bluuebunny/crossref_metadata_2025 huggingface dataset:
Continuous Glucose Monitoring in Pediatric Diabetic Ketoacidosis
Authors: Pott Thomas , Jimenez-Vega Jose , Parker Jessica , Fitzgerald Robert
Published: November 2022

Background:

Use of real-time continuous glucose monitoring (rtCGM) in ambulatory settings improves overall glycemic control and reduces the incidence of diabetic ketoacidosis (DKA) in adults and children/adolescents with type 1 diabetes (T1D). However, the use of rtCGM in children with DKA has not been well studied.

Method:

This prospective, single-arm, single-center study assessed the accuracy, reliability, and feasibility of a commercially available rtCGM device compared with point-of-care (POC) capillary and serum glucose values in pediatric patients admitted to the pediatric intensive care unit for DKA. The primary outcome was the accuracy of rtCGM glucose values compared with POC capillary and serum glucose values during standard treatment of DKA as assessed by Clarke Error Grid (CEG) analysis. Secondary outcomes were assessment of the relationship between rtCGM readings and degree of acidosis and mean length of hospital stay (LOS).

Results:

Data from 35 hospitalized children (mean ± SD age, 11.9 ± 4.1 years) with DKA were included in our analysis. Five hundred twenty-four time-matched glucose values between serum glucose and rtCGM and 91 time-matched glucose values between POC capillary glucose and rtCGM were obtained. The effect of acidosis on accuracy CEG analysis showed 95.4% of the 524 matched CGM/POC pairs and 95.6% of the 91 matched CGM/serum glucose pairs in the clinically acceptable A + B zones. The average LOS was 1.32 ± 0.73 days. Serum bicarbonate level did not appear to affect the accuracy of rtCGM in the setting of DKA.

Conclusions:

Continuous glucose monitoring use in inpatient pediatric DKA treatment was found to be feasible and reliable.
Lemon Balm (Melissa officinalis) Essential Oil Moderately Affects Strychnine-Induced and Pentylenetetrazol-Induced Convulsions —In Silico and In Vivo Studies
Authors: Stojanović Nikola M. , Rajković Ivan , Raičević Vidak , Petković Milan N. , Randjelović Pavle J. , Radulović Niko S.
Published: November 2022

Epileptic seizures are a consequence of uncontrolled neuronal discharge and demand urgent and prolonged treatment. Due to a lack of potent and low-risk drugs that could prevent seizures, efforts are underway to discover new drugs, and plant metabolites are often considered valuable candidates in this search. Lemon balm ( Melissa officinalis L., Lamiaceae) is a world-renowned medicinal plant affecting central nervous system function. In this study, we aimed to examine whether the results from in silico modeling of the interactions of major lemon balm essential oil constituents with GABAA and glycine receptors correspond to in vivo results of the convulsions in mice induced by the application of either pentylenetetrazol (GABAA antagonistic) or strychnine (glycine receptor antagonist). While molecular docking experiments of essential oil constituents to the two receptors demonstrated the possibility of ligand–receptor interactions, no binding poses were scored highly, and as the in vivo effect of the essential oil on convulsions seems to be only moderate, the results of the in silico study seem not to contradict results obtained by in vivo models. Thus, we can say that molecular docking might be a useful tool in initial screening for active constituents of natural product mixtures and the potential prediction of their activity in models in vivo.
Acrometastasis of the Lower Limb Carries a Poorer Prognosis: A Retrospective Cohort Study
Authors: Thompson Rory P. , Raina Prince , Downie Samantha , Jariwala Arpit C.
Published: November 2022

Background

Bony metastasis distal to the knee is rare and often reported alongside metastasis distal to the elbow. We sought to provide empirical evidence of the epidemiology, presentation, and prognosis of lower limb acrometastasis, alongside investigation of the distribution of metastases present while lower limb acrometastases form.

Methods

This retrospective cohort study identified 44 radiologically confirmed cases of lower limb acrometastasis from a single region. Case note review facilitated the extraction of data relating to the stated aims. Patients were grouped by extent of metastasis at primary diagnosis. Mann-Whitney U test compared metastatic burden, and Kaplan-Meier analysis compared survival.

Results

Prostate and breast carcinoma were the most commonly diagnosed primary tumors. Sixty-eight acrometastatic lesions were identified, of which 70% presented asymptomatically. Lower limb acrometastasis was associated with metastatic disease at a significantly greater number of sites than those presenting with metastasis proximal to the knee only (P = .007) and conveyed a significantly worse survival than metastasis proximal to the knee or nil metastasis (P < .001). Median survival from diagnosis of lower limb acrometastasis was 1.0 year.

Conclusion

Lower limb acrometastasis is associated with a large metastatic burden and occurs in the terminal year of disease. Radiological identification of cases reveals a distinct cohort of acrometastatic lesions, more likely to present asymptomatically, and arises from alternate primary carcinomas than those in previous literature.

