Chat Generative Pretrained Transformer (ChatGPT) and Bard: Artificial Intelligence Does not yet Provide Clinically Supported Answers for Hip and Knee Osteoarthritis

BACKGROUND

Advancements in artificial intelligence (AI) have led to the creation of large language models (LLMs), such as Chat Generative Pretrained Transformer (ChatGPT) and Bard, that analyze online resources to synthesize responses to user queries. Despite their popularity, the accuracy of LLM responses to medical questions remains unknown. This study aimed to compare the responses of ChatGPT and Bard regarding treatments for hip and knee osteoarthritis with the American Academy of Orthopaedic Surgeons (AAOS) Evidence-Based Clinical Practice Guidelines (CPGs) recommendations.

METHODS

Both ChatGPT (Open AI) and Bard (Google) were queried regarding 20 treatments (10 for hip and 10 for knee osteoarthritis) from the AAOS CPGs. Responses were classified by 2 reviewers as being in "Concordance," "Discordance," or "No Concordance" with AAOS CPGs. A Cohen's Kappa coefficient was used to assess inter-rater reliability, and Chi-squared analyses were used to compare responses between LLMs.

RESULTS

Overall, ChatGPT and Bard provided responses that were concordant with the AAOS CPGs for 16 (80%) and 12 (60%) treatments, respectively. Notably, ChatGPT and Bard encouraged the use of non-recommended treatments in 30% and 60% of queries, respectively. There were no differences in performance when evaluating by joint or by recommended versus non-recommended treatments. Studies were referenced in 6 (30%) of the Bard responses and none (0%) of the ChatGPT responses. Of the 6 Bard responses, studies could only be identified for 1 (16.7%). Of the remaining, 2 (33.3%) responses cited studies in journals that did not exist, 2 (33.3%) cited studies that could not be found with the information given, and 1 (16.7%) provided links to unrelated studies.

CONCLUSIONS

Both ChatGPT and Bard do not consistently provide responses that align with the AAOS CPGs. Consequently, physicians and patients should temper expectations on the guidance AI platforms can currently provide.

A triple cysteine motif as major determinant of the modulation of neuronal KV7 channels by the paracetamol metabolite N-acetyl-p-benzo quinone imine

BACKGROUND AND PURPOSE

The analgesic action of paracetamol involves KV7 channels, and its metabolite N-acetyl-p-benzo quinone imine (NAPQI), a cysteine modifying reagent, was shown to increase currents through such channels in nociceptors. Modification of cysteine residues by N-ethylmaleimide, H2O2, or nitric oxide has been found to modulate currents through KV7 channels. The study aims to identify whether, and if so which, cysteine residues in neuronal KV7 channels might be responsible for the effects of NAPQI.

EXPERIMENTAL APPROACH

To address this question, we used a combination of perforated patch-clamp recordings, site-directed mutagenesis, and mass spectrometry applied to recombinant KV7.1 to KV7.5 channels.

KEY RESULTS

Currents through the cardiac subtype KV7.1 were reduced by NAPQI. Currents through all other subtypes were increased, either by an isolated shift of the channel voltage dependence to more negative values (KV7.3) or by such a shift combined with increased maximal current levels (KV7.2, KV7.4, KV7.5). A stretch of three cysteine residues in the S2-S3 linker region of KV7.2 was necessary and sufficient to mediate these effects.

CONCLUSION AND IMPLICATION

The paracetamol metabolite N-acetyl-p-benzo quinone imine (NAPQI) modifies cysteine residues of KV7 subunits and reinforces channel gating in homomeric and heteromeric KV7.2 to KV7.5, but not in KV7.1 channels. In KV7.2, a triple cysteine motif located within the S2-S3 linker region mediates this reinforcement that can be expected to reduce the excitability of nociceptors and to mediate antinociceptive actions of paracetamol.

[Advances in the application of dynamic virtual patients in prosthodontics]

With the development and application of technologies such as facial scanning, intraoral scanning, virtual facebow and mandibular movement tracking in prosthodontics, dynamic virtual patients are gradually applied to preoperative analysis, esthetic diagnosis, treatment planning, and restorative implementation, becoming a research hotspot in recent years. This review focuses on data acquisition, construction of dynamic virtual patients and their application advantages, aiming to provide a reference for the clinical application of related digital technologies.

The effect of training to target cognitive biases towards social rejection in eating disorders

OBJECTIVE

This study examined the effect of cognitive bias modification for interpretation (CBM-I) training in Korean women with eating disorders (EDs).

METHOD

Sixty-three women with EDs participated in the study. Participants were randomly assigned to the intervention group where they received six sessions of CBM-I training (n = 31) in addition to treatment-as-usual or were put on a waiting list (n = 32). Participants' interpretation and attention biases, emotion regulation, affect, and ED psychopathology were assessed at baseline, end-of-intervention (4 weeks), and follow-up (8 weeks).

RESULTS

Participants who completed the CBM-I training displayed greater reductions in negative interpretation bias (Δη2 = 0.107) and emotion dysregulation (Δη2  = 0.085) with medium to large effect sizes compared to the control group, which were maintained from baseline to follow-up. Disengagement from negative faces and a focus on positive faces was found in the intervention group with a moderate effect size at the end-of-intervention (Δη2  = 0.090). Both intervention and control groups showed improvements in ED psychopathology. Baseline neuroticism was positively correlated with CBM-I effect.

DISCUSSION

The results suggest that modifying interpretation bias towards ambiguous social stimuli might be an effective adjuvant treatment to reduce negative expectations of social situations and improve emotion regulation in women with bulimia nervosa and anorexia nervosa.

The Nevus Lipomatosus Superficialis of Face: A Case Report and Literature Review

Nevus lipomatosus superficialis (NLS) is a hamartoma of adipose tissue, rarely reported in the past 100 years. We treated one case, and we conducted a systematic review of the literature. A 41-year-old man presented with a cutaneous multinodular lesion in the posterior region near the right auricle. The lesion was excised and examined histopathologically. To review the literature, we searched PubMed with the keyword "NLS." The search was limited to articles written in English and whose full text was available. We analyzed the following data: year of report, nation of corresponding author, sex of patient, age at onset, duration of disease, location of lesion, type of lesion, associated symptoms, pathological findings, and treatment. Of 158 relevant articles in PubMed, 112 fulfilled our inclusion criteria; these referred to a total of 149 cases (cases with insufficient clinical information were excluded). In rare cases, the diagnosis of NLS was confirmed when the lesion coexisted with sebaceous trichofolliculoma and Demodex infestation. Clinical awareness for NLS has increased recently. NLS is an indolent and asymptomatic benign neoplasm that may exhibit malignant behavior in terms of huge lesion size and specific anatomical location. Early detection and curative treatment should be promoted.

Extended Prophylactic Antibiotics for Primary and Aseptic Revision Total Joint Arthroplasty: A Meta-Analysis

BACKGROUND

There is growing interest in extended antibiotic prophylaxis (EAP) following total joint arthroplasty (TJA); however, the benefit of EAP remains controversial. For this investigation, both oral and intravenous antibiotic protocols were included in the EAP group.

METHODS

The Cochrane Database of Systematic Reviews, Cochrane Register of Controlled Trials, PubMed, MEDLINE, Web of Science, Ovid Embase, Elton B. Stephens CO, and Cumulative Index to Nursing and Allied Health Literature were queried for literature comparing outcomes of primary and aseptic revision total hip arthroplasty (THA) and total knee arthroplasty (TKA) patients who were treated with either ≤24 hours of postoperative antibiotic prophylaxis (standard of care [SoC]) or >24 hours of EAP. The primary outcome was periprosthetic joint infection (PJI). A pooled relative-risk random-effects Mantel-Haenszel model was implemented to compare cohorts.

RESULTS

There were 18 studies with a total of 19,153 patients included. There was considerable variation in antibiotic prophylaxis protocols with first-generation cephalosporins being the most commonly implemented antibiotic for both groups. Patients treated with EAP were 35% less likely to develop PJI relative to the SoC (P = .0004). When examining primary TJA, patients treated with EAP were 39% and 40% less likely to develop a PJI for TJA (P = .0008) and THA (P = .02), respectively. There was no significant difference for primary TKA (P = .17). When examining aseptic revision TJA, EAP led to a 36% and 47% reduction in the probability of a PJI for aseptic revision TJA (P = .007) and aseptic revision TKA (P = .008), respectively; there was no observed benefit for aseptic revision THA (P = .36).

CONCLUSIONS

This meta-analysis demonstrated that patients treated with EAP were less likely to develop a PJI relative to those treated with the SoC for all TJA, primary TJA, primary THA, aseptic revision TJA, and aseptic revision TKA. There was no significant difference observed between EAP and SoC for primary TKA or aseptic revision THA.

The mediating role of the left ventricular mass index on the relationship between the fluid balance and left ventricular diastolic function in patients with chronic kidney disease

BACKGROUND

The pathophysiological mechanism of cardiovascular disease in patients with chronic kidney disease (CKD) is complicated. Mediation analysis is an important statistical tool for gaining insight into the complex mechanisms of exposure-outcome effects. We investigated the potential mediating role of the left ventricular mass index (LVMI) on the association between fluid balance (overhydration/extracellular water, OH/ECW) and left ventricular diastolic function (E/e´ ratio) in patients with CKD not yet on dialysis.

METHODS

Bioimpedance spectroscopy, echocardiography, and laboratory evaluations were performed on 425 consecutive patients on the same day. The patients were classified into two groups according to the estimated glomerular filtration rate corresponding to CKD stages 3 and 5. Mediation analysis was performed using the PROCESS macro and bootstrapping methods.

