bluuebunny/crossref_metadata_2025 huggingface dataset:
Endoaortic Balloon Occlusion in Totally Endoscopic and Percutaneous Robotic Cardiac Surgery
Authors: Kaneyuki Daisuke , Yost Colin C. , Round Kellen , Wu Meagan , Guy T. Sloane
Published: February 2023

Previous studies have shown that the endoaortic balloon occlusion (EABO) can provide satisfactory aortic cross-clamping with comparable surgical outcomes to thoracic aortic clamping in the setting of minimally invasive and robotic cardiac surgery. We described our approach to EABO use in totally endoscopic and percutaneous robotic mitral valve surgery. Preoperative computed tomography angiography is required to evaluate the quality and size of the ascending aorta, identify access sites for peripheral cannulation and endoaortic balloon insertion, and screen for other vascular anomalies. Continuous bilateral upper extremity arterial pressure and cranial near-infrared spectroscopy monitoring are essential to detect obstruction of the innominate artery due to distal balloon migration. Transesophageal echocardiography is needed for continuous monitoring of balloon positioning and antegrade cardioplegia delivery. Direct fluorescent visualization of the endoaortic balloon on the robotic camera allows for verification of balloon and efficient repositioning if needed. The surgeon should assess hemodynamic and imaging information simultaneously during the balloon inflation and delivery of antegrade cardioplegia. Aortic root pressure, systemic blood pressure, and balloon catheter tension affect the position of the inflated endoaortic balloon in the ascending aorta. The surgeon should eliminate all slack in the balloon catheter and lock it into position to prevent proximal balloon migration after the completion of antegrade cardioplegia. Using scrupulous preoperative imaging assessment and continuous intraoperative monitoring, the EABO can achieve adequate cardiac arrest in totally endoscopic robotic cardiac surgery, even in patients with previous sternotomy without compromise of surgical outcomes.
Is Fascism really back in Italy?
Authors: Agnew John
Published: February 2023

Italy was the homeland of Fascism (proper noun). From 1922 until 1943, a self-described Fascist regime ruled the country. As a result of the national election on 25 September 2022, a political party with its roots in that Fascism became the dominant partner in a far-right coalition national government. Does this signify the full-fledged return of the past for Italy's future or does it represent something else again? As Umberto Eco once claimed, Fascism was an unstable cocktail of beliefs and practices associated increasingly with the whims of one man: Benito Mussolini. From this perspective, unlike Nazism, which can be plausibly defined neatly in terms of its central obsessions with biological races and anti-semitism, Fascism has lent itself to multiple interpretations. Hence, fascism (common noun) has become a term used in a myriad of ways to describe a range of political ideologies, albeit all anchored to the singular significance of national identities at the expense of much else. I challenge Eco's claim that Fascism had no elemental ideological core and then trace the history of Fascism in Italy and how its memory lived on after the demise of the regime most intimately connected to it. I then turn to recent Italian politics and what the changed historical-geographical context of the times suggests about which elements, if any, of the original Fascism can be expected to re-emerge under the new regime. I end with the conclusion that whatever “fascism” does presently emerge in Italy will be unlike the original version. In fact, most of the core of what branded the original Fascism looks mostly irreproducible in contemporary Italy.
Smart city planning and the challenges of informality in India
Authors: Prasad Deepti , Alizadeh Tooran , Dowling Robyn
Published: February 2023

Smart city initiatives are mushrooming across the Global South, yet their implications for urban informality – a distinct challenge of planning in the cities of the Global South – remain overlooked. Using the Indian case as a focus and drawing upon empirical studies in three cities of Bhubaneswar, Pune, and Chennai, which are among the first 20 smart cities prioritised for implementation in the Smart Cities Mission, we show how informality challenges the understanding of the smart city. We analyse how this phenomenon is framed in smart city planning, focusing on the three domains of affordable housing, infrastructure services, and citizen engagement. We argue that using informality as a lens of critical analysis offers a new perspective on the ‘Southern theory’ of smart cities. In doing so, we highlight the disregard of informality at the cost of socio-spatial division – as a significant challenge for smart city development in India.
An inquiry into the Pakistani statecraft in tackling COVID-19
Authors: Shah Rahat , Ma Xiaolin
Published: February 2023

As the second largest country in South Asia, Pakistan has succeeded relatively well in tackling COVID-19 after it broke out in 2020. Due to this, it is necessary to inquire into Pakistan's statecraft to find out how it responded to the pandemic issue, first domestically and then globally. As one of the key neighboring countries of China where the large-scale pandemic started, Pakistan has been very vulnerable to the epidemic. However, the Pakistani government led by Imran Khan has achieved a remarkable record in controlling COVID-19. No doubt, the domestic progress in Pakistan is destined to enhance its reputation abroad. For example, the international community has extended encouraging words and deeds to Pakistan, while some developed EU countries have policies designed by Pakistani Goverment because Islamabad has adopted successful social security and financial stimulus strategies. This study aims to give a balanced understanding of what policy, approaches, and strategies have been used by the current ruling elites of Pakistan; and how the domestic achievements have effectively bolstered its prestigious image on the global stage.
Validation of an accelerometer-based gait assessment: Establishing test-retest reliability, convergent validity, and predictive validity for concussion symptom endorsement
Authors: Lecci Len , Dugan Kelly , Zeiger Ken , Keith Julian , Taravath Sasidharan , Tseh Wayland , Williams Mark
Published: February 2023

Background

Gait accelerometer (sensor) technology has proven effective in predicting several medical outcomes, but less is known regarding its prediction of concussion symptoms relative to conventional measures of gait and balance.

