bluuebunny/crossref_metadata_2025 huggingface dataset:
Successful treatment of pulmonary haemorrhage and acute respiratory distress syndrome caused by fulminant Stenotrophomonas maltophilia respiratory infection in a patient with acute lymphoblastic leukaemia – case report
Authors: Andrei Stefan , Ghiaur Alexandra , Brezeanu Lavinia , Martac Cristina , Nicolau Andreea , Coriu Daniel , Droc Gabriela
Published: September 2020

Background

Stenotrophomonas maltophilia-induced pulmonary haemorrhage is considered a fatal infection among haematological patients. The outcome can be explained by the patients’ immunity status and late diagnosis and treatment.

Case presentation

We present the rare case of successful outcome in a 61-year-old female who developed alveolar haemorrhage and acute respiratory distress syndrome 8 days after a chemotherapy session for her acute lymphoblastic leukaemia, in the context of secondary bone marrow aplasia. Stenotrophomonas maltophilia was isolated in sputum culture. The patient benefitted from early empirical treatment with colistin followed by trimethoprim/sulfamethoxazole, according to the antibiogram. Despite a severe initial clinical presentation in need of mechanical ventilation, neuromuscular blocking agents infusion, and ventilation in prone position, the patient had a favourable outcome and was discharged from intensive care after 26 days.

Conclusions

Stenotrophomonas maltophilia severe pneumonia complicated with pulmonary haemorrhage is not always fatal in haematological patients. Empirical treatment of multidrug-resistant Stenotrophomonas maltophilia in an immunocompromised haematological patient presenting with hemoptysis should be taken into consideration.
Risk of Parkinson’s disease following gout: a population-based retrospective cohort study in Taiwan
Authors: Hu Li-Yu , Yang Albert C. , Lee Shyh-Chyang , You Zi-Hong , Tsai Shih-Jen , Hu Chang-Kuo , Shen Cheng-Che
Published: September 2020

Background

The progressive neurodegenerative disorder Parkinson disease (PD) is well-established as the second most common neurodegenerative disease. Associations between the sequential risk of PD and gout have been addressed in other studies, but findings have been inconclusive. Accordingly, we executed the present study with the purpose of assessing PD risk in patients with gout.

Methods

From Taiwan’s National Health Insurance Research Database, we identified the data of patients newly diagnosed as having gout between January 1, 2000 and December 1, 2000. A cohort of patients without gout, matched for sex and age, was constructed for comparison. Hazard ratios (HRs) and the incidence rate of subsequent PD were calculated for both cohorts and separately for male and female groups. The gout and comparison cohorts consisted of 7900 patients each.

Results

The HR for PD was not significantly higher in the gout cohort compared with the control cohort (HR 1.01, 95% confidence interval [CI], 0.93–1.31, P = .268), even after adjustment for age, urbanization, monthly income, sex, and comorbidities. We did not observe gender differences in the gout–PD association (male: HR 1.01, 95% CI, 0.88–1.36, P = .400; female: HR 1.11, 95% CI, 0.84–1.46, P = .466).

Conclusions

Our study identified that there was no protective effect of gout for the risk of PD in the Taiwanese population.
Efficacy of combination-chemotherapy with pirarubicin, ifosfamide, and etoposide for soft tissue sarcoma: a single-institution retrospective analysis
Authors: Saito Shiro , Aiba Hisaki , Yamada Satoshi , Okamoto Hideki , Hayashi Katsuhiro , Kimura Hiroaki , Miwa Shinji , Otsuka Takanobu , Murakami Hideki
Published: September 2020

Background

The standard chemotherapy regimens for soft tissue sarcoma are doxorubicin-based. This retrospective study aimed to assess the efficacy and safety of pirarubicin, ifosfamide, and etoposide combination therapy for patients with this disease.

Methods

Between 2008 and 2017, 25 patients with soft tissue sarcoma were treated with pirarubicin (30 mg/m2, 2 days), ifosfamide (2 g/m2, 5 days), and etoposide (100 mg/m2, 3 days) every 3 weeks. The primary endpoint was overall response, and the secondary endpoint was adverse events of this regimen.

Results

Responses to this regimen according to RECIST criteria were partial response (n = 9, 36%), stable disease (n = 9, 36%) and progressive disease (n = 7, 28%). During the treatment phase, frequent grade 3 or worse adverse events were hematological toxicities including white blood cell decreases (96%), febrile neutropenia (68%), anemia (68%), and platelet count decreases (48%). No long-term adverse events were reported during the study period.

Conclusion

This regimen was comparable to previously published doxorubicin-based combination chemotherapy in terms of response rate. Although there were no long-lasting adverse events, based on our results, severe hematological toxicity should be considered.
Healthcare worker perceptions of the implementation context surrounding an infection prevention intervention in a Zambian neonatal intensive care unit
Authors: Cowden Carter , Mwananyanda Lawrence , Hamer Davidson H. , Coffin Susan E. , Kapasa Monica L. , Machona Sylvia , Szymczak Julia E.
Published: September 2020

Background

Infants in the neonatal intensive care unit (NICU) are particularly susceptible to healthcare-associated infections (HAIs). NICUs in low- and middle income countries face additional challenges to HAI prevention. There is a need to better understand the role of the implementation context surrounding infection prevention interventions in low- and middle income countries.

Aim

The aim of this study was to identify NICU healthcare worker perceptions of an intervention to reduce bloodstream infections in a large Zambian NICU.

