bluuebunny/crossref_metadata_2025 huggingface dataset:
Contact stress reliability analysis based on first order second moment for variable hyperbolic circular arc gear
Authors: Qi Zhang , Guang Wen , Zhixin Chen , Qin Zhou , Guoqi Xiang , Guangchun Yang , Xuegang Zhang
Published: July 2022

Aiming at the contact strength reliability of variable hyperbolic circular arc gear, a reliability analysis method for contact strength of variable hyperbolic circular arc gear based on Kriging model and advanced first-order and second-moment algorithm is proposed. Kriging model was used to establish the limit state equation of the contact stress reliability analysis of variable hyperbolic circular arc gear, and the advanced first-order second-moment method was used to analyze the contact stress reliability of variable hyperbolic circular arc gear based on the limit state equation of the contact stress. In order to verify the effectiveness of the proposed algorithm, a Markov Chain Monte Carlo reliability analysis method based on Important Sampling was proposed. Markov Chain and Important Sampling were exploited to improve the accuracy of contact reliability analysis based on Monte Carlo method for variable hyperbolic circular arc gear. The comparison between the analysis results of Markov Chain Monte Carlo with Important Sampling method and first order second moment shows that it is feasible to analyze the reliability of variable hyperbolic circular arc gear by first-order second-moment method.
Harmonisation of large-scale, heterogeneous individual participant adverse event data from randomised trials of statin therapy
Authors: Cholesterol Treatment Trialists’ Collaboration
Published: July 2022

Background:

Meta-analyses of individual-level data from randomised trials are often required to detect clinically worthwhile effects. The Cholesterol Treatment Trialists’ Collaboration, which includes data from numerous large long-term statin trials, is conducting a review of the effects of statin therapy on all adverse events collected in those trials. This article describes the approaches used and challenges faced to systematically capture and categorise the data.

Methods:

Protocols, statistical analysis plans, case report forms, clinical study reports and datasets were obtained, reviewed and checked. Relevant baseline and follow-up data from each trial was then reorganised into standardised formats based upon the Clinical Data Interchange Standards Consortium Study Data Tabulation Model. Adverse event data were organised and coded (automatically or, where necessary, manually) according to a common medical dictionary based upon the Medical Dictionary for Regulatory Activities.

Results:

Data from 23 double-blind statin trials and 5 open-label statin trials were provided, either through direct data transfer or through online access platforms. Together, these trials provided 845 datasets containing over 38 million records relating to 30,495 study variables and 181,973 randomised participants. Of the 46 Clinical Data Interchange Standards Consortium Study Data Tabulation Model domains that could potentially have been used to organise the data, the 13 most relevant to the project were identified and utilised, including 6 domains related to post-randomisation adverse events. Nearly 1.2 million adverse events were extracted and mapped to over 45,000 unique adverse event terms. Of these adverse events, 99% were coded to a Medical Dictionary for Regulatory Activities ‘lower level term’, with the remainder coded to a ‘higher level term’ or, very rarely, only a ‘higher level group term’.

Conclusion:

In this meta-analysis of adverse event data from the large randomised trials of statins, approaches based on common standards for data organisation and classification have provided a resource capable of allowing reliable and rapid evaluation of any previously unknown benefits or hazards of statin therapy.
The influence of a nanoparticle gel loaded with siRNA-cyclooxygenase on flexor tendon healing: an in vivo animal study
Authors: Yang Qian Qian , Chen Jing , Zhou You Lang , Tang Jin Bo
Published: July 2022

We investigated the influence of cyclooxygenase (COX)-1 and COX-2 siRNAs delivered through a nanoparticle-gel system on the strength of flexor tendon repairs. Sixteen flexor digitorum profundus (FDP) tendons of chicken toes were transected, repaired and wrapped with gels to evaluate gel adherence. We found that the gel adhered to the tendon surface firmly. Next, 56 tendons were used in a first set of in vivo experiments to compare the therapeutic effects of different doses of COX siRNAs. Another 15 tendons were added in a second set to further assess the effects of a dosage of 12 μg. After 4 weeks, the mean strength of the repaired tendons increased most notably in the toes treated with 12 μg COX siRNAs, and the number of samples with low strength (<35 N) was significantly smaller than in the group without molecular treatment. We conclude that COX-1 and COX-2 siRNAs delivered through a nanoparticle-gel system increased the healing strength of the repaired tendons.
Effect of inhaled budesonide/formoterol fumarate dihydrate delivered via two different devices on lung function in patients with COPD and low peak inspiratory flow
Authors: Huber Bärbel , Keller Claus , Jenkins Martin , Raza Abid , Aurivillius Magnus
Published: July 2022

Background and aims:

Low peak inspiratory flow (PIF) is common following severe exacerbations of chronic obstructive pulmonary disease (COPD). Patients with COPD and low PIF may be at risk of suboptimal delivery of inhaled therapies to the airways, especially when using devices such as dry powder inhalers (DPIs), which require greater inspiratory effort than metered dose inhalers (MDIs). We report the results from a 2-week crossover study evaluating the effects of inhaled dual therapy with budesonide/formoterol fumarate dihydrate with an MDI with a spacer versus a DPI in patients with COPD and low PIF.

