bluuebunny/crossref_metadata_2025 huggingface dataset:
Incidence and risk factors of anastomotic complications after lung transplantation
Authors: Delbove Agathe , Senage Thomas , Gazengel Pierre , Tissot Adrien , Lacoste Philippe , Cellerin Laurent , Perigaud Christian , Danner-Boucher Isabelle , Cavailles Arnaud , Lepoivre Thierry , Mugniot Antoine , Nicolet Johanna , Horeau-Langlard Delphine , Groleau Nicolas , Fedun Yannick , Rozec Bertrand , Magnan Antoine , Roussel Jean-Christian , Blanc François-Xavier
Published: July 2022

Background:

Anastomotic complications are common after lung transplantation (1.4–33% of cases) and still associated with a high morbi-mortality.

Methods:

The current study is a monocenter retrospective analysis of symptomatic anastomotic complications (SAC) occurring after lung transplantation between 2010 and 2016, using the macroscopic, diameter, and suture (M-D-S) classification from consensus of French experts in bronchoscopy. The objectives were to determine incidence from surgery, risk factors, and impact of survival of SAC. We defined SAC as M-D-S abnormalities (stenosis ⩾ 50% or dehiscence) requiring bronchoscopic or surgical interventions.

Results:

A total of 121 patients were included. SAC occurred in 26.5% of patients ( n = 32), divided in symptomatic stenosis for 23.7% ( n = 29), and symptomatic dehiscence in 2.5% ( n = 3). In multivariate analysis, donor bacterial lung infection [HR 2.08 (1.04–4.17), p = 0.04] and age above 50 years [HR 3.26 (1.04–10.26), p = 0.04] were associated with SAC occurrence. Cystic fibrosis etiology was associated with better survival on Kaplan–Meier curve ( p < 0.001). SAC [HR 2.15 (1.07–4.32), p = 0.03] was independently associated with worst survival. The 29 symptomatic patients because of stenosis required endoscopic procedure, of whom 16 patients needed bronchial stent placement. Four patients underwent surgery: three patients because of dehiscence and one because of severe bilateral stenosis (re-transplantation).

Discussion:

SAC occurred in 26.5% of patients. Donor lung infection was the only alterable identified factors. The increase rate of SAC in older patients above 50 years of age encourages in regular endoscopic monitoring.
Association of COPD exacerbations and acute cardiovascular events: a systematic review and meta-analysis
Authors: Müllerová Hana , Marshall Jonathan , de Nigris Enrico , Varghese Precil , Pooley Nick , Embleton Nina , Nordon Clementine , Marjenberg Zoe
Published: July 2022

Background:

The majority of patients with chronic obstructive pulmonary disease (COPD) suffer from comorbid cardiovascular (CV) disease. Accumulating evidence suggests a temporal association between COPD exacerbations and acute CV events, possibly due to lung hyperinflation, increased hypoxemia and systemic inflammation. The aims of the study were to estimate the risk of (1) acute CV events [acute myocardial infarction (AMI), CV-related death] or stroke in the months following a COPD exacerbation and (2) COPD exacerbation in the months following an acute CV event.

Methods:

A systematic literature review of observational studies published since 2000 was conducted by searching literature databases (Medline and Embase). Studies were eligible if conducted in adults with COPD, exposed to either COPD exacerbation or acute CV events, with outcomes of acute CV events or COPD exacerbation reported. Studies were appraised for relevance, bias and quality. Meta-analyses, using random-effect models, were performed for each outcome of interest, thus providing a pooled relative risk (RR) and its 95% confidence interval.

Results:

Eight studies were identified, of which seven were used for the meta-analyses examining the risk of CV events 1–3 months after an exacerbation compared with none. For stroke (six studies), RR was 1.68 (95% CI = 1.19–2.38). For AMI (six studies), RR was 2.43 (95% CI = 1.40–4.20). No studies exploring risk of exacerbation following an acute CV event were identified.

Conclusion:

This meta-analysis identified a markedly increased risk of stroke or AMI within a relatively short period of time following a COPD exacerbation. Although the underlying mechanisms are not fully elucidated, patients with COPD should be monitored for risk of CV outcomes after exacerbations. In addition, preventing exacerbations may decrease the risk of subsequent acute CV events.

Registration:

The study protocol was published via PROSPERO: International Prospective Register of Systematic Reviews (#CRD42020211055).
Efficacy of mRNA anti-SARS-CoV-2 vaccination and dynamics of humoral immune response in patients with solid tumors: results from the institutional registry of an Italian tertiary cancer center
Authors: Fucà Giovanni , Lecchi Mara , Ciniselli Chiara Maura , Ottini Arianna , Spagnoletti Andrea , Mazzeo Laura , Morelli Daniele , Frati Paola , Stroscia Martina , Ebrahem Elisabella , Sottotetti Elisa , Galli Giulia , D’Elia Maria Grazia , Lobefaro Riccardo , Ducceschi Monika , Di Guardo Lorenza , Bhoori Sherrie , Provenzano Salvatore , Platania Marco , Niger Monica , Colombo Elena , Nichetti Federico , Duca Matteo , Rivoltini Licia , Mortarini Roberta , Baili Paolo , Apolone Giovanni , de Braud Filippo , Verderio Paolo , Damian Silvia
Published: July 2022

Background:

Systemic immunosuppression characterizing cancer patients represents a concern regarding the efficacy of anti-severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccination, and real-world evidence is needed to define the efficacy and the dynamics of humoral immune response to mRNA-based anti-SARS-CoV-2 vaccines.

