bluuebunny/crossref_metadata_2025 huggingface dataset:
Relationship, differences, and agreement between objective and subjective sleep measures in chronic spinal pain patients with comorbid insomnia: a cross-sectional study
Authors: Bilterys Thomas , Van Looveren Eveline , Malfliet Anneleen , Nijs Jo , Meeus Mira , Danneels Lieven , Ickmans Kelly , Cagnie Barbara , Goubert Dorien , Moens Maarten , De Baets Liesbet , Munneke Wouter , Mairesse Olivier
Published: April 2023

Sleep disturbances are one of the most frequent reported problems in people with nonspecific chronic spinal pain (nCSP) and presents an additional treatment challenge. Interventions targeting sleep problems are mainly based on subjective sleep complaints and do not take objective sleep into consideration. The aim of this cross-sectional study was to evaluate the relationship and conformity between self-reported and objectively measured sleep parameters (ie, questionnaire vs polysomnography and actigraphy). The baseline data of 123 people with nCSP and comorbid insomnia who are participating in a randomized controlled trial were analyzed. Pearson correlations were used to investigate the relationship between objective and subjective sleep parameters. Differences between objective and subjective sleep parameters were analyzed using t tests. Bland–Altman analyses were performed to quantify and visualize agreement between the different measurement methods. Except for the significant moderate correlation between perceived time in bed (TIB) and actigraphic TIB (r = 0.667, P < 0.001), all other associations between subjective and objective measures were rather weak (r < 0.400). Participants underestimated their total sleep time (TST) (mean difference [MD] = −52.37 [−67.94, −36.81], P < 0.001) and overestimated sleep onset latency (SOL) (MD = 13.76 [8.33, 19.20], P < 0.001) in general. The results of this study suggest a discrepancy (differences and lack of agreement) between subjective and objective sleep parameters in people with nCSP and comorbid insomnia. No or weak associations were found between self-reported sleep and objectively measured sleep. Findings suggest that people with nCSP and comorbid insomnia tend to underestimate TST and overestimate SOL. Future studies are necessary to confirm our results.
Lesbian shared IVF: the ROPA method: a systematic review
Authors: Brandão Pedro , Ceschin Nathan
Published: April 2023

The ROPA (Reception of Oocytes from PArtner) method, also known as lesbian shared IVF (in vitro fertilization), is an assisted reproduction technique for female couples, in which one of the women provides the oocytes (genetic mother) and the other receives the embryo and gestates (gestational mother). As a double parented method, it is the only way lesbian women may biologically share motherhood. This is a narrative review of data concerning ROPA published in PubMed, Scopus, and Cochrane Library. A total of 35 articles were included, 10 about motivations for undergoing ROPA, 13 about ethics or legislation, 4 about motherhood, and 8 studies reporting clinical outcomes. Despite being used for more than a decade, there is a paucity of data regarding this technique in scientific literature. Most women choose this technique to share biological motherhood, but medical issues may also justify its use. Many ethical and legal issues are still to be solved. Despite the small number of studies, data regarding the outcomes of this technique and the resulting motherhood are reassuring.
Epidemiology of Work-Related Traumatic Spinal Cord Injury
Authors: Bae Suk Won , Shin Hyung-Ik , Bang Moon Suk , Lee Min-Yong
Published: April 2023

Objective

We aimed to identify the incidence and burden of work-related traumatic spinal cord injury (wrTSCI) in Korea in the 10-year period from 2010 to 2019.

Methods

We used nationwide workers' compensation insurance data. The study population comprised industrially injured workers with TSCI diagnosis codes. The annual incidence of wrTSCI (number per million workers) was calculated.

Results

The mean annual incidence of wrTSCI was 22.8/1,000,000 (95% confidence interval, 20.5 to 25.0), and the mean total cost per claim was 231.40 million KRW. The incidence of TSCI in the cervical region was the highest (13.1/1,000,000; 95% confidence interval, 11.4 to 14.9), and most cases were in the construction industry (47.3%).

Conclusion

These findings can help identify specific at-risk groups and facilitate the development of prevention strategies.
Inflammatory score predicts early hematoma expansion and poor outcomes in patients with intracerebral hemorrhage
Authors: Chu Heling , Huang Chuyi , Zhou Zaiying , Tang Yuping , Dong Qiang , Guo Qihao
Published: April 2023

Background:

This study aimed to develop a prediction score named inflammatory score based on proper integration of several inflammatory markers and investigate whether it was associated with hematoma expansion and poor outcomes in patients with intracerebral hemorrhage (ICH).

Methods:

This study involved a consecutive series of spontaneous ICH patients of two cohorts admitted within 24 hours after symptom onset. Inflammatory score (0–9) was developed with the combination of neutrophil-to-lymphocyte ratio, platelet-to-lymphocyte ratio, monocyte-to-lymphocyte ratio, systemic immune-inflammation index, lactate dehydrogenase, and C-reactive protein. The authors investigated the association between inflammatory score and hematoma expansion and poor outcomes by using univariate and multivariate logistic regression analyses. The optimal cutoff point of inflammatory score was determined by receiver operating characteristic analysis in the development cohort and then validated.

Results:

A total of 301 and 154 ICH patients were enrolled in the development and validation cohorts. Inflammatory score was significantly higher in patients with hematoma expansion and poor outcomes. The multivariate logistic regression analysis revealed inflammatory score was independently associated with hematoma expansion, secondary neurological deterioration within 48 hours, 30-day mortality, and 3-month poor modified Rankin scale (4–6). The diagnostic accuracy of inflammatory score exhibited by area under the curve showed numerically or statistically higher than most of the individual indicators. Moreover, inflammatory score greater than or equal to 5 was selected as the optimal cutoff point, which was further prospectively validated with high diagnostic accuracy.

