bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical Outcomes of Distraction Arthroplasty with Arthroscopic Microfracture for Advanced Stage Ankle Osteoarthritis
Authors: Ikuta Yasunari , Nakasa Tomoyuki , Tsuyuguchi Yusuke , Ota Yuki , Kanemitsu Munekazu , Adachi Nobuo
Published: October 2019

Category:

Ankle Arthritis, Arthroscopy

Introduction/Purpose:

Ankle trauma is highly implicated in the etiology of osteoarthritis (OA) of the ankle, and posttraumatic ankle OA is often observed in younger patients. In advanced stages, ankle arthrodesis has been considered as a gold standard treatment, and total ankle arthroplasty is also developed over the past decade for older patients. However, the surgical treatment of severe ankle OA for younger, active patients remains challenging. Ankle distraction arthroplasty is an alternative option for treatment of severe ankle OA in younger patients. The distraction device enables joint distraction with ankle motion that induces cartilage repair of the ankle. This study aimed to clarify the clinical outcome of the ankle distraction arthroplasty with arthroscopic microfracture for ankle OA in younger patients.

Methods:

This retrospective analysis included 7 ankle OA patients who underwent distraction arthroplasty with arthroscopic microfracture, in 5 men and 2 women, with a mean age of 45.9 years (range, 39-62). Range of motion (ROM) and American Orthopaedic Foot & Ankle Society (AOFAS) ankle-hindfoot score were evaluated as the clinical outcomes. The talotibial joint space was identified as anterior, center and posterior segment on lateral view. The width of joint space in each segment was measured on pre- and post-operative weight-bearing radiographs. The distraction device was removed at 3 months after initial surgery, and second look arthroscopy was also performed at the same time. The arthroscopic findings were assessed retrospectively.

Results:

All 7 patients were followed with a mean follow-up period of 4.2 years. One patient who had the worst preoperative AOFAS score of 19 converted to arthroscopic ankle arthrodesis at 2 years after the initial surgery. The mean total ROM and AOFAS score improved from 29.3 to 37.1 (p = 0.028), from 41.7 to 76.1 (p = 0.018), respectively. Weight-bearing radiographs showed a width of ankle joint space with anterior, center and posterior of 1.9 mm, 1.8 mm, 2.0 mm at preoperative status and 2.9 mm, 2.8 mm, 2.9 mm at final follow-up status. Second look arthroscopy revealed that the fibrous cartilage like tissue covered the cartilage defect area at the talotibial joint in all patients.

Conclusion:

Our findings suggest that the distraction arthroplasty with arthroscopic microfracture could be a useful option for active patients with advanced stage of ankle OA. Good clinical status and the width of joint space had been preserved for a maximum of seven years. Further follow-up was required to elucidate the long-term clinical results.
Associations in the Sagittal Plane: No Evidence that Foot Radiographs Predict Sagittal Alignment or Degeneration of the Spine
Authors: Khan Jannat M. , Idarraga Alex , Skipor Joseph , Kalish Chaim , Berkowitz Mark , Louie Philip K. , Bohl Daniel D. , Lee Simon , An Howard S. , Hamid Kamran S.
Published: October 2019

Category:

Ankle, Ankle Arthritis, Hindfoot, Midfoot/Forefoot

Introduction/Purpose:

The interaction between hip pathology and spinopelvic alignment is a current subject of interest in orthopedics with a number of recently performed studies. However, little is known regarding the interaction between foot & ankle (F&A) pathology and spinopelvic alignment, despite common complaints from patients such as back pain potentially caused by an outturning foot. The purpose of this study is to test for associations between F&A pathology and spinopelvic alignment and degeneration.

Methods:

A retrospective cohort study was conducted involving consecutive patients who presented to both F&A and spine surgeons within the same practice. Inclusion criteria required that each patient have the following radiographic views while in a weight bearing, standing position: lateral of lumbar spine; anteroposterior (AP), lateral, and mortise of ankle; AP, lateral, and oblique of foot. Patients were excluded from analysis if there was radiographic evidence of previous surgical instrumentation in the spine, ankle, or foot. Bonferroni correction was performed to account multiple statistical analyses, which resulted in the level of significance set to p<0.001.

Results:

A total of 55 patients met inclusion criteria. There were no associations found between F&A pathology and spinopelvic alignment/degeneration (p>0.001 for each; Table 1).

Conclusion:

A common patient concern is that a foot condition may be contributing to low back pain through altered gait and postural dynamics. With the numbers available, we were unable to demonstrate statistical associations between F&A radiographic findings and spinopelvic alignment or degeneration. Orthopaedic surgeons can address patients’ concerns about the relationship
Demographic Factors Associated with Insertional and Noninsertional Achilles Tendinopathy
Authors: Levitsky Matt , Greisberg Justin , Vosseller J Turner , Dey Shirin , Hickey Briana
Published: October 2019

Category:

Sports

Introduction/Purpose:

Achilles tendinopathy is a common clinical entity encountered by orthopaedic surgeons, although the demographics of patients that suffer from this pathology are incompletely understood. It has been suggested that there may be differences in patients that get insertional (IAT) and noninsertional Achilles tendinopathy (NIAT), and our clinical experience has been that older, less active patients tend to get insertional tendinopathy. The goal of this study is to further investigate the features of patients in a single institution who presented with Achilles tendinopathy.

