bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of Navigation on 30-Day Outcomes for Adult Spinal Deformity Surgery
Authors: Katz Austen D. , Galina Jesse , Song Junho , Hasan Sayyida , Perfetti Dean , Virk Sohrab , Silber Jeff , Essig David
Published: September 2021

Study Design

Retrospective database study.

Objective

Navigation has been increasingly used to treat degenerative disease, with positive radiographic and clinical outcomes and fewer adverse events and reoperations, despite increased operative time. However, short-term analysis on treating adult spinal deformity (ASD) surgery with navigation is limited, particularly using large nationally represented cohorts. This is the first large-scale database study to compare 30-day readmission, reoperation, morbidity, and value-per-operative time for navigated and conventional ASD surgery.

Methods

Adults were identified in the National Surgical Quality Improvement Program (NSQIP) database. Multivariate regression was used to compare outcomes between navigated and conventional surgery and to control for predictors and baseline differences.

Results

3190 ASD patients were included. Navigated and conventional patients were similar. Navigated cases had greater operative time (405 vs 320 min) and mean RVUs per case (81.3 vs 69.7), and had more supplementary pelvic fixations (26.1 vs 13.4%) and osteotomies (50.3 vs 27.7%) ( P <.001). In univariate analysis, navigation had greater reoperation (9.9 vs 5.2%, P = .011), morbidity (57.8 vs 46.8%, P = .007), and transfusion (52.2 vs 41.8%, P = .010) rates. Readmission was similar (11.9 vs 8.4%). In multivariate analysis, navigation predicted reoperation (OR = 1.792, P = .048), but no longer predicted morbidity or transfusion. Most reoperations were infectious and hardware-related.

Conclusions

Despite controlling for patient-related and procedural factors, navigation independently predicted a 79% increased odds of reoperation but did not predict morbidity or transfusion. Readmission was similar between groups. This is explained, in part, by greater operative time and transfusion, which are risk factors for infection. Reoperation most frequently occurred for wound- and hardware-related reasons, suggesting navigation carries an increased risk of infectious-related events beyond increased operative time.
Pyloric stent insertion in malignant gastric outlet obstruction: moving beyond palliation
Authors: Saeed Saad Muhammad , Bilal Sundus , Siddique Muhammad Zeeshan , Saqib Muhammad , Shahid Shahana , Ghumman Azhar Noor , Yusuf Muhammed Aasim
Published: September 2021

Background:

Self-expandable metallic stents have not only largely replaced surgical gastrojejunostomy for unresectable gastric cancers, but their role as bridging therapy for resectable obstructing tumours is also evolving.

Objective:

To evaluate the efficacy and safety of pyloric stents in gastric outlet obstruction in patients with gastric cancer and assess survival in patients with resectable obstructing gastric tumours in whom stents were inserted as a bridge to surgery.

Methods:

We retrospectively reviewed the electronic medical records of patients who underwent self-expandable metallic stent insertion for gastric outlet obstruction due to gastric cancer from January 2014 to March 2019.

Results:

Out of 161 patients, clinical improvement was observed in 159 (99%) and 156 (97%) at 1 and 12 weeks of stent placement, respectively. None of these patients experienced serious complications, such as perforation or aspiration pneumonia. Of these 161 patients, enteral stents were placed as bridging therapy prior to surgery in 40 (24.8%). Among these, 35 (87.5%) of 40 underwent neo-adjuvant chemotherapy followed by curative surgery. Of the 35 patients, 3 failed to follow-up. One-year survival following curative surgery was 87.5%. Stent helped to reduce vomiting and improve nutrition, measured by the body mass index ( p = 0.36) and serum albumin ( p = 0.05), over a 4-week period following stent insertion.

Conclusion:

Pyloric stents are useful in relieving malignant gastric outlet obstruction, maintaining nutrition during neo-adjuvant treatment and improving survival without additional risk of postoperative complications. They have traditionally been used for palliation, but should also be considered as bridging therapy for obstructing resectable gastric tumours during neo-adjuvant treatment.
Sonographic Optic Nerve Diameter and Clinical Biomarkers in Patients With Poorly Controlled Diabetes: A Comparative Analysis With Nondiabetic Subjects
Authors: Udoh Benjamin Effiong , Erim Akwa Egom , Archibong Bassey E. , Paulinus Samson O. , Ezeokpo Basil Chukwuma , Agwu Kenneth Kalu
Published: September 2021

Objective:

The study assessed optic nerve diameter (OND) and clinical biomarkers in patients with poorly controlled diabetes compared with healthy nondiabetic volunteers.

Materials and Methods:

There were 1320 adult participants recruited to the study. The cohort was divided into 600 Type 2 diabetic (DM II) patients and 720 apparently healthy, nondiabetic volunteers. The OND was measured using a high-resolution dedicated ultrasound device (Sonoace 5500; Medicol, Medison, Miami, FL, USA) with a 10-MHz linear array transducer. Subjects were examined in a supine position with their eyes closed. Three measurements of the OND were taken and the average recorded. Hemoglobin A1c concentration and lipid profiles were determined using Bio-Rad Diamat analyzer (Bio-Rad, Hercules, CA). Body mass index and age were matched for both cohorts for comparativeness.

