bluuebunny/crossref_metadata_2025 huggingface dataset:
P083 Primary Goujerot- Sjögren Syndrome: a pediatric case report
Authors: Hadef Djohra , Slimani Samy , Ouchen Yamina
Published: November 2021

Background

Gourgerot-Sjögren syndrome (GSS) is a systemic autoimmune disease characterized by lymphocytic infiltration of the exocrine glands leading to dryness of the mucous membranes. It may also involve other organs and organ systems. GSS can be primary (pGSS) or secondary due to other autoimmune diseases. pSGS mainly affects women over 40 years old, but can occur at any age. GSS is rare in children and is often secondary to other diseases. We report the case of a 12-year-old girl with primary Gougerot-Sjögren Syndrome

Methods and results

A 12-year-old girl from Batna (Algeria) presented to her pediatrician in 2016 for a rash with arthralgia. She had no relevant past medical history and is the child of a non-consanguineous marriage. Clinical examination found a well-nourished child with a purpuric rash on her lower limbs. She complained of arthralgia without clinical signs of arthritis. The child also complained of a sensation of a foreign body and burning in both eyes. The eye exam was normal except for a positive Schirmer's test. There were no signs of parotitis. Laboratory tests showed an erythrocyte sedimentation rate (ESR) of 84 mm the first h and a negative C-reactive protein (CRP). She was also Leukopenic. Serological testing resulted in a positive Anti SS-A and Anti SS-B. The abdominal pelvic ultrasound was normal.

The patient was diagnosed with primary Gougerot-Sjögren Syndrome. Artificial tears and hydroxychloroquine were started as initial therapy. One year later we added an immunosuppressant (Methotrexate) due to the persistence of clinical signs.

Conclusion

Our case is particular in that primary Gougerot-Sjögren Syndrome is rare in children. Routine follow- up with this patient is important to determine whether it is indeed pGSS with pediatric onset or GSS secondary to another autoimmune disease.
P086 Kawasaki syndrome and Epstein Barr virus: a case report (again!)
Authors: Boutrid N , Rahmoune H , Bioud B , Amrane M , Chehad A S
Published: November 2021

Background

Kawasaki disease (kDa), also known as mucocutaneous lymph node syndrome, is always updating. We present the case of a toddler boy with concomitant positive EBV serology.

Material

The infant is referred to the pediatric ward for stomatitis with cheilitis, fever> 40 ° C, asthenia, irritability evolving for 4–5 days. In addition, clinical examination revealed multiple, small cervical lymph nodes, < 1 cm. There is no conjunctivitis, no skin rash, nor reactivation of the BCG scar. Biology reveals hyperleukocytosis with very high ESR and CRP. ECG and Echo-heart, requested for suspicion of Kawasaki syndrome, are normal.

Results

Empirical treatment with Aciclovir—Cefalexin with topical care was started. Viral serologies return HSV (-), CMV (-), but EBV (+).

Clinical improvement was noted within 36 h. However, inflammatory markers improve within 2–3 days.

At 15 days, the child presents with typical convalescent peeling of the fingers and toes; associated with marked thrombocytosis. The diagnosis of Kawasaki Syndrome is definitively confirmed.

Discussion

The exact aetiology of Kawasaki syndrome remains unclear. Among the factors frequently encountered, the Epstein Barr Virus is reported for almost 30 years.

The syndrome frequency is highest before the age of 5 years; similar to Infectious Mono-Nucleosis (due to EBV…).

Our case depicts a concomitant Kawaski syndrome and positive EBV serology; without any detectable coronary artery abnormality.

Conclusion

Kawasaki syndrome is a real “chameleon” condition with possible cardiovascular complications. The viral aetiology springs up through “an old friend”: the Epstein Barr Virus ...Even without any aneurysm (also associated with EBV), the American Heart Association recommends long-term monitoring for all Kawasaki syndromes.
P094 “Neonatal lupus”: a unique name for very different realities
Authors: Lazrag Z , Bourkhissi L , Nassih H , Bourahouat A , Ait Sab I
Published: November 2021

Background

Neonatal lupus is a rare condition linked to the maternal-fetal transmission of maternal anti-SSA and/or anti-SSB antibodies, more rarely anti-U1-RNP. The most frequent clinical manifestations are cardiac and cutaneous, more rarely hematological (thrombocytopenia, leuco-neutropenia), hepatic (cholestasis), neurological (spastic paresis, lymphocytic meningitis) or renal. We report two observations of neonatal lupus: a classic form, and a rare form.

Observations

First case: A female newborn, premature of 37 weeks, from a first-degree consanguineous marriage, having a mother followed for systemic lupus erythematosus, with poor therapeutic compliance, presented at H1 of life with neonatal respiratory distress. The clinical examination revealed severe bradycardia at 67 Bpm. The electrocardiogram showed complete atrioventricular block, with a moderate pericarditis on the echocardiography, minimal tricuspid insufficiency, interatrial communication, and a 6 mm foramen oval with LR shunt. The immunological test had objectified positive antinuclear, anti-SSA and anti-SSB antibodies. An implementation of a pacemaker with inter-atrial communication ligation were performed successfully. The evolution was marked by the appearance of a malar erythema with generalized lesions of discoid lupus at the age of 14 months, treated with local corticosteroid therapy, with good outcomes. The control immunological workup was negative at 18 months.

