bluuebunny/crossref_metadata_2025 huggingface dataset:
Thoracic surgery in patients on veno-venous extracorporeal membrane oxygenation for COVID-19 associated acute respiratory distress syndrome
Authors: Karampinis Ioannis , Al-Shammari Abdullah , Hartley Philip , Patel Mehul , Arachchillage Deepa R J , Jordan Simon , Thakuria Louit , Garfield Ben , Ledot Stephane , Buderi Silviu
Published: May 2022

Objectives:

The COVID-19 pandemic has generated a new type of acute respiratory distress syndrome (ARDS) arising as a complication of COVID-19 pneumonia. Extreme cases require the support of extracorporeal membrane oxygenation (ECMO). Here we present the outcomes of patients that underwent surgical tracheostomy or thoracic surgery at a single tertiary centre whilst on ECMO support for COVID-19 related ARDS.

Methods:

18 patients requiring thoracic input whilst on ECMO support during the first wave of COVID-19 (March–June 2020) were included. Thoracic surgery was required both for performing surgical tracheostomies in the operating theatre and for treating emergencies arising under the ECMO treatment such as bleeding complications.

Results:

Thirteen patients underwent a surgical tracheostomy, whilst five patients had an invasive thoracic procedure. Anticoagulation was withheld for at least 12 h in the perioperative setting regardless of the indication. One patient was re-operated for haemothorax immediately after the end of the primary operation. 94.5% of the patients were successfully decannulated from ECMO support. Overall 30-day mortality in the cohort was 5.5% (1/18).

Conclusions:

Thoracic surgeons can play a valuable role in supporting an ECMO unit during the COVID pandemic, by treating ECMO related complications and by safely performing surgical tracheostomies. Withholding anticoagulation in the perioperative window was not associated with increased thromboembolic events and is desirable when interventions or surgery is indicated in this patient cohort to avoid excessive bleeding.
In vitro hemocompatibility screening of a slippery liquid impregnated surface coating for extracorporeal organ support applications
Authors: Roberts Teryn R , Seekell Raymond P , Zang Yanyi , Harea George , Zhang Zheng , Batchinsky Andriy I
Published: May 2022

Introduction:

Clot formation, infection, and biofouling are unfortunate but frequent complications associated with the use of blood-contacting medical devices. The challenge of blood-foreign surface interactions is exacerbated during medical device applications involving substantial blood contact area and extended duration of use, such as extracorporeal life support (ECLS). We investigated a novel surface modification, a liquid-impregnated surface (LIS), designed to minimize protein adsorption and thrombus development on medical plastics.

Methods:

The hemocompatibility and efficacy of LIS was investigated first in a low-shear model with LIS applied to the lumen of blood incubation vials and exposed to human whole blood. Additionally, LIS was evaluated in a 6 h ex vivo circulation model with swine blood using full-scale ECLS circuit tubing and centrifugal pumps with clinically relevant flow rate (1.5 L/min) and shear conditions for extracorporeal carbon dioxide removal.

Results:

Under low-shear, LIS preserved fibrinogen concentration in blood relative to control polymers (+40 ± 6 mg/dL vs polyvinyl chloride, p < .0001), suggesting protein adsorption was minimized. A fibrinogen adhesion assay demonstrated a dramatic reduction in protein adsorption under low shear (87% decrease vs polyvinyl chloride, p = .01). Thrombus deposition and platelet adhesion visualized by scanning electron microscopy were drastically reduced. During the 6 h ex vivo circulation, platelets in blood exposed to LIS tubing did not become significantly activated or procoagulant, as occurred with control tubing; and again, thrombus deposition was visually reduced.

Conclusions:

A LIS coating demonstrated potential to reduce thrombus formation on medical devices. Further testing is needed specialized to clinical setting and duration of use for specific medical target applications.
Instantaneous wave free ratio value impact on left internal mammary artery graft patency
Authors: Ordiene Rasa , Unikas Ramunas , Aldujeli Ali , Benetis Rimantas , Jakuska Povilas , Ceponiene Indre , Jankauskas Antanas , Plisiene Jurgita , Lenkutis Tadas , Rudokaite Gabriele , Braukyliene Rima , Stonis Mindaugas , Davies Justin , Punjabi Prakash P
Published: May 2022

Objectives

To assess whether instantaneous wave – free ratio (iFR) value is associated with left internal mammary artery (LIMA) graft failure at 12 months follow-up post coronary artery bypass graft (CABG).

Background

Data suggests bypass to a non-significant left anterior descending artery (LAD) lesion due to visual over-estimation may lead to LIMA graft failure. Implementing iFR may result in better arterial graft patency.

Methods

In iCABG (iFR guided CABG) study patients planned to undergo an isolated CABG procedure was prospectively enrolled and iFR was performed for LAD. Coronary computed tomography angiography was performed at 2 and 12 months follow-up. The primary endpoint of this study was to determine the rate of LIMA graft occlusion or hypoperfusion at 2 and 12-months follow-up. We considered a composite secondary endpoint of Major adverse cardiovascular and cerebrovascular event (MACCE) as a secondary outcome.

