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1. Outcomes of Positive and Suspicious Findings in Clinical Computed Tomography Lung Cancer Screening and the Road Ahead

Author: Jacob Sands, Andrea Borondy Kitts, Jalil Afnan, Andrea B. McKee, Shawn Regis, Kimberly M. Rieger-Christ, and Brady McKee
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, Lung Neoplasms, business.industry, Nodule (medicine), Cancer detection, Radiation Dosage, medicine.disease, Humans, Mass Screening, Medicine, Radiology, medicine.symptom, Detection rate, Tomography, X-Ray Computed, business, Lung cancer, Early Detection of Cancer, Lung cancer screening, Retrospective Studies
Abstract: RATIONALE Future optimization of CT lung cancer screening algorithms will depend on clinical outcomes data. OBJECTIVES To report the outcomes of positive and suspicious findings in a clinical CT lung cancer screening program. METHODS We retrospectively reviewed results for patients from our institution undergoing lung cancer screening from 1/2012 through 12/2018, with follow-up through 12/2019. All exams were retrospectively re-scored using Lung-RADS® v1.1. Metrics assessed included positive, probably benign and suspicious exam rates, frequency/nature of care escalation, and lung cancer detection rates following a positive, probably benign, and suspicious exam result and overall. We calculated time required to resolve suspicious exams as malignant or benign. Results were broken down by subcategories, reason for positive/suspicious designation, and screening round. RESULTS During the study period 4301 individuals underwent a total of 10897 exams. The number of positive (13.9%), suspicious (5.5%), and significant incidental (6.4%) findings were significantly higher at baseline screening. Cancer detection and false positive rates were 2.0% and 12.3% at baseline vs 1.3% and 5.1% across subsequent screening rounds respectively. Baseline solid nodule(s) 6 to < 8 mm were the only probably benign findings resulting in lung cancer detection within 12 months. New solid nodules 6 to < 8 mm were the only Lung-RADS® 4A findings falling within the Lung-RADS® predicted cancer detection range of 5-15% (12.8%). 38.5% of Lung-RADS® 4A cancers were detected within three months. CONCLUSIONS Modification of the definition and suggested workup of positive and suspicious lung cancer screening findings appears warranted.
Published: 2022
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2. See one, do one, teach one: Reimagining reproductive endocrinology and infertility training programs to expand access to care

Author: Tia Jackson-Bey, Holly Mehr, Jacob Christ, Michelle Vu, and Christopher N. Herndon
Subjects: Embryology, medicine.medical_specialty, Medical education, Reproductive endocrinology and infertility, business.industry, Reproductive medicine, Psychological intervention, Obstetrics and Gynecology, Health equity, Reproductive Medicine, Health care, medicine, business, Psychology, Inclusion (education), Curriculum, Reproductive health
Abstract: Objective To provide a review of the current literature surrounding barriers to reproductive medicine and present examples of how resident and fellow education can be used to overcome these barriers. Design A review of relevant literature addressing barriers to reproductive medicine, resident and fellow education, and related materials was completed. Setting Academic medical institutions Patients None Interventions None Main outcome measures Health disparities and barriers in access to care Results Of barriers in access to care, three here are reviewed in detail: cost of healthcare, racial inequities, and marginalization of immigrant communities. Suggested strategies to mitigate these barriers include: reducing racial inequities through improved diversity within reproductive medicine and resident and fellow anti-racism training, opportunities for trainees to engage in advocacy, strengthening REI clinical exposure and educational curriculums in training programs, inclusion of residents and fellows in clinical care, and improving the accessibility of fertility care through implementing approaches to optimize the management of infertility in challenging resource-constrained settings. Conclusions Infertility is one of the most prevalent reproductive health diseases, yet profound disparities and inequities in access to care exist today in the United States. Lower income, minority and immigrant communities are among those most marginalized. Improved access to care begins with broadened OB/GYN and REI trainee education which acknowledges the barriers these communities face and provides strategies to help overcome these obstacles to care.
Published: 2022
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3. Digital Interventions for People With Co-Occurring Depression and Problematic Alcohol Use

Author: Heleen Riper, Matthijs Blankers, Jack Dekker, Anna E. Goudriaan, Carolien Christ, and Maria J. E. Schouten
Subjects: medicine.medical_specialty, Alcohol Drinking, Depression/epidemiology, Psychological intervention, Review, Comorbidity, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, AcademicSubjects/MED00860, 030212 general & internal medicine, Psychiatry, Grading (education), Depression (differential diagnoses), Depression, business.industry, Alcohol dependence, General Medicine, Mental health, Confidence interval, Meta-analysis, Dual diagnosis, business, 030217 neurology & neurosurgery
Abstract: Aims This systematic review and meta-analysis assessed the effectiveness of digital interventions addressing depressive symptoms and alcohol use simultaneously among people with co-occurring depression and problematic alcohol use. Methods Seven databases were searched for trials evaluating digital interventions aimed at depression and alcohol use. Random-effects meta-analyses were conducted to pool effects on depressive symptoms and alcohol use up to 3-month and 6-month follow-up. Overall quality for every outcome was assessed with GRADE (Grading of Recommendations Assessment, Development and Evaluation). Results The pooled effect of digital interventions compared to their comparators was in favour of digital interventions. Small but significant effects on depressive symptoms at 3-month follow-up were found (g = 0.34, 95% confidence interval (CI): 0.06–0.62, P = 0.02, k = 6) and non-significant effects at 6-month follow-up (g = 0.29, 95% CI: −0.16 to 0.73, P = 0.15, k = 5). For alcohol use, the pooled effect of digital interventions was small and non-significant at 3-month follow-up (g = 0.14, 95% CI: −0.02 to 0.30, P = 0.07, k = 6) and significant at 6-month follow-up (g = 0.14, 95% CI: 0.07–0.20, P = 0.005, k = 5). Sensitivity analysis indicated the latter finding to be sensitive to statistical estimator choice. Quality of evidence was moderate, except for depressive symptoms at 6-month follow-up for which it was low. Conclusion Based on the literature, digital interventions are effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with comorbid depression and problematic alcohol use. More high-quality trials are needed to confirm the current findings., Short Summary: Depression and problematic alcohol use often co-occur and are associated with negative outcomes. Digital interventions were found effective in reducing depressive symptoms at 3-month follow-up and alcohol use at 6-month follow-up among people with co-occurring depression and problematic alcohol use. More trials are needed to confirm the current evidence base.
Published: 2022
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4. An Investigation Using Specific Absorption Rate Analysis to Diagnose Early- stage Breast Tumor using UWB Antenna

Author: Rahul Krishnan and Jobin Christ
Subjects: medicine.diagnostic_test, Phantoms, Imaging, business.industry, Specific absorption rate, Breast Neoplasms, Magnetic resonance imaging, medicine.disease, Microwave imaging, Breast cancer, Positron emission tomography, Humans, Medicine, Mammography, Female, Radiology, Nuclear Medicine and imaging, Breast, Tomography, Stage (cooking), Microwaves, skin and connective tissue diseases, business, Nuclear medicine
Abstract: Aims: This work was focused on the detection of early-stage breast tumors and their location. Background: The most frequently seen disease progression and mortality in women's lives is Breast Cancer. Because of breast cancer/tumors, the risk of mortality for women has risen exponentially. From the 2020 deadline for breast cancer, women who died from carcinoma were 123.8 cases per lac women between 2006-2010. This problem is also overcome by the early identification of the tumor using different detection procedures like X-ray mammography, computerized tomography, ultrasound imaging technique, Positron Emission Tomography (PET), Magnetic Resonance Imaging (MRI), microwave imaging. Researchers carried out multiple studies in these areas. Objective: To detect early-stage breast tumors and their location using SAR analysis. Methods: The major dielectrical difference between cancerous breast tissues and normal tissues in this technique is the microwave frequency range. The term Specific Absorption Rate (SAR) describes the amount of energy which is absorbed (W/kg) in the breast tissue. This segment illustrates the usefulness to diagnose the tumor position in the breast by means of maximum SAR value coordinates. Changes in breast and tumor size are important for the risk of diagnosis. The power absorbed in connecting with a normal breast and a tumor breast is measured and equivalent for different breast masses. The maximum SAR is also analyzed at distinct tumor locations at various frequency ranges. Results: It is observed that max SAR coordinates are very close to the actual tumor location. So, the maximal value of SAR coordinates indicates the existence of a tumor in the breast phantom. Conclusion: The simulated data above strongly suggests that the Max SAR values were higher in the breast phantom with tumor as compared to the breast without tumor. With different tumor radius (3 mm and 5 mm) analyzed with different resonant frequencies like 3GHz, 4GHz and 5GHz at the actual tumor location of (0, 0, 35). Even though a model representing the real properties of breast tissue is required to assess the validation of any imaging process, so the real-time development of an equivalent breast phantom and its execution is needed.
Published: 2021
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5. Performance of the ESC 0/2h-algorithm using high-sensitivity cardiac troponin I in the early diagnosis of myocardial infarction

Author: Eva Ganovská, Beatriz López, Nicolas Geigy, Adam Bakula, Tobias Reichlin, Òscar Miró, Raphael Twerenbold, Sofia Calderón, Maria Rubini Gimenez, Michael Freese, Thomas Nestelberger, Karin Wildi, Joaquim Gea, Michael Christ, Tobias Zimmermann, Carolina Fuenzalida, Pedro Lopez-Ayala, Damian Kawecki, Christian Puelacher, Beata Morawiec, Eliska Potlukova, Jasper Boeddinghaus, Desiree Wussler, Matthias Diebold, Tobias Resa, Isabel Campodarve, Samyut Shrestha, Noemi Glarner, Katharina Rentsch, Ivo Strebel, Oliver Reuthebuch, Piotr Munzk, Friedrich Eckstein, Luca Koechlin, Christian Mueller, Danielle Menosi Gualandro, Tobias Breidthardt, Jeanne du Fay de Lavallaz, Jiri Parenica, Arnold von Eckardstein, F. Javier Martín-Sánchez, Sandra Mitrovic, Dagmar I. Keller, Esther Rodríguez Adrada, Simon Martin Frey, and University of Zurich
Subjects: medicine.medical_specialty, Cardiac troponin, Myocardial Infarction, 610 Medicine & health, 030204 cardiovascular system & hematology, 2705 Cardiology and Cardiovascular Medicine, 03 medical and health sciences, 0302 clinical medicine, Predictive Value of Tests, Internal medicine, 540 Chemistry, medicine, Humans, Prospective Studies, 030212 general & internal medicine, Myocardial infarction, reproductive and urinary physiology, 10038 Institute of Clinical Chemistry, urogenital system, business.industry, Chest discomfort, Troponin I, Reproducibility of Results, Emergency department, medicine.disease, Triage, 3. Good health, Early Diagnosis, embryonic structures, Cardiology, biological phenomena, cell phenomena, and immunity, Cardiology and Cardiovascular Medicine, business, Algorithms, Biomarkers
Abstract: The 2020 guidelines of the European Society of Cardiology (ESC) recommend a novel ESC 0/2h-algorithm as the preferred alternative to the ESC 0/1h-algorithm in the early triage for rule-out and/or rule-in of Non-ST-segment-elevation myocardial infarction (NSTEMI). The aim was to prospectively validate the performance of the ESC 0/2h-algorithm using the high-sensitivity cardiac troponin I (hs-cTnI) assay (ARCHITECT) in an international, multicenter diagnostic study enrolling patients presenting with acute chest discomfort to the emergency department.
Published: 2021
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6. 0/2 h-Algorithm for Rapid Triage of Suspected Myocardial Infarction Using a Novel High-Sensitivity Cardiac Troponin I Assay

Author: Carolina Mitrovic, Esther Rodriguez Calderón, Tobias Munzk, Joaquim Campodarve, Maria Rubini Gimenez, Thomas Nestelberger, F. Javier Martín-Sánchez, Sandra Rentsch, Gea, Luca Koechlin, Michael Christ, Christian Zimmermann, Christian Mueller, Bernhard Okamura, Gemma Martínez-Nadal, Eva Adrada, Noemi Fuenzalida, Jiri Ganovská, Katharina Geigy, Desiree Wussler, Sofia López, Eliska du Fay de Lavallaz, Jeanne Puelacher, Pedro Lopez-Ayala, Karin Wildi, Dagmar I. Keller, Michael Breidthardt, Ana Yufera Sanchez, Matthias Potlukova, Nicolas Diebold, Beata Morawiec Piotr Glarner, Adam Strebel, Simon Bakula, Arnold Parenica, Beatriz Freese, Damian Kawecki, Isabel von Eckardstein, Òscar Miró, Danielle M Frey, Jasper Boeddinghaus, Samyut Shrestha, Jennifer Rohner, Tobias Gualandro, and Raphael Twerenbold
Subjects: medicine.medical_specialty, Cardiac troponin, business.industry, Internal medicine, Biochemistry (medical), Clinical Biochemistry, medicine, Cardiology, Myocardial infarction, Sensitivity (control systems), medicine.disease, business, Triage
Abstract: Background We aimed to derive and validate a 0/2 h-algorithm using the new high-sensitivity cardiac troponin I (hs-cTnI)-VITROS assay (VITROS® Immunodiagnostic Products hs-Troponin I Reagent Pack, Ortho Clinical Diagnostics) for rapid rule-out/in of non-ST-segment elevation myocardial infarction (NSTEMI). Methods The final diagnosis was centrally adjudicated by 2 independent cardiologists according to the fourth universal definition of myocardial infarction (MI) among 1888 patients presenting to the emergency department with acute chest pain. hs-cTnI-VITROS concentrations were measured at presentation and at 2 h in a blinded fashion. The optimal assay-specific thresholds for the hs-cTnI-VITROS 0/2 h-algorithm were derived in a randomly selected 70% of the cohort and validated in the remaining 30%. Results NSTEMI was the final diagnosis in 216/1322 (16.3%) patients of the derivation cohort. Rule-out was defined as baseline hs-cTnI concentrations of 3 h or a baseline hs-cTnI concentration of Conclusion hs-cTnI-VITROS concentrations at presentation combined with absolute changes within the first 2 h allowed safe rule-out and accurate rule-in of NSTEMI in two-thirds of unselected patients presenting with acute chest pain to the emergency department. Trial registration www.clinicaltrials.gov: NCT0047058
Published: 2021
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7. Clustering based on comorbidities in patients with chronic heart failure: an illustration of clinical diversity

Author: Daisy J.A. Janssen, Nicole H.M.K. Uszko-Lencer, Lowie E.G.W. Vanfleteren, Hans-Peter Brunner-La Rocca, Emiel F.M. Wouters, Simon Rechberger, Christ Werter, Martijn A. Spruit, Swetlana Gaffron, Frits M.E. Franssen, Eefje Janssen, Cardiologie, RS: Carim - H02 Cardiomyopathy, MUMC+: MA Med Staf Spec Cardiologie (9), RS: CAPHRI - R1 - Ageing and Long-Term Care, Health Services Research, Pulmonologie, and RS: NUTRIM - R3 - Respiratory & Age-related Health
Subjects: medicine.medical_specialty, medicine.medical_treatment, Cardiomyopathy, Heart failure, Comorbidity, Ventricular Function, Left, Clustering, Comorbidities, Interquartile range, Internal medicine, Diabetes mellitus, medicine, Cluster Analysis, Humans, Diseases of the circulatory (Cardiovascular) system, COPD, VALIDITY, FRAILTY, Disease burden, Rehabilitation, Ejection fraction, business.industry, Stroke Volume, Original Articles, CARE, medicine.disease, Precision medicine, LIFE, RC666-701, RELIABILITY, Original Article, Cardiology and Cardiovascular Medicine, business, PULMONARY REHABILITATION, COPING STYLES
Abstract: Aims It is increasingly recognized that the presence of comorbidities substantially contributes to the disease burden in patients with heart failure (HF). Several reports have suggested that clustering of comorbidities can lead to improved characterization of the disease phenotypes, which may influence management of the individual patient. Therefore, we aimed to cluster patients with HF based on medical comorbidities and their treatment and, subsequently, compare the clinical characteristics between these clusters. Methods and results A total of 603 patients with HF entering an outpatient HF rehabilitation programme were included [median age 65 years (interquartile range 56–71), 57% ischaemic origin of cardiomyopathy, and left ventricular ejection fraction 35% (26–45)]. Exercise performance, daily life activities, disease‐specific health status, coping styles, and personality traits were assessed. In addition, the presence of 12 clinically relevant comorbidities was recorded, based on targeted diagnostics combined with applicable pharmacotherapies. Self‐organizing maps (SOMs; www.viscovery.net) were used to visualize clusters, generated by using a hybrid algorithm that applies the classical hierarchical cluster method of Ward on top of the SOM topology. Five clusters were identified: (1) a least comorbidities cluster; (2) a cachectic/implosive cluster; (3) a metabolic diabetes cluster; (4) a metabolic renal cluster; and (5) a psychologic cluster. Exercise performance, daily life activities, disease‐specific health status, coping styles, personality traits, and number of comorbidities were significantly different between these clusters. Conclusions Distinct combinations of comorbidities could be identified in patients with HF. Therapy may be tailored based on these clusters as next step towards precision medicine. The effect of such an approach needs to be prospectively tested.
Published: 2021
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8. Functional near‐infrared spectroscopy to assess pain in neonatal circumcisions

