bluuebunny/crossref_metadata_2025_split huggingface dataset:
Cause of death and influencing factors of chronic renal failure on maintenance hemodialysis
Authors: Fan Xing , Li Jing , Bi Zhao-yu , Liang Wei , Wang Feng-juan 
Published: July 2023

Objective: To investigate the causes of death in patients with chronic renal failure (CRF) on maintenance hemodialysis and its influencing factors.
Methods: This is a retrospective study. A total of 300 patients with chronic renal failure undergoing maintenance hemodialysis who were admitted to the Affiliated Hospital of Hebei University from March 2020 to October 2022 were selected as subjects. Various information of patients were collected. In addition, 80 dead patients in this group were investigated for the cause of death, including cardiovascular and cerebrovascular diseases, infections, multi organ failure, and other causes, and the death-related conditions of cardiovascular and cerebrovascular diseases, such as triglyceridr,,total cholesterol, and in blood lipid levels were analyzed.
Results: Among the 80 dead patients, cardiovascular and cerebrovascular diseases accounted for a higher proportion of death (66%). Univariate Logistic regression analysis showed that advanced age, plasma homocysteine, blood parathyroid hormone, hyperphosphatemia, hypertension, high volume load and left ventricular hypertrophy were risk factors for death in patients with chronic renal failure on maintenance hemodialysis. Multivariate Logistic regression analysis showed that high volume load, left ventricular hypertrophy and anemia were risk factors for death on maintenance hemodialysis. The levels of hemoglobin (HGB) and high-density lipoprotein (HDL) in patients who died of cardiovascular and cerebrovascular diseases were significantly lower than those in the non-cardio-cerebrovascular death group (P=0.00), and the levels of serum phosphorus, TG and TC were significantly higher than those in the non-cardio-cerebrovascular death group (P, P=0.00; TG, P=0.02; TC, P=0.01).
Conclusion: Cardiovascular and cerebrovascular diseases are the leading cause of death in patients with chronic renal failure on maintenance hemodialysis. Adequate dialysis and normal hemoglobin levels are favorable protective factors.
doi: https://doi.org/10.12669/pjms.39.5.7037
How to cite this: Fan X, Li J, Bi Z, Liang W, Wang F. Cause of death and influencing factors of chronic renal failure on maintenance hemodialysis. Pak J Med Sci. 2023;39(5):---------. doi: https://doi.org/10.12669/pjms.39.5.7037
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Impact of sodium fluoride and nano silver fluoride-based varnishes on remineralisation of enamel caries: an in-vitro study
Authors: Deulkar Pranjali Vilas , Rathi Nilesh , Thosar Nilima , Deshpande Meghana Ajay , Bane Sphurti Pramod 
Published: July 2023

Background: The aim of this study was to perform a comparative evaluation of 5% Sodium fluoride varnish, neutral nano silver fluoride (NSF) varnish and acidulated nano silver fluoride varnish in remineralising artificially induced enamel caries of primary teeth. Methods: 39 primary anterior teeth were sectioned 2mm below the cemento-enamel junction (CEJ) and mounted in acrylic resin blocks. Incipient enamel caries were induced on the samples artificially and primary Vicker’s surface microhardness (SMH) was assessed. Samples were divided equally and applied varnishes; Group 1: 5% Sodium fluoride varnish; Group 2: Neutral NSF varnish, and Group 3: Acidulated NSF varnish. A pH cycling protocol of 7 days was followed, and second Surface microhardness (SMH) testing was carried out. One sample from each group was observed for Scanning electron microscopy and Energy Dispersive Spectroscopy (SEM EDS). Statistical analysis was conducted using HSD Tukey and one way ANOVA tests. Results: There was a statistically significant difference between the pre-treatment and post-treatment values of all three groups. The difference in SMH after applying 5% Sodium fluoride varnish and acidulated NSF varnish was statistically significant (p<0.01). Similarly, neutral NSF varnish and acidulated NSF varnish also showed statistical significance (p<0.01). However, SMH after application of 5% Sodium fluoride varnish and neutral NSF varnish was statistically not significant. The SEM EDS analysis revealed the presence of an even fine granular layer of minerals on the surface of treated enamel in the acidulated NSF group whereas other groups showed uneven deposits of minerals. EDS showed fluoride and silver in groups containing NSF. Conclusions: Acidulated NSF varnish has the highest efficacy followed by neutral NSF varnish and 5% Sodium fluoride in remineralisation of enamel caries in primary teeth.
Interventions to support adolescents and young adults with the healthcare transition from paediatric to adult nephrology health services: A scoping review protocol
Authors: Kinch Melissa , Kroll Thilo , Stokes Diarmuid , Somanadhan Suja 
Published: July 2023