Results

In total 69 patients were included with no differences regarding age, sex and risk factors. At 2 months, 50 of LIMAs with pre-CABG iFR median 0.855 (0.785 – 0.892) were patent. Hypoperfusion was found in 8 LIMAs (median iFR 0.88 (0.842 – 0.90)). While, 7 LIMAs (median iFR 0.91 (0.88 – 0.96)) were occluded ( p = 0.04). At 12 months, when iFR of LAD was >0.85: just 12 (31.6% out of all patent LIMAS) grafts were patent and 24 (100.0% out of all hypoperfused/occluded) grafts were hypoperfused or occluded ( p < 0.001). In terms of MACCE, no difference ( p = 1.0) was found between all 3 groups divided according to iFR value.

Conclusions

Instantaneous wave – free ratio value above 0.85 in LAD is a powerful tool predicting LIMA graft failure at 1-year follow up period.
Cyclic changes of sensory parameters in migraine patients
Authors: Helfenstein Carolin , Strupf Marion , Stefke Andrea , Fraunberger Britta , Renner Bertold , Suchantke Insa , Rothermel Markus , Messlinger Karl , DeCol Roberto , Namer Barbara
Published: May 2022

Background

Migraine shows a cyclic pattern with an inter-ictal-, a pre-ictal, an ictal- and a post-ictal phase. We aimed to examine changes in psychophysical parameters during the migraine cycle.

Methods

The perception of nociceptive and non-nociceptive stimuli and an electrically induced axon-reflex-erythema were assessed in 20 healthy controls and 14 migraine patients on five consecutive days according to different phases of the migraine cycle. Pain was rated three times during a 10-second electrical stimulus. The size of the axon-reflex-erythema was determined using laser-Doppler-imaging. Intensity and hedonic estimates of odours presented by Sniffin’ Sticks were rated.

Results

In healthy controls, no significant changes over the test days were observed. In migraine patients pain thresholds at the head decreased with an ictal minimum. Less habituation after five seconds of stimulation at the head was found pre-ictally, whereas reduced habituation to 10-second electrical stimulation was present in all phases. The axon-reflex-erythema size showed an inter-ictal-specific minimum at the head. odours were perceived ictally as more unpleasant and intense.

Conclusions

Somatosensory functions, pain thresholds and habituation as predominantly central parameters, axon-reflex-erythema as a peripheral function of trigeminal neurons and odour perception as a predominantly extra-thalamic sensation change specifically over the migraine cycle indicating complex variations of neuronal signal processing.
Validation of diagnostic ICHD-3 criteria for menstrual migraine
Authors: Verhagen Iris E , Spaink Hermes AJ , van der Arend Britt WH , van Casteren Daphne S , MaassenVanDenBrink Antoinette , Terwindt Gisela M
Published: May 2022

Objective

To assess validity of ICHD-3 diagnostic criteria for menstrual migraine.

Methods

We performed a longitudinal E-diary study in premenopausal women with migraine. Menstrual migraine diagnosis was self-reported at baseline, and verified according to diary based ICHD-3 criteria and a previous proposed statistical model. Validity of self-reported menstrual migraine was compared to diary based diagnosis and statistical diagnosis. Test-retest reliability and concordance between both methods were determined. Clinical characteristics of perimenstrual and non-perimenstrual migraine attacks were compared in women with and without menstrual migraine.

Results

We included 607 women. Both women who did and women who did not self-report to suffer from menstrual migraine fulfilled ICHD-3 criteria in the E-diary in two thirds of cases. Pure menstrual migraine was extremely rare (<1%). Concordance between statistical and diary based diagnosis was minimal (κ = 0.28, 95% CI:0.23–0.33). Women diagnosed with menstrual migraine showed 37–50% longer attack duration and increased triptan intake (OR 1.19–1.22, p < 0.001) during perimenstrual attacks.

Conclusion

Self-reported menstrual migraine diagnosis has extremely poor accuracy. Two thirds of women suffer from menstrual migraine, independent of self-reports. Pure menstrual migraine is rare. Women with menstrual migraine have longer attack duration and increased triptan intake during perimenstrual attacks, in contrast to women without menstrual migraine. Prospective headache (E-)diaries are required for a menstrual migraine diagnosis, also in clinical practice.
Buoyancy force and Arrhenius energy impacts on Buongiorno electromagnetic nanofluid flow containing gyrotactic microorganism
Authors: Safdar Rabia , Gulzar Iqra , Jawad Muhammad , Jamshed Wasim , Shahzad Faisal , Eid Mohamed R
Published: May 2022

In this study, an incompressible, steady, and magnetohydrodynamic flow of Buongiorno nanofluid through a stretchable surface has been analyzed by adopting a theoretical and numerical approach. This paper involves the impacts of buoyancy forces, thermal conductivity, chemically diffusion, and Arrhenius activation energy. Moreover, the influence of the suspension of gyrotactic microorganisms in the nanofluids is also a part of this study. It is assumed that the behavior of viscosity varies as a function of time and the suspension of microorganisms remain consistent throughout the study. A system of PDEs is reduced to a solvable system of ODEs by applying a suitable similarity transformation. For the sake of numerical solutions, the shooting method has been employed. Wolfram Mathematica has been used to deal with the BVP. In addition, the behaviors of different emerging parameters comprising velocity outline, temperature outline, concentration distribution, the density outline of gyrotactic microorganisms have also been demonstrated by graphical illustrations. From the extracted results, it has been observed that the rising values of viscosity of fluid produce a decline in the velocity parameter. Also, an increment has been noticed in the temperature profile for the growing behavior of the mixed convective factor.
Leveraging information literacy: Mapping the conceptual influence and appropriation of information literacy in other disciplinary landscapes
Authors: Hicks Alison , McKinney Pam , Inskip Charlie , Walton Geoff , Lloyd Annemaree
Published: May 2022

