bluuebunny/crossref_metadata_2025 huggingface dataset:
Practice patterns of dialysis access and outcomes in patients wait-listed early for kidney transplantation
Authors: Sylvestre Raphaëlle , Alencar de Pinho Natalia , Massy Ziad A. , Jacquelinet Christian , Prezelin-Reydit Mathilde , Galland Roula , Stengel Bénédicte , Coscas Raphael ,   on behalf of the French REIN registry
Published: October 2020

Background

Early kidney transplantation (KT) is the best option for patients with end-stage kidney disease, but little is known about dialysis access strategy in this context. We studied practice patterns of dialysis access and how they relate with outcomes in adults wait-listed early for KT according to the intended donor source.

Methods

This study from the REIN registry (2002–2014) included 9331 incident dialysis patients (age 18–69) wait-listed for KT before or by 6 months after starting dialysis: 8342 candidates for deceased-donor KT and 989 for living-donor KT. Subdistribution hazard ratios (SHR) of KT and death associated with hemodialysis by catheter or peritoneal dialysis compared with arteriovenous (AV) access were estimated with Fine and Gray models.

Results

Living-donor candidates used pretransplant peritoneal dialysis at rates similar to deceased-donor KT candidates, but had significantly more frequent catheter than AV access for hemodialysis (adjusted OR 1.25; 95%CI 1.09–1.43). Over a median follow-up of 43 (IQR: 23–67) months, 6063 patients received transplants and 305 died before KT. Median duration of pretransplant dialysis was 15 (7–27) months for deceased-donor recipients and 9 (5–15) for living-donor recipients. Catheter use in deceased-donor candidates was associated with a lower SHR for KT (0.88, 95%CI 0.82–0.94) and a higher SHR for death (1.53, 95%CI 1.14–2.04). Only five deaths occurred in living-donor candidates, three of them with catheter use.

Conclusions

Pretransplant dialysis duration may be quite long even when planned with a living donor. Advantages from protecting these patients from AV fistula creation must be carefully evaluated against catheter-related risks.
Language disparity is not a significant barrier for time-sensitive care of acute ischemic stroke
Authors: Anderson Noriko , Janarious Afra , Liu Shimeng , Flanagan Lisa A. , Stradling Dana , Yu Wengui
Published: October 2020

Background

Language barriers were reported to affect timely access to health care and outcome. The aim of this study was to investigate the effect of language disparity on quality benchmarks of acute ischemic stroke therapy.

Methods

Consecutive patients with acute ischemic stroke at the University of California Irvine Medical Center from 2013 to 2016 were studied. Patients were categorized into 3 groups according to their preferred language: English, Spanish, and other languages. Quality benchmarks and outcomes of the 3 language groups were analyzed.

Results

Of the 928 admissions, 69.7% patients recorded English as preferred language, as compared to 17.3% Spanish and 13.0% other languages. There was no significant difference in the rate of receiving intravenous thrombolysis (24.3, 22.1 and 21.0%), last-known-well to door time, door-to-imaging time, door-to-needle time, and hospital length of stay among the 3 language groups. In univariate analysis, the other languages group had lower chance of favorable outcomes than the English-speaking group (26.3% vs 40.4, p < 0.05) while the Spanish-speaking group had lower mortality rate than English-speaking group (3.1% vs 7.7%, p = 0.05). After adjusting for age and initial NIHSS scores, multivariate regression models showed no significant difference in favorable outcomes and mortality between different language groups.

Conclusion

We demonstrate no significant difference in quality benchmarks and outcome of acute ischemic stroke among 3 different language groups. Our results suggest that limited English proficiency is not a significant barrier for time-sensitive stroke care at Comprehensive Stroke Center.
Oncogenic miR-20b-5p contributes to malignant behaviors of breast cancer stem cells by bidirectionally regulating CCND1 and E2F1
Authors: Xia Liqin , Li Feng , Qiu Jun , Feng Zhongming , Xu Zihan , Chen Zhengtang , Sun Jianguo
Published: October 2020

Background

Breast cancer is the leading cause of cancer mortality in women worldwide. Therefore, it is of great significance to identify the biological mechanism of tumorigenesis and explore the development of breast cancer to achieve a better prognosis for individuals suffering from breast cancer. MicroRNAs (miRNAs) have become a hot topic in cancer research, but the underlying mechanism of its involvement in cancer remains unclear.

Methods

The miRNA profile between breast cancer stem cells (BCSCs, CD44+CD24−/low) and control MCF-7 breast cancer cells was obtained in a previous study. Based on biological analysis, miR-20b-5p was hypothesized to be a key factor due to the malignant behavior of BCSCs. Then, agomir-20b-5p and antagomir-20b-5p were transfected into MCF-7 and T47D breast cancer cells to detect cell migration, wound healing and proliferation, and lentivirus vectors silencing or overexpressing miR-20b-5p were transfected into T47D-CSCs to detect proliferation and apoptosis. The effect of miR-20b-5p on xenograft growth was investigated in vivo by transfection of a lentivirus-overexpression vector into T47D cells. The target genes were predicted by the online programs picTar, miRanda and TargetScan and verified by dual luciferase assay, and changes in protein expression were detected by western blot.

