bluuebunny/crossref_metadata_2025 huggingface dataset:
Predicting medical graduates’ clinical performance using national competency examination results in Indonesia
Authors: Utomo Prattama Santoso , Randita Amandha Boy Timor , Riskiyana Rilani , Kurniawan Felicia , Aras Irwin , Abrori Cholis , Rahayu Gandes Retno
Published: April 2022

Background

Indonesia has applied a national competency exit-examination for medical graduates since 2014, called The Indonesia Medical Doctor National Competency Examination (IMDNCE). This examination is administered to ensure the competence of medical graduates from at present 83 medical schools in Indonesia. Although many studies reported their evaluation on medical licensing examinations, there are not many studies performed to evaluate the correlation of a national licensing examination to the graduates’ clinical practice.

Aims

This research aimed to evaluate the performance of new medical doctors in Indonesia in their internship period after the IMDNCE completion, and whether it might become a predictive indicator for the new medical doctors’ clinical performance.

Methods

An observational cross-sectional study was performed in November–December 2017 on 209 doctors who were new medical graduates. Thirty-one senior doctors from a range of regions in Indonesia who were recruited and trained previously participated in the observation. The Clinical Performance Instrument (CPI) tool was developed as an evaluation tool of the new doctors’ clinical competence to be observed for three weeks. The obtained data were analysed using descriptive statistics and correlated to the IMDNCE scores.

Results

The mean (95% CI) of the CPI for all participants was 83.0 (80.8–85.2), with no correlation of CPI score with IMDNCE results in domains of communication, professionalism and patient safety (p > 0.05). However, the mean total of the CPI observation scores from doctors who graduated from public medical schools was higher than those graduating from private medical schools. Also, there were differences in scores related to the institution’s accreditation grade (p < 0.05).

Conclusion

There is no difference between CPI and national competency examination results. There was no statistical correlation between the clinical performance of new medical doctors during their internship to CBT and OSCE scores in the national competency examination. New doctors’ performance during internship is affected by more complex factors, not only their level of competencies.
Development and usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy in gout
Authors: te Kampe Ritch , Boonen Annelies , Jansen Tim L. , Elling Jan Mathis , Flendrie Marcel , van Eijk-Hustings Yvonne , Janssen Matthijs , van Durme Caroline , de Vries Hein
Published: April 2022

Background

The aim of this study is to develop and assess usability of a web-based patient-tailored tool to support adherence to urate-lowering therapy (ULT) among gout patients in a clinical setting.

Methods

The content of the tool was based on the Integrated Change (I-Change) model. This model combines various socio-cognitive theories and assumes behavioral change is a result of becoming aware of the necessity of change by integrating pre-motivational, motivational, and post-motivational factors. An expert group (five gout experts, three health services researchers, and one health behavior expert) was assembled that decided in three meetings on the tool’s specific content (assessments and personalized feedback) using information from preparatory qualitative studies and literature reviews. Usability was tested by a think aloud approach and validated usability questionnaires.

Results

The I-Change Gout tool contains three consecutive sessions comprising 80 questions, 66 tailored textual feedback messages, and 40 tailored animated videos. Navigation through the sessions was determined by the patients’ intention to adapt suboptimal ULT adherence. After the sessions, patients receive an overview of the personalized advices and plans to support ULT adherence. Usability testing among 20 gout patients that (ever) used ULT and seven healthcare professionals revealed an overall score for the tool of 8.4 ± 0.9 and 7.7 ± 1.0 (scale 1–10). Furthermore, participants reported a high intention to use and/or recommend the tool to others. Participants identified some issues for further improvement (e.g. redundant questions, technical issues, and text readability). If relevant, these were subsequently implemented in the I-Change Gout tool, to allow further testing among the following participants.

Conclusion

This study provides initial support for the usability by patients and healthcare professionals of the I-Change Gout tool to support ULT adherence behavior.
Sex differences in rumen fermentation and microbiota of Tibetan goat
Authors: Guo Xinyu , Sha Yuzhu , Lv Weibing , Pu Xiaoning , Liu Xiu , Luo Yuzhu , Hu Jiang , Wang Jiqing , Li Shaobin , Zhao Zhidong
Published: April 2022

Background

The gut microbiota play an important role in maintaining host metabolism, the immune system and health, while sex, genotype, diet and health have specific effects on the composition of the gut microbiota. Therefore, to explore the sex differences in the structure and function of rumen microbiota in Tibetan goats, herein we analyzed sex differences in rumen fermentation parameters, rumen microbiota and the expression of genes related to VFA transport in Tibetan goats.

Results

The results showed that the contents of acetic acid and propionic acid in the rumen of TGM (Tibetan goat male) were significantly higher than those in TGFm (Tibetan goat female) (P < 0.05), and total VFAs was significantly higher in TGM than TGFm (P < 0.05). Expression of the VFA transport-related genes DRA, AE2, MCT-1, NHE1, and NHE2 in the rumen epithelium of TGFm was significantly higher than that in TGM. Analysis of the composition and structure of the rumen microbiota revealed significant sex differences. At the phylum level, Firmicutes and Bacteroidetes were the dominant phyla in Tibetan goats. In addition, Fibrobacteres and Spirochaetes had significantly greater relative abundances in TGFm than in TGM (P < 0.05). At the genus level, the relative abundance of Fibrobacter, Ruminococcus_1 and Pyramidobacter was significantly higher in TGFm than in TGM (P < 0.05). The functional prediction results showed that replication, recombination and repair, RNA processing and modification were mainly enriched in TGFm (P < 0.05).

Conclusions

Correlation analysis revealed significant associations of some rumen microbiota with the fermentation product VFAs and VFA transport-related genes. We concluded that yearling TGM and TGFm have distinct fermentation and metabolism abilities when adapting to the plateau environment, which provides a certain sex reference basis for Tibetan goat adaptation to the plateau environment.
A functional role of S100A4/non-muscle myosin IIA axis for pro-tumorigenic vascular functions in glioblastoma
Authors: Inukai Madoca , Yokoi Ako , Ishizuka Yuuki , Hashimura Miki , Matsumoto Toshihide , Oguri Yasuko , Nakagawa Mayu , Ishibashi Yu , Ito Takashi , Kumabe Toshihiro , Saegusa Makoto
Published: April 2022

Background

Glioblastoma (GBM) is the most aggressive form of brain tumor and has vascular-rich features. The S100A4/non-muscle myosin IIA (NMIIA) axis contributes to aggressive phenotypes in a variety of human malignancies, but little is known about its involvement in GBM tumorigenesis. Herein, we examined the role of the S100A4/NMIIA axis during tumor progression and vasculogenesis in GBM.

Methods

We performed immunohistochemistry for S100A4, NMIIA, and two hypoxic markers, hypoxia-inducible factor-1α (HIF-1α) and carbonic anhydrase 9 (CA9), in samples from 94 GBM cases. The functional impact of S100A4 knockdown and hypoxia were also assessed using a GBM cell line.

Results

In clinical GBM samples, overexpression of S100A4 and NMIIA was observed in both non-pseudopalisading (Ps) and Ps (-associated) perinecrotic lesions, consistent with stabilization of HIF-1α and CA9. CD34(+) microvascular densities (MVDs) and the interaction of S100A4 and NMIIA were significantly higher in non-Ps perinecrotic lesions compared to those in Ps perinecrotic areas. In non-Ps perinecrotic lesions, S100A4(+)/HIF-1α(−) GBM cells were recruited to the surface of preexisting host vessels in the vascular-rich areas. Elevated vascular endothelial growth factor A (VEGFA) mRNA expression was found in S100A4(+)/HIF-1α(+) GBM cells adjacent to the vascular-rich areas. In addition, GBM patients with high S100A4 protein expression had significantly worse OS and PFS than did patients with low S100A4 expression. Knockdown of S100A4 in the GBM cell line KS-1 decreased migration capability, concomitant with decreased Slug expression; the opposite effects were elicited by blebbistatin-dependent inhibition of NMIIA.

Conclusion

S100A4(+)/HIF-1α(−) GBM cells are recruited to (and migrate along) preexisting vessels through inhibition of NMIIA activity. This is likely stimulated by extracellular VEGF that is released by S100A4(+)/HIF-1α(+) tumor cells in non-Ps perinecrotic lesions. In turn, these events engender tumor progression via acceleration of pro-tumorigenic vascular functions.
Human infection with a reassortant swine-origin influenza A(H1N2)v virus in Taiwan, 2021
Authors: Yang Ji-Rong , Kuo Chuan-Yi , Yu I.-Ling , Kung Fang-Yen , Wu Fang-Tzy , Lin Jen-Shiou , Liu Ming-Tsan
Published: April 2022

Background

Influenza A virus infections occur in different species, causing mild-to-severe symptoms that lead to a heavy disease burden. H1N1, H1N2 and H3N2 are major subtypes of swine influenza A viruses in pigs and occasionally infect humans.

Methods

A case infected by novel influenza virus was found through laboratory surveillance system for influenza viruses. Clinical specimens were tested by virus culture and/or real-time RT–PCR. The virus was identified and characterized by gene sequencing and phylogenetic analysis.

Results

In 2021, for the first time in Taiwan, an influenza A(H1N2)v virus was isolated from a 5-year old girl who was suffering from fever, runny nose and cough. The isolated virus was designated A/Taiwan/1/2021(H1N2)v. Full-genome sequencing and phylogenetic analyses revealed that A/Taiwan/1/2021(H1N2)v is a novel reassortant virus containing hemagglutinin (HA) and neuraminidase (NA) gene segments derived from swine influenza A(H1N2) viruses that may have been circulating in Taiwan for decades, and the other 6 internal genes (PB2, PB2, PA, NP, M and NS) are from human A(H1N1)pdm09 viruses.

Conclusion

Notably, the HA and NA genes of A/Taiwan/1/2021(H1N2)v separately belong to specific clades that are unique for Taiwanese swine and were proposed to be introduced from humans in different time periods. Bidirectional transmission between humans and swine contributes to influenza virus diversity and poses the next pandemic threat.
Outcomes following balloon tibioplasty versus conventional osteosynthesis techniques for Schatzker type III tibial plateau fractures: a systematic review
Authors: Blankenship Andrew , Singleton Amy , Hiatt Logan , Evanson Kirk W. , Phillips Seth , Miller Richard
Published: April 2022

Introduction

Schatzker type III fractures of the tibial plateau require elevation of the depressed portions to regain articular congruity. Balloon tibioplasty has been used as an alternative to conventional metal instruments for elevation of the lateral tibial plateau. This study compared functional outcomes following balloon tibioplasty or conventional osteosynthesis techniques in patients with type III fractures of the tibial plateau.

Materials and methods

A systematic literature search was performed using PubMed, EMBASE, and Cochrane Library to identify studies published through March 29, 2021, pertaining to balloon tibioplasty or conventional osteosynthesis techniques for type III fractures. Non-human studies, opinion or editorial pieces, systematic reviews, case series (< 5 patients), and articles published in a non-English language were excluded. Primary outcomes were Rasmussen clinical score, range of motion, and Knee Society Score (KSS). A Joanna Briggs Institute (JBI) risk of bias assessment was performed for all studies.

