bluuebunny/crossref_metadata_2025 huggingface dataset:
What Is the Potential Value of a Randomized Trial of Different Thresholds to Initiate Invasive Ventilation? A Health Economic Analysis
Authors: Yarnell Christopher J. , Barrett Kali , Heath Anna , Herridge Margaret , Fowler Robert A. , Sung Lillian , Naimark David M. , Tomlinson George
Published: June 2024

OBJECTIVES:

To estimate the expected value of undertaking a future randomized controlled trial of thresholds used to initiate invasive ventilation compared with usual care in hypoxemic respiratory failure.

PERSPECTIVE:

Publicly funded healthcare payer.

SETTING:

Critical care units capable of providing invasive ventilation and unconstrained by resource limitations during usual (nonpandemic) practice.

METHODS:

We performed a model-based cost-utility estimation with individual-level simulation and value-of-information analysis focused on adults, admitted to critical care, receiving noninvasive oxygen. In the primary scenario, we compared hypothetical threshold A to usual care, where threshold A resulted in increased use of invasive ventilation and improved survival compared with usual care. In the secondary scenario, we compared hypothetical threshold B to usual care, where threshold B resulted in decreased use of invasive ventilation and similar survival compared with usual care. We assumed a willingness-to-pay of 100,000 Canadian dollars (CADs) per quality-adjusted life year.

RESULTS:

In the primary scenario, threshold A was cost-effective compared with usual care due to improved hospital survival (78.1% vs. 75.1%), despite more use of invasive ventilation (62% vs. 30%) and higher lifetime costs (86,900 vs. 75,500 CAD). In the secondary scenario, threshold B was cost-effective compared with usual care due to similar survival (74.5% vs. 74.6%) with less use of invasive ventilation (20.2% vs. 27.6%) and lower lifetime costs (71,700 vs. 74,700 CAD). Value-of-information analysis showed that the expected value to Canadian society over 10 years of a 400-person randomized trial comparing a threshold for invasive ventilation to usual care in hypoxemic respiratory failure was 1.35 billion CAD or more in both scenarios.

CONCLUSIONS:

It would be highly valuable to society to identify thresholds that, in comparison to usual care, either increase survival or reduce invasive ventilation without reducing survival.
Clinical and Histological Effects of Calcium Hydroxyapatite Filler in the Orofacial Region: A Study in Rats
Authors: Thums Marianna Ávila , Payeras Márcia Rodrigues , Cherubini Karen , Koth Valesca Sander , Salum Fernanda Gonçalves
Published: June 2024

BACKGROUND

Calcium hydroxyapatite (CaHA) dermal filler has been increasingly used in facial aesthetic procedures.

OBJECTIVE

To investigate clinical and histological changes associated with calcium hydroxyapatite (CaHA) dermal filler in the orofacial region.

MATERIALS AND METHODS

Forty-eight female Wistar rats were divided into CaHA and control groups. The material was applied in the ventral tongue and the submandibular region; the animals were euthanized after 7, 30, and 90 days.

RESULTS

After 7 days, yellowish nodules with a firm consistency were observed on the tongue. In 2 animals, the material migrated to the base of the tongue. Histopathological examination revealed CaHA spheres surrounded by an infiltrate, predominantly composed of macrophages. In the CaHA group, the percentage of collagen in the tongue and dermis was higher compared with the control group (p < .05) at both 30 and 90 days. The thickness of the epidermis/dermis was also higher in the CaHA group (p < .05). In 5 submandibular glands containing material, areas of edema and hyperemia were observed, along with infiltrates of neutrophils, lymphocytes, and plasma cells. Changes in the morphology of ducts and acini in adjacent regions were evident.

CONCLUSION

CaHA exhibits satisfactory properties for filling and collagen biostimulation in the tested regions. Further studies are required to explore the potential for migration and the glandular alterations.
Inhibition of α-Amino-3-Hydroxy-5-Methyl-4-Isoxazolepropionic Acid Receptors Ameliorates Atrial Inflammation and Vulnerability to Atrial Fibrillation in Rats with Anxiety Disorders
Authors: Zou Ying , Liu Xin , Hu Yiqian , Zhang Cui , Shen Bo , Yang Bo
Published: June 2024

Previous studies have found that anxiety disorders may increase the incidence of atrial fibrillation (AF). More and more studies have shown that α-amino-3-hydroxy-5-methyl-4-isoxazolepropionic acid receptors (AMPARs) are involved in the occurrence and development of cardiovascular diseases. However, the role of AMPARs in AF associated with anxiety disorder remains unclear. The aim of this study was to investigate the effect of AMPARs on AF susceptibility in rats with anxiety disorder and its possible mechanism. The anxiety disorder rat model was established by unpredictable empty bottle stimulation and was treated with AMPARs agonist and antagonist. Our results showed that AMPARs antagonist treatment significantly reduced sympathetic activity, improved heart rate variability, shortened action potential duration, prolonged effective refractory period, reduced AF induction rate, and improved cardiac electrical remodeling and the expression of inflammatory factors. In addition, inhibition of AMPARs reduced the phosphorylation of IκBα and p65. Our experimental results suggest that inhibition of AMPARs can reduce autonomic remodeling, improve atrial electrical remodeling, and suppress myocardial inflammation, which provides a potential therapeutic strategy for the treatment of AF associated with anxiety disorder.
Quercetin Protects Against Hypertensive Renal Injury by Attenuating Apoptosis: An Integrated Approach Using Network Pharmacology and RNA Sequencing
Authors: Zhang Xiu-li , Li Jia-peng , Wu Mei-zhu , Wu Jin-kong , He Shu-yu , Lu Yao , Ding Qi-hang , Wen Ying , Long Lin-zi , Fu Chang-geng , Farman Ali , Shen A-ling , Peng Jun
Published: June 2024