Results:

The mean OND of the DM II patients was 3.10 ± 0.14 mm (range of 2.6–4.0 mm), which was significantly ( P < .05) lower than the control volunteers (4.22 ± 0.15 mm). The OND demonstrated a negative significant correlation with HA1c, duration of diabetes and low-density lipoprotein cholesterol level ( P < .05). Lipid profiles, blood urea, serum creatinine, and hemoglobin A1c showed statistical difference between diabetics and control subjects.

Conclusion:

Poorly controlled DM II patients may have significantly narrower OND than nondiabetic patients. This imaging biomarker has the potential to transform visual care for DM II patients.
Study of Cracking Mechanism and Wear Resistance in Laser Cladding Coating of Ni-based Alloy
Authors: Yu Zhenglei , Li Lunxiang , Zhang Deqiang , Shi Guangfeng , Yang Guang , Xu Zezhou , Zhang Zhihui
Published: September 2021

Nickel-based alloy coatings were widely used for the remanufacturing of dies and moulds by laser cladding, but the crack sensitivity would be increase due to the higher strength and hardness, which reduced the wear resistance of Ni-based alloys. In this paper, Ni-based coatings with the addition of a plastic phase (an austenitic stainless net) were prepared using laser cladding technology, and the CeO2 was added in cladding layers. The cracking mechanism, microhardness, microstructure, phase composition, and wear properties were investigated. The relationship between thermal stress and the elastic and plastic fracture had been developed from the standpoint of fracture mechanics and thermal elastic fracture mechanics. The fracture criterion of the nickel-based coating was obtained, and the study has shown that the crack sensitivity could be reduced by decreasing the thermal expansion coefficient Δα. Thus, a new method was proposed, which the stainless steel nets were prefabricated on the substrate. It was found that the number of cracks reduced significantly with the addition of stainless steel net. When the stainless steel net with 14 mesh was added in Ni-based coatings, the average microhardness of nickel composite coating was 565 HV0.2, which was 2.6 times higher than that of the 45 steel substrate. Although the rare earth oxide 4 wt.% CeO2 and stainless steel net were added in the Ni-based coating reducing the microhardness (the average microhardness is 425 HV0.2), the wear resistance of it improved substantially. The wear volume of Ni-based composite coating was 0.56×10−5 mm3·N−1·m−1, which was 85.1% lower than that of 45 steel. The experiment results have shown that the Nickel-based composite coating is equipped with low crack sensitivity and high abrasive resistance with austenitic stainless net and the rare earth oxide 4 wt.% CeO2. This research offers an efficient solution to produce components with low crack susceptibility and high wear-resistance coatings fabricated by laser cladding.
A Journey to the West: The Ancient Dispersal of Rice Out of East Asia
Authors: Spengler Robert N. , Stark Sören , Zhou Xinying , Fuks Daniel , Tang Li , Mir-Makhamad Basira , Bjørn Rasmus , Jiang Hongen , Olivieri Luca M. , Begmatov Alisher , Boivin Nicole
Published: September 2021

Rice is one of the most culturally valued and widely grown crops in the world today, and extensive research over the past decade has clarified much of the narrative of its domestication and early spread across East and South Asia. However, the timing and routes of its dispersal into West Asia and Europe, through which rice eventually became an important ingredient in global cuisines, has remained less clear. In this article, we discuss the piecemeal, but growing, archaeobotanical data for rice in West Asia. We also integrate written sources, linguistic data, and ethnohistoric analogies, in order to better understand the adoption of rice outside its regions of origin. The human-mediated westward spread of rice proceeded gradually, while its social standing and culinary uses repeatedly changing over time and place. Rice was present in West Asia and Europe by the tail end of the first millennium BC, but did not become a significant crop in West Asia until the past few centuries. Complementary historical, linguistic, and archaeobotanical data illustrate two separate and roughly contemporaneous routes of westward dispersal, one along the South Asian coast and the other through Silk Road trade. By better understanding the adoption of this water-demanding crop in the arid regions of West Asia, we explore an important chapter in human adaptation and agricultural decision making.
Effectiveness of plants and green infrastructure utilization in ambient particulate matter removal
Authors: Wróblewska Katarzyna , Jeong Byoung Ryong
Published: September 2021

Air pollution is regarded as an increasingly threatening, major environmental risk for human health. Seven million deaths are attributed to air pollution each year, 91% of which is due to particulate matter. Vegetation is a xenobiotic means of removing particulate matter. This review presents the mechanisms of PM capture by plants and factors that influence PM reduction in the atmosphere. Vegetation is ubiquitously approved as a PM removal solution in cities, taking various forms of green infrastructure. This review also refers to the effectiveness of plant exploitation in GI: trees, grasslands, green roofs, living walls, water reservoirs, and urban farming. Finally, methods of increasing the PM removal by plants, such as species selection, biodiversity increase, PAH-degrading phyllospheric endophytes, transgenic plants and microorganisms, are presented.
Handling climate change education at universities: an overview
Authors: Leal Filho Walter , Sima Mihaela , Sharifi Ayyoob , Luetz Johannes M. , Salvia Amanda Lange , Mifsud Mark , Olooto Felicia Motunrayo , Djekic Ilija , Anholon Rosley , Rampasso Izabela , Kwabena Donkor Felix , Dinis Maria Alzira Pimenta , Klavins Maris , Finnveden Göran , Chari Martin Munashe , Molthan-Hill Petra , Mifsud Alexandra , Sen Salil K. , Lokupitiya Erandathie
Published: September 2021

Background

Climate change is a problem which is global in nature, and whose effects go across a wide range of disciplines. It is therefore important that this theme is taken into account as part of universities´ teaching and research programs.