Objective

To establish the reliability and validity of gait accelerometer data. We first examine test-retest reliability and the impact of footwear and walking surfaces on gait. We then examine the convergent validity between gait accelerometer data and the NIH 4-meter gait test. Finally, we compare gait accelerometer data to gait speed and balance measures for predicting concussion symptoms.

Methods

Study 1 used a crossover study design with 60 participants to evaluate retest reliability and examine the effects of footwear (shoes/no-shoes) and walking surface (tile floor/grass) on gait accelerometer data. Study 2 employed a cross-sectional design with 1008 participants to assess gait accelerometer correlations with NIH 4-meter gait and the prediction of Centers for Disease Control and Prevention (CDC) concussion symptoms relative to previously validated gait and balance measures.

Results

Retest reliability (4-day average retest interval) for the no shoes/tile surface condition ranged from .72-.91 (mean = .80). Significant effects of footwear and especially walking surface revealed by Analysis of Variances (ANOVAs) on gait accelerometer data for the power, stride, balance, and symmetry domains indicate the need to standardize these variables. Gait accelerometer data correlates significantly with NIH 4-meter gait scores. Regression analyses found that gait accelerometer data predicts CDC concussion symptom endorsement, outperforming the BESS and NIH 4-meter gait at least three-fold.

Conclusions

When standardized on footwear and walking surface, gait accelerometers achieve strong test-retest reliability, converge with established measures of gait speed, and are superior to established measures of gait speed and balance when predicting concussion symptoms. Gait accelerometers represent a rapid tool for collecting additional gait information to quantify the behavioral sequelae of concussion and potentially inform return-to-play decision-making.
Knowledge, Attitude, and Practice of Intimate Partner Violence and Its Determinants Among Female Nursing Students in Abakaliki, Southeast Nigeria
Authors: Anikwe Chidebe C. , Anikwe Helen I. , Okorochukwu Bartholomew C. , Ikeoha Cyril C. , Ikeotuonye Arinze C. , Ewah Richard L. , Eze Justus N.
Published: February 2023

To assess the knowledge, attitude, practice, and determinants of intimate partner violence (IPV) among nursing female student in a tertiary hospital in Abakaliki. A cross-sectional descriptive study was done in a tertiary hospital in Abakaliki between 1st March 2018 and 31st August 2018 among 450 nursing female student. They were interviewed using a Composite Abuse Scale (CAS) version 2013. Analysis was done using IBM SPSS Statistic version 20. The prevalence of any type of IPV among respondents was 47.8%. The majority (70.9%) were aware of IPV and the commonest mode of information was mass media (60.0%). Majority of the respondent would resort to prayer following IPV and only 15.5% would report to police. The most common form of abuse reported was emotional &or harassment abuse (26.6%). Student’s age (OR = 0.42; 95% CI [0.41, 0.92]), social class (OR = 0.60; 95% CI [0.40, 0.90]), level of study (OR = 0.45; 95% CI [0.29, 0.68]), and partner’s level of education (OR = 0.60; 95% CI [0.42, 0.88]) were determinant of respondent experiencing IPV. Less than 50% of the respondent were aware of legislation against IPV. The study shows a high level of IPV among the studied group. Screening for IPV is advocated among the students’ population especially among the young adolescent. Efforts should also be made by the government to increase awareness about Nigerian law against IPV.
Contemporary Review: Autograft Bone Use in Foot and Ankle Surgery
Authors: Iturregui Jose M. , Moses Alex M. , Shi Glenn G. , Haupt Edward T.
Published: February 2023

Bone autografts are frequently harvested for use in foot and ankle surgery. A commonly used harvest site is the iliac crest; however, because of known morbidity with this site, the tibia and calcaneus are attractive alternatives. There remains limited understanding regarding the osteogenic potential of autografts from each of these locations. In this review, we provided an update of the known data on bone autografts from the iliac crest, tibia, and calcaneus, focusing on the total cells harvested from each site as well as the presence of osteogenic osteoprogenitor cells.

