bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteonecrosis of the jaw in primary dental care: Recognition and referral
Authors: Burns Megan , Patel Vinod
Published: September 2022

Osteoradionecrosis (ORN) and medication-related osteonecrosis of the jaw (MRONJ) are uncommon conditions, however when present they have a significant impact on a patient’s quality of life and are notoriously difficult to treat. With medical advances resulting in improved survival rates and increased life expectancy, it is likely that general dental practitioners (GDPs) will more frequently be involved in the oral health management of patients at risk of both ORN and MRONJ. Though management of both diseases is beyond the scope of primary care dentistry, the GDP still has a key role in the patient’s overall care. It is therefore important to have a good understanding of these conditions and their consequences for dental treatment in order to provide adequate patient support. Management requires a multidisciplinary approach to treatment and as part of this GDPs are integral in prevention, early recognition and maintenance of oral health following diagnosis. This article aims to refresh the reader’s knowledge regarding MRONJ and ORN and support the GDP in managing this patient group.
Determination of the indoor air bacterial profile in Jimma University Specialized Hospital, Southwest Ethiopia
Authors: Girma Andualem , Lamore Yonas
Published: September 2022

Objective:

Microorganisms are one of the main indoor air contaminants. In a hospital setting, a range of hospital-acquired infectious diseases are caused due to indoor air pollution. Studies conducted on hospital patients and healthcare workers revealed that indoor air pollution is causing more severe health problems than outdoor air pollution. Thus, this study aimed to determine the bacterial indoor air quality in Jimma University Specialized Hospital in southwest Ethiopia.

Method:

An institution-based cross-sectional study was conducted from late May to October 2020. Indoor air samples were collected through a passive method by exposing prepared sample plates for prescheduled exposure time, and bacterial species were identified using morphology and biochemical tests.

Result:

Based on the findings, neither of the wards showed a similar microbial concentration. Among the studied wards, the minimum and the maximum bacterial distribution ranged from 280 to 6369 cfu/m3, respectively. Staphylococcus aureus, coagulase-negative spp., Klebsiella spp., Escherichia coli, Bacillus spp., Proteus spp., and Streptococcus spp. were bacterial isolates. Statistically, the concentration of the bacteria in all the studied wards was tested significantly different ( p ⩽ 0.001).

Conclusion:

Among studied wards, the emergency outpatient ward showed a maximum bacterial concentration in contrast to the minor operating room. Based on the criteria of the World Health Organization on hospital-acquired infections, studied wards were highly contaminated.
In-hospital mortality and its predictors among adult stroke patients admitted in Debre Markos Comprehensive Specialized Hospital, Northwest Ethiopia
Authors: Admas Maru , Teshome Muluken , Petrucka Pammla , Telayneh Animut Takele , Alamirew Nakachew Mekonnen
Published: September 2022

Introduction:

Stroke is the second-leading global cause of death next to ischemic heart disease. The burden of stroke mortality, morbidity, and disability is increasing across the world. In Ethiopia, evidence on the survival status of adult stroke patients is insufficient. The purpose of this study is to estimate in-hospital mortality and its predictors among adult stroke patients.

Methods:

Institution-based retrospective follow-up study was conducted on adult stroke patients who were admitted to Debre Markos Comprehensive Specialized Hospital from 1 November 2015 to 31 October 2020. Through simple random sampling, 382 patient charts were selected from 1125 stroke patients for 5 years follow-up period. Data were entered using EpiData™ version 4.1 and exported to Stata/SE™ version 14 for cleaning, coding, categorizing, and analysis. Predictor variables were selected using 95% confidence interval with a corresponding adjusted hazard ratio.

Results:

In this study, 219 (57.33%) males and the mean (standard deviation) age of 57.65 ± 14.3 years. The in-hospital mortality rate of stroke was 12.8%; the median (interquartile range) time to mortality and Glasgow Coma Scale were 7 (4–13) days and 14 (11–15), respectively. The incidence of in-hospital mortality was 29/1000, 11/1000, 8/1000, and 13.6/1000 person-days in the first, second, third, and end of follow-up weeks, respectively. Pneumonia (adjusted hazard ratio = 3.51 (95% confidence interval = 1.86, 6.61)), hemorrhagic stroke (adjusted hazard ratio = 2.03 (95% confidence interval = 1.03, 3.99)), moderate impairment Glasgow Coma Scale (9–12) (adjusted hazard ratio = 2.16 (95% confidence interval = 1.08, 4.29)), severe impairment Glasgow Coma Scale (3–8) (adjusted hazard ratio = 2.38 (95% confidence interval = 1.01, 5.67)), history of hypertension (adjusted hazard ratio = 2.01 (95% confidence interval = 1.08, 3.74)), and increased intracranial pressure (adjusted hazard ratio = 2.12 (95% confidence interval = 1.10, 4.07)) were statistically significant predictors for in-hospital mortality.

