bluuebunny/crossref_metadata_2025 huggingface dataset:
Addressing Disparities Using Continuous Glucose Monitors and Remote Patient Monitoring for Youth With Type 1 Diabetes
Authors: Lee Ming Yeh , Ritter Victor , Shaw Blake , Ferstad Johannes O. , Johari Ramesh , Scheinker David , Bishop Franziska , Desai Manisha , Maahs David M. , Prahalad Priya
Published: December 2024

Background:

Youth with type 1 diabetes (T1D) and public insurance have lower diabetes technology use. This pilot study assessed the feasibility of a program to support continuous glucose monitor (CGM) use with remote patient monitoring (RPM) to improve glycemia for youth with established T1D and public insurance.

Methods:

From August 2020 to June 2023, we provided CGM with RPM support via patient portal messaging for youth with established T1D on public insurance with challenges obtaining consistent CGM supplies. We prospectively collected hemoglobin A1c (HbA1c), standard CGM metrics, and diabetes technology use over 12 months.

Results:

The cohort included 91 youths with median age at enrollment 14.7 years, duration of diabetes 4.4 years, 33% non-English speakers, and 44% Hispanic. Continuous glucose monitor data were consistently available (≥70%) in 23% of the participants. For the 64% of participants with paired HbA1c values at enrollment and study end, the median HbA1c decreased from 9.8% to 9.0% ( P < .001). Insulin pump users increased from 31 to 48 and automated insulin delivery users increased from 11 to 38.

Conclusions:

We established a program to support CGM use in youth with T1D and barriers to consistent CGM supplies, offering lessons for other clinics to address disparities with team-based, algorithm-enabled, remote T1D care. This real-world pilot and feasibility study noted challenges with low levels of protocol adherence and obtaining complete data in this cohort. Future iterations of the program should explore RPM communication methods that better align with this population’s preferences to increase participant engagement.
Sozo Kurahashi’s philosophy of Japanese early childhood education and care: An analysis of poetic descriptions of his interactions with children
Authors: Suizu Sachie
Published: December 2024

This study examined the philosophy of Sozo Kurahashi—referred to as the “Fröbel of Japan” and the “father” of Japanese Early Childhood Education and Care—by focusing on the poetic descriptions of his and other teachers’ interactions with children in his essays. It also compared these descriptions with specific scenes observed by the author in a kindergarten. Specifically, this study focused on his usage of the term kokoro-mochi (state of heart). He used this concept to convey three main ideas: (1) a child’s state of heart is very faint and extremely short-lived; (2) it exists separately from the rationale behind something; and (3) paradoxically, teachers tend to neglect children’s present state of heart, despite loving and educating them. From his perspective, adults tend to overlook children’s present feelings, because they see the present as the determinant of the future while educating them. Kurahashi seems to emphasize that children should not be viewed from a third-person perspective, but should be engaged with through a second-person perspective. Furthermore, Kurahashi encouraged teachers to empathize with each child’s state of heart. Therefore, he highlighted the need to engage with children in the present, caring for their being, responding to their feelings, and respecting their creativity in spontaneous play. His philosophy provides insights into the attitudes toward children.
Gnostic notes on temporal validity
Authors: Jang Austin , Offer-Westort Molly , Wang Serena , Aronow P. M.
Published: December 2024

Kevin Munger argues that, when an agnostic approach is applied to social scientific inquiry, the goal of prediction to new settings is generically impossible. We aim to situate Munger’s critique in a broader scientific and philosophical literature and to point to ways in which gnosis can and, in some circumstances, must be used to facilitate the accumulation of knowledge. We question some of the premises of Munger’s arguments, such as the definition of statistical agnosticism and the characterization of knowledge. We further emphasize the important role of microfoundations and particularism in the social sciences. We assert that Munger’s conclusions may be overly pessimistic as they relate to practice in the field.
Metabolic Syndrome: An Updated Review on Diagnosis and Treatment for Primary Care Clinicians
Authors: Peterseim Carolyn Mae , Jabbour Katarzyna , Kamath Mulki Ashwini
Published: December 2024

Objective:

Metabolic syndrome is a cluster of cardiovascular risk factors (central obesity, hypertension, dyslipidemia, and insulin resistance) that affects between 12.5% and 31.4% of adults worldwide. It correlates with increased risks of cardiovascular disease, diabetes, cancer, and overall mortality in a dose-dependent fashion. This review aims to provide primary care clinicians an updated review of the evidence on metabolic syndrome, with a focus on treatment.

Design:

Scoping evidence review.

Eligibility Criteria:

English-language studies of evidence Level I or II that focused on defining, diagnosing, and treating metabolic syndrome or its components.

Information Sources:

PubMed and Cochrane Database of Systematic Reviews.

Results:

Though evidence is still lacking for improved outcomes with treating the syndrome per se, addressing its individual components reduces risks. Lifestyle changes like weight loss and increased physical activity are first line. Surgical options assist with weight loss for certain patients. Pharmacotherapies like glucagon-like peptide-1 receptor agonists, sodium-glucose cotransporter-2 inhibitors, statins, and antihypertensives also have efficacy.

