bluuebunny/crossref_metadata_2025 huggingface dataset:
Medial Patellofemoral Ligament Reconstruction with Quadriceps Autograft for Neglected Unreduced Patellar Subluxation: A Case Report
Authors: Hutami Wintang Dayinta Tanaya , Hasan Jafri
Published: February 2023

Introduction:

The medial patellofemoral ligament is the primary stabilizer of the patellofemoral joint. Over the past decade, reconstruction has been recommended in adults with patellar instability. However, the reconstruction methods have not been standardized. The best graft and reconstruction methods have not yet been identified

Methods:

A 44-year-old female patient with knee unable to flex with pain following trauma. Patient underwent medial patellofemoral ligament reconstruction with quadriceps autograft. Arthroscopy was performed on anterolateral and anteromedial of the patella, obtained elongation and titling of the patella with medial articular surface defect, debridement was conduct. The MPFL reconstruction was done with the superficial quad graft technique, the end of the graft was sutured and measured, drilled the femur on the Schottle point using C-Arm guide according to the graft diameter. The graft is placed in the subvastus space, fixation of the graft with superior to inferior side switches, examined to ensure the stabilisation of the flexion and extension tension and fixated with screw

Results:

After the operation, the patient is able to perform regular daily activities without any complaints

Conclusion:

This study has found that medial patellofemoral ligament reconstruction using quadriceps autograft leads to an acceptable functional outcome for treating neglected unreduced patellar subluxation
A Modified Mason – Allen Suture Bridge for Musculotendinous Rotator Cuff Repair in Elderly Patient: A case report
Authors: Prasetia Renaldi , Whitiana Greesea Dinamaria , Rasyid Hermawan Nagar
Published: February 2023

Introduction:

As geriatric patient remains active, high functional outcomes is expected, treating rotator cuff in geriatric patient is usual nowadays. But, compromised vascularity and healing potential of soft tissue in older patients contributes to high incidence of re-rupture. Factor could be improved for decreasing the possibility of re-rupture is the suture technique. Modified Mason-Allen technique provides better biomechanical strength which offer high fixation strength, minimal gap formation and tendon strangulation and mechanical stability until tendon healing.

Case Presentation:

A 62-year-old female evaluated for 1 year history of pain around her right shoulder with history of trauma 1 year prior. From the physical examination, she reported significant decrease passive and active range of movement of the shoulder, particularly on abduction which less than 90 degrees. Neer test was positive with positive on Job test and Hawkins test. MRI showed a picture of massive rotator cuff tear. Corticosteroid injection and physical therapy were performed but pain and functional limitation still persisted. We decided to perform arthroscopy. We found subscapularis longitudinal tear, LHBT tear, humeral head bone defect, subacromial bursitis and massive supraspinatus tear. We perform acromioplasty, bursectomy, subacromial decompression, subscapular repair, debridement of supraspinatus footprint and anchor placement as modified Mason-Allen suture bridge.

Clinical Discussion:

In order to prevent re-tears, tendon fixation to bone and footprint reconstruction are important. Trans osseous-equivalent (suture bridge) was giving better biomechanical properties for the repaired tendon. In Modified Mason- Allen techniques, combination of horizontal matrass as a rip stops and vertical simple sutures as main holding power. This suture bridge was giving a compressive mechanism for enthesis to footprint enhancing healing. Several advantages of Mason – Allen suture bridge are very strong tissue holding property, rip stop which prevent tendon pull-out and less possibility strangulation, impingement or irritation.

Conclusion:

Modified Mason – Allen technique provides better biomechanical strength and restoration of footprint which allow the repaired tendon to heal and decrease the incidence of re-rupture.
Characteristics of Ruptured Anterior Cruciate Ligament (ACL) Patients at Hasan Sadikin Hospital Bandung
Authors: Utoyo Ghuna Arioharjo , AS Marsahala
Published: February 2023

Background:

ACL injury is the most common injury in sports knee injuries. An ACL injury can be a stretch to the ligament or it can be completely torn. The ACL ligament is one of the main ligaments in the knee region. Discussions about ligaments in the knee joint are still rarely heard, especially in Indonesia. So there is little knowledge for the community. The discussion of literature originating from Indonesia is still small and makes it difficult for the public to obtain information related to this ligament rupture. Cases in Indonesia are quite numerous and varied, so a better understanding of ACL rupture injuries is needed. In the last 5 years, 187 cases were found at Hasan Sadikin Hospital, Bandung, with a variety of cases and different treatments, especially using the arthroscopy method.

Methods:

This study was conducted to determine the characteristics of ACL injured patients at Hasan Sadikin Hospital, Bandung Period January 2017 to December 2021. The inclusion criteria in this study were all patients with ACL injuries from January 2017 to December 2021 with complete medical record data.