Conclusion:

In-hospital mortality of stroke was relatively high, and the median time to mortality was 8 days. Pneumonia, hemorrhagic stroke, Glasgow Coma Scale, history of hypertension, and increased intracranial pressure were identified predictors.
Conjunctivitis as the important indicator of pediatric granulomatosis with polyangiitis
Authors: Jari Mohsen , Rastinmaram Zahra , Niazi Elahe , Mousavi Zahra
Published: September 2022

Granulomatosis with polyangiitis disease is a rare vasculitis characterized by granulomatous inflammation of respiratory tracts and glomerulonephritis along with vasculitis of other organs. In this study, a 14- year-old boy was referred from ophthalmology clinic to the pediatric rheumatology ward due to drug-resistant conjunctivitis. He had a history of chronic rhinorrhea and nighttime coughing, and he was diagnosed with allergic rhinitis. Complete blood count showed leukocytosis and thrombocytosis, and the estimated sedimentation rate was elevated. Laboratory tests showed hematuria, proteinuria, and highly positive antineutrophil cytoplasmic antibody. Moreover, sinus computed tomography demonstrated pansinusitis, and spiral chest computed tomography showed multiple pulmonary nodules in both his lungs. Finally, based on renal biopsy, the patient was confirmed as a case of granulomatosis with polyangiitis. It is notable that acute or chronic conjunctivitis may be a manifestation of rheumatic diseases.
Alternative Social Media and the Complexities of a More Participatory Culture: A View From Scuttlebutt
Authors: Mannell Kate , Smith Eden T.
Published: September 2022

Recent research has highlighted the emergence of “alternative social media” platforms. Developed by open source communities with non-commercial goals, these platforms can offer more expansive participatory cultures than corporate platforms. However, such platforms also involve new kinds of participatory challenges, such as requiring high technological literacy. This article examines the complexity of enacting participatory cultures by drawing on an ethnographic study of Scuttlebutt, a decentralized social media platform being developed by an open source community. This examination focuses on three key features of participatory culture as enacted on Scuttlebutt: varying modes and sites of participation; reflexivity about who is participating and how; and an evaluation of limits to participation. It also considers the challenges that arise from Scuttlebutt’s approach and how these highlight the profound difficulty of trying to enact fuller models of participatory culture. From these findings, we argue that Scuttlebutt provides an important example of the experimentation that alternative social media platforms are conducting around open, democratic modes of socio-technical organizing, and note that this experimentation raises important questions about how we conceptualize participation and the future of social media.
The impact of COVID-19 on psychosocial wellbeing of nursing and midwifery staff in Denmark: A cross-sectional study
Authors: Rothmann Mette Juel , Holton Sara , Wynter Karen , Rasmussen Bodil , Skjøth Mette Maria
Published: September 2022

Internationally, nurses and midwives played a major role in the care of patients with COVID-19. More qualitative studies now exist, but still little is known about the psychosocial impact. The aim of this study was to assess the psychosocial impact of the COVID-19 pandemic on nurses and midwives in Denmark. A cross-sectional survey completed by nurses and midwives employed at a university hospital in Denmark between May and June 2020 was conducted. Psychological distress was assessed using the Depression, Anxiety and Stress Scale (DASS-21). The study was conducted in accordance with the STROBE guidelines. A total of 1416 (37.9%) nurses and midwives completed the survey, 61% (n = 843) felt at risk of getting COVID-19, and 27% (n = 377) felt more stressed than usual. Overall, nurses and midwives did not experience psychological distress at the beginning of the pandemic. However, exposure to COVID-19 was associated with symptoms of depression, anxiety, and stress.
A Comparison of Percutaneous Kyphoplasty with High-Viscosity and Low-Viscosity Bone Cement for Treatment of Osteoporotic Vertebral Compression Fractures: A Retrospective Study
Authors: Wang Wenhao , Liu Hao , Wu Zhikai , Teng Yun , Huang Yixue , Liu Tao , Yang Huilin
Published: September 2022

Background

Osteoporotic vertebral compression fracture (OVCF) has become a health issue of worldwide concern. Percutaneous kyphoplasty (PKP) is one of the main surgical methods for OVCFs. This study aimed to evaluate and compare the clinical efficacy and safety of PKP with high- and low-viscosity bone cement for OVCFs.

Methods

Totally 62 patients with single-level OVCF were enrolled in this study from December 2018 to April 2021. Among them, 32 cases underwent PKP with high-viscosity bone cement, while 30 cases underwent PKP with low-viscosity bone cement. Visual analog scale (VAS) scores and Oswestry disability index (ODI) scores were used in the pre- and post-operative period to assess patients’ rehabilitation. Compression rates of anterior vertebra height (AVH) and posterior vertebra height (PVH) were analyzed to evaluate the restoration of vertebra height. Leakage rates and locations were recorded to show clinical safety.

Results

VAS and ODI scores both significantly improved in 2 groups at 1 day, 1 month, and 3 months after surgery. Compression rates of AVH and PVH at 1 day and 3 months after PKP were lower than those before surgery. However, there was no significant difference in VAS scores, ODI scores, and compression rates between both groups. However, PKP with high-viscosity bone cement achieved a lower bone cement leakage rate significantly, which showed the safety of high-viscosity bone cement in PKP.

Conclusions

PKP with high- and low-viscosity bone cement both improved the recovery of patients and restored vertebra heights. Notably, PKP with high-viscosity bone cement can achieve favorable clinical outcomes as well as lower bone cement leakage rate.
Treatment of Vancouver Type B Periprosthetic Femoral Fractures Using Cortical Strut Allografts
Authors: Kwon Dae Gyu , Park Jin Seong , Moon Kyoung Ho
Published: September 2022

Introduction

The optimal surgical treatment for Vancouver B2 and B3 fractures has not been determined, and bone defects and delays in fracture healing significantly affect treatment outcomes. Some authors have argued that when a serious bone defect is present, the use of cortical strut allografts for the treatment of type B2 and B3 periprosthetic femoral fractures (PFFs) after hip joint replacement may be beneficial. This study aimed to determine the usefulness of cortical strut allografts based on mid-to long-term clinical radiologic results after surgical treatment of Vancouver B-type PFFs.