Conclusions:

The inflammatory score is a reliable predictor for early hematoma expansion and short-term and long-term poor outcomes with good diagnostic accuracies in ICH patients.
Management of leaks following one-anastomosis gastric bypass: an updated systematic review and meta-analysis of 44 318 patients
Authors: Kermansaravi Mohammad , Kassir Radwan , Valizadeh Rohollah , Parmar Chetan , Davarpanah Jazi Amir Hossein , Shahmiri Shahab Shahabi , Benois Marine
Published: April 2023

Introduction:

One-anastomosis gastric bypass (OAGB) complication, such as leakage, can be dangerous and should be managed properly, yet little data exist in the literature regarding the management of leaks after OAGB, and there are no guidelines to date.

Methods:

The authors performed a systematic review and meta-analysis of the literature and 46 studies, examining 44 318 patients were included.

Results:

There were 410 leaks reported in 44 318 patients of OAGB published in the literature, which represents a prevalence of 1% of leaks after OAGB. The surgical strategy was very variable among all the different studies; 62.1% of patients with leaks had to undergo another surgery due to the leak. The most commonly performed procedure was peritoneal washout and drainage (with or without T-tube placement) in 30.8% of patients, followed by conversion to Roux-en-Y gastric bypass in 9.6% of patients. Medical treatment with antibiotics, with or without total parenteral nutrition alone, was conducted in 13.6% of patients. Among the patients with the leak, the mortality rate related to the leak was 1.95%, and the mortality due to the leak in the population of OAGB was 0.02%.

Conclusion:

The management of leaks following OAGB requires a multidisciplinary approach. OAGB is a safe operation with a low leak risk rate, and the leaks can be managed successfully if detected in a timely fashion.
Racial and Ethnic Disparities Among Hearing Aid and Cochlear Implant Patients at a Tertiary-Level Academic Otology Practice
Authors: Casazza Julia A. , Mitton Tanner J. , Yancey Kristen L. , Whitson Johanna J. , Hunter Jacob B.
Published: April 2023

Objective

Utilization of hearing aids (HAs) and cochlear implants (CIs) is limited, with our group previously demonstrating that non-White patients pursue CI less than White patients. The aim of this study was to compare the demographic makeup of patients more recently evaluated for both interventions in our clinic, exploring the influence of insurance on pursuit of HA, and whether changes have occurred in CI uptake.

Study design

Retrospective chart review.

Setting

Tertiary-level academic otology clinic.

Methods

All patients (18 yr or older) evaluated for an HA or CI in 2019 were included. Demographic variables (including race, insurance, and socioeconomic status) were compared between patients who did and did not obtain an HA or CI.

Results

In 2019, 390 patients underwent an HA evaluation, and 195 patients received a CI evaluation. Relative to patients evaluated for CI, patients evaluated for HA were more likely to be White (71.3% versus 79.4%, p = 0.027). Examining factors that affected HA purchase, Black race (odds ratio, 0.32; 95% confidence interval, 0.12–0.85; p = 0.022), and lower socioeconomic status (odds ratio, 0.99; 95% confidence interval, 0.98–1.00; p = 0.039) were associated with decreased odds. Demographic variables and AzBio quiet scores were not associated with decision to pursue CI surgery.

Conclusions

White patients comprised a larger proportion of HA evaluations than CI evaluations. Furthermore, White patients and those of higher socioeconomic status were more likely to purchase HA. Improved outreach and expanded insurance benefits for HA are needed to ensure equal access to aural rehabilitation.
Analysis of the value of artificial intelligence combined with musculoskeletal ultrasound in the differential diagnosis of pain rehabilitation of scapulohumeral periarthritis
Authors: Yu Li , Li Yun , Wang Xiao-Fei , Zhang Zhao-Qing
Published: April 2023

To explore the value of artificial intelligence combined with musculoskeletal ultrasound in the differential diagnosis of pain rehabilitation of scapulohumeral periarthritis. A total of 165 patients with periarthritis of the shoulder, who were admitted to our hospital from January 2020 to January 2022, were selected. Konica SONIMAGE HS1 PLUS color Doppler ultrasound diagnostic instrument was used to detect muscles and bones of patients with scapulohumeral periarthritis. This study proposed an intelligent clustering analysis algorithm with musculoskeletal ultrasound parameters. The neural network was trained on a GeForce RTX 3060 with the Adam W optimizer, a batch size of 12, and an initial learning rate of 5E-4. Each batch of 2 types of trained samples was input into the network in a specific proportion. Pain was assessed on a 10-point visual analogue scale. On the affected side of scapulohumeral periarthritis, the mild pain group showed thickening of the shoulder posterior capsule (2.02 ± 0.72) mm with clear edges. In the moderate pain group, the thickness of the shoulder posterior capsule gradually narrowed (1.01 ± 0.38) mm and became even thinner than that of the unaffected side, with irregular and blurred edges. In the severe pain group, the thickness of the shoulder posterior capsule largely returned to normal (1.21 ± 0.42) mm, and the edge was clear. Multivariate logistic regression showed that in addition to musculoskeletal ultrasound parameters, the length of service, work nature, and the busy degree of work of patients with periarthritis of the shoulder were significant factors that influenced shoulder periarthritis pain (P < .05). The performance of the proposed intelligent auscultation algorithm was further examined in a clinical setting, in which we used 165 clinical musculoskeletal ultrasound samples (including 81 positive and 84 negative samples) as a test set. The accuracy, sensitivity, and specificity were 0.833, 0.872, and 0.801, respectively. Musculoskeletal ultrasound combined with artificial intelligence algorithm is a new diagnostic and staging tool for scapulohumeral periarthritis.
Primary pulmonary artery tumors easily misdiagnosed as pulmonary embolism: A review
Authors: Liu Xiuqing , Liu Xuhan , Li Ruirui , Zhang Weihua
Published: April 2023