Quercetin is known for its antihypertensive effects. However, its role on hypertensive renal injury has not been fully elucidated. In this study, hematoxylin and eosin staining, terminal deoxynucleotidyl transferase dUTP nick-end labeling (TUNEL) staining, and Annexin V staining were used to assess the pathological changes and cell apoptosis in the renal tissues of angiotensin II (Ang II)–infused mice and Ang II–stimulated renal tubular epithelial cell line (NRK-52E). A variety of technologies, including network pharmacology, RNA-sequencing, immunohistochemistry, and Western blotting, were performed to investigate its underlying mechanisms. Network pharmacology analysis identified multiple potential candidate targets (including TP53, Bcl-2, and Bax) and enriched signaling pathways (including apoptosis and p53 signaling pathway). Quercetin treatment significantly alleviated the pathological changes in renal tissues of Ang II–infused mice and reversed 464 differentially expressed transcripts, as well as enriched several signaling pathways, including those related apoptosis and p53 pathway. Furthermore, quercetin treatment significantly inhibited the cell apoptosis in renal tissues of Ang II–infused mice and Ang II–stimulated NRK-52E cells. In addition, quercetin treatment inhibited the upregulation of p53, Bax, cleaved-caspase-9, and cleaved-caspase-3 protein expression and the downregulation of Bcl-2 protein expression in both renal tissue of Ang II–infused mice and Ang II–stimulated NRK-52E cells. Moreover, the molecular docking results indicated a potential binding interaction between quercetin and TP53. Quercetin treatment significantly attenuated hypertensive renal injury and cell apoptosis in renal tissues of Ang II–infused mice and Ang II–stimulated NRK-52E cells and by targeting p53 may be one of the potential underlying mechanisms.
Advances in gynecologic simulation: implementation, validity, and new resources
Authors: Edmonds Kathryn , Warner Steve , Endicott Scott
Published: June 2024

Purpose of review

Simulation plays an integral role in gynecological surgical training that will continue and grow in the future. It aims to supplement surgical training as residents are experiencing decreased surgical volumes. It has also been recognized as a means for assessing a trainee's capabilities to the point of being incorporated into the board certification process. This review will highlight the recent updates in research and resources available for gynecologic surgery simulation.

Recent findings

The literature reviewed demonstrated that, across the board, participants in simulation find it beneficial. A variety of low-fidelity and high-fidelity models, virtual reality programs, and artificial intelligence technology have been developed recently. As the field advances, researchers have started to investigate methods to increased engagement and provide feedback without the need for direct observation, the logical next step considerations to maximize the impact and availability of simulation.

Gynecologic surgery training programs must stay abreast of the wide variety of simulation training available. Efforts should continue to be made to investigate the impact of simulation patient outcomes. The academic medicine community has a responsibility to ensure high-quality simulation is available to all surgical trainees to avoid disparities between low-resource and high-resource programs.
Myofascial pelvic pain: the forgotten player in chronic pelvic pain
Authors: Namazi Golnaz , Chauhan Navya , Handler Stephanie
Published: June 2024

Purpose of review

In this review article, we discuss myofascial-related chronic pelvic pain, pathophysiology, symptomology, and management options.

Recent findings

Despite high prevalence of myofascial pelvic pain, screening is not routinely performed by providers. Treatment modalities include pelvic floor physical therapy, pelvic floor trigger point injections with anesthetics or botulinum toxin A and cryotherapy. Other adjunct modalities, such as muscle relaxants and intravaginal benzodiazepines, are used, but data regarding their effectiveness is sparse.

Myofascial pelvic pain is an important, though overlooked component of chronic pelvic pain. Multimodal, multidisciplinary approach including patient education, pelvic floor physical therapy, and trigger point injections is the mainstay of the management of myofascial pelvic pain.
Holistic approach to care for patients with endometriosis
Authors: Molina Andrea , Carter Ashlie , Alexander Lacy , Davé Arpit , Riley Kristin
Published: June 2024

Purpose of review

Endometriosis is a chronic, often debilitating, disease which is typically managed with surgery and hormonal medications. However, many patients feel they lack agency when managing endometriosis symptoms. The purpose of this review is to discuss the mental and physical management strategies, the long-term health consequences, and the role of a multidisciplinary team in the treatment of endometriosis.

Recent findings

Evidence is becoming more robust regarding the role of complementary care and physical activity in the management of endometriosis. Health risks such as infertility are well known and newer evidence is evolving regarding perinatal and cardiovascular health risks. There are also trends towards multiple specialist involvement in the care of endometriosis and the benefit of interdisciplinary collaboration.

Endometriosis is a frequently recurrent condition requiring not only meticulous medical and surgical care, but also coordinated longitudinal disease management and impact mitigation. Gynecologists should be aware of the short-term and long-term implications of the disease to empower patients on the management of their overall health.
Association Between Adherence to a 3-Month Cardiac Rehabilitation Program and Long-Term Clinical Outcomes in Japanese Patients With Cardiac Implantable Electronic Devices
Authors: Yanagi Hidetoshi , Konishi Harumi , Omae Katsuhiro , Yamamoto Kazuya , Murata Makoto , Ueda Nobuhiko , Ishibashi Kohei , Noguchi Teruo , Kusano Kengo
Published: June 2024

Purpose:

The objective of this study was to evaluate the association between comprehensive cardiac rehabilitation (CCR) completion and long-term clinical outcomes in patients with cardiac implantable electronic devices (CIED).