Results:

The results of this study showed that the age range of ACL patients was 14-64 years, with an average age of 24.5 years. male to female is 4.67:1. There were 10 patients who were athletes. The type of ACL injury was partial, there were 39 patients and the total was 148 patients. Other comorbidities Hoffa syndrome 18 patients. Plica syndrome 30 patients. Joint flexibility 19 people, who do not have joint flexibility 168 patients. Management of patients with remnant resurface as many as 163 patients and 23 patients who underwent augmentation. Other problems after ACL surgery were 18 patients underwent menisectomy and 6 patients underwent meniscus repair

Conclusion:

From the results of this study, the characteristics of patients with ACL rupture were found to be on average at the age of 24.5 years, male gender, college students. 10 professional athletes suffered ACL ruptures. More patients suffered total rupture than partial. Treatment for ACL patients is more often with remnant surfaces. After ACL treatment, complications such as menisectomy could occur as many as 38 patients and 16 patients underwent meniscus repair
Anatomic Acromioclavicular Joint Reconstruction Using Semitendinosus Graft with Internal Bracing in Chronic Acromioclavicular Joint Dislocation: Case Series
Authors: Adisthanaya Surya , Febyan  , Artha Ida Ayu Ratna Dewi Arrisna , Astawa Putu
Published: February 2023

Introduction:

Acromioclavicular joint dislocations represent a frequent condition, affecting a very specific and generally active population and accounting for around 9% of all shoulder injuries.

Case Presentation:

We present a series of patients who underwent AC Joint reconstruction using Semitendinosus graft with internal bracing. The beach chair position is used for acromioclavicular reconstruction surgery. In this technique, we restore the anatomy, reconstruct the coracoclavicular ligament, and reinforced the acromioclavicular ligament. And it is reliable for chronic acromioclavicular joint injury. At final follow up we found excellent results with average pain score of 1.6, and average ROM of 160° of forward flexion and abduction, 70° of external rotation, and internal rotation level at T11. Postoperative function also showed great improvements with average ASES of 85 points, an average Constant Score of 89 points. This technique also achieved acceptable radiographic results, with an average coracoclavicular distance increase of 1.4 mm

Discussion & Conclusion:

The loss of AC joint congruence with the Weaver Dunn procedure suggested that possibly the problem wasn’t only biological. This technique seems to be especially advantageous as it allows for an anatomic, biological, and minimally invasive procedure while avoiding some of the inconveniences described in other reports. Although demanding, it can be reproducibly performed arthroscopically, and good clinical outcomes should be expected.
Interposition elbow arthroplasty clinical and functional outcomes: A Systematic review
Authors: Adhimulia Kevin Jonathan , Aminata Iman Widya , Mangasah Holong , Nugroho Johanes Jethro
Published: February 2023

Objective:

Painful and stiff elbow, especially in young patients, results in severe impairment in daily activities. Persistent pain and stiffness despite conservative treatment indicate surgical arthroplasty. Total elbow arthroplasty (TEA) is relatively contraindicated in young patients with high activity due to the risk of early prosthetic loosening. Furthermore, TEA is relatively expensive and inaccessible, especially in developing countries. Interposition elbow arthroplasty has been an alternative to TEA with the possibility of further reconstruction and lower cost. This study aimed to conduct a systematic review of literature evaluating clinical and functional outcomes of various interposition elbow arthroplasty.

Methods:

We conducted a systematic review to obtain outcomes of interposition elbow arthroplasty. Literature searching was conducted in PubMed, Cochrane Library, and ScienceDirect. We included clinical studies, case series, or case reports related to interposition elbow arthroplasty. Relevant studies were critically appraised by Oxford Central for Evidence-Based Medicine (CEBM) critical appraisal tool. Relevant data including functional outcome, pain, and range of motion (ROM) was then pooled and analyzed.

Results:

We selected 15 relevant studies including nine retrospective clinical studies, three case series, and three case reports. All studies showed significant improvement of range of motion (ROM) and Mayo Elbow Performance Score (MEPS). The pain score of MEPS also showed improvement in several studies. Pooled study analysis showed an overall Z score of 20.4 (p<0,001) for ROM with a mean difference of 55.5°, Z score of 16.28 (p<0,001) for MEPS, and 9.30 (p<0,001) for MEPS pain score.

Conclusion:

Interposition elbow arthroplasty significantly improved clinical and functional outcomes postoperatively in patients with stiff and painful elbows.
Comparison of Autografts vs Allografts for Anterior Cruciate Ligament Reconstruction: A Meta-Analysis of Current Perspective
Authors: Adisthanaya Surya , Febyan  , Astawa Putu
Published: February 2023

Objective:

To describe the outcomes of autografts and allografts in anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) reconstruction with respect to instrumented laxity measurements, patient-reported outcome scores, complications, and graft failure risk.

Methods:

We searched PubMed, Cochrane Library, and EMBASE for published randomized controlled trials (RCT) and case controlled trials (CCTs) to compare the outcomes of the autografts versus allografts after cruciate ligament reconstruction. Data analyses were performed using Cochrane Collaboration RevMan 5.0.

Results:

Nine studies were identified from the literature review. Of these studies, three studies compared the results of bone–patellar tendon–bone (BPTB) and ligament augmentation and reconstruction system (LARS), while six studies compared the results of four-strand hamstring tendon graft (4SHG) and LARS. The comparative study showed no difference in Lysholm score and failure risk between autografts and synthetics.

Discussion:

The combined results of the meta-analysis indicated that there was a significantly lower rate of side-to-side difference > 3 mm (Odds Ratio [OR] 2.46, 95% confidence intervals [CI] 1.44–4.22, P = 0.001), overall IKDC (OR 0.40, 95% CI 0.19–0.83, P = 0.01), complications (OR 2.54, 95% CI 1.26–5.14, P = 0.009), and Tegner score (OR −0.31, 95% CI −0.52–0.10, P = 0.004) in the allografts group than in the autografts group.