Methods

A three-tiered approach was used, consisting of a bibliometric analysis, an online survey and a set of case studies, which allow a profile to be built, as to how a sample of universities from 45 countries handle climate change as part of their teaching programs.

Results

This paper reports on a study which aimed at identifying the extent to which matters related to climate change are addressed within the teaching and research practices at universities, with a focus on the training needs of teaching staff. It consists of a bibliometric analysis, combined with an online worldwide survey aimed at ascertaining the degree of involvement from universities in reducing their own carbon footprint, and the ways they offer training provisions on the topic. This is complemented by a set of 12 case studies from universities round the world, illustrating current trends on how universities handle climate change. Apart from reporting on the outcomes of the study, the paper highlights what some universities are doing to handle climate issues, and discusses the implications of the research.

Conclusions

The paper lists some items via which universities may better educate and train their students on how to handle the many challenges posed by climate change.
Ancestry inference using reference labeled clusters of haplotypes
Authors: Wang Yong , Song Shiya , Schraiber Joshua G. , Sedghifar Alisa , Byrnes Jake K. , Turissini David A. , Hong Eurie L. , Ball Catherine A. , Noto Keith
Published: September 2021

Background

We present ARCHes, a fast and accurate haplotype-based approach for inferring an individual’s ancestry composition. Our approach works by modeling haplotype diversity from a large, admixed cohort of hundreds of thousands, then annotating those models with population information from reference panels of known ancestry.

Results

The running time of ARCHes does not depend on the size of a reference panel because training and testing are separate processes, and the inferred population-annotated haplotype models can be written to disk and reused to label large test sets in parallel (in our experiments, it averages less than one minute to assign ancestry from 32 populations using 10 CPU). We test ARCHes on public data from the 1000 Genomes Project and the Human Genome Diversity Project (HGDP) as well as simulated examples of known admixture.

Conclusions

Our results demonstrate that ARCHes outperforms RFMix at correctly assigning both global and local ancestry at finer population scales regardless of the amount of population admixture.
Anomaly detection in genomic catalogues using unsupervised multi-view autoencoders
Authors: Ferré Quentin , Chèneby Jeanne , Puthier Denis , Capponi Cécile , Ballester Benoît
Published: September 2021

Background

Accurate identification of Transcriptional Regulator binding locations is essential for analysis of genomic regions, including Cis Regulatory Elements. The customary NGS approaches, predominantly ChIP-Seq, can be obscured by data anomalies and biases which are difficult to detect without supervision.

Results

Here, we develop a method to leverage the usual combinations between many experimental series to mark such atypical peaks. We use deep learning to perform a lossy compression of the genomic regions’ representations with multiview convolutions. Using artificial data, we show that our method correctly identifies groups of correlating series and evaluates CRE according to group completeness. It is then applied to the ReMap database’s large volume of curated ChIP-seq data. We show that peaks lacking known biological correlators are singled out and less confirmed in real data. We propose normalization approaches useful in interpreting black-box models.

Conclusion

Our approach detects peaks that are less corroborated than average. It can be extended to other similar problems, and can be interpreted to identify correlation groups. It is implemented in an open-source tool called atyPeak.
In silico vaccine design and epitope mapping of New Delhi metallo-beta-lactamase (NDM): an immunoinformatics approach
Authors: Fathollahi Matin , Fathollahi Anwar , Motamedi Hamid , Moradi Jale , Alvandi Amirhooshang , Abiri Ramin
Published: September 2021

Background

Antibiotic resistance is a global health crisis. The adage that “prevention is better than cure” is especially true regarding antibiotic resistance because the resistance appears and spreads much faster than the production of new antibiotics. Vaccination is an important strategy to fight infectious agents; however, this strategy has not attracted sufficient attention in antibiotic resistance prevention. New Delhi metallo-beta-lactamase (NDM) confers resistance to many beta-lactamases, including important carbapenems like imipenem. Our goal in this study is to use an immunoinformatics approach to develop a vaccine that can elicit strong and specific immune responses against NDMs that prevent the development of antibiotic-resistant bacteria.

Results

In this study, 2194 NDM sequences were aligned to obtain a conserved sequence. One continuous B cell epitope and three T cell CD4+ epitopes were selected from NDMs conserved sequence. Epitope conservancy for B cell and HLA-DR, HLA-DQ, and HLA-DP epitopes was 100.00%, 99.82%, 99.41%, and 99.86%, respectively, and population coverage of MHC II epitopes for the world was 99.91%. Permutation of the four epitope fragments resulted in 24 different peptides, of which 6 peptides were selected after toxicity, allergenicity, and antigenicity assessment. After primary vaccine design, only one vaccine sequence with the highest similarity with discontinuous B cell epitope in NDMs was selected. The final vaccine can bind to various Toll-like receptors (TLRs). The prediction implied that the vaccine would be stable with a good half-life. An immune simulation performed by the C-IMMSIM server predicted that two doses of vaccine injection can induce a strong immune response to NDMs. Finally, the GC-Content of the vaccine was designed very similar to E. coli K12.

