bluuebunny/crossref_metadata_2025 huggingface dataset:
Ernährung und Hausmittel bei Atemwegserkrankungen aus Sicht der chinesischen Medizin
Authors: Rieckmann Ruth
Published: March 2022

Erkrankungen der Atemwege und Atmungsorgane, die mit Schwäche, Schleim und Trockenheit einhergehen, lassen sich gezielt ernährungstherapeutisch beeinflussen. An die Art und Phase der Erkrankung angepasste diätetische Strategien und Hausmittel der chinesischen Medizin tragen dazu bei, die Abwehrkräfte (Wei-Qi) zu stärken, die Atemwegsbeschwerden und danach andauernde körperliche Schwäche zu lindern.

Auf der Basis der Musterdifferenzierung der chinesischen Medizin ausgewählte Hausmittel wie Kraftbrühen, Essenzen und Heilpilze können in allen Phasen von der Prävention über die Therapie bis zur Rekonvaleszenz eingesetzt werden. Im Folgenden werden Strategien und Hausmittel für akute und chronische Formen von Husten/Bronchitis, Dyspnoe und COPD vorgestellt. Beim Vorliegen entsprechender Symptome und TCM-Muster kann ein flankierender Einsatz zur Prävention oder in der Rekonvaleszenz von COVID-19 erfolgen.
Wilder Thymian – bei Atemwegsinfekten etwas für Ihre Praxis!
Authors: Jobst Detmar
Published: March 2022

Sie würden gerne in Ihrer Praxis mehr mit Thymian arbeiten, sind aber noch nicht dazu gekommen, sich damit zu beschäftigen, wissenschaftlich? –Wir liefern Ihnen einige Fakten
Unterschätzte Helfer: Myofunktionelle Übungen bei Schlafapnoe
Authors: Brück Sarah , Hoffmann Marisa
Published: March 2022

Bleierne Müdigkeit und Sekundenschlaf – Patienten mit Schlafapnoe leiden und sind häufig in ihrer Lebensqualität eingeschränkt. Wie Therapeuten mit myofunktionellem Training helfen können, beschreiben Kieferexpertin Marisa Hoffmann und Physiotherapeutin Sarah Brück, die sich mit dem Thema in ihrer Bachelorarbeit auseinandergesetzt hat.
A Cystic Clival Chordoma with CT and MRI Unconventional Appearances
Authors: Guadalupi Pamela , Gessi Marco , Massimi Luca , Caldarelli Massimo , Gaudino Simona
Published: March 2022

We present the first case of clival cystic chordoma with extradural location, transdural transgression, and moderate bone involvement in a 10-year-old girl. Chordoma showed unconventional appearances on computed tomography (CT) and magnetic resonance imaging (MRI), due to cystic components, extradural space location with extensive intradural extension, moderate superficial bone involvement. Surgery confirmed the extradural location and histopathological examination revealed cystic chordoma. MRI and CT findings were not characteristic for a single lesion; differential diagnoses included cystic lesions such as epidermoid and dermoid cyst, ecchordosis physaliphora, and benign notochordal cell tumors.
Effects of nanomaterials on Cs3Sb photocathode emission performance
Authors: Liu Yanwen , Tian Hong , Li Fen , Wang Guojian , Wang Xiaoxia
Published: March 2022

A new approach to preparing the cesium antimonide photocathode has been developed. A tungsten sponge diffusion barrier layer, instead of the conventional nickel pipe, was used as the evaporation source so that a slow and uniform evaporation of the photoemissive materials, whose direction and amount could be well controlled, was realized. Then, the cathode substrate surface was modified with a nanoparticle layer, resulting in better photoemissive material adsorption and higher light absorbance. A new technique of treating the tungsten sponge, which worked as the barrier layer to the diffusion of the photoemissive materials, was studied. The tungsten–copper alloy was subjected to direct high-frequency heating in a vacuum chamber so that the copper in the alloy evaporated rapidly, resulting in smooth and shiny tungsten sponge. In comparison with the conventional method for fabricating the tungsten sponge, in which the copper in the tungsten–copper alloy was removed chemically, the new method removed the copper more completely, took less time, and caused less pollution. By means of direct-current magnetic sputtering, a layer of osmium nanoparticles of 50 nm diameter was deposited on the photocathode substrate surface. Then, a diode tube for the photocathode emission test equipped with a small titanium ion pump, whose pressure was as low as 5 × 10−8 Pa, was developed. A comparative emission performance test was carried out on the photocathode with the substrate surface covered with an osmium film vs that covered with osmium nanoparticles. The highest quantum efficiencies of the stable photoemission from the two photocathodes were 1.80 × 10−3 and 5.13 × 10−3, respectively. Moreover, the light absorptivity of the osmium nanoparticle-coated photocathode was 2.16 times that of the osmium film-coated photocathode, and the quantum efficiency of the former was 2.85 times that of the latter. Therefore, the improvement in the quantum efficiency of the osmium nanoparticle-coated photocathode is mainly attributed to the increase in the light absorptivity.
Effect assessment of spatial sampling length on the orthonormal basis functions detector
Authors: Ma Jianfei , Ding Kai , Yan Bing
Published: March 2022

