bluuebunny/crossref_metadata_2025 huggingface dataset:
What are the Major Risk Factors for Nonunion in Pilon Fractures?
Authors: Wilson Anthony L. , Boyd Brandon , Cichos Kyle , Murali Sudarsan , Mihas Alexander K. , Patch David A. , McGwin Gerald , Johnson Michael D. , Spitler Clay A.
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Pilon fractures are difficult injuries to manage as they are typically associated with extensive soft tissue damage. Although staged management of external fixation followed by open reduction and internal fixation is often used to prevent additional soft tissue damage and its associated complications, rates of nonunion remain high in this patient population. The purpose of this study is to evaluate and identify factors associated with increased rates of nonunion following operative fixation of pilon fractures.

Methods:

A retrospective review of all operatively managed pilon fractures at a single level 1 trauma center from 2014 to 2019 was performed. Minimum six-month follow-up was required for inclusion. Patients with skeletal immaturity or amputation prior to definitive fixation were excluded. Patients were grouped based on presence or absence of nonunion, which was defined as lack of bridging bone in at least 3 of 4 cortices and the presence of pain with ambulation at six-month follow-up. Demographics, injury and operative characteristics, and surgical outcomes were compared between the two groups.

Results:

Among the 279 patients meeting inclusion criteria, 48 developed nonunion at 6-month follow-up (17.2%). Average follow-up was 3.2 years. Patients with nonunion had significantly higher rates of open fractures (50.0% vs. 22.1%, p<0.001) and more required skin grafts (14.6% vs. 5.6%, p=0.029), muscle flap coverage (12.5% vs. 2.6%, p=0.002), and bone grafting (25.0% vs. 3.9%, p<0.001) compared to controls. Those who developed nonunion had significantly lower rates of medial column fixation (43.8% vs. 67.5%, p=0.002) and higher rates of surgical site infection (45.8% vs. 7.8%, p<0.001). Rates of AO/OTA 43C fractures (70.8% vs. 52.4%) and fractures treated with plates overlapping the site of external fixation (39.5% vs. 26.6%) were higher in the nonunion group, but did not reach statistical significance (p=0.064 and p=0.098). There were no significant differences in demographics, mechanism of injury, Gustilo-Anderson classification, associated ipsilateral lower extremity injuries, surgical approach, or type of fixation between the two groups.

Conclusion:

In the present study, pilon fractures were found to have a nonunion rate of 17.2% at six-month follow-up. Nonunion was associated with the presence of open fracture, need for soft tissue coverage or bone grafting, and surgical site infection. Medial column fixation was associated with a lower rate of nonunion in these fractures.
Is It Safe to Prep the External Fixator in Situ During Staged ORIF of Pilon Fractures? A Retrospective Comparative Cohort Study
Authors: Yeramosu Teja , Hayes Amanda , Young Porter , Cinats David , Kates Stephen , Patel Tejas J. , Perdue Paul W.
Published: November 2022

Category:

Trauma; Ankle

Introduction/Purpose:

Pilon fractures usually result from high energy mechanisms and are associated with signifcant soft tissue injuries in addition to complex fracture patterns. Treatment typically involves staged management with initial placement of an external fixator and subsequent definitive internal fixation once soft tissues are amenable. The purpose of this study was to compare the risk of fracture-related infection (FRI) and unplanned re-operation after staged open reduction and internal fixation (ORIF) of pilon fractures between cases in which elements of the temporizing external fixator (ex-fix) were prepped into the surgical field and cases in which it was completely removed prior to definitive fixation.

Methods:

This was a multi-surgeon retrospective comparative cohort study on patients 18 years and older with pilon fractures who underwent operative treatment over a ten-year period between January 1, 2010 to January 1, 2020 at an academic-level 1 trauma center. Medical records and radiographic images were reviewed for each patient to assess demographics, clinical characteristics and surgical outcomes. The primary outcome measures were FRI and unplanned re-operation, including arthrodesis and amputation. All analyses were completed using JMP Software (Version 15.0, SAS Institute Inc., Cary, NC), and an alpha of 0.05 was used for statistical significance.

Results:

133 patients underwent staged ORIF, 47 with retained elements of the ex-fix prepped in situ for definitive ORIF and 86 with the ex-fix entirely removed. The overall rate of FRI was 23.3% while the overall rate of unplanned re-operation was 11.3% (4.5% rate of arthrodesis and 6.8% rate of amputation). There was no difference in FRI between the group in which ex-fix was prepped in versus the group in which it was completely removed (23.4% vs 23.3%, p=0.985) and no difference in overall rate of unplanned re-operation (10.6% vs 11.6%, p=0.863). Assessing the subset of patients with FRI, those with ex-fix prepped in had a higher prevalence of infection with MRSA and MSSA (81.8% vs 40%, p=0.021). Using alpha=0.05, and power=0.8, a sample size of 42 patients with FRI post-ORIF (27 with ex-fix prepped in, and 15 with ex-fix removed) would be needed to detect a difference in MRSA/MSSA bacteriology.

