bluuebunny/crossref_metadata_2025 huggingface dataset:
Preventive treatment patterns and treatment satisfaction in migraine: results of the OVERCOME (EU) study
Authors: Pascual Julio , Panni Tommaso , Dell’Agnello Grazia , Gonderten Saygin , Novick Diego , Evers Stefan
Published: July 2023

Background

Insights into the burden, needs and treatment of migraine from internet-based surveys in diverse real-world migraine populations are needed, especially at a time when novel preventive migraine medications are becoming part of the therapeutic armamentarium. The objectives of this analysis are to describe traditional preventive (orals and onabotulinum toxin A) treatment patterns in the OVERCOME (EU) study migraine cohort, as well as treatment patterns and patient satisfaction with current treatment in a subgroup of respondents eligible for migraine preventive medication.

Methods

The cross-sectional non-interventional OVERCOME (EU) study was conducted (October 2020–February 2021) via an online survey among adults (aged ≥ 18 years) resident in Germany or Spain. Participants, registered in existing online panels, who were willing to provide consent were considered. The migraine cohort included participants reporting headache/migraine in the past year, identified based on a validated migraine diagnostic questionnaire and/or self-reported physician diagnosis. A subgroup of survey respondents defined as eligible for migraine preventive medication at the point in time the cross-sectional survey was taken was also analysed. Variables assessed included sociodemographic and migraine-related clinical characteristics, preventive (traditional and calcitonin gene-related peptide monoclonal antibodies) treatment patterns and patient satisfaction with current treatment. Results are descriptive only.

Results

Of the 20,756 participants in the migraine cohort, 78.5% sought professional medical care, 50.8% received a migraine diagnosis and only 17.7% had ever used preventive medication. Half (53.3%) of participants currently using preventives took their most recent medication for six months or less. Most patients (73.9%) classified as eligible for preventive medication (based on headache frequency and/or at least moderate disability due to migraine) reported not using traditional preventives and many of those who did (66.8%) were not satisfied with their current standard of care.

Conclusions

Our findings highlight the low proportion of people diagnosed with migraine despite a higher rate of consultation and suggest the need for better access to treatment for people with migraine and new preventive therapies with improved efficacy and safety profiles to improve adherence and patient satisfaction.
Very high HDL-C (high-density lipoprotein cholesterol) is associated with increased cardiovascular risk in patients with NSTEMI (non-ST-segment elevation myocardial infarction) undergoing PCI (percutaneous coronary intervention)
Authors: Chen Lijuan , Zhao Yuanyuan , Wang Zheng , Wang Yifei , Bo Xiangwei , Jiang Xiaoxi , Hao Chunshu , Ju Chengwei , Qu Yangyang , Dong Hongjian
Published: July 2023

Background

Studies in populations with or without cardiovascular disease have shown that very high HDL-C levels are associated with an increased risk of cardiovascular events. However, the exact relationship between HDL-C levels and long-term prognosis remains unknown in patients with myocardial infarction (MI) undergoing percutaneous coronary intervention (PCI).

Methods

This was a post hoc secondary analysis of long-term follow-up results in patients undergoing PCI open-label, observational cohort study. Patients with MI who had undergone PCI were enrolled. Restricted cubic spline (RCS) analysis and logistic regression analysis were performed to assess the relationship between HDL-C levels and the risk of cardiovascular events.

Results

A total of 1934 patients with MI undergoing PCI were enrolled in our analysis and our population was divided in 3 groups according to the HDL-C plasma levels: HDL-C < 40 mg/dL (low HDL-C); HDL-C between 40 and 80 mg/ dL (medium HDL-C); and HDL-C > 80 mg/dL (high HDL-C). RCS analysis showed a nonlinear U-shaped association between HDL-C levels and major adverse cardiac and cerebrovascular events (MACCE) in patients with NSTEMI with adjusted variables. After adjusting for potential confounders, the follow-up analysis indicated that high risk group had elevated occurrence of MACCE than low risk group (HDL-C 35 and 55 mg/dL) (OR:1.645, P = 0.006).

Conclusions

Our analysis demonstrated that there is a U-shaped association between HDL-C and MACCE in patients with NSTEMI undergoing PCI.
Doing primary care integration: a qualitative study of meso-level collaborative practices
Authors: Leslie Myles , Fadaak Raad , Pinto Nicole
Published: July 2023

Background

The integration of Primary Care (PC) into broader health systems has been a goal in jurisdictions around the world. Efforts to achieve integration at the meso-level have drawn particular attention, but there are few actionable recommendations for how to enact a ‘pro-integration culture’ amongst government and PC governance bodies. This paper describes pragmatic integration activity undertaken by meso-level participants in Alberta, Canada, and suggests ways this activity may be generalizable to other health systems.

Methods

11 semi-structured interviews with nine key informants from meso-level organizations were selected from a larger qualitative study examining healthcare policy development and implementation during the COVID-19 pandemic. Selected interviews focused on participants’ experiences and efforts to ‘do’ integration as they responded to Alberta’s first wave of the Omicron variant in September 2021. An interpretive descriptive approach was used to identify repeating cycles in the integration context, and pragmatic integration activities.

