bluuebunny/crossref_metadata_2025 huggingface dataset:
Muscular branches from the ulnar artery are the basis for a pedicled partial flexor digitorum superficialis muscle flap
Authors: Czinner Martin , Hamrikova Petra , Tuček Michal , Peterkova Tereza , Kebrle Radek
Published: June 2024

The feasibility of a pedicled flexor digitorum superficialis muscle flap was studied in 10 fresh cadavers. The number, length and distance from the flexion wrist crease of muscular branches from the ulnar artery in the distal 10 cm of the forearm were recorded. The mean number of muscular branches was 2.7 (range 1–4). The mean distance of the most distal branch was 35 mm (range 26–40) from the proximal wrist flexion crease. Its mean length was 20 mm (range 16–26). A partial muscle flap was raised on the most distal branch and transposed over the median nerve in the distal forearm. Dissection and transposition of this flap were feasible in all specimens. The reliable pattern of muscular branches to the flexor digitorum superficialis allows the elevation of a pedicled partial muscle flap that can cover the median nerve in the distal forearm.

Level of evidence: V
Nomenclature of the radial nerve: distinguishing between the deep branch of the radial nerve and the posterior interosseous nerve
Authors: Braun Natalie , Save Ameya V. , Lee Steve K. , Wolfe Scott W.
Published: June 2024

To address an inconsistency in the nomenclature of the anatomy and compressive syndromes of the deep branch of the radial nerve, we advocate for a single compression syndrome that presents along a spectrum from pain to posterior interosseous nerve palsy.
Dorsal spanning plating for complex carpometacarpal fracture-dislocations: a retrospective case series
Authors: Lee Cheng-Yeh , Wu Chin-Hsien , Tu Yuan-Kun
Published: June 2024

We studied the outcome of dorsal spanning plate for complex carpometacarpal fracture-dislocation management as a feasible option in nine patients, even on delayed presentation with substantial metacarpal shortening. However, patients must be informed about the need for plate removal.
Women’s Experiences of Benevolent Sexism in Intimate Relationships With Men Are Associated With Costs and Benefits for Personal and Relationship Wellbeing
Authors: Alba Beatrice , Cross Emily J. , Hammond Matthew D.
Published: June 2024

Women’s everyday experiences of benevolent sexism include being praised for loving men (heterosexual intimacy), praised for caregiving (complementary gender differentiation), and being overhelped (protective paternalism). We investigated women’s perceptions of partners and their wellbeing in the context of self-reported experiences of benevolent sexism in their relationships with men. Integrated data analysis on three community samples of women in Australia (total N = 724) indicated that women’s experiences of protective paternalism were associated with greater psychological distress, lower relationship satisfaction, and perceiving partners as less reliable and more patronizing and undermining. By contrast, experiencing heterosexual intimacy was associated with perceiving partners as more reliable, less patronizing and undermining, and with greater relationship satisfaction. Mixed associations emerged for experiencing complementary gender differentiation, including lower psychological distress and also lower relationship wellbeing. These findings advance understanding of the specific costs and benefits of benevolent sexism in relationships between women and men.
Armed conflict as a threat to social cohesion: Large-scale displacement and its short- and long-term effects on in-group perceptions
Authors: Mayer Sabrina J , Dollmann Jörg , Jacobsen Jannes , Walter Lisa
Published: June 2024

This study investigates the short- and long-term consequences of armed conflict and displacement on social cohesion among citizens within attacked nations, using Ukraine and Bosnia and Herzegovina as case studies. Through a pre-registered vignette study in Ukraine (December 2022; N = 1,623), we reveal a significant difference in social cohesion between those who stayed in the country during the war and those who left. This difference intensified when those who left did not want to return. A similar difference persists in Bosnia and Herzegovina 30 years after the Bosnian War (May 2023, N = 338), despite extensive reconciliation efforts. Our findings point towards an understudied consequence of armed conflict and displacement on social cohesion within the attacked nation and shed light on the challenges to post-war reconciliation.
Opioid Use Prior to Adult Spine Deformity Correction Surgery is Associated With Worse Pre- and Postoperative Back Pain and Prolonged Opioid Demands
Authors: Sardi Juan P. , Smith Justin S. , Gum Jeffrey L. , Rocos Brett , Charalampidis Anastasios , Lenke Lawrence G. , Shaffrey Christopher I. , Cheung Kenneth M. C. , Qiu Yong , Matsuyama Yukihiro , Pellisé Ferran , Polly David W. , Sembrano Jonathan N. , Dahl Benny T. , Kelly Michael P. , de Kleuver Marinus , Spruit Maarten , Alanay Ahmet , Berven Sigurd H. , Lewis Stephen J. ,   AO Spine Knowledge Forum Deformity
Published: June 2024

Study Design

Prospective multicenter database post-hoc analysis.

Objectives

Opioids are frequently prescribed for painful spinal conditions to provide pain relief and to allow for functional improvement, both before and after spine surgery. Amidst a current opioid epidemic, it is important for providers to understand the impact of opioid use and its relationship with patient-reported outcomes. The purpose of this study was to evaluate pre-/postoperative opioid consumption surrounding ASD and assess patient-reported pain outcomes in older patients undergoing surgery for spinal deformity.

