bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of Previous Arthroscopic Meniscectomy on Midterm to Long-term Outcomes After Medial Open-Wedge High Tibial Osteotomy
Authors: Kim Daean , Kim Kang-II , Kim Jun-Ho , Lee Sang Hak , Ko Taeyoung
Published: December 2023

Background:

Few studies have evaluated the clinical and radiological outcomes of medial open-wedge high tibial osteotomy (MOWHTO) in patients who had previously undergone arthroscopic meniscectomy.

Purpose:

To verify whether previous arthroscopic meniscectomy affects the clinical and radiological outcomes of MOWHTO.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A total of 183 consecutive knees that underwent MOWHTO and had a minimum 5 years of follow-up were retrospectively reviewed. We compared the preoperative and postoperative clinical and radiological data of 32 knees with a history of meniscectomy (previous meniscectomy group) to 151 control knees without a history of meniscectomy. Cartilage status was also compared at first- and second-look arthroscopic surgery according to the International Cartilage Repair Society grading system. Failure was defined as conversion to total knee arthroplasty or revision MOWHTO. On subgroup analysis, the previous meniscectomy group was divided into 2 subgroups based on the time from meniscectomy to MOWHTO (<3 vs ≥3 years).

Results:

The mean age at the time of surgery was 55.9 years (range, 38-70 years), and the mean follow-up period was 86.2 months (range, 60-164 months). The mean time between meniscectomy and MOWHTO was 48.9 months (range, 5-156 months), and all meniscectomy procedures were performed on the medial side. Preoperative patient characteristics were similar between the study groups. Clinical and radiological outcomes were not significantly different between the groups at the latest follow-up, and no significant between-group differences were observed regarding postoperative cartilage status on arthroscopic examination. One knee in the control group underwent conversion to total knee arthroplasty at 7 years postoperatively for arthritic progression. Subgroup analysis of the previous meniscectomy group indicated no significant differences in clinical outcomes based on the time from meniscectomy to MOWHTO.

Conclusion:

Based on the results, a history of meniscectomy did not adversely affect the midterm to long-term outcomes of MOWHTO. Furthermore, the time between previous meniscectomy and MOWHTO was not associated with the clinical outcomes of MOWHTO.
Medical Students’ Attitudes Toward AI in Medicine and their Expectations for Medical Education
Authors: Kimmerle Joachim , Timm Jasmin , Festl-Wietek Teresa , Cress Ulrike , Herrmann-Werner Anne
Published: December 2023

Objectives

Artificial intelligence (AI) is used in a variety of contexts in medicine. This involves the use of algorithms and software that analyze digital information to make diagnoses and suggest adapted therapies. It is unclear, however, what medical students know about AI in medicine, how they evaluate its application, and what they expect from their medical training accordingly. In the study presented here, we aimed at providing answers to these questions.

Methods

In this survey study, we asked medical students about their assessment of AI in medicine and recorded their ideas and suggestions for considering this topic in medical education. Fifty-eight medical students completed the survey.

Results

Almost all participants were aware of the use of AI in medicine and had an adequate understanding of it. They perceived AI in medicine to be reliable, trustworthy, and technically competent, but did not have much faith in it. They considered AI in medicine to be rather intelligent but not anthropomorphic. Participants were interested in the opportunities of AI in the medical context and wanted to learn more about it. They indicated that basic AI knowledge should be taught in medical studies, in particular, knowledge about modes of operation, ethics, areas of application, reliability, and possible risks.

Conclusions

We discuss the implications of these findings for the curricular development in medical education. Medical students need to be equipped with the knowledge and skills to use AI effectively and ethically in their future practice. This includes understanding the limitations and potential biases of AI algorithms by teaching the sensible use of human oversight and continuous monitoring to catch errors in AI algorithms and ensure that final decisions are made by human clinicians.
Acute Vision Loss in Patients With Allergic Fungal Rhinosinusitis: A Case Series
Authors: Allami Hussain , Alarfaj Hadeel Muhammad , Almousa Hisham , Aldhahri Razan Abdullah , Alfallaj Rayan , Alharbi Abdulmajeed , Alotaibi Sarah S. , Alokby Ghassan , Alsaleh Saad
Published: December 2023

Allergic fungal rhinosinusitis (AFRS) is a subtype of chronic noninvasive sinusitis accounting for 7.8% (0.2%-26.7%) of all chronic rhinosinusitis cases. A definitive diagnosis is usually made after sinus surgery. Successful treatment requires a combination of surgical and medical management. Although orbital involvement is relatively common, reports on optic neuropathy and acute vision loss are limited. Herein, we present a series of 3 patients with AFRS who presented with acute visual loss as the chief complaint. All 3 patients were otherwise healthy adults in their early 20s with extensive nasal polyps on endoscopic nasal examination and bone erosion in the bilateral orbits and lateral wall of the sphenoid sinus on the affected side on imaging. One of the 3 patients had bilateral cranial nerve IV defects in addition to cranial nerve III defects. All patients underwent endoscopic sinus surgery with orbital decompression and were followed up postoperatively by both otolaryngology and ophthalmology services with endoscopic and radiologic evaluation. Unfortunately, no meaningful improvement in vision was observed in any patient despite successful nerve decompression. Prompt diagnosis and early medical and surgical intervention are warranted to prevent complications in patients with AFRS with orbital extension.
Computer-aided detection thresholds for digital chest radiography interpretation in tuberculosis diagnostic algorithms
Authors: Vanobberghen Fiona , Keter Alfred Kipyegon , Jacobs Bart K.M. , Glass Tracy R. , Lynen Lutgarde , Law Irwin , Murphy Keelin , van Ginneken Bram , Ayakaka Irene , van Heerden Alastair , Maama Llang , Reither Klaus
Published: December 2023

