bluuebunny/crossref_metadata_2025 huggingface dataset:
Research Enterprise of the Congenital Heart Surgeons’ Society 2018 to 2023: History, Accomplishments, Transformation, and Challenges
Authors: DeCampli William M.
Published: September 2023

The history of the research arm of the Congenital Heart Surgeons’ Society (CHSS) through 2017 was contained within two prior publications that covered CHSS history in general. The present article is the first to focus explicitly on the research enterprise, with emphasis on the period 2018 to 2023. During this time, the challenges of continuing to build multiple cohorts with lifelong follow-up and to transform the enterprise to a premiere research organization became manifest. Although continuing its commitment to produce impactful research results and to educate the Kirklin/Ashburn Fellow, the research team devoted considerable effort to defining the problems of cohort relevance, workflow, data management, long-term patient follow-up, CHSS member engagement, and the regulatory burden. The team wrote a proposal outlining ways to solve the challenges. A major change from a single-institution “Data Center” to a two-institution Center for Research & Quality (CRQ) was made, assuring increased faculty members and resources. The proposed changes to structure and process began execution in mid-2022. A second Kirklin/Ashburn Fellowship position was created. Between 2018 and 2022, the CRQ produced 17 publications and launched five new research initiatives. This article chronicles the exciting five-year period in which the CHSS research enterprise began a transformation with the intent to become the premiere research organization in the world in the specialty of congenital cardiac surgery.
The Early History of the Congenital Heart Surgeons’ Society
Authors: Mavroudis Constantine , Williams William G.
Published: September 2023

The concept of a new organization for congenital heart surgeons in North America to discuss their difficult cases and offer each other potential solutions began in 1973. This article pays tribute to the founders of the Congenital Heart Surgeons’ Society and offers insight into the desire of these surgeons to improve clinical outcomes for children with congenital heart disease.
From “Informal Club” to “Authoritative Voice”: The Progression of CHSS to Become the Face of Congenital Heart Surgery
Authors: Dearani Joseph A.
Published: September 2023

This article reviews the transformation of the Congenital Heart Surgeons’ Society from an informal organization to become the leading authority in congenital heart surgery. By advocating for public reporting of patient outcomes, education, and research CHSS is now recognized as the premier organization for advancing the science and practice of congenital heart surgery.
Recommendations for Centers Performing Pediatric Heart Surgery in the United States
Authors: Backer Carl L. , Overman David M. , Dearani Joseph A. , Romano Jennifer C. , Tweddell James S. , Ram Kumar S. , Marino Bradley S. , Bacha Emile A. , Jaquiss Robert D. B. , Zaidi Ali N. , Gurvitz Michelle , Costello John M. , Pierick Trudy A. , Ravekes William J. , Reagor James A. , St. Louis James D. , Spaeth James , Mahle William T. , Shin Andrew Y. , Lopez Keila N. , Karamlou Tara , Welke Karl F. , Bryant Roosevelt , Adil Husain S. , Chen Jonathan M. , Kaza Aditya , Wells Winfield J. , Glatz Andrew C. , Cohen Mitchell I. , McElhinney Doff B. , Parra David A. , Pasquali Sara K.
Published: September 2023

Care and outcomes for the more than 40,000 patients undergoing pediatric and congenital heart surgery in the United States annually are known to vary widely. While consensus recommendations have been published across numerous fields as one mechanism to promote a high level of care delivery across centers, it has been more than two decades since the last pediatric heart surgery recommendations were published in the United States. More recent guidance is lacking, and collaborative efforts involving the many disciplines engaged in caring for these children have not been undertaken to date. The present initiative brings together professional societies spanning numerous care domains and congenital cardiac surgeons, pediatric cardiologists, nursing, and other healthcare professionals from diverse programs around the country to develop consensus recommendations for United States centers. The focus of this initial work is on pediatric heart surgery, and it is recommended that future efforts focus in detail on the adult congenital population. We describe the background, rationale, and methodology related to this collaborative effort, and recommendations put forth for Essential Care Centers (essential services necessary for any program), and Comprehensive Care Centers (services to optimize comprehensive and high-complexity care), encompassing structure, process, and outcome metrics across 14 domains.
Comparison Between Relative Efficacy of Erector Spinae Plane Block and Caudal Epidural Block for Postoperative Analgesia in Lumbar Fusion Surgery- A Prospective Randomized Controlled Study
Authors: Patel Yogin , Ramachandran Karthik , Shetty Ajoy Prasad , Chelliah Sekar , Subramanian Balavenkat , Kanna Rishi Mugesh , Shanmuganathan Rajasekaran
Published: September 2023

Study Design

Prospective, randomized controlled double-blinded study.

Objective

To compare the relative efficacy of ultrasound-guided ESPB and CEB for postoperative analgesia after a single-level lumbar fusion surgery and compared it with conventional multimodal analgesia.

Methods

81 patients requiring single-level lumbar fusion surgery were randomly allocated into 3 groups (ESPB group, CEB group, and the control group). Demographic and surgical data (blood loss, duration of surgery, perioperative total opioid consumption, muscle relaxants used) were assessed. Postoperatively, the surgical site pain, alertness scale, satisfaction score, time to mobilization, and complications were recorded.