Results

MiR-20b-5p had the highest degree in both the miRNA-gene network and miRNA-GO network to regulate BCSCs. Overexpression of miR-20b-5p significantly promoted the migration and wound healing ability of MCF-7 cells and T47D cells compared with the control (P < 0.05). In addition, miR-20b-5p facilitated the proliferation of MCF-7 cells and T47D-CSCs (P < 0.05) and inhibited the apoptosis of T47D-CSCs (P < 0.05). Moreover, miR-20b-5p promoted xenograft growth compared with the control group (P < 0.05). Accordingly, potential targets of both CCND1 and E2F1 were predicted by bioinformatics analysis. MiR-20b-5p directly targeted both CCND1 and E2F1 in a dual luciferase assay, while antagomir-20b-5p downregulated the protein levels of CCND1 and E2F1.

Conclusions

Oncogenic miR-20b-5p was confirmed to promote the malignant behaviors of breast cancer cells and BCSCs. The underlying mechanism lies in that miR-20b-5p overall enhanced both CCND1 and E2F1 targets via bidirectional regulation probably involving direct downregulation and indirect upregulation.
Diagnostic ability of OCT parameters and retinal ganglion cells count in identification of glaucoma in myopic preperimetric eyes
Authors: Rolle Teresa , Bonetti Beatrice , Mazzucco Alberto , Dallorto Laura
Published: October 2020

Background

The aim of the study is to evaluate the diagnostic ability of OCT parameters and retinal ganglion cells (RGCs) count in identify glaucomatous disease in myopic preperimetric eyes.

Methods

This was a cross-sectional observational study. The study group consisted of 154 eyes: 36 controls, 64 preperimetric (PPG), and 54 primary openangle glaucoma (POAG) eyes. Each group was divided into three subgroups based on axial length: emmetropic, myopic with axial length (AL) < 25 mm, and myopic with AL > 25 mm, to analyze the effect of myopia. The RGCs count was obtained using a model described later. As regard the influence of myopia on OCT parameters and RGC count, we performed Pearson’s correlation. The Area Under Receiver Operator Characteristics Curves (AUROC curves) evaluated which parameter had the best sensitivity and specificity in identifying glaucoma in myopic eyes.

Results

In Pearson’s test, all Ganglion Cell Complex (GCC) thicknesses showed the weakest and less significant correlation with AL in all groups. All the AUROCs were statistically significant, and above 0.5. Inferior GCC and Global Loss Volume (GLV) showed the highest AUCs in all myopic group and the best diagnostic ability in distinguishing control from glaucomatous eyes. RGCcount showed good AUROC in all groups, with sensitivities of about 83% in myopic eyes, and specificity over 91% in all groups.

Conclusions

GCC is the parameter less influenced by the AL, and the inferior GCC and the GLV have the best diagnostic performance. The RGCcount has good sensitivity and specificity, so it can be used as a complementary test in the diagnosis of glaucoma in myopic preperimetric eyes.
Diabetic macular edema with pachychoroid features
Authors: Kang Kyungeun , Lee Hyungwoo , Jang Minsu , Kim Hyung Chan , Chung Hyewon
Published: October 2020

Background

To investigate the clinical features of diabetic macular edema (DME) in eyes with pachychoroid phenotypes using multimodal retinal imaging.

Methods

We retrospectively reviewed 210 eyes from 210 DME patients and analyzed the clinical and imaging parameters, including visual acuity, central macular thickness (CMT), subfoveal choroidal thickness (SFCT) and neural retina layer thickness (NRT). The DME eyes were divided into two groups: group 1 (80 eyes with submacular detachment [SMD]) and group 2 (130 eyes without SMD). The clinical and imaging parameters of 285 eyes from 285 diabetic patients without DME were collected as a control group.

Results

DME eyes with pachychoroid phenotypes were more frequent in group 1 than in group 2 (53 eyes [66.25%] and 53 eyes [40.77%], respectively, P < 0.001). Pachychoroid phenotypes were identified in 108 (37.90%) of the control eyes. CMT and NRT were greater in group 1 than in group 2. In group 1, 37 eyes had SMD combined with focal edema, and 43 eyes had SMD combined with diffuse-type edema. No significant difference in pachychoroid phenotypes was found between the focal and diffuse types (26 [70.27%] and 27 [62.79%], respectively, P = 0.481). In group 2, 70 eyes had focal-type edema, and 60 eyes had diffuse-type edema. No significant difference in the frequency of pachychoroid phenotypes was found (32 [45.71%] and 21 [35.00%], respectively, P = 0.215). Interestingly, among the 70 eyes with focal edema in group 2, 13 (40.6%) and 5 (13.2%) eyes with and without pachychoroid phenotypes showed no definite microaneurysms, respectively.

Conclusion

SMD and focal edema without definite microaneurysms may be clinical manifestations of DME with pachychoroid phenotypes and possibly related to choroidal circulation disturbance in DME.
Postoperative enterocolitis assessment using two different cut-off values in the HAEC score in Hirschsprung patients undergoing Duhamel and Soave pull-through
Authors: Gunadi  , Sukarelawanto Afnandito Valeno Risky , Ritana Azmi , Balela Naisya , Putri Wayan Julita Krisnanti , Sirait Dian Nirmala , Paramita Vincentia Meta Widya , Sasmita Andika Purba , Dwihantoro Andi , Makhmudi Akhmad
Published: October 2020

Background

Hirschsprung-associated enterocolitis (HAEC) is the most severe and potentially lethal complication of Hirschsprung disease (HSCR) which might occur following definitive surgery. Our objectives were: 1) to compare the incidence of HAEC after Duhamel and Soave procedures using different cut-off values of the HAEC scoring method; and 2) to associate them with the risk factors, including sex, aganglionosis type, mothers’ age at childbirth, gestational age, and mothers’ educational level.

