bluuebunny/crossref_metadata_2025 huggingface dataset:
Nasopharyngeal Tube and Functional Treatment in Pierre Robin Sequence: A Tertiary Clinical Experience From 150 Cases
Authors: Blanc Fabian , Harrewijn Inge , Duflos Claire , Maggiulli Frederica , Captier Guillaume
Published: July 2021

Objectives:

To describe the initial care practices for children with Pierre Robin sequence (PRS) and analyze the factors predicting the severity of the obstruction breathing disorders.

Design:

A retrospective single-center study of 150 children with PRS.

Setting:

Single tertiary care center, Regional Competence Center for the diagnosis and treatment of PRS.

Patients:

A total of 150 children with PRS consecutively followed between 1986 and 2017. Group 1 comprises children without specific respiratory management; group 2, children requiring prone positioning to alleviate their respiratory distress symptoms; and group 3, children requiring nasopharyngeal airway tube (NT) or nonconservative surgical treatment.

Main outcome measures:

Evolution and results of the initial treatment of PRS.

Results:

Forty-two percent (n = 63) were attributed to group 1, 39% (n = 50) to group 2, and 19% (n = 29) to group 3. Preterm birth, birth weight, or associated congenital malformations were not significantly different between the groups. However, the age of exclusive oral feeding was significantly different: 1 day (quartiles: 0-3) for group 1; 11 days (quartiles: 1-28) for group 2; 39 days (quartiles: 19-111) for group 3 ( P < .0001). Considering the NT, its use relieves the upper airway obstruction, assessed by a respiratory polygraphy, in 14 children.

Conclusions:

Nasopharyngeal airway tube has become our major first-line treatment, avoiding more complex procedures in most of the cases. The achievement of exclusive oral feeding seems to be a good predictor of the severity of respiratory symptoms in PRS.
Fostering Critical Reflection and Productive Dialogue in Music Teacher Education
Authors: Harry Adam G. , Salvador Karen
Published: July 2021

Because teaching is an inherently political act, it is important for music teacher educators to consider their role in the public discourse and how they approach the political dimensions of teaching with future music educators. In this interest article, we offer a theoretical basis for engaging preservice music teachers in critical reflection and productive dialogue throughout their undergraduate music education coursework. In combination with theory, we describe specific strategies for designing environments and activities that encourage students to identify and question dualistic thinking, engage with diverse ideas and perspectives, and interrogate underlying assumptions and discursive patterns in their own and others’ thinking. Increasing undergraduate student competency in critical reflection and dialogue could motivate and assist them to pass on these important skills to their future PK–12 students.
Error analyses of a Multi-Input-Multi-Output cantilever beam test
Authors: Maji Arup , Moreu Fernando , Woodall James , Hossain Maimuna
Published: July 2021

Multi-Input-Multi-Output vibration testing typically requires the determination of inputs to achieve desired response at multiple locations. First, the responses due to each input are quantified in terms of complex transfer functions in the frequency domain. In this study, two Inputs and five Responses were used leading to a 5 × 2 transfer function matrix. Inputs corresponding to the desired Responses are then computed by inversion of the rectangular matrix using Pseudo-Inverse techniques that involve least-squared solutions. It is important to understand and quantify the various sources of errors in this process toward improved implementation of Multi-Input-Multi-Output testing. In this article, tests on a cantilever beam with two actuators (input controlled smart shakers) were used as Inputs while acceleration Responses were measured at five locations including the two input locations. Variation among tests was quantified including its impact on transfer functions across the relevant frequency domain. Accuracy of linear superposition of the influence of two actuators was quantified to investigate the influence of relative phase information. Finally, the accuracy of the Multi-Input-Multi-Output inversion process was investigated while varying the number of Responses from 2 (square transfer function matrix) to 5 (full-rectangular transfer function matrix). Results were examined in the context of the resonances and anti-resonances of the system as well as the ability of the actuators to provide actuation energy across the domain. Improved understanding of the sources of uncertainty from this study can be used for more complex Multi-Input-Multi-Output experiments.
The Influence of Authority Role and Victim Gender on Perceptions of Female-Perpetrated Child Sexual Abuse
Authors: Muniz Caitlyn N. , Powers Ráchael A.
Published: July 2021

Child sexual abuse is often perceived differently based on characteristics of the victim and the perpetrator. However, unknown is whether variations in perceptions occur when the relationship to and gender of the victim are manipulated—particularly when the offender is a woman. The current study sought to explore whether authority role (neighbor, teacher, family, or clergy) and victim gender affect perceived outcomes for the victim. A factorial vignette design was used to randomly assign participants to one of eight conditions, and a series of analyses of variance (ANOVAs) were conducted to assess differences in perceived victim outcomes for the vignettes. Results showed significant differences for authority role, victim gender, and the interactions between authority and victim gender for nearly all dependent variables. Respondents recognized that the scenarios presented were damaging and harmful; however, certain authority positions (i.e., teachers) were sexualized leading to diminished perceptions of negative outcomes, particularly for male victims.
Investing in Gentrification: The Eligibility of Gentrifying Neighborhoods for Federal Place-Based Economic Investment in U.S. Cities
Authors: Brazil Noli , Portier Amanda
Published: July 2021

