bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigating and Supporting Patient and Caregiver Sensemaking in Complex Medical Decisions Using Participatory Design
Authors: Fadem Sarah
Published: April 2023

Background. Patients and caregivers facing complex health decisions must make sense of unfamiliar, emotionally challenging information and experiences. For patients with hematological malignancy, bone marrow transplant (BMT) may be the best chance for a cure but has significant risk of morbidity and mortality. This study aimed to investigate and support patient and caregiver sensemaking as they consider BMT. Methods. Ten BMT patients and 5 caregivers engaged in remote participatory design (PD) workshops. Participants drew timelines of their memorable experiences leading up to BMT. Then, they used transparency paper to annotate their timelines and design improvements to this process. Results. Thematic analysis of drawings and transcripts revealed a 3-phase sensemaking process. In phase 1, participants were introduced to BMT and understood it as a possibility, not an inevitability. In phase 2, they focused on meeting prerequisites including remission and donor identification. Participants came to believe they needed transplant, consequently describing BMT not as a decision between viable options, but that transplant was their “only chance” for survival. In phase 3, participants attended an orientation detailing the extensive risks of transplant, leading to anxiety and doubt. Participants designed solutions that provided reassurance to those grappling with the life-altering impacts of transplant. Conclusions. For patients and caregivers navigating complex health decisions, sensemaking is a dynamic, ongoing process that affects expectations and emotional well-being. Interventions targeting reassurance alongside risk information can alleviate emotional impact and facilitate expectation development. The integration of PD and sensemaking methodologies enables participants to create holistic, tangible representations of experiences while empowering stakeholder engagement in intervention design. This method could be applied to other complex medical contexts to understand lived experiences and develop effective support interventions.

Highlights

Bone marrow transplant patients and caregivers experienced an evolving, emotionally challenging process of gradually understanding the transplant procedure and its risks. The solutions that participants designed centered on providing reassurance alongside risk information, suggesting future interventions could target emotional support as patients attempt to meet prerequisites and grapple with the risks of the potentially curative procedure. By viewing the challenges of complex medical decisions in terms of sensemaking and applying visual methods such as participatory design, researchers can facilitate expression of the dynamic, multifaceted, emotional components of experience and empower stakeholder involvement in intervention design.
Treating Children With Physical Disabilities: A Video-Based Educational Resource Using Simulated Participants
Authors: Kimmel Alexandra , Nozetz Erin , Salisbury Mary , Okanlami Oluwaferanmi , Talwalkar Jaideep , Martin Andrés
Published: April 2023

OBJECTIVES

Children with physical disabilities (CWPD) have historically experienced inadequate and insensitive care across medical settings. A lack of comfort and knowledge about CWPD is prevalent among healthcare provider trainees. We developed a new, readily distributable educational resource about CWPD for healthcare students and conducted a study to determine its efficacy in improving their attitudes toward CWPD.

METHODS

We collaborated with a working group of stakeholders in the disability community to develop an educational resource for healthcare students. We developed nine short video clips (with a cumulative duration of 27 min) of a primary care visit using simulated participants and embedded them into a 50-min workshop. We conducted a study of the workshop's utility for volunteer healthcare students using synchronous videoconferencing. Participating students completed assessments at baseline and after the workshop. Our primary outcome measure was a change in the Attitudes to Disabled Persons—Original (ATDP-O) scale.

RESULTS

Forty-nine healthcare students participated in the training session: 29 (59%) from medicine, and 21 (41%) from physician assistant or nursing programs. The materials were easy to deliver virtually. The workshop resulted in measurable change in attitudes regarding physical disabilities, with improvement in ATDP-O scores between baseline ( M = 31.2, SD = 8.9) and endpoint ( M = 34.8, SD = 10.1) scores ( t(49)= 3.28, P = .002, Cohen's d = 0.38).

CONCLUSION

This video-based educational resource on CWPD is readily distributable and can be delivered virtually as a workshop. The video-enhanced workshop improved healthcare students’ perceptions and attitudes toward CWPDs. All materials are available to view, download, or adapt by end-use instructors.
Acquired Focal Choroidal Excavation Secondary to Pachychoroid Choroidal Neovascular Membrane After Central Serous Chorioretinopathy
Authors: Garg Anubhav , Khaleel Husam , Wahab Charbel , Yan Peng
Published: April 2023

Purpose: To report a case of acquired conforming-type focal choroidal excavation (FCE) secondary to a pachychoroid choroidal neovascular membrane (CNVM) triggered by central serous chorioretinopathy (CSCR). Methods: A case and its findings were analyzed. Results: A 54-year-old Asian man who had spontaneous resolution of CSCR in the right eye presented with a pachychoroid CNVM and FCE 1 year after the initial CSCR diagnosis. Intravitreal antivascular endothelial growth factor injections were initiated, and the subretinal fluid and intraretinal hemorrhage resolved. The patient was followed for FCE progression for 3 years. Conclusions: Acquired FCE can occur secondary to CSCR and pachychoroid CNVM. The pathogenesis may be focal choroidal ischemia, choroidal vascular collapse, and fibrosis leading to choroidal excavation. This case highlights the progression of the spectrum of pachychoroid disorders from CSCR, pachychoroid CNVM, and subsequent acquired confirming-type FCE. Further research is needed to assess other diseases leading to acquired FCE and to determine the underlying mechanism.
Rivers and Bogs: Slow Protests in Aphra Behn’s Oroonoko
Authors: Taff Dyani J
Published: April 2023