Methods

Medical records of patients with HSCR who underwent Soave and Duhamel procedures in our institution, Indonesia (January 2012 – December 2016) were reviewed retrospectively. Two cut-off values of the HAEC scoring system (i.e., ≥10 and ≥ 4) were utilized.

Results

Eighty-three patients with HSCR were recruited in this study (Soave: 37 males and 7 females vs. Duhamel: 28 males and 11 females; p = 0.18). The incidence of HAEC after surgery was 14/83 (16.9%) and 38/83 (45.8%) for cut-off values of ≥10 and ≥ 4, respectively (p = 0.00012), and tended to have an association with sex (p = 0.09). Although it was not statistically significant (p = 0.07), the frequency of HAEC after Soave procedure tended to be higher in patients with their mother’s age of ≤35 years at childbirth than those with their mother’s age of > 35 years (OR = 7.9; 95% CI = 0.9–72.1). Multivariate analysis indicated none of the risk factors were associated with the frequency of HAEC after definitive surgery.

Conclusions

The lower cut-off value of ≥4 might increase the possibility to diagnose HAEC, particularly the mild cases. The incidence of HAEC after definitive surgery was not associated with any risk factors in our cohort patients. Further multicenter studies with a larger sample size are necessary to confirm our findings.
Psychometric properties and measurement invariance of the 7-item game addiction scale (GAS) among Chinese college students
Authors: Liu Yujie , Wang Qian , Jou Min , Wang Baohong , An Yang , Li Zifan
Published: October 2020

Background

The 7-item Gaming Addiction Scale (GAS) has been used as a screening tool for addictive game use worldwide, and this study aimed to examine its psychometric properties and measurement invariance among college students in China.

Methods

Full-time students from multiple colleges in China were recruited. A total of 1040 completed questionnaires were used in the final analysis. Reliability of the GAS was assessed by internal consistency and split-half reliability. Validity of the GAS was assessed by structural validity, convergent validity, discriminant validity, and concurrent validity. A series of Multigroup Confirmatory Factor Analysis (MG-CFA) were conducted to test and establish measurement invariance across gender, class standing, family income and parental educational level.

Results

Exploratory factor analysis revealed a unidimensional structure of the GAS. The GAS exhibited excellent internal consistency (Cronbach’s α = 0.951, theta coefficient = 0.953, omega coefficient = 0.959) and structural validity (χ2 /df = 0.877 (p < 0.05), CFI = 0.999, TIL = 0.996, RMSEA =0.000). Concurrent validity of the GAS was confirmed by its correlation with problematic internet use, sleep quality, nine dimensions of psychiatric symptoms, and substance use. The GAS also demonstrated measurement invariance across father’s educational level (Δχ2 (df) = 19.128 (12), ΔCFI = − 0.009, ΔRMSEA = 0.010 for weak factorial model; Δχ2 (df) = 50.109 (42), ΔCFI = − 0.010, ΔRMSEA = 0.007 for strict factorial model.) and mother’s educational level (Δχ2 (df) = 6.679 (12), ΔCFI = 0.007, ΔRMSEA = − 0.010 for weak factorial model; Δχ2 (df) =49.131 (42), ΔCFI = − 0.009, ΔRMSEA = − 0.004 for strict factorial model), as well as partial measurement invariance across gender (except for item 2), class standing (except for item 7) and family income (except for item 5).

Conclusions

The Chinese version of the 7-item GAS can be an adequate assessment tool to assess internet gaming disorder among the college student population in China.
Associations between gender, school socioeconomic status, and cardiorespiratory fitness among elementary and middle school students
Authors: Walker Timothy J. , Craig Derek W. , Pavlovic Andjelka , Thiele Shelby , Kohl Harold W.
Published: October 2020

Background

Schools play an important role in providing access to physical activity opportunities for children. There are common economic and gender disparities in physical activity and health-related fitness among children, which may inform a school’s programming needs. The purpose of this study is to gain a better understanding about gender, school-level socioeconomic status, and children’s cardiorespiratory fitness.

Methods

This observational study used 2017–2018 school year data from schools in the Dallas Metropolitan area participating in the Healthy Zone School (HZS) program. Three data sources were integrated: 1) FitnessGram® data, 2) school-level data from the Texas Education Agency, and 3) HZS survey data. Being in the Healthy Fitness Zone (HFZ) for aerobic capacity was the dependent variable, and gender and the percentage of economically disadvantaged students (at the school-level) were key independent variables. Mixed-effects logistic regression models examined associations between dependent and independent variables. Final models were adjusted for age and type of aerobic test.

Results

There were 67 schools and 15,052 students included in the analysis. When testing main effects, girls had lower odds for being in the HFZ for aerobic capacity than boys (OR = 0.54, CI = 0.47–0.62). Additionally, having a greater percentage of students who were economically disadvantaged was associated with lower odds for being in the HFZ for aerobic capacity (0.98, CI = 0.98–0.99). There was a significant interaction between gender and the percentage of economically disadvantaged students. Results indicated girls had even lower odds (than boys) for being in the HFZ in schools with 90% economically disadvantaged students (OR = 0.44, CI = 0.35–0.55) versus in schools with 15% economically disadvantage students (OR = 0.62, CI = 0.51–0.76).

