bluuebunny/crossref_metadata_2025 huggingface dataset:
Reliability analysis and selective maintenance for multistate queueing system
Authors: Tang Tang , Jia Lijuan , Hu Jin , Wang Yue , Ma Cheng
Published: July 2021

The reliability theory of the multi-state system (MSS) has received considerable attention in recent years, as it is able to characterize the multi-state property and complicated deterioration process of systems in a finer way than that of binary-state system. In general, the performance of the task processing type MSS is typically measured by an operation time (processing speed). Whereas, considering the queueing phenomenon caused by the random arrival and processing of tasks, some other criteria should be taken into account to evaluate the quality of service (QoS) and the profit of stakeholders, such as waiting time, service and abandon rate of tasks and consequent profit rate. In this article, we focus on the queueing process of tasks and analyse the performance and reliability of MSS in an M/M/2 queueing model, which is referred to as a multi-state queueing system (MSQS). Two kinds of deterioration are studied including the gradual degradation of servers and the sudden breakdown of the whole system. A performance assessment function is defined to obtain the profit rate of MSQS in different performance states. Based on the proposed performance function, the selective maintenance method is studied to optimize the accumulated profit under the constraint of maintenance resource and time.
The risks and benefits of early venous thromboembolism prophylaxis after elective spinal surgery: A single-centre experience
Authors: Kiguchi Misaki M , Schobel Hannah , TenEyck Emily , Earls Brent , Pan-Chen Sarah , Freedman Elizabeth , Ives Amy L , Rungkitwattanakul Dhakrit , Mo Fred , Woo Edward Y
Published: July 2021

Background

There is a wide ranging incidence of venous thromboembolism after surgery and it continues to be a major cause of morbidity after spinal procedures.This study’s aim was to investigate the relationship between timing and administration of venous thromboembolism (VTE) pharmacologic chemoprophylaxis after spinal surgery and the resulting VTE and bleeding complications by reviewing current practices and outcomes at a high-volume single institution to better define opportunities for perioperative intervention to prevent VTE without increasing bleeding complications.

Methods

All patients who underwent elective one or two-stage lumbar spinal fusion procedures were identified. A logistic regression was used to evaluate (1) risk of symptomatic VTE within 30 days of surgery and (2) bleeding-related complications. The odds of developing a VTE as well as bleeding-related complications were compared among the three treatment groups: no chemoprophylaxis, chemoprophylaxis < 24h of surgery and chemoprophylaxis given > 24h post-surgery.

Results

When adjusted for doses administered, the odds of developing a postoperative VTE within 30 days were 0.189 (95% confidence interval (0.044, 0.808)) in patients who received anticoagulation < 24h postoperatively, compared to those who received no anticoagulation (p = 0.025). There was no difference in bleeding rates.

Conclusion

Patients undergoing elective spinal surgery who received anticoagulation within 24h of the conclusion of their procedure had an 81% reduction in the odds of developing a deep vein thrombosis within 30 days with no significant difference in bleeding complications.
Drug-Drug interaction among admitted patients at primary, district and referral hospitals’ medical wards in East Gojjam Zone, Amhara Regional State, Ethiopia
Authors: Tessema Zenaw , Yibeltal Desalegn , Wubetu Muluken , Dessie Bekalu , Molla Yalew
Published: July 2021

Objectives:

This study was aimed to assess the type, prevalence, characteristics of drug interaction and factors associated from admitted patients in medical wards at primary, district and referral hospitals in East Gojjam Zone, Amhara Regional State, Ethiopia.

Methods:

A facility-based retrospective cross-sectional study design was conducted among admitted patients in medical wards at different hospitals of East Gojjam Zone from September 2019 to February 2020. Patient-specific data were extracted from patient medical prescription papers using a structured data collection tool. Potential drug–drug interaction was identified using www.drugs.com as drug–drug interaction checker. Data were analyzed using SPSS version 23.0. To identify the explanatory predictors of potential drug–drug interaction, logistic regression analysis was done at a statistical significance level of p-value < 0.05.

Results:

Of the total 554 prescriptions, 51.1% were prescribed for females with a mean (±standard deviation) age of 40.85 ± 23.09 years. About 46.4% prescriptions of patients had one or more comorbid conditions, and the most frequent identified comorbid conditions were infectious (18.6%) and cardiac problems (6.3%) with 0.46 ± 0.499 average number of comorbid conditions per patient. Totally, 1516 drugs were prescribed with 2.74 ± 0.848 mean number per patient and range of 2–6. Two hundred and forty-two (43.7%) prescriptions had at least one potential drug–drug interaction, and it was found that 292 drug interactions were presented. Almost half of the drug–drug interaction identified was moderate (50%). Overall, the prevalence rate of drug–drug interaction was 43.7%. Older age (adjusted odds ratio = 8.301; 95% confidence interval (5.51–12.4), p = 0.000), presence of comorbidities (adjusted odds ratio = 1.72; 95% confidence interval (1.10–2.68), p = 0.000) and number of medications greater or equal to 3 (adjusted odds ratio = 2.69; 95% confidence interval (1.42–5.11), p = 0.000) were independent predictors for the occurrence of potential drug–drug interaction.