Magnetic anomaly detection (MAD) is a passive way to detect hidden magnetic objects. As the major way of MAD, the orthonormal basis function (OBF) detector has been widely researched and applied. During the practical signal processing process, we found that the performance of the OBF detector is mainly affected by the space sampling length. However, there is almost no literature studying the relationship between the OBF detector and the space sampling length. In our work, the effect of the spatial sampling length on the performance of the OBF detector is assessed from the perspective of the statistical distribution of independent and correlated background noise. The theoretical and experimental results both turn out to be that the smaller the noise correlation, the more evident the gain effect of the spatial sampling length on the performance of the OBF detector under the same signal-to-noise ratio. Therefore, the spatial sampling length should be fitted with the noise environment to attain a better trade-off between detector performance and computing resources.
A modern-day alchemy: Double glow plasma surface metallurgy technology
Authors: Xu Zhong , Huang Jun , Wu Hongyan , Xu Zaifeng , Liu Xiaoping , Lin Naiming , Wei Dongbo , Zhang Pingze
Published: March 2022

In the long history of science and technology development, one goal is to diffuse solid alloy elements into the surface of steel materials to form surface alloys with excellent physical and chemical properties. On the basis of plasma nitriding technology, double glow plasma surface metallurgy technology has answered this challenge. This technology, which seems to be a modern-day alchemy, can use any element in the Periodic Table of chemical elements, including solid metal elements and their combinations, to form many types of surface alloyed layers with high hardness, wear resistance, corrosion resistance, and high temperature oxidation resistance on various metal materials. For example, nickel base alloys, stainless steels, and high speed steels are formed on the surfaces of ordinary carbon steels; high hardness, wear resistance, and high temperature oxidation resistance alloys are formed on the surface of the titanium alloy. This article briefly introduces the formation and principle of double glow plasma surface metallurgy technology and summarizes the experimental results and industrial applications. The significance and development prospect of this technology are discussed.
Spectral characteristics of a short glow discharge with a grid anode
Authors: Lyu Xingbao , Yuan Chengxun , Avtaeva Svetlana , Kudryavtsev Anatoly , Yao Jingfeng , Liu Yangguo , Zhou Zhongxiang , Wang Xiaoou
Published: March 2022

In a previous study, the characteristics of plasma generated by fast electrons behind a grid anode with short glow discharge were studied using numerical simulation. The source of the post-anode plasma electrons is considered to be the direct current glow discharge itself in the gap between a cathode and a grid anode. However, the electron attenuation of the microwave radiation in the post-anode space measured in experiments does not correspond to the numerical predictions. In this paper, the current–voltage characteristics of the short glow discharge with a grid anode and the spectral characteristics of the discharge in both the electrode gap and the space behind the grid anode are studied; the effective thickness of the plasma in the post-anode space is estimated using a spectral method.
Approximate uniformity of the size distribution in the crescent-shaped dune swarm: A downsized experimental reinvestigation
Authors: He Nan , Lin Yuanwei , Zhang Yang , Yang Bin
Published: March 2022

Crescent-shaped dunes, or barchans, usually move in swarms in nature, where their sizes become closer to each other while migrating downstream collectively. A major cause of such a phenomenon is the collision among the dunes. Therefore, it is of importance to elucidate the pattern of the local dune interaction process, i.e., the double-dune collision. In this study, based on a downsized water tunnel experiment that adopts two colors of sand samples, the double-dune collision pattern is parameterized, which is investigated as a function of the initial mass ratio of the two dunes. The results depict from a distinctive perspective that the double-dune collision is essential in realizing the uniformity of the size distribution in a dune swarm. The proposed concepts could aid in the development of a comprehensive parameterization for the double-dune collision system.
Hierarchical energy coordination of flywheel energy storage array system for wind farms based on consensus algorithm
Authors: Zhang Zhanqiang , Meng Keqilao , Liu Qing , Wu Huijuan
Published: March 2022

The flywheel energy storage (FES) array system plays an important role in smoothing the power output of wind farms. Therefore, how to allocate the total charging and discharging power of wind farms to individual FES system (FESS) units has long been a research hotspot. We propose a hierarchical coordinated control strategy applying the concept of the state of energy (SOE) of FESS units. Energy allocation is achieved by investigating the consensus algorithm of the SOE for both an undirected graph and unbalanced directed graph. Then, we propose another approach to convert the adjacency matrix into a column stochastic matrix using the idea of the PageRank algorithm for an unbalanced directed graph and achieve an SOE consensus of FESS units using the power iteration method. Simulation results demonstrate that the proposed algorithm is effective.
An advanced physical modeling of adsorption mechanism of pharmaceutical compound on a biochar
Authors: Ben Yahia Manel
Published: March 2022

In this paper, the adsorption process of a pharmaceutical compound (tetracycline: TC) on a biochar was theoretically analyzed. The adsorbent was activated via two different methods (impregnation method and dry mixing method). The adsorption mechanism of TC was understood through an analysis of double-layer model parameters, suggesting that the adsorption of TC can be achieved via formation of two layers on both adsorbents. This modeling showed that this aggregation process was present and absent for the adsorption systems TC–biochar impregnation method (BCI) and TC–biochar dry mixing method (BCD), respectively. Comparatively, it was demonstrated that both adsorbents were characterized by excellent adsorption capacities and they can be alternatives to remove TC. The interactions between TC–BCD, TC–BCI, and TC–TC were estimated by an adsorption energy calculation at different temperatures. Overall, the interpretation of the model parameters provided plausible insights into the adsorption mechanism.
Water-driven energy harvesting characteristics of MoSi thin film devices
Authors: Jeon Buil , Yoon Giwan
Published: March 2022

