bluuebunny/crossref_metadata_2025 huggingface dataset:
Ability to Retension Knotless Suture Anchors: A Biomechanical Analysis of Simulated Bankart Lesions
Authors: LeVasseur Matthew R. , Mancini Michael R. , Williams Nicholas , Obopilwe Elifho , Cote Mark P. , Coyner Katherine J. , Arciero Robert A. , Caldwell Paul E. , Mazzocca Augustus D.
Published: June 2022

Background:

Knotless suture anchors are gaining popularity in arthroscopic glenohumeral labral repairs. The ability to retension knotless designs after initial anchor placement has been reported; however, no studies have quantified this claim or investigated the biomechanical consequence of retensioning.

Purpose/Hypothesis:

To determine whether knotless and knotted suture anchors have biomechanical or anatomic differences with regard to labral repairs and to determine whether retensioning of knotless suture anchors affects capsular tension, labral height, and capsular shift. We hypothesized that retensioning of knotless anchors would result in improved capsular tension compared with conventional knotted suture anchors.

Study Design:

Controlled laboratory study.

Methods:

A total of 18 fresh-frozen cadaveric shoulders with a mean age of 56 years were dissected to the capsule and disarticulated at the humeral capsular insertion. The scapula was potted and placed in a custom shoulder simulator to tension the capsule via braided sutures localized to the anteroinferior glenohumeral ligament. Specimens were randomized into 3 groups: (1) Knotted (KT), (2) Knotless with end retensioning (KLend), and (3) Knotless with stepwise retensioning (KLstepwise). All repairs were completed using all-suture anchors placed at the 5-, 4-, and 3-o’clock positions. KLstepwise was used to simulate an intraoperative technique. Resultant mean capsular tension under 5 mm of displacement (subfailure loading) was measured for each anchor placement and retensioning step. Labral height and capsular shift were measured using a MicroScribe digitizer.

Results:

The intact, defect, 1-anchor, 2-anchor, and 3-anchor tensions were not significantly different between the KT and KLend groups. For the latter, retensioning of all knotless anchors increased capsular tension by 2.1 N compared with its 3-anchor state, although this was not statistically significant ( P = .081). The KLstepwise group explored an alternative method to retension the capsule using knotless anchors, with similar final capsular tensions compared with the other groups. All repairs had similar improvements in capsulolabral height and superior capsular shift.

Conclusion:

Knotted and knotless suture anchors provided similar overall restorations in anteroinferior glenohumeral ligament tension. However, knotless devices were capable of small but statistically insignificant improvements in capsular tension with retensioning.

Clinical Relevance:

Retensioning of knotless anchors allows the surgeon to tighten regions of the glenohumeral capsule that remain lax after repair.
The Validity of Measures of Instructional Alignment With State Standards Based on Surveys of Enacted Curriculum
Authors: Atchison Drew , Garet Michael S. , Smith Toni M. , Song Mengli
Published: June 2022

This paper uses a validity argument approach to examine the validity evidence for measures of instructional alignment based on an instrument adapted from the Surveys of Enacted Curriculum (SEC). Using the instrument, Grade 4 math and Grade 5 English language arts teachers reported the level of emphasis they gave to subject-specific topics and cognitive demands in their instruction, which provided the data for measuring instructional alignment—both overall and by topic and by cognitive demand—with state standards. We found that (a) teachers differentiated topics but not cognitive demands when reporting on the content of their instruction, (b) teachers likely overreported levels of emphasis on topics and cognitive demands, and (c) overall alignment and alignment by cognitive demand were not significantly associated with teachers’ value-added scores. Although this study examined a specific version of the SEC, we believe the findings apply more broadly to SEC-based measures of instructional alignment.
Stances Toward Anti-Racist Medical Education: A Qualitative Analysis of Critical Consciousness in First-Year Medical Students
Authors: Novak Daniel A. , Hallowell Ronan , Llobrera Kairos , Schreiber Jacob , Wright Erika , Elliott Donna
Published: June 2022

As future physicians, first-year medical students are well positioned to work on the long-term creation of a more equitable healthcare system. But how prepared are first-year medical students to begin the work of dismantling structural racism in the US healthcare system? In this study, we analyzed a sample of 75 medical-student reflective responses to a book focused on the legacy of racism in medicine. Our findings indicate that students enter medical school in a range of states of critical consciousness that are visible in their “stances” toward addressing racial inequality in the healthcare system. The stances described in our findings extend the critical consciousness framework, providing a more nuanced understanding of students’ starting orientations to health justice. Because students arrive in different stances toward confronting the systemic inequalities inherent to the US healthcare system, understanding these stances may help medical educators tailor learning experiences to medical students’ needs more effectively.
Understanding the Intensive Care Unit Experience of Patients and Relatives at the End-of-Life During the Coronavirus Disease 2019 Pandemic
Authors: Eskell Matthew , Thompson Jamie , Powell Ohema , Torlinski Tomasz , Mullhi Randeep
Published: June 2022

