bluuebunny/crossref_metadata_2025 huggingface dataset:
Macromolecular Interactions in Cartilage Extracellular Matrix Vary According to the Cartilage Type and Location
Authors: Rathnayake Manula S. B. , Farrugia Brooke L. , Kulakova Karyna , ter Voert Colet E. M. , van Osch Gerjo J. V. M. , Stok Kathryn S.
Published: March 2021

Objective

To investigate GAG-ECM (glycosaminoglycan–extracellular matrix) interactions in different cartilage types. To achieve this, we first aimed to determine protocols for consistent calculation of GAG content between cartilage types.

Design

Auricular cartilage containing both collagen and elastin was used to determine the effect of lyophilization on GAG depletion activity. Bovine articular, auricular, meniscal, and nasal cartilage plugs were treated using different reagents to selectively remove GAGs. Sulfated glycosaminoglycan (sGAG) remaining in the sample after treatment were measured, and sGAG loss was compared between cartilage types.

Results

The results indicate that dry weight of cartilage should be measured prior to cartilage treatment in order to provide a more accurate reference for normalization. Articular, meniscal, and nasal cartilage lost significant amounts of sGAG for all reagents used. However, only hyaluronidase was able to remove significant amount of sGAG from auricular cartilage. Furthermore, hyaluronidase was able to remove over 99% of sGAG from all cartilage types except auricular cartilage where it only removed around 76% of sGAG. The results indicate GAG-specific ECM binding for different cartilage types and locations.

Conclusions

In conclusion, lyophilization can be performed to determine native dry weight for normalization without affecting the degree of GAG treatment. To our knowledge, this is the first study to compare GAG-ECM interactions of different cartilage types using different GAG extraction methods. Degree of GAG depletion not only varied with cartilage type but also the same type from different anatomic locations. This suggests specific structure-function roles for GAG populations found in the tissues.
Cerebral blood flow changes during aging process and in cognitive disorders: A review
Authors: Mokhber Naghmeh , Shariatzadeh Aidin , Avan Abolfazl , Saber Hamidreza , Babaei Golnaz Shojaeian , Chaimowitz Gary , Azarpazhooh M. Reza
Published: March 2021

We aimed to summarize the available evidence on cerebral blood flow (CBF) changes in normal aging and common cognitive disorders. We searched PubMed for studies on CBF changes in normal aging and cognitive disorders up to 1 January 2019. We summarized the milestones in the history of CBF assessment and reviewed the current evidence on the association between CBF and cognitive changes in normal aging, vascular cognitive impairment (VCI) and Alzheimer’s disease (AD). There is promising evidence regarding the utility of CBF studies in cognition research. Age-related CBF changes could be related to a progressive neuronal loss or diminished activity and synaptic density of neurons in the brain. While a similar cause or outcome theory applies to VCI and AD, it is possible that CBF reduction might precede cognitive decline. Despite the diversity of CBF research findings, its measurement could help early detection of cognitive disorders and also understanding their underlying etiology.
Prevalence of Class I, II and III skeletal relationships and its association with dental anomalies in an ethnic Chinese orthodontic population
Authors: Chan Grace Xiu Ling , Tan Elaine Li Yen , Chew Ming Tak , Wong Hung Chew , Foong Kelvin Weng Chiong , Yow Mimi
Published: March 2021

Objectives:

To investigate the prevalence of skeletal Classes I, II and III in a Chinese orthodontic population, and determine its association with the prevalence of dental anomalies.

Methods:

This retrospective cross-sectional study was conducted on 2508 ethnic Chinese orthodontic patients aged 14 to 25 years who attended the Department of Orthodontics at the National Dental Centre Singapore. Radiographs, photographs and clinical records of the study sample were examined for the prevalence of dental anomalies in the permanent dentition, excluding third molars. The anteroposterior skeletal relationship was determined based on the A point–Nasion–B point angle measured from the lateral cephalogram, whereby Class I: A point–Nasion–B point = 3.6° ± 2.5° (1 standard deviation) that is 1.1° to 6.1°; Class II: A point–Nasion–B point greater than 6.1°; Class III: A point–Nasion–B point less than 1.1°. Logistic regression was used to determine the association between the anteroposterior skeletal relationship and the occurrence of various dental anomalies.

Results:

The prevalence of the anteroposterior skeletal relationship was: 49.5% Class I; 23.1% Class II; and 27.4% Class III. Class III patients had significantly lower odds of impacted teeth compared to Class I patients (odds ratio 0.608, 95% confidence interval 0.463–0.798; P=0.00009). There was no significant difference in the occurrence of the anomalies among the various anteroposterior skeletal types.