Methods:

We conducted an observational study that included patients with solid tumors who were candidates for mRNA anti-SARS-CoV-2 vaccination at the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. The primary objective was to monitor the immunologic response to the mRNA anti-SARS-CoV-2 vaccination in terms of anti-spike antibody levels. All the patients received two doses of the mRNA-1273 vaccine or the BNT162b2 vaccine. Healthcare workers served as a control group of healthy subjects.

Results:

Among the 243 patients included in the present analysis, 208 (85.60%) and 238 (97.94%) resulted seroconverted after the first and the second dose of vaccine, respectively. Only five patients (2.06%) had a negative titer after the second dose. No significant differences in the rate of seroconversion after two vaccine doses were observed in patients as compared with the control group of healthy subjects. Age and anticancer treatment class had an independent impact on the antibody titer after the second dose of vaccination. In a subgroup of 171 patients with available data about the third timepoint, patients receiving immunotherapy with immune checkpoint inhibitors seem to have a higher peak of antibodies soon after the second dose (3 weeks after), but a more pronounced decrease at a late timepoint (3 months after).

Conclusions:

The systemic immunosuppression characterizing cancer patients did not seem to dramatically affect the humoral response to anti-SARS-CoV-2 mRNA vaccines in our population of patients with solid tumors. Further investigation is needed to dissect the interplay between immunotherapy and longitudinal dynamics of humoral response to mRNA vaccines, as well as to analyze the cellular response to mRNA vaccines in cancer patients.
Monkeypox – a description of the clinical progression of skin lesions: a case report from Colorado, USA
Authors: Ortiz-Martínez Yeimer , Rodríguez-Morales Alfonso J. , Franco-Paredes Carlos , Chastain Daniel B. , Gharamti Amal A. , Vargas Barahona Lilian , Henao-Martínez Andrés F.
Published: July 2022

A rapidly emerging global outbreak of monkeypox virus infection (MPXV) in over 50 non-endemic countries was identified in May 2022. We report the case and images of a patient with MPXV presenting with genital lesions later complicated by superimposed cellulitis in Colorado, USA. MPXV lesions are susceptible to bacterial superinfection, and with the advent of new cases, the early identification of skin lesions and their evolution during MPXV are imperative for treating clinicians. Clinicians should consider MPXV in differential diagnoses of sexually transmitted diseases presenting with genital lesions.
Evolving epidemiology of HIV/AIDS in Campania region, 2011–2018: Is HIV/AIDS population in Campania different?
Authors: Fusco Francesco Maria , Sangiovanni Nadia , Mascolo Silvia , Carleo Maria Aurora , Sardo Massimo , Viglietti Rosaria , Parrella Giovanni , Tambaro Orsola , Iodice Valentina , Di Flumeri Giusy , Menna Anna , Galano Assunta , Laudiero Anna , Mariniello Antonietta , De Cenzo Milena , Manzillo Elio , Esposito Vincenzo , Chirianni Antonio , Sangiovanni Vincenzo
Published: July 2022

Objectives:

Data on HIV/AIDS cases in Italy are collected using a standardised form. Regional epidemiology may vary. We described the epidemiological and clinical characteristics of newly diagnosed persons with HIV in the ‘Cotugno’ hospital in Naples during 2011–2018 and compared them with national data to identify similarities and differences.

Methods:

Data source for the Campania region is the data collection forms sent to the national surveillance system. The data source for the national data is from the periodic annual bulletins on HIV/AIDS published by the National Institute of Health.

Results:

In all, 1149 persons with HIV were diagnosed in ‘Cotugno’ (69.7% of those diagnosed in Campania). Persons with HIV in Campania showed many similarities with the Italian population: men were in the majority in both groups (about 75%), foreign origin was about 30%, heterosexuals were the most represented risk group, followed by men who have sex with men and injecting drug use in both samples. Some notable differences are also present. Among the risk factors for HIV acquisition, injecting drug use is significantly more common in Campania. Among the reasons for testing, significant differences are evident for almost all reasons, with screening activities (testing for concurrent diseases, for diagnosis of sexually transmitted diseases, screening in hospital during maternity care and screening in drug-addition services or prisons) being more common at the national level. The Campania population has a more severe disease pattern, with a significantly higher proportion of patients diagnosed with less than 200 CD4 cells/µL and AIDS. For each variable, we compared trends in the Campania region and in Italy using Spearman’s correlation coefficient. Almost all trends show a weak correlation.

Conclusion:

In conclusion, the prevalence of injecting drug use is still consistent, and requires specific campaigns. The reasons for testing are different: screening activities work less in Campania than in Italy. This untimely approach contributes to a more severe clinical picture in Campania.
Dialysis Patients’ Preferences on Resuscitation: A Cross-Sectional Study Design
Authors: Alzayer Husam , Geraghty Annette M. , Sebastian Kuruvilla K. , Panesar Hardarsh , Reddan Donal N.
Published: July 2022

Background:

End-stage kidney disease is associated with a 10- to 100-fold increase in cardiovascular mortality compared with age-, sex-, and race-matched population. Cardiopulmonary resuscitation (CPR) in this cohort has poor outcomes and leads to increased functional morbidity.

Objective:

The aim of this study is to assess patients’ preferences toward CPR and advance care planning (ACP).

Design:

cross-sectional study design.

