Tag: pubmed

J Foot Ankle Surg. 2022 Aug 31:S1067-2516(22)00261-7. doi: 10.1053/j.jfas.2022.08.011. Online ahead of print.

ABSTRACT

Ankle fractures are a common traumatic lower extremity injury and are generally classified and characterized by the rotational mechanism of injury. At each malleolus (i.e., posterior, medial, and lateral) a fracture can occur or a ligamentous injury may be sustained. The purpose of this retrospective study was to determine if bone mineral density is a contributing factor on the number of fractured malleoli versus soft tissue injury in adult ankle fractures. Data was obtained from a registry of ankle fractures that were operatively treated by the foot and ankle team throughout our institutional facilities, from July 2017 to August 2019, and in which a preoperative computerized tomography scan was performed. Regional bone mineral density (BMD) was measured by calculating the average Hounsfield Unit (HU) on axial computerized tomography images of the distal fibula and tibia. The average HU was then compared to the number of fractured malleoli. One hundred eight patients met the study criteria. We identified statistically significant relationships between decreased BMD with increasing age (p < .01) and the male gender (p < .01). After adjusting for the covariates age and gender, no statistically significant relationship was identified between BMD and the number of malleoli involved in a given ankle fracture (p = .11). These findings suggest that while more investigation is required for ankle fracture patterns and BMD evaluation, increased age and biologic female gender is significantly related to decreased BMD as identified via HU.

PMID:36210259 | DOI:10.1053/j.jfas.2022.08.011

Vaccine. 2022 Oct 3:S0264-410X(22)01216-6. doi: 10.1016/j.vaccine.2022.09.082. Online ahead of print.

ABSTRACT

INTRODUCTION: Brazil experienced moments of collapse in its health system throughout 2021, driven by the emergence of variants of concern (VOC) combined with an inefficient initial vaccination strategy against Covid-19.

OBJECTIVES: To support decision-makers in formulating COVID-19 immunization policy in the context of limited vaccine availability and evolving variants over time, we evaluate optimal strategies for Covid-19 vaccination in Brazil in 2021, when vaccination was rolled out during Gamma variant predominance.

METHODS: Using a discrete-time epidemic model we estimate Covid-19 deaths averted, considering the currently Covid-19 vaccine products and doses available in Brazil; vaccine coverage by target population; and vaccine effectiveness estimates. We evaluated a 5-month time horizon, from early August to the end of December 2021. Optimal vaccination strategies compared the outcomes in terms of averted deaths when varying dose intervals from 8 to 12 weeks, and choosing the minimum coverage levels per age group required prior to expanding vaccination to younger target populations. We also estimated dose availability required over time to allow the implementation of optimal strategies.

RESULTS: To maximize the number of averted deaths, vaccine coverage of at least 80 % should be reached in older age groups before starting vaccination into subsequent younger age groups. When evaluating varying dose intervals for AZD1222, reducing the dose interval from 12 to 8 weeks for the primary schedule would result in fewer COVID-19 deaths, but this can only be implemented if accompanied by an increase in vaccine supply of at least 50 % over the coming six-months in Brazil.

CONCLUSION: Covid-19 immunization strategies should be tailored to local vaccine product availability and supply over time, circulating variants of concern, and vaccine coverage in target population groups. Modelling can provide valuable and timely evidence to support the implementation of vaccination strategies considering the local context, yet following international and regional technical evidence-based guidance.

PMID:36210250 | DOI:10.1016/j.vaccine.2022.09.082

J Voice. 2022 Oct 6:S0892-1997(22)00234-X. doi: 10.1016/j.jvoice.2022.08.001. Online ahead of print.

ABSTRACT

OBJECTIVES: 1) To investigate if vocal variation produced by assigned-female-at-birth (AFAB) non-binary people differed from vocal variation produced by cisgender (cis) participants. Cue values produced by non-binary participants were predicted to differ from those values produced by cisgender participants. 2) To determine if previous subjective assessments of bright voice quality in AFAB non-binary participants were quantifiable, and if so, if non-binary and cisgender participants differed in their voice quality production.

STUDY DESIGN: A quantitative comparative research design.

METHODS: Phonetic and statistical analyses of continuous speech samples produced by AFAB non-binary and cisgender participants. Vocal cues were mean fundamental frequency (F0) and bright voice quality, measured by cepstral peak prominence-smoothed and spectral slope, with speaker gender as the predictor.