Methods:

We used ICD-9 and ICD-10 codes to find patients who presented with Achilles tendinopathy to two foot and ankle surgeons at one academic medical center from 2007-2018. We made note of patient characteristics such as age, gender, BMI, medical comorbidities, and level of activity. Physical examination, including the presence of a gastrocnemius equinus, was noted as well. Characteristics of insertional and non-insertional tendinopathy subgroups were compared using Student’s T-tests and chi- squared tests.

Results:

The characteristics of 948 consecutive patients were analyzed. The mean age was 55 years and 50.5% of the patients were male. Patients with IAT had significantly higher BMIs than did those with NIAT (30.5 compared to 28.0, p < .05). The mean age was 54.5 years in the IAT group compared to 55.8 years in the NIAT group (p>.05). Patients with NIAT self-identified as active a greater percentage of the time (63% vs 45%, p<0.5). 76% of the IAT group had a gastrocnemius equinus on physical examination, compared to 67% of the non-insertional group. Antecedent fluoroquinolone antibiotic use was only reported in 10% of patients, and all of these patients presented with NIAT.

Conclusion:

The age at which patients present with insertional and noninsertional Achilles tendinopathy is not significantly different, although patients with NIAT had a lower BMI and self-identified as active a greater percentage of the time. A gastrocnemius equinus was present in a high percentage of patients with both IAT and NIAT. Fluoroquinolone use was not involved in most cases, although, when it was, patients presented with NIAT.
Adverse Events in Total Ankle Arthroplasty, Analysis of the FDA Medical and User Facility Device Experience Database
Authors: Mahmoud Karim , Metikala Sreenivasulu , O’Connor Kathryn , Farber Daniel
Published: October 2019

Category:

Ankle Arthritis

Introduction/Purpose:

Total ankle replacement has become a popular treatment option for end stage ankle arthritis. Most of the reports of adverse events following total ankle replacement have been from high volume institutions and are subject to either observational or selection bias as well as potential under-reporting as they do not include the experience of community and lower volume centers and surgeons. The FDA’s Medical and User Facility Device Experience (MAUDE) Database provides a more complete scope of adverse events due to the mandatory reporting requirements by the FDA of implant manufactures. We reviewed the database to identify the common modes of failure and complications of total ankle implants

Methods:

We retrospectively reviewed reports of the MAUDE database from November 2011 to September 2018 regarding all total ankle implants. Each device in the MAUDE database is classified with a 3-letter code, we identified the 2 codes assigned to total ankle arthroplasty devices, and manually searched the FDA’s published Device Classification list for adverse events. All events were reviewed and classified. Data related to patient age or sex, surgeon, medical center location are not available in the database

Results:

We identified 1000 adverse reports in the period between November 2011 and September 2018. After exclusion of duplicate reports for single events or reports irrelevant to total ankle arthroplasty, a total of 697 adverse event reports were noted. The most common mode of failure was aseptic loosening (21%), followed by infection (16%), alignment and mechanical issues (instability, malalignment, malposition, stiffness, impingement) (15%), implantation issues (pin, screw or drill breakage, alignment guide problems) (9%), polyethylene related problems (wear, displaced or fractured implants) (7%), bony and soft tissue overgrowth (6%), and peri-prosthetic fractures (5%).

Conclusion:

Our analysis reveals that the most reported mode of failure was aseptic loosening followed by infection. However, it is notable that there are a significant number of issues with implant alignment and mechanics, complications during implantation and polyethylene component failure that are under-reported in the literature. Knowledge of these adverse events may help surgeons avoid similar complications as well as lead to improvement in component implantation and design
Gastrocnemius Muscle Structure Remodels Within the First Month Following Acute Achilles Tendon Rupture
Authors: O’Connor Kathryn M , Hullfish Todd J. , Baxter Josh R.
Published: October 2019

Category:

Sports, Trauma, Achilles Tendon

Introduction/Purpose:

Two out of three patients Achilles tendon ruptures have limited plantarflexor function 1-year following Achilles tendon rupture. While tendon elongation has been reported as a possible mechanism of functional deficits, the effects of rupture on plantarflexor muscle structure has not been as rigorously investigated. A recent study found that gastrocnemius fascicle length was decreased 6-months following Achilles tendon rupture compared to the uninjured limb. However, the changes in muscle structure following the first month of injury – when the healing tendon is most susceptible to elongation – has not yet been established. The purpose of this study was to quantify the structural changes to the medial gastrocnemius in patients who suffered acute Achilles tendon ruptures and were treated non-operatively.

Methods:

To test our hypothesis that plantarflexor structure would undergo rapid remodeling following Achilles tendon rupture, we quantified muscle structure in ten patients (9 male, Age: 44 ± 12; BMI: 28.6 ± 6.5) who provide informed written consent in this IRB approved study. We acquired B-mode ultrasound images of the medial gastrocnemius muscle at the initial presentation (week 0), two weeks, and four weeks following the injury. The same investigator acquired all the ultrasound images and measured fascicle length, pennation angle, muscle thickness, and echo intensity. These measurements had a coefficient of variation less than 10%. We compared these structural measurements of the injured muscle at each time point with the contralateral muscle scans at the initial presentation using paired t-tests.

