bluuebunny/crossref_metadata_2025 huggingface dataset:
Medical software as a virtual service: A multifaceted approach to telemedicine through software-as-a-service and user-centric features
Authors: Mi Yanlin , O’Reilly Barry A , Tabirca Sabin
Published: December 2024

Background

This article presents medical software-as-a-virtual service platform, a comprehensive telemedicine solution integrating software-as-a-service principles with user-centric features to enhance healthcare service efficiency, accessibility, and patient–provider interaction.

Methods

Medical software-as-a-virtual service employs a multifaceted approach, incorporating a robust questionnaire system for data collection and an empathetic virtual agent module to facilitate nuanced patient–provider interactions. The platform prioritizes privacy and data security through advanced encryption standard encryption and data anonymization, aligning with Health Insurance Portability and Accountability Act standards.

Results

The initial deployment of medical software-as-a-virtual service demonstrates significant improvements in data collection efficiency, patient engagement, and healthcare service quality. The platform’s adaptability is evidenced by its successful application in specialized fields such as radiology and prolapse. User feedback underscores the system’s ease of use and potential for reducing healthcare providers’ workload.

Discussion

Despite its promising outcomes, medical software-as-a-virtual service faces challenges, including the need for in-person treatment and limited virtual agent customization. Short-term improvements aim to enhance appointment scheduling, speech recognition, and agent personalization. Long-term goals include integrating artificial intelligence for diagnostic assistance, Internet of Things for comprehensive remote care, and advanced virtual agents for improved patient interaction.

Conclusion

Medical software-as-a-virtual service emerges as a transformative telemedicine solution, effectively addressing contemporary healthcare challenges. Its continuous evolution, marked by the integration of advanced technologies and user-centered design, holds the potential to reshape the landscape of remote healthcare delivery. Future research will focus on refining platform features and examining the broader impact on healthcare systems and patient outcomes.
The impact of patient communication software app on facilitating communication with mechanically ventilated patients: A randomized clinical trial
Authors: Poursadeghi Zahra , Miri Kheizaran , Hajiabadi Fatemeh , Mazloum Seyyed Reza , Malekzadeh Javad , Niazi Fereshteh
Published: December 2024

Background & Aim

The use of mechanical ventilation devices as a supportive respiratory system for hospitalized patients in intensive care units is often accompanied by the inability of alert patients to establish verbal communication. This study aims to determine the impact of patient communication software on facilitating communication for mechanically ventilated patients in the intensive care unit.

Methodology

This clinical trial was conducted with two groups, each comprising 60 alert, mechanically ventilated patients hospitalized in medical universities in Mashhad, from December 2022 to January 2023. Patients were randomly assigned to the intervention and control groups. In the intervention group, communication with the patient was established using specially designed software, while in the control group, conventional methods were used to identify patient needs. Data collection tools included a demographic questionnaire and the Ease of Communication Scale. SPSS software (version 20) was utilized for data analysis, employing chi-square, independent t-test, Mann–Whitney, Wilcoxon and paired t-tests. Cohen's d was also used to evaluate the magnitude of the effect size.

Results

The composition of the groups, including gender and marital status, was comparable, as was their baseline demographic and clinical characteristics (age, gender, education level, marital status, underlying diseases, airway type, hospital stay length, sedative medication, and mechanical ventilation duration), with no significant differences found ( p > 0.05). Before the intervention, there was no difference in communication ease scores between the groups. Post-intervention, the intervention group showed significantly improved communication ease scores compared to the control group ( P < 0.001) The Wilcoxon test results indicated a significant reduction in the average communication ease score after the intervention within both the intervention and control groups.

Conclusion

Software designed to assist communication for patients on mechanical ventilation with artificial airways could enhance their ability to communicate their needs more effectively, offering an alternative to methods such as lip-reading, writing, alphabet boards and communication boards.
The significance and value of the historiography of science in science communication
Authors: Liu Bing
Published: December 2024

In the current development of science communication, to achieve the desired communication objectives, either in formal science education or science popularization for the public, the utilization of resources on the history of science has become a necessity. However, due to the limitations of their professional background, science teachers and science-popularization workers still face problems in understanding the history of science, which naturally affects the appropriate use of resources on the history of science in science communication. One possible way to solve this problem is to learn and gain some basic knowledge of the historiography of science.
Evaluating the Care Gaps and Inequalities Arising in Continuing Healthcare (CHC) Delivery in Rural Areas
Authors: Deaney Carl , Hemingway Elizabeth , Reesby Danielle , Scott Victoria
Published: December 2024

This paper examines the provision of Continuing Healthcare (CHC) within the National Health Service (NHS) in England. It identifies significant care gaps and barriers that mainly affect rural communities; despite CHC’s crucial role in supporting individuals with complex and ongoing healthcare needs, disparities in access and delivery persist, exacerbating health inequalities in rural areas where communities often live in more significant deprivation. Three case studies serve to highlight these challenges to gain a better understanding of the systemic issues at play. The overarching themes underpinning the difficulties in delivering care to rural communities are the insignificant distances between services and the hurdles to obtaining funding. Rural regions often have higher costs due to insufficient local resources and inadequate staffing. These case studies illustrate that rural communities have reduced service availability and logistical challenges, which can lead to delayed or inadequate care.
Pre-Operative Direct Oral Anticoagulant Level Measurement Reduces Time to Surgery in Hip Fracture Patients
Authors: P’ng Stephanie Su-Yin , Teh Yue Wern , Reynolds Sophie , Boardman Glenn , Jones Christopher W. , Seymour Hannah
Published: December 2024

Introduction

The optimal management of patients taking DOAC medications in the perioperative trauma setting is based on limited evidence. Current guidelines recommend withholding DOAC medications 48-72 hours pre-operatively. The objective of this trial was to determine the utility of measuring DOAC levels prior to surgery, evaluate the safety of a cut-off level of <50 ng/mL and to compare the outcomes with time parameters.

