bluuebunny/crossref_metadata_2025 huggingface dataset:
Nomograms predict survival of patients with lymph node-positive, luminal a breast cancer
Authors: Li Yilun , Ma Li
Published: August 2021

Background

To develop nomograms for the prediction of the 1-, 3-, and 5-year overall survival (OS) and breast cancer-specific survival (BCSS) for patients with lymph node positive, luminal A breast cancer.

Methods

Thirty-nine thousand fifty-one patients from The Surveillance, Epidemiology, and End Results (SEER) database were included in our study and were set into a training group (n = 19,526) and a validation group (n = 19,525). Univariate analysis and Cox proportional hazards analysis were used to select variables and set up nomogram models on the basis of the training group. Kaplan-Meier curves and the log-rank test were adopted in the survival analysis and curves plotting. C-index, calibration plots and ROC curves were used to performed internal and external validation on the training group and validation group.

Results

Following independent factors were included in our nomograms: Age, marital status, grade, ethnic group, T stage, positive lymph nodes numbers, Metastasis, surgery, radiotherapy, chemotherapy. In both the training group and testing group, the calibration plots show that the actual and nomogram-predicted survival probabilities are consistent greatly. The C-index values of the nomograms in the training and validation cohorts were 0.782 and 0.806 for OS and 0.783 and 0.804 for BCSS, respectively. The ROC curves show that our nomograms have good discrimination.

Conclusions

The nomograms may assist clinicians predict the 1-, 3-, and 5-year OS and BCSS of patients with lymph node positive, luminal A breast cancer.
The landscape of immune checkpoint inhibitor therapy in advanced lung cancer
Authors: Wang Chengdi , Li Jingwei , Zhang Qiran , Wu Jiayang , Xiao Yuxuan , Song Lujia , Gong Hanlin , Li Yalun
Published: August 2021

Background

The advent of immune checkpoint inhibitors (ICIs) therapy has resulted in significant survival benefits in patients with non-small-cell lung cancer (NSCLC) without increasing toxicity. However, the utilisation of immunotherapy for small-cell lung cancer (SCLC) remains unclear, with a scarcity of systematic comparisons of therapeutic effects and safety of immunotherapy in these two major lung cancer subtypes. Herein, we aimed to provide a comprehensive landscape of immunotherapy and systematically review its specific efficacy and safety in advanced lung cancer, accounting for histological types.

Methods

We identified studies assessing immunotherapy for lung cancer with predefined endpoints, including overall survival (OS), progression-free survival (PFS), objective response rate (ORR), and treatment-related adverse events (TRAE), from PubMed, Embase, Medline, and Cochrane library. A random-effects or fixed-effect model was adopted according to different settings.

Results

Overall, 38 trials with 20,173 patients with lung cancer were included in this study. ICI therapy resulted in a significantly prolonged survival in both patients with NSCLC and SCLC when compared with chemotherapy (hazard ratio [HR] = 0.74; 95% confidence interval [CI], 0.70–0.79] and [HR = 0.82; 95% CI, 0.75–0.90], respectively). The magnitude of disease control and survival benefits appeared superior with ICI plus standard of care (SOC) when compared with SOC alone. OS and PFS advantages were observed only when immunotherapy was employed as the first-line treatment in patients with SCLC.

Conclusion

ICI therapy is a promising therapeutic option in patients with NSCLC and SCLC. ICI plus SOC can be recommended as the optimal first-line treatment for patients with SCLC, and double-target ICIs combined with SOC are recommended in patients with NSCLC as both the first and subsequent lines of treatment. Additionally, non-first-line immunotherapy is not recommended in patients with SCLC.
Increasing uptake of colon cancer screening in a medically underserved population with the addition of blood-based testing
Authors: Ioannou Stephanie , Sutherland Kyle , Sussman Daniel A. , Deshpande Amar R.
Published: August 2021

Background

Adherence to colorectal cancer screening in the United States is suboptimal, particularly in medically underserved populations due to significant barriers to care. Unique accessible, low-cost, and non-invasive screening tests for this population could greatly benefit current rates. In this article, we assess patient preference and the impact of offering a blood-based test on screening rates in a cost-free health fair setting from April 2017 to April 2019.

Methods

Participants who met colorectal cancer screening eligibility criteria set forth by the United States Preventive Services Task Force were recommended to attend the colon cancer screening station. Those participants who elected to attend were offered various, accepted screening methods, and if they declined, were offered alternative blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes.

Results

Of 1401 participants who were recommended to attend, 640 (45.7%) participants were evaluated at the colon cancer screening station, of whom 460 were eligible for testing. Amongst these, none selected colonoscopy, 30 (6.5%) selected fecal immunochemical testing, and 430 (93.5%) selected blood-based testing. Only 2 participants returned the fecal immunochemical tests. In the blood test cohort, 88 were positive and 20 received a follow up colonoscopy.

Conclusions

Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.
Prognostic factors of brain metastasis and survival among HER2-positive metastatic breast ﻿cancer patients: a systematic literature review
Authors: Hackshaw Michelle D. , Danysh Heather E. , Henderson Mackenzie , Wang Eric , Tu Nora , Islam Zahidul , Ladner Amy , Ritchey Mary E. , Salas Maribel
Published: August 2021

Background

Patients with breast cancer who overexpress the human epidermal growth factor receptor 2 (HER2) and subsequently develop brain metastasis (BM) typically experience poor quality of life and low survival. We conducted a comprehensive literature review to identify prognostic factors for BM and predictors of survival after developing BM, and the effects of therapies with different mechanisms of action among patients with HER2+ breast cancer (BC).