Methods

Patients ≥60 years of age from 12 international centers undergoing spinal fusion of at least 5 levels and a minimum 2-year follow-up were included. Patient-reported outcome scores were collected using the Numeric Rating Scale for back and leg pain (NRS-B; NRS-L) at baseline and at 2 years following surgery. Opioid use, defined based on a specific question on case report forms and question 11 from the SRS-22r questionnaire, was assessed at baseline and at 2-year follow-up.

Result

Of the 219 patients who met inclusion criteria, 179 (81.7%) had 2-year data on opioid use. The percentages of patients reporting opioid use at baseline (n = 75, 34.2%) and 2 years after surgery (n = 55, 30.7%) were similar ( P = .23). However, at last follow-up 39% of baseline opioid users (Opi) were no longer taking opioids, while 14% of initial non-users (No-Opi) reported opioid use. Regional pre- and postoperative opioid use was 5.8% and 7.7% in the Asian population, 58.3% and 53.1% in the European, and 50.5% and 40.2% in North American patients, respectively. Baseline opioid users reported more preoperative back pain than the No-Opi group (7.0 vs 5.7, P = .001), while NRS-Leg pain scores were comparable (4.8 vs 4, P = .159). Similarly, at last follow-up, patients in the Opi group had greater NRS-B scores than Non-Opi patients (3.2 vs 2.3, P = .012), but no differences in NRS-Leg pain scores (2.2 vs 2.4, P = .632) were observed.

Conclusions

In this study, almost one-third of surgical ASD patients were consuming opioids both pre- and postoperatively world-wide. There were marked international variations, with patients from Asia having a much lower usage rate, suggesting a cultural influence. Despite both opioid users and nonusers benefitting from surgery, preoperative opioid use was strongly associated with significantly more back pain at baseline that persisted at 2-year follow up, as well as persistent postoperative opioid needs.
Graft Position, Healing, and Resorption in Anterior Glenohumeral Instability: A Comparison of 4 Glenoid Augmentation Techniques
Authors: Delgado Cristina , Calvo Emilio , Díaz Heredia Jorge , Cañete Pablo , García Navlet Miguel , Ruiz Ibán Miguel Angel
Published: June 2024

Background:

The success of glenoid augmentation procedures depends on accurate placement and healing of the graft to the glenoid. Different glenoid augmentation techniques have been described, but no comparative studies between them exist.

Purpose:

To assess the bone graft position, healing, and resorption in a group of patients treated with 1 of 4 procedures: arthroscopic anterior bone-block procedure using either (1) fresh-frozen iliac crest allograft or (2) iliac crest autograft, (3) open Latarjet, or (4) arthroscopic Latarjet.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 40 patients (87.5% men; mean age, 29.5 ± 7.9 years) were included, with 10 patients in each of the procedure groups. The graft position in the axial and sagittal planes was assessed on postoperative computed tomography (CT). Graft healing and resorption were assessed in a second CT scan performed 1 year postoperatively. Qualitative variables were compared between the 4 procedures using the chi-square test, and quantitative variables were compared with the Student t test or Mann-Whitney U test.

Results:

No differences were found between the procedures in the axial or sagittal position. The healing rate was significantly lower in the allograft bone-block group (20%) compared with the autograft bone-block (80%), open Latarjet (90%), and arthroscopic Latarjet (90%) groups ( P < .001). Graft resorption developed in 17 of 40 (42.5%) cases overall. Osteolysis occurred in 100% of cases in the allograft bone-block group compared with 50% in the autograft group, 20% in the open Latarjet group, and 0% in the arthroscopic Latarjet group ( P < .001). The glenoid surface area on 1-year CT scan was significantly lower in the allograft bone-block group compared with the autograft bone-block, open Latarjet, and arthroscopic Latarjet groups ( P < .001).

Conclusion:

Arthroscopic bone-block, open Latarjet, and arthroscopic Latarjet procedures provided accurate bone graft positioning. However, very high rates of osteolysis and nonunion were observed in the iliac crest fresh-frozen allograft bone-block procedure when compared with the other procedures.
The Medical Student Guide to Pharmacy: Piloting an Interactive Textbook on Basic Pharmacology Principles and Clinical Correlations
Authors: Walsh Kendra L. , Warrier Sarita S.
Published: June 2024

OBJECTIVES

Despite the wide use of medications in clinical practice, graduating medical students often feel unprepared for the task of prescribing upon starting residency. With recent educational initiatives aiming to transform learning modalities, we sought to pilot an interactive textbook on basic pharmacology principles at our institution as a supplement to first-year lectures and assess its subjective impact on students’ knowledge of content as well as confidence to apply material in the real world through pre- and post-intervention surveys.

METHODS

First-year medical students were invited to complete non-validated, voluntary, anonymous, emailed, online surveys consisting of Likert scale and free-text response questions. Our investigation served as a pilot test for future iterations of this research.

RESULTS

Response rates for the pre- and post-intervention surveys were 73/145 (50%) and 38/145 (26%), respectively, with the post-intervention survey further reduced to 13 individuals who indicated use of the interactive textbook. Questions regarding interactive textbook chapters that overlapped with course content were excluded from data analysis due to an inability to separate learning gains from lectures versus the interactive textbook. Post-intervention survey responses all showed significant changes in mean Likert scale scores on student-perceived knowledge and confidence to apply material with P < .001. Free-text response questions revealed limited exposure to the field of pharmacy and interactions with pharmacists prior to medical school.