Methods:

This randomized, open-label, two-period (each 1 week in duration) crossover efficacy and safety study included patients with severe-to-very severe COPD and PIF < 50 L/min (NCT04078126). Patients were randomized 1:1 to twice-daily budesonide/formoterol fumarate dihydrate MDI (BFF MDI) 320/10 µg with a spacer for 1 week followed by twice-daily budesonide/formoterol fumarate dihydrate DPI (BUD/FORM DPI) 320/9 µg for 1 week, or the inverse. The primary endpoint was peak change from baseline in forced expiratory volume in 1 s (FEV1) within 4 h post-dose following 1 week of treatment. Other assessments included pre-dose lung function, pharmacokinetics, and safety, as assessed by adverse events.

Results:

The modified intention-to-treat analysis set comprised 30 patients (mean age: 66.9 years; mean baseline FEV1: 766 mL; mean COPD assessment test score: 22.20). Following 1 week of treatment, both BFF MDI and BUD/FORM DPI improved mean [95% confidence interval (CI)] peak FEV1 4 h post-dose [256 (190, 322) mL and 274 (208, 340) mL, respectively]. No clinically meaningful difference between treatments was observed for any lung function endpoint. There were no unexpected safety findings.

Conclusion:

Dual therapy with BFF MDI and with BUD/FORM DPI led to improvements in lung function in patients with severe-to-very severe COPD and low PIF.
The management of patent foramen ovale in divers: where do we stand?
Authors: Apostolos Anastasios , Drakopoulou Maria , Trantalis George , Synetos Αndreas , Oikonomou George , Karapanayiotides Theodoros , Tsioufis Costas , Toutouzas Konstantinos
Published: July 2022

Diving is a fascinating activity, but it does not come without any cost; decompression illness (DCI) is one of the most frequent diseases occurring in divers. Rapid surfacing after diving causes alveolar rupture and bubbles release, which enter in the systemic circulation and could embolize numerous organs and tissues. The presence of patent foramen ovale (PFO) contributes to the passage of venous gas bubbles into the arterial circulation, increasing the risk of complications related to DCI. The diagnosis is established with a detailed medical history, a comprehensive clinical evaluation, and a multimodal imaging approach. Although the percutaneous closure of PFO is ambiguous for divers, as a primary prevention strategy, transcatheter management is considered as beneficial for DCI recurrence prevention. The aim of this study is to introduce the basic principles of DCI, to review the pathophysiological connection between DCI and PFO, to highlight the risk factors and the optimal treatment, and, last but not least, to shed light on the role of closure as primary and secondary prevention.
Noninvasive Glucose Measurements Through Transcutaneous Raman Spectroscopy: A Review
Authors: Loyola-Leyva Alejandra , Hernández-Vidales Karen , Loyola-Rodríguez Juan Pablo , González Francisco Javier
Published: July 2022

Background:

People living with diabetes need constant glucose monitoring to avoid health complications. However, they do not monitor their glucose levels as often as recommended, probably because glucose measurement devices can be painful, costly, need testing strips or sensors, require lancing the finger or inserting a sensor with risk of infection, and can be inaccurate or have failures. Therefore, developing new alternatives for noninvasive glucose measurements that overcome these disadvantages is necessary, being Raman spectroscopy (RS) a solution.

Objective:

This review aims to provide an overview of the current glucose-monitoring technologies and the uses and advantages of RS to improve noninvasive transcutaneously glucose-monitoring devices.

Results:

The skin has been used to assess glucose levels noninvasively because it is an accessible tissue where glucose can be measured in the interstitial fluid (ISF) in the epidermis (especially in the stratum corneum). The most selected skin sites to apply RS for noninvasive glucose measurements were the nailfold, finger, and forearm because, in these sites, the penetration depth of the excitation light can reach the stratum corneum (10-20 µm) and the ISF. Studies found that RS is a good optical technique to measure glucose noninvasively by comparing glucose levels obtained by RS with those from invasive methods such as glucose meters with testing strips during an oral glucose tolerance test (OGTT).

Conclusions:

New alternatives for noninvasive glucose measurements that overcome the disadvantages of current devices is necessary, and RS is a possible solution. However, more research is needed to evaluate the stability, accuracy, costs, and acceptance.
Personalizing the Use of a Intermittently Scanned Continuous Glucose Monitoring Device in Individuals With Type 1 Diabetes: A Cost-Effectiveness Perspective in the Netherlands (FLARE-NL 9)
Authors: Emamipour Sajad , van Dijk Peter R. , Bilo Henk J.G. , Edens Mireille A. , van der Galiën Onno , Postma Maarten J. , Feenstra Talitha L. , van Boven Job F. M.
Published: July 2022

Aims:

Intermittently scanned continuous glucose monitoring (isCGM) is a method to monitor glucose concentrations without using a finger prick. Among persons with type 1 diabetes (T1D), isCGM results in improved glycemic control, less disease burden and improved health-related quality of life (HRQoL). However, it is not clear for which subgroups of patients isCGM is cost-effective. We aimed to provide a real-world cost-effectiveness perspective.

Methods:

We used clinical data from a 1-year nationwide Dutch prospective observational study (N = 381) and linked these to insurance records. Health-related quality of life was assessed with the EQ-5D-3L questionnaire. Individuals were categorized into 4 subgroups: (1) frequent hypoglycemic events (58%), (2) HbA1c > 70 mmol/mol (8.5%) (19%), (3) occupation that requires avoiding finger pricks and/or hypoglycemia (5%), and (4) multiple indications (18%). Comparing costs and outcomes 12 months before and after isCGM initiation, incremental cost-effectiveness ratios (ICERs) were calculated for the total cohort and each subgroup from a societal perspective (including healthcare and productivity loss costs) at the willingness to pay of €50,000 per quality-adjusted life year (QALY) gained.