Conclusion:

Although there were relatively high complication rates in this cohort of pilon fractures treated with staged ORIF, prepping in elements of the external fixator did not lead to a significant increase in rates of fracture-related infection nor unplanned re-operation, including arthrodesis and amputation. This study offers clinical support regarding a common practice used to assist in reduction and definitive fixation of distal tibial pilon fractures.
Myelofibrosis
Authors: Passamonti Francesco , Mora Barbara
Published: November 2022

The clinical phenotype of primary and post–polycythemia vera and postessential thrombocythemia myelofibrosis (MF) is dominated by splenomegaly, symptomatology, a variety of blood cell alterations, and a tendency to develop vascular complications and blast phase. Diagnosis requires assessing complete cell blood counts, bone marrow morphology, deep genetic evaluations, and disease history. Driver molecular events consist of JAK2V617F, CALR, and MPL mutations, whereas about 8% to 10% of MF are “triple-negative.” Additional myeloid-gene variants are described in roughly 80% of patients. Currently available clinical-based and integrated clinical/molecular-based scoring systems predict the survival of patients with MF and are applied for conventional treatment decision-making, indication to stem cell transplant (SCT) and allocation in clinical trials. Standard treatment consists of anemia-oriented therapies, hydroxyurea, and JAK inhibitors such as ruxolitinib, fedratinib, and pacritinib. Overall, spleen volume reduction of 35% or greater at week 24 can be achieved by 42% of ruxolitinib-, 47% of fedratinib-, 19% of pacritinib-, and 27% of momelotinib-treated patients. Now, it is time to move towards new paradigms for evaluating efficacy like disease modification, that we intend as a robust and unequivocal effect on disease biology and/or on patient survival. The growing number of clinical trials potentially pave the way for new strategies in patients with MF. Translational studies of some molecules showed an early effect on bone marrow fibrosis and on variant allele frequencies of myeloid genes. SCT is still the only curative option, however, it is associated with relevant challenges. This review focuses on the diagnosis, prognostication, and treatment of MF.
Using Blue Mini-LEDs as a Light Source Designed a Miniaturized Optomechanical Device for the Detection of Direct Bilirubin
Authors: Ye Zhi Ting , Kuo Hsin-Ching , Tseng Shen Fu , Chung Shu-Ru , Tsou Shang-Xuan
Published: November 2022

This study developed a miniaturized optomechanical device (MOD) for the feasibility study of direct bilirubin in urine using high-collimation blue mini-light-emitting diodes (Mini-LEDs) as the light source. The constructed MOD used optical spectroscopy to analyze different concentrations of direct bilirubin using the absorbance spectrum to achieve a noninvasive method for detection. The experimental results showed that between the absorbance and different concentrations of direct bilirubin at the blue Mini-LEDs central wavelength (462 nm) was the optimum fitting wavelength; in the direct bilirubin concentration range from 0.855 to 17.1 μmol/L, the coefficient of determination (R2) was 0.9999, the limit of detection (LOD) of 0.171 μmol/L, and the limit of quantitation (LOQ) of 0.570 μmol/L. Therefore, we propose using blue Mini-LEDs as a light source to design a MOD to replace the invasive blood sampling method with a spectroscopic detection of direct bilirubin concentration corresponding to absorbance.
Epididymal adenomatoid tumor: a case report and literature review
Authors: Efared Boubacar , Boubacar Idrissa , Soumana Djibo , Bako Aïchatou Balaraba Abani , Coulibaly Idrissa Seriba , Koura Hamadou Halidou , Boureima Habiba Salifou , Nouhou Hassan
Published: November 2022

Background

Adenomatoid tumor is a very rare benign neoplasm of mesothelial origin affecting mainly female and male genital tracts. The diagnosis is challenging as this tumor mimics many differential diagnoses. The current literature offers only some case reports and short series of adenomatoid tumors.

Case presentation

A 47-year-old patient with unremarkable medical history presented for chronic mild pain of the right testis evolving for months. The physical examination shows a palpable right intrascrotal nodule of 10 mm in greatest diameter. The nodule was painful, mobile with firm consistency. The laboratory investigations were within normal limits, the scrotal ultrasonography showed a well-circumscribed predominantly hyperechoic intrascrotal nodule in the right epididymal head with heterogeneous echostructure. Excisional biopsy of the lesion was performed and the histopathological analysis showed a well-circumscribed tumor with microcystic and trabecular architecture made of small interconnected tubules and cysts lined by flattened cells with prominent vacuolization and thread-like bridging strands, consistent with an epididymal adenomatoid tumor. The postoperative course was uneventful and the patient was discharged. Four months after surgical treatment, the patient has no sign of the disease.

Conclusion

Testicular adenomatoid tumors are uncommon benign neoplasms with diagnostic challenge. Adenomatoid tumors arising in epididymis are managed by excisional biopsy with testis-sparing surgery avoiding unnecessary orchidectomy.
BioByGANS: biomedical named entity recognition by fusing contextual and syntactic features through graph attention network in node classification framework
Authors: Zheng Xiangwen , Du Haijian , Luo Xiaowei , Tong Fan , Song Wei , Zhao Dongsheng
Published: November 2022

Background

Automatic and accurate recognition of various biomedical named entities from literature is an important task of biomedical text mining, which is the foundation of extracting biomedical knowledge from unstructured texts into structured formats. Using the sequence labeling framework and deep neural networks to implement biomedical named entity recognition (BioNER) is a common method at present. However, the above method often underutilizes syntactic features such as dependencies and topology of sentences. Therefore, it is an urgent problem to be solved to integrate semantic and syntactic features into the BioNER model.

