bluuebunny/crossref_metadata_2025 huggingface dataset:
Scoping review: Evidence for long-term follow-up and monitoring in shoulder and elbow arthroplasty
Authors: Morris Daniel Leslie James , Candal-Couto Jaime , Watts Adam Charles , Rangan Amar , Tambe Amol
Published: February 2023

Aims

Long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty remains contentious, with a wide spectrum of non-evidence-based mechanisms used. This scoping review aims to outline related evidence, thereby informing research requirements.

Methods

Studies relevant to shoulder and elbow arthroplasty follow-up, surveillance and time-related failure were included. The review included randomised controlled trials, systematic reviews and economic studies indexed in MEDLINE, Embase, Cochrane CDSR and Cochrane CENTRAL since 1 January 2012. In addition, all registry studies, follow-up studies, cohort studies and case reports indexed in MEDLINE since 1 January 2020 were included. The screening was undertaken by two reviewers. Key characteristics of each study were described, alongside a narrative review.

Results

Twenty-one articles were included. We were unable to identify evidence that long-term follow-up and monitoring of asymptomatic shoulder and elbow arthroplasty identifies failure or leads to a revision that is of reduced patient morbidity and cost. In addition, no evidence was apparent to inform whether patients will self-present with a failing implant. Several surveillance mechanisms were identified.

Conclusion

This scoping review highlights the paucity of evidence related to long-term follow-up and monitoring of shoulder and elbow arthroplasty, and the need for high-quality data to inform the development of evidence-based care pathways.
Combatting with challenges in medical education during COVID-19 pandemic: A mixed-methods study on the effectiveness of e-learning in pediatric clinical clerkship of a university hospital, Pakistan
Authors: Saeed Sana , Raza Mahanoor , Kaleem Sidra , Qureshi Sonia , Hussain Areeba , Aslam Nadeem , Madhwani Akber
Published: February 2023

The purpose of this research is to ascertain the effectiveness of using the e-learning method for a module in pediatric clerkship at the [redacted name] University Hospital, Karachi. The fourth-year undergraduate medical students, who rotates for eight weeks in Pediatric clerkship, participated in this study. It was a sequential (Quantitative-Qualitative) mixed-method study, which was conducted from May-August 2020. Students were divided according to their status of in-person rotation (Novice, Semi-expert, Expert). The quantitative component of the study consisted of pre and post-tests and pre-validated post-session feedback., while focused-group discussions were done to explore students’ experiences. SPSS version 20.0 was used for quantitative data while qualitative data underwent content analysis. Fifty-nine participants (68.8%) were female. The intervention batch comprised of 102 students (41 Novice (40.2%), 21 Semi-expert (19.6%), and 40 Expert (39.2%)). Using paired t-test analysis between pre and post-test scores of each session, it was discerned that there was indeed a positive effect on knowledge acquisition during each session, depicted by the improvement in test scores. The Semi-expert and Expert groups were merged for analysis. The Novice group was found to be statistically significant for only the common newborn problem session. The qualitative component explored students' views, and three main themes emerged, i.e., the effectiveness of online learning, barriers and challenges to online learning, and future goals to enhance online learning. In conclusion, E-learning is an effective way of continuing the process of delivering medical education, especially in unprecedented times. Technological enhancements will help carry the impact forward as a blended-learning pedagogical approach in undergraduate medical education.
Ruptures of the Anthropocene: A crisis of justice
Authors: Kumar Ankit
Published: February 2023

The Anthropocene and associated sense of crises, most prominently climate change, have opened up an urgency versus justice dilemma. While an epochal thinking drives the urgency, it is essential to attend to the ruptures illustrated by historical events like colonisation that shape the fabric of the Anthropocene and its impacts. Historical patterns of extraction and racialisation that underline the Anthropocene and climate change fit neatly into the schema for contemporary and future energy transitions shaped by an apolitical discourse of urgency and emergency. Attending to the historical ruptures helps root universal and apolitical urgency in justice for/from particular places and peoples and reframe ideas like climate emergency and climate crisis as more accurate climate justice emergency and climate justice crisis.
Improving the reliability of smartphone-based urine colorimetry using a colour card calibration method
Authors: Noor Azhar Muhaimin , Bustam Aida , Naseem Fathmath Sausan , Shuin Soo Siew , Md Yusuf Mohd Hafyzuddin , Hishamudin Naseeha Ubaidi , Poh Khadijah
Published: February 2023

Objective

Urine colorimetry using a digital image–based colorimetry is potentially an accessible hydration assessment method. This study evaluated the agreement between urine colorimetry values measured with different smartphone brands under various lighting conditions in patients with dengue fever.

Methods

The urine samples were photographed in a customized photo box, under five simulated lighting conditions, using five smartphones. These images were analyzed using Adobe Photoshop to obtain urine Red, Green and Blue (RGB) values with and without colour correction. A commercially available colour calibration card was used for colour correction. Using intraclass correlation coefficient (ICC), inter-phone and intra-phone agreements of urine RGB values were analyzed.

Results

Without colour correction, the various smartphones produced the highest agreement for Blue and Green values under the ‘daylight’ lighting condition. With colour correction, ICC values showed ‘exceptional’ inter-phone and intra-phone agreement for the Blue and Green values (ICC > 0.9). Red values showed ‘poor’ (ICC < 0.5) agreement with and without colour correction in all lighting conditions. Out of the five phones compared in this study, Phone 4 produced the lowest intra-phone agreement.