Results:

From a societal perspective, isCGM was dominant in all subgroups (ie higher HRQoL gain with lower costs) except for subgroup 1. From a healthcare payer perspective, the probabilities of isCGM being cost-effective were 16%, 9%, 30%, 98%, and 65% for the total cohort and subgroup 1, 2, 3, and 4, respectively. Most sensitivity analyses confirmed these findings.

Conclusions:

Comparing subgroups of isCGM users allows to prioritize them based on cost-effectiveness. The most cost-effective subgroup was occupation-related indications, followed by multiple indications, high HbA1c and the frequent hypoglycemic events subgroups. However, controlled studies with larger sample size are needed to draw definitive conclusions.
Reducing Explicit Blatant Dehumanization by Correcting Exaggerated Meta-Perceptions
Authors: Landry Alexander P. , Schooler Jonathan W. , Willer Robb , Seli Paul
Published: July 2022

If explicitly, blatantly dehumanizing a group of people—overtly characterizing them as less than human—facilitates harming them, then reversing this process is paramount. Addressing dehumanization among American political partisans appears especially crucial, given that it has been linked to their anti-democratic hostility. Perhaps because of its overt nature, partisans recognize—and greatly exaggerate—the extent to which out-partisans explicitly, blatantly dehumanize them. Past research has found that when people perceive they are dehumanized by an outgroup (i.e., meta-dehumanization), they respond with reciprocal dehumanization. Therefore, we reasoned that partisans’ dehumanization could be reduced by correcting their exaggerated meta-dehumanization. Indeed, across three preregistered studies ( N = 4,154), an intervention correcting American partisans’ exaggerated meta-dehumanization reduced their own dehumanization of out-partisans. This decreased dehumanization persisted at a 1-week follow-up and predicted downstream reductions in partisans’ anti-democratic hostility, suggesting that correcting exaggerated meta-dehumanization can durably mitigate the dark specter of dehumanization.
Actual Cleaning and Simulated Cleaning Attenuate Psychological and Physiological Effects of Stressful Events
Authors: Lee Spike W. S. , Millet Kobe , Grinstein Amir , Pauwels Koen H. , Johnston Phillip R. , Volkov Alexandra E. , van der Wal Arianne J.
Published: July 2022

The human mind harbors various mechanisms for coping with stress, but what role does physical behavior play? Inspired by ethological observations of autogrooming activity across species, we offer a general hypothesis: cleaning attenuates effects of stressful events. Preregistered behavioral and psychophysiological experiments ( N = 3,066 in United Kingdom, United States, and Canada) found that (a) concrete visual simulation of cleaning behavior alleviated residual anxiety from a stress-inducing physical scene, an effect distinct from touch, and (b) actual cleaning behavior enhanced adaptive cardiovascular reactivity to a highly stressful context of social performance/evaluation, which provides the first physiological evidence for the attenuation of stress-related effects by cleaning. Overall, actual cleaning and simulated cleaning attenuate effects of physical or psychological stressors, even when they have nothing to do with contamination or disease and would not be resolved by cleaning. Daily cleaning behavior may facilitate coping with stressors like physical risks and psychological threats to the self.
Feeling the Future? Mixed Empirical Evidence for a Link Between Processing Fluency and Judgments About Future Probability
Authors: Landwehr Jan R. , Winkler Svenja , Bornemann Torsten
Published: July 2022

Many daily decisions require estimates of the inherently indeterminate probability of future events. We propose that people rely on heuristics instead of formal reasoning to come up with such estimates and that processing fluency may serve as a heuristic cue. Across seven experimental online studies that use random samples of MTurk workers as participants, statistical mediation analyses provide support for the notion that manipulating the fluency of utopic city pictures (presentation duration: 300 vs. 900 ms), statements about future societal developments (prior exposure: no vs. yes), and election promises made on Twitter during the 2020 U.S. presidential race (presentation size: small vs. large) has an indirect effect via subjective fluency on estimated probabilities of future occurrences. However, the total effects of the experimental manipulations on probability judgments show no consistent pattern, being negative in one study, positive in two studies, and not different from zero in the remaining four studies.
The Role of Certainty in a Two-Person Volunteer’s Dilemma
Authors: Villiger Daniel , Ullrich Johannes , Krueger Joachim I.
Published: July 2022

In the standard volunteer’s dilemma (VoD), a single prosocial act (i.e., volunteering) yields the optimal overall outcome. Whereas the volunteer’s outcome is certain, the defector’s outcome depends on what others do. This research addressed the confounding of prosocial responses with uncertainty avoidance in the standard VoD. In Experiment 1, participants ( N = 102) considered 18 hypothetical one-shot two-person VoD scenarios with certain, risky, and uncertain outcomes when volunteering. In Experiment 2, participants ( N = 496) considered three hypothetical one-shot two-person VoD scenarios; a certain VoD and two uncertain VoDs of which one had a lower expected collective outcome of volunteering than the certain VoD and the other a higher one. Results suggest that volunteering does not reflect a desire to avoid uncertainty but to maximize expected collective outcomes, reinforcing the assumption that the high volunteering rates we see in a standard VoD are due to social/moral preferences and social projection.
Metformin and the risk of dementia based on an analysis of 396,332 participants
Authors: Ji Shiliang , Zhao Xingxing , Zhu Ruifang , Dong Yongchao , Huang Lifeng , Zhang Taiquan
Published: July 2022

Background:

AMPK has attracted widespread interest as a potential therapeutic target for age-related diseases, given its key role in controlling energy homeostasis. Metformin (Met) has historically been used to treat Type 2 diabetes and has been shown to counteract age-related diseases. However, studies regarding the relationship between Met and a variety of age-related classifications of cognitive decline have reported mixed findings.

