bluuebunny/crossref_metadata_2025 huggingface dataset:
When fatigue postpartum is also prodromal
Authors: Balshi Alexandra , Bove Riley
Published: December 2024

Postpartum fatigue (PPF) is a common issue affecting mothers, characterized by reduced capacity for physical and mental activity in the weeks to months following delivery. While often attributed to the demands of infant care, severe or atypical PPF can signal an underlying medical condition, such as multiple sclerosis (MS). In this narrative review, guidance is provided to clinicians on recognizing signs of severe or atypical PPF, differentiating it from MS-associated fatigue. Patients’ qualitative descriptions of fatigue, its intensity, and specific triggers can be particularly informative, as MS fatigue is severe, recurrent, often refractory to rest, and/or exacerbated by high temperatures. By identifying such cases early, healthcare providers can support timely diagnosis and intervention, ultimately improving outcomes for women who may be at risk for MS.
Ambiguous loss: The experiences of remand prisoners’ loved ones
Authors: Masson Isla , Booth Natalie
Published: December 2024

Remand remains a particularly punitive and painful form of incarceration for prisoners, as well as their loved ones on the outside attempting to provide support. Drawing on in-depth qualitative data collected from 61 loved ones’ supporting remanded prisoners in England and Wales, this article examines how the ambiguity and unknowns associated with this form of incarceration is particularly painful. Through the unique application of Boss’s theory of Ambiguous Loss, this article contributes new knowledge about the nature, scope and resilience shown by loved ones supporting remanded prisoners, indicating where future research and policy should be focused.
Challenges and strategies of developing internet hospital: Combining qualitative interview and documentary research
Authors: Lai Yunfeng , Ho Qiong , Wang Yao , Liang Xiaonan , Xue Yan , Ung Carolina Oi Lam , Li Meng , Yao Dongning , Liu Buping , Bian Ying , Xie Zhirong , Hu Hao
Published: December 2024

Objectives

As an innovative technology, internet hospitals have the potential to improve healthcare services. However, the pioneering nature of internet hospitals means that they are still in the early stages of development. This study aimed to investigate the challenges and strategies involved in establishing internet hospitals by public medical institutions in China.

Methods

In this study, a qualitative research combined qualitative interview and documentary research was conducted at an internet hospital affiliated with a public tertiary hospital in China. With the documentary collection, interviews were completed with the hospital's decision makers, operators, information technology personnel, clinicians, and pharmacists, as well as the internet hospital's operators, technicians, and external technical partners. Thematic analysis was employed to interpret all the materials collected.

Results

Totally 20 participants took part in the interviews. The main challenges in developing internet hospitals include low physician motivation to participate in internet hospital services, low acceptability of internet hospital services among patients, lack of service specifications, and insufficient versatile talents. In the development planning, four phases were established: first, the development of primary services; second, the integration of online and offline services; third, the provision of online prescriptions; and fourth, a focus on differentiation. The service model innovation highlighted four key dimensions, including: (1) the importance of patient and department classification in defining the value proposition; (2) the pivotal role of a high-level coordination department with resource coordination capability in key processes; (3) the significance of independent platform construction and talent cultivation as guarantees of key resources; and (4) the revolutionary profit formula of personalized digital health and patient-centric services.

Conclusions

In internet hospitals, primary challenges are evident in physicians’ cognition, patient education, and management skills. Internet hospitals, designed to offer personalized digital health and patient-centric services, necessitate more substantial innovations in service models and clinical care.
Cultural Adaption and Validation of the Arabic Version of the CANHELP Lite Bereavement Questionnaire
Authors: Alanzi Mansour , Alanazi Mohammed
Published: December 2024

Bereavement, the experience of losing a loved one, significantly affects emotional, psychological, and physical wellbeing. Assessing the quality of end-of-life care and the bereavement experiences of family members is crucial for improving healthcare services. The CANHELP Lite Bereavement Questionnaire, a validated tool for evaluating end-of-life care from bereaved family members’ perspectives, needs cultural adaptation for non-English-speaking contexts. This study aimed to adapt and validate the Arabic version of the CANHELP Lite Bereavement Questionnaire for Arabic-speaking populations, considering their unique cultural, social, and religious contexts. The adaptation process involved systematic translation, back-translation, and expert evaluation to ensure cultural sensitivity and linguistic appropriateness. The psychometric properties of the adapted questionnaire were tested among 269 bereaved Saudi family members, revealing a Cronbach's alpha of 0.950 for internal consistency reliability. Face and content validity assessments confirmed item relevance, and concurrent validity was established with a Pearson correlation coefficient of 0.886. The study concluded that the Arabic version is a valid and reliable instrument for assessing satisfaction with end-of-life care, aiding in identifying areas for improvement in bereavement support within Arabic-speaking populations and enhancing healthcare services in culturally diverse settings.
How Can Clinical Communication Alleviate the Negative Impacts of Social Determinants of Health?: A Secondary HINTS 6 Dataset Analysis
Authors: Wu Qiwei Luna , Kindratt Tiffany B , Brannon Grace Ellen
Published: December 2024