Methods

Semi-structured interviews were conducted with NICU staff during a prospective cohort study examining the impact of an infection prevention bundle on bloodstream infections. Interviews were analyzed using an integrated approach, combining inductive theme generation with an application of the Consolidated Framework for Implementation Research (CFIR).

Results

Interviews were conducted with 17 NICU staff (5 physicians and 12 nurses). Respondents believed the bundle elements were easy to use, well-designed and facilitated improved performance. Four organizational characteristics that facilitated HAI transmission were identified – (1) lack of NICU admission protocols; (2) physical crowding; (3) understaffing; and (4) equipment shortages. Respondents suggested that NICU resource constraints reflected a societal ethos that devalued the medical care of infants. Despite the challenges, respondents were highly motivated to prevent HAIs and believed this was an achievable goal. They enthusiastically welcomed the bundle but expressed serious concern about sustainability following the study.

Conclusions

By eliciting healthcare worker perceptions about the context surrounding an infection prevention intervention, our study identified key organizational and societal factors to inform implementation strategies to achieve sustained improvement.
Prevalence and factors associated with severe depressive symptoms in older west African people living with HIV
Authors: Bernard Charlotte , Font Hélène , Diallo Zélica , Ahonon Richard , Tine Judicaël Malick , N’guessan Abouo Franklin , Tanon Aristophane , Messou Eugène , Seydi Moussa , Dabis François , de Rekeneire Nathalie ,   the IeDEA West Africa Cohort Collaboration, Zannou Marcel Djimon , Poda Armel , Sarfo Fred Stephen , Messou Eugene , Chenal Henri , Minga Kla Albert , Bissagnene Emmanuel , Tanon Aristophane , Seydi Moussa , Patassi Akessiwe Akouda , Koumakpai-Adeothy Sikiratou Adouni , Renner Lorna Awo , N’Gbeche Sylvie Marie , Bosse Clarisse Amani , Kouakou Kouadio , Folquet Madeleine Amorissani , Eboua François Tanoh , Traore Fatoumata Dicko , Takassi Elom , Dabis François , Arrive Elise , Balestre Eric , Becquet Renaud , Bernard Charlotte , Arikawa Shino Chassagne , Doring Alexandra , Jaquet Antoine , Malateste Karen , Rabourdin Elodie , Tiendrebeogo Thierry , Desmonde Sophie , Jesson Julie , Leroy Valeriane , Ekouevi Didier Koumavi , Azani Jean-Claude , Coffie Patrick , Cissé Abdoulaye , Gnepa Guy , Horo Apollinaire , Kouadio Christian , Tchounga Boris
Published: September 2020

Background

Depression is one of the most common psychiatric disorders in people living with HIV (PLHIV). Depression has a negative impact on both mental and physical health and is mainly associated with suboptimal HIV treatment outcomes. To encourage successful aging and the achievement of the 3 × 90 objectives in older PLHIV, the psychological domain must not be neglected. In this context and as data are scarce in West Africa, this study aimed to evaluate the prevalence and the factors associated with severe depressive symptoms in older PLHIV living in this region of the world.

Methods

Data from PLHIV aged ≥50 years and on ART since ≥6 months were collected in three clinics (two in Côte d’Ivoire, one in Senegal) participating in the West Africa International epidemiological Databases to Evaluate AIDS (IeDEA) collaboration. The severity of depressive symptoms was measured using the Center for Epidemiological Studies Depression scale (CES-D), and associated factors were identified using logistic regressions.

Results

The median age of the 334 PLHIV included in the study was 56.7 (53.5–61.1), 57.8% were female, and 87.1% had an undetectable viral load. The prevalence of severe depressive symptoms was 17.9% [95% Confidence Interval (95% CI): 13.8–22.0]. PLHIV with severe depressive symptoms were more likely to be unemployed (adjusted Odd Ratio (aOR) = 2.8; 95% CI: 1.4–5.7), and to be current or former tobacco smokers (aOR = 2.6; 95% CI: 1.3–5.4) but were less likely to be overweight or obese (aOR = 0.4; 95% CI: 0.2–0.8).

Conclusions

The prevalence of severe depressive symptoms is high among older PLHIV living in West Africa. Unemployed PLHIV and tobacco smokers should be seen as vulnerable and in need of additional support. Further studies are needed to describe in more details the reality of the aging experience for PLHIV living in SSA. The integration of screening and management of depression in the standard of care of PLHIV is crucial.
Hospital admissions for non-communicable disease in the UK military and associations with alcohol use and mental health: a data linkage study
Authors: Goodwin L. , Leightley D. , Chui Z. E. , Landau S. , McCrone P. , Hayes R. D. , Jones M. , Wessely S. , Fear N. T.
Published: September 2020

Background

Since the recent conflicts in Iraq and Afghanistan, the short-term focus of military healthcare research has been on the consequences of deployment for mental health and on those wounded or injured in combat. Now that these conflicts have ended for the UK Armed Forces, it is important to consider the longer term physical and mental health consequences, and just as importantly, the links between these. The aims of this study were to determine the most common physical conditions requiring a hospital admission in UK military personnel and whether they were more common in personnel with a mental health condition, smokers, and/or those misusing alcohol compared to those without.

Methods

Data linkage of a prospective UK military cohort study to electronic admitted patient care records for England, Wales and Scotland. Nine thousand nine hundred ninety military personnel completed phase 2 of a military cohort study (56% response rate, data collected from 2007 to 2009), with analyses restricted to 86% of whom provided consent for linkage to healthcare records (n = 8602). Ninety percent were male and the mean age at phase 2 was 36 years. The outcome was physical non communicable diseases (NCDs) requiring a hospital admission which occurred after phase 2 of the cohort when the mental health, smoking and alcohol use exposure variables had been assessed until the end of March 2014.