Second case: A 2-month-old boy from a non-consanguineous marriage with a mother followed for Sjögren's syndrome was admitted for a symptomatology dating back to birth marked by the appearance of diffuse petechial purpura. Clinically, the infant presented diffuse discoid macules throughout the body. The somatic examination, particularly cardiovascular, was normal. The biological workup showed haemolytic anaemia with a positive coombs test and severe thrombocytopenia. The electrocardiogram and echocardiography were normal. The immunological workup had objectified positive anti-SSA, anti-SSB and anti-nuclear antibodies. The infant was treated by oral corticosteroids (prednisolone) for 4 months, with good outcomes. The control immunological workup was negative at 6 months.

Conclusion

The clinical manifestations of neonatal lupus are polymorphic, and the only one that may expose to life threat is complete atrioventricular block. All mothers with known lupus or with positive anti-SSA autoantibodies should be monitored during pregnancy with repeated ultrasounds.
Efficacy and safety of tocilizumab in Behçet’s syndrome with refractory arterial lesions: a single-centre observational cohort study in China
Authors: Zhong Hua , Liu Tian , Liu Yanying , Zhang Xiaoying , Zhou Yunshan , Su Yin
Published: November 2021

Objective

The aim of this observational cohort study was to assess the effectiveness and safety of the IL-6-receptor inhibitor tocilizumab (TCZ) in Behçet’s syndrome (BS) with refractory arterial involvement.

Methods

Ten patients admitted to the Rheumatology and Immunology Department of Peking University People’s Hospital between January 2014 and December 2019 were enrolled. The enrolled patients met the BS international criteria and exhibited severe arterial impairments. Refractory arterio-BS was diagnosed based on objective vascular symptoms unexplainable by other known illnesses, and resistance to traditional immunosuppressants and glucocorticoids after 12 weeks. Patients received 8 mg/kg TCZ infusions every 4 weeks for ≥24 weeks, with simultaneous continuation of immunosuppressants and glucocorticoids. Clinical and imaging data were assessed before and after TCZ treatment.

Results

The enrolled patients were men aged 44.3 (10.5) years; the median disease duration was 186.5 (45.7) months, and the average age of arterial impairment onset was 38.7 (12.9) years. The following trends were observed: improvement and maintenance of symptoms after the 26.8 (7.2)-month follow-up, n = 9; complete remission, n = 6; partial response, n = 3; immunosuppressant dose reduction, n = 4; radiologic improvement of arterial lesions, n = 4; and TCZ discontinuation owing to enlarged abdominal aortic aneurysm relapse, n = 1. The average daily glucocorticoid dose reduced from 54.5 (20.6) to 8.3 (3.6) mg/d (P < 0.001), while the median ESR and CRP values reduced from 50 (2–82) mm/h and 32.9 (2.1–62.3) mg/dl to 4 (1–10) mm/h and 2.9 (0.2–12.1) mg/dl, respectively (P < 0.001). No TCZ-associated side effects were noted.

Conclusion

TCZ proved to be safe and effective for refractory arterial lesions in BS, with a steroid- and immunosuppressant-sparing benefit.
Certolizumab pegol treatment in axial spondyloarthritis mitigates fat lesion development: 4-year post-hoc MRI results from a phase 3 study
Authors: Baraliakos Xenofon , Kruse Sebastian , Auteri Simone E , de Peyrecave Natasha , Nurminen Tommi  , Kumke Thomas , Hoepken Bengt , Braun Jürgen
Published: November 2021

Objectives

Fat lesions (FLs) on MRI T1 sequences are considered to be early indicators of structural spinal progression in axial spondyloarthritis (axSpA) patients. In this post-hoc analysis from RAPID-axSpA, we assess whether tumour necrosis factor inhibitor (TNFi) treatment over 4 years impacts FLs in spinal vertebral edges (VEs) of patients with axSpA.

Methods

In RAPID-axSpA (NCT01087762), a 4-year, phase 3 randomized trial, participants were randomized to certolizumab pegol (CZP; 400 mg loading dose at Weeks 0/2/4 then 200/400 mg every 2/4 weeks) or placebo (PBO) at baseline; PBO-randomized participants switched to CZP at Week 16/24 (denoted PBO-randomized/CZP). Spinal MRI scans were taken at Weeks 0, 12, 48, 96 and 204. Changes in proportions of VEs with FLs are reported as odds ratios (ORs) between time points.

Results

Overall, 136 participants (CZP: 89, PBO-randomized/CZP: 47) had a baseline and ≥1 post-baseline MRI. The OR (95% confidence interval) vs baseline of FLs was higher in PBO-randomized/CZP vs CZP-randomized participants at Weeks 48 [3.35 (2.16–5.19) vs 1.45 (1.07–1.97)], 96 [2.62 (1.77–3.88) vs 1.84 (1.36–2.48)] and 204 [2.55 (1.59–4.06) vs 1.71 (1.23–2.37)]. Across 204 weeks, FLs increased more in VEs with baseline inflammation [Week 204 OR: 4.84 (2.56–9.18)] than those without [OR: 1.15 (0.78–1.71)]. VEs in which inflammation was resolved by Week 12 had lower FL prevalence at Weeks 48, 96 and 204 compared with VEs with unresolved inflammation.

Conclusions

Early and sustained suppression of inflammation mitigates the risk of long-term FL development in the spine in study participants with axSpA evaluated over 4 years.