Conclusions:

The occurrence of impacted teeth was lower in Class III than Class I, while no significant differences were noted for hyperdontia, hypodontia, peg-shaped upper lateral incisors, transposition and double teeth. The occurrence of all investigated dental anomalies had no significant difference between Class II and Class I.
Supervisors’ Leadership Styles’ Influence on Foreign Teachers’ Self-Efficacy in a Cross-Cultural Work Setting: A Moderated Mediation Analysis
Authors: Gumah Bernard , Wenbin Liu , Aziabah Maxwell Akansina
Published: March 2021

Leadership style impacts on the manner and frequency of feedback transmission. However, communication challenges between superiors and subordinates originate from cultural differences, which undermine the usefulness of feedback. The study tested leadership style’s effect on self-efficacy through a moderated mediation approach, examined through the lens of the cross-cultural adaptation theory. Path analysis conducted on data from 281 foreign teachers in Chengdu, China, revealed that there is a positive effect of Chinese supervisors’ leadership styles on foreign teacher’s self-efficacy. Leadership style similarly has an influence on the nature of feedback. And the nature of feedback in turn mediates leadership style and self-efficacy. We establish in particular that transactional and transformational leadership styles, through the nature of feedback, influence self-efficacy of foreign teachers. Moreover, the association between the nature of feedback and self-efficacy is moderated by the perceived value of feedback. Employees’ perceptions are also found to be crucial in determining the value of feedback. It is thus imperative for supervisors and managers working with foreigners as subordinates to figure out when and how to provide valuable feedback. We conclude with suggested areas for further research.
Risk Stratification of Elderly Patients Undergoing Spinal Surgery Using the Modified Frailty Index
Authors: Kweh Barry Ting Sheen , Lee Hui Qing , Tan Terence , Tew Kim Siong , Leong Ronald , Fitzgerald Mark , Matthew Joseph , Kambourakis Anthony , Liew Susan , Hunn Martin , Tee Jin Wee
Published: March 2021

Study Design:

Retrospective cohort.

Objectives:

To validate the 11-item modified Frailty Index (mFI) as a perioperative risk stratification tool in elderly patients undergoing spine surgery.

Methods:

All consecutive cases of spine surgery in patients aged 65 years or older between July 2016 and June 2018 at a state-wide trauma center were retrospectively reviewed. The primary outcome was post-operative major complication rate (Clavien-Dindo Classification ≥ III). Secondary outcome measures included the rate of all complications, 6-month mortality and surgical site infection.

Results:

A total of 348 cases were identified. The major complication rate was significantly lower in patients with an mFI of 0 compared to ≥ 0.45 (18.3% versus 42.5%, P = .049). As the mFI increased from 0 to ≥ 0.45 there was a stepwise increase in risk of major complications ( P < .001). Additionally, 6-month mortality rate was considerably lower when the mFI was 0 rather than ≥ 0.27 (4.2% versus 20.4%, P = .007). Multivariate analysis demonstrated an mFI ≥ 0.27 was significantly associated with an increased incidence of major complication (OR 2.80, 95% CI 1.46-5.35, P = .002), all complication (OR 2.93, 95% CI 1.70-15.11, P < .001), 6-month mortality (OR 7.39, 95% CI 2.55-21.43, P < .001) and surgical site infection (OR 4.43, 95% CI 1.71-11.51, P = .002). The American Society of Anesthesiologists’ (ASA) index did not share a stepwise relationship with any outcome.

Conclusion:

The mFI is significantly associated in a gradated fashion with increased morbidity and mortality. Patients with an mFI ≥ 0.27 are at greater risk of major complications, all-complications, 6-monthy mortality, and surgical site infection.
Anthropometric study as a predictor of anterior cruciate ligament sizes in Asian Indonesian population
Authors: Pontoh Ludwig AP , Rahyussalim Ahmad Jabir , Widodo Wahyu , Fiolin Jessica , Rhatomy Sholahuddin
Published: March 2021

Objectives:

To evaluate whether anthropometric data can predict anterior cruciate ligament (ACL) sizes on magneti resonance imaging (MRI) in Asian population.

Background:

Reconstruction of ACL has been performed over a decade ago. Recently, more individualized ACL reconstruction is performed taking account of each patient’s ACL characteristics. However, there has been limited study regarding ACL sizes in Asian Indonesian population. This study aimed to evaluate the role of anthropometric data in ACL sizes using MRI in Asian Indonesian population.

Study Design:

Retrospective Study.

Method:

A series of 531 knees from 420 patients with knee pain and intact ACL confirmed by MRI study. Length, width and inclination angle of ACL were measured using a T2-weighted sagittal MRI 3.0 Tesla Magnetom Skyra. Height, weight, body mass index (BMI) and age were recorded. Multiple regression analysis was used to determine relationship between the anthropometric data and size of ACL measurements.

Result:

ACL length and width were significantly different between male and female, consecutively. Mean ACL length was 35.36 ± 3.63 mm, male was significantly longer (36.59 ± 3.24 mm) compared to female (32.77 ± 2.99 mm), p < 0.0001. Mean ACL width was 10.23 ± 1.84 mm, male was significantly wider (10.85 ± 1.59 mm) compared to female (8.93 ± 1.64 mm), p < 0.0001. The mean ACL inclination angle was 47.75° ± 3.07° (range 40.17°–57.12°). The strongest correlation for ACL length was height and weight (r = 0.437; r = 0.341 consecutively, p < 0.0001). Females had stronger correlation compared to males for ACL length (R2 = 0.489 vs R2 = 0.418). ACL width showed weak correlation with anthropometric data. The following regression analysis equation was obtained for ACL length: ACL length = 60.697 − 0.11*age + 0.461*weight (kg) − 16.522*height (meter) − 1.093*BMI (R2 = 0.539; p < 0.0001).

