bluuebunny/crossref_metadata_2025 huggingface dataset:
Significance of coagulation and fibrinolysis markers for benign and malignant soft tissue tumors
Authors: Asanuma Kunihiro , Nakamura Tomoki , Hagi Tomohito , Okamoto Takayuki , Kita Kouji , Nakamura Koichi , Matsuyama Yumi , Yoshida Keisuke , Asanuma Yumiko , Sudo Akihiro
Published: April 2021

Background

The intimate relationship between coagulation and fibrinolysis in malignant tumors is a well-known phenomena, with the malignant phenotype enhancing coagulation and fibrinolysis. We hypothesized that soft tissue sarcoma (STS) affects the expression of coagulation and fibrinolysis markers, which could be used to distinguish STS from benign soft tissue tumors. We analyzed the correlations between plasma levels of D-dimer (DD), plasmin-α2 plasmin inhibitor complex (PIC), soluble fibrin (SF), and thrombin-antithrombin III complex (TAT) in benign soft tissue tumors and STS to elucidate whether these markers can be used to predict STS.

Methods

Plasma DD, PIC, SF and TAT levels in primary soft tissue tumors (benign 67, STS 68) were measured before biopsy or treatment. The marker levels were analyzed and compared to various clinicopathological parameters.

Results

In malignancy (STS), the average DD, PIC and SF levels were significantly higher than in benign tumors. Multivariate logistic analysis of continuous variables indicated that only PIC exhibited a significant difference (OR: 24.5, 95%CI: 3.55–170, p = 0.0012). Receiver operating characteristic curve analysis produced area under the curve values for DD: 0.691, PIC: 0.784, SF: 0.734 and TAT: 0.588. Youden’s index was used to establish thresholds of 0.37 (DD), 0.80 (PIC), 0.90 (SF) and 0.82 (TAT). Threshold values for PIC and SF indicated high specificity (0.881, 0.791) and high positive predictive value (0.818, 0.745), respectively. The highest accuracy value among the markers was observed for PIC (0.704). Significant differences in multivariate analysis of binary variables were demonstrated by categorizing low and high groups based on their threshold, PIC (≥0.80) (OR: 3.36, 95%CI: 1.19–9.43, p = 0.0212) and SF (≥0.90) (OR: 2.63, 95%CI: 1.04–6.66, p = 0.0404) .

Conclusions

Of the coagulation and fibrinolysis markers studied, increased PIC levels were related to STS and over 0.80 PIC was the most suitable for the prediction of STS, which, along with other diagnostic tools, represents a helpful subsidiary tool for the prediction of STS.
Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review
Authors: Reece Jeanette C. , Neal Eleanor F. G. , Nguyen Peter , McIntosh Jennifer G. , Emery Jon D.
Published: April 2021

Background

Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes.

Methods

A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design.

Results

Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up.

Conclusions

Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up.
Correction to: RGD4C peptide mediates anti-p21Ras scFv entry into tumor cells and produces an inhibitory effect on the human colon cancer cell line SW480
Authors: Huang Chen-Chen , Liu Fang-Rui , Feng Qiang , Pan Xin-Yan , Song Shu-Ling , Yang Ju-Lun
Published: April 2021

An amendment to this paper has been published and can be accessed via the original article.
Self-produced audio-visual animation introduction alleviates preoperative anxiety in pediatric strabismus surgery: a randomized controlled study
Authors: Jin Yuexi , Jiang Aifen , Jiang Wanna , Wu Wenxin , Ye Lisha , Kong Xiaojiang , Liu Le , Jin Zhousheng
Published: April 2021

Background

Hospital anxiety caused by strabismus surgery has an unpleasant and disturbing feeling for both children and their parents. This study aimed to determine the effect of viewing a self-produced audio-visual animation introduction on preoperative anxiety and emergence agitation of pediatric patients undergoing strabismus surgery.

Methods

In this prospective randomized study, 1 hundred children scheduled for strabismus surgery with aged 3 ~ 6 years. The children were randomly divided into 2 groups (n = 50 for each), Group A: using a self-produced audio-visual animation introduction; Group C: controlled group without audio-visual animation introduction. Children’s preoperative anxiety was determined by the modified Yale Preoperative Anxiety Scale (mYPAS) at different time points: the night before surgery(T1), at pre-anesthetic holding room(T2), and just before anesthesia induction(T3). The Spielberger State-Trait Anxiety Inventory (STAI) was used to record the anxiety of parents at T1,T2 and T3. The incidence and the degree of emergence agitation were recorded.

Results

The mYPAS scores at T2 and T3 were higher than T1(p < 0.05) in both groups. The average score of mYPAS in Group A was significantly lower than in Group C at T2 and T3(p < 0.05). The STAI scores in Group A at T2 and T3 were significantly lower than in Group C(p < 0.05). The incidence of agitation in Group A was lower than that in Group C(p < 0.05).