Results

A total of 95 studies were identified, with 10 studies (and 132 total patients) meeting inclusion criteria: 1 study focused on balloon tibioplasty, 8 studies reported outcomes following conventional osteosynthesis, and 1 study compared outcomes of the two techniques. Mean follow-up times varied widely, from 4 to 76.3 months. Where reported, balloon tibioplasty resulted in good to excellent functional outcomes as indicated by Rasmussen clinical scores (mean 28.3 in a case series; mean 28.9 in a randomized controlled trial) and range of motion (≥ 140° in both studies) 1–2 years following surgery. KSS was not reported consistently enough for comparison. Studies ranged from low to high risk of bias according to the JBI assessment.

Conclusions

Balloon tibioplasty can lead to excellent functional outcomes in patients with depression fractures of the lateral tibial plateau. More research is needed to directly compare outcomes following treatment with balloon tibioplasty or conventional osteosynthesis techniques.
Peri-articular administration of tranexamic acid is an alternative route in total knee arthroplasty: a systematic review and meta-analysis
Authors: Fan DingYuan , Ma Jia , Liu XiaoHua , Zhang Lei
Published: April 2022

Background

As an antifibrinolytic agent, tranexamic acid (TXA) is increasingly used in total knee arthroplasty (TKA) to reduce blood loss. The administration of intravenous and intra-articular TXA has been well explored, but the most efficient way to administer TXA remains in question. Peri-articular injection (PAI) of TXA is a recently mentioned method. A meta-analysis of the efficacy of PAI TXA in patients after TKA should be performed.

Methods

A systematic search was performed within PubMed, Embase, and the Cochrane Library up to November 8, 2021. Two authors independently screened studies for eligibility and extracted data for analysis. The primary outcome was haemoglobin change. The secondary outcomes were haematocrit change, total drainage volume, thromboembolic events, and blood transfusion.

Results

A total of ten studies were included in this meta-analysis. The results indicated that there was a significant decrease in haemoglobin change when using PAI TXA compared with no TXA (mean difference − 1.05; 95% CI − 1.28 to − 0.81;P < 0.00001;I2 = 0%), but it had no significant differences compared with IA and IV (mean difference − 0.01; 95% CI − 0.17 to − 0.14;P = 0.85;I2 = 39%). There were no significant differences between the TXA < 1.5 g subgroup (0.10, 95% CI − 0.27 to 0.46;P = 0.60;I2 = 0%) and the TXA ≥ 1.5 g subgroup (0.18, 95% CI − 0.12 to 0.48;P = 0.24;I2 = 74%). In addition, the combined group (PAI plus IV or IA) was superior to the IV or IA group in terms of haemoglobin change (mean difference − 0.51; 95% CI − 0.76 to − 0.27;P < 0.0001;I2 = 19%). Regarding haematocrit change, the pooled result showed it was significantly less in the PAI group than the non-TXA group. Similarly, comparing it against the IV subgroup, the result revealed a difference in favour of the PAI group, with a mean difference of − 1.89 g/dL (95% CI − 2.82 to − 0.95;P < 0.0001;I2 = 67%). For total drainage volume, the pooled result was in favour of PAI TXA over no TXA (297 ml, 95% CI − 497.26 to − 97.23;P = 0.004;I2 = 87%), but it had no significant difference compared with IA and IV (mean difference − 37.98; 95% CI − 115.68 to 39.71;P = 0.34;I2 = 95%). There was no significant difference in thromboembolic events (OR 0.74; 95% CI 0.25 to 2.21;P = 0.59;I2 = 0%). Blood transfusion was not significantly different between the PAI group and the non-TXA group (OR 0.50; 95% CI 0.23 to 1.06;P = 0.07;I2 = 21%), and there was no significant difference between PAI and the other two TXA injection methods (OR 0.72; 95% CI 0.41 to 1.25;P = 0.24;I2 = 19%).

Conclusion

PAI has comparable effects to IV and IA injections. PAI is an alternative injection route of TXA for patients who have undergone TKA.
Measurement for gap balancing technique in patients undergoing total knee arthroplasty: a large retrospective observational study
Authors: Xuequan Zhao , Bin Zhao , Shuzhang Yao , Kanduo Cao , Chongxi Ren
Published: April 2022

Background

Many traditional methods are available to prevent unbalance of extension and flexion gap during total knee arthroplasty (TKA), but there are no reports on the use of measurement and positioning method before tibial osteotomy with self-made tools. We designed a self-made tool measuring the location before tibial osteotomy and determined the clinical effect.

Methods

The retrospective study included patients who received TKA at our hospital, between January 1, 2012 and December 31, 2015. A new method, named as the measurement and localization before osteotomy with self-made tools, was developed to measure the osteotomy position of the posterior femoral condyle during TKA. They were divided into two groups, one that received the new method (Group I), and the other that received the traditional method as a control (Group I I). HSS score, Oxford score, VAS score and knee joint activity were evaluated in two groups.

Results

One hundred and eighty-seven of 210 eligible patients were included. The function of knee joint in all patients was improved and the pain was obviously relieved. Significant differences were found in the HSS score, Oxford score, VAS score, knee joint activity between two groups at 5-year follow-up (p < 0.05).