Conclusions

Colour calibration using photo colour cards improved the reliability of smartphone-based urine colorimetry, making this a promising point-of-care hydration assessment tool using the ubiquitous smartphone.
“Asians Are the Least Troublemaker”: Navigating Racial In-betweenness in Korean American Community-based Spaces
Authors: Park Eujin
Published: February 2023

While Asian Americans have long been positioned as a deserving and productive racial foil to problematic and unworthy Black and Latinx communities, in recent years, they have been more frequently portrayed as actively politicized in opposition to other communities of color. Despite this portrayal in the media, social science research reveals a much more complicated portrait of Asian American racial positioning that explores how Asian Americans diversely navigate their racial in-betweenness, or what Leslie Bow calls racial interstitiality. Contributing to this research, this article analyzes how Korean Americans, as a racialized ethnic group, engage with Whiteness and their own racial position within co-ethnic community spaces. Drawing from a multi-sited ethnography of a Korean language school and an ethnic supplementary academy (called hagwon) in the Chicago suburbs, the article argues that co-ethnic community spaces are active sites of racialization that both challenge and reproduce White dominance. In these spaces, Korean Americans forged counter-narratives for their children but simultaneously reified dominant narratives relating to Whiteness, anti-Blackness, and Asian Americans. The findings strengthen scholarly understandings of how Asian Americans understand their racial identities in relation to others, the role of community institutions in racialization, and how the damaging logics of White supremacy can seep into non-White spaces.
Quality metrics in the management of acute stroke in Greece during the first 5 years of Registry of Stroke Care Quality (RES-Q) implementation
Authors: Palaiodimou Lina , Kargiotis Odysseas , Katsanos Aristeidis H , Kiamili Argyro , Bakola Eleni , Komnos Apostolos , Zisimopoulou Vaso , Natsis Konstantinos , Papagiannopoulou Georgia , Theodorou Aikaterini , Zompola Christina , Safouris Apostolos , Psychogios Klearchos , Ntais Evangelos , Plomaritis Panagiotis , Karamatzianni Georgia , Mavriki Andriana , Koutsokera Maria , Lykou Christina , Koutroulou Ioanna , Gourbali Vanessa , Skafida Anastasia , Roussopoulou Andromachi , Kourtesi Georgia , Papamichalis Panagiotis , Papagiannopoulos Sotirios , Gryllia Maria , Tavernarakis Antonios , Kazis Dimitrios , Karapanayiotides Theodoros , Magoufis Georgios , Giannopoulos Sotirios , Tsivgoulis Georgios
Published: February 2023

Introduction:

Establishment of a prospective stroke registry may promote the documentation and improvement of acute stroke care. We present the status of stroke management in Greece using the Registry of Stroke Care Quality (RES-Q) dataset.

Methods:

Consecutive patients with acute stroke were prospectively registered in RES-Q registry by contributing sites in Greece during the years 2017–2021. Demographic and baseline characteristics, acute management, and clinical outcomes at discharge were recorded. Stroke quality metrics, with a specific interest in the association between acute reperfusion therapies and functional recovery in ischemic stroke patients are presented.

Results:

A total of 3590 acute stroke patients were treated in 20 Greek sites (61% men, median age 64 years; median baseline NIHSS 4; 74% ischemic stroke). Acute reperfusion therapies were administered in almost 20% of acute ischemic stroke patients, with a door to needle and door to groin puncture times of 40 and 64 min, respectively. After adjustment for contributing sites, the rates of acute reperfusion therapies were higher during the time epoch 2020–2021 compared to 2017–2019 (adjusted OR 1.31; 95% CI 1.04–1.64; p < 0.022; Cochran-Mantel-Haenszel test). After propensity-score-matching, acute reperfusion therapies administration was independently associated with higher odds of reduced disability (one point reduction across all mRS scores) at hospital discharge (common OR 1.93; 95% CI 1.45–2.58; p < 0.001).

Conclusions:

Implementation and maintenance of a nationwide stroke registry in Greece may guide the stroke management planning, so that prompt patient transportation, acute reperfusion therapies, and stroke unit hospitalization become more widely accessible, improving the functional outcomes of stroke patients.
Arthroscopic-Assisted Anterior Glenoid Reconstruction Using Nonrigid Fixation With Distal Tibia Osteochondral Allograft
Authors: Hoyt Benjamin W. , Riccio Cory A. , Tokish John M. , LeClere Lance E. , Kilcoyne Kelly G. , Dickens Jonathan F.
Published: February 2023

Introduction:

Traumatic anterior glenohumeral instability events result in a capsulolabral (Bankart lesion) and/or osseous injury with subsequent attritional bone loss, particularly with recurrence. Up to 88% of patients with recurrent instability experience glenoid bone loss, which predisposes to future dislocations and subluxations, even with arthroscopic capsulolabral repair. The surgical management of glenoid bone loss includes a number of different techniques such as the Latarjet or coracoid transfer as well as other osseous and osteoarticular autografts and allografts. However, operative management of shoulder instability has increasingly shifted toward arthroscopic approaches with preservation of anatomy when possible.