Information literacy forms a key concept within Library and Information Science, where it forms the focus of scholarship, conferences, journals and teaching librarian practice, alike. However, little is known about how other fields and disciplines have employed these outputs within their own research and practice. This paper examines how the concept of information literacy has been leveraged into the discourses of non-Library and Information Science disciplinary landscapes. This is achieved through a qualitative mapping of five different fields and disciplines, including Higher Education, Management and Business, Public Health, Nursing and Psychology, to identify how information literacy terminology, definitions, theories and frameworks have travelled across scholarly and practice boundaries to become appropriated into other disciplinary landscapes. The aim of this collaborative work is to develop an indicative rather than an exhaustive understanding of what travels within information literacy research and practice and to strengthen the Library and Information Science narrative on the impact of information literacy activities.
Delivering Physical Activity Recommendations in Daily Clinical Cancer Care: An Observational Interview Study in Prostate Cancer Out-Patient Clinics Using an Empirical Ethics of Care Approach
Authors: Ladefoged Kopp Schmidt Mette , Østergren Peter , Cormie Prue , Sønksen Jens , Midtgaard Julie
Published: May 2022

Physical activity (PA) has shown to mitigate many of the common side effects of cancer treatments. The promotion of PA by health care professionals (HCPs) can facilitate the adoption of PA by patients with cancer. Drawing on an empirical ethics of care approach, this article explores how the delivery of PA recommendations is done within clinical cancer care. Based on 175 observations of consultations between doctors, nurses and patients and interviews with 27 doctors and nurses, we show how delivering PA recommendations was related to four care practices: “adjusting information to match the patient’s needs and situation,” “managing current and anticipated treatment-induced side effects,” “using visual aids and quantifiable data,” and “maintaining a good relationship between the patient and the HCP.” Drawing on these findings, we discuss strategies to strengthen the delivery of PA recommendations in clinical cancer care.
Pre-test Cortisol Levels in Predicting Short Synacthen Test Outcome: A Retrospective Analysis
Authors: Ravindran Ravikumar , Carter Joanne L , Kumar Asit , Capatana Florin , Khan Ishrat N , Adlan Mohamed A , Premawardhana Lakdasa D
Published: May 2022

Objective:

Short Synacthen tests (SSTs) are expensive, dependent on Synacthen availability, and need supervision. To reduce SST testing, we examined the utility of pre-test cortisol (Cort0) and related parameters in predicting outcome.

Design and Measurements:

We retrospectively examined the following in all SSTs; (i) Cort0 (ii) indications (iii) and time and place of testing. Receiver operated characteristic (ROC) curves were devised for Cort0 to obtain the best cut-off for outcome prediction in those who had SSTs between 8 and 10 am (Group 1) and at other times (Group 2).

Results:

Of 506 SSTs, 13 were unsuitable for analysis. 111/493 SSTs (22.5%) were abnormal. (1) ROC curves predicted – (a) SST failure with 100% specificity when Cort0 was ⩽124 nmol/L (Group 1), or ⩽47 (Group 2); (b) a normal SST with 100% sensitivity when Cort0 ⩾314 nmol/L (Group 1) and ⩾323 nmol/L (Group 2). (2) There was significant correlation between Cort0 and 30-minute cortisol ( rs = 0.65-0.78, P  < .001). (3) Median Cort0 was lower in those who failed SSTs compared to those who passed (147 vs 298 nmol/L respectively, P  < .001). (4) SST failure was commoner in Group 1 vs 2 ( P = .001). (5) There was no difference in outcome between out-patient and inpatient SSTs. (6) SST failure was most common for ‘steroid related’ indications (39.6%, P  < .001).

Conclusions:

This study indicates that (1) Cort0 ⩾ 323 (Group1) and ⩾314 nmol/L (Group 2) predicted a normal SST with 100% sensitivity; (2) Using these cut offs 141/493 (28.6%) tests may have been avoided; (3) supporting evidence should be considered in those with a lower pre-test predictability of failure.
The great replacement: Strategic mainstreaming of far-right conspiracy claims
Authors: Ekman Mattias
Published: May 2022

This paper assesses how the ‘Great Replacement’ conspiracy theory (the idea that ethnically homogeneous populations in European nations are being ‘replaced’ by people of non-European origin) is articulated online by three different actors. By analyzing argument patterns and multimodal features of the cases, the paper shows that the conspiracy theory is a flexible political discourse that can be used strategically by both far-right and mainstream right-wing actors. It highlights the role of affect in online communication, and particularly how anti-immigration actors feed off circulating emotions such as insecurity and fear among the citizenry. The results show that processes of demographic change, caused by immigration, are negatively politicized through the use of pseudo-scientific sources, historic narratives of ethnic homogeneity, threat frames, visual fear appeals and other elements that constitute the wider conspiracy theory of an ongoing ‘replacement’ of native populations. The paper argues that the mainstreaming of conspiracy claims and theories related to immigration poses a threat, not only to democratic institutions and societies, but also to people of immigrant backgrounds.
Methodological reflections on curating an artistic event with African youth in a Norwegian city
Authors: Mainsah Henry , Rafiki Nicole
Published: May 2022