Materials and Methods

We performed a cohort study of patients aged 50 years and older admitted with a hip fracture who underwent surgery between January 12 017 and December 31 2019. Primary outcome was time to surgery (TTS) in hours. Secondary outcomes include inpatient transfusion and thromboembolism rates and 30-day mortality.

Results

1579 patients underwent operative management of their hip fracture. The mean TTS in the DOAC group was 33.0 hours. This was significantly longer when compared to patients not on anticoagulation whose mean TTS was 24.4hours (95% CI -13.78: −8.71, P value <.05). It was also significantly higher than patients on warfarin whose mean TTS was 26.4hours (95% CI -12.41: −4.18, P value <.05). There was no significant difference in the transfusion rate and 30-day mortality between the groups (X2 = 2.086, df = 2, P value = .352)]. There was no significant difference in transfusion rates and 30-day mortality between the patients with a DOAC level <50 ng/mL compared with the patients not on any anticoagulation. There was no significant difference in 30-day mortality or transfusion rates between those patients on a DOAC operated within 48 hours compared with those operated after 48 hours ( P value = .67).

Discussion and Conclusion

DOAC therapy delays surgery for patients with a hip fracture. Using a DOAC level <50 ng/mL is a safe level to proceed with surgery and reduces the TTS compared to following current guidelines. If DOAC levels are not available the data still supports operation at 48 hours.
Beliefs of EFL University Instructors about Teaching Listening in Integration with Speaking, Ethiopia
Authors: Shago Addisu B. , Bushisso Elias W. , Olamo Taye G. M.
Published: December 2024

This study investigated EFL instructors’ beliefs about teaching listening integrated with speaking skills at Hawassa University, Ethiopia through a mixed-methods approach. A comprehensive sampling technique identified survey respondents whereas a purposive sampling technique selected participants for qualitative data. Employing a 5-point Likert scale questionnaires were framed to analyze input and method domains. Conversely, utilizing semi-structured interviews (four themes) and observations (seven themes) were categorized using NVIVO 12 Pro. Descriptive statistics illustrated the importance of input domains (familiar topics, feedback, knowledge elements, authentic materials, technology integration) and method domains (pre-, while and post-listening phases, and task-based instruction). However, qualitative findings showed inconsistencies between beliefs and practices indicating a need for more effective lesson planning, authentic materials, technology integration, and effective implementation of listening phases. Inferential statistics revealed a strong positive relationship between dependent and independent variables, which showed a significant impact. Consequently, a balanced approach to these domains is crucial for effective integration requiring professional development programs to address the finding’s disparities. The study recommends practical training, authentic material design, technology integration, and progressive assessment with an emphasis on lesson planning. It further suggests exploring practical interventions, comparative studies, longitudinal studies, and student focused studies to enhance the quality of these findings.
Smooth muscle spheroids: Superior building blocks for bladder tissue engineering
Authors: Planta Dafni , Gerwinn Tim , Baumgartner Valentin , Salemi Souzan , Eberli Daniel , Horst Maya
Published: December 2024

Background:

Congenital bladder disorders in children necessitate innovative approaches for bladder tissue regeneration, aiming to minimize complications associated with conventional therapies. This study focused on generating a cell-seeded scaffold using superior smooth muscle cells (SMCs) by exploring the potential of smooth muscle cell spheroids (3D SMCs) compared to conventionally cultured SMCs (2D SMCs) for bladder tissue engineering. Additionally, adipose-derived stem cells (ADSCs) were investigated for their impact on SMC proliferation and maturation, and pre-differentiated smooth muscle-like ADSCs (pADSCs) for their potential as alternative cell source.

Methods:

3D SMCs were seeded into a compressed collagen scaffold as monoculture and as co-culture with ADSCs or pADSCs and incubated for 2 weeks. Their contractile potential as well as proliferation and cell distribution within the scaffold were compared to conventionally cultured 2D SMCs by immunofluorescent staining and qRT-PCR.

Results:

3D SMCs in collagen scaffolds exhibited significantly superior cell distribution, proliferation, and contractile marker expression compared to 2D SMCs. While ADSCs showed limited impact, co-culture with pADSCs enhanced contractile marker expression, though not surpassing 3D SMC monoculture.