Results

The total opioid consumption in the first 24 hours was significantly lower in both the block groups than in the control group (103.70 ± 13.34 vs 105 ± 16.01 vs 142.59 ± 40.91mcg; P < .001). The total muscle relaxant consumption was also significantly less in block groups compared to controls (50.93 ± 1.98 vs 52.04 ± 3.47 vs 55.00 ± 5.29 mg; P < .001). The intraoperative blood loss was significantly less in both the block group (327.78 ± 40.03 mL, 380.74 ± 77.80 mL) than the control group (498.89 ± 71.22 mL) ( P < .001). Among the block groups, the immediate postoperative pain relief was better in the CEB group, however, the ESPB group had a longer duration of postoperative pain relief.

Conclusion

Both ESPB and CEB produce adequate postoperative analgesia after lumbar fusion however the duration of action was significantly longer in the ESPB group with relatively shorter surgical time and lesser blood loss compared to the CEB group.
Resection of Orbital Myxoma With Magnetic Resonance Imaging Evidence of Ethmoid Sinus Origin: Case Report and Review of 20 Patients in the Literature
Authors: Matsuo Toshihiko , Tanaka Takehiro
Published: September 2023

A 41-year-old woman showed a palpable mass at the superonasal orbital edge on the right side. Magnetic resonance imaging demonstrated a lobulated fluid-containing tubular mass which extended anteriorly to posteriorly along the medial orbital wall, nasal to the eyeball. She was followed once a year for 8 years until the age of 49 years when she decided to undergo surgical resection because of the enlarged mass. The lobulated large mass was resected and the pathology showed sparsely distributed spindle cells, positive for CD34, in alcian blue-positive mucous substances, indicative of myxoma. Postoperative magnetic resonance imaging showed residual lobulated tubular mass along the optic nerve on the medial side and superior to the eyeball. The residual orbital mass showed stable structure with more evident connection with the ethmoid sinus lesion, suggestive of the ethmoid origin, in 12 years until the age of 61 years. In the review of 20 patients with orbital myxomas in the literature, in addition to this case, roughly classified locations in the orbit were retrobulbar in 8 patients, on the lateral side of the orbit in 4, on the superior side in 6, on the medial side in 1 (this patient), and in the orbit with no specific description in 2. In pathological examinations, immunohistochemistry was not done in 8 patients, done but all negative in 2, and positive in 11 patients: nerve sheath myxoma was diagnosed in 3 patients based on positive S100 staining. Orbital myxoma is rare but considered in differential diagnosis of orbital masses.
Design, Implementation, and Evaluation of an Intensive Course on Issues in Women's Health and Gender-Based Medicine
Authors: Acosta-Martínez Maricedes , Chandran Latha , Cohen Siobhan , Biegon Anat
Published: September 2023

OBJECTIVES

Sex and gender have profound effects on disease prevalence, presentation, and outcome, but these issues are not covered in depth in standard medical school curricula. To improve understanding of women's health, an intensive 1-month class was offered to fourth-year medical students.

METHODS

The class combined background lectures on the biological and social determinants of women's health with presentations on specific medical conditions by practicing clinicians and students. Students’ anonymous responses to end-of-class evaluation used by Stony Brook University School of Medicine as well as pre- and post-class answers to the question “why are women twice as likely to go to the doctor” were analyzed using quantitative, descriptive, and qualitative approaches.

RESULTS

The class was given between 2017 and 2022 to a total of 154 students. Course evaluations were submitted by 133 students. Over 80% of responders ranked the class as good or excellent and many expressed surprise about how much sex and gender influence health. Furthermore, before taking the class responders favored gender stereotypes (82%) and OB/GYN visits (56%) as the main reasons why women utilize healthcare more often than men, whereas only 31% of post-class answers included these factors ( p < .0001), which were replaced by others including misdiagnosis, high rate of adverse effects of medications, implicit bias, and longevity.

CONCLUSION

A dedicated class given to students at the end of their undergraduate medical training increased awareness and knowledge of the effects of sex and gender on women's health.
The Therapeutic Use of Plasma from Covid-19 Convalescent Patients
Authors: Duque-Rodríguez Jorge , Ishida-Gutiérrez Cecilia , Espino-Solis Gerardo Pavel
Published: September 2023

The outbreak of coronavirus disease (COVID-19) requires multidisciplinary teamwork to explore new methodological designs with the aim of approaching treatment strategies on different fronts. In principle, the rationale for the use of convalescent plasma is consistent from both an efficacy and safety point of view. Although there are still few completed randomized trials, the latest published results regarding efficacy are inconclusive. Immediate studies should target convalescent plasma preparations with a high titer of anti–SARS-CoV-2 antibodies and given early in the disease course. Regarding safety, its use with minimum risk factors or side effects is well documented. However, comparative research studies that involve the determination of antibody titers to support efficacy are required. Moreover, regulatory agencies and national blood systems should take a positive position via evaluation, supervisory, and control systems to maintain a blood-tissue store that meets the needs of the community and its hospitals.
A Review of Iron Overload in Beta-Thalassemia Major, and a Discussion on Alternative Potent Iron Chelation Targets
Authors: Yadav Piyush Kumar , Singh Ajay Kumar
Published: September 2023

