bluuebunny/crossref_metadata_2025 huggingface dataset:
Early results of reverse total shoulder arthroplasty using a patient-specific baseplate to address severe glenoid deficiency
Authors: Moran Thomas E , Sumpter Anna E , Berry Carter J , Brockmeier Stephen F , Werner Brian C
Published: September 2023

Background

The purpose of this study was to describe outcomes of patients undergoing reverse total shoulder arthroplasty (rTSA) using a patient-specific, custom glenoid component to address severe glenoid deficiency.

Methods

Retrospective chart review identified patients at a single institution undergoing rTSA using the glenoid vault reconstruction system (VRS) between 2017 and 2022. Radiographic evaluation, range of motion and patient-reported outcome (PRO) measures, complications, and re-operations were assessed.

Results

Fourteen shoulders were included. There was 100% implant survivorship of the glenoid baseplate at mean follow-up of 26.6 months. Mean range of motion improved in forward elevation (62–106 degrees), abduction (41–100 degrees), and external rotation (11–36 degrees). In 7 of 13 patients available for PRO collection, the mean final Visual Analog Pain Scale (VAS) score was 1.29, Single Assessment Numeric Evaluation (SANE) score was 72.14, American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score was 77.14, and Penn Shoulder score was 72.26.

Conclusions

Use of this custom glenoid resulted in encouraging clinical and radiographic outcomes, with no failures in implant survivorship seen at early follow-up. Larger prospective studies with longer-term follow-up should be undertaken in order to better determine the efficacy and longevity of this implant.

Study Design

Retrospective case series; Level of evidence, 4.
Private Investment in Chinese Football Clubs: Political Capital and State–Business Exchanges
Authors: Ross Tobias , Sullivan Jonathan , Lai Hongyi
Published: September 2023

Business–government relations play a crucial role in China's economic development and policy implementation. Situated in an asymmetric dependency nexus, local officials court business investments to facilitate policy and boost their political careers, while under Xi Jinping private firms are increasingly incentivised to support party-state goals to gain access to political capital. In this study, we use the case of football development to show how private business actors and government officials enter reciprocal relationships based on the exchange of respective financial and political capital. Using insights from semistructured interviews with practitioners and macro-level data, such as investors’ characteristics and financial data, we explore the role of political capital in state–business exchanges, specifying the mechanisms of this interaction (motivations, forms, and perceived benefits) and three distinct investment scenarios in the case of football. Besides insights into the sector, the article contributes to the understanding of the modus operandi of private business and local government in the Chinese political economy at large.
Mnemonic Soft Power: The Role of Memory in China's Quest for Global Power
Authors: Ohnesorge Hendrik W. , Owen John M.
Published: September 2023

In twenty-first-century international relations, the telling of stories is as important an instrument of national power as are military strength or economic prowess. Geared not towards coercion or inducement but rather drawing on the forces of attraction and persuasion, such practices can be attributed to the realm of soft power, which plays a key role in today's great-power politics. Starting from these premises, the article explores the role of memory and its relation to soft power. By way of an empirical example, it argues that the recourse to and utilisation of memory constitutes a crucial component in China's quest for global power. In so doing, the article first establishes a conceptual bridge between soft power and memory in international relations. Subsequently, by taking into account contemporary empirical evidence, it identifies and discusses two select narratives – colonialism and tianxia – as core components of Chinese mnemonic soft power.
Knowledge and attitude regarding the COVID-19 pandemic among undergraduate health science students of Nepal: An online survey
Authors: Anand Ayush , Gupta Ashwini , Singh Sweta , Pyakurel Sulav , Karkee Rajendra , Pyakurel Prajjwal
Published: September 2023

Objectives:

This study aims to assess health science students’ knowledge and attitude about COVID-19 epidemiology, management, and prevention; and the association of knowledge and attitude with various sociodemographic characteristics.

Methods:

An online survey was done among 524 undergraduate health science students using a pre-tested questionnaire across 19 health science institutions in Nepal from 30 June to 11 August 2021. All subjects were enrolled in the study after informed consent. Outcomes were Knowledge level, attitude level, and predictors of knowledge level and attitude level. Bivariate analysis was done to determine the association between variables.

Results:

Of 524 students, 42.9% were male, and 57.1% were female. More than half (54.6%) and the majority (85.1%) participants had good knowledge and attitude, respectively. Approximately three-fifths (59.4%) of the participants were from the B. P. Koirala Institute of Health Sciences (BPKIHS). Students in BPKIHS (odds ratio = 1.774; 95% confidence interval = 1.243–2.533), junior years (odds ratio = 8.892; 95% confidence interval = 5.814–13.599), age less than 23 years (odds ratio = 2.985; 95% confidence interval = 2.089–4.266) were more likely to have good knowledge. Students under 23 years (odds ratio = 24.160; 95% confidence interval: 9.570–60.992) and those in junior years (odds ratio = 4.460; 95% confidence interval = 3.753–5.300) were likely to have a good attitude level. Students in BPKIHS (odds ratio = 0.443; 95% confidence interval = 0.272–0.722) were less likely to have a good attitude.

