bluuebunny/crossref_metadata_2025 huggingface dataset:
Patient and treatment characteristics and safety outcomes of patients with relapsing-remitting multiple sclerosis treated with natalizumab in Greece: Results from the multicenter, 5-year prospective observational study ‘TOPICS greece’
Authors: Karanasios Panagiotis , Karachalios Georgios , Gourgioti Rania , Alexopoulou Antonia , Mastorodemos Vasileios ,   TOPICS Study Group
Published: July 2021

Background

Natalizumab is a highly efficacious treatment for relapsing-remitting multiple sclerosis (RRMS).

Objective

To assess the real-world long-term safety of natalizumab in RRMS.

Methods

This multicenter, 5-year prospective observational study, included adults with RRMS newly initiated on natalizumab as per the approved product label in the routine care in Greece. Safety was evaluated by collecting serious adverse events (SAEs) following study enrollment.

Results

Between 19-Apr-2012 and 18-Dec-2014, 304 eligible patients (median age at natalizumab initiation: 38.0 years; median disease duration: 6.2 years) were enrolled by 20 hospital-based neurologists. Over a median treatment duration period of 58.7 months, 50.7% of the patients discontinued natalizumab, mainly due to anti-JCV antibody detection (59.1%). The adverse event treatment discontinuation rate was 5.2%. The SAE incidence rate during the safety data collection period (median: 48.7 months) was 4.6%. The most common SAEs were infections (1.0%), including 2 cases (0.7%) of progressive multifocal leukoencephalopathy (PML), and no other opportunistic infections. PML diagnoses occurred 6.2-6.7 years after natalizumab initiation, and approximately 2 years after first detection of anti-JCV antibody for both patients. The incidence rate of malignancies was 0.7%.

Conclusion

In real-world settings in Greece, natalizumab displayed an acceptable safety profile, with no new safety signals emerging.
Building a Personal Brand as a CEO: A Case Study of Vivy Yusof, the Cofounder of FashionValet and the dUCk Group
Authors: Md Saad Nor Hasliza , Yaacob Zulnaidi
Published: July 2021

Social media is a new platform for CEOs to build their image and create a strong personal brand to represent themselves and their company. This research examines an outstanding Malaysian fashion icon and social media–savvy businesswoman with over a million followers on Instagram, Vivy Yusof, the youngest Malaysian e-commerce mogul and an example of a successful CEO who has used personal branding to build an empire in the fashion industry. The objectives of this research are to identify the type of messages Vivy Yusof communicates to her audience through her personal Instagram posts and to identify the ways Vivy Yusof’s audience engages with her posts on Instagram. Her Instagram post content is classified using the Honeycomb framework that comprises seven functional building blocks, namely, presence, relationships, reputation, groups, identity, conversations, and sharing. In this study, the content of Vivy Yusof’s Instagram posts is categorized by how she focuses on the various functional building blocks in her posts and the implications these blocks have on how her audience interacts with the posts. Her social media presence confirms the importance of CEO personal branding because of her role and influence on the masses evidenced by the willingness of her followers to interact (through likes and comments) and engage with her posts on any subject matter, relating either to her business or personal life. The study contributes to a growing body of literature on personal branding strategies by shedding light on the association between content strategies and engagement with social media content.
Developing a New Model for Understanding Teacher Satisfaction With Online Learning
Authors: Liu Dongping , Zhang Hai
Published: July 2021

Teacher online learning is an important way to solve teacher shortage and improve teachers’ professional development. However, previous research works that focused on teacher-as-learner satisfaction with online learning were not enough. The aim of this study is to investigate factors that influence teacher satisfaction with online learning. The potential relation and whether there are differences in gender and teaching year among the factors were also studied. The Teacher Satisfaction Index (TSI) model is newly proposed based on the American Customer Satisfaction Index (ACSI) model. A questionnaire survey was administered to 108 middle school teachers from four cities in China. Structure equation modeling was used to corroborate the initial model hypotheses regarding the relationship between variables (teacher satisfaction, teacher perceived quality, teacher expectation, teacher loyalty, and teacher complaint). A t-test and analysis of variance were conducted to investigate whether gender and teaching year were related to teacher satisfaction with online learning. Three main findings emerged. First, perceived quality predicted by teacher expectation significantly influenced teacher satisfaction with online learning. Also, teacher satisfaction significantly affected complaints and loyalty. Second, gender had no effect on the five variables. Third, teaching year played a significant role in teacher expectation. This study provides empirical evidence on what factors affect teacher satisfaction with online learning, gives insight into the development of the teacher online learning system, and suggests designer and administrator strategies for the platform content design and management.
Time to Achieving Clinically Significant Outcomes after Meniscal Allograft Transplantation
Authors: Huddleston Hailey , Mehta Nabil , Polce Evan , Gilat Ron , Alzein Mohamad , Parvaresh Kevin , Verma Nikhil , Cole Brian , Yanke Adam
Published: July 2021

Objectives:

Meniscal allograft transplantation (MAT) is a surgical treatment option for patients with meniscus deficiencies. Prior studies have defined clinically significant outcomes such as minimal clinical important difference (MCID) and patient acceptable symptomatic state (PASS) for commonly administered patient reported outcome measures (PROMs) after MAT. The purpose of this study was to determine the time to achieving MCID and PASS and to identify any risk factors affecting achievement in patients undergoing MAT.

