bluuebunny/crossref_metadata_2025 huggingface dataset:
Structural Insights Into Thyroid Hormone Receptors
Authors: Tambones Izabella , le Maire Albane
Published: November 2024

Thyroid hormone receptors (TRs) are essential components of the endocrine system, mediating the cellular effects of thyroid hormones. The 2 TR genes, THRA and THRB, encode 4 isoforms, with TRα1 and TRβ1 being the most prevalent. TRs are ligand-dependent transcription factors and members of the nuclear receptor superfamily, indispensable for human growth, development, and metabolism. Dysfunctional TR signaling can lead to conditions such as resistance to thyroid hormone (RTH) syndrome, thyroid cancer, and metabolic disorders. Structurally, TRs comprise several domains: a variable N-terminal domain, a conserved DNA-binding domain, and a ligand-binding domain that mediates interaction with hormones and transcriptional coregulators. TRs predominantly function as heterodimers with the retinoid X receptor (RXR), binding to thyroid hormone response elements in target genes to regulate their transcription. This review examines the structural studies on TRs, primarily performed through x-ray crystallography, that have provided detailed insights into TR functions, including DNA recognition, ligand binding, and coregulator interactions. We also discuss how these findings have deepened our understanding of TR mechanisms and contributed to the interpretation of pathogenic mutations.
Diabetes Remission After Radical Nephrectomy in a Geriatric Patient With Obesity and Type 2 Diabetes—34 Months’ Follow-Up
Authors: Tripathi Pramod , Kadam Nidhi , Sharma Baby , Shah Manisha , Vijayakumar Venugopal , Kuppusamy Maheshkumar
Published: November 2024

Diabetes mellitus significantly affects survival in patients with renal cell carcinoma undergoing nephrectomy, requiring personalized care. This case involved a 64-year-old man with type 2 diabetes (T2D) who underwent radical nephrectomy for renal cell carcinoma. He consented to a 1-year intensive lifestyle intervention (ILI), including a vegan diet (to lower calorie intake, reduce uric acid, support renal health, and promote weight loss), intermittent fasting, regular exercise, psychological support, and medical management. Quarterly biochemical assessments and monthly adherence evaluations were conducted. Post intervention, the patient achieved diabetes remission, maintaining glycated hemoglobin A1c (HbA1c) below 6.5% (48 mmol/mol) (reference range, <6.5%; <48 mmol/mol) without medication. He lost 36 kg (79.37 lb), reducing his body mass index from 35.3 to 25.1. His lipid profile normalized (total cholesterol, 175 to 127 mg/dL (4.53 to 3.29 mmol/L) (reference range, <200 mg/dL; <5.18 mmol/L); triglycerides, 155 to 73 mg/dL (1.75 to 0.82 mmol/L) (reference range, <150 mg/dL; <1.69 mmol/L), allowing the discontinuation of statins. Improvements in serum creatinine and high-sensitivity C-reactive protein levels were also observed. The patient exhibited normal glucose tolerance, consecutively passing an oral glucose tolerance test for 2 years. This case highlights the potential of lifestyle modifications in managing T2D in patients with a history of nephrectomy.
A Stronger IMPACT on Career Development for Early- and Mid-career Faculty
Authors: Gorelick Daniel A , Gertz Jason , Basham Kaitlin J , Treviño Lindsey S
Published: November 2024

Nuclear receptors are important in normal physiology and disease. Physicians and scientists who study nuclear receptors organize and attend conferences and symposia devoted to foundational and translational nuclear receptor research, but the field lacks a platform for early-stage investigators and aspiring leaders. In 2019, Zeynep Madak-Erdogan, Rebecca Riggins, and Matthew Sikora founded Nuclear Receptor (NR) Interdisciplinary Meeting for Progress And Collaboration Together (IMPACT, https://nrimpact.com), a collaborative group designed for early- and mid-career faculty who study nuclear receptors in any context or organism [1]. NR IMPACT addresses challenges for early- and mid-career faculty. Here, we review the progress of NR IMPACT and discuss how our peer-mentoring cohort is removing hurdles for new faculty and advancing nuclear receptor biology.
The Management of Symptomatic Moyamoya Disease in Pediatric Patients: A Systematic Review and Meta-Analysis
Authors: Shahbandi Ataollah , Sattari Shahab Aldin , Azad Tej D. , Xia Yuanxuan , Lehner Kurt , Yang Wuyang , Feghali James , Reynolds Rebecca A. , Akbari S. Hassan A. , Groves Mari L. , Xu Risheng , Caplan Justin M. , Bettegowda Chetan , Cohen Alan R. , Huang Judy , Tamargo Rafael J. , Gonzalez L. Fernando
Published: November 2024

BACKGROUND AND OBJECTIVES:

The optimal management strategy for pediatric patients with symptomatic moyamoya disease (MMD) is not well established. This systematic review and meta-analysis compares surgical vs conservative management and direct/combined bypass (DB/CB) vs indirect bypass (IB) for pediatric patients with symptomatic MMD.

METHODS:

MEDLINE and PubMed were searched from inception to March 17, 2024. For analysis of surgical vs conservative treatment, the primary and secondary outcomes were follow-up ischemic stroke and intracranial hemorrhagic events, respectively. For analysis of DB/CB vs IB, the primary outcome was follow-up ischemic stroke, and secondary outcomes included follow-up transient ischemic attack, new or worsened seizures, symptomatic improvement, modified Rankin Scale score ≤2, and Matsushima grade A at the last follow-up.