Objective:

To assess the potential effect of Met on the onset of dementia and discuss the possible biological mechanisms involved.

Methods:

This study was registered in the PROSPERO database (CRD420201251468). PubMed, Embase, and Cochrane Library were searched from inception to 25 May 2021, for population-based cohort studies. Effect estimates with 95% confidence intervals (CIs) were pooled using the random-effects model. Meta-regression and subgroup analyses were performed to explore sources of heterogeneity and the stability of the results.

Results:

Fourteen population-based cohort studies (17 individual comparisons) involving 396,332 participants were identified. Meta-analysis showed that Met exposure was significantly associated with reduced risk of all subtypes of dementias [relative risk (RR) = 0.79, 95% CI = 0.68–0.91; p < 0.001]. Conversely, no significant reduction in risk was observed for those who received Met monotherapy at the onset of vascular dementia (VD), Parkinson’s disease (PD), and Alzheimer’s disease (AD). The effect was more prominent in patients who had long-term Met exposure (⩾4 years) (RR = 0.38, 95% CI = 0.32–0.46; p < 0.001), while no such significant effect was found with short-term Met exposure (1–2 years) (RR = 1.20, 95% CI = 0.87–1.66; p < 0.001). Moreover, no association was observed for Met exposure in participants of European descent (RR = 1.01, 95% CI = 0.66–1.54; p = 0.003) compared with those from other countries.

Conclusion:

Based on the evidence from population-based cohort studies, our findings suggest that the AMPK activator, Met, is a potential geroprotective agent for dementias, particularly among long-term Met users. Due to the significant heterogeneity among the included studies, we should interpret the results with caution.
Starting fear is a stronger predictor of long-term fear than rate of change in fear in human fear conditioning
Authors: Zbozinek Tomislav D. , Tanner Alexandra S. , Craske Michelle G.
Published: July 2022

In rodent studies, faster extinction rate has been shown to predict less long-term fear. However, this has scarcely been studied in humans. The present report investigated the association between extinction rate and long-term fear in humans. We secondarily evaluated specificity of extinction rate by including other fear conditioning values as predictors, including acquisition intercept, acquisition rate, and extinction intercept. Lastly, we investigated whether trait measures of behavioral approach, behavioral inhibition, anxiety, and depression predicted long-term fear. Results show that slower extinction rate predicted less long-term fear when tested alone in the model. However, when including other fear conditioning variables, extinction rate no longer predicted long-term fear. Instead, greater fear at the beginning of acquisition was the most robust predictor of greater long-term fear (all three measures of fear), followed by greater fear at the beginning of extinction (unconditional stimulus expectancy only). These effects occurred for both the danger signal (i.e., conditional stimulus; CS+) and safety signal (i.e., CS−). The results suggest that fear at the start of acquisition and, secondarily, extinction are predictors of long-term fear. Lastly, there were no effects of trait behavioral approach, behavioral inhibition, anxiety, or depression. This report has relevance for improving our understanding and treatment of anxiety disorders.
Magnitude of neonatal near miss in public hospitals in Eastern Ethiopia: A cross-sectional study
Authors: Tola Melese Adugna , Semahegn Agumasie , Tiruye Getahun , Tura Abera Kenay
Published: July 2022

Objectives:

Although neonatal near miss is an emerging concept and a tool for improving neonatal care, its magnitude and associated factors are less researched in Ethiopia. Thus, this study was aimed to uncover the magnitude of neonatal near miss and its associated factors in public hospitals in Eastern Ethiopia.

Methods:

A facility-based cross-sectional study was employed on a randomly selected 405 mother–neonate pairs. An interview using a structured questionnaire accompanied by review of medical records was used to collect data from the mothers and records of the neonates. Neonatal near miss was defined as having any of the pragmatic (gestational age < 33 weeks, birth weight < 1750 g, and fifth minutes Apgar score < 7) or management criteria. Crude and adjusted logistic regression analysis was done to identify associated factors and presented with adjusted odds ratio with 95% confidence interval.

Results:

Of 401 mother–neonate pairs included in the study, 126 (31.4%, 95% confidence interval = [26.9, 36.2]) neonates had at least one neonatal near miss event at discharge. Neonatal near miss was more likely among neonates from referred women (adjusted odds ratio = 2.24, 95% confidence interval = [1.25, 4.03]), no antenatal care (adjusted odds ratio = 2.08, 95% confidence interval = [1.10, 3.93]), antepartum hemorrhage (adjusted odds ratio = 4.29, 95% confidence interval = [2.16, 8.53]), premature rupture of membrane (adjusted odds ratio = 4.07, 95% confidence interval = [2.05, 8.07]), obstructed labor (adjusted odds ratio = 2.61, 95% confidence interval = [1.23, 5.52]), non-vertex presentation (adjusted odds ratio = 3.03, 95% confidence interval = [1.54, 5.95]), and primiparous (adjusted odd ratio = 2.67, 95% confidence interval = [1.49, 4.77]).

