bluuebunny/crossref_metadata_2025 huggingface dataset:
Aligning Incentives for Surgical Innovation: Review of the Literature and Best Practices
Authors: Becker Devra B.
Published: January 2023

Background: Innovation in the clinical surgical space is often generated by the insight and ideas of practicing surgeons whose ideas solve direct and relevant clinical problems with both novel products and reimagined processes. Despite some successes in both product and process development, innovation in the practicing surgical space does not occur with the frequency one might expect and does not consistently result in adoption of profitable or health-improving new products or processes. One barrier to successful innovation is the misalignment of incentives for early-stage innovation in the clinical surgical enterprise. This project was undertaken to determine best innovation practices for clinical Divisions and Departments. Methods: Best practices for innovation in industry were determined by company-specific examples, as well as literature review in the business and medical literature. Concepts were then integrated to determine a viable model that aligns incentives to encourage early-stage innovation. Proposal: The centralized Moderated Innovation Database (MID) of early-stage exploratory ideas integrates best practices of innovation in a low-cost, sustainable model. The MID must be executed in 3 phases to ensure viability in implementation. This model is likely to encourage innovation by both improving stakeholder satisfaction with and engagement in the process, and by increasing capture of early-stage innovation. Conclusion: Infrastructure for early-stage ideas will help align incentives for early-stage innovation, and the MID is consistent with best practices for innovation.
What Happens When you Ask for Feedback? Anticipating and Addressing Challenges Can Be Effective for Eliciting Parents’ Views About Their Critically Ill Child's Retrieval to Paediatric Intensive Care
Authors: Barber Victoria , Evans Ruth , Ramnarayan Padmanabhan , Wray Jo ,   PhD on behalf of the DEPICT study team
Published: January 2023

User feedback is an important element of health-service evaluation and can be used to improve services but can be difficult to obtain, particularly in acute care situations. As part of a national study, we explored stakeholders’ perspectives on paediatric critical care retrieval processes through questionnaires and interviews. Obtaining feedback in a highly charged, stressful and busy paediatric intensive care unit (PICU) environment is fraught with difficulties so we aimed to optimise each stage of data collection by being both proactive and reactive. Patient and public involvement occurred throughout and engagement with sites and supporting local research staff to approach and recruit families were prioritised. High-quality study materials were developed to reduce local staff burden and promote and maintain study awareness. We describe strategies used and what worked/did not work. We suggest approaches for optimising elicitation of parents’ experiences in difficult circumstances, highlighting the importance of engagement and commitment of PICU staff.
Does Structured Patient Education Reduce the Peri-Operative Anxiety and Depression Levels in Elective Chest Surgery Patients? A Double-Blinded Randomized Trial of 300 Patients
Authors: Jamwal Tilotma , Kumar Reena , Pulle Mohan Venkatesh , Kumar Arvind , Jain Kanika
Published: January 2023

Psychological distress associated with surgery is an emerging issue. The study was conducted to assess the impact of structured patient education viz-a-viz routine patient education on anxiety and depression levels in patients undergoing elective chest surgery. It is a prospective, double-blind randomized study, conducted from February 2019 to February 2020 at a tertiary care center in India, on patients who underwent elective chest surgeries. A total of 300 patients were randomized using a computer-generated randomization sequence, into 2 equal groups (150 subjects each). Study group included patients who underwent structured patient education (Group A), whereas control group included patients who underwent routine patient education (Group B). The 2 groups were compared for anxiety and depression levels at admission as well as discharge using Hospital Anxiety and Depression Scale. Also, at the time of discharge, the groups were compared for the effectiveness of patient education using a validated Questionnaire B. In comparison to routine education, patients receiving structured education showed significantly lesser scores for anxiety and depression at discharge ( P < .001). Also, structured patient education proved to be effective in comparison to the routine education in educating the patients in all parameters as determined by the Questionnaire B ( P < .05). It can be concluded that structured educational intervention is strongly recommended in patients undergoing chest surgery which can help alleviate perioperative anxiety and depression. Such intervention helps patient get an understanding of the surgical procedure and assist them in facing the condition in a better way.
Complex Patient Navigation by Veteran Patients in the Veterans Health Administration (VHA) for Chronic Headache Disease: A Qualitative Study
Authors: Lindsey Hayley M , Goldman Roberta E , Riley Samantha D , Baird Sean , Burrone Laura , Grinberg Amy S , Fenton Brenda T , Sico Jason J , Damush Teresa M
Published: January 2023

Patients living with headache diseases often have difficulty accessing evidence-based care. Authors conducted a qualitative research study with 20 patients receiving headache care at seven Headache Centers of Excellence within the Veterans Health Administration to examine their experiences navigating headache care. This study employed thematic qualitative analysis and conducted cross-case comparisons. Several key findings emerged. 1) Most patients saw multiple healthcare providers over numerous years before reaching a headache specialist to manage chronic headaches. 2) Receipt of high-quality and comprehensive headache specialty care was associated with high satisfaction. 3) Patients with headache diseases reported oftentimes they experienced an arduous journey across multiple healthcare systems and between several healthcare providers before receiving evidence-based headache treatment that they found acceptable. Results demonstrate that most patients were satisfied with their current specialty headache care in the Veterans Health Administration. Authors discuss implications for future studies and highlight ways to improve patient satisfaction and timely access to appropriate headache care.
Apical pulmonary lesions suspected of malignancy visible on neck CT angiography performed for acute stroke: Prevalence, treatment, and clinical implications – the PLEURA study
Authors: Dittrich Tolga D , Aujesky Mara , Rudin Salome , Zietz Annaelle , Wagner Benjamin , Polymeris Alexandros , Altersberger Valerian L , Sinnecker Tim , Gensicke Henrik , Engelter Stefan T , Lyrer Philippe , Hess Viviane , Sutter Raoul , Nickel Christian H , Bonati Leo H , Fischer Urs , Psychogios Marios , Katan Mira , De Marchis Gian Marco
Published: January 2023

Background:

Computed tomography angiography (CTA) of the supraaortic arteries is commonly used for acute stroke workup and may reveal apical pulmonary lesions (APL).

