bluuebunny/crossref_metadata_2025_split huggingface dataset:
Public-health risks from tea drinking: Fluoride exposure
Authors: Krishnankutty Nimisha , Storgaard Jensen Tina , Kjær Jeannett , Jørgensen Jan Stener , Nielsen Flemming , Grandjean Philippe 
Published: February 2021

Aims: Due to new evidence on fluoride neurotoxicity during early life, this study examined maternal exposure to fluoride through tea consumption in a low-fluoride region and measured fluoride releases from commercially available teas (tea bags and loose teas) to determine the need to limit fluoride exposure. Methods: Maternal urine fluoride (MUF) concentrations were measured in spot urine samples ( N=118) from first-trimester pregnant women and in prepared tea infusions made with deionised water from 33 brand teas and 57 loose-tea products, as determined by the direct method of using a fluoride-selective electrode. Results: The fluoride concentration in the local drinking water supplies ranged from 0.10 to 0.18 mg/L, and the creatinine-adjusted MUF ranged from 0.09 to 1.57 mg/L. Seventeen per cent of the women were daily tea drinkers, and their MUFs were higher than those with no consumption ( p=0.002). The fluoride concentration from tea bags ranged from 0.34 to 2.67 mg/L, while loose teas showed 0.72–4.50 mg/L (black), 0.56–1.58 mg/L (oolong), 1.28–1.50 mg/L (green), and 0.33–1.17 mg/L (white tea). Conclusions: Fluoride exposure among pregnant women increases with tea consumption, with likely risks of developmental neurotoxicity to their children. As the fluoride release from tea varies widely, the fluoride concentration should be indicated on tea packages in order to allow consumers to make informed decisions on minimising their fluoride exposure.
Evaluating the Impact of Medial Arterial Calcification on Outcomes of Infrageniculate Endovascular Interventions for Treatment of Diabetic Foot Ulcers
Authors: Skolnik Jennifer , Weiss Robert , Meyr Andrew J. , Dhanisetty Ravi , Choi Eric T. , Cunningham-Hill Matthew , Rubin Daniel , Oresanya Lawrence 
Published: February 2021

Background: Medial arterial calcification (MAC) of the tibial and pedal arteries has been associated with an increased risk of amputation among people with diabetes. Endovascular interventions on infrageniculate vessels are frequently performed with the intent of treating peripheral artery disease (PAD) and decreasing the risk of amputation in those with diabetes. This study aimed to investigate how the extent of MAC impacts outcomes of endovascular procedures in people with diabetic foot ulcers (DFU). Methods: We identified all patients who had undergone infrageniculate angioplasty in the setting of DFU at our institution between 2009 and 2019. Subjects were assigned a MAC score based on the severity of MAC in each vessel visualized on plain radiographs of the ankle and foot. We evaluated the relationship between MAC and the primary outcome, major adverse limb event (MALE), using stratified Cox proportional modeling. Results: Among 99 subjects with DFU who had undergone infrageniculate angioplasty, MALE occurred in 50% (95% confidence interval [CI] 38%-61%) of patients within 1 year of intervention. On univariate Cox regression analysis, each 1 point increment in MAC score (hazard ratio [HR], 1.09; 95% CI 1.01-1.18), the third tertile of MAC score (HR, 2.27; 95% CI 1.01-5.11), age (HR 0.96; 95% CI 0.93-0.99), and wound grade (HR, 5.34; 95% CI 2.17-13.14), were significantly associated with increased risk of MALE. On adjusted analysis stratified by wound grade, MAC score was found to be associated with MALE only in patients with a low wound grade. Conclusion: Increased severity of MAC is associated with increased risk of MALE for subjects undergoing infrageniculate angioplasty with a low wound grade. Further research is needed to better understand the complex relationships of MAC, PAD, DFU, and interventions aimed at promoting healing of DFU.
Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery
Authors: Heise Daniel , Bednarsch Jan , Kroh Andreas , Schipper Sandra , Eickhoff Roman , Lang Sven , Neumann Ulf , Ulmer Florian 
Published: February 2021

