bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Preseason Versus In-Season Play on Achilles Tendon Injuries in the National Football League
Authors: Ready Lauren V. , Li Neill Y. , Worobey Samantha , Lemme Nicholas J. , Yang Daniel S. , Yang JaeWon , Krill Michael , Owens Brett D.
Published: December 2021

Background:

A ruptured Achilles tendon (AT) can sideline a player for 6 to 12 months and reduce their power rankings by more than 50%. Previous research has compared AT rupture rates in different game conditions.

Purpose:

To determine environmental and physiological risk factors for AT tears, given the minimal amount of research on AT ruptures in the National Football League (NFL).

Study Design:

Case series; Level of evidence, 4.

Methods:

NFL players with a diagnosed AT tear between 2009 and 2016 were selected as the study population for this retrospective analysis. Data on NFL injury were collected from an established database composed of publicly available information. Player profiles were employed to determine position, team, and game statistics at the time of injury. The proportion of NFL rookies was approximated by summing the number of draft picks and the number of signed, undrafted free agents and measured against the number of roster spots before the season.

Results:

Between 2009 and 2016, there were 101 documented AT tears. Of these, 64% (65/101) occurred before the official season, including preseason games. Of the 36 tears that occurred in-season, 34 were during games. Overall, 29% (19/65) of the preseason tears occurred in rookies and 100% (36/36) of the in-season tears affected nonrookies. Of the rookies with AT ruptures, 42.11% returned to play in the NFL, while 62.20% of the nonrookies came back to partake in future seasons. Despite an average age of 26.7 years, the tear distribution was bimodal with players aged 24 and 36 years exhibiting the highest rates of tear.

Conclusion:

In our review of AT tears in NFL athletes, a large percentage of the tears occurred in rookie players, especially during the preseason. We also found that tears during the season occurred in only nonrookies, suggesting that the preseason is when rookies experience the greatest risk for injury.
High Variability of Mesenchymal Stem Cells Obtained via Bone Marrow Aspirate Concentrate Compared With Traditional Bone Marrow Aspiration Technique
Authors: Brozovich Ava , Sinicrope Brent J. , Bauza Guillermo , Niclot Federica Banche , Lintner David , Taraballi Francesca , McCulloch Patrick C.
Published: December 2021

Background:

Bone marrow aspirate (BMA) is a common source for harvesting mesenchymal stem cells (MSCs), other progenitor cells, and associated cytokines and growth factors to be used in the biologic treatment of various orthopaedic pathologies. The aspirate is commonly centrifuged into a concentrated volume that can be immediately administered to a patient using commercially available kits. However, the handling and efficacy of BMA concentrate (BMAC) are still controversial.

Purpose:

To characterize BMA versus BMAC for MSC quantity, potency, and cytokine profile.

Study Design:

Controlled laboratory study.

Methods:

From 8 participants (age, 17-68 years), 30 mL of bone marrow was aspirated by a single surgeon from either the proximal humerus or distal femur and was separated into 2 equal samples. One sample was kept as BMA, and the other half was centrifuged into BMAC. The 2 samples then underwent flow cytometry for detection of MSCs, cell analysis for colony-forming units (CFUs), and cytokine profiling. A 2-tailed t test was used to detect differences between MSCs, CFUs, and cytokine density concentrations between BMA and BMAC.

Results:

The average concentration of MSCs in both BMA and BMAC was 0.001%. Average MSC events detected by flow cytometry were significantly higher in BMA versus BMAC (15.1 and 8.1, respectively; P < .045). Expanded MSCs demonstrated similar phenotypes, but CFUs were significantly increased in BMA compared with BMAC (104 vs 68 CFUs, respectively; P < .001). Total protein concentration and cytokine profiling demonstrated great variability between BMA and BMAC and between patients. Most importantly, BMAC failed to concentrate MSCs in 6 of 8 samples.

Conclusion:

There is great variability in MSC concentration, total protein concentration, and cytokine profile between BMA and BMAC.

Clinical Relevance:

When studying the clinical efficacy of BMAC, one must also evaluate the sample itself to determine the presence, concentration, and potency of MSCs if this is to be considered a cell-based therapy. Further standard operating procedures need to be investigated to ensure reproducible results and appropriate treatments.
Does Instructional Mode Alter the Effectiveness of a Curricular Response to Campus Sexual Violence?
Authors: Johnson Katherine M. , Liddell Jessica L. , Lederer Alyssa M. , Sheffield Sydney
Published: December 2021

Online coursework is becoming a teaching and learning staple in higher education, especially since the onset of the COVID-19 pandemic. However, there is minimal literature regarding academic courses for campus sexual violence prevention, particularly comparing online versus face-to-face modalities. This study examined whether the effectiveness of a semester-long credit-bearing course (GESS 1900), designed to educate first year college students about correlates of sexual violence in order to ultimately reduce campus sexual violence, differed by instructional mode. Two cohorts had completed GESS 1900 in-person when the COVID-19 pandemic struck; the third cohort was taught entirely online through synchronous instruction and with the exact same faculty instructors and course materials. This created a natural experiment to compare outcomes by instructional mode. We used a quasi-experimental, pretest–posttest survey design to compare in-person ( n = 92) versus online ( n = 45) GESS 1900 students across eight previously validated attitudinal measures related to gender, sexuality, and sexual violence. Results from a two-way, mixed-factorial ANOVA showed no significant differences related to instructional mode on seven of the eight measures. Findings further showed change over time in the desired direction for all students, regardless of instructional mode; many measures showed different starting points for the two groups, but similar rates of change over time. Thus both in-person and synchronous online versions of GESS 1900 were effective in shaping positive student outcomes. The findings have important implications for educators seeking new or multiple delivery methods to educate college students about the pressing health concern of sexual violence.
Nursing Student's Experiences of Meditation on Twin Hearts During Eight Weeks Practice: A Qualitative Content Analysis
Authors: Meena B.M. , Manasa B. , Vijayakumar Vinu , Salagame Kiran Kumar K. , Jois Srikanth N.
Published: December 2021

Background

Meditation on Twin Hearts (MTH) involves blessing the earth to alleviate the sufferings, and praying for the well-being of the entire society using heart and crown chakra. This meditation is characterized by mechanisms of loving-kindness, self-healing imagery, and open awareness.

