bluuebunny/crossref_metadata_2025 huggingface dataset:
Complete-genome sequencing and comparative genomic characterization of blaNDM-5 carrying Citrobacter freundii isolates from a patient with multiple infections
Authors: Ye Jianzhong , Jin Lulu , Li Yaling , Xu Hao , Lin Yishuai , Zhou Tieli , Zheng Beiwen , Wang Maofeng , Wang Zhongyong
Published: August 2023

Background

The emergence and wide spread of carbapenemase-producing Enterobacteriaceae (CPE) poses a growing threat to global public health. However, clinically derived carbapenemase-producing Citrobacter causing multiple infections has rarely been investigated. Here we first report the isolation and comparative genomics of two blaNDM-5 carrying Citrobacter freundii (C. freundii) isolates from a patient with bloodstream and urinary tract infections.

Results

Antimicrobial susceptibility testing showed that both blaNDM-5 carrying C. freundii isolates were multidrug-resistant. Positive modified carbapenem inactivation method (mCIM) and EDTA-carbapenem inactivation method (eCIM) results suggested metallo-carbapenemase production. PCR and sequencing confirmed that both metallo-carbapenemase producers were blaNDM-5 positive. Genotyping and comparative genomics analyses revealed that both isolates exhibited a high level of genetic similarity. Plasmid analysis confirmed that the blaNDM-5 resistance gene is located on IncX3 plasmid with a length of 46,161 bp, and could successfully be transferred to the recipient Escherichia coli EC600 strain. A conserved structure sequence (ISAba125-IS5-blaNDM-5-trpF-IS26-umuD-ISKox3) was found in the upstream and downstream of the blaNDM-5 gene.

Conclusions

The data presented in this study showed that the conjugative blaNDM-5 plasmid possesses a certain ability to horizontal transfer. The dissemination of NDM-5-producing C. freundii isolates should be of close concern in future clinical surveillance. To our knowledge, this is the first study to characterize C. freundii strains carrying the blaNDM-5 gene from one single patient with multiple infections.
Opioid prescribing for acute postoperative pain: an overview of systematic reviews related to two consensus statements relevant at patient, prescriber, system and public health levels
Authors: McCorquodale C. L. , Greening R. , Tulloch R. , Forget P.
Published: August 2023

Background

National guidelines for rational opioid prescribing for acute postoperative pain are needed to optimise postoperative pain control and function whilst minimising opioid-related harm.

Objectives

This overview of systematic reviews aims to summarise and critically assess the quality of systematic reviews related to the 20 recommendations from two previously published consensus guideline papers (ten relevant at patient and prescriber levels and ten at a system / Public Health level). It also aims to identify gaps in research that require further efforts to fill these in order to augment the evidence behind creating national guidelines for rational opioid prescribing for acute postoperative pain.

Methods

A systematic database search using PubMed/MEDLINE and Cochrane was conducted in November 2022. Furthermore, reference lists were reviewed. All identified systematic reviews were assessed for eligibility. Data from each study was extracted using a pre-standardised data extraction form. The methodological quality of the included reviews was assessed by two independent reviewers using the AMSTAR 2 checklist. Descriptive synthesis of the results was performed.

Results

A total of 12 papers were eligible for analysis. Only eight out of the total 20 prioritised recommendations had systematic reviews that provided evidence related to them. These systematic reviews were most commonly of critically low quality.

Conclusion

The consensus papers provide guidance and recommendations based on the consensus of expert opinion that is based on the best available evidence. However, there is a lack of evidence supporting many of these consensus statements. Efforts to further analyse interventions that aim to reduce the rates of opioid prescribing and their adverse effects should therefore continue.
Primary care services in the English NHS: are they a thorn in the side of integrated care systems? A qualitative analysis
Authors: Mitchell Claire , Higgerson James , Tazzyman Abigail , Whittaker Will
Published: August 2023

Background

As integrated care systems are embedded across England there are regions where the integration process has been evaluated and continues to evolve. Evaluation of these integrated systems contributes to our understanding of the challenges and facilitators to this ongoing process. This can support integrated care systems nationwide as they continue to develop. We describe how two integrated care partnerships in different localities, at differing stages of integration with contrasting approaches experienced challenges specifically when integrating with primary care services. The aim of this analysis was to focus on primary care services and how their existing structures impacted on the development of integrated care systems.

Methods

We carried out an exploratory approach to re-analysing our previously conducted 51 interviews as part of our prior evaluations of integrated health and care services which included primary care services. The interview data were thematically analysed, focussing on the role and engagement of primary care services with the integrated care systems in these two localities.

Results

Four key themes from the data are discussed: (i) Workforce engagement (engagement with integration), (ii) Organisational communication (information sharing), (iii) Financial issues, (iv) Managerial information systems (data sharing, IT systems and quality improvement data). We report on the challenges of ensuring the workforce feel engaged and informed. Communication is a factor in workforce relationships and trust which impacts on the success of integrated working. Financial issues highlight the conflict between budget decisions made by the integrated care systems when primary care services are set up as individual businesses. The incompatibility of information technology systems hinders integration of care systems with primary care.