RESULTS: At the group level, non-binary participants produced intermediate F0 values – significantly lower than the cis women’s and significantly higher than the cis men’s. Individually, the majority of non-binary participants produced mean F0 in this intermediate range. Non-binary participants produced significantly less negative spectral slope and higher cepstral peak prominence-smoothed, indicative of a brighter, more resonant voice quality. Individual-level results indicated that vocal training and vocal tract physiology did not fully account for the results found.

CONCLUSION: Participants’ agency, particularly their motivation to alter vocal output to avoid being misgendered, has an effect on the AFAB non-binary participants’ F0 production and potentially their voice quality. The majority of AFAB non-binary participants uniquely produced the cue combination of intermediate F0 and bright voice quality.

PMID:36210223 | DOI:10.1016/j.jvoice.2022.08.001

Eur Urol. 2022 Oct 6:S0302-2838(22)02636-7. doi: 10.1016/j.eururo.2022.09.008. Online ahead of print.

ABSTRACT

BACKGROUND: The functional status of immune cells in the tumor microenvironment and tumor characteristics may explain bacillus Calmette-Guérin (BCG) failure in high-risk non-muscle-invasive bladder cancer (NMIBC).

OBJECTIVE: To characterize molecular correlates of post-BCG high-grade (HG) recurrence using multiomics analysis.

DESIGN, SETTING, AND PARTICIPANTS: Patients with BCG-treated NMIBC (n = 156) were included in the study. Metachronous tumors were analyzed using RNA sequencing (n = 170) and whole-exome sequencing (n = 195). Urine samples were analyzed for immuno-oncology-related proteins (n = 190) and tumor-derived DNA (tdDNA; n = 187).

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: The primary endpoint was post-BCG HG recurrence. Cox regression and Wilcoxon rank-sum, t, and Fisher’s exact tests were used for analyses.

RESULTS AND LIMITATIONS: BCG induced activation of the immune system regardless of clinical response; however, immunoinhibitory proteins were observed in the urine of patients with post-BCG HG recurrence (CD70, PD1, CD5). Post-BCG HG recurrence was associated with post-BCG T-cell exhaustion (p = 0.002). Pre-BCG tumors from patients with post-BCG T-cell exhaustion had high expression of genes related to cell division and immune function. A high predicted post-BCG exhaustion score for pre-BCG tumors was associated with worse post-BCG HG recurrence-free survival (HGRFS; p = 0.002). This was validated in independent cohorts. Pre-BCG class 2a and 2b tumors (UROMOL2021 scheme) were associated with worse post-BCG HGRFS (p = 0.015). Post-BCG exhaustion was observed in patients with high pre-BCG neoantigen load (p = 0.017) and MUC4 mutations (p = 0.002). Finally, the absence of post-BCG tdDNA clearance identified patients at high risk of recurrence (p = 0.018). The retrospective design and partial overlap for analyses are study limitations.

CONCLUSIONS: Post-BCG HG recurrence may be caused by T-cell exhaustion. Tumor subtype and pre-BCG tumor characteristics may identify patients at high risk of post-BCG HG recurrence. Urinary measurements have potential for real-time assessment of treatment response.

PATIENT SUMMARY: A dysfunctional immune response to bacillus Calmette-Guérin (BCG) therapy may explain high-grade recurrences of bladder cancer.

PMID:36210217 | DOI:10.1016/j.eururo.2022.09.008

Eur J Orthop Surg Traumatol. 2022 Oct 9. doi: 10.1007/s00590-022-03388-8. Online ahead of print.

ABSTRACT

INTRODUCTION: Open pelvic fractures (OPFs) are uncommon but potentially lethal traumatic injuries. Often caused by high energy blunt trauma, they can cause severe injury to abdominal and pelvic structures. We sought to conduct a review of the literature in order to ascertain the rates of genitourinary injury and vaginal laceration after OPF and the rates of resulting infection and mortality.

METHODS: A review of PubMed was conducted to identify studies reporting the rates of genitourinary injury from OPF. Study characteristics, patient characteristics, and outcomes were collected. The data were pooled, and descriptive statistics were obtained.