Objectives

Use of computer-aided detection (CAD) software is recommended to improve tuberculosis screening and triage, but threshold determination is challenging if reference testing has not been performed in all individuals. We aimed to determine such thresholds through secondary analysis of the 2019 Lesotho national tuberculosis prevalence survey.

Methods

Symptom screening and chest radiographs were performed in participants aged ≥15 years; those symptomatic or with abnormal chest radiographs provided samples for Xpert MTB/RIF and culture testing. Chest radiographs were processed using CAD4TB version 7. We used six methodological approaches to deal with participants who did not have bacteriological test results to estimate pulmonary tuberculosis prevalence and assess diagnostic accuracy.

Results

Among 17 070 participants, 5214 (31%) had their tuberculosis status determined; 142 had tuberculosis. Prevalence estimates varied between methodological approaches (0.83–2.72%). Using multiple imputation to estimate tuberculosis status for those eligible but not tested, and assuming those not eligible for testing were negative, a CAD4TBv7 threshold of 13 had a sensitivity of 89.7% (95% CI 84.6–94.8) and a specificity of 74.2% (73.6–74.9), close to World Health Organization (WHO) target product profile criteria. Assuming all those not tested were negative produced similar results.

Conclusions

This is the first study to evaluate CAD4TB in a community screening context employing a range of approaches to account for unknown tuberculosis status. The assumption that those not tested are negative – regardless of testing eligibility status – was robust. As threshold determination must be context specific, our analytically straightforward approach should be adopted to leverage prevalence surveys for CAD threshold determination in other settings with a comparable proportion of eligible but not tested participants.
Contribution of pressure and flow changes to resistance reduction after pulmonary arterial hypertension treatment: a meta-analysis of 3898 patients
Authors: Farmakis Ioannis T. , Baroutidou Amalia , Patsiou Vasiliki , Arvanitaki Alexandra , Doundoulakis Ioannis , Hobohm Lukas , Zafeiropoulos Stefanos , Konstantinides Stavros V. , D'Alto Michele , Badagliacca Roberto , Giannakoulas George
Published: December 2023

Background

Pulmonary arterial hypertension (PAH)-targeted therapies exert significant haemodynamic changes; however, systematic synthesis is currently lacking.

Methods

We searched PubMed, CENTRAL and Web of Science for studies evaluating mean pulmonary artery pressure (mPAP), cardiac index/cardiac output (CI/CO) and pulmonary vascular resistance (PVR) of PAH-targeted therapies either in monotherapy or combinations as assessed by right heart catheterisation in treatment-naïve PAH patients. We performed a random-effects meta-analysis with meta-regression.

Results

We included 68 studies (90 treatment groups) with 3898 patients (age 47.4±13.2 years, 74% women). In studies with small PVR reduction (<4 WU), CI/CO increase (R2=62%) and not mPAP reduction (R2=24%) was decisive for the PVR reduction (p<0.001 and p=0.36, respectively, in the multivariable meta-regression model); however, in studies with large PVR reduction (>4 WU), both CI/CO increase (R2=72%) and mPAP reduction (R2=35%) contributed significantly to the PVR reduction (p<0.001 and p=0.01, respectively). PVR reduction as a percentage of the pre-treatment value was more pronounced in the oral+prostanoid intravenous/subcutaneous combination therapy (mean difference −50.0%, 95% CI −60.8– −39.2%), compared to oral combination therapy (−41.7%, −47.6– −35.8%), prostanoidi.v./s.c.monotherapy (−31.8%, −37.6– −25.9%) and oral monotherapy (−21.6%, −25.4– −17.8%). Changes in haemodynamic parameters were significantly associated with changes in functional capacity of patients with PAH as expressed by the 6-min walking distance.

Conclusion

Combination therapies, especially with the inclusion of parenteral prostanoids, lead to remarkable haemodynamic improvement in treatment-naïve PAH patients and may unmask the contribution of mPAP reduction to the overall PVR reduction in addition to the increase in CO.
ERS International Congress 2023: highlights from the Clinical Techniques, Imaging and Endoscopy Assembly
Authors: Moretti Antonio , Pietersen Pia Iben , Hassan Maged , Shafiek Hanaa , Prosch Helmut , Tarnoki Adam Domonkos , Annema Jouke T. , Munavvar Mohammed , Bonta Peter I. , de Wever Walter , Juul Amanda Dandanell
Published: December 2023

The Clinical Techniques, Imaging and Endoscopy Assembly is involved in the diagnosis and treatment of several pulmonary diseases, as demonstrated at the 2023 European Respiratory Society (ERS) International Congress in Milan, Italy.