RESULTS

OH/ECW and LVMI were positively correlated with the E/e´ ratio in both the CKD stages 3 and five groups. In CKD stage 5, there was a statistically significant association between OH/ECW and LVMI, whereas no correlation was observed in CKD stage 3. In the mediation analysis, LVMI positively mediated the relationship between OH/ECW and E/e´ ratio when controlling for confounders in patients with CKD stage 5 (B = 2.602; Boot 95% confidence interval, 1.313-4.076).

CONCLUSION

In our analysis, the indirect effect of mediators was significant in patients with advanced CKD. Therefore, our study suggests that further research on several other risk factors may be needed to determine the underlying mechanisms of association between the associated factors in all CKD stages.

Strikingly High Rates of Periprosthetic Joint Infection Following Revision Surgery for Periprosthetic Fractures Regardless of Surgery Timing

BACKGROUND

Periprosthetic fractures following total hip arthroplasty (THA) often occur in the early postoperative period. Recent data has indicated that early revisions are associated with higher complication rates, particularly periprosthetic joint infection (PJI). The purpose of this study was to assess the effect of timing of periprosthetic fracture surgery on complication rates. We hypothesized that complication rates would be significantly higher in revision surgeries performed within 3 months of the index THA.

METHODS

The Medicare Part A claims database was queried from 2010 to 2017 to identify patients who underwent surgery for a periprosthetic fracture following primary THA. Patients were divided based on time between index and revision surgeries: <1, 1 to 2, 2 to 3, 3 to 6, 6 to 9, 9 to 12, and >12 months. Complication rates were compared between groups using multivariate analyses to adjust for demographics, comorbidities, and types of revision surgery.

RESULTS

Of 492,340 THAs identified, 4,368 (0.9%) had a subsequent periprosthetic fracture requiring surgery: 1,725 (39.4%) at <1 month, 693 (15.9%) at 1 to 2 months, 202 (4.6%) at 2 to 3 months, 250 (5.7%) at 3 to 6 months, 134 (3.1%) at 6 to 9 months, 85 (19.4%) at 9 to12 months, and 1,279 (29.3%) at >12 months. The risk of PJI was 11.0% in the <1 month group, 11.1% at 1 to 2 months, 7.9% at 2 to 3 months, 6.8% at 3 to 6 months, 8.2% at 6 to 9 months, 9.4% at 9 to 12 months, and 8.5% at >12 months (P = .12). Adjusting for confounding factors, risk of PJI following periprosthetic fracture surgery was similar regardless of timing (P > .05). Rates of subsequent dislocation and aseptic loosening were also similar regardless of timing.

CONCLUSIONS

The risk of PJI following repeat surgery for a periprosthetic fracture was strikingly high regardless of timing (6.8 to 11.1%), underscoring the high-risk of complications.

[Long-term clinical evaluation of different types of resin-bonded fixed partial denture to replace lost anterior teeth]

Objective: To evaluate the clinical survival rates and influence factors of different types of resin-bonded fixed partial dentures (RBFPD) used in anterior missing teeth restoration. Methods: Ninety-three RBFPD were delivered to 92 patients [92 patients,43 males and 49 females, average age (46.1±12.8) years] who visited Peking University School and Hospital of Stomatology from January 2006 to December 2021 for restoration of 1 or 2 anterior missing teeth. Altogether 32 cases of glass fiber reinforced RBFPD, 39 cases of glass-based ceramic RBFPD and 22 cases of porcelain-fused-to-metal RBFPD were retrospectively analyzed. The complete survival rate, functional survival rate, patients' satisfaction and color matching of the restorations were recorded and evaluated every year since the replacement with RBFPD. The Kaplan-Meier survival curve method was used for survival analysis, and the Log-rank analysis was used to compare the effect of the number of missing teeth, position (maxillary or mandibular), cantilever or non-cantilever and gender on the survival rate of the restorations. Results: The overall survival time for the 93 RBFPD was 13.7 years (95%CI: 12.3-15.1 years). There was a decreasing trend in complete survival and functional survival for all three material RBFPD from year to year, but complete and functional survival rates exceeded 90% at year 5 and exceeded 80% at year 10. The complete survival rate of the glass-ceramic RBFPD was higher than the other two during the follow-up period, with a complete survival rate of 90% (35/39) at year 15. The porcelain-fused-to-metal RBFPD had a higher functional survival rate in years 1-8, but the complete and functional survival rates showed a substantial decrease after year 9. The single-factor Log-rank analysis showed that the success rate of porcelain-fused-to-metal RBFPD was significantly higher than that of glass fiber reinforced RBFPD (χ²=7.33, P=0.007), and the success rate of RBFPD with 1 missing tooth restored was significantly higher than that of RBFPD with 2 missing teeth restored (χ²=3.23, P=0.072). The differences in success rates between different restoration positions (maxillary and mandibular), cantilever or non-cantilever, and gender factors were not statistically significant (χ²=2.26, P=0.133; χ²=0.68, P=0.411; χ²=1.07, P=0.300). Conclusions: For the restoration of individual missing anterior teeth, both porcelain-fused-to-metal RBFPD and glass-based ceramic RBFPD achieve a high long-term clinical success rate, with glass-based ceramic RBFPD being more able to ensure long-term restorative result.

[Clinical characteristics of children with SARS-CoV-2 Omicron variant infection in Kunming]

Objective: To investigate the clinical characteristics of hospitalized children infected with the Omicron variant in Kunming after the withdrawal of non-pharmaceutical interventions (NPI) and analyze the risk factors of severe cases. Methods: Clinical data was retrospectively collected from 1 145 children with SARS-CoV-2 Omicron infection who were hospitalized in six tertiary grade A hospitals in Kunming from December 10th, 2022 to January 9th, 2023. According to clinical severity, these patients were divided into the general and severe SARS-CoV-2 groups, and their clinical and laboratory data were compared. Between-group comparison was performed using t-test, chi-square test and Mann-Whitney U test. Spearman correlation test and multivariate Logistic regression analysis were used to determine the risk factors of severe illness. Results: A total of 1 145 hospitalized patients were included, of whom 677 were male and 468 female. The age of these patients at visit was 1.7 (0.5, 4.1) years. Specifically, there were 758 patients (66.2%) aged ≤3 years at visit and 387 patients (33.8%) aged >3 years. Of these children, 89 cases (7.8%) had underline diseases and the remaining 1 056 cases (92.2%) had no combined diseases. Additionally, of all the patients, 319 cases (27.9%) were vaccinated with one or two doses of SARS-CoV-2 vaccine, 748 cases (65.3%) had acute upper respiratory tract infection (AURTI), and six cases died (0.5%). A total of 1 051 cases (91.8%) were grouped into general SARS-CoV-2 group and 94 cases (8.2%) were grouped into severe SARS-CoV-2 group. Compared with the general cases, the severe cases showed a lower rate of SARS-CoV-2 vaccination and younger median age, lower lymphocyte count, as well as proportions of CD8+T lymphocyte (36 cases (38.3%) vs. 283 cases (26.9%), 0.5 (2.6, 8.0) vs. 1.6 (0.5, 3.9) years, 1.3 (1.0, 2.7) ×109 vs. 2.7 (1.3,4.4)×109/L, 0.17 (0.12, 0.24) vs. 0.21 (0.15, 0.16), respectively, χ2=4.88, Z=-2.21,-5.03,-2.53, all P<0.05). On the other hand, the length of hospital stay, proportion of underline diseases, ALT, AST, creatine kinase isoenzyme, and troponin T were higher in the severe group compared to those in the general group ((11.6±5.9) vs. (5.3±1.8) d, 41 cases (43.6%) vs. 48 cases (4.6%), 67 (26,120) vs. 20 (15, 32) U/L, 51 (33, 123) vs. 44 (34, 58) U/L、56.9 (23.0, 219.3) vs. 3.6 (1.9, 17.9) U/L, 12.0 (4.9, 56.5) vs. 3.0 (3.0, 7.0) ×10-3 pg/L,respectively, t=-20.43, χ2=183.52, Z=-9.14,-3.12,-6.38,-3.81, all P<0.05). Multivariate regression analysis indicated that increased leukocyte count (OR=1.88, 95%CI 1.18-2.97, P<0.01), CRP (OR=1.18, 95%CI 1.06-1.31, P<0.01), ferritin (OR=1.01, 95%CI 1.00-1.00, P<0.01), interleukin (IL)-6 (OR=1.05, 95%CI 1.01-1.08, P=0.012), D-dimer (OR=2.56, 95%CI 1.44-4.56, P<0.01) and decreased CD4+T lymphocyte (OR=0.84, 95%CI 0.73-0.98, P=0.030) were independently associated with the risk of severe SARS-CoV-2 in hospitalized children with Omicron infection. Conclusions: After the withdrawal of NPI, the pediatric inpatients with Omicron infection in Kunming were predominantly children younger than 3 years of age, and mainly manifested as AURTI with relatively low rate of severe SARS-CoV-2 infection and mortality. Elevated leukocyte counts, CRP, ferritin, IL-6, D-dimer, and decreased CD4+T lymphocytes are significant risk factors for developing severe SARS-CoV-2 infection.

Closed Reduction Technique for Acetabular Fractures with Femoral Head Protrusion and Concomitant Superolateral Impaction: A Case Report

CASE

Closed reduction of acetabular fractures with femoral head protrusion and superolateral femoral head impaction may be challenging because the intact acetabular roof may block anatomic reduction with traditional maneuvers. We report the use of a 5-step technique for this unique pattern: medializing force to disengage the femoral head, axial traction to clear the intact ilium, lateralizing force to center the head underneath the acetabular roof, confirmation of femoral head stability, and skeletal traction placement.