Background: Due to technological advancements and improved medical management of adolescents and young adults (AYAs) living with renal disease, there has been an exponential increase noted in the number of patients advancing from the paediatric to adult nephrology healthcare setting. Subsequently, more AYAs are required to undergo the process of healthcare transition from paediatric to adult healthcare services. This process is often a challenging period for young people and families and is often associated with a decline in physical and psychosocial health outcomes of AYAs with renal disorders. To ensure a successful transition, AYAs must develop the ability to manage their renal condition, including the medical and psychosocial aspects of their condition, independently. Despite significant research into the transition from paediatric to adult healthcare for this unique patient cohort, the transition period remains a challenge. The scoping review will aim to map, explore, and understand the interventions that are currently available to offer positive perceptions and experiences of transition for both AYAs living with renal disorders and their families. Methods: A systematic literature search will be conducted of PubMed, PsycInfo, CINAHL, ASSIA, EMBASE and Web of Science databases from the year 2000 to present. Two independent reviewers will screen the peer-reviewed literature obtained and assess them against the inclusion criteria to determine their inclusion eligibility. Data will be extracted and synthesised using a template refined by the authors. The scoping review will be undertaken in accordance with PRISMA-ScR guidelines. Data will undergo a formal critical appraisal using recognised appraisal tools. Conclusions: Through mapping this knowledge, the scoping review will aim to identify interventions that are currently available and identify gaps within the literature. This evidence may support the development of transitional care interventions in the future, promote patient satisfaction, and improve patient outcome measures and experiences.
Development of the Production of Meat and Dairy Products As a Factor in Ensuring the Country's Food Security
Authors: Yarnyh E. , Bashina O. , Agentova G. 
Published: July 2023

The purpose of the study is to analyze the change in the volume of livestock production for all categories of agricultural producers. The first category is represented by agricultural organizations, including business partnerships and companies, production cooperatives, unitary enterprises, subsidiary farms of non-agricultural organizations and institutions. The second category is household households, which include personal subsidiary farms and other individual farms of citizens who have plots in horticultural or horticultural non-profit associations. The third category is personal subsidiary plots for the production and processing of agricultural products in household and field plots. Along with production, the presented article discusses the directions for using the produced meat and dairy products, the structure of production, product losses. In addition, the dynamics of changes in the fleet of agricultural machinery is presented, as well as an analysis of the impact of the number and labor productivity of workers engaged in agricultural production for 2010–2020. to the level of agricultural production.
The main objective of the study is to identify opportunities to improve the efficiency of the livestock sector of the agro-industrial complex.
The paper identifies the main directions of the development potential of the livestock sector of the agro-industrial complex.
Developing the Royal College of Emergency Medicine's advanced clinical practitioners in the Wessex region: design, implementation and review of a regional training programme
Authors: Freshwater Els , McPherson Melinda 
Published: July 2023