Conclusion:

This systematic review comparing long-term outcomes after cruciate ligament reconstruction with either autograft or allografts suggests no significant differences in failure risk. Autografts were inferior to allografts with respect to restoring knee joint stability and patient-reported outcome scores, and were also associated with more postoperative complications.
Arthroscopy Revision of Medial Meniscus Posterior Root (MMPR) Reconstruction Using Gracillis Tendon Graft. A Case Report
Authors: Setyawan Wahyu , Artha Arrisna
Published: February 2023

The techniques for medial meniscal posterior roots (MMPR) repair can vary in relationship to the surgical approach, type of suture, device used, and fixation technique. Anatomic reduction, meniscal root fixation, and prevent extursion are possible by the trans-tibial pull-out repair procedure for MMPR tears. But it has been found that it has a substantially weaker than the natural root with unsactisfactory healing rates.

Objective:

We purposed this technique to reduce the failure of meniscus repair with a more anatomical, better healing and reproducible outcome

Case Presentation:

A 60-year-old female patient with Medial Meniscus Posterior Root tear LaPrade classification type 2. She had arthroscopic transtibial pull-out meniscal root repair using Ethibond No. 5 non-absorbable suture material. Six months after surgery, she had retear on MMPR and we performed the arthroscopic MMPR reconstruction with gracilis tendon graft. 3 months after surgery, patient has a good function and MRI evaluation.

Conclusion:

This arthroscopic medial meniscus posterior root reconstruction using gracilis graft is provide an anatomical repair, a more strong with a biological healing than previous repair techniques.
Outcomes Arthroscopic Partial Menisectomy Compared with Arthroscopic Meniscal Repair on Meniscal Tears : A Systematic Review
Authors: Wisnawan I Made Yedi , Aryana IGN Wien
Published: February 2023

Introduction:

Meniscal tears is one of the most common injury in knee. The surgical management of meniscal tears has seen an increasing trend towards meniscal repair from partial meniscectomy. The purpose of this study is to evaluate and review the comparison of the results between arthroscopic partial menisectomy with meniscal repair on meniscal tears by evaluating clinical outcomes and radiological outcomes.

Method:

Systematic review and meta-analysis was conducted using PRISMA guidelines. Literature was searched through PubMed, Google Scholar, Science Direct and Cochrane Library using Boolean operators. The outcomes assessed by Lysholm, Tegner IKDC, KOOS score and osteoarthritis radiological outcomes.

Results:

Six studies included in the systematic review. Five are retrospective cohort studies and one is prospective cohort study. Total sample size were around 527 patients, with 308 patients undergoing APM procedure and the rest 219 patients had meniscal repair.

Discussion:

Most studies showed meniscal repair had better outcomes compared to APM with significant difference in almost all outcomes measurement. Only one study reported APM better than meniscal tear in KOOS score.

Conclusion:

There are significant difference between APM and meniscal repair in the patients reported outcome and also in the OA radiologic outcomes. There is only one study that showed APM have better clinical outcomes compared with meniscal repair. The choice of which procedure to perform relies on the surgeon’s preference and the patient condition.
Radiographic Parameters of Adult Hip Dysplasia
Authors: Welton K. Linnea , Kraeutler Matthew J. , Garabekyan Tigran , Mei-Dan Omer
Published: February 2023

As knowledge about the origin and morphologic characteristics of hip pain in the young adult has evolved, so too has the clinician’s ability to assess for various pathologies of the hip on radiographs, magnetic resonance imaging (MRI)/magnetic resonance arthrography (MRA), and computed tomography (CT). Because there is no algorithm at this time directly indicating what to do in more subtle hip morphologies, such as microinstability and borderline hip dysplasia (BHD), a skilled hip preservation specialist must use multiple imaging sources and know how to interpret them correctly. Imaging parameters used in the workup for hip dysplasia and BHD include the lateral center-edge angle, Tönnis angle, iliofemoral line, and presence of an upsloping lateral sourcil or everted labrum, among many others. The purpose of this narrative review was to detail various established criteria and parameters on anteroposterior pelvis plain radiographs, MRI/MRA, and CT that assist in defining the nature and severity of instability present in a dysplastic hip, thereby aiding in the development of patient-specific surgical treatment plans.
Blood Flow Restriction Following ACL Reconstruction
Authors: Johns William , Wiafe Bright M. , Hammoud Sommer
Published: February 2023

Background:

Blood flow restriction (BFR) therapy is a technique that uses partial occlusion of arterial blood flow in tandem with low-load resistance training to promote an environment of metabolic stress within muscle tissue. It is hypothesized that such therapy can facilitate protein synthesis and muscle hypertrophy even in the setting of age, injury, or postoperative rehabilitation—conditions which are marred by muscle atrophy and progressive loss of function. Therefore, BFR may be a successful option to facilitate strength gains even in patients unable to perform traditional high-load resistance training.

Indications:

BFR therapy has been shown to be efficacious when used in healthy athletes, the elderly, or in postoperative patients undergoing rehabilitation after upper or lower extremity procedures. More specifically, BFR application in patients undergoing knee surgery has been shown to reduce muscle atrophy post operatively.

Technique Description:

BFR involves application of a tourniquet or occlusion cuff at 70% of the determined arterial occlusion pressure (commonly 150-180 mm Hg). The arterial occlusion pressure is calculated by observing the loss of Doppler ultrasonography signal at the pedal pulses with sequential inflation of a blood pressure cuff. This cuff should be applied as proximal as possible at the affected extremity. The patient subsequently performs 5 exercises, including 3 sets of 15 repetitions of each exercise, with 30 seconds of rest in between sets. The cuff remains inflated for all 5 exercises.

Results:

BFR in tandem with low-load resistance training has been shown to be effective in improving lower extremity muscle torque and mass of the quadriceps and hamstring muscles when used after knee surgery, specifically anterior cruciate ligament (ACL) reconstruction. The most commonly reported adverse outcomes after BFR include muscle soreness and sensory paresthesias; however, BFR is generally believed to be safe and acceptable for use in a broad spectrum of patients.

Discussion/Conclusion:

Muscle atrophy and loss of strength are hallmarks of aging, injured, and postoperative patients. Traditional means of high-intensity strength training is not feasible in these patient populations, and the use of BFR in tandem with lower intensity strength training shows promise in its ability to promote improvements in muscle strength and hypertrophy. However, more high-level research into the long-term effects, complications, and optimal BFR training regimen is warranted.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Interventions for the empowerment of older people and informal caregivers in transitional care decision-making: short report of a systematic review
Authors: Kraun Lotan , De Vliegher Kristel , Ellen Moriah , van Achterberg Theo
Published: February 2023

Background

Care transitions across different settings necessitate careful decision-making for all parties involved, yet research indicates that older people and informal caregivers do not have a strong voice in such decisions.

Objective

To provide a systematic overview of the literature about interventions designed to empower older people and informal caregivers in transitional care decision-making.

Design

A systematic review (Prospero Protocol CRD42020167961; funded by the EU’s Horizon 2020 program).

Data sources

Five databases were searched: PubMed, EMBASE, Web of Science, PsycINFO, and CINAHL.

Review methods

The review included evaluations of empowerment in decision-making interventions for older people and informal caregivers facing care transitions, that were published from the inception of the databases up until April 2022. Data extractions were performed by two independent researchers and the quality of studies was assessed with the relevant JBI-critical appraisal tools. A narrative descriptive analysis of the results was performed.

Findings

Ten studies, reporting on nine interventions, and including a total of 4642 participants, were included. Interventions included transition preparation tools, support from transition coaches, shared decision-making interventions, and advance care planning. Designs and outcomes assessed were highly diverse and showed a mix of positive and lacking effects.

Conclusions

There is a lack of research on how to empower older people and their informal caregivers in transitional care decision-making. Empowerment in decision-making is usually not central in transitional care interventions, and effects on actual empowerment are mostly not assessed. Conclusions on how to empower older people and informal caregivers in transitional care decision-making cannot be drawn.
Medium and long-term radiographic and clinical outcomes of Dynesys dynamic stabilization versus instrumented fusion for degenerative lumbar spine diseases
Authors: Zhou Lu-Ping , Zhang Ren-Jie , Wang Jia-Qi , Zhang Hua-Qing , Shang Jin , Gao Yang , Jia Chong-Yu , Ding Jing-Yu , Zhang Lai , Shen Cai-Liang
Published: February 2023

Background

Dynesys stabilization (DS) is utilized to preserve mobility at the instrumental segments and prevent adjacent segment pathology in clinical practice. However, the advantages of DS method in medium and long-term follow-up remain controversial.

Objective

To compare the radiographic and clinical outcomes between DS and instrumented fusion in the treatment of degenerative lumbar spine disease with or without grade I spondylolisthesis with a minimum follow-up period of 2 years.

Methods

We conducted a comprehensive search of PubMed, EMBASE, Cochrane, and Web of Science databases, Chinese National Knowledge Databases, and Wanfang Database for potentially eligible articles. Clinical outcomes were assessed in terms of VAS and ODI scores, screw loosening and breakage, and surgical revision. Radiographic outcomes were assessed in terms of postoperative range of movement (ROM) and disc heigh. Moreover, adjacent segment degeneration (ASDeg) and adjacent segment disease (ASDis) were evaluated.

Results

Seventeen studies with 1296 patients were included in the meta-analysis. The DS group was associated with significantly lower postoperative VAS scores for low-back and leg pain, and lower rate of surgical revision than the fusion group. Moreover, the Dynesys group showed significantly less ASDeg than the fusion group but showed no significant advantage over the fusion group in terms of preventing ASDis. Additionally, the ROM at the stabilized segments of the fusion group decreased significantly and that at the adjacent segments increased significantly compared with those of the DS group.

