bluuebunny/crossref_metadata_2025 huggingface dataset:
3D-printing for the precision assessment of a new medical device
Authors: COSMI Francesca , MASO Alberto DAL , ZATTA Giorgio
Published: September 2021

Additive manufacturing played a keyrole in investigating the precision of a recently-developed device that measures the elastic characteristics of the trabecular bone by simulating the application of loads on a virtual biopsy obtained from radiographic images of the proximal epiphyses in the patient’s hand fingers. The simulation results are combined in a Bone Structure Index (BSI), which has shown to be able to detect trabecular bone alterations due to osteoporosis or other pathological situations. In order to obtain a large number of measurements without having voluntary patients undergo unnecessary radiations, the precision assessment tests were carried out on a 3D-printed phantom hand, in which different mimicked trabecular structures (chips) were inserted. Each mimicked bone had a unique internal structure and density and was 3D-printed using radiopaque composite materials. Fifteen different chips were additively manufactured; 20 measurements were performed on each chip. BSI and BSI_T-score precision values were computed according to ISO 5725 and ISCD standards. For all the chips, no relationship was found between the mean [Formula: see text] and standard deviation [Formula: see text] of the measurements in each chip. The range of the 95% confidence interval ([Formula: see text]) was computed assuming the repeatability standard deviation [Formula: see text] as the known standard deviation of the measurement method (average of [Formula: see text] values): [Formula: see text], corresponding to [Formula: see text]. Least Significant Change was evaluated as well: [Formula: see text], corresponding to [Formula: see text]. The 95% confidence intervals are small when compared to the commonly-accepted diagnostic values, where a patient is classified as osteoporotic if T-score < −2.5, non-osteoporotic if T-score > -1 and osteopoenic if -2.5 < T-score < -1. The LSC results are in line with the requirements for the gold-standard osteoporosis diagnostic systems. Additive manufacturing made it possible to avoid irradiation of humans in this precision assessment.
Effects of dry turning parameters of Incoloy 800H superalloy using Taguchi-based Grey relational analysis and modeling by response surface methodology
Authors: Palanisamy A , Jeyaprakash N , Sivabharathi V , Sivasankaran S
Published: September 2021

Incoloy 800H is an austenitic Fe-Ni-Cr based superalloy and used in many applications due to their high corrosion resistance and creep-strength. However, this alloy is difficult to machine or cut material because of their eminent characteristics such as rapid-work hardening, lesser thermal conductivity and easy to tool-material attraction. Hence, the necessary experimental investigation is required to study and optimize the turning parameters of this alloy. This work presents the investigation of turning parameter effects on the Incoloy 800H superalloy with cryogenically treated cutting tool. The dry turning experiments were conducted based on Taguchi L9 Orthogonal array (OA) with the input parameters of cutting speed, feed rate and depth of cut. The outputs such as material removal rate, surface roughness, cutting force and tool-tip temperature were considered as the responses. The measured output responses were optimized and modeled using Taguchi-based Grey relational analysis (GRA) and response surface methodology (RSM), respectively. The tool flank wear and tool life were examined on coated insert with cryogenically treated, coated insert (without cryogenic treatment) and uncoated insert for comparison. The results revealed that greater amount of tool-wear reduction was observed in the case of coated tool with-cryogenically treated about 47.88%, coated tool without-cryogenically treated about 27.51% when compared with an uncoated tool. Besides, analysis of variance (ANOVA) was performed to find the most significant parameter over the obtained responses. The obtained mathematical model through RSM was agreed with the experimental result. Further, the machined surface topography was examined using White Light Interferometer (WLI).
Simulation of softening in high pressure torsion process using continuum damage mechanics model
Authors: Katiyar Shubhi , Dixit Prakash Mahadeo
Published: September 2021

Severe Plastic Deformations (SPD) processes are used for grain refinement without any loss in ductility. Among various SPD processes, High Pressure Torsion (HPT) is extensively used in industries due to generation of high angle grain boundaries and cost effectiveness. Very little work has been reported on the numerical analysis of softening with recovery that might occur in a work-piece undergoing HPT. The present work is an attempt to study the softening behaviour in HPT processed mild steel and aluminium alloy using the Lemaitre’s continuum damage mechanics (CDM) model. This model is implemented in ABAQUS/Explicit through a user defined material model subroutine (VUMAT). A parametric study is carried out to study the effect on softening of various parameters like the compressive load, the friction at the die-workpiece interface, and the height to diameter ratio. Information about the softening with recovery provides an insight into the hardness and microstructure homogeneity in HPT processed work-piece, which is useful in the design of HPT process.
Benefit of Belatacept in Cord Blood-Derived Regulatory T Cell-Mediated Suppression of Alloimmune Response
Authors: He Xing , Li Sang , Zhang Juan , Cao Lu , Yang Cejun , Rong Pengfei , Yi Shounan , Ghimire Kedar , Ma Xiaoqian , Wang Wei
Published: September 2021

