bluuebunny/crossref_metadata_2025 huggingface dataset:
Regional analgesia techniques for effective recovery from coronary artery bypass surgeries: a retrospective study involving the experience of a single center
Authors: Cosarcan Sami Kaan , Sezer Özer Ali , Gürkahraman Sami , Erçelen Ömür
Published: July 2022

Background

Pain after cardiac surgery is both multifocal and multifactorial. Sternotomy, sternal retraction, internal mammary dissection, posterior rib dislocation or fracture, potential brachial plexus injury, and mediastinal and pleural drains all contribute to pain experienced in the immediate postoperative period. Ineffective pain management can result in systemic and pulmonary complications and significant cardiac consequences.

Methods

This study compared the effectiveness of regional anesthesia techniques for perioperative pain management in cardiac surgery patients at our clinic. The effects of different analgesic methods, in terms of contributing to recovery, were examined.

Results

The records of 221 patients who had undergone coronary bypass surgery were evaluated retrospectively. The extubation rate in the operating room was 91%. No patient received balloon pump support, and 20 patients were transferred to the cardiovascular intensive care unit while intubated. Regional anesthesia was performed on two of these 20 patients, but not on the remaining 18. Examination of intraoperative and postoperative opioid consumption revealed significantly lower levels among patients receiving regional anesthesia. The most effective results among the regional anesthesia techniques applied were achieved with double injection erector spinae plane block.

Conclusion

Regional anesthesia techniques severely limit opioid consumption during cardiac surgery. Their importance will gradually increase in terms of rapid recovery criteria. Based on our study results, double injection of the erector spinae plane block seems to be the most effective technique in cardiac surgery. We therefore favor the use of fascial plane blocks during such procedures.

Trial Numbers The study is registered with ClinicalTrials (NCT05282303). Ethics committee registration and approval were Granted under Number 2021.464.IRB1.131.
Positive predictive value estimates for noninvasive prenatal testing from data of a prenatal diagnosis laboratory and literature review
Authors: Liu Siping , Yang Fang , Chang Qingxian , Jia Bei , Xu Yushuang , Wu Ruifeng , Li Liyan , Chen Weishan , Yin Ailan , Huang Fodi , Feng Suxin , Li Fenxia
Published: July 2022

Objective

Since 2011, noninvasive prenatal testing (NIPT) has undergone rapid expansion, with both utilization and coverage. However, conclusive data regarding the clinical validity and utility of this testing tool are lacking. Thus, there is a continued need to educate clinicians and patients about the current benefits and limitations in order to inform pre- and post-test counseling, pre/perinatal decision making, and medical risk assessment/management.

Methods

This retrospective study included women referred for invasive prenatal diagnosis to confirm positive NIPT results between January 2017 and December 2020. Prenatal diagnosis testing, including karyotyping, chromosomal microarray analysis (CMA) were performed. Positive predictive values (PPVs) were calculated.

Results

In total, 468 women were recruited. The PPVs for trisomies 21, 18, and 13 were 86.1%, 57.8%, and 25.0%, respectively. The PPVs for rare chromosomal abnormalities (RCAs) and copy number variants (CNVs) were 17.0% and 40.4%, respectively. The detection of sex chromosomal aneuploidies (SCAs) had a PPV of 20% for monosomy X, 23.5% for 47,XXX, 68.8% for 47,XXY, and 62.5% for 47,XYY. The high-risk groups had a significant increase in the number of true positive cases compared to the low- and moderate-risk groups.

Conclusions

T13, monosomy X, and RCA were associated with lower PPVs. The improvement of cell-free fetal DNA screening technology and continued monitoring of its performance are important.
Four-year follow-up of LCAR-B38M in relapsed or refractory multiple myeloma: a phase 1, single-arm, open-label, multicenter study in China (LEGEND-2)
Authors: Zhao Wan-Hong , Wang Bai-Yan , Chen Li-Juan , Fu Wei-Jun , Xu Jie , Liu Jie , Jin Shi-Wei , Chen Yin-Xia , Cao Xing-Mei , Yang Yun , Zhang Yi-Lin , Wang Fang-Xia , Zhang Peng-Yu , Lei Bo , Gu Liu-Fang , Wang Jian-Li , Zhang Hui , Bai Ju , Xu Yan , Zhu Han , Du Juan , Jiang Hua , Fan Xiao-Hu , Li Jian-Yong , Hou Jian , Chen Zhu , Zhang Wang-Gang , Mi Jian-Qing , Chen Sai-Juan , He Ai-Li
Published: July 2022

Background

LCAR-B38M is a chimeric antigen receptor T cell product with two binding domains targeting B cell maturation antigen. Our previous reports showed a remarkable efficacy of LCAR-B38M in patients with relapsed/refractory multiple myeloma (RRMM) at a median follow-up of 2 years. Here, we report long-term safety and efficacy data from a median follow-up of 4 years.

Methods

LEGEND-2 was a phase 1, single-arm, open-label study conducted in four registered sites in China. Seventy-four participants with RRMM received LCAR-B38M treatment. Lymphodepletion was performed using cyclophosphamide or cyclophosphamide plus fludarabine. LCAR-B38M, at a median dose of 0.513 × 106 cells/kg, was intravenously administered either in three split infusions or in a single infusion. The primary objective was the safety of LCAR-B38M, and the secondary objective was efficacy.