Indications:

Arthroscopic-assisted allograft distal tibia bone block augmentation to the anterior glenoid is indicated for revision anterior glenohumeral instability procedures with anterior bone loss and in primary cases of anterior instability with critical bone loss.

Technique:

Our technique for nonrigid arthroscopic anterior glenoid reconstruction with allograft distal tibia and anterior labral repair is performed preferentially in the lateral position without necessitating patient repositioning. The preplanned tibial bone block is prepared on a back table prior to the arthroscopic procedure. After creation of portals and elevation of labral tissue, a guide and drill are used to introduce a retrograde reamer which is deployed to create a perpendicular edge for apposition of the allograft tibia. The bone block is then introduced through a rotator interval portal by pulling sutures retrograde through glenoid bone tunnels and is secured to the prepared surface medial to the liberated labrum. The articular surface of the graft and glenoid are aligned and suture-based fixation is used to compress the bone block against the native glenoid. The anterior labral tissue is then mobilized over the graft and repaired to the native glenoid when possible.

Description/Conclusion:

The benefits of allograft tibia augmentation for anterior instability with glenoid bone loss include an anatomic joint surface restoration including articular cartilage, lack of donor site morbidity, and a minimally invasive arthroscopic approach. When performed arthroscopically and with nonrigid fixation, this technique permits concurrent anterior labral repair and anatomic reconstruction, safe graft passage without necessity of a far medial portal, and expeditious return to function.
Reduced proliferation of bone marrow MSC after allogeneic stem cell transplantation is associated with clinical outcome
Authors: Katzerke Christiane , Schaffrath Judith , Lützkendorf Jana , Janssen Maike , Merbach Anne-Kathrin , Nerger Katrin , Binder Mascha , Baum Cornelia , Lauer Kirstin , Rohde Christian , Willscher Edith , Müller-Tidow Carsten , Müller Lutz P.
Published: February 2023

Engraftment and differentiation of donor hematopoietic stem cells is decisive for the clinical success of allogeneic stem cell transplantation (alloSCT) and depends on the recipient’s bone marrow (BM) niche. A damaged niche contributes to poor graft function after alloSCT; however, the underlying mechanisms and the role of BM multipotent mesenchymal stromal cells (MSC) are ill-defined. Upon multivariate analysis in 732 individuals, we observed a reduced presence of proliferation-capable MSC in BM aspirates from patients (N = 196) who had undergone alloSCT. This was confirmed by paired analysis in 30 patients showing a higher frequency of samples with a lack of MSC presence post-alloSCT compared with pre-alloSCT. This reduced MSC presence was associated with reduced survival of patients after alloSCT and specifically with impaired graft function. Post-alloSCT MSC showed diminished in vitro proliferation along with a transcriptional antiproliferative signature, upregulation of epithelial-mesenchymal transition and extracellular matrix pathways, and altered impact on cytokine release upon contact with hematopoietic cells. To avoid in vitro culture bias, we isolated the CD146+/CD45–/HLA-DR– BM cell fraction, which comprised the entire MSC population. The post-alloSCT isolated native CD146+MSC showed a similar reduction in proliferation capacity and shared the same antiproliferative transcriptomic signature as for post-alloSCT colony-forming unit fibroblast–derived MSC. Taken together, our data show that alloSCT confers damage to the proliferative capacity of native MSC, which is associated with reduced patient survival after alloSCT and impaired engraftment of allogeneic hematopoiesis. These data represent the basis to elucidate mechanisms of BM niche reconstitution after alloSCT and its therapeutic manipulation.
Cobalt-doped double-layer α-Fe2O3 nanorod arrays for enhanced photoelectrochemical reduction of Cr(VI)
Authors: Bai Long , Wang Jueyu , Yang Kuo , Yan Yi , Jin Meitong , Cui Daizong , Zhao Min
Published: February 2023

Element doping is an important method for improving the performance levels of photoelectrochemical (PEC) cells. Nevertheless, to date, the PEC conversion efficiency and photocurrent characteristics of the available photoanodes remain very low. In this study, cobalt (Co) was selectively doped into the bottom and/or top layers of double-layered α-Fe2O3 nanorod arrays grown on conductive transparent substrates (F:SnO2, FTO) via a two-step hydrothermal method; this process was performed to enhance the charge transfer ability and thus significantly improve the PEC performance. The light response capabilities of all α-Fe2O3 films were evaluated by an electrochemical workstation under dark or visible light irradiation conditions. The sample of Co doped in the bottom layer exhibited a high photoelectrochemical performance, achieving a current density of 1.37 mA/cm2 at + 1.0 V versus saturated calomel electrode (SCE); additionally, the sample exhibited a photoelectric synergistic ability to reduce Cr(VI) in an aqueous solution, with 84.85% reduction in 180 min. Under the influence of the electric field inside the double-layer electrode, the photoexcited electrons and holes are transferred to the surfaces of the FTO substrate and the photoanode, increasing the current density and enhancing Cr(VI) reduction. The results of this study offer an alternative approach for designing novel photoanodes with improved PEC performance levels by engineering the electron density distribution and band structure for efficient carrier separation; the results may provide new solutions in heavy metal reduction and contaminant degradation projects.
microRNA regulation of skin pigmentation in golden-back mutant of crucian carp from a rice-fish integrated farming system
Authors: Zhang Xianbo , Luo Mingkun , Jiang Bingjie , Zhu Wenbin , Min Qianwen , Hu Jinli , Liu Ting , Fu Jianjun , Shi Xiulan , Wang Pan , Wang Lanmei , Dong Zaijie
Published: February 2023

Background

MicroRNAs (miRNAs) are endogenous small non-coding RNAs (21–25 nucleotides) that act as essential components of several biological processes. Golden-back crucian carp (GBCrC, Carassius auratus) is a naturally mutant species of carp that has two distinct body skin color types (golden and greenish-grey), making it an excellent model for research on the genetic basis of pigmentation. Here, we performed small RNA (sRNA) analysis on the two different skin colors via Illumina sequencing.