The role of Regulatory T cells (Tregs) in tolerance induction post-transplantation is well-established, but Tregs adoptive transfer alone without combined immunosuppressants have failed so far in achieving clinical outcomes. Here we applied a set of well-designed criteria to test the influence of commonly used immunosuppressants (belatacept, tacrolimus, and mycophenolate) on cord blood-derived Tregs (CB-Tregs). Our study shows that while none of these immunosuppressants modulated the stability and expression of homing molecules by CB-Tregs, belatacept met all other selective criteria, shown by its ability to enhance CB-Tregs-mediated in vitro suppression of the allogeneic response without affecting their viability, proliferation, mitochondrial metabolism and expression of functional markers. In contrast, treatment with tacrolimus or mycophenolate led to reduced expression of functional molecule GITR in CB-Tregs, impaired their viability, proliferation and mitochondrial metabolism. These findings indicate that belatacept could be considered as a candidate in Tregs-based clinical immunomodulation regimens to induce transplant tolerance.
The development of National Safety and Quality Digital Mental Health Standards
Authors: Brown Peggy , Prest Ben , Miles Paul , Rossi Vanessa
Published: September 2021

Objective:

Digital mental health services offer innovative ways for individuals to access services but are not without risk. Our objective was to develop National Safety and Quality Digital Mental Health (NSQDMH) Standards that improve the quality of digital mental health service provision and protect service users from harm.

Method:

The NSQDMH Standards were developed by adapting the National Safety and Quality Health Service (NSQHS) Standards and adding components highlighted through a national consultation process as critical to the safety and quality of services. Further public consultation and pilot testing assisted in refining the NSQDMH Standards.

Results:

The NSQDMH Standards comprise three standards—Clinical and Technical Governance, Partnering with Consumers, and Model of Care—and were launched in November 2020.

Conclusions:

The NSQDMH Standards provide a quality assurance mechanism to improve digital mental health care in Australia.
Social Determinants of Health May Predict End of Life Portable Orders for Life Sustaining Treatment Form Completion and Treatment Selections
Authors: Gievers Ladawna , Khaki Sheevaun , Dotson Abby , Chen Zunqiu , Macauley Robert C. , Tolle Susan
Published: September 2021

Background:

End of life (EOL) care planning is important for aging adults given the growing prevalence of chronic medical conditions in the US. The Portable Orders for Life Sustaining Treatment (POLST) program promotes communication between clinicians and patients with advanced illness about EOL treatment preferences. Despite growing resources for EOL care, utilization remains unequal based on social determinants of health (SDOH), including race, language, urbanization, and education. We evaluated the relationship between POLST form selections and completion rates and SDOH.

Methods:

Oregon POLST Registry and American Community Survey data from 2013 to 2017 were analyzed retrospectively. POLST form completion rates and selections, and various SDOH, including age, income, insurance status, urbanization, etc. were recorded. Data were merged based on ZIP codes and analyzed using χ2 or Wilcoxon-Mann-Whitney tests. Logistic regression was performed.

Results:

127,588 POLST forms from 319 ZIP codes were included. POLST form completion rates were highest among urban ZIP codes, and urban registrants more often selected CPR and full treatment. ZIP codes with higher incomes tended to select CPR. ZIP codes with higher rates of private insurance completed POLST forms, and selected CPR and full treatment more frequently. ZIP codes with higher rates of Bachelor’s degrees (or higher) completed POLST forms and selected full treatment more frequently.

Conclusions:

Various SDOH-specifically, urbanization, insurance status, income level and educational level achieved-may influence POLST form completion rates and selections. The expanding socioeconomic diversity and growth of urban communities, highlight the need for broader access to EOL planning and POLST.
Impact of Surgical Margin Status on Survival in Gastric Cancer: A Systematic Review and Meta-Analysis
Authors: Jiang Zhiyuan , Liu Chunyu , Cai Zhaolun , Shen Chaoyong , Yin Yuan , Yin Xiaonan , Zhao Zhou , Mu Mingchun , Yin Yiqiong , Zhang Bo
Published: September 2021

Background

It is inconclusive whether R1 margin determined by postoperative pathological examination indicates worse long-term survival in gastric cancer (GC) patients after curative intent resection (CIR). Hence, we aimed to systematically pool the conflicting evidence to fill this gap.

Methods

The present study was performed according to the published protocol and Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Published studies examining the impact of microscopic margin status on overall survival (OS) and 5-year OS rate in GC were systematically searched in PubMed, Embase, and Cochrane Library databases. RevMan 5.3 was used to conduct statistical analysis, and the Grading of Recommendations, Assessment, Development, and Evaluations approach was used to assess the certainty of evidence for each outcome.

Results

Twenty-three retrospective cohort studies including 19 992 patients were analyzed. The pooled hazard ratio for OS of 14 studies was 2.06 (95% confidence interval [CI]: 1.61–2.65, low certainty), indicating that R1 margin predicted inferior OS. Subgroup and sensitivity analyses upheld the statistical stability of this finding. The pooled odds ratio (OR) of 14 studies was .21 (95% CI: .17–.26, moderate certainty), demonstrating that the presence of R1 margins was associated with a poorer 5-year OS rate. Sensitivity analyses and most of the subgroup analyses confirmed this finding, except the “esophagogastric junction (EGJ) cancers” subgroup, which included two studies with a pooled OR of .41 (95% CI: .10–1.61).

