bluuebunny/crossref_metadata_2025 huggingface dataset:
Override rate of drug-drug interaction alerts in clinical decision support systems: A brief systematic review and meta-analysis
Authors: Felisberto Mariano , Lima Geovana dos Santos , Celuppi Ianka Cristina , Fantonelli Miliane dos Santos , Zanotto Wagner Luiz , Dias de Oliveira Júlia Meller , Mohr Eduarda Talita Bramorski , dos Santos Ranieri Alves , Scandolara Daniel Henrique , Cunha Célio Luiz , Hammes Jades Fernando , da Rosa Júlia Salvan , Demarchi Izabel Galhardo , Wazlawick Raul Sidnei , Dalmarco Eduardo Monguilhott
Published: June 2024

Primary studies have demonstrated that despite being useful, most of the drug-drug interaction (DDI) alerts generated by clinical decision support systems are overridden by prescribers. To provide more information about this issue, we conducted a systematic review and meta-analysis on the prevalence of DDI alerts generated by CDSS and alert overrides by physicians. The search strategy was implemented by applying the terms and MeSH headings and conducted in the MEDLINE/PubMed, EMBASE, Web of Science, Scopus, LILACS, and Google Scholar databases. Blinded reviewers screened 1873 records and 86 full studies, and 16 articles were included for analysis. The overall prevalence of alert generated by CDSS was 13% (CI95% 5–24%, p-value <0.0001, I^2 = 100%), and the overall prevalence of alert override by physicians was 90% (CI95% 85–95%, p-value <0.0001, I^2 = 100%). This systematic review and meta-analysis presents a high rate of alert overrides, even after CDSS adjustments that significantly reduced the number of alerts. After analyzing the articles included in this review, it was clear that the CDSS alerts physicians about potential DDI should be developed with a focus on the user experience, thus increasing their confidence and satisfaction, which may increase patient clinical safety.
Effectiveness of interventions to prevent abuse in people living with dementia in community settings: A systematic review
Authors: Peter A Seelia , Prabhu M Mukhyaprana , Tolson Debbie , Nayak Baby S , Bhandary Rajeshkrishna P , V Binil , Devi Elsa Sanatombi
Published: June 2024

The abuse of older adults is a societal, and legal issue. A person living with dementia is at high risk for abuse due to their physical and cognitive decline.

Objectives

This review examined the evidence for interventions to prevent the abuse of people living with dementia in the community.

Methods

The articles were retrieved from 2000 to 2023 from six databases, including MEDLINE via PubMed, CINAHL Plus via EBSCO, EMBASE, ProQuest Medical Library, Web of Science, and Scopus. The research articles that focused on finding the effectiveness of interventions for preventing abuse of people living with dementia in community settings were included in this review. The review included randomized controlled trials and pre-test post-test trials only. The quality appraisal of the eligible studies was done using ROB 2 and ROBINS II. The findings were tabulated and narratively synthesised.

Results

Out of 1831 articles, only three were included in this review. Only two RCTs were included in this efficacy review. Both the studies showed that the interventions were not effective in reducing abuse. The studies utilised family caregiver interventions like psychological interventions and online supportive education. The review identified psychological interventions with some evidence. Another study was a quasi-experimental study that used dialectical behaviour therapy as an intervention to reduce abuse occurrence. The study showed low evidence and focused only on reporting of elder abuse as an outcome.