RESULTS:

Twenty-two included studies yielded 1091 patients, with a median follow-up duration of 35.7 months. Regarding surgical vs conservative management, 428 patients were analyzed. Surgical treatment was associated with lower odds of ischemic stroke (odds ratios [OR] = 0.33 [95% CI, 0.11-0.97], P = .04), and intracranial hemorrhagic events tended to be lower with surgery (OR = 0.25 [0.06-1.03], P = .05). Regarding DB/CB techniques vs IB, 875 patients were analyzed. The groups had similar rates of ischemic stroke (OR = 0.79 [0.31-1.97], P = .61), transient ischemic attack (OR = 1.27[0.46-3.55], P = .64), new or worsened seizures (OR = 1.05[0.3-3.65], P = .93), symptomatic improvement (OR = 2.45[0.71-8.45], P = .16), and follow-up modified Rankin Scale ≤2 (OR = 1.21 [0.16-8.85], P = .85). CB was associated with higher Matsushima grade A relative to IB (OR = 3.44 [1.32-9.97], P = .01).

CONCLUSION:

Surgical revascularization yielded more favorable clinical outcomes than conservative management in this meta-analysis. Clinical outcomes were similar between DB/CB vs IB techniques. Surgical flow augmentation, either by DB/CB or IB, seems to benefit pediatric patients with symptomatic MMD.
Digital and Financial Literacy for Uplifting Women and Achieving Sustainable Development Goals
Authors: Mishra Deepak , Kandpal Vinay , Agarwal Naveen , Kumar Rakesh , singh Rajesh , Priyadarshi Neeraj , Twala Bhekisipho
Published: November 2024

Digital and financial literacy are changing the landscape of the globe in terms of its approach to development. These two literacies also help to achieve women’s empowerment and, consequently, the sustainable development goals (SDGs) more quickly. This systematic literature review looks at the two literacies and their effects, focusing on women’s participation and showing how digital literacy not only increases women’s access to knowledge and connectivity but is also a door to women’s entrepreneurship and financial independence. Likewise, financial literacy, when coupled with digital skills, can be a breakthrough to the traditional socioeconomic barrier – poverty – by assisting women in making informed economic decisions, increasing their financial independence and resilience in the face of a global crisis. Empirical realities that still hinder women’s education, such as cultural norms, infrastructural deficiencies and educational gaps, still exist. However, the paper points out that to have a more equal world based on the SDGs, the double literacy strategy for women’s empowerment should not be negotiable.
An evaluation of a mentoring program in Emergency Medicine: A qualitative assessment using semi-structured interviews
Authors: Lasfer Chafika , Taylor David
Published: November 2024

Background Mentorship plays a crucial role in professional development, particularly in fields like emergency medicine. However, the dynamics of mentor-mentee relationships in this context remain underexplored. Understanding these dynamics is essential for optimizing mentorship programs and enhancing healthcare outcomes. This research investigates the factors influencing mentorship relationships in emergency medicine within the United Arab Emirates (UAE) context. It seeks to uncover the characteristics and dynamics of these relationships through qualitative analysis, providing insights into facilitators and barriers to success. Methods The study adopts a qualitative approach, conducting interviews with both mentors and mentees. Thematic analysis is employed to identify recurring themes in mentor-mentee interactions. The analysis delves into the supportive, communicative, approachable, knowledgeable, and empathetic traits of effective mentors. It also explores hindrances such as time constraints, resource limitations, random mentor allocation, and gender and cultural differences. Results The research findings underscore the pivotal role of mentors in fostering successful mentorship relationships. Effective mentors exhibit traits such as supportiveness, communication skills, approachability, knowledge, and empathy. Conversely, barriers to these relationships include mentees' behavior, time and resource constraints, random mentor allocation, and gender and cultural disparities. Conclusions While highlighting the importance of mentorship in emergency medicine, the study identifies the need for tailored mentorship approaches. It emphasizes the significance of selecting, training, and supporting mentors and optimizing mentorship programs. The research also suggests developing guidelines, aligning mentorship goals with healthcare priorities, fostering diversity, and integrating mentorship into professional development and quality assurance mechanisms. Ultimately, this study sheds light on the complexities of mentor-mentee relationships in emergency medicine, offering valuable insights for academic research, practice, and policy development in the UAE healthcare context.
Optimization of the autolysis of rainbow trout viscera for amino acid release using response surface methodology
Authors: Domínguez Haizea , Iñarra Bruno , Labidi Jalel , Bald Carlos
Published: November 2024

Background Due to the huge amounts of their production in Europe, their environmental impact, and the difficulty in processing them, there is a clear necessity for the valorization of rainbow trout viscera. Considering that the production of fishmeal with viscera can be problematic, and in order to make viscera more profitable, the production of fish protein hydrolysates has been considered. Although silage and enzymatic hydrolysis are the most common methods for obtaining hydrolysates, autolysis has emerged as an alternative method that uses endogenous enzymes of the viscera. Methods Considering the stability and characteristics of the enzymes, a factorial design was carried out using three variables: pH, temperature, and water content. The design resulted in 15 experiments, and the results were analyzed using response surface methodology. The optimum parameters were validated by comparing the predicted outcomes with experimental results. Additionally, a kinetics study was conducted to shorten the autolysis time. Results from autolysis were compared with those from silage and enzymatic hydrolysis in a previous study. Results The optimal conditions for achieving the highest degree of hydrolysis and yield of free amino acids (FAAs) per 100 g of viscera and per total protein were determined to be a pH of 8, a temperature of 40 °C, and a water content of 6.85%. The pH and content of the added water were found to be significant variables during autolysis (p < 0.05). The kinetic study showed that 7 h was still required to be effective. Conclusions Autolysis achieved a lower degree of hydrolysis than silage; however, as it solubilized more protein, the global yield of free amino acids per 100 g of viscera was slightly higher. It was concluded that endogenous alkaline proteases could be used in an autolytic process to obtain a free amino acid-rich hydrolysate from trout viscera.
Skrypt biochemiczny
Authors: Cichosz Marcin , Kiełkowska Urszula , Kurzawa Marzena
Published: November 2024

