bluuebunny/crossref_metadata_2025 huggingface dataset:
Increased Complication and Hardware Removal Rates Associated with Headed Screws in Subtalar and Ankle Arthrodeses
Authors: Bailey Evan , Hoch Caroline P. , Goodloe Jonathan B. , Scott Daniel J. , Gross Christopher E.
Published: November 2022

Category:

Ankle; Other

Introduction/Purpose:

With a reported screw removal rate of 9-47% following subtalar (ST) or ankle arthrodesis, an added economic and surgical burden is imposed on both the patients and the healthcare system. The purpose of this study is to determine if there are any clinical or patient-reported outcome differences between headless, variable-pitched screws and headed screws in ST or ankle arthrodesis.

Methods:

A retrospective chart review identified 120 patients (128 feet) who underwent ST (n=98) or ankle (n=30) arthrodesis with a single fellowship-trained foot and ankle surgeon at a single academic medical center between December 2015 and December 2020. These patients passed the criteria of excluding those who underwent both arthrodeses simultaneously (i.e., tibiotalocalcaneal arthrodesis) and did not have at least three months of follow-up or postoperative X-rays in their medical record. Overall, 71 procedures used headless screws and 57 used headed screws.

Results:

There was no difference in any treatment duration or postoperative patient-reported outcome measure between groups. However, there was a significant difference between groups among rates of nonunion (headless=19.7%, headed=35.1%;p=.050), overall complication (headless=33.8%, headed=54.4%; p=.019), reoperation (headless=11.3%, headed=33.3%; p=.002), and hardware removal (headless=4.2%, headed=29.8%; p<.001). There were also significantly more screw issues (i.e., broken, displacement, impingement) with headed screws (headless=0.0%, headed=5.3%; p=.050). Furthermore, of the eight patients who underwent two arthrodeses, headed screws were removed six (37.5%) times, with half attributable to nonunion, whereas headless screws were never removed.

Conclusion:

The use of headed screws in ST or ankle arthrodesis is associated with significantly higher rates of complication and hardware removal, as compared to headless screws. These results suggest headless, variable-pitched screw fixation for ST and ankle arthrodesis procedures may offer improved outcomes, although further studies should be conducted to confirm this.
Applying CRISPR-Cas9 screens to dissect hematological malignancies
Authors: Iyer Deepak Narayanan , Schimmer Aaron D. , Chang Hong
Published: November 2022

Bit by bit, over the last few decades, functional genomic tools have been piecing together the molecular puzzle driving tumorigenesis in human patients. Nevertheless, our understanding of the role of several genes and regulatory elements that drive critical cancer-associated physiological processes from disease development to progression to spread is very limited, which significantly affects our ability of applying these insights in the context of improved disease management. The recent advent of clustered regularly interspaced short palindromic repeats (CRISPR)-CRISPR-associated protein 9 (Cas9)–based technology and its application in cancer genomics has, however, allowed the generation of a wealth of knowledge that has helped decipher several critical questions associated with translational cancer research. Precisely, the high-throughput capability coupled with a high level of technological plasticity associated with the CRISPR-Cas9 screens have expanded our horizons from a mere struggle to appreciate cancer as a genetic disease to observing the integrated genomic/epigenomic network of numerous malignancies and correlating it with our present knowledge of drugging strategies to develop innovative approaches for next-generation precision cancer medicine. Specifically, within blood cancers, current CRISPR screens have specifically focused on improving our understanding of drug resistance mechanisms, disease biology, the development of novel therapeutic approaches, and identifying the molecular mechanisms of current therapies, with an underlying aim of improving disease outcomes. Here, we review the development of the CRISPR-Cas9 genome-editing strategy, explicitly focusing on the recent advances in the CRISPR-Cas9–based screening approaches, its current capabilities, limitations, and future applications in the context of hematological malignancies.
Early selexipag initiation and long-term outcomes: insights from randomised controlled trials in pulmonary arterial hypertension
Authors: Coghlan J. Gerry , Gaine Sean , Channick Richard , Chin Kelly M. , du Roure Camille , Gibbs J. Simon R. , Hoeper Marius M. , Lang Irene M. , Mathai Stephen C. , McLaughlin Vallerie V. , Mitchell Lada , Simonneau Gérald , Sitbon Olivier , Tapson Victor F. , Galiè Nazzareno
Published: November 2022

Further understanding of when to initiate therapies in pulmonary arterial hypertension (PAH) is important to improve long-term outcomes.Post hocanalyses of GRIPHON (NCT01106014) and exploratory analyses of TRITON (NCT02558231) suggested benefit of early selexipag initiation on long-term outcomes, despite no additional benefitversusinitial double combination on haemodynamic and functional parameters in TRITON.Post hocanalyses investigated the effect of early selexipag initiation on disease progression and survival in a large, pooled PAH cohort. Data from newly diagnosed (≤6 months) PAH patients from GRIPHON and TRITON were pooled. Patients on active therapy with selexipag (pooled selexipag group) were compared with those on control therapy with placebo (pooled control group). Disease progression end-points were defined as per the individual studies. Hazard ratios (HR) and 95% CI for time to first disease progression event up to end of double-blind treatment (selexipag/placebo) +7 days and time to all-cause death up to end of study were estimated using Cox regression models. The pooled dataset comprised 649 patients, with 44% on double background therapy. Selexipag reduced the risk of disease progression by 52%versuscontrol (HR: 0.48; 95% CI: 0.35–0.66). HR for risk of all-cause death was 0.70 (95% CI: 0.46–1.10) for the pooled selexipagversuscontrol group. Sensitivity analyses accounting for the impact of PAH background therapy showed consistent results, confirming the appropriateness of data pooling. Thesepost hoc, pooled analyses build on previous insights, further supporting selexipag use within 6 months of diagnosis, including as part of triple therapy, to delay disease progression.
Positive selection-driven fixation of a hominin-specific amino acid mutation related to dephosphorylation in IRF9
Authors: Chen Jianhai , He Xuefei , Jakovlić Ivan
Published: November 2022