Results

As Omicron arrived in Alberta, integration and relations between meso-level PC and central health system participants were tense, but efforts to improve the situation were successfully made. In this context of cycling relationships, staffing changes made in reaction to exogenous shocks and political pressures were clear influences on integration. However, participants also engaged in specific behaviours that advanced a pro-integration culture. They did so by: signaling value through staffing and resource choices; speaking and enacting personal and group commitments to collaboration; persevering; and practicing bi-directional communication through formal and informal channels.

Conclusions

Achieving PC integration involves not just the reactive work of responding to exogenous factors, but also the proactive work of enacting cultural, relationship, and communication behaviors. These behaviors may support integration regardless of the shocks, staff turnover, and relational freeze-thaw cycles experienced by any health system.
Retrospective analysis of vertical Hepatitis C exposure and infection in children in Western New York
Authors: Dieye Ndeye Licka , Varol Mine , Zorich Shauna C. , Millen Amy E. , Yu Karl O. A. , Gómez-Duarte Oscar G.
Published: July 2023

Background

Vertical transmission of hepatitis C virus (HCV) is the primary cause of hepatitis C in the pediatric population. Nonetheless, only a small proportion of HCV-exposed children are tested. This study aimed to measure the proportion of HCV-exposed children tested and infected in Western New York and to identify factors influencing the odds of testing and infection in this population.

Methods

This was a 11-year retrospective chart review study in which clinical, demographic, and behavioral data for HCV-exposed children and their mothers were collected. This period included year 2019 when a hepatitis C program began promoting early hepatitis C screening among infants born to mothers positive for hepatitis C. PCR-based detection of hepatitis C was used for children under 18 months of age and antibody testing for children above 18 months of age, followed by PCR if the antibody testing was positive. Logistic regression models were used to determine which characteristics associate with testing and infection status.

Results

From a total of 133 children evaluated in clinic for hepatitis C from 2011 to 2021, 96.2% (128/133) were seen from 2019 to 2021. Among the 133 HCV-exposed children in our sample, 72.1% (96/133) were tested for HCV, 62.4% (83/133) were tested by PCR, 9.0% (12/133) tested by antibody, and 5.2% (5/95) of those tested were infected. Only one child out of 12 was positive for hepatitis C antibody yet, subsequent PCR testing was negative in this child. Among all five hepatitis C infected children, four were diagnosed with neonatal abstinence syndrome, five had maternal history of illicit drug use, one had maternal history of HIV infection, and all of them were identified after the hepatitis C program open in 2019. The odds of a child being tested were lower for those accompanied by their biological mother at their clinic visit (odds ratio, 0.16; 95% CI, 0.06–0.45).

Conclusions

Screening programs on hepatitis C vertical transmission improved detection of hepatitis C among exposed children. The proportion of children born to mothers with hepatitis C in Western New York that were positive for hepatitis C was 5.2%, suggesting that similar proportion of exposed infants born before 2019 were lost for follow up.
Endovascular treatment of symptomatic hepatic venous outflow obstruction post major liver resection
Authors: Ghibes Patrick , Artzner Christoph , Partovi Sasan , Hagen Florian , Nadalin Silvio , Grözinger Gerd
Published: July 2023

Purpose

To evaluate efficacy, safety, and outcomes of endovascular treatment of hepatic vein stenosis post major liver resection.

Methods

A retrospective data analysis was performed including all interventional treatments of hepatic vein stenosis post major liver resection since 2010. Post procedural course and clinical parameters including amount of ascites accumulation and relevant laboratory values were assessed during the follow-up period. Primary and primary assisted hepatic venous patency time were calculated.

Results

Twelve patients (median age 55.5, IQR 49.75 to 61.5 years) undergoing a total of 16 interventions were included. Interventions were primary stent placement (n = 3), primary balloon angioplasty (n = 8), three re-interventions and two aborted interventions (no significant pressure gradient). Technical success was 100% (16/16). Permanent reduction and / or complete resolution of ascites was achieved in 72% (8/11). Laboratory parameters related to liver function did not show significant improvement after intervention. Median follow-up period was 6 months (IQR: 1.5 to 18 months). The median primary patency time for patients with balloon angioplasty was 11 months (IQR: 1.375 to 22.25 months) and assisted patency time was 13.25 months (IQR: 4.5 to 22.25 months). The median primary patency time for patients with angioplasty and stent placement was 1 months (IQR: 1.0 to 1.5 months) and assisted patency time was 2.0 months (IQR: 1.5 to 2.5months).