Results

A total of 679 known miRNAs and 254 novel miRNAs were identified, of which 32 were detected as miRNAs with significant differential expression (DEMs). 23,577 genes were projected to be the targets of 32 DEMs, primarily those involved in melanogenesis, adrenergic signaling in cardiomyocytes, MAPK signaling pathway and wnt signaling pathway by functional enrichment. Furthermore, we built an interaction module of mRNAs, proteins and miRNAs based on 10 up-regulated and 13 down-regulated miRNAs in golden skin. In addition to transcriptional destabilization and translational suppression, we discovered that miRNAs and their target genes were expressed in the same trend at both the transcriptional and translational levels. Finally, we discovered that miR-196d could be indirectly implicated in regulating melanocyte synthesis and motility in the skin by targeting to myh7 (myosin-7) gene through the luciferase reporter assay, antagomir silencing in vivo and qRT-PCR techniques.

Conclusions

Our study gives a systematic examination of the miRNA profiles expressed in the skin of GBCrC, assisting in the comprehension of the intricate molecular regulation of body color polymorphism and providing insights for C. auratus breeding research.
Development of unigene-derived SSR markers from RNA-seq data of Uraria lagopodioides (Fabaceae) and their application in the genus Uraria Desv. (Fabaceae)
Authors: Liu Chaoyu , Zhang Maomao , Zhao Xueli
Published: February 2023

Background

Uraria Desv. belongs to the tribe Desmodieae (Fabaceae), a group of legume plants, some of which have medicinal properties. However, due to a lack of genomic information, the interspecific relationships, genetic diversity, population genetics, and identification of functional genes within Uraria species are still unclear.

Results

Using RNA-Seq, a total of 66,026 Uraria lagopodioides unigenes with a total sequence content of 52,171,904 bp were obtained via de novo assembly and annotated using GO, KEGG, and KOG databases. 17,740 SSRs were identified from a set of 66,026 unigenes. Cross-species amplification showed that 54 out of 150 potential unigene-derived SSRs were transferable in Uraria, of which 19 polymorphic SSRs were developed. Cluster analysis based on polymorphisms successfully distinguished seven Uraria species and revealed their interspecific relationships. Seventeen samples of seven Uraria species were clustered into two monophyletic clades, and phylogenetic relationships of Uraria species based on unigene-derived SSRs were consistent with classifications based on morphological characteristics.

Conclusions

Unigenes annotated in the present study will provide new insights into the functional genomics of Uraria species. Meanwhile, the unigene-derived SSR markers developed here will be invaluable for assessing the genetic diversity and evolutionary history of Uraria and relatives.
Evaluating the effects of Esmolol on cardiac function in patients with Septic cardiomyopathy by Speck-tracking echocardiography—a randomized controlled trial
Authors: Wang Junyi , Gao Xinjing , He Zhengzhong , Wang Jinxiang , Xu Guowu , Li Tong
Published: February 2023

Background

Esmolol as one treatment of sepsis induced cardiomyopathy (SIC) is still controversial. The objective of this study is to evaluate cardiac function after reducing heart rate by Esmolol in patients with SIC using speck-tracking echocardiography.

Methods

This study was a single-center, prospective, and randomized controlled study. A total of 100 SIC patients with a heart rate more than 100/min, admitted to the Intensive Care Department of Tianjin Third Central Hospital from March 1, 2020 to September 30, 2021, were selected as the research subjects. They were randomly divided into the Esmolol group (Group E) and the conventional treatment group (Group C), each with 50 cases. The target heart rate of patients in Group E was controlled between 80/min and 100/min. Speck-tracking echocardiography (STE) and pulse indicating continuous cardiac output monitoring (PICCO) were performed in both groups at 1 h, 24 h, 48 h, 72 h, 96 h and 7 d after admission, with data concerning left ventricular global longitudinal strain (GLS), left ventricular ejection fraction (LVEF) and global ejection fraction (GEF), left ventricular systolic force index (dP/dtmx) were obtained, respectively. Hemodynamics and other safety indicators were monitored throughout the whole process. These subjects were followed up to 90 d, with their mortality recorded at Day 28 and Day 90, respectively. Statistical analyses were performed using SPSS version 21.

Results

With 24 h of Esmolol, all patients in Group E achieved the target heart rate, and there was no deterioration of GLS, or adverse events. However, compared with those in Group C, their GLS, GEF and dP/dtmx were increased, and the difference was statistically significant (P > 0.05). Compared with patients in Group C, those in Group E had lower short-term mortality, and logistic regression analysis also suggested that Esmolol improved patient outcomes.

Conclusion

In SIC patients, the application of Esmolol to lower heart rate decreased their short-term mortality while not making any impairment on the myocardial contractility.