Methods:

A prospectively maintained MAT registry was retrospectively reviewed from April 2014-May 2020. Patients who underwent revision MAT or did not complete preoperative PROMs were excluded. International Knee Documentation Committee (IKDC) and Knee Injury and Osteoarthritis Outcome Scores (KOOS) were administered preoperatively and at 6-months, 1-year, and 2-years postoperatively. Previously defined MCID and PASS thresholds were utilized and Kaplan-Meier survival curve analysis with interval censoring was used to calculate the cumulative percentages of MCID, and PASS achievement at each follow-up time interval (5-7, 11-13, and 23-25 months).

Results:

Eighty-four patients (mean age: 28.2±9.7) were included. Time to MCID and PASS is presented in Table 1. Previously reported PASS values for KOOS Pain, Symptoms, and Sport did not reach an AUC>0.70 and thus were not included in analysis. Worker’s compensation status was found to delay time to achieving MCID for all PROs (HR=0.238-0.305, P=0.008-0.020) and PASS for KOOS Symptoms (HR=0.171, P = 0.026) and IKDC (HR=1.88, P<0.001) (Table 2 and 3). Higher preoperative PRO score was associated with mildly delaying the time to achieving MCID for all PROs (HR=0.947-0.970, P<0.001), while higher preoperative PRO scores were associated with shorter time to achieving PASS on KOOS Symptoms and KOOS QOL (HR=1.030-1.043, P=0.001). Greater BMI (HR=0.946, P=0.020) and the number of focal chondral defects (HR=0.083-0.255, P=0.007-0.029) was associated with delayed MCID for KOOS ADL and QOL, respectively, while concomitant realignment surgery decreased time to MCID on KOOS Sports (HR=2.542, P=0.008).

Conclusions:

This study defined the time to achieving MCID and PASS on IKDC and KOOS subscores for patients undergoing MAT. Worker’s compensation status, BMI, and the presence of focal chondral defects may prolong time to achievement of MCID and PASS after MAT.

[Table: see text][Table: see text][Table: see text]
Performance in Major League Baseball Pitchers After Surgical Treatment of Thoracic Outlet Syndrome
Authors: Gutman Brian , Hadley Christopher , Kirsch Jacob , Joyce Christopher , Namdari Surena , Gutman Michael
Published: July 2021

Objectives:

Thoracic outlet syndrome (TOS) can be a career threatening injury for baseball pitchers. The purpose of this study is to determine the efficacy of surgical management for TOS as a function of return to play and quantitative pitching metrics.

Methods:

Twenty-seven major league baseball pitchers underwent surgical treatment for TOS between January 2001 and December 2017. Analysis of pre and postoperative pitching metrics were used to assess the effect of surgery on 20 pitchers who returned to pitch in Major League Baseball (MLB). All pitching metrics were compared via assessing performance two years prior to surgery and two years after surgery. For 20 pitchers who returned to pitch, MLB pitching metrics of earned run average (ERA), walks plus hits per innings pitched (WHIP), wins above replacement (WAR), strikeouts per nine innings (K/9), average fastball velocity, and strike percentage, were used to assess a pitcher’s ability to return to preoperative performance level.

Results:

Of the 27 pitchers, 20 pitchers were diagnosed with neurogenic thoracic outlet syndrome (NTOS) and seven with venous thoracic outlet syndrome (VTOS). The average age of onset of TOS was 28.6 years. There was no significant difference between the age of onset between the NTOS and VTOS populations (p=0.272). Of the 27 pitchers, 20 (74.1%) were able to return to MLB play at a mean of 297 days (range, 105-638 days) after surgery. Pitching metrics demonstrated that pitcher ERA remained inferior postoperatively compared to baseline preoperative performance (3.66 vs 4.50, p=0.03). Fastball velocity (p=0.94), strike percentage (p=0.50), and K/9 (p=0.878) were equivalent to pre-injury performance. There was no difference in preoperative pitching metrics between pitchers who were able to return and pitchers who were unable to return to the MLB.

Conclusions:

About 3/4 of professional pitchers who undergo surgical intervention for TOS are able to return to play at the MLB level. With regards to performance, the majority of metrics were unchanged from prior to surgery, indicating return at a similar functional level.
Early Use of Blood Flow Restriction Training with Low-Intensity Exercises following Anterior Cruciate Ligament Reconstruction Improves Quadriceps Strength and Post-Operative Pain: A Randomized Controlled Trial
Authors: Curley Andrew , Galel Alexandra , Fryar Caroline , Lewis Jennifer , Wang David , Fackler Nathan , Chang Edward
Published: July 2021

Objectives:

Blood flow restriction therapy (BFRT) has been proposed as a method to enhance rehabilitation following anterior cruciate ligament reconstruction (ACLR). However, a paucity of data exists to support the use of BFRT in clinical practice. The purpose of this study is to determine if early application of BFRT, used with low-weight therapy exercises, increases quadriceps strength, and functional outcomes following ACLR compared to a traditional rehabilitation protocol without BFRT.

