bluuebunny/crossref_metadata_2025 huggingface dataset:
Skin ulcers caused by ruxolitinib in a patient with chronic cutaneous graft-versus-host disease
Authors: Aslan Candır Burcu , Yiğenoğlu Tuğçe Nur , Kızıl Çakar Merih , Dal Mehmet Sinan , Altuntaş Fevzi
Published: January 2022

Introduction

Graft-versus-host disease (GVHD) is a common complication of allogeneic hematopoietic cell transplantation (HCT). In the treatment of chronic GVHD, skin directed therapy, systemic corticosteroids, calcineurin inhibitors (such as cyclosporine (CsA) and tacrolimus), rituximab, mycophenolate mofetil (MMF), extracorporeal photopheresis (ECP) and ruxolitinib are used.

Case report

We present an 18 year old male with Philadelphia chromosome positive acute B lymphoblastic leukemia, treated with allogeneic HCT from a full matched sibling donor. The patient had grade 2 chronic cutaneous GVHD resistant to corticosteroids, CsA, MMF, and ECP treatment. Three months after initiation of ruxolitinib therapy, the patient developed skin ulcers on his lower extremities.

Management & outcome

The biopsy revealed that the changes were caused by the drug reactions. We suspected ruxolitinib as the likely cause of these ulcerative lesions after evaluating the adverse drug reaction probability scale. The adverse drug score was 4, therefore, ruxolitinib treatment was discontinued. Ulcerative lesions fully recovered after 4 weeks of follow-up.

Discussion

Ruxolitinib is used in the treatment of chronic GVHD that has been resistant to steroids and other salvage therapies. In our case, ruxolitinib was used as a salvage therapy in a patient who had refractory chronic skin GVHD. Ruxolitinib-related skin lesions with ulcers of lower extremities and whole body erythematous skin lesions were reported previously in patients with myelofibrosis. The pathophysiology of ruxolitinib related skin ulcers is unknown. Skin changes of patients using ruxolitinib should be closely monitored, and newly developing lesions should be suspected of being drug-related and biopsied.
Health-related quality of life among cervical cancer patients at Kenyatta National Hospital
Authors: Shajahan Ahamed Mehreen , Degu Amsalu
Published: January 2022

Background

Previous study showed that health-related quality of life (HRQoL) was adversely affected during treatment of cervical cancer, with a worsening global score. Therefore, this study aimed to determine the HRQoL of cervical cancer patients at Kenyatta National Hospital.

Methods

A cross-sectional study design was employed among cervical cancer patients. All eligible consecutive samples of 103 cervical cancer patients were included in the study. Following consent, patients were interviewed using The European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire 30 (EORTC QLQ-30) and Cervical Cancer Module CX24 (EORTC QLQ-CX24). The data were entered and analyzed using the SPSS version 20.0 software. Univariate and multivariate binary logistic regression analysis was employed to investigate the predictors of HRQoL. A p-value of ≤ 0.05 was considered statistically significant.

Results

The majority (69%) of the patients had a poor overall quality of life while 31% of study participants had a good quality of life. Patients with early-stage disease were 7.3 times (AOR = 7.3, 95% CI = 2.4–21.7, p = 0.000) more likely to have a good HRQoL than patients with advanced-stage disease. Patients with no comorbidities were 3.1 times (COR = 3.1, 95% CI = 1.1–9.1, p = 0.037) more likely to have a good HRQoL than patients with comorbidities.

Conclusion

The overall HRQoL among cervical cancer patients was poor in the setting. Advanced stage of disease and presence of comorbidities were the significant predictors of poor quality of life.
Vincristine induced fever in a child with embryonal rhadbomyosarcoma
Authors: Janani Dr. Arul , Shruthilaya Dr. Anandkumar , Dhaarani Dr. Jayaraman , Julius Dr. Scott X
Published: January 2022

Introduction

Febrile episodes in oncology is common are mostly of infectious etiology requiring repeated investigations and escalation of antibiotics. But, drug induced fever occur more often than we think in oncological set-up.

Case Report

A 5 year old male child with rhabdomyosarcoma, developed high grade fever spikes following Vincristine monotherapy. Infective etiology work up was negative and the fever responded to corticosteroids.

Management and Outcome

He was treated with corticosteroids as premedication considering vincristine induced fever. The further courses of VCR- monotherapy were uneventful with steroids as premedication.