Level of Evidence:

Level V, expert opinion.
Genetics of migraine: where are we now?
Authors: Grangeon Lou , Lange Kristin Sophie , Waliszewska-Prosół Marta , Onan Dilara , Marschollek Karol , Wiels Wietse , Mikulenka Petr , Farham Fatemeh , Gollion Cédric , Ducros Anne ,   on behalf of the European Headache Federation School of Advanced Studies (EHF-SAS)
Published: February 2023

Migraine is a complex brain disorder explained by the interaction of genetic and environmental factors. In monogenic migraines, including familial hemiplegic migraine and migraine with aura associated with hereditary small-vessel disorders, the identified genes code for proteins expressed in neurons, glial cells, or vessels, all of which increase susceptibility to cortical spreading depression. The study of monogenic migraines has shown that the neurovascular unit plays a prominent role in migraine. Genome-wide association studies have identified numerous susceptibility variants that each result in only a small increase in overall migraine risk. The more than 180 known variants belong to several complex networks of “pro-migraine” molecular abnormalities, which are mainly neuronal or vascular. Genetics has also highlighted the importance of shared genetic factors between migraine and its major co-morbidities, including depression and high blood pressure. Further studies are still needed to map all of the susceptibility loci for migraine and then to understand how these genomic variants lead to migraine cell phenotypes.
The comparison of emergency medical service responses to and outcomes of out-of-hospital cardiac arrest before and during the COVID-19 pandemic in Thailand: a cross-sectional study
Authors: Huabbangyang Thongpitak , Klaiangthong Rossakorn , Silakoon Agasak , Sretimongkol Suttida , Sangpakdee Sutasinee , Khiaolueang Manit , Seancha Pattama , Nuansamlee Tontrakan , Kamsom Anucha , Chaisorn Ratree
Published: February 2023

Background

During the coronavirus disease 2019 (COVID-19) pandemic, the format of patients with out-of-hospital cardiac arrest (OHCA) management was modified. Therefore, this study compared the response time and survival at the scene of patients with OHCA managed by emergency medical services (EMS) before and during the COVID-19 pandemic in Thailand.

Methods

This retrospective, observational study used EMS patient care reports to collect data on adult patients with OHCA coded with cardiac arrest. Before and during the COVID-19 pandemic was defined as the periods of January 1, 2018–December 31, 2019, and January 1, 2020–December 31, 2021, respectively.

Results

A total of 513 and 482 patients were treated for OHCA before and during the COVID-19 pandemic, respectively, showing a decrease of 6% (% change difference =− 6.0, 95% confidence interval [CI] − 4.1, − 8.5). However, the average number of patients treated per week did not differ (4.83 ± 2.49 vs. 4.65 ± 2.06; p value = 0.700). While the mean response times did not significantly differ (11.87 ± 6.31 vs. 12.21 ± 6.50 min; p value = 0.400), the mean on-scene and hospital arrival times were significantly higher during the COVID-19 pandemic compared with before by 6.32 min (95% CI 4.36–8.27; p value < 0.001), and 6.88 min (95% CI 4.55–9.22; p value < 0.001), respectively. Multivariable analysis revealed that patients with OHCA had a 2.27 times higher rate of return of spontaneous circulation (ROSC) (adjusted odds ratio = 2.27, 95% CI 1.50–3.42, p value < 0.001), and a 0.84 times lower mortality rate (adjusted odds ratio = 0.84, 95% CI: 0.58–1.22, p value = 0.362) during the COVID-19 pandemic period compared with that before the pandemic.

Conclusions

In the present study, there was no significant difference between the response time of patients with OHCA managed by EMS before and during COVID-19 pandemic period; however, markedly longer on-scene and hospital arrival times and higher ROSC rates were observed during the COVID-19 pandemic than those in the period before the pandemic.
Single nucleotide polymorphism (SNP) markers for genetic diversity and population structure study in Ethiopian barley (Hordeum vulgare L.) germplasm
Authors: Yirgu Mihret , Kebede Mulugeta , Feyissa Tileye , Lakew Berhane , Woldeyohannes Aemiro Bezabih , Fikere Mulusew
Published: February 2023

Background

High-density single nucleotide polymorphisms (SNPs) are the most abundant and robust form of genetic variants and hence make highly favorable markers to determine the genetic diversity and relationship, enhancing the selection of breeding materials and the discovery of novel genes associated with economically important traits. In this study, a total of 105 barley genotypes were sampled from various agro-ecologies of Ethiopia and genotyped using 10 K single nucleotide polymorphism (SNP) markers. The refined dataset was used to assess genetic diversity and population structure.

Results

The average gene diversity was 0.253, polymorphism information content (PIC) of 0.216, and minor allelic frequency (MAF) of 0.118 this revealed a high genetic variation in barley genotypes. The genetic differentiation also showed the existence of variations, ranging from 0.019 to 0.117, indicating moderate genetic differentiation between barley populations. Analysis of molecular variance (AMOVA) revealed that 46.43% and 52.85% of the total genetic variation occurred within the accessions and populations, respectively. The heat map, principal components and population structure analysis further confirm the presence of four distinct clusters.

Conclusions

This study confirmed that there is substantial genetic variation among the different barley genotypes. This information is useful in genomics, genetics and barley breeding.
Epidemiological characteristics of deaths from road traffic accidents in Addis Ababa, Ethiopia: a study based on traffic police records (2018–2020)
Authors: Alemayehu Micheal , Woldemeskel Asfawesen , Olani Ararso Baru , Bekelcho Tariku
Published: February 2023

Introduction

Road traffic accidents are a major cause of fatal and nonfatal injuries, causing permanent disabilities, and other indirect health complications. Each year, road traffic accidents (RTA) cause a lot of fatalities and injuries in Ethiopia, putting the country among the list of the most affected countries by RTA in the world. Despite the high rates of road traffic collisions in Ethiopia, very little is known about the factors that contribute to fatal RTA in the country.