CONCLUSION

Our pilot study on the initial use of an interactive textbook titled The Medical Student Guide to Pharmacy presented us with valuable insight into providing first-year medical students with a clinically oriented supplemental resource within coursework on basic pharmacology. Challenges for the future include better integrating the interactive textbook into class lectures to facilitate increased use by students as well as developing more targeted, validated assessments of the impact it has on students’ learning.
Environmental (in)justice and the post-political
Authors: Gladkova Ekaterina
Published: June 2024

Food production plays a crucial role for challenging the escalating environmental breakdown. It is also a fertile ground for analysing environmental (in)justice and its components of recognition and participation in environmental decision-making. Scholars of environmental justice have paid limited attention to the post-political and its implications for the ability to challenge the ecologically destructive status quo. This article innovatively combines environmental justice perspective with the literature on the post-political condition, using the case study of pig farming intensification in rural Northern Ireland. Northern Ireland has been driving policy to encourage growth and intensify its meat production, resulting in a sharp rise of intensive farms. The resulting pollution have and continue generating environmental justice concerns. Using qualitative data from a 2-month fieldwork in November-December 2018, the article shows that local community’s ideas around how farming should be organised were not recognised. Their participation in environmental decision-making was also reduced to an empty ritual; formal inclusion did not translate into a genuine impact on the decision-making outcome. In the post-political landscape, environmental justice concerns become harder to address; environmental decision-making becomes a means of serving the operations of capitalism, stifling disputes around the neoliberal growth agenda, and precluding possibilities for a meaningful change of the ecologically destructive status quo.
Interphalangeal Resection Arthroplasty for the Prevention and Treatment of Diabetic Deformities and Ulcers of the Toes: A Systematic Review and Meta-analysis
Authors: Yammine Kaissar , Mouawad Joseph , Honeine Mohammad Omar , Assi Chahine
Published: June 2024

Background:

Diabetic foot ulcers (DFUs) are serious complications that induce a high risk of lower extremity amputations and mortality. Compared with the standard of care, few reports analyzed the outcome of surgical treatment mainly for diabetic toe deformities and ulcers. The aim of this study is to collate evidence on the outcomes of interphalangeal resection arthroplasty (IP-RA) in preventing and treating diabetic toe ulcers distal to the metatarsophalangeal joint.

Methods:

A search strategy has been developed including electronic databases from inception. Only ulcers distal to the metatarsophalangeal joints were included. Noninfected and infected ulcers were also included at any toe location (dorsal/side/plantar). Outcomes were defined as healing rate, time to heal, ulcer recurrence, ulcer transfer, postintervention infection, wound dehiscence, and additional surgeries including amputation. Proportional meta-analysis was conducted for frequency outcomes.

Results:

Six observational studies comprising 217 patients with 244 IP-RA procedures were included. The mean follow-up period was 23.4 ± 8.2 months. Weighted frequencies were as follows: healing rate (93.6%), ulcer recurrence frequency (4.3%), ulcer transfer frequency (15.4%), postoperative infection (10.5%), wound dehiscence (17.8%), revision surgery (5%), and amputation rate (3.4%). The mean healing time was 4.3 ± 1.8 weeks.

Conclusion:

This review suggests that IP-RA is effective in preventing and treating diabetic toe deformities and ulcers with a modest rate of complications for this specific and often challenging clinical presentation.
Friend or foe? A spatial approach to overlay bicycle and scooter trajectories
Authors: Porojkow Iwan , Lißner Sven
Published: June 2024

Dockless e-scooter schemes have seen increasing popularity in 28 German cities. Increasing use on insufficiently dimensioned bicycle infrastructure can lead to conflicts between e-scooter riders and cyclists. A new approach was developed in order to detect potential zones of conflict by overlaying aggregated bicycle and e-scooter trajectories in the City of Dresden, Germany. Bicycle data is being obtained by the annual STADTRADELN campaign where cyclists record and transmit daily trips via GPS for a period of three weeks. Simultaneously, e-scooter API data has been collected over a course of 8 weeks from June to September 2021. Origin/Destination data has been generated and routed over a OSM network in order to obtain aggregate d e-scooter flows. We extrapolated the aggregated bicycle data to match them with the timeframe of the e-scooter data acquisition. Afterwards we spatially joined both: bicycle and e-scooter flows and calculated the link wise proportion of e-scooter trips in relation to bicycle trip volumes. Two important findings emerged: (1) Residential roads have a higher proportion of e-scooter trips. (2) E-scooters are exposed to high bicycle trip volumes on primary roads with bicycle infrastructure. We conclude that this approach can detect possible links of conflict, where overtaking cyclists or insufficient space can lead to dangerous situations. That approach is biased towards a missing route choice model for e-scooter riders or better route data of e-scooters, which needs further research.
Primary care clinician perspectives on automated nephrology e-consults for diabetic kidney disease: a pre-implementation qualitative study
Authors: Chu Chi D. , Dohan Daniel , Estrella Michelle M. , Shlipak Michael G. , Tuot Delphine S.
Published: June 2024

Background

Many patients with diabetic kidney disease (DKD) do not receive evidence-based, guideline-recommended treatment shown to reduce DKD progression and complications. Proactive electronic consultations (e-consults) are an emerging intervention strategy that could potentially allow nephrologists to provide timely and evidence-based guidance to primary care providers (PCPs) engaged in early DKD care.