Author: Kurtulus Izzetoglu, Gordon A. Barr, Arjunan Ganesh, Olivia Nelson, Shih-Shan Lang, C D Kurth, Bingqing Zhang, Theresa DiMaggio, Christine C. Greco, Alexis A. Topjian, Ian Yuan, and Lori Christ
Subjects: Male, Spectroscopy, Near-Infrared, Local anesthetic, medicine.drug_class, business.industry, Infant, Newborn, Infant, Pain, Anesthesiology and Pain Medicine, Nociception, Circumcision, Male, Interquartile range, Pain assessment, Anesthesia, Pediatrics, Perinatology and Child Health, Anesthetic, medicine, Noxious stimulus, Humans, Functional near-infrared spectroscopy, Anesthetics, Local, Prefrontal cortex, business, Pain Measurement, medicine.drug
Abstract: Pain assessment is challenging in neonates. Behavioral and physiological pain scales do not assess neocortical nociception, essential to pain encoding and central pain pathway development. Functional near-infrared spectroscopy (fNIRS) can assess neocortical activation to noxious stimuli from changes in oxy-(HbO) and total-hemoglobin concentrations (HbT). This study aims to assess fNIRS nociceptive functional activation in the prefrontal cortex of neonates undergoing circumcision through changes in HbO and HbT, and the correlation between changes in fNIRS and Neonatal Infant Pain Scale (NIPS), a behavioral pain assessment scale.In healthy term neonates, HbO, HbT, and NIPS were recorded during sequential circumcision events 1-Prep before local anesthetic injection; 2-Local anesthetic injection; 3-Prep before incision; 4-Oral sucrose; 5-Incision; 6-Gomco (hemostatic device) attached; 7-Gomco twisted on; and 8-Gomco removed. fNIRS and NIPS changes after each event were assessed with Wilcoxon signed-rank test and summarized as median and interquartile range (IQR). Changes in fNIRS vs. NIPS were correlated with Spearman coefficient.In 31 neonates fNIRS increased (median [IQR] µmol/L) with noxious events: Local injection (HbO: 1.1 [0.5, 3.1], p .001; HbT: 2.3 [0.2, 7.6], p .001), Gomco attached (HbO: 0.7 [0.1, 1.7], p = .002; HbT: 0.7 [-0.2, 2.9], p = .02), and Gomco twisted on (HbO: 0.5 [-0.2, 1.7], p = .03; HbT: 0.8 [-0.1, 3.3], p = .02). fNIRS decreased with non-noxious event: Prep before incision (HbO: -0.6 [-1.2, -0.2] p .001; HbT: -1 [-1.8, -0.4], p .001). Local anesthetic attenuated fNIRS increases to subsequent sharp stimuli. NIPS increased with subsequent sharp stimuli despite local anesthetic. Although fNIRS and NIPS changed in the same direction, there was not a strong correlation between them.During neonatal circumcision, changes in fNIRS differed between different types of painful stimuli, which was not the case for NIPS, suggesting that fNIRS may complement NIPS to assess the quality of pain.
Published: 2021
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9. Community-acquired pneumonia subgroups and differential response to corticosteroids: a secondary analysis of controlled studies

Author: Wittermans, Esther, van der Zee, Philip A, Qi, Hongchao, van de Garde, Ewoudt M W, Blum, Claudine A, Christ-Crain, Mirjam, Gommers, Diederik, Grutters, Jan C, Voorn, G Paul, Bos, Willem Jan W, Endeman, Henrik, Afd Pharmacoepi & Clinical Pharmacology, Pharmacoepidemiology and Clinical Pharmacology, Intensive Care, Pulmonary Medicine, Epidemiology, Afd Pharmacoepi & Clinical Pharmacology, and Pharmacoepidemiology and Clinical Pharmacology
Subjects: Pulmonary and Respiratory Medicine, medicine.medical_specialty, business.industry, Mortality rate, medicine.disease, Systemic inflammation, Latent class model, Pneumonia, Community-acquired pneumonia, Original Research Articles, Internal medicine, Respiratory Infections, Cohort, medicine, Biomarker (medicine), Observational study, medicine.symptom, business
Abstract: Background Latent class analysis (LCA) has identified subgroups with meaningful treatment implications in acute respiratory distress syndrome. We performed a secondary analysis of three studies to assess whether LCA can identify clinically distinct subgroups in community-acquired pneumonia (CAP) and whether the treatment effect of adjunctive corticosteroids differs between subgroups. Methods LCA was performed on baseline clinical and biomarker data from the Ovidius trial (n=304) and the Steroids in Pneumonia (STEP) trial (n=727), both randomised controlled trials investigating adjunctive corticosteroid treatment in CAP, and the observational TripleP cohort (n=201). Analyses were conducted independently in two cohorts (Ovidius–TripleP combined and the STEP trial). In both cohorts, differences in clinical outcomes and response to adjunctive corticosteroid treatment were examined between subgroups identified through LCA. Results A two-class model fitted both cohorts best. Class 2 patients had more signs of systemic inflammation compared to class 1. In both cohorts, length of stay was longer and in-hospital mortality rate was higher in class 2. In the Ovidius trial, corticosteroids reduced the median length of stay in class 2 (6.5 versus 9.5 days) but not in class 1 (p-value for interaction=0.02). In the STEP trial, there was no significant interaction for length of stay. We found no significant interaction between class assignment and adjunctive corticosteroid treatment for secondary outcomes. Conclusions In two independent cohorts, LCA identified two classes of CAP patients with different clinical characteristics and outcomes. Given the different response to adjunctive corticosteroids in the Ovidius trial, LCA might provide a useful basis to improve patient selection for future trials., Latent class analysis of baseline clinical and biomarker data identified two distinct classes of patients with community-acquired pneumonia in two cohorts. In one cohort, the response to adjunctive corticosteroid treatment differed between classes. https://bit.ly/3ClR92L
Published: 2021
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10. Healing at Home: applying innovation principles to redesign and optimise postpartum care

Author: Jessica S Gaulton, Ryan Schumacher, Kirstin Leitner, Laura Scalise, Deborah S Driscoll, Raina M. Merchant, Lauren Hahn, Lori Christ, and Roy Rosin
Subjects: Nursing, business.industry, Postpartum care, Medicine, General Medicine, business
Published: 2021
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11. Evaluation of Long-Term Outcomes and Toxicity After Stereotactic Phosphorus-32–Based Intracavitary Brachytherapy in Patients With Cystic Craniopharyngioma