Conclusion

R1 margin detected by pathological examination might exhibit a high correlation with poorer OS and 5-year OS rate in GC (except EGJ cancers) patients who underwent CIR. To figure out the effect of R1 margin on survival of different stages and histological types need prospective studies with large sample sizes and standardized methods. What is the best treatment for R1 margin patients also need more in-depth and special research.
Paper, glass, algorithm: teleprompters and the invisibility of screens
Authors: Alexander Neta , Keren Tali
Published: September 2021

The teleprompter, invented in 1948 as a memory aid for show business, has become a ubiquitous technology in modern politics. Yet, the hidden ways in which this device shapes our understanding of performance, newscasting, and political rhetoric are rarely studied by media scholars. Recognizing this lacuna, this article traces the evolution of the teleprompter from a cumbersome, human-operated device to an invisible system of screens designed to conceal its own existence. The teleprompter has not only shaped the standardization of speech, but also restructured the televised spectacle by collapsing the sonic, the tactile, and the optical. By focusing on teleprompter fiascos and moments of breakdown from President Eisenhower to President Trump, we make a broader argument regarding the importance of failure and the accidental to the study of visual culture.
Vessel Diameter Evaluated by Intravascular Ultrasound Versus Angiography
Authors: Iida Osamu , Takahara Mitsuyoshi , Soga Yoshimitsu , Fujihara Masahiko , Kawasaki Daizo , Hirano Keisuke , Choi Donghoon , Mano Toshiaki
Published: September 2021

Purpose:

Although reference vessel diameter (RVD) is conveniently measured by angiography during femoropopliteal (FP) endovascular therapy (EVT) in clinical practice, angiography will potentially underestimate RVD. On the other hand, intravascular ultrasound (IVUS) can measure RVD precisely. The aim of this study was to reveal the difference between angiography- and IVUS-assessed RVD in patients undergoing FP-EVT for symptomatic peripheral artery disease (PAD).

Methods:

We analyzed a prospective and multicenter database including 1967 limbs of 1725 patients with symptomatic PAD undergoing IVUS-supported FP-EVT. The study outcome measure was the difference between IVUS- and angiography-assessed distal RVD ( ΔRVD), calculated as angiography-assessed RVD subtracted from IVUS-assessed RVD. The clinically important difference was defined as 1 mm or larger.

Results:

IVUS-assessed RVD was significantly larger than angiography-assessed RVD (6.0±1.0 mm vs 5.0±1.0 mm; p<0.001). Mean ΔRVD (IVUS- minus angiography-assessed RVD) was 0.98 mm (95% CI, 0.94–1.03 mm). ΔRVD was 1 mm or larger in 48.8% (46.5%–51.0%) of the whole population. Multivariate analysis demonstrated that small angiography-assessed RVD, angiography-assessed bilateral calcification, and history of stent implantation were significantly associated with an increasing risk of ΔRVD ≥1mm, whereas presence of chronic total occlusion (CTO) was significantly associated with a decreasing risk of ΔRVD ≥1 mm.

Conclusion:

The current study revealed the difference between angiography-assessed reference lumen diameter and IVUS-assessed reference EEM diameter of FP lesions. About half of population had ΔRVD ≥1 mm. IVUS-assessed RVD was more likely to be different by angiography in cases with small vessels, CTO, bilateral calcification, and history of stent implantation.
Comparative Bioavailability and Pharmacokinetics Between the Solid Form of Metformin vs a Novel Liquid Extemporaneous Formulation in Children
Authors: Alemón-Medina Radamés , Altamirano-Bustamante Nelly , Lugo-Goytia Gustavo , García-Álvarez Raquel , Rivera-Espinosa Liliana , Torres-Espíndola Luz María , Chávez-Pacheco Juan Luis , Juárez-Olguín Hugo , Gómez-Garduño Josefina , Flores-Pérez Carmen , Fernández-Pérez Paola Gabriela
Published: September 2021

Metformin pharmacokinetics in a liquid extemporaneous formulation from commercial tablets was determined in paediatric patients. A randomized, transversal clinical trial was conducted in 34 children and adolescents between 7 and 17 years of age. 17 children were randomized to take metformin in the liquid formulation and, after a 1-week wash period, a 500 mg metformin tablet was administered to them. Blood samples were obtained in Whatman 903® cards at 0, 1, 2, 4, 8, 12 and 24 hours. Extraction was made by direct precipitation with acetonitrile (ACN) and methanol, detection by UPLC and tandem mass spectrometry. The method was accurate, precise, selective and linear from 50 to 1000 ng/mL (r = .9982). Comparative pharmacokinetics, tablet vs formulation, were as follows: Cmax1503.2 ng/mL vs 1521.4, Tmax1.5 h vs 2.3, and half-life 8.2 vs 7.5 h. The liquid formulation of metformin showed similar pharmacokinetics to the tablet, and the ratios (90% CI) of geometric mean for metformin were 100.63% (89.13–113.6), 98.08% (88.04–109.2), and 97.52% (84.9–112.01), for Cmax, AUC0-t, and AUC 0-∞, respectively. Pharmacokinetics was determined using WinNonlin Pro 3.1 software. The liquid formulation of metformin showed similar pharmacokinetics to the tablet, allowing a more precise dose adjustment and ease of administration.
Posterior circulation collateral flow modifies the effect of thrombectomy on outcome in acute basilar artery occlusion
Authors: Broocks Gabriel , Faizy Tobias D , Meyer Lukas , Groffmann Maximilian , Elsayed Sarah , Kniep Helge , Flottmann Fabian , Bechstein Matthias , Rusche Thilo , Schön Gerhard , Nawabi Jawed , Sporns Peter , Fiehler Jens , Kemmling Andre , Hanning Uta
Published: September 2021

Background

In basilar artery occlusion stroke, the impact of the collateral circulation on infarct progression in the context of endovascular treatment is yet poorly studied.

Aim

This study investigates the impact of the posterior circulation collateral score (PCCS) on functional outcome according to the extent of early ischemic changes and treatment. We hypothesized that the presence of collaterals, quantified by the PCCS, mediates the effect of endovascular treatment on functional outcome in patients with acute basilar artery occlusion.

Methods

In this multicenter observational study, patients with basilar artery occlusion and admission computed tomography were analyzed. At baseline, Posterior circulation Acute Stroke Prognosis Early Computed Tomography score (pcASPECTS) was assessed and PCCS was quantified using an established 10-point grading system. Logistic regression analyses were performed to identify factors associated with good functional outcome (modified Rankin Scale scores 0–2 at day 90).

Results

A total of 151 patients were included, of which 112 patients (74%) underwent endovascular treatment. In patients with a better PCCS (>5), the rate of good outcome was significantly higher (55% vs. 11%; p = 0.001). After adjusting for PCCS, vessel recanalization was significantly associated with improved functional outcome (aOR: 4.53, 95%CI: 1.25–16.4, p = 0.02), while there was no association between recanalization status and outcome in univariable analysis. Patients with low pcASPECTS generally showed very poor outcomes (mean modified Rankin Scale score 5.3, 95%CI: 4.9–5.8).

Conclusion

PCCS modified the effect of recanalization on functional outcome, particularly in patients with less pronounced ischemic changes in admission computed tomography. These results should be validated to improve patient selection for endovascular treatment in basilar artery occlusion, particularly in uncertain indications, or to triage patients at risk for very poor outcomes.
Isolation and Identification of Cyclooctasulfur From the Octocoral Sinularia humilis (van Ofwegen, 2008)
Authors: Zeng Jhao-Syuan , Liu Yi-Hung , Yang San-Nan , Chien Su-Ying , Wen Zhi-Hong , Liu Hsin-Tzu , Tsai Yu-Chi , Sung Ping-Jyun
Published: September 2021

Chemical examination of the octocoral Sinularia humilis, collected in the waters of Taiwan, led to the isolation of S8 (1). Its structure was determined by a single-crystal x-ray diffraction analysis and this is the first time that S8 has been reported from a marine invertebrate.
Safety profile of GreenLight XPS laser photoselective vaporisation of the prostate in patients at high risk of bleeding
Authors: Waters Darragh K , Khalid Raihan , Mustafa Fatalla , Omeire Frederick , Jones Barry J
Published: September 2021

Objective:

This study aimed to assess the utility and safety profile of the GreenLight Xcelerated Performance System (XPS) photoselective vaporisation of the prostate (PVP) to treat benign prostatic hyperplasia (BPH) in high-risk patients.

Patients and methods:

A retrospective study of a prospectively managed database was carried out. The study reviewed a single surgeon’s experience of treating high-risk patients with GreenLight XPS PVP between two sites over a four-year period. Patients considered to be high risk were those who were at an increased risk of bleeding, those who had a prostate size >80 mL, those with preoperative urinary retention and/or those aged >80 years.

Results:

In total, 374 patients were identified as being high risk for GreenLight PVP. Patient age ranged from 44 to 96 years ( Mage=71 years). Of the 374 patients, 103 were aged >80 years. All 374 patients were considered to be at an increased risk of bleeding, as they underwent GreenLight PVP while taking antiplatelet agents (not including aspirin), anticoagulant agents or both. Ninety-one patients had preoperative urinary retention and indwelling urinary catheter. Fifty-four patients had a prostate size >80 mL. Length of stay varied from 1 to 14 days. Most patients ( n=270) were discharged on postoperative day 1. There were no perioperative blood transfusions. One patient developed acute coronary syndrome on postoperative day 4, requiring percutaneous coronary intervention. Twenty-two patients required readmission: 12 due to urinary retention with or without haematuria, and 10 due to haematuria without associated acute retention. Two patients required cystoscopy and bladder washout. There were two blood transfusions in the ‘readmission due to haematuria’ group. Outcomes for patients aged >80 years were favourable. The average length of stay was 2.7 days (range 1–14 days). This group was responsible for 12 of the 22 readmissions. There were no perioperative cardiovascular events.

Conclusion:

We conclude that GreenLight XPS PVP is a safe procedure in patients with one or more high-risk factors. The ability to proceed without the need to stop antiplatelets or anticoagulant agents also allows for high-risk medical patients to be treated without the additional risks of cardiovascular events.

Level of evidence:

Not applicable for this multicentre audit.
The Impact of Geopolitical Influence on Regional Cooperation and Integration in East Asia
Authors: Hartono Arianto Christian
Published: September 2021

Recent developments in regional studies argue that geopolitical influence is one factor affecting the regional order. However, studies on geopolitical influence have yet to cover East Asia to explain East Asia's regional order. The quantitative approach to geopolitical influence studies still faces a methodological challenge because it uses an arbitrary weighting of geopolitical influence in developing an index. In order to address those challenges, this research deploys factor analysis as a non-arbitrary weighting system to measure the geopolitical influence of China, Japan, Russia, and the US in East Asia during the period from 2005 to 2018. Additionally, this research explores how the geopolitical influence of those countries affects East Asia's regional cooperation and integration. The research shows that: (1) China has been able to compete with the US for geopolitical influence in East Asia since 2014, and (2) Chinese, Japanese, Russian, and US geopolitical influence positively contributes to regional cooperation and integration in East Asia, with the US and China as the main contributors. The research highlights three possible causes to explain the results: China's regional infrastructure initiatives, rejuvenation of China's view on globalization, and the relative decline of US relations with the allies in the region.
Modes and Trajectories of Shadow Education in Denmark and China: Fieldwork Reflections by a Comparativist
Authors: Zhang (张薇) Wei
Published: September 2021

