bluuebunny/crossref_metadata_2025 huggingface dataset:
STUDY OF THE QUALITY OF LIFE AND COSTS OF PATIENTS ON THE WAITING LIST AGAINST PATIENTS UNDERTAKEN FOR BARIATRIC SURGERY
Authors: López Negrete Cueto E , García Santos G , Llosa Pérez J , Carrasco Aguilera B , Díaz Vico T , Moreno Gijón M , Rodicio Miravalles J L , Sanz Álvarez L
Published: May 2021

INTRODUCTION

Bariatric surgery is the only effective long-term treatment for patients with morbid obesity, being the deterioration of the quality of life of these patients one of the main reasons for surgery. In this work, we prospectively analyze the impact of health-related quality of life (HRQoL) and comorbidities among patients who underwent bariatric surgery versus those on the waiting list.

MATERIAL AND METHODS

Between January and December 2017 139 patients (70 operated on and 69 on waiting list) were included in the study, with a 2-year follow-up. Quality of life was measured using the SF-12v2 and IWQoL-Lite questionnaires. Sociodemographic, clinical, and surgical variables were collected. The cost was evaluated through analytical accounting of Diagnosis-Related Groups.

RESULTS

12 and 24 months follow-up showed statistically significant improvement in all areas of the HRQoL in the surgical group (p < 0.001). Likewise, this group showed a reduction in comorbidities and healthcare needs. On the other side, those patients on the waiting list showed a deterioration in most of HRQL parameters. The surgical cost is estimated at 3.558€ per patient.

CONCLUSIONS

Bariatric surgery significantly improves both quality of life and patients’ comorbidities. This, along with the fact that the surgical cost of 3.558€ pays for itself in just two years, could justify a greater investment in these types of procedures as a suitable healthcare strategy.
RELATIONSHIP BETWEEN SURGEON'S PHYSIOLOGICAL AND KINEMATIC PARAMETERS AND THE QUALITY OF SURGICAL PERFORMANCE AND WORKLOAD IN LAPAROSCOPIC TRAINING
Authors: Sánchez-Margallo J A , Castillo Rabazo J , Durán Rey D , López-Agudelo I , González-Portillo M R , Gloor P A , Sánchez-Margallo F M
Published: May 2021

INTRODUCTION

This study presents the first steps and results towards the development of a system for predicting the quality of surgical performance and workload in laparoscopic training.

MATERIAL AND METHODS

Surgeons wore a smartwatch which recorded their heart rate and hand motion during each laparoscopic procedure. Data was then correlated with both the Surgery Task Load Index (SURG-TLX) subjective questionnaire and the Global Operational Assessment of Laparoscopic Skills (GOALS) objective evaluation tool. Statistical analysis was conducted in order to study the relationship between parameters and to compare the results according to the surgeons’ level of experience.

RESULTS

Nine laparoscopic surgeons participated in this study, five gynecologists and four digestive surgeons. Gynecological surgeons showed a positive correlation between their level of experience, heart rate, hand motion, and GOALS score, except for bimanual dexterity. The reduction in the variability of hand accelerations led to improved tissue handling. Digestive surgeons showed a negative correlation between their level of experience and the reported temporal demand and complexity of the procedure. Novice digestive surgeons reported increased workload during surgery, mainly in mental, physical, and temporal workload. In both surgical specialties, it was observed that reduction in surgical workload was associated with improved GOALS score.

CONCLUSIONS

Preliminary results showed that bimanual dexterity is independent of the experience of gynecological surgeons. During laparoscopic surgical procedures, reduced variability in hand accelerations leads to better tissue manipulation. In addition, in gynecological and upper gastrointestinal procedures, reduced surgical workload is associated with improved surgical performance.
PREDICTIVE FACTORS OF INCISIONAL HERNIA AFTER NEPHRECTOMY
Authors: Martínez Izquierdo G , Arnaiz Pérez A R , Escolano Fernández E , Merayo Álvarez M , Carrasco Aguilera B , Ibero Casadiego P , Rodicio Miravalles J L , Molina Escudero R
Published: May 2021

INTRODUCTION

Kidney diseases’ surgical approach is multiple, tending to reduce postoperative complications such as incisional hernia, a complication with an incidence around 5-15% and which usually appears after the first year of surgery, being this the possible trigger of serious pathologies that make essential the need to identify predictive factors of its appearance.

MATERIAL AND METHODS

A retrospective observational study was carried out in 269 patients undergoing nephrectomy (partial or radical) or nephroureterectomy between 2004 and 2018, with the aim of identifying possible predictive factors of incisional hernia after these surgeries. Preoperative (epidemiological and comorbidities), intraoperative (type of surgery, approach and closure, duration) and postoperative data (different possible complications) were taken into account. A univariate and multivariate analysis were performed, using Chi-square test and logistic regression, respectively.

RESULTS

The median follow-up time was 52.2 months (SD = 39.5), time in which 22 patients had an incisional hernia (8.2%), showing this association with preoperative and postoperative variables. As preoperative data COPD, obesity, ASA and a history of previous laparotomy were related in the univariate analysis, while only obesity was associated in the multivariate analysis (p = 0.003); among postoperative items surgical wound infection, postoperative pulmonary complication, seroma and the need for transfusion and reoperation showed association in the univariate analysis, but only surgical wound infection was the one confirmed in the multivariate analysis (p = 0.049).