Conclusion:

Anthropometric data can be utilized as a predictor of ACL length in Asian Indonesian population. The ACL length in Asian Indonesian population is shorter than that in Western population study.
Effect of Achilles Tendon Rupture on Player Performance and Longevity in Women’s National Basketball Association Players
Authors: Tramer Joseph S. , Khalil Lafi S. , Buckley Patrick , Ziedas Alexander , Kolowich Patricia A. , Okoroha Kelechi R.
Published: March 2021

Background:

Women’s National Basketball Association (WNBA) players have a greater incidence of lower extremity injury compared with male players, yet no data exist on functional outcomes after Achilles tendon rupture (ATR).

Purpose:

To evaluate the effect of Achilles tendon repair on game utilization, player performance, and career longevity in WNBA athletes.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

WNBA players from 1997 to 2019 with a history of ATR (n = 12) were matched 1:2 to a healthy control group. Player characteristics, game utilization, and in-game performance data were collected for each athlete, from which the player efficiency rating (PER) was calculated. Statistical analysis was performed comparing postinjury data to preinjury baseline as well as cumulative career data. Changes at each time point relative to the preinjury baseline were also compared between groups.

Results:

Of the 12 players with ATR, 10 (83.3%) returned to play at the WNBA level at a mean (±SD) of 12.5 ± 3.3 months. Four players participated in only 1 WNBA season after injury. There were no differences in characteristics between the 10 players who returned to play after injury and the control group. After return to play, the WNBA players demonstrated a significant decrease in game utilization compared with preinjury, playing in 6.0 ± 6.9 fewer games, starting in 12.7 ± 15.4 fewer games, and playing 10.2 ± 9.1 fewer minutes per game ( P < .05 for all). After the index date of injury, the players with Achilles repair played 2.1 ± 1.2 more years in the WNBA, while control players played 5.35 ± 3.2 years ( P < .01) Additionally, the players with Achilles repair had a significant decrease in PER in the year after injury compared with preinjury (7.1 ± 5.3 vs 11.0 ± 4.4; P = .02). The reduction in game utilization and decrease in PER in these players was maintained when compared with the matched controls ( P < .05 for both).

Conclusion:

The majority of WNBA players who sustained ATR were able to return to sport after their injury; however, their career longevity was shorter than that of healthy controls. There was a significant decrease in game utilization and performance in the year after return to play compared with healthy controls.
Changes to Family Caregiving of Older Adults and Adults with Disabilities during COVID-19
Authors: Lightfoot Elizabeth , Yun Heejung , Moone Rajean , Otis Jacob , Suleiman Kamal , Turck Kenneth , Kutzler Courtney
Published: March 2021

The strict restrictions to reduce the spread of COVID-19 have disrupted the lives of many at-risk people and their family caregivers. This study explored how family caregivers perceived that family caregiving had changed during COVID-19 and the strategies they used to cope with these changes. We conducted 52 semi-structured interviews with family caregivers of adults over age 65 or adults with disabilities and analyzed the data through an inductive thematic analysis. Caregivers perceived the largest COVID-19-related caregiving changes to be limited social and physical contacts, changed caregiving tasks, reduced services and supports, and a new focus on vigilance and safety. Caregivers made numerous changes to caregiving, including keeping connected, keeping relatives occupied, getting support and services in new ways, and reducing caregiver stress.
Recovery in occupational health psychology and human resource management research: An Interview with Prof. Sabine Sonnentag and Prof. Ute Stephan
Authors: Sonnentag Sabine , Stephan Ute , Wendsche Johannes , de Bloom Jessica , Syrek Christine , Vahle-Hinz Tim
Published: March 2021

While academic research on recovery was rather segregated between occupational health psychology and management research at the beginning of the 20s century and streams of research developed independently, recent developments hint at a closing divide and better integration of recovery research across disciplines. This for example becomes evident in publications of researchers across the traditional outlets within both fields, as well as increasing close collaborations of researchers firmly rooted in one of the fields. In preparation of this special issue, the editors were interested in whether this development represents a convergence or even a true merging of research in these different disciplines. We therefore interviewed Prof. Sabine Sonnentag as expert from occupational health psychology research and Prof. Ute Stephan with expertise in management research. Both are excellent and world-famous researchers in their disciplines. We discussed the current state, the advances during the last years, and the future directions of recovery research in their respective fields. We also talked about their perspectives on integrative topics and about specific issues in both domains that might stimulate a new recovery management research agenda.
Assessing the impacts of Airbnb listings on London house prices
Authors: Todd James , Musah Anwar , Cheshire James
Published: March 2021

Over the course of the last decade, sharing economy platforms have experienced significant growth within cities around the world. Airbnb, which is one of the largest and best-known platforms, provides the focus for this paper and offers a service that allows users to rent properties or spare rooms to guests. Its rapid growth has led to a growing discourse around the consequences of Airbnb rentals within the local context. The research within this paper focuses on determining impact on local housing prices within the inner London boroughs by constructing a longitudinal panel dataset, on which a fixed and random effects regression was conducted. The results indicate that there is a significant and modest positive association between the frequency of Airbnb and the house price per square metre in these boroughs.
ERS International Congress 2020: highlights from the Paediatric Assembly
Authors: Ardura-Garcia Cristina , Cuevas-Ocaña Sara , Freitag Nadine , Kampouras Asterios , King John A. , Kouis Panayiotis , Mensink-Bout Sara M. , Whitehouse Abigail L. , Williams Emma , Dassios Theodore , Duijts Liesbeth , Ersu Refika H , Gaillard Erol A. , Horsley Alex R. , Proesmans Marijke , Rottier Robbert , Schramm Dirk , Moeller Alexander , Pijnenburg Marielle W.
Published: March 2021

