Exact Probability Test Research Articles

Coagulase-Negative Staphylococci in Neonatal Blood: How Concerning?

Objective Coagulase-negative staphylococci (CoNS) are being implicated as one of the leading causes of bloodstream infection (BSI). To study the spectrum, prevalence, and antimicrobial susceptibility of CoNS causing BSI in neonates. Materials and Methods A cross-sectional study was done in level III neonatal intensive care unit (NICU). Blood samples in automated culture bottles were processed as per the standard technique. Previously validated methods were followed for the characterization of CoNS and for AST of standard antibiotics by Kirby Bauer disk diffusion and vancomycin by agar dilution. The prevalence of causative organisms and susceptibility of CoNS were statistically analyzed. Categorical variables were compared by chi-square or Fisher's exact probability tests. Result In total, 1,365 blood samples (1,365 neonates) were studied, of which 383 (28.05%) were positive and 982 (71.94%) were negative. Gram-positive organisms (GPC) predominated ( n = 238; 62.14%) ( p < 0.001) with 41.77% (160/383) S. aureus and 13.83% (53/383) CoNS. CoNS included S. epidermidis (19, 38%), S . haemolyticus (7, 14%), S. hominis (6, 12%), S. simulans (6,12%), S. capitis (5,10%), S. cohnii (4, 8%), S. warneri (1, 2%), and S. xylosus (1, 2%). The susceptibility to netilmicin, linezolid, and vancomycin was 100% ( p ≤ 0.001), and 54% ( n = 27) had vancomycin MIC of 0.125 μg/mL but methicillin-resistant CoNS (MRCoNS) was 70%. Methicillin-susceptible (MS) CoNS had lower MIC of vancomycin ( p < 0.05) than MRCoNS. Conclusion The spectrum of pathogens causing BSI in neonates is changing with predominance of GPC and among CoNS, S. epidermidis . Considerable proportion of MRCoNS with the emergence of MIC creep for vancomycin requires immediate attention.

The Role of C- Reactive Protein (CRP) in the Diagnosis of Neonatal Sepsis

Background: Neonatal sepsis or septicemia is the term that has been used to describe the systemic response to infection in a newborn infant during the first 28 days of life. Neonatal mortality is increasingly recognized as an important global public health challenge that must be addressed if we wish to reduce child death disparities between rich and poor countries. Most of the estimated 4 million neonatal deaths per year occur in low and middle-income countries. Objective: The aim of this study is to evaluate the role of C-reactive protein (CRP) in the diagnosis of neonatal sepsis. Method of the Study: This is a cross-sectional study carried out in the Department of Neonatology, BSMMU, Dhaka over a period of 6 months between January 2013 to June 2013. Newborns with suspected sepsis admitted to BSMMU were the study population. Clinically diagnosed cases of neonatal sepsis aged &lt; 28 days of both sexes whose parents or guardians provided informed consent were eligible for enrollment in the study. The subjects were selected consecutively from the study population. Data were collected using a structured questionnaire containing all the variables of interest. Data were processed and analyzed using the computer software SPSS (Statistical Package for Social Sciences). The test statistics used to analyze the data were Chi-square (χ2) or Fisher’s Exact Probability Test &amp; Student’s t-Test. Result: The sensitivity of CRP in correctly detecting neonatal sepsis of those who have the disease is 94.44%, while the specificity of the test in correctly differentiating neonates who do not have the disease is 13.72%. The positive predictive value (PPV) of the test is 27.86% and the negative predictive value of the test is 87.5%. The percentages of false positives and false negatives as yielded by the test are 72.13% and 12.5% respectively. Conclusion: The sensitivity of CRP was higher at 94.44% but specificity was low 13.72%. A combination of tests may increase the sensitivity, ........

The association between gingivitis and oral spirochetes in young cats and dogs.

Although gingivitis frequently occurs in young cats, spirochetes are often found in the early stages of periodontal disease. This study was conducted to determine the association between gingivitis and oral spirochetes in young cats and dogs. The degree of gingivitis was evaluated in a total of 68 cats and 31 dogs under one year of age, and plaques were collected from each carnassial. To detect spirochetes or Porphyromonas gulae in plaque samples, 16S rRNA gene was amplified by polymerase chain reaction (PCR) using specific primers. All data were analyzed using Fisher's exact probability test and odds ratio (OR) with a 95% confidence interval (95% CI). The prevalence of gingivitis was significantly higher in young cats (92.6%) than in young dogs (45.2%). The positive rate of spirochetes by PCR in gingivitis cases was 85.4% in young cats and 15.4% in young dogs, and the positive rate of P. gulae was 66.7% in young cats and 15.4% in young dogs. Both results were significantly higher in young cats than in young dogs. In young cats, spirochetes were significantly associated with gingivitis (OR = 7.95; 95% CI = 1.17, 53.83; P < 0.05), but P. gulae was not (OR = 2.44; 95% CI = 0.38, 15.66; P = 0.23). These results suggest that spirochetes may be associated with the early stages of periodontal disease in cats.