Author: Rui Liu, Ekkehard M. Kasper, Anand Mahadevan, Yaming Wang, Xin Yu, Chenhao Hu, Sebastian M. Christ, and Bo Feng
Subjects: Cancer Research, medicine.medical_specialty, medicine.medical_treatment, Radiography, Brachytherapy, 030218 nuclear medicine & medical imaging, Craniopharyngioma, 03 medical and health sciences, 0302 clinical medicine, medicine, Humans, Pituitary Neoplasms, Radiology, Nuclear Medicine and imaging, Cyst, Retrospective Studies, Radiation, Cysts, business.industry, Intracavitary brachytherapy, medicine.disease, Radiation therapy, Oncology, 030220 oncology & carcinogenesis, Toxicity, Cohort, Radiology, business, Phosphorus Radioisotopes
Abstract: Purpose Interstitial brachytherapy based on phosphorus-32 (P-32) has an established role as a minimally invasive treatment modality for patients with cystic craniopharyngioma. However, reporting on long-term outcomes with toxicity profiles for large cohorts is lacking in the literature. The purpose of this study is therefore to evaluate the long-term visual, endocrinal, and neurocognitive functions in what is the largest patient series having received this treatment to date. Methods and Materials We retrospectively evaluated 90 patients with cystic craniopharyngiomas who were treated with stereotactic intracavitary brachytherapy between 1998 and 2010. Colloidal activity of injected radioisotope P-32 was based on an even distribution within the tumor. After treatment, patients were followed-up for a minimum of 5 years and over a mean of 121 months (60-192 months) to assess radiographic and clinical responses. Results The 90 patients included in our study cohort underwent a total of 108 stereotactic surgical procedures for 129 craniopharyngioma-related cysts. Of the included tumors, 65 (72.2%) were associated with a single cyst, 15 (16.7%) were associated with 2 cysts, and 10 (11.1%) tumors had developed septations with 3 to 4 cysts. Stereotactic cyst puncture and content aspiration were used to drain a mean cyst fluid volume of 21.4 mL (1.0-55.0 mL). Each cyst was then instilled for interstitial brachytherapy with colloidal P-32 solution. Based on radiographic follow-up assessments, 56 cysts (43.4%) showed resolution and/or nonrecurrence, which was classified as a complete response to treatment; 47 cysts (36.4%) showed a partial response; and 5 cysts (3.9%) displayed a stable appearance. Treatment resulted in immediate and clinically significant vision improvement in 54 of 63 (86%) symptomatic patients, and this improvement was maintained. Progression-free survival rates at 5 and 10 years were 95.5% and 84.4%, respectively. Conclusions P-32–based interstitial brachytherapy can play an effective role in managing patients with cystic craniopharyngiomas. It can be considered a valid alternative to surgery in select patients with a favorable toxicity profile and long-term clinical outcomes.
Published: 2021
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12. Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Author: Labeau, Sonia O, Afonso, Elsa, Benbenishty, Julie, Blackwood, Bronagh, Boulanger, Carole, Brett, Stephen J, Calvino-Gunther, Silvia, Chaboyer, Wendy, Coyer, Fiona, Deschepper, Mieke, François, Guy, Honore, Patrick M, Jankovic, Radmilo, Khanna, Ashish K, Llaurado-Serra, Mireia, Lin, Frances, Rose, Louise, Rubulotta, Francesca, Saager, Leif, Williams, Ged, Blot, Stijn I, Dritan, Muzha, Antoni Margarit Ribas, Fernando, Lipovesty, Cecilia, Loudet, Fiona, Coyer, Philipp, Eller, Nafseen, Mostafa, Patrick, M Honoré, Vanesa Mercado Telleria, Jasmina, Smajic, Paula Cristina Nogueira, Khalid Mahmood Khan Nafees, Romuald, Hentchoya, Louise, Rose, Javiera, Soledad, Frances, Lin, Yenny, Cardenas, Amylkar Garay Reyes, Alan, Sustic, Meropi, Mpouzika, Tamas, Vymazal, Hanne Irene Jensen, Hernan, Aguirre-Bermeo, Liivi, Maddison, Maija, Valta, Silvia, Calvino-Gunther, Frank, Bloos, Faustina Excel Adipa, Vasilios, Koulouras, Judy, Enamorado, Zsuzsann, Ágoston, Hrönn, Birgisdóttir, Amit, Gupta, Mohan, Gurjar, Bram, Kilapong, Seyed Mohammadreza Hashemian, Ignacio, Martin-Loeches, Julie, Benbenishty, Andrea, Cortegiani, Kelly, Fletcher, Yoshiro, Hayashi, Wangari, Waweru-Siika, Khalid, Abidi, Sang-Min, Lee, Burhan, Hadri, Mihails, Dolgusevs, Fayez François Abillama, Tomas, Jovaisa, Cyril, Thix, Muhammed, Elhadi, Basri Mat Nor, Shanti, Ratnam, Mohd Zulfakar Mazlan, Sundaresan, Maiyalagan, Luis, Sánchez-Hurtado, Adrian, Belii, Mendsaikhan, Naranpurev, Prabha, Gautam, Dylan De Lange, Rachael, Parke, Rose Ekama Ilesanmi, Mirjana, Shosholcheva, Antonija, Petosic, Ranveig, Lind, Madiha Hashmi Ffarcsi, Javier, Bogarin, Aaron Mark Hernandez, Malgorzata, Mikaszewska-Sokolewicz, Bruno, Sousa, Dana, Tomescu, Dorel, Sandesc, Theogene, Twagirumugabe, Vitaly, Gusarov, Maie, Ebaid, Radmilo, Jankovic, Gari, Slobodianiuk, Andrea, Martonova, Rihard, Knafelj, Mervyn, Mer, Emilio, Maseda, Bernardo, Panka, Joerg, C Schefold, Eva, Joelsson-Alm, Konlawij, Trongtrakul, Lorna, Merritt-Charles, Lamia Ouanes Besbes, Yalım, Dikmen, Lesia, Zgrzheblovska, Mark, Fielding, Francesca, Rubulotta, Ashish, K Khanna, Leif, Saager, Ingrid von der Osten, Alban, Greca, Alma, Cani, Nordian, Xhindi, Genci, Hyska, Antonio Margarit Ribas, Susana, Pinto, Paulo, Alves, Romina, Esposito, Emanuel, Valgolio, John Thomas Sanchez Minope, Antonio, Abdala, Maria, Ayala, Silvina, Bravo, Ana, Bantar, Patricia, Delgado, Gustavo, Badariotti, Fernando, Lipovestky, Ana, Diaz, Pablo, Saul, Mariano, Setten, Alejandra, Aucapina, Ysica, Acosta, Victor, Gonzalez, Luis, Camputaro, Fernando, Baccaro, Robert, Villa, Marcela, Mastantuono, Emiliano, Dean, Oscar Fernández Rostello, Patricia, Brizuela, Julio Ricardo Bartoli, Matias, Guereschi, Cristian, Quiroga, Sofia, Putruele, Paula, Villegas, Veronica, Curilen, Ruben, Fernandez, Mariangeles Gabriela Nocheretti, Rosana Gabriela Escalante, Cecilia Inés Loudet, Silvia, Fernandez, Ana Laura Gonzalez, Gustavo Andres Alvarez, Federico, Iglesias, Silvia, Chaparro, Graciela, Zakalik, Gonzalo, Pagella, Matías, Baini, Pierina Arias Campos, Ignacio, Sabbag, Armando, Schmukler, Imelda Perdomo Fonseca, Gonzalo Martín Alvarez, Mario, Ramirez, Fernando, Tapia, Carlos Alejandro Bascary, Graciela Del Valle Gimenez, Fernando Pablo Bertoletti, Esteban, Milioto, Pablo Julio Maldonaldo Bonsignore, Maria Alejandra Fernandez, Julie, Smith, Tim, Chimunda, Lorraine, Thompson, Teena, Maguire, Wendy, Chaboyer, Stacey, Watts, Marion, Mitchell, Madeleine, Powell, India, Lye, Leanne, Parsons, Nerilee, Baker, Claire, Reynolds, Amy, Thompson, Kristy, Masters, Kellie, Sosnowski, Lynette, Morrison, Gavin, D Leslie, Ramanathan, Lakshmanan, Alexis, Tabah, Wendy, Brown, Sharon, McDowell-Skaines, Andrea, Mclucas, Chris, Smith, Mandy, Tallot, Sarah, Jones, Michelle, Barakat-Johnson, Thomas, Leong, Rand, Butcher, Kerrie, Martin, Philipp, Douschan, Dirk von Lewinski, René, Schmutz, Uta, Kolussi, Fatema, Salman, Zainab, Ateya, Koen De Decker, Niels Van Regenmortel, Anita, Jans, Patricia, Wijnands, Stefano, Coremans, Patrick, M Honore, David De Bels, Tanja, Depuydt, Caroline, Paillet, Luc-Marie, Jacquet, Walter, Swinnen, Francis, Hannes, Matthia, Mergeay, Stijn Van de Velde, Silvie, Allaert, Pieter, Hoste, Christophe, Borin, Sandrine, Balon, Vincent, Fraipont, Patrick, Biston, Nicolas De Schryver, Thierry, Dugernier, Ilse Van Cotthem, Angelica Olivetto de Almeida, Silvia Angelica Jorge, Delmiro, Becker, Raysa Cristina Schmidt, Evellyn, Oliveira, Aline, Ramalho, Eliane, Mazocoli, Audrey, Fioretti, Elaine, Barros, Leticia, Serpa, Suzana, Bianchini, Ticiane, Campanili, Taís, Pantaleao, Paulo Carlos Garcia, Ana Lucia Vitti Ronchini, Rayanne, Santos, Nurulhuda Binti, A Manap, Sean, Bagshaw, Dominic, Carney, Jon, Davidow, Ella, Rokosh, Andréa Maria Laizner, Samantha, Smith, Megan, Mcquirter, Betty Star Kampayana, René, Favre, Martin, Sills, Julie, Dallaire, Cathy, Becker, Sherissa, Microys, Bonnie, Bowes, Jennifer, Lajeunesse, Rishi, Ghosh, Jacqueline, Baptiste-Savoie, Rose, 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Michael, Isanan, Marta, Tubacka, Przemyslaw, Jasiewicz, Miroslaw, Czuczwar, Michal, Borys, Aleksandra, Gutysz-Wojnicka, Lidia, Glinka, Ryszard, Gawda, Jan, Bilawicz, Paula, Cabrita, João, Vieira, Margarida Ferreira Figueiredo, Cristiana Mota Pinheiro, Nelson, Antunes, Laura, Pedro, Fatima, Ferreira, Isabel, Parente, Maria, Varela, Fatima, Fernandes, Claudia, Martins, Abel, Viveiros, Raquel, Cavaco, Clara Santa Rita, Sofia, Dias, Ana Margarida Feranandes, Pedro, Silva, Catarina, Nunes, João, Cabral, Filpe, Pires, Hilaryano, Ferreira, Jacinta, Santos, Vitor Manuel Vaz Pinto, Bruno Miguel Bispo, Amelia, Ferreira, Elena, Molinos, Estevão, Lafuente, Ricardo, Gregorio, Humberto, Costa, Ângela, Lima, Susana, Ferreira, Vanda, Seromenho, Eulália, Luis, Idália, Valerio, Helena, Cesar, Ana, Tavares, Ahmed Subhy Alsheikhly, Saeed, Mahmood, Catalin Traian Guran, Alida, Moise, Daniela Carmen Filipescu, Mihail, Luchian, Mihai, Popescu, Monica Adriana Scutariu, Cristina, Petrisor, Natalia, Hagau, 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Slobodianiuk, Daria, Rabarova, Danca, Lančaričová, Janko, Vlaovic, Matjaž, Groznik, Milica, Lukic, Janja, Perme, Maja, Sostaric, Nejc, Umek, Tomislav, Mirkovic, Simon, Dolenc, Misa, Fister, Nika, Zorko, Andrej, Markota, Nomhle Princess Yeni, Phumele, Jali, Shelley, Schmollgruber, Muhommed Ridwaan Syed, Nivisha, Parag, Robert, Wise, Maria, Galiana, José Alejandro Navarro, Ana María De Pablo, Patricia, Albert, Pilar, Martinez, Yolanda, Mendiara, Barbara, Garcia, Ana Alabart Llinas, Marilyn, Riveiro, Elisabet, Gallart, Alba, Riera, Miquel, Sanz, Swagotika, Salo, Miguel Angel Gimenez Lajara, Montserrat Venturas Nieto, Rosa, Garcia, José Manuel Garcia Pena, Maria Carmen Gorgolas, Maria Aranzazu Isasi, Rafael, Sierra, Federico, Gordo, Isabel, Conejo, Vicent, Salvà-Costa, Carolina, Garzón-Tovar, Sara, Lospitao, Rafael, Gonzalez, Pedro, Gutierrez, Mercè, Girona, Jordi, Adamuz, Pablo Garcia Olivares, José Peral Gutierrez de Ceballos, Celia, Tirado, Irene De Wit, Ana Belén Curto Polo, Maria Del Mar Diaz Salcedo, Javier, Ripolles-Melchor, Eugenio, Martinez-Hurtado, Jorge Duerto Alvarez, María Luisa Bravo Arcas, Juan Ignacio Torres Gonzalez, Ana Belén Sánchez de la Ventana, Pablo Lopez-Arcas Calleja, Raquel Garcia Alvarez, Purificacion Sanchez Zamora, Alvaro Ortega Guerrero, Rosario, Cosano, Jonathan, Perez-Vacas, Margarita, Campos-Perez, Emma Moreno Barreiro, Losune Cano Sanchez, Monica Garcia Diaz, Raquel, Jimenez, Lorena Del Rio Cabajo, Daniel Sancho Muriel, Helena Fernandez Alonso, Ana Wensell Fernández, Isabel Santín Piñan, Guillermo Muñiz Albaiceta, Maria Cristina Iglesias Fernandez, Francisco Javier Saenz Abos, Pablo, Monedero, Ramon Molina Chueca, Lydia Gallego Aguirre, Silvia Call Manosa, Carmen Partera Luque, Neus, Calpe, Monica Recio Losilla, Meritxell Tapia Fores, Olga, Farre, Oscar, Fernandez, M Del Rosario Villar Redondo, Donaldo, S Arteta Arteta, Maria Angeles Hurtado Sanchez, Cristina Paños Espinosa, Laura Martinez Reyes, Laura Claramunt Domenech, Carmen Velasco Guillén, Josep Trenado Alvarez, Mercedes Del Cotillo, Jesus Emilio Barrueco-Francioni, Belen Burgos Conde, Maria Pilar Sogues Blanco, Maria Luisa Blasco, Ana Isabel Clement, Clara, Hurtado, Luz Coronado Sanz, David, Perez-Torres, Estefanía, Prol-Silva, Jorge, Pereira, Iván Areán González, Anastasio Espejo Cano, Cesar Rodriguez Nuñez, Inmaculada Lorenzo Fernadez, Alejandra Azahara Marguello Fernandez, Rosa Del Bosque Diez, Badiola, Hilario, Begoña, Zalba-Etayo, Ana, Pascual-Bielsa, Preveen, Banwarie, Dick, Nahar, Alisha van Axel, Naraindath, N Boedjawan, Erika Backlund Jansson, Ann-Sofie, Malvemyr, Lotta, Johansson, Ulla, Sandberg, Catarina, Tingsvik, Gunilla, Mattsson, Gun, Löf, Martin, Spångfors, Mona, Ringdal, Sebastian, Geijer, Lotti, Orvelius, Mia, Hylen, Caroline, Lagerhäll, Eva, Åkerman, Viveca Hamback Hellkvist, Ulrica, Mickelsson, Ewa, Wahlbom, Ing-Marie, Larsson, Ewa, Wallin, Filippo, Boroli, Solenne, Ory, Margaret Lynn Jong, Alexander, Dullenkopf, Martin, Lang, Yvan, Fleury, Marianne, Maus, Nawfel, Ben-Hamouda, Anne, Fishman, Mei Yu Hsu, Shu Chuan Chang, Konlawij, Trongtratul, Chaiwut, Sawawiboon, Sunthiti, Morakul, Bodin, Khwannimit, Keevan, Singh, Dale, Ventour, Dianne, Figaro-Barclay, Sasha, Sankar-Maharaj, Mhamed Sami Mebazaa, Salma, Kamoun, Souheil, Elatrous, Lamia, Besbes, Fekri, Abroug, Walid, Naija, Youssef Zied Elhechmi, Walid, Sellami, Zied, Hajjej, Takoua, Merhabene, Imen, Talik, Ozlem Ozkan Kuscu, Ozcengiz, Dilek, Avşar, Zerman, Hayriye Cankar Dal, Sema, Turan, Semih, Aydemir, Hakan, Yilmaz, Duygu Kayar Calili, Seval, İzdes, Melike, Cengiz, Ayça, Gümüş, Banu, Taşdemir, Ali, Kağnıcı, Mustafa, Ay, Serap Avcı Ay, Gulbahar, Caliskan, Turkay, Akbas, Abidin Oner Balbay, Serdar, Efe, Volkan, Inal, Gülseren, Elay, Pınar, Karabacak, Boğaç, Özserezli, Evren, Şentürk, Oktay, Demirkiran, Suha, Bozbay, Elif, Erdogan, Mustafa, Akker, Nebia, Peker, Asu, Ozgultekin, Sibel Ocak Serin, Can, Turan, Gulsah, Karaoren, Senay, Goksu, Sait, Karakurt, Huseyin, Arikan, Fethi, Gül, İsmail, Cinel, Iskender, Kara, Hasan Nabi Undar, Yesim Serife Bayraktar, Jale Bengi Çelik, Murat Emre Tokur, Demet Tok Aydin, İsmail, Yildiz, Beysim, Özcan, Başar, Erdivanli, Ahmet, Eroglu, Devrim, Akdağ, Nurdan, Ünlü, Adonis, Dungca, Ashwaq, Ali, Bindu, Thankamma, Paul Eric Reyes, Sini, John, Ajitha, Rajendran, Fatima Kasem El Ahmad, Kathleen Ann Smiley, Susanna, Hojden, Mia Thorning Miller, Vishnu Das Sasidharan Nair, Maria Gracia San Antonio, Khaled Al Qawasmeh, Sabah Abu Shawish, Hilary, Twiggs, Ines, Rosado, Volodymyr, Babych, Faye, Morren, Charlotte, Young, Nicola, Vaughan-Jones, Stephanie, Harris, Karen, Burns, Carmel, Georgiev, Rosina, Shayamano, Ian, Kerslake, Peter, Creber, Ana, Vochin, Catherine, O'Brien, Paul, Caddell, Samantha, Hagan, Mandy, Hughes, Tomasz, Torlinski, James, Sherwin, Santhana, Kannan, Amber, Markham, Richard, Lebon, Jason, Cupitt, Julius, Cranshaw, Nigel, White, Victoria, Marriott, Wendy, Milner, Casiano Barrera Groba, Joao, Azoia, Petra, 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A.S., Goller, S., Afonso, E., Larina, E., Labeau, Sonia O. 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[0000-0003-2145-0345], Apollo - University of Cambridge Repository, Critical Care, Labeau S.O., Afonso E., Benbenishty J., Blackwood B., Boulanger C., Brett S.J., Calvino-Gunther S., Chaboyer W., Coyer F., Deschepper M., Francois G., Honore P.M., Jankovic R., Khanna A.K., Llaurado-Serra M., Lin F., Rose L., Rubulotta F., Saager L., Williams G., Blot S.I., Muzha D., Ribas A.M., Lipovesty F., Loudet C., Eller P., Mostafa N., Telleria V.M., Smajic J., Nogueira P.C., Nafees K.M.K., Hentchoya R., Soledad J., Cardenas Y., Reyes A.G., Sustic A., Mpouzika M., Vymazal T., Jensen H.I., Aguirre-Bermeo H., Maddison L., Valta M., Bloos F., Adipa F.E., Koulouras V., Enamorado J., Agoston Z., Birgisdottir H., Gupta A., Gurjar M., Kilapong B., Hashemian S.M., Martin-Loeches I., Cortegiani A., Fletcher K., Hayashi Y., Waweru-Siika W., Abidi K., Lee S.-M., Hadri B., Dolgusevs M., Abillama F.F., Jovaisa T., Thix C., Elhadi M., Nor B.M., Ratnam S., Mazlan M.Z., Maiyalagan S., Sanchez-Hurtado L., Belii A., 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N.N., Jansson E.B., Malvemyr A.-S., Johansson L., Sandberg U., Tingsvik C., Mattsson G., Lof G., Spangfors M., Ringdal M., Geijer S., Orvelius L., Hylen M., Lagerhall C., Akerman E., Hellkvist V.H., Mickelsson U., Wahlbom E., Larsson I.-M., Wallin E., Boroli F., Ory S., Jong M.L., Dullenkopf A., Lang M., Fleury Y., Maus M., Ben-Hamouda N., Fishman A., Hsu M.Y., Chang S.C., Trongtratul K., Sawawiboon C., Morakul S., Khwannimit B., Singh K., Ventour D., Figaro-Barclay D., Sankar-Maharaj S., Mebazaa M.S., Kamoun S., Elatrous S., Besbes L., Abroug F., Naija W., Elhechmi Y.Z., Sellami W., Hajjej Z., Merhabene T., Talik I., Kuscu O.O., Dilek O., Zerman A., Dal H.C., Turan S., Aydemir S., Yilmaz H., Calili D.K., Izdes S., Cengiz M., Gumus A., Tasdemir B., Kagnici A., Ay M., Ay S.A., Caliskan G., Akbas T., Balbay A.O., Efe S., Inal V., Elay G., Karabacak P., Ozserezli B., Senturk E., Demirkiran O., Bozbay S., Erdogan E., Akker M., Peker N., Ozgultekin A., Serin S.O., Turan C., Karaoren G., Goksu S., Karakurt S., Arikan H., Gul F., Cinel I., Kara I., Undar H.N., Bayraktar Y.S., Celik J.B., Tokur M.E., Aydin D.T., Yildiz I., Ozcan B., Erdivanli B., Eroglu A., Akdag D., Unlu N., Dungca A., Ali A., Thankamma B., Reyes P.E., John S., Rajendran A., Ahmad F.K.E., Smiley K.A., Hojden S., Miller M.T., Das Sasidharan Nair V., Antonio M.G.S., Qawasmeh K.A., Shawish S.A., Twiggs H., Rosado I., Babych V., Morren F., Young C., Vaughan-Jones N., Harris S., Burns K., Georgiev C., Shayamano R., Kerslake I., Creber P., Vochin A., O'Brien C., Caddell P., Hagan S., Hughes M., Torlinski T., Sherwin J., Kannan S., Markham A., Lebon R., Cupitt J., Cranshaw J., White N., Marriott V., Milner W., Groba C.B., Azoia J., Polgarova P., George S., Kapoor R., Lynch C., Fox N., Cranmer K., Llewellym T., Matthews K., Maltby L., Ibao J., Boulton K., Jarman R., Baxter K., Raj A.S., Moghal A., White J., Barrowcliffe S., Pulletz M., Ganeshalingam V., Baruah R., Baker H., Woods J., Ei P.P., Ogbeide V., Hayden P., Hughes J., Balasubramanian M., Salberg A., Saha R., Holmquist D., Derbyshire C., Smith N., Stones E., Ademokun J., Legorburo M.S., North S., Brett C., Jaundoo H., Craig J., Whiteley S., Howcroft C., Wilby L., Delve P., Shaw D., Williams K., Welters I.D., McMullen J., Brett S., Flores L., Trueman-Dawkins T., Templeton M., Adams J., Prowle J., Byers H., McDonnell A., Rose B.O., Reece-Anthony R., Mendes L., Vizcaychipi M., Bull R., Lacaden G., Santiago E., Delgado C.C., Farnell-Ward S., Thorpe E., Somerville J., Williams A., Cummings D., Derrick H., Brumwell S., Randell C., McCann N., Aves E., Berry G., Szakmany T., Gunter U., Pulak P., Sarkar N., Wright K., Gomes V., Jones J., Palfrey R., Camsooksai J., Lewis A., Eneas A., Tridente A., Barr L., Thomas B., Parkin E., Horner D., Frey C., Bench S., Baumber R., Broadhurst P., Jackson M., Williams L., Clark M., Paddle J., Bean S., Buckley S., Palfreeman C., Liu S., Allison N., Attwood B., Parsons P., Houghton V., Turner S.J., Higgins D., Bielskute E., Horrigan N., Jacob R., Habgood K., Zaki A., Collins A., Lord J., Ramiro C., Kubisz-Pudelko A., Kotze M., Williams H., Iovenko I., Tsarev A., Briva A., Mendez G., Napolitano L., Teig M., Rodriguez G.E., Ben-Jacob T., Potestio C., Eng T., Mahanes D., Khanna A., Duggal A., Nananmori M., Lois M., Karamchandani K., Bealer C., Barefield C., Terry D., Fivecoat P., Idowu O., Cata J., Clesi T., Peterson J., Hatton K., Dhaliwal J., Mueller D., Tao J., Eltorai A.S., Pastores S.M., Remor N., Salazar J., Barkas D., Joffe A., Barnes C., Sona C., Schallom M., Short J., Lorenzo J., Von Der Osten I., Borkowska M., Demarre L., Pleitinckx V., Xing C., Debue A.-S., Goller S., Larina E., Labeau, S. O., Blackwood, B., Brett, S. J., Deschepper, M., Francois, G., Honore, P. M., Khanna, A. K., Williams, G., Blot, S. I., Ribas, A. M., Telleria, V. M., Nogueira, P. C., Nafees, K. M. K., Reyes, A. G., Jensen, H. I., Adipa, F. E., Agoston, Z., Hashemian, S. M., Lee, S. -M., Abillama, F. F., Nor, B. M., Mazlan, M. Z., Sanchez-Hurtado, L., De lange, D., Ilesanmi, R. E., Ffarcsi, M. H., Hernandez, A. M., Schefold, J. C., Besbes, L. O., Minope, J. T. S., Rostello, O. F., Bartoli, J. R., Nocheretti, M. G., Escalante, R. G., Loudet, C. I., Gonzalez, A. L., Alvarez, G. A., Campos, P. A., Fonseca, I. P., Alvarez, G. M., Bascary, C. A., del Valle Gimenez, G., Bertoletti, F. P., Bonsignore, P. J. M., Fernandez, M. A., Leslie, G. D., Mclucas, A., Jacquet, L. -M., de Almeida, A. O., Jorge, S. A., Schmidt, R. C., Garcia, P. C., Ronchini, A. L. V., Manap, N. B. A., Laizner, A. M., Mcquirter, M., Kampayana, B. S., Sepulveda, M. I., Zamorano, M. J. F., Zhao, R. H., Hu, L. P., Jiao, Q. F., Wang, H. Y., Xia, C. J., Insu, L., Zhu, J. Y., Zhu, J. F., Huang, R. F., Wang, L. L., Song, J. H., Liu, X. M., Li, Z. S., Li, L. C., Zeng, J. M., Hu, X. C., Wang, R. X., Tak, P. S., Ho, S. W., Jiang, Q. X., Huang, L. P., Liu, X. L., Jiang, J. H., Gong, Y. Y., Lei, D. H., Bi, A. P., Zhao, H. M., Cao, Z. Q., Wu, S. F., Tian, X. F., Feng, Z. X., Liu, X. Z., Jiang, Z. X., Wang, G. X., Hu, R. L., Li, X. Q., Yu, Z. J., Yang, Y. X., Gama, L. M. S., Hernandez, J. S., Ochoa, M. -E., Reyes, A. J. G., Filipovic-Grcic, I., Vukovic, A., Pecenkovic, S., Suput, A., Radivojevic, R. C., Culjak, H., Adam, V. N., Pedersen, K. R., Kjaergard, I. E., Kodal, A. M., Hansen, T. C. B., Pedersen, A. S. B., Thomsen, T. D., Frandsen, T. M., Bliksted, I. A., Tamayo, L. M., Tutillo, D. R. M., Hurtado, C. V., Garcia, M. F., Kutimets, M., Lofqvist, C., Sakki, J. -K., Valta, M. A., Plantefeve, G., Deserts, M. D., Gunther, S. C., Timsit, J. -F., Farkas, J. -C., Bosl, K., Schuppel, S., Stubner, A., Osei, I. P., Kusi-Appiah, A. -C., Yakubu, Y. H., Patsiou, E. -C., Stalika, K. M. M., Enamorado, J. E., Jonasdottir, R. J., Lestari, M. I., Finn, D. O. C. R., Mcpherson, S., Ghioldi, D. M., Bruno, A. V., Maggiore, S. M., Volta, C. A., Taibi, M. R., Tranello, F. P., Giusti, G. D., Martin, M. A., Correia, M. C., Kim, J. H., Kim, K. C., Bae, J. -M., Park, S. Y., Park, T. S., Lee, H. B., Kim, S. C., Chee, H. K., Huh, J. W., Sim, Y. S., Ahn, J. -J., Kang, B. J., Lee, W. -Y., Lee, S. J., Feghaly, M. E., Belkhair, W. A., Tababa, O. W. E., Alkhumsi, S. I. R., Alshrif, A. I., Aboufray, A. A., Triki, A. R., Zahra, H. B., Al-Alawi, M. M. S., Ghula, M. A. A., Bahrin, L. K. K., Deva, S. R., Rahim, A. H. A., Hassan, W. N. W., Ismail, W. N. W., Ali, M. N., Khoo, T. M., Samat, N. M., Tong, J. M. G., Adib, N. A. N., Nor, M. B. M., Sulaiman, S. R., Foong, K. W., Hua, N. P., Zermeno, J. M., Nava, C. L. L., Nandyelly, S. J. R., Sanchez-Hurtado, L. A., Nava, L. P. A., Herrera, J. G., de Anda, G. F. V., Namendys-Silva, S. A., Romero-Gonzalez, J. P., Sosa, M. A., de Molina Serrano, J. I. R., Iburrigarro, S. R., Padilla, N. R. C., Pineda, A. A. V., Villafuerte, M. V. E., Herrera, M. O. G., Subedi, N. B., Pathak, S. D., Vermeijden, J. W., Gerritsen, R. T., Fijen, J. -W., Adejumo, P. O., Sankey, B. J., Olsen, B. F., Jensen, K. D., Johansen, B. F., Finnstrom, I. J., Skorstad, E. M., Lunde, G. A., Akselsen, G. R., Monstad, K. R., Hogvall, L., Malmin, S. K., Andersen, M. H., Hargott, R. F., de Jesus Ortiz, A., Cabral, D. M. B., Rivas, J. C., Moreira, M. L., Ellazar, C. G., Cerezo, F. D., Palo, J. E., Aperocho, C. A. J., Figueiredo, M. F., Pinheiro, C. M., Rita, C. S., Feranandes, A. M., Pinto, V. M. V., Bispo, B. M., Lima, A., Alsheikhly, A. S., Guran, C. T., Filipescu, D. C., Scutariu, M. A., Ebaid, M. S., Velickovic, D., Rajkovic, M., Stanojevic, M., Turcan, A., Lancaricova, D., Yeni, N. P., Syed, M. R., Navarro, J. A., De Pablo, A. M., Llinas, A. A., Lajara, M. A. G., Nieto, M. V., Pena, J. M. G., Gorgolas, M. C., Isasi, M. A., Salva-Costa, V., Garzon-Tovar, C., Olivares, P. G., de Ceballos, J. P. G., Polo, A. B. C., del Mar Diaz Salcedo, M., Alvarez, J. D., Arcas, M. L. B., Gonzalez, J. I. T., de la Ventana, A. B. S., Calleja, P. L. -A., Alvarez, R. G., Zamora, P. S., Guerrero, A. O., Barreiro, E. M., Sanchez, L. C., Diaz, M. G., Muriel, D. S., Alonso, H. F., Fernandez, A. W., Pinan, I. S., Albaiceta, G. M., Fernandez, M. C. I., Abos, F. J. S., Chueca, R. M., Aguirre, L. G., Manosa, S. C., Luque, C. P., Losilla, M. R., Fores, M. T., del Rosario Villar Redondo, M., Arteta Arteta, D. S., Sanchez, M. A. H., Espinosa, C. P., Reyes, L. M., Domenech, L. C., Guillen, C. V., Alvarez, J. T., del Cotillo, M., Barrueco-Francioni, J. E., Conde, B. B., Blanco, M. P. S., Blasco, M. L., Clement, A. I., Sanz, L. C., Gonzalez, I. A., Cano, A. E., Nunez, C. R., Fernadez, I. L., Fernandez, A. A. M., Boedjawan, N. N., Jansson, E. B., Malvemyr, A. -S., Lof, G., Spangfors, M., Lagerhall, C., Akerman, E., Hellkvist, V. H., Larsson, I. -M., Jong, M. L., Hsu, M. Y., Chang, S. C., Mebazaa, M. S., Elhechmi, Y. Z., Kuscu, O. O., Dal, H. C., Calili, D. K., Izdes, S., Gumus, A., Tasdemir, B., Kagnici, A., Ay, S. A., Balbay, A. O., Ozserezli, B., Senturk, E., Serin, S. O., Gul, F., Cinel, I., Undar, H. N., Bayraktar, Y. S., Celik, J. B., Tokur, M. E., Aydin, D. T., Yildiz, I., Ozcan, B., Akdag, D., Unlu, N., Reyes, P. E., Ahmad, F. K. E., Smiley, K. A., Miller, M. T., Antonio, M. G. S., Qawasmeh, K. A., Shawish, S. A., Groba, C. B., Raj, A. S., Ei, P. P., Legorburo, M. S., Welters, I. D., Mcmullen, J., Mcdonnell, A., Rose, B. O., Delgado, C. C., Mccann, N., Turner, S. J., Rodriguez, G. E., Eltorai, A. S., Pastores, S. M., Demarre, L., and Debue, A. -S.
Subjects: Male, Original, medicine.medical_treatment, artificial, Critical Care and Intensive Care Medicine, Medical and Health Sciences, Pressure ulcer, law.invention, Decubitus epidemiology, ICU, Morbidity, Mortality, Outcome, Pressure injury, Risk factors, Adult, Aged, Hospital Mortality, Humans, Patient Discharge, Prevalence, Risk Factors, Intensive Care Units, Respiration, Artificial, 0302 clinical medicine, decubitus epidemiology, pressure injury, pressure ulcer, outcome, risk factors, morbidity, mortality, law, Medicine and Health Sciences, adults, Medicine, Simplified Acute Physiology Score, icu, ziekenhuissterfte, Immunodeficiency, intensive care, European Society of Intensive Care Medicine (ESICM) Trials Group Collaborators, mannen, volwassenen, COST, Intensive care unit, STATE, ULCERS, Underweight, medicine.symptom, Life Sciences & Biomedicine, Human, medicine.medical_specialty, risicofactoren, Decubitus epidemiology, ICU, Pressure injury, Pressure ulcer, Outcome, Risk factors, Morbidity, Mortality, pressure injuries, Intensive Care Unit, prevalentie, NO, 1117 Public Health and Health Services, DecubICUs Study Team, 03 medical and health sciences, Critical Care Medicine, Anesthesiology, General & Internal Medicine, Health Sciences, ouderen, Mechanical ventilation, Science & Technology, business.industry, decubitus, Risk Factor, 030208 emergency & critical care medicine, 1103 Clinical Sciences, Odds ratio, medicine.disease, Emergency & Critical Care Medicine, Confidence interval, 030228 respiratory system, Emergency medicine, kunstmatige ademhaling, RISK-FACTORS, business, respiration
Abstract: Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347, Funder: Flemish Society for Critical Care Nurses, Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score < 19, ICU stay > 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat.
Published: 2021
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13. Excess Mortality Among Hospitalized Patients With Hypopituitarism—A Population-Based, Matched-Cohort Study