From interventional pulmonology, the congress included several exciting results for the use of bronchoscopy in lung cancer, including augmented fluoroscopy, robotic-assisted bronchoscopy and cryobiopsies. In obstructive lung disease, the latest results on bronchoscopic treatment of emphysema with hyperinflation and chronic bronchitis were presented. Research on using cryobiopsies to diagnose interstitial lung disease was further explored, with the aims of elevating diagnostic yield and minimising risk.

For imaging, the latest updates in using artificial intelligence to overcome the increased workload of radiologists were of great interest. Novel imaging in sarcoidosis explored the use of magnetic resonance imaging, photon-counting computed tomography and positron emission tomography/computed tomography in the diagnostic work-up. Lung cancer screening is still a hot topic and new results were presented regarding incorporation of biomarkers, identifying knowledge gaps and improving screening programmes.

The use of ultrasound in respiratory medicine is an expanding field, which was demonstrated by the large variety in studies presented at the 2023 ERS Congress. Ultrasound of the diaphragm in patients with amyotrophic lateral sclerosis and myasthenia gravis was used to assess movements and predict respiratory fatigue. Furthermore, studies using ultrasound to diagnose or monitor pulmonary disease were presented. The congress also included studies regarding the training and assessment of competencies as an important part of implementing ultrasound in clinical practice.
ERS International Congress 2023: highlights from the Respiratory Intensive Care Assembly
Authors: Bianquis Clara , Leiva Agüero Sebastian , Cantero Chloé , Golfe Bonmatí Alejandro , González Jessica , Hu Xinxin , Lacoste-Palasset Thomas , Livesey Alana , Guillamat Prats Raquel , Salai Grgur , Sykes Dominic L. , Toland Sile , van Zeller Cristiano , Viegas Pedro , Vieira Ana Luisa , Zaneli Stavroula , Karagiannidis Christian , Fisser Christoph
Published: December 2023

Early career members of Assembly 2 (Respiratory Intensive Care) attended the 2023 European Respiratory Society International Congress in Milan, Italy. The conference covered acute and chronic respiratory failure. Sessions of interest to our assembly members and to those interested in respiratory critical care are summarised in this article and include the latest updates in respiratory intensive care, in particular acute respiratory distress syndrome and mechanical ventilation.
Metasurface-driven polarization-division multiplexing of PCSEL for optical communications
Authors: Miao Wen-Chien , Chang Chia-Hsun , Hsiao Fu-He , Chang Yun-Han , Huang Jhih-Hao , Su Huan-Teng , Lin Chang-Yi , Lin Chun-Liang , Chow Chi-Wai , Hong Yu-Heng , Huang Yao-Wei , Kuo Hao-Chung
Published: December 2023

Free-space optical communications hold promising advantages, including a large bandwidth, access to license-free spectrum, high data rates, quick and simple deployment, low power consumption, and relaxed quality requirements. Nevertheless, key technical challenges remain, such as a higher transmission efficiency, a lower transmission loss, and a smaller form factor of optical systems. Here, we demonstrate the viability of circular-polarization-multiplexed multi-channel optical communication using metasurfaces alongside a photonic-crystal surface-emitting laser (PCSEL) light source at wavelength of 940 nm. Through the light manipulation with metasurface, we split the linearly polarized incidence into left and right circular polarizations with desired diffraction angles. Such orthogonal polarization states provide a paradigm of polarization division multiplexing technique for light communication. The PCSEL light source maintains a low divergence angle of about 0.373 degrees after passing through an ultra-thin metasurface without further bulky collimator or light guide, making end-to-end (E2E) and device-to-device (D2D) communications available in a compact form. Both light source and modulated polarized light exhibit a − 3 dB bandwidth over 500 MHz, with successful 1 Gbit/s transmission demonstrated in eye diagrams. Our results affirm that metasurface effectively boosts transmission capacity without compromising the light source's inherent properties. Future metasurface designs could expand channel capacity, and its integration with PCSEL monolithically holds promise for reducing interface losses, thereby enhancing efficiency.
Surgical induced necrotizing scleritis following intraocular lens replacement
Authors: de los Mártires Pablo González , Pérez Gonzalo Guerrero , Bujanda Iñigo Les , Guerra Iñaki Elejalde , Mulero Henar Heras , Silva Esther Compains
Published: December 2023

Purpose

To report a surgical-induced necrotizing scleritis, as well as its medical and surgical management.

Methods

Case-report.

Results

An 88 year-old patient with a three-day severe single-left-eye ocular pain. One-time surgery involving PPV with removal of dislocated intraocular lens and secondary implantation of iris-claw Artisan® lens was performed 6 months earlier. Visual acuity of 20/100. Slit-lamp examination revealed a 5 × 2 mm non-suppurative superior scleral defect. Empirical topical antibiotic treatment with dexamethasone, as well as oral doxycycline was started. Infectious and autoimmune diseases were ruled out. Non-infectious scleritis treatment was conducted with intravenous Methylprednisolone 3 day pulses, followed by weekly tapered Prednisone and intramuscular Methotrexate. However, 1 month after the diagnosis, the defect was worsened; hence, a heterologous scleral patch graft was performed and, days after the intervention, Adalimumab was initiated. To date, 6 months later, remains with proper scleral patch, a diary low-dose Prednisone, and spacing Adalimumab treatment.

