bluuebunny/crossref_metadata_2025 huggingface dataset:
Superior-Labrum Anterior-Posterior Return to Sport Index (SLAP-RSI) Score to Quantify Psychological Readiness to Return to Play (223)
Authors: Colasanti Christopher , Hurley Eoghan , Lorentz Nathan , Markus Danielle , Matache Bogdan , Campbell Kirk , Jazrawi Laith , Strauss Eric
Published: October 2021

Objectives:

Superior-labrum anterior-posterior (SLAP) tears are common among athletic populations and may require surgical treatment. Return to play post-operatively may be complicated by a number of factors, including psychological readiness to return. The purpose of this study was to evaluate the use of the SLAP Return to Sport Index (SLAP-RSI) score to quantify psychological readiness to return to play following operative management of SLAP tears.

Methods:

A retrospective review of athletes who underwent operative management of SLAP tears with a minimum of 12-month follow-up was performed. Patients were evaluated for their psychological readiness to return to sport using the SLAP-RSI score. The SLAP-RSI score was created by adapting the terms in the Anterior (ACL-RSI score) with terms related to SLAP tears. A SLAP-RSI score > 56 is considered a passing score for being psychologically ready to return to play.

Results:

The study included 174 athletes who underwent operative management of SLAP tears. Overall, 73.5% percent of patients were able to return to play, and the mean SLAP-RSI score in this cohort was 74.1±20.9, as compared to 46.7±27.7 in those who were unable to return (p<0.0001). Of those who returned, 82.1% passed the SLAP-RSI benchmark of 56, while of those who did not return, 33.3% passed the SLAP-RSI benchmark of 56. Additionally, a significant difference was found in each component of the SLAP-RSI score between the two cohorts (p<0.05). No individual component of the SLAP-RSI score was below 56 in patients who were able to return to play, while none was above 56 in those who were unable to return. Among patients who were unable to return, ones who cited lifestyle reasons had a higher SLAP-RSI score (77.4 ± 21.8) than those who cited residual pain (28.2 ± 15.1) or fear of re-injury (42.6 ± 23.6) (p<0.0001).

Conclusions:

Following the operative management of SLAP repair, patients that are unable to return to play exhibit poor psychological readiness to return which may be due to residual pain or fear of re-injury.
Open Subpectoral Biceps Tenodesis versus Arthroscopic Repair for SLAP Tears in Patients under 30 (224)
Authors: Colasanti Christopher , Hurley Eoghan , Lorentz Nathan , Campbell Kirk , Alaia Michael , Strauss Eric , Jazrawi Laith , Matache Bogdan
Published: October 2021

Objectives:

The purpose of this study is to compare the outcomes of mini-open subpectoral biceps tenodesis (BT) to arthroscopic repair (AR) for SLAP tears in patients under 30.

Methods:

A retrospective review of patients who underwent either isolated BT or AR for the diagnosis of a SLAP tear was performed. Patients with a follow-up duration of <24 months were excluded. The American Shoulder & Elbow Surgeons (ASES) score, Visual Analogue Scale (VAS), Subjective Shoulder Value (SSV), patient satisfaction, willingness to undergo surgery again, revisions, and return to work/sport were evaluated. A p value of <0.05 was considered to be statistically significant.

Results:

Our study included 103 patients in total; 29 patients were treated with BT, and 74 were treated with AR. The mean age was 24.8 years, 79.4% were male, and the mean follow-up duration was 60 months. At final follow up, there was no difference between treatment groups in any of the functional outcome measures assessed (p > 0.05). Overall, there was no significant difference in the total rate of RTP (BT: 76.3%, AR: 85%; p = 0.53), timing of RTP (BT: 8.8 months, AR: 9.4 months; p = 0.61), and total rate of RTP among overhead athletes (BT: 84.2%, AR: 83.3%; p = 1). However, there was a significantly lower rate of revision surgery with BT (0%) as compared to AR (14.1%; p = 0.03).

Conclusions:

In patients under the age of 30 with isolated SLAP tear pathology, BT is a reliable alternative to AR, with a low rate of revision surgery, and excellent patient reported outcomes.
Current Healthcare Utilization and Alternative Strategies for Rotator Cuff Tendinopathy (239)
Authors: Ryan Claire , Fatehi Amirreza , Valencia Victoria , Ring David , Jayakumar Prakash
Published: October 2021

Objectives:

Rotator cuff disease is one of the most common reasons for people to seek upper extremity specialty care. Rotator cuff tendinopathy is typically a part of the normal aging process and is often well adapted. Healthcare utilization for the condition varies widely and can range from formal physical therapy to surgery. Evidence of the effectiveness of some interventions for rotator cuff tendinopathy is lacking and for others, such as steroid injection or subacromial decompression, suggests no benefit. There is an opportunity to streamline care for this common condition and, in doing so, conserve finite healthcare resources. The purpose of this study was to characterize the current healthcare utilization for rotator cuff tendinopathy using a large claims database in an effort to identify opportunities to streamline care and develop value-based treatment algorithms.