Conclusions:

Metabolic syndrome is an independent risk factor for many poor health outcomes. Its individual components should be treated with medication and behavioral changes to reduce cardiovascular risk and prevent diabetes and its complications. More research is needed on how to treat the syndrome itself. A diagnosis of metabolic syndrome may be useful for motivating patients toward lifestyle changes, though more research is needed on how to treat the syndrome versus its components.
Randomized Trial of Pulsatile and Nonpulsatile Flow in Cyanotic and Acyanotic Congenital Heart Surgery
Authors: Patel Krishna , Lin Tracie K. , Clark Joseph B. , Ceneviva Gary D. , Imundo Jason R. , Spear Debra , Kunselman Allen R. , Thomas Neal J. , Myers John L. , Ündar Akif
Published: December 2024

Background

The study objective was to determine the impact of cardiopulmonary bypass perfusion modalities on cerebral hemodynamics and clinical outcomes in congenital cardiac surgery patients stratified by acyanotic versus cyanotic heart disease.

Methods

A total of 159 pediatric (age <18 years) cardiac surgery patients were prospectively randomized to pulsatile or nonpulsatile cardiopulmonary bypass and stratified by type of congenital heart disease: acyanotic versus cyanotic. Intraoperative cerebral gaseous microemboli counts and middle cerebral artery pulsatility index were assessed. Organ injury was quantified by Pediatric Logistic Organ Dysfunction-2 (PELOD-2) score at 24, 48, and 72 h postoperatively. Additional outcomes included Pediatric Risk of Mortality-3 score, vasoactive–inotropic score, duration of mechanical ventilation, intensive care and hospital length of stay, and 180-day mortality. Heterogenous variance linear models (ie, ANOVA and mixed models) and χ2 tests were used to compare groups for continuous and categorical variables, respectively.

Results

Within congenital heart disease subgroups, patients randomized to nonpulsatile versus pulsatile bypass had similar preoperative and operative characteristics. While the intraoperative pulsatility index was higher in the pulsatile subset of both acyanotic and cyanotic groups ( P < .05), regional cerebral oxygen saturation, mean arterial pressure, and gaseous microemboli counts were similar. Postoperative PELOD-2 scores decreased at similar rates in the acyanotic and cyanotic subgroups regardless of the perfusion modality utilized. There were also no significant between-group differences in the additional postoperative outcomes by perfusion modality in either acyanotic or cyanotic groups.

Conclusions

Despite patients undergoing pulsatile cardiopulmonary bypass experiencing a more physiologic pulsatility index in both acyanotic and cyanotic groups, no significant differences in cerebral hemodynamics or clinical outcomes were appreciated.
A novel variant in VMA21 causing adult-onset phenotype of X-linked myopathy with excessive autophagy with cardiac involvement in a Chinese patient
Authors: Chen Lin , Fang Ming-juan , Xu Dabing , Shi Yong-guang , Han Yong-zhu , Yu Xu-en , Xu Yin
Published: December 2024

X-linked myopathy with excessive autophagy (XMEA) is an X-linked recessive hereditary disorder, characterized by childhood onset weakness of predominantly limb and trunk skeletal muscles due to progressive loss of muscle tissue. Cardiovascular system is clinically spared generally. Here, we report the clinical characteristics, muscle biopsy and genetic findings of one adult-onset individual suffering from XMEA, caused by a novel variant in a Chinese patient. Unusually, the patient developed unexplained hypertension with high left ventricular voltage and cardiac left ventricular hypertrophy at the age of 27. Muscle MRI revealed extensive fat infiltration in the lower extremities involving vastus medialis, vastus lateralis, vastus intermedius, and long head of the biceps femoris, while rectus femoris, gracilis, adductor magnus, semimembranosus, and sartorius muscle relatively preserved. A muscle biopsy indicated numerous cytoplasmic autophagic vacuoles and deposition of complement C5b-9 and also expression of MHC class I. Immunofluorescence staining showed increased immunoreactivity of lysosomal membrane protein LAMP2 and autophagosome protein LC3A/B both localized with cytoplasmic vacuoles, and autophagy carrier protein P62-positive vacuoles accumulated remarkably in the patient's muscle. VMA21 protein levels were lower than controls in skeletal muscle tissue, suggesting a possible pathogenicity related to an alteration of the splicing efficiency in intronic mutation. This is the first report of a Chinese patient with a novel hemizygous intronic c.163 + 3A > G variant in the VMA21 gene, expanding the mutational and phenotypic spectrum of this disease.
Achieving health equity in bladder cancer care: Addressing disparities through collaborative research and evidence-based strategies
Authors: Castellon-Lopez Yelba , Thompson Patricia A
Published: December 2024

The United States has seen a decrease in the incidence of bladder cancer and a decline in mortality rates over the past 20 years. However, not all groups have benefited equally from this trend. The American Association of Community Cancer Centers (ACCC) has issued ten strategies to improve cancer care delivery for underserved patient populations. Unfortunately, the evidence supporting the best methods for reducing disparities in different patient groups and care delivery settings remains severely limited. In this short communication, using a personalized narrative woven into a clinical case, we highlight the need for more research on bladder cancer care delivery to ensure that significant investments in precision oncology translate into genuine improvements for all patients diagnosed with bladder cancer.
Sociodemographic Factors Associated with Improved Metabolic Syndrome in Slum Dwelling Adults in Kenya: A Randomized Controlled Trial
Authors: Okube Okubatsion Tekeste , Kimani Samuel T.
Published: December 2024

Background

Sociodemographic factors have been implicated in cardiovascular health with differential morbidity and mortality. It is essential to comprehend how sociodemographic factors contribute to the improvement of Metabolic Syndrome (MetS), the primary cardiovascular diseases indicator.