In this article, we experimentally examine, for the first time, the water-driven energy harvesting characteristics of molybdenum silicide (MoSi) thin film devices. The water-driven energy harvesting characteristics of MoSi devices originate from the direct contact between water and the surface of the device. The magnitude of the generated voltage varies from about 0.1 to 7 mV depending on the conditions of the devices being in contact with water. Voltage continues to be generated between the wet and dry sides of the MoSi device as long as water persists on its surfaces, even though it does not stream or flow on the surface of the device. The influence of the size of the electrodes and their area of contact with water on the water-driven energy harvesting characteristics of MoSi devices is also investigated.
Diamond’s sparkle is in more than gemstones
Authors: Kramer David
Published: March 2022

The transparent carbon allotrope is finding new applications, but expanded use for electronics will depend on further advances in crystal growth.
How does light behave in a material whose refractive index vanishes?
Authors: Liberal Iñigo , Engheta Nader
Published: March 2022

The light’s wavelength becomes effectively infinite, and the spatial and temporal variations of its electric and magnetic fields decouple.
Corrigendum: The gap of cultural heritage protection with climate change adaptation in the context of spatial planning. The case of Greece (2021 IOP Conf. Ser.: Earth Environ. Sci.
899 012022
Authors: Asprogerakas E , Gourgiotis A , Pantazis P , Samarina A , Konsoula P , Stavridou K
Published: March 2022

Please see Article PDF for corrigendum text.
Is perioperative drop in PTH better than postoperative PTH in predicting hypocalcaemia after thyroid surgery?
Authors: Hashem Mohamed , Lim CB , Balasubramanian SP
Published: March 2022

Introduction

Postoperative surgical hypoparathyroidism (PoSH) following thyroid surgery is well known complication. Several predictive factors have been identified including perioperative parathyroid hormone (PTH) levels. The aim of the study is to determine how a drop in perioperative parathyroid hormone (PTH) compares to postoperative day one PTH in predicting hypocalcaemia.

Methods

Medical records of consecutive patients who had either total or completion thyroidectomy with or without central neck dissection between January 2016 and December 2018 in a single thyroid surgery unit were accessed to retrieve data on demographics, pathology, surgery, perioperative biochemistry and management.

Results

Of 295 included patients, there were 227 (76.9%) females. Forty-five (15.3%) had completion thyroidectomy, while the rest had total thyroidectomy. Seventy-eight (26.4%) had concomitant central neck dissection.

64 (21.7%) had day 1 hypocalcaemia and this was persistent at six months in 31 patients (10.5%). Both day one PTH and drop in PTH predicted day one hypocalcaemia (P<0.001) and 6-month hypoparathyroidism (p<0.001). The area under ROC curves for day one PTH and drop in PTH for day one hypocalcaemia (0.729 vs 0.726 respectively) and for 6-month hypoparathyroidism (0.964 vs 0.958 respectively) were similar; albeit slightly better for day 1 PTH.

Conclusion

Day 1 PTH is equivalent to (if not better than) drop in PTH in predicting short and long term PoSH. Preoperative PTH measurements are therefore not needed in detection and/or management of PoSH after thyroid surgery.
Is the subdivision of Thy3 nodules needed? Audit reviewing the management of Thy3 nodules, and the associated malignancy rates.
Authors: Davies Brooke , Sajjanshetty Mallikarjun
Published: March 2022

Introduction

Following the 2014 update to the BAETS thyroid nodule cytology guidance, the management of Thy3 lesions was modified by subdivision into Thy3a and Thy3f categories. Both lesions remain indeterminate but are proposed to have differing risks of malignancy when counselling patents: these risks have been called into question by subsequent data.

Methods

This, retrospective, Audit aimed to review the management of Thy3 (Thy3a and Thy3f) cytological diagnoses, within an NHS Trust, and compare this to the BAET Guidance 2014. Further, malignancy rates for Thy3a and Thy3f cytology were made over the calculated over the period.118 patients with a Thy3 cytology identified between 2014 and 2019. Data separated into data pre-2015 and 2015 onwards.

Results

In 2014, 29% of Thy3a nodules were managed in line with 2014 BAETS guidance. This improved to 34% from 2015. Meanwhile, Thy3f diagnoses were managed mostly in favour of the BAETS guidelines – 83% in 2014 and 92% 2015 onwards. The malignancy rates found, amongst all 118 patients, were 17.2% and 14.8% for Thy3f and Thy3a nodules respectively.

Conclusions

At this institution, Thy3 cytological diagnoses, regardless of classification into Thy3a or Thy3f, were largely treated in the same way (by a diagnostic hemi-thyroidectomy). The management of the nodules may reflect a variety of factors, including how comfortable patients and surgeons are when handling uncertainty. With malignancy rates for both Thy3a and Thy3f nodules being much the same, it is not surprising that they are managed in a similar way.
Multifocal Micropapillary Thyroid Cancers: Should We Adopt a More Conservative Approach?
Authors: Woodley Niall , Rabbitte Carragh , Clark Louise
Published: March 2022

Introduction

There is a trend toward more conservative management of solitary micropapillary thyroid carcinomas (mPTC). Incidental findings of multifocal mPTC are a regular subject of discussion at multidisciplinary team (MDT) meetings, however, guidance on its management is limited.

Methods

All patients discussed at the West of Scotland Thyroid Cancer MDT between November 2008 and July 2020 with multifocal mPTC (10mm or less) on the first surgical pathology specimen were included. Cases with solitary mPTC on the first surgical pathology specimen were excluded, as were any cases with pathology that would alter prognosis e.g. papillary carcinoma >10mm.

Results

52 patients were included in the final analysis, representing 6% of the total cases discussed at the Thyroid cancer MDT. The incidence has increased over time. 76.9% (40) of cases were female with a mean age of 48.6. Median follow up was 23.5 months (Range 1–119). 15.4% (8) of cases had pathological lymphadenopathy on pre-operative imaging. Capsular or vascular invasion and extrathyroid extension were common (26.9%, 9.6% and 32.7% of cases respectively). 55.8% (29) of cases underwent additional treatment after the finding of multifocal mPTC. Overall, 1 (1.9%) patient developed recurrence and is still alive at 75 months follow up after salvage treatment. 1 (1.9%) patient died during follow up, not felt to be related to their thyroid disease.

Conclusion

Multifocal mPTC is an increasingly common MDT discussion. Recurrence rates are low and may respond well to salvage therapy. A more conservative approach may be an appropriate management strategy for this patient cohort.
Four distinct enhancement patterns of abnormal parathyroid glands on three phase CT imaging.
Authors: Vance-Daniel Joseph , Stroud Lauren , Burney Kashif , Jamal Karim
Published: March 2022

Aim

CT imaging is increasingly used in the pre-operative localisation of abnormal parathyroid glands. Parathyroid glands typically enhance in the arterial phase and washout in the delayed phase. The aim of this novel study was to analyse and classify all various enhancement patterns.

Method

42 patients underwent a three-phase CT which identified 45 abnormal glands all of which subsequently had surgical excision and histological assessment. The Houndsfield Units (HU) in the 45 glands was compared with that of an area of normal adjacent thyroid in the three phases and classified as below:

Results

45 glands were surgically removed, 37 were adenomas and 8 hyperplastic on histology. The adenomas were classified as follows: type A (48.7%), type B (5.4%), type C (43.2%) and type D (2.7%). Hyperplastic glands were classified as type A (37.5%) and type B (62.5%).

Conclusion

Traditionally type A is the prevalent enhancement pattern, yet several other patterns of enhancement are observed in this study which vary between adenomatous and hyperplastic glands. Clinician awareness of this is important and lack of typical enhancement should not be used in isolation to exclude an abnormal parathyroid gland.
Revision Parathyroid Surgery – Challenges and Considerations in Comparison to Primary Surgery
Authors: McClean Adam , England James
Published: March 2022

Aim

Revision parathyroidectomy is made necessary by recurrent and persistent parathyroid disease. The aim of this study was to identify specific challenges in revision surgery compared to primary parathyroid surgery.

Methods

All revision parathyroidectomies performed by a single surgeon in a tertiary referral centre over a 17- year period were identified. Cases were assessed for: demographics; imaging; histology; biochemistry; gland weight, location, and ectopia; and cure rate. Results were compared to a consecutive series of 100 primary parathyroidectomies. Statistical analysis was performed using SPSS software.

Results

28 revision surgeries were identified (18 persistent, 7 recurrent, 3 insufficient data). Demographics were well matched. Ultrasound correctly localised the pathological gland in 18% of revision cases, compared to 37% of primary cases. Technetium-sestamibi scanning correctly localised the pathological gland in 71% of revision cases, compared to 69% of primary cases. Preoperative calcium was significantly higher in revision cases (2.88 vs 2.80, P<0.05). There was no significant difference in post-operative calcium, pre- or post-operative parathyroid hormone levels, or gland location. 37% of glands excised in revision surgery were ectopic, compared to 24% of primary surgeries (P=0.16). Gland weight was significantly higher in revision cases (2758mg vs 1154mg, P<0.05). Cure rate was significantly lower in revision surgery (86% vs 97%, P<0.05).

Conclusion

In revision parathyroidectomy, patients present with higher pre-operative calcium, larger adenomas, and a trend towards ectopia. Cure rate is significantly lower following revision surgery. Ultrasound is a poor identifier of adenoma presence and location in revision surgery, whereas Technetium-sestamibi scanning is of value in both primary and revision cases.
An audit of thyroidectomy for Graves’ Disease, in a large UK tertiary centre
Authors: Jones Larissa , Khan Shaila , Tolley Neil , Palazzo Fausto , Cox Jeremy , Agha-Jaffar Rochan , Robinson Stephen , Di Marco Aimee
Published: March 2022

Aims

Patients undergoing thyroidectomy for Graves’ disease are at increased risk of post-operative complications and therefore require additional pre-operative preparation and close post-operative assessment. This study aimed to assess the pre- and post-operative management and morbidity in a single UK tertiary centre.

