bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of tilt and decentration of Visian Implantable Collamer Lens (ICL V4c) on visual quality: an observational study
Authors: Niu Lingling , Zhang Zhe , Miao Huamao , Zhao Jing , Li Meiyan , He Ji C. , Yao Peijun , Zhou Xingtao
Published: July 2022

Background

The central hole of the Visian Implantable Collamer Lens (ICL V4c) provides a reference to observe its tilt or decentration. This study aimed to investigate the tilt and decentration effects of ICL V4c on visual quality after implantation.

Methods

A total of 135 eyes from 69 patients who underwent ICL V4c implantation were included in this study. Evaluation of uncorrected distance visual acuity (UDVA), corrected distance visual acuity (CDVA), and aberrations were performed 6-months postoperatively. The anterior segment parameters were collected using CASIA2 anterior segment-optical coherence tomography, tilt and decentration of ICL V4c were analyzed using MATLAB software. All patients received questionnaires to investigate the visual quality postoperatively.

Results

The safety and effectiveness were 1.18 ± 0.17 and 1.11 ± 0.18, respectively. No significant changes were observed regarding higher-order and spherical aberrations after the operation; however, coma and trefoil significantly increased compared to preoperative values. The average total decentration and tilt was 0.21 ± 0.12 mm and 2.54 ± 1.00°, respectively. Horizontal, vertical, and total values of tilt and decentration were not significantly associated with postoperative CDVA, UDVA, and aberrations. The most common visual symptom was halo, and 97.04% of patients had a satisfaction score ≥ 8. The total or horizontal tilt was significantly positively correlated with the frequency, severity, and bothersome scores from the questionnaires.

Conclusions

ICL V4c implantation can obtain high visual quality and patient satisfaction. Although the degree of tilt and decentration after ICL V4c implantation was small, a positive effect on subjective visual quality was observed.
Comparison of pedicle screw placement accuracy between two types of imaging support (Artis Zeego versus two-dimensional fluoroscopy): a cross-sectional observational study
Authors: Matsuoka Akira , Toyone Tomoaki , Okano Ichiro , Kudo Yoshifumi , Ishikawa Koji , Maruyama Hiroshi , Ozawa Tomoyuki , Shirahata Toshiyuki , Inagaki Katsunori
Published: July 2022

Background

The pedicle screw system is widely used in spine surgery, and it provides rigid fixation and leads to successful subsequent deformity correction and bony fusion. The standard imaging technique for pedicle screw insertion is two-dimensional images obtained from C-arm-type X-ray fluoroscopy. Artis Zeego is an emerging intraoperative imaging technique that can provide conventional two-dimensional fluoroscopic images and rapid three-dimensional fluoroscopic computed tomography reconstruction imaging. The aim of this study is to compare the insertion accuracies of PS placement using Artis Zeego and conventional 2D X-ray fluoroscopy.

Methods

In this study, we retrospectively reviewed the postoperative images of thoracolumbar fusion patients who underwent surgery using pedicle screws between 2013 and 2018. Pedicle screw malplacement was assessed using a four-grade classification by Rao et al. Misplacement rates were compared between pedicle screws assisted with Artis Zeego and two-dimensional fluoroscopy.

Results

A total of 1107 pedicle screws in 153 patients were inserted using Artis Zeego, and 427 pedicle screws in 80 patients were inserted using fluoroscopy. The overall perforation rate was 4.2% (46 perforations of 1106 pedicle screws) in the Artis Zeego group and 7.7% (33 perforations of 427 pedicle screws) in the fluoroscopy group. In the Artis Zeego group, 43 (3.9%) screws were classified as grade 1, and three (0.3%) screws were classified as grade 2. In the fluoroscopy group, 21 (4.9%) screws were classified as grade 1, 10 (2.3%) screws were classified as grade 2, and 2 (0.5%) screws were classified as grade 3. The use of Artis Zeego was associated with a significantly lower screw malplacement rate than was the use of fluoroscopy (p < 0.001).

Conclusions

Our results demonstrated that pedicle screw placement with Artis Zeego was associated with a lower malplacement rate than was conventional two-dimensional fluoroscopy. No severe malplacement was observed in the Artis Zeego group. Thus, Artis Zeego could be a good option for improving pedicle screw accuracy.
Impact of the COVID-19 pandemic on hernia surgery in a Swedish healthcare region: a population-based cohort study
Authors: Kollatos Christos , Hanna Sarmad , Sandblom Gabriel
Published: July 2022

Background

Swedish healthcare has been reorganised during the COVID-19 pandemic, affecting the availability of surgery for benign conditions. The aim of this study was to determine the effects of COVID-19 on emergency and elective hernia surgery in a Swedish healthcare region.

Methods

Using procedure codes, data from inguinal and ventral hernia procedures performed at the three hospitals in Jönköping Region, Sweden, from March 1st 2019 to January 31st 2021, were retrieved from a medical database. The cohort was divided into two groups: the COVID-19 group (March 1st 2020–January 31st 2021) and the control group (March 1st 2019–January 31st 2020). Demographic and preoperative data, hernia type, perioperative findings, and type of surgery were analysed.