Levels of Evidence:

Level IV: Case series
Vancomycin Powder Is Highly Cost-Effective in Total Ankle Arthroplasty
Authors: Nam Hannah H. , Martinazzi Brandon J. , Kirchner Gregory J. , Adeyemo Adeshina , Mansfield Kirsten , Dopke Kelly , Ptasinski Anna , Bonaddio Vincenzo , Aynardi Michael C.
Published: November 2022

Prosthetic joint infection (PJI) is a costly and potentially fatal complication in total ankle arthroplasty (TAA). Some surgeons apply topical vancomycin powder to minimize the risk of infection during TAA procedures. The purpose of our study was to determine the cost-effectiveness of using vancomycin powder to prevent PJI following TAA and to propose an economic model that can be applied by foot and ankle surgeons in their decision to incorporate vancomycin powder in practice. Using our institution’s records of the cost of 1 g of topical vancomycin powder, we performed a break-even analysis and calculated the absolute risk reduction and number needed to treat for varying costs of vancomycin powder, PJI infection rates, and costs of TAA revision. Costing $3.06 per gram at our institution, vancomycin powder was determined to be cost-effective in TAA if the PJI rate of 3% decreased by an absolute risk reduction of 0.02% (Number Needed to Treat = 5304). Furthermore, our results indicate that vancomycin powder can be highly cost-effective across a wide range of costs, PJI infection rates, and varying costs of TAA revision. The use of vancomycin powder remained cost-effective even when (1) the price of vancomycin powder was as low as $2.50 to as high as $100.00, (2) infection rates ranged from .05 to 3%, and (3) the cost of the TAA revision procedure ranged from $1000 to $10 000.

Levels of Evidence: IV
Parental Transmission and the Importance of the (Noncausal) Effects of Education on Political Engagement: Missing the Forest for the Trees
Authors: Hebbelstrup Rye Rasmussen Stig , Weinschenk Aaron , Dawes Christopher T. , Hjelmborg Jacob v. B. , Klemmensen Robert
Published: November 2022

By most accounts, an important prerequisite for a well-functioning democracy is engaged citizens. A very prominent explanation of variation in political engagement suggests that parental transmission through socialization accounts for individual-level differences in political engagement. In this paper, we show, using a large Danish twin survey ( N = 2,071), that classic formulations of parental transmission theory can be supplemented by findings from the biopolitics literature, allowing us to disentangle when heritable factors are important and when socialization factors are important predictors of political engagement. We show that as the level of family politicization and consistency increases, the influence of genes decreases. We take this to imply that family socialization can compensate for (genetic) individual differences and foster increased political engagement. By only focusing on the “causal” effect of education, we are missing the forest for the trees.
Factors Associated With Unfavorable Radiological Outcomes After Opening-Wedge High Tibial Osteotomy for Varus Knees
Authors: Shim Seung Jae , Jeong Ho Won , Kim Saeil , Park Yong-Geun , Lee Yong Seuk
Published: November 2022

Background:

Corrective osteotomy around the knee is based on deformity profiles of the femoral and tibial sides. Opening-wedge high tibial osteotomy (OWHTO) can be favored if the outcomes are not different, even if there is a certain degree of abnormal parameters after correction.

Purpose/Hypothesis:

The purpose of this study was to identify the factors associated with unfavorable radiological outcomes after OWHTO for varus knees. Our hypothesis was that there would be an optimal situation in which double-level osteotomy (DLO) has advantages over isolated OWHTO and an optimal cutoff value of structural parameters for which DLO should be considered in patients with severe varus knees.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

The radiological and clinical outcomes of 337 patients who underwent OWHTO were retrospectively evaluated. A subgroup analysis was performed according to the weightbearing line ratio (WBLR) (group 1: <25th percentile; group 2: 25th-75th percentile; and group 3: >75th percentile) and factors associated with unfavorable radiological outcomes. For the assessment of cutoff values of the parameters favoring DLO, unfavorable radiological outcomes were categorized as follows: (1) medial proximal tibial angle (MPTA) >95°, (2) joint-line convergence angle (JLCA) >4° (insufficient medial release), (3) JLCA <0° (medial instability), (4) recurrence of a varus deformity, and (5) lateral hinge fracture.

Results:

The mean follow-up period was 66.2 ± 19.1 months. A low preoperative WBLR was related to a larger preoperative to postoperative change (Δ) in the WBLR, a larger reduction in coronal translation, a larger ΔMPTA, a wide preoperative lateral joint space, and a narrow preoperative medial joint space ( P < .001, P < .001, P < .001, P = .016, and P = .003, respectively). However, only an MPTA >95° was significantly related to a low WBLR in the subgroup analysis according to unfavorable radiological outcomes ( P = .038). The cutoff value of ΔWBLR causing an MPTA >95° was 46.5%, which showed a good area under the curve of 0.800, with a sensitivity of 74.4% and a specificity of 82.7%. The clinical outcomes significantly improved at the final follow-up compared with those preoperatively, with no significant differences between the WBLR groups.

