bluuebunny/crossref_metadata_2025 huggingface dataset:
A Predictive Model to Evaluate Pathologic Complete Response in Rectal Adenocarcinoma
Authors: Qing Shuiwang , Gu Lei , Du Tingting , Yin Xiaolan , Zhang Ke-jia , Zhang Huo-jun
Published: September 2023

Introduction: Neoadjuvant chemo-radiotherapy (nCRT) before surgery was a standard treatment strategy for locally advanced rectal cancer (LARC). The aim of this study was to assess the relationship between the predictive factors and pathological complete response (pCR) in rectal cancer patients, especially in ultra-low ones. Method: A total of 402 patients were involved in this retrospective study. The logistic regression analyses were used to compare the different subgroups in univariate analysis. Multivariate analysis was performed to determine the independent predictive factors of pCR by using a logistic regression model. Results: A total of 402 patients received preoperative CRT. In all patients, multivariate analysis revealed that circumferential tumor extent rate (CER) (≤ 2/3cycle vs >2/3 cycle, P < .001, OR = 4.834, 95% CI: 2.309-10.121), carcinoembryonic antigen (CEA) level (both ≤ 5 vs pre > 5 and post ≤ 5 vs both > 5, P = .033, OR = 1.537, 95% CI: 1.035-2.281), and interval time between the end of CRT and surgery ( P = .031, OR = 2.412, 95% CI: 1.086-5.358) were predictive factors for pCR. The area under the curve (AUC) of the predictive model was 0.709 (95% CI: 0.649-0.769), which was significantly higher than the CER (0.646, 95% CI: 0.584-0.709), interval time (0.563, 95% CI: 0.495-0.631) and CEA level (0.586, 95% CI: 0.518-0.655). In ultra-low rectal patients, multivariate logistic regression analysis revealed that CER (≤ 2/3 cycle vs > 2/3 cycle, P = .003, OR = 7.203, 95% CI: 1.934-26.823) and mismatch repair (MMR) status (pMMR vs dMMR, P = .016, OR = 0.173, 95% CI: 0.041-0.720) were predictive factors for pCR. The AUC of the predictive model was 0.653 (95% CI: 0.474-0.832). Conclusion: New predictive models were varied by the histologic types and MMR statuses to evaluate the trend of tumor response to nCRT in all RC cases and ultra-low RC patients, which may be used to individualize stratify for selected LARC patients.
The Ageing Foot
Authors: Kakagia Despoina D. , Karadimas Efthimios J. , Stouras Ioannis A. , Papanas Nikolaos
Published: September 2023

Feet suffer significant stress throughout a lifetime and undergo ageing-associated problems due to gradual tissue degeneration affecting the skin, connective tissue, and nerves. Oxygen supply to the tissues may be diminished. The skin gets dry and calluses, ulcers and fungal infections of the skin and nails are not uncommon. Ligaments and tendons degenerate and, without proper prevention, deformities including claw toes, hammer toes, tendonitis, and bursitis may occur. Skeletal toe deformities such as bunions, bony spurs, and hallux valgus may increase discomfort, while stress fractures may have an adverse impact on the patients’ quality of life. The ageing foot pathology may add up to common age-related problems, such as crystal deposition arthropathies, diabetes mellitus, peripheral circulatory disorders, and peripheral edema, increasing morbidity. This review summarizes ageing-related feet problems, focusing on prevention and treatment. Foot health has a paramount role in overall wellbeing, therefore prevention, proper foot care, and prompt diagnosis and management of ageing-related changes are vital for maintaining a healthy, active status.
Comparison of Plasma Metabolites From Patients With Non-Small Cell Lung Cancer by Erlotinib Treatment and Skin Rash
Authors: Lee Won Kil , Myong Jisoo , Kwag Eunbin , Shin Younmin , Son Ji Woong , Yoo Byong Chul , Kim Byoung-Soo , Yoo Hwa-Seung , Choi Jeong June
Published: September 2023

Erlotinib is a necessary anticancer treatment for non-small cell lung cancer (NSCLC) patients yet it causes severe side effects such as skin rash. In this study, researchers compared the untargeted compound profiles before and after erlotinib administration to observe changes in blood metabolites in NSCLC patients. The levels of 1005 substances changed after taking erlotinib. The levels of 306 and 699 metabolites were found to have increased and decreased, respectively. We found 5539 substances with peak area differences based on the presence of skin rash. Carbohydrate, amino acid, and vitamin metabolic pathways were altered in response to the onset of erlotinib-induced skin rash. Finally, this study proposed using plasma metabolites to identify biomarker(s) induced by erlotinib, as well as target molecule(s), for the treatment of dermatological toxic effects.
Review of interferometric synthetic aperture sonar interferometric phase filtering methods
Authors: Huang Pan , Ding Weimin , Wang Xiujuan , Teng Xiaojie
Published: September 2023

Interferometric synthetic aperture sonar (InSAS) is a novel three dimensional underwater mapping system, which is widely used in various fields. Interferometric phase filtering is a crucial process in InSAS signal processing. The study of interferogram filtering method has great significance to improve the signal-to-noise ratio (SNR) of interferogram, reduce the difficulty of phase unwrapping, and improve the accuracy of digital elevation maps. Firstly, this article introduces the sources of interferometric phase noise. Secondly, it illustrates the difference between real domain filter and complex domain filter by simulation experiment. Thirdly, the various methods of InSAS interferogram filtering are systematically studied, which can be classified into spatial domain filtering and transform domain filtering. The transform domain filtering can be further divided into frequency domain and wavelet transform filtering. Moreover, the advantages and disadvantages of various methods are analyzed theoretically. Finally, numerical simulation and real-data processing experiments are performed, and the advantages and shortcomings of several methods are compared using residue numbers, root mean square error (RMSE), and CPU time as evaluation criteria.
Suspicion About Suspicion Probes: Ways Forward
Authors: Barrett Daniel W. , Neuberg Steven L. , Luce Carol
Published: September 2023