Conclusions

Results suggest girls in Healthy Zone Schools have lower odds to meet aerobic capacity fitness standards than boys. Additionally, boys and girls in schools serving a greater percentage of economically disadvantaged students have lower odds to meet aerobic capacity fitness standards. Last, girls have even lower odds of meeting HFZ standard when attending a school serving a greater percentage of economically disadvantaged students. Thus, schools need to provide more programs for girls targeting aerobic physical activity. This is especially important for schools serving a high percentage of low-income students.
El Niño Southern Oscillation as an early warning tool for dengue outbreak in India
Authors: Pramanik Malay , Singh Poonam , Kumar Gaurav , Ojha V. P. , Dhiman Ramesh C.
Published: October 2020

Background

Dengue is rapidly expanding climate-sensitive mosquito-borne disease worldwide. Outbreaks of dengue occur in various parts of India as well but there is no tool to provide early warning. The current study was, therefore, undertaken to find out the link between El Niño, precipitation, and dengue cases, which could help in early preparedness for control of dengue.

Methods

Data on Oceanic Niño Index (ONI) was extracted from CPC-IRI (USA) while the data on monthly rainfall was procured from India Meteorological Department. Data on annual dengue cases was taken from the website of National Vector Borne Disease Control Programme (NVBDCP). Correlation analysis was used to analyse the relationship between seasonal positive ONI, rainfall index and dengue case index based on past 20 years’ state-level data. The dengue case index representing ‘relative deviation from mean’ was correlated to the 3 months average ONI. The computed r values of dengue case index and positive ONI were further interpreted using generated spatial correlation map. The short-term prediction of dengue probability map has been prepared based on phase-wise (El Niño, La Niña, and Neutral) 20 years averaged ONI.

Results

A high correlation between positive ONI and dengue incidence was found, particularly in the states of Arunachal Pradesh, Chhattisgarh, Haryana, Uttarakhand, Andaman and Nicobar Islands, Delhi, Daman and Diu. The states like Assam, Himachal Pradesh, Meghalaya, Manipur, Mizoram, Jammu & Kashmir, Uttar Pradesh, Orissa, and Andhra Pradesh shown negative correlation between summer El Niño and dengue incidence. Two - three month lag was found between monthly ‘rainfall index’ and dengue cases at local-scale analysis.

Conclusion

The generated map signifies the spatial correlation between positive ONI and dengue case index, indicating positive correlation in the central part, while negative correlation in some coastal, northern, and north-eastern part of India. The findings offer a tool for early preparedness for undertaking intervention measures against dengue by the national programme at state level. For further improvement of results, study at micro-scale district level for finding month-wise association with Indian Ocean Dipole and local weather variables is desired for better explanation of dengue outbreaks in the states with ‘no association’.
The prevalence of physical inactivity in Iranian adolescents and the impact of economic and social inequalities on it: results of a National Study in 2018
Authors: Moradi Ghobad , Mostafavi Farideh , Piroozi Bakhtiar , Zareie Bushra , Mahboobi Marzieh , Rasouli Mohammad Aziz
Published: October 2020

Background

This study aims to determine the prevalence of physical inactivity in Iranian adolescents aged 10–12 years and the impact of socioeconomic inequality on it.

Methods

In this descriptive study, the study population consisted of 10–12 years old adolescents from an Iranian population from Kurdistan, Fars and Markazi provinces in 2018. The sample size was 1590 individuals. The sampling method was cluster sampling. Data was collected using demographic questionnaire, modifiable activity questionnaire (MAQ) and socioeconomic questionnaire. Cut points on the MAQ for light activity, moderate activity and heavy activity were MET< 3, MET = 3–6 and MET> 6, respectively. Linear and logistic regression were used to estimate the final model and the Oaxaca analysis method was applied. All analyses were performed in Stata/SE 14.0.

Results

Of the 1590 participants, 52.82% were male. The results showed that 25.79% of the subjects were physically inactive and 7.30% engaged in moderate physical activity during the week. The average physical activity during 1 week was more in boys than in girls (P-value< 0.05). Adolescents of mothers with secondary and high school education were more likely to have physical inactivity than mothers with a high school diploma or higher (AOR: 1.35, 95% CI: 1.02–1.77). The concentration index was −.11, indicating a greater concentration of physical inactivity in adolescents with low socioeconomic levels.

Conclusion

One-fourth of the study population had physical inactivity in this age group. Socioeconomic levels, parental literacy, and sex of adolescents were associated with the level of physical activity.
Innovative rehabilitative bracing with applied resistance improves walking pattern recovery in the early stages of rehabilitation after ACL reconstruction: a preliminary investigation
Authors: Rocchi Jacopo Emanuele , Labanca Luciana , Luongo Valeria , Rum Lorenzo
Published: October 2020

Background

The use of knee braces early after anterior cruciate ligament (ACL) reconstruction is a controversial issue. The study preliminarily compares the effect of a traditional brace blocked in knee extension and a new functional brace equipped with a spring resistance on walking and strength performance early after ACL reconstruction performed in the acute/subacute stage.

Methods

14 ACL-reconstructed patients wore either a traditional (Control group: CG, 7 subjects) or a new functional brace (Experimental group: EG 7 subjects) until the 30th post-operative day. All patients were tested before surgery (T0), 15, 30, and 60 days after surgery (T1, T2, and T3, respectively). Knee angular displacement and ground reaction forces (GRF) during the stance phase of the gait cycle were analyzed at each session and, at T3, maximal voluntary isometric contraction (MVIC) for knee flexor/extensor muscles was performed. Limb symmetry indexes (LSI) of GRF and MVIC parameters were calculated.