Conclusion:

A ΔWBLR ≥46.5% led to an MPTA >95°. However, clinical outcomes were not affected. DLO should be considered if the surgeon desires a postoperative MPTA ≤95°.
Factors Influencing the Booking Gestational Age Among Antenatal Clinic Attendees at Primary Health Centers in South West, Nigeria: A Cross-Sectional Study
Authors: Olufemi Olayinka Temitope , Sebutu Bello Ibrahim , Oluwafemi Olajubu Temitope , Oloyede Oyegbade Olanrewaju , Omobolanle Olajubu Aanuoluwapo , Tamunotonye Ezeoma Ikechi
Published: November 2022

Background

Antenatal care (ANC) is a recognized factor for favorable pregnancy outcomes. Despite the benefits associated with early initiation of antenatal care, late booking still predominates in sub-Saharan Africa including Nigeria.

Objective

This study aimed to assess the factors, including family dynamics, associated with the booking gestational age among women attending ANC clinics in a Local Government Area of Osun State, Nigeria.

Methods

A descriptive cross-sectional study was conducted among 255 pregnant women attending ANC at the Primary Health Centres in Osun State, who were selected by stratified random sampling technique. Data were obtained with aid of a semi-structured questionnaire and subjected to descriptive and inferential analyses.

Results

The mean age of respondents was 27.3 ± 5.1 years. Their mean booking gestational age was 23.0 ± 6.6 weeks, while the majority (85.3%) booked late for ANC. Most (122, 54.2%) of the respondents booked in the second trimester. The opinion of the husband influenced most women (54.2%) in the decision regarding the time of ANC booking. There was no association between the booking gestational age and each of respondents’ age, education, parity, perceived family support, level of family functioning, and other sociodemographic characteristics. The booking GA was however significantly related to the previous booking GA at the last pregnancy ( p = .004).

Conclusion

Late initiation of antenatal care was high among pregnant women attending PHCs in the study area and it was not associated with measures of family dynamics. The predominant influence of husbands’ opinion on time of booking suggests the need for strategic outreach to males through relevant reproductive health educational campaigns.
Minimally Invasive Foot & Ankle Surgery: A Review and a Novel Technique
Authors: Wendler Derrick E. , Stewart Gary W. , Bailey Erroll J. , Shofoluwe Ademola I. , Nwaibu Uzoma
Published: November 2022

Category:

Hindfoot; Midfoot/Forefoot

Introduction/Purpose:

There has been a growing interest in the utility of minimally invasive surgery (MIS) to correct foot and ankle deformities. MIS is performed using small, targeted incisions rather than large incisions required of open procedures. Proposed benefits of MIS include preservation of blood supply, limited injury to adjacent soft tissue, and fewer wound complications amongst many others. (Neufeld et al, Lu et al). To date, a large number of minimally invasive techniques have been developed to treat common deformities such as hallux valgus, hammertoe, and bunionette. However, there is no brief review that summarizes the literature comparing open surgery with its minimally invasive counterpart. Additionally the options available for MIS treatment of Flexible Adult Acquired Flat Foot/Progressive Collapsing Foot Deformity have failed to keep pace.

Methods:

We will begin by synthesizing data on MIS in the foot and ankle through analysis of those three aforementioned deformities, summarizing both technique and associated research. Then, we will introduce a novel technique for stage II (flexible) flat foot correction, the Mini-BEAR (bone extra articular reconstruction). Historically treated with the now largely insufficient FDL transfer, we believe this new technique will not only prove biomechanically efficacious but also lead to improved patient safety and lower complication rates. The rapid pace at which novel MIS procedures are developed requires surgeons to be disciplined in conducting and analyzing studies; this synopsis will aim to aid in that process.

Results:

A novel surgical technique that involves a minimally invasive, all bone extra-articular reconstruction (Mini-BEAR) system. We believe that this technique can potentially replace the multiple long surgical incisions that accompany the traditional medial displacement calcaneal osteotomy, lateral column lengthening, and Cotton procedures with minimal ones, reduce post-operative recovery time, reduce operating room procedure time, and produce a better cosmetic result. Additionally, we believe it will reduce narcotic use secondary to less pain by virtue of less surgical work on the patient. We have also performed a cadaveric anatomic study that qualitatively and quantitatively observed the tendinous and neurovascular structures at risk with the Mini- BEAR procedure.

Conclusion:

The majority of the publications on the use of MIS to address deformities in the foot and ankle are small cohort studies or retrospective case reviews; many of which lack a control group. Due to this, data showing improvements in MIS vs open techniques is rare. However this is to be expected in a newer, developing field and as larger studies are performed there is optimism that this trend may change. (attached file is example of chart, we have similar format for all 4 deformities discussed in this paper)
Comparative Risk Stratification for Prediction of Early Postoperative Morbidity and Mortality after Open Fixation of Periarticular Lower Extremity Fractures
Authors: Xu Amy L. , Raad Micheal , Sotsky Rachel B. , Hughes Alice J. , Aiyer Amiethab A.
Published: November 2022

Category:

Trauma; Ankle; Hindfoot

Introduction/Purpose:

The standardized identification of patients who are at higher risk of early postoperative adverse events has implications for quality improvement, preoperative medical optimization, and cost reduction through bundled payments. The purpose of the present study was to develop points-based risk stratification systems for predicting 30-day adverse events (AEs) and mortality after open fixation of periarticular hip, knee, and ankle fractures.