Results

As of May 25, 2021, the median follow-up was 47.8 months. All patients experienced ≥ 1 adverse events (AEs). Grade ≥ 3 AEs were observed in 45/74 (60.8%) patients. Cytokine release syndrome (CRS) occurred in 68/74 (91.9%) cases; 7 (9.5%) had grade ≥ 3 CRS. One patient experienced grade 1 central nervous system toxicity. The overall response rate was 87.8%. Fifty-four out of 74 (73.0%) patients achieved complete response. The median progression-free survival was 18.0 months, and the median overall survival for all patients was not reached. The median duration of response was 23.3 months. Four patients experienced viral infection more than 6 months post-infusion, and four patients developed second primary non-hematological malignancies at a median time of 11.5 months post-CAR-T cell transfer.

Conclusions

The 4-year follow-up data of LCAR-B38M therapy demonstrated a favorable long-term safety profile and a durable response in patients with RRMM.

Trial registration Clinicaltrials.gov NCT03090659 (retrospectively registered on March 27, 2017); ChiCTR-ONH-17012285.
Randomized double-blind controlled trial to assess the efficacy of intravenous acetaminophen associated with strong opioids in the treatment of acute pain in adult cancer patients: study protocol
Authors: Leiva Ofelia , Castellano Joel , Letelier Luz M. , Rojas Luis , Viviani Paola , Gonzalez Antonio , Perez-Cruz Pedro
Published: July 2022

Background

Cancer pain is one of the most frequent and relevant symptoms in cancer patients and impacts on patient’s quality of life. International and local standards recommend as an initial strategy the use of an analgesic scheme composed of strong opioids associated with adjuvants such as acetaminophen, based upon the assumption that combining drugs could have a better analgesic effect, could allow lowering opioid dosing, and could prevent the occurrence of adverse effects of opioids. However, there is uncertainty about the impact of acetaminophen as an adjuvant in patients who use strong opioids for moderate to severe pain management in cancer patients. The aim of this study is to assess the efficacy and safety of intravenous acetaminophen associated with strong opioids in hospitalized adult cancer patients who have moderate to severe cancer-related pain.

Methods

We will perform a randomized double-blinded controlled study comparing intravenous acetaminophen 1 g 4 times a day versus placebo for 48 h as an adjuvant to strong opioids. We will assess pain intensity as a primary outcome, using the verbal numerical rating scale (VNRS, I0 to 10 scale with higher scores meaning higher pain intensity), and we will compare the mean difference in pain intensity between baseline and 48 h among the placebo and intervention groups. We estimate that a decrease of 1 point in the VNRS would be clinically significant. Assuming a standard deviation in pain intensity of 1.7 points, an alpha of 0.025, and a power of 0.8, we estimate a sample size of 112 patients, with 56 patients in each arm. Secondary outcomes include the difference in total opioid use between baseline and at 48 h among the groups, and adverse effects such as drowsiness, constipation, nausea, and vomiting would be evaluated.

Discussion

The randomized, double-blind, placebo-controlled design is the best strategy to assess the efficacy of acetaminophen as an adjuvant in adult cancer patients with moderate to severe pain who are receiving strong opioids. We expect to contribute to national and international guidelines with these results.

Trial registration

Clinicaltrials.gov NCT04779567. Registered on March 3, 2021. Retrospectively registered.
Myo-inositol supplementation for prevention of gestational diabetes mellitus in overweight and obese pregnant women: a systematic review and meta-analysis
Authors: Mashayekh-Amiri Sepideh , Mohammad-Alizadeh-Charandabi Sakineh , Abdolalipour Somaiyeh , Mirghafourvand Mojgan
Published: July 2022

Background

The prevalence of gestational diabetes mellitus [GDM] and of its most important predisposing factor, i.e. overweight and obesity, have increased dramatically over the past 20 years. Therefore, the aim of this study was to systematically review the articles on the effect of myo-inositol supplementation on the prevention of GDM in pregnant women with overweight and obesity.

Methods

We conducted a systematic literature search in electronic database (MEDLINE, Cochrane Library, ClinicalTrials.gov, Embase, ProQuest, PubMed, Google scholar, Scopus, Web of science and forward and backward citations) to identify all randomized controlled trials (RCTs) published until 21 December 2021. Finally, Among the 118 identified records, four studies were eligible and were included in this systematic review. The meta-analysis results were reported in the form of odds ratio (OR) to compare the incidence of GDM and pregnancy outcomes. They were also presented in the form of mean difference (MD) to compare fasting glucose (FG), 1-h and 2-h oral glucose tolerance test (OGTT) levels between the two groups. This study was registered on PROSPERO, number CRD42021290570.

Results

The results showed that the incidence of GDM was significantly lower in the myo-inositol group (OR 0.32, 95% CI 0.21 to 0.48; P < 0.001; I2 = 0%; Moderate certainty evidence). Moreover, FG-OGTT (MD − 2.64 mg/dl, 95% CI − 4.12 to − 1.17; P < 0.001; I2 = 0%; Moderate certainty evidence), 1-h-OGTT (MD − 7.47 mg/dl, 95% CI − 12.24 to − 2.31; P = 0.005; I2 = 27%; Low certainty evidence) and 2-h-OGTT levels (MD − 10.51 mg/dl, 95% CI − 16.88 to − 4.14; P = 0.001; I2 = 59%; Low certainty evidence) in the myo-inositol group were significantly lower than in the control group. Regarding the pregnancy outcomes, the incidence of gestational hypertension and preterm delivery was significantly lower in the myo-inositol group. However, no between-group difference was observed in the other outcomes.