Conclusions

Integrated care systems are national policy. Their alignment with primary care services, long considered to be the cornerstone of the NHS, is more crucial than ever. The two localities we evaluated as integration developed both described different challenges and facilitators between primary care and integrated care systems. Differences between the two localities allow us to explore where progress has been made and why.
Gastrıc cancer surgery in elderly patients: promising results from a mid-western population
Authors: Yazici Hilmi , Esmer Ahmet Cem , Eren Kayaci Ayse , Yegen Sevket Cumhur
Published: August 2023

Backgrounds

Extended resection for gastric cancer in elderly patients is still challenging for surgeons. This study aimed to evaluate the prognosis and the postoperative outcomes of elderly patients underwent gastric cancer surgery in a high-volume center.

Methods

The medical records of patients with gastric cancer surgery at Marmara University Hospital’s General Surgery Department were examined retrospectively. Patients were divided into two groups: Age ≤ 70 and Age > 70. The clinicopathological data of the patients were compared. The prognostic factors regarding gastric cancer surgery were analyzed with Cox proportional regression models. Kaplan Meier analysis and log-rank test were used to compare Overall Survival (OS) and Cancer-Specific Survival (CSS) among the groups. Competing risk regression analysis was used to examine cause-specific hazards among elderly patients.

Results

The number of eligible patients was 250. Age > 70 group was 68 patients, and Age ≤ 70 group was 182 patients. There is no significant difference between the patient’s demographics or pathological outcomes. Neoadjuvant therapies performed less in elderly patients [40 (22%) vs. 7 (10%), p: 0.03, respectively]. There was no significant difference in severe complication (≥ Grade III) rates in both groups. Multivariate analysis showed that advanced T stage and adjacent organ invasion were the independent risk factors for OS. No significant difference was observed between the groups regarding OS (Log Rank (Mantel-Cox): 0.102). Younger patients have worse CSS than those who are older. Cause-specific hazard model demonstrated a not increased hazard ratio [HR: 1.04(0.78–1.38)] for elderly patients for OS and CSS.

Conclusion

Gastric resections can be safely performed for elderly patients diagnosed with gastric cancer. This study showed that growing age is no longer a factor that will affect the clinician’s decision in performing surgery in gastric cancer patients.
Association between all-cause mortality and trajectories across quality and duration of sleep and cognitive function: based on Group-Based Multivariate Trajectory modeling
Authors: Lin Jianlin , Xiao Jian , Li Qiao , Cao Li
Published: August 2023

Background

Sleep duration and quality are associated with cognition, but the interaction of the 3 indicators and their association with all-cause mortality is unclear.

Methods

We used data from the Chinese Longitudinal Healthy Longevity Survey from 2005–2018 to identify latent trajectories of sleep duration, sleep quality, and cognitive function. Secondly, the multinomial logistic model was adopted to determine predictors of trajectory groups. Finally, the Cox regression model was used to examine the association between these trajectory groups and all-cause mortality.

Results

A total of 5046 adults (49% women) with an average age of 76.34 were included in the study. The median follow-up period was 11.11 years, during which 1784 (35%) participants died. We identified 4 latent groups among older adults: ‘Good-performance’ (51%), ‘Decreasing’ (26%), ‘Oversleep & cognitive impairment’ (12%), and ‘Sleep-deprived’ (11%). Individuals in the ‘Decreasing’ had a 51% increased risk of all-cause mortality (HR = 1.51, 95% CI: 1.25 – 1.81,p < .001). Individuals in the ‘Oversleep & cognitive impairment’ had a 170% increased risk of all-cause mortality (HR = 2.7 95% CI: 2.13 – 3.43,p < .001). Women had a higher risk of all-cause mortality regardless of trajectory group (47–143% men VS. 74–365% women). Both urban and rural areas have a similarly increased risk of all-cause mortality (48–179%).

Conclusions

Our study reveals the latent trajectories across sleep duration, sleep quality, and cognitive function in older Chinese and further explores their association with death. These findings provide a rational basis for cognitive interventions and reduce all-cause mortality.
Older adults, clinicians, and researchers’ preferences for measuring adherence to resistance and balance exercises
Authors: McArthur Caitlin , Duhaime Gabriella , Gonzalez David , Notthoff Nanna , Theou Olga , Kehler Scott , Quigley Adria
Published: August 2023

Background

Resistance and balance training are important exercise interventions for older populations living with chronic diseases. Accurately measuring if an individual is adhering to exercises as prescribed is important to determine if lack of improvement in health outcomes is because of issues with adherence. Measuring adherence to resistance and balance exercises is limited by current methods that depend heavily on self-report and are often better at and tailored towards capturing aerobic training parameters (e.g., step count, minutes of moderate to vigorous physical activity). Adherence measures must meet users’ needs to be useful.

Methods

Using a Dillman tailored study design, we surveyed researchers who conduct exercise trials, clinicians who prescribe exercise for older adults, and older adults to determine: (1) how they are currently measuring adherence; (2) barriers and facilitators they have experienced to measurement; and (3) the information they would like collected about adherence (e.g., repetitions, sets, intensity, duration, frequency, quality). Surveys were disseminated internationally through professional networks, professional organizations, and social media. Participants completed an online survey between August 2021 and April 2022.