Methods

A prespecified search strategy was used to identify research studies investigating BM in patients with HER2+ BC published in English during January 1, 2009–to June 25, 2021. Articles were screened using a two-phase process, and data from selected articles were extracted.

Results

We identified 25 published articles including 4097 patients with HER2+ BC and BM. Prognostic factors associated with shorter time to BM diagnosis after initial BC diagnosis included younger age, hormone receptor negative status, larger tumor size or higher tumor grade, and lack of treatment with anti-HER2 therapy. Factors predictive of longer survival after BM included having fewer brain lesions (< 3 or a single lesion) and receipt of any treatment after BM, including radiosurgery, neurosurgery and/or systemic therapy. Patients receiving combination trastuzumab and lapatinib therapy or trastuzumab and pertuzumab therapy had the longest median survival compared with other therapies assessed in this review.

Conclusions

More research is needed to better understand risk factors for BM and survival after BM in the context of HER2+ BC, as well as the assessment of new anti-HER2 therapy regimens that may provide additional therapeutic options for BM in these patients.
Tick-borne encephalitis related uveitis: a case report
Authors: Voulgari Nafsika , Blanc Claire-May , Guido Vanessa , Rossi Daniele C. , Guex-Crosier Yan , Hoogewoud Florence
Published: August 2021

Background

Tick-borne encephalitis (TBE) is an infectious disease of the central nervous system caused by the TBE virus (TBEV), which is usually transmitted by a tick-bite, with increasing incidence in northeastern Europe and eastern Asia during the past decade. Ocular involvement has not been described in the literature to date.

Case presentation

A 58-year-old patient presented to the emergency department with occipital headaches and poor balance for 5 days. He reported a tick-bite 6 weeks before without erythema migrans followed by a flu-like syndrome. Serological testing was negative for Borreliosis and TBEV. At presentation, he was febrile with neck stiffness and signs of ataxia. Three days later, he presented unilateral visual loss in his right eye. Examination revealed non granulomatous anterior uveitis, vitreous inflammation, and retinal haemorrhages at the posterior pole without macular oedema or papillitis. Polymerase chain reaction (PCR) of the cerebrospinal fluid returned negative for all Herpes family viruses. No clinical evidence of other infection nor malignancy was identified. A seroconversion of the TBEV- immunoglobulin titres was observed 2 weeks later while the serum antibodies for Borrelia were still not detected. Magnetic resonance imaging was unremarkable. We concluded to the diagnosis of TBE-related uveitis. Under supportive treatment, there was complete resolution of the neurological symptoms and the intraocular inflammation without sequelae within the following weeks.

Conclusions

We describe a new association of TBEV with uveitis. In view of the growing number of TBE cases and the potential severity of the disease we aim at heightening awareness to achieve prompt recognition, prevention, and treatment.
Ectopic thyroid tissue in the iris: a case report
Authors: Wagner Helena , Auw-Hädrich Claudia , Werner Martin , Reinhard Thomas
Published: August 2021

Background

Ectopic thyroid tissue in the iris, also known as a thyroid glandular epithelial choristoma of the iris, has only been described twice in the literature. In both cases it remained asymptomatic.

Case presentation

A 67-year-old female patient presented for the first time in mid-2017 with corneal endothelial decompensation, with a history of complicated cataract surgery and IStent® implantation. Slit lamp microscopy showed endothelial decompensation, pseudophakia, anterior synechiae and a whitish iris tumour adhering to the endothelium. The latter had existed since childhood. Given these findings, reduced visual acuity of hand movement perception and an intraocular pressure of 23 mmHg, we performed a keratoplasty combined with an en bloc resection of the iris tumour at 9 o’clock and sector iridectomy at the end of 2019. Histological and immunohistological examination of the iris tumour unexpectedly revealed thyroid tissue. After the procedure described above, the patient had an increase in visual acuity while the graft stayed clear and the eye showed no evidence of tumour recurrence or other complications.

Conclusions

We report a third case of ectopic thyroid tissue in the iris. Both previous cases remained asymptomatic, whereas in our case, size and location of the ectopic thyroid tissue contributed to a more complex cataract surgery resulting in endothelial decompensation. Therefore, in such cases appropriate patient information should be provided prior to cataract surgery. Furthermore, careful histological examination and examination of the thyroid is important to exclude malignant diagnoses such as a metastasis of a follicular thyroid carcinoma.
Evaluation of the efficacy, safety, and stability of posterior chamber phakic intraocular lenses for correcting intractable myopic anisometropic amblyopia in a pediatric cohort
Authors: Morkos Fathy Fawzy , Fawzy Nader F. , El Bahrawy Mohamed , Fathy Nada , Elkitkat Rania Serag
Published: August 2021

Background

Myopic anisometropic amblyopia in pediatrics is one of the most challenging clinical situations that can face an ophthalmologist. Conventional correction modalities for myopic anisometropia, using spectacles, contact lenses, and/or occlusion therapy, may not be suitable for some pediatric patients or for some ocular conditions. This may lead to the development of anisometropic amblyopia. The aim of the present study was to evaluate the visual and the refractive efficacy, safety, and stability of Posterior Chamber Phakic Intraocular Lenses (PC-pIOLs) for correcting myopic anisometropic amblyopia in a pediatric cohort.