Methods

The objective of this study was to explore perspectives about potential barriers and facilitators associated with a proactive e-consult program to improve DKD care delivery. We conducted semi-structured qualitative interviews with PCPs across three different health systems. Interview transcripts were reviewed in a rapid qualitative analysis approach to iteratively identify, refine, and achieve consensus on a final list of themes and subthemes.

Results

A total of 18 interviews were conducted. PCPs across all sites identified similar challenges to delivering guideline-recommended DKD care. PCPs were supportive of the proactive e-consult concept. Three major themes emerged surrounding (1) perceived potential benefits of proactive e-consults, including educational value and improved specialist access; (2) concerns about the proactive nature of e-consults, including the potential to increase PCP workload and the possibility that e-consults could be seen as documenting substandard care; and (3) leveraging of care teams to facilitate recommended DKD care, such as engaging clinic-based pharmacists to implement specialist recommendations from e-consults.

Conclusion

In this pre-implementation qualitative study, PCPs noted potential benefits and identified concerns and implementation barriers for proactive e-consults for DKD care. Strategies that emerged for promoting successful implementation included involving clinic support staff to enact e-consult recommendations and framing e-consults as a system improvement effort to avoid judgmental associations.
PPIH acts as a potential predictive biomarker for patients with common solid tumors
Authors: Ye Jun , Ying Jianchao , Chen Haixia , Wu Zhiping , Huang Chaolin , Zhang Chuan , Chen Zhitao , Chen Haini
Published: June 2024

Background

Our previous studies have indicated that mRNA and protein levels of PPIH are significantly upregulated in Hepatocellular Carcinoma (LIHC) and could act as predictive biomarkers for patients with LIHC. Nonetheless, the expression and implications of PPIH in the etiology and progression of common solid tumors have yet to be explored, including its potential as a serum tumor marker.

Methods

We employed bioinformatics analyses, augmented with clinical sample evaluations, to investigate the mRNA and protein expression and gene regulation networks of PPIH in various solid tumors. We also assessed the association between PPIH expression and overall survival (OS) in cancer patients using Kaplan-Meier analysis with TCGA database information. Furthermore, we evaluated the feasibility and diagnostic efficacy of PPIH as a serum marker by integrating serological studies with established clinical tumor markers.

Results

Through pan-cancer analysis, we found that the expression levels of PPIH mRNA in multiple tumors were significantly different from those in normal tissues. This study is the first to report that PPIH mRNA and protein levels are markedly elevated in LIHC, Colon adenocarcinoma (COAD), and Breast cancer (BC), and are associated with a worse prognosis in these cancer patients. Conversely, serum PPIH levels are decreased in patients with these tumors (LIHC, COAD, BC, gastric cancer), and when combined with traditional tumor markers, offer enhanced sensitivity and specificity for diagnosis.

Conclusion

Our findings propose that PPIH may serve as a valuable predictive biomarker in tumor patients, and its secreted protein could be a potential serum marker, providing insights into the role of PPIH in cancer development and progression.
Systematic druggable genome-wide Mendelian randomization identifies therapeutic targets for lung cancer
Authors: Song Wenfu , Li Yingying , Yao Yaxuan , Sun Shiling , Guan Xutao , Wang Bing
Published: June 2024

Background

Drug repurposing provides a cost-effective approach to address the need for lung cancer prevention and therapeutics. We aimed to identify actionable druggable targets using Mendelian randomization (MR).

Methods

Summary-level data of gene expression quantitative trait loci (eQTLs) were sourced from the eQTLGen resource. We procured genetic associations with lung cancer and its subtypes from the TRICL, ILCCO studies (discovery) and the FinnGen study (replication). We implemented Summary-data-based Mendelian Randomization analysis to identify potential therapeutic targets for lung cancer. Colocalization analysis was further conducted to assess whether the identified signal pairs shared a causal genetic variant.

Findings

In the main analysis dataset, we identified 55 genes that demonstrate a causal relationship with lung cancer and its subtypes. However, in the replication cohort, only three genes were found to have such a causal association with lung cancer and its subtypes, and of these, HYKK (also known as AGPHD1) was consistently present in both the primary analysis dataset and the replication cohort. Following HEIDI tests and colocalization analyses, it was revealed that HYKK (AGPHD1) is associated with an increased risk of squamous cell carcinoma of the lung, with an odds ratio and confidence interval of OR = 1.28,95%CI = 1.24 to 1.33.

Interpretation

We have found that the HYKK (AGPHD1) gene is associated with an increased risk of squamous cell carcinoma of the lung, suggesting that this gene may represent a potential therapeutic target for both the prevention and treatment of lung squamous cell carcinoma.
Caution for psychiatrists: malignant hyperthermia risks with the anesthetic agent succinylcholine (Suxamethonium) during electroconvulsive therapy
Authors: Nakano Masaki , Funayama Michitaka , Takata Taketo , Wakisaka Riko , Koyama Genki , Koreki Akihiro , Ishida Takuto , Uchida Hiroyuki , Mimura Masaru
Published: June 2024

Background

Malignant hyperthermia is a potentially lethal condition triggered by specific anesthetic drugs, especially a depolarizing muscle relaxant of succinylcholine (Suxamethonium). Despite the frequent use of succinylcholine with electroconvulsive therapy (ECT), there has been no reported case of potentially lethal malignant hyperthermia following ECT. In addition, the time interval between the administration of succinylcholine and the onset of malignant hyperthermia has not been outlined in the context of ECT.