For years, arrhythmias have been well documented in the medical arena as a cardiovascular consequence of iron overload (IO). They are thought to be linked to the accumulation of iron in the myocardium. Iron is the earth's fourth most abundant element and the second most plentiful metal (after aluminium). When it comes to biology, iron fills two roles: it's necessary and it's poisonous. It is necessary as a trace iron element since it is found in hemoproteins such as haemo-globin, but it is poisonous in excess amounts of the ability to produce free radicals, which can harm the biological system. The high prevalence of cardiomyopathy in patients with hemosiderosis, particularly in cases of transfusional iron overload, strongly suggests that iron deposition in the heart plays a key role in the development of heart failure. Thalassemia major, which necessitates blood transfusion as a treatment, absorbs a large amount of iron in the patient's duodenum. Moreover, Iron Overload causes a threat to vital organs such as the liver and, initiates events of the pathologic progression involving apoptosis, fibrosis, and ultimately cardiac dysfunction. Furthermore, we discuss the iron overload issue as it relates to beta-thalassemia major patient blood transfusion treatment, as well as key individuals accountable for iron excess that ultimately leads to cardiomyopathy.
Venous Thromboembolism Prophylaxis with Enoxaparin Versus Unfractionated Heparin in Patients with Low Body Weight
Authors: Kaylor David Michael , Wade Regan Merrell , Chappell Kathryn Brinkley , Niemann Meredith Huff , VanArsdale Vanessa Marie
Published: September 2023

Background

Although reduced doses of enoxaparin have been studied in low body weight patients, no study has directly compared enoxaparin to unfractionated heparin for venous thromboembolism (VTE) prophylaxis in this population.

Objective

To determine the most safe and efficacious parenteral venous thromboembolism prophylaxis regimen for low body weight patients.

Design

Retrospective cohort.

Methods

Hospitalized patients weighing < 55 kg receiving either enoxaparin or unfractionated heparin for VTE prophylaxis over a period of two and a half years were evaluated. Primary outcomes included rates of VTE and overall bleeding events. Secondary outcomes included rates of major and clinically relevant minor bleeding. Dosing regimens were analyzed to determine associations between dose, weight, creatinine clearance, VTE, and bleeding events. Primary and secondary outcomes were evaluated using Chi squared and Fischer's Exact tests.

Results

Three hundred and sixty-one patients contributed 400 episodes of VTE prophylaxis. Most patients were female (88%), had a Padua score ≥ 4 (82%) and were admitted to medical/surgical units (76%). VTE rates were 0.4% in patients receiving enoxaparin and 2.5% in patients receiving unfractionated heparin ( P = 0.334). Bleeding rates were 12% and 11% in the enoxaparin and unfractionated heparin groups, respectively ( P = 1). Patients receiving enoxaparin 30 mg daily had bleeding rates of 7.6% compared to 14.7% in patients receiving 40 mg daily ( P = 0.134). Patients receiving heparin twice daily had no bleeding events compared to 12.9% of patients receiving heparin three times daily ( P = 0.222).

Conclusion

Overall, no difference in VTE or bleeding rates were found between patients weighing < 55 kg receiving enoxaparin versus unfractionated heparin, and there was no difference in bleeding or VTE events in the patients receiving enoxaparin 30 mg daily. Due to this, empirically reducing the dose of enoxaparin for VTE prophylaxis appears reasonable and safe in patients weighing < 55 kg.
Consumer Jurisdiction and Choice of Law Rules in European and Chinese Private International Law
Authors: Chen Zhen
Published: September 2023

This article compares consumer jurisdiction and choice of law issues in China and the EU. It aims to answer the following questions. What is the notion of consumer? Are farmers, package travel tourists and timeshare tourists consumers? Are dual-purpose contracts consumer contracts? Is a consumer jurisdiction rule needed in China and if yes, under what ground and with what conditions? Is choice of court agreement in consumer contracts valid? How to limit the exercise of party autonomy and what role mandatory provisions may play? Shall consumer contract and tort claims be subject to the same applicable law? Based on a comparative analysis with European law, this article concludes that to improve cross-border consumer protection, China should reform its law to include package travel contracts and timeshare contracts into consumer contracts and determine the nature of dual-purpose contracts pursuant to their primary purpose. Moreover, the current limitation on party autonomy should be lifted by providing freedom to both parties and relying on mandatory provisions as a safety valve. The consumer choice of law rule and its interaction with the general contract choice of law and tort choice of law rule needs to be reexamined.
EGR1-mediated metabolic reprogramming to oxidative phosphorylation contributes to ibrutinib resistance in B-cell lymphoma
Authors: Liu Yunxia , Kimpara Shuichi , Hoang Nguyet M. , Daenthanasanmak Anusara , Li Yangguang , Lu Li , Ngo Vu N. , Bates Paul D. , Song Longzhen , Gao Xiaoyue , Bebel Samantha , Chen Madelyn , Chen Ruoyu , Zhang Xiyu , Selberg Paul E. , Kenkre Vaishalee P. , Waldmann Thomas A. , Capitini Christian M. , Rui Lixin
Published: September 2023