Conclusion

An endovascular approach for the treatment of hepatic venous stenosis post major liver resection is safe and efficient to reduce and / or resolve refractory ascites. However, liver function parameters seem not to be improved by the procedure. Stent placement can be a reasonable option in patients with significant residual stenotic disease post angioplasty.
Inflammatory profile of keratoconic corneal epithelium
Authors: Marques Junia Cabral , Ladislau de Carvalho Karina Inácio , Xavier Rafaela , Nosé Walton , Rizzo Luiz Vicente
Published: July 2023

Background

Recent studies have presented inflammatory features on keratoconus (KC) and many inflammatory markers are described in the tears of patients with this disease. The KC pathogenesis is still unknown just like the correlation with inflammatory patterns. However, environmental and genetic issues may be part of the progress of KC. In addition, some systemic features, such as allergy and obesity, seem to be related to the progression of KC. Our purpose was to evaluate the neuropeptides vasoactive intestinal peptide (VIP), neuropeptide Y (NPY), chemokines ligand 2 (CCL-2) and 5 (CCL-5), and interleukins 6 (IL-6) and 8 (IL-8) on corneal epithelial cells and blood of patients with KC and in healthy controls. In addition, the neutrophil-to-lymphocyte ratio (NLR) was evaluated to predict inflammation.

Methods

This including prospective observational study included 32 KC patients who underwent corneal crosslinking (CXL) and 32 control patients who underwent photorefractive keratectomy (PRK). Patients’ corneal epithelial cells were removed surgically, and blood (buffy coat) was analyzed. Samples in triplicate were evaluated on rt-PCR for neuropeptides (VIP e NPY), interleukins (IL-6 e IL-8), and chemokines (CCL-2 and CCL-5).

Results

Our study showed statistically higher CCL-5 and IL-8 on corneal epithelial cells in patients with KC. Blood cells were statistically higher in VIP and NPY in the KC group. Interleukin-8 on blood cells was statistically significant in KC’S group; for CCL-2 and CCL-5 they were statistically lower in patients with KC compared with controls. NLR showed no difference between the groups.

Conclusions

Our data support the findings of other studies that suggested altering KC status, such as inflammatory corneal disease. The presence of IL-8 in the cornea and blood samples of KC’s group suggested systemic disease with a possible local or repercussion action. Further studies are warranted to elucidate KC pathogenesis and its correlation to systemic disease.
A novel technique of penetrating keratoplasty to prevent intraocular contents extrusion for infectious keratitis
Authors: Yang Yukun , Kang Qian , Lian Hao , Qi Wei , Cao Duanrong , Yao Xiaoming
Published: July 2023

Purpose

To evaluate the safety and the effectiveness of our novel penetrating keratoplasty for infectious keratitis.

Methods

Retrospective, noncomparative, interventional case series of patients with infectious keratitis who received the novel penetrating keratoplasty technique were analyzed. A prepared plastic sheet was located between the diseased cornea and iris-lens diaphragm. After the diseased lesions were removed, the graft was positioned on the plastic sheet and sutured to the recipient bed. The plastic sheet was pulled out from the anterior chamber before the all interrupted sutures were placed. The intra- and post-operative complications, the outcome of the graft and the number of corneal endothelial cells were analyzed.

Results

A total of 82 eyes of 82 patients was included. The mean follow-up period was 29 ± 16 months (range from 13 to 45 months). No intraocular content extrusion, simultaneous cataract extraction and suprachoroidal hemorrhage occurred. Direct contact between the infectious cornea and the graft was successfully avoided. Greater than expected endothelial cell reduction or complications were not found.

Conclusions

This modified technique effectively prevents the extrusion of intraocular contents while avoiding the direct contact with donor endothelium during the procedure. The occurrence rate of complications such as endothelial cell loss is not higher than the conventional methods.
Evaluation of pharmaceutical care services in the Middle East Countries: a review of studies of 2013–2020
Authors: Sallom Hebah , Abdi Abdikarim , Halboup Abdulsalam M , Başgut Bilgen
Published: July 2023

Introduction

Pharmaceutical care services (PCs) have evolved significantly over the last few decades, with a greater focus on patient’s safety and proven effectiveness in a wide range of contexts. Many of the evidence supporting this technique comes from the United States, the evaluation and adoption of (PCs) which differ greatly across the globe.

Objective

The goal of this study was to identify and assess the efficacy of pharmaceutical care services in various pharmaceutical aspects throughout seventeen Middle Eastern nations.

Method

The Arkesy and O’Malley technique was used to conduct a scoping review. It was conducted using PubMed/Medline, Scopus, Cochrane Library, Springer Link, Clinical Trials, and Web of Science etc. The Van Tulder Scale was utilized in randomized trials research, whereas the dawn and black checklists were used in non-randomized trials research. A descriptive and numerical analysis of selected research was done. The scope of eligible PCs, pharmaceutical implementers, study outcomes, and quality were all identified by a thematic review of research.

Results

There were about 431,753 citations found in this study, and 129 publications were found to be eligible for inclusion after analysing more than 271 full-text papers. The study design was varied, with 43 (33.3%) RCTs and 86 (66.7%) n-RCTs. Thirty-three (25.6%) of the studies were published in 2020. Jordan, Saudi Arabia, and Turkey were home to the majority of the studies (25.6%, 16.3%, and 11.6%) respectively. Thirty-seven studies (19.7%) were concerned with resolving drug related problems (DRPs), whereas 27 (14.4%) were concerned with increasing quality of life (QOL) and 23 (12.2%) with improving drug adherence. Additionally, the research revealed that the average ratings of the activities provided to patients improved every year.

