bluuebunny/crossref_metadata_2025 huggingface dataset:
Non-binary possibilities of creative agency
Authors: Harris Daniel X
Published: April 2023

In this short essay I draw on the works of Maxine Greene, Donna Haraway and Anna Craft to reject traditional dualisms and binaries, in favour of proposing a possibility studies that is driven by an activist creative agency, in which thinking and doing are entangled and activated across multispecies contexts, and across multiple temporalities. I call readers to action in living potentially harder but more fulfilling, interconnected and sustainable lives and work, as these three philosophers do, through an emergent possibility studies with the ability to radically change education, scholarship and research, through ‘wide-awake’ hearts, minds and relationships.
Curiosity and networks of possibility
Authors: Zurn Perry , Bassett Dani S.
Published: April 2023

The concept of possibility has long been intertwined with the discourse of curiosity. The way things might be can disturb the way things are, but we have to be ready for it. Curiosity provides that readiness. There is a kind of critical curiosity that opens the space of possibility by exploiting the instability of the present, second guessing its current contours and exploring how else the world might be constructed or understood. Put differently, it is because of curiosity that revolutions in science, knowledge, and society become possible. The two work in tandem. If curiosity can be a critical comportment toward the possible, then to fully understand possibility one must also understand curiosity. In this brief essay, we take a moment to think that jointure. How might curiosity studies illuminate possibility studies? From our respective vantage points of philosophy and neuroscience, we analyze possibility through curiosity. In doing so, we ultimately illuminate the novelty bias that informs both concepts, the network structures that characterize them, and the adjacent worlds and opportunities they offer.
Vonoprazan: A New Potassium-Competitive Acid Blocker
Authors: St. Onge Erin , Phillips Bradley
Published: April 2023

Objective: To review the safety, efficacy, and tolerability of vonoprazan for the treatment of Helicobacter pylori infection in adults. Data Sources: A literature search was performed through PubMed using the following key terms: vonoprazan, Voquezna, TAK-438, potassium-competitive acid blocker, H pylori, and gastrointestinal. Study Selection and Data Extraction: Selected articles included those which described clinical studies of the pharmacology, pharmacokinetics, efficacy, safety, or tolerability of vonoprazan. Data Synthesis: Vonoprazan works by competing with potassium on the proton pump to inhibit gastric acid secretion. Phase 3 clinical trials have shown that vonoprazan is noninferior to proton pump inhibitors (PPIs) as a component of H pylori eradication regimens. Vonoprazan has also shown promise in duodenal ulcer-healing rates and in reducing symptoms of heartburn. Common adverse effects associated with vonoprazan include nasopharyngitis, diarrhea, constipation, flatulence, dyspepsia, headache, and abdominal pain. Conclusion: Clinical practice guidelines recommend PPIs as the antisecretory agent of choice in H pylori eradication regimens with histamine-2 receptor antagonists (H2RAs) as potential alternatives. However, the use of either class of medications may be limited by adverse effects, drug interactions, and tolerability. Potassium-competitive acid blockers (P-CABs), like vonoprazan, may be safe and effective alternative antisecretory agents for H pylori eradication regimens, as well as other gastrointestinal disorders.
Comparison of postoperative nausea and vomiting between Remimazolam and Propofol in Patients undergoing oral and maxillofacial surgery: a prospective Randomized Controlled Trial
Authors: Kim Eun-Jung , Kim Cheul-Hong , Yoon Ji-Young , Byeon Gyeong-Jo , Kim Hee Young , Choi Eun-Ji
Published: April 2023

Background

Remimazolam is a recently approved, ultra-short-acting benzodiazepine. However, few studies have investigated remimazolam in relation to postoperative nausea and vomiting (PONV). This study aimed to compare the effects of remimazolam and propofol on PONV in patients undergoing oral and maxillofacial surgery.

Methods

Patients (n = 206) aged 19–65 years who were scheduled for oral and maxillofacial surgery were randomized into two groups, the remimazolam (R) and propofol group (P). In the R group (n = 94), remimazolam was used to induce anesthesia at 12 mg/kg/h and to maintain anesthesia at 1–2 mg/kg/h. In the P group (n = 95), anesthesia was induced and maintained with propofol (target effect-site concentration: 3–5 µg/ml). In both groups, remifentanil was administered at a target effect-site concentration of 2.5-4 ng/ml. The primary outcome was the overall incidence of PONV during the first 24 h after surgery. Secondary outcomes included the severity of nausea, use of rescue antiemetics, severity of postoperative pain, use of rescue analgesia, and quality of recovery.

Results

The incidence of PONV during the first 24 h after surgery was 11.7% and 10.5% in the R group and P group, respectively, and there was no significant difference in the severity of nausea (P > 0.05). Ten patients in the R group and ten patients in the P group required rescue antiemetics during the first 24 h after surgery (P = 0.98). No inter-group differences were observed in terms of postoperative pain score, use of rescue analgesia, and quality of recovery (P > 0.05).

Conclusions

In this study, remimazolam did not increase the incidence and severity of PONV compared with propofol.

