bluuebunny/crossref_metadata_2025 huggingface dataset:
Is group-based physical therapy superior to individual rehabilitation in elderly adults after total knee arthroplasty? A prospective observational study
Authors: Krumov Julian , Obretenov Vasil , Bozov Hristo , Tzachev Nedelcho , Milanova Hristina , Panayotov Kiril , Papathanasiou Jannis
Published: December 2022

Knee osteoarthritis (OA) is the most prevalent joint disease and one of the leading causes of disability, poor physical activity levels (PAL), and quality of life (Qol) of elderly people worldwide. The purpose of this study was to evaluate the superiority of a novel group-based physical therapy (GBPT) intervention compared to a more traditional one-to-one individual physical therapy (IPT) among elderly Bulgarian subjects underwent total knee arthroplasty (TKA). One hundred and thirty elderly TKA recipients of both genders with mean age=72.69±0.44 were randomly assigned to GBPT or to one-to-one IPT. Elderly participants were assessed at baseline and at 3 and 6 months after both rehabilitation interventions, with the use of the following evaluation tools: Physical Activity Scale for the Elderly (PASE), Six-Minute Walk Test (6MWT), and Short Form Health Survey questionnaire (SF-36v2). At 6 months elderly TKA recipients who received GBPT achieved 7.36 points more in the PASE questionnaire when compared with the IPT group. Elderly participants of the GBPT group walked significantly longer distance during the 6MWT than TKA recipients attended IPT, respectively 421.56 m vs. 398.62 m, (p< 0.001). Furthermore, significantly greater improvement in health-related quality of life (HRQoL) was obtained from the elderly participants of the GBPT arm compared with the participants of the IPT arm, respectively 70, 7% vs. 60, 8% at 6 months follow up. We conclude that our results suggest the superiority of the GBPT in terms of PAL (PASE score, 6MWT) and HRQoL among elderly TKA recipients across the first 6 months.
Learning curve of fiberoptic bronchoscope-guided tracheal intubation through supraglottic airway device for pediatric airway management: a manikin study
Authors: Ji Sang-Hwan , Cho Sung-Ae , Jang Young-Eun , Kim Eun-Hee , Kim Jin-Tae , Kim Hee-Soo , Lee Ji-Hyun
Published: December 2022

Background: Although fiberoptic-guided endotracheal intubation using a supraglottic airway device (SAD) is a good alternative for the management of difficult airways, its learning curve for residents has not been evaluated in pediatric patients. We aimed to train residents using a pediatric manikin and obtain learning curves to evaluate the efficiency of the training.Methods: We conducted a single-armed prospective study with anesthesiology residents. Plain endotracheal tube (ETT) intubation guided by a fiberoptic bronchoscope through Ambu® AuraGainTM was demonstrated in a pediatric manikin to the participants before training. The procedure was divided into four steps: SAD insertion, vocal cord identification, carina identification, and ETT insertion into the trachea. The results and elapsed procedure times of each trial were recorded. The learning curves for the participants were constructed and analyzed using the cumulative sum method.Results: All the 30 participants acquired proficiency at the end of practice between eight and 25 trials. The overall success rate for the procedure was 92.8%, and above 80% for all participants. Mean ± standard deviation procedure time was 71.3 ± 50.7 s. The 4th step accounted for 86.2% and 48.0% of the total failures and procedure time, respectively. The procedure time rapidly decreased in the 2nd trial; a modest decline was observed thereafter.Conclusions: Trainees can obtain proficiency for fiberoptic-guided intubation through SAD within 25 times when using pediatric manikin. Effect of the training on performance in actual clinical situation should be studied.
Effect of patient decision aids on choice between sugammadex and neostigmine in surgeries under general anesthesia: a multicenter randomized controlled trial
Authors: Wang Li-Kai , Lin Yao-Tsung , Chen Jui-Tai , Lan Winnie , Hung Kuo-Chuan , Chen Jen-Yin , Liu Kuei-Jung , Yen Yu-Chun , Chou Yun-Yun , Cherng Yih-Giun , Tam Ka-Wai
Published: December 2022

Background: Shared decision making using patient decision aids (PtDAs) was established over a decade ago, but few studies have evaluated its efficacy in Asian countries. We therefore evaluated the application of PtDAs in a decision conflict between two muscle relaxant reversal agents, neostigmine and sugammadex, and sequentially analyzed the regional differences and operating room turnover rates.Methods: This multicenter, outcome-assessor-blind, randomized controlled trial included 3,132 surgical patients from two medical centers admitted between March 2020 and August 2020. The patients were randomly divided into the classical and PtDA groups for pre-anesthesia consultations. Their clinicodemographic characteristics were analyzed to identify variables influencing the choice of reversal agent. On the day of the pre-anesthesia consultation, the patients completed the four SURE scale (sure of myself, understand information, risk-benefit ratio, encouragement) screening items. The operating turnover rates were also evaluated using anesthesia records. Results: Compared with the classical group, the PtDA group felt more confident about receiving sufficient medical information (P < 0.001), felt better informed about the advantages and disadvantages of the medications (P < 0.001), exhibited a superior understanding of the benefits and risks of their options (P < 0.001), and felt surer about their choice (P < 0.001). Moreover, the PtDA group had a significantly greater tendency to choose sugammadex over neostigmine (P < 0.001). Conclusions: PtDA interventions in pre-anesthesia consultations provided surgical patients with clear knowledge and better support. PtDAs should be made available in other medical fields to enhance shared clinical decision-making.
Mechanisms and implications in gene polymorphism mediated diverse reponses to sedatives, analgesics and muscle relaxants
Authors: Sun Yan , Zhu Hongyu , Esmaeili Elham , Tang Xue , Wu Zhilin
Published: December 2022