Methods:

This retrospective cohort study included 834 patients with CIED who participated in CCR, which included a cardiopulmonary exercise test or 6-min walk test. Patients with a left ventricular ejection fraction ≤40%, predicted peak oxygen uptake ≤80%, or B-type natriuretic peptide level ≥80 pg/mL were eligible. The primary outcome was all-cause mortality.

Results:

After excluding 241 patients with duplicate records and 69 who underwent CCR in the outpatient department, the data of 524 patients were analyzed. Mean age was 64 ± 15 yr, 389 (74%) patients were men, left ventricular ejection fraction was 31 ± 15%, and 282 (54%) patients had a history of hospitalization for worsening heart failure. Of the patients referred for CCR, 294 (56%) completed the program, and an additional 230 patients started but did not complete CCR. Over a 3.7-yr median follow-up period, all-cause mortality occurred in 156 (30%) patients. Completers had lower all-cause mortality rates than non-completers (log-rank 15.77, P< .001). After adjusting for prognostic baseline characteristics, completers had 58% lower all-cause mortality risks than non-completers (HR = 0.42; 95% CI, 0.27-0.64, P< .001).

Conclusions:

Three-mo CCR program completion was associated with lower mortality risks in patients with CIED. New programs or management methods are needed to decrease mortality risks, especially for those who cannot complete CCR programs.
Physical exercise in liver diseases
Authors: Zhang Yunwei , Cao Chunyan , Li Chaofan , Witt Russell G. , Huang Hai , Tsung Allan , Zhang Hongji
Published: June 2024

Liver diseases contribute to ~2 million deaths each year and account for 4% of all deaths globally. Despite various treatment options, the management of liver diseases remains challenging. Physical exercise is a promising nonpharmacological approach to maintain and restore homeostasis and effectively prevent and mitigate liver diseases. In this review, we delve into the mechanisms of physical exercise in preventing and treating liver diseases, highlighting its effects on improving insulin sensitivity, regulating lipid homeostasis, and modulating immune function. In addition, we evaluate the impact of physical exercise on various liver diseases, including liver ischemia/reperfusion injury, cardiogenic liver disease, metabolic dysfunction–associated steatotic liver disease, portal hypertension, cirrhosis, and liver cancer. In conclusion, the review underscores the effectiveness of physical exercise as a beneficial intervention in combating liver diseases.
GENETIC ETIOLOGY AND CLINICAL FEATURES OF ACHROMATOPSIA IN JAPAN
Authors: Inooka Taiga , Hayashi Takaaki , Tsunoda Kazushige , Kuniyoshi Kazuki , Kondo Hiroyuki , Mizobuchi Kei , Suga Akiko , Iwata Takeshi , Yoshitake Kazutoshi , Kondo Mineo , Goto Kensuke , Ota Junya , Kominami Taro , Nishiguchi Koji M. , Ueno Shinji
Published: June 2024

Purpose:

To ascertain the characteristics of achromatopsia (ACHM) in Japan by analyzing the genetic and phenotypic features of patients with ACHM.

Methods:

The medical records of 52 patients from 47 Japanese families who were clinically diagnosed with ACHM were reviewed in this retrospective observational study.

Results:

Thirty-six causative variants of ACHM were identified in 26 families via whole-exome sequencing: PDE6C (12 families), CNGA3 (10 families), CNGB3 (two families), and GNAT2 (two families). However, none of the 6 causative variants that are known to cause ACHM, or the 275 other genes listed in RetNet, were observed in 19 families. A significant trend toward older age and worsening of ellipsoid zone disruption on optical coherence tomography images was observed (P < 0.01). Progressive ellipsoid zone disruptions were observed in 13 eyes of seven patients during the follow-up visits. These patients harbored one or more variants in PDE6C.

Conclusion:

The ACHM phenotype observed in this study was similar to those observed in previous reports; however, the causative gene variants differed from those in Europe. The low identification ratio of causative genes in whole-exome sequencing suggests the presence of unique hotspots in Japanese patients with ACHM that were not detectable via ordinal whole-exome sequencing.
RETICULAR PSEUDODRUSEN DISAPPEARANCE AFTER DEVELOPMENT OF MACULAR NEOVASCULARIZATION
Authors: Menean Matteo , Sacconi Riccardo , Tombolini Beatrice , L'abbate Gaia , Beretta Federico , Bandello Francesco , Querques Giuseppe
Published: June 2024

Purpose:

To explore changes in reticular pseudodrusen (RPD) number and location after the development of macular neovascularization (MNV) in eyes with prior intermediate age-related macular degeneration, focusing on different retinal regions differently affected by MNV.

Methods:

This retrospective longitudinal study included intermediate age-related macular degeneration eyes with RPD that developed MNV. Reticular pseudodrusen were assessed at baseline when MNV was diagnosed (MNV stage) and after anti–vascular endothelial growth factor treatment. Three regions of interest were considered: MNV area, subretinal fluid (SRF) area, and a marginal area of 1,000 µm around SRF (marginal zone). Reticular pseudodrusen counts were compared with age- and sex-matched control eyes with RPD that did not develop MNV.

Results:

Reticular pseudodrusen number exhibited a significant decrease after MNV development in the MNV area (P = 0.048) and in the area with SRF (P = 0.078). A statistically significant decrease was also disclosed in the marginal area around SRF (P = 0.002), associated with larger SRF areas. Control eyes did not show any significant change in the RPD count.