In this article, we remember experiences of our participation in an artistic event for youth of African descent in a Norwegian city to reflect on the potential of arts-based methods for exploring migrant and diasporic youth identities. Reflecting on the process of curating an event titled Afrikanske Dager in Drammen (African days in Drammen) involving young Africans in a Norwegian city, we demonstrate the methodological potential photography making, exhibition and dance performance. We show how processes of collaborative photography making provide spaces for participants to negotiate and think through identity and self-representation. We tease out the potential of dance choreography and performance as avenues for participants to embody and retell old histories from the archive of African presence in Norway. We discuss how the event making process was the site of unstable hierarchies where roles and positions constantly changed and highlight the power relations involved in the collaborative production of knowledge from artistic practice.
Psychological Variables Associated With Post-Traumatic Stress Disorder in Firefighters: A Systematic Review
Authors: Serrano-Ibáñez Elena R. , Corrás Tania , del Prado Mirtha , Diz Javier , Varela Carmen
Published: May 2022

Firefighters are repeatedly exposed to work-related potential traumatic events and have an increased risk of developing post-traumatic stress disorder (PTSD). However, the mechanisms implicated in this relationship are not clear. The aim of this study was to analyse the risk and protective factors related to the development of PTSD in firefighters. According to PRISMA, a systematic review of scientific literature was conducted in Web of Science, PsycINFO, Scopus, PubMed and the Cochrane Central Register of Controlled Trials. Quality in Prognosis Studies (QUIPS) was used as the methodological quality indicator of the selected articles (PROSPERO reference CRD42020213009). Prognostic studies involving active firefighters with presence of post-traumatic symptomatology, presenting original findings, and written in Spanish or English were included. A total of 1768 potentially eligible articles were identified. According to the inclusion criteria, 87 articles were selected to evaluate the full text. Finally, 19 articles were included, comprising 12,298 active firefighters. There is high heterogeneity in the variables evaluated in the different studies. Taking the data for which this review has found more evidence (moderate support), operational stress, job duration, burnout, expressive suppression and rumination could be risk factors of PTSD, and belongingness and dispositional mindfulness could be protective factors. Other variables with weak support (e.g. resilience) were analysed. This review analyses the available literature, highlighting its scarcity for future research on the subject. Due to repeated trauma exposure, it is important to continue investigations and bear these variables in mind for the prevention of PTSD in firefighters.
Safety and Effectiveness of Excimer Laser Ablation Combined With Drug-Coated Balloon for Atherosclerotic Obliterans in the Lower Extremity
Authors: Jiang Xiaolang , Ju Shuai , Chen Bin , Jiang Junhao , Shi Yun , Ma Tao , Lin Changpo , Xu Xin , Fu Weiguo , Dong Zhihui
Published: May 2022

Purpose:

To evaluate the safety and effectiveness of excimer laser ablation (ELA) combined with drug-coated balloon (DCB) for atherosclerotic obliterans (ASO) of the lower extremities.

Materials and Methods:

From June 2019 to December 2020, all eligible patients were enrolled. Demographics, characteristics of lesions, complications, and follow-up information were collected and analyzed. The primary endpoint was major amputation-free survival (MAFS). Secondary endpoints included technical success, primary patency, bailout stent, distal embolization, target lesion reintervention (TLR), and ulcer healing rate. Major amputation-free survival and primary patency were calculated by Kaplan-Meier analysis.

Results:

A total of 71 patients were enrolled. Forty-eight (81.7%) patients presented critical limb ischemia (CLI) and 48.6% of them was calcification class 4 according to Peripheral Arterial Calcium Scoring System (PACSS). Chronic totally occluded (CTO) disease was the most common lesion in 66.0% of them and superficial femoral artery (SFA) was the most common segment in 59.6%. Technical success rate was 93.0%. One-year follow-up was finished in 25 (35.2%) patients. The primary patency and MAFS were 92.0%±27.6% and 96.0%±20.0% at 12 months, respectively. During the mean follow-up of 9.4±4.3 months, clinically-driven TLR occurred in 2 (2.8%) patients, and major and minor amputation occurred in 2 (2.8%) and 1 (1.4%) patient, respectively.

Conclusion:

The early results demonstrated that ELA was an effective treatment in de novo, in-stent restenosis (ISR) and CTO lesions. Meanwhile, ELA could prepare the lumen for the use of DCB and reduce the implantation of stents, especially in segments unsuitable for stenting. Mid-term and long-term results need to be awaited.
A reduced dimension multiple signal classification–based direct location algorithm with dense arrays
Authors: Li Jianfeng , Zhao Gaofeng , Li Baobao , Wang Xianpeng , Huang Mengxing
Published: May 2022

Aiming at the issue of parameter matching in conventional two-step location, a reduced dimension multiple signal classification direct position determination algorithm based on multi-array is proposed. Based on the idea of dimension reduction, the algorithm avoids multi-dimensional search in spatial domain and attenuation coefficient domain and reduces the search complexity. Simulation results show that the performance of the algorithm is better than the traditional angle of arrival two-step localization algorithm and subspace data fusion direct localization algorithm.
Probing the Action of Screened Anticancer Triazole–Tetrazole Derivatives Against COVID-19 Using Molecular Docking and DFT Investigations
Authors: Hussein Rageh K. , Khouqeer Ghada , Alkaoud Ahmed M. , El-Khayatt Ahmed M.
Published: May 2022