Objective

Determine the role of sociodemographic factors in improving MetS among adults residing in the Slums of Nairobi, Kenya.

Methods

Adults with MetS participated in this randomized controlled trial study for a period of 12-months. A random assignment was used to place eligible participants in the intervention or control groups. The intervention group received lifestyle intervention that entails not using tobacco products or alcohol, exercising, and adhering to recommended dietary guidelines, while the control group had standard medical care. Clinical, biochemistry, and lifestyle habits were measured before and a year after the intervention. The association between the sociodemographic factors and the improvement in MetS was examined using a multiple logistic regression model with backward conditional.

Results

In the intervention group, lack of improvement in metabolic syndrome was significantly higher among aged (≥50 years) respondents [AOR = 9.097; P < .001]; Protestants [AOR = 7.292; P = .017] and Catholics [AOR = 5.270; P = .050]. Compared to unemployed, formally employed respondents had an 84.6% lower chance of having MetS [AOR = 0.154; P = .005]. Within the control group, lack of improvement in metabolic syndrome was significantly higher among aged (≥50 years) respondents [AOR = 5.013; P = .047]. Compared to respondents who had less than $100, individuals with monthly incomes between $100 and $500 had a roughly 10-fold [AOR = 10.499; P = .024] higher chance of having MetS.

Conclusion

In the current study, the findings show that sociodemographic factors namely: advanced age, unemployment, being Protestants and Catholics as well as higher income were negatively associated with improvement in MetS. The findings indicate that social factors have impact in the management and intervention outcomes of CVDs. Programmers and policy makers should plan interventions for CVD prevention and response with these factors in mind.
Patients and physicians differently consider severity and outcomes of systemic sclerosis-associated interstitial lung disease: Results of an international survey
Authors: Petelytska Liubov , Elhai Muriel , Galetti Ilaria , Guimaraes Vera , Yan Qingran , Muraru Sinziana , Sauer Gesa , Msabri Gharbi Nada , Sen Parikshit , Khadija El-Aoufi , Jordan Suzana , Distler Oliver , Bruni Cosimo
Published: December 2024

Objectives:

We aimed to identify which measures are considered important by patients and physicians when assessing disease severity and outcomes in systemic sclerosis-associated interstitial lung disease.

Methods:

We designed an international survey based on a systematic literature review data and distributed it to patients with systemic sclerosis-associated interstitial lung disease and physicians with expertise in treating it. Survey participants rated on a scale of 1–10 the importance of each item defining severe systemic sclerosis-associated interstitial lung disease and outcomes considering the aim of the treatment, with higher values representing increasing importance. Items scored on average ⩾ 8 and voted ⩾ 8 by ⩾ 80% of participants were arbitrarily considered as highly ‘important’.

Results:

In general, 388 physicians and 350 patients completed the survey. Referral to lung transplantation, need for oxygen supplementation, interstitial lung disease extent and dyspnoea were important severity domains to both physicians and patients. Similarly, death, decline of pulmonary functional tests, increase of interstitial lung disease extent on high-resolution computed tomography and onset/worsening of dyspnoea were important treatment outcomes for both groups. We observed a discrepancy for both severity tools and outcomes, with patients deeming patients-reported outcomes domains and lung infections as more important than physicians did.

Conclusion:

The perspectives of patients and physicians partially overlap, when considering targets of treatment of systemic sclerosis-associated interstitial lung disease and items contributing to the perceived disease severity. Based on these insights, the opinions of both stakeholders should be included in defining the long-term targets of systemic sclerosis-associated interstitial lung disease treatment.
Clinical and Radiographic Comparison of Lateral Malleolar Ankle Fractures Treated with or without Deltoid Fixation
Authors: Cho David , Drakos Mark , Kukadia Saanchi , Eble Stephanie , Kumar Prashanth
Published: December 2024

Category:

Ankle; Other

Introduction/Purpose:

There is a lack of consensus on how deltoid injuries should be addressed in the setting of acute ankle fractures. This study aims to evaluate whether deltoid repair during lateral malleolar fracture fixation leads to improved clinical outcomes compared to fixation without deltoid repair.

Methods:

This was a single-center retrospective study conducted from the institutional review board-approved Foot and Ankle Registry data, and the protocol was approved by the steering committee at the investigators’ institution. Patient-reported outcomes via PROMIS scores were collected preoperatively and at least one year postoperatively for all patients. Inclusion criteria included patients aged 18 or older who underwent open fixation for a SER IV equivalent lateral malleolar ankle fracture with a deltoid injury and had preoperative PROMIS scores. Excluded were patients without preoperative radiographs and patients with histories of previous ipsilateral ankle surgeries, rheumatoid arthritis, or gout. Retrospective review of the registry was performed, and 146 patients were included. 80 patients received a deltoid repair (DR) and 66 patients did not receive a deltoid repair (NDR). Preoperative and postoperative medial clear space (MCS) were reviewed for all patients.