Conclusion:

For the first time, a collagen scaffold seeded with 3D SMCs was generated and evaluated. This study recommends 3D SMCs as optimal building blocks for bladder tissue engineering, highlighting the potential of pADSCs as an alternative cell source. These findings offer crucial insights for refining cell sources as well as culture techniques in pediatric bladder regeneration and provide a superior cell-seeded scaffold for further bladder tissue engineering experiments.
A Primer on Abdominoplasty Safety
Authors: Stein Michael J. , Karaev Sophia , Matarasso Alan
Published: December 2024

Background: Abdominoplasty continues to be a frequently performed plastic surgery procedure. Futhermore, an increase in both surgical and medical weight loss is contributing to the procedure's increasing popularity. Technical refinements have improved surgical outcomes and safety. Despite this, it remains a procedure with one of the highest morbidity and mortality risks in aesthetic plastic surgery. Methods: A review of abdominoplasty complications and best practices was performed in order to provide a succinct review of the most prevalent safety issues in abdominoplasty surgery. Proposal: In order to mitigate the risk of complications, risk stratification, patient selection, and using evidence-based techniques are essential. In the present study, the authors provide recommendations for approaching the most common safety considerations of this procedure. Conclusion: Appropriate patient selection, surgical technique and proper protocols, ensures surgeons control the modifiable risk factors that increase complications. Implementing nonpharmacologic and pharmacologic interventions reduce the risk of venous thromboembolism. Using evidence-based techniques tailored to the specific patient's anatomy ensures the vascular territories of the abdominoplasty flap are respected and perfusion for wound healing is optimized.
Assessing the Necessity and Cost-effectiveness of Radiology Reports for Plain Hand Radiographs in Outpatient Clinics
Authors: Al-Zeer Bader , Al Hosni Ahmed , Tang David
Published: December 2024

Purpose: The purpose of this study was to determine the necessity and cost-effectiveness of radiologists’ interpretation of plain hand radiographs for diagnosing and managing different hand pathologies in the plastic surgery outpatient clinic setting. Methods: Through a retrospective cohort study, we identified new patient encounters from January 2021 to December 2022 in an outpatient hand clinic. We included patients with radiology reports that were submitted subsequent to the surgeon's consult note in clinic. Plastic surgeons’ interpretations were compared with radiology reports, and findings were categorized as concordant, discrepant (different with no impact on management), or discordant (different with an impact on management). Analysis included radiograph type, underlying mechanism, site of pathology, and hand fellowship training for surgeons. Direct cost was calculated using billing code fees. Results: A total of 241 cases were included in the study: 187 were concordant (77.6%), 53 were discrepant (22%) and only one was discordant (0.4%). Trauma was the predominant reported mechanism (90.5%). Most pathologies were in the phalanges (53.5%), followed by metacarpals (30.7%) and carpals (15.8%). Univariate analysis demonstrated no significant association between radiograph type ( P = .829), underlying mechanism ( P = .172), site of pathology ( P = .482), surgeon's training ( P = .551) and concordance with radiology reports. Total direct cost of radiographs reporting in this study was 8477 CAD. Conclusion: The study identified high concordance rates of hand radiograph findings between plastic surgeons and radiologists, with radiology reports rarely impacting patient management. Given the significant patient volume in plastic surgery hand clinics, these findings prompt further considerations in optimizing cost-effective diagnostic practices.
The Republic of Kazakhstan’s multi-vector foreign policy
Authors: Nyshanbayev Nurbolat , Bekov Kairat , Baizakova Zhulduz , Amangeldy Alipbayev
Published: December 2024

The purpose of this scientific work is to assess the developing directions of Kazakhstan’s interaction with other states in various spheres. Different methods of scientific research were used in the study, namely analysis and synthesis, comparison, deduction, abstraction, formal legal method etc. Since independence, Kazakhstan’s multi-vector foreign policy has to some extent contributed to maintaining the balance of power in the region. Having chosen the professional diplomat Tokayev as his successor, Nazarbayev resigned on March 19, 2019, ushering in a new, unanalysed phase of the multi-vector foreign policy that has developed over the past 30 years. A theoretical analysis of the development of Kazakhstan’s foreign policy during the transition of power was carried out. It is concluded that during the transition of power, the multi-vector foreign policy develops in a new direction and in accordance with the priority of geo-economic values. The practical value of this research lies in the contribution to the literature of understanding the concept of multi-vector foreign policy or balance-based foreign policy during power transitions.
“How We Think, Who We Are, and Who We Want to Be”: Authentic Participatory Action Research for Social Studies
Authors: Bradt Nancy Ku
Published: December 2024

Two high school students interviewed their peers to understand what they perceive to be the benefits and challenges of having cross-cultural backgrounds and shared these findings at an academic conference. Analyzing the qualitative data through the frameworks of Authentic Intellectual Work (AIW) and Participatory Action Research (PAR), I demonstrate that while the project was well-aligned with the key characteristics of both frameworks—that students constructed social studies knowledge, learned research and other skills, took a central role in a research project, and presented their findings through elaborated communication—the project could have been more powerful if I had guided the youth to more deeply explore social studies concepts such as bias and stereotypes and more explicitly highlighted justice-oriented goals. Through the above analysis, I provide a case study of what AIW and PAR look like in K-12 social studies education and how they can support social studies learning, teaching, and research. Further, as the AIW and PAR frameworks complement each other, I propose their synthesis as Authentic Participatory Action Research (APAR), which can guide high-quality, justice-oriented social studies instruction and research. APAR can be especially effective when it is offered with focused mentorship and when students leverage existing opportunities/events in their immediate communities to share their research findings with relevant stakeholders. Given that our world and nation are increasingly polarized and fraught with social and political conflicts, high-quality, justice-oriented social studies education can support our diverse children and youth to understand and confront issues of equity, power, and opportunity. This research is a case study of such high-quality, justice-oriented social studies.
Patient-Reported Experience Measures in Pediatric Healthcare—A Rapid Evidence Assessment
Authors: Bartholdson C. , Broström E. , Iversen M. D. , Granhagen Jungner J.
Published: December 2024