Methods

We retrospectively reviewed the outcomes of 48 patients with postoperative PFFs. The mean duration of follow-up was 6.7 years. The 22 patients were treated with cortical strut allograft. Each case was characterized and described in detail, including the length of allograft and the union period, and possible correlations between allograft length and strut-to-host bone union were analyzed. Clinical evaluations included Parker mobility and Harris hip scores. At the final follow-up, we assessed the radiological results using the Beals and Tower’s criteria, stem subsidence, and fracture union time.

Results

All 48 fractures united at an average of 21.5 weeks, and strut-to-host bone union was typically observed within 32 months. No positive correlation was identified between the allograft length and incorporation period. There was one deep infection and four cases of dislocation, but there was no fracture or malunion of the cortical strut allografts. No evidence of femoral loosening was observed in any of the patients.

Conclusion

Cortical strut allografts used to treat type B PFFs showed high rates of bone union and survival. In mid-to long-term follow-up, the cortical strut allograft length did not affect to incorporation time. The author concluded that cortical strut allografts are useful treatment for PFFs regardless subtype classification of the Vancouver type B.
Comparing lexical bundles across three advanced mathematical text types: a corpus-based genre-focused investigation
Authors: Alasmary Abdullah A.
Published: September 2022

Although much research has been conducted on academic multi-word units across a range of academic disciplines, little attention has been given to the distribution of such units in mathematics. Drawing on three parallel corpora of doctoral dissertations, textbook chapters, and research journal articles, this study compares the use of recurrent bundles across three mathematical text types using a combination of corpus methodology and linguistic analysis. The corpus treatment of bundles is then supplemented with an analysis of their structural forms and discourse functions. A total of 291 four-word bundles that recur at least 25 times per million words, and appear in 15% or more of the texts were retrieved and their structural and functional attributes examined. Results indicate that student-produced texts tend to use fewer and less varied lexical bundles than research articles and educational texts. The three text types also show considerable variation in the use of structural forms of recurrent bundles, with the student writing incorporating more phrasal patterns, while expert texts employing clausal constructions. Functionally, the three text types exhibit striking similarities, making greater use of research- and text-oriented bundles but producing a much narrower range of participant-based bundles.
Framing the Games: US Media Coverage of the Beijing 2022 Winter Olympics
Authors: Boykoff Jules
Published: September 2022

The Olympics are a media behemoth. Much media coverage of the Games is straight-up sports fare delivered in the predictable rhythms of victory and defeat. However, with the Beijing 2022 Winter Games, US media outlets offered significant coverage exploring the political and human-rights concerns. This paper identifies and analyzes the predominant frames that US media outlets employed when covering the Beijing Olympics. The empirical data for this study derive from the New York Times, USA Today, the Wall Street Journal, and the Washington Post, the four most-circulated newspapers in the country. The timeframe includes the lead-up to the Games, the actual Olympics, and the aftermath. This systematic content analysis—which examines both hard news and opinion journalism—also engages in indexing analysis: tracking who journalists turn to for insight and comment and how this affects the discourse bandwidth and the emergence of predominant frames.
A Practical Classification System for Acute Cervical Spinal Cord Injury Based on a Three-Phased Modified Delphi Process From the AOSpine Spinal Cord Injury Knowledge Forum
Authors: Hachem Laureen D. , Zhu Mary , Aarabi Bizhan , Davies Benjamin , DiGiorgio Anthony , Evaniew Nathan , Fehlings Michael G. , Ganau Mario , Graves Daniel , Guest James , Ha Yoon , Harrop James , Hofstetter Christopher , Koljonen Paul , Kurpad Shekar , Marco Rex , Martin Allan R , Nagoshi Narihito , Nouri Aria , Rahimi-Movaghar Vafa , Rodrigues-Pinto Ricardo , Wengel Valerie ter , Tetreault Lindsay , Kwon Brian , Wilson Jefferson R.
Published: September 2022

Study Design

A modified Delphi study.

Objective

To assess current practice patterns in the management of cervical spinal cord injury (SCI) and develop a simplified, practical classification system which offers ease of use in the acute setting, incorporates modern diagnostic tools and provides utility in determining treatment strategies for cervical SCI.

Methods

A three-phase modified Delphi procedure was performed between April 2020 and December 2021. During the first phase, members of the AOSpine SCI Knowledge forum proposed variables of importance for classifying and treating cervical SCI. The second phase involved an international survey of spine surgeons gauging practices surrounding the role and timing of surgery for cervical SCI and opinions regarding factors which most influence these practices. For the third phase, information obtained from phases 1 and 2 were used to draft a new classification system.

Results

396 surgeons responded to the survey. Neurological status, spinal stability and cord compression were the most important variables influencing decisions surrounding the role and timing of surgery. The majority (>50%) of respondents preferred to perform surgery within 24 hours post-SCI in clinical scenarios in which there was instability, severe cord compression or severe neurology. Situations in which <50% of respondents were inclined to operate early included: SCI with mild neurological impairments, with cord compression but without instability (with or without medical comorbidities), and SCI without cord compression or instability.