Results:

Both DR and NDR cohorts demonstrated significant improvement in Physical Function, Pain Interference, Pain Intensity, and Global Physical Health. There were no significant differences in preoperative and postoperative PROMIS domains between the two cohorts. There were also no significant differences in preoperative MCS and postoperative MCS between the two cohorts. There were no significant differences in the incidence of subsequent procedures for removal of painful hardware, revisions, infections, progression to arthritis, and persistent pain.

Conclusion:

This study compares short- to medium-term patient-reported clinical outcomes and complications of lateral malleolar ankle fractures with and without deltoid repair. Repairing the deltoid did not increase the incidence of postoperative complications and produced similar PROMIS scores at 1-year minimum follow-up. This study suggests that any potential differences in outcomes between groups are not large enough to be clinically meaningful in the short term and that other factors may be more relevant in determining the best course of treatment. A longer follow-up is required to evaluate long-term functional and clinical outcomes.
Coding Patterns and Implications on Reimbursement in Foot & Ankle Surgery
Authors: Rogero Ryan G. , Grear Benjamin J. , Murphy Garnett A. , Richardson David R. , Rider Carson M. , Bettin Clayton C.
Published: December 2024

Category:

Other; Midfoot/Forefoot

Introduction/Purpose:

Coding is an essential part of a foot and ankle surgeon’s duties and can both quantify the amount of work done by the surgeon and influence compensation. The purpose of this study was to evaluate the coding patterns among foot and ankle orthopaedic surgeons and to quantify the effects of these on reimbursement using real-life patient cases.

Methods:

A survey consisting of 12 commonly encountered real deidentified patient cases was administered to all foot and ankle fellowship-trained orthopaedic surgeons of a large, combined academic-private practice orthopaedic group. The scenarios included pre-operative diagnostic imaging and reports, intra-operative imaging, and post-operative radiographs. Surgeons were asked which Current Procedural Terminology (CPT) codes would be applied and if any Modifiers to these codes would be utilized. If multiple CPT codes were utilized, surgeons were asked to list the codes in the same order as would be theoretically listed on their operative notes. Respondents were allowed to use any sources of information they desired to complete the survey. Total work-relative value units (RVUs) and the generated reimbursement values were calculated for each case and respondent using the 2024 Centers for Medicare & Medicaid Services (CMS) conversion factor ($32.74 per RVU), with the primary procedure reimbursed at 100%, with additional procedures reimbursed at 50%.

Results:

Five surgeons completed the survey. Among case scenarios, four of the 12 cases had at least four of the five respondents in agreement on the primary CPT code, whereas only one case had 100% agreement among respondents on the primary CPT code. Similarly, only five of the 12 cases had at least four of the five respondents in agreement regarding modifier usage, with only one case having 100% agreement among respondents on modifier utilization. Modifier 59 was most utilized. The total RVU and reimbursement difference between the respondents with the highest and lowest listed RVUs was 216.06 and $3,627.92, respectively (Table 1). The cases with the most variability among both RVUs and modifiers involved a Lisfranc injury, Charcot reconstruction, and midfoot fracture-dislocation.

Conclusion:

Great variability exists between foot and ankle surgeons when coding common foot and ankle procedures. Surgeons should be aware of these differences and the large effect they can have on quantifying reimbursement. Increasing competency with coding and maximizing reimbursement for work performed should continue to be emphasized.
Comparison of the Thickness of the Anterior and Posterior Cortical Bone of the Fibula at the Site of Screw Fixation in Lateral Malleolar Fractures
Authors: Lee Jaehyung , Kim Janghyun , Chae Sungkuk , Oh Seung ho , Cha Dongheon
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

In Weber type B rotational ankle fractures, fixation of the fibular fracture with interfragmentary lag screws and plates has traditionally been widely used. However, there have been instances in which interfragmentary lag screw fixation failed to offer sufficient stability particularly when the cortical bone thickness in the posterior part of the fibula was insufficient. In this study, our objective was to compare the thickness of the anterior and posterior cortical bone in the sagittal plane at the screw fixation site in surgically treated lateral malleolar fractures.

Methods:

A retrospective analysis of medical records was conducted on patients who underwent open reduction and internal fixation for Weber type B ankle fractures at our institution between March 2019 and December 2022. Exclusion criteria comprised patients without preoperative CT scans, those aged 19 years or younger, individuals with a history of prior surgery at the same site, and cases in which measuring cortical bone thickness was challenging due to severe fracture comminution. The radiographic assessment involved measuring and comparing the thickness of the anterior and posterior cortical bone at the fibular fracture site in the sagittal plane of the CT scans.

Results:

Among the total of 105 patients, 52 were male and 53 were female, with a mean age of 50.5 years. In the CT sagittal plane, the anterior cortical bone thickness of the fibula measured 2.40 mm, while the posterior thickness was 1.37 mm (p=0.005), indicating a statistically significant difference. Upon stratifying patients into male and female groups, it was observed that the anterior cortical bone thickness of the fibula was significantly greater in men compared to women (2.64 mm vs. 2.15 mm, p=0.002), and the posterior thickness was also significantly higher (1.51 mm vs. 1.25 mm, p=0.031).