Conclusion

This review found very few studies and was not able to draw a conclusion on the effectiveness of interventions for abuse in people living with dementia. Given the paucity of research, there is a clear need to identify how to overcome the challenges faced in elder abuse research and further refine the development of approaches to reduce elder abuse among people living with dementia in community settings.
Output fault-tolerant control of underwater vehicle based on adaptive sliding mode control under multiple constraints
Authors: Zhu Dewen , Zhu Zhiyu
Published: June 2024

In order to improve the stability of the underwater vehicle, the output fault-tolerant control method of the underwater vehicle based on adaptive sliding mode control is designed on the basis of setting multiple constraints. After the dynamic analysis of the underwater vehicle and its thruster, the output dimension constraint, input amplitude constraint, and state amplitude constraint were set. Based on these three constraints, the recursive cerebellar neural network is used to identify the time-varying and nonlinear unknown faults in the underwater vehicle online, and a deep convolution neural network is used to detect the known faults of the underwater vehicle. The error correction output code is then combined with a support vector machine to classify the detected faults. Finally, the output fault-tolerant control of an underwater vehicle is realized based on adaptive sliding mode control. The experiment shows that after the application of this method, because the recursive cerebellar neural network and the deep convolution neural network can estimate the size of the fault information in time, the sliding mode fault-tolerant controller can readjust the output of the controller according to the result of the fault identification to offset the effect of the fault on the robot, so that the robot can continue to maintain the original stable operation state. Even if the thruster has faults, this method can adjust the output of the thruster in time and reconstruct and recover the total control output, so that the actual output thrust is very close to the expected value, to achieve fault-tolerant control of the underwater vehicle output.
Friendship is Rare: The Influence of Off-Bench Friendships on Support for the U.S. Supreme Court
Authors: Armaly Miles T. , Schoenherr Jessica A.
Published: June 2024

“Cross-aisle” interpersonal relationships on the Supreme Court receive significant attention from the justices and the media that covers them. When speaking to the public, justices frequently deflect questions about legal differences with each other by pointing to their ability to get along off the bench, suggesting everyone is just doing their job and there are no hard feelings when opinions go the other way. We theorize these tales of off-bench collegiality create a non-judicial avenue for public evaluation of the Court and its justices. But we also suspect that case outcomes limit these stories’ influence. To test this theory, we conducted a survey experiment that exposed individuals to several stories about judicial friendships. We find that discussing friendships influences attitudes toward the Court most when such stories include a clear cue about the friendly justices’ opposing ideologies. When accounting for ex ante policy preferences, however, that influence is entirely attenuated. Our results indicate these stories impact evaluations of the Court, but outcome-based evaluations prove more critical, suggesting the menu of options for the Court to bolster public support is limited in the context of case outcomes.
First multicenter study evaluating the utility of the BENCHMARKTM BMXTM 81 large-bore access catheter in neurovascular interventions
Authors: Abdelsalam Ahmed , Fountain Hayes B , Ramsay Ian A , Luther Evan M , Sowlat Mohammad Mahdi , Silva Michael A , Hassan Ameer E , Patel Aman B , Eatz Tiffany , Joseph Pradeep , Regenhardt Robert W , Satti Sudhakar R , Siddiqui Adnan H , Sanikommu Sai , Baig Ammad A , Khandelwal Priyank , Spiotta Alejandro M , Starke Robert M
Published: June 2024

Introduction

This study is the first multicentric report on the safety, efficacy, and technical performance of utilizing a large bore (0.081″ inner diameter) access catheter in neurovascular interventions.

Methods

Data were retrospectively collected from seven sites in the United States for neurovascular procedures via large bore 0.081″ inner diameter access catheter (Benchmark BMX81, Penumbra, Inc.). The primary outcome was technical success, defined as the access catheter reaching its target vessel. Safety outcomes included periprocedural device-related and access site complications.

Results

There were 90 consecutive patients included. The median age of the patients was 63 years (IQR: 53, 68); 53% were female. The most common interventions were aneurysm embolization (33.3%), carotid stenting (12.2%), and arteriovenous malformation embolization (11.1%). The transradial approach was most used (56.7%), followed by transfemoral (41.1%). Challenging anatomic variations included severe vessel tortuosity (8/90, 8.9%), type 2 aortic arch (7/90, 7.8%), type 3 aortic arch (2/90, 2.2%), bovine arch (2/90, 2.2%), and severe angle (<30°) between the subclavian artery and target vessel (1/90, 1.1%). Technical success was achieved in 98.9% of the cases (89/90), with six cases requiring a switch from radial to femoral (6.7%) and one case from femoral to radial (1.1%). There were no access site complications or complications related to the 0.081″ catheter. Two postprocedural complications occurred (2.2%), unrelated to the access catheter.