Conclusion

Studies in the Middle East continue to provide evidence supporting the positive impact of pharmaceutical care services on both hard and soft outcomes measured in most studies. Yet there was rare focus on the value of the implemented services. Thus, rigorous evaluation of the economic impact of implemented pharmaceutical care services in the Middle East and assessment of their sustainability is must.
‘Struggling to participate in everyday life’: emerging adults’ experiences of living with long-term health challenges
Authors: Rasalingam Anurajee , Brekke Idunn , Stenberg Una , Haaland-Øverby Mette , Helseth Sølvi
Published: July 2023

Aim

To gain a deeper understanding of the experiences of participation in the everyday life of emerging adults living with long-term health challenges and how this influences their own quality of life.

Methods

Using an explorative study design, data were collected through in-depth interviews with a sample of 12 young people aged 18–29 years living with long-term health challenges in Norway.

Findings

The analysis identified one overarching theme of struggling to participate in everyday life, and four subthemes: the notion of being independent but also dependent, experiencing mismatch between needs and support, experiencing deprivation of spontaneity and feeling uncertain about the future. The emerging adults experienced difficulties with participation in key areas of life such as education, employment and leisure activities. Associated symptoms of their diagnosis, limited physical abilities and lack of sufficient support made it hard to participate in everyday life the way they aspired to.

Conclusion

The challenges of living with a long-term health challenge as an emerging adult contributed to limitations in participation in different areas of life that was perceived as important for their quality of life.
Human papillomavirus vaccine acceptance among adolescent girls in Ethiopia: a systematic review and meta-analysis
Authors: Zewdie Amare , Kasahun Abebaw Wasie , Habtie Adane , Gashaw Anteneh , Ayele Mulat
Published: July 2023

Background

Cervical cancer is the fourth most common cancer affecting females. Human papillomavirus vaccination of adolescent girls is the primary strategy for cervical cancer prevention but in Ethiopia, it lacks emphasis. Despite different studies done and found a highly variable level of vaccine acceptance; however, there was no summarized evidence on the issues as a nation. Thus this systematic review and meta-analysis aimed to assess the pooled prevalence of human papillomavirus vaccine acceptance by adolescent girls and its associated factors in Ethiopia.

Method

A systematic review and meta-analysis were conducted using PRISMA guidelines. Comprehensive literature was searched in PubMed, Google Scholar, and African Online Journal databases. A weighted inverse variance random effect model was used to estimate pooled prevalence. Cochrane Q-test and I2statistics were computed to assess heterogeneity among studies. Funnel plot and Eggers test were done to assess publication bias. Review manager software was used to identify factors associated with vaccine acceptance.

Result

Overall, 157 articles were retrieved and finally 7 articles were included in this review. The pooled prevalence of adolescent human papillomavirus vaccine acceptance was 46.52% (95%CI; 30.47-62.57%). Subgroup analysis showed that adolescent vaccine acceptance was highest in the Oromia region and lowest in Addis Ababa. Knowledge about human papillomavirus vaccination (AOR = 3.89, 95% CI: (2.85–5.32)) and attitude (AOR = 2.65, 95% CI: (2.03– 3.44)) were significantly associated with adolescent’s vaccine acceptance.

Conclusion

Human papillomavirus vaccine acceptance of adolescent girls in Ethiopia was low. Knowledge about the vaccine and attitude to vaccination were positively associated with their vaccine acceptance. Therefore, policymakers and program planners should target school-aged adolescents in increasing their awareness and changing their attitudes to enhance their vaccine acceptance in order to prevent and control cervical cancer.
Prognostic value of the post-exercise heart rate recovery and BHDE-index in chronic obstructive pulmonary disease
Authors: Chen Shih-Yu , Huang Chun-Kai , Wu Chia-Ling , Peng Hui-Chuan , Yu Chong-Jen , Chien Jung-Yien
Published: July 2023

Background

The BODE index, consisting of body mass index (B), airflow obstruction (O), dyspnea score (D), and exercise capacity (E), can predict outcomes in COPD. However, when spirometry was restricted to prevent cross-infection such as COVID-19 pandemic, a modified index would be needed. Because cardiovascular dysfunction is associated with poor clinical outcomes in COPD, we conducted a novel BHDE-index by replacing spirometry with post-exercise heart rate recovery (HRR, H) and evaluated its predictive performance in this observational study.

Methods

From January 2019 to December 2019, enrolled patients were analyzed as a derivation cohort for the setup of the model. This model was verified in another group of patients generated between January 2020 and December 2020, as the validation cohort. The post exercise HRR was defined as the difference of heart rate immediately after and 1 min after test cessation.