Method

Retrospective analysis of patients undergoing thyroidectomy for Graves’ between 2014–19. The primary endpoint was thyroid status pre-operatively and post-operative morbidity. Secondary endpoints were administration of potassium iodide, vitamin D and beta blockers and assessment of post-operative parathyroid function.

Results

Ninety-two thyroidectomies were undertaken for Graves’ in the five-year period. Pre-operatively 98% were successfully rendered euthyroid or hypothyroid and 2% hyperthyroid but required emergency surgery. Post-operative hypocalcaemia occurred in 26% but was temporary in 92%. Vocal cord palsy was found in 11%, but in all cases was temporary (post-operative laryngoscopy was reported in 93%). 49% had received potassium iodide, 53% beta-blockers and 48% vitamin D. Post-operative calcium and PTH estimation was undertaken on day 0 in 99% and 97% respectively and day 1 in 100% and 98%.

Conclusion

This audit of specialist practice shows a majority of patients rendered eu- or hypothyroid pre-operatively and low complication rates, with the majority being temporary. Pre-operative medical optimization was not undertaken uniformly in all patients and although outcomes were good, a protocol to improve consistency has been developed in response.
Complications of Neck Drains in Thyroidectomies: Systematic Review and Meta-Analysis
Authors: Yip Hao Meng , Ong Qi Jia , Soh Terrence
Published: March 2022

Background

Intraoperative placement of neck drains in thyroidectomy patients remains a widespread practice, despite prevailing evidence discouraging this practice. This systematic review and meta-analysis was conducted to update the currently available evidence base.

Methods

Two independent investigators performed a comprehensive literature search to identify randomized control trials that evaluated post-operative complications associated with neck drains. This was conducted using four databases: Medline, Web of Science, EMBASE and Cochrane. Identified articles were then screened using a strict eligibility criterion. 16 studies were included in the final quantitative analysis and assessed for risk of bias. All methods were in accordance with recommendations from the Cochrane Review Group, UK National Health Service Centre for Reviews and Dissemination, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.

Results

Our initial search yielded 743 articles and 16 were included for final quantitative synthesis. The overall analysis demonstrated that post-operative hematomas [pooled OR = 2.09 (1.04, 4.21); p=0.04] and surgical site infections [pooled OR = 3.85 (2.04, 7.28); p<0.01] were significantly more likely in the drained group. Furthermore, hospital stays were longer in the drained group [pooled mean difference = 0.88 days (0.56, 1.20); p<0.01]. There were no significant differences in fluid volumes within the thyroid bed between study groups [pooled mean difference = -2.30 mL (-4.82, 0.21); p=0.07].

Conclusion

The drained patient group had overall higher odds of hematomas, surgical site infections and longer hospital stays. Therefore, we recommend against this practice of neck drain insertions in patients that have undergone thyroidectomies.
Long term post-surgical hypoparathyroidism (PoSH) – time to revise the definition?
Authors: Arshad Muhammad Fahad , Dhami Amardass , Quarrell Gillian , Balasubramanian Saba P
Published: March 2022

Aims

Post-surgical hypoparathyroidism (PoSH) is common after thyroidectomy. Most cases recover within 6 months. If persistent beyond 6 months, PoSH is considered to be ‘long term’ as per BAETS guidelines. The aim of the study is to determine the frequency of late recovery in this group and factors that can predict this.

Methods

Adult patients undergoing total or completion thyroidectomy between 2009–18 were included in this cohort prospective observational study. Records of patients who met certain inclusion criteria (started on calcium or activated vitamin D, or day 1 adjusted calcium <2.1 mmol/L, or day 1 PTH <1.6 pmol/L) were reviewed to identify those with PoSH at 6 months. Demographic, biochemical, surgical, pathological and clinical follow-up data is described and analysed.

Results

Out of 911 patients undergoing thyroidectomy, 270 met the inclusion criteria. Of these, 192 were started on supplements and 138 (71.9%) recovered within six months. Of the remaining 54 patients, 19 (47.5%) had remission and 21 had ongoing PoSH beyond 3 years follow-up (median follow-up 4.5 years). All of those recovered had a PTH of ≥1.6 pmol/L at/beyond 6 months. There was no difference in age, gender, diagnosis, extent of surgery, or calcium levels between the two groups.

Conclusions

Recovery from PoSH is common beyond 6 months, raising the question of whether the 6-month threshold is appropriate. In patients with a PTH level of ≥1.6 pmol/L at/after 6 months, the chances of recovery are high (60%).
Long-term cure of primary hyperparathyroidism after scan directed parathyroidectomy
Authors: Patel Neil , Mihai Radu
Published: March 2022

Background

The advent of sestamibi scintigraphy led to an enthusiastic acceptance of minimally invasive parathyroidectomy (MIP). Recently, doubts have been raised about the efficacy of limited neck exploration and some surgeons proposed bilateral neck exploration to be (once again) the gold standard operation for primary hyperparathyroidism.

Methods

A departmental database was used to identify patients who had MIP after concordant dual localisation. Long-term follow-up data was obtained to ascertain any further treatment for recurrent disease and confirm most recent biochemical status. Patients with negative localisation scans and those with familial disease were excluded.

