bluuebunny/crossref_metadata_2025 huggingface dataset:
Damage location diagnosis of frame structure based on wavelet denoising and convolution neural network implanted with Inception module and LSTM
Authors: Chi Yaolei , Cai Chaozhi , Ren Jianhua , Xue Yingfang , Zhang Nan
Published: April 2023

Accurate diagnosis of the damage location of the frame structure is very important for the overall damage assessment and subsequent maintenance of the frame structure. However, the frame structure generally works in the noise environment, which increases the difficulty of health monitoring and fault diagnosis of frame structure based on vibration data. In order to realize the accurate damage location diagnosis of structural frame under noise environment, this paper proposes a fault diagnosis method based on wavelet denoising, convolutional neural network, Inception module, and long short-term memory (LSTM) on the basis of complete ensemble empirical mode decomposition with adaptive noise (CEEMDAN). In order to verify the effectiveness and superiority of the method proposed in this paper, the 4-story steel frame model of the University of British Columbia is taken as the research object, and the experiments are carried out with the method proposed in this paper, and under the same conditions, the comparative experiments are carried out with other similar methods. The experimental results show that the method proposed in this paper not only has high accuracy, but also has strong anti-noise ability, and its performance is better than other similar methods. Therefore, the fault diagnosis method proposed in this paper can effectively perform the accurate diagnosis of damage location of frame structure under noise environment.
A month in the country: The sesquicentenary of David Ferrier’s classical cerebral localisation researches of 1873
Authors: Larner Andrew J J
Published: April 2023

The experimental studies of David Ferrier (1843–1928), establishing many of the principles of cerebral localisation which still underpin neurological reasoning in clinical practice, were first reported 150 years ago. This paper briefly reviews Ferrier’s experimental work, first undertaken in the laboratory at the West Riding Lunatic Asylum in Wakefield, West Yorkshire and his resulting publications of 1873, as well as some contemporaneous responses to his findings. These not only established ‘motor centres’ pertinent to physiology and the signs of cerebral disease but also, from the outset, had ramifications for Ferrier’s understanding of higher mental functions. That linguistic, mnemonic and perceptual cognitive functions might be related to localised areas within the brain received its most emphatic initial impetus from Ferrier’s work.
The Role of BTBD7 in Normal Development and Tumor Progression
Authors: Liu Yun , Song Jiwu , Gu Jianchang , Xu Shuangshuang , Wang Xiaolan , Liu Yunxia
Published: April 2023

BTB/POZ domain-containing protein 7 (BTBD7) has a relative molecular weight of 126KD and contains two conserved BTB/POZ protein sequences. BTBD7 has been shown to play an essential role in normal human development, precancerous lesions, heat-stress response, and tumor progression. BTBD7 promotes branching morphogenesis during development and participates in the salivary gland, lung, and tooth formation. Furthermore, many studies have shown that aberrant expression of BTBD7 promotes heat stress response and the progression of precancerous lesions. BTBD7 has also been found to play an important role in cancer. High expression of BTBD7 affects tumor progression by regulating multiple pathways. Therefore, a complete understanding of BTBD7 is crucial for exploring human development and tumor progression. This paper reviews the research progress of BTBD7, which lays a foundation for the application of BTBD7 in regenerative medicine and as a biomarker for tumor prediction or potential therapeutic target.
Association of the anti-thyroid peroxidase antibody with chronic hand pain in older adults in the Third National Health and Nutrition Examination Survey: a cross-sectional study
Authors: Tagoe Clement E. , Wang Wanyi , Barbour Kamil E.
Published: April 2023

Background:

Autoimmune thyroid disease (AITD) is the commonest autoimmune disease. Although viewed as a classic form of single-organ autoimmunity, AITD is increasingly associated with non-thyroid sequelae including musculoskeletal manifestations and chronic pain syndromes. However, large population-based studies are needed.

Objectives:

To examine the relationships between chronic hand pain and the AITD autoantibodies, anti-thyroid peroxidase antibody (TPOAb), and anti-thyroglobulin antibody (TgAb), in the Third National Health and Nutrition Examination Survey (NHANES III).

Design:

This is a cross-sectional study.

Methods:

We examined data from NHANES III on 4820 persons aged 60 years or older with respect to hand pain and its association with TPOAb and TgAb. Log-binomial regressions were fit to examine the associations between the anti-thyroid autoantibodies and hand pain.

Results:

Positive TPOAb was associated with a higher prevalence of hand pain than negative TPOAb [prevalence ratio (PR) = 1.158, p = 0.048] in the unadjusted model. This association was no longer significant after controlling for age, body mass index, gender, and diabetes ( p = 0.313). When positive TPOAb was considered as a categorical variable with four levels, the highest quartile was associated with hand pain in the unadjusted (PR = 1.489, p = 0.005) and adjusted models (PR = 1.325, p = 0.042). There was no significant association between TgAb and hand pain when covariates were controlled for.