Structural disparities (eg, food insecurities, housing, and lack of transportation) at different social levels (eg, personal, family, and community) are strong determinants of health, influencing individuals’ and population well-being worldwide. Research is scarce examining how clinical communication can mitigate the negative impact of social disparities obstructing the reception of quality healthcare. In this study, we explore the mediation role of patient-centered communication (PCC) between social determinants of health (SDH) and quality of care. Using a sample of 5437 adult who visited a healthcare provider in the past 12 months from the sixth Health Information National Trends Survey (HINTS 6), our key points of findings included that the models showed PCC partially mediating the connections from (a) “skipped meals” (effect = −.08, 95%CI = [−.12, −.04]), (b) “unaffordable meals” (effect = −.08, 95%CI = [−.11, −.05]), (c) “fear of eviction” (effect = −.1, 95%CI = [−.14, −.06]), and (d) “lack of transportation” (effect = −.12, 95%CI = [−.16, −.08]) to quality of care (QoC). Specifically, better communication had a positive impact on mediating the disparities; poor communication did not. Demonstrating in a nationally representative sample, our findings indicate the key role of patient-centered clinical communication in effectively alleviating the inherent challenges faced by people with low health literacy and socioeconomic status. Theoretical and practical implications are discussed.
Perspectives on Ligament Augmentation Techniques: A Survey of the American Orthopaedic Foot & Ankle Society
Authors: Alexeev Sergei , Zona Nathaniel , Stark Samuel D. , Buckley Sara E. , Hunt Kenneth
Published: December 2024

Category:

Ankle; Midfoot/Forefoot

Introduction/Purpose:

Ligament augmentation techniques (LATs) are surgical procedures in which anatomical ligaments are repaired or reconstructed with utilization of a synthetic ligament which spans from bone to bone and is fixated intra- or trans-osseously. There is an extensive, and growing, body of literature reporting LAT use in the foot and ankle. The prevalence of LAT use in the clinical practice of foot and ankle surgery is not well reported. Furthermore, indications for LAT use, such as patient characteristics, are not clearly defined. Surgical decision-making regarding LAT use is not characterized, and the influence of surgeon characteristics on use of LATs has also not been studied. This survey of the AOFAS membership aimed to understand foot and ankle surgeon preferences and practices in utilizing LATs.

Methods:

Survey questions were generated by a committee of experienced researchers and foot and ankle surgeons. Survey invitations were sent to the membership of the AOFAS, and only attending-level physicians were polled. There were 55 possible questions, which were gated by branching logic pertinent to the respondent’s characteristics and practices. Results were analyzed with descriptive statistics. Analysis of significance between groups was generated using the chi-squared test. A p-value of < 0.05 was considered statistically significant.

Results:

In total, 204 of 205 surveys received were completed (99.5%). 78.4% of surgeons practice in North America, across a diverse geographic span. Most physician have a primarily foot and ankle practice (88.1%), and 92.1% treat college or professional level athletes. 88.1% of surgeons utilize LATs in the foot and ankle. The most common indication for LAT use reported was quicker return-to-play (67.1%). The patient characteristics most influential of LAT use were elite athlete (67.2%), obesity (47.4%), manual laborer (46.9%), and cavovarus alignment (46.3%) (Figure 1). Significant diversity exists in level of surgeon concern for LAT device costs (p < 0.01), as well as in setting in which surgeons learned their LAT skills (p < .01). 97.7% of respondents who use LATs augment the ATFL.

Conclusion:

LATs are widely used by the membership of the AOFAS. Surgeon characteristics have a large effect on their use of LATs, and rate of utilization. Many surgeons’ motivations for LAT use are centered around athletic participation, patient employment, and patient anatomy. Concern for safety and efficacy of LAT use is the primary detractor in the use of this technique. Vast diversity exists in the ligaments which are repaired with ligament augmentation. A multitude of novel constructs were self-reported, and techniques which are not reported in the literature were described. We can expect further progress in clinical use of LATs.
Polymethylmethacrylate (PMMA) Augmentation Increases the Strength of Midfoot Beam Constructs in Charcot Neuroarthropathy Model: A Biomechanical Study
Authors: Pattisapu Naveen , Huang Dave , Porter Giselle M. , Owhonda Rebisi , Charlton Timothy , Gross Christopher E. , Thordarson David , Metzger Melodie
Published: December 2024

Category:

Basic Sciences/Biologics; Diabetes

Introduction/Purpose:

Even with the best conservative care, patients with Charcot Neuroarthropathy (CN) of the foot and ankle often ulcerate, increasing their risk of infection, amputation, and death. Surgical fixation has a 30% risk of recurrent ulceration, likely due to poor host bone quality which is prone to deformity recurrence and subsequent ulceration. We propose midfoot beam reconstruction with PMMA augmentation as a novel means of improving fixation.

Methods:

A protocol was developed to create the characteristic CN midfoot fragmentation both visually and fluoroscopically in each of tweleve matched-pair cadaveric feet. Afterward, the pairs were divided into two groups (1) Midfoot beam fusion alone, and (2) Midfoot beam fusion augmented with PMMA. In both groups, a solid 7.0 mm beam was placed into the medial column and a solid, 5.5 mm beam was placed across the lateral column. In the PMMA group, 8-10 mL of PMMA was inserted into the medial column. The hindfoot of each specimen was potted and the metatarsal heads were cyclically loaded for 1800 cycles, followed by load to failure while load and displacement were continually recorded.

Results:

One specimen in the beam only group failed before reaching the 1800th cycle and therefore was not included in the failure analysis. The midfoot beam only group demonstrated greater mean displacement during cycle testing compared to the PMMA group, p< 0.05. The maximum force (N), stiffness (N/mm) and toughness (Nmm) were all significantly greater in group augmented with PMMA, p< 0.05.

