bluuebunny/crossref_metadata_2025 huggingface dataset:
Association between obstructive sleep apnea (OSA) and atrial fibrillation (AF): A dose-response meta-analysis
Authors: Zhang Dong , Ma Yibo , Xu Jian , Yi Fu
Published: August 2022

Background:

Refractory hypoxemia episodes are characteristic of obstructive sleep apnea (OSA). Patients with OSA suffer from oxidative stress in all systems. Atrial fibrillation (AF) is a type of arrhythmia that may be induced by OSA. In this study, we explored the dose-response relationship between OSA and AF. Our research provides the basis for a novel approach to AF prevention.

Methods:

We screened four databases (PubMed, Embase, the Cochrane Library, and Web of Science) for observational studies on OSA and AF. Studies were collected from database establishment to November 2020. We performed a traditional subgroup meta-analysis. Linear and spline dose-response models were applied to assess the association between the apnea-hypopnea index, an indicator of OSA severity, and the risk of AF. Review Manager version 5.3 software and Stata 16.0 were used for the analysis.

Results:

Sixteen observational studies were included in the study. We excluded a study from the conventional meta-analysis. In the subgroup analysis, the odds ratios for new onset AF for no obvious reason, new onset AF after surgical operations, such as coronary artery bypass grafting, and AF after ablation treatment were 1.71 (95% CI 1.37–2.13, P < .05), 2.65 (95% CI 2.32–3.01, P < .05), and 2.93 (95% CI 2.47–3.49, P < .05), respectively. Linear dose-response meta-analysis results revealed that the risk of AF increased with increasing apnea-hypopnea index value.

Conclusion:

Through dose-response meta-analysis, we found a potential dose-response relationship between OSA severity and the risk of AF. This relationship should be considered in interventions aimed at AF prevention in the future.
Exploring psychopathological and cognitive factors associated with help-seeking intentions among Korean high school students: A cross-sectional study
Authors: Seo Yong-Won , Choi Bo-Ram , Kim Min-Sun , Lim Myung-Ho
Published: August 2022

Competitive college admissions and academic pressure have continuously increased the psychopathological burden of Korean high school students. Seeking help is one of the primary means of managing mental health, and more attention is required. This study aimed to explore the psychopathological and cognitive factors related to the help-seeking intentions of Korean high school students.

This cross-sectional study was conducted between July and August 2020 using the General Help-Seeking Questionnaire, Symptom Checklist-90-R, and Mental Health Literacy Scale. Four hundred and twenty-one Korean high school students (275 males, 146 females; average age 17.44 years [standard deviation = 0.651]) completed self-report questionnaires. We performed analysis of variance, Spearman’s correlation analysis, and stepwise regression analysis to explore the factors related to help-seeking intentions.

The final model showed an explanatory power of 23.6% for the overall variance in help-seeking intentions. Somatization (β = −0.200; P = .001) and hostility (β = −0.203; P = .001) had a negative effect on help-seeking intentions. Further, knowledge of where to seek information (β = 0.230; P < .001) and attitudes promoting recognition and help-seeking behavior (β = 0.095; P = .030) had a positive effect.

Students responded to society’s negative awareness of mental illness by converting psychopathology into socially acceptable symptoms. Educational support can improve mental health literacy. This study is expected to help improve mental illness awareness and increase adolescents’ access to public services.
Blade needle therapy versus conventional acupuncture for knee osteoarthritis: A meta-analysis
Authors: Yin Xunlong , Liu Yuan , Liu Wu , Liang Wei , Liang Qingyong
Published: August 2022

Background:

This study investigated the hypothesis that the efficacy of blade needle therapy for the treatment of knee osteoarthritis (KOA) is superior to that of conventional acupuncture. In addition, the efficacy of blade needle therapy versus conventional acupuncture for the treatment of KOA was analyzed in a meta-analysis.

Methods:

Randomized controlled trials (RCTs) of blade needle therapy and conventional acupuncture for treating KOA were retrieved from the electronic databases CNKL, Wanfang, VIP, PubMed, EMBASE and the Cochrane Library from the commencement of each database to July of 2021. Data were extracted and evaluated by 2 reviewers independently. RevMan 5.3 software was used to conduct the meta-analysis after the studies were evaluated.

Results:

A total of 11 RCTs were included, all from China, involving 1142 patients. The meta-analysis results showed that the effective rate of the blade needle group was better than that of the conventional acupuncture group (OR = 3.61, 95% CI [2.56–5.10], P < .00001).

Conclusion:

The efficacy of blade needle treatment for KOA is superior to that of conventional acupuncture, but more high-quality studies are needed for future validation due to the low proportion of high-quality studies included and the possible bias factor.
Midgut malrotation presenting with hyperemesis gravidarum: A case report
Authors: Zhao Hongjiang , Wu Linzhen , Yang Bin , Shang Hongkai
Published: August 2022

Rationale:

Midgut malrotation is a rare congenital abnormality resulting from failure of complete intestinal rotation and subsequent fixation during early fetal development. There appeared to be no obvious symptoms in most patients, and a few patients may exhibit symptoms similar to hyperemesis gravidarum, such as nausea and vomiting. Here, we present a case of midgut malrotation presenting as hyperemesis gravidarum.

Patient concerns:

A 27-year-old woman with an intrauterine pregnancy of 27 + 6 weeks complained of severe nausea and vomiting for 2 weeks.