Drugs are continuously being evaluated for novel therapeutic uses. The purpose of this work was to screen anticancer triazole/tetrazole derivatives for effectiveness against the SARS-CoV-2 main protease (Mpro). First, the chemical structures’ activity was derived from conceptual quantum chemical calculations. According to molecular docking analysis, the compounds scored good interactions against SAR-COV-2's Mpro, with binding energies extending from −8.21 to −8.97 kcal/mol. The docked complexes included various bindings with His41 and Cys145, both catalytic residues responsible for cleavage of the SARS-CoV-2 Mpro. Among the 4 studied compounds, TD3 exhibited the highest affinity by achieving the most stable binding energy and lowest value for the inhibition constant. Most striking was that TD3 not only formed strong bonds with the catalytic residues His41 and Cys145, but also captured the residues of the catalytic loop (Cys44 to Pro52), which flank the catalytic dyads in Mpro's active site. As a result, the studied triazole/tetrazole derivatives, notably TD3, must be reviewed as potent drugs that could be repurposed for SARS-CoV-2 treatment.
Octasulfur in Alcyonarians and Ascidians
Authors: Kalinin Vladimir I.
Published: May 2022

The finding of S8 in the extract of the alcyonarian Sinularia humilis in 2021 was not the first record for marine invertebrates, because a similar finding was published in 1995 for the ascidian Polycitor sp.
Portable hardware & software technologies for addressing ophthalmic health disparities: A systematic review
Authors: Labkovich Margarita , Paul Megan , Kim Eliott , A. Serafini Randal , Lakhtakia Shreyas , Valliani Aly A , Warburton Andrew J , Patel Aashay , Zhou Davis , Sklar Bonnie , Chelnis James , Elahi Ebrahim
Published: May 2022

Vision impairment continues to be a major global problem, as the WHO estimates 2.2 billion people struggling with vision loss or blindness. One billion of these cases, however, can be prevented by expanding diagnostic capabilities. Direct global healthcare costs associated with these conditions totaled $255 billion in 2010, with a rapid upward projection to $294 billion in 2020. Accordingly, WHO proposed 2030 targets to enhance integration and patient-centered vision care by expanding refractive error and cataract worldwide coverage. Due to the limitations in cost and portability of adapted vision screening models, there is a clear need for new, more accessible vision testing tools in vision care. This comparative, systematic review highlights the need for new ophthalmic equipment and approaches while looking at existing and emerging technologies that could expand the capacity for disease identification and access to diagnostic tools. Specifically, the review focuses on portable hardware- and software-centered strategies that can be deployed in remote locations for detection of ophthalmic conditions and refractive error. Advancements in portable hardware, automated software screening tools, and big data-centric analytics, including machine learning, may provide an avenue for improving ophthalmic healthcare.
funCode—Versatile Syntax and Semantics for Functional Harmonic Analysis Labels
Authors: Lepper Markus , Trancòn y Widemann Baltasar , Oehler Michael
Published: May 2022

Traditional harmonic analysis annotations can be represented in a computer model of a piece of music by plain text strings. But whenever automated processing like analysis, comparison or retrieval is intended, a formal definition is helpful. This should cover not only the syntactic structure, but also the semantics, i.e. the intended meaning, and thus adheres to the technique of mathematical remodelling of existing cultural phenomena. The resulting models can serve as a basis for automated processing, but also help to clarify the communication and discussion among humans substantially. This article proposes such a definition in four layers, which address different problems of encoding and communication: (a) relation of symbol sequences to staff positions, (b) combining functions, (c) chord roots, and (d) interval structure and voice leading. Only one of them is specific to functional (Riemannian) theory and can possibly be replaced to represent scale degree theory. The proposal is configurable to different interval specification methods and open to localisation. Syntax and semantics are defined by precise mathematical means, borrowed from computer science, and thus are unambiguously documented.
Lateral Harvest of an Osseous-Based Quadriceps Tendon Autograft Results in Thinner Remaining Patellar Bone
Authors: Perry Allison K. , Dandu Navya , Knapik Derrick M. , Inoue Nozomu , Gursoy Safa , Bush-Joseph Charles A. , Yanke Adam B. , Chahla Jorge
Published: May 2022

Background:

Patellar fracture after quadriceps tendon (QT) autograft harvest for anterior cruciate ligament reconstruction (ACLR) has been reported in up to 8.8% of patients.

Purpose:

To determine the thickness of the remaining patellar bone across the QT graft harvest location while providing clinical guidance for safely harvesting a patellar bone block when using a QT graft in ACLR.

Study Design:

Descriptive laboratory study.

Methods:

Medial and lateral QT graft boundaries were marked using a bone saw on 13 cadaveric patellae, and 3-dimensional computed tomography models were created. After the harvest of a virtual bone block with a maximum depth of 10 mm, the thickness of the remaining bone was measured across the graft harvest location in 9 zones. The thickness of the remaining bone was analyzed according to zone, graft harvest location, and patellar facet length. Risk zones were defined as <50% total patellar depth remaining.