CONCLUSIONS

Obesity and surgical wound infection were proved to be the main predictive factors for the appearance of incisional hernia after nephrectomy.
COST-EFFECTIVENESS OF THE APPLICATION OF BOTULINUM TOXIN VERSUS BIOFEEDBACK AS TREATMENT IN PATIENTS WITH ANISMUS
Authors: Gómez Torres G A , Canales Aguirre A A , De la Cerda Trujillo L F , Herrera Rodríguez G L , Maciel Gutiérrez V M , Valenzuela Pérez J A , Hernández García F S
Published: May 2021

INTRODUCTION

Anismus is a pathology that is responsible for up to 50% of constipation cases, there are mainly 2 treatments: biofeedback and the use of botulinum toxin, with similar results. Does the application of botulinum toxin have a better cost-effectiveness index compared to biofeedback as a treatment in patients with anismus?

The objective is to establish whether the application of botulinum toxin as a treatment in patients with anismus represents a better cost-effectiveness index compared to biofeedback.

MATERIAL AND METHODS

A randomized prospective cost-effectiveness trial was conducted evaluating the effectiveness of biofeedback treatment compared to the application of botulinum toxin in patients with anismus. Patients were followed up at month 1, 3, and 6 after management.

RESULTS

A total of 9 patients were included, 4 in the botulinum toxin group and 5 in the biofeedback group. The efficacy of botulinum toxin was 75% at month 1 and 3 and 50% at month 6. The efficacy of biofeedback remained at 80% at 6 months. The expense for biofeedback treatment was $ 17,458.32 MXN compared to $ 7,846.08 MXN for botulinum toxin.

CONCLUSION

A decrease in the average cost of $ 9,612.24 MXN was obtained in favor of the use of botulinum toxin for the treatment of anismus.
MIXED REALITY APPLICATION FOR SURGICAL PLANNING IN VIDEO-ASSISTED PULMONARY LOBECTOMY
Authors: Sánchez-Margallo J A , Fernández Anzules R A , Plaza de Miguel C , Sánchez-Margallo F M
Published: May 2021

INTRODUCTION

The adoption of surgical planning systems could greatly simplify the performance of video-assisted thoracoscopic surgery and improve its safety.

MATERIAL AND METHODS

A new application for surgical planning in video-assisted thoracoscopic surgery was developed, making use of the HoloLens (v1) mixed reality device. The information was displayed in the form of interactive holograms, by means of gestural, visual or voice control. The application was validated during a video-assisted right upper lobectomy surgery, including systematic lymphadenectomy for squamous cell carcinoma in the right upper lobe.

RESULTS

No complications were shown during surgery. Prior to surgery, the system allowed the surgeon to access in real time the patient's medical history, review the computed tomography study, and visualize and manipulate a 3D model of the lung with its respective vascular and bronchial elements, as well as the tumor to be removed. The surgeon’s vision using the device was easily shared with the rest of the surgical team. The surgeon placed the holographic models with the surgical planning information behind the field of view of the operating table for possible reference during the procedure. The weight and heat generated by the device were considered ergonomic aspects to be improved.

CONCLUSIONS

The system provides real-time access to important patient information for surgical planning during video-assisted lobectomy surgery, without losing the sterility of the surgical act. The surgeon's view can be shared for communication and learning purposes, as well as recorded for later review of surgical complications.
GALLBLADDER ADENOCARCINOMA. CURRENT STATUS OF THE NEW FORECAST FACTORS AND THEIR IMPACT ON SURVIVAL. CASES AND CONTROLS STUDY
Authors: Camarero Rodríguez E , García-Botella A , Pizarro M J , Avellana R , de la Serna S , Pérez-Aguirre E , Díez-Valladares L , Torres A J
Published: May 2021

INTRODUCTION

We present the results after surgery for gallbladder adenocarcinoma in our centre. The Total Risk Score (TRS) is a useful index to predict the amount of residual disease that is observed in reinterventions with curative intent that are carried out in these tumors.

MATERIAL AND METHODS

Retrospective study of cases and controls. Review of 2019 patients who underwent cholecystectomy from 2012 to 2019 in a Hepatobiliopancreatic Surgery Unit. Exposure of a total of 75 patients for the study (15 cases versus 60 controls, 1: 4 ratio).

RESULTS

15 patients were diagnosed with gallbladder adenocarcinoma, 10 of which were incidental (66.7%).

Oncological resection was R0 in 93.33% of the cases and R1 in the remaining 6.67%.

TRS was low in 9% of cases, moderate in 45.45%, and high in another 45.45%.

The rate of reoperation with oncological intention is 60% in our series (9 patients), and residual disease was observed in 4 of them (44.4%). In 3 of the patients, an exploratory laparotomy was performed without associated resection due to the extent of the disease (33.3%). The percentage of R0 after reoperation was 77.7%. The median survival after surgery is 38.67 months (95% confidence interval (29.73 - 67.34).

CONCLUSIONS

The study of the pathological tissue results for the performance of revision surgery could guide the oncological attitude in the future if its validity is confirmed with more multicentre studies.
SURGICAL DIFFICULTY AND PELVIMETRY IN RECTAL CANCER. IS IT USEFUL?
Authors: Fernández Hevia M , García Alonso L , Alonso Batanero E , Ramos C , Suárez Sánchez A , Rodríguez García J I , García Flórez L J , Granero Trancón J E
Published: May 2021

INTRODUCTION

Different difficulty factors have been described in rectal cancer surgery as BMI, male gender, tumor height, neoadjuvant treatment or narrow pelvis. Pelvimetry is not a routine preoperative study in rectal cancer.