Results:

Gastrocnemius muscle structure following an acute Achilles tendon rupture differed with the healthy-contralateral muscle throughout the first four weeks following injury (Figure). Fascicle length was 15% shorter (P < 0.001) and pennation angle was 21% greater (P < 0.001) at the presentation of injury (week 0). These differences in fascicle length (P < 0.001) and pennation angle persisted throughout the 4 weeks after the injury (P < 0.008). Muscle thickness changes were not detected at any of the post-injury visits. Muscle quality, measured as mean echo intensity, was 8% lower in the injured limb immediately (P= 0.008) and 11% lower 2 weeks following injury (P < 0.001). At week 4 muscle quality had returned to within 1% of the contralateral limb (P = 0.393).

Conclusion:

Our findings support our hypothesis that the gastrocnemius muscle fascicles of the affected side would demonstrate shorter length and greater pennation angle than the contralateral control muscle. These findings are a preliminary set of data from a larger clinical cohort of patients that were enrolled in an ongoing 1-year long prospective study. Achilles tendon ruptures elicit rapid changes in the configuration and quality of the medial gastrocnemius, which may explain long-term functional deficits.
Rising Burden of Alcohol-Associated Foot and Ankle Fractures Presenting to U.S. Emergency Departments: 2000-2017
Authors: Pirruccio Kevin , Farber Daniel C.
Published: October 2019

Category:

Ankle, Trauma, Epidemiology

Introduction/Purpose:

The most frequent cause of traumatic foot and ankle fractures is a fall to the ground. Alcohol consumption, especially in excess, has the potential to impart a significant fall risk on patients by reducing postural control resulting in imbalance. However, the relationship between the consumption of alcohol and the risk of traumatic foot and ankle fracture is poorly characterized. The purpose of this study was to report national estimates, injury mechanisms, and demographic characteristics of patients presenting to U.S. emergency departments (EDs) with traumatic foot and ankle fractures associated with alcohol consumption.

Methods:

This cross-sectional, retrospective epidemiological study analyzes case narratives in the National Electronic Injury Surveillance System (NEISS) database to examine national estimates of traumatic foot and ankle fractures associated with alcohol consumption presenting to U.S. emergency departments between 2000 and 2017, sampling in two-year intervals. Data from the Organisation for Economic Co-operation and Development (OECD) on the “Value for Total U.S. Adult Alcohol Consumption in Liters/Capita” was used in a simple regression model to demonstrate how increased alcohol consumption in the United States has predicted changes in the national number of alcohol-associated foot and ankle fractures over time.

Results:

Nationally, alcohol-associated foot and ankle fractures increased significantly between the 2000-2001 (N=2,878; C.I. 1,869-3,887) and 2016-2017 (N=8,778; C.I. 6,751-10,806) periods (p<0.001). Simple regression (R2 = 0.87; p<0.001) demonstrated that in the U.S., a one-tenth increase in the total liters of alcohol consumed per capita predicted an additional 606 alcohol-associated foot and ankle fractures presenting to U.S. EDs. About two-thirds of patients suffered ankle fractures (65.6%; C.I. 61.1%-70.1%). Fractures were commonly sustained by male patients (58.4%; C.I. 53.9%-62.9%) at home (46.5%; C.I. 40.9%- 52.2%); roughly one-third of patients required admission to the hospital (29.7%; C.I. 24.5%-34.9%). The most common injury mechanisms for alcohol-associated foot and ankle fractures were falls to the ground from standing height (33.0%; C.I. 28.8%- 37.2%), and falls down stairs or steps (31.0%; C.I. 26.1%-35.9%).

Conclusion:

Falls to the ground mechanistically link alcohol consumption to traumatic fractures of the foot and ankle. These new findings highlight how the negative societal impacts of alcohol – and potentially other substances – may be overlooked. As a result, this information should serve as an impetus to direct national attention towards awareness and preventative measures. Furthermore, our findings may help clinicians identify, educate, and counsel patients with certain demographic risk factors for alcohol-associated foot and ankle fractures.
Clinical Significance of Ankle Arthroscopy in the Diagnosis of Type B Ankle Fracture Associated with the Distal Tibiofibular Syndesmosis Injury
Authors: Qiang Huang , Xiangyang Xu
Published: October 2019

Category:

Arthroscopy, Trauma

Introduction/Purpose:

To investigate clinical significance of ankle arthroscopy in the diagnosis of type B ankle fracture associated with the distal tibiofibular syndesmosis injury.

Methods:

From February 2014 to December 2016, the authors diagnosed and treated 35 cases of type B ankle fractures. including 23 males and 12 females; with an average age of (43.05±12.480) years. Each patient underwent preoperative assessment: according to the patient’s clinical manifestations and imaging examination, and before the operation and after internal fixation of ankle fracture, the Cotton test and the external rotation test were done in the C arm X-ray, the initial diagnosis whether there is the distal tibiofibular syndesmosis injury. When the Cotton test and the external rotation test was used, Ankle arthroscopy was used to observe and evaluate whether there is the distal tibiofibular syndesmosis injury. For patients with the distal tibiofibular syndesmosis injury, In addition to the internal fixation of the ankle fracture, the TightRope was used to repair the injury. And observation of repair effect by ankle arthroscopy.

Results:

After internal fixation of ankle fracture, the Cotton test and the external rotation test was performed under the C arm X-ray, there were no the distal tibiofibular syndesmosis injury in 22 patients. Preoperative CT showed 6 cases of combined the distal tibiofibular syndesmosis injury, Preoperative MRI showed 13 cases of combined the distal tibiofibular syndesmosis injury. Ankle arthroscopy confirmed 11 cases of combined the distal tibiofibular syndesmosis injury. The sensitivity of ankle arthroscopy and MRI diagnosis combined with the distal tibiofibular syndesmosis injury was higher than that of CT sensitivity(P<0.05). The sensitivity of ankle arthroscopy for the diagnosis of the distal tibiofibular syndesmosis injury was weaker than that of MRI in the diagnosis of the distal tibiofibular syndesmosis injury (P<0.05). MRI diagnosis of the distal tibiofibular syndesmosis injury can be false positive.