Case presentation

We present the case of a 79-year-old woman suffering from severe depression, who experienced severe malignant hyperthermia due to succinylcholine administration during an ECT session. She presented with a high fever of 40.2 °C, tachycardia of 140/min, hypertension with a blood pressure exceeding 200 mmHg, significant muscle rigidity, and impaired consciousness. These symptoms emerged two hours after ECT, which occurred in a psychiatric ward rather than an operating room, and reached their peak in less than 24 h. She was given 60 mg of dantrolene, which quickly reduced the muscular rigidity. Subsequently, she received two additional doses of 20 mg and 60 mg of dantrolene, which brought her fever down to 36.2 °C and completely eased her muscle rigidity within two days after ECT.

Conclusions

This is the first reported case of potentially lethal malignant hyperthermia after ECT. In addition, it highlights the delayed onset of malignant hyperthermia following an ECT procedure, emphasizing the necessity for psychiatrists to recognize its onset even after the treatment. In the light of potentially lethal consequences of malignant hyperthermia, it is critically important for psychiatrists to closely monitor both intraoperative and postoperative patient’s vital signs and characteristic physical presentations, promptly identify any symptomatic emergence, and treat it immediately with dantrolene.
Effects of mobile Internet use on the health of middle-aged and older adults: evidences from China health and retirement longitudinal study
Authors: Wang Ying , Chen Hong
Published: June 2024

The rapid development of digital technology has radically changed people’s lives. Simultaneously, as the population is rapidly aging, academic research is focusing on the use of Internet technology to improve middle-aged and older people’s health, particularly owing to the popularity of mobile networks, which has further increased the population’s accessibility to the Internet. However, related studies have not yet reached a consensus. Herein, empirical analysis of the influence of mobile Internet use on the subjective health and chronic disease status of individuals in their Middle Ages and above was conducted utilizing ordered logit, propensity score matching (PSM), and ordered probit models with data from the 2020 China Health and Retirement Longitudinal Study. The study aimed to provide a theoretical basis and reference for exploring technological advances to empower the development of a healthy Chinese population and to advance the process of healthy aging. The health of middle-aged and older adults mobile Internet users was greatly improved, according to our findings. Further, the use of mobile Internet by these persons resulted in improvements to both their self-assessed health and the state of their chronic diseases. As per the findings of the heterogeneity analysis, the impact of mobile Internet use was shown to be more pronounced on the well-being of middle-aged persons aged 45–60 years compared to those aged ≥ 60 years. Further, the endogeneity test revealed that the PSM model could better eliminate bias in sample selection. The results suggest that the estimates are more robust after eliminating endogeneity, and that failure to disentangle sample selectivity bias would overestimate not only the facilitating effect of mobile Internet use on the self-assessed health impacts of middle-aged and older adults, but also the ameliorating effect of mobile Internet use on the chronic diseases of middle-aged and older adults. The results of the mechanistic analysis suggest that social engagement is an important mediating mechanism between mobile Internet use and the health of middle-aged and older adults. This implies that mobile Internet use increases opportunities for social participation among middle-aged and older adults, thereby improving their health.
Serum S1P level in interstitial lung disease (ILD) is a potential biomarker reflecting the severity of pulmonary function
Authors: Ding Fangping , Wang Zhenyang , Wang Jing , Ma Yingmin , Jin Jiawei
Published: June 2024

Background

sphingosine-1-phosphate (S1P), a naturally occurring sphingolipid, has been involved in pulmonary interstitial remodeling signaling. However, no study has examined its clinical merits for interstitial lung disease (ILD). This study aimed to investigate the serum level of S1P in ILD patients and its clinical correlation with the severity of disease in the two main types of ILDs: the IPF and the CTD-ILD patients.

Methods

This retrospective observational pilot study included 67 ILD patients and 26 healthy controls. These patients were stratified into the IPF group (35) and the CTD-ILD group (32). The severity of ILD was evaluated through pulmonary function indicators and the length of hospital stay.

Results

Serum S1P level was statistically higher in ILD patients than in health control (p = 0.002), while the Serum S1P levels in CTD-ILD and IPF patients were comparable. Serum S1P level further showed statistically negative correlation with pulmonary function indexes (TLC% pred, FVC% pred and FEV1% pred) and positive correlation with length of hospital stay (r = -0.38, p = 0.04; r = -0.41, p = 0.02, r = -0.37, p = 0.04; r = 0.42, p = 0.02, respectively) in CTD-ILD patients, although serum S1P level was not significantly correlated with inflammatory indexes. The IPF patients failed to exhibit a significant correlation of serum S1P level with pulmonary function and length of hospital stay.

Conclusions

Serum S1P level might be a clinically useful biomarker in evaluating the severity of CTD-ILD patients rather than IPF patients.
Prediction of subsequent fragility fractures: application of machine learning
Authors: Zabihiyeganeh Mozhdeh , Mirzaei Alireza , Tabrizian Pouria , Rezaee Aryan , Sheikhtaheri Abbas , Kadijani Azade Amini , Kadijani Bahare Amini , Sharifi Kia Ali
Published: June 2024

Background

Machine learning (ML) has shown exceptional promise in various domains of medical research. However, its application in predicting subsequent fragility fractures is still largely unknown. In this study, we aim to evaluate the predictive power of different ML algorithms in this area and identify key features associated with the risk of subsequent fragility fractures in osteoporotic patients.