Conclusion:

TPOAb may be associated with the presence of chronic hand pain in persons aged over 60 years, especially at higher serum levels.
Rethinking ‘Hope’ and ‘Resilience’ in the Anthropocene: An Interview with David Chandler
Authors: Chandler David , Hathout Shahira
Published: April 2023

This is an interview with David Chandler, Professor of International Relations at Westminster University, UK, a leading scholar in the field of international politics and policy discourses of resilience in the Anthropocene. This interview explores the challenges presented by the Anthropocene and the ways that discourses of ‘hope’ and ‘resilience’ might effectively reflect and negotiate them.
Counter-collaborations towards alternative bio-securitizations
Authors: Arefin Mohammed Rafi , Prouse Carolyn
Published: April 2023

In this commentary, we argue that geographical thought and praxis must engage with repressive biosecurity and biosurveillance systems and fight for alternatives. In doing so, geographers can contribute to an emerging anti-colonial and anti-racist interdisciplinary science. We suggest two counter-collaborations towards alternative bio-securitizations: working with those who have been cast out of biopolitical worlds and have long been fostering life for their communities; and working with practitioners of hegemonic science to re-direct biomedical efforts. Building these collaborations would orient biosecurity praxis to those biosecuritizations that already exist at the margins of violent security programs and foster communal and just care relations as the foundation for a liberatory and interdisciplinary science.
Appropriateness of antimicrobial selection for treatment of pneumonia in selected public hospitals of Eastern Ethiopia: A cross-sectional study
Authors: Jambo Abera , Edessa Dumessa , Adem Fuad , Gashaw Tigist
Published: April 2023

Objective:

Inappropriate antimicrobial use leads to drug resistance and poor clinical outcomes. Considering the lack of data regarding the drug use patterns in the treatment of pneumonia in selected study areas, the authors felt compelled to assess the appropriateness of antimicrobial usage in the treatment of pneumonia at Hiwot Fana Specialized Comprehensive University Hospital and Jugal Hospital from May 1 to 31, 2021.

Methods:

A cross-sectional retrospective study was conducted using the medical cards of 693 admitted patients with pneumonia. The collected data were analyzed using SPSS version 26. Bivariable and multivariable logistic regression analyses were used to identify the factors associated with an initial inappropriate antibiotic use. A p value of 0.05 was used to determine the statistical significance of the association using an adjusted odds ratio with 95% confidence interval.

Results:

Of the total participants, 116 (16.74%, 95% confidence interval: 14.1–19.6) of them received an initial inappropriate antimicrobial regimen. Ceftriaxone plus azithromycin was the most prescribed antimicrobial agent. Patients who were younger than 5 years (adjusted odds ratio = 1.71; 95% confidence interval: 1.00–2.94), between 6 and 14 years (adjusted odds ratio = 3.14; 95% confidence interval: 1.64–6.00), and older than 65 years (adjusted odds ratio = 2.97; 95% confidence interval: 1.07–2.66), with comorbid conditions (adjusted odds ratio = 1.74; 95% confidence interval: 1.10–2.72) and prescribed by medical interns (adjusted odds ratio = 1.80; 95% confidence interval: 1.14–2.84) were associated with an initial inappropriate antimicrobial use.

Conclusion:

Around one out of every six patients had received initial inappropriate treatments. Adherence to the recommendation of guidelines and attention to extreme-aged groups and comorbidity may improve antimicrobial use.
Metastatic large-cell neuroendocrine carcinoma of the lung masquerading as a primary gallbladder carcinoma: A case report
Authors: Syposs Chauncey , Agostini-Vulaj Diana
Published: April 2023

Gallbladder neuroendocrine carcinoma is rare, representing ~4% of all primary malignant gallbladder neoplasms. We report the case of a 75-year-old female who presented for radiologic restaging for lung adenocarcinoma diagnosed elsewhere, demonstrating a hypermetabolic gallbladder mass. With concern for a gallbladder primary, radical cholecystectomy followed. Gross showed a 2-cm polypoid fundic mass; microscopically, tumor cells were arranged in sheets, with organoid features and necrosis, variable cytoplasm, vesicular-granular chromatin, prominent nucleoli, frequent mitoses, and apoptotic figures. Immunohistochemically, synaptophysin, chromogranin, CK7, and TTF-1 were positive; Ki67 was 80%. The combined findings were diagnostic of large-cell neuroendocrine carcinoma. Further investigation including outside slide review with additional stains revealed the lung primary to be classified large-cell neuroendocrine carcinoma, thus the gallbladder tumor representing metastasis. Within 4 months, the patient expired with widespread metastases. To our knowledge, this is the first reported case of metastatic lung large-cell neuroendocrine carcinoma to gallbladder in the English literature.
Health Services Use and Outcomes for Hospital Admissions With a Major Cardiovascular Event Recorded in Health Care Administrative Data in Patients Receiving Maintenance Hemodialysis: A Retrospective Cohort Study
Authors: Al-Jaishi Ahmed A. , Jeyakumar Nivethika , Kang Yuguang , De Chickera Sonali , Dixon Stephanie N. , Luo Bin , Sontrop Jessica , Walsh Michael , Tonelli Marcello , Garg Amit X.
Published: April 2023

Background:

Administrative data are used in studies of hemodialysis care to report cardiovascular-related hospitalizations. Showing recorded events are associated with significant health care resource use and poor outcomes would confirm that administrative data algorithms identify clinically meaningful events.