Conclusions

In this study, immunoinformatics strategies were used to design a vaccine against different NDM variants that could produce an effective immune response against this antibiotic-resistant factor.
Genetic changes involving the coral gastrovascular system support the transition between colonies and bailed-out polyps: evidence from a Pocillopora acuta transcriptome
Authors: Chuang Po-Shun , Mitarai Satoshi
Published: September 2021

Background

A coral colony is composed of physiologically integrated polyps. In stony corals, coloniality adopts a wide diversity of forms and involves complex ontogenetic dynamics. However, molecular mechanisms underlying coloniality have been little studied. To understand the genetic basis of coloniality and its contribution to coral ecology, we induced polyp bail-out in a colonial coral, Pocillopora acuta, and compared transcription profiles of bailed-out polyps and polyps in normal colonies, and their responses to heat shock and hyposalinity.

Results

Consistent with morphological formation of a gastrovascular system and its neural transmission and molecular transport functions, we found genetic activation of neurogenesis and development of tube-like structures in normal colonies that is absent in bailed-out polyps. Moreover, relative to bailed-out polyps, colonies showed significant overexpression of genes for angiotensin-converting enzymes and endothelin-converting enzymes. In response to hyperthermal and hyposaline treatments, a high proportion of genetic regulation proved specific to either bailed-out polyps or colonies. Elevated temperatures even activated NF-κB signaling in colonies. On the other hand, colonies showed no discernible advantage over bailed-out polyps in regard to hyposalinity.

Conclusions

The present study provides a first look at the genetic basis of coloniality and documents different responses to environmental stimuli in P. acuta colonies versus those in bailed-out polyps. Overexpression of angiotensin-converting enzymes and endothelin-converting enzymes in colonies suggests possible involvement of these genes in development of the gastrovascular system in P. acuta. Functional characterization of these coral genes and further investigation of other forms of the transition to coloniality in stony corals should be fruitful areas for future research.
The effect of an eye mask on midazolam requirement for sedation during spinal anesthesia: a randomized controlled trial
Authors: Yoo Seon Woo , Ki Min-Jong , Kim Dal , Oh Yu Jin , Lee Jeongwoo
Published: September 2021

Background

Midazolam is frequently used for sedation during spinal anesthesia. However, external environmental factors, such as bright surgical lights, may hamper patient relaxation, which may lead to an increase in the dose of midazolam required and the likelihood of adverse drug effects. We investigated whether using an eye mask to block the external environment could reduce midazolam requirements during spinal anesthesia.

Methods

Participants aged 18–‒80 years, scheduled for elective surgery under spinal anesthesia, were randomly divided into a masked group (wearing eye masks during surgery, n = 20) and a control group (no mask, n = 18). The sedation level was assessed using a modified Observer Assessment of Alertness and Sedation (MOAA/S) scale. Midazolam (1 mg) was incrementally administered every 5 min until moderate sedation (MOAA/S score of 3) was achieved. The bispectral index (BIS) was monitored, and the onset and maintenance times of a BIS < 80 were recorded.

Results

The two groups had similar demographic characteristics. The midazolam requirements were significantly lower in the masked group than in the control group (2.8 mg vs. 3.7 mg, P = 0.024). However, the onset and maintenance times for a BIS < 80 were similar. In addition, there were no significant differences in the incidence of side effects or patient satisfaction between the two groups.

Conclusions

Blocking the external environment with an eye mask during spinal anesthesia can reduce the requirement for sedatives, such as midazolam.

Trial registration

The trial was retrospectively registered with the Clinical Research Information Service (No. KCT0005528, 15/10/2020) entitled “Can we reduce an amount of sleeping pills just by blocking light?”.
Development of a simulation-based curriculum for Pediatric prehospital skills: a mixed-methods needs assessment
Authors: Padrez Kevin A. , Brown John , Zanoff Andy , Chen Carol C. , Glomb Nicolaus
Published: September 2021

Background

The assessment and treatment of pediatric patients in the out-of-hospital environment often presents unique difficulties and stress for EMS practitioners.

Objective

Use a mixed-methods approach to assess the current experience of EMS practitioners caring for critically ill and injured children, and the potential role of a simulation-based curriculum to improve pediatric prehospital skills.

Methods

Data were obtained from three sources in a single, urban EMS system: a retrospective review of local pediatric EMS encounters over one year; survey data of EMS practitioners’ comfort with pediatric skills using a 7-point Likert scale; and qualitative data from focus groups with EMS practitioners assessing their experiences with pediatric patients and their preferred training modalities.

Results

2.1% of pediatric prehospital encounters were considered “critical,” the highest acuity level. A total of 136 of approximately 858 prehospital providers responded to the quantitative survey; 34.4% of all respondents either somewhat disagree (16.4%), disagree (10.2%), or strongly disagree (7.8%) with the statement: “I feel comfortable taking care of a critically ill pediatric patient.” Forty-seven providers participated in focus groups that resulted in twelve major themes under three domains. Specific themes included challenges in medication dosing, communication, and airway management. Participants expressed a desire for more repetition and reinforcement of these skills, and they were receptive to the use of high-fidelity simulation as a training modality.