In Aphra Behn’s 1688 novel Oroonoko, the title character owns enslaved people when he is in Africa and is himself enslaved and forced to migrate to and labor in the Suriname River watershed. The narrator praises his European-ness and denies the value of his African-ness, framing the failure of his shipboard and plantation protests as the fate of a tragic romance hero. But the narrator’s perspective on Oroonoko is only one dimension of this story: the narrative weaves and folds and digresses like a river winding down to the sea, moving through locations that are neither fully wet nor dry, salt nor fresh. Both formally and scenically, Behn challenges readers to move slowly, to resist the desire for narrative and environmental control, to embrace the uncertainty, danger, and shifting, undefined nature of the coastal ecotone. She holds before us the deeply violent consequences of European heroic romance as it drives Oroonoko’s and the narrator’s actions in the Atlantic world and invites us to imagine environments and circuitous logics that protest that violence. Attending to the novel’s coastal-ness enables resistance to dominant English seventeenth-century ideologies about racial, gendered, and species mastery.
A framework to characterize young school children's individual mathematical creativity—an integrative review
Authors: Bruhn Svenja , Lüken Miriam M.
Published: April 2023

Both educational policies and current mathematics education research highlight that all students should be given the opportunity to be creative in mathematics class. However, if creativity is of such significance to mathematics learning, how can we describe the mathematical creativity of school children? Conducting an integrative literature review, this article aims to answer this question by synthesizing conceptual aspects and research results on the mathematical creativity of young school children working on mathematical open tasks. Here, concepts of creativity in mathematics education based on a divergent production approach are emphasized in detail. This leads to the introduction of the term “individual mathematical creativity” and to the suggestion of a framework to qualitatively characterize the individual mathematical creativity of school children working on open tasks. Its relevance and application as a scientific and/or educational tool to analyze and foster the creativity of students are explained exemplarily using the creative task processing of the 6-year-old student Jessica.
Downing the Master's Tools? New Research Strategies to Address Social Determinants of Health Inequalities
Authors: Schrecker Ted
Published: April 2023

A dramatic increase in the volume of research literature referencing social determinants of health (SDH) since the report of the World Health Organization Commission on the topic in 2008 has not been matched by expansion of policies and interventions to reduce health inequalities by way of SDH. This article argues that familiar hierarchies of evidence that privilege clinical epidemiology as used in evidence-based medicine are inappropriate to address SDH. They misunderstand both the range of relevant evidence and the value-based nature of standards of proof. A richer conceptual armamentarium is available; it includes several applications of the concepts of epidemiological worlds and the lifecourse, which are explained in the article. A more appropriate evidentiary approach to SDH and health inequalities requires “downing the master's tools,” to adapt Audre Lorde's phrase, and instead applying a multidisciplinary approach to assessing the evidence that adequately reflects the complexity of the relevant causal pathways. Doing so is made more difficult by the power structures that shape research priorities, yet it is essential.
Chronic GVHD after steroid-sensitive, -dependent, and -refractory acute GVHD: incidence and clinical outcomes
Authors: Herzog Shannon , Weisdorf Daniel J. , Shanley Ryan , Rayes Ahmad , Holtan Shernan G. , Young Jo-Anne , MacMillan Margaret L. , El Jurdi Najla
Published: April 2023

Chronic graft-versus-host disease (cGVHD) is a major limitation to the long-term success of allogeneic hematopoietic cell transplantation (HCT). Our prior study of acute GVHD (aGVHD) defined distinct treatment-response groups based on the response to first-line corticosteroids: steroid-sensitive (SS), steroid-resistant (SR), and steroid-dependent (SD) aGVHDs. We conducted a retrospective, single-institution, cohort study to assess the incidence, risk factors, and clinical outcomes of patients with cGVHD after a previous diagnosis of SS, SD, or SR aGVHD, compared with those with no history of aGVHD. Among 784 consecutive adult and pediatric recipients of HCT for hematologic malignancies between 2008 and 2016, 347 (44%) developed aGVHD, with 13% SS, 12% SD, and 19% SR aGVHD. The 3-year cumulative incidence of cGVHD was 25%. Among those with cGVHD, 39% had no prior aGVHD diagnosis, whereas among those with a prior aGVHD diagnosis, 16% had SS, 24% had SD, and 21% had SR aGVHD. Mild or moderate cGVHD was highest among those with preceding SD aGVHD, whereas severe cGVHD was most frequent among those with previous SR aGVHD. We identified SD and SR aGVHDs as significant independent risk factors for the development of cGVHD after allogeneic HCT, whereas SS aGVHD was not a risk factor. Our study demonstrates that cGVHD after SD aGVHD did not have an intermediate prognosis between SR and SS groups as hypothesized; rather, cGVHD after both SD and SR aGVHD have similar prognoses. Our findings suggest that previous aGVHD response states are important predictors of cGVHD severity and outcomes.
Association of genetic risk and lifestyle with incident adult-onset asthma in the UK Biobank cohort
Authors: Liang Huaying , Jing Danrong , Zhu Yiqun , Li Dianwu , Zhou Xin , Tu Wei , Liu Hong , Pan Pinhua , Zhang Yan
Published: April 2023

Background

Both genetic and lifestyle factors contribute to the development of asthma, but whether unfavourable lifestyle is associated with similar increases in risk of developing asthma among individuals with varying genetic risk levels remains unknown.