Aim:

To determine the prevalence, follow-up algorithms, and in-hospital outcomes of stroke patients with APL on CTA.

Methods:

We retrospectively included consecutive adult patients with ischemic stroke, transient ischemic attack, or intracerebral hemorrhage and available CTA at a tertiary hospital between January 2014 and May 2021. We reviewed all CTA reports for the presence of APL. APL were classified as malignancy suspicious or benign appearing based on radiological-morphological criteria. We performed regression analyses to investigate the impact of malignancy suspicious APL on different in-hospital outcome parameters.

Results:

Among 2715 patients, APL on CTA were found in 161 patients (5.9% [95%CI: 5.1–6.9]; 161/2715). Suspicion of malignancy was present in one third of patients with APL (36.0% [95%CI: 29.0–43.7]; 58/161), 42 of whom (72.4% [95%CI: 60.0–82.2]; 42/58) had no history of lung cancer or metastases. When performed, further investigations confirmed primary or secondary pulmonary malignancy in three-quarters (75.0% [95%CI: 50.5–89.8]; 12/16), with two patients (16.7% [95%CI: 4.7–44.8]; 2/12) receiving de novo oncologic therapy. In multivariable regression, the presence of radiologically malignancy suspicious APL was associated with higher NIHSS scores at 24 h (beta = 0.67, 95%CI: 0.28–1.06, p = 0.001) and all-cause in-hospital mortality (aOR = 3.83, 95%CI: 1.29–9.94, p = 0.01).

Conclusions:

One in seventeen patients shows APL on CTA, of which one-third is malignancy suspicious. Further work-up confirmed pulmonary malignancy in a substantial number of patients triggering potentially life-saving oncologic therapy.
Short to Early-Mid Term Clinical Outcomes and Survival of Pyrocarbon Shoulder Implants: A Systematic Review and Meta-Analysis
Authors: Franceschetti Edoardo , Gregori Pietro , Giurazza Giancarlo , Papalia Giuseppe , Caraffa Auro , Papalia Rocco
Published: January 2023

Background

The appropriate surgical treatment option for young and active patients undergoing shoulder arthroplasty for arthritis remains questionable. Pyrolitic carbon (pyrocarbon) has been shown to improve implant longevity and decrease wear when in contact with cartilage or bone. The present systematic review aimed to evaluate clinical and radiological outcomes as well as the survivorship of pyrocarbon shoulder implants.

Methods

The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were followed. A systematic search was performed using the MEDLINE, EMBASE and Cochrane Library databases. All the studies dealing with the use of pyrolitic shoulder implants were pooled, data of interest were extracted and statistically analyzed through meta-analysis.

Results

A total of 9 studies were included for a total of 477 shoulders treated. The overall mean rate of survival of the implants was 93.4 ± 5.8% and 80% ± 26.5% at 2 years and final follow up, respectively, while resulting 82.4% ± 22.1% and 92.3% ± 3.5% for PISA (pyrocarbon interposition shoulder arthroplasty) and hemi-arthroplasty/hemi-resurfacing, respectively.

Conclusions

Pyrolitic carbon shoulder implants showed good survivorship and clinical outcomes at an early to early-midterm follow-up. More studies and better-designed trials are needed in order to enrich the evidence on long-term outcomes and comparison with other shoulder replacement options for young and active patients.

Level of Evidence

IV.
Radiographic Forefoot Width Following Minimally Invasive Chevron Akin Bunionectomy
Authors: Klavas Derek M. , Rosemberg Dov L. , Bordignon Glaucia , Lin Johnny , Lee Simon , Bohl Daniel D.
Published: January 2023

Background:

Hallux valgus (HV) is a common cause of pain and deformity of the forefoot. Minimally invasive chevron Akin (MICA) bunionectomy is a method for HV correction associated with less pain and swelling, with early return to weightbearing in a regular shoe. The purpose of this study was to determine how the MICA procedure affects forefoot width.

Methods:

Twenty-eight patients (26 female, 2 male; 9 left, 19 right) at a single institution who underwent primary MICA for HV correction by 3 treating surgeons were retrospectively reviewed. Pre- and postoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle (DMAA), bony forefoot width, and soft tissue forefoot width were measured by 2 independent observers. Radiographic measurements were calibrated using fifth metatarsal length. Wilcoxon signed rank test compared changes in HVA, IMA, DMAA, and forefoot widths. Pearson correlation coefficient evaluated association between HVA, IMA, DMAA, and changes in forefoot width.