Conclusions

Critically ill pediatric prehospital encounters are rare. Over one third of EMS practitioners expressed a low comfort level in managing critically ill children. High-fidelity simulation may be an effective means to improve the comfort and skills of prehospital providers.
A comparative study of forest methods for time-to-event data: variable selection and predictive performance
Authors: Liu Yingxin , Zhou Shiyu , Wei Hongxia , An Shengli
Published: September 2021

Background

As a hot method in machine learning field, the forests approach is an attractive alternative approach to Cox model. Random survival forests (RSF) methodology is the most popular survival forests method, whereas its drawbacks exist such as a selection bias towards covariates with many possible split points. Conditional inference forests (CIF) methodology is known to reduce the selection bias via a two-step split procedure implementing hypothesis tests as it separates the variable selection and splitting, but its computation costs too much time. Random forests with maximally selected rank statistics (MSR-RF) methodology proposed recently seems to be a great improvement on RSF and CIF.

Methods

In this paper we used simulation study and real data application to compare prediction performances and variable selection performances among three survival forests methods, including RSF, CIF and MSR-RF. To evaluate the performance of variable selection, we combined all simulations to calculate the frequency of ranking top of the variable importance measures of the correct variables, where higher frequency means better selection ability. We used Integrated Brier Score (IBS) and c-index to measure the prediction accuracy of all three methods. The smallerIBSvalue, the greater the prediction.

Results

Simulations show that three forests methods differ slightly in prediction performance. MSR-RF and RSF might perform better than CIF when there are only continuous or binary variables in the datasets.

For variable selection performance,

When there are multiple categorical variables in the datasets, the selection frequency of RSF seems to be lowest in most cases. MSR-RF and CIF have higher selection rates, and CIF perform well especially with the interaction term.

The fact that correlation degree of the variables has little effect on the selection frequency indicates that three forest methods can handle data with correlation.

When there are only continuous variables in the datasets, MSR-RF perform better. When there are only binary variables in the datasets, RSF and MSR-RF have more advantages than CIF.

When the variable dimension increases, MSR-RF and RSF seem to be more robustthan CIF

Conclusions

All three methods show advantages in prediction performances and variable selection performances under different situations. The recent proposed methodology MSR-RF possess practical value and is well worth popularizing. It is important to identify the appropriate method in real use according to the research aim and the nature of covariates.
Measuring advance care planning behavior in Dutch adults: translation, cultural adaptation and validation of the Advance Care Planning Engagement Survey
Authors: van der Smissen Doris , van der Heide Agnes , Sudore Rebecca L. , Rietjens Judith A. C. , Korfage Ida J.
Published: September 2021

Background

Advance care planning (ACP) enables people to define, discuss, and record preferences for treatment and care. Measures of ACP behavior are lacking in the Netherlands. We aimed to translate, culturally adapt and validate the 34-item ACP Engagement Survey into Dutch.

Methods

Following validation guidelines, we tested content validity, internal consistency, reproducibility, construct validity, interpretability and criterion validity among persons with and without chronic disease.

Results

Forward-backward translation indicated the need of only minor adaptations. Two hundred thirty-two persons completed baseline and retest surveys; 121 were aged ≥60 years. Persons with chronic disease (n = 151) considered the survey more valuable than those without (66 vs. 59, p < 0.001, scale of 20–100), indicating good content validity. Internal consistency (Cronbach’s alpha: 0.97) and reproducibility (intraclass correlation: 0.88) were good. Total ACP Engagement was higher among persons with chronic disease than those without (2.9 vs. 2.4, p < 0.01, scale of 1 to 5), indicating good psychometric support for construct validity and interpretability. Positive correlations of the ACP Engagement Survey and the General Self-Efficacy survey indicated good criterion validity (p < 0.05).

Conclusions

This study provided good psychometric support for the validity and reliability of the Dutch 34-item ACP Engagement Survey. This instrument can be used to assess involvement in ACP in adults with and without chronic disease.
A novel pN3 gastric cancer staging system with superior prognostic utility based upon the examination of over 31 lymph nodes: a propensity score-matching analysis
Authors: Hu Qiantao , Pan Siwei , Guo Zijun
Published: September 2021

Background

Individuals with pN3 gastric cancer (GC) account for a large proportion of pN + GC, and exhibit poor survival outcomes. The pN3 stage is defined based upon the number of metastatic lymph nodes (mLNs), but the subclassification of pN3 patients based upon the number of examined LNs (eLNs) is rarely performed.

Methods

In total, 2894 pTxN3M0 GC patients in the Surveillance, Epidemiology, and End Results database that had undergone surgery from 2000 to 2016 were selected for analysis. The X-tile software was used to select the optimal cutoff values. Cox proportional regression analyses were used to evaluated hazard ratios corresponding to the risk of death. Selection bias was minimized via propensity score matching (PSM).

Results

As the number of eLNs rose, the risk of death for patients trended downwards. Survival analyses indicated that patients with ≤ 31 eLNs exhibited significantly poorer survival outcomes as compared to patients with > 31 eLNs (5-year OS: 18.4% vs. 24.7%), and this result remained significant when analyzing 857 pairs of patients following PSM analysis. Significant differences in prognosis were additionally observed when comparing pN3a and pN3b patients with ≤ 31 or > 31 eLNs under pT3/4a stage. For pT4b stage, pN3a patients with > 31 eLNs also exhibited a better prognosis than other patients. The novel TNM staging system designed exhibited excellent utility as a tool for the prognostic evaluation of this GC patient population.

Conclusions

These results suggest that in pN3 GC, a minimum of 32 LNs should be examined. The novel TNM staging system for pN3 patients described herein, which was developed based upon the number of eLNs, may thus be of value in clinical settings.
The PSC scientific community resource: an asset for multi-omics interrogation of primary sclerosing cholangitis
Authors: Ali Ahmad Hassan , Juran Brian D. , Schlicht Erik M. , Bianchi Jackie K. , McCauley Bryan M. , Atkinson Elizabeth J. , Lazaridis Konstantinos N.
Published: September 2021

Background

Primary sclerosing cholangitis (PSC) is a rare, chronic cholestatic liver disease that often progresses to end-stage liver disease and/or the development of hepatobiliary neoplasia. Lack of prognostic tools and treatment options for PSC is driven in part by our poor understanding of its pathogenesis, which is thought to be complex, the interaction of genetic variants, environmental influences and biological response throughout the course of disease. The PSC Scientific Community Resource (PSC-SCR) seeks to overcome previous shortcomings by facilitating novel research in PSC with the ultimate goals of individualizing patient care and improving patient outcomes.

Methods

PSC patients who receive their health care at Mayo Clinic or a collaborating site are identified by chart review and invited in person or by mail to participate. Non-Mayo patients are offered enrollment if they provide sufficient access to their medical records to evaluate inclusion/exclusion criteria. Controls without liver disease are identified with assistance of the Mayo Clinic Biobank. Participant consent is obtained at the beginning of the recruitment process by mail-in, electronic or face-to-face protocols. Clinical data is extracted from the medical record by qualified physicians and entered in a custom designed database. Participants fill out a custom-designed, comprehensive questionnaire, which collects scientifically relevant demographic and clinical information. Biospecimens are collected using mail-in kits thar are returned via overnight carrier service and processed by the biospecimen accessioning and processing facility at Mayo Clinic, which coordinates sample transfers and provides required sample preparation services. The resource is currently being utilized to perform omics-scale projects investigating the exposome, metabolome, methylome, immunome and microbiome in PSC. Datasets and residual biospecimens will be shared with researchers proposing scientifically sound PSC-focused research with approval of the appropriate review boards.

Discussion

Patient-based studies leveraging the latest technologies for targeted and wide-scale interrogation of multiple omics layers offer promise to accelerate PSC research through discovery of unappreciated aspects of disease pathogenesis. However, the rarity of PSC severely limits such studies. Here we describe our effort to overcome this limitation, the PSC-SCR, a repository of patient biospecimens coupled with clinical and omics data for use by the broader PSC research community.
Effect of virtual reality exercises on balance and fall in elderly people with fall risk: a randomized controlled trial
Authors: Zahedian-Nasab Noorolla , Jaberi Azita , Shirazi Fatemeh , Kavousipor Somayyeh
Published: September 2021

Background

Deficient balance and fear of falling in elderly people can lead to disturbed daily activities, falling, and finally reduced quality of life. Therefore, evaluation of low-risk methods that might partially improve balance in this group of people is of utmost importance. The present study aimed to investigate the impact of Virtual Reality (VR) exercises based on Xbox Kinect on balance and fear of falling among elderly people.

Methods

This clinical trial was performed on 60 elderly individuals living in nursing homes divided into two groups of control and Xbox. The participants in the intervention group received VR exercises based on Xbox Kinect in form of two 30–45-min sessions held on a weekly basis for 6 weeks. The individuals in the control group, on the other hand, received routine exercises of the nursing homes. The research tools used in this study included a demographic questionnaire, the Berg Balance Scale (BBS), the Timed Up and Go (TUG) test, and the Falling Efficacy Scale (FES).

Results

The findings of the current study demonstrated that the scores of BBS and TUG test as the indices of balance among elderly people improved significantly in the Xbox group after the intervention (p < 0.001 for both BBS and TUG test). Moreover, the score of fear of falling diminished significantly in the intervention group compared to the control group (p < 0.001).

Conclusion

According to the results of the present investigation, 6 weeks of VR balance exercises could enhance balance and fear of falling among elderly people living in nursing homes.

Trial registration

Code:IRCT20190727044347N1, Date: 17-8-2019.
Expectations and behaviour of older adults with neurological disorders regarding general practitioner consultations: an observational study
Authors: Schönenberg Aline , Teschner Ulrike , Prell Tino
Published: September 2021

Background

Patients’ relationship with their GPs is linked to adherence, patient behaviour and satisfaction with healthcare. Several factors pertaining to this relationship have already been identified, however expectations and preferences vary depending on age and diagnosis. Chronically ill elderly patients constitute a group of patients with specific needs that are not yet understood.