Results

Eighty-eight older adults, 149 clinicians, and 41 researchers responded to the surveys. Most clinicians and researchers were between the ages of 30 and 39 years, and 70.0% were female. Most older adults were aged 70–79 years, and 46.6% were female. Diaries and calendars (either analog or digital) were the most common current methods of collecting adherence data. Users would like information about the intensity and quality of exercises completed that are presented in clear, easy to use formats that are meaningful for older adults where all data can be tracked in one place. Most older adults did not measure adherence because they did not want to, while clinicians most frequently reported not having measurement tools for adherence. Time, resources, motivation, and health were also identified as barriers to recording adherence.

Conclusions

Our work provides information about current methods of measuring exercise adherence and suggestions to inform the design of future adherence measures. Future measures should comprehensively track adherence data in one place, including the intensity and quality of exercises.
Mucinous tubular and spindle cell carcinoma of the kidney: a report of seven cases
Authors: Ling Chunxiang , Tan Ru , Li Jiamei , Feng Jizhen
Published: August 2023

Objective

To further analyse the imaging features and tumour outcomes of mucinous tubular and spindle cell carcinoma (MTSCC) of the kidney.

Materials and methods

The current study retrospectively reviewed the clinical information of seven patients diagnosed with MTSCC at our institution from January 2011 to March 2023.

Results

The median age at diagnosis was 52 years (range, 32–66 years) and the majority of patients were female (71.4%). On conventional abdominal ultrasound, the majority of the tumours (5/7) were heterogeneous hypoechoic or slightly hypoechoic. Colour Doppler flow imaging showed blood flow within the tumour in 2 cases and peripheral blood flow signal in 1 case. On non-enhanced CT, all tumours had a spherical or ovoid shape, with an expansile growth mode, and had clear or unclear boundaries with the surrounding renal parenchyma. The tumours were either partially exophytic (n = 4) or parenchymal (n = 3), while no cases of completely exophytic tumour was observed (n = 0). On contrast-enhanced CT, the majority of tumours (5/7) showed a heterogenous pattern of enhancement and the mean tumour diameter was 6.7 ± 4.4 cm (range, 2.1–16.8 cm). All patients underwent partial or radical nephrectomy for pT1a (42.9%), pT1b (28.5%), pT2 (14.3%) or pT3b (14.3%) stage. Among these, 1 patient (14.3%) had a level I tumour thrombus at diagnosis and died of disease 24.5 months later. The remaining patients had no recurrence or metastasis.

Conclusion

MTSCC is not universally indolent, which tends to occur in female patients of a broad range of ages. MTSCC is a hypovascular renal tumour, which is different from clear cell renal cell carcinoma (RCC); however, it is difficult to distinguish MTSCC from other hypovascular RCC subtypes because of the overlap of their imaging characteristics.
The intestinal carrier status of Enterococcus spp. in children: clonal diversity and alterations in resistance phenotypes before and after admission to a pediatric intensive care unit
Authors: Shirvani Fariba , Hassanzadeh Romina , Attaran Bahareh , Ghandchi Ghazale , Abdollahi Nafiseh , Gholinejad Zari , Sheikhi Zahra , Behzad Azita , Fallah Fatemeh , Azimi Leila , Safarkhani Azam , Karimi Abdollah , Mahdavi Alireza , Armin Shahnaz , Ghanaiee Roxana Mansour , Tabatabaei Sedigheh Rafiei , Fahimzad Seyed Alireza , Alebouyeh Masoud
Published: August 2023

Background

This study aimed to investigate the intestinal carrier status of Enterococcus spp. among children in a pediatric intensive care unit (PICU) and reveal the role of hospitalization in the alteration of resistance phenotypes and clonal diversity of the isolates during admission and discharge periods.

Methods

Two separate stool samples were collected from hospitalized patients in the pediatric intensive care unit at admission and discharge times. The culture was done, and Enterococcus species were tested for antimicrobial susceptibility and carriage of vanA-D gene subtypes. Random Amplified Polymorphic DNA (RAPD)-PCR was used for a phylogenetic study to check the homology of pairs of isolates.

Results

The results showed carriage of Enterococci at admission, discharge, and at both time points in 31%, 28.7%, and 40.1% of the cases, respectively. High frequencies of the fecal Enterococcus isolates with vancomycin-resistance (VR, 32.6% and 41.9%), high-level of gentamicin-resistance (HLGR, 25.6% and 27.9%), and multi-drug resistance phenotypes (MDR, 48.8% and 65.1%) were detected at admission and discharge times, respectively. Resistance to vancomycin, ampicillin, and rifampicin was higher among E. faecium, but resistance to ciprofloxacin was higher in E. faecalis isolates. The increased length of hospital stay was correlated with the carriage of resistant strains to vancomycin, ampicillin, and ciprofloxacin. While the homology of the isolates was low among different patients during hospitalization, identical (9%) and similar (21%) RAPD-PCR patterns were detected between pairs of isolates from each patient.