MATERIAL AND METHODS

Retrospective observational study in 228 patients. Operative time was evaluated as a difficult surgical parameter and its relationship with pelvimetric variables was studied.

RESULTS

Our average operative time was 255,4 ± 65,8 minutes. Significant results were found with regard to patients’ BMI, distance to the anal margin, type of approach, need for neoadjuvant therapy and the following pelvimetry parameters. In the univariate analysis, the parameters were pubis height, pelvis depth, angle of the right levator in coronal plane, the ratio of the pelvis inlet diameter with respect to its depth, the ratio of the angle promontory-S3-coccyx with respect to the angle S3-coccyx-lower border of the pubis and the ratio of the area of the mesorectum to the area of the pelvis in the sagittal plane. In multivariate analysis, the variables that most influenced the surgical time were the type of approach, the BMI, the location of the tumor, the intraoperative complications and the ratio of the mesorectum area to the area of the pelvis in the sagittal plane.

CONCLUSION

Pelvimetry is a simple tool that completes preoperative studies and also obtains better surgical planning in complex pelvises.
INFLAMMATORY MARKERS IN THE DIAGNOSIS OF COMPLICATED ACUTE APPENDICITIS
Authors: Michi Campos J , Merayo Álvarez M , García González L , Carrasco Aguilera B , Rodicio Miravalles J L , Díaz Vico T , Sanz Álvarez L , Granero Trancón J E
Published: May 2021

INTRODUCTION

Appendicitis constitutes one of the most frequent surgical emergencies. New inflammatory markers such as the neutrophil-lymphocyte ratio (NLR) have recently emerged, which are added to others such as leukocyte count and C-reactive protein (CRP), and whose role in the diagnosis of appendicitis remains unclear.

MATERIAL AND METHODS

We conducted an observational, descriptive, longitudinal and retrospective study of 484 adults appendectomized between April 2017 and May 2019 in a tertiary hospital. Sociodemographic, clinical, laboratory, imaging and surgical variables were collected.

RESULTS

32.2% of appendicitis were complicated. All patients had a complete blood count and basic biochemistry (98.5% with CRP). Complicated appendicitis had a mean of 14538 leukocytes, 12.4 CRP and 8.7 NLR, and uncomplicated appendicitis had 14667 leukocytes, 5 CRP and 10.7 NLR. When analyzing the relationship of inflammatory markers with the existence or not of complicated appendicitis, CRP yielded an area under the curve (AUC) of 73.1% (95% CI: 0.684-0.779, p < 0.01), while leukocytes and NLR had 52.6% and 55.9%. The CRP cut-off point was determined to be 3.5 which presented a higher discriminative power to predict complicated appendicitis, with a sensitivity and specificity of 70.1% and 65.3% respectively.

CONCLUSIONS

Of the inflammatory markers studied, only CRP proved to be a valid parameter to help differentiate preoperatively those appendicitis uncomplicated from complicated appendicitis.
IMPLEMENTATION OF THE EVALUATION TO IMPROVE RESIDENT SURGICAL SKILLS
Authors: Cifrián Canales I , Rodríguez García J I , Suárez Sánchez A , Merayo Álvarez M , Alonso Batanero E , García Santos G , García Flórez L J , Granero Trancón J E
Published: May 2021

INTRODUCTION

A guided and structured learning process with an evaluation method is essential for resident training. A survey carried out in our department showed that the implementation of an objective evaluation of surgical skills is of great interest to residents.

MATERIAL AND METHODS

During 2020, a structured and objective evaluation of elemental procedures was implemented for first, third and fifth-year general surgery residents. The preoperative briefing is carried out to discuss the clinical case and plan the surgery. Then, the resident performs the surgical intervention, assisted by an expert surgeon who guides him according to his level and the difficulties encountered. A structured evaluation is carried out, using The American Board of Surgery model Operative Performance Rating System (OPRS). With the postoperative debriefing, the resident’s strengths and weaknesses are analyzed and self-reflected with the recording.

RESULTS

Eleven evaluations have been performed: 3 laparoscopic appendectomies (R1), 2 laparoscopic cholecystectomies (R3) and 3 laparoscopic sigmoidectomies (R5). In 3 of them, it was performed by 2 different evaluators (live and recorded surgery). Patient safety was not compromised. Participants indicated a high level of satisfaction and greater motivation in surgical learning.

CONCLUSION

Implementing this evaluation method in the current training programme of General and Digestive Surgery Residency is feasible and may be beneficial for the controlled development of their surgical skills.
LAPAROSCOPIC LIVER RESECTION VIA LAPAROSCOPY: EXPERIENCE IN OUR CENTRE
Authors: del Val Ruiz P , Sanz Navarro S , Carrasco Aguilera B , García Bernardo C , Miyar de Leon A , Solar García L , Diaz Vico T , Granero Trancón J E
Published: May 2021

INTRODUCTION

Laparoscopic liver surgery has undergone a great evolution in recent years, allowing increasingly complex resections without increasing complications and with evident postoperative benefits. Our purpose is to analyze our initial experience in this type of resection.

MATERIAL AND METHODS

We performed a retrospective observational study analyzing 41 patients who underwent liver resections by laparoscopy in our centre from March 2019 to January 2020.