Methods

This case series, prospective, interventional study was conducted at Watany Eye Hospital, Cairo, Egypt. It comprised children and teenagers with myopic anisometropic amblyopia and unsuccessful conventional therapy. After implantation of Intraocular Collamer Lenses “ICLs” (Visian ICL, Model V4c, STAAR Surgical, Monrovia, California, USA), postoperative follow-up visits were scheduled, with automated refraction and Pentacam imaging performed.

Results

The study enrolled 42 eyes of 42 patients. The age range was 3 to 18 years (mean ± SD = 10.74 years ±4.16). The mean preoperative spherical equivalent (SE) was − 12.85 D ± 2.74. The results declared a significant improvement in the postoperative Corrected Distance Visual Acuity “CDVA” (P value < 0.01) and SE (P value < 0.01). The efficacy index had a value of 1.18 ± 0.3 and the safety index was 1.09 ± 0.24. The follow-up visits had a mean ± SD of 14.67 months ±16.56 (range of 1 to 54 months). The results showed a refractive stability, with statistically insignificant improvements in the patients’ visual acuity and refractive status on evaluating the enrolled pediatrics during the follow-up visits compared to the first postoperative visits. No postoperative complications were encountered. Worthy of mention is that there was a significant (80%) non-compliance with the prescribed postoperative occlusion therapy.

Conclusions

The present study, with the longest reported follow-up range, declared the long-term efficacy, safety, and stability of Visian ICLs for correcting myopic anisometropic amblyopia in pediatrics. The reported non-compliance with occlusion therapy validates the early implantation of Visian ICLs in cases with failed conventional therapy to guard against anisometropic amblyopia.
Long-term effects of intravitreal bevacizumab and aflibercept on intraocular pressure in wet age-related macular degeneration
Authors: Kähkönen Mikael , Tuuminen Raimo , Aaltonen Vesa
Published: August 2021

Background

To evaluate the incidence of sustained elevation of intraocular pressure (SE-IOP) associated with intravitreal injections of anti-vascular endothelial growth factors (anti-VEGF) bevacizumab and aflibercept in patients with wet age-related macular degeneration (wAMD).

Methods

A retrospective cohort study consisting of 120 eyes from 120 patients with anti-VEGF treatment for wAMD. Three different anti-VEGF groups were considered: i) 71 cases receiving bevacizumab only, ii) 49 cases receiving bevacizumab before switch to aflibercept, iii) 49 cases after switch to aflibercept. 120 uninjected fellow eyes served as controls. SE-IOP was defined as an increase from baseline ≥5 mmHg on 2 consecutive follow-up visits. The incidence of SE-IOP was analysed using exact Poisson tests and survival analysis. The time course of IOP was evaluated with linear mixed effect modelling.

Results

In total, 6 treated eyes (2.38% incidence per eye-year) and 9 fellow eyes (3.58% incidence per eye-year) developed SE-IOP, and survival analysis showed no statistically significant difference (p = 0.43). Furthermore, the incidence of SE-IOP did not differ between the three anti-VEGF groups. Comparing the injected eyes of patients under 70 years to those of patients over 70 years, there was a statistically significant difference in survival without SE-IOP (incidence of 16.7% vs 0.7%, respectively,p < 0.0001).

Conclusion

Intravitreal anti-VEGF injections were not associated with sustained elevation of IOP. These results do not support the claim that repeated anti-VEGF injections could elevate IOP.
Barriers, facilitators and solutions for active inclusive play for children with a physical disability in the Netherlands: a qualitative study
Authors: van Engelen L. , Ebbers M. , Boonzaaijer M. , Bolster E. A. M. , van der Put E. A. H. , Bloemen M. A. T.
Published: August 2021

Background

Children with physical disabilities (PD) are less physically active than typically developing peers. The most important contributor to physical activity for primary school-aged children is outside play and therefore this should be part of every child’s life. However, children with PD experience multiple barriers to participation in playgrounds. Despite recent improvements in the accessibility of Dutch playgrounds, the participation of children with PD has not increased. This study aims to explore facilitators, barriers and solutions influencing the participation of children with PD in Dutch outdoor playgrounds, from parents’ and professionals’ perspectives.

Methods

Twelve semi-structured interviews with parents of children with PD aged 2–12 years and five focus group meetings with professionals working with these children were conducted. To ensure data saturation, we performed three member-check meetings. Two independent researchers analyzed the data using an inductive thematic approach.

Results

Similar barriers, facilitators and solutions were mentioned by parents and professionals. Three main themes were identified: the emotional barrier versus the physical barrier, play as a part of an inclusive society and the role of professionals in facilitating active inclusive play. The most important personal factors were physical and social problems experienced when children with PD wanted to join outdoor play. Interestingly, parents and professionals believed the social barrier was far more important than the physical one. The most important environmental factor was that the Dutch society is not sufficiently inclusive.