Place-based policies commonly target disadvantaged neighborhoods for economic improvement, typically in the form of job opportunities, business development or affordable housing. To ensure that investment is channeled to truly distressed areas, place-based programs narrow the pool of eligible neighborhoods based on a set of socioeconomic criteria. The criteria, however, may not be targeting the places most in need. In this study, we examine the relationship between neighborhood gentrification status and 2018 eligibility for the New Markets Tax Credits, Opportunity Zones, Low Income Housing Tax Credits, and the Community Development Financial Institutions Program. We find that large percentages of gentrifying neighborhoods are eligible for each of the four programs, with many neighborhoods eligible for multiple programs. The Opportunity Zone program stands out, with the probability of eligibility nearly twice as high for gentrifying tracts than not-gentrifying tracts. We also found that the probability of eligibility increases with a greater percentage of adjacent neighborhoods experiencing gentrification.
Ultrasonographic assessment of the caudal vena cava diameter in cats during blood donation
Authors: Sänger Florian , Dorsch Roswitha , Hartmann Katrin , Dörfelt René
Published: July 2021

Objectives

Ultrasonography of the caudal vena cava (CVC) has been previously established to assess fluid status in dogs but not in cats. The aim of this study was to determine CVC diameter changes during feline blood donation.

Methods

Inter- and intra-observer variability were assessed in 11 client-owned cats. Minimal and maximal CVC diameters were assessed longitudinally in the subxiphoid view (SV) and right paralumbar view (PV), and transversely in the right hepatic intercostal view (HV). Eighteen client-owned, healthy, anaesthetised cats were evaluated during 21 blood donation procedures of 10 ml/kg in the same anatomical locations before (T0) and after (T1) blood donation, and after volume resuscitation with 30 ml/kg lactated Ringer’s solution (T2). The CVC index was calculated.

Results

Intra-observer variability was acceptable for all probe positions, except for the HV, whereas inter-observer variability was considered unacceptable for all probe positions. Complete measurements were obtained during 21 blood donations at T0, T1 and T2 at the SV, during 18/21 blood donations at the HV and during 16/21 blood donations at the PV. At the SV, the minimal CVC diameter between T1 and T2 ( P <0.001), and the maximal CVC diameter between T0 and T1 and between T1 and T2 ( P <0.001) were significantly different. At the HV, the minimal vertical diameter, maximal vertical diameter and minimal horizontal diameter were different between all timepoints ( P <0.001). The maximal horizontal diameter was different between T1 and T2 ( P = 0.002). At the PV, both diameters were different between all timepoints ( P <0.001). The CVC index was not different between timepoints.

Conclusion and relevance

Significant probe position dependent CVC diameter changes with marked overlap were observed before and after blood donation, and after fluid bolus. No absolute CVC diameter could be used to indicate hypovolaemia. Ultrasonographic assessment of the feline CVC is highly operator-dependent. The CVC index is not useful in cats.
Ultrasound evaluation of access complications: Thrombosis, aneurysms, pseudoaneurysms and infections
Authors: Meola Mario , Marciello Antonio , Di Salle Gianfranco , Petrucci Ilaria
Published: July 2021

Arteriovenous fistula (AVF) complications are classified based on fistula outcomes. This review aims to update colour Doppler (CD) and pulse wave Doppler (PWD) roles in managing early and late complications of the native and prosthetic AVF. Vascular access (VA) failure occurs because inflow or outflow stenosis activates Wirchow’s triad inducing thrombosis. Therefore, the diagnosis of the tributary artery and outgoing vein stenosis will be the first topic considered. Post-implantation complications occur from the inability to achieve AVF maturation and dialysis suitability due to inflow/outflow stenosis. Late stenosis is usually a sequence of early defects repaired to maintain patency. Less frequently, in the mature AVF or graft, complications are acquired ‘de novo’. They derive either from incorrect management of vascular access (haematoma, pseudoaneurysm, prosthesis infection) or wall pathologies (aneurysm, myxoid valve degeneration, kinking, coiling, abnormal dilation from defects of elastic structures). High-resolution transducers (10–20 MHz) allow the characterization of the wall damage, haemodynamic dysfunctions, early and late complications even if phlebography remains the gold standard for the diagnosis for its sensitivity and specificity.
Estimation of mechanical properties of friction stir processed Al 6061/Al2O3-Tib2 hybrid metal matrix composite layer via artificial neural network and response surface methodology
Authors: Khojastehnezhad Vahid M , Pourasl Hamed H , Bahrami Arian
Published: July 2021