Background: Since 2015, the Royal College of Emergency Medicine (RCEM) has championed an advanced clinical practitioner (ACP) credentialling process for clinicians working in advanced practice roles in the emergency department. While this process ensures a standard of advanced practice that is both governable and robust, it requires structure and support to complete successfully. This article reports the design and implementation of a regional programme aimed at supporting trainees through the RCEM ACP training process to the point of credentialling. Methods: A regional training programme was implemented and a mixed-methods approach (that included a quantitative analysis of training programme completion rates and a qualitative review of trainee feedback) was used to analyse the outcomes. The programme incorporated a structured educational programme, educational supervision and annual review, alongside integration into the deanery school board and facilitation of training time. Results: Between 2016 and 2022, a total of 46 trainee RCEM ACPs were recruited to the programme. Of these, 19 had credentialled by spring 2022 and 20 were in ongoing training, aiming for credentialling. During this time, these participants accounted for 19% of the nationally credentialled ACP workforce (19 of 99). Since 2020, the first pass rate for programme trainees has been 71%, compared to the national average of 38%. Credentialled ACPs, when asked how well the programme prepared them to credential with the RCEM, responded positively, with most scoring the programme between 4 and 5, with 5 being marked as ‘excellent’. Free text comments in feedback on the programme were collated and reviewed for common themes resulting in key themes of ‘supportive’, ‘excellence’ and ‘adequate preparation for credentialling’. Conclusion: Meeting the criteria for RCEM credentialling as an ACP is a demanding process that requires support and structure. The development and implementation of a regional training programme not only meets these requirements but yields higher credentialling success rates and creates trainee satisfaction in the process.
SURGICAL DEBRIDEMENT IN LONG BONE CHRONIC OSTEOMYELITIS: IS RADICAL DEBRIDEMENT NECESSARY? EVOLVING CONCEPTS AND REVIEW OF CASES IN A TERTIARY BONE INFECTION UNIT
Authors: Langit Mickhael , Tay Kae-Sian , Al-Omar Hussain Khalil , Muir Ross , Bates Joanna , Chuo Cher Bing , Barlow Gavin , Sharma Hemant 
Published: July 2023

IntroductionWide, tumor-like resection for chronic osteomyelitis (COM), a standard practice previously, has been challenged recently with adequate, local debridement. This paper reviews the evolution of surgical debridement for long bone osteomyelitis, and presents the outcome of adequate debridement in a tertiary bone infection unit.Materials & MethodsRetrospective review of records from 2014 to 2020 of patients with long bone osteomyelitis. All records were searched electronically and imaging reviewed. All patients were managed by Multidisciplinary Infection Team protocol.Results53 patients (54 bones) with median age of 45.5 years (IQR 31 to 55) and mean follow-up of 29 months (12 – 59) were identified. According to Cierny-Mader classification, ten bones were type I, 39 were type III, and five were type IV; via the BACH classification of long bone osteomyelitis 21 were uncomplicated, 32 were complex, and one had limited options. All patients were treated with single-staged management with one planned second stage stabilization. Seventy-five percent grew positive microbial cultures. Forty-six (85%) cases had resolution of COM after index procedure and 51 (94%) had resolution at last follow up. Four (7%) patients underwent second surgical procedure and six (11%) patients had complications.ConclusionsWe report high COM resolution rate through detailed pre operative evaluation and planning with multidisciplinary team approach. We challenge the need for wide tumor-like resection and the need for regenerative procedures in all cases of COM. Adequate debridement and local delivery of high concentration of antibiotic appears to provide comparable outcomes.
THE USE OF OSSEOINTEGRATED TITANIUM IMPLANTS TO TREAT BILATERAL AMPUTEES
Authors: Lu William , Oomatia Atiya , Al Muderis Munjed 
Published: July 2023

IntroductionThis study reports on minimum 2 year follow up outcomes on functional and quality of life of patients after undergoing bilateral osseointegration in comparison to traditional socket prosthesis.Materials & MethodsThis is a prospective pilot study of 35 patients, consisting of 30 males and 5 females, aged 22–66 (mean 36) years at surgery, with minimum two-year follow-up. Selection criteria were age over 18 years, bilateral amputees who had socket-related problems or were wheelchair-bound with short stumps and non-reconstructable limb pathology. Principle outcome measures included the Questionnaire for persons with a Trans-Femoral Amputation (Q-TFA), Short Form Health Survey 36 (SF-36), Six Minute Walk Test (6MWT), Timed Up and Go (TUG), and K-levels. Adverse events were recorded including infection, revision surgery, fractures, and implant failures.ResultsComparisons were made using differences between the mean pre-operative and mean post-operative values for each outcome measure. Significant improvements in all validated outcome measures were observed. All patient who were wheelchair bound prior to the surgery were able to mobilise post operatively. The occurrence levels of adverse events, including the infection rate and revision rate within this patient cohort, were similar to other established trans-femoral osseointegration studies.ConclusionsThese preliminary results indicate that osseointegration surgery is a safe and effective alternative treatment for bilateral amputees experiencing socket-related discomfort. Compared to the suboptimal outcomes of socket prostheses, osseointegration currently provides one of the best chances for any bilateral amputee to walk again and regain the ability to perform daily activities.
THE USE OF THE MASQUELET TECHNIQUE IN PAEDIATRIC LIMB RECONSTRUCTION: A CASE SERIES
Authors: Franco Aubrey Conrad , Hemmady Ronak , Green Robert Nicholas , Giles Stephen Nicholas , Fernandes James Alfred 
Published: July 2023