Conclusions

The high rate of intestinal carriage of VR, HLGR-, and MDR-Enterococci at admission and during hospitalization in the PICU, and the impact of increased length of hospital stay on the fecal carriage of the resistant strains show the importance of antibiotic stewardship programs to control their transmission and spread in children.
MRI findings in children with migraine or tension-type headache
Authors: Toker Rabia Tütüncü , Mutlucan Ilknur Ozdeniz , Tanrıverdi Cigdem , Demir Aylin Bican
Published: August 2023

Purpose

Migraine and tension-type headache are common primary headaches in children. There is a risk of developing secondary headache in children. The current study was aimed to evaluate magnetic resonance imaging findings (MRI) in children with migraine or tension-type headache.

Methods

The study was planned in children with migraine or tension-type headaches who have been followed up in the pediatric neurology outpatient clinic with regular office visits for at least two years and had neuroimaging in the last year.

Results

280 patients (187 female patients) datas were studied. 91 (61 female patients) were followed up with the diagnosis of migraine and 189 (126 female patients) with the diagnosis of tension-type headaches. The age of patients was found to be 13.1 ± 3.4 years. Brain tumor was found in one child with tension-type headache who had papilledema. Incidental MRI findings found 7.7% and 12.7% in migraine and tension-type headache, respectively. MRI findings in the study were arachnoid cyst (14), pituitary adenoma (6), mega cisterna magna (6), pineal cyst (3), non-specific gliosis (2) and tumor (1).

Conclusion

Arachnoid cysts were found incidental as the most common MRI finding in children with migraine or tension-type headache. The rare life-threatening secondary headache may develop in children. The fundus examination as a complement to the neurological examination can be useful for requesting MRI.
COVID-19 and democracy: a scoping review
Authors: Sorsa Ville-Pekka , Kivikoski Katja
Published: August 2023

Background

The resilience of democracy is tested under exogenous shocks such as crises. The COVID-19 pandemic has recently tested the resilience of democratic institutions and practices around the world.

Aim

The purpose of this article is to scope the early research literature that discusses democracy and the COVID-19 pandemic. We review scientific journal articles published during the first two years of the pandemic. We ask three research questions in scoping this body of literature: (1) what are the key topic areas of all published research that associates itself with both democracy and COVID-19, (2) what kinds of conceptual and theoretical contributions has research literature that more specifically discusses democracy under the pandemic produced, and (3) what are the impacts of democracy to the pandemic and vice versa according to empirical research?

Methods

The scoping review methodology draws on systematic literature search strategies, computational methods, and manual coding. The systematic Web of Science search produced 586 articles for which we conducted a Correlated Topic Model. After technical and manual screening, we identified 94 journal articles that were manually coded.

Results

The early research on democracy and the COVID-19 pandemic offers a versatile body of scholarship. The topic modeling shows that the scholarship discusses issues of crises, governance, rights, society, epidemiology, politics, electorate, technology, and media. The body of papers with conceptual and theoretical contributions has offered new insights on the difficulties, possibilities, and means to maintain democracy under a pandemic. Empirical research on democracy’s impact on the COVID-19 pandemic and vice versa varies in terms of methodology, geographical scope, and scientific contributions according to the direction of influence studied. Democracy appears to have a significant impact on some aspects of policy responses and epidemiological characteristics of the pandemic. In most parts of the world, the scope, franchise, and authenticity of democracy narrowed down due to the pandemic, albeit in most cases only temporarily.

Conclusions

A significant number of papers show that the pandemic has accentuated democratic backsliding but is unlikely to have undermined established democracies that have proved resilient in face of the pandemic. But empirical research has also made visible some weak signals of antidemocratic tendencies that may become more accentuated in the longer run.
Neglected gaps in improving the health, wellbeing, and care for sexual and gender minority young people living in low- and lower-middle- income countries: a scoping review
Authors: Frances Cara , Garnsey Camille , DeMulder Jessica
Published: August 2023

Background

There is a lack of reliable data on the size, characteristics, and experiences of sexual and gender minority (SGM) young people (ages 10–24) in low- and lower-middle- income countries (LMICs). This review examines the research conducted in the last thirteen years with and about SGM young people living in low-income settings and seeks to answer the question: What is known about the mental and physical health needs, safety, and wellbeing of SGM young people living in LMICs?

Methods

We conducted a scoping review informed by the methodological frameworks put forth by Arksey and O’Malley and the Joanna Briggs Institute. We systematically searched two general social science databases and one topic-specific database for peer-reviewed papers, of any research design, that included SGM young people or explored attitudes toward SGM young people in LMICs. We included papers that reported on factors influencing the health and wellbeing of SGM populations, including physical and mental health, healthcare-seeking behaviors, substance use, experiences of discrimination and/or stigma, experiences of violence and abuse (emotional, physical, and/or sexual), economically motivated paid sex practices, housing or economic security, and attitudes of others toward SGM populations.

Results

Of the 5,409 unique records identified, 79 papers drawing from data collected from 74 unique studies met the inclusion criteria. Only 50 of the 79 papers included SGM young people as participants, with just 13 focusing exclusively on SGM young people ages 10–24. The included papers were classified into three thematic groupings: attitudes toward SGM populations (n = 26), risks to health (n = 40), and experiences of stigma and discrimination (n = 13).