Trial registration

ClinicalTrials.gov, https://clinicaltrials.gov, NCT01087762.
Theodicy and Crisis: Explaining Variation in U.S. Believers’ Faith Response to the COVID-19 Pandemic
Authors: Beyerlein Kraig , Nirenberg David , Zubrzycki Geneviève
Published: November 2021

Based on a national survey of U.S. adults conducted six weeks into the COVID-19 pandemic, this article investigates how crisis affects religious faith. Almost no Americans reported losing or a weakening of faith in response to the pandemic at this time. By contrast, nearly one-third of believers indicated that the coronavirus outbreak had strengthened their faith. We theoretically develop and empirically test three religious factors—theodicy, practices, and tradition—to explain variation in the strengthening effect of the COVID-19 pandemic among believers. Results from statistical models show that two theodicic interpretations—believing that God: is using the pandemic as a way to tell humanity to change; and will personally protect you from the virus—significantly increased believers’ reports of faith strengthening, controlling for other factors. We also found that Black Protestants were more likely to report these interpretations, which in turn strengthened their faith in response to the pandemic.
Carbon Dioxide Changes during High-flow Nasal Oxygenation in Apneic Patients: A Single-center Randomized Controlled Noninferiority Trial
Authors: Riva Thomas , Greif Robert , Kaiser Heiko , Riedel Thomas , Huber Markus , Theiler Lorenz , Nabecker Sabine
Published: November 2021

Background

Anesthesia studies using high-flow, humidified, heated oxygen delivered via nasal cannulas at flow rates of more than 50 l · min–1 postulated a ventilatory effect because carbon dioxide increased at lower levels as reported earlier. This study investigated the increase of arterial partial pressure of carbon dioxide between different flow rates of 100% oxygen in elective anesthetized and paralyzed surgical adults before intubation.

Methods

After preoxygenation and standardized anesthesia induction with nondepolarizing neuromuscular blockade, all patients received 100% oxygen (via high-flow nasal oxygenation system or circuit of the anesthesia machine), and continuous jaw thrust/laryngoscopy was applied throughout the 15-min period. In this single-center noninferiority trial, 25 patients each, were randomized to five groups: (1) minimal flow: 0.25 l · min–1, endotracheal tube; (2) low flow: 2 l · min–1, continuous jaw thrust; (3) medium flow: 10 l · min–1, continuous jaw thrust; (4) high flow: 70 l · min–1, continuous jaw thrust; and (5) control: 70 l · min–1, continuous laryngoscopy. Immediately after anesthesia induction, the 15-min apnea period started with oxygen delivered according to the randomized flow rate. Serial arterial blood gas analyses were drawn every 2 min. The study was terminated if either oxygen saturation measured by pulse oximetry was less than 92%, transcutaneous carbon dioxide was greater than 100 mmHg, pH was less than 7.1, potassium level was greater than 6 mmol · l–1, or apnea time was 15 min. The primary outcome was the linear rate of mean increase of arterial carbon dioxide during the 15-min apnea period computed from linear regressions.

Results

In total, 125 patients completed the study. Noninferiority with a predefined noninferiority margin of 0.3 mmHg · min–1 could be declared for all treatments with the following mean and 95% CI for the mean differences in the linear rate of arterial partial pressure of carbon dioxide with associated P values regarding noninferiority: high flow versus control, –0.0 mmHg · min–1 (–0.3, 0.3 mmHg · min–1, P = 0.030); medium flow versus control, –0.1 mmHg · min–1 (–0.4, 0.2 mmHg · min–1, P = 0.002); low flow versus control, –0.1 mmHg · min–1 (–0.4, 0.2 mmHg · min–1, P = 0.003); and minimal flow versus control, –0.1 mmHg · min–1 (–0.4, 0.2 mmHg · min–1, P = 0.004).

Conclusions

Widely differing flow rates of humidified 100% oxygen during apnea resulted in comparable increases of arterial partial pressure of carbon dioxide, which does not support an additional ventilatory effect of high-flow nasal oxygenation.

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Value of contrast-enhanced ultrasound combined with percutaneous ultrasound-guided fine-needle aspiration in the diagnosis of solid pancreatic lesions
Authors: Gui Yang , Dai Menghua , Meng Zhilan , Chang Xiaoyan , Tan Li , Zhang Jing , Chen Xueqi , Zhou Tongtong , Zhang Qing , Xiao Mengsu , Lyu Ke , Jiang Yuxin
Published: November 2021

Background:

Contrast-enhanced ultrasound (CEUS) can detect lesions hidden in inflammatory regions and find necrosis or areas of severe fibrosis within the lesion. This retrospective study aimed to compare the diagnostic accuracy of solid pancreatic lesions using percutaneous ultrasound (US)-guided fine-needle aspiration (FNA) with or without CEUS assessment.

Methods:

Clinical, imaging, and pathologic data of 181 patients from January 2014 to December 2018 in Pecking Union Medical College Hospital, with solid pancreatic masses who underwent percutaneous US-FNA and ThinPrep cytologic test were retrospectively evaluated. Patients were divided into CEUS and US groups according to whether CEUS was performed before the biopsy. According to FNA cytology diagnoses, we combined non-diagnostic, neoplastic, and negative cases into a negative category. The positive category included malignant, suspicious, and atypical cases. The final diagnosis was confirmed by pathology or clinical and radiological follow-up for at least 12 months. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of US-FNA were evaluated between the two groups.