Objective:

The objective of this study was to describe the 30-day health service use and outcomes when a hospital admission with myocardial infarction, congestive heart failure, or ischemic stroke is recorded in administrative databases.

Design:

This is a retrospective review of linked administrative data.

Patients and Setting:

Patients receiving maintenance in-center hemodialysis in Ontario, Canada, between April 1, 2013, and March 31, 2017, were included.

Measurements:

Records from linked health care databases at ICES in Ontario, Canada were considered. We identified hospital admission with the most responsible diagnosis recorded as myocardial infarction, congestive heart failure, or ischemic stroke. We then assessed the frequency of common tests, procedures, consultations, post-discharge outpatient drug prescriptions, and outcomes within 30 days following the hospital admission.

Methods:

We used descriptive statistics to summarize results using counts and percentages for categorical variables and means with standard deviations or medians with quartile ranges for continuous variables.

Results:

There were 14 368 patients who received maintenance hemodialysis between April 1, 2013, and March 31, 2017. The number of events per 1000 person-years was 33.5 for hospital admissions with myocardial infarction, 34.2 for congestive heart failure, and 12.9 for ischemic stroke. The median (25th, 75th percentile) duration of hospital stay was 5 (3-10) days for myocardial infarction, 4 (2-8) days for congestive heart failure, and 9 (4-18) days for ischemic stroke. The chance of death within 30 days was 21% for myocardial infarction, 11% for congestive heart failure, and 19% for ischemic stroke.

Limitations:

Events, procedures, and tests recorded in administrative data can be misclassified compared with medical charts.

Conclusions:

In patients receiving maintenance hemodialysis, hospital admissions of major cardiovascular events routinely recorded in health administrative databases are associated with significant use of health service resources and poor health outcomes.
Effect of titanium dioxide on Streptococcus mutans biofilm
Authors: Sanders Molly K , Duarte Simone , Ayoub Hadeel M , Scully Allison C , Vinson LaQuia A , Gregory Richard L
Published: April 2023

Background:

Streptococcus mutans ( S. mutans) participates in the dental caries process. Titanium dioxide (TiO2) nanoparticles produce reactive oxygen species capable of disrupting bacterial DNA synthesis by creating pores in cell walls and membranes.

Objective:

The objective of this study was to determine the effect of TiO2 on the disruption of S. mutans biofilm.

Methods:

This study was conducted in four phases involving a TiO2-containing toothbrush and TiO2 nanoparticles. Each phase was completed using 24 h established S. mutans biofilm growth. Phase one data was collected through a bacterial plating study, assessing biofilm viability. Biofilm mass was evaluated in phase two of the study by measuring S. mutans biofilm grown on microtiter plates following crystal violet staining. The third phase of the study involved a generalized oxygen radical assay to determine the relative amount of oxygen radicals released intracellularly. Phase four of the study included the measurement of insoluble glucan/extracellular polysaccharide (EPS) synthesis using a phenol-sulfuric acid assay.

Results:

Both exposure time and time intervals had a significant effect on bacterial viability counts ( p = 0.0323 and p = 0.0014, respectively). Bacterial counts after 6 min of exposure were significantly lower than after 2 min ( p = 0.034), compared to the no treatment control ( p = 0.0056). As exposure time increased, the amount of remaining biofilm mass was statistically lower than the no treatment control. Exposure time had a significant effect on oxygen radical production. Both the 30 and 100 nm TiO2 nanoparticles had a significant effect on bacterial mass. The silver nanoparticles and the 30 and 100 nm TiO2 nanoparticles significantly inhibited EPS production.

Conclusion:

The TiO2-containing toothbrush kills, disrupts, and produces oxygen radicals that disrupt established S. mutans biofilm. TiO2 and silver nanoparticles inhibit EPS production and reduce biofilm mass. The addition of TiO2 to dental products may be effective in reducing cariogenic dental biofilm.
Primary Mpox and Secondary Syphilis in an HIV Patient: A Community Hospital Experience
Authors: Castanares Geocel-Grace , D’Assumpcao Carlos , Fang Michelle , McPheeters Rick , Heidari Arash
Published: April 2023

Mpox was an emerging outbreak in California in 2022, primarily in major metropolitan areas, as part of the global mpox outbreak declared by World Health Organization in July 2022. Community hospitals outside of major metropolitan areas have seen fewer cases to date, so they may be less equipped to diagnose and treat patients with mpox. They may have limited public health resources commensurate with the area’s population density. Mpox may also be superimposed on ongoing local outbreaks of other sexually transmitted infections. We present a case of a person with HIV who contracted mpox and also developed secondary syphilis. Early detection can be beneficial for prompt treatment, decreased burden of disease for the individual, and prevention of further spread of the infection.
Failure to Thrive in a Middle-Aged Female: A Case of Congenital Incomplete Pancreas From a Rare Genetic Defect
Authors: Ugonabo Onyinye , Mohamed Turki , Kheetan Murad , Sherif Ahmed
Published: April 2023