Results

A total 1329 patients underwent hernia surgery during the study period; 579 were operated during the COVID-19 period and 750 during the control period. The number of emergency ventral hernia repairs increased during the COVID-19 period, but no difference in inguinal hernia repair rate was seen. The characteristics of patients that underwent hernia repair were similar in the two groups. Moreover, the decrease in elective ventral hernia repair rate during the COVID-19 period did not result in a higher risk for strangulation.

Conclusion

There is no evidence to suggest that the decrease in the number of elective ventral hernia repairs during the COVID-19 period had any impact on the risk for strangulation. Indications for surgery in patients with a symptomatic ventral or inguinal hernia should be carefully evaluated. Studies with greater power and longer follow-up are needed to gain a full understanding of the effects of the COVID-19 pandemic on hernia surgery.
Clinical evaluation of giomer- and resin-based fissure sealants on permanent molars affected by molar-incisor hypomineralization: a randomized clinical trial
Authors: Özgür Beste , Kargın Seren Tuğçe , Ölmez Merih Seval
Published: July 2022

Background

Molar-incisor hypomineralization (MIH) is a common condition among children that significantly increases the risk of caries. The objective of this research was to evaluate the clinical success of giomer- and conventional resin-based sealants applied on first permanent molars (FPMs) affected by MIH.

Methods

One-hundred FPMs with MIH which were indicated for non-invasive fissure sealant were selected in 39 children, aged 6–12 years. Using a split mouth design, the FPMs were randomized into two groups; Group 1. Resin sealant (etch-and-rinse + Conceal F) and Group 2. Giomer sealant (self-etch primer + BeautiSealant). Clinical evaluation was performed using the modified United States Public Health Service (USPHS) criteria at 1, 3, 6 and 12 months. The Log-rank, Fisher’s exact test and Kaplan–Meier analysis were used for statistical analysis.

Results

At 12 months, the retention rates in Group 1 and Group 2 were 68% and %8, respectively (p = 0.000). The cumulative survival rates of conventional resin sealants were significantly higher than giomer sealants for all follow-up visits (p < 0.05). In Groups 1 and 2, the distribution of unsuccessful sealants on mandibular vs maxillary FPMs were 32.1% vs 31.8% (p = 0.612) and 91.7% vs 92.3% (p = 0.664), respectively. Although the success rate was higher for teeth with white opacities or lesions with less extension in Group 1, no significant difference was found. The average survival time was found as 10.46 ± 3.21 months in Group 1 and 4.02 ± 4.43 months in Group 2.

Conclusions

The conventional resin-based sealants yielded a better clinical performance over the 12-month evaluation period than the giomer sealants which were applied with self-etch primer. The high failure rate observed in giomer sealants could be explained by the possible deficiency in the etching capacity of self-etch primer on MIH-affected teeth.

Trial registrationClinicalTrials.gov, NCT04929782. Registered 10 June 2021—Retrospectively registered,https://clinicaltrials.gov/ct2/show/NCT04929782.
Diagnostic value of oral “beefy red” patch combined with fingertip blood mean corpuscular volume in vitamin B12 deficiency
Authors: Xu Xiaoheng , Liu Yang , Xiong Xiaoqin , Yao Yanmei , Hu Huiting , Jiang Xiao , Meng Wenxia
Published: July 2022

Objectives

To investigate the diagnostic value of accessible fingertip mean corpuscular volume (MCV) combined with a visible “beefy red” patch in the diagnosis of vitamin B12 (VB12) deficiency in local clinics and hospitals without in-house clinical laboratories, especially in remote areas.

Materials and methods

The medical history data of patients complaining of oral mucosal pain at the Stomatological Hospital of Southern Medical University were reviewed. All included patients underwent fingertip blood routine examination, specific serological test (serum VB12, folic acid, iron, and ferritin), and detailed oral clinical examinations. According to the results of the serum VB12 test patients were divided into case and control groups. In diagnostic test, the diagnostic value of the “beefy red” patch and elevated MCV in VB12 deficiency was evaluated by the receiver operator characteristic curve.

Results

There were more female patients than male patients in the case group (serum VB12 level < 148 pmol/L, n = 81) and control group (serum VB12 level ≥ 148 pmol/L, n = 60), mostly middle-aged and elderly patients. There were no statistical differences in gender and age between the two groups. In the case group, the number of individuals with stomach disease was 13, the number of individuals with “beefy red” patch was 78, the number of individuals with oral ulcer was 29, the number of individuals with “MCV > 100fL” and “folic acid < 15.9 nmol/L” were respectively 68 and 5. All were more than that in control group (P < 0.05). The diagnostic test, “beefy red patch” has high sensitivity (0.963) but low specificity(0.883), “MCV > 100 fL” has high specificity (0.933) but low specificity (0.815), and “MCV > 100 fL combined with beefy red patch” has maximal specificity (0.950), and area under the curve (0.949).