Conclusions:

In this study, we found that neonatal near miss is higher than previous findings in Ethiopia. Improving neonatal near miss requires promoting antenatal care, maternal referral system, and early identification and management of obstetric complications.
Differences in Empathy According to Nonverbal Expression Elements of Emojis: Focusing on the Humanoid Emojis of KakaoTalk
Authors: Jeon Hye-Jin
Published: July 2022

To identify the most effective type of emojis for inducing empathy, the nonverbal expression factors of emojis that generate empathy differences were categorized as body language types (the presence of movement and contextual information), emotion type (joy and sadness), and degree of bodily expression (upper body and whole body). After dividing the data into joyful and sad emotion groups, differences in empathy according to the body language types and degree of bodily expression of emojis were confirmed. As a result, in the sad emotions group, empathy was higher in the movement type and the type combining movement and contextual information than the static body language type and the contextual information type without movement. However, the difference in empathy according to the degree of body expression and the interaction effect between body language types and degree of body expression were not significant. On the other hand, in the joyful emotions group, neither the main effect nor the interaction effect was significant. These results indicate that the effective emoji types for inducing empathy are the upper body of the movement type and the upper body combined with movement and contextual information. These types are also considered to work more effectively when applied to emotions with low mirroring and emotion recognition rates, such as sad emotion.
Petrified heart in a patient with Wolfram Syndrome
Authors: Siani Agnese , Proaspatu Mirela , Lanzo Giuseppe , Irico Paolo , Rodolfi Sara , Carriero Serena , Guglielmo Marco
Published: July 2022

Myocardial calcification is a rare complication of severe systemic sepsis. The pathophysiological mechanisms underlying calcium accumulation in cardiomyocytes in generalized sepsis are complex and still under investigation. It is a serious and life-threatening condition, usually diagnosed by autopsy, rarely with imaging techniques. We describe the case of a 38-year-old woman with Wolfram Syndrome who developed diffuse myocardial calcification during an episode of generalized sepsis.
Trocar-Based Surgical Approach to Suprachoroidal Hemorrhage Drainage
Authors: Pericak Olivia , Chin Eric K. , Almeida David R.P.
Published: July 2022

Purpose:

Suprachoroidal hemorrhage is an uncommon but serious ocular condition that typically occurs in the setting of intraocular surgery and trauma. We present an external trans-conjunctival vitreoretinal trocar-cannula-based drainage of suprachoroidal hemorrhage as a viable surgical approach.

Methods:

Case report.

Results:

Trans-conjunctival trocar-cannula-based drainage of suprachoroidal hemorrhage is a safe and efficacious surgical approach to drainage of large choroidal hemorrhages.

Conclusions:

Although discrepancies persist regarding the optimal surgical approach to suprachoroidal hemorrhage management; herein, we describe the successful execution of an external trans-conjunctival vitreoretinal trocar-cannula-based drainage of suprachoroidal hemorrhage.
Profiling Gingivoperiosteoplasty (GPP): A Cross-Sectional Analysis Using a Nationally Validated Pediatric Surgery Database
Authors: Arias Fernando D. , Rochlin Danielle H. , Rabbani Piul S. , Shetye Pradip R. , Staffenberg David A. , Flores Roberto L.
Published: July 2022

Objective:

Compare short term surgical outcomes and trends in cleft lip repair with or without gingivoperiosteoplasty (GPP).

Design:

Retrospective review of the ACS NSQIP-Pediatric database from 2014 to 2019.

Patients:

Patients between 2 and 18 months of age undergoing any initial cleft lip repair, with or without GPP, were selected via relevant CPT® codes.

Main Outcome Measures:

Patient demographics, comorbidities, 30-day readmissions and post-operative complications are assessed.

Results:

From 2014 to 2019, a total of 6269 patients were identified, of which 6.67% underwent GPP (n = 418). Patients undergoing GPP were significantly older with an average age of 9 months compared to 5 months in the non-GPP group ( P < .001). Co-morbidities were similar amongst both cohorts, although patients undergoing GPP were more likely to have a higher ASA class ( P = .006), cardiac risk factors ( P = .012) and syndromic diagnosis ( P < .001). There were no differences in 30-day short term surgical outcomes. GPP was associated with increased operative time by ~25 minutes when compared to cleft lip repair alone ( P < .001).

Conclusion:

GPP was not associated with increased 30-day postoperative complications, readmission, reoperation, or total length of hospital stay, and was associated with an increased operative time of 25 minutes. Children undergoing GPP were significantly older in age and were more likely to have a higher ASA class/cardiac risk factors.
Selective versus non-selective NSAIDs as prophylaxis for heterotopic ossification following hip arthroplasty: a meta-analysis
Authors: Migliorini Filippo , Pintore Andrea , Baroncini Alice , Pastor Torsten , Hildebrand Frank , Maffulli Nicola
Published: July 2022

Background

Some patients have demonstrated evidence of heterotopic ossification (HO) following total hip arthroplasty (THA). Selective and non-selective non-steroidal anti-inflammatory drugs (NSAIDs) are used as prophylaxis for HO following THA. This meta-analysis compared selective versus non-selective NSAIDs as prophylaxis for HO following THA.

Material and methods

The present study was conducted according to the PRISMA 2020 guidelines. All the clinical investigations comparing selective versus non-selective NSAIDs as prophylaxis for HO following THA were accessed in February 2022. An assessment of the methodological quality and statistical analyses were performed through the risk of bias summary tool of the Review Manager 5.3 software (Cochrane Collaboration, Copenhagen). The modified Brooker staging system was used to rate the efficacies of the interventions.

