bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiofrequency Microtenotomy or Physical Therapy for Achilles Tendinopathy: Results of a Randomized Clinical Trial
Authors: Al-Ani Zeiad , Meknas Dana , Kartus Jüri-Toomas , Lyngedal Øyvind , Meknas Khaled
Published: December 2021

Background:

Achilles tendinopathy is a painful disorder, and various treatment options are available. Bipolar radiofrequency microtenotomy (RFM) has shown promising results in treating tendinosis.

Purpose/Hypothesis:

The purpose was to compare the results between treatment with bipolar RFM and physical therapy (PT) for patients with midportion Achilles tendinopathy. It was hypothesized that RFM would be equivalent or superior to PT.

Study Design:

Randomized controlled trial; Level of evidence, 1.

Methods:

A total of 38 patients with midportion Achilles tendinopathy were evaluated for 2 years. The patients were randomized to receive either RFM or PT. There were 20 patients in the RFM group and 18 patients in the PT group. Clinical outcomes were assessed using the visual analog scale (VAS) for pain and the Foot and Ankle Outcome Score (FAOS). The degree of tendinosis was evaluated with magnetic resonance imaging (MRI) of the affected ankle performed before intervention and 2 years after intervention.

Results:

In both groups, the VAS scores at the 2-year follow-up were significantly improved compared with preintervention: from 7.2 ± 1.5 to 1.0 ± 1.4 for the RFM group and from 5.9 ± 1.3 to 3.1 ± 1.8 for the PT group ( P < .01 for both). Compared with the PT group, the RFM group had significantly better VAS scores at both the 1- and 2-year follow-ups ( P < .01 for both) and better scores on 4 of the 5 FAOS subscales at the 2-year follow-up ( P < .01 for all). MRI revealed an improvement in the tendinosis score in both groups, without any significant difference between the groups.

Conclusion:

In this randomized study, the clinical assessments revealed significant improvements in the VAS, FAOS, and tendinosis score as seen on MRI 2 years after intervention with either RFM or PT in patients with midportion Achilles tendinopathy. The improvement was significantly better in the RFM group with regard to VAS and FAOS, but not in the MRI appearance.

Registration:

NCT03274557 ( ClinicalTrials.gov identifier).
Effect of Modified Arthroscopic Latarjet on Acromiohumeral Distance at 5-Year Follow-up
Authors: Liang Daqiang , Liu Haifeng , Liang Xinzhi , Qin Qihuang , Long Lujue , Huang Yong , Lu Wei , Deng Zhenhan
Published: December 2021

Background:

It is unclear whether coracoacromial ligament release during the Latarjet procedure will increase superior translation of the shoulder joint.

Purpose:

To evaluate whether a modified suture button Latarjet procedure can decrease the acromiohumeral distance (AHD).

Study Design:

Case series; Level of evidence, 4.

Methods:

A retrospective analysis was conducted among 155 patients who underwent a modified suture button Latarjet procedure between 2013 and 2015. AHD was measured on bilateral computed tomography scans taken preoperatively and on scans of the affected shoulder taken on postoperative day 1 and postoperative month (POM) 6, POM 36, and POM 60. At each time point, we recorded pain on a visual analog scale (VAS) and objective shoulder function using the American Shoulder and Elbow Surgeons, Rowe, and Walch-Duplay scores. Preoperative and final follow-up VAS and functional scores were compared using the paired t test. Pairwise comparison of AHD values at each follow-up time point were compared with the preoperative intact side using the paired t test. Intra- and interobserver reproducibility of the AHD measurements was evaluated using the intraclass correlation coefficient.

Results:

A total of 104 patients who met the criteria completed the final follow-up, which occurred at 62.6 ± 2.4 months (mean ± SD). When compared with presurgery, the VAS and all functional scores improved significantly at the last follow-up ( P < .001 for all). Intra- and interobserver intraclass correlation coefficients indicated good reliability for the ADH measurements. Preoperatively, there were no differences in AHD values between the intact and affected shoulders (7.8 ± 0.8 mm for both; P = .851). The AHD values at postoperative day 1 and POM 6, POM 36, and POM 60 were 9.6 ± 0.7 mm, 8.6 ± 0.9 mm, 8.0 ± 0.8 mm, and 7.9 ± 0.8 mm, respectively, all of which were larger than those of the preoperative intact side ( P < .001 for all).

Conclusion:

The modified suture button Latarjet procedure not only offered satisfactory therapeutic effects but also did not decrease the AHD at 5-year follow-up.
Training of airway management for anesthesia teams – Measurement of transfer into daily work routine by questionnaire
Authors: Eismann Hendrik , Palmaers Thomas , Hagemann Vera , Flentje Markus
Published: December 2021

Theory

Problems in airway management are rare in anesthesia but when they occur, they have serious consequences for the patient. For this reason, training is recommended for professionals involved in anesthetic care. Here we investigated, if a newly developed technical/ non-technical hybrid airway training would be relevant for daily practice in a tertiary referral hospital.

Hypotheses

We hypothesized that: (a) both parts of the validated questionnaires meet the quality criteria for the application in anesthesia teams, (b) even though the team regularly deals with airway management, airway management training is relevant to all professions and (c) contents of the developed training can be integrated into the behaviour of the teams.