The Causative Organism of Neonatal Sepsis by Blood Culture

Background: Neonatal septicemia is a clinical illness that occurs within the first four weeks of life and is defined by systemic signs and symptoms brought on by a widespread bacterial infection. The most frequent cause of illness and mortality in the neonatal era is bacterial infections. Early detection of this potentially fatal illness is essential for prompt treatment and a successful outcome since complications like shock, disseminated intravascular coagulation, and multi-system organ failure can lead to the fulminant and lethal course of infection. Objective: The present study was undertaken to detect the causative organism of neonatal sepsis by blood culture. Method of the Study: This is a cross- sectional study carried out in the Department of Neonatology, BSMMU, Dhaka over a period of 6 months between January 2013 to June 2013. Newborns with suspected sepsis admitted to BSMMU were the study population. Clinically diagnosed cases of neonatal sepsis aged &lt; 28 days of both sexes whose parents or guardians provided informed consent were eligible for enrollment in the study. The subjects were selected consecutively from the study population. Data were collected using a structured questionnaire containing all the variables of interest. Data were processed and analyzed using the computer software SPSS (Statistical Package for Social Sciences). The test statistics used to analyze the data were Chi-square (χ2) or Fisher’s Exact Probability Test &amp; Student’s t-Test. Result: The study included a total of 138 neonates (both preterm and term) of clinically diagnosed cases of sepsis. All the neonates were subjected to test for WBC, IT ratio CRP, and blood culture. In terms of gestational age over 80% were preterm and the rest 19.6% were term neonates. Among the neonates, 40 (29%) had early onset sepsis (EOS) and 98(71%) had late-onset sepsis (LOS). Of the culture- positive cases, Klebsiella was predominant (33.33%) followed by E. coli (22.2%), Acinetobacter (16.66%) and Pseudomonas (11.1%). Less commonly found organisms are Staphylococcus aureus, Enterobacter, Enterococcous Cytrobacter, and others. Conclusion: Sepsis screening is more useful for ruling out the diagnosis of newborn septicemia, which can be made rationally if two screenings conducted 12 to 24 hours apart are negative. It is preferable to wait for the findings of the sepsis screen before starting antibiotics in a neonate who is otherwise stable or suspected of having sepsis due to maternal risk factors.

Intrathecal Buprenorphine versus Intrathecal Fentanyl as Adjuvants to Hyperbaric Bupivacaine in Spinal Anaesthesia for Lower Segment Caesarean Sections: A Randomised Clinical Study

Introduction: Spinal anaesthesia is the choice technique for Lower Segment Caesarean Section (LSCS). When using subarachnoid block (spinal analgesia), opioids are employed as the main adjuvants along with local anaesthetics to achieve intra/postoperative analgesia. These opioids have desirable properties such as reducing the dose of local anaesthetics, minimising side-effects, providing analgesia, and prolonging the duration of anaesthesia. Aim: To evaluate and compare the efficacy between intrathecal Buprenorphine and Fentanyl as adjuvants to hyperbaric bupivacaine (0.5%) in women undergoing LSCS under spinal anaesthesia. Materials and Methods: A randomised double-blinded clinical trial was conducted at Bharati Vidyapeeth Hospital and Research Centre in Pune, Maharashtra, India between July 2021 and February 2022. A total of 80 parturients with American Society of Anaesthesilogists (ASA) grade II, aged 18 and older, scheduled for elective LSCS, were randomly divided into two groups of 40 each. Group B received 1.8 mL of 0.5% Bupivacaine with 60 μg Buprenorphine, while Group F received 1.8 mL of 0.5% Bupivacaine with 25 μg Fentanyl. The onset/duration of motor block and sensory block, intraoperative haemodynamics, sideeffects, postoperative pain, and demand for the first rescue analgesia were assessed using Chi-square test, Fisher’s-exact probability test, or independent sample t-test. Results: Demographic data such as age, weight, Body Mass Index (BMI), and ASA grade were similar in both groups. The mean duration of surgery in Group B and Group F was 48.12±6.86 min and 48.25±6.56 min, respectively. The mean duration of sensory blockade in Group B was 264.38±37.16 min, and in Group F it was 193.50±34.27 min. The total duration of motor block was 231.00±43.74 minutes in Group B and 171.00±36.87 min in Group F. The total duration of sensory and motor block in Group B was significantly longer (p-value &lt;0.05). The mean time to first rescue analgesia in Group B and Group F was 304.63 min and 228.63 min, respectively (p-value &lt;0.05). Conclusion: The present study concluded that both drugs are safe and suitable as adjuvants with local anaesthetics in spinal anaesthesia for LSCS. The addition of intrathecal buprenorphine to bupivacaine provides a more promising postoperative analgesic effect compared to intrathecal fentanyl, without causing any significant maternal or neonatal side-effects.

Analysis of microbial colonies from the first-pass meconium of healthy neonates: Comparison of vaginally and cesarean section born

Abstract Background: The colonization and diversification of early microbes in the infant digestive tract are crucial to the health and pathophysiology of all neonates. Fundamentally, whether the gut is sterile at birth is the key question in understanding human microbial colonization. Although the gut of an infant at birth has long been believed sterile, this paradigm has been challenged. Objectives: To confirm or reject the fist-pass meconium is sterile. Methods: The first-pass meconium of healthy term infants was collected and examined by the bacterial inoculation and identification, and molecular analysis. Results were correlated with their delivery modes. First-pass meconium was immediately collected from 60 full-term newborns. Fresh meconium was examined by the bacterial inoculation and identification. DNA was extracted from the meconium samples for real-time polymerase chain reaction. The comparisons of fecal bacterial counts by the mode of delivery were calculated by using unpaired Student’s t test. Differences in the detection rate of bacteria were calculated by Fisher’s exact probability test (Statistical Package for the Social Sciences [SPSS], version 10). P &lt; 0.05 was considered statistically significant. Results: In the vaginally born (VB) group, 46.34% of meconium samples had detectable microbes, which were associated with vaginosis and existed in the urine and stool. In the cesarean-section born (CB) group, although microbes could not be isolated by the traditional bacterial culture methods, the bacterial counts and bacterial DNAs were detected by molecular technology. Conclusion: Meconium is not sterile. Bacteria were present in the first-pass meconium of term, healthy, VB and CB infants.

Early Cranial Ultrasound Changes as Predictors of Outcome during First Year of Life in Infants with Perinatal Asphyxia- A Prospective Cohort Study

Introduction: Perinatal Asphyxia (PA) causes impaired exchange of ventilatory gases, or ischemia that leads to persistent decrease in oxygen levels (hypoxemia) and increase in carbon dioxide levels (hypercarbia). It occurs during the peripartum period can contribute to early neonatal mortality and morbidity. Aim: To assess the role of early changes in cranial ultrasound a predictor of outcome in babes with PA. Materials and Methods: This prospective cohort study was conducted in a tertiary care neonatal unit in Maharani Laxmi Bai Medical College, Jhansi, Uttar Pradesh, India, from July 2018 to October 2019. A total of 50 neonates with PA were studied. Cranial ultrasound was performed at or after seven days of life. Neurodevelopment assessment of the subjects were done at 3, 6, 9 and 12 months of life using Development Quotient (DQ). Variables were analysed by student’s t-test and categorical variables were analysed by Fisher’s-exact probability test using graph pad software. Results: Out of 50 infants of PA, 29 had an abnormal ultrasound scan and 21 had normal ultrasound scan. A 16/29 patients had abnormal outcome along with abnormal ultrasound scan while rest of the 13 had normal outcome. The mean DQ of the neonates having abnormal ultra sonographic examination was significantly lower as compared to those with normal examination. A 6 out of 21 neonates had abnormal outcome inspite of having normal ultrasound scan. Cranial ultrasound has a specificity=55%, sensitivity=73%, Positive Predictive Value (PPV)=58% and Negative Predictive Value (NPV)=71% in predicting neurodevelopment outcome of patients with birth asphyxia. Conclusion: Cranial Utrasonography (USG) findings in PA babies reveal a strong association with the development severity.