Conclusions:

Overall, health science students had adequate knowledge and a good attitude regarding COVID-19. However, students lacked knowledge regarding infectiousness, transmission, post-vaccination observation period, remdesivir use, convalescent plasma therapy, and awake-prone positioning. Knowledge and attitude scores were associated with age, stream, and study institution.
Augmented Web-based applicant experiences for anesthesiology away audition rotations: A systematic review of the current literature
Authors: Zhitny Vladislav Pavlovich , Kawana Eric , Vachirakorntong Benjamin , Djesevic Enes , DiCaro Michael V. , Mendelson Brian J.
Published: September 2023

Objective:

The objective of this paper is to evaluate Augmented Web-based Applicant Experiences in the field of Anesthesiology. We hope to advocate for Augmented Web-based Applicant Experiences rotations and address their limitations in case in-person rotations become restricted again.

Methods:

A thorough search of articles from the years 1978 to 2023 was completed using the search phrases “Away Rotations Anesthesiology,” “Away Rotations Anesthesia,” “Audition Rotation Anesthesia” and “Audition Rotation Anesthesiology.” These search phrases were used on both the PubMed (Medline) and Excerpta medica database (EMBASE) databases, and the number of total articles that appeared was 73. These articles were then filtered to gather relevant articles for our study.

Results:

After the articles were filtered, there was one remaining article that was used for our study. To supplement this article, 29 additional sources were added using the worldwide web. However, these did not address rotations in Anesthesiology. Although these other sources did not involve Anesthesiology residencies, they still provide significant perspectives that can be applied to online rotations. A total of 30 sources were used for our manuscript.

Conclusion:

Although in-person rotations are preferred, Augmented Web-based Applicant Experiences rotations are valuable as they give residency programs an opportunity to evaluate students. Augmented Web-based Applicant Experiences rotations also provide students with learning opportunities and also help familiarize them with the residency programs. There are limitations that come with Augmented Web-based Applicant Experiences rotations. However, addressing these shortcomings can help Augmented Web-based Applicant Experiences rotations become a proper substitution for in-person rotations if they become restricted again.
Long-Term Opioid Use After Free Flap Breast Reconstruction: Incidence and Associated Factors
Authors: Cadwell Joshua B. , Kim Minji , Graziano Francis D. , Mehta Meghana , Seier Ken , Tan Kay See , Nelson Jonas A. , Afonso Anoushka M.
Published: September 2023

Background: Opioid dependence can occur in 6% to 10% of patients undergoing breast reconstruction. With the expansion of interdisciplinary initiatives to decrease opioid use after surgery, an updated look at the incidence of and risk factors for prolonged opioid dependence after free flap breast reconstruction is essential. Methods: We retrospectively identified all cases of free flap breast reconstruction completed at our institution from 2017 to 2020. Patients undergoing additional surgery within 120 days of the free flap procedure were excluded. Postoperative opioid prescriptions were identified; prolonged opioid use was defined as the receipt of additional prescriptions 91 to 120 days after surgery. Demographic and perioperative variables were assessed for their relationship with prolonged opioid use by logistic regressions. Results: A total of 732 patients were included in the final analysis; of these, 15 patients (2%) received additional opioid prescriptions 91 to 120 days after surgery (ie, had prolonged opioid use). Univariable associations were identified between prolonged opioid use and intraoperative morphine milliequivalents (OR = 2.3 per 50 units [95% CI, 1.5-3.5]; P < .001), opioid prescriptions 31 to 60 days after surgery (OR = 16.1 [95% CI, 4.0-65.0]; P < .001) and 61 to 90 days after surgery (OR = 89.4 [95% CI, 13.7-584.5]; P < .001), and history of substance use disorder (OR = 8.3 [95% CI, 2.2-31.6]; P = .002), anxiety (OR = 3.8 [95% CI, 1.2-12.1]; P = .023), or mood disorder (OR = 12.7 [95% CI, 1.3-121.3]; P = .027). Conclusion: In our cohort, 2% of patients who underwent autologous breast reconstruction (15/732) had prolonged opioid use. The currently used perioperative opioid minimization initiatives may benefit patients undergoing autologous breast reconstruction.
Serotonin Syndrome in Critical Care
Authors: Miller Daniel , Shah Deesha , Huribal John , Felice Skye , Trandafirescu Theo
Published: September 2023

Serotonin syndrome is a life-threatening syndrome that can occur when medications or drugs that cause serotonergic activity are taken. Frequently this syndrome is caused using 2 serotonergic medications at once or switching from 1 serotonergic medication to another without tapering appropriately. The classic triad of serotonin syndrome is neuromuscular excitability, autonomic dysfunction, and altered mental status. Patients can have symptoms ranging from tachycardia, diaphoresis, fever, and hypertension to severe swings in blood pressure, tremors, hyperreflexia, muscle rigidity, and even death. Most patients admitted to the hospital with fevers, tachycardia with hypertension, or hypotension will have blood cultures drawn as infection can easily explain these symptoms. If these symptoms persist, however, other options should be explored, including serotonin syndrome.
Older Age, Poor Preoperative Quadriceps Muscle Strength, and Residual Pain as Risk Factors for Poor Quadriceps Muscle Strength Recovery at 1 Year After ACL Reconstruction: A TMDU MAKS Study of 402 Patients
Authors: Hasegawa Shoichi , Nakagawa Yusuke , Yoshihara Aritoshi , Nakamura Tomomasa , Katagiri Hiroki , Hayashi Masaya , Yoshimura Hideya , Nagase Tsuyoshi , Sekiya Ichiro , Koga Hideyuki
Published: September 2023

Background:

Poor postoperative quadriceps muscle strength recovery after anterior cruciate ligament reconstruction (ACLR) leads to delayed return to sports and lower patient satisfaction.