Methods:

Using de-identified records in a large claims data base that includes over 350 private-sector payers, we identified patients with a new visit claim between April and June 2016 in one state with an ICD-10 diagnosis code for rotator cuff tendinopathy. The most common atraumatic diagnoses and the frequency of interventions, such as surgery, physical or occupational therapy, advanced imaging, and injections were tracked. We recorded all return visits (including post-operative visits), tests, treatments, and costs for 3 months prior and 6 months after diagnosis. We then calculated the potential cost savings using an alternative treatment strategy for rotator cuff tendinopathy based on value-based care principals.

Results:

The percentage of enrollees undergoing specific interventions was MRI 19%; physical therapy visit 29%; injections 52%; return visits 44%; and surgery 17%. Alternative treatment strategies, such as a reliance on home exercises rather than formal physical therapy, avoidance of injections and limiting MRIs to patients considering surgery accounted for a potential mean payment that was 8% of the actual mean payments of claims paid out in the database.

Conclusions:

Conclusion: Our analysis identified notable variation in care of people with rotator cuff tendinopathy. Alternative treatment strategies identified an opportunity for improving value given growing evidence that limiting some of the more commonly used interventions is unlikely to diminish health and might even improve it by increasing self-efficacy.
Clinical Outcomes of Primary versus Revision Surgery using Arthroscopic Anatomic Glenoid Reconstruction for Anterior Shoulder Instability. (244)
Authors: Wong Ivan , Murphy Ryland , Sparavalo Sara , Ma Jie
Published: October 2021

Objectives:

Revision surgeries after prior shoulder stabilization are known to have worse outcomes as compared to their primary counterparts. To date, no studies have looked at the utility of arthroscopic anatomic glenoid reconstruction (AAGR) as a revision surgery. The purpose of this study was to assess the clinical outcomes of primary versus revision AAGR for anterior shoulder instability with bone loss.

Methods:

We performed a retrospective review on consecutive patients with prospectively collected data who underwent AAGR from 2012 to 2018. Patients who received AAGR for anterior shoulder instability with bone loss and had a minimum follow-up of two years were included. Exclusion criteria included patients with rotator cuff pathology, multidirectional instability and glenoid fractures. There were 68 patients (48 primary and 20 revision) who met inclusion/exclusion criteria. Our primary outcome was measured using the Western Ontario Shoulder Instability Index (WOSI) and Disabilities of Arm, Shoulder, Hand (DASH) scores. Secondary outcomes included post-operative complications and post-operative recurrent instability.

Results:

The primary group showed a significant improvement in most-recent post-operative WOSI from 62.7 to 20.7 (P<0.001, α=0.05) and in DASH from 26.89 to 6.7 (p<0.001, α=0.05). The revision group also showed a significant improvement in WOSI from 71.5 to 34.6 (p<0.001, α=0.05) and in DASH from 39.5 to 17.0 (p<0.05, α=0.05). When comparing between groups, the revision group had worse WOSI scores (34.6) at most recent follow-up compared to the primary group (20.7); p<0.05. The most-recent DASH scores also showed the revision group (17.0) having worse outcomes than the primary group (6.7); p<0.05. Important to note that the minimal clinically important difference (MCID) was met for WOSI (MCID=10.4) but not DASH (MCID=10.83). There were no post-operative reports of instability in either group. For complications, one hardware failure (suture anchor) was seen in the primary group, and two hardware removals were seen in the revision group.

Conclusions:

While patient reported scores indicated worse outcomes in the revision group, the significant clinical improvement in DASH and WOSI, along with the lack of recurrent instability provides evidence that AAGR is a suitable option for revision patients.
Holding water for the city: Emergent geographies of storage and the urbanization of nature
Authors: Randle Sayd
Published: October 2021

In the US West, water stories are often aqueduct stories, narratives of moving the vital resource from one place to another. This paper, in contrast, explores nascent efforts to keep the water still, in the name of helping buffer cities from the anticipated impacts of climate change. Scripted as potential holding sites for an urban water reserve, aquifers and the task of filling them now orient a range of policies and material investments across Southern California. Building on writings that explore the multi-scalar politics of storing and stockpiling vaccines, resources, and lively or uncooperative commodities, this analysis approaches storage as a key moment within circulation, a dynamic, constitutive stillness that conditions flows. Three early-stage subterranean water stockpiling projects connected to the City of Los Angeles are explored, and used to demonstrate how the pursuit of storage is remaking material and political relationships within and between urban jurisdictions, while complicating long-fraught urban–rural relations within the region's waterscape. These shifts suggest the value of reorienting the notion of the urbanization of nature to better attend to the geographies of resource storage, in addition to those of resource flows and circulations.
Reasons why Prescribers Decrease Psychotropic Medication for Foster Youth
Authors: Coon Jodi C. , Rapp John T. , Ramey Erica
Published: October 2021

Although prescribers frequently use psychotropic medication to treat emotional and behavioral problems for children in foster care, and states are required to monitor psychotropic medication usage with foster youth, few studies have evaluated the extent to which prescribers decrease psychotropic medication. We developed a system to track medication decreases for foster youth to ascertain why deprescriptions occurred. Researchers reviewed case files for 223 children and adolescents in a child welfare system who had received services via a state-funded project from October 2016 through January 2021. We found 99 individuals who had (a) prescriptions for one or more psychotropic medications at intake and (b) received both behavioral and medication review services. Results show only 32 (32%) of individuals in this sample experienced a deprescription of psychotropic medication while receiving services from the project. Analyses for these 32 individuals revealed four key findings. First, the most frequently deprescribed medications were stimulants and antipsychotics. Second, the most common reasons for decreasing any psychotropic medication were (a) medication advocacy and (b) adverse side effects. Notably, only foster youth aged 12 years or younger experienced medication reductions due to adverse side effects. Third, stimulants and antipsychotics accounted for the highest percentage of undesirable side effects. Fourth, practitioners deprescribed stimulants and antipsychotics for adverse side effects two times more often than for behavior or symptom improvement. These findings may contribute to the development of deprescribing guidelines for children in state welfare systems.
A Review on Ultrasonic-Assisted Forming: Mechanism, Model, and Process
Authors: Shao Guangda , Li Hongwei , Zhan Mei
Published: October 2021

Compared with conventional forming processes, ultrasonic-assisted forming technology with a high frequency and small amplitude can significantly improve the forming quality of materials. Owing to the advantages of reduced forming force, improved surface quality, avoidance of forming defects, and strengthened surface structure, ultrasonic-assisted forming technology has been applied to increasingly advanced forming processes, such as incremental forming, spinning, and micro-forming. However, in the ultrasonic-assisted forming process, there are multiple ultrasonic mechanisms, such as the volume effect and surface effect. The explanation of the effect of ultrasonic vibration (UV) on plastic deformation remains controversial, hindering the development of related technologies. Recently, many researchers have proposed many new theories and technologies for ultrasonic-assisted forming. To summarize these developments, systematic discussions on mechanisms, theoretical models, and forming performances are provided in this review. On this basis, the limitations of the current study are discussed. In addition, an outlook for ultrasonic-assisted forming is proposed: efficient and stable UV systems, difficulty forming components with complex geometry, explanation of the in-depth mechanism, a systematic theoretical prediction model, and multi-field-coupling energy-assisted forming are considered to be hot spots in future studies. The present review enhances existing knowledge of ultrasonic-assisted forming, and facilitates a fast reference for related researchers.
Robotic Walker for Slope Mobility Assistance with Active-Passive Hybrid Actuator
Authors: Li Junqiang , Zhao Lei , Li Tiejun
Published: October 2021

Walking assistance can be realized by active and passive robotic walkers when their users walk on even roads. However, fast signal processing and real-time control are necessary for active robotic walkers when the users walk on slopes, while assistive forces cannot be provided by passive robotic walkers when the users walk uphill. A robotic walker with an active-passive hybrid actuator (APHA) was developed in this study. The APHA, which consists of a rotary magnetorheological (MR) brake and a DC motor, can provide mobility assistance to users walking both uphill and downhill via the cooperative operation of the MR brake and DC motor. The rotary MR brake was designed with a T-shaped configuration, and the system was optimized to minimize the brake volume. Prototypes of the APHA and robotic walker were constructed. A control algorithm for the robotic walker was developed based on the characteristics of the APHA and the structure of the robotic walker. The mechanical properties of the APHA were characterized, and experiments were conducted to evaluate the mobility assistance supplied by the robotic walker on different roads. The results show that the APHA can meet the requirements of the robotic walker, and suitable assistive forces can be provided by the robotic walker, which has a simple mechanical structure and control method.
Decay detection of constructional softwoods using machine olfaction
Authors: Suzuki Masaki , Miyauchi Teruhisa , Isaji Shinichi , Hirabayashi Yasushi , Naganawa Ryuichi
Published: October 2021

Fungal decomposition of wood severely affects the soundness of timber constructions. The diagnosis of wood decay requires direct observations or sampling by skilled experts. Wood decay often occurs in obscure spaces, including the enclosed inner spaces of walls or under the floor. In this study, we examined the ability of machine olfaction to detect odors of fungi grown on common construction softwoods to provide a novel diagnostic method for wood construction soundness. The combination of a simple device equipped with semiconductor gas sensors (gas sensor array) and multivariate analysis discriminated a fungi-related odor from control odor without instrumental analysis (e.g., gas chromatography). This method is often referred to as machine olfaction or electronic nose. We measured the odor of wood test pieces that were infected with Fomitopsis palustris or Trametes versicolor and sound test pieces using a gas sensor array. The sensor responses of the specimens showed different patterns between the inoculated and control samples. Each specimen class formed independent groups in a principal component score plot, almost regardless of wood species, fungal species, or cultivation period. This method provides a new decay diagnosis method that is cost-effective and easy to operate.
Filling gaps of genome scaffolds via probabilistic searching optical maps against assembly graph
Authors: Huang Bin , Wei Guozheng , Wang Bing , Ju Fusong , Zhong Yi , Shi Zhuozheng , Sun Shiwei , Bu Dongbo
Published: October 2021

Background

Optical maps record locations of specific enzyme recognition sites within long genome fragments. This long-distance information enables aligning genome assembly contigs onto optical maps and ordering contigs into scaffolds. The generated scaffolds, however, often contain a large amount of gaps. To fill these gaps, a feasible way is to search genome assembly graph for the best-matching contig paths that connect boundary contigs of gaps. The combination of searching and evaluation procedures might be “searching followed by evaluation”, which is infeasible for long gaps, or “searching by evaluation”, which heavily relies on heuristics and thus usually yields unreliable contig paths.

Results

We here report an accurate and efficient approach to filling gaps of genome scaffolds with aids of optical maps. Using simulated data from 12 species and real data from 3 species, we demonstrate the successful application of our approach in gap filling with improved accuracy and completeness of genome scaffolds.

Conclusion

Our approach applies a sequential Bayesian updating technique to measure the similarity between optical maps and candidate contig paths. Using this similarity to guide path searching, our approach achieves higher accuracy than the existing “searching by evaluation” strategy that relies on heuristics. Furthermore, unlike the “searching followed by evaluation” strategy enumerating all possible paths, our approach prunes the unlikely sub-paths and extends the highly-probable ones only, thus significantly increasing searching efficiency.
LongStitch: high-quality genome assembly correction and scaffolding using long reads
Authors: Coombe Lauren , Li Janet X. , Lo Theodora , Wong Johnathan , Nikolic Vladimir , Warren René L. , Birol Inanc
Published: October 2021

Background

Generating high-quality de novo genome assemblies is foundational to the genomics study of model and non-model organisms. In recent years, long-read sequencing has greatly benefited genome assembly and scaffolding, a process by which assembled sequences are ordered and oriented through the use of long-range information. Long reads are better able to span repetitive genomic regions compared to short reads, and thus have tremendous utility for resolving problematic regions and helping generate more complete draft assemblies. Here, we present LongStitch, a scalable pipeline that corrects and scaffolds draft genome assemblies exclusively using long reads.

Results

LongStitch incorporates multiple tools developed by our group and runs in up to three stages, which includes initial assembly correction (Tigmint-long), followed by two incremental scaffolding stages (ntLink and ARKS-long). Tigmint-long and ARKS-long are misassembly correction and scaffolding utilities, respectively, previously developed for linked reads, that we adapted for long reads. Here, we describe the LongStitch pipeline and introduce our new long-read scaffolder, ntLink, which utilizes lightweight minimizer mappings to join contigs. LongStitch was tested on short and long-read assemblies of Caenorhabditis elegans, Oryza sativa, and three different human individuals using corresponding nanopore long-read data, and improves the contiguity of each assembly from 1.2-fold up to 304.6-fold (as measured by NGA50 length). Furthermore, LongStitch generates more contiguous and correct assemblies compared to state-of-the-art long-read scaffolder LRScaf in most tests, and consistently improves upon human assemblies in under five hours using less than 23 GB of RAM.

Conclusions

Due to its effectiveness and efficiency in improving draft assemblies using long reads, we expect LongStitch to benefit a wide variety of de novo genome assembly projects. The LongStitch pipeline is freely available at https://github.com/bcgsc/longstitch.
Brain areas involved with obsessive-compulsive disorder present different DNA methylation modulation
Authors: de Oliveira Kátia Cristina , Camilo Caroline , Gastaldi Vinícius Daguano , Sant’Anna Feltrin Arthur , Lisboa Bianca Cristina Garcia , de Jesus Rodrigues de Paula Vanessa , Moretto Ariane Cristine , Lafer Beny , Hoexter Marcelo Queiroz , Miguel Euripedes Constantino , Maschietto Mariana ,   Biobank for Aging Studies Group, Akiyama Érika Dionisio , Grinberg Lea Tenenholz , Leite Renata Elaine Paraizo , Suemoto Claudia Kimie , de Lucena Ferretti-Rebustini Renata Eloah , Pasqualucci Carlos Augusto , Jacob-Filho Wilson , Brentani Helena
Published: October 2021

Background

Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts and repetitive actions, that presents the involvement of the cortico-striatal areas. The contribution of environmental risk factors to OCD development suggests that epigenetic mechanisms may contribute to its pathophysiology. DNA methylation changes and gene expression were evaluated in post-mortem brain tissues of the cortical (anterior cingulate gyrus and orbitofrontal cortex) and ventral striatum (nucleus accumbens, caudate nucleus and putamen) areas from eight OCD patients and eight matched controls.

Results

There were no differentially methylated CpG (cytosine-phosphate-guanine) sites (DMSs) in any brain area, nevertheless gene modules generated from CpG sites and protein-protein-interaction (PPI) showed enriched gene modules for all brain areas between OCD cases and controls. All brain areas but nucleus accumbens presented a predominantly hypomethylation pattern for the differentially methylated regions (DMRs). Although there were common transcriptional factors that targeted these DMRs, their targeted differentially expressed genes were different among all brain areas. The protein-protein interaction network based on methylation and gene expression data reported that all brain areas were enriched for G-protein signaling pathway, immune response, apoptosis and synapse biological processes but each brain area also presented enrichment of specific signaling pathways. Finally, OCD patients and controls did not present significant DNA methylation age differences.

Conclusions

DNA methylation changes in brain areas involved with OCD, especially those involved with genes related to synaptic plasticity and the immune system could mediate the action of genetic and environmental factors associated with OCD.
Fusobacterium nucleatum predicts a high risk of metastasis for esophageal squamous cell carcinoma
Authors: Li Zhen , Shi Chao , Zheng Jiawen , Guo Yongjun , Fan Taibing , Zhao Huan , Jian Dongdong , Cheng Xiaolei , Tang Hao , Ma Jie
Published: October 2021

Background

Esophageal squamous cell carcinoma (ESCC) is the major type of esophageal cancer in China. The role of the bacteria present in ESCC tissue in neoplastic progression has not been fully elucidated. This study aimed to uncover different bacterial communities in ESCC tissues and examine the correlation between the abundance of the esophageal flora and clinicopathologic characteristics of ESCC.

Results

Microorganisms in tumors and normal tissues showed obvious clustering characteristics. The abundance of Fusobacterium (P = 0.0052) was increased in tumor tissues. The high level of Fusobacterium nucleatum was significantly associated with pT stage (P = 0.039) and clinical stage (P = 0.0039). The WES data showed that COL22A1, TRBV10–1, CSMD3, SCN7A and PSG11 were present in only the F. nucleatum-positive ESCC samples. GO and protein domain enrichment results suggested that epidermal growth factor might be involved in the regulation of cell apoptosis in F. nucleatum-positive ESCC. Both a higher mutational burden and F. nucleatum-positive was observed in tumors with metastasis than in tumors without metastasis.

Conclusion

F. nucleatum is closely related to the pT stage and clinical stage of ESCC. The abundance of F. nucleatum and tumor mutation burden may be used in combination as a potential method to predict metastasis in ESCC.
Route of Zika virus infection in Aedes aegypti by transmission electron microscopy
Authors: da Encarnação Sá-Guimarães Thayane , Salles Tiago Souza , Rocha dos Santos Carlucio , Moreira Monica Ferreira , de Souza Wanderley , Caldas Lucio Ayres
Published: October 2021

Background

Zika fever has been a global health security threat, especially in the tropical and subtropical regions where most of the cases occur. The disease is caused by Zika virus (ZIKV), which belongs to the family Flaviviridae, genus Flavivirus. The virus is transmitted by Aedes mosquitoes, mostly by Aedes aegypti, during its blood meal. In this study we present a descriptive analysis, by transmission electron microscopy (TEM), of ZIKV infection in A. aegypti elected tissues at the 3rd day of infection. ZIKV vertical transmission experiments by oral infection were conducted to explore an offspring of natural infection.

Results

Gut and ovary tissues harbored a higher number of viral particles. The ZIKV genome was also detected, by RT-qPCR technique, in the organism of orally infected female mosquitoes and in their eggs laid.

Conclusions

The data obtained suggest that the ovary is an organ susceptible to be infected with ZIKV and that virus can be transmitted from mother to a fraction of the progeny.
Alien balsams, strawberries and their pollinators in a warmer world
Authors: Najberek Kamil , Kosior Andrzej , Solarz Wojciech
Published: October 2021

Background

Strawberries are a common crop whose yield success depends on the availability of pollinators. Invasive alien plants, such asImpatiens glanduliferaandI. parviflora, are also attractive for bees and hoverflies, respectively, and occur in close proximity to strawberry cultivation areas. The aim of the study was to test whether alien plants may decrease pollination of strawberry cultivation. However, even if the pollinators are abundant, efficiency of their pollination may decrease as a result of revisits of flowers that were already probed. It is addressed by pollinators by scent marking. Moreover, such revisits can be determined by nectar replenishment, which may occur rapidly in nectar-rich flowers. We studied revisits toI. glanduliferaby bumblebees and defined the factors that influence the probability of revisits (air temperature; pollinator species; family caste and size; flower area; sun radiation; and time of day).

Results

We found that the two alien species decreased the number of pollinators visiting strawberries. Apoidea, Bombini and Syrphidae significantly decreased onFragaria×ananassawhen alienImpatienswere present. We also revealed the influence of increasing air temperature on bumblebee foraging, which was particularly significant for female workers. At very high temperatures (> 37°C), bumblebee males revisited probed flowers less often than female workers.

Conclusions

Our results demonstrate that in experimental conditions attractive alien species decrease pollination of strawberries, which may negatively affect production of this crop. Although the results have not been verified in real-life strawberry fields yet, we recommend that alien plant species that share the same pollinators and occur in close proximity of strawberries are controlled. Moreover, we found that revisits of probed flowers may weaken feeding efficiency of bumblebees. If revisits are not induced by nectar replenishment, then global warming may pose a serious threat to the survival of colonies, which may have consequences also for the plants that attract them, e.g., for strawberries.
Postspinal anesthesia shivering in lower abdominal and lower limb surgeries: a randomized controlled comparison between paracetamol and dexamethasone
Authors: Esmat Ibrahim M. , Mohamed Marwa M. , Abdelaal Wail A. , El-Hariri Hazem M. , Ashoor Tarek M.
Published: October 2021

Background

Shivering is known to be a frequent complication in patients undergoing surgery under neuraxial anesthesia with incidence of 40–70%. Although many pharmacological agents have been used to treat or prevent postspinal anesthesia shivering (PSAS), the ideal treatment wasn’t found. This study evaluated the efficacy of paracetamol and dexamethasone to prevent PSAS in patients undergoing lower abdominal and lower limb surgeries.

Methods

Three hundred patients scheduled for surgeries under spinal anesthesia (SA) were allocated into three equal groups to receive a single preoperative dose of oral paracetamol 1 g (P group), dexamethasone 8 mg intravenous infusion (IVI) in 100 ml normal saline (D group) or placebo (C group), 2 h preoperatively, in a randomized, double-blind trial. The primary endpoint was the incidence of clinically significant PSAS. Secondary endpoints included shivering score, the change in hemodynamics, adverse events (e.g., nausea, vomiting and pruritis) and patients` satisfaction.

Results

Clinically significant PSAS was recorded as (15%) in P group, (40%) in D group and (77%) in C group (P < 0.001). The mean blood pressure values obtained over a 5-25 min observation period were significantly higher in the D group (P < 0.001). Core temperature 90 min after SA was significantly lower in the 3 groups compared to prespinal values (P < 0.001). Nausea, vomiting and pruritis were significantly higher in the C group (P < 0.001). P and D groups were superior to C group regarding the patients’ satisfaction score (P < 0.001).

Conclusion

Paracetamol and dexamethasone were effective in prevention of PSAS in patients undergoing lower abdominal and lower limb surgeries compared to placebo controls.

Trial registration

ClinicalTrials.gov Identifier: NCT03679065 / Registered 20 September 2018 - Retrospectively registered, http://www.ClinicalTrial.gov.
Isolated calf deep venous thrombosis: frequency on venous ultrasound and clinical characteristics
Authors: Heller Thomas , Becher Mattes , Kröger Jens-Christian , Beller Ebba , Heller Susanne , Höft Raimund , Weber Marc-André , Meinel Felix G.
Published: October 2021

Background

It remains controversial whether to include calf veins in the initial ultrasound evaluation of suspected deep venous thrombosis (DVT). We sought to investigate the frequency and clinical characteristics of isolated calf DVT.

Materials and methods

In this retrospective analysis, we investigated a cohort of 596 patients (median age 69 years, 52.3% women) who had been imaged with complete lower extremity venous duplex ultrasound for suspected acute DVT. Radiology reports were analyzed for the presence and localization of DVT. Clinical information was collected from patients’ electronic charts.

Results

DVT was found in 157 patients (26.3%), of which 74 patients (47.1%) had isolated calf DVT. Isolated calf DVTs were located in the posterior tibial veins (22 patients, 29.7%), peroneal veins (41 patients, 55.4%) and muscle veins (19 patients, 25.7%). There were no differences in age or sex between patients with isolated calf DVT and patients with proximal DVT. Isolated calf DVT was more commonly associated with leg pain (52.7% vs. 33.7%, p = 0.0234) and less commonly associated with subjective leg swelling (35.1% vs. 55.4%, p = 0.0158) and objectively measured difference in leg circumference (23% vs. 39.8%, p = 0.0268). D-Dimers were significantly lower in patients with isolated lower leg DVT (median 2.3 vs. 6.8 mg/L, p < 0.0001) compared to patients with proximal DVT.

Conclusions

Isolated calf DVT represents approximately half of DVT cases and has different clinical characteristics than proximal DVT.
Amino acids predict prognosis in patients with acute dyspnea
Authors: Wiklund Karolin , Gränsbo Klas , Almgren Peter , Peyman Marjaneh , Tegnér Lena , Toni-Bengtsson Maria , Wieloch Mattias , Melander Olle
Published: October 2021

Background

To identify amino acids that can predict risk of 90-day mortality in patients with acute dyspnea.

Method

Plasma levels of nine amino acids were analyzed 663 adult patients admitted to the Emergency Department (ED) with acute dyspnea. Cox proportional hazards models were used to examine the relation between amino acid levels and the risk of 90-day mortality.

Result

Eighty patients (12.1%) died within 90 days of admission. An “Amino Acid Mortality Risk Score” (AMRS), summing absolute plasma levels of glycine, phenylalanine and valine, demonstrated that among the patients belonging to quartile 1 (Q1) of the AMRS, only 4 patients died, compared to 44 patients in quartile 4. Using Q1 of the AMRS as reference, each increment of 1 SD in the AMRS was associated with a hazard ratio (HR) of 2.15 for 90-day mortality, and the HR was > 9 times higher in Q4.

Conclusion

Glycine, phenylalanine and valine are associated with a risk of 90-day mortality in patients admitted to the ED for acute dyspnea, suggesting that these amino acids may be useful in risk assessments.
Low methodological quality of systematic reviews on acupuncture: a cross-sectional study
Authors: Ho Leonard , Ke Fiona Y. T. , Wong Charlene H. L. , Wu Irene X. Y. , Cheung Andy K. L. , Mao Chen , Chung Vincent C. H.
Published: October 2021

Background

While well-conducted systematic reviews (SRs) can provide the best evidence on the potential effectiveness of acupuncture, limitations on the methodological rigour of SRs may impact the trustworthiness of their conclusions. This cross-sectional study aimed to evaluate the methodological quality of a representative sample of SRs on acupuncture effectiveness.