Conclusion:

In a CN cadaveric model, PMMA augmentation significantly decreased gapping during cyclic loading and nearly doubled the load to failure compared to midfoot beams alone. Clinical Relevance: The results of this biomechanical study demonstrate that augmentation of midfoot beams with PMMA increases the strength and stiffness of the fusion construct, which may reduce the risk of nonunion and infection in patients with neuropathic midfoot collapse.
Preoperative Incongruent Subtalar Joint Predicts Less Favorable Clinical Outcome in Total Ankle Arthroplasty
Authors: Kyung Min Gyu , Kim Jahyung , Kim Joonhee , Lee Hye Ran , Kim Ji Hye , Yoon A Ro , Kim Min Ju , Lee Dong Yeon
Published: December 2024

Category:

Ankle Arthritis; Hindfoot

Introduction/Purpose:

The clinical role of incongruent subtalar joints on ankle arthritis as well as that on the clinical outcome of surgical treatment such as total ankle arthroplasty (TAA) has not yet been fully understood. The mobile subtalar joint may compensate for malalignment of the arthritic ankle as well as counteract the effect of realigning surgeries. We aimed to determine the clinical effect of incongruent subtalar joint space on TAA.

Methods:

We retrospectively reviewed 34 patients who underwent TAA, which were grouped according to the status of subtalar joint incongruency. For clinical parameters, American Orthopaedic Foot & Ankle Society (AOFAS) score and pain visual analog scale (VAS) were collected. For radiographic parameters, preoperative talar tilt angle, medial distal tibial angle, and anterior distal tibial angle were measured. A comparison of clinical and radiographic parameters between groups as well as multiple regression analysis was performed to identify contributing factors to the final functional outcome.

Results:

Interobserver and intraobserver reliabilities of subtalar joint congruency demonstrated substantial agreement. At the final follow-up, the AOFAS score was significantly higher in the congruent group (n=13) compared to that of the incongruent group (n=21), (90.38 vs. 79.57, p=0.007). However, there was no significant difference in pain VAS between the groups at the final follow-up (p=0.181). For measured radiographic parameters, there were no significant differences between the two groups in talar tilt angle, medial distal tibial angle, and anterior distal tibial angle. In multiple regression analysis, the female sex (p=0.006) and incongruency of the subtalar joint (p=0.013) were found to be significant contributing factors to the final AOFAS score.

Conclusion:

Patients in which the preoperative subtalar joint is incongruent showed less favorable AOFAS scores after undergoing TAA. A thorough preoperative investigation should be taken into the state of the subtalar joint for TAA.
Preserving Paratenon in Acute Achilles Tendon Repair: A 5-Year Follow-Up
Authors: Kord Mohammad Hossein Chegini , Ebrahimi Alireza , Waryasz Gregory R. , Ashkani-Esfahani Soheil , Razi Mohammad
Published: December 2024

Category:

Sports; Trauma

Introduction/Purpose:

Achilles Tendon (AT) rupture is one of the most prevalent adult tendon injuries, with the incidence rate estimated to range between 7 to 40 in 100000 person-years. Although some surgical approaches involve incising or removing the Paratenon when repairing injured or degenerative tendons, an alternative perspective suggests preserving the paratenon during AT repair could potentially benefit healing through two proposed mechanisms: retaining the hematoma, which may contain factors with stem cell-like properties and reducing mechanical stress on the skin incision site. The aim of this study was to investigate the potential influence of Paratenon preservation on the outcomes of AT repair in a 5-year follow up study.

Methods:

After receiving IRB approval, we conducted a single-center study in Tehran, Iran, involving a consecutive series of 52 patients who sustained acute AT ruptures (less than 2 weeks from injury) and underwent a modified surgical technique performed by surgeons affiliated with the local institution. The technique involved careful skin incision while preserving the Paratenon intact and performing the tendon repair over the retained Paratenon (Figure 1). Patients were prospectively evaluated with a mean follow-up duration of 5 years (between 48 to 72 months). Functional outcomes were assessed using the Achilles Tendon Rupture Score (ATRS) and the American Orthopedic Foot and Ankle Society (AOFAS) rating scales in all patients at 6, 9, 18, and 36 months postoperatively. Two complementary follow-up visits at 12 and 24 months after the last visit were scheduled.

Results:

The mean AOFAS and ATRS scores were 83±4 and 85.7±3.1, respectively, by the 36-month follow-up visit. Approximately 90.1% of patients regained preinjury activity levels during the complementary follow-up visits, including 71.3% of professional athletes returning to prior recreation. Isokinetic testing revealed plantar flexion and dorsiflexion strength deficits of 83.7±5.1% and 87.8±3.6% compared to the uninjured sides at 3 months after the surgery. Calf muscle atrophy was minimal. While 19 patients reported initial activity-related pain, these symptoms resolved within 12 months. No wound complications, nerve injuries, or footwear issues occurred during the study period.