The coronavirus disease 2019 (COVID-19) pandemic has had a significant impact on patients and relatives’ experiences of end-of-life care, as well as changing the provision of these services in intensive care units (ICUs) across the world. Established methods for assisting relatives through the grieving process have required modification due to the unique features and circumstances surrounding deaths from this disease. This mixed-methods study from the United Kingdom (UK) aims to review data from patients who died in a large ICU (the unit had a capacity for more than 100 ventilated patients), over the course of approximately 1 year. The inpatient noting of these patients was reviewed specifically for details of visiting practices, chaplaincy support, and patient positioning (prone vs supine) prior to death. Using this data, recommendations are made to improve end-of-life care services. To allow relatives the opportunity to attend the ICU, there is a need for early recognition of patients approaching the end of life. Clear explanations of the need for prone positioning and increased access to chaplaincy services were also identified.
Around the World in 283 Days: Traveling with the Laymen’s Foreign Missions Inquiry Commission of Appraisal
Authors: Lindsey Peggy Bowler
Published: June 2022

The Laymen’s Foreign Missions Inquiry was an ambitious attempt by seven mainline Protestant denominations to evaluate the state of American foreign missions in 1931–32. It consisted of two parts, a fact-finding mission and the Commission of Appraisal, the findings of which are known as the Hocking Report. The Report stirred quite a bit of controversy and helped shape American Protestant missions for years to come. This article is based on a collection of letters written by the secretary of the Commission; it offers a glimpse into the inner workings of the Commission as it traveled around the world.
Assessment of the Needs of Rural Older People in Bangladesh
Authors: Ali Isahaque , Azman Azlinda , Ahmed Manzur Kadir , Akhtar Tahmina , Deceukelier Bruno
Published: June 2022

The objective of this study is to examine the needs of older population in rural Bangladesh. Through a purposive sampling, 80 participants were selected from eight villages located in eight administrative districts. In-depth interviews were conducted to collect some quantitative and mostly qualitative data. The study findings indicated that the majority of rural older people were in abject poverty, had limited social security and suffered from ill health, malnutrition, and inadequate medical and general health services. Also, they lacked steady income, had lost family relations, suffered from social isolation and loneliness, and are dependent on others. Due to loss of family relations, they lacked caregivers and had little or no social status and position, thus making them susceptible to depression, frustration and stress. Moreover, they have limited access to recreational and transportation facilities, as well as community-based support programmes. Our findings suggest implementation of social security and protection schemes in the rural area and extension of adequate and quality health care facilities to the rural older. In summary, rural older people in Bangladesh need a more balanced and integrated social and medical care policies to maintain a decent quality of life.
Multimorbidity matters in low and middle-income countries
Authors: Basto-Abreu Ana , Barrientos-Gutierrez Tonatiuh , Wade Alisha N , Oliveira de Melo Daniela , Semeão de Souza Ana S , Nunes Bruno P , Perianayagam Arokiasamy , Tian Maoyi , Yan Lijing L , Ghosh Arpita , Miranda J Jaime
Published: June 2022

Multimorbidity is a complex challenge affecting individuals, families, caregivers, and health systems worldwide. The burden of multimorbidity is remarkable in low- and middle-income countries (LMICs) given the many existing challenges in these settings. Investigating multimorbidity in LMICs poses many challenges including the different conditions studied, and the restriction of data sources to relatively few countries, limiting comparability and representativeness. This has led to a paucity of evidence on multimorbidity prevalence and trends, disease clusters, and health outcomes, particularly longitudinal outcomes. In this paper, based on our experience of investigating multimorbidity in LMICs contexts, we discuss how the structure of the health system does not favor addressing multimorbidity, and how this is amplified by social and economic disparities and, more recently, by the COVID-19 pandemic. We argue that generating epidemiologic data around multimorbidity with similar methods and definition is essential to improve comparability, guide clinical decision-making and inform policies, research priorities, and local responses. We call for action on policy to refinance and prioritize primary care and integrated care as the center of multimorbidity.
American Society of Maxillofacial Surgeons: The Last 25 Years and the Next 25 Years
Authors: Yu Jack C. , Lin Alexander Y.
Published: June 2022

Professional organizations, like most complex human entities in the world including companies and countries, undergo periodic changes. Sometimes, these changes happen in years, while others may take decades or more. This year is the 75th anniversary of the American Society of Maxillofacial Surgeons (ASMS), a society born of necessity after World War II, even though its inception goes further back several decades. This brief article commemorates this important landmark and summarizes some key events of the last 25 years from 1997 to 2022, as others have nicely summarized the earlier periods. In addition to changes in clinical, research, and education in the context of craniofacial surgery, the review also examines from the national and global perspectives within which exists ASMS. These historical comparisons allow for appreciation of changes and, more importantly, permits the educated forecast of the future. It is our hope that from the lessons learned from the past will emerge a brighter, better tomorrow.
Use of scenario earthquakes for seismic hazard assessment in low-seismicity, stable continental regions: A case study from Indiana, USA
Authors: Sherrill Elizabeth M , Hamburger Michael W , Anna Nowicki Jessee M
Published: June 2022