Conclusion

The BMX™ 81 large-bore access catheters was safe and effective in both radial and femoral access across a wide range of neurovascular procedures, achieving high technical success without any access site or device-related complications.
Enhanced diaphragm excursion and exercise tolerance in COPD patients through inspiratory muscle training after standardised pulmonary rehabilitation: randomised controlled trial
Authors: Shiraishi Masashi , Higashimoto Yuji , Sugiya Ryuji , Mizusawa Hiroki , Takeda Yu , Noguchi Masaya , Nishiyama Osamu , Yamazaki Ryo , Kudo Shintarou , Kimura Tamotsu , Matsumoto Hisako
Published: June 2024

Objective

Inspiratory muscle training (IMT) is used to improve inspiratory muscle strength in patients with COPD. However, the effect of IMT on diaphragmatic function has not yet been thoroughly evaluated. This study aimed to evaluate the effect of IMT on maximum diaphragmatic excursion (DEmax) using ultrasonography in patients with COPD.

Methods

This was a single-centre, randomised, prospective, parallel-group, unblinded controlled trial involving 38 participants with stable COPD. Participants underwent a standardised 12-week pulmonary rehabilitation (PR) programme followed by a 12-week IMT programme, consisting of home-based IMT and low-frequency outpatient PR sessions supervised by physiotherapists (once every 2 weeks),versuslow-frequency outpatient PR alone as a control. The DEmaxand exercise tolerance were measured.

Results

Out of the 38 patients initially enrolled in the PR programme, 33 successfully completed it and were subsequently randomised to the IMT programme. Finally, 15 (94%) and 14 (88%) patients from the IMT and control groups, respectively, completed the study. Following the IMT programme, DEmaxincreased in the IMT group (mean±sd50.1±7.6 mm to 60.6±8.0 mm, p<0.001), but not in the control group (47.4±7.9 mm to 46.9±8.3 mm, p=0.10). Changes in DEmaxand exercise tolerance (peak oxygen uptake) were greater in the IMT group than in the control group (both p<0.01).

Conclusions

IMT following the PR programme improved DEmaxand exercise tolerance. Therefore, DEmaxmay be an important outcome of IMT.
Efficacy of tezepelumab in patients with severe asthma and persistent airflow obstruction
Authors: Israel Elliot , Castro Mario , Ambrose Christopher S. , Llanos Jean-Pierre , Molfino Nestor A. , Martin Nicole L. , Ponnarambil Sandhia S. , Martin Neil
Published: June 2024

Background

Persistent airflow obstruction (PAO) in patients with asthma can be difficult to treat. Tezepelumab blocks thymic stromal lymphopoietin, an epithelial cytokine implicated in asthma pathogenesis. This analysis evaluated the efficacy of tezepelumab in patients with severe, uncontrolled asthma and PAO.

Methods

PATHWAY (phase 2b) and NAVIGATOR (phase 3) were multicentre, randomised, double-blind, placebo-controlled studies. Thispost hocanalysis included PATHWAY and NAVIGATOR patients who received tezepelumab 210 mg or placebo every 4 weeks for 52 weeks. Change from baseline to week 52 in pre-bronchodilator forced expiratory volume in 1 s (FEV1) and the annualised asthma exacerbation rate (AAER) over 52 weeks were assessed in patients with and without PAO (post-bronchodilator FEV1/forced vital capacity ratio <0.7) at baseline.