Methods:

Twenty-six patients undergoing ACLR were randomized to receive either: (1) a traditional rehabilitation program (n=14), or (2) a modified program using BFRT with low-weight (20-50% of 1-repetition maximum) exercises (n=12). Two patients crossed over from the control to BFRT groups. An as treated analysis was performed for biweekly measurements in the acute postoperative period of range of motion (ROM), thigh circumference, and terminal knee extension (TKE) strength. Circumference and TKE strength were analyzed as a percentage of the contralateral side. VAS and IKDC scores were assessed preoperatively and during the first 12 weeks postoperatively.

Results:

Compared to the control group, the BFRT patients demonstrated significantly greater TKE strength at week 8 (68.3% vs. 82.7%, p = 0.022), week 10 (69.0% vs. 82.8%, p = 0.044), and week 12 (64.4% vs. 84.2%, p = 0.002) , as well as greater overall change in TKE strength from week 3 to 12 (8.3% vs 24.4%, p = 0.044). The BFRT group reported significantly lower VAS values at week 6 (2.5 vs. 0.6, p = 0.041), though scores were similar at week 12 (0.9 vs. 1.0, p = 0.912).There was no significant difference for knee ROM, thigh circumference, or IKDC scores at any time point.

Conclusions:

In comparison to a traditional rehabilitation protocol following ACLR, BFRT used in conjunction with low-weight exercises during the acute postoperative period was associated with significantly lower VAS scores at week 6, as well as greater quadriceps strength at 8, 10, and 12 weeks. These results suggest that BFRT may accelerate rehabilitation after ACLR, though future studies are needed to assess long-term outcomes.

[Table: see text]
Spontaneous Correction of External Tibiofemoral Rotational Deformity and Tibial Tuberosity-Trochlear Groove Measurements Occurs After Medial Patellofemoral Ligament Reconstruction in Fixed or Obligatory Dislocators
Authors: Aitchison Alexandra , Lin Kenneth , Green Daniel
Published: July 2021

Objectives:

Tibial tubercle to trochlear groove distance (TT-TG) and external tibiofemoral rotation (TFR) through the knee joint have been identified as potential contributing factors to patellar instability. In patients with a fixed or obligatory lateral patella dislocation (FOD), the normal force vector of the extensor mechanism is altered, so instead of a direct axial pull to cause extension, it exerts a lateralizing and external rotatory force on the tibia via the tibial tubercle. The purpose of this study is to investigate postoperative changes in TT-TG and TFR after medial patellofemoral ligament reconstruction (MPFLR) in two clinical cohorts: standard traumatic patellar instability (SPI) patients and FOD patients. We hypothesized that by surgically relocating the patella in the trochlea, and re-establishing medial sided soft tissue tension, the increased medializing force vector on the patella may exert enough force to alter resting rotation of the tibia in relation to the femur in the FOD group.

Methods:

A retrospective study was performed from April 2009 to February 2019. FOD and SPI patients under 18 years with available magnetic resonance imaging (MRI) of the knee before and after MPFLR were eligible. All FOD patients in the time frame were analyzed and SPI patients were randomly selected. Exclusion criteria were outside institution MRI, concomitant alignment procedures done at the time of MPFLR, and prior MPFLR or tibial tubercle osteotomy. TT-TG and TFR (using the posterior femoral and tibial condylar lines) were measured blindly on initial axial MRI. Statistical analysis using a paired sample t-test was performed with significance set at p<0.05.

Results:

A total of 30 patients were included, 14 in the FOD group and 16 in the SPI group. The mean age at time of surgery was 13.9 years (range 10-17 years), 53% of the cohort was female, and the mean time from surgery to follow-up MRI was 2.0 years. Demographics by group are shown in Table 1. TT-TG and TFR were not significantly different preoperatively versus postoperatively in the SPI group (Table 2). In the FOD group, both TT-TG (17.7 vs 13.7, P=.019) and TFR (8.6 vs 3.1, P=.025) decreased significantly on postoperative MRI.

Conclusions:

The postoperative decrease in TT-TG and TFR in the FOD group suggests that MPFLR in fixed or obligatory dislocators can improve the external rotation deformity through the level of the joint, and thus may help normalize the forces acting through the extensor mechanism.

[Table: see text][Table: see text]
Lateral Extra-Articular Tenodesis Reduces the Rate of Revision Anterior Cruciate Ligament Reconstruction in Elite Athletes
Authors: Balendra Ganesh , Willinger Lukas , Jones Mary , Williams Andy , Borque Kyle
Published: July 2021

Objectives:

Lateral extra-articular tenodesis (LET) has been shown to decrease the re-rupture rates in cases of ACL reconstruction (ACLR) at high risk of failure when combined with hamstring (HS) autograft ACLR. The effects of LET have never been evaluated in elite athletes and have only sparingly been assessed when combined with bone-patellar tendon-bone (BTB) ACLR. The purpose of this study was to assess the efficacy and safety of the addition of a LET.

Methods:

A retrospective consecutive series of elite athletes who underwent primary ACL reconstruction by the senior author during the period of January 2005 to June 2018 were evaluated. An elite athlete was defined as one who is either paid or participates in national or international level competition in their sport. The primary outcome measure was undergoing revision ACLR, while the secondary outcome was the need for any further operative procedure. Chi square test was used to determine differences and statistical significance was defined as p < 0.05.