Conclusion:

Ankle arthroscopy can directly observe the medial triangle ligament of the ankle, the distal tibiofibular syndesmosis injury, which provides the basis for correct diagnosis and treatment of Type B ankle fracture with the distal tibiofibular syndesmosis injury. And it can evaluate the stability of ankle after repairing the distal tibiofibular syndesmosis injury.
Clinical Outcomes of Acute Achilles Tendon Rupture Repair Utilizing Supine Positioning
Authors: Rogero Ryan , Beck David , Larwa Joseph , Fuchs Daniel , Raikin Steven M.
Published: October 2019

Category:

Sports, Trauma

Introduction/Purpose:

With no consensus regarding the optimal technique for repair of Achilles tendon ruptures, identifying techniques which minimize complications and maximize functional outcomes is essential. Previous studies on Achilles repair performed in the supine position have demonstrated low complication rates, avoidance of issues related to anesthesia set-up of prone positioning, and decreased operating room times, though these studies have included relatively low patient numbers and lacked functional outcomes. The purpose of this study is to evaluate the clinical outcomes of a large cohort of patients undergoing acute Achilles tendon repair in the supine position.

Methods:

We conducted a retrospective review of patients undergoing open repair of acute Achilles tendon ruptures with supine positioning by one fellowship-trained foot & ankle surgeon at a single outpatient surgical location from 2010-2016. During each procedure, a longitudinal incision was made just medial to the tendon extending approximately 3.5 cm both proximally and distally from the level of the rupture. Exclusion criteria included age <18 years old, repair >21 days from date of injury, and undergoing any additional procedures other than concomitant tendon transfers. Postoperative chart notes were reviewed to identify any complications experienced by patients, and surgical site records were reviewed for tourniquet times. Patients were contacted and asked about their satisfaction with surgical outcome and to complete the Foot & Ankle Ability Measure (FAAM)- Activities of Daily Living (ADL) and –Sports subscales, as well as the Visual Analog Scale (VAS) for pain.

Results:

Two-hundred eleven patients, including 31 (14.7%) females, were included in the study, with a mean age of 40.9 years and mean BMI of 28.8 kg/m2. Patients had an average of duration from injury to surgery of 8.5 days (range, 1-21 days) and mean tourniquet time of 35.5 minutes (range, 16-77 minutes). Four patients (1.9%) experienced a postoperative complication, including 2 superficial wound infections and 2 deep vein thromboses. There were no sural nerve-related injuries or tendon re-ruptures. At an average of 56.8 months postoperatively (range 24-99 months), patients reported a mean VAS pain of 0.6 ± 1.3/10 and mean FAAM-ADL and FAAM-Sports scores of 93.9 ± 12.4/100 and 84.7 ± 19.6/100, respectively. Additionally, 91.4% reported being satisfied with the outcome of the surgery.

Conclusion:

With an extremely low complication rate, mid- to long-term functional scores comparable to other reported Achilles tendon repair techniques, and high rate of patient satisfaction, open repair of Achilles tendon ruptures performed in a supine position offers surgeons a safe and effective treatment method.
Clinical and Radiographic Outcomes of 3D Printed Total Talus Arthroplasty
Authors: Scott Daniel , Steele John , Fletcher Amanda , Parekh Selene
Published: October 2019

Category:

Ankle, Ankle Arthritis, Hindfoot, Trauma

Introduction/Purpose:

Patients with talar avascular necrosis have limited treatment options to manage their symptoms. Historically, surgical options have been limited and can leave patients with little ankle motion and have high failure rates. The use of custom 3D printed total talar replacements (TTR) has arisen as a treatment option for these patients, possibly allowing for better preservation of hind-foot motion. Patients undergoing TTR will demonstrate a statistically significant improvement in FAOS scores at one year after surgery.

Methods:

We retrospectively reviewed 15 patients who underwent a TTR over 2 years. Patient outcomes were reviewed including age, sex, comorbidities, etiology of talar pathology, number and type of prior surgeries, pre-operative and post-operative weight bearing radiographs, as well as FAOS and VAS scores, and range of motion. Data analysis performed with student T-test and multivariate regression.

Results:

Results: FAOS scores showed statistically significant improvements post-operatively as compared to pre-operative scores. There was a statistically significant decrease in VAS pain scores from 7.0 pre-operatively to 3.4 post operatively. There was no significant difference in pre-operative and post-operative coronal and sagittal alignment on weight bearing radiographs. All FAOS sub-score shows statistically significant improvements, with the exception of the sports/recreation sub-scale, did show a trend towards improved outcomes (p =0.19). Average follow-up was 12.8 months.