Results

In this paper, we propose a novel biomedical named entity recognition model, named BioByGANS (BioBERT/SpaCy-GraphAttentionNetwork-Softmax), which uses a graph to model the dependencies and topology of a sentence and formulate the BioNER task as a node classification problem. This formulation can introduce more topological features of language and no longer be only concerned about the distance between words in the sequence. First, we use periods to segment sentences and spaces and symbols to segment words. Second, contextual features are encoded by BioBERT, and syntactic features such as part of speeches, dependencies and topology are preprocessed by SpaCy respectively. A graph attention network is then used to generate a fusing representation considering both the contextual features and syntactic features. Last, a softmax function is used to calculate the probabilities and get the results. We conduct experiments on 8 benchmark datasets, and our proposed model outperforms existing BioNER state-of-the-art methods on the BC2GM, JNLPBA, BC4CHEMD, BC5CDR-chem, BC5CDR-disease, NCBI-disease, Species-800, and LINNAEUS datasets, and achieves F1-scores of 85.15%, 78.16%, 92.97%, 94.74%, 87.74%, 91.57%, 75.01%, 90.99%, respectively.

Conclusion

The experimental results on 8 biomedical benchmark datasets demonstrate the effectiveness of our model, and indicate that formulating the BioNER task into a node classification problem and combining syntactic features into the graph attention networks can significantly improve model performance.
Expression of PmACRE1 in Arabidopsis thaliana enables host defence against Bursaphelenchus xylophilus infection
Authors: Xie Wanfeng , Xu Xiaomei , Qiu Wenjing , Lai Xiaolin , Liu Mengxia , Zhang Feiping
Published: November 2022

Background

Pine wilt disease (PWD) is a destructive disease that endangers pine trees, resulting in the wilting, with yellowing and browning of the needles, and eventually the death of the trees. Previous studies showed that theAvr9/Cf-9rapidly elicited (PmACRE1) gene was downregulated byBursaphelenchus xylophilusinfection, suggesting a correlation betweenPmACRE1expression and pine tolerance. Here, we used the expression ofPmACRE1inArabidopsis thalianato evaluate the role ofPmACRE1in the regulation of host defence againstB. xylophilusinfection.

Results

Our results showed that the transformation ofPmACRE1intoA. thalianaenhanced plant resistance to the pine wood nematode (PWN); that is, the leaves of the transgenic line remained healthy for a longer period than those of the blank vector group. Ascorbate peroxidase (APX) activity and total phenolic acid and total flavonoid contents were higher in the transgenic line than in the control line. Widely targeted metabolomics analysis of the global secondary metabolites in the transgenic line and the vector control line showed that the contents of 30 compounds were significantly different between these two lines; specifically, the levels of crotaline, neohesperidin, nobiletin, vestitol, and 11 other compounds were significantly increased in the transgenic line. The studies also showed that the ACRE1 protein interacted with serine hydroxymethyltransferase, catalase domain-containing protein, myrosinase, dihydrolipoyl dehydrogenase, ketol-acid reductoisomerase, geranylgeranyl diphosphate reductase, S-adenosylmethionine synthase, glutamine synthetase, and others to comprehensively regulate plant resistance.

Conclusions

Taken together, these results indicate thatPmACRE1has a potential role in the regulation of plant defence against PWNs.
A primary cardiac schwannoma of the right ventricle: a case report and literature review
Authors: Wang Fang , Li Lin , Ma Heng , Chi Xiao-Xiao
Published: November 2022

Background

Primary cardiac schwannoma remains extremely rare and difficult to distinguish from other myocardial tumours. We report a case of cardiac schwannoma that occurred in the lateral wall of the right ventricle and grew in the myocardial walls. It is the third case of schwannoma that occurred in the free wall of the right ventricle. Moreover, we reviewed and summarised the literature for cases involving benign cardiac schwannomas.

Case presentation

We present a case of a 64-year-old woman who presented to our centre with syncope for 1–2 min. Echocardiogram and contrast-enhanced computed tomography subsequently revealed a 2.9 × 1.9 cm homogeneous mass originating from the anterior wall of the right ventricle. The patient underwent thoracotomy to resect the mass, which was pathologically verified as Schwann cell tumour.

Conclusions

This is a rare case added to the limited existing literature on cardiac schwannoma. Comprehensive analysis of various imaging examinations is helpful to determine the extent of the tumour. Complete surgical resection is recommended for similar cases involving cardiac schwannomas, especially when the patient has related symptoms. Patients generally have a good prognosis. The pathogenesis of cardiac schwannoma needs further research in order to prevent and manage this rare lesion.
Effect of posture on anorectal manometric measurements in female patients with fecal incontinence and rectoanal intussusception
Authors: Tsunoda Akira , Takahashi Tomoko , Osawa Ikuko
Published: November 2022

Purpose

This study aimed to investigate the influence of erect position on anorectal manometry in patients with rectoanal intussusception (RAI).

Methods

This was a single center prospective observational study. Eighty female patients with fecal incontinence (FI) who underwent defecography between 1st January 2016 and 30th April 2022 were included. The effect of posture on commonly measured parameters during manometry was assessed in the left-lateral and erect positions. The severity of FI was assessed using FI Severity Index (FISI).