Results:

456 elite athletes underwent ACLR during this time period. Overall 9.1% (31 of 339) underwent revision ACLR. In the ACLR + LET group, 3.4% (4 of 117) underwent ACLR revision (relative risk reduction [RRR], 0.626, p = 0.045) (table 1). Subgroup analysis by graft type yielded similar ratios, but did not reach statistical significance (Tables 2 and 3). There was no difference in re-operation rates between the ACLR alone and ACLR + LET groups (33.9% vs 30.7%, p = 0.531).

Conclusions:

The addition of a LET significantly reduced the rate of revision ACLR in elite athletes and did not increase the rate of subsequent operations.
Glenoid Bone Loss After First-Time Posterior Instability Events: A Prospective Cohort Study
Authors: Owens Brett , Slaven Sean , LeClere Lance , Donohue Michael , Tennent David , Cameron Kenneth , Posner Matthew , Dickens Jonathan , Bedrin Michael
Published: July 2021

Objectives:

To prospectively determine the amount of bone loss associated with posterior instability and to determine predisposing factors based on pre-instability imaging.

Methods:

A total of 714 athletes were evaluated prospectively for 4+ years. At baseline, every patient received a subjective history of shoulder instability as well as bilateral noncontrast shoulder magnetic resonance imaging (MRI) regardless of any reported history of shoulder instability. The cohort was prospectively followed during the study period, and those who were diagnosed with posterior glenohumeral instability were identified. Postinjury MRIs with contrast were obtained and compared with the screening MRI. Glenoid version, perfect-circle-based bone loss was measured for each patient’s pre- and post-injury MRI using previously described methods.

Results:

Of the 714 athletes (1428 shoulders) who were prospectively followed during the 4-year period, 5 athletes (7 shoulders) sustained a first-time posterior instability event (1 dislocation, 5 subluxations), and one athlete (1 shoulder) sustained a recurrent posterior instability event. At baseline, 6 out of 8 shoulders were noted to have some level of dysplasia and/or bone loss. Glenoid bone loss increased significantly after instability event in terms of percentage linear bone loss (6.96 ± 4.66 versus 13.54% ± 4.66, p=0.014) and total area of bone loss (3.51 ± 2.78 versus 8.10 ± 3.25, p= 0.009). Baseline glenoid retroversion >10° was associated with a significant greater percentage of bone loss (2.58 ± 1.94 versus 5.79 ± 1.28, p=0.028).

Conclusions:

Patients with posterior instability tend to have baseline dysplasia and/or glenoid bone loss. Glenoid bone loss of 8.1% was observed after index posterior instability event, with baseline glenoid retroversion >10° being associated with more bone loss.
The Effect of Single Sport Specialization in Youth Sports: A Prospective Cohort Study
Authors: Campbell Richard , Weekes Danielle , Mattson Meghan , Tjoumakaris Fotios , Pepe Matthew , Tucker Bradford , Lee Donghoon
Published: July 2021

Objectives:

Large numbers of youth participate in both team and individual sports. In recent years, sports specialization has become increasingly popularized in younger athletes. There is concern that early sports specialization increases the risk of overuse injuries in youth athletes. The purpose of this investigation was to determine the prevalence of sport specialization in youth athletes, and prospectively examine whether specialization correlates with an increased incidence of athletic injury.

Methods:

895 high school freshman athletes were enrolled starting in 2016, with the intent of following them through the completion of their high school careers. They were recruited from 3 high schools within the same school district. Sports specialization was defined as participating in a single sport in excess of 6 months of the year at the exclusion of other sports. Athletes’ demographic information, sport commitment and injury history were collected through a sports specialization and injury survey. The same athletes were queried again at the conclusion of each season to collect injury information. Athletic training records were used to corroborate, in order to ensure capture of all injuries reported to health care personnel.

Results:

Of the 895 athletes, 216 (24.1%) reported sport specialization at some point during their high school sports careers. Specialized athletes were exposed to significantly more sports activity (8.41 hours/week vs 7.10 hours/week, p<0.00001 ). They were also much more likely (70.6% vs 25.1%, p< .00001) to compete on a club or travel team for their sport. Male athletes were more likely to specialize than females (27.0% vs 19.3%, p<0.0072). Baseball (12.1% of specialized athletes vs 4.9% of all athletes, p<0.000032) main sport athletes were the only athletes significantly more likely to report specialization. Specialized athletes were significantly more likely than their nonspecialized counterparts to report an injury (39.8% vs 33.2%, p< 0.0271). These athletes suffered from higher severity injuries, requiring more time to recover than their peers. (p<0.0483). Despite the higher propensity for injury in specialized athletes and greater tendency for specialization in males, female athletes were more likely to report injures (p<0.0053). The most common reported injuries were of the knee, ankle, and head (18.6%, 18.2%, 16.6% of all injuries respectively). Season ending injuries were also most commonly knee, ankle, and head injuries (48.5%, 15.2%, 12.1% respectively), with 30.3% of all reported season ending injuries being ACL tears.