Methods

A healthy lifestyle score was constructed using body mass index, smoking status, physical activities and dietary pattern to further categorise into ideal, intermediate and poor groups. Genetic risk of asthma was also categorised as three groups based on the tertiles of polygenic risk score established using 212 reported and verified single-nucleotide polymorphisms of European ancestry in the UK Biobank study. We examined the risk of incident asthma related with each lifestyle level in each genetic risk group by Cox regression models.

Results

Finally, 327 124 participants without baseline asthma were included, and 157 320 (48.1%) were male. During follow-up, 6238 participants (1.9%) developed asthma. Compared to ideal lifestyle in a low genetic risk group, poor lifestyle was associated with a hazard ratio of up to 3.87 (95% CI, 2.98–5.02) for developing asthma in a high genetic risk group. There was interaction between genetic risk and lifestyle, and the population-attributable fraction of lifestyle and genetic risk were 30.2% and 30.0% respectively.

Conclusion

In this large contemporary population, lifestyle and genetic factors jointly play critical roles in the development of asthma, and the effect values of lifestyle on incident adult-onset asthma were greater than that of genetic risk. Our findings highlighted the necessity of a comprehensive intervention for the prevention of asthma despite the genetic risk.
Effects of AMF Compound Inoculants on Growth, Ion Homeostasis, and Salt Tolerance-Related Gene Expression in Oryza sativa L. Under Salt Treatments
Authors: Zhang Bo , Shi Feng , Zheng Xu , Pan Hongyang , Wen Yuqiang , Song Fuqiang
Published: April 2023

Increased soil salinization is among the main factors that limits safe rice production. Arbuscular mycorrhizal fungi (AMF) have been shown to alleviate the toxic effects of salt stress in plants. However, more studies on AMF combined with other functional microorganisms are needed to further improve salt tolerance in rice. Therefore, the compound inoculum Funneliformis mosseae (Fm) together with two functional microorganisms, Piriformospora indica (Pi) and Agrobacterium rhizogenes (Ar) was evaluated for their effect on the rice growth, photosynthetic gas exchange parameters, ion homeostasis, and the expression of salt tolerance-related genes under 0, 80, 120 and 160 mM salt stress conditions. The results showed that: (1) the rice seedling biomass of the AMF compound inoculant treatment group was significantly higher than that of the non-inoculation treatment group (P < 0.05); (2) under NaCl stress, inoculation with AMF compound inoculants can activate the rice antioxidant enzyme system and improve osmoregulation ability; (3) AMF compound inoculants can increase the concentration of K+ in the plant and inhibit the transfer of Na+ to rice leaves, maintaining a high K+/Na+; and (4) AMF compound inoculants could induce and regulate the overexpression of genes related to salt tolerance, photosynthesis and ion homeostasis in rice, and improve the tolerance of rice under salt stress. Our study showed that AMF compound inoculants could improve the adaptability of rice under NaCl stress and promote plant growth by regulating the photosynthetic gas exchange parameter, reactive oxygen species (ROS) scavenging ability, and ion homeostasis of plants. These results suggest that AMF compound inoculants may play an important role in improving rice productivity in salinized soil.

Graphical Abstract
Comparison of two multi-trait association testing methods and sequence-based fine mapping of six additive QTL in Swiss Large White pigs
Authors: Nosková A. , Mehrotra A. , Kadri N. K. , Lloret-Villas A. , Neuenschwander S. , Hofer A. , Pausch H.
Published: April 2023

Background

Genetic correlations between complex traits suggest that pleiotropic variants contribute to trait variation. Genome-wide association studies (GWAS) aim to uncover the genetic underpinnings of traits. Multivariate association testing and the meta-analysis of summary statistics from single-trait GWAS enable detecting variants associated with multiple phenotypes. In this study, we used array-derived genotypes and phenotypes for 24 reproduction, production, and conformation traits to explore differences between the two methods and used imputed sequence variant genotypes to fine-map six quantitative trait loci (QTL).

Results

We considered genotypes at 44,733 SNPs for 5,753 pigs from the Swiss Large White breed that had deregressed breeding values for 24 traits. Single-trait association analyses revealed eleven QTL that affected 15 traits. Multi-trait association testing and the meta-analysis of the single-trait GWAS revealed between 3 and 6 QTL, respectively, in three groups of traits. The multi-trait methods revealed three loci that were not detected in the single-trait GWAS. Four QTL that were identified in the single-trait GWAS, remained undetected in the multi-trait analyses. To pinpoint candidate causal variants for the QTL, we imputed the array-derived genotypes to the sequence level using a sequenced reference panel consisting of 421 pigs. This approach provided genotypes at 16 million imputed sequence variants with a mean accuracy of imputation of 0.94. The fine-mapping of six QTL with imputed sequence variant genotypes revealed four previously proposed causal mutations among the top variants.

Conclusions

Our findings in a medium-size cohort of pigs suggest that multivariate association testing and the meta-analysis of summary statistics from single-trait GWAS provide very similar results. Although multi-trait association methods provide a useful overview of pleiotropic loci segregating in mapping populations, the investigation of single-trait association studies is still advised, as multi-trait methods may miss QTL that are uncovered in single-trait GWAS.
Successful treatment of nephrotic syndrome due to pregnancy-related crescentic IgA nephropathy: a case report
Authors: Shima Hisato , Doi Toshio , Okamoto Takuya , Inoue Tomoko , Tashiro Manabu , Wariishi Seiichiro , Kawahara Kazuhiko , Okada Kazuyoshi , Minakuchi Jun
Published: April 2023

Background

Crescentic immunoglobulin A (IgA) nephropathy, defined as > 50% of the glomeruli with crescents, often has a poor renal prognosis. Because of the high prevalence of pre-eclampsia in the second trimester of pregnancy, we often fail to investigate the new onset of glomerulonephritis and the aggravation of subclinical nephropathies. We report a case of nephrotic syndrome suggestive of crescentic IgA nephropathy possibly triggered by pregnancy.

Case presentation

A 33-year-old multipara was referred for persistent proteinuria, hematuria, and hypoalbuminemia two months postpartum. The patient was diagnosed with proteinuria for the first time at 36 weeks of gestation. The patient was normotensive during pregnancy. Renal biopsy revealed crescentic IgA nephropathy, with cellular crescents in 80% of the glomeruli and no global sclerosis. After treatment with pulse steroids followed by high-dose oral glucocorticoids and tonsillectomy, a gradual improvement was seen in proteinuria, hematuria, and hypoalbuminemia.

Conclusion

Although the precise mechanism remains unclear, pregnancy possibly triggered the new onset of crescentic IgA nephropathy or the aggravation of subclinical IgA nephropathy.
Ultrasonographic classification of 26 cases of fetal umbilical-portal-systemic venous shunts and the correlations with fetal chromosomal abnormalities
Authors: Lu Lihua , Yao Limin , Wei Hui , Hu Jilin , Li Dongmei , Yin Yifei , Su Jie , Li Qian , Zhu Shu , Tang Xinhua , Huang Wenming , Zhu Baosheng , Zhang Jinman
Published: April 2023

Objective

To investigate the ultrasonographic classification of fetal umbilical-portal-systemic venous shunts (UPSVS) and the correlations with fetal chromosomal abnormalities.

Methods

We retrospectively analyzed the ultrasound characteristics and the corresponding chromosomal abnormalities of 26 cases of fetal UPSVS prenatally diagnosed.

Results

A total of 26 fetuses diagnosed as UPSVS were included, including four cases of type I UPSVS, ten of type II, three of type IIIA, and nine of type IIIB. Four cases of type I were all complicated by fetal heart enlargement and heart insufficiency, of which one case had multiple malformations, and all four cases terminated pregnancies. Six of ten cases of type II terminated pregnancies, including four of Down’s syndrome, one of twin reversed arterial perfusion sequence, one of fetal edema but with normal copy number variation (CNV) by chorionic villus sampling. The other four of ten cases were isolated type II with normal chromosomes, which were delivered at full term and were normal in growth and development when followed up 34 months after birth. Three cases of type IIIA all terminated pregnancies, of which one had multiple malformations, one had right multicystic dysplastic kidney, and one had fetal heart enlargement and heart failure. Among nine of type IIIB, seven with chromosomal abnormalities and/ or complicated malformations terminated pregnancies, and two with isolated type IIIB and normal chromosomes were delivered at full term, and were normal in growth and development (one was followed up to 33 months after birth and the other 20 months after birth).

Conclusion

Fetal UPSVS can be clearly diagnosed and typed by prenatal ultrasonography. Fetal prognosis is determined by the types of UPSVS and complicated malformations and/ or chromosomal abnormalities. The probability of fetal chromosomal abnormalities in UPSVS fetuses is related to the ultrasonographic classification.
The co-morbidity of DSM-V Gambling with DSM-V mental disorders and substance abuse in a Kenyan context of high risk schizophrenia
Authors: Ndetei David M. , Mutiso Victoria , Momanyi Reinpeter , Nyamai Pascalyne , Musyimi Christine , Mamah Daniel
Published: April 2023

Introduction

There is evidence that gambling disorder shares similarities with other types of addictive behavior, such as occurs in substance abuse. In addition, co-morbidity of gambling with mental disorders has been established in school-going students.

Aim

This study aimed at determining the comorbidity of DSM-V gambling disorder with DSM-V mental disorders and substance abuse in high school, college and university students in Kenya.

Methods

This was a cross-sectional study among 536 high school, college and university students. We collected data on socio-demographic characteristics, economic indicators, DSM-V diagnosis including DSM-V gambling disorder and substance use disorders using the WHO ASSIST tool. Descriptive and inferential analyses were done.

Results

A total of 536 students participated in the study, of which 11.4% (61 out of 536) had DSM-V gambling disorder. Male gender (AOR = 12.0, 95% CI: 4.99–34.3), antisocial personality disorder (AOR = 3.42, 95% CI: 1.34–8.54), tobacco use (AOR = 4.42, 95% CI: 1.15–18.3) and conduct disorder (AOR = 7.56, 95% CI: 2.34–25.1) were predictors of gambling disorder.

Conclusion

Gambling is highly prevalent in Kenya learning institutions at 11.4% and is associated with mental disorders and substance use. There is a need for public awareness of gambling among Kenyan youths.
Efficacy of percutaneous kyphoplasty on vertebral compression fractures with different bone mineral densities: a retrospective study
Authors: Ge Chen , Chen Zhe , Cao Peng
Published: April 2023

Background

This study was performed to investigate the clinical efficacy of percutaneous kyphoplasty (PKP) for vertebral compression fractures with different bone mineral densities (BMD).