Purpose/Hypothesis:

The purpose of this study was to examine factors that affect quadriceps muscle strength 1 year after ACLR. It was hypothesized that older age, poor preoperative quadriceps muscle strength, and residual pain would be risk factors for poor quadriceps muscle strength recovery.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

Included were patients from multiple institutions who underwent primary ACLR using autologous hamstring tendon grafts between August 1, 2013, and March 31, 2018, and who had at least 1 year of follow-up data. Patients with past ligamentous injuries in the affected knee, previous injuries or operations in the contralateral knee, accompanying ligament injuries of grade 2 or 3, or inflammatory or other types of osteoarthritis were excluded. Patients were categorized as having muscle strength ≥80% (good strength recovery) or <80% (poor strength recovery) compared with the contralateral leg at 1 year postoperatively. Multivariate logistic regression analysis was performed to investigate the factors influencing postoperative quadriceps muscle strength. In addition, a categorical analysis was conducted based on factors extracted by the multivariate logistic regression analysis.

Results:

A total of 402 patients were included. Multivariate logistic regression analysis revealed that age at surgery ( P = .020), preoperative quadriceps muscle strength ( P = .006), and postoperative Knee injury and Osteoarthritis Outcome Score (KOOS)-Pain score ( P = .002) were significantly associated with quadriceps muscle strength at 1 year postoperatively. The odds of poor muscle strength recovery according to categorical analysis were 5.0-fold higher for patients aged >40 versus ≤20 years, 4.2-fold higher for those with preoperative quadriceps muscle index <60% versus ≥80%, and 7.7-fold higher for those with a postoperative KOOS-Pain score of <85 versus 100.

Conclusion:

Older age, poor preoperative quadriceps muscle strength, and low postoperative KOOS-Pain score were risk factors for poor quadriceps muscle strength 1 year after primary ACLR. Surgical indications, including age, preoperative active rehabilitation, and pain control, should be considered for optimization of postoperative quadriceps muscle strength recovery.
Mapping Anti-Asian Xenophobia: State-Level Variation in Implicit and Explicit Bias against Asian Americans across the United States
Authors: Yoo Nari , Nicholson Harvey L. , Chang Doris F. , Okazaki Sumie
Published: September 2023

Using national data from Project Implicit, the authors examine state-level variations in implicit and explicit bias against Asian Americans held by non–Asian Americans ( n = 196,678) from 2018 to 2022. The authors also explore state-level sociodemographic correlates of both types of bias. The findings reveal considerable heterogeneity in implicit and explicit bias across states. Moreover, Republican and swing states had higher levels of implicit bias against Asian Americans, and states with older median ages and greater percentages of Asian populations were associated with less explicit bias. This study underscores the importance of state-level variation in and structural factors of biases against Asian Americans as contexts for examining attitudes toward Asian Americans.
Student Leadership Development Initiative for Medical Students: Lessons Learned From Transitioning to Virtual Modalities
Authors: SenthilKumar Gopika , Sommers Kelli C. , He Yizeng , Stark Katarina , Craig Taylor , Keval Aliyah , Shah Neemit , Patel Kahaan , Meurer John
Published: September 2023

Leadership training is a necessary component of undergraduate medical education. Our group successfully implemented a student-led organization starting from 2016 (Student Leadership Development Initiative; SLDI) that aimed to provide medical students with exposure to physician-leader career paths in an informal, organic, interactive setting. The COVID-19 pandemic necessitated a shift to online programming, and given the high prevalence of ZOOMTM fatigue, we incorporated monthly, freely available, self-directed modules as an additional leadership training opportunity. The goals of this study are to assess the (1) feasibility of and participation in a virtual student organization focused on leadership training, (2) whether students’ perceptions of the importance of leadership were associated with participation in SLDI, and (3) lessons learned from transitioning to virtual modalities. An anonymous, retrospective cross-sectional survey with 13-items was distributed through an email listserv and a 6-question survey was sent to attendees following each virtual group-discussion. A Fisher's exact test was conducted to assess whether the number of modules completed was associated with students’ perception of leadership importance. Survey results showed that 85% strongly agreed or agreed that SLDI helped them develop professional goals and career paths, and 74% reported benefits in becoming more compassionate physician leaders and valuing wellness. All respondents completed ≥1 self-directed module, and the students’ perception of leadership importance did not influence the number of self-directed modules completed ( p > .05). Most participants (63%) attended ≥67% of virtual events, and postevent feedback was positive; however, only 46% of respondents reported meeting someone new at events and 32% reported that they intended on connecting with new contacts. Our results suggest that virtual leadership student-organization, involving small-group discussions and self-directed modules, is feasible and beneficial for medical students. However, the inability to promote meaningful networking opportunities is a major limitation of a virtual training model.
Isolated Large Glenoid Fracture and Acute Glenohumeral Dislocation in Elderly Patients: A Case Series Treated Surgically With Reverse Shoulder Arthroplasty and Augmented Glenoid
Authors: Ippolito Giorgio , Zitiello Michele , De Marinis Giancarlo , Di Lucia Pierluca , Surace Michele F , Franceschetti Edoardo , Gregori Pietro , Papalia Rocco , Faoro Luca , Ferraro Sergio
Published: September 2023