Results

At T3, EG showed greater peak knee flexion angle of injured limb compared to CG (41 ± 2° vs 32 ± 1°, p < 0.001). During weight acceptance, a significant increase of anteroposterior GRF peak and vertical impulse from T1 to T3 was observed in the injured limb in EG (p < 0.05) but not in CG (p > 0.05). EG showed a greater side-to-side LSI of weight acceptance peak of anteroposterior GRF at T2 (113 ± 23% vs 69 ± 11%, p < 0.05) and T3 (112 ± 23% vs 84 ± 10%, p < 0.05).

Conclusions

The preliminary findings from this study indicate that the new functional brace did help in improving gait biomechanical pattern in the first two months after ACL reconstruction compared to a traditional brace locked in knee extension.
Restoring global offset and lower limb length with a 3 offset option double-tapered stem
Authors: Biggi Stefano , Banci Lorenzo , Tedino Riccardo , Capuzzo Andrea , Cattaneo Gabriele , Tornago Stefano , Camera Andrea
Published: October 2020

Background

A proper restoration of hip biomechanics is fundamental to achieve satisfactory outcomes after total hip arthroplasty (THA). A global hip offset (GO) postoperatively reduction of more than 5 mm was known to impair hip functionality after THA. This study aimed to verify the restoration of the GO radiographic parameter after primary THA by the use of a cementless femoral stem available in three different offset options without length changing.

Methods

From a consecutive series of 201 patients (201 hips) underwent primary cementless THA in our center with a minimum 3-year follow up, 80 patients (80 hips) were available for complete radiographic evaluation for GO and limb length (LL) and clinical evaluation with Harris hip score (HHS). All patients received the same femoral stem with three different offset options (option A with – 5 mm offset, option B and option C with + 5 mm offset, constant for each sizes) without changing stem length.

Results

Mean GO significantly increased by + 3 mm (P < 0.05) and mean LL significantly decreased by + 5 mm (P < 0.05) after surgery, meaning that postoperatively the limb length of the operated side increased by + 5 mm. HHS significantly improved from 56.3 points preoperatively to 95.8 postoperatively (P < 0.001). Offset option A was used in 1 hip (1%), B in 59 hips (74%) and C in 20 hips (25%).

Conclusions

The femur is lateralized with a mean of + 5 mm after surgery than, the native anatomy, whatever type of stem was used. Thus, the use of this 3-offset options femoral stem is effective in restoring the native biomechanical hip parameters as GO, even if 2 offset options were considered sufficient to restore GO.
Complication of osteo reconstruction by utilizing free vascularized fibular bone graft
Authors: Ou Qifeng , Wu Panfeng , Zhou Zhengbing , Pan Ding , Tang Ju-yu
Published: October 2020

The success of free vascularized fibular bone graft (FVFBG) has accelerated the osteo reconstruction which results from trauma, resection of a tumor or an infectious bone segment, or correction of congenital deformity. But the complication behind should not be overlooked. The failure could necessitate a second surgery, which prolong the rehabilitation period and produce further health cost. Worst, the patients may suffer a permanent impaired ankle function, or a sustained morpho-functional loss on reconstructive area which are hard to save. To provide an overview of the complication related to reconstruction by FVFBG, a narrative review is conducted to identify the complications including their types and rates, the contributing factors, the approaches to measure and the techniques to avoid. Methodologically, by quick research on Pubmed and abstract reading of reviews, we characterize five reconstructive areas where FVFBG were most frequently applied: extremities, mandible, spine, osteonecrosis of femoral head, and penile. Following, the complications on different reconstructive areas are retrieved, studied and presented in five (or more specifically, six) separate sections. By the way, meaningful difference between FVFBG and other bone flap was presented in a few words if necessary. Donor-site morbidities were studied and summarized as a whole. In these literatures, the evidences documented on limb and mandibular reconstruction have the fullest detail, followed by the spine and lastly the penile. In conclusion, FVFBG, though a mature technique, needs further deep and comprehensive study and maybe device-based assistance to achieve better reconstructive effect and minimize donor-site damage.
The relationships between bariatric surgery and sexual function: current evidence based medicine
Authors: Liu Shengzhuo , Cao Dehong , Ren Zhengju , Li Jinze , Peng Lei , Zhang Qin , Cheng Bo , Cheng Zheyu , Ai Jianzhong , Zheng Xiaonan , Liu Liangren , Wei Qiang
Published: October 2020

Background

Controversy remains despite several studies have discussed the role of bariatric surgery in improving male’s sexual function. This study aims to evaluate the efficacy of bariatric surgery in promoting male’s erectile function.

Methods

PubMed, EMbase, The Cochrane Library, CNKI and Clinical Trails.gov were searched from database inception to May 2019. The language of publication was limited in English. The International Index of Erectile Function (IIEF) score and Brief Male Sexual Function Inventory (BSFI) score were set as the primary outcome.