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.
Treatment of Complex Anal Fistula by Video-Assisted Anal Fistula Treatment Combined with Anal Fistula Plug: A Single-Center Study
Authors: Zhang Yuru , Li Fei , Zhao Tuanjie , Cao Feng , Zheng Yamin , Li Ang 
Published: February 2021

Objective. The surgical treatment of complex anal fistulae is very challenging because of the incidence of incontinence after traditional approaches. There are no studies on the role of video-assisted anal fistula treatment (VAAFT) combined with anal fistula plug (AFP) in the complex anal fistulae. The aim of this study was to demonstrate the efficacy of treating complex anal fistulae using VAAFT combined with AFP. Method. This was a retrospective, nonrandomized observational study. 57 consecutive patients with complex anal fistulae who had undergone the VAAFT with AFP in our hospital between April 2016 and December 2019 were included. The primary outcomes were the cure rate, recurrence rate, and Wexner incontinence scores; the secondary outcomes were surgery time, blood loss, wound healing time postoperatively, pain, and patient satisfaction. Results. All 57 patients completed the surgery and follow-up, with an average follow-up time of 28 months; 6 patients suffered with recurrence (recurrence rate: 10.5%). The average surgery time was 57.9 minutes, and the average wound healing time was 46 days. There were no severe postoperative complications, and anal sphincter function was protected in all patients. Conclusions. The treatment of complex anal fistula by VAAFT combined with AFP is safe and effective, has a high healing rate and few postoperative complications, and is a promising surgery that can effectively protect the patient’s anal sphincter function.
BMUS journal club on Twitter: An analysis of the first #BMUS_JC discussions
Authors: Reeve Ruth , Moore Stephen , Kirkpatrick Catherine 
Published: February 2021

Introduction Journal clubs have evolved over recent years within healthcare to encourage continuing professional development. More recently, there has been a move from face-to-face group meetings to virtual groups utilising social media platforms. This article aims to explore the discussions and narrative following the inaugural BMUS journal club, highlighting the key discussions and themes from the participants and to provide a narrative for the future of ultrasound continuing professional development. Methods The August 2020 journal club chat was focussed on the article featured in Ultrasound: “Sonographers’ level of autonomy in communication in Australian obstetric settings: Does it affect their professional identity?” by Thomas et al. Data consisting of Twitter correspondence were extracted and analysed from the advanced search function on Twitter using #BMUS_JC thread. An initial review ensured related content was included. A second review and semantic thematic analysis was then conducted on the 123 tweets. Results In total, seven overall themes were identified between the three sub-threads within the journal club discussions. Those participating in the Twitter discussion recognised the limitations and barriers for communicating results to patients, acknowledging that training, support and regulatory involvement is required for sonographers to change practice locally and internationally. Conclusion The group discussions on Twitter highlight the ongoing issues for sonographers’ professional identity worldwide. Furthermore, our analysis echo other contemporary studies which indicate that Twitter journal clubs act as a fruitful and dynamic source of continuing professional development, particularly in an era where social distancing is encouraged. The outcomes of the first BMUS journal club support the wider evidence that online journal clubs can provide a successful platform for professional discussion and debate.
Assessment and review of treatment for secondary spontaneous pneumothorax using medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis
Authors: Zhang Lei , Xie Tian , Fu Yihui , Wu Haihong 
Published: February 2021

Aims: To evaluate the efficacy of medical thoracoscopy-assisted argon plasma coagulation in association with autologous blood pleurodesis in spontaneous pneumothorax. Patients and methods: Three male patients with spontaneous pneumothorax were treated; medical thoracoscopy-assisted argon plasma coagulation combined with autologous blood pleurodesis was conducted for all patients whose duration of the air leak exceeded 7 days. We systematically reviewed all of the relevant literature to analyze and sum up the treatments of secondary spontaneous pneumothorax. Results: The air leaks were all sealed and no recurrence of pneumothorax was reported. No complications of fever, bleeding, or signs of infection were observed during the process. Conclusion: The authors believe that the combination of medical thoracoscopy-assisted argon plasma coagulation and autologous blood pleurodesis is safe and effective. However, due to the number of patients included in this uncontrolled case study, more cases will be collected in the future. The reviews of this paper are available via the supplemental material section.
Elevated risk of colorectal, liver, and pancreatic cancers among HCV, HBV and/or HIV (co)infected individuals in a population based cohort in Canada
Authors: Darvishian Maryam , Butt Zahid A. , Wong Stanley , Yoshida Eric M. , Khinda Jaskaran , Otterstatter Michael , Yu Amanda , Binka Mawuena , Rossi Carmine , McKee Geoff , Pearce Margo , Alvarez Maria , Wong Jason , Cook Darrel , Grennan Troy , Buxton Jane , Tyndall Mark , Woods Ryan , Krajden Mel , Bhatti Parveen , Janjua Naveed Z. 
Published: February 2021

Introduction: Studies of the impact of hepatitis C virus (HCV), hepatitis B virus (HBV) and HIV mono and co-infections on the risk of cancer, particularly extra-hepatic cancer, have been limited and inconsistent in their findings. Methods: In the British Columbia Hepatitis Testers Cohort, we assessed the risk of colorectal, liver, and pancreatic cancers in association with HCV, HBV and HIV infection status. Using Fine and Gray adjusted proportional subdistribution hazards models, we assessed the impact of infection status on each cancer, accounting for competing mortality risk. Cancer occurrence was ascertained from the BC Cancer Registry. Results: Among 658,697 individuals tested for the occurrence of all three infections, 1407 colorectal, 1294 liver, and 489 pancreatic cancers were identified. Compared to uninfected individuals, the risk of colorectal cancer was significantly elevated among those with HCV (Hazard ration [HR] 2.99; 95% confidence interval [CI] 2.55–3.51), HBV (HR 2.47; 95% CI 1.85–3.28), and HIV mono-infection (HR 2.30; 95% CI 1.47–3.59), and HCV/HIV co-infection. The risk of liver cancer was significantly elevated among HCV and HBV mono-infected and all co-infected individuals. The risk of pancreatic cancer was significantly elevated among individuals with HCV (HR 2.79; 95% CI 2.01–3.70) and HIV mono-infection (HR 2.82; 95% CI 1.39–5.71), and HCV/HBV co-infection. Discussion/Conclusion: Compared to uninfected individuals, the risk of colorectal, pancreatic and liver cancers was elevated among those with HCV, HBV and/or HIV infection. These findings highlight the need for targeted cancer prevention and diligent clinical monitoring for hepatic and extrahepatic cancers in infected populations.
Intra- and inter-rater reliability of the Behaviour Mapping Schedule: A direct observational tool for classifying children’s play behaviour
Authors: Dankiw Kylie A , Baldock Katherine L , Kumar Saravana , Tsiros Margarita D 
Published: February 2021

Identifying and describing children’s play behaviours is an important component of evaluating child development. The Behaviour Mapping Schedule is a direct observational tool which aims to describe and quantify children’s play behaviours but is yet to undergo reliability testing. This study aimed to determine the intra- and inter-rater reliability of the Behaviour Mapping Schedule. Twelve children aged 3–5 years were each video recorded for one 20-minute playtime period at a purposively selected Community Children’s Centre in Adelaide, South Australia. The video recordings were coded independently by two raters against 23 behaviour codes. Intraclass correlation coefficients (ICCs) were calculated. Intra-rater ICCs for nearly 70% of the behaviour codes were considered ‘excellent’; likewise, for inter-rater ICCs on more than 50% of the behaviour codes. Overall, the Behaviour Mapping Schedule is a reliable tool for observing children’s play behaviour; however, additional training resources may be useful to further strengthen inter-rater reliability.
Continuous Subcutaneous Insulin Infusions vs. Multiple Daily Injections of Insulin in Hospitalized Patients: Glycemic Trends in the First 24 Hours of Admission
Authors: Halstrom Amanda , Moledina Iram , Peragallo-Dittko Virginia , Ancona Karena , Islam Shahidul , Klek Stanislaw , Rothberger Gary 
Published: February 2021