Conclusions:

Specialized student athletes tend to have significantly more injuries than non-specialized athletes, as well as more severe injuries than non-specialized athletes. This is one of the largest and most comprehensive studies to date, evaluating the effect of sports specialization on the incidence of athletic injury in high school athletes.
Equity-Focused, Trauma-Informed Policy Can Mitigate COVID-19’s Risks to Children’s Behavioral Health
Authors: Champine Robey B. , Lang Jason M. , Mamidipaka Anusha
Published: July 2021

Both vulnerabilities to COVID-19 and childhood trauma have deep roots in health inequities. Children of color especially risk severe COVID-19 illness, with long-term effects that amplify existing health disparities, including trauma exposure. Similarly, children of color report more adverse childhood experiences (ACEs) than non-Hispanic White children. ACEs and other potentially traumatic events are associated with lifelong physical and psychological health problems. Policy must prioritize health equity (the absence of differences in health care access, quality, and outcomes based on ethnicity, race, and socioeconomic status). A trauma-informed approach emphasizes recovery and resilience. Principles of health equity can join with trauma-informed policy and practice for families and communities to help mitigate the effects of childhood trauma during the pandemic and beyond.
Thumb Ulcer Presenting As Soft Tissue Infection in a Patient With Sweet’s Syndrome Intolerant To Systemic Corticosteroids: A Case Report
Authors: Yuen Kimberley , Asai Yuka , Hendry J. Michael
Published: July 2021

Sweet’s syndrome, also known as acute febrile neutrophilic dermatosis, is an uncommon dermatological condition characterized by sudden onset, painful, erythematous/violaceous papules, plaques and ulcers, and specific histopathologic findings. Ulcers commonly present on the trunk, neck, hands and typically respond to systemic corticosteroid treatment. Here, we present a case of a 63-year-old woman with Sweet’s syndrome that presented with a thumb ulcer resembling a soft tissue infection. The thumb lesion was refractory to management for an infection and tissue pathology was consistent with a Sweet’s lesion. The patient was intolerant to first line therapy of oral prednisone, but the lesion was initially responsive to topical clobetasol and maintenance therapy of oral dapsone. This case emphasizes the importance of a careful history, examination, workup and maintaining a broad differential diagnosis to prevent misdiagnosis. We also demonstrate the potential effectiveness of initial topical treatment for problematic Sweet’s lesions when systemic steroids are contraindicated.
Murine bone marrow mesenchymal stromal cells have reduced hematopoietic maintenance ability in sickle cell disease
Authors: Tang Alice , Strat Ana Nicolle , Rahman Mahmudur , Zhang Helen , Bao Weili , Liu Yunfeng , Shi David , An Xiuli , Manwani Deepa , Shi Patricia , Yazdanbakhsh Karina , Mendelson Avital
Published: July 2021

Sickle cell disease (SCD) is characterized by hemolytic anemia, which can trigger oxidative stress, inflammation, and tissue injury that contribute to disease complications. Bone marrow mesenchymal stromal cells (MSCs) tightly regulate hematopoietic stem cell (HSC) homeostasis in health and disease, but their functionality in SCD remains unclear. We identified for the first time that murine SCD MSCs have altered gene signatures, reduced stem cell properties, and increased oxidative stress, due in part to hemolysis. Murine SCD MSCs had lower HSC maintenance ability in vitro and in vivo, as manifested by increased HSC mobilization and decreased HSC engraftment after transplant. Activation of Toll-like receptor-4 through p65 in MSCs further contributed to MSC dysfunction. Transfusions led to an improved MSC and HSC oxidative state in SCD mice. Improving the regulation between MSCs and HSCs has vital implications for enhancing clinical HSC transplantation and gene therapy outcomes and for identification of new molecular targets for alleviating SCD complications.
How do lizard niches conserve, diverge or converge? Further exploration of saurian evolutionary ecology
Authors: Pelegrin Nicolás , Winemiller Kirk O. , Vitt Laurie J. , Fitzgerald Daniel B. , Pianka Eric R.
Published: July 2021

Background

Environmental conditions on Earth are repeated in non-random patterns that often coincide with species from different regions and time periods having consistent combinations of morphological, physiological and behavioral traits. Observation of repeated trait combinations among species confronting similar environmental conditions suggest that adaptive trait combinations are constrained by functional tradeoffs within or across niche dimensions. In an earlier study, we assembled a high-resolution database of functional traits for 134 lizard species to explore ecological diversification in relation to five fundamental niche dimensions. Here we expand and further examine multivariate relationships in that dataset to assess the relative influence of niche dimensions on the distribution of species in 6-dimensional niche space and how these may deviate from distributions generated from null models. We then analyzed a dataset with lower functional-trait resolution for 1023 lizard species that was compiled from our dataset and a published database, representing most of the extant families and environmental conditions occupied by lizards globally. Ordinations from multivariate analysis were compared with null models to assess how ecological and historical factors have resulted in the conservation, divergence or convergence of lizard niches.

Results

Lizard species clustered within a functional niche volume influenced mostly by functional traits associated with diet, activity, and habitat/substrate. Consistent patterns of trait combinations within and among niche dimensions yielded 24 functional groups that occupied a total niche space significantly smaller than plausible spaces projected by null models. Null model tests indicated that several functional groups are strongly constrained by phylogeny, such as nocturnality in the Gekkota and the secondarily acquired sit-and-wait foraging strategy in Iguania. Most of the widely distributed and species-rich families contained multiple functional groups thereby contributing to high incidence of niche convergence.