Conclusion:

Preserving the Paratenon during AT repair showed satisfactory functional and clinical outcomes without any case of the wound complications that are common after open repairs. These findings support the hypothesis that an intact Paratenon aids tendon healing and reduces complication rates. Retaining the Paratenon may also help mitigate the "bowstring" effect on the repaired Achilles tendon. This surgical technique warrants further investigation as a potential strategy for enhancing outcomes following AT ruptures.
PROMIS Ability to Predict Outcomes and Time to Surgery for Patients Treated with Bunion Surgery for Hallux Valgus
Authors: Gauthier Chase , Kumar Padam , Paradis Austin , Dias Travis , Ecker Thomas , Gonzalez Tyler , Jackson J. Benjamin
Published: December 2024

Category:

Midfoot/Forefoot; Bunion

Introduction/Purpose:

Patient-reported outcome metrics are useful in determining a patient’s clinical response to a given intervention. Despite their usefulness, few studies have identified the potential prognostic value of patient-reported outcome metrics. This study looks to evaluate whether preoperative PROMIS scores can predict time to surgery and improvement in postoperative PROMIS scores in those undergoing hallux valgus correction surgery.

Methods:

A retrospective review was conducted of patients undergoing surgical intervention for hallux valgus at a single academic institution between June 2020 and June 2023. Demographic information, time to surgery, PROMIS scores, and preoperative radiographic measurements were collected. The minimal clinically important difference (MCID) in PROMIS scores was defined as half of the standard deviation of the change in PROMIS scores. A total of 209 patients were included in the study. Categorical and continuous data were compared using the Chi-squared test and Student’s T-test, respectively. Multivariable logistic regression analysis was utilized to control for confounding variables. All p< 0.05 were considered statistically significant.

Results:

Higher preoperative pain interference (PI) (OR=1.3, p< 0.001), mobility (OR=1.22, p=0.003), and global health-physical (OR=1.14, p=0.043) scores were independent predictors for increased odds of achieving an MCID in PI score. Lower preoperative physical function (PF) (OR=1.18, p=0.007) scores and higher preoperative PI (OF=1.16, p=0.005) and global health-physical (OR=1.22, p=0.001) scores were independent predictors for increased odds of achieving an MCID in PF scores. No factors were independently associated with achieving an MCID in mobility scores. Finally, being seen first by an MD (OR=3.7, p=0.034) and being unmarried (OR=34.3, p=0.032) were both independent predictors for having surgery within 6 months of presentation. Hallux valgus and Intermetatarsal angles at presentation did not significantly influence either the ability to achieve an MCID in PROMIS scores or time to surgery.

Conclusion:

Worse preoperative PI and PF scores were independently associated with an increased likelihood of achieving an MCID in those respective scores when controlling for confounding variables. Additionally, the severity of a patient’s hallux valgus, based upon their radiographic measurements at presentation, did not significantly influence a patient’s postoperative outcomes or time to surgery. These results suggest that patients with more severe hallux valgus symptoms, but not necessarily more severe hallux valgus radiographic findings, are most likely to clinically improve following surgical intervention.
Results of Autograft vs Allograft with Bone Marrow Aspirate Concentrate in Lateral Column Lengthening for Reconstruction of Progressive Collapsing Flatfoot Deformity
Authors: Huang Daran , Cher Eric Wei Liang , Png Wenxian , Singh Inderjeet Rikhraj
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

Although Evan’s lateral column lengthening (LCL) calcaneal osteotomy is the standard joint-sparing surgical option to correct the forefoot abduction in Johnson and Strom Grade IIB progressive collapsing flatfoot deformity (PCFD), studies evaluating the choice of filling (autograft or allograft) for the osteotomy site on outcomes reveal heterogeneous results. The purpose of this study is to compare the results of graft choice on bony union, subsequent clinical outcomes and complication rates after LCL osteotomy.

Methods:

This was a retrospective study of 34 patients who underwent Evan’s LCL divided into 2 cohorts dependent on the type of graft used for the opening osteotomy (Group A used tricortical autograft harvested from the iliac crest, n = 24; Group B used tricortical allograft soaked in the patient’s own bone marrow aspirate concentrate, n = 10). Patient demographics, time to union, postoperative complications, and patient-reported outcome measures were compared among groups using univariable analyses. Minimum follow-up was 24 months.

Results:

Both groups demonstrated significant improvement in Visual Analogue Scale (VAS) of the midfoot and hindfoot, American Orthopaedic Foot & Ankle Society (AOFAS)-Mid and AOFAS-Hind scores at 6 months (P < 0.05) and continued experiencing improvement at 24 months postoperatively (P < 0.05). Nevertheless, there was no statistically significant difference in clinical outcomes or time to union between autograft and allograft when performing Evan’s LCL. In terms of complications, neither group experienced any non-union, though all who experienced surgical complications were from group A - 3 patients suffered peroneal tendinopathy, 1 patient experienced Achilles tendinopathy, 2 patients underwent removal of implants and 1 patient had chronic pain due to irritation to the plantar nerve.

Conclusion:

Significant and early improvement in clinical outcomes were observed in both groups with 100% union rates. Though Group A (iliac crest autograft) had higher rates of complications, it did not fare worse on patient-reported outcome measures when performing Evan’s LCL. Future studies involving larger sample sizes with standardized definitions for radiographic union will be critical to further elucidate graft-related impacts on outcomes after LCL.
Impact of stroke order on Chinese spelling in the Vietnamese Chinese as a second language context
Authors: Liang Yuan , Ng Stella
Published: December 2024