Analysis of differentially expressed microRNA and protein expression profiles carried by exosomes in the plasma of patients with Takayasu's arteritis

Objective: To detect the microRNAs (miRNAs) and proteins carried by exosomes in the plasma of patients with newly diagnosed Takayasu's arteritis (TAK) and analyze their possible roles in the pathogenesis of TAK. Methods: Ten patients with newly diagnosed TAK from the Department of Rheumatology and Immunology, Peking Union Medical College Hospital were selected during June-November 2020. Five healthy controls were matched with five patients by age and sex. RNA sequencing and protein mass spectrometry were used to detect miRNAs and proteins, respectively, carried by exosomes in the plasma. Differentially expressed miRNAs (DE-miRNAs) and proteins (DEPs) were screened. Thereafter, hierarchical cluster analysis, function, signal pathway, and protein domain enrichment analysis of DE-miRNAs and DEPs were performed. Finally, miRNAs and proteins related to vasculitis and autoimmunity were identified. The possible roles of the miRNAs and proteins in the pathogenesis of TAK were explored. Enumeration data were compared using Fisher's exact probability test or Chi-square test, and a P-value<0.05 was considered significant. Results: Compared with the healthy controls, patients with TAK had 29 DE-miRNAs on their plasma exosomes. Among these DE-miRNAs, miR-101-3p, miR-122-5p, miR-143-3p, miR-185-3p, miR-192-5p, miR-194-5p, miR-19a-3p, miR-19b-3p, miR-20b-5p, miR-21-5p, miR-22-3p, miR-335-5p, miR-34a-5p, miR-3613-5p, miR-548ad-5p, miR-590-3p, and miR-7-5p were upregulated; whereas miR-1249-3p, miR-141-3p, miR-199a-5p, miR-199b-5p, miR-200a-3p, miR-200c-3p, miR-204-5p, miR-29c-5p, miR-335-3p, miR-381-3p, miR-4433b-5p, and miR-584-5p were downregulated. Finally, miR-34a-5p, miR-200c-3p, miR-143-3p, miR-22-3p, and miR-21-5p were identified. Among the 357 DEPs screened, 236 DEPs were upregulated, whereas 121 DEPs were downregulated. Finally, kallikrein B1 (KLKB1), kininogen 1 (KNG1), desmoplakin (DSP) were identified. Conclusion: MiR-34a-5p, miR-200c-3p, miR-143-3p, miR-22-3p, miR-21-5p, KLKB1, KNG1, and DSP carried by exosomes in plasma might participate in the pathogenesis of TAK by regulating vascular physiology, inflammation, autoimmunity, and other processes. They may be biomarkers and therapeutic targets of TAK.

Facilitated self-medication practice in pharmacies in combating oral health needs: A questionnaire-based study

Abstract Aim: Many dental patients seek symptomatic treatment at pharmacies due to the lack of awareness and cost of definitive treatments such as fillings, scaling, and root canal therapy. Pharmacists are increasingly facilitating dental health self-medication due to this trend. Thus, this study aimed to determine the prevalence of pharmacist-facilitated self-medication and medication dispensing for dental and oral health needs, as well as their perspectives and limitations. Materials and Methods: In this questionnaire-based study, 101 pharmacists were enrolled using a convenience sampling method. The questionnaire survey tool comprised 21 close-ended questions distributed under three sections: demographics, facilitated self-medication practice, and attitude toward it, providing us with a prevalence of pharmacist-facilitated self-medication and their perspective toward this practice. Chi-square test or Fisher’s exact probability test along with logistic regression was performed for statistical analysis of data. Results: The study found that 96% of pharmacists dispensed prescription and OTC dental drugs. Analgesics (76.2%), antipyretics (52.5%), and antibiotics (46.5%) were the most common medications dispensed by respondents for toothache. Mild problems, patient experience, and self-knowledge allowed for rational self-medication. The main argument against the practice was that dentists should solely prescribe dental medications as they need more definitive treatment rather than arbitrary consumption of antibiotic. Conclusion: This study reveals a high prevalence of facilitated self-medication with non-steroidal anti-inflammatory drugs being the most commonly dispensed drug for oral health needs. Further studies with greater inclusive sample size are required to assess, monitor the effects of pharmacist-facilitated self-medication, and suggest amendments in pharmacy act for the benefit of both dental patients and community pharmacists.

A Descriptive Cross-Sectional Study on Clinical Profile and Outcome of Delirium in Trauma Patients in the Semi-Closed Intensive Care Unit of a Medical College