Methods

For this observational study, 100 (44 female, mean age 72.72 + − 8.28 years) patients were interviewed. Multiple linear or binary logistic regression as well as analysis of variance was used to understand the link between factors pertaining to GP relationship and patient behaviour, and principal component analysis was performed to understand the underlying structure of patients’ needs.

Results

Patients attribute high importance to their GP’s opinion of them. On average, what the GP thinks about the patients is almost as important as what their partners think. Patients primarily want to be perceived as engaged, friendly and respected individuals, and it is important for patients to be liked by their GP. This importance is linked to active preparation; 65% of the patients prepared actively for GP consultations. Expectations regarding GP consultations can be split into two components: a medical aspect with a subfactor concerning emotional support, and a social component. Prominent factors influencing the relationship are the possibility to talk about emotions and mental well-being, trust, and GP competency. Satisfaction and trust were mainly linked to medical competency. Being able to show emotions or talk about mental well-being enhances perceived GP competence, satisfaction, and active patient preparation. However, a focus on the social component such as frequent talking about private topics reduces both perceived GP competency as well as active patient preparation.

Conclusion

Older patients take GP consultations seriously, and their expectations regarding GP consultations focus on medical competence and care as well as empathetic listening and understanding. Older persons seek a deeper connection to their GPs and are willing to be active and cooperative. As the patient–GP relationship influences health outcomes, treatment of older patients should be adjusted to enable this active participation.
A comparison of demographic, epidemiological and clinical characteristics of hospital influenza-related viral pneumonia patients
Authors: Fu Bin , Wu Zhengjie , Huang Lingtong , Chai Zhaohui , Zheng Peidong , Sun Qinmiao , Gu Silan , Xu Qiaomai , Feng Haiting , Tang Lingling
Published: September 2021

Background

Through the comparison of the demographic, epidemiological, and clinical characteristics of hospital human influenza (influenza A (H1N1) pdm09, H3N2, and B)-related and hospitalized avian-origin influenza A (H7N9)-related viral pneumonia patients, find the different between them.

Methods

A retrospective study was conducted in hospitalized influenza-related viral pneumonia patients.

Results

Human influenza A-related patients in the 35–49-year-old group were more than those with B pneumonia patients (p = 0.027), and relatively less in the ≥ 65-year-old group than B pneumonia patients (p = 0.079). The proportion of comorbid condition to human influenza A pneumonia was 58%, lower than B pneumonia and H7N9 pneumonia patients (78% vs. 77.8%; p = 0.013). The proportion of invasive mechanical ventilation (IMV), lymphocytopenia, elevated lactate dehydrogenase to hospitalized human influenza A-related viral pneumonia patients was higher than B pneumonia patients (p < 0.05), but lower than H7N9 pneumonia patients (p < 0.05). In the multivariate analysis, pulmonary consolidation (odds ratio (OR): 13.67; 95% confidence interval (CI) 1.54–121.12; p = 0.019) and positive bacterial culture (sputum) (OR: 7.71; 95% CI 2.48–24.03; p < 0.001) were independently associated with IMV, while shock (OR: 13.16; 95% CI 2.06–84.07; p = 0.006), white blood cell count > 10,000/mm3 (OR: 7.22; 95% CI 1.47–35.58; p = 0.015) and positive bacterial culture(blood or sputum) (OR: 6.27; 95% CI 1.36–28.85; p = 0.018) were independently associated with death in the three types hospitalized influenza-related viral pneumonia patients.

Conclusions

Hospital influenza B-related viral pneumonia mainly affects the elderly and people with underlying diseases, while human influenza A pneumonia mainly affects the young adults; however, the mortality was similar. The hospitalized human influenza A-related viral pneumonia patients was severer than B pneumonia patients, but milder than H7N9 pneumonia patients. Pulmonary consolidation and positive bacterial culture (sputum) were independently associated with IMV, while shock, white blood cell count > 10,000/mm3, and positive bacterial culture (blood or sputum) were independently associated with death to three types hospitalized influenza-related viral pneumonia patients.
Efficacy of tetracyclines and fluoroquinolones for the treatment of macrolide-refractory Mycoplasma pneumoniae pneumonia in children: a systematic review and meta-analysis
Authors: Ahn Jong Gyun , Cho Hye-Kyung , Li Donghe , Choi Miyoung , Lee Jina , Eun Byung-Wook , Jo Dae Sun , Park Su Eun , Choi Eun Hwa , Yang Hyeon-Jong , Kim Ki Hwan
Published: September 2021

Background

Mycoplasma pneumoniaeis a common pathogen that causes community-acquired pneumonia in school-age children. Macrolides are considered a first-line treatment forM. pneumoniaeinfection in children, but macrolide-refractoryM. pneumoniae(MRMP) strains have become more common. In this study, we assessed the efficacy of tetracyclines and fluoroquinolones in MRMP treatment in children through a systematic review and meta-analysis.

Methods

Two reviewers individually searched 10 electronic databases (Medline/Pubmed, Embase, the Cochrane Library, and core Korean, Chinese, and Japanese journals) for papers published from January 1, 1990 to March 8, 2018. The following data for each treatment group were extracted from the selected studies: intervention (tetracyclines and fluoroquinolones/comparator), patient characteristics (age and sex), and outcomes (fever duration, hospital stay length, treatment success rate, and defervescence rates 24, 48, and 72 h after starting treatment).