Setting:

Two outpatient dialysis units.

Patients:

Adults undergoing dialysis for more than 3 months were included. Exclusion criteria were severe cognitive impairment or non-English-speaking patients.

Measurements:

A structured interview with the use of Willingness to Accept Life-Sustaining Treatment (WALT) tool.

Methods:

Demographic data were collected, and baseline Montreal Cognitive Assessment, Patient Health Questionnaire–9, Duke Activity Status Index, Charlson comorbidity index, and WALT instruments were used. Descriptive analysis, chi-square, and t test were performed along with probability plot for testing hypotheses.

Results:

Seventy participants were included in this analysis representing a 62.5% response rate. There was a clear association between treatment burden, anticipated clinical outcome, and the likelihood of that outcome with patient preferences. Low-burden treatment with expected return to baseline was associated with 98.5% willingness to accept treatment, whereas high-burden treatment with expected return to baseline was associated with 94.2% willingness. When the outcome was severe functional or cognitive impairment, then 45.7% and 28.5% would accept low-burden treatment, respectively. The response changed based on the likelihood of the outcome. In terms of resuscitation, more than 75% of the participants would be in favor of receiving CPR and mechanical ventilation at their current health state. Over 94% of patients stated they had never discussed ACP, whereas 59.4% expressed their wish to discuss this with their primary nephrologist.

Limitations:

Limited generalizability due to lack of diversity. Unclear decision stability due to changes in health status and patients’ priorities.

Conclusions:

ACP should be incorporated in managing chronic kidney disease (CKD) to improve communication and encourage patient involvement.
Japanese prime ministers and party leadership
Authors: Uchiyama Yu
Published: July 2022

This article shows what were/are the features of Japanese prime ministers as party leaders, as well as how and why these features have changed over the last 20 years. It focuses on three dimensions: party centralisation, internal cohesion and leadership security. On party centralisation, the electoral reform of 1994 introduced a single-member district system into the House of Representatives, or Lower House. This reform ended intra-party competition within the LDP that had existed under the multi-member system and since then the party has become much more centralised. On internal cohesion, the electoral reform has provided the prime minister with a powerful instrument to control the party: the power of endorsement. On leadership security, prime ministers like Koizumi Junichirō and Abe Shinzō were successful in restraining rebels and securing their leadership by effectively using the power of endorsement along with the power of appointment. However, a considerable number of prime ministers in the 21st century have had short tenures of about one year. While the personalisation of politics has made the position of popular prime ministers more secure, it has made unpopular prime ministers highly vulnerable.
Complications of alcohol injections for Morton’s neuroma
Authors: Ortu Sebastiano , Fiori Enrico , Bagnoli Ignazio , Valente Angiola , Pisanu Francesco , Caggiari Gianfilippo , Doria Carlo , Milano Luigi
Published: July 2022

Introduction

Morton’s neuroma (MN) is a neuropathic metatarsalgia that causes pain in the plantar aspect of the forefoot generally between the third and fourth metatarsal heads. Treatment can be nonoperative or surgical. Among nonoperative procedures, alcohol injections are still commonly used as considered simple, relatively safe and well-tolerated treatment. However, they present transient and minor complications.

Methods

Two hundred patients with a diagnosis of MN underwent ultrasound-guided injections with a 47.5% alcohol solution between 2013 and 2020. We reviewed the current literature to highlight the known complications of this treatment, comparing them to the complications developed by our patients.

Results

Three patients out of 200 patients, developed necrosis of skin and subcutaneous tissue not described in previous studies about MN.

Conclusions

Our study focuses attention on the complications subsequent to the alcohol injection therapy for MN. Patients and surgeons should be aware that in a small number of cases this therapy can be burdened by necrotic complications of the skin.
Locational Strategy of Special Economic Zones in India
Authors: Chakraborty Tamali
Published: July 2022

The establishment of special economic zones (SEZs) in Indian districts is intended to bring rapid economic growth to India. However, the data on SEZs show that SEZs are concentrated in only a few Indian districts and thus aggravate the problem of regional inequality. In this paper, the strategy of concentration of SEZs is analysed with a backdrop of the new economic geography theory. The data of the variables are extracted from Census 2011 and other sources for all 640 districts. The Tobit model is used to determine the locational factors behind the establishment of the SEZs in a district of India. The results show that the variables such as urbanization, distance from megacity, districts with a seaport and districts with airports have a significant impact on the number of SEZ approvals as well as SEZ notifications. The concentration of SEZs is mainly due to favourable market and infrastructural conditions.

JEL codes: O10, C24, D63
Communicative and Supportive Strategies: A Qualitative Study Investigating Nursing Staff’s Communicative Practice With Patients With Aphasia in Stroke Care
Authors: Loft Mia Ingerslev , Volck Cecilie , Jensen Lise Randrup
Published: July 2022

This study aimed to provide detailed descriptions of the influences on the nursing staff’s communicative practices with patients with aphasia in the context of usual stroke care interactions, and secondly to explore the nursing staff’s use or non-use of supportive techniques, including the SCATM method. A qualitative design was chosen, combining field observations and semi-structured interviews. Inductive and deductive qualitative content analysis was used. The results showed that the nursing staff’s interactions with patients with aphasia were influenced by organizational and environmental influences, nurses’ roles and functions and supporting patients with aphasia in communication. The role of the nursing staff in caring for the psychosocial well-being of patients is deprioritised in favor of other tasks. If there is no time or culture for prioritizing time for conversing with patients and supporting their psychosocial well-being, communication-partner training like SCATM is likely hindered.
Do mergers and acquisitions disrupt marketing capabilities?
Authors: Reddy Rama Krishna , Park Sung-Jin , Bindroo Vishal
Published: July 2022