Background: Continuous subcutaneous insulin infusion (CSII) is a common diabetes treatment modality. Glycemic outcomes of patients using CSII in the first 24 hours of hospitalization have not been well studied. This timeframe is of particular importance because insulin pump settings are programmed to achieve tight outpatient glycemic targets which could result in hypoglycemia when patients are hospitalized. Methods: This retrospective cohort study evaluated 216 hospitalized adult patients using CSII and 216 age-matched controls treated with multiple daily injections (MDI) of insulin. Patients using CSII did not make changes to pump settings in the first 24 hours of admission. Blood glucose (BG) values within the first 24 hours of admission were collected. The primary outcome was frequency of hypoglycemia (BG < 70 mg/dL). Secondary outcomes were frequency of severe hypoglycemia (BG < 40 mg/dL) and hyperglycemia (BG ≥ 180 mg/dL). Results: There were significantly fewer events of hypoglycemia [incident rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.42–0.88, p = 0.007] and hyperglycemia (IRR 0.79, 95% CI 0.65–0.96, p = 0.02) in the CSII group compared to the MDI group. There was a trend toward fewer events of severe hypoglycemia in the CSII group (IRR 0.15, 95% CI 0.02–0.93, p = 0.06). Conclusions: Patients using CSII experienced fewer events of both hypoglycemia and hyperglycemia in the first 24 hours of hospital admission than those treated with MDI. Our study demonstrates that CSII use is safe and effective for the treatment of diabetes within the first 24 hours of hospital admission.
Analysis of the Waste Volume and CO2-Equivalent Caused by the Use of Selected Patch Pumps
Authors: Winkelkötter Jana , Reitz Thore 
Published: February 2021

Background: The use of tube-free insulin pumps is increasing. To protect the environment, the use of resources and the amount of emissions into the environment should be kept as low as possible when designing these systems. In addition to basic waste avoidance, the composition of the waste produced must be considered. Methods: To compare current tube-free pumps from an ecological standpoint, a tube-free insulin pump with a modular design and two non-modular tube-free pumps were subjected to manual separation, manual sorting, characterization, and mass determination. The annual waste volume of a user was measured, and the recyclability was assessed. The global warming potential (GWP) resulting from extraction of raw materials, energetic utilization of waste, and landfill of the incineration residues was balanced. Results: For the modular tube-free pump, a total waste volume of 5.5 kg/a (recycling percentage 44.3%) was determined. The non-modular systems generated 4.9 kg/a (recycling percentage 14.6%) and 5.1 kg/a (recycling percentage 16.0%) waste. The product-specific GWP of the modular system was approximately 50% lower than that of the non-modular systems; the packaging-specific GWP was 2.5 times higher. In total, a GWP of 13.6 kg CO2-equivalent per year could be determined for the modular system and a GWP of 15.5 kg CO2-equivalent per year for the non-modular systems. Conclusions: Although the modular micropump has a higher total waste volume, a greater ecological potential can be attributed to it. This is based on the recyclability of the system due to its modularity and the possible reduction of packaging waste.
Opioid Consumption Patterns and Prolonged Opioid Use Among Opioid-Naïve Ankle Fracture Patients
Authors: Skibicki Hope , Saini Sundeep , Rogero Ryan , Nicholson Kristen , Shakked Rachel J. , Fuchs Daniel , Winters Brian S. , Raikin Steven M. , Pedowitz David I. , Daniel Joseph N. 
Published: February 2021

Introduction Previous literature has demonstrated an association between acute opioid exposure and the risk of long-term opioid use. Here, the investigators assess immediate postoperative opioid consumption patterns as well as the incidence of prolonged opioid use among opioid-naïve patients following ankle fracture surgery. Methods Included patients underwent outpatient open reduction and internal fixation of an ankle or tibial plafond fracture over a 1-year period. At patients’ first postoperative visit, opioid pills were counted and standardized to the equivalent number of 5-mg oxycodone pills. Prolonged use was defined as filling a prescription for a controlled substance more than 90 days after the index procedure, tracked by the New Jersey Prescription Drug Monitoring Program up to 1 year postoperatively. Results At the first postoperative visit, 173 patients consumed a median of 24 out of 40 pills prescribed. The initial utilization rate was 60%, and 2736 pills were left unused. In all, 32 (18.7%) patients required a narcotic prescription 90 days after the index procedure. Patients with a self-reported history of depression (P = .11) or diabetes (P = .07) demonstrated marginal correlation with prolonged narcotic use. Conclusion Our study demonstrated that, on average, patients utilize significantly fewer opioid pills than prescribed and that many patient demographics are not significant predictors of continued long-term use following outpatient ankle fracture surgery. Large variations in consumption rates make it difficult for physicians to accurately prescribe and predict prolonged narcotic use. Level of Evidence: Level III
Acetabular Cartilage Thickness Differs Among Cam, Pincer, or Mixed-Type Femoroacetabular Impingement: A Descriptive Study Using In Vivo Ultrasonic Measurements During Surgical Hip Dislocation
Authors: Steppacher Simon Damian , Meier Malin Kristin , Albers Christoph Emanuel , Tannast Moritz , Siebenrock Klaus Arno 
Published: February 2021

Objective To investigate acetabular cartilage thickness among (1) 8 measurement locations on the lunate surface and (2) different types of femoroacetabular impingement (FAI). Design Prospective descriptive study comparing in vivo measured acetabular cartilage thickness using a validated ultrasonic device during surgical hip dislocation in 50 hips. Measurement locations included the anterior/posterior horn and 3 locations on each peripheral and central aspect of the acetabulum. The clock system was used for orientation. Thickness was compared among cam (11 hips), pincer (8 hips), and mixed-type (31 hips) of FAI. Mean age was 31 ± 8 (range, 18-49) years. Hips with no degenerative changes were included (Tönnis stage = 0). Results Acetabular cartilage thickness ranged from 1.7 mm to 2.7 mm and differed among the 8 locations ( P < 0.001). Thicker cartilage was found on the peripheral aspect at 11 and 1 o’clock positions (mean of 2.4 mm and 2.7 mm, respectively). At 5 out of 8 locations of measurement (anterior and posterior horn, 1 o’clock peripheral, 12 and 2 o’clock central), cartilage thickness was thinner in hips with pincer impingement compared to cam and/or mixed-type of FAI ( P ranging from <0.001 to 0.031). No difference in thickness existed between cam and mixed-type of impingement ( P = 0.751). Conclusion Acetabular cartilage thickness varied topographically and among FAI types. This study provides first baseline information about topographical cartilage thickness in FAI measured in vivo. Thinner cartilage thickness in pincer deformities could be misinterpreted as joint degeneration and could therefore have an impact on indication for hip preserving surgery.
Structural Morphology of Rabbit Patella and Suprapatella Cartilage by Microscopic MRI and Polarized Light Microscopy
Authors: Mantebea Hannah , Batool Syeda , Hammami Mouhamad , Xia Yang 
Published: February 2021

Objective In order to appreciate the roles articular cartilage of sesamoid bones and sesamoid fibrocartilage play in anatomy and pathology, the articular cartilage of the patella ( n = 4) and suprapatella ( n = 4) (a sesamoid fibrocartilage) of 12 to 14 weeks old New Zealand rabbits were studied qualitatively and quantitatively. Design/Method The intact knee joints and block specimens from the joints were imaged using microscopic magnetic resonance imaging (µMRI) at a 97.6-µm pixel resolution for the former and 19.5-µm resolution for the latter. Histological sections were made out of the µMRI-imaged specimens, which were imaged using polarized light microscopy (PLM) at 0.25-, 1-, and 4-µm pixel resolutions. Results The patella cartilage varied in thickness across the medial to lateral ends of the sesamoid bone with the central medial aspect slightly thicker than the lateral aspect. The suprapatella fibrocartilage decreased proximally away from the knee joint. Quantitative results of patellar cartilage showed strong dependence of fiber orientation with the tissue depth. Three histological zones can be clearly observed, which are similar to articular cartilage from other large animals. The sesamoid fibrocartilage has one thin surface layer (10 µm thick) of parallel-arranged structured fibers followed immediately by the majority of random fibers in bulk tissue. T2 relaxation time anisotropy was observed in the patellar cartilage but not in the bulk fibrocartilage. Conclusion Given the different functions of these 2 different types of cartilages in joint motion, these quantitative results will be beneficial to future studies of joint diseases using rabbits as the animal model.