Trial registration

KCT0006965, Clinical Research Information Service (CRIS), Republic of Korea. Registration date: 26/01/2022.
Association of ABO blood groups with venous thrombosis recurrence in middle-aged patients: insights from a weighted Cox analysis dedicated to ambispective design
Authors: Munsch Gaëlle , Goumidi Louisa , van Hylckama Vlieg Astrid , Ibrahim-Kosta Manal , Bruzelius Maria , Deleuze Jean-François , Rosendaal Frits R. , Jacqmin-Gadda Hélène , Morange Pierre-Emmanuel , Trégouët David-Alexandre
Published: April 2023

Background

In studies of time-to-events, it is common to collect information about events that occurred before the inclusion in a prospective cohort. When the studied risk factors are independent of time, including both pre- and post-inclusion events in the analyses, generally referred to as relying on an ambispective design, increases the statistical power but may lead to a selection bias. In the field of venous thromboembolism (VT),ABOblood groups have been the subject of extensive research due to their substantial effect on VT risk. However, few studies have investigated their effect on the risk of VT recurrence. Motivated by the study of the association of genetically determinedABOblood groups with VT recurrence, we propose a methodology to include pre-inclusion events in the analysis of ambispective studies while avoiding the selection bias due to mortality.

Methods

This work relies on two independent cohorts of VT patients, the French MARTHA study built on an ambispective design and the Dutch MEGA study built on a standard prospective design. For the analysis of the MARTHA study, a weighted Cox model was developed where weights were defined by the inverse of the survival probability at the time of data collection about the events. Thanks to the collection of information on the vital status of patients, we could estimate the survival probabilities using a delayed-entry Cox model on the death risk. Finally, results obtained in both studies were then meta-analysed.

Results

In the combined sample totalling 2,752 patients including 993 recurrences, the A1 blood group has an increased risk (Hazard Ratio (HR) of 1.18,p = 4.2 × 10–3) compared with the O1 group, homogeneously in MARTHA and in MEGA. The same trend (HR = 1.19,p = 0.06) was observed for the less frequent A2 group.

Conclusion

The proposed methodology increases the power of studies relying on an ambispective design which is frequent in epidemiologic studies about recurrent events. This approach allowed to clarify the association ofABOblood groups with the risk of VT recurrence. Besides, this methodology has an immediate field of application in the context of genome wide association studies.
Hospital mortality prediction in traumatic injuries patients: comparing different SMOTE-based machine learning algorithms
Authors: Hassanzadeh Roghayyeh , Farhadian Maryam , Rafieemehr Hassan
Published: April 2023

Background

Trauma is one of the most critical public health issues worldwide, leading to death and disability and influencing all age groups. Therefore, there is great interest in models for predicting mortality in trauma patients admitted to the ICU. The main objective of the present study is to develop and evaluate SMOTE-based machine-learning tools for predicting hospital mortality in trauma patients with imbalanced data.

Methods

This retrospective cohort study was conducted on 126 trauma patients admitted to an intensive care unit at Besat hospital in Hamadan Province, western Iran, from March 2020 to March 2021. Data were extracted from the medical information records of patients. According to the imbalanced property of the data, SMOTE techniques, namely SMOTE, Borderline-SMOTE1, Borderline-SMOTE2, SMOTE-NC, and SVM-SMOTE, were used for primary preprocessing. Then, the Decision Tree (DT), Random Forest (RF), Naive Bayes (NB), Artificial Neural Network (ANN), Support Vector Machine (SVM), and Extreme Gradient Boosting (XGBoost) methods were used to predict patients' hospital mortality with traumatic injuries. The performance of the methods used was evaluated by sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy, Area Under the Curve (AUC), Geometric Mean (G-means), F1 score, and P-value of McNemar's test.

Results

Of the 126 patients admitted to an ICU, 117 (92.9%) survived and 9 (7.1%) died. The mean follow-up time from the date of trauma to the date of outcome was 3.98 ± 4.65 days. The performance of ML algorithms is not good with imbalanced data, whereas the performance of SMOTE-based ML algorithms is significantly improved. The mean area under the ROC curve (AUC) of all SMOTE-based models was more than 91%. F1-score and G-means before balancing the dataset were below 70% for all ML models except ANN. In contrast, F1-score and G-means for the balanced datasets reached more than 90% for all SMOTE-based models. Among all SMOTE-based ML methods, RF and ANN based on SMOTE and XGBoost based on SMOTE-NC achieved the highest value for all evaluation criteria.

Conclusions

This study has shown that SMOTE-based ML algorithms better predict outcomes in traumatic injuries than ML algorithms. They have the potential to assist ICU physicians in making clinical decisions.
Asking informed consent may lead to significant participation bias and suboptimal cardiovascular risk management in learning healthcare systems
Authors: Zondag Anna G. M. , Groenhof T. Katrien J. , van der Graaf Rieke , van Solinge Wouter W. , Bots Michiel L. , Haitjema Saskia ,   UCC-CVRM study group, de Jong Pim A. , Verhaar Marianne C. , Visseren Frank L. J. , Asselbergs Folkert W. , van der Kaaij Niels P. , Hoefer Imo E. , de Borst Gert J. , Ruigrok Ynte M. , Hollander Monika , Lely A. Titia , Emmelot-Vonk Mariëlle H.
Published: April 2023

Background

The Utrecht Cardiovascular Cohort – CardioVascular Risk Management (UCC-CVRM) was set up as a learning healthcare system (LHS), aiming at guideline based cardiovascular risk factor measurement in all patients in routine clinical care. However, not all patients provided informed consent, which may lead to participation bias. We aimed to study participation bias in a LHS by assessing differences in and completeness of cardiovascular risk management (CVRM) indicators in electronic health records (EHRs) of consenting, non-consenting, and non-responding patients, using the UCC-CVRM as an example.