Conclusions

The biomet knee prosthesis was selected for all intraoperative implants. All operations were completed by the same senior surgeon. The use of self-made tools may contribute to improve the balance between flexion and extension gaps as well as the balance between internal and external gaps during TKA, and overcome knee flexion instability.
ZMAT1 acts as a tumor suppressor in pancreatic ductal adenocarcinoma by inducing SIRT3/p53 signaling pathway
Authors: Ma Zuyi , Li Zhenchong , Wang Shujie , Zhou Zixuan , Liu Chunsheng , Zhuang Hongkai , Zhou Qi , Huang Shanzhou , Zhang Chuanzhao , Hou Baohua
Published: April 2022

Background

Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancer due to its highly aggressive phenotype and lack of effective biomarkers or treatment strategies. ZMAT1 belongs to the C2H2 type zinc finger family, but its biological function is rarely investigated, as well as its role in cancer development.

Methods

Multiple bioinformatics analyses were used to evaluate ZMAT1 expression and potential role in PDAC. Intro and vivo studies were performed to assess the effects of ZMAT1 on PDAC cells growth. Furthermore, CHIP-seq and luciferase reporter assay was conducted to identify its specific regulatory mechanism in PDAC.

Results

The current study identified the down-regulation of ZMAT1 and its associations with unfavorable clinicopathological characteristics and poor survival of PDAC. Further, we found overexpression of ZMAT1 inhibited pancreatic cancer cell proliferation by inducing p21, leading to impaired S/G2 cell cycle progression. Besides, over-expression of ZMAT1 led to decreased pancreatic cancer cell apoptosis. Mechanistically, ZMAT1 up-regulated p53 expression and inhibition of p53 abrogated the effect of ZMAT1 over-expression on pancreatic cancer cell, indicating the role of ZMAT1 in PDAC was dependent on p53. By performing CHIP-seq assay, we found ZMAT1 did not bind to P53 but bound to the promoter region of SIRT3, an upstream regulator for p53. Luciferase reporter assay showed transfection of ZMAT1 induced SIRT3 transcription, suggesting ZMAT1 was a transcriptional activator for SIRT3.

Conclusion

Our findings indicated the role of ZMAT1-SIRT3-p53 signaling pathway during tumor growth, highlighting that ZMAT1 is a tumor suppressor and novel biomarker of PDAC.
Mouse mesenchymal stem cell-derived exosomal miR-466f-3p reverses EMT process through inhibiting AKT/GSK3β pathway via c-MET in radiation-induced lung injury
Authors: Li Yi , Shen Zhufu , Jiang Xiao , Wang Yuanyuan , Yang Zuozhang , Mao Yuchi , Wu Zhixian , Li Gaofeng , Chen Hong
Published: April 2022

Background

Radiation-induced lung fibrosis (RILF) is a common complication of thoracic radiotherapy. Alveolar epithelial cells play a crucial role in lung fibrosis via epithelial-mesenchymal transition (EMT). Exosomes derived from mesenchymal stem cells own the beneficial properties to repair and regeneration of damaged tissues, however the underlying mechanisms remain poorly understood.

Methods

Mouse mesenchymal stem cells-derived exosomes (mMSCs-Exo) were isolated by differential centrifugation, and their protective effects were assessed in vivo and in vitro, respectively. EMT-associated proteins were measured via western blot assay and/or immunofluorescence staining. The miRNA expression was measured by microarray assay and qPCR. Furthermore, bioinformatics prediction with KEGG analysis, luciferase assay, and rescue experiments were performed to explore the molecular mechanism underlying miR-466f-3p.

Results

mMSCs-Exos were efficiently isolated ranging from 90-150 nm with high expression of exosomal markers (CD63, TSG101, and CD9). mMSCs-Exos administration efficiently relieved radiation-induced lung injury with less collagen deposition and lower levels of IL-1β and IL-6. Meanwhile, in vitro results showed mMSCs-Exos treatment obviously reversed EMT process induced by radiation. Among enriched miRNA cargo in exosomes, miR-466f-3p was primarily responsible for the protective effects via inhibition of AKT/GSK3β pathway. Our mechanistic study further demonstrated that c-MET was the direct target of miR-466f-3p, whose restoration partially abrogated mMSCs-Exo-mediated inhibition in both EMT process and AKT/GSK3β signaling activity induced by radiation.

Conclusions

Our findings indicated that exosomal miR-466f-3p derived from mMSCs may possess anti-fibrotic properties and prevent radiation-induced EMT through inhibition of AKT/GSK3β via c-MET, providing a promising therapeutic modality for radiation-induced lung fibrosis.
Short term high-intensity interval training in patients scheduled for major abdominal surgery increases aerobic fitness
Authors: Michel Anna , Gremeaux Vincent , Muff Guillaume , Pache Basile , Geinoz Sandrine , Larcinese Ana , Benaim Charles , Kayser Bengt , Demartines Nicolas , Hübner Martin , Martin David , Besson Cyril
Published: April 2022

Background

Prehabilitation may improve postoperative clinical outcomes among patients undergoing major abdominal surgery. This study evaluated the potential effects of a high-intensity interval training (HIIT) program performed before major abdominal surgery on patients’ cardiorespiratory fitness and functional ability (secondary outcomes of pilot trial NCT02953119).

Methods

Patients were included before surgery to engage in a low-volume HIIT program with 3 sessions per week for 3 weeks. Cardiopulmonary exercise and 6-min walk (6MWT) testing were performed pre- and post-prehabilitation.