Results

A total of 447 patients with COPD were enrolled. Patients with abnormal HRR were older, with more severe airway obstruction, severe airway symptoms, faster resting heart rate, shorter 6-min walk distance and higher frequency of severe acute exacerbation in previous one year. The prediction performance of the BHDE-index for one-year severe COPD exacerbation was similar to that of the BODE-index in both the derivation and validation groups [area under the receiver operating characteristic curve (AUROC) 0.76 vs. 0.75, p = 0.369; AUROC 0.74 vs. 0.79, p = 0.05]. The prediction performance for 1 year mortality was also similar between BHDE-index and BODE-index in both cohorts [AUROC 0.80 vs. 0.77, p = 0.564; 0.76 vs. 0.70, p = 0.234]. Univariate and multivariate analyses also showed that the BHDE-index was an independent and important predictor of annual severe COPD exacerbation in the derivation and validation cohorts.

Conclusions

The BHDE-index is a good and easy-to-perform prediction model for the risk of severe acute exacerbation and 1-year mortality in COPD wherever spirometry results are unavailable.
Treatment of humeral shaft fractures with different treatment methods: a network meta-analysis of randomized controlled trials
Authors: Qiu Hao , Liu Yuting , Chen Yu , Weng Zheng , Liu Dun , Dong Jing , Lu Minpeng
Published: July 2023

Purpose

Humeral shaft fractures (HSFs) can be treated non-operatively (Non-OP), with open reduction and plate osteosynthesis (ORPO), minimally invasive plate osteosynthesis (MIPO), or with intramedullary nails (IMN). However, the best treatment for HSFs still remains controversial.We performed a network meta-analysis to explore which should be the best method for HSFs.

Methods

The computerized search had been conducted on electronic databases PubMed, EMBASE, Cochrane Library, and Medline from the establishment of the database to the end of December 2022. The quality evaluation of the included literature had been completed by Review Manager (version 5.4.1). Stata 17.0 software (Stata Corporation, College Station, Texas, USA)was used for network meta-analysis.We included randomized controlled trials (RCTs) comparing different treatments to treating HSFs.

Results

The pairwise comparison results demonstrated that there was no statistical difference between IMN, MIPO, Non-OP, and ORPO in terms of radial nerve injury and infection, and Non-OP presented significantly more nonunion than ORPO, IMN, and MIPO. However, no statistically significant difference between ORPO, IMN, and MIPO was discovered. The results of the network meta-analysis displayed that surface under the cumulative ranking curve (SUCRA) probabilities of IMN, MIPO, Non-OP, and ORPO in radial nerve injury were 46.5%, 66.9%, 77.3%, and 9.3%, respectively, in contrast, that in infection were 68.6%, 53.3%, 62.4%, and 15.4%, respectively, and that in nonunion were 51.7%, 93.1%, 0.7%, and 54.5%, respectively.

Conclusion

We came to the conclusion that MIPO is currently the most effective way to treat HSFs.

Trial registration

Name of the registry: Prospero, 2. Unique Identifying number or registration ID: CRD42023411293.
Effects of UBE3A on the insulin resistance in polycystic ovary syndrome through the ubiquitination of AMPK
Authors: Ma Ning , Zhou Jing , Zhou Zhi , Wan Bangbei , Lu Weiying
Published: July 2023

Background

Polycystic ovary syndrome (PCOS) is a reproductive hormonal abnormality and a metabolic disorder, which is frequently associated with insulin resistance (IR). We aim to investigate the potential therapeutic effects of Ubiquitin-protein ligase E3A (UBE3A) on IR in the PCOS rats via Adenosine 5‘-monophosphate (AMP)-activated protein kinase (AMPK) activation.

Methods

The PCOS and IR rats model was established by dehydroepiandrosterone (DHEA) and high fat diet (HFD) treatment, and the fat rate, glucose tolerance and insulin tolerance were measured. The IR rats numbers were calculated. Besides, the mRNA levels of glucose transporter 4 (GLUT4) and UBE3A were detected by RT-qPCR. Furthermore, the relationship between was demonstrated by co-IP assay. The phosphorylation and ubiquitination of AMPK were analyzed by western blot.

Results

UBE3A was up-regulated in the PCOS rats. UBE3A knockdown significantly decreased the fat rate, glucose tolerance and insulin tolerance in the PCOS and IR rats. Additionally, the GLUT4 levels were significantly increased in PCOS + IR rats. Besides, after UBE3A knockdown, the IR rats were decreased, the p-IRS1 and p-AKT levels were significantly up-regulated. Furthermore, UBE3A knockdown enhanced phosphorylation of AMPK through decreasing the ubiquitination of AMPK. AMPK knockdown reversed the role of UBE3A knockdown in the PCOS + IR rats.

Conclusions

UBE3A knockdown inhibited the IR in PCOS rats through targeting AMPK. Our study indicated that UBE3A might become a potential biological target for the clinical treatment of PCOS.
Forces and moments generated during extrusion of a maxillary central incisor with clear aligners: an in vitro study
Authors: McKay Abraham , McCray Julie , Bankhead Brent , Lee Michael M. , Miranda Gabriel , Adel Samar M. , Kim Ki Beom
Published: July 2023

Objective

To assess the possibility of extrusion of a maxillary central incisor with the use of buccal and lingual pressure columns in the absence of attachments, and to evaluate the forces and moments experienced by the teeth using both thermoformed and 3D-printed clear aligners.