Conclusion:

Our hypothesis was confirmed that these patients show statistically significant improvements in AOFS and VAS scores at 1 year. Sagittal and coronal alignment was well maintained at an average of 1 year following surgery. TTR represents an exciting treatment options for patients with talar avascular necrosis, though longer-term follow-up is needed.
The Prevalence of Hallux Rigidus and its Risk Factors
Authors: Senga Yoshiyuki , Nishimura Akinobu , Sudo Akihiro
Published: October 2019

Category:

Midfoot/Forefoot

Introduction/Purpose:

Hallux rigidus (HR) is known as osteoarthritis of the first metatarsophalangeal joint (MPJ). The radiographical findings of HR are characterized by joint space narrowing, osteophytic lipping of the metatarsal head and proximal phalanx and sesamoid hypertrophy. HR is not so rare in daily medical practice, but its prevalence and risk factors are not completely understood. The purpose of this cross-sectional study, using a population-sample from Japan, is to investigate the prevalence of HR and its risk factors among Japanese community dwellers.

Methods:

In this study, we analyzed the cohort studies in 2009, 2011, 2013 and 2015 covering the elderly (=50 years). We excluded the participants with hallux valgus (HV) because it is difficult to distinguish HR from HV completely. Knee osteoarthritis (KOA) was scored according to the Kellgren-Lawrence grading system and was defined as grade=2. HR was scored according to the Hattrup and Johnson classification and was defined as grade=1. Continuous and categorical variables were compared using the t-test and chi-square test, respectively. The logistic regression model was used to examine the relationship between predictor variables and HR. The Cochran-Armitage trend test was used to examine the relationships between the presence or absence of HR and the severity of KOA in a linear trend. All p values presented are two-sided and p values < 0.05 were considered statistically significant.

Results:

A total of 416 (171 men, 245 women) participants fulfilled this study criterion. The prevalence of HR was 17.8%. The rate of grade0, grade1, grade2, and grade3 of HR were 82.2%, 10.1%, 6.7%, and 0.96%, respectively. Univariate analysis revealed age (=65), KOA, and Gout Attack (GA) were significantly associated with HR (Table 1). In addition, they were confirmed as independent risk factors of HR in the multivariate analysis. All parameters were significantly associated with HR. The odds ratio of age, KOA, and GA were 2.46, 1.83, and 4.87, respectively (p <0.05). KOA severity is significantly associated with the presence or absence of HR (p <0.05).

Conclusion:

While previous reports have demonstrated a higher prevalence of HR (27.2-44.4%), HV was not excluded in that study. To achieve the accurate evaluation, we examined the epidemiology and prevalence of HR among participants without HV. HR prevalence in the elderly (=50 years) was 17.8%. Although multifactorial risk factors have been proposed in the literature, our study revealed that age (=65), KOA, and GA were the independent risk factors for HR. KOA severity was associated with the presence or absence of HR.
Nosocomial spread of OXA-232-producing Klebsiella pneumoniae ST15 in a teaching hospital, Shanghai, China
Authors: Li Xin , Ma Wei , Qin Qin , Liu Shanrong , Ye Liyan , Yang Jiyong , Li Boan
Published: October 2019

Background

The spread and outbreak of Enterobacteriaceae producing OXA-48-like carbapenemases have become more and more prevalent in China.

Results

A total of 62 non-duplicated OXA-232-producing K. pneumoniae (OXA232Kp) were isolated between 2015 and 2017. An outbreak of OXA232Kp was observed in burn ICU. The 62 OXA232Kp isolates were all belongs to ST15 and categorized into two PFGE types (A and B). Type A was dominated of the isolates, which contained 61 clinical isolates and divided into 10 subtypes (A1-A10). In addition, most of OXA232Kp strains exhibited low-level carbapenems resistance. All strains carried a 6141 bp ColKP3 plasmid harboring the blaOXA-232 gene which is highly homologous to other blaOXA-232-bearing plasmids involved in other studies in eastern China.

Conclusions

In this study, clone transmission of OXA232Kp ST15was observed. Highly significant homology among the blaOXA-232-bearing plasmids indicated the important role of the 6.1 kb ColE-like plasmid on the prevalence of blaOXA-232 gene in China.
Aging progression of human gut microbiota
Authors: Xu Congmin , Zhu Huaiqiu , Qiu Peng
Published: October 2019

Background

Human gut microbiota are important for human health and have been regarded as a “forgotten organ”, whose variation is closely linked with various factors, such as host genetics, diet, pathological conditions and external environment. The diversity of human gut microbiota has been correlated with aging, which was characterized by different abundance of bacteria in various age groups. In the literature, most of the previous studies of age-related gut microbiota changes focused on individual species in the gut community with supervised methods. Here, we aimed to examine the underlying aging progression of the human gut microbial community from an unsupervised perspective.

Results

We obtained raw 16S rRNA sequencing data of subjects ranging from newborns to centenarians from a previous study, and summarized the data into a relative abundance matrix of genera in all the samples. Without using the age information of samples, we applied an unsupervised algorithm to recapitulate the underlying aging progression of microbial community from hosts in different age groups and identify genera associated to this progression. Literature review of these identified genera indicated that for individuals with advanced ages, some beneficial genera are lost while some genera related with inflammation and cancer increase.

Conclusions

The multivariate unsupervised analysis here revealed the existence of a continuous aging progression of human gut microbiota along with the host aging process. The identified genera associated to this aging process are meaningful for designing probiotics to maintain the gut microbiota to resemble a young age, which hopefully will lead to positive impact on human health, especially for individuals in advanced age groups.
Early inter-hospital transfer of patients with myocardial infarction without a doctor, paramedic or nurse on board: results from a French regional emergency care network
Authors:   for the SCA-Alp Investigators, Cassan Sebastien , Rata Mihaela , Vallenet Claire , Fromage Philippe , Champly Frederic , Broin Patrick , Peribois Guillaume , Sierra Valerie , Lutz Cedric , Mangin Lionel , Savary Dominique , Ageron François-Xavier , Belle Loic
Published: October 2019

Background

In France, patients with acute coronary syndromes (ACS) are usually transferred from remote hospitals to percutaneous coronary intervention (PCI) centres in mobile intensive care units (MICUs) with on-board medical staff. They are then returned to the remote hospitals by MICU 48 h after PCI. However, MICU transportation and beds in a PCI centre are in short supply. Therefore, we investigated clinical outcomes among intermediate-risk ACS patients who were transferred in private ambulances without an on-board medic or paramedic; and returned to the remote hospital sooner after PCI.