Primary pulmonary artery tumors (PPATs), originating from the pulmonary artery intima, are rare tumors characterized by pulmonary artery luminal occlusion and pulmonary hypertension. Diagnosis of this rare entity is a challenging dilemma with the need for a high expertise in the radiological and pathological identification of PPATs. computed tomographic pulmonary angiography of PPATs may show filling defects, which are easily misdiagnosed. The radionuclide scan, along with other imaging examinations, can assist with the diagnosis, but the pathological diagnosis requires a puncture or surgical resection. Most primary pulmonary artery tumors are malignant, with poor prognosis and lack of specificity in clinical manifestations. However, there is no unified understanding and standard for diagnosis and treatment. In this review, we discuss the status, diagnosis, and treatment of primary pulmonary artery tumors, as well as how clinicians can better understand and treat the disease.
Comprehensive treatment of ear keloid: A case report
Authors: Wang Meng-Meng , Cai Xiang-Na , Ji Ying-Chang
Published: April 2023

Rationale:

Ear keloid is one of the more common forms of keloid, which may cause pain and itching, and is aesthetically unappealing. Recurrence is common with any monotherapy which prompted a comprehensive, multidimensional approach.

Patient concerns:

A 24-year-old female was evaluated in our department on April 6, 2021, due to an “8-year recurrence following a left ear keloid resection.” In July 2013, a left auricle keloid excision was performed in a local hospital. One year following the operation, the scar at the surgical site had proliferated, gradually spreading beyond the original scar borders. Patients worry about recurrence after surgery affecting the appearance of the ear.

Diagnosis:

Ear keloid.

Interventions:

The patient underwent a 2-stage re-resection of the keloid, followed by postoperative radiotherapy, and triamcinolone acetonide injection around the incision at the time of the second operation. Finally, silicone gel was applied for antiscar treatment.

Outcomes:

There has been no postoperative recurrence of ear keloid during the 12-month follow-up.

Lessons:

For ear keloids, combination therapy offers an improved approach with an excellent aesthetic appearance and less risk of recurrence than traditional monotherapy.
Case report: One human Streptococcus suis infection in Shandong Province, China
Authors: Liu Yuwei , Kou Zengqiang , Wang Xin , Chen Shuyu , Li Renpeng , Wang Qiang
Published: April 2023

Background:

Streptococcus suis is an emerging zoonotic pathogen. Human infections with S suis have been identified in Europe, North America, South America, Oceania, Africa and Asia. As the most common clinical symptom of human S suis, meningitis develops in 50% to 60% of infected patients, and approximately 60% of the patients with meningitis symptoms have neurologic sequelae. The cost of infection with S suis imposes a tremendous burden on patients’ families.

Case presentation:

A 56-year-old woman was infected with S suis. The patient reared pigs in her backyard. At admission, her blood examination showed a leukocyte count of 27.28 × 109/L with 94.20% neutrophils. Cerebrospinal fluid was cloudy with a leukocyte count of 2700 × 106/L. Cerebrospinal fluid cultures revealed gram-positive cocci identified as S suis type II. Ceftriaxone was then administered.

Conclusion:

Human infections with S suis highlights the need for health education, prevention and surveillance it.
Comparison Between Peripheral and Central Blood Cultures in Pediatric Oncology Patients With Blood Stream Infections
Authors: Asleh Mahdi , Khalaila Aya , Yousef Remah , Leibovitz Eugene , Danino Dana
Published: April 2023

Background:

Current guidelines for fever in children with cancer recommend obtaining blood cultures from all lumens of the central venous catheter (CVC) and to consider a concurrent peripheral blood culture. We assessed the characteristics of blood stream infections (BSI) in oncology children and compared central and peripheral pathogen growth.

Methods:

A prospective, computerized surveillance of BSI in children treated at the oncology unit between May 2014 and July 2020. The growth of the same organism within a month was considered a single episode, ≥2 organisms in the same culture were defined as different episodes. Only children with concomitant cultures, drawn at presentation before initiation of antibiotics were included in the comparison between CVC and peripheral cultures.

Results:

A total of 139 episodes in 81 children (with implanted Port-A-catheters) were considered true BSI. Of the 94/139 (67.6%) cases where a central and peripheral culture were concomitantly obtained, 52/94 (55.3%) had positive central/peripheral cultures that grew the same organism, 31/94 (33.0%) had positive central cultures only, and 11/94 (11.7%) had positive peripheral cultures only. In 3/94 cases, the organisms that grew from the CVC were not identical to those from the peripheral site. Four of 52 (7.7%) of the same positive central/peripheral pathogens had different susceptibility testing results. Higher CVC removal rates were observed when both peripheral and CVC cultures were positive (P=0.044).