RESULTS

The mean age of the patients was 64.5 years (SD 11) with a mean BMI of 27.56 (from 4.59). The most common surgical indication was colon cancer metastasis (41.4%), followed by hepatocarcinoma (36.6%) and usually single lesions (75.6%). The procedure passed without complications except in the case of 5 patients who required conversion to open surgery (12.5%) and 3 patients (7.5%) who required intraoperative transfusion. During the postoperative period 4 patients (9.8%) presented complications and all of them were classified as Clavien-Dindo II. We only reported 1 death (2.4%) in > 90 days, which was not related to the reason for surgery. No reinterventions were necessary during admission and there were no readmissions in the first 30 days after discharge,

CONCLUSIONS

Laparoscopic liver surgery is technically demanding and requires previous experience in open surgery, as well as specific training, which makes a regulated implementation of the technique necessary.
USE OF LASER PHOTOCOAGULATION THROUGH ENDOBRONCHIAL APPROACH AS AN ALTERNATIVE TREATMENT FOR BRONCHIAL CARCINOID TUMOR.CASE REPORT
Authors: García González L A , Aragón Valverde F J , Pérez Méndez I P , Gutiérrez Pérez A B , Vaquero Cacho M , Ongay Ibáñez D , González Sánchez L
Published: May 2021

INTRODUCTION

Bronchial carcinoid tumor constitutes less than 5% of lung tumors. Eighty-five percent are histologically typical, located in the main airways, generally benign with malignant potential. Clinically they present with persistent cough, respiratory infections and wheezing. Radiologically they manifest as a smooth border mass with calcifications in 25% and obstruction of the main bronchi with atelectasis. The definitive diagnosis is histopathological.

According to current NCCN guidelines resection is the first line of treatment.

MATERIAL AND METHODS

Female, 37 years old, smoker, presents with dyspnea, dry cough and fever. Hypoxemia with absent VM in the left lung base. Chest RX/CT with increased density in LIL and hypercapillary nodule of 15x14mm in LMB that conditions stenosis of the lumen and atelectasis of the LSL. No adenopathies. Spirometry FVC 43% FEV1 44% FEV1/FVC 82%. Video/ecobronchoscopy with endobronchial lesion in LMB occupying 100% of the lumen cT1cN0.PA: carcinoid tumor.

RESULTS

In MDT, endobronchial approach with rigid bronchoscopy is decided, performing mechanical debridement in its entirety and laser photocoagulation with immediate bronchial repermeabilization. Spirometry FVC 67%; FEV1 66%; FEV1/FVC 98%. PA: typical carcinoid. Follow-up for 12 months with CT and bronchoscopy without evidence of recurrence.

CONCLUSION

According to Reuling, the endobronchial approach is a treatment alternative in intraluminal tumors <20 mm, regardless of their histologic grade; likewise, Van der Heijden proposes it as the first line of therapy; however, more prospective studies with long-term follow-up are needed. Follow-up with CT and bronchoscopy is recommended to rule out local recurrences.
PATENTS OF MEDICAL-SURGICAL DEVICES IN SPAIN: WHAT, WHERE AND WHO INVENT AND PROTECT THEIR INVENTIONS?
Authors: Díaz Cortés R , Rodicio Miravalles J L , Rodríguez García J I
Published: May 2021

INTRODUCTION

Among the strategic lines of the EECTI document (Spanish Strategy for Science, Technology and Innovation 2021-2027) related with health, there is a subline that refers to: New diagnostic and therapeutic techniques. The objective is to analyze the patents of medical-surgical devices in the field of Minimally Invasive Surgery (MIS) in Spain.

MATERIAL AND METHODS

Data related to surgical devices in MIS and Laparoscopic Surgery are collected between January 2019 and December 2020 using the information from the Boletín de Vigilancia Tecnológica, documents obtained from collaboration between the OEPM and ITEMAS. They are extracted and analyzed in the patent application documents: the owner, the number of inventors by sex, Autonomous Community, type of device and health specialties where they are involved.

RESULTS

In the last two years, 16 patents of medical-surgical devices related to MIS have been published. In 7 cases (43.75%) the owner is an individual, in 6 cases a company (37.5%) and in 3 cases an institution (18.75%). 34 inventors are collected and only 6 (17.65%) of them are women. Most of them are for laparoscopic surgery devices related to specialties such as General and Digestive Surgery, Gynecology or Urology, and MIS instruments are mostly related to Traumatology and Orthopedic Surgery.

CONCLUSIONS

In recent years there are still few patents in Spain related to minimally invasive surgery. Most of the patents have private ownership, almost all with male inventors, from regions of the southeast of Spain and involving specialties that work in large cavities.
LAPAROSCOPIC APPROACH OF THE MAIN BILE DUCT IN TREATMENT OF CHOLEDOCHOLITHIASIS. EXPERIENCE OF A BILIO-PANCREATIC UNIT
Authors: Gil Vázquez P , Ferreras Martínez D , Gómez Pérez B , Sánchez-Bueno F
Published: May 2021

INTRODUCTION

The aim is to analyze the validity and safety of a new program of laparoscopic common bile duct exploration (LCBE) in the treatment of choledocholithiasis (CD), evaluating hospital stay and cost-effectiveness.

MATERIAL AND METHODS

Today, there is controversy over which is the best therapeutic option in choledocholithiasis: preoperative ERCP followed by laparoscopic cholecystectomy (LC) versus LCBE. We designed this prospective, non-randomized, single-center study with 118 patients (67 women and 51 men, a mean age of 69.8 ± 17.3 years old). Sixty-six patients began a two-stage management (ERCP + LC), failing to clean the bile duct by endoscopy in 15 cases. LCBE was performed in 59 patients (49 at the beginning and 11 after ERCP failure). Seven of them required conversion to open surgery.