Conclusion

Surgery-induced necrotizing scleritis is a severe condition that compromise the ocular and visual integrity. Proper diagnosis, as well as early treatment is required to achieve remission, prevent relapses, and avoid structural complications. In refractory cases, anti-TNF-α immunotherapy associated with surgical tectonic graft interventions can achieve promising results.
Carbon dioxide and trace oxygen concentrations impact growth and product formation of the gut bacterium Phocaeicola vulgatus
Authors: Keitel Laura , Braun Kristina , Finger Maurice , Kosfeld Udo , Yordanov Stanislav , Büchs Jochen
Published: December 2023

Background

The promising yet barely investigated anaerobic speciesPhocaeicola vulgatus(formerlyBacteroides vulgatus) plays a vital role for human gut health and effectively produces organic acids. Among them is succinate, a building block for high-value-added chemicals. Cultivating anaerobic bacteria is challenging, and a detailed understanding ofP. vulgatusgrowth and metabolism is required to improve succinate production. One significant aspect is the influence of different gas concentrations. CO2is required for the growth ofP. vulgatus.However, it is a greenhouse gas that should not be wasted. Another highly interesting aspect is the sensitivity ofP. vulgatustowards O2. In this work, the effects of varying concentrations of both gases were studied in the in-house developed Respiratory Activity MOnitoring System (RAMOS), which provides online monitoring of CO2, O2,and pressure under gassed conditions. The RAMOS was combined with a gas mixing system to test CO2and O2concentrations in a range of 0.25-15.0 vol% and 0.0-2.5 vol%, respectively.

Results

Changing the CO2concentration in the gas supply revealed a CO2optimum of 3.0 vol% for total organic acid production and 15.0 vol% for succinate production. It was demonstrated that the organic acid composition changed depending on the CO2concentration. Furthermore, unrestricted growth ofP. vulgatusup to an O2concentration of 0.7 vol% in the gas supply was proven. The viability decreased rapidly at concentrations larger than or equal to 1.3 vol% O2.

Conclusions

The study showed thatP. vulgatusrequires little CO2, has a distinct O2tolerance and is therefore well suited for industrial applications.
Staphylococcal superantigen-like protein 10 enhances the amyloidogenic biofilm formation in Staphylococcus aureus
Authors: Rahman Shakilur , Das Amit Kumar
Published: December 2023

Staphylococcus aureus is a highly infectious pathogen that represents a significant burden on the current healthcare system. Bacterial attachment to medical implants and host tissue, and the establishment of a mature biofilm, play an important role in chronic diseases such as endocarditis, osteomyelitis and wound infections. These biofilms decrease bacterial susceptibility to antibiotics and immune defences, making the infections challenging to treatment. S. aureus produces numerous exotoxins that contribute to the pathogenesis of the bacteria. In this study, we have identified a novel function of staphylococcal superantigen-like protein 10 (SSL10) in enhancing the formation of staphylococcal biofilms. Biofilm biomass is significantly increased when SSL10 is added exogenously to bacterial cultures, whereas SSL2 and SSL12 are found to be less active. Exogenously added SSL10 mask the surface charge of the bacterial cells and lowers their zeta potential, leading to the aggregation of the cells. Moreover, the biofilm formation by SSL10 is governed by amyloid aggregation, as evident from spectroscopic and microscopic studies. These findings thereby give the first overview of the SSL-mediated amyloid-based biofilm formation and further drive the future research in identifying potential molecules for developing new antibacterial therapies against Staphylococcus aureus.
Twelfth thoracic vertebra erector spinae plane block for postoperative analgesia and early recovery after lumbar spine surgery in elderly patients: a single-blind randomized controlled trial
Authors: Zhang Aijia , Chen Jiaxin , Zhang Xiaoyun , Jiang Tao , Li Dongmei , Cai Xuemin , Wang Haixu , Ding Wengang
Published: December 2023

Background

Severe pain after lumbar spine surgery can delay recovery in elderly patients. We explored the efficacy of T12 erector spinal plane block (ESPB) in elderly patients who underwent lumbar spine surgery.

Methods

A total of 230 patients undergoing lumbar spine surgery were divided and randomly allocated to ultrasound-guided ESPB (n = 115) and control (n = 115) groups. The ESPB group received 20 mL of 0.4% ropivacaine bilaterally at the T12 level after intubation, whereas the control group did not receive a block. The primary outcome was the numeric rating scale (NRS) score at 12 h after surgery. Secondary outcomes included the NRS score and tramadol use within 72 h postoperatively, intraoperative remifentanil use, incidence of postoperative delirium (POD), complications of ESPB, ambulation time, and length of hospitalization after surgery.

Results

The12-hour NRS (median (IQR)) score was remarkably lower in the ESPB group than in the control group (2 (1–3) vs. 3 (2–4), p = 0.004), as well as NRS score within 48 h (P < 0.01). The ESPB group had less intraoperative remifentanil use (P < 0.001), and less tramadol use within 72 h postoperatively (P < 0.001). Seven patients (6.7%) developed POD in the ESPB group and ten patients (9.3%) in the control group, without any statistically significant difference (P > 0.05). The ambulation time and length of hospitalization after surgery were shorter in the ESPB group than in the control group (P < 0.05). No ESPB-related complications were observed.