Motivated by the resource-based view (RBV) of the firm, this study explores whether mergers and acquisitions (M&As) can facilitate or impede a firm’s marketing capabilities. Furthermore, this study also examines whether the influence of M&As on a firm’s marketing capabilities is conditional to the type of deals, that is, domestic versus cross-border acquisitions. Using the difference-in-differences research design with a large sample of 15,509 firm-year observations for 898 US public acquirers, this study tests the postacquisition changes in a firm’s marketing capabilities as reflected in the sensitivity of sales revenue to marketing-related expenditure. The results of the empirical tests show a postacquisition increase in sales sensitivity, suggesting that firms can enhance their marketing capabilities through M&As. However, it is also found that the enhancement in marketing capabilities is limited to domestic M&As and disappears for cross-border acquisitions. This result suggests that more salient differences in a firm’s marketing environment attributable to cross-border acquisitions may disrupt a firm’s marketing capabilities and dampen the positive effect of M&As.

Fields of Specialization: Strategic management, marketing

JEL CLASSIFICATION: G34; L25; M30
High thrombus platelet content is associated with a lower rate of first pass effect in stroke treated by endovascular therapy
Authors: Delvoye François , Di Meglio Lucas , Consoli Arturo , Nomenjanahary Mialitiana Solo , Dupont Sébastien , Labreuche Julien , Maier Benjamin , Piotin Michel , Blanc Raphael , Escalard Simon , Boursin Perrine , Hamdani Mylène , Redjem Hocine , Smajda Stanislas , Hébert Solène , Sabben Candice , de Noordhout Alain Maertens , Jandrot-Perrus Martine , Lapergue Bertrand , Mazighi Mikael , Ho-Tin-Noé Benoit , Desilles Jean-Philippe
Published: July 2022

Background and purpose:

First pass effect (FPE), the occurrence of complete reperfusion after one pass with no rescue attempt during endovascular therapy (EVT), is associated with the best clinical outcome after an acute ischemic stroke (AIS). Previous studies evaluating FPE occurrence according to EVT technical strategies, occlusion locations, or thrombus composition have provided controversial results. Here, we performed a correlation analysis between FPE occurrence and AIS thrombus cellular composition, as assessed using quantitative biochemical assays.

Patients and methods:

Homogenates of AIS thrombi from 250 patients were prepared by mechanical grinding. Platelet, red blood cell (RBC), and leukocyte contents of AIS thrombi were respectively estimated by quantification of GP (glycoprotein) VI, heme, and DNA in thrombus homogenates. FPE was defined as a modified Thrombolysis in Cerebral Infraction (mTICI) score of 2C or 3 after a single EVT device pass.

Results:

AIS thrombi successfully removed after a single pass were poorer in GPVI (0.098 ± 0.023 vs 0.111 ± 0.024 ng/mg, p < 0.001) compared to those whose removal had required several passes. GPVI content was also significantly associated with a higher number of device passes and a longer procedure time. No such significant correlation was found with DNA and heme content.

Discussion and conclusion:

Thrombus platelet content may hamper thrombus removal by EVT. This result suggests that adjunctive therapies or functionalization of retrieval devices targeting platelets may improve EVT efficacy.
Towards a feminist political ecology of health: Mystery kidney disease and the co-production of social, environmental, and bodily difference
Authors: Senanayake Nari
Published: July 2022

This article argues for a more rigorous engagement with intersectionality within political ecologies of health. Building on the work of feminist scholars who explore the co-production of social and ecological differences, I examine how health improvement schemes that target practices of natural resource use concentrate value (economic and ecological) and health dividends in particular bodies at the expense of others. As part of this intervention, I draw on long-term and ongoing ethnographic research in north-central Sri Lanka. This region is an endemic zone for a mysterious and deadly form of kidney disease (CKDu) as well as the site of frenzied health improvement intervention. Specifically, and in response to scientific studies that link kidney disease to agrochemical use and drinking water, an increasingly diverse range of actors, from different branches of the state apparatus to private industries and civil society organizations, have invested heavily in reconfiguring the region’s water supply infrastructure and agrarian landscapes. Through an analysis of resident testimonies, I demonstrate that the burden of subsidizing these new “healthful” practices of water provision and agricultural production is unevenly experienced, as are residents’ abilities to adopt and maintain them over time and space. More crucially, I illustrate how schemes designed to heal turn on the production of differentiated harms, including new gendered labor burdens for poor women, and intensified agrochemical use for ecologically and economically resource-poor farmers. Developing these narratives toward a feminist political ecology of health, I demonstrate how social, ecological, and bodily differences intersect to constitute new patterns of health and harm in the dry zone. I conclude by reflecting on how this approach can explain the paradoxical effects of well-intentioned disease mitigation strategies.
Granulocytic myeloid-derived suppressor cells to prevent and treat murine immune-mediated bone marrow failure
Authors: Feng Xingmin , Kim Jisoo , Gonzalez-Matias Gladys , Aggarwal Nidhi , Manley Ash Lee , Wu Zhijie , Solorzano Sabrina , Batchu Sai , Gao Shouguo , Chen Jichun , Young Neal S.
Published: July 2022