Conclusions

According to both parents and professionals, the most important barrier to active inclusive outdoor play was social, hindering the participation of children with PD in play with typically developing peers. To overcome such problems, professionals should take an active role in empowering children with PD and their parents. Furthermore, it is important to introduce outdoor active play early, so it becomes part of normal daily life. In addition, a change in the mindset of typically developing children and their parents seems essential to achieve true inclusive active play.
A pilot feasibility study of gabapentin for managing pain in children with dystonic cerebral palsy
Authors: Harvey Adrienne , Waugh Mary-Clare , Rice James , Antolovich Giuliana , Copeland Lisa , Orsini Francesca , Scheinberg Adam , McKinnon Clare , Thorley Megan , Baker Felicity , Chalkiadis George , Stewart Kirsty
Published: August 2021

Background

Gabapentin is often used to manage pain in children with dystonic cerebral palsy, however the evidence for its effectiveness in this population is limited. The primary objective of this feasibility pilot study was to assess the factors which might impact on a future randomised controlled trial including the ability to recruit and retain participants, assess adherence/compliance to the prescribed intervention, and ability to complete all outcome assessments. The secondary objective was to gather preliminary evidence for the effectiveness of gabapentin at reducing pain, improving comfort and reducing dystonia in children with dystonic cerebral palsy.

Methods

This open label pilot study recruited children aged 5–18 years with dystonic cerebral palsy and accompanying pain affecting daily activities from four centres around Australia. Children were prescribed gabapentin for 12 weeks and were assessed at baseline, 6 weeks and 12 weeks. The primary outcome was feasibility of the protocol. Secondary outcomes were pain behaviour, pain intensity, care and comfort, individualised goal setting and dystonia severity.

Results

Thirteen children (mean age 10.4 years (SD 2.4yrs), 9 females) were recruited from 71 screened over 15 months. Two children withdrew while eight children experienced side effects. There were issues with adherence to medication dosage regimens and data collection. Improvements were seen in pain behaviour, comfort and pain related goals at 12 weeks. Dystonia was not significantly changed.

Conclusions

Whilst gabapentin has potential to improve pain and comfort in children with dystonic CP, the feasibility of implementing a definitive randomised controlled trial is low. Alternative trials designs are required to further examine the effectiveness of gabapentin in this heterogeneous population.

Trial registration

The trial was registered with the Australian Clinical Trial Registry (ACTRN12616000366459) on 22/03/2016 and the Therapeutic Goods Administration (CT-2016-CTN-00500-1) on 22/06/2016.
Measuring job stress in transportation workers: psychometric properties, convergent validity and reliability of the ERI and JCQ among professional drivers
Authors: Useche Sergio A. , Alonso Francisco , Cendales Boris , Montoro Luis , Llamazares Javier
Published: August 2021

Background

The accumulated evidence has shown how professional drivers are, in psychosocial terms, among the most vulnerable workforces, and how their crashes (some of them preceded by stressful working conditions) constitute both an occupational and public health concern. However, there is a clear lack of validated tools for measuring stress and other key hazardous issues affecting transport workers, and most of the existing ones, frequently generic, do not fully consider the specific features that properly describe the work environment of professional driving. This study assessed the psychometric properties, convergent validity and consistency of two measures used for researching occupational stress among professional drivers: the Siegrist’s ERI (Effort-Reward Imbalance Inventory) and Karasek’s JCQ (Job Content Questionnaire).

Methods

We examined the data collected from 726 Spanish professional drivers. Analyses were performed using Structural Equation Models, thus obtaining basic psychometric properties of both measures and an optimized structure for the instruments, in addition to testing their convergent validity.

Results

The results suggest that the abbreviated versions of ERI (10 items) and JCQ (20 items) have clear dimensional structures, high factorial weights, internal consistency and an improved fit to the task’s dynamics and hazards, commonly faced by of professional drivers; a short set of items with low psychometrical adjustment was excluded, and the root structure of the questionnaires was kept.

Conclusions

This study supports the value and reliability of ERI-10 and JCQ-20 for measuring job stress among professional drivers. Also, there is a high consistency between both measures of stress, even though they belong to different theoretical conceptions of the phenomenon. In practical settings, these instruments can be useful for occupational researchers and practitioners studying stress-related issues from the perspective of human factors.
LncRNA DLGAP1-AS2 regulates miR-503/cyclin D1 to promote cell proliferation in non-small cell lung cancer
Authors: Wang Lu , Tang Lei , Ge Tengfei , Zhu Feng , Liu Dan , Guo Hua , Qian Peng , Xu Ning
Published: August 2021

Background

LncRNA DLGAP1-AS2 plays an oncogenic role in glioma, while its role in other cancers is unknown. This study aimed to study the role of DLGAP1-AS2 in non-small cell lung cancer (NSCLC).

Methods

Expression of DLGAP1-AS2 in NSCLC and paired non-tumor tissues from 64 NSCLC patients and the prognostic value of DLGAP1-AS2 for NSCLC were analyzed by performing a 5-year follow-up study. The interaction between DLGAP1-AS2 and miR-503 was confirmed by dual luciferase reporter assay, and their relationship was explored in NSCLC cells transfected with DLGAP1-AS2 expression vector or miR-503 mimic. The roles of DLGAP1-AS2 and miR-503 in regulating cyclin D1 expression were analyzed by RT-qPCR and Western blot. Cell proliferation was analyzed by CCK-8 assay.

Results

DLGAP1-AS2 was upregulated in NSCLC and predicted poor survival. Interaction between DLGAP1-AS2 and miR-503 was confirmed by dual luciferase activity assay. Overexpression experiments showed that DLGAP1-AS2 and miR-503 overexpression failed to significantly affect the expression of each other. Interestingly, DLGAP1-AS2 overexpression upregulated cyclin D1, a target of miR-503, increased cell proliferation and reduced the effects of miR-503 overexpression on cyclin D1 expression and cell proliferation.