Results:

At mean follow-up of 5.4 (range 3-13.7) months, bony forefoot width decreased significantly by 3.7 mm (4%, P < .001) and soft tissue forefoot width decreased by 2.5 mm (2%, P < .01). Decrease in HVA was moderately correlated with change in bony forefoot width ( r = .38, P < .05) and change in soft tissue forefoot width ( r = .45, P < .05). Decrease in IMA was moderately correlated with change in bony forefoot width ( r = .45, P < .05) and change in soft tissue forefoot width ( r = .44, P < .05).

Conclusion:

The MICA procedure resulted in modest, yet significant, decrease in both bony and soft tissue forefoot width. Decrease in HVA and IMA demonstrated moderate correlation with changes in forefoot width. Patients can be counseled on these changes leading up to, and after, MICA bunionectomy surgery.

Level of Evidence:

Level III, retrospective comparative series.
Detailed intraocular pressure curve by telemetric tonometry with an implanted pressure sensor before and after PreserFlo® MicroShunt implantation: a case report
Authors: Gassel Caroline Julia , Dzhelebov Dimitar Nikolov , Voykov Bogomil
Published: January 2023

Continuous control of intraocular pressure (IOP) is crucial to preventing long-term damage to the optic nerve in glaucoma. Recently, a novel telemetric IOP sensor (EYEMATE-IO™, Implandata Ophthalmic Products GmbH, Hannover, Germany) has been developed that continuously records IOP. The patient can read the IOP measurements wirelessly using a hand-held reading device. We present the case of a 70-year-old patient with primary open-angle glaucoma who had been implanted with an EYEMATE-IO™ and recently underwent minimally invasive bleb-filtering surgery with the PreserFlo® MicroShunt (Santen, Osaka, Japan). This case demonstrates both the benefits of continuous pressure measurement with EYEMATE-IO™ and the ability of the PreserFlo® MicroShunt to significantly reduce IOP fluctuations.
Adaptation of an evidence-based parenting intervention for integration into maternal-child home-visiting programs: Challenges and solutions
Authors: Peacock-Chambers Elizabeth , Moran Michael , Clark Maria Carolina , Borelli Jessica L. , Byatt Nancy , Friedmann Peter D. , Suchman Nancy E. , Feinberg Emily
Published: January 2023

Background

The objective of this study was to assess potential challenges, prioritize adaptations, and develop an implementation and research approach to integrate and study a parenting intervention for mothers in recovery from substance use disorders in community-based home-visiting programs.

Method

An explanatory mixed-methods design, guided by process mapping with Failure Modes and Effects Analysis tools, and an Advisory Panel of 15 community members, identified potential implementation challenges and recommended solutions for the proposed intervention within five pre-specified domains. Thematic content analysis identified themes from detailed field notes.

Results

The Advisory Panel identified 44 potential challenges across all domains. They determined that the recruitment domain was most likely to create challenges. Regarding the potential challenges, two cross-domain themes emerged: (1) development of mistrust in the community and (2) difficulty initiating and sustaining engagement. Potential solutions and adaptations to protocols are reported.

Conclusion

Mistrust in the community was cited as a potentially important challenge for the delivery and study of an evidence-based parenting intervention for mothers in recovery through home-visiting programs. Adaptations to research protocols and intervention delivery strategies are needed to prioritize the psychological safety of families, particularly for groups that have been historically stigmatized.
Acculturation, Dietary Behaviors, and Macronutrient Intake Among Mexican Americans With Prediabetes: The Starr County Diabetes Prevention Initiative
Authors: Brown Sharon A. , Becker Heather A. , García Alexandra A. , Velasquez Mary M. , Tanaka Hirofumi , Winter Mary A. , Perkison William B. , Brown Eric L. , Aguilar David , Hanis Craig L.
Published: January 2023

Purpose:

The purpose of the study was to examine the influences of sex and acculturation on dietary behaviors, macronutrient intake, and dietary quality in participants enrolled in a diabetes prevention initiative in Starr County, Texas.

Methods:

Baseline data from the Starr County diabetes prevention study (N = 300) were analyzed—acculturation (country of origin, years in Starr County, language and food preferences), depressive symptoms (Patient Health Questionnaire-9), healthy eating self-efficacy (Weight Efficacy Lifestyle Questionnaire-Short Form), diet quality (USDA Healthy Eating Index), fat avoidance (Fat Avoidance Scale, Spanish version), and macronutrients. Descriptive statistics and univariate analysis of covariance were used to examine differences based on acculturation, controlling for sex.

Results:

Participants were predominantly female (73%) and, on average, 51 years of age. Language and food preferences favored Spanish language and Hispanic foods, respectively. The majority (71%) was born in Mexico but had resided in Starr County for 33 years, on average. Depressive symptoms were moderate, and eating self-efficacy scores suggested low confidence in making healthy food choices, particularly for saturated fats. Spanish language preference was associated with worse dietary habits. The mean dietary quality score was lower than the national average (54 vs 59 nationally); females had slightly higher dietary quality than males and a higher mean fat avoidance score, although differences were not clinically significant. Intakes of carbohydrate, saturated fats, and cholesterol were higher than recommended daily allowances.