Conclusion:

The assessment of fibula cortical bone thickness at the site of Weber B type lateral malleolar fractures revealed that the anterior cortical bone was thicker than the posterior cortical bone, and males exhibited greater thickness compared to females. We posit that these findings could provide valuable guidance in the selection of screw type and fixation direction during surgical interventions for lateral malleolar fractures.
Demographic Disparities in 30-Day Outcomes Following Achilles Tendon Repair
Authors: Fanfan Dino , Rittmeyer William , Kumar Aditi , Murray Daniel , Chapman Cary B.
Published: December 2024

Category:

Sports; Ankle

Introduction/Purpose:

With more people participating in sporting activities, the occurrence of Achilles tendon rupture is increasing in the USA. Specific risk factors for Achilles tendon repair complications such as tobacco use, diabetes mellitus, steroid use, and obesity, have been well-reviewed in current literature. However, the impact of demographic disparities such as race and gender on the 30-day postoperative surgical complication of an Achilles tendon repair has not been extensively reported. Accordingly, we sought to investigate whether demographic disparities in 30-day postoperative Achilles repair outcomes exist and to what extent.

Methods:

The American College of Surgeons National Surgical Quality Improvement Program Database was queried for all patients undergoing surgical repair of Achilles tendon rupture from 2012 to 2021. Patients were identified using the common procedure terminology (CPT) codes 27650 and 27652. Patients were evaluated according to race and gender. A multivariate logistic regression was conducted for each complication to evaluate whether demographic factors independently were associated with complications after adjusting for various variables (age, obesity rate, diabetic/nondiabetic, smoker/nonsmoker, ASA class). Medical complications included rates of deep vein thrombosis (DVT), superficial surgical site infection (SSI), deep SSI (dSSI), wound disruption after surgery/dehiscence, readmission rate and reoperation rate.

Results:

A total of 6333 patients who underwent Achilles tendon were included in the study, 25% (N =1607) were women, 49.0% (N =3101) reported as White, 21.1% (N =1336) as Black/African American and 29.9% (N =1896) as Other. In our unadjusted analysis, there was a higher prevalence of DVT in white patients. Following a multivariate analysis, neither race or gender of the patient were associated with a difference in rates of all complications, wound, dSSI, wound disruption after surgery, readmission rate and reoperation rate. Only race demonstrated a significant difference in the rate of superficial SSI (χ2 = 7.21; p=.0272) following multivariate analysis.

Conclusion:

When adjusted for age, smoking, diabetes, obesity and ASA class, there was a statistically significant although clinically insignificant difference in superficial surgical site infection rate between white patients, black patients, and patients of other races not seen in any other post-operative outcome. In our unadjusted analysis, there was a higher prevalence of DVT in white patients possibly because these patients were generally older and DVTs are more common in elderly patients. This study highlights advancements in the delivery of equitable care, but we recognize that there continues to be disparities in surgical care which requires strong and worthwhile solutions.
Diabetic Management and Infection Risk in Total Ankle Arthroplasty
Authors: Wu Kevin , Anastasio Albert T. , Krez Alexandra , O'Neill Conor N. , Mitra Kishen , Adams Samuel B. , DeOrio James K. , Easley Mark E. , Nunley James A.
Published: December 2024

Category:

Ankle; Ankle Arthritis

Introduction/Purpose:

As total ankle arthroplasty (TAA) rises in popularity nationwide for the management of end-stage arthritis, patient selection and medical optimization are crucial for the mitigation of infection risk. Diabetes increases the risk of infection due to compromised immunity and impaired wound-healing mechanisms. However, there is limited research on how diabetic management, inclusive of medications and glucose control, may impact infection risks post-TAA. This study aims to demonstrate the impact of diabetic management on the occurrence of periprosthetic joint infection (PJI) following TAA.

Methods:

This was a retrospective study of patients who underwent a TAA at a single academic institution from March 2002 to May 2022. Patients with diabetes who developed an intraarticular infection following TAA were propensity score matched to diabetic patients who did not. Data collection included demographics, implant types, diabetic medications, and preoperative hemoglobin A1c. PJI was diagnosed based on Musculoskeletal Infection Society (MSIS) criteria. Statistical analyses assessed differences in medication use, glucose control, and infection rates between groups.

Results:

Of the 1,863 patients who underwent TAA, 177 patients had a diagnosis of diabetes. The infection rate in patients with diabetes (2.8%) was higher than the total cohort rate (0.8%). Five patients with diabetes developed a PJI at an average of 2.2 months postoperatively. This cohort (n=5) was compared to propensity score-matched controls (n=15). There was no significant difference in diabetic medication use. Patients who developed PJI had higher rates of uncontrolled diabetes (60.0% vs. 6.7%) and average A1c levels (7.02% vs. 6.29%) compared to controls.

