bluuebunny/crossref_metadata_2025 huggingface dataset:
Free and Informed Elections? Disinformation and Democratic Elections Under Article 3 of Protocol 1 of the ECHR
Authors: Shattock Ethan
Published: September 2022

This article examines European Court of Human Rights (ECtHR) jurisprudence concerning free elections and identifies relevant approaches that can be applied to electoral disinformation. The relationship between disinformation and freedom of expression has attracted considerable academic scrutiny in recent years. However, surprisingly little attention has been given to the right to free elections. This article addresses this gap by identifying key ECtHR approaches to free elections under Article 3 of Protocol 1 of the ECHR and evaluating the Court’s interpretive reasoning in the disinformation context. Focus is given to cases where the Court has addressed falsified information in the electoral process. Considering the special relationship between freedom of expression and free elections in Strasbourg jurisprudence, focus is also given to the Court’s contemplation of acceptable limitations to freedom of expression under Article 10 of the ECHR in response to deceptive political expression. Mapping the Court’s reasoning in key decisions, this article identifies informed democratic engagement as a crucial requirement that permeates the Court’s approach to elections. Considering the importance of democracy in the Court’s reasoning, this article argues that the Court should be more proactive in elucidating key standards for Contracting Parties to make democracies more resilient to electoral disinformation.
Matching into Orthopedic Surgery in the U.S. Navy: A Review of Applicant Selection Criteria
Authors: O’Mary Kevin , Tompane Trevor , Perry Nic , Smith Jennifer , Janney Cory
Published: September 2022

Introduction

The U.S. Navy offers an attractive opportunity for residency training in orthopedic surgery. The factors that Navy orthopedic residency program leadership finds important in applicant selection for training have not been reported. Additionally, data regarding the academic competitiveness of recently matched applicants have not been previously published. This study presents the results of two surveys administered to all navy orthopedic program directors and department chairmen, as well as data for United States Medical Licensing Examination (USMLE) Steps 1 and 2, medical school class percentile, leadership responsibilities, research endeavors, and letters of recommendation of both matched and unmatched applicants.

Materials and Methods

Two anonymous surveys were administered to all program directors and department chairmen at Navy orthopedic residency training programs with questions designed to gauge perceived importance of various application factors when selecting for the match. The results were compiled, and mean levels of importance were reported. Deidentified data were collected on all applicants to Navy orthopedic residency programs from 2015 to 2019. Data points specific to USMLE Step 1 and 2 board scores, medical school class percentile, research, leadership, and letters of recommendation were analyzed using single and multiple logistic regression analyses, and odds ratios for each variable were calculated.

Results

Navy leadership unanimously expressed that clerkship performance at the individual program director’s institution was most important, followed by Steps 1 and 2 licensing examination scores. Single logistic regression analyses showed that Step 1 score and clinical, leadership, and recommendation scores were statistically significant. When controlled for Step 1 score, only academic performance and leadership scores maintained statistical significance.

Conclusions

Applicants to Navy orthopedic surgery residency programs should strive to be competitive in all aspects of their application, with specific emphasis placed on outstanding performance during orthopedic clerkships, demonstration of leadership characteristics, and academic excellence. With transition to a pass/fail grading system for Step 1, there will be more emphasis on other measures of academic success, such as Step 2 scores and clinical clerkship grades.
Comprehensive Landscape of Cyclin Pathway Gene Alterations and Co-occurrence with FGF/FGFR Aberrations Across Urinary Tract Tumors
Authors: Jardim Denis L F , Millis Sherri Z , Ross Jeffrey S , Lippman Scott , Ali Siraj M , Kurzrock Razelle
Published: September 2022

Background

Cyclin pathway gene alterations are frequent in urothelial tumors and may co-exist with other important aberrations, leading to therapeutic opportunities. We characterized the landscape of cyclin gene alterations in urothelial and non-urothelial urinary tract (UT) malignancies.

Patients and Methods

Overall, 6842 urothelial and 897 non-urothelial UT cancers were analyzed (hybrid-capture-based comprehensive genomic profile (Foundation Medicine)). Alteration frequency in cyclin-sensitizing and -resistance genes, and co-occurrence with fibroblast growth factor receptor (FGFR) gene abnormalities were evaluated.

Results

Cyclin-activating gene alterations were detected in 47.3% of urothelial and 37.9% of non-urothelial UT cancers. Frequency varied by histology and tumor site. CDKN2A and CDKN2B loss were the most frequent alterations in urothelial tumors (present in 38.5% and 30.4% of patients, respectively). Both genes were less frequently altered in adenocarcinomas (15.2% and 8.9%), but commonly altered in squamous cell carcinomas (74.4% and 39%). Tumors of neuroendocrine origin were relatively silent in activating cyclin alterations, but frequently displayed Rb1 alterations (86% and 83.7% of neuroendocrines and small cell carcinomas). Urachal tumors (n = 79) presented a distinct landscape of cyclin alterations relative to other UT cancers, with less frequent alterations overall. FGF/FGFR genes were altered in 34.9% of urothelial (22.1% in FGFR3), and 19.4% of non-urothelial urinary tract tumors (6.8% FGFR3). Cyclin-activating alterations frequently co-occurred with FGF/FGFR alterations but were in general mutually exclusively with cyclin resistance alterations (RB1/CCNE1).