Methods

In the French Alps, the RESURCOR network manages ‘SCA-Alp’ transfers using strict management protocols in ambulances with trained drivers and automatic external defibrillators, but without heart rhythm monitoring. We conducted an observational retrospective study that assessed outcomes (death and emergency return to the PCI centre within 48 h) in patients transferred using SCA-Alp. Our population comprised stabilized patients with ST-segment elevation myocardial infarction (STEMI) who returned to the remote hospital within 24–48 h of PCI, and uncomplicated patients with non-ST-segment elevation myocardial infarction (NSTEMI) within 24–72 h of symptom onset who come from and returned to (‘round-trip’) the remote hospital on the day of PCI (return < 12 h after PCI).

Results

Between 2010 and 2014, 101 STEMI and 490 NSTEMI patients were transferred using SCA-Alp. No adverse events occurred during transportation and no deaths were reported. Two of 591 patients (0.3% [95% confidence interval 0.1–1.4%]) experienced a stent thrombosis within 48 h of PCI that required a second urgent PCI; both were event free at 6-month follow-up.

Conclusions

Inter-hospital transfer using SCA-Alp is associated with low event rates in intermediate-risk ACS patients, allowing a more streamlined use of medical facilities and freeing-up of beds in PCI centres.
Adherence to anti-osteoporosis medication associated with lower mortality following hip fracture in older adults: a nationwide propensity score-matched cohort study
Authors: Yu Shan-Fu , Cheng Jur-Shan , Chen Ying-Chou , Chen Jia-Feng , Hsu Chung-Yuan , Lai Han-Ming , Ko Chi-Hua , Chiu Wen-Chan , Su Yu-Jih , Cheng Tien-Tsai
Published: October 2019

Background

We investigated the association of anti-osteoporosis medication with mortality risk in older adults with hip fractures and evaluated the influence of medication adherence on mortality.

Methods

We conducted a population-based cohort study and identified a total of 13,123 patients aged 65 years or older with hip fracture from the Taiwan National Health Insurance Database during the period 2001–2010. Individuals with (n = 2092) and without (n = 2092) receiving anti-osteoporosis medication were matched using propensity score matching (1:1 ratio). The 1-, 3- and 5-year survival rates after the index fracture were compared between patients with and without treatment. In the treated group, survival rate was compared between those with good and non-adherence. Good adherence was defined as the medication possession ratio of ≥80% and non-adherence as a ratio < 80%.

Results

The 1-, 3- and 5-year mortality rates were significantly lower in the treated vs. the non-treated group (allp < 0.0001). In the treated group, the estimated 1-, 3- and 5-year survival rates were higher in those with good adherence than in those with non-adherence (allp < 0.0001). Regarding all-cause mortality, the adjusted hazard ratio in the treated vs. the non-treated group was 0.63 (95% confidence interval 0.58–0.68,p < 0.0001). The good adherence subgroup showed a significantly lower mortality risk than that in the non-adherence subgroup (hazard ratio 0.41, 95% confidence interval 0.32–0.51,p < 0.0001).

Conclusions

The 1-, 3- and 5-year survival rates were significantly higher in patients receiving anti-osteoporosis medication than in the untreated group. All-cause mortality rates were lower in patients with good adherence to anti-osteoporosis medication.
Assessment of extended-spectrum β-lactamase (ESBLs) – producing Escherichia coli from minced meat of cattle and swab samples and hygienic status of meat retailer shops in Jimma town, Southwest Ethiopia
Authors: Abayneh Mengistu , Tesfaw Getnet , Woldemichael Kifle , Yohannis Moti , Abdissa Alemseged
Published: October 2019

Background

The impact of animals sources of food as a possible reservoir for extended-spectrum β-lactamase (ESBL) - Producing E. coli, and the dissemination of such strains into the food production chain need to be assessed. This study was aimed to assess the presence and antimicrobial susceptibility patterns of ESBLs - producing E. coli isolates from minced meat and environmental swab samples at meat retailer shops of Jimma town, Southwest Ethiopia.

Methodology

A cross-sectional descriptive study was conducted from March to June, 2016. A total of 168 minced meat and swab samples were first enriched by buffered peptone water (BPW) for overnight and streaked onto MacConkey agar. Double disk synergy (DDS) method was used for detection of ESBL-producing strains. A disk of amoxicillin + clavulanic acid (20/10 μg) was placed in the center of Mueller-Hinton agar plate, and cefotaxime (30 μg) and ceftazidime (30 μg) were placed at a distance of 20 mm from the central disk. Checklist was used to assess hygienic status of butcher shops and practices meat handlers.