Methods

We retrospectively analyzed data from patients presented with fragility fractures at our Fracture Liaison Service, categorizing them into index fragility fracture (n = 905) and subsequent fragility fracture groups (n = 195). We independently trained ML models using 27 features for both male and female cohorts. The algorithms tested include Random Forest, XGBoost, CatBoost, Logistic Regression, LightGBM, AdaBoost, Multi-Layer Perceptron, and Support Vector Machine. Model performance was evaluated through 10-fold cross-validation.

Results

The CatBoost model outperformed other models, achieving 87% accuracy and an AUC of 0.951 for females, and 93.4% accuracy with an AUC of 0.990 for males. The most significant predictors for females included age, serum C-reactive protein (CRP), 25(OH)D, creatinine, blood urea nitrogen (BUN), parathyroid hormone (PTH), femoral neck Z-score, menopause age, number of pregnancies, phosphorus, calcium, and body mass index (BMI); for males, the predictors were serum CRP, femoral neck T-score, PTH, hip T-score, BMI, BUN, creatinine, alkaline phosphatase, and spinal Z-score.

Conclusion

ML models, especially CatBoost, offer a valuable approach for predicting subsequent fragility fractures in osteoporotic patients. These models hold the potential to enhance clinical decision-making by supporting the development of personalized preventative strategies.
What are medical students taught about persistent physical symptoms? A scoping review of the literature
Authors: Nagel Catie , Queenan Chloe , Burton Chris
Published: June 2024

Background

Persistent Physical Symptoms (PPS) include symptoms such as chronic pain, and syndromes such as chronic fatigue. They are common, but are often inadequately managed, causing distress and higher costs for health care systems. A lack of teaching about PPS has been recognised as a contributing factor to poor management.

Methods

The authors conducted a scoping review of the literature, including all studies published before 31 March 2023. Systematic methods were used to determine what teaching on PPS was taking place for medical undergraduates. Studies were restricted to publications in English and needed to include undergraduate medical students. Teaching about cancer pain was excluded. After descriptive data was extracted, a narrative synthesis was undertaken to analyse qualitative findings.

Results

A total of 1116 studies were found, after exclusion, from 3 databases. A further 28 studies were found by searching the grey literature and by citation analysis. After screening for relevance, a total of 57 studies were included in the review. The most commonly taught condition was chronic non-cancer pain, but overall, there was a widespread lack of teaching and learning on PPS. Several factors contributed to this lack including: educators and learners viewing the topic as awkward, learners feeling that there was no science behind the symptoms, and the topic being overlooked in the taught curriculum. The gap between the taught curriculum and learners’ experiences in practice was addressed through informal sources and this risked stigmatising attitudes towards sufferers of PPS.

Conclusion

Faculties need to find ways to integrate more teaching on PPS and address the barriers outlined above. Teaching on chronic non-cancer pain, which is built on a science of symptoms, can be used as an exemplar for teaching on PPS more widely. Any future teaching interventions should be robustly evaluated to ensure improvements for learners and patients.
Physical and insecticidal durability of Interceptor®, Interceptor® G2, and PermaNet® 3.0 insecticide-treated nets in Burkina Faso: results of durability monitoring in three sites from 2019 to 2022
Authors: Raharinjatovo Jacky , Dabiré Roch Kounbobr , Esch Keith , Soma Dieudonné Diloma , Hien Aristide , Camara Tiecoura , Diouf Mame Birame , Belemvire Allison , Gerberg Lilia , Awolola Taiwo Samson , Koné Adama , Jacob Djenam , Vandecandelaere Sophie , Baes Marie , Poyer Stephen
Published: June 2024

Background

National Malaria Programmes (NMPs) monitor the durability of insecticide-treated nets (ITNs) to inform procurement and replacement decisions. This is crucial for new dual active ingredients (AI) ITNs, for which less data is available. Pyrethroid-only ITN (Interceptor®) and dual AI (Interceptor® G2, and PermaNet® 3.0) ITNs were assessed across three health districts over 36 months in southern Burkina Faso to estimate median ITN survival, insecticidal efficacy, and to identify factors contributing to field ITN longevity.

Methods

Durability was monitored through a prospective study of a cohort of nets distributed during the 2019 mass campaign. Three health districts were selected for their similar pyrethroid-resistance, environmental, epidemiological, and population profiles. Households were recruited after the mass campaign, with annual household questionnaire follow-ups over three years. Each round, ITNs were withdrawn for bioassays and chemical residue testing. Key measures were the percentage of cohort ITNs in serviceable condition, insecticidal effectiveness, and chemical residue content against target dose. Cox proportional hazard models were used to identify determinants influencing ITN survival.

Results

At endline, the median useful life was 3.2 (95% CI 2.5–4.0) years for PermaNet® 3.0 ITNs in Orodara, 2.6 (95% CI 1.9–3.2) years for Interceptor® G2 ITNs in Banfora and 2.4 (95% CI 1.9–2.9) years for Interceptor® ITNs in Gaoua. Factors associated with ITN survival included cohort ITNs from Orodara (adjusted hazard ratio (aHR) = 0.58, p = 0.026), households seeing less rodents (aHR = 0.66, p = 0.005), female-headed households (aHR = 0.66, p = 0.044), exposure to social behavior change (SBC) messages (aHR = 0.52, ≤ 0.001) and folding nets when not in use (aHR = 0.47, p < 0.001). At endline, PermaNet® 3.0 ITN recorded 24-h mortality of 26% against resistant mosquitos on roof panels, with an 84% reduction in PBO content. Interceptor® G2 ITN 72-h mortality was 51%, with a 67% reduction in chlorfenapyr content. Interceptor® ITN 24-h mortality was 71%, with an 84% reduction in alpha-cypermethrin content.