Purpose

This study aims to identify the experiences and perceived benefits associated with practicing MTH by nursing students.

Method

Qualitative method using content analysis was used to study meditation experiences. After obtaining the informed consent, 22 nursing students were introduced to MTH. Experiences and feedback from meditation sessions were reported each day during their 8 week practice. Nursing students also answered seven open-ended questions on the last day of the meditation session.

Findings

The verbatim descriptions of experiences reported by nursing students were abstracted to elements (17), properties (6), and categories (2). Identified properties are positive experiences, experiences of awareness, energy experiences, tangible outcomes, physiological reactions, and feedback on the study program.

Conclusion

The experiences narrated by nursing students include positive affective experiences, health benefits, resolution of problem, awareness and energy experiences, and prosocial tendencies. These findings indicate that MTH would enhance the well-being of the nursing students and could be used as a self-care measure.
Healthcare Providers Face Numerous Challenges in Treating Patients with Psoriasis: Results from a Mixed-Methods Study
Authors: Murray Suzanne , Crowley Jeffrey , Gooderham Melinda J. , Kivitz Alan , Chandran Vinod , Péloquin Sophie , Doghramji Paul P. , Freeman Christie , Lazure Patrice
Published: December 2021

Background

The paradigm shift toward biologic medications in psoriasis care requires healthcare providers (HCPs) to become acquainted with mechanisms of action and safety profiles of these new treatments to confidently use them in practice. A better understanding of this paradigm shift is necessary to provide adequate education for HCPs in psoriasis care.

Objectives

This study assessed clinical practice gaps and challenges experienced by HCPs caring for patients with psoriasis.

Methods

A mixed-methods approach was used to identify practice gaps and clinical challenges of dermatologists, rheumatologists, primary care physicians, physician assistants, and nurse practitioners with various levels of clinical experience in academic and community-based settings. Qualitative and quantitative data were collected sequentially. Interviews were transcribed and thematically analyzed.

Results

A total of 380 psoriasis care providers in Canada and the US participated in this study. Analysis revealed challenges in establishing an accurate diagnosis of psoriasis (including screening for sub-type and distinguishing psoriasis from other skin conditions), selecting treatment (particularly regarding recently approved treatments), monitoring side effects, and collaborating with other HCPs involved in psoriasis care.

Conclusion

These findings highlight educational needs of HCPs involved in psoriasis care that could have repercussions on accurate and timely diagnosis of the condition, treatment initiation, side effect monitoring, and continuity of care. Findings provide a starting point for clinicians to reflect on their practice and for the improvement of continuing professional development interventions that would bridge these gaps.
Fostering therapeutic security in insecure times: Populism and the new rise of nationalism
Authors: Chrząstowski Szymon
Published: December 2021

A sense of security is a key issue in attachment theory and its derivation, attachment narrative therapy. This article focuses on an analysis of threats to security that result from the socio-cultural context in which psychotherapy and supervision are conducted. Europe is perceived as a relatively safe place. However, growing populism and nationalism are affecting the context in which psychotherapy is being carried out, by reducing the sense of security of patients, therapists and supervisors alike. The article explores this phenomenon. An example of supervision will be provided, carried out by Arlene Vetere shortly after the brutal murder of a prominent Polish politician. Consideration will be given to the agreement of views between the supervisee and the supervisor, as well as its significance to the supervision. The manner in which security is built within supervision rooted in attachment narrative therapy will also be analysed. The thesis posited is that a sense of security is not an innate personal characteristic but results from actively working towards it and a description of such actions is also offered in the article.
Comparing the impact on the prognosis of acute myocardial infarction critical patients of using midazolam, propofol, and dexmedetomidine for sedation
Authors: Jiang Xiaowei , Yan Min
Published: December 2021

Background

There are less studies focusing on the sedative therapy of acute myocardial infarction (AMI) critical patients. This study aim to compare the impact on the prognosis of AMI critical patients of using midazolam, propofol and dexmedetomidine.

Methods

We collected clinical data from the Medical Information Mart for Intensive Care III (MIMIC III) database. Data on 427 AMI patients with sedatives using were recruited from in Coronary Heart Disease Intensive Care unit (CCU).

Results

There were 143 patients in midazolam using, 272 in propofol using and 28 in dexmedetomidine using. The rate of 28-days mortality was 23.9% in overall patients. Through logistic regression analysis, only midazolam using was significant association with increased 28-days mortality when compared with propofol or dexmedetomidine using. In the subgroup analysis of age, gender, body mass index (BMI), white blood cell (WBC), beta-block, and revascularization, the association between midazolam using and increased 28-days mortality remained significantly. Through propensity score matching, 140 patients using midazolam and 192 using non-midazolam were successfully matched, the midazolam using presented with higher rate of CCU mortality, hospital mortality and 28-days mortality, longer of mechanical ventilation time and CCU duration. E-value analysis suggested robustness to unmeasured confounding.