Conclusion:

Our findings suggest that the elevated risk of PJI observed in individuals with diabetes subsequent to TAA may be attributed not solely to the presence of diabetes, but to inadequate glycemic control. Effectively managing blood glucose levels is imperative for achieving favorable outcomes following TAA.
Dynamic Fixation vs Static Screw Fixation for Syndesmosis Injuries in Pronation External Rotation Ankle Fractures
Authors: Kang Hyunseong , Lim Chaemoon , Choi Sungwook
Published: December 2024

Category:

Trauma; Ankle

Introduction/Purpose:

The current standard treatment for ankle syndesmosis injury is static screw fixation. Dynamic fixation was developed to restore the dynamic function of the syndesmosis. The purpose of this study was to determine that which of static screw fixation and dynamic fixation is better for treatment of ankle syndesmosis injury in pronation external rotation fractures.

Methods:

30 patients were treated with dynamic fixation (DF group) and 28 patients with static screw fixation (SF group). The primary outcome was Olerud–Molander Ankle Outcome Score. The secondary outcome were Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score, radiographic outcomes, complications and cost effectiveness. To evaluate the radiographic outcome, the tibiofibular clear space, tibiofibular overlap, and medial clear space were compared using the pre-operative and last follow-up plain radiographs. To evaluate the cost effectiveness, the total hospital cost was compared between the two groups.

Results:

There was no significant difference in primary outcome. Moreover, there were no significant difference in secondary outcome, including Visual Analogue Scale score and American Orthopedic Foot and Ankle Society score and radiographic outcome. Two cases of reduction loss and four cases of screw breakage were observed in the SF group. No complication in the DF group was observed. Dynamic fixation was more cost effective than static screw fixation with respect to the total hospital cost

Conclusion:

Although dynamic fixation provided similar clinical and radiologic outcome, dynamic fixation is more cost effective with fewer complications than static screw fixation in ankle syndesmosis injury of pronation-external rotation fractures.
Efficacy of 3D Wound Assessment in Predicting Granulation Tissue Velocity Following Negative Pressure Wound Therapy in Diabetic Foot Ulcers
Authors: Ahn Jiyong , Flaherty Alexandra F. , Kim Yoochang , Bejarano-Pineda Lorena , DiGiovanni Christopher W. , Ashkani-Esfahani Soheil , Waryasz Gregory R.
Published: December 2024

Category:

Diabetes; Midfoot/Forefoot

Introduction/Purpose:

Wound healing in diabetic foot ulcers (DFU) poses challenges, requiring extensive debridement and amputations. Negative pressure wound therapy (NPWT) can be utilized for DFUs with large soft tissue defects to promote granulation tissue growth. The optimal timeframe for successful NPWT lacks extensive studies. Advanced wound scanning with a three-dimensional (3D) camera can enhance DFU area and volume calculations. This study aimed to investigate the efficacy of 3D wound assessment in predicting granulation tissue filling velocity following NPWT in DFUs.

Methods:

After receiving IRB approval from the single Korean center, a retrospective case series study was performed for 101 DFUs (Wagner classification 3 and 4) undergoing NPWT from September 2018 to June 2019. Demographic data, vascular patency, and wound characteristics were recorded. Wound was irrigated before NPWT. An infra-red 3D camera (inSight ®, eKare, Fairfax, VA, USA) was used to capture digital photographs. Wound area and volume were measured. Measurements were taken weekly from before treatment to one month after using inSight ® cloud software. The risk factors of diabetic foot ulcers related to wound healing were evaluated.

Results:

NPWT resulted in significant area improvements for open diabetic foot ulcers (p = 0.001). Postoperative 1-week area change velocity was 1.35 cm2/day, peaking at 2 weeks (1.84 cm2/day). Volume also showed significant improvement over time (p = 0.001), with a 1-week peak velocity of 1.20 cm3/day. All peak area and volume changes occurred within two weeks after NPWT application. Midfoot and hindfoot exhibited higher velocity of volume than forefoot (p = 0.001). Postoperative volume change was the fastest with a patent peroneal artery.

Conclusion:

3D wound assessment for velocity of granulation tissue filled in an open DFU after NPWT could be effective to predict outcomes. Most wound healing following NPWT in DFUs was completed within two weeks. Application of NPWT for an additional two weeks did not significantly impact the completion of wound healing even though midfoot and hindfoot exhibited higher velocity of volume than forefoot.
HFD aggravated the arthritis and atherosclerosis by altering the intestinal status and gut microbiota
Authors: Shi Na , Jiang Shan , Zhao Yue , Zhang Yang , Duan Xinwang , Hong Guo-bao , Yang Zhongshan , Duan Yuanyuan , Niu Haitao
Published: December 2024