Conclusion:

The prevalence of potential drug–drug interaction among admitted patients was relatively high. Pharmacodynamic drug–drug interaction was the common mechanism of drug–drug interaction with moderate degree. Therefore, close follow-up of hospitalized patients is highly recommended.
InstaMigrants: Global Ties and Mundane Publics of Russian-Speaking Bloggers with Migration Background
Authors: Smoliarova Anna , Bodrunova Svetlana S
Published: July 2021

Russian-speaking diaspora has spread across the world during the last century and plays a significant role in cultural and political life of the host countries. But its virtual presence remains heavily understudied; it is only Russian-speaking news websites that have received some scholarly attention. This study aims at estimating the globality of mass self-communication of Russian emigrants on Instagram in the context of virtual diaspora studies as a new form of imagined communities. Instagram communication of emigrants illustrates how the nature of mass self-communication influences the nature of ties between diaspora members. We confirm the global scale of ties that are developed by the Russian-speaking “InstaMigrants” by network analysis. We also show that such seemingly apolitical publics possess a potential for politicization of everyday life and migration experience in unconventional ways.
Identifying the Moderating and Mediating Variables in Parental Mediation Practices in Nigerian Families in the Digital Age
Authors: Adigwe Ifeanyi
Published: July 2021

This study examined the moderating and mediating variables in parental mediation practices in Nigerian families in the digital age. This study applied a multi-stage sampling technique to achieve an adequate representation of the population in six educational districts in Lagos, Nigeria. The study included 1,270 adult sample. Data were obtained through questionnaire from parents of children in the selected schools. Findings of the study showed that a strong and positive relationship exists between parent’s age and educational level and parent’s gender and educational level. These relationships were evident as strong moderating variables for the four mediation strategies measured in this study. It was found that, relating to the digital literacy of parents, the hierarchical regression analyses showed that only 7% of variance in parental mediation practice, in the case of participatory learning, was explained. By implication, the constructs of digital literacy are more relevant to participatory learning mediation practice compared to other parental mediation practices in the context of Nigerian families.
How Black Teen Girls Navigate Social Media to Form Romantic Relationships
Authors: Weser Veronica U. , Opara Ijeoma , Sands Brandon E. , Fernandes Claudia-Santi F. , Hieftje Kimberly D.
Published: July 2021

The purpose of this study was to explore the use of social media within the context of heterosexual Black teen girls’ romantic partner selection processes. To better understand Black teen girls’ experiences, five focus groups ( N = 27; aged 14–18 years) were conducted over Zoom. An inductive thematic analysis revealed four major themes: (1) the use of different platforms to gather different types of information, (2) the rules of social media scouting, (3) detecting partner qualities through social media, and (4) exploring Black teen girls’ experience with social media and dating. Participants in our study primarily used Instagram to understand a potential partner’s true self, while Twitter was used to assess a potential partner’s political leanings. Our participants shared numerous “rules” related to the partner-scouting process. Black teen girls in our study explained that photos index a potential partner’s style and hygiene, while memes were used to gauge sense of humor compatibility. More specific to Black teen girls, across all focus groups, participants shared their experiences of racism and bias, such as being associated with Black stereotypes, cultural invalidation, and being accused of “acting White.” Although teen girls of various racial and ethnic groups may use social media to vet romantic partners, findings reveal that Black teen girls navigate social media in a unique way, including being highly attuned to signs of bias. Our findings suggest that in the first few months of COVID-19 social distancing had little impact on our participant’s practice of using social media to vet potential romantic partners.
Work Experiences and Challenges to Employment Sustainability for People With Mental Illness in Supported Employment Programs
Authors: Shankar Janki , Li Lun , Tan Shawn
Published: July 2021

Supported employment (SE) is an evidence-based program that has shown much promise in helping people with severe mental illnesses (SMIs) to gain and sustain competitive employment. However, there are significant variations in employment outcomes across SE programs in Canada that can be partly explained by SE service users’ experiences in their work environment. The work environment can exert a considerable influence on the interest in and ability to sustain the employment of a person with an SMI. This study explores the work experiences of individuals with SMIs who are involved in an SE program and who understand the challenges of and barriers to sustaining such employment. Semistructured, in-depth interviews were conducted with 15 individuals with SMIs, and the data were analyzed using a constructivist grounded theory approach. Challenges to the employment sustainability of an individual with SMI were found to arise primarily from three intersecting contexts: the SE program, the work environment, and the larger Canadian labor market. The findings suggest that SE programs will better promote employment sustainability if they adhere closely to individual placement and support model of SE. SE service providers (employment specialists) must be equipped with a wide range of knowledge and skills to meet the needs of individuals with SMIs if sustainable employment is to be achieved. It is recommended that there must be investment in training for employment specialists to assist SE service users to achieve sustainable employment outcomes.
Wooden Chest Syndrome: A Case Report of Fentanyl-Induced Chest Wall Rigidity
Authors: Rosal Nathaniel R. , Thelmo Franklin L. , Tzarnas Stephanie , DiCalvo Lauren , Tariq Shafaq , Grossman Craig
Published: July 2021