Suspicion probes are the traditional tool employed to assess the extent to which participants suspect intentional misdirection or deception within the research context. A primary reason psychologists use deception in research settings is to prevent participants from altering their behavior in light of knowing what is being studied, which could undermine internal validity as well as threaten the generalizability of findings to the real world (i.e., external validity). The present article elucidates a number of challenges with suspicion probes. A definition and framework for conceptualizing the construct of suspicion in research settings are proposed. Following a literature review, an analysis of existing evidence, and new data on the prevalence of using and reporting suspicion probes, we conclude that suspicion is a likely problem in research practice. We provide a decision guide to help researchers navigate the numerous choices involved in addressing potential suspicion and call for a combination of (a) renewed research leading to empirically supported tools and best practices and (b) systemic changes to editorial policies, funding practices, professional standards, and research training that would increase rigor and focus on this aspect of research methodology.
Major incident preparedness in a post pandemic world: A survey of anaesthetists
Authors: Brooks James , Marsden Sarah , Edwardson Stuart Andrew
Published: September 2023

The COVID-19 pandemic profoundly changed anaesthetic and critical care departments across the UK and fulfilled the definition of a major incident for an extended period of time. It is regularly highlighted that individual and organisational readiness for major incident is inconsistent, as is support in the aftermath. Post-pandemic rates of anxiety and PTSD in healthcare staff have significantly increased, but we still have no embedded method of helping to prevent it. Clinical debriefing is an emerging tool with proven improved psychological outcomes for staff following an adverse event. We surveyed 354 anaesthetists of a range of grades and experiences prior to attending a webinar centred on major incident organisation, human factors and clinical debrief. While 73.8% knew where to access their hospital’s major incident plan, only 16.8% had been trained in any form of clinical debrief. Only 29% had ever received any formal training in major incident management. It seems that the occurrence of major incidents is no longer a ‘once in a career’ event. The inconsistencies in training and preparedness shown in our survey highlight opportunities for our workforce to be more agile and subsequently better supported for the future.
Changes in flexor pollicis longus tendon cross-sectional dimensions after A1 pulley release for paediatric trigger thumb
Authors: Ok Cha Hyeong , Shin Young Ho , Kim Ho Yeon , Kim Jae Kwang
Published: September 2023

In this study, 30 patients with unilateral paediatric trigger thumb were examined with measurements taken within 1 month before surgery, and at 3 months after surgery. We measured the dorsal-palmar (DP) diameter, radioulnar (RU) diameter and cross-sectional area (CSA) of the flexor pollicis longus (FPL) tendon at two sites: just proximal to the A1 pulley and underneath the A1 pulley using ultrasonography. Following surgical A1 pulley release, the DP diameter, RU diameter and CSA of the FPL tendon just proximal to the A1 pulley significantly decreased from 2.6 mm to 2.2 mm, from 5.1 mm to 4.2 mm and from 11 mm2 to 7.8 mm2, respectively. Additionally, the RU diameter and CSA of the FPL tendon at the area beneath the A1 pulley significantly increased from 2.2 mm to 3.2 mm and from 4.3 mm2 to 5.8 mm2, respectively. This finding suggests that the conformation of the FPL tendon of the affected thumb tends to return to that of the contralateral uninvolved thumb after A1 pulley release. Underdevelopment of the inner space around the A1 pulley may contribute to the development of paediatric trigger thumb.

Level of evidence: III
The impact of healthcare systems on the clinical diagnosis and disease-modifying treatment usage in relapse-onset multiple sclerosis: a real-world perspective in five registries across Europe
Authors: Nicholas Richard , Rodgers Jeff , Witts James , Lerede Annalaura , Friede Tim , Hillert Jan , Forsberg Lars , Glaser Anna , Manouchehrinia Ali , Ramanujam Ryan , Spelman Tim , Klyve Pernilla , Drahota Jiri , Horakova Dana , Joensen Hanna , Pontieri Luigi , Magyari Melinda , Ellenberger David , Stahmann Alexander , Butzkueven Helmut , Van Der Walt Anneke , Bezlyak Vladimir , Lines Carol , Middleton Rod
Published: September 2023

Introduction:

Prescribing guidance for disease-modifying treatment (DMT) in multiple sclerosis (MS) is centred on a clinical diagnosis of relapsing–remitting MS (RRMS). DMT prescription guidelines and monitoring vary across countries. Standardising the approach to diagnosis of disease course, for example, assigning RRMS or secondary progressive MS (SPMS) diagnoses, allows examination of the impact of health system characteristics on the stated clinical diagnosis and treatment access.

Methods:

We analysed registry data from six cohorts in five countries (Czech Republic, Denmark, Germany, Sweden and United Kingdom) on patients with an initial diagnosis of RRMS. We standardised our approach utilising a pre-existing algorithm (DecisionTree, DT) to determine patient diagnoses of RRMS or secondary progressive MS (SPMS). We identified five global drivers of DMT prescribing: Provision, Availability, Funding, Monitoring and Audit, data were analysed against these concepts using meta-analysis and univariate meta-regression.