Methods

All patients visiting the University Medical Center Utrecht for first time evaluation of a(n) (a)symptomatic vascular disease or condition were invited to participate. Routine care data was collected in the EHR and an informed consent was asked. Differences in patient characteristics were compared between consent groups. We performed multivariable logistic regression to identify determinants of non-consent. We used multinomial regression for an exploratory analysis for the determinants of non-response. Presence of CVRM indicators were compared between consent groups. A waiver (19/641) was obtained from our ethics committee.

Results

Out of 5730 patients invited, 2378 were consenting, 1907 non-consenting, and 1445 non-responding. Non-consent was related to young and old age, lower education level, lower BMI, physical activity and haemoglobin levels, higher heartrate, cardiovascular disease history and absence of proteinuria. Non-response increased with young and old age, higher education level, physical activity, HbA1c and decreased with lower levels of haemoglobin, BMI, and systolic blood pressure. Presence of CVRM indicators was 5–30% lower in non-consenting patients and even lower in non-responding patients, compared to consenting patients. Non-consent and non-response varied across specialisms.

Conclusions

A traditional informed consent procedure in a LHS may lead to participation bias and potentially to suboptimal CVRM, which is detrimental for feedback on findings in a LHS. This underlines the importance of reassessing the informed consent procedure in a LHS.
Hierarchical network meta-analysis models for synthesis of evidence from randomised and non-randomised studies
Authors: Hussein Humaira , Abrams Keith R. , Gray Laura J. , Anwer Sumayya , Dias Sofia , Bujkiewicz Sylwia
Published: April 2023

Background

With the increased interest in the inclusion of non-randomised data in network meta-analyses (NMAs) of randomised controlled trials (RCTs), analysts need to consider the implications of the differences in study designs as such data can be prone to increased bias due to the lack of randomisation and unmeasured confounding. This study aims to explore and extend a number of NMA models that account for the differences in the study designs, assessing their impact on the effect estimates and uncertainty.

Methods

Bayesian random-effects meta-analytic models, including naïve pooling and hierarchical models differentiating between the study designs, were extended to allow for the treatment class effect and accounting for bias, with further extensions allowing for bias terms to vary depending on the treatment class. Models were applied to an illustrative example in type 2 diabetes; using data from a systematic review of RCTs and non-randomised studies of two classes of glucose-lowering medications: sodium-glucose co-transporter 2 inhibitors and glucagon-like peptide-1 receptor agonists.

Results

Across all methods, the estimated mean differences in glycated haemoglobin after 24 and 52 weeks remained similar with the inclusion of observational data. The uncertainty around these estimates reduced when conducting naïve pooling, compared to NMA of RCT data alone, and remained similar when applying hierarchical model allowing for class effect. However, the uncertainty around these effect estimates increased when fitting hierarchical models allowing for the differences in study design. The impact on uncertainty varied between treatments when applying the bias adjustment models. Hierarchical models and bias adjustment models all provided a better fit in comparison to the naïve-pooling method.

Conclusions

Hierarchical and bias adjustment NMA models accounting for study design may be more appropriate when conducting a NMA of RCTs and observational studies. The degree of uncertainty around the effectiveness estimates varied depending on the method but use of hierarchical models accounting for the study design resulted in increased uncertainty. Inclusion of non-randomised data may, however, result in inferences that are more generalisable and the models accounting for the differences in the study design allow for more detailed and appropriate modelling of complex data, preventing overly optimistic conclusions.
SGLT-2 inhibitors may increase ultrafiltration in incident peritoneal dialysis patients: a case report
Authors: Lai Jia-Wen , Lin Hsuan-Jen , Chou Che-Yi
Published: April 2023

Background

Adequate fluid removal to achieve euvolemic status can be difficult in patients with incident peritoneal dialysis (PD). Limited treatments such as increased high dextrose PD solutions and icodextrin are currently available. We reported four incident PD patients whose’ ultrafiltration volume was increased after sodium-glucose cotransporter-2 inhibitors.

Case presentation.

The four reported cases were diabetic kidney disease stage 5 (cases 1–3) and IgA nephritis (case 4) patients whostartedt PD because of acute pulmonary edema (case 1 and 3), nausea vomiting (case 2), and hyperkalemia (case 4). They had an ultrafiltration volume of 700-1000 ml per day but hpersistentted peripheral pitting edema or pulmonary edema. Their ultrafiltration volincreased after dapagliflozin 5 mg daily, and the fluid overload symptoms ere improved. No hypotension, or hypoglycemia was found, and the urine was not increased during dapagliflozin treatment.

Conclusions

SGLT-2 inhibitors may increase ultrafiltration in incident PD patients. More studies are needed to support the safety of SGLT-2 inhibitors in PD patients.
Cycling in primary progressive multiple sclerosis (CYPRO): study protocol for a randomized controlled superiority trial evaluating the effects of high-intensity interval training in persons with primary progressive multiple sclerosis
Authors: Kupjetz Marie , Joisten Niklas , Rademacher Annette , Gonzenbach Roman , Bansi Jens , Zimmer Philipp
Published: April 2023

Background

Primary progressive multiple sclerosis (PPMS) is the least prevalent multiple sclerosis (MS) phenotype. For persons with PPMS (pwPPMS), pharmacological treatment options are limited. As a complementary non-pharmacological treatment, endurance training improves the health-related quality of life (HRQoL), numerous MS symptoms, and MS-related performance impediments. High-intensity interval training (HIIT) has been shown to induce superior effects compared to moderate-intensity continuous training (MCT). As current evidence is based on MS samples with mixed phenotypes, generalizability to pwPPMS remains unclear.