Materials and methods

A three-axis force and moment sensor (Aidin Robotics, Anyang, South Korea) was used to measure the forces and moments during extrusion of an upper left central incisor (UL1) and any forces experienced by the upper right central incisor (UR1) using thermoformed aligners and 3D-printed aligners. For the thermoformed aligners, the materials used were ATMOS® (American Orthodontics, Sheboygan, WI) and Zendura FLX® (Bay Materials LLC, Fremont, CA). 3D-printed aligners were fabricated using TC-85 clear photocurable resin (Graphy Inc., Seoul, South Korea). For each material type, three conditions were tested: Group 1: No attachment or pressure columns (control); Group 2: Attachment only; and Group 3: Pressure columns only. Each group was planned for 0.5 mm of extrusion on the UL1.

Results

All force readings collected demonstrated statistically significant differences when compared by materials and when compared by groups, with a P value of < 0.001. In the absence of attachment or pressure columns (Group 1), ATMOS® and TC-85 groups exerted extrusive force on the UL1. However, significantly lower forces and moments were exerted by the TC-85 group in comparison to the ATMOS® and Zendura FLX® groups. In the presence of attachment (Group 2), all three ATMOS®, Zendura FLX® and TC-85 groups exerted extrusive force on the UL1, with the TA group showing different directions of faciolingual force, mesiodistal force and faciolingual inclination on the UR1 when compared to the other two thermoformed groups. Whereas in the presence of pressure columns (Group 3), only the TC-85 3D-printed aligner group exerted extrusive force. Thermoformed aligners generated significantly higher mean forces and moments than 3D-printed aligners. Significant levels of unintended forces and moments were present in all groups.

Conclusions

Force levels generated during extrusion with clear aligners are significantly lower with those 3D-printed using TC-85 than with those thermoformed using ATMOS® or Zendura FLX®. Attachments consistently generated extrusive forces, and may be an effective adjunct in achieving extrusion of incisors. Extrusion may be achieved without the use of attachments by utilizing pressure columns in 3D-printed aligners using TC-85. While different strategies can generate extrusive forces, there are significant unintended forces and moments.
A randomized controlled trial on the effects and acceptability of individual mindfulness techniques – meditation and yoga – on anxiety and depression in people with Parkinson’s disease: a study protocol
Authors: Kwok Jojo Yan Yan , Auyeung Man , Pang Shirley Yin Yu , Ho Philip Wing Lok , Yu Doris Sau Fung , Fong Daniel Yee Tak , Lin Chia-chin , Walker Richard , Wong Samuel Yeung-shan , Ho Rainbow Tin Hung
Published: July 2023

Background

Between 40 and 50% of patients with Parkinson’s disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants’ experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management.

Methods

We will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews.

Discussion

The study would also generate important insights to enhance the patients’ adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services.

Trial registration

WHO Primary Registry – Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 (https://www.chictr.org.cn/showproj.html?proj=125878).
Isolation and identification of active ingredients and biological activity of Dioscorea nipponica Makino
Authors: Xia Guangqing , Zhao Guanshu , Pei Shichun , Zheng Yanping , Zang Hao , Li Li
Published: July 2023

This study reported the isolation and identification of bioactive compounds from Dioscorea nipponica Makino, a plant used in traditional medicine for various ailments. Nine compounds were isolated, including a new compound named as diosniposide E, which was elucidated by analyzing its 1H-NMR, 13C-NMR, DEPT, COSY, HMBC and MS data and comparing them with data available in literature. The other eight compounds were identified as known compounds. Theoretical calculations of energy and the generation of a molecular electrostatic potential surface map were employed to assess the antioxidant capacity of nine compounds, the calculation results exhibited that compounds 5 and 6 had strong antioxidant capacities. To further evaluate the antioxidant activities of the investigated compounds, the DPPH and ABTS assays were conducted. The results from the DPPH scavenging activity test revealed that compounds 4–6 exhibited enhanced scavenging activities compared to L-ascorbic acid, while displaying similar efficacy to trolox. Moreover, the ABTS scavenging activities of compounds 4–6 were found to surpass those of L-ascorbic acid and trolox. In terms of α-glucosidase inhibition, compounds 3 and 4 displayed remarkable inhibitory activities that surpassed the effects of acarbose. Additionally, compound 2 exhibited potent anticholinesterase activities, outperforming donepezil. This research provides insights into the potential bioactive compounds present in Dioscoreanipponica Makino and may contribute to its use in traditional medicine.
Perception and knowledge of learners about the use of 3D technologies in manual therapy education – a qualitative study
Authors: Kovanur Sampath Kesava , Arumugam Ashokan , Yaghi Esra , Fairs Emma , Andersen Patrea
Published: July 2023

Objectives

Manual therapy is a specific hands-on approach used and taught by various professions such as physiotherapy and osteopathy. The current paradigm of teaching manual therapy incorporates the traditional ‘See one, do one, teach one’ approach. However, this ‘teacher centred’ approach may not enable learners to develop the complex clinical skills of manual therapy. In this context, 3D technologies such as virtual reality may facilitate the teaching and learning of manual therapy. Hence the aim of the current study was to investigate the perception, knowledge and attitude of manual therapy learners about the use of 3D technologies in manual therapy education.