Responses to sedatives, analgesics and muscle relaxants vary among patients under general anesthesia, which could be ascribed to the disparities of clinical characteristics and genetic factors of individuals. Accumulating researches have indicated that gene polymorphisms of the receptors, transporters and metabolizing enzymes associated with anesthetics play a considerable role in their efficacy. However, a systematically summarized study on the mechanisms of gene polymorphisms on pharmacodynamics and pharmacokinetics of anesthetics is still lacking. In this paper, the recent researches on pharmacogenomics of sedatives, analgesics and muscle relaxants are comprehensively reviewed, and the contributions and mechanisms of polymorphisms to the differences of individual efficacy of these drugs are discussed, so as to provide guidance for the formulation of a rational anesthesia regimen for patients with various genotypes.
Subretinal fluid in a patient with systemic lupus erythematosus
Authors: Park Jong Beom , Kim Kiyoung , Kang Min Seok , Kim Eung Suk , Yu Seung-Young
Published: December 2022

A 28-year-old male patient presented to the outpatient department with visual disturbance in both eyes. The patient had a history of stage IV lupus nephritis that was diagnosed at the age of 14 years and had undergone hemodialysis at the age of 23 years. After he started hemodialysis, the systemic condition was well controlled, and systemic steroids were not used. His best-corrected visual acuity (BCVA) was 20/200 in the right eye and 20/100 in the left eye. Funduscopic examination revealed shallow subretinal fluid (SRF) and serous retinal detachment in both eyes. The first impression of this patient was central serous chorioretinopathy. However, the late phase of fluorescein angiography (FA) demonstrated multiple subretinal leakages, and the late phase of indocyanine green angiography showed choroidal vascular engorgement and multiple hyperfluorescent plaques in both eyes. Systemic lupus erythematosus showed moderate activity according to the results of the systemic evaluation. Based on the clinical examination, lupus choroidopathy was suspected in both eyes. Half-fluence photodynamic therapy (PDT) was administered to both eyes rather than systemic steroids because the patient was systemically stable. Three months after PDT, no SRF was observed in either eye. In addition, multiple subretinal leakages on FA were reduced compared to those before treatment. There was no recurrence of SRF for 4 years after PDT, and the final BCVA was 20/70 in the right eye and 20/40 in the left eye. During this time, numerous hypoautofluorescence spots appeared adjacent to the major retinal vessels in fundus autofluorescence.
Durable Response of Immune Checkpoint Inhibitor for a Patient with Advanced Gastric Adenosquamous Carcinoma
Authors: Lai Cheng-Lun , Chen Ming-Huang
Published: December 2022

Gastric adenosquamous carcinoma (GASC) is an extremely rare malignancy of the stomach. It is generally diagnosed at an advanced stage and is associated with a poor prognosis. Notably, the standard treatments for GASC remain undetermined because of the condition's rarity. In this report, we present a patient diagnosed with advanced GASC with positive predictive biomarkers for immune checkpoint inhibitors (ICIs), who achieved a durable response through nivolumab monotherapy. We also review and discuss the management of GASC and possible roles of ICIs in gastric cancers.
Characteristics and containment of the outbreak caused by the SARS-CoV-2 Omicron variants in Shanghai, China
Authors: Zhou Hongrang , Wang Xiaoling , Li Guifu , Wang Xiaoming , Zhou Zhe , Kong Wen , Pan Yinjun , Xu Xingxing , Ye Kaiyou , Pan Junfeng , Xiao Ning
Published: December 2022

Objective:

The study aimed to describe the characteristics and containment of the Omicron variants in Shanghai compared with the previous severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants in China.

Methods:

We summarized the data retrieved from the Shanghai Municipal Health Commission from January to June 2022 and the National Health Commission of the People's Republic of China from March 2020 to August 2021. Epidemiological analysis was utilized to describe the differences among SARS-CoV-2 variants and the infection situation in the outbreaks in China.

Results:

The Omicron variants had the characteristics of high insidiousness, rapid transmission, high infectivity, and short incubation period, which were consistent with the characteristics of outbreaks caused by Omicron in other regions in China and abroad. There were 568978 asymptomatic infections in Shanghai from Feburary 26 to June 30, 2022, accounting for 90.73% of the SARS-CoV-2 infections in this outbreak wave. It's significantly different from a total of 23277 SARS-CoV-2 infections in China between March 31, 2020 and August 8, 2021, of which 41.97% of the cases were asymptomatic infections.

Conclusions:

Compared with previous outbreaks emerged in China, the Omicron outbreak in Shanghai was characterized by multiple point dissemination, wide coverage, a large number of close contacts of confirmed infections and asymptomatic carriers, and difficult source tracing. The lessons from Shanghai's response to Omicron showed that the dynamic zero-COVID policy is still the most suitable response to the virus which can quickly find the infections and curb the transmission route.
Subjective Assessment of Bonded Fixed Lingual Retainers
Authors: Kulkarni Narayan B , Shah Vinaykumar D
Published: December 2022

Aims:

This study aimed to assess the patients' subjective assessment of bonded fixed lingual retainers after completion of active orthodontic treatment.