Results

A total of 35 (20.80%) biochemically confirmed E. coli were obtained from 168 samples. Of these, 21 (23.9%) of them were detected from 88 minced meat and the other 14 (17.5%) from 80 swab samples taken from butcher’s hand, knives, chopping board and protective clothing. From 35 E. coli isolates, 7(20%) of them were confirmed as ESBL- producers. Among ESBL- producing strains, 85.7% were resistant for cefotaxime and ceftriaxone and 71.4% for ceftazidime. Among non-ESBLs-producing strains only seven isolates were resistant to third generation cephalosporin. All E. coli isolates were resistant to ampicillin, penicillin and erythromycin, and susceptible to amikacin. Poor hygienic status of butcher shops and unhygienic practice of meat handlers were observed.

Conclusion

The detections of ESBLs- producing strains could be contributed for the increment of multi drug resistant isolates. This study also concluded that, unhygienic meat handling and processing practice can contribute for contaminations of meat. Thus, strategies should be planned and implemented to improve the knowledge and practice of butchers about handling and processing of meat.
Albumin losses during hemodiafiltration: all dialyzers are not created equal - a case report
Authors: Cuvelier Charles , Tintillier Michel , Migali Gabriela , Van Ende Charlotte , Pochet Jean-Michel
Published: October 2019

Background

Online hemodiafiltration (OL-HDF) is associated with better removal of both small and middle molecules and might improve survival compared to conventional hemodialysis (HD). Nevertheless, hemodiafiltration (HDF) can lead to an increase in albumin loss across the dialyzer, especially with high permeability membrane and high convective volume (CV). We present the case of a patient treated by OL-HDF who developed severe hypoalbuminemia resulting from massive albumin loss into dialysate.

Case presentation

A 71-year-old woman with ESRD started renal replacement therapy in December 2016. She was treated by high volume post-dilution OL-HDF, 4 h, 3 times per week. The dialyzer was the Phylther HF20SD (a 2.0m2 heat sterilized high flux (HF) polyphenylene membrane from Bellco). At the initiation of dialysis, the serum albumin was 4.0 g/dl. During the following months, the patient developed severe hypoalbuminemia. The lowest value observed was 2.26 g/dl in July 2017. Diagnostic workup excluded nephrotic syndrome, hepatic failure and malabsorption. The patient was shifted from OL-HDF to standard HF HD, keeping the same dialyzer and dialysis schedule. During the following months, we observed a progressive correction of the hypoalbuminemia (3.82 g/dl at last follow-up). To precise the impact of the epuration technique on the albumin losses in this patient, we measured the amount of albumin in dialysate during one session with the Phylther HF20SD on OL-HDF and one session with the same filter but on standard HD. The CV was 29.0 l for the HDF session. The total albumin losses were 23.6 g on OL-HDF and 4.6 g on HD.

Conclusion

OL-HDF can lead to significant albumin loss into the dialysate, especially with high permeability membrane and high CV. When prescribing post-dilutional OL-HDF, the choice of the dialyzer membrane should be made with caution. Users of the steam sterilized polyphenylene membrane, the Phylther SD, should be informed of the risk of large albumin loss with this membrane during post-dilution OL-HDF.
Effect of interpregnancy weight change on perinatal outcomes: systematic review and meta-analysis
Authors: Teulings Noor E. W. D. , Masconi Katya L. , Ozanne Susan E. , Aiken Catherine E. , Wood Angela M.
Published: October 2019

Background

Although obesity is a well-known risk factor for adverse pregnancy outcomes, evidence is sparse about the effects of interpregnancy weight change on the risk of adverse perinatal complications in a subsequent pregnancy. The current study aims to assess the effect of interpregnancy weight change on the risk of developing gestational diabetes, pre-eclampsia, pregnancy induced hypertension, preterm birth, or delivering a large- or small-for-gestational age neonate.

Methods

Pubmed, Ovid Embase, ClinicalTrial.gov and the Cochrane library were systematically searched up until July 24th, 2019. Interpregnancy weight change was defined as the difference between pre-pregnancy weight of an index pregnancy and a consecutive pregnancy. Inclusion criteria included full text original articles reporting quantitative data about interpregnancy weight change in multiparous women with any time interval between consecutive births and the risk of any perinatal complication of interest. Studies reporting adjusted odds ratios and a reference group of − 1 to + 1 BMI unit change between pregnancies were harmonised by meta-analysis.

Results

Twenty-three cohort studies identified a total of 671,906 women with two or more consecutive pregnancies. Seven of these studies were included in the meta-analysis (280,672 women). Interpregnancy weight gain was consistently associated with a higher risk of gestational diabetes, pre-eclampsia, pregnancy induced hypertension and large-for-gestational age births. In contrast, interpregnancy weight loss was associated with a lower risk of delivering a large-for-gestational age neonate. The effect magnitude (relative risk) of interpregnancy weight gain on pregnancy induced hypertension or delivering a large-for-gestational age neonate was greater among women with a normal BMI in the index pregnancy compared to women with a starting BMI ≥25 kg/m2.

Conclusion

These findings confirm that interpregnancy weight change impacts the risk of developing perinatal complications in a subsequent pregnancy. This provides evidence in support of guidelines encouraging women to achieve post-partum weight loss, as their risk of perinatal complications might be minimised if they return to their pre-pregnancy weight before conceiving again.