Wooden chest syndrome (WCS) describes a finding of fentanyl-induced skeletal muscle rigidity causing ventilatory failure. Known primarily to anesthesiology, pulmonary, and critical care fields, WCS is a rare complication that may affect patients of all ages if exposed to intravenous fentanyl, characterized by a patient’s inability to properly ventilate. Given the rise of synthetic opioid deaths across the United States in the past decade, an understanding of all of fentanyl’s effects on the body is necessary. In this article, we present a case of WCS in a patient with acute respiratory distress syndrome in a 61-year-old female.
The Outcomes of Interprofessional Experiential Learning for Underrepresented Racial/Ethnic Minority Students to Address Latino Childhood Obesity
Authors: Garcia Melawhy L. , Nguyen-Rodriguez Selena T. , Gatdula Natalia , Aguirre Diana , Rascon Mayra , Bird Mara , Rios-Ellis Britt , Frank Gail C.
Published: July 2021

Addressing Latino childhood obesity requires effective health promotion programs and culturally resonant health professionals. The current profiles of public health professionals and registered dietitians point to the need to increase the number of Latino students trained in community-based participatory research and engagement of underserved populations. To address this workforce gap, the Center for Latino Community Health, Evaluation, and Leadership Training developed the Sanos y Fuertes: Healthy & Strong Graduate Research Fellowship to provide Latino graduate students with research training, professional development, and mentorship. Five cohorts of seven graduate students participated in a yearlong experiential learning program. Graduate research fellows received monthly research and professional development training from faculty, staff, and community health workers. Furthermore, fellows engaged in mentored research through the development and implementation of a Latino childhood obesity prevention curriculum and intervention. A mixed-method evaluation approach was used to assess the effectiveness of the program. Fellows completed baseline, posttraining, and follow-up assessments. Assessment surveys measured training experiences (e.g., research methods, community engagement), confidence (e.g., research methods, health education), and knowledge and skills (e.g., community health program skills). The training resulted in significant increases in skills and confidence between pre- and postassessments that were sustained at follow-up. Based on these findings, we recommend that student training programs include research as experiential learning with multidisciplinary, interprofessional teams and that community-based, community-engaged, or translational research teams include community health workers as integral members for research with marginalized, underserved populations.
Allies Welcomed to Advance Racial Equity (AWARE) Faculty Seminar Series: Program Design and Implementation
Authors: Tucker Edmonds Brownsyne , Neal Chemen , Shanks Anthony , Scott Nicole , Robertson Sharon , Rouse Caroline E , Bernard Caitlin , Sotto-Santiago Sylk
Published: July 2021

Introduction:

In the wake of George Floyd’s murder, White faculty in our department began to express the desire to gain a greater understanding of structural racism and racial inequity. To facilitate this learning, support allyship, and mitigate the emotional labor and taxation that frequently falls on faculty of color to respond to these appeals, we developed AWARE (Allies Welcomed to Advance Racial Equity), a faculty seminar series primarily designed for and led by a majority White faculty to tackle the topics of structural racism, Whiteness, and Anti-racist action.

Methods:

We developed a 6-session seminar series, identifying 5 White faculty as lecturers and a cadre of Black and White volunteer facilitators, to lead 60-minute sessions comprised of lecture, facilitated small group reflection, and large group sharing, that reviewed key topics/texts on structural racism, Whiteness, and Anti-racism.

Results:

Attendance ranged from 26 to 37 participants at each session. About 80% of faculty participated in at least 1 session of the program. The majority of participants (85%) felt “more empowered to influence their current environment to be more inclusive of others” and were “better equipped to advocate for themselves or others.” Most (81%) felt “more connected to their colleagues following completion of the program.” Ultimately, faculty thought highly of the program upon completion with 26/27 (96%) stating they would recommend the program to a colleague.

Discussion:

We offer a reproducible model to improve departmental climate by engaging in the shared labor of educating our colleagues and communities about structural racism, Whiteness, and Anti-racism to create a point of entry into reflection, dialogue, and deliberate actions for change.
Fecal microbiome differs between patients with systemic sclerosis with and without small intestinal bacterial overgrowth
Authors: Levin Daniel , De Palma Giada , Zou Hannah , Bazzaz Ava Hadi Zadeh , Verdu Elena , Baker Barbara , Pinto-Sanchez Maria Ines , Khalidi Nader , Larché Maggie J , Beattie Karen A. , Bercik Premysl
Published: July 2021

Introduction:

Gastrointestinal manifestations of systemic sclerosis affect up to 90% of patients, with symptoms including diarrhea and constipation. Small intestinal bacterial overgrowth is a condition associated with increased numbers of pathogenic bacteria in the small bowel. While currently unknown, it has been suggested that dysregulation of the fecal microbiota may play a role in the development of systemic sclerosis and small intestinal bacterial overgrowth.

Objectives:

Our study aimed to describe the fecal microbiota of patients with systemic sclerosis and compare it between those with and without a diagnosis of small intestinal bacterial overgrowth. We also compared the fecal microbiota of systemic sclerosis patients with that of healthy controls to understand the association between particular bacterial taxa and clinical gastrointestinal manifestations of systemic sclerosis.

Methods:

A total of 29 patients with systemic sclerosis underwent breath testing to assess for small intestinal bacterial overgrowth, provided stool samples to determine taxonomic assignments, and completed the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract 2.0, which details symptoms and quality-of-life factors. Stool samples were compared between systemic sclerosis patients with and without small intestinal bacterial overgrowth, and between patients with systemic sclerosis and a healthy control cohort (n = 20), aged 18–80 years.