Conclusions

Visible oral “beefy red” patch combined with accessible fingertip blood MCV could improve the rate of diagnosis in VB12 deficiency, especially in the elderly in local clinics and hospitals without in-house clinical laboratories in China, which is conducive to early disease detection and treatment.
Association between coffee consumption and periodontal diseases: a systematic review and meta-analysis
Authors: Rhee Yeonjae , Choi Yongjun , Park Jeongmin , Park Hae Ryoun , Kim Kihun , Kim Yun Hak
Published: July 2022

Background

Several studies have demonstrated association between coffee consumption and periodontal diseases. However, no systematic review and meta-analysis was performed. Therefore, we performed a systematic review and meta-analysis to evaluate the association between coffee intake and periodontitis.

Methods

We defined PICO statement as “Do coffee drinkers have a higher association of periodontitis or tooth loss than non-coffee drinkers?”. We searched for articles using the Embase and Medline databases. The odds ratio was used as an effect measure to evaluate the association between coffee and periodontitis We divided coffee intake doses into three groups: no intake (≤ 0.03 cups/day), low intake (0.03 < x < 1 cups/day), and high intake (≥ 1 cup/day). Cohort and cross-sectional studies were eligible for inclusion in this study. The Newcastle–Ottawa scale was used to qualitatively assess the risk of bias. The degree of heterogeneity between studies was quantified using I2statistics.

Results

Six articles were analysed, including two cohort studies and four cross-sectional studies. The pooled unadjusted odds ratios of periodontitis were 1.14 (0.93–1.39), 1.05 (0.73–1.52), 1.03 (0.91–1.16) and 1.10 (0.84–1.45) in the 4 meta-analyses (coffee drinker vs. non-coffee drinker, high intake vs. low intake, low intake vs. no intake, high intake vs. no intake), respectively.

Conclusion

This is the first meta-analysis to investigate the relationship between coffee consumption and periodontitis. There was no relationship between coffee consumption and periodontitis. Further studies are required to assess whether a relationship between coffee consumption and periodontitis exists or not.

PROSPERO registration number: CRD42022301341.
Consent in organ transplantation: putting legal obligations and guidelines into practice
Authors: Raza Farrah , Neuberger James
Published: July 2022

Consent in medical practice is a process riddled with layers of complexities. To some extent, this is inevitable given that different medical conditions raise different sets of issues for doctors and patients. Informed consent and risk assessment are highly significant public health issues that have become even more prominent during the course of the Covid-19 pandemic. In this article we identity relevant factors for clinicians to consider when ensuring consent for solid organ transplantation. Consent to undergo solid organ transplantation is more complex than most surgical and other clinical interventions because of the many factors involved, the complexity of the options and the need to balance competing risks. We first out the context in which consent is given by the patient. We then outline the legal principles pertaining to consent in medical practice as it applies in the UK and the implication of recent legal judgments. The third section highlights specific complexities of consent in organ transplantation and identifies relevant factors in determining consent for organ transplantation. The fourth section offers practical recommendations. We propose a novel ‘multi-factor approach’ to informed consent in transplantation which includes understanding risk, effective communication, and robust review processes. Whilst understanding risk and communication are a given, our suggestion is that including review processes into the consent process is essential. By this we specifically mean identifying and creating room for discretion in decision-making to better ensure that informed consent is given in practice. Discretion implies that health care professionals use their judgement to use the legal judgements as guidance rather than prescriptive. Discretion is further defined by identifying the relevant options and scope of clinical and personal factors in specified transplantation decisions. In particular, we also highlight the need to pay attention to the institutional dimension in the consent process. To that end, our recommendations identify a gap in the current approaches to consent. The identification of areas of discretion in decision-making processes is essential for determining when patients need to be involved. In other words, clinicians and healthcare professionals need to consider carefully when there is room for direction and where there is little or no room for exercising discretion. In sum, our proposed approach is a modest contribution to the on-going debate about consent in medicine.
End-users feedback and perceptions associated with the implementation of a clinical-rule based Check of Medication Appropriateness service
Authors: Quintens Charlotte , Peetermans Willy E. , Van der Linden Lorenz , Declercq Peter , Van den Bosch Bart , Spriet Isabel
Published: July 2022

Background

To support appropriate prescribing hospital-wide, the ‘Check of Medication Appropriateness’ (CMA) service was implemented at the University Hospitals Leuven. The CMA concerns a clinical rule based and pharmacist-led medication review service. The aim of this study was to explore both physicians’ and pharmacists’ feedback on the optimised CMA service to further improve the service.

Methods

An anonymous e-questionnaire was sent to all physicians active in the University Hospitals Leuven (n = 1631) and to all clinical pharmacists performing the CMA service (n = 16). Feedback was collected using multiple choice questions. During a 5-month period, physicians were also contacted in case of non-acceptance of recommendations to investigate barriers affecting implementation. Thematic analysis was performed and additional acceptance after telephone contact within 24 h was registered.

Results

A total of 119 physicians (7.3%) and 16 pharmacists (100%) completed the e-questionnaire. The overall service was assessed as clinically relevant to highly relevant by 77.7% of physicians. The main reasons for non-acceptance of recommendations were related to workload, work environment and time constraints. About two thirds (66.3%) of initially not-accepted recommendations were accepted after phone contact. A nearly full consensus was reached among pharmacists (15/16) on the centralised CMA being complementary to current clinical pharmacy activities. Two major barriers were reported by pharmacists: (1) too limited time allocation and (2) a large number of irrelevant alerts.