Trial registration

Chinese Clinical Trial Registry, ChiCTR2100047513. Registered June 20, 2021- Retrospectively registered, http://www.chictr.org.cn/index.aspx. The study protocol followed the CONSORT guidelines. The study protocol was performed in the relevant guidelines.
Myocardial injury after major non-cardiac surgery evaluated with advanced cardiac imaging: a pilot study
Authors: Álvarez-Garcia Jesús , Popova Ekaterine , Vives-Borrás Miquel , de Nadal Miriam , Ordonez-Llanos Jordi , Rivas-Lasarte Mercedes , Moustafa Abdel-Hakim , Solé-González Eduard , Paniagua-Iglesias Pilar , Garcia-Moll Xavier , Viladés-Medel David , Leta-Petracca Rubén , Oristrell Gerard , Zamora Javier , Ferreira-González Ignacio , Alonso-Coello Pablo , Carreras-Costa Francesc
Published: February 2023

Background

Myocardial injury after non-cardiac surgery (MINS) is a frequent complication caused by cardiac and non-cardiac pathophysiological mechanisms, but often it is subclinical. MINS is associated with increased morbidity and mortality, justifying the need to its diagnose and the investigation of their causes for its potential prevention.

Methods

Prospective, observational, pilot study, aiming to detect MINS, its relationship with silent coronary artery disease and its effect on future adverse outcomes in patients undergoing major non-cardiac surgery and without postoperative signs or symptoms of myocardial ischemia. MINS was defined by a high-sensitive cardiac troponin T (hs-cTnT) concentration > 14 ng/L at 48–72 h after surgery and exceeding by 50% the preoperative value; controls were the operated patients without MINS. Within 1-month after discharge, cardiac computed tomography angiography (CCTA) and magnetic resonance imaging (MRI) studies were performed in MINS and control subjects. Significant coronary artery disease (CAD) was defined by a CAD-RADS category ≥ 3. The primary outcomes were prevalence of CAD among MINS and controls and incidence of major cardiovascular events (MACE) at 1-year after surgery. Secondary outcomes were the incidence of individual MACE components and mortality.

Results

We included 52 MINS and 12 controls. The small number of included patients could be attributed to the study design complexity and the dates of later follow-ups (amid COVID-19 waves). Significant CAD by CCTA was equally found in 20 MINS and controls (30% vs 33%, respectively). Ischemic patterns (n = 5) and ischemic segments (n = 2) depicted by cardiac MRI were only observed in patients with MINS. One-year MACE were also only observed in MINS patients (15.4%).

Conclusion

This study with advanced imaging methods found a similar CAD frequency in MINS and control patients, but that cardiac ischemic findings by MRI and worse prognosis were only observed in MINS patients. Our results, obtained in a pilot study, suggest the need of further, extended studies that screened systematically MINS and evaluated its relationship with cardiac ischemia and poor outcomes.

Trial registration Clinicaltrials.gov identifier: NCT03438448 (19/02/2018).
Application of food exchange portion method in home-based nutritional intervention for elderly patients with chronic heart failure
Authors: Zhou Ce , Wang Shan , Sun Xing , Han Yuhao , Zhang Li , Liu Meixia
Published: February 2023

Background

The home treatment of elderly patients with chronic heart failure (CHF) is often accompanied by malnutrition, which increases the risk of re-hospitalisation and affects the prognosis. Therefore, how to effectively improve the nutritional self-management of patients is a current focus of medical research. This study aims to test the effect of home-based nutritional intervention method on improving the nutritional status of elderly patients with CHF.

Methods

A total of 90 hospitalised elderly patients with CHF were randomly divided into the experimental group (n = 45) and the control group (n = 45). The patients in both groups were given standardised drug therapy and their nutritional status was evaluated using a body composition analyser prior to discharge (protein, body fat percentage, visceral fat area, skeletal muscle, upper arm muscle circumference, left lower limb and right lower limb muscle mass), with the cardiopulmonary function evaluated using a six-minute walk test and the metabolic equivalents method. The control group was given general nutrition education and routine dietary guidance from cardiac rehabilitation nurses, while the experimental group was given an individualised nutrition prescription by dietitians based on the evaluation results, according to which one-to-one food exchange dietary intervention training was given until the patients mastered the process.

Results

The nutritional indexes at the end of the study were significantly higher in the experimental group than in the control group and were higher than those before the intervention (P < 0.05). The muscle circumference of the upper arm, the muscle mass of the left lower limb and the right lower limb had no statistical significance following the intervention compared to the control group and before the intervention (P > 0.05). The cardiopulmonary function indexes were significantly better in the experimental group at the end of the study than before the intervention and were better than those in the control group, with statistically significant differences (P < 0.05), while no significant changes were observed in the control group before and after the intervention (P > 0.05).

Conclusion

The home-based nutritional intervention method of food exchange portions can effectively improve the nutritional status of elderly patients with CHF, with the distribution of visceral fat more reasonable and the cardiopulmonary function and exercise endurance improved.
Be aware of non-specific presentation of pulmonary embolism: a case report
Authors: Li Hang , Dai Qinghai , Shu Lingfeng , Yang Dongyi , Wu Tao
Published: February 2023

Background

The early diagnosis of non-specific presentation of pulmonary embolism (PE) is difficult because the symptoms are non-specific and varied.