Results:

Fecal microbiome analyses demonstrated differences between systemic sclerosis patients with and without small intestinal bacterial overgrowth and differences in the diversity of species between healthy controls and patients with systemic sclerosis. Trends were also observed in anticentromere antibody systemic sclerosis patients, including higher Alistipies indistincus spp. levels associated with increased methane levels of breath gas testing and higher Slakia spp. levels associated with increased rates of fecal soiling.

Conclusions:

Our results suggest that changes to the fecal microbiome occur in patients with small intestinal bacterial overgrowth and systemic sclerosis when compared to healthy controls. As a cross-sectional study, the potential pathophysiologic role of an altered microbiome in the development of systemic sclerosis was not considered and hence needs to be further investigated.
Uncovering the effects of heterogeneity and parameter sensitivity on within-host dynamics of disease: malaria as a case study
Authors: Horn Shade , Snoep Jacky L. , van Niekerk David D.
Published: July 2021

Background

The fidelity and reliability of disease model predictions depend on accurate and precise descriptions of processes and determination of parameters. Various models exist to describe within-host dynamics during malaria infection but there is a shortage of clinical data that can be used to quantitatively validate them and establish confidence in their predictions. In addition, model parameters often contain a degree of uncertainty and show variations between individuals, potentially undermining the reliability of model predictions. In this study models were reproduced and analysed by means of robustness, uncertainty, local sensitivity and local sensitivity robustness analysis to establish confidence in their predictions.

Results

Components of the immune system are responsible for the most uncertainty in model outputs, while disease associated variables showed the greatest sensitivity for these components. All models showed a comparable degree of robustness but displayed different ranges in their predictions. In these different ranges, sensitivities were well-preserved in three of the four models.

Conclusion

Analyses of the effects of parameter variations in models can provide a comparative tool for the evaluation of model predictions. In addition, it can assist in uncovering model weak points and, in the case of disease models, be used to identify possible points for therapeutic intervention.
Comprehensive analysis of formin gene family highlights candidate genes related to pollen cytoskeleton and male fertility in wheat (Triticum aestivum L.)
Authors: Duan Wen-jing , Liu Zi-han , Bai Jian-fang , Yuan Shao-hua , Li Yan-mei , Lu Feng-kun , Zhang Tian-bao , Sun Jia-hui , Zhang Feng-ting , Zhao Chang-ping , Zhang Li-ping
Published: July 2021

Background

Formin, a highly conserved multi-domain protein, interacts with microfilaments and microtubules. Although specifically expressedformingenes in anthers are potentially significant in research on male sterility and hybrid wheat breeding, similar reports in wheat, especially in thermo-sensitive genic male sterile (TGMS) wheat, remain elusive.

Results

Herein, we systematically characterized theformingenes in TGMS wheat line BS366 namedTaFormins(TaFHs) and predicted their functions in inducing stress response. In total, 25TaFHgenes were uncovered, majorly localized in 2A, 2B, and 2D chromosomes. According to the neighbor-joining (NJ) method, all TaFH proteins from wheat and other plants clustered in 6 sub-groups (A-F). The modeled 3D structures of TaFH1-A/B, TaFH2-A/B, TaFH3-A/B and TaFH3-B/D were validated. And different numbers of stress and hormone-responsive regulatory elements in their 1500 base pair promoter regions were contained in the TaFH genes copies.TaFHshad specific temporal and spatial expression characteristics, wherebyTaFH1,TaFH4, andTaFH5were expressed highly in the stamen of BS366. Besides, the accumulation ofTaFHswas remarkably lower in a low-temperature sterile condition (Nanyang) than fertile condition (Beijing), particularly at the early stamen development stage. The pollen cytoskeleton of BS366 was abnormal in the three stages under sterile and fertile environments. Furthermore, under different stress levels,TaFHsexpression could be induced by drought, salt, abscisic acid (ABA), salicylic acid (SA), methyl jasmonate (MeJA), indole-3-acetic acid (IAA), polyethylene glycol (PEG), and low temperature. Some miRNAs, including miR167, miR1120, and miR172, interacts withTaFHgenes; thus, we constructed an interaction network between microRNAs,TaFHs,phytohormone responses, and distribution of cytoskeleton to reveal the regulatory association between upstream genes ofTaFHfamily members and sterile.

Conclusions

Collectively, this comprehensive analysis provides novel insights intoTaFHsand miRNA resources for wheat breeding. These findings are, therefore, valuable in understanding the mechanism of TGMS fertility conversion in wheat.
Design of a novel multifunction decision support/alerting system for in-patient acute care, ICU and floor (AlertWatch AC)
Authors: Colquhoun Douglas A. , Davis Ryan P. , Tremper Theodore T. , Mace Jenny J. , Gombert Jan M. , Sheldon William D. , Connolly Joseph J. , Adams Justin F. , Tremper Kevin K.
Published: July 2021

Background

Multifunction surveillance alerting systems have been found to be beneficial for the operating room and labor and delivery. This paper describes a similar system developed for in-hospital acute care environments, AlertWatch Acute Care (AWAC).