CONCLUSION

Acetabular fractures with femoral head protrusion and concomitant superolateral impaction may be reduced with an initial medializing force followed by axial and lateralizing forces.

Interactions of calmodulin kinase II with the dopamine transporter facilitate cocaine-induced enhancement of evoked dopamine release

Typical and atypical dopamine uptake inhibitors (DUIs) prefer distinct conformations of the dopamine transporter (DAT) to form ligand-transporter complexes, resulting in markedly different effects on behavior, neurochemistry, and potential for addiction. Here we show that cocaine and cocaine-like typical psychostimulants elicit changes in DA dynamics distinct from those elicited by atypical DUIs, as measured via voltammetry procedures. While both classes of DUIs reduced DA clearance rate, an effect significantly related to their DAT affinity, only typical DUIs elicited a significant stimulation of evoked DA release, an effect unrelated to their DAT affinity, which suggests a mechanism of action other than or in addition to DAT blockade. When given in combination, typical DUIs enhance the stimulatory effects of cocaine on evoked DA release while atypical DUIs blunt them. Pretreatments with an inhibitor of CaMKIIα, a kinase that interacts with DAT and that regulates synapsin phosphorylation and mobilization of reserve pools of DA vesicles, blunted the effects of cocaine on evoked DA release. Our results suggest a role for CaMKIIα in modulating the effects of cocaine on evoked DA release without affecting cocaine inhibition of DA reuptake. This effect is related to a specific DAT conformation stabilized by cocaine. Moreover, atypical DUIs, which prefer a distinct DAT conformation, blunt cocaine's neurochemical and behavioral effects, indicating a unique mechanism underlying their potential as medications for treating psychostimulant use disorder.

Interaction Effect of Phase Angle and Age on Femoral Neck Bone Mineral Density in Patients with Non-Dialysis Chronic Kidney Disease Stage 5

Background: Low bone mass is common in malnourished patients with chronic kidney disease (CKD) and can lead to a higher risk of fractures. Elderly and CKD patients have the same risk factors for protein-energy wasting, sarcopenia, and osteoporosis. Here, we investigated the association between phase angle (PhA) and bone mineral density (BMD) in dialysis-naïve patients with CKD stage 5 (CKD5) and identified a statistical relationship between PhA and age, which affects bone density. Methods: Bio-impedance spectroscopy for evaluating body composition and PhA and dual-energy X-ray absorptiometry for determining the BMD were simultaneously performed in 167 consecutive patients (mean age, 59.65 ± 13.98 years; women, 40.1%). Two-way analysis of variance (ANOVA) was conducted to assess the potential interaction effect of PhA and age on femoral neck BMD (FN-BMD). Results: Our results showed that PhA and age were independently associated with FN-BMD and T-score in multiple linear regressions analyses. A significant interaction effect of PhA and age on FN-BMD was found on two-way ANOVA (p = 0.028). The average BMD values for the first and second tertiles of the PhA were higher in the young versus elderly group, whereas patients in the elderly group had higher BMD in the third tertiles. Conclusions: A relationship was noted between PhA and BMD in patients with advanced-stage CKD. The effect of PhA level on FN-BMD differed between elderly and young patients. Our study suggested that higher PhA levels could be a marker explaining the maintenance of good bone health in elderly patients with CKD5. Further longitudinal analyses are needed to determine whether PhA predicts the risk of CKD-MBD-related fractures during CKD progression.

Effect of modifying negative interpretation bias toward ambiguous social stimuli across eating and personality disorders

OBJECTIVE

Heightened sensitivity toward social rejection has been implicated in eating disorders (ED) and personality disorder (PD). This study examined the effect of a cognitive bias modification training (CBM-I) targeting the interpretation of ambiguous social situations in individuals with comorbid ED and PD.

METHOD

A total of 128 participants [33 with ED and PD, 22 with ED-only, 22 with PD-only, and 51 healthy controls (HC)] were recruited from a hospital and university settings, and included in the final analyses. The participants were randomly assigned to a CBM-I task with benign resolutions or a control task with neutral resolutions in a counterbalanced order in two sessions using a within-subject design. Interpretation bias toward social stimuli was measured using the ambiguous sentence completion task before and after completing the assigned task.

RESULTS

The CBM-I task increased benign and decreased negative interpretations with large effect sizes in the diagnostic groups, and with a moderate effect size in the HC group. Participants' anxiety levels were also reduced after the task. The size of the change in negative interpretation was positively associated with baseline negative affect, and negatively associated with baseline positive affect.

DISCUSSION

The results suggest that modifying interpretation bias has the potential as a transdiagnostic target of treatment for ED and PD, and a fully powered clinical trial with consecutive sessions would be warranted.

PUBLIC SIGNIFICANCE

Participants with eating disorders and/or personality disorder, and healthy controls completed a single session of a cognitive training intervention targeting rejection sensitivity. The training produced a large decrease in negative interpretation in the diagnostic groups, and a moderate effect in healthy controls. The findings indicate that training for positive processing of social information may be of value to augment treatment in conditions such as eating disorders and personality disorder, in which there are high levels of rejection sensitivity.

A Practical and Analytical Comparative Study of Gel-Based Top-Down and Gel-Free Bottom-Up Proteomics Including Unbiased Proteoform Detection

Proteomics is an indispensable analytical technique to study the dynamic functioning of biological systems via different proteins and their proteoforms. In recent years, bottom-up shotgun has become more popular than gel-based top-down proteomics. The current study examined the qualitative and quantitative performance of these two fundamentally different methodologies by the parallel measurement of six technical and three biological replicates of the human prostate carcinoma cell line DU145 using its two most common standard techniques, label-free shotgun and two-dimensional differential gel electrophoresis (2D-DIGE). The analytical strengths and limitations were explored, finally focusing on the unbiased detection of proteoforms, exemplified by discovering a prostate cancer-related cleavage product of pyruvate kinase M2. Label-free shotgun proteomics quickly yields an annotated proteome but with reduced robustness, as determined by three times higher technical variation compared to 2D-DIGE. At a glance, only 2D-DIGE top-down analysis provided valuable, direct stoichiometric qualitative and quantitative information from proteins to their proteoforms, even with unexpected post-translational modifications, such as proteolytic cleavage and phosphorylation. However, the 2D-DIGE technology required almost 20 times as much time per protein/proteoform characterization with more manual work. Ultimately, this work should expose both techniques' orthogonality with their different contents of data output to elucidate biological questions.

[Analysis of reproductive outcomes in the first IVF-ET cycle after laparoscopic treatment in patients with endometriosis]

Objective: To explore the effect of endometriosis (EM) on reproductive outcomes of young patient with EM after laparoscopic treatment in the first in vitro fertilization-embryo transfer (IVF-ET) cycle. Methods: The clinical data and reproductive outcomes of 394 infertile patients with EM after laparoscopic treatment (EM group) and 3 242 infertile patients caused by gamete transport disorder (control group) in the first IVF-ET cycle were collected in Chongqing Health Center for Women and Children from January 2016 to June 2021. The information included baseline characteristics, oocyte retrieval, embryo development, clinical pregnancy, miscarriage, and live birth. Propensity score matching (PSM) method was used to perform 1∶2 matching between EM group and control group. The impact of EM on reproductive outcomes was analyzed in the retrospective observational study. Results: In the initial data, compared with control group, the number of two pronucleus (2PN) zygotes (9.7±4.8 vs 9.0±4.4), the number of transferable embryos (6.2±3.6 vs 5.5±3.4) and the rate of transferable embryos (64.0% vs 60.8%) on the third day were significantly lower in EM group, and the differences were statistically significant (all P<0.05). After PSM was performed, there were 394 and 787 cases in EM group and control group, respectively. Compared with control group, the number of 2PN zygotes (9.7±4.9 vs 9.0±4.4), the 2PN fertility rate (77.1% vs 75.3%), the number of transferable embryos on the third day (6.2±3.6 vs 5.5±3.4), the transferable embryos rate on the third day (63.8% vs 60.8%) were significantly lower in EM group, and the differences were statically significant (all P<0.05). The study did not find the effect of EM on embryo implantation rate, pregnancy rate, early miscarriage rate, live birth rate and preterm birth rate (all P>0.05). Conclusions: EM might interfere with the development of oocytes and embryos. Obtaining top-quality embryos may be an effective way to improve the prognosis of patients with EM after laparoscopic treatment.

Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA: A Randomized Controlled Trial

BACKGROUND

The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).

METHODS

Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ≥2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ≥450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ≥1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05.

RESULTS

Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ≥1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis.

CONCLUSIONS

The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR.

LEVEL OF EVIDENCE

Therapeutic Level I . See Instructions for Authors for a complete description of levels of evidence.

Ceramic Femoral Heads Exhibit Lower Wear Rates Compared to Cobalt Chrome: A Meta-Analysis

BACKGROUND

Wear between the femoral head and acetabular liners continues to limit the longevity of total hip arthroplasty implants despite advances in implant materials. The purpose of this meta-analysis was to compare linear wear rates of cobalt-chromium (CoCr) and fourth-generation ceramic femoral heads on highly cross-linked polyethylene (XLPE) liners.

METHODS

A systematic review following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to identify all studies between 2003 and 2020 that examined in vivo wear rates of either fourth-generation ceramics or CoCr femoral heads on XLPE liners. Studies were analyzed in a weighted means analysis of wear rates and a random effects meta-analysis.