This article aimed to assess the impact of stroke order on Chinese spelling among Chinese as a second language (CSL) learners in Vietnam, using a cross-sectional design and an error analysis. It seeked to distinguish between sequence errors and traditional form errors in Chinese spelling and explored their relationship. The study involved 94 CSL students from four Vietnamese universities who participated in a writing-to-dictation test, a stroke identification task and a character orthographic awareness task in Chinese. Eight types of sequence errors were identified, most of which occurred within the basic orthographic units for Chinese spelling, namely the logographeme or the radical. The results of the generalized linear mixed model indicated that character frequency, stroke identification scores, orthography awareness scores and Chinese proficiency all had a significant impact on the spelling accuracy of CSL learners. In addition, a significant negative association was found between sequence accuracy and form errors. A one-way analysis of variance further revealed that the sequence error across orthographic units was an indicator of learners’ Chinese level. These findings contribute to a deeper understanding of the impact of stroke order on Chinese spelling and highlight the importance of considering not only stroke-related knowledge but also orthographic units of varying grain sizes in stroke order writing. Drawing from the empirical findings, the article explored possible educational implications of stroke order in the teaching of spelling to CSL learners.
Data Resource Profile: Heart Valve Society Aortic Valve Database (HVS AV Database)
Authors: van der Ven Carlijn C.E.M. , Kluin Jolanda , Takkenberg Johanna J.M. , El-Hamamsy Ismail , Meuris Bart , Pibarot Philippe , Youssefi Pouya , Lansac Emmanuel , Verbrugghe Peter , Veen Kevin M. ,   on behalf of the Aortic Valve Research Network Investigators
Published: December 2024

Background

Multicenter, standardized, long-term data are essential for assessing outcomes of patients following aortic (valve) treatment. To facilitate this, the international Heart Valve Society (HVS) Aortic Valve (AV) Database was established. This paper provides an overview of the HVS AV Database.

Methods

The HVS AV Database includes adult patients with aortic valve disease (regurgitation and/or stenosis), with or without ascending aorta aneurysm, undergoing surgical or transcatheter intervention. It has an ambispective design, and centers interested in interventional outcomes following aortic (valve) intervention can participate free of charge.

Results

The variables collected in the database are harmonized with the International Consortium for Health Outcomes Measurement (ICHOM) standard Set of Patient-Centered Outcome Measures for Heart Valve Disease (HVD). In total, 33 outcome variables, including 12 clinical and 21 echocardiographic, and 286 case-mix variables are collected. Currently, the database includes 10,893 patients from 78 participating centers worldwide, with 7910 patients having undergone aortic valve repair and 1968 aortic valve replacement. Participating centers can extract their own data at any time, and multicenter research proposals are encouraged. The database is compliant with GCP, FDA, GDPR and HIPAA regulations, supporting data transfer across continents.

Conclusions

The HVS AV Database is aimed at improving outcomes for patients requiring intervention for aortic (valve) disease. Through uniform scientific reporting, it contributes to global efforts to standardize data capture, improve patient outcomes and shift the focus from device to global patient outcomes.
Development of an orthotopic pulmonary valve replacement porcine model for mechanical heart valve thrombosis
Authors: Langenaeken Tom , Van Hecke Manon , De Meester Pieter , Roets Jean , Meuris Arthur , Verbrugghe Peter , Rega Filip , Meuris Bart
Published: December 2024

Objective

Animal models are indispensable for the development of valve prostheses like we currently know them. Recent developments have questioned the validity of sheep as the model of choice for the evaluation of mechanical heart valves. The pig has been raised as a better alternative due to a more comparable coagulation system. We therefore compared the thrombogenicity of the sheep compared to the pig in a model of pulmonary valve replacement.

Methods

Pigs (n = 12) and sheep (n = 5) underwent pulmonary valve replacement with a mechanical valve in orthotopic position. No antithrombotic medication of any kind was given. Follow-up period was 5 months or until established valve thrombosis. Valve performance was assessed by monthly cardiac ultrasounds combined with post-mortem macro- and microscopical analysis of the valve and downstream organs.

Results

In the pig cohort, valve thrombosis was established after less than a month in all but one animal. Post-mortem valve examination showed terminal valve thrombosis with immobilized hinges. In the sheep cohort, all animals completed the follow-up period of 5 months. At post-mortem examination, all valves were free from any thrombi or deposits with both leaflets mobile.

Conclusion

The sheep model appears not thrombogenic enough to elicit mechanical valve thrombosis in the highly thrombogenic pulmonary position. Contrarily, the porcine model elicits massive thrombosis at a fast rate in an identical position. These findings confirm that we should shift to the pig as a standard for (mechanical valve) thrombosis research.
Bioinformatics based exploration of the anti-NAFLD mechanism of Wang’s empirical formula via TLR4/NF-κB/COX2 pathway
Authors: Chen Suhong , Zhou Chuanjie , Huang Jiahui , Qiao Yunlong , Wang Ning , Huang Yuzhen , Li Bo , Xu Wanfeng , He Xinglishang , Wang Kungen , Zhi Yihui , Lv Guiyuan , Shen Shuhua
Published: December 2024

Background

Nonalcoholic fatty liver disease (NAFLD) has developed as a leading public wellness challenge as a result of changes in dietary patterns. Unfortunately, there is still a lack of effective pharmacotherapy methods for NAFLD. Wang’s empirical formula (WSF) has demonstrated considerable clinical efficacy in treating metabolic disorders for years. Nevertheless, the protective effect of WSF against NAFLD and its underlying mechanism remains poorly understood.