Conclusions

Spinal stability, cord compression and neurological status are the most important variables influencing surgeons’ practices surrounding the surgical management of cervical SCI. Based on these results, a simplified classification system for acute cervical SCI has been proposed.
Injuries to Ice Hockey Referees and Linesmen: A Survey of International Ice Hockey Federation Officials
Authors: Popkin Charles A. , Fortney Thomas A. , Padaki Ajay S. , Rogers Andrew J. , Trofa David P. , Lynch T. Sean , Tuominen Markku , Stuart Michael J.
Published: September 2022

Background:

Ice hockey referees and linesmen are at risk for musculoskeletal injuries because of the lack of protective equipment and contact with players, sticks, pucks, the ice surface and boards.

Purpose:

To quantify and analyze injuries reported by officials of the International Ice Hockey Federation (IIHF).

Study Design:

Descriptive epidemiology study.

Methods:

A 61-question survey tool was designed by an interdisciplinary team to evaluate musculoskeletal injuries experienced by ice hockey officials. This survey was administered to 600 active IIHF referees and linesmen. Only completed survey responses were included in the statistical analysis. Continuous variables were analyzed using unpaired t-tests, while categorical data were assessed utilizing chi-square tests.

Results:

Of the 600 surveys administered, 264 surveys were completed by officials from 45 countries (44% response rate). Of the respondents, 72% were male, and 28% were female, with a mean age of 31.1 ± 5.8 years. Officiating experience averaged 11.4 ± 6.0 years (6.3 ± 4.5 years with the IIHF). A total of 295 injuries were reported by 55% of the officials. Injuries occurred more frequently during games compared with training, and officials who worked year-round had more total injuries than those who took time off ( P = .03). The most common injuries involved the wrist and hand (n = 64 [22%]), head and face (n = 58 [20%]), and the knee (n = 47 [16%]). Wrist and hand trauma included 23 fractures. Knee and shoulder injuries were most likely to require surgery compared with other body areas ( P < .001); 30 officials underwent surgery because of an acute knee injury (10%). Injury prevention activities were effective at reducing injuries ( P = .04).

Conclusion:

Most ice hockey officials experienced musculoskeletal injuries during their career. The risk of trauma to the wrist and hand can possibly be reduced via equipment modifications including protective gloves. A greater emphasis should be placed on injury prevention programs and time away from officiating competitions.
Self-Scheduling Process Efficiency and Utilization of Online Self-Scheduling of Lab Tests: A Retrospective Analysis of Self-Scheduled Appointments for COVID Testing
Authors: North Frederick , Nelson Elissa M. , Majerus Rebecca J. , Thompson Matthew C. , Knutson Aric J. , Crum Brian A.
Published: September 2022

Introduction

The COVID 19 pandemic increased the need for rapid and accurate diagnostic testing for COVID. When testing became available, a systems response was needed to efficiently accommodate the high-volume flow of patients who needed testing. Self-scheduling of COVID testing was developed to help patients safely and efficiently schedule their COVID testing online or with a mobile app.

Methods

We captured the counts of COVID test appointments, time patients spent in scheduling COVID test appointments, appointment lead times, and no-shows for COVID test appointments. For 17 months of self-scheduling, we retrospectively compared self-scheduling with the concurrent staff scheduling of COVID tests.

Results

From November 2020 through March 2022 there were 619 104 scheduled appointments for COVID testing with 22% (136 252) being self-scheduled. For asymptomatic self-scheduled COVID tests, accounting for 10.3% (63 605/619 104) of total COVID tests scheduled, median time to self-schedule was 3.1 min, interquartile range (IQR) [2.4,4.7]. For symptomatic self-schedulers accounting for 11.7% (72 647/619 104) of total COVID tests scheduled, the median time to self-triage and self-schedule was 5.8 min, IQR[4.3,8.9]. Self-scheduled COVID appointments increased to 44% (42 387/97 086) of the total COVID appointments during the peak month of January 2022. Median appointment lead time for symptomatic self-scheduled COVID test appointments was 6.6 h compared to 2.9 h ( P < .0001) for symptomatic staff scheduled appointments. However, adjusting for the 24% (32 194/135 252) that self-scheduled during hours when testing was unavailable, the median appointment lead time for symptomatic self-scheduled patients dropped to 3.6 h. No-shows were 2.5% for self-scheduled appointments compared to 3.0% no-shows that were staff scheduled (odds ratio 0.83, P < .0001).

Conclusion

COVID testing was self-scheduled for a large percent of scheduled COVID tests, taking patients only a few minutes to complete. Self-scheduling use increased over time, associated with a decreasing use of staff scheduled appointments and lower no-shows.
A mixed-mode data collection approach for building inventory development: Application to school buildings in Central Sulawesi, Indonesia
Authors: Opabola Eyitayo A , Galasso Carmine , Rossetto Tiziana , Nurdin Sukiman , Idris Yunita , Aljawhari Karim , Rusydy Ibnu
Published: September 2022