Conclusions

Based on the results, myo-inositol has shown to be a new and safe preventive strategy in reducing the incidence of GDM and in regulating FG and 1-h and 2-h OGTT levels, and also in reducing the incidence of GDM complications such as preterm delivery and gestational hypertension in pregnant women with overweight and obesity.
Grape seed and skin extract, a potential prebiotic with anti-obesity effect through gut microbiota modulation
Authors: Mokrani Mohamed , Charradi Kamel , Limam Ferid , Aouani Ezzedine , Urdaci Maria C.
Published: July 2022

Background

Obesity is a worldwide health problem and a significant risk factor for diabetes and cardiovascular diseases. Gut microbiota (GM) plays an essential role in obesity, and prebiotics such as polyphenols could be one way to improve microbial dysbiosis-induced obesity.

Objective

This study was designed to assess the effectiveness of grape seed and skin extract (GSSE), and/or orlistat on obese rats fed with high fat diet by targeting GM modulations. The impact of treatments was also studied in non-obese rats.

Material and methods

Rats were rendered obese or kept with a standard diet for three months. Then they were treated either with GSSE or orlistat or with the combined treatment (GSOR) during three months and then sacrificed. Adipose tissues, blood and faeces were collected and analyzed.

Results

In obese rats and to a lesser extent in non-obese rats, treatments decreased the weight of various adipose tissues and the serum levels of cholesterol, LDL, triglycerides, lipase, and CRP and increased HDL and adiponectin. GSOR treatment was even more efficient that orlistat. Obese rats had less GM diversity than non-obese rats and orlistat reduced it even more. However, diversity was restored with GSSE and GSOR treatments. Potential pathogenic Streptococcus alactolyticus/gallolyticus species were greatly increased in obese rats and drastically reduced with the treatments, as wells as other potential pathobionts.

Conclusions

GSSE exerts beneficial effects in obese rats and restores, at least partially, the observed dysbiosis. GSOR induced the highest beneficial effect. Moreover, the various treatments could also enhance physiological and GM modifications in non obese rats.
Abnormal blood 25-hydroxyvitamin D in critically ill patients: prevalence, predictors, and its association with in-hospital mortality
Authors: Xie Juntao , Chen Qingui , He Dejian
Published: July 2022

Background

Abnormal vitamin D is prevalent in critical care settings, but its association with prognosis remains unclear. The study aimed to investigate the prevalence and predictors of abnormal blood 25-hydroxyvitamin D (25(OH)D), as well as its association with prognosis in critically ill patients.

Methods

Patients aged ≥ 18 years who were once admitted to the intensive care units (ICUs) of the Beth Israel Deaconess Medical Center between 2008 and 2019 with at least one measurement record of blood 25(OH)D were included as study population. Baseline characteristics associated with deficient or elevated blood 25(OH)D were investigated by univariable logistic regression analysis. The association between abnormal blood 25(OH)D and hospital mortality was examined by multivariable logistic regression analysis.

Results

A total of 1091 patients were included. Deficient 25(OH)D (< 30 ng/mL) was found in 790 (72.41%) patients and 17 (1.56%) were with an elevated level (> 60 ng/mL). A younger age, male, comorbid liver disease, and dialysis were risk factors of deficient blood 25(OH)D, while comorbid myocardial infarction, dementia, and rheumatic disease were protective factors evaluated by univariable logistic regression. Being admitted to cardiac vascular ICU or coronary care unit were associated with increased risk of elevated blood 25(OH)D. Patients with elevated blood 25(OH)D showed non-significantly higher hospital mortality compared to those with normal or deficient blood 25(OH)D (35.29% versus 14.44% and 14.56%, P = 0.058). After adjusted for potential confounding factors, elevated blood 25(OH)D was associated with increased risk of hospital mortality [odds ratio (OR) 3.80, 95% confidence interval (CI) 1.22–11.82, P = 0.021] when compared to those with normal blood 25(OH)D, but there was no significant association between deficient blood 25(OH)D and hospital mortality (OR 1.12, 95% CI 0.74–1.72, P = 0.589).

Conclusions

These findings suggest deficient blood 25(OH)D was rather common in critically ill patients, but was not an independent risk factor of hospital mortality, while elevated blood 25(OH)D was associated with worse prognosis.
The Mechanical and Thermal Properties of Cement CAST Mortar/Graphene Oxide Composites Materials
Authors: Janjaroen Thidatip , Khammahong Sunisar , Tuichai Wattana , Karaphun Attaphol , Phrompet Chaiwat , Sriwong Chaval , Ruttanapun Chesta
Published: July 2022