Results:

In 64,235 patients, we found variations in DMT use between countries, with higher usage in RRMS and lower usage in SPMS, with correspondingly lower usage in the UK compared to other registers. Factors such as female gender ( p = 0.041), increasing disability via Expanded Disability Status Scale (EDSS) score ( p = 0.004), and the presence of monitoring ( p = 0.029) in SPMS influenced the likelihood of receiving DMTs. Standardising the diagnosis revealed differences in reclassification rates from clinical RRMS to DT-SPMS, with Sweden having the lowest rate Sweden (Sweden 0.009, range: Denmark 0.103 – UK portal 0.311). Those with higher EDSS at index ( p < 0.03) and female gender ( p < 0.049) were more likely to be reclassified from RRMS to DT-SPMS. The study also explored the impact of diagnosis on DMT usage in clinical SPMS, finding that the prescribing environment and auditing practices affected access to treatment.

Discussion:

This highlights the importance of a healthcare system’s approach to verifying the clinical label of MS course in facilitating appropriate prescribing, with some flexibility allowed in uncertain cases to ensure continued access to treatment.
Psychometric evaluation of the Chinese version of the media Health Literacy Questionnaire: A validation study
Authors: Li Wenbo , Zhang Yanli , Liang Jiaqing , Yu Hongyu
Published: September 2023

Background

The media play an important role in health promotion and disease prevention, while at the same time, a variety of mixed health messages in the media are beginning to pose new challenges to them. However, there is a lack of media health literacy (MHL) assessment tools in China. Therefore, the purpose of this study was to translate the Media Health Literacy (MeHLit) questionnaire into Chinese and to assess its psychometric properties.

Methods

This cross-sectional study was conducted from October to December 2022, and a methodological study of the translation and validation of the MeHLit questionnaire was conducted.

Results

As a result of an extensive translation and cultural adaptation process, the final MeHLit questionnaire was developed, which includes five dimensions and 21 items. Cronbach's α value of the questionnaire was 0.859, and Cronbach's α value of the dimensions ranged from 0.776 to 0.911, which is fairly good. As a result, the test–retest reliability coefficient and the split-half reliability coefficient of the questionnaire are both equal to 0.907. Its content validity index was 0.946, suggesting a reasonable level of content validity. Through exploratory factor analysis, a five-factor structure was identified based on the eigenvalues, total variance explained, and scree plot. As a result of the validation factor analysis, all recommended fit indicators were appropriate.

Conclusion

The Chinese version of the MeHLit questionnaire has been successfully introduced in China. It has shown good psychometric properties among the Chinese public and can be used as a tool to evaluate MHL in health screening.
How Do Users Examine Online Messages to Determine If They Are Credible? An Eye-Tracking Study of Digital Literacy, Visual Attention to Metadata, and Success in Misinformation Identification
Authors: Steinfeld Nili
Published: September 2023

Although previous studies examined the role of digital literacy in successful identification of misinformation, scant scholarly attention has been given to users’ attention to metadata as informative areas that attest to message credibility. This study introduces a novel approach and methodology to contribute to our understanding of how users evaluate and identify misinformation, and the relationship between users’ ocular attention to metadata, misinformation identification, and digital literacy. In an eye-tracking study, participants were asked to rate the credibility of online messages posted on social media and web pages. Throughout the session, participants’ eye movements were recorded. The results indicate that digital literacy predicts successful identification of online misinformation, as well as webpage scan patterns, specifically devoting attention and focusing gaze at metadata areas that provide cues attesting to the credibility of the messages. In addition, successful identification of misinformation is positively linked to ocular attention to information metadata. In other words, technology-savvy users devote more attention to information metadata, which leads to better identification of misinformation, and they are also directly more successful at identifying misinformation online.
The child and God: Some reflections from disability theology on divine-child encounters
Authors: Barfield Robin
Published: September 2023

There is a longstanding discussion in child theology around the role of cognition for faith formation. This article explores research in the area of disability theology in order to examine potential benefits for Christian ministry to the child. It suggests three areas which may be profitable: the importance of increasing information to accompany development; the importance of the role of the teacher as embodiment and model of discipleship; and the requirement to give better account for ritualised processes within evangelical children’s ministry.
Bifactor SEM and MIRT Structure of a 12-Item Human Immunodeficiency Virus Stigma Scale in Peruvian Adults
Authors: Ramos-Vera Cristian , Basauri-Delgado Miguel , Diaz Peña Misael , Tinoco Alberto Jose , Perez Arroyo Karen , Herrera Mamani Betsabel , Sánchez-Villena Andy , Saintila Jacksaint
Published: September 2023

Background:

The stigma associated with human immunodeficiency virus (HIV) can lead to prejudice and discrimination against people who have been infected by this virus, consequently, it is important to have a validated tool to measure this phenomenon. However, there is only 1 national precedent that has validated the scores of this instrument in its 21-item version. Therefore, this study examined the bifactor structural equation method (SEM) and multidimensional item response theory (MIRT) structure of a 12-item human immunodeficiency virus stigma scale in Peruvian adults.

Methods:

We evaluated 342 patients (57.6% female and 42.45% male) diagnosed with HIV receiving highly active antiretroviral therapy (HAART) from a hospital located in East Lima, aged 18 to 45 years ( M = 31.4, SD = 9.79). A SEM was used to test 2 measurement models, a 4-factor correlated oblique model and a bifactor model due to high interfactor relationships.