Author: Beat Mueller, Timo Siepmann, Emanuel Christ, Fahim Ebrahimi, Mirjam Christ-Crain, Alexander Kutz, Philipp Schuetz, Ulrich Wagner, and Ben Min-Woo Illigens
Subjects: Male, medicine.medical_specialty, Pediatrics, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, 030209 endocrinology & metabolism, Context (language use), Hypopituitarism, Biochemistry, law.invention, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, law, Internal medicine, Humans, Medicine, Hospital Mortality, 030212 general & internal medicine, Aged, Excess mortality, Inpatients, business.industry, Patient-centered outcomes, Biochemistry (medical), Odds ratio, Length of Stay, Middle Aged, medicine.disease, Intensive care unit, 3. Good health, Hospitalization, Survival Rate, Intensive Care Units, Cohort, Diabetes insipidus, Female, business, Diabetes Insipidus
Abstract: Context Patients with hypopituitarism face excess mortality in the long-term outpatient setting. However, associations of pituitary dysfunction with outcomes in acutely hospitalized patients are lacking. Objective The objective of this work is to assess clinical outcomes of hospitalized patients with hypopituitarism with or without diabetes insipidus (DI). Design, Setting, and Patients In this population-based, matched-cohort study from 2012 to 2017, hospitalized adult patients with a history of hypopituitarism were 1:1 propensity score–matched with a general medical inpatient cohort. Main Outcome Measures The primary outcome was in-hospital mortality. Secondary outcomes included all-cause readmission rates within 30 days and 1 year, intensive care unit (ICU) admission rates, and length of hospital stay. Results After matching, 6764 cases were included in the study. In total, 3382 patients had hypopituitarism and of those 807 (24%) suffered from DI. All-cause in-hospital mortality occurred in 198 (5.9%) of patients with hypopituitarism and in 164 (4.9%) of matched controls (odds ratio [OR] 1.32, [95% CI, 1.06-1.65], P = .013). Increased mortality was primarily observed in patients with DI (OR 3.69 [95% CI, 2.44-5.58], P Conclusions Patients with hypopituitarism are highly vulnerable once hospitalized for acute medical conditions with increased risk of mortality and adverse clinical outcomes. This was most pronounced among those with DI.
Published: 2020
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14. Deep Learning for Stock Market Index Price Movement Forecasting Using Improved Technical Analysis

Author: Bikramaditya Ghosh, Chinthakunta Manjunath, Balamurugan Marimuthu, and Christ
Subjects: General Computer Science, Computer science, Movement (music), business.industry, Deep learning, Technical analysis, General Engineering, Econometrics, Artificial intelligence, business, Stock market index
Published: 2021
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15. Optimization of the Health and Safety Protocol for Covid-19 through the use of the QR Code in the Tailing Disposal System Project, Quellaveco - Moquegua, 2020

Author: Barriga Paria Christ Jesus and Cristobal Coaguila Berly David
Subjects: Protocol (science), Structure (mathematical logic), Software, Work (electrical), Operations research, Covariance matrix, business.industry, Computer science, General Engineering, business, Occupational safety and health, Selection (genetic algorithm), Curse of dimensionality
Abstract: The purpose of this research work is to optimize the occupational health and safety protocol by increasing distancing and mitigating physical contact to prevent the spread of Covid-19, using QR catches to identify personnel. Contrasting the sanitary measures to protect the health and integrity of the personnel of the operations area of the Tailing Disposal System -Quellaveco project. For the study of the database, factor analysis is used as a multivalent statistical method, with this method the number of 997 daily reports was analyzed, addressing the study of the structure of correlations between a large number of variables, factor analysis assists in the selection of a representative subgroup of variables and creates new variables called factors, when performing the analysis and treatment of 24 variables with the SPSS 25 software, the variables with the correlation matrix were reduced to 13, and with the total variance explained, a matrix different from that of identity was defined, reducing the dimensionality of the problem from 13 to 5 factors.
Published: 2021
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16. Loss of statin treatment years during pregnancy and breastfeeding periods in women with familial hypercholesterolemia

Author: Kjetil Retterstøl, Anders Hovland, Christ Berge, Kirsten B. Holven, Jeanine E. Roeters van Lennep, Martin Prøven Bogsrud, Tone Svilaas, Marianne Klevmoen, Elisabeth Kleivhaug Vesterbekkmo, and Internal Medicine
Subjects: Adult, Male, Pediatrics, medicine.medical_specialty, Statin, medicine.drug_class, Breastfeeding, Norwegian, Familial hypercholesterolemia, Hyperlipoproteinemia Type II, Pregnancy, medicine, Humans, Child, business.industry, Norway, Statin treatment, medicine.disease, language.human_language, Breast Feeding, Cross-Sectional Studies, language, Female, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Cardiology and Cardiovascular Medicine, business
Abstract: Background and aims: Women with heterozygous familial hypercholesterolemia (FH) are recommended to initiate statin treatment at the same age as men (from 8 to 10 years of age). However, statins are contraindicated when pregnancy is planned, during pregnancy and breastfeeding. The aim of the study was to determine the duration of pregnancy-related off-statin periods and breastfeeding in FH women. Methods: A cross-sectional study using an anonymous online self-administered questionnaire was conducted. Women with FH were recruited through Lipid Clinics in Norway and Netherlands and national FH patient organizations. Results: 102 women with FH (n = 70 Norwegian and n = 32 Dutch) were included in the analysis. Total length of pregnancy-related off-statin periods was estimated for 80 women where data were available, and was median (min-max) 2.3 (0–14.2) years. Lost statin treatment time was estimated for 67 women where data were available, and was median (min-max) 18 (0–100)% at mean (SD) age of 31 (4.3) years at last pregnancy. More women breastfed in Norway (83%) and for longer time [8.5 [1-42] months] compared to the Netherlands [63%, p = 0.03; 3.6 (0–14) months, p < 0.001]. Eighty-six percent of the women reported need for more information on pregnancy and breastfeeding in relation to FH. Conclusions: Young FH women lose years of treatment when discontinuing statins in relation to pregnancy and breastfeeding periods and should be closely followed up to minimize the duration of these off-statin periods. Whether these periods of interrupted treatment increase the cardiovascular risk in FH women needs to be further elucidated.
Published: 2021

17. Síndrome da cauda equina em cão e tratamento cirúrgico para descompressão e estabilização lombossacra / Cauda equina syndrome in dog and surgical treatment for decompression and lombossacra stabilization

Author: Luciana Hugue de Souza Zat, Aquiles Frare Muraro, and Quezia Silva Christ
Subjects: Marketing, Pharmacology, Organizational Behavior and Human Resource Management, medicine.medical_specialty, Decompression, business.industry, Strategy and Management, Pharmaceutical Science, Cauda equina, Cauda equina syndrome, medicine.disease, Surgery, medicine.anatomical_structure, Drug Discovery, medicine, Surgical treatment, business
Published: 2021
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18. Effect of physical fatigue and smoking cigarettes on the CPR effectiveness performed by soldiers

Author: Joanna Pieczyńska and Beata Zysiak-Christ
Subjects: Emergency Medical Services, medicine.medical_specialty, business.industry, medicine.medical_treatment, education, Physical fitness, Context (language use), Critical Care and Intensive Care Medicine, Affect (psychology), Physical Fatigue, Emergency Medicine, Physical therapy, Medicine, Cpr quality, Cardiopulmonary resuscitation, business, Body mass index, health care economics and organizations, Performance quality
Abstract: INTRODUCTION: The witness of the event plays an important role in the diagnosis of cardiac arrest in the victim. Taking quick actions to restore basic life functions is the essence of pre-hospital assistance, and this applies not only to civilian conditions but also to combat operations. During extraordinary occurrences and civil-military cooperation, the soldier’s physical fitness and the ability to perform cardiopulmonary resuscitation effectively give a better chance to save the cardiac arrest victim’s life. The study aimed to assess the quality of cardiopulmonary resuscitation (CPR) performed by soldiers before and after physical activity, taking account of smoking by the examined persons. MATERIAL AND METHODS: Fifty-four soldiers took part in the study. The assessment included a 2-minute CPR performance by the soldier before and after physical activity in the Tactical Field Care zone. The Little Anne phantom was used to record CPR quality. Among the examined soldiers, 20% were active smokers. RESULTS: The research showed that the average CPR effectiveness before exercise was significantly higher than after combat operations (75% vs. 73%). The research also demonstrated that, physical fatigue significantly reduced the rate of chest compressions and the percentage of full chest recoil during CPR. Smoking had no significant effect on the quality of CPR performance. The quality of performance of the CPR components correlated with Body Mass Index (BMI), age, and time since the last training completion. CONCLUSIONS: The quality of CPR performance after combat exercise is lower than before the physical fatigue. While smoking does not affect CPR performance quality, other factors such as BMI, age, and time since the last training completion are relevant in this context.
Published: 2021
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19. Is there an association between the plasma levels of uremic toxins from gut microbiota and anemia in patients on hemodialysis?

Author: Natália A. Borges, Jean Christ Cédras Capo-Chichi, Drielly Cristhiny Mendes de Vargas Reis, Lia S. Nakao, and Denise Mafra
Subjects: Nephrology, medicine.medical_specialty, Creatinine, medicine.diagnostic_test, business.industry, Anemia, Urology, medicine.medical_treatment, Hematocrit, medicine.disease, Gastroenterology, chemistry.chemical_compound, chemistry, Erythropoietin, Internal medicine, Medicine, Hemodialysis, Hemoglobin, business, medicine.drug, Kidney disease
Abstract: Anemia is one of the most frequent complications in patients with chronic kidney disease (CKD). Despite being multifactorial, the relative or absolute deficiency of erythropoietin production is the leading cause. Recent studies have shown that uremic toxins produced by the gut microbiota also may play a role in the genesis of anemia in these patients. To evaluate the possible association between uremic toxins plasma levels and anemia in patients with CKD on hemodialysis (HD). This cross-sectional study evaluated one hundred fifty-four patients (53.2% men, 51.2 ± 11.2 years, hemoglobin (Hb) levels of 11.2 ± 1.6 g/dL). Biochemical variables such as urea, creatinine, hemoglobin, hematocrit, were measured according to standard methods and uremic toxins such as indoxyl sulfate (IS), indole-3-acetic acid (IAA), p-cresyl sulfate (p-CS) plasma levels were measured by reverse-phase high-performance liquid chromatography (RP-HPLC). The levels of uremic toxins such as IS, IAA, p-CS were increased in all patients. However, no correlation was found between uremic toxins plasma levels and anemia parameters. Only patients with Hb
Published: 2021
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20. Impact of Sodium Levels on Functional Outcomes in Patients With Stroke – A Swiss Stroke Registry Analysis

Author: Henrik Gensicke, Benjamin Wagner, Patrick R. Wright, Laura Potasso, Leo H. Bonati, Andrea Wiencierz, Tolga Dittrich, Mirjam Christ-Crain, Gian Marco De Marchis, Alexandros A Polymeris, and Julie Refardt
Subjects: Male, medicine.medical_specialty, Stroke registry, Time Factors, Endocrinology, Diabetes and Metabolism, Clinical Biochemistry, Context (language use), Biochemistry, Disability Evaluation, Patient Admission, Endocrinology, Risk Factors, Modified Rankin Scale, Informed consent, Internal medicine, medicine, Humans, In patient, Prospective Studies, Registries, Prospective cohort study, Stroke, Aged, Aged, 80 and over, business.industry, Sodium, Biochemistry (medical), Middle Aged, medicine.disease, Patient Discharge, Treatment Outcome, Female, Hyponatremia, business, Switzerland
Abstract: Context Correction of hyponatremia might represent an additional treatment for improving stroke patients’ clinical outcomes. Objective Admission hyponatremia is associated with worse clinical outcome in stroke patients, but whether normalization of hyponatremia improves outcome is unknown. We investigated whether normalization of hyponatremia affects patients’ disability, mortality, and stroke recurrence within 3 months; length of hospitalization; and discharge destination. Design This was a registry-based analysis of data collected between January 2016 and December 2018. We linked data from Swiss Stroke Registry (SSR) with electronic patients’ records for extracting sodium values. Setting We analyzed data of hospitalized patients treated at University Hospital of Basel. Patients Stroke patients whose data and informed consent were available. Main outcome measure Modified Rankin Scale (mRS) score at 3 months. The tested hypothesis was formulated after SSR data collection but before linkage with electronic patients’ records. Results Of 1995 patients, 144 (7.2%) had hyponatremia on admission; 102 (70.8%) reached normonatremia, and 42 (29.2%) remained hyponatremic at discharge. An increase of initial sodium was associated with better functional outcome at 3 months (odds ratio [OR] 0.94; 95% CI, 0.90-0.99, for a shift to higher mRS per 1 mmol/L sodium increase). Compared with normonatremic patients, patients who remained hyponatremic at discharge had a worse functional outcome at 3 months (odds ratio 2.46; 95% CI, 1.20-5.03, for a shift to higher mRS). No effect was found on mortality, recurrence, or length of hospitalization. Conclusions In hospitalized acute stroke patients, persistent hyponatremia is associated with worse functional outcome. Whether active correction of hyponatremia improves outcome remains to be determined in prospective studies.
Published: 2021
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21. Duration of antibiotic treatment using procalcitonin-guided treatment algorithms in older patients