The arms race between humans and pathogens drives the evolution of the human genome. It is thus expected that genes from the interferon-regulatory factors family (IRFs), a critical family for anti-viral immune response, should be undergoing episodes of positive selection. Herein, we tested this hypothesis and found multiple lines of evidence for positive selection on the amino acid site Val129 (NP_006075.3:p.Ser129Val) of human IRF9. Interestingly, the ancestral reconstruction and population distribution analyses revealed that the ancestral state (Ser129) is conserved among mammals, while the derived positively selected state (Val129) was fixed before the “out-of-Africa” event ~ 500,000 years ago. The motif analysis revealed that this young amino acid (Val129) may serve as a dephosphorylation site of IRF9. Structural parallelism between homologous genes further suggested the functional effects underlying the dephosphorylation that may affect the immune activity of IRF9. This study provides a model in which a strong positive Darwinian selection drives a recent fixation of a hominin-specific amino acid leading to molecular adaptation involving dephosphorylation in an immune-responsive gene.
Exogenous ABA and IAA modulate physiological and hormonal adaptation strategies in Cleistocalyx operculatus and Syzygium jambos under long-term waterlogging conditions
Authors: Cisse El-Hadji Malick , Zhang Juan , Li Da-Dong , Miao Ling-Feng , Yin Li-Yan , Yang Fan
Published: November 2022

Background

The mechanisms of abscisic acid (ABA) and auxin (IAA) in inducing adventitious root (AR) formation, biomass accumulation, and plant development under long-term waterlogging (LT-WL) conditions are largely unexplored. This study aimed to determine the roles of exogenous application of ABA and IAA in two woody plants (Cleistocalyx operculatus and Syzygium jambos) under LT-WL conditions. A pot experiment was conducted using a complete randomized design with two factors: (i) LT-WL and (ii) application of exogenous phytohormones (ABA and IAA) for 120 d.

Results

Results revealed that exogenous ABA and IAA promoted LT-WL tolerance in both species. In C. operculatus and S. jambos, plant height, the number of blades, leaf area, and fresh shoot weight were increased by exogenous IAA under LT-WL. However, exogenous ABA affected more the adventitious and primary root in C. operculatus compared to S. jambos. LT-WL decreased drastically the photosynthetic activities in both species, but adding moderate amounts of exogenous ABA or IAA protected the photosynthesis apparatus under LT-WL. Exogenous phytohormones at certain levels decreased the superoxide anion level and malondialdehyde accumulation in plants under LT-WL. Also, the increase of the peroxidases and superoxide dismutase activities by exogenous phytohormones was more marked in C. operculatus compared to S. jambos. Meanwhile, the catalase activity was down-regulated in both species by exogenous phytohormones. Exogenous ABA or IAA positively regulated the jasmonic acid content in ARs under LT-WL. Moderate application of exogenous ABA or IAA in plants under LT-WL decreased the ABA content in the leaves. Lower accumulation of IAA and ABA in the leaves of C. operculatus under LT-WL was positively correlated with a decrease in antioxidant activity.

Conclusions

Lastly, C. operculatus which has greater morphology indexes was more tolerant to waterlogging than S. jambos. Moreover, the adaptive strategies via exogenous ABA were more built around the below-ground biomass indexes particularly in C. operculatus, while exogenous IAA backed the above-ground biomass in both species. Overall, the exogenous hormones applied (spraying or watering) influenced differentially the plant’s responses to LT-WL. The phytohormonal profile of plants exposed to waterlogging stress varied depending on the species’ tolerance level.
Association between serum liver enzymes and hypertension using propensity score matching analysis: evidence from a large kurdish prospective cohort study
Authors: Fard Mina Tahmasebi , Najafi Farid , Rezaeian Shahab , Kohsari Maryam , Moradinazar Mehdi
Published: November 2022

Background

The association between liver enzymes and hypertension (HTN) has been reported in some studies and the findings are inconsistent. This study was conducted to evaluate the association of liver enzymes with HTN among the Iranian Kurdish population.

Methods

This prospective cohort study was a part of the 5-years (2017–2021) follow-up phase of the Ravansar Non-Communicable Disease (RaNCD) cohort study in Kermanshah province, western Iran.The association between alanine aminotransferase (ALT), aspartate aminotransferase (AST), gamma-glut amyl transferase (GGT), and alkaline phosphatase (ALP) and HTN was investigated by Cox proportional-hazard model (CPHM). We used one-to-one Propensity score matching (PSM) analysis to minimize the effects of confounding factors on the relationship between liver enzymes and HTN .

Results

The full population included a total of 8267 participants. According to PSM, for liver enzyme GGT a total of 3664 participants were analyzed. The results of multivariate CPHM showed there is a relationship between participants with high level of GGT and had a higher risk of HTN (HR 1.34; 95% CI: 1.11–1.63). After PSM analysis, the effect of GGT on HTN remained positive and significant (HR 1.48; 95% CI: 1.22–1.78). The 5-years incidence rate of HTN in men and women were 1.27 and 0.81 (person-year), respectively.GGT had the greatest accuracy, which demonstrated an AUROC of 0.7837.