Prospectively registered with PROSPERO (CRD42017067326).
Screening antiproliferative drug for breast cancer from bisbenzylisoquinoline alkaloid tetrandrine and fangchinoline derivatives by targeting BLM helicase
Authors: Zhang Wangming , Yang Shuang , Liu Jinhe , Bao Linchun , Lu He , Li Hong , Pan Weidong , Jiao Yanchao , He Zhixu , Liu Jielin
Published: October 2019

Background

The high expression of BLM (Bloom syndrome) helicase in tumors involves its strong association with cell expansion. Bisbenzylisoquinoline alkaloids own an antitumor property and have developed as candidates for anticancer drugs. This paper aimed to screen potential antiproliferative small molecules from 12 small molecules (the derivatives of bisbenzylisoquinoline alkaloids tetrandrine and fangchinoline) by targeting BLM642–1290helicase. Then we explore the inhibitory mechanism of those small molecules on proliferation of MDA-MB-435 breast cancer cells.

Methods

Fluorescence polarization technique was used to screen small molecules which inhibited the DNA binding and unwinding of BLM642–1290helicase. The effects of positive small molecules on the ATPase and conformation of BLM642–1290helicase were studied by the malachite green-phosphate ammonium molybdate colorimetry and ultraviolet spectral scanning, respectively. The effects of positive small molecules on growth of MDA-MB-435 cells were studied by MTT method, colony formation and cell counting method. The mRNA and protein levels of BLM helicase in the MDA-MB-435 cells after positive small molecule treatments were examined by RT-PCR and ELISA, respectively.

Results

The compound HJNO (a tetrandrine derivative) was screened out which inhibited the DNA binding, unwinding and ATPase of BLM642–1290helicase. That HJNO could bind BLM642–1290helicase to change its conformationcontribute to inhibiting the DNA binding, ATPase and DNA unwinding of BLM642–1290helicase. In addition, HJNO showed its inhibiting the growth of MDA-MB-435 cells. The values of IC50after drug treatments for 24 h, 48 h and 72 h were 19.9 μmol/L, 4.1 μmol/L and 10.9 μmol/L, respectively. The mRNA and protein levels of BLM helicase in MDA-MB-435 cells increased after HJNO treatment. Those showed a significant difference (P < 0.05) compared with negative control when the concentrations of HJNO were 5 μmol/L and 10 μmol/L, which might contribute to HJNO inhibiting the DNA binding, ATPase and DNA unwinding of BLM helicase.

Conclusion

The small molecule HJNO was screened out by targeting BLM642–1290helicase. And it showed an inhibition on MDA-MB-435 breast cancer cells expansion.
Predictive value of lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) in patients with oesophageal cancer undergoing concurrent chemoradiotherapy
Authors: Li Ke-Jie , Xia Xiao-Fang , Su Meng , Zhang Hui , Chen Wen-Hao , Zou Chang-Lin
Published: October 2019

Background and objectives

The survival rate of patients with advanced oesophageal cancer is very low and can vary significantly, even among patients with the same TNM stage. It is important to look for indicators that are economical and readily available to predict overall survival. The aim of this study was to determine whether lymphocyte-to-monocyte ratio (LMR) and neutrophil-to-lymphocyte ratio (NLR) could be potential predictors of survival in patients with advanced oesophageal squamous cell carcinoma (ESCC) undergoing concurrent chemoradiotherapy.

Methods

Differences in survival among 204 patients with advanced oesophageal cancer who underwent concurrent chemoradiotherapy were collected and analysed. Univariate and multivariate COX regression analyses were used to investigate the association between blood inflammatory markers and patient survival before treatment.

Results

Univariate COX regression analyses showed that a history of alcohol use, neutrophil count, LMR, NLR, tumour length, and N stage were significantly associated with the survival of tumour patients receiving concurrent chemoradiotherapy. Multivariate COX regression analysis showed that NLR and LMR were predictors of outcome in tumour patients receiving chemoradiotherapy. According to receiver operating characteristic (ROC) curve analysis, the AUC of LMR and NLR was 0.734 and 0.749, and the best cutoff point for LMR and NLR was 3.03 and 2.64, respectively.

Conclusions

LMR and NLR can be used to predict the survival of patients with advanced oesophageal cancer receiving concurrent chemoradiotherapy, thereby providing clinicians with suggestions for further treatment options.
Pre-travel health care attendance among migrant travellers visiting friends and relatives (VFR): a 10-year retrospective analysis
Authors: Ferrara Pietro , Masuet-Aumatell Cristina , Ramon-Torrell Josep Maria
Published: October 2019

Background

Travellers visiting friends and relatives (VFR) define a specific population of travellers exposed to higher risks for health and safety than tourists. The aim of this study was to assess differentials in pre-travel health care in VFR travellers compared to other travellers.

Methods

A retrospective cohort study was performed including attendees of the Travel Medicine Clinic of the Hospital Universitari de Bellvitge, Barcelona, Spain, between January 2007 and December 2017.

Results

Over the 10-year period, 47,022 subjects presented to the travel clinic for pre-travel health care, 13.7% of whom were VFR travellers. These showed higher rates of vaccination against yellow fever and meningococcus, but lower rates for hepatitis A, hepatitis B, influenza, rabies, cholera, polio, typhoid IM vaccine and tetanus vaccine boosters. Regarding malaria prevention measures, results highlighted that VFR travellers, when compared with tourists, were more likely to be prescribed with chemoprophylaxis, particularly with mefloquine, than with atovaquone/proguanil.

Conclusions

Findings from this large-scale study indicated differences in vaccination rates and completion, as well as in chemoprophylaxis for malaria, between VFR and non-VFR travellers, fostering specific interventions for promoting adherence to pre-travel health advice among migrant travellers.