Methods:

Query of the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) database yielded 65,529 patients who underwent periarticular hip, knee, and ankle fracture repair from 2010-2019. We collected patient demographics and preoperative risk factors. To generate our risk stratification systems, 60% of patients were randomly designated as the development cohort and analyzed with multivariable regression plus bootstrap modeling to identify independent risk factors for early AE and mortality. A nomogram analysis was then conducted to assign scores for each risk factor and generate two points-based risk stratification systems, for AE and mortality. To validate our models, the systems were applied to the remaining 40% of patients (the validation cohort) and tested for predictive ability.

Results:

In total, 13,212 patients (20.2%) experienced any AE and 3,613 patients (5.5%) mortality within 30 days of fracture fixation. Patients were assigned points for each of the following in both risk stratification systems: fracture type (+4 hip, +2 knee, +0 ankle), male gender (+1), age (>=80 years +5, 60-79 years +3, 40-59 years +2), functionally dependent (+2), anemia (+2 for AE, +1 for mortality), pulmonary disease (+3 for AE, +1 for mortality), congestive heart failure (+3 for AE, +2 for mortality), and end- stage renal disease (+3 for AE, +1 for mortality). Corticosteroid use (+1), hypertension (+1), and insulin-dependent diabetes (+2) were additional predictors for only AEs. The AE and mortality models had maximum scores of 27 and 17 points, and Harrell C statistics of 0.66 and 0.75, respectively. The estimated risk of developing early AE ranged from 3.4-79.5% and mortality from 0.08- 54.4%.

Conclusion:

Fracture type, male gender, age >=40 years, corticosteroid use, functional dependence, anemia, hypertension, insulin-dependent diabetes, pulmonary disease, congestive heart failure, and end-stage renal disease can be used in the prediction of early AE or mortality following open fixation of periarticular lower extremity fractures, with a marked disparity in estimated risks depending on the number of risk factors possessed by a patient.
The Statistical Fragility of Platelet-Rich Plasma as Treatment for Achilles Tendinopathy: A Systematic Review and Meta-Analysis
Authors: Xu Amy L. , Ortiz-Babilonia Carlos D. , Gupta Arjun , Rogers Davis L. , Aiyer Amiethab A. , Vulcano Ettore
Published: November 2022

Category:

Basic Sciences/Biologics; Hindfoot; Sports

Introduction/Purpose:

Randomized controlled trial (RCT) outcomes reaching statistical significance, frequently determined by p<0.05, are often used to guide decision-making. Noted lack of reproducibility of some RCTs has brought special attention to the limitations of this approach. In this meta-analysis, we assessed the robustness of RCTs evaluating platelet-rich plasma (PRP) for the treatment of Achilles tendinopathy (AT) by using fragility indices.

Methods:

RCTs comparing outcomes after PRP injection versus alternative treatment in patients with chronic AT were evaluated. Representative datasets were generated for each reported continuous outcome event using summary statistics. The fragility index (FI) and continuous FI (CFI) were determined for dichotomous and continuous outcomes, respectively, by manipulating each dataset until reversal of significance (a=0.05) was achieved. The corresponding fragility quotient (FQ) and continuous FQ (CFQ) were calculated by dividing FI/CFI by sample size.

Results:

Of 432 studies screened, 8 studies (52 outcome events) were included in the present analysis. The 12 dichotomous outcomes had a median FI of 4.5 (FQ: 0.111), and the 40 continuous outcomes had a median CFI of 5 (CFQ: 0.154). All 52 outcome events included lost-to-follow-up data, and 12 (23.1%) indicated a greater number of patients lost to follow-up than the FI or CFI.

Conclusion:

Our findings suggest that RCTs evaluating PRP for AT therapy lack statistical robustness, since changing only a small number of events may alter outcome significance. Given the importance of RCTs in clinical decision-making, fragility indices should be reported alongside p-values to indicate the strength of statistical findings. It is paramount that future RCTs be designed with consideration of sample size from both recruitment and retention perspectives to maximize protocol robustness and determine the true therapeutic effect of PRP in AT.
Patient Specific Instrumentation and Total Ankle Arthroplasty
Authors: Yau James K. , Murty An , Kakwani Rajesh , Townshend David N.
Published: November 2022

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

Total Ankle Arthroplasty (TAA) can now be performed using Patient Specific Instrumentation (PSI). Advantages include the ability to pre-operatively plan bone resections and implant position and reduce the number of intra- operative surgical steps. The aim of this study was to compare PSI with Standard Instrumentation (SI) in a non-randomised retrospective cohort study with respect to patient reported outcomes, tourniquet time, fluoroscopy time and post-operative alignment.

Methods:

159 patients (111 male, 48 female) undergoing a total of 168 INFINITY TAA using PSI (Prophecy, Wright Medical Technology) or SI between 2014 and 2020 were included with a minimum follow up of 12 months. Patient reported outcome measures (PROMS) were obtained pre-operatively and at one year and included the Manchester-Oxford Foot Questionnaire (MOXFQ), Ankle Osteoarthritis Scale (AOS) and EQ-5D Index. Coronal plane deformity correction was assessed using the midline tibiotalar angle (MTTA). Demographics, tourniquet time and intra-operative fluoroscopy times were obtained from the hospital records.

Results:

There were 106 TAA in the SI group and 62 TAA in the PSI group. The was no significant difference in total MOXFQ, AOS or EQ5D. There was however a significant difference (p=.032) in favour of PSI in the walking/standing domain of the MOXFQ at 12 months. There was a significantly reduced tourniquet time (PSI mean: 95.39 mins, SI mean: 116.87 mins, p<.001) and radiation exposure (PSI mean: 31 seconds, SI mean: 53 seconds, p<.001). Angular correction was more accurate in the PSI group (PSI mean: 1.29°, SI mean: 2.26°, p=.005).

Conclusion:

This study supports the use of patient specific instrumentation to decrease operative time, reduce intraoperative fluoroscopy and improve accuracy of implantation in TAA. The walking/standing domain of the MOXFQ has been shown to be the most sensitive to change and in this study demonstrated a further potential benefit.
Charcot Arthropathy Limb Salvage with 3D Custom Cage and Dynamic Hindfoot Fusion Nail Combination Fixation: A Case-Series
Authors: Zhang Hui , Vogel Maxwell , Malarkey William M. , Cush Gerard J.
Published: November 2022

Category:

Diabetes; Ankle; Hindfoot

Introduction/Purpose:

Patients with Charcot arthropathy with hindfoot collapse present a difficult challenge for foot and ankle surgeons. While traditional limb salvage options include tibiotalocalcaneal (TTC) arthrodesis with accepted shortening, thin wire external fixation, or TTC arthrodesis with bulk femoral head allograft, new 3-dimensional (3D) custom patient specific implants offer a new treatment modality for limb salvage for this difficult issue. The purpose of this case-series is to offer one surgeon's experience with this new treatment technique for limb salvage.

Methods:

All patients undergoing limb salvage procedures for hindfoot collapse between 2018 and 2022 with a custom 3D hindfoot cage with TTC hindfoot fusion intramedullary nail were included for analysis. Along with patient demographics and length of follow up, patients were asked a series of questions on a telephone survey in order to measure patient reported outcomes including current ambulatory status and whether they would have elected to undergo the same treatment modality again. Complications were also tracked. Finally, radiographs were analyzed to evaluate the degree of deformity correction on both coronal and sagittal planes as well as degree of deformity correction maintenance at last radiographic follow up.

Results:

13 patients were included in the analysis. 10 of the 13 patients had Charcot arthropathy. 2 patients had deep infections that ultimately required below knee amputation. 11 out of 13 patients had successful limb salvage as defined by the maintenance of a functional limb without need for amputation. Interestingly, both patients who failed limb salvage and required below knee amputations reported that they would prefer to have undergone the same attempt at limb salvage even with the resulting amputation. Radiographically, the average amount of coronal plane deformity correction was 25 degrees while the average amount of sagittal plane deformity correction was 6 degrees. The average amount of deformity correction maintenance seen at last radiographic follow up was high with a loss of only 0.5 degrees in coronal plane deformity correction loss throughout the time period and an average of 2 degrees of sagittal plane deformity correction loss.

Conclusion:

While still a challenging pathology to treat, custom patient specific 3D implants combined with TTC hindfoot fusion nail is a viable construct for patients with Charcot arthropathy undergoing limb salvage for hindfoot collapse.
Quality of MIS vs Open Joint Preparations of the Foot and Ankle
Authors: Zhao John Z. , Kaiser Philip , Farina Evan , DeGruccio Christina M. , Miller Christopher P.
Published: November 2022

Category:

Other; Ankle; Hindfoot; Lesser Toes; Midfoot/Forefoot

Introduction/Purpose:

Minimally invasive surgery (MIS) is growing in the field of foot and ankle surgery, and the MIS burr is an emerging tool. While commonly used to perform osteotomies, the burr can also be utilized for arthrodesis joint preparation that traditionally would be performed through open incisions. To date, there is no study comparing the quality of joint preparation between using a fluoroscopy-guided MIS technique compared to traditional open techniques. The goal of this cadaveric study is to compare the percentage of joint surfaces prepared between MIS and open techniques, for the most common joints that are fused in foot and ankle surgery.

Methods:

Open joint preparation was performed under direct visualization with open incisions. MIS joint preparation was performed percutaneously using fluoroscopic guidance alone, without arthroscopy. After joint preparation, cadaveric samples were disarticulated, and joint surfaces were analyzed for percentage of cartilaginous surface removed. The percentage of joint surface prepared was compared between the open and MIS techniques.

Results:

Ten cadaveric samples were used for the MIS technique, and five samples for the open technique. Percentage of joint surface prepared was not statistically different for 15/17 joint surfaces. The MIS technique demonstrated statistically significant (p=0.048) better preparation than open in the talar head and the cuboid at the CC joint. Qualitative inspection of these two joints suggested the open technique frequently missed the most plantar surface of the talar head and the medial side of the CC joint, whereas the MIS technique performed better in these areas.