Conclusion

Results of this study showed GGT could be a potential biomarker among liver enzymes for early detection of HTN. Therefore, monitoring GGT levels is helpful in the early detection of HTN.
The predictive effect of direct-indirect bilirubin ratio on clinical events in acute coronary syndrome: results from an observational cohort study in north China
Authors: Li Jiayu , Xin Yanguo , Li Jingye , Meng Meng , Zhou Li , Qiu Hui , Chen Hui , Li Hongwei
Published: November 2022

Background:

Patients with extremely high-risk ASCVD usually suffered poor prognosis, bilirubin is considered closely related to cardiovascular outcomes. However, there is controversy over the relationship between bilirubin and coronary artery disease. This study aimed to evaluate the predictive value of the DIBIL ratio in patients with extremely high-risk ASCVD.

Methods:

10,260 consecutive patients with extremely high-risk ASCVD were enrolled in this study. All patients were divided into three groups according to their DIBIL ratio. The incidence of MACCEs was recorded, and in a competing risk regression, the incidence of MACCEs and their subgroups were recorded. The direct-indirect bilirubin ratio (DIBIL ratio) was calculated by the direct bilirubin (umol/L)/indirect bilirubin (umol/L) ratio, all laboratory values were obtained from the first fasting blood samples during hospitalization.

Results:

The area under the ROC curve of the DIBIL ratio to predict the occurrence of all-cause death was 0.668, the cut-off value of which is 0.275. Competing risk regression indicated that DIBIL ratio was positively correlated with all-cause death [1.829 (1.405–2.381), p < 0.001], CV death [1.600 (1.103, 2.321), p = 0.013]. The addition of DIBIL ratio to a baseline risk model had an incremental effect on the predictive value for all-cause death [IDI 0.004(0, 0.010), p < 0.001; C-index 0.805(0.783–0.827), p < 0.001].

Conclusion:

The DIBIL ratio was an excellent tool to predict poor prognosis, suggesting that this index may be developed as a biomarker for risk stratification and prognosis in extremely ASCVD patients.
Evaluation of index of cardiac-electrophysiological balance in patients with subarachnoid hemorrhage
Authors: Yücetas Seyho Cem , Kaya Hakan , Kafadar Safiye , Kafadar Huseyin , Tibilli Hakan , Akcay Ahmet
Published: November 2022

Background

Various electrocardiographic (ECG) changes occur after subarachnoid hemorrhage (SAH). Prolonged QT and corrected QT (QTc) intervals are notable changes. QT, QTc, T peak-to-end T(p-e) intervals, and Tp-e/QTc ratio are used as ventricular arrhythmia indices. In recent publications, the cardiac electrophysiological balance index (ICEB), which provides more information than other ECG parameters (QT, QTc, etc.), is recommended in predicting the risk of ventricular arrhythmia. This study aims to assess ICEB in aneurysmal SAH patients.

Methods

The study included 50 patients diagnosed with aneurysmal SAH and 50 patients diagnosed with hypertension without end-organ damage as the control group. All patients’ Fisher scores and Glasgow Coma Scale (GCS) scores were recorded. Both groups were given 12-lead ECGs. QT, QTc, Tp-e intervals, QRS duration, ICEB (QT/QRS), ICEBc (QTc/QRS), and T(p-e)/QTc values were calculated and analyzed between groups.

Results

Compared to the control group; QT (426,64 ± 14,62 vs. 348,84 ± 12,24 ms, p < 0,001), QTc (456,24 ± 28,84 vs. 392,48 ± 14,36 ms, p < 0,001), Tp-e (84,32 ± 3,46 vs. 70,12 ± 3,12, p < 0,001), Tp-e/QTc (0,185 ± 0,08 vs. 0,178 ± 0,02, p < 0,001), ICEB (4,53 ± 0,78 vs. 3,74 ± 0,28, p < 0,001) and ICEBc (4,86 ± 0,86 vs. 4,21 ± 0,24, p < 0,001) were significantly higher in patients with aneurysmal SAH. QT, QTc and Tp-e interval, Tp-e/QTc ratio, ICEB (QT/QRS) and ICEBc (QTc/QRS) were positively correlated with the Fisher score and were negatively correlated with the GCS. According to linear regression analyses, the ICEBc (QTc/QRS) found to be independently associated with the Fisher score.

Conclusion

The values of the ICEB and ICEBc were significantly increased in patients with aneurysmal SAH. The severity of SAH was positively correlated with the ICEB and ICEBc. The ICEBc (QTc/QRS) independently associated with the Fisher score. This may that SAH suggest may predispose to malignant ventricular arrhythmias.
An integrated skin cancer education program in renal transplant recipients and patients with glomerular disease
Authors: Thet Zaw , Lam Alfred King-yin , Ng Shu-Kay , Aung Soe Yu , Han Thin , Ranganathan Dwarakanathan , Newsham Stephanie , Borg Jennifer , Pepito Christine , Khoo Tien K.
Published: November 2022