This paper presents the influence of the graphene oxide (GO) sheet contents at conditions of 0, 0.01, 0.03, 0.05, and 0.1 wt% on the mechanical and thermal properties of GO/CAST 11 LW mortar (GMT) composites for heat insulating brick. The GMT composites were prepared by a simple mixing method. The structure of GMT composites was investigated by X-ray diffraction (XRD) and Raman spectroscopy (Raman) techniques. The small grain sizes of GMT composites were confirmed by transmission electron microscopy (TEM). The mechanical properties of GMT composites are increased with increasing GO contents. A lot of functional groups in GO such as carboxylic acid reacted with a calcium silicate hydrate, CaH2O4Si (CSH), calcium hydroxide, Ca(OH)2 (CH) and Ettringite, and Ca6[Al(OH)6]2(SO4)3·26H2O (CA) phases in the mortar, which can be considered good mechanical properties in the GMT composites. The heat insulation values of GMT composites were improved by the interaction with the CSH, CH, and CA phases in the cement mortar on the surface of GO. The highest compressive and tensile strengths and low heat transfer rate of about 0.465 W/min were observed at 0.05 of GO (GMT_0.05) composites in the curing age of 7 days. Thus, a new pathway of GMT composites can be prepared by a simple mixing method to significantly improve the mechanical and thermal properties of mortar GMT composites.
Metabolic modeling of the International Space Station microbiome reveals key microbial interactions
Authors: Kumar Rachita K. , Singh Nitin Kumar , Balakrishnan Sanjaay , Parker Ceth W. , Raman Karthik , Venkateswaran Kasthuri
Published: July 2022

Background

Recent studies have provided insights into the persistence and succession of microbes aboard the International Space Station (ISS), notably the dominance ofKlebsiella pneumoniae. However, the interactions between the various microbes aboard the ISS and how they shape the microbiome remain to be clearly understood. In this study, we apply a computational approach to predict possible metabolic interactions in the ISS microbiome and shed further light on its organization.

Results

Through a combination of a systems-based graph-theoretical approach, and a constraint-based community metabolic modeling approach, we demonstrated several key interactions in the ISS microbiome. These complementary approaches provided insights into the metabolic interactions and dependencies present amongst various microbes in a community, highlighting key interactions and keystone species. Our results showed that the presence ofK. pneumoniaeis beneficial to many other microorganisms it coexists with, notably those from thePantoeagenus. Species belonging to theEnterobacteriaceaefamily were often found to be the most beneficial for the survival of other microorganisms in the ISS microbiome. However,K. pneumoniaewas found to exhibit parasitic and amensalistic interactions withAspergillusandPenicilliumspecies, respectively. To prove this metabolic prediction,K. pneumoniaeandAspergillus fumigatuswere co-cultured under normal and simulated microgravity, whereK. pneumoniaecells showed parasitic characteristics to the fungus. The electron micrography revealed that the presence ofK. pneumoniaecompromised the morphology of fungal conidia and degenerated its biofilm-forming structures.

Conclusion

Our study underscores the importance ofK. pneumoniaein the ISS, and its potential positive and negative interactions with other microbes, including potential pathogens. This integrated modeling approach, combined with experiments, demonstrates the potential for understanding the organization of other such microbiomes, unravelling key organisms and their interdependencies.
Virtual prevention of eating disorders in children, adolescents, and emerging adults: a scoping review
Authors: Pellegrini Danielle , Grennan Laura , Bhatnagar Neera , McVey Gail , Couturier Jennifer
Published: July 2022

Background

During the COVID-19 pandemic, there was a necessity for eating disorder (ED) outpatient treatment to be delivered virtually. Given this transition, and the surge in new ED cases, there was an urgent need to investigate virtually delivered ED prevention programs. This review aimed to identify the available evidence on virtual ED prevention programs for children, adolescents, and emerging adults.

Method

Using scoping review methodology, seven databases were searched for studies published from January 2000 to April 2021 reporting on virtually delivered ED prevention interventions for children and adolescents (< 18 years) and emerging adults (18–25 years). Studies were excluded if they contained adults (> 25 years) and individuals with clinical ED diagnoses. Abstracts and full-text papers were reviewed independently by two reviewers. Data was extracted on study type, methodology, age, sample size, virtual intervention, outcomes, and results. In April 2022, we used a forward citation chaining process to identify any relevant articles from April 2021 to April 2022.

Results

Of 5129 unique studies identified, 67 met eligibility criteria, which included asynchronous (n = 35) and synchronous (n = 18) internet-based programs, other e-technology including mobile apps (n = 3) and text messaging interventions (n = 1), computer-based programs (n = 6), and online caregiver interventions focused on child outcomes (n = 4). Few studies mainly included children and adolescents (n = 18), whereas the vast majority included emerging adults (n = 49). For children and adolescents, the most widely researched programs were Student Bodies and its adapted versions (n = 4), eBody Project (n = 2), and Parents Act Now (n = 2). For emerging adults, the most widely researched programs were Student Bodies and its adapted versions (n = 16), eBody Project (n = 6) and Expand Your Horizon (n = 4). These interventions were effective at reducing various symptoms and ED risk. Some studies demonstrated that virtual prevention intervention efficacy resembled in-person delivery.

Conclusion

Virtual prevention interventions for EDs can be effective, however more research is needed studying their impact on children and adolescents and on improving access for vulnerable groups. Additional efficacy studies are required, such as for text messaging and mobile app ED prevention interventions. Evidence-based recommendations for virtual ED prevention for children, adolescents, and emerging adults at-risk for EDs should be prioritized.
Psychometric evaluation of the muscle dysmorphic disorder inventory (MDDI) among gender-expansive people
Authors: Compte Emilio J. , Cattle Chloe J. , Lavender Jason M. , Brown Tiffany A. , Murray Stuart B. , Capriotti Matthew R. , Flentje Annesa , Lubensky Micah E. , Obedin-Maliver Juno , Lunn Mitchell R. , Nagata Jason M.
Published: July 2022

Purpose

Muscle dysmorphia is generally classified as a specific form of body dysmorphic disorder characterized by a pathological drive for muscularity and the preoccupation that one is too small or not sufficiently muscular. The majority of research on the condition has been conducted in cisgender men with a paucity of literature on gender minority people, a population that is at risk for muscle dysmorphia. One of the most widely used measures of muscle dysmorphia symptoms, the Muscle Dysmorphic Disorder Inventory (MDDI), has not been psychometrically validated for use in gender minority samples, the aim of the present study.