Methods

We performed a retrospective analysis of 232 patients with single-segment vertebral compression fractures who underwent PKP. Patients were divided into the normal BMD, osteopenia, and osteoporosis groups according to their average lumbar BMD before surgery. The visual analog scale (VAS) was used to compare differences in pain relief before and after surgery in each group. Corrections of the wedge angle and kyphotic angle before and after surgery were observed using anteroposterior and lateral radiographs and compared among the groups, as was the incidence of bone cement leakage.

Results

Patients were followed up for 6–12 months, with an average follow-up time of 9.12 ± 1.68 months. The VAS score, wedge angle, and kyphotic angle of the three groups of patients decreased significantly at the end of the follow-up (P < 0.05). The changes in VAS score and wedge angle correction in the osteoporosis group were significantly larger than those in the normal BMD and osteopenia groups (P < 0.05). There were no significant differences among the three groups in terms of kyphotic angle correction or bone cement leakage rates (P > 0.05).

Conclusions

PKP has a positive effect on vertebral compression fractures with different BMD, and is especially suitable for osteoporotic vertebral compression fractures.
Comparison of the preventive effect of colchicine versus diphenhydramine, prednisolone, and a combination therapy on intraperitoneal adhesion bands: an experimental study in rats
Authors: Malekhosseini Seyed Ali , Alizadeh Behzad , Hosseinzadeh Ahmad , Shahriarirad Reza , Naseri Reyhaneh , Kazemi Kourosh , Shamsaeefar Alireza , Tanideh Nader
Published: April 2023

Background

Peritoneal adhesion formation is an inevitable consequence of abnormal repair of the peritoneum following different peritoneal injuries of intra-abdominal operations with the subsequent morbidity that they represent. Vast efforts have been made to elucidate the cause and prevent the development of abdominal adhesions. The aim of our study is to compare the capability of colchicine versus diphenhydramine (DPH) and methylprednisolone (MP), and also prednisolone in adhesion prevention.

Methods

Sixty-one male Wistar stock rats were divided into four groups. The first group attended as the control group. Groups 2, 3, and 4 received oral combination of MP + DPH solution (20 mg/kg), colchicine (0.02 mg/kg), and prednisolone (1 mg/ kg), respectively. Adhesion bands were induced by standardized abrasion of the peritoneum through a midline laparotomy. All rats were sacrificed on the 15th-day post medication administration and the subjects underwent an exploratory laparotomy. The presence of adhesions was evaluated with the modified using Nair's classification.

Results

The proportion of the control group with substantial adhesion bands (73.3%) was significantly higher than that of the MP + DPH (13.3%), colchicine (33.3%), and prednisolone (31.3%) groups. There were significant differences between the scores of the control and the MP + DPH, colchicine, and prednisolone groups (P = 0.001, 0.028, and 0.019, respectively). There was no statistically significant difference to favor colchicine against MP + DPH (P = 0.390) or MP + DPH against prednisolone (P = 0.394).

Conclusions

Both colchicine and combination of DPH + MP prevented postoperative abdominal adhesions separately in our study. However, the lowest adhesion formation rate was observed in the DPH + MP group, even lower than the prednisolone group.
Comparison the treatment of anterior inferior tibiofibular ligament anatomical repair and syndesmosis screw fixation for syndesmotic injuries in ankle fracture
Authors: Lin Xuping , Tu Chengquan , Lin Weihuang , Xie Weina , Guo Xiaowei , Liu Qingjun
Published: April 2023

Background

The fixation method of syndesmotic injuries in ankle fractures remains controversial. The goal of the study was to compare radiographic and clinical outcomes between anterior inferior tibiofibular ligament (AITFL) anatomical repair with syndesmosis screw fixation in syndesmotic injuries.

Methods

We analyzed 62 patients who were treated with AITFL anatomical repair or syndesmosis screw fixation for syndesmotic injuries in an advanced teaching hospital between March 2016 and March 2019. Fixation was performed with AITFL anatomical repair in 30 patients (AAR group) and syndesmosis screw in 32 patients (SS group). Radiographic evaluations were the differences in mean anterior and posterior (A difference and P difference) tibiofibular distance between injured and uninjured ankle computed tomography (CT) scan at 6 months postoperatively. Clinical evaluation of patients was done using the American Orthopaedic Foot & Ankle Society (AOFAS) Ankle Hindfoot Score, the Olerud-Molander Ankle (OMA) score and visual analogue scale (VAS) score at 1, 3, 6 months and 1, 2 years postoperatively.

Results

The A difference and P difference on CT was no differences (1.6 ± 0.8 mm, 1.3 ± 0.7 mm vs. 1.5 ± 0.7 mm, 1.2 ± 0.7 mm) between the two groups (All of P > 0.05). The AAR group had higher mean AOFAS score (65.6 ± 5.9, 82.3 ± 4.2, 87.6 ± 5.6 vs. 61.8 ± 5.2, 79.1 ± 4.0, 83.8 ± 4.9; P = 0.008, 0.003, 0.007) and higher mean OMA score (45.7 ± 8.7, 79.2 ± 6.5, 84.1 ± 5.3 vs. 40.4 ± 7.3, 74.8 ± 6.3, 80.3 ± 5.8; P = 0.012, 0.009, 0.010)) at 1, 3 and 6 months postoperatively. The AAR group had lower mean VAS scores (2.6 ± 1.2, 1.7 ± 0.7 vs. 3.4 ± 1.2, 2.2 ± 1.1; P = 0.018, 0.038) at 1 and 3 months postoperatively.