Sun-protective strategies focusing on skin cancer awareness are needed in immunosuppressed patients at risk of skin cancers. The study aims to determine the effect of an integrated skin cancer education program on skin cancer awareness and sun-protective behaviours in renal transplant recipients (RTRs) and patients with glomerular disease (GD) treated with long-term immunosuppressants. A pilot prospective cohort study in Central Queensland, Australia was undertaken among adult RTRs and patients with GD, who completed survey questionaries on skin cancer and sun-health knowledge (SCSK), sun-protection practices and skin examination pre- and post-education. Fifty patients (25 RTRs, 25 patients with GD) participated in the study. All of them completed questionnaires at pre-, 3-month post-education and 92%(n = 46) at 6-month post-education. There was a significant increase in SCSK scores from baseline at 3-months (p < 0.001) and 6-months post-intervention (p < 0.01). Improved knowledge was retained for 6 months after education. There were changes in 2 of 8 photoprotective behaviours at 6 months. Interventional education enhanced regular self-skin examination rate (p < 0.001) as well as the frequency of full skin checks by general practitioners (GPs) (p < 0.001). Overall, RTRs had better compliance with sun-protective methods and higher skin examination rates by themselves and/ or GPs before and after the intervention of education compared to patients with GD. To conclude, an integrated skin cancer education program improved knowledge of skin cancer and skin health as well as the frequency of self-skin examination and formal skin assessments. However, improvement in patient compliance did not extend to other sun-protective practices.
Effects of deficient mismatch repair on the prognosis of patients with stage II and stage III colon cancer during different postoperative periods
Authors: Zhang Chunze , Zhan Yixiang , Ni Kemin , Liu Zhaoce , Xin Ran , Han Qiurong , Li Guoxun , Ping Hangyu , Liu Yaohong , Zhao Xuanzhu , Wang Wanting , Yan Suying , Sun Jing , Zhang Qinghuai , Wang Guihua , Zhang Zili , Zhang Xipeng , Hu Xia
Published: November 2022

Background

We evaluated the prognostic role of deficient mismatch repair (dMMR) systems in stage II and stage III colon cancer patients during different postoperative periods. We also assessed whether patients aged ≥75 could benefit from chemotherapy.

Methods

This retrospective study was conducted across three medical centers in China. Kaplan–Meier survival methods and Cox proportional hazards models were used to evaluate the differences in overall survival (OS) and disease-free survival (DFS) rates. Propensity score matching was performed to reduce imbalances in the baseline characteristics of the patients. Landmark analysis was performed to evaluate the role of dMMR during different postoperative periods.

Results

The median follow-up time for all patients was 45.0 months (25–75 IQR: 38.0–82.5). There was no significant OS (p = 0.350) or DFS (p = 0.752) benefit associated with dMMR for stage II and III patients during the first postoperative year. However, significant OS (p < 0.001) and DFS (p < 0.001) benefits were observed from the second postoperative year until the end of follow-up. These differences remained after propensity score matching. Moreover, chemotherapy produced no OS (HR = 0.761, 95% CI: 0.43–1.34,p = 0.341) or DFS (HR = 0.98, 95% CI: 0.51–1.88,p = 0.961) benefit for patients aged ≥75 years.

Conclusion

The benefits of dMMR in stage III patients were observed from the second postoperative year until the end of follow-up. However, the prognosis of patients with dMMR is not different from that of patients with proficient mismatch repair (pMMR) during the first postoperative year. In addition, elderly patients aged ≥75 years obtained no significant survival benefits from postoperative chemotherapy.
Early outcomes of anterior segment parameters after implantable collamer lens V4c implantation
Authors: Lin Qinghong , Yang Dong , Zhou Xingtao
Published: November 2022

Background

This study investigated the early outcomes of anterior segment parameters after implanting an implantable collamer lens with a central hole (ICL V4c) in patients with myopia and determined the earliest follow-up time for detecting potential complications.

Methods

Sixty-two patients were included, and the following parameters were measured at baseline (preoperative), 1 day, 1 week, and 1, 3, and 6 months after the operation: intraocular pressure (IOP), endothelial cell density (ECD), central anterior chamber depth (CACD), anterior chamber volume (ACV), nasal and temporal anterior chamber angle (n-ACA and t-ACA), horizontal corneal diameter (white-to-white, WTW), and axial length (AL). The vault was measured at each post-operative timepoint.

Results

The postoperative IOP and ECD at the 6 months were both statistically similar to the baseline. The post-operative CACD and ACV were significantly less at all timepoints compared with the baseline (P < 0.001) and stayed stable from 1 day and 1 month after the operation, respectively. Postoperative n-ACA and t-ACA decreased significantly at 1 day and 1 week compared with the baseline (P < 0.001), while tended to stabilization at 1, 3, and 6 months. The vault kept decreasing significantly at 1 day, 1 week, and 1 month, but stayed stable at 3 and 6 months. The postoperative n-ACA and t-ACA positively correlated with the baseline ACA, CACD, and ACV.

Conclusions

The anterior chamber parameters tended to stabilization early after the operation. Thus, it is essential to evaluate patients’ anterior segment status at earlier timepoints and prevent complications with prompt and non-invasive intervention.
Clinical significance of serum and vitreous soluble interleukin-2 receptor in patients with intraocular lymphoma
Authors: Suzuki Kayo , Namba Kenichi , Kase Satoru , Ogino Yo , Hase Keitaro , Iwata Daiju , Mizuuchi Kazuomi , Hiraoka Miki , Kitaichi Nobuyoshi , Ishida Susumu
Published: November 2022

Background

Intraocular lymphoma (IOL) is a masquerade syndrome that mimics uveitis, making diagnosis difficult. The serum soluble interleukin-2 receptor (sIL-2R), which is cleaved by matrix metalloproteinase (MMP) -2 and MMP-9, has been recognized as a tumor-related biomarker of malignant lymphomas. The aim of this study was to review the reliability of serum and vitreous sIL-2R for distinguishing IOL from uveitis.