Results:

Acceptable fit indices were identified for the oblique model (χ2/df = 1.26, SRMR = 0.044, RMSEA [90% CI] = 0.028 [0.000-0.047], CFI = 0.996, TLI = 0.994). In the same way, similar results were evident for the bifactor model (χ2/df = 1.14, SRMR = 0.039, RMSEA [90% CI] = 0.020 [0.000-0.044], CFI = 0.998, TLI = 0.997), however, in the latter it showed a greater explanation for the unidimensional model ( H = 0.87, PUC = 0.82, LCA = 0.70), which was also evidenced by the bifactor MIRT analysis.

Conclusion:

It is concluded that the 12-item HIV Stigma Scale meets the psychometric properties of internal structure and unifactorial reliability.
Climate Variability and Development Interventions Influence Migration Aspirations and Capabilities of Project Beneficiaries in Southern Ethiopia
Authors: Mayer Niklas , Darebo Tadele Dana , Fourie Elsje , Bosse Giselle
Published: September 2023

In recent years, the European Union (EU) and other donors have increasingly instrumentalised their development cooperation to meet their own domestic migration policy goals, under the assumption that different development interventions—such as building climate resilience – may result in less outward migration from the recipient country. However, it is not yet understood how increased climate resilience would influence individual migration aspirations and capabilities. We conducted 32 in-depth interviews (IDI) and eight focus group discussions (FGD) with beneficiaries of the EU RESET Plus climate-resilience building project in southern Ethiopia. Half of the respondents are adult direct beneficiaries, and the other half are indirect beneficiaries (youths 17–24 years old). By applying a modified aspirations-capabilities framework, we extended the migration-development nexus to climate change and climate-resilience building. We found that climate change worsened perceived conditions and prospects for the future, while the development intervention mostly reinforced already emerging migration aspirations. By improving agricultural output in the context of climate variability, the RESET Plus project contributed to supporting people who wanted to stay to actually be able to do so but also encouraging those wanting to leave by slightly increasing migration capabilities.
Association Between Depression Symptoms and Emotional-Communication Dynamics
Authors: Gregory Amy J. P. , Dirks Melanie A. , Nitschke Jonas P. , Wong Jessica M. , Human Lauren J. , Bartz Jennifer A.
Published: September 2023

Communicating emotional experiences effectively is critical for adaptive functioning and personal and interpersonal well-being. Here, we investigated whether variability in depression symptoms undermines people’s ability to express their emotions to others (“emotional expressive accuracy”) and how those communication dynamics influence other’s impressions. In Phase 1, 49 “targets” were videotaped describing significant autobiographical events; they then watched their videos and continuously rated how positive/negative they were feeling throughout the narrative. In Phase 2, 171 “perceivers” watched subsets of videos from targets and similarly rated each target’s affect. Results from 1,645 unique target–perceiver observations indicate a link between target’s depressive symptoms and impaired emotional expressive accuracy for positive events, B = −0.002, t(1,501) = −3.152, p = .002. Likewise, more depressive targets were rated less favorably by perceivers, again when sharing positive events, B = −0.012, t(1,511) = −10.145, p < .001. Given the beneficial effects of “capitalization”—sharing positive experiences with others—these findings may illustrate one link between depressive symptoms and impoverished relationships.
Facing Emotions: Between- and Within-Sessions Changes in Facial Expression During Psychological Treatment for Depression
Authors: Fisher Hadar , Reiss Philip T. , Atias Dovrat , Malka Michal , Shahar Ben , Shamay-Tsoory Simone , Zilcha-Mano Sigal
Published: September 2023

The main diagnostic criteria for major depressive disorder (MDD) are consistent experiences of high levels of negative emotions and low levels of positive emotions. Therefore, modification of these emotions is essential in the treatment of MDD. In the current study, we harnessed a computational approach to explore whether experiencing negative emotions during psychological treatment is related to subsequent changes in these emotions. Facial expressions were automatically extracted from 175 sessions of 58 patients with MDD. Within sessions, a U-shaped trajectory of change in valence was observed in which patients expressed an increase in negative emotions in the middle of the session. Between sessions, a consistent increase in valence was observed. A trajectory of within-sessions decrease followed by an increase in valence was positively associated with greater perceived positive emotions and subsequent decreases in depressive symptoms. These findings highlight the importance of targeting negative emotions during treatment to achieve more favorable outcomes.
The surgical outcome of postoperative radial neck nonunion: Retrospective case series with systematic review
Authors: Kholinne Erica , Lee Hyun-Joo , Jeon In-Ho
Published: September 2023

Purposes

This study aim to describe surgical outcome in treating postoperative radial neck nonunion and to perform a systematic review to evaluate the surgical outcome of symptomatic radial neck nonunion.

Methods

The study included ten patients with symptomatic postoperative radial neck nonunion from 2010 to 2016 which were treated surgically with either bone grafting (bone-grafting group) or radial head resection (resection group). The patient demographics, pre- and postoperative clinical scores were recorded. The PubMed, OVID/Medline, Cochrane, Google Scholar, and EMBASE databases were searched using the keywords “radial neck nonunion” according to the MeSH index. A systematic review was performed using PRISMA guidelines.