Background

One of the most frequent complications in patients affected by traumatic anterior dislocations is bony Bankart lesion. This study evaluates the clinical and functional outcomes of 10 patients with isolated large glenoid fracture and acute glenohumeral dislocation treated with reverse shoulder arthroplasty.

Methods

Patients older than 69 years who underwent reverse shoulder arthroplasty after isolated large glenoid fracture and acute glenohumeral dislocation between 2016 and 2022 at the same institute were selected. Shoulder range of motion and pain level was assessed. The impact on quality of life has been evaluated through four measures: the constant scale, the simple shoulder test (SST), the OXFORD scale, and The University of California—Los Angeles (UCLA) shoulder scale.

Results

The mean Constant score was 77.1 (range 68–84), the mean SST score was 9.4 (range 8–10), the Oxford score was 44.3 (range 35–48), and the UCLA shoulder scale was 27.1 (range 24–30). No reoperation was performed on any patient in this series.

Conclusion

Reverse shoulder arthroplasty for elderly patients with bony Bankart lesion and acute glenohumeral dislocation represents a valuable option in terms of clinical results, patient satisfaction and early- to medium-term complications.
A Tutorial on Causal Inference in Longitudinal Data With Time-Varying Confounding Using G-Estimation
Authors: Loh Wen Wei , Ren Dongning
Published: September 2023

In psychological research, longitudinal study designs are often used to examine the effects of a naturally observed predictor (i.e., treatment) on an outcome over time. But causal inference of longitudinal data in the presence of time-varying confounding is notoriously challenging. In this tutorial, we introduce g-estimation, a well-established estimation strategy from the causal inference literature. G-estimation is a powerful analytic tool designed to handle time-varying confounding variables affected by treatment. We offer step-by-step guidance on implementing the g-estimation method using standard parametric regression functions familiar to psychological researchers and commonly available in statistical software. To facilitate hands-on usage, we provide software code at each step using the open-source statistical software R. All the R code presented in this tutorial are publicly available online.
Psychology Is a Property of Persons, Not Averages or Distributions: Confronting the Group-to-Person Generalizability Problem in Experimental Psychology
Authors: McManus Ryan M. , Young Liane , Sweetman Joseph
Published: September 2023

When experimental psychologists make a claim (e.g., “Participants judged X as morally worse than Y”), how many participants are represented? Such claims are often based exclusively on group-level analyses; here, psychologists often fail to report or perhaps even investigate how many participants judged X as morally worse than Y. More troubling, group-level analyses do not necessarily generalize to the person level: “the group-to-person generalizability problem.” We first argue for the necessity of designing experiments that allow investigation of whether claims represent most participants. Second, we report findings that in a survey of researchers (and laypeople), most interpret claims based on group-level effects as being intended to represent most participants in a study. Most believe this ought to be the case if a claim is used to support a general, person-level psychological theory. Third, building on prior approaches, we document claims in the experimental-psychology literature, derived from sets of typical group-level analyses, that describe only a (sometimes tiny) minority of participants. Fourth, we reason through an example from our own research to illustrate this group-to-person generalizability problem. In addition, we demonstrate how claims from sets of simulated group-level effects can emerge without a single participant’s responses matching these patterns. Fifth, we conduct four experiments that rule out several methodology-based noise explanations of the problem. Finally, we propose a set of simple and flexible options to help researchers confront the group-to-person generalizability problem in their own work.
A systematic narrative review of coroners’ Prevention of Future Deaths reports (PFDs): A tool for patient safety in hospitals
Authors: Bremner Benjamin T. , Heneghan Carl , Aronson Jeffrey K. , Richards Georgia C.
Published: September 2023