Conclusions

The CMA was perceived as clinically relevant by the majority of end-users. Acceptance rate of pharmaceutical recommendations was further increased by calling the physician. Increasing the specificity of clinical rules in the future is imperative.
Contributions and challenges of healthcare financing towards universal health coverage in Ethiopia: a narrative evidence synthesis
Authors: Debie Ayal , Khatri Resham B. , Assefa Yibeltal
Published: July 2022

Background

High burden of healthcare expenditure precludes the poor from access to quality healthcare services. In Ethiopia, a significant proportion of the population has faced financial catastrophe associated with the costs of healthcare services. The Ethiopian Government aims to achieve universal health coverage (UHC) by 2030; however, the Ethiopian health system is struggling with low healthcare funding and high out-of-pocket (OOP) expenditure despite the implementation of several reforms in health care financing (HCF). This review aims to map the contributions, successes and challenges of HCF initiatives in Ethiopia.

Methods

We searched literature in three databases: PubMed, Scopus, and Web of science. Search terms were identified in broader three themes: health care financing, UHC and Ethiopia. We synthesised the findings using the health care financing framework: revenue generation, risk pooling and strategic purchasing.

Results

A total of 52 articles were included in the final review. Generating an additional income for health facilities, promoting cost-sharing, risk-sharing/ social solidarity for the non-predicted illness, providing special assistance mechanisms for those who cannot afford to pay, and purchasing healthcare services were the successes of Ethiopia’s health financing. Ethiopia's HCF initiatives have significant contributions to healthcare infrastructures, medical supplies, diagnostic capacity, drugs, financial-risk protection, and healthcare services. However, poor access to equitable quality healthcare services was associated with low healthcare funding and high OOP payments.

Conclusion

Ethiopia's health financing initiatives have various successes and contributions to revenue generation, risk pooling, and purchasing healthcare services towards UHC. Standardisation of benefit packages, ensuring beneficiaries equal access to care and introducing an accreditation system to maintain quality of care help to manage service disparities. A unified health insurance system that providing the same benefit packages for all, is the most efficient way to attain equitable access to health care.
Access to personal protective equipment in healthcare workers during the COVID-19 pandemic in the United Kingdom: results from a nationwide cohort study (UK-REACH)
Authors: Martin Christopher A. , Pan Daniel , Nazareth Joshua , Aujayeb Avinash , Bryant Luke , Carr Sue , Gray Laura J. , Gregary Bindu , Gupta Amit , Guyatt Anna L. , Gopal Alan , Hine Thomas , John Catherine , McManus I Chris , Melbourne Carl , Nellums Laura B. , Reza Rubina , Simpson Sandra , Tobin Martin D. , Woolf Katherine , Zingwe Stephen , Khunti Kamlesh , Pareek Manish ,   On behalf of the UK-REACH Study Collaborative Group, Pareek Manish , Gray Laura , Nellums Laura , Guyatt Anna L. , John Catherine , McManus I. Chris , Woolf Katherine , Abubakar Ibrahim , Gupta Amit , Abrams Keith R. , Tobin Martin D. , Wain Louise , Carr Sue , Dove Edward , Khunti Kamlesh , Ford David , Free Robert
Published: July 2022

Background

Healthcare workers (HCWs) are at high risk of SARS-CoV-2 infection. Effective use of personal protective equipment (PPE) reduces this risk. We sought to determine the prevalence and predictors of self-reported access to appropriate PPE (aPPE) for HCWs in the UK during the COVID-19 pandemic.

Methods

We conducted cross sectional analyses using data from a nationwide questionnaire-based cohort study administered between December 2020-February 2021. The outcome was a binary measure of self-reported aPPE (access all of the time vs access most of the time or less frequently) at two timepoints: the first national lockdown in the UK in March 2020 (primary analysis) and at the time of questionnaire response (secondary analysis).

Results

Ten thousand five hundred eight HCWs were included in the primary analysis, and 12,252 in the secondary analysis. 35.2% of HCWs reported aPPE at all times in the primary analysis; 83.9% reported aPPE at all times in the secondary analysis. In the primary analysis, after adjustment (for age, sex, ethnicity, migration status, occupation, aerosol generating procedure exposure, work sector and region, working hours, night shift frequency and trust in employing organisation), older HCWs and those working in Intensive Care Units were more likely to report aPPE at all times. Asian HCWs (aOR:0.77, 95%CI 0.67–0.89 [vs White]), those in allied health professional and dental roles (vs those in medical roles), and those who saw a higher number of COVID-19 patients compared to those who saw none (≥ 21 patients/week 0.74, 0.61–0.90) were less likely to report aPPE at all times. Those who trusted their employing organisation to deal with concerns about unsafe clinical practice, compared to those who did not, were twice as likely to report aPPE at all times. Significant predictors were largely unchanged in the secondary analysis.