Results

Average time from primary surgery to nonunion was 10.7 months. Four and six patients received bone-grafting and radial head resection procedure. The mean age for resection group is older than bone grafting group (59 versus 28.75 years). The resection group patients presented with more significant pre-operative symptoms, associated injuries, loss of radial head articular congruity, and bone loss. All patients achieved favorable outcome. The systematic review included 12 publications with a total of 19 patients. The incidence of radial neck nonunion was 73.7% and 26.3% following conservative and operative treatment respectively. About 42.1% received operative treatment due to symptomatic progression.

Conclusions

Radial neck nonunion is rare and mostly appears asymptomatic. Operative treatment is advocated for symptomatic cases. Articular congruity and degree of bone loss are major determinant for surgical treatment of radial neck nonunion. Surgical treatment for symptomatic radial neck nonunion resulted in favorable outcome.
ACL Reconstruction With Quadriceps Soft Tissue Autograft Versus Bone-Patellar Tendon-Bone Autograft in Cutting and Pivoting Athletes: Outcomes at Minimum 2-Year Follow-up
Authors: Renfree Sean P. , Brinkman Joseph C. , Tummala Sailesh V. , Economopoulos Kostas J.
Published: September 2023

Background:

The optimal graft choice for anterior cruciate ligament (ACL) reconstruction (ACLR) in the high-level cutting and pivoting athlete remains controversial. Studies have shown similar outcomes when directly comparing bone-patellar tendon-bone (BPTB) autograft versus quadriceps soft tissue (QST) autograft in the general population. However, no studies have directly compared these 2 grafts in athletes participating in cutting and pivoting sports.

Hypothesis:

It was hypothesized that, compared with BPTB autograft, the QST autograft would result in similar patient-reported outcomes and rates of retear, return to sport, and complications.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

A retrospective review was performed on athletes participating in cutting and pivoting sports (soccer, American football, lacrosse, and basketball) who underwent primary ACLR with either BPTB autograft or QST autograft chosen by the athlete between January 2015 and January 2019. The International Knee Documentation Committee (IKDC) subjective knee evaluation and Lysholm Knee Scoring Scale were used to evaluate patient-reported outcomes. Return-to-sport and complication rates were identified. Descriptive statistics were expressed using Mann-Whitney test or Student t test for continuous variables and the chi-square test for categorical variables.

Results:

A total of 68 athletes (32 QST, 36 BPTB) were included for analysis. The percentage follow-up was 89% (32/36) for the QST autograft group and 86% (36/42) for the BPTB autograft group. The 2-year IKDC score (QST, 90.5 ± 6.6 vs BPTB, 89.7 ± 7.8) and 2-year Lysholm score (QST, 91.3 ± 7.5 vs BPTB, 90.5 ± 8.6) were similar between groups. The percentage of athletes able to return to sport within the follow-up period was also similar (88% vs 83%; P = .63). There were 2 retears requiring revision in the BPTB group (6%) and no retears in the QST group ( P = .18). One contralateral ACL rupture occurred in the QST group (3%) and 4 in the BPTB group (11%) ( P = .21).

Conclusion:

The QST and BPTB autografts demonstrated similar patient-reported outcomes, return-to-sport rates, and complication rates after primary ACLR at 2-year follow-up. Both autografts appear to be reliable and consistent options for ACLR in the cutting and pivoting athlete.
Age, Gender, Body Mass Index, and Foot Loading During Gait
Authors: Castellini Jorge Luis Alberto , Grande Ratti María Florencia , Chan Débora Mirta
Published: September 2023

Background:

The aim was to analyze changes in normal functional parameters of gait analysis by aging, sex, and body mass index (BMI).

Methods:

A cross-sectional study with a consecutive sample of asymptomatic subjects was performed between 2014 and 2020. Primary outcomes were time and force parameters (contact time and center of force [CoF] time), in the heel, midfoot, and metatarsal areas, measured using an in-office force platform.

Results:

A total of 156 subjects (312 feet) were included, including 67% of women with a mean age of 47 years. The mean of total contact time was similar in males and females ( P = .695) and across BMI ( P = .413). Contact time did not show differences by region ( P = .648 heel, P = .286 midfoot, and P = .690 metatarsal). CoF time in the heel and metatarsal areas did not change between males and females ( P = .288 and P = .879, respectively); meanwhile, it was different in midfoot ( P = .002). Maximum force showed a reduction between sexes in the heel ( P = .039) but did not in the midfoot and metatarsal areas. By age, differences were detected in the heel and metatarsal areas in females ( P = .002 and P = .001) and the metatarsal area in males ( P = .001). According to the age groups, total contact time increased in females ( P = .001) but not in males ( P = .018), and no differences were detected between foot areas. In females, CoF time did not change either foot areas or age groups. In males, CoF time values increased in the midfoot area in the older group ( P = .001).

Conclusion:

Time variables did not change by foot region, independent of age, sex, and BMI. Heel maximum force decreased in females, probably linked to adaptive phenomena by aging. The midfoot remains stable, and acts as an undamaged “bridge.” These parameters could be interpreted as normal in asymptomatic subjects.

Level of Evidence:

Level III, diagnostic and prognostic.
The Foot and Ankle in Ultramarathon Runners: Results of the Ultrarunners Longitudinal TRAcking (ULTRA) Study
Authors: Jastifer James R. , Hoffman Martin D.
Published: September 2023

Background:

The foot and ankle play a critical role in ultramarathon running. Because foot and ankle injuries are the most common location of injury in this group, proper care is essential for prevention. In this sport, small issues can become big problems over such long distances, and understanding the preventative measures taken by ultramarathon runners may provide insight for other athletes looking to avoid similar problems. The purpose of this study was to examine the routine and preventative care of the foot and ankle, as well as injury rates, in this group of high-risk athletes.