RESULTS: Eight studies encompassing 343 patients were included. Average age was 35.1 years (10-85.9), 28% were female, and the average Injury Severity Score was 26.5 (4-75). 95.5% of patients had a blunt mechanism of injury. Motor vehicle collision (23.9%), motorcycle accident (19.7%), and pedestrian struck (19.3%) were the most common etiologies. Overall mortality and infection rates were 31.2% and 18.7%, respectively. 19.7% of patients suffered an injury to the genitourinary system, and 32.4% of females sustained a vaginal laceration.

DISCUSSION: OPFs have the potential for extremely high morbidity and mortality. While much research has been done to prevent early mortality from hemorrhage, there is comparatively little research into late mortality stemming from infection and sepsis. Intravenous antibiotics are the mainstay of treatment, and local antibiotics usage has been encouraged. In patients with a vaginal laceration, it is important to provide antibiotic coverage for vaginal flora.

PMID:36209481 | DOI:10.1007/s00590-022-03388-8

Nurs Open. 2022 Oct 9. doi: 10.1002/nop2.1397. Online ahead of print.

ABSTRACT

AIM: To examine effects of holistic sleep improvement strategies on frontline nurses who served in Wuhan, China, during a public health emergency (COVID-19).

DESIGN: A pre-post-test design with single group was conducted with a convenience sample applied the Transparent Reporting of Evaluations with Non-randomized Designs statement.

METHODS: Fifty-two nurses were recruited from a COVID-19 designated hospital, receiving holistic sleep improvement intervention, which concentrated on scientific human resource management, comfortable sleep environment establishment, self-relaxation and self-adjustment training and humanistic care. Data was collected at baseline and 4-week follow-up post intervention using self-reported questionnaires.

RESULTS: The total score of Pittsburgh Sleep Quality Index scale was 8.69 ± 4.346 at baseline. After 4 weeks of follow-up, the score statistically significantly decreased to 7.48 ± 3.691. Subjective sleep quality (p = .016), sleep efficiency (p = .015), sleep disturbances (p = .007) were statistically significantly improved after the intervention, while there were no statistically significant differences in sleep latency (p = .205), sleep duration (p = .375), sleep medication (p = .723) or daytime dysfunction (p = .747).

PMID:36209473 | DOI:10.1002/nop2.1397

JPEN J Parenter Enteral Nutr. 2022 Oct 9. doi: 10.1002/jpen.2455. Online ahead of print.

ABSTRACT

BACKGROUND: There is controversy regarding the optimal timing of initiating PN in critically ill patients. We aimed to evaluate the association between early PN and clinical outcomes and explore the mediation effects of different macronutrients in a cohort of mechanically ventilated patients.

METHODS: This is a post-hoc analysis of the NEED trial aiming to investigate the effect of implementing an evidence-based feeding guideline in newly-admitted critically ill patients. All eligible patients were divided into those who received early PN within the first three days of enrollment (Early PN) or those who did not (Non-early PN). Propensity score matching (PSM) with a one-to-one nearest neighbor-matching algorithm was applied to control potential confounders. Mediation analysis was used to test the indirect effect of different macronutrients from PN on the relationship between early PN and 28-day mortality.

RESULTS: The PSM created 370 matched pairs out of 1154 patients that met the eligibility criteria. Compared with non-early PN, patients receiving early PN had significantly higher 28-day mortality (19.7% versus 12.4%; hazard ratio = 1.904, 95% confidence interval [CI]: 1.063-3.410, P = 0.03). Mediation analysis showed that amino acids from early PN mediated 65% (mediation effect = 0.07, 95% CI: 0.02-0.13, P = 0.01) of the detrimental effect of early PN on the 28-day mortality.

CONCLUSIONS: Early PN is associated with increased 28-day mortality in critically ill patients requiring invasive mechanical ventilation. The detrimental effect may be mediated by intravenous amino acids from early PN. This article is protected by copyright. All rights reserved.

PMID:36209461 | DOI:10.1002/jpen.2455

Ultrastruct Pathol. 2022 Jul 4;46(4):388-400. doi: 10.1080/01913123.2022.2107750.