Discussion

We present the case of vincristine induced fever in a child with embryonal rhabdomyosarcoma. Clinician’s should consider drug induced fever at appropriate conditions, to avoid leading to antibiotic resistance.
Validation of a coupled multibody and TEHL simulation by a piston/cylinder component test rig
Authors: Kroneis Markus , Scheerer René , Bobach Lars , Bartel Dirk
Published: January 2022

A tribological highly stressed contact in the actuating system of axial piston machines is located between the control piston and the control chamber. This paper presents a new type of component test rig for measuring the frictional force and the gap heights between piston and cylinder. For this purpose, the original system is reduced to the actuator system, whereby the real kinematics and the loading forces are maintained. The axial movement of the control piston and the pressure in the control chamber can be configured individually. The measurement results of different parameter variations are compared with the results of the simulation. The simulation based on a coupled multibody and TEHL simulation with a transient, three-dimensional, thermal elastohydrodynamic contact calculation.
Perceived Discrimination, Experiential Avoidance, and Mental Health among Hispanic Adults in Primary Care
Authors: Zvolensky Michael J. , Rogers Andrew H. , Mayorga Nubia A. , Shepherd Justin M. , Bakhshaie Jafar , Garza Monica , Viana Andres G. , Ochoa-Perez Melissa , Lemaire Chad , Ruiz Ana , Peraza Natalia
Published: January 2022

The Hispanic population is the largest minority group in the United States and frequently experiences racial discrimination and mental health difficulties. Prior work suggests that perceived racial discrimination is a significant risk factor for poorer mental health among Hispanic in the United States. However, little work has investigated how perceived racial discrimination relates to anxiety and depression among Hispanic adults. Thus, the current study evaluated the explanatory role of experiential avoidance in the relation between perceived racial discrimination and anxiety/depressive symptoms and disorders among Hispanic adults in primary care. Participants included 202 Spanish-speaking adults ( Mage = 38.99, SD = 12.43, 86.1% female) attending a community-based Federally Qualified Health Center. Results were consistent with the hypothesis that perceived racial discrimination had a significant indirect effect on depression, social anxiety, and anxious arousal symptoms as well as the number of mood and anxiety disorders through experiential avoidance. These findings suggest future work should continue to explore experiential avoidance in the association between perceived racial discrimination and other psychiatric and medical problems among the Hispanic population.
Analysis of exterior beam-column joints under varying column axial load and code comparisons
Authors: Sakr Mohammed A , Saad Ahmad G , El-korany Tamer M
Published: January 2022

This paper presents a finite element (FE) study of beam-column joints subjected to cyclic loading. This study is primarily dependent on investigating the shear behavior of joints under the influence of different column axial load ratios. Wherefore, a total range of the column axial load ratios, whether in tension or compression has been considered. This paper proposes a two-dimensional (2D) FE model that considers material non-linearity. The proposed FE model was verified with experimental results from literature that tested varying column axial load ratios and different failure modes. The examination among experiential and numerical outcomes demonstrated that the FE model can reenact the conduct of beam-column joints and can catch the different failure modes with acceptable accuracy. A parametric study was established using the proposed FE model and strut-and-tie (ST) model of Pauletta to assess the Eurocode joint shear strength equations. For this purpose, four specimens were designed according to Eurocode recommendations while two other specimens were designed to satisfy all of the Eurocode recommendations except for the required joint confinement. An interaction diagram was introduced for each specimen to express the behavior under varying column axial load ratios. The results of the comparison between Eurocode, FE model, and ST model showed some differences in calculating the joint shear strength capacity, especially under column tension loads. Furthermore, this paper proposed new design equations based on Eurocode equations taking into account the column axial load effect. These proposed equations worked to increase the accuracy in calculating the joint shear strength capacity. Proposed equations were compared to the FE model results and other experimental results available in the literature. The comparison showed that the differences with the FE model decreased and that the proposed equations had better accuracy at different tension and compression loads than the Eurocode.
Macro-strain based deflection and neutral axis position monitoring of reinforced concrete beams during corrosion
Authors: Fouad Nariman , Saifeldeen Mohamed A
Published: January 2022

This article proposes a new technique of monitoring neutral axis positions and deflection of Reinforced Concrete (RC) beam during corrosion of steel reinforcement using macro-strain measurements of distributed long-gauge sensors. A different group of distributed long-gauge Packaged Carbon Fiber Line (PCFL) sensors with self-compensation and effective packaging system is installed on the compression and tension fibers of the concrete surface and steel reinforcements of RC beam to verify the proposed method experimentally. An accelerated corrosion method utilizing a salt solution and the constant current was used to achieve the required corrosion levels. The estimated deflection measured by the developed method is compared with the results using Linear Variable Displacement Transducer (LVDTs). It has been demonstrated that long-gauge PCFL sensors could provide the same accuracy. The distributed measured strains were utilized to evaluate the deterioration of the structure’s health with the advance of corrosion. Based on corrosion monitoring experimental results, it can be confirmed that using distributed PCFL sensors mounted on steel reinforcements or concrete surface, the locations and progress of the damage with corrosion time can be detected effectively. The maximum error in the estimated deflection from PCFL sensors mounted on the concrete surface compared to the LVDTs before the onset and after 24 h of accelerated corrosion was 0.5% and 2.5%, respectively.
Development and validation of a progressive web application to educate partial denture wearers
Authors: Ng Jade Yi Ming , Lim Tong Wah , Tarib Natasya , Ho Ting Khee
Published: January 2022