The use of Bruton tyrosine kinase inhibitors, such as ibrutinib, to block B-cell receptor signaling has achieved a remarkable clinical response in several B-cell malignancies, including mantle cell lymphoma (MCL) and diffuse large B-cell lymphoma (DLBCL). Acquired drug resistance, however, is significant and affects the long-term survival of these patients. Here, we demonstrate that the transcription factor early growth response gene 1 (EGR1) is involved in ibrutinib resistance. We found that EGR1 expression is elevated in ibrutinib-resistant activated B-cell–like subtype DLBCL and MCL cells and can be further upregulated upon ibrutinib treatment. Genetic and pharmacological analyses revealed that overexpressed EGR1 mediates ibrutinib resistance. Mechanistically, TCF4 and EGR1 self-regulation induce EGR1 overexpression that mediates metabolic reprogramming to oxidative phosphorylation (OXPHOS) through the transcriptional activation of PDP1, a phosphatase that dephosphorylates and activates the E1 component of the large pyruvate dehydrogenase complex. Therefore, EGR1-mediated PDP1 activation increases intracellular adenosine triphosphate production, leading to sufficient energy to enhance the proliferation and survival of ibrutinib-resistant lymphoma cells. Finally, we demonstrate that targeting OXPHOS with metformin or IM156, a newly developed OXPHOS inhibitor, inhibits the growth of ibrutinib-resistant lymphoma cells both in vitro and in a patient-derived xenograft mouse model. These findings suggest that targeting EGR1-mediated metabolic reprogramming to OXPHOS with metformin or IM156 provides a potential therapeutic strategy to overcome ibrutinib resistance in relapsed/refractory DLBCL or MCL.
Metagenomic sequencing reveals altered gut microbial compositions and gene functions in patients with non-segmental vitiligo
Authors: Luan Mei , Niu Mengtian , Yang Pengju , Han Dan , Zhang Yudan , Li Weizhe , He Qiannan , Zhao Yixin , Mao Binyue , Chen Jianan , Mou Kuanhou , Li Pan
Published: September 2023

Background

Vitiligo has been correlated with an abnormal gut microbiota. We aimed to systematically identify characteristics of the gut microbial compositions, genetic functions, and potential metabolic features in patients with non-segmental vitiligo.

Methods

Twenty-five patients with non-segmental vitiligo and 25 matched healthy controls (HCs) were enrolled. Metagenomic sequencing and bioinformatic analysis were performed to determine the gut microbiota profiles. Differences in gut microbiota diversity and composition between patients with vitiligo and HCs were analyzed. Gene functions and gut metabolic modules were predicted with the Kyoto Encyclopedia of Gene and Genomes (KEGG) and MetaCyc databases.

Results

Compared with HCs, alpha diversity of intestinal microbiome in vitiligo patients was significantly reduced. At the species level, the relative abundance of Staphylococcus thermophiles was decreased, and that of Bacteroides fragilis was increased in patients with vitiligo compared with those of the HCs. Linear discriminant analysis (LDA) effect size (LEfSe) analysis revealed representative microbial markers of Lachnospiraceae_bacterium_BX3, Massilioclostridium_coli, TM7_phylum_sp_oral_taxon_348 and Bacteroides_fragilis for patients with vitiligo. KEGG gene function analysis showed that the NOD-like receptor signaling pathway was significantly enriched in patients with vitiligo. Gut metabolic modules (GMMs) analysis showed that cysteine degradation was significantly down-regulated, and galactose degradation was up-regulated in patients with vitiligo. A panel of 28 microbial features was constructed to distinguish patients with vitiligo from HCs.

Conclusions

The gut microbial profiles and genetic functions of patients with vitiligo were distinct from those of the HCs. The identified gut microbial markers may potentially be used for earlier diagnosis and treatment targets.
A novel role for Helicobacter pylori cytotoxin-associated gene A in negative regulation of autophagy in human gastric cells
Authors: Sakatani Akihiko , Hayashi Yoshito , Saiki Hirotsugu , Kato Minoru , Uema Ryotaro , Inoue Takanori , Kimura Keiichi , Yoshii Shunsuke , Tsujii Yoshiki , Shinzaki Shinichiro , Iijima Hideki , Takehara Tetsuo
Published: September 2023

Background

Autophagy plays an important role in carcinogenesis and tumor progression in many cancers, including gastric cancer. Cytotoxin-associated gene A (CagA) is a well-known virulent factor in Helicobacter pylori (H. pylori) infection that plays a critical role in gastric inflammation and gastric cancer development. However, its role in autophagy during these processes remains unclear. Therefore, we aimed to clarify the role of CagA in autophagy in CagA-related inflammation.

Methods

We evaluated the autophagic index of AGS cells infected with wild-type cagA-positive H. pylori (Hp-WT) and cagA-knockout H. pylori (Hp-ΔcagA) and rat gastric mucosal (RGM1) cells transfected with CagA genes. To identify the mechanisms underlying the down regulation of autophagy in AGS cells infected with H. pylori, we evaluated protein and mRNA expression levels of autophagy core proteins using western blotting and quantitative reverse transcription-polymerase chain reaction (RT-PCR). To determine whether autophagy induced the expression of the pro-inflammatory mediator, cyclooxygenase-2 (COX-2), we evaluated COX-2 expression in AGS cells treated with an autophagy inducer and inhibitor and infected with H. pylori. In addition, we evaluated whether COX-2 protein expression in AGS cells influenced beclin-1 (BECN1) expression with si-RNA transfection when infected with H. pylori.

Results

Autophagic flux assay using chloroquine showed that autophagy in AGS cells was significantly suppressed after H. pylori infection. The autophagic index of AGS cells infected with Hp-WT was decreased significantly when compared with that in AGS cells infected with Hp-ΔcagA. The autophagic index of RGM1 cells transfected with CagA was lower, suggesting that CagA inhibits autophagy. In addition, BECN1 expression levels in AGS cells infected with Hp-WT were reduced compared to those in AGS cells infected with Hp-ΔcagA. Furthermore, COX-2 expression in AGS cells infected with H. pylori was controlled in an autophagy-dependent manner. When AGS cells were transfected with small interfering RNA specific for BECN1 and infected with Hp-WT and Hp-ΔcagA, COX-2 was upregulated significantly in cells infected with Hp-ΔcagA.