Results

The most common NCDs requiring a hospital admission were gastrointestinal disorders 5.62% (95% Confidence Intervals (CI) 5.04, 6.19) and joint disorders 5.60% (95% CI 5.02, 6.18). Number of NCDs requiring a hospital admission was significantly higher in those with a common mental disorder (Hazard ratio (HR) 1.40 (95% CI 1.16–1.68), post-traumatic stress disorder (HR 1.78 (95% CI 1.32–2.40)) and in current smokers (HR 1.35 (95% CI 1.12–1.64) compared to those without the disorder, and non-smokers, respectively.

Conclusions

Military personnel with a mental health problem are more likely to have an inpatient hospital admission for NCDs compared to those without, evidencing the clear links between physical and mental health in this population.
Association of nitrite inhalants use and unprotected anal intercourse and HIV/syphilis infection among MSM in China: a systematic review and meta-analysis
Authors: Zhang Yonghui , Bao Rantong , Leuba Sequoia I. , Li Jiaming , Wang Hongyi , Zhang Jing , Chu Zhenxing , Geng Wenqing , Jiang Yongjun , Xu Junjie
Published: September 2020

Background

Nitrite inhalant use is very common among men who have sex with men (MSM) in China. However, there is lack of national representative data on use among Chinese MSM, and the mechanism of how nitrite inhalant use impacts HIV infection in MSM is unclear. This meta-analysis aims to understand the characteristics of Chinese MSM nitrite inhalant users and to determine the associations between nitrite inhalant use and sexual behaviors, the prevalence of HIV, and the prevalence of syphilis.

Methods

We searched PubMed, Web of Science, Chinese National Knowledge Infrastructure, Chinese Wanfang Data, and VIP Chinese Journal Database for relevant literature published from January 1985 to December 2017.

Results

Fifteen eligible studies, with a total of 18,981 Chinese MSM participants, were included. Compared with nitrite inhalant nonusers, users were more likely to be younger, have a higher level of education, and seek sexual partners using the Internet. Nitrite inhalant users were more likely to engage in high-risk sexual behaviors, including condomless anal intercourse (odds ratio [OR] = 1.33), group sex (OR = 2.26), and commercial intercourse (OR = 1.50). Nitrite inhalants users had a higher prevalence of HIV (OR = 1.83), higher prevalence of syphilis (OR = 1.38) and had higher lifetime HIV testing rates (OR = 1.33) compared with nonusers (each p < 0.05).

Conclusions

Nitrite inhalant users have higher HIV and syphilis prevalence by increasing levels of high-risk sexual behaviors. China should expand HIV testing, treatment as prevention (TasP), and Pre-exposure prophylaxis (PrEP) among MSM, especially among nitrite inhalants using MSM, to reduce their risk of HIV infection and transmission.
Invasive pulmonary aspergillosis in immunocompetent patients hospitalised with influenza A-related pneumonia: a multicenter retrospective study
Authors: Chen Liang , Han Xiudi , Li Yanli , Zhang Chunxiao , Xing Xiqian
Published: September 2020

Background

Increasing cases of pulmonary aspergillosis (IPA) in immunocompetent patients with severe influenza have been reported. Howevere, the risk factors for occurence and death are largely unknown.

Methods

Data of hospitalised patients with influenza A-related pneumonia (FluA-p) obtained from five teaching hospitals from 2031 to 2018, were reviewed. Univariate and multivariate logistical regression analyses were performed to determine the risk factors involved in the acquisition and 60-day mortality in IPA patients.

Results

Of the 693 FluA-p patients included in the study, 3.0% (21/693) were IPA patients with a 60-day mortality of 42.9% (9/21). Adjusted for confounders, a Cox proportional hazard model showed that IPA was associated with increased risk for 60-day mortality [hazard ratio (HR)4.336,95% confidence interval (CI)1.191–15.784,p = 0.026] in FluA-p patients. A multivariate logistic regression model confirmed that age (odd ratio (OR)1.147,95% CI1.048–1.225,p = 0.003), systemic corticosteroids use before IPA diagnosis (OR33.773,95% CI5.681–76.764,p <  0.001), leukocytes > 10 × 109/L (OR1.988,95% CI1.028–6.454,p = 0.029) and lymphocytes < 0.8 × 109/L on admission (OR34.813,95% CI1.676–73.006,p = 0.022), were related with the acquisition of IPA. Early neuraminidase inhibitor use (OR0.290,95% CI0.002–0.584,p = 0.021) was associated with a decreased risk for a 60-day mortality in IPA patients.

Conclusions

Our results showed that IPA worsen the clinical outcomes of FluA-p patients. The risk factors for the acquisition and death were helpful for the clinicians in preventing and treating IPA.
The utility of transbronchial rebiopsy for peripheral pulmonary lesions in patients with advanced non-squamous non-small cell lung cancer
Authors: Tateishi Akiko , Matsumoto Yuji , Tanaka Midori , Nakai Toshiyuki , Sasada Shinji , Aoshima Masahiro , Tsuchida Takaaki
Published: September 2020

Background

Patients treated for non-squamous (non-Sq) non-small cell lung cancer (NSCLC) often require repeat biopsies to determine the optimal subsequent treatment. However, the differences between rebiopsy and initial biopsy in terms of their diagnostic yields and their ability to test the molecular profiles using bronchoscopy with radial endobronchial ultrasound guidance in patients with advanced NSCLC remain unclear. Hence, we aimed to compare the diagnostic yields and ability for molecular analyses of rebiopsies with those of initial biopsies.