Author: Philipp Schuetz, Gaëtan Gavazzi, Rodrigo Octavio Deliberato, Eva Heilmann, Lila Bouadma, Jin-Xiang Wang, Tobias Welte, Florence Tubach, Albertus Beishuizen, Stefan Schroeder, Yahya Shehabi, Konrad Reinhart, Jos A H van Oers, Alessia Verduri, Angela Branche, Stella Sala Soares Lima, Sabine Drevet, Armand R. J. Girbes, Vandack Nobre, Claudia Gregoriano, Kristina B. Kristoffersen, Jean Chastre, Mirjam Christ-Crain, Long Wei, Maarten W. N. Nijsten, Michael Tamm, Caspar Corti, Carolina F. Oliveira, Djillali Annane, Evelien de Jong, Michel Wolff, Charles-Edouard Luyt, Pierre Damas, Beat Mueller, Daiana Stolz, Nathalie Layios, Dylan W. de Lange, and Matthias Briel
Subjects: Aging, medicine.medical_specialty, medicine.drug_class, Antibiotics, antibiotic stewardship, Procalcitonin, law.invention, 03 medical and health sciences, AcademicSubjects/MED00280, 0302 clinical medicine, Randomized controlled trial, Older patients, law, Internal medicine, medicine, Clinical endpoint, Humans, Blood culture, 030212 general & internal medicine, Aged, Randomized Controlled Trials as Topic, medicine.diagnostic_test, business.industry, 030208 emergency & critical care medicine, General Medicine, older patients, Confidence interval, Anti-Bacterial Agents, Intensive Care Units, age, Meta-analysis, Systematic Review, Geriatrics and Gerontology, business, ageing/15, Algorithms, procalcitonin
Abstract: Background Older patients have a less pronounced immune response to infection, which may also influence infection biomarkers. There is currently insufficient data regarding clinical effects of procalcitonin (PCT) to guide antibiotic treatment in older patients. Objective and design We performed an individual patient data meta-analysis to investigate the association of age on effects of PCT-guided antibiotic stewardship regarding antibiotic use and outcome. Subjects and methods We had access to 9,421 individual infection patients from 28 randomized controlled trials comparing PCT-guided antibiotic therapy (intervention group) or standard care. We stratified patients according to age in four groups (85 years [n = 505]). The primary endpoint was the duration of antibiotic treatment and the secondary endpoints were 30-day mortality and length of stay. Results Compared to control patients, mean duration of antibiotic therapy in PCT-guided patients was significantly reduced by 24, 22, 26 and 24% in the four age groups corresponding to adjusted differences in antibiotic days of −1.99 (95% confidence interval [CI] −2.36 to −1.62), −1.98 (95% CI −2.94 to −1.02), −2.20 (95% CI −3.15 to −1.25) and − 2.10 (95% CI −3.29 to −0.91) with no differences among age groups. There was no increase in the risk for mortality in any of the age groups. Effects were similar in subgroups by infection type, blood culture result and clinical setting (P interaction >0.05). Conclusions This large individual patient data meta-analysis confirms that, similar to younger patients, PCT-guided antibiotic treatment in older patients is associated with significantly reduced antibiotic exposures and no increase in mortality.
Published: 2021
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22. Distal femoral replacement – Cemented or cementless? Current concepts and review of the literature

Author: Francis J. Hornicek, Nicola Fabbri, and Alexander B. Christ
Subjects: 030222 orthopedics, medicine.medical_specialty, business.industry, Tumor resection, Aseptic loosening, Patient survival, medicine.disease, Article, Surgery, Metastatic carcinoma, Clinical Practice, 03 medical and health sciences, Fixation (surgical), 0302 clinical medicine, medicine, Orthopedics and Sports Medicine, 030212 general & internal medicine, Sarcoma, Implant, business
Abstract: Distal femoral endoprosthetic replacement has been successfully used to reconstruct distal femoral defects after tumor resection for over four decades. Despite continued advances, aseptic loosening continues to be the most common failure mode after infection. Debate still exists about a variety of design features and the optimal fixation method remains controversial. To date, no large-scale study or meta-analysis has demonstrated the superiority of one fixation technique over another. While the classic dichotomy of cemented versus cementless stems is well-known, the contemporary surgeon needs to fully understand the optimal clinical setting for each type of fixation technique and additional strategies to maximize implant stability. In clinical practice, the choice of fixation must be tailored to the individual patient. The surgeon must consider whether the operation is being performed for primary sarcoma or metastatic carcinoma, the presence of distant metastases, age, comorbidities, and whether radiotherapy has been previously given or will be required at the site of fixation. The best strategy for each patient optimizes tumor control and appropriately weighs risks of fixation failure versus the expected patient survival. This review will explore cemented and uncemented distal femoral replacement and highlight modern concepts to optimize each technique.
Published: 2021
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23. Tissue-resident macrophages mediate neutrophil recruitment and kidney injury in shiga toxin-induced hemolytic uremic syndrome

Author: Camille Soun, Stephanie Thiebes, Barbara Sitek, Denise Zwanziger, Judith-Mira Pohl, Julia K. Lill, Franziska Hoffmann, Oliver Hofnagel, Daniel R. Engel, Jenny Bottek, Ferdinand von Eggeling, Faikah Gueler, Robin Christ, Michael J. Hickey, Nirojah Subramaniam, and Thilo Bracht
Subjects: 0301 basic medicine, Chemokine, Population, Medizin, 030232 urology & nephrology, Kidney, Shiga Toxin, Mice, 03 medical and health sciences, 0302 clinical medicine, Escherichia coli, medicine, Animals, education, education.field_of_study, biology, business.industry, Macrophages, Shiga toxin, medicine.disease, CXCL1, CXCL2, 030104 developmental biology, medicine.anatomical_structure, Neutrophil Infiltration, Nephrology, Hemolytic-Uremic Syndrome, Immunology, biology.protein, Tumor necrosis factor alpha, business, Kidney disease
Abstract: Enterohaemorrhagic E. coli cause major epidemics worldwide with significant organ damage and very high percentages of death. Due to the ability of enterohaemorrhagic E. coli to produce shiga toxin these bacteria damage the kidney leading to the hemolytic uremic syndrome. A therapy against this serious kidney disease has not been developed yet and the impact and mechanism of leukocyte activation and recruitment are unclear. Tissue-resident macrophages represent the main leukocyte population in the healthy kidney, but the role of this important cell population in shiga toxin-producing E. coli-hemolytic uremic syndrome is incompletely understood. Using state of the art microscopy and mass spectrometry imaging, our preclinical study demonstrated a phenotypic and functional switch of tissue-resident macrophages after disease induction in mice. Kidney macrophages produced the inflammatory molecule TNFα and depletion of tissue-resident macrophages via the CSF1 receptor abolished TNFα levels in the kidney and significantly diminished disease severity. Furthermore, macrophage depletion did not only attenuate endothelial damage and thrombocytopenia, but also activation of thrombocytes and neutrophils. Moreover, we observed that neutrophils infiltrated the kidney cortex and depletion of macrophages significantly reduced the recruitment of neutrophils and expression of the neutrophil-attracting chemokines CXCL1 and CXCL2. Intravital microscopy revealed that inhibition of CXCR2, the receptor for CXCL1 and CXCL2, significantly reduced the infiltration of neutrophils and reduced kidney injury. Thus, our study shows activation of tissue-resident macrophages during shiga toxin-producing E. coli-hemolytic uremic syndrome leading to the production of disease-promoting TNFα and CXCR2-dependent recruitment of neutrophils.
Published: 2021
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24. Is There a Relationship between County-Level Food Insecurity Rates and Breast Cancer Stage at Diagnosis?

Author: Chinedum O. Ojinnaka, Meg Bruening, and Jaclyn Christ
Subjects: Adult, Cancer Research, Nutrition and Dietetics, business.industry, Psychological intervention, Medicine (miscellaneous), Breast Neoplasms, Bivariate analysis, Middle Aged, medicine.disease, Food insecurity, Food Insecurity, Breast cancer, Oncology, Quartile, medicine, Surveillance, Epidemiology, and End Results, Humans, Female, County level, business, Poverty, Stage at diagnosis, Aged, Demography
Abstract: The relationship between county food insecurity (FI) rate and breast cancer stage at diagnosis is not clear. Using 2010-2016 Surveillance Epidemiology and End Results (SEER) and Feeding America data we analyzed the association between county FI rate in quartiles (low, medium, high, very high) and breast cancer stage at diagnosis among adult females (≥18 years). We also analyzed the effect of insurance status and county poverty level on this relationship, and whether this relationship varies among non-elderly (
Published: 2021
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25. THE IMPLEMENTATION OF GAMIFICATION CONCEPT INSIDE ONLINE CLASSROOM ACTIVITIES TO PROMOTE STUDENTS’ ENGAGEMENT

Author: Feryan Christ Jonathan and Michael Recard
Subjects: Government, Coronavirus disease 2019 (COVID-19), Computer science, business.industry, Online learning, Public relations, business
Abstract: Online learning has made massive development nowadays. Due to the spread of Covid-19, the government made a policy to prohibit physical meetings in schools. However, this new policy caused a problem of engagement in online learning. During the lesson, students are giving slow and minimum responses to the teacher’s instruction. This happens in most of the school that operates online learning. Therefore, a solution to improve engagement in online classroom is needed. The implementation of the gamification concept is one of the great alternatives. The implementation of this concept has reaped positive results from various fields, including education. With the right application, this method can be a powerful tool to teach in online learning.
Published: 2021
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26. Reflection Properties of the Human Skin From 40 to 110 GHz: A Confirmation Study

Author: Andreas Christ, Theodoros Samaras, Adrian Aeschbacher, Niels Kuster, Bernadetta Tarigan, and Fereshteh Rouholahnejad
Subjects: Male, Absorption (acoustics), Materials science, Physiology, Biophysics, Impedance matching, Human skin, Imaging phantom, law.invention, Optics, law, Humans, Radiology, Nuclear Medicine and imaging, Radiometry, Bioelectromagnetics, Skin, Phantoms, Imaging, business.industry, General Medicine, Models, Theoretical, body regions, Reflection (physics), Electromagnetic reflection, Female, business, Electromagnetic Phenomena, Waveguide
Abstract: Several recent theoretical dosimetric studies above 6 GHz apply generic layered skin models. For this frequency range, new experimental phantoms for over-the-air performance of wireless devices were proposed that simulate the impedance matching effects of the stratum corneum layer (SCL) with a low-loss coating layer. The aim of this study was to verify the skin models by comparing their reflection coefficients S11 with measurements of 37 human volunteers (21 males, 16 females, 5-80 years) at 21 body locations (10 at palm, 11 at arm/face) with different SCL thicknesses, using waveguides covering frequencies from 40 to 110 GHz. Such measurements were also carried out with the phantom material. The statistical analysis showed strong evidence that S11 depends on the SCL thickness and no evidence that S11 depends on sex. The measured S11 values for thin and thick skin can be represented by SCL layers of 15 and 140 μm, respectively. These values correspond well to the assumptions of previous studies. (The cohort did not include volunteers doing heavy manual work.) The phantom material mimics the matching effect of the SCL with deviations from the waveguide measurements of less than 0.85 dB (22%), which confirms the suitability of layered phantoms to represent the electromagnetic reflection/absorption of human skin. © 2021 Bioelectromagnetics Society.
Published: 2021
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27. ENDOCRINOLOGY IN THE TIME OF COVID-19-2021 UPDATES: The management of diabetes insipidus and hyponatraemia

Author: Mirjam Christ-Crain, John A.H. Wass, Mark Sherlock, Christopher J. Thompson, and Ewout J. Hoorn
Subjects: medicine.medical_specialty, Consensus, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, History, 21st Century, Severity of Illness Index, Distance Counseling, Thirst, Endocrinology, Internal medicine, Severity of illness, medicine, Ambulatory Care, Humans, Practice Patterns, Physicians', Desmopressin, Expert Testimony, Pandemics, business.industry, SARS-CoV-2, Acute kidney injury, COVID-19, General Medicine, medicine.disease, Clinical Practice Guidance, Telemedicine, Hospitalization, Diabetes insipidus, medicine.symptom, business, Hyponatremia, Complication, Fluid replacement, Diabetes Insipidus, medicine.drug
Abstract: COVID-19 has changed the nature of medical consultations, emphasizing virtual patient counselling, with relevance for patients with diabetes insipidus (DI) or hyponatraemia. The main complication of desmopressin treatment in DI is dilutional hyponatraemia. Since plasma sodium monitoring is not always possible in times of COVID-19, we recommend to delay the desmopressin dose once a week until aquaresis occurs allowing excess retained water to be excreted. Patients should measure their body weight daily. Patients with DI admitted to the hospital with COVID-19 have a high risk for mortality due to volume depletion. Specialists must supervise fluid replacement and dosing of desmopressin. Patients after pituitary surgery should drink to thirst and measure their body weight daily to early recognize the development of postoperative SIAD. They should know hyponatraemia symptoms. Hyponatraemia in COVID-19 is common with a prevalence of 20–30% and is mostly due to SIAD or hypovolaemia. It mirrors disease severity and is an early predictor of mortality. Hypernatraemia may also develop in COVID-19 patients, with a prevalence of 3–5%, especially in ICU, and derives from different multifactorial reasons, for example, due to insensible water losses from pyrexia, increased respiration rate and use of diuretics. Hypernatraemic dehydration may contribute to the high risk of acute kidney injury in COVID-19. IV fluid replacement should be administered with caution in severe cases of COVID-19 because of the risk of pulmonary oedema.
Published: 2021

28. Safety of active auditory implants in magnetic resonance imaging

Author: Nina Standaert, Nicolas Verhaert, Guy Fierens, Christ Glorieux, and Ronald Peeters
Subjects: medicine.medical_specialty, medicine.medical_treatment, ASTM, American Society for Testing and Materials, Review, Active hearing implant, MRI, Magnetic Resonance Imaging, Food and drug administration, 03 medical and health sciences, 0302 clinical medicine, Cochlear implant, B0, Static magnetic field, medicine, Medical physics, In patient, 030223 otorhinolaryngology, Adverse effect, Confusion, B1+RMS, Magnitude of the radiofrequency electromagnetic field, medicine.diagnostic_test, Health professionals, business.industry, RF, Radiofrequency, Magnetic resonance imaging, FDA, Food and Drug Administration, MRI Safety, RF1-547, Otorhinolaryngology, Adverse events, TS, Technical Specification, Systematic review, Systematic Review, Implant, medicine.symptom, Radiology, business, 030217 neurology & neurosurgery, dB/dt, Gradient magnetic field, ISO, International Standardization Organization
Abstract: Magnetic resonance imaging (MRI) has become the gold standard for the diagnosis of many pathologies. Using MRI in patients with auditory implants can however raise concerns due to mutual interactions between the implant and imaging device, resulting in potential patient risks. Several implant manufacturers have been working towards more MRI safe devices. Older devices are however often labelled for more stringent conditions, possibly creating confusion with patients and professionals. With this myriad of different devices that are implanted in patients for lifetimes of at least 20 years, it is crucial that both patients and professionals have a clear understanding of the safety of their devices. This work aims at providing an exhaustive overview on the MRI safety of active auditory implants. The available industry standards that are followed by manufacturers are outlined and an overview of the latest scientific developments focusing on the last five years is provided. In addition, based on the analysis of the adverse events reported to the Food and Drug Administration (FDA) and in literature within the past ten years, a systematic review of the most commonly occurring issues for patients with auditory implants in the MRI environment is provided. Results indicate that despite the release of more MRI conditional active hearing implants on the market, adverse events still occur. An extensive overview is provided on the MRI safety of active auditory implants, aiming to increase the understanding of the topic for healthcare professionals and contribute to safer scanning conditions for patients. ispartof: Journal of Otology vol:16 issue:3 pages:185-198 ispartof: location:China status: Published online
Published: 2021
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29. Selective resection of cushing microadenoma guided by preoperative hybrid 18-fluoroethyl-L-tyrosine and 11-C-methionine PET/MRI

Author: Mirjam Christ-Crain, Freimut D. Juengling, Sven Berkmann, Beat Mueller, Egbert U. Nitzsche, Luigi Mariani, and Michel Roethlisberger
Subjects: Adenoma, Endocrinology, Diabetes and Metabolism, medicine.medical_treatment, 030209 endocrinology & metabolism, Context (language use), Cohort Studies, 03 medical and health sciences, Methionine, 0302 clinical medicine, Endocrinology, Humans, Medicine, Pathological, Retrospective Studies, Transsphenoidal surgery, medicine.diagnostic_test, Brain Neoplasms, business.industry, Magnetic resonance imaging, Middle Aged, medicine.disease, Magnetic Resonance Imaging, Exact test, Positron-Emission Tomography, Mann–Whitney U test, Tyrosine, Tomography, business, Nuclear medicine, 030217 neurology & neurosurgery
Abstract: 11-C-methionine (MET)-positron emission tomography (PET) as an adjunct to magnetic resonance imaging (MRI) has been proposed as a suitable molecular imaging modality for localizing pituitary adenomas in Cushing’s disease. 18-F-Fluoroethyl-L-tyrosine (FET)-PET, which is more widely available has not yet been reported in this context. Retrospective double-center cohort study on 15 patients who underwent transsphenoidal surgery for biochemically proven Cushing’s disease between 2011 and 2019. Preoperative MET-PET/MRI and/or FET-PET/MRI were compared with intraoperative and histopathological examinations using the Mann Whitney U test and the Fisher’s Exact test, along with positive predictive value calculations. Fifteen patients were included, with a mean age of 47.2 (18–69) years. Six patients received either a MET-PET/MRI or a FET-PET/MRI and 3 patients both exams, respectively. 67% of the tumors were detected by MRI (MET-PET-group [56%]; FET-PET-group [78%]). All tumors were microadenomas with a mean adenoma volume of 0.19 cm3 (0.02–0.78), all of which displayed a circumscribed pathological FET- and/or MET-uptake. FET-PET/MRI results positively correlated with the localization of the tumor confirmed intraoperatively and histopathologically in all cases, resulting in a sensitivity and specificity of FET-PET/MRI for tumor localization of 100% (95% CI 66.37–100%). One MET-PET/MRI suggested a localization contralateral to the expected spot. The sensitivity and specificity of MET-PET for tumor localization hence was 89% (95% CI 51.75–99.72%). Preoperative hybrid FET-PET/MRI and MET-PET/MRI have a high predictive value in localizing corticotroph adenoma for selective adenomectomy in Cushing’s disease.
Published: 2021
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30. Quality of orthodontic care—A multicenter cohort study in Germany