While large earthquakes have been documented in stable continental regions, such as the central United States, they occur too infrequently to provide reliable observations of earthquake-related impacts. Using the state of Indiana as a case study, we investigate the impacts of five deterministic scenarios—three occurring outside the borders of the state and two within the state. They include a M7.3 Wabash Valley event in southern Illinois, a M7.6 New Madrid event in southeastern Missouri, a M6.2 event in west central Ohio, a M6.2 event near Evansville, Indiana, and a M5.8 Indianapolis event. The locations and magnitudes are based on known fault locations and credible interpretations of the earthquake history in the region. We use a combination of the US Geological Survey’s ShakeMap and the Federal Emergency Management Agency’s (FEMA) Hazus software packages to assess earthquake-triggered ground shaking and its effects on the built environment. We also use the United States Geological Survey (USGS) Ground Failure estimation tool to examine the spatial distribution of anticipated earthquake-induced landslides and liquefaction. The five main deterministic scenario models indicate that moderate-sized urban earthquakes may represent a greater threat to a state like Indiana than a large-magnitude event from the New Madrid seismic zone. To better understand the influence of earthquake source parameters on impacts, we conducted a sensitivity analysis for earthquakes near Indianapolis and Evansville, where we reviewed losses due to differences in magnitude, depth, strike, and dip. Based on the model projections, magnitude and depth have first-order and relatively predictable influence on losses. The orientation and dip of the causative fault in relation to populated areas can alter economic losses for an event of the same magnitude by 13%–32%. Deterministic scenario analyses, such as those presented here, can potentially be of widespread utility for understanding earthquake impacts in the central United States and other low-seismicity, stable continental regions.
Guided post-earthquake reconnaissance surveys considering resource constraints for regional damage inference
Authors: Sheibani Mohamadreza , Ou Ge
Published: June 2022

The extent of loss in a seismic hazard can be moderated with on-time allocation of funds and initiation of recovery tasks. Among various examinations conducted following the hazard, buildings damages are assessed as part of the reconnaissance survey to learn and document the impact of the earthquake on structures. The results of the survey are used in financial aid estimation, which is crucial for the community rapid recovery acts after the hazard. Due to the urgent need for this information, the amount of information gained per unit of time should be optimized. This article aims at answering the question of how to maximize the information gain in the presence of resource constraints by directing the efforts of a reconnaissance surveying team. A data-driven method is proposed that actively learns the patterns of damage and recommends the most informative buildings to be inspected while considering the resource limitations. The framework utilizes an efficient active learning method based on mutual information and developed for Gaussian process regression (GPR) to identify the information-rich cases. To assess the contribution of information gain and resource allocation in the overall outcome of the damage inference, two simulated earthquake testbeds are studied. It is shown that in a co-optimization approach, damage labels of the majority of buildings can be accurately predicted after 1 week of damage inspections.
Differential responses of COPD macrophages to respiratory bacterial pathogens
Authors: Lea Simon , Beech Augusta , Baker James , Gaskell Rosemary , Pindolia Dharmendra , Dikwa Aisha Baba , Shah Rajesh , Singh Dave
Published: June 2022

COPD patients have increased susceptibility to airway bacterial colonisation.Haemophilus influenzae, Moraxella catarrhalisandStreptococcus pneumoniaeare three of the most common respiratory bacterial species in COPD.H. influenzaecolonisation,but not other bacteria, in COPD patients is associated with higher sputum neutrophil counts. Alveolar macrophages are key in clearance of bacteria as well as releasing mediators to recruit and activate other immune cells in response to infection. The aim was to characterise differences in COPD macrophage responses toH. influenzae, M. catarrhalisand S. pneumoniae,focusing on release of inflammatory and chemotactic mediators, and apoptosis regulation.

 Lung macrophages and monocyte-derived macrophages from COPD patients and control subjects were exposed toH. influenzae, M. catarrhalisor S. pneumoniae.Cytokine secretion(tumour necrosis factor-α,interleukin (IL)-6, CXCL8, CCL5 and IL-1β) were measured by ELISA and quantitative reverse transcriptase PCR (RT-qPCR), and apoptosis genes MCL-1, BCL-2, BAX and BAK1 by RT-qPCR. Apoptosis and reactive oxygen species (ROS) release were also measured.

 Macrophages responded differentially to the bacterial species, with increased, prolonged production of the neutrophil chemoattractant CXCL8 in response toH. influenzaeandM. catarrhalisbut notS. pneumoniae.S. pneumoniaeinitiated macrophage apoptosis and ROS release,H. influenzaeandM. catarrhalisdid not and increased anti-apoptosis gene expression (BCL-2 5.5-fold and MCL-1 2.4-fold, respectively).

 Differential cytokine responses of macrophages to these bacterial species can explain neutrophilic airway inflammation associated withH. influenzae,but notS. pneumoniaein COPD. Furthermore, delayed macrophage apoptosis is a potential mechanism contributing to inability to clearH. influenzae.
Computed tomography on lung cancer screening is useful for adjuvant comorbidity diagnosis in developing countries
Authors: de Mattos Juliane Nascimento , Santiago Escovar Carlos Eugênio , Zereu Manuela , Rubin Adalberto Sperb , Camargo Spencer Marcantonio , Mohammed Tan-Lucien , dos Santos Ricardo Sales , Verma Nupur , Penha Pereira Diana , Guedes Pinto Erique , Machuca Tiago , Medeiros Tássia Machado , Hochhegger Bruno
Published: June 2022

Purpose

The aim of this study was to analyse and quantify the prevalence of six comorbidities from lung cancer screening (LCS) on computed tomography (CT) scans of patients from developing countries.

Methods

For this retrospective study, low-dose CT scans (n=775) were examined from patients who underwent LCS in a tertiary hospital between 2016 and 2020. An age- and sex-matched control group was obtained for comparison (n=370). Using the software, coronary artery calcification (CAC), the skeletal muscle area, interstitial lung abnormalities, emphysema, osteoporosis and hepatic steatosis were accessed. Clinical characteristics of each participant were identified. A t-test and Chi-squared test were used to examine differences between these values. Interclass correlation coefficients (ICCs) and interobserver agreement (assessed by calculating kappa coefficients) were calculated to assess the correlation of measures interpreted by two observers. p-values <0.05 were considered significant.

