Editorial: Management of PJI/SSI after joint arthroplasty.

The management of periprosthetic joint infection (PJI) and surgical site infection (SSI) after joint arthroplasty poses a major challenge in orthopedic surgery. This Editorial provides an overview of the studies published in the special issue "Management of PJI/SSI after Joint Arthroplasty", summarizing the key findings from these studies, which cover a wide range of topics, including stringent preventive strategies, comprehensive diagnostic methods, and personalized treatment modalities. The authors concluded the editorial with their perspectives regarding the status quo of research in this field and future directions for research, such as the development of novel antibiotics, biofilm research, patient-specific risk factors, and the integration of technological advancements (such as machine learning and artificial intelligence) into clinical practice. The authors emphasized the need for continued research, interdisciplinary collaboration, and the application of innovative technologies to enhance patient outcomes and mitigate the burden of these infections on healthcare systems.

The effect of different preventive strategies during total joint arthroplasty on periprosthetic joint infection: a network meta-analysis.

BACKGROUND: Periprosthetic joint infection after total joint arthroplasty has a large incidence, and it may often require two or more stages of revision, placing an additional burden on clinicians and patients. The purpose of this network meta-analysis is to evaluate the effect of four different preventive strategies during total joint arthroplasty on the prevention of periprosthetic joint infection. METHODS: The study protocol was registered at PROSPERO (CRD: 42,023,448,868), and the literature search databases included Web of Science, PubMed, OVID Cochrane Central Register of Controlled Trials, OVID EMBASE, and OVID MEDLINE (R) ALL that met the requirements. The network meta-analysis included randomized controlled trials, retrospective cohort studies and prospective cohort studies with the outcome of periprosthetic joint infection. The gemtc R package was applied to perform the network meta-analysis to evaluate the relative results of different preventive strategies. RESULTS: This network meta-analysis study included a total of 38 articles with 4 preventive strategies and negative controls. No improvement was observed in antibiotic-loaded bone cement compared with negative controls. Chlorhexidine showed the highest probability of delivering the best preventive effect, and povidone iodine had the second highest probability. Although vancomycin ranked after chlorhexidine and povidone iodine, it still showed a significant difference compared with negative controls. In addition, the incidence after applying chlorhexidine was significantly lower than that after applying negative controls and vancomycin. In the heterogeneity test between direct and indirect evidence, there was no apparent heterogeneity between them. CONCLUSION: The study indicated that chlorhexidine, povidone iodine and vancomycin showed significant efficacy in preventing periprosthetic joint infection after total joint arthroplasty, while antibiotic-loaded bone cement did not. Therefore, more high-quality randomized controlled trials are needed to verify the results above.

Reducing the risk of suicidal behaviors in medical graduate students: exploration of student-supervisor relationship and subjective family socioeconomic status.

Objective: This study aimed to investigate the association between the risk of suicidal behaviors and student-supervisor relationships and subjective family socioeconomic status (SFSS) in medical graduate students, and to propose preventive strategies to reduce the suicidal risk among medical graduate students. Materials and methods: A total of 1,310 validated questionnaires were collected from medical graduate students, which included demographic information, study programs, the Suicidal Behaviors Questionnaire-Revised (SBQ-R) questionnaire, the Leader-Member Exchange 7 (LMX-7) questionnaire, and SFSS by MacArthur Scale. Multiple regression analysis was employed to examine the associations between variables and adjust for confounders. A moderation analysis, containing simple slope analysis and Johnson-Neyman interval plots were used to analyze the moderating effect of the SFSS in the association of SBQ-R and LMX-7 scores. Results: A total of 88 participants (6.7%) were at risk of suicidal behaviors. In the high-quality student-supervisor relationship group (LMX-7 score ≥ 25), SFSS was significantly higher than in the low- and moderate-quality relationship group (p=0.002). The median SBQ-R score and proportion of suicide risk was significantly lower (p<0.001) in the high-quality student-supervisor relationship group. Multiple regression analysis indicated LMX-7 scores (ß=-0.098, 95% CI [-0.118, -0.077], p<0.001) and SFSS (ß=-0.073, 95% CI [-0.127, -0.019], p=0.008) were significantly negatively associated with SBQ-R, whereas the interaction term of SFSS with LMX-7 (ß=0.018, 95% CI [0.007, 0.029], p=0.001) showed a significant positive association with SBQ-R. The Johnson-Neyman interval showed a significant association between LMX-7 and SBQ-R scores only when SFSS was less than 7.82 (p<0.05). Conclusion: The risk of suicidal behaviors was associated with student-supervisor relationships and SFSS among medical graduate students. Poor relationships with supervisor were associated with an elevated risk of suicidality, and SFSS moderated this association. Educators should pay increased attention to the suicidal risk of medical graduate students with poor supervisor relationships, especially those from families with low SFSS, and provide timely preventive strategies.