Results

Between June 2001 – August 2014 a total of 404 patients (108M:296F, median age 63 years, range 17–90 years) underwent MIP and had normalisation of calcium in first 6 weeks after the operation. Data were missing in 14 patients therefore data on 390 patients was analysed. During follow-up, 375 patients remained normocalcaemic (2.36mmol/L IQR: 2.29–2.44 mmol/L) at a median 75 months (IQR: 20–118months). Only 15 (3.85%) patients had biochemical evidence of recurrent hypercalcaemia (2.70mmol/L, IQR: 2.63–2.75 mmol/L) at 92 months (IQR: 6–196 months) after initial operation. Of these, 5 (1.28%) patients underwent a second parathyroid procedure.

Conclusion

Recurrence after scan-directed unilateral neck exploration occurred in 4% of patients after a long disease-free interval. Only one patient had recurrent disease within 1 year of primary surgery. Bilateral neck exploration at the time of initial operation, in this selected cohort, is unlikely to had uncovered multi-gland disease and prevent disease recurrence. Focused parathyroidectomy in patients with convincing localisation studies should continue.
Surgical volume-patient outcome relationships for parathyroidectomy in the England: analysis of an administrative dataset for the Getting It Right First Time programme
Authors: Lansdown Mark , Gray William , Day Jamie , Wass John , Briggs Tim
Published: March 2022

Introduction

Previous studies suggest a relationship between surgical volume and patient outcomes for parathyroid surgery. However, most studies are small and from outside the UK. The aim of this study was to use Hospital Episodes Statistics to investigate volume-outcome relationships for parathyroid surgery in England.

Methods

We examined a five-year period (April 2014-March 2019 inclusive) for elective, adult admissions for surgery for primary hyperparathyroidism without a diagnosis of multiple endocrine neoplasia, parathyroid cancer or renal disease. Volume was the number of procedures conducted in the same financial year as the index procedure. The primary outcome measure was emergency readmission at 30 days or length of stay greater than 2 days which were taken to represent poorer outcomes.

Results

We included 17,498 parathyroidectomies. Across the period the number of surgeons conducting parathyroid surgery changed little (280 in 2014/15 and 2018/19), although the number of procedures conducted rose from 3,331 to 3,848 per annum. From the lowest surgeon volume category (1–10 per annum) to the highest (≥ 60 per annum) the proportion of patients readmitted at 30 days or with an extended length of stay decreased 11.7% to 7.0%, diagnosis of hypoparathyroidism within one year from 16.3% to 10.9%, repeat parathyroid procedures within one year from 2.5% to 1.0% and mortality rate at one year from 1.0% to 0.5%. These differences persisted after adjustment for demographic and procedural covariates.

Conclusion

Higher surgeon annual volume is associated with improved patient outcomes for parathyroid surgery. BAETS should consider recommending a minimum yearly workload.
Epithelial–mesenchymal transition in organ fibrosis development: current understanding and treatment strategies
Authors: Liu Lexin , Sun Qizhe , Davis Frank , Mao Jianhua , Zhao Hailin , Ma Daqing
Published: March 2022

Organ fibrosis is a process in which cellular homeostasis is disrupted and extracellular matrix is excessively deposited. Fibrosis can lead to vital organ failure and there are no effective treatments yet. Although epithelial–mesenchymal transition (EMT) may be one of the key cellular mechanisms, the underlying mechanisms of fibrosis remain largely unknown. EMT is a cell phenotypic process in which epithelial cells lose their cell-to-cell adhesion and polarization, after which they acquire mesenchymal features such as infiltration and migration ability. Upon injurious stimulation in different organs, EMT can be triggered by multiple signaling pathways and is also regulated by epigenetic mechanisms. This narrative review summarizes the current understanding of the underlying mechanisms of EMT in fibrogenesis and discusses potential strategies for attenuating EMT to prevent and/or inhibit fibrosis. Despite better understanding the role of EMT in fibrosis development, targeting EMT and beyond in developing therapeutics to tackle fibrosis is challenging but likely feasible.
Risk of outcomes in a Spanish population with chronic kidney disease
Authors: Alcázar Roberto , Escobar Carlos , Palacios Beatriz , Aranda Unai , Varela Luis , Capel Margarita , Sicras Antoni , Sicras Aram , Hormigo Antonio , Manito Nicolás , Botana Manuel
Published: March 2022

Objectives

To assess mortality and cardiovascular and renal outcomes among patients with chronic kidney disease (CKD) (primary objective), with a particular focus on heart failure (HF) risk following diagnosis of CKD (secondary objective) in Spain.

Methods

We conducted an observational study comprising cross-sectional and longitudinal retrospective analyses using secondary data from electronic health records. For the primary objective, adults with prevalent CKD [estimated glomerular filtration rate (eGFR) <60 or ≥60 mL/min/1.73 m2 with a urine albumin:creatinine ratio (UACR) ≥30 mg/g at the index date (1 January 2017)] were included. For the secondary objective, adults with incident CKD in 2017 were enrolled.

Results

In the prevalent population, 46 786 patients with CKD without HF [75.8 ± 14.4 years, eGFR 51.4 ± 10.1 mL/min/1.73 m2; 75.1% on renin–angiotensin system inhibitors (RASis)] and 8391 with CKD and HF (79.4 ± 10.9 years, eGFR 46.4 ± 9.8 mL/min/1.73 m2) were included. In the prevalent population, the risk of all-cause death {hazard ratio [HR] 1.107 [95% confidence interval (CI) 1.064–1.153]}, HF hospitalization [HR 1.439 (95% CI 1.387–1.493)] and UACR progression [HR 1.323 (95% CI 1.182–1.481)] was greater in those patients with CKD and HF versus CKD only. For the incident population, 1594 patients with CKD without HF and 727 with CKD and HF were included. Within 24 months from the CKD diagnosis (with/without HF at baseline), 6.5% of patients developed their first HF hospitalization. Although 60.7% were taking RASis, only 3.4% were at maximal doses and among diabetics, 1.3% were taking sodium-glucose cotransporter-2 inhibitors.

Conclusions

The presence of HF among CKD patients markedly increases the risk of outcomes. CKD patients have a high risk of HF, which could be partially related to insufficient treatment.
The resilience of the British and European goods industry: Challenge of Brexit
Authors: Uddin Moshfique , Chowdhury Anup , Wood Geoffrey
Published: March 2022

This is a study of the volume flexibility of the British and European goods industry, and its relative ability to cope with exogenous shocks, using the case of the Brexit process in a comparative context. It is located within the literature on comparative capitalism, and what it tells us in terms of how different institutional orders may be equipped to deal with such events. Using data for goods firms across 27 EU countries and the UK, we find that the UK goods industry has coped poorly with the shocks related to the Brexit process: its volume flexibility has declined. Brexit also has had an, albeit lesser, impact on the volume flexibility of their European firms counterparts. In particular, smaller firms in the EU coped better, a possible reflection of stronger institutional supports. However, firms that investing more in R&D, provide training to improve management efficiency, and apply innovation to improve asset efficiency, seem to be coping better. This study illustrates how the withdrawal of Britain from supra-national European institutions seems to have accentuated any negative effects of domestic institutions on firms, and, indeed, has had even worse consequences than the 2008 economic crisis for the British goods industry. The latter would suggest it is ill equipped to cope with further shocks, such as the 2020 pandemic. We draw out the implications for theorizing, policy and future research.
COVID-19 association with purpura fulminans: report of a life threatening complication in a fully vaccinated patient
Authors: Zhitny Vladislav Pavlovich , Lyons Mitchell , Perloff Andrea , Menezes John , Pistorio Ashley , Baynosa Richard
Published: March 2022

SARS-CoV-2 manifestations have been an ongoing evolving topic that has spread beyond its initial respiratory associations. Recently, there have been reports of COVID-19 infections found to be associated with vascular pathologies. Here, we describe a case of a fully vaccinated COVID-19 adult male with past medical history of purpura fulminans that presented with diffuse necrotic cutaneous tissue sequelae resulting in intensive care unit management and dry gangrene of upper extremity. On admission, it was found that the patient had decreased activity rather than quantity of coagulation pathway protein S. Early recognition and work up are essential in patients with known history of vascular disease and confirmed cases of SARS-CoV-2 positive polymerase chain reaction.
Pneumatosis cystoides intestinalis with pneumoperitoneum in an 87-years-old male patient: a case report
Authors: Piltcher-da-Silva Rodrigo , Sasaki Vivian Laís , Zangari Matheus Antonio Chiconelli , Gallotti Felipe Melloto , Saenger Bruna Freitas , Piltcher-Recuero Mariana , de Melo Rocha Gabriela , da Costa Marco Raeder , Coelho Júlio Cezar Uili
Published: March 2022

Pneumatosis cystoides intestinalis (PCI) is a rare condition, characterized by gas-filled cysts in the intestinal wall. The mesentery and intra-abdominal ligaments can be affected. PCI is classified as primary or secondary and associated with multiple predisposing factors. An asymptomatic 87-year-old man underwent an abdominal tomography for follow-up of bladder carcinoma. The examination revealed intestinal and mesenteric pneumatosis associated with pneumoperitoneum. At laparoscopy, intestinal and mesenteric pneumatosis without intestinal infarction was identified. He was discharged on the fifth postoperative day. PCI is a benign condition that can be confused with mesenteric ischemia. Treatment is conservative, with periodic clinical evaluations. Surgical procedure is unnecessary for its diagnosis or management.
Financial Status and Well-being in Recently Separated Military Veterans
Authors: Elbogen Eric B , Zeber John E , Vogt Dawne , Perkins Daniel F , Finley Erin P , Copeland Laurel A
Published: March 2022

Introduction

Veterans transitioning from military service to civilian life manage numerous changes simultaneously, in health, employment, social relationships, and finances. Financial problems may impact financial well-being as well as adjustment to civilian life in general; yet, research on Veterans’ financial challenges remains limited. This study examined six indicators of perceived financial status among newly transitioned Veterans over a period of 3 years and then examined perceived financial well-being measured in two domains—satisfaction and functioning—and difficulty adjusting to civilian life as functions of financial status.

Materials and Methods

A sample representing 48,965 Veterans who separated from active duty/activated status in fall 2016 provided informed consent and survey data over their first 33 post-military months; data were analyzed in weighted regression models that included demographics, military characteristics, social support, resilience, life stress, and indicators of financial status.