Urban disaster risk management and reduction requires the development and periodic updating of regional building inventories. However, the development of such inventories can be very cost-intensive and time-consuming, making this a challenging task, particularly for low- and middle-income countries. This article discusses a mixed-mode building inventory data collection framework using a rapid and cost-effective remote survey technique that can be deployed in various geographic contexts. A key component of the proposed approach is an inter-rater reliability analysis of data collected from traditional sidewalk surveys and remote surveys for a small subset of buildings in the considered building portfolio, which is used to assess the suitability of the remote survey for the location(s) considered. The framework is demonstrated by developing a regional database of school buildings in the Central Sulawesi region of Indonesia. The database consists of 2536 school buildings from 454 elementary and high schools in the Palu, Sigi, and Donggala regions, susceptible to earthquake-induced ground shaking, tsunami, liquefaction, and landslides. The developed database can be used in pre-event/long-term risk analysis and management, post-event/near-real-time loss estimation, and regional-level decision-making on school assets and related policies. The database has been made available for public use and can be readily harmonized with similar databases for other regions.
Wodegongjieite, ideally KCa3(Al7Si9)O32, a new sheet silicate isostructural with the feldspar polymorph kokchetavite, KAlSi3O8
Authors: Mugnaioli Enrico , Xiong Fahui , Xu Xiangzhen , Gemmi Mauro , Wirth Richard , Yang Jingsui , Grew Edward S.
Published: September 2022

Wodegongjieite occurs in the Cr-11 chromitite orebody of the Luobusa ophiolite in the Kangjinla district, Tibet, China. It is found in two inclusions in corundum: (1) as a partial overgrowth (holotype) up to 1.5 μm thick around a spheroid 20 μm across of wenjiite (Ti10(Si,P,□)7), kangjinlaite (Ti11(Si,P)10), zhiqinite (TiSi2) and badengzhuite (TiP), and (2) as pools up to 0.25 μm wide filling interstices between wenjiite, jingsuiite (TiB2), osbornite–khamrabaevite (Ti[N,C]) and corundum. Energy dispersive analyses gave Al2O334.09, SiO249.11, K2O 2.56, CaO 11.71, SrO 2.53, total 100.0 wt.%, corresponding to K0.58Sr0.26Ca2.25Al7.20Si8.80O31.20, ideally KCa3(Al7Si9)O32, for Si + Al = 16 cations.

Single-crystal studies were carried out with three-dimensional electron diffraction providing data for anab initiostructure solution in the hexagonal space groupP6/mcc(#192) witha= 10.2(2) Å,c= 14.9(3) Å,V= 1340(50) Å3andZ= 2. Density (calc.) = 2.694 g⋅cm–3. The refinement, which assumes complete Si–Al disorder, gives averageT1–O andT2–O bond lengths both as 1.65 Å. It was not practical to use unconstrained refinement for the occupancies of the large cation sites 6fand 2a. Theab initiomodel shows clearly that the two cation sites have different sizes and coordination. Consequently, we imposed the condition (1) that all the K occupies the 2asite as the average K–O bond length of 3.07 Å is close to the average K–O bond lengths reported in kokchetavite and (2) that all the Ca occupies the 6fsite as the average Ca–O bond length of 2.60 Å (2.36 Å and 2.84 Å for Ca–O1 and Ca–O3, respectively) is reasonable for Ca–O. Assuming that all K and all Ca are located at the 2asite and 6fsite, respectively, Sr occupancies of these sites could be refined. Thermal parameters are positive and in a reasonable range. The structure is a sheet silicate isostructural with the K-feldspar polymorph kokchetavite, with two crystallographically distinct sites for K, but not with the topologically identical anorthite polymorph dmisteinbergite (CaAl2Si2O8) with only a single site for Ca. Substitution of K by Ca at the 6fsite is associated with marked rotation of the Si,Al tetrahedra and a collapse of the structure to accommodate the smaller Ca ion.

The spheroid of intermetallic phases is believed to have formed from the interaction of mantle-derived CH4+ H2fluids with basaltic magmas at depths of ~30–100 km, resulting in precipitation of corundum that entrapped intermetallic melts. Associated immiscible silicate melt of granodioritic composition crystallised metastably to wodegongjieite instead of a mixture of anorthite and K-feldspar.
Screening high-risk population of persistent postpartum hypertension in women with preeclampsia using latent class cluster analysis
Authors: Li Yuan-Yuan , Cao Jing , Li Jia-Lei , Zhu Jun-Yan , Li Yong-Mei , Wang De-Ping , Liu Hong , Yang Hai-Lan , He Yin-Fang , Hu Li-Yan , Zhao Rui , Zheng Chu , Zhang Yan-Bo , Cao Ji-Min
Published: September 2022

Background

A significant proportion of women with preeclampsia (PE) exhibit persistent postpartum hypertension (PHTN) at 3 months postpartum associated with cardiovascular morbidity. This study aimed to screen patients with PE to identify the high-risk population with persistent PHTN.

Methods

This retrospective cohort study enrolled 1,000 PE patients with complete parturient and postpartum blood pressure (BP) profiles at 3 months postpartum. The enrolled patients exhibited new-onset hypertension after 20 weeks of pregnancy, while those with PE superimposed upon chronic hypertension were excluded. Latent class cluster analysis (LCCA), a method of unsupervised learning in machine learning, was performed to ascertain maternal exposure clusters from eight variables and 35 subordinate risk factors. Logistic regression was applied to calculate odds ratios (OR) indicating the association between clusters and PHTN.

Results

The 1,000 participants were classified into three exposure clusters (subpopulations with similar characteristics) according to persistent PHTN development: high-risk cluster (31.2%), medium-risk cluster (36.8%), and low-risk cluster (32.0%). Among the 1,000 PE patients, a total of 134 (13.4%) were diagnosed with persistent PHTN, while the percentages of persistent PHTN were24.68%, 10.05%, and 6.25% in the high-, medium-, and low-risk clusters, respectively. Persistent PHTN in the high-risk cluster was nearly five times higher (OR, 4.915; 95% confidence interval (CI), 2.92–8.27) and three times (OR, 2.931; 95% CI, 1.91–4.49) than in the low- and medium-risk clusters, respectively. Persistent PHTN did not differ between the medium- and low-risk clusters. Subjects in the high-risk cluster were older and showed higher BP, poorer prenatal organ function, more adverse pregnancy events, and greater medication requirement than the other two groups.