Results

One or more comorbidities were identified in 86.6% of the patients and in 40% of the controls. The most prevalent comorbidity was osteoporosis, present in 44.2% of patients and in 24.8% of controls. New diagnoses of cardiovascular disease, emphysema and osteoporosis were made in 25%, 7% and 46% of cases, respectively. The kappa coefficient for CAC was 0.906 (p<0.001). ICCs for measures of liver, spleen and bone density were 0.88, 0.93 and 0.96, respectively (p<0.001).

Conclusions

CT data acquired during LCS led to the identification of previously undiagnosed comorbidities. The LCS is useful to facilitate comorbidity diagnosis in developing countries, providing opportunities for its prevention and treatment.
52-year follow-up of a birth cohort reveals a high pneumonia incidence among young men
Authors: Holma Pia , Pesonen Paula , Mustonen Olli , Järvelin Marjo-Riitta , Kauma Heikki , Auvinen Juha , Hautala Timo
Published: June 2022

Background

Knowledge of pneumonia incidence and risk factors in adults is mainly based on clinical studies of selected patient data and registers with ageing populations. Prospective population-based investigations, such as birth cohort studies, are needed to understand pneumonia incidence and risk factors among young and working-age populations.

Methods

Northern Finland Birth Cohort (NFBC) 1966 data (n=6750) were analysed for pneumonia incidence and risk factors. Incidence analysis was replicated using data from an independent NFBC 1986 cohort (n=9207). Pneumonia in relation to chronic conditions and lifestyle factors was analysed.

Results

A peak with a maximum of 227 pneumonia episodes per 10 000 among men between the ages of 19 and 21 years was found in two independent cohorts. Pneumonia was associated with male sex (relative risk 1.72, 95% CI 1.45–2.04; p<0.001), low educational level (relative risk 2.30, 95% CI 1.72–3.09; p<0.001), smoking (relative risk 1.55, 95% CI 1.31–1.84; p<0.001), asthma (relative risk 2.19, 95% CI 1.73–2.75; p<0.001), cardiovascular diseases (relative risk 2.50, 95% CI 2.04–3.07; p=0.001), kidney diseases (relative risk 4.14, 95% CI 2.81–6.10; p<0.001), rheumatoid arthritis (relative risk 2.69, 95% CI 1.80–4.01; p<0.001), psoriasis (relative risk 2.91, 95% CI 1.92–4.41; p<0.001) and type II diabetes (relative risk 1.80, 95% CI 1.34–2.42; p<0.001). Men with excessive alcohol consumption at age 31 years were at risk of future pneumonia (relative risk 2.40, 95% CI 1.58–3.64; p<0.001).

Conclusions

Birth cohort data can reveal novel high-risk subpopulations, such as young males. Our study provides understanding of pneumonia incidence and risk factors among young and working age populations.
Identification of the CIPK-CBL family gene and functional characterization of CqCIPK14 gene under drought stress in quinoa
Authors: Xiaolin Zhu , Baoqiang Wang , Xian Wang , Xiaohong Wei
Published: June 2022

Background

Calcineurin-like Protein (CBL) and CBL interacting protein kinase (CIPK) play a key role in plant signal transduction and response to various environmental stimuli. Quinoa, as an important plant with high nutritional value, can meet the basic nutritional needs of human Cash crop, is also susceptible to abiotic stress. However, CBL-CIPK in quinoa have not been reported.

Results

In this study, 16 CBL and 41 CIPK genes were identified in quinoa. CBL-CIPK gene shows different intron-exon gene structure and motif, they participate in different biological processes, and form a complex regulatory network between CBL-CIPK proteins. Many cis-regulatory element associated with ABA and drought have been found. The expression patterns of CBL-CIPK showed different expression patterns in various abiotic stresses and tissues. RT-qPCR showed that most members of these two gene families were involved in drought regulation of quinoa, in particular, the expression levels of CqCIPK11, CqCIPK15, CqCIPK37 and CqCBL13 increased significantly under drought stress.

Conclusions

The structures and functions of the CBL-CIPK family in quinoa were systematically explored. Many CBL-CIPK may play vital roles in the regulation of organ development, growth, and responses to abiotic stresses. This research has great significance for the functional characterisation of the quinoa CBL-CIPK family and our understanding of the CBL-CIPK family in higher plants.
Detection of residual pulmonary alterations with lung ultrasound and effects on postoperative pulmonary complications for patients with asymptomatic SARS-CoV-2 infection undergoing surgeries
Authors: González-Suárez Susana , Barbara Ferreras Antonio , Caicedo Toro Melissa , Aznar de Legarra Macarena
Published: June 2022

Background

For patients with a clinical course of active SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection, there may be a higher risk of perioperative complications. Our main objective is to detect the residual pulmonary alterations in asymptomatic patients after SARS-CoV-2 infection undergoing surgery and determine their relationship with the clinical course of SARS-CoV-2 infection. The secondary aim is to investigate whether the presence of residual pulmonary alterations have any affects on the severity of postoperative pulmonary complications.