Objectives

the objective of this study is to assess the epidemiological characteristics of deaths from road traffic accidents in Addis Ababa, Ethiopia: A study based on traffic police records (2018–2020).

Method

A retrospective observational study design was conducted used in this study. All road traffic accident victims reported to Addis Ababa police station between 2018 and 2020 were study population and the collected data was evaluated with Statistical Package for the Social Sciences (SPSS) version 26 software. Binary logistic regression model was used to indicate the association between dependent and independent variables. Statistically, significant associations were declared at P < 0.05.

Result

There were 8458 recorded road traffic accidents in Addis Ababa during 2018–2020. Among these accidents, 1274 (15.1%) caused death while 7184 (84.1%) caused an injury. Males accounted for 77.1% of the decedents (sex ratio of almost 3.36:1). The majority 1020 (80%) of the fatality occurred on a straight road and 1106 (86.8%) of the fatality occurred in dry weather. Weekday 1.243 (AOR, 1.234, 95 CI, 1.071–1.443), driver educational status below grade twelve 0.326(AOR 0.326, CI, 0.285–0.374), and commercial truck vehicle 1.682 (OR, 1.696, CI, 1.410–2.040) were statistically associated with fatality after adjusting for potential confounding variables.

Conclusion

The prevalence of RTA fatality in Addis Ababa is high. The accidents that occurred during the weekdays were more fatal. Driver’s educational status, weekdays, and vehicle type were factors associated with mortality. There is a need to introduce road safety interventions that targeted identified factors in this study to reduce fatalities attributed to RTIs.
An observational study of dose dense chemotherapy with lipegfilgrastim support in early breast cancer
Authors: Rashed Ahmed , Fitzpatrick Orla M , Easty David J , Coyne Zac , Collins Dearbhaile , Mallet Victoria , Milewski Maciej , Egan Keith , Breathnach Oscar S , Grogan Liam , Hennessy Bryan T , Morris Patrick G
Published: February 2023

Purpose

Breast cancer is one of the most prevalent malignant diseases in women. The development of dose dense chemotherapy regimens has improved clinical outcomes but has been associated with increased hematological toxicity. Currently there is a paucity of data on the use of lipegfilgrastim in dose dense AC treatment in early breast cancer. The purpose of this study was to assess the use of lipegfilgrastim in the treatment of early breast cancer and to examine the incidence of treatment-related neutropenia during the dose dense AC phase and subsequent paclitaxel treatment.

Methods

This was a single arm, non-interventional, prospective study. The primary endpoint was to determine the rate of neutropenia defined as ANC of < 1.0 × 109/L, during four cycles of dose dense AC with lipegfilgrastim support. The secondary endpoints were the incidence of febrile neutropenia, (temperature > 38 °C and ANC < 1.0 × 109/L), treatment delays, premature treatment cessation and toxicity.

Results

Forty-one participants were included in the study. Of the 160 planned dose dense AC treatments, 157 were administered, and 95% (152/160) of these were given on time. The rate of treatment delay was 5% (95% CI 2.2 to 9.9%) due to infection (4) and mucositis (1). Four (10%) patients developed febrile neutropenia. The most frequently occurring adverse event was grade 1 bone pain.

Conclusion

Lipegfilgrastim is an effective option in the prophylaxis of chemotherapy-induced neutropenia, and its use in everyday anti-cancer treatment can be considered.
Promoter hypermethylation analysis of host genes in cervical intraepithelial neoplasia and cervical cancers on histological cervical specimens
Authors: Shi Liye , Yang Xue , He Ling , Zheng Chunying , Ren Zhen , Warsame Juweria Abdisamad , Suye Suye , Yan Lei , Cai Haiyi , Xiao Xiao , Fu Chun
Published: February 2023

Background

DNA methylation is an essential factor in the progression of cervical intraepithelial neoplasia (CIN) to cervical cancer. The aim was to investigate the diagnostic value provided by methylation biomarkers of six tumor suppressor genes (ASTN1, DLX1, ITGA4, RXFP3, SOX17 and ZNF671) for cervical precancerous lesions and cervical cancer.

Methods

The histological cervical specimens of 396 cases including 93 CIN1, 99 CIN2, 93 CIN3 and 111 cervical cancers were tested for methylation-specific PCR assay (GynTect®) of score and positive rate. Among them, 66 CIN1, 93 CIN2, 87 CIN3 and 72 cervical cancers were further used for paired analysis. A chi-square test was used to analyze the difference of methylation score and positive rate in cervical specimens. The paired t-test and paired chi-square test were for analyzing the methylation score and positive rate in paired CIN and cervical cancer cases. The specificity, sensitivity, odds ratio (OR) and 95% confidence interval (95% CI) of the GynTect® assay for CIN2 or worse (CIN2 +) and CIN3 or worse (CIN3 +) were evaluated.