Conclusions:

The overall preference for speaking Spanish and the influence of language on dietary intake should inform future dietary interventions. Accommodating cultural norms and food preferences remain major challenges to improving dietary quality among the diverse Hispanic ethnic groups.
Behavior Modification for Adult Onset Diabetes
Authors: Greene Geoffrey
Published: January 2023

A pilot project tested the feasibility of applying behavior change techniques to improve weight and diabetic control among outpatient adult onset diabetics. The results indicated:

1. significantly greater improvements in fasting blood glucose levels among 31 patients receiving education in behavior modification than among 8 patients not receiving the education

2. that a minimum of four sessions were necessary for an effective intervention, as reflected in reduction of both fasting blood sugar and weight, and

3. that the five subjects attending four sessions lost a mean of 4.8 pounds (2.18 kgs.) or three times as much weight as those attending less than three sessions.

Although small in numbers, this pilot project is significant because it uses behavioral techniques not previously reported with adult diabetics. Diabetes educators would benefit from integrating these techniques of behavior modification into their programs, and using them to replicate this study or further research within their own practice.
Cereset Research Standard Operating Procedures for Insomnia: A Randomized, Controlled Clinical Trial
Authors: Tegeler Catherine L. , Munger Clary Heidi , Shaltout Hossam A. , Simpson Sean L. , Gerdes Lee , Tegeler Charles H.
Published: January 2023

Background

Interventions for insomnia that also address autonomic dysfunction are needed.

Objective

We evaluate Cereset Research™ Standard Operating Procedures (CR-SOP) in a pilot randomized, controlled trial. CR-SOP is a less operator-dependent, more generalizable innovation of HIRREM®, a noninvasive, closed-loop, allostatic, acoustic stimulation neurotechnology demonstrated to improve insomnia and autonomic function.

Methods

Adults with Insomnia Severity Index (ISI) scores of ≥8 were randomized to receive ten sessions of CR-SOP, with tones linked to brainwaves (LB, intervention), or a sham condition of random tones not linked to brainwaves (NL, control). Measures were collected at enrollment and 0-14 days and 4-6 weeks post-allocated intervention. The primary outcome was differential change in ISI from baseline to 4-6 weeks post-intervention. Secondary self-report measures assessed sleep quality65 and behavioral outcomes. Ten-minute recordings of heart rate and blood pressure were collected to analyze autonomic function (heart rate variability [HRV] and baroreflex sensitivity).

Results

Of 22 randomized, 20 participants completed the allocated condition. Intention to treat analysis of change from baseline to the 4-6 week outcome demonstrated mean ISI score reduction of 4.69 points among controls (SE 1.40). In the intervention group, there was an additional 2.58 point reduction in ISI score (SE 2.13; total reduction of 7.27, P = .24). Sleep quality and some measures of autonomic function improved significantly among the intervention group compared to control.

Conclusions

This pilot study compared use of a standardized, allostatic, acoustic neurotechnology intervention with a sham, active control condition. The magnitude of change in insomnia severity was clinically relevant and similar to the findings in a prior, fully powered trial, but the differential improvement observed was not statistically significant. Significant improvements were demonstrated in sleep quality and some autonomic function measures.
Dual Antiplatelet Therapy After an Acute Nonminor Stroke
Authors: Downey Jacquie , Blackwell Sarah , Germain Kenda , Pinner Nathan A. , Starr Jessica A.
Published: January 2023

Background:

In select patients with minor ischemic stroke, dual antiplatelet therapy (DAPT) with aspirin plus clopidogrel is recommended if initiated early and continued for 21 to 90 days. Dual antiplatelet therapy use, in a broader population, has shown to increase the risk of bleeding without an increased antithrombotic benefit. An ongoing area of uncertainty is whether DAPT would benefit the nonminor stroke population when continued for 21 to 90 days.?s

Objective:

To describe the effects of DAPT after a nonminor stroke.

Methods:

This single-center, retrospective cohort study included patients initiated on antiplatelet therapy started within 1 week of symptom onset for a nonminor ischemic stroke from January 2013 to January 2020. Patients with any bleeding disorder or National Institutes of Health Stroke Scale score <4 were excluded. The primary endpoint was major bleeding at 3 months. Secondary endpoints included recurrent stroke and minor bleeding.

Results:

A total of 158 patients met criteria for inclusion. Ninety (57%) received DAPT, and 68 (43%) received single antiplatelet therapy (SAPT). The primary endpoint occurred in 3 patients in the DAPT group and 1 patient in the SAPT group ( P = 0.463). Minor bleeding occurred in 1 patient receiving DAPT and 2 patients receiving SAPT ( P = 0.402). There were 10 patients in the DAPT group and 5 patients in the SAPT group who experienced recurrent stroke or transient ischemic attack ( P = 0.429). Limitations of this study include the retrospective single-center study design.