Conclusion

Propofol or dexmedetomidine are preferred to be used in AMI critical patients for sedative therapy.
Effect of catheter ablation on clinical outcomes in patients with atrial fibrillation and significant functional mitral regurgitation
Authors: Wu Jin-Tao , Zhao Dan-Qing , Zhang Fu-Tao , Liu Xiao-Jie , Hu Juan , Zhang Lei-Ming , Fan Xian-Wei , Yang Hai-Tao , Yan Li-Jie , Liu Jing-Jing , Wang Shan-Ling
Published: December 2021

Background

In patients with atrial fibrillation (AF) and functional mitral regurgitation (MR), catheter ablation reduces the severity of MR and improves cardiac remodeling. However, its effects on prognosis are uncertain.

Methods

This retrospective study included 151 consecutive patients with AF and functional MR, 82 (54.3%) of whom were treated by catheter ablation (Ablation group) and 69 (45.7%) with drug therapy without ablation (Non-ablation group). Forty-three pairs of these patients were propensity matched on the basis of age, CHA2DS2-VASc scores, and left ventricular ejection fraction. The primary outcome evaluated was severity of MR, cardiac remodeling and the combined incidence of subsequent heart failure-related hospitalization and strokes/transient ischemic attacks.

Results

Patients in the Ablation group showed a significant decrease in the severity of MR (p < 0.001), a significant decrease in the left atrial diameter (p = 0.010), and significant improvement in the left ventricular ejection fraction (p = 0.015). However, patients in the Non-ablation group showed only a significant decrease in the severity of MR (p = 0.004). The annual incidence of the studied events was 4.9% in the Ablation group and 16.7% in the Non-ablation group, the incidence being significantly lower in the ablation than Non-ablation group (p = 0.026) according to Kaplan–Meier curve analyses. According to multivariate Cox regression analysis, catheter ablation therapy (hazard ratio [HR] 0.27, 95% confidence interval [CI] 0.09–0.84;p = 0.024) and heart failure at baseline (HR 3.84, 95% CI 1.07–13.74;p = 0.038) were independent predictors of the incidence of the studied events.

Conclusions

Among patients with AF and functional MR, catheter ablation was associated with a significantly lower combined risk of heart failure-related hospitalization and stroke than in a matched cohort of patients receiving drug therapy alone.
Aggregation and combination of cardiovascular risk factors and their association with 10-year all-cause mortality: the PERU MIGRANT Study
Authors: Bazalar-Palacios Janina , Jaime Miranda J. , Carrillo-Larco Rodrigo M. , Gilman Robert H. , Smeeth Liam , Bernabe-Ortiz Antonio
Published: December 2021

Objective

To estimate the association between the aggregation and pair-wise combination of selected cardiovascular risk factors (CVRF) and 10-year all-cause mortality.

Methods

Secondary data analysis of the PERU MIGRANT study, a prospective population-based cohort. Ten-year all-cause mortality was determined for participants originally enrolled in the PERU MIGRANT Study (baseline in 2007) through the National Registry of Identification and Civil Status. The CVRF included hypertension, type 2 diabetes mellitus, hypercholesterolemia, and overweight/obesity. Exposures were composed of both the aggregation of the selected CVRF (one, two, and three or more CVRF) and pair-wise combinations of CVRF. Cox regression models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI).

Findings

Of the 989 participants evaluated at baseline, 976 (98.8%) had information about vital status at 10 years of follow-up (9992.63 person-years), and 63 deaths were recorded. In the multivariable model, adjusting for sociodemographic and lifestyle variables, participants with two CVRF (HR: 2.48, 95% CI: 1.03–5.99), and those with three or more CVRF (HR: 3.93, 95% CI: 1.21–12.74) had higher all-cause mortality risk, compared to those without any CVRF. The pair-wise combinations associated with the highest risk of all-cause mortality, compared to those without such comorbidities, were hypertension with type 2 diabetes (HR: 11.67, 95% CI: 3.67–37.10), and hypertension with overweight/obesity (HR: 2.76, 95% CI: 1.18–6.71).

Conclusions

The aggregation of two or more CVRF and the combination of hypertension with type 2 diabetes or overweight/obesity were associated with an increased risk of 10-year all-cause mortality. These risk profiles will inform primary and secondary prevention strategies to delay mortality from cardiovascular risk factors.
Cardiac impact of high-frequency irreversible electroporation using an asymmetrical waveform on liver in vivo
Authors: Li Jing , Wang Jingjing , Zhang Xiaobo , Zhang Xiao , Gao Hongmei , Xiao Yueyong
Published: December 2021

Background

High-Frequency Irreversible Electroporation (H-FIRE) is a novel technology for non-thermal ablation. Different from Irreversible electroporation (IRE), H-FIRE delivers bipolar electrical pulses without muscle contraction and does not cause electrolysis. Currently, little is known regarding the cardiac safety during the administration of H-FIRE on liver. The aim of this study was to evaluate the changes of electrocardiogram (ECG) and biomarkers of cardiac damage during asymmetrical waveform of H-FIRE therapy in vivo.