RESULTS

A total of 36 studies met inclusion criteria (1,657 CoCr and 659 ceramic patients). The pooled, weighted mean wear rate was 0.063 mm/year (standard deviation [SD]: 0.061, confidence interval [CI]: 0.049-0.077) for CoCr and 0.047 mm/year (SD: 0.057, CI: 0.033-0.062; P < .01) for ceramic (P < .01). A meta-analysis of 4 studies directly comparing ceramic and CoCr found that CoCr heads demonstrated 0.029 mm/year more wear than ceramic heads (95% CI: 0.026-0.059, P = .306). Mean wear for 32-mm heads was significantly higher for ceramic (P < .01), while mean wear for 36-mm heads was significantly higher for CoCr (P < .01).

CONCLUSION

Fourth-generation ceramic femoral heads were found to have significantly lower wear rates than CoCr heads. Unlike previous studies, this meta-analysis included only in vivo studies and those with the same generation of highly XLPE liners.

Rescue of Misfolded Organic Cation Transporter 3 Variants

Organic cation transporters (OCTs) are membrane proteins that take up monoamines, cationic drugs and xenobiotics. We previously reported novel missense mutations of organic cation transporter 3 (OCT3, SLC22A3), some with drastically impacted transport capabilities compared to wildtype. For some variants, this was due to ER retention and subsequent degradation of the misfolded transporter. For other transporter families, it was previously shown that treatment of misfolded variants with pharmacological and chemical chaperones could restore transport function to a certain degree. To investigate two potentially ER-bound, misfolded variants (D340G and R348W), we employed confocal and biochemical analyses. In addition, radiotracer uptake assays were conducted to assess whether pre-treatment with chaperones could restore transporter function. We show that pre-treatment of cells with the chemical chaperone 4-PBA (4-phenyl butyric acid) leads to increased membrane expression of misfolded variants and is associated with increased transport capacity of D340G (8-fold) and R348W (1.5 times) compared to untreated variants. We herein present proof of principle that folding-deficient SLC22 transporter variants, in particular those of OCT3, are amenable to rescue by chaperones. These findings need to be extended to other SLC22 members with corroborated disease associations.

Phosphatidylinositol 4,5-bisphosphate (PIP2) facilitates norepinephrine transporter dimerization and modulates substrate efflux

The plasmalemmal norepinephrine transporter (NET) regulates cardiovascular sympathetic activity by clearing extracellular norepinephrine in the synaptic cleft. Here, we investigate the subunit stoichiometry and function of NET using single-molecule fluorescence microscopy and flux assays. In particular, we show the effect of phosphatidylinositol 4,5-bisphosphate (PIP2) on NET oligomerization and efflux. NET forms monomers (~60%) and dimers (~40%) at the plasma membrane. PIP2 depletion results in a decrease in the average oligomeric state and decreases NET-mediated substrate efflux while not affecting substrate uptake. Mutation of the putative PIP2 binding residues R121, K334, and R440 to alanines does not affect NET dimerization but results in decreased substrate efflux that is not altered upon PIP2 depletion; this indicates that PIP2 interactions with these residues affect NET-mediated efflux. A dysregulation of norepinephrine and PIP2 signaling have both been implicated in neuropsychiatric and cardiovascular diseases. This study provides evidence that PIP2 directly regulates NET organization and function.

Use of a monoblock dual-mobility acetabular component in primary total hip arthroplasty in patients at high risk of dislocation

INTRODUCTION

Dislocation is amongst the most common complications following total hip arthroplasty (THA). Dual-mobility bearings have been suggested as one way to reduce the risk of dislocation, particularly among patients at increased risk. The purpose of this study was to determine the outcomes of a monoblock dual-mobility shell for patients at high risk for dislocation following primary THA.

METHODS

A total of 155 primary THAs with a monoblock, cementless dual-mobility acetabular component were performed in patients at high risk for dislocation. Two patients died prior to their two-year follow-up. The remaining 153 THAs were followed for a mean of 5.1 years (range: 2.1 to 9.3).

RESULTS

There were no dislocations; however, four patients underwent revision surgery: one for an early periprosthetic acetabular fracture, one for an early periprosthetic femoral fracture, one for a late periprosthetic femoral fracture, and one for leg-length discrepancy. Intraoperative complications included one periprosthetic acetabular fracture treated with protected weight-bearing and one intraoperative proximal femoral fracture treated with cerclage wiring. Harris Hip Scores improved from a mean of 42.4 points preoperatively to a mean of 82.4 points postoperatively (p < 0.001). No cups were radiographically loose. At a mean follow-up of 5.1 years, survivorship of the acetabular component was 99.3% (95% CI, 98.1-100%) and survivorship without any reoperation was 97.4% (95% CI, 95.9-100%).

DISCUSSION

Although there were no dislocations in this high-risk population, periprosthetic fractures of the femur and acetabulum were common with the implants utilised.

[Antibody levels of measles, rubella and mumps viruses in healthy population in Shanghai from 2010 to 2020]

Objective: To determine IgG antibody levels of measles, rubella, mumps in healthy population in Shanghai from 2010 to 2020 and analyze the trend of antibody changes in different age groups. Methods: 10 828 healthy people without measles, rubella and mumps in Shanghai were included in the study from 2010 to 2020. Serum samples were collected from 12 age groups, and the serum IgG antibody of measles, rubella and mumps were detected by ELISA. The difference of antibody positive rates and antibody levels were analyzed. Results: The median age M (Q₁, Q₃) of 10 828 objects were 8 years old (9 months old, 20 years old). Males accounted for 48.34% (5 234/10 828) and females accounted for 50.92% (5 514/10 828). Unknown gender information accounted for 0.74% (80/10 828), and 27.03% (2 927/10 828) of participants had unknown MMR immunization history. The total positive rates of measles, rubella and mumps IgG antibody were 76.78%, 64.46% and 64.29% and their GMCs were 541.45 mIU/ml, 31.76 IU/ml and 133.73 U/ml respectively. There were significant differences in serum IgG antibody GMC of measles, rubella and mumps in each year (F_measles=180.74, P<0.001; F_rubella=189.95, P<0.001; F_mumps=122.40, P<0.001). The positive rate of measles antibody was higher than that of rubella and mumps, and the difference was statistically significant (χ²=518.09, P<0.001). Conclusion: The level of measles IgG antibody in healthy people in Shanghai is higher, while the level of rubella and mumps IgG antibody is slightly lower.

[Risk factors and resistance patterns of invasive Acinetobacter Baumannii infection in Children]

Objective: To understand the risk factors and antibiotics-resistant patterns of invasive Acinetobacter baumannii infection in Children. Methods: This retrospective study was conducted in 6 tertiary hospitals from January 2016 to December 2018. The basic information, clinical data and the results of antimicrobial susceptibility testing were collected from the 98 pediatric inpatients with Acinetobacter baumannii isolated from blood or cerebrospinal fluid and analyzed. According to the susceptibility of the infected strains to carbapenems, they were divided into carbapenem-sensitive Acinetobacter baumannii (CSAB) group and carbapenem-resistant Acinetobacter baumannii (CRAB) group. According to the possible sources of infection, they were divided into nosocomial infection group and community infection group. Chi-square test or Fisher exact test were used to analyze categorical variables and rank sum test were used to analyze continuous variables. The risk factors of invasive CRAB infection in children were analyzed by Logistic regression. Result: There were 56 males and 42 females in 98 cases. The onset age of patients was 8 (2, 24) months. There were 62 cases (63%) from rural area. A total of 87 cases (89%) were confirmed with bloodstream infection, and 12 cases (12%) confirmed with meningitis (1 case was accompanied with bloodstream infection). In these patients, 66 cases (67%) received invasive medical procedures or surgery, 54 cases (55%) received carbapenems-containing therapy. Twenty-four cases were infected with CRAB, and 74 cases with CSAB. The onset age of cases in CRAB group was lower than that in CSAB group (4 (1, 9) vs. 10 (4, 24) months, Z=-2.16, P=0.031). The proportions of hospitalization in intensive care unit, carbapenem antibiotics using, pneumonia and adverse prognosis in CRAB group were higher than those in CSAB group (6 cases (25%) vs. 4 cases (5%), 18 cases (75%) vs. 36 cases (49%), 17 cases (71%) vs. 17 cases (23%), 6 cases (25%) vs. 4 cases (5%), χ²=5.61, 5.09, 18.32, 5.61, all P<0.05). Seventy-seven cases were nosocomial infection and 21 cases were hospital-acquired infection. The proportion of children hospitalized in high-risk wards for nosocomial infections, length of hospitalization, number of antimicrobial therapy received and duration of antimicrobial therapy were higher in the hospital associated infection group than those in the community acquired infection group (all P<0.05). Logistic regression analysis showed that children from rural area (OR=8.42, 95%CI 1.45-48.88), prior mechanical ventilation (OR=12.62, 95%CI 1.31-121.76), and prior antibiotic therapy (OR=4.90, 95%CI 1.35-17.72) were independent risk factors for CRAB infection. The resistance percentage of CSAB isolates to many classes of antibiotics was <6% except to gentamicin, which was as high as 20% (13/65). All CRAB isolates of resistant to ampicillin-sulbactam (20/20), cefepime (23/23), piperacillin (17/17), meropenem (23/23) and imipenem (24/24) were 100%. The resistance percentage to other antibiotics were up to 42%-96%. Conclusions: Most of invasive Acinetobacter baumannii infection in children in China are hospital-acquired. The outcome of invasive CRAB infection was poorer than that of CSAB infection. The drug resistance rate of CRAB strains isolated is high. Living in rural area, prior invasive mechanical ventilation and prior antibiotic therapy were independent risk factors for invasive CRAB infection. The prevention and control of nosocomial infection and appropriate use of antibiotics to reduce Acinetobacter baumannii infection.