Purpose

In the domain of shadow education (private supplementary tutoring), Denmark and China may be placed at opposite ends of a spectrum. Denmark has a recently emerged, small, and high-cost sector that mostly serves low achievers, while China has a more industrialized sector with a long history and economies of scale. The paper juxtaposes the two to shed light on each.

Design/Approach/Methods

The article is a personal narrative of the author's research experiences. She grew up and had initial education in China before moving to the Nordic realm for 2 years. This provided a set of initial lenses, which were subsequently deployed in research partnership from her current base in China with colleagues in Denmark.

Findings

The juxtaposition raises questions that might otherwise not have been asked and provides insights that might otherwise not have been gained. Danish families hesitate to use shadow education for advantages in the egalitarian society, in contrast to Chinese patterns that stress competition and achievement. These facets have implications for the modes of shadow education and even the names of tutorial companies.

Originality/Value

The paper has a methodological value in addition to its substantive insights on the trajectories of shadow education in the two countries.
On the concept and connotation of science popularization ethics
Authors: Liu Xuan , Ren Fujun , Ge Haitao
Published: September 2021

Some ethical norms should be followed in science popularization. Such norms are related to, but also different from, the ethics of science and technology, communication and education. This paper explores the definition of science popularization ethics in Chinese and foreign literature and reflects on the concept and connotation of the ethical norms that should be followed in science popularization in China. It suggests that the ethical norms that people should follow in science popularization should be defined as ‘science popularization ethics’ in China.
National Non-verbal Cognitive Ability Test (BNV) Development Study
Authors: Bildiren Ahmet , Bıkmaz Bilgen Özge , Korkmaz Mediha
Published: September 2021

The aim of the present study is to develop a national non-verbal cognitive ability test in Turkey. Test items were developed during the first stage and applied as a pilot study on 3,073 children in the age interval of 4 to 13. The test was given its final form based on the values of item difficulty, item distinctiveness, item total score correlation. Norm study was carried out at 12 different provinces with a total of 9,129 children comprised of 4,464 females (49%) and 4,665 (51%) males. Test-retest, split-halves, KR-20, and KR-21 methods were applied for the reliability analyses of the study. Standard error, standard deviation, and reliability coefficient were calculated for the measurement. Content and construct validity along with criterion-related validity analysis methods were used for validity analyses. The KR-20 reliability coefficient obtained from the complete sample group was estimated as 0.92. Test-retest reliability coefficient was determined as 0.80. A correlation of .71 was determined between Naglieri Cognitive Ability test and BNV test. A correlation of .67 was determined between Toni-3 test and BNV test while a correlation of .86 was determined between BNV and Colored Progressive Matrices Test.
What Are the Sources and Negative Effects of Assistant Principals’ Work Intensification?
Authors: Cansoy Ramazan , Türkoğlu Muhammet Emin , Balıkçı Abdullah
Published: September 2021

This study sought to provide an understanding of the sources of work intensification and its effects on assistant principals in Turkey, and the coping strategies they use. The participants of this qualitative study were a sample of 18 assistant principals. The current qualitative study was based on semi-structured interviews. Data analysis was performed through descriptive and content analysis. This study revealed that assistant principals had work intensification related to heavy paperwork, a variety of administrative affairs, a variety of tasks, school size, and lack of experience. Assistant principals’ work intensification caused negative psychological and physical health, work-family conflict, limited social relationships, and a decrease in professional commitment. Assistant principals spent time with their families, engaged in task sharing, received support from colleagues, took part in various social events, planned work habits and managed priorities to reduce the negative effects of work intensification.
The Impact of Corticosteroid Injection Timing on Infection Rates Following Spine Surgery: A Systematic Review and Meta-Analysis
Authors: Kazarian Gregory S. , Steinhaus Michael E. , Kim Han Jo
Published: September 2021

Study Design/Setting:

Systematic review/meta-analysis.

Objectives:

The objective of this review was to assess how the risk of infection following lumbar spine surgery varies as a function of the timing of preoperative corticosteroid spinal injections (CSIs).

Methods:

A systematic review and meta-analysis was performed in accordance with the PRISMA guidelines. PubMed and EMBASE databases were searched and data was pooled for meta-analysis.

Results:

Six studies were identified for inclusion. Two (33.3%) demonstrated a significant relationship between the timing of preoperative CSIs and the risk of postoperative infection, while 4 (66.7%) demonstrated no impact. A total of 2.5% (110/4,448) of patients who underwent CSI <1 month before surgery experienced a postoperative infection, as compared to 1.2% (1,466/120, 943) of controls, which was statistically significant (RR = 1.986 95% CI 1.202-3.282 P = 0.007). A total of 1.6% (25/1,600) of patients who underwent CSI 0-3 months before surgery experienced a postoperative infection, as compared to 1.6% (201/12, 845) of controls (RR = 0.887 95% CI 0.586-1.341, P = 0.569). A total of 1.1% (199/17 870) of patients who underwent CSI 3-6 months before surgery experienced a postoperative infection, as compared to 1.3% (1,382/102, 572) of controls (RR = 1.053 95% CI 0.704-1.575, P = 0.802). Differences in infection risk for 0-3 months and 3-6 months were not statistically significant.