Results

Fourteen patients completed an average of 8.6 ± 2.2 (mean ± SD) sessions during a period of 27.9 ± 6.1 days. After the program, $$\dot{\mathrm{V}}$$

V
˙

O2 peak (+ 2.4 ml min−1 kg−1, 95% CI 0.8–3.9, p = 0.006), maximal aerobic power (+ 16.8 W, 95% CI 8.2–25.3, p = 0.001), $$\dot{\mathrm{V}}$$

V
˙

O2 at anaerobic threshold (+ 1.2 ml min−1 kg−1, 95%CI 0.4–2.1, p = 0.009) and power at anaerobic threshold (+ 12.4 W, 95%CI 4.8–20, p = 0.004) were improved. These changes were not accompanied by improved functional capacity (6MWT: + 2.6 m, 95% CI (− 19.6) to 24.8, p = 0.800).

Conclusion

A short low-volume HIIT program increases cardiorespiratory fitness but not walking capacity in patients scheduled for major abdominal surgery. These results need to be confirmed by larger studies.
Analysis of quality of knowledge structure and students’ perceptions in extension concept mapping
Authors: Prasetya Didik Dwi , Pinandito Aryo , Hayashi Yusuke , Hirashima Tsukasa
Published: April 2022

Extension concept mapping is a technique to connect prior existing concept maps with new knowledge structures. It offers advantages in each stage of the knowledge-integrating process and encourages learners to improve their performance. While previous studies have confirmed that the extended kit-build concept map outperformed the extended scratch-build approach in terms of comprehension test scores and map size, they have yet to evaluate the quality of concept maps and students' perceptions. Although the size of the concept map components could represent the breadth of personal knowledge, it does not constantly describe the good knowledge structure. In addition, the student's degree of acceptance after the concept mapping demonstrates their intention to use systems in the future. The present study aims to compare the effect of extended scratch-build and extended kit-build on the students' quality of knowledge structures and perceptions. Fifty-five second-year university students were involved and divided into two groups: control and experimental. The control group utilized the extended scratch-build map, while the experimental group used the extended kit-build concept mapping tool. Quality of propositions and structural map scores as learning outcomes were used to measure the students' knowledge structures. The possibility of a relationship between quality scores was expressed using the Spearman correlation. This study involved the Technology Acceptance Model to confirm the students' perceptions of extension concept mapping tools. The perceived ease-of-use, perceived usefulness, and behavioral intention constructs were used to investigate users' intentions. The findings suggest that the quality of propositions and structural map scores in the experimental group were significantly higher than in the control group. This study also found that the extended kit-build method achieved better perceptions scores than the extended scratch-build.
Fogarty-assisted transcatheter embolization of a large renal high-flow arteriovenous fistula
Authors: Becker Lena S. , Hinrichs Jan B.
Published: April 2022

Background

Renal high-flow arteriovenous fistulas and its complications may involve high output heart failure, hematuria, hypertension or lethal hemorrhage.

Case presentation

This case report covers the case of a 65-year-old male patient with a large renal high-flow arteriovenous fistula of the right kidney (RAVF), treated with balloon-assisted coil and liquid (n-Butyl Cyanoacrylate) embolization. By use of ballon-occlusion with an over-the-wire Fogarty catheter and advancement of a microcatheter through the lumen distal to the balloon during the transcatheter embolization of a high-flow RAVF, control of arterial blood flow is feasible by temporary occlusion of the afferent artery. This technique of flow modulation facilitates controlled deployment of embolization materials and decreases the risk of inadvertent distal embolization by use of only one 6-French (F) arterial sheath.

Conclusions

Balloon-assisted embolization using a Fogarty occlusion catheter represents a feasible, safe and effective treatment option for the treatment of large, high-flow arteriovenous fistulas of the kidney.
The diagnostic process from primary care to child and adolescent mental healthcare services: the incremental value of information conveyed through referral letters, screening questionnaires and structured multi-informant assessment
Authors: Aydin Semiha , Siebelink Bart M. , Crone Matty R. , van Ginkel Joost R. , Numans Mattijs E. , Vermeiren Robert R. J. M. , Michiel Westenberg P.
Published: April 2022

Background

A variety of information sources are used in the best-evidence diagnostic procedure in child and adolescent mental healthcare, including evaluation by referrers and structured assessment questionnaires for parents. However, the incremental value of these information sources is still poorly examined.

Aims

To quantify the added and unique predictive value of referral letters, screening, multi-informant assessment and clinicians’ remote evaluations in predicting mental health disorders.

Method

Routine medical record data on 1259 referred children and adolescents were retrospectively extracted. Their referral letters, responses to the Strengths and Difficulties Questionnaire (SDQ), results on closed-ended questions from the Development and Well-Being Assessment (DAWBA) and its clinician-rated version were linked to classifications made after face-to-face intake in psychiatry. Following multiple imputations of missing data, logistic regression analyses were performed with the above four nodes of assessment as predictors and the five childhood disorders common in mental healthcare (anxiety, depression, autism spectrum disorders, attention-deficit hyperactivity disorder, behavioural disorders) as outcomes. Likelihood ratio tests and diagnostic odds ratios were computed.

Results

Each assessment tool significantly predicted the classified outcome. Successive addition of the assessment instruments improved the prediction models, with the exception of behavioural disorder prediction by the clinician-rated DAWBA. With the exception of the SDQ for depressive and behavioural disorders, all instruments showed unique predictive value.

Conclusions

Structured acquisition and integrated use of diverse sources of information supports evidence-based diagnosis in clinical practice. The clinical value of structured assessment at the primary–secondary care interface should now be quantified in prospective studies.
Relationship Between TSH Levels and Cognition in the Young Adult: An Analysis of the Human Connectome Project Data
Authors: Santhanam Prasanna , Nath Tanmay , Lindquist Martin A , Cooper David S
Published: April 2022

Context

The nature of the relationship between serum thyrotropin (TSH) levels and higher cognitive abilities is unclear, especially within the normal reference range and in the younger population.