Case presentation

A 69-year-old female patient had syncope accompanied by gait disturbance, without obvious inducement. The patient was initially suspected to have cerebral infarction, but the symptoms did not improve and myocardial markers increased after two days of symptomatic treatment for myocardial infarction. Hence, PE was suspected and computed tomography pulmonary angiography (CTPA) examination confirmed the diagnosis. CTPA showed multiple emboli in pulmonary artery and its branches, so high-risk PE was diagnosed. Intravenous thrombolysis was administered, and pulmonary CTA showed a significant reduction of emboli in pulmonary artery and its left and right branches.

Conclusion

This case report highlights the importance of improving the clinical awareness about non-specific presentation of PE and avoiding misdiagnosis or missed diagnosis.
Proteinuria is a risk factor for acute kidney injury after cardiac surgery in patients with stages 3–4 chronic kidney disease: a case control study
Authors: Jiang Wuhua , Chen Zhihong , Xu Jiarui , Luo Zhe , Teng Jie , Ding Xiaoqiang , Zhao Shuan , Xu Xialian
Published: February 2023

Background

Acute kidney injury (AKI) is a common complication after cardiac surgery, and preoperative renal dysfunction is an important risk factor. Proteinuria indicates renal structural damage, but there are few studies on proteinuria and the risk of AKI after cardiac surgery in patients with renal dysfunction. This study aimed to elucidate whether proteinuria can predict AKI after cardiac surgery in patients with renal dysfunction.

Methods

Patients with stages 3–4 chronic kidney disease (CKD) who underwent cardiac surgery were included in this retrospective study. AKI was defined according to the KDIGO criteria. The association between proteinuria and AKI in patients with CKD stages 3–4 was investigated.

Results

The incidence of AKI in the entire cohort (n = 1546) was 53.55%. The in-hospital mortality of patients with was higher than patients without AKI (AKI vs. no AKI, 4.7 vs. 0.8%, P < 0.001). Multivariate logistic regression analysis showed that proteinuria was an independent risk factor for AKI (trace to 1+ OR 2.37; 2+ –3+ OR 5.16) and AKI requiring renal replacement therapy (AKI-RRT) (trace to 1+ OR 3.64; 2+–3+ OR 5.71). Mild proteinuria (trace to 1+ OR 2.59) was also an independent risk factor for in-hospital death. In patients with diabetes mellitus, mild proteinuria (OR 1.925), instead of severe proteinuria (2–3+), was a risk factor of AKI in patients with kidney dysfunction and diabetes.

Conclusions

In the population of patients with renal dysfunction, the incidence of AKI was high, which significantly compromised renal and overall prognosis. As a simple and inexpensive routine test, preoperative proteinuria still has value in predicting AKI in patients with impaired renal function.
Contemporary aetiology of acute heart failure in a teaching hospital in Ghana
Authors: Agyekum Francis , Folson Aba A. , Asare Bernard Yeboah-Asiamah , Doku Alfred , Kpodonu John , Okine Rafiq , Fokuoh Forster , Akamah Joseph Atiah
Published: February 2023

Background

Heart failure (HF) is recognized as a global public health disease associated with high morbidity and mortality. It is suggested that the main underlying causes of HF in developing countries differ from those identified in well-resourced countries. This study therefore presents the cardiovascular risk factors and the underlying aetiology of HF among admitted patients in a teaching Hospital in Ghana.

Method

The study prospectively recruited 140 consecutive patients admitted for heart failure at the Medical department of the Korle-Bu Teaching Hospital from March to October, 2014. The study evaluated the cardiovascular risk factors and the aetiologies of heart failure, and compared the risk factors and aetiologies with patient’s age and gender.

Results

The mean age of the study participants was 51.3 ± 16.8 years. The commonest cardiovascular risk factors observed were hypertension (46.5%), history of previous HF (40.7%), excessive alcohol use (38.6%), and family history of heart disease (29.3%); predominantly hypertension (68.3%). The major underlying aetiology of HF were dilated cardiomyopathy (38.6%), hypertensive heart disease (21.4%), ischaemic heart disease (13.6%) and valvular heart disease (12.9%). These underlying aetiology of HF were more common in patients aged 40 years and above (p = 0.004) and those presenting with multiple risk factors (p = 0.001).

Conclusion

The major underlying aetiology of heart failure in adults were dilated cardiomyopathy, hypertensive heart disease, ischaemic heart disease and valvular heart disease, which were significantly high among patients aged 40 years and above and those presenting multiple risk factors. Hypertension, excessive alcohol use, family history of heart disease and personal history of previous heart failure diagnosis are noted as the main cardiovascular risk factors among heart failure patients.
When a joint model should be preferred over a linear mixed model for analysis of longitudinal health-related quality of life data in cancer clinical trials
Authors: Touraine Célia , Cuer Benjamin , Conroy Thierry , Juzyna Beata , Gourgou Sophie , Mollevi Caroline
Published: February 2023

Background

Patient-reported outcomes such as health-related quality of life (HRQoL) are increasingly used as endpoints in randomized cancer clinical trials. However, the patients often drop out so that observation of the HRQoL longitudinal outcome ends prematurely, leading to monotone missing data. The patients may drop out for various reasons including occurrence of toxicities, disease progression, or may die. In case of informative dropout, the usual linear mixed model analysis will produce biased estimates. Unbiased estimates cannot be obtained unless the dropout is jointly modeled with the longitudinal outcome, for instance by using a joint model composed of a linear mixed (sub)model linked to a survival (sub)model. Our objective was to investigate in a clinical trial context the consequences of using the most frequently used linear mixed model, the random intercept and slope model, rather than its corresponding joint model.