Conclusion:

Reticular pseudodrusen reduction after MNV development suggests a complex interplay involving the MNV itself, the presence of SRF, and trophic changes. The results of this study highlight the role of MNV in retinal nutritional balance and provide intriguing results in the RPD life cycle.
EFFICACY AND SAFETY OF THE PROPOSED BIOSIMILAR AFLIBERCEPT, SDZ-AFL, IN PATIENTS WITH NEOVASCULAR AGE-RELATED MACULAR DEGENERATION
Authors: Bordon Arnaldo F. , Kaiser Peter K. , Wolf Armin , Cen Liyi , Heyn Jens , Urosevic Dragan , Dodeller Francis , Allmannsberger Lisa , Silva Rufino
Published: June 2024

Purpose:

The Phase 3 Mylight study was designed to confirm clinical equivalence of proposed biosimilar aflibercept (SOK583A1; Sandoz [proposed biosimilar aflibercept, SDZ-AFL]) to its reference biologic (Eylea; Regeneron Pharmaceuticals, Inc; Bayer AG [reference aflibercept, Ref-AFL]).

Method:

Mylight was a prospective, double-masked, 2-arm, parallel Phase 3 study. Participants with neovascular age-related macular degeneration were randomized 1:1 to receive eight injections of SDZ-AFL (n = 244) or Ref-AFL (n = 240) over 48 weeks. The primary endpoint was mean change in best-corrected visual acuity score from baseline to Week 8. Secondary endpoints included anatomical outcomes, best-corrected visual acuity at Weeks 24 and 52, safety, and pharmacokinetics.

Results:

Similarity in mean change in best-corrected visual acuity score was established between SDZ-AFL (n = 235) and Ref-AFL (n = 226) at Week 8 (difference: −0.3 [90% CI, −1.5 to 1.0]) and Week 52. No clinically meaningful differences occurred between groups in anatomical outcomes. Safety profiles were similar, with comparable incidences of treatment-related adverse events (SDZ-AFL: 2.5%; Ref-AFL: 2.9%). The incidence of anti-drug antibodies was similar between groups. Systemic free aflibercept concentrations 24 hours postdose were low and comparable between SDZ-AFL and Ref-AFL.

Conclusion:

Proposed biosimilar aflibercept matched reference aflibercept in efficacy, safety, and pharmacokinetics in participants with neovascular age-related macular degeneration. Therefore, this Phase 3 study confirmed biosimilarity of SDZ-AFL to Ref-AFL.
MENISCUS MICROPYON
Authors: Russell Jonathan F. , Fowler Benjamin J. , Al-Khersan Hasenin , Lazzarini Thomas A. , Patel Nimesh A. , Syed Nasreen A. , Russell Stephen R.
Published: June 2024

Purpose:

To describe an ophthalmoscopic sign, termed a meniscus micropyon, and its possible association with proliferative vitreoretinopathy/epiretinal membrane (ERM) formation after retinal surgery with gas tamponade.

Methods:

Patients with intravitreal gas were examined postoperatively by one of six vitreoretinal surgeons from four institutions. A micropyon was defined as a white–yellow, solid-appearing consolidation along the meniscus (i.e., the fluid–gas interface).

Results:

A micropyon was visualized and photographed in 49 patients who received intravitreal gas. Preoperatively, retinal breaks were present in all 49 eyes and rhegmatogenous retinal detachment in 45 (92%). Postoperatively, 39 eyes (80%) developed epiretinal proliferation: 16 eyes (33%) developed recurrent rhegmatogenous retinal detachment from proliferative vitreoretinopathy, 6 eyes (12%) re-detached without frank proliferative vitreoretinopathy, 9 eyes (18%) developed postoperative ERM/worsening, and 8 eyes (16%) had postoperative ERM but no preoperative optical coherence tomography to determine if the postoperative ERM was new or worsening. The single-operation anatomical success in eyes with a micropyon was 51%, which was lower than that of a contemporaneous rhegmatogenous retinal detachment control group (91%) in which no micropyon was detected. In two patients, micropyons were biopsied during pars plana vitrectomy and examined histopathologically; they consist predominantly of white blood cells.

Conclusion:

The meniscus micropyon is an ophthalmoscopic sign that can occur after retinal surgery with gas tamponade. Features that distinguish a micropyon from postvitrectomy fibrin/fibrinoid syndrome include delayed appearance, hyperautofluorescence, absence of translucent strands or sheets in the anterior chamber or vitreous cavity, and the histopathologic identification of white blood cells. A clinically detectable micropyon may be a biomarker of proliferative vitreoretinopathy/ERM formation.
Modified Delphi RAND/UCLA Consensus on Recommendations for Preventing Surgical Site Infections in Colorectal Surgery
Authors: Roberti Javier , Rodríguez Viviana , Seijo Mariana , Rodríguez Ana Paula , Guglielmino Marina , Jorro-Barón Facundo , Baigorria María de los Angeles , Villa Silvia , Cornistein Wanda , Ocampo Cecilia V. , Clara Liliana , Colque Angel M. , Staneloni María I. , Piccinini Pablo , Pidal Paola , Bagnulo Homero , Albornoz Henry , Vivas Carlos , Pike Patrick , García-Elorrio Ezequiel
Published: June 2024