Conclusions

The results of this study suggest that the AITFL anatomical repair technique could effectively improve ankle function during daily activity. Therefore, AITFL anatomical repair technique is expected to become a better fixation method for syndesmotic injuries.
Views of people living with dementia and their carers on their present and future: a qualitative study
Authors: Nimmons Danielle , Manthorpe Jill , West Emily , Rait Greta , Sampson Elizabeth L , Iliffe Steve , Davies Nathan
Published: April 2023

Background

Dementia leads to multiple issues including difficulty in communication and increased need for care and support. Discussions about the future often happen late or never, partly due to reluctance or fear. In a sample of people living with dementia and carers, we explored their views and perceptions of living with the condition and their future.

Methods

Semi-structured interviews were conducted in 2018-19 with 11 people living with dementia and six family members in England. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis.

Results

Findings were explored critically within the theory of social death and three themes were developed: (1) loss of physical and cognitive functions, (2) loss of social identity, and (3) social connectedness. Most participants living with dementia and carers wanted to discuss the present, rather than the future, believing a healthy lifestyle would prevent the condition from worsening. Those with dementia wanted to maintain control of their lives and demonstrated this by illustrating their independence. Care homes were often associated with death and loss of social identity. Participants used a range of metaphors to describe their dementia and the impact on their relationships and social networks.

Conclusion

Focusing on maintaining social identity and connectedness as part of living well with dementia may assist professionals in undertaking advance care planning discussions.
Assessing perceptions about critical thinking, motivation learning strategies in online psychiatric and mental health nursing education among Egyptian and Saudi undergraduate nursing students
Authors: AlOtaibi Nora Ghalib , Alshowkan Amira , Kamel Neama , El-Ashry Ayman Mohamed , AlSaleh Nagla Saleh , Abd Elhay Eman Sameh
Published: April 2023

Background

The pandemic context prompts nursing students to be involved in online learning. Researchers indicated that critical thinking develops through the learning process, but the link between critical thinking and online learning in nursing does not have sufficient evidence.

Aim of Study

This research examines student perceptions about critical thinking, motivation, and learning strategies in online psychiatric nursing education among nursing students at Imam Abdulrahman bin Faisal University in Saudi Arabia and Alexandria University in Egypt.

Subject and Methods

An online survey was designed to collect data anonymously. A total of 75 Saudi undergraduates and 105 Egyptian nursing students who met the inclusion criteria participated. The online survey assessed three parts: socio-demographic data, critical thinking motivational, and cognitive processing strategy scales.

Results

The current study found that using a motivating method for online learning inspired students to engage in critical thinking and cognitive processing strategies in a psychiatric and mental health nursing course, even in two different contexts.

Conclusion

This study demonstrates that using motivational methods for online learning encourages students to engage in critical thinking and cognitive processing strategies in psychiatry and mental health care courses, even in two different settings.
Facilitators and barriers to seasonal malaria chemoprevention (SMC) uptake in Nigeria: a qualitative approach
Authors: Ogbulafor Nnenna , Uhomoibhi Perpetua , Shekarau Emmanuel , Nikau Jamilu , Okoronkwo Chukwu , Fanou Nadia M. L. , Mbaye Ibrahima Marietou , Ndiaye Jean-Louis , Tchouatieu Andre-Marie , Poku-Awuku Abena , Merle Corinne , Scott Susana , Milligan Paul , Ali Aminu , Yusuf Hauwa’u Evelyn , Oguche Stephen , Dahiru Tukur
Published: April 2023

Background

SMC was adopted in Nigeria in 2014 and by 2021 was being implemented in 18 states, over four months between June and October by 143000 community drug distributors (CDDs) to a target population of 23million children. Further expansion of SMC is planned, extending to 21 states with four or five monthly cycles. In view of this massive scale-up, the National Malaria Elimination Programme undertook qualitative research in five states shortly after the 2021 campaign to understand community attitudes to SMC so that these perspectives inform future planning of SMC delivery in Nigeria.

Methods

In 20 wards representing urban and rural areas with low and high SMC coverage in five states, focus group discussions were held with caregivers, and in-depth interviews conducted with community leaders and community drug distributors. Interviews were also held with local government area and State malaria focal persons and at national level with the NMEP coordinator, and representatives of partners working on SMC in Nigeria. Interviews were recorded and transcribed, those in local languages translated into English, and transcripts analysed using NVivo software.

Results

In total, 84 focus groups and 106 interviews were completed. Malaria was seen as a major health concern, SMC was widely accepted as a key preventive measure, and community drug distributors (CDDs) were generally trusted. Caregivers preferred SMC delivered door-to-door to the fixed-point approach, because it allowed them to continue daily tasks, and allowed time for the CDD to answer questions. Barriers to SMC uptake included perceived side-effects of SMC drugs, a lack of understanding of the purpose of SMC, mistrust and suspicions that medicines provided free may be unsafe or ineffective, and local shortages of drugs.