Methods

After approval by the Hospital’s Ethical Committee, this prospective observational study included consecutive patients (n=103) undergoing various surgical procedures and anesthetic techniques with a history of past SARS-CoV-2 infection. On the day of surgery these patients remained asymptomatic and the polymerase chain reaction (PCR) test for SARS-CoV-2 was negative. The history, physical findings, and clinical course of SARS-CoV-2 infection were recorded. Lung ultrasound was performed before surgery to evaluate the possible residual pulmonary alterations (≥ 3 B-lines and pleural thickening), along with determitation of pulmonary static compliance values during surgery. Postoperative pulmonary complications were collected during hospital stay.

Results

24.27% (n=25) patients presented ≥ 3 B-lines, and 28% (n=29) patients presented pleural thickening. For 15 patients (21.7%) the pulmonary compliance was < 40 mL/cm H2O. Patients with pleural thickening had a higher incidence of pneumonia, acute respiratory syndrome distress, a need for vasoactive drugs and required more days of hospitalization during SARS-CoV-2 infection (p= 0.004, 0.001, 0.03, 0.00 respectively). Patients with ≥ 3 B-lines needed more days in an intensive care unit and vasoactive drugs during SARS-CoV2 infection (p= 0.04, 0.004 respectively). Postoperative pulmonary complications were observed in 5.8% (n=6) of the patients, and were more frequent in the presence of both, ≥ 3 B-lines and pleural thickening (p= 0.01).

Conclusions

In asymptomatic post-COVID-19 patients, pathological findings detected by lung ultrasound before surgery are associated with the severity of the SARS-CoV2 infection and resulted in more postoperative pulmonary complications. In these patients, the incidence of postoperative pulmonary complications appears similar to that described in the surgical population before the pandemic.

Trial registration

clinicaltrials.gov (NCT04922931). June 21, 2021. “Retrospectively registered”
Real-world experience of erenumab in patients with chronic or episodic migraine in the UAE
Authors: Alsaadi Taoufik , Noori Suzan , Varakian Razmig , Youssef Saly , Almadani AbuBaker
Published: June 2022

Background

Erenumab is a fully human monoclonal antibody and a highly potent, first-in-class calcitonin gene-related peptide receptor inhibitor approved for migraine prevention in adults. Randomised, placebo-controlled trials show that erenumab treatment results in clinically meaningful responses, including significant reductions in monthly migraine days. Real-world evidence of the effectiveness of erenumab in patients with migraine is accruing, but gaps remain, and findings may vary according to region. We evaluated the usage patterns and effectiveness of erenumab in real-world settings in patients with migraine in the United Arab Emirates (UAE).

Methods

This retrospective, observational real-world study enrolled patients ≥ 18 years with migraine who were prescribed erenumab in the UAE. Data were collected at baseline and Months 1, 3 and 6. The primary study objective was to characterise usage patterns of erenumab in patients with chronic migraine (CM) or episodic migraine (EM) in real-world settings in the UAE.

Results

Of the 166 patients, 124 (74.7%) were females. The mean (standard deviation) age at migraine onset was 29 (7.93) years. Seventy-one patients (42.8%) had CM and 95 (57.2%) had EM.

In the overall population, the mean monthly headache/migraine days (MHD) at baseline was 15.7 (8.45) and mean change from baseline was − 8.2 (8.83) at Month 1, − 11.0 (9.15) at Month 3 and − 11.3 (8.90) at Month 6. The mean change from baseline in monthly acute migraine-specific medication days (MSMD) was − 9.0 (8.07) at Month 1, − 9.7 (8.73) at Month 3 and − 10.7 (8.95) at Month 6. At all time points, most patients achieved at least 50% reduction in MHD (80%–91%) and MSMD (84%–94%).

Similar reductions in MHD and MSMD and clinical benefit in CM or EM were seen with erenumab monotherapy or erenumab add-on therapy, with or without dose escalation and for treatment naïve or ≥ 1 previous preventive treatment failures, with additional clinical benefit in the erenumab add-on therapy and dose escalation to 140 mg subgroups.

Conclusion

In this real-world study on erenumab use in the UAE, patients prescribed erenumab achieved clinically meaningful reductions in MHD and MSMD at all assessed time points. Erenumab was well tolerated with no new safety events.
Racial-ethnic disparities in potentially preventable complications after cesarean delivery in Maryland: an observational cohort study
Authors: Lankford Allison , Roland Laura , Jackson Christopher , Chow Jonathan , Keneally Ryan , Jackson Amanda , Douglas Rundell , Berger Jeffrey , Mazzeffi Michael
Published: June 2022

Background

Potentially preventable complications are monitored as part of the Maryland Hospital Acquired Conditions Program and are used to adjust hospital reimbursement. Few studies have evaluated racial-ethnic disparities in potentially preventable complications.

Our study objective was to explore whether racial-ethnic disparities in potentially preventable complications after Cesarean delivery exist in Maryland.

Methods

We performed a retrospective observational cohort study using data from the Maryland Health Services Cost Review Commission database. All patients having Cesarean delivery, who had race-ethnicity data between fiscal years 2016 and 2020 were included. Multivariable logistic regression modeling was performed to estimate risk-adjusted odds of having a potentially preventable complication in patients of different race-ethnicity.