Conclusion

The findings indicate that the health and wellbeing of SGM young people in LMICs has been historically under-researched. While SGM young people have received more attention from researchers in recent years, the body of literature as a whole is disjointed and sparse, and often studies are about SGM young people, rather than with and for them. Our review highlights the need for more and better research, more accurate and disaggregated demographic data, and leadership and participation of SGM-led community-based organizations in the co-design of studies that focus on SGM young people.
Students’ attitudes, beliefs and perceptions surrounding 2SLGBTQIA + health education and inclusiveness in Canadian physiotherapy programs
Authors: Primeau Codie A. , Philpott Holly T. , Vader Kyle , Unger Janelle , Le Christina Y. , Birmingham Trevor B. , MacDermid Joy C.
Published: August 2023

Background

Patients who identify as 2SLGBTQIA + report negative experiences with physiotherapy. The objectives were to evaluate student attitudes, beliefs and perceptions related to 2SLGBTQIA + health education and working with individuals who identify as 2SLGBTQIA + in entry-level physiotherapy programs in Canada and to evaluate physiotherapy program inclusiveness towards 2SLGBTQIA + persons.

Methods

We completed a nationwide, cross-sectional survey of physiotherapy students from Canadian institutions. We recruited students via email and social media from August-December 2021. Frequency results are presented with percentages. Logistic regression models (odds ratios [OR], 95%CI) were used to evaluate associations between demographics and training hours with feelings of preparedness and perceived program 2SLGBTQIA + inclusiveness.

Results

We obtained 150 survey responses (mean age = 25 years [range = 20 to 37]) from students where 35 (23%) self-identified as 2SLGBTQIA + . While most students (≥ 95%) showed positive attitudes towards working with 2SLGBTQIA + patients, only 20 students (13%) believed their physiotherapy program provided sufficient knowledge about 2SLGBTQIA + health and inclusiveness. Students believed more 2SLGBTQIA + training is needed (n = 137; 92%), believed training should be mandatory (n = 141; 94%) and were willing to engage in more training (n = 138; 92%). Around half believed their physiotherapy program (n = 80, 54%) and clinical placements (n = 75, 50%) were 2SLGBTQIA + -inclusive and their program instructors (n = 69, 46%) and clinical instructors (n = 47, 31%) used sex/gender-inclusive language. Discrimination towards 2SLGBTQIA + persons was witnessed 56 times by students and most (n = 136; 91%) reported at least one barrier to confronting these behaviours. Older students (OR = 0.89 [0.79 to 0.99]), individuals assigned female at birth (OR = 0.34 [0.15 to 0.77]), and students self-identifying as 2SLGBTQIA + (OR = 0.38 [0.15 to 0.94]) were less likely to believe their program was 2SLGBTQIA + inclusive. Older students (OR = 0.85 [0.76 to 0.94]) and 2SLGBTQIA + students (OR = 0.42 [0.23 to 0.76]) felt the same about their placements. Students who reported > 10 h of 2SLGBTQIA + training were more likely to believe their program was inclusive (OR = 3.18 [1.66 to 6.09]).

Conclusions

Entry-level physiotherapy students in Canada show positive attitudes towards working with 2SLGBTQIA + persons but believe exposure to 2SLGBTQIA + health and inclusiveness is insufficient in their physiotherapy programs. This suggests greater attention dedicated to 2SLGBTQIA + health would be valued.
Socio-economic factors, mood, primary care utilization, and quality of life as predictors of intervention cessation and chronic stress in a type 2 diabetes prevention intervention (PREVIEW Study)
Authors: Huttunen-Lenz Maija , Raben Anne , Adam Tanja , Macdonald Ian , Taylor Moira A. , Stratton Gareth , Mackintosh Kelly , Martinez J. Alfredo , Handjieva-Darlenska Teodora , Bogdanov Georgi Assenov , Poppitt Sally D. , Silvestre Marta P. , Fogelholm Mikael , Jalo Elli , Brand-Miller Jennie , Muirhead Roslyn , Schlicht Wolfgang
Published: August 2023

Background

Sedentary lifestyle and unhealthy diet combined with overweight are risk factors for type 2 diabetes (T2D). Lifestyle interventions with weight-loss are effective in T2D-prevention, but unsuccessful completion and chronic stress may hinder efficacy. Determinants of chronic stress and premature cessation at the start of the 3-year PREVIEW study were examined.

Methods

Baseline Quality of Life (QoL), social support, primary care utilization, and mood were examined as predictors of intervention cessation and chronic stress for participants aged 25 to 70 with prediabetes (n = 2,220). Moderating effects of sex and socio-economic status (SES) and independence of predictor variables of BMI were tested.

Results

Participants with children, women, and higher SES quitted intervention earlier than those without children, lower SES, and men. Lower QoL, lack of family support, and primary care utilization were associated with cessation. Lower QoL and higher mood disturbances were associated with chronic stress. Predictor variables were independent (p ≤ .001) from BMI, but moderated by sex and SES.