Conclusions

Bilateral T12 ESPB lowered the NRS score within 48 h after lumbar spine surgery, decreased perioperative opioid use and resulted in faster recovery in elderly patients but did not significantly reduce the incidence of POD.

Trial registration

The study was retrospectively registered at www.chictr.org.cn (ChiCTR2100042037) on January 12, 2021.
Machine learning-based model for predicting major adverse cardiovascular and cerebrovascular events in patients aged 65 years and older undergoing noncardiac surgery
Authors: Wu Xuejiao , Hu Jiachen , Zhang Jianjun
Published: December 2023

Background

Few evidence-based prediction models have been developed for predicting major adverse cardiovascular and cerebrovascular events (MACCE) in patients aged 65 years or older undergoing noncardiac surgery. In this study, we aimed to analyze the risk factors for perioperative MACCE in patients aged 65 years or older undergoing noncardiac surgery and construct a prediction model.

Methods

In this nested case–control study, a total of 342 Chinese patients who were aged ≥ 65 years and underwent medium- or high-risk noncardiac surgery in our hospital were included. There were 84 cases with MACCE (the MACCE group) and 258 without MACCE (the control group). Univariable logistic regression analysis was performed to identify the risk factors for MACCE. Least absolute shrinkage and selection operator (LASSO) regression was used to screen the variables. Nomogram was constructed using the selected variables. Machine learning methods, including Decision Tree, XGBoost, Support Vector Machine, K-nearest Neighbor, and Neural network, was used to establish, validate, and compare the performance of different prediction models.

Results

A prediction model based on nine variables, including age ≥ 85 years, history of ischemic chest pain, symptoms of decompensated heart failure, high-risk surgery, intraoperative minimum systolic blood pressure, postoperative systolic blood pressure, Cr levels over 2.0 mg/dL, left ventricular ejection fraction, and perioperative blood transfusion, was constructed. This LASSO logistic regression model showed good discriminatory ability to predict MACCE (area under the curve = 0.89; 95% confidence interval, 0.818 – 0.963) and fit to the test set (Hosmer–Lemeshow, χ2 = 7.4053,P = 0.4936). The decision curve analysis showed a positive net benefit of the new model. Compared with logistic regression model, the XGBoost model showed better prediction ability (area under the curve = 0.903). A preoperative prediction model based on five variables, including age ≥ 85 years, symptoms of decompensated heart failure, ischemic chest pain, high-risk type of surgery and Cr levels over 2.0 mg/dL was also constructed. This model showed good discriminatory ability to predict MACCE before surgery (area under the curve = 0.720 [95% CI, 0.591–0.848]. Both models compared with the modified RCRI score had improvement in reclassification.

Conclusion

By analyzing Chinese patients aged ≥ 65 years undergoing medium- or high-risk noncardiac surgery, the risk factors for perioperative MACCE were identified. Then, simple prediction models were constructed and validated, which showed good prediction performance and may be used as a decision-making assistant tool for clinicians. These findings provide a basis for preventing and improving the perioperative management of MACCE.
The impact of COVID-19 on the mental health of older sexual minority Canadians in the CLSA
Authors: Grady Alexandra , Stinchcombe Arne
Published: December 2023

Purpose

Limited research has examined the mental health impacts of the COVID-19 pandemic on sexual minority (i.e., lesbian, gay, bisexual; LGB) older adults using a longitudinal approach. This study aimed to compare the mental health trajectories (i.e., reported symptoms of depression and loneliness) of LGB and heterosexual participants across four time points.

Methods

Data were drawn from the Canadian Longitudinal Study on Aging (CLSA), an ongoing study on the experiences of adults between 45 to 85 at Baseline. Data included for analysis were collected at Baseline (2011-2015), Follow-up 1 (2015-2018), and two time points during the COVID-19 pandemic (April-December 2020). We used General Estimating Equations (GEE) to model changes in depression symptoms (CESD-10; n = 47,728) and loneliness (UCLA 3-item loneliness scale; n = 41,698), adjusting for covariates (i.e., age, sex, race/ethnicity, education, and income).

Results

Results indicated that LGB participants reported more symptoms of depression (B = .595, p < .001) and loneliness (B = .313, p < .001) in comparison to heterosexual peers across the four time points. Mean depression and loneliness scores increased regardless of sexual orientation.

Conclusion

This study highlighted the detrimental effects of the pandemic on the mental health of older adults regardless of sexual orientation. It also showed that LGB older adults experienced more loneliness and depression symptoms than heterosexual older adults both before and during the pandemic. Understanding diverse identities, needs, and disparities in mental health is critical to promoting equitable aging experiences for everyone.
What frail, older patients talk about when they talk about self-care—a qualitative study in heart failure care
Authors: Eckerblad Jeanette , Klompstra Leonie , Heinola Linda , Rojlén Sandra , Waldréus Nana
Published: December 2023

Background

Self-care plays a crucial role in the management of heart failure (HF) and is especially important for older patients who are frail. However, there is limited knowledge about how frail, older patients with HF perceive and experience self-care. Therefore, the aim of this study was to describe the experiences of self-care among frail, older patients with HF.

Methods

A qualitative descriptive design with semi-structured interviews with frail, older patients diagnosed with HF (n = 19; median age 82 years). Thematic analysis, guided by Braun and Clarke, was used to analyse the data.

Results

Two main themes emerged from the analysis: 1) “To maintain my health,” encompassing various aspects such as hygiene practices, engaging in physical activity, medication adherence, following a healthy diet, and ensuring adequate rest; and 2) “To maintain my well-being and happiness,” highlighting the importance of hobbies, maintaining independence, participating in social activities, and creating a supportive environment.

Conclusion

This study provides valuable insights into the perspectives of frail, older patients with HF regarding self-care. It was observed that older patients often associate self-care with general well-being, hygiene, and happiness. Clear communication between healthcare providers and patients is essential to align different perspectives on self-care and ensure that self-care plans are tailored to individual needs. Moreover, addressing the emotional well-being and happiness of patients should be prioritized, as these factors play a significant role in promoting self-care adherence.
LAG3 is an independent prognostic biomarker and potential target for immune checkpoint inhibitors in malignant pleural mesothelioma: a retrospective study
Authors: Arimura Ken , Hiroshima Kenzo , Nagashima Yoji , Nakazawa Tadao , Ogihara Akira , Orimo Mami , Sato Yasuto , Katsura Hideki , Kanzaki Masato , Kondo Mitsuko , Tagaya Etsuko
Published: December 2023

Background

Lymphocyte-activation gene 3 (LAG3) is an immune checkpoint receptor; novel LAG3 immune checkpoint inhibitors (ICIs) exhibit therapeutic activity in melanoma. The role of LAG3and ICIs of LAG3 are unknown in malignant pleural mesothelioma (MPM). This study aimed to uncover the prognostic landscape of LAG3 in multiple cancers and investigate the potential of using LAG3 as an ICIs target in patients with MPM.

Methods

We used The Cancer Genome Atlas (TCGA) cohort for assessing mRNA expression and our cohort for immunohistochemical expression. TCGA cohort were analyzed using the Wilcoxon rank-sum test to compare mRNA expression between normal and tumor tissues in multiple cancers. We used 86 MPM cases from TCGA and 38 MPM cases from our cohort to analyze the expression of LAG3 in tumor-infiltrating lymphocytes. The mean LAG3 mRNA expression was set as the cut-off and samples were classified as positive/negative for immunohistochemical expression. Overall survival (OS) of patients with MPM was determined using the Kaplan–Meier method based on LAG3 mRNA and immunohistochemical expression. OS analysis was performed using the multivariate Cox proportional hazards model. The correlation of LAG3 expression and mRNA expression of tumor immune infiltration cells (TIICs) gene markers were estimated using Spearman correlation. To identify factors affecting the correlation of LAG3 mRNA expression, a multivariate linear regression model was performed.

Results

LAG3 mRNA was associated with prognosis in multiple cancers. Elevated LAG3 mRNA expression was correlated with a better prognosis in MPM. LAG3 expression was detected immunohistochemically in the membrane of infiltrating lymphocytes in MPM. LAG3 immunohistochemical expression was correlated with a better prognosis in MPM. The multivariate Cox proportional hazards model revealed that elevated LAG3 immunohistochemical expression indicated a better prognosis. In addition, LAG3 mRNA expression was correlated with the expression of various gene markers of TIICs, the most relevant to programmed cell death 1 (PD-1) with the multivariate linear regression model in MPM.

Conclusions

LAG3 expression was correlated with prognosis in multiple cancers, particularly MPM; LAG3 is an independent prognostic biomarker of MPM. LAG3 regulates cancer immunity and is a potential target for ICIs therapy. PD-1 and LAG3 inhibitors may contribute to a better prognosis in MPM.

Trial registration

This study was registered with UMIN000049240 (registration day: August 19, 2022) and approved by the Institutional Review Board (approval date: August 22, 2022; approval number: 2022–0048) at Tokyo Women’s Medical University.
One case report of epilepsy and rapidly progressive cognitive impairment after levofloxacin treatment
Authors: Su Zhan , Zhang Guimei , Shen Yanxin , Li Xiangting , Wang Zixun , Zhang Haining
Published: December 2023

Objective

To report a case of seizure and rapidly progressive cognitive impairment 20 min after intravenous administration of levofloxacin.

Case summary

A 56-year-old woman was admitted to hospital with episodic unconsciousness and unresponsiveness. About 4 days ago, she experienced a loss of consciousness, fell to the floor, and yelled for 2 min, 20 min before the first intravenous dose of levofloxacin. The patient developed symptoms of cognitive impairment after the seizure. Levofloxacin is a synthetic third generation fluoroquinolone used to treat various infectious diseases. Upon admission, the patient was conscious and unresponsive. After 11 days of symptomatic and supportive treatment, the patient was discharged from the hospital with cognition restored to baseline level and no recurrence of seizures 10 months after discharge.