Causal relationship between chronic obstructive pulmonary disease and heart failure: A Mendelian randomization study.

BACKGROUND: Causal association between chronic obstructive pulmonary disease (COPD) and heart failure (HF) has been controversial. This study used Mendelian Randomization (MR) analysis to clarify the potential causal connection between these two conditions. OBJECTIVES: The purpose of the study was to investigate the causal relationship between COPD and HF based on the hypothesis that the genetic predisposition to COPD could lead to an increased risk of developing HF METHODS: A two-sample MR analysis of genetic data was performed for COPD and HF. This study was based on genome-wide association study (GWAS) data, including 6,915 patients with confirmed COPD and 186,723 controls. The odds ratios (ORs) and their 95 % confidence intervals (95 %CIs) were estimated using a fixed effects inverse variance weighting (IVW) method. Several supplementary statistical methods, including MR-Egger, weighted median, maximum likelihood, penalized weighted median, and random effects IVW, were applied to enhance the robustness of findings. Moreover, MR-PRESSO was employed as an alternative method for statistical detection. RESULTS: Pooled data for HF were obtained from different GWASs, including 4,7309 confirmed HF patients and 930,014 controls. The MR analysis, based on the IVW model, revealed that COPD was significantly associated with an increased risk of HF. Specifically, the obtained findings showed that COPD patients had a higher risk of developing HF (Model 1: OR = 1.068, 95 %CI: 1.006-1.134, p = 0.031; Model 2: OR = 1.038, 95 %CI: 1.006-1.071, p = 0.020), indicating a causal relationship between COPD and HF. No evidence was found to suggest a reverse causal effect of HF on COPD incidence. CONCLUSION: The MR analysis substantiates a causal link between COPD and HF, with no evidence supporting a reverse causation from HF to COPD. These findings underscore the importance of proactive COPD management as a potential strategy to prevent the development of HF, highlighting the need for targeted interventions in patients with COPD to mitigate their risk of HF.

Vitamin C as Scavenger of Reactive Oxygen Species during Healing after Myocardial Infarction.

Currently, coronary artery bypass and reperfusion therapies are considered the gold standard in long-term treatments to restore heart function after acute myocardial infarction. As a drawback of these restoring strategies, reperfusion after an ischemic insult and sudden oxygen exposure lead to the exacerbated synthesis of additional reactive oxidative species and the persistence of increased oxidation levels. Attempts based on antioxidant treatment have failed to achieve an effective therapy for cardiovascular disease patients. The controversial use of vitamin C as an antioxidant in clinical practice is comprehensively systematized and discussed in this review. The dose-dependent adsorption and release kinetics mechanism of vitamin C is complex; however, this review may provide a holistic perspective on its potential as a preventive supplement and/or for combined precise and targeted therapeutics in cardiovascular management therapy.

Screening ovarian cancer by using risk factors: machine learning assists.

BACKGROUND AND AIM: Ovarian cancer (OC) is a prevalent and aggressive malignancy that poses a significant public health challenge. The lack of preventive strategies for OC increases morbidity, mortality, and other negative consequences. Screening OC through risk prediction could be leveraged as a powerful strategy for preventive purposes that have not received much attention. So, this study aimed to leverage machine learning approaches as predictive assistance solutions to screen high-risk groups of OC and achieve practical preventive purposes. MATERIALS AND METHODS: As this study is data-driven and retrospective in nature, we leveraged 1516 suspicious OC women data from one concentrated database belonging to six clinical settings in Sari City from 2015 to 2019. Six machine learning (ML) algorithms, including XG-Boost, Random Forest (RF), J-48, support vector machine (SVM), K-nearest neighbor (KNN), and artificial neural network (ANN) were leveraged to construct prediction models for OC. To choose the best model for predicting OC, we compared various prediction models built using the area under the receiver characteristic operator curve (AU-ROC). RESULTS: Current experimental results revealed that the XG-Boost with AU-ROC = 0.93 (0.95 CI = [0.91-0.95]) was recognized as the best-performing model for predicting OC. CONCLUSIONS: ML approaches possess significant predictive efficiency and interoperability to achieve powerful preventive strategies leveraging OC screening high-risk groups.