Introduction: Delirium in trauma patients is common and underdiagnosed.&#x0D; Objectives: This study aimed to identify the risk factors and outcome of delirium in trauma patients in a mixed semi-closed intensive care unit.&#x0D; Methodology: This descriptive cross-sectional study was done on 77 patients of age 18 years or more admitted for more than 24 hours with the history of road traffic accidents, falls, drowning, physical assaults, and self- inflicted violence in a level three intensive care unit of the National Medical College for six months. The whole sampling method was used in our study and all cases during a given time were included in the study. The Confusion Assessment Method-ICU and Richmond Agitation Sedation Scale were used to diagnose delirium and level of arousal respectively. All data was transferred to the excel sheet and transferred to a statistical package for the social sciences-16. The Chi-square test and Fisher’s exact probability test were used to detect the difference between groups in the univariate analysis, as appropriate. The variables were analyzed using binary logistic regression. Any variables which had P&lt;0.2 after the univariable risk regression and all other potential variables associated with the delirium were included for the multivariable risk regression. The level of significance was P&lt;0.05.&#x0D; Result: Of the 77 ICU admissions 17(22.1%) developed delirium. Hyperactive delirium was the most common motor subtype 9(52.9%). The mean duration of delirium was 3.69±4.06 days. Age, hypertension, blood transfusion, and orthopedic trauma were identified as risk factors for delirium. Delirious patients had a longer length of stay in the ICU (7.0 ±4.6 vs 4.5±4.1 days) with no impact on the duration of mechanical ventilation, mortality, reintubation, and unplanned extubation.&#x0D; Conclusion: Age, hypertension, blood transfusion and orthopaedic trauma were identified as the risk factor for delirium in trauma patients that should be identified early to prevent complications such as longer length of stay in the ICU, longer duration of mechanical ventilation, mortality, reintubation and unplanned extubation.

Interpersonal Communication Skills Of Pediatric Residents Of Tertiary Care Teaching Hospital, Eastern Uttar Pradesh, India: A Pilot Study

Introduction: Effective communication set a platform where parents feel connected with his or her doctors, which can ultimately improve health, mediated through participation in care.&#x0D; Aims: To Assess the interpersonal communication skills of Paediatric resident doctors.&#x0D; Settings and Design: Tertiary Care Teaching Hospital, Eastern Uttar Pradesh, India.&#x0D; Methods and Material: - A cross-sectional study was conducted among all Pediatrics trainee residents working in department of Pediatrics, Tertiary Care Teaching Hospital, Eastern Uttar Pradesh, India. A standardized self-administered questionnaire (Interpersonal Communication Skill Inventory) was used to assess the IPC skills. The inventory has four sections which includes, delivering clear messages, active listening, giving and getting feedback and handling of emotional interaction while communications.&#x0D; Statistical analysis used: The data were tabulated and analyzed with SPSS-19 and Fisher exact probability test was used to compare the data.&#x0D; Results: Total of 45 residents was assessed, male were 19 and female were 26. Age of resident doctors was between 25 to 30 yrs. Out of 45 residents, 57.8% were confident in sending the clear messages 31.1% were active listener, 20% were confident in giving and the getting the feedback, and 15.5% were confident in handling the Emotional Interactions. Female residents were confident in giving and getting feedback (p=0.01) and handling emotional interactions (p=0.03). Increased in experiences improves handling emotional interactions (p=0.03)&#x0D; Conclusions: The delivering clear messages and active listening during conversation improved with experience whereas, to improve skills like handling emotional interaction and giving and the getting feedback of resident doctor would require structured training program.

1071. Retrospective study evaluating the cytokine dynamics in COVID-19 patients who were treated with casirivimab/imdevimab

Abstract Background Neutralizing antibody therapy such as casirivimab/imdevimab is known to significantly reduce the viral load of SARS-CoV-2, but there is limited study on the clinical prognosis of neutralizing antibody therapy, especially in Asia, and the dynamics of cytokines is unknown worldwide. Several cytokines have been investigated as biomarkers to predict oxygen demand, among which CCL17 and INF3 have received approved and covered by the national health insurance in Japan. Methods Between July 2021 - December 2021, patient’s demographic, laboratory, radiological findings, prognosis, and cytokine kinetics (IFN-λ3, CCL17) at National Center for Global Health and Medicine, Tokyo, Japan, were analyzed using medical charts and serum samples. Univariate analysis was performed using Fisher's exact probability test and Mann-Whitney U test to evaluate the clinical characteristics of the group with oxygen demand compared with those of the group without oxygen demand. Results Thirty-four patients were analyzed. The median age of the cohort was 57.5 years (IQR 52.8-67.3), and 25 (73.5%) were male. Eight patients (23.5%) had been fully vaccinated and three patients (8.8%) had been vaccinated once. The severity of disease before casirivimab/imdevimab was asymptomatic in two (5.9%), mild in 12 (35.3%), moderate in 20 (58.8%) cases. Of the 17 cases in which mutant strains were identified, 16 were delta strains. The IFN-λ3 level (pg/mL) before casirivimab/imdevimab was significantly higher (7.6 vs. 17.2, p = 0.005), while the CCL17 level (pg/mL) was significantly lower (148.8 vs. 64.2, p = 0.036) in the group with oxygen demand during the therapeutic course compared to those in the group without oxygen demand. After casirivimab/imdevimab was administered, the IFN-λ3 level decreased to a median of 0.0 (IQR 0.0-0.3), while the CCL17 level increased to median of 220.3 (IQR 135.8-304.8), with no statistically significant differences between both groups (Figure 1). None of the patients became seriously ill. Figure 1A and 1B show the changing of the cytokine dynamics in COVID-19 patients who were treated with casirivimab/imdevimab on IFN-λ3 level and CCL17 level, respectively. Conclusion There was a statistically significant difference between IFN-λ3 and CCL17 levels before casirivimab/imdevimab in both groups. Our results suggest that casirivimab/immudevimab may improve the clinical prognosis for COVID-19 patients with delta strains. Disclosures All Authors: No reported disclosures.