Conclusion

DS showed comparable clinical outcomes and provided benefits in preserving the motion at the stabilized segments, thus limiting the hypermobility at the adjacent segments and preventing ASDeg compared with the fusion method in degenerative disease with or without grade I spondylolisthesis.
Robotic partial cystectomy with excision of mesh after inguinal hernia repair: a case report
Authors: Ramesmayer Christian , Lusuardi Lukas , Griessner Hubert , Gruber Ricarda , Oberhammer Lukas
Published: February 2023

Background

Mesh erosion into the bladder after hernioplasty is sparsely reported in literature and may be underestimated in clinical practice. We report a case of a patient who was referred to our department due to recurrent urinary tract infections caused by a bladder stone due to mesh migration after inguinal hernia repair 22 years ago.

Case presentation

A 67-year-old male patient was referred from the outpatient urologist for transurethral resection of the prostate in September 2021 due to recurrent urinary tract infections caused by benign prostatic enlargement and bladder stone formation. During the operation, parts of the stone were smashed and the prostate was resected. Additionally, a mesh eroding from the bladder roof was detected masqueraded by the stone. A computed tomography scan, which was performed afterwards, revealed a 20 × 25 mm mesh migration into the bladder after inguinal hernia repair on the left with concomitant stone adhesion to the mesh. After revealing patient history, an inguinal hernia repair with mesh implantation was done 22 years ago. A robotic assisted partial cystectomy and mesh excision was performed. The patient recovered well.

Conclusion

Mesh erosion into the urinary bladder after hernia repair can occur up to two decades after the primary operation. Although it is rarely reported, it can be a possible cause for recurrent urinary tract infections and therefore a mentionable complication after inguinal hernia operation. Robotic-assisted laparoscopic partial cystectomy with complete excision of the mesh is an option for definitive treatment.
Improving the resident assessment process: application of App-based e-training platform and lean thinking
Authors: Yuan Wenqing , Li Zhengqian , Han Jiangli , Chu Hongling , Lu Shan , Gu Shixian , Shen Ning
Published: February 2023

Background

The assessment system for standardized resident training is crucial for developing competent doctors. However, it is complex, making it difficult to manage. The COVID-19 pandemic has also aggravated the difficulty of assessment. We, therefore, integrated lean thinking with App-based e-training platform to improve the assessment process through Define–Measure–Analyze–Improve–Control (DMAIC) cycles. This was designed to avoid unnecessary activities that generate waste.

Methods

Panels and online surveys were conducted in 2021–2022 to find the main issues that affect resident assessment and the root causes under the frame of waste. An online app was developed. Activities within the process were improved by brainstorming. Online surveys were used to improve the issues, satisfaction, and time spent on assessment using the app.

Results

A total of 290 clinical educators in 36 departments responded to the survey, and 153 clinical educators used the online app for assessment. Unplanned delay or cancellation was defined as the main issue. Eleven leading causes accounted for 87.5% of the issues. These were examiner time conflict, student time conflict, insufficient examiners, supervisor time conflict, grade statistics, insufficient exam assistants, reporting results, material archiving, unfamiliarity with the process, uncooperative patients, and feedback. The median rate of unplanned delay or cancellation was lower with use of the app (5% vs 0%, P < 0.001), and satisfaction increased (P < 0.001). The median time saved by the app across the whole assessment process was 60 (interquartile range 60–120) minutes.

Conclusions

Lean thinking integrated with an App-based e-training platform could optimize the process of resident assessment. This could reduce waste and promote teaching and learning in medical education.
Bulk and single-cell characterisation of the immune heterogeneity of atherosclerosis identifies novel targets for immunotherapy
Authors: Xiong Jie , Li Zhaoyue , Tang Hao , Duan Yuchen , Ban Xiaofang , Xu Ke , Guo Yutong , Tu Yingfeng
Published: February 2023

Background

Immune cells that infiltrate lesions are important for atherosclerosis progression and immunotherapies. This study was aimed at gaining important new insights into the heterogeneity of these cells by integrating the sequencing results of multiple samples and using an enhanced single-cell sequencing workflow to overcome the limitations of a single study.

Results

Integrative analyses identified 28 distinct subpopulations based on gene expression profiles. Further analysis demonstrated that these cells manifested high heterogeneity at the levels of tissue preferences, genetic perturbations, functional variations, immune dynamics, transcriptional regulators, metabolic changes, and communication patterns. Of the T cells, interferon-induced CD8+ T cells were involved in the progression of atherosclerosis. In contrast, proinflammatory CD4+ CD28nullT cells predicted a poor outcome in atherosclerosis. Notably, we identified two subpopulations of foamy macrophages that exhibit contrasting phenotypes. Among them, TREM2- SPP1+ foamy macrophages were preferentially distributed in the hypoxic core of plaques. These glycolytic metabolism-enriched cells, with impaired cholesterol metabolism and robust pro-angiogenic capacity, were phenotypically regulated by CSF1 secreted by co-localised mast cells. Moreover, combined with deconvolution of the bulk datasets, we revealed that these dysfunctional cells had a higher proportion of ruptured and haemorrhagic lesions and were significantly associated with poor atherosclerosis prognoses.