Conclusion:

The MIS technique provides similar percentages of surface area prepared compared to traditional open techniques. In certain joints with greater depth, the MIS technique may provide better joint preparation. This study suggests that MIS joint preparation is a reasonable, and possibly advantageous, alternative to open preparation in arthrodesis surgery when performed by experienced MIS surgeons.
Trimodality Versus Surgery as Needed: Is Delayed or Salvage Esophagectomy Justified?
Authors: Wirsik Naita M. , Bruns Christiane J.
Published: November 2022

For advanced carcinomas of the esophagus multimodal therapies consisting of neoadjuvant treatment with chemo- and/or radiation followed by surgical resection are the standard of care in western countries. Still unknown remains the question if clinical full responders to neoadjuvant treatment should receive an esophagectomy with all its perioperative risks as they could be pathological full responders potentially without further oncologic benefit. In this article we discuss the possible benefits and disadvantages of an organ sparing approach in comparison of the standard of care for patients with esophageal cancer.
Occurrence of virulence factors and carbapenemase genes in Salmonella enterica serovar Enteritidis isolated from chicken meat and egg samples in Iraq
Authors: Kanaan Manal Hadi Ghaffoori , Khalil Zena Kassem , Khashan Hawazin Thamir , Ghasemian Abdolmajid
Published: November 2022

Background

Food-borne infections mainly due to Salmonella enterica serovar Enteritidis (S. Enteritidis) are major concerns worldwide. S. Enteritidis isolates may serve as reservoirs for spreading antimicrobial drug resistance genes including carbapenemases. This study aimed to screen the occurrence of virulence factors, carbapenemases, and antibiotic resistance genes in S. Enteritidis isolated from chicken meat and eggs in Iraq.

Results

In total, 1000 non-duplicated chicken meat and 1000 egg samples were collected during 2019–2020. Presumptive S. Enteritidis isolates were initially identified by standard bacteriology tests and then were confirmed using polymerase chain reaction (PCR). Carbapenem resistance was detected using the disk diffusion method. Virulence and carbapenemase genes were screened using the PCR method. In total, 100 (5.0%) S. Enteritidis isolates were identified from 2000 samples collected using phenotypic and molecular methods. These isolates were identified from 4.9% chicken meat (n = 49/1000) and 5.1% egg (n = 51/1000) samples, respectively. The most and the least susceptibility was found to gentamicin and ceftazidime antibiotics, respectively. The prevalence of different virulence factors were as follows: phoP/Q (40.0%), traT (30.0%), stn (22.0%), slyA (11.0%), and sopB (9.0%). Among 20 carbapenem-resistant S. Enteritidis isolates, the most predominant carbapenemase gene was blaIMP (35.0%, n = 7), followed by blaOXA−48−like (25.0%, n = 5), and blaNDM (10.0%, n = 2), while the blaKPC and blaVIM genes were not detected. The coexistence of blaIMP, blaOXA−48−like, and blaNDM genes was determined in two isolates. The prevalence of different antibiotic resistance genes were as follows: tetA (87.1%), tetB (87.1%), dfrA1 (77.6%), and sul1 (83.6%).

Conclusion

Considering the existence of carbapenem-resistant S. Enteritidis harboring different virulence and antibiotic resistance genes in chicken meat and egg samples, adherence to proper hygienic conditions should be considered.
Serum MPO levels and activities are associated with angiographic coronary atherosclerotic plaque progression in type 2 diabetic patients
Authors: Chen Qiujing , Chen Shuai , Dai Yang , Wang Xiaoqun , Ding Fenghua , Zhang Ruiyan , Shen Weifeng , Hu Wenbo , Lu Lin , Pan Wenqi
Published: November 2022

Background

The uncontrolled production of MPO promotes inflammation, oxidative stress and atherosclerosis. Serum MPO levels are increased in patients with diabetes compared with patients without diabetes.

Objectives

This study aimed to investigate whether the serum levels and activities of MPO are related to coronary plaque progression in patients with type 2 diabetes mellitus (T2DM).

Material and methods

Serum MPO levels and activities were measured in 161 patients with diabetes with plaque progression (plaque progression group) and 87 patients with diabetes with no plaque progression (no plaque progression group). These patients were eligible based on the inclusion criteria and received quantitative coronary angiography at baseline and after approximately 1 year of follow-up. The characteristics and parameters of the participants at baseline were documented.

Results

Serum MPO levels and activities were significantly higher in plaque progression group than in no plaque progression group (P < 0.001). We categorized these patients with diabetes into MPO level or activity tertile subgroups. Significant differences in the plaque progression ratio and prominent changes in the minimal lumen diameter, stenosis diameter and coronary artery stenosis score were observed across the tertile subgroups of MPO levels and activities (all P < 0.01). Moreover, serum MPO levels and activities correlated significantly with these indices of coronary artery disease severity after adjustment for other risk factors. Multivariable regression analyses revealed that serum MPO levels and activities remained independently associated with plaque progression, in addition to smoking, hypertension and CRP levels (all P < 0.05).