This study aimed to describe what is known in the scientific literature about patient-reported experience measures (PREMs) in pediatric healthcare and identify areas for further exploration. PubMed, Web of Science, CINAHL, Google Scholar, COCHRANE, and SveMed+ combined with free text search in FireFox and Safari web browsers using Medical Subject Headings terms were used. Outcomes of interest were patient experience and measures of these constructs. Of the 316 studies identified, 68 met the inclusion criteria. Forty-eight studies (72%) were published between 2015 and 2020 and more than half (53%) were published in Europe. Most studies of PREMs in pediatric healthcare included adult proxies as participants. Seventy-eight percent of studies consisted of > 100 participants. Thirty-six studies (53%) were quantitative studies, 26 (38%) were evaluative studies of patient experience measures, and 6 (9%) were qualitative in design. Three hundred eleven domains were identified and further categorized into 14 domain areas. This research is important because it aims to amplify the voices of children in healthcare and establish a foundation for developing validated pediatric-PREMs that is grounded in children's firsthand experiences of care, rather than relying primarily on proxy accounts.
Money and Mission: Models of Funding God’s Mission
Authors: Evans Louisa
Published: December 2024

While the Great Commission was not predicated on money, the lack of finances has been an obstacle to mission participation for many Global South Christians. This article examines the challenges that money poses for Global South mission, proposes that the use of “mission funding models” can clarify the issues of mission funding decisions, challenges the prevailing understanding of mission, and charts a way forward to increase mission participation for those who are financially disadvantaged.
Urban climate experiments: Governance tensions and opportunities for justice
Authors: Manganelli Alessandra
Published: December 2024

Urban climate experiments are considered as key vehicles for testing and materialising alternative futures. Yet, the capacity of experiments to be transformative and to go in the direction of greater justice is far from evident. While the debate on experimental governance hints at transformative challenges of urban experiments, scope of this paper is to make such challenges explicit, observing how they can constrain but also enable experiments in contributing to more socio-ecologically just change. To achieve that, this paper frames transformative challenges of urban experiments as critical governance tensions. The concept of tension illuminates the dialectics between limits to transformative action on the one hand, and opportunities to enhance scopes of action on the other. By analysing and connecting among each other key strands of debate on experimental governance, the paper identifies three main types of tensions characterising the governance of urban climate experiments, that is, socio-material, organisational and institutional (governance tensions). The analysis of the tensions is further developed by embedding a socio-ecological justice lens. Indeed, drawing insights from literature on urban climate justice, the paper shows how key dimensions of justice – namely distributive, procedural, recognition and restorative justice – run transversal to the three types of tensions. As a result, by experiencing and learning from governance tensions urban climate experiments can envision opportunities to better embed justice in their governing practices.
Underwater Cultural Heritage as a Water Resource: Knowledge for Sustainability
Authors: Perez-Alvaro Elena
Published: December 2024

This article explores how knowledge of underwater cultural heritage can emerge as a valuable water resource, contributing to the water-related objectives outlined in the 2030 United Nations Agenda for Sustainable Development, specifically Goal 6: Clean Water and Sanitation and Goal 14: Life Below Water. The United Nations World Water Development Report 2021 (UN Report, 2021) emphasizes the centrality of values in water resources governance. Throughout history, people from various civilizations have inhabited water-rich environments, leaving both tangible and intangible remnants. Consequently, underwater cultural heritage presents itself as a reservoir of information that can inform contemporary water resource practices and serve as a tool for grasping the value of water in sustainability processes. However, cultural dimensions are often overlooked in water research. This study adopts an innovative approach to illuminate current challenges in water sustainability, illustrating how cultural heritage, situated in its aquatic environment, can offer a fresh perspective on these issues. Through small case studies, this article suggests a forward-looking or future-oriented approach to understanding and engaging with water culture.
Real-world results of the Zeiss selective laser trabeculoplasty in adult South African primary open-angle glaucoma patients
Authors: Church Brian , Wassermann Pierre
Published: December 2024

Background:

Selective laser trabeculoplasty (SLT) is an effective long-term option for the treatment of open-angle glaucoma.

Objectives:

To investigate the real-world efficacy and safety of SLT with the Zeiss VISULAS green laser in medically treated primary open-angle glaucoma (POAG).

Design:

Retrospective, single-center study.

Methods:

POAG patients ⩾18 years of age on at least one antiglaucoma medication prior to the procedure, who underwent SLT with the Zeiss VISULAS green laser (Carl Zeiss Meditec, Jena, Germany). Medications were terminated or reinstated at subsequent follow-ups depending on the intraocular pressure (IOP) control. The primary efficacy outcome measures were mean reduction in glaucoma medications and mean reduction in IOP at 3, 6, and 12 months compared to baseline. Safety outcomes were intra- or post-procedural complications.

Results:

One hundred fifty-six eyes of 156 patients, aged 66.5 ± 13.2 years, were recruited. The mean number of medications was reduced from 2.3 ± 1.0 at baseline to 0.8 ± 1.1 and 0.8 ± 1.2 at 3- and 6 months, respectively ( p < 0.001). Despite the reduction of medications, the mean IOP (mmHg) was reduced from 16.6 ± 3.10 at baseline to 15.4 ± 3.82 at 3 months ( n = 156) and 15.1 ± 3.30 at 6 months ( n = 140) ( p < 0.001). IOP reduction ⩾20% was observed in 28.8% of patients at 3 months and 27.9% of patients at 6 months. In the 12-month follow-up group ( n = 22), mean medications and IOP (mmHg) at baseline were 2.3 ± 0.9 and 16.0 ± 2.80, respectively, which decreased to 0.9 ± 1.1 ( p < 0.001) and 14.5 ± 1.92 ( p = 0.103), respectively. At 3- and 6-month post-procedure, 59.6% of patients and 60% of patients, respectively, were medication-free compared to none at baseline. At 6 months, 69.3% of patients maintained IOP lower than or equal to pre-procedure IOP on fewer medications compared to baseline. No vision-threatening intra- or post-procedure complications were noted.

Conclusion:

SLT with the Zeiss VISULAS green laser resulted in a clinically and statistically significant reduction in number of medications needed for IOP control. The procedure had a good safety profile similar to that described in the literature for SLT, with no vision-threatening complications.
Articulatory and phonological performance in people with mild cognitive impairment and Alzheimer's disease: A scoping review
Authors: Cera Maysa , Bertolucci Paulo Henrique Ferreira , Ramos Nathani Cristine do Carmo , de Castro Corrêa Camila , Vilela Carla dos Reis Piffer , Ortiz Karin Zazo
Published: December 2024

Background: Markers of phonological and articulatory processing, though at times difficult to identify, may be useful for the assessment of changes in the speech of people with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Objective: To review the evidence on phonological and articulatory speech processing in older adults with MCI and AD and identify the most sensitive speech assessment tasks for detecting impairments in these abilities. Methods: This scoping review of the PubMed, Scopus, Lilacs, Web of Science, Google Scholar, ProQuest, and Embase databases was updated in April 2024. Studies of older adults with MCI and AD that evaluated articulatory or phonological aspects of speech were included in the review. Two independent reviewers used EndNote and Rayyan software to evaluate search results in a two-phase process, consisting of (1) title and abstract screening, and (2) full-text review. Results: Of the 163 studies retrieved, 41 were selected in Phase 1. At the end of Phase 2, 29 studies were included in the review. All studies included individuals with AD and only one also included participants with MCI. Normal phonological and articulatory performance was observed in MCI. In AD, phonological or articulatory alterations were associated with the speech assessment method, sample size, and diagnosis of atypical dementia. Conclusions: Phonological and articulatory changes may occur in AD but may be difficult to identify. Single repetition or naming tasks may be more sensitive for detecting these impairments.
Open Reconstruction of Fibular Collateral Ligament Rupture Using a Partial-Thickness Biceps Femoris Tendon Autograft
Authors: Sabzevari Soheil , Levitt Sarah J. , Kahan Jory , Vasavada Kinjal , Fanelli Gregory , LaPrade Robert F. , Medvecky Michael J.
Published: December 2024

Background:

Fibular collateral ligament (FCL) injuries are uncommon incidents, with less favorable healing rates compared to medial collateral ligament injuries, often necessitating repair or reconstruction as the predominant treatment approach.

Indications:

Using a partial-thickness biceps femoris tendon (PTBFT) autograft for FCL reconstruction or augmentation is a viable option for both acute and chronic FCL injuries, especially in patients unwilling to accept allograft tissue and in settings with limited access to allografts.

Technique:

The fibular head attachments of the biceps femoris tendon (BFT), FCL, and popliteofibular ligament are inspected for injury. The biceps–iliotibial band (ITB) interval is opened, and the native FCL is assessed at its midsubstance for injury. The mid-aspect of the ITB was incised in line with its fibers, and the femoral insertion of FCL is localized. A 10-mm × 70-mm graft is harvested from the middle third of the BFT, preserving the distal insertion on the fibular head. Locking Krackow sutures are placed into the proximal end of the graft, which is passed under the ITB. A femoral tunnel is created at the FCL attachment site, and the graft is placed into the femoral tunnel and secured to the femur using an interference screw.

Results:

Postoperatively, the patient is instructed on foot-flat touch weightbearing with 2 crutches, on a knee immobilizer, for the first 2 weeks. Increasing weightbearing status and range of motion are expected in a stepwise manner. Return to sports is permitted after 6 to 9 months and depends on the presence of any additional injuries, strength, and functional recovery. There no studies available yet on clinical outcomes.