Friction stir processing is one of the solid-state processes which can be used to modify the structure and properties of alloys. In addition, it has become one of the most promising techniques for the preparation of the surface layer composites. To pursue cost savings and a time-efficient design, the mathematical model and optimization of the process can represent a valid choice for engineers. Friction stir processing was employed to generate an Al 6061/Al2O3-TiB2 hybrid composite layer, and mechanical properties such as the hardness and wear behavior were also measured. The relationship between the hardness and wear behavior, process parameters of friction stir processing were evaluated using an artificial neural network and response surface methodology. The rotational speed (1500–1800 rpm), traverse speeds (25, 50, 100 mm/min), and the number of passes (1–4) with constant axial force (2.61 kN) were used as the input, while the hardness and weight loss values were the output. Experimentally, the results showed that the process parameters have significant effect on hardness and wear behavior of Al 6061/Al2O3-TiB2. In addition, the developed artificial neural network and response surface methodology models can be employed as alternative methods to compute the hardness and weight loss for given process parameters. The results of both models showed that the estimated values for the hardness and wear behavior of the processed zone had an error less than 0.60%, which indicated reliability, and an evaluation of the estimated values of both models and the experimental values confirmed that the artificial neural network is a better model than response surface methodology.
Precision bite ramps and aligners: An elective choice for deep bite treatment
Authors: Greco Mario , Rombolà Andrea
Published: July 2021

Objective:

To review a series of clinical studies demonstrating the clinical efficiency of aligners with bite ramps in the treatment of severe deep bite.

Materials and Methods:

In order to predictably manage the correction of deep bite with aligners, precision bite ramps on maxillary incisors have been used while posterior extrusion and anterior intrusion in the lower jaw with lateral attachments and proper levelling of the curve of Spee have been planned. Transverse correction and controlled upper and lower incisors proclination completed the treatment plan.

Results:

Full deep bite correction with normal overbite was obtained in nine months of treatment by a combination of anterior intrusion and posterior torque correction, distal tipping and relative extrusion.

Conclusion:

The use of bite ramps represents a valid option for the successful treatment of deep bite with aligners creating proper space for lateral sector extrusion and supporting lower anterior intrusion and controlled proclination.
Numerical study of ceramic catalytic turbine technology for emission reduction during vehicle warm-up
Authors: Wang Leilei , Tan Xu , Sun Harold , Engeda Abraham , Hou Hongjuan , Kim Jinsu
Published: July 2021

Ceramic Catalytic Turbine (CCT) Technology is expected to become an important means to reduce vehicle emissions, especially during engine warm-up. In this paper, catalytic reaction was numerically simulated in 3D for a CCT on a gasoline engine during the warm-up period. The results showed that turbulence in the turbine promotes catalytic activity; CCT starts to significantly affect exhaust pollution since turbine inlet temperature of 550 K; the conversion efficiency of harmful gas in exhaust rises sharply when turbine inlet reaches 575–625 K; when the inlet temperature is about 720 K, the conversion efficiencies of C3H6, CO, and NO reach 23.7%, 21.1%, and 15.5%, respectively. Meanwhile the gas temperature is increased by about 30 K at turbine outlet. In addition, during the process of numerical modeling and calculation, it is found that minor change in boundary layer thickness has a negligible impact on the simulation. However, an extremely thin boundary layer will cause computational divergence. The intensity of catalytic reaction can influence the convergence of numerical calculation, while the moving average of the catalytic reaction with the turbine inlet temperature, in return, can reveal the catalytic light-off process.
Acoustic emission and moving window-improved kernel entropy component analysis for structural condition monitoring of hoisting machinery under various working conditions
Authors: Li Yang , Xu Feiyun
Published: July 2021

Acoustic emission (AE) has been widely used to the nondestructive evaluation (NDE) and structural health monitoring (SHM) of hoisting machinery recently. Kernel entropy component analysis (KECA) is generally applied to extract the AE features based on its excellent nonlinear ability. However, traditional KECA specifically requires a considerable number of components (e.g. eigenvalues and eigenvectors) to excellently describe the original data, which leads to a reduction in the effect of approximate dimensionality reduction of high-dimensional data, thus causing readily unacceptable condition monitoring result. To overcome this weakness, a novel method named moving window-improved kernel entropy component analysis (MW-IKECA) is proposed in this study for structural condition monitoring of hoisting machinery, which is aimed at extracting more AE feature information and improving the condition identification accuracy. Firstly, a twiddle factor is introduced in the KECA model for the purpose of breaking the restriction that the projection axes originate only from the feature vectors and maximizing the independence between the components. Meanwhile, the moving window local strategy is incorporated into the proposed IKECA to extract more rich and effectiveness AE feature information at different scales. Finally, the Cauchy–Schwarz (CS) statistic is utilized to calculate the similarity between probability density functions and maintain the angular structure of the MW-IKECA feature space for the task of improving the monitoring accuracy and shortening the monitoring time-delay of MW-IKECA. Results of the experimental and practical engineering application validate the effectiveness and superiority of the proposed method in AE-based crane SHM under different working conditions compared with the traditional KECA and some combinatorial methods.
A Community Partnered Approach to Promoting COVID-19 Vaccine Equity
Authors: Scott Taylor , Gutschow Benjamin , Ragavan Maya I. , Ho Ken , Massart Mylynda , Ripper Lisa , Muthama Victor , Miller Elizabeth , Bey Jamil , Abernathy Rev. Paul
Published: July 2021