Results

Eight studies involving 537 participants were included. Fever duration and hospital stay length were shorter in the tetracycline group than in the macrolide group (weighted mean difference [WMD] = − 1.45, 95% confidence interval [CI]: − 2.55 to − 0.36,P = 0.009; and WMD = − 3.33, 95% CI: − 4.32 to − 2.35,P < 0.00001, respectively). The therapeutic efficacy was significantly higher in the tetracycline group than in the macrolide group (odds ratio [OR]: 8.80, 95% CI: 3.12–24.82). With regard to defervescence rate, patients in the tetracycline group showed significant improvement compared to those in the macrolide group (defervescence rate after 24 h, OR: 5.34, 95% CI: 1.81–15.75; after 48 h, OR 18.37, 95% CI: 8.87–38.03; and after 72 h, OR: 40.77, 95% CI: 6.15–270.12). There were no differences in fever improvement within 24 h in patients in the fluoroquinolone group compared to those in the macrolide group (OR: 1.11, 95% CI: 0.25–5.00), although the defervescence rate was higher after 48 h in the fluoroquinolone group (OR: 2.78, 95% CI: 1.41–5.51).

Conclusion

Tetracyclines may shorten fever duration and hospital stay length in patients with MRMP infection. Fluoroquinolones may achieve defervescence within 48 h in patients with MRMP infection. However, these results should be carefully interpreted as only a small number of studies were included, and they were heterogeneous.
The syndrome of inappropriate antidiuresis after vaccination against COVID-19: case report
Authors: Lindner Gregor , Ryser Basil
Published: September 2021

Background

The Syndrome of Inappropriate Antidiuresis (SIADH) has been described to be associated with a multitude of conditions and medications, including the severe acute respiratory syndrome coronavirus 2. We describe the case of a patient with newly diagnosed and symptomatic SIADH after receiving the second COVID-19 vaccination not explained otherwise.

Case presentation

A 79-year-old male person was admitted to the emergency department due to a worsening of his general health state expressed by weakness, fatigue and anorexia. Vital signs and clinical findings were normal, in particular the patient was considered to be euvolemic. Laboratory investigations revealed a serum sodium of 117 mmol/L, a serum osmolality of 241 mosm/kg and a urea of 1.2 mmol/L with creatinine within normal range. Urine chemistry showed a urine osmolality of 412 mosm/kg and urine sodium of 110 mmol/L. TSH, C-reactive protein, and basal cortisol levels were normal. Under therapy with balanced crystalloid fluids, hyponatremia worsened and in absence of diuretic medications, diagnosis of SIADH was made. Since fluid restriction was not sufficiently effective, oral urea was administered. Under this therapy regimen hyponatremia resolved.

Conclusions

Local as well as systemic reactions have been described for the new mRNA-based vaccines including pain and fever. Therefore, it is imaginable that the vaccine might trigger SIADH in some patients.
Impact of the relationship between hemoglobin levels and renal interstitial fibrosis on long-term outcomes in type 2 diabetes with biopsy-proven diabetic nephropathy
Authors: Shimizu Miho , Furuichi Kengo , Kitajima Shinji , Toyama Tadashi , Oshima Megumi , Ogura Hisayuki , Sato Koichi , Nakagawa Shiori , Yamamura Yuta , Miyagawa Taro , Hara Akinori , Iwata Yasunori , Sakai Norihiko , Kitagawa Kiyoki , Yoshimura Mitsuhiro , Yokoyama Hitoshi , Wada Takashi
Published: September 2021

Background

Progression of renal anemia has been shown to be associated with advanced renal tubulointerstitial lesions. This retrospective study investigated the impact of lower hemoglobin (Hb) levels and renal interstitial fibrosis and tubular atrophy (IFTA) on long-term outcomes in type 2 diabetes with biopsy-proven diabetic nephropathy.

Methods

A total of 233 patients were enrolled. The severity of IFTA was scored according to the classification by the Renal Pathology Society. Patients were stratified according to baseline Hb tertiles by IFTA status. The outcomes were the first occurrence of renal events (requirement for dialysis or 50 % decline in estimated glomerular filtration rate from baseline) and all-cause mortality.

Results

At baseline, 151 patients had severe IFTA. There were no patients who have been received erythropoiesis-stimulating agents at the time of renal biopsy. The severity of IFTA was the independent pathological factor of lower Hb levels. During the mean follow-up period of 8.6 years (maximum, 32.4 years), 119 renal events and 42 deaths were observed. Compared with the combined influence of the highest tertile of Hb and mild IFTA, the risks of renal events were higher for the middle tertile and for the lowest tertile of Hb in severe IFTA, whereas the risk of renal events was higher for the lowest tertile of Hb in mild IFTA. The risk of mortality was higher for the lowest tertile of Hb only in severe IFTA. There were significant interactions of tertile of Hb and IFTA in renal events and mortality.

Conclusions

Impacts of lower Hb levels on long-term outcomes of diabetic nephropathy were greater in severe IFTA than in mild IFTA.