Conclusions

In conclusion, the H. pylori CagA protein negatively regulated autophagy by downregulating BECN1. CagA-induced autophagy inhibition may be a causative factor in promoting pro-inflammatory mediator production in human gastric epithelial cells.
Group Model Building on causes and interventions for falls in Singapore: insights from a systems thinking approach
Authors: Lai Wei Xuan , Chan Angelique Wei-Ming , Matchar David Bruce , Ansah John Pastor , Lien Christopher Tsung Chien , Ismail Noor Hafizah , Wong Chek Hooi , Xu Tianma , Ho Vanda Wen Teng , Tan Pey June , Lee June May Ling , Sim Rita Siew Choo , Manap Normala
Published: September 2023

Background

Falls in older adults are the result of a complex web of interacting causes, that further results in other physical, emotional, and psychological sequelae. A conceptual framework that represents the reciprocal dynamics of these causal factors can enable clinicians, researchers, and policymakers to clarify goals in falls intervention in older adults.

Methods

A Group Model Building (GMB) exercise was conducted with researchers and clinicians from academic units and public healthcare institutes in Singapore. The aim of the exercise was to produce a shared visual representation of the causal structure for falls and engage in discussions on how current and future falls intervention programmes can address falls in the older adults, especially in the Asian context. It was conducted in four steps: 1) Outlining and prioritising desirable patient outcomes, 2) Conceptual model building, 3) Identifying key intervention elements of effective falls intervention programmes, 4) Mapping of interventions to outcomes. This causal loop diagram (CLD) was then used to generate insights into the current understanding of falls causal relationships, current efforts in falls intervention in Singapore, and used to identify gaps in falls research that could be further advanced in future intervention studies.

Results

Four patient outcomes were identified by the group as key in falls intervention: 1) Falls, 2) Injurious falls, 3) Fear of falling, and 4) Restricted mobility and life space. A CLD of the reciprocal relationships between risk factors and these outcomes are represented in four sub-models: 1) Fear of falling, 2) Injuries associated with falls, 3) Caregiver overprotectiveness, 4) Post-traumatic stress disorder and psychological resilience. Through this GMB exercise, the group gained the following insights: (1) Psychological sequelae of falls is an important falls intervention outcome. (2) The effects of family overprotectiveness, psychological resilience, and PTSD in exacerbating the consequences of falls are not well understood. (3) There is a need to develop multi-component falls interventions to address the multitude of falls and falls related sequelae.

Conclusion

This work illustrates the potential of GMB to promote shared understanding of complex healthcare problems and to provide a roadmap for the development of more effective preventive actions.
Cyclophosphamide induced early remission and was superior to rituximab in idiopathic membranous nephropathy patients with high anti-PLA2R antibody levels
Authors: Xue Cheng , Wang Jian , Pan Jinyan , Liang Congdie , Zhou Chenchen , Wu Jun , Song Shuwei , Cui Linlin , Zhang Liming , Liu Yawei , Dai Bing
Published: September 2023

Rituximab (RTX) and cyclophosphamide (CYC) based treatments are both recommended as first-line therapies in idiopathic membranous nephropathy (IMN) by KDIGO 2021 guideline. However, the efficacy of RTX vs. CYC-based treatments in IMN is still controversial. We performed this systemic review and meta-analysis registered in PROSPERO (CRD 42,022,355,717) by pooling data from randomized controlled trials or cohort studies in IMN patients using the EMBASE, PubMed, and Cochrane libraries (till Orc 1, 2022). The primary outcomes were the complete remission (CR) rate + partial remission (PR) rate. CR rate, immunologic response rate, relapse rate, and the risk of serious adverse events (SAE) were secondary outcomes. Eight studies involving 600 adult patients with IMN were included with a median follow-up duration of 12 to 60 months. RTX induced a similar overall remission rate compared with CYC (RR 0.88, 95% CI: 0.71, 1.09,P = 0.23). At the follow-up time of 6 months, RTX was associated with a lower CR + PR rate compared with CYC (RR 0.67, 95% CI: 0.52, 0.88,P = 0.003). Moreover, RTX might be less effective in inducing CR + PR than CYC treatment in IMN patients with high antiPLA2R antibody levels (RR 0.67, 95% CI: 0.48, 0.94,P = 0.02). The occurrences of CRs, relapse rates, immunologic response rates, and SAE were not significantly different between RTX and CYC, respectively. In conclusion, although the long-term efficacy and safety of CYC compared to RTX were comparable, CYC might respond faster and be more advantageous in IMN patients with high antiPLA2R antibody titers.
Health related quality of life during dialysis modality transitions: a qualitative study
Authors: Dumaine Chance S. , Fox Danielle E. , Ravani Pietro , Santana Maria J. , MacRae Jennifer M.
Published: September 2023

Background

Modality transitions represent a period of significant change that can impact health related quality of life (HRQoL). We explored the HRQoL of adults transitioning to new or different dialysis modalities.