Anteromedial Portal Technique, but Not Outside-in Technique, Is Superior to Standard Transtibial Technique in Knee Stability and Functional Recovery After Anterior Cruciate Ligament Reconstruction: A Network Meta-analysis

To compare the postoperative outcomes of 4 different femoral drilling techniques in anterior cruciate ligament reconstruction. Three databases were searched for randomized controlled trials comparing any 2 or more of the following femoral drilling techniques in anterior cruciate ligament reconstruction: standard transtibial (sTT), anteromedial portal (AMP), outside-in (OI), or modified transtibial (mTT) technique. A Bayesian network meta-analysis was performed to assess postoperative stability and functional recovery in terms of the side-to-side difference (measured by arthrometry), Lachman test, pivot-shift test, International Knee Documentation Committee subjective and objective scores, Lysholm score, and Tegner score. The Fisher exact probability test and χ2 test were used to compare the incidences of infection and graft rupture, respectively. We included 20 randomized controlled trials involving 1,515 patients. The AMP technique showed a lower side-to-side difference (standardized mean difference, -0.33; 95% credible interval [CrI], -0.53 to -0.12), higher negative rate on the pivot-shift test (odds ratio, 2.19; 95% CrI, 1.38 to 3.44), and higher International Knee Documentation Committee objective score (odds ratio, 3.13; 95% CrI, 1.42 to 7.82) than the sTT technique. However, knee stability and functional outcomes did not differ significantly between the OI and sTT techniques. Safety outcomes of the mTT technique were unavailable. The incidence of graft rupture was 5.20% for the OI technique, 2.27% for the AMP technique, and 1.51% for the sTT technique. The OI technique had a significantly higher incidence of graft rupture than the sTT technique (χ2= 4.421, P= .035). No significant difference in the incidence of infection was found between the sTT, AMP, and OI techniques (P= .281). The AMP technique, but not the OI technique, was superior to the sTT technique in knee stability and functional recovery. The OI technique had a higher incidence of graft rupture than the sTT technique. There was no significant difference between the AMP and OI techniques or between the mTT technique and any other femoral drilling technique. Level II, meta-analysis of Level I and II studies.

Correlations of serum TgAb and TPOAb and clinicopathological features of PTC in children and adolescents

Objective: To analyze the correlations between serum thyroglobulin antibody (TgAb) and thyroid peroxidase antibody (TPOAb) and clinicopathological features in children and adolescents with papillary thyroid carcinoma (PTC). Methods: A retrospective analysis was conduced on the clinicopathological data of children and adolescents (age≤21 years old) with PTC admitted to Tianjin Medical University Cancer Hospital from 2011 to 2019, and then, we used χ2 test or Fisher's exact probability test to compare the differences in clinicopathological characteristics between groups with different TgAb and TPOAb status and multivariate logistic regression model analysis to evaluate independent predictors of cervical lymph node metastasis. Results: A total of 304 patients, including 89 males and 215 females, aged 5-21 years (median age 19 years), were enrolled in this study. The comparison between groups with different TgAb and TPOAb status showed that there were significant differences in gender, preoperative thyroglobulin (Tg) level, primary tumor location, number of primary tumors and maximum tumor diameter (all P<0.05), which suggested that TgAb+group (n=81) and TPOAb+group (n=84) had relatively better primary tumor characteristics. Patitents with TgAb+and TPOAb+were more common in females and their preoperative Tg level was mostly within the normal range, and there were significant differences in primary tumor location, number of primary tumors and maximum tumor diameter between TgAb+and TgAb-(223 cases) groups (all P<0.05). There was significant difference in the maximum tumor diameter between TPOAb+and TPOAb-(220 cases) groups (P<0.05). Analysis of risk factors for cervical lymph node metastasis showed that independent risk factors for central lymph node metastasis were maximum tumor diameter>2 cm (OR=2.84, 95%CI: 1.59-5.07, P<0.001) and extra-thyroid extension (OR=0.32, 95%CI: 0.17-0.60, P<0.001), and independent risk factors for lateral neck lymph node metastasis included age≤14 years old (OR=0.34, 95%CI: 0.18-0.67, P=0.002), preoperative Tg+(OR=2.16, 95%CI: 1.10-4.24, P=0.026) and maximum tumor diameter>2 cm (OR=3.99, 95%CI: 2.33-6.82, P<0.001). Conclusion: It is recommended to test routinely serum TgAb and TPOAb before surgery in children and adolescents with PTC. Preoperative Tg+, age≤14 years, maximum tumor diameter>2 cm, and extra-thyroid extension are risk factors for cervical lymph node metastasis.