Bias and sensitivity in numerosity perception of negative emotions among individuals with high social anxiety

The cognitive model of social anxiety suggests an association between social anxiety and cognitive bias toward negative social information. This study investigated the numerosity perception of emotional faces among individuals with high social anxiety. Seventy-five college students completed self-reported questionnaires—assessing social anxiety symptoms—and a numerosity comparison experiment. In each trial of the experiment, participants were presented with a group of 16 emotional faces, varying in the number of faces expressing positive and negative emotions. They were asked to judge which emotion—positive or negative—was more numerous in the crowd. Bias and sensitivity in numerosity perception of emotions were estimated by fitting a psychometric function to participants’ responses. Individuals with low social anxiety showed a bias toward positive faces (t(17) = 2.44, p = 0.026), while those with high social anxiety did not (t(17) = 1.87, p = 0.079). Correlation analyses indicated that social anxiety was negatively associated with the parameters of the function (mean for bias and standard deviation for sensitivity; r =  − 0.34, p = 0.003 for mean; r =  − 0.23, p = 0.047 for standard deviation). Thus, our results suggest that socially anxious individuals lack the bias toward positive emotion and are more sensitive to negative emotion than nonanxious individuals in perceiving the numerosity of facial expressions.

Low-dose clozapine monotherapy for recurrent non-suicidal self-injury: A case report

Non-suicidal self-injury (NSSI) is a challenging issue in clinical settings. In the present case series, we report two female adolescents with recurrent depression and NSSI. Numerous approaches, such as anti-depressants, anti-psychotics, and even electroconvulsive therapy, were not effective. Clozapine has been implemented in a broad spectrum of psychiatric disorders, particularly refractory depression, impulse control problems, suicidal ideation, and NSSI. With a low dose (12.5-25 mg) of clozapine, the depressive symptoms and NSSI remarkably improved, and the improvement was sustained over four months after discharge. Low-dose clozapine monotherapy may be a treatment option with refractory depression and NSSI.

The Cost-Effectiveness of Tibial Metaphyseal Cones in Revision Total Knee Arthroplasty

BACKGROUND

The purpose of this study is to evaluate the cost-effectiveness of tibial cones in revision total knee arthroplasty.

METHODS

A Markov model was used for cost-effectiveness analysis. The average cone price was obtained from Orthopedic Network News. The average cone aseptic loosening rate was determined by literature review. Hospitalization costs and baseline re-revision rates were calculated using the PearlDiver Database.

RESULTS

The maximum cost-effective cone price varied from $3514 at age 40 to $648 at age 90, compared to the current average selling price of $4201. Cones became cost-effective with baseline aseptic loosening rates of 0.89% annually at age 40 to 4.38% annually at age 90, compared to the current average baseline loosening rate of 0.76% annually.

CONCLUSION

For the average patient, tibial cones are not cost-effective, but may become so at lower prices, in younger patients, or in patients at substantially increased risk of aseptic loosening.

COVID-19 susceptibility and clinical outcomes in autoimmune inflammatory rheumatic diseases (AIRDs): a systematic review and meta-analysis

OBJECTIVE

This meta-analysis aims to assess the susceptibility to and clinical outcomes of COVID-19 in autoimmune inflammatory rheumatic disease (AIRD) and following AIRD drug use.

MATERIALS AND METHODS

We included observational and case-controlled studies assessing susceptibility and clinical outcomes of COVID-19 in patients with AIRD as well as the clinical outcomes of COVID-19 with or without use of steroids and conventional synthetic disease-modifying antirheumatic drugs (csDMARDs).

RESULTS

Meta-analysis including three studies showed that patients with AIRD are not more susceptible to COVID-19 compared to patients without AIRD or the general population (OR: 1.11, 95% CI: 0.58 to 2.14). Incidence of severe outcomes of COVID-19 (OR: 1.34, 95% CI: 0.76 to 2.35) and COVID-19 related death (OR: 1.21, 95% CI: 0.68 to 2.16) also did not show significant difference. The clinical outcomes of COVID-19 among AIRD patients with and without csDMARD or steroid showed that both use of steroid (OR: 1.69, 95% CI: 0.96 to 2.98) or csDMARD (OR: 1.35, 95% CI: 0.63 to 3.08) had no effect on clinical outcomes of COVID-19.

CONCLUSIONS

AIRD does not increase susceptibility to COVID-19, not affecting the clinical outcome of COVID-19. Similarly, the use of steroids or csDMARDs for AIRD does not worsen the clinical outcome.

[To take the initiative in the prevention and control of the coronavirus disease 2019 epidemic in the changing and unchanged strategies]

In early 2020, an outbreak of coronavirus disease 2019 (COVID-19) epidemic happened in China. In the following three months, 42 600 medical personnels and more than 9 000 public health employees were "rushed out" of their own position and onto Wuhan and other areas in Hubei Province. They helped to strengthen the treatment of severe cases and the isolation of mild cases, and actively carried out community screenings, and eventually won victory in the defense of Wuhan. During the normalization stage of prevention and control of the epidemic of COVID-19, China adopted the expanded preventive strategy by focusing on widely implement PCR testing, and integrate general and emergency departments to improve the performance of public health system. In this stage, China put out the cluster of epidemics that have occurred in several places one after another, and effectively controlled the spread of the epidemic in 2 to 3 incubation periods. In the stage of "dynamic zeroing", China emphasized the strategy of "grasping early, grasping the basics", focused on specific measures such as precise prevention in key areas. The rule of golden 24 hours was used to control the spread of the epidemic within one incubation period. During the epidemic, China continues to adopt active prevention and control strategies. This self-confidence and determination depends on adhering to the leadership of the Communist Party of China, the distinct essence of medical and health services, and significant advantages of social governance on health.

Neuropsychological adverse drug reactions of Remdesivir: analysis using VigiBase, the WHO global database of individual case safety reports

OBJECTIVE

Although remdesivir (GS-5734) has recently demonstrated clinical benefits against the pandemic outbreak of coronavirus disease 2019 (COVID-19), neuropsychological adverse reactions (ADRs) remain to be examined in real-world settings. Therefore, we aimed to identify and characterize the neuropsychological ADRs associated with remdesivir use.

MATERIALS AND METHODS

We obtained data for this international pharmacovigilance cohort study from individual case safety reports (ICSRs) in a World Health Organization database (VigiBase) from the first report on remdesivir on February 17, 2020, until August 30, 2020 (n=1,403,532). ADRs reported to be relevant to remdesivir were compared with the full database by using a Bayesian neural network method to calculate the information component (IC).

RESULTS

A total of 2,107 reported cases of neuropsychological ADRs suspected to be associated with remdesivir were identified from among all ICSRs in the database during the observation period. Although 108 neuropsychological ADRs (64 neurologic events and 44 psychologic events) were reported in association with the medication, no statistically significant pharmacovigilance signal could be detected; the IC025 value was negative for all of the neuropsychological dysfunctions (anxiety [n=13, 0.62%], seizures [n=12, 0.57%], lethargy [n=6, 0.28%], agitation [n=5, 0.25%], cerebral infarction [n=3, 0.14%], ischemic stroke [n=3, 0.14%], and hemiparesis [n=3, 0.14%]).

CONCLUSIONS

Our study demonstrates that remdesivir, a novel drug applied to the treatment of COVID-19, does not have a significant association with adverse neurologic or psychiatric reactions in the real-world setting.

Influence of Preseason Versus In-Season Play on Achilles Tendon Injuries in the National Football League

Background:

A ruptured Achilles tendon (AT) can sideline a player for 6 to 12 months and reduce their power rankings by more than 50%. Previous research has compared AT rupture rates in different game conditions.

Purpose:

To determine environmental and physiological risk factors for AT tears, given the minimal amount of research on AT ruptures in the National Football League (NFL).

Study Design:

Case series; Level of evidence, 4.

Methods:

NFL players with a diagnosed AT tear between 2009 and 2016 were selected as the study population for this retrospective analysis. Data on NFL injury were collected from an established database composed of publicly available information. Player profiles were employed to determine position, team, and game statistics at the time of injury. The proportion of NFL rookies was approximated by summing the number of draft picks and the number of signed, undrafted free agents and measured against the number of roster spots before the season.

Results:

Between 2009 and 2016, there were 101 documented AT tears. Of these, 64% (65/101) occurred before the official season, including preseason games. Of the 36 tears that occurred in-season, 34 were during games. Overall, 29% (19/65) of the preseason tears occurred in rookies and 100% (36/36) of the in-season tears affected nonrookies. Of the rookies with AT ruptures, 42.11% returned to play in the NFL, while 62.20% of the nonrookies came back to partake in future seasons. Despite an average age of 26.7 years, the tear distribution was bimodal with players aged 24 and 36 years exhibiting the highest rates of tear.

Conclusion:

In our review of AT tears in NFL athletes, a large percentage of the tears occurred in rookie players, especially during the preseason. We also found that tears during the season occurred in only nonrookies, suggesting that the preseason is when rookies experience the greatest risk for injury.