ABSTRACT

Congenital granular cell epulis (CGCE) is a rare tumor of gingiva that is exclusive to newborns, has marked female predominance, and is rarely associated with other abnormalities. Although benign in behavior, CGCE can be lethal by obstruction of respiration and/or deglutition and can require a multidisciplinary team of specialist at birth for survival of an otherwise normal infant. Histologically, CGCE resembles granular cell tumor (GCT), but unlike GCT, which is Schwannian-derived, derivation of CGCE remains an enigma, largely because of its low prevalence. This study presents 24 new cases of CGCE, the largest series since the original description 150 years ago and permits detailed study of homogeneity of cases diagnosed as CGCE as well as detailed comparisons of CGCE with GCT by clinical, morphological, immunohistochemical, and ultrastructural studies. The data show homogeneity within the CGCE cases, more differences than similarities between CGCE and GCT, and no immunohistochemical staining for common placental proteins/hormones in CGCE. The findings support a primitive mesenchymal cell origin, and a progressive degenerative process in CGCE, rather than neoplasia. Prenatal detection of this lesion is important to facilitate adequate preparations for support of these infants during labor and delivery.

PMID:36209431 | DOI:10.1080/01913123.2022.2107750

J Math Biol. 2022 Oct 9;85(5):48. doi: 10.1007/s00285-022-01807-2.

ABSTRACT

The complexity of biological systems, and the increasingly large amount of associated experimental data, necessitates that we develop mathematical models to further our understanding of these systems. Because biological systems are generally not well understood, most mathematical models of these systems are based on experimental data, resulting in a seemingly heterogeneous collection of models that ostensibly represent the same system. To understand the system we therefore need to understand how the different models are related to each other, with a view to obtaining a unified mathematical description. This goal is complicated by the fact that a number of distinct mathematical formalisms may be employed to represent the same system, making direct comparison of the models very difficult. A methodology for comparing mathematical models based on their underlying conceptual structure is therefore required. In previous work we developed an appropriate framework for model comparison where we represent models, specifically the conceptual structure of the models, as labelled simplicial complexes and compare them with the two general methodologies of comparison by distance and comparison by equivalence. In this article we continue the development of our model comparison methodology in two directions. First, we present a rigorous and automatable methodology for the core process of comparison by equivalence, namely determining the vertices in a simplicial representation, corresponding to model components, that are conceptually related and the identification of these vertices via simplicial operations. Our methodology is based on considerations of vertex symmetry in the simplicial representation, for which we develop the required mathematical theory of group actions on simplicial complexes. This methodology greatly simplifies and expedites the process of determining model equivalence. Second, we provide an alternative mathematical framework for our model-comparison methodology by representing models as groups, which allows for the direct application of group-theoretic techniques within our model-comparison methodology.

PMID:36209430 | DOI:10.1007/s00285-022-01807-2

Orv Hetil. 2022 Oct 9;163(41):1639-1648. doi: 10.1556/650.2022.32580. Print 2022 Oct 9.

ABSTRACT

INTRODUCTION: Ensuring the supply of healthcare professionals is an important health policy issue nowadays.

OBJECTIVE: The aim of our research is to provide a comprehensive picture of the health workforce situation in the European OECD countries.

DATA AND METHODS: Indicators analyzed regarding the numbers of practising midwives, nurses, physiotherapists and total hospital beds were derived from the “OECD Health Statistics 2021” database for the period 2000-2018. 24 European OECD countries were grouped according to the type of healthcare system and geographical location. Data were subsequently compared by parametric and nonparametric tests, focusing especially on years 2000, 2010, 2018.

RESULTS: Between 2000 and 2018, there was a 14% increase in the average number of midwives, a 30% increase in the average number of nurses, and a 41% increase in the average number of physiotherapists per 100,000 population in the OECD countries examined. Per 100 hospital beds, the average number of midwives increased by 72%, the number of nurses by 86%, and the number of physiotherapists by 97%. Significant results for all three years analyzed were obtained in the number of physiotherapists per 100 hospital beds (p = 0.014; p<0.001; p = 0.002) when comparing the Western and Eastern European countries examined. As for the healthcare systems, significant results were obtained only in the number of nurses per 100 hospital beds for the year 2010 (p = 0.048).

CONCLUSION: Among healthcare professional groups, the number of physiotherapists increased the most in Europe. The numbers of healthcare professionals per 100 beds are significantly higher in Western European countries analyzed compared to Eastern European countries. Orv Hetil. 2022; 163(41): 1639-1648.

PMID:36209424 | DOI:10.1556/650.2022.32580