Results

Defecography showed that 30 patients had circumferential RAI (CRAI), and 50 had non-CRAI. There were no significant differences in age, parity, FI type, and FISI scores between the groups. However, FISI scores were significantly lower in 51 patients with passive FI than 12 patients with mixed FI type [21 (8–38) vs. 32 (8–43), P = 0.007]. Endo-anal ultrasound showed no significant difference in the incidence of sphincter defects between the groups. Maximum squeeze pressure was significantly lower in the erect position than in the left-lateral position in the CRAI patients [119 cm H2O (59‒454 cm H2O) vs. 145 cm H2O (65‒604 cm H2O), P = 0.006] however, this finding was not observed in the non-CRAI group and the subgroup of anterior RAI patients. In either group, maximum resting pressure, defecation desire volume, and maximum tolerated volume were significantly higher, while anal canal length was significantly shorter in the erect position than in the left-lateral position, respectively.

Conclusion

Voluntary contraction in female FI patients with CRAI was suppressed in the erect position.
Prevalence of sarcopenia under different diagnostic criteria and the changes in muscle mass, muscle strength, and physical function with age in Chinese old adults
Authors: Cao Mengyu , Lian Junsong , Lin Xisheng , Liu Jinwei , Chen Chao , Xu Shuaixuan , Ma Shuang , Wang Fang , Zhang Nihui , Qi Xiaolei , Xu Guogang , Peng Nan
Published: November 2022

Background

At present, there are several diagnostic criteria of sarcopenia were used in China, and the diagnostic criteria were not unified. This study aims to investigate the consistency between the latest sarcopenia diagnostic criteria Asian Working Group for Sarcopenia(AWGS 2019) and other common diagnostic criteria. The changes of muscle mass, muscle strength and physical function with age and their effects on the diagnosis of sarcopenia were also analyzed.

Methods

A total of 1009 men aged ≥60 years were enrolled from multiple communities. Skeletal muscle mass index, grip strength and 6 m gait speed were measured. The consistency of AWGS 2019 with other diagnostic criteria was analyzed and the trends of these three indicators were observed. The differences of muscle mass, muscle strength and function among different diagnostic criteria and age groups were evaluated. In addition, the change trends of these three indicators with age were observed.

Results

According to AWGS 2019 diagnostic criteria, the incidence of sarcopenia in male aged 60–69 years, 70–79 years and over 80 years was 1.5%, 9.6% and 33.1%, respectively. AWGS 2019 was highly consistent with other diagnostic criteria (Kappa = 0.66–0.80, P < 0.01), except the Foundation for the National Institutes of Health(FNIH) (Kappa = 0.32, P < 0.01). When AWGSA2019 diagnostic criteria are applied, the prevalence of decreased muscle strength (39.1%) and physical function (46.4%) was significantly higher than that of low muscle mass (35.9%) in the men over 80 years old. Muscle strength (P < 0.01) and function (P < 0.01) decreased at the same rate with age, both of which were more significant than muscle mass (P < 0.01).

Conclusion

AWGS 2019 was highly consistent with other criteria. Maintaining muscle mass should be the focus of attention before age 80, while improving muscle strength and function should be focused after age 80 to prevent disability.
Challenges in managing a multifactorial eosinophilic pneumonia: daptomycin vs strongyloidiasis case report
Authors: Eckhardt Lynda G. J. , Kelley Jordan L. , Maes Dorothy
Published: November 2022

Background

Eosinophilia is defined as a blood eosinophil count > 500/mcL with etiology usually an allergic reaction or parasitic infection which can lead to serious organ damage.

Case presentation

A patient being treated for hardware infection develops eosinophilia while on daptomycin in the setting of a positive strongyloides antibody. The patient was on chronic steroids prior to admission for epitheliopathy which complicated care. The daptomycin was discontinued, ivermectin initiated to treat strongyloidiasis, and high dose steroids initiated simultaneously. Eosinophilia resolved and patient discharged home after two months in the hospital.

Conclusion

Multifactorial eosinophilia poses question of steroid harm in the setting of parasitic infection. Patient was treated for both strongyloides and daptomycin induced eosinophilia with improvement and discharge from the hospital.
Bedaquiline resistance probability to guide treatment decision making for rifampicin-resistant tuberculosis: insights from a qualitative study
Authors: Tu Pham Hien Trang , Anlay Degefaye Zelalem , Dippenaar Anzaan , Conceição Emilyn Costa , Loos Jasna , Van Rie Annelies
Published: November 2022

Background

Bedaquiline (BDQ) is a core drug for rifampicin-resistant tuberculosis (RR-TB) treatment. Accurate prediction of a BDQ-resistant phenotype from genomic data is not yet possible. A Bayesian method to predict BDQ resistance probability from next-generation sequencing data has been proposed as an alternative.

Methods

We performed a qualitative study to investigate the decision-making of physicians when facing different levels of BDQ resistance probability. Fourteen semi-structured interviews were conducted with physicians experienced in treating RR-TB, sampled purposefully from eight countries with varying income levels and burden of RR-TB. Five simulated patient scenarios were used as a trigger for discussion. Factors influencing the decision of physicians to prescribe BDQ at macro-, meso- and micro levels were explored using thematic analysis.