The script is intended for students of chemistry studies who, in the course of their education, study subjects related to biology, biochemistry, microbiology, food analysis and natural medicine technology. Many years of observations and conducting classes indicate that presenting some topics may be useful in a condensed form, which is especially important during laboratory classes. The number of hours of classes intended for the "biochemical" subjects in various fields of study at the Faculty of Chemistry of the Nicolaus Copernicus University in Toruń is quite large, hence the fast pace of classes and the need to familiarise oneself with the issues discussed. This script gives you the opportunity to deepen your knowledge, primarily practical, regarding the implementation of the issues discussed in it. We hope that the presented content will help you prepare to participate in the classes.
Introducción
Authors: Vergel John
Published: November 2024

En los siguientes cinco capítulos de la presente sección, los lectores identificarán los resultados de la indagación educativa, en general, y curricular, en particular, de algunos de estos proyectos. En el capítulo 8 se explora la brecha entre el currículo oficial y el currículo operativo del curso de pediatría de un programa de medicina, donde se discuten las implicaciones de la alineación curricular en su contexto. El capítulo 9 se enfoca en describir el diseño del currículo de una rotación de pediatría en el internado de un programa de medicina, desde la perspectiva experiencial. El capítulo 10 muestra un caso de diseño curricular basado en actividades profesionales encomendables en un posgrado médicoquirúrgico, específicamente de la rotación por la unidad de cuidados intensivos que realizan residentes de un programa de medicina interna. El capítulo 11 explora las brechas curriculares de las rotaciones por especialidades quirúrgicas en el pregrado de Medicina. Por último, en el capítulo 12 se analiza el currículo de la asignatura Clínica Quirúrgica de un programa de medicina con un enfoque en los contenidos de las normas de comportamiento dentro del quirófano usando como lente de análisis los currículos concurrentes.
Estudio de caso: diagnóstico comunicacional en el aula
Authors: Enríquez Ojeda Juan Fernando
Published: November 2024

En este capítulo se expone un ejercicio de diagnóstico comunicacional, dentro de una situación problemática puntual, llevado a cabo a través de una investigación con estudiantes de octavo semestre del programa de Medicina de la Universidad Cooperativa de Colombia, sede Pasto, durante su rotación por el servicio de quirófanos del Hospital San Pedro de la ciudad de Pasto, dentro de la asignatura Cirugía General y Especialidades Quirúrgicas.
Evaluando un sistema de evaluación programática en medicina interna
Authors: Enríquez Ojeda Juan Fernando , Palacios Ortega Esther Roxana , Jurado Sanabria Natallie
Published: November 2024

En este capítulo se exponen los resultados de la investigación desarrollada para develar un sistema de evaluación programática correspondiente a la rotación “consulta externa e interconsultas” del programa de posgrado en Medicina Interna de una universidad privada en Bogotá. Se llevó a cabo una investigación-acción aplicando tres métodos: una revisión documental del plan de trabajo elaborado por la universidad, la observación de la práctica clínica, apoyada en registros audiovisuales, y encuestas aplicadas a docentes y estudiantes del programa sobre su percepción del sistema de evaluación de la asignatura. Al final se realizó un análisis de los diferentes instrumentos de evaluación de la asignatura, tomando en cuenta criterios de calidad respaldados en evidencia científica, para formular una propuesta de intervención.
Microcurrículo en la unidad de cuidado intensivo
Authors: Arias Jiménez Juan Miguel , Pacheco Melo Carlos Andrés , Valencia Castañeda Olga Beatriz
Published: November 2024

Durante la rotación de los residentes de medicina interna por la unidad de cuidados intensivos (UCI) se emplean actividades de aprendizaje, dentro de las que se encuentran: ronda multidisciplinar, seminarios, presentación de casos clínicos y actividades de simulación, las cuales tienen como objetivo generar un nuevo conocimiento en los residentes. A su vez, se revisan la mayor cantidad de temas académicos posibles, proceso que se complementa con actividades prácticas en donde se brinda acompañamiento permanente al residente, lo que les permite a los docentes identificar en tiempo real las oportunidades de mejora y convierte esta rotación en un pilar fundamental dentro del acto médico del internista.
Diseño instruccional de los MEIP
Authors: Aguia-Rojas Karen , Forero-Nieto Sandra-Liliana , Espinosa-Aranzales Ángela-Fernanda
Published: November 2024

En el presente capítulo, se describe la construcción de cada uno de los niveles. El primero se enmarca en el lente epistemológico del funcionalismo estructural; el segundo, en la sociología del conflicto, y el tercer nivel, en una perspectiva pragmática. La evolución de los MEIP se aborda desde el modelo de diseño instruccional de Jerrold Kemp.
Code and Data Repository for Reproducible Feature Selection for High-Dimensional Measurement Error Models
Authors: Zhou Xin , Li Yang , Zheng Zemin , Wu Jie , Zhang Jiarui
Published: November 2024