Discussion

Epilepsy is a rare adverse reaction to levofloxacin treatment. The patient in this case had infection-related signs before the onset of the disease, and the disease progressed rapidly with fluctuating changes. After ruling out degenerative, infectious, toxic, and autoimmune causes, the patient’s symptoms may be attributed to levofloxacin, and this is the first case of seizure and rapidly progressive cognitive impairment after levofloxacin injection reported in the literature. Clinicians should be aware that unexplained, rapidly progressing cognitive impairment with infection-related signs before onset may be a rare side effect of antibiotics.
The impact of the COVID-19 pandemic on cardiovascular disease prevention and corresponding geographical inequalities in England: interrupted time series analysis
Authors: Castanon Alejandra , Grasic Katja , Chen Simon , Ma Florence , Oboli Godspower , Bray Benjamin D. , Hughes Andrew , White Martin , Ahmad Shahed , Pearson-Stuttard Jonathan
Published: December 2023

Background

There has been disruption to the detection and management of those with hypertension and atrial fibrillation (AF) during the COVID-19 pandemic. This is likely to vary geographically and could have implications for future mortality and morbidity. We aimed to estimate the change in diagnosed prevalence, treatment and prescription indicators for AF and hypertension and assess corresponding geographical inequalities.

Methods

Using the Quality and Outcomes Framework (2016/17 to 2021/22) and the English Prescribing Datasets (2018 to 2022), we described age standardised prevalence, treatment and prescription item rates for hypertension and AF by geography and over time. Using an interrupted time-series (ITS) analysis, we estimated the impact of the pandemic (from April 2020) on missed diagnoses and on the percentage change in medicines prescribed for these conditions. Finally, we described changes in treatment indicators against Public Health England 2029 cardiovascular risk targets.

Results

We observed 143,822 fewer (-143,822, 95%CI:-226,144, -61,500, p = 0.001) diagnoses of hypertension, 60,330 fewer (-60,330, 95%CI: -83,216, -37,444, p = 0.001) diagnoses of AF and 1.79% fewer (-1.79%, 95%CI: -2.37%, -1.22%), p < 0.0001) prescriptions for these conditions over the COVID-19 impact period. There was substantial variation across geography in England in terms of the indirect impact of the COVID-19 pandemic on the diagnosis, prescription, and treatment rates of hypertension and AF. 20% of Sub Integrated Care Boards account for approximately 62% of all missed diagnoses of hypertension. The percentage of individuals who had their hypertension controlled fell from 75.8% in 2019/20 to 64.1% in 2021/22 and the percentage of individuals with AF who were risk assessed fell from 97.2% to 90.7%.

Conclusions

Hypertension and AF detection and management were disrupted during the COVID-19 pandemic. The disruption varied considerably across diseases and geography. This highlights the utility of administrative and geographically granular datasets to inform targeted efforts to mitigate the indirect impacts of the pandemic through applied secondary prevention measures.
The role of military service in preventing depression in China: evidence from a nationally representative longitudinal survey
Authors: Li Haoran , Zhang Ning , Zhang Jingya , Xie Tao , He Rongxin , Jiang Yufei , Mao Ying , Zhu Bin
Published: December 2023

Background

Despite recognition in the West that military veterans experience more mental health issues than the general population, little research has focused on this subject in China. This study examined the associations between male veterans’ military experience and depression in China.

Methods

A sample of 12,914 men including 669 veterans was included in the final analysis and propensity score matching, multivariable regressions and fixed effect model were used.

Results

The military experience was associated with a lower likelihood of depression in male veterans. In the subgroup analysis, military experience was associated with a lower likelihood of depression among married and urban male veterans. Military experience was also associated with a lower likelihood of depression in both “junior college and above” and “below junior college” groups. In contrast, evidence was lacking regarding the associations between military experience and depression for unmarried and rural veterans.

Conclusions

Individual characteristics could influence the relationship between military experience and depression in male veterans, and the mental health of veterans should be paid more attention and guaranteed.
Finding your lane: experiences and beyond for adults learning to swim
Authors: Wilson Shawn , Miller Alison Moira , Casson Destiny , Ramos William D.
Published: December 2023

The purpose of this study was to examine experiences and impacts from participating in an adult swim instruction program. We conducted 20 semi-structured interviews with adults aged 18 + who had participated in an adult learn to swim program. Participants were interviewed through a virtual platform using a semi-structured protocol. Data were coded individually by each member of the research team for emerging thematic outcomes with final consensus among all those involved in the analysis. Participants expressed adult learn to swim programs had an effect in three areas: (a) life affordance, (b) emotional affect, and (c) interpersonal relationships. Public health experts and aquatics leaders should consider targeting programs aimed at teaching adults to learn how to swim, especially to marginalized individuals and those who did not grow up in the United States. The authors highlight how these programs can create life affordances well beyond lap swimming and even water safety.
Prevalence, etiology, clinical features and management associated with impacted and transmigrated mandibular canines: a systematic review
Authors: Sathyanarayana Haritha Pottipalli , Nucci Ludovica , d’Apuzzo Fabrizia , Perillo Letizia , Padmanabhan Sridevi , Grassia Vincenzo
Published: December 2023

Background

The occurrence of mandibular canine impaction and/ or transmigration is a rare clinical entity but diagnosis and treatment planning is of clinical significance. The associated etiological factors and the clinical guidelines for the management are still not clear.

The aim of this systematic review was to summarize the available data to report the prevalence and identify the etiological factors, clinical features, and various treatment outcomes in patients with mandibular canine impaction and/or transmigration.

Methods

The review protocol was registered in PROSPERO (CRD42021222566) and was conducted and reported according to the PRISMA and Cochrane Handbook / Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. A computerized search of studies published up to April 30, 2023, was conducted using the following databases: Medline, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Scopus, Web of Science, and Latin American and Caribbean Health Sciences Literature. A manual search of the reference and citation lists of eligible articles and existing systematic reviews for any additions were also conducted. The Newcastle–Ottawa Scale quality assessment tool was used to assess the studies' quality.