Airborne transmission of common swine viruses.

The transmission of viral aerosols poses a vulnerable aspect in the biosecurity measures aimed at preventing and controlling swine virus in pig production. Consequently, comprehending and mitigating the spread of aerosols holds paramount significance for the overall well-being of pig populations. This paper offers a comprehensive review of transmission characteristics, influential factors and preventive strategies of common swine viral aerosols. Firstly, certain viruses such as foot-and-mouth disease virus (FMDV), porcine reproductive and respiratory syndrome virus (PRRSV), influenza A viruses (IAV), porcine epidemic diarrhea virus (PEDV) and pseudorabies virus (PRV) have the potential to be transmitted over long distances (exceeding 150 m) through aerosols, thereby posing a substantial risk primarily to inter-farm transmission. Additionally, other viruses like classical swine fever virus (CSFV) and African swine fever virus (ASFV) can be transmitted over short distances (ranging from 0 to 150 m) through aerosols, posing a threat primarily to intra-farm transmission. Secondly, various significant factors, including aerosol particle sizes, viral strains, the host sensitivity to viruses, weather conditions, geographical conditions, as well as environmental conditions, exert a considerable influence on the transmission of viral aerosols. Researches on these factors serve as a foundation for the development of strategies to combat viral aerosol transmission in pig farms. Finally, we propose several preventive and control strategies that can be implemented in pig farms, primarily encompassing the implementation of early warning models, viral aerosol detection, and air pretreatment. This comprehensive review aims to provide a valuable reference for the formulation of efficient measures targeted at mitigating the transmission of viral aerosols among swine populations.

Analysis of Socio-Demographic Profiles of Suicidal Hanging Cases to Formulate a Preventive Strategy: An Autopsy-Based Study Conducted at a Tertiary Care Hospital in the North-East Region of India.

Introduction Hanging is a common method of suicide in India and worldwide. Analyzing the socio-demographic characteristics to formulate a preventive strategy to reduce the incidence of suicide by hanging is often considered a low-cost but effective intervention for developing countries like India. The present study reports on preventive measures based on socio-demographic data of suicidal hanging cases brought for autopsy in a city in Northeast India. There is no scientific literature originating from the Northeast region of India that stresses on the preventive aspect of suicidal hanging cases to date.  Methods This is an observational study based on retrospective data. Data related to socio-demographic characteristics were collected from all the suicidal hanging cases reported for medicolegal autopsy at a tertiary care hospital in Dibrugarh, a city in Northeast India, from June 2012 to June 2013.  Results A total of 1241 cases were brought for autopsy, out of which 70 (5.64%) cases were determined to be death due to suicidal hanging. Male victims accounted for the majority of the cases, and most victims were in their third decade of life. Additionally, various other factors, such as marital status, occupational status, place of occurrence, psychiatric history, pregnancy status, and selection of suspension point, were studied. Conclusion Socio-demographic data generated from various research studies can play a crucial role in the early identification of vulnerable individuals and enable the prompt delivery of mental health services and other measures of interventions. Implementing policy-based strategies, such as restricting access to means and materials used in hanging, can have a positive impact on overall outcomes. Additionally, involving electronic or print media to de-popularize hanging as a clean and painless method proves to be another effective intervention.

Functionalized protein microparticles targeting hACE2 as a novel preventive strategy for SARS-CoV-2 infection.