RESULTS

LCBE approach was more effective in cleaning the bile duct than ERCP (88.1% vs 72.7%; p = 0.032) with no statistics differences in terms of postoperative morbidity or mortality. In the multivariate analysis, the LCBE was an independent factor in the reduction of hospital stay and the economic costs derived from the management of these patients, reducing it 6.13 days (CI95% 2.98 - 9.27; p < 0.001) the hospital stay and 3,218.16€ (CI95% 1,082.4 - 5,354.8; p = 0.001) the costs respect to the classical approach, with an incremental cost-effectiveness index (CEI) of -209.

CONCLUSION

LCBE is an effective and safe technique. It significantly reduces hospital stay and costs derived from the management of the patients with choledocholithiasis.
Outcomes for circulatory death and brainstem death pancreas transplantation with or without use of normothermic regional perfusion
Authors: Richards J A , Roberts J L , Fedotovs A , Paul S , Cottee S , Defries G , Watson C J E , Pettigrew G J
Published: May 2021

Simultaneous pancreas and kidney transplantation is the optimum treatment for patients with type 1 diabetes and renal failure, providing survival benefit over deceased donor kidney transplant alone. Here the authors demonstrate that utilization of donation after circulatory death pancreases is a safe approach to expanding the donor pool with equivalent results to donation after brainstem death transplantation. They also demonstrate that pancreas transplantation after normothermic regional perfusion is feasible, but it will require ongoing prospective study to ensure that the benefits seen for liver transplantation do not come at the expense of pancreas transplant outcomes.
Karyotype differentiation inAmeroglossum(Linderniaceae) and closely related genera endemic to Brazilian inselbergs
Authors: Santos Amanda S , Almeida Erton M , Felix Leonardo P , Guerra Marcelo
Published: May 2021

Ameroglossum is composed of shrubs endemic to inselbergs in north-eastern Brazil, currently circumscribed in Linderniaceae. Chromosomal counts for this family are few, but quite variable, ranging from 2n = 14 to 60. We investigated the chromosomal numbers of 14 species of Linderniaceae with emphasis on Ameroglossum and analysed the distribution of heterochromatin and 5S and 35S rDNA sites for most species. We found 2n = 60 for the species of Ameroglossum (except Ameroglossum genaroanum with 2n = 64), Catimbaua and Isabelcristinia, 2n = 50 for Cubitanthus alatus and 2n = 28 for Torenia thouarsii and Vandellia diffusa. All of them had small, similar chromosomes and 5S and 35S rDNA sites overlapping with CMA+ bands. The species with 2n = 50–64 showed a single pair of 5S and 35S rDNA sites, V. diffusa had two pairs of 5S and one pair of 35S rDNA sites and T. thouarsii had two pairs of each. Furthermore, other CMA+ and DAPI+ bands have been seen in almost all species. The karyotypical similarities among the species of Ameroglossum, Catimbaua, Cubitanthus and Isabelcristinia suggest a close relationship between representatives of Linderniaceae typical of inselbergs.
Diffusion models reveal white matter microstructural changes with ageing, pathology and cognition
Authors: Raghavan Sheelakumari , Reid Robert I , Przybelski Scott A , Lesnick Timothy G , Graff-Radford Jonathan , Schwarz Christopher G , Knopman David S , Mielke Michelle M , Machulda Mary M , Petersen Ronald C , Jack Clifford R , Vemuri Prashanthi
Published: May 2021

White matter microstructure undergoes progressive changes during the lifespan, but the neurobiological underpinnings related to ageing and disease remains unclear. We used an advanced diffusion MRI, Neurite Orientation Dispersion and Density Imaging, to investigate the microstructural alterations due to demographics, common age-related pathological processes (amyloid, tau and white matter hyperintensities) and cognition. We also compared Neurite Orientation Dispersion and Density Imaging findings to the older Diffusion Tensor Imaging model-based findings. Three hundred and twenty-eight participants (264 cognitively unimpaired, 57 mild cognitive impairment and 7 dementia with a mean age of 68.3 ± 13.1 years) from the Mayo Clinic Study of Aging with multi-shell diffusion imaging, fluid attenuated inversion recovery MRI as well as amyloid and tau PET scans were included in this study. White matter tract level diffusion measures were calculated from Diffusion Tensor Imaging and Neurite Orientation Dispersion and Density Imaging. Pearson correlation and multiple linear regression analyses were performed with diffusion measures as the outcome and age, sex, education/occupation, white matter hyperintensities, amyloid and tau as predictors. Analyses were also performed with each diffusion MRI measure as a predictor of cognitive outcomes. Age and white matter hyperintensities were the strongest predictors of all white matter diffusion measures with low associations with amyloid and tau. However, neurite density decrease from Neurite Orientation Dispersion and Density Imaging was observed with amyloidosis specifically in the temporal lobes. White matter integrity (mean diffusivity and free water) in the corpus callosum showed the greatest associations with cognitive measures. All diffusion measures provided information about white matter ageing and white matter changes due to age-related pathological processes and were associated with cognition. Neurite orientation dispersion and density imaging and diffusion tensor imaging are two different diffusion models that provide distinct information about variation in white matter microstructural integrity. Neurite Orientation Dispersion and Density Imaging provides additional information about synaptic density, organization and free water content which may aid in providing mechanistic insights into disease progression.
On the potential origin and characteristics of cancer stem cells
Authors: Trosko James E
Published: May 2021