Results

After removing 6 duplicates, 3700 articles were identified. For the final analysis, 19 studies published between 1985 and 2023 met all the eligibility criteria and were included. A total of 7 studies presented as good and 12 studies presented as satisfactory. Patients were screened in ten studies and diagnostic records from archives were retrieved in nine studies. The total number of diagnostic records screened was 138.394, and the total number of patients from the included studies was 43.127.

Conclusions

Based on the findings from this systematic review, the prevalence of mandibular canine impaction ranged from 0.008% to 1.29% while canine transmigration from 0.12% to 0.98%. Crowding of the mandibular arch, the presence of a retained deciduous canine, and odontoma or cyst are the etiological factors more commonly associated with mandibular canine impaction and or transmigration. Surgical extraction and surgical exposure followed by orthodontic traction are the two most frequently carried out treatment modalities in the management of mandibular canine impaction and or transmigration.
Using of non-pharmacological pain methods, and the perceived barriers, among nurses in critical care unit in Palestine
Authors: Tohol Wafaa Jameel , Abuejheisheh Ashraf Jehad , Fashafsheh Imad , Amro Nawaf
Published: December 2023

Background

Pain is alleviated in one of the two common approaches, pharmacological or non-pharmacological intervention. Using non-pharmacological methods may have beneficial effect and priority on decreasing patients’ level of pain and decreasing the side effects of pharmacological methods in ICU patients. This study aimed to assess ICU Palestinian nurses use and barriers of non-pharmacological pain management.

Methods

A quantitative descriptive cross-sectional design was used to collect responses from a convenient sample of 215 nurses working in six hospitals in Plaestine. The timeframe for data collection was from August 2022 to December 2022. This study had three instrument packages. The first part is demographic data. The second is a tool that used 4-point Likert scale to examine ICU nursing use of non-pharmacological pain methods and it consisted of 16 items. The third is six items of perceived barriers to use non-pharmacological pain methods. All statistical procedures were analyzed using Statistical Package of Social Science (SPSS) version 28.

Results

More than two-thirds of the nurses used non-pharmacological pain methods in ICU. 60% of the nurses have high levels of use, 10.2% have very high levels. The two highest perceived barriers to use nonpharmacological method were the lack of time, workload, and patient instability with 83.7% (n = 180), and 77.2% (n = 166), respectively. Demographic variables were not significantly associated with the use of non-pharmacological pain management methods, except age.

Conclusion

Adopting culturally sensitive non-pharmacological pain methods to decrease ICU patients’ level of pain, may positively reflected on patients’ outcome and on healthcare system. Developing, implementing and continuous monitoring of guidelines regarding using nonpharmacological for nurses and physicians are recommended which will be reflected positively on patients’ outcomes. Great efforts to overcome the barriers of lack of time and workload is impertive to increase the clinical usage of nonpharmacological pain methods.
Pet feeding habits and the microbiological contamination of dog food bowls: effect of feed type, cleaning method and bowl material
Authors: Raspa Federica , Schiavone Achille , Pattono Daniele , Galaverna Davide , Cavallini Damiano , Vinassa Marica , Bergero Domenico , Dalmasso Alessandra , Bottero Maria Teresa , Valle Emanuela
Published: December 2023

Background

Safe pet feeding practices and food bowl hygiene measures are important for minimising the risk of microbiological contaminations in the domestic environment. This study compares the practices reported by dog and cat caregivers, and investigates whether cleaning method, feed type or bowl material affects the microbiological contamination of dog food bowls.

Results

Data from 351 dog caregivers and 186 cat caregivers were collected via an online survey. The majority of dogs (70.7%) were fed twice daily, whereas cats (43%) were mostly fed ad libitum. The most common material for dog food bowls was metal (67.1%) versus plastic (38.1%) and metal (37.6%) for cats. Dog food bowls were most frequently cleaned after each meal (35.7%); whereas for cats, 21.5% were cleaned after each meal, 22.7% once a day and 19.3% 2–3 times a week. Total mesophilic aerobic bacteria counts (TMABc), Enterobacteriaceae counts and pathogenic bacteria (Salmonella spp., Campylobacter spp., Verotoxigenic E. coli [VTEC]) were assessed for 96 dog food bowls. TMABc were higher in metal vs. plastic bowls (p < 0.001) and in those used for wet food vs. dry food (p = 0.0397). Enterobacteriaceae counts were higher in bowls washed by hand vs. dishwasher (p = 0.0515), whereas no differences were found between hand washing vs. dry wiping. Salmonella spp., Campylobacter spp. or E. coli VTEC contaminations were not detected.

Conclusions

The surveyed Italian dog and cat caregivers reported different habits concerning feeding frequency, food bowl material and cleaning frequency. Wet food and metal bowls were associated with higher levels of microbiological contamination of dog food bowls. Furthermore, in relation to wet washing methods, contaminations were likely to be greater following hand washing than they were following the use of a dishwasher. Practical guidelines for safe feeding practices and hygiene measures are needed to minimise the risk of microbiological contaminations in domestic environments.