Results

According to the chi-square test trend, hypermethylation increased with severity of the lesions as defined by histological grading (P = 0.000). The methylation score above 1.1 was more common in CIN2 + than in CIN1. The DNA methylation scores in the paired groups of CIN1, CIN3 and cervical cancer were significant differences (P = 0.033, 0.000 and 0.000, respectively), except for CIN2 (P = 0.171). While the positive rate of GynTect® in each paired group had no difference (all P > 0.05). The positive rate of every methylation marker in the GynTect® assay showed differences in four cervical lesion groups (all P < 0.05). The specificity of GynTect® assay for detection of CIN2 + /CIN3 + were higher than high-risk human papillomavirus test. With CIN1 as a reference, the positive status of GynTect®/ZNF671 were significantly higher in CIN2 + : odds ratio (OR) 5.271/OR 13.909, and in CIN3 + : OR 11.022/OR 39.150, (all P < 0.001).

Conclusion

The promoter methylation of six tumor suppressor genes is related to the severity of cervical lesions. The GynTect® assay based on cervical specimens provides diagnostic values for detecting CIN2 + and CIN3 + .
The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway
Authors: Nyttingnes Olav , Benth Jūratė Šaltytė , Hofstad Tore , Rugkåsa Jorun
Published: February 2023

Background

Mental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects.

Aim

To test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others.

Methods

Using national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014–2017 predicted an increase in the standardized suicide ratios in 2014–2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287).

Results

We found no adverse effects on patients’ health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care.

Conclusions

Lower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.
Capacity-based legislation in Norway has so far scarcely influenced the daily life and responsibilities of patients’ carers: a qualitative study
Authors: Wergeland Nina Camilla , Fause Åshild , Weber Astrid Karine , Fause Anett Beatrix Osnes , Riley Henriette
Published: February 2023

Background

When capacity-based mental health legislation was introduced in Norway in 2017, there was concern about the consequences of change in the law for patients’carer whose community treatment order was revoked as a result of being assessed as having capacity to consent. The concern was that the lack of a community treatment order would increase carers’ responsibilities in an already challenging life situation.

The aim of this study is to explore carers’ experiences of how their responsibility and daily life were affected after the patient’s community treatment order was revoked based on capacity to consent.

Method

We conducted individual in-depth interviews from September 2019 to March 2020 with seven carers of patients whose community treatment order was revoked following assessment of capacity to consent, based on the change in the legislation. The transcripts were analysed with inspiration from reflexive thematic analysis.

Results

The participants had little knowledge about the amended legislation, and three out of seven did not know about the change at the time of the interview. Their responsibility and daily life were as before, but they felt that the patient was more content, without relating this to the change in the law. They had found that coercion was necessary in certain situations, which made them worry whether the new legislation would make it more difficult to use coercion.

Conclusion

The participating carers had little or no knowledge of the change in the law. They were involved in the patient’s everyday life as before. The concerns prior to the change about a worse situation for carers had not affected them. On the contrary, they found that their family member was more satisfied with life and the care and treatment provided. This may suggest that the intention of the legislation to reduce coercion and increase autonomy was fulfilled for these patients, without resulting in any significant change in carers’ lives and responsibilities.
A school-family blended multi-component physical activity program for Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC): protocol for a cluster randomized controlled trial
Authors: Zhou Lin , Liang Wei , He Yuxiu , Duan Yanping , Rhodes Ryan E. , Lippke Sonia , Baker Julien S. , Liang Yu , Han Lin , Liu Wan Xin , Liu Qi
Published: February 2023

Background

Fundamental motor skills (FMSs) are crucial for children’s health and comprehensive development. Obese children often encounter a considerable challenge in the development of FMSs. School-family blended PA programs are considered a potentially effective approach to improve FMSs and health-related outcomes among obese children, however, empirical evidence is still limited. Therefore, this paper aims to describe the development, implementation, and evaluation of a 24-week school-family blended multi-component PA intervention program for promoting FMSs and health among Chinese obese children, namely the Fundamental Motor Skills Promotion Program for Obese Children (FMSPPOC) employing behavioral change techniques (BCTs) and building on the Multi-Process Action Control (M-PAC) framework as well as using the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework for improving and evaluating the program.

Methods

Using a cluster randomized controlled trial (CRCT), 168 Chinese obese children (8–12 years) from 24 classes of six primary schools will be recruited and randomly assigned to one of two groups by a cluster randomization, including a 24-week FMSPPOC intervention group and a non-treatment waiting-list control group. The FMSPPOC program includes a 12-week initiation phase and a 12-week maintenance phase. School-based PA training sessions (2 sessions/week, 90 min each session) and family-based PA assignments (at least three times per week, 30 min each time) will be implemented in the initiation phase (semester time), while three 60-min offline workshops and three 60-min online webinars will be conducted in the maintenance phase (summer holiday). The implementation evaluation will be undertaken according to the RE-AIM framework. For intervention effectiveness evaluation, primary outcome (FMSs: gross motor skills, manual dexterity and balance) and secondary outcomes (health behaviors, physical fitness, perceived motor competence, perceived well-being, M-PAC components, anthropometric and body composition measures) will be collected at four time-points: at baseline, 12-week mid-intervention, 24-week post-intervention, and 6-month follow-up occasions.