Results

There were 101,608 patients who had Cesarean delivery in 33 hospitals during the study period and met study inclusion criteria. Among them, 1,772 patients (1.7%), experienced at least one potentially preventable complication. Patients who had a potentially preventable complication were older, had higher admission severity of illness, and had more government insurance. They also had more chronic hypertension and pre-eclampsia (both P<0.001). Median length of hospital stay was longer in patients who had a potentially preventable complications (4 days vs. 3 days, P<0.001) and median hospital charges were approximately $4,600 dollars higher, (P<0.001). The odds of having a potential preventable complication differed significantly by race-ethnicity group (P=0.05). Hispanic patients and Non-Hispanic Black patients had higher risk-adjusted odds of having a potentially preventable complication compared to Non-Hispanic White patients, OR=1.26 (95% CI=1.05 to 1.52) and OR=1.17 (95% CI=1.03 to 1.33) respectively.

Conclusions

In Maryland a small percentage of patients undergoing Cesarean delivery experienced a potentially preventable complication with Hispanic and Non-Hispanic Black patients disproportionately impacted. Continued efforts are needed to reduce potentially preventable complications and obstetric disparities in Maryland.
The study of direct and indirect effects of radiofrequency ablation on tumor microenvironment in liver tumor animal model
Authors: Jiang An-Na , Wang Bing , Wang Song , Zhao Kun , Wu Hao , Yan Kun , Wu Wei , Yang Wei
Published: June 2022

Background

Direct and indirect effects of radiofrequency ablation (RFA) on tumor microenvironment of the liver tumor have been noted, which was reported to be related to a variety of tyrosine protein kinase or cytokinetic pathway, but have not been thoroughly investigated and conclusive.

Purpose

To elucidate direct and indirect effects of RFA on tumor microenvironment in the liver tumor model, and to explore the role of the specific inhibitor in tumor growth by targeting the key pathway of RFA.

Materials and methods

One hundred and ten mice with H22 liver tumor were used in animal experiments. Eighty-four mice were randomized into three groups: control, direct RFA and indirect RFA (a block slide was inside the middle of the tumor). The growth rate of the residual tumor after RFA was calculated (n = 8 each group) and the pathologic changes at different time points (6 h, 24 h, 72 h and 7d after RFA) were evaluated (n = 5 in each subgroup). After semi-quantitative analysis of the pathological staining, the most significant marker after RFA was selected. Then, the specific inhibitor (PHA) was applied with RFA and the tumor growth and pathological changes were evaluated and compared with RFA alone. The Kruskal-Wallis test was used for evaluating the significance of different treatments in the pathological positive rate of specific markers in tumor. The two-way analysis of variance was used to determine the significance of treatment in tumor growth or body weight.

Results

The growth rate of the residual tumor in the direct RFA group was faster than the indirect RFA group (P = 0.026). The pathological analysis showed the expression of HSP70 (73 ± 13% vs 27 ± 9% at 24 h, P < 0.001), SMA (70 ± 18% vs 18 ± 7% at 6 h, P < 0.001) and Ki-67 (51 ± 11% vs 33 ± 14% at 7d, P < 0.001) in the direct RFA group was higher than those in the indirect RFA group after RFA. On the other hand, the expression of c-Met (38 ± 11% vs 28 ± 9% at 24 h, P = 0.01), IL-6 (41 ± 10% vs 25 ± 9% at 24 h, P < 0.001) and HIF-α (48 ± 10% vs 28 ± 8% at 24 h, P < 0.001) in the indirect RFA group was higher than those in the direct RFA group. And the expression of c-Met increased mostly in both direct and indirect RFA group compared to the baseline (53 and 65% at 72 h). Then the specific inhibitor of c-Met-PHA was applied with RFA. The growth rate of the tumor was significantly slower in the RFA + PHA group than the RFA alone group (1112.9 ± 465.6 mm3 vs 2162.7 ± 911.1 mm3 at day 16, P = 0.02).

Conclusion

Direct and indirect effects of RFA on tumor microenvironment changed at different time points and resulted in increased residual tumor growth in the animal model. It can be potentially neutralized with specific inhibitor of related pathways, such as tyrosine-protein kinase c-Met.
Lifestyle behaviors in Swedish university students before and during the first six months of the COVID-19 pandemic: a cohort study
Authors: Larsson Kristina , Onell Clara , Edlund Klara , Källberg Henrik , Holm Lena W. , Sundberg Tobias , Skillgate Eva
Published: June 2022

Background

Changes in Swedish university students’ lifestyle behaviors during the COVID-19 pandemic are unknown. This study aimed to assess physical activity, sitting time, meal frequency and risk substance use (alcohol, tobacco, and illicit use of drugs) in Swedish university students before and during the first six months of the COVID-19 pandemic, for all and stratified by age and sex.

Methods

Data were obtained from the Sustainable University Life cohort study in which web-based surveys were sent to university students repeatedly for one year. Baseline assessment (before the pandemic) was between August 2019-March 2020, follow-up 1 (FU1) between March-June 2020, and follow-up 2 (FU2) between June–September 2020. Participants reported weekly minutes of physical activity, daily sitting hours, meal frequency by weekly intake of different meals, and motivation for eating irregularly, if so. Also, harmful use of alcohol, tobacco and illicit drugs was assessed. Population means and differences with 95% confidence intervals (95% CI) in lifestyle behaviors between time points were calculated with Generalized Estimating Equations.