Hepatocyte nuclear factor-1 beta (HNF1B) gene is predominantly expressed in the liver, kidney, lung, genitourinary tract, and pancreas. It is an important transcription factor that regulates pancreas development. Mutation or absence of this gene is rare and can cause incomplete pancreatic development known as the agenesis of the dorsal pancreas. This rare genetic abnormality is associated with other disorders like maturity-onset diabetes of the young, abnormal liver function tests, genitourinary tract malformation, pancreatitis, and renal cysts. Diagnosing this genetic abnormality is difficult, especially in patients presenting with symptoms specific to only one system. Management is based on disease manifestation and involves a multidisciplinary approach. Our case describes a 51-year-old female with poorly controlled diabetes mellitus and Mullerian duct anomalies who presented with abdominal pain, fatigue, dizziness, and electrolyte derangement. Contrast-enhanced computed tomography (CECT) of the abdomen showed a multicystic kidney and a pancreatic head with a missing body and tail. Further workup revealed an HNF1B mutation.
General Surgery Training and One Year of COVID-19. What Has Been the Impact on Residents’ Operating Room Surgical Activity? A Report From an Italian Academic Hospital
Authors: Bresadola Vittorio , Brollo Pier Paolo , Muschitiello Davide , Quattrin Rosanna
Published: April 2023

BACKGROUND

In the last year and a half, the COVID-19 pandemic has put great pressure on the healthcare systems of many countries, Italy included, leading to a reorganization of hospital activities and a dramatic reduction in surgical activity. Our study aimed to evaluate, from a quantitative and qualitative perspective, the impact of this reduction on the formation of surgery residents at the Academic Hospital of Udine.

METHODS

We compared the resident's surgical activity during the pandemic year (March 2020–2021) with the one during the pre-pandemic year, declining the surgical procedures by timing, type, and complexity and categorizing the residents by postgraduate year (PGY) and surgical role.

RESULTS

Our analysis highlighted how the main reductions occurred in the elective and medium complexity surgery due to the procrastination of benign pathologies such as hernias, cholelithiasis, and hemorrhoids, which also appeared to be the more frequent cases where the residents are first operators. On the other hand, the residents of the last PGY still maintained a good exposure to neoplasm and high complexity interventions, which are cardinal aspects in the last year of formation.

CONCLUSIONS

These results mostly confirmed the critical points noted by the resident surgeons themselves, highlighting however the specific impact on different PGY and surgical activities, offering a starting point to better understand how to challenge the negative effect that the COVID-19 pandemic has had on the surgical resident formation.
Emergency medical services: the next linking asset for public health approaches to palliative care?
Authors: Juhrmann Madeleine L. , Grindrod Andrea E. , Gage Caleb H.
Published: April 2023

Emergency medical services (EMS) are a unique workforce providing 24/7 emergency care across high-income countries (HICs) and low- and middle-income countries (LMICs). Although traditionally perceived as first responders to traumatic and medical emergencies, EMS scope of practice has evolved to respond to the changing needs of communities, including a growing demand for community-based palliative care. Public health provides a useful framework to conceptualise palliative and end-of-life care in community-based settings. However, countries lack public policy frameworks recognising the role EMS can play in initiating palliative approaches in the community, facilitating goals of care at end of life and transporting patients to preferred care settings. This article aims to explore the potential role of EMS in a public health palliative care approach in a critical discussion essay format by (1) discussing the utility of EMS within a public health palliative care approach, (2) identifying the current barriers preventing public health approaches to EMS palliative care provision and (3) outlining a way forward through priorities for future research, policy, education and practice. EMS facilitate equitable access, early provision, expert care and efficacious integration of community-based palliative care. However, numerous structural, cultural and practice barriers exist, appearing ubiquitous across both HICs and LMICs. A Public Health Palliative Care approach to EMS Framework highlights the opportunity for EMS to work as a linking asset to build capacity and capability to support palliative care in place; connect patients to health and community supports; integrate alternative pathways by engaging multidisciplinary teams of care; and reduce avoidable hospital admissions by facilitating home-based deaths. This article articulates a public health approach to EMS palliative and end-of-life care provision and offers a preliminary framework to illustrate the components of a potential implementation and policy strategy.
Haglund Excision and Suture Bridge Repair
Authors: Anastasio Albert T. , Hinton Zoe , Danilkowicz Richard , Amendola Annunziato
Published: April 2023

Background:

Haglund deformity and insertional Achilles tendinopathy involve a degenerative process demonstrating disorganized collagen and mucoid degenerative material causing pain and swelling.

Indications:

Operative management through a distally based midline incision should be explored if symptoms are refractory to nonoperative management (activity and shoewear modifications, heel lifts, physical therapy, and heel sleeves). Direct lateral approach with small longitudinal split and removal of lateral prominence “pump bump” is performed when a patient has pain isolated solely to the prominence. We feel that endoscopic removal does not allow for appropriate evaluative of degenerative tissue.

Techniques:

Through a distally based incision, we dissect to the level of the paratenon and make one smooth cut through paratenon and tendon. We then excise the mucoid, degenerative tissue. Removal of Haglund deformity and exostosis is carefully accomplished with a saw. We then utilize a rongeur to smooth Haglund deformity and any remaining medial/lateral calcaneal prominences. We then complete a dual-row speed bridge with 4 suture anchors (horizontal mattress) and a modified Mason-Allen technique. A Thompson test is then repeated and the longitudinal split is repaired. Postoperatively, we have patients weight bear as tolerated in a boot for with suture removal and transition to shoewear at the 2-week mark. We begin range of motion and activity once the wound has healed. We expect return to sport beginning at 3 months with full return by 6 months.