Diagnosis:

Magnetic resonance imaging showed obvious dilatation in the proximal part of the duodenum and gastric cavity and the absence of a duodenal path dorsal to the superior mesenteric artery, which was diagnosed as midgut malrotation.

Interventions:

Considering that the patient’s vital signs were stable, without manifestation of peritonitis or the risks of surgery to the fetus, conservative treatment was adopted. Unfortunately, the fetus developed severe hydrocephalus at 32 weeks. The patient and her family decided to abandon the fetus, and a mid-trimester-induced abortion was performed.

Outcomes:

The related symptoms completely disappeared after delivery, and the relevant examination after discharge also confirmed the presence of midgut malrotation without gastrointestinal discomfort within 1 year after delivery.

Lessons:

Midgut malrotation can be considered as a differential diagnosis of hyperemesis gravidarum. Conservative treatment under close monitoring is desirable in pregnant women diagnosed with midgut malrotation.
Bariatric surgery and the neurohormonal switch: Early insulin resistance recordings after laparoscopic sleeve gastrectomy
Authors: Haran Cheyaanthan , Lim Yu kai , Aljanabi Imad , Bann Simon , Wickremesekera Susrutha
Published: August 2022

Laparoscopic sleeve gastrectomy (LSG) is a bariatric operation with a safe risk profile. It has been proven to successfully reduce weight, decrease insulin resistance (IR), and ameliorate diabetes mellitus. The aim of this study was to determine if there is an early improvement in IR after LSG and its association with weight loss.

This was a prospective observational study of 32 patients who underwent LSG at a single center over a 3-year period. Serum insulin and fasting glucose levels were recorded preoperatively, on day 1 postoperatively, and 3 weeks after LSG. IR levels were calculated using the Homeostasis Model Assessment 2 Version 2.23. IR levels were compared along with the overall weight loss, via body mass index. β-cell function was the secondary outcome.

IR significantly improved the day after surgery with a statistically significant mean difference of 0.89 units (P = .043) and significantly more so 3 weeks postoperatively, with a mean difference of 4.32 units (P < .0005). β-cell function reduced 3 weeks postoperatively, with a mean difference of 23.95 %β (P = .025), while body mass index significantly reduced, with a mean difference of 4.32 kg/m2 (P < .0005).

Early improvement of IR was observed on postoperative day 1 after LSG before any weight loss. This raises the possibility of an undetermined, underlying neurohormonal switch that improves IR. Further investigation is needed to determine this mechanism, as it may lead to an improvement in the medical management of diabetes mellitus.
Revisiting factors associated with blood culture positivity: Critical factors after the introduction of automated continuous monitoring blood culture systems
Authors: Lin Pei-Chin , Chang Chia-Ling , Chung Yi-Hua , Chang Chih-Chun , Chu Fang-Yeh
Published: August 2022

Blood culture is the main tool used to identify causative pathogens. Adequate volume and number of culture sets are considered key to blood culture positivity rate. It is not known whether these factors remain critical to the positivity rate after the introduction of automated continuous blood culture system monitoring.

We measured blood volume per bottle and described the distribution of blood volume and number of culture sets. Multivariate logistic regression was performed to determine the independent association of blood volume, number of culture sets, diagnosis of sepsis in a patient, and other covariates with blood culture results.

Only 6.9% of the blood culture bottle volumes complied with the guidance (8–10 mL), with the highest culture positivity rate (18%). Of the culture events, only one set of blood was cultured in 60.9% of events. In the multivariate analysis, blood culture volume per event (odds ratio [OR], 1.09 [95% confidence interval [CI], 1.06–1.11]), patients with a diagnosis of sepsis (OR, 2.86 [95% CI, 2.06–3.98]), and samples from the emergency department (OR, 2.29 [95% CI, 1.72–3.04]), but not the number of culture sets (OR, 0.74 [95% CI, 0.50–1.12]), were observed to be statistically significant with respect to blood culture positivity rate.

Our results revealed that the total blood culture volume and the diagnosis of sepsis were critical factors affecting blood culture positivity rate. However, the proportion of blood culture bottles with the optimal blood volume was very low, and optimizing blood volume would be key to increasing blood culture positivity rate.
Effects of resilience, burnout, and work-related physical pain on work-life balance of registered nurses in South Korean nursing homes: A cross-sectional study
Authors: Min Deulle
Published: August 2022

Background:

While nursing homes increase, the number of registered nurses (RNs) working there continues to decline. This study explored the effects of resilience, burnout, and work-related physical distress on the work-life balance of RNs to improve retention rates.

Methods:

This cross-sectional study involved 155 RNs working in 37 nursing homes, spread across 10 South Korean cities. Data were collected from May to July 2019 using self-report questionnaires, with items relating to general and work-related characteristics, work-life balance, resilience, and burnout. Multiple regression analysis was performed to identify factors affecting participants’ work-life balance, including variables that showed significant results in univariate analysis. All analyses were performed using the PASW SPSS win 26.0 program.

Results:

Participants’ average age was 48.48 years, and they had been working as RNs for 17.36 years on average. Work-related physical pain was reported by 70.3% of participants. Resilience had a positive correlation with work-life balance (r = 0.38; P < .001), whereas burnout had a negative correlation with work-life balance (r = −0.45; P < .001). Work-related physical pain (β = −0.27; 95% confidence interval [CI], −25.89 to −7.48), resilience (β = 0.20; 95% CI, 0.02–0.70), and burnout (β = −0.33; 95% CI, −0.9 to −0.24) affected participants’ work-life balance.