Methods

An exploratory qualitative research design using semi-structured interviews was used in this study. A total of ten manual therapy (5 physiotherapy and 5 osteopathic) students (mean age = 32; 80% female) enrolled in an appropriate physiotherapy or osteopathic degree provided by a New Zealand recognized institution (e.g., university or polytechnic) participated in this study. Data saturation was achieved after 10 interviews (average duration: 35 min) that provided thick data. A thematic analysis was used for data analysis.

Results

Six factors were identified which appeared to influence participants’ perception of role of technology in manual therapy education. These were (1) the sufficiency of current teaching method; (2) evolution as a learner (a novice to an expert); (3) need for objectivity; (4) tutor feedback; (5) knowledge and (6) barriers and enablers. These six factors influenced the participants’ perception about the role of 3D technologies in manual therapy education with participants evidently taking two distinct/polarized positions (‘no role’ (techstatic) versus a ‘complete role’ (techsavvy)).

Conclusion

Although 3D technology may not replace face-to-face teaching, it may be used to complement the traditional approach of learning/teaching to facilitate the learning of complex skills according to the perceptions of manual therapy learners in our study. The advantage of such an approach is an area of future research.
Enhancing medical education in respiratory diseases: efficacy of a 3D printing, problem-based, and case-based learning approach
Authors: Yan Xuebo , Zhu Yingying , Fang Lei , Ding Peishan , Fang Shu , Zhou Jinhua , Wang Jiong
Published: July 2023

Objectives

The present study aims to investigate the efficacy of utilizing three-dimensional (3D) printing technology in concert with Problem-Based Learning (PBL) and Case-Based Learning (CBL) pedagogical approaches in educating senior undergraduate clinical medical students on respiratory diseases.

Methods

A cohort of 422 fourth-year clinical medicical students of from Anhui Medical University, pursuing a five-year program, were arbitrarily segregated into two distinct groups. The experimental group was subjected to a combined pedagogical approach, which included 3D printing technology, PBL and CBL (referred to as DPC). Conversely, the control group was exposed to conventional teaching methodologies for respiratory disease education. The effectiveness of the teaching methods was subsequently appraised using both theoretical test scores and custom questionnaires.

Results

Post-quiz scores indicated a statistically significant improvement in the DPC group as compared to the traditional group (P < 0.01). Self-evaluation and satisfaction questionnaires revealed that the DPC group’s self-assessment scores outperformed the traditional group in several aspects, including clinical thinking ability, learning initiative, self-study ability, anatomical knowledge mastery, confidence in learning, ability to analyze and solve problems, comprehension of the knowledge, help to clinical thinking and level of satisfaction on the teaching methods (P < 0.01). However, within the unsatisfied DPC sub-group, none of these self-assessment aspects, except for comprehension of the knowledge, impacted the learning efficacy (P > 0.05).

Conclusion

The deployment of the DPC pedagogical approach may confer unique experiential learning opportunities for students, potentially enhancing theoretical test scores and promoting self-evaluation and satisfaction in the context of respiratory disease education. Hence, it may be instrumental in augmenting the overall teaching efficacy.
Undergraduate ultrasound training: prospective comparison of two different peer assisted course models on national standards
Authors: Weimer Johannes , Dionysopoulou Anna , Strelow Kai-Uwe , Buggenhagen Holger , Weinmann-Menke Julia , Dirks Klaus , Weimer Andreas , Künzel Julian , Börner Norbert , Ludwig Michael , Yang Yang , Lorenz Liv , Ille Carlotta , Müller Lukas
Published: July 2023

Background

A thorough knowledge of sonography is essential in clinical practice. Therefore, sonography training is increasingly incorporated into the medical school curriculum, entailing different course models. The question arises which model is most effective to convey sustained sonographic skills.

Methods

Two different peer-assisted learning (PAL) sonography course models were developed as part of a clinical prospective study. The course content was based on the national resident curriculum of the German Society for Ultrasound in Medicine (DEGUM). Model A consists of a 10-week course and model B of a two-day compact course. Each model entailed 20 teaching units (TU). A script was used to prepare for each unit. Two modified OSCE exams of the ultrasound skills (max = 50 points per exam) were performed during the last teaching unit to assess the competence level. For subjective self-assessment and model evaluation, a questionnaire with a 7-point Likert scale was employed.

Results

A total of 888 students of the 3rd year participated as part of a voluntary elective in the study (744 in model A and 144 in model B). In the exams, participants in model A (median 43 points) scored significantly higher than those in model B (median 39; p < 0.01). Participants in model A (mean 1.71 points) obtained significantly higher mean competency gain scores in subject knowledge than model B (mean 1.43 points; p < 0.01) participants. All participants were satisfied with the course concept (A: mean 1.68 vs. B: mean 1.78 points; p = 0.05), the teaching materials (A: mean 1.81 vs. B: mean 1.69 points; p = 0.52), and the tutor’s didactic skills (A: mean 1.24 vs. B: mean 1.15 points; p < 0.05).