Methods

We first illustrate and compare the models on data of patients with metastatic pancreatic cancer. We then perform a more formal comparison through a simulation study.

Results

From the application, we derived hypotheses on the situations in which biases arise and on their nature. Through the simulation study, we confirmed and complemented these hypotheses and provided general explanations of the bias mechanisms.

Conclusions

In particular, this article reveals how the linear mixed model fails in the typical situation where poor HRQoL is associated with an increased risk of dropout and the experimental treatment improves survival. Unlike the joint model, in this situation the linear mixed model will overestimate the HRQoL in both arms, but not equally, misestimating the difference between the HRQoL trajectories of the two arms to the disadvantage of the experimental arm.
Adjusting for outcome risk factors in immigrant datasets: total or direct effects?
Authors: Nilsen Roy Miodini , Klungsøyr Kari , Stigum Hein
Published: February 2023

Background

When quantifying differences in health outcomes between immigrants and non-immigrants, it is common practice to adjust for observed differences in outcome risk factors between the groups being compared. However, as some of these outcome risk factors may act as mediators on the causal path between the exposure and outcome, adjusting for these may remove effects of factors that characterize the immigrants rather than removing a bias between immigrants and non-immigrants.

Methods

This study investigates the underlying conditions for which adjusting for outcome risk factors in regression models can lead to the estimation of either total or direct effect for the difference in health outcomes between immigrants and non-immigrants. For this investigation, we use modern tools in causal inference to construct causal models that we believe are highly relevant in an immigrant dataset. In these models, the outcome risk factor is modeled either as a mediator, a selection factor, or a combined mediator/selection factor. Unlike mediators, selection factors are variables that affect the probability of being in the immigrant dataset and may contribute to a bias when comparing immigrants and non-immigrants.

Results

When the outcome risk factor acts both as a mediator and selection factor, the adjustment for the risk factor in regression models leads to the estimation of what is known as a “controlled” direct effect. When the outcome risk factor is either a selection factor or a mediator alone, the adjustment for the risk factor in regression models leads to the estimation of a total effect or a controlled direct effect, respectively. In all regression analyses, also adjusting for various confounding paths, including mediator-outcome confounding, may be necessary to obtain valid controlled direct effects or total effects.

Conclusions

Depending on the causal role of the outcome risk factors in immigrant datasets, regression adjustment for these may result in the estimation of either total effects or controlled direct effects for the difference in outcomes between immigrants and non-immigrants. Because total and controlled direct effects are interpreted differently, we advise researchers to clarify to the readers which types of effects are presented when adjusting for outcome risk factors in immigrant datasets.
Synovial sarcoma of the tibial nerve - case report of a rare tumor in a rare location requiring early diagnosis
Authors: Hemerková Pavlína , Matulová Hana , Vališ Martin , Soukup Jiří , Kanta Martin , Jandura Jiří
Published: February 2023

Background

We present the case of a patient with a rare synovial sarcoma (SS) of the tibial nerve. So far, only 4 cases of patients with SS originating from the tibial nerve have been described in the literature, and our patient is only the second patient whose limb was saved during treatment. Synovial sarcomas are malignant mesenchymal tumors, i.e., tumors arising from connective tissue. Synovial sarcomas account for 5–10% of all soft tissue sarcomas. However, the name synovial sarcoma is misleading, because the tumor does not originate from synovial cells, but rather from primitive mesenchymal cells. The name most likely originated from the localization around the large joints on the limbs, more often on the lower ones, in the area of the knee joints.

We point out the aspects of correct and quick diagnosis and subsequent treatment, which has very important effect on the patient’s prognosis. Primary less radical excision without prior biopsy verification leads to a higher risk of local recurrence, even if a proper reexcision was performed immediately after biopsy verification of the sarcoma.

Case presentation

A woman born in 1949 began to suffer at the end of 2020 with escalating pain under the left inner ankle with a projection to the sole and fingers. Her personal, family work and social history were insignificant. After the initial neurological examination, the patient was sent for an ultrasound examination of the ankle, which showed a lobular mass measuring 50 × 22 × 16 mm and according magnetic resonance imaging, the finding appeared to be a suspicious neurinoma of the tibial nerve. The tumor was surgically excised, without prior biopsy verification: a 50 × 20 mm tumor was dissected in the distal part of the tarsal canal, which grew through the structure of the tibial nerve and in some places into the surrounding area and appeared intraoperatively as a neurofibroma. But histologically the tumor was classified as monophasic synovial sarcoma. The patient was indicated for a wide reexcision of the skin with the subcutaneous tissue of size 91 × 20 × 15 mm. Now the patient is being treated with external radiotherapy to the tumor bed and she is able to walk.