Conclusion:

Interventions to facilitate work-life balance among nursing home RNs must aim to increase resilience and reduce burnout and work-related physical pain. A healthy work-life balance should improve RN retention in nursing homes, boosting the safety and quality of life of residents in turn.
Isolated sigmoid varicose vein rupture and hemorrhage: A case report
Authors: Li Weiwei , Wang Jianli , Fu Hua , Liu Jinlong
Published: August 2022

Rationale:

Ectopic varices are the collateral circulation of portal vein located anywhere in the gastrointestinal tract other than the esophageal and gastric regions. Rupture of these varices often results in life-threatening hemorrhage. Management guidelines for ectopic variceal bleeds are not yet standardized because cases are rare and treatment approaches described in the literature vary considerably.

Patient concerns:

A 53-year-old woman with a 20-year history of chronic hepatitis C cirrhosis came to our hospital for treatment due to intermittent black stools for 4 days. After admission, the patient developed hemorrhagic shock, with hemodynamic instability.

Diagnosis:

Postoperative histological examination confirmed the diagnosis of sigmoid varicose veins.

Intervention:

Emergency colonoscopy showed that a varicose vein mass in the sigmoid colon wall 30 cm from the anus was ruptured and bleeding. Percutaneous transhepatic inferior mesenteric venography revealed the presence of a varicose mass of sigmoid colon veins. After embolization of the sigmoid varicose veins with spring coils, angiography showed that the hemorheology of the distal varicose vein mass was slow but not completely blocked. Three days after embolization, the patient had hematochezia again. Splenectomy and sigmoid colon resection were performed immediately.

Outcomes:

Follow-up computed tomography showed no residual varices were observed after sigmoid colon resection.

Lessons:

Ectopic varices, which are rare sequelae of portal hypertension, need to be taken seriously because bleeding from these varices can be catastrophic. We report a case of isolated sigmoid variceal rupture and hemorrhage due to portal hypertension in cirrhosis. The patient experienced failure of endoscopic hemostasis and sigmoid colon venous coil embolization. She was eventually successfully brought to hemostasis by surgery.
High plasma soluble thrombomodulin levels indicated poor prognosis of decompensated liver cirrhosis: a prospective cohort study
Authors: Wei Xinhuan , Du Xiaofei , Liu Yali , Wu Jun , Zhang Jing
Published: August 2022

Objective

Hepatic sinusoidal endothelial injury is a prominent characteristic of liver cirrhosis. We determined plasma soluble thrombomodulin (sTM) levels in cirrhosis patients to evaluate the relationship between vascular injury and long-term prognosis.

Methods

A prospective single-center study was performed. The participants were followed up for every 6 months or until death or transplantation. A chemiluminescent enzyme immunoassay was used to establish a baseline sTM.

Results

Among the 219 patients with decompensated liver cirrhosis, 53.42% were caused by hepatitis B and hepatitis C. Plasma sTM levels were much higher in cirrhosis than in healthy controls and increased parallel with Child-Pugh classification (P < 0.01) and the amount of ascites (P = 0.04). After adjusting for sex, age, international normalized ratio, bilirubin, and other potential factors, multivariate Cox regression revealed that per TU/ml elevation of plasma sTM causes an increase of 8% in mortality, and per-SD elevation of thrombomodulin causes a 53% increase in mortality. As the mortality rates in low (5.90–12.60 TU/ml) and medium (12.70–18.00 TU/ml) sTM levels were similar, so we chose the cutoff of 18.00 TU/ml to divide into two groups, and K-M analysis indicated that patients with sTM >18.0 TU/ml demonstrated an additional 2.01 times death risk (95% CI, 1.13–7.93; P = 0.01) than those with sTM ≤18.0 TU/ml.

Conclusion

Plasma sTM in cirrhosis was significantly increased in parallel with the severity of liver dysfunction. sTM elevation than 18 TU/ml indicated a poor prognosis of decompensated liver cirrhosis.
Survival Rates After Pediatric Traumatic Out-of-Hospital Cardiac Arrest Suggest an Underappreciated Therapeutic Opportunity
Authors: Lanyi Maria , Elmer Jonathan , Guyette Francis X. , Martin-Gill Christian , Venkat Arvind , Traynor Owen , Walker Heather , Seaman Kristen , Kochanek Patrick M. , Fink Ericka L.
Published: August 2022

Objectives

Children with traumatic arrests represent almost one third of annual pediatric out-of-hospital cardiac arrests (OHCAs). However, traumatic arrests are often excluded from study populations because survival posttraumatic arrest is thought to be negligible. We hypothesized that children treated and transported by emergency medical services (EMS) personnel after traumatic OHCA would have lower survival compared with children treated after medical OHCA.

Methods

We performed a secondary, observational study of children younger than 18 years treated and transported by 78 EMS agencies in southwestern Pennsylvania after OHCA from 2010 to 2014. Etiology was determined as trauma or medical by EMS services. We analyzed patient, cardiac arrest, and resuscitation characteristics and ascertained vital status using the National Death Index. We used multivariable logistic regression to test the association of etiology with mortality after covariate adjustment.