Conclusions

Cyclin pathway activating alterations are common in urinary tract tumors, but frequency varies with histology and tumors sites. Co-occurrence of cyclin and FGFR pathway alterations may inform therapeutic opportunities.
Accounting for Injustice
Authors: Stahl Matt , Arewa Olufunmilayo B.
Published: September 2022

Despite their incalculable musical contributions and the continuing profitability of their hit recordings, R&B singers of the 1960s often have reached and passed retirement age in conditions of profound economic insecurity. This tragic irony is well known, but the long-standing institutional practices that have essentially ensured this typical outcome have remained obscure. At the center of the problem is individual royalty income associated with the sale and licensing of recordings. Record companies’ royalty accounting processes are notoriously complex and secret, and companies have strong incentives to overreport expenses and underreport earnings in their maintenance of individual artist royalty accounts.

Hitherto unstudied documents from the archive of the National Office of the American Federation of Television and Radio Artists (AFTRA) shed light on the accounting practices of the major and indie record companies to whom artists like Mary Wells, Ruth Brown, and Sam Moore were signed. After 1959, singers recording for signatory companies were included in the employer-sponsored AFTRA Health and Retirement Funds. As a fiduciary, the Funds were obligated to monitor and enforce employer contributions based on singers’ annual earnings, including contractual royalty payments. Newly discovered archival evidence helps explain how the Funds’ lax enforcement led to healthcare ineligibility and chronically underfunded pensions for many R&B performers. The interaction of companies’ nefarious contractual royalty accounting practices and the AFTRA Funds’ at-best inconsistent monitoring and enforcement of companies’ obligations hindered singers’ prospects for financial stability and comfortable retirement after long careers and the contribution of enduring recordings to contemporary culture.
Sorgentina-RF Fusion Neutron Plant: Preliminary Design of the Bioshielding In Compliance With Dose Constraints For Workers Exposure
Authors: Ferrari P , Contessa G M , Moro F , Gadani G , Lepore L , Pietropaolo A ,   the SRF Collaboration, Agostini Pietro , Angiolini Massimo , Alberghi Ciro , Candido Luigi , Capogni Marco , Capone Mauro , Cataldo Sebastiano , Contessa Gian Marco , D'Arienzo Marco , Del Dotto Alessio , Diamanti Dario , Nicola Dongiovanni Danilo , Farini Mirko , Ferrari Paolo , Fiore Angela , Flammini Davide , Fonnesu Nicola , Frisoni Manuela , Gadani Gianni , Grasso Giacomo , Guardati Manuela , Guidoni David , Lamberti Marco , Lepore Luigi , Mancini Andrea , Mariani Andrea , Marinari Ranieri , Marzo Giuseppe A , Mastroianni Bruno , Moro Fabio , Orefice Agostina , Orsetti Valerio , Pietropaolo Antonino , Pinna Tonio , Rizzo Antonietta , Rydzy Alexander , Salvi Stefano , Santoli Demis , Santucci Alessia , Saraceno Luca , Sartorio Camillo , Scaglione Salvatore , Sermenghi Valerio , Serra Emanuele , Simonetti Andrea , Spassovsky Ivan Panov , Terranova Nicholas , Tosti Silvano , Ubaldini Alberto , Utili Marco , Voukelatou Konstantina , Zito Pietro , Zola Danilo , Zummo Giuseppe
Published: September 2022

An accelerator-driven 14 MeV neutron source of new concept, denominated SORGENTINA-RF, will be installed in ENEA Brasimone Research Centre, to test the feasibility of producing radionuclides of medical relevance using fusion neutrons. The main goal of the facility is generating 99Mo as precursor of 99mTc, a radionuclide widely used in nuclear medicine diagnostic procedures, using the 14 MeV fusion neutrons produced by the plant. This work describes the study performed for the design of a proper shielding structure that aims at fulfilling the requirement of 0.01 mSv/h dose rate limit on the external surface of the shielding during beam-on operations. The proposed shielding consists of a layered structure composed of 2 m standard concrete and 1 m baritic concrete. The design is still in the preliminary phase to assess the feasibility and the economic issues as well as structural impact of the shielding structure.
Increased Difficulties Managing Chronic Medical Conditions During the COVID-19 Pandemic Are Associated With Increased Alcohol and Cannabis Use Among Unhoused and Unstably Housed Women
Authors: Riley Elise D. , Warner Leah , Hahn Judith A. , Braun Carl , Dilworth Samantha , Zevin Barry , Neilands Torsten B. , Weiser Sheri D.
Published: September 2022

Objectives

The COVID-19 pandemic caused dramatic upsurges in stress and anxiety across the United States, as well as increased substance use to cope with pandemic-related stress. Few studies have focused exclusively on extremely disadvantaged individuals who are already at risk for substance use. We sought to understand factors associated with increased alcohol and cannabis use during the first 10 months of the COVID-19 pandemic among unsheltered and unstably housed women.

Methods

Between July and December 2020, we conducted phone surveys with San Francisco unhoused and unstably housed women regarding substance use, health, and health services use since the beginning of the pandemic (March 2020).