Rheumatoid arthritis (RA) and cardiovascular disease (CVD) are both the chronic inflammatory disease. To investigate the influence of secondary atherosclerosis on arthritis mice, we treated the ApoE−/− mice with K/BxN serum and high fat diet (HFD), and subsequently assessed the phenotypes as well as immune profiles of K/BxN serum and HFD induced ApoE−/− mice. We found that HFD treatment aggravated the hyperlipidemia, atherosclerotic lesions, ankle swelling and arthropathy of mice. We further demonstrated that HFD altered the gut microbiota and metabolism, intestinal homeostasis and Th17/Treg cell balance in lamina propria lymphocytes. Moreover, HFD decreased the number of Peyer’ s patches and altered the expression profiling of gut immune cells. In addition, HFD increased the number of aortic leukocytes and macrophages, then aggravated the atherosclerosis in aorta, which led to greater inflammation in mice aorta and aortic root. Collectively, our study indicated that HFD aggravated the arthritis and atherosclerosis, which may be contributed by microbiota dysbiosis, the intestinal permeability and disrupted immunological homeostasis.
Variable and slow-paced neural dynamics in HVC underlie plastic song production in juvenile zebra finches
Authors: Bistere Linda , Wilczek Stefan , Vallentin Daniela
Published: December 2024

Zebra finches undergo a gradual refinement of their vocalizations, transitioning from variable juvenile songs to the stereotyped song of adulthood. To investigate the neural mechanisms underlying song crystallization—a critical phase in this developmental process—we performed intracellular recordings in HVC (a premotor nucleus essential for song learning and production) of juvenile birds. We then compared these recordings to previously published electrophysiological data from adult birds. We found that HVC projection neurons in juvenile zebra finches during the song crystallization phase exhibited more variable spiking patterns compared to the precise bursting observed in adult HVC projection neurons. Additionally, subthreshold membrane potential fluctuations in juvenile neurons exhibited longer durations and larger amplitude excitatory postsynaptic potentials. These distinct temporal dynamics in HVC during song crystallization likely play a crucial role in the fine-tuning processes that shape the precise timing and structure of the mature zebra finch song.
Lung recruitment with HFOV versus VTV/AC in preterm infants with RDS
Authors: Eldegwi Marwa , Shaltout Ali , Elagamy Osama , Salama Dina , Elshaer Mohammed , Shouman Basma
Published: December 2024

Objectives

To compare the effect of lung recruitment using high frequency ventilation versus volume targeted ventilation on duration of intubation as well as its effect on lung inflammation in preterm infants with respiratory distress syndrome.

Methods

The study was conducted on a total of 40 preterm infants, 34 weeks gestational age or less, having RDS that needed intubation and mechanical ventilation within the first 72 h after their birth at the NICU of Mansoura University Children’s Hospital during the period from July 2020 to July 2022. Infants included were randomly assigned into two groups, Group A who were subjected to LRM using HFOV (20 cases) and Group B who were subjected to LRM using VTV/AC (20 cases). TGF-β1 level was measured in BAL samples of all studied infants at two time points; before lung recruitment maneuver and at day 5 after lung recruitment or just before extubation if extubation occurs earlier than 5 days.

Results

Lung recruitment maneuver had no significant effect on time to extubation. Both groups showed no significant difference in rate of prematurity complications nor delta change of TFG-β1 level in tracheal aspirate of those preterm infants measured before lung recruitment and five days after recruitment or at extubation when extubation occurred earlier.

Conclusions

Lung recruitment maneuver was not associated with significant difference between both groups of preterm infants. The results obtained from our study, being the first of its kind to compare the effect of lung recruitment, provide a promising research area for further investigations.
Exploring correlates of high psychiatric inpatient utilization in Switzerland: a descriptive and machine learning analysis
Authors: Jaffé Mariela E. , Weinmann Stefan , Meyer Andrea H. , Stepulovs Helen , Luethi Regula , Borgwardt Stefan , Lieb Roselind , Lang Undine E. , Huber Christian G. , Moeller Julian
Published: December 2024

Background

This study investigated socio-demographic, psychiatric, and psychological characteristics of patients with high versus low utilization of psychiatric inpatient services. Our objective was to better understand the utilization pattern and to contribute to improving psychiatric care.

Methods

One-hundred and twenty inpatients of the University Psychiatric Clinics (UPK) Basel, Switzerland, participated in this cross-sectional study. All patients were interviewed using different clinical scales. As target variables we investigated the number of days of psychiatric inpatient treatment within a 30-month period.

Results

Despite including multiple relevant patient variables and using elaborate statistical models (classic univariate und multiple regression, LASSO regression, and non-linear random forest models), the selected variables explained only a small percentage of variance in the number of days of psychiatric inpatient treatment with cross-validated R2 values ranging from 0.16 to 0.22. The number of unmet needs of patients turned out to be a meaningful and hence potentially clinically relevant correlate of the number of days of psychiatric inpatient treatment in each of the applied statistical models.

Conclusions

High utilization behavior remains a complex phenomenon, which can only partly be explained by psychiatric, psychological, or social/demographic characteristics. Self-reported unmet patient needs seems to be a promising variable which may be targeted by further research in order to potentially reduce unnecessary hospitalizations or develop better tailored psychiatric treatments.
Medically assisted integrated rehabilitation program for people with opioid dependence: a quasi-experimental evaluation using multi-criteria decision analysis
Authors: Islam M. Kamrul , Fadnes Lars Thore , Johansson Kjell Arne , Ruths Sabine , Rutten-van Mölken Maureen , Askildsen Jan Erik
Published: December 2024

Background

Opioid use disorders constitute a vast disease burden, need for comprehensive treatment, and substantial costs to individuals, families, and society. The multifaceted needs of people with opioid dependence call for integrated care. The study aims to assess the added value of an integrated medically assisted rehabilitation (MAR) program providing opioid agonist therapy for patients with opioid dependence as compared to the standard of care (SoC) in Norway.