Methods:

The Ultrarunners Longitudinal TRAcking (ULTRA) Study is the largest known prospective longitudinal study of ultramarathon runners. In this portion of the study, participants reported general health status, running behavior and performance, as well as foot and ankle care, injuries, stretching frequency, and shoewear.

Results:

A total of 734 ultramarathon runners participated in the study. This group ran a median of 40.2 km per week. Overall, 71.2% of active ultramarathon runners reported a foot or ankle injury in the previous 12 months. The most common injuries reported were plantar fasciitis (36.3%), Achilles tendinitis (24.0%), nonspecific foot pain (14.0%), and stress fractures (13.4%). Sit and reach flexibility test showed that 63.7% of runners could not reach past their toes. There were no significant correlations for sit and reach flexibility or stretching frequency with injury rate.

Conclusion:

The high prevalence of foot and ankle injuries in ultramarathon runners does not appear to be influenced by arch type, foot strike pattern, orthotic usage, stretching behavior, or actual flexibility. A high percentage of the study runners used comfort as a shoe selection method, independent of alignment or foot strike pattern. These findings guide the clinician in shared decision making with runners about routine care, including injury prevention and shoe selection.

Level of Evidence:

Level II, prospective study.
Imaging of malignancies of the biliary tract- an update
Authors: Hennedige Tiffany Priyanthi , Neo Wee Thong , Venkatesh Sudhakar Kundapur
Published: September 2023

Malignancies of the biliary tract include cholangiocarcinoma, gallbladder cancers and carcinoma of the ampulla of Vater. Biliary tract adenocarcinomas are the second most common primary hepatobiliary cancer. Due to their slow growing nature, non-specific and late symptomatology, these malignancies are often diagnosed in advanced stages with poor prognosis. Apart from incidental discovery of gall bladder carcinoma upon cholecystectomy, early stage biliary tract cancers are now detected with computed tomography (CT) and magnetic resonance imaging (MRI) with magnetic resonance cholangiopancreatography (MRCP). Accurate characterization and staging of these indolent cancers will determine outcome as majority of the patients’ are inoperable at the time of presentation. Ultrasound is useful for initial evaluation of the biliary tract and gallbladder masses and in determining the next suitable modality for further evaluation. Multimodality imaging plays an integral role in the management of the biliary tract malignancies. The imaging techniques most useful are MRI with MRCP, endoscopic retrograde cholangiopancreatography (ERCP), endoscopic ultrasound (EUS) and positron emission tomography (PET). In this review we will discuss epidemiology and the role of imaging in detection, characterization and management of the biliary tract malignancies under the three broad categories of cholangiocarcinomas (intra- and extrahepatic), gallbladder cancers and ampullary carcinomas.
IDH mutations in G2-3 conventional central bone chondrosarcoma: a mono institutional experience
Authors: Setola Elisabetta , Benini S. , Righi A. , Gamberi G. , Carretta E. , Ferrari C. , Avnet S. , Palmerini E. , Magagnoli G. , Gambarotti M. , Lollini P. L. , Cesari M. , Cocchi S. , Paioli A. , Longhi A. , Scotlandi K. , Laginestra M. A. , Donati D. M. , Baldini N. , Ibrahim T.
Published: September 2023

Background

Heterozygous isocitrate dehydrogenase (IDH) mutations occur in about half of conventional central bone chondrosarcomas (CCBC). Aim of this study was to assess the frequency and prognostic impact of IDH mutations in high grade CCBC patients.

Methods

64 patients with G2 and G3 CCBC were included. DNA extraction, PCR amplification of IDH1/2 exon 4s, and sequencing analysis with Sanger were performed.

Results

IDH mutations were detected in 24/54 patients (44%): IDH1 in 18, IDH2 in 4, and both IDH1/2 in 2 patients. The frequency of mutations was 37% in G2 vs. 69% in G3 (p = 0.039), and 100% in three Ollier disease associated chondrosarcoma. 5-year overall survival (OS) at 124 months (range 1-166) was 51%, with no significant difference based on the IDH mutational status: 61% in IDHmut vs. 44% in IDH wild type (IDHwt). The 5-year relapse free survival (RFS) was 33% (95% CI:10–57) for IDHmut vs. 57% (95%CI: 30–77) for IDHwt. Progression free survival (PFS) was 25% (95%CI:1–65) IDHmut vs. 16% (95%CI: 0.7–52) IDHwt. 55% (5/9) of IDHmut G2 became higher grade at the recurrence, as compared with 25% (3/12) of G2 IDHwt.

Conclusions

This study shows a higher frequency of IDH mutations in G3 CCBC as compared with G2. No significant differences in OS, RFS, and PFS by mutational status were detected. After relapse, a higher rate of G3 for IDH mutated CCBC was observed.
Comparison of clinical outcomes and prognosis between surgery and endoscopic submucosal dissection in patients with synchronous multifocal early gastric cancer
Authors: Bao Linsen , Gao Hengfei , Pu Lingxiao , Sui Chao , Ji Kangkang , Wang Feng , Tao Liang , Feng Min , Wang Meng
Published: September 2023

Background

Synchronous multiple early gastric cancer (SMEGC) refers to the simultaneous occurrence of two or more malignant cancer lesions in the stomach. For patients with multiple early gastric carcinomas, the choice of appropriate treatment remains controversial. This study is dedicated to comparing the clinical outcomes and prognosis of patients with SMEGC who underwent endoscopic submucosal dissection (ESD) or gastrectomy.