In this review, the Paediatric Assembly of the European Respiratory Society (ERS) presents a summary of the highlights and most relevant findings in the field of paediatric respiratory medicine presented at the virtual ERS International Congress 2020. Early Career Members of the ERS and Chairs of the different Groups comprising the Paediatric Assembly discuss a selection of the presented research. These cover a wide range of research areas, including respiratory physiology and sleep, asthma and allergy, cystic fibrosis, respiratory infection and immunology, neonatology and intensive care, epidemiology, bronchology and lung and airway development. Specifically, we describe the long-term effect in lung function of premature birth, mode of delivery and chronic respiratory conditions such as cystic fibrosis. In paediatric asthma, we present risk factors, phenotypes and their progression with age, and the challenges in diagnosis. We confirm the value of the lung clearance index to detect early lung changes in cystic fibrosis. For bronchiectasis treatment, we highlight the importance of identifying treatable traits. The use of biomarkers and genotypes to identify infants at risk of long-term respiratory morbidity is also discussed. We present the long-term impact on respiratory health of early life and fetal exposures to maternal obesity and intrauterine hypoxia, mechanical ventilation hyperoxia, aeroallergens, air pollution, vitamin A deficient intake and bronchitis. Moreover, we report on the use of metabolomics and genetic analysis to understand the effect of these exposures on lung growth and alveolar development. Finally, we stress the need to establish multidisciplinary teams to treat complex airway pathologies.
Comparison of Modified Mohr–Coulomb Model and Bai–Wierzbicki Model for Constructing 3D Ductile Fracture Envelope of AA6063
Authors: Gao Jianye , He Tao , Huo Yuanming , Song Miao , Yao Tingting , Yang Wanbo
Published: March 2021

Ductile fracture of metal often occurs in the plastic forming process of parts. The establishment of ductile fracture criterion can effectively guide the selection of process parameters and avoid ductile fracture of parts during machining. The 3D ductile fracture envelope of AA6063-T6 was developed to predict and prevent its fracture. Smooth round bar tension tests were performed to characterize the flow stress, and a series of experiments were conducted to characterize the ductile fracture firstly, such as notched round bar tension tests, compression tests and torsion tests. These tests cover a wide range of stress triaxiality (ST) and Lode parameter (LP) to calibrate the ductile fracture criterion. Plasticity modeling was performed, and the predicted results were compared with corresponding experimental data to verify the plasticity model after these experiments. Then the relationship between ductile fracture strain and ST with LP was constructed using the modified Mohr–Coulomb (MMC) model and Bai-Wierzbicki (BW) model to develop the 3D ductile fracture envelope. Finally, two ductile damage models were proposed based on the 3D fracture envelope of AA6063. Through the comparison of the two models, it was found that BW model had better fitting effect, and the sum of squares of residual error of BW model was 0.9901. The two models had relatively large errors in predicting the fracture strain of SRB tensile test and torsion test, but both of the predicting error of both two models were within the acceptable range of 15%. In the process of finite element simulation, the evolution process of ductile fracture can be well simulated by the two models. However, BW model can predict the location of fracture more accurately than MMC model.
Associations between trunk-to-peripheral fat ratio and cardiometabolic risk factors in elderly Japanese men: baseline data from the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study
Authors: Kouda Katsuyasu , Fujita Yuki , Ohara Kumiko , Tachiki Takahiro , Tamaki Junko , Yura Akiko , Moon Jong-Seong , Kajita Etsuko , Uenishi Kazuhiro , Iki Masayuki
Published: March 2021

Background

Body mass-independent parameters might be more appropriate for assessing cardiometabolic abnormalities than weight-dependent indices in Asians who have relatively high visceral adiposity but low body fat. Dual-energy X-ray absorptiometry (DXA)-measured trunk-to-peripheral fat ratio is one such body mass-independent index. However, there are no reports on relationships between DXA-measured regional fat ratio and cardiometabolic risk factors targeting elderly Asian men.

Methods

We analyzed cross-sectional data of 597 elderly men who participated in the baseline survey of the Fujiwara-kyo Osteoporosis Risk in Men (FORMEN) study, a community-based single-center prospective cohort study conducted in Japan. Whole-body fat and regional fat were measured with a DXA scanner. Trunk-to-appendicular fat ratio (TAR) was calculated as trunk fat divided by appendicular fat (sum of arm and leg fat), and trunk-to-leg fat ratio (TLR) as trunk fat divided by leg fat.

Results

Both TAR and TLR in the group of men who used ≥ 1 medication for hypertension, dyslipidemia, or diabetes (“user group”; N = 347) were significantly larger than those who did not use such medication (“non-user group”; N = 250) (P < 0.05). After adjusting for potential confounding factors including whole-body fat, both TAR and TLR were significantly associated with low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglyceride, fasting serum insulin, and the insulin resistance index in the non-user group and non-overweight men in the non-user group (N = 199).