Results

Data from 8 studies and 1526 patients were collected. 60.8% were female. No difference was found in the sample size, mean age, and percentage of females between the two groups at baseline. No statistically significant difference was found between selective and non-selective NSAIDs in term of efficacy. 72% (1078 of 1502) of the patients were classified as Brooker 0, 21% (322 of 1502) as Brooker I, 5% (80 of 1502) as Brooker II, 1% (16 of 1502) as Brooker III, and 0.1% (2 of 1502) as Brooker IV.

Conclusion

Selective and non-selective NSAIDs were equally effective when used as prophylaxis for HO following THA.

Level of evidence

Level III, systematic review and meta-analysis.
The evolutionary history of cribellate orb-weaver capture thread spidroins
Authors: Correa-Garhwal Sandra M. , Baker Richard H. , Clarke Thomas H. , Ayoub Nadia A. , Hayashi Cheryl Y.
Published: July 2022

Background

Spiders have evolved two types of sticky capture threads: one with wet adhesive spun by ecribellate orb-weavers and another with dry adhesive spun by cribellate spiders. The evolutionary history of cribellate capture threads is especially poorly understood. Here, we use genomic approaches to catalog the spider-specific silk gene family (spidroins) for the cribellate orb-weaverUloborus diversus.

Results

We show that the cribellar spidroin, which forms the puffy fibrils of cribellate threads, has three distinct repeat units, one of which is conserved across cribellate taxa separated by ~ 250 Mya. We also propose candidates for a new silk type, paracribellar spidroins, which connect the puffy fibrils to pseudoflagelliform support lines. Moreover, we describe the complete repeat architecture for the pseudoflagelliform spidroin (Pflag), which contributes to extensibility of pseudoflagelliform axial fibers.

Conclusions

Our finding that Pflag is closely related to Flag, supports homology of the support lines of cribellate and ecribellate capture threads. It further suggests an evolutionary phase following gene duplication, in which both Flag and Pflag were incorporated into the axial lines, with subsequent loss of Flag in uloborids, and increase in expression of Flag in ecribellate orb-weavers, explaining the distinct mechanical properties of the axial lines of these two groups.
Compromised cardiopulmonary resuscitation quality due to regurgitation during endotracheal intubation: a randomised crossover manikin simulation study
Authors: Lin Li-Wei , DuCanto James , Hsu Chen-Yang , Su Yung-Cheng , Huang Chi-Chieh , Hung Shih-Wen
Published: July 2022

Background

Regurgitation is a complication common during cardiopulmonary resuscitation (CPR). This manikin study evaluated the effect of regurgitation during endotracheal intubation on CPR quality.

Methods

An airway-CPR manikin was modified to regurgitate simulated gastric contents into the oropharynx during chest compression during CPR. In total, 54 emergency medical technician-paramedics were assigned to either an oropharyngeal regurgitation or clean airway scenario and then switched to the other scenario after finishing the first. The primary outcomes were CPR quality metrics, including chest compression fraction (CCF), chest compression depth, chest compression rate, and longest interruption time. The secondary outcomes were intubation success rate and intubation time.

Results

During the first CPR–intubation sequence, the oropharyngeal regurgitation scenario was associated with a significantly lower CCF (79.6% vs. 85.1%, P < 0.001), compression depth (5.2 vs. 5.4 cm, P < 0.001), and first-pass success rate (35.2% vs. 79.6%, P < 0.001) and greater longest interruption duration (4.0 vs. 3.0 s, P < 0.001) than the clean airway scenario. During the second and third sequences, no significant difference was observed in the CPR quality metrics between the two scenarios. In the oropharyngeal regurgitation scenario, successful intubation was independently and significantly associated with compression depth (hazard ratio = 0.47, 95% confidence interval, 0.24–0.91), whereas none of the CPR quality metrics were related to successful intubation in the clean airway scenario.

Conclusion

Regurgitation during endotracheal intubation significantly reduces CPR quality.

Trial registration

ClinicalTrials.gov, NCT05278923, March 14, 2022.
Structural brain network measures in elderly patients with cerebral small vessel disease and depressive symptoms
Authors: Gu Yumeng , Zhao Ping , Feng Wenjun , Xia Xiaoshuang , Tian Xiaolin , Yan Yu , Wang Xiaowen , Gao Decheng , Du Yanfen , Li Xin
Published: July 2022

Objectives

To investigate the relationship between diffusion tensor imaging (DTI) indicators and cerebral small vessel disease (CSVD) with depressive states, and to explore the underlying mechanisms of white matter damage in CSVD with depression.

Method

A total of 115 elderly subjects were consecutively recruited from the neurology clinic, including 36 CSVD patients with depressive state (CSVD+D), 34 CSVD patients without depressive state (CSVD-D), and 45 controls. A detailed neuropsychological assessment and multimodal magnetic resonance imaging (MRI) were performed. Based on tract-based spatial statistics (TBSS) analysis and structural network analysis, differences between groups were compared, including white matter fiber indicators (fractional anisotropy and mean diffusivity) and structural brain network indicators (global efficiency, local efficiency and network strength), in order to explore the differences and correlations of DTI parameters among the three groups.

Results

There were no significant differences in terms of CSVD burden scores and conventional imaging findings between the CSVD-D and CSVD+D groups. Group differences were found in DTI indicators (p <  0.05), after adjusting for age, gender, education level, and vascular risk factors (VRF), there were significant correlations between TBSS analysis indicators and depression, including: fractional anisotropy (FA) (r = − 0.291, p <  0.05), mean diffusivity (MD) (r = 0.297, p < 0.05), at the same time, between structural network indicators and depression also show significant correlations, including: local efficiency (ELocal) (r = − 0.278, p < 0.01) and network strength (r = − 0.403, p < 0.001).