Conclusions

DLGAP1-AS2 may regulate miR-503/cyclin D1 to promote cell proliferation in NSCLC.
Paraplegia due to intradural cement leakage after vertebroplasty: a case report and literature review
Authors: Baek In-Hwa , Park Hyung-Youl , Kim Ki-Won , Jang Tae-Yang , Lee Jun-Seok
Published: August 2021

Background

Vertebroplasty (VP) is considered an alternative therapy in an osteoporotic compression fracture that failed conservative treatment. However, cement leakage into the intradural space can cause catastrophic complications. To the best of our knowledge, intradural cement leakage following VP has been reported only in 7 cases. We report here a case of intradural cement leakage following VP with a literature review.

Case presentation

An 84-year-old female with an L1 osteoporotic fracture underwent percutaneous VP at a local hospital. Immediately after the procedure, she complained of weakness, numbness, and pain in both legs, and her back pain aggravated. She was transferred to our hospital. The initial muscle power was grade 2 for the right leg and grade 4 for the left leg. Computed tomography (CT) scan showed intradural cement leakage from T10 to L2. Magnetic resonance imaging showed an intradural mass lesion. Although we performed total laminectomy with durotomy and removed intradural cement completely, the neurological deficit did not completely recover. The muscle power was grade 3 for the right leg and grade 4 for the left leg at the last follow-up.

Conlcusions

If a neurological deficit is found after VP, a CT scan should be taken to confirm the pattern of cement leakage. In case of intradural cement leakage, surgical decompression should be recommended to improve neurological deficit. To prevent intradural cement leakage during the VP, the needle tip should not perforate the medial wall of the pedicle with appropriate viscosity of cement.
Does meniscectomy have any advantage over conservative treatment in middle-aged patients with degenerative medial meniscus posterior root tear?
Authors: Lee Nam-Hun , Seo Hyoung-Yeon , Sung Myung-Jin , Na Bo-Ram , Song Eun-Kyoo , Seon Jong-Keun
Published: August 2021

Background

The best treatment for degenerative medial meniscus posterior root tear (MMPRT) remains controversial. This study aimed to compare the clinical and radiological outcomes of arthroscopic meniscectomy and conservative treatment for degenerative MMPRT.

Methods

From January 2007 to December 2014, 146 patients (Meniscectomy group, 90; Conservative group, 56) were evaluated. Clinical outcomes were assessed using the Visual Analog Scale, International Knee Documentation Committee subjective scoring scale, Tegner activity scale, and Lysholm knee scoring scale at the final follow-up. Radiologic outcomes evaluated the progression of osteoarthritis (OA) according to the Kellgren-Lawrence (K-L) classification. We compared the hip-knee-ankle angle (HKAA), medial proximal tibial angle, tibial posterior slope angle, and width of medial joint space. After an average follow-up of 6.3 years, the survivorship was analyzed using the Kaplan–Meier method.

Results

All clinical outcomes were significantly improved in both groups after treatment, with no significant differences between the two groups at the final follow-up. The progression of OA according to the K-L classification, HKAA and width of medial joint space was significantly advanced in the meniscectomy group (p = 0.03, 0.04, 0.03, respectively). The 10-year survival rates in the meniscectomy and conservative groups were 87 and 88%, respectively.

Conclusions

This study demonstrated that both conservative treatment and meniscectomy provided symptomatic relief. However, it was confirmed that OA progression was more severe in the meniscectomy. We conclude that arthroscopic meniscectomy had no advantage over conservative treatment in terms of clinical outcomes and OA progression in middle-aged patients with MMPRT.

Level of evidence

Level III; retrospective comparative study.
Consistency of 3D femoral torsion measurement from MRI compared to CT gold standard
Authors: Häller Thomas Vincent , Schenk Pascal , Jud Lukas , Hoch Armando , Götschi Tobias , Zingg Patrick Oliver
Published: August 2021

Background

Several hip and knee pathologies are associated with aberrant femoral torsion. Diagnostic workup includes computed tomography (CT) and magnetic resonance imaging (MRI). For three-dimensional (3D) analysis of complex deformities it would be desirable to measure femoral torsion from MRI data to avoid ionizing radiation of CT in a young patient population. 3D measurement of femoral torsion from MRI has not yet been compared to measurements from CT images. We hypothesize that agreement will exist between MRI and CT 3D measurements of femoral torsion.

Methods

CT and MRI data from 29 hips of 15 patients with routine diagnostic workup for suspected femoroacetabular impingement (FAI) were used to generate 3D bone models. 3D measurement of femoral torsion was performed by two independent readers using the method of Kim et al. which is validated for CT. Inter-modalitiy and inter-reader intraclass correlation coefficients (ICC) were calculated.

Results

Between MRI and CT 3D measurements an ICC of 0.950 (0.898; 0.976) (reader 1) respectively 0.950 (0.897; 0.976) (Reader 2) was found. The ICC (95% CI) expressing the inter-reader reliability for both modalities was 0.945 (0.886; 0.973) for MRI and 0.957 (0.910; 0.979) for CT, respectively. Mean difference between CT and MRI measurement was 0.42° (MRI – CT, SD: 2.77°, p = 0.253).