Conclusions:

Overall, 11.7% of BSI episodes were identified only by peripheral culture and 7.7% of paired organisms did not share the same susceptibility test results which emphasizes the importance of a peripheral culture in managing fever in oncology children.
Effectiveness of Scalp Cooling to Prevent Chemotherapy-Induced Alopecia in Patients Undergoing Breast Cancer Treatment
Authors: Contreras Molina Miguel , Álvarez Bueno Celia , Cavero Redondo Iván , Lucerón Lucas-Torres María Isabel , Jiménez López Estela , García Maestro Ana
Published: April 2023

Background

Chemotherapy-induced alopecia could cause significant psychological changes, affecting patients’ quality of life and their capacity to cope with the disease.

Objectives

The aims of this study was to analyze the effectiveness of scalp cooling (SC) to prevent chemotherapy-induced alopecia in patients with breast cancer and to compare the use of automated versus nonautomated therapy delivery devices.

Methods

We searched the Cochrane Central Register of Controlled Trials, MEDLINE (through PubMed), Scopus, Web of Science, and ClinicalTrials.gov from their inception to October 2022. A meta-analysis was performed to assess the effects of SC to prevent chemotherapy-induced alopecia in patients with breast cancer using fixed-effects models to calculate the pooled relative risk (RR) and corresponding 95% confidence interval (CI).

Results

The 8 included studies showed a 43% reduction in the risk of chemotherapy-induced alopecia (RR, 0.57; 95% CI, 0.50–0.64) after the use of SC. Moreover, the use of automated SC devices showed a 47% reduction (RR, 0.53; 95% CI, 0.45–0.60) in the risk of chemotherapy-induced alopecia versus a 43% reduction in the risk of chemotherapy-induced alopecia for nonautomated SC devices (RR, 0.57; 95% CI, 0.44–0.70).

Conclusion

Our results showed that SC significantly reduced the risk of chemotherapy-induced alopecia.

Implications for Practice

Local cold application is a nonpharmacologic therapy that may provide a useful intervention to reduce hair loss and contribute to the psychological well-being of women. Scalp cooling contributes directly to reducing concern about altered body image and to reducing anxiety related to self-concept.
Effectiveness of Pictorial Education Handout on Tracheostomy Care Self-efficacy in Patients With Head and Neck Cancer and Family Caregivers
Authors: Wang Tongyao , Voss Joachim G. , Schiltz Nicolas , Rezaee Rod , Chhabra Nipun , Mazanec Susan R.
Published: April 2023

Background

Learning and performing tracheostomy care are challenging for laypersons. Effective pictorial patient education handouts are needed for nonprofessional individuals to learn health management skills.

Objectives

The study aims to (1) evaluate the preliminary efficacy of the pictorial education handout on patients’ and family members’ self-efficacy in tracheostomy care and (2) identify demographic, psychological, and education-related factors associated with lower self-efficacy on tracheostomy care.

Interventions/Methods

This was a preliminary pilot study with a pretest-posttest design. We recruited a total of 39 participants, including 22 patients with head and neck cancer–related tracheostomy and 17 family caregivers in 2021. All participants received A3-size (297 × 420 mm) pictorial patient education handouts on how to suction and how to clean their tracheostomy at home.

Results

Pictorial education handouts showed a medium to large effect size on self-efficacy in the patient (Cohen D = 0.46) and caregiver participants (Cohen D = 0.78). Participants with higher anxiety were associated with a greater gain in self-efficacy with the pictorial patient education handouts (r = 0.35, P = .027).

Conclusions

Pictorial patient education handouts were effective tools for improving patients’ and family caregivers’ confidence in tracheostomy care, and it is particularly helpful for individuals with high anxiety with tracheostomy.

Implication for Practice

Clinical nurses should use the pictorial education handouts not only to assist patients and family members on learning and practicing tracheostomy care but also to relieve anxiety associated with tracheostomy care at home.
Pre- and Post-Hemodialysis Cerebral Blood Flow Velocity in Patients With End-Stage Renal Disease
Authors: Batur Caglayan Hale , Erten Yasemin , Akyol Gurses Asli , Irkec Ceyla , Nazliel Bijen
Published: April 2023

Background:

This study assessed the consequences of hemodialysis (HD) on hemodynamic parameters of cerebral circulation by measuring middle cerebral artery blood flow velocities using transcranial Doppler ultrasound before and after a single dialysis session in patients with end-stage renal disease (ESRD).

Materials and Methods:

Fifty clinically stable patients with ESRD undergoing HD and 40 healthy controls were recruited for the study. Blood pressure, heart rate, and body weight were measured. Transcranial Doppler ultrasound evaluations and blood analyses were performed immediately before and after a single dialysis session.

Results:

The mean cerebral blood flow velocities (CBFVs) in the ESRD patients before HD was 65 ± 17 cm/second and did not differ from that of the normal controls (64 ± 14 cm/s) (P = 0.735). The postdialysis CBFV also did not differ from that of the controls (P = 0.054).

Conclusion:

Compensatory cerebral autoregulation and chronic adjustment to therapy may be the reason for the nondeviation of the CBFV values from normality observed in both sessions.
Extrauterine Mesonephric-like Carcinoma
Authors: Euscher Elizabeth D. , Marques-Piubelli Mario L. , Ramalingam Preetha , Wistuba Ignacio , Lawson Barrett C. , Frumovitz Michael , Malpica Anais
Published: April 2023