Objective:

A questionnaire comprising 11 questions evaluated the patients' experience with bonded fixed lingual retainer.

Materials and Methods:

The content was validated by a group of seven experienced orthodontists. The questionnaire survey was run using Google Forms, responded by 45 (50.6%) males and 44 (49.4%) females between the ages ranging from 19 to 42 years. Their responses were rated on a Visual Analogue Scale as applicable. Cronbach's alpha test was utilised for assessing the reliability, and the Chi-square test was used for the quantitative variables.

Results:

33.7% of individuals were most comfortable, and 2.2% had severe discomfort during retainer placement. 6.6% of individuals had severe difficulty maintaining oral hygiene in the upper arch and 4.4% in lower teeth and gums, respectively. 2.2% had severe difficulty in speech. 85.4% had no tongue ulceration. 37.1% of respondents had a very good overall experience with fixed bonded lingual retainer, 59.5% had mild problems and only 1.1% had severe problems with a very bad experience.

Conclusions:

The study concluded that the overall experience of respondents with fixed lingual bonded retainer had mild problems. It was comfortable for most of the patients in maintaining oral hygiene with mild difficulty in speech and chewing. The cause of failure of the retainer was mainly due to bond failure or broken wire in the retainer.
Audit of Prostate Cancer Diagnosis Using P63 and Prostate-Specific Antigen Immunostains at a Tertiary Care Hospital in South-East Nigeria
Authors: Amadi Darlington C , Ndukwe Chinedu Onwuka , Obiorah Christopher C , Ukah Cornelius Ozobia
Published: December 2022

Introduction:

Prostate cancer (CaP) is a leading cancer diagnosis and cause of cancer-related deaths among Nigerian men, and the accuracy of the pathologic diagnosis is critical for optimal patient care. This study aims to define the relative proportional accuracy of the histological diagnosis of prostatic cancer with hematoxylin and eosin (H and E) slides at Federal Medical Centre (FMC) Owerri, Nigeria. It also seeks to determine Gleason's grading and grade group pattern of CaP in our hospital.

Materials and Methods:

This study is a 5-year retrospective study reviewing all the H and E slides of prostatic Tru-Cut biopsies that were already diagnosed as cancer at FMC Owerri. These diagnoses were read and confirmed using their morphological appearance on light microscopy. Those that were suspicious, especially those that were diagnosed with well-differentiated adenocarcinoma (Gleason 3 + 3) and poorly differentiated carcinoma (Gleason 5 + 5), were sent for immunohistochemical studies. The well-differentiated carcinomas were stained for basal cells using P63, whereas poorly differentiated carcinomas were stained with prostate-specific antigens to confirm tissue of origin. These are to differentiate them from benign mimickers and metastatic carcinomas, respectively.

Results:

The age range of the patients was between 50 and 99 years, with a mean age of 72.84 years and peak age in the 70–79 years of age group. Using immunohistochemistry on the specimens which fitted into the criteria for immunohistochemistry, this study showed the relative proportional accuracy of the histological diagnosis of prostatic cancer using H and E to be 95.55% and the positive predictive value of H and E to be 0.83. With respect to International Society of Urological Pathology (ISUP) group grading, high-grade cancers predominated, and the most predominant grade is 5.

Conclusion:

H and E stain has high diagnostic accuracy (95.55%), but a 4.45% diagnostic error using H and E is quite significant. Immunohistochemistry, therefore, should act as a most valuable adjunctive, which significantly increases the diagnostic accuracy of prostatic carcinoma diagnosis.
Nomophobia among medical students before and after COVID-19 – A propensity score-matched study
Authors: Kadiyala Pavan Kumar , Dayala P. Prasanth , Duggirala Naga Chaitanya , Busi Sukeerthi
Published: December 2022

Introduction:

NOMObile PHone PhOBIA (NOMOPHOBIA) is a psychological condition where people fear of being detached from mobile phone connectivity or use. Mobile phones became the main source of entertainment and academics during the lockdown enforced to contain COVID-19. The present study aims to find the change in the prevalence, severity, and characteristics of nomophobia among medical students.

Materials and Methods:

A cross-sectional study was conducted among medical students during September 2019 and after the second wave of COVID-19 in September 2021, using Google Forms. The form included sociodemographic data, clinical details, characteristics of mobile phone usage, and the Nomophobia Questionnaire (NMP-Q). The two groups (2019 and 2021) were matched using propensity score matching (PSM) analysis.

Results:

There were significant differences between the groups in terms of age, time spent and purpose of mobile phone usage, and frequently used mobile applications. Among the 2019 and 2021 groups, 99.50% and 99.54% had nomophobia, respectively. No significant differences were found between the groups in terms of severity, and dimensions of NMP-Q, except the dimension of “losing connectedness.” After PSM, similar results of nil significant differences, except the increase in severity of the dimension of “losing connectedness” in the 2021 group were found.

Conclusion:

The COVID-19 infection and lockdown, which happened during the era of technological advancement, have not changed the characteristics of nomophobia among medical students. However, post-COVID-19, there is a significant increase in the feelings of losing ubiquitous connectivity provided by mobile phones. If you find yourself always alert for phone notifications or reaching out to get your phone at frequent intervals, it’s time for a digital detox.
Changes in corneal topography asymmetry indices after corneal collagen cross-linking in keratoconus
Authors: Seleim Al Shaimaa M. , Abd-Elhalim Tamer I. , Shaheen Mohammed A. , Allam Waleed A.
Published: December 2022

Purpose

The aim of this study was to evaluate the changes in corneal topography asymmetry indices after corneal collagen cross-linking (CXL) in patients with keratoconus and to analyze their correlation with visual acuity changes and preoperative average keratometric (K) value.