Conclusions

We systematically explored atherosclerotic immune heterogeneity and identified cell populations underlying atherosclerosis progression and poor prognosis, which may be valuable for developing new and precise immunotherapies.
Low serum anti-Müllerian hormone is associated with semen quality in infertile men and not influenced by vitamin D supplementation
Authors: Holt Rune , Yahyavi Sam Kafai , Kooij Ireen , Andreassen Christine Hjorth , Andersson Anna-Maria , Juul Anders , Jørgensen Niels , Blomberg Jensen Martin
Published: February 2023

Background

Anti-Müllerian hormone (AMH) is released by testicular Sertoli cells and of great importance during fetal male sexual development, but less is known about the role of circulating AMH during adulthood. In vitro studies have shown that vitamin D may induce AMH transcription, but a controlled trial investigating the possible effect of vitamin D on serum AMH has not been conducted in men.

Methods

A single-center, double-blinded, randomized placebo-controlled clinical trial (NCT01304927) conducted in Copenhagen, Denmark. A total of 307 infertile men were included and randomly assigned (1:1) to a single dose of 300,000 IU cholecalciferol followed by 1400 IU cholecalciferol + 500 mg of calcium daily (n = 151) or placebo (n = 156) for 150 days. Difference in serum AMH was a predefined secondary endpoint. Explorative outcomes were associations between serum AMH and gonadal function in infertile men. The primary endpoint was difference in semen quality and has previously been published.

Results

Infertile men in the lowest AMH tertile had significantly lower sperm concentration (∆T3-1 16 mill/mL (228%); P < 0.001), sperm count (∆T3-1 55 million (262%); P < 0.001), motile sperm count (∆T3-1 28 million (255%); P < 0.001), progressive motile sperm count (∆T3-1 18 million (300%); P < 0.001), testis size (∆T3-1 2.7 mL (16%); P < 0.001), serum inhibin B (∆T3-1 72 pg/mL (59%); P < 0.001), inhibin B/FSH ratio (∆T3-1 48 (145%); P < 0.001), and higher FSH (∆T3-1 2.6 (38%); P < 0.001) than the tertile of infertile men with highest serum AMH. Vitamin D supplementation had no effect on serum AMH compared with placebo treatment.

Conclusions

In infertile men, low serum AMH is associated with severely impaired gonadal function illustrated by poor semen quality and lower testosterone/LH ratio. Serum AMH in infertile men was not influenced by vitamin D supplementation.
Comparative effectiveness of BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19
Authors: Wei Jie , Zhang Weiya , Doherty Michael , Wallace Zachary S. , Sparks Jeffrey A. , Lu Na , Li Xiaoxiao , Zeng Chao , Lei Guanghua , Zhang Yuqing
Published: February 2023

Background

Both BNT162b2 (Pfizer–BioNTech) and ChAdOx1 nCoV-19 (Oxford–AstraZeneca) vaccines have shown high efficacy against COVID-19 in randomized controlled trials. However, their comparative effectiveness against COVID-19 is unclear in the real world. We evaluated the comparative effectiveness of the BNT162b2 and ChAdOx1 nCoV-19 vaccines against COVID-19 in the UK general population.

Methods

We emulated a target trial using IQVIA Medical Research Database (IMRD), an electronic primary care database from the UK (2021). We included 1,311,075 participants, consisting of 637,549 men and 673,526 women age≥18 years, who received vaccination with BNT162b2 or ChAdOx1 nCoV-19 between January 1 and August 31, 2021. The outcomes consisted of confirmed diagnosis of SARS-CoV-2 infection, hospitalisation for COVID-19 and death from COVID-19 in the IMRD. We performed a cox-proportional hazard model to compare the risk of each outcome variable between the two vaccines adjusting for potential confounders with time-stratified overlap weighting of propensity score (PS).

Results

During a mean of 6.7 months of follow-up, 20,070 confirmed SARS-CoV-2 infection occurred in individuals who received BNT162b2 vaccine (PS weighted incidence rate: 3.65 per 1000 person-months), and 31,611 SARS-CoV-2 infection occurred in those who received ChAdOx1 nCoV-19 vaccine (PS weighted incidence rate: 5.25 per 1000 person-months). The time-stratified PS weighted rate difference of SARS-CoV-2 infection for BNT162b2 group vs. ChAdOx1 nCoV-19 group was -1.60 per 1000 person-months (95% confidence interval [CI]: -1.76 to -1.43 per 1000 person-months), and the hazard ratio was 0.69 (95% CI: 0.68 to 0.71). The results were similar across the stratum of sex, age (<65 and ≥65 years), and study periods (i.e., alpha-variant predominance period and delta-variant predominance period). The PS weighted incidence of hospitalisation for COVID-19 was also lower in the BNT162b2 vaccine group than that in the ChAdOx1 vaccine group (RD: -0.09, 95%CI: -0.13 to -0.05 per 1000 person-months; HR: 0.65, 95%CI: 0.57 to 0.74). No significant difference in the risk of death from COVID-19 was observed between the two comparison groups.

Conclusions

In this population-based study, the BNT162b2 vaccine appears to be more efficacious than the ChAdOx1 nCoV-19 vaccine against SARS-CoV-2 infection and hospitalisation for COVID-19 but not death from COVID-19.
Roles of E2F family members in the diagnosis and prognosis of head and neck squamous cell carcinoma
Authors: Li Yaoxu , Huang Yinpei , Li Bing , Yang Kai
Published: February 2023

Background

Head and neck squamous cell carcinoma (HNSCC) is the sixth most prevalent cancer worldwide. E2Fs are a group of transcription factors involved in the carcinogenesis and progression of various cancers. However, the exact roles of each member of E2F family in the development and progression of HNSCC are still unknown.