Conclusions

Based on the findings, viewing a self-produced audio-visual animation can effectively alleviate the preoperative anxiety for both children and their parents in pediatric strabismus surgery, and it was effective for reducing emergence agitation as well.

Trial registration

The trial was prospectively registered before patient enrollment at Chinese Clinical Trial Registry (Clinical Trial Number: ChiCTR1900025116, Date: 08/12/2019).
Two case reports of continued progression of chronic ocular graft-versus-host disease without concurrent systemic comorbidities treated by amniotic membrane transplantation
Authors: Ikarashi Hideto , Aketa Naohiko , Shimizu Eisuke , Takano Yoji , Kawakita Tetsuya , Uchino Yuichi , Matsumoto Yukihiro , Ogawa Junko , Tsubota Kazuo , Ogawa Yoko
Published: April 2021

Background

Chronic ocular graft-versus-host disease (oGVHD) is an ocular comorbidity of graft-versus-host disease (GVHD) that usually occurs concurrently with systemic manifestations. Failure to detect and treat oGVHD in its early stages may lead to progression of ocular signs and symptoms leading to oGVHD that is refractory to conventional treatment.

Case presentation

We report the clinical course of a 19-year-old male and a 59-year-old female with severe and progressive chronic oGVHD without concurrent systemic signs of chronic graft-versus-host disease (cGVHD). Although their systemic conditions had been stable, both suffered from severe oGVHD and were referred to our clinic. Both cases exhibited marked improvement in conjunctival inflammation and fibrotic changes after amniotic membrane transplantation (AMT). Both cases underwent keratoplasty eventually to stabilize ocular surface conditions and to improve visual function.

Conclusions

We reported the clinical outcomes of 2 cases of chronic oGVHD without concurrent systemic comorbidities that were treated with AMT. The clinician should be aware that cGVHD may persist in target organs even in the absence of concurrent systemic comorbidities following seemingly successful systemic treatment. A multidisciplinary team approach is essential in the early detection and therapeutic intervention for chronic oGVHD.
Health and adverse childhood experiences among homeless youth
Authors: Barnes Andrew J. , Gower Amy L. , Sajady Mollika , Lingras Katherine A.
Published: April 2021

Background

Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.

Methods

Using data from 119,254 8th–11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.

Results

The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status.

Conclusions

ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.
A home-based, post-discharge early intervention program promotes motor development and physical growth in the early preterm infants: a prospective, randomized controlled trial
Authors: Fan Juan , Wang Jianhui , Zhang Xianhong , He Ruiyun , He Shasha , Yang Mei , Shen Yujie , Tao Xiaojun , Zhou Mei , Gao Xiong , Hu Lijun
Published: April 2021

Background

The implementation of early intervention (EI) in medical settings is time-consuming and resource-intensive, which limits its extensive use. In 2018, the Chinese Eugenics Association developed a home-based, post-discharge EI program. This study aims at evaluating the impact of this EI program on neurodevelopment and physical growth of early preterm infants.

Methods

This study was a prospective, partially blinded, randomized controlled trial (RCT), followed by an open phase. A total of 73 infants born at 28+ 0 ~ 31+ 6 weeks’ gestation who were admitted to the Children’s Hospital of Chongqing Medical University between December 1, 2019, and June 31, 2020, were enrolled. Another 33 infants were retrospectively recruited as the reference group. Thirty-seven infants randomized in the first early intervention, then standard care (EI-SC) group performed a 30-day EI during RCT period, while 36 infants allocated to SC-EI group were given EI in the following open phase. The test of infant motor performance (TIMP), development quotient (DQ), and anthropometric measures (length, weight, head circumference) were measured at the baseline (T0), termination of the RCT (T1), and termination of the open phase (T2). Repeated measures analysis was performed for comparison among groups.

Results

From T0 to T1, both groups had significant improvements in all outcome measures (all p < 0.001). A 30-day EI program was more effective in improving TIMP than standard care (from 53.12 ± 8.79 to 83.50 ± 11.85 in EI-SC group vs from 50.52 ± 8.64 to 75.97 ± 13.44 in SC-EI group, F = 4.232, p = 0.044). EI-SC group also had greater improvements in length, weight, and head circumference than SC-EI group (all p < 0.05). From T0 to T2, there was no significant difference regarding the improvements in all outcomes between the groups (all p > 0.05). At the endpoint of T2, the EI-SC and SC-EI group had similar TIMP and anthropometric measures, but much higher than the reference group (all p < 0.05).

Conclusions

These findings demonstrated that a home-based, post-discharge EI program in this study was a practical approach to promote motor development and physical growth in early preterm infants.