Setting and design

This is a prospective interventional noncomparative nonrandomized study that was conducted at the Outpatient Clinic of the Ophthalmology Department of Tanta University Hospital.

Patients and methods

CXL was conducted in 30 eyes of 15 patients with keratoconus. Quantitative descriptors of corneal topography were measured with corneal tomography using a rotating Scheimpflug camera (Pentacam-Oculus). They included seven indices: index of surface variance (ISV), center of keratoconus index (CKI), index of height asymmetry (IHA), index of vertical asymmetry (IVA), keratoconus index (KI), index of height decentration (IHD), and minimum radius of curvature (Rmin). Follow-up of cases was done for 6 months.

Results

There was a statistically significant improvement in ISV (P<0.001), IVA (P<0.001), KI (P<0.001), CKI (P=0.007), IHD (P<0.001), and Rmin (P=0.001). However, there was no statistically significant difference in IHA (P=0.082). The improvement in postoperative indices was not correlated with the changes in corrected distance visual acuity. The preoperative average K value was statistically significantly positively correlated with the improvement in KI (r=0.589, P=0.001), ISV (r=0.495, P=0.005), preoperative IHD (r=0.422, P=0.020), and preoperative CKI (r=0.663, P=0.001), with a statistically significant negative correlation with the preoperative Rmin (r=−0,916, P>0.001). However, the preoperative average K value was not significantly correlated with the improvements in IHA (r=−0,078, P=0.681) and IVA (r=0.204, P=0.280).

Conclusion

There was a significant improvement in six of the seven topography indices 6 months after CXL. Improvement in these indices was not correlated with corrected distance visual acuity changes. The preoperative average K value was significantly correlated with the improvement in KI, ISV, preoperative IHD, preoperative CKI, and preoperative Rmin.
Ranibizumab versus aflibercept for macular edema secondary to nonischemic central retinal vein occlusion in young adult patients
Authors: Amer Ahmed A. , El Shafie Mohamed A.M. , Hassan Nader H.F.
Published: December 2022

Purpose

The aim of this study was to compare the effect ranibizumab and aflibercept in the treatment of macular edema secondary to nonischemic central retinal vein occlusion (CRVO) in young adults.

Patients and methods

This is a prospective double-armed clinical trial that enrolled 40 eyes of 40 young adult patients (aged <50 years) with macular edema due to CRVO. The patients were randomized into two groups of 20 patients each. The first group received intravitreal injection of ranibizumab, whereas the second group received intravitreal aflibercept injection. All patients were subjected to measurement of best-corrected visual acuity, fluorescein angiography to detect retinal ischemia, and spectral domain optical coherence tomography to measure the macular edema at baseline and during a 12-month follow-up period. In each group, three intravitreal injections were given with a 1-month interval between injections.

Results

In group 1, the best-corrected visual acuity had a significant steady increase over time from a baseline value of 48.25±6.4 ETDRS letters to 55.85±10.3 letters at 1 year (P=0.017). Similarly, in group 2, there was also a significant steady increase over time from a baseline value of 55.9±7.2 letters to 60.75±8.4 letters at 1 year (P=0.035), with no statistically significant difference between the two groups (P>0.05). Regarding the central subfield thickness (CST), in the first group, a statistically significant decrease in the CST was reported over time from a baseline value of 557.85±69.7–295.1±55.9 μm at 1 year (P<0.001). Similarly, in the second group, the CST decreased significantly from a baseline value of 570.65±59.2–328.2±72.4 μm at 1 year, with no statistically significant difference between the two groups (P>0.05).

Conclusion

Ranibizumab and aflibercept showed a comparable promising outcome in the management of macular edema secondary to nonischemic CRVO in patients aged less than 50 years. Further multicentric randomized clinical trials are needed to confirm these results.
Unusual Case of Central Retinal Artery Occlusion with Hyperhomocystenemia
Authors: Agrawal Deepak
Published: December 2022

Central Retinal Artery occlusion is an emergency. Causes of nonarteritic occlusion include cardiogenic embolism, hematological conditions (sickle cell disease, hypercoagulable states, leukemia, lymphoma, etc.,), and other vascular diseases such as carotid artery dissection, moyamoya disease, and Fabry’s disease. Arteritic etiology is mostly caused by giant cell arteritis. Other vasculitic disorders such as Susac syndrome, systemic lupus erythematosus, and polyarteritis nodosa have also been implicated.
Assessment of the factors that affect the selection of a dentifrice among a population of 18–24-year-old students in Mangalore: A questionnaire survey
Authors: Jain Aakash , Pralhad Swati , Jain Animesh
Published: December 2022

Introduction:

Bacterial plaque accumulation is the primary etiological factor for periodontal disease; hence, prevention of its accumulation is the cornerstone to any oral hygiene practice. Mechanical tooth cleaning by means of toothbrush and a dentifrice remains the most reliable and common method for controlling supragingival plaque. The objective of the study was to evaluate the factors considered while choosing a dentifrice and also to assess the role of socioeconomic status in determining these factors.

Materials and Methods:

This was a questionnaire study carried out among undergraduate students from the business and mass communication background of two private degree colleges in Dakshina Kannada, India. Two hundred and fifty-five students were included in the study. The questionnaire consisted of 24 close-ended questions.

Results and Conclusion:

The parameters of brand name, availability, and the flavor of the dentifrice are among the most accepted factors that a consumer takes into consideration in selecting a dentifrice. Parameters of influence (parents, colleagues, and celebrities), advertisement, and dentist recommendations of a dentifrice were also found to have a major influence on the consumer in selecting a dentifrice.
Comparison of simvastatin 1.2% gel and alendronate 1% gel in chronic periodontitis as local drug delivery: A randomized clinical trial
Authors: Shetty Bhavya , Karegowda Pallavi , Khan Safiya Fatima , Yadalam Umesh , Nambiar Manjusha
Published: December 2022

Introduction:

Simvastatin (SMV) is used for the treatment of hypercholesterolemia. Long-term systemic administration of SMV has been shown to result in increased bone mineral density. Alendronate (ALN) is known to inhibit osteoclastic bone resorption and has osteostimulative properties.

Aim:

To compare percentile changes in gain in clinical attachment level and reduction of pocket depth, and to radiographically evaluate osseous defect fill with subgingival local drug delivery of 1.2% SMV gel and 1% ALN gel.

Materials and Methods:

A split-mouth study was conducted with 40 infrabony defects from 20 patients diagnosed with chronic periodontitis. The sites were assigned as test site 1 (SMV gel) or test site 2 (ALN gel). After phase I therapy, a single application of SMV gel or ALN gel was done into periodontal pockets. Clinical periodontal parameters and percentage of bone fill were evaluated at baseline, 3 and 6 months.

Results:

There was a statistically significant reduction in pocket depth, plaque index, and bleeding index scores, gain in Clinical attachment level (CAL) and bone defect fill from baseline to 6 months at both sites. On comparison between the groups, test site 2 showed significant improvement in clinical attachment level than in test site 1 at 6-month follow-up. Test site 2 showed more percentage bone fill than test site 1.

Conclusion:

Usage of both SMV and ALN gels in periodontal intra bony defects can lead to significant improvements in clinical and radiographic parameters; however, ALN showed better osseous defect fill.
Effect of an educational intervention on manual toothbrush bristle wear: A light microscopic study
Authors: Bhole Siddhi Shekhar , Vibhute Nupura A. , Belgaumi Uzma , Kadashetti Vidya , Bommanavar Sushma , Kamate Wasim
Published: December 2022

Background and Objectives:

The usage of a toothbrush with the most appropriate bristle type and a correct brushing technique are the most important factors in determining the thoroughness of plaque control. The dental undergraduate course conventionally does not impart tooth brushing techniques in the preclinical years. This study aimed to assess the effect of an educational intervention of correct tooth brushing technique on the wear of toothbrush bristles by light microscopic examination amongst the budding dental professionals.

Materials and Methods:

Toothbrush bristle wear was measured by light microscopy before and after an educational intervention amongst 30 first-year dental professional students. Wear index (WI), wear rate (WR), and acceptable percentage of bristle end morphology were calculated. Mann–Whitney U-statistics test and unpaired t-test were used to compare measurements of acceptable percentage and gender wise, respectively. The difference was said to be significant if P < 0.05.

Results:

The mean WI before intervention was 0.29 ± 0.122 and after the intervention was 0.23 ± 0.07, while the mean WR before intervention was 1.6 ± 0.167 and after the intervention was 1.17 ± 0.46% of bristle end morphology before intervention was 52.5 ± 10.064 and after intervention was 64.5 ± 5.625 with the difference being statistically significant with P < 0.05.

Interpretations and Conclusion:

The present study highlights the importance of imparting a correct tooth brushing technique in reducing the toothbrush bristle wear and improving the efficiency of the toothbrush in maintaining optimum oral hygiene. Early intervention of correct oral hygiene measures is especially prudent for the budding dental professional for future healthcare delivery to the general population.
The Influence of Pin Material and Coatings on the Incidence of Pin Site Infection after External Fixation
Authors: Arveladze Samson , Moriarty Fintan , Jennison Toby
Published: December 2022

Introduction:

External fixation is used for a wide variety of surgical treatments. The transcutaneous pins used in external fixation, however, provide a route for bacterial migration from the external to subcutaneous space, and high rates of pin site infection have been reported. The material of which the pin is composed, or any surface coating that is applied, may significantly influence tissue integration and pin site infection. However, clinical data are scarce. The aim of this systematic review and meta-analysis was to summarize the clinical evidence for the role of pin material, and surface coatings, on the incidence of infection at external fixator pin sites.

Materials and Methods:

A systematic review was performed following registration with PROSPERO. A search was performed using Medline, Embase, and Cochrane. Inclusion criteria were (1) recorded diagnosis of infection, (2) involved external fixation, (3) any bone, (4) English language, (5) human subjects, (5) pin material known, and (6) all levels of evidence. All stages of the review process were performed by two independent reviewers. A meta-analysis was performed using a random effects model meta-analysis to produce odds ratios. Study bias was assessed using the Cochrane risk of bias tool Rob II. Strength of evidence was based on the American Academy of Orthopaedic Surgeons methodology for defining the strength of recommendation.