Methods

The swines (n = 7) in IRE group, which used 100 pulses (2200 V, 100–100 μs configuration), were administrated with muscle relaxant under anesthesia. In the absence of muscle relaxant, 7 swines in H-FIRE group were performed with 2400 pulses (3000 V, 5–3–3–5 μs configuration). Midazolam (0.5 mg/kg) and xylazine hydrochloride (20 mg/kg) were given to induce sedation, followed by Isoflurane (2.5%, 100% oxygen, 3 L/min) to maintain sedation in all the swines. Limb lead ECG recordings were analyzed by two electrophysiologists to judge the arrhythmia. Cardiac and liver tissue was examined by pathology technique.

Results

The ablation zones were larger in H-FIRE than IRE. Both IRE and H-FIRE did not affect the autonomous cardiac rhythm. Even when the electrical signal of IRE and H-FIRE fell on ventricular vulnerable period. Moreover, cTnI in IRE group showed an increase in 4 h after ablation, and decreased to baseline 72 h after ablation. However, cTnI showed no significant change during the administration of H-FIRE.

Conclusions

The study suggests an asymmetrical waveform for H-FIRE is a promising measure for liver ablation. The results were based on normal liver and the swines without potential cardiac diseases. With the limitations of these facts, asymmetrical waveform for H-FIRE of liver tissue seems relatively safe without major cardiac complications. The safety of asymmetrical waveform for H-FIRE needs to evaluate in future.
Variations in TM6SF2, PCSK9 and PCSK7 genes and risk of hepatic steatosis after liver transplantation: a cross-sectional study
Authors: Eshraghian Ahad , Moasser Elham , Azarpira Negar , Fattahi Mohammad Reza , Nikeghbalian Saman , Malek-Hosseini Seyed Ali , Geramizadeh Bita
Published: December 2021

Background

Genetic abnormalities might have important role in pathogenesis of hepatic steatosis after liver transplantation. We aimed to investigate association between genetic variations in transmembrane 6 superfamily member 2 (TM6SF2) rs58542926, proprotein convertase subtilisin/kexin type 9 (PCSK9) rs505151 and proprotein convertase subtilisin/kexin type 7 (PCSK7) rs2277287 with hepatic steatosis in liver transplant recipients.

Methods

In a cross-sectional study, adult (> 18 years) liver transplant recipients who were referred for their routine post-transplant follow-up between June 2018 and September 2018 were included in the study. Hepatic steatosis in transplant recipients was assessed by controlled attenuation parameter (CAP). Polymerase chain reaction-restriction fragment length polymorphism (PCR–RFLP) was used to study TM6SF2 rs58542926, PCSK7 rs2277287 and PCSK9 rs505151 genotypes.

Results

107 liver transplant recipients were included. There was no association between different genotypes of PCSK9 rs505151 and PCSK7 rs2277287 with hepatic steatosis in liver transplant recipients (P value > 0.05). The presence of TT genotype of TM6SF2 rs58542926 was higher in patients with hepatic steatosis measured by CAP after liver transplantation. In patients with moderate and severe hepatic steatosis (grade 2 and 3 steatosis), AG + GG genotypes of PCSK9 rs505151 were more prevalent than AA genotype (OR 8.667; 95% CI 1.841–40.879; P value = 0.004) compared to patients with mild steatosis (grade 1). In multivariate regression model, AG + GG genotypes of PCSK9 rs505151 were associated with moderate and severe steatosis in liver transplant recipients (OR 5.747; 95% CI 1.086–30.303; P value = 0.040).

Conclusions

Genetic variations in TM6SF2 rs58542926 and PCSK9 rs505151 might be associated with hepatic steatosis in liver transplant recipients.
Higher prevalence of geriatric depression, catastrophizing pain and sleep disorders in institutionalized elders: a cross-sectional study in Galle District, Sri Lanka
Authors: Abeysekera N. W. B. Y. , De Zoysa Eric
Published: December 2021

Background

Population aging is a significant social problem in the twenty first century. Recent economic and social changes lead increasing number of elders to spend their lives in elderly homes. Institutionalized elders have to face many physical and psychological problems which negatively impact their quality of life. Geriatric depression (GD), catastrophizing pain (CP) and sleep disorders (SD) are some common problems among them.

Methods

Present study was designed to assess the prevalence of GD, CP and SD and their correlations in institutionalized elders. A descriptive cross-sectional study was conducted in elderly homes (n = 20) in the Galle district of Sri Lanka enrolling 310 subjects. GD, CP and SD were assessed using validated Sinhala versions of Geriatric Depression Scale (GDS), Pain Catastrophizing Scale (PCS) and Pittsburgh Sleep Quality Index (PSQI) respectively. Data were analyzed using SPSS version 25.0 for windows by using descriptive statistics, the Pearson’s chi-square test and Pearson’s bivariate correlation (p < 0.05).

Results

Among the participants (response rate: 95.7%), 34.8% (n = 108) and 65.2% (n = 202) were males and females respectively. Age range of the subjects was 60–103 years with the mean age of 74.97 years (SD 8.852). Most of the study subjects (n = 234, 75.5%) had spent five or less than 5 years in elderly homes at the time of the study and 52.8% (n = 164) of them were unmarried. GD was present in 76.5% (95% CI: 71.7–81.2) of subjects and of them 44% had moderate to severe depression. PCS revealed that 29% (95% CI: 24.0–34.1) had CP. SD were identified in 55.5% (95% CI: 49.5–61.0) of elders and according to PSQI, 86% (95% CI: 82.3–90.0) had poor quality sleep. Positive correlations between GD and CP (r = 0.24,p < 0.01), GD and SD (r = 0.13,p = 0.02), CP and SD (r = 0.32,p < 0.01) were statistically significant.