Conclusions

Only a third of HCWs in the UK reported aPPE at all times during the first lockdown and that aPPE had improved later in the pandemic. We also identified key determinants of aPPE during the first UK lockdown, which have mostly persisted since lockdown was eased. These findings have important implications for the safe delivery of healthcare during the pandemic.
Effects of fee-for-service, diagnosis-related-group, and mixed payment systems on physicians’ medical service behavior: experimental evidence
Authors: Li Xing , Zhang Yue , Zhang Xinyuan , Li Xinyan , Lin Xing , Han Youli
Published: July 2022

Background

Healthcare reforms in many countries have shown a movement from pure payment systems to mixed payment systems. However, there remains an insufficient understanding of how to design better mixed payment systems and how such systems, especially Diagnosis-Related-Group (DRG)-based systems, benefit patients. We therefore designed a controlled laboratory experiment to investigate the effects of fee-for-service (FFS), DRG, and mixed payment systems on physicians’ service provision.

Methods

A total of 210 medical students were recruited from Capital Medical University as subjects. They, in the role of physicians, were randomly divided into seven groups and chose the quantity of medical services for different patient types under pure FFS, pure DRG, or mixed payment schemes that included two FFS-based mixed payment schemes and three DRG-based mixed payment schemes. There were five rounds of each group of experiments, and each subject made 18 decisions per round. The quantity of medical services provided by subjects were collected. And relevant statistics were computed and analyzed by nonparametric tests and random effects model.

Results

The results showed that the physicians’ overprovision (underprovision) of services under FFS (DRG) schemes decreased under mixed payment schemes, resulting in higher benefit to patients under mixed payment schemes. Patients’ health conditions also affected physicians’ behavior but in different directions. Higher disease severity was associated with higher deviation of physicians’ quantity choices from the optimal quantity under DRG and DRG-based mixed payment schemes, while the opposite was found for FFS and FFS-based mixed payment schemes.

Conclusions

Mixed payment systems are a better way to balance physicians’ profit and patients’ benefit. The design of mixed payment systems should be adjusted according to the patient’s health conditions. When patients are in lower disease severity and resource consumption is relatively small, prospective payments or mixed systems based on prospective payments are more suitable. While for patients in higher disease severity, retrospective payments or mixed systems based predominantly on retrospective payments are better.
Number of standard modifiable risk factors and mortality in patients with first-presentation ST-segment elevation myocardial infarction: insights from China Acute Myocardial Infarction registry
Authors: Li Sidong , Gao Xiaojin , Yang Jingang , Xu Haiyan , Wang Yang , Zhao Yanyan , Yin Lu , Wu Chao , Wang Yi , Zheng Yang , Li Bao , Zhang Xuan , Ye Yunqing , Fu Rui , Dong Qiuting , Sun Hui , Yan Xinxin , Wu Yuan , Zhang Jun , Jin Chen , Li Wei , Yang Yuejin ,   on behalf of CAMI investigators
Published: July 2022

Background

Recent publications reported a paradoxical finding that there was an inverse association between the number of standard modifiable risk factors (SMuRFs; smoking, hypertension, diabetes, and hyperlipidemia) and mortality in patients with myocardial infarction. However, the current evidence is only limited to those highly developed countries with advanced medical management systems.

Methods

The China Acute Myocardial Infarction registry is a prospective observational study including patients with acute myocardial infarction from three-level hospitals across 31 administrative regions throughout mainland China. A total of 16,228 patients with first-presentation ST-elevation myocardial infarction (STEMI) admitted to hospitals from January 2013 to September 2014 were enrolled in the current analysis. Cox proportional hazard models adjusting for baseline characteristics, clinical profiles at presentation, and in-hospital treatments were used to assess the association of the number of SMuRFs with all-cause mortality at 30 days after STEMI presentation.

Results

A total of 1918 (11.8%), 11,503 (70.9%), and 2807 (17.3%) patients had 0, 1–2, and 3–4 SMuRFs at presentation, respectively. Patients with fewer SMuRFs were older and more likely to be females, experienced longer pre-hospital delays, and were less likely to receive primary percutaneous coronary intervention and evidence-based medications. Compared with those without any SMuRF, patients with 1–2 SMuRFs and 3–4 SMuRFs were associated with an HR of 0.74 (95% CI, 0.63–0.87) and 0.63 (0.51–0.77) for all-cause mortality up to 30 days in the unadjusted model (Ptrend< 0.0001). However, after multivariate adjustment, the number of SMuRFs was positively associated with increased mortality risk (HR for 1–2 SMuRFs, 1.15 [0.95–1.39]; HR for 3–4 SMuRFs, 1.31 [1.02–1.68];Ptrend= 0.03), and the association was only significant among patients admitted to hospitals beyond 12 h from onset (HR for 1–2 SMuRFs, 1.39 [1.03–1.87]; HR for 3–4 SMuRFs, 2.06 [1.41–3.01]) but not their counterparts (Pinteraction= 0.01).

Conclusions

The increased crude mortality risk among patients without SMuRFs is explained by confounding factors related to their poor risk profiles (old age, longer pre-hospital delays, and poor clinical management). After multivariate adjustment, a higher risk-factor burden was associated with poor prognosis among patients with STEMI.
From the Global Initiative for Asthma report and asthma guidelines to real-life asthma control: is there room for improvement?
Authors: Novembre Elio , Giovannini Mattia , Barni Simona , Mori Francesca
Published: July 2022

Available guidelines for asthma management represent an important and suitable tool to make the entire medical process evidence-based, effective, and safe for patients. Their purpose is to help doctors and patients formulate the best decisions in regard to asthma management by choosing the most appropriate strategies in each specific clinical situation.