Surgical site infections (SSIs) are a major health care issue, with worse outcomes and higher costs in Latin America than in other countries. To reduce SSIs in colorectal surgery (CRS), we conducted a mixed-method study between May and December 2021, which included a literature review, Delphi expert consensus panel, and SSI reduction recommendations. The literature review identified 150 relevant articles, deriving 19 recommendations based on the GRADE framework. A panel of 14 experts from Argentina, Chile, and Uruguay, specializing in infection control, participated in a modified Delphi consensus process. They evaluated the recommendations using a Likert scale and assessed 13 criteria to reach consensus. After rounds of evaluation and expert discussions, 6 recommendations achieved consensus and were deemed appropriate for SSI prevention in CRS: presurgical bathing, surgical antibiotic prophylaxis, mechanical colon preparation, preincision antisepsis with alcohol and antisepsis, monitoring of hyperglycemic patients, and control of normothermia. Implementing such a multifaceted set of recommendations presents challenges, and a bundled approach has been suggested to improve the adherence to complex prevention strategies. Previous research has underscored the importance of effective implementation strategies, including engagement, education, execution, and evaluation, as well as fostering a culture of safety and readiness for change. This study offers expert recommendations for preventing SSIs in CRS, particularly in Latin America. These are crucial for regional health care organizations. Compliance with basic infection prevention measures remains a concern. A bundled approach was suggested to evaluate adherence to health care protocols in Argentina and Uruguay. Aligning guidelines and practices can increase patient safety and reduce the impact of SSIs on Latin American health care.
Candida auris induces phagocytosis, reactive oxygen species production and inflammation through TLR2, TLR4 and Dectin-1 dependent signaling in macrophages
Authors: Duan Zhimin , He Yanzhi , Wang Jianing , Chen Xu , Chen Qing , Li Min
Published: June 2024

Candida auris (C. auris) is an important fungal pathogen with high rates of transmissibility, mortality, and drug resistance. However, studies on its pathogenicity, host-pathogen interactions, and macrophage immune responses against C. auris are still limited. This study compared the immune response induced by Candida albicans and C. auris, and explored the inflammation mechanisms of macrophages induced by C. auris. Macrophages showed a lower phagocytosis rate, reactive oxygen species production, and expression of pro-inflammatory cytokines like interleukin (IL)-6, tumor necrosis factor-α and IL-1β against C. auris when compared with Candida albicans. To further study the mechanism of inflammatory response induced by C. auris, macrophages were stimulated with C. auris for different concentration and duration. The expression and secretion of IL-6, tumor necrosis factor-α and IL-1β stimulated by C. auris depended on the activation of Toll-like receptor 2 (TLR2), TLR4, Dectin-1, and downstream signaling pathways. TLR2, TLR4, and Dectin-1 participated in the recognition and phagocytosis of C. auris. Dectin-1 was the most important receptor in mediating immune response, while TLR4 was the most critical receptor in influencing the inflammatory response. Overall, the study revealed that C. auris induced a lower level of phagocytosis, production of reactive oxygen species, and expression of inflammatory factors than Candida albicans, and that TLR2, TLR4, and Dectin-1 played important roles in the induction of inflammation.
Effects of Custom Molded Foot Orthoses on Balance, Gait Speed, and Pain in Postmenopausal Osteoporotic Women: A Prospective Experimental Study
Authors: Parashar Umang , Kumar Yashika
Published: June 2024

Introduction

Osteoporotic changes displace the center of pressure (COP) closer to the limits of stability, causing balance impairment and alteration of gait characteristics. Bone architecture destruction hinders the weight-bearing capacity of lower extremities, causing foot pain, redness, and swelling. Foot orthoses increase somatosensory input and shock absorption, thus improving balance, gait speed, and pain.

Objectives

The aim of this study was to evaluate and quantify the effects of custom-molded insoles on the balance, gait speed, and foot pain of postmenopausal osteoporotic women.

Study Design

This study is a parallel group randomized control trial.

Methods

A total of 44 postmenopausal osteoporotic women were recruited and randomized into two groups: experimental (EG) (n = 22) and control (CG) (n = 22). EG completed a 2-week intervention period with custom-molded insoles, whereas CG did not receive any intervention. Balance, gait speed, and foot pain were measured at baseline and after 2 weeks for both groups.

Results

The comparison of preintervention and postintervention outcomes for both groups highlighted that they were similar at baseline; however, EG showed significant improvement in all outcome measures after 2 weeks.

Conclusions

This study provides preliminary evidence that custom-molded insoles had a positive effect on the proprioceptive feedback of the lower limb, thus enhancing balance. The inclusion of a heel cup in the orthoses minimized the abnormal movement of the ankle that affected the mechanical stability of the lower limbs. Additionally, they increased the surface of contact, thus reducing the load per unit of surface, minimizing foot pain and discomfort.

Clinical Relevance

Osteoporotic falls and fractures have severe consequences and are a major public health concern; therefore, developing effective fall prevention strategies is crucial. Custom-molded insoles could help improve balance, gait speed, and pain, potentially reducing falls while also improving the quality of life for postmenopausal osteoporotic women.
Preliminary Evaluation of a Questionnaire to Measure Program-Level Sense of Belonging Among Student Physical Therapists
Authors: Almonroeder Thomas Gus , Duellman Jonathan , Edmonds Nicole , O'Rourke Beth , Rivera Nikolaos
Published: June 2024

Introduction.

A greater sense of belonging has been found to correspond with better academic performance/motivation, retention, and general mental well-being among college students. As a result, it is important to be able to meaningfully assess student physical therapists’ sense of belonging.

Review of Literature.

While there are questionnaires available to assess sense of belonging at the university level, it is also important to be able to assess students’ sense of belonging in a narrower context, such as within their program of study. The purpose of this study was to develop and evaluate a program-specific tool, referred to as the Program Sense of Belonging (ProSB) questionnaire, that could be used to assess sense of belonging among student physical therapists. As part of this study, we examined the internal structure of the ProSB questionnaire items and assessed internal consistency.