Comparison study of clinicopathological features of cellular schwannoma between retroperitoneum and other sites.

Cellular schwannoma (CS) is a relatively rare neural tumor with few reports. This study aimed to compare the clinicopathological characteristics of CS in the retroperitoneum and other sites by analyzing the hematoxylin-eosin (HE) staining and immunohistochemical (IHC) staining results, to provide some help for pathological diagnosis. A total of 79 CS cases from the Department of Pathology, Peking University International Hospital were collected, and the diagnosis was based on the 5th WHO classification of soft tissue tumors. The staining results of HE and IHC were judged and analyzed according to the instructions. The t-tests, Chi-square test and Fisher's exact probability test were used for statistical analysis. Compared with other sites, the volume of retroperitoneal CS tumors were larger (t=4.265, P=0.001) and more likely to recur (χ2=4.223, P=0.04). Nerve sheath structures were rare around the tumors (χ2=60.096, P=0.000). Immunohistochemically, there was a difference in the expression of glial fibrillary acidic protein (GFAP), Cytokeratin (CK), and myelin basic protein (MBP) between the two groups (χ2=54.290, P=0.000; χ2=4.879, P=0.027; χ2=31.792, P=0.000). But there was no difference in expression between the two groups in the other indexes. It founded that Retroperitoneal CS was often positive for GFAP and CK, suggesting it originated from unmyelinated Schwann cells. CS in other sites, the expression of GFAP and CK was often negative, indicating they derived from myelinated Schwann cells. The expression of MBP in the peripheral nerve sheath structure of CS can be used to determine whether the tumor originates from myelinated or unmyelinated Schwann cells. These findings may provide a reference for revealing pathogenesis, diagnosis and evaluating prognosis of CS.

Comparison of Subjective Facial Emotion Recognition and "Facial Emotion Recognition Based on Multi-Task Cascaded Convolutional Network Face Detection" between Patients with Schizophrenia and Healthy Participants.

Patients with schizophrenia may exhibit a flat affect and poor facial expressions. This study aimed to compare subjective facial emotion recognition (FER) and FER based on multi-task cascaded convolutional network (MTCNN) face detection in 31 patients with schizophrenia (patient group) and 40 healthy participants (healthy participant group). A Pepper Robot was used to converse with the 71 aforementioned participants; these conversations were recorded on video. Subjective FER (assigned by medical experts based on video recordings) and FER based on MTCNN face detection was used to understand facial expressions during conversations. This study confirmed the discriminant accuracy of the FER based on MTCNN face detection. The analysis of the smiles of healthy participants revealed that the kappa coefficients of subjective FER (by six examiners) and FER based on MTCNN face detection concurred (κ = 0.63). The perfect agreement rate between the subjective FER (by three medical experts) and FER based on MTCNN face detection in the patient, and healthy participant groups were analyzed using Fisher's exact probability test where no significant difference was observed (p = 0.72). The validity and reliability were assessed by comparing the subjective FER and FER based on MTCNN face detection. The reliability coefficient of FER based on MTCNN face detection was low for both the patient and healthy participant groups.

The regularity of sensory recovery after wound repair on the wrist and back of hand with anterolateral femoral flap without nerve anastomosis

The regularity of sensory recovery after wound repair on the wrist and back of hand with anterolateral femoral flap without nerve anastomosis

Characteristics of cow's milk allergy and sensitization in Chinese patients.

Characteristics of cow's milk allergy and sensitization in Chinese patients.