Methods

We investigated 301 patients with advanced non-Sq NSCLC who underwent radial endobronchial ultrasound-guided transbronchial biopsy (TBB) for peripheral pulmonary lesions (PPLs) between August 2014 and July 2017. Patients were divided into the rebiopsy and initial biopsy groups: the latter referred to the biopsy that determined the definitive diagnosis. The diagnostic yields and ability for molecular analyses were compared between the two groups, and the factors affecting the TBB diagnostic yield were identified using univariate and multivariate analyses.

Results

The diagnostic yields of the rebiopsy and initial biopsy groups were comparable (86.8 and 90.8%, respectively; p = 0.287). Furthermore, 93.0 and 94.0% of the patients in the rebiopsy and initial biopsy groups, respectively, had adequate specimens for gene profiling and mutational analysis (p = 0.765). The factors that increased the diagnostic yield were a positive bronchus sign (p < 0.001) and tumour location within the internal two-thirds of the lungs (p = 0.026).

Conclusions

The PPL diagnostic yield of the rebiopsy group was as high as that of the initial biopsy group. Hence, TBB for PPLs is feasible for patients requiring rebiopsy as well as for those with initial diagnoses. Adequate, high-quality biopsy specimens can be obtained by transbronchial rebiopsy for molecular testing.
Comparison of patient-reported outcomes measurement information system and legacy instruments in multiple domains among older veterans with chronic back pain
Authors: Nayfe Rabih , Chansard Matthieu , Hynan Linda S. , Mortensen Eric M. , Annaswamy Thiru , Fraenkel Liana , Makris Una E.
Published: September 2020

Background

Chronic low back pain (cLBP) results in significant physical, psycho-social and socioeconomic burden. Identifying efficient and reliable patient reported outcome measures is critical for research and clinical purposes. The NIH’s Patient Reported Outcomes Measurement Information System (PROMIS) instruments have not been compared to validated “legacy” instruments in older adults with cLBP. This study evaluates construct (convergent and discriminant) validity and time to complete (TTC) PROMIS as compared to legacy instruments.

Methods

We enrolled older Veterans (age 60+) with cLBP with/without leg pain scheduled for lumbar epidural steroid injections. Subjects completed PROMIS computer adaptive test item banks and corresponding legacy instruments in the following domains: pain intensity, interference, and behavior; functional status; depression and anxiety; fatigue; sleep and social functioning. Convergent and discriminant validity between PROMIS and legacy instruments was evaluated using Spearman rank order correlations; Mann-Whitney U tests compared TTC.

Results

Of the 71 Veterans recruited, the median (IQR) age was 67 (63–71) years old, 94% were men, 76% were White, 17% Black, and 96% were Non-Hispanic. Spearman correlations between PROMIS and legacy instruments showed moderate to very strong convergent validity in all domains (r = 0.4–1.0), except for social functioning and pain behavior (PROMIS Pain Behavior with Fear Avoidance Belief Questionnaire). The total median TTC for all PROMIS items was significantly shorter than legacy items, 8 min 50 s vs 29 min 14 s respectively, p < 0.001.

Conclusions

Given time efficiency of using PROMIS, along with strong construct validity, PROMIS instruments are a practical choice for measuring multidimensional PROs in older Veterans with cLBP for both research and clinical purposes.
Single posterior debridement, interbody fusion, and fixation on patients with continuous multivertebral lumbar spine tuberculosis (CMLSTB)
Authors: Long Weihong , Gong Liqun , Cui Yaqing , Qi Jie , Duan Dapeng , Li Weiwei
Published: September 2020

Background

Patients with continuous multi-vertebral lumbar spine tuberculosis (CMLSTB) were subjected to single posterior debridement, interbody fusion, and fixation to explore their clinical outcomes.

Methods

Sixty-seven CMLSTB patients who underwent single posterior debridement interbody fusion and fixation between January 2008 to December 2017 were studied. The operation time, blood loss, perioperative complication rate, cure rate, Visual Analog Scale (VAS), Oswetry disability index (ODI), Japanese Orthopedic Association (JOA), Erythrocyte Sedimentation Rate (ESR), C-reactive protein (CRP), kyphotic Cobb’s angle and time of interbody fusion were analyzed to understand their therapeutic effects on CMLSTB patients.

Results

The patients were followed up for 20–48 months, with a mean of 24.3 months. The mean operation time was 215.5 min (range, 120–280 min), whereas 818.0 ml of blood was lost (range, 400–1500 ml) with a perioperative complication rate of 6.0% and a cure rate of 95.5%. During the last phase of follow-up, the mean preoperative VAS score (5.7) and ODI (72.0%) decreased significantly to 1.4 (t = 31.4, P<0.01) and 8.4% (t = 48.4, P<0.01), respectively. Alternatively, the mean preoperative ESR and CRP (74.7 mm /h and 69.3 mg/L, respectively) decreased to average values (tESR = 39.7, PESR<0.001; tCRP = 50.2, PCRP<0.001), while the JOA score (13.9) significantly increased to 23.0 (t = − 11.6, P<0.01). The preoperative kyphotic Cobb’s angle (20.5°) decreased to 4.8° after the operation (t = 14.0, P<0.01); however, the kyphotic correction remained intact at the time of follow-up (t = − 0.476, P = 0.635). Furthermore, the mean of interbody fusion time was identified to be 8.8 months (range, 6–16 months).