Results

Among 128 participants, increased use of alcohol and cannabis were reported by 15% and 23%, respectively. The odds of increased use of both substances were 4 times higher in participants who also had increased difficulties managing symptoms of a chronic medical condition during the pandemic.

Conclusions

An intentional and comprehensive approach to managing the health of particularly vulnerable individuals during the COVID pandemic could help alleviate its exacerbating influences. Such an approach should include resources, tools and interventions for managing substance use, as well as chronic, non-COVID medical conditions, which are common and strongly tied to substance use in unhoused and unstably housed women.
Impact of an Infant-Driven Feeding Initiative on Feeding Outcomes in the Preterm Neonate
Authors: Ilahi Zara , Capolongo Theresa , DiMeglio Angela , Demissie Saleshi , Rahman Amanda
Published: September 2022

Background:

Poor feeding techniques result in adverse outcomes for preterm infants. Infant-driven feeding (IDF) is a structured feeding method that standardizes neonatal cue-based feedings, and matches the neurodevelopmental stage of the preterm infant. The purpose of this quality improvement project is to assess whether initiation of an IDF initiative impacts time from first nipple feed (NF) to full NF and to discharge in infants born before 35 weeks' gestational age. Secondary aims include assessment of the impact of IDF on neonatal growth and feasibility of following an IDF protocol in a level III neonatal intensive care unit (NICU).

Methods:

This quality improvement project assesses differences in time to first NF, length of hospital stay, and neonatal growth before and after usage of an IDF protocol. Eighty infants were included, 40 prior to and 40 after IDF intervention. Nurses were trained on IDF philosophy and methods prior to initiation.

Results:

IDF was associated with discharge at a younger corrected gestational age (CGA), attainment of ad lib feeds at a younger CGA, and shorter amount of days between first NF and discharge. Infants utilizing IDF had slower weight gain, demonstrated by a larger drop in z score in the IDF group. The medical team and bedside nurses were able to follow the IDF protocol with few exceptions.

Implications for Practice/Research:

IDF allows for optimization of a preterm infant's NICU stay and prepares infants for a safe discharge sooner. This could lead to increased parental satisfaction and decreased hospital cost. Further studies are indicated to ensure these benefits remain and focus on impact direct breastfeeding plays in the IDF model.
Philanthropic Foundations' Discourse and Nursing's Future
Authors: Kneipp Shawn M. , Drevdahl Denise J. , Canales Mary K.
Published: September 2022

In this article, we examine external agents' effect on nursing's professional evolution and the consequences for the discipline's collective agency, social contract, and self-regulation. Situated within Foucault's theories of power, we review how the power of organizations reaches into the fabric of everyday life and explore how philanthropic foundations have influenced a diverse array of disciplines, including nursing. Through a genealogic lens, we examine nursing history and professionalization and conclude with concerns surrounding nursing's exercise of its collective agency during one of the most significant, discipline-shaping activities of modern times—Robert Wood Johnson Foundation's Future of Nursing initiatives.
Considering the “Bitter Rivalry” Within the Context of European and Colonial History of Women Healers
Authors: Falk-Rafael Adeline
Published: September 2022

Polarized opinion among nurses regarding two 19th century nurses is damaging in its divisiveness. The nursing works of Nightingale and Seacole in the 19th century are presented within the context of European and Colonial history involving the rise to power of the medical profession, the decline of women healers, and the beginning of professional nursing in an effort to understand the factors contributing to the polarization. A Supplemental Digital Content video abstract is available at http://links.lww.com/ANS/A55.
A Conceptual Model to Guide Patient-to-Provider Communication of Adverse Childhood Experiences in Primary Care
Authors: Strauch Kimberly A.
Published: September 2022

Communicating with adults about childhood adversity is not an innate clinical skill nor is it a routine assessment element. Nurse practitioners may be aware of the significance adverse childhood experience (ACE) exposure has on adult health and well-being; however, they may not be prepared to identify, interpret, and subsequently act on that information. This article presents the development of a conceptual model to guide patient-to-provider communication of adverse childhood experiences in primary care (the PPC-ACE model). This includes a description of the model and its associated foundational elements, underlying assumptions, implications for nursing practice, and opportunities to use this model to guide future ACEs-related research.
Effect of Circular Stapler Diameter on Anastomotic Leakage Rate and Stenosis After Open Total Gastrectomy With Esophagojejunostomy
Authors: Mittelstädt Anke , Reitberger Helena , Fleischmann Julia , Elshafei Moustafa , Brunner Maximilian , Anthuber Anna , Krautz Christian , Lucio Marianna , Merkel Susanne , Grützmann Robert , Weber Georg F.
Published: September 2022

Background:

Anastomotic leakage (AL) and stenosis (AS) are two of the most severe postoperative complications after total gastrectomy with esophagojejunostomy. The stapler diameter can be chosen by the surgeon. Therefore, this study aims to assess the correlation between the stapler size as main independent variable as well as other different risk factors and AL and AS.

Methods:

We conducted a retrospective analysis of data from 356 patients who underwent open total gastrectomy between 2000 and 2018, mostly due to gastric cancer (96.9%). After propensity score matching the outcome parameters AL and AS were compared between the two stapler size groups. We also assessed different risk factors for AL and AS in cancer patients using multivariate analysis.