Results:

This study enrolled 107 male and 74 female patients (average age: 60 years). There were 58 cases in the US group and 123 cases in the CEUS group. No statistically significant differences in age, gender, or lesion size were found between the two groups. The diagnostic accuracy of the CEUS group was 95.1% (117/123), which was higher than the 86.2% (50/58) observed in the US group (P = 0.036). The sensitivity, specificity, PPV, and NPV of the CEUS group were increased by 7.5%, 16.7%, 3.4%, and 18.8%, respectively, compared with the US group. However, the differences of the two groups were not statistically significant.

Conclusions:

Compared with the conventional US, the use of CEUS could improve the biopsy accuracy and avoid the need for a repeat biopsy, especially for some complicated FNA cases.
Association between common cardiovascular drugs and depression
Authors: Tao Shu-Hui , Ren Xue-Qun , Zhang Li-Jun , Liu Mei-Yan
Published: November 2021

Objective:

Cardiovascular diseases are associated with an increased risk of depression, but it remains unclear whether treatment with cardiovascular agents decreases or increases this risk. The effects of drugs on individual usage are also often unknown. This review aimed to examine the correlation between depression and common cardiovascular drugs, develop more potent interventions for depression in cardiovascular patients, and further research on the bio-behavioural mechanisms linking cardiovascular drugs to depression.

Data sources:

The data in this review were obtained from articles included in PubMed, EMBASE, and Web of Science.

Study selection:

Clinical trials, observational studies, review literature, and guidelines about depression and cardiovascular drugs were selected for the article.

Results:

We systematically investigated whether the seven most used cardiovascular drugs were associated with altered risk of incident depression in this literature review. Statins have been proven to have antidepressant effects. Some studies believe angiotensin-converting enzyme inhibitors (ACEIs)/angiotensin receptor blocker (ARB) can exert an antidepressant influence by acting on the renin-angiotensin system, but further clinical trials are needed to confirm this. Beta-blockers have previously been associated with depression, but the current study found no significant association between beta blockers and the risk of depression. Aspirin may have antidepressant effects by suppressing the immune response, but its role as an antidepressant remains controversial. calcium channel blockers (CCBs) can regulate nerve signal transduction by adjusting calcium channels, but whether this effect is beneficial or harmful to depression remains unclear. Finally, some cases have reported that nitrates and diuretics are associated with depression, but the current clinical evidence is insufficient.

Conclusions:

Statins have been proven to have antidepressant effect, and the antidepressant effects of ACEIs/ARB and aspirin are still controversial. CCBs are associated with depression, but it is unclear whether it is beneficial or harmful. No association has been found with β-blockers, diuretics, and nitrates.
Analysis of long- and medium-term particulate matter exposures and stroke in the US-based Health Professionals Follow-up Study
Authors: Xu Yenan , Chen Jarvis T. , Holland Isabel , Yanosky Jeff D. , Liao Duanping , Coull Brent A. , Wang Dong , Rexrode Kathryn , Whitsel Eric A. , Wellenius Gregory A. , Laden Francine , Hart Jaime E.
Published: November 2021

Purpose:

Stroke is a leading cause of mortality worldwide, and air pollution is the third largest contributor to global stroke burden. Existing studies investigating the association between long-term exposure to particulate matter (PM) and stroke incidence have been mixed and very little is known about the associations with medium-term exposures. Therefore, we wanted to evaluate these associations in an cohort of male health professionals.

Methods:

We assessed the association of PM exposures in the previous 1 and 12 months with incident total, ischemic, and hemorrhagic stroke in 49,603 men in the prospective US-based Health Professionals’ Follow-up Study 1988–2007. We used spatiotemporal prediction models to estimate monthly PM less than 10 (PM10) and less than 2.5 (PM2.5), and PM2.5–10 at all mailing addresses. We used time-varying Cox proportional hazards models adjusted for potential confounders based on previous literature to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for each 10-μg/m3 increase in exposure in the preceding 1 and 12 months. We explored possible effect modification by age, obesity, smoking, aspirin use, diet quality, physical activity, diabetes, and Census region.

Results:

We observed 1,467 cases of incident stroke. Average levels of 12-month PM10, PM2.5–10, and PM2.5 were 20.7, 8.4, and 12.3 µg/m3, respectively. In multivariable adjusted models, we did not observe consistent associations between PM and overall or ischemic stroke. There was a suggestion of increased risk of hemorrhagic stroke (12-month PM10 multivariable HR: 1.13 [0.86, 1.48]; PM2.5–10: 1.12 [0.78, 1.62]; PM2.5:1.17 [0.76, 1.81], all per 10 µg/m3). There was little evidence of effect modification.

Conclusions:

We observed only weak evidence of an association between long-term exposure to PM and risks of overall incident stroke. There was a suggestion of increasing hemorrhagic stroke risk.
Patient-reported Outcome Measures following Traumatic Lower Extremity Amputation: A Systematic Review and Meta-analysis
Authors: Tirrell Abigail R. , Kim Kevin G. , Rashid Waleed , Attinger Christopher E. , Fan Kenneth L. , Evans Karen K.
Published: November 2021

Background:

Outcomes after traumatic major lower extremity amputation (MLEA) have focused on surgical complications, despite the life-altering impact on patients. With advances in the surgical management of MLEA, a heightened need for consistent reporting of patient-centered outcomes (PCO) remains. This meta-analysis assesses articles for the prevalence and methods of PCO reporting among traumatic MLEA studies.