Author: Ines Graf, K. Reck, Sabine Ruf, V. Röper, Bert Braumann, Ulrike Fritz, Hildegard Christ, T. Bartzela, U. Schumann, Karolin Höfer, Michael Wolf, Niko C. Bock, Paul Georg Jost-Brinkmann, and Dirk Wiechmann
Subjects: Male, medicine.medical_specialty, Treatment outcome, Orthodontics, Logistic regression, Orthodontics, Corrective, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Germany, medicine, Humans, 030212 general & internal medicine, Quality of Health Care, Retrospective Studies, business.industry, 030206 dentistry, Odds ratio, medicine.disease, Confidence interval, Treatment Outcome, Cohort, Oral and maxillofacial surgery, Physical therapy, Female, Oral Surgery, Malocclusion, business, Cohort study
Abstract: Orthodontic care and its effectiveness have increasingly become the focus of political and public attention in the recent past. Therefore, this multicenter cohort study aimed to report about the effectiveness of orthodontic treatments in Germany and to identify potential influencing factors.A total of 586 patients from seven German study centers were screened for this cohort study, of which 361 patients were recruited at the end of their orthodontic treatment. Of these, 26 patients had missing study models and/or missing treatment information. Thus, 335 participants were included. The severity of malocclusion was rated using the Peer Assessment Rating (PAR) Index at baseline (T0) retrospectively and-prospectively-after the retention period (T1). Practitioner-, treatment- and patient-related information were analyzed in order to detect potential predictive factors for treatment effectiveness.Study participants (202 female and 133 male) were on average 14.8 (standard deviation [SD] ± 6.1) years old at start of active treatment. Average PAR score at T0 was 25.96 (SD ± 10.75) and mean posttreatment PAR score was 3.67 (SD ± 2.98) at T1. An average decrease of total PAR score by 22.30 points (SD ± 10.73) or 83.54% (SD ± 14.58; p 0.001) was detected. Furthermore, 164 treatments (49.1%) were categorized as 'greatly improved' but only 3 treatments (0.9%) as 'worse or no different'; 81.5% of all cases finished with a high-quality treatment outcome (≤5 PAR points at T1). Logistic regression analyses detected staff experience as a significant predictive factor for high-quality results (odds ratio 1.27, p = 0.001, 95% confidence interval 1.11-1.46).The improvement rate among this selected German cohort indicated an overall very good standard of orthodontic treatment. Staff experience proved to be a predictive factor for high-quality results.ZIEL: Die kieferorthopädische Versorgung und ihre Effektivität sind in der jüngeren Vergangenheit zunehmend in den Fokus von Politik und Öffentlichkeit gelangt. Ziel dieser multizentrischen Kohortenstudie war es daher, Erkenntnisse über die Effektivität von kieferorthopädischen Behandlungen in Deutschland zu generieren und mögliche Einflussfaktoren zu erfassen.Für diese Kohortenstudie wurden insgesamt 586 Patient*innen aus sieben deutschen Studienzentren gescreent, von denen 361 Patient*innen bei Abschluss ihrer kieferorthopädischen Behandlung rekrutiert werden konnten. Von diesen fehlten bei 26 Patient*innen Studienmodelle und/oder Behandlungsinformationen. Daher wurden 335 Teilnehmende in die Studie aufgenommen. Der Schweregrad der Malokklusion wurde mit dem PAR(Peer Assessment Rating)-Index zu Beginn (T0) retrospektiv und – nach der Retentionszeit (T1) – prospektiv bewertet. Behandler-, therapie- und patient*innenbezogene Informationen wurden analysiert, um mögliche prädiktive Faktoren für die Wirksamkeit der Behandlung zu ermitteln.Die Probanden (202 weibliche, 133 männliche) waren zu Beginn der aktiven Behandlung im Durchschnitt 14,8 (Standardabweichung [SD] ± 6,1) Jahre alt. Der durchschnittliche PAR-Score zum Zeitpunkt T0 lag bei 25,96 (SD ± 10,75), der durchschnittliche PAR-Score nach der Behandlung bei 3,67 (SD ± 2,98; T1). Dabei wurde eine mittlere PAR-Score-Reduktion von 22,30 Punkten (SD ± 10,73) oder 83,54 % (SD ± 14,58; p 0,001) festgestellt. Darüber hinaus wurden 164 Behandlungen (49,1 %) als „greatly improved“ kategorisiert, aber nur 3 Behandlungen (0,9 %) als „worse or no different“; 81,5 % aller Fälle schlossen mit einem hochwertigen okklusalen Behandlungsergebnis (≤5 PAR-Punkte bei T1) ab. Logistische Regressionsanalysen wiesen die Erfahrung des an der Behandlung beteiligten Personals als signifikanten prädiktiven Faktor für qualitativ hochwertige Ergebnisse nach (Odds Ratio 1,27, p = 0,001, 95 %-Konfidenzintervall 1,11‑1,46).Die okklusale Verbesserungsquote in dieser ausgewählten deutschen Kohorte ließ auf einen insgesamt sehr hohen Standard der kieferorthopädischen Behandlung schließen. Die Erfahrung des behandelnden Teams erwies sich als ein prädiktiver Faktor für qualitativ hochwertige Ergebnisse.
Published: 2021
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31. The dark sides of people analytics: reviewing the perils for organisations and employees

Author: Abdullah Redzepi, Franz Strich, Lisa Giermindl, Ulrich Leicht-Deobald, and Oliver Christ
Subjects: Information management, business.industry, computer science, information management, Library and Information Sciences, Onboarding, Business studies, Data science, business studies, Great Rift, Analytics, Human resource management, Retention Management, Information system, business, social sciences, Information Systems
Abstract: Technological advances in the field of artificial intelligence (AI) are heralding a new era of analytics and data-driven decision-making. Organisations increasingly rely on or use people analytics to optimise human resource management practices in areas such as recruitment, onboarding, performance evaluation, personnel development, health and retention management. Recent progress in the field of AI and ever-increasing volumes of digital data have raised expectations and contributed to a very positive image of people analytics. However, transferring and applying the efficiency-driven logic of analytics to manage humans carries numerous risks, challenges, and ethical implications. Based on a theorising review our paper analyses perils that can emerge from the use of people analytics. By disclosing the underlying assumptions of people analytics and offering a perspective on current and future technological advancements, we identify six perils and discuss their implications for organisations and employees. Then, we illustrate how these perils may aggravate with increasing analytical power of people analytics, and we suggest directions for future research. Our theorising review contributes to information system research at the intersection of analytics, artificial intelligence, and human-algorithmic management.
Published: 2021
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32. Investigations on NiTi shape memory alloy thin wall structures through laser marking assisted wire arc based additive manufacturing

Author: Ashish K. Shukla, Kushvinder S. Bindra, Christ P. Paul, I. A. Palani, Shalini Singh, Sergey Belyaev, Natalia Resnina, and A. N. Jinoop
Subjects: Microelectromechanical systems, 0209 industrial biotechnology, Fabrication, Materials science, business.industry, Strategy and Management, technology, industry, and agriculture, 02 engineering and technology, Shape-memory alloy, Management Science and Operations Research, 021001 nanoscience & nanotechnology, Laser, Industrial and Manufacturing Engineering, law.invention, 020901 industrial engineering & automation, law, Nickel titanium, Residual stress, parasitic diseases, Surface roughness, Optoelectronics, 0210 nano-technology, Actuator, business
Abstract: Micro Electro Mechanical System (MEMS) devices require thin Shape Memory Alloy (SMA) structures for actuator and vibration damper applications. However, fabricating customized SMA based thin structures are crucial and challenging for specific device requirements using conventional manufacturing. The above issues can be addressed using advanced manufacturing techniques, like - Wire Arc Additive Manufacturing (WAAM) technique. However, fabrication of the thin-wall structures with controlled geometry using WAAM is technically challenging due to melt-pool instability, residual stress, and distortion during fabrication. One of the methods to address the above issues is hybridization of WAAM with pre-surface treatment using Laser-marking. In the present work, the effect of number of laser passes during laser marking is investigated and the deployment of laser-marking treatment before deposition of each WAAM layer reduced the surface roughness (24 μm to 2.8 μm) and surface energy, which reduces the track width. The defects and distortions are successfully eliminated with 2 mm width of marked laser track on which thin section is fabricated. The fabricated samples are systematically investigated using characterization techniques to examine their surface morphological and mechanical properties. Shape Memory recovery of the fabricated sample is also investigated through its actuation characteristics by joule and hot plate heating with maximum achieved displacement of 2.4 mm. Through this technique, feature size of WAAM can be reduced, which will play a significant role in fabrication of complex components with thin structures.
Published: 2021
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33. Improved in-hospital outcome for radial access in a large contemporary cohort of primary percutaneous coronary intervention

Author: Michael Edlinger, Dirk von Lewinski, Jakob Dörler, Matthias Frick, Kurt Huber, Thomas Stefenelli, Günter Christ, Johann Sipötz, Axel Bauer, Hannes Alber, Matthias Hasun, Rudolf Berger, Uta C. Hoppe, Clemens Steinwender, Elisabeth Laßnig, Franz Weidinger, Franz X. Roithinger, Peter Siostrzonek, Anna Rab, Gudrun Lamm, and Herwig Schuchlenz
Subjects: medicine.medical_specialty, business.industry, Cardiogenic shock, medicine.medical_treatment, Percutaneous coronary intervention, Odds ratio, medicine.disease, Confidence interval, Internal medicine, Cohort, Conventional PCI, medicine, Cardiology, Original Article, Myocardial infarction, Cardiology and Cardiovascular Medicine, business, Mace
Abstract: BACKGROUND: Randomised controlled trials have shown diverse results for radial access in patients undergoing primary percutaneous coronary intervention (PPCI). Moreover, it is questionable whether radial access improves outcome in patients with cardiogenic shock undergoing PPCI. We aimed to investigate the outcome according to access site in patients with or without cardiogenic shock, in daily clinical practice. METHODS: For the present analysis we included 9,980 patients undergoing PPCI between 2012 and 2018, registered in the multi-centre, nationwide registry on PCI for myocardial infarction (MI). In-hospital mortality, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE) until discharge were compared between 4,498 patients with radial (45%) and 5,482 patients with femoral (55%) access. RESULTS: Radial compared to femoral access was associated with lower in-hospital mortality (3.5% vs. 7.7%; P
Published: 2021
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34. Gene Therapy for Overactive Bladder: A Review of BK-Channel α-Subunit Gene Transfer

Author: Arnold Melman, George J. Christ, Kelvin P. Davies, Karl-Erik Andersson, and Eric S. Rovner
Subjects: BK channel, Genetic enhancement, Review, 030204 cardiovascular system & hematology, urologic and male genital diseases, Bioinformatics, Placebo, 03 medical and health sciences, 0302 clinical medicine, medicine, Pharmacology (medical), 030212 general & internal medicine, General Pharmacology, Toxicology and Pharmaceutics, Adverse effect, Chemical Health and Safety, Urinary bladder, biology, business.industry, ion channels, General Medicine, medicine.disease, female genital diseases and pregnancy complications, big potassium channel, Clinical trial, medicine.anatomical_structure, Erectile dysfunction, Overactive bladder, gene expression, biology.protein, business, urinary bladder, Safety Research
Abstract: A need exists for local (ie, bladder-specific) interventions to treat overactive bladder (OAB) with low risk of unwanted postprocedural outcomes. Gene therapy targeted to leverage endogenous physiology in bladder cells may assist in restoring normal cell and organ function. Herein, we review the potential promise of gene therapy for treating OAB, focusing on gene transfer of URO-902, a non-viral naked plasmid DNA expressing the big potassium (BK) channel. We searched PubMed for articles concerning functional aspects of the BK channel and its potential use for gene transfer as local OAB treatment. Results from preclinical, phase 1, and phase 2 studies of URO-902 for erectile dysfunction and phase 1 studies of URO-902 for OAB are included. The BK channel has been extensively studied; however, URO-902 is the first gene therapy used in clinical trials directed toward treating OAB via the BK channel. In both URO-902 studies, there were no serious adverse events considered treatment related and no adverse events leading to early withdrawal. Both studies included secondary efficacy endpoints with promising results suggesting improvement in OAB symptoms, and quality of life, with use of URO-902 versus placebo. Gene therapy involving the BK channel, such as gene transfer with URO-902, has demonstrated promising safety and efficacy results in women with OAB. Findings warrant further investigation of the use of URO-902 for OAB treatment.
Published: 2021
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35. Modelling of photovoltaic-thermal collectors for the provision of electricity and low temperature heat—Comparison of different flow rate control approaches to optimize the electrical yield

Author: Daniel Christ and Martin Kaltschmitt
Subjects: Yield (engineering), Renewable Energy, Sustainability and the Environment, business.industry, 020209 energy, Nuclear engineering, 020208 electrical & electronic engineering, Photovoltaic system, Context (language use), 02 engineering and technology, Radiation, Variable flow, Volumetric flow rate, Thermal, 0202 electrical engineering, electronic engineering, information engineering, Environmental science, Electricity, business
Abstract: Photovoltaic-thermal (PVT) collectors can provide heat and electricity. A quasi-stationary model of a PVT collector is presented and validated based on measured data. Subsequently, the electrical and thermal performance of such a collector is simulated for different locations. These simulations focus on different flow rate control approaches with the aim of maximizing the electrical yield. The simulation results show that the two control approaches presented in this paper have the potential to increase the electrical output for all locations. The increase in additional electrical output at locations with higher solar radiation is significantly higher than the increase in solar radiation between the locations investigated. Additionally, the cooling fluids’ temperature differences for such PVT collectors vary between the investigated control approaches, where variable flow rates lead to a steadier increase in cooling fluids’ temperature. In conclusion, the flow rate needs to be adopted to the pre-defined main goal of the respective PVT collector. The use of variable flow rates by providing low-temperature heat at a more constant temperature level appears to be advantageous in this context.
Published: 2021
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36. Endoscopic vacuum therapy versus stent treatment of esophageal anastomotic leaks (ESOLEAK): study protocol for a prospective randomized phase 2 trial

Author: Jakob R. Izbicki, Isabel Rieck, Tobias Goeser, Christiane Bruns, Seung-Hun Chon, Thomas Rösch, Florian Gebauer, Hildegard Christ, Marcus Kantowski, Karl Karstens, and Michael Tachezy
Subjects: Adult, medicine.medical_specialty, Leak, Medicine (General), Esophageal Neoplasms, medicine.medical_treatment, Esophageal cancer, Medicine (miscellaneous), Anastomotic Leak, Pilot Projects, Anastomosis, law.invention, 03 medical and health sciences, Study Protocol, 0302 clinical medicine, Clinical Trials, Phase II as Topic, R5-920, Randomized controlled trial, Meta-Analysis as Topic, law, medicine, Clinical endpoint, Humans, Pharmacology (medical), Prospective Studies, Anastomotic leaks, Randomized Controlled Trials as Topic, Retrospective Studies, medicine.diagnostic_test, business.industry, Endoscopic vacuum therapy, Stent, Endoscopy, medicine.disease, Self-expanding metal stents, Surgery, Esophagectomy, Treatment Outcome, 030220 oncology & carcinogenesis, Quality of Life, 030211 gastroenterology & hepatology, Stents, business, Interventional endoscopy, Negative-Pressure Wound Therapy
Abstract: Background Intrathoracic anastomotic leaks represent a major complication after Ivor Lewis esophagectomy. There are two promising endoscopic treatment strategies in the case of leaks: the placement of self-expanding metal stents (SEMS) or endoscopic vacuum therapy (EVT). Up to date, there is no prospective data concerning the optimal endoscopic treatment strategy. This is a protocol description for the ESOLEAK trial, which is a first small phase 2 randomized trial evaluating the quality of life after treatment of anastomotic leaks by either SEMS placement or EVT. Methods This phase 2 randomized trial will be conducted at two German tertiary medical centers and include a total of 40 patients within 2 years. Adult patients with histologically confirmed esophageal cancer, who have undergone Ivor Lewis esophagectomy and show an esophagogastric anastomotic leak on endoscopy or present with typical clinical signs linked to an anastomotic leak, will be included in our study taking into consideration the exclusion criteria. After endoscopic verification of the anastomotic leak, patients will be randomized in a 1:1 ratio into two treatment groups. The intervention group will receive EVT whereas the control group will be treated with SEMS. The primary endpoint of this study is the subjective quality of life assessed by the patient using a systematic and validated questionnaire (EORTC QLQ C30, EORTC QLQ-OES18 questionnaire). Important secondary endpoints are healing rate, period of hospitalization, treatment-related complications, and overall mortality. Discussion The latest meta-analysis comparing implantation of SEMS with EVT in the treatment of esophageal anastomotic leaks suggested a higher success rate for EVT. The ESOLEAK trial is the first study comparing both treatments in a prospective manner. The aim of the trial is to find suitable endpoints for the treatment of anastomotic leaks as well as to enable an adequate sample size calculation and evaluate the feasibility of future interventional trials. Due to the exploratory design of this pilot study, the sample size is too small to answer the question, whether EVT or SEMS implantation represents the superior treatment strategy. Trial registration ClinicalTrials.gov NCT03962244. Registered on May 23, 2019. DRKS-ID DRKS00007941
Published: 2021