This directory contains the code for the double projection knockoff filter (DP-knockoff) algorithm.
Inovação na Performance Musical Cantada na Escola de Música da UEMG
Authors: Peliccioni Sobreiro Andréa , Da Silva Solange Terezinha , Do Carmo Jonatha Maximiniano
Published: November 2024

Resumo
Este relato de experiência descreve o projeto de pesquisa “Adaptando canções de Edmundo Villani-Côrtes: uma proposta de performance musical cantada para Surdos e ouvintes”, financiado pelo Programa de Apoio à Projetos de Extensão da Escola de Música da UEMG. O objetivo foi adaptar quatro canções do compositor mineiro Edmundo Villani-Côrtes (1930) para um público de Surdos e ouvintes, promovendo a inclusão no contexto artístico. O projeto incluiu a construção e realização de uma performance no auditório da Escola de Música da UEMG, seguida pela gravação e compartilhamento em redes sociais para validação artística. Essa estratégia buscou expandir o alcance da iniciativa, promovendo acessibilidade para um público mais amplo, superando limitações físicas e geográficas.
O EMPODERAMENTO FEMININO, NA EDUCAÇÃO PÚBLICA, ATRAVÉS DE OFICINAS COM FOCO NA CULTURA MAKER
Authors: Oliveira de Souza Vânia , Duarte Caboclo Antolin Gisele , Antolin Mauricio Quelhas
Published: November 2024

A escola tem importante papel social na formação do indivíduo, por isso é essencial a inserção da convivência em diferentes coletividades e exercício da cidadania, preparando-o para ser um cidadão consciente e autônomo. Para isso, é importante despertar à conscientização coletiva com o objetivo de potencializar os vínculos sociais. Portanto, a temática do empoderamento feminino surge como uma forma de promover mudanças sociais no educando, contribuindo para o comprometimento com a luta pela igualdade de gênero e por uma sociedade mais justa e igualitária. Neste sentido, o objetivo do estudo é descrever as atividades realizadas sobre o empoderamento feminino aplicadas através de um projeto de extensão, com eixos temáticos que viabilizem a construção da identidade feminina e promova a reflexão sobre a desigualdade de gênero, contribuindo para uma educação pública de qualidade. A partir deste estudo, foi possível concluir que o desenvolvimento do projeto, na escola pública, através de oficinas pode contribuir para o empoderamento dos jovens educandos, através do estímulo a consciência crítica e a autonomia, promovendo uma reflexão e uma nova compreensão da realidade feminina no Brasil, o que pode contribuir para o processo de fortalecimento das mulheres e meninas, promovendo o combate à discriminação e a desigualdade de gênero.
Autism and the healthcare assistant: key issues
Authors: Barber Chris
Published: November 2024

This series of articles will explore the neurodivergent condition of autism from a range of different perspectives. This article, the eleventh and final one in the series, will summarise the key issues highlighted in the series and explore the next autistic decade.
Information allies: how librarians can support healthcare assistants
Authors: Tank Amy
Published: November 2024

In this article, the author discusses how healthcare assistants can use and work with libraries to support their own practice and professional development.
IMAGE SEGMENTATION OF ECTOPIC BONE FORMATION USING A DEEP CONVOLUTIONAL NETWORK: ANALYSIS PROTOCOL AND MATERIAL
Authors: Kjærgaard K. , Ding M. , Mansourvar M.
Published: November 2024

Introduction

Experimental bone research often generates large amounts of histology and histomorphometry data, and the analysis of these data can be time-consuming and trivial. Machine learning offers a viable alternative to manual analysis for measuring e.g. bone volume versus total volume.

The objective was to develop a neural network for image segmentation, and to assess the accuracy of this network when applied to ectopic bone formation samples compared to a ground truth.

Method

Thirteen tissue slides totaling 114 megapixels of ectopic bone formation were selected for model building. Slides were split into training, validation, and test data, with the test data reserved and only used for the final model assessment. We developed a neural network resembling U-Net that takes 512×512 pixel tiles. To improve model robustness, images were augmented online during training.

The network was trained for 3 days on a NVidia Tesla K80 provided by a free online learning platform against ground truth masks annotated by an experienced researcher.

Result

During training, the validation accuracy improved and stabilised at approx. 95%. The test accuracy was 96.1 %.

Conclusion

Most experiments using ectopic bone formation will yield an inter-observer or inter-method variance of far more than 5%, so the current approach may be a valid and feasible technique for automated image segmentation for large datasets. More data or a consensus-based ground truth may improve training stability and validation accuracy.

The code and data of this project are available upon request and will be available online as part of our publication.
SAME-DAY DISCHARGE TRENDS IN TOTAL HIP ARTHROPLASTY: A NATIONWIDE ANALYSIS OF 235,393 PATIENTS AND 25,388 SAME-DAY DISCHARGES
Authors: Bulut H. , Tomey D.
Published: November 2024

Introduction

The concept of same-day discharge has garnered increasing significance within orthopedic surgery, particularly in hip and knee procedures. Despite initial concerns surrounding the absence of prolonged hospital care, a burgeoning body of evidence highlights numerous advantages associated with same-day discharge, ranging from mitigating in-hospital infections to offering substantial financial and psychosocial benefits for both patients and healthcare providers. In this study, we aim to scrutinize the trends in same-day discharge specifically within the realm of total hip arthroplasties.