Discussion/Conclusion:

FCL reconstruction or augmentation utilizing a PTBFT autograft is an underused treatment option for patients with isolated FCL insufficiency or as part of multiligamentous injuries. This procedure offers advantages such as an anatomic reconstruction; single incision for both graft harvest and FCL reconstruction; shorter, cost-effective surgery with fewer implants used; and a safer approach with reduced risk of neurovascular structures due to lack of a fibular head tunnel. This is a valuable option in the limited source setting or in a patient not accepting of allografts.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
JAK2 p.R564 germ line variants associated with hereditary thrombocythemia and hematologic neoplasms
Authors: Stewart Brittany L , Carraway Hetty E , Alvarez Adriana L , Lesmana Harry , Molina John C , Tu Zheng Jin , Bosler David S , Gerds Aaron T. , Jha Babal K , Calvaresi Emilia , Nakitandwe Joy , Singh Abhay
Published: December 2024

The Janus kinase 2 (JAK2) V617F mutation activates the transcription pathway and has been well-characterized as a driver of myeloproliferative neoplasms (MPNs). Recently, there has been a heightened interest in understanding germline predisposition to hematological malignancies including MPN, including several reports of familial MPN. Here, we retrospectively analyzed medical records and data from genetic testing to describe twelve patients with germline variants at amino acid position 564 of JAK2. This includes three supportive cases adding to prior literature regarding the germline JAK2 R564Q association with hereditary thrombocythemia, as well as confirmation of JAK2 R564L as a germline variant associated with MPN. Importantly, the symptomatic burden for many of the individuals in this series is comparable to that of individuals with the canonical V617F mutation profile. In the JAK2 R564Q cases, we noted a pattern of familial aggregation, presence of congenital thrombocythemia and co-occurrence with hematological neoplasms. Identification of germline predisposition is essential to understanding the pathogenesis of disease, impact on families, and opportunities for preventive care. Continued research is essential to further characterize the penetrance of these conditions, and how best to monitor, treat and optimize management for these families.
Artificial intelligence in tuberculosis: a new ally in disease control
Authors: McClean Mairi , Panciu Traian Constantin , Lange Christoph , Duarte Raquel , Theis Fabian
Published: December 2024

The challenges to effective tuberculosis (TB) disease control are considerable, and the current global targets for reductions in disease burden seem unattainable. The combination of complex pathophysiology and technical limitations results in difficulties in achieving consistent, reliable diagnoses, and long treatment regimens imply serious physiological and socioeconomic consequences for patients. Artificial intelligence (AI) applications in healthcare have significantly improved patient care regarding diagnostics, treatment and basic research. However, their success relies on infrastructures prioritising comprehensive data generation and collaborative research environments to foster stakeholder engagement. This viewpoint article briefly outlines the current and potential applications of advanced AI models in global TB control and the considerations and implications of adopting these tools within the public health community.
High-flow nasal cannula is an expensive and clunky placebo: myth or maxim?
Authors: Jones Gareth A.L. , Ramnarayan Padmanabhan
Published: December 2024

High-flow nasal cannula (HFNC) is now a commonly used noninvasive method of providing respiratory support to children and young people. Its rapid spread into varied clinical applications has often left assessment of the evidence of its mechanism of action and clinical benefit lagging behind its uptake. This review will discuss the proposed mechanisms of action of HFNC, review the evidence base for its use, cover its applications in paediatrics and outline its limitations.
Renal venous flow in different regions of the kidney are different and reflecting different etiologies of venous reflux disorders in septic acute kidney injury: a prospective cohort study
Authors: Chen Rongping , Lian Hui , Zhao Hua , Wang Xiaoting ,   and Critical Care Ultrasound Study Group
Published: December 2024

Background

Acute kidney injury (AKI) is a frequent complication of sepsis. While impaired renal venous reflux indicates renal congestion, the relationship between AKI outcomes and hemodynamic parameters remains debated. This study aimed to investigate the utility of renal venous flow patterns in various regions of septic patients and to explore the association between hemodynamic parameters and renal function prognosis.

Methods

In this single-center, prospective longitudinal study, adult sepsis patients diagnosed with AKI were enrolled. Renal ultrasonography was performed within 24 h of ICU admission (D1), then repeated at D3 and D5. Patterns of proximal renal venous flow (PRVF) and intrarenal venous flow (IRVF) patterns were confirmed by two blinded sonographers. Kaplan–Meier survival analysis was used to evaluate renal prognosis, and cumulative incidence curves were generated for renal function recovery time.

Results

The study included 96 septic patients. Inconsistencies between PRVF and IRVF patterns occurred in 31.9%, with PRVF patterns being more severe in 88% of these. A relatively strong correlation was observed between PRVF and CVP, but this trend was less evident in IRVF. For RVSI of PRVF at ICU admission, the AUC to predict 28-day renal function prognosis was 0.626 (95% CI 0.502–0.750, P = 0.044), while combined PRVF and IRVF had a higher predictive ability (AUC 0.687, 95% CI 0.574–0.801, P = 0.003). The 28-day renal prognosis was poorer in the PRVF 5-day non-improvement group compared to the 3-day improvement group (P = 0.001) and 5-day improvement group (P = 0.012). Patients with a persistent monophasic PRVF pattern within 5 days had a worse prognosis than the non-monophasic group (P = 0.005).

Conclusions

Our study reveals that patterns of PRVF and IRVF are not entirely congruent, stepwise evaluation is useful in determining the intervention site for renal vein reflux disorders. Combined PRVF and IRVF had a higher predictive ability for 28-day renal function prognosis. Early improvement in renal venous congestion is crucial for better renal function prognosis.