Results:

The current body of literature shows significant patient satisfaction and minimal risk of complication. Some authors have shown significant improvement in American Orthopaedic Foot and Ankle Score (AOFAS) scores, with only 1 patient requiring a flexor hallucis longus (FHL) transfer and no complications. Further studies identify early weight-bearing in Achilles suture bridge technique to have some promise with improvement in visual analog scale (VAS)/AOFAS scores, though there is risk of wound breakdown.

Discussion/Conclusion:

An Achilles suture bridge technique with early weight-bearing is a viable option for patients with Haglund deformity, and insertional Achilles tendinopathy who have failed conservative management.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Suture-Staple Fixation of Os Acetabuli: Description of a Novel Fixation Technique Using Linked Knotless Suture Anchors
Authors: Tadepalli Vaibhav , Gwathmey Winston
Published: April 2023

Background:

An os acetabuli is a bone fragment of the acetabular rim. Several stabilization techniques have been described in the literature including the use of canulated headless compression screws, sutures placed over screws, and knotted suture anchors; however, the use of screws near the joint could either lead to irritation or increased joint surface wear if placed improperly.

Indications:

Fixation of an os acetabuli is indicated when removal of the os would result in under-coverage of the femoral head which would in turn lead to a rapid onset of arthritis.

Technique Description:

This novel technique for os acetabuli fixation uses knotless suture anchors to create a “suture-staple” construct. Following the debridement of fibrous tissue and labral repair, reduction of the acetabular os is accomplished and confirmed on intraoperative fluoroscopy. Knottless FiberTak™ Suture Anchors are placed in the anterior and the posterior aspects of the os, and the anchor suture of one anchor is passed through the pass suture of the second anchor to create a “suture-staple” configuration.

Results:

Maintenance of reduction and pain-free motion of the hip was confirmed at 3-month clinic follow-up. The x-rays obtained at this time revealed no evidence of arthritis and appropriate coverage of the hip joint.

Discussion/Conclusion:

Outcomes of other methods of os fixation are largely lacking; however, outcomes using a knotted suture anchor technique in 3 patients with 1-year follow-up seem to indicate fully healed os fragments in all patients with improvement in patient-reported outcomes scores. Longer-term follow-up will be needed to ensure this similar technique produces similar outcomes.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
A bedside swallowing screen for the identification of post-extubation dysphagia on the intensive care unit – validation of the Gugging Swallowing Screen (GUSS)—ICU
Authors: Troll Claudia , Trapl-Grundschober Michaela , Teuschl Yvonne , Cerrito Adrien , Compte Montserrat Gallego , Siegemund Martin
Published: April 2023

Purpose

Screening for dysphagia at the intensive care unit (ICU) soon after extubation can prevent aspiration, pneumonia, lower mortality, and shorten re-feeding interval. This study aimed to modify the Gugging Swallowing Screen (GUSS), which was developed for acute stroke patients, and to validate it for extubated patients in the ICU.

Methods

In this prospective study, forty-five patients who had been intubated for at least 24 h were recruited consecutively at the earliest 24 h after extubation. The modified GUSS-ICU was performed twice by two speech and language therapists independently. Concurrently, gold standard the flexible endoscopic evaluation of swallowing (FEES) was performed by an otorhinolaryngologist. Measurements were conducted within a three-hour period; all testers were blinded to each other’s results.

Results

According to FEES, 36 of 45 (80%) participants were diagnosed with dysphagia; 13 of those were severe, 12 moderate, and 11 mild. Compared to FEES, the GUSS-ICU predicted dysphagia well (area under the curve for the initial rater pair: 0.923, 95% CI 0.832–1.000 and 0.923, 95% CI 0.836 -1.000 for the second rater pair). The sensitivity was 91.7% (95% CI 77.5–98.3%) and 94.4% (95% CI 81.3–99.3%); the specificity was 88.9% (51.8–99.7%) and 66.7% (29.9–92.5%); the positive predictive values were 97.1% (83.8–99.5%) and 91.9% (81.7–96.6%), and the negative predictive values were 72.7% (46.8–89%) and 75% (41.9–92.6%) for the first and second rater pairs, respectively.

Dysphagia severity classification according to FEES and GUSS-ICU correlated strongly (Spearman’s rho: 0.61 for rater 1 and 0.60 for rater 2, p < 0.001). Agreement by all testers was good (Krippendorffs Alpha: 0.73). The interrater reliability showed good agreement (Cohen`s Kappa: 0.84, p < 0.001).

Conclusion

The GUSS-ICU is a simple, reliable, and valid multi-consistency bedside swallowing screen to identify post-extubation dysphagia at the ICU.

Trial registration

ClinicalTrials.gov Identifier: NCT04532398,31/08/2020.
Clinical and microbiological profiles in post-chemotherapy neutropenic fever in hematological malignancy: exploration of clinical phenotype patterns by two-step cluster analysis
Authors: Chan Choi Wan , Molassiotis Alex , Lee Harold K. K.
Published: April 2023

Background

Epidemiology of infectious diseases causing febrile illness varies geographically with human attributes. Periodic institutional surveillance of clinical and microbiological profiles in adding data to updating trends, modulating pharmatherapeutics, signifying possible excessive treatments and risk of drug resistance in post-chemotherapy neutropenic fever (NF) in hematological malignancy (HM) is limited. We aimed to review institutional clinical and microbiological data and explore clinical phenotype pattern groups among data.