Subjects.

One hundred twenty-four student physical therapists from 2 different physical therapist education programs completed the ProSB questionnaire.

Methods.

We conducted an exploratory factor analysis to examine the internal structure of the ProSB questionnaire and examined Cronbach's alpha to assess the internal consistency of the items associated with each retained factor.

Results.

For the final 10-item version of the ProSB questionnaire, 2 factors were retained, which explained 57.5% of the variance (factor 1 = 30.9%, factor 2 = 26.6%). The 5 items that loaded on factor 1 were related to “social acceptance,” while the 5 items that loaded on factor 2 were related to “valued competence.” Both subscales exhibited acceptable levels of internal consistency (Cronbach's alpha ≥0.84).

Discussion.

The ProSB questionnaire appears to capture different dimensions of student physical therapists’ sense of belonging (social acceptance, valued competence) at the program level.

Conclusion:

Based on our preliminary findings, the ProSB questionnaire appears to be a valid tool for assessing program-level sense of belonging among student physical therapists.
Prostate-specific membrane antigen-PET/CT may result in stage migration in prostate cancer: performances, quantitative analysis, and potential criticism in the clinical practice
Authors: Alongi Pierpaolo , Messina Marco , Pepe Alessio , Arnone Annachiara , Vultaggio Viola , Longo Costanza , Fiasconaro Elisa , Mirabile Alessia , Ricapito Rosaria , Blasi Livio , Arnone Gaspare , Messina Carlo
Published: June 2024

Aim

The early detection of prostate cancer (PCa) metastatic disease with PET imaging leads to stage migration and change of disease management. We aimed to assess the impact on clinical management deriving from prostate-specific membrane antigen (PSMA) imaging with a digital PET/CT during the routine application in the staging and restaging process of PCa.

Material and methods

Eighty consecutive PCa patients underwent 18F-PSMA-1007. Digital PET/CT were retrospectively evaluated and discussed with oncologists to evaluate the impact on clinical management. Performances analysis, correlation among variables also considering semiquantitative parameters have been conducted.

Results

In the whole group of 80 patients at staging (N = 31) and restaging (N = 49), the detection rate of PSMA PET was 85% for all lesions. At staging, the performance analysis resulted in sensitivity 77.6%, specificity 89.5%, negative predictive value (NPV) 77.6%, positive predictive value (PPV) 89.5%, accuracy 85.7%, and area under curve (AUC) 0.87%. The performance of restaging PET in the group of patients with PSA values <1 ng/ml resulted in the following values: sensitivity 66.7%, specificity 92.9%, NPV 85.7%, PPV 81.3%, accuracy 82.6%, and AUC 0.79. Semiquantitative analysis revealed a mean value of SUVmax, metabolic tumor volume, and total lesion PSMA expression with differences in patients with high risk compared to low intermediate. At restaging PET, semiquantitative values of patients with total prostate specific antigen (tPSA) ≤ 1 ng/ml were significantly less than those of the tPSA > 1 ng/ml. A significant impact on clinical management was reported in 46/80 patients (57.5%) based on PSMA PET findings at staging and restaging.

Conclusion

Although PSMA-PET provides optimal performances, its current role in redefining a better staging should be translated in the current clinical scenario about potential improvement in clinical/survival outcomes.
Predictive significance of intraprostatic volumetric parameters derived from early and standard time 68Ga-PSMA PET/CT images in newly diagnosed prostate cancer patients
Authors: Erdogan Ezgi Basak , Tekce Ertugrul , Koca Serhat , Aslan Nesrin , Toluk Ozlem , Aydin Mehmet
Published: June 2024

Objective

To investigate the relationship between intraprostatic 68Ga-prostate-specific membrane antigen (PSMA) uptake values and volumetric parameters derived from early pelvic and standard-time whole-body 68Ga-PSMA PET/computed tomography (CT) images in untreated prostate cancer (PCa) patients, and to assess the predictive significance of these data in relation to disease prognosis, comparing them with the Gleason score, clinical risk classification and the presence of metastatic disease detected in 68Ga-PSMA PET/CT imaging.

Methods

Eighty-one newly diagnosed PCa patients underwent early phase pelvic imaging at the 5th minute and standard time whole-body imaging at the 60th minute. Various threshold values were used in intraprostatic delineations to compute maximum standardized uptake value (SUVmax), mean standardized uptake value (SUVmean), intraprostatic PSMA tumor volume and intraprostatic total lesion PSMA uptake. Correlations between early and standard time measurements, as well as changes in SUV parameters over time, were examined. The association of these values with Gleason score, clinical risk status (National Comprehensive Cancer Network), and metastatic disease was explored.

Results

SUVmax measurements from both early and standard time images distinguished all three groups (clinical risk scores, Gleason score and metastatic group), with standard imaging demonstrating statistical superiority in receiver operating characteristic analyses. Strong correlations were observed between early and standard-time PET parameters. Changes in intraprostatic SUVmax and SUVmean values over time did not exhibit predictive value.