Discussion

The FMSPPOC program will provide new insights into the design, implementation, and evaluation of FMSs promotion among obese children. The research findings will also supplement empirical evidence, understanding of potential mechanisms, and practical experience for future research, health services, and policymaking.

Trial registration

Chinese Clinical Trial Registry; ChiCTR2200066143; 25 Nov 2022.
Trauma of separation: the social and emotional impact of institutionalization on children in a post-soviet country
Authors: Ismayilova Leyla , Claypool Emily , Heidorn Emma
Published: February 2023

Background

In the former Soviet Union (fSU) region, which has the highest rate of institutional care worldwide, ‘social orphans’—indigent children who have one or both parents living—are placed in publicly run residential institutions to receive education, food, and shelter. Few studies have focused on understanding the emotional effects of separation and life in an institutional environment on children who grow up with their families.

Methods

Semi-structured qualitative interviews (N = 47) were conducted with 8- to 16-year-old children with a history of institutional care placement and their parents in Azerbaijan. Semi-structured qualitative interviews were conducted with 8- to 16-year-old children (n = 21) involved in the institutional care system in Azerbaijan and their caregivers (n = 26). Trained interviewers collected narratives about children’s experiences prior to being separated from their families while living in an institution, as well as the impact of institutional placement on their emotional well-being. We applied thematic analysis with inductive coding.

Results

Most of the children entered institutions around the school entry age. Prior to entering institutions, children had already experienced disruptions within their family environments and multiple traumatic events, including witnessing domestic violence, parental divorce, and parental substance abuse. Once institutionalized, these children may have had their mental health further impaired by a sense of abandonment, a strictly regimented life, and insufficiencies of freedom, privacy, developmentally stimulating experiences, and, at times, safety.

Conclusion

This study illustrates the emotional and behavioral consequences of institutional placement and the need to address accumulated chronic and complex traumatic experiences that occurred before and during institutional placement, which may affect emotion regulation and the familial and social relationships of children who lived in institutions in a post-Soviet country. The study identified mental health issues that could be addressed during the deinstitutionalization and family reintegration process to improve emotional well-being and restore family relationships.
Comparison of re-revision rate and radiological outcomes between Kerboull-type plate and metal mesh with impaction bone grafting for revision total hip arthroplasty
Authors: Ishizu Hotaka , Shimizu Tomohiro , Sasazawa Fumio , Takahashi Daisuke , Terkawi Mohamad Alaa , Takahashi Kaname , Ohashi Yusuke , Kanayama Masahiro , Iwasaki Norimasa
Published: February 2023

Background

This study compared the re-revision rate and radiographic outcomes of revision total hip arthroplasty (THA) using a Kerboull-type acetabular reinforcement device (KT plate) with bulk structural allograft and metal mesh with impaction bone grafting (IBG).

Methods

Ninety-one hips of 81 patients underwent revision THA for American Academy of Orthopedic Surgeons (AAOS) classification type III defects from 2008 to 2018. Of these, seven hips of five patients and 15 hips of 13 patients were excluded due to insufficient follow-up information (< 24 months) and large bone defects with a vertical defect height ≥ 60 mm, respectively. The current study compared the survival and radiographic parameters of 45 hips of 41 patients using a KT plate (KT group) and 24 hips of 24 patients using a metal mesh with IBG (mesh group).

Results

Eleven hips (24.4%) in the KT group and 1 hip (4.2%) in the mesh group exhibited radiological failure. Moreover, 8 hips in the KT group (17.0%) required a re-revision THA, while none of the patients in the mesh group required a re-revision. The survival rate with radiographic failure as the endpoint in the mesh group was significantly higher than that in the KT group (100% vs 86.7% at 1-year and 95.8% vs 80.0% at 5-years, respectively;p = 0.032). On multivariable analysis evaluating factors associated with radiographic failure, there were no significant associations with any radiographic measurement. Of the 11 hips with radiographic failure, 1 (11.1%), 3 (12.5%), and 7 (58.3%) hips were of Kawanabe classification stages 2, 3, and 4, respectively.

Conclusions

The findings of this study suggest that revision THA using KT plates with bulk structure allografts could provide poorer clinical outcomes than revision THA using a metal mesh with IBG. Although revision THA using KT plates with bulk structural allografts could set the true hip center, there is no association between a high hip center and clinical outcomes. The relationship between the position of the KT plate and the host bone might be considered more carefully.
Medium-term clinical results in patients with floating hip injuries
Authors: Yang Yun , Zou Chang , Fang Yue , Shakya Sujan
Published: February 2023

Background

The objective of this study was to evaluate the effectiveness of our strategy for managing floating hip injuries.

Methods

From January 2014 and December 2019, all patients with a floating hip underwent surgical treatment in our hospital were included in the retrospective study, with a minimum follow-up of 1 year. All patients were managed according to a standardised strategy. Data on epidemiology, radiography, clinical outcomes and complications were collected and analysed.