Results

Financial status immediately post-separation included having stable housing (88%), being able to pay for necessities (83%), keeping up with creditors (88%), having insurance for catastrophic events such as disability (79%), saving for retirement (62%), and setting aside 3 months of salary (50%). Thirteen percent of Veterans disclosed troubled financial status, having achieved no more than two of these financial goals; 38% had moderate and 49% excellent financial status. Troubled or moderate financial status, Black race, enlisted, and higher levels of stress predicted lower financial functioning. Older age, college degree at baseline, employment, and social support predicted better financial satisfaction. Veterans with troubled financial status reported greater difficulty adjusting to civilian life (odds ratio 1.34); women were less likely to report difficulty adjusting to civilian life (odds ratio 0.85).

Conclusions

Findings indicate that financial satisfaction and functioning may be sensitive to psychosocial factors (social support and stress). Findings also underscore the value of assessing Veterans’ financial status (poor debt management and lack of future planning), providing encouragement and assistance to pursue a college degree, and improving household financial management, thus increasing the likelihood that Veterans will have the necessary tools to manage their finances after separation and achieve whole health well-being.
Graves’ Disease Combined With Orthostatic Hypotension: A Two-Case Report
Authors: Han Ya-Juan , Yu Zhao-Ying , Miao Run , Chen Shuo , Wang Yu-Bing
Published: March 2022

Graves’ disease (GD) is the most common cause of hyperthyroidism in the clinic, accounting for about 85% of all hyperthyroidisms. However, hyperthyroidism combined with OH has been rarely reported in the international community. We analyzed the clinical characteristics and pathogenesis of GD combined with orthostatic hypotension. We conducted a retrospective analysis of 2 GD combined with orthostatic hypotension cases diagnosed by Chinese and Western Medical Association Hospital of Southern Medical University from July to August 2018 and discussed their clinical characteristics, treatment methods, and pathogenesis. The main clinical manifestations of both two patients with hyperthyroidism were vertigo during postural changes or activities and relief from supine position and blood volume supplementation. Considering the lack of blood volume, the symptoms were alleviated after symptomatic treatment. The possibility of hyperthyroidism combined with orthostatic hypotension should be taken into consideration in clinical diagnosis and treatment.
Part I: Background and Clinical Considerations for Stress Fractures in Female Military Recruits
Authors: Abbott Alexandra , Wang Cindy , Stamm Michaela , Mulcahey Mary K
Published: March 2022

Introduction

Stress fractures (SFx) represent a significant proportion of musculoskeletal injuries in military recruits internationally. Incidence rates as high as 40% have been reported, varying by country and branch of military cohorts. Tibial SFx are the most common, followed by other lower extremity sites, and are related to the emphasis on running during training. SFx disproportionately affect female recruits, similarly to a disparity demonstrated in female athletes.

Methods

A literature review of articles relevant to our review was conducted using PubMed, utilizing keywords stress fracture, military, recruits, diagnosis, management, treatment, prevention, epidemiology, background, and/or female. Articles older than 10 years old (prior to 2010) were not considered. Review articles were considered, but if a research article was cited by a review, the research was included directly. Articles with primary military data, members of the military as subjects, especially when female recruits were included, were strongly considered for inclusion in this review.

Results

SFx can cause medical morbidity and financial burden and can require discharge from military service. SFx management in the military has cost the United States approximately $100 million annually, which may be underestimated due to lost duty hours or medical discharge with resulting compensation. However, SFx incidence rates have been demonstrated to be reducible with concerted efforts in military cohorts.

Conclusion

This review, Part I of a two-part series, provides updated information for multidisciplinary management of SFx in female military recruits. There are many similarities to management in athletes, but unique nuances of the military recruit require specific knowledge to reduce the high incidence rates of injury.
An Examination of Factors That Influence Receipt of Reproductive Health Screenings Among Female Veterans
Authors: Ferras Madisen , Dye Judy , Ayala Guadalupe X , Schmied Emily
Published: March 2022

Introduction

As the number of women veterans grows, so does the need to ensure they receive timely health care, including preventive reproductive health screenings such as cervical cancer screenings and mammograms. However, little is known about the rates of reproductive health screenings among veterans and what factors may be related to screening. The objectives of this cross-sectional study were to (1) understand healthcare treatment-seeking experiences among women veterans, (2) determine the rate of adherence to screening guidelines for cervical and breast cancers, and (3) examine potential correlates of adherence to clinical reproductive health screening guidelines.

Materials and Methods

Women veterans completed an electronically administered survey, which assessed personal characteristics, psychological health symptoms, military service history, health insurance status, healthcare-seeking experiences (e.g., barriers to and satisfaction with care), and receipt of cervical and breast cancer screenings. Multivariable logistic regression identified factors associated with adherence to clinical guidelines for cervical and breast cancer screening.

Results

Of the 90 women (mean age = 38.78; SD = 12.19) who participated, 64 (71.10%) reported meeting all age-applicable screening guidelines. The most common barriers to obtaining women’s healthcare were availability of convenient appointment times, finding time in your schedule to make and go to an appointment, and long wait times for appointments. Multivariable logistic regression revealed veterans without a regular women’s health provider were less likely to adhere to guidelines than those with a regular provider (OR = 0.16; 95% CI, 0.04-0.57).

Discussion

Many women veterans are unable to receive reproductive health screenings; continued efforts are needed to determine how to increase adherence in this unique population.