Methods

A total of 180 patients with more than one malignant cancer lesion in the stomach who had received gastrectomy or ESD between 2012 and 2021 were retrospectively evaluated to determine their clinical outcomes and prognosis. Univariate and multivariate logistic regression were utilized to identify risk factors for tumor recurrence.

Results

Over the 57.5 months median follow-up period for the 140 enrolled cases, tumor recurrence occurred in 8 (12%) in the ESD group but only 1 (1%) in the surgery group. Relapse-free survival (RFS) was higher in the surgery group (p = 0.023) in all cases; however, there was no significant difference in Overall survival (OS, p = 0.772). Complications were significantly higher in the surgery group than in the ESD group, but fewer in the radical distal gastrectomy group. Multivariate regression analysis revealed that ESD(p = 0.034), the main lesion size > 2 cm(p = 0.019), and undifferentiated tumor(p = 0.022) were independent risk factors for tumor recurrence.

Conclusions

For the treatment of simultaneous multifocal early gastric cancer, ESD has a good short-term effect and higher quality of life. However, ESD has a higher risk of recurrence than surgery. And we found that the partial gastrectomy appears to be considered as adequate treatment for some SMEGC patients.
Investigation of the association between habitual dietary FODMAP intake, metabolic parameters, glycemic status, and anthropometric features among apparently healthy overweight and obese individuals
Authors: Hemami Reyhaneh Mokhtari , Shakarami Amir , Ardekani Abnoos Mokhtari , Aghaii Sara , Makarem Dorna , Nikrad Negin , Farhangi Mahdieh Abbasalizad , Pour Abbasi Mohammad Sadegh
Published: September 2023

Background

The predisposition of humans to metabolic syndrome is affected by many factors, including diet and lifestyle. Fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) are a set of carbohydrates that are fermented by gut microbiota. In animal studies, supplementation with FODMAP-rich diets as prebiotics can alter body composition and gut microbiota. This study evaluates any relationship between FODMAP and metabolic syndrome risk factors among adults with metabolic syndrome in Iran.

Methods

This cross-sectional study is based on sociodemographic information from 347 overweight and obese participants selected from outpatient clinics through public declaration. Participants body composition and anthropometric measures were also determined. A validated Food Frequency Questionnaire (FFQ) with 168 questions was used to collect dietary data. Biochemical parameters, including serum total cholesterol (TC), triglycerides (TG), high-density lipoprotein cholesterol (HDL-C), fasting serum glucose (FSG), and insulin levels, were determined by enzymatic methods. In addition, the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) and Quantitative Insulin Sensitivity Check Index (QUICKI) were calculated.

Results

In moderate FODMAP and low FODMAP groups, lower waist-to-hip ratio (WHR) and higher fat-free mass (FFM) were achieved in higher tertiles. In high FODMAP groups, higher systolic blood pressure (SBP) was shown in the higher tertile (P < 0.05). Higher insulin, HOMA-IR, and lower QUICKI in the second tertile of the high FODMAP group were also observed.

Conclusion

Findings of this study highlight the potential role of FODMAP in managing metabolic syndrome and open a new field of research.
Adaptation of the professionalism mini-evaluation exercise instrument into Turkish: a validity and reliability study
Authors: Taşçı Ali İhsan , Akdeniz Esra , Gülpınar Mehmet Ali , Danacıoğlu Yavuz Onur , Sarı Emine Ergül , Yaşar Levent , Karandere Faruk , Ferahman Sina
Published: September 2023

Background

There is an ongoing search for standardized scales appropriate for each culture to evaluate professionalism, which is one of the basic competencies of a physician. The Professionalism Mini-evaluation Exercise (P-MEX) instrument was originally developed in Canada to meet this need. In this study, it was aimed to adapt the P-MEX to Turkish and to evaluate the validity and reliability of the Turkish version.

Methods

A total of 58 residents at Bakirkoy Dr. Sadi Konuk Training and Research Hospital were assessed with the Turkish version of P-MEX by 24 raters consisting of faculty members, attending physicians, peer residents, and nurses during patient room visits, outpatient clinic and group practices. For construct validity, the confirmatory factor analysis was performed. For reliability, Cronbach’s alpha scores were calculated. Generalizibility and decision studies were undertaken to predict the reliability of the validated tool under different conditions. After the administration of P-MEX was completed, the participants were asked to provide feedback on the acceptability, feasibility, and educational impact of the instrument.

Results

A total of 696 forms were obtained from the administration of P-MEX. The content validity of P-MEX was found to be appropriate by the faculty members. In the confirmatory factor analysis of the original structure of the 24-item Turkish scale, the goodness-of-fit parameters were calculated as follows: CFI = 0.675, TLI = 0.604, and RMSEA = 0.089. In the second stage, the factors on which the items loaded were changed without removing any item, and the model was modified. For the modified model, the CFI, TLI, and RMSEA values were calculated as 0.857, 0.834, and 0.057, respectively. The decision study on the results obtained from the use of P-MEX in a Turkish population revealed the necessity to perform this evaluation 18 times to correctly evaluate professionalism with this instrument. Cronbach’s alpha score was 0.844. All the faculty members provided positive feedback on the acceptability, feasibility, and educational impact of the adapted P-MEX.