Conclusion

Single posterior debridement, interbody fusion, and fixation may be one of the surgical choices for the treatment of CMLSTB patients.
Stress, anxiety, self-efficacy, and the meanings that physical therapy students attribute to their experience with an objective structured clinical examination
Authors: Ferreira Érica de Matos Reis , Pinto Rafael Zambelli , Arantes Paula Maria Machado , Vieira Érica Leandro Marciano , Teixeira Antônio Lúcio , Ferreira Fabiane Ribeiro , Vaz Daniela Virgínia
Published: September 2020

Background

Excessive stress and anxiety can impair learning. The objective structured clinical examination (OSCE) is a valuable tool to assess and promote the acquisition of clinical skills. However, significant OSCE-related stress and anxiety are frequently reported. The aim of this study was to investigate the relationships between physiological stress, self-reported levels of anxiety due to an OSCE, self-efficacy, and the meanings that physical therapy students attribute to their experience with the exam.

Design

Concurrent mixed methods study.

Methods

A total of 32 students took part in this study. All were enrolled in the third semester of a 10-semester Physical Therapy Bachelor Program. Salivary cortisol levels, self-reported anxiety (State-Trait Anxiety Inventory, STAI) were measured before the OSCE. Exam scores and self-efficacy ratings were also recorded. Correlations between variables were tested with the Pearson correlation, with ɑ at 0.05. Semi-structured interviews were used to explore the personal perspectives of students. Thematic analysis was used to investigate emergent themes.

Results

Trait anxiety scores were significantly higher than normative values (p < 0.001). A high proportion of students showed high (STAI> 49) state anxiety (37.5%) and trait anxiety (65.6%). Salivary cortisol was not associated anxiety (p > 0.05). Neither stress nor anxiety correlated with OSCE scores. A moderate and significant direct correlation was found for self-efficacy scores and OSCE scores (r = 0.475, p = 0.007). Students reported that confidence had a calming effect and led to better self-perceived performance. They also reported that the OSCE can provide meaningful learning experiences despite being stressful.

Conclusions

A high proportion of our students reported a stable/lingering negative affect. However, neither stress nor anxiety related to OSCE scores. Students’ confidence in their capabilities was correlated with their performance. Their subjective reports suggest that self-confidence may have protected them from the negative effects of stress and anxiety on academic performance.
Challenges and opportunities for telehealth in the management of chronic obstructive pulmonary disease: a qualitative case study in Greece
Authors: Gaveikaite Violeta , Grundstrom Casandra , Winter Stefan , Schonenberg Helen , Isomursu Minna , Chouvarda Ioanna , Maglaveras Nicos
Published: September 2020

Background

Telehealth (TH) was introduced as a promising tool to support integrated care for the management of chronic obstructive pulmonary disease (COPD). It aims at improving self-management and providing remote support for continuous disease management. However, it is often not clear how TH-supported services fit into existing pathways for COPD management. The objective of this study is to uncover where TH can successfully contribute to providing care for COPD patients exemplified in a Greek care pathway. The secondary objective is to identify what conditions need to be considered for successful implementation of TH services.

Methods

Building on a single case study, we used a two-phase approach to identify areas in a Greek COPD care pathway where care services that are recommended in clinical guidelines are currently not implemented (challenges) and areas that are not explicitly recommended in the guidelines but that would benefit from TH services (opportunities). In phase I, we used the care delivery value chain framework to identify the divergence between the clinical guidelines and the actual practice captured by a survey with COPD healthcare professionals. In phase II, we conducted in-depth interviews with the same healthcare professionals based on the discovered divergences. The responses were analyzed with respect to identified opportunities for TH and care pathway challenges.

Results

Our results reveal insights in two areas. First, several areas with challenges were identified: patient education, self-management, medication adherence, physical activity, and comorbidity management. TH opportunities were perceived as offering better bi-directional communication and a tool for reassuring patients. Second, considering the identified challenges and opportunities together with other case context details a set of conditions was extracted that should be fulfilled to implement TH successfully.

Conclusions

The results of this case study provide detailed insights into a care pathway for COPD in Greece. Addressing the identified challenges and opportunities in this pathway is crucial for adopting and implementing service innovations. Therefore, this study contributes to a better understanding of requirements for the successful implementation of integrated TH services in the field of COPD management. Consequently, it may encourage healthcare professionals to implement TH-supported services as part of routine COPD management.
Health care providers’ weight management practices for adolescent obesity and alignment with clinical practice guidelines: a multi-centre, qualitative study
Authors: Kebbe M. , Perez A. , Buchholz A. , Scott S. D. , McHugh T.-L. F. , Dyson M. P. , Ball G.D.C.
Published: September 2020

Background

Clinical practice guidelines (CPGs) include evidence-based recommendations for managing obesity in adolescents. However, information on how health care providers (HCPs) implement these recommendations in day-to-day practice is limited. Our objectives were to explore how HCPs deliver weight management health services to adolescents with obesity and describe the extent to which their reported practices align with recent CPGs for managing pediatric obesity.

Methods

From July 2017 to January 2018, we conducted a qualitative study that used purposeful sampling to recruit HCPs with experience in adolescent weight management from multidisciplinary, pediatric weight management clinics in Edmonton and Ottawa, Canada. Data were collected using audio-recorded focus groups (4–6 participants/group; 60–90 min in length). We applied inductive, semantic thematic analysis and the congruent methodological approach to analyze our data, which included transcripts, field notes, and memos. Qualitative data were compared to recent CPGs for pediatric obesity that were published by the Endocrine Society in 2017. Of the 12 obesity ‘treatment-related’ recommendations, four were directly relevant to the current study.