Results:

After exclusion, 8 studies were further analyzed. One study compared stainless steel and titanium with an odds ratio of 1.00 (95% confidence interval [CI]: −0.70–2.70). Three studies compared stainless steel to hydroxyapatite (HA)-coated pins with an odds ratio of 0.25 (95% CI: −0.52–1.02). Two studies analyzed titanium compared to HA-coated pins with an odds ratio of 1.12 (95% CI: −4.25–6.48). Two studies analyzed silver compared to stainless steel with an odds ratio of 0.12 (95% CI: −0.89–1.12). However, the strength of evidence was limited for all studies. Overall, 0 studies had a low risk of bias, 4 studies had an unknown risk of bias, and 4 studies had a high risk of bias.

Conclusion:

There is currently limited evidence of the effect of different pin material or coatings on the incidence of pin site infection, with the available studies showing contrasting results. Further high-quality and adequately powered studies are required to provide definitive guidance.
The Prevalence and Causes of Low Vision and Visual Impairment in School-Aged Children
Authors: Talebnejad Mohammad Reza , Khalili Mohammad Reza , Tajbakhsh Zahra , Masoumpour Masoumeh Beygom , Mahdaviazad Hamideh , Mohammadi Elham , Keshtkar Maryam , Nowroozzadeh Mohammad Hossein
Published: December 2022

Purpose:

To determine the prevalence and causes of visual impairment (VI) in Shiraz schoolchildren aged between 6 and 12 years.

Methods:

In the present population-based study, stratified random sampling was used to select 2400 schoolchildren aged 6–12 years from all four educational districts of Shiraz, Iran. Using the definitions of the World Health Organization, VI was defined as best-corrected visual acuity (BCVA) ≤0.5 logMAR (20/60) in the better eye, and blindness as BCVA worse than 1.3 logMAR (20/400) in the better eye. The low vision was defined as BCVA equal to or worse than 0.5 logMAR (20/60) in either eye. Data were recorded from a detailed interview and ocular examination of each eligible student.

Results:

The mean age of the students was 9.1 ± 1.6 years. The prevalence of VI was 3/2001 (0.14%). The cause of VI in all these three patients (100%) was amblyopia due to high refractive errors (high ametropia and astigmatism). Regarding the main refractive errors leading to VI among these three patients, one patient had bilateral high hyperopia (compound hyperopic astigmatism), one of them had bilateral high astigmatism, and the other one had compound myopic astigmatism. According to a visual acuity of less than or equal to 20/60 in at least one eye, 9/2001 (0.4%) of children had low vision.

Conclusions:

This study revealed a low prevalence of VI in a sample of 6- to 12-year-old school-aged children. Amblyopia in the setting of high ametropia and astigmatism were the most common causes of VI.
Segmentation Error Correction of the Optical Coherence Tomography Angiography Images in Peer-Reviewed Studies
Authors: Falavarjani Khalil Ghasemi , Anvari Pasha , Alemzadeh Sayyed Amirpooya , Moghaddam Mohammad Mehdi Johari , Habibi Abbas , Ashrafkhorasani Maryam
Published: December 2022

Purpose:

To assess the percentage of published articles reporting optical coherence tomography angiography (OCTA) metrics regarding the report of segmentation error correction.

Methods:

A comprehensive search was conducted using the PubMed database for articles on OCTA imaging published between January 1, 2015, and January 1, 2021. All original articles reporting at least one of the OCTA metrics were extracted. The article text was reviewed for the segmentation correction strategy. In addition, the number of articles that mentioned the lack of segmentation error correction as a limitation of the study was recorded.

Results:

From the initial 5288 articles, 1559 articles were included for detailed review. One hundred ninety-six articles (12.57%) used manual correction for segmentation errors. Of the remaining articles, 589 articles (37.8%) excluded images with significant segmentation errors, and 99 articles (6.3%) mentioned segmentation errors as a limitation of their study. The rest of the articles (675, 43.3%) did not address the segmentation error. Multiple logistic regression analysis revealed that ignorance of segmentation error was significantly associated with lower journal ranks, earlier years of publication and disease category of age-related macular degeneration, and glaucoma (allP< 0.001).

Conclusions:

A significant proportion of peer-reviewed articles in PubMed, disregarded the segmentation error correction. The conclusions of such studies should be interpreted with caution. Editors, reviewers, and authors of OCTA articles should pay special attention to the correction of segmentation errors.
Unilateral Acute Central Serous Chorioretinopathy with Inactivated Coronavirus Disease 2019 Vaccination
Authors: Abrishami Mojtaba , Hosseini Seyedeh Maryam , Shoeibi Nasser , Heidarzadeh Hamid Reza
Published: December 2022

Purpose:

To report unilateral acute-onset central serous chorioretinopathy (CSC) following vaccination with inactivated coronavirus disease 2019 (COVID-19) vaccine in a healthy patient.

Methods:

Case report and review of literature.

Results:

A 39-year-old male was referred with sudden-onset, painless, unilateral blurred vision in the right eye. His first dose of the Sinopharm vaccine was injected 2 days before. A complete ocular examination revealed central subretinal fluid (SRF) accumulation in favor of CSC in the right eye. Systemic workup disclosed no previous COVID-19 infection or any systemic involvement. After 3 weeks, SRF decreased remarkably without treatment.

Conclusions:

It is proposed that CSC development can be an ocular adverse effect of COVID-19 vaccination, although it is infrequent. Ophthalmologists should be aware of the possible association between COVID-19 vaccination and ocular adverse effects, but vaccination is the best effectual measure against COVID-19.
Incidence of Glaucoma after Combined Descemet's Stripping Endothelial Keratoplasty and Retropupillary Fixated Iris-Claw Lens
Authors: Mansoori Tarannum , Mohan Gandrapu Poojitha , Srirampur Arjun , Pesala Veerendranath
Published: December 2022

Purpose:

To assess the incidence of glaucoma after combined Descemet's stripping endothelial keratoplasty (DSEK) and retropupillary fixated iris-claw intraocular lens (IOL) implantation in the patients with bullous keratopathy (BK) who required secondary IOL or IOL exchange.