Extrauterine mesonephric-like carcinoma (ExUMLC) shares histologic, immunohistochemical (IHC), and molecular (MOL) features with endometrial mesonephric-like carcinoma (EnMLC). Its rarity and histologic overlap with Mullerian carcinomas contribute to underrecognition of ExUMLC. Aggressive behavior of EnMLC is well-documented; behavior of ExUMLC is yet to be characterized. This study presents the clinicopathologic, IHC, and MOL features of 33 ExUMLC identified over a 20-year time period (2002-2022) and compares the behavior of this cohort to more common upper gynecologic Mullerian carcinomas (low-grade endometrioid, LGEC; clear cell, CCC; high-grade serous, HGSC) and EnMLC diagnosed over the same time period. ExUMLC patients ranged from 37 to 74 years old (median=59 y); 13 presented with advanced stage (FIGO III/IV) disease. Most ExUMLC had the characteristic mixture of architectural patterns and cytologic features, as previously described. Two ExUMLC had sarcomatous differentiation, 1 with heterologous rhabdomyosarcoma. Twenty-one ExUMLC (63%) had associated endometriosis, and 7 (21%) arose in a borderline tumor. In 14 (42%) cases, ExUMLC was part of a mixed carcinoma representing >50% of the tumor in 12. Twenty-six cases (79%) were incorrectly classified as follows: LGEC or HGEC (12); adenocarcinoma, not otherwise specified (3); HGSC (3); LGSC (2); mixed carcinoma (1); carcinosarcoma, Mullerian type (2); seromucinous carcinoma (1); transitional pattern of HGSC (1); and female adnexal tumor of probable Wolffian origin (1). Three patients had occult synchronous endometrial LGEC. IHC facilitated diagnosis in all cases with an expression of GATA-3 and/or TTF-1 in conjunction with decreased hormone receptor expression in most tumors. MOL testing (n=20) identified a variety of mutations, most frequently:KRAS(15);TP53(4);SPOP(4); andPIK3CA(4). ExUMLC and CCC were more likely to be associated with endometriosis (P<0.0001). ExUMLC and HGSC had more recurrences compared with CCC and LGEC (P<0.0001). Histologic subtype was associated with longer disease-free survival for LGEC and CCC versus HGSC and ExUMLC (P<0.001). ExUMLC trended towards a similar poor overall survival as HGSC compared with LGEC and CCC, and EnMLC trended to shorter survival compared with ExUMLC. Neither finding reached significance. No differences were seen between EnMLC and ExUMLC with respect to presenting stage or recurrence. Staging, histotype, and endometriosis were associated with disease-free survival, but on multivariate analysis, only stage remained as an independent predictor of outcome. The tendency of ExUMLC to present at an advanced stage and have distant recurrence points to more aggressive behavior compared with LGEC with which it is most frequently confused, underscoring the importance of an accurate diagnosis.
The effects of exercise interventions on physical performance and activities of daily living in oldest-old and frail older adults: a review of the literature
Authors: Lau Lay Khoon , Tou Nien Xiang , Abdul Jabbar Khalid , Tang Jia Ying , Gao Jonathan , Ding Yew Yoong , Ng Yee Sien
Published: April 2023

This review examined and compared the effects of exercise interventions using portable exercise equipment on muscle strength, balance, and ability to perform activities of daily living (ADL) in the oldest-old and frail. We also examined the differences in the intervention characteristics between these two groups. The CINAHL, MEDLINE and COCHRANE databases were searched using specific text words and MeSH for randomised controlled trials published from 2000 to 2021, which involved exercise interventions for either oldest-old (≥75 years old) or physically frail (reduced muscular strength, endurance and physiological function) older adults. A total of 76 articles were included in this review, in which 61 studies involved oldest-old adults and 15 studies examined frail adults. Subgroup reviews of community dwelling and institutionalized adults were performed. The empirical evidence suggests that single-component and multicomponent exercise interventions, produced positive effects for both older adult groups on muscle strength and balance, respectively. The effects of multicomponent interventions on muscular strength could be dependent on the number of exercise components per session. The effects of exercises on ADL enhancement were less clear. We advocate for single intervention resistance training in all oldest-old and frail seniors to improve strength, if compliance to exercise duration is an issue.
Clinical and Electrophysiological Characteristics of Very Early Guillain–Barré Syndrome
Authors: Kumar Mritunjai , Dhar Nikita , Tiwari Ashutosh , Singh Jagbir , Jatale Vinayak
Published: April 2023

Purpose:

This study compared the clinical and electrodiagnostic (EDX) features and long-term outcomes of patients with very early Guillain–Barré syndrome (VEGBS, duration of illness ≤4 days) and those with early/late (>4 days)-presenting GBS.

Methods:

One hundred patients with GBS were clinically evaluated and categorized into VEGBS and early/late GBS groups. Electrodiagnostic studies were performed on the bilateral median, ulnar, and fibular motor nerves and the bilateral median, ulnar, and sural sensory nerves. Admission and peak disability were assessed using the 0 to 6 Guillain–Barré Syndrome Disability Scale (GBSDS). The primary outcome was disability at 6 months, which was categorized as complete (GBSDS ≤1) or poor (GBSDS ≥2). The secondary outcomes were frequencies of abnormal electrodiagnostic findings, in-hospital progression, and mechanical ventilation (MV).

Results:

Patients with VEGBS had higher peak disability (median 5 vs. 4; P = 0.02), frequent in-hospital disease progression (42.9% vs. 19.0%, P < 0.01), needed MV (50% vs. 22.4%; P < 0.01), and less frequent albuminocytologic dissociation (52.4% vs. 74.1%; P = 0.02) than those with early/late GBS. Thirteen patients were lost to follow-up at 6 months (nine patients with VEGBS and four patients with early/late GBS). The proportion of patients with complete recovery at 6 months was comparable (60.6% vs. 77.8%; P = ns). Reduced d-CMAP was the most common abnormality, noted in 64.7% and 71.6% of patients with VEGBS and early/late GBS, respectively (P = ns). Prolonged distal motor latency (≥130%) was more common in early/late GBS than in VEGBS (36.2% vs. 25.4%; P = 0.02), whereas absent F-waves were more frequent in VEGBS (37.7% vs. 28.7%; P = 0.03).