Methods

Patients who underwent diagnostic vitrectomy for marked vitreous haze at Hokkaido University Hospital between April 2014 and June 2019 were enrolled. The patients were divided into an IOL group and a uveitis group, according to the pathology of their vitreous samples. The IOL group was further divided at the time of vitrectomy into patients who already had extraocular involvement (IOL with extraocular involvement group) and patients with no evidence of having extraocular involvement (IOL without extraocular involvement group). Serum sIL-2R, and intravitreal sIL-2R, MMP-2, and MMP-9 levels were assessed.

Results

Twenty-five eyes of 25 patients, and 15 eyes of 15 patients were included in the IOL group and uveitis group, respectively. The serum sIL-2R levels were significantly lower in the IOL group than in the uveitis group (P < 0.05), and 20.0% and 66.7% in the IOL and the uveitis group showed high sIL-2R value above the normal range. Vitreous sIL-2R tended to be higher in the IOL group than in the uveitis group (P = 0.80). Serum sIL-2R was significantly lower in the IOL without extraocular involvement group than in the IOL with extraocular involvement group (P < 0.05); 5.9% in the IOL without extraocular involvement group and 50.0% in the IOL with extraocular involvement group showed high sIL-2R value above the normal range. Vitreous sIL-2R, MMP-2, and MMP-9 tended to be higher in the IOL with extraocular involvement group than in the IOL without extraocular involvement group (P = 0.30, < 0.05, 0.16).

Conclusions

Serum sIL-2R is often within the normal range in IOL patients. Even if it is within the normal range, the possibility of IOL should be considered. Serum sIL-2R is not a reliable biomarker for IOL, whereas vitreous sIL-2R may be useful for the diagnosis of IOL.
Characteristics of paediatric foot arches according to body mass among primary school students in Wrocław, Poland
Authors: Górna Sara , Pazdro-Zastawny Katarzyna , Basiak-Rasała Alicja , Kolator Mateusz , Krajewska Joanna , Zatoński Tomasz
Published: November 2022

Background

The purpose of this study, conducted within the framework of the project entitled ‘Let’s get the kids moving’, was to determine the associations between children’s longitudinal and transverse foot arch and their weight, gender and age.

Method

The pro-health initiative ‘Let’s get the kids moving’ was created by researchers of the Medical University and the Run for Health Foundation. A total of 655 children (51.5% boys) aged 7 to 10 years from primary schools in south-western Poland participated in the study. The mean age of the subjects was 8.7 ± 0.8 years. In all the children, we assessed anthropometric measurements (weight and height) and the longitudinal and transverse arch of the foot under the load of their weight. A two-dimensional foot scanner (Sensor Medica, Italy) was used to examine the plantar part of the children’s feet.

Results

The data collected from the 655 subjects revealed that excessive weight predisposed them to less longitudinal and transverse arching. The foot shape was not differentiated by gender or age.

Conclusions

Screening school-aged children’s footprints can detect abnormalities in the shape of children’s feet early on, which allows for early diagnosis of functional or structural flatfoot in children.
Mid-upper arm circumference as a substitute for body mass index in the assessment of nutritional status among adults in eastern Sudan
Authors: Musa Imad R. , Omar Saeed M. , Adam Ishag
Published: November 2022

Background

Body mass index (BMI) remains the most used indicator of nutritional status despite the presence of a potentially credible alternative. Mid-upper arm circumference (MUAC) is an anthropometric measure that requires simple equipment and minimal training. The aim of this study was to compare MUAC with BMI and propose a MUAC cut-off point corresponding to a BMI of < 18.5 kg/m2 (underweight) and ≥ 30.0 kg/m2 (obesity) among Sudanese adults.

Methods

A cross-sectional study using multistage cluster sampling was conducted in New-Halfa, eastern Sudan. Participants’ age and sex were recorded and their MUAC, weight and height were measured using the standard procedures. The MUAC (cm) cut-offs corresponding to < 18.5 kg/m2 and ≥ 30.0 kg/m2 were calculated and determined using receiver operating characteristic (ROC) curve analysis

Results

Five hundreds and fifty-two adults were enrolled in the study. The median (interquartile range, IQR) of the participants age was 31.0 (24.0 ̶ 40.0) years and 331 (60.0%) of them were females. The medians (IQR) of BMI and MUAC were 22.4 (19.1 ̶ 26.3) kg/m2 and 25.0 (23.0 ̶ 28.0) cm, respectively.

There was a significant positive correlation between MUAC and BMI (r = 0.673, p < 0.001).

Of the 552 enrolled participants, 104 (18.8%), 282 (51.1%), 89 (16.1%) and 77 (13.9%) were normal weight, underweight, overweight and obese, respectively. Best statistically derived MUAC cut-off corresponding to a BMI < 18.5 kg/m2 (underweight) was ≤ 25.5 cm in both males and females (Youden’s Index, YI = 0.51; sensitivity = 96.0%; specificity = 54.0%), with a good predictive value (AUROCC = 0.82). Best statistically derived MUAC cut-off corresponding to a BMI ≥ 30.0 kg/m2 (obesity) was ≥ 29.5 cm in both males and females (YI = 0.62, sensitivity = 70.3%, specificity = 92.0%), with a good predictive value (AUROCC = 0.86, 95.0% CI = 0.76 – 0.95).