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately affected communities of color. To dismantle these disparities, it is critical to promote COVID-19 vaccine equity, both through increasing vaccine access and addressing vaccine mistrust. This article describes a community–academic collaboration (the Community Vaccine Collaborative [CVC]), whose mission is to ensure COVID-19 vaccine equity among marginalized communities. Based in Pittsburgh, Pennsylvania, our group has focused on inclusion of marginalized groups into vaccine clinical trials, addressing vaccine mistrust, and building systems to ensuring equitable access to the COVID-19 vaccine. We review formation of the CVC, activities to-date, and recommendations for other communities interested in developing similar collaboratives.
Pancreatic acinar cells utilize tyrosine to synthesize L-dihydroxyphenylalanine
Authors: Li Guang-Wen , Li Ji , Feng Xiao-Yan , Chen Hui , Chen Ye , Liu Jing-Hua , Zhang Yue , Hong Feng , Zhu Jin-Xia
Published: July 2021

The pancreatic β cells can synthesize dopamine by taking L-dihydroxyphenylalanine, but whether pancreatic acinar cells synthesize dopamine has not been confirmed. By means of immunofluorescence, the tyrosine hydroxylase -immunoreactivity and aromatic amino acid decarboxylase (AADC)- immunoreactivity were respectively observed in pancreatic acinar cells and islet β cells. Treatment with L-dihydroxyphenylalanine, not tyrosine, caused the production of dopamine in the incubation of INS-1 cells (rat islet β cell line) and primary isolated islets, which was blocked by AADC inhibitor NSD-1015. However, only L-dihydroxyphenylalanine, but not dopamine, was detected when AR42J cells (rat pancreatic acinar cell line) were treated with tyrosine, which was blocked by tyrosine hydroxylase inhibitor AMPT. Dopamine was detected in the coculture of INS-1 cells with AR42J cells after treatment with tyrosine. In an in vivo study, pancreatic juice contained high levels of L-dihydroxyphenylalanine and dopamine. Both L-dihydroxyphenylalanine and dopamine accompanied with pancreatic enzymes and insulin in the pancreatic juice were all significantly increased after intraperitoneal injection of bethanechol chloride and their increases were all blocked by atropine. Inhibiting TH with AMPT blocked bethanechol chloride-induced increases in L-dihydroxyphenylalanine and dopamine, while inhibiting AADC with NSD-1015 only blocked the dopamine increase. Bilateral subdiaphragmatic vagotomy of rats leads to significant decreases of L-dihydroxyphenylalanine and dopamine in pancreatic juice. These results suggested that pancreatic acinar cells could utilize tyrosine to synthesize L-dihydroxyphenylalanine, not dopamine. Islet β cells only used L-dihydroxyphenylalanine, not tyrosine, to synthesize dopamine. Both L-dihydroxyphenylalanine and dopamine were respectively released into the pancreatic duct, which was regulated by the vagal cholinergic pathway. The present study provides important evidences for the source of L-dihydroxyphenylalanine and dopamine in the pancreas.
Digital Lifestyle Medicine: Designing, Delivering, and Scaling for Impact
Authors: Mauriello Leanne , Artz Kristi
Published: July 2021

Digital Lifestyle Medicine (DLM) is a consumer-centric model of care which elevates the importance of daily behaviors in preventing and reversing chronic disease using virtual and digital modalities to reach patients in the context where lifestyle behaviors occur and empower them to stay well. DLM is health care reimagined, designed to inspire patients to live their best life by enabling skill-building, self-efficacy, and sustainable behavior change supported by peers, scientific-evidence, and a multidisciplinary team of lifestyle medicine (LM) clinicians. Importantly, it requires insights and collaboration from healthcare experts and technology entrepreneurs to provide a profoundly different “user experience” layered with context, relevance, and scalability. Using examples from our DLM practice, we describe how key components of LM practice, including a multidisciplinary care team, behavior change support, health coaching, and peer support, are prime for digital delivery. We conclude by providing preliminary patient outcomes to date, key success factors, and opportunities for enhancement and expansion to inform the adoption and successful implementation of DLM across the collective of LM practice.
COVID-19: Implications for Physical Activity, Health Disparities, and Health Equity
Authors: Hasson Rebecca , Sallis James F. , Coleman Nailah , Kaushal Navin , Nocera Vincenzo G. , Keith NiCole
Published: July 2021

Physical activity is one of the most efficacious pathways to promoting mental and physical health, preventing disease, and, most important during the COVID-19 pandemic, bolstering a stronger immune system. Efforts to “flatten the curve” have resulted in the temporary closure of exercise facilities and gyms, suspension of sport activities, and advisories to avoid public recreational spaces. All of these changes have made traditional opportunities to be physically active difficult to access. These changes have also exacerbated existing disparities in access to social and environmental supports for physical activity, potentially contributing to a widening gap in physical activity participation among those at greatest risk for COVID-19. Physical activity can play a special role in reducing the inequitable consequences of COVID-19; however, expansion and better targeting of evidence-informed interventions are needed that address the unique barriers present in communities that have been economically and socially marginalized to achieve health equity in COVID-19 outcomes. This review highlights effective and feasible strategies that provide more equitable access to physical activity programs and spaces across the United States. With a renewed investment in physical activity, this behavior can play a crucial role in improving population health and reducing disparities during the COVID-19 pandemic and beyond.
Principal professional identity: Giving voice to children in a vulnerable Spanish context
Authors: Rodríguez Carmen Lucena , Cruz-González Cristina , Segovia Jesús Domingo
Published: July 2021