Results

Eleven studies with a total of 370 patients were enrolled in this meta-analysis. The results showed significant improvement in the IIEF score (erectile function: MD = 5.33, 95% CI 4.12–6.54; intercourse satisfaction: MD = 2.57, 95% CI 1.19–3.94; orgasmic function: MD = 0.50, 95%CI 0.60–0.94; overall satisfaction: MD = 1.67, 95% CI 0.78–2.56; sexual desire: MD = 1.27, 95% CI 0.61–1.93; total erectile function: MD = 7.21, 95% CI 4.33–10.10) and the BSFI score (erection: MD =2.53, 95% CI 2.39–2.67; ejaculation: MD = 1.40, 95% CI 1.28–1.51; desire: MD =1.40, 95% CI 1.32–1.49; problem assessment: MD = 2.20, 95% CI 2.06–2.34; sexual satisfaction: MD = 0.70, 95% CI 0.60–0.76) in obese individuals after bariatric surgery.

Conclusions

This systematic review and meta-analysis indicated that bariatric surgery could be effective in promoting males’s sexual function for obese individuals.
Efficacy and cardiovascular safety of the new estrogen-free contraceptive pill containing 4 mg drospirenone alone in a 24/4 regime
Authors: Palacios Santiago , Colli Enrico , Regidor Pedro-Antonio
Published: October 2020

Background

A new estrogen-free contraceptive has been approved by both the FDA and more than 15 European authorities. It is composed of drospirenone (DRSP) at a dosage of 4 mg in a regimen 24/4. The molecule is known to have anti-gonadotropic, anti-mineralocorticoid, anti-estrogenic, and antiandrogenic properties. The purpose of these clinical trials with a new estrogen-free contraceptive was to introduce a contraceptive method with high efficacy and showing a profile with low cardiovascular risks.

Methods

Three European and American multicenter clinical trials have been conducted in more than 2500 patients and more than 25,000 cycles, not only demonstrating an excellent efficacy (Pearl Index of 0.73) but also investigating possible cardiovascular risks. In the USA study, 422 participants (41.9%) had a risk factor for VTE, while in the European studies, 261 patients (16.6%) had at least one VTE risk factor. Amount of arterial and venous thromboembolic events, hemostasiological data, blood pressure development, and ECG data were evaluated.

Results

No single case of VTE was documented, no changes in hemastosiological parameters were observed, a small decrease in RR in patients with pretreatment values between 130 and 140 and/or 85 to 90 mm HG and no influence on ECG parameters were observed.

Conclusions

The introduction of a new estrogen-free contraceptive with 4 mg of non-micronized drospirenone in a 24/4-day regimen expands contraception options for women as not only a high efficacy could be demonstrated during clinical trials but also a very high cardiovascular safety profile was observed even in women with cardiovascular risk factors.

Trial registration

EudraCT registration numbers: 2010–021787-15 & 2011–002396-42. Clincaltrials.gov: NCT02269241.
“The whole package deal”: experiences of overweight/obese women living with polycystic ovary syndrome
Authors: Ee Carolyn , Smith Caroline , Moran Lisa , MacMillan Freya , Costello Michael , Baylock Brandi , Teede Helena
Published: October 2020

Background

Polycystic Ovary Syndrome (PCOS) is a common female reproductive disorder with multiple manifestations. There are relatively few qualitative studies exploring the nature of living with PCOS despite its high prevalence. Qualitative research can enhance clinical practice via the provision of patient insights into the experience of living with their condition.

Methods

We conducted two focus groups and three semi-structured interviews of Australian overweight/obese women with PCOS aged 18–46 years between March and April 2017 who were recruited through social media advertising. Interviews and focus groups were audio recorded and transcribed verbatim. Thematic analysis was applied to the data, using the method of constant comparison.

Results

Ten women contributed data from two focus groups and two semi-structured interviews. Five themes emerged from the data: complexity of the condition with its multiple manifestations, difficulties with delayed diagnosis and lack of information provided after diagnosis, negative experiences on social media and online forums and the need for support, frustration over lack of a “cure”; and the impact of symptoms and concern about long-term sequelae.

Conclusions

Living with PCOS appears to generate a significant degree of anxiety about the future, dissatisfaction with current treatment models, and loss of feminine identity. Gaps in timely diagnosis, information and support provision need to be addressed. This includes supporting weight management as a fundamental concern for women with PCOS.
Prediction of incident myocardial infarction using machine learning applied to harmonized electronic health record data
Authors: Mandair Divneet , Tiwari Premanand , Simon Steven , Colborn Kathryn L. , Rosenberg Michael A.
Published: October 2020

Background

With cardiovascular disease increasing, substantial research has focused on the development of prediction tools. We compare deep learning and machine learning models to a baseline logistic regression using only ‘known’ risk factors in predicting incident myocardial infarction (MI) from harmonized EHR data.

Methods

Large-scale case-control study with outcome of 6-month incident MI, conducted using the top 800, from an initial 52 k procedures, diagnoses, and medications within the UCHealth system, harmonized to the Observational Medical Outcomes Partnership common data model, performed on 2.27 million patients. We compared several over- and under- sampling techniques to address the imbalance in the dataset. We compared regularized logistics regression, random forest, boosted gradient machines, and shallow and deep neural networks. A baseline model for comparison was a logistic regression using a limited set of ‘known’ risk factors for MI. Hyper-parameters were identified using 10-fold cross-validation.

Results

Twenty thousand Five hundred and ninety-one patients were diagnosed with MI compared with 2.25 million who did not. A deep neural network with random undersampling provided superior classification compared with other methods. However, the benefit of the deep neural network was only moderate, showing an F1 Score of 0.092 and AUC of 0.835, compared to a logistic regression model using only ‘known’ risk factors. Calibration for all models was poor despite adequate discrimination, due to overfitting from low frequency of the event of interest.