Comparative study of the effects between second toe tibial dorsal artery flap and second toe tibial plantar proper artery flap in repairing finger skin and soft tissue defects

Objective: To compare the effects between second toe tibial dorsal artery flap (2-TDAF) and second toe tibial plantar proper artery flap (2-TPPAF) in repairing finger skin and soft tissue defects. Methods: A retrospective cohort study was conducted. From January 2019 to June 2020, 27 patients with skin and soft tissue defects at the fingertips with area of 1.5 cm×1.2 cm-2.6 cm×1.8 cm after debridement who met the inclusion criteria were admitted to Suzhou Ruihua Orthopaedic Hospital, including 21 males and 6 females, aged 19-59 (37±10) years. According to flap repair methods used in the defective fingers, the patients were divided into 2-TDAF group (12 cases) and 2-TPPAF group (15 cases). The area of 2-TDAF ranged from 1.5 cm×1.2 cm to 2.5 cm×1.6 cm, and the area of 2-TPPAF ranged from 1.7 cm×1.3 cm to 2.6 cm×1.8 cm. Full-thickness skin grafts from the medial side of the ipsilateral leg were grafted to the wounds in donor sites, and the wounds in donor sites of skin grafts were directly sutured. Flap arterial diameter, flap excision time, flap survival situation of patients in 2 weeks after operation, and follow-up time were recorded. At the last follow-up, the two-point discrimination distance of flap graft site, total action motion (TAM) of the finger joints, and wound healing of the flap donor site were recorded; the Vancouver scar scale (VSS) was used to score the scar in donor area of the second toe and the recipient area of fingers; the appearance and self-satisfaction subscales of the Michigan hand outcomes questionnaire (MHQ) were used to evaluate the affected finger. Data were statistically analyzed with independent sample t test or Fisher's exact probability test. Results: The flap artery diameter of patients in 2-TDAF group was 0.35-0.80 (0.56±0.14) mm and the flap cutting time was (14.0±2.7) min, which were significantly shorter than 0.80-1.35 (1.02±0.16) mm and (19.7±3.4) min in 2-TPPAF group (with t values of 7.81 and 4.79, respectively, P<0.01). The flaps of patients in the 2 groups in recipient areas survived well in 2 weeks after operation, and the wounds in donor areas of flaps of patients in the 2 groups healed well at the last follow-up. There was no statistically significant difference in the postoperative follow-up time, and two-point discrimination distance of flap graft site, TAM of the finger joints, VSS score of scar in the second toe donor site and the finger recipient site, and the appearance and self-satisfaction of MHQ scores of the affected finger at the last follow-up (P>0.05). Conclusions: Compared with 2-TPPAF, 2-TDAF has a shallower anatomical layer and shorter time for surgical flap removal, which can preserve the proper arteries and nerves at the base of the toes and reduce the damage to the donor site.

Mid-Term Outcomes of Cemented Stem and Subtrochanteric Shortening Derotational Osteotomy in Total Hip Arthroplasty for Crowe IV Developmental Dysplasia.

Performing subtrochanteric osteotomy with cemented components in patients with Crowe IV developmental dysplasia of the hip (DDH) is technically challenging and not widely reported. This study aimed to evaluate the mid-term outcomes of cemented stem total hip arthroplasty (THA) with subtrochanteric femoral shortening and transverse derotational osteotomy in patients with Crowe IV DDH. Data collected from patients with Crowe IV DDH who underwent cemented stem THA with subtrochanteric femoral shortening and transverse derotational osteotomy between 2010 and 2018 were retrospectively evaluated. The cemented Lubinus SP II femoral component and the cementless CombiCup acetabular component were used together in all cases. These data, including Harris hip scores, limb length discrepancy (LLD), severity of limp, Trendelenburg test, bone union, length of the resected femur, limb lengthening, level of the osteotomy site, and length bridging the osteotomy site, as well as complications, were analyzed. A paired Student t-test was used to analyze continuous variables, categorical data were compared using Fisher's exact probability test, and correlation analysis was performed using Spearman's rank correlation coefficient. Among 14 included patients (10 females and four males), the mean age was 60.4 years (range, 47-73). The mean follow-up period was 49.1 months, and no patient was lost to follow-up. The mean Harris hip score improved from 40.7 to 87.7. The mean LLD decreased from 52 to 12.7 mm. The mean length of the excised femoral segment was 38.4 mm, and the mean length of limb lengthening was 27.1 mm. The mean distance between the osteotomy site and the lesser trochanter was 21.1 mm after surgery. The mean length of the femoral stem bridging the osteotomy site was 97.6 mm. Finally, the mean osteotomy union time was 10.6 months. No statistically significant correlation was found between the osteotomy union time and these factors. No neurological deficits were noted. Delayed union was observed in one patient, and postoperative dislocation was observed in two patients. Cement leakage into the osteotomy gap was observed in one patient, however, no revisions were required, and no signs of loosening or migration were observed. Cemented stem THA combined with subtrochanteric femoral shortening and transverse derotational osteotomy is safe and effective in treating patients with Crowe IV DDH. Rather than leading to nonunion, cement leakage may negatively affect bone healing.