Conclusion

Patients with PE can be classified into high-, medium-, and low-risk clusters according to persistent PHTN severity; each cluster has cognizable clinical features. This study’s findings stress the importance of controlling persistent PHTN to prevent future cardiovascular disease.
Healthcare practitioner perceptions on barriers impacting cannabis prescribing practices
Authors: Hachem Yasmina , Abdallah Sara J. , Rueda Sergio , Wiese Jessica L. , Mehra Kamna , Rup Jennifer , Cowan Juthaporn , Vigano Antonio , Costiniuk Cecilia T.
Published: September 2022

Background

Canadians seeking medical cannabis (MC) may encounter difficulties in finding a healthcare provider (HCP) who authorizes their access to it. Barriers that HCPs face in authorizing MC are unclear. The objectives of this study were to evaluate HCP opinions, knowledge, comfort, and practice in MC prescribing and counseling on recreational cannabis use, and whether the COVID-19 pandemic affected MC prescribing practices.

Methods

Eligible participants included HCPs (e.g., attending physicians, nurses, pharmacists) in Canada. A questionnaire evaluating their knowledge, comfort, and practice in medical and recreational cannabis was designed based on instruments developed in previous studies. Between April 13th-December 13th 2021, ninety-one healthcare associations were asked to distribute the survey to their members, and an advertisement was placed in the online Canadian Medical Association Journal. Descriptive statistics were used to analyze the results.

Results

Twenty-four organizations agreed to disseminate the survey and 70 individuals completed it. Of respondents, 71% were attending physicians or medical residents, while the remainder were nurses, pharmacists or other HCPs. Almost none (6%) received training in MC in professional school but 60% did receive other training (e.g., workshops, conferences). Over half (57%) received more questions regarding MC since recreational cannabis was legalized, and 82% reported having patients who use MC. However, 56% felt uncomfortable or ambivalent regarding their knowledge of MC, and 27% were unfamiliar with the requirements for obtaining MC in Canada. The most common symptoms for recommending MC were pain and nausea, whereas the most common conditions for recommending it were cancer and intractable pain. The strongest barrier to authorizing MC was uncertainty in safe and effective dosage and routes of administration. The strongest barrier to recommending or authorizing MC was the lack of research evidence demonstrating its safety and efficacy. During the pandemic, many respondents reported that a greater number of their patients used cannabis to relieve anxiety and depression.

Conclusions

Our results suggest that HCPs across Canada who responded to our survey are unfamiliar with topics related to MC. The strongest barriers appear to be lack of clinical research, and uncertainty in safe and effective MC administration. Increasing research, training, and knowledge may help HCPs feel more equipped to make informed treatment/prescribing decisions, which may help to improve access to MC.
Gut health of horses: effects of high fibre vs high starch diet on histological and morphometrical parameters
Authors: Colombino Elena , Raspa Federica , Perotti Maria , Bergero Domenico , Vervuert Ingrid , Valle Emanuela , Capucchio Maria Teresa
Published: September 2022

Background

The conventional feeding management of horses is still characterized by high starch and low fibre diets, which can negatively affect horse’s gastrointestinal health. Thus, the aim of this study was to compare the effects of a high-starch (HS) vs. a high-fibre (HF) diet on gut health in horses. A total of 19 Bardigiano horses destined for slaughter and aged 14.3 ± 0.7 months were randomly allotted to two dietary groups: HS (5 fillies and 4 colts,) and HF group (7 fillies and 3 colts). They received the same first-cut meadow hay but different complementary feeds for 72 days: HS group was fed 8 kg/animal/day of a starch-rich complementary feed while HF group was fed 3.5 kg/animal/day of a fibre‐rich complementary feed. At slaughter, stomachs were separated and washed for the evaluation of the glandular and squamous regions. Also, duodenum, jejunum, ileum, apex of the caecum, sternal flexure, pelvic flexure, right dorsal colon, rectum and liver were excised and submitted to histomorphometrical evaluation.

Results

The glandular region of HS group presented more severe gastric mucosa lesions compared to the HF group (P = 0.006). Moreover, a statistical tendency (P = 0.060) was found for the squamous region, presenting a higher score in HS than HF diet. Regarding morphometry, in jejunum villus height to crypt depth (Cd) ratio was influenced by sex, being greater in males than in females (P = 0.037) while in ileum Cd depended on interaction between sex and diet, being greater in males of HS group (P = 0.029). Moreover, in the duodenum and right dorsal colon the severity of the inflammation depended on sex (P = 0.024 and 0.050), being greater in females than in males. On the contrary, in the jejunum and in the pelvic flexure, inflammation was influenced by diet, being more severe in HS than in HF group (P = 0.024 and 0.052).