Results

Of the 1334 included patients, 782 (58.6%) had PAO at baseline. At week 52, greater improvements in pre-bronchodilator FEV1from baseline were observed in tezepelumabversusplacebo recipients with PAO (least-squares (LS) mean 0.24versus0.07 L; difference 0.17 L, 95% confidence interval (CI): 0.11–0.23) and without PAO (LS mean 0.20versus0.12 L; difference 0.08 L, 95% CI: 0.01–0.15). Tezepelumab reduced the AAERversusplacebo by 61% (95% CI: 51–69) and 56% (95% CI: 42–67) in patients with and without PAO, respectively. For patients with PAO at baseline, the proportion without PAO at week 52 was higher with tezepelumab (12.1%) than placebo (6.6%) (odds ratio 1.96, 95% CI: 1.30–2.94).

Conclusion

Tezepelumab improved lung function and reduced exacerbationsversusplacebo in patients with severe, uncontrolled asthma with and without PAO.
Biological characteristics and metabolic phenotypes of different anastomosis groups of Rhizoctonia solani strains
Authors: Sun Meili , Wang Hancheng , Ye Guo , Zhang Songbai , Li Zhen , Cai Liuti , Wang Feng
Published: June 2024

Background

Rhizoctonia solani is an important plant pathogen worldwide, and causes serious tobacco target spot in tobacco in the last five years. This research studied the biological characteristics of four different anastomosis groups strains (AG-3, AG-5, AG-6, AG-1-IB) of R. solani from tobacco. Using metabolic phenotype technology analyzed the metabolic phenotype differences of these strains.

Results

The results showed that the suitable temperature for mycelial growth of four anastomosis group strains were from 20 to 30oC, and for sclerotia formation were from 20 to 25oC. Under different lighting conditions, R. solani AG-6 strains produced the most sclerotium, followed by R. solani AG-3, R. solani AG-5 and R. solani AG-1-IB. All strains had strong oligotrophic survivability, and can grow on water agar medium without any nitrutions. They exhibited three types of sclerotia distribution form, including dispersed type (R. solani AG-5 and AG-6), peripheral type (R. solani AG-1-IB), and central type (R. solani AG-3). They all presented different pathogenicities in tobacco leaves, with the most virulent was noted by R. solani AG-6, followed by R. solani AG-5 and AG-1-IB, finally was R. solani AG-3. R. solani AG-1-IB strains firstly present symptom after inoculation. Metabolic fingerprints of four anastomosis groups were different to each other. R. solani AG-3, AG-6, AG-5 and AG-1-IB strains efficiently metabolized 88, 94, 71 and 92 carbon substrates, respectively. Nitrogen substrates of amino acids and peptides were the significant utilization patterns for R. solani AG-3. R. solani AG-3 and AG-6 showed a large range of adaptabilities and were still able to metabolize substrates in the presence of the osmolytes, including up to 8% sodium lactate. Four anastomosis groups all showed active metabolism in environments with pH values from 4 to 6 and exhibited decarboxylase activities.

Conclusions

The biological characteristics of different anastomosis group strains varies, and there were significant differences in the metabolic phenotype characteristics of different anastomosis group strains towards carbon source, nitrogen source, pH, and osmotic pressure.
Developing survey weights to ensure representativeness in a national, matched cohort study: results from the children and young people with Long Covid (CLoCk) study
Authors: Rojas Natalia K , De Stavola Bianca L , Norris Tom , Cortina-Borja Mario , Nugawela Manjula D , Hargreaves Dougal , Dalrymple Emma , McOwat Kelsey , Simmons Ruth , Stephenson Terence , Shafran Roz ,   CLoCk Consortium, Pereira Snehal M Pinto
Published: June 2024

Background

Findings from studies assessing Long Covid in children and young people (CYP) need to be assessed in light of their methodological limitations. For example, if non-response and/or attrition over time systematically differ by sub-groups of CYP, findings could be biased and any generalisation limited. The present study aimed to (i) construct survey weights for the Children and young people with Long Covid (CