bluuebunny/crossref_metadata_2025 huggingface dataset:
Correlation between Preoperative Serum Levels of Calcium, Phosphate, and Intact Parathyroid Hormone and Radiological Outcomes in Spinal Interbody Fusion among End-Stage Renal Disease Patients
Authors: Shih Ting-Yu , Wu Yun-Che , Tseng Sheng-Chieh , Chen Kun-Hui , Pan Chien-Chou , Lee Cheng-Hung
Published: December 2021

Spinal fusion surgery for end-stage renal disease (ESRD) patients is a clinical challenge. This study aimed to investigate whether postoperative radiological outcomes are related to preoperative serum calcium, phosphate, or intact parathyroid hormone (iPTH) levels in patients with ESRD who underwent spinal interbody fusion surgery. This study included 62-consecutive patients with ESRD who underwent anterior cervical discectomy and fusion (ACDF) or transforaminal lumbar interbody fusion (TLIF) surgery for symptomatic spinal disorder. The most recent preoperative serum calcium, phosphate, and iPTH levels were recorded, and the postoperative radiographic outcomes were assessed. A significant correlation was found between the occurrence of cage subsidence and higher blood phosphate, calcium–phosphate product (Ca × P), and iPTH levels in the TLIF group. The occurrence of pedicle screw loosening was related to higher blood phosphate and Ca × P product in the TLIF group. However, no correlation was found between the fusion grades and the serum levels in either the TLIF or ACDF groups. These results indicated that higher preoperative serum phosphate and Ca × P product are risk factors for both cage subsidence and screw loosening in patients with ESRD who underwent TLIF surgery. Higher iPTH levels are also a possible risk factor for cage subsidence.
Comparison of Indexes to Measure Comorbidity Burden and Predict All-Cause Mortality in Rheumatoid Arthritis
Authors: Huang Yun-Ju , Chen Jung-Sheng , Luo Shue-Fen , Kuo Chang-Fu
Published: December 2021

Objectives: To examine the comorbidity burden in patients with rheumatoid arthritis (RA) patients using a nationwide population-based cohort by assessing the Charlson Comorbidity Index (CCI), Elixhauser Comorbidity Index (ECI), Multimorbidity Index (MMI), and Rheumatic Disease Comorbidity Index (RDCI) scores and to investigate their predictive ability for all-cause mortality. Methods: We identified 24,767 RA patients diagnosed from 1998 to 2008 in Taiwan and followed up until 31 December 2013. The incidence of comorbidities was estimated in three periods (before, during, and after the diagnostic period). The incidence rate ratios were calculated by comparing during vs. before and after vs. before the diagnostic period. One- and 5-year mortality rates were calculated and discriminated by low and high-score groups and modified models for each index. Results: The mean score at diagnosis was 0.8 in CCI, 2.8 in ECI, 0.7 in MMI, and 1.3 in RDCI, and annual percentage changes are 11.0%, 11.3%, 9.7%, and 6.8%, respectively. The incidence of any increase in the comorbidity index was significantly higher in the periods of “during” and “after” the RA diagnosis (incidence rate ratios for different indexes: 1.33–2.77). The mortality rate significantly differed between the high and low-score groups measured by each index (adjusted hazard ratios: 2.5–4.3 for different indexes). CCI was slightly better in the prediction of 1- and 5-year mortality rates. Conclusions: Comorbidities are common before and after RA diagnosis, and the rate of accumulation accelerates after RA diagnosis. All four comorbidity indexes are useful to measure the temporal changes and to predict mortality.
Challenging Visualization of Sentinel Lymph Nodes in Upper Urinary Tract Urothelial Carcinoma
Authors: Polom Wojciech , Cytawa Wojciech , Polom Anna , Frankiewicz Mikołaj , Szurowska Edyta , Lass Piotr , Matuszewski Marcin
Published: December 2021

Purpose: The purpose of this study was to assess the possibility of detecting sentinel lymph nodes (SLNs) and to perform analysis of lymphatic outflow in patients with suspicion of upper tract urothelial carcinoma (UTUC) with the use of a radioisotope-based technique. Methods: During 2018–2021, a prospective study was conducted on 19 patients with the suspicion of UTUC and for whom diagnostic ureterorenoscopy (URS) was planned. Technetium-99m (99mTc) nanocolloid radioactive tracer injection and a tumor biopsy were performed for staging procedures. Three-dimensional (3D) reconstruction and fusion of images were performed for better localization of lymph nodes (LNs). Detection of SLNs and the analysis of the radiotracer outflow was conducted with the use of single-photon emission-computed tomography/computed tomography (SPECT/CT) lymphangiography. Results: The mean age of the patients was 73.4 years; 7 (36%) were male. Pathological staging from the biopsy was T0—8 (42%), Ta—7 (36%), T1—4 (21%). SLNs were detected in two of 19 cases (10%). In one patient a single SLN (5.3%) was visualized, and in another case (5.3%), multiple (double) radioactive lymph nodes were visualized. In 17 out of the 19 (89.5%) cases, no lymphatic outflow was observed, and out of these five cases (26.3%) of gravitational leakage of injected radiotracer to the retroperitoneal space was noted. Conclusions: We demonstrated that detection of SLNs in the upper urinary tract is possible yet challenging. Radiotracer injection in the upper urinary tract during ureterorenoscopy is difficult to perform, and the expected result of injection is unsatisfactory. Lymphatic outflow from the tumor site to the first LNs in our studied group of patients is visible in 10.5% of cases. SPECT/CT lymphangiography in cases of UTUC may provide valuable information about a patient’s individual anatomy of the lymphatic system and the position of the first lymph nodes draining lymph with potential metastatic cells from the tumor.
Determinants and Dynamic Changes of Generic Quality of Life in Human Bladder Cancer Patients
Authors: Tsai Yuh-Shyan , Wu Tzu-Yi , Jou Yeong-Chin , Tzai Tzong-Shin , Wang Jung-Der
Published: December 2021

We measured and determined the factors associated with long-term generic quality-of-life (QOL) changes in human bladder cancer patients. We utilized the World Health Organization QOL-Brief questionnaire to assess consecutive patients’ QOL at outpatient clinics of our hospital. A mixed-effects model was constructed to investigate the determinants of QOL changes according to each domain and individual item after controlling for demographic and clinical factors, as well as the effect of radical cystectomy. We also applied a kernel smoothing method to describe the long-term dynamic changes after the first definite treatment. In total, 1185 repeated measurements were collected from 343 bladder cancer patients. The mixed-effects models demonstrated that marital status, monthly income, and comorbidity with heart disease and diabetes were significant determinants among all the study participants. Regardless of the urinary diversion type, radical cystectomy contributed to lower scores for all four domains, mainly from 4–5 years after cystectomy, which declined significantly in patients who were older than 60 years. As for non-muscle-invasive bladder cancer (NMIBC) patients with preserved bladders, tumor recurrence was a major predictor for lower scores for sexual activity in the social domain. In summary, generic QOL can be independently influenced by many factors, not only cystectomy and tumor recurrence, which should be discussed with patients before treatment.
Acute Lower Gastrointestinal Bleeding in an Emergency Department and Performance of the SHA2PE Score: A Retrospective Observational Study
Authors: Cerruti Titouan , Maillard Michel Haig , Hugli Olivier
Published: December 2021

Lower gastrointestinal bleeding (LGIB) is a frequent cause of emergency department (ED) consultation, leading to investigations but rarely to urgent therapeutic interventions. The SHA2PE score aims to predict the risk of hospital-based intervention, but has never been externally validated. The aim of our single-center retrospective study was to describe patients consulting our ED for LGIB and to test the validity of the SHA2PE score. We included 251 adult patients who consulted in 2017 for hematochezia of <24 h duration; 53% were male, and the median age was 54 years. The most frequent cause of LGIB was unknown (38%), followed by diverticular disease and hemorrhoids (14%); 20% had an intervention. Compared with the no-intervention group, the intervention group was 26.5 years older, had more frequent bleeding in the ED (47% vs. 8%) and more frequent hypotension (8.2% vs. 1.1%), more often received antiplatelet drugs (43% vs. 18%) and anticoagulation therapy (28% vs. 9.5%), more often had a hemoglobin level of <10.5 g/dl (49% vs. 6.2%) on admission, and had greater in-hospital mortality (8.2% vs. 0.5%) (all p < 0.05). The interventions included transfusion (65%), endoscopic hemostasis (47%), embolization (8.2%), and surgery (4%). The SHA2PE score predicted an intervention with sensitivity of 71% (95% confidence interval: 66–83%), specificity of 81% (74–86%), and positive and negative predictive values of 53% (40–65%) and 90% (84–95%), respectively. SHA2PE performance was inferior to that in the original study, with a 1 in 10 chance of erroneously discharging a patient for outpatient intervention. Larger prospective validation studies are needed before the SHA2PE score can be recommended to guide LGIB patient management in the ED.
Biplanar Low-Dose Radiograph Is Suitable for Cephalometric Analysis in Patients Requiring 3D Evaluation of the Whole Skeleton
Authors: Kerbrat Adeline , Rivals Isabelle , Dupuy Pauline , Dot Gauthier , Berg Britt-Isabelle , Attali Valérie , Schouman Thomas
Published: December 2021

Background: The biplanar 2D/3D X-ray technology (BPXR) is a 2D/3D imaging system allowing simultaneous stereo-corresponding posteroanterior (PA) and lateral 2D views of the whole body. The aim of our study was to assess the feasibility of cephalometric analysis based on the BPXR lateral skull view to accurately characterize facial morphology. Method: A total of 17 landmarks and 11 angles were placed and/or calculated on lateral BPXR and lateral cephalograms of 13 patients by three investigators. Five methods of angle identification were performed: the direct construction of straight lines on lateral cephalograms (LC-A) and on BPXR (BPXR-A), as well as the calculation of angles based on landmark identification on lateral cephalograms (LA-L) and on BPXR with the PA image (BPXR-LPA) or without (BPXR-L). Intra- and interoperator reliability of landmark identification and angle measurement of each method were calculated. To determine the most reliable method among the BPXR-based methods, their concordance with the reference method, LC-A, was evaluated. Results: Both imaging techniques had excellent intra- and interoperator reliability for landmark identification. On lateral BPXR, BPXR-A presented the best concordance with the reference method and a good intra- and interoperator reliability. Conclusion: BPXR provides a lateral view of the skull suitable for cephalometric analysis with good reliability.
Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy
Authors: Kovács-Ábrahám Zoltán , Aczél Timea , Jancsó Gábor , Horváth-Szalai Zoltán , Nagy Lajos , Tóth Ildikó , Nagy Bálint , Molnár Tihamér , Szabó Péter
Published: December 2021

Intraoperative stress is common to patients undergoing carotid endarterectomy (CEA); thus, impaired oxygen and metabolic balance may appear. In this study, we aimed to identify new markers of intraoperative cerebral ischemia, with predictive value on postoperative complications during CEA, performed in regional anesthesia. A total of 54 patients with significant carotid stenosis were recruited and submitted to CEA. Jugular and arterial blood samples were taken four times during operation, to measure the jugulo-arterial carbon dioxide partial pressure difference (P(j-a)CO2), and cortisol, S100B, L-arginine, and lactate levels. A positive correlation was found between preoperative cortisol levels and all S100B concentrations. In addition, they are positively correlated with P(j-a)CO2 values. Conversely, postoperative cortisol inversely correlates with P(j-a)CO2 and postoperative S100B values. A negative correlation was observed between maximum systolic and pulse pressures and P(j-a)CO2 after carotid clamp and before the release of clamp. Our data suggest that preoperative cortisol, S100B, L-arginine reflect patients’ frailty, while these parameters postoperatively are influenced by intraoperative stress and injury. As a novelty, P(j-a)CO2 might be an emerging indicator of cerebral blood flow during CEA.
A Multifunctional, Low-Volume Resuscitation Cocktail Improves Vital Organ Blood Flow and Hemostasis in a Pig Model of Polytrauma with Traumatic Brain Injury
Authors: St. John Alexander E. , Wang Xu , Ringgold Kristyn , Lim Esther B. , Chien Diana , Statz Matthew L. , Stern Susan A. , White Nathan J.
Published: December 2021

The resuscitation of polytrauma with hemorrhagic shock and traumatic brain injury (TBI) is a balance between permissive hypotension and maintaining vital organ perfusion. There is no current optimal solution. This study tested whether a multifunctional resuscitation cocktail supporting hemostasis and perfusion could mitigate blood loss while improving vital organ blood flow during prolonged limited resuscitation. Anesthetized Yorkshire swine were subjected to fluid percussion TBI, femur fracture, catheter hemorrhage, and aortic tear. Fluid resuscitation was started when lactate concentration reached 3–4 mmol/L. Animals were randomized to one of five groups. All groups received hydroxyethyl starch solution and vasopressin. Low- and high-dose fibrinogen (FBG) groups additionally received 100 and 200 mg/kg FBG, respectively. A third group received TXA and low-dose FBG. Two control groups received albumin, with one also including TXA. Animals were monitored for up to 6 h. Blood loss was decreased and vital organ blood flow was improved with low- and high-dose fibrinogen compared to albumin controls, but survival was not improved. There was no additional benefit of high- vs. low-dose FBG on blood loss or survival. TXA alone decreased blood loss but had no effect on survival, and combining TXA with FBG provided no additional benefit. Pooled analysis of all groups containing fibrinogen vs. albumin controls found improved survival, decreased blood loss, and improved vital organ blood flow with fibrinogen delivery. In conclusion, a low-volume resuscitation cocktail consisting of hydroxyethyl starch, vasopressin, and fibrinogen concentrate improved outcomes compare to controls during limited resuscitation of polytrauma.
Supraglottic Botulinum Toxin Improves Symptoms in Patients with Laryngeal Sensory Dysfunction Manifesting as Abnormal Throat Sensation and/or Chronic Refractory Cough
Authors: Novakovic Daniel , Sheth Meet , Stewart Thomas , Sandham Katrina , Madill Catherine , Chacon Antonia , Nguyen Duy Duong
Published: December 2021

Laryngeal sensory dysfunction (LSD) encompasses disorders of the vagal sensory pathways. Common manifestations include chronic refractory cough (CRC) and abnormal throat sensation (ATS). This study examined clinical characteristics and treatment outcomes of LSD using a novel approach of laryngeal supraglottic Onabotulinum toxin Type A injection (BTX). This was a retrospective review of clinical data and treatment outcomes of supraglottic BTX in patients with LSD. Between November 2019 and May 2021, 14 patients underwent 25 injection cycles of supraglottic BTX for treatment of symptoms related to LSD, including ATS and CRC. Primary outcome measures included the Newcastle Laryngeal Hypersensitivity Questionnaire (LHQ), Cough Severity Index (CSI), Reflux Symptom Index (RSI), and Voice Handicap Index-10 (VHI-10) at baseline and within three months of treatment. Pre- and post-treatment data were compared using a linear mixed model. After supraglottic BTX, LHQ scores improved by 2.6. RSI and CSI improved by 8.0 and 5.0, respectively. VHI-10 did not change as a result of treatment. Short-term response to SLN block was significantly associated with longer term response to BTX treatment. These findings suggest that LSD presents clinically as ATS and CRC along with other upper airway symptoms. Supraglottic BTX injection is a safe and effective technique in the treatment of symptoms of LSD.
Walking the Line with Ticagrelor: Meta-Analysis Comparing the Safety and Efficacy of Ticagrelor Monotherapy after a Short Course of Ticagrelor-Based Dual Antiplatelet Therapy versus Standard Therapy in Complex Percutaneous Coronary Intervention
Authors: Condello Francesco , Sturla Matteo , Terzi Riccardo , Polimeni Alberto , Stefanini Giulio G.
Published: December 2021

(1) Shorter-duration dual antiplatelet therapy (DAPT) followed by single antiplatelet therapy has been shown to significantly reduce bleeding events while preserving anti-ischemic effects in patients undergoing conventional percutaneous coronary interventions (PCI). Whether this strategy is also safe and effective in complex PCI remains elusive; (2) A systematic search of randomized controlled trials comparing a short course of ticagrelor-based DAPT versus standard DAPT in patients undergoing complex PCI was performed; (3) Of 10,689 studies screened, 3 were identified for a total of 4176 participants on ticagrelor monotherapy after a short course of ticagrelor-based DAPT, and 4209 on standard DAPT. The pooled analysis revealed no difference in the outcomes of major bleeding, myocardial infarction, definite or probable stent thrombosis and ischemic stroke. A significant reduction in the risk of cardiovascular death (incidence rate ratio (IRR) 0.52; 95% CI 0.28–0.96; p = 0.04), all-cause death (IRR 0.65; 95% CI 0.49–0.86; p = 0.003), and any bleeding events (IRR 0.62; 95% CI 0.47–0.81; p < 0.001) was seen in the shorter DAPT group; (4) Among patients undergoing complex PCI, ticagrelor monotherapy after a short course of ticagrelor-based DAPT significantly reduced bleeding risk without increasing ischemic risk. More data are needed to definitively explain mortality benefits.
Characterization of RAN Translation and Antisense Transcription in Primary Cell Cultures of Patients with Myotonic Dystrophy Type 1
Authors: Koehorst Emma , Núñez-Manchón Judit , Ballester-López Alfonsina , Almendrote Miriam , Lucente Giuseppe , Arbex Andrea , Chojnacki Jakub , Vázquez-Manrique Rafael , Gómez-Escribano Ana , Pintos-Morell Guillem , Coll-Cantí Jaume , Ramos-Fransi Alba , Martínez-Piñeiro Alicia , Suelves Mònica , Nogales-Gadea Gisela
Published: December 2021

Myotonic Dystrophy type 1 (DM1) is a muscular dystrophy with a multi-systemic nature. It was one of the first diseases in which repeat associated non-ATG (RAN) translation was described in 2011, but has not been further explored since. In order to enhance our knowledge of RAN translation in DM1, we decided to study the presence of DM1 antisense (DM1-AS) transcripts (the origin of the polyglutamine (polyGln) RAN protein) using RT-PCR and FISH, and that of RAN translation via immunoblotting and immunofluorescence in distinct DM1 primary cell cultures, e.g., myoblasts, skin fibroblasts and lymphoblastoids, from ten patients. DM1-AS transcripts were found in all DM1 cells, with a lower expression in patients compared to controls. Antisense RNA foci were found in the nuclei and cytoplasm of a subset of DM1 cells. The polyGln RAN protein was undetectable in all three cell types with both approaches. Immunoblots revealed a 42 kD polyGln containing protein, which was most likely the TATA-box-binding protein. Immunofluorescence revealed a cytoplasmic aggregate, which co-localized with the Golgi apparatus. Taken together, DM1-AS transcript levels were lower in patients compared to controls and a small portion of the transcripts included the expanded repeat. However, RAN translation was not present in patient-derived DM1 cells, or was in undetectable quantities for the available methods.
Spontaneous Reporting of Adverse Drug Reactions in a Pediatric Population in a Tertiary Hospital
Authors: López-Valverde Laura , Domènech Èlia , Roguera Marc , Gich Ignasi , Farré Magí , Rodrigo Carlos , Montané Eva
Published: December 2021

The pediatric population is a vulnerable group for adverse drug reactions (ADRs), and data on spontaneous reporting of ADRs in the hospital setting are scarce. We conducted a retrospective analysis of ADRs in pediatric patients spontaneously reported by health care professionals to a Pharmacovigilance Program in a tertiary hospital between 2010 and 2020, and we compared characteristics of ADRs between pediatric age subgroups. From 1787 spontaneously reported ADRs in an 11-year period, 103 (5.85%) were pediatric ADRs. The median age of patients with ADRs was 8.4 years (range 1 day–17 years) and 57.3% were male. The most frequent ADRs reported were nervous system disorders (13.6%) and the most frequently involved drugs were antineoplastics and immunodulators (32.4%). A 59.2% of the ADRs were serious and 55.3% were classified as being type B reactions. Medication errors were involved in 7.8% of the ADRs and 11.9% of the suspected drugs were used off-label. Spontaneous reports of ADRs in newborns, infants, and toddlers were more serious and less often described in the product data sheet than in children and adolescents (p < 0.001 and p = 0.004 respectively). Medication errors were more frequent in patients under two years of age. These results should be interpreted with caution due to under-reporting and biases in spontaneous reporting of ADRs.
The Assessment of Fear of COVID-19 among the Elderly Population: A Cross-Sectional Study
Authors: Agrawal Siddarth , Dróżdż Mateusz , Makuch Sebastian , Pietraszek Alicja , Sobieszczańska Małgorzata , Mazur Grzegorz
Published: December 2021

The prevailing COVID-19 pandemic has dramatically affected the mental health and well-being of individuals. This cross-sectional study aimed to assess the perceived fear of COVID-19 among older adults in Poland and identify subpopulations with the highest risk of potential mental health disorders. The study was conducted in November–December 2020 on 500 people aged ≥60 years (mean M = 67.9, standard deviation SD = 4.2). In order to collect information on participants’ characteristics and COVID-19-related information, they were asked to complete a questionnaire based on recorded telephone calls. Perceived fear of COVID-19 was measured using Fear of COVID-19 Scale (FCV-19S), which ranges from 7 to 35. Multiple linear regression was performed to identify factors associated with the perceived fear of COVID-19. Our results showed that the highest level of fear of COVID-19 infection was observed among women (p = 0.025) and patients taking anticoagulants (p = 0.004). Moreover, older adults with higher anxiety levels were more likely to be fearful of COVID-19 (according to the GAS-10 scale; p < 0.001). These findings may help policy makers and healthcare workers to adapt and implement better mental health strategies to help the elderly fight fear and anxiety during the prevailing pandemic.
Analysis of the Different Lymphatic Drainage Patterns during Sentinel Lymph Node Biopsy for Skin Melanoma
Authors: Cirocchi Roberto , Metaj Giulio , Cicoletti Michela , Arcangeli Fabrizio , De Sol Angelo , Poli Giulia , Bruzzone Paolo , Gioia Sara , Anagnostou Christos , Loreti Fabio , Francesconi Simona , Ricci Linda , Laurenti Maria Elena , Capotorti Andrea , Artico Marco , D’Andrea Vito , Henry Brandon Michael , Fedeli Piergiorgio , Carlini Luigi
Published: December 2021

In the last two decades, studies of lymphoscintigraphy imaging in lymphatic mapping reported an extreme heterogeneity of skin lymphatic drainage of some skin area, in contrast with the previous scientific literature. The aim of this study was to investigate the presence of any correlations between the topographical location of cutaneous melanoma and the topographical location of sentinel lymph nodes. Data from 165 patients undergoing sentinel lymph node biopsy between January 2013 and May 2021 were analyzed, demonstrating that melanomas in the Lumbar region presented a significant more heterogeneous drainage by site than those in the Scapular region (p < 0.01) and that melanomas in the Subscapular region were significantly more heterogeneous by laterality (unilateral vs. bilateral) than those in the Scapular region (p < 0.05). Results of this study supported the evidence of multiple lymphatic drainage as regards the sentinel node biopsy performed in skin melanoma located on the dorsal subscapular region and lumbar region. For this reason, the association of preoperative lymphoscintigraphy with another imaging evaluation is needed in these critical cutaneous areas. Recent technical developments enabling fluorescence lymphography together with indocyanine green have significantly improved the visualization of lymphatic drainage patterns at a microscopic level. In the preoperative phase, any doubt can be resolved by associating the SPET-CT scan to lymphoscintigraphy, while during the intraoperative phase, an additional evaluation with indocyanine green can be performed in doubtful cases. The aim of the duplex lymphatic mapping (pre and/or intraoperative) is an accurate search of sentinel nodes, in order to reduce the rate of false negatives.
Motivational Determinants of Objective Physical Activity in Women with Fibromyalgia Who Attended Rehabilitation Settings
Authors: Pastor-Mira María-Ángeles , López-Roig Sofía , Martínez-Zaragoza Fermín , Toribio Eva , Nardi-Rodríguez Ainara , Peñacoba Cecilia
Published: December 2021

Being physically active has positive effects on fibromyalgia functioning. However, promoting an active lifestyle in these patients continues to be a relevant clinical challenge. Our aim was to test a motivational model to explain light (LPA) and moderate-vigorous physical activity (MVPA). A cross-sectional prospective study was conducted at a tertiary level of care. Participants completed sociodemographic, clinical, motivational (physical activity self-efficacy and goal preferences) and behavioral measures (activity avoidance). LPA and MVPA were measured with triaxial accelerometers, starting the same day of the aforementioned assessment. Out of 211 women, 183 completed this measure. Structural models were performed. Our results show that the best fit indices (CFI = 0.97, SRMR = 0.04) showed a model with direct influence of PA self-efficacy on MVPA (p < 0.01) and indirect influence on LPA (p < 0.001). LPA received the influence of PA self-efficacy mainly through activity avoidance (p < 0.01). Clinical variables did not have any effect on PA intensities. Thus, the motivational variables showed different paths to explain two PA intensities. Targeting PA self-efficacy in rehabilitation settings is needed to enhance both daily LPA and MVPA intensities.
High versus Standard Intensity of Thromboprophylaxis in Hospitalized Patients with COVID-19: A Systematic Review and Meta-Analysis
Authors: Kollias Anastasios , Kyriakoulis Konstantinos G. , Trontzas Ioannis P. , Rapti Vassiliki , Kyriakoulis Ioannis G. , Theochari Christina A. , Dimakakos Evangelos , Poulakou Garyphallia , Syrigos Konstantinos
Published: December 2021

Thromboprophylaxis in hospitalized patients with COVID-19 has been associated with a survival benefit and is strongly recommended. However, the optimal dose of thromboprophylaxis remains unclear. A systematic review and meta-analysis (PubMed/EMBASE) of studies comparing high (intermediate or therapeutic dose) versus standard (prophylactic dose) intensity of thrombo-prophylaxis with regard to outcome of hospitalized patients with COVID-19 was performed. Randomized and non-randomized studies that provided adjusted effect size estimates were included. Meta-analysis of 7 studies comparing intermediate versus prophylactic dose of thromboprophylaxis (2 randomized and 5 observational, n = 2009, weighted age 61 years, males 61%, ICU 53%) revealed a pooled adjusted relative risk (RR) for death at 0.56 (95% confidence intervals (CI) 0.34, 0.92) in favor of the intermediate dose. For the same comparison arms, the pooled RR for venous thromboembolism was 0.84 (95% CI 0.54, 1.31), and for major bleeding events was 1.63 (95% CI 0.79, 3.37). Meta-analysis of 17 studies comparing therapeutic versus prophylactic dose of thromboprophylaxis (2 randomized and 15 observational, n = 7776, weighted age 64 years, males 54%, ICU 21%) revealed a pooled adjusted RR for death at 0.73 (95% CI 0.47, 1.14) for the therapeutic dose. An opposite trend was observed in the unadjusted analysis of 15 observational studies (RR 1.24 (95% CI 0.88, 1.74)). For the same comparison arms, the pooled RR for venous thromboembolism was 1.13 (95% CI 0.52, 2.48), and for major bleeding events 3.32 (95% CI 2.51, 4.40). In conclusion, intermediate compared with standard prophylactic dose of thromboprophylaxis appears to be rather safe and is associated with additional survival benefit, although most data are derived from observational retrospective analyses. Randomized studies are needed to define the optimal thromboprophylaxis in hospitalized patients with COVID-19.
Gender Differences in the Impact of Plasma Xanthine Oxidoreductase Activity on Coronary Artery Spasm
Authors: Watanabe Ken , Watanabe Tetsu , Otaki Yoichiro , Murase Takayo , Nakamura Takashi , Kato Shigehiko , Tamura Harutoshi , Nishiyama Satoshi , Takahashi Hiroki , Arimoto Takanori , Watanabe Masafumi
Published: December 2021

Xanthine oxidoreductase (XOR) is the rate-limiting enzyme in uric acid (UA) production that plays a pivotal role in generating oxidative stress. Gender differences in the impact of plasma XOR activity on coronary artery spasm (CAS) remain unclear. We investigated plasma XOR activity in 132 patients suspected of having CAS (male, n = 78; female, n = 54) and who underwent an intracoronary acetylcholine provocation test. Plasma XOR activity was significantly lower in female patients compared with male patients. CAS was provoked in 36 male patients and 17 female patients, and both had significantly higher plasma XOR activity than those without. Multivariate logistic regression analysis showed that this activity was independently associated with the incidence of CAS in both sexes after adjusting for confounding factors. The optimal cut-off values for predicting CAS were lower in female patients than in male patients. Multivariate analysis demonstrated that female patients with high XOR activity exhibited a higher incidence of CAS than male patients. Plasma XOR activity was an independent predictor of the incidence of CAS in both sexes. The impact of plasma XOR activity on CAS was stronger in female patients than in male patients.
Bilateral Renal Tumors in Children: The First 5 Years’ Experience of National Centralization in The Netherlands and a Narrative Review of the Literature
Authors: van Peer Sophie E. , Hol Janna A. , van der Steeg Alida F. W. , Grotel Martine van , Tytgat Godelieve A. M. , Mavinkurve-Groothuis Annelies M. C. , Janssens Geert O. R. , Littooij Annemieke S. , de Krijger Ronald R. , Jongmans Marjolijn C. J. , Lilien Marc R. , Drost Jarno , Kuiper Roland P. , van Tinteren Harm , Wijnen Marc H. W. A. , van den Heuvel-Eibrink Marry M.
Published: December 2021

Survival of unilateral Wilms tumors (WTs) is exceeding 90%, whereas bilateral WTs have an inferior outcome. We evaluated all Dutch patients with bilateral kidney tumors, treated in the first five years of national centralization and reviewed relevant literature. We identified 24 patients in our center (2015–2020), 23 patients had WT/nephroblastomatosis and one renal cell carcinoma. Patients were treated according to SIOP-RTSG protocols. Chemotherapy response was observed in 26/34 WTs. Nephroblastomatosis lesions were stable (n = 7) or showed response (n = 18). Nephron-sparing surgery was performed in 11/22 patients undergoing surgery (n = 2 kidneys positive margins). Local stage in 20 patients with ≥1 WT revealed stage I (n = 7), II (n = 4) and III (n = 9). Histology was intermediate risk in 15 patients and high risk in 5. Three patients developed a WT in a treated nephroblastomatosis lesion. Two of 24 patients died following toxicity and renal failure, i.e., respectively dialysis-related invasive fungal infection and septic shock. Genetic predisposition was confirmed in 18/24 patients. Our literature review revealed that knowledge is scarce on bilateral renal tumor patients with metastases and that radiotherapy seems important for local stage III patients. Bilateral renal tumors are a therapeutic challenge. We describe management and outcome in a national expert center and summarized available literature, serving as baseline for further improvement of care.
Monocyte Chemotactic Proteins (MCP) in Colorectal Adenomas Are Differently Expressed at the Transcriptional and Protein Levels: Implications for Colorectal Cancer Prevention
Authors: Wierzbicki Jarosław , Lipiński Artur , Bednarz-Misa Iwona , Lewandowski Łukasz , Neubauer Katarzyna , Lewandowska Paulina , Krzystek-Korpacka Małgorzata
Published: December 2021

The expression of monocyte chemotactic proteins (MCPs) in colorectal polyps and their suitability as targets for chemoprevention is unknown, although MCP expression and secretion can be modulated by non-steroidal inflammatory drugs. This study was designed to determine the expression patterns of MCP-1/CCL2, MCP-2/CCL8, and MCP-3/CCL7 at the protein (immunohistochemistry; n = 62) and transcriptional levels (RTqPCR; n = 173) in colorectal polyps with reference to the polyp malignancy potential. All chemokines were significantly upregulated in polyps at the protein level but downregulated at the transcriptional level by 1.4-(CCL2), 1.7-(CCL7), and 2.3-fold (CCL8). There was an inverse relation between the immunoreactivity toward chemokine proteins and the number of corresponding transcripts in polyps (CCL2 and CCL7) or in normal mucosa (CCL8). The downregulation of chemokine transcripts correlated with the presence of multiple polyps (CCL2 and CCL8), a larger polyp size (CCL2, CCL7, and CCL8), predominant villous growth patterns (CCL2, CCL7 and CCL8), and high-grade dysplasia (CCL2 and CCL8). In conclusion, MCP-1/CCL2, MCP-2/CCL8, and MCP-3/CCL7 chemokines are counter-regulated at the protein and transcriptional levels. Chemokine-directed chemopreventive strategies should therefore directly neutralize MCP proteins or target molecular pathways contributing to their enhanced translation or reduced degradation, rather than aiming at CCL2, CCL7 or CCL8 expression.
Psychological Impact of the COVID-19 Pandemic on Out-of-Hospital Health Professionals: A Living Systematic Review
Authors: Soto-Cámara Raúl , García-Santa-Basilia Noemí , Onrubia-Baticón Henar , Cárdaba-García Rosa M. , Jiménez-Alegre José Julio , Reques-Marugán Ana María , Molina-Oliva María , Fernández-Domínguez Juan José , Matellán-Hernández María Paz , Morales-Sanchez Almudena , Navalpotro-Pascual Susana
Published: December 2021

Health professionals (HPs), especially those working in the front line, have been one of the groups most affected by the COVID-19 pandemic. The objective of this study is to identify the best available scientific evidence on the impact of the COVID-19 pandemic on the mental health of out-of-hospital HPs in terms of stress, anxiety, depression, and self-efficacy. A living systematic review of the literature was designed, consulting the electronic online versions of the CINHAL, Cochrane Library, Cuiden, IBECS, JBI, LILACS, Medline PyscoDoc, PsycoINFO, Scopus, and Web of Science databases in November 2021. Original research was selected, published in either English, Spanish, French, Italian, or Portuguese. In total, 2082 publications were identified, of which 16 were included in this review. The mental health of out-of-hospital HPs was affected. Being a woman or having direct contact with patients showing suspicious signs of COVID-19 or confirmed cases were the factors related to a greater risk of developing high levels of stress and anxiety; in the case of depressive symptoms, it was having a clinical history of illnesses that could weaken their defenses against infection. Stopping unpleasant emotions and thoughts was the coping strategy most frequently used by these HPs.
Functional Changes of the Genitourinary and Gastrointestinal Systems before and after the Treatment of Endometrial Cancer—A Systematic Review
Authors: Oplawski Marcin , Średnicka Agata , Dutka Aleksandra , Tim Sabina , Mazur-Bialy Agnieszka
Published: December 2021

The incidence of endometrial cancer (EC), which coexists with such civilization diseases as diabetes, obesity or hypertension, is constantly increasing. Treatment includes surgery as well as brachytherapy, teletherapy, rarely chemotherapy or hormone therapy. Due to the good results of the treatment, the occurrence of side effects of therapy becomes a problem for the patients. One of the large groups of side effects includes the pelvic organ prolapse, urinary and fecal incontinence. The aim of this study was to present current knowledge on the occurrence of pelvic floor dysfunction in women treated for EC. A literature review was conducted in the PubMED and WoS databases, including articles on pelvic floor dysfunction in women with EC. PRISMA principles were followed in the research methodology. A total of 1361 publications were retrieved. Based on the inclusion and exclusion criteria, 24 papers were eligible for the review. Mostly retrospective studies based on different questionnaires were evaluated. No prospective studies were found in which, in addition to subjective assessment, clinical examination and objective assessment of urinary incontinence were used. Studies show a significant increase in the incidence of pelvic floor disorders, including urinary incontinence, after various forms of EC treatment. We believe that assessment of complications after endometrial cancer treatment is clinically relevant. The review emphasizes the importance of programming prospective studies to prevent and address these disorders at each stage of oncologic treatment.
Temporal Trends and Outcome of Patients with Acute Coronary Syndrome and Prior Myocardial Infarction
Authors: Orvin Katia , Shechter Alon , Zahger Doron , Shklovski Vitaly , Ovdat Tal , Beigel Roy , Kornowski Ran , Eisen Alon
Published: December 2021

Patients who have previously had a myocardial infarction (MI) are considered a high-risk group with increased risk for cardiovascular (CV) events. During the last decade, the outcome of acute coronary syndrome (ACS) patients has improved due to advances in medical therapy and interventional techniques. We aimed to examine temporal trends and outcomes of patients with prior MI admitted due to ACS from the Acute Coronary Syndrome Israeli Survey (ACSIS). Included were 16,934 ACS patients, of whom 31.4% had prior MI. For temporal trend analysis, the cohort was divided into an early period (2000–2008) and late period (2010–2018). For patients with prior MI, patients in the late period had a higher rate of CV risk factors and were treated more frequently with revascularization and guidelines-directed medical therapy. Recurrent MI (6.7% vs. 12%, p < 0.001), MACE (10.6% vs. 21%, p < 0.001) and 1-year mortality (10.7% vs. 14.6%, p < 0.001) were significantly lower in the late period. However, the mortality rate for patients with prior MI remained higher compared with patients without prior MI (10.7% vs. 6.8% p < 0.001) with an overall higher mortality rate in the STEMI group. Thus, despite significant improvement in outcome measures in the contemporary era, ACS patients with prior MI are still at increased risk for recurrent ischemic CV events and mortality.
Effect of Dexamethasone Combination with Gentamicin in Chemical Labyrinthectomy on Hearing Preservation and Vertigo Control in Patients with Unilateral Meniere’s Disease: A Randomized Controlled Clinical Trial
Authors: Bae Seong-Hoon , Lee Jeon-Mi , Lee Hyun-Jin , Na Gina , Kim Sung-Huhn
Published: December 2021

Chemical labyrinthectomy using gentamicin is a popular method for treating intractable vertigo attacks in Meniere’s disease. However, the risk of hearing loss remains a major concern for clinicians. We investigated the effect of simultaneous dexamethasone and gentamicin application on hearing preservation and vertigo control in patients with intractable unilateral Meniere’s disease. A single-institutional, prospective, single-blinded, randomized clinical trial was conducted. Gentamicin-soaked Gelfoam® was directly applied on the oval window following middle ear exploration. On the round window, dexamethasone-soaked Gelfoam® was applied in the gentamicin with dexamethasone group (GD group, n = 18), and saline-soaked Gelfoam® was applied in the gentamicin with sham reagent group (GO group, n = 19). The hearing change 8 weeks after the procedure and vertigo control 2–12 months after the procedure were investigated. The high-frequency hearing threshold was significantly increased in the GO group (p = 0.005 and 0.012 for 4 and 8 kHz, respectively), but not in the GD group. The short-term (2–6 months) vertigo control was more successful in the GD group (57.89% vs. 94.44%, p = 0.019), but long-term control (6–12 months) was insignificant. In conclusion, the combined application of gentamicin and dexamethasone in chemical labyrinthectomy is an effective method for protecting high-frequency hearing and vertigo control.
Long-Term Assessment of Periodontal Tissues after Corticotomy-Assisted Orthodontic Arch Expansion
Authors: Sulewska Magdalena Ewa , Baczewska Amelia , Bugała-Musiatowicz Beata , Waszkiewicz-Sewastianik Emilia , Pietruski Jan Krzysztof , Pietruska Małgorzata
Published: December 2021

Objectives: The aim of the study was the long-term assessment of the condition of periodontal tissues after corticotomy-assisted orthodontic expansion in patients with transverse maxillary deficiency. Materials and Methods: The study included a group of 18 adults (9 women, 9 men) aged between 24 and 40 years who were at least 5 years post treatment. The following parameters were assessed: the full mouth plaque index (FMPI), full mouth bleeding on probing (FMBOP), probing depth (PD), clinical attachment level (CAL), gingival recession height (GR), recession width (RW), papilla height (PH), papilla width (PW), bone sounding (BS), phenotype, and KT. Results: During examination performed at least 5 years after the completion of orthodontic treatment, the values of PD and CAL were found to be considerably decreased compared to the examination one year post treatment (PD: −0.23; 95% Cl: −0.29, −0.16) (CAL: −0.04; 95% Cl: −0.17, 0.10). The other parameters—FMPI, FMBOP, GR, RW, PH, PW, BS, phenotype, and KT—did not change significantly. Conclusions: Corticotomy-assisted orthodontic arch expansion does not have a negative effect on the periodontium in long-term observations. Clinical Relevance: Orthodontic arch expansion can lead to bone dehiscence and gingival recession. Long-term observations revealed that corticotomy-assisted orthodontic expansion of the upper arch is not followed by negative changes in periodontal status.
Longitudinal Analyses of the Reciprocity of Depression and Anxiety after Traumatic Brain Injury and Its Clinical Implications
Authors: Wang Biyao , Zeldovich Marina , Rauen Katrin , Wu Yi-Jhen , Covic Amra , Muller Isabelle , Haagsma Juanita A. , Polinder Suzanne , Menon David , Asendorf Thomas , Andelic Nada , von Steinbuechel Nicole ,   CENTER-TBI Participants and Investigators
Published: December 2021

Depression and anxiety are common following traumatic brain injury (TBI). Understanding their prevalence and interplay within the first year after TBI with differing severities may improve patients’ outcomes after TBI. Individuals with a clinical diagnosis of TBI recruited for the large European collaborative longitudinal study CENTER-TBI were screened for patient-reported major depression (MD) and generalized anxiety disorder (GAD) at three, six, and twelve months post-injury (N = 1683). Data were analyzed using autoregressive cross-lagged models. Sociodemographic, premorbid and injury-related factors were examined as risk factors. 14.1–15.5% of TBI patients reported moderate to severe MD at three to twelve months after TBI, 7.9–9.5% reported GAD. Depression and anxiety after TBI presented high within-domain persistency and cross-domain concurrent associations. MD at three months post-TBI had a significant impact on GAD at six months post-TBI, while both acted bidirectionally at six to twelve months post-TBI. Being more severely disabled, having experienced major extracranial injuries, an intensive care unit stay, and being female were risk factors for more severe MD and GAD. Major trauma and the level of consciousness after TBI were additionally associated with more severe MD, whereas being younger was related to more severe GAD. Individuals after TBI should be screened and treated for MD and GAD early on, as both psychiatric disturbances are highly persistent and bi-directional in their impact. More severely disabled patients are particularly vulnerable, and thus warrant timely screening and intensive follow-up treatment.
The Electrical Activity of the Orbicularis Oris Muscle in Children with Down Syndrome—A Preliminary Study
Authors: Szyszka-Sommerfeld Liliana , Sycińska-Dziarnowska Magdalena , Woźniak Krzysztof , Machoy Monika , Wilczyński Sławomir , Turkina Anna , Spagnuolo Gianrico
Published: December 2021

The aim of this study was to assess the electrical activity of the superior (SOO) and inferior (IOO) orbicularis oris muscles in children with Down syndrome (DS) and in children without DS. After applying the inclusion and exclusion criteria, 30 subjects were eligible to participate in the later stages of the research—15 subjects with DS (mean age 10.1 ± 1.1) and 15 healthy controls (mean age 9.8 ± 1.0). The electrical potentials of the SOO and IOO muscles were recorded using a DAB-Bluetooth electromyography machine (Zebris Medical GmbH, Germany) during the following tasks: At clinical rest, saliva swallowing, lip protrusion, lip compression, and production of the syllable/pa/. The Mann–Whitney U test was conducted to compare the study results between the groups. An analysis of the electromyographical (EMG) recordings showed that the electrical activity of the orbicularis oris muscle in children with DS and lip incompetence was significantly higher compared to healthy children during saliva swallowing, lip compression, and when producing the syllable/pa/, and this may suggest greater muscular effort due to the need to seal the lips during these functional conditions.
Induction of Remission in Pediatric Crohn’s Disease Patients Assessed by the Mucosal Inflammation Noninvasive Index
Authors: Herman Roma , Dumnicka Paulina , Pieczarkowski Stanisław , Fyderek Krzysztof
Published: December 2021

Mucosal healing (MH) is the main therapeutic goal of Crohn’s disease (CD). The Mucosal Inflammation Noninvasive Index (MINI) appears to be a promising tool for distinguishing MH from its inflammation. This study aims to evaluate MINI in monitoring remissions induced by exclusive enteral nutrition (EEN) in pediatric CD patients. Out of 55 newly diagnosed CD children, 31 who completed 6–8 weeks of EEN were analyzed. Clinical and biochemical data, activity of CD assessed with the Pediatric Crohn’s Disease Activity Index (PCDAI) and MINI were compared within seven days pre- and post-EEN. Response to induction therapy was defined as a decrease of PCDAI by >12.5 points. The follow-up was performed up to 12 months after EEN termination. Out of 31 children who completed 6–8 weeks of EEN, eight required corticosteroids in addition to EEN. Twenty-four patients (77%) responded to induction therapy. In responders, MINI decreased from 19 (Q1:17; Q3:22) to 12 (Q1:6; Q3:14), p < 0.001. The diagnostic accuracy of post-EEN MINI and post-EEN fecal calprotectin (FC) for treatment failure were AUC: 0.899 (95%CI: 0.737–1.000) and 0.762 (95%CI: 0.570–0.954), respectively. In the follow-up of 25 patients (80.6%), the post-EEN MINI of ≥13 points predicted CD relapse (87.5% sensitivity; 64.7% specificity), while FC had no prognostic value. MINI allows for monitoring of EEN and is superior in predicting disease relapse to FC.