Methods

CYPRO is a parallel-group, single-center, and single-blind randomized controlled superiority trial evaluating the effects of HIIT compared to MCT in pwPPMS. Sixty-one pwPPMS are randomized (1:1) to perform volume-matched HIIT or MCT sessions on bicycle ergometers two to three times per week in addition to standard rehabilitative care during their three-week inpatient stay at Valens rehabilitation clinic, Switzerland. Standard rehabilitative care comprises endurance and strength training, physiotherapy, and occupational therapy. HIIT sessions include six 90-second intervals at 95% peak heart rate (HRpeak), interspersed by 90-second active breaks with unloaded pedaling, aimed to reach 60%HRpeak. MCT represents the standard treatment at Valens rehabilitation clinic and is performed as continuous cycling at 60%HRpeak for the duration of 26 minutes. The primary outcome is cardiorespiratory fitness, assessed as peak oxygen consumption (V̇O2peak) during cardiopulmonary exercise testing (CPET). Secondary outcomes include peak power output during CPET, walking capacity, cognitive performance, HRQoL, fatigue, anxiety and depressive symptoms, and blood-derived biomarkers (e.g., serum neurofilament light chain, glial fibrillary acidic protein, kynurenine pathway metabolites) related to MS pathophysiology. All outcomes are assessed at baseline and discharge after three weeks. Venous blood sampling is additionally performed immediately and two hours after the first HIIT or MCT session.

Discussion

CYPRO will expand current knowledge on symptom management and rehabilitation in MS to the subpopulation of pwPPMS, and will contribute to the exploration of potential disease-modifying effects of endurance training in MS. The superiority design of CYPRO will allow deriving explicit recommendations on endurance training design in pwPPMS that can be readily translated into clinical practice.

Trial registration

CYPRO has been prospectively registered at ClinicalTrials.gov on 8 February 2022 (NCT05229861).
Developing DELPHI expert consensus rules for a digital twin model of acute stroke care in the neuro critical care unit
Authors: Dang Johnny , Lal Amos , Montgomery Amy , Flurin Laure , Litell John , Gajic Ognjen , Rabinstein Alejandro ,   on behalf of The Digital Twin Platform for education, research, and healthcare delivery investigator group, Cervantes-Arslanian Anna , Marcellino Chris , Robinson Chris , Kramer Christopher L. , Freeman David W. , Hwang David Y. , Manno Edward , Wijdicks Eelco , Siegel Jason , Fugate Jennifer , Gomes Joao A. , Burns Joseph , Gobeske Kevin , Hawkes Maximiliano , Couillard Philippe , Hocker Sara , Datar Sudhir , Chakraborty Tia
Published: April 2023

Introduction

Digital twins, a form of artificial intelligence, are virtual representations of the physical world. In the past 20 years, digital twins have been utilized to track wind turbines' operations, monitor spacecraft's status, and even create a model of the Earth for climate research. While digital twins hold much promise for the neurocritical care unit, the question remains on how to best establish the rules that govern these models. This model will expand on our group’s existing digital twin model for the treatment of sepsis.

Methods

The authors of this project collaborated to create a Direct Acyclic Graph (DAG) and an initial series of 20 DELPHI statements, each with six accompanying sub-statements that captured the pathophysiology surrounding the management of acute ischemic strokes in the practice of Neurocritical Care (NCC). Agreement from a panel of 18 experts in the field of NCC was collected through a 7-point Likert scale with consensus defined a-priori by ≥ 80% selection of a 6 (“agree”) or 7 (“strongly agree”). The endpoint of the study was defined as the completion of three separate rounds of DELPHI consensus. DELPHI statements that had met consensus would not be included in subsequent rounds of DELPHI consensus. The authors refined DELPHI statements that did not reach consensus with the guidance of de-identified expert comments for subsequent rounds of DELPHI. All DELPHI statements that reached consensus by the end of three rounds of DELPHI consensus would go on to be used to inform the construction of the digital twin model.

Results

After the completion of three rounds of DELPHI, 93 (77.5%) statements reached consensus, 11 (9.2%) statements were excluded, and 16 (13.3%) statements did not reach a consensus of the original 120 DELPHI statements.

Conclusion

This descriptive study demonstrates the use of the DELPHI process to generate consensus among experts and establish a set of rules for the development of a digital twin model for use in the neurologic ICU. Compared to associative models of AI, which develop rules based on finding associations in datasets, digital twin AI created by the DELPHI process are easily interpretable models based on a current understanding of underlying physiology.
Robot-assisted percutaneous balloon compression for trigeminal neuralgia- preliminary experiences
Authors: Li Ning , Sun Tao , Hu Bin , Zhao Kun , Zhang Changming , Liu Jinlong , Yang Chao
Published: April 2023

Objectives

This study aims to discuss the availability of robot-assisted percutaneous balloon compression (PBC) for trigeminal neuralgia (TN) and share our preliminary experiences.

Methods

Patients with TN who underwent robot-assisted PBC from June to September 2022 were enrolled. We designed a fixing plug for robot-assisted PBC, three-dimensional structured light registration was used, puncture trajectory was the line connects the medial third of inner and outer aperture of foramen ovale. Numerical Rating Scale (NRS), Barrow Neurological Institute (BNI) pain and numbness intensity score were used to evaluate the facial pain and numbness.