Conclusions:

CSIs <1 month prior to lumbar spine surgery are a significant risk factor for infection, while CSIs beyond that point showed no such association. Surgeons should consider avoiding CSIs <1 month of the use of CSIs of the spine.
No Difference in Neck Pain or Health-Related Quality Measures Between Patients With or Without Degenerative Cervical Spondylolisthesis
Authors: Kaye Ian David , Sebastian Arjun S. , Wagner Scott C. , Semenza Nicholas , Bowles Daniel , Schroeder Gregory D. , Kepler Chris K. , Woods Barret I. , Radcliff Kris E. , Kurd Mark F. , Rihn Jeff , Anderson David Greg , Hilibrand Alan S. , Vaccaro Alexander R.
Published: September 2021

Study Design

This study is a retrospective case control.

Objectives

This study aims to determine whether cervical degenerative spondylolisthesis (DS) is associated with increased baseline neck/arm pain and inferior health quality states compared to a similar population without DS.

Methods

Patient demographics, pre-operative radiographs, and baseline PROMs were reviewed for 315 patients undergoing anterior cervical decompression and fusion (ACDF) with at least 1 year of follow-up. Patients were categorized based on the presence (S) or absence of a spondylolisthesis (NS). Statistically significant variables were further explored using multiple linear regression analysis.

Results

49/242 (20%) patients were diagnosed with DS, most commonly at the C4–5 level (27/49). The S group was significantly older than the NS group (58.0 ± 10.7 vs 51.9 ± 9.81, P = .001), but otherwise, no demographic differences were identified. Although a higher degree of C2 slope was found among the S cohort (22.5 ± 8.63 vs 19.8 ± 7.78, P = .044), no differences were identified in terms of preoperative visual analogue scale (VAS) neck pain or NDI. In the univariate analysis, the NS group had significantly increased VAS arm pain relative to the S group (4.93 ± 3.16 vs 3.86 ± 3.30, P = .045), which was no longer significant in the multivariate analysis.

Conclusions

Although previous reports have suggested an association between cervical DS and neck pain, we could not associate the presence of DS with increased baseline neck or arm pain. Instead, DS appears to be a relatively frequent (20% in this series) age-related condition reflecting radiographic, rather than necessarily clinical, disease.
The Missionary Vocation Today: What is the Role of the Missionary in a Rapidly Changing Society?: A Selected Reading List on the Christian Missionary.
Authors: Eastman Addison J. , Poetig Richard B. , Price Frank W.
Published: September 2021

The Reverend Addison J. Eastman has been a missionary of the American Baptist Foreign Missionary Society in Burma, and is now Director of the Missionary Personnel Program in the Division of Foreign Missions, NCCC-USA.

The Reverend Richard B. Poetig has been sent by the Commission on Ecumenical Mission and Relations of the United Presbyterian Church in the U.S.A. to serve as Minister for Industrial Evangelism, in the United Church of Christ, Manila, The Philippines.

Frank W. Price is Director of the Missionary Research Library
Protestant Missionary Obligation at the end of Our Time
Authors: Michalson Carl
Published: September 2021

This is another article in the preparatory studies on “The Missionary Obligation of the Church” looking toward the Willingen meeting of the international Missionary Council. Presented in 1951 under the auspices of the Division of Foreign Missions of the National Council of the Churches of Christ in the U.S.A., its prophetic character is seen more clearly in the perspective of twelve years, for it is more appropriate and helpful now than then.

Dr. Michalson is Professor of Systematic Theology at Drew University.
Tolerance, Mission, and Aid to Underdeveloped Countries
Authors: Hanssen-Bauer Svein
Published: September 2021

This article originally appeared in Norsk tidsskrift for misjon, Volume 16, Number 4 (1962). Publication of this English version is by permission of the Egede Instituttet in Oslo. The translation from the Norwegian was done by Dr. Per Hassing, Associate Professor of Missions at the Boston University School of Theology.

The article is of unusual significance for the insights it contains with regard to the resolution of a perplexing and crucial problem in our day, namely, the proper Christian response to the current popular demand for tolerance and neutrality in the matter of religious conviction in the matrix of sensitive nationalisms and extensive intercultural exchange.

The Reverend Mr. Svein Hanssen-Bauer, who holds a B.D. degree from the University of Oslo, is an ordained minister of the Church of Norway (Lutheran) and a lektor (teacher) in the Frogner Skole in Oslo. Currently he is directing a study of “The Church and the Underdeveloped Countries” for the Egede Instituttet, of which Professor Doctor O. G. Myklebust is the Director.
Donor bone marrow–derived macrophage MHC II drives neuroinflammation and altered behavior during chronic GVHD in mice
Authors: Adams Rachael C. , Carter-Cusack Dylan , Shaikh Samreen N. , Llanes Genesis T. , Johnston Rebecca L. , Quaife-Ryan Gregory , Boyle Glen , Koufariotis Lambros T. , Möller Andreas , Blazar Bruce R. , Vukovic Jana , MacDonald Kelli P. A.
Published: September 2021