This study is registered with ClinicalTrials.gov, number NTC06159010. Retrospectively registered 28 November 2023.
Role of stimulating combined visceral meridians by laser acupuncture on asthma exacerbation and quality of life of asthmatic patients
Authors: Al Sharkawy Asmaa A. A. , Hamdy Gehan , Gharib Ahmed , Elsheikh Mai S.
Published: December 2024

Background

Asthma patients with atopic tendencies often experience airway inflammation and structural changes. Common triggers for asthma exacerbations include exercise, specific foods, and respiratory viral infections. Acupuncture has been investigated as a possible treatment for asthma management, but the efficacy of specific acupuncture points remains uncertain.

Objective

This study aimed to evaluate the impact of stimulating specific acupuncture points along combined visceral meridians on asthma exacerbations triggered by various factors. It also assessed improvements in quality of life, focusing on symptoms, daily activities, environmental influences, and health-related quality of life (HRQoL) using the Mini Asthma Questionnaire.

Method

The study included 50 patients with chronic persistent asthma who were randomly assigned and categorized based on the Global Initiative for Asthma (GINA) guidelines for asthma control. Over 5 weeks, participants underwent 12 laser acupuncture (LA) sessions targeting acupuncture points on the lung, heart, conception vessel, spleen, and stomach meridians. A low-level laser (780 nm wavelength, 800 mW output) was used to deliver 9.6 J/cm2 per acupoint in continuous mode. Outcomes were assessed at baseline and 5 weeks post-treatment using the Mini Asthma Questionnaire, Asthma Control Test (ACT), and Forced Expiratory Volume in 1 s (FEV1).

Results

Following 5 weeks of laser acupuncture sessions, there was a significant improvement in exercise tolerance (p < 0.001) and a marked reduction in asthma exacerbations triggered by viral infections and food allergies (p < 0.001). The overall Mini Asthma Questionnaire scores were significantly increased from 37.08 ± 10.14 at baseline to 72.60 ± 9.97 post-treatment (p < 0.001). Spirometry findings demonstrated a significant improvement in FEV1 (p > 0.005).

Conclusion

Laser acupuncture targeting combined visceral meridians shows promise in enhancing exercise tolerance and reducing asthma exacerbations caused by viral infections and food allergies. This approach significantly improves the quality of life for school-aged children with asthma.
Presentation and Management of Highly Differentiated Follicular Carcinoma of Ovarian Origin With DICER1 Gene Variants
Authors: Seav Susan , Atiq Mazen , Lo Ying-Chun , Shah Jagruti , Dorigo Oliver , Dosiou Chrysoula
Published: December 2024

Struma ovarii (SO) is a rare subtype of ovarian teratoma composed of more than 50% thyroid tissue. Extraovarian spread of SO, called peritoneal strumosis, was previously considered benign given the lack of histological malignant features. However, the 2020 World Health Organization Classification of Female Genital Tumors reclassified peritoneal strumosis as highly differentiated follicular carcinoma of ovarian origin (HDFCO), highlighting its low-grade malignant potential. We present a 38-year-old woman with SO treated initially with right salpingo-oophorectomy, with recurrence 2 years later with multifocal metastatic lesions in the abdomen and pelvis that was successfully treated with surgical resection, total thyroidectomy, and 157 mCi of I-131. Tumor molecular testing revealed a pathogenic DICER1 variant (c.5428G>T, exon 25). A second variant (c.319delinsTGCTGGTTTGACA, exon 4) was of uncertain significance. Germline testing confirmed the second DICER1 variant and also identified an increased risk variant in the APC gene (c.3920T>A). This is a rare case of extensive HFDCO with DICER1 variants, which has been associated with thyroid cancer. Given the germline DICER1 variant, this may also represent the first reported instance of DICER1 syndrome manifesting as HDFCO. Further research into the prognostic factors and optimal treatment of HFDCO is needed.
Statin-Induced Necrotizing Autoimmune Myopathy: Diagnosis and Treatment Approach
Authors: Srinivasan Varshini , Prabu Samyuktha , Sfeir Jad G , Muthusamy Kalpana
Published: December 2024

The widespread use of statins for cardiovascular diseases has unveiled a new subset of inflammatory myopathy, immune-mediated necrotizing myopathy (IMNM). We describe below an unusual case of anti-3-hydroxy-3-methylglutaryl-coenzyme A reductase (anti-HMGCR) myopathy. A 64-year-old male individual with type 2 diabetes, hyperlipidemia, and coronary artery disease presented with progressive proximal muscle weakness and pain for 3 months. He took atorvastatin 40 mg for 4 years, which was discontinued due to elevated liver enzymes and resumed treatment with rosuvastatin 5 mg later due to worsening hyperlipidemia. Physical examination showed significant weakness of the hip, shoulder girdle, and biceps/triceps. Creatinine kinase (CK) was found to be 232.48 µkat/L (13 921 IU/L) (normal: 0.833-5.133 µkat/L; 50-308 IU/L). Electromyography and left vastus lateralis muscle biopsy showed findings of myonecrosis. Anti-HMGCR assay was strongly positive with antibodies > 200 chemiluminescent units (CU) (normal: 0-20 CU). He was started on prednisone followed by human-immunoglobulin (IVIG) which led to a decline in CK. Statin-induced necrotizing autoimmune myopathy (SINAM) is an exceptionally rare side effect of statins. Although statins come with a good side-effect profile, one should be aware of marked, persistent elevations in muscle enzyme levels. Prompt confirmation with antibody levels, drug discontinuation, and early initiation of immunosuppression can lead to good outcomes.
Satiety Hormone LEAP2 After Low-Calorie Diet With/Without Endobarrier Insertion in Obesity and Type 2 Diabetes Mellitus
Authors: Emini Mimoza , Bhargava Raghav , Aldhwayan Madhawi , Chhina Navpreet , Rodriguez Flores Marcela , Aldubaikhi Ghadah , Al Lababidi Moaz , Al-Najim Werd , Miras Alexander D , Ruban Aruchuna , Glaysher Michael A , Prechtl Christina G , Byrne James P , Teare Julian P , Goldstone Anthony P
Published: December 2024