Results

The perception and interpretation of BDQ resistance probability values varied widely between physicians. The limited availability of other RR-TB drugs and the high cost of BDQ hindered physicians from altering the BDQ-containing regimen and incorporating BDQ resistance probability in their decision-making. The little experience with BDQ susceptibility testing and whole-genome sequencing results, and the discordance between phenotypic susceptibility and resistance probability were other barriers for physicians to interpret the resistance probability estimates. Especially for BDQ resistance probabilities between 25% and 70%, physicians interpreted the resistance probability value dynamically, and other factors such as clinical and bacteriological treatment response, history of exposure to BDQ, and resistance profile were often considered more important than the BDQ probability value for the decision to continue or stop BDQ. In this grey zone, some physicians opted to continue BDQ but added other drugs to strengthen the regimen.

Conclusions

This study highlights the complexity of physicians' decision-making regarding the use of BDQ in RR-TB regimens for different levels of BDQ resistance probability.. Ensuring sufficient access to BDQ and companion drugs, improving knowledge of the genotype–phenotype association for BDQ resistance, availability of a rapid molecular test, building next-generation sequencing capacity, and developing a clinical decision support system incorporating BDQ resistance probability will all be essential to facilitate the implementation of BDQ resistance probability in personalizing treatment for patients with RR-TB.
The use of two Comfort Young Child Formulas in the dietary management of toddlers with functional constipation: a randomized controlled trial
Authors: Sevilla Daniel Alfonso Cisneros , Hofman Denise , Madero Sergio Díaz , Fernández Miriam Contreras , Kudla Urszula , Kontopodi Eva , Hageman Jeske H. J. , Ángel Darelia Alelí Topete , Esquer Joshué David Covarrubias
Published: November 2022

Background

Pharmacological intervention with laxatives is the conventional treatment for functional constipation (FC). Data to support the dietary management of FC is lacking. This study compared the efficacy of two Comfort young child formulas (YCFs) with regards to the maintenance of healthy stooling parameters in toddlers with a history of constipation. It was registered in the Netherlands Trial Registry [identifier: NL7420 (NTR7653)], registration date 20/09/2018.

Methods

Ninety-five healthy toddlers, aged 12 to 32 months, diagnosed with FC (Rome III criteria) were randomized to receive one of two study formulas after pharmacological treatment. For the first month of the intervention, subjects received a laxative in a decreasing maintenance dose alongside a test or control formula (maintenance phase). Subsequently, subjects only consumed formula for another month (post-maintenance phase). Stooling parameters were obtained weekly using the Bristol Stool Scale and the modified Rome III Questionnaire on Paediatric Gastrointestinal Symptoms for infants and toddlers. Differences in percentages of hard stools (primary outcome) and other stooling parameters were analysed using analysis of covariance and Chi-Square methods.

Results

Both formulas resulted in similar overall percentage of hard stools during the intervention period, respectively 5.02% in the test and 2.99% in the control group (n.s.). In the test group, percentages dropped from 7.11% at the end of the maintenance phase, to 3.92% at the end of the post-maintenance phase. In contrast, the percentage of hard stools in the control group was similar at the end of the maintenance (3.18%) and post-maintenance phase (2.83%; n.s.). No difference was found in the overall stool frequency between groups. At the end of the maintenance phase, only 22% and 19% of toddlers consuming the test and control formulae, respectively, met 2 or more of the criteria for FC. At the end of the study, this percentage of subjects decreased further to 9% in the test group, which tended to be lower compared to the 21% found in the control (p = 0.107). No laxative use was reported in either study group during the post-maintenance phase.

Conclusion

Both Comfort YCF support the maintenance of improved stooling over time in toddlers with a history of constipation. The percentage of subjects suffering from functional constipation tended to be lower after the intervention period when receiving the formula with intact protein.
Circadian clock gene Clock-Bmal1 regulates cellular senescence in Chronic obstructive pulmonary disease
Authors: Li Lingling , Zhang Min , Zhao Chunyang , Cheng Yusheng , Liu Chuanmei , Shi Minhua
Published: November 2022

Chronic obstructive pulmonary disease (COPD) is a progressive respiratory disease. COPD is associated with accelerated lung aging. Circadian clock is believed to play important roles in COPD. Although the circadian molecular clock regulates cellular senescence, there is no information available regarding the impact of COPD. The aim of this study is to investigate the role of the circadian clock protein BMAL1 and CLOCK in cellular senescence in order to understand the cellular mechanisms of accelerated aging of COPD. Bmal1 and Clock levels were assessed in the plasma samples of non-smokers, smokers, and patients with COPD. The regulation of ciracadian clock expression and cell senescence by cigarette smoke extract (CSE) was studied in vitro, and small interfering RNA (siRNA) and overexpression of Bmal1 or Clock were employed to investigate the role of circadian clock on cell senescence. Herein, patients with COPD showed lower Bmal1 and Clock expression in the plasma. Interestingly, CSE exposure contributed to the increased cell senescence, decreased Clock and Bmal1 in human bronchial epithelial cells (Beas-2B cells). We found that knockdown of Clock or Bmal1 lead to upregulation of cell senescence in Beas-2B cells, while overexpression of Clock or Bmal1 inhibited cell senescence in Beas-2B cells, which is through the MAPK pathways. Therefore, our findings indicated that Bmal1 or Clock deficiency may be a significant factor to increase cellular senescence of the lung to develop COPD.
Fistula of acromioclavicular cyst treated with a staged reverse total shoulder arthroplasty: a case report
Authors: Emam Mohammed , Singhani Neil , Persaud Christine , Aibinder William
Published: November 2022