The ‘cancer stem cell’ hypothesis has pointed to a specific target for new cancer therapies. The hypothesis is based on the observation that only the ‘cancer stem cell’ among the other heterogeneous cancer cells can sustain the growth of the cancer. The goal is to identify biomarkers of ‘cancer stem cells’ to distinguish them from the ‘cancer non-stem cells’ and normal adult tissue-specific stem cells. This analyst posits a hypothesis that, although all cancers originated from a single cell, there exist two types of ‘cancer stem cells’ either by the ‘Stem Cell hypothesis’ or from the ‘De-differentiation hypothesis’. It is proposed that there exist two different ‘cancer stem cells’. Some ‘cancer stem cells’ (a) lack the expression of connexins or gap junction genes and lack any form of gap junctional intercellular communication (GJIC) or (b) they have the expressed connexin-coded proteins for functional GJIC but are dysfunctional by some expressed oncogene. This is consistent with the Loewenstein hypothesis that a universal characteristic of cancer cells is they do not have growth control, nor terminally differentiate. This review speculates the normal organ-specific adult stem cell, that is ‘initiated’, is the origin of the ‘cancer stem cells’ with expressed Oct4A gene and no expressed connexin genes; whereas the other cancer stem cell has no expressed Oct4A genes but expressed connexin gene, whose coded protein is dysfunctional. Hence. both types of ‘cancer stem cells’ lack GJIC, for two different reasons, the selective therapies have to be different for these different cell types.
Interstitial Axon Collaterals of Callosal Neurons Form Association Projections from the Primary Somatosensory to Motor Cortex in Mice
Authors: Oka Yuichiro , Doi Miyuki , Taniguchi Manabu , Tiong Sheena Y X , Akiyama Hisanori , Yamamoto Takuto , Iguchi Tokuichi , Sato Makoto
Published: May 2021

Association projections from cortical pyramidal neurons connect disparate intrahemispheric cortical areas, which are implicated in higher cortical functions. The underlying developmental processes of these association projections, especially the initial phase before reaching the target areas, remain unknown. To visualize developing axons of individual neurons with association projections in the mouse neocortex, we devised a sparse labeling method that combined in utero electroporation and confocal imaging of flattened and optically cleared cortices. Using the promoter of an established callosal neuron marker gene that was expressed in over 80% of L2/3 neurons in the primary somatosensory cortex (S1) that project to the primary motor cortex (M1), we found that an association projection of a single neuron was the longest among the interstitial collaterals that branched out in L5 from the earlier-extended callosal projection. Collaterals to M1 elongated primarily within the cortical gray matter with little branching before reaching the target. Our results suggest that dual-projection neurons in S1 make a significant fraction of the association projections to M1, supporting the directed guidance mechanism in long-range corticocortical circuit formation over random projections followed by specific pruning.
Retreatment of Chronic Hepatitis C Infection: Real-World Regimens and Outcomes From National Treatment Programs in Three Low- and Middle-Income Countries
Authors: Boeke Caroline E , Hiebert Lindsey , Waked Imam , Tsertsvadze Tengiz , Sharvadze Lali , Butsashvili Maia , Zakalashvili Mamuka , Naing Win , Gupta Neil , Kateera Fredrick , McClure Craig , Ward John W , Ramers Christian B
Published: May 2021

Access to recommended second-line treatments is limited for patients who fail initial hepatitis C virus (HCV) therapy in low- and middle-income countries. Alternative regimens and associated outcomes are not well understood. Through a pooled analysis of national program data in Egypt, Georgia, and Myanmar, we observed SVR rates >90% for alternative retreatment regimens.
Association of Respiratory Syncytial Virus Infection and Underlying Risk Factors for Death Among Young Infants Who Died at University Teaching Hospital, Lusaka Zambia
Authors: Forman Leah S , Macleod William , Mwananyanda Lawrence , Kwenda Geoffrey , Pieciak Rachel , Mupila Zachariah , Murphy Caitriona , Thea Donald , Chikoti Chilufya , Yankonde Baron , Ngoma Benard , Chimoga Charles , Gill Christopher J
Published: May 2021

Background

Respiratory syncytial virus (RSV) is a leading cause of acute lower respiratory tract infections and child mortality. While RSV disease burden is highest in low- and middle-income countries, most knowledge about risk factors for fatal RSV disease comes from high-income settings.

Methods

Among infants aged 4 days to <6 months who died at University Teaching Hospital in Lusaka, Zambia, we tested nasopharyngeal swabs obtained postmortem for RSV using reverse transcriptase–quantitative polymerase chain reaction. Through a systematic review of death certificates and hospital records, we identified 10 broad categories of underlying medical conditions associated with infant deaths. We used backward-selection models to calculate adjusted and unadjusted risk ratios (RRs) for the association between each underlying condition and RSV status.

Results

From 720 infant deaths, 6% (44) were RSV-positive, 70% were <4 weeks old, and 54% were male. At least 1 underlying condition was found in 85% of infants, while 63% had ≥2. Prematurity/low birth weight (53% [384]) and complications of labor and delivery (32% [230]) were the most common conditions. Congenital cardiac conditions were significantly associated with an increased risk of RSV infection (4%, 32; adjusted RR: 3.57; 95% CI: 1.71–7.44). No other underlying conditions were significantly associated with RSV.

Conclusions

Other than congenital cardiac conditions, we found a lack of association between RSV and underlying risk factors. This differs from high-income settings, where RSV mortality is concentrated among high-risk infants. In this population, birth-related outcomes are the highest mortality risk factors. Improved neonatal care remains crucial in the fight against neonatal mortality.
Indication for Antibiotic Prescription Among Children Attending Primary Healthcare Services in Rural Burkina Faso
Authors: Sié Ali , Ouattara Mamadou , Bountogo Mamadou , Dah Clarisse , Compaoré Guillaume , Boudo Valentin , Lebas Elodie , Brogdon Jessica , Nyatigo Fanice , Arnold Benjamin F , Lietman Thomas M , Oldenburg Catherine E
Published: May 2021

Of 61 355 visits by children <5 years old to 48 government-run primary healthcare facilities in Nouna District, Burkina Faso, 30 975 had an antibiotic prescribed (58% for pneumonia diagnoses). A minority of prescriptions were for diagnoses not requiring antibiotics, including malaria, nonbloody diarrhea, and cough without pneumonia.
Integrating electronic health data records to develop and validate a predictive model of hospital-acquired acute kidney injury in non-critically ill patients
Authors: Segarra Alfons , Del Carpio Jacqueline , Marco Maria Paz , Jatem Elias , Gonzalez Jorge , Chang Pamela , Ramos Natalia , de la Torre Judith , Prat Joana , Torres Maria J , Montoro Bruno , Ibarz Mercedes , Pico Silvia , Falcon Gloria , Canales Marina , Huertas Elisard , Romero Iñaki , Nieto Nacho
Published: May 2021

Background

Models developed to predict hospital-acquired acute kidney injury (HA-AKI) in non-critically ill patients have a low sensitivity, do not include dynamic changes of risk factors and do not allow the establishment of a time relationship between exposure to risk factors and AKI. We developed and externally validated a predictive model of HA-AKI integrating electronic health databases and recording the exposure to risk factors prior to the detection of AKI.

Methods

The study set was 36 852 non-critically ill hospitalized patients admitted from January to December 2017. Using stepwise logistic analyses, including demography, chronic comorbidities and exposure to risk factors prior to AKI detection, we developed a multivariate model to predict HA-AKI. This model was then externally validated in 21 545 non-critical patients admitted to the validation centre in the period from June 2017 to December 2018.

Results

The incidence of AKI in the study set was 3.9%. Among chronic comorbidities, the highest odds ratios (ORs) were conferred by chronic kidney disease, urologic disease and liver disease. Among acute complications, the highest ORs were associated with acute respiratory failure, anaemia, systemic inflammatory response syndrome, circulatory shock and major surgery. The model showed an area under the curve (AUC) of 0.907 [95% confidence interval (CI) 0.902–0.908), a sensitivity of 82.7 (95% CI 80.7–84.6) and a specificity of 84.2 (95% CI 83.9–84.6) to predict HA-AKI, with an adequate goodness-of-fit for all risk categories (χ2 = 6.02, P = 0.64). In the validation set, the prevalence of AKI was 3.2%. The model showed an AUC of 0.905 (95% CI 0.904–0.910), a sensitivity of 81.2 (95% CI 79.2–83.1) and a specificity of 82.5 (95% CI 82.2–83) to predict HA-AKI and had an adequate goodness-of-fit for all risk categories (χ2 = 4.2, P = 0.83). An online tool (predaki.amalfianalytics.com) is available to calculate the risk of AKI in other hospital environments.

Conclusions

By using electronic health data records, our study provides a model that can be used in clinical practice to obtain an accurate dynamic and updated assessment of the individual risk of HA-AKI during the hospital admission period in non-critically ill patients.
Dietary recommendations for prevention of atherosclerosis
Authors: Riccardi Gabriele , Giosuè Annalisa , Calabrese Ilaria , Vaccaro Olga
Published: May 2021

This review aims at summarizing updated evidence on cardiovascular disease (CVD) risk associated with consumption of specific food items to substantiate dietary strategies for atherosclerosis prevention. A systematic search on PubMed was performed to identify meta-analyses of cohort studies and RCTs with CVD outcomes. The evidence is highly concordant in showing that, for the healthy adult population, low consumption of salt and foods of animal origin, and increased intake of plant-based foods—whole grains, fruits, vegetables, legumes, and nuts—are linked with reduced atherosclerosis risk. The same applies for the replacement of butter and other animal/tropical fats with olive oil and other unsaturated-fat-rich oil. Although the literature reviewed overall endorses scientific society dietary recommendations, some relevant novelties emerge. With regard to meat, new evidence differentiates processed and red meat—both associated with increased CVD risk—from poultry, showing a neutral relationship with CVD for moderate intakes. Moreover, the preferential use of low-fat dairies in the healthy population is not supported by recent data, since both full-fat and low-fat dairies, in moderate amounts and in the context of a balanced diet, are not associated with increased CVD risk; furthermore, small quantities of cheese and regular yogurt consumption are even linked with a protective effect. Among other animal protein sources, moderate fish consumption is also supported by the latest evidence, although there might be sustainability concerns. New data endorse the replacement of most high glycemic index (GI) foods with both whole grain and low GI cereal foods. As for beverages, low consumption not only of alcohol, but also of coffee and tea is associated with a reduced atherosclerosis risk while soft drinks show a direct relationship with CVD risk. This review provides evidence-based support for promoting appropriate food choices for atherosclerosis prevention in the general population.
Effects of Fire on Ground-Dwelling Spider (Araneae) Assemblages in Central Indiana Forests
Authors: Milne Marc A , Gonsiorowski Joseph , Tuft Nathan , Deno Brodrick , Ploss Tyler , Acosta Janise , Frandsen Lucas , Venable Casey
Published: May 2021