Methods:

An electronic database search was completed using Ovid MEDLINE for studies published between 2000 and 2020. Studies were included that reported any outcome of traumatic MLEA. Weighted means of outcomes were calculated when data were available. The prevalence of PCO was assessed in the categories of physical function, quality of life (QOL), psychosocial, and pain. Trends in PCO reporting were analyzed using Pearson’s chi-squared test and analysis of variance when appropriate.

Results:

In total, 7001 studies were screened, yielding 156 articles for inclusion. PCO were evaluated in 94 (60.3%) studies; 83 (53.2%) reported physical function and mobility outcomes, 33 (21.2%) reported QOL and satisfaction measures, 38 (24.4%) reported psychosocial data, and 43 (27.6%) reported pain outcomes. There was no change in prevalence of PCO reporting when comparing 5-year intervals between 2000 and 2020 (P = 0.557).

Conclusions:

Optimization of function and QOL following traumatic MLEA has become a cornerstone of surgical success; however, only 60% of studies report PCO, with no trend over the last two decades suggesting improvement. As healthcare progresses toward patient-centered care, this inconsistent means of reporting PCO calls for improved inclusion and standardization of instruments to assess function, QOL, and other patient-focused measures.
Surgical Debulking of Persistent Orofacial Swelling in a Patient with Melkersson–Rosenthal Syndrome
Authors: Azimi Roxana , Lee Linus , Stams Victor E.
Published: November 2021

Melkersson–Rosenthal syndrome (MRS) is a rare neuro-mucocutaneous granulomatous disorder that is likely underdiagnosed due to its variability on presentation. Few patients present with the characteristic triad of orofacial swelling, recurrent facial palsy, and lingua plicata; in fact, most patients present with only one or two of the symptoms. Additionally, patients are evaluated by a variety of specialists, including ophthalmologists, otolaryngologists, dermatologists, and plastic surgeons, depending on their particular symptom. There is no consensus standard of care for MRS due to a limited understanding of the disease. We describe a case of a patient with a 5-year history of persistent orofacial edema in the setting of Melkersson–Rosenthal syndrome refractory to medical management, who was treated with surgical debulking of the upper lip. We encourage increased clinical suspicion for Melkersson–Rosenthal syndrome when evaluating persistent orofacial edema in the plastic surgery clinic and highlight the importance of obtaining a full patient history. Surgical debulking can correct for aesthetic deformity while sparing oral function.
Little or No Differences in Hip Morphology Between Professional Dancers and Controls: A Systematic Review
Authors: Nogier Alexis , Tourabaly Idriss , Barreau Xavière , Ramos-Pascual Sonia , van Rooij Floris , Saffarini Mo , Courtin Cyril
Published: November 2021

Objective:

To systematically evaluate and synthesize the literature on bony hip morphology of professional dancers, as measured by 2D or 3D imaging techniques.

Data Sources:

A literature search was performed on November 20, 2020, using MEDLINE, Embase, and Cochrane. Clinical studies were eligible if they reported on hip morphology of professional dancers. Two independent reviewers screened titles, abstracts, and full-texts to determine eligibility; performed data extraction; and assessed the quality of eligible studies according to the Joanna Briggs Institute (JBI) checklist. This systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines.

Main Results:

The search returned 1384 records; 449 were duplicates, 923 were excluded after title/abstract/full-text screening, and 12 were eligible, reporting on 447 individuals (352 professional dancers and 95 controls). The JBI checklist indicated that 11 studies scored ≥4 points. For professional dancers, lateral center edge angle was 22.4 to 30.8 degrees, acetabular version was 6.7 to 13.5 degrees, neck–shaft angle was 132.5 to 139.5 degrees, and femoral version was 4.7 to 14.4 degrees. Statistically significant differences between dancers and controls were found in some of the studies for acetabular version, neck–shaft angle, and femoral version, although only femoral version showed clinically relevant differences.

Conclusions:

The bony hip morphology of professional dancers is similar to that of other athletes and age-matched controls, which is in contrast to the authors' clinical experience. We presume that the abnormal morphology we have seen at the clinic is only present in symptomatic dancers who require total hip arthroplasty (THA) and is not a general characteristic of all dancers. Further studies should compare the hip morphology of dancers undergoing THA with matched nondancers.
SafeSport: Perceptions of Harassment and Abuse From Elite Youth Athletes at the Winter Youth Olympic Games, Lausanne 2020
Authors: Mountjoy Margo , Vertommen Tine , Tercier Stephane , Greinig Susan , Burrows Kirsty
Published: November 2021

Objective:

To analyze the Winter Youth Olympic Games (YOG) 2020 athletes' understanding and perceptions of harassment and abuse in sport and their knowledge of reporting mechanisms.

Design:

A cohort study.

Setting:

The Winter YOG2020 in Lausanne, Switzerland.

Participants:

Accredited athletes at the YOG2020.

Intervention:

An athlete safeguarding educational program was delivered at the YOG2020. Participating athletes were encouraged to answer a survey embedded in the safeguarding educational materials during the YOG.

Main Outcome Measures:

Perception of occurrence of harassment and abuse as well as knowledge of the term “safe sport” and reporting mechanisms.

Results:

The survey response rate of athletes attending the Safe Sport Booth was 69%. When asked to define Safe Sport, 10% of athletes at the YOG2020 correctly identified a sport environment free from harassment and abuse, 20% identified fair play/antidoping, and 19% safety. When presented with the definition of harassment and abuse, 30.4% expressed surprise, in contrast to 46% in the summer YOG2018. A third (32%) reported that harassment and abuse was either “likely” or “very likely” present in their sport, which was similar to the YOG2018 (34%). The group of athletes not knowing where to go to report harassment and abuse was greater than in the YOG2018 (26% vs 11%). There were no differences in responses between competitive sex (boys' vs girls' events) or type of sport (team vs individual).