Conclusions

Policy-based strategy in public health should consider how preventive interventions may better accommodate different individual states and life situations, which could influence intervention completion. Intervention designs should enable in-built flexibility in delivery enabling response to individual needs.

Trial registration

ClinicalTrials.gov Identifier: NCT01777893.
Comparison of the intraarticular osteotomy and the “window” osteotomy in the treatment of tibial plateau fracture involving depressed posterolateral fragments
Authors: Fang Zhixun , Pei Xuan , Cheng Yipeng , Chen Jianan , Zhou Wei , Chen Yu , Baosu Yaolatu , Qian Shenglong , Liu Ximing , Wang Guodong
Published: August 2023

Objectives

The methods of reduction of depressed posterolateral fragments in tibial plateau fracture through anterolateral approaches remain controversial. This paper aimed to compare the intraarticular osteotomy technique and the “window” osteotomy technique for the reduction of depressed posterolateral fragments through anterolateral approach.

Method

From January 2015 to January 2022, we retrospectively reviewed the data on patients with tibial plateau fracture involving depressed posterolateral fragments treated with the intraarticular osteotomy or the “window” osteotomy. 40 patients underwent the intraarticular osteotomy were divided into group A, while 36 patients underwent the “window” osteotomy were divided into group B. The operative time, bone grafting volume, fracture healing time, complication, reduction quality and postoperative functional results were compared between the two groups.

Results

The average follow-up duration was 16.6 ± 3.7 months. The average bone grafting volume for all patients in group B was essential larger than group A (p = 0.001). Compared to group B, patients in groups A had significantly shorter fracture healing time (p = 0.011). The depth of depressed articular surface, PSA and the radiographic evaluation at 2 days and 6 months after surgery in group A were significantly lower than group B (p<0.05). Based on the HSS knee-rating score, no significant difference in function results was found between the two groups (p>0.05). No significant difference was found in operation time and blood loss between the two groups (p>0.05).

Conclusion

The intraarticular osteotomy could obtain satisfactory clinical results in tibial plateau fracture involving posterolateral fragments.
Mortality following proximal femoral fractures in elderly patients: a large retrospective cohort study of incidence and risk factors
Authors: Baghdadi Soroush , kiyani Maryam , kalantar Seyyed Hadi , Shiri Samira , Sohrabi Omid , Beheshti Fard Shahabaldin , Afzal Sina , Khabiri Seyyed Saeed
Published: August 2023

Background

Global prevalence of osteoporosis and fragility fractures is increasing due to the aging population. Proximal femoral fractures are among the most common orthopedic conditions in elderly that significantly cause health deterioration and mortality. Here, we aimed to evaluate the mortality rates and risk factors, besides the functional outcomes after these injuries.

Methods

In a retrospective cohort study, all patients admitted with a femoral neck or intertrochanteric fracture between 2016 and the end of 2018 were enrolled in this study. Medical records were reviewed to include patients over 60 years of age who had a proximal femoral fracture and had a complete medical record and radiographs. Exclusion criteria included patients with pathological fractures, cancer under active treatment, follow-up loss, and patient access loss. Demographic and clinical features of patients alongside the details of fracture and patient management were recorded and analyzed. In-hospital and post-discharge mortalities due to included types of fractures at one and 12 months were the primary outcome. Modified Harris Hip Scores (mHHS) was the measure of functional outcome.

Results

A total of 788 patients including 412 females (52.3%) and 376 males (47.7%) with a mean age of 76.05 ± 10.01 years were included in this study. Among patients, 573 (72.7%) had an intertrochanteric fracture, while 215 (27.3%) had a femoral neck fracture, and 97.1% of all received surgical treatment. With a mean follow-up of 33.31 months, overall mortality rate was 33.1%, and 5.7% one-month and 20.2% 12-months rates. Analysis of 1-month mortality showed a significant mortality difference in patients operated after 48 h of fracture (p = 0.01) and in patients with American Society of Anesthesiologists (ASA) scores of 3–4 compared to ASA scores of 1–2 (p = 0.001). One-year mortality data showed that the mortality rate in femoral neck fractures was lower compared to other types of fracture. Surgical delay of > 48 h, ASA scores of 3–4, and treatment by proximal femoral plate were associated with shorter survival. The overall mean mHHS score was 53.80 ± 20.78.

Conclusion

We found several risk factors of mortality, including age ≥ 80 years, a > 48-hour delay to surgery, and pre-operative ASA scores of 3–4 in patients with proximal femoral fracture. Furthermore, the use of a proximal femoral plate was a significant risk factor for mortality and lower mHHS scores.
De-epithelialized overlap flap to secure urethroplasty in second stage hypospadias repair: revisiting the Smith technique
Authors: AbouZeid Amr Abdelhamid , Habak Reda Abualyazeed , Hamad Mostafa Mahmoud , Shahin Alaa-Eldin Medhat
Published: August 2023

Background

The application of a second layer between the neourethra and skin was a major contribution, which has improved the outcome of hypospadias repair. Here, we report our experience of revisiting the original Smith technique using a de-epithelialized overlap flap to support the urethroplasty in staged hypospadias repair.