Results

Eventually, nine patients were enrolled, the structured light registrations were successfully finished in all patients with a mean registration error of 0.68 mm. All the punctures of foramen ovales were successfully done one-time. Of note, the balloons were all got pear-shaped followed by 150 to 180 s compression. Though, postoperatively, all the patients complained of facial numbness and four patients suffered from transient masseter weakness, all patients got fully or mostly pain relief. It should be noted that is the numbness and weakness gradually relieved during follow-up.

Conclusion

Three-dimensional structured light registration and robot assisted PBC is an effective choice for patients with TN. Extension line between the medial third of the inner and outer aperture of foramen ovale might be a safe and effective puncture trajectory to this procedure.
Correlation of ABO blood groups with treatment response and efficacy in infants with persistent pulmonary hypertension of the newborn treated with inhaled nitric oxide
Authors: Guan Yi , Jin Ya , Lu Yongxue , Ao Dang , Gu Pingjiao , Yang Jiyan , Liu Guosheng , Han Shasha
Published: April 2023

Objective

Not all infants with persistent pulmonary hypertension of the newborn (PPHN) respond to inhaled nitric oxide (iNO) therapy, as it is known to improve oxygenation in only 50% to 60% of cases. In this study, we investigated whether ABO blood groups were a relevant factor affecting the improvement of oxygenation by nitric oxide (NO) therapy in infants with PPHN.

Methods

This study was a retrospective, multicenter, and cohort-controlled trial that involved 37 medical units. Infants with PPHN who met the inclusion criteria and were treated with NO (a vasodilator) alone from July 1, 2015, to June 30, 2020, were selected and assigned into three groups: blood type A, blood type B, and blood type O (there were only 7 cases of blood type AB, with a small number of cases, and therefore, blood type AB was excluded for further analysis). The response to iNO therapy was defined as an increase in the ratio of the partial pressure of arterial oxygen (PaO2)/fraction of inspired oxygen (FiO2) > 20% from the basal value after treatment. Oxygenation was assessed mainly based on the two values, oxygenation index (OI) and PaO2/FiO2. The correlation of ABO blood groups with responses to iNO therapy and their influence on the efficacy of iNO therapy was analyzed based on the collected data.

Results

The highest proportion of infants with PPHN who eventually responded to iNO therapy was infants with blood type O. Infants with blood type O more readily responded to iNO therapy than infants with blood type B. Oxygenation after iNO treatment group was optimal in the blood type O group and was the worst in the blood type A group among the three groups. Infants with blood type O showed better efficacy than those with blood types A and B.

Conclusion

ABO blood groups are correlated with responses to iNO therapy in infants with PPHN, and different blood groups also affect the efficacy of NO therapy in infants with PPHN. Specifically, infants with blood type O have a better response and experience the best efficacy to iNO therapy.
Global knowledge, attitude, and practice towards COVID-19 among pregnant women: a systematic review and meta-analysis
Authors: Jahromi Abdolreza Sotoodeh , Jokar Mohammad , Sharifi Nader , Omidmokhtarloo Benyamin , Rahmanian Vahid
Published: April 2023

Background

Pregnant women form a specially vulnerable group due to unique changes in pregnancy, leading to a higher risk of getting a severe infection. As severe COVID-19 increases the risk of preeclampsia, preterm delivery, gestational diabetes, and low birth weight in pregnancy, there is a need to enhance pregnant women’s knowledge, attitudes, and practices to prevent these complications. This systematic review and meta-analysis aimed to determine their levels of knowledge, attitudes, and practice (KAP) regarding COVID-19 at the global level.

Methods

The systematic literature search was conducted in the English language, including Google Scholar, Scopus, PubMed/MEDLINE, Science Direct, Web of Science, EMBASE, Springer, and ProQuest, from the occurrence of the pandemic until September 2022. We used The Newcastle Ottawa scale for cross-sectional studies checklist to evaluate the risk of bias in the studies. Data were extracted by a Microsoft Excel spreadsheet and analyzed by STATA software version 14. We also employed Cochran Q statistics to assess the heterogeneity of studies and utilized Inverse variance random-effects models to estimate the pooled level of pregnant women’s KAP towards COVID-19 infection prevention.

Results

Based on the preferred reporting items for systematic reviews and meta-analyses (PRISMA) and inclusion criteria, 53 qualified studies were acquired from several countries. In total, 51 articles (17,319 participants) for knowledge, 15 articles (6,509 participants) for attitudes, and 24 articles (11,032 participants) for practice were included in this meta-analysis. The pooled good knowledge, positive attitude, and appropriate practice in pregnant women were estimated at 59%(95%CI: 52–66%), 57%(95%CI: 42–72%), and 53%(95%CI: 41–65%), respectively. According to subgroup analysis, the level of knowledge, attitude, and practice were 61%(95%CI: 49–72), 52%(95%CI: 30–74), and 50%(95%CI: 39–60), respectively, in Africa, and 58.8%(95%CI: 49.2–68.4), 60%(95%CI: 41–80) and 60% (95%CI: 41–78), respectively, in Asia.

Conclusion

The Knowledge, attitude, and practice towards COVID-19 infection prevention in pregnant women were low. It is suggested that health education programs and empowerment of communities, especially pregnant women, about COVID-19 continue with better planning. For future studies, we propose to investigate the KAP of COVID-19 in pregnant women in countries of other continents and geographical regions.
Combined maternal risk factors and the Quadruple test to predict late-onset preeclampsia in pregnant Thai women
Authors: Bunyapipat Phattarika , Pruksanusak Ninlapa , Suwanrath Chitkasaem , Geater Alan
Published: April 2023

Background

This study aimed to evaluate the predictive power of a model combining maternal risk factors and the Quadruple screen test for late-onset preeclampsia (PE).