Results

Twenty-eight patients were enrolled, with an average age of 45 years. The mean follow-up was 36.9 months. According to the Liebergall classification, Type A floating hip injuries predominated (n = 15, 53.6%). Head and chest injuries were the most common associated injuries. When multiple operative settings were required, we prioritized the fixation of the femur fracture at the first operation. The mean time from injury to definitive femoral surgery was 6.1 days, with most (75%) femoral fractures treated with intramedullary fixation. More than half (54%) of acetabular fractures were treated with a single surgical approach. Pelvic ring fixation included isolated anterior fixation, isolated posterior fixation, combined anterior and posterior fixation, of which isolated anterior fixation was the most common. Postoperative radiographs suggested that the anatomic reduction rates of acetabulum and pelvic ring fractures were 54% and 70%, respectively. According to grading system of Merle d’Aubigne and Postel, 62% of patients achieved satisfactory hip function. Complications included delayed incision healing (7.1%), deep vein thrombosis (10.7%), heterotopic ossification (10.7%), femoral head avascular necrosis (7.1%), post-traumatic osteoarthritis (14.3%), fracture malunion (n = 2, 7.1%) and nonunion (n = 2, 7.1%). In the patients with complications described above, only two patients underwent resurgery.

Conclusions

Although there is no difference in clinical outcomes and complications among different types of floating hip injuries, special attention should be paid to anatomical reduction of the acetabular surface and restoration of the pelvic ring. In addition, the severity of such compound injuries often exceeds that of an isolated injury and often requires specialised multidisciplinary management. Because of no standard guidelines for treatment of such injuries, our experience in the management of such a complex case is to fully assess the complexity of the injury and formulate an appropriate surgical plan based on the principles of damage control orthopaedics.
Efficacy and safety of Obex® in overweight and obese subjects: a randomised, double-blind, placebo-controlled clinical trial
Authors: Cabrera-Rode Eduardo , Cubas-Dueñas Ileana , Acosta Janet Rodríguez , Hernández Jeddú Cruz , González Ana Ibis Conesa , Calero Teresa M. González , Domínguez Yuri Arnold , Rodríguez José Hernández , Rodríguez Antonio D. Reyes , Álvarez Álvarez Aimee , Valdés Ragmila Echevarría , Espinosa Liudmila Jorge , Belent Onelia Torres , Benavides Zoila Bell , Estévez Elizabeth Senra , Rodríguez Yanet Abreu , del Valle Rodríguez Juana , Juliá Silvia Marín
Published: February 2023

Background

Obex® may be helpful in reducing body weight and fat. The current study was carried out to evaluate the efficacy and safety of Obex® in the treatment of overweight and obese subjects.

Methods

A double-blind, randomised, controlled phase III clinical trial was conducted involving 160 overweight and obese subjects (BMI ≥ 25.0 and < 40 kg/m2) aged 20 to 60 years, who received Obex® (n = 80) and placebo (n = 80) plus non-pharmacological treatment (physical activity and nutritional counseling). One sachet of Obex® or placebo were administered before the two main meals each day for 6 months. In addition to anthropometric measurements and blood pressure, fasting plasma and 2 h glucose levels during the oral glucose tolerance test, lipid profile, insulin, liver enzymes, creatinine, and uric acid (UA) were determined, insulin resistance (HOMA-IR) beta-cell function (HOMA-β) were assessed and insulin sensitivity (IS) was calculated with three indirect indexes.

Results

After 3 months of Obex®, 48.3% of the participants (28/58) achieved complete success in reducing both weight and waist circumference by greater than or equal to 5% from baseline, as opposed to 26.0% (13/50) of individuals receiving placebo (p = 0.022). Compared to baseline, at 6 months no differences were found between the groups concerning anthropometric and biochemical measurements, except for high-density lipoprotein cholesterol (HDL-c) levels, which were higher in subjects receiving Obex® compared to those receiving placebo (p = 0.030). After 6 months of treatment, both groups showed reduced cholesterol and triglyceride levels (p < 0.012) compared to baseline value. However, only those intake Obex® showed reduced insulin concentrations and HOMA-IR, improved IS (p < 0.05), and decreased creatinine and UA levels (p < 0.005).

Conclusions

The consumption of Obex® together with lifestyle changes increased HDL-c, contributed to a rapid reduction of weight and waist circumference, as well as improved insulin homeostasis, which did not occur in the placebo group, and appears to be safe as an adjunct at conventional obesity treatment.

Trial registration

Clinical trial protocol was registered in the Cuban public registry of clinical trials under code RPCEC00000267 on 17/04/2018 and also registered in the international registry of clinical trials, ClinicalTrials.gov, under code: NCT03541005 on 30/05/2018.
Referral patterns for retinoblastoma patients in Ethiopia
Authors: Sherief Sadik Taju , Wu Fran , O’Banion Jacquelyn , Teshome Tiliksew , Dimaras Helen
Published: February 2023

Background

Increased lag time between the onset of symptoms and treatment of retinoblastoma (RB) is one of the factors contributing to delay in diagnosis. The aim of this study was to understand the referral patterns and lag times for RB patients who were treated at Menelik II Hospital in Addis Ababa, Ethiopia.