Myeloid-derived suppressor cells (MDSCs) are immature myeloid cells that originate in the bone marrow (BM) and have immunoregulatory functions. MDSCs have been implicated in the pathogenesis of several autoimmune diseases but have not been investigated in immune aplastic anemia (AA). We examined the roles of granulocytic-MDSCs (G-MDSCs) in murine models of human AA and BM failure (BMF). As both prophylaxis and therapy, BM-derived G-MDSCs improved pancytopenia and BM cellularity and suppressed BM T-cell infiltration in major histocompatibility complex (MHC)-matched C.B10 BMF mice. These effects were not obtained in the MHC-mismatched CByB6F1 AA model, likely because of MHC disparity between G-MDSCs and donor T cells. Single-cell RNA sequencing demonstrated that G-MDSCs downregulated cell cycle–related genes in BM-infiltrated T cells, consistent with suppression of T-cell proliferation by G-MDSCs through reactive oxygen species pathways. Clearance of G-MDSCs in the MHC-mismatched CByB6F1 model using anti-Ly6G antibody facilitated T cell–mediated BM destruction, suggesting an intrinsic immunosuppressive property of G-MDSCs. However, the same anti-Ly6G antibody in the MHC-matched C.B10 AA model mildly mitigated BMF, associated with expansion of an intermediate Ly6G population. Our results demonstrate that G-MDSC eradication and therapeutic efficacy are immune context-dependent.
Genetic and immunohistochemical profiling of NK/T-cell lymphomas reveals prognostically relevant BCOR-MYC association
Authors: Oishi Naoki , Satou Akira , Miyaoka Masashi , Kawashima Ichiro , Segawa Takahiro , Miyake Kunio , Mochizuki Kunio , Kirito Keita , Feldman Andrew L. , Nakamura Naoya , Kondo Tetsuo
Published: July 2022

Extranodal NK/T-cell lymphoma, nasal type (ENKTL) is an Epstein-Barr virus-positive, aggressive lymphoma with a heterogeneous cell of origin and variable clinical course. Several clinical prognostic indices have been proposed for ENKTL; however, there are few pathological biomarkers. This multi-institutional study sought to identify histologically assessable prognostic factors. We investigated mutation profiles by targeted next-generation sequencing (NGS) and immunohistochemical assessments of expression of MYC, Tyr705-phosphorylated (p-)STAT3, and CD30 in 71 ENKTL samples. The median age of the patients was 66 years (range, 6-100). The most frequent mutations were in STAT3 (27%), JAK3 (4%), KMT2D (19%), TP53 (13%), BCOR (10%), and DDX3X (7%). Immunohistochemistry (IHC) revealed that ENKTLs with STAT3 mutations exhibited higher expression of pSTAT3 and CD30. BCOR mutations were associated with increased MYC expression. Univariate analysis in the entire cohort showed that stage (II, III, or IV), BCOR mutations, TP53 mutations, and high MYC expression (defined as ≥40% positive neoplastic cells) were associated with reduced overall survival (OS). Multivariate modeling identified stage (II, III, or IV) and high MYC expression as independent adverse prognostic factors. In a subgroup analysis of patients treated with anthracycline (AC)-free chemotherapy and/or radiotherapy (RT) with curative intent, BCOR but not high MYC expression was an independent adverse prognostic factor. In conclusion, activating STAT3 mutations are common in ENKTLs and are associated with increased CD30 expression. MYC overexpression is, at least in part, associated with deleterious BCOR mutations, and this BCOR–MYC linkage may have prognostic significance, underscoring the potential utility of IHC for MYC in risk stratification of patients with ENKTL.
Functional outcome after digit replantation versus amputation
Authors: Bott Sarah M. , Rachunek Katarzyna , Medved Fabian , Bott Thomas S. , Daigeler Adrien , Wahler Theodora
Published: July 2022

Background

The success of digit replantation is mainly based on survival rates. The functional outcome as well as the recovery of sensibility are essential parameters for judging the outcome after digit replantation but have been poorly assessed in previous studies.

Patients and methods

Forty-eight patients with 56 complete traumatic digit amputations occurring between 2008 and 2013 returned for a follow-up examination, the earliest being 6 months postoperatively. Each patient’s range of motion, fingertip-to-table distance, fingertip-to-palm distance, grip and pinch strengths, static two-point discrimination (2-PD), and Semmes–Weinstein monofilament (SWM) test level were assessed in order to compare functional outcome and recovery of sensibility between successful replantation (n = 19) and primary or secondary amputation (n = 37). Subjective assessments of the pain level and function of the upper extremity were performed using the numerical rating scale and the DASH score, respectively.

Results

Replanted digits achieved 58% of the median total range of motion of the corresponding uninjured digits. Grip and pinch strength were not significantly different after thumb or finger replantation or amputation. Recovery of sensibility was excellent after replantation, with a median static 2-PD of 5 mm and a reduction of pressure sensibility of two levels of the SWM test compared to the contralateral side. After amputation, the median static 2-PD was also very good, with a median value of 6 mm and a reduction of pressure sensibility of only one level according to the SWM test. There was significantly less pain after replantation at rest (p = 0.012) and under strain (p = 0.012) compared to patients after amputation. No significant differences were observed in the DASH score between the two groups.

Conclusion

Comparable functional results and sensory recovery but significantly less pain at rest and under strain can be expected after digit replantation when compared to digit amputation.

Level of evidence

IV.
Petrositis caused by fluconazole-resistant candida: case report and literature review
Authors: Jin Ling , Liu Shuangxi , Tan Shiwang , Wang Yang , Zhao Yumin , Yu Shaoqing
Published: July 2022

Background

Petrositis is a rare and fatal complication associated with otitis media. It is most likely caused by bacterial infections, but in some cases it is caused by fungal infections.

Case study

The case in this report is associated with fungal petrositis. The clinical symptoms are: ear pain from chronic otitis media, severe headache, peripheral facial palsy and diplopia. The case was finally confirmed through imaging of middle ear, bacterial culture, pathology, and blood Metagenomic next-generation sequencing (mNGS) test. The patient was treated with sensitive antifungal drugs.

Conclusion

Drug treatment is conservative but efficient method in this case. mNGS can provide pathogenic reference, when antibiotic is not efficient enough for fungal infections or drug-resistant fungal infections cases. This allows we to adjust drug use for the treatment.
Clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia
Authors: Guan Xinxian , Gao Shasha , Zhao He , Zhou Huiting , Yang Yan , Yu Shenglin , Wang Jian
Published: July 2022

Background

Pneumonia is a serious problem that threatens the health of newborns. This study aimed to investigate the clinical characteristics of hospitalized term and preterm infants with community-acquired viral pneumonia.

Methods

This was a retrospective analysis of cases of community-acquired viral pneumonia in the Neonatal Department. Nasopharyngeal aspirate (NPA) samples were collected for pathogen detection, and clinical data were collected. We analysed pathogenic species and clinical characteristics among these infants.

Results

RSV is the main virus in term infants, and parainfluenza virus (PIV) 3 is the main virus in preterm infants. Patients infected with PIV3 were more susceptible to coinfection with bacteria than those with respiratory syncytial virus (RSV) infection (p < 0.05). Preterm infants infected with PIV3 were more likely to be coinfected with bacteria than term infants (p < 0.05), mainly gram-negative bacteria (especially Klebsiella pneumonia). Term infants with bacterial infection were more prone to fever, cyanosis, moist rales, three concave signs, elevated C-reactive protein (CRP) levels, respiratory failure and the need for higher level of oxygen support and mechanical ventilation than those with simple viral infection (p < 0.05). The incidence of hyponatremia in neonatal community-acquired pneumonia (CAP) was high.

Conclusions

RSV and PIV3 were the leading causes of neonatal viral CAP. PIV3 infection is the main cause of viral CAP in preterm infants, and these individuals are more likely to be coinfected with bacteria than term infants, mainly gram-negative bacteria. Term infants with CAP coinfected with bacteria were more likely to have greater disease severity than those with single viral infections.
Social anxiety disorder and its associated factors: a cross-sectional study among medical students, Saudi Arabia
Authors: Al‑Johani Wejdan M. , AlShamlan Nouf A. , AlAmer Naheel A. , Shawkhan Rammas A. , Almayyad Ali H. , Alghamdi Layla M. , Alqahtani Hatem A. , Al-Shammari Malak A. , Gari Danya Mohammed Khalid , AlOmar Reem S.
Published: July 2022

Background

Social Anxiety disorder (SAD) is common worldwide. However, data from Saudi Arabia is deficient. This study aims to determine the prevalence of SAD across Saudi medical students and its associations with sociodemographic factors and their academic performance.

Methods

The main outcome was presence/absence of SAD and the secondary outcome was its level of severity. These were assessed from the Social Phobia Inventory. Associated factors included sociodemographic variables, as well as educational characteristics of students. Descriptive statistics were reported as counts and percentages, and unadjusted and adjusted odds ratios (OR) and their 95% confidence intervals (CIs) were computed through bivariate and multivariate logistic regression.

Results

Of 5896 Saudi medical students who participated in the study, the prevalence of SAD was almost 51%. While 8.21% and 4.21% had reported severe and very severe SAD, respectively. Older age students were at lower risk of developing SAD (OR = 0.92, 95% CI = 0.89 – 0.96). In contrast, females (OR = 1.13, 95% CI = 1.01 – 1.26), students enrolled in private colleges and colleges implementing non-problem-based learning (OR = 1.29, 95% CI = 1.09 – 1.52 and OR = 1.29. 95% CI = 1.15 – 1.46 respectively) were at higher risk. A significant elevated risk of SAD was found among students who had previously failed, and had a low GPA.

Conclusion

SAD is prevalent among the sampled population, and different associated factors were identified. Current results could raise the awareness of faculty members and healthcare providers towards early detection and management of these cases.
Factors associated with loss to follow up among HIV-exposed children: a historical cohort study from 2000 to 2017, in Porto Alegre, Brazil
Authors: da Silva Calvo Karen , Knauth Daniela Riva , Hentges Bruna , Leal Andrea Fachel , da Silva Mariana Alberto , Silva Danielle Lodi , Vasques Samantha Correa , Hamester Letícia , da Silva Daila Alena Raenck , Dorneles Fernanda Vaz , Fraga Fernando Santana , Bobek Paulo Ricardo , Teixeira Luciana Barcellos
Published: July 2022

Background

There are many inequalities in terms of prevention and treatment for pregnant women with HIV and exposed children in low and middle-income countries. The Brazilian protocol for prenatal care includes rapid diagnostic testing for HIV, compulsory notification, and monitoring by the epidemiological surveillance of children exposed to HIV until 18 months after delivery. The case is closed after HIV serology results are obtained. Lost to follow-up is defined as a child who was not located at the end of the case, and, therefore, did not have a laboratory diagnosis. Lost to follow-up is a current problem and has been documented in other countries. This study analyzed factors associated with loss to follow-up among HIV-exposed children, including sociodemographic, behavioral, and health variables of mothers of children lost to follow-up.