Conclusion

The trunk-to-peripheral fat ratio was associated with cardiometabolic risk factors independently of whole-body fat mass. Parameters of the fat ratio may be useful for assessing cardiometabolic risk factors, particularly in underweight to normal-weight populations.
Correction to: Development of a genetic evaluation for hair shedding in American Angus cattle to improve thermotolerance
Authors: Durbin Harly J. , Lu Duc , Yampara-Iquise Helen , Miller Stephen P. , Decker Jared E.
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article.
Effects of sevoflurane exposure on apoptosis and cell cycle of peripheral blood lymphocytes, and immunologic function
Authors: Ji Zhimin , Wu Wanjun , Zhou Fan , Hu Junfang , Xu Qiuping , Yang Weibin , Peng Xueyong , Wang Xinguo , Zhang Cheng , Li Li
Published: March 2021

Background

Waste anesthetic gases (WAGs) leaked from new-type halogenated inhalational anesthetics such as sevoflurane have been were reported to pose a risk for the health of operating room personnel. The effects of WAGs on peripheral blood lymphocytes, however, remain yet controversial. The present study was undertaken to examine the effects of occupational sevoflurane exposure on the peripheral blood lymphocytes of medical personnel who work in the operating room.

Methods

A cohort of 56 medical residents were divided into exposed group (n = 28) and control group (non-exposed group) (n = 28). Gas chromatography was used to measure the concentration of sevoflurane in the medical resident’s breathing zone during surgeries under inhalation anesthesia in the exposure group. The gas collection lasted an hour. Peripheral blood lymphocytes were isolated from venous blood, and then apoptosis and cell cycle were analyzed by flow cytometry. EDTA-anticoagulated whole blood was harvested to analyze the lymphocyte subsets by flow cytometry. Immunoglobulins (IgA, IgM, IgG) were quantified by immunoturbidimetry.

Results

The average concentration of sevoflurane in the exposed group was 1.03 ppm with a range from 0.03 ppm to 2.24 ppm. No significant effects were found on the apoptosis rates or cell cycles of peripheral blood lymphocytes in the exposed group relative to the control group (P > 0.05). Similarly, there were no significant differences in the lymphocyte subsets or the levels of immunoglobulins (IgA, IgM, IgG) between the two groups (P > 0.05).

Conclusions

Occupational exposure to low-level sevoflurane has no significant effect on the peripheral blood lymphocytes of operating room staff, but this conclusion needs to be confirmed by multicenter and long-term follow-up studies with large samples.

Trial registration number and date of registration

ChiCTR2000040772, December 9, 2020 (Retrospective registration).
Time dependent hazard ratio estimation using instrumental variables without conditioning on an omitted covariate
Authors: MacKenzie Todd A. , Martinez-Camblor Pablo , O’Malley A. James
Published: March 2021

Background

Estimation that employs instrumental variables (IV) can reduce or eliminate bias due to confounding. In observational studies, instruments result from natural experiments such as the effect of clinician preference or geographic distance on treatment selection. In randomized studies the randomization indicator is typically a valid instrument, especially if the study is blinded, e.g. no placebo effect. Estimation via instruments is a highly developed field for linear models but the use of instruments in time-to-event analysis is far from established. Various IV-based estimators of the hazard ratio (HR) from Cox’s regression models have been proposed.

Methods

We extend IV based estimation of Cox’s model beyond proportionality of hazards, and address estimation of a log-linear time dependent hazard ratio and a piecewise constant HR. We estimate the marginal time-dependent hazard ratio unlike other approaches that estimate the hazard ratio conditional on the omitted covariates. We use estimating equations motivated by Martingale representations that resemble the partial likelihood score statistic. We conducted simulations that include the use of copulas to generate potential times-to-event that have a given marginal structural time dependent hazard ratio but are dependent on omitted covariates. We compare our approach to the partial likelihood estimator, and two other IV based approaches. We apply it to estimation of the time dependent hazard ratio for two vascular interventions.

Results

The method performs well in simulations of a stepwise time-dependent hazard ratio, but illustrates some bias that increases as the hazard ratio moves away from unity (the value that typically underlies the null hypothesis). It compares well to other approaches when the hazard ratio is stepwise constant. It also performs well for estimation of a log-linear hazard ratio where no other instrumental variable approaches exist.

Conclusion

The estimating equations we propose for estimating a time-dependent hazard ratio using an IV perform well in simulations. We encourage the use of our procedure for time-dependent hazard ratio estimation when unmeasured confounding is a concern and a suitable instrumental variable exists.
Correction to: Effect of interactive cognitive-motor training on eye-hand coordination and cognitive function in older adults
Authors: Chan Pi-Tuan , Chang Wen-Chi , Chiu Huei-Ling , Kao Ching-Chiu , Liu Doresses , Chu Hsin , Chou Kuei-Ru
Published: March 2021

An amendment to this paper has been published and can be accessed via the original article.
Bittersweet: infective complications of drug-induced glycosuria in patients with diabetes mellitus on SGLT2-inhibitors: two case reports
Authors: Bartolo Caroline , Hall Victoria , Friedman N. Deborah , Lanyon Chloe , Fuller Andrew , Morrissey C. Orla , Athan Eugene
Published: March 2021

Background

Sodium-glucose co-transporter 2 (SGLT2) inhibitors are novel hypoglycemic agents which reduce reabsorption of glucose at the renal proximal tubule, resulting in significant glycosuria and increased risk of genital mycotic infections (GMI). These infections are typically not severe as reported in large systematic reviews and meta-analyses of the medications. These reviews have also demonstrated significant cardiovascular benefits through other mechanisms of action, making them attractive options for the management of Type 2 diabetes mellitus (T2DM). We present two cases with underlying abnormalities of the urogenital tract in which the GMI were complicated and necessitated cessation of the SGLT2 inhibitor.