Methods

Available data from 372 NF episodes were included. Demographics, types of malignancies, laboratory data, antimicrobial treatments and febrile-related outcome data such as predominant pathogens and microbiological diagnosed infections (MDIs) were collected. Descriptive statistics, two-step cluster analysis and non-parametric tests were employed.

Results

The occurrences of microbiological diagnosed bacterial infections (MDBIs; 20.2%) and microbiological diagnosed fungal infections (MDFIs; 19.9%) were almost equal. Gram-negative pathogens (11.8%) were comparable with gram-positive pathogens (9.9%), with gram-negative being slightly predominant. Death rate was 7.5%. Two-step cluster analysis yielded four distinct clinical phenotype pattern (cluster) groups: cluster 1 ‘lymphomas without MDIs’, cluster 2 ‘acute leukemias MDBIs’, cluster 3 ‘acute leukemias MDFIs’ and cluster 4 ‘acute leukemias without MDIs’. Considerable NF events with antibiotic prophylaxis being not identified as MDI might have cases in low-risk with non-infectious reasons causing febrile reactions that might possibly not require prophylaxis.

Conclusions

Regular institutional surveillance with active parameter assessments to signify risk levels in the post-chemotherapy stage, even prior to the onset of fever, might be an evidence-based strategy in the management of NF in HM.
The value of deep learning-based computer aided diagnostic system in improving diagnostic performance of rib fractures in acute blunt trauma
Authors: Tan Hui , Xu Hui , Yu Nan , Yu Yong , Duan Haifeng , Fan Qiuju , Zhanyu Tian
Published: April 2023

Background

To evaluate the value of a deep learning-based computer-aided diagnostic system (DL-CAD) in improving the diagnostic performance of acute rib fractures in patients with chest trauma.

Materials and methods

CT images of 214 patients with acute blunt chest trauma were retrospectively analyzed by two interns and two attending radiologists independently firstly and then with the assistance of a DL-CAD one month later, in a blinded and randomized manner. The consensusdiagnosis of fib fracture by another two senior thoracic radiologists was regarded as reference standard. The rib fracture diagnostic sensitivity, specificity, positive predictive value, diagnostic confidence and mean reading time with and without DL-CAD were calculated and compared.

Results

There were 680 rib fracture lesions confirmed as reference standard among all patients. The diagnostic sensitivity and positive predictive value of interns weresignificantly improved from (68.82%, 84.50%) to (91.76%, 93.17%) with the assistance of DL-CAD, respectively. Diagnostic sensitivity and positive predictive value of attendings aided by DL-CAD (94.56%, 95.67%) or not aided (86.47%, 93.83%), respectively. In addition, when radiologists were assisted by DL-CAD, the mean reading time was significantly reduced, and diagnostic confidence was significantly enhanced.

Conclusions

DL-CAD improves the diagnostic performance of acute rib fracture in chest trauma patients, which increases the diagnostic confidence, sensitivity, and positive predictive value for radiologists. DL-CAD can advance the diagnostic consistency of radiologists with different experiences.
Cardiovascular risk and kidney function profiling using conventional and novel biomarkers in young adults: the African-PREDICT study
Authors: Degenaar A , Jacobs A , Kruger R , Delles C , Mischak H , Mels CMC
Published: April 2023

Background

Low- and middle-income countries experience an increasing burden of chronic kidney disease. Cardiovascular risk factors, including advancing age, may contribute to this phenomenon. We (i) profiled cardiovascular risk factors and different biomarkers of subclinical kidney function and (ii) investigated the relationship between these variables.

Methods

We cross-sectionally analysed 956 apparently healthy adults between 20 and 30 years of age. Cardiovascular risk factors such as high adiposity, blood pressure, glucose levels, adverse lipid profiles and lifestyle factors were measured. Various biomarkers were used to assess subclinical kidney function, including estimated glomerular filtration rate (eGFR), urinary albumin, uromodulin and the CKD273 urinary proteomics classifier. These biomarkers were used to divide the total population into quartiles to compare extremes (25th percentiles) on the normal kidney function continuum. The lower 25th percentiles of eGFR and uromodulin and the upper 25th percentiles of urinary albumin and the CKD273 classifier represented the more unfavourable kidney function groups.

Results

In the lower 25th percentiles of eGFR and uromodulin and the upper 25th percentile of the CKD273 classifier, more adverse cardiovascular profiles were observed. In multi-variable adjusted regression analyses performed in the total group, eGFR associated negatively with HDL-C (β= -0.44; p < 0.001) and GGT (β= -0.24; p < 0.001), while the CKD273 classifier associated positively with age and these same risk factors (age: β = 0.10; p = 0.021, HDL-C: β = 0.23; p < 0.001, GGT: β = 0.14; p = 0.002).