Conclusions

There was consistency between 3D measurements of femoral torsion between computer rendered MRI images compared to measurements with the “gold standard” of CT images. ICC for inter-modality and inter-reader consistency indicate excellent reliability. Accurate, reliable and reproducible 3D measurement of femoral torsion is possible from MRI images.
Assessment of knee flexor muscles strength in patients with patellar instability and its clinical implications for the non-surgical treatment of patients after first patellar dislocation - pilot study
Authors: Małecki Krzysztof , Fabiś Jarosław , Flont Paweł , Fabiś-Strobin Anna , Niedzielski Kryspin
Published: August 2021

Background

Biomechanical studies indicate that during outward rotation of the tibia and the valgus knee joint position, the patella is shifted in the lateral direction. After first-time patellar dislocation, the dynamic position of the femur in relation to the tibia plays an important role in joint stability, because the medial stabilizer of the patella (mostly the MPFL) is damaged or inefficient. The most important factor in controlling the rotational movement of the tibia in relation to the thigh are the hamstring muscles. The aim of the study therefore is to determine whether patients with patellar instability have a significant weakness in the knee flexor muscles, which can predispose to recurrent dislocations. This is an important consideration when planning the rehabilitation of patients with first-time patellar dislocation.

Methods

The study enrolled 33 patients with confirmed recurrent patellar dislocation, including six patients with bilateral involvement. In the study group, the hamstring muscles (both sides) were evaluated at velocities of 60 and 180 deg/s for the following parameters: peak torque, torque at 30 degrees of knee flexion, angle of peak torque and peak torque hamstring to quadriceps ratio (H/Q ratio).

Results

In the recurrent patellar dislocation group, a statistically significant weakness in knee flexors was observed for both angular velocities compared to age and gender normative data. No such relationship was observed in the control group of heathy subjects. In patients with one-sided dislocation, no differences were found in knee flexors peak torque, torque at 30 degrees of knee flexion, angle of peak torque or H/Q ratio between the healthy and affected limbs for either angular velocity.

Conclusions

In patients with recurrent patellar dislocation, knee flexors strength is decreased significantly in both the unaffected and affected limbs. This may indicate a constitutional weakening of these muscles which can predispose to recurrent dislocations.

Trial registration

The study was retrospectively registered on ClinicalTrials.gov (NCT04838158), date of registration; 22/03/2021.
Metabolic syndrome and its components are associated with thyroid volume in adolescents
Authors: Xiao Yang , Mao Jingjing , Mao Xiaodong , Wang Qifeng , Li Xingjia , Chen Guofang , Guo Ling , Huang Huaying , Mu Yiming , Xu Shuhang , Liu Chao
Published: August 2021

Objective

To explore the association between metabolic syndrome (MetS) and its component and thyroid volume in Chinese adolescents, and to compare the detection rate of MetS under the three different diagnostic criteria.

Methods

A total of 1097 school students (610 males and 487 females, ages 12–15 years) were enrolled. All the participants underwent physical examination, biochemical test, and thyroid gland ultrasonography. The thyroid volume of normal, overweight and obese group was compared. We also analyzed the association between the number of MetS components and thyroid volume. Linear and multiple linear regression were applied to explore the association between metabolic parameters and thyroid volume.

Results

The thyroid volume of the males in overweight (t = 3.784, P < 0.001) and obese group (t = 5.068, P < 0.001) was significantly larger than that in normal group; the thyroid volume of the females in overweight group (t = 4.627,P < 0.001) was significantly larger than that of normal group. As the number of MetS components increased, the thyroid volume also increased significantly (F = 10.64, P < 0.01). Height, weight, body mass index (BMI), waist circumference, hip circumference, systolic blood pressure, fasting insulin, homeostasis model assessment of insulin resistance (HOMA-IR), uric acid and triglyceride were all positively associated with thyroid volume in the adolescents (P all < 0.001). Meanwhile, there was a negative association between high-density lipoprotein cholesterol (HDL-C) and thyroid volume (P < 0.001). According to multiple linear regression, waist circumference (β = 0.029, 95 %CI: 0.015 ~ 0.042; P < 0.01) and waist height ratio (β = 3.317, 95 %CI: 1.661 ~ 4.973; P < 0.01) were predict factors of thyroid volume. No statistical difference was found in the detection rates of metabolic syndrome under the three diagnostic criteria.

Conclusions

Overweight, obesity and metabolic syndrome was associated with adolescent thyroid volume. Central obesity may be an independent risk factor for thyroid enlargement in adolescents.
Dental vulnerability scale in primary health care: evidence of content and structure internal validity
Authors: da Costa Palacio Danielle , Rebustini Flavio , de Oliveira Daniele Boina , Neto João Peres , Barbieri Wander , Sanchez Thais Paragis , Mafra Ana Carolina Cintra Nunes , Bonfim Daiana , Nascimento Monteiro Camila , Filho Valmir Vanderlei Gomes , Ribeiro Danielle Viana , Loschiavo Leandro Marsico , Miraglia João Luiz , Pereira Antonio Carlos
Published: August 2021

Background

Access to oral health services remains a challenge in the Brazilian healthcare system, especially in the primary health care setting, where the use of a risk stratification tool that could identify individuals with higher dental vulnerability would be extremely valuable. However, there literature on this theme is scarce, and there is no validated instrument in Brazil that is capable of measuring dental vulnerability. Hence, this psychometric study aimed at the development and evaluation of content and internal structure validity of the Dental Vulnerability Scale for Primary Health Care (PHC).