Conclusions

Comparison of empirical patterns with those generated by null models suggests that ecological filters promote limited sets of trait combinations, especially where similar conditions occur, reflecting both niche convergence and conservatism. Widespread patterns of niche convergence following ancestral niche diversification support the idea that lizard niches are defined by trait-function relationships and interactions with environment that are, to some degree, predictable and independent of phylogeny.
Role of community health volunteers in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Malawi: a qualitative study
Authors: Safary Elvis , Mwandeti Micrina , Matanje Beatrice , Beiersmann Claudia , Mtaita Caroline , Shiroya Veronica , Winkler Volker , Deckert Andreas , Kumar Pratap , Phiri Sam , Neuhann Florian
Published: July 2021

Background

In recent years, there has been greater recognition of the important role of community health volunteers in many countries and their important role informs many health programs. This include health education, provision of services such as screening, monitoring and referral to health facilities. Their roles are better understood in the areas of communicable diseases like HIV infection, Tuberculosis and Malaria however little is known about their role in non-communicable diseases. This study seeks to explore perception of CHVs’ functions, tasks, and their fulfilment in identifying people with elevated blood pressure for diagnosis and monitoring of hypertension in Lilongwe, Malawi.

Methods

This was a qualitative naturalistic research design utilizing observation and semi-structured interviews with community health volunteers working in Lilongwe, Malawi. Interviews were carried out with the researcher. Participants were recruited from the ZaMaC project. An interview guide was developed with a category-guided deductive approach. The interviews were recorded through note taking. Data analysis was performed using content analysis approach.

Results

Community health volunteers have multiple roles in prevention and monitoring of hypertension. They act as health educators and provide lifestyle counselling. They screened for hypertension and monitored blood pressure and assisted community members to navigate the health system such as linkage to health facilities. These roles were shaped in response to community needs.

Conclusion

This study indicates the complexities of the roles of community health volunteer in identifying people with elevated BP for diagnosis and monitoring of hypertension. Understanding community health volunteers’ roles provides insight into their required competencies in provision of their daily activities as well as required training to fill in their knowledge gaps.
Comparison of the novel VieScope with conventional and video laryngoscope in a difficult airway scenario – a randomized, controlled simulation trial
Authors: Ecker Hannes , Kolvenbach Simone , Stranz Sebastian , Herff Holger , Wetsch Wolfgang A.
Published: July 2021

Background

Endotracheal intubation continues to be the gold standard for securing the airway in emergency situations. Difficult intubation is still a dreadful situation when securing the airway.

Objective

To compare VieScope with Glidescope and conventional Macintosh laryngoscopy (MAC) in a simulated difficult airway situation.

Methods

In this randomized controlled simulation trial, 35 anesthesiologists performed endotracheal intubation using VieScope, GlideScope and MAC in a randomized order on a certified airway manikin with difficult airway.

Results

For the primary endpoint of correct tube position, no statistical difference was found (p = 0.137). Time until intubation for GlideScope (27.5 ± 20.3 s) and MAC (20.8 ± 8.1 s) were shorter compared to the VieScope (36.3 ± 10.1 s). Time to first ventilation, GlideScope (39.3 ± 21.6 s) and MAC (31.9 ± 9.5 s) were also shorter compared to the VieScope (46.5 ± 12.4 s). There was no difference shown between handling time for VieScope (20.7 ± 7.0 s) and time until intubation with GlideScope or MAC. Participants stated a better Cormack & Lehane Score with VieScope, compared to direct laryngoscopy.

Conclusion

Rate of correct tracheal tube position was comparable between the three devices. Time to intubation and ventilation were shorter with MAC and Glidescope compared to VieScope. It did however show a comparable handling time to video laryngoscopy and MAC. It also did show a better visualization of the airway in the Cormack & Lehane Score compared to MAC.

Trial registration

The study was registered at the German Clinical Trials Register www.drks.de (Identifier: DRKS00024968) on March 31st 2021.
A longitudinal study of suicide and suicide attempt in northwest of Iran: incidence, predictors, and socioeconomic status and the role of sociocultural status
Authors: Fakhari Ali , Farahbakhsh Mostafa , Esmaeili Elham Davtalab , Azizi Hosein
Published: July 2021

Background

A detailed community-level understanding of socioeconomic status (SES) and sociocultural status (SCS) of suicides and suicide attempters (SAs) in a prospective design could have significant implications for policymakers at the local prevention and treatment levels. The effect of SCS and SES on SAs is poorly understood and investigated in Iran. The present study aimed to investigate the incidence, trend, and role of SES and SCS on suicide and SAs.

Methods

A longitudinal study was conducted based on the registry for SAs in Malekan County, Iran, from 2015 to 2018. Demographic characteristics, SES, SCS, incidence rates, and predictors of suicidal behaviors were measured via structured instruments. Simple and multiple logistic regressions were used to estimate crude and adjusted odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 853 SAs (32 suicides and 821 attempts) were identified during the study. Trend analysis revealed that the suicide rate significantly decreased from 2014 (10.28) to 2018 (1.75) per 100,000. In the final multiple variable models, age (26–40), male sex, unemployment, antisocial activities, history of SA, hanging method, and season (spring) increased the suicide risk while religious commitment had protective effects on suicide.