Conclusions:

Outcomes of this study, such as the development of youth-friendly terminology and emphasizing mechanisms for reporting of harassment and abuse, should inform the development of safeguarding educational materials for youth athletes.
Comparing acupoint catgut embedding and acupuncture therapies in simple obesity
Authors: Zhao Hui Yan , Kim Sungha , Yang Changsop , Son Mi Ju
Published: November 2021

Introduction:

As society develops, obesity has become a growing public health issue that seriously affects people's health and quality of life. Acupoint catgut embedding therapy is a new treatment method that continuously stimulates acupoints by implanting catguts into acupoints that has been widely used in East Asian countries to treat obesity. The objective of this systematic review is to evaluate the effectiveness and safety of acupoint catgut embedding therapy alone or the combination with other acupuncture therapies compared with same acupuncture therapies for obesity.

Methods:

Nine electronic databases will be searched from inception to September 2021 without language limitations. Clinicaltrials.gov and the WHO International Clinical Trials Registry platform will also be searched for ongoing trials. Randomized controlled trials that evaluated the effectiveness of acupoint catgut embedding therapy alone or the combination with other acupuncture therapies compared with same acupuncture therapies for obesity will be included. Two independent reviewers will select the studies, extract the data, and assess the quality of the papers. Risk of bias assessment and meta-analysis will follow the Cochrane guideline, and meta-analysis will be conducted using the RevMan version 5.4.1 software from Cochrane Collaboration. Grading of Recommendations Assessment, Development and Evaluation will be conducted to assess the confidence in the estimates of effect. The primary outcome will be to assess body mass index, body weight, waist circumference, hip circumference, waist-hip ratio, and body fat percentage. The secondary outcome will be to evaluate metabolic markers and adverse effects.

Discussion:

The systematic review will provide evidence of the safety and effectiveness of acupoint catgut embedding therapy with other acupuncture therapies in clinical settings for obese patients. This systematic review will be disseminated in a peer-reviewed publication or relevant academic conference.

Trial register number:

INPLASY2021100014
Mother's Own Milk and Its Relationship to Growth and Morbidity in a Population‐based Cohort of Extremely Preterm Infants
Authors: Lund Anna‐My , Domellöf Magnus , Pivodic Aldina , Hellström Ann , Stoltz Sjöström Elisabeth , Hansen‐Pupp Ingrid
Published: November 2021

Objectives:

The aim of the study was to evaluate the relationships between intake of mother's own milk (MOM), compared with intake of pasteurized donor milk (DM), and postnatal growth, incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD), in extremely preterm infants.

Methods:

Swedish population‐based cohort of surviving extremely preterm infants born 2004 to 2007. Exposure to MOM and DM was investigated from birth until 32 weeks postmenstrual age (PMA) in 453 infants. Primary outcome variables were change in z‐score (Δ) from birth to 32 weeks PMA for weight, length, and head circumference (HC). Secondary outcomes were incidence of ROP and BPD. Mixed models adjusting for confounders were used to investigate the association between exposures and outcomes.

Results:

Infants’ mean gestational age (GA) was 25.4 weeks. Unadjusted, MOM (per 10 mL · kg−1 · day−1) was associated with Δweight and ΔHC with beta estimates of 0.03 z‐score units (95% CI, 0.02–0.04, P < 0.001) and 0.03 z‐score units (95% CI, 0.01–0.05, P = 0.003), respectively. After adjustment for predefined confounders, the association remained significant for Δweight and ΔHC. A similar pattern was found between Δweight and each 10% increase of MOM. Unadjusted, a higher intake of MOM (mL · kg−1 · day−1) was significantly associated to a lower probability of any ROP and severe ROP; however, these associations did not remain in the adjusted analyses. No associations were found between MOM (mL · kg−1 · day−1) and BPD. Moreover, no associations were found between DM and growth or morbidity outcomes.

Conclusions:

An increased intake of MOM, as opposed to DM (and not formula feeding), was associated with improved postnatal weight gain and HC growth from birth until 32 weeks PMA in extremely preterm infants. Interventions aiming at increasing early intake of unpasteurized MOM for extremely preterm infants should be encouraged.
Predicting Subtype of Growth Hormone Pituitary Adenoma based on Magnetic Resonance Imaging Characteristics
Authors: Liu Chen-Xi , Wang Sheng-Zhong , Heng Li-Jun , Han Yu , Ma Yu-Hui , Yan Lin-Feng , Yu Ying , Wang Wen , Hu Yu-Chuan , Cui Guang-Bin
Published: November 2021

Purpose

This study aimed to investigate the value of magnetic resonance (MR) characteristics in differentiating the subtypes of growth hormone pituitary adenomas.

Materials and Methods

The clinical and MR imaging data of 70 patients with growth hormone pituitary adenoma confirmed by surgery and pathology were retrospectively analyzed. The tumors were divided into dense granular (DG; 36 cases) and sparse granular subtypes (SG; 34 cases). The tumors' MR features were analyzed, including the mean and maximum diameters, T2 signal intensity, T2 relative signal intensity (rSI), homogeneity, enhancement degree, and invasiveness (Knosp grade). Mann-Whitney U test and χ2 test were used to analyze MR characteristics between the 2 groups. The independent predictors and predictive probabilities of tumor subtypes were obtained via a logistic regression model, and the efficacy was compared by receiver operating characteristic curve.