Methods

This historical cohort study included information on mothers of children exposed to HIV, born in Porto Alegre, from 2000 to 2017. The research outcome was the classification at the end of the child's follow-up (lost to follow-up or not). Factors associated with loss to follow-up were investigated using the Poisson regression model. Relative Risk calculations were performed. The significance level of 5% was adopted for variables in the adjusted model.

Results

Of 6,836 children exposed to HIV, 1,763 (25.8%) were classified as lost to follow-up. The factors associated were: maternal age of up to 22 years (aRR 1.25, 95% CI: 1.09–1.43), the mother’s self-declared race/color being black or mixed (aRR 1.13, 95% CI: 1.03–1.25), up to three years of schooling (aRR 1.45, 95% CI: 1.26–1.67), between four and seven years of schooling (aRR 1.14, 95% CI: 1.02–1.28), intravenous drug use (aRR 1.29, 95% CI: 1.12–1.50), and HIV diagnosis during prenatal care or at delivery (aRR 1.37, 95% CI: 1.24–1.52).

Conclusion

Variables related to individual vulnerability, such as race, age, schooling, and variables related to social and programmatic vulnerability, remain central to reducing loss to follow-up among HIV-exposed children.
FK506 increases susceptibility to musculoskeletal infection in a rodent model
Authors: Shiels Stefanie M. , Muire Preeti J. , Wenke Joseph C.
Published: July 2022

Background

Delayed fracture healing caused by soft tissue loss can be resolved by the administration of a Th1 immunosuppressant, such as FK506. Additionally, open fractures are at high risk for infection. We hypothesized that the inclusion of an immunosuppressant to a subject at risk for a musculoskeletal infection will increase the likelihood of infection.

Methods

A rat model of musculoskeletal infection was used. Sprague Dawley rats received a stabilized femur defect and were inoculated with 104 CFUStaphylococcus aureusvia a collagen matrix. Six hours after inoculation, the wounds were debrided of collagen and devitalized tissue and irrigated with sterile saline. The animals were randomized into two groups: carrier control and FK506, which were administered daily for 14 days and were euthanized and the tissues harvested to measure local bioburden.

Results

The dosing regimen of FK506 that restored bone healing increased the bioburden in the bone and on the fixation implant compared to the carrier control animals. As expected, the administration of FK506 decreased circulating white blood cells, lymphocytes, neutrophils, and monocytes. Additionally, the red blood cell count, hematocrit, and body weight were lower in those animals that received FK506 compared to carrier control.

Conclusions

FK506 administration decreased the systemic immune cell counts and increased the bacterial bioburden within a model of musculoskeletal infection. Collectively, these outcomes could be attributed to the overall T cell suppression by FK506 and the altered antimicrobial activity of innate cells, thereby allowingS. aureusto thrive and subsequently leading to infection of severe, musculoskeletal injuries. These observations reveal the crucial continued investigation for the clinical use of FK506, and other immunosuppressant compounds, in trauma patients who are at increased risk of developing infections.
Is it necessary to perform a retrosigmoid transposition of the left ureter in Bricker Ileal Conduit surgery?
Authors: Wang Jinyou , Tuo Zhouting , Gao Mingzhu , Min Jie , Wang Yi , Zhang Tao , Yu Dexin , Bi Liangkuan
Published: July 2022

Background

The need for the left ureter to pass through the subsigmoid during ileal conduit diversion surgery has not been investigated in any studies. A modified technique is simply used in the ileal conduit with the left ureter straight over the sigmoid colon due to the possible damage and lack of scientifically validated advantages of this procedure. Our study aimed to investigate the feasibility of the suggested surgical technique, as well as to evaluate perioperative outcomes and postoperative complications with a focus on the prevalence of small bowel obstruction (SBO) and ureteroileal anastomotic stricture (UAS).

Methods

A prospective single-center cohort of 84 consecutive patients undergoing laparoscopic radical cystectomy (LRC) and ileal conduit urinary diversion was conducted between January 2018 and April 2020. The incidence of SBO and UAS, perioperative outcomes, and postoperative complications were compared between a trial group of 30 patients receiving the modified procedure and a control group of 54 patients receiving the conventional Bricker ileal conduit.

Results

The two groups were comparable concerning patient characteristics and clinicopathologic features. No differences were observed in terms of the operation time, perioperative outcomes, and short-term (< 90 days) postoperative complications between the two groups. There were no occurrences of UAS in the modified group, while there were two cases (3.70%) in the patients who received Bricker's ureteroileal anastomosis (p = 0.535).

Conclusion

In the present study, a simple and feasible modified technique of ileal conduit is proposed. Compared with traditional techniques, our method has several advantages, including the ability to avoid compression of the left ureter from the mesentery without establishing a retrosigmoid tunnel, a low rate of UAS, and the ability to perform a secondary operation at long-term follow-up.
A novel brain-controlled wheelchair combined with computer vision and augmented reality
Authors: Liu Kaixuan , Yu Yang , Liu Yadong , Tang Jingsheng , Liang Xinbin , Chu Xingxing , Zhou Zongtan
Published: July 2022

Background

Brain-controlled wheelchairs (BCWs) are important applications of brain–computer interfaces (BCIs). Currently, most BCWs are semiautomatic. When users want to reach a target of interest in their immediate environment, this semiautomatic interaction strategy is slow.