Methods

We recruited eligible adults (≥ 18) transitioning to dialysis from pre-dialysis or undertaking a dialysis modality change between July and September 2017. Nineteen participants (9 incident and 10 prevalent dialysis patients) completed the KDQOL-36 survey at time of transition and three months later. Fifteen participants undertook a semi-structured interview at three months. Qualitative data were thematically analyzed.

Results

Four themes and five sub-themes were identified: adapting to new circumstances (tackling change, accepting change), adjusting together, trading off, and challenges of chronicity (the impact of dialysis, living with a complex disease, planning with uncertainty). From the first day of dialysis treatment to the third month on a new dialysis therapy, all five HRQoL domains from the KDQOL-36 (symptoms, effects, burden, overall PCS, and overall MCS) improved in our sample (i.e., those who remained on the modality).

Conclusions

Dialysis transitions negatively impact the HRQoL of people with kidney disease in various ways. Future work should focus on how to best support people during this time.
A qualitative study on hope in iranian end stage renal disease patients undergoing hemodialysis
Authors: Rambod Masoume , Pasyar Nilofar , Parviniannasab Ali Mohammad
Published: September 2023

Background

End Stage Renal Disease (ESRD) patients undergoing hemodialysis are faced with serious problems in their lives. Hope, as a multifaceted factor, plays a critical role in these patients’ lives. Given the multifaceted process of hope, this study aimed to describe hope and identify the challenges, strategies, and outcomes of hope in Iranian ESRD patients undergoing hemodialysis.

Methods

This is a qualitative study using content analysis. The participants were selected using purposive sampling. The data were collected using deep, semi-structured interviews with 14 participants; it continued until reaching data saturation. Graneheim and Lundman content analysis approach was used to analyze the data.

Results

Five main categories and twenty-two subcategories emerged; the categories consisted of (1) Hope described as a particular event to happen, (2) Opportunities and threats to achieve hope, (3) Negative emotions as barriers to achieve hope, (4) Positive coping strategies to achieve hope, and (5) Growth and excellence as the outcomes of hope.

Conclusions

Based on the findings, ESRD patients undergoing hemodialysis described hope as a positive feeling of expectation and desire for a special thing to happen. They faced threats and opportunities to achieve hope, which exposed them to negative emotions as barriers of hope. Thus, they make use of positive coping strategies to achieve hope. Moreover, hope led to growth and excellence. Through awareness of hope, definition and strategies to achieve it, and teaching them, physicians and nurses working in hemodialysis wards can enhance hope in patients.
Identification of potential biomarkers of myopia based on machine learning algorithms
Authors: Zhang Shengnan , Wang Tao , Wang Huaihua , Gao Bingfang , Sun Chao
Published: September 2023

Purpose

This study aims to identify potential myopia biomarkers using machine learning algorithms, enhancing myopia diagnosis and prognosis prediction.

Methods

GSE112155 and GSE15163 datasets from the GEO database were analyzed. We used “limma” for differential expression analysis and “GO plot” and “clusterProfiler” for functional and pathway enrichment analyses. The LASSO and SVM-RFE algorithms were employed to screen myopia-related biomarkers, followed by ROC curve analysis for diagnostic performance evaluation. Single-gene GSEA enrichment analysis was executed using GSEA 4.1.0.

Results

The functional analysis of differentially expressed genes indicated their role in carbohydrate generation and polysaccharide synthesis. We identified 23 differentially expressed genes associated with myopia, four of which were highly effective diagnostic biomarkers. Single gene GSEA results showed these genes control the ubiquitin-mediated protein hydrolysis pathway.

Conclusion

Our study identifies four key myopia biomarkers, providing a foundation for future clinical and experimental validation studies.
A psychometric evaluation of the Swedish translation of the Perceived Stress Scale: a Rasch analysis
Authors: Rozental Alexander , Forsström David , Johansson Magnus
Published: September 2023

Background

Stress reflects physical and psychological reactions to imposing demands and is often measured using self-reports. A widely-used instrument is the Perceived Stress Scale (PSS), intended to capture more general aspects of stress. A Swedish translation of the PSS is available but has not previously been examined using modern test theory approaches. The aim of the current study is to apply Rasch analysis to further the understanding of the PSS’ measurement properties, and, in turn, improve its utility in different settings.

Methods

Data from 793 university students was used to investigate the dimensionality of different version of the PSS (14, 10, and 4 items) as well as potential response patterns among the participants.

Results

The current study demonstrates that the PSS-14 has two separate factors, divided between negatively worded items (perceived stress) and positively worded items (perceived [lack of] control), although with only the negative subscale exhibiting good reliability. Response patterns were analyzed using Differential Item Functioning, which did not find an influence of gender on any of the items, but for age regarding the positive subscale (items 6 and 9). The PSS-10 also demonstrated adequate reliability for the negative subscale, but the PSS-4 was not deemed suitable as a unidimensional scale.

Conclusions

Based on the results, none of the versions of the PSS should be used by sum-scoring all of the items. Only the negative items from the PSS-14 or PSS-10 can be used as unidimensional scales to measure general aspects of stress. As for different response patterns, gender may nevertheless be important to consider, as prior research has found differences on several items. Meanwhile, content validity is discussed, questioning the relevance of anger and being upset when measuring more general aspects of stress. Finally, a table to convert the PSS-7 (i.e., negative items) ordinal sum scores to interval level scores is provided.
Musculoskeletal manifestations associated with transthyretin-mediated (ATTR) amyloidosis: a systematic review
Authors: Aldinc Emre , Campbell Courtney , Gustafsson Finn , Beveridge Abigail , Macey Richard , Marr Laura , Summers Catherine , Zhang Dafang
Published: September 2023

Background

Hereditary and wild-type transthyretin-mediated (ATTRv and ATTRwt) amyloidoses result from the misfolding of transthyretin and aggregation of amyloid plaques in multiple organ systems. Diagnosis of ATTR amyloidosis is often delayed due to its heterogenous and non-specific presentation. This review investigates the association of musculoskeletal (MSK) manifestations with ATTR amyloidosis and the delay from the onset of these manifestations to the diagnosis of ATTR amyloidosis.

Methods

This systematic review utilized Medline and EMBASE databases. Search criteria were outlined using a pre-specified patient, intervention, comparator, outcome, time, study (PICOTS) criteria and included: amyloidosis, ATTR, and MSK manifestations. Publication quality was assessed utilizing Joanna Briggs Institute (JBI) critical appraisal checklists.

The search initially identified 7,139 publications, 164 of which were included. PICOTS criteria led to the inclusion of epidemiology, clinical burden and practice, pathophysiology, and temporality of MSK manifestations associated with ATTR amyloidosis. 163 publications reported on ATTR amyloidosis and MSK manifestations, and 13 publications reported on the delay in ATTR amyloidosis diagnosis following the onset of MSK manifestations.

Results

The MSK manifestation most frequently associated with ATTR amyloidosis was carpal tunnel syndrome (CTS); spinal stenosis (SS) and osteoarthritis (OA), among others, were also identified. The exact prevalence of different MSK manifestations in patients with ATTR amyloidosis remains unclear, as a broad range of prevalence estimates were reported. Moreover, the reported prevalence of MSK manifestations showed no clear trend or distinction in association between ATTRv and ATTRwt amyloidosis.

MSK manifestations precede the diagnosis of ATTR amyloidosis by years, and there was substantial variation in the reported delay to ATTR amyloidosis diagnosis. Reports do suggest a longer diagnostic delay in patients with ATTRv amyloidosis, with 2 to 12 years delay in ATTRv versus 1.3 to 1.9 years delay in ATTRwt amyloidosis.

Conclusion

These findings suggest that orthopedic surgeons may play a role in the early diagnosis of and treatment referrals for ATTR amyloidosis. Detection of MSK manifestations may enable earlier diagnosis and administration of effective treatments before disease progression occurs.
Biomechanical effects of S1 sacroiliac screws versus S2 sacroiliac screws on sacroiliac screws combined with a lumbar iliac fixation in the treatment of vertical sacral fractures: a biomechanical finite element analysis
Authors: Ma Yupeng , Huang Tao , Liu Weiwei , Hong Huanyu , Zhao Yong , Lin Jiangtao , Li Yu
Published: September 2023

Objective

To examine the impact of sacroiliac screw position and length on the biomechanical properties of triangular osteosynthesis in treating unilateral vertical sacral fractures and provide a clinical reference.

Methods

Unilateral Denis type II sacral fractures were modelled using finite elements to represent Tile C pelvic ring injuries. Six sacroiliac screws were used with iliolumbar fixation patterns to fix the sacral fractures, and the sacral stability, maximum pressure, and stress distribution were compared among the internal fixation modalities.

Results

The best vertical stability of the internal fixation model was achieved when the S1 segment was fixed with lengthened sacroiliac screws, followed by when the S1 segment was fixed using normal sacroiliac screws. There was no significant difference in vertical stability between the S1 + S2 dual-segment fixation model and the S1-segment fixation model. The maximum pressure under a vertical force of 600 N showed a trend of L5LS1 < L5NS1 < L5LS12 < L5LS2 < L5NS2 < L5NS12.

Conclusions

In unilateral vertical sacral fractures (Denis II) treated with triangular osteosynthesis using triangular jointing combined with unilateral iliolumbar + sacroiliac screw fixation, the use of a single lengthened sacroiliac screw for the S1 segment is recommended to achieve the best vertical stability of the sacrum with less maximum compression on the internal fixation components. If it is not possible to apply a lengthened sacroiliac screw, the use of a normal sacroiliac screw for the S1 segment is recommended. Adding an S2 screw does not significantly increase the vertical stability of the sacrum.
Early stages of learning in interprofessional education: stepping towards collective competence for healthcare teams
Authors: Kemp Sandra , Brewer Margo
Published: September 2023

Background

Interprofessional education (IPE) is a core element of many health professional education curricula. To date the focus of much research has been on student perceptions of, and attitudes towards, the learning experience. Little is known about the impact of early IPE experience on how students understand and learn about effective interprofessional teamwork.

Methods

This qualitative study involved first year university students enrolled in health professions degrees and investigated their descriptions of interprofessional teamwork through graphic elicitation and interviews. Participants were enrolled in a large-scale interprofessional unit (subject) in the university.

Results

The data were analysed through the lens of a tool that classifies dimensions of interprofessional activity. The findings indicated the majority of students had what was classified as a Stage 1 (or ‘nascent’) understanding of integration between work practices and a Stage 2 (or ‘emerging’) understanding of the dimensions of interprofessional teamwork which were commitment, identity, goals, roles and responsibilities, and interdependence.