The Global Initiative for Asthma (GINA) document, together with other national and international recommendations, is one of the main documents used for asthma prevention and management in Italy, but several studies reported that these recommendations are often not applied in real-life clinical practice, which consequently results in inadequate asthma control.

In this context, a substantial simplification of the GINA document and asthma guidelines may represent a feasible strategy to be pursued to ameliorate the knowledge among GPs, primary care pediatricians, and specialists taking care of children and adults with asthma.

On the other hand, another critical factor that may explain unsatisfactory control of asthma is the limited importance that all recommendations place on asthma heterogeneity. In the era of personalized medicine and target therapies, phenotype-driven asthma management may become a desirable approach for optimizing the management of asthmatic patients. In addition, digital health strategies have been investigated in the literature to improve asthma monitoring and may represent a promising tool in the future from this point of view.

Relevant stakeholders should continue to investigate how to optimize real-life asthma control to propose novel solutions to translate into clinical practice.
Feasibility of inpatient cardiac rehabilitation after percutaneous mitral valve reconstruction using clipping procedures: a retrospective analysis
Authors: Schmidt Thomas , Kowalski Marek , Bjarnason-Wehrens Birna , Ritter Frank , Mönnig Gerold , Reiss Nils
Published: July 2022

Background

To date, no studies on the feasibility or outcomes of cardiac rehabilitation (CR) after percutaneous mitral valve reconstruction using clipping procedures have been published. The aim of this study was to report on our first experiences with this special target group.

Methods

Monocentric retrospective analysis of 27 patients (72 ± 12 years old, 52% female) who underwent multimodal inpatient CR in the first 2 month after MitraClip™ implantation. A six-minute-walking-test, a handgrip-strength-test and the Berg-Balance-Scale was conducted at the beginning and end of CR. Echocardiography was performed to rule out device-related complications.

Results

Adapted inpatient CR started 16 ± 13 days after clipping intervention and lasted 22 ± 4 days. In 4 patients (15%) CR had to be interrupted or aborted prematurely due to cardiac decompensations. All other patients (85%) completed CR period without complications. Six-minute-walking-distance improved from 272 ± 97 to 304 ± 111 m (p < .05) and dependence on rollator walker or walking aids was significantly reduced (p < .05). Results of handgrip-strength-test and Berg-Balance-Scale increased (p < .05). Overall, social-medical and psychological consultations were well received by the patients and no device-related complications occurred during rehabilitation treatments.

Conclusions

The results indicate that an adapted inpatient CR in selected patients after MitraClip™ implantation is feasible. Patients benefited from treatments both at functional and social-medical level and no device-related complications occurred. Larger controlled studies are needed.
Psychedelics in the treatment of unipolar and bipolar depression
Authors: Bosch Oliver G. , Halm Simon , Seifritz Erich
Published: July 2022

This is a narrative review about the role of classic and two atypical psychedelics in the treatment of unipolar and bipolar depression. Since the 1990s, psychedelics experience a renaissance in biomedical research. The so-called classic psychedelics include lysergic acid diethylamide (LSD), psilocybin, mescaline and ayahuasca. Characteristic effects like alterations in sensory perception, as well as emotion- and self-processing are induced by stimulation of serotonin 2A receptors in cortical areas. The new paradigm of psychedelic-assisted psychotherapy suggests a therapeutic framework in which a safely conducted psychedelic experience is integrated into a continuous psychotherapeutic process. First randomized, controlled trials with psilocybin show promising efficacy, tolerability, and adherence in the treatment of unipolar depression. On the other hand, classic psychedelics seem to be associated with the induction of mania, which is an important issue to consider for the design of research and clinical protocols. So called atypical psychedelics are a heterogeneous group with overlapping subjective effects but different neurobiological mechanisms. Two examples of therapeutic value in psychiatry are 3,4-methyl​enedioxy​methamphetamine (MDMA) and ketamine. Since 2020 the ketamine enantiomer esketamine has been granted international approval for treatment-resistant unipolar depression, and also first evidence exists for the therapeutic efficacy of ketamine in bipolar depression. Whether psychedelics will fulfil current expectations and find their way into broader clinical use will depend on future rigorous clinical trials with larger sample sizes. A well-considered therapeutic and legal framework will be crucial for these substances to create new treatment settings and a potential paradigm shift.
Optimal instance subset selection from big data using genetic algorithm and open source framework
Authors: Zhai Junhai , Song Dandan
Published: July 2022