Method

In this observational study, 104 professionals took part in a one-day technical/non-technical hybrid airway training programme. Participants received a questionnaire six months after training, based on selected scales of the validated tools; “Training Evaluation Inventory” and “Transfer Climate Questionnaire”.

RESULTS

The scales of “perceived usefulness”, “task cues” and “positive reinforcement” showed good internal consistency and all were rated higher than 3.9 on a 5-point Likert scale (1=complete rejection; 5=fullest approval). The scale “negative reinforcement and punishment” showed satisfactory internal consistency for physicians (rated 2.75 ± 0.8). By removing an item in each case, the scales “attitude towards training” (rated 4.93 ± 0.2) and “extinction” (rated 3.02 ± 0.8) showed satisfactory internal consistency for nurses and anesthetic technicians. “Social Cues” did not meet qualitative criteria. There was no difference in the assessment by the professional groups.

CONCLUSIONS

The presented training course was perceived as useful by both professional groups equally, which supported the interprofessional concept. The content was positively reinforced in practice six months after training and is relevant for professionals who are regularly confronted with the topic “airway management”. Scales which meet qualitative criteria for only one profession and the scale “social cues” should be reconsidered in the context of an interprofessional team.
Blockchain Technology for Projects: A Multicriteria Decision Matrix
Authors: Lu Weisheng , Wu Liupengfei , Xue Fan
Published: December 2021

This research aims to develop a multicriteria decision matrix (MCDM) for project management practitioners, which will support blockchain type selection, evaluate blockchain platforms, and plan blockchain systems. The MCDM is substantiated through a case study, which includes a questionnaire and an illustrative example pertinent to the construction industry. It was discovered in this study that consortium blockchain is superior in dealing with the characteristics of projects, and Hyperledger Fabric is chosen as the best applicable platform. In planning a blockchain-based project management system, project management practitioners should consider user requirements such as network participants, principal transactions, communication channels, and smart contracts.
Statistical Analyses of the Strengths of Particulate Reinforced Metal Matrix Composites (PRMMCs) Subjected to Multiple Tensile and Shear Stresses
Authors: Chen Geng , Xin Shengzhen , Zhang Lele , Broeckmann Christoph
Published: December 2021

For design and application of particulate reinforced metal matrix composites (PRMMCs), it is essential to predict the material strengths and understand how do they relate to constituents and microstructural features. To this end, a computational approach consists of the direct methods, homogenization, and statistical analyses is introduced in our previous studies. Since failure of PRMMC materials are often caused by time-varied combinations of tensile and shear stresses, the established approach is extended in the present work to take into account of these situations. In this paper, ultimate strengths and endurance limits of an exemplary PRMMC material, WC-Co, are predicted under three independently varied tensile and shear stresses. In order to cover the entire load space with least amount of weight factors, a new method for generating optimally distributed weight factors in an n dimensional space is formulated. Employing weight factors determined by this algorithm, direct method calculations were performed on many statistically equivalent representative volume elements (SERVE) samples. Through analyzing statistical characteristics associated with results the study suggests a simplified approach to estimate the material strength under superposed stresses without solving the difficult high dimensional shakedown problem.
Influence of juvenile and mature wood on anatomical and chemical properties of early and late wood from Chinese fir plantation
Authors: Lu Changqing , Wu Jun , Jiang Qianqian , Liu Yamei , Zhou Liang , You Yunfei , Cheng Yitang , Liu Shengquan
Published: December 2021

The proportion of juvenile wood affects the utilization of wood seriously, and the transition year of juvenile wood (JW) and mature wood (MW) plays a decisive role in the rotation and the modification of wood. To find out the demarcation of JW and MW, the tracheid length (TL) and microfibril angle (MFA) of early wood (EW) and late wood (LW) from four Chinese fir clones were measured by optical microscopy and X-ray diffraction. Then the data were analyzed by the k-means clustering method. The correlation and the differences among wood properties between JW and MW were compared. Results indicated that the LW showed better properties than that of EW, but the anatomical differences between EW and LW did not influence the demarcation of JW and MW. The cluster analysis of TL and MFA showed that the transition year was in the 16th year and the transition zone of EW and LW was different among clones. The MW has longer and wider tracheid, thicker cell walls, and smaller MFA. In terms of chemistry, MW had a higher content of holocellulose, α-cellulose, less content of extract, but no significant difference in lignin content compared with JW. The stabilization of chemical components was earlier than that of the anatomic properties. Correlation analysis showed that there were strong correlations between the chemical composition and anatomical characteristics in JW and MW. In general, compared with chemical components, anatomical indicators were more suitable for JW and MW demarcation. The differences and correlations between JW and MW properties provide a theoretical basis for wood rotation and planting.
Robotic excision of interaortocaval paraganglioma: a case report with the literature review
Authors: Handa Anoop , Dash Sharat Chandra , Solanki Nimit , Singh Gagandeep
Published: December 2021

Background

Paragangliomas are rare neuroendocrine tumors of extra adrenal origin. The symptomatic paragangliomas require multimodal treatment approach.

Case Presentation

We report a case of 34-year-old female who presented with complains of headache and blurring of vision. Examination revealed Hypertensive crisis with grade 3 retinopathy. The patient was diagnosed as a case of extra-adrenal paraganglioma during evaluation for secondary hypertension. Magnetic Resonance Imaging of the abdomen revealed 23*28*28 mm mass lesion in the inter-aortocaval region at the level of L3–L4. The patient was started on medical management for hypertension and was managed safely with robot-assisted surgery, owing to enhanced visualization of feeding vessels and avoidance of excessive manipulation of tumor.