Case presentations

Both cases are patients with T2DM on empagliflozin, an SGLT2 inhibitor. The first case is a 64 year old man with Candida albicans balanitis and candidemia who was found to have an obstructing renal calculus and prostatic abscess requiring operative management. The second case describes a 72 year old man with Candida glabrata candidemia who was found to have prostatomegaly, balanitis xerotica obliterans with significant urethral stricture and bladder diverticulae. His treatment was more complex due to fluconazole resistance and concerns about urinary tract penetration of other antifungals. Both patients recovered following prolonged courses of antifungal therapy and in both cases the SGLT2 inhibitor was ceased.

Conclusions

Despite their cardiovascular benefits, SGLT2 inhibitors can be associated with complicated fungal infections including candidemia and patients with anatomical abnormalities of the urogenital tract may be more susceptible to these infections as demonstrated in these cases. Clinicians should be aware of their mechanism of action and associated risk of infection and prior to prescription, assessment of urogenital anatomical abnormalities should be performed to identify patients who may be at risk of complicated infection.
Divergences on expected pneumonia cases during the COVID-19 epidemic in Catalonia: a time-series analysis of primary care electronic health records covering about 6 million people
Authors: Coma Ermengol , Méndez-Boo Leonardo , Mora Núria , Guiriguet Carolina , Benítez Mència , Fina Francesc , Fàbregas Mireia , Balló Elisabet , Ramos Francisa , Medina Manuel , Argimon Josep M.
Published: March 2021

Background

Pneumonia is one of the complications of COVID-19. Primary care electronic health records (EHR) have shown the utility as a surveillance system. We therefore analyse the trends of pneumonia during two waves of COVID-19 pandemic in order to use it as a clinical surveillance system and an early indicator of severity.

Methods

Time series analysis of pneumonia cases, from January 2014 to December 2020. We collected pneumonia diagnoses from primary care EHR, a software system covering > 6 million people in Catalonia (Spain). We compared the trend of pneumonia in the season 2019–2020 with that in the previous years. We estimated the expected pneumonia cases with data from 2014 to 2018 using a time series regression adjusted by seasonality and influenza epidemics.

Results

Between 4 March and 5 May 2020, 11,704 excess pneumonia cases (95% CI: 9909 to 13,498) were identified. Previously, we identified an excess from January to March 2020 in the population older than 15 years of 20%. We observed another excess pneumonia period from 22 october to 15 november of 1377 excess cases (95% CI: 665 to 2089). In contrast, we observed two great periods with reductions of pneumonia cases in children, accounting for 131 days and 3534 less pneumonia cases (95% CI, 1005 to 6064) from March to July; and 54 days and 1960 less pneumonia cases (95% CI 917 to 3002) from October to December.

Conclusions

Diagnoses of pneumonia from the EHR could be used as an early and low cost surveillance system to monitor the spread of COVID-19.
Radiomic model for differentiating parotid pleomorphic adenoma from parotid adenolymphoma based on MRI images
Authors: Song Le-le , Chen Shun-jun , Chen Wang , Shi Zhan , Wang Xiao-dong , Song Li-na , Chen Dian-sen
Published: March 2021

Background

Distinguishing parotid pleomorphic adenoma (PPA) from parotid adenolymphoma (PA) is important for precision treatment, but there is a lack of readily available diagnostic methods. In this study, we aimed to explore the diagnostic value of radiomic signatures based on magnetic resonance imaging (MRI) for PPA and PA.

Methods

The clinical characteristic and imaging data were retrospectively collected from 252 cases (126 cases in the training cohort and 76 patients in the validation cohort) in this study. Radiomic features were extracted from MRI scans, including T1-weighted imaging (T1WI) sequences and T2-weighted imaging (T2WI) sequences. The radiomic features from three sequences (T1WI, T2WI and T1WI combined with T2WI) were selected using univariate analysis, LASSO correlation and Spearman correlation. Then, we built six quantitative radiomic models using the selected features through two machine learning methods (multivariable logistic regression, MLR, and support vector machine, SVM). The performances of the six radiomic models were assessed and the diagnostic efficacies of the ideal T1-2WI radiomic model and the clinical model were compared.

Results

The T1-2WI radiomic model using MLR showed optimal discriminatory ability (accuracy = 0.87 and 0.86, F-1 score = 0.88 and 0.86, sensitivity = 0.90 and 0.88, specificity = 0.82 and 0.80, positive predictive value = 0.86 and 0.84, negative predictive value = 0.86 and 0.84 in the training and validation cohorts, respectively) and its calibration was observed to be good (p > 0.05). The area under the curve (AUC) of the T1-2WI radiomic model was significantly better than that of the clinical model for both the training (0.95 vs. 0.67, p < 0.001) and validation (0.90 vs. 0.68, p = 0.001) cohorts.