Conclusions:

Patients with VEGBS were more disabled at admission than those with early/late GBS. However, 6 month's outcomes were similar between the groups. F-wave abnormalities were frequent in VEGBS, and distal motor latency prolongation was common in early/late GBS.
Changes in Inpatient Electroconvulsive Therapy Utilization Between 2019 and 2020
Authors: Luccarelli James , Henry Michael E. , Smith Felicia , Beach Scott R. , McCoy Thomas H.
Published: April 2023

Objectives

Electroconvulsive therapy (ECT) is an essential procedure for a range of psychiatric conditions. Multiple single-center studies have documented reduction in ECT administration in 2020 because of the coronavirus disease 2019 pandemic, but there have been little nationally representative data from the United States. The aim of this study was to examine the demographics of patients receiving ECT in 2019 and 2020 and to characterize temporal and regional variations in ECT utilization.

Methods

The 2019 and 2020 National Inpatient Sample, an administrative database of inpatient hospitalizations in the United States, was queried for hospitalizations involving the delivery of ECT based on procedural codes. Overall number of ECT procedures was calculated based on the overall number of ECT procedural claims.

Results

In the 2019 NIS, 14,230 inpatient hospitalizations (95% confidence interval, 12,936–15,524) involved the use of ECT, with a cumulative 52,450 inpatient ECT procedures administered. In 2020, the number of inpatient hospitalizations with ECT decreased to 12,055 (95% confidence interval, 10,878–13,232), with a 10.0% reduction in overall procedures to 47,180. Whereas January and February ECT hospitalizations were comparable in both years, ECT hospitalizations decreased by more than 25% in March through May 2020 relative to 2019 volume. There was regional variability in the change in ECT utilization between 2019 and 2020.

Conclusions

Electroconvulsive therapy use among general hospital inpatients declined between 2019 and 2020, with regional variability in the magnitude of change. Further study is warranted into the root causes and optimal responses to these changes.
ApoA-I Protects Pancreatic β-cells from Cholesterol-induced Mitochondrial Damage and Restores their Ability to Secrete Insulin
Authors: Manandhar Bikash , Pandzic Elvis , Deshpande Nandan , Chen Sing-Young , Wasinger Valerie , Kockx Maaike , Glaros Elias , Ong Kwok Leung , Thomas Shane R. , Wilkins Marc R. , Whan Renee M. , Cochran Blake J. , Rye Kerry-Anne
Published: April 2023

Objective:High cholesterol levels in pancreatic β-cells cause oxidative stress and decrease insulin secretion. β-cells can internalize apolipoprotein (apo) A-I, which increases insulin secretion. This study asks whether internalization of apoA-I improves β-cell insulin secretion by reducing oxidative stress.

Approach:Ins-1E cells were cholesterol-loaded by incubation with cholesterol-methyl-β-cyclodextrin. Insulin secretion in the presence of 2.8 or 25 mM glucose was quantified by radioimmunoassay. Internalization of fluorescently labelled apoA-I by β-cells was monitored by flow cytometry. The effects of apoA-I internalization on β-cell gene expression was evaluated by RNA sequencing. ApoA-I binding partners on the β-cell surface were identified by mass spectrometry. Mitochondrial oxidative stress was quantified in β-cells and isolated islets with MitoSOX and confocal microscopy.

Results:An F1-ATPase β-subunit on the β-cell surface was identified as the main apoA-I binding partner. β-cell internalization of apoA-I was time-, concentration-, temperature-, cholesterol- and F1-ATPase β-subunit-dependent. β-cells with internalized apoA-I (apoA-I+cells) had higher cholesterol and cell surface F1-ATPase β-subunit levels than β-cells without internalized apoA-I (apoA-I−cells). The internalized apoA-I co-localized with mitochondria and was associated with reduced oxidative stress and increased insulin secretion. The ATPase inhibitory factor 1, IF1, attenuated apoA-I internalization and increased oxidative stress in Ins-1E β-cells and isolated mouse islets. Differentially expressed genes in apoA-I+and apoA-I−Ins-1E cells were related to protein synthesis, the unfolded protein response, insulin secretion and mitochondrial function.

Conclusions:These results establish that β-cells are functionally heterogeneous and apoA-I restores insulin secretion in β-cells with elevated cholesterol levels by improving mitochondrial redox balance.
Use of genetic correlations to examine selection bias
Authors: Shapland Chin Yang , Gkatzionis Apostolos , Hemani Gibran , Tilling Kate
Published: April 2023

Observational studies are rarely representative of their target population, because there are known and unknown factors that affect an individual’s choice to participate (known as the selection mechanism). Selection can cause bias in a given analysis, if the outcome is related to selection (conditional on the other variables in the model). However, the selection mechanism usually cannot be detected from the observed data if we have no data on the non-selected sample - for example, when the selected sample is participants in a research study. Here, we develop methods to examine the selection mechanism by comparing correlations among variables in the selected sample to those expected under no selection. We examine the use of four hypothesis tests to identify induced associations between genetic variants in the selected sample. We evaluate these approaches with Monte Carlo simulations. Finally, these approaches are demonstrated with an applied example, using data from UK Biobank (UKBB), with alcohol intake as exposure to test the presence of selection bias. The proposed tests have identified selection due to alcohol intake into UKBB, and the subsample of individuals with weekly alcohol intake. Analyses in UKBB with alcohol consumption as exposure or outcome may be biased by this selection.
Incidence and Pattern of Childhood Cancer in Addis Ababa, Ethiopia (2012 - 2017)
Authors: Belay Amanuel , Ali Ahmed , Ayele Wondimu , Assefa Mathewos , Jemal Ahmedin , Kantelhardt Eva J.
Published: April 2023

Background

Cancer is becoming a major public health problem and a leading cause of death in children worldwide. However, little is known about the epidemiology of childhood cancer in Ethiopia. This study, therefore, assessed childhood cancer incidence patterns in Addis Ababa using the Addis Ababa city population-based cancer registry data from 2012-2017.