Conclusion

This report draws attention to a rare type of malignant nerve tumor, which both clinically and radiologically can mimic benign peripheral nerve sheath tumors. Synovial sarcoma should be considered in very painful resistances, typically located around the joints of the lower limbs, the growth of which can be slow. Because the size of the tumor is a negative prognostic factor, it is necessary to make a timely diagnosis using MR imaging and a biopsy with histological examination and to start treatment quickly. Surgical treatment should take place only after a biopsy with histological examination of the tumor so that it is sufficiently radical and does not have to undergo an additional reoperation, as happened in the case of our patient.
Eclampsia with hypothyroidism complicated with posterior reversible encephalopathy syndrome–a case report
Authors: Yin Xuejing , Duan Yu , Zhang Lifang , Feng Zhichao , Yin Caixia , Zhu Sujie , Chen Jinhua , Peng Xinsen
Published: February 2023

Background

Posterior reversible encephalopathy syndrome (PRES) is a rare neurological disorder with complex physiopathological mechanisms that have not been fully understood. Early identification is of great prognostic significance, of which the symptoms and radiological abnormalities can be completely reversed. If the diagnosis and treatment are delayed, ischemia and massive infarction may be developed in some patients. Posterior reversible encephalopathy syndrome (PRES) has been reported mainly in association with postpartum eclampsia, which have been rarely reported, while the association with hypothyroidism has not been reported at home or abroad.

Case presentation

Here we report on a pregnant 29-year-old with multipara and a chief complication of hypothyroidism. She presented in the emergency department with frequent attacks of severe headache symptoms resulting from reversible cerebral vasoconstriction syndrome (RCVS), accompanied with prenatal eclampsia. PRES was determined by radiological examination.

Conclusion

To the best of our knowledge, this is the first case of PRES complicated by hypothyroidism and prepartum eclampsia.Clinicians should be alert for the co-occurence of eclampsia, PRES, and RCVS when patients have convulsions after a typical throbbing headache. Moreover, regular monitoring of thyroid function during pregnancy should also occupy certain special attention.
Machine learning-based colorectal cancer prediction using global dietary data
Authors: Abdul Rahman Hanif , Ottom Mohammad Ashraf , Dinov Ivo D.
Published: February 2023

Background

Colorectal cancer (CRC) is the third most commonly diagnosed cancer worldwide. Active health screening for CRC yielded detection of an increasingly younger adults. However, current machine learning algorithms that are trained using older adults and smaller datasets, may not perform well in practice for large populations.

Aim

To evaluate machine learning algorithms using large datasets accounting for both younger and older adults from multiple regions and diverse sociodemographics.

Methods

A large dataset including 109,343 participants in a dietary-based colorectal cancer ase study from Canada, India, Italy, South Korea, Mexico, Sweden, and the United States was collected by the Center for Disease Control and Prevention. This global dietary database was augmented with other publicly accessible information from multiple sources. Nine supervised and unsupervised machine learning algorithms were evaluated on the aggregated dataset.

Results

Both supervised and unsupervised models performed well in predicting CRC and non-CRC phenotypes. A prediction model based on an artificial neural network (ANN) was found to be the optimal algorithm with CRC misclassification of 1% and non-CRC misclassification of 3%.

Conclusions

ANN models trained on large heterogeneous datasets may be applicable for both younger and older adults. Such models provide a solid foundation for building effective clinical decision support systems assisting healthcare providers in dietary-related, non-invasive screening that can be applied in large studies. Using optimal algorithms coupled with high compliance to cancer screening is expected to significantly improve early diagnoses and boost the success rate of timely and appropriate cancer interventions.
MMP14 expression levels accurately predict the presence of extranodal extensions in oral squamous cell carcinoma: a retrospective cohort study
Authors: Noda Yuri , Ishida Mitsuaki , Yamaka Ryosuke , Ueno Yasuhiro , Sakagami Tomofumi , Fujisawa Takuo , Iwai Hiroshi , Tsuta Koji
Published: February 2023

Background

Extranodal extension (ENE) is an adverse prognostic factor for oral squamous cell carcinoma (OSCC), and patients with OSCC along with ENE require neck dissection. In this study, we developed a novel ENE histology-based pathological predictor using MMP14 expression patterns in small biopsy specimens.

Methods

A total of 71 surgically resected tissue, 64 dissected lymph node (LN), and 46 biopsy specimens were collected from 71 patients with OSCC. Immunohistochemical analyses of total MMP14 expression in the tumour nest and cancer-associated fibroblasts (CAFs) were performed using the MMP14 co-scoring system (high- or low-risk). The association analysis of MMP14 expression in metastatic LNs was performed with respect to the presence and absence of ENE. Clinicopathological analyses and multivariate examinations were performed to assess the risks of metastasis and ENE presence. The predictive value of ENE and the impact of ENE and MMP14 expression on 5-year overall survival were examined.

Results

High-risk MMP14 expression was detected in metastatic LN specimens with ENE. MMP14 expression in tumour nests and CAFs and its overexpression at the tumour–stromal interface significantly correlated with the presence of ENE. The MMP14 co-scoring system was an independent risk predictor for ENE, with sensitivity, specificity, and accuracy of over 80% in biopsy samples; patients with a high risk in the MMP14 co-scoring system had significantly worse prognoses in both resections and biopsies.

Conclusion

The MMP14 co-scoring system accurately predicted ENE presence and poor prognosis via immunohistochemical evaluation of small biopsies. This system is a simple, accurate, and inexpensive immunohistochemical approach that can be used in routine pathological diagnosis for effective treatment planning.