Conclusions

The T1-2WI radiomic model in our study is complementary to the current knowledge of differential diagnosis for PPA and PA.
Early renal function trajectories, cytomegalovirus serostatus and long-term graft outcomes in kidney transplant recipients
Authors: Law Jonathan P. , Borrows Richard , McNulty David , Sharif Adnan , Ferro Charles J.
Published: March 2021

Background

Improved recognition of factors influencing graft survival has led to better short-term kidney transplant outcomes. However, efforts to prevent long-term graft decline and improve graft survival have seen more modest improvements. The adoption of electronic health records has enabled better recording and identification of donor-recipient factors through the use of modern statistical techniques. We have previously shown in a prevalent renal transplant population that episodes of rapid deterioration are associated with graft loss.

Methods

Estimated glomerular filtration rates (eGFR) between 3 and 27 months after transplantation were collected from 310 kidney transplant recipients. We utilised a Bayesian approach to estimate the most likely eGFR trajectory as a smooth curve from an average of 10,000 Monte Carlo samples. The probability of having an episode of rapid deterioration (decline greater than 5 ml/min/1.73 m2per year in any 1-month period) was calculated. Graft loss and mortality data was collected over a median follow-up period of 8 years. Factors associated with having an episode of rapid deterioration and associations with long-term graft loss were explored.

Results

In multivariable Cox Proportional Hazard analysis, a probability greater than 0.8 of rapid deterioration was associated with long-term death-censored graft loss (Hazard ratio 2.17; 95% Confidence intervals [CI] 1.04–4.55). In separate multivariable logistic regression models, cytomegalovirus (CMV) serostatus donor positive to recipient positive (Odds ratio [OR] 3.82; 95%CI 1.63–8.97), CMV donor positive (OR 2.06; 95%CI 1.15–3.68), and CMV recipient positive (OR 2.03; 95%CI 1.14–3.60) were associated with having a greater than 0.8 probability of an episode of rapid deterioration.

Conclusions

Early episodes of rapid deterioration are associated with long-term death-censored graft loss and are associated with cytomegalovirus seropositivity. Further study is required to better manage these potentially modifiable risks factors and improve long-term graft survival.
Diagnostic accuracy of semiquantitative point of care urine albumin to creatinine ratio and urine dipstick analysis in a primary care resource limited setting in South Africa
Authors:   On behalf of the ARK Consortium, Currin Sean D. , Gondwe Mwawi S. , Mayindi Nokthula B. , Chipungu Shingirai , Khoza Bongekile L. , Tollman Stephen , Fabian June , George Jaya A.
Published: March 2021

Background

The prevalence of chronic kidney disease (CKD) is predicted to rise over the next few decades. In resource-limited settings access to central laboratory services is limited. Point-of-care (POC) urine dipstick testing offers the potential to detect markers of kidney damage (albuminuria) as well as markers of other disease processes. We evaluated the diagnostic accuracy of the semi-quantitative albumin-creatinine ratio (ACR) Sysmex UC-1000 POC urine dipstick system as well as the extent of other abnormal dipstick findings in urine.

Methods

700 participants from a rural area in South Africa were screened for albuminuria. A spot urine sample was used to measure POC and central laboratory ACR. We determined the sensitivity, specificity, positive predictive value and negative predictive value of the POC ACR, and recorded dipstick parameters.

Results

The prevalence of albuminuria was 11.6% (95%CI; 9.3–14.2). Those with albuminuria had higher mean diastolic (82 vs 79 mmHg, p = 0.019) and systolic (133 vs 128 mmHg, p = 0.002) blood pressures and a higher proportion of diabetes mellitus (17.6 vs 4.9%, p < 0.001). The sensitivity of the POC ACR system was 0.79, specificity 0.84, positive predictive value 0.39 and negative predictive value 0.97. The sensitivity improved to 0.80, 0.85, 0.85 and 0.89 in those with elevated blood pressure, diabetes mellitus, HIV positive status, and those 65 years and older, respectively. Abnormalities other than albuminuria were detected in 240 (34.3%) of the samples; 88 (12.6%) were positive for haematuria, 113 (16.1%) for leucocytes, 66 (9.4%) for nitrites and 27 (3.9%) for glycosuria.

Conclusion

Our study shows that POC ACR has good negative predictive value and could be used to rule out albuminuria when screening for CKD. Additionally, a high proportion of participants had other urine abnormalities detected with dipsticks which may reflect kidney disease or co-morbid untreated genitourinary pathology such as urinary tract infections or endemic schistosomiasis with important implications for CKD.
Intensive neurorehabilitation for patients with prolonged disorders of consciousness: protocol of a mixed-methods study focusing on outcomes, ethics and impact
Authors: Sharma-Virk Manju , van Erp Willemijn S. , Lavrijsen Jan C. M. , Koopmans Raymond T. C. M.
Published: March 2021

Background

Prolonged disorders of consciousness (PDOC) are amongst the severest sequelae of acquired brain injury. Evidence regarding epidemiology and rehabilitation outcomes is scarce. These knowledge gaps and psychological distress in families of PDOC patients may complicate clinical decision-making. The complex PDOC care and associated moral dilemmas result in high workload in healthcare professionals.

Since 2019, all PDOC patients in the Netherlands have access to intensive neurorehabilitation up to 2 years post-injury provided by one rehabilitation center and four specialized nursing homes. Systematic monitoring of quantitative rehabilitation data within this novel chain of care is done in a study called DOCTOR. The optimization of tailored PDOC care, however, demands a better understanding of the impact of PDOC on patients, their families and healthcare professionals and their views on rehabilitation outcomes, end-of-life decisions and quality of dying. TheTrueOutcomes ofPDOC(TOPDOC) study aims to gain insight in the qualitative outcomes of PDOC rehabilitation and impact of PDOC on patients, their families and healthcare professionals.