Effective delivery of post-insertion instructions is essential for denture care and oral health. This study aimed to develop a progressive web application (PWA) to educate patients’ chairside and serve as a reference material. A need analysis was conducted before prototype development. Subsequently, the prototype was subjected to content verification, design appraisal and usability testing. The results of usability testing revealed a user task success rate of 94.4%, with an adjusted Wald 95% confidence interval of 83–100%. User satisfaction assessed using the Single Ease Questionnaire and System Usability Score reported a mean score of 6.13 (95% CI: 5.69–6.55) and 85.9 (95% CI: 82.2–89.6), respectively, indicating good usability. This study highlights the systematic approach of developing an evidence-based educational PWA to meet the usability standards for mobile applications. This PWA is useful in clinical studies to explore mobile technologies’ potential in educating denture wearers, especially in the older population.
Change in Abdominal Aortic Aneurysm Sac Diameter After Endovascular Repair: A Single-Center Experience From Taiwan
Authors: Tseng Hsien-Wei , Chang Po-Ya , Chang Chin-Hao , Wu I-Hui , Hsu Ron-Bin , Chan Chih-Yang
Published: January 2022

Purpose:

The purpose of this study was to investigate the change in the diameter of infrarenal abdominal aortic aneurysm (AAA) sacs after endovascular aortic repair (EVAR) in Taiwanese patients and to depict its association with clinical outcomes.

Materials and Methods:

This retrospective cohort study was conducted on patients who underwent EVAR for infrarenal AAA between January 2011 and December 2016. All preoperative and follow-up computed tomography (CT) images were reviewed. Postoperative CT angiography was arranged after 1 month and annually thereafter. The maximal diameter on the axial plane and the maximal diameter perpendicular to the centerline on the coronal and sagittal planes were measured. The study examined post-EVAR sac diameter change over time and compared the differences in adverse events (AEs) among groups.

Results:

The survey included a total of 191 patients with a median follow-up duration of 2.5 (interquartile range: 1.1–2.9) years. Overall survival rates at 1, 2, and 5 years were 92%, 81%, and 76%, respectively. According to their last CT scans, the patients were categorized into 3 groups as follows: shrinkage, stationary, and enlargement, which comprised 58 (30.4%), 118 (61.8%), and 15 (7.9%) patients, respectively. Pre-EVAR characteristics and sac diameters were similar among the groups. Sac shrinkage was exclusively observed in the first 2 years, whereas sac enlargement developed at all follow-up periods. Patients with sac enlargement had higher incidence rates of endoleaks, complications, and reintervention than the other groups.

Conclusion:

Based on our observations, post-EVAR sac shrinkage only occurs in the first 2 years; however, post-EVAR sacs may enlarge at any point and even after 5 years. In our study, patients with sac enlargement had higher rates of adverse events and reintervention.
Reverse Cheese-Wire Septotomy to Create a Distal Landing Zone for Thoracic Endovascular Aortic Repair
Authors: Stern Jordan R. , Pham Xuan-Binh D. , Lee Jason T.
Published: January 2022

Purpose:

The objective of this study is to describe a novel method for creating a distal landing zone for thoracic endovascular aortic repair (TEVAR) in chronic aortic dissection. The technique is described in a patient with prior total arch and descending aortic replacement, with false lumen expansion.

Technique:

A cheese-wire endovascular septotomy was desired to create a single lumen above the celiac axis. To avoid dividing the septum caudally across the visceral segment, we performed a modified septotomy in a cephalad direction. Stiff wires were passed into the prior surgical graft, through true lumen on the right and false lumen on the left. An additional wire was passed across an existing fenestration at the level of the celiac axis, and snared and externalized. 7F Ansel sheaths were advanced and positioned tip-to-tip at the fenestration. Using the stiff wires as tracks, the through-wire was pushed cephalad to endovascularly cut the septum. Angiogram demonstrated successful septotomy, and TEVAR was performed to just above the celiac with successful aneurysm exclusion and no endoleak or retrograde false lumen perfusion. Follow-up computed tomography angiogram (CTA) showed continued exclusion without false lumen perfusion.

Conclusions:

This novel modification in a reverse direction provides an alternative method for endovascular septotomy, when traditional septotomy may threaten the visceral vessels.
Research on the influence of length-width ratio on cruciform parachute airdropping performance
Authors: Cheng Han , Ouyang Yihao , Zhang Ying , Pan Jie
Published: January 2022

Different from the other design parameters in general drogues, there are few studies about the parameter of Length-Width Ratio (LWR). Therefore, the fluid structure coupling model based on the Finite Element Method was used to study the deceleration characteristics and terminal trajectory stability of parachute system in this work. And the graphic transformation technology commonly used in Computer Graphics was used to realize the following of flow field with the trajectory movement. In this work, the cruciform parachutes with different LWR were taken as the research objects, and the above method was used to obtain the trajectory curves, deceleration characteristic curves, and stability curves of the cruciform parachutes under different external conditions. It was found that the deceleration performance was negatively correlated with the LWR when the other design parameters and working conditions remained unchanged, and the trajectory stability and the stability of the parachute were positively correlated with the LWR. Subsequently, the cruciform parachute with the LWR of 4.5 was used for airdropping test, and the accuracy of numerical method used in this work was verified. Then the deceleration processes of cruciform parachute (LWR: 4.5) under different dropping conditions were calculated. It could be found that the external launching conditions had a limited impact on the deceleration performance. The LWR was another design parameter that had a greater impact on the deceleration performance after the parameter of canopy area. Finally, the drag coefficient correction equation representing the deceleration performance was proposed for the first time.
Artificial Intelligence Applications in the Imaging of Epilepsy and Its Comorbidities: Present and Future
Authors: Cendes Fernando , McDonald Carrie R.
Published: January 2022