Methods

RNASeq and clinical follow-up information were extracted from The Cancer Genome Atlas (TCGA). The expressions of E2Fs and their roles in HNSCC progression were explored using the R software and the cBioPortal database.

Results

Our results showed that the mRNA levels of E2Fs were significantly higher in HNSCC tumors than in normal tissues. E2F1, E2F3, E2F4, E2F6, and E2F7 were identified as reliable diagnostic markers. E2Fs (except for E2F3) expressions were closely related to the clinical features (excluding metastasis) of HNSCC. High E2F6 mRNA expression was an independent risk factor for the OS of female HNSCC patients. In addition, high E2F4 expression could lead to poor prognosis in HNSCC in both males and females, high expressions of E2F5, E2F6, and E2F7 were associated with poor OS of female HNSCC patients, while high E2F2 and E2F8 expressions were positively correlated with the OS of male HNSCC patients. Interestingly, E2Fs expressions had stronger associations with immune cell infiltrations in male HNSCC patients than in female HNSCC patients.

Conclusion

The expressions of E2Fs were found to be correlated with the progression of HNSCC. E2F1, E2F3, E2F4, E2F6, and E2F7 could be good diagnostic molecules for HNSCC. In addition, E2F6 was an independent risk factor for the prognosis of female HNSCC patients.
Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 1. Introduction and project description
Authors: Valdez Mario , Stollak Ira , Pfeiffer Erin , Lesnar Breanne , Leach Kaitlin , Modanlo Nina , Westgate Carey C. , Perry Henry B.
Published: February 2023

Background

The Curamericas/Guatemala Maternal and Child Health Project, 2011–2015, was implemented in the Western Highlands of the Department of Huehuetenango, Guatemala. The Project utilized three participatory approaches in tandem: the Census-Based, Impact-Oriented (CBIO) Approach, the Care Group Approach, and the Community Birthing Center Approach. Together, these are referred to as the Expanded CBIO Approach (or CBIO+).

Objective

This is the first article of a supplement that assesses the effectiveness of the Project’s community-based service delivery platform that was integrated into the Guatemalan government’s rural health care system and its special program for mothers and children called PEC (Programa de Extensión de Cobertura,or Extension of Coverage Program).

Methods

We review and summarize the CBIO+ Approach and its development. We also describe the Project Area, the structure and implementation of the Project, and its context.

Results

The CBIO+ Approach is the product of four decades of field work. The Project reached a population of 98,000 people, covering the entire municipalities of San Sebastián Coatán, Santa Eulalia, and San Miguel Acatán. After mapping all households in each community and registering all household members, the Project established 184 Care Groups, which were composed of 5–12 Care Group Volunteers who were each responsible for 10–15 households. Paid Care Group Promoters provided training in behavior change communication every two weeks to the Care Groups. Care Group Volunteers in turn passed this communication to the mothers in their assigned households and also reported back to the Care Group Promoters information about any births or ﻿deaths that they learned of during the previous two weeks as a result of their regular contact with their neighbors. At the outset of the Project, there was one Birthing Center in the Project Area, serving a small group of communities nearby. Two additional Birthing Centers began functioning as the Project was operating. The Birthing Centers encouraged the participation of traditional midwives (calledcomadronas) in the Project Area.

Conclusion

This article serves as an introduction to an assessment of the CBIO+ community-based, participatory approach as it was implemented by Curamericas/Guatemala in the Western Highlands of the Department of Huehuetenango, Guatemala. This article is the first of a series of articles in a supplement entitled Reducing Inequities in Maternal and Child Health in Rural Guatemala through the CBIO+ Approach of Curamericas.
Reducing inequities in maternal and child health in rural Guatemala through the CBIO+ Approach of Curamericas: 6. Management of pregnancy complications at Community Birthing Centers (Casas Maternas Rurales)
Authors: Olivas Elijah T. , Valdez Mario , Muffoletto Barbara , Wallace Jacqueline , Stollak Ira , Perry Henry B.
Published: February 2023

Background

In Guatemala, Indigenous women have a maternal mortality ratio over twice that of non-Indigenous women. Long-standing marginalization of Indigenous groups and three decades of civil war have resulted in persistent linguistic, economic, cultural, and physical barriers to maternity care. Curamericas/Guatemala facilitated the development of three community-built, -owned, and -operated birthing centers, Casas Maternas Rurales (referred to here as Community Birthing Centers), where auxiliary nurses provided physically accessible and culturally acceptable clinical care. The objective of this paper is to assess the management of complications and the decision-making pathways of Birthing Center staff for complication management and referral. This is the sixth paper in the series of 10 articles. Birthing centers are part of the Expanded Census-based, Impact-oriented Approach, referred to as CBIO+.

Methods

We undertook an explanatory, mixed-methods study on the handling of pregnancy complications at the Birthing Centers, including a chart review of pregnancy complications encountered among 1,378 women coming to a Birthing Center between 2009 and 2016 and inductively coded interviews with Birthing Center staff.