Results

The mean and maximum diameters of growth hormone adenoma in DG and SG were 1.77 versus 2.45 and 1.95 versus 3.00 cm (median, P < 0.05), respectively. There was a significant difference between the 2 groups in T2 signal intensity and rSI (P values were 0.02 and 0.001, respectively). Most DG adenomas (86.1%) appeared as hypointense on T2 images, and 38.2% of SG adenomas were hyperintense. There was no significant difference in tumor homogeneity (P = 0.622). A significant difference was found in the Knosp grade between the 2 subtypes (P = 0.004). In addition, the enhancement degree of SG adenomas was significantly higher than that of DG adenomas (P = 0.001). Logistic regression analysis showed that high T2 rSI value and marked contrast enhancement were independent predictors of the 2 subtypes, and the odds ratios were 4.811 and 4.649, respectively. The multivariate logistic model obtained relatively high predicting efficacy, and the area under the curve, sensitivity, and specificity were 0.765, 0.882, and 0.500, respectively.

Conclusions

There are significant differences in tumor size, T2 signal intensity, T2 rSI, enhancement degree, and invasiveness between DG and SG adenomas. The logistic model based on the marked contrast enhancement and high T2 rSI value has an important value in predicting the subtype of growth hormone adenoma.
In Vitro Study of the Precision and Accuracy of Measurement of the Vascular Inner Diameter on Computed Tomography Angiography Using Deep Learning Image Reconstruction: Comparison With Filtered Back Projection and Iterative Reconstruction
Authors: Suzuki Shigeru , Samejima Wakana , Harashima Shingo , Fukui Rika
Published: November 2021

Objective

This study aimed to compare the performance of deep learning image reconstruction (DLIR) with that of standard filtered back projection (FBP) and adaptive statistical iterative reconstruction V (ASiR-V) for measurement of the vascular diameter on computed tomography (CT) angiography model.

Methods

We used 6 vascular models of 3 wall thicknesses. We used DLIR, FBP, and ASiR-V for reconstruction, and compared the accuracy and precision of vascular diameter measurement, as well as the image noise, among the 3 reconstruction methods.

Results

Image noise was in the order of FBP > ASiR-V > DLIR. The vascular diameters measured using DLIR and ASiR-V were comparable with, or significantly closer to, the actual diameter than those measured using FBP. The precision of the diameter measurement using DLIR was comparable with or significantly superior to that using FBP/ASiR-V.

Conclusions

Use of DLIR, as compared with FBP or ASiR-V, for image reconstruction can improve the precision and accuracy of vascular diameter measurement.
Assessment of Image Quality of Coronary Computed Tomography Angiography in Obese Patients by Comparing Deep Learning Image Reconstruction With Adaptive Statistical Iterative Reconstruction Veo
Authors: Wang Hongwei , Wang Rui , Li Ying , Zhou Zhen , Gao Yifeng , Bo Kairui , Yu Min , Sun Zhonghua , Xu Lei
Published: November 2021

Objective

The aim of the study was to evaluate the image quality of coronary computed tomography (CT) angiography (CCTA) in obese patients by using deep learning image reconstruction (DLIR) in comparison with adaptive statistical iterative reconstruction Veo (ASiR-V).

Methods

We prospectively evaluated 60 obese patients (body mass index [BMI] ≥ 30 kg/m2) who underwent coronary CT angiography in a single center. All CT scans were performed with GE Revolution 256-row CT at 120 kV (group A; 20 men, 10 women; mean age = 54.3 years; mean BMI = 33.4 kg/m2) or 100 kV (group B; 18 men; 12 women; mean age = 56.8 years; mean BMI = 32.9 kg/m2). Images in group A were reconstructed using ASiR-V, whereas images in group B were reconstructed using ASiR-V, DLIR-medium (DLIR-M), and DLIR-high (DLIR-H). Three blinded independent readers assessed the subjective image quality and measured the objective image quality. Radiation dose estimates were calculated and compared between patients by using 0.014 and 0.026 mSv·mGy−1 cm−1 corresponding to chest and heart conversion coefficients, respectively.

Results

The subjective score was significantly higher for images reconstructed using 120-kV ASiR-V (3.8), DLIR-M (3.9), and DLIR-H (4.0) compared with those reconstructed using 100-kV ASiR-V (3.5). Image noise was significantly lower in images reconstructed using DLIR-H compared with those reconstructed using other reconstruction algorithm (P < 0.001, respectively). The contrast-to-noise ratio was significantly higher in the DLIR-H group than in the groups using other reconstruction algorithm (P < 0.001). The effective radiation dose was significantly lower in group B than in group A (P < 0.001).

Conclusions

Compared with ASiR-V, DLIR improved image quality in obese individuals without comprising image quality or increasing the radiation dose.
Is a Close Follow-Up Computed Tomography Necessary for Acute Falcine and Tentorial Subdural Hematoma?
Authors: Oztek Murat Alp , Mossa-Basha Mahmud , DeConde Robert , Mogensen Monique A. , Cross Nathan M. , Cohen Wendy , Yuh William T.C.
Published: November 2021

Objective

This study aimed to assess the changes and values on follow-up computed tomography (F/U-CT) for isolated falcine (F-SDH) and tentorial (T-SDH) subdural hematomas (SDHs).