Artificial intelligence (AI) is increasingly used in medical image analysis and has accelerated scientific discoveries across fields of medicine. In this review, we highlight how AI has been applied to neuroimaging in patients with epilepsy to enhance classification of clinical diagnosis, prediction of treatment outcomes, and the understanding of cognitive comorbidities. We outline the strengths and shortcomings of current AI research and the need for future studies using large datasets that test the reproducibility and generalizability of current findings, as well as studies that test the clinical utility of AI approaches.
Color Doppler and Microvascular Flow Imaging to Evaluate the Degree of Inflammation in a Case of Hidradenitis Suppurativa
Authors: Rumolo Mariateresa , Santarsiere Marika , Menna Biagio Francesco , Minelli Rocco , Vergara Emilia , Brunetti Arturo , Gisonni Pietro
Published: January 2022

Microvascular flow imaging is a new ultrasound technique with better ability than color Doppler imaging to identify small vessels that have slow blood flow, and it permits better evaluation of the features, especially microvascular architecture, of various lesions. We describe a case of inguinal hidradenitis suppurativa in a patient with positive risk factors (young age, female, smoker, and obese), diagnosed by ultrasonography using B-Mode, color Doppler, and finally also with microvascular flow imaging. Our aim is to demonstrate the usefulness of this new technique in characterization of lesions.
Gluten, Inflammation, and Neurodegeneration
Authors: Philip Ashok , White Nicole D.
Published: January 2022

Growing evidence supports a potential link between dietary gluten intake and neurodegenerative disease in susceptible populations. Observational data supporting this link are described along with interventional study data evaluating the effects of restricting gluten from the diet in patients with neurologic disorders. Suggested underlying mechanisms between gluten intake and neurodegeneration are discussed.
Rejecting and retaining aspects of selfhood: Constructing desistance from abuse as a ‘masculine’ endeavour
Authors: Morran David
Published: January 2022

Evaluative studies of men who have attended domestic violence perpetrator programmes have, thus far, paid attention to the question of what they are expected to desist from. This is entirely appropriate. However, the question of what they are expected to achieve, or ‘become’, is less clearly articulated, indeed often overlooked. Based on a series of interviews with men who had completed perpetrator programmes, the narratives explored in this articles suggest that their abusive behaviour was underpinned by fears about how to ‘perform masculinity’ satisfactorily in the past. Consequentially, the programme experience was perceived as threatening or as ‘feminising’. However, the accounts of these men suggest that in desisting from abusive behaviour, issues of identity and processes of behaviour change remain profoundly gendered. Indeed, committing to desistance is perceived as something of an ‘heroic struggle’ in which qualities associated with being a ‘proper man’ are harnessed and utilised in the process.
A Network Pharmacology Perspective Investigation of the Pharmacological Mechanisms of the Herbal Drug FDY003 in Gastric Cancer
Authors: Lee Ho-Sung , Lee In-Hee , Kang Kyungrae , Park Sang-In , Jung Minho , Yang Seung Gu , Kwon Tae-Wook , Lee Dae-Yeon
Published: January 2022

Gastric cancer (GC) is one of the most common and deadly malignant tumors worldwide. While the application of herbal drugs for GC treatment is increasing, the multicompound–multitarget pharmacological mechanisms involved are yet to be elucidated. By adopting a network pharmacology strategy, we investigated the properties of the anticancer herbal drug FDY003 against GC. We found that FDY003 reduced the viability of human GC cells and enhanced their chemosensitivity. We also identified 8 active phytochemical compounds in FDY003 that target 70 GC-associated genes and proteins. Gene ontology (GO) enrichment analysis suggested that the targets of FDY003 are involved in various cellular processes, such as cellular proliferation, survival, and death. We further identified various major FDY003 target GC-associated pathways, including PIK3-Akt, MAPK, Ras, HIF-1, ErbB, and p53 pathways. Taken together, the overall analysis presents insight at the systems level into the pharmacological activity of FDY003 against GC.
Peroneal Stabilization Via Tightening of the Peroneal Tendon Sheath
Authors: Cates Nicole K. , Salerno Nicholas D. , Kavanagh Amber M. , Schuberth John M. , Rubin Laurence G.
Published: January 2022