Results

1877 students (73% women, mean age 26.5 years) answered the baseline survey. Weekly exercise decreased by -5.7 min (95% CI: -10.0, -1.5) and -7.7 min (95% CI: -12.6, -2.8) between baseline and FU1 and FU2, respectively. Weekly daily activities increased by 5.6 min (95% CI: 0.3, 11.7) and 14.2 min (95% CI: 7.9, 20.5) between baseline and FU1 and FU2. Daily sitting time decreased by -1.4 h (95% CI: -1.7, -1.2) between baseline and FU2. Breakfast intake increased by 0.2 days per week (95% CI: 0.1, 0.3) between baseline and FU2. Lunch intake decreased by -0.2 days per week (95% CI: -0.2, -0.1) between baseline and FU1 and by -0.2 days per week (95% CI: -0.3, -0.0) between baseline and FU2. Dinner intake decreased by -0.1 days per week (95% CI: -0.2, -0.0) between baseline and both FU1 and FU2. Only minor differences in risk substance use were observed. Similar changes were observed in analyses stratified by age and sex.

Conclusions

Lifestyle behaviors in Swedish university students slightly improved during the first six months of the COVID-19 pandemic compared to before.

Trial registration

ClinicalTrials.gov, NCT04465435. 10/07/2020.
No inflammatory effects after acute inhalation of barium sulfate particles in human volunteers
Authors: Monsé Christian , Westphal Götz , Raulf Monika , Jettkant Birger , van Kampen Vera , Kendzia Benjamin , Schürmeyer Leonie , Seifert Christoph Edzard , Marek Eike-Maximilian , Wiegand Felicitas , Rosenkranz Nina , Wegener Christopher , Merget Rolf , Brüning Thomas , Bünger Jürgen
Published: June 2022

Background

Most threshold limit values are based on animal experiments. Often, the question remains whether these data reflect the situation in humans. As part of a series of investigations in our exposure lab, this study investigates whether the results on the inflammatory effects of particles that have been demonstrated in animal models can be confirmed in acute inhalation studies in humans. Such studies have not been conducted so far for barium sulfate particles (BaSO4), a substance with very low solubility and without known substance-specific toxicity. Previous inhalation studies with zinc oxide (ZnO), which has a substance-specific toxicity, have shown local and systemic inflammatory respones. The design of these human ZnO inhalation studies was adopted for BaSO4 to compare the effects of particles with known inflammatory activity and supposedly inert particles. For further comparison, in vitro investigations on inflammatory processes were carried out.

Methods

Sixteen healthy volunteers were exposed to filtered air and BaSO4 particles (4.0 mg/m3) for two hours including one hour of ergometric cycling at moderate workload. Effect parameters were clinical signs, body temperature, and inflammatory markers in blood and induced sputum. In addition, particle-induced in vitro-chemotaxis of BaSO4 was investigated with regard to mode of action and differences between in vivo and in vitro effects.

Results

No local or systemic clinical signs were observed after acute BaSO4 inhalation and, in contrast to our previous human exposure studies with ZnO, no elevated values of biomarkers of inflammation were measured after the challenge. The in vitro chemotaxis induced by BaSO4 particles was minimal and 15-fold lower compared to ZnO.

Conclusion

The results of this study indicate that BaSO4 as a representative of granular biopersistent particles without specific toxicity does not induce inflammatory effects in humans after acute inhalation. Moreover, the in vitro data fit in with these in vivo results. Despite the careful and complex investigations, limitations must be admitted because the number of local effect parameters were limited and chronic toxicity could not be studied.
A predictive model for optimal continuous positive airway pressure in the treatment of pure moderate to severe obstructive sleep apnea in China
Authors: Wang Le , Chen Xing , Wei Dong-hui , Liang Mao-li , Wang Yan , Chen Bao-yuan , Zhang Jing , Cao Jie
Published: June 2022

Background

Numerous predictive formulas based on different ethnics have been developed to determine continuous positive airway pressure (CPAP) for patients with obstructive sleep apnea (OSA) without laboratory-based manual titrations. However, few studies have focused on patients with OSA in China. Therefore, this study aimed to develop a predictive equation for determining the optimal value of CPAP for patients with OSA in China.

Methods

526 pure moderate to severe OSA patients with attended CPAP titrations during overnight polysomnogram were spited into either formula derivation (419 patients) or validation (107 patients) group according to the treatment time. Predictive model was created in the derivation group, and the accuracy of the model was tested in the validation group.

Results

Apnea hypopnea index (AHI), body mass index (BMI), longest apnea time (LAT), and minimum percutaneous oxygen saturation (minSpO2) were considered as independent predictors of optimal CPAP through correlation analysis and multiple stepwise regression analysis. The best equation to predict the optimal value of CPAP was: CPAPpred = 7.581 + 0.020*AHI + 0.101*BMI + 0.015*LAT-0.028*minSpO2 (R2 = 27.2%, p < 0.05).The correlation between predictive CPAP and laboratory-determined manual optimal CPAP was significant in the validation group (r = 0.706, p = 0.000). And the pressure determined by the predictive formula did not significantly differ from the manually titrated pressure in the validation cohort (10 ± 1 cmH2O vs. 11 ± 3 cmH2O, p = 0.766).