The Masquelet technique, also known as the ‘induced membrane technique’ has been utilised in adult reconstruction with varied success. However, there is limited literature on its use in children and this study aims to share our experience.Materials & MethodsBetween 2014 and 2022, 7 children underwent bone defect/infection reconstruction using Masquelet technique, four for complications of Congenital Pseudoarthrosis of Tibia (CPT) treatment, two with chronic osteomyelitis and one for Osteogenesis imperfecta with infected nonunion. The length of the defect relative to the length of the bone (index of reconstruction expressed as a percentage), time to union and complications were evaluated with standard radiographs and from electronic medical records.ResultsThe mean age was 11 years and the procedure was done in five tibiae, one femur and a metatarsal. The mean time interval was 7.1 weeks between the first and second stage surgery. The mean index of reconstruction was 25.8% and the mean follow up period was 17 months. Though six patients achieved union with a mean time to union of 6.5 months (range 4.5 to 10), two patients with multiple previous surgeries for CPT decided to have ablation despite union. The interosseous Masquelet technique of cross synostosis between the tibia and fibula is being highlighted.ConclusionsThe Masquelet technique is a reliable method in complex aetiologies and complications that require methodical planning to achieve good results especially in rescue situations of the tibia.
WHAT IS THE VALUE OF A HIP-SPECIFIC MRI IN THE MANAGEMENT OF PATIENTS WITH SYMPTOMATIC HIP DYSPLASIA UNDERGOING COMBINED HIP ARTHROSCOPY AND PERIACETABULAR OSTEOTOMY? A MULTICENTRE TRIAL
Authors: Verhaegen Jeroen , Milligan Kenneth , Zaltz Ira , Stover Michael , Sink Ernest , Belzile Etienne , Clohisy John , Poitras Stéphane , Beaule Paul 
Published: July 2023

The gold standard treatment of hip dysplasia is a peri-acetabular osteotomy (PAO). Labral tears are seen in the majority of patients presenting with hip dysplasia and diagnosed using Magnetic Resonance Imaging (MRI). The goal was to (1) evaluate utility/value of MRI in patients undergoing hip arthroscopy at time of PAO, and (2) determine whether MRI findings of labral pathology can predict outcome.A prospective randomized controlled trial was conducted at tertiary institutions, comparing patients with hip dysplasia treated with isolated PAO versus PAO with adjunct hip arthroscopy. This study was a subgroup analysis on 74 patients allocated to PAO and adjunct hip arthroscopy (age 26±8 years; 89.2% females). All patients underwent radiographic and MRI assessment using a 1.5-Tesla with or 3-Tesla MRI without arthrography to detect labral or cartilage pathology. Clinical outcome was assessed using international Hip Outcome Tool-33 (iHOT).74% of patients (55/74) were pre-operatively diagnosed with a labral tear on MRI. Among these, 41 underwent labral treatment (74%); whilst among those without a labral tear on MRI, 42% underwent labral treatment (8/19). MRI had a high sensitivity (84%), but a low specificity (56%) for labral pathology (p=0.053). There was no difference in pre-operative (31.3±16.0 vs. 37.3±14.9; p=0.123) and post-operative iHOT (77.7±22.2 vs. 75.2±23.5; p=0.676) between patients with and without labral pathology on MRI.Value of MRI in the diagnostic work-up of a patient with hip dysplasia is limited. MRI had a high sensitivity (84%), but low specificity (44%) to identify labral pathology in patients with hip dysplasia. Consequently, standard clinical MRI had little value as a predictor of outcome with no differences in PROM scores between patients with and without a labral tear on MRI. Treatment of labral pathology in patients with hip dysplasia remains controversial. The results of this subgroup analysis of a prospective, multi-centre RCT do not show improved outcome among patients with dysplasia treated with labral repair.
ORTHOPAEDIC INSTRUMENTS AND ORTHOPAEDIC OPERATIONS CAN EXCEED NOISE REGULATION: A SYSTEMATIC REVIEW
Authors: Mistry Dylan , Ahmed Usman , Aujla Randeep , Aslam Nadim , D'Alessandro Peter , Malik Shahbaz 
Published: July 2023