Conclusions

These results suggested that HS diet provoked more severe mucosa lesions in the glandular region of the stomach and a higher inflammation both in the jejunum and pelvic flexure. The present study can represent a starting point for further investigations on gut health in horses.
Peripheral blood transcriptomic clusters uncovered immune phenotypes of asthma
Authors: Lee Hyun Woo , Baek Min-gyung , Choi Sungmi , Ahn Yoon Hae , Bang Ji-Young , Sohn Kyoung-Hee , Kang Min-Gyu , Jung Jae-Woo , Choi Jeong-Hee , Cho Sang-Heon , Yi Hana , Kang Hye-Ryun
Published: September 2022

Background

Transcriptomic analysis has been used to elucidate the complex pathogenesis of heterogeneous disease and may also contribute to identify potential therapeutic targets by delineating the hub genes. This study aimed to investigate whether blood transcriptomic clustering can distinguish clinical and immune phenotypes of asthmatics, and microbiome in asthmatics.

Methods

Transcriptomic expression of peripheral blood mononuclear cells (PBMCs) from 47 asthmatics and 21 non-asthmatics was measured using RNA sequencing. A hierarchical clustering algorithm was used to classify asthmatics. Differentially expressed genes, clinical phenotypes, immune phenotypes, and microbiome of each transcriptomic cluster were assessed.

Results

In asthmatics, three distinct transcriptomic clusters with numerously different transcriptomic expressions were identified. The proportion of severe asthmatics was highest in cluster 3 as 73.3%, followed by cluster 2 (45.5%) and cluster 1 (28.6%). While cluster 1 represented clinically non-severe T2 asthma, cluster 3 tended to include severe non-T2 asthma. Cluster 2 had features of both T2 and non-T2 asthmatics characterized by the highest serum IgE level and neutrophil-dominant sputum cell population. Compared to non-asthmatics, cluster 1 showed higher CCL23 and IL1RL1 expression while the expression of TREML4 was suppressed in cluster 3. CTSD and ALDH2 showed a significant positive linear relationship across three clusters in the order of cluster 1 to 3. No significant differences in the diversities of lung and gut microbiomes were observed among transcriptomic clusters of asthmatics and non-asthmatics. However, our study has limitations in that small sample size data were analyzed with unmeasured confounding factors and causal relationships or function pathways were not verified.

Conclusions

Genetic clustering based on the blood transcriptome may provide novel immunological insight, which can be biomarkers of asthma immune phenotypes.

Trial registration Retrospectively registered
Pulmonary function and chest computed tomography abnormalities 6–12 months after recovery from COVID-19: a systematic review and meta-analysis
Authors: Lee Jong Hyuk , Yim Jae-Joon , Park Jimyung
Published: September 2022

Background

Some coronavirus disease 2019 (COVID-19) survivors experience prolonged and varying symptoms, a condition termed post-acute COVID-19 syndrome (PACS). However, the prevalence of chronic pulmonary sequelae of PACS during long-term follow-up remains unclear. Several studies have examined this issue and reported heterogeneous results.

Methods

We conducted a systematic review and meta-analysis using a random-effects model to estimate the pooled prevalence of the pulmonary sequelae of COVID-19, as demonstrated by pulmonary function testing (PFT) and chest computed tomography (CT) performed at least 6 months after initial infection. PubMed, Embase, and Cochrane Library databases were searched from January 1, 2020 to December 31, 2021 to identify related studies. We investigated whether the prevalence of pulmonary sequelae decreased over time and attempted to identify the factors associated with their development by performing multiple subgroup and meta-regression analyses.

Results

Of the 18,062 studies identified, 30 met our eligibility criteria. Among these studies, 25 and 22 had follow-up PFT and chest CT data, respectively. The follow-up durations were approximately 6 and 12 months in 18 and 12 studies, respectively. Impaired diffusion capacity was the most common abnormality on PFT (pooled prevalence 35%, 95% confidence interval [CI] 30–41%) with a prevalence of 39% (95% CI 34–45%) and 31% (95% CI 21–40%) in the 6-month and 12-month follow-up studies, respectively (P = 0.115). Restrictive pulmonary dysfunction evident as reduced forced vital capacity was less frequent (pooled prevalence 8%, 95% CI 6–11%); however, its prevalence was lower in the 12-month follow-up studies than in the 6-month follow-up studies (5% [95% CI 3–7%] vs. 13% [95% CI 8–19%], P = 0.006). On follow-up chest CT, the pooled prevalence of persistent ground-glass opacities and pulmonary fibrosis was 34% (95% CI 24–44%) and 32% (95% CI 23–40%), respectively, and the prevalence did not decrease over time. As every meta-analysis showed significant between-study heterogeneity, subgroup and meta-regression analyses were performed to identify potential effect modifiers; the severity of index infection was associated with the prevalence of impaired diffusion capacity and pulmonary fibrosis.

Conclusions

A substantial number of COVID-19 survivors displayed pulmonary sequelae as part of PACS. Except for restrictive pulmonary dysfunction, the prevalence of these sequelae did not decrease until 1 year after initial infection. Considering the association between the severity of acute COVID-19 and risk of pulmonary sequelae, patients who recover from severe COVID-19 require close respiratory follow-up.

Systematic review registration number PROSPERO CRD42021234357
Integrated lipidomics and network pharmacology analysis to reveal the mechanisms of berberine in the treatment of hyperlipidemia
Authors: Chen Yuting , Li Kaipeng , Zhao Han , Hao Zhangsen , Yang Yuxin , Gao Mingming , Zhao Ding
Published: September 2022

Background

Berberine (BBR), an isoquinoline alkaloid isolated from Rhizoma Coptis, is widely used in the treatment of hyperlipidemia (HLP) in China. At present, the efficacy of BBR against HLP is relatively clear, but there are few researches on its mechanism. The purpose of this study was to evaluate the potentially beneficial role of BBR in HLP hamster models, as well as investigate its possible mechanisms and potential lipid biomarkers in combination with network pharmacology.