Conclusion

Although intraprostatic PSMA PET parameters generally aligned at both early and standard times, parameters obtained from standard time images showed more robust correlations with clinical risk scores, Gleason score and metastasis status in newly diagnosed, untreated PCa patients.
The nonsalvageable tibia: amputation and prosthetics
Authors: Rivero Steven , Stevens Nicole M.
Published: June 2024

Mangled extremities are a challenging problem for the orthopaedic surgeon. The decision for salvage versus amputation is multifactorial. Several work groups have attempted to create scoring systems to guide treatment, but each case must be regarded individually. As surgical technique and prosthetics continue to improve, amputations should be seen as a viable reconstructive option, rather than failure. This article reviews scoring systems for the mangled extremity, outcomes on salvage versus amputation, amputation surgical technique, and prosthetic options.
Tibial bone loss
Authors: Schaffler Benjamin C. , Konda Sanjit R.
Published: June 2024

Critical bone loss after open fractures, while relatively uncommon, occurs most frequently in high-energy injuries. Fractures of the tibia account for the majority of open fractures with significant bone loss. A number of different surgical strategies exist for treatment of tibial bone loss, all with different advantages and disadvantages. Care should be taken by the surgeon to review appropriate indications and all relevant evidence before selecting a strategy.
Aerosol Box Use in Reducing Health Care Worker Contamination During Airway Procedures (AIRWAY) Study: Secondary Workload and Provider Outcomes in a Simulation-Based Trial*
Authors: Singer Harel Dana , Lin Yiqun , Lo Carl Y. , Cheng Adam , Davidson Jennifer , Chang Todd P. , Matava Clyde , Buyck Michael , Neveu Guylaine , Collia Natasha , Fayyaz Jabeen , Manshadi Keya , Levy Arielle , Pellerin Stephanie , Pirie Jonathan ,   for the International Network for Simulation-based Pediatric Innovation, Research, and Education Aerosol Generating Medical Procedures (INSPIRE AGMP) Investigators
Published: June 2024

OBJECTIVES:

An aerosol box aims to reduce the risk of healthcare provider (HCP) exposure to infections during aerosol generating medical procedures (AGMPs), but little is known about its impact on workload of team members. We conducted a secondary analysis of data from a prospective, multicenter, randomized controlled trial evaluating the impact of aerosol box use on patterns of HCP contamination during AGMPs. The objectives of this study are to: 1) evaluate the effect of aerosol box use on HCP workload, 2) identify factors associated with HCP workload when using an aerosol box, and 3) describe the challenges perceived by HCPs of aerosol box use.

DESIGN:

Simulation-based randomized trial, conducted from May to December 2021.

SETTING:

Four pediatric simulation centers.

SUBJECTS:

Teams of two HCPs were randomly assigned to control (no aerosol box) or intervention groups (aerosol box).

INTERVENTIONS:

Each team performed three scenarios requiring different pediatric airway management (bag-valve-mask [BVM] ventilation, laryngeal mask airway [LMA] insertion, and endotracheal intubation [ETI] with video laryngoscopy) on a simulated COVID-19 patient. National Aeronautics and Space Administration-Task Load Index (NASA-TLX) is a standard tool that measures subjective workload with six subscales.

MEASUREMENTS AND MAIN RESULTS:

A total of 64 teams (128 participants) were recruited. The use of aerosol box was associated with significantly higher frustration during LMA insertion (28.71 vs. 17.42; mean difference, 11.29; 95% CI, 0.92–21.66; p = 0.033). For ETI, there was a significant increase in most subscales in the intervention group, but there was no significant difference for BMV. Average NASA-TLX scores were all in the “low” range for both groups (range: control BVM 23.06, sd 13.91 to intervention ETI 38.15; sd 20.45). The effect of provider role on workloads was statistically significant only for physical demand (p = 0.001). As the complexity of procedure increased (BVM → LMA → ETI), the workload increased in all six subscales (p < 0.05).

CONCLUSIONS:

The use of aerosol box increased workload during ETI but not with BVM and LMA insertion. Overall workload scores remained in the “low” range, and there was no significant difference between airway provider and assistant.
Social Determinants of Health and Health-Related Quality of Life Following Pediatric Septic Shock: Secondary Analysis of the Life After Pediatric Sepsis Evaluation Dataset, 2014–2017*
Authors: Lenz Kyle B. , McDade Jessica , Petrozzi Mariagrazia , Dervan Leslie A. , Beckstead Rylee , Banks Russell K. , Reeder Ron W. , Meert Kathleen L. , Zimmerman Jerry , Killien Elizabeth Y.
Published: June 2024

OBJECTIVES:

Social determinants of health (SDOH) are associated with disparities in disease severity and in-hospital outcomes among critically ill children. It is unknown whether SDOH are associated with later outcomes. We evaluated associations between SDOH measures and mortality, new functional morbidity, and health-related quality of life (HRQL) decline among children surviving septic shock.

DESIGN:

Secondary analysis of the Life After Pediatric Sepsis Evaluation (LAPSE) prospective cohort study was conducted between 2014 and 2017.

SETTING:

Twelve academic U.S. PICUs were involved in the study.

PATIENTS:

Children younger than 18 years with community-acquired septic shock were involved in the study.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We assessed associations between race, ethnicity, income, education, marital status, insurance, language, and home U.S. postal code with day 28 mortality, new functional morbidity at discharge per day 28, and HRQL decline using logistic regression. Of 389 patients, 32% (n= 98) of families had household income less than $50,000 per year. Median Pediatric Risk of Mortality (PRISM) score was 11 (interquartile range 6, 17). We found that English language and Area Deprivation Index less than 50th percentile were associated with higher PRISM scores. Mortality was 6.7% (n= 26), new functional morbidity occurred in 21.8% (n= 78) of patients, and HRQL decline by greater than 10% occurred in 31.0% of patients (n= 63). We failed to identify any association between SDOH measures and mortality, new functional morbidity, or HRQL decline. We are unable to exclude the possibility that annual household income greater than or equal to $50,000 was associated with up to 81% lesser odds of mortality and, in survivors, more than three-fold greater odds of HRQL decline by greater than 10%.