Results:

Small circular stapler diameter (21/25 mm; n = 147 vs 28/29/31 mm; n = 209) was identified as a significant risk factor for the occurrence of AL (10% vs 4% for smaller vs larger staplers; P = 0.042). In multivariate analysis for the occurrence of AL an ASA score ≥ 3 could be identified as a risk factor (OR 2.85; 95% CI = 1.13–7.15; P = 0.026). Additionally, smaller stapler size could be identified as a risk factor for AS (OR small 1.00, OR large 0.24; 95% CI: 0.06–0.97; P = 0.045). AL was associated with lower survival (18.1 vs 38.16 months; P = 0.0119).

Conclusion:

The application of a larger circular stapler for esophagojejunostomy in open total gastrectomy shows significantly lower rates of AL and stenosis. Therefore, the largest possible stapler diameter should be applied.
Dynamic Radiographs are Unreliable to Assess Arthrodesis following Cervical Fusion: A Modeled Radiostereometric Analysis of Cervical Motion
Authors: Pinter Zachariah W. , Skjaerlund Jonathan , Michalopoulos Giorgos D. , Nathani Karim R. , Bydon Mohamad , Nassr Ahmad , Sebastian Arjun S. , Freedman Brett A.
Published: September 2022

Study Design.

In vitro study

Objective.

The purpose of the present study was to utilize an idealized cervical spine model to determine whether the parallax effect or changes in the position of the spine relative to the x-ray generator influence intervertebral motion parameters on dynamic cervical spine radiographs.

Summary of Background Data.

The utility of flexion-extension radiographs in clinical practice remains in question due to poor reliability of the parameters utilized to measure motion.

Methods.

A cervical spine model with tantalum beads inserted into the tip of each spinous process was utilized to measure interspinous process distance on plain radiographs (IPD). The model was then manipulated to alter the generator angle and generator distance, and the IPD was measured. The impact of individual and combined changes in these parameters on IPD was assessed. Multivariate analysis was performed to identify independent drivers of variability in IPD measurements.

Results.

Isolated changes in the generator distance and generator angle and combined changes in these parameters led to significant changes in the measured IPD at each intervertebral level in neutral, flexion, and extension, which, in many instances, exceeded an absolute change of >1 mm or >2 mm. Multivariate analysis revealed that generator distance and generator angle are both independent factors impacting IPD measurements that have an additive effect.

Conclusion.

In an idealized cervical spine model, small clinically feasible changes in spine position relative to the x-ray generator produced substantial variability in interspinous process distance measurements, with absolute changes that often exceeded established cutoffs for determining the presence of pathologic motion across a fused segment. This study further reinforces that motion assessment on dynamic radiographs is not a reliable method for determining the presence of an arthrodesis unless these sources of variability can be consistently eliminated.

Level of Evidence.

III
Bilateral nephrolithiasis and upper tract transitional cell carcinoma in horseshoe kidney
Authors: Gaines Jacob M. , Macdonald Eric J. , Rai Arun , Hoenig David , Smith Arthur , Okeke Zeph , Aro Tareq
Published: September 2022

Nephroureterectomy is currently the criterion-standard treatment for high-grade upper tract urothelial carcinoma. Current guidelines and expert opinions propose some exceptions to this approach based on patient characteristics, disease status, and function of the contralateral kidney. We present a rare case of a patient with horseshoe kidney, bilateral large nephrolithiasis, high-grade upper tract urothelial carcinoma in one moiety, and relative parenchymal thinning of the contralateral side. The patient was treated with a percutaneous, minimally invasive, nephron sparing approach. The patient also had intracollecting system instillations of gemcitabine and docetaxel. Minimally invasive percutaneous resection of high-grade upper tract urothelial carcinoma is a safe procedure in select cases. Current guidelines may not apply to all patients; unique scenarios with upper tract urothelial carcinoma may require personalized decision-making and treatment at specialized centers.
Vitamin D receptor polymorphism and prostate cancer prognosis
Authors: El-attar Ahmed Z. , Hussein Samia , Salama Mariam F. A. , Ibrahim Hanaa M. , AlKaramany Amira S. , Elsawi Mansour K. , Hemeda Mohamed , Algazeery Ahmed
Published: September 2022

Background

Prostatic epithelial cells synthesize the active form of vitamin D (1,25-dihydroxyvitamin D3), which participates in regulating prostate growth. Calcitriol, a synthetic form of vitamin D3, exhibits antiproliferative and prodifferentiation activities in prostate cancer. The function of 1,25-dihydroxyvitamin D3 is mediated by its binding to vitamin D receptor (VDR). VDR forms a heterodimer, typically with retinoid X receptor, to regulate vitamin D target genes. We evaluated the relationship between VDR polymorphism and clinical characteristics associated with prostate cancer risk and prognosis among Egyptian men.

Materials and methods

This case-control study included 2 groups of patients: group A, a control group of 50 subjects with benign prostate hyperplasia, and group B, 50 subjects newly diagnosed with prostate cancer. All participants performed complete blood count (CBC), liver and kidney function tests, prostate specific antigen (PSA) measurement, histopathological analysis and immunohistochemistry for Dickkopf Homolog 3 (DKK3). Restriction fragment length polymorphism-polymerase chain reaction (RFLP-PCR) was performed to detect VDR polymorphism.