Conclusions

Our case report emphasizes on the robot assisted surgical technique for the removal of tumor in a vulnerable anatomical position and presents a review of the literature.
Bayesian spatio-temporal distributed lag modeling for delayed climatic effects on sparse malaria incidence data
Authors: Rotejanaprasert Chawarat , Ekapirat Nattwut , Sudathip Prayuth , Maude Richard J.
Published: December 2021

Background

In many areas of the Greater Mekong Subregion (GMS), malaria endemic regions have shrunk to patches of predominantly low-transmission. With a regional goal of elimination by 2030, it is important to use appropriate methods to analyze and predict trends in incidence in these remaining transmission foci to inform planning efforts. Climatic variables have been associated with malaria incidence to varying degrees across the globe but the relationship is less clear in the GMS and standard methodologies may not be appropriate to account for the lag between climate and incidence and for locations with low numbers of cases.

Methods

In this study, a methodology was developed to estimate the spatio-temporal lag effect of climatic factors on malaria incidence in Thailand within a Bayesian framework. A simulation was conducted based on ground truth of lagged effect curves representing the delayed relation with sparse malaria cases as seen in our study population. A case study to estimate the delayed effect of environmental variables was used with malaria incidence at a fine geographic scale of sub-districts in a western province of Thailand.

Results

From the simulation study, the model assumptions which accommodated both delayed effects and excessive zeros appeared to have the best overall performance across evaluation metrics and scenarios. The case study demonstrated lagged climatic effect estimation of the proposed modeling with real data. The models appeared to be useful to estimate the shape of association with malaria incidence.

Conclusions

A new method to estimate the spatiotemporal effect of climate on malaria trends in low transmission settings is presented. The developed methodology has potential to improve understanding and estimation of past and future trends in malaria incidence. With further development, this could assist policy makers with decisions on how to more effectively distribute resources and plan strategies for malaria elimination.
Concerns and potential improvements in end-of-life care from the perspectives of older patients and informal caregivers: a scoping review
Authors: Motamedi Mina , Brandenburg Caitlin , Bakhit Mina , Michaleff Zoe A. , Albarqouni Loai , Clark Justin , Ooi Meidelynn , Bahudin Danial , Chróinín Danielle Ní , Cardona Magnolia
Published: December 2021

Background

Overtreatment in advanced age i.e. aggressive interventions that do not improve survival and are potentially harmful, can impair quality of care near the end of life (EOL). As healthcare provider perspectives on care quality may differ from that of service users, the aim of this study was to explore the views of older patients near EOL or their caregivers about the quality of health care at the EOL based on their lived experience, and to identify healthcare service improvements.

Methods

Medline and backward citation searches were conducted for qualitative or quantitative studies reported on the views of patients and/or informal caregivers about EOL care quality. Thematic analysis was used to summarise qualitative data (primary analysis); narrative and tabulations were used to summarise quantitative data (secondary analysis).

Results

Thirty articles met the inclusion criteria. Five main qualitative themes regarding quality care emerged: (1) Effective communication between clinicians and patients/caregivers; (2) Healthcare that values patient preferences and shared decision making; (3) Models of care that support quality of life and death with dignity; (4) Healthcare services that meet patient expectations; and (5) Support for informal caregivers in dealing with EOL challenges. The quantitative articles supported various aspects of the thematic framework.

Conclusion

The findings of this study show that many of the issues highlighted by patients or bereaved relatives have persisted over the past two decades. There is an urgent need for comprehensive evaluation of care across the healthcare system and targeted redesign of existing EOL care pathways to ensure that care aligns with what patients and informal caregivers consider high-quality patient-centred care at the EOL.
The influence of etiology on surgical outcomes in neovascular glaucoma
Authors: Medert Charles M. , Sun Catherine Q. , Vanner Elizabeth , Parrish Richard K. , Wellik Sarah R.
Published: December 2021

Background

The authors sought to evaluate visual outcomes in patients with varying etiologies of neovascular glaucoma (NVG), who were treated with glaucoma drainage devices (GDD).

Methods

This was a retrospective case series of patients at a large academic teaching institution who had surgical intervention for neovascular glaucoma between September 2011 and May 2019. Eyes were included if there was documented neovascularization of the iris/angle with an intraocular pressure (IOP) > 21 mmHg at presentation. Eyes must also have been treated with surgical intervention that included a GDD. Primary outcome measure was visual acuity at the 1-year post-operative visit. Secondary outcome measure was qualified success after surgery defined by: pressure criteria (5 mmHg < IOP ≤ 21 mmHg), no re-operation for elevated IOP, and no loss of LP vision.

Results

One hundred twenty eyes met inclusion criteria. 61.7% had an etiology of proliferative diabetic retinopathy (PDR), 23.3% had retinal vein occlusions (RVO), and the remaining 15.0% suffered from other etiologies. Of patients treated with GDD, eyes with PDR had better vision compared to eyes with RVO at final evaluation (p = 0.041). There was a statistically significant difference (p = 0.027) in the mean number of glaucoma medications with Ahmed eyes (n = 70) requiring 1.9 medications and Baerveldt eyes (n = 46) requiring 1.3 medications at final evaluation.

Conclusions

In our study, many patients with NVG achieved meaningful vision, as defined by World Health Organization (WHO) guidelines, and IOP control after GDD. Outcomes differed between patients with PDR and RVO in favor of the PDR group. Different GDD devices had similar performance profiles for VA and IOP outcomes. Direct prospective comparison of Baerveldt, Ahmed, and cyclophotocoagulation represents the next phase of discovery.
Early aEEG can predict neurodevelopmental outcomes at 12 to 18 month of age in VLBWI with necrotizing enterocolitis: a cohort study
Authors: Chen Si , Xiao Xiuman , Lin Su , Zhu Jianghu , Liang Lidan , Zhu Minli , Yang Zuqin , Chen Shangqin , Lin Zhenlang , Liu Yanli
Published: December 2021

Background

Studies have shown that neurological damage is common in necrotizing enterocolitis (NEC) survivors. The purpose of the study was to investigate the predictive value of amplitude-integrated electroencephalogram (aEEG) for neurodevelopmental outcomes in preterm infants with NEC.

Methods

Infants with NEC were selected, and the control group was selected based on 1:1–2 pairing by gestational age. We performed single-channel (P3–P4) aEEG in the two groups. The Burdjalov scores were compared between the two groups. Cranial magnetic resonance imaging (MRI) was performed several months after birth. The neurological outcomes at 12 to 18 months of age were compared with the Gesell Developmental Schedules (GDS). The predictive value of aEEG scores for neurodevelopmental delay was calculated.

Results

There was good consistency between the two groups regarding general conditions. In the 1st aEEG examination, the patients in NEC group had lower Co (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P = 0.001), Cy (1.0 (0.0, 2.0) vs. 3.0 (3.0, 4.0), P < 0.001), LB (1.0 (0.0, 2.0) vs. 2.0 (2.0, 2.0), P < 0.001), B (1.0 (1.0, 2.0) vs. 3.0 (3.0, 3.5), P < 0.001) and T (3.0 (2.0, 8.0) vs. 10.0 (10.0, 11.5), P < 0.001), than the control group. Cranial MRI in NEC group revealed a widened interparenchymal space with decreased myelination. The abnormality rate of cranial MRI in the NEC group was higher than that in the control group (P = 0.001). The GDS assessment indicated that NEC children had inferior performance and lower mean scores than the control group in the subdomains of gross motor (71 (SD = 6.41) vs. 92 (SD = 11.37), P < 0.001), fine motor (67 (SD = 9.34) vs. 96 (SD = 13.69), adaptive behavior (76 (SD = 9.85) vs. 95 (SD = 14.38), P = 0.001), language (68 (SD = 12.65) vs. 95 (SD = 11.41), P < 0.001), personal-social responses (80 (SD = 15.15) vs. 93(SD = 14.75), P = 0.037) and in overall DQ (72 (SD = 8.66) vs. 95 (SD = 11.07), P < 0.001). The logistic binary regression analysis revealed that the NEC patients had a significantly greater risk of neurodevelopmental delay than the control group (aOR = 27.00, 95% CI = 2.561–284.696, P = 0.006). Confirmed by Spearman’s rank correlation analysis, neurodevelopmental outcomes were significantly predicted by the 1st aEEG Burdjalov score (r = 0.603, P = 0.001). An abnormal 1st Burdjalov score has predictive value for neurodevelopmental delay with high specificity (84.62%) and positive predictive value (80.00%).

Conclusions

Children with NEC are more likely to develop neurodevelopmental delay. There is high specificity and PPV of early aEEG in predicting neurodevelopmental delay.
The effect of acetate Ringer’s solution versus lactate Ringer’s solution on acid base physiology in infants with biliary atresia
Authors: Liu Xiang , Cao Hongyan , Tan Xiaona , Shi Jing , Qiao Li , Zhang Qi , Shi Lei
Published: December 2021

Background

The choice of the perioperative crystalloid is a key component of the fluid management and must take into account the liver function and the appearing metabolic disorders to avoid increase the liver extra metabolism. The aim of this study is to analyze the effect of acetate Ringer’s solution or lactate Ringer’s solution in biliary atresia patients.

Methods

We included 68 infant patients aged between 21 ~ 65 d, ASA physical status II or III, who underwent elective Kasai hepatoportoenterostomy, received either AR and LR for intravenous fluid resuscitation according to their group allocation. Lactate concentration, serum electrolytes and pH were noteded before skin incision (T1), end of surgery (T2) and postoperative 12 h. We also recorded the time of operation, stay of hospital, loss of blood and urinary, total volume of infusion of crystalloid.

Results

Lactate level was significantly higher in Group LR than in Group AR patients at T2(0.76 ± 0.13 versus 0.57 ± 0.22,P = 0.03). Compared with T3, sodium and chlorine were significantly higher in two groups at T2(145.2 ± 3.1 versus 143.4 ± 3.4 and 104.6 ± 3.7 versus 105.2 ± 2.1). No significant differences were noted in potassium, HCO3−and calcium. There was no statistically significant difference in pH. No glycopenia was recorded in two groups. No significant difference was noted in administration of vasoactive drug (0.7% versus 1%).

Conclusions

Resuscitation with AR and LR was associated with similar clinical improvement in infants with biliary atresia. Use of AR reduced the level of lactate comparison with LR.
Long-acting injectable antipsychotic (LAI) prescribing trends during COVID-19 restrictions in Canada: a retrospective observational study
Authors: McKee Kyle A. , Crocker Candice E. , Tibbo Philip G.
Published: December 2021

Background

The COVID-19 pandemic has had significant impacts on how mental health services are delivered to patients throughout Canada. The reduction of in-person healthcare services have created unique challenges for individuals with psychotic disorders that require regular clinic visits to administer and monitor long-acting injectable antipsychotic medications.

Methods

To better understand how LAI usage was impacted, national and provincial patient-level longitudinal prescribing data from Canadian retail pharmacies were used to examine LAI prescribing practices during the pandemic. Prescribing data on new starts of medication, discontinuations of medications, switches between medications, antipsychotic name, concomitant medications, payer plan, gender and age were collected from January 2019 to December 2020 for individuals ≥18-years of age, and examined by month, as well as by distinct pandemic related epochs characterized by varying degrees of public awareness, incidence of COVID-19 infections and public health restrictions.

Results

National, and provincial level data revealed that rates of LAI prescribing including new starts, discontinuations and switches between LAI products remained highly stable (i.e., no statistically significant differences) throughout the study period.

Conclusions

Equal numbers of LAI new starts and discontinuations prior to and during the pandemic suggests prescribing of LAI antipsychotics, for those already in care, continued unchanged throughout the pandemic. The observed consistency of LAI prescribing contrasts with other areas of healthcare, such as cardiovascular and diabetes care, which experienced decreases in medication prescribing during the COVID-19 pandemic.
Knowledge, attitude and practice towards cervical cancer prevention among mothers of girls aged between 9 and 14 years: a cross sectional survey in Zimbabwe
Authors: Zibako Petmore , Tsikai Nomsa , Manyame Sarah , Ginindza Themba G.
Published: December 2021

Background

Cervical cancer (CC) morbidity and mortality is still high in developing countries like Zimbabwe. Treatment for CC is out of reach for many women, hence the need to maximise on prevention which mainly includes screening and administering human papillomavirus (HPV) vaccine. Knowledge about CC prevention is a prerequisite for utilisation of all the available options for CC prevention, yet little is known about its levels and the corresponding attitudes and practices on cancer prevention methods within the society.

Methods

A cross sectional survey was done to assess knowledge, attitude and practice (KAP) on CC prevention among mothers of girls aged between 9 and 14 years in Zimbabwe as well as factors explaining the KAP. Four hundred and six mothers participate. Descriptive and inferential statistics (binary logistic regression and Chi-Square test of association) were applied to determine participant characteristics with KAP using STATA version 16 software.

Findings

Overall KAP of cervical cancer prevention is in a poor state. The knowledge was poor with 24% being able to say CC is caused by HPV; the attitude is negative with 58% being of the opinion that CC is caused by witchcraft and it is a death sentence, while the bad practices of relying only on traditional means were being practiced. Factors associated with knowledge are: not having medical aid (odds: 0.17, 95%CI: 0.05–0.59, p = 0.005) and high levels of education (secondary level odds: 4.20; 95%CI: 2.25–7.84 p < 0.001 and tertiary odds: 7.75; 95%CI: 2.04–29.45, p-value: 0.003 compared to primary education). Attitude towards CC management was driven by levels of education (secondary level odds: 0.39, 95%CI: 0.20–0.78, p = 0.007 and tertiary odds: 0.12, 95%CI: 0.04–0.33, p < 0.001), the same factor increases odds of good practice (secondary odds: 3.78, 95%CI: 1.99–7.18, p < 0.001 and tertiary odds: 3.78, 95%CI: 1.99–7.18, p < 0.001). On the other hand, HPV vaccine knowledge was also very moderate (with majority of mothers not knowing the right age of vaccination; vaccine acceptability was high (90%), but uptake was very low (8% had their daughter vaccinated).

Conclusion

KAP about CC prevention was poor with factors necessary for improvement of KAP identified as education, medical insurance coverage. Making health education easily accessible in schools, primary health facilities and various media platforms will help to address the myths on causes of CC and how it can be treated. Health education and availability of free screening services and free vaccine will improve CC prevention out outcomes.
Identification of components in Kazakhstan honeys that correlate with antimicrobial activity against wound and skin infecting microorganisms
Authors: McLoone Pauline , Zhumbayeva Aizhan , Yunussova Sofiya , Kaliyev Yerkhat , Yevstafeva Ludmila , Verrall Susan , Sungurtas Julie , Austin Ceri , Allwood J. Will , McDougall Gordon J.
Published: December 2021

Background

Antimicrobial drug resistance is a major public health threat that can render infections including wound and skin infections untreatable. The discovery of new antimicrobials is critical. Approaches to discover novel antimicrobial therapies have included investigating the antimicrobial activity of natural sources such as honey. In this study, the anti-microbial activity and chemical composition of 12 honeys from Kazakhstan and medical grade manuka honey were investigated.

Methods

Agar well diffusion and broth culture assays were used to determine anti-microbial activity against a range of skin and wound infecting micro-organisms. Folin-Ciocalteu method was used to determine the total phenol content of the honeys and non-targeted liquid chromatography analysis was performed to identify components that correlated with antimicrobial activity.

Results

In the well diffusion assay, the most susceptible micro-organisms were a clinical isolate of Methicillin resistant Staphylococcus aureus (MRSA) and Enterococcus faecalis (ATCC 19433). Buckwheat & multi-floral honey from Kazakhstan demonstrated the highest antimicrobial activity against these two micro-organisms. Kazakhstan honeys with a buckwheat floral source, and manuka honey had the highest total phenol content. Non-targeted liquid chromatography analysis identified components that correlated with anti-microbial activity as hydroxyphenyl acetic acid, p-coumaric acid, (1H)–quinolinone, and abscisic acid.

Conclusions

The Kazakhstan honeys selected in this study demonstrated antimicrobial activity against wound and skin infecting micro-organisms. Compounds identified as correlating with antimicrobial activity could be considered as potential bioactive agents for the treatment of wound and skin infections.
The medical futility experience of nursing professionals in Greece
Authors: Voultsos Polychronis , Tsompanian Anna , Tsaroucha Alexandra K.
Published: December 2021

Background

Providing futile medical care is an ever-timely ethical problem in clinical practice. While nursing personnel are very closely involved in providing direct care to patients nearing the end of life, their role in end-of-life decision-making remains unclear.

Methods

This was a prospective qualitative study conducted with experienced nursing professionals from December 2020 through May 2021. Individual in-depth qualitative interviews were conducted with sixteen participants. We performed a thematic analysis of the data.

Results

Importantly, many participants werehalf-hearted intheirattitude towardsaccepting or defining futile medical care. Furthermore, interestingly, a list of well-described circumstances emerged, under which the dying process is most likely to be a “bad and undignified” process. These circumstances reflected situations revolving around a) pain and suffering, b) treating patients with respect, c) the appearance and image of the patient body, and d) the interaction between patients and their relatives. Fear of legal action, the lack of a regulatory framework, physicians being pressured by (mostly uninformed) family members and physicians’ personal motives were reported as important reasons behind providing futile medical care. The nursing professional’s role as a participant in decisions on futile care and as a mediator between physicians and patients (and family members) was highlighted. Furthermore, the patient’s role in decisions on futile care was prioritized. The patient’s effort to keep themselves alive was also highlighted. This effort impacts nursing professionals’ willingness to provide care. Providing futile care is a major factor that negatively affects nursing professionals’ inner attitude towards performing their duties. Finally, the psychological benefits of providing futile medical care were highlighted, and the importance of the lack of adequately developed end-of-life care facilities in Greece was emphasized.

Conclusions

These findings enforce our opinion that futile medical care should be conceptualized in the strict sense of the term, namely, as caring for a brain-dead individual or a patient in a medical condition whose continuation would most likely go against the patient’s presumed preference (strictly understood). Our findings were consistent with prior literature. However, we identified some issues that are of clinical importance.
Heart atlas for retrospective cardiac dosimetry: a multi-institutional study on interobserver contouring variations and their dosimetric impact
Authors: Stockinger Marcus , Karle Heiko , Rennau Hannes , Sebb Sabine , Wolf Ulrich , Remmele Julia , Bührdel Sandra , Bartkowiak Detlef , Blettner Maria , Schmidberger Heinz , Wollschläger Daniel
Published: December 2021

Purpose

Cardiac effects after breast cancer radiation therapy potentially affect more patients as survival improves. The heart’s heterogeneous radiation exposure and composition of functional structures call for establishing individual relationships between structure dose and specific late effects. However, valid dosimetry requires reliable contouring which is challenging for small volumes based on older, lower-quality computed tomography imaging. We developed a heart atlas for robust heart contouring in retrospective epidemiologic studies.

Methods and materials

The atlas defined the complete heart and geometric surrogate volumes for six cardiac structures: aortic valve, pulmonary valve, all deeper structures combined, myocardium, left anterior myocardium, and right anterior myocardium. We collected treatment planning records from 16 patients from 4 hospitals including dose calculations for 3D conformal tangential field radiation therapy for left-sided breast cancer. Six observers each contoured all patients. We assessed spatial contouring agreement and corresponding dosimetric variability.

Results

Contouring agreement for the complete heart was high with a mean Jaccard similarity coefficient (JSC) of 89%, a volume coefficient of variation (CV) of 5.2%, and a mean dose CV of 4.2%. The left (right) anterior myocardium had acceptable agreement with 63% (58%) JSC, 9.8% (11.5%) volume CV, and 11.9% (8.0%) mean dose CV. Dosimetric agreement for the deep structures and aortic valve was good despite higher spatial variation. Low spatial agreement for the pulmonary valve translated to poor dosimetric agreement.