Methods

All pregnant women that received the Quadruple test for Down syndrome at 15+ 0-20+ 6weeks’ gestation were recruited. Maternal serum α-fetoprotein, β-human chorionic gonadotropin, unconjugated estriol, and inhibin A were measured as multiples of the median. A logistic regression model was used to identify predictors associated with late-onset PE with severe features. The receiver operating characteristic (ROC) curve and area under the curve (AUC) were used to assess the model’s predictive ability.

Results

Fifty-five of the 2,000 pregnant women had PE, and 31 of 55 women had late-onset PE. Multivariate analysis identified maternal age ≥ 35 years, inhibin A, history of previous PE, history of infertile, cardiac disease, chronic hypertension, and thyroid disease as significant risk factors. The area under the curve of the receiver operating characteristic curve was 0.78. The likelihood ratio to predict late-onset PE was 49.4 (total score > 60).

Conclusions

Our model combining serum inhibin A with maternal risk factors was useful in predicting late-onset PE. Close monitoring of these patients is recommended.
Prognostic significance of lymphovascular invasion in patients with pT1b esophageal squamous cell carcinoma
Authors: Liu Linxiu , Lin Hua , Shen Guihua , Liu Yong , Qin Xiumin , Yuan Yanling , Wang Bingzhi , Xue Liyan
Published: April 2023

Background

Lymphovascular invasion (LVI) is a crucial predictor of lymph node metastasis (LNM). However, few studies have investigated the LVI positivity rate and its clinical significance in pT1b esophageal squamous cell carcinoma (ESCC) using immunohistochemistry and elastin staining.

Methods

We collected data from158 patients with pT1b ESCC who had undergone radical esophagectomy. All paraffin blocks of invasive carcinoma from each patient were subjected to HE staining, elastin staining + CK (AE1/AE3) immunohistochemistry (E&IHC), and CD31/D2-40 + CK (AE1/AE3) double immunohistochemistry (D-IHC). The LVI was classified into types, i.e., vascular invasion (VI) and lymphatic vessel invasion (LI), and its location, quantity, and clinical significance were explored.

Results

The positivity rates of VI by E&IHC (E-VI), VI by CD31D-IHC (CD31-VI), and LI by D2-40 D-IHC (D2-40-LI) were significantly higher than those obtained by HE staining (P < 0.001, respectively). CD31-VI and E-VI were independent adverse prognostic factors for recurrence-free survival (RFS), and they were significantly associated with poor distant metastasis-free survival and overall survival in pT1b ESCC. Intratumoral LVI was also crucial in pT1b ESCC, and L2 (the count of D2-40-LI was 5 or more) was the strongest predictor for LNM and RFS in pT1b ESCC.

Conclusion

E&IHC and D-IHC can dramatically improve the detection rate of LVI in pT1b ESCC, and the classification and grading of LVI can help to improve the prediction of LNM and prognosis.
The compared study about femoral stem malalignment with or without the special curved rasp during DAA total hip arthroplasty
Authors: Lin Bei , Lan Yiping , Lu Zhiming , Xie Shiwei , Lin Feitai , Weng Yan , Feng Eryou , Chen Jinhua
Published: April 2023

Objective

To investigate whether the application of a curved rasp on the femoral side is effective in reducing the incidence of stem malalignment in total hip replacement with direct anterior approach (DAA-THA), followed by the analysis of the independent risk factors affecting stem malalignment.

Methods

Retrospective analysis was carried out covering 160 patients undergoing DAA-THA from January 2019 to December 2021, with Tri-Lock (BPS, Depuy) stem applied in all 113 patients were screened according to inclusion and exclusion criteria. The data of gender, age, body mass index, preoperative diagnoses, Dorr classification, FAR ratio, pelvic morphology ratio, WOMAC scores, were analyzed to explore the independent factors influencing the malalignment of the femoral prosthesis implantation. Then data of patients were divided into group A and group B according to whether the curved rasp was taken during the operation. The chi-square test was performed to compare the incidence of femoral stem malalignment between the two groups.

Results

There revealed two independent risk factors: BMI and FAR ratio that affected femoral stem malalignment. The increased BMI was associated with a higher probability of femoral stem malalignment (P<0.05), the probability of malalignment of femoral stem in FAR ratio<1 was 1.15 times higher than that in FAR>1(OR = 1.15, 95% CI: 1.03–1.28, P<0.05). Further grouping analysis showed that the incidence of femoral stem malalignment in patients with intraoperative application of curved rasp was 27%, while in patients without curved rasp, the incidence of femoral stem malalignment increased significantly to 48.7%(P<0.05). The placement angle of prosthesis in group A was significantly better than that in group B, especially mild femoral stem malalignment (0%) and severe femoral stem malalignment (2.70%), and the difference was statistically significant (P < 0.05). There found no significant difference in age, gander, intraoperative complications and last follow-up assessment of WOMAC scores between the two groups of patients.

Conclusions

In DAA-THA, BMI and FAR ratio act as the independent risk factors for femoral stem malalignment. Intraoperative use of a curved rasp significantly reduces the incidence of malalignment of the femoral stem.
A comparative study between two methods of delivery of chemotherapeutic agent in patients with bone and soft tissue sarcoma of lower extremity
Authors: Shan Jing , Lv Sumei , Li Haihong , Wang Donglai , Zhang Xiaoyu , Liu Wei
Published: April 2023

Background

We aimed to compare the effects of peripherally inserted central catheters (PICC) and implantable venous access devices (TIVADs) in terms of complications and shoulder function in patients with malignant bone and soft tissue tumors of the lower extremities.