Results

Data were collected through three focus groups with 16 HCPs (n = 10 Edmonton; n = 6 Ottawa; 94% female; 100% Caucasian), including dietitians, exercise specialists, nurses, pediatricians, psychologists, and social workers. We identified three main themes that we later compared with CPG recommendations, including: (i) discuss realistic expectations regarding weight management (e.g., shift focus from weight to health; explore family cohesiveness; foster delayed vs instant gratification), (ii) personalize weight management (e.g., address personal barriers to change; consider developmental readiness), and (iii) exhibit non-biased attitudes and practices (e.g., de-emphasize individual causes of obesity; avoid making assumptions about lifestyle behaviors based on weight). Based on these qualitative findings, HCPs applied all four CPG recommendations in their practices.

Conclusions

HCPs provided practical insights into what and how they delivered weight management for adolescents, which included operationalizing relevant CPG recommendations in their practices.
Correction to: Value of endometrial echo pattern transformation after hCG trigger in predicting IVF pregnancy outcome: a prospective cohort study
Authors: Hou Zhaojuan , Zhang Qiong , Zhao Jing , Xu Aizhuang , He Aihua , Huang Xi , Xie Shi , Fu Jing , Xiao Lan , Li Yanping
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
The potential role of microvascular pathology in the neurological manifestations of coronavirus infection
Authors: MacLean M. A. , Kamintsky L. , Leck E. D. , Friedman A.
Published: September 2020

Human coronaviruses are highly pathogenic viruses that pose a serious threat to human health. Examples include the severe acute respiratory syndrome outbreak of 2003 (SARS-CoV-1), the Middle East Respiratory Syndrome (MERS-CoV) outbreak of 2012, and the current SARS-CoV-2 (COVID-19) pandemic. Herein, we review the neurological manifestations of coronaviruses and discuss the potential pathogenic role of blood–brain barrier dysfunction. We present the hypothesis that pre-existing vascular damage (due to aging, cardiovascular disease, diabetes, hypertension or other conditions) facilitates infiltration of the virus into the central nervous system (CNS), increasing neuro-inflammation and the likelihood of neurological symptoms. We also discuss the role of a neuroinflammatory cytokine profile in both blood–brain barrier dysfunction and macrovascular disease (e.g. ischemic stroke and thromboembolism). Future studies are needed to better understand the involvement of the microvasculature in coronavirus neuropathology, and to test the diagnostic potential of minimally-invasive screening tools (e.g. serum biomarkers, fluorescein retinal angiography and dynamic-contrast MRI).
The therapeutic effect to eldecalcitol + bisphosphonate is superior to bisphosphonate alone in the treatment of osteoporosis: a meta-analysis
Authors: Zheng Zaoqian , Luo Jinyu
Published: September 2020

Background

Osteoporosis is a metabolic bone disease. Bisphosphonate (BP) and eldecalcitol (ELD) are two clinical first-line drugs for osteoporosis patients. However, the effect of ELD + BP vs. BP alone on osteoporosis treatment is still unclear. The present meta-analysis was conducted to evaluate the different therapeutic effect of BP + ELD vs. BP alone in osteoporosis treatment.

Methods

Eligible documents that selected from online databases including PubMed, Embase, and Cochrane Library were included in this study (updated to March 3, 2020). The quality assessment of the included studies was based on the guidelines of Cochrane. Meta-analysis was performed according to criteria such as intervention plan and outcome. The indicators including bone mineral density (BMD) in all enrolled studies were included in the current analysis. Pooled odds ratios (ORs) and weighted mean differences (WMDs) with 95% confidence intervals (CI) were calculated using fixed- or random-effects models. Then, heterogeneity analysis was performed based on Cochran’s Q test and I2 statistics.

Results

A total of 4 studies (456 cases) with high quality were enrolled in this study. The effect of ELD + BP was superior to BP alone based on indicators including femoral neck BMD (FN-BMD) and total hip BMD (TH-BMD) in patients with followed up ≤ 6 months. Moreover, the effect of ELD + BP was superior to BP alone based on lumbar spine BMD (LS-BMD) in patients with 12 months followed up.

Conclusion

Therapeutic effect of ELD + BP was superior to BP alone in osteoporotic patients based on the influence of BMD.
Optimal surgical methods to treat intertrochanteric fracture: a Bayesian network meta-analysis based on 36 randomized controlled trials
Authors: Cheng Yan-xiao , Sheng Xia
Published: September 2020

Background

There are several surgical methods to treat intertrochanteric fracture: dynamic hip screw (DHS), compression hip screw (CHS), percutaneous compression plate (PCCP), Medoff sliding plate, less invasive stabilization system (LISS), Gamma nail, proximal femoral nail (PFN), and proximal femoral nail anti-rotating (PFNA). We therefore conducted a network meta-analysis to compare eight surgical interventions, including DHS, CHS, PCCP, Medoff sliding plate, LISS, Gamma nail, PFN, and PFNA, to provide the optimal surgical intervention for intertrochanteric fracture.

Methods

An electronic search of 4 databases (PubMed, Embase, Cochrane library, and Web of Science) from inception to July 2020. Two or more of the eight surgical interventions, including the DHS, CHS, PCCP, Medoff sliding plate, LISS, Gamma nail, PFN, and PFNA, for intertrochanteric fracture were included. The methodological quality of the included studies was assessed using the Cochrane Collaboration risk of bias (ROB) tool. Network meta-analysis was conducted by using R-3.5.1 software with the help of package “gemtc”. The odd ratios (ORs) with 95% credibility interval (CrI) were used to assess complications and standard mean difference (SMD) with 95% CrI to calculate the continuous outcomes (operative time, intraoperative blood loss, and Harris hip score). Surfaces under the cumulative ranking curves (SUCRA) were used to rank the intervention.

Results

A total of 36 RCTs were included in this study. The results of this network meta-analysis showed that, compared with the CHS and DHS group, PFNA exhibited a beneficial role in reducing the blood loss (SMD, 152.50; 95% CrI, 72.93 to 232.45; and SMD, 184.40; 95% CrI, 132.99 to 235.90, respectively). PFNA achieved the lowest value for the surface under the cumulative ranking curve (SUCRA) for the blood loss (SURCA = 0.072) and highest of Harris hip score (SURCA = 0.912). PCCP may have the lowest probability of the operative time (SURCA = 0.095). There were no significant differences among the eight surgical procedures in complications.

Conclusion

PFNA technique is the optimal treatment method for intertrochanteric fracture. Larger, longitudinal RCTs addressing current limitations, including sources of bias, inconsistency, and imprecision, are needed to provide more robust and consistent evidence.
Correction to: Bone defect reconstruction with a novel biomaterial containing calcium phosphate and aluminum oxide reinforcement
Authors: Keppler Alexander M. , Saller Maximilian M. , Alberton Paolo , Westphal Ines , Heidenau Frank , Schönitzer Veronika , Böcker Wolfgang , Kammerlander Christian , Schieker Matthias , Aszodi Attila , Neuerburg Carl
Published: September 2020

An amendment to this paper has been published and can be accessed via the original article.
A three-arm, multicenter, open-label randomized controlled trial of hydroxychloroquine and low-dose prednisone to treat recurrent pregnancy loss in women with undifferentiated connective tissue diseases: protocol for the Immunosuppressant regimens for LIving FEtuses (ILIFE) trial
Authors: Yang Shaoying , Ni Ruoning , Lu Yikang , Wang Suli , Xie Feng , Zhang Chunyan , Lu Liangjing
Published: September 2020

Background

Undifferentiated connective tissue disease (UCTD) is known to induce adverse pregnancy outcomes and even recurrent spontaneous abortion (RSA) by placental vascular damage and inflammation activation. Anticoagulation can prevent pregnancy morbidities. However, it is unknown whether the addition of immune suppressants to anticoagulation can prevent spontaneous pregnancy loss in UCTD patients. The purpose of this study is to evaluate the efficacy of hydroxychloroquine (HCQ) and low-dose prednisone on recurrent pregnancy loss for women with UCTD.

Methods

The Immunosuppressant for Living Fetuses (ILIFE) Trial is a three-arm, multicenter, open-label randomized controlled trial with the primary objective of comparing hydroxychloroquine combined with low-dose prednisone and anticoagulation with anticoagulation alone in treating UCTD women with recurrent spontaneous abortion. The third arm of using hydroxychloroquine combined with anticoagulant for secondary comparison. A total of 426 eligible patients will be randomly assigned to each of the three arms with a 1:1:1 allocation ratio. The primary outcome is the rate of live births. Secondary outcomes include adverse pregnancy outcomes and progression of UCTD.

Discussion

This is the first multi-center, open-label, randomized controlled trial which evaluates the efficacy of immunosuppressant regimens on pregnancy outcomes and UCTD progression. It will provide evidence on whether the immunosuppressant ameliorates the pregnancy prognosis in UCTD patients with RSA and the progression into defined connective tissue disease.

Trial registration

ClinicalTrials.govNCT03671174. Registered on 14 September 2018.
A mathematical analysis of a system of Caputo–Fabrizio fractional differential equations for the anthrax disease model in animals
Authors: Rezapour Shahram , Etemad Sina , Mohammadi Hakimeh
Published: September 2020

We study a fractional-order model for the anthrax disease between animals based on the Caputo–Fabrizio derivative. First, we derive an existence criterion of solutions for the proposed fractional$\mathcal {CF}$CF-system of the anthrax disease model by utilizing the Picard–Lindelof technique. By obtaining the basic reproduction number$\mathcal{R}_{0}$R0of the fractional$\mathcal{CF}$CF-system we compute two disease-free and endemic equilibrium points and check the asymptotic stability property. Moreover, by applying an iterative approach based on the Sumudu transform we investigate the stability of the fractional$\mathcal{CF}$CF-system. We obtain approximate series solutions of this system by means of the homotopy analysis transform method, in which we invoke the linear Laplace transform. Finally, after the convergence analysis of the numerical method HATM, we present a numerical simulation of the$\mathcal{CF}$CF-fractional anthrax disease model and review the dynamical behavior of the solutions of this$\mathcal {CF}$CF-system during a time interval.
Sorption of urea hydrogen peroxide by co-pyrolysed bone meal and cow dung slowed-down phosphorus and nitrogen releases but boosted agronomic efficiency
Authors: Luyima Deogratius , Sung Jwakyung , Lee Jae-Han , Woo Seong-Ah , Park Seong-Jin , Oh Taek-Keun
Published: September 2020