Conclusion

Only PermaNet® 3.0 ITNs surpassed the standard three-year survival threshold. Identified protective factors should inform SBC messaging. Significant decreases in chemical content and resulting impact on bioefficacy warrant more research in other countries to better understand dual AI ITN insecticidal performance.
Diet quality from mid to late life and its association with physical frailty in late life in a cohort of Chinese adults
Authors: Lai Jun S. , Chua Kevin Y. , Li Huiqi , Koh Woon-Puay
Published: June 2024

Background

It is unclear if improving diet quality after midlife could reduce the risk of physical frailty at late life. We aimed to associate changes in diet quality after midlife with physical frailty at late life.

Methods

Diet quality in 12,580 participants from the Singapore Chinese Health Study was assessed with the Dietary Approaches to Stop Hypertension (DASH) scores at baseline (1993–1998; mean age 53 years) and follow-up 3 (2014–2016; mean age 73 years). Physical frailty was assessed using the modified Cardiovascular Health Study phenotype at follow-up 3. Multivariable logistic regressions examined associations between DASH scores and physical frailty.

Results

Comparing participants in extreme quartiles of DASH scores, the odds ratios (OR) [95% confidence interval (CI)] for physical frailty were 0.85 (0.73,0.99) at baseline and 0.49 (0.41, 0.58) at follow-up 3. Compared to participants with consistently low DASH scores, participants with consistently high scores (OR 0.74, 95% CI: 0.59, 0.94) and those with > 10% increase in scores (OR 0.78, 95% CI: 0.64, 0.95) had lower odds of frailty. Compared to those in the lowest DASH tertiles at both time-points, significantly lower odds of physical frailty were observed in those who were in the highest DASH tertiles at both time points [0.59 (0.48, 0.73)], and in those who improved their scores from the lowest [0.68 (0.51, 0.91)] or second tertile at baseline [0.61 (0.48, 0.76)] to the highest tertile at follow-up 3.

Conclusions

Maintaining a high diet quality or a substantial improvement in diet quality after midlife could lower the risk of physical frailty at late life.
Diversifying the anthracycline class of anti-cancer drugs identifies aclarubicin for superior survival of acute myeloid leukemia patients
Authors: Qiao Xiaohang , van der Zanden Sabina Y. , Li Xiaoyang , Tan Minkang , Zhang Yunxiang , Song Ji-Ying , van Gelder Merle A. , Hamoen Feija L. , Janssen Lennert , Zuur Charlotte L. , Pang Baoxu , van Tellingen Olaf , Li Junmin , Neefjes Jacques
Published: June 2024

The efficacy of anthracycline-based chemotherapeutics, which include doxorubicin and its structural relatives daunorubicin and idarubicin, remains almost unmatched in oncology, despite a side effect profile including cumulative dose-dependent cardiotoxicity, therapy-related malignancies and infertility. Detoxifying anthracyclines while preserving their anti-neoplastic effects is arguably a major unmet need in modern oncology, as cardiovascular complications that limit anti-cancer treatment are a leading cause of morbidity and mortality among the 17 million cancer survivors in the U.S. In this study, we examined different clinically relevant anthracycline drugs for a series of features including mode of action (chromatin and DNA damage), bio-distribution, anti-tumor efficacy and cardiotoxicity in pre-clinical models and patients. The different anthracycline drugs have surprisingly individual efficacy and toxicity profiles. In particular, aclarubicin stands out in pre-clinical models and clinical studies, as it potently kills cancer cells, lacks cardiotoxicity, and can be safely administered even after the maximum cumulative dose of either doxorubicin or idarubicin has been reached. Retrospective analysis of aclarubicin used as second-line treatment for relapsed/refractory AML patients showed survival effects similar to its use in first line, leading to a notable 23% increase in 5-year overall survival compared to other intensive chemotherapies. Considering individual anthracyclines as distinct entities unveils new treatment options, such as the identification of aclarubicin, which significantly improves the survival outcomes of AML patients while mitigating the treatment-limiting side-effects. Building upon these findings, an international multicenter Phase III prospective study is prepared, to integrate aclarubicin into the treatment of relapsed/refractory AML patients.
Access to mifepristone, misoprostol, and contraceptive medicines in eight countries in the Eastern Mediterranean Region: descriptive analyses of country-level assessments
Authors: Afifi Mohamed , Hemachandra Nilmini , Sikandar Qais , Hajjeh Rana , Loi Ulrika Rehnström , Läser Laurence , Qato Dima , Abdul Zahir Sidiqui , Chikvaidze Paata , Abbas Raghad Abdul Redha , Al-Kinani Khalid , Hasan Hanan , El-Kak Faysal , Rady Alissar , Brngali Omelkheir , Hashem Mohamed , Bezad Rachid , Amine Cheikh , Hafid Hachri , Afzal Sabeen , Zaidi Raza , Thom Ellen , Uzma Qudsia , Al-Masri Hadeel , Qamar Zakri Abu , Ghanem Buthaina , Ward Itimad Abu , Shaar Ali Nashat , Farah Ubah , Mohamed Yusuf Omar , Umar Al-Umra , Eladawy Maha
Published: June 2024

Background

Despite their importance in reducing maternal mortality, information on access to Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region is limited.