Fire is a natural disturbance that occurs in many temperate and tropical ecosystems worldwide. As ubiquitous members of these ecosystems, spiders (Araneae) are often affected by fire, and their response to this disturbance has been shown to be dependent on taxonomy, functional diversity, seasonality, and a variety of environmental factors. We examined the effect of fire on ground-dwelling spider assemblages in temperate forests in central Indiana over 5 yr and found that spider assemblages were significantly affected by fire disturbance. Overall spider abundance decreased, whereas species richness and diversity remained unaffected. We also found that spider response depended heavily on the family and/or guild to which the spider belonged. We suspect that altered habitat heterogeneity, the patchy nature of fire’s effect on leaf litter, and the high rate of recolonization by spiders all played important roles in these observed patterns.
The effect of different bonded retainer wires on tooth mobility immediately after orthodontic treatment
Authors: Kučera Josef , Marek Ivo , Littlewood Simon J
Published: May 2021

Objectives

This study aimed to compare the immediate influence of four commonly used retainer wires on tooth mobility following orthodontic treatment with fixed appliances.

Materials and Methods

Eighty patients after orthodontic treatment were assigned to four study groups (n = 20 in each group). Groups were provided with directly bonded fixed retainers—0.0150″ (group A), 0.0175″ (group B), 0.016 × 0.022″ (group C), and 0.0215″ (group D). Tooth mobility was measured using the Periotest device at two times—after removal of fixed appliance (T1) and after bonding of the retainer (T2). Values of tooth mobility, ‘Periotest values’, were analysed between groups and compared with the physiologic tooth mobility in a control group of untreated patients (n = 65). Kruskal–Wallis H, Mann–Whitney U, Dunn’s test, Fisher’s exact test, and binary logistic regression tests were used to analyze the data.

Results

Tooth mobility after orthodontic treatment was significantly increased. While canines remained within normal range of tooth mobility, values for incisors increased on average to the first degree of tooth mobility (slight mobility). Logistic regression analysis identified age as a significant predictor for increased tooth mobility (P = 0.032) with odds ratio 1.065 (95% CI 1.005–1.128), with mobility increasing with age. After bonding of the retainer in all four groups, the tooth mobility was reduced to values which were not significantly different form normal physiological values found in the control group (P > 0.05). There were no differences in the amount of change or in tooth mobility values at T2 between the different types of bonded retainers.

Limitations

Age of subjects in the control group was significantly higher than that in the study groups. An alternation method was used instead of randomization to distribute the four different types of retainers.

Conclusions

All of the retainer wires were able to successfully reduce the increased tooth mobility caused by orthodontic treatment to normal levels. The values of tooth mobility after placement of retainers were within the range of physiologic tooth mobility.
Do Concerns about Immigration Change after Adolescence? How Education and Critical Life Events Affect Concerns about Immigration
Authors: Kratz Fabian
Published: May 2021

This study investigates whether critical life events that typically occur during early adulthood (i.e., labor market entry, unemployment, parenthood) impact concerns about immigration. Two mechanisms suggest that these critical life events lead to a widening of education-specific differences: First, the amplification of ethnic competition following critical life events may be more pronounced for individuals with low educational attainment. Second, psychological adaptation processes of individuals with low levels of education may more frequently result in scapegoating. These mechanisms provide a rationale for the education-as-buffer hypothesis, according to which individuals with lower educational attainment are more prone to exhibit increasing concerns about immigration following critical life events. Estimations of distributed fixed effects models relying on data from the German Socio-Economic Panel Study (1999–2017) show that labor market entry, unemployment, and parenthood increase concerns about immigration more strongly for individuals with low educational attainment. Replicating significant impact differences between educational groups for the three critical life events makes a strong case for the education-as-buffer hypothesis. Overall, this study demonstrates that concerns about immigration are responsive to critical life events and calls for further theorizing as to how educational attainment may shape attitudes towards immigration over the life course.
Validation and comparison of 28 risk prediction models for coronary artery disease
Authors: Lenselink Chris , Ties Daan , Pleijhuis Rick , van der Harst Pim
Published: May 2021

Aims

Risk prediction models (RPMs) for coronary artery disease (CAD), using variables to calculate CAD risk, are potentially valuable tools in prevention strategies. However, their use in the clinical practice is limited by a lack of poor model description, external validation, and head-to-head comparisons.

Methods and results

CAD RPMs were identified through Tufts PACE CPM Registry and a systematic PubMed search. Every RPM was externally validated in the three cohorts (the UK Biobank, LifeLines, and PREVEND studies) for the primary endpoint myocardial infarction (MI) and secondary endpoint CAD, consisting of MI, percutaneous coronary intervention, and coronary artery bypass grafting. Model discrimination (C-index), calibration (intercept and regression slope), and accuracy (Brier score) were assessed and compared head-to-head between RPMs. Linear regression analysis was performed to evaluate predictive factors to estimate calibration ability of an RPM. Eleven articles containing 28 CAD RPMs were included. No single best-performing RPM could be identified across all cohorts and outcomes. Most RPMs yielded fair discrimination ability: mean C-index of RPMs was 0.706 ± 0.049, 0.778 ± 0.097, and 0.729 ± 0.074 (P < 0.01) for prediction of MI in UK Biobank, LifeLines, and PREVEND, respectively. Endpoint incidence in the original development cohorts was identified as a significant predictor for external validation performance.

Conclusion

Performance of CAD RPMs was comparable upon validation in three large cohorts, based on which no specific RPM can be recommended for predicting CAD risk.