Trial registration

CHICTR, CTR1900028330, registered December 19, 2019, https:// http://www.chictr.org.cn/showproj.aspx?proj=45706
Suspected Agomelatine-induced restless legs syndrome: a case report
Authors: Abdul Karim Mustafa , Al-Baz Nadeen , Ouanes Sami , Alabdulla Majid , Haddad Peter M.
Published: April 2021

Background

Restless Legs Syndrome (RLS) is a sensorimotor disorder characterized by unpleasant and distressing sensations in the lower limbs that are more pronounced in the evening, commence or worsen at rest, and show partial or complete relief following movement. It can occur as a primary disorder, secondary to medical conditions or treatment with medications including but not limited to antidepressants or antipsychotics.

Case presentation

A 32-year old man with major depressive disorder showed partial response to Escitalopram 10 mg daily. Agomelatine 25 mg at night was added to Escitalopram to treat his residual depressive symptoms, namely insomnia and tiredness. Within two days he developed restlessness and unpleasant sensations in his legs which were worse at night. Symptom severity increased over the following days, prompting an urgent consultation a week later. The patient’s presentation met the criteria for RLS. Agomelatine was discontinued leaving the patient on Escitalopram alone. The patient’s symptoms improved within 24 h of stopping Agomelatine, with complete resolution four days later. There was no recurrence of RLS during follow-up. The patient scored 6 on Naranjo’s adverse drug reaction probability scale, indicating a probable adverse drug reaction caused by Agomelatine.

Conclusions

To the best of our knowledge, this is the first case report of suspected Agomelatine-induced RLS. Clinicians need to be aware of RLS to enable prompt diagnosis and management. We suggest adding Agomelatine to the list of agents that can potentially induce RLS.
Grey matter abnormalities in Tourette syndrome: an activation likelihood estimation meta-analysis
Authors: Wen Fang , Yan Junjuan , Yu Liping , Wang Fang , Liu Jingran , Li Ying , Cui Yonghua
Published: April 2021

Background

Tourette syndrome (TS) is a neurodevelopmental disorder defined by the continual presence of primary motor and vocal tics. Grey matter abnormalities have been identified in numerous studies of TS, but conflicting results have been reported. This study was an unbiased statistical meta-analysis of published neuroimaging studies of TS structures.

Methods

A voxel quantitative meta-analysis technique called activation likelihood estimation (ALE) was used. The meta-analysis included six neuroimaging studies involving 247 TS patients and 236 healthy controls. A statistical threshold of p < 0.05 was established based on the false discovery rate and a cluster extent threshold of 50 voxels.

Results

We found that grey matter volumes were significantly increased in the bilateral thalamus, right hypothalamus, right precentral gyrus, left postcentral gyrus, left inferior parietal lobule, right lentiform nucleus, and left insula of TS patients compared to those of healthy controls. In contrast, grey matter volumes were significantly decreased in the bilateral postcentral gyrus, bilateral anterior cingulate, bilateral insula, left posterior cingulate and left postcentral gyrus of TS patients compared to those of healthy controls.

Conclusions

Our present meta-analysis primarily revealed significant increases in grey matter volumes in the thalamus and lentiform nucleus, and decreased grey matter volumes in the anterior cingulate gyrus, of TS patients compared to those in healthy controls. Most of these identified regions are associated with cortico-striato-thalamo-cortical circuits. Further studies with larger sample sizes are needed to confirm these changes in grey matter volumes in TS patients.
Socioeconomic inequality in psychological distress among older adults in India: a decomposition analysis
Authors: Srivastava Shobhit , Purkayastha Naina , Chaurasia Himanshu , Muhammad T.
Published: April 2021

Background

Older people coming from a lower wealth gradient are more vulnerable to have stressful life events further adding more risk for common mental health disorders and psychological distress situations. The present study explores the associations between socioeconomic and health-related variables and psychological distress among older adults in India and the contribution of such factors to the inequalities in psychological distress.

Methods

A cross-sectional survey of 9181 older adults conducted as ‘Building a Knowledge Base on Population Ageing in India’ was assessed. Logistic regression and decomposition models were used to analyze the data. Psychological distress was measured from General Health Questionnaire (GHQ-12). The value of Cronbach's alpha was 0.90. It was having a scale of 0 to 12 on the basis of experiencing stressful symptoms and was re-coded as 0 (representing 6+ stressful symptoms) and 1 (representing 5 and fewer symptoms).

Results

Older adults from the poorest wealth quintile, having no source of income, not working for the last one year period, suffering from multi-morbidity, disabled, with low activities of daily living and low instrumental activities of daily living and poor cognitive ability were suffering from high psychological distress in India. Further, factors such as religion, caste, education, living arrangements, and self-worth in the family were major contributors to the concentration of psychological distress in older adults from poor households (concentration index: − 0.23).