Methods

Cochrane Database of Systematic Reviews, MEDLINE, and EMBASE were searched for SRs focusing on the treatment effect of manual acupuncture or electro-acupuncture published during January 2018 and March 2020. Eligible SRs must contain at least one meta-analysis and be published in English language. Two independent reviewers extracted the bibliographical characteristics of the included SRs with a pre-designed questionnaire and appraised the methodological quality of the studies with the validated AMSTAR 2 (A MeaSurement Tool to Assess systematic Reviews 2). The associations between bibliographical characteristics and methodological quality ratings were explored using Kruskal-Wallis rank tests and Spearman’s rank correlation coefficients.

Results

A total of 106 SRs were appraised. Only one (0.9%) SR was of high overall methodological quality, zero (0%) was of moderate-quality, six (5.7%) and 99 (93.4%) were of low-quality and critically low-quality respectively. Among appraised SRs, only ten (9.4%) provided an a priori protocol, four (3.8%) conducted a comprehensive literature search, five (4.7%) provided a list of excluded studies, and six (5.7%) performed meta-analysis appropriately. Cochrane SRs, updated SRs, and SRs that did not search non-English databases had relatively higher overall quality.

Conclusions

Methodological quality of SRs on acupuncture is unsatisfactory. Future reviewers should improve critical methodological aspects of publishing protocols, performing comprehensive search, providing a list of excluded studies with justifications for exclusion, and conducting appropriate meta-analyses. These recommendations can be implemented via enhancing the technical competency of reviewers in SR methodology through established education approaches as well as quality gatekeeping by journal editors and reviewers. Finally, for evidence users, skills in SR critical appraisal remain to be essential as relevant evidence may not be available in pre-appraised formats.
Differences in assistive technology installed for people with dementia living at home who have wandering and safety risks
Authors: Curnow Eleanor , Rush Robert , Gorska Sylwia , Forsyth Kirsty
Published: October 2021

Background

Assistive Technology for people with dementia living at home is not meeting their care needs. Reasons for this may be due to limited understanding of variation in multiple characteristics of people with dementia including their safety and wandering risks, and how these affect their assistive technology requirements. This study therefore aimed to explore the possibility of grouping people with dementia according to data describing multiple person characteristics. Then to investigate the relationships between these groupings and installed Assistive Technology interventions.

Methods

Partitioning Around Medoids cluster analysis was used to determine participant groupings based upon secondary data which described the person characteristics of 451 people with dementia with Assistive Technology needs. Relationships between installed Assistive Technology and participant groupings were then examined.

Results

Two robust clustering solutions were identified within the person characteristics data. Relationships between the clustering solutions and installed Assistive Technology data indicate the utility of this method for exploring the impact of multiple characteristics on Assistive technology installations. Living situation and caregiver support influence installation of assistive technology more strongly than level of risk or cognitive impairment. People with dementia living alone received different AT from those living with others.

Conclusions

Results suggest that caregiver support and the living situation of the person with dementia influence the type and frequency of installed Assistive Technology. Reasons for this include the needs of the caregiver themselves, the caregiver view of the participants’ needs, caregiver response to alerts, and the caregiver contribution to the assistive technology assessment and selection process. Selection processes should be refined to account for the needs and views of both caregivers and people with dementia. This will require additional assessor training, and the development of validated assessments for people with dementia who have additional impairments. Policies should support the development of services which provide a wider range of AT to facilitate interventions which are focused on the needs of the person with dementia.
Norovirus GII.2[P16] strain in Shenzhen, China: a retrospective study
Authors: Wang Jing , Jin Miao , Zhang Hailong , Zhu Yanan , Yang Hong , Yao Xiangjie , Chen Long , Meng Jun , Hu Guifang , He Yaqing , Duan Zhaojun
Published: October 2021

Background

Norovirus (NoV) is the main cause of non-bacterial acute gastroenteritis (AGE) outbreaks worldwide. From September 2015 through August 2018, 203 NoV outbreaks involving 2500 cases were reported to the Shenzhen Center for Disease Control and Prevention.

Methods

Faecal specimens for 203 outbreaks were collected and epidemiological data were obtained through the AGE outbreak surveillance system in Shenzhen. Genotypes were determined by sequencing analysis. To gain a better understanding of the evolutionary characteristics of NoV in Shenzhen, molecular evolution and mutations were evaluated based on time-scale evolutionary phylogeny and amino acid mutations.