Graft-versus-host disease (GVHD) remains the leading cause of nonrelapse mortality after allogeneic stem cell transplantation for hematological malignancies. Manifestations of GVHD in the central nervous system (CNS) present as neurocognitive dysfunction in up to 60% of patients; however, the mechanisms driving chronic GVHD (cGVHD) in the CNS are yet to be elucidated. Our studies of murine cGVHD revealed behavioral deficits associated with broad neuroinflammation and persistent Ifng upregulation. By flow cytometry, we observed a proportional shift in the donor-derived T-cell population in the cGVHD brain from early CD8 dominance to later CD4 sequestration. RNA sequencing of the hippocampus identified perturbations to structural and functional synapse-related gene expression, together with the upregulation of genes associated with interferon-γ responses and antigen presentation. Neuroinflammation in the cortex of mice and humans during acute GVHD was recently shown to be mediated by resident microglia-derived tumor necrosis factor. In contrast, infiltration of proinflammatory major histocompatibility complex (MHC) class II+ donor bone marrow (BM)–derived macrophages (BMDMs) was identified as a distinguishing feature of CNS cGVHD. Donor BMDMs, which composed up to 50% of the CNS myeloid population, exhibited a transcriptional signature distinct from resident microglia. Recipients of MHC class II knockout BM grafts exhibited attenuated neuroinflammation and behavior comparable to controls, suggestive of a critical role of donor BMDM MHC class II expression in CNS cGVHD. Our identification of disease mediators distinct from those in the acute phase indicates the necessity to pursue alternative therapeutic targets for late-stage neurological manifestations.
Impact of comorbidity in older patients with peripheral T-cell lymphoma: an international retrospective analysis of 891 patients
Authors: Mead Monica , Cederleuf Henrik , Björklund Maja , Wang Xiaoyan , Relander Thomas , Jerkeman Mats , Gaut Daria , Larson Sarah , Ellin Fredrik
Published: September 2021

Peripheral T-cell lymphoma (PTCL) is a heterogeneous group of aggressive neoplasms with poor outcomes, commonly affecting older patients with comorbidities. This study aims to describe outcomes of older patients with PTCL in a large international cohort. Patients aged ≥70 years with PTCL diagnosed from 1 January 2010 to 31 December 2015 in the Swedish Lymphoma Registry (SLR) and California Cancer Registry (CCR) were identified. Data on comorbidity were retrospectively collected according to the Charlson Comorbidity Index (CCI), and clinical outcomes were extracted. A total of 891 patients were included (SLR, n = 173; CCR, n = 718). Median age was 77 (SLR) and 78 (CCR) years. Included subtypes were as follows: angioimmunoblastic T-cell lymphoma, n = 226; anaplastic large-cell lymphoma, n = 122; enteropathy-associated T-cell lymphoma (EATL), n = 31; hepatosplenic TCL, n = 7; natural killer–/T-cell lymphoma, n = 62; PTCL not otherwise specified, n = 443. CCI data were available in 775 patients (87%), and CCI scores were divided into the groups CCI = 0 (39%), CCI = 1 (22%), and CCI > 1 (39%). Median age did not differ among the CCI groups (P = .72). Patients with a CCI > 1 had a worse median overall survival (4.4 months) compared with patients with CCI = 0 (11.9 months) and CCI = 1 (8.4 months; P < .001). Comorbidity and advancing age in as little as 5-year increments are important adverse factors in this group. Most patients died of lymphoma within a year from diagnosis, underscoring the importance of developing new treatments.
Phylodynamic and phylogeographic analysis of the complete genome of the West Nile virus lineage 2 (WNV-2) in the Mediterranean basin
Authors: Srihi Haythem , Chatti Noureddine , Ben Mhadheb Manel , Gharbi Jawhar , Abid Nabil
Published: September 2021

Background

The West Nile virus is a highly contagious agent for a wide range of hosts. Its spread in the Mediterranean region raises several questions about its origin and the risk factors underlying the virus’s dispersal.

Materials and methods

The present study aims to reconstruct the temporal and spatial phylodynamics of West Nile virus lineage 2 in the Mediterranean region using 75 complete genome sequences from different host species retrieved from international databases.

Results

This data set suggests that current strains of WNV-2 began spreading in South Africa or nearby regions in the early twentieth century, and it migrated northwards via at least one route crossing the Mediterranean to reach Hungary in the early 2000s, before spreading throughout Europe. Another introduction event, according to the data set collected and analyses performed, is inferred to have occurred in around 1978. Migratory birds constitute, among others, additional risk factors that enhance the geographical transmission of the infection.

Conclusion

Our data underline the importance of the spatial–temporal tracking of migratory birds and phylodynamic reconstruction in setting up an efficient surveillance system for emerging and reemerging zoonoses in the Mediterranean region.
Does overnight duty affect vascular endothelial function?
Authors: Garu A. , Nitta Eri , Yoshida Yuri , Yata Erika , Tsunematsu Akari , Araki Tsuyoshi , Nagai Atsushi , Yano Shozo
Published: September 2021

Background

The reactive hyperemia index (RHI), which is obtained from the measurement of peripheral arterial tonometry (PAT), is highly associated with the percentage change in the end-diastolic arterial diameter (%flow-mediated dilatation) at reactive hyperemia. Low RHI is reported to be a mortality risk in patients with a high risk of cardiovascular (CV) disease. CV events are thought to be induced by physical and mental stress, including long-term fatigue and lack of sleep. However, the relationship between fatigue, lack of sleep, and endothelial function has not yet been established.