Methods

The NAFLD model was established using a 17-week high-sucrose and high-fat (HSHF) diet with 32 ICR mice. In assessing the therapeutic efficacy of WSF on NAFLD, we detected changes in body weight, viscera weight, biomarkers of glycolipid metabolism in serum and liver, transaminase levels and histopathology of liver with H&E and Oil Red O staining after oral administration. The chemical components in WSF were extensively identified and gathered utilizing the HPLC-Q-TOF/MS system, database mining from HMDB, MassBank, and TCMSP databases, alongside literature searches from CNKI, Wanfang and VIP databases. The forecast of network pharmacology approach was then utilized to investigate the probable mechanisms by which WSF improves NAFLD based on the performance of prospective target identification and pathway enrichment analysis. Besides, molecular docking was also conducted for the verification of combination activities between active components of WSF and core proteins related to NAFLD. In final, validation experiments of obtained pathways were conducted through ELISA, immunohistochemistry (IHC), and western blot (WB) analysis.

Results

Pharmacodynamic outcomes indicated that WSF intervention effectively mitigated obesity, fat accumulation in organs, lipid metabolism disorders, abnormal transaminase levels and liver pathology injury in NAFLD mice (P < 0.05, 0.01). A total of 72 existent ingredients of WSF were acquired by HPLC-Q-TOF/MS and database, and 254 common targets (11.6% in total targets) of NAFLD and WSF were identified. Network pharmacology revealed that WSF presses NAFLD via modulating TNF, IL6, AKT1, IL1B, PTGS2 (COX2), and other targets, and the probable pathways were primarily inflammatory signaling pathways, as confirmed by molecular docking. Molecular biology experiments further conformed that WSF could decrease levels of inflammatory factors like IL-1β, IL-6 and TNF-α (P < 0.01) and expression of TLR4, NF-κB and COX-2 (P < 0.05, 0.01) in the liver.

Conclusion

WSF treatment effectively protects against lipid metabolism disorders and liver inflammation injury in HSHF diet-induced NAFLD mice, and its molecular mechanism might be via suppressing the TLR4/NF-κB/COX-2 inflammatory pathway to reduce the release of inflammatory cytokines in the liver.

Graphical abstract
ENPP2 promotes progression and lipid accumulation via AMPK/SREBP1/FAS pathway in chronic lymphocytic leukemia
Authors: Lu Liyan , Hu Xinting , Han Yang , Wang Hua , Tian Zheng , Zhang Ya , Wang Xin
Published: December 2024

Background

Disorders of lipid metabolism are critical factors in the progression of chronic lymphocytic leukemia (CLL). However, the characteristics of lipid metabolism and related regulatory mechanisms of CLL remain unclear.

Methods

Hence, we identified altered metabolites and aberrant lipid metabolism pathways in patients with CLL by ultra-high-performance liquid chromatography-mass spectrometry-based non-targeted lipidomics. A combination of transcriptomics and lipidomics was used to mine relevant target molecule and downstream signaling pathway. In vitro cellular assays, quantitative real-time polymerase chain reaction (qRT-PCR), western blot, fluorescent staining, RNA sequencing, and coimmunoprecipitation were used to monitor the molecular levels as well as to explore the underlying mechanisms.

Results

Significant differences in the content of 52 lipid species were identified in CLL samples and healthy controls. Functional analysis revealed that alterations in glycerolipid metabolism, glycerophospholipid metabolism, sphingolipid metabolism, and metabolic pathways had the greatest impact on CLL. On the basis of the area under the curve value, a combination of three metabolites (phosphatidylcholine O-24:2_18:2, phosphatidylcholine O-35:3, and lysophosphatidylcholine 34:3) potentially served as a biomarker for the diagnosis of CLL. Furthermore, utilizing integrated lipidomic, transcriptomic, and molecular studies, we reveal that ectonucleotide pyrophosphatase/phosphodiesterase 2 (ENPP2) plays a crucial role in regulating oncogenic lipogenesis. ENPP2 expression was significantly elevated in patients with CLL compared with normal cells and was validated in an independent cohort. Moreover, ENPP2 knockdown and targeted inhibitor PF-8380 treatment exerted an antitumor effect by regulating cell viability, proliferation, apoptosis, cell cycle, and enhanced the drug sensitivity to ibrutinib. Mechanistically, ENPP2 inhibited AMP-activated protein kinase (AMPK) phosphorylation and promoted lipogenesis through the sterol regulatory element-binding transcription factor 1 (SREBP-1)/fatty acid synthase (FAS) signaling pathway to promote lipogenesis.

Conclusions

Taken together, our findings unravel the lipid metabolism characteristics of CLL. Moreover, we demonstrate a previously unidentified role and mechanism of ENPP2 in regulation of lipid metabolism, providing a novel therapeutic target for CLL treatment.
Transgenic tomato strategies targeting whitefly eggs from apoplastic or ovary-directed proteins
Authors: Thompson Natalie S. , Anwar Aliya Fathima , Krum David , Ream Michael , Shouse Eva , Weston Zachary , Chen Yun-Ru , Sam Aisa , Deguchi Michihito , Kariuki Samwel M. , Rudrabhatla Sairam V. , Curtis Wayne R.
Published: December 2024

Background

Transgenic plants expressing proteins that target the eggs of the ubiquitous plant pest Bemisia tabaci (whitefly) could be an effective insecticide strategy. Two approaches for protein delivery are assessed using the mCherry reporter gene in transgenic tomato plants, while accommodating autofluorescence in both the plant, phloem-feeding whitefly and pedicle-attached eggs.