Conclusions

Our study suggests that DNN may not offer substantial benefit when trained on harmonized data, compared to traditional methods using established risk factors for MI.
Using machine learning methods to predict in-hospital mortality of sepsis patients in the ICU
Authors: Kong Guilan , Lin Ke , Hu Yonghua
Published: October 2020

Background

Early and accurate identification of sepsis patients with high risk of in-hospital death can help physicians in intensive care units (ICUs) make optimal clinical decisions. This study aimed to develop machine learning-based tools to predict the risk of hospital death of patients with sepsis in ICUs.

Methods

The source database used for model development and validation is the medical information mart for intensive care (MIMIC) III. We identified adult sepsis patients using the new sepsis definition Sepsis-3. A total of 86 predictor variables consisting of demographics, laboratory tests and comorbidities were used. We employed the least absolute shrinkage and selection operator (LASSO), random forest (RF), gradient boosting machine (GBM) and the traditional logistic regression (LR) method to develop prediction models. In addition, the prediction performance of the four developed models was evaluated and compared with that of an existent scoring tool – simplified acute physiology score (SAPS) II – using five different performance measures: the area under the receiver operating characteristic curve (AUROC), Brier score, sensitivity, specificity and calibration plot.

Results

The records of 16,688 sepsis patients in MIMIC III were used for model training and test. Amongst them, 2949 (17.7%) patients had in-hospital death. The average AUROCs of the LASSO, RF, GBM, LR and SAPS II models were 0.829, 0.829, 0.845, 0.833 and 0.77, respectively. The Brier scores of the LASSO, RF, GBM, LR and SAPS II models were 0.108, 0.109, 0.104, 0.107 and 0.146, respectively. The calibration plots showed that the GBM, LASSO and LR models had good calibration; the RF model underestimated high-risk patients; and SAPS II had the poorest calibration.

Conclusion

The machine learning-based models developed in this study had good prediction performance. Amongst them, the GBM model showed the best performance in predicting the risk of in-hospital death. It has the potential to assist physicians in the ICU to perform appropriate clinical interventions for critically ill sepsis patients and thus may help improve the prognoses of sepsis patients in the ICU.
Breast cancer pathology services in sub-Saharan Africa: a survey within population-based cancer registries
Authors: Ziegenhorn Hannes-Viktor , Frie Kirstin Grosse , Ekanem Ima-Obong , Ebughe Godwin , Kamate Bakarou , Traore Cheick , Dzamalala Charles , Ogunbiyi Olufemi , Igbinoba Festus , Liu Biying , Bauer Marcus , Thomssen Christoph , Parkin Donald Maxwell , Wickenhauser Claudia , Kantelhardt Eva Johanna
Published: October 2020

Background

Pathologists face major challenges in breast cancer diagnostics in sub-Saharan Africa (SSA). The major problems identified as impairing the quality of pathology reports are shortcomings of equipment, organization and insufficiently qualified personnel. In addition, in the context of breast cancer, immunohistochemistry (IHC) needs to be available for the evaluation of biomarkers. In the study presented, we aim to describe the current state of breast cancer pathology in order to highlight the unmet needs.

Methods

We obtained information on breast cancer pathology services within population-based cancer registries in SSA. A survey of 20 participating pathology centres was carried out. These centres represent large, rather well-equipped pathologies. The data obtained were related to the known population and breast cancer incidence of the registry areas.

Results

The responding pathologists served populations of between 30,000 and 1.8 million and the centres surveyed dealt with 10–386 breast cancer cases per year. Time to fixation and formalin fixation time varied from overnight to more than 72 h. Only five centres processed core needle biopsies as a daily routine. Technical problems were common, with 14 centres reporting temporary power outages and 18 centres claiming to own faulty equipment with no access to technical support. Only half of the centres carried out IHC in their own laboratory. For three centres, IHC was only accessible outside of the country and one centre could not obtain any IHC results. A tumour board was established in 13 centres.

Conclusions

We conclude that breast cancer pathology services ensuring state-of-the-art therapy are only available in a small fraction of centres in SSA. To overcome these limitations, many of the centres require larger numbers of experienced pathologists and technical staff. Furthermore, equipment maintenance, standardization of processing guidelines and establishment of an IHC service are needed to comply with international standards of breast cancer pathology.
Maternal lipid profile in early pregnancy is associated with foetal growth and the risk of a child born large-for-gestational age: a population-based prospective cohort study
Authors: Adank Maria C. , Benschop Laura , Kors Alet W. , Peterbroers Kelly R. , Smak Gregoor Anna M. , Mulder Monique T. , Schalekamp-Timmermans Sarah , Roeters Van Lennep Jeanine E. , Steegers Eric A. P.
Published: October 2020

Background

Lipids such as cholesterol and triglycerides play an important role in both maternal and foetal energy metabolism. Little is known about maternal lipid levels in pregnancy and their effect on foetal growth. The aim of this study was to assess maternal lipid levels, foetal growth and the risk of small-for-gestational age (SGA) and large-for-gestational age (LGA).