CONCLUSIONS:

In this secondary analysis of the 2014–2017 LAPSE dataset, we failed to identify any association between SDOH measures and in-hospital or postdischarge outcomes following pediatric septic shock. This finding may be reflective of the high illness severity and single disease (sepsis) of the cohort, with contribution of clinical factors to functional and HRQL outcomes predominating over prehospital and posthospital SDOH factors.
Reaching for 90:90:90 in Correctional Facilities in South Africa and Zambia: Virtual Cross-Section of Coverage of HIV Testing and Antiretroviral Therapy During Universal Test and Treat Implementation
Authors: Hoffmann Christopher J. , Herce Michael E. , Chimoyi Lucy , Smith Helene J. , Tlali Mpho , Olivier Cobus J. , Topp Stephanie M. , Muyoyeta Monde , Reid Stewart E. , Hausler Harry , Charalambous Salome , Fielding Katherine
Published: June 2024

Background:

People in correctional settings are a key population for HIV epidemic control. We sought to demonstrate scale-up of universal test and treat in correctional facilities in South Africa and Zambia through a virtual cross-sectional analysis.

Methods:

We used routine data on 2 dates: At the start of universal test and treat implementation (time 1, T1) and 1 year later (time 2, T2). We obtained correctional facility census lists for the selected dates and matched HIV testing and treatment data to generate virtual cross-sections of HIV care continuum indicators.

Results:

In the South African site, there were 4193 and 3868 people in the facility at times T1 and T2; 43% and 36% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 1803 (43%) and 1386 (36%) had known HIV status, 804 (19%) and 845 (21%) were known to be living with HIV, and 60% and 56% of those with known HIV were receiving antiretroviral therapy (ART). In the Zambian site, there were 1467 and 1366 people in the facility at times T1 and T2; 58% and 92% were matched with HIV testing or treatment data, respectively. At T1 and T2, respectively, 857 (59%) and 1263 (92%) had known HIV status, 277 (19%) and 647 (47%) were known to be living with HIV, and 68% and 68% of those with known HIV were receiving ART.

Conclusions:

This virtual cross-sectional analysis identified gaps in HIV testing coverage, and ART initiation that was not clearly demonstrated by prior cohort-based studies.
Identifying Independent Predictors of Short-Term Postoperative Morbidity in Patients Undergoing Cranioplasty
Authors: Bajaj Anitesh , Khazanchi Rushmin , Sadagopan Nishanth S. , Weissman Joshua P. , Gosain Arun K.
Published: June 2024

Background:

The present study intends to identify independent predictors of short-term postoperative complications and health utilization in patients undergoing cranioplasty.

Methods:

Demographic, clinical, and intraoperative characteristics were collected for each patient undergoing cranioplasty in the National Surgery Quality Improvement Program database from 2011 to 2020. The 30-day outcomes analyzed were medical complications, wound complications, return to the operating room, extended hospital stay, and non-home discharge. Bivariate analyses were initially used to identify variables that yielded a P value less than 0.2 which were subsequently analyzed in a multivariate logistic regression to identify independent predictors of the aforementioned outcomes.

Results:

In total, 2316 patients undergoing cranioplasty were included in the analysis. Increased operative time and totally dependent functional status significantly increased odds of returning to the operating room. Increased age, operative time, cranioplasty size >5 cm, and various comorbidities were associated with increased odds of non-home discharge. Bleeding disorders were independently associated with increased odds of wound complications. Increased age, operative time, cranioplasty size >5 cm, and several medical history features predisposed to medical complications. Demographic characteristics, including age and race, along with various operative and medical history characteristics were associated with increased odds of extended length of stay.

Conclusions

Identification of risk factors can help guide preoperative risk management in cranioplasty.
Hypoglobus, Exophthalmos, and Interpupillary Distance: Measuring Globe Dystopia in Thyroid Eye Disease
Authors: Saffari Persiana S. , Nesemann John , Katsev Blake , Palileo Bea Martina U. , Yeganeh Amir , Mustak Hamzah , Wang Yi , Rootman Daniel B.
Published: June 2024

Purpose:

Thyroid eye disease (TED) is characterized by a variety of disfiguring periocular changes. Vertical globe changes affecting the relative position of the eyelids are not well understood in patients with TED. This study seeks to determine the effect of orbital decompression on vertical globe displacement in patients with TED, without TED, and with intraconal tumor (ICT).

Methods:

For this cross-sectional study, a clinical database was used to identify patients with TED. Comparison groups were drawn from separate anonymized databases. Vertical position and interpupillary distance (IPD) were measured from photographs and exophthalmos was measured via Hertel’s exophthalmometer. Primary outcomes were vertical globe position at baseline and postoperatively in patients with TED and ICT. Secondary outcomes included the relationship between vertical globe position, exophthalmos, and IPD.

Results:

Among 269 participants meeting the inclusion criteria, mean vertical globe position was significantly lower in patients with TED following lateral decompression surgery compared to controls, after accounting for race, age, and sex. While patients with ICT had a significant difference in preoperative and postoperative IPD, patients with TED did not. Medial or inferior decompression did not significantly change globe position and lateral decompression did not cause lateral canthal dystopia in patients with TED. No association between postoperative changes in exophthalmometry, IPD, and globe position was found in patients with TED.

Conclusions:

Patients with TED experience hypoglobus that does not improve following decompression surgery. There was no correlation between change in vertical globe position and exophthalmos or IPD among patients with TED. Surgeons should discuss the possibility of hypoglobus as a persistent finding for patients with TED undergoing decompression surgery.