Results:

We observed substantial variability in QT bone block harvest location, in which the distance between the lateral boundary of the harvest location and the lateral patellar cortex was from 21.2% to 49.2% of the axial patellar width. There was significantly less bone remaining in the lateral columns (mean ± SD, 7.56 ± 2.19 mm) compared with the medial columns (9.83 ± 2.10 mm) of the graft harvest location ( P = .028). The number of risk zones was significantly associated with distance to the lateral cortical edge, with an increase in 0.59 zones with every 1-mm decrease in distance to the lateral cortex edge ( b = -0.585; R 2 = 0.620; P = .001). With every 1-mm increase in the distance of the lateral cortex to the lateral graft boundary, the thickness of bone remaining in the lateral column increased by 0.412 mm ( P < .001). No risk zones were encountered when the lateral boundary of the harvest location was created 18.9 mm from the lateral edge of the patella or 43% of the total patellar width from the lateral edge.

Conclusion:

Harvest of a more laterally based QT autograft bone block resulted in thinner remaining patellar thickness, increasing the potential of encountering a risk zone for fracture.

Clinical Relevance:

Care should be taken to avoid harvesting the patellar bone block too laterally during ACLR.
European Stroke Organisation (ESO) guideline on pharmacological interventions for long-term secondary prevention after ischaemic stroke or transient ischaemic attack
Authors: Dawson Jesse , Béjot Yannick , Christensen Louisa M , De Marchis Gian Marco , Dichgans Martin , Hagberg Guri , Heldner Mirjam R , Milionis Haralampos , Li Linxin , Pezzella Francesca Romana , Taylor Rowan Martin , Tiu Cristina , Webb Alastair
Published: May 2022

Recurrent stroke affects 9% to 15% of people within 1 year. This European Stroke Organisation (ESO) guideline provides evidence-based recommendations on pharmacological management of blood pressure (BP), diabetes mellitus, lipid levels and antiplatelet therapy for the prevention of recurrent stroke and other important outcomes in people with ischaemic stroke or transient ischaemic attack (TIA). It does not cover interventions for specific causes of stroke, including anticoagulation for cardioembolic stroke, which are addressed in other guidelines. This guideline was developed through ESO standard operating procedures and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology. The working group identified clinical questions, selected outcomes, performed systematic reviews, with meta-analyses where appropriate, and made evidence-based recommendations, with expert consensus statements where evidence was insufficient to support a recommendation. To reduce the long-term risk of recurrent stroke or other important outcomes after ischaemic stroke or TIA, we recommend: BP lowering treatment to a target of <130/80 mmHg, except in subgroups at increased risk of harm; HMGCoA-reductase inhibitors (statins) and targeting a low density lipoprotein level of <1.8 mmol/l (70 mg/dl); avoidance of dual antiplatelet therapy with aspirin and clopidogrel after the first 90 days; to not give direct oral anticoagulant drugs (DOACs) for embolic stroke of undetermined source and to consider pioglitazone in people with diabetes or insulin resistance, after careful consideration of potential risks. In addition to the evidence-based recommendations, all or the majority of working group members supported: out-of-office BP monitoring; use of combination treatment for BP control; consideration of ezetimibe or PCSK9 inhibitors when lipid targets are not achieved; consideration of use of low-dose DOACs in addition to an antiplatelet in selected groups of people with coronary or peripheral artery disease and aiming for an HbA1c level of <53 mmol/mol (7%) in people with diabetes mellitus. These guidelines aim to standardise long-term pharmacological treatment to reduce the burden of recurrent stroke in Europe.
The Longitudinal Relationship Between Peer Relations and Empathy and Their Joint Contribution to Reducing Bullying in Middle School: Findings From a Randomized Trial of Cooperative Learning
Authors: Van Ryzin Mark J. , Roseth Cary J.
Published: May 2022

The positive peer relations arising from cooperative learning can contribute to the development of affective empathy, which in turn can reduce bullying (Van Ryzin & Roseth, 2019). However, from a theoretical perspective, the direction of effects between peer relations and empathy could be in the opposite direction, or bi-directional. In the current paper, we employed a process-oriented approach (i.e., cross-lag difference score modeling; McArdle, 2009) to investigate the longitudinal relationship between positive peer relations and affective empathy as well as their joint effect on bullying. Using four waves of data from a cluster randomized trial including 15 middle schools (7 intervention and 8 control schools; N = 1,890 students, 47.1% female, 75.2% White), we found a bi-directional or reciprocal relationship between peer relations and affective empathy, and change in both constructs predicted lower levels of bullying. Cooperative learning predicted positive change in peer relations and affective empathy, as well as lower levels of bullying. These results suggest that the structured social interactions that occur during cooperative learning can enhance student interpersonal relations, and simultaneously the experiential skill building of cooperative learning can contribute to a more profound understanding of the emotional states of others. These effects amplify one another and, in turn, significantly reduce bullying in middle school. Given that cooperative learning has already been demonstrated to enhance academic motivation and achievement (Roseth et al., 2008), we argue that cooperative learning offers an effective, attractive alternative to traditional curriculum-based bullying prevention programs.
Nutritional health status: association of stunted and wasted children and their mothers
Authors: Khadija Ulfat , Mahmood Shahid , Ainee Ammara , Quddoos Muhammad Yousaf , Ahmad Hajra , Khadija Afeefa , Zahra Syeda Mahvish , Hussain Ashiq
Published: May 2022

Background

Across the globe, 149 and 49 million children are stunted and wasted, respectively. Prevalence of stunting and wasting is 40.2 and 17.7% in children of Pakistan. Stunting and wasting are accompanied with genetics, dietary factor, lack of information, bottle feeding, illiterate parents, less birth interval, infection such as diarrhoea, low birth weight, mother suffering from malnutrition during pregnancy, breastfeeding, pharmaceutical, and hormonal, psychosocial, and low social-economic status.