Results

Forty eight of 209 children (23%) had traumatic OHCA. Children with trauma were older than those with medical OHCA (13.2 [3.8–15.9] vs 0.5 [0.2–2.4] years, P < 0.001). Prehospital return of spontaneous circulation frequency for trauma versus medical etiology was similar (90% vs 87%, P = 0.84). Patients with trauma had higher mortality (69% vs 45% P = 0.004).

Conclusions

More than 8 of 10 children with EMS treated and transported OHCA achieved return of spontaneous circulation. Despite lower survival rates than medical OHCA patients, almost one third of children with a traumatic etiology survived throughout the study period. Future research programs warrant inclusion of children with traumatic OHCA to improve outcomes.
Are 2 Radiographic Views As Good as 3 Views to Diagnose Ankle Fractures in Children and Adolescents?
Authors: Abouassaly Marcel , Blumetti Francesco Camara , Gauthier Luke , Willis Ross Baxter , Kontio Ken , Highmore Kerri , Abdeen Nishard , Plint Amy Catherine , Tse Sandy , Barrowman Nick , Moroz Paul John
Published: August 2022

Objectives

Ankle radiographs are among the most commonly obtained trauma images in the pediatric population, with the standard 3 views (AP/mortise [M]/lateral [L]) routinely ordered in the emergency department. The purpose of this study was to compare the diagnostic accuracy, sensitivity, and specificity of sets of 2 views (AP/L or M/L) with the standard 3 views.

Methods

One hundred twenty sets of ankle radiographs of skeletally immature patients obtained in the emergency department of a level 1 pediatric trauma center were used. These included sets with and without fractures. Sets of 3 and 2 views were reviewed by pairs of pediatric-trained orthopedic surgeons, radiologists, and emergency physicians. Each completed 3 randomized viewing sessions where all possible combinations for each set of radiographs were reviewed. Diagnoses for the 3 sets of views were compared for accuracy, sensitivity, and specificity.

Results

Overall accuracy, sensitivity, and specificity for all reviewers were as follows: AP/M/L 74%, 94%, and 90%, AP/L 71%, 90%, and 94%, as well as M/L 69%, 90%, and 91%. P values for accuracy, sensitivity, and specificity of AP/L and M/L compared with 3 views were 0.34, 0.04, and 0.52, as well as 0.04, 0.004, and 1.00, respectively.

Conclusions

In skeletally immature patients, statistically significant differences in accuracy were obtained when comparing the standard 3 AP/M/L views with more limited M/L views, suggesting that this set of 2 views is not as accurate. Differences in sensitivity of limited views were also statistically significant. Conversely, differences in accuracy between the standard 3 views and AP/Lateral views were not statistically significant. While more limited AP/L views may be comparable in accuracy and specificity and lead to dramatically decreased radiation and costs, this can be at the expense of less diagnostic sensitivity and increased risk of misdiagnosing or missing certain fractures.

Level of Evidence

Level III
Benzodiazepine Use for Pediatric Patients With Suspected Nonconvulsive Status Epilepticus With or Without Simplified Electroencephalogram
Authors: Takase Ryo , Sasaki Ryuji , Tsuji Satoshi , Uematsu Satoko , Kubota Mitsuru , Kobayashi Tohru
Published: August 2022

Objectives

In the present study, we aimed to determine the changes in the administration rate of benzodiazepines for pediatric patients with suspected nonconvulsive status epilepticus (NCSE) before and after the introduction of simplified electroencephalography (sEEG) in the emergency department.

Methods

This retrospective cohort study included patients who were younger than 18 years and were admitted to the emergency department from August 1, 2009, to July 31, 2017, with altered level of consciousness and nonpurposeful movement of eyes or extremities after the cessation of convulsive status epilepticus. Patients with apparent persistent convulsions, those who were fully conscious on arrival, and those who were transferred from another hospital were excluded. The patients were categorized into pre and post groups based on the introduction of sEEG, and benzodiazepine administration was compared between the 2 groups.

Results

During the study period, 464 patients with status epilepticus visited our emergency department and 69 and 93 patients fulfilling the study criteria were categorized into the pre and post groups, respectively. There were no significant differences in patient background characteristics between the 2 groups. Simplified electroencephalography was recorded in 52 patients in the post group. Benzodiazepines were administered in 44 of 69 patients (63.8%) in the pre group and 44 of 93 (47.3%) in the post group, and the benzodiazepine administration rate was significantly decreased after the introduction of sEEG (P = 0.04). The hospitalization rate was significantly lower in the post group, but there were no significant differences in the rates of intensive care unit admission, reconvulsion after discharge, and final diagnoses between the 2 groups.

Conclusions

Simplified electroencephalography might aid in determining the need for anticonvulsant treatment for suspected NCSE in pediatric patients. Albeit not a definitive diagnostic tool, sEEG might be a reliable choice in the evaluation of pediatric patients with suspected NCSE.
Childhood tuberculosis
Authors: Cameron Lindsay H. , Cruz Andrea T.
Published: August 2022

Purpose of review

We discuss the most recent literature to support the identification of children at risk for tuberculosis and optimal testing and treatment strategies.

Recent findings

The identification and management of children with tuberculosis has increased in complexity due to the recent severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) pandemic, greater use of immunosuppressive agents, and the administration of shorter, rifamycin-containing treatment regimens. Advancements in the diagnosis and treatment of tuberculosis in children include: use of interferon gamma release assays (IGRAs); molecular-based tests; and shorter courses of treatment. While the essential steps to identify and treat children at risk for tuberculosis remain unchanged, providers must be aware of impact of these challenges.

The SARS-CoV-2 pandemic will likely have a negative impact on global tuberculosis control. It is important that countries maintain a comprehensive approach to the identification and management of children at risk for tuberculosis. Increasing evidence supports enhanced utilization of IGRAs and molecular-based testing to improve the diagnosis of tuberculosis in children. Shorter course, rifamycin-based treatment regimens are available to treat children with tuberculosis infection; however, their use is limited in some immunosuppressed children due to drug-drug interactions.
New approaches to management of fever and neutropenia in high-risk patients
Authors: Douglas Abby , Thursky Karin , Slavin Monica
Published: August 2022

Purpose of review

Patients receiving treatment for acute leukaemia and haematopoietic cell transplantation (HCT) have prolonged neutropenia and are at high risk of neutropenic fever, with bacterial and particularly invasive fungal infections as feared complications, possessing potentially serious consequences including intensive care admission and mortality. Concerns for these serious complications often lead to long durations of broad-spectrum antimicrobial therapy and escalation to even broader therapy if fever persists. Further, the default approach is to continue neutropenic fever therapy until count recovery, leaving many patients who have long defervesced on prolonged antibiotics.

Recent findings

This article details recent progress in this field with particular emphasis on early discontinuation studies in resolved neutropenic fever and improved imaging techniques for the investigation of those with persistent neutropenic fever. Recent randomized controlled trials have shown that early cessation of empiric neutropenic fever therapy is well tolerated in acute leukaemia and autologous HCT patients who are clinically stable and afebrile for 72 h. Delineation of the best approach to cessation (timing and/or use of fluoroquinolone prophylaxis) and whether this approach is well tolerated in the higher risk allogeneic HCT setting is still required. Recent RCT data demonstrate utility of FDG-PET/CT to guide management and rationalize antimicrobial therapy in high-risk patient groups with persistent neutropenic fever.

Acute leukaemic and autologous HCT patients with resolved neutropenic fever prior to count recovery can have empiric therapy safely discontinued or de-escalated. There is an emerging role of FDG-PET/CT to support decision-making about antibiotic and antifungal use in high-risk persistent/recurrent neutropenic fever patients.
Machine Learning in Metopic Craniosynostosis: Does Phenotypic Severity Predict Long-Term Esthetic Outcome?
Authors: Blum Jessica D. , Beiriger Justin , Villavisanis Dillan F. , Morales Carrie , Cho Daniel Y. , Tao Wenzheng , Whitaker Ross , Bartlett Scott P. , Taylor Jesse A. , Goldstein Jesse A. , Swanson Jordan W.
Published: August 2022

Background:

There have been few longitudinal studies assessing the effect of preoperative phenotypic severity on long-term esthetic outcomes in metopic craniosynostosis. This study evaluates the relationship between metopic severity and long-term esthetic outcomes using interfrontal angle (IFA) and CranioRate, a novel metopic synostosis severity measure.

Methods:

Patients with metopic craniosynostosis who underwent bifrontal orbital advancement and remodeling between 2012 and 2017 were reviewed. Preoperative computed tomography head scans were analyzed for IFA and CranioRate, a machine learning algorithm which generates quantitative severity ratings including metopic severity score (MSS) and cranial morphology deviation (CMD). Long-term esthetic outcomes were assessed by craniofacial surgeons using blinded 3-rater esthetic grading of clinical photos. Raters assessed Whitaker score and the presence of temporal hollowing, lateral orbital retrusion, frontal bone irregularities and/or “any visible irregularities.”

Results:

Preoperative scans were performed at a mean age of 7.7±3.4 months, with average MSS of 6/10, CMD of 200/300, and IFA of 116.8±13.8 degrees. Patients underwent bifrontal orbital advancement and remodeling at mean 9.9±3.1 months. The average time from operation to esthetic assessment was 5.4±1.0 years. Pearson correlation revealed a significant negative correlation between MSS and age at computed tomography (r=−0.451, P=0.004) and IFA (r=−0.371, P=0.034) and between IFA and age at surgery (r=−0.383, P=0.018). In multinomial logistic regression, preoperative MSS was the only independent predictor of visible irregularities (odds ratio=2.18, B=0.780, P=0.024) and preoperative IFA alone significantly predicted Whitaker score, with more acute IFA predicting worse Whitaker score (odds ratio=0.928, B=−0.074, P=0.928).