Context

The liver/foregut satiety hormone liver-expressed antimicrobial peptide 2 (LEAP2) is an inverse agonist at the acyl ghrelin receptor (GHSR), increasing after food intake and decreasing after bariatric surgery and short-term nonsurgical weight loss, but effects of long-term dietary weight loss are unknown.

Objective

The objective of this study was to examine and compare the effects of these interventions on fasting and postprandial plasma LEAP2 and investigate potential metabolic mediators of changes in plasma LEAP2.

Methods

Plasma LEAP2 was measured in a previously published 2-year trial comparing standard medical management (SMM) (including 600-kcal/day deficit) with duodenal-jejunal bypass liner (DJBL, Endobarrier) insertion (explanted after 1 year) in adults with obesity and inadequately controlled type 2 diabetes mellitus.

Results

In the SMM group (n = 25-37), weight decreased by 4.3%, 8.1%, 7.8%, and 6.4% at 2, 26, 50, and 104 weeks and fasting plasma LEAP2 decreased from baseline mean ± SD 15.3 ± 0.9 ng/mL by 1.7, 3.8, 2.1, and 2.0 ng/mL, respectively. Absolute/decreases in fasting plasma LEAP2 positively correlated with absolute/decreases in body mass index, glycated hemoglobin A1c, fasting plasma glucose, serum insulin, homeostatic model assessment for insulin resistance, and serum triglycerides. Despite greater weight loss in the DJBL group (n = 23-30) at 26 to 50 weeks (10.4%-11.4%), the decrease in fasting plasma LEAP2 was delayed and attenuated (vs SMM), which may contribute to greater weight loss by attenuating GHSR signaling. Plasma LEAP2 did not increase with weight regain from 50 to 104 weeks after DJBL explant, suggesting a new set point with weight loss maintenance. Increases in plasma LEAP2 after a 600-kcal meal (10.8%-16.1% at 1-2 hours) were unaffected by weight loss, improved glucose metabolism, or DJBL insertion (n = 9-25), suggesting liver rather than duodenum/jejunum may be the primary source of postprandial LEAP2 secretion.

Conclusion

These findings add to our understanding of the regulation and potential physiological role of plasma LEAP2.
A Novel Homozygous BMP15 Mutation Causes Ovarian Dysgenesis and Primary Amenorrhea
Authors: Cohen Amitay , Rossetti Raffaella , Florsheim Natan , Samson Abraham O , Renbaum Paul , Carbone Erika , Persani Luca , Levy-Lahad Ephrat , Abu-Libdeh Abdulsalam , Zangen David
Published: December 2024

Context

Despite a growing number of studies, the genetic etiology in many cases of ovarian dysgenesis is incompletely understood.

Objectives

This work aimed to study the genetic etiology causing absence of spontaneous pubertal development, hypergonadotropic hypogonadism, and primary amenorrhea in 2 sisters.

Methods

Whole-exome sequencing was performed on DNA extracted from peripheral lymphocytes of 2 Palestinian sisters born to consanguineous parents. Following a BMP15 variant identification, confirming genetic segregation studies were performed in family members. Three-dimensional (3D) modeling for BMP15 dimer and BMP15-GDF-9 heterodimer were followed by functional studies in human ovarian COV434 granulosa cells cotransfected with plasmid harboring either the variant or a wild-type (WT) control, and a second plasmid harboring a luciferase-reporter-gene with a BMP-responsive element.

Results

A novel homozygous c.G959A/p.C320Y BMP15 mutation was identified in both sisters, and segregated with the disease in the family. By 3D-structure modeling, the mutations were predicted to damage a cysteine-knot motif, disrupt BMP15 dimerization, and severely impair activation of the BMP pathway. The homologous mutation C53Y occurring and identified spontaneously in sheep results in sterility in homozygotes, mimicking the human phenotype here. A 3.8-fold decrease in BMP15 signaling was observed in vitro in cells expressing the homozygous BMP15 mutant when compared to the WT control.

Conclusion

The novel homozygous missense C320Y mutation is the first homozygous human BMP15 variant causing impaired signaling ability, which correlates with the predicted 3D-structural changes leading to ovarian dysgenesis. The homologous mutation in sheep mimics the human phenotype by infertility. Beyond genetic counseling, and considering ovarian preservation, the ovine model enables further elucidation and interventions in the BMP signaling.