Conclusion

The study suggests that among older people, there is a wide disparity of experiencing psychological distress across different socio-economic groups with significant factors being responsible for inequality in psychological distress. There is a need to build a “win-win” circumstance across sectors, including a broad spectrum of health, social and economic benefits to the vulnerable older population.
Measles vaccine coverage among children born to Somali immigrants in Norway
Authors: Jenness Sherin Marie , Aavitsland Preben , White Richard Aubrey , Winje Brita Askeland
Published: April 2021

Background

Despite overall good vaccination coverage in many countries, vaccine hesitancy has hindered full coverage and exposed groups to the risk of outbreaks. Somali immigrant groups have been known to have low measles vaccination coverage, leading to outbreaks in their communities. Current research indicates a general lack of trust in the healthcare system, the use of alternative information sources and inadequate health literacy can be contributing factors. We explore measles vaccine coverage in children born to Somali parents in Norway, whether it has changed over time and factors that may influence coverage.

Methods

Data was extracted from the National Population Register on all children born in Norway from 2000 to 2016, where both parents originated from Somalia. Date of birth, gender, residential area at birth and date of immigration and emigration for both parents was linked to information on measles vaccination from the National Immunisation Register.

Results

We found that children born to Somali immigrants in Norway had suboptimal measles vaccine coverage at 2 years; for children born in 2016 the coverage was 85%. Coverage declined between 2000 and 2016, and at a greater rate for boys than girls. Children born to mothers residing in Norway for 6 years or more had lower coverage compared to those with mothers residing less than 2 years prior to their birth. Children born in the capital and surrounding county had significantly lower coverage than children born elsewhere in Norway.

Discussion

New targeted interventions are needed to improve measles vaccine coverage among Somali immigrants in Norway. Some possible strategies include using Somali social media platforms, improving communication with Somali parents and tighter cooperation between various countries’ vaccination programmes.
Assessment of respiratory dust exposure and lung functions among workers in textile mill (Thamine), Myanmar: a cross-sectional study
Authors: Oo Thet Wai , Thandar Mya , Htun Ye Minn , Soe Pa Pa , Lwin Thant Zaw , Tun Kyaw Myo , Han Zaw Myo
Published: April 2021

Background

Airborne dusts are being potentially harmful for workers in occupational environment. Exposure to respirable dust is the most important concern in textile workers for the widespread of occupational lung diseases, especially more serious in developing countries. The aim of the study was to assess the respirable dust exposure and associated factors of lung functions among textile workers.

Methods

A cross-sectional study was carried out at a textile mill (Thamine), Yangon Region, from April to December, 2018 and a total of 207 textile workers were randomly selected by using a multistage sampling procedure. Data were collected by using a structured questionnaire for respiratory symptoms, an air sampling pump for assessment of respirable dust exposure, and a spirometer for testing the lung functions. Logistic regression analysis was performed to assess the associated factors of lung functions. Odds ratios with a 95% confidence interval were computed for strength of associations at the significance level of α ≤ 0.05.

Results

The mean (± standard deviation, SD) respirable dust exposure was 3.3 mg/m3 (± 0.69) and the prevalence of increased respirable dust exposure (> 3 mg/m3) was 50.7%. The level of respirable dust exposure was highest in the textile workers involving at twisting department. The means (± SD) spirometry values were FVC 82.8% (± 17.8), FEV1 83.6% (± 18.5), and FEV1/FVC 0.9 (± 0.1). Overall magnitude of reduced lung functions was 40.1%, and the prevalence of reduced FVC, FEV1, and FEV1/FVC were 36.7, 34.3 and 3.9% respectively. The current working at twisting department, > 5 years of service duration, respiratory symptoms and increased respirable dust exposure were associated with reduction in FVC and FEV1.

Conclusions

The current working department, service duration, respiratory symptoms and exposure to respirable dust were predictors of lung functions in textile workers. An adequate ventilation, good work practices, hygienic workplace, safety and health training regarding potential health effects, and periodically assessment of lung functions are the critical elements for control of respirable dust exposure and reduction of occupational lung diseases.
Metabolic syndrome in Thai adolescents and associated factors: the Thai National Health Examination Survey V (NHES V)
Authors: Siwarom Sirinapa , Aekplakorn Wichai , Pirojsakul Kwanchai , Paksi Witchuri , Kessomboon Pattapong , Neelapaichit Nareemarn , Chariyalertsak Suwat , Assanangkornchai Sawitri , Taneepanichskul Surasak
Published: April 2021

Background

Presence of metabolic syndrome (MetS) in early life may influence cardiovascular outcome later in adulthood. There is limited data regarding MetS among Thai adolescents. This study aimed to estimate the prevalence of MetS and related factors in Thai adolescents.

Methods

Data on MetS components of 1934 Thai adolescents aged 10–16 years were obtained from the 5th National Health Examination Survey. Age at first screen time exposure, duration of screen time, frequency of food intake and physical activities were collected from interviews. MetS was defined according to 3 definitions: International Diabetes Federation (IDF), Cook’s, and de Ferranti’s.