Conclusions:

More severe preoperative phenotypes of metopic craniosynostosis were associated with worse esthetic dysmorphology. Objective measures of preoperative metopic severity predicted long-term esthetic outcomes.
An International Expert Delphi Consensus on Defining Textbook Outcome in Liver Surgery (TOLS)
Authors: Görgec Burak , Benedetti Cacciaguerra Andrea , Pawlik Timothy M. , Aldrighetti Luca A. , Alseidi Adnan A. , Cillo Umberto , Kokudo Norihiro , Geller David A. , Wakabayashi Go , Asbun Horacio J. , Besselink Marc G. , Cherqui Daniel , Cheung Tan To , Clavien Pierre-Alain , Conrad Claudius , D’Hondt Mathieu , Dagher Ibrahim , Dervenis Christos , Devar John , Dixon Elijah , Edwin Bjørn , Efanov Mikhail , Ettore Giuseppe M. , Ferrero Alessandro , Fondevilla Constantino , Fuks David , Giuliante Felice , Han Ho-Seong , Honda Goro , Imventarza Oscar , Kooby David A. , Lodge Peter , Lopez-Ben Santiago , Machado Marcel A. , Marques Hugo P. , O’Rourke Nick , Pekolj Juan , Pinna Antonio D. , Portolani Nazario , Primrose John , Rotellar Fernando , Ruzzenente Andrea , Schadde Erik , Siriwardena Ajith K. , Smadi Sameer , Soubrane Olivier , Tanabe Kenneth K. , Teh Catherine S.C. , Torzilli Guido , Van Gulik Thomas M. , Vivarelli Marco , Wigmore Stephen J. , Abu Hilal Mohammad
Published: August 2022

Objective:

To reach global expert consensus on the definition of TOLS in minimally invasive and open liver resection among renowned international expert liver surgeons using a modified Delphi method.

Background:

Textbook outcome is a novel composite measure combining the most desirable postoperative outcomes into one single measure and representing the ideal postoperative course. Despite a recently developed international definition of Textbook Outcome in Liver Surgery (TOLS), a standardized and expert consensus-based definition is lacking.

Methods:

This international, consensus-based, qualitative study used a Delphi process to achieve consensus on the definition of TOLS. The survey comprised 6 surgical domains with a total of 26 questions on individual surgical outcome variables. The process included 4 rounds of online questionnaires. Consensus was achieved when a threshold of at least 80% agreement was reached. The results from the Delphi rounds were used to establish an international definition of TOLS.

Results:

In total, 44 expert liver surgeons from 22 countries and all 3 major international hepato-pancreato-biliary associations completed round 1. Forty-two (96%), 41 (98%), and 41 (98%) of the experts participated in round 2, 3, and 4, respectively. The TOLS definition derived from the consensus process included the absence of intraoperative grade ≥2 incidents, postoperative bile leakage grade B/C, postoperative liver failure grade B/C, 90-day major postoperative complications, 90-day readmission due to surgery-related major complications, 90-day/in-hospital mortality, and the presence of R0 resection margin.

Conclusions:

This is the first study providing an international expert consensus-based definition of TOLS for minimally invasive and open liver resections by the use of a formal Delphi consensus approach. TOLS may be useful in assessing patient-level hospital performance and carrying out international comparisons between centers with different clinical practices to further improve patient outcomes.
Impact of Axillary Lymph Node Dissection and Sentinel Lymph Node Biopsy on Upper Limb Morbidity in Breast Cancer Patients
Authors: Che Bakri Nur Amalina , Kwasnicki Richard M. , Khan Naairah , Ghandour Omar , Lee Alice , Grant Yasmin , Dawidziuk Aleksander , Darzi Ara , Ashrafian Hutan , Leff Daniel R.
Published: August 2022

Objective:

To evaluate the impact of axillary lymph node dissection (ALND) and sentinel lymph node biopsy (SLNB) on upper limb (UL) morbidity in breast cancer patients.

Background:

Axillary de-escalation is motivated by a desire to reduce harm of ALND. Understanding the impact of axillary surgery and disparities in operative procedures on postoperative arm morbidity would better direct resources to the point of need and cement the need for de-escalation strategies.

Methods:

Embase, MEDLINE, CINAHL, and PsychINFO were searched from 1990 until March 2020. Included studies were randomized-controlled and observational studies focusing on UL morbidities, in breast surgery patients. The study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The prevalence of UL morbidity comparing SLNB and ALND at <12 months, 12 to 24 months, and beyond 24 months were analyzed.

Results:

Sixty-seven studies were included. All studies reported a higher rate of lymphedema and pain after ALND compared with SLNB. The difference in lymphedema and pain prevalence between SLNB and ALND was 13.7% (95% confidence interval: 10.5–16.8, P<0.005) and 24.2% (95% confidence interval: 12.1–36.3, P<0.005), respectively. Pooled estimates for prevalence of reduced strength and range of motion after SLNB and ALND were 15.2% versus 30.9% and 17.1% versus 29.8%, respectively. Type of axillary surgery, greater body mass index, and radiotherapy were some of the predictors for UL morbidities.

Conclusions:

Prevalence of lymphedema after ALND was higher than previously estimated. ALND patients experienced greater rates of lymphedema, pain, reduced strength, and range of motion compared with SLNB. The findings support the continued drive to de-escalate axillary surgery.
Persistent Hiccups Induced by Supratentorial Infarcts and Successful Treatments With Combination of Perampanel and Baclofen: A Case Report
Authors: Morita Kohei , Nuki Yoshitsugu , Hashizume Hiroya , Togo Masaya
Published: August 2022

Case

A 52-year-old man developed a cerebral infarction from the right middle cerebral artery occlusion, and the infarction extensively damaged the right insula. Three months after the onset of the cerebral infarction, persistent hiccups appeared, occurring during sleep. The thoracic and abdominal cavities showed no lesions; hence, the hiccups were considered to be caused by central nervous system dysfunction. Administration of metoclopramide, chlorpromazine, and diazepam were ineffective, while levetiracetam had a partial effect. Combining perampanel with baclofen finally suppressed the symptoms.