Methods

The study included primary cases of proximal hypospadias with significant chordee who underwent two-stage repair during the period 2016 through 2021. The ventral curvature was corrected at first stage by excision of the urethral plate, followed by covering the ventral shaft by skin flaps or inner preputial graft. The second stage (Thiersch -Duplay urethroplasty) was performed six months later. The de-epithelialized overlap flap (double breasting) technique was used to cover the neo-urethra in all cases, which was combined with a dartos scrotal flap to cover the proximal neourethra when indicated.

Results

The study included 17 boys with proximal hypospadias who underwent two-stage repair. Follow up period after the second stage ranged between 6 and 30 months (mean 19.7; median 18.5). Post-operative complications were detected in 7 cases (41%). Most complications were related to distal/glanular disruptions whether partial or complete (5 cases). One case developed a penoscrotal fistula that was closed surgically. Another case (belonging to the group which used preputial graft in the 1st stage) presented 21 months after the second stage with urethral stricture (penoscrotal).

Conclusion

Applying the de-epithelialized double-breasting skin closure can offer alternative second layer coverage for the neourethra along the penile shaft in staged repair of proximal hypospadias.
Diagnostic dilemma in a patient with history of medullary thyroid carcinoma and abnormal serum liver enzymes; a case report with six years follow up
Authors: Rahmani Fatemeh , Tohidi Maryam , Azmoudeh-Ardalan Farid , Sadeghi Amir , Hadaegh Farzad
Published: August 2023

Background

Medullary thyroid carcinoma (MTC) is a neuroendocrine tumor that originates from parafollicular C-cells. Calcitonin (Ctn) and carcinoembryonic antigen (CEA) are useful biomarkers for monitoring MTC cases.

Case presentation

Here, we describe a 48-year-old woman, who presented in 2014 with bilateral thyroid nodules. Report of fine needle aspiration was suspicious for MTC; initial laboratory evaluation showed serum Ctn level of 1567 pg/mL. After excluding type 2 multiple endocrine neoplasia syndrome clinically, total thyroidectomy and neck lymph node dissection were performed. The final histopathological diagnosis was right lobe MTC with neither vascular invasion nor lymph node involvement. On regular follow-up visits, Ctn and CEA levels have been undetectable, and repeated cervical ultrasonographic exams were unremarkable from 2014 to 2021. As liver enzymes became elevated in 2016, the patient was further evaluated by a gastroenterologist. Abdominopelvic ultrasonography revealed a coarse echo pattern of the liver parenchyma with normal bile ducts. A liver fibroscan showed a low fibrosis score (7kPa). The patient was recommended to use ursodeoxycholic acid. According to the progressive rise of liver enzymes with a cholestatic pattern in October 2020, a liver biopsy was performed that showed tiny nests of neuroendocrine-like cells with a background of primary biliary cholangitis (PBC). Immunohistochemical stainings were positive for chromogranin A (CgA), and synaptophysin and negative for Ctn, CEA, and thyroglobulin. Further imaging investigations did not reveal any site of a neuroendocrine tumor in the body. Considering normal physical exam, imaging findings, as well as normal serum levels of Ctn, CEA, CgA, and procalcitonin, the patient was managed as a PBC.

Conclusion

In follow-up of a patient with MTC, we reported progressively increased liver enzymes with a cholestatic pattern. Liver biopsy revealed nests of neuroendocrine-like cells with a background of PBC, the findings that might suggest acquiring neuroendocrine phenotype by proliferating cholangiocytes.
Evaluation of the masking ability, marginal adaptation, and fracture resistance of screw-retained lithium disilicate implant-supported crowns cemented to titanium bases versus preparable abutments
Authors: Kordi Ahmad Waled Mohamad , Salman Abdallah Ibrahim , Metwally Nayrouz Adel , Khamis Mohamed Moataz
Published: August 2023

Background

Straight preparable abutments and titanium bases (ti-base) can be used to support single-unit screw-retained lithium disilicate implant-supported restorations. The choice between using both abutments depends on many factors. The purpose of this in vitro study was to compare the masking ability, marginal adaptation, and fracture resistance of screw-retained lithium disilicate implant-supported crowns cemented to straight preparable abutments and ti-bases.

Methods

Twenty laboratory implant analogs (Straumann Bone Level; Straumann AG) were randomly divided into 2 groups (n = 10 each) according to the type of the abutment used. Preparable abutment group and ti-base group. Lithium disilicate crowns were used to restore the specimens. All specimens were subjected to thermocycling (from 5 to 55 °C for 2000 cycles) followed by cyclic loading (120 000 cycles). The vertical marginal gap between the abutment finish line and the most apical part of the crown was measured in (µm) by using a stereomicroscope after cementation and after thermocycling and cyclic loading. A spectrophotometer was used to evaluate the masking ability of the specimens after cementation. The load required to fracture the crowns was measured in Newtons (N) by using a universal testing machine after thermocycling and cyclic loading. The Shapiro-Wilk test of normality was used. The appropriate statistical test was used.