Conclusion

The results suggest that the cut-offs based on MUAC can be used for community-based screening of underweight and obesity
LINC02126 is a potential diagnostic, prognostic and immunotherapeutic target for lung adenocarcinoma
Authors: Wang Junbin , Liu Jixian , Hou Qinghua , Xu Mengmeng
Published: November 2022

Background

Adenocarcinoma has long been an independent histological class of lung cancer, which leads to high morbidity and mortality. We aimed to investigate the contribution of LINC02126 in lung adenocarcinoma.

Methods

RNA sequencing data and clinical information were downloaded. Diagnostic efficiency and survival analysis of LINC02126 were performed, followed by functional analysis of genes co-expressed with LINC02126 and differentially expressed genes (DEGs) in different LINC02126 expression groups. Tumor immune microenvironment (TIME) cell infiltration and correlation analysis of tumor mutation burden were performed in different LINC02126 expression groups.

Results

In lung adenocarcinoma, the expression level of LINC02126 was significantly decreased. Significant expression differences of LINC02126 were found in some clinical variables, including T staging, M staging, sex, stage, and EGFR mutation. LINC02126 had potential diagnostic and prognostic value for patients. In the low LINC02126 expression group, the infiltration degree of most immune cells was significantly lower than that in the high LINC02126 expression group. Tumor mutation burden level and frequency of somatic mutation in patients with low LINC02126 expression group were significantly higher than in patients with high LINC02126 expression group.

Conclusions

LINC02126 could be considered as a diagnostic, prognostic and immunotherapeutic target for lung adenocarcinoma.
A quantitative accuracy assessment of the use of a rigid robotic arm in navigated placement of 726 pedicle screws
Authors: Benech Carlo Alberto , Perez Rosa , Benech Franco , Shirk Torrey , Bucklen Brandon S.
Published: November 2022

Background

Traditional minimally invasive fluoroscopy-based techniques for pedicle screw placement utilize guidance, which may require fluoroscopic shots. Computerized tomography (CT) navigation results in more accurate screw placement. Robotic surgery seeks to establish access and trajectory with greater accuracy.

Objective

This study evaluated the screw placement accuracy of a robotic platform.

Methods

Demographic data, preoperative/postoperative CT scans, and complication rates of 127 patients who underwent lumbosacral pedicle screw placement with minimally invasive navigated robotic guidance using preoperative CT were analyzed.

Results

On the GRS scale, 97.9% (711/726) of screws were graded A or B, 1.7% (12/726) of screws graded C, 0.4% (3/726) of screws graded D, and 0% graded E. Average offset from preoperative plan to final screw placement was 1.9 ± 1.5 mm from tip, 2.2 ± 1.4 mm from tail and 2.9 ± 2.3° of angulation.

Conclusions

Robotic-assisted surgery utilizing preoperative CT workflow with intraoperative fluoroscopy-based registration improves pedicle screw placement accuracy within a patient’s pedicles.
Micro-computed tomographic evaluation of endodontic ledge position in relation to canal curvatures
Authors: Berutti Elio , Alovisi Mario , Moccia Edoardo , Carossa Massimo , De Caro Giovanni , Roccuzzo Andrea , Pasqualini Damiano , Scotti Nicola
Published: November 2022

Background

Endodontic ledge (EL) formation is the most common complication of endodontic treatment. Although various etiological factors have been identified, canal curvature is the most significant variable correlated with EL formation. The aim of this micro-computed tomographic (micro-CT) study was to evaluate EL position in the mesial canals of the lower molars in relation to the degree of canal curvature.

Methods

Forty intact mandibular first molars with independent mesial canals with 20°–40° primary mesio-distal curvature, 10°–30° buccal-lingual canal curvature and 4 < r ≤ 8 mm main curvature radius were selected. Working length was measured with a K-File #10 and a high resolution pre-operative micro-CT analysis was performed. Ledges were created at the point of maximum canal curvature using stainless steel K-Files #30–35, alternating irrigation with 5% NaOCl and 10% EDTA. A post-operative high-resolution micro-CT analysis was then completed. Pre- and post-operative images were analyzed. The angle (α) formed between the vector passing through the geometric center of the EL and the center of the original canal lumen and the line joining the centers of the mesio-buccal and mesio-lingual canal orifices was calculated, and a descriptive statistical analysis was achieved. The α angle values were analyzed in relation to canal curvature using Kruskal-Wallis and post hoc Dunn’s tests. The level of significance was set at P < 0.05.

Results

The α angles appeared inversely proportional to canal curvatures in the buccal-lingual and mesio-distal projections. The mean α angle was 36.4° (standard deviation 10.64; 95% confidence interval 34.1–40.9).

Conclusion

Within the limitations of this study, endodontic ledges develop in the opposite direction to the three-dimensional canal curvature and their position is influenced by the degree of curvature. Clinically, the α angle values may be related to the recommended direction to manage endodontic ledges.
Uptake of and adherence to oral pre-exposure prophylaxis among adolescent girls and young women at high risk of HIV-infection in Kampala, Uganda: A qualitative study of experiences, facilitators and barriers
Authors: Kayesu Ivy , Mayanja Yunia , Nakirijja Catherine , Machira Yvonne Wangũi , Price Matt , Seeley Janet , Siu Godfrey
Published: November 2022

Background

There is limited information on factors that influence oral pre-exposure prophylaxis (PrEP) uptake and adherence among adolescent girls and young women (AGYW). We conducted a qualitative methods study to explore experiences, facilitators and barriers of PrEP uptake and adherence to PrEP among AGYW at risk of Human Immunodeficiency Virus (HIV) infection in Kampala, Uganda.