37. Dose-Dependent Early Postoperative Opioid Use Is Associated with Periprosthetic Joint Infection and Other Complications in Primary TJA

Author: Brian C Chung, Alexander B. Christ, Daniel A. Oakes, Haley Nakata, Nathanael Heckmann, Cory K Mayfield, Gabriel Bouz, and Jay R. Lieberman
Subjects: Male, medicine.medical_specialty, Prosthesis-Related Infections, Arthroplasty, Replacement, Hip, Periprosthetic, Patient Readmission, Risk Assessment, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Internal medicine, Surgical Wound Dehiscence, medicine, Humans, Surgical Wound Infection, Orthopedics and Sports Medicine, Arthroplasty, Replacement, Knee, Aged, Retrospective Studies, Arthritis, Infectious, Pain, Postoperative, 030222 orthopedics, Dose-Response Relationship, Drug, Wound dehiscence, business.industry, Confounding, Venous Thromboembolism, General Medicine, Odds ratio, Perioperative, Middle Aged, medicine.disease, Confidence interval, Pulmonary embolism, Venous thrombosis, Elective Surgical Procedures, Female, Surgery, business, 030217 neurology & neurosurgery
Abstract: Background Opioids are commonly prescribed for postoperative pain following total joint arthroplasty. Despite widespread use, few studies have examined the dose-dependent effect of perioperative opioid use on postoperative complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Therefore, we examined the dose-dependent relationship between opioid use and postoperative complications following primary THA and TKA. Methods We queried the Premier Healthcare Database to identify adult patients who underwent primary elective THA or TKA from 2004 to 2014, and quantified opioid consumption within the first 3 postoperative days. Opioid consumption was standardized to morphine milligram equivalents (MMEs). Patients were divided into quintiles on the basis of MME exposure: 172 MMEs. Primary outcomes included postoperative periprosthetic joint infection, pulmonary embolism, deep venous thrombosis, and pulmonary complications. Secondary outcomes included wound infection, wound dehiscence, and readmission within 30 and 90 days postoperatively. Univariate and multivariate analyses were performed to compare differences between groups and to account for confounders. Results A total of 1,525,985 patients were identified. The mean age was 65.7 ± 10.8 years, 598,320 patients (39.2%) were male, and 1,174,314 patients (77.0%) were Caucasian. On multiple logistic regression analysis, increasing MME exposure was associated with a dose-dependent increased risk of postoperative complications. Compared with patients receiving 172 MMEs was associated with greater odds of periprosthetic joint infection (adjusted odds ratio [aOR], 1.37; 95% confidence interval [CI], 1.33 to 1.42), deep venous thromboembolism (aOR, 1.34; 95% CI, 1.30 to 1.38), pulmonary embolism (aOR, 1.29; 95% CI, 1.25 to 1.34), and pulmonary complications (aOR, 1.06; 95% CI, 1.05 to 1.08). Exposure to >172 MMEs was associated with increased risk of wound infection (aOR, 1.37; 95% CI, 1.33 to 1.41), wound dehiscence (aOR, 1.24; 95% CI, 1.19 to 1.31), and readmission within 30 (aOR, 1.21; 95% CI, 1.20 to 1.22) and 90 days (aOR, 1.20; 95% CI, 1.19 to 1.21). Conclusions Increasing opioid use within the early postoperative period following THA or TKA was associated with a dose-dependent increased risk of periprosthetic joint infection and venous thromboembolic events. Level of evidence Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Published: 2021
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38. Distributed temporal graph analytics with GRADOOP

Author: Martin Junghanns, Erhard Rahm, Matthias Täschner, Lucas Schons, Timo Adameit, Gomez Kevin A, Philip Fritzsche, Christopher Rost, and Lukas Christ
Subjects: Power graph analysis, Structure (mathematical logic), Theoretical computer science, Computer science, business.industry, Dataflow, Data model, Hardware and Architecture, Analytics, Scalability, Pattern matching, business, Bitemporal Modeling, MathematicsofComputing_DISCRETEMATHEMATICS, Information Systems
Abstract: Temporal property graphs are graphs whose structure and properties change over time. Temporal graph datasets tend to be large due to stored historical information, asking for scalable analysis capabilities. We give a complete overview of Gradoop, a graph dataflow system for scalable, distributed analytics of temporal property graphs which has been continuously developed since 2005. Its graph model TPGM allows bitemporal modeling not only of vertices and edges but also of graph collections. A declarative analytical language called GrALa allows analysts to flexibly define analytical graph workflows by composing different operators that support temporal graph analysis. Built on a distributed dataflow system, large temporal graphs can be processed on a shared-nothing cluster. We present the system architecture of Gradoop, its data model TPGM with composable temporal graph operators, like snapshot, difference, pattern matching, graph grouping and several implementation details. We evaluate the performance and scalability of selected operators and a composed workflow for synthetic and real-world temporal graphs with up to 283 M vertices and 1.8 B edges, and a graph lifetime of about 8 years with up to 20 M new edges per year. We also reflect on lessons learned from the Gradoop effort.
Published: 2021
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39. 'Stroke mimics' – Differenzialdiagnose des Schlaganfalls in der Notfallmedizin

Author: Manuel Bolognese, L.-B. Lakatos, Michael Christ, and M. Müller
Subjects: Gynecology, medicine.medical_specialty, business.industry, Emergency Medicine, Medicine, business
Abstract: Schlaganfalle gehoren zu den weltweit fuhrenden Ursachen fur Behinderung und Tod. Da der Erfolg der Rekanalisationsbehandlung mit intravenoser Thrombolyse oder mechanischer Thrombektomie zeitabhangig ist („Time is brain“), besteht ein groser Druck zur raschen Therapieentscheidung. Dies erhoht die Wahrscheinlichkeit einer Fehldiagnose, da schlaganfallahnliche Symptome auch bei anderen Krankheiten vorliegen konnen. Der vorliegende Beitrag soll einen Uberblick uber die haufigsten Krankheitsbilder geben, die einen Schlaganfall vortauschen („stroke mimics“). Eine der vielen Herausforderungen fur ein in der Primarversorgung tatiges Notfallteam besteht darin, die wesentlichen „mimics“ und ihre diagnostischen Besonderheiten zu kennen und somit die Rate der Fehldiagnosen zu reduzieren.
Published: 2021
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40. Hospitalizations for heart failure: still major differences between East and West Germany 30 years after reunification

Author: Anja Neumann, Martin Scherer, Ralph Bosch, Ulrich Laufs, Rolf Wachter, Uwe Riemer, Stefan Störk, Johann Bauersachs, Marcus Dörr, and Michael Christ
Subjects: medicine.medical_specialty, Epidemiology, Age adjustment, Population, Medizin, Heart failure, 030204 cardiovascular system & hematology, Regional disparities, West germany, 03 medical and health sciences, 0302 clinical medicine, Original Research Articles, Germany, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, Hospital Mortality, Original Research Article, 030212 general & internal medicine, education, Hospital days, education.field_of_study, Absolute number, business.industry, Germany, West, Wirtschaftswissenschaften, medicine.disease, In‐hospital mortality, Hospitalization, RC666-701, Cardiology and Cardiovascular Medicine, business, Regional differences, Demography
Abstract: Aims: Heart failure (HF) is the most common primary inpatient diagnosis in Germany. We examined temporal trends of HF hospitalization within Germany focusing on regional differences. Methods and results: We analysed aggregated data of more than 320 million hospitalizations in Germany from 2000 to 2017. Temporal trends of HF-related parameters were analysed, focusing on regional differences between the federal states. The absolute number of HF-related hospitalizations throughout Germany increased continuously and almost doubled (from 239 694 to 464 724 cases, +94%) with the relative increase being higher in East Germany compared with West Germany (119% vs. 88%). These regional differences persisted after age standardization with 609 and 490 cases per 100 000 population, respectively. The length of stay decreased continuously across Germany (from 14.3 to 10.2 days; −29%), while the total number of HF-related hospital days increased by 51% in East Germany and 35% in West Germany. In 2017, HF remained the leading cause of in-hospital death (8.9% of all cases), with a markedly higher rate in East vs. West Germany (65 vs. 43 deaths per 100 000 population). Conclusions: Heart failure remains the most common cause of hospitalization and in-hospital death throughout Germany. The increase in HF-related morbidity and mortality was much higher in East Germany compared with West Germany during the observation period. A more detailed understanding of these striking disparities 30 years after the German reunification requires further investigations. There is an urgent need for action with regard to stronger control of risk factors and improvement of both chronic HF management and healthcare structures. CA Extern
Published: 2021
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41. Mesenchymal stromal cells mitigate liver damage after extended resection in the pig by modulating thrombospondin-1/TGF-β

Author: Bruno Christ, Peggy Stock, Madlen Christ, Sebastian Krämer, Kristin Schubert, Claudia Gittel, Silvio Erler, Martin von Bergen, Janine Brach, Uta-Carolin Pietsch, Sandra Nickel, Reinhard Henschler, Franziska Tautenhahn, Hans-Michael Tautenhahn, Steven Dooley, Seddik Hammad, Uwe Eichfeld, Michael Bartels, H Kühne, Christiane Wild, Johannes Broschewitz, Isabella Metelmann, Andreas Roth, Caroline Burger, Manja Baunack, Undine Lange, and Sebastian Vlaic
Subjects: business.industry, Regeneration (biology), Mesenchymal stem cell, Biomedical Engineering, Medicine (miscellaneous), Cell Biology, Article, Transplantation, medicine.anatomical_structure, Cell culture, Hepatocyte, Regenerative medicine, Thrombospondin 1, Cancer research, Mesenchymal stem cells, Medicine, Platelet, business, Developmental Biology, Transforming growth factor
Abstract: Post-surgery liver failure is a serious complication for patients after extended partial hepatectomies (ePHx). Previously, we demonstrated in the pig model that transplantation of mesenchymal stromal cells (MSC) improved circulatory maintenance and supported multi-organ functions after 70% liver resection. Mechanisms behind the beneficial MSC effects remained unknown. Here we performed 70% liver resection in pigs with and without MSC treatment, and animals were monitored for 24 h post surgery. Gene expression profiles were determined in the lung and liver. Bioinformatics analysis predicted organ-independent MSC targets, importantly a role for thrombospondin-1 linked to transforming growth factor-β (TGF-β) and downstream signaling towards providing epithelial plasticity and epithelial-mesenchymal transition (EMT). This prediction was supported histologically and mechanistically, the latter with primary hepatocyte cell cultures. MSC attenuated the surgery-induced increase of tissue damage, of thrombospondin-1 and TGF-β, as well as of epithelial plasticity in both the liver and lung. This suggests that MSC ameliorated surgery-induced hepatocellular stress and EMT, thus supporting epithelial integrity and facilitating regeneration. MSC-derived soluble factor(s) did not directly interfere with intracellular TGF-β signaling, but inhibited thrombospondin-1 secretion from thrombocytes and non-parenchymal liver cells, therewith obviously reducing the availability of active TGF-β.
Published: 2021
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42. A Big Data Analysis Using Fuzzy Deep Convolution Network Based Model for Heart Disease Classification

Author: Pankaj Kumar, Manohar Manur, Alok Kumar Pani, and Christ
Subjects: General Computer Science, Heart disease, Computer science, business.industry, Big data, General Engineering, medicine, Pattern recognition, Artificial intelligence, medicine.disease, business, Fuzzy logic, Convolution
Published: 2021
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43. Microcontroller‐Based Variable Rate Syringe Pump for Microfluidic Application

Author: N. Ashwin Kumar, S. Swarnalatha, G. B. Tejashree, S. Pavithra, and M. C. Jobin Christ
Subjects: Syringe driver, Microcontroller, Computer science, business.industry, Arduino, Microfluidics, business, Computer hardware
Published: 2021
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44. Laser-Based Metal Additive Manufacturing: Technology, Global Scenario and Our Experiences

Author: Christ P. Paul, Kushvinder S. Bindra, A. N. Jinoop, and Atul Kumar
Subjects: Manufacturing sector, Engineering, Manufacturing technology, business.industry, Manufacturing, Paradigm shift, Laser additive manufacturing, business, Energy source, Field (computer science), Manufacturing engineering, Indian scenario
Abstract: Additive manufacturing (AM) brought a paradigm shift in the manufacturing sector by introducing “feature-based design and manufacturing” and it is one of the pillars of the fourth industrial revolution or Industry 4.0. The technology is bringing a transformation in the industrial manufacturing through “metal additive manufacturing” (MAM), which allows the fabrication of metallic components having intricate/complex shapes and designs that were not perceived previously through conventional manufacturing route. Laser, a tool of power and precision is the most commonly used energy source for MAM and thus the term “laser additive manufacturing” (LAM) is coined. Considering the potential and the various freedoms offered by the technology, a dedicated research and development programme in the area of LAM was started in the year 2003 at Raja Ramanna Centre for Advanced Technology (RRCAT). This review article includes a discussion about the different LAM technologies along with its advantages and limitations. It also includes the global and Indian scenario of the technology, along with discussions on the contributions of the technology towards Industry 4.0. It will also discuss the details of the LAM systems developed at RRCAT and some of the recent research works and engineering components developed at LAM lab, RRCAT. This article will serve as reference material for beginners to appreciate this novel technology and as a reference document for researchers in the field.
Published: 2021
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45. Internet Addiction As Correlates To Depression and Life Satisfaction

Author: Christ Michael C. Entienza
Subjects: Impulse control disorder, business.industry, General Mathematics, Addiction, media_common.quotation_subject, Life satisfaction, medicine.disease, Education, Test (assessment), Computational Mathematics, Mild depression, Computational Theory and Mathematics, medicine, The Internet, Time management, Psychology, business, Depression (differential diagnoses), Clinical psychology, media_common
Abstract: Common behavioral problem described as an impulse control disorder which doesn’t include the use of an intoxicating drug very similar to pathological, is known as Internet Addiction, a rampant disorder during the digital age. This study looked into the relationship of internet addiction towards depression and life satisfaction. Two hundred respondents from various courses of a State University were chosen using fishbowl sampling. The Philippine Student Health Questionnaire was administered and 100% test results were retrieved. Results showed that most of the respondents are average users. There are also significant numbers who are problematic and the least were excessive users. Most respondents were suffering from mild depression and worryingly there were respondents having moderately severe and severe depression. For life satisfaction, results shows that most respondents are satisfied while some reported that they are slightly satisfied and least reported are dissatisfied. Statistics showed that there is no significant correlation between internet addiction and life satisfaction; however, there is a positive correlation between internet addiction and depression. Results highly suggests exerting efforts for awareness in regulating proper usage of internet such as time management. For Life Satisfaction, it is suggested to continue and share lifestyle practices which contribute to satisfaction and work on areas that need improvement promoting better life satisfaction.
Published: 2021
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46. Incidence of hyperkalemia during hypertonic saline test for the diagnosis of diabetes insipidus

Author: Martin Fassnacht, Julie Refardt, Irina Chifu, Mirjam Christ-Crain, Wiebke Fenske, and Laura Potasso
Subjects: polyuria–polydipsia syndrome, Hyperkalemia, Endocrinology, Diabetes and Metabolism, Potassium, 030232 urology & nephrology, 3% nacl, chemistry.chemical_element, Diseases of the endocrine glands. Clinical endocrinology, 03 medical and health sciences, 0302 clinical medicine, Endocrinology, Bolus (medicine), Internal Medicine, Medicine, Primary polydipsia, 030212 general & internal medicine, Prospective cohort study, business.industry, Research, potassium, RC648-665, medicine.disease, pps, Hypertonic saline, chemistry, Anesthesia, Diabetes insipidus, Tonicity, medicine.symptom, business
Abstract: Objective Hyperkalemia has been reported upon different hypertonic saline infusion protocols. Since hypertonic saline test has recently been validated for the differential diagnosis of diabetes insipidus (DI), we aimed to investigate the course of plasma potassium during the test. Design We analyzed data of 90 healthy volunteers and 141 patients with polyuria–polydipsia syndrome (PPS) from two prospective studies evaluating the hypertonic saline test. Our primary outcome was the incidence rate of hypertonic saline-induced hyperkalemia > 5 mmol/L. Methods Participants received a 250 mL bolus of 3% NaCl solution, followed by 0.15 mL/min/kg body weight continuously infused targeting a plasma sodium level of 150 mmol/L. Blood samples and clinical data were collected every 30 min. Results Of the 231 participants, 16% (n = 37/231) developed hyperkalemia. The incidence of hyperkalemia was higher in healthy volunteers and in patients with primary polydipsia (25.6% (n = 23/90) and 9.9% (n = 14/141), respectively), and only occurred in 3.4% (n = 2/59) of patients with diabetes insipidus. Hyperkalemia developed mostly at or after 90-min test duration (81.1%, n => 30/37). Predictors of hyperkalemia (OR (95% CI)) were male sex (2.9 (1.2–7.4), P => 0.02), a plasma potassium at baseline > 3.9 mmol/L (5.2 (1.8–17.3), P => 0.004), normonatremia at 30-min test duration (3.2 (1.2–9.5), P => 0.03), and an increase in potassium levels already at 30-min test duration as compared to baseline (4.5 (1.7–12.3), P => 0.003). Hyperkalemia was transient and resolved spontaneously in all cases. Conclusion The hypertonic saline test can lead to hyperkalemia, especially in patients with primary polydipsia who experience a longer test duration. Monitoring potassium levels in these patients is recommended.
Published: 2021
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47. Physicians’ self-efficacy, beliefs and intentions to provide tobacco cessation services: A cross-sectional study in Riyadh, Saudi Arabia