Conclusions

Our findings indicated that demographic characteristics, low SES, and SCS are associated with suicide. In this county, trend of suicide and SA were decreased from 2014 to 2018. This study findings highlight the need to consider a wide range of contextual variables, socio-demographic, SES, and SCS in suicide prevention strategies. Improving inter-sectoral collaborations and policymakers’ attitudes are imperative for SA reduction.
Low CT attenuation and high fatty infiltration rate of psoas are risk factors for incisional hernias after appendicectomy: a cross-sectional single-center study from China
Authors: Du Xuechao , Sun Pengtao , Yan Yuchang , Gong Xiang , Lian Yufei , Pan Zhenyu
Published: July 2021

Background

Decreased computed tomography (CT) attenuation of muscle is independently associated with muscle weakness. The CT attenuation of the abdominal wall muscles may correlate with that of the psoas in patients without ventral hernias. This means that the CT attenuation of the psoas may be related to the occurrence of incisional hernias (IH). CT-determined sarcopenia was deemed inefficient in predicting the development of IH, while limited attention has been paid to the association between muscle fatty infiltration and incidences of IH. In this study, we aim to investigate whether the psoas’ CT measurement parameters, including the average CT attenuation, fatty infiltration rate and psoas muscle index, are associated with IH.

Methods

In this study, adult patients who had undergone an appendicectomy in the past and had then, for any reason, been hospitalised in our hospital from January 2018 to December 2019 were enrolled. The patients were classified into an IH group and a non-IH group. Their psoas’ CT attenuation, fatty infiltration rate (FIR) and psoas muscle index (PMI) were measured or calculated. Sarcopenia was defined according to their PMI. Differences between the two groups’ indices were then compared. A logistic regression model was applied to assess the effects of psoas’ CT measurement parameters on the occurrence of IH.

Results

One hundred twenty patients were included in this study. The psoas’ CT attenuation (p = 0.031) and PMI (p = 0.042) in the IH group were significantly lower than those in the non-IH group, and FIR in the IH group was significantly higher than in the non-IH group (p < 0.001). The patients’ psoas’ CT attenuation, FIR, PMI, age, gender and whether they had a history of smoking, were all significant factors in the univariate logistic regression analysis. After adjusting for confounding factors, a multivariate logistic regression analysis demonstrated that the psoas’ CT attenuation was an independent protective factor (p = 0.042), and FIR was an independent risk factor (p = 0.018), while neither PMI (p = 0.118) nor sarcopenia (p = 0.663) showed a significant effect on the incidence of IH.

Conclusions

When an appendectomy has been performed, a decreased CT attenuation and increased FIR of the psoas can be considered risk factors for IH.
Does psychological distress influence postoperative satisfaction and outcomes in patients undergoing total knee arthroplasty? A prospective cohort study
Authors: Bian Tao , Shao Hongyi , Zhou Yixin , Huang Yong , Song Yang
Published: July 2021

Background

Preoperative psychological distress may be related to dissatisfaction and poorer outcomes after total knee arthroplasty (TKA). However, the kind of psychological distress that could influence postoperative satisfaction and outcomes remains controversial. Few studies have examined these issues in Chinese cohorts. Thus, this study aimed to examine (1) the prevalence of preoperative psychological distress in patients undergoing TKA and (2) whether preoperative psychological distress influences patient satisfaction, early postoperative outcomes, and improvement of knee function after TKA.

Methods

We prospectively included 210 patients undergoing unilateral primary TKA between March 2017 and September 2017 at our institution. Preoperatively, patients completed the Depression Anxiety and Stress Scales and new Knee Society Scores (KSS) questionnaires. At 3 months and 1 year postoperatively, patients’ KSS and overall satisfaction were assessed. Stepwise multivariate linear regression models were used to assess the variables that influenced changes in each KSS item.

Results

Preoperatively, 89 (42.4%) patients experienced psychological distress. The satisfaction rate and postoperative KSS were not significantly different between patients with or without psychological distress; a higher preoperative score was shown to predict less KSS improvement. Patients with depression had fewer symptom score changes.

Conclusions

The prevalence of preoperative psychological distress was relatively high; thus, surgeons should consider the patient’s psychological state. Patients’ satisfaction was not influenced by psychological factors. Patients with depression and higher preoperative scores had lower symptom scores and KSS improvement, respectively.
The aiming device for cervical distractor pin insertion: a proof-of-concept, feasibility study
Authors: Bunmaprasert Torphong , Luangkittikong Sittichai , Tosinthiti Menghong , Nivescharoenpisan Supachoke , Raphitphan Raphi , Sugandhavesa Nantawit , Liawrungrueang Wongthawat , Riew K. Daniel
Published: July 2021

Background

Restoration of cervical lordosis after anterior discectomy and fusion is a desirable goal. Proper insertion of the vertebral distraction or Caspar pin can assist lordotic restoration by either putting the tips divergently or parallel to the index vertebral endplates. With inexperienced surgeons, the traditional free-hand technique for Caspar pin insertion may require multiple insertion attempts that may compromise the vertebral body and increase radiation exposure during pin localization. Our purpose is to perform a proof-of-concept, feasibility study to evaluate the effectiveness of a pin insertion aiming device for vertebral distraction pin insertion.

Methods

A Smith-Robinson approach and anterior cervical discectomy were performed from C3 to C7 in 10 human cadaveric specimens. Caspar pins were inserted using a novel pin insertion aiming device at C3-4, C4-5, C5-6, and C6-7. The angles between the cervical endplate slope and Caspar pin alignment were measured with lateral cervical imaging.