Methods

Invasive cancer cases diagnosed in ages 0-14 years from 2012-2017 were obtained from the Addis Ababa City population-based Cancer Registry. Cases were grouped according to the International Classification of Childhood Cancer, 3rd edition (ICCC-3) based on morphology and primary anatomic site. Age-standardized incidence rates (ASR) were calculated by the direct method using the world standard population.

Results

The overall average annual incidence rate during 2012-2017 in children was 84.6 cases per million, with rates higher in boys (98.97 per million) than in girls (69.7 per million). By age, incidence rates per million increased from 70.8 cases in ages 0-4 years to 88.4 cases in ages 5-9 years to 110.0 cases 10-14 years. Leukemia was the most common childhood cancer in both boys (29.1%) and girls (26.8%), followed by lymphoma in boys (24.7%) and renal tumours (13.1%) in girls. The overall cancer incidence rate decreased from 87.02 per million in 2012 to 51.07 per million in 2017.

Conclusion

The burden of childhood cancer is considerably high in Addis Ababa, and its profile is generally similar to those from other parts of sub-Saharan Africa except that renal tumour is the 2ndmost commonly diagnosed cancer in girls in Addis Ababa. Future studies should examine risk factors for the occurrence of childhood cancer in Addis Ababa and other parts of Ethiopia.
EFFICACY AND SAFETY OF NICORANDIL IN ACUTE CORONARY SYNDROME: A META-ANALYSIS
Authors: Dani Avichal , Raithatha Shubh , Desai Dev
Published: April 2023

Background

Nicorandil acts as a potassium channel opener, however its cardio protective benefit is still uncertain. This meta-analysis was conducted with the objective of evaluating the efficacy of nicorandil in improving cardiovascular outcomes in acute coronary syndrome.

Main Body

A total of 24 RCTs with 1640 patients in the nicorandil group and 1592 patients in the control group were identified following PRISMA guidelines till November 2019 and were matched for inclusion and exclusion criteria. The following search strings and MESH terms were used: “nicorandil”, “ACS”, “MACE”. Following this, nicorandil was evaluated for its efficacy and safety outcomes. RevMan 5.3 was used for appropriate statistical tests. Fixed and Random Effect Model Test were used and p<0.05 was considered statistically significant.

Results

Administration of nicorandil was found to be associated with a significant decrease in MACE (RR = 0.686, 95% CI = 0.509-0.925, p=0.013), no-reflow phenomenon (RR =0.395, 95% CI = 0.266-0.588, p<0.001) and worsening of HF (RR =0.441, 95% CI = 0.221-0.882, p=0.021). It was also associated with significant improvement in LVEF (SMD= 0.637, 95% CI= 0.0972 to 1.177, p=0.021) and significant lowering of cTFC (SMD= -0.216, 95% CI= -0.428 to -0.0041, p=0.046)

Conclusions

Nicorandil does indeed exert a cardio protective effect by improving cardiovascular outcomes. There is a significant decrease in occurrences of MACE and worsening of HF. There is also significant improvement in LVEF.
Direct and indirect impact of the COVID-19 pandemic on the survival of kidney transplant recipients: a national observational study in France
Authors: Leye Elhadji , Delory Tristan , Karoui Khalil El , Espagnacq Maude , Khlat Myriam , Coeur Sophie Le , Lapidus Nathanaël , Hejblum Gilles
Published: April 2023

Background

During the pandemic period, healthcare systems were substantially reorganized for managing COVID-19 cases. The corresponding changes on the standard care of persons with chronic diseases and the potential consequences on their outcomes remain insufficiently documented. This observational study investigates the direct and indirect impact of the pandemic period on the survival of kidney transplant recipients (KTR), in particular in those not hospitalized for COVID-19.

Methods

We conducted a cohort study using the French national health data system which contains all healthcare consumptions in France. Incident persons with end stage kidney disease between January 1, 2015 and December 31, 2020 who received a kidney transplant were included and followed-up from their transplantation date to December 31, 2021. The survival of KTR during the pre-pandemic and pandemic periods was investigated using Cox models with time-dependent covariates, including vaccination and hospitalization events.

Findings

There were 10,637 KTR included in the study, with 324 and 430 deaths observed during the pre-pandemic (15,115 person-years of follow-up) and pandemic periods (14,657 person-years of follow-up), including 127 deaths observed among the 659 persons with a COVID-19-related hospitalization. In multivariable analyses, the risk of death during the pandemic period was similar to that observed during the pre-pandemic period (hazard ratio (HR) [95% confidence interval]: 0 ·92 [0·77–1·11]), while COVID-19-related hospitalization was associated with an increased risk of death (HR: 10 ·62 [8·46–13·33]). In addition, pre-emptive kidney transplantation was associated with a lower risk of death (HR: 0·71 [0·56–0·89]), as well as a third vaccine dose (HR: 0·42 [0·30– 0·57]), while age, diabetes and cardiovascular diseases were associated with higher risks of death.