Methods

The intervention includes a comprehensive tertiary care integrated MAR program in Bergen. SoC is a much less intense primary care program in Oslo. 682 and 609 patients from Bergen, and 864 and 771 patients from Oslo were included in 2017 and 2019, respectively. A multi-criteria decision analysis (MCDA) framework was used where the relative preferences of the importance of the outcomes were obtained from a discrete choice experiment among five different stakeholder-groups. Seven outcomes related to health, well-being, experience of the care process, and cost were measured. The performance scores were measured in a study with a quasi-experimental design. Scores were analyzed using linear mixed methods. Performance scores for the outcomes were standardized and multiplied by their relative preferences to obtain the overall value scores in the MCDA.

Results

We found similar value scores for both care delivery models regarding physical functioning, psychological well-being, social relationships & participation, enjoyment of life, and total costs. The Bergen-model scored higher on continuity of care (0.733 versus 0.680), while the SoC-model scored higher on person-centeredness (0.772 versus 0.635). Overall value scores were marginally in favor of the MAR-Bergen (0.708 versus 0.705 for patients).

Conclusion

Acknowledging the significance of different life aspects emphasizes the need for integrated care at a specific level for people with opioid dependence. We conclude that the two highly effective treatment approaches produce promising outcomes in a challenging population and are quite similar. However, further research with more robust longitudinal data is needed.
Automated redaction of names in adverse event reports using transformer-based neural networks
Authors: Meldau Eva-Lisa , Bista Shachi , Melgarejo-González Carlos , Norén G. Niklas
Published: December 2024

Background

Automated recognition and redaction of personal identifiers in free text can enable organisations to share data while protecting privacy. This is important in the context of pharmacovigilance since relevant detailed information on the clinical course of events, differential diagnosis, and patient-reported reflections may often only be conveyed in narrative form. The aim of this study is to develop and evaluate a method for automated redaction of person names in English narrative text on adverse event reports. The target domain for this study was case narratives from the United Kingdom’s Yellow Card scheme, which collects and monitors information on suspected side effects to medicines and vaccines.

Methods

We finetuned BERT – a transformer-based neural network – for recognising names in case narratives. Training data consisted of newly annotated records from the Yellow Card data and of the i2b2 2014 deidentification challenge. Because the Yellow Card data contained few names, we used predictive models to select narratives for training. Performance was evaluated on a separate set of annotated narratives from the Yellow Card scheme. In-depth review determined whether (parts of) person names missed by the de-identification method could enable re-identification of the individual, and whether de-identification reduced the clinical utility of narratives by collaterally masking relevant information.

Results

Recall on held-out Yellow Card data was 87% (155/179) at a precision of 55% (155/282) and a false-positive rate of 0.05% (127/ 263,451). Considering tokens longer than three characters separately, recall was 94% (102/108) and precision 58% (102/175). For 13 of the 5,042 narratives in Yellow Card test data (71 with person names), the method failed to flag at least one name token. According to in-depth review, the leaked information could enable direct identification for one narrative and indirect identification for two narratives. Clinically relevant information was removed in less than 1% of the 5,042 processed narratives; 97% of the narratives were completely untouched.

Conclusions

Automated redaction of names in free-text narratives of adverse event reports can achieve sufficient recall including shorter tokens like patient initials. In-depth review shows that the rare leaks that occur tend not to compromise patient confidentiality. Precision and false positive rates are acceptable with almost all clinically relevant information retained.
Artificial intelligence in anesthesiology: a bibliometric analysis
Authors: Xie Bi-Hua , Li Ting-Ting , Ma Feng-Ting , Li Qi-Jun , Xiao Qiu-Xia , Xiong Liu-Lin , Liu Fei
Published: December 2024

The application of artificial intelligence (AI) in anesthesiology has become increasingly widespread. However, no previous study has analyzed this field from the bibliometric analysis dimension. The objective of this paper was to assess the global research trends in AI in anesthesiology using bibliometric software. Literatures relevant to AI and anesthesiology were retrieved from the Web of Science until 10 April 2024 and were visualized and analyzed using Excel, CiteSpace, and VOSviewer. After screening, 491 studies were included in the final bibliometric analysis. The growth rate of publications, countries, institutions, authors, journals, literature co-citations, and keyword co-occurrences was computed. The number of publications increased annually since 2018, with the most significant contributions from the USA, China, and England. The top 3 institutions were Yuan Ze University, National Taiwan University, and Brunel University London. The top three journals were Anesthesia & Analgesia, BMC Anesthesiology, and the British Journal of Anaesthesia. The researches on the application of AI in predicting hypotension have been extensive and represented a hotspot and frontier. In terms of keyword co-occurrence cluster analysis, keywords were categorized into four clusters: ultrasound-guided regional anesthesia, postoperative pain and airway management, prediction, depth of anesthesia (DoA), and intraoperative drug infusion. This analysis provides a systematic analysis on the literature regarding the AI-related research in the field of anesthesiology, which may help researchers and anesthesiologists better understand the research trend of anesthesia-related AI.