Methods

Stunted and wasted children and their mothers were called on and detail discussions related to research plan were carried out. Informed consent was assured from mothers, for participation in the study. The demographics, anthropometrics, vital signs observations, body composition, clinical signs and symptoms, dietary intake and associated biomarkers (CBC, level of urea nitrogen in blood, serum albumin globulin and serum creatinine.) were tools for nutritional health status assessment. SPSS software was implied on data.

Results

The study found that 27.2% mothers were belonged to stunted children, 17.3% belonged to wasted children, and 50.9% belonged to those children who were suffering from both stunting and wasting condition.57.9% mothers who were illiterate belong to stunted and wasted children. CBC and Hb test was prominent, stunted and wasted children had Hb 9.88 mg/dL, whereas, their mothers had 10.8 mg/dL as average Hb. The average height and weight of stunted and wasted children was 68.6 cm and 7.11 kg respectively. Dietary patterns and diet quality of both mothers and children were poor, due to lack of affordability; they were not able to eat healthy food.

Conclusion

Stunting and wasting ultimately resulted in poor growth and development of children. Most of children were anemic, they height and weight less than WHO growth standards. They had less knowledge and poor intake of food diet pattern so children growth was poor.
Analysis of the cause of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy
Authors: Zhang Fan , Zhang Shun , Huang Haifeng , Zhang Qing , Zhang Shengjie , Zhang Shiwei , Guo Hongqian
Published: May 2022

Objectives

To investigate the causes of missed diagnosis in mpMRI/TRUS fusion-guided targeted prostate biopsy.

Methods

The clinical data of 759 patients who underwent transperineal prostate biopsy from March 2021 to June 2021 at Nanjing DrumTower Hospital were retrospectively analyzed. Twenty-one patients had MRI contraindications. Ultimately, 738 patients completed mpMRI/TRUS fusion-guided targeted prostate biopsy + 12-core transperineal systematic biopsy after mpMRI and PI-RADS scoring. The pathological diagnoses from targeted and systematic biopsy were compared to evaluate and analyze the reasons for missed diagnoses in targeted biopsy.

Results

A total of 388 prostate cancer patients were identified, including 37 (9%) missed diagnoses with targeted biopsy and 44 (11.34%) with systematic biopsy. Between the target biopsy missed diagnosis group and not missed diagnosis group, there was no significant difference in age (71.08 ± 7.11 vs. 71.80 ± 7.94), but PSA (13.63 ± 12.41 vs. 54.54 ± 177.25 ng/ml), prostate volume (61.82 ± 40.64 vs. 44.34 ± 25.07 cm3), PSAD (0.27 ± 0.28 vs. 1.07 ± 2.91), and ISUP grade [1(1) vs. 3(2)] were significantly different. The pathological results of the 37 targeted biopsy missed diagnoses were recompared with MRI: 21 prostate cancers were normal on MRI; 9 cancer areas were abnormal on MRI; and 7 cancer areas on MRI were PI-RADS 3.

Conclusions

Early prostate cancer, large prostate, effect of local anesthesia, doctor–patient cooperation, MRI diagnosis, and operator technology were possible factors for missed diagnosis in targeted biopsy. Improvements imaging technology, greater experience, and personalized biopsy may lead to an accurate pathological diagnosis.
Barriers and facilitators of access to maternal, newborn and child health services during the first wave of COVID-19 pandemic in Nigeria: findings from a qualitative study
Authors: Akaba Godwin O , Dirisu Osasuyi , Okunade Kehinde S. , Adams Eseoghene , Ohioghame Jane , Obikeze Obioma O. , Izuka Emmanuel , Sulieman Maryam , Edeh Michael
Published: May 2022

Background

COVID-19 pandemic may have affected the utilization of maternal and newborn child health services in Nigeria but the extent, directions, contextual factors at all the levels of healthcare service delivery in Nigeria is yet to be fully explored.

The objective of the study was to explore the barriers and facilitators of access to MNCH services during the first wave of COVID-19 pandemic in Nigeria.

Methods

A qualitative study was conducted among different stakeholder groups in 18 public health facilities in Nigeria between May and July,2020. In-depth interviews were conducted among 54 study participants (service users, service providers and policymakers) selected from across the three tiers of public health service delivery system in Nigeria (primary health centers, secondary health centers and tertiary health centers). Coding of the qualitative data and identification of themes from the transcripts were carried out and thematic approach was used for data analyses.

Results

Barriers to accessing MNCH services during the first wave of COVID-19-pandemic in Nigeria include fear of contracting COVID-19 infection at health facilities, transportation difficulties, stigmatization of sick persons, lack of personal protective equipment (PPE) /medical commodities, long waiting times at hospitals, shortage of manpower, lack of preparedness by health workers, and prioritization of essential services.

Enablers to access include the COVID-19 non-pharmacological measures instituted at the health facilities, community sensitization on healthcare access during the pandemic, and alternative strategies for administering immunization service at the clinics.