Results

A decision support surveillance system has been developed which extracts comprehensive electronic health record (EHR) data including live data from physiologic monitors and ventilators and incorporates them into an integrated organ icon-based patient display. Live data retrieved from the hospitals network are processed by presenting scrolling median values to reduce artifacts. A total of 48 possible alerts are generated covering a broad range of critical patient care concerns. Notification is achieved by paging or texting the appropriated member of the critical care team. Alerts range from simple out of range values to more complex programing of impending Ventilator Associated Events, SOFA, qSOFA, SIRS scores and process of care reminders for the management of glucose and sepsis. As with similar systems developed for the operating room and labor and delivery, there are green, yellow, and red configurable ranges for all parameters. A census view allows surveillance of an entire unit with flashing or text to voice alerting and enables detailed information by windowing into an individual patient view including live physiologic waveforms. The system runs via web interface on desktop as well as mobile devices, with iOS native app available, for ease of communication from any location. The goal is to improve safety and adherence to standard management protocols.

Conclusions

AWAC is designed to provide a high level surveillance view for multi-bed hospital units with varying acuity from standard floor patients to complex ICU care. Alerts are generated by algorithms running in the background and automatically notify the selected member of the patients care team. Its value has been demonstrated for low acuity patients, further study is required to determine its effectiveness in high acuity patients.
Statistical analysis of two arm randomized pre-post designs with one post-treatment measurement
Authors: Wan Fei
Published: July 2021

Background

Randomized pre-post designs, with outcomes measured at baseline and after treatment, have been commonly used to compare the clinical effectiveness of two competing treatments. There are vast, but often conflicting, amount of information in current literature about the best analytic methods for pre-post designs. It is challenging for applied researchers to make an informed choice.

Methods

We discuss six methods commonly used in literature: one way analysis of variance (“ANOVA”), analysis of covariance main effect and interaction models on the post-treatment score (“ANCOVAI” and “ANCOVAII”),ANOVAon the change score between the baseline and post-treatment scores (“ANOVA-Change”), repeated measures (“RM”) and constrained repeated measures (“cRM”) models on the baseline and post-treatment scores as joint outcomes. We review a number of study endpoints in randomized pre-post designs and identify the mean difference in the post-treatment score as the common treatment effect that all six methods target. We delineate the underlying differences and connections between these competing methods in homogeneous and heterogeneous study populations.

Results

ANCOVAandcRMoutperform other alternative methods because their treatment effect estimators have the smallest variances.cRMhas comparable performance toANCOVAIin the homogeneous scenario and toANCOVAIIin the heterogeneous scenario. In spite of that,ANCOVAhas several advantages overcRM:i) the baseline score is adjusted as covariate because it is not an outcome by definition; ii) it is very convenient to incorporate other baseline variables and easy to handle complex heteroscedasticity patterns in a linear regression framework.

Conclusions

ANCOVAis a simple and the most efficient approach for analyzing pre-post randomized designs.
Management of COVID-19 ICU-survivors in primary care: - a narrative review
Authors: Schmidt KFR , Gensichen J. , Gehrke-Beck S. , Kosilek R. P. , Kühne F. , Heintze C , Baldwin L. M. , Needham D. M.
Published: July 2021

Many survivors of critical illness suffer from long-lasting physical, cognitive, and mental health sequelae. The number of affected patients is expected to markedly increase due to the COVID-19 pandemic. Many ICU survivors receive long-term care from a primary care physician. Hence, awareness and appropriate management of these sequelae is crucial. An interdisciplinary authorship team participated in a narrative literature review to identify key issues in managing COVID-19 ICU-survivors in primary care. The aim of this perspective paper is to synthesize important literature to understand and manage sequelae of critical illness due to COVID-19 in the primary care setting.
The thalamus in trigeminal neuralgia: structural and metabolic abnormalities, and influence on surgical response
Authors: Danyluk Hayden , Andrews Jennifer , Kesarwani Rohit , Seres Peter , Broad Robert , Wheatley B. Matt , Sankar Tejas
Published: July 2021

Background

Medically-refractory trigeminal neuralgia (TN) can be treated successfully with operative intervention, but a significant proportion of patients are non-responders despite undergoing technically successful surgery. The thalamus is a key component of the trigeminal sensory pathway involved in transmitting facial pain, but the role of the thalamus in TN, and its influence on durability of pain relief after TN surgery, are relatively understudied. We aimed to test the hypothesis that variations in thalamic structure and metabolism are related to surgical non-response in TN.

Methods

We performed a longitudinal, peri-operative neuroimaging study of the thalamus in medically-refractory TN patients undergoing microvascular decompression or percutaneous balloon compression rhizotomy. Patients underwent structural MRI and MR spectroscopy scans pre-operatively and at 1-week following surgery, and were classified as responders or non-responders based on 1-year post-operative pain outcome. Thalamus volume, shape, and metabolite concentration (choline/creatine [Cho/Cr] and N-acetylaspartate/creatine [NAA/Cr]) were evaluated at baseline and 1-week, and compared between responders, non-responders, and healthy controls.

Results

Twenty healthy controls and 23 patients with medically-refractory TN treated surgically (17 responders, 6 non-responders) were included. Pre-operatively, TN patients as a group showed significantly larger thalamus volume contralateral to the side of facial pain. However, vertex-wise shape analysis showed significant contralateral thalamus volume reduction in non-responders compared to responders in an axially-oriented band spanning the outer thalamic circumference (peak p = 0.019). Further, while pre-operative thalamic metabolite concentrations did not differ between responders and non-responders, as early as 1-week after surgery, long-term non-responders showed a distinct decrease in contralateral thalamic Cho/Cr and NAA/Cr, irrespective of surgery type, which was not observed in responders.

Conclusions

Atrophy of the contralateral thalamus is a consistent feature across patients with medically-refractory TN. Regional alterations in preoperative thalamic structure, and very early post-operative metabolic changes in the thalamus, both appear to influence the durability of pain relief after TN surgery.
Validity and reliability of the medial temporal lobe atrophy scale in a memory clinic population
Authors: Molinder Anna , Ziegelitz Doerthe , Maier Stephan E. , Eckerström Carl
Published: July 2021

Background

Visual rating of medial temporal lobe atrophy (MTA) is often performed in conjunction with dementia workup. Most prior studies involved patients with known or probable Alzheimer’s disease (AD). This study investigated the validity and reliability of MTA in a memory clinic population.

Methods

MTA was rated in 752 MRI examinations, of which 105 were performed in cognitively healthy participants (CH), 184 in participants with subjective cognitive impairment, 249 in subjects with mild cognitive impairment, and 214 in patients with dementia, including AD, subcortical vascular dementia and mixed dementia. Hippocampal volumes, measured manually or using FreeSurfer, were available in the majority of cases. Intra- and interrater reliability was tested using Cohen’s weighted kappa. Correlation between MTA and quantitative hippocampal measurements was ascertained with Spearman’s rank correlation coefficient. Moreover, diagnostic ability of MTA was assessed with receiver operating characteristic (ROC) analysis and suitable, age-dependent MTA thresholds were determined.

Results

Rater agreement was moderate to substantial. MTA correlation with quantitative volumetric methods ranged from -0.20 (p< 0.05) to -0.68 (p < 0.001) depending on the quantitative method used. Both MTA and FreeSurfer are able to distinguish dementia subgroups from CH. Suggested age-dependent MTA thresholds are 1 for the age group below 75 years and 1.5 for the age group 75 years and older.

Conclusions

MTA can be considered a valid marker of medial temporal lobe atrophy and may thus be valuable in the assessment of patients with cognitive impairment, even in a heterogeneous patient population.
Non-haemorrhagic uterine rupture at 28 weeks of pregnancy following previous caesarean section: a case report
Authors: Lumala Alfred , Atwijukire Vicent
Published: July 2021

Background

There is need to put forward more symptoms and signs that could suggest a diagnosis of uterine rupture so that clinicians’ suspicion is increased; there is also need to put forward uncommon intraoperative findings in patients with uterine rupture to correlate with the signs and symptoms of patients.

Case presentation

A 33 year old Gravida 5 Para 4 + 0 with 2 previous caesarean section scars at 28 weeks of amenorrhoea, presented to hospital complaining of lower abdominal pain for 11 h. She had no vaginal bleeding or vaginal discharge or pain on passing urine. On examination she had no pallor, pulse rate was 84 bpm, blood pressure was 110/80 mm of mercury (mmHg), fundal height was 27 cm (cm), fetal heart rate was regular at 150 beats per minute (bpm) and her cervix had a parous os. She was diagnosed with preterm labour and given dexamethasone intramuscularly, then an obstetric ultrasound scan was done and it revealed severe oligohydramnios. Decision do deliver her by emergency caesarean section was made and intraoperative findings were of a uterine rupture along the uterine scar with a fetal arm protruding through and vernix caseosa in the peritoneal cavity, without active uterine bleeding. The patient recovered well postoperatively.

Conclusions

There is need to suspect uterine rupture in pregnant women with previous caesarean section scars if they present with abdominal pain and are found to have severe oligohydramnios despite having no history of any vaginal discharge, even when the fetal heart rate is normal and they are haemodynamically stable and without vaginal bleeding and remote from term.
Evaluation of factors that predict the success rate of trial of labor after the cesarean section
Authors: Mi Yang , Qu Pengfei , Guo Na , Bai Ruimiao , Gao Jiayi , Ma Zhengfeei , He Yiping , Wang Caili , Luo Xiaoqin
Published: July 2021

Background

For most women who have had a previous cesarean section, vaginal birth after cesarean section (VBAC) is a reasonable and safe choice, but which will increase the risk of adverse outcomes such as uterine rupture. In order to reduce the risk, we evaluated the factors that may affect VBAC and and established a model for predicting the success rate of trial of the labor after cesarean section (TOLAC).

Methods

All patients who gave birth at Northwest Women’s and Children’s Hospital from January 2016 to December 2018, had a history of cesarean section and voluntarily chose the TOLAC were recruited. Among them, 80% of the population was randomly assigned to the training set, while the remaining 20% were assigned to the external validation set. In the training set, univariate and multivariate logistic regression models were used to identify indicators related to successful TOLAC. A nomogram was constructed based on the results of multiple logistic regression analysis, and the selected variables included in the nomogram were used to predict the probability of successfully obtaining TOLAC. The area under the receiver operating characteristic curve was used to judge the predictive ability of the model.