Objective

To assess the relationship between serum TSH levels and mental health and sleep quality parameters (fluid intelligence [Gf], MMSE (Mini-Mental State Examination), depression scores, and, finally, Pittsburgh Sleep Quality Index (PSQI) scores (working memory, processing speed, and executive function) in young adults.

Methods

This was a retrospective analysis of the data from the Human Connectome Project (HCP). The HCP consortium is seeking to map human brain circuits systematically and identify their relationship to behavior in healthy adults. Included were 391 female and 412 male healthy participants aged 22-35 years at the time of the screening interview. We excluded persons with serum TSH levels outside the reference range (0.4-4.5 mU/L). TSH was transformed logarithmically (log TSH). All the key variables were normalized and then linear regression analysis was performed to assess the relationship between log TSH as a cofactor and Gf as the dependent variable. Finally, a machine learning method, random forest regression, predicted Gf from the dependent variables (including alcohol and tobacco use). The main outcome was normalized Gf (nGf) and Gf scores

Results

Log TSH was a significant co-predictor of nGF in females (β = 0.31(±0.1), P < .01) but not in males. Random forest analysis showed that the model(s) had a better predictive value for females (r = 0.39, mean absolute error [MAE] = 0.81) than males (r = 0.24, MAE = 0.77).

Conclusion

Higher serum TSH levels might be associated with higher Gf scores in young women.
Heavier Weight of Resected Thyroid Specimen Is Associated With Higher Postoperative Morbidity in Benign Goiter
Authors: Mintziras Ioannis , Ringelband Rolf , Jähne Joachim , Vorländer Christian , Dotzenrath Cornelia , Zielke Andreas , Klinger Carsten , Holzer Katharina
Published: April 2022

Objective

The impact of heavier weight of resected thyroid specimen on postoperative morbidity after total thyroidectomy for multinodular benign goiter remains unclear.

Methods

Data from the prospective StuDoQ|Thyroid registry of the German Society of General and Visceral Surgery were analyzed regarding the weight of the resected thyroid specimen and perioperative morbidity (vocal cord palsy, hemorrhage, surgical site infection, and hypocalcemia). To achieve a homogeneous patient population, only patients with total thyroidectomy for multinodular benign goiter were included.

Results

A total of 7911 patients from 105 departments underwent total thyroidectomy for benign conditions (January 2017-July 2020). The median resected weight of the thyroid specimen in all patients was 53 g (interquartile range 32-92). In 1732 patients, the specimen weight exceeded 100 g. Intraoperative neuromonitoring was used in 99.5% of patients. Postoperative laryngoscopy revealed vocal cord dysfunction in 480 of 15 822 (3.03%) nerves at risk, with unilateral dysfunction in 454 (2.87%) of patients and bilateral dysfunction in 13 patients (0.08%). In multivariable analysis, a thyroid weight >100 g was an independent predictor of early postoperative vocal cord dysfunction [odds ratio (OR) 1.462, 95% CI 1.108-1.930, P = 0.007). Heavier (>100 g) thyroid weight was an independent predictor of surgical site infection (OR 1.861, 95% CI 1.203-2.880, P = 0.005) and also predicted postoperative hemorrhage in the univariate analysis (OR 1.723, 95% CI 1.027-2.889, P = 0.039). On the contrary, postoperative parathyroid function was not affected.

Conclusions

Heavier (>100 g) resected thyroid weight independently predicts higher postoperative morbidity, including early vocal cord palsy and surgical site infection after total thyroidectomy for benign multinodular goiter.
Machine Learning-Based Models Predicting Outpatient Surgery End Time and Recovery Room Discharge at an Ambulatory Surgery Center
Authors: Gabriel Rodney A. , Harjai Bhavya , Simpson Sierra , Goldhaber Nicole , Curran Brian P. , Waterman Ruth S.
Published: April 2022

BACKGROUND:

Days before surgery, add-ons may be scheduled to fill unused surgical block time at an outpatient surgery center. At times, outpatient surgery centers have time limitations for end of block time and discharge from the postanesthesia care unit (PACU). The objective of our study was to develop machine learning models that predicted the following composite outcome: (1) surgery finished by end of operating room block time and (2) patient was discharged by end of recovery room nursing shift. We compared various machine learning models to logistic regression. By evaluating various performance metrics, including F1 scores, we hypothesized that models using ensemble learning will be superior to logistic regression.

METHODS:

Data were collected from patients at an ambulatory surgery center. The primary outcome measurement was determined to have a value of 1 (versus 0) if they met both criteria: (1) surgery ends by 5 pm and (2) patient is discharged from the recovery room by 7 pm. We developed models to determine if a procedure would meet both criteria if it were scheduled at 1 pm, 2 pm, 3 pm, or 4 pm. We implemented regression, random forest, balanced random forest, balanced bagging, neural network, and support vector classifier, and included the following features: surgery, surgeon, service line, American Society of Anesthesiologists score, age, sex, weight, and scheduled case duration. We evaluated model performance with Synthetic Minority Oversampling Technique (SMOTE). We compared the following performance metrics: F1 score, area under the receiver operating characteristic curve (AUC), specificity, sensitivity, precision, recall, and Matthews correlation coefficient.

RESULTS:

Among 13,447 surgical procedures, the median total perioperative time (actual case duration and PACU length stay) was 165 minutes. When SMOTE was not used, when predicting whether surgery will end by 5 pm and patient will be discharged by 7 pm, the average F1 scores were best with random forest, balanced bagging, and balanced random forest classifiers. When SMOTE was used, these models had improved F1 scores compared to no SMOTE. The balanced bagging classifier performed best with F1 score of 0.78, 0.80, 0.82, and 0.82 when predicting our outcome if cases were to start at 1 pm, 2 pm, 3 pm, or 4 pm, respectively.

CONCLUSIONS:

We demonstrated improvement in predicting the outcome at a range of start times when using ensemble learning versus regression techniques. Machine learning may be adapted by operating room management to allow for a better determination whether an add-on case at an outpatient surgery center could be appropriately booked.
Anesthesia Patient Safety: Next Steps to Improve Worldwide Perioperative Safety by 2030
Authors: Warner Mark A. , Arnal Daniel , Cole Daniel J. , Hammoud Rola , Haylock-Loor Carolina , Ibarra Pedro , Joshi Muralidhar , Khan Fauzia A. , Lebedinskii Konstantin M. , Mellin-Olsen Jannicke , Miyasaka Katsuyuki , Morriss Wayne W. , Onajin-Obembe Bisola , Toukoune Robinson , Yazbeck Patricia
Published: April 2022

Patient safety is a core principle of anesthesia care worldwide. The specialty of anesthesiology has been a leader in medicine for the past half century in pursuing patient safety research and implementing standards of care and systematic improvements in processes of care. Together, these efforts have dramatically reduced patient harm associated with anesthesia. However, improved anesthesia patient safety has not been uniformly obtained worldwide. There are unique differences in patient safety outcomes between countries and regions in the world. These differences are often related to factors such as availability, support, and use of health care resources, trained personnel, patient safety outcome data collection efforts, standards of care, and cultures of safety and teamwork in health care facilities. This article provides insights from national anesthesia society leaders from 13 countries around the world. The countries they represent are diverse geographically and in health care resources. The authors share their countries’ current and future initiatives in anesthesia patient safety. Ten major patient safety issues are common to these countries, with several of these focused on the importance of extending initiatives into the full perioperative as well as intraoperative environments. These issues may be used by anesthesia leaders around the globe to direct collaborative efforts to improve the safety of patients undergoing surgery and anesthesia in the coming decade.
Relationships Between Body Mass Index, Allogeneic Transfusion, and Surgical Site Infection After Knee and Hip Arthroplasty Surgery
Authors: Tanaka Kenichi A. , Pontikes Andrew E. , Van David , Vandyck Kofi , Butt Amir , Mazzeffi Michael A. , Thakral Rishi , Stewart Kenneth E.
Published: April 2022

BACKGROUND:

Increased body mass index (BMI) is considered as an important factor that affects the need for total knee and hip arthroplasty (TKA/THA) and the rate of perioperative complications. Previous investigations have not fully established the relationship of BMI and perioperative transfusion with surgical site infection (SSI) or the relationship of BMI and perioperative transfusion after TKA or THA.

METHODS:

The National Surgical Quality Improvement Program database was used to perform a retrospective cohort study involving 333,223 TKA and 41,157 THA cases between 2011 and 2018. Multivariable regression assessed the associations of BMI (5 standard categories) and transfusion with SSI. Odds ratio (OR) of SSI was calculated relative to a normal BMI (18.5–24.9 kg/m2) after adjustment of potential confounding factors.

RESULTS:

Perioperative transfusion decreased significantly over time for both TKA and THA; however, SSI rates remained steady at just under 1% for TKA and 3% for THA. In TKA, a higher OR for SSI was associated only with a BMI of 40+ (OR, 1.86; 95% confidence interval [CI], 1.60–2.18) compared to a referent BMI. In THA, increased ORs of SSI were seen for all BMI levels above normal and were highest for a BMI 40+ (OR, 3.08; 95% CI, 2.47–3.83). In TKA, ORs of transfusion decreased with increasing BMI and were lowest for a BMI 40+ (OR, 0.51; 95% CI, 0.47–0.54). In THA, ORs of transfusion began to increase slightly in overweight patients, reaching an OR of 1.36 (95% CI, 1.21–1.54) for a BMI 40+.

CONCLUSIONS:

SSI incidence remained unchanged despite continuous reductions in blood transfusion in TKA and THA patients over 8 years. In TKA, ORs for SSI increased, but ORs for transfusion decreased with increasing BMI above normal. Conversely, in THA, ORs for SSI and transfusion both increased for a BMI 40+, but only OR for transfusion increased in underweight patients. These findings suggest the importance of controlling obesity in reducing SSI following TKA and THA.
Kim Namch’ŏn’s Barley: Architecture of Loss and Life in Late Colonial Korea
Authors: Park John
Published: April 2022

This study examines the aesthetic significance of the apartment building in Kim Namch’ŏn’s Barley in relationship to the novella’s narrative form. Actively directing the narrative movement, on the one hand, and representing the sense of alienation experienced by Korean intellectuals in the colonial period, on the other, the building is both realistic and allegorical. Its functional role in the narrative development, as well as its symbolic representation of the dominant presence of Western forms, both architectural and ideological, renders the figure of the apartment building essentially ambiguous. This study claims that this ambiguous quality of the building achieves the realist aesthetics that Kim theorized. To articulate this aesthetic and literary theoretical achievement, the article demonstrates how the architecture of the building shapes the narrative movement and describes how the building itself provides the interpretive frame for understanding the significant scenes of the narrative, whose contours the building shapes. The author concludes with an analysis of an unremarkable but critical turn toward the end of the narrative that challenges and resists the interpretive frame the building imposes. This turn grounds the possibility of the experience of alienation becoming art.
Delayed HSV-1 Encephalitis Relapse After Epilepsy Surgery: A Case Report
Authors: Johnson Gabrielle W. , Han Rowland H. , Gupta Vivek P. , Leuthardt Eric C.
Published: April 2022

BACKGROUND AND IMPORTANCE:

Herpes simplex virus 1 encephalitis (HSVE) can be a rare postoperative complication after neurosurgery. We present the case of a patient with postoperative, twice recurrent HSVE after 20 years, the longest latency period reported after neurosurgery.