Method

This retrospective analysis delves into the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database spanning from 2017 to 2021. Leveraging patient data sourced from the ACS NSQIP database, we sought to elucidate patterns and shifts in same-day discharge practices pertaining to total hip arthroplasties.

Result

The preoperative analysis illuminated several notable disparities between patients undergoing same-day hip arthroplasty and those necessitating hospitalization. Notably, same-day hip patients skewed younger, comprising 48.3%females compared to 55.6% in hospitalized hip patients. Furthermore, a lower prevalence of medical comorbidities such as diabetes mellitus (8.5% vs.12.9%), current smoking (9.3% vs. 12.2%), and severe COPD(1.9% vs. 4.1%) was observed among same-day hip group. Operatively, same-day hip surgeries boasted shorter durations, averaging 83.9 minutes, in contrast to the 92.3minutes for hospitalized hip procedures. Postoperatively, same-day hip patients exhibited significantly diminished rates of 30-day readmissions (1.7%vs. 3.5%), procedure-related readmissions (1.0%vs.2.1%), reoperations (1.1%vs.1.9%), and mortality (0.02% vs. 0.04%). Moreover, the prevalence of the same-day discharge concept experienced a remarkable ascent from 2016 to 2021, with rates escalating from 1.5% to 25.6% of all total hip arthroplasties over a span of just six years.

Conclusion

In conclusion, same-day discharge is a feasible and safe option for selected THA patients.
THE PREOPERATIVE GAIT PATTERN IS ASSOCIATED WITH MIGRATION OF TOTAL KNEE ARTHROPLASTY: AN EXPLORATORY RADIOSTEREOMETRY STUDY WITH TWO YEARS’ FOLLOW-UP
Authors: Petersen E. T. , Linde K. N. , Burvil C. C. H. , Rytter S. , Koppens D. , Dalsgaard J. , Hansen T. B. , Stilling M.
Published: November 2024

Introduction

Knee osteoarthritis often causes malalignment and altering bone load. This malalignment is corrected during total knee arthroplasty surgery, balancing the ligaments. Nonetheless, preoperative gait patterns may influence postoperative prosthesis load and bone support. Thus, the purpose is to investigate the impact of preoperative gait patterns on postoperative femoral and tibial component migration in total knee arthroplasty.

Method

In a prospective cohort study, 66 patients with primary knee osteoarthritis undergoing cemented Persona total knee arthroplasty were assessed. Preoperative knee kinematics was analyzed through dynamic radiostereometry and motion capture, categorizing patients into four homogeneous gait patterns. The four subgroups were labeled as the flexion group (n=20), the abduction (valgus) group (n=17), the anterior drawer group (n=10), and the tibial external rotation group (n=19). The femoral and tibial component migration was measured using static radiostereometry taken supine on the postoperative day (baseline) and 3-, 12-, and 24- months after surgery. Migration was evaluated as maximum total point motion.

Result

Of the preoperatively defined four subgroups, the abduction group with a valgus-characterized gait pattern exhibited the highest migration for both the femoral (1.64 mm (CI95% 1.25; 2.03)) and tibial (1.21 mm (CI95% 0.89; 1.53)) components at 24-month follow-up. For the femoral components, the abduction group migrated 0.6 mm (CI95% 0.08; 1.12) more than the external rotation group at 24 months. For the tibial components, the abduction group migrated 0.43 mm (CI95% 0.16; 0.70) more than the external rotation group at 3 months. Furthermore, at 12- and 24-months follow-up the abduction group migrated 0.39 mm (95%CI 0.04; 0.73) and 0.45 mm (95%CI 0.01; 0.89) more than the flexion group, respectively.

Conclusion

A preoperative valgus-characterized gait pattern seems to increase femoral and tibial component migration until 2 years of follow-up. This suggests that the implant fixation depends on load distributions originating from specific preoperative gait patterns.
IS HUMAN HEIGHT BASED ON A LUCAS SEQUENCE RELATIONSHIP BETWEEN THE FOOT HEIGHT, TIBIAL LENGTH, FEMUR LENGTH, AND BODY LENGTH?
Authors: Robbins C. , Paley D. , Sutaria S. , Pinsky D. , Roberts D.
Published: November 2024

Introduction

Research studies have established mathematical correlations between the lengths of bone segments and the possible biomechanical implications of these correlations. The Lucas sequence comprises a series of integers that adhere to the same recurrence relation as the Fibonacci sequence; it differs in that it can start with any two initial integers. The purpose of this study is to determine whether segmental lengths of the foot height, tibia, femur, and upper body follow a Lucas sequence pattern.

Method

This was a retrospective radiographic review of patients who underwent full-body EOS scans. The AP scan was used to measure standing foot height (Ft), tibial length (T), femoral length (Fe), upper body length (UB), and full body length. A linear regression test was performed to determine whether a Lucas sequence-based relationship exists between Ft + T and Fe, and between T + Fe and UB.

Result

The regression for the relationship between Ft + T and Fe for the entire cohort (R= 0.82, R2= 0.70), the female subset (R= 0.94, R2= 0.88) and the male subset (R= 0.75, R2= 0.57), all demonstrated a strong positive correlation between Ft + T and Fe and showed that Ft + T is a likely predictor of Fe. The regression test for the entire cohort demonstrated a moderately positive correlation between T + Fe and UB (R= 0.41, R2= 0.17, F(1, 145) = 29.42, p= 2.4E-07). A stronger correlation was found for the relationship between T + Fe and UB (R= 0.57, R2= 0.32, F(1, 35) = 16.64, p= 2.5E-05) for the female subset relative to the male subset (R= 0.20, R2= 0.038, F(1, 35) = 4.37, p= 0.04).