Results

A total of 778 pregnant women were included in this study. Among them, 595 (76.48%) successfully underwent TOLAC, whereas 183 (23.52%) failed and switched to cesarean section. In multi-factor logistic regression, parity = 1, pre-pregnancy BMI < 24 kg/m2, cervical score ≥ 5, a history of previous vaginal delivery and neonatal birthweight < 3300 g were associated with the success of TOLAC. The area under the receiver operating characteristic curve in the prediction and validation models was 0.815 (95% CI: 0.762–0.854) and 0.730 (95% CI: 0.652–0.808), respectively, indicating that the nomogram prediction model had medium discriminative power.

Conclusion

The TOLAC was useful to reducing the cesarean section rate. Being primiparous, not overweight or obese, having a cervical score ≥ 5, a history of previous vaginal delivery or neonatal birthweight < 3300 g were protective indicators. In this study, the validated model had an approving predictive ability.
Conservative versus accelerated rehabilitation after rotator cuff repair: a systematic review and meta-analysis
Authors: Longo Umile Giuseppe , Risi Ambrogioni Laura , Berton Alessandra , Candela Vincenzo , Migliorini Filippo , Carnevale Arianna , Schena Emiliano , Nazarian Ara , DeAngelis Joseph , Denaro Vincenzo
Published: July 2021

Background

The purpose of this systematic review and meta-analysis is to compare the conservative and accelerated rehabilitation protocols in patients who underwent arthroscopic rotator cuff repair in terms of clinical outcomes and range of motions at 3, 6, 12, and 24-month follow-up.

Methods

According to PRISMA guidelines, a systematic review of the literature was performed. For each included article, the following data has been extracted: authors, year, study design, level of evidence, demographic characteristics, follow-up, clinical outcomes, range of motions, and retear events. A meta-analysis was performed to compare accelerated versus conservative rehabilitation protocols after arthroscopic rotator cuff repair. The retear rate, postoperative Constant-Murley score and range of motions at 3, 6, 12, and 24 months of follow-up were the outcomes measured.

Results

The search strategy yielded 16 level I-II clinical studies. A total of 1424 patients, with 732 patients and 692 in the accelerated and conservative group, were included. The average age (mean ± standard deviation) was 56.1 ± 8.7 and 56.6 ± 9 in the accelerated and conservative group. The mean follow-up was 12.5 months, ranging from 2 to 24 months. The meta-analysis showed no statistically significant differences in terms of retear rate between the groups (P = 0.29). The superiority of the accelerated group was demonstrated in terms of external rotation (P < 0.05) at 3-month follow-up; in terms of forward elevation, external rotation, abduction (P < 0.05), but not in terms of Constant-Murley score at 6-month follow-up; in terms of forward elevation (P < 0.05) at 12-month follow-up. No significant differences between the two group were highlighted at 24-month follow-up.

Conclusions

No statistically significant differences in the retear rate among the accelerated and conservative group have been demonstrated. On the other hand, statistically and clinically significant differences were found in terms of external rotation at 3 and 6 months of follow-up in favour of the accelerated group. However, no differences between the two groups were detected at 24 months follow-up.
The 30-s chair stand test can be a useful tool for screening sarcopenia in elderly Japanese participants
Authors: Sawada Shuji , Ozaki Hayao , Natsume Toshiharu , Deng Pengyu , Yoshihara Toshinori , Nakagata Takashi , Osawa Takuya , Ishihara Yoshihiko , Kitada Tomoharu , Kimura Ken , Sato Nobuhiro , Machida Shuichi , Naito Hisashi
Published: July 2021

Background

Low muscle strength has been focused on as an essential characteristic of sarcopenia, and the 30-s chair stand test (CS-30) could be a particularly useful test for assessing muscle strength. While it is speculated to be a beneficial tool for the assessment of sarcopenia, this remains to be verified. In this study, we examined the reliability and optimal diagnostic score of the CS-30 for assessing sarcopenia in elderly Japanese participants.

Methods

This cross-sectional study included 678 participants (443 females and 235 males) who underwent the test for sarcopenia as per the Asian Working Group for Sarcopenia (AWGS) 2019, the CS-30 test, and the isometric knee-extension muscle strength test. ROC analysis was used to estimate the optimal CS-30 scores at which sarcopenia was detected.

Results

CS-30 scores were positively associated with sarcopenia (OR: 0.88; 95% CI:0.82–0.93). The AUC of the CS-30 for sarcopenia definition were 0.84 (p < 0.001) for females and 0.80 (p < 0.001) for males. The optimal number of stands in the CS-30 that predicted sarcopenia was 15 for females (sensitivity, 76.4%; specificity, 76.8%) and 17 for males (sensitivity, 75.0%; specificity, 71.7%).

Conclusions

The CS-30 was found to be a reliable test for sarcopenia screening in the elderly Japanese population.
The current clinical practice of general orthopaedic surgeons in the treatment of lateral ankle sprain: a questionnaire survey in Miyazaki, Japan
Authors: Yokoe Takuji , Tajima Takuya , Yamaguchi Nami , Morita Yudai , Chosa Etsuo
Published: July 2021

Background

Lateral ankle sprain (LAS) is one of the most common musculoskeletal injuries. Numerous studies regarding LAS have been performed. However, there are few studies evaluating the current clinical practice of orthopaedic surgeons regarding LAS. The purpose of this study was to evaluate the current clinical practice of general orthopaedic surgeons in the treatment of LAS.