Conclusion

Age, lifestyle and health measures impact kidney health even in the third decade.
Are women with preterm labour at risk for negative birth experience? a comparative cross-sectional study from Iran
Authors: Najafi Zahra , Mirghafourvand Mojgan , Ghanbari-Homaie Solmaz
Published: April 2023

Background

The unpredictable nature of preterm labour can be a stressful experience for the mother. The occurrence of preterm birth can lead to the failure of the mother's previous expectations regarding the process of labour and birth leading to negative perception towards birth.

Methods

This descriptive-analytical cross-sectional study was conducted in Tabriz, Iran. We employed convenience sampling to recruit eligible mothers with term birth (314 women) and preterm birth (157 women). Childbirth Experience Questionnaire 2.0, Preterm Birth Experiences and Satisfaction Scale, and Delivery Fear Scale were used to measure the woman’s fear of delivery during labour and birth experience. Data were analysed by general linear model.

Results

The prevalence of negative birth experience in the term and preterm birth groups was 31.8% and 14.3%, respectively. The results of the multivariable general linear model, after the adjustment of demographic and obstetric characteristics, showed that there was no statistically significant difference between the two groups of mothers with term and preterm birth [β (95% CI): -0.06 (-0.22 to 0.09);p = 0.414] in terms of childbirth experience. However, the fear of delivery had a significant relationship with the childbirth experience [-0.02 (-0.03 to -0.01);p < 0.001].

Conclusion

There was no statistically significant difference in terms of women’s childbirth experience between the mothers with term and preterm births. The fear of delivery during labour was the predictor of childbirth experience. In order to improve women's childbirth experience, interventions should be made to reduce their fear during labour.
Automated Breast Ultrasound (ABUS)-based radiomics nomogram: an individualized tool for predicting axillary lymph node tumor burden in patients with early breast cancer
Authors: Chen Yu , Xie Yongwei , Li Bo , Shao Hua , Na Ziyue , Wang Qiucheng , Jing Hui
Published: April 2023

Objectives

Preoperative evaluation of axillary lymph node (ALN) status is an essential part of deciding the appropriate treatment. According to ACOSOG Z0011 trials, the new goal of the ALN status evaluation is tumor burden (low burden, < 3 positive ALNs; high burden, ≥ 3 positive ALNs), instead of metastasis or non-metastasis.

We aimed to develop a radiomics nomogram integrating clinicopathologic features, ABUS imaging features and radiomics features from ABUS for predicting ALN tumor burden in early breast cancer.

Methods

A total of 310 patients with breast cancer were enrolled. Radiomics score was generated from the ABUS images. Multivariate logistic regression analysis was used to develop the predicting model, we incorporated the radiomics score, ABUS imaging features and clinicopathologic features, and this was presented with a radiomics nomogram. Besides, we separately constructed an ABUS model to analyze the performance of ABUS imaging features in predicting ALN tumor burden. The performance of the models was assessed through discrimination, calibration curve, and decision curve.

Results

The radiomics score, which consisted of 13 selected features, showed moderate discriminative ability (AUC 0.794 and 0.789 in the training and test sets). The ABUS model, comprising diameter, hyperechoic halo, and retraction phenomenon, showed moderate predictive ability (AUC 0.772 and 0.736 in the training and test sets). The ABUS radiomics nomogram, integrating radiomics score with retraction phenomenon and US-reported ALN status, showed an accurate agreement between ALN tumor burden and pathological verification (AUC 0.876 and 0.851 in the training and test sets). The decision curves showed that ABUS radiomics nomogram was clinically useful and more excellent than US-reported ALN status by experienced radiologists.

Conclusions

The ABUS radiomics nomogram, with non-invasive, individualized and precise assessment, may assist clinicians to determine the optimal treatment strategy and avoid overtreatment.
Local ocular safety of the subconjunctival injection of cetuximab in rabbits
Authors: Aghaei Hossein , Kheirkhah Ahmad , Alizadeh Ali Mohammad , Es’haghi Acieh , Aliakbar-Navahi Roshanak , Keikha Zahra , Chaibakhsh Samira
Published: April 2023

Background

To evaluate the safety of different doses of subconjunctival cetuximab in rabbits.

Methods

After general anesthesia rabbits received a subconjunctival injection of 2.5 mg in 0.5 ml, 5 mg in 1 ml, and 10 mg in 2 ml of cetuximab in their right eyes (two rabbits in each group). A similar volume of normal saline solution was injected subconjunctivally in the left eyes. The histopathologic changes were evaluated after enucleation with the aid of H&E staining.

Results

No significant difference were observed between the treated and control eyes in terms of conjunctival inflammation, goblet cell density, or limbal blood vessel density for all administered doses of cetuximab.

Conclusion

Subconjunctival injection of cetuximab with the administrated doses in rabbit eyes are safe.
The relationship between emotional neglect and non-suicidal self-injury among middle school students in China: the mediating role of social anxiety symptoms and insomnia
Authors: Hou Shiyi , Twayigira Mireille , Luo Xuerong , Song Lintong , Cui Xilong , Xie Qiuxiang , Shen Yanmei , Yang Feilong , Yuan Xiuhong
Published: April 2023

Background

Non-suicidal self-injury (NSSI) is a vital public concern around the world, and it often starts in adolescence. Emotional neglect (EN) has been considered a distal risk factor for NSSI, but the effects of social anxiety symptoms (SA) and insomnia on this relationship have remained unclear. This study aimed to investigate the potential pathways from EN to NSSI, examining the role of SA and insomnia in this association.