Methods

The items were developed based on a qualitative exploratory analysis. A total of 172 items were prepared and submitted to a panel of specialists, with content validity analyzed with the Content Validity Ratio (CVR), resulting in an the initial version of the instrument composed by 41 items. Internal structure validity was analyzed by Exploratory Factor Analysis (EFA), Confirmatory Factor Analysis (CFA), and by applying 3 reliability indicators (Cronbach’s Alpha, McDonald's Omega and Greatest Lower Bound – GBL), with a sample of 1227 individuals.

Results

The final configuration indicated a scale of 15 items divided into 4 dimensions (overall health, oral health, infrastructure, and healthcare services) with explained variance of 72.11%. The factor loads varied from 0.37 to 0.96. The model adjustment indices were set at × 2/df(51) = 3.23, NNFI = 0.95, CFI = 0.98, GFI = 0.96, AGFI = 0.97, RMSEA = 0.04 and RMSR = 0.03.

Conclusion

DVS presented satisfactory evidence of validity, indicating its suitability to be used by healthcare professionals, students and managers to plan oral health actions and services at PHC.
Influence of active versus passive parental presence on the behavior of preschoolers with different intelligence levels in the dental operatory: a randomized controlled clinical trial
Authors: AlDhelai Thiyezen Abdullah , Khalil Amani Mohamed , Elhamouly Yasmine , Dowidar Karin M. L.
Published: August 2021

Background

Dental fear and anxiety still pose the most common factors proposed for the child’s negative behavior in the dental operatory. Intelligence has an impact on the children’s communication, feelings, and responsiveness to dental situations. The benefits of parental presence on reinforcing the child’s behavior during dental treatment are still debatable. This study aimed to assess the effect of parental active versus parental passive presence techniques on the overall behavior of preschool children with different intelligence levels.

Methods

This randomized controlled trial was conducted from December 2017 to August 2019. It recruited 150 healthy children, 3–6-year-old, with no history of previous dental pain/treatment, and intelligence quotient level of 70– ≤ 110 stratified into 3 equal groups (high, average, low). In the first visit, each IQ group was randomly divided into test (PAP) and control (PPP) groups. In the second visit, dental fear was assessed before preventive intervention, the test groups were then managed using parental active presence technique, while the control groups were managed using parental passive presence technique. The overall behavior was assessed at the end of the visit. Data was analyzed using Chi-square test and logistic regression analysis.

Results

The parental active presence technique had significant effect on children with high and low intelligence quotients. There were significantly higher odds of positive behavior in high than low intelligence quotient children, (OR 4.08, 95% CI 1.43, 11.67, P = 0.01). The parental active presence technique had significantly higher odds of positive behavior than the parental passive presence technique, (OR 4.08, 95% CI 1.71, 9.76, P = 0.002).

Conclusions

The parental active presence technique had positively influenced the children’s overall behavior irrespective of their intelligence levels. This trial was retrospectively registered, trial identifier number: NCT04580316, 8/11/2020.
Higher levels of unmet support needs in spouses are associated with poorer quality of life – a descriptive cross-sectional study in the context of palliative home care
Authors: Norinder Maria , Årestedt Kristofer , Lind Susanne , Axelsson Lena , Grande Gunn , Ewing Gail , Holm Maja , Öhlén Joakim , Benkel Inger , Alvariza Anette
Published: August 2021

Background

Family caregivers often report having unmet support needs when caring for someone with life-threatening illness. They are at risk for psychological distress, adverse physical symptoms and negatively affected quality of life. This study aims to explore associations between family caregivers’ support needs and quality of life when caring for a spouse receiving specialized palliative home care.

Methods

A descriptive cross-sectional design was used: 114 family caregivers completed the Carer Support Needs Assessment Tool (CSNAT) and the Quality of Life in Life-Threatening Illness – Family caregiver version (QOLLTI-F) and 43 of them also answered one open-ended question on thoughts about their situation. Descriptive statistics, multiple linear regression analyses, and qualitative content analysis, were used for analyses.

Results

Higher levels of unmet support needs were significantly associated with poorer quality of life. All CSNAT support domains were significantly associated with one or more quality of life domains in QOLLTI-F, with the exception of the QoL domain related to distress about the patient condition. However, family caregivers described in the open-ended question that their life was disrupted by the patient’s life-threatening illness and its consequences. Family caregivers reported most the need of more support concerning knowing what to expect in the future, which they also described as worries and concerns about what the illness would mean for them and the patient further on. Lowest QoL was reported in relation to the patient’s condition, and the family caregiver’s own physical and emotional health.

Conclusion

With a deeper understanding of the complexities of supporting family caregivers in palliative care, healthcare professionals might help to increase family caregivers’ QoL by revealing their problems and concerns. Thus, tailored support is needed.
Evaluation of the effect of multipoint intra-mucosal vaginal injection of a specific cross-linked hyaluronic acid for vulvovaginal atrophy: a prospective bi-centric pilot study
Authors: Berreni Nicolas , Salerno Jennifer , Chevalier Thierry , Alonso Sandrine , Mares Pierre
Published: August 2021

Background

Vulvo-vaginal atrophy (VVA) is one of the common consequences of estrogen deficiency especially after the menopause. Several studies have assessed the effects of Hyaluronic acid (HA) on physical and sexual symptoms associated with VVA with promising results. However, most of these studies have focused on subjective assessment of symptom response to topically administered preparations. Nonetheless, HA is an endogenous molecule and it is logical that its effects are best realized if injected in the superficial epithelial layers. Desirial® is the first crosslinked HA that is administered by injection in the vaginal mucosa. The aim of this study was to explore the effect of multipoint vaginal intra-mucosal injections of specific cross-linked hyaluronic acid (DESIRIAL®, Laboratoires VIVACY) on several clinical and patient reported core outcomes.