Methods

This study was nested in a prospective cohort study that offered daily oral PrEP to AGYW. Between April 2019 and October 2020 we conducted in-depth interviews with 26 AGYW aged 14–24 years who had been offered or had been using PrEP for at least 6 months, including PrEP adherers (8), non-adherers (8) and those who had declined PrEP (10). After 12 months, follow-up interviews were conducted with 12 AGYW who had adhered to PrEP and those who had dropped it. Thematic analysis was conducted and data were further examined and categorized into the 5 constructs of the Socio-Ecological Model (SEM).

Results

PrEP uptake and adherence were facilitated by factors including: perceptions that one’s own or partner’s sexual behaviour was high risk, a negative attitude towards condoms, social support and wanting to maintain a negative HIV status after receiving a negative HIV test result. Good adherence to PrEP was enabled by effective counselling, support tools such as alarms and phone reminders and incentives like free treatment for STIs and other illnesses during study visits. Barriers to uptake included: anxiety about the pill burden, perceptions of being too young for PrEP and fear of being labelled `prostitute’ or `HIV positive’. Poor adherence was attributed to doubt over the efficacy of PrEP as a result of beliefs that because HIV was incurable, no medicine could prevent it. Alcohol use, side effects experienced, and mobility all had a negative impact on adherence. The majority of PrEP users reported feeling safe as a result of using PrEP which had both good and negative implications on their sexual behaviour, specifically the number of sexual partners and condom use.

Conclusion

Addressing community misconceptions to maximize uptake of PrEP among AGYW is important. Targeted education messages, and counselling to address misconceptions in ways that capture the attention of AGYW in communities are required.
Where do nursing students make mistakes when calculating drug doses? A retrospective study
Authors: Wennberg-Capellades Laia , Fuster-Linares Pilar , Rodríguez-Higueras Encarnación , Fernández-Puebla Alberto Gallart , Llaurado-Serra Mireia
Published: November 2022

Background

Research internationally shows that nursing students find dosage calculation difficult. Identifying the specific aspects of dose calculation procedures that are most commonly associated with errors would enable teaching to be targeted where it is most needed, thus improving students’ calculation skills. The aim of this study was to analyze where specifically nursing students make mistakes when calculating drug doses.

Method

Retrospective analysis of written examination papers including dosage calculation exercises from years 1, 2, and 3 of a nursing degree program. Exercises were analyzed for errors in relation to 23 agreed categories reflecting different kinds of calculation or steps in the calculation process. We conducted a descriptive and bivariate analysis of results, examining the relationship between the presence of errors and the proportion of correct and incorrect final answers.

Results

A total of 285 exam papers including 1034 calculation exercises were reviewed. After excluding those that had been left blank, a total of 863 exercises were analyzed in detail. A correct answer was given in 455 exercises (52.7%), although this varied enormously depending on the type of exercise: 89.2% of basic dose calculations were correct, compared with just 2.9% of those involving consideration of maximum concentration. The most common errors were related to unit conversion, more complex concepts such as maximum concentration and minimum dilution, or failure to contextualize the answer to the clinical case. Other frequent errors involved not extracting the key information from the question, not including the units when giving their answer, and not understanding the question. In general, fewer errors in basic dose calculations were made by students at later stages of the degree program.

Conclusions

Students struggle with more complex dose calculations. The main errors detected were related to understanding the task and the key concepts involved, as well as not following the correct steps when solving the problem.
Effectiveness and implementation of an online intervention (MINDxYOU) for reducing stress and promote mental health among healthcare workers in Spain: a study protocol for a stepped-wedge cluster randomized trial
Authors: López-del-Hoyo Yolanda , Fernández-Martínez Selene , Pérez-Aranda Adrián , Barceló-Soler Alberto , Guzman-Parra Jose , Varela-Moreno Esperanza , Campos Daniel , Monreal-Bartolomé Alicia , Beltrán-Ruiz María , Moreno-Küstner Berta , Mayoral-Cleries Fermín , García-Campayo Javier
Published: November 2022

Background

The World Health Organization has formally recognized that healthcare professionals are at risk of developing mental health problems; finding ways to reduce their stress is mandatory to improve both their quality of life and, indirectly, their job performance. In recent years, particularly since the COVID-19 pandemic outbreak, there has been a proliferation of online interventions with promising results. The purpose of the present study is twofold: to test the effectiveness of an online, self-guided intervention, MINDxYOU, to reduce the stress levels of healthcare workers; and to conduct an implementation study of this intervention. Additionally, an economic evaluation of the intervention will be conducted.

Methods

The current study has a hybrid effectiveness-implementation type 2 design. A stepped wedge cluster randomized trial design will be used, with a cohort of 180 healthcare workers recruited in two Spanish provinces (Malaga and Zaragoza). The recruitment stage will commence in October 2022. Frontline health workers who provide direct care to people in a hospital, primary care center, or nursing home setting in both regions will participate. The effectiveness of the intervention will be studied, with perceived stress as the main outcome (Perceived Stress Scale), while other psychopathological symptoms and process variables (e.g., mindfulness, compassion, resilience, and psychological flexibility) will be also assessed as secondary outcomes. The implementation study will include analysis of feasibility, acceptability, adoption, appropriateness, fidelity, penetration, and sustainability. The incremental costs and benefits, in terms of quality-adjusted life years, will be examined by means of cost-utility and cost-effectiveness analyses.