Methods:

In this retrospective case series, medical records of 22 patients who underwent combined DSEK and retropupillary fixated iris-claw IOL implantation were evaluated. Preoperative vision, intraocular pressure (IOP), postoperative IOP at different time periods, and intraoperative and postoperative complications were analyzed.

Results:

A total of 22 eyes of 22 patients (7 females and 15 males) were analyzed. The median age was 62 years, and the median duration of the postoperative follow-up was 106.5 days. The corrected distance visual acuity improved from a median of 1.85 logMAR to 1.68 logMAR. None of the patients had intraoperative complications. Three patients (13.6%) had dislocation of the donor tissue on the 1st postoperative day and were successfully rebubbled. Six eyes (27.3%) had graft failure and required penetrating keratoplasty. Eleven eyes (50%) had a sustained rise in the IOP, of which 2 (9.09%) had ocular hypertension and 9 eyes (40.9%) progressed to glaucoma.

Conclusions:

DSEK combined with retropupillary fixated iris-claw lens is a good surgical option for the management of aphakic/pseudophakic BK in patients who require secondary IOL or IOL exchange. Regular IOP monitoring after the surgery is an essential, as there is a risk of IOP rise and glaucoma in the postoperative period. Clinicians should be vigilant and control the IOP to prevent glaucoma progression.
Association of Resolved Paracentral Acute Middle Maculopathy Lesions with Diabetic Retinopathy
Authors: Maltsev Dmitrii S. , Kulikov Alexei N. , Burnasheva Maria A.
Published: December 2022

Purpose:

To evaluate the association between paracentral acute middle maculopathy (PAMM) lesions and diabetic retinopathy (DR) using optical coherence tomography angiography (OCTA).

Methods:

Thirteen diabetic patients without DR, 13 patients with mild nonproliferative DR (NPDR), 18 patients with moderate-to-severe NPDR, and 20 patients with proliferative DR (PDR) were included in this retrospective study. For each patient, 6 mm × 6 mm macular OCTA scans of both eyes were reviewed for the presence of acute and resolved PAMM lesions.

Results:

Among diabetic patients with and without DR, 49 (94.9%) and 7 (53.8%) patients demonstrated small resolved PAMM lesions, respectively. The odds ratio for the presence of resolved PAMM lesions in the eye with DR compared to the eye of diabetic patient without DR was 21.8 (P < 0.001, 95% confidence interval 7.0–67.8). In the mild NPDR group, moderate-to-severe NPDR group, and the PDR group, 11 (84.6%), 18 (100.0%), and 20 (100.0%) patients demonstrated resolved PAMM lesions, respectively. There was a statistically significant increasing prevalence of PAMM lesions as the severity of DR increased (P < 0.001).

Conclusion:

Small resolved PAMM lesions are a common form of ischemic retinal lesions in DR.
A Randomized Study comparing Intraoperative Ultrasound and Palpatory Method in Patients with Breast Cancer
Authors: Singh Chandrashekhar , Kumar Deepak , Chintamani
Published: December 2022

Objectives:

This study was conducted to compare the accuracy of intraoperative ultrasound (IOUS) against the conventional palpatory method in terms of margin status after breast conservation surgery (BCS) for breast cancer.

Methods:

The randomized study was conducted at the Department of Surgery along with Department of Pathology and Radiology at a Tertiary Care Hospital in Delhi, India, from January 2017 to June 2018. Eighty patients requiring BCS with histopathological confirmed diagnosis of breast cancer Stage I/II were included and randomized into group IOUS (n = 40) and palpatory method group (n = 40). IOUS was done by an ultrasound probe, palpatory method was done by two fingers and BCS was done at 1 cm from the free margins. The BCS specimen obtained was labeled and sent for histopathology. The histopathological report for tumor-free margin was compared with IOUS and intraoperative palpatory method.

Results:

Demographic (age and menopausal status) and clinical characteristics (tumor stage, tumor side, estrogen receptor-positive, progesterone receptor positive, and human epidermal growth factor receptor 2 neu negative) of the two groups were comparable (P > 0.05). Compared to the palpation method group, the IOUS group had lesser involved margins (15% vs. 30%) but statistically, it was comparable (P = 0.1104). There were comparable postoperative surgical complications, such as wound infection (5% vs. 2.5%), seroma (2.5% vs. 5%), and hematoma (0% vs. 2.5%) (P = 0.55) among the two groups.

Conclusion:

Intraoperative ultrasonography is a novel method that allows superiority of tumor margin negativity in comparison to the conventional palpatory method after BCS.
Yeast Cells Provide a New Approach to Interpretation of Genetic Instability Mechanism
Authors: Evstratova Ekaterina , Mishra Kaushala Prasad , Petin Vladislav , Tolkaeva Mariia
Published: December 2022

Context:

Evidence of yeast cell genetic instability are presented. The genetic instability of wild-type yeast cells and their radiosensitive mutants are compared. DNA damage and its repair are not responsible for genetic instability triggering. Identity of relative biological effectiveness values for cell survival and genetic instability was demonstrated for yeast cells with various ability to repair radiation damage.