Background

Acromioclavicular (AC) joint cysts are relatively rare. There are two distinct etiologies of AC cysts. Type 1 is isolated to the AC joint, while type 2, is related to a tear or rupture of the rotator cuff (RC). The disease is usually a rare result of advanced AC joint arthritis or RC-tear arthropathy. Patients may present with signs and symptoms of RC impingement and tear. Conservative management may be used initially in asymptomatic individuals who are also not concerned with cosmesis. Aspiration and steroid injection of the cyst has been reported as one method of non-surgical management of these lesions, however, there is a high rate of recurrence.

Case Presentation

We report a case of A 72-year-old right-handed female with past medical history of type two diabetes mellitus, chronic smoking, and a prior right RC repair with distal clavicle resection who presented with an AC joint cyst complicated by a draining fistula as a result of cyst aspiration and steroid injection. Due to the persistent drainage of the cyst and concern for infection, the patient was treated with a staged reverse shoulder arthroplasty given the setting of an irreparable rotator cuff tear and end-stage cuff-tear arthropathy.

Conclusion

This case demonstrates an important complication of persistent draining fistula resulting from AC joint cyst aspiration and steroid injection in the setting of advanced RC-tear arthropathy. In immunocompromised patients, staged reverse shoulder arthroplasty should be considered for treatment of these draining fistulas especially when the concern for periprosthetic infection is high.
Negative appendectomy rate in patients diagnosed with acute appendicitis
Authors: Chaochankit Wongsakorn , Boocha Aeraungkoon , Samphao Srila
Published: November 2022

Background

Acute appendicitis is the most common cause of acute lower abdominal pain leading patients to the emergency department. This study aims to find the negative appendectomy rate in patients diagnosed with acute appendicitis from 2015 to 2019.

Methods

This study was a retrospective cohort study in the patients preoperatively diagnosed with acute appendicitis and underwent appendectomy from January 2015 to December 2019. Negative appendectomy is defined as the final pathologic results confirmed normal, congestion or peri-appendicitis.

Results

The study population was 892 patients which was 54.3% female. The five-year negative appendectomy rate was 8.6% (n = 77) and 70% in female (n = 54). The factors associated with increasing the negative appendectomy rate were female (OR 2.23, P = 0.003), age ≤ 40 years old (OR 2.35, P = 0.003), and no history of diarrhea (OR 2.42, P = 0.017). Whereas the factors related to decline in the negative appendectomy rate were white blood cell count (WBC) $$\ge$$
≥
10,000 (OR 0.39, P = 0.016), neutrophil (N) $$\ge$$
≥
75% (OR 0.28, P < 0.001), and positive appendicitis from ultrasonography of abdomen (OR 0.04, P < 0.001) or computed tomography of abdomen (OR 0.07, P < 0.001).

Conclusion

The negative appendectomy rate was less than 10% in this study. Female, age 40 ≤ years old and history of diarrhea were related to increase in negative appendectomy. The factors that related to decline in negative appendectomy were leukocytosis with cells shift to the left, positive acute appendicitis from abdominal ultrasonography and CT scan. However, to request the further imaging studies to diagnose patients with suspected acute appendicitis depends on the risk and benefit to each patient and the choice of investigation.
Durvalumab-induced thyroiditis in a patient with non-small cell lung carcinoma: a case report and review of pathogenic mechanisms
Authors: de Filette Jeroen M. K. , André Stéphanie , De Mey Lynn , Aspeslagh Sandrine , Karmali Rafik , Van der Auwera Bart J , Bravenboer Bert
Published: November 2022

Background

Immune checkpoint inhibitors (ICI) targeting cytotoxic T-lymphocyte-associated protein 4 (CTLA-4), programmed cell death protein 1 and its ligand (PD-1/PD-L1) have become the current standard-of-care for advanced cancers. This novel therapeutic approach comes with its costs in the form of immune-related adverse events (irAE), including endocrinopathy.

Case presentation

A 63-year-old woman was diagnosed with a non-small cell lung carcinoma of the right superior lobe, cT3N2M0. She developed thyrotoxicosis followed by hypothyroidism induced by consolidation immunotherapy with durvalumab (anti-PD-L1). Analysis of the human leukocyte antigen (HLA) region showed HLA-DR4 (susceptible) and DR13 (protective). The possible mechanisms are subsequently discussed in detail.

Conclusions

The case of a patient with thyroiditis associated with the PD-L1 inhibitor durvalumab is described, highlighting the need for proactive monitoring of thyroid hormone levels. Identifying biomarkers associated with an increased risk of ICI-induced side effects (such as HLA) is of interest for better patient selection, optimal management and improved understanding of the mechanisms involved.
Educational games created by medical students in a cultural safety training game jam: a qualitative descriptive study
Authors: Pimentel Juan , López Paola , Correal Camilo , Cockcroft Anne , Andersson Neil
Published: November 2022

Background

Cultural safety training, whereby health professionals learn to reflect on their own culture and to respect the cultural identity of patients, could address intercultural tensions in health care. Given the context of their medical education, however, medical students might perceive such training to be dull or even unnecessary. Game jams, collaborative workshops to create and play games, are a potentially engaging learning environment for medical students today. How medical students learn while making games is poorly documented. This study describes the characteristics of educational games created by participants in a cultural safety game jam and the concepts they used to create games.