Peroneal subluxation is a rare but debilitating pathology that can be the result of a superior peroneal retinaculum tear or intrasheath laxity. On clinical examination of both cases, the pathology is observed when the ankle is circumducted in eversion and dorsiflexion. With a superior peroneal retinaculum tear, the tendons dislocate from the peroneal groove, whereas with intrasheath laxity the tendons remain in the groove. In the present case series, peroneal stabilization was performed for both superior peroneal retinaculum tear and intrasheath laxity. With our technique, the fibro-osseous connections of the peroneal tendon sheath are detached from the distal one third of the fibula. Drill holes are made through the fibula for suture to be passed through and the peroneal tendon sheath is reattached to the fibula through horizontal mattress sutures via pants over vest technique to restore tension to the sheath. A total of 5 patients underwent peroneal stabilization, 100% (5/5) of which had preoperative pain with palpation along the peroneal tendons and a palpable click with range of motion of the ankle joint. Postoperatively, 100% (5/5) of the patients were fully weight-bearing, compared to 60% (3/5) preoperatively. No patients had residual subluxation of the peroneal tendons postoperatively or a need for revisional surgery. Residual peroneal tendonitis was present in 20% (1/5) of patients and sural neuritis occurred in 20% (1/5) of patients. The peroneal tendons are physiologically tightened within the peroneal tendon sheath to mitigate the pathologic subluxation, without sacrificing tendons for transfer or using allograft material.

Clinical Level of Evidence: Therapeutic, Case Series, Level 4
Evaluating discrepancy rates of radiology resident provisional reports for cross-sectional body imaging studies at a tertiary hospital
Authors: Kia-Sheng Phua Jonathan , Tim-Ee Cheng Lionel
Published: January 2022

Introduction

Urgent radiological studies obtained during on-call hours are often preliminarily read by on-call residents before consultant radiologists finalise the reports at a later time. Such provisional radiology reports provide important information to guide initial patient management. This study aims to determine discrepancy rates between provisional reports and final interpretations, and to assess the clinical significance of such discrepancies.

Methods

This retrospective quality assurance project reviewed a total of 1218 cross-sectional imaging studies of the body (thorax, abdomen and pelvis) done between July 2015 and May 2016 during on-call hours. The studies included 1201 Computed tomography (CT) scans and 17 Magnetic Resonance Imaging (MRI) scans. Studies with incomplete or unavailable reports were excluded. Conclusions of both the provisional and final reports of each study were reviewed for concordance, with reference to the full report if needed. Discrepancies were graded according to the ACR 2016 RADPEER scoring system.

Results

There were 1210 studies with complete reports. Discrepant reports were noted in 183 (15.1%) studies. Of these, 89 (7.3%) were assessed to be clinically significant and the majority of these (55) were due to interpretations which should be made most of the time. CT of the abdomen and pelvis were the most prone to discrepant reports, accounting for 148 cases (80.9%).

Conclusion

The majority of preliminary reports for on-call body scans were concordant with final interpretations. The discrepancy rates for provisional body scan reports provided by residents while on call were comparable to those previously reported in literature.
Noninformative Vision of Body Movements can Enhance Tactile Discrimination
Authors: Suzuishi Yosuke , Hidaka Souta
Published: January 2022

Vision of the body without task cues enhances tactile discrimination performance. This effect has been investigated only with static visual information, although our body usually moves, and dynamic visual and bodily information provides ownership (SoO) and agency (SoA) sensations to body parts. We investigated whether vision of body movements could enhance tactile discrimination performance. Participants observed white dots without any textural information showing lateral hand movements (dynamic condition) or static hands (static condition). For participants experiencing the dynamic condition first, it induced a lower tactile discrimination threshold, as well as a stronger SoO and SoA, compared to the static condition. For participants observing the static condition first, the magnitudes of the enhancement effect in the dynamic condition were positively correlated between the tactile discrimination and SoO/SoA. The enhancement of the dynamic visual information was not observed when the hand shape was not maintained in the scrambled white dot images. Our results suggest that dynamic visual information without task cues can enhance tactile discrimination performance by feeling SoO and SoA only when it maintains bodily information.
Pacemaker Lead Placement via Transmural Approach in an Adult With Palliated Single Ventricle Heart Disease
Authors: Tunks Robert D. , Myers John L. , Cohen Mark H. , Moser Kevin , Imundo Jason R.
Published: January 2022

Given the lack of systemic venous return to the heart, palliated single ventricle patients frequently require epicardial pacemaker implantation for management of dysrhythmias including sinus node dysfunction, atrial arrhythmias, and heart block. Repeated device hardware replacement, frequently required due to high lead thresholds or other device failure, is a challenging and significant problem for this population. 3-dimensional imaging can assist in delineating the cardiac anatomy allowing for novel approaches to intervention. We review a patient with extracardiac Fontan circulation who underwent placement of an endocardial atrial pacemaker lead via a transmural approach with a 3D-printed model used for procedural guidance.
Does the Interval Slide Procedure Reduce Supraspinatus Tendon Repair Tension?: A Biomechanical Cadaveric Study
Authors: Porschke Felix , Nolte Philip Christian , Knye Christian , Weiss Christel , Studier-Fischer Stefan , Gruetzner Paul Alfred , Guehring Thorsten , Schnetzke Marc
Published: January 2022

Background:

The benefits of the interval slide (IS) procedure in retracted rotator cuff tears remain controversial.

Purpose:

The purpose was to evaluate the effect of the IS procedure on repair tension (RT). It was hypothesized that the IS procedure (anterior IS [AIS], posterior IS [PIS], and intra-articular capsular release [CR]) would reduce the RT of a supraspinatus tendon.

Study Design:

Controlled laboratory study.