Aim:

To demonstrate yeast cells provide a new approach to the interpretation of genetic instability mechanism.

Materials and Methods:

The following haploid and their homozygous diploid yeast strains of wild-type and radiosensitive mutants have been used – 211-1a (radiation absorbed dose [RAD]) and 211 (RAD/RAD), S288C (RAD) and XS800 (RAD/RAD), XS774-4d (rad51) and XS806 (rad51/rad51), g160/2d (rad52) and XS1898 (rad52/rad52), g218/7c (rad54) and XS1879 (rad54/rad54), 5a3bα (RAD/RAD). Megri-139-B (RAD/RAD). Cells were irradiated with 60Co γ-rays and with 239Pu α-particles. Genetic instability was quantitatively evaluated by the percentage of colonies formed after control.

Results:

Cells from colonies produced by control and irradiated cells at 1, 2, and 3 days after control were characterized by increased radiosensitivity, enhanced number of morphologically changed colonies, and the content of nonviable cells. Cell ploidy, not the ability of cells to recover from radiation damage, determines genetic instability – both resistant and radiosensitive diploid cells, in contrast to haploid ones, reveal the greatest genetic instability (100% vs. 20%).

Conclusion:

A possible mechanism for the delayed colony formation may be defects in the chromosomes, which are more lethal for haploid rather than diploid yeast cells. That is why genetic instability is more pronounced for diploid rather than haploid strains.
Squamous Cell Carcinoma of GallBladder: A Systematic Review
Authors: Biswas Rituparna , Halder Anirban , Roy Manas Pratim
Published: December 2022

ABSTRACT

Background:

Pure squamous cell carcinoma (SCC) of gallbladder (GB) is a rare malignancy with a distinct clinicopathological spectrum compared to its adenocarcinoma variant. Owing to the scarcity of cases, a detailed course of it remains unknown.

Search Methodology:

A comprehensive search of the PubMed and Google Scholar was done to find all articles pertaining to pure SCC of GB. Individual patient data analysis and meta-analysis of 94 patients, data of whom gathered from 72 selected articles, were done to understand demography, patterns of care, prognostic variables, and survival outcome.

Results:

Female propensity was found with a median age of 64 years for the entire cohort. Cholelithiasis was frequently found (80.7%). Symptomatology was nonspecific, patients often presented with features of acute cholecystitis. In many instances, tumor was not found on imaging too, instead when simple cholecystectomy was attempted for cholelithiasis, cancer was eventually diagnosed per or postoperatively. No specific tumor marker was found. Tumors were usually bulky (average size = 6.58 cm) with extensive loco-regional spread and significant adjacent organ infiltration (advanced T and N stage), upfront metastases were unusual though (13.8%). The median survival of the presented cohort was 7 months (follow up period ranged from 1 to 120 months). The median disease-free survival was 6 months and an estimated 1, 3 and 5 years survival were 41.8%, 14.5%, and 11%, respectively. Surprisingly, 3 patients lived for 10 years and beyond, among them 2 had an early stage disease but one had T4 disease yet survived with radical surgery alone. Kaplan–Meier univariate survival analysis revealed that radical cholecystectomy (involving resection of GB, liver bed, involved organ and loco regional lymph nodes) with R0 margin and size of tumor ≤6.58 cm were associated with better survival.

Conclusion:

Our study suggests that radical cholecystectomy with R0 margin is crucial for favourable outcome. However, despite that, the outcome stays dismal. Focus on adjuvant therapies including chemotherapy and radiotherapy is the need of the hour.
Quick and easy game bot detection based on action time interval estimation
Authors: Kang Yong Goo , Kim Huy Kang
Published: December 2022

Game bots are illegal programs that facilitate account growth and goods acquisition through continuous and automatic play. Early detection is required to minimize the damage caused by evolving game bots. In this study, we propose a game bot detection method based on action time intervals (ATIs). We observe the actions of the bots in a game and identify the most frequently occurring actions. We extract the frequency, ATI average, and ATI standard deviation for each identified action, which is to used as machine learning features. Furthermore, we measure the performance using actual logs of the Aion game to verify the validity of the proposed method. The accuracy and precision of the proposed method are 97% and 100%, respectively. Results show that the game bots can be detected early because the proposed method performs well using only data from a single day, which shows similar performance with those proposed in a previous study using the same dataset. The detection performance of the model is maintained even after 2 months of training without any revision process.
Growth in the ecological transition: green, zero or de-growth?
Authors: Priewe Jan
Published: December 2022

The article discusses the ongoing transition to climate neutrality in 2050 with a focus on the options of green growth, zero growth or de-growth. First, the stylised facts about the greenhouse effect and the status quo are shown with special attention to emerging economies as key contributors to greenhouse gas emissions since 1990. Globally, brown growth is still predominant. Since the Global South has to reduce emissions as much as the Global North, the resource-rich countries in the South face the gravest challenges. Second, different scenarios of the global transition with different combinations of GDP growth and reduction rates of the emission-to-GDP ratio are shown. The result is that both variables are important, but the reduction of the emissions ratio is more important than growth. Zero growth per se is not necessarily effective in reaching the Paris goals. Third, low green growth in the North is advised (under certain conditions also zero growth), and moderate green growth in the South. Zero growth without capital accumulation in a closed economy would terminate capitalism in its common definition, in contrast to zero growth in an open economy. Third, proposals from ecological economics for zero growth and de-growth are diverse and involve significant shortcomings, especially regarding the macroeconomic analysis.