Methods

As part of a trial, 268 Colombian medical students divided into 48 groups participated in an eight-hour game jam to create a prototype of an educational game on cultural safety. In this qualitative descriptive study, we reviewed the description of the games uploaded by participants, including the name, objective, game narrative, rules, rewards, penalties, and pictures. An inductive thematic analysis collated their descriptions.

Results

The game descriptions illustrated the characteristics of the educational games and the aspects of the cultural safety concept that the students used to create games. Medical students situated cultural safety within a continuum with culturally unsafe actions at one end and cultural safety at the other end. Although not familiar with game design, the students designed prototypes of basic educational games including game dynamics, game scenarios, learning objectives, and pedagogical strategies.

Conclusion

The findings of this study could help researchers and educators to understand how medical students learn from game design and the kind of games that game jam participants can create without previous game design skills.
Pulse oximeter provision and training of non-physician anesthetists in Zambia: a qualitative study exploring perioperative care after training
Authors: Peterson Meagan E. , Mattingly Aviva S. , Merrell Sylvia Bereknyei , Asnake Betelehem M. , Ahmed Imraan , Weiser Thomas G.
Published: November 2022

Background

Pulse oximetry monitoring is included in the WHO Safe Surgery Checklist and recognized as an essential perioperative safety monitoring device. However, many low resource countries do not have adequate numbers of pulse oximeters available or healthcare workers trained in their use. Lifebox, a nonprofit organization focused on improving anesthetic and surgical safety, has procured and distributed pulse oximeters and relevant educational training in over 100 countries. We aimed to understand qualitatively how pulse oximetry provision and training affected a group of Zambian non-physician anesthetists’ perioperative care and what, if any, capacity gaps remain.

Methods

We identified and approached non-physician anesthetists (NPAPs) in Zambia who attended a 2019 Lifebox pulse oximetry training course to participate in a semi-structured interview. Interviews were audio recorded and transcribed. Codes were iteratively derived; the codebook was tested for inter-rater reliability (pooled kappa > 0.70). Team-based thematic analysis identified emergent themes on pulse oximetry training and perioperative patient care.

Results

Ten of the 35 attendees were interviewed. Two themes emerged concerning pulse oximetry provision and training in discussion with non-physician anesthetists about their experience after training: (1) Impact on Non-Physician Anesthetists and the Healthcare Team and (2) Impact on Perioperative Patient Monitoring. These broad themes were further explored through subthemes. Increased knowledge brought confidence in monitoring and facilitated quick interventions. NPAPs reported improved preoperative assessments and reaffirmed the necessity of having pulse oximetry intraoperatively. However, lack of device availability led to case delays or cancellations. A portable device travelling with the patient to the recovery ward was noted as a major improvement in postoperative care. Pulse oximeters also improved communication between nurses and NPAPs, giving NPAPs confidence in the recovery process. However, this was not always possible, as lack of pulse oximeters and ward staff unfamiliarity with oximetry was commonly reported. NPAPs expressed that wider pulse oximetry availability and training would be beneficial.

Conclusion

Among a cohort of non-physician anesthetists in Zambia, the provision of pulse oximeters and training was perceived to improve patient care throughout the perioperative timeline. However, capacity and resource gaps remain in their practice settings, especially during transfers of care. NPAPs identified a number of areas where patient care and safety could be improved, including expanding access to pulse oximetry training and provision to ward and nursing staff to ensure the entire healthcare team is aware of the benefits and importance of its use.
A human centred approach to digital technologies in health care delivery among mothers, children and adolescents
Authors: Haroun Yasini , Sambaiga Richard , Sarkar Nandini , Kapologwe Ntuli A. , Kengia James , Liana Jafary , Kimatta Suleiman , James Johanita , Simon Vendelin , Hassan Fatma , Mbwasi Romuald , Fumbwe Khadija , Litner Rebecca , Kahamba Gloria , Dillip Angel
Published: November 2022

Background:

Healthcare outcomes in child, adolescent and maternal in Tanzania are poor, and mostly characterised by fragmentary service provision. In order to address this weakness, digital technologies are sought to be integrated in the milieu of health as they present vast opportunities especially in the ability to improve health information management and coordination. Prior to the design and implementation of the Afya-Tek digital intervention, formative research was carried out to ensure that the solution meets the needs of the users. The formative research aimed to examine: the burden of disease and related health seeking behaviour; workflow procedures and challenges experiencing healthcare actors; adolescent health and health seeking behaviour; and lastly examine technological literacy and perceptions on the use of digital technologies in healthcare delivery. This paper therefore, presents findings from the formative research.

Methods:

The study employed exploratory design grounded in a qualitative approach. In-depth interview, focus group discussion, participant observation and documentary review methods were used for collecting data at different levels. The analysis was done thematically, whereby meaning was deduced behind the words which the participants used.