Methods

One thousand three hundred thirty seven Chinese middle school students (Mage = 13.040, SD = 0.981, 50.2% males) in China were enrolled in this cross-sectional study. Participants completed the Emotional Neglect sub-scale of Childhood Trauma Questionnaire (CTQ-SF), the Social Anxiety Scale for Adolescent (SAS-A), Athens Insomnia Scale (AIS) and non-suicidal self-injury assessment. Structural equation modelling (SEM) was used to test the possible mediation model among these variables.

Results

231(17.3%) students reported NSSI history during last year and 322 (24.1%) participants reported experiences of EN. Students who experienced EN have higher rates of NSSI compared to students without EN history (29.2% vs 13.5%). EN, SA, insomnia and NSSI were positively related to each other. Furthermore, both SA and insomnia played a mediating role in the relationship between EN and NSSI, the series mediating effect of SA and insomnia on this association was also significant after controlling for demographics. Indirect effects accounted for 58.26% of the total effects (EN → NSSI).

Conclusions

Our study revealed that EN was associated with NSSI, SA and insomnia play indirect roles in the association between EN and NSSI. The findings of our research may have implications for clinicians, families, and schools in their efforts to lower the risk of NSSI in adolescents.
Hybrid pedicle screw and modified cortical bone trajectory technique in transforaminal lumbar interbody fusion at L4-L5 segment: finite element analysis
Authors: Kahaer Alafate , Zhang Rui , Wang Yixi , Luan Haopeng , Maimaiti Abulikemu , Liu Dongshan , Shi Wenjie , Zhang Tao , Guo Hailong , Rexiti Paerhati
Published: April 2023

Background

Investigate the biomechanical properties of the hybrid fixation technique with bilateral pedicle screw (BPS) and bilateral modified cortical bone trajectory screw (BMCS) in L4-L5 transforaminal lumbar interbody fusion (TLIF).

Methods

 Three finite element (FE) models of the L1-S1 lumbar spine were established according to the three human cadaveric lumbar specimens. BPS-BMCS (BPS at L4 and BMCS at L5), BMCS-BPS (BMCS at L4 and BPS at L5), BPS-BPS (BPS at L4 and L5), and BMCS-BMCS (BMCS at L4 and L5) were implanted into the L4-L5 segment of each FE model. The range of motion (ROM) of the L4-L5 segment, von Mises stress of the fixation, intervertebral cage, and rod were compared under a 400-N compressive load with 7.5 Nm moments in flexion, extension, bending, and rotation.

Results

 BPS-BMCS technique has the lowest ROM in extension and rotation, and BMCS-BMCS technique has the lowest ROM in flexion and lateral bending. The BMCS-BMCS technique showed maximal cage stress in flexion and lateral bending, and the BPS-BPS technique in extension and rotation. Compared to the BPS-BPS and BMCS-BMCS technique, BPS-BMCS technique presented a lower risk of screw breakage and BMCS-BPS technique presented a lower risk of rod breakage.

Conclusion

 The results of this study support that the use of the BPS-BMCS and BMCS-BPS techniques in TLIF surgery for offering the superior stability and a lower risk of cage subsidence and instrument-related complication.
Application of transverse acetabular ligament in total hip arthroplasty: a systematic review
Authors: Ning Dongfang , Xu Feng , Zhang Zhongxing , Yang Xiaolong , Wei Jun
Published: April 2023

Introduction

In total hip arthroplasty (THA), the correct position of the acetabular component directly determines the outcome of the surgery, or the success of the surgery. Therefore, how to accurately locate the position of the acetabular component has become a very critical step in THA. As an important anatomical structure of the hip joint, the transverse acetabular ligament (TAL) is helpful for acetabular component orientation in THA. The aim of this systematic review was to investigate application of TAL in THA.

Materials and methods

A systematic literature search of PUBMED, EMBASE, and Cochrane Library was performed (January and February 2023) using keywords “total hip arthroplasty,” “total hip replacement,” “total hip replacements,” “total hip arthroplasties,” “total hip prosthesis,” and “transverse acetabular ligament” in all possible combinations. Reference lists of included articles were reviewed. Study design, surgical approach, patient demographics, TAL identification rate, appearance of the TAL, anteversion and inclination angle and rate of dislocations were recorded.

Results

In total, 19 studies met the screening criteria. Study designs were prospective cohorts (42%), retrospective cohorts (32%), Case series (21%), and randomized controlled trial (5%). Twelve of the 19 (63.2%) studies investigated the application of TAL as an anatomical landmark for locating acetabular component position in THA. Analysis revealed that TAL is a reliable anatomical landmark for acetabular component orientation within the safe zone in THA.

Conclusions

TAL can reliably be used to align the acetabular component in the safe zone for anteversion and inclination in THA. However, TAL has individual variation influenced by some risk factors. More randomized controlled studies with larger numbers of patients are needed to investigate the precision and accuracy of TAL as an intraoperative landmark in THA.

Level of evidence

IV.