Conclusion:

There was a comparable risk of bleeding and recurrent stroke between DAPT and SAPT in patients admitted with an acute nonminor stroke.
Quantifying the potential benefits of risk-mitigation strategies on present and future seismic losses in Kathmandu Valley, Nepal
Authors: Mesta Carlos , Kerschbaum David , Cremen Gemma , Galasso Carmine
Published: January 2023

Structural risk-mitigation measures have been shown to significantly reduce earthquake-induced physical damage and casualties in various regions worldwide. However, these benefits remain unknown or inadequately quantified for potential future events in some hazard-prone areas such as Kathmandu Valley, Nepal, which this article addresses. The analysis involves modeling an earthquake scenario similar to the 2015 Gorkha earthquake (moment magnitude 7.8) and using four exposure inventories representing the current (2021) urban system or near-future (2031) development trajectories that Kathmandu Valley could experience. The results predict substantial losses (€8.2 billion in repair/reconstruction costs and 89,199 fatalities) in 2021 if the building stock’s quality is assumed to have remained the same as in 2011 (Scenario A). However, a partial improvement of the building stock’s quality in the present (Scenario B) can decrease financial losses and fatalities by 17% and 44%, respectively. Moreover, under a “no change” pathway for 2031 (Scenario C), where the quality of the expanding building stock remains the same as in 2011, and the number of buildings is larger to reflect population growth, financial losses and fatalities will increase by 20% and 25% respectively over those of Scenario A. In contrast, further upgrades to the building stock’s quality by 2031 (Scenario D) would reduce financial and human losses by 14% and 54% respectively, relative to those of Scenario A. In addition, the largest financial and human losses computed in the four scenarios are consistently associated with the low- and middle-income population. The main findings of this article can be used to inform decision makers about the benefits of investing in forward-looking seismic risk-mitigation efforts.
SAMHD1 single nucleotide polymorphisms impact outcome in children with newly diagnosed acute myeloid leukemia
Authors: Marrero Richard J. , Cao Xueyuan , Wu Huiyun , Elsayed Abdelrahman H. , Klco Jeffery M. , Ribeiro Raul C. , Rubnitz Jeffrey E. , Ma Xiaotu , Meshinchi Soheil , Aplenc Richard , Kolb E. Anders , Ries Rhonda E. , Alonzo Todd A. , Pounds Stanley B. , Lamba Jatinder K.
Published: January 2023

Cytarabine arabinoside (Ara-C) has been the cornerstone of acute myeloid leukemia (AML) chemotherapy for decades. After cellular uptake, it is phosphorylated into its active triphosphate form (Ara-CTP), which primarily exerts its cytotoxic effects by inhibiting DNA synthesis in proliferating cells. Interpatient variation in the enzymes involved in the Ara-C metabolic pathway has been shown to affect intracellular abundance of Ara-CTP and, thus, its therapeutic benefit. Recently, SAMHD1 (SAM and HD domain–containing deoxynucleoside triphosphate triphosphohydrolase 1) has emerged to play a role in Ara-CTP inactivation, development of drug resistance, and, consequently, clinical response in AML. Despite this, the impact of genetic variations in SAMHD1 on outcome in AML has not been investigated in depth. In this study, we evaluated 25 single nucleotide polymorphisms (SNPs) within the SAMHD1 gene for association with clinical outcome in 400 pediatric patients with newly diagnosed AML from 2 clinical trials, AML02 and AML08. Three SNPs, rs1291128, rs1291141, and rs7265241 located in the 3′ region of SAMHD1 were significantly associated with at least 1 clinical outcome: minimal residual disease after induction I, event-free survival (EFS), or overall survival (OS) in the 2 cohorts. In an independent cohort of patients from the COG-AAML1031 trial (n = 854), rs7265241 A>G remained significantly associated with EFS and OS. In multivariable analysis, all the SNPs remained independent predictors of clinical outcome. These results highlight the relevance of the SAMHD1 pharmacogenomics in context of response to Ara-C in AML and warrants the need for further validation in expanded patient cohorts.
Denoising Fault-Aware Wavelet Network: A Signal Processing Informed Neural Network for Fault Diagnosis
Authors: Shang Zuogang , Zhao Zhibin , Yan Ruqiang
Published: January 2023

Deep learning (DL) is progressively popular as a viable alternative to traditional signal processing (SP) based methods for fault diagnosis. However, the lack of explainability makes DL-based fault diagnosis methods difficult to be trusted and understood by industrial users. In addition, the extraction of weak fault features from signals with heavy noise is imperative in industrial applications. To address these limitations, inspired by the Filterbank-Feature-Decision methodology, we propose a new Signal Processing Informed Neural Network (SPINN) framework by embedding SP knowledge into the DL model. As one of the practical implementations for SPINN, a denoising fault-aware wavelet network (DFAWNet) is developed, which consists of fused wavelet convolution (FWConv), dynamic hard thresholding (DHT), index-based soft filtering (ISF), and a classifier. Taking advantage of wavelet transform, FWConv extracts multiscale features while learning wavelet scales and selecting important wavelet bases automatically; DHT dynamically eliminates noise-related components via point-wise hard thresholding; inspired by index-based filtering, ISF optimizes and selects optimal filters for diagnostic feature extraction. It's worth noting that SPINN may be readily applied to different deep learning networks by simply adding filterbank and feature modules in front. Experiments results demonstrate a significant diagnostic performance improvement over other explainable or denoising deep learning networks. The corresponding code is available at https://github.com/albertszg/DFAWnet.
Predictors of adverse diastolic remodeling in non-diabetic patients presenting with ST-elevation myocardial infarction
Authors: Al Ali Lawien , Groot Hilde E. , Assa Solmaz , Lipsic Erik , Hummel Yoran M. , van Veldhuisen Dirk J. , Voors Adriaan A. , van der Horst Iwan C. C. , Lam Carolyn S. , van der Harst Pim
Published: January 2023

Background

Adverse systolic remodeling after ST-elevation myocardial infarction (STEMI) is associated with poor clinical outcomes. However, little is known about diastolic remodeling. The purpose of this study was to identify the factors leading to diastolic remodeling.

Methods

Echocardiography was performed during hospitalization and at 4 months follow-up in 267 non-diabetic STEMI patients from the GIPS-III trial. As parameters of diastolic remodeling we used (1.) the E/e′ at 4 months adjusted for the E/e′ at hospitalization and (2.) the change in E/e′ between hospitalization and 4 months. Multivariable regression models correcting for age and sex were constructed to identify possible association of clinical and angiographic variables as well as biomarkers with diastolic remodeling.

Results

Older age, female gender, hypertension, multi vessel disease, higher glucose and higher peak CK were independent predictors of higher E/e′ at 4 months in a multivariable model (R2:0.20). After adjustment for E/e′ during hospitalization only female gender, multivessel disease and higher glucose remained predictors of E/e′ at four months (R2:0.40). Lower myocardial blush grade, AST and NT-proBNP were independent predictors of a higher increase of E/e′ between hospitalization and at 4 months in a multivariable model (R2:0.08).

Conclusions

Our data supports the hypothesis that female gender, multivessel coronary artery disease, and microvascular damage are important predictors of adverse diastolic remodeling after STEMI. In addition, our data suggests that older age and hypertension prior to STEMI may have contributed to worse pre-existing diastolic function.

Trial registration: NIH, NCT01217307. Prospectively registered on October 8th 2010, https://clinicaltrials.gov/ct2/show/NCT01217307.
Falls and fracture risk screening in primary care: update and validation of a postal screening tool for community dwelling older adults recruited to UK Prevention of Falls Injury Trial (PreFIT)
Authors: Bruce Julie , Hossain Anower , Ji Chen , Lall Ranjit , Arnold Susanne , Padfield Emma , Underwood Martin , Lamb Sarah E.
Published: January 2023

Background

Postal screening has not previously been validated as a method for identifying fall and fracture risk in community-dwelling populations. We examined prognostic performance of a postal risk screener used in the UK Prevention of Falls Injury Trial (PreFIT; ISRCTN71002650), to predict any fall, recurrent falls, and fractures over 12 months. We tested whether adding variables would improve screener performance.

Methods

Nine thousand eight hundred and eight community-dwelling participants, aged 70 years and older, and 63 general practices in the UK National Health Service (NHS) were included in a large, pragmatic cluster randomised trial comparing screen and treat fall prevention interventions. The short postal screener was sent to all participants in the trial intervention arms as an A4 sheet to be completed and returned to the GP (n = 6,580). The postal screener items were embedded in the baseline pre-randomisation postal questionnaire for all arms of the trial (n = 9,808). We assessed discrimination and calibration using area under the curve (AUC). We identified additional predictors using data from the control arm and applied these coefficients to internal validation models in the intervention arm participants. We used logistic regression to identify additional predictor variables.

Findings

A total of 10,743 falls and 307 fractures were reported over 12 months. Over one third of participants 3,349/8,136 (41%) fell at least once over 12 month follow up. Response to the postal screener was high (5,779/6,580; 88%). Prediction models showed similar discriminatory ability in both control and intervention arms, with discrimination values for any fall AUC 0.67 (95% CI 0.65 to 0.68), and recurrent falls (AUC 0.71; 95% CI 0.69, 0.72) but poorer discrimination for fractures (AUC 0.60; 95% CI 0.56, 0.64). Additional predictor variables improved prediction of falls but had modest effect on fracture, where AUC rose to 0.71 (95% CI 0.67 to 0.74). Calibration slopes were very close to 1.

Conclusion

A short fall risk postal screener was acceptable for use in primary care but fall prediction was limited, although consistent with other tools. Fracture and fall prediction were only partially reliant on fall risk although were improved with the additional variables.
The density of bone marrow mononuclear cells and CD34+ cells in patients with three neurologic conditions
Authors: Nguyen Kien Trung , Hoang Nhung Thi My , Nguyen Hoang-Phuong , Nguyen Thanh Liem
Published: January 2023

Background

This study aimed to identify the density of mononuclear cells (MNCs) and CD34+ cells in the bone marrow of patients with three neurologic conditions.

Methods

The study included 88 patients with three neurologic conditions: 40 with cerebral palsy (CP) due to oxygen deprivation (OD), 23 with CP related to neonatal icterus (NI), and 25 with neurological sequelae after traumatic brain injury. Bone marrow aspiration was conducted from the patients’ bilateral anterior iliac crest under general anesthesia in an operating theater. MNCs were isolated by Ficoll gradient centrifugation and then infused intrathecally.

Results

There was a significant difference in the average MNC per ml and percentage of CD34+ cells by the type of disease, age group, and infusion time (p value < 0.05). The multivariable regression model showed the percentage of CD34+ association with the outcome (gross motor function 88 items- GMFM-88) in patients with CP.

Conclusions

The density of MNCs was 5.22 million cells per mL and 5.03% CD34+ cells in patients with three neurologic conditions. The highest density of MNCs in each ml of bone marrow was found in patients with CP due to OD, whereas the percentage of CD34+ cells was the highest among patients with CP related to NI.
Aneurysmal subarachnoid hemorrhage with PFBC and beta thalassemia: a case report
Authors: Yu Kuangyang , Pang Jinwei , Yang Xiaobo , Peng Jianhua , Jiang Yong
Published: January 2023

Background

Primary familial brain calcification (PFBC), habitually called Fahr’s disease, is characterized by bilateral calcification of the basal ganglia, accompanied by extensive calcification of the cerebellar dentate nucleus, brainstem cerebrum, and cerebellum at the grey-white matter junction. However, there are few reports about PFBC with aneurysmal subarachnoid hemorrhage (aSAH) and thalassemia.