Conclusion

Access to MNCH services were negatively affected by lockdown during the first wave of COVID-19 pandemic in Nigeria particularly due to challenges resulting from restrictions in movements which affected patients/healthcare providers ability to reach the hospitals as well as patients’ ability to pay for health care services. Additionally, there was fear of contracting COVID-19 infection at health facilities and the health systems inability to provide enabling conditions for sustained utilization of MNCH services. There is need for government to institute alternative measures to halt the spread of diseases instead of lockdowns so as to ensure unhindered access to MNCH services during future pandemics. This may include immediate sensitization of the general public on modes of transmission of any emergent infectious disease as well as training of health workers on emergency preparedness and alternative service delivery models.
International proficiency trial for bovine viral diarrhea virus (BVDV) antibody detection: limitations of milk serology
Authors: Wernike Kerstin , Beer Martin
Published: May 2022

Background

Control programs were implemented in several countries against bovine viral diarrhea (BVD), one of the most significant cattle diseases worldwide. Most of the programs rely on serological diagnostics in any phase of the program. For the detection of antibodies against BVD virus (BVDV), neutralization tests as well as a variety of (commercially available) ELISAs are used. Here, test systems applied in various laboratories were evaluated in the context of an international interlaboratory proficiency trial. A panel of standardized samples comprising five sera and five milk samples was sent to veterinary diagnostic laboratories (n=51) and test kit manufacturers (n=3).

Results

The ring trial sample panel was investigated by nine commercially available antibody ELISAs as well as by neutralization tests against diverse BVDV-1, BVDV-2 and/or border disease virus (BDV) strains. The negative serum and milk sample as well as a serum collected after BVDV-2 infection were mostly correctly tested regardless of the applied test system. A serum sample obtained from an animal immunized with an inactivated BVDV-1 vaccine tested positive by neutralization tests or by total antibody or Erns-based ELISAs, while all applied NS3-based ELISAs gave negative results. A further serum, containing antibodies against the ovine BDV, reacted positive in all applied BVDV ELISAs, a differentiation between anti-BDV and anti-BVDV antibodies was only enabled by parallel application of neutralization tests against BVDV and BDV isolates. For the BVDV antibody-positive milk samples (n=4), which mimicked prevalences of 20% (n=2) or 50% (n=2), considerable differences in the number of positive results were observed, which mainly depended on the ELISA kit and the sample incubation protocols used. These 4 milk samples tested negative in 43.6%, 50.9%, 3.6% and 56.4%, respectively, of all investigations. Overall, negative results occurred more often, when a short sample incubation protocol instead of an over-night protocol was applied.

Conclusions

While the seronegative samples were correctly evaluated in most cases, there were considerable differences in the number of correct evaluations for the seropositive samples, most notably when pooled milk samples were tested. Hence, thorough validation and careful selection of ELISA tests are necessary, especially when applied during surveillance programs in BVD-free regions.
A deep learning-based approach for the diagnosis of adrenal adenoma: a new trial using CT
Authors: Kusunoki Masaoki , Nakayama Tomohiro , Nishie Akihiro , Yamashita Yasuo , Kikuchi Kazufumi , Eto Masatoshi , Oda Yoshinao , Ishigami Kousei
Published: May 2022

Objective:

To develop and validate deep convolutional neural network (DCNN) models for the diagnosis of adrenal adenoma (AA) using CT.

Methods:

This retrospective study enrolled 112 patients who underwent abdominal CT (non-contrast, early, and delayed phases) with 107 adrenal lesions (83 AAs and 24 non-AAs) confirmed pathologically and with 8 lesions confirmed by follow-up as metastatic carcinomas. Three patients had adrenal lesions on both sides. We constructed six DCNN models from six types of input images for comparison: non-contrast images only (Model A), delayed phase images only (Model B), three phasic images merged into a 3-channel (Model C), relative washout rate (RWR) image maps only (Model D), non-contrast and RWR maps merged into a 2-channel (Model E), and delayed phase and RWR maps merged into a 2-channel (Model F). These input images were prepared manually with cropping and registration of CT images. Each DCNN model with six convolutional layers was trained with data augmentation and hyperparameter tuning. The optimal threshold values for binary classification were determined from the receiver-operating characteristic curve analyses. We adopted the nested cross-validation method, in which the outer fivefold cross-validation was used to assess the diagnostic performance of the models and the inner fivefold cross-validation was used to tune hyperparameters of the models.

Results:

The areas under the curve with 95% confidence intervals of Models A–F were 0.94 [0.90, 0.98], 0.80 [0.69, 0.89], 0.97 [0.94, 1.00], 0.92 [0.85, 0.97], 0.99 [0.97, 1.00] and 0.94 [0.86, 0.99], respectively. Model E showed high area under the curve greater than 0.95.

Conclusion:

DCNN models may be a useful tool for the diagnosis of AA using CT.

Advances in knowledge:

The current study demonstrates a deep learning-based approach could differentiate adrenal adenoma from non-adenoma using multiphasic CT.
Imaging of bone marrow pitfalls with emphasis on MRI
Authors: Saifuddin Asif , Tyler Philippa , Rajakulasingam Ramanan
Published: May 2022

Normal marrow contains both hematopoietic/red and fatty/yellow marrow with a predictable pattern of conversion and skeletal distribution on MRI. Many variations in normal bone marrow signal and appearances are apparent and the reporting radiologist must differentiate these from other non-neoplastic, benign or neoplastic processes. The advent of chemical shift imaging has helped in characterising and differentiating more focal heterogeneous areas of red marrow from marrow infiltration. This review aims to cover the MRI appearances of normal marrow, its evolution with age, marrow reconversion, variations of normal marrow signal, causes of oedema-like marrow signal, and some common non-neoplastic entities, which may mimic marrow neoplasms.