Conclusions

Prevalence of GD, CP and SD were significantly higher in this sample of institutionalized elders who were apparently healthy. Findings highlighted the importance of early screening of physical and psychological problems in institutionalized elders to assure better quality of life and to reduce the burden to health care system of the country.
Social networks moderate the association between physical fitness and cognitive function among community-dwelling older adults: a population-based study
Authors: Foong Hui Foh , Ibrahim Rahimah , Hamid Tengku Aizan , Haron Sharifah Azizah
Published: December 2021

Background

Physical fitness declines with age. Low levels of physical fitness appear to be a risk factor of cognitive impairment. Literature elucidates social networking as a potential moderator for the relationship between physical fitness and cognitive impairment. Present study aimed to examine the relationship between physical fitness and cognitive function among community-dwelling older Malaysians, and if social network moderates said relationship.

Methods

Data of 2322 representative community-dwelling older adults were obtained from the first wave of the “Longitudinal Study on Neuroprotective Model for Healthy Longevity” national survey. Cognitive function, physical fitness and social network was assessed through Malay-version of Mini-Mental State Examination, 2-min step test and Lubben Social Network Scale-6 respectively. Moderated hierarchical multiple regression was employed to investigate if social networks moderate the relationship between physical fitness and cognitive function.

Results

A positive association between physical fitness and cognitive function were found upon controlling for covariates. Moderated hierarchical multiple regression revealed social networks to be a moderator of the association between physical fitness and cognitive function. When physical fitness was low, those with small social network revealed lowest cognitive function.

Conclusions

Social networks moderated the relationship between physical fitness and cognitive function as older adults with low levels of physical fitness and small social networks revealed lowest cognitive function. Therefore, community support or peer-based interventions among physically unfit older adults should be implemented to promote cognitive function.
Short and long-term outcomes of elderly patients undergoing left-sided colorectal resection with primary anastomosis for cancer
Authors: Kryzauskas Marius , Bausys Augustinas , Kuliavas Justas , Bickaite Klaudija , Dulskas Audrius , Poskus Eligijus , Bausys Rimantas , Strupas Kestutis , Poskus Tomas
Published: December 2021

Background

The proportion of elderly colorectal cancer (CRC) patients requiring surgery is increasing. Colorectal resection for left-sided cancers is the most controversial as the primary anastomosis or end-colostomy and open or minimally invasive approaches are available. Therefore, this study was conducted to investigate the short- and long-term outcomes in elderly patients after resection with primary anastomosis for left-sided CRC.

Methods

The cohort study included left-sided colorectal cancer patients who underwent resection with primary anastomosis. The participants were divided into non-elderly (≤75 years) and elderly (> 75 years) groups. Short- and long-term postoperative outcomes were investigated.

Results

In total 738 (82%) and 162 (18%) patients were allocated to non-elderly and elderly groups, respectively. Minimally invasive surgery (MIS) was less prevalent in the elderly (42.6% vs 52.7%, p = 0.024) and a higher proportion of these suffered severe or lethal complications (15.4% vs 9.8%, p = 0.040). MIS decreased the odds for postoperative complications (OR: 0.41; 95% CI: 0.19–0.89, p = 0.038). The rate of anastomotic leakage was similar (8.5% vs 11.7%, p = 0.201), although, in the case of leakage 21.1% of elderly patients died within 90-days after surgery. Overall- and disease-free survival was impaired in the elderly. MIS increased the odds for long-term survival.

Conclusions

Elderly patients suffer more severe complications after resection with primary anastomosis for left-sided CRC. The risk of anastomotic leakage in the elderly and non-elderly is similar, although, leakages in the elderly seem to be associated with a higher 90-day mortality rate. Minimally invasive surgery is associated with decreased morbidity in the elderly.
Serotype distribution and incidence of invasive early onset and late onset group B streptococcal disease amongst infants in Singapore
Authors: Kam Kai-Qian , Thoon Koh Cheng , Tee Wen Sim Nancy , Ang Michelle Lay Teng , Tan Natalie Woon Hui , Yeo Kee Thai , Li Jiahui , Chong Chia Yin
Published: December 2021

Background

The current group B streptococcal (GBS) preventive measures had reduced invasive GBS early onset disease (EOD) incidences worldwide, but the late onset disease (LOD) incidences had remained unchanged. Administration of a safe and effective GBS vaccine in addition to the current strategies were thought to be the next steps in reducing the incidences of invasive GBS infection especially LOD. In this study, we aimed to examine the causative GBS serotypes in invasive GBS disease, determine the incidences of EOD and LOD, and compare the risk factors between EOD and LOD.

Methods

A retrospective study of infants ≤ 90-day-old over an 8-year period (2010–2017). The incidences of EOD and LOD were obtained by using patients with EOD and LOD who were born in our institution as the numerator and the live births in our institution per year of the study period as the denominator. Available GBS isolates were serotyped by the National Public Health Laboratory using capsular serotyping methods. The risk factors of EOD and LOD were compared.

Results

A total of 71 infants were identified; 16 (22.5%) and 55 (77.5%) of them had EOD and LOD, respectively. Serotype III (n = 42, 71.2%) was the most common serotype amongst the 59 isolates available for serotyping. Serotypes Ia, Ib, II, III, and V accounted for 98.3% (n = 58) of the invasive GBS diseases. The overall incidence was 0.42 per 1000 live births. The mean incidences of EOD and LOD were 0.13 per 1000 live births and 0.29 per 1000 live births, respectively. On multivariate analysis, risk factors for LOD as compared to EOD were: Chinese ethnicity (OR 27.1, 95% CI 3.0–243.1, p = 0.003) and negative/unknown maternal GBS status (OR 20.0, 95% CI 2.0–250.0, p = 0.012). Prematurity and intrapartum risk factors (peripartum maternal pyrexia, prolonged rupture of membrane) of EOD were not associated with LOD.