Conclusion

This study demonstrates that total height is made up of sequential segments whose lengths approximate a Lucas series. The Fibonacci sequence is therefore once again implicated in human body proportions.
CHATBOTS IN LIMB LENGTHENING AND RECONSTRUCTION SURGERY
Authors: Bafor A. , Iobst C. , Francis K. T. , Strub D. , Kold S.
Published: November 2024

Introduction

The recent introduction of Chatbots has provided an interactive medium to answer patient questions. The accuracy of responses with these programs in limb lengthening and reconstruction surgery has not previously been determined. Therefore, the purpose of this study was to assess the accuracy of answers from 3 free AI chatbot platforms to 23 common questions regarding treatment for limb lengthening and reconstruction.

Method

We generated a list of 23 common questions asked by parents before their child's limb lengthening and reconstruction surgery. Each question was posed to three different AI chatbots (ChatGPT 3.5 [OpenAI], Google Bard, and Microsoft Copilot [Bing!]) by three different answer retrievers on separate computers between November 17 and November 18, 2023. Responses were only asked one time to each chatbot by each answer retriever. Nine answers (3 answer retrievers × 3 chatbots) were randomized and platform-blinded prior to rating by three orthopedic surgeons. The 4-point rating system reported by Mika et al. was used to grade all responses.

Result

ChatGPT had the best response accuracy score (RAS) with a mean score of 1.73 ± 0.88 across all three raters (range of means for all three raters – 1.62 – 1.81) and a median score of 2. The mean response accuracy scores for Google Bard and Microsoft Copilot were 2.32 ± 0.97 and 3.14 ± 0.82, respectively. This ranged from 2.10 – 2.48 and 2.86 – 3.54 for Google Bard and Microsoft Copilot, respectively. The differences between the mean RAS scores were statistically significant (p < 0.0001). The median scores for Google Bard and Microsoft Copilot were 2 and 3, respectively.

Conclusion

Using the Response Accuracy Score, the responses from ChatGPT were determined to be satisfactory, requiring minimal clarification, while the responses from Microsoft Copilot were either satisfactory, requiring moderate clarification, or unsatisfactory, requiring substantial clarification.
PRE- AND POSTOPERATIVE RESIDUAL URINE IN 796 MEN > 65 YEARS UNDERGOING ELECTIVE ORTHOPAEDIC SURGERY: A SINGLE-CENTRE, PROSPECTIVE COHORT STUDY
Authors: Gryet I. , Jensen C. G. , Pedersen A. R. , Skov S.
Published: November 2024

Introduction

Postvoid residualurine (PVR) can be an unknown chronic disorder, but it can also occur after surgery. A pilot-study initiated in Elective Surgery Center, Silkeborg led to collaboration with a urologist to develop a flowchart regarding treatment of PVR. Depending on the severity, men with significant PVR volumes were either recommend follow up by general practitioner or referred to an urologist for further diagnose and/or treatment. Aim: to determine the prevalence of pre- and postoperative PVR in men >65 years undergoing orthopedic surgeries and associated risk factors.

Method

A single-center, prospective cohort study. Male patients were consecutively included during one year from April 2022. Data was extracted from the electronic patient files: age, lower urinary tract symptoms (LUTS), co-morbidity (e.g. diabetes), type of surgery and anesthesia, opioid use, pre- and postoperative PVR.

Result

796 participants; 316 knee-, 276 hip-, 26 shoulder arthroplasties and 178 lower back spinal surgeries.

95% (755) were bladder scanned preoperatively.

12% (89) had PVR 150-300ml, and 3% (23) had PVR >300ml.

There was a higher risk of preoperative PVR ≥150ml in patients reporting LUTS, OR 1.97(1.28;3.03), having known neurological disease, OR 3.09(1.41;6.74), and the risk increased with higher age, OR 1.08 per year (1.04;1.12). Diabetes and the type of surgery was not associated with higher risk of PVR.

72% (569) had a postoperative bladder scan. 15% (95%CI: 12-19%) (70) patients without PVR preoperatively had PVR ≥150ml postoperatively.

Conclusion

Approximately 15% of the men had PVR ≥150ml preoperatively. Neurological disease was the most severe risk factor and secondary if reporting LUTS. As expected, the risk increased with age. Neither diabetes nor the type of surgery was associated with higher risk.

15% of men without preoperative PVR had PVR after surgery. It is not possible to conclude if it is transient or chronic but further studies are ongoing.
A SYSTEMATIC REVIEW OF STAPLES, TENSION-BAND PLATES, AND PERCUTANEOUS EPIPHYSIODESIS SCREWS FOR LEG-LENGTH DISCREPANCY (LLD) TREATMENT
Authors: Tirta M. , Hjorth M. H. , Jepsen J. F. , Kold S. , Rahbek O.
Published: November 2024

Introduction

Epiphysiodesis, defined as the process of closing the growth plate (physis), have been used for several years as a treatment option of cases where the predicted leg-length discrepancy (LLD) falls between 2 to 5 cm. The aim of this study was to systematically review the existing literature on the effectiveness of three different epiphysiodesis techniques with implant usage for the treatment of leg-length discrepancy in the pediatric population. The secondary aim was to address the reported complications of staples, tension-band plates (TBP) and percutaneous epiphysiodesis screws (PETS).