Methods

To this end, we combined computer vision (CV) and augmented reality (AR) with a BCW and proposed the CVAR-BCW: a BCW with a novel automatic interaction strategy. The proposed CVAR-BCW uses a translucent head-mounted display (HMD) as the user interface, uses CV to automatically detect environments, and shows the detected targets through AR technology. Once a user has chosen a target, the CVAR-BCW can automatically navigate to it. For a few scenarios, the semiautomatic strategy might be useful. We integrated a semiautomatic interaction framework into the CVAR-BCW. The user can switch between the automatic and semiautomatic strategies.

Results

We recruited 20 non-disabled subjects for this study and used the accuracy, information transfer rate (ITR), and average time required for the CVAR-BCW to reach each designated target as performance metrics. The experimental results showed that our CVAR-BCW performed well in indoor environments: the average accuracies across all subjects were 83.6% (automatic) and 84.1% (semiautomatic), the average ITRs were 8.2 bits/min (automatic) and 8.3 bits/min (semiautomatic), the average times required to reach a target were 42.4 s (automatic) and 93.4 s (semiautomatic), and the average workloads and degrees of fatigue for the two strategies were both approximately 20.

Conclusions

Our CVAR-BCW provides a user-centric interaction approach and a good framework for integrating more advanced artificial intelligence technologies, which may be useful in the field of disability assistance.
Lipidomic identification of urinary extracellular vesicles for non-alcoholic steatohepatitis diagnosis
Authors: Zhu Qingfu , Li Hengrui , Ao Zheng , Xu Hao , luo Jiaxin , Kaurich Connor , Yang Rui , Zhu Pei-Wu , Chen Sui-Dan , Wang Xiao-Dong , Tang Liang-Jie , Li Gang , Huang Ou-Yang , Zheng Ming-Hua , Li Hui-Ping , Liu Fei
Published: July 2022

Background and Aims

Non-alcoholic fatty liver disease (NAFLD) is a usual chronic liver disease and lacks non-invasive biomarkers for the clinical diagnosis and prognosis. Extracellular vesicles (EVs), a group of heterogeneous small membrane-bound vesicles, carry proteins and nucleic acids as promising biomarkers for clinical applications, but it has not been well explored on their lipid compositions related to NAFLD studies. Here, we investigate the lipid molecular function of urinary EVs and their potential as biomarkers for non-alcoholic steatohepatitis (NASH) detection.

Methods

This work includes 43 patients with non-alcoholic fatty liver (NAFL) and 40 patients with NASH. The EVs of urine were isolated and purified using the EXODUS method. The EV lipidomics was performed by LC-MS/MS. We then systematically compare the EV lipidomic profiles of NAFL and NASH patients and reveal the lipid signatures of NASH with the assistance of machine learning.

Results

By lipidomic profiling of urinary EVs, we identify 422 lipids mainly including sterol lipids, fatty acyl lipids, glycerides, glycerophospholipids, and sphingolipids. Via the machine learning and random forest modeling, we obtain a biomarker panel composed of 4 lipid molecules including FFA (18:0), LPC (22:6/0:0), FFA (18:1), and PI (16:0/18:1), that can distinguish NASH with an AUC of 92.3%. These lipid molecules are closely associated with the occurrence and development of NASH.

Conclusion

The lack of non-invasive means for diagnosing NASH causes increasing morbidity. We investigate the NAFLD biomarkers from the insights of urinary EVs, and systematically compare the EV lipidomic profiles of NAFL and NASH, which holds the promise to expand the current knowledge of disease pathogenesis and evaluate their role as non-invasive biomarkers for NASH diagnosis and progression.
Benchmarking AutoML frameworks for disease prediction using medical claims
Authors: A. Romero Roland Albert , Y. Deypalan Mariefel Nicole , Mehrotra Suchit , Jungao John Titus , Sheils Natalie E. , Manduchi Elisabetta , Moore Jason H.
Published: July 2022

Objectives

Ascertain and compare the performances of Automated Machine Learning (AutoML) tools on large, highly imbalanced healthcare datasets.

Materials and Methods

We generated a large dataset using historical de-identified administrative claims including demographic information and flags for disease codes in four different time windows prior to 2019. We then trained three AutoML tools on this dataset to predict six different disease outcomes in 2019 and evaluated model performances on several metrics.

Results

The AutoML tools showed improvement from the baseline random forest model but did not differ significantly from each other. All models recorded low area under the precision-recall curve and failed to predict true positives while keeping the true negative rate high. Model performance was not directly related to prevalence. We provide a specific use-case to illustrate how to select a threshold that gives the best balance between true and false positive rates, as this is an important consideration in medical applications.

Discussion

Healthcare datasets present several challenges for AutoML tools, including large sample size, high imbalance, and limitations in the available features. Improvements in scalability, combinations of imbalance-learning resampling and ensemble approaches, and curated feature selection are possible next steps to achieve better performance.

Conclusion

Among the three explored, no AutoML tool consistently outperforms the rest in terms of predictive performance. The performances of the models in this study suggest that there may be room for improvement in handling medical claims data. Finally, selection of the optimal prediction threshold should be guided by the specific practical application.