. parapsilosis infection compared to C. albicans (31.6% vs 48%; p=0.037).

DAIR patients had more co-infection with bacteria (63.5% vs 47.4%; p=0.013) and more previous surgeries (median 4 vs 3; p=0.007), but multivariate analysis showed that these were not independent risk factors for failure. There was no difference in mortality between DAIR patients and those with other surgery (13.5% vs 17.7%; p=0.372).

DAIR was successful in 45/96 (46.9%) cases compared to 110/169 (65.1%) cases with other surgery (p<0.004). Early DAIR (surgery performed <I month from implantation/infection onset) was not more effective than late DAIR (surgery performed after 1 month)(early DAIR 44.4% cure vs 63.9% cure in late DAIR; p=0.004).

Two-stage revision was successful in 54/78 (69.2%), which was significantly better than DAIR (p=0.003). One-stage revision was successful in 51/76 (67.1%) patients; also significantly better than DAIR (p=0.002), but equivalent to two-stage revision (p=0.777).

Conclusion

DAIR was successful in less than half of patients with Candida PJI. We could not identify any subgroup which might have better outcomes with this surgical option. Interestingly, almost 90% of our patients with Candida PJI had no immunocompromise. One or two-stage revision offer a better option, if possible, and do not increase mortality.