Methods

Nationwide multicenter prospective cohort study in the settings of early and prolonged intensive neurorehabilitation with a two-year follow-up period, involving three study populations: PDOC patients > 16 years, patients’ family members and healthcare professionals involved in PDOC care. Families’ and healthcare professionals’ views on quality of rehabilitation outcomes, end-of-life decisions and dying will be qualitatively assessed using comprehensive questionnaires and in-depth interviews. Ethical dilemmas will be explored by studying moral deliberations. The impact of providing care to PDOC patients on healthcare professionals will be studied in focus groups.

Discussion

To our knowledge, this is the first nationwide study exploring quality of outcomes, end-of-life decisions and dying in PDOC patients and the impact of PDOC in a novel chain of care spanning the first 24 months post-injury in specialized rehabilitation and nursing home settings.

Newly acquired knowledge in TOPDOC concerning quality of outcomes in PDOC rehabilitation, ethical aspects and the impact of PDOC will enrich quantitative epidemiological knowledge and outcomes arising from DOCTOR. Together, these projects will contribute to the optimization of centralized PDOC care providing support to PDOC patients, families and healthcare professionals.
The effect of solution-focused counseling on violence rate and quality of life of pregnant women at risk of domestic violence: a randomized controlled trial
Authors: Dinmohammadi Sepideh , Dadashi Mohsen , Ahmadnia Elahe , Janani Leila , Kharaghani Roghieh
Published: March 2021

Background

Domestic violence during pregnancy as one of the most common social problems and major challenges of health systems can affect the health of the mother and fetus. The study aimed to compare the two groups of intervention based on solution-focused counseling and control in terms of violence and quality of life amounts in women who had experienced domestic violence.

Methods

A randomized controlled trial on 90 pregnant women was blocked into two intervention groups (n = 45) and a control (n = 45). The intervention group received six counseling sessions with a solution-focused approach. Study tool included conflict tactics scale (CTS- 2) and short form health survey (SF-36). The tools were completed once before the intervention and again 6 weeks after the end of the counseling sessions by the participants of both groups. TheP-value less than 0.05 was considered statistically significant.

Results

A total of 82/90 pregnant women were analyzed. The results showed that median and interquartile range (IQR) of physical, psychological and sexual violence significantly decreased in the intervention group than the control group (Ps = 0.001). Moreover, quality of life scores significantly improved in the intervention group compared to the control group (P = 0.001).

Conclusion

Solution-focused counseling could be an effective approach to reduce the amount of violence and increase the quality of life in women exposed to domestic violence.

Trial registration

Iranian Registry of Clinical TrialsIRCT2017040628352N4. Date of registration: August 20th 2017.
Factors and outcomes associated with the induction of labor in referral hospitals of Amhara regional state, Ethiopia: a multicenter study
Authors: Debele Tibeb Zena , Cherkos Endeshaw Admassu , Badi Marta Berta , Anteneh Kiber Temesgen , Demssie Fitsum Wolde , Abdo Abdella Amano , Mihret Muhabaw Shumye
Published: March 2021

Background

Induction of labor is an artificial initiation of uterine contractions after fetal viability with the aim of vaginal delivery prior to the onset of spontaneous labor. Prevalence of induction of labor is increasing worldwide with subsequent increase in failure rate. However, there is limited evidence on labor induction in Ethiopia. Therefore, this study was aimed at assessing the prevalence and associated factors of failed induction of labor among women undergoing induction of labor at referral hospitals of Amhara national regional state, Ethiopia, 2016.

Method

A multicenter cross-sectional study was conducted at referral hospitals found in Amhara national regional state from February 01 to September 30, 2016. Multistage sampling technique was employed to select a total of 484 women who underwent labor induction. Pre-tested structured questionnaires and checklists were used to collect the data. Data were entered into EPI info version 7 and analyzed using SPSS version 20 software. Stepwise Binary Logistic regression model was fitted to identify factors associated with failed induction of labor. The level of significance was determined based on the adjusted odds ratio with 95% confidence interval at the p-value of ≤0.05.

Result

The prevalence of failed induction of labor among women undergoing induction of labor was 31.4% (95% CI: 27.0, 36.0). Failed induction of labor was independently predicted by a Bishop score of ≤5 (AOR = 2.1; 95% CI: 1.3, 3.6), prolonged latent first stage of labor (AOR = 2.0; 95% CI: 1.2, 3.5), induction with oxytocin alone (AOR = 4.2; 95% CI: 2.2, 8.1), nulliparity (ARO = 1.9; 95% CI: 1.2, 2.9), post term pregnancy (AOR = 4.1; 95% CI: 1.8, 9.3) and hypertensive disorder of pregnancy (AOR = 2.4; 95% CI: 1.5, 5.1).

Conclusion

Failed induction of labor was high in the study area compared to the reports of previous studies done in Ethiopia. The majority of the determinants of failed induction of labor were connected with unjustifiable and inconsistent indication of induction of labor. Thus, preparing standardized practical guidelines and preventing unjustifiable case selection may help reduce the current high failure rates.