The coronavirus disease 2019 (COVID-19) pandemic is caused by severe acute respiratory syndrome coronavirus 2(SARS-CoV-2), resulting in a serious burden on public health and social economy worldwide. SARS-CoV-2 infection is mainly initialized in the nasopharyngeal cavity through the binding of viral spike (S) protein to human angiotensin-converting enzyme 2 (hACE2) receptors which are widely expressed in many human cells. Thus, blockade of the interaction between viral S protein and hACE2 receptor in the primary entry site is a promising prevention strategy for the management of COVID-19. Here we showed protein microparticles (PMPs) decorated with hACE2 could bind and neutralize SARS-CoV-2 S protein-expressing pseudovirus (PSV) and protect host cells from infection in vitro. In the hACE2 transgenic mouse model, administration of intranasal spray with hACE2-decorated PMPs markedly decreased the viral load of SARS-CoV-2 in the lungs though the inflammation was not attenuated significantly. Our results provided evidence for developing functionalized PMPs as a potential strategy for preventing emerging air-borne infectious pathogens, such as SARS-CoV-2 infection.

An Education-Counseling Program for Young Prehypertensive Adults.

In this non-equivalent control group, non-synchronized study, we assessed the effects of an education-counseling program for young prehypertensive adults. We included 40 and 47 prehypertensive individuals in the experimental and control groups, respectively. A structured questionnaire (pretest) was used to assess prehypertension-related knowledge, attitudes, health-promoting behavior, and self-efficacy. The experimental group underwent the 8-week program, while the control group received basic prehypertension and self-management education. Subsequently, blood pressure (BP) was measured, and prehypertension-related knowledge, attitudes, health-promoting behavior, and self-efficacy were evaluated using a questionnaire (posttest). There were significant intergroup differences in knowledge (t = 3.04, p = .003), attitudes (t = 6.41, p < .001), behavior (t = 11.60, p < .001), self-efficacy (t = 11.76, p < .001), and systolic BP (t = -5.49, p < .001); however, diastolic BP was not significantly different (t = -0.73, p = .473). Our findings demonstrated that the program is effective in improving knowledge, attitudes, behavior, self-efficacy, and systolic BP. Therefore, it can be used to prevent progression to hypertension.

Development of a machine learning model to predict lateral hinge fractures by analyzing patient factors before open wedge high tibial osteotomy.

PURPOSE: Several methods have been developed to prevent lateral hinge fractures (LHFs), using only classic statistical models. Machine learning is under the spotlight because of its ability to analyze various weights and model nonlinear relationships. The purpose of this study was to create a machine learning model that predicts LHF with high predictive performance. METHODS: Data were collected from a total of 439 knees with medial osteoarthritis (OA) treated with Medial open wedge high tibial osteotomy (MOW-HTO) from March 2014 to February 2020. The patient data included age, sex, height, and weight. Preoperative, determined, and modifiable factors were categorized using X-ray and CT data to create ensemble models with better predictive performance. Among the 57 ensemble models, which is the total number of possible combinations with six models, the model with the highest area under curve (AUC) or F1-score was selected as the final ensemble model. Gain feature importance analysis and the Shapley additive explanations (SHAP) feature explanation were performed on the best models. RESULTS: The ensemble model with the highest AUC was a combination of a light gradient boosting machine (LGBM) and multilayer perceptron (MLP) (AUC = 0.992). The ensemble model with the highest F1-score was the model that combined logistic regression (LR) and MLP (F1-score = 0.765). Distance X was the most predictive feature in the results of both model interpretation analyses. CONCLUSION: Two types of ensemble models, LGBM with MLP and LR with MLP, were developed as machine learning models to predict LHF with high predictive performance. Using these models, surgeons can identify important features to prevent LHF and establish strategies by adjusting modifiable factors. STUDY DESIGN: Retrospective cohort study.

COVID-19 and preventive strategy.

In December 2019, an unprecedented outbreak of the novel coronavirus disease 2019 (COVID-19), an infectious disease caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) began to spread internationally, now impacting more than 293,750,692 patients with 5,454,131 deaths globally as of January 5, 2022. COVID-19 is highly pathogenic and contagious which has caused a large-scale epidemic impacting more deaths than the severe acute respiratory syndrome (SARS) epidemic in 2002-2003 or the Middle East respiratory syndrome (MERS) epidemic in 2012-2013. Although COVID-19 symptoms are mild in most people, in those with pre-existing comorbidities there is an increased risk of progression to severe disease and death. In an attempt to mitigate this pandemic, urgent public health measures including quarantining exposed individuals and social distancing have been implemented in most states, while some states have even started the process of re-opening after considering both the economic and public health consequences of social distancing measures. While prevention is crucial, both novel agents and medications already in use with other indications are being investigated in clinical trials for patients with COVID-19. The collaboration between healthcare providers, health systems, patients, private sectors, and local and national governments is needed to protect both healthcare providers and patients to ultimately overcome this pandemic. The purpose of this review is to summarize the peer-reviewed and preprint literature on the epidemiology, transmission, clinical presentation, and available therapies as well as to propose a preventive strategy to overcome the present global pandemic.