Case presentation

We describe a patient admitted to the hospital with an acute deterioration in the level of consciousness with no history of neuropsychiatric features or movement disorders. After computed tomography (CT) and CT angiography (CTA), the patient was diagnosed with PFBC, accompanied by aneurysmal subarachnoid haemorrhage (aSAH), intracranial haemorrhage (ICH), and hemoglobin electrophoresis suggested beta-thalassemia. This patient underwent craniotomy aneurysm clipping and intracranial hematoma removal.

Conclusions

For patients with PFBC, we should pay attention to their blood pressure and intracranial vascular conditions. The CTA is necessary to clarify the cerebrovascular conditions of the patient, especially when combined with hypertension and persistent headache or other related prodromal symptoms of cerebrovascular disease.
Epidemiology of obesity and high blood pressure among school-age children from military families: the largest report from our region
Authors: Dormanesh Banafshe , Arasteh Peyman , Daryanavard Roya , Mardani Maryam , Ahmadi Meysam , Nikoupour Hamed
Published: January 2023

Background

For the first time, we aimed to determine the epidemiology and associated factors of obesity and hypertension among children of military families in our region.

Methods

In this multi-centered study, children between the ages of 5 to 12 years old, entered the study. Data on baseline and clinical characteristics, history of disease and anthropometric measurements, were collected.

Results

Among 504 children, 44.2% were males. Mean (SD) age of participants was 7.9 ± 1.9 years. Overall, 5% were obese and 9.9% were overweight. In total, 16.3% had elevated BP, 12.5% had stage one and 0.2% had stage two hypertension.

Age (beta = 0.306, OR = 1.35, 95% CI:1.14—1.61), obesity/overweight (OR = 5.58, 95% CI:2.59—12.0), history of hypertension in mother (OR = 43.24, 95% CI:5.99—312.11), low birth weight (OR = 7.96, 95% CI:2.59—12.0), physical activity (OR = 0.27, 95% CI:0.10—0.72), and consumption of fast food more than once a week (OR = 3.36, 95% CI:1.82—6.19), were associated with risk of hypertension.

Furthermore, age (beta = 0.346, OR = 1.41, 95% CI:1.21—1.64), history of childhood obesity in the father (OR = 3.78, 95% CI: 1.77—8.06) and mother (OR = 2.44, 95% CI:1.07—5.56), and physical activity (OR = 0.27, 95% CI:0.11—0.66), were associated with obesity.

Conclusion

Age, obesity/overweight, history of hypertension in the mother, birth weight, physical activity, and consumption of fast food, were associated with risk of hypertension. Moreover, age, history of childhood obesity in parents, and physical activity, were associated with obesity.

Furthermore, we found that school-age children in military families have higher rates of hypertension and overweight compared to other reports from our region.
Clinical characteristics of 683 children and adolescents, aged 0–18 years, newly diagnosed with type 1 diabetes mellitus in Henan Province: a single-center study
Authors: Huang Ai , Chen Qiong , Yang Wei , Cui Yan , Wang Qingzhi , Wei Haiyan
Published: January 2023

Background

Type 1 diabetes mellitus (T1DM) is a common chronic systemic disease that threatens the health of children worldwide. Diabetic ketoacidosis (DKA) is the most severe acute complication of diabetes and can lead to death. This study aimed to explore the epidemiological features, clinical manifestations, and risk factors for DKA in children and adolescents newly diagnosed with T1DM in the Department of Endocrinology of the Children’s Hospital of Henan Province.

Methods

Medical records of 683 children and adolescents newly diagnosed with T1DM in our center from March 2014 to November 2021 were retrospectively analyzed. The data included the general condition, laboratory indexes, and clinical symptoms. The patients were divided into three groups according to age: Group I, 0–3 years; Group II, 4–9 years; and Group III, 10–18 years.

Results

The incidence of DKA was 62.96% and was highest in Group I. Group I had the lowest C-peptide and hemoglobin A1c, but the highest blood glucose at first diagnosis, and 25-hydroxyvitamin D3 levels, hospitalization lengths, and medical costs. 25.5% of the children were delayed in diagnosis. Logistic regression analysis showed that elevated HbA1c levels and hyperglycemia were independent risk factors for DKA. On the other hand, C-peptide and 25- hydroxyvitamin D were protective factors for DKA.