Conclusions

The predictive formula based on AHI, BMI, LAT, and minSpO2 is useful in calculating the effective CPAP for patients with pure moderate to severe OSA in China to some extent.
Outcome of teeth restored with CAD/CAM zirconium dioxide post-cores: a retrospective study with a follow-up period of 3–6 years
Authors: Ying Shunv , Chen Song , Wang Siyuan , Xu Lingli , Wang Xiaofeng , He Fuming , Liu Wei
Published: June 2022

Statement of problem

Computer aided design/computer aided manufacturing (CAD/CAM) zirconia post-cores is one of the options of post crown restoration materials due to their esthetic properties and superior mechanical strength. However, the clinical effect on aesthetics and strength properties is unclear due to the lack of results of their long-term follow-up.

Purpose

This retrospective clinical study aims to analyze the survival rate, clinical manifestations, and failure factors after CAD/CAM zirconia post-core restoration.

Material and methods

Clinical and radiographic examinations were performed on 342 patients with 400 teeth for 3–6 years postsurgical follow-up examination. The patients were all received CAD/CAM zirconia post-cores and all-ceramic crowns at the Department of Prosthodontics in the public hospital. The retrospective outcomes were conducted after zirconia post restoration, including survival rate by Kaplan–Meier analysis and findings of manifestations and failure factors. The effects of gender and dental position on survival rate were analyzed by Cox–Mantel Test.

Results

This study retrospectively evaluated 261 teeth from 229 patients with a 35% drop-out rate. The survival rate was 96.0%, and the success rate was 92.4%. According to the tooth position classification, the survival rate was 100% for 101 anterior teeth, 95.4% for 69 premolars, and 88.3% for 91 molars. According to gender, the survival rate of the male group was 92.3%, while that of the female group was 98.0%, with a significant difference (P < 0.01). The complications included crown fracture (1.9%) periapical inflammation (1.9%), crown debonding (1.1%), percussion abnormal (1.9%) and root fracture (0.8%).

Conclusions

Within the limitations of this retrospective study, it can be concluded that CAD/CAM zirconia post-cores are clinically promising. Compared with the posterior teeth, CAD/CAM zirconia post-cores are more suitable for anterior teeth.
A comparison of behavioural models explaining cervical cancer screening uptake
Authors: Dsouza Jyoshma Preema , Broucke Stephan Van den , Pattanshetty Sanjay , Dhoore William
Published: June 2022

Background

Cervical cancer represents a very high burden of disease, especially in Low- and Middle-income economies. Screening is a recommended prevention method in resource-poor settings. Cervical cancer screening (CCS) uptake is influenced by various psycho-social factors, most of which are included in behavioural models. Unlike demographic characteristics, these factors are modifiable. While few studies have compared these models in terms of their capacity to predict health behaviour, this study considers three health behaviour theories to assess and compare the predictors of CCS behaviour and intention.

Methods

A survey was conducted among 607 sexually active women in the South Indian state of Karnataka. Data was collected regarding socio-demographic factors, health literacy, knowledge on CCS, and the socio-cognitive factors related to CCS that are represented in the Health Belief Model (HBM), Theory of Planned Behaviour (TPB) and Theory of Care-Seeking Behaviour (TCSB). Logistic regression analyses tested to what extent each of the theoretical models explained cervical cancer screening (CCS) intention and regular screening behaviour, comparing the variance explained by each of the models.

Results

CCS intention was best explained by the TPB, followed by the HBM. Of the constructs included in these models, positive attitude towards the screening procedure and perceived benefits contributed most significantly to screening intention, followed by fear, anxiety or embarrassment related to the disease or screening procedure, and context specific barriers.

Conclusion

Health behavioural models such as the TPB and HBM can help to identify the main socio-cognitive factors explaining the intention of women to participate in CCS. As such, they can inform interventions to target specific determinants of screening intention and behaviour, and enhance their effectiveness by addressing women’s screening attitude, perceived benefits, and emotions as well as reducing context specific barriers to screening.
Predicting nursing students’ psychological well-being: network analysis based on a model of thriving through relationships
Authors: Zhou Lu , Sukpasjaroen Khunanan , Wu YuMing , Wang Lei , Chankoson Thitinan , Cai EnLi
Published: June 2022

Background

Psychological well-being plays a vital role in nursing students’ mental health and affects their decisions to stay in the nursing profession, particularly during the COVID-19 outbreak. Close relationships are undeniably linked to psychological well-being, but it is unknown how the specific pathways through which close relationships are related to each other and which are most strongly linked to nursing students’ psychological well-being.

Aims

To explore the network structure, central and bridge factors among well-being characteristics, and predictors based on a model of thriving through relationships.

Methods

A cross-sectional research design was used with a sample of undergraduate nursing students (531 participants from the Southwest part of China). We used a network model to analyze the network structure of perceived social support, mindfulness, self-integrity, self-compassion, professional self-concept, savoring, intentional self-regulation, non-relational self-expansion, relational self-expansion, attachment insecurity, and psychological well-being.

Results

 A highly interconnected network of psychological well-being featured predictors and traits were formed. Node 8 (self-kindness), node 9 (self-judgment), and node 23 (non-relational self-expansion) were the predictors with the highest centrality in the network. Perceived social support and professional self-concept were most central in linking predictors to psychological well-being traits. Attachment insecurity was a non-supportive factor for predicting psychological well-being among female nursing students.

Conclusions

Interventions based on these supportive/non-supportive predictors, which operate on different psychological levels, hold promise to achieve positive effects on psychological well-being among nursing students.