Patient harm due to unsafe healthcare is widespread, potentially devastating, and often preventable. Hoping to eliminate avoidable harms, the World Health Organization (WHO) published the Global Patient Safety Action Plan in July 2021. The UK's National Health Service relies on several measures, including ‘never events’, ‘serious incidents’, ‘patient safety events’ and coroners’ Prevention of Future Deaths reports (PFDs) to monitor healthcare quality and safety. We conducted a systematic narrative review of PubMed and medRxiv on 19 February 2023 to explore the strengths and limitations of coroners’ PFDs and whether they could be a safety tool to help meet the WHO's Global Patient Safety Action Plan. We identified 17 studies that investigated a range of PFDs, including preventable deaths involving medicines and an assessment during the COVID-19 pandemic. We found that PFDs offered important information that could support hospitals to improve patient safety and prevent deaths. However, inconsistent reporting, low response rates to PFDs, and difficulty in accessing, analysing and monitoring PFDs limited their use and adoption as a patient safety tool for hospitals. To fulfil the potential of PFDs, a national system is required that develops guidelines, sanctions failed responses and embeds technology to encourage the prevention of future deaths.
The weaponisation of ‘trauma-informed’ discourse in prison policy: An abolition feminist critique
Authors: Carlton Bree , Russell Emma K
Published: September 2023

Taking an abolition feminist standpoint, this article develops a critique of the absorption of the language of ‘trauma-informed practice’ into gendered penal policy. We use Carol Bacchi's methodology for post-structural policy analysis, which centres around the question, ‘what is the problem represented to be?’, and apply it to an Australian correctional policy document designed to inform practice in the Victorian women's prison system: Strengthening Connections. We find that the policy constructs criminalised women's trauma as an individual psychological pathology that causes ‘criminal offending’ and makes them vulnerable to further harm. In effect, the prison is framed as both necessary for the protection of the community and for the protection of criminalised women themselves. We argue that these discursive distortions sanitise the structural violence of the prison and revalorise the carceral state under the guises of rehabilitation and therapy. Our contribution highlights broader implications and challenges for criminological research that engages attempts to ‘soften’ carceral conditions without reckoning with their capacity to entrench gendered carceralism.
Implementation readiness for evidence-based autism practices in school systems
Authors: Stahmer Aubyn C , Suhrheinrich Jessica , Yu Yue , Melgarejo Melina , Schetter Patricia , Young Greg A
Published: September 2023

Background

The increase in the number of autistic children being identified has led to increased demand on public schools to provide high-quality services. Effectively scaling up evidence-based practice (EBP) use for autistic students is challenging, given the complicated organization of special education. Teachers have significant challenges implementing autism EBP with fidelity. Factors such as implementation leadership and climate and attitudes toward EBP are linked to successful EBP use and may vary at different levels of the education system. Examining mechanisms of successful implementation is a critical step to support scale-up.

Method

In this observational study, conducted from September 2018 to March 2020, California school personnel ( n = 2273) at multiple levels of the system completed surveys related to implementation climate, leadership, and attitudes toward EBP. Data were collected throughout California at the Special Education Local Plan Areas, County Office of Education, and district and school levels from educators and administrators working in public schools supporting autistic students. Multi-level modeling was conducted to characterize implementation readiness.

Results

Overall, implementation climate and leadership scores are low across levels with regional levels rated more positively than districts or schools. Attitudes toward EBP were moderate, with those working in schools having the poorest ratings and specialists/trainers and related service providers (e.g., speech-language pathologists) having the highest ratings.

Conclusions

Outcomes provide a unique opportunity to compare implementation factors across organizational levels with a large, statewide sample. These data provide guidance for developing implementation interventions at multiple levels of the education system to increase readiness for effective scale-up of autism EBP in schools. Personnel and leaders at different organizational levels may need differentiated training targeting improved implementation climate and leadership. Personnel within districts and schools may experience a particular benefit from leadership support for EBP implementation.
Screening for Esophageal Squamous Cell Carcinoma: A Review
Authors: Kodaganur Gopinath Srinivas , Jiwnani Sabita
Published: September 2023

Esophageal cancer is amongst the most common types of cancer in Asia. It is a deadly disease where incidence almost parallels mortality. It is of 2 major subtypes, adenocarcinoma being more common in the global north and squamous cell carcinoma being more common in the global south. China, Japan, India, Iran, and other Asian countries contribute to roughly 80% of the global disease burden. Fortunately, esophageal squamous cell cancers (ESCC) are also amenable for screening. Natural history studies have shown that severe dysplasia carries the highest risk of progression to ESCC. Early detection has shown to be extremely beneficial, with cure rates above 90% for precursor lesions and early-stage esophageal cancer. There are various modalities available for screening—Chinese balloon cytology is a low cost technique that can be applied for mass screening but has only moderate sensitivity (39%-62%). Recent studies have demonstrated that using methylated DNA markers and applying artificial intelligence technology can significantly improve the yield of cytology. Lugol’s chromo-endoscopy has been demonstrated to have good sensitivity and specificity (>85%), but is an invasive technique and requires operator expertise. Other image enhancing techniques such as narrow-band imaging, autofluorescence, endocytoscopy and micro-endoscopy are promising, but currently not cost effective for mass screening. There are 3 large randomized trials underway in China, initial published results have demonstrated a detection rate between 0.7% to 1.2% for ESCC and 4% to 6% for pre cursor lesions. These trials, with some of them involving >100 000 patients have demonstrated the feasibility of endoscopic screening, but long term results are awaited.
Critical Decision-Making: Technical Aspects of Performing POEM
Authors: Salgado Sanjay M. , Carr-Locke David L.
Published: September 2023

Achalasia has become increasingly diagnosed in the last decade and has become an important therapeutic entity for advanced endoscopists since the advent of PerOral Endoscopic Myotomy (POEM). This treatment now provides a highly successful minimally-invasive approach which, for most patients, is an outpatient procedure. Consistent success depends on patient selection, sound technique and management of infrequent adverse events . This article focusses on these three areas and hopes to assist referring gastroenterologists in understanding the appropriateness of POEM for achalasia and to guide those endoscopists embarking on a POEM program in making decisons.
Calcitonin gene-related peptide causes migraine aura
Authors: Al-Khazali Haidar M. , Ashina Håkan , Wiggers Astrid , Rose Kathrine , Iljazi Afrim , Christensen Rune Häckert , Schytz Henrik Winther , Amin Faisal Mohammad , Ashina Messoud
Published: September 2023

Background

Although the involvement of calcitonin gene-related peptide (CGRP) in migraines is well-established, its specific role in investigating the aura phase, which often precedes the headache, remains largely unexplored. This study aims to instigate CGRP’s potential in triggering aura, thus establishing its role in the early stages of migraine.

Methods

In this open-label, non-randomized, single-arm trial, 34 participants with migraine with aura received continuous intravenous infusion of CGRP (1.5 µg/min) over 20 min on a single experimental day. Participants were required to be free of headache and report no use of acute medications 24 h before infusion start. The primary endpoint was the incidence of migraine aura during the 12-hour observational period after the start of infusion.

Results

Thirteen (38%) of 34 participants developed migraine aura after CGRP infusion. In addition, 24 (71%) of 34 participants developed migraine headache following CGRP infusion.

Conclusions

Our findings suggest that CGRP could play an important role in the early phases of a migraine attack, including during the aura phase. These insights offer a new perspective on the pathogenesis of migraines with aura. They underscore the need for additional research to further explore the role of CGRP in these initial stages of a migraine attack, and potentially inform future development of therapeutic interventions.

Trial registration

ClinicalTrials.gov Identifier: NCT04592952.

Graphical Abstract
SubMDTA: drug target affinity prediction based on substructure extraction and multi-scale features
Authors: Pan Shourun , Xia Leiming , Xu Lei , Li Zhen
Published: September 2023

Background

Drug–target affinity (DTA) prediction is a critical step in the field of drug discovery. In recent years, deep learning-based methods have emerged for DTA prediction. In order to solve the problem of fusion of substructure information of drug molecular graphs and utilize multi-scale information of protein, a self-supervised pre-training model based on substructure extraction and multi-scale features is proposed in this paper.

Results

For drug molecules, the model obtains substructure information through the method of probability matrix, and the contrastive learning method is implemented on the graph-level representation and subgraph-level representation to pre-train the graph encoder for downstream tasks. For targets, a BiLSTM method that integrates multi-scale features is used to capture long-distance relationships in the amino acid sequence. The experimental results showed that our model achieved better performance for DTA prediction.

Conclusions

The proposed model improves the performance of the DTA prediction, which provides a novel strategy based on substructure extraction and multi-scale features.
Physiological, anatomical and quality indexes of root tuber formation and development in chayote (Sechium edule)
Authors: Cheng Shaobo , Liu Yuhang , Su Lihong , Liu Xuanxuan , Chu Qianwen , He Zhongqun , Zhou Xiaoting , Lu Wei , Jiang Chengyao , Zheng Wangang
Published: September 2023

Background

Chayote is an underutilized species of Cucurbitaceae. It is rich in nutrients such as protein, minerals, phenols and its extracts have anti-cardiovascular and anti-cancer effects, making it a versatile plant for both medicinal and culinary purposes. Although research on its root tuber is limited, they are rich in starch and have a structure similar to that of potatoes, cassava, and sweet potatoes. Therefore, they can serve as potential substitutes for potatoes and offer promising prospects as agricultural and industrial resources. However, the physiological and cellular mechanisms of chayote root tuber formation and development are still unclear.

Results

In this study, we observed the growth habit of ‘Tuershao’ (high yield of root tuber). The results revealed that the tuber enlargement period of ‘Tuershao’ lasts approximately 120 days, with the early enlargement phase occurring during 0–30 days, rapid enlargement phase during 30–90 days, and maturation phase during 90–120 days. Physiological indicators demonstrated a gradual increase in starch content as the tuber developed. The activities of sucrose synthase (SUS) and invertase (VIN) showed a consistent trend, reaching the highest level in the rapid expansion period, which was the key enzyme affecting tuber expansion. Moreover, the special petal like structure formed by the secondary phloem and secondary xylem of the tuber resulted in its enlargement, facilitating the accumulation of abundant starch within the thin-walled cells of this structure. Principal component analysis further confirmed that starch content, SUS and VIN activities, as well as the concentrations of calcium (Ca), iron (Fe), and selenium (Se), were the major factors influencing tuber development. Moreover, the low temperature environment not only promoted the growth of ‘Tuershao’ tubers but also enhanced the accumulation of nutritional substances.