Conclusions

Serum MPO levels and activities are significantly associated with coronary atherosclerotic plaque progression in patients with type 2 diabetes.
Microvascular invasion risk scores affect the estimation of early recurrence after resection in patients with hepatocellular carcinoma: a retrospective study
Authors: Wang Sheng , Zheng Weizhi , Zhang Zhencheng , Zhang Guo-hua , Huang Dan-jiang
Published: November 2022

Background

Microvascular invasion (MVI) is a histological factor that is closely related to the early recurrence of hepatocellular carcinoma (HCC) after resection. To investigate whether a noninvasive risk score system based on MVI status can be established to estimate early recurrence of HCC after resection.

Methods

Between January 2018 to March 2021, a total of 108 patients with surgically treated single HCC was retrospectively included in our study. Fifty-one patients were pathologically confirmed with MVI and 57 patients were absent of MVI. Univariate and multivariate logistic regression analysis of preoperative laboratory and magnetic resonance imaging (MRI) features were used to screen noninvasive risk factors in association with MVI in HCC. Risk scores based on the odds ratio (OR) values of MVI-related risk factors were calculated to estimate the early recurrence after resection of HCC.

Results

In multivariate logistic regression analysis, tumor size > 2 cm (P = 0.024, OR 3.05, 95% CI 1.19–11.13), Prothrombin induced by vitamin K absence-II > 32 mAU/ml (P = 0.001, OR 4.13, 95% CI 1.23–11.38), irregular tumor margin (P = 0.018, OR 3.10, 95% CI 1.16–8.31) and apparent diffusion coefficient value < 1007 × 10− 3mm2/s (P = 0.035, OR 2.27, 95% CI 1.14–7.71) were independent risk factors correlated to MVI in HCC. Risk scores of patients were calculated and were then categorized into high or low-risk levels. In multivariate cox survival analysis, only high-risk score of MVI was the independent risk factor of early recurrence (P = 0.009, OR 2.11, 95% CI 1.20–3.69), with a sensitivity and specificity of 0.52, 0.88, respectively.

Conclusion

A risk score system based on MVI status can help stratify patients in high-risk of early recurrence after resection of HCC.
Parents’ perspectives on preparing for parenthood: a qualitative study on Greenland’s universal parenting programme MANU 0–1 year
Authors: Ingemann Christine , Jensen Else , Olesen Ingelise , Tjørnhøj-Thomsen Tine , Kvernmo Siv , Larsen Christina Viskum Lytken
Published: November 2022

Background

The transition to parenthood has received increasing attention in research, partly due to evidence pointing out the crucial developmental period of a child’s first thousand days. Parenting programmes aim to prepare and support families in their transition and distress. For a programme to be implemented successfully it is important to consider parents’ needs and resources. Bringing parents’ perspectives and experiences to the forefront of the implementation of the Greenlandic parenting programme MANU 0–1 Year (MANU) is important for determining if the programme can meet its aim of contributing to thriving families. This study aims to investigate how parents’ notions and experiences of parenthood are reflected and challenged in MANU.

Method

Data were collected in three of Greenland’s five municipalities. Qualitative interviews were held with 38 mothers and 12 fathers either individually or as couples: a total of 40 interviews. Additionally, a Sharing Circle with three fathers was held. Interviews were in Greenlandic or Danish. A thematic, inductive analysis was applied.

Results

In their transition to parenthood, participants experienced a reprioritisation of their life and changes in their network. It is important to parents that their child experiences security and care, and participants describe this in contrast to their own childhood. Community is the most important value in child-rearing. Conversations and advice from family members and friends are mentioned as a means to prepare for birth and parenthood. Additionally, conversations with midwives and MANU sessions were also used for preparation. Parents appreciated learning from and listening to other parents in MANU sessions. However, accessing MANU depends on the individual parent’s interest and ability to attend sessions.

Conclusions

Parents’ notions and experiences of parenthood are addressed in the programme, but the use of MANU depends on the parents’ attendance and how it is organised and locally offered. The study suggests that MANU has the possibility to create a space for parents to reflect and prepare. However, for MANU to be universal as intended and to reach both mother and father the facilitation of sessions could be revisited.
Barriers and facilitators to cervical cancer screening among under-screened women in Cuenca, Ecuador: the perspectives of women and health professionals
Authors: Vega Crespo Bernardo , Neira Vivian Alejandra , Ortíz Segarra José , Andrade Andrés , Guerra Gabriela , Ortiz Stalin , Flores Antonieta , Mora Lorena , Verhoeven Veronique , Gama Ana , Dias Sónia , Verberckmoes Bo , Vermandere Heleen , Michelsen Kristien , Degomme Olivier
Published: November 2022

Background

Cervical cancer screening is a cost-effective method responsible for reducing cervical cancer-related mortality by 70% in countries that have achieved high coverage through nationwide screening strategies. However, there are disparities in access to screening. In Ecuador, although cervical cancer is the second most common cancer in women, only 58.4% of women of reproductive age have ever been screened for cervical cancer.