Physical Exercise and Health: A Focus on Its Protective Role in Neurodegenerative Diseases.

Scientific evidence has demonstrated the power of physical exercise in the prevention and treatment of numerous chronic and/or age-related diseases, such as musculoskeletal, metabolic, and cardiovascular disorders. In addition, regular exercise is known to play a key role in the context of neurodegenerative diseases, as it helps to reduce the risk of their onset and counteracts their progression. However, the underlying molecular mechanisms have not yet been fully elucidated. In this regard, neurotrophins, such as brain-derived neurotrophic factor (BDNF), nerve growth factor (NGF), glia cell line-derived neurotrophic factor (GDNF), neurotrophin-3 (NT-3), and neurotrophin-4 (NT-4), have been suggested as key mediators of brain health benefits, as they are involved in neurogenesis, neuronal survival, and synaptic plasticity. The production of these neurotrophic factors, known to be increased by physical exercise, is downregulated in neurodegenerative disorders, suggesting their fundamental importance in maintaining brain health. However, the mechanism by which physical exercise promotes the production of neurotrophins remains to be understood, posing limits on their use for the development of potential therapeutic strategies for the treatment of neurodegenerative diseases. In this literature review, we analyzed the most recent evidence regarding the relationship between physical exercise, neurotrophins, and brain health, providing an overview of their involvement in the onset and progression of neurodegeneration.

Epidemiological analysis of SARS-COV-2 B.1.617.2 (delta variant) transmission in an educational institute.

Background: Despite having an effective COVID-19 vaccine, the COVID-19 pandemic is far from over and the delta variant continues to cause havoc across several continents. The present study was conducted to analyze and describe the occurrence of COVID-19 cases among completely vaccinated individuals. Methods: In an educational institute in Western Maharashtra, we analyzed a cluster of RTPCR positive COVID-19 cases among fully vaccinated students which occurred in 12 days. The cases were linked to a series of curricular and co-curricular events in the institute. A detailed epidemiological investigation and genome sequencing of cases were conducted. IgG antibodies against S1 protein of novel SARS-CoV-2 were estimated for cases and age, sex, and vaccination status matched controls. Results: All 37 identified cases were mild COVID. 188 high risk (HR) contacts of the cases were identified. The overall secondary attack was 9.5%. Out of 31 cases and 50 controls, 09 (29%) cases and 08 (16%) controls were found to have IgG antibodies against S1 protein of novel SARS-CoV-2 titer of more than 60 U/ml. Whole-genome sequencing of 15 samples of the cluster showed the presence of the Delta variant of SARS-CoV-2. No correlation was observed between Ct value and IgG S1 antibody titers. Conclusion: The study provides significant evidence that only vaccination alone does not completely protect against SARS-CoV-2 B.1.617.2 (Delta) variant infection. An all-encompassing multicomponent strategy involving implementation of NPIs, robust contact tracing, early identification and isolation of cases, and high vaccination coverage is the way forward for the prevention of COVID-19.

Retrospective analysis and prevention strategies of blood-borne occupational exposure in Beijing Red Cross Blood Center from 2010 to 2021 / 中国输血杂志