Methods

We evaluated the psychometric properties of the MDDI in a sample of 1031 gender-expansive individuals (gender minority people whose gender identity differs from that assumed for their sex assigned at birth and is not exclusively binary man or woman) aged 18–74 who were part of The PRIDE Study, a large-scale, U.S., longitudinal cohort study.

Results

Using a two-step, split-sample exploratory and confirmatory factor analytic approach, we found support for the original three-factor structure of the measure. The subscales showed adequate internal consistency, and convergent validity was supported based on significant associations of the MDDI subscale scores with theoretically related scores on a widely used measure of disordered eating.

Conclusions

These findings provided novel support for adequate psychometric properties of the MDDI in a sample of gender-expansive individuals, facilitating the use of this measure in future research on muscle dysmorphia in this understudied and at-risk population.
Nuclear alpha-synuclein is present in the human brain and is modified in dementia with Lewy bodies
Authors: Koss David J. , Erskine Daniel , Porter Andrew , Palmoski Pawel , Menon Hariharan , Todd Olivia G. J. , Leite Marta , Attems Johannes , Outeiro Tiago F.
Published: July 2022

Dementia with Lewy bodies (DLB) is pathologically defined by the cytoplasmic accumulation of alpha-synuclein (aSyn) within neurons in the brain. Predominately pre-synaptic, aSyn has been reported in various subcellular compartments in experimental models. Indeed, nuclear alpha-synuclein (aSynNuc) is evident in many models, the dysregulation of which is associated with altered DNA integrity, transcription and nuclear homeostasis. However, the presence of aSynNuc in human brain cells remains controversial, yet the determination of human brain aSynNuc and its pathological modification is essential for understanding synucleinopathies. Here, using a multi-disciplinary approach employing immunohistochemistry, immunoblot, and mass-spectrometry (MS), we confirm aSynNuc in post-mortem brain tissue obtained from DLB and control cases. Highly dependent on antigen retrieval methods, in optimal conditions, intra-nuclear pan and phospho-S129 positive aSyn puncta were observed in cortical neurons and non-neuronal cells in fixed brain sections and in isolated nuclear preparations in all cases examined. Furthermore, an increase in nuclear phospho-S129 positive aSyn immunoreactivity was apparent in DLB cases compared to controls, in both neuronal and non-neuronal cell types. Our initial histological investigations identified that aSynNuc is affected by epitope unmasking methods but present under optimal conditions, and this presence was confirmed by isolation of nuclei and a combined approach of immunoblotting and mass spectrometry, where aSynNuc was approximately tenfold less abundant in the nucleus than cytoplasm. Notably, direct comparison of DLB cases to aged controls identified increased pS129 and higher molecular weight species in the nuclei of DLB cases, suggesting putative pathogenic modifications to aSynNuc in DLB. In summary, using multiple approaches we provide several lines of evidence supporting the presence of aSynNuc in autoptic human brain tissue and, notably, that it is subject to putative pathogenic modifications in DLB that may contribute to the disease phenotype.
Is Metaverse in education a blessing or a curse: a combined content and bibliometric analysis
Authors: Tlili Ahmed , Huang Ronghuai , Shehata Boulus , Liu Dejian , Zhao Jialu , Metwally Ahmed Hosny Saleh , Wang Huanhuan , Denden Mouna , Bozkurt Aras , Lee Lik-Hang , Beyoglu Dogus , Altinay Fahriye , Sharma Ramesh C. , Altinay Zehra , Li Zhisheng , Liu Jiahao , Ahmad Faizan , Hu Ying , Salha Soheil , Abed Mourad , Burgos Daniel
Published: July 2022

The Metaverse has been the centre of attraction for educationists for quite some time. This field got renewed interest with the announcement of social media giant Facebook as it rebranding and positioning it as Meta. While several studies conducted literature reviews to summarize the findings related to the Metaverse in general, no study to the best of our knowledge focused on systematically summarizing the finding related to the Metaverse in education. To cover this gap, this study conducts a systematic literature review of the Metaverse in education. It then applies both content and bibliometric analysis to reveal the research trends, focus, and limitations of this research topic. The obtained findings reveal the research gap in lifelogging applications in educational Metaverse. The findings also show that the design of Metaverse in education has evolved over generations, where generation Z is more targeted with artificial intelligence technologies compared to generation X or Y. In terms of learning scenarios, there have been very few studies focusing on mobile learning, hybrid learning, and micro learning. Additionally, no study focused on using the Metaverse in education for students with disabilities. The findings of this study provide a roadmap of future research directions to be taken into consideration and investigated to enhance the adoption of the Metaverse in education worldwide, as well as to enhance the learning and teaching experiences in the Metaverse.
Insall proximal realignment with/without tibial tubercle osteotomy for recurrent patellar instability yields acceptable medium- to long-term results but risk of osteoarthritis progression is considerable
Authors: Waaler Per Arne Skarstein , Jellestad Truls , Hysing-Dahl Trine , Elvehøy Elise , Inderhaug Eivind
Published: July 2022

Purpose

The purpose of this study was to evaluate clinical and radiological results in patients operated for recurrent patellar instability with a surgical approach consisting of Insall proximal realignment with/without tibial tubercle osteotomy (TTO).