Data is accumulating at an incredible rate, and the era of big data has arrived. Big data brings great challenges to traditional machine learning algorithms, it is difficult for learning tasks in big data scenario to be completed on stand-alone. Data reduction is an effective way to solve this problem. Data reduction includes attribute reduction and instance reduction. In this study, we focus on instance reduction also called instance selection, and view the instance selection as an optimal instance subset selection problem. Inspired by the ideas of cross validation and divide and conquer, we defined a novel criterion called combined information entropy with respect to a set of classifiers to measure the importance of an instance subset, the criterion uses multiple independent classifiers trained on different subsets to measure the optimality of an instance subset. Based on the criterion, we proposed an approach which uses genetic algorithm and open source framework to select optimal instance subset from big data. The proposed algorithm is implemented on two open source big data platforms Hadoop and Spark, the conducted experiments on four artificial data sets demonstrate the feasibility of the proposed algorithm and visualize the distribution of selected instances, and the conducted experiments on four real data sets compared with three closely related methods on test accuracy and compression ratio demonstrate the effectiveness of the proposed algorithm. Furthermore, the two implementations on Hadoop and Spark are also experimentally compared. The experimental results show that the proposed algorithm provides excellent performance and outperforms the three methods.
Sparse Radon transform in the mixed frequency-time domain with ℓ1-2 minimization
Authors: Geng Weiheng , Chen Xiaohong , Li Jingye , Ma Jitao , Tang Wei , Wu Fan
Published: July 2022

Due to the finite acquisition aperture and sampling of seismic data, the Radon transform (RT) suffers from a smearing problem which reduces the resolution of the estimated model. In addition, inverting the RT is typically an ill-posed problem. To address these challenges, a sparse RT mixing the [Formula: see text] and [Formula: see text] norms of the RT coefficients in the mixed frequency-time domain is developed, and it is denoted as SRTL1-2. In most conventional sparse RTs, the sparse constraint term often is the [Formula: see text] norm of the Radon model. We prove that the sparsity effect of the [Formula: see text] minimization is better than that of the [Formula: see text] norm alone by comparing and analyzing their 2D distribution patterns and threshold functions. The difference of the convex functions algorithm and the alternating direction method of multipliers algorithm are modified by combining the forward and inverse Fourier transforms to solve the corresponding sparse inverse problem in the mixed frequency-time domain. Our method is compared with three RT methods, including a least-squares RT (LSRT), a frequency-domain sparse RT (FSRT), and a time-invariant RT in the mixed frequency-time domain based on an iterative 2D model shrinkage method (SRTIS). Furthermore, we modify the basis function in SRTL1-2 by including an orthogonal polynomial transform to fit the amplitude-variation-with-offset (AVO) signatures found in seismic data, and we denote this as high-order SRTL1-2. Compared to the SRTL1-2, the high-order SRTL1-2 performs better when processing seismic data with AVO signatures. Synthetic and real data examples indicate that our method has better performance than the LSRT, FSRT, and SRTIS in terms of attenuation of multiples, noise mitigation, and computational efficiency.
Unsupervised time series clustering, class-based ensemble machine learning, and petrophysical modeling for predicting shear sonic wave slowness in heterogeneous rocks
Authors: Bhattacharya Shuvajit
Published: July 2022

Shear sonic logs are critical for formation evaluation, rock physics, quantitative reservoir characterization, and geomechanical studies. Although empirical and conventional machine learning (ML) have been used for shear sonic slowness estimates, both approaches suffer from multiple fundamental problems. New approaches to ML, namely, unsupervised multivariate time series clustering (Toeplitz inverse covariance-based clustering) and class-based ensemble ML, are integrated with geologic information and petrophysical inversion-based multimineral models to predict rock properties of the Wolfcamp Formation in the Midland Basin, United States. These new approaches consider the interdependence of wireline log attributes, temporal or depth dependence of log responses, multimodal geologic factors, and variability of individual ML model-based results to generate the best possible ML model. The results from the proposed approach indicate highly accurate and consistent shear sonic log predictions with a minimal error for thousands of feet (hundreds of meters) in several wells in the Wolfcamp Formation, covering a large study area in the basin. The results are used in estimating elastic properties, such as Poisson’s ratio, lambda-rho (incompressibility), and mu-rho (rigidity) to delineate brittle and ductile units in the formation.
Factorized Hilbert-space metrics and non-commutative quasi-Hermitian observables
Authors: Znojil Miloslav
Published: July 2022

In 1992, Scholtz et al. (Ann. Phys., 213 (1992) 74) showed that a set of non-Hermitian operators can represent observables of a closed unitary quantum system, provided only that its elements are quasi-Hermitian (i.e., roughly speaking, Hermitian with respect to an ad hoc inner-product metric). We show that such a version of quantum mechanics admits a simultaneous closed-form representation of the metric

and of the observables

,

in terms of auxiliary operators Z

k
with

. At N = 2 the formalism degenerates to the well-known

quantum mechanics using factorized metric

, where

is parity and where

is charge.
Increased Incidence of Hashimoto Thyroiditis in Selenium Deficiency: A Prospective 6-Year Cohort Study
Authors: Wu Qian , Wang Yue , Chen Ping , Wei Jing , Lv Hongjun , Wang Si , Wu Yajun , Zhao Xuan , Peng Xiaogang , Rijntjes Eddy , Wang Youfa , Schomburg Lutz , Shi Bingyin
Published: July 2022

Context

In 2015, we reported an increased prevalence of thyroid disease in a county of low habitual selenium (Se) intake in comparison to a neighboring county with higher intake in a cross-sectional survey in Shaanxi Province, China.