Method

A single-center, cross- sectional study was conducted in January 2018. All new patients with a confirmed RB diagnosis who had presented to Menelik II Hospital from May 2015 to May 2017 were eligible. A questionnaire developed by the research team was administered to the patient’s caregiver by phone.

Results

Thirty-eight patients were included in the study and completed the phone survey. Twenty-nine patients (76.3%) delayed seeing a health care provider for ≥ 3 months from the onset of symptoms, with the most common reason being the belief that it was not a problem (96.5%), followed by 73% saying it was too expensive. The majority of patients (37/38, 97.4%) visited at least 1 additional health care facility prior to reaching a RB treatment facility. The mean overall lag time from noticing the first symptom to treatment was 14.31 (range 0.25–62.25) months.

Conclusion

Lack of knowledge and cost are major barriers to patients first seeking care for RB symptoms. Cost and travel distance are major barriers to seeing referred providers and receiving definitive treatment. Delays in care may be alleviated by public education, early screening, and public assistance programs.
Associations of reproductive factors with incidence of myocardial infarction and ischemic stroke in postmenopausal women: a cohort study
Authors: Jeong Su-Min , Yoo Jung Eun , Jeon Keun Hye , Han Kyungdo , Lee Heesun , Lee Dong-Yun , Shin Dong Wook
Published: February 2023

Background

To assess the association between the reproductive factors of age at menarche, age at menopause, and reproductive span and the incidence of myocardial infarction (MI) and ischemic stroke (IS).

Methods

We used a population-based retrospective cohort study from the National Health Insurance Service database of Korea including a total of 1,224,547 postmenopausal women. Associations between age at menarche (≤ 12, 13–14 [reference], 15, 16, and ≥ 17 years), age at menopause (< 40, 40–45, 46–50, 51–54 [reference], and ≥ 55 years), and reproductive span (< 30, 30–33, 34–36, 37–40 [reference], and ≥ 41 years) and the incidence of MI and IS were assessed by Cox proportional hazard models with adjustment for traditional cardiovascular risk factors and various reproductive factors.

Results

During a median follow-up of 8.4 years, 25,181 MI and 38,996 IS cases were identified. Late menarche (≥ 16 years), early menopause (≤ 50 years), and short reproductive span (≤ 36 years) were linearly associated with a 6%, 12–40%, and 12–32% higher risk of MI, respectively. Meanwhile, a U-shaped association between age at menarche and risk of IS was found, with a 16% higher risk in early menarche (≤ 12 years) and a 7–9% higher risk in late menarche (≥ 16 years). Short reproductive span was linearly associated with an increased risk of MI, whereas both shorter and longer reproductive spans were associated with an increased risk of IS.

Conclusions

This study demonstrated different patterns of association between age at menarche and incidence of MI and IS: a linear association for MI versus a U-shaped association for IS. Female reproductive factors in addition to traditional cardiovascular risk factors should be considered when assessing overall cardiovascular risk in postmenopausal women.
Comprehensive analysis of PHGDH for predicting prognosis and immunotherapy response in patients with endometrial carcinoma
Authors: Zhang He , Kong Weimin , Zhao Xiaoling , Xie Yunkai , Luo Dan , Chen Shuning
Published: February 2023

Background

PHGDH (Phosphoglycerate Dehydrogenase) is the first branch enzyme in the serine biosynthetic pathway and plays a vital role in several cancers. However, little is known about the clinical significance of PHGDH in endometrial cancer.

Methods

Clinicopathological data of endometrial cancer were downloaded from the Cancer Genome Atlas database (TCGA). First, the expression of PHGDH in pan-cancer was investigated, as well as the expression and prognostic value of PHGDH in endometrial cancer. The effect of PHGDH expression on the prognosis of endometrial cancer was analyzed by Kaplan-Meier plotter and Cox regression. The relationship between PHGDH expression and clinical characteristics of endometrial cancer was investigated by logistic regression. Receiver operating characteristic (ROC) curves and nomograms were developed. Possible cellular mechanisms were explored using the Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis, the Gene Ontology (GO), and gene set enrichment analysis (GSEA). Finally, TIMER and CIBERSORT were used to analyze the relationship between PHGDH expression and immune infiltration. CellMiner™ was used to analyze the drug sensitivity of PHGDH.

Results

The results showed that PHGDH expression was significantly higher in endometrial cancer tissues than in normal tissues at mRNA and protein levels. Kaplan-Meier survival curves showed that patients in the high expression group had shorter overall survival (OS) and disease free survival (DFS) than patients in the low PHGDH expression group. Multifactorial COX regression analysis further supported that high PHGDH expression was an independent risk factor associated with prognosis in patients with endometrial cancer. The results showed estrogen response, mTOR, K-RAS, and epithelial mesenchymal transition (EMT) were differentially elevated in the high-expression group of the PHGDH group. CIBERSORT analysis showed that PHGDH expression is related to the infiltration of multiple immune cells. When PHGDH is highly expressed, the number of CD8+T cells decreases.

Conclusion

PHGDH plays a vital role in the development of endometrial cancer, which is related to tumor immune infiltration, and can be used as an independent diagnostic and prognostic marker for endometrial cancer.