Conclusion

The findings of this study showed that the Turkish version of P-MEX had sufficient validity and reliability in assessing professionalism among residents. Similarly, the acceptability and feasibility of the instrument were found to be high, and it had a positive impact on education.

Trial registration

2020/249, Bakirkoy Dr. Sadi Konuk Training and Research Hospital.
Machine learning-derived identification of tumor-infiltrating immune cell-related signature for improving prognosis and immunotherapy responses in patients with skin cutaneous melanoma
Authors: Leng Shaolong , Nie Gang , Yi Changhong , Xu Yunsheng , Zhang Lvya , Zhu Linyu
Published: September 2023

Background

Immunoblockade therapy based on the PD-1 checkpoint has greatly improved the survival rate of patients with skin cutaneous melanoma (SKCM). However, existing anti-PD-1 therapeutic efficacy prediction markers often exhibit a poor situation of poor reliability in identifying potential beneficiary patients in clinical applications, and an ideal biomarker for precision medicine is urgently needed.

Methods

10 multicenter cohorts including 4 SKCM cohorts and 6 immunotherapy cohorts were selected. Through the analysis of WGCNA, survival analysis, consensus clustering, we screened 36 prognostic genes. Then, ten machine learning algorithms were used to construct a machine learning-derived immune signature (MLDIS). Finally, the independent data sets (GSE22153, GSE54467, GSE59455, and in-house cohort) were used as the verification set, and the ROC index standard was used to evaluate the model.

Results

Based on computing framework, we found that patients with high MLDIS had poor overall survival and has good prediction performance in all cohorts and in-house cohort. It is worth noting that MLDIS performs better in each data set than almost all models which from 51 prognostic signatures for SKCM. Meanwhile, high MLDIS have a positive prognostic impact on patients treated with anti-PD-1 immunotherapy by driving changes in the level of infiltration of immune cells in the tumor microenvironment. Additionally, patients suffering from SKCM with high MLDIS were more sensitive to immunotherapy.

Conclusions

Our study identified that MLDIS could provide new insights into the prognosis of SKCM and predict the immunotherapy response in patients with SKCM.
Factors associated with mobile medical clinic use: a retrospective cohort study
Authors: Coaston Angela , Lee Soo-Jeong , Johnson Julene K. , Weiss Sandra , Hoffmann Thomas , Stephens Caroline
Published: September 2023

Background

Mobile medical clinics have been used for decades to provide primary and preventive care to underserved populations. While several studies have examined their return on investment and impact on chronic disease management outcomes in the Mid-Atlantic and East Coast regions of the United States, little is known about the characteristics and clinical outcomes of adults who receive care aboard mobile clinics on the West Coast region. Guided by the Anderson Behavioral Model, this study describes the predisposing, enabling, and need factors associated with mobile medical clinic use among mobile medical clinic patients in Southern California and examines the relationship between mobile clinic utilization and presence and control of diabetes and hypertension.

Methods

We conducted a retrospective cohort study of 411 adults who received care in four mobile clinic locations in Southern California from January 1, 2018, to December 31, 2019. Data were collected from patient charts on predisposing (e.g., sex, race, age), enabling (e.g., insurance and housing status), and need (e.g., chronic illness) factors based on Andersen’s Behavioral Model. Zero-truncated negative binomial regression was used to examine the association of chronic illness (hypertension and diabetes) with number of clinic visits, accounting for potential confounding factors.

Results

Over the course of the 2-year study period, 411 patients made 1790 visits to the mobile medical clinic. The majority of patients were female (68%), Hispanic (78%), married (47%), with a mean age of 50 (SD = 11). Forty-four percent had hypertension and 29% had diabetes. Frequency of mobile clinic utilization was significantly associated with chronic illness. Patients with hypertension and diabetes had 1.22 and 1.61 times the rate of mobile medical clinic visit than those without those conditions, respectively (IRR = 1.61, 95% CI, 1.36–1.92; 1.22, 95% CI, 1.02–1.45).

Conclusions

Mobile clinics serve as an important system of health care delivery, especially for adults with uncontrolled diabetes and hypertension.
Autophagy, a critical element in the aging male reproductive disorders and prostate cancer: a therapeutic point of view
Authors: Raee Pourya , Tan Shing Cheng , Najafi Sajad , Zandsalimi Farshid , Low Teck Yew , Aghamiri Shahin , Fazeli Elham , Aghapour Mahyar , Mofarahe Zahra Shams , Heidari Mohammad Hossein , Fathabadi Fatemeh Fadaei , Abdi Farid , Asouri Mohsen , Ahmadi Ali Asghar , Ghanbarian Hossein
Published: September 2023

Autophagy is a highly conserved, lysosome-dependent biological mechanism involved in the degradation and recycling of cellular components. There is growing evidence that autophagy is related to male reproductive biology, particularly spermatogenic and endocrinologic processes closely associated with male sexual and reproductive health. In recent decades, problems such as decreasing sperm count, erectile dysfunction, and infertility have worsened. In addition, reproductive health is closely related to overall health and comorbidity in aging men. In this review, we will outline the role of autophagy as a new player in aging male reproductive dysfunction and prostate cancer. We first provide an overview of the mechanisms of autophagy and its role in regulating male reproductive cells. We then focus on the link between autophagy and aging-related diseases. This is followed by a discussion of therapeutic strategies targeting autophagy before we end with limitations of current studies and suggestions for future developments in the field.