Results

During the study period, 1378 women presented to a Birthing Center for delivery-related care. Of the 211 peripartum complications encountered, 42.2% were successfully resolved at a Birthing Center and 57.8% were referred to higher-level care. Only one maternal death occurred, yielding a maternal mortality ratio of 72.6 maternal deaths per 100,000 live births. The qualitative study found that staff attribute their successful management of complications to frequent, high-quality trainings, task-shifting, a network of consultative support, and a collaborative atmosphere.

Conclusion

The Birthing Centers were able to resolve almost one-half of the peripartum complications and to promptly refer almost all of the others to a higher level of care, resulting in a maternal mortality ratio less than half that for all Indigenous Guatemalan women. This is the first study we are aware of that analyzes the management of obstetrical complications in such a setting. Barriers to providing high-quality maternity care, including obtaining care for complications, need to be addressed to ensure that all pregnant women in such settings have access to a level of care that is their fundamental human right.
Reducing inequities in maternal and child health in rural Guatemala through the CBIO+﻿ Approach of Curamericas: 9.﻿ Key stakeholder perspectives on strengthening the CBIO+ Approach
Authors: Lambden Jason , Martin Shayanne , Valdez Mario , Stollak Ira , Westgate Carey C. , Perry Henry B.
Published: February 2023

Background

Community-based health interventions have been an integral part of recent health gains globally. An innovative approach to delivering community health care combines the Census-Based, Impact-Oriented (CBIO) Approach with Care Groups and Community Birthing Centers called Casas Maternas Rurales. CBIO+ was adopted by Curamericas/Guatemala in its Maternal and Child Health Project, 2011–2015. Here, we describe the opinions of Project staff and local government health care workers about the strengths and challenges of CBIO+. 

Methods

Self-administered questionnaires, key informant interviews, and focus group discussions were used to obtain the views of 21 staff members from Curamericas/Guatemala as well as 15 local government health workers. The evaluation focused on four primary areas: (1) advisability of integrating the CBIO+ Approach into the government’s rural health system, (2) staff knowledge of the CBIO+ Approach, (3) advantages, disadvantages and challenges of the CBIO+ Approach, and (4) proposed improvements to the CBIO+ Approach. The data were coded into categories and from these categories themes were derived.

Results

The most commonly mentioned advantage of CBIO+ was the inclusion of the community in program planning, which improved participation. Many respondents noted that the CBIO+ Approach was challenging to implement in communities with internal conflicts. Among other challenges mentioned were coordinating (both among the Project staff and with others in the communities), maintenance of a high level of community participation, and overcoming opposition of men to women’s participation in Care Groups. The staff mentioned a number of possible changes, including increasing male involvement, raising salaries for community-level paid staff, providing volunteers with incentives, and improving coordination both internally and externally. There was a strong demand among the local Ministry of Public Health and Social Welfare staff for the Project to continue.

Conclusion

The CBIO+ Approach and its implementation by Curamericas/Guatemala was overall embraced by local staff. By eliciting﻿ feedback while the project was ongoing, actionable areas for improvement were identified.
Prediction of outcomes in subjects with type 2 diabetes and diabetic foot ulcers in Catalonian primary care centers: a multicenter observational study
Authors: Bundó Magdalena , Vlacho Bogdan , Llussà Judit , Bobé Isabel , Aivar Meritxell , Ciria Carmen , Martínez‐Sánchez Ana , Real Jordi , Mata‐Cases Manel , Cos Xavier , Dòria Montserrat , Viade Jordi , Franch‐Nadal Josep , Mauricio Dídac
Published: February 2023

Background

Diabetic foot and lower limb complications are an important cause of morbidity and mortality among persons with diabetes mellitus. Very few studies have been carried out in the primary care settings. The main objective was to assess the prognosis of diabetic foot ulcer (DFU) in patients from primary care centers in Catalonia, Spain, during a 12‐month follow‐up period.

Methods

We included participants with type 2 diabetes and a new DFU between February 2018 and July 2019. We estimated the incidence of mortality, amputations, recurrence and healing of DFU during the follow‐up period. A multivariable analysis was performed to assess the association of these outcomes and risk factors.

Results

During the follow‐up period, 9.7% of participants died, 12.1% required amputation, 29.2% had a DFU recurrence, and 73.8% healed. Having a caregiver, ischemia or infection were associated with higher mortality risk (hazard ratio [HR]:3.63, 95% confidence interval [CI]:1.05; 12.61, HR: 6.41, 95%CI: 2.25; 18.30, HR: 3.06, 95%CI: 1.05; 8.94, respectively). Diabetic retinopathy was an independent risk factor for amputation events (HR: 3.39, 95%CI: 1.37; 8.39). Increasing age decreased the risk for a DFU recurrence, while having a caregiver increased the risk for this event (HR: 0.97, 95%CI: 0.94; 0.99). The need for a caregiver and infection decreased the probability of DFU healing (HR: 0.57, 95%CI: 0.39; 0.83, HR: 0.64, 95%CI: 0.42; 0.98, respectively). High scores for PEDIS (≥7) or SINBAD (≥3) were associated with an increased risk for DFU recurrence and a lower probability of DFU healing, respectively.

Conclusions

We observed high morbidity among subjects with a new DFU in our primary healthcare facilities. Peripheral arterial disease, infection, and microvascular complications increased the risk of poor clinical outcomes among subjects with DFU.