Methods

Patients that underwent surgery for recurrent patellar instability at one centre with a uniform technique between 2004 and 2020 were included. Eligible patients were assessed by clinical examination and the disease-specific Banff Patellofemoral Instability Instrument 2.0 (BPII 2.0). Pre- and postoperative radiographs were analysed for patellofemoral osteoarthritis (OA) according to Iwano. Preoperative Magnetic Resonance Imaging (MRI) and radiographs were analysed for anatomical risk factors for patellar instability. Student t-test, chi-square test and ANOVA-analyses were used to investigate whether anatomical risk factors and/or patient characteristics could predict an inferior outcome.

Results

Forty-six patients (47 knees) were included at a mean follow-up time of 6.6 years (SD 4.6; range 1–17). Mean BPII 2.0 score was 60.4 (SD 18.4; range 26–98), and 10.6% (n = 5) had suffered a postoperative redislocation. Progression to evident patellofemoral OA was seen in 15% of the patients (p < 0.05). The presence of pathoanatomic risk factors did not correlate with recurrent postoperative instability or inferior BPII 2.0 score at the final evaluation.

Conclusion

Patients treated with the current approach reported acceptable medium- to long-term results, but the risk of patellofemoral OA progression is significant. These findings add to the knowledge of expected outcomes after procedures involving Insall proximal realignment, and can guide clinical decision making for surgeons using similar methods.

Level of evidence

Level IV, case series.
Improving the diagnosis of radiation necrosis after stereotactic radiosurgery to intracranial metastases with conventional MRI features: a case series
Authors: Lasocki Arian , Sia Joseph , Stuckey Stephen L.
Published: July 2022

Background

The distinction between true disease progression and radiation necrosis after stereotactic radiosurgery to intracranial metastases is a common, but challenging, clinical scenario. Improvements in systemic therapies are increasing the importance of this distinction. A variety of imaging techniques have been investigated, but the value of any individual technique is limited.

Case presentation

Assessment should extend beyond simply the appearances of the lesion at a given timepoint, but also consider local anatomy and lesion evolution. Firstly, enlargement of a metastasis is affected by local anatomical boundaries, such as the dural reflections or cerebrospinal fluid spaces. In contrast, the radiation dose administered with stereotactic radiosurgery does not respect these anatomical boundaries and is largely concentric around the treated lesion. Therefore, new, non-contiguous enhancement across such a boundary can be confidently attributed to radiation necrosis. Secondly, the dynamic nature of radiation necrosis may result in a change in lesion shape, with different portions of the lesion simultaneously enlarging and regressing. Regression of part of a lesion indicates radiation necrosis, even if the overall lesion enlarges. This case series describes these two features and provides illustrative clinical examples in which these features allowed a confident diagnosis of radiation necrosis.

Conclusions

The distinction between true disease progression and radiation necrosis should extend beyond just the appearances of the lesion. More nuanced interpretation incorporating a relationship to anatomical boundaries and a change in shape can improve accurate diagnosis of radiation necrosis.
A pilot study to investigate real-time digital alerting from wearable sensors in surgical patients
Authors: Joshi Meera , Ashrafian Hutan , Arora Sonal , Sharabiani Mansour , McAndrew Kenny , Khan Sadia N. , Cooke Graham S. , Darzi Ara
Published: July 2022

Background

Continuous vital sign monitoring may identify changes sooner than current standard monitoring.

Objective

To investigate if the use of real-time digital alerts sent to healthcare staff can improve the time taken to identify unwell patients and those with sepsis.

Design

A prospective cohort study design.

Setting

West Middlesex University Hospital, UK.

Participants

Fifty acutely unwell surgical patients admitted to hospital.

Intervention

Patients wore a lightweight wearable sensor measuring heart rate (HR), respiratory rate (RR) and temperature every 2 min whilst standard intermittent ward monitoring of vital signs was performed by nurses. Digital alerts were sent to healthcare staff from the sensor to a smartphone device. All alerts were reviewed for recruited patients to identify the exact time on the sensor in which deterioration occurred. The time to acknowledgement was then reviewed for each action and an average time to acknowledgement calculated.

Results

There were 50 patients recruited in the pilot study, of which there were vital sign alerts in 18 patients (36%). The total number of vital sign alerts generated in these 18 patients was 51. Of these 51 alerts, there were 7 alerts for high HR (13.7%), 33 for RR (64.7%) and 11 for temperature (21.6%). Out of the 27 acknowledged alerts, there were 2 alerts for HR, 17 for RR and 8 for temperature. The average time to staff acknowledgement of the notification for all alerts was 154 min (2.6 h).

There were some patients which had shown signs of deterioration in the cohort. The frequency of routine observation monitoring was increased in 2 cases, 3 patients were referred to a senior clinician and 2 patients were initiated on the sepsis pathway.