Methods

A cohort bi-centric pilot study. The chosen outcomes included change in vaginal mucosa thickness, biological markers for collagen formation, vaginal flora, vaginal pH, vaginal health index, vulvo-vaginal atrophy symptoms and sexual function 8 weeks post Desirial® injection. Patients’ satisfaction was also assessed using the patient global impression of improvement (PGI-I) scale.

Results

A total of 20 participants were recruited between 19/06/2017 and 05/07/2018. At the end of the study, there was no difference in the median total thickness of the vaginal mucosa or in procollagen I, III or Ki67 fluorescence. However, there was a statistically significant increase in COL1A1 and COL3A1 gene expression (p = 0.0002 and p = 0.0010 respectively). There was also a significant reduction in reported dyspareunia, vaginal dryness, vulvar pruritus, vaginal chafing and significant improvement in all female sexual function index dimensions. Based on PGI-I, 19 patients (95%) reported varying degrees of improvement where, 4 (20%) felt slightly better; 7 (35%) better and 8 (40%) much better.

Conclusions

Multi-point vaginal intra-mucosal injections, of Desirial® (a crosslinked HA) was significantly associated with the expression of CoL1A1 and CoL3A1 suggesting stimulation of collagen formation. Furthermore, there was a significant reduction in VVA symptomatology and a significant improvement in patient satisfaction and sexual function scores. However, there was no demonstrable change in the total vaginal mucosal thickness.

Study registration ID-RCB: 2016-A00124-47, Protocol code number: LOCAL/2016/PM-001.
Comparison of various aspects of women’s lives between infertile and women with and without tubal ligation: a comparative cross-sectional study
Authors: Ashrafi Mahnaz , Sadatmahalleh Shahideh Jahanian , Mirzaei Negin , Jahangiri Nadia , Youseflu Samaneh , Nasiri Malihe
Published: August 2021

Background

The aim of this study is to compare anxiety, depression, body image, self-esteem, sexual function, and quality of life (QoL) between infertile women and control fertile women undergoing tubal ligation (TL) and using condom.

Methods

This cross-sectional study was conducted on 600 women in three groups of infertile and control fertile women with or without TL (200 women in each group), who met the inclusion criteria. They were selected from Royan Institute and a number of health care centers in Tehran (Iran) from May 2017 to February 2019. The subjects were asked to fill out the Short Form Health Survey (SF-12), Female Sexual Function Index (FSFI), Hospital Anxiety and Depression Scale (HADS), Body Image Concern Inventory (BICI), and Rosenberg’ Self-Esteem Scale (RSES). One-way ANOVA was used to identify the possible statistical differences between the three groups of participants.

Results

The mean scores of all FSFI domains were lower in the control TL women, and the differences between the three groups in all dimensions were statistically significant. In addition, the TL group had more female sexual dysfunction (FSD) comparing to the infertile and condom group (22.43 ± 5.30, 24.79 ± 4.74, and 28.03 ± 3.29, respectivelyP <  0.001). There was a significant difference between the three groups in SF-12 scores (76.59 ± 13.14, 68.49 ± 14.47, and 78.87 ± 12.62, respectivelyP < 0.001). Also there was a significant difference between the three groups in anxiety, depression, and total scores of HADS (P < 0.001). Furthermore, infertile women had lower body image (P < 0.05) and the TL group had lower self-esteem comparing to the two other groups (P  < 0.05).

Conclusions

The findings revealed the adverse effects of using TL on the anxiety, depression, sexual life, body image, and QoL of women. It is recommended that health-care professionals should increase their awareness and knowledge regarding the side-effects of using TL on women’s lives and share this information with the patients.
Fertility preservation in patients with uterus didelphys and endometrial carcinoma: a case report
Authors: Yu Jiao , Shang Jing , Wen Hongwu , Xu Yang
Published: August 2021

Background

Endometrial cancer combining uterus didelphys is quite rare clinically which partially explains that there is no discussion about young patients’ fertility preservation and follow up of tumor outcome.

Case presentation

In this article, we report a case of unilateral endometrial carcinoma found in a young patient with uterus didelphys who was treated with high-efficiency progesterone due to unfinished child-bearing. During the follow-up, the affected uterine endometrium was not reversed by progesterone. So, the patient underwent the abdominal surgery with the left uterus and left fallopian tube resection. We performed three consecutive immunohistochemical studies of the contralateral uterine endometrium to verify the safety of preserving the contralateral uterus and its appendages which preserved her fertility.

Conclusions

Endometrial cancer occurring in patients with uterus didelphys is quite rare in child-bearing age. In this case report, we preserved the patient’s contralateral uterus based on patient’s strong needs and negative IHC analysis of the preserved side uterine endometrium. However, the tumor and fertility outcome require more follow-up.