Methods

We analyzed 65 cases of TIVADs (chest wall) and 65 cases of PICC at the orthopedic department of the Fourth Hospital of Hebei Medical University between June 2019 and December 2021, which were diagnosed with malignant bone tumors or soft tissue tumors of the lower extremities (tumors had to be relatively sensitive to chemotherapy), received regular chemotherapy, with ≥ 14 cycles (42 weeks). The two groups were compared in terms of catheter indwelling time, catheter-related complications, Constant-Murley shoulder function score, and displacement of the position of the catheter end on the catheterization side.

Results

Compared to the PICC group, at six months after catheterization, the TIVADs group reported better outcomes for catheter indwelling time, catheter-related complications, and Constant-Murley score for the catheterization-side shoulder joint (p < 0.05). The TIVADs group also reported less displacement of the catheter end position after 180° abduction of the catheterization-side shoulder joint (p < 0.05).

Conclusions

Compared with PICC, TIVADs can prolong catheter indwelling time, reduce catheter-related complications, and maintain shoulder joint function, which makes it an ideal venous-access approach when providing chemotherapy to patients with malignant bone and soft tissue tumors of the lower extremities.
Ultrasonography is an effective tool for the evaluation of traumatic vertebral artery injuries distal to fourth cervical vertebra in the emergency room
Authors: Ishimoto Yuyu , Iwasaki Hiroshi , Sonekatsu Mayumi , Murata Shizumasa , Kozaki Takuhei , Hashizume Hiroshi , Tsutsui Shunji , Takami Masanari , Nagata Keiji , Hira Kazuhiro , Kato Seiya , Yamada Hiroshi
Published: April 2023

Background

This study aimed to determine the feasibility of ultrasonography in the assessment of cervical vertebral artery (VA) injury as an alternative to computed tomography angiography (CTA) in the emergency room.

Methods

We analyzed 50 VAs from 25 consecutive patients with cervical spine injury that had been admitted to our emergency room. Ultrasonography and CTA were performed to assess the VA in patients with cervical spine injury. We examined the sensitivity and specificity of ultrasonography compared with CTA.

Results

Among these VAs, six were occluded on CTA. The agreement between ultrasonography and CTA was 98% (49/50) with 0.92 Cohen's Kappa index. The sensitivity, specificity, and positive and negative predictive values of ultrasonography were 100%, 97.7%, 85.7%, and 100%, respectively. In one case with hypoplastic VA, the detection of flow in the VA by ultrasonography differed from detection by CTA. Meanwhile, there were two cases in which VAs entered at C5 transverse foramen rather than at C6 level. However, ultrasonography could detect the blood flow in these VAs.

Conclusions

Ultrasonography had a sensitivity of 100% compared with CTA in assessment of the VA. Ultrasonography can be used as an initial screening test for VA injury in the emergency room.
The use of intraoperative cell salvage in total hip arthroplasty with subtrochanteric shortening osteotomy for the treatment of high hip dislocation: a retrospective cohort study
Authors: Zhao Enze , Zhu Xiaoyan , Zhou Kai , Liu Zunhan , Lu Hanpeng , Chen Jiali , Zhou Zongke
Published: April 2023

Background

Intraoperative cell salvage (ICS) is an important component of blood management in patients undergoing orthopedic surgery. However, the role of ICS is less well defined in total hip arthroplasty (THA) with subtrochanteric shortening osteotomy (SSO) which is a common surgical technique to manage high hip dislocation. This study aimed to determine the effect of ICS during THA with SSO and to identify factors associated with the ability to salvage sufficient collection for reinfusion in patients with high hip dislocation.

Methods

We identified 178 patients who underwent THA with SSO for high hip dislocation between November 2010 and April 2021. The consecutive cohort was analyzed by logistic regression to determine the effect of ICS on postoperative allogeneic blood transfusion (ABT) and to explore the associations between patient demographics, clinical and radiographic characteristics, preoperative laboratory examination, and surgical variables with the ability to generate adequate blood salvage to reinfuse.

Results

In the consecutive cohort of 178 patients, cell salvage was reinfused in 107 patients (60.1%) and postoperative allogeneic red blood cell (RBC) transfusion within 3 days of implantation was administrated in 40 patients (22.5%). In multivariate analysis, the reinfusion of ICS (OR (95%CI) 0.17 (0.07–0.47)), center of rotation (COR) height ≥ 60 mm (OR (95%CI) 3.30 (1.21–9.01)), the length of SSO ≥ 30 mm (OR (95%CI) 2.75 (1.05–7.22)) and the use of drainage (OR (95%CI) 2.28 (1.04–5.03)) were identified as independent factors of postoperative allogeneic RBC transfusion. In addition, the following variables were identified as independent factors associated with the ability to generate sufficient blood salvage volume for reinfusion: COR height ≥ 60 mm (OR (95%CI) 3.47 (1.58–7.61)), limb-length discrepancy (LLD) ≥ 25 mm (OR (95%CI) 2.55 (1.15–5.65)) and length of SSO ≥ 30 mm (OR (95%CI) 2.75 (1.33–5.69)).