Method

This systematic review was performed according to PRISMA guidelines. We searched MEDLINE (PubMed), Embase, Cochrane Library, Web of Science and Scopus for studies on skeletally immature patients with LLD treated with epiphysiodesis with an implant. The extracted outcome categories were effectiveness of epiphysiodesis (LLD measurements pre/post-operatively, successful/unsuccessful) and complications that were graded on severity.

Result

Forty-four studies (2184 patients) were included, from whom 578 underwent TBP, 455 PETS and 1048 staples. From pooled analysis of the studies reporting success rate, 64% (150/234) successful TBP surgeries (10 studies), 78% (222/284) successful PETS (9 studies) and 52% (212/407) successful Blount staples (8 studies). Severe complications rate was 7% for PETS, 17% for TBP and 16% for Blount staples. TBP had 43 cases of angular deformity (10%), Blount staples 184 (17%) while PETS only 18 cases (4%).

Conclusion

Our results highlighted that PETS seems to be the most successful type of epiphysiodesis surgery with an implant, with higher success rate and lower severe complications than TBP or Blount staples.
AO SPINE GUIDELINE FOR THE USE OF OSTEOBIOLOGICS (AOGO) IN ANTERIOR CERVICAL DISCECTOMY AND FUSION FOR SPINAL DEGENERATIVE CASES
Authors: Meisel H. J. , Jain A. , Wu Yabin , Martin C. , Muthu S. , Hamouda W. , Rodrigues-Pinto R. , Arts J. J. , Vadalà G. , Ambrosio L.
Published: November 2024

Introduction

To develop an international guideline (AOGO) about use of osteobiologics in Anterior Cervical Discectomy and Fusion (ACDF) for treating degenerative spine conditions.

Method

The guideline development process was guided by AO Spine Knowledge Forum Degenerative (KF Degen) and followed the Guideline International Network McMaster Guideline Development Checklist. The process involved 73 participants with expertise in degenerative spine diseases and surgery from 22 countries. Fifteen systematic reviews were conducted addressing respective key topics and evidence were collected. The methodologist compiled the evidence into GRADE Evidence-to-Decision frameworks. Guideline panel members judged the outcomes and other criteria and made the final recommendations through consensus.

Result

Five conditional recommendations were created. A conditional recommendation is about the use of allograft, autograft or a cage with an osteobiologic in primary ACDF surgery. Other conditional recommendations are about use of osteobiologic for single or multi-level ACDF, and for hybrid construct surgery. It is suggested that surgeons use other osteobiologics rather than human bone morphogenetic protein-2 in common clinical situations. Surgeons are recommended to choose one graft over another or one osteobiologic over another primarily based on clinical situation, and the costs and availability of the materials.

Conclusion

This AOGO guideline is the first to provide recommendations for the use of osteobiologics in ACDF. Despite the comprehensive searches for evidence, there were few studies completed with small sample sizes and primarily as case series with inherent risks of bias. Therefore high quality clinical evidence is demanded to improve the guideline.
PATIENT EXPERIENCES OF SHARED DECISION-MAKING WHEN CHOOSING TREATMENT FOR THEIR DISTAL RADIUS FRACTURE: A QUALITATIVE STUDY
Authors: Nøhr L. M. , Simony A. , Abrahamsen C.
Published: November 2024

Introduction

Shared decision making (SDM) was introduced in hospital Lillebelt in 2019 and research reports that patients are more satisfied with their treatment, if they play an active role in choosing treatment. A Decision-Helper was constructed and introduced in the treatment for Colles fractures. This study aimed to understand how patients experience shared decision-making (SDM) for an acute illness, and how it affects them when making decisions about the treatment of their distal radius fracture.

Method

An exploratory, qualitative study design was performed to understand the patient's experience, during the choice of treatment with SDM. 12 were recruited when they came to their first follow-up 5 days after the injury, in the outpatient clinic. 10 were interviewed; 3 face to face and 7 by telephone. All women aged 57-87 years and all had a displaced Colles fracture, which had been reduced in the Emergency Room.

Result

Analyzing the interviews three themes emerged: 1) Acute situation. Patients was positive towards SDM, but found it demanding to participate in. Patients was still in crisis, 5 days after suffering from a fracture. Patients were unable to remember the information given in the ER, regarding the use of the Decision helper. Few had prepared themselves for the consult in the outpatient clinic. 2) Influence on treatment choice. It was unclear to the majority of patients, that cast or surgery, resulted in similar clinical outcomes. 3) The treatment decision was based on personal factors, more than the information received during the consult.

Conclusion

Patients wants to be included in the treatment decision. It is important to highlight that booth treatments are equal in clinical outcome, before introducing the Decision-Helper. The doctor´s demeanor is of great importance to the patient's experience. Introducing SDM in the clinical setting requires training and repeated observations, to succeed.
PREHABILITATION FOR FRAIL PATIENTS UNDERGOING HIP AND KNEE ARTHROPLASTY: JOINT PREP FEASIBILITY STUDY FOR A RANDOMIZED CONTROLLED TRIAL
Authors: Khalid T. , Shlomo Y. B. , Bertram W. , Culliford L. , enderson E. , Jepson M. , Johnson E. , Palmer S. , Whitehouse M. , Wylde V.
Published: November 2024

Introduction

Approximately 20-25% of patients having joint replacement in the UK have moderate-severe frailty. Frailty is associated with poorer outcomes after joint replacement. Targeting frailty pre-operatively with exercise and protein supplementation could improve post-operative outcomes. Prior to conducting a randomised controlled trial (RCT), a feasibility study was necessary to inform trial design and delivery.