Co-pyrolysis of animal manure biomass with bone meal (BM) and soaking of the resultant biochar in urea containing solutions may offer a sustainable and cheap way of formulating slow-release nitrogen (N) and phosphorus (P) fertilisers. This method can lead to optimisation of the carbon sequestration capacity of the biochar, abatement of environmental pollution by P and N and alleviation of the severity of the projected future scarcity of P. A few studies have indicated that sorption can create efficient slow-release fertilisers although all of them utilised charged moieties such as ammonium ions to formulate them and as a result, there is a paucity of data concerning the efficiency of fertilisers formulated using uncharged compounds like urea. It’s against that background that we examined the possibility of leveraging co-pyrolysis and sorption with urea containing solutions to formulate slow-release N and P fertilisers along with assessing the agronomic efficiency of the formulated fertilisers through cultivating lettuce in pots for two seasons. Both urea-hydrogen peroxide (UHP) and urea were utilised as N sources. UHP (CDBM-UHP) and urea (CDBM-Urea) containing biochars averagely released 64.40% and 87.00% of the added N, respectively over the 28-day incubation period with the amount of N released decreasing with increasing concentrations of BM in the biochar. Lettuce yields and nutrient use efficiencies of N and P were higher in the CDBM-UHP than in the CDBM-Urea treatments. It’s therefore clear that sorption of UHP by BM containing biochar concomitantly slows-down releases of N and P and boosts the agronomic efficiency of the fertilisers.
Assessment of genetic risk for improved clinical-neuropathological correlations
Authors: Spencer Barbara E. , Jennings Robin G. , Fan Chun C. , Brewer James B.
Published: September 2020

In the clinical diagnosis of dementia with Lewy bodies, distinction from Alzheimer’s disease is suboptimal and complicated by shared genetic risk factors and frequent co-pathology. In the present study we tested the ability of polygenic scores for Alzheimer’s disease, dementia with Lewy bodies, and Parkinson’s disease to differentiate individuals in a 2713-participant, pathologically defined sample. A dementia with Lewy bodies polygenic score that excluded apolipoprotein E due to its overlap with Alzheimer’s disease risk was specifically associated with at least limbic (transitional) Lewy-related pathology and a pathological diagnosis of dementia with Lewy bodies. An Alzheimer’s disease polygenic score was associated with neuritic plaques and neurofibrillary tangles but not Lewy-related pathology, and was most strongly associated with an Alzheimer’s pathological diagnosis. Our results indicate that an assessment of genetic risk may be useful to clinically distinguish between Alzheimer’s disease and dementia with Lewy bodies. Notably, we found no association with a Parkinson’s disease polygenic score, which aligns with evidence that dementia with Lewy bodies has a distinct genetic signature that can be exploited to improve clinical diagnoses.
Managing intra-articular deformity in high Tibial osteotomy: a narrative review
Authors: Micicoi Grégoire , Khakha Raghbir , Kley Kristian , Wilson Adrian , Cerciello Simone , Ollivier Matthieu
Published: September 2020

The joint line convergence angle (JLCA) has a normal range between 0° to 2°, which increases in magnitude depending on the severity and stage of osteoarthritis in the knee.

The JLCA represents the interaction of the intra-articular deformity arising from the osteoarthritis and the surrounding soft tissue laxity. Therefore, the JLCA has become a vital parameter in analysing the long leg alignment views for corrective planning before osteotomy surgery. Recent studies have considered the influence on how the preoperative JLCA is measured and its influence on achieving accurate postoperative desired correction in high tibial osteotomy surgery.

The JLCA also reflects the influence of soft tissue laxity in a lower limb malalignment and many surgeons encourage it to be taken into account to avoid non physiological correction and/or overcorrection with negatively impacted postoperative patient outcome.

This present review addressed how to obtain an accurate preoperative measurement of the JLCA, its influence on postoperative deformity analysis and how to reduce errors arising from an elevated preoperative JLCA.

We have proposed a formula to help determine the value to subtract from the planned correction in order to avoid an overcorrection when performing a corrective osteotomy.

Level of clinical evidence IV, narrative review.
LncRNA SNHG14 promotes OGD/R-induced neuron injury by inducing excessive mitophagy via miR-182-5p/BINP3 axis in HT22 mouse hippocampal neuronal cells
Authors: Deng Zexiang , Ou Hao , Ren Fei , Guan Yujiao , Huan Ye , Cai Hongwei , Sun Bei
Published: September 2020

Background

Long non-coding RNA (lncRNA) small nucleolar RNA host gene 14 (SNHG14) is associated with cerebral ischemia–reperfusion (CI/R) injury. This work aims to explore the role of SNHG14 in CI/R injury.

Methods

HT22 (mouse hippocampal neuronal cells) cell model was established by oxygen–glucose deprivation/reoxygenation (OGD/R) treatment. The interaction among SNHG14, miR-182-5p and BNIP3 was verified by luciferase reporter assay. Flow cytometry, western blot and quantitative real-time PCR were performed to examine apoptosis, the expression of genes and proteins.

Results

SNHG14 and BNIP3 were highly expressed, and miR-182-5p was down-regulated in the OGD/R-induced HT22 cells. OGD/R-induced HT22 cells exhibited an increase in apoptosis. SNHG14 overexpression promoted apoptosis and the expression of cleaved-caspase-3 and cleaved-caspase-9 in the OGD/R-induced HT22 cells. Moreover, SNHG14 up-regulation enhanced the expression of BNIP3, Beclin-1, and LC3II/LC3I in the OGD/R-induced HT22 cells. Furthermore, SNHG14 regulated BNIP3 expression by sponging miR-182-5p. MiR-182-5p overexpression or BNIP3 knockdown repressed apoptosis in OGD/R-induced HT22 cells, which was abolished by SNHG14 up-regulation.

Conclusion

Our study demonstrates that lncRNA SNHG14 promotes OGD/R-induced neuron injury by inducing excessive mitophagy via miR-182-5p/BINP3 axis in HT22 mouse hippocampal neuronal cells. Thus, SNHG14/miR-182-5p/BINP3 axis may be a valuable target for CI/R injury therapies.