【Objective】 To understand the occupational exposure of blood center staff during blood collection and supply, analyze the influencing factors, explore preventive measures and improve the self-protection awareness of staff, so as to further improve the prevention of such occupational exposure in blood centers. 【Methods】 Seventy-two occupational exposure cases, which occurred and registered in Beijing Red Cross Blood Center from January 2010 to December 2021, were reviewed by retrospective survery methods, and such cases were classified and analyzed statistically. The incidence of blood-borne occupational exposure was compared by genders, departments, occurrence locations, education level, occupation type, work link, causes of exposure and body parts, so as to analyze the influencing factors, and then propose corresponding prevention strategies. 【Results】 From 2010 to 2021, a total of 72 blood-borne occupational exposure cases occurred. When classified by gender, the exposure rate of women was more than twice that of men; by age, the exposure rate of 18~25 years old was the highest, reaching 7.84%, but 26~40 years old group contributed the most cases, accounting for 70.83% (51/72); by working years, the exposure rate of staff with working years less than 3 years was relatively high, but the staff with 4~10 working years contributed the most cases, accounting for 54.17% (39/72); by the education level, the the exposure rate of stall with bachelor degree and below was the highest(90.28%, 65/72); by the professional title level, the exposure rate of staff with primary and intermediate professional titles was relatively high (94.44% , 68/72); by departments, the exposure rate of Blood Donation Service was the highest (81.94%, 59/72), which was twice or even three times than that of other departments; by occupational type, nurses had the highest exposure rate, accounting for 87.5% (63/72); by body parts, hands were the most vulnerable body parts to occupational exposure; by location, the exposure rate on mobile vehicles is four times than that in indoor places; by the number of exposure times, the incidence of one exposure cases accounted for 72.22%(52/72)while multiple exposure was rare by work link, the exposure rate of the sampling link was significantly higher than that of the other links. 【Conclusion】 Blood-borne occupational exposure of staff in blood centers is closely related to gender, age, working years, professional title level, department, occupational type, occurrence place, and body part, and has nothing to do with the education level. More attention should be paid to middle-aged female nurses on the front line of blood donation service, staff with primary or intermediate titles and undergraduate degrees. Otherwise, training and protection should be enhanced, operation methods be standardized, the blood collection environment be improved, and the management, automation and intelligent level of blood collection be promoted.

Systematic analysis of drug dispensing errors and preventive measures in outpatient pharmacies / 药学实践杂志

Objective To understand the current situation of dispensing errors and effective prevention and control measures in outpatient pharmacies in domestic hospitals, in order to further improve the quality of drug dispensing. Methods The Chinese journal database was retrieved from 2015 to 2020 for the literature on the dispensing errors of outpatient pharmacies and the continuous improvement of the quality after the measures were taken in secondary and tertiary hospitals. Results Of the 146 literatures retrieved, 13 were included in the analysis (11 in tertiary hospitals and 2 in secondary hospitals). Before the improvement, the median of the drug dispensing error rate was 5.1‰, and after the improvement it was 1.1‰. Before and after the improvement, the types of drug dispensing errors were mainly quantity errors (52.5% vs. 51.3%), variety errors (28.3% vs. 28.7%), specifications and dosage forms errors (6.2% vs. 6.7%), and labeling errors (2.1% vs. 2.9%). The improvement measures taken for the reasons of dispensing errors have a high overlap rate, and they are concentrated in two aspects: personnel factors and drug factors. Conclusion The use of continuous quality improvement tools in hospital outpatient pharmacy to control and prevent dispensing errors is still a hotspot of current research. The composition of the types of errors after improvement has basically not changed. The implemen-tation of standardized operating procedures and other continuous improvement comprehensive measures can effectively reduce the incidence of dispensing errors, and contribute to the implementation of the “Expert Consensus on Medication Error Management in China”.

Epidemiological Characteristics of COVID-19 Resurgence in Areas Initially Under Control.

Objectives: To investigate the epidemiological characteristics and infection routes of new cases in order to provide information for preventing COVID-19 resurgence in areas initially under control. Methods: The information of new symptomatic and asymptomatic patients in Chinese mainland was collected. The location distribution, epidemic course, infection routes and patients' characteristics of outbreaks were described and analyzed. Results: There were 43 new outbreaks with 3,795 symptomatic patients in Chinese mainland from March 21, 2020 to June 13, 2021. These outbreaks mainly occurred in central, border and coastal port cities. The main infection route of first generation indigenous patients was contact with imported cases and contaminated goods or environments. The infection routes of secondary generation patients mainly included family transmission, indoor social gathering infection, nosocomial infection and other infection routes. Family transmission was the most common infection route, and indoor social gathering was the most important reason for the large-scale outbreaks. Conclusions: Strengthen the management of imported patients and staff in high-risk posts was the key point to avoid the first generation indigenous patients. Adequate family isolation, prompt management policies for indoor public place and monitor of population at risk of infection were key strategies for preventing COVID-19 resurgence in areas initially under control.