Results

Both transgenic strategies were segregated to homozygous genotype using digital PCR. The first strategy uses a glycotransferase secretion signal peptide. Despite bright apoplastic accumulation, mCherry is not evident in the eggs. The second strategy targets in vivo whitefly eggs, where the mCherry transgene was fused to a protein transduction domain (PTD) to facilitate uptake into the whitefly hemolymph as well as a synthetic vitellogenin ovary-targeting sequence. Phloem-specific expression of the mCherry fusion is achieved from a Commelina viral promoter. Accumulation was not sufficient to be observed in females feeding on these ovary-targeting plants nor in their eggs subsequently laid on non-transgenic plants. Egg protection may be mediated by protease activity which is observed in macerated eggs.

Conclusions

mCherry proved an effective reporter for the desired tissue-specific expression in tomato, but insufficiently sensitive to allow for localization in feeding whiteflies or their eggs. Segregated homozygous transgenic tomato lines were important for drawing these conclusions. The implications of these observations to possible pest-control strategies including preliminary expression of analogous chitinase constructs are discussed.
Self-monitoring of blood pressure following a stroke or transient ischaemic attack (TASMIN5S): a randomised controlled trial
Authors: McManus R. J. , Smith A. , Temple E. , Yu L. M. , Allen J. , Doogue R. , Ford G. A. , Glynn L. , Guthrie B. , Hall P. , Hinton L. , Hobbs F. D. R. , Mant J. , McKinstry B. , Mead G. , Morton K. , Rai T. , Rice C. , Roman C. , Stoddart A. , Tarassenko L. , Velardo C. , Williams M. , Yardley L. ,   on behalf of the TASMIN5S investigators
Published: December 2024

Background

Blood pressure (BP) control following stroke is important but currently sub-optimal. This trial aimed to determine whether self-monitoring of hypertension with telemonitoring and a treatment escalation protocol, results in lower BP than usual care in people with previous stroke or transient ischaemic attack (TIA).

Methods

Unblinded randomised controlled trial, comparing a BP telemonitoring-based intervention with control (usual care) for hypertension management in 12 primary care practices in England. People with previous stroke or TIA with clinic systolic BP 130–180 mmHg, taking ≤ 3 antihypertensive medications and on stable treatment for at least four weeks were randomised 1:1 using secure online system to intervention or control. The BP:Together intervention comprised self-monitoring of blood pressure with a digital behavioural intervention which supported telemonitoring of self-monitored BP with feedback to clinicians and patients regarding medication titration. The planned primary outcome was difference in clinic measured systolic BP 12 months from randomisation but was not available following early study termination due to withdrawal of funding during the COVID-19 pandemic. Instead, in addition to pre-randomised data, routinely recorded BP was extracted from electronic patient records both pre- and post-randomisation and presented descriptively only. An intention to treat approach was taken.

Results

From 650 postal invitations, 129 (20%) responded, of whom 95 people had been screened for eligibility prior to the pandemic (November 2019-March 2020) and 55 (58%) were randomised. Pre-randomisation routinely recorded mean BP was 145/78 mmHg in the control (n = 26) and 145/79 mmHg in the self-monitoring (n = 21) groups. Post-randomisation mean BP was 134/73 mmHg in the control (n = 19) and 130/75 mmHg in the self-monitoring (n = 25) groups. Participants randomised to self-monitoring used the intervention for ≥ 7 months in 25/27 (93%) of cases.

Conclusions

Recruitment of people with stroke/TIA to a trial comparing a BP self-monitoring and digital behavioural intervention to usual care was feasible prior to the COVID-19 pandemic and the vast majority of those randomised to intervention used it while the trial was running. Routinely recorded blood pressure control improved in both groups. Digital interventions including self-monitoring are feasible for people with stroke/TIA and should be definitively evaluated in future trials.

Trial registration

ISRCTN57946500 06/09/2019 Prospective.
Early response of anti-vascular endothelial growth factor (anti-VEGF) in diabetic macular edema (DME) management: microperimetry and optical coherence tomography (OCT) findings: a pilot study at national eye center of third world country
Authors: Ihsan Grimaldi , Kwartika Ameliza , Widyanatha Made Indra , Virgana Rova , Iskandar Erwin , Kartasasmita Arief Sjamsulaksan
Published: December 2024

Purpose

To evaluate early response of retinal sensitivity (RS) and retinal morphology in diabetic macular edema (DME) patients after intravitreal anti-vascular endothelial growth factor (anti-VEGF) treatment.

Methods

Sixteen eyes of 12 DME patients were included in this study conducted prospectively. All eyes underwent functional and morphologic examination of the macular area using microperimetry and optical coherence tomography (OCT) before and after intravitreal anti-VEGF injection. To determine significant differences between the values, paired t test was used. A correlation between CMT and RS was made using Spearman’s test.

Results

Patients were evaluated at baseline, one week and one month after injection. The central macular thickness (CMT) decreased significantly from 449.33 ± 100.79 μm to 427.94 ± 85.76 μm to 357.93 ± 75.92 μm. The RS improved significantly from 7.94 ± 6.43 dB to 11.09 ± 7.42 dB at one week and to 14.22 ± 7.66 dB at one month after treatment. The CMT was significant negatively correlated to RS (r=-0.259, p = < 0.001), with decay of 0.025 dB for every 1 μm increase of CMT.