Platelet Phenotype Analysis of COVID-19 Patients Reveals Progressive Changes in the Activation of Integrin αIIbβ3, F13A1, the SARS-CoV-2 Target EIF4A1 and Annexin A5

Background: The fatal consequences of an infection with severe acute respiratory syndrome coronavirus 2 are not only caused by severe pneumonia, but also by thrombosis. Platelets are important regulators of thrombosis, but their involvement in the pathogenesis of COVID-19 is largely unknown. The aim of this study was to determine their functional and biochemical profile in patients with COVID-19 in dependence of mortality within 5-days after hospitalization. Methods: The COVID-19-related platelet phenotype was examined by analyzing their basal activation state via integrin αIIbβ3 activation using flow cytometry and the proteome by unbiased two-dimensional differential in-gel fluorescence electrophoresis. In total we monitored 98 surviving and 12 non-surviving COVID-19 patients over 5 days of hospital stay and compared them to healthy controls (n = 12). Results: Over the observation period the level of basal αIIbβ3 activation on platelets from non-surviving COVID-19 patients decreased compared to survivors. In line with this finding, proteomic analysis revealed a decrease in the total amount of integrin αIIb (ITGA2B), a subunit of αIIbβ3, in COVID-19 patients compared to healthy controls; the decline was even more pronounced for the non-survivors. Consumption of the fibrin-stabilizing factor coagulation factor XIIIA (F13A1) was higher in platelets from COVID-19 patients and tended to be higher in non-survivors; plasma concentrations of the latter also differed significantly. Depending on COVID-19 disease status and mortality, increased amounts of annexin A5 (ANXA5), eukaryotic initiation factor 4A-I (EIF4A1), and transaldolase (TALDO1) were found in the platelet proteome and also correlated with the nasopharyngeal viral load. Dysregulation of these proteins may play a role for virus replication. ANXA5 has also been identified as an autoantigen of the antiphospholipid syndrome, which is common in COVID-19 patients. Finally, the levels of two different protein disulfide isomerases, P4HB and PDIA6, which support thrombosis, were increased in the platelets of COVID-19 patients. Conclusion: Platelets from COVID-19 patients showed significant changes in the activation phenotype, in the processing of the final coagulation factor F13A1 and the phospholipid-binding protein ANXA5 compared to healthy subjects. Additionally, these results demonstrate specific alterations in platelets during COVID-19, which are significantly linked to fatal outcome.

Suicide associated with COVID-19 infection: an immunological point of view

OBJECTIVE

Coronavirus disease 2019 (COVID-19) is a pandemic and leading cause of death. Beyond the deaths directly caused by the virus and the suicides related to the psychological response to the dramatic changes as socioeconomic related to the pandemic, there might also be suicides related to the inflammatory responses of the infection. Infection induces inflammation as a cytokine storm, and there is an increasing number of studies that report a relationship between infection and suicide.

MATERIALS AND METHODS

We searched the World Health Organization status report and the PubMed database for keywords (COVID-19, suicide, infection, inflammation, cytokines), and reviewed five cytokine pathways between suicide and inflammation using two meta-analyses and two observational studies starting from November 31, 2020, focusing on the relationship between suicide and inflammation by infection. First, we discussed existing evidence explaining the relationship between suicidal behaviors and inflammation. Second, we summarized the inflammatory features found in COVID-19 patients. Finally, we highlight the potential for these factors to affect the risk of suicide in COVID-19 patients.

RESULTS

Patients infected with COVID-19 have high amounts of IL-1β, IFN-γ, IP10, and MCP1, which may lead to Th1 cell response activation. Also, Th2 cytokines (e.g., IL-4 and IL-10) were increased in COVID-19 infection. In COVID-19 patients, neurological conditions, like headache, dizziness, ataxia, seizures, and others have been observed.

CONCLUSIONS

COVID-19 pandemic can serve as a significant environmental factor contributing directly to increased suicide risk; the role of inflammation by an infection should not be overlooked.

Similar 90-day outcomes among inpatient and outpatient arthroplasties : a single-surgeon matched cohort analysis

AIMS

The proportion of arthroplasties performed in the ambulatory setting has increased considerably. However, there are concerns whether same-day discharge may increase the risk of complications. The aim of this study was to compare 90-day outcomes between inpatient arthroplasties and outpatient arthroplasties performed at an ambulatory surgery centre (ASC), and determine whether there is a learning curve associated with performing athroplasties in an ASC.

METHODS

Among a single-surgeon cohort of 970 patients who underwent arthroplasty at an ASC, 854 (88.0%) were matched one-to-one with inpatients based on age, sex, American Society of Anesthesiologists (ASA) grade, BMI, and procedure (105 could not be adequately matched and 11 lacked 90-day follow-up). The cohort included 281 total hip arthroplasties (THAs) (32.9%), 267 unicompartmental knee arthroplasties (31.3%), 242 primary total knee arthroplasties (TKAs) (28.3%), 60 hip resurfacings (7.0%), two revision THAs (0.3%), and two revision TKAs (0.3%). Outcomes included readmissions, reoperations, visits to the emergency department, unplanned clinic visits, and complications.

RESULTS

The inpatient and outpatient groups were similar in all demographic variables, reflecting successful matching. The reoperation rate was 0.9% in both cohorts (p = 1.000). Rates of readmission (2.0% inpatient vs 1.6% outpatient), any complications (5.9% vs 5.6%), minor complications (4.2% vs 3.9%), visits to the emergency department (2.7% vs 1.4%), and unplanned clinic visits (5.7% vs 5.5%) were lower in the outpatient group but did not reach significance with the sample size studied. A learning curve may exist, as seen by significant reductions in the reoperation and overall complication rates among outpatient arthroplasties over time (p = 0.032 and p = 0.007, respectively), despite those in this group becoming significantly older and heavier (both p < 0.001) during the study period.

CONCLUSION

Arthroplasties performed at ASCs appear to be safe in appropriately selected patients, but may be associated with a learning curve as shown by the significant decrease in complication and reoperation rates during the study period. Cite this article: Bone Joint J 2021;103-B(7 Supple B):84-90.

National Trends in Post-Acute Care Costs Following Total Knee Arthroplasty From 2007 to 2016

BACKGROUND

Post-acute care continues to represent a target for cost savings with increasing popularity of value-based payment models in total knee arthroplasty (TKA). Rapid recovery and accelerated rehabilitation protocols have been successful in reducing costs at the institutional level, but national trends are less clear. This study aimed to determine if advancements in perioperative care led to a reduction in post-acute care costs and resource utilization following TKA.

METHODS

We reviewed a consecutive series of 79,843 primary TKA patients from the Humana claims dataset from 2007 to 2016. Post-acute care costs included any claims within 90 days of surgery for subacute or inpatient rehabilitation, home health, outpatient or emergency visits, prescription medications, physical therapy, and readmissions. Demographics, episode-of-care and post-acute care costs, readmissions, and discharge disposition were compared. Controlling for demographics and comorbidities, multivariate regression analyses were performed to compare trends in discharge disposition and post-acute care costs.

RESULTS

From 2007 to 2016, the average episode-of-care costs ($46,754 vs $31,856) and post-acute care costs per patient decreased ($20,224 vs $13,498). Rates of discharge to skilled nursing facilities (25.0% vs 22.5%) and inpatient rehabilitation also declined (12.4% vs 2.1%). Readmissions also decreased (8.1% vs 7.1%) saving an average of $324 per patient. When compared to 2007-2012, total costs declined most rapidly after 2013 primarily due to a $3516 (21%) decrease in post-acute spending.

CONCLUSION

There has been a substantial decline in post-acute care costs and resource utilization following TKA, with the largest decrease occurring following the introduction of Medicare bundled payment models in 2013.

Body mass index and mortality in patients with cardiovascular disease: an umbrella review of meta-analyses

OBJECTIVE

Although many previous meta-analyses of epidemiological studies have demonstrated a relationship between body mass index (BMI) and mortality, inconsistent findings among cardiovascular disease patients have been observed. Thus, we performed an umbrella review to understand the strength of evidence and validity of claimed associations between BMI and mortality in patients with cardiovascular diseases.

MATERIALS AND METHODS

We comprehensively re-analyzed the data of meta-analyses of observational studies and randomized controlled trials on associations between BMI and mortality among patients with cardiovascular diseases. We also assessed the strength of evidence of the re-analyzed outcomes, which were determined from the criteria including statistical significance of the p-value of random-effects, as well as fixed-effects meta-analyses, small-study effects, between-study heterogeneity, and a 95% prediction interval.

RESULTS

We ran comprehensive re-analysis of the data from the 21 selected studies, which contained a total of 108 meta-analyses; 23 were graded as convincing evidence and 12 were suggestive, 42 were weak, and 23 were non-significant.

CONCLUSIONS

Underweight increased mortality in acute coronary syndrome (ACS), heart failure, and after therapeutic intervention for patients with cardiovascular diseases. Overweight, on the other hand decreased mortality in patient's ACS, atrial fibrillation, and heart failure with convincing evidence.

The Effect of Four Weeks Dietary Intervention with 8-Hour Time-Restricted Eating on Body Composition and Cardiometabolic Risk Factors in Young Adults

Recently, intermittent fasting, also known as time-restricted eating (TRE), has become a popular diet trend. Compared to animal studies, there have been few studies and inconclusive findings investigating the effects of TRE in humans. In this study, we examined the effects of 8 h TRE on body weight and cardiometabolic risk factors in young adults who were mainly active at night. A total of 33 young adults completed the 8 h TRE for 4 weeks. Body composition was measured by bioelectrical impedance analysis at baseline and every 2 weeks, and blood samples were collected at baseline and week 4. Daily dietary records were logged throughout the intervention period. Participants experienced significant changes in body weight (−1.0 ± 1.4 kg), body mass index (−0.4 ± 0.5 kg/m²), and body fat (−0.4 ± 1.9%) after 4 weeks of TRE. When participants were divided into weight loss/gain groups based on their weight change in week 4, fat mass reduction was significantly higher in the weight loss group than in the weight gain group. Regarding cardiometabolic risk factors, levels of fasting insulin and insulin resistance improved in the weight loss group after intervention, but not in the weight gain group. All subjects showed late-shifted sleeping patterns, but no significant differences in sleep duration, sleep quality, or psychological measures between the two groups. When meal frequency and energy proportion were evaluated, the average meal frequency was 2.8 ± 0.5 and energy proportions of breakfast, lunch, dinner, and snacks were 4.5, 39.2, 37.6, and 18.5%, respectively; there were no significant differences between the two groups. However, the saturated fat intake at dinner was lower in the weight loss group (3.1 ± 3.2%, 6.0 ± 2.5% respectively). In conclusion, 8 h TRE can be applied as a lifestyle strategy to manage body weight and cardiometabolic risk factors among young adults with late chronotypes.