Discussion

Lesions at the right insula impair respiratory reflex and may present with hiccups as a symptom of respiratory reflex disinhibition. Here, we review similar cases of treatment-resistant hiccups, as well as perampanel and baclofen efficacy in myoclonus cases.

Conclusions

Our patient's case suggested that perampanel with baclofen may be effective for myoclonus due to respiratory reflex disinhibition and can be used to treat hiccups derived from cerebral infarctions.
Lab practices that improve coronavirus disease 2019 detection accuracy using real-time PCR
Authors: Soufan Ghadir , Berro Nour , Nahle Sahar , Darwish Malak , Ghaddar Maysaa , Makki Mohamad , Younes Mahmoud , Sater Fadi Abdel
Published: August 2022

The number of coronavirus disease 2019 (COVID-19) cases significantly increased with the emergence of multiple variants of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This has led to an ongoing effort focused on developing the diagnostic detection tests. Among the currently available tests, real-time reverse transcriptase PCR (RT-PCR) has been considered as the ‘golden method’ for the detection of SARS-COV-2. However, a significant number of inaccurate (false-negative/false-positive) results have been reported in spite of this method's reliability and effectiveness. These unreliable results may arise because of various issues encountered throughout the entire testing process starting with the sampling phase, going through the PCR process, and ending with the result analysis. This article aims to shed light on the errors that occur during the COVID-19 testing process and suggest ways to overcome them effectively. Accurate testing could be optimized by following the correct swabbing technique, using adequate RT-PCR kits and controls, setting clear lab guidelines, and properly interpreting the results.
Optimal health and economic impact of non-pharmaceutical intervention measures prior and post vaccination in England: a mathematical modelling study
Authors: Tildesley Michael J. , Vassall Anna , Riley Steven , Jit Mark , Sandmann Frank , Hill Edward M. , Thompson Robin N. , Atkins Benjamin D. , Edmunds John , Dyson Louise , Keeling Matt J.
Published: August 2022

Background.
Even with good progress on vaccination, SARS-CoV-2 infections in the UK may continue to impose a high burden of disease and therefore pose substantial challenges for health policy decision makers. Stringent government-mandated physical distancing measures (lockdown) have been demonstrated to be epidemiologically effective, but can have both positive and negative economic consequences. The duration and frequency of any intervention policy could, in theory, be optimized to maximize economic benefits while achieving substantial reductions in disease.
Methods.
Here, we use a pre-existing SARS-CoV-2 transmission model to assess the health and economic implications of different strengths of control through time in order to identify optimal approaches to non-pharmaceutical intervention stringency in the UK, considering the role of vaccination in reducing the need for future physical distancing measures. The model is calibrated to the COVID-19 epidemic in England and we carry out retrospective analysis of the optimal timing of precautionary breaks in 2020 and the optimal relaxation policy from the January 2021 lockdown, considering the willingness to pay (WTP) for health improvement.
Results.
We find that the precise timing and intensity of interventions is highly dependent upon the objective of control. As intervention measures are relaxed, we predict a resurgence in cases, but the optimal intervention policy can be established dependent upon the WTP per quality adjusted life year loss avoided. Our results show that establishing an optimal level of control can result in a reduction in net monetary loss of billions of pounds, dependent upon the precise WTP value.
Conclusion.
It is vital, as the UK emerges from lockdown, but continues to face an on-going pandemic, to accurately establish the overall health and economic costs when making policy decisions. We demonstrate how some of these can be quantified, employing mechanistic infectious disease transmission models to establish optimal levels of control for the ongoing COVID-19 pandemic.
Psychological inoculation can reduce susceptibility to misinformation in large rational agent networks
Authors: Pilditch Toby D. , Roozenbeek Jon , Madsen Jens Koed , van der Linden Sander
Published: August 2022

The unchecked spread of misinformation is recognized as an increasing threat to public, scientific and democratic health. Online networks are a contributing cause of this spread, with echo chambers and polarization indicative of the interplay between the search behaviours of users and reinforcement processes within the system they inhabit. Recent empirical work has focused on interventions aimed at inoculating people against misinformation, yielding success on the individual level. However, given the evolving, dynamic information context of online networks, important questions remain regarding how such inoculation interventions interact with network systems. Here we use an agent-based model of a social network populated with belief-updating users. We find that although equally rational agents may be assisted by inoculation interventions to reject misinformation, even among such agents, intervention efficacy is temporally sensitive. We find that as beliefs disseminate, users form self-reinforcing echo chambers, leading to belief consolidation—irrespective of their veracity. Interrupting this process requires ‘front-loading’ of inoculation interventions by targeting critical thresholds of network users before consolidation occurs. We further demonstrate the value of harnessing tipping point dynamics for herd immunity effects, and note that inoculation processes do not necessarily lead to increased rates of ‘false-positive’ rejections of truthful communications.
Alternative COVID-19 mitigation measures in school classrooms: analysis using an agent-based model of SARS-CoV-2 transmission
Authors: Woodhouse M. J. , Aspinall W. P. , Sparks R. S. J. , Brooks-Pollock E. , Relton C.
Published: August 2022