Methods:

A total of 31 Thiel-embalmed human cadaveric shoulders (mean age, 74 years; range, 68-84 years) were tested. Full-thickness supraspinatus tendon tears were created, and 1 cm of tendon was resected to simulate a retracted defect. Shoulders were randomized into intervention (n = 16) and control (n = 15) groups. In all shoulders, the load during tendon reduction to footprint was measured, an endpoint was defined as maximum tendon lateralization before 50 N was reached, and the RT (load during lateralization to endpoint) of the native tendon (t1) was evaluated. In the intervention group, AIS (t2), PIS (t3), and CR (t4) were performed in order, with RT measurement after each step. In the control group, RT was assessed at the same time points without the intervention.

Results:

A complete reduction of the tendon was not achieved in any of the shoulders. Mean maximum lateralization was 6.7 ± 1.30 mm, with no significant differences between groups. In the intervention group, the overall IS procedure reduced RT about 47.0% (t1 vs t4: 38.7 ± 3.9 vs 20.5 ± 12.3 N; P < .001). AIS reduced RT significantly (t1 vs t2: 38.7 ± 3.9 vs 27.4 ± 10.5 N; P < .001), whereas subsequent PIS (t2 vs t3: 27.4 ± 10.5 vs 23.2 ± 12.4 N; P = .27) and CR (t3 vs t4: 23.2 ± 12.4 vs 20.5 ± 12.3 N; P = .655) did not additionally reduce tension. Comparison between groups at t4 revealed a reduction of RT of about 47.8% (control vs intervention: 39.3 ± 4.0 vs 20.5 ± 12.3 N; P < .001).

Conclusion:

The IS procedure reduces RT of the supraspinatus tendon in human cadaveric shoulders. However, performing PIS and CR subsequent to AIS does not reduce tension additionally.

Clinical Relevance:

These findings provide surgeons with a biomechanical rationale regarding the efficacy of the IS procedure.
Systematic Review of Intraoperative Blood Salvage in the Surgical Management of Craniosynostosis
Authors: Nathan Shelby , Shang Michelle , Reid Russell
Published: January 2022

Introduction/Background: The purpose of this systematic review is to assess the literature regarding complications associated with intraoperative blood salvage (IOBS) in the setting of surgical management of craniosynostosis. Methods: A systematic review was performed using PubMed/MEDLINE by 2 independent reviewers which included any primary literature investigating the use of IOBS in the surgical management of craniosynostosis. Results: The literature search resulted in 354 initial articles. After removing duplicates and articles not written in English, 330 articles underwent title review, resulting in 25 papers for abstract review. A total of 24 manuscripts were reviewed and 9 were deemed appropriate for inclusion of this systematic review. Two of the nine articles mentioned complications as a secondary objective. Conclusion: There is a paucity of current literature measuring the complications of IOBS in craniosynostosis patients undergoing cranial vault reconstruction.
baredSC: Bayesian approach to retrieve expression distribution of single-cell data
Authors: Lopez-Delisle Lucille , Delisle Jean-Baptiste
Published: January 2022

Background

The number of studies using single-cell RNA sequencing (scRNA-seq) is constantly growing. This powerful technique provides a sampling of the whole transcriptome of a cell. However, sparsity of the data can be a major hurdle when studying the distribution of the expression of a specific gene or the correlation between the expressions of two genes.

Results

We show that the main technical noise associated with these scRNA-seq experiments is due to the sampling, i.e., Poisson noise. We present a new tool named baredSC, for Bayesian Approach to Retrieve Expression Distribution of Single-Cell data, which infers the intrinsic expression distribution in scRNA-seq data using a Gaussian mixture model. baredSC can be used to obtain the distribution in one dimension for individual genes and in two dimensions for pairs of genes, in particular to estimate the correlation in the two genes’ expressions. We apply baredSC to simulated scRNA-seq data and show that the algorithm is able to uncover the expression distribution used to simulate the data, even in multi-modal cases with very sparse data. We also apply baredSC to two real biological data sets. First, we use it to measure the anti-correlation between Hoxd13 and Hoxa11, two genes with known genetic interaction in embryonic limb. Then, we study the expression of Pitx1 in embryonic hindlimb, for which a trimodal distribution has been identified through flow cytometry. While other methods to analyze scRNA-seq are too sensitive to sampling noise, baredSC reveals this trimodal distribution.

Conclusion

baredSC is a powerful tool which aims at retrieving the expression distribution of few genes of interest from scRNA-seq data.
Acceptance and safety of femoral versus radial access for percutaneous coronary intervention (PCI): results from a large monitor-controlled German registry (QuIK)
Authors: Reifart Jörg , Göhring Stefan , Albrecht Alexander , Haerer Winfried , Levenson Benny , Ringwald Gerd , Gärtner Patrick , Reifart Nicolaus
Published: January 2022

Background

In 2015 and 2018, European Society of Cardiology guidelines for percutaneous coronary intervention (PCI) favoring radial access over femoral access were published. These recommendations were based on randomized trials suggesting that patients treated radially experienced reduced bleeding complications and all-cause mortality. We aimed to assess acceptance and results of radial access in a real-world scenario by analyzing all PCI cases in the Quality Assurance in Invasive Cardiology (QuIK) registry.