Conclusions

Changes in FA, MD values and structural network indicators in DTI parameters can predict the depressive state of CSVD to a certain extent, providing a more direct structural basis for the hypothesis of abnormal neural circuits in the pathogenesis of vascular-related depression. In addition, abnormal white matter alterations in subcortical neural circuits probably affect the microstructural function of brain connections, which may be a mechanism for the concomitant depressive symptoms in CSVD patients.
Statin and aspirin as adjuvant therapy in hospitalised patients with SARS-CoV-2 infection: a randomised clinical trial (RESIST trial)
Authors: Ghati Nirmal , Bhatnagar Sushma , Mahendran Manjit , Thakur Abhishek , Prasad Kshitij , Kumar Devesh , Dwivedi Tanima , Mani Kalaivani , Tiwari Pawan , Gupta Ritu , Mohan Anant , Saxena Anita , Guleria Randeep , Deepti Siddharthan
Published: July 2022

Background

Statins and aspirin have been proposed for treatment of COVID-19 because of their anti-inflammatory and anti-thrombotic properties. Several observational studies have shown favourable results. There is a need for a randomised controlled trial.

Methods

In this single-center, open-label, randomised controlled trial, 900 RT-PCR positive COVID-19 patients requiring hospitalisation, were randomly assigned to receive either atorvastatin 40 mg (Group A, n = 224), aspirin 75 mg (Group B, n = 225), or both (Group C, n = 225) in addition to standard of care for 10 days or until discharge whichever was earlier or only standard of care (Group D, n = 226). The primary outcome variable was clinical deterioration to WHO Ordinal Scale for Clinical Improvement ≥ 6. The secondary outcome was change in serum C-reactive protein, interleukin-6, and troponin I.

Results

The primary outcome occurred in 25 (2.8%) patients: 7 (3.2%) in Group A, 3 (1.4%) in Group B, 8 (3.6%) in Group C, and 7 (3.2%) in Group D. There was no difference in primary outcome across the study groups (P = 0.463). Comparison of all patients who received atorvastatin or aspirin with the control group (Group D) also did not show any benefit [Atorvastatin: HR 1.0 (95% CI 0.41–2.46) P = 0.99; Aspirin: HR 0.7 (95% CI 0.27–1.81) P = 0.46]. The secondary outcomes revealed lower serum interleukin-6 levels among patients in Groups B and C. There was no excess of adverse events.

Conclusions

Among patients admitted with mild to moderate COVID-19 infection, additional treatment with aspirin, atorvastatin, or a combination of the two does not prevent clinical deterioration.

Trial Registry Number CTRI/2020/07/026791 (http://ctri.nic.in; registered on 25/07/2020)
Randomized controlled trial of the relative efficacy of high-dose intravenous ceftriaxone and oral cefixime combined with doxycycline for the treatment of Chlamydia trachomatis and Neisseria gonorrhoeae co-infection
Authors: Nguyen Phuong Thi Thu , Pham Ha Viet , Van Dung Hoang , Pham Linh Van , Nguyen Hoi Thanh , Nguyen Hung Van
Published: July 2022

Objectives

Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG) are the commonest bacterial causes of sexually transmitted infections in humans with high incidence of co-infection. Treatment with high doses of ceftriaxone (CRO) and cefixime (CFM) is strongly recommended due to the reduced drug susceptibility of NG. However, their safety and efficacy have not been confirmed. We compared the safety and efficacy of a single 1 g intravenous (IV) dose of ceftriaxone (CRO) plus doxycycline (DOX) versus a single 800 mg oral dose of cefixime (CFM) plus DOX for the treatment of NG-CT co-infection.

Methods

An open-label randomized controlled trial was conducted on 125 individuals aged > 18 years with untreated gonorrhea and chlamydia to compare a single 1 g intravenous dose of CRO + DOX and a single 800 mg oral dose of CFM + DOX. The primary outcome was the clearance of NG from all the initially infected sites. Secondary outcomes included symptom resolution, changes in the serum clearance levels, glomerular filtration rate, and antibiotic minimum inhibitory concentrations.

Results

Both regimens were highly effective in treating gonorrhea with success rates of 96.7% (95% confidence interval [CI] 88.8–99.1%) for CRO and 95.3% (95% CI 87.1–98.4%) for CFM. However, CRO + DOX was superior to CFM + DOX for the treatment of NG-CT co-infection (odds ratio 4.41, 95% CI 1.11–25.7). The safety profiles of the two regimens were similar.

Conclusions

CRO + DOX was superior to CFM + DOX for the treatment of NG-CT co-infection. CFM + DOX may be indicated in patients with CRO allergy and in settings where CRO is unavailable.

Trial registration ClinicalTrials.gov (NCT05216744) on 31/01/22.
The stay strong app as a self-management tool for first nations people with chronic kidney disease: a qualitative study
Authors: Nagel Tricia , Dingwall Kylie M. , Sweet Michelle , Kavanagh David , Majoni Sandawana W , Sajiv Cherian , Cass Alan
Published: July 2022

Background

The high burden of chronic kidney disease in First Nations peoples requires urgent attention. Empowering people to self-manage their own condition is key, along with promotion of traditional knowledge and empowerment of First Nations communities. This study explores the potential of a culturally responsive tool, already found to have high acceptability and feasibility among First Nations people, to support self-management for First Nations people with kidney failure. The Stay Strong app is a holistic wellbeing intervention. This study explores the suitability of the Stay Strong app to support self-management as shown by the readiness of participants to engage in goal setting. Data were collected during a clinical trial which followed adaption of research tools and procedures through collaboration between content and language experts, and community members with lived experience of kidney failure.