Conclusions

For the purpose of retrospective dosimetry based on older imaging, geometric surrogate volumes for cardiac organs at risk can yield better contouring agreement than anatomical definitions, but retain limitations for small structures like the pulmonary valve.
The developing landscape of combinatorial therapies of immune checkpoint blockade with DNA damage repair inhibitors for the treatment of breast and ovarian cancers
Authors: Zhu Lingling , Liu Jiewei , Chen Jiang , Zhou Qinghua
Published: December 2021

The use of immune checkpoint blockade (ICB) using antibodies against programmed death receptor (PD)-1, PD ligand (PD-L)-1, and cytotoxic T-lymphocyte antigen 4 (CTLA-4) has redefined the therapeutic landscape in solid tumors, including skin, lung, bladder, liver, renal, and breast tumors. However, overall response rates to ICB therapy remain limited in PD-L1-negative patients. Thus, rational and effective combination therapies will be needed to address ICB treatment resistance in these patients, as well as in PD-L1-positive patients who have progressed under ICB treatment. DNA damage repair inhibitors (DDRis) may activate T-cell responses and trigger inflammatory cytokines release and eventually immunogenic cancer cell death by amplifying DNA damage and generating immunogenic neoantigens, especially in DDR-defective tumors. DDRi may also lead to adaptive PD-L1 upregulation, providing a rationale for PD-L1/PD-1 blockade. Thus, based on preclinical evidence of efficacy and no significant overlapping toxicity, some ICB/DDRi combinations have rapidly progressed to clinical testing in breast and ovarian cancers. Here, we summarize the available clinical data on the combination of ICB with DDRi agents for treating breast and ovarian cancers and discuss the mechanisms of action and other lessons learned from translational studies conducted to date. We also review potential biomarkers to select patients most likely to respond to ICB/DDRi combination therapy.
Machine learning and deep learning predictive models for type 2 diabetes: a systematic review
Authors: Fregoso-Aparicio Luis , Noguez Julieta , Montesinos Luis , García-García José A.
Published: December 2021

Diabetes Mellitus is a severe, chronic disease that occurs when blood glucose levels rise above certain limits. Over the last years, machine and deep learning techniques have been used to predict diabetes and its complications. However, researchers and developers still face two main challenges when building type 2 diabetes predictive models. First, there is considerable heterogeneity in previous studies regarding techniques used, making it challenging to identify the optimal one. Second, there is a lack of transparency about the features used in the models, which reduces their interpretability. This systematic review aimed at providing answers to the above challenges. The review followed the PRISMA methodology primarily, enriched with the one proposed by Keele and Durham Universities. Ninety studies were included, and the type of model, complementary techniques, dataset, and performance parameters reported were extracted. Eighteen different types of models were compared, with tree-based algorithms showing top performances. Deep Neural Networks proved suboptimal, despite their ability to deal with big and dirty data. Balancing data and feature selection techniques proved helpful to increase the model’s efficiency. Models trained on tidy datasets achieved almost perfect models.
Prevalence, antimicrobial susceptibility and virulence gene profiles of Arcobacter species isolated from human stool samples, foods of animal origin, ready-to-eat salad mixes and environmental water
Authors: Uljanovas Dainius , Gölz Greta , Brückner Vanessa , Grineviciene Audrone , Tamuleviciene Egle , Alter Thomas , Malakauskas Mindaugas
Published: December 2021

Background

Members of the genus Arcobacter are considered as emerging zoonotic food and waterborne pathogens that cause gastroenteritis and bacteremia in humans. However, the potential risk that Arcobacter species pose to public health remains unassessed in various countries, including Baltic states. Therefore, the aim of this study was to determine the prevalence, antimicrobial susceptibility and presence of putative virulence genes of Arcobacter isolates recovered from humans, food products and environmental water in Lithuania.

Results

A total of 1862 samples were collected and examined from 2018 to 2020 in the city of Kaunas. Overall, 11.2% (n = 208) of the samples were positive for the presence of Arcobacter spp. The highest prevalence was detected in chicken meat (36%), followed by environmental water (28.1%), raw cow milk (25%), ready-to-eat salad mixes (7.1%) and human stool (1.7%). A. butzleri was the most frequently isolated species (n = 192; 92.3%), followed by A. cryaerophilus (n = 16; 7.7%). Arcobacter spp. antimicrobial susceptibility testing revealed unimodally distributed aggregated minimal inhibitory concentrations (MICs) for gentamicin, tetracycline, ciprofloxacin, ampicillin and erythromycin. However, a bimodal distribution for azithromycin was found with 96.2% of determined MICs above the epidemiological cut-off value (ECOFF) defined for Campylobacter jejuni (0.25 µg/ml). Majority of the Arcobacter isolates (n = 187; 89.9%) showed high susceptibility to ciprofloxacin with MICs below or equal to the ECOFF value of 0.5 µg/ml. The putative virulence genes cadF (100%), ciaB (100%), cj1349 (99%), tlyA (99%), mviN (97.9%) and pldA (95.8%) were the predominant genes detected among A. butzleri isolates. In contrast, the mviN and ciaB genes were present in all, whereas cj1349 (12.5%), tlyA (25%) and hecA (12.5%) were only detected in few A. cryaerophilus isolates.

Conclusions

Our results demonstrate that food products and environmental water in Lithuania are frequently contaminated with Arcobacter spp. that carry multiple putative virulence genes. Furthermore, A. butzleri were isolated from 1.7% of inpatients. Fluoroquinolones and aminoglycosides were found to be more effective against Arcobacter in comparison to other antimicrobial agents. However, further studies are needed to determine the pathogenic mechanisms and factors that facilitate the spread of Arcobacter infections.
The evolved divergence of γ-secretase-susceptibility of homologous proteins Ngfrb and Nradd in zebrafish
Authors: Jayne Tanya , Newman Morgan , Baer Lachlan , Lardelli Michael
Published: December 2021

Objective

NGFR/p75NTR and NRADD/NRH proteins are closely related structurally and are encoded by genes that arose from a duplication event early in vertebrate evolution. The transmembrane domain (TMD) of NGFR is cleaved by γ-secretase but there is conflicting data around the susceptibility to γ-secretase cleavage of NRADD proteins. If NGFR and NRADD show differential susceptibility to γ-secretase, then they can be used to dissect the structural constraints determining substrate susceptibility. We sought to test this differential susceptibility.

Results

We developed labelled, lumenally-truncated forms of zebrafish Ngfrb and Nradd and a chimeric protein in which the TMD of Nradd was replaced with the TMD of Ngfrb. We expressed these in zebrafish embryos to test their susceptibility to γ-secretase cleavage by monitoring their stability using western immunoblotting. Inhibition of γ-secretase activity using DAPT increased the stability of only the Ngfrb construct. Our results support that only NGFR is cleaved by γ-secretase. Either NGFR evolved γ-secretase-susceptibility since its creation by gene duplication, or NRADD evolved to be refractory to γ-secretase. Protein structure outside of the TMD of NGFR is likely required for susceptibility to γ-secretase.
Would you like to be contacted about future research?
Authors: Newington Lisa , Alexander Caroline M. , Wells Mary
Published: December 2021

Many research participants are willing to be contacted about future research opportunities, however this question is not always asked. Furthermore, if participants do consent for contact about future research, this information is not always accessible to other research teams. We discuss our experience of recruiting individuals who have previously taken part in healthcare research and suggest potential strategies to support this process and enable greater research participation.
Is kallikrein-8 a blood biomarker for detecting amnestic mild cognitive impairment? Results of the population-based Heinz Nixdorf Recall study
Authors: Schramm Sara , Jokisch Martha , Jöckel Karl-Heinz , Herring Arne , Keyvani Kathy
Published: December 2021

Background

Kallikrein-8 (KLK8) might be an early blood-biomarker of Alzheimer’s disease (AD). We examined whether blood KLK8 is elevated in persons with amnestic mild cognitive impairment (aMCI) which is a precursor of AD, compared to cognitively unimpaired (CU) controls.

Methods

Forty cases and 80 controls, matched by sex and age (± 3years), were participants of the longitudinal population-based Heinz Nixdorf Recall study (baseline: 2000–2003). Standardized cognitive performance was assessed 5 (T1) and 10 years after baseline (T2). Cases were CU at T1 and had incidental aMCI at T2. Controls were CU at T1 and T2. Blood KLK8 was measured at T2. Using multiple logistic regression the association between KLK8 in cases vs. controls was investigated by estimating odds ratios (OR) and 95% confidence intervals (95%CI), adjusted for inter-assay variability and freezing duration. Using receiver operating characteristic (ROC) analysis, the diagnostic accuracy of KLK8 was determined by estimating the area under the curve (AUC) and 95%CI (adjusted for inter-assay variability, freezing duration, age, sex).

Results

Thirty-seven participants with aMCI vs. 72 CU (36.7%women, 71.0±8.0 (mean±SD) years) had valid KLK8 measurements. Mean KLK8 was higher in cases than in controls (911.6±619.8 pg/ml vs.783.1±633.0 pg/ml). Fully adjusted, a KLK8 increase of 500pg/ml was associated with a 2.68 (1.05–6.84) higher chance of having aMCI compared to being CU. With an AUC of 0.92 (0.86–0.97), blood KLK8 was a strong discriminator for aMCI and CU.

Conclusion

This is the first population-based study to demonstrate the potential clinical utility of blood KLK8 as a biomarker for incipient AD.
Does lateral arm technique decrease the rate of clip migration in stereotactic and tomosynthesis-guided biopsies?
Authors: Weaver Olena , Cohen Ethan O. , Perry Rachel E. , Tso Hilda H. , Phalak Kanchan , Srinivasan Ashmitha , Bassett Roland , Leung Jessica W. T.
Published: December 2021

Background

Mammography-guided vacuum-assisted biopsies (MGVAB) can be done with stereotaxis or digital breast tomosynthesis guidance. Both methods can be performed with a conventional (CBA) or a lateral arm biopsy approach (LABA). Marker clip migration is relatively frequent in MGVAB (up to 44%), which in cases requiring surgery carries a risk of positive margins and re-excision. We aimed to compare the rates of clip migration and hematoma formation between the CBA and LABA techniques of prone MGVAB. Our HIPAA compliant retrospective study included all consecutive prone MGVAB performed in a single institution over a 20-month period. The LABA approach was used with DBT guidance; CBA utilized DBT or stereotactic guidance. The tissue sampling techniques were otherwise identical.

Results

After exclusion, 389 biopsies on 356 patients were analyzed. LABA was done in 97 (25%), and CBA in 292 (75%) cases. There was no statistical difference in clip migration rate with either 1 cm or 2 cm distance cut-off [15% for CBA and 10% for LABA for 1 cm threshold (p = 0.31); 5.8% or CBA and 3.1% or LABA for 2 cm threshold (p = 0.43)]. There was no difference in the rate of hematoma formation (57.5% in CDB and 50.5% in LABA, p = 0.24). The rates of technical failure were similar for both techniques (1.7% for CBA and 3% for LABA) with a combined failure rate of 1%.

Conclusions

LABA and CBA had no statistical difference in clip migration or hematoma formation rates. Both techniques had similar success rates and may be helpful in different clinical situations.