Method

Fifty-four cases of isolated F-SDH and/or T-SDH were retrospectively reviewed. Subdural hematoma morphology, mass effect on the adjacent parenchyma, and interval change at F/U-CT were evaluated. Subdural hematoma size was measured parallel and perpendicular to the falx/tentorium (long or short axis, respectively).

Results

Short-axis increase on F/U-CT was seen only in 5 F-SDHs (16%) and 7 T-SDHs (19%), with a maximum of a 2-mm increase. Long-axis growth was more prominent and frequent, seen in 18 F-SDH patients (56.2%) and 19 T-SDH patients (51.4%), with maximum change of up to 43 mm. Falcine SDH and T-SDH were ipsilateral and contiguous in 77.8% of patients. Minimal mass effect was seen in 13 patients (24.1%), which was resolved or stable on F/U-CT. Anticoagulation did not affect SDH size. No patients required neurosurgery or died.

Conclusions

Based on our limited data, the current standard of F/U-CT may be unnecessary in patients with isolated F-SDH and/or T-SDH, which expand minimally along the short axis without a significant mass effect. Characteristic anatomic structure of the tentorium and falx, and their connectivity may direct SDH expansion and limit mass effect as well as injury to the adjacent parenchyma.
Perspectives on mental illness stigma among African immigrant pregnant and post-partum women in an urban setting: a brief report
Authors: Pederson Aderonke Bamgbose , Waldron Elizabeth , Burnett-Zeigler Inger , Clark Crystal , Lartey Lynette , Wisner Katherine
Published: November 2021

Purpose

This study assessed the perspectives of pregnant and post-partum African immigrant women on mental illness.

Methods

We conducted a focus group session (N=14) among pregnant and postpartum African immigrant women in June 2020. We used an inductive driven thematic analysis to identify themes related to mental health stigma.

Results

Five core themes emerged: conceptualization of mental health, community stigmatizing attitudes, biopsychosocial stressors, management of mental health and methods to reduce stigma.

Conclusion

Understanding the perspectives of pregnant African immigrant women at the intersection of their race, ethnicity, gender and migration is necessary to improve engagement with mental health services.
Persistent frustration-induced reconfigurations of brain networks predict individual differences in irritability
Authors: Linke J.O. , Haller S.P. , Xu E. , Nguyen L. , Chue A. , Zapp C. , Revzina O. , Perlstein S. , Ross A.J. , Tseng W.-L. , Shaw P. , Brotman M.A. , Pine D.S. , Gotts S.J. , Leibenluft E. , Kircanski K.
Published: November 2021

Background

Frustration, the response to blocked goal attainment, is a universal affective experience, but how the brain embodies frustration is not known. Understanding brain network dynamics during frustration may provide insight into pediatric irritability, one of the most frequent reasons for psychiatric consultation in youth and a risk factor for affective disorders and suicidality.

Methods

Using fMRI, we investigated changes in neural network architecture from a baseline resting-state, through a task that included frustrative nonreward (FNR) and anticipation of new feedback following FNR (FNR+1), to a post-task resting-state in a transdiagnostic sample of 66 youth (33 female, mean age 14 years). Using a train/test/held-out procedure, we aimed to predict past-week irritability from the global efficiency (i.e., Eglob, capacity for parallel information processing) of brain networks before, during, and after frustration.

Results

Compared to pre-task resting state, FNR+1 and the post-state resting state were uniquely associated with a more segregated brain network organization. Nodes that were originally affiliated with the default-mode-temporal-limbic and fronto-parietal networks contributed most to this reconfiguration. Solely Eglob of brain networks that emerged after the frustrating task predicted self- and observer-rated irritability in previously unseen data. Self-reported irritability was predicted by Eglob of a fronto-temporal-limbic module, while observer-rated irritability was predicted by Eglob of motor-parietal and ventral-prefrontal-subcortical modules.

Discussion

We characterize frustration as an evolving brain network process and demonstrate the importance of the post-frustration recovery period for the pathophysiology of irritability; an insight that, if replicated, suggests specific intervention targets for irritability.
Computations of State Ventilation and Respiratory Parameters
Authors: Yang Quangang
Published: November 2021

Background

In mechanical ventilation, there are still some challenges to turn a modern ventilator into a fully reactive device, such as lack of a comprehensive target variable and the unbridged gap between input parameters and output results. This paper aims to present a state ventilation which can provide a measure of two primary, but heterogenous, ventilation support goals. The paper also tries to develop a method to compute, rather than estimate, respiratory parameters to obtain the underlying causal information.

Methods

This paper presents a state ventilation, which is calculated based on minute ventilation and blood gas partial pressures, to evaluate the efficacy of ventilation support and indicate disease progression. Through mathematical analysis, formulae are derived to compute dead space volume/ventilation, alveolar ventilation, and CO2 production.

Results

Measurements from a reported clinical study are used to verify the analysis and demonstrate the application of derived formulae. The state ventilation gives the expected trend to show patient status, and the calculated mean values of dead space volume, alveolar ventilation, and CO2 production are 158mL, 8.8L/m, and 0.45L/m respectively for a group of patients.

Discussions and Conclusions

State ventilation can be used as a target variable since it reflects patient respiratory effort and gas exchange. The derived formulas provide a means to accurately and continuously compute respiratory parameters using routinely available measurements to characterize the impact of different contributing factors.