This case study investigated the strategies used by a school principal who successfully leads an educational centre in a vulnerable context. This article aims to explore how a school in a vulnerable context can be strengthened by the actions implemented by the principal and his leadership based on social and pedagogical commitment. Initially, the key aspects identified by the school community in the principal’s identity were analysed, and subsequently compared with their own perception to understand their professional development and leadership practices. The findings identify three main strategies that have been implemented to improve the school climate: (a) building relationships and involving the community in educational change; (b) enhancing cooperative work and the joint vision of the school–professional learning communities; and (c) give children a voice, respect children and fight for equal opportunities. Comprehensive keys to professional practice are drawn from these findings.
Mechanochemical sulfonation of aromatic compounds using NaHSO4·H2O/P2O5
Authors: Zuo Lu-Lu , Qin Shuai , Zhang Pu , Qin Yu-Jun , Guo Zhi-Xin
Published: July 2021

A series of aromatic sulfonic acids is synthesized by subjecting arenes and NaHSO4·H2O to high-speed ball milling in the presence of P2O5. It is suggested the aromatic sulfonation occurs via in situ generated H2SO4 to give aromatic sulfonic acids. In some cases, formation of diaryl sulfones was observed.
Outcomes of endovascular treatment for acute ischaemic stroke in Mater Dei Hospital, Malta
Authors: Cilia Kyle , Grech Reuben , Mallia Maria
Published: July 2021

Introduction

The aim of this study was to assess the outcomes of endovascular treatment for acute ischaemic stroke in Mater Dei Hospital, Malta and compare them with international data.

Methods

A prospective review of all patients who underwent mechanical thrombectomy from 2015 to the end of 2019 was performed. Eligible patients had large vessel occlusion confirmed on computed tomography angiography. Demographical data, the National Institutes of Health stroke scale at presentation, endovascular procedure details and process times were analysed. The thrombolysis in cerebral infarction score was used to assess the degree of reperfusion. A thrombolysis in cerebral infarction score of 2b–3 was considered as successful recanalisation. Functional outcome (modified Rankin scale score) and mortality at 90 days were measured. Functional independence was defined as a modified Rankin scale score of 2 or less.

Results

A total of 132 patients underwent endovascular treatment, one patient was excluded due to incomplete data. The mean age was 71 (range 25–94) years, and the mean National Institutes of Health stroke scale at presentation was 14. Of the 131 patients treated, 69 received intravenous thrombolysis. Successful recanalisation (thrombolysis in cerebral infarction score 2b–3) was achieved in 80% of patients (105/131); 53% of patients (69/131) achieved functional independence at 90 days, with a mortality of 21% at 90 days. Symptomatic intracranial haemorrhage was recorded in 16 patients (12%) There was a statistical difference in the functional independence and mortality rate in favour of the successful recanalisation group.

Conclusion

Our data are consistent with a favourable clinical outcome after successful recanalisation. Service in Malta is achieving favourable outcomes for patients treated with mechanical thrombectomy for acute ischaemic stroke.
Relationship between sarcopenia/myosteatosis and frailty in hospitalized patients with cirrhosis: a sex-stratified analysis
Authors: Feng Hongjuan , Wang Xiaoyu , Mao Lihong , Yu Zihan , Cui Binxin , Lin Lin , Hui Yangyang , Zhao Xingliang , Xu Xin , Fan Xiaofei , Wang Bangmao , Yu Qingxiang , Jiang Kui , Sun Chao
Published: July 2021

Background:

Previous studies have shown that sarcopenia appears to be a significant contributor to physical frailty among outpatients with cirrhosis. However, the evidence is scant regarding the relationship between sarcopenia and multi-dimensional frailty among inpatients. We aimed to investigate the potential contribution of sarcopenia to frailty in hospitalized patients with cirrhosis in a sex-dependent manner.

Methods:

This cohort enrolled consecutive cirrhotics. Muscle quantity and quality were assessed using the computed tomography-based skeletal muscle index (SMI) and intramuscular adipose tissue content, respectively. Frailty phenotype was clarified by a self-reported Frailty Index. Multiple linear regression determined the association between sarcopenia and frailty phenotype.

Results:

A total of 202 cirrhotic patients with 48.5% male were included. The median Frailty Index was 0.13, rendering 17.3% subjects as frail. Among the 16 frail men, 68.8% had sarcopenia and 62.5% exhibited myosteatosis. In contrast, among the 19 frail women, 26.3% had sarcopenia and 15.8% exhibited myosteatosis. Frail patients had a significantly lower median SMI (42.80 cm2/m2) compared with those with pre-frailty (48.23 cm2/m2) and with robust status (50.82 cm2/m2) in the male but not the female group. In male patients, multivariate linear regression implicated age (β  = 0.330, p < 0.001), SMI (β  = −0.260, p < 0.001), albumin (β  = −0.245, p = 0.005), and sodium (β  = −0.179, p = 0.037) as independent risk factors for frailty.