Results

Patients with prostate cancer and controls showed a significantly different CA genotype frequency (p = 0.007). Furthermore, prostate-specific antigen levels were significantly different in different genotypes in patients with prostate cancer (p < 0.001). Finally, T stage and the VDR ApaI C/A polymorphism were significantly associated (p < 0.041).

Conclusion

The VDR ApaI C/A polymorphism may be a diagnostic and prognostic marker for prostate cancer in Egyptian men.
Bowen Disease Within a Circumscribed Palmar Hypokeratosis
Authors: Torre-Castro Juan , Nájera Laura , Salgüero Irene , Requena Luis
Published: September 2022

Circumscribed palmar or plantar hypokeratosis is a focal disorder of keratinization that consists of a reduction in the thickness of the corneal layer of the epidermis of palms or soles. Although it is considered a benign entity, the thinning of the stratum corneum facilitates ultraviolet damage in the affected skin, which may result in an increased risk of developing focal epidermal dysplasia. Other factors, such as immunosuppression in transplanted patients, may play a role as well. We present a case of circumscribed palmar or plantar hypokeratosis with features of Bowen disease limited to the hypokeratotic epidermis.
Reduction of Glare Discomfort and Photostress Recovery Time Through the Use of a High-Energy Visible–Filtering Contact Lens
Authors: Renzi-Hammond Lisa M. , Buch John , Xu Jie , Hammond Billy R.
Published: September 2022

Objectives:

Glare discomfort (GDC) is the slight pain (discomfort) that arises when exposed to light that exceeds one's adaptive state. Such light can also cause a temporary loss in visual function (photostress, PS). We tested the hypothesis that filtering with a high-energy visible (HEV) light–filtering contact lens can reduce GDC and speed PS recovery time.

Methods:

Sixty-one subjects were randomized and fit with study lenses and 58 subjects completed as cohort (20–65 years of age). A double-masked, randomized, contralateral design was used (HEV filter on one eye; control lens on the other). Participants were given a 5-s exposure to a broadband white photostressor. Video images were analyzed, and palpebral fissure size during exposure was measured, as was PS recovery time to a 2-degree mid-wave target.

Results:

The HEV-filtering test lens was statistically superior (P<0.0001) to the clear comparison contact lens with respect to the magnitude of squint (44.9% squint reduction) and photostress recovery time (24.3% faster recovery).

Conclusions:

High-energy visible light–filtering contacts can reduce GDC and speed PS recovery. Filtering HEV light before it is incident upon the retina is a natural strategy (e.g., by the lens and macular pigment) for attenuating some of the deleterious effects of bright broadband light.
Novel High-Resolution Imaging Using ANTERION Optical Coherence Tomography to Assess Fluid Reservoir Change in Scleral Lens Periphery
Authors: Tran Stephanie , Roberts Cynthia J. , Mahmoud Ashraf , Pisano Stephanie , Mundy Chantelle
Published: September 2022

Objectives:

To assess scleral lens fluid reservoir (FR) change simultaneously in four quadrants with single acquisition using novel ANTERION anterior segment swept-source optical coherence tomography (SS-OCT).

Methods:

A prospective, observational, clinical study of 18 subjects (30 eyes) was performed on adults fitted with a scleral lens for ocular surface disease (n=8), irregular cornea/scar (n=7), and corneal ectasia (n=15). ANTERION anterior segment SS-OCT imaging was obtained at the initial visit and at the follow-up to determine pre and post scleral lens settling, measured in microns, centrally and peripherally. Peripheral measurements were grouped into four quadrants. Repeated-measures ANOVA was performed comparing vault post minus pre differences by quadrant, and TTests comparing difference in FR by lens design were performed with a significant threshold at P<0.05.

Results:

The mean central scleral lens settling was significant at −48.3±41.7 μm. The change in FR by quadrant was superior (S): −47.8±67.3 μm, inferior (I): −68.0±102.2 μm, nasal (N) −46.3±63.4 μm, and temporal (T): −56.7±49.3 μm. There were no significant differences in lens settling between the quadrants. Within the three categories, the irregular cornea group experienced significantly greater lens settling. There was no significant difference in central FR when comparing lens design or lens diameter.

Conclusions:

The ANTERION SS-OCT allows for high-resolution central and peripheral assessment of FR in scleral lens wear. With increased technology available for scleral lens customization, this imaging modality can assist in more detailed assessment in quadrant-specific scleral lens designs.
Healthy dietary indices and noncancer pain: a systematic review of cross-sectional and longitudinal studies
Authors: Chand Rani R. , Blyth Fiona M. , Khalatbari-Soltani Saman
Published: September 2022