[Study of sequential surgical guide assisting full arch immediate implant placement and provisionalization in patients with severe periodontitis]

To explore the technical process and the therapeutic effect of using sequential surgical guide with independent intellectual property rights assisting immediate implantation and restoration of the full arch, with the support from the periodontal splint for mobile supporting teeth, patients with severe periodontitis who planned to undergo immediate full arch implantation were recruited from August 2019 to December 2020 at the Department of Prosthodontics, Department of Periodontology, Department of Implantology and First Clinical Division, Peking University School and Hospital of Stomatology. Through the procedure of collecting preoperative maxillofacial data, making systematic diagnostic design, making periodontal splints fixation, producing surgical guide, and carrying out guided surgery for full arch immediate implantation, eight cases were included. By registering the postoperative cone-beam CT (CBCT) with the preoperative data, the difference between the actual three-dimensional position of the implants and the virtual design was observed, and the accuracy of the implant placement position guided by the sequential guide was statistically analyzed using SPSS 25.0 software. Analysis indicators include coronal and apical global displacement, coronal horizontal and vertical displacement, apical horizontal and vertical displacement, and angular deviation. Results revealed that the 8 patients [2 males and 6 females, aged (49.0±9.3) years (38-65 years)] of recruited cases included 7 cases of maxilla and 1 cases of mandible. A total of 48 implants, of which 44 implants were placed upright and 4 were placed tilted, 16 implants in the anterior region and 32 implants in the posterior region. No guide plate fracture or damage to important anatomical structures were reported. The overall displacement at the coronal point [(0.83±0.48) mm] and the global displacement at the apical point [(1.36±0.57) mm] were within the clinically acceptable safety range, and the horizontal displacement and vertical displacement at the coronal point, horizontal displacement and vertical displacement at the apical point, and the angle deviation of implants axial have no statistic significant difference in the anterior and posterior region (P>0.05). Periodontal splints combined with sequential surgical guides to assist patients with severe periodontitis for immediate full arch implantation and immediate restoration can expand the indications of guide assisted implant surgery. It meets the safety requirements in clinical applications.

Costs of unicompartmental compared with total knee arthroplasty : a matched cohort study over ten years

AIMS

The aim of this study was to compare ten-year longitudinal healthcare costs and revision rates for patients undergoing unicompartmental knee arthroplasty (UKA) and total knee arthroplasty (TKA).

METHODS

The Humana database was used to compare 2,383 patients undergoing UKA between 2007 and 2009, who were matched 1:1 from a cohort of 63,036 patients undergoing primary TKA based on age, sex, and Elixhauser Comorbidity Index. Medical and surgical complications were tracked longitudinally for one year following surgery. Rates of revision surgery and cumulative mean healthcare costs were recorded for this period of time and compared between the cohorts.

RESULTS

Patients undergoing TKA had significantly higher rates of manipulation under anaesthesia (3.9% vs 0.9%; p < 0.001), deep vein thrombosis (5.0% vs 3.1%; p < 0.001), pulmonary embolism (1.5% vs 0.8%; p = 0.001), and renal failure (4.2% vs 2.2%; p < 0.001). Revision rates, however, were significantly higher for UKA at five years (6.0% vs 4.2%; p = 0.007) and ten years postoperatively (6.5% vs 4.4%; p = 0.002). Longitudinal-related healthcare costs for patients undergoing TKA were greater than for those undergoing UKA at one year ($24,771 vs $22,071; p < 0.001) and five years following surgery ($26,549 vs $25,730; p < 0.001); however, the mean costs of TKA were comparable to UKA at ten years ($26,877 vs $26,891; p = 0.425).

CONCLUSION

Despite higher revision rates, patients undergoing UKA had lower mean healthcare costs than those undergoing TKA up to ten years following the procedure, at which time costs were comparable. In the era of value-based care, surgeons and policymakers should be aware of the costs involved with these procedures. UKA was associated with fewer complications at one year postoperatively but higher revision rates at five and ten years. While UKA was significantly less costly than TKA at one and five years, costs at ten years were comparable with a mean difference of only $14. Lowering the risk of revision surgery should be targeted as a source of cost savings for both UKA and TKA as the mean related healthcare costs were 2.5-fold higher in patients requiring revision surgery. Cite this article: Bone Joint J 2021;103-B(6 Supple A):23-31.

Early outcomes of a modern cemented total knee arthroplasty : is tibial loosening a concern?

AIMS

Recent total knee arthroplasty (TKA) designs have featured more anatomical morphologies and shorter tibial keels. However, several reports have raised concerns about the impact of these modifications on implant longevity. The aim of this study was to report the early performance of a modern, cemented TKA design.

METHODS

All patients who received a primary, cemented TKA between 2012 and 2017 with a minimum two-year follow-up were included. The implant investigated features an asymmetrical tibial baseplate and shortened keel. Patient demographic details, Knee Society Scores (KSS), component alignment, and the presence of radiolucent lines at final follow-up were recorded. Kaplan-Meier analyses were performed to estimate survivorship.

RESULTS

A total of 720 of 754 primary TKAs (95.5%) were included with a mean follow-up of 3.9 years (SD 1.3); 562 (78.1%) were cruciate-retaining and 158 (21.9%) were posterior-stabilized. A total of 11 (1.5%) required reoperation for periprosthetic joint infection and seven (1.0%) for aseptic tibial loosening (five cruciate-retaining, two posterior-stabilized). Loosening occurred at a mean of 3.3 years (0.9 to 6.5). There were no cases of loosening in the 33 patients who received a 14 mm × 30 mm tibial stem extension. All-cause survivorship was 96.6% at three years (95% confidence interval (CI) 95.3% to 98.0%) and 96.2% at five years (95% CI 94.8% to 97.7%). Survivorship with revision for aseptic loosening was 99.6% at three years (95% CI 99.1% to 100.0%) and 99.1% at five years (95% CI 98.4% to 99.9%). Tibial components were in significantly more varus in those with aseptic loosening (mean 3.4° (SD 3.7°) vs 1.3° (SD 2.0°); p = 0.015). There were no other differences in demographic, radiological, or surgical characteristics between revised and non-revised TKAs for aseptic loosening (p = 0.293 to 1.00). Mean KSS improved significantly from 57.3 (SD 9.5) preoperatively to 92.6 (SD 8.9) at the final follow-up (p < 0.001).

CONCLUSION

This is the largest series to date of this design of implant. At short-term follow-up, the rate of aseptic tibial loosening is not overly concerning. Further observation is required to determine if there will be an abnormal rate of loosening at mid- to long-term follow-up. Cite this article: Bone Joint J 2021;103-B(6 Supple A):51-58.

Preoperative Corticosteroid Injections Demonstrate a Temporal and Dose-Dependent Relationship with the Rate of Postoperative Infection Following Total Hip Arthroplasty

BACKGROUND

Corticosteroid injections (CSI) are commonly used for the treatment of osteoarthritis of the hip. There is concern, however, that these injections may increase the risk of postoperative infection if a subsequent total hip arthroplasty (THA) is performed. The purpose of the present investigation is to determine the relationship between CSI and the risk of periprosthetic joint infection (PJI) and surgical site infections (SSIs) following THA.

METHODS

The PearlDiver database was reviewed for patients undergoing THA from 2011 to 2018. Patients with unilateral hip osteoarthritis who received an intra-articular hip CSI prior to ipsilateral THA were matched in a sequential 1:1 fashion based on age, gender, and Charlson Comorbidity Index with THA patients who did not receive an injection in the preoperative period. PJI and SSI within 6 months of the surgical procedure were recorded. Statistical analysis included chi-squared test and multivariate logistic regression. Results were considered significant at P < .05.

RESULTS

In total, 29,058 patients underwent a hip CSI within 6 months prior to THA. CSI within 4 months of surgery was associated with a higher incidence of PJI at 6-month follow up (1.6% vs 1.1%, P = .040). An injection within 1 month of surgery corresponded to a higher odds of PJI (odds ratio [OR] 1.97) than an injection 4 months prior to surgery (OR 1.24). Furthermore, the quantity of CSI administered within the 3 months prior to THA demonstrated a dose-dependent relationship, with each subsequent injection increasing odds of PJI (OR 1.45-3.59). A similar relationship was observed for SSI.

CONCLUSION

There appears to be both a time and dose-dependent association of hip CSI and PJI following THA. Surgeons should consider delaying elective THA if a CSI has been administered within the 4 months prior to the planned procedure.

[Expression and clinicopathological significance of Bcl - 2 and Bax genes in colorectal cancer patients complicated with schistosomiasis]

OBJECTIVE

To investigate the expression and clinicopathological significance of Bcl-2 and Bax genes in colorectal cancer (CRC) patients complicated with schistosomiasis.

METHODS

The CRC patients receiving surgical treatment in the First Affiliated Hospital of Dali University from June 2016 to June 2020 were recruited as the study subjects, and 30 subjects were randomly sampled from the CRC patients complicated with schistosomiasis (CRC-S group) and 30 subjects were randomly sampled from the CRC patients without schistosomiasis (CRC group) using a random number table method. The cancer specimens were sampled from subjects in the CRC-S and CRC groups, and the peri-cancer specimens were sampled from subjects in the CRC group. The Bcl-2 and Bax expression was quantified in cancer and peri-cancer specimens using a real-time fluorescent quantitative PCR (qPCR) assay and immunohistochemistry at transcriptional and translational levels, and the cell apoptosis was detected in cancer specimens using HE staining.