Industries such as agriculture, construction and military have stringent rules about hearing protection due to the risk of noise induced hearing loss (NIHL). Due to the use of power tools, orthopaedic staff may be at risk of the same condition. The UK Health and Safety Executive (HSE) have clear standards as to what is deemed acceptable occupational noise levels on an A-weighted and C weighted scale. This review is aimed to assess evidence on noise exposure testing within Orthopaedic theatres to see if it exceeds the HSE regulations.A targeted search of online databases PUBMED and EMBASE was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) principles. This review was registered prospectively in PROSPERO. An eligibility criterion identifying clinical studies which assessed noise exposure for Orthopaedic staff in theatres were included. Noise exposure data was extracted from these studies and a comparison was made with A weighted and C weighted acceptable exposure levels as quoted in the HSE regulations.Fourteen papers were deemed eligible, which reviewed 133 Orthopaedic operations and 64 Orthopaedic instruments. In total, 61% (81 of 132) of Orthopaedic operations and 70% (45 of 64) of instruments exceeded the noise regulations on an A weighted scale. 22% (10 of 46) of operations exceeded the maximum C weighted peak acceptable noise level.Orthopaedic instruments and operations can exceed safe occupational noise levels. NHS Trusts have clear policies about noise exposure in the workplace but have yet to identify Orthopaedic theatres as a potential at risk area. Orthopaedic staff need education, monitoring and protection whereas Employers and Occupational Health should consider assessments to identify at risk staff in Orthopaedic theatres and offer preventative methods from NIHL.
WHEN SHOULD A DEEP INFECTION IN TOTAL HIP ARTHROPLASTY BE CLASSIFIED AS THEATRE-ACQUIRED? NEW INSIGHTS FROM OLD DATA
Authors: Thomas Andrew , Wilkinson Martyn 
Published: July 2023

The documentation of deep infection rates in joint replacement is fraught with multiple difficulties. Deep infections acquired in theatre may present late, but some later presenting deep infections are clearly haematogenous, and not related to surgical management. The effect of Ultra Clean Air on infection rates was published by Charnley in 1972 (CORR,87:167–187). The data is valuable because large numbers of THRs were performed in standard and Ultra Clean theatres, and detailed microbiology of the air was also recorded. No IV antibiotics were used, so only the effect of air quality was studied.We extracted the data on theatre type and numbers from Table 3, and numbers and intervals from surgery of deep infections from Table 7. Theatre types with 300 air changes per hour and 3.5 CFU/M3 were classified as Ultra Clean. A logistic regression model was used to examine the effect of theatre type and time elapsed after procedure on the probability of becoming infected.The model suggests that, controlling for time period, Ultra Clean Air is associated with a significantly lower probability of infection, with an OR of 0.30, p = 2.74 × 10−6. The effect is larger earlier post-surgery, but it does persist. The results are best reviewed as a graphic, which shows that Ultra Clean Air clearly affects the deep infection rate for up to four years post-surgery.Ultra Clean Air reduces infection rates for up to four years post-surgery, so it is safe to assume that infections presenting after this are haematogenous. Ultra Clean Air does not eliminate early deep infection, so some early infections are not related to air quality. It is not practical to undertake widespread detailed retrospective analyses of cases. When monitoring infection rates there needs to be a balance between failing to record infections related to surgical technique and waiting many years to record low numbers of very late presenting problems. We suggest that registries should regard infections documented within three years of surgery as treatment complications.For any figures or tables, please contact the authors directly.