Associations of Nutritional, Lifestyle, and Metabolic Factors With Non-alcoholic Fatty Liver Disease: An Umbrella Review With More Than 380,000 Participants.

Background & Aims: Nonalcoholic fatty liver disease (NAFLD) is the most common liver injury. We performed this umbrella review of meta-analyses to summarize the evidence on the associations of nutritional, lifestyle, and metabolic factors with NAFLD. Methods: We searched the PubMed, Embase, and Web of Science databases from inception until July 2, 2020, to identify meta-analyses of observational studies which explored the associations of nutritional, lifestyle, and metabolic factors with NAFLD. Evidence levels were assessed using summary effect sizes, 95% prediction intervals, between-study heterogeneity, evidence of small-study effects, and evidence of excess significance bias for each meta-analysis. (No. of PROSPERO, CRD42020200124). Results: Twenty two risk or protective factors from 10 published meta-analyses were included and studied. Three risk factors (sugar-sweetened beverage consumption, serum fetuin-A, and waist circumference) with highly suggestive levels of evidence and three risk factors (soft drink consumption, former smoking, and body mass index) with suggestive levels of evidence were identified. Only two protective factors (physical activity and serum vitamin D level [among adults in Western countries]) with suggestive levels of evidence were identified. Furthermore, other six risk factors and two protective factors with weak levels of evidence were identified. Conclusions: We found varying levels of evidence of associations of nutritional, lifestyle, and metabolic factors and NAFLD. The results suggest that nutritional and lifestyle management should be considered as a major primary preventive strategy for NAFLD. Moreover, considering the low quality of included meta-analyses and limited area of research topics, future high-quality original studies and meta-analyses should be performed to study these associations.

Prediction and Development of Preventive Strategies for Lateral Hinge Fracture During Opening Wedge High Tibial Osteotomy Based on Osteotomy Configurations.

BACKGROUND: Lateral hinge fracture (LHF) is a major complication of opening wedge high tibial osteotomy (OWHTO) and may result in poor outcomes. PURPOSE/HYPOTHESIS: The purpose of this study was to develop preventive strategies by identifying factors that affect LHFs. We hypothesized that (1) each LHF type would have different affecting factors and that (2) specific operative strategies that can contribute to the prevention of each LHF type can be developed. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: We retrospectively analyzed 261 consecutive knees treated with biplanar OWHTO between March 2014 and December 2017. Perioperative radiological variables that can affect LHFs were measured and divided into 2 categories: unmodifiable and modifiable. A regression model was developed, and subgroup analyses involving comparisons between the non-LHF group and each LHF group were performed. The weightbearing line (WBL) ratio was measured at 2 weeks and 1 year after surgery to determine the serial changes in each LHF type. RESULTS: A total of 66 knees (25.3%) were diagnosed with LHFs. From these, 26 (39.4%), 13 (19.7%), 15 (22.7%), and 12 (18.2%) showed type I, II, III, and I-variant LHFs, respectively. In the subgroup analysis, a larger posterior gap and distance X and a smaller fibular height (FH) were significant unmodifiable factors, while the retrotubercular thickness was a significant modifiable factor, for type I LHF. For type II LHF, a smaller lateral condylar slope and a larger distance X were significant unmodifiable factors, while the lateral distal fragment thickness and the osteotomy-condylar angle were significant modifiable factors. For type III LHF, a larger lateral condylar width and distance X and a smaller FH were significant unmodifiable factors, while the lateral proximal fragment thickness and the retrotubercular angle (RA) were significant modifiable factors. A smaller FH and a larger distance X were significant unmodifiable factors for type I-variant LHFs, while the lateral thickness ratio and the RA were significant modifiable factors. Between postoperative week 2 and 1 year, the WBL ratio decreased in cases with type I LHFs (P < .001) and increased in those with type II (P = .001) and type I-variant (P = .006) LHFs. CONCLUSION: Unmodifiable and modifiable factors for the development of LHFs after OWHTO differ among LHF types. To prevent LHFs, the causes of each LHF must be identified, the patient's specific geometry be considered in the preoperative planning, and the surgical technique be modified according to the modifiable factors. In addition, during the rehabilitation period after OWHTO, specific caution and close observation are necessary for alignment changes related to each LHF type.