Conclusions

ICS was efficacious in reducing the exposure rate of postoperative RBC transfusion for high hip dislocation during THA with SSO. In addition, patients with greater COR height, larger LLD, and longer length of SSO were predisposed to generate sufficient collection for reinfusion in THA with SSO.
Epidemiology of musculoskeletal disorders among iranian adults: results from a non-communicable disease cohort study
Authors: Najafi Farid , Darbandi Mitra , Neya Sepideh Kazemi , Belasi Masoud Tokazebani , Izadi Neda , Pasdar Yahya , Barzegar Akbar
Published: April 2023

Background

Persistent pain and reduced mobility and dexterity are the typical characteristics of Musculoskeletal disorders (MSDs). We aimed to determine the prevalence of back and joint pain, back, and joint stiffness, arthritis, and osteoporosis among adults and their distribution according to sociodemographic characteristics and comorbidities.

Methods

This cross-sectional study was conducted on 9,520 participants aged 35–65 years from baseline data of the Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west of Iran. MSDs were evaluated by the RaNCD cohort study physician using a standard questionnaire. Binary logistic regression was used to determine associations and reported by odds ratios (OR) and 95% confidence intervals (CI).

Results

The MSDs in women were significantly more than in men (59.06% vs. 40.94%, P < 0.001). Skeletal muscle mass (SMM) was significantly lower in subjects with MSDs, and waist circumference (WC) and visceral fat area (VFA) were higher than in the non-MSDs (P < 0.001). MSDs were significantly more common in urban men and women (OR = 1.33; 95% CI: 1.14–1.50 and OR = 1.59; 95% CI: 1.39–1.82, respectively). Obesity increased the odds of MSDs in women (OR = 1.57; 95% CI: 1.33–1.84), whereas there was no association between BMI and MSDs in men. Men with high socioeconomic status (SES) had lower odds of MSDs than men with weak SES (OR = 0.77; 95% CI: 0.64–0.92).

Conclusion

The MSDs were more prevalent among older people, women, obese people and urban dwellers. Lifestyle modification, especially weight loss may be helpful in reducing and controlling MSDs.
Posterior pelvic ring involvement detected with CT taken within a week of admission in acute fragility fractures of the pelvis (FFP) does not predict failure of conservative treatment: a retrospective cohort study
Authors: Putzeys Guy , Dekeyser Thomas , Garré Patrick , Chesser Tim , Pottel Hans
Published: April 2023

Background

Acute low energy pubic rami fractures in the elderly receive primarily conservative treatment. There is debate to what extent posterior ring involvement, which is detected superiorly by CT compared to X-ray, has an impact on outcome and may require modified treatment. We want to demonstrate if posterior ring involvement has an influence on different types of outcome in primarily conservatively treated acute FFP, questioning the usefulness of early CT. Additionally we analysed the early fracture pattern in cases where conservative treatment failed with need for secondary surgery.

Methods

A retrospective cohort study of 155 consecutive patients, recruited between 2009 and 2016, aged over 65 years diagnosed with an acute LE-PFr on X-ray at the emergency department of a single, level-one trauma centre and receiving an early CT. A set of outcome parameters was compared between patients with an isolated pubic rami fracture (CTia) and patients who had a combined posterior pelvic ring fracture (CTcp).

Results

There were 155 patients of whom 85.2% were female with a mean age of 83 years. 76.8% of patients living at home returned home and 15.5% moved to a nursing home. Mortality rate during hospitalisation was 6.4% and 14.8% at one year post-trauma. Secondary fracture displacement occurred in 22.6%. Secondary surgery was performed in 6 cases (3.9%). Median hospitalisation length of stay was 21 days (range 0 to 112 days). There was no significant association between the subgroups and change in residential status (p = 0.65), complications during hospitalisation (p = 0.75), mortality rate during admission (p = 0.75) and at 1 year (p = 0.88), readmission within 30 days (p = 0.46) and need for secondary surgery (p = 0.2). There was a significant increased median length of stay (p = 0.011) and rate of secondary displacement (p = 0.015) in subgroup CTcp. Secondary displacement had no impact on in-hospital complications (p = 0.7) nor mortality rate during admission (p = 0.79) or at 1 year (0.77). Early CT in patients who underwent secondary surgery showed stable B2.1 lesions in 4 of 6 cases.

Conclusions

Our data suggest that early CT in patients with conservatively treated acute LE-PFr in order to detect posterior lesions, has limited value in predicting failure of conservative treatment.
Effect of coffee on color stability and surface roughness of newly introduced single shade resin composite materials
Authors: Rohym Shaimaa , Tawfeek Hossam El Mandouh , Kamh Raghda
Published: April 2023

Background

Dentists started to follow the era of using single-shade resin composite restorations to avoid color shade selection. Our study was done to evaluate and compare the color stability of two single-shade resin composite materials.

Methods

Sixty samples were randomly allocated into two main groups (n = 30) according to the composite resin used: Group O: (Omnichroma) samples and Group V: (Venus Peral) samples. Each group was then divided into two subgroups (n = 15): group O1 and V1: samples immersed in coffee. Group O2 and V2: samples immersed in distilled water. Color changes (ΔE) and roughness values (Ra) were evaluated at baseline, first, and 14thdays of immersion. The color change was assessed using Vita Easyshade V, while surface roughness was assessed using a profilometer and Atomic Force Microscope (AFM). Data were collected and statistically analyzed using two-way variance analysis (ANOVA) and Tukey's post-hoc test (p < 0.05).

Results

Group O1 and V1 recorded the highest ΔE00(P = 0.002, 0.0001, respectively) and Ra values (P < 0.001) with no significant difference between both materials at 14 days.

Conclusion

Single shade resin composite with innovative chromatic material technology has dramatic color change and surface roughness that sacrifice esthetic success.