Conclusions

These findings contribute to a deeper understanding of the formation and developmental mechanisms of ‘Tuershao’ tubers, providing valuable guidance for cultivation practices aimed at improving crop yield.
Association between independent practice time and patient outcomes in the emergency department: a retrospective study of residents in three urban hospitals in Taiwan
Authors: Chen Yi-Ying , Ko Patrick Chow-In , Chi Chien-Yu , Chong Kah Meng , Chen Yen-Pin , Huang Chien-Hua
Published: September 2023

Background

The purpose of the study was to investigate the relationship between the independent practice time of residents and the quality of care provided in the Emergency Department (ED) across three urban hospitals in Taiwan. The study focused on non-pediatric and non-obstetric complaints, aiming to provide insights into the optimal balance between resident autonomy and patient safety.

Methods

A comprehensive retrospective study was conducted using de-identified electronic health records (EHRs) from the hospital's integrated medical database (iMD) from August 2015 to July 2019. The independent practice time was defined as the duration from the first medical order by a resident to the first modifications by the attending physician. The primary outcome was revisits to the ED within 72 h following discharge. Statistical analysis was conducted using RStudio and pyGAM.

Results

The study identified several factors associated with shorter independent practice times (< 30 minutes), including older patient age, male sex, higher body temperature, higher heart rate, lower blood pressure, and the presence of certain comorbidities. Residents practicing independently for 30–120 minutes were associated with similar adjusted odds of patient revisits to the ED (OR 1.034, 95% CI 0.978–1.093) and no higher risk of 7-day mortality (OR 0.674, 95% CI 0.592–0.767) compared to the group with less autonomy. However, independent practice times exceeding 120 minutes were associated with higher odds of revisiting the ED within 72 h. For the group with 120–210 minutes of independent practice time, the OR was 1.113 (95% CI: 1.025–1.208, p = 0.011). For the group with > 210 minutes, the OR was 1.259 (95% CI: 1.094–1.449, p = 0.001), indicating an increased risk of adverse outcomes as the independent practice time increasing.

Conclusions

The study concludes that while providing residents an independent practice time between 30 to 120 minutes may be beneficial, caution should be exercised when this time exceeds 120 minutes. The findings underscore the importance of optimal supervision in enhancing patient care quality and safety. Further research is recommended to explore the long-term effects of different levels of resident autonomy on patient outcomes and the professional development of the residents themselves.
Ascertaining asthma status in epidemiologic studies: a comparison between administrative health data and self-report
Authors: Rousseau Marie-Claude , Conus Florence , El-Zein Mariam , Benedetti Andrea , Parent Marie-Elise
Published: September 2023

Background

Studies have suggested that agreement between administrative health data and self-report for asthma status ranges from fair to good, but few studies benefited from administrative health data over a long period. We aimed to (1) evaluate agreement between asthma status ascertained in administrative health data covering a period of 30 years and from self-report, and (2) identify determinants of agreement between the two sources.

Methods

We used administrative health data (1983–2012) from the Quebec Birth Cohort on Immunity and Health, which included 81,496 individuals born in the province of Quebec, Canada, in 1974. Additional information, including self-reported asthma, was collected by telephone interview with 1643 participants in 2012. By design, half of them had childhood asthma based on health services utilization. Results were weighted according to the inverse of the sampling probabilities. Five algorithms were applied to administrative health data (having ≥ 2 physician claims over a 1-, 2-, 3-, 5-, or 30-year interval or ≥ 1 hospitalization), to enable comparisons with previous studies. We estimated the proportion of overall agreement and Kappa, between asthma status derived from algorithms and self-reports. We used logistic regression to identify factors associated with agreement.

Results

Applying the five algorithms, the prevalence of asthma ranged from 49 to 55% among the 1643 participants. At interview (mean age = 37 years), 49% and 47% of participants respectively reported ever having asthma and asthma diagnosed by a physician. Proportions of agreement between administrative health data and self-report ranged from 88 to 91%, with Kappas ranging from 0.57 (95% CI: 0.52–0.63) to 0.67 (95% CI: 0.62–0.72); the highest values were obtained with the [≥ 2 physician claims over a 30-year interval or ≥ 1 hospitalization] algorithm. Having sought health services for allergic diseases other than asthma was related to lower agreement (Odds ratio = 0.41; 95% CI: 0.25–0.65 comparing ≥ 1 health services to none).

Conclusions

These findings indicate good agreement between asthma status defined from administrative health data and self-report. Agreement was higher than previously observed, which may be due to the 30-year lookback window in administrative data. Our findings support using both administrative health data and self-report in population-based epidemiological studies.
Establishment of a predictive model for postpartum hemorrhage in twins: a retrospective study
Authors: Qi Sangsang , Fu Xianhu
Published: September 2023

Objective

To explore the risk factors and develop a predictive model for postpartum hemorrhage in twin pregnancies.

Methods

All patients who gave birth at Ningbo Women and Children’s Hospital from January 2018 to August 2022 were recruited. Patients were randomly allocated to a training cohort (n$$=$$
=
1395) validation cohort (n$$=$$
=
650) at a 7:3 ratio. In the training cohort, LASSO regression for screening variables and multifactorial logistic regression analysis were performed to identify independent risk factors for postpartum hemorrhage in twin pregnancies. A nomogram was established based on the results of multiple logistic regression analysis. Nomogram performance was quantified using the receiver operating characteristic curve, Hosmer- Lemeshow test and decision curve analysis.