Pain is a global public health problem given its high prevalence and incidence, long duration, and social and economic impact. There is growing interest in nutrition as potential modifiable risk factor related to pain; however, the associations between healthy dietary patterns and pain have not yet been well established. Thus, we aimed to systematically review and synthesise current cross-sectional and longitudinal evidence on the relationship between a priori healthy dietary patterns and noncancer pain among adults aged ≥18 years. We identified relevant published cross-sectional and longitudinal studies by systematically searching several electronic databases from inception to September 2021. Risk of bias was assessed using the modified Newcastle–Ottawa scale for cohort studies. A total of 14 cross-sectional and 6 longitudinal studies were included in the review. These studies measured different dietary scores/indices, such as different measures of adherence to the Mediterranean diet and the dietary inflammatory index. Pain ascertainment methods and pain measurements used differed across studies. All 20 of the included studies had different study designs and statistical analysis. Of these studies, 10 reported an inverse association between adherence to a healthy dietary pattern and pain, 5 reported mixed results, and 5 reported no associations. Despite notable heterogeneity, 50% of included observational studies reported that adherence to a healthy diet, particularly the Mediterranean diet, is inversely associated with pain. Of note, the cross-sectional design of most studies precludes any causal interpretation. Moreover, limited and inconsistent evidence from longitudinal studies highlights the need for further studies.
Relationships Between the Physical Work Environment, Postures and Musculoskeletal Pain During COVID-19
Authors: Snodgrass Suzanne J. , Weerasekara Ishanka , Edwards Suzi , Heneghan Nicola R. , Puentedura Emilio J. , James Carole
Published: September 2022

Objective

To understand the flexible work practices during the COVID-19 pandemic and their impact on work-related musculoskeletal disorders (MSDs) and depression in frequent computer users.

Methods

An e-survey determined the extent of workplace changes and MSD, and the relationships between them using descriptive-statistics and chi-squared tests.

Results

Of 700 who commenced the survey, 511 were analyzed. Since the pandemic commenced, 80% of respondents reported they were working more from home; and 89% reported some musculoskeletal pain. Compared with prepandemic, more people worked in nonergonomic environments, computer configurations and body postures. Work location was associated with upper back pain (P = 0.011); body posture with headache (P = 0.027) and low back pain (P = 0.003).

Conclusion

Nonergonomic work environments of frequent computer users during COVID-19 are related to having upper back pain, whereas nonergonomic postures are related to having headache and low back pain.
Primary Prevention of Weight Gain Among New Bus Operators
Authors: Olson Ryan , Rice Sean P. M. , Bauer Talya N. , Wipfli Brad , Anger W. Kent , Bodner Todd , Graven Peter , Greenspan Leah S.
Published: September 2022

Objective

This study aimed to test the feasibility and efficacy of an enhanced onboarding intervention to prevent weight gain and support the early job success of new bus operators.

Methods

Control participants (n = 9) completed usual practice new employee training and onboarding. Intervention participants (n = 14) completed five supplemental trainings and four online challenges during their first year. Primary outcomes were body weight, dietary behaviors, physical activity, and sleep duration/quality. Early job success was evaluated with measures of newcomer adjustment.

Results

The difference between intervention and control participants in body weight change at 12-month was −6.71 lb (Cohen's d = −1.35). Differences in health behavior changes were mixed, but newcomer adjustment changes favored the intervention group.

Conclusions

Results support the feasibility of enhanced onboarding for bus operators to prevent worsening health while simultaneously advancing their success as new employees.
Early detection of obstructive sleep apnea in patients with atrial fibrillation
Authors: Oster Madeleine , Thornsberry Joshua D. , Howard Lindsay A. , Talley Michele H.
Published: September 2022

Background:

Obstructive sleep apnea (OSA) is an independent and modifiable risk factor for atrial fibrillation (AF) and correlates with a three-fold higher risk of incident AF. Although OSA is prevalent in patients with AF, it remains underdiagnosed. Guidelines for OSA screening are ambiguous.

Local Problem:

A small community hospital in the southeast United States lacked standardized OSA screening and consistent sleep clinic referral for hospitalized patients with AF.

Methods:

Over 3 months, an OSA bundle (including screening, education, and referral) was implemented for hospitalized patients with AF. A retrospective electronic health record (EHR) review established a baseline comparison group. Descriptive analyses between the intervention and comparison groups evaluated the effectiveness of the OSA bundle.

Interventions:

Eligible patients received OSA screening with the STOP-Bang questionnaire. A STOP-Bang score of 3 or higher triggered patient education about the arrhythmogenic relationship of OSA and AF. At discharge, patients received an ambulatory sleep clinic referral. After 3 months, an EHR review assessed the rate of sleep clinic follow-up, sleep testing, OSA diagnosis, and initiation of positive airway pressure.

Results:

Of the 68 patients in the comparison group and 33 patients in the intervention group, the rate of OSA screening increased from 4.4% to 100%. Sleep clinic referral increased from 66.7% to 93.5%. Sleep clinic follow-up increased from 0% to 10%.

Conclusion:

Screening for OSA and sleep clinic referral improved with the OSA bundle; however, sleep clinic follow-up remained low. Further quantitative and qualitative investigation is needed to better understand barriers to sleep clinic follow-up.
Effect of Increased Intra-abdominal Pressure on the Esophagogastric Junction
Authors: Siboni Stefano , Bonavina Luigi , Rogers Benjamin D. , Egan Ciara , Savarino Edoardo , Gyawali C. Prakash , DeMeester Tom R.
Published: September 2022

With the advent of high-resolution esophageal manometry, it is recognized that the antireflux barrier receives a contribution from both the lower esophageal sphincter (intrinsic sphincter) and the muscle of the crural diaphragm (extrinsic sphincter). Further, an increased intra-abdominal pressure is a major force responsible for an adaptive response of a competent sphincter or the disruption of the esophagogastric junction resulting in gastroesophageal reflux, especially in the presence of a hiatal hernia. This review describes how the pressure dynamics in the lower esophageal sphincter were discovered and measured over time and how this has influenced the development of antireflux surgery.
The impact of residual hematoma after evacuation on the outcomes of patients with ruptured intracranial aneurysms with intracerebral hematoma: A longitudinal single-center observational study
Authors: Yang Yifan , Richard Seidu A. , Lan Zhigang
Published: September 2022

Intracerebral hematoma (ICH) as a result of ruptured of intracranial aneurysms often arises in patients with subarachnoid hemorrhage. Few studies focused on risk factors for ICH and not the impact of residual hematoma after evacuation on the outcomes of the patients. Therefore, 2 questions need to be answered: does residual hematoma after evacuation have impact on the outcome of patients who present with ICH as a result of ruptured intracranial aneurysms? Is radical pursuit of the hematoma necessary?

The study was a single-center longitudinal observational type. Data of 2044 consecutive patients with subarachnoid hemorrhage from January 2009 to December 2019 were reviewed. ICHs were established and the locations of aneurysms as well as hematoma volumes were measured by computed tomographic scan before aneurysm occlusion. Only patients who received aneurysm clipping were included. Patients were stratified into hematoma evacuation without residuals versus residual hematoma after evaluation groups, and outcome was assessed according to the modified Rankin Scale (mRS) at 6 months.

Out of the 1365 patients who received clipping, 476 patients presented in poor grade, whereas 889 patients’ good grade. Our mRS scores revealed that patients who attained hematoma evacuation without residuals in the good-grade category attained better functional outcome than those with residual hematoma after evacuation. Contrarily, our mRS scores did not establish any significant difference in outcome between the poor-grade patients with hematoma evacuation without residuals and patients with residual hematoma after evacuation. Furthermore, our logistic regression model showed that advance age, poor Hunt-Hess grade, and vascular injury due to surgery were contributing factors for poor outcome of patients with ICH.

Our data suggested that aggressive hematoma evacuation may not benefit the poor-grade patients. Majority of poor outcomes were due to surgical complications which were vascular related as a result of excessive pursuit of ICH.
Efficacy and safety of endostar combined with chemoradiotherapy versus chemoradiotherapy alone in locally advanced cervical cancer: A PRISMA-compliant systematic review and meta-analysis
Authors: Maimaitiming Nuersimanguli , Ma Xiaoli , Wei Yu , Cao Leiyu , Gao Yan , Zhang Li
Published: September 2022

Background:

To evaluate the role and safety of endostar in cervical cancer by comparing the efficacy and adverse reactions of endostar combined with concurrent chemoradiotherapy in patients with locally advanced cervical carcinoma.

Methods:

The quality of the included literature was evaluated by searching the database for the comparison of endostar combined with concurrent radiotherapy and chemotherapy in cervical cancer patients; objective response rate (ORR) and disease control rate (DCR) were used as the main outcome indicators, and statistical analysis was performed using RevMan5.3 and State15.3 software.

Results:

A total of 13 studies were included in this study, including 1057 patients with locally advanced cervical cancer, suggesting that endostar combined with chemoradiotherapy can significantly improve the objective response rate (ORR: odds ratio 3.88, 95% confidence interval 2.77–5.45, P < .00001) and disease control rate (DCR: odds ratio 4.43, 95% confidence interval 2.78–7.04; P < .00001), and there was no significant increase in treatment-related adverse reactions.

Conclusions:

In this meta-analysis, endostar combined with concurrent chemoradiotherapy significantly improved ORR and DCR in patients with locally advanced cervical cancer without increasing toxicity. However, this study only analyzed the short-term efficacy of endostar, and its influence on overall survival and progression-free survival needs to be further verified in large randomized controlled trials with long-term follow-up.
Ligamentum flavum hypertrophy significantly contributes to the severity of neurogenic intermittent claudication in patients with lumbar spinal canal stenosis
Authors: Kim Joohyun , Kwon Woo-Keun , Cho Hyunwook , Lee Subum , Lee Jang-Bo , Park Jung-Yul , Jin Dong Uk , Jung Eui Yub , Hur Junseok W.
Published: September 2022