Conclusion:

Sarcopenia is associated with multi-dimensional frailty in male patients with cirrhosis. It is tempting to incorporate sex-specific intervention with the purpose of mitigating frailty among inpatients.
Rehabilitation and Return-to-Play Criteria After Fresh Osteochondral Allograft Transplantation: A Systematic Review
Authors: Stark Michael , Rao Somnath , Gleason Brendan , Jack Robert A. , Tucker Bradford , Hammoud Sommer , Freedman Kevin B.
Published: July 2021

Background:

Fresh osteochondral allograft (OCA) is a treatment option that allows for the transfer of size-matched allograft cartilage and subchondral bone into articular defects of the knee. Although long-term studies show good functional improvement with OCA, there continues to be wide variability and a lack of consensus in terms of postoperative rehabilitation protocols and return to sport.

Purpose:

To systematically review the literature and evaluate the reported rehabilitation protocols after OCA of the knee, including weightbearing and range of motion (ROM) restrictions as well as return-to-play criteria.

Study Design:

Systematic review; Level of evidence, 4.

Methods:

PubMed, EMBASE, Cumulative Index of Nursing Allied Health Literature, SPORTDiscus, and Cochrane databases were searched according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for studies on knee OCA. Studies were included if they reported return-to-play data or postsurgical rehabilitation protocols.

Results:

A total of 62 studies met the inclusion criteria, with a total of 3451 knees in 3355 patients. Concomitant procedures were included in 30 of these studies (48.4%). The most commonly cited rehabilitation protocols included weightbearing restrictions and ROM guidelines in 100% and 90% of studies, respectively. ROM was most commonly initiated within the first postoperative week, with approximately half of studies utilizing continuous passive motion. Progression to weightbearing as tolerated was reported in 60 studies, most commonly at 6 weeks (range, immediately postoperatively to up to 1 year). Of the 62 studies, 37 (59.7%) included an expected timeline for either return to play or return to full activity, most commonly at 6 months (range, 4 months to 1 year). Overall, 13 studies (21.0%) included either objective or subjective criteria to determine return to activity within their rehabilitation protocol.

Conclusion:

There is significant heterogeneity for postoperative rehabilitation guidelines and the return-to-play protocol after OCA of the knee in the literature, as nearly half of the included studies reported use of concomitant procedures. However, current protocols appear to be predominantly time-based without objective criteria or functional assessment. Therefore, the authors recommend the development of objective criteria for patient rehabilitation and return-to-play protocols after OCA of the knee.
Interaction between cognitive leisure activity and long-chain polyunsaturated fatty acid intake on global cognitive decline in a Japanese longitudinal cohort study: National Institute for Longevity Sciences-Longitudinal Study of Aging
Authors: Horikawa Chika , Otsuka Rei , Nishita Yukiko , Tange Chikako , Kato Yuki , Tanaka Takao , Rogi Tomohiro , Shibata Hiroshi , Ando Fujiko , Shimokata Hiroshi
Published: July 2021

Background

There is a growing interest in the significance of adopting a variety of lifestyle habits for maintaining cognitive function among older adults. A lifestyle that is easy to modify, simple, and less burdensome for older people is ideal. We investigated the longitudinal association between global cognitive decline and cognitive leisure activities (CLAs) combined with long-chain polyunsaturated fatty acids (LCPUFAs) intake.

Methods

The National Institute for Longevity Sciences-Longitudinal Study of Aging (NILS-LSA) enrolled community-dwelling middle-aged and older men and women who were randomly selected from Obu-City and Higashiura Town, Aichi, Japan. Baseline data (2006–2008), including CLAs and dietary intake, were obtained from 517 participants (aged 60–84 years) with normal cognition. Global cognitive decline, defined as the Mini-Mental State Examination (MMSE) score ≤ 27, was assessed at baseline and four years later. Interaction between CLAs and LCPUFAs on cognitive decline was investigated using a multiple logistic analysis with adjustment for confounders. CLA engagement and LCPUFA intake were divided into high and low groups according to the frequency at which each participant engaged in the activity and the median intake level according to sex, respectively.

Results

A significant interaction was detected for the combination of CLA engagement and LCPUFA intake. Logistic regression coefficients revealed significant interactions when participants engaged in more than five CLA varieties. One of the CLAs, art appreciation, produced a significant main effect against cognitive decline and a significant interaction in combination with LCPUFA intake. The major LCPUFAs—docosahexaenoic acid and arachidonic acid—also exhibited a significant interaction. The combination of high LCPUFA intake and high art appreciation frequency yielded a lower adjusted odds ratio for cognitive decline than the combination of low LCPUFA and low art appreciation [0.25 (95 % confidence intervals, 0.11–0.56)].