Methods

The QuIK registry prospectively collects data on all diagnostic and interventional coronary procedures from 148 private practice cardiology centers in Germany. Major adverse cardiac and cerebrovascular events (MACE) were defined as myocardial infarction, stroke, or death during hospitalization.

Results

From 2012 to 2018, 189,917 patients underwent PCI via either access method. The rate of radial approach steadily increased from 13 to 49%. The groups did not differ significantly with respect to age or extent of coronary disease. Femoral approach was significantly more common in patients with ST elevation myocardial infarction and cardiogenic shock. Overall, there were significant differences in MACE (radial 0.12%; femoral 0.24%; p < 0.0009) and access site complications (radial 0.2%; femoral 0.8% (p < 0.0009).

Conclusion

Our data reveals an increase in use of radial access in recent years in Germany. The radial approach emerged as favorable regarding MACE in non-myocardial infarction patients, as well as favorable regarding access site complication regardless of indication for percutaneous intervention.
Health care utilization following “digi-physical” assessment compared to physical assessment for infectious symptoms in primary care
Authors: Entezarjou Artin , Sjöbeck Maria , Midlöv Patrik , Nymberg Veronica Milos , Vigren Lina , Labaf Ashkan , Jakobsson Ulf , Calling Susanna
Published: January 2022

Background

The use of chat-based digital visits (eVisits) to assess infectious symptoms in primary care is rapidly increasing. The “digi-physical” model of care uses eVisits as the first line of assessment while assuming a certain proportion of patients will inevitably need to be further assessed through urgent physical examination within 48 h. It is unclear to what extent this approach can mitigate physical visits compared to assessing patients directly using office visits.

Methods

This pre-COVID-19-pandemic observational study followed up “digi-physical” eVisit patients (n = 1188) compared to office visit patients (n = 599) with respiratory or urinary symptoms. Index visits occurred between March 30th 2016 and March 29th 2019. The primary outcome was subsequent physical visits to physicians within two weeks using registry data from Skåne county, Sweden (Region Skånes Vårddatabas, RSVD).

Results

No significant differences in subsequent physical visits within two weeks (excluding the first 48 h) were noted following “digi-physical” care compared to office visits (179 (18.0%) vs. 102 (17.6%), P = .854). As part of the “digital-physical” concept, a significantly larger proportion of eVisit patients had a physical visit within 48 h compared to corresponding office visit patients (191 (16.1%) vs. 19 (3.2%), P < .001), with 150 (78.5%) of these eVisit patients recommended some form of follow-up by the eVisit physician.

Conclusions

Most eVisit patients (68.9%) with respiratory and urinary symptoms have no subsequent physical visits. Beyond an unavoidable portion of patients requiring urgent physical examination within 48 h, “digi-physical” management of respiratory and urinary symptoms results in comparable subsequent health care utilization compared to office visits. eVisit providers may need to optimize use of resources to minimize the proportion of patients being assessed both digitally and physically within 48 h as part of the “digi-physical” concept.

Trial registration

Clinicaltrials.gov identifier: NCT03474887.
A rare case of renal infarction due to heroin and amphetamine abuse: case report
Authors: Khokhar Suhail , Garcia Daniela , Thirumaran Rajesh
Published: January 2022

Background

Renal infarctions as a result of recreational drug use are rare and are commonly associated with cocaine use. Although amphetamines have a similar mechanism of action as cocaine, there are few reports linking them to ischemic events, and only one to renal infarction. Similarly, few reports link heroin use with infarcts, but never in the kidney. Although uncommon, several mechanisms have been implicated in heroin and amphetamine-induced infarction, including vasculopathy, vasculitis and the activation of the coagulation cascade.

Case Presentation

47-year-old female with a past medical history of non-intravenous heroin and amphetamine abuse, chronic obstructive pulmonary disease, hypertension, hyperlipidemia presented with right lower extremity swelling and rash, which was diagnosed as cellulitis and treated appropriately. Incidentally, the patient was found to have an acute kidney injury and further workup identified multiple renal infarcts in the right kidney. The patient had no past medical history of clotting disorders. Blood culture and urine cultures were sterile; autoimmune and hypercoagulable workup were negative. Urinalysis was unremarkable. Urine toxicology was only positive for opiates and amphetamines, which were thought to be the most likely cause of the renal infarct. Patient was lost to outpatient follow up due to noncompliance, but returned to the hospital for re-emergence of her cellulitis, during which no new infarcts were discovered, and the previous renal infarct had scarred over.

Conclusion

There are very few reports of heroin and amphetamine-induced infarctions. This case report describes a rare but important complication of heroin/amphetamine abuse that could be easily overlooked.
The mediator role of resilience between psychological predictors and health-related quality of life in breast cancer survivors: a cross-sectional study
Authors: Zhou Kaina , Ning Fan , Wang Wen , Li Xiaomei
Published: January 2022

Background

Although many psychological factors have been associated with health-related quality of life (HRQoL), the mediator role of resilience between psychological predictors (i.e., coping styles and perceived social support) and HRQoL has rarely been explored in breast cancer survivors (BCSs).