Conclusions

Based on the findings, the stages for a learning trajectory for interprofessional education are proposed and each stage is mapped to dimensions of interprofessional activity. A number of pedagogical strategies are suggested in order to move students through this two-stage model of learning and ensure their readiness for interprofessional teamwork as health professionals.
Medium-to-long term sustainability of a health systems intervention to improve service readiness and quality of non-communicable disease (NCD) patient care and experience at primary care settings in Uganda
Authors: Katende David , Kasamba Ivan , Sekitoleko Isaac , Nakuya Kevin , Kusilika Caleb , Buyinza Allan , Mubiru Michael Charles , Mutungi Gerald , Nyirenda Moffat , Grosskurth Heiner , Baisley Kathy
Published: September 2023

Background

With the double burden of rising chronic non-communicable diseases (NCDs) and persistent infectious diseases facing sub-Saharan Africa, integrated health service delivery strategies among resource-poor countries are needed.

Our study explored the post-trial sustainability of a health system intervention to improve NCD care, introduced during a cluster randomised trial between 2013 and 2016 in Uganda, focusing on hypertension (HT) and type-2 diabetes mellitus (DM) services.

In 2020, 19 of 38 primary care health facilities (HFs) that constituted the trial’s original intervention arm until 2016 and 3 of 6 referral HFs that also received the intervention then, were evaluated on i) their facility performance (FPS) through health worker knowledge, and service availability and readiness (SAR), and ii) the quality-of-patient-care-and-experience (QoCE) received.

Methods

Cross-sectional data from the original trial (2016) and our study (2020) were compared. FPS included a clinical knowledge test with 222 health workers: 131 (2016) and 91 (2020) and a five-element SAR assessment of all 22 HFs. QoCE assessment was performed among 420 patients: 88 (2016) and 332 (2020). Using a pair-matched approach, FPS and QoCE summary scores were compared. Linear and random effects Tobit regression models were also analysed.

Results

The mean aggregate facility performance (FPS) in 2020 was lower than in 2016: 70.2 (95%CI = 66.0–74.5) vs. 74.8 (95%CI = 71.3–78.3) respectively, with no significant difference (p = 0.18). Mean scores declined in 4 of 5 SAR elements.

Overall FPS was negatively affected by rural or urban HF location relative to peri-urban HFs (p < 0.01). FPS was not independently predicted but patient club functionality showed weak association (p = 0.09).

QoCE declined slightly to 8.7 (95%CI = 8.4–91) in 2020 vs 9.5 (95%CI = 9.1–9.9) in 2016 (p = 0.02) while the proportion of patients receiving adequate quality care also declined slightly to 88.2% from 98.5% respectively, with no statistical difference (p = 0.20). Only the parent district weakly predicted QoCE (p = 0.05).

Conclusions

Four years after the end of research-related support, overall facility performance had declined as expected because of the interrupted supplies and a decline in regular supervision. However, both service availability and readiness and quality of HT/DM care were surprisingly well preserved.

Sustainability of an NCD intervention in similar settings may remain achievable despite the funding instability following a trial’s end but organisational measures to prepare for the post-trial phase should be taken early on in the intervention process.
Protocol for an economic evaluation of a tele-neurologic intervention alongside a stepped wedge randomised controlled trial (NeTKoH)
Authors: Gonçalves Ana S. Oliveira , Mayer Imke , Schulz Ricarda S. , Flöel Agnes , von Podewils Felix , Angermaier Anselm , Wainwright Kerstin , Kurth Tobias ,   the NeTKoH Consortium, Filser Paula J. , Alkhayer Aiham , Horn Verena , Köhn Wieland , Kotarz-Boettcher Malgorzata , Krüger Anne , Weil Cordula , Witt Carl , Chenot Jean-Francois , Kiel Simone , Michalowsky Elisa , Böttcher Michael , Graja Diana , Reber Katrin C. , Resch Olga , Rothe Juliane , Syring Jacqueline
Published: September 2023

Background

A significant and growing portion of the global burden of diseases is caused by neurological disorders. Tele-neurology has the potential to improve access to health care services and the quality of care, particularly in rural and underserved areas. The economic evaluation of the stepped wedge randomised controlled trial NeTKoH aims to ascertain the cost-effectiveness and cost-utility regarding the effects of a tele-neurologic intervention in primary care in a rural area in Germany.

Methods

This protocol outlines the methods used when conducting the trial-based economic evaluation of NeTKoH. The outcomes used in our economic analysis are all prespecified endpoints of the NeTKoH trial. Outcomes considered for the cost-utility and cost-effectiveness analyses will be quality-adjusted life years (QALYs) derived from the EQ-5D-5L, proportion of neurologic problems being solved at the GP’s office (primary outcome), hospital length-of-stay and number of hospital stays. Costs will be prospectively collected during the trial by the participating statutory health insurances, and will be analysed from a statutory health insurance perspective within the German health care system. This economic evaluation will be reported complying with the Consolidated Health Economic Evaluation Reporting Standards (CHEERS) checklist.

Discussion

This within-trial economic evaluation relaying the costs and outcomes of an interdisciplinary tele-consulting intervention will provide high-quality evidence for cost-effectiveness and policy implications of a tele-neurological programme, including the potential for application in other rural areas in Germany or other jurisdictions with a comparable health system.

Trial registration

German Clinical Trials Register (DRKS00024492), date registered: September 28, 2021.