Interpretation

Considering persons living with a kidney transplant with no severe COVID-19-related hospitalization, the pandemic period was not associated with a higher risk of death.

Funding

Initiative Économie de la Santé de Sorbonne Université (Idex Sorbonne Université, programmes Investissements d’Avenir); Ministère de la Solidarité et de la Santé (PREPS 20-0163).
Identification of probable child maltreatment using prospectively recorded information between 5 months and 17 years in a longitudinal cohort of Canadian children
Authors: Scardera Sara , Langevin Rachel , Collin-Vezina Delphine , Comtois Cabana Maude , Pinto Pereira Snehal M , Côté Sylvana , Ouellet-Morin Isabelle , Geoffroy Marie-Claude
Published: April 2023

Background

Both prospective and retrospective measures of child maltreatment predict mental health problems, despite their weak concordance. Research remains largely based on retrospective reports spanning the entire childhood due to a scarcity of prospectively completed questionnaires targeting maltreatment specifically.

Objective

We developed a prospective index of child maltreatment in the Québec Longitudinal Study of Child Development (QLSCD) using prospective information collected from ages 5 months to 17 years and examined its concordance with retrospective maltreatment.

Participants and Setting

The QLSCD is an ongoing population-based cohort that includes 2,120 participants born from 1997-1998 in the Canadian Province of Quebec.

Methods

As the QLSCD did not have maltreatment as a focal variable, we screened 29,600 items completed by multiple informants (mothers, children, teachers, home observations) across 14 measurement points (0-17 years). Items that could reflect maltreatment were first extracted. Two maltreatment experts reviewed these items for inclusion and determined cut-offs for possible child maltreatment. Retrospective maltreatment was self-reported at 23 years.

Results

Indicators were derived across preschool, school-age and adolescence periods and by the end of childhood and adolescence, including presence (yes/no), chronicity (re-occurrence), extent of exposure and cumulative maltreatment. Across all developmental periods, the presence of maltreatment was as follows: physical abuse (16.3-21.8%), psychological abuse (3.3-21.9%), emotional neglect (20.4-21.6%), physical neglect (15.0-22.3%), supervisory neglect (25.8-44.9%), family violence (4.1-11.2%) and sexual abuse (9.5% in adolescence only).

Conclusions

In addition to the many future research opportunities offered by these prospective indicators of maltreatment, this study offers a roadmap to researchers wishing to undertake a similar task.

Highlights

In this longitudinal cohort, maltreatment experts retained 251 of 29,600 items available

Probable maltreatment indicators were derived: presence, chronicity, extent of exposure, and cumulative maltreatment

Prevalence rates vary from 3.3% and 44.9% across developmental periods, and 16.5-67.3% by the end of adolescence

Prospective and retrospective maltreatment identify different groups of individuals

As most studies use retrospective data, findings suggest that the representation of child maltreatment is incomplete and retrospective reports should be complimented by prospective data, whenever possible
Deep Learning Using High-Resolution Images of Forearm Predicts Fracture
Authors: Chapurlat Roland , Ferrari Serge , Li Xiaoxu , Peng Yu , Xu Min , Bui Min , Sornay-Rendu Elisabeth , lespessailles Eric , Biver Emmanuel , Seeman Ego
Published: April 2023

Importance

Fragility fractures are a public health problem. Over 70% of women having fractures have osteopenia or normal BMD, but they remain unidentified and untreated because the definition of ‘osteoporosis’, a bone mineral density (BMD) T-Score ≤ -2.5SD, is often used to signal bone fragility.

Objective

As deep learning facilitates investigation of bone’s multi-level hierarchical structure and soft tissue, we tested whether this approach might better identify women at risk of fracture before fracture.

Design

We pooled data from three French and Swiss prospective population-based cohorts (OFELY, QUALYOR, GERICO) that collected clinical risk factors for fracture, areal BMD and distal radius measurements with high resolution peripheral quantitative tomography (HRpQCT). Using only three-dimensional images of the distal radius, ulna and soft tissue acquired by HRpQCT, an algorithm, a Structural Fragility Score-Artificial Intelligence (SFS-AI), was trained to distinguish 277 women having fractures from 1401 remaining fracture-free during 5 years and then was tested in a validation cohort of 422 women.

Setting

European postmenopausal women

Participants

We have studied postmenopausal women considered as representative of the general population, who were followed for a median 9.4 years in OFELY, 5.4 years in QUALYOR and 5.7 years in GERICO.

Main outcome and measure

All types of incident fragility fractures

Results

We used data from 2666 postmenopausal women, with age range of 42-94. In women ≥ 65 years having ‘All Fragility Fractures’ or ‘Major Fragility Fractures’, SFS-AI generated an AUC of 66-70%, sensitivities of 60-68% and specificity of 71%. Sensitivities were greater than achieved by the fracture risk assessment (FRAX) with BMD or BMD (6.7-26.7%) with lower specificities than these diagnostics (∼95%).

Conclusion and relevance

The SFS-AI is a holistic surrogate of fracture risk that pre-emptively identifies most women needing prompt treatment to avert a first fracture.

Key Points

Question

Can a deep learning model (DL)° based on high resolution images of the distal forearm predict fragility fractures?

Findings

In the setting of 3 pooled population-based cohorts, the DL model predicted fractures substantially better than areal bone mineral density and FRAX, especially in women ≥65 years.

Meaning

Our DL model may become an easy to use way to identify postmenopausal women at risk for fracture to improve fracture prevention.