Results

The average Superior Endplate-to-Caspar Pin angle (SE-CP) and the average Inferior Endplate-to-Caspar Pin angle (IE-CP) were 6.2 ± 2.0° and 6.3 ± 2.2° respectively. For the proximal pins, the SE-CP and the IE-CP were 4.0 ± 1.1°and 5.2 ± 2.4° respectively. For the distal pins, the SE-CP and the IE-CP were 7.7 ± 1.4° and 6.2 ± 2.0° respectively. No cervical endplate violations occurred.

Conclusion

The novel Caspar pin insertion aiming device can control the pin entry points and pin direction with the average SE-CP and average IE-CP of 6.2 ± 2.0° and 6.3 ± 2.2°, respectively. The study shows that the average different angles between the Caspar pin and cervical endplate are less than 7°.
Implications of gender-based variabilities in bone mineral density and hemoglobin levels
Authors: Zhou Yumei , Liu Shengjun , Wang Ximei , Fu Yuhan , Su Fan , Cao Lei , Zha Xiaojuan , Wen Yufeng
Published: July 2021

Background

Studies reported that there is a relationship between volumetric bone mineral density (vBMD) and hemoglobin (HGB) in sickle cell anemia, chronic obstructive pulmonary disease, inflammatory bowel disease, and chronic kidney disease, it is not clear whether this association exists in normal populations or different genders. In order to further clarify the relationship between vBMD and HGB, and provide the basis for the diagnosis of related diseases, this study was conducted in the physical examination population.

Methods

A cross-sectional study was conducted on a health check-up population from Wannan area of China from January to December 2018. The study involved 1238 individuals aged 23 to 85 years. Linear regression analysis and smooth curve were applied to determine the relationship of HGB and vBMD.

Results

The average level of vBMD in the population was 130.11 ± 79.51 mg/cm3, after adjusting for age, body mass index (BMI), systolic blood pressure (SBP), diastolic blood pressure (DBP), total cholesterol (TC), triglycerides (TG), glucose (GLU), high-density lipoprotein (HDL) and low-density lipoprotein (LDL). A U-shape relationship was established between vBMD and HGB, the cut off value of HGB was 130 g/L. After gender stratification, the results showed a U-shaped curve relationship between vBMD and HGB in male group, and a linear relationship between vBMD and HGB in female group. The vBMD decreased with HGB when HGB < 120 g/L, and increased when HGB ≥ 120 g/L in male group.

Conclusion

The relationship between vBMD and HGB in the male physical examination population presents a U-shaped curve.
Research on epileptic EEG recognition based on improved residual networks of 1-D CNN and indRNN
Authors: Ma Mengnan , Cheng Yinlin , Wei Xiaoyan , Chen Ziyi , Zhou Yi
Published: July 2021

Background

Epilepsy is one of the diseases of the nervous system, which has a large population in the world. Traditional diagnosis methods mostly depended on the professional neurologists’ reading of the electroencephalogram (EEG), which was time-consuming, inefficient, and subjective. In recent years, automatic epilepsy diagnosis of EEG by deep learning had attracted more and more attention. But the potential of deep neural networks in seizure detection had not been fully developed.

Methods

In this article, we used a one-dimensional convolutional neural network (1-D CNN) to replace the residual network architecture’s traditional convolutional neural network (CNN). Moreover, we combined the Independent recurrent neural network (indRNN) and CNN to form a new residual network architecture-independent convolutional recurrent neural network (RCNN). Our model can achieve an automatic diagnosis of epilepsy EEG. Firstly, the important features of EEG were learned by using the residual network architecture of 1-D CNN. Then the relationship between the sequences were learned by using the recurrent neural network. Finally, the model outputted the classification results.

Results

On the small sample data sets of Bonn University, our method was superior to the baseline methods and achieved 100% classification accuracy, 100% classification specificity. For the noisy real-world data, our method also exhibited powerful performance.

Conclusion

The model we proposed can quickly and accurately identify the different periods of EEG in an ideal condition and the real-world condition. The model can provide automatic detection capabilities for clinical epilepsy EEG detection. We hoped to provide a positive significance for the prediction of epileptic seizures EEG.
Spatiotemporal evolution of epileptic seizure based on mutual information and dynamic brain network
Authors: Ma Mengnan , Wei Xiaoyan , Cheng Yinlin , Chen Ziyi , Zhou Yi
Published: July 2021

Background

Epilepsy was defined as an abnormal brain network model disease in the latest definition. From a microscopic perspective, it is also particularly important to observe the Mutual Information (MI) of the whole brain network based on different lead positions.

Methods

In this study, we selected EEG data from representative temporal lobe and frontal lobe epilepsy patients. Based on Phase Space Reconstruction and the calculation of MI indicator, we used Complex Network technology to construct a dynamic brain network function model of epilepsy seizure. At the same time, about the analysis of our network, we described the index changes and propagation paths of epilepsy discharge in different periods, and spatially monitors the seizure change process based on the analysis of the parameter characteristics of the complex network.

Results

Our model portrayed the functional synergy between the various regions of the brain and the state transition during the seizure process. We also characterized the EEG synchronous propagation path and core nodes during seizures. The results shown the full node change path and the distribution of important indicators during the seizure process, which makes the state change of the seizure process more clearly.

Conclusion

In this study, we have demonstrated that synchronization-based brain networks change with time and space. The EEG synchronous propagation path and core nodes during epileptic seizures can provide a reference for finding the focus area.