The SARS-CoV-2 epidemic has impacted children's education, with schools required to implement infection control measures that have led to periods of absence and classroom closures. We developed an agent-based epidemiological model of SARS-CoV-2 transmission in a school classroom that allows us to quantify projected infection patterns within primary school classrooms, and related uncertainties. Our approach is based on a contact model constructed using random networks, informed by structured expert judgement. The effectiveness of mitigation strategies in suppressing infection outbreaks and limiting pupil absence are considered. COVID-19 infections in primary schools in England in autumn 2020 were re-examined and the model was then used to estimate infection levels in autumn 2021, as the Delta variant was emerging and it was thought likely that school transmission would play a major role in an incipient new wave of the epidemic. Our results were in good agreement with available data. These findings indicate that testing-based surveillance is more effective than bubble quarantine, both for reducing transmission and avoiding pupil absence, even accounting for insensitivity of self-administered tests. Bubble quarantine entails large numbers of absences, with only modest impact on classroom infections. However, maintaining reduced contact rates within the classroom can have a major benefit for managing COVID-19 in school settings.
Synergistic effect of nanostructure and calcium ions on improving the bioactivity of titanium implants
Authors: Zhang Yue , Wang Jingwen , Hosseinijenab Shahrzad , Yu Yiqiang , Lv Chao , Luo Cheng , Zhang Weijie , Sun Xi , Zhang Lei
Published: August 2022

Surface structure and composition play essential roles in the osseointegration of titanium implants. In the present study, a nanoscale surface structure incorporated with calcium ions was fabricated on a titanium surface by hydrothermal treatment. The characteristics of the surfaces were analysed, and the bioactivity of the samples was evaluated
in vitro
and
in vivo
. nm-Ti and nm/Ca-Ti surfaces were significantly more hydrophilic than control-Ti surfaces. nm/Ca-Ti samples showed much faster bone-like apatite precipitation in simulated body fluid than the other samples. The results of MC3T3-E1 cell tests demonstrated that both nm-Ti and nm/Ca-Ti surfaces accelerated cell adhesion and proliferation. The highest level of osteogenesis-related genes (Runx2, bone morphogenetic protein-2, osteopontin and osteocalcin) were observed in nm/Ca-Ti samples, followed by nm-Ti samples. Alizarin red staining experiment showed that the amount of extracellular matrix mineralized nodules in nm/Ca-Ti group was significantly higher than others. In animal experiments using SD rats, nm/Ca-Ti showed the highest value of new bone formation at two and four weeks. The present study suggested that the nanostructure and calcium ions showed synergetic effects on accelerating bone-like apatite precipitation and osteoblast cell growth and differentiation. Animal experiment further indicated that such surface could promote early osteogenesis.
Artificial light impacts the mate success of female fireflies
Authors: Owens Avalon C. S. , Lewis Sara M.
Published: August 2022

Anthropogenic light pollution is a novel environmental disruption that affects the movement, foraging and mating behaviour of nocturnal animals. Most of these effects are sublethal, and their net impact on reproductive fitness and population persistence is often extrapolated from behavioural data. Without dedicated tracking of wild individuals, however, it is impossible to predict whether populations in light-polluted habitats will decline or, instead, move to shaded refuges. To disentangle these conflicting possibilities, we investigated how artificial light affects mating and movement in North AmericanPhotinus, a genus of bioluminescent fireflies known to experience courtship failure under artificial light. The degree to which artificial light reduced mate success depended on the intensity of the light treatment, its environmental context, and the temporal niche of the species in question. In the laboratory, direct exposure to artificial light completely prevented mating in semi-nocturnalPhotinus obscurellus. In the field, artificial light had little impact on the movement or mate success of localPhotinus pyralisandPhotinus marginellusbut strongly influenced mate location inPhotinus greeni; all three species are relatively crepuscular. Our nuanced results suggest greater appreciation of behavioural diversity will help insect conservationists and dark sky advocates better target efforts to protect at-risk species.
Facile extraction and characterization of calcium hydroxide from paper mill waste sludge of Bangladesh
Authors: Molla Mohammad Robel , Begum Most. Hosney Ara , Farhad Syed Farid Uddin , Asadur Rahman A. S. M. , Tanvir Nazmul Islam , Bashar Muhammad Shahriar , Bhuiyan Riyadh Hossen , Alam Md. Sha , Hossain Mohammad Sajjad , Rahman Mir Tamzid
Published: August 2022

Herein, paper mill waste sludge (PMS) from two different sources has been investigated to extract calcium hydroxide, Ca(OH)
2
by a facile and inexpensive extraction process. PMS samples, collected from local paper mill plants of Bangladesh, were the main precursors wherein HCl and NaOH were used for chemical treatment. The as-synthesized products were analysed by a variety of characterization tools including X-ray diffraction (XRD), Fourier transform infrared (FTIR) spectroscopy, Raman spectroscopy, scanning electron microscopy (SEM) and energy dispersive X-ray (EDX) elemental analyses. Our studies confirm that the extracted product contains Ca(OH)
2
as a major content, albeit it also includes CaCO
3
phase owing to the inescapable carbonation process from the surrounding environment. The particle size of the synthesized products is in the range of 450–500 nm estimated from SEM micrographs. The crystallite domain size of the same estimated from XRD analyses and was found to be approximately 47 and 31 nm respectively for product-A and product-B considering major (101) Bragg peak of Ca(OH)
2
. The yield percentage of the isolated products is about 65% for samples collected from both sources.