Conclusions

Preserving cognitive function might be associated with a combination of varied and high-frequency engagement in CLAs combined with high LCPUFA intake.
Factors associated with TBS worse than BMD in non-osteoporotic elderly population: Bushehr elderly health program
Authors: Panahi Nekoo , Ostovar Afshin , Fahimfar Noushin , Aghaei Meybodi Hamid Reza , Gharibzadeh Safoora , Arjmand Babak , Sanjari Mahnaz , Khalagi Kazem , Heshmat Ramin , Nabipour Iraj , Soltani Akbar , Larijani Bagher
Published: July 2021

Background

Bone mineral density (BMD) and trabecular bone score (TBS) are moderately correlated. TBS is sometimes used as an adjuvant to BMD in the fracture risk assessment. Some individuals with normal BMD or osteopenia, have more degraded TBS. We aimed to identify factors associated with TBS worse than BMD in the non-osteoporotic elderly population.

Methods

The study subjects were selected from 2384 women and men aged ≥60 years participating in the second stage of the Bushehr Elderly Health program, a population-based prospective cohort study in Iran. The BMDs of different sites and the lumbar spine texture were measured using dual-energy X-ray absorptiometry and the TBS algorithm, respectively. Subjects were categorized based on their BMD and TBS status. Logistic regression was performed to identify the factors associated with “TBS worse than BMD” in non-osteoporotic individuals.

Results

Of 1335 participants included in the study, 112 of 457 women, and 54 of 878 men had worse TBS than BMD. In multivariable analysis, TBS worse than BMD in women was statistically significantly associated with years since menopause (OR: 1.04 (1.00–1.07)) and waist circumference (OR: 1.09 (1.05–1.14)). However, in men, the condition was statistically significantly associated with waist circumference (OR: 1.10 (1.03–1.17)), current smoking (OR: 2.54 (1.10–5.84)), and HDL-C (OR: 1.03 (1.00–1.06)).

Conclusion

The results of the study show that higher waist circumference is associated with more degraded TBS than BMD in both men and women. Years passed since menopause and current smoking, respectively in women and men, were associated with more degraded TBS. Considering TBS values in older individuals with higher waist circumference, or a history of smoking despite normal BMDs might help more accurate assessment of bone health. However, further studies are required to confirm the benefit.
Effectiveness comparisons of drug therapies for postoperative aneurysmal subarachnoid hemorrhage patients: network meta‑analysis and systematic review
Authors: Yu Wanli , Huang Yizhou , Zhang Xiaolin , Luo Huirong , Chen Weifu , Jiang Yongxiang , Cheng Yuan
Published: July 2021

Objective

To compare the effectiveness of various drug interventions in improving the clinical outcome of postoperative patients after aneurysmal subarachnoid hemorrhage (aSAH) and assist in determining the drugs of definite curative effect in improving clinical prognosis.

Methods

Eligible Randomized Controlled Trials (RCTs) were searched in databases of PubMed, EMBASE, and Cochrane Library (inception to Sep 2020). Glasgow Outcome Scale (GOS) score, Extended Glasgow Outcome Scale (GOSE) score or modified Rankin Scale (mRS) score was used as the main outcome measurements to evaluate the efficacy of various drugs in improving the clinical outcomes of postoperative patients with aSAH. The network meta-analysis (NMA) was conducted based on a random-effects model, dichotomous variables were determined by using odds ratio (OR) with 95% confidence interval (CI), and a surface under the cumulative ranking curve (SUCRA) was generated to estimate the ranking probability of comparative effectiveness among different drug therapies.

Results

From the 493 of initial citation screening, forty-four RCTs (n = 10,626 participants) were eventually included in our analysis. Our NMA results showed that cilostazol (OR = 3.35,95%CI = 1.50,7.51) was the best intervention to improve the clinical outcome of patients (SUCRA = 87.29%, 95%CrI 0.07–0.46). Compared with the placebo group, only two drug interventions [nimodipine (OR = 1.61, 95%CI 1.01,2.57) and cilostazol (OR = 3.35, 95%CI 1.50, 7.51)] achieved significant statistical significance in improving the clinical outcome of patients.

Conclusions

Both nimodipine and cilostazol have exact curative effect to improve the outcome of postoperative patients with aSAH, and cilostazol may be the best drug to improve the outcome of patients after aSAH operation. Our study provides implications for future studies that, the combination of two or more drugs with relative safety and potential benefits (e.g., nimodipine and cilostazol) may improve the clinical outcome of patients more effectively.
Atypical presentation of Charcot-Marie-Tooth disease type 1C with a new mutation: a case report
Authors: Turčanová Koprušáková Monika , Grofik Milan , Kantorová Ema , Jungová Petra , Chandoga Ján , Kolisek Martin , Valkovič Peter , Škorvánek Matej , Ploski Rafal , Kurča Egon , Sivák Štefan
Published: July 2021

Background

Charcot-Marie-Tooth 1C (CMT1C) is a rare form of dominantly inherited CMT1 neuropathy caused by a mutated gene encoding lipopolysaccharide-induced tumour necrosis alpha factor (LITAF).

Case presentation

We report a 56-year-old patient with an atypical clinical phenotype of CMT1C, which started as progressive weakness of a single upper limb resembling acquired inflammatory neuropathy. Nerve conduction studies (NCS) and temporarily limited and partial effects of immunotherapy supported the diagnosis of inflammatory neuropathy. Significant progression of polyneuropathy, despite intensive long-lasting immunotherapy, together with repeatedly negative auxiliary investigations (CSF, MRI and antibodies) and genetic testing results finally led to the diagnosis of CMT1C neuropathy.