RESULTS

A total of 60 subjects were enrolled, including 30 cases in the CRC group and 30 cases in the CRC-S group. There were no significant differences between the two groups in terms of gender distribution (χ² = 0.271, P > 0.05), mean age (t = -0.596, P > 0.05), tumor growth pattern (χ² = 0.275, P > 0.05), tumor location (χ² = 4.008, P > 0.05), tumor invasion depth (χ² = 0.608, P > 0.05), degree of tumor differentiation (χ² = 0.364, P > 0.05), or presence of vascular metastasis (χ² = 1.111, P > 0.05), while significant differences were seen between the two groups in terms of histological type, presence of lymph node metastasis and TMN staging (χ² = 5.963, 8.297 and 5.711, all P values < 0.05). qPCR assay and immunohistochemistry quantified significantly higher Bcl-2 and Bax expression in cancer specimens from the CRC and CRC-S groups than in the peri-cancer specimens from the CRC group at both translational and transcriptional levels (all P values < 0.05), and higher Bcl-2 and lower Bax expression were seen in the cancer specimens from the CSC-S group than that from the CRC group (all P values < 0.05). In addition, the cell apoptotic rate was significantly greater in the cancer specimens in the CRC group than in the CRC-S group (42.00% vs. 23.35%; χ² = 41.500, P = 0.000).

CONCLUSION

Schistosomiasis may be involved in the development and progression of CRC through affecting Bcl-2 and Bax gene expression in the apoptosis signaling pathway.

Constitutive Endocytosis of the Neuronal Glutamate Transporter Excitatory Amino Acid Transporter-3 Requires ARFGAP1

The eukaryotic endocytic pathway regulates protein levels available at the plasma membrane by recycling them into specific endosomal compartments. ARFGAP1 is a component of the coat protein I (COPI) complex but it also plays a role in promoting adapter protein-2 (AP-2) mediated endocytosis. The excitatory amino acid transporter-3 (EAAT3) mediates the reuptake of glutamate from the synaptic cleft to achieve rapid termination of synaptic transmission at glutamatergic synapses. In this study, we identified two interacting proteins of EAAT3 by mass spectrometry (MS) ARFGAP1 and ARF6. We explored the role of ARFGAP1 and ARF6 in the endocytosis of EAAT3. Our data revealed that ARFGAP1 plays a role in the recycling of EAAT3, by utilizing its GTPase activating protein (GAP) activity and ARF6 acting as the substrate. ARFGAP1 promotes cargo sorting of EAAT3 via a single phenylalanine residue (F508) located at the C-terminus of the transporter. ARFGAP1-promoted AP-2 dependent endocytosis is abolished upon neutralizing F508. We utilized a heterologous expression system to identify an additional motif in the C-terminus of EAAT3 that regulates its endocytosis. Impairment in endocytosis did not affect somatodendritic targeting in cultured hippocampal neurons. Our findings support a model where endocytosis of EAAT3 is a multifactorial event regulated by ARFGAP1, occurring via the C-terminus of the transporter, and is the first study to examine the role of ARFGAP1 in the endocytosis of a transport protein.

Revision Surgery for Instability After Total Hip Arthroplasty: Does Timing Matter?

BACKGROUND

Instability is a common reason for revision surgery after total hip arthroplasty (THA). Recent studies suggest that revisions performed in the early postoperative period are associated with higher complication rates. The purpose of this study is to assess the effect of timing of revision for instability on subsequent complication rates.

METHODS

The Medicare Part A claims database was queried from 2010 to 2017 to identify revision THAs for instability. Patients were divided based on time between index and revision surgeries: <1, 1-2, 2-3, 3-6, 6-9, 9-12, and >12 months. Complication rates were compared between groups using multivariate analyses to adjust for demographics and comorbidities.

RESULTS

Of 445,499 THAs identified, 9298 (2.1%) underwent revision for instability. Revision THA within 3 months had the highest rate of periprosthetic joint infection (PJI): 14.7% at <1 month, 12.7% at 1-2 months, and 10.6% at 2-3 months vs 6.9% at >12 months (P < .001). Adjusting for confounding factors, PJI risk remained elevated at earlier periods: <1 month (adjusted odds ratio [aOR]: 1.84, 95% confidence interval [CI]: 1.51-2.23, P < .001), 1-2 months (aOR: 1.45, 95% CI: 1.16-1.82, P = .001), 2-3 months (aOR: 1.35, 95% CI: 1.02-1.78, P = .036). However, revisions performed within 9 months of index surgery had lower rates of subsequent instability than revisions performed >12 months (aOR: 0.67-0.85, P < .050), which may be due to lower rates of acetabular revision and higher rates of head-liner exchange in this later group.

CONCLUSION

When dislocation occurs in the early postoperative period, delaying revision surgery beyond 3 months from the index procedure may be warranted to reduce risk of PJI.

[Feasibility analysis of visual analogue scale in esthetic evaluation of anterior implant-supported single crown in maxilla]

Objective: To test the reproducibility of the visual analogue scale (VAS) used in the evaluation of the esthetic effect of anterior dental implants, and to explore the factors that affect the correlation between VAS and pink esthetic score/white esthetic score (PES/WES). Methods: From January 2018 to August 2019, a total of 108 doctors and patients were recruited in the Department of Prosthodontics, Implantology and Fourth Clinical Division of Peking University School and Hospital of Stomatology. Among them, there were 35 dental implant specialists who were familiar with PES/WES [implant specialist group, 25 males, 10 females, (37.3±4.5) years old], 34 dentists who were not familiar with PES/WES [dentist group, specialized in Prosthodontics, Periodontology, Orthodontics, and Oral Maxillofacial Surgery, 24 males, 10 females, (36.1±4.2) years old], 39 patients [patient group, 28 males, 11 females, (45.4±8.3) years old]. Twenty oral pictures of patients [12 males, 8 females, (43.7±6.4) years old] treated in the Department of Prosthodontics, Peking University School and Hospital of Stomatology from December 2016 to December 2017 were taken for single implant restoration for esthetic evaluation with VAS. Score 0 for evaluation of not beautiful and score 10 for very beautiful. Re-evaluation of the same 20 pictures with VAS after 1 month, and perform repeatability evaluation of VAS using chi-square test were conducted. At the same time, 13 implant specialists were randomly selected, to score the same photos with PES/WES. The PES scoring elements were the fullness of the mesial gingival papilla, the fullness of the distal gingival papilla, the curvature of the gingival margin, the protrusion of the root surface, the color and the texture of the soft tissue. The scoring elements of WES were crown shape, crown contour, crown color, surface texture, transparency and individual characteristics in order. Pearson correlation analysis was used to evaluate the correlation between the score of VAS and PES/WES. And the influence of the group on the correlation between PES/WES and VAS was analyzed. Results: The PES score was 7.5±1.8, and the WES score was 7.6±1.9 and the total score was 15.1±3.4. The VAS score of the implant specialist group was 6.8±1.8. The repeatability test of the two VAS results in the patient group was not statistically significant (Kappa=0.012, P>0.05); the two VAS results of the implant specialist group and the dentist group both had good repeatability (Kappa=0.727 and 0.556, P<0.01). The VAS score was weakly correlated with the total PES/WES score (r=0.27, P<0.01). The VAS score was correlated with the score elements in PES/WES (P<0.01), and the color (r=0.20) and shape (r=0.22) of the crown were the larger correlation coefficients. The correlation coefficients between the VAS score and the PES/WES scoring system decreased among the implant specialist group (r=0.49, moderate correlation), the dentist group (r=0.25, weak correlation) and the patient group (r=0.12, P>0.05). Conclusions: The consistency of VAS and PES/WES is affected by the cognition of the scorer. The combination of the two scoring systems is feasible and necessary for physicians to evaluate the overall esthetic effect of implant restoration.

Risk factors of COVID-19 mortality: a systematic review of current literature and lessons from recent retracted articles

OBJECTIVE

Recently, two influential articles that reported the association of (hydroxy)chloroquine or angiotensin converting enzyme (ACE) inhibitors and coronavirus disease 2019 (COVID-19) mortality were retracted due to significant methodological issues. Therefore, we aimed to analyze the same clinical issues through an improved research method and to find out the differences from the retracted papers. We systematically reviewed pre-existing literature, and compared the results with those of the retracted papers to gain a novel insight.

MATERIALS AND METHODS

We extracted common risk factors identified in two retracted papers, and conducted relevant publication search until June 26, 2020 in PubMed. Then, we analyzed the risk factors for COVID-19 mortality and compared them to those of the retracted papers.

RESULTS

Our systematic review demonstrated that most demographic and clinical risk factors for COVID-19 mortality were similar to those of the retracted papers. However, while the retracted paper indicated that both (hydroxy)chloroquine monotherapy and combination therapy with macrolide were associated with higher risk of mortality, our study showed that only combination therapy of hydroxychloroquine and macrolide was associated with higher risk of mortality (odds ratio 2.33; 95% confidence interval 1.63-3.34). In addition, our study demonstrated that use of ACE inhibitors or angiotensin receptor blockers (ARBs) was associated with reduced risk of mortality (0.77; 0.65-0.91).

CONCLUSIONS

When analyzing the same clinical issues with the two retracted papers through a systematic review of randomized controlled trials and relevant cohort studies, we found out that (hydroxy)chloroquine monotherapy was not associated with higher risk of mortality, and that the use of ACE inhibitors or ARBs was associated with reduced risk of mortality in COVID-19 patients.