Methods

Healthy hospital workers (n = 13, 6 men and 7 women) with an average age of 31.6 years were assigned to this study after they provided written informed consent. During the study period, we conducted 72 measurements of reactive hyperemia-peripheral arterial tonometry (RH-PAT) in the morning before or after their duty. At each measurement of the RH-PAT, we recorded the participants’ hours of sleep and evaluated their degree of fatigue using a visual analog scale (VAS).

Results

Although the VAS was significantly less (36 ± 16% and 64 ± 12%, p < 0.001) and the hours of sleep were longer (6.0 ± 1.1 h and 2.3 ± 1.0 h, p < 0.001) before duty compared to those after duty, the RHI was comparable between them (2.12 ± 0.53 vs. 1.97 ± 0.50, p = 0.21). The VAS score was significantly higher in participants with low RHI (< 1.67) than in those with normal RHI (≥ 2.07) (59 ± 13% and 46 ± 21%, respectively, p < 0.05). However, binary logistic regression showed no significant association between low RHI and the VAS when adjusted for systemic blood pressure (SBP) and heart rate variability (HRV). In a simple regression analysis, the RHI was significantly correlated with the VAS score but not with sleep duration. A multiple linear regression analysis also showed no significant association between the RHI and VAS scores after adjustment for SBP and HRV.

Conclusions

Vascular endothelial function was not associated with overnight duty, hours of sleep, or degree of fatigue in healthy young adults. Since the RHI may be decreased in severe fatigue conditions through autonomic nerve activity, one should consider the physical and mental conditions of the examinee when evaluating the RH-PAT results.
Costs of inpatient hospitalisations in the last year of life in older New Zealanders: a cohort study
Authors: Scott Oliver W. , Gott Merryn , Edlin Richard , Moyes Simon A. , Muru-Lanning Marama , Kerse Ngaire
Published: September 2021

Background

Rapidly ageing populations means that many people now die in advanced age. This paper investigated public hospital and long-term care home costs in the 12 months before death in Māori and non-Māori of advanced age in New Zealand.

Methods

Data from an existing longitudinal study (LiLACS NZ) was used, in which 937 older New Zealanders were enrolled in 2010. At the time of this study, 213 Māori and 241 non-Māori in the cohort had died. National Health Index numbers were linked to the hospitalisation National Minimum Dataset to ascertain public hospitalisation and care home costs in the last year of life.

Results

The average total publicly funded hospital and long-term care home costs in the 12 months prior to death were $16,211 and $17,351 for Māori and non-Māori respectively. Non-Māori tended to have long lengths of stay in their last year of life, and non-Māori men had the highest proportion with high costs and long lengths of stay in care homes. Costs in the last year of life were 8.1 times higher in comparison to costs for individuals who did not die in the same time period.

Conclusion

Despite New Zealand’s commitment to providing an equitable level of healthcare, this study illustrated that ethnic and gender disparities are still apparent at the end of life. This raises questions as to whether money at the end of life is being spent appropriately, and how it could potentially be more equitably targeted to meet the diverse needs of older people and their families.
Early kidney injury predicts disease progression in patients with COVID-19: a cohort study
Authors: Xia Tingting , Zhang Wenjing , Xu Yu , Wang Bin , Yuan Zhiquan , Wu Na , Xiang Ying , Li Chengying , Shan Yifan , Xie Weijia , Wang Youhao , Zhang Yao , Bai Li , Li Yafei
Published: September 2021

Background

The receptor of severe respiratory syndrome coronavirus 2 (SARS-CoV-2), angiotensin-converting enzyme 2, is more abundant in kidney than in lung tissue, suggesting that kidney might be another important target organ for SARS-CoV-2. However, our understanding of kidney injury caused by Coronavirus Disease 2019 (COVID-19) is limited. This study aimed to explore the association between kidney injury and disease progression in patients with COVID-19.

Methods

A retrospective cohort study was designed by including 2630 patients with confirmed COVID-19 from Huoshenshan Hospital (Wuhan, China) from 1 February to 13 April 2020. Kidney function indexes and other clinical information were extracted from the electronic medical record system. Associations between kidney function indexes and disease progression were analyzed using Cox proportional-hazards regression and generalized linear mixed model.

Results

We found that estimated glomerular filtration rate (eGFR) and creatinine clearance (Ccr) decreased in 22.0% and 24.0% of patients with COVID-19, respectively. Proteinuria was detected in 15.0% patients and hematuria was detected in 8.1% of patients. Hematuria (HR 2.38, 95% CI 1.50–3.78), proteinuria (HR 2.16, 95% CI 1.33–3.51), elevated baseline serum creatinine (HR 2.84, 95% CI 1.92–4.21) and blood urea nitrogen (HR 3.54, 95% CI 2.36–5.31), and decrease baseline eGFR (HR 1.58, 95% CI 1.07–2.34) were found to be independent risk factors for disease progression after adjusted confounders. Generalized linear mixed model analysis showed that the dynamic trajectories of uric acid was significantly related to disease progression.

Conclusion

There was a high proportion of early kidney function injury in COVID-19 patients on admission. Early kidney injury could help clinicians to identify patients with poor prognosis at an early stage.

Graphic abstract