Method

We conducted a randomised feasibility study with embedded qualitative work. Patients aged ≥65 years, frail and undergoing THR or TKR were recruited from three UK hospitals. Participants were randomly allocated on a 1:1 ratio to the intervention or usual care group. The intervention group had a 1:1 appointment with a physiotherapist and were provided with a home-based, tailored daily exercise programme and a daily protein supplement for 12 weeks before their operation, supported by six telephone calls from a physiotherapist. Questionnaires were administered at baseline and 12 weeks after randomisation. Interviews were conducted with 19 patients. Feasibility outcomes were eligibility and recruitment rates, intervention adherence, and acceptability of the trial and the intervention.

Result

411 patients were sent a screening pack. Of the 168 patients who returned a screening questionnaire, 79 were eligible and consented to participate, and 64 were randomised. Of the 33 participants randomised to the intervention, 26 attended the intervention appointment. Eighteen participants (69%) received all six intervention follow-up telephone calls. Nineteen participants completed an intervention adherence log; 13 (68%) adhered to the exercise programme and 11 (58%) adhered to the protein supplementation. The overall retention rate was 86% at 12 weeks. The 12-week follow-up questionnaire was returned by 84% of participants who were sent a questionnaire. Interviews found that the trial and intervention were generally acceptable, but areas of potential improvements were identified.

Conclusion

This study demonstrated that a larger study is possible and has identified improvements to optimise the design of a RCT.
COMPARISON OF THE GLENOID INDEX BY COMPUTED TOMOGRAPHY WITH MAGNETIC RESONANCE IMAGING
Authors: Ahmed N. A. , Narendran K. , Ahmed N. A.
Published: November 2024

Introduction

Anterior shoulder instability results in labral and osseous glenoid injuries. With a large osseous defect, there is a risk of recurrent dislocation of the joint, and therefore the patient must undergo surgical correction. An MRI evaluation of the patient helps to assess the soft tissue injury. Currently, the volumetric three-dimensional (3D) reconstructed CT image is the standard for measuring glenoid bone loss and the glenoid index. However, it has the disadvantage of exposing the patient to radiation and additional expenses. This study aims to compare the values of the glenoid index using MRI and CT.

Method

The present study was a two-year cross-sectional study of patients with shoulder pain, trauma, and dislocation in a tertiary hospital in Karnataka. The sagittal proton density (PD) section of the glenoid and enface 3D reconstructed images of the scapula were used to calculate glenoid bone loss and the glenoid index. The baseline data were analyzed using descriptive statistics, and the Chi-square test was used to test the association of various complications with selected variables of interest.

Result

The glenoid index calculated in the current study using 3D volumetric CT images and MR sagittal PD images was 0.95±0.01 and 0.95±0.01, respectively. The CT and MRI glenoid bone loss was 5.41±0.65% and 5.38±0.65%, respectively. When compared, the glenoid index and bone loss calculated by MRI and CT revealed a high correlation and significance with a p-value of <0.001.

Conclusions

The study concluded that MRI is a reliable method for glenoid measurement. The sagittal PD sequence combined with an enface glenoid makes it possible to identify osseous defects linked to glenohumeral joint damage and dislocation. The values derived from 3D CT are identical to the glenoid index and bone loss determined using the sagittal PD sequence in MRI.
BIOPRINTED LIVING TISSUE CONSTRUCTS WITH LAYER-SPECIFIC, GROWTH FACTOR-LOADED MICROSPHERES FOR IMPROVED ENTHESIS HEALING OF A ROTATOR CUFF ABSTRACT
Authors: Bai L. , Yin Z.
Published: November 2024

Introduction

The healing of rotator cuff injuries poses significant challenges, primarily due to the complexity of recreating the native tendon-to-bone interface, characterized by highly organized structural and compositional gradients. Addressing this, our innovative approach leverages bioprinted living tissue constructs, incorporating layer-specific growth factors (GFs) to facilitate enthesis regeneration. This method aims to guide in situ zonal differentiation of stem cells, closely mirroring the natural enthesis tissue architecture.

Method

Our strategy involves the utilization of advanced bioprinting technology to fabricate living tissue constructs. These constructs are meticulously designed with embedded microsphere-based delivery carriers, ensuring the sustained release of tenogenic, chondrogenic, and osteogenic growth factors. This layer-specific release mechanism is tailored to promote the precise differentiation of stem cells across different regions of the construct, aligning with the gradient nature of enthesis tissues.

Result

In vitro studies demonstrated that our layer-specific tissue constructs significantly outperformed basal constructs without GFs, achieving region-specific differentiation of stem cells. More critically, in a rabbit model of rotator cuff tear, these bioprinted living tissue constructs expedited enthesis regeneration. Key outcomes included improved biomechanical properties, enhanced collagen deposition and alignment, and the formation of a gradient fibrocartilage interface with aligned collagen fibrils. After 12 weeks, the constructs achieved an ultimate load failure of 154.3 ± 9.5 N resembling that of native enthesis tissues, marking a notable achievement in tissue engineering.

Conclusion

Our exploration introduces a viable and innovative strategy for engineering living tissue constructs that exhibit region-specific differentiation capabilities. This approach holds significant promise for the functional repair of gradient enthesis tissues, potentially revolutionizing the treatment of rotator cuff injuries by closely replicating the natural tendon-to-bone interface, thus offering a promising avenue for future clinical applications.