Ligamentum flavum hypertrophy (LFH) is a known contributor to lumbar spinal canal stenosis (LSCS). However, the clinical significance and quantitative role of LFH compared to other components, such as disc bulging and facet hypertrophy, have not yet been examined. We investigated the correlation between the quantitative radiological factors, clinical symptoms, and outcomes in patients with LSCS. In total, 163 patients diagnosed with single-level (L4–L5) stenosis were included. The patients were divided into 2 groups according to claudication severity: >100 m for mild (n = 92) and < 100 m for severe (n = 71). The visual analog scale (VAS) was used to quantify back and leg pain, and the Oswestry Disability Index (ODI) and Short form-36 (SF-36) physical component summary (PCS) scores, and Macnab criteria were evaluated as clinical factors 6 months after treatment. We measured the baseline canal cross-sectional area, ligamentum flavum (LF) area, disc herniation area, dural sac area, fat area, and LF thickness using MRI. A comparative analysis was performed to evaluate the association between radiologic and clinical factors. Additionally, further comparative analyses between the types of surgeries were performed. Among various radiologic factors, the baseline LF thickness (odds ratio [OR] 1.73; 95% confidence interval [CI] 1.25–2.41) was the only major contributing factor to the severity of claudication in the multivariate logistic regression analysis. The types of surgery (decompression alone vs fusion) did not significantly differ in terms of their clinical outcomes, including back and leg VAS, ODI, SF-36 PCS, and satisfaction with the MacNab classification. LF thickness is a major factor contributing to claudication severity.
Double-negative T cells are increased in HIV-infected patients under antiretroviral therapy
Authors: Korbi Fatma , Zamali Imen , Rekik Raja , Ben Hmid Ahlem , Hidri Mouldi , Kammoun Rebai Wafa , Jelili Zeineb , Masmoudi Senda , Rahal Souleiman Karim , Ben Ayed Azza , Ben Ahmed Mélika
Published: September 2022

Double-negative T (DNT) cells are a T-cell subset with a CD4–CD8– phenotype. They represent 1% to 5% of circulating lymphocytes, but an increase in this proportion can be found during lymphoproliferative and autoimmune diseases. This increase has also been reported in persons with HIV (PWH). The aim of this work was to better describe the proportion of DNT cell subset in PWH. We retrospectively collected 984 samples from PWH referred for lymphocyte immunophenotyping over a 7.5-year period. Quantification of DNT cells was performed by flow cytometry. DNT cell proportion was calculated by subtracting the CD4+ and CD8+ subsets proportions from the total of T cells. A total of 984 blood samples from PWH were collected. Mean CD4 T-cell count was decreased in such patients while DNT cell frequency was increased with a mean of 6.7%. More than half of the patients had a DNT cell proportion >5%. Patients with DNT cell proportion over 5% exhibited significantly reduced CD3+ and CD4+ T-cell counts, while CD8+ T-cell count was unchanged compared to patients with normal DNT cell rates. Interestingly, DNT cell percentage was negatively correlated with CD4 and CD3 T-cell counts in all included patients. Moreover, the DNT cell proportion was significantly increased in subjects with CD4+ T cells <200/mm3 compared to those with CD4+ T cells >200/mm3. Interestingly, DNT cell proportions were significantly higher in patients with high viral load compared with those presenting undetectable viral load. HIV infection is associated with an increase in DNT cell proportion. This increase is more frequent as the CD4 count is decreased and the viral load is increased. DNT cell subset should not be omitted when interpreting immunophenotyping in PWH as it appears to be associated with disease progression in patients under antiretroviral therapy.
Integrated bioinformatics analysis reveals potential mechanisms associated with intestinal flora intervention in nonalcoholic fatty liver disease
Authors: Liu Yingying , Liu Xinkui , Zhou Wei , Zhang Jingyuan , Wu Jiarui , Guo Siyu , Jia Shanshan , Wang Haojia , Li Jialin , Tan Yingying
Published: September 2022

Background:

Nonalcoholic fatty liver disease (NAFLD) is a common chronic liver disease that imposes a huge economic burden on global public health. And the gut-liver axis theory supports the therapeutic role of intestinal flora in the development and progression of NAFLD. To this end, we designed bioinformatics study on the relationship between intestinal flora disorder and NAFLD, to explore the possible molecular mechanism of intestinal flora interfering with NAFLD.

Methods:

Differentially expressed genes for NAFLD were obtained from the GEO database. And the disease genes for NAFLD and intestinal flora disorder were obtained from the disease databases. The protein-protein interaction network was established by string 11.0 database and visualized by Cytoscape 3.7.2 software. Cytoscape plug-in MCODE and cytoHubba were used to screen the potential genes of intestinal flora disorder and NAFLD, to obtain potential targets for intestinal flora to interfere in the occurrence and process of NAFLD. Enrichment analysis of potential targets was carried out using R 4.0.2 software.

Results:

The results showed that 7 targets might be the key genes for intestinal flora to interfere with NAFLD. CCL2, IL6, IL1B, and FOS are mainly related to the occurrence and development mechanism of NAFLD, while PTGS2, SPINK1, and C5AR1 are mainly related to the intervention of intestinal flora in the occurrence and development of NAFLD. The gene function is mainly reflected in basic biological processes, including the regulation of metabolic process, epithelial development, and immune influence. The pathway is mainly related to signal transduction, immune regulation, and physiological metabolism. The TNF signaling pathway, AGE-RAGE signaling pathway in diabetic activity, and NF-Kappa B signaling pathways are important pathways for intestinal flora to interfere with NAFLD. According to the analysis results, there is a certain correlation between intestinal flora disorder and NAFLD.

Conclusion:

It is speculated that the mechanism by which intestinal flora may interfere with the occurrence and development of NAFLD is mainly related to inflammatory response and insulin resistance. Nevertheless, further research is needed to explore the specific molecular mechanisms.