Discussion

MINDxYOU is designed to reduce healthcare workers’ stress levels through the practice of mindfulness, acceptance, and compassion, with a special focus on how to apply these skills to healthy habits and considering the particular stressors that these professionals face on a daily basis. The present study will show how implementation studies are useful for establishing the framework in which to address barriers to and promote facilitators for acceptability, appropriateness, adoption, feasibility, fidelity, penetration, and sustainability of online interventions. The ultimate goal is to reduce the research-to-practice gap.

Trial registration

This study was registered in ClinicalTrials.gov on 29/06/2022; registration number: NCT05436717.
Medical screening tests and vaccination among hospital-based physicians in Israel
Authors: Eltalakat Sameeh , Gariba Berjas Abu , Peleg Roni , Kaplan Daniel , Treister‑Goltzman Yulia
Published: November 2022

Background

Very few studies have evaluated physician participation in screening tests and vaccinations. The aim was to evaluate attitudes and actual practice of screening tests and vaccinations among hospital-based physicians and to identify factors that predict actual performance.

Methods

A cross-sectional study including 220 physicians in various specializations. The study was conducted between January 1, 2017 and December 10, 2017. The statistical analysis was performed during October, 2020 and completed in October 25, 2020.

Results

The vast majority of physicians (94%) believed in the importance of screening tests for physicians, but less than half actually underwent the tests themselves. A high percentage of physicians measured their BMI (84.5%) and had a serum lipid profile test (67.7%) and complete blood counts (75%) over the previous five years, but less than a third of female physicians over 50 years of age had a mammogram and only 8% of the physicians over 50 had a fecal occult blood test. A high percentage of physicians were vaccinated for Hepatitis A and B, chickenpox and measles (66-96% for the various vaccinations), but only 41% had an influenza vaccination in the previous year. In a multivariate logistic regression model, physicians who believed that hospital physicians bore a responsibility for recommending screening tests to their patients were more likely to have their BMI and their blood pressure checked (OR = 2.234, P = 0.007). They were more likely to undergo laboratory testing (OR = 4.082, P < 0.0001) and tended to get vaccinated more (OR = 1.907, P = 0.051).

Conclusion

The rate of screening tests and vaccinations among hospital-based physicians is sub-optimal and very low for fecal occult blood testing and mammograms. Structured programs are required to implement screening tests and vaccinations among physicians.
Recommendations for improving the working conditions and cultures of distressed junior doctors, based on a qualitative study and stakeholder perspectives
Authors: Spiers Johanna , Kokab Farina , Buszewicz Marta , Chew-Graham Carolyn A. , Dunning Alice , Taylor Anna K. , Gopfert Anya , van Hove Maria , Teoh Kevin Rui-Han , Appleby Louis , Martin James , Riley Ruth
Published: November 2022

Background

Doctors, including junior doctors, are vulnerable to greater levels of distress and mental health difficulties than the public. This is exacerbated by their working conditions and cultures. While this vulnerability has been known for many years, little action has been taken to protect and support junior doctors working in the NHS. As such, we present a series of recommendations from the perspective of junior doctors and other relevant stakeholders, designed to improve junior doctors’ working conditions and, thus, their mental health.

Methods

We interviewed 36 junior doctors, asking them for recommendations for improving their working conditions and culture. Additionally, we held an online stakeholder meeting with a variety of healthcare professionals (including junior doctors), undergraduate medical school leads, postgraduate speciality school leads and NHS policymakers where we asked what could be done to improve junior doctors’ working conditions. We combined interview data with notes from the stakeholder discussions to produce this set of recommendations.

Results

Junior doctor participants and stakeholders made organisational and interpersonal recommendations. Organisational recommendations include the need for more environmental, staff and educational resources as well as changes to rotas. Interpersonal recommendations include changes to communication and recommendations for better support and teamwork.

Conclusion

We suggest that NHS policymakers, employers and managers consider and hopefully implement the recommendations set out by the study participants and stakeholders as reported in this paper and that the gold standards of practice which are reported here (such as examples of positive learning environments and supportive supervision) are showcased so that others can learn from them.
Human thirst behavior requires transformation of sensory inputs by intrinsic brain networks
Authors: Hsu Li-Ming , Yang Jen-Tsung , Wen Xuyun , Liang Xia , Lin Leng-Chieh , Huang Yen-Chu , Tsai Yuan-Hsiung
Published: November 2022

Background

To survive and thrive, many animals, including humans, have evolved goal-directed behaviors that can respond to specific physiological needs. An example is thirst, where the physiological need to maintain water balance drives the behavioral basic instinct to drink. Determining the neural basis of such behaviors, including thirst response, can provide insights into the way brain-wide systems transform sensory inputs into behavioral outputs. However, the neural basis underlying this spontaneous behavior remains unclear. Here, we provide a model of the neural basis of human thirst behavior.

Results

We used fMRI, coupled with functional connectivity analysis and serial-multiple mediation analysis, we found that the physiological need for water is first detected by the median preoptic nucleus (MnPO), which then regulates the intention of drinking via serial large-scale spontaneous thought-related intrinsic network interactions that include the default mode network, salience network, and frontal-parietal control network.

Conclusions

Our study demonstrates that the transformation in humans of sensory inputs for a single physiological need, such as to maintain water balance, requires large-scale intrinsic brain networks to transform this input into a spontaneous human behavioral response.