Conclusion

This study demonstrates the evaluation of digital alerts to nurses in real time. Although not all alerts were acknowledged, deterioration on the ward observations was detected and actions were taken accordingly. Patients were started on the sepsis pathway and escalation to senior clinicians occurred. Further research is required to review why only some alerts were acknowledged and the effects of digital alerting on patient outcomes.

Trial registration

ClinicalTrials.gov, NCT04638738
Correlation between self-efficacy, fear of movement, empowerment, enablement, and number of visits to physiotherapist among patients with musculoskeletal disorders in primary health care: a feasibility study
Authors: Törnblom Madelene , Hansson Eva Ekvall
Published: July 2022

Background

Musculoskeletal disorders are a costly burden for health care and social care services. Patients with musculoskeletal disorders are often treated by physiotherapists in primary health care. Psychosocial variables can be a significant obstacle to recovering from musculoskeletal injuries.

The primary aim of this pilot study was to assess the feasibility of performing a prospective study investigating whether self-efficacy, fear of movement, empowerment, or enablement has any relation to the number of visits to physiotherapists among patients with a musculoskeletal disorder in primary health care.

Methods

Prospective study with a consecutive selection including eleven female and eight male patients age ranged between 22 and 82 years old seeking physiotherapist for the first time for a musculoskeletal disorder in primary health care. Primary outcome measures included operational and practical feasibility regarding recruitment of participants, use of questionnaires, and key variables to be collected as part of the study. Secondary outcomes included the correlation between self-efficacy (Exercise Self-Efficacy Scale (ESES-S)), fear of movement (Tampa Scale for Kinesiophobia (TSK-SV)), empowerment (Making Decisions Scale), enablement (Patient Enablement Instrument (PEI)), and the number of visits to physiotherapists. Statistical analysis was done using IBM SPSS statistics version 28 with analysis of correlation using Spearman’s rank correlation coefficient.

Results

Nineteen patients accepted to participate in the study and were included in the final analysis. Between 14 and 18 completed questionnaires were included.

There was a statistically significant correlation between the number of visits to the physiotherapist and self-efficacy, rho=0.692 and p=0.006.

Conclusion

The results of the study showed that the design is feasible in terms of recruitment of participants and use of questionnaires. New variables to collect in a large-scale study were identified. In a large-scale study, attention needs to be focused on the improvement of the number of completed questionnaires. The results of this study indicate that the present care of patients with a low level of self-efficacy is not optimal.
Stigma, psychosocial and economic effects of yaws in the Philippines: an exploratory, qualitative study
Authors: Dofitas Belen Lardizabal , Kalim Sherjan P. , Toledo Camille B. , Richardus Jan Hendrik
Published: July 2022

Background

Yaws is a chronic, non-venereal, highly contagious skin and bone infection affecting children living in impoverished, remote communities and caused by Treponema pallidum subspecie pertenue. Social stigma and economic losses due to yaws have been reported anecdotally in the Southern Philippines but have not been well-documented.

Objective

To describe and compare the psychological, social, and economic effects of yaws from the perspective of patients, contacts, and key informants in two areas of the Philippines.

Materials and methods

Yaws and contacts were identified through clinicoseroprevalence surveys conducted in the Liguasan Marsh area, Mindanao, Southern Philippines in 2017 and among the Aetas, an indigenous people community in Quezon province, Luzon region in 2020. Skin examinations and serologic tests confirmed the diagnosis of active, latent, or past yaws among the children and adults. Trained health personnel conducted in-depth interviews of those affected by yaws and their guardians, household contacts, and key informants, such as health workers regarding their perceptions, feelings, health-seeking behaviors, and effects of yaws on their lives.

Results

A total of 26 participants were interviewed: 17 from Mindanao and 9 from Luzon. Aside from the physical discomforts and embarrassment, yaws was considered stigmatizing in Mindanao, because positive non-treponemal tests or treponemal antibody tests were associated with syphilis and promiscuity. These have led to loss of employment and income opportunities for adults with latent or past yaws. In contrast, the Aetas of Luzon did not perceive yaws as stigmatizing, because it was a common skin problem. Plantar yaws interfered with the Aeta’s gold panning livelihood due to the pain of wounds.

Conclusions

Yaws is not merely a chronic skin and bone disease. It can lead to significant psychosocial and economic problems as well. Yaws is a generally forgotten disease in the Philippines. There is no yaws surveillance and control program. Treatments are not readily available for the populations affected, thus perpetuating the infection and negative effects.

Significance of study

This is the first study to document the psychosocial and economic effects of yaws among Filipinos. Information campaigns about yaws and a yaws control program are needed to reduce stigma and discrimination.
Evaluating the value of a 3D printed model for hands-on training of gynecological pelvic examination
Authors: Kiesel Matthias , Beyers Inga , Kalisz Adam , Wöckel Achim , Quenzer Anne , Schlaiß Tanja , Wulff Christine , Diessner Joachim
Published: July 2022

Background

Simulation in the field of gynecological pelvic examination with educational purposes holds great potential. In the current manuscript we evaluate a 3D printed model of the female pelvis, which improves practical teaching of the gynecological pelvic examination for medical staff.