Methodology

A qualitative study was performed to understand the current barriers to screening and to identify strategies that could increase uptake in Azuay province, Ecuador. Seven focus group discussions (FGDs) were conducted with under-screened women and health professionals (HPs). The FGDs were recorded and transcribed. Content analysis was done using the socio-ecological framework to categorize and analyse the data.

Results

Overall, 28 women and 27 HPs participated in the study. The two groups perceived different barriers to cervical cancer screening. The HPs considered barriers to be mainly at the policy level (lack of a structured screening plan; lack of health promotion) and the individual level (lack of risk perception; personal beliefs). The women identified barriers mainly at organizational level, such as long waiting times, lack of access to health centres, and inadequate patient–physician communication. Both groups mentioned facilitators at policy level, such as national campaigns promoting cervical cancer screening, and at community and individual level, including health literacy and women’s empowerment.

Conclusions

The women considered access to health services the main barrier to screening, while the HPs identified a lack of investment in screening programmes and cultural patterns at the community level as major obstacles. To take an integrated approach to cervical cancer prevention, the perspectives of both groups should be taken into account. Additionally, new strategies and technologies, such as self-administered human papillomavirus (HPV) testing and community participation, should be implemented to increase access to cervical cancer screening.
Complications of injections in conservative treatment of degenerative spine disease: a prospective unicentric study
Authors: Voelker Anna , Pirlich Markus , Heyde Christoph-Eckhard
Published: November 2022

Background

Spinal injection has been an accepted part of conservative therapy for degenerative diseases. The drugs used can cause side effects and severe complications. The aim of this study was to determine the occurrence of general side effects (GSE) and complications when performing consecutive different types of spinal injections and to evaluate pain reduction.

Methods

Prospective data evaluation of patients with degenerative spine disease at hospital admission, discharge, and six and 12 weeks after discharge. All patients received a specific injection protocol depending on their symptoms and radiological findings. The injections performed were dorsal sacroiliac joint injections, perineural injections, epidural interlaminar and epidural periradicular injections, and facet joint injections. Potential complications were categorized and recorded as GSE and complications. In addition, the Numerical Analog Scale (NAS) for pain, the Oswestry Disability Index (ODI) were evaluated.

Results

Forty-eight patients were enrolled. There were 282 spinal injections performed. A total of 131 common treatment-related events were recorded. Depending on the type of injection, transient pain at the injection site (32.4–73.5%), radiating pain (9.4–34.7%), and nerve root irritation (2–18.4%) were the most common. One complication with postpuncture syndrome occurred with epidural-interlaminar injection. No persistent neurologic deficits occurred. The highest rate of GSE was observed with periradicular injections (relative frequency (RF) = 0.8), followed by epidural-interlaminar injections (RF = 0.65), least frequently with FJ injections (RF = 0.32). From the time of admission to discharge, NAS scores were significantly decreased and ODI score significantly improved at discharge (p < 0.001), but relapse occurred at the 12-week follow-up.

Conclusions

Various consecutive spinal injections for conservative treatment of degenerative spine diseases are safe and lead to a decrease in pain and improvement in quality of life. GSE are common, but not persistent. Although complications are rare, they can have serious consequences for the patient.
Advance care planning for patients with cancer and family caregivers in Indonesia: a qualitative study
Authors: Martina Diah , Kustanti Christina Yeni , Dewantari Rahajeng , Sutandyo Noorwati , Putranto Rudi , Shatri Hamzah , Effendy Christantie , van der Heide Agnes , van der Rijt Carin C. D. , Rietjens Judith A. C.
Published: November 2022

Background

Individuals’ willingness to engage in advance care planning is influenced by factors such as culture and religious beliefs. While most studies on advance care planning in Asia have been performed in high-income countries, Indonesia is a lower-middle-income country, with a majority of strongly collectivist and religiously devout inhabitants. We studied the perspectives of Indonesian patients with cancer and family caregivers regarding advance care planning by first exploring their experiences with medical information-disclosure, decision-making, and advance care planning and how these experiences influence their perspectives on advance care planning.

Methods

We conducted semi-structured interviews among 16 patients with cancer and 15 family caregivers in a national cancer center in Jakarta and a tertiary academic general hospital in Yogyakarta. We performed an inductive thematic analysis using open, axial, and selective coding. The rigor of the study was enhanced by reflective journaling, dual coding, and investigator triangulation.

Results

Twenty-six of 31 participants were younger than 60 years old, 20 were Muslim and Javanese, and 17 were college or university graduates. Four major themes emerged as important in advance care planning: (1) participants’ perceptions on the importance or harmfulness of cancer-related information, (2) the importance of communicating bad news sensitively (through empathetic, implicit, and mediated communication), (3) participants’ motives for participating in medical decision-making (decision-making seen as patients’ right or responsibility, or patients’ state of dependency on others), and (4) the complexities of future planning (e.g., due to its irrelevance to participants’ religious beliefs and/or their difficulties in seeing the relevance of future planning).

Conclusions

Culturally sensitive approaches to advance care planning in Indonesia should address the importance of facilitating open communication between patients and their families, and the various perspectives on information provision, bad news communication, and decision-making. Advance care planning should focus on the exploration of patients’ values, rather than drafting treatment plans in advance.