Conclusions

The LOD incidence had remained higher than EOD incidence in our cohort. A GBS vaccine that covers the major causative serotypes found in our cohort can potentially reduce the overall GBS disease burden in the country.
Identification of bio-climatic determinants and potential risk areas for Kyasanur forest disease in Southern India using MaxEnt modelling approach
Authors: Pramanik Malay , Singh Poonam , Dhiman Ramesh C.
Published: December 2021

Background

Kyasanur forest disease (KFD), known as monkey fever, was for the first time reported in 1957 from the Shivamogga district of Karnataka. But since 2011, it has been spreading to the neighbouring state of Kerala, Goa, Maharashtra, and Tamil Nadu. The disease is transmitted to humans, monkeys and by the infected bite of ticks Haemaphysalis spinigera. It is known that deforestation and ecological changes are the main reasons for KFD emergence, but the bio-climatic understanding and emerging pathways remain unknown.

Methods

The present study aims to understand the bio-climatic determinants of distribution of tick vector of KFD in southern India using the Maximum Entropy (MaxEnt) model. The analysis was done using 34 locations of Haemaphysalis spinigera occurrence and nineteen bio-climatic variables from WorldClim. Climatic variables contribution was assessed using the Jackknife test and mean AUC 0.859, indicating the model performs with very high accuracy.

Results

Most influential variables affecting the spatial distribution of Haemaphysalis spinigera were the average temperature of the warmest quarter (bio10, contributed 32.5%), average diurnal temperature range (bio2, contributed 21%), precipitation of wettest period (bio13, contributed 17.6%), and annual precipitation (bio12, contributed 11.1%). The highest probability of Haemaphysalis spinigera presence was found when the mean warmest quarter temperature ranged between 25.4 and 30 °C. The risk of availability of the tick increased noticeably when the mean diurnal temperature ranged between 8 and 10 °C. The tick also preferred habitat having an annual mean temperature (bio1) between 23 and 26.2 °C, mean temperature of the driest quarter (bio9) between 20 and 28 °C, and mean temperature of the wettest quarter (bio8) between 22.5 and 25 °C.

Conclusions

The results have established the relationship between bioclimatic variables and KFD tick distribution and mapped the potential areas for KFD in adjacent areas wherein surveillance for the disease is warranted for early preparedness before the occurrence of outbreaks etc. The modelling approach helps link bio-climatic variables with the present and predicted distribution of Haemaphysalis spinigera tick.
Length of hospital stay after delivery among Danish women with congenital heart disease: a register-based cohort study
Authors: Kirkegaard Anne Marie , Breckling Maria , Nielsen Dorte Guldbrand , Tolstrup Janne S. , Johnsen Søren Paaske , Ersbøll Annette Kjær , Kloster Stine
Published: December 2021

Background

The literature about the impact of congenital heart disease (CHD) on the length of hospital stay after delivery is limited, and nonexisting in a country with free and equal access to healthcare. We aimed to examine the hypothesis that Danish women with CHD have a longer hospital stay after delivery compared to women without CHD. Secondarily, we aimed to examine the hypothesis that cesarean section modifies the association.

Methods

The study was a national cohort study using Danish nationwide registers in 1997–2014. Maternal CHD was categorized as simple, moderate, or complex CHD. The comparison group consisted of women without CHD. Outcome of interest was length of hospital stay after delivery registered in complete days. Mode of delivery was categorized as cesarean section or vaginal delivery. Data was analyzed using a generalized linear model with a Poisson distribution.

Results

We included 939,678 births among 551,119 women. Women without CHD were on average admitted to the hospital for 3.6 (SD 3.7) days, whereas women with simple, moderate, and complex CHD were admitted for 3.9 (SD 4.4), 4.0 (SD 3.8) and 5.1 (SD 6.7) days, respectively. The adjusted length of hospital stay after delivery was 12% (relative ratio (RR) = 1.12, 95% confidence interval (CI) 1.07–1.18), 14% (RR = 1.14, 95% CI: 1.07–1.21), and 45% (RR = 1.45, 95% CI: 1.24–1.70) longer among women with simple, moderate, and complex CHD, respectively, compared to women without CHD. The association between maternal CHD and length of hospital stay was not modified by mode of delivery (p-value of interaction = 0.62). Women who gave birth by cesarean section were on average admitted to the hospital for 2.7 days longer compared to women with vaginal delivery.

Conclusion

The hospital stay after delivery was significantly longer among women with CHD as compared to women without CHD. Further, higher complexity of CHD was associated with longer length of stay. Cesarean section did not modify the association.
RETRACTED ARTICLE: FAM83H-AS1/miR-485-5p/MEF2D axis facilitates proliferation, migration and invasion of hepatocellular carcinoma cells
Authors: Zhao Wenpeng , Guo Jiang , Li Honglu , Cai Liang , Duan Youjia , Hou Xiaopu , Diao Zhenying , Shao Xihong , Du Hongliu , Li Changqing
Published: December 2021

Background

Abundant evidence has manifested that long noncoding RNAs (lncRNAs) are closely implicated in human cancers, including hepatocellular carcinoma (HCC). Remarkably, lncRNA FAM83H antisense RNA 1 (FAM83H-AS1) has been reported to be a tumor-propeller in multiple cancers. However, its effect on HCC progression remains unknown.