Author: Yara Bashawri, Hadeel AlSaran, Nervana Elkhadragy, and Sharon L. Christ
Subjects: Self-efficacy, medicine.medical_specialty, business.industry, Cross-sectional study, medicine.medical_treatment, theory of reasoned action, smoking cessation, Theory of reasoned action, tobacco cessation services, Family medicine, Medicine, Smoking cessation, business, physicians’ beliefs
Abstract: Introduction Prevalence of tobacco use in the Kingdom of Saudi Arabia (KSA) is 12.2% and negatively impacting the health of the population. Diseases such as lung cancer, heart diseases, and poor prognosis of COVID-19 can be prevented by tobacco cessation. Physicians are trusted among patients and therefore are well-positioned to provide tobacco cessation services, however, their attitudes about such services are unknown. Our purpose is to assess attitudes about providing tobacco cessation services among physicians practicing in KSA. Methods This study is questionnaire-based and of crosssectional design. We applied the Theory of Reasoned Action (TRA) framework to guide our study. Twenty percent (n=25) of primary care centers were randomly selected. A paperbased survey was administered to 291 physicians practicing in the selected primary care centers, each item mapped onto one of the seven TRA constructs. Constructs assessed were: demographics, self-efficacy, knowledge, subjective beliefs, normative beliefs, control beliefs, and intentions to provide tobacco cessation services. Constructs were measured with latent variables, and associations were estimated in a structural equation path model. Results The majority (71%) of physicians reported minimal or no training on tobacco cessation. The average score for tobacco treatment knowledge was 4.09 out of 10 questions. On a scale of 1 to 5, the mean score for intention to provide tobacco cessation services was 3.26. Mean scores for subjective, normative, and control beliefs were 3.45, 3.41, and 3.43, respectively. Mean score for self-efficacy was 3.38. Self-efficacy had a strong influence on intention to provide cessation services via several pathways. Conclusions Due to lack of prior training among physicians, we recommend delivering future tobacco cessation training. Such training would be effective, given that scores on selfefficacy, beliefs, and intentions, in this study indicate a promising attitude toward the provision of tobacco cessation services.
Published: 2021

48. Development of imaging-based risk scores for prediction of intracranial haemorrhage and ischaemic stroke in patients taking antithrombotic therapy after ischaemic stroke or transient ischaemic attack: a pooled analysis of individual patient data from cohort studies

Author: Henry Ma, Eleni Sakka, Hugues Chabriat, Duncan Wilson, Appu Suman, Peter J. Kelly, SL Ho, Charlotte Zerna, Eric Jouvent, Lawrence K.S. Wong, Anthea Parry, Frances Harrington, Jan Stam, Christopher Patterson, Rustam Al-Shahi Salman, Shigeru Inamura, Krishna A Dani, Henry Houlden, Sebastian Thilemann, Kotaro Iida, Chao Xu, Eunbin Ko, Daniel Guisado-Alonso, Urs Fischer, Caroline E. Lovelock, Man Yu Tse, Wing Chi Fong, Azlisham Mohd Nor, Clare Shakeshaft, Philippe Maeder, Henrik Gensicke, Stefan T. Engelter, James Okwera, Christopher Chen, Dulka Manawadu, John F. Corrigan, Efrat Kliper, Shelagh B. Coutts, Alexander P. Leff, Kam Tat Leung, Chathuri Yatawara, Leopold Hertzberger, M. Eline Kooi, Kazuhisa Yoshifuji, Hing Lung Ip, Keon-Joo Lee, Sanjeevikumar Meenakishundaram, Hiroyuki Irie, Marc Randall, Hatice Ozkan, Hideo Hara, Jill Abrigo, Raquel Delgado-Mederos, Shaloo Singhal, Enrico Flossmann, Beatriz Gómez-Ansón, Paul O'Mahony, Carmen Barbato, Ahamad Hassan, Francesca M Chappell, Harald Proschel, Vincent Mok, Masashi Nishihara, Lakshmanan Sekaran, Derya Selcuk Demirelli, Chu Peng Hoi, Hakan Ay, Joan Martí-Fàbregas, Rebeca Marín, Anne Cristine Guevarra, Martin Cooper, Einor Ben Assayag, Anne-Marie Mendyk, Christine Roffe, Myung Suk Jang, Maarten van Gemert, Hannah Cohen, Jae-Sung Lim, YK Wong, Bonnie Y.K. Lam, Janet Putterill, Wouter Schoonewille, Nick S. Ward, Nikola Sprigg, Kui Kai Lau, Bernard Esisi, Peter M. Rothwell, Henk Verbiest, Kirsty Harkness, Elisa Merino, Gareth Ambler, Arumug Nallasivam, Nigel Smyth, Paul A. Armitage, Heinrich Mattle, Pol Camps-Renom, Martin M. Brown, David Cohen, Min Lou, Pankaj Sharma, Sarah Gunkel, Elles Douven, Andreas Charidimou, Djamil Vahidassr, Cathy Soufan, Alexandros A Polymeris, Michael G. Hennerici, Chris Moran, Rachel Marsh, Mahmud Sajid, Kyohei Fujita, David J. Werring, Joanna M. Wardlaw, Derek Hayden, Joseph Kwan, Timothy J. England, Jaap van der Sande, Luis Prats-Sánchez, Paul Guyler, Ryan Hoi Kit Cheung, Koon-Ho Chan, Frank-Erik de Leeuw, Simone Browning, Jon Scott, Adrian Barry, Alejandro Martínez-Domeño, Luc Bracoub, Dinesh Chadha, Ijaz Anwar, Deborah Kelly, Moon-Ku Han, Anil M. Tuladhar, Thomas Gattringer, Fiona Carty, Abduelbaset Elmarim, Syed Mansoor, Enrico Flossman, Dilek Necioglu Orken, Jane Sword, Velandai Srikanth, Ping Wing Ng, Thomas W. Leung, Richard Shek-kwan Chang, Hans Rolf Jäger, Marwan El-Koussy, Jeroen Hendrikse, Khaled Darawil, Kazunori Toyoda, Mathuri Prabhakaran, Karim Mahawish, Ethem Murat Arsava, Jihoon Kang, Kwok Kui Wong, Michael Power, Felix Fluri, Enas Lawrence, Maam Mamun, Sissi Ispoglou, Mathew Burn, Siu Hung Li, Henry K.F. Mak, Kaori Miwa, Els De Schryver, Franz Fazekas, Jonathan G. Best, Louise Shaw, Hen Hallevi, Keith W. Muir, Ilse Burger, Adrian Wong, Nils Peters, Susana Muñoz-Maniega, Yusuke Yakushiji, David Calvet, Mark White, Michael McCormick, Vinodh Krishnamurthy, David Hargroves, Jan C. Purrucker, Tae Jin Song, Masayuki Shiozawa, Noortje A.M. Maaijwee, Prasanna Aghoram, Nicolas Christ, Lino Ramos, Yannie Soo, Thanh G. Phan, Parashkev Nachev, David J. Seiffge, Kim Wiegertjes, Leo H. Bonati, Chahin Pachai, Oi Ling Chan, Yvo B.W.E.M. Roos, Santiago Medrano-Martorell, Natan M. Bornstein, Elizabeth A. Warburton, Richard Li, Prabel Datta, Pascal P. Gratz, Edmund Ka Ming Wong, Hedley C. A. Emsley, Marie-Yvonne Douste-Blazy, Gunaratam Gunathilagan, Nagaendran Kandiah, Masatoshi Koga, Roland Veltkamp, Lee-Anne Slater, Suk Fung Tsang, Beom Joon Kim, Simon Jung, Zeynep Tanriverdi, Sarah Caine, Peter J. Koudstaal, Laurence Legrand, Kari Saastamoinen, Ale Algra, Jean-Louis Mas, Christine Delmaire, Fidel Nuñez, Robert J. van Oostenbrugge, Sebastian Eppinger, Lillian Choy, Robert Luder, Vincent I.H. Kwa, Aad van der Lugt, Marie Dominique Fratacci, Stephen Makin, Layan Akijian, Régis Bordet, Mi Hwa Yang, Ying Zhou, Elio Giallombardo, Adrian R Parry-Jones, John S. Thornton, Amos D. Korczyn, Narayanaswamy Venketasubramanian, David J. Williams, Aravindakshan Manoj, Julie Staals, Solveig Horstmann, Dianne H.K. van Dam-Nolen, Claire Cullen, Benjamin Wagner, Jun Tanaka, Martin Dennis, Stef Bakker, Gregory Y.H. Lip, L. Jaap Kappelle, Robin Lemmens, Achim Gass, David Mangion, Matthew Smith, Toshio Imaizumi, Wenyan Liu, Jeremy Molad, Christopher Price, Paul J. Nederkoorn, P. J. A. M. Brouwers, Vincent Thijs, Sze Ho Ma, Mark Schembri, Peter Wilkinson, Janice E. O’Connell, Karen Ma, John Ly, Leonidas Panos, Chung Yan Chan, Toshihiro Ide, Christopher Traenka, Joost Jöbsis, Gargi Banerjee, Paul Berntsen, Michael J. Thrippleton, Raymond T.F. Cheung, Christopher Karayiannis, Werner H. Mess, Robert Simister, Jayesh Modi Medanta, Syuhei Ikeda, John Mitchell, Linxin Li, Mauro S.B. Silva, Eric Vicaut, John Coyle, Shoichiro Sato, Michelle Davis, Jonathan Birns, Richard J. Perry, Sean M. Murphy, KC Teo, Maria del C. Valdés Hernández, Bibek Gyanwali, Tarek A. Yousry, Kath Pasco, Sebastian Köhler, Joachim Fladt, Edward S. Hui, Philippe Lyrer, Young Dae Kim, Anna K. Heye, Eric E. Smith, Saima Hilal, Ender Uysal, Ji Hoe Heo, Ysoline Beigneux, Cisca Linn, Hee-Joon Bae, Simon Leach, Winnie C.W. Chu, Ronil V. Chandra, Neurology, ACS - Atherosclerosis & ischemic syndromes, ANS - Neurovascular Disorders, MUMC+: HZC Med Staf Spec Klinische Neurofys (9), RS: Carim - B06 Imaging, MUMC+: HZC Klinische Neurofysiologie (5), Klinische Neurowetenschappen, Psychiatrie & Neuropsychologie, RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience, MUMC+: MA Neurologie (3), RS: Carim - B05 Cerebral small vessel disease, MUMC+: Hersen en Zenuw Centrum (3), MUMC+: MA Med Staf Spec Neurologie (9), RS: NUTRIM - R1 - Obesity, diabetes and cardiovascular health, Beeldvorming, and MUMC+: DA BV Klinisch Fysicus (9)
Subjects: Adult, Male, Risk, EXTERNAL VALIDATION, medicine.medical_specialty, Neurology, MODELS, Clinical Neurology, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Fibrinolytic Agents, Recurrence, Internal medicine, Antithrombotic, Humans, Medicine, Prospective cohort study, 610 Medicine & health, Stroke, METAANALYSIS, Aged, Ischemic Stroke, Science & Technology, medicine.diagnostic_test, business.industry, Proportional hazards model, Magnetic resonance imaging, Middle Aged, Disorders of movement Donders Center for Medical Neuroscience [Radboudumc 3], medicine.disease, Magnetic Resonance Imaging, Ischemic Attack, Transient, ATRIAL-FIBRILLATION, Cardiology, Female, Neurology (clinical), Neurosciences & Neurology, business, Intracranial Hemorrhages, Life Sciences & Biomedicine, 030217 neurology & neurosurgery, Fibrinolytic agent, Cohort study
Abstract: Contains fulltext : 235277.pdf (Publisher’s version ) (Closed access) BACKGROUND: Balancing the risks of recurrent ischaemic stroke and intracranial haemorrhage is important for patients treated with antithrombotic therapy after ischaemic stroke or transient ischaemic attack. However, existing predictive models offer insufficient performance, particularly for assessing the risk of intracranial haemorrhage. We aimed to develop new risk scores incorporating clinical variables and cerebral microbleeds, an MRI biomarker of intracranial haemorrhage and ischaemic stroke risk. METHODS: We did a pooled analysis of individual-patient data from the Microbleeds International Collaborative Network (MICON), which includes 38 hospital-based prospective cohort studies from 18 countries. All studies recruited participants with previous ischaemic stroke or transient ischaemic attack, acquired baseline MRI allowing quantification of cerebral microbleeds, and followed-up participants for ischaemic stroke and intracranial haemorrhage. Participants not taking antithrombotic drugs were excluded. We developed Cox regression models to predict the 5-year risks of intracranial haemorrhage and ischaemic stroke, selecting candidate predictors on biological relevance and simplifying models using backward elimination. We derived integer risk scores for clinical use. We assessed model performance in internal validation, adjusted for optimism using bootstrapping. The study is registered on PROSPERO, CRD42016036602. FINDINGS: The included studies recruited participants between Aug 28, 2001, and Feb 4, 2018. 15 766 participants had follow-up for intracranial haemorrhage, and 15 784 for ischaemic stroke. Over a median follow-up of 2 years, 184 intracranial haemorrhages and 1048 ischaemic strokes were reported. The risk models we developed included cerebral microbleed burden and simple clinical variables. Optimism-adjusted c indices were 0·73 (95% CI 0·69-0·77) with a calibration slope of 0·94 (0·81-1·06) for the intracranial haemorrhage model and 0·63 (0·62-0·65) with a calibration slope of 0·97 (0·87-1·07) for the ischaemic stroke model. There was good agreement between predicted and observed risk for both models. INTERPRETATION: The MICON risk scores, incorporating clinical variables and cerebral microbleeds, offer predictive value for the long-term risks of intracranial haemorrhage and ischaemic stroke in patients prescribed antithrombotic therapy for secondary stroke prevention; external validation is warranted. FUNDING: British Heart Foundation and Stroke Association.
Published: 2021
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49. Adipose Stem Cells Enhance Nerve Regeneration and Muscle Function in a Peroneal Nerve Ablation Model

Author: Jacqueline M. Bliley, Andrew Portell, Juliana A. Passipieri, Kaushik P. Venkatesh, George J. Christ, Kacey G. Marra, Joshua Glazier, Joseph A. Frank, Jack Dienes, Damian Grybowski, and Benjamin K. Schilling
Subjects: Pathology, medicine.medical_specialty, medicine.medical_treatment, 0206 medical engineering, Biomedical Engineering, Adipose tissue, Bioengineering, 02 engineering and technology, Biochemistry, Biomaterials, 03 medical and health sciences, Peripheral Nerve Injuries, Peripheral nerve, medicine, Animals, Humans, Muscle, Skeletal, 030304 developmental biology, 0303 health sciences, business.industry, Stem Cells, Regeneration (biology), Peroneal Nerve, Skeletal muscle, Ablation, Sciatic Nerve, 020601 biomedical engineering, Nerve Regeneration, Rats, medicine.anatomical_structure, Quality of Life, Stem cell, business, Function (biology)
Abstract: Severe peripheral nerve injuries have devastating consequences on the quality of life in affected patients, and they represent a significant unmet medical need. Destruction of nerve fibers results in denervation of targeted muscles, which, subsequently, undergo progressive atrophy and loss of function. Timely restoration of neural innervation to muscle fibers is crucial to the preservation of muscle homeostasis and function. The goal of this study was to evaluate the impact of addition of adipose stem cells (ASCs) to polycaprolactone (PCL) nerve conduit guides on peripheral nerve repair and functional muscle recovery in the setting of a critical size nerve defect. To this end, peripheral nerve injury was created by surgically ablating 6 mm of the common peroneal nerve in a rat model. A PCL nerve guide, filled with ASCs and/or poloxamer hydrogel, was sutured to the nerve ends. Negative and positive controls included nerve ablation only (no repair), and reversed polarity autograft nerve implant, respectively. Tibialis anterior (TA) muscle function was assessed at 4, 8, and 12 weeks postinjury, and nerve and muscle tissue was retrieved at the 12-week terminal time point. Inclusion of ASCs in the PCL nerve guide elicited statistically significant time-dependent increases in functional recovery (contraction) after denervation; ∼25% higher than observed in acellular (poloxamer-filled) implants and indistinguishable from autograft implants, respectively, at 12 weeks postinjury (
Published: 2021
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50. Vision loss in patients with giant cell arteritis treated with tocilizumab

Author: Godehard Scholz, Jennifer Amsler, Odile Stalder, Lisa Christ, Christoph Tappeiner, Iveta Kysela, Luca Seitz, Peter M. Villiger, Stephan Reichenbach, and Florian Kollert
Subjects: Male, medicine.medical_specialty, lcsh:Diseases of the musculoskeletal system, genetic structures, 610 Medicine & health, Antibodies, Monoclonal, Humanized, chemistry.chemical_compound, Tocilizumab, Vision loss, Internal medicine, medicine, Humans, In patient, Glucocorticoids, Giant cell arteritis, business.industry, Incidence (epidemiology), medicine.disease, Rheumatology, eye diseases, Anterior ischemic optic neuropathy (AION), Treatment Outcome, chemistry, Concomitant, Cohort, Orthopedic surgery, Female, lcsh:RC925-935, business, Research Article
Abstract: Objectives Giant cell arteritis (GCA) may lead to vision loss. To what extent tocilizumab (TCZ) is able to prevent vision loss is unknown. The aim was to analyze the occurrence of vision loss in a large GCA cohort treated with TCZ. Methods In this observational monocentric study, GCA patients treated with TCZ between the years 2010 and 2018 were studied. Demographic, clinical, and laboratory data were analyzed. Results A total of 186 patients were included (62% female); 109 (59%) fulfilled the American College of Rheumatology (ACR) criteria, in 123 (66%) patients, large vessel vasculitis was diagnosed by magnetic resonance-angiography (MRA). Cumulative duration of TCZ treatment was 224 years, median treatment duration was 11.1 (IQR 5.6–17.9) months. Glucocorticoids (GC) were tapered over a median of 5.8 (IQR 3.0–8.5) months. At baseline, visual symptoms were present in 70 (38%) and vision loss in 21 (11%) patients. Patients with vision loss at baseline were older (p = 0.032), had a lower C-reactive protein (p = 0.002), and showed a negative association with MRA of the aorta (p = 0.006). Two patients (1.1%) developed vision loss, both at the initiation of TCZ treatment. Conclusion Our data show a very low incidence of vision loss in TCZ-treated patient. The two cases of AION occurred at the initiation of therapy, they support the hypothesis that advanced, and established structural changes of arteries are key factors for this accident. Whether a shorter duration of concomitant GC treatment is risky regarding vision loss needs to be studied.
Published: 2021
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