Results

Regarding the masking ability, the color difference (∆E) showed no statistically significant difference between the ti-base group (2.6 ± 0.2) and the preparable abutment group (2.6 ± 0.3) (P = .888). The average of the microgap values (µm) was greater in ti-basegroup after cementation (13.9 ± 9.2) than preparable group (7.63 ± 1.78) with no statistically significant difference between the 2 groups (P = .49). After cyclic loading and thermocycling, the average microgap values (µm) was significantly greater in the ti base group (21.3 ± 7.4) than in preparable group (13.3 ± 1.5) (P = .02). The load required to fracture the specimens was greater in the preparable group (1671.5 ± 143.8) than in the ti-base group (1550.2 ± 157.5) with no statistically significant difference between the 2 groups (P = .089).

Conclusion

The abutments used in the present study did not compromise the masking ability of the screw-retained lithium disilicate implant supported crowns. Moreover, the crowns cemented to preparable abutments had better marginal adaptation and higher fracture resistance when compared to those cemented to ti-bases.

Clinical implications

Straight preparable abutments are considered as an alternative to the ti-bases when restoring single screw-retained lithium disilicate implant-supported crowns with comparable fracture resistance, marginal adaptation, and masking ability.
Assessing the thyroid autoimmunity association with recurrent aphthous stomatitis
Authors: Karimi Fariba , Lavaee Fatemeh , Nematollahi Aida , Sahmeddini Sarina
Published: August 2023

Background

Recent investigations have highlighted autoimmune origins and abnormal immune responses; particularly those related to T cell-mediated immunity and elevated T lymphocyte cells in the oral mucosa. Therefore, we investigated the relationship between recurrent aphthous stomatitis (RAS) and autoimmune thyroid diseases (ATDs) in an Iranian population.

Methods

A cross-sectional study was performed on 102 patients diagnosed with ATD (cases) and 102 healthy patients (controls) who had been referred for the routine dental treatment. All participants were asked for the history of RAS and their age, gender, other systemic diseases, medications, and frequency of RAS in a year. Matching was performed based on the propensity scores for age and sex. In addition, the number of lesions in each recurrence in both groups was assessed and compared. The type of thyroid disease has been assessed for case participants and has been confirmed by the endocrinologist. The chi-square test, t-test, and Mann-Whitney U test were used to analyze the data using SPSS 18.

Results

Patients with ATD had higher RAS than healthy controls (P = 0.040). ATD patients had 1.93 times more risk for RAS, and the frequency of RAS in a year was 3.15times higher in these patients (P = 0.011). Moreover, the frequency of RAS was higher in patients with hypothyroidism than in those with hyperthyroidism. However, there were no significant differences in the size and the number of lesions between the groups.

Conclusion

The risk and frequency of RAS were significantly higher in patients with ATDs. This would provide valuable insights into the underlying mechanisms and potential treatment strategies for both conditions.
Berberine improves inhibitory avoidance memory impairment of Toxoplasma gondii-infected rat model of ketamine-induced schizophrenia
Authors: Gholizadeh Neghin , Dalimi Abdolhossein , Ghaffarifar Fatemeh , Nader-Mohammadi Mehryar , Molavi Parviz , Dadkhah Masoomeh , Molaei Soheila
Published: August 2023

Background

Memory impairment caused by Toxoplasma gondii infection has been documented. Berberine (BRB) is well known for its enhancing effects on memory and has shown promising results. However, the impact of BRB on T. gondii infection and schizophrenia-induced consolidation and reconsolidation memory impairment is still unclear. Here; we examined the effect of BRB on the inhibitory avoidance (IA) memory consolidation and reconsolidation impairment induced by T. gondii infection, and ketamine (Ket) as a pharmacological model of schizophrenia. Also; the brain-derived neurotrophic factor (BDNF) levels in the medial prefrontal cortex (mPFC) and hippocampus were analyzed.

Methods

Rats were infected with T. gondii RH strain or received Ket (30 mg/kg/day) intraperitoneally (i.p) for at least five consecutive days (as the model of schizophrenia). Then followed by oral administration with BRB (25 mg/kg/day) for five days. Finally, the IA memory retention test was examined 48 post-conditioning, and BDNF was measured.

Results

Results indicated IA memory impairment in T. gondii-infected animals since lower step-through latency (STL) was observed than in control animals. We found significant (P = 0.01, P = 0.001) elevations in STL and a significant decrease (P = 0.001) in total time spent in the dark area following BRB administration in infected and Ket-treated rats, indicating improvement (increased STL) in consolidation and reconsolidation memory. Moreover, BDNF levels were reduced (P = 0.01) in the hippocampus and mPFC regions of both T. gondii- infected and Ket-induced groups, which remarkably enhanced after BRB treatment. Furthermore; we found that BRB administration notably increased the mPFC BDNF levels in mPFC (P < 0.01) and hippocampus (P = 0.001) in the Ket-treated and rats infected with T. gondii.

Conclusion

Taken together; BRB may be a valuable preclinical treatment for improving memory impairment through BDNF expression in PFC and hippocampus, therefore; BRB is suggested for memory disturbances induced by T. gondii infection.