Methods

A questionnaire survey was conducted from September 2020 to December 2020 in Miyazaki, Japan, to evaluate the clinical practice of general orthopaedic surgeons in the treatment of LAS. The survey was composed of 12 questions that were developed with consideration of the recommendations in the current clinical practice guidelines (CPGs) published by the Dutch orthopaedic society. The questions in this study were focused on the diagnosis, conservative treatment, rehabilitation, and the criteria for return to sports (RTS).

Results

The survey response rate was 82.7% (129/156). Among the respondents, 95.3% did not consider the Ottawa Ankle Rules in the decision to perform plain radiography for patients. Rehabilitation following LAS was performed in 58.9% of patients. Eighty-five (65.9%) of the surgeons used only one factor as the criterion for RTS. The absence of pain was the most frequently used criterion (45.7%). No objective criteria were used for the RTS decision in athletes with LAS.

Conclusions

The present study suggested that most general orthopaedic surgeons do not provide the care for patients with LAS recommended by the current CPGs. No objective criteria for the RTS decision are used for athletes with LAS.
Swedish quality registry for caries and periodontal diseases (SKaPa): validation of data on dental caries in 6- and 12-year-old children
Authors: Mensah Tita , Tranæus Sofia , Cederlund Andreas , Naimi-Akbar Aron , Klingberg Gunilla
Published: July 2021

Background

The Swedish Quality Registry for caries and periodontal disease (SKaPa) automatically collects data on caries and periodontitis from patients’ electronic dental records. Provided the data entries are reliable and accurate, the registry has potential value as a data source for registry-based research. The aim of this study was to evaluate the reliability and accuracy of the SKaPa registry information on dental caries in 6- and 12-year-old children.

Method

This diagnostic accuracy study compared dental caries data registered at an examination with dental health status registered in the patient’s electronic dental records, and with corresponding data retrieved from the SKaPa registry. Clinical examinations of 170 6- and 12-year-old children were undertaken by one of the researchers in conjunction with the children’s regular annual dental examinations where the number of teeth were registered, and dental caries was diagnosed using ICDAS II. Teeth with fillings were defined as filled and were added to the ICDAS II score and subsequently dft/DFT was calculated for each individual. Cohen’s Kappa, the intraclass correlation coefficient (ICC), and sensitivity and specificity were calculated to test the agreement of the ‘decayed and filled teeth’ in deciduous and permanent teeth (dft/DFT) from the three sources.

Results

Cohen’s Kappa of the dft/DFT-values was calculated to 0.79 between the researcher and the patient record, to 0.95 between patient dental record and SKaPa, and to 0.76 between the researcher and SKaPa. Intraclass correlation coefficient (ICC) was calculated to 0.96 between the researcher and the patient journal, to 0.99 between the patient dental record vs. SKaPa, and to 0.95 between the researcher and SKaPa.

Conclusion

The SKaPa registry information demonstrated satisfactory reliability and accuracy on dental caries in 6- and 12-year-old children and is a reliable source for registry-based research.

Trial registration The study was registered in Clinical Trials (www.ClinicalTrials.gov, NCT03039010)
Prevalence of periodontitis in obese patients in Bahrain: a cross-sectional study
Authors: Alsalihi Leena , Bain Crawford , Milosevic Alexander , Hassan Amar , Janahi Abeer , Sivaramakrishnan Gowri
Published: July 2021

Background

Adult obesity has been associated with various systemic diseases and is an increasing problem in Bahrain. Recent evidence indicates a correlation between adult obesity and periodontitis. Hence the aim of this study was to assess the prevalence of periodontitis in overweight/obese adults in Bahrain and to determine the factors associated with periodontitis in these obese adults.

Method

This cross-sectional study was conducted in overweight subjects attending Ministry of Health (MOH) Nutrition Clinics at primary health centers in Bahrain. After obtaining the institutional ethics approval, the demographic and anthropometric data, including Body Mass Index (BMI) and waist circumference (WC) using World Health Organization (WHO) thresholds for severity of obesity, were recorded. Periodontal status was measured using the Community Periodontal Index (CPI) and the extent and severity of periodontal disease were categorized according to the number of sextants with CPI codes 3 and 4.

Results

A total of 372 participated with a mean age 44.0 (± 10.5) years for males, and 42.5 (± 11.2) years for females. Periodontitis was present in 361 (97%) of participants. Hypertension and diabetes were the most prevalent co-morbidities at 23.4% and 16% respectively. Mean WC was significantly greater in males at 114 cm (± 15.6) compared to females 109.5 cm (± 12.5) (p < 0.001). BMI was not associated with severity or extent of periodontitis but WC was weakly correlated in males but not in females (Spearman rho =  + 0.2, p < 0.05). In the logistic regression model using overall WC to predict the severity of periodontitis, the adjusted OR was 1.02 (95% CI 1.00–1.04) and for age it was 1.05 (95% CI 1.00–1.07).

Conclusion

The prevalence of periodontitis was high in this sample of overweight Bahrainis. BMI was not correlated with periodontitis but WC had a weak positive correlation. Implementation of periodontal health screening as a routine part of a nutrition clinic program is recommended.