Objective

To explore longitudinal effects of low Se status, a prospective cohort study was conducted in the same area from 2013 to 2019, and thyroid peroxidase autoantibodies (TPO-Abs) and disease incidence were compared.

Methods

A total 1254 individuals from 1500 reinvited participants were successfully enrolled. Venous blood, fingernails, and urine samples were collected and analyzed to evaluate thyroid status, TPO-Abs, serum Se, and urinary iodine. Diagnosis of Hashimoto thyroiditis (HT) was based on elevated thyrotropin, presence of TPO-Abs, and ultrasound characteristics. Se deficiency was categorized using a serum concentration of 80 µg/L as a threshold, and tested by logistic regression for a relationship to TPO-Abs and HT.

Results

Se deficiency was observed in 46.2% of participants from the adequate-Se county (Ziyang) and in 89.7% from the low-Se county (Ningshan). Se concentrations in fingernails differed strongly by residency (Ziyang vs Ningshan; 678.7 vs 364.3 μg/kg; Z = –9.552; P < .001). Newly diagnosed HT in Ziyang was less frequent than in Ningshan (0.09% vs 0.31%; χ 2 = 4.350; P = .037). The conversion rate to seropositive TPO-Abs was 10.2% in Ningshan vs 5.6% in Ziyang. Excluding iodine as confounding factor, low-Se was confirmed as a risk factor for HT (relative risk [95% CI]; 3.65 [1.03-12.90]; P < .05).

Conclusion

The data indicate an increased incidence of TPO-Ab seroconversion with low Se supply and support the hypothesis that Se deficiency contributes to HT as a modifiable risk factor.
In Vivo Photometry Reveals Insulin and 2-Deoxyglucose Maintain Prolonged Inhibition of VMH Vglut2 Neurons in Male Mice
Authors: Rawlinson Sasha , Reichenbach Alex , Clarke Rachel E , Nuñez-Iglesias Juan , Dempsey Harry , Lockie Sarah H , Andrews Zane B
Published: July 2022

The ventromedial hypothalamic (VMH) nucleus is a well-established hub for energy and glucose homeostasis. In particular, VMH neurons are thought to be important for initiating the counterregulatory response to hypoglycemia, and ex vivo electrophysiology and immunohistochemistry data indicate a clear role for VMH neurons in sensing glucose concentration. However, the temporal response of VMH neurons to physiologically relevant changes in glucose availability in vivo has been hampered by a lack of available tools for measuring neuronal activity over time. Since the majority of neurons within the VMH are glutamatergic and can be targeted using the vesicular glutamate transporter Vglut2, we expressed cre-dependent GCaMP7s in Vglut2 cre mice and examined the response profile of VMH to intraperitoneal injections of glucose, insulin, and 2-deoxyglucose (2DG). We show that reduced available glucose via insulin-induced hypoglycemia and 2DG-induced glucoprivation, but not hyperglycemia induced by glucose injection, inhibits VMH Vglut2 neuronal population activity in vivo. Surprisingly, this inhibition was maintained for at least 45 minutes despite prolonged hypoglycemia and initiation of a counterregulatory response. Thus, although VMH stimulation, via pharmacological, electrical, or optogenetic approaches, is sufficient to drive a counterregulatory response, our data suggest VMH Vglut2 neurons are not the main drivers required to do so, since VMH Vglut2 neuronal population activity remains suppressed during hypoglycemia and glucoprivation.
Hypothalamic Expression of Estrogen Receptor Isoforms Underlies Estradiol Control of Luteinizing Hormone in Female Rats
Authors: Henriques Patricia C , Aquino Nayara S S , Campideli-Santana Ana C , Silva Juneo F , Araujo-Lopes Roberta , Franci Celso R , Coimbra Candido C , Szawka Raphael E
Published: July 2022

Luteinizing hormone (LH) secretion during the ovarian cycle is governed by fluctuations in circulating estradiol (E2) that oppositely regulate kisspeptin neurons in the anteroventral periventricular nucleus (AVPV) and arcuate nucleus (ARC) of the hypothalamus. However, how these effects are orchestrated to achieve fertility is unknown. Here, we have tested the hypothesis that AVPV and ARC neurons have different sensitivities to E2 to coordinate changes in LH secretion. Cycling and ovariectomized rats with low and high E2 levels were used. As an index of E2 responsiveness, progesterone receptor (PR) was expressed only in the AVPV of rats with high E2, showing the preovulatory LH surge. On the other hand, kisspeptin neurons in the ARC responded to low E2 levels sufficient to suppress LH release. Notably, the Esr1/Esr2 ratio of gene expression was higher in the ARC than AVPV, regardless of E2 levels. Accordingly, the selective pharmacological activation of estrogen receptor α (ERα) required lower doses to induce PR in the ARC. The activation of ERβ, in turn, amplified E2-induced PR expression in the AVPV and the LH surge. Thus, ARC and AVPV neurons are differently responsive to E2. Lower E2 levels activate ERα in the ARC, whereas ERβ potentiates the E2 positive feedback in the AVPV, which appears related to the differential Esr1/Esr2 ratio in these 2 brain areas. Our findings provide evidence that the distinct expression of ER isoforms in the AVPV and ARC plays a key role in the control of periodic secretion of LH required for fertility in females.