Methods

We included 5702 women from the Generation R Study, a prospective population-based cohort. Maternal lipid levels (total cholesterol, triglycerides and high-density lipoprotein cholesterol [HDL-c]) were measured in early pregnancy (median 13.4 weeks, 90% range [10.5 to 17.2]). Low-density lipoprotein cholesterol (LDL-c), remnant cholesterol and non-HDL-c were calculated. Foetal growth was measured repeatedly by ultrasound. Information on birth anthropometrics was retrieved from medical records. A birth weight below the 10th percentile was defined as SGA and above the 90th percentile as LGA.

Results

Maternal triglyceride and remnant cholesterol levels were associated with increased foetal head circumference and abdominal circumference growth rates. Triglycerides and remnant cholesterol were positively associated with the risk of LGA (odds ratio [OR] 1.11, 95% confidence interval [CI] [1.01 to 1.22] and OR 1.11, 95% CI [1.01 to 1.23], respectively). These associations were independent of maternal pre-pregnancy body mass index, but not maternal glucose levels. We observed no association between maternal lipids in early pregnancy and SGA.

Conclusions

Our study suggests a novel association of early pregnancy triglyceride and remnant cholesterol levels with foetal growth, patterns of foetal growth and the risk of LGA. Future studies are warranted to explore clinical implication possibilities.
Highly multiplexed quantifications of 299 somatic mutations in colorectal cancer patients by automated MALDI-TOF mass spectrometry
Authors: Xu Chang , Peng Danli , Li Jialu , Chen Meihua , Hu Yujie , Hou Mingliang , Shang Qingjuan , Liang Qi , Li Jie , Li Wenfeng , Wu Xiaoli , Liu Changbao , Hu Wanle , Cai Mao , Zhang Huxiang , Chen Guorong , Yu Lingling , Zheng Xiaoqun , Jiang Feizhao , Luan Ju , Jin Shengnan , Ding Chunming
Published: October 2020

Background

Detection of somatic mutations in tumor tissues helps to understand tumor biology and guide treatment selection. Methods such as quantitative PCR can analyze a few mutations with high efficiency, while next generation sequencing (NGS) based methods can analyze hundreds to thousands of mutations. However, there is a lack of cost-effective method for quantitatively analyzing tens to a few hundred mutations of potential biological and clinical significance.

Methods

Through a comprehensive database and literature review we selected 299 mutations associated with colorectal cancer. We then designed a highly multiplexed assay panel (8-wells covering 299 mutations in 109 genes) based on an automated MADLI-TOF mass spectrometry (MS) platform. The multiplex panel was tested with a total of 319 freshly frozen tissues and 92 FFPE samples from 229 colorectal cancer patients, with 13 samples also analyzed by a targeted NGS method covering 532 genes.

Results

Multiplex somatic mutation panel based on MALDI-TOF MS detected and quantified at least one somatic mutation in 142 patients, with KRAS, TP53 and APC being the most frequently mutated genes. Extensive validation by both capillary sequencing and targeted NGS demonstrated high accuracy of the multiplex MS assay. Out of 35 mutations tested with plasmid constructs, sensitivities of 5 and 10% mutant allele frequency were achieved for 19 and 16 mutations, respectively.

Conclusions

Automated MALDI-TOF MS offers an efficient and cost-effective platform for highly multiplexed quantitation of 299 somatic mutations, which may be useful in studying the biological and clinical significance of somatic mutations with large numbers of cancer tissues.
Everolimus-eluting bioresorbable scaffolds and metallic stents in diabetic patients: a patient-level pooled analysis of the prospective ABSORB DM Benelux Study, TWENTE and DUTCH PEERS
Authors: Hommels T. M. , Hermanides R. S. , Berta B. , Fabris E. , De Luca G. , Ploumen E. H. , von Birgelen C. , Kedhi E.
Published: October 2020

Background

Several studies compared everolimus-eluting bioresorbable scaffolds (EE-BRS) with everolimus-eluting stents (EES), but only few assessed these devices in patients with diabetes mellitus.

Aim

To evaluate the safety and efficacy outcomes of all-comer patients with diabetes mellitus up to 2 years after treatment with EE-BRS or EES.

Methods

We performed a post hoc pooled analysis of patient-level data in diabetic patients who were treated with EE-BRS or EES in 3 prospective clinical trials: The ABSORB DM Benelux Study (NTR5447), TWENTE (NTR1256/NCT01066650) and DUTCH PEERS (NTR2413/NCT01331707). Primary endpoint of the analysis was target lesion failure (TLF): a composite of cardiac death, target vessel myocardial infarction or clinically driven target lesion revascularization. Secondary endpoints included major adverse cardiac events (MACE): a composite of all-cause death, any myocardial infarction or clinically driven target vessel revascularization, as well as definite or probable device thrombosis (ST).

Results

A total of 499 diabetic patients were assessed, of whom 150 received EE-BRS and 249 received EES. Total available follow-up was 222.6 patient years (PY) in the EE-BRS and 464.9 PY in the EES group. The adverse events rates were similar in both treatment groups for TLF (7.2 vs. 5.2 events per 100 PY, p = 0.39; adjusted hazard ratio (HR) = 1.48 (95% confidence interval (CI): 0.77–2.87), p = 0.24), MACE (9.1 vs. 8.3 per 100 PY, p = 0.83; adjusted HR = 1.23 (95% CI: 0.70–2.17), p = 0.47), and ST (0.9 vs. 0.6 per 100 PY, p > 0.99).

Conclusion

In this patient-level pooled analysis of patients with diabetes mellitus from 3 clinical trials, EE-BRS showed clinical outcomes that were quite similar to EES.