Methods

A standardized assessment tool measuring access to Mifepristone, Misoprostol, and contraceptive medicines included in the WHO essential medicines list (EML) was implemented in eight countries in the Eastern Mediterranean Region (Afghanistan, Iraq, Lebanon, Libya, Morocco, Palestine, Pakistan, and Somalia) between 2020–2021. The assessment focused on five access measures: 1) the inclusion of medicines in national family planning guidelines; 2) inclusion of medicines in comprehensive abortion care guidelines; 3) inclusion of medicines on national essential medicines lists; 4) medicines registration; and 5) procurement and forecasting of Mifepristone, Misoprostol, and contraceptive medicines. A descriptive analysis of findings from these eight national assessments was conducted.

Results

Only Lebanon and Pakistan included all 12 contraceptives that are enlisted in the WHO-EML within their national family planning guidelines. Only Afghanistan and Lebanon included mifepristone and mifepristone-misoprostol combination in post-abortion care guidelines, but these medicines were not included in their national EMLs. Libya and Somalia lacked a national regulatory authority for medicines registration. Most contraceptives included on the national EMLs for Lebanon, Morocco and Pakistan were registered. Misoprostol was included on the EMLs—and registered—in six countries (Afghanistan, Iraq, Lebanon, Morocco, Palestine, and Pakistan). However, only three countries procured misoprostol (Iraq, Morocco, and Somalia).

Conclusion

These findings can guide efforts aimed at improving the availability of Mifepristone, Misoprostol, and contraceptive medicines in the Eastern Mediterranean Region. Opportunities include expanding national EMLs to include more options for Mifepristone, Misoprostol, and contraceptive medicines and strengthening the registration and procurement systems to ensure these medicines’ availability were permitted under national law and where culturally acceptable.
Online training to improve BLS performance with dispatcher assistance? Results of a cluster-randomised controlled simulation trial
Authors: Bathe Janina , Daubmann Anne , Doehn Christoph , Napp Antonia , Raudies Marco , Beck Stefanie
Published: June 2024

Background

The prognosis for patients improves significantly with effective cardiopulmonary resuscitation (CPR) performed by bystanders. Current research indicates that individuals who receive CPR from trained bystanders have a greater likelihood of survival compared to those who receive dispatcher-assisted CPR from untrained laypersons. This cluster-randomised controlled trial assessed the impact of a 30-min online training session prior to a simulated cardiac arrest situation with dispatcher-assisted CPR (DA-CPR) on enhancing Basic Life Support (BLS) performance.

Methods

This study was performed in 2018 in Hamburg, Germany. The primary outcome was the practical BLS skills of high school students in simulated out-of-hospital cardiac arrest scenarios with dispatcher assistance. The intervention group participants underwent a 30-min online BLS training session, while the control group did not receive an intervention. It was hypothesized that the average practical BLS scores of the intervention group would be 1.5 points higher than those of the control group.

Results

BLS assessments of 286 students of 16 different classes were analysed. The estimated mean BLS score in the intervention group was 7.60 points (95% CI: 6.76 to 8.44) compared to 6.81 (95% CI: 5.97 to 7.65) in the control group adjusted for BLS training and class. Therefore, the estimated mean difference between the groups was 0.79 (95% CI: -0.40 to 1.97) and not significantly different (p-value: 0.176). Based on a logistic regression analysis the intervention had only a significant effect on the chance to pass the item “vertically above the chest” (OR = 4.99; 95% CI: 1.46 to 17.12) adjusted for BLS training and class.

Conclusion

Prior online training exhibits beneficial impacts on the BLS performance of bystanders during DA-CPR. To maximise the effect size, online training should be incorporated into a set of interventions that are mutually complementary and specifically designed for the target participants.

Trial registration

DRKS00033531. "Kann online Training Laien darauf vorbereiten Reanimationsmaßnahmen unter Anleitung der Leitstelle adäquat durchzuführen? " Registered on January 29, 2024.
Hooked on zombie worms? Genetic blueprints of bristle formation in Osedax japonicus (Annelida)
Authors: Tilic Ekin , Miyamoto Norio , Herranz Maria , Worsaae Katrine
Published: June 2024

Background

This study sheds light on the genetic blueprints of chaetogenesis (bristle formation), a complex biomineralization process essential not only for the diverse group of bristle worms (annelids) but also for other spiralians. We explore the complex genetic mechanisms behind chaetae formation in Osedax japonicus, the bone-devouring deep-sea worm known for its unique ecological niche and morphological adaptations.

Results

We characterized the chaetal structure and musculature using electron microscopy and immunohistochemistry, and combined RNAseq of larval stages with in-situ hybridization chain reaction (HCR) to reveal gene expression patterns integral to chaetogenesis. Our findings pinpoint a distinct surge in gene expression during the larval stage of active chaetogenesis, identifying specific genes and cells involved.

Conclusions

Our research underscores the value of studying on non-model, "aberrant" organisms like Osedax, whose unique, temporally restricted chaetogenesis provided insights into elevated gene expression across specific larval stages and led to the identification of genes critical for chaetae formation. The genes identified as directly involved in chaetogenesis lay the groundwork for future comparative studies across Annelida and Spiralia, potentially elucidating the homology of chaetae-like chitinous structures and their evolution.