Results

The prevalence of MetS was 4.1% by IDF, 8.0% by Cook’s, and 16.8% by de Ferranti’s definition. The overall prevalence was higher in male (19.0%) than female adolescents (15.3%). The most common MetS components composition among Thai adolescents was high waist circumference with high serum triglyceride and low HDL-cholesterol (40.0% for IDF, 22.6% for Cook’s and 43.5% for de Ferranti’s definition). Exposure to screen media during the first 2 years of life had a 1.3- fold increased odds of MetS by 1 out of 3 definitions (OR 1.30, 95% CI. 1.01–1.68). Duration of physical activity associated with decreased odds of MetS by Cook’s definition (OR 0.96, 95% CI. 0.92–0.99).

Conclusions

The prevalence of MetS among Thai adolescents was higher than previously reported by other studies. Screen media exposure during the first 2 years of life should be discouraged and measures to promote physical activity among children and adolescents should be strengthen.
Diagnostic accuracy of sensory and motor tests for the diagnosis of carpal tunnel syndrome: a systematic review
Authors: Dabbagh Armaghan , MacDermid Joy C. , Yong Joshua , Packham Tara L. , Macedo Luciana G. , Ghodrati Maryam
Published: April 2021

Background

Carpal tunnel syndrome (CTS) is the most common entrapment mononeuropathy of the upper extremity. The previous systematic review of the diagnostic tests for CTS was outdated. The objective of this study was to compile and appraise the evidence on the accuracy of sensory and motor tests used for the diagnosis of CTS.

Methods

MEDLINE, CINAHL, and Embase databases were searched on January 20, 2020. Studies assessing at least one diagnostic accuracy property of the sensory or motor tests for CTS diagnosis were selected by two independent reviewers. Diagnostic test accuracy extension of the PRISMA guidelines was followed. Risk of bias and applicability concerns were rated using QUADAS-2 tool. Any reported diagnostic accuracy property was summarized. Study characteristics and any information on the accuracy of the sensory and motor tests for CTS diagnosis were extracted.

Results

We included sixteen clinical studies, assessing thirteen different sensory or motor tests. The most sensitive test for CTS diagnosis was the Semmes-Weinstein monofilament test (with 3.22 in any radial digit as the normal threshold) with sensitivity from 0.49 to 0.96. The tests with the highest specificity (Sp) were palmar grip strength (Sp = 0.94), pinch grip strength (Sp from 0.78 to 0.95), thenar atrophy (Sp from 0.96 to 1.00), and two-point discrimination (Sp from 0.81 to 0.98).

Conclusions

The evidence was inconclusive on which sensory or motor test for CTS diagnosis had the highest diagnostic accuracy. The results suggest that clinicians should not use a single sensory or motor test when deciding on CTS diagnosis.

Trial registration

PROSPERO CRD42018109031, on 20 December 2018.
The incidence and analysis of ipsilateral occult hernia in patients undergoing hernia repair: a single institution retrospective study of 1066 patients
Authors: He Jun , Xu Ying-jie , Sun Peng , Wang Jue , Yang Cheng-guang
Published: April 2021

Background

Misdiagnosis or failure to intraoperatively detect occult hernia in the inguinal region can lead to the recurrence of postoperative hernia and the appearance of local pain symptoms, which affect the patient’s quality of life and make it difficult to reperform hernia repair.

Methods

This study included 1066 inguinal hernia patients who underwent surgical treatment at Shanghai Tongren Hospital between January 2016 and October 2018 to investigate ipsilateral occult hernia epidemiology, to analyze the characteristics of ipsilateral occult hernias with regards to patient age, gender, classification and anatomical site, and to explore the superiority and inferiority of the expert hernia surgeons/ non-expert hernia surgeons group and of operation methods in finding occult inguinal hernias.

Results

The incidence of ipsilateral occult hernia in the surgical population was 8.26%. Ipsilateral occult hernia included indirect inguinal hernia, direct inguinal hernia, femoral hernia, obturator hernia, and spigelian hernia, among which the highest incidence was direct inguinal hernia (4.11%), followed by indirect inguinal hernia (2.45%). There was no difference in the incidence of ipsilateral occult hernia between males and females, but there were significant differences in the incidence of ipsilateral occult hernia, which decreased gradually with increasing age in patients younger than 70 years-old; there was no difference in incidence in patients over 70 years-old. There were significant differences in the incidence of ipsilateral occult hernia in the bilateral inguinal region between direct and femoral hernia, with the higher incidence found on the right side; in contrast, there was no difference in the incidence of indirect inguinal hernia in the bilateral inguinal region. There was no difference in the ability of experienced physicians to detect ipsilateral occult inguinal hernias, either professionally or by surgery.