Methods

HLP hamster model was induced by high-fat diet. Hematoxylin—eosin (HE) staining was used to determine the degree of hepatic pathological injury. Liquid chromatography-mass spectrometry was used to analyze lipid metabolism profiles of liver samples, and multiple statistical analysis methods were used to screen and identify lipid biomarkers. The possible molecular mechanism was unraveled by network pharmacology.

Results

The results showed that 13 metabolites, including CE (16:1), HexCer (D18:1/19:0) and LPC (O-22:0) were biomarkers of BBR regulation. CHPT1, PLA2G4A, LCAT and UGCG were predicted as the lipid-linked targets of BBR against HLP, whilst glycerophospholipid and sphingolipid metabolism were the key pathways of BBR against HLP.

Conclusions

In summary, this study provides new insights into the protective mechanism of BBR against HLP through network pharmacology and lipidomic approaches.
Mainstream genetic testing for women with ovarian cancer provides a solid basis for patients to make a well-informed decision about genetic testing
Authors: Bokkers Kyra , Bleiker Eveline M. A. , Hoogendam Jacob P. , Velthuizen Mary E. , Schreuder Henk W. R. , Gerestein Cornelis G. , Lange Joost G. , Louwers Jacqueline A. , Koudijs Marco J. , Ausems Margreet G. E. M. , Zweemer Ronald P.
Published: September 2022

Background

There is a growing need for genetic testing of women with epithelial ovarian cancer. Mainstream genetic testing provides an alternative care pathway in which non-genetic healthcare professionals offer pre-test counseling themselves. We aimed to explore the impact of mainstream genetic testing on patients’ experiences, turnaround times and adherence of non-genetic healthcare professionals to the mainstream genetic testing protocol.

Methods

Patients receiving pre-test counseling at the gynecology departments between April 2018 and April 2020 were eligible to participate in our intervention group. Patients receiving pre-test counseling at the genetics department between January 2017 and April 2020 were eligible to participate in our control group. We evaluated patients’ experiences with questionnaires, consisting of questions regarding knowledge, satisfaction and psychosocial outcomes. Patients in the intervention group were sent two questionnaires: one after pre-test counseling and one after receiving their DNA test result. Patients in our control group were sent one questionnaire after receiving their test result. In addition, we collected data regarding turnaround times and adherence of non-genetic healthcare professionals to the mainstream genetic testing protocol.

Results

Participation was 79% in our intervention group (105 out of 133 patients) and 60% in our control group (91 out of 152 patients). Knowledge regarding genetics, decisional conflict, depression, anxiety, and distress were comparable in the two groups. In the intervention group, the risk of breast cancer in patients carrying a pathogenic germline variant was discussed less often (49% versus 74% in control group, p ≤ 0.05), and the mean score of regret about the decision to have genetic testing was higher than in the control group (mean 12.9 in the intervention group versus 9.7 in the control group, p ≤ 0.05), although below the clinically relevant threshold of 25. A consent form for the DNA test and a checklist to assess family history were present for ≥ 95% of patients in the intervention group.

Conclusion

Mainstream genetic testing is an acceptable approach to meet the increase in genetic testing among women with epithelial ovarian cancer.
The role of nutrition rehabilitation in the recovery of survivors of critical illness: underrecognized and underappreciated
Authors: Moisey Lesley L. , Merriweather Judith L. , Drover John W.
Published: September 2022

Many survivors of critical illness face significant physical and psychological disability following discharge from the intensive care unit (ICU). They are often malnourished, a condition associated with poor outcomes, and nutrition remains problematic particularly in the early phases of ICU recovery. Yet nutrition rehabilitation, the process of restoring or optimizing nutritional status following illness, is seldom prioritized, possibly because it is an underrecognized and underappreciated area in critical care rehabilitation and research. To date, 16 original studies have been published where one of the objectives includes measurement of indices relating to nutritional status (e.g., nutrition intake or factors impacting nutrition intake) in ICU survivors. The primary aim of this narrative review is to provide a comprehensive summary of key themes arising from these studies which form the basis of our current understanding of nutritional recovery and rehabilitation in ICU survivors. ICU survivors face a multitude of barriers in achieving optimal nutrition that are of physiological (e.g., poor appetite and early satiety), functional (e.g., dysphagia, reduced ability to feed independently), and psychological (e.g., low mood, body dysmorphia) origins. Organizational-related barriers such as inappropriate feeding times and meal interruptions frequently impact an ICU survivor’s ability to eat. Healthcare providers working on wards frequently lack knowledge of the specific needs of recovering critically ill patients which can negatively impact post-ICU nutrition care. Unsurprisingly, nutrition intake is largely inadequate following ICU discharge, with the largest deficits occurring in those who have had enteral nutrition prematurely discontinued and rely on an oral diet as their only source of nutrition. With consideration to themes arising from this review, pragmatic strategies to improve nutrition rehabilitation are explored and directions for future research in the field of post-ICU nutrition recovery and rehabilitation are discussed. Given the interplay between nutrition and physical and psychological health, it is imperative that enhancing the nutritional status of an ICU survivor is considered when developing multidisciplinary rehabilitation strategies. It must also be recognized that dietitians are experts in the field of nutrition and should be included in stakeholder meetings that aim to enhance ICU rehabilitation strategies and improve outcomes for survivors of critical illness.