Results

A total of nine districts reported NoV outbreaks and the reported NoV outbreaks peaked from November to March. Among the 203 NoV outbreaks, 150 were sequenced successfully. Most of these outbreaks were associated with the NoV GII.2[P16] strain (45.3%, 92/203) and occurred in school settings (91.6%, 186/203). The evolutionary rates of the RdRp region and the VP1 sequence were 2.1 × 10–3 (95% HPD interval, 1.7 × 10–3–2.5 × 10–3) substitutions/site/year and 2.7 × 10–3 (95% HPD interval, 2.4 × 10–3–3.1 × 10–3) substitutions/site/year, respectively. The common ancestors of the GII.2[P16] strain from Shenzhen and GII.4 Sydney 2012[P16] diverged from 2011 to 2012. The common ancestors of the GII.2[P16] strain from Shenzhen and previous GII.2[P16] (2010–2012) diverged from 2003 to 2004. The results of amino acid mutations showed 6 amino acid substitutions (*77E, R750K, P845Q, H1310Y, K1546Q, T1549A) were found only in GII.4 Sydney 2012[P16] and the GII.2[P16] recombinant strain.

Conclusions

This study illustrates the molecular epidemiological patterns in Shenzhen, China, from September 2015 to August 2018 and provides evidence that the epidemic trend of GII.2[P16] recombinant strain had weakened and the non-structural proteins of the recombinant strain might have played a more significant role than VP1.
Hepatitis B virus infection in Nigeria: a systematic review and meta-analysis of data published between 2010 and 2019
Authors: Ajuwon Busayo I. , Yujuico Isabelle , Roper Katrina , Richardson Alice , Sheel Meru , Lidbury Brett A.
Published: October 2021

Background

Hepatitis B virus (HBV) is an infectious disease of global significance, causing a significant health burden in Africa due to complications associated with infection, such as cirrhosis and liver cancer. In Nigeria, which is considered a high prevalence country, estimates of HBV cases are inconsistent, and therefore additional clarity is required to manage HBV-associated public health challenges.

Methods

A systematic review of the literature (via PubMed, Advanced Google Scholar, African Index Medicus) was conducted to retrieve primary studies published between 1 January 2010 and 31 December 2019, with a random-effects model based on proportions used to estimate the population-based prevalence of HBV in the Nigerian population.

Results

The final analyses included 47 studies with 21,702 participants that revealed a pooled prevalence of 9.5%. A prevalence estimate above 8% in a population is classified as high. Sub-group analyses revealed the highest HBV prevalence in rural settings (10.7%). The North West region had the highest prevalence (12.1%) among Nigeria’s six geopolitical zones/regions. The estimate of total variation between studies indicated substantial heterogeneity. These variations could be explained by setting and geographical region. The statistical test for Egger’s regression showed no evidence of publication bias (p = 0.879).

Conclusions

We present an up-to-date review on the prevalence of HBV in Nigeria, which will provide critical data to optimise and assess the impact of current prevention and control strategies, including disease surveillance and diagnoses, vaccination policies and management for those infected.
Creating symptom-based criteria for diagnostic testing: a case study based on a multivariate analysis of data collected during the first wave of the COVID-19 pandemic in New Zealand
Authors: French Nigel , Jones Geoff , Heuer Cord , Hope Virginia , Jefferies Sarah , Muellner Petra , McNeill Andrea , Haslett Stephen , Priest Patricia
Published: October 2021

Background

Diagnostic testing using PCR is a fundamental component of COVID-19 pandemic control. Criteria for determining who should be tested by PCR vary between countries, and ultimately depend on resource constraints and public health objectives. Decisions are often based on sets of symptoms in individuals presenting to health services, as well as demographic variables, such as age, and travel history. The objective of this study was to determine the sensitivity and specificity of sets of symptoms used for triaging individuals for confirmatory testing, with the aim of optimising public health decision making under different scenarios.

Methods

Data from the first wave of COVID-19 in New Zealand were analysed; comprising 1153 PCR-confirmed and 4750 symptomatic PCR negative individuals. Data were analysed using Multiple Correspondence Analysis (MCA), automated search algorithms, Bayesian Latent Class Analysis, Decision Tree Analysis and Random Forest (RF) machine learning.

Results

Clinical criteria used to guide who should be tested by PCR were based on a set of mostly respiratory symptoms: a new or worsening cough, sore throat, shortness of breath, coryza, anosmia, with or without fever. This set has relatively high sensitivity (> 90%) but low specificity (< 10%), using PCR as a quasi-gold standard. In contrast, a group of mostly non-respiratory symptoms, including weakness, muscle pain, joint pain, headache, anosmia and ageusia, explained more variance in the MCA and were associated with higher specificity, at the cost of reduced sensitivity. Using RF models, the incorporation of 15 common symptoms, age, sex and prioritised ethnicity provided algorithms that were both sensitive and specific (> 85% for both) for predicting PCR outcomes.

Conclusions

 If predominantly respiratory symptoms are used for test-triaging,  a large proportion of the individuals being tested may not have COVID-19. This could overwhelm testing capacity and hinder attempts to trace and eliminate infection. Specificity can be increased using alternative rules based on sets of symptoms informed by multivariate analysis and automated search algorithms, albeit at the cost of sensitivity. Both sensitivity and specificity can be improved through machine learning algorithms, incorporating symptom and demographic data, and hence may provide an alternative approach to test-triaging that can be optimised according to prevailing conditions.