Conclusions

Ipsilateral occult inguinal hernia has a higher incidence in patients with inguinal hernia, especially older patients; therefore, it is necessary for experienced surgeons to carefully detect for possible occult hernia during the operation and in elderly patients.
The Resonance and the Allium ureteral stents in the treatment of non-malignant refractory ureterostenosis
Authors: Gao Wei , Xing Tianying , Ou Tongwen
Published: April 2021

Background

Refractory non-malignant ureterostenosis is challenging to treat. The experience to treat the stenosis primarily cause by retroperitoneal fibrosis with the Resonance and Allium metallic stent is still limited. We aim to evaluate the efficacy and safety of these two stents and provide alternative treatment options.

Methods

A retrospective study was conducted for patients with non-malignant ureterostenosis and treated with the Resonance and Allium stents from March 2011 to September 2020 in our department. The efficacy was evaluated by the change of serum creatinine, glomerular filtration rate (GFR), the proportion of GFR of the affected side and hydronephrosis grade. The safety was evaluated by postoperative presence of moderate or severe overactive bladder (OAB), recurrent urinary infection, pain, stent displacement, encrustation and re-obstruction.

Results

33 patients were eligible for the study, including 18 cases treated by the Resonance stents and 15 patients treated by the Allium stents. The patients of two groups had similar age and gender proportion. The cause of ureterostenosis was mainly retroperitoneal fibrosis in both groups but the Resonance group had more idiopathic cases. Follow-up time was significantly longer in the Resonance group than the Allium group (36.2 ± 24.0 vs 9.4 ± 5.0 months, p < 0.001). Both groups showed improvement or maintenance of serum creatinine level, GFR, the GFR proportion of the affected side and hydronephrosis grade after treatment. The Resonance group presented significant higher incidence of moderate or severe OAB, recurrent urinary infection and pain, while the Allium group showed significant more cases of re-obstruction.

Conclusion

Both the Resonance and Allium stent can relieve the non-malignant refractory ureterostenosis effectively. The Resonance stent may cause more irritable symptoms while the Allium stent may have a higher rate of re-obstruction. The long term efficacy and safety of the Allium stent in treating non-malignant refractory ureterostenosis requires further study.
Association between severity of prenatally diagnosed hydronephrosis and receipt of surgical intervention postnatally among patients seen at a fetal-maternal center
Authors: Baker Zoë G. , Hannallah Arthi , Trabold Melissa , Estell Danielle , Deng Cherry , Chang Andy Y. , Sparks S. Scott , De Filippo Roger , Vasquez Evalynn
Published: April 2021

Background

Hydronephrosis (HN) is the most common abnormality detected on prenatal ultrasound. This study sought to stratify outcomes of patients by severity of prenatal HN with postnatal outcomes.

Methods

This was a retrospective review of patients referred to a tertiary care fetal-maternal clinic with diagnosis of prenatal HN from 2004 to 2019. HN severity was categorized as mild, moderate, or severe. Data were analyzed to determine the association between HN severity and surgical intervention. Decision for surgery was based on factors including history of multiple urinary tract infections, evidence of renal scarring, and/or reduced renal function. Surgery-free survival time was represented by the Kaplan–Meier method, and hazard ratios were calculated using the log-rank test.

Results

131 kidneys among 101 infants were prenatally diagnosed with hydronephrosis; 35.9% had mild HN, 29.0% had moderate HN, and 35.1% had severe HN. 8.5% of patients with mild HN, 26.3% of patients with moderate HN, and 65.2% of patients with severe HN required surgery. Patients with severe HN were 12.2 (95% CI 6.1–24.4; p < 0.001) times more likely to undergo surgery for HN than patients with mild HN and 2.9 (95% CI 1.5–5.3; p = 0.003) times more likely to undergo surgery than patients with moderate HN. Patients with moderate HN were 4.3 times more likely to require surgery than patients with mild HN (95% CI 1.5–12.9; p = 0.01). Median age at surgery was 11.8 months among patients with mild HN (IQR 11.7–14.1 months), 6.6 months among patients with moderate HN (IQR 4.2–16.4 months), and 5.4 months among patients with severe HN (3.7–12.4 months).

Conclusion

Among this cohort of referrals from a fetal-maternal clinic, severity of HN correlated with increased likelihood of surgical intervention. Continued assessment of patients with prenatal HN should be evaluated to best determine the role of the pediatric urologist in cases of prenatal HN.
An experimental intraradicular biofilm model in the pig for evaluating irrigation techniques
Authors: Tanaka Toshinori , Yahata Yoshio , Handa Keisuke , Venkataiah Suresh V. , Njuguna Mary M. , Kanehira Masafumi , Hasegawa Tatsuya , Noiri Yuichiro , Saito Masahiro
Published: April 2021

Background

We established an in vivo intraradicular biofilm model of apical periodontitis in pigs in which we compared the efficacy of different irrigant activation techniques for biofilm removal.