Conclusions

Retinal thickening due to DME can be adequately quantified using OCT, while microperimetry can offer information about retinal sensitivity in the exact location. Therefore, microperimetry can be a useful tool in predicting the functional outcome and determining the efficacy of anti-VEGF treatment for DME patients.
The effect of eye movement desensitization on neurocognitive functioning compared to retrieval-only in PTSD patients: a randomized controlled trial
Authors: Susanty Eka , Sijbrandij Marit , Srisayekti Wilis , Suparman Yusep , Huizink Anja C.
Published: December 2024

Background

There is robust evidence that posttraumatic stress disorder (PTSD) is associated with neurocognitive deficits, such as executive dysfunction or memory dysfunction. Eye Movement Desensitization and Reprocessing (EMDR) is an evidence-based treatment for PTSD, in which eye movements (EMs) are performed during traumatic memory retrieval. We examined whether Eye Movement Desensitization (EMD) improves neurocognitive functioning in PTSD patients, in comparison with a retrieval-only control condition without EMs.

Methods

Adult patients with PTSD (N = 91) were randomized into EMD (N = 47) or retrieval-only (N = 44). Data were collected at baseline (T0), one-week post-treatment (T1), one-month follow-up (T2), and at three-month follow-up (T3). Outcome measures were the California Verbal Learning Test (CVLT), the Trail Making Test (TMT), and the Digit Span Subtest of the Wechsler Adult Intelligence Scale fourth edition (WAIS-IV). We conducted linear mixed model to analyse the main outcomes.

Results

There was a main effect of time, indicating improvements for both the EMD and retrieval-only groups in CVLT scores, TMT A, TMT B and Digit Span score of WAIS-IV (Bonferroni-adjusted p’s < 0.001) from T0 to T3. There were no effects of group (p = .64) or group by time on CVLT total trial A (T3; p = .34), delay A (T3; p = .76), TMT A (T3; p = .61), TMT B (T3: p = .58), and Digit Span scores (T3; p = .78) of the WAIS-IV, indicating no significant differences between groups on any of the outcomes.

Conclusion

Comparing EMD and retrieval-only did not show evidence for additive effects of EMs on the treatment of PTSD in terms of improvements in neurocognitive functioning. Thus, treatments based on retrieval of traumatic memories may be used to improve neurocognitive functioning in patients with PTSD.

Clinical trial registration

The trial was registered 19/12/2017 at ClinicalTrials.gov, identifier [ISRCTN55239132].
A happy place to be in: how beliefs about living places influence depression in Chinese international student returnees
Authors: Jin Ruining , Yin Meiling , Shen Qiang , Le Tam-Tri
Published: December 2024

Background

The mental health of Chinese international student returnees is a critical concern impacting their well-being and successful reintegration into home society, especially in the post-COVID-19 era. This study examines how beliefs about changing living conditions, emigration intentions, and belief in fate influence depression levels among these returnees.

Methods

A cross-sectional survey collected data from 1,014 returnees through WeChat public groups. Depression levels were measured using the Patient Health Questionnaire-9 (PHQ-9), and Bayesian analysis with Markov Chain Monte Carlo (MCMC) algorithms was employed for statistical examination.

Findings

It was found that a stronger belief that changing one's living environment can bring happiness is associated with lower depression levels, highlighting the positive role of agency thinking in mental health. This association is moderated by emigration intentions and belief in fate. Specifically, among returnees who believe that changing living conditions enhances happiness, those with stronger intentions to emigrate from China exhibited lower depression levels, while those with a strong belief in fate showed higher depression levels.

Implications

These results suggest that both agency and pathway thinking significantly affect the mental health of returnees. To support their well-being and reintegration, we recommend that policymakers create more diverse and inclusive environments within China that accommodate returnees' aspirations. Educational institutions should offer counseling services that bolster returnees' proactive strategies for achieving personal goals. Additionally, mental health interventions should address cultural beliefs, such as fatalism, which might hinder proactive coping mechanisms.
Implementation and evaluation of an optimized surgical clerkship teaching model utilizing ChatGPT
Authors: Huang Yi , Xu Bei-bei , Wang Xiu-yan , Luo Yun-cheng , Teng Miao-miao , Weng Xuejian
Published: December 2024

Objective

This study aims to explore the effect of an innovative teaching model incorporating ChatGPT on medical students’ learning outcomes, compliance with learning activities, and overall satisfaction with the learning process.

Methods

A cohort of 64 students participating in general surgery clerkships at Wenzhou People’s Hospital during the 2022–2023 academic year were randomly assigned into 4 groups, each comprising 16 students. Two of these groups were designated as the study group, where ChatGPT was employed as a supplementary educational tool. The remaining 2 groups served as control groups and used traditional multimedia-based learning methods. Outcomes, including learning effectiveness, compliance, and satisfaction, were evaluated using questionnaires and tests.

Results

The study groups exhibited significantly higher levels of compliance and satisfaction compared to the control groups. Specifically, the study groups exhibited significantly greater compliance in both pre-class preparation and post-class review activities (P < 0.05). During classroom teaching, Group 1 of the study group achieved significantly higher compliance than the control groups (P < 0.0001), while Group 2 of the study group showed significantly higher compliance than Group 1 (P < 0.001). In terms of seeking feedback and assistance, both Groups 1 and 2 of the study group had significantly higher compliance compared to Group 1 of the control group (P < 0.01, P < 0.001 respectively). Overall satisfaction was significantly higher in the study groups compared to the control groups (P < 0.0001), particularly with respect to course organization (P < 0.001, P < 0.05).

Conclusion

The incorporation of ChatGPT into the surgical clerkship teaching model substantially enhances learner compliance and satisfaction, offering notable advantages in educational effectiveness.