Conclusions

Recommendations from this study were shared with all community drug distributors and others involved in SMC campaigns during cascade training in 2022, including the need to strengthen communication about the safety and effectiveness of SMC, recruiting distributors from the local community, greater involvement of state and national level pharmacovigilance coordinators, and stricter adherence to the planned medicine allocations to avoid local shortages. The findings reinforce the importance of retaining door-to-door delivery of SMC.
Iron oxide nanoparticles carried by probiotics for iron absorption: a systematic review
Authors: Ciont Călina , Mesaroș Amalia , Pop Oana Lelia , Vodnar Dan Cristian
Published: April 2023

Background

One-third of the world's population has anemia, contributing to higher morbidity and death and impaired neurological development. Conventional anemia treatment raises concerns about iron bioavailability and gastrointestinal (GI) adverse effects. This research aims to establish how iron oxide nanoparticles (IONPs) interact with probiotic cells and how they affect iron absorption, bioavailability, and microbiota variation.

Methods

Pointing to the study of the literature and developing a review and critical synthesis, a robust search methodology was utilized by the authors. The literature search was performed in the PubMed, Scopus, and Web of Science databases. Information was collected between January 2017 and June 2022 using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) protocols for systematic reviews and meta-analyses. We identified 122 compatible research articles.

Results

The research profile of the selected scientific articles revealed the efficacy of IONPs treatment carried by probiotics versus conventional treatment. Therefore, the authors employed content assessment on four topics to synthesize previous studies. The key subjects of the reviewed reports are the characteristics of the IONPs synthesis method, the evaluation of cell absorption and cytotoxicity of IONPs, and the transport of IONPs with probiotics in treating anemia.

Conclusions

To ensure a sufficient iron level in the enterocyte, probiotics with the capacity to attach to the gut wall transport IONPs into the enterocyte, where the maghemite nanoparticles are released.

Graphical Abstract
Safety and feasibility of laparoscopic liver resection for intrahepatic cholangiocarcinoma: a propensity score-matched study
Authors: Shen Zefeng , Tao Liye , Cai Jingwei , Zheng Junhao , Sheng Yubin , Yang Zaibo , Gong Linghan , Song Chao , Gao Jiaqi , Ying Hanning , Xu Junjie , Liang Xiao
Published: April 2023

Background

Laparoscopic liver resection (LLR) is controversial in treating intrahepatic cholangiocarcinoma (ICC). Therefore, this study aimed to evaluate the safety and feasibility of LLR for the treatment of ICC and explored the independent factors affecting the long-term prognosis of ICC.

Methods

We included 170 patients undergoing hepatectomy for ICC from December 2010 to December 2021 and divided them into LLR group and open liver resection (OLR) group. We used propensity score matching (PSM) analysis to reduce the impact of data bias and confounding variables and then compared the short-term and long-term prognosis of LLR and OLR in treating ICC; Cox proportional hazards regression model was adopted to explore the independent factors affecting the long-term prognosis of ICC.

Results

A total of 105 patients (70 in the LLR group and 35 in the OLR group) were included after 2:1 PSM analysis. There was no difference in demographic characteristics and preoperative indexes between the two groups. The perioperative results of the OLR group were worse than those of the LLR group, that is, the intraoperative blood transfusion rate (24 (68.6) vs 21 (30.0)), blood loss (500 (200–1500) vs 200 (100–525)), and the morbidity of major postoperative complications (9 (25.7) vs 6 (8.5)) in the OLR group were worse than those in LLR group. LLR could enable patients to obtain an equivalent long-term prognosis compared to OLR. The Cox proportional hazards regression model exhibited that no matter before or after PSM, preoperative serum CA12-5 and postoperative hospital stay were independent factors affecting overall survival, while only lymph node metastasis independently influenced recurrence-free survival.

Conclusions

Compared with ICC treated by OLR, the LLR group obtained superior perioperative period outcomes. In the long run, LLR could enable ICC patients to receive an equivalent long-term prognosis compared to OLR. In addition, ICC patients with preoperative abnormal CA12-5, lymph node metastasis, and more extended postoperative hospital stay might suffer from a worse long-term prognosis. However, these conclusions still need multicenter extensive sample prospective research to demonstrate.
Molecular fingerprints of nuclear genome and mitochondrial genome for early diagnosis of lung adenocarcinoma
Authors: Xu Yichun , Yang Yong , Wang Yichao , Su Jun , Chan Tianlong , Zhou Jiajing , Gong Yi , Wang Ke , Gu Yifeng , Zhang Congmeng , Wu Guanjin , Bi Ling , Qin Xiong , Han Junsong
Published: April 2023

Background

Lung adenocarcinoma (LUAD) is the most prevalent subtype of lung cancer with high morbidity and mortality rates. Due to the heterogeneity of LUAD, its characteristics remain poorly understood. Exploring the clinical and molecular characteristics of LUAD is challenging but vital for early diagnosis.

Methods

This observational and validation study enrolled 80 patients and 13 healthy controls. Nuclear and mtDNA-captured sequencings were performed.

Results

This study identified a spectrum of nuclear and mitochondrial genome mutations in early-stage lung adenocarcinoma and explored their association with diagnosis. The correlation coefficient for somatic mutations in cfDNA and patient-matched tumor tissues was high in nuclear and mitochondrial genomes. The mutation number of highly mutated genes was evaluated, and the Least Absolute Shrinkage and Selection Operator (LASSO) established a diagnostic model. Receiver operating characteristic (ROC) curve analysis explored the diagnostic ability of the two panels. All models were verified in the testing cohort, and the mtDNA panel demonstrated excellent performance. This study identified somatic mutations in the nuclear and mitochondrial genomes, and detecting mutations in cfDNA displayed good diagnostic performance for early-stage LUAD. Moreover, detecting somatic mutations in the mitochondria may be a better tool for diagnosing early-stage LUAD.

Conclusions

This study identified specific and sensitive diagnostic biomarkers for early-stage LUAD by focusing on nuclear and mitochondrial genome mutations. This also further developed an early-stage LUAD-specific mutation gene panel for clinical utility. This study established a foundation for further investigation of LUAD molecular pathogenesis.
Clinical outcomes and prediction nomogram model for postoperative hemoglobin < 80 g/L in patients following primary lumbar interbody fusion surgery
Authors: Xiong Xu , Liu Jia-Ming , Liu Zi-Hao , Chen Jiang-Wei , Liu Zhi-Li
Published: April 2023

Objective

To analyze the association between different postoperative hemoglobin (Hb) levels and postoperative outcomes in patients who have undergone primary lumbar interbody fusion, and to investigate the risk factors and establish a predictive nomogram mode for postoperative Hb < 80 g/L.

Methods

We retrospectively analyzed 726 cases who underwent primary lumbar interbody fusion surgery between January 2018 and December 2021in our hospital. All patients were divided into three groups according to the postoperative Hb levels (< 70 g/L, 70–79 g/L, ≥ 80 g/L). The postoperative outcomes among the three groups were compared, and the risk factors for postoperative Hb < 80 g/L were identified by univariate and multivariable logistic regression analysis. Based on these independent predictors, a nomogram model was developed. Predictive discriminative and accuracy ability of the predicting model was assessed using the concordance index (C-index) and calibration plot. Clinical application was validated using decision curve analysis. Internal validation was performed using the bootstrapping validation.

Results

Patients with postoperative Hb < 80 g/L had higher rates of postoperative blood transfusion, a greater length of stay, higher rates of wound complications, and higher hospitalization costs than those with postoperative Hb ≥ 80 g/L. Preoperative Hb, preoperative platelets, fusion segments, body mass index, operation time, and intraoperative blood loss independently were associated with postoperative Hb < 80 g/L. Intraoperative blood salvage was found to be a negative predictor for postoperative Hb < 80 g/L (OR, 0.21 [95% CI 0.09–0.50]). The area under the curve of the nomogram model was 0.950. After internal validations, the C-index of the model was 0.939. The DCA and calibration curve suggested that the nomogram model had a good consistency and clinical utility.

Conclusions

Postoperative Hb < 80 g/L in patients following primary lumbar interbody fusion surgery increased blood transfusions requirement and was independently associated with poor outcomes. A novel nomogram model was established and could conveniently predict the risk of postoperative Hb < 80 g/L in patients after this type of surgery.
The effectiveness of early surgical stabilization for multiple rib fractures: a multicenter randomized controlled trial
Authors: Wang Zhengwei , Jia Yifei , Li Mi
Published: April 2023

Introduction

Multiple rib fractures (≥ 3 displaced rib fractures and/or flail chest) are severe chest trauma with high morbidity and mortality. Rib fixation has become the first choice for multiple rib fracture treatment. However, the timing of surgical rib fixation is unclear.

Materials and methods

The present study explored whether early rib fracture fixation can improve the outcome of multiple rib fractures. The present research included patients who were hospitalized in three Jiangsu hospitals following diagnosis with multiple rib fractures. Patients received early rib fracture fixation (≤ 48 h) or delayed rib fracture fixation (> 48 h) utilizing computer-based random sequencing (in a 1:1 ratio). The primary outcome measures included hospital length of stay, intensive care unit (ICU) stay, mechanical ventilation, inflammatory cytokine levels, infection marker levels, infection, and mortality.

Results

A total of 403 individuals were classified into two groups, namely, the early group (n = 201) and the delayed group (n = 202). Patients belonging to the two groups had similar baseline clinical data, and there were no statistically significant differences between them. Early rib fracture fixation greatly decreased the length of stay in the ICU (4.63 days vs. 6.72 days, p < 0.001), overall hospital stay (10.15 days vs. 12.43 days, p < 0.001), ventilation days (3.67 days vs. 4.55 days, p < 0.001), and hospitalization cost (6900 USD vs. 7600 USD, p = 0.008). Early rib fracture fixation can decrease inflammatory cytokine levels and infection marker levels, prevent hyperinflammation and improve infection in patients with multiple rib fractures. The timing of rib fracture fixation does not influence the surgical procedure time, operative blood loss, 30-day all-cause mortality, or surgical site infection.

Conclusion

The findings from the present research indicated that early rib fracture fixation (≤ 48 h) is a safe, rational, effective and economical strategy and worth clinical promotion.
Unique case of pelvic congestion syndrome caused by a new communication branch of the portal-vena cava system
Authors: Zheng Wei , Sun Chun , Yang Jinming , Wu Yingfeng
Published: April 2023

Congenital portosystemic shunt (CPS) is a developmental anomaly of the portal vein system. The disease can cause blood from the portal vein to flow into the vena cava, resulting in various atypical clinical manifestations. Pelvic congestion syndrome (PCS) caused by CPS is particularly rare. A young woman with PCS had an abnormal communicating branch of the left ovarian vein (OV). Her left OV drained normally into the left renal vein, and at the same time communicated with the portal vein, forming an extrahepatic portosystemic shunt. With embolization of her left OV, the patient was cured of PCS.