Methods

FAM83H-AS1 expression was analyzed by RT-qPCR. Colony formation, EdU, and flow cytometry as well as transwell assays were implemented to analyze the biological functions of FAM83H-AS1 on HCC progression. Luciferase reporter, RIP and RNA pull-down assays were implemented to detect the interaction among FAM83H-AS1, microRNA-485-5p (miR-485-5p), and myocyte enhancer factor 2D (MEF2D) in HCC cells.

Results

FAM83H-AS1 expression in HCC cells was markedly elevated. FAM83H-AS1 accelerated cell proliferation, migration and invasion whereas inhibiting cell apoptosis in HCC. Besides, we confirmed that FAM83H-AS1 acts as a miR-485-5p sponge in HCC cells. Additionally, MEF2D was verified to be a direct target of miR-485-5p. FAM83H-AS1 could upregulate MEF2D expression via sponging miR-485-5p. Further, rescue experiments testified that MEF2D upregulation or miR-485-5p downregulation offset the repressive effect of FAM83H-AS1 depletion on HCC cell progression.

Conclusions

FAM83H-AS1 facilitates HCC malignant progression via targeting miR-485-5p/MEF2D axis, suggesting that FAM83H-AS1 may be a promising biomarker for HCC treatment in the future.
The prevalence and prognostic impact of tumor-infiltrating lymphocytes in uterine carcinosarcoma
Authors: da Silva Jesse Lopes , de Albuquerque Lucas Zanetti , Rodrigues Fabiana Resende , de Mesquita Guilherme Gomes , Chaves Cláudia Bessa Pereira , Bonamino Martín Hernán , de Melo Andreia Cristina
Published: December 2021

Objective

To examine the prevalence and prognostic role of tumor microenvironment (TME) markers in uterine carcinosarcoma (UCS) through immunohistochemical characterization.

Methods

The internal database of our institution was queried out for women with UCS who underwent surgery and thereafter postoperative chemotherapy with carboplatin and paclitaxel between January 2012 and December 2017. Tissue microarrays containing surgical samples of UCS from 57 women were assessed by immunohistochemistry for CD3, CD4, CD8, FOXP3, PD-1, PD-L1, and PD-L2.

Results

The mean age was 65.3 years (range, 49 to 79 years). For the epithelial component (E), CD3_E and CD4_E were highly expressed in 38 (66.7%) and in 40 (70.1%) patients, respectively, and were significantly associated with more advanced stages (p = 0.038 and p = 0.025, respectively). CD8_E was highly expressed in 42 (73.7%) patients, FOXP3_E 16 (28.1%), PD-1_E 35 (61.4%), PD-L1_E 27 (47.4%) and PD-L2_E 39 (68.4%). For the sarcomatous component (S), the prevalence of high expression was: CD3_S 6 (10.5%), CD4_S 20 (35.1%), CD8_S 44 (77.2%), FOXP3_S 8 (14%), PD-1_S 14 (24.6%), PD-L1_S 14 (24.6%) and PD-L2_S 8 (14%). By multivariate analysis, the CD8/FOXP3_S ratio (p = 0.026), CD4_E (p = 0.010), PD-L1_E (p = 0.013) and PD-L1_S (p = 0.008) markers significantly influenced progression-free survival. CD4/FOXP3_S ratio (p = 0.043), PD-1_E (p = 0.011), PD-L1_E (p = 0.036) and PD-L1_S (p = 0.028) had a significant association with overall survival.

Conclusion

Some differences in UCS clinical outcomes may be due to the subtype of TILs and PD-1/PD-L1 axis immune checkpoint signaling.
Degradation of skeletal mass in locally advanced oesophageal cancer between initial diagnosis and recurrence
Authors: Zouhry Yacine , Taibi Abdelkader , Durand-Fontanier Sylvaine , Darbas Tiffany , Forestier Geraud , Monteil Jacques , Lebrun-Ly Valérie , Fayemendy Philippe , Leobon Sophie , Jesus Pierre , Deluche Elise
Published: December 2021

Background

The prognostic value of a low skeletal mass index (SMI) has been investigated in locally advanced oesophageal (LAE) cancer at diagnosis. However, nothing is known about its evolution and clinical impact between initial diagnosis and recurrence.

Methods

A total of 89 patients treated for LAE cancer between January 2009 and December 2019 were included in this study. Computed tomography (CT) scans before treatment and at recurrence were evaluated. SMI and other body composition parameters were analysed by the L3 scan method.

Results

Participants were aged 66.0 (36.0–86) years. The incidence of low SMI increased by 12.3% between diagnosis and recurrence (70.7% vs. 83.0%, respectively) over a median follow-up of 16.9 (1.7–101.6) months. Patients with high SMI at diagnosis showed loss of muscle mass (58.0 vs. 55.2 cm2/m2, respectively; P < 0.001) and decreased body mass index (BMI) (27.9 vs. 26.3 kg/m2, respectively; P = 0.05), but fat mass was increased (68.9 vs. 72.0 cm2/m2, respectively; P = 0.01). Patients with low SMI at diagnosis showed no significant changes in body composition parameters and no improvement of SMI, even with nutritional support. Low SMI (hazard ratio [HR]: 1.8; 95% confidence interval [CI]: 1.02–3.16) was an independent predictor (P = 0.041) of high nutritional risk index (HR: 1.79; 95% CI: 1.03–3.11; P = 0.039) at diagnosis.