Methods

Twenty roots from the deciduous mandibular second premolar of 5 male pigs were used. After pulpectomy, canals were left open for 2 weeks and then sealed for 4 weeks to enable the development of an intracanal biofilm. The intraradicular biofilms was evaluated using SEM and bacterial 16S rRNA gene-sequencing. To investigate the efficacy of biofilm removal, root canal irrigations were performed using conventional needle, passive ultrasonic, subsonic, or laser-activated irrigation. Real-time PCR was conducted to quantitate the remaining biofilm components. Statistical analysis was performed using ANOVA followed by a Tukey kramer post-hoc test with α = 0.05.

Results

The pulp exposure model was effective in inducing apical periodontitis and SEM analysis revealed a multi-layer biofilm formation inside the root canal. 16S rRNA sequence analysis identified Firmicutes, Bacteroidetes, and Fusobacteria as the predominant bacterial phyla components, which is similar to the microbiome profile seen in humans. None of the tested irrigation techniques completely eradicated the biofilm components from the root canal, but the subsonic and laser-activated irrigation methods produced the lowest bacterial counts (p < 0.05).

Conclusions

An experimental intraradicular biofilm model has been successfully established in pigs. Within the limitations of the study, subsonic or laser-activated irrigation demonstrated the best biofilm removal results in the pig system.
Analysis of oral microbial dysbiosis associated with early childhood caries
Authors: Zheng Hui , Xie Tengfei , Li Shaokai , Qiao Xiaotong , Lu Youguang , Feng Yan
Published: April 2021

Background

"Core microbes" play a key role in the development of caries and lead to microbial disorders. Our goal was to detect the core microbes associated with the microbiota imbalance in early childhood caries (ECC).

Methods

Fifteen caries-free children and fifteen high-caries (DMFT ≥ 10) children aged 4–6 years old were recruited according to the diagnostic criteria of caries suggested by the WHO. The 16S rRNA genes from samples of plaque in saliva were amplified by PCR, and the PCR products were sequenced by the Illumina Miseq platform. The sequencing results were analyzed by professional software to determine the composition and structure of the saliva microorganisms.

Results

There were statistically significant differences between the groups regarding the relative abundance of Streptococcus mutans (Wilcoxon rank-sum test, P < 0.05). No significant difference was found between the groups regarding other species or functional genes.

Conclusion

S. mutans, together with other pathogens, may play a prominent role and act as "core microbes" in the occurrence and development of early childhood caries.
Surgery for fibroadenoma arising from axillary accessory breast
Authors: Lee Sung Ryul
Published: April 2021

Background

Patients with fibroadenomas in axillary accessory breasts (AABs) have a palpable mass, cyclic axillary pain, and aesthetic concerns that must be addressed. We compared the baseline patient characteristics, AAB characteristics, and surgical outcomes of patients with AABs with and without fibroadenomas undergoing surgical excision. We also monitored the patients for recurrence of axillary fibroadenomas.

Methods

This retrospective study involved 2310 women who underwent AAB excision from 2014 to 2019. Patients with and without a palpable fibroadenoma were divided into a fibroadenoma group and non-fibroadenoma group, respectively. All patients underwent complete excision of accessory mammary gland (AMG) tissue, including fibroadenomas in the AABs. We removed the fibroadenoma and the AMG tissue with a minimal axillary incision.

Results

Thirty-nine patients had a palpable fibroadenoma in the AAB, and all patients in the fibroadenoma group had cyclic axillary pain and a palpable axillary mass. There were no significant differences in the patients’ age, weight of the AMG tissue, liposuction volume, or fibroadenoma laterality between the two groups. The body mass index in the fibroadenoma group was lower than that in the non-fibroadenoma group (19.9 vs. 22.3 kg/m2, respectively; P < 0.000). Concurrent fibroadenoma excision in a normal breast on the chest was performed more often in the fibroadenoma group than in the non-fibroadenoma group (35.9% (14/39) vs. 4.1% (92/2271), respectively; P < 0.000). The mean fibroadenoma size was 2.1 cm (range, 1.1–9.1 cm). All patients were satisfied with the degree of postoperative pain relief, disappearance of palpable lesions, and cosmetic improvement. No patients developed fibroadenoma recurrence.

Conclusions

Complete excision of the AMG tissue and fibroadenoma is appropriate in patients with an AAB with a fibroadenoma. Surgeons should also consider the high incidence of concurrent fibroadenomas in the normal breasts on the chest.
Measuring barriers to fistula care: investigating composite measures for targeted fistula programming in Nigeria and Uganda
Authors: Sripad Pooja , Arnoff Elly , Warren Charlotte , Tripathi Vandana
Published: April 2021

Background

Accessing surgical repair poses challenges to women living with female genital fistula who experience intersectional vulnerabilities including poverty, gender, stigma and geography. Barriers to fistula care have been described qualitatively in several low- and middle-income countries, but limited effort has been made to quantify these factors. This study aimed to develop and validate composite measures to assess barriers to accessing fistula repair in Nigeria and Uganda.