Results:

Findings suggest that the perceived burden of diseases and health seeking behaviour differ across age and social group. Multiple work-related challenges, such as lack of proper mechanism to track referrals and patient’s information were noted across healthcare actors. There was a keen interest in the use of technologies shown by all study participants to improve care coordination and health outcomes among health system actors. Participants shared their views on how they envision the digital system working.

Conclusion:

The formative research provided insightful background information with regard to the study objectives. The findings are used for informing the subsequent phases of the co-development and implementation of the Afya-Tek digital health intervention; with a view to making it relevant to the needs of those who will use it in the future. As such, the findings have to a large extent met the purpose of the current study by envisaging the best ways to design digital intervention tailored to meet the needs of those who will be using it.
Challenges to the provision of specialized care in remote rural municipalities in Brazil
Authors: Nunes Fabiely Gomes da Silva , Santos Adriano Maia dos , Carneiro Ângela Oliveira , Fausto Márcia Cristina Rodrigues , Cabral Lucas Manoel da Silva , Almeida Patty Fidelis de
Published: November 2022

This case study analyses the challenges to providing specialized care in Brazilian remote rural municipalities (RRM). Interviews were conducted with managers from two Brazilian states (Piauí and Bahia). We identified that the distance between municipalities is a limiting factor for access and that significant care gaps contribute to different organizational arrangements for providing and accessing specialized care. Physicians in all the RRMs offer specialized care by direct disbursement to users or sale of procedures to managers periodically, compromising municipal and household budgets. Health regions do not meet the demand for specialized care and exacerbate the need for extensive travel. RRM managers face additional challenges for the provision of specialized care regarding the financing, implementation of cooperative arrangements, and the provision of care articulated in networks to achieve comprehensive care, seeking solutions to the locoregional specificities.
The antigen CD300e drives T cell inflammation in adipose tissue and elicits an antibody response predictive of the insulin sensitivity recovery in obese patients
Authors: Coletta Sara , Trevellin Elisabetta , Benagiano Marisa , Romagnoli Jacopo , Della Bella Chiara , D’Elios Mario Milco , Vettor Roberto , de Bernard Marina
Published: November 2022

Obesity and insulin resistance (IR), the key features of metabolic syndrome, are closely associated with a state of chronic, low-grade inflammation. Bariatric surgery leads to a considerable reduction in the adipose tissue mass and systemic inflammation along with a reduction of IR, with a whole-body metabolic improvement. However, a sizable portion of people experience an IR relapse within few years of remission.

Numerous studies have attempted to explore the best clinical predictors of the improvement of insulin sensitivity and the maintenance of glucose homeostasis after bariatric surgery, but no simple fasting blood test has been found to be effective in predicting the short and long-term beneficial effects on glycaemia.

With the present study, we investigated T-cell and antibody responses against CD300e, an antigen highly expressed in the adipose tissue of patients with obesity before the bariatric surgery-induced weight loss. We found both in fat tissue and in peripheral blood anti-CD300e-specific T helper 1 responses. Moreover, we evidenced in the sera of individuals with obesity an antibody response towards CD300e and revealed the existence of a significant correlation between the level of antibodies before surgery and the maintenance of glucose control after the intervention.
Discrepancies in infant feeding recommendations between grandmothers and healthcare providers in rural Mexico
Authors: Luna Paulina , Paredes-Ruvalcaba Nerli , Valdes Tania , Guerrero Barbara , García-Martínez Angélica , Escamilla Rafael Pérez , Bueno-Gutiérrez Diana
Published: November 2022

Background

Infant feeding practices are rapidly changing within rural areas in Mexico, including indigenous communities. The aim of this study was to compare infant feeding recommendations between grandmothers and healthcare providers, to better understand the factors that may influence these practices within these communities. This study builds on research that recognizes the legacy of colonization as an ongoing process that impacts the lives of people through many pathways, including the substandard healthcare systems available to them.

Methods

Qualitative study based on secondary data analysis from interviews and focus groups guided by a socioecological framework conducted in 2018 in two rural, Indigenous communities in Central Mexico. Participants were purposively selected mothers (n = 25), grandmothers (n = 11), and healthcare providers (n = 24) who offered care to children up to two years of age and/or their mothers. Data were coded and thematically analyzed to contrast the different perspectives of infant feeding recommendations and practices between mother, grandmothers, and healthcare providers.

Results

Grandmothers and healthcare providers differed in their beliefs regarding appropriate timing to introduce non-milk foods and duration of breastfeeding. Compared to grandmothers, healthcare providers tended to believe that their recommendations were superior to those from people in the communities and expressed stereotypes reflected in negative attitudes towards mothers who did not follow their recommendations. Grandmothers often passed down advice from previous generations and their own experiences with infant feeding but were also open to learning from healthcare providers through government programs and sharing their knowledge with their daughters and other women. Given the contradictory recommendations from grandmothers and healthcare providers, mothers often were unsure which advice to follow.

Conclusions

There are important differences between grandmothers and healthcare providers regarding infant feeding recommendations. Healthcare providers may perceive their recommendations as superior given the neocolonial structures of the medical system. Public health policies are needed to address the different recommendations mothers receive from different sources, by harmonizing them and following an evidence-informed approach. Breastfeeding programs need to value and to seek the participation of grandmothers.