Conclusion

These results suggest that sonography-specific competency may be obtained through different course models, with a model stretching over several weeks leading to a higher competence level. Further research should assess the long-term retention of the skills obtained in different models.
Development and validation of prediction model for overall survival in patients with lymphoma: a prospective cohort study in China
Authors: Li Xiaosheng , Chen Yue , Sun Anlong , Wang Ying , Liu Yao , Lei Haike
Published: July 2023

Objective

The survival of patients with lymphoma varies greatly among individuals and were affected by various factors. The aim of this study was to develop and validate a prognostic model for predicting overall survival (OS) in patients with lymphoma.

Methods

We conducted a prospective longitudinal cohort study in China between January 2014 and December 2018 (n = 1,594). After obtaining the follow-up data, we randomly split the cohort into the training cohort (n = 1,116) and the validation cohort (n = 478). The least absolute shrinkage and selection operator (LASSO) regression analysis was used to select the predictors of the model. Cox stepwise regression analysis was used to identify independent prognostic factors, which were finally displayed as static nomogram and web-based dynamic nomogram. We calculated the concordance index(C-index) to describe how the predicted survival of objectively confirmed prognosis. The calibration plot is used to evaluate the prediction accuracy and discrimination ability of the model. Net reclassification index (NRI) and decision curve analysis (DCA) curves were also used to evaluate the prediction ability and net benefit of the model.

Results

Nine variables in the training cohort were considered to be independent risk factors for patients with lymphoma in the final model: age, Ann Arbor Stage, pathologic type, B symptoms, chemotherapy, targeted therapy, lactate dehydrogenase (LDH), β2-microglobulin and C-reactive protein (CRP). The C-indices of OS were 0.749 (95% CI, 0.729–0.769) in the training cohort and 0.731 (95% CI, 0.762–0.700) in the validation cohort. A good agreement between prediction by nomogram and actual observation was shown in the calibration curve for the probability of survival in both the training cohort and validation cohorts. The areas under curve (AUC) of the area under the receiver operating characteristic (ROC) curves for 1-year, 3-year, and 5-year OS were 0.813, 0.800, and 0.762, respectively, in the training cohort, and 0.802, 0.768, and 0.721, respectively, in the validation cohort. Compared with the Ann Arbor Stage system, NRI and DCA showed that the model had a higher predictive capacity and net benefit.

Conclusion

The prediction models reliably estimate the outcome of patients with lymphoma. The model had high discrimination and calibration, which provided a simple and reliable tool for the survival prediction of the patients, and it might help patients benefit from personalized intervention.
How effectively are social accountability mechanisms being applied in mental health services within the newly federalized health system of Nepal? A multi-stakeholder qualitative study
Authors: Devkota Hridaya Raj , Baral Yuba Raj , Khanal Bindu , Adhikary Pratik
Published: July 2023

Background

The burden of mental health problems and inequalities in healthcare has emerged as critical issues, in Nepal. Strengthened citizen-driven social accountability (SA) is an effective strategy for building equitable health systems and providing quality healthcare services to all, yet SA in mental health is an under-researched area in Nepal.

Objective

This study explores changes in mental health service delivery in the re-configured federal health system and discusses the functioning and effectiveness of SA in the federalized context of Nepal.

Method

This case study research used a qualitative approach to data collection. We conducted Key Informant Interviews (KIIs), and Focus Group Discussions (FGDs) with local stakeholders including people with experience of mental health problems. The audio-recorded interviews and discussions were transcribed and analyzed using a thematic content method.

Results

A total of 49 participants were recruited, and 17 participated in interviews and 32 participated in six focus group discussions. From the data, eight themes emerged: Policy challenges in mental health, Governance and service delivery, Tokenism in the application of social accountability processes, Weak role of key actors in promoting accountability, Complaints and response, Discriminatory health and welfare system, Public attitudes and commitment towards mental health, and No differences experienced by the change to a federal system. It was found that existing health policies in Nepal inadequately cover mental health issues and needs. The prevailing laws and policies related to mental health were poorly implemented. There is a lack of clarity at different levels of government about the roles and responsibilities in the delivery of mental health services. Poor intra- and inter-governmental coordination, and delays in law-making processes negatively impacted on mental health service delivery. SA mechanisms such as social audits and public hearings exist within government health systems, however, application of these in mental health services was found poor. Rights-holders with mental health problems had not experienced any change in the provision of healthcare services for them even after the federalization.

Conclusion

Mental health is insufficiently addressed by the health policies in Nepal, and SA mechanisms appeared to be rarely institutionalized to promote good governance and provide effective healthcare services to vulnerable populations. The provision of more equitable services and honest implementation of SA tools may foster greater accountability and thereby better service delivery for people with mental health problems.