Conclusions

CMT1C should be added to the list of inherited neuropathies that need to be considered in suspected cases of inflammatory demyelinating neuropathy.
Are birth outcomes in low risk birth cohorts related to hospital birth volumes? A systematic review
Authors: Walther Felix , Kuester Denise , Bieber Anja , Malzahn Jürgen , Rüdiger Mario , Schmitt Jochen
Published: July 2021

Background

There is convincing evidence that birth in hospitals with high birth volumes increases the chance of healthy survival in high-risk infants. However, it is unclear whether this is true also for low risk infants. The aim of this systematic review was to analyze effects of hospital’s birth volume on mortality, mode of delivery, readmissions, complications and subsequent developmental delays in all births or predefined low risk birth cohorts. The search strategy included EMBASE and Medline supplemented by citing and cited literature of included studies and expert panel highlighting additional literature, published between January/2000 and February/2020. We included studies which were published in English or German language reporting effects of birth volumes on mortality in term or all births in countries with neonatal mortality < 5/1000. We undertook a double-independent title-abstract- and full-text screening and extraction of study characteristics, critical appraisal and outcomes in a qualitative evidence synthesis.

Results

13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive.

Conclusion

Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries.

Systematic review registration

PROSPERO: CRD42018095289
Vaginal misoprostol versus intracervical Foley catheter for cervical ripening in postdate primigravid women: a randomized clinical trial
Authors: Abdi Nazanin , Alavi Azin , Pakbaz Forough , Darabi Hossein
Published: July 2021

Background

Being one of the most common indications of labor induction, postdate pregnancy can lead to serious maternal and fetal complications. In this study we aimed to compare vaginal misoprostol with intracervical Foley catheter (FC) for cervical ripening in postdate primigravid women.

Methods

This randomized clinical trial included 120 primigravid women aged 18–35 years with singleton,  postdate pregnancies, and Bishop score ≤ 4. Participants were randomized into two equal groups. The first group received 25 µg vaginal misoprostol and the second group had an 18 Fr FC inserted into their cervical canal. Labor induction was performed using oxytocin in both groups if progression of labor or true contractions did not occur within 6 h of the interventions. In case of nonreassuring fetal heart rate, fetal distress, placental abruption, or prolonged labor, C-section was performed.

Results

The frequency of normal vaginal delivery, Cesarean section, meconium-stained amniotic fluid, and neonatal intensive care unit admission did not differ significantly between groups. Placental abruption and uterine tachysystole occurred more frequently in the misoprostol group (15.0 vs. 1.7%, P = 0.008 and 21.7 vs. 0.0%, P < 0.001, respectively). A significantly higher number of women in the FC group required oxytocin (73.3 vs. 41.7%, P < 0.001). Duration of labor was significantly higher in the FC group (P = 0.001).

Conclusions

Due to the lower rate of placental abruption and uterine tachysystole observed with FC, it appears to be superior to vaginal misoprostol for cervical ripening in postdate primigravid women; however, its longer labor duration and higher oxytocin requirement should be taken into consideration.

Trial registration

Iranian Registry of Clinical Trials, IRCT20181218042033N4. Registered 19/04/2020. Retrospectively registered, https://www.irct.ir/trial/47037
Primary tumor surgery improves survival in non-metastatic primary urethral carcinoma patients: a large population-based investigation
Authors: Wu Jie , Wang Yu-Chen , Luo Wen-Jie , Bo-Dai  , Ye Ding-Wei , Zhu Yi-Ping
Published: July 2021

Background

Primary urethral carcinoma (PUC) is a rare genitourinary malignancy with a relatively poor prognosis. The aim of this study was to examine the impact of surgery on survival of patients diagnosed with PUC.

Methods

A total of 1544 PUC patients diagnosed between 2004 and 2016 were identified based on the SEER database. The Kaplan-Meier estimate and the Fine and Gray competing risks analysis were performed to assess overall survival (OS) and cancer-specific mortality (CSM). The multivariate Cox regression model and competing risks regression model were used to identify independent risk factors of OS and cancer-specific survival (CSS).

Results

The 5-yr OS was significantly better in patients who received either local therapy (39.8%) or radical surgery (44.7%) compared to patients receiving no surgery of the primary site (21.5%) (p < 0.001). Both local therapy and radical surgery were each independently associated with decreased CSM, with predicted 5-yr cumulative incidence of 45.4 and 43.3%, respectively, compared to 64.7% for patients receiving no surgery of the primary site (p < 0.001). Multivariate analyses demonstrated that primary site surgery was independently associated with better OS (local therapy, p = 0.037; radical surgery, p < 0.001) and decreased CSM (p = 0.003). Similar results were noted regardless of age, sex, T stage, N stage, and AJCC prognostic groups based on subgroup analysis. However, patients with M1 disease who underwent primary site surgery did not exhibit any survival benefit.

Conclusion

Surgery for the primary tumor conferred a survival advantage in non-metastatic PUC patients.