Results

A total of 2045 patients were included in this study. Multifactorial Logistic regression analysis showed maternal age, assisted reproduction, platelet count, fibrinogen level, albumin level, hypertensive disorders of pregnancy, placenta praevia, number of previous cesarean deliveries, number of previous intrauterine manipulation, and neonatal weight were independent risk factors for postpartum hemorrhage in twin births. The area under curve (AUC) for the training cohort was 0.810 [95$$\%$$
%
CI (0.781, 0.839)], with a sensitivity of 76.5$$\%$$
%
, specificity of 71.0$$\%$$
%
, and positive and negative predictive values of 0.358 and 0.935, respectively, while the AUC for the validation cohort was 0.821 [95$$\%$$
%
CI (0.781, 0.860)], with a sensitivity of 80.9$$\%$$
%
, specificity of 69.49$$\%$$
%
, and positive predictive value and negative predictive value of 0.426 and 0.929, respectively.

Conclusion

The predictive model can effectively and quantitatively assess the risk of postpartum hemorrhage in twin pregnancies and help clinicians to take personalized preventive measures.
Systematic analysis of RNASET2 gene as a potential prognostic and immunological biomarker in clear cell renal cell carcinoma
Authors: Liu Yifu , Zhang Zhicheng , Xi Ping , Chen Ru , Cheng Xiaofeng , Liu Ji , Zhu Qiqi , Nie Yechen , Sun Ting , Gong Binbin , Wang Siyuan
Published: September 2023

Background

RNASET2 has been identified as an oncogene with anti-angiogenic and immunomodulatory effects in a variety of cancers, but its function in clear cell renal cell carcinoma (ccRCC) is still not well understood.

Methods

The RNASET2 expression matrix was extracted from the The Cancer Genome Atlas (TCGA) and Gene Expression Omnibus (GEO) datasets and analyzed for diagnostic and prognostic value. RNASET2 mRNA expression was detected by quantitative polymerase chain reaction (qPCR) in ccRCC patients and renal cancer cell lines. Wound healing assay, transwell assay, western blotting, and tube formation assays were used to evaluate the function of RNASET2 in renal cancer in vitro. In addition, transcriptome sequencing was performed on knockdown RNASET2 kidney cancer cells to analyze their potential signaling pathways. Moreover, the immune microenvironment and mutational status were evaluated to predict the potential mechanisms of RNASET2 involvement in renal cancer progression. Sensitivity to common chemotherapeutic and targeted agents was assessed according to the Genomics of Drug Sensitivity in Cancer (GDSC) database.

Results

RNASET2 expression was significantly upregulated in ccRCC tissues and renal cancer cell lines, predicting poor prognosis for patients. In vitro experiments showed that silencing RNASET2 inhibited the migration and pro-angiogenic ability of renal cancer cells. Transcriptome sequencing suggested its possible involvement in the remodeling of the immune microenvironment in renal cell carcinoma. Furthermore, bioinformatics analysis and immunohistochemical staining showed that RNASET2 was positively correlated with the infiltration abundance of regulatory T cells. Finally, we mapped the mutational landscape of RNASET2 in ccRCC and found its predictive value for drug sensitivity.

Conclusions

Our results suggest that RNASET2 is a promising biomarker and therapeutic target in ccRCC.
Predictors of bacteremia in febrile infants under 3 months old in the pediatric emergency department
Authors: Guo Bei-Cyuan , Chen Yin-Ting , Chang Yu-Jun , Chen Chun-Yu , Lin Wen-Ya , Wu Han-Ping
Published: September 2023

Introduction

Fever may serve as the primary indicator of underlying infection in children admitted to the pediatric emergency department (PED), especially in high-risk young infants. This study aimed to identify early clinical factors that could help predict bacteremia in young febrile infants.

Methods

The study included infants under 90 days of age who were admitted to the PED due to fever. Patients were divided into two groups based on the presence or absence of bacteremia and further divided into three age groups: (1) less than 30 days, (2) 30 to 59 days, and (3) 60 to 90 days. Several clinical and laboratory variables were analyzed, and logistic regression and receiver operating characteristic (ROC) analyses were used to identify potential risk factors associated with bacteremia in young febrile infants.

Results

A total of 498 febrile infants were included, of whom 6.4% were diagnosed with bacteremia. The bacteremia group had a higher body temperature (BT) at triage, especially in neonates, higher pulse rates at triage, longer fever subsidence time, longer hospital stays, higher neutrophil counts, and higher C-reactive protein (CRP) levels than those of the non-bacteremia group. ROC analysis showed that the best cut-off values for predicting bacteremia in infants with pyrexia were a BT of 38.7 °C, neutrophil count of 57.9%, and CRP concentration of 53.8 mg/L.

Conclusions

A higher BT at triage, increased total neutrophil count, and elevated CRP levels may be useful for identifying bacteremia in young febrile infants admitted to the PED.