Methods

First Nations (i.e., Aboriginal and Torres Strait Islander) participants receiving haemodialysis in the Northern Territory (n = 156) entered a three-arm, waitlist, single-blind randomised controlled trial which provided collaborative goal setting using the Stay Strong app at baseline or at 3 months. Qualitative data gathered during delivery of the intervention were examined using both content and thematic analysis.

Results

Almost all participants (147, 94%) received a Stay Strong session: of these, 135 (92%) attended at least two sessions, and 83 (56%) set more than one wellbeing goal. Using a deductive approach to manifest content, 13 categories of goals were identified. The three most common were to: ‘connect with family or other people’, ‘go bush/be outdoors’ and ‘go home/be on country’. Analysis of latent content identified three themes throughout the goals: ‘social and emotional wellbeing’, ‘physical health’ and ‘cultural connection’.

Conclusion

This study provides evidence of the suitability of the Stay Strong app for use as a chronic condition self-management tool. Participants set goals that addressed physical as well as social and emotional wellbeing needs, prioritising family, country, and cultural identity. The intervention aligns directly with self-management approaches that are holistic and prioritise individual empowerment. Implementation of self-management strategies into routine care remains a key challenge and further research is needed to establish drivers of success.
Prognostic models for outcome prediction in patients with advanced hepatocellular carcinoma treated by systemic therapy: a systematic review and critical appraisal
Authors: Li Li , Li Xiaomi , Li Wendong , Ding Xiaoyan , Zhang Yongchao , Chen Jinglong , Li Wei
Published: July 2022

Objective

To describe and analyze the predictive models of the prognosis of patients with hepatocellular carcinoma (HCC) undergoing systemic treatment.

Design

Systematic review.

Data sources

PubMed and Embase until December 2020 and manually searched references from eligible articles.

Eligibility criteria for study selection

The development, validation, or updating of prognostic models of patients with HCC after systemic treatment.

Results

The systematic search yielded 42 eligible articles: 28 articles described the development of 28 prognostic models of patients with HCC treated with systemic therapy, and 14 articles described the external validation of 32 existing prognostic models of patients with HCC undergoing systemic treatment. Among the 28 prognostic models, six were developed based on genes, of which five were expressed in full equations; the other 22 prognostic models were developed based on common clinical factors. Of the 28 prognostic models, 11 were validated both internally and externally, nine were validated only internally, two were validated only externally, and the remaining six models did not undergo any type of validation. Among the 28 prognostic models, the most common systemic treatment was sorafenib (n = 19); the most prevalent endpoint was overall survival (n = 28); and the most commonly used predictors were alpha-fetoprotein (n = 15), bilirubin (n = 8), albumin (n = 8), Child–Pugh score (n = 8), extrahepatic metastasis (n = 7), and tumor size (n = 7). Further, among 32 externally validated prognostic models, 12 were externally validated > 3 times.

Conclusions

This study describes and analyzes the prognostic models developed and validated for patients with HCC who have undergone systemic treatment. The results show that there are some methodological flaws in the model development process, and that external validation is rarely performed. Future research should focus on validating and updating existing models, and evaluating the effects of these models in clinical practice.

Systematic review registration

PROSPERO CRD42020200187.
Severity of age-related macular degeneration at first presentation in Bhutan: a 3-year national study
Authors: Rai Bhim B. , Morley Michael G. , Bernstein Paul S. , Maddess Ted
Published: July 2022

Background

Medical services are still developing in Bhutan. There is no published national report on age-related macular degeneration (AMD). We therefore aim to determine the demographic characteristics and severity of AMD at first presentation among Bhutanese patients attending their recently inaugurated vitreoretinal (VR) clinics over a 3-year national survey, and to inform national health policy to develop suitable health program to prevent AMD-related blindness and visual impairment.

Methods

A retrospective cross-sectional consecutive case series study was conducted on all new AMD cases in Bhutan. If a patient presented with asymmetrical AMD, the eye with more severe AMD was considered. If both the eyes had the same severity one eye was chosen randomly. Collection of demographic data and clinical details including diagnostic testing (fundus photography, OCT and fluorescent angiography) and clinical staging were performed.

Results

Of 521 new AMD patients aged 71.9 ± 11.3 years, 306/521 (58.7%) were males (p = 0.005). At their first presentation, 234/521 patients (44.9%) already had late-stage AMD. Importantly, 69/234 patients (29.5%), that is half of total neovascular AMD (nAMD) patients, had disciform scars (DS) which were beyond treatment, and 7/234 patients (3.0%) had geographic atrophy (GA). Seven patients had retinal pigment epithelium tear at presentation. Fourteen of nineteen polypoidal choroidal vasculopathy (PCV) patients were younger than 50 years.

Conclusions

Half of nAMD cases presented as DS not amenable to the treatment. Many potentially treatable nAMD patients had already lost central vision and were legally blind. Young people with PCV losing vision early in life with longer morbidity-affected life and socio-economic burden was concerning. GA and DS cases need visual rehabilitation to improve their QoL. Incorporating a screening program for AMD with effective health education, and maintaining a national AMD Registry, would potentially lower AMD-related blindness and visual impairment.