Conclusions

The percentage of patients with a low SMI increased during follow-up. Our data suggest that an assessment of skeletal muscle parameters and nutrition support may be more useful in patients with a high SMI.
Clinical characteristics and surgical outcomes of isolated inferior rectus palsy
Authors: Fu Licheng , Zhu Binbin , Yan Jianhua
Published: December 2021

Aim

As isolated inferior rectus muscle (IRM) palsy represents a rare clinical entity, very limited information is available on this condition. The aim of this report was to elucidate the etiology, clinical characteristics and surgical outcomes of isolated IRM palsy.

Methods

Isolated IRM palsy cases who underwent surgical treatments at the Zhongshan Ophthalmic Center, Sun Yat-sen University, China over the period from January 2008 to June 2019 were reviewed retrospectively. Data evaluated from these cases included their etiology, ocular alignment, ocular motility, surgical procedures and surgical outcomes.

Results

A total of 61 patients (40 males, 21 females) were included in this review. Their mean ± SD age was 27.21 ± 16.03 years (range: 2 to 73 years). In these cases, 32 (52.5%) involved traumatic injury, 28 (45.9%) congenital hypoplasia or absence of inferior rectus and 1 (1.6%) with thyroid ophthalmopathy. The right eye was affected in 33 patients (54.1%), the left in 24 patients (39.3%), and both eyes in 4 patients (6.6%). The main clinical presentations consisted of hypertropia of the affected eye, motility limitation in abduction and depression and incyclotropia. After treatment consisting of various surgical approaches, including muscle repair or resection of the affected inferior rectus, recession of ipsilateral superior rectus, elongation of contralateral superior oblique and partial transposition of the horizontal rectus, the isolated IRM palsy was rectified in 49 patients (80.4%) with one surgery, while 11 cases (18.0%) required two surgeries and 1 case (1.6%) needed three surgeries. Finally, 52 patients (85.2%) showed a complete recovery, 6 (9.9%) improved and 3 (4.9%) experienced a surgical failure.

Conclusion

The main etiologies of isolated IRM palsy involved traumatic injury and developmental events. Overall, surgical outcomes of the various approaches employed were quite effective.
Cost-utility analysis of esketamine and electroconvulsive therapy in adults with treatment-resistant depression
Authors: Degerlund Maldi Kinza , Asellus Peter , Myléus Anna , Norström Fredrik
Published: December 2021

Background

Electroconvulsive therapy (ECT) has long been used for treating individuals with treatment-resistant depression (TRD). Esketamine has recently emerged as a new treatment for TRD due to its rapid antidepressant effects. To further inform the decision regarding choice of treatment, this paper aims to evaluate whether ECT or esketamine is the more cost-effective option.

Methods

The cost-effectiveness was derived as cost per quality-adjusted life-year (QALY) using a Markov model from a societal and life-time perspective. The incremental cost-effectiveness ratio (ICER) was calculated. Health states included different depression and remission states and death. Data to populate the model was derived from randomised controlled trials and other research. Various sensitivity analyses were carried out to test the robustness of the model.

Results

The base case scenario shows that ECT is cost-effective compared to esketamine and yields more QALYs at a lower cost. The sensitivity analysis shows that ECT is cost-effective in all scenarios and ECT dominates esketamine in 12 scenarios.

Conclusions

This study found that, from a cost-effectiveness point of view, ECT should be the first-hand option for individuals with TRD, when other first line treatments have failed. Considering the lack of economic evaluation of ECT and esketamine, this study is of great value to decision makers.
Midday meals as an early childhood nutrition intervention: evidence from plantation communities in Sri Lanka
Authors: De Silva Perera Udeni , Inder Brett A.
Published: December 2021

Background

High rates of child malnutrition are a major public health concern in developing countries, particularly among vulnerable communities. Midday meals programs can be effective for combatting childhood malnutrition among older children. However, their use in early childhood is not well documented, particularly within South Asia. Anthropometric measures and other socioeconomic data were collected for children below the age of 5 years living in selected Sri Lankan tea plantations, to assess the effectiveness of midday meals as a nutrition intervention for improving growth among young children.

Methods

The study exploits a natural experiment whereby the provision of the midday meals program is exogenously determined at the plantation level, resulting in comparable treatment and control groups. Longitudinal data was collected on heights and weights of children, between 2013 and 2015. Standardized weight-for-age, height-for-age and weight-for-height, and binary variables for stunting, wasting and underweight are constructed, following WHO guidelines. All modelling uses STATA SE 15. Random-effects regression with instrumental variables is used for modelling standardized growth while random-effects logistic regression is used for the binary outcomes. Robustness analysis involves different estimation methods and subsamples.

Results

The dataset comprises of longitudinal data from a total of 1279 children across three tea plantations in Sri Lanka, with 799 children in the treatment group and 480 in the control group. Results show significant positive effects of access to the midday meals program, on the growth of children. A child with access to the midday meals intervention reports an average standardized weight-for-age 0.03 (±0.01) and height-for-age 0.05 (±0.01) units higher than a similar child without access to the intervention. Importantly, access to the intervention reduces the likelihood of being underweight by 0.45 and the likelihood of wasting by 0.47. The results are robust to different model specifications and across different subsamples by gender, birthweight and birth-year cohort.

Conclusions

Midday meals programs targeting early childhood can be an effective intervention to address high rates of child malnutrition, particularly among vulnerable communities in developing countries like Sri Lanka.