Conclusions

The incidence of DKA among children and adolescents in the Henan Province is very high. Moreover, DKA can be easily delayed in diagnosis. Newly diagnosed infants with T1DM are more likely to present with DKA, suffer more severe metabolic disorders, endure longer hospital stays, and accrue higher medical costs.
Exploration of the external and internal factors that affected learning effectiveness for the students: a questionnaire survey
Authors: Chen Ding-Ping , Chang Su-Wei , Burgess Annette , Tang Brian , Tsao Kuo-Chien , Shen Chia-Rui , Chang Pi-Yueh
Published: January 2023

Learning effectiveness may be affected by internal and external factors, including personal attitude, motivations, learning skills, learning environment and peer pressure. This study sought to explore potential factors on students who majored in medical technology. The 106 students who completed their internship at Chang Gung Memorial Hospital were enrolled in this study. A written questionnaire was analyzed to explore the relationship between potential factors and learning effectiveness. The strength of relationship between the outcome and each factor was evaluated using Spearman correlation coefficients. A multiple linear regression model was constructed to assess how those factors affected learning effectiveness altogether. The results indicated that the learning effectiveness of the students mainly depended on three factors: the “extracurricular studies” and “willingness to cooperate” were positively associated with learning effectiveness. However, the “weakened motivation due to uncertainty” is negatively associated with learning effectiveness. We suggested that the educators can understand the uncertainty of students about the future. Additionally, the projects that require joint cooperation and discussion need to be given. The most important thing is that students should be able to integrate the learning content instead of rote.
The equine patellar ligaments and the infrapatellar fat pad – a microanatomical study
Authors: Fjordbakk Cathrine Taule , Marques-Smith Patrick
Published: January 2023

Background

Interpretation of patellar ligament (PL) ultrasonography may be difficult, as hypoechoic or heterogenous echogenicity are common findings. Verifying suspected disease of equine PLs by histopathology is also problematic as descriptions of normal PL vascularity and histology are scarce. The current study describes the PL and infrapatellar fat pad (IFP) vascular pattern from computed tomography scans of barium perfused normal equine specimens (n = 8; age 10 days to 18 years), as well as routine histology to serve as a reference for future investigations into PL pathology and IFP disease.

Results

The PLs received a bipolar blood supply. Vascular architecture consisted of numerous distinct longitudinal vessels with several horizontal connections, which branched into extensive latticeworks of smaller vessels throughout the ligaments. Several vascular connections between the PLs and the IFP were identified. One distinct longitudinal vessel was seen entering each of the IFP lobes at the distocranial aspect, branching extensively into lobar vascular networks which anastomosed by several horizontal branches at the mid portion of the IFP where the two lobes merge. Histologically, there were large variations in PL interfascicular endotenon thickness, vascularity and fatty infiltration; these parameters increased with age for the intermediate and medial PL. Areas of metaplastic tenocytes / chondroid metaplasia were identified in all investigated adult medial PLs; in 2/7 in the intermediate PL and in 4/7 in the lateral PL. The adult IFP consisted of white unilocular adipose tissue, organized in lobules separated by thin connective tissue septa increasing in thickness towards the periphery and the distocentral aspect.

Conclusions

The equine PLs and IFP are highly vascularized structures with ample vascular connections suggestive of crosstalk. This, together with the large variation in PL endotenon thickness, vascularity and fatty infiltration, should be taken into consideration when assessing potential PL histopathology as these changes increase with age and are found in horses without clinical signs of stifle disease. Metaplastic tenocytes / chondroid metaplasia should be considered a normal finding throughout the medial PL and is not age dependent. The role of the equine IFP in stifle disease has yet to be elucidated.
Clinical characteristics and outcomes of gastrointestinal stromal tumor patients receiving surgery with or without TKI therapy: a retrospective real-world study
Authors: Wang Lingquan , Ni Zhentian , Xu Wei , Mei Yu , Li Chen , Zhu Zhenggang , Liu Wentao
Published: January 2023

Purpose

To retrospectively analyze the clinical characteristics of patients undergoing surgical treatment for gastrointestinal stromal tumors (GISTs) in Ruijin Hospital and explore the relevant prognosis clinical factors after surgical treatment.

Methods

We screened out 1015 patients with GISTs diagnosed and treated during January 2010 to December 2019. We performed univariate analysis by the log-rank test and multivariate analysis by COX regression. The Kaplan–Meier method was used to estimate the disease-free survival (DFS) and overall survival (OS) of the whole group.

Results

All 1015 patients in the whole group received radical surgery, and the proportion of patients with high, intermediate, and low risk was 31.1%, 21.7%, and 47.3%, respectively. Among the 480 low-risk patients, surgery could achieve radical therapy; only the Ki-67 index was related to DFS and OS (DFS: p = 0.032, OS: p = 0.009) among the 140 intermediate-risk patients with tumors located in the stomach, whether received Tyrosine kinase inhibitors (TKIs) therapy did not affect the prognosis of patients (DFS: p = 0.716, OS: p = 0.848). Among the 331 high-risk patients, those with non-gastric tumors (those outside the stomach, duodenum, and small intestine, HR 1.55, 95% CI 1.19–2.00, p < 0.001), tumor diameter > 10 cm (hazard ratio, HR 2.63, 95% confidence interval, CI 2.09–4.03, p < 0.001), as well as high-risk patients with mitotic rate > 10/50 HPF (HR 2.74, 95% CI 2.00–3.76, p < 0.001), the overall prognosis was obviously worse than that of other patients. For some high-risk patients, prolonged postoperative imatinib therapy could significantly improve the survival of patients (HR 0.43, 95% CI 0.15–0.66, p < 0.001).

Conclusions

For the vast majority of GIST patients, surgery can be curative; but in intermediate-risk patients, the Ki-67 index and postoperative TKI treatment are closely related to prognosis. For intermediate-risk patients whose primary tumor is the stomach, the value of TKI-targeted therapy after surgery seem be not necessary in our study. However, for some high-risk patients, the prognosis of patients can be improved by appropriately prolonging the treatment time of TKI.