Methods

This quantitative study built on qualitative findings to content validate composite measures and investigates post-repair client surveys conducted at tertiary hospitals in Northern and Southern Nigeria and Central Uganda asking women about the degree to which a range of barriers affected their access. An iterative scale development approach included exploratory and confirmatory factor analyses of two samples (n = 315 and n = 142, respectively) using STATA 13 software. Reliability, goodness-of-fit, and convergent and predictive validity were assessed.

Results

A preliminary 43-item list demonstrated face and content validity, triangulated with qualitative data collected prior to and concurrently with survey data. The iterative item reduction approach resulted in the validation of a set of composite measures, including two indices and three sub-scales. These include a Financial/Transport Inaccessibility Index (6 items) and a multidimensional Barriers to Fistula Care Index of 17 items comprised of three latent sub-scales: Limited awareness (4 items), Social abandonment (6 items), and Internalized stigma (7 items). Factor analyses resulted in favorable psychometric properties and good reliability across measures (ordinal thetas: 0.70–0.91). Higher levels of barriers to fistula care are associated with a woman living with fistula for longer periods of time, with age and geographic settings as potential confounders.

Conclusions

This set of composite measures that quantitatively captures barriers to fistula care can be used separately or together in research and programming in low- and middle-income countries.
Lateral decubitus position to facilitate pelvic examination of the patient with severe obesity
Authors: Breitkopf Daniel M.
Published: April 2021

Background

Patients with elevated BMI pose a number of challenges for the gynecologist. Pelvic examination may be more difficult due to adiposity in the perineum and labia, increasing the distance between the vulva and cervix. The objective of the current work was to describe use of the lateral decubitus position to improve visualization of the cervix in women with severe obesity.

Methods

A case series was collected. From 7/1/2010 until 1/31/2020, all records of patients with obesity and unsuccessful cervical visualization during pelvic exam in the dorsal lithotomy position in the author’s clinical practice were reviewed after obtaining Mayo Clinic Institutional Review Board approval. For the lateral decubitus position, the patient was asked to lie on her side on the exam table, facing away from the examiner with knees bent. An assistant elevated the upper bent leg 45 degrees from horizontal, exposing the perineum. A vaginal speculum was then placed in the vagina with the posterior blade toward the anus. The speculum was opened gently as would be done with examination in dorsal lithotomy position until the cervix was visualized.

Results

Eleven patients with severe obesity in the gynecologic practice of the author with prior unsuccessful cervical visualization in dorsal lithotomy position were examined in the lateral decubitus position. In all but one case the cervix was successfully visualized in the lateral decubitus position and all intended intrauterine procedures were successfully performed.

Conclusions

In this case series, the use of the lateral decubitus position appears to improve visualization of the cervix in the outpatient setting among women with severe obesity. Consideration should be given to use of the lateral decubitus position when the cervix cannot be visualized in the dorsal lithotomy position.
Standardizing clinical culture specimen collection in Ethiopia: a training‐of‐trainers
Authors: Kue Jennifer , Bersani Ashley , Stevenson Kurt , Yimer Getnet , Wang Shu-Hua , Gebreyes Wondwossen , Hazim Carmen , Westercamp Matthew , Omondi Michael , Amare Berhanu , Alebachew Gebrie , Abubeker Rajiha , Fentaw Surafel , Tigabu Eyasu , Kirley Denise , Vanderende Daniel , Bancroft Elizabeth , Gallagher Kathleen M. , Kanter Theresa , Balada-Llasat Joan-Miquel
Published: April 2021

Background

Proper specimen collection is central to improving patient care by ensuring optimal yield of diagnostic tests, guiding appropriate management, and targeting treatment. The purpose of this article is to describe the development and implementation of a training-of-trainers educational program designed to improve clinical culture specimen collection among healthcare personnel (HCP) in Ethiopia.

Methods

A Clinical Specimen Collection training package was created consisting of a Trainer’s Manual, Reference Manual, Assessment Tools, Step-by-Step Instruction Guides (i.e., job aides), and Core Module PowerPoint Slides.

Results

A two-day course was used in training 16 master trainers and 47 facility-based trainers responsible for cascading trainings on clinical specimen collection to HCP at the pre-service, in-service, or national-levels. The Clinical Specimen Collection Package is offered online via The Ohio State University’s CANVAS online platform.

Conclusions

The training-of-trainers approach may be an effective model for development of enhanced specimen collection practices in low-resource countries.