CLINICAL PRESENTATION:

A 21-year-old man with a history of HSVE at 13 months and intractable epilepsy presented for surgical resection of seizure focus. The patient underwent left temporal craniotomy and resection of left temporal encephalomalacia. Five days after discharge, the patient presented with fever and headache and was found to have herpes simplex virus 1 (HSV-1)–positive cerebral spinal fluid. The infection was treated with acyclovir, with subsequent symptomatic improvement. Six weeks later the patient represented with recurrent symptoms and HSV-1–positive cerebral spinal fluid. This recurrence was treated with a prolonged course of acyclovir, followed by suppressive valacyclovir therapy, resulting in symptomatic improvement.

CONCLUSION:

HSV-1 encephalitis is a rare but previously reported complication after neurosurgery procedures. In patients with relapse of HSVE, the latency period can range from weeks to years after primary infection, and multiple relapses are rare. We present the case of a patient with twice recurrent, postoperative HSV-1 encephalitis 20 years after initial infection. We aim to emphasize that HSV status should be considered during treatment planning in patients with a history of HSVE being treated for HSV-related illnesses, and HSVE should remain on the differential in these patients when presenting with fever and neurological symptoms after surgery, regardless of time since initial infection.
Acute Floatation-REST Improves Perceived Recovery After a High-Intensity Resistance Exercise Stress in Trained Men
Authors: CALDWELL LYDIA K. , KRAEMER WILLIAM J. , POST EMILY M. , VOLEK JEFF S. , FOCHT BRIAN C. , NEWTON ROBERT U. , HÄKKINEN KEIJO , MARESH CARL M.
Published: April 2022

Purpose

The aim of the present investigation was to determine whether a 1-h floatation-restricted environmental stimulation therapy (floatation-REST) session could augment recovery from high-intensity resistance exercise (6 × 10 back squats, 2-min rest) known to induce significant metabolic, adrenergic, and mechanical stress.

Methods

Eleven healthy resistance-trained males (age, 22.5 ± 2.3 yr; height, 176.4 ± 6.0 cm; weight, 85.7 ± 6.2 kg; back squat one-repetition maximum, 153.1 ± 20.1 kg; strength-to-weight ratio, 1.8 ± 0.2) completed the within-subject, crossover controlled study design. Participants completed two exercise testing blocks separated by a 2-wk washout. In one block, the high-intensity resistance exercise protocol was followed by a 1-h floatation-REST session, whereas recovery in the alternate block consisted of a passive sensory-stimulating control. Markers of metabolic stress, neuroendocrine signaling, structural damage, inflammation, and perceptions of soreness, mood state, and fatigue were assessed over a 48-h recovery window.

Results

Floatation-REST significantly attenuated muscle soreness across recovery (P = 0.035) with greatest treatment difference immediately after the intervention (P = 0.002, effect size (ES) = 1.3). Significant differences in norepinephrine (P = 0.028, ES = 0.81) and testosterone (P = 0.028, ES = 0.81) immediately after treatment revealed the modification of neuroendocrine signaling pathways, which were accompanied by greater improvements in mood disturbance (P = 0.029, ES = 0.81) and fatigue (P = 0.001, ES = 1.04).

Conclusions

Because no adverse effects and significant and meaningful benefits were observed, floatation-REST may prove a valuable intervention for managing soreness and enhancing performance readiness after exercise.
The introduction of foreign deities in Egypt during the Late Bronze Age
Authors: Καλαϊτζάκη Άννα
Published: April 2022

Η εισαγωγή των Συροπαλαιστινιακών θεοτήτων στην Αίγυπτο παρατηρείται τηνπερίοδο, όπου η χώρα επεκτείνεται πολιτικά, μέσω πολεμικών εκστρατειών, στην Εγγύς Ανατολή. Σε ένα αρκετά συμπαγές αρχαιολογικό υλικό το οποίο προέρχεται από την Αίγυπτο και την ευρύτερη περιοχή της Συροπαλαιστίνης σκαραβαίοι, στήλες, σφραγίδες και πλακίδια πιστοποιούν την εμφάνιση/αφομοίωση των ξένων θεοτήτων στην Αίγυπτο και δημιουργούν αρκετά ερωτήματα που αφορούν τα αίτια εισαγωγήςτους, την χρήση τους από τα ανώτερα και κατώτερα κοινωνικά στρώματα καθώς καιτην ταύτιση τους με τις Αιγυπτιακές θεότητες. Ο σκοπός της ομιλίας είναι α) ναα ναδείξει τη συμβολή της Αιγυπτιακής πολιτικής στην περιοχή της Συροπαλαιστίνης, β) να ερμηνεύσει την εισαγωγή ξένων θεοτήτων από την Εγγύς Ανατολή καθώς καιτην επιρροή τους στο θρησκευτικό σύστημα της αρχαίας Αιγύπτου κατά την ΥΕΧ, γ)να αναδείξει την επίσημη θρησκεία και να τη διαχωρίσει από την προσωπική λατρείαστην Αίγυπτο και δ) να επανεξετάσει το σχετικό αρχαιολογικό υλικό και τηνεικονογραφία της Εγγύς Ανατολής και της Αιγύπτου (σκαραβαίοι, σφραγίδες,πλακίδια και ειδώλια).