Methods

We evaluated the benefit of a 3D printed model of the female pelvis (Pelvisio®) as part of a seminar (“skills training”) for teaching gynecological examination to medical students. Each student was randomly assigned to Group A or B by picking a ticket from a box. Group A underwent the skills training without the 3D printed model. Group B experienced the same seminar with integration of the model. Both groups evaluated the seminar by answering five questions on Likert scales (1–10, 1 = “very little” or “very poor”, 10 equals “very much” or “very good”). Additionally, both groups answered three multiple-choice questions concerning pelvic anatomy (Question 6 to 8). Finally, Group B evaluated the 3D printed model with ten questions (Question 9 to 18, Likert scales, 1–10).

Results

Two of five questions concerning the students’ satisfaction with the seminar and their gained knowledge showed statistically significant better ratings in Group B (6.7 vs. 8.2 points and 8.1 vs. 8.9 points (p < 0.001 and p < 0.009). The other three questions showed no statistically significant differences between the traditional teaching setting vs. the 3D printed model (p < 0.411, p < 0.344 and p < 0.215, respectively). The overall mean score of Question 1 to 5 showed 8.4 points for Group B and 7.8 points for Group A (p < 0.001). All three multiple-choice questions, asking about female pelvic anatomy, were answered more often correctly by Group B (p < 0.001, p < 0.008 and p < 0.001, respectively). The mean score from the answers to Questions 9 to 18, only answered by Group B, showed a mean of 8.6 points, indicating, that the students approved of the model.

Conclusion

The presented 3D printed model Pelvisio® improves the education of female pelvic anatomy and examination for medical students. Hence, training this pivotal examination can be supported by a custom designed anatomical model tailored for interactive and explorative learning.
Where Have All the Articles Gone? The Use of Zero Articles in Marmora and Lake, Ontario
Authors: Bigelow Lauren , Tagliamonte Sali A.
Published: July 2022

In May 2019, the authors conducted sociolinguistic interviews with 39 White residents of Marmora and Lake, Ontario, a place founded predominately by British settlers, with a mixed farming/mining economy up until the late twentieth century. The data are rich in well-known dialect features, including preterit come, zero relative pronouns, and, most strikingly, zero articles. Praat analyses confirm that these zero articles are not simply due to phonetic reduction, and analysis of the zero variants exposes several trends. Among the oldest members of the population, the incidence of zero articles is relatively frequent, especially among men, a typical pattern for dialect obsolescence. In addition to phonetic conditioning, consistent with definite article reduction at earlier times, the data also show a strong effect of information status, consistent with patterns for the zero definite article in York, England. Older individuals use zero articles across more contexts compared to younger ones, suggesting systemic adjustments in an evolving grammatical system. The authors argue that the use of the zero articles in Marmora reflects an earlier stage in the history of both the definite and indefinite articles in English. They also consider cultural changes and psychological impacts from personal commentaries to highlight the importance of social context. This research demonstrates that rural Ontario offers key insight into the earlier stages and current state of dialects in North America.
Uptalk in Chicano Southern California English
Authors: Asch Madeline , Brogan Franny D.
Published: July 2022

The present study aims to build on limited Chicano English intonation research by exploring the frequency, phonetic properties, timing, and potential origins of uptalk in neutral declarative statements of Chicano Southern California English (CSCE). Fifteen native CSCE speakers and five native Anglo Southern California English (ASCE) speakers from the Los Angeles Metropolitan Area (all college-age women) participated in three tasks varying in their formality. Five measures were examined across dialects and within the CSCE speaker group: uptalk frequency, starting pitch, scaling, rise alignment, and peak delay. Results show that CSCE and ASCE speakers produce extremely similar uptalk contours both in how often they occur and in their phonetic manifestations, suggesting that ASCE uptalk, rather than the Mexican Spanish circumflex contour, is the main source of intonational transfer for final rising in CSCE. Furthermore, while Angela Barry proposes that ASCE uptalk is unmarked, we find that uptalk frequency is conditioned by task formality for both dialect groups, indicating that this variable may have since risen above the level of consciousness. The amount of Spanish spoken in childhood and the academic environment of the colleges attended by our CSCE participants also affect how often uptalk is produced and its beginning pitch level.
The Foreignizing Crime Novel: Anatomy of a Publishing Phenomenon
Authors: Gulddal Jesper
Published: July 2022

One of the most important trends in contemporary crime fiction is the proliferation and commercial success of crime novels written in English but set in foreign places and featuring foreign detectives—that is, the rise of the foreignizing crime novel. In spite of its prominence in the marketplace, the foreignizing crime novel has so far not been subjected to detailed analysis and has not been recognized as a distinctive crime fiction subgenre defined by its specific form of transnationalism. With the aim of addressing this knowledge gap, this essay offers a critical analysis of the foreignizing crime novel in four steps. Following a definitional discussion of the various contemporary forms of transnational crime fiction (1), it outlines the results of a mapping exercise that shows the distribution of “target” countries in primarily British and American foreignizing crime fiction; the purpose of this mapping is to provide an overview of the format and gain a preliminary understanding of its underlying logics (2). The next step is an analysis of textual characteristics (3). Despite being underappreciated and sometimes reviled by critics, the foreignizing crime novel is in fact, as this analysis shows, a complex narrative form that embodies some of the key questions of contemporary crime fiction research—questions about, for example, the role of place; the relationship between the local, the national, and the global; and the transnational horizon of contemporary crime writing. By way of conclusion, the essay argues that the foreignizing crime novel occupies a paradoxical position between two opposite valences: it is at the same time an instance of cultural appropriation and a genuine and distinctive form of world literature (4).