Methods

A total of 231 BCSs participated in this cross-sectional survey. Pearson correlation was performed to analyze the relationships among coping styles (confrontation, avoidance, and resignation), perceived social support, resilience, and HRQoL. A multivariate linear regression analysis was applied to identify the psychological predictors of HRQoL and resilience, respectively. A structural equation modeling (SEM) was employed to examine the mediating role of resilience between coping styles, perceived social support, and HRQoL.

Results

Perceived social support and resilience were positively associated with confrontation. Resilience was positively associated with perceived social support. HRQoL had positive correlations with confrontation/avoidance, perceived social support, and resilience. Resilience and resignation/avoidance were significant independent predictors of HRQoL, while resignation/confrontation and perceived social support were significant independent predictors of resilience. Confrontation/resignation, perceived social support, and resilience had significant direct effects on HRQoL; confrontation/resignation and perceived social support had significant direct effects on resilience; resilience had significant mediator roles between confrontation/resignation, perceived social support, and HRQoL.

Conclusions

Resilience was a significant mediator between coping styles, perceived social support, and HRQoL. A resilience-oriented intervention is recommended to alleviate the detrimental influences of low resilience on HRQoL, providing a new strategy for improving the health status of BCSs.
Efficacy of rituximab therapy in children with nephrotic syndrome: a 10-year experience from an Iranian pediatric hospital
Authors: Bazargani Behnaz , Noparast Zahra , Khedmat Leila , Fahimi Daryoosh , Esfahani Seyed Taher , Moghtaderi Mastaneh , Abbasi Arash , Afshin Azadeh , Mojtahedi Sayed Yousef
Published: January 2022

Background

There are controversy results in the optimal management of children with steroid-dependent and steroid-resistant nephrotic syndrome (SDNS, SRNS). This study aimed to determine the efficacy and safety of rituximab (RTX) in these pediatric patients.

Methods

Medical records of 1–18-year-old Iranian children with SDNS (n = 26) and SRNS (n = 22) with a follow-up for at least 24 months were included from 2009 to 2019. The short- and long-term responses to RTX were respectively evaluated to determine the random protein-to-creatinine ratio after 6 and 24 months and classified as complete (CR) and partial (PR) remission or no response.

Results

Male patients (n = 26) were slightly predominate. The median age of patients at the time of RTX therapy was 8.6 ± 4.01 years. At the end of the 6-month follow-up, CR and PR occurred in 23 (47.9%) and 12 (25%) patients, respectively. Of 23 patients with CR, 18 (69.2%) and 5(22.7%) had SDNS and SRNS, respectively (p < 0.005). However, only 18 (37.5%) of patients after 24 months had been in CR. No significant difference in the CR rate was found between the two groups. RTX was more effective when administered during the proteinuria-free period (p = 0.001).

Conclusion

In the short term, RTX significantly was efficient in inducing complete or PR in SDNS and SRNS patients. However, the favorable response rate in a long-term follow-up was insignificantly lower between the two groups.
A picture of health: determining the core population served by an urban NHS hospital trust and understanding the key health needs
Authors: Beaney Thomas , Clarke Jonathan M. , Grundy Emily , Coronini-Cronberg Sophie
Published: January 2022

Background

NHS hospitals do not have clearly defined geographic populations to whom they provide care, with patients able to attend any hospital. Identifying a core population for a hospital trust, particularly those in urban areas where there are multiple providers and high population churn, is essential to understanding local key health needs especially given the move to integrated care systems. This can enable effective planning and delivery of preventive interventions and community engagement, rather than simply treating those presenting to services. In this article we describe a practical method for identifying a hospital’s catchment population based on where potential patients are most likely to reside, and describe that population’s size, demographic and social profile, and the key health needs.

Methods

A 30% proportional flow method was used to identify a catchment population using an acute hospital trust in West London as an example. Records of all hospital attendances between 1st April 2017 and 31st March 2018 were analysed using Hospital Episode Statistics. Any Lower Layer Super Output Areas where 30% or more of residents who attended any hospital for care did so at the example trust were assigned to the catchment area. Publicly available local and national datasets were then applied to identify and describe the population’s key health needs.

Results

A catchment comprising 617,709 people, of an equal gender-split (50.4% male) and predominantly working age (15 to 64 years) population was identified. Thirty nine point six percent of residents identified as being from Black and Minority Ethnic (BAME) groups, a similar proportion that reported being born abroad, with over 85 languages spoken. Health indicators were estimated, including: a healthy life expectancy difference of over twenty years; bowel cancer screening coverage of 48.8%; chlamydia diagnosis rates of 2,136 per 100,000; prevalence of visible dental decay among five-year-olds of 27.9%.

Conclusions

We define a blueprint by which a catchment can be defined for a hospital trust and demonstrate the value a hospital-view of the local population could provide in understanding local health needs and enabling population-level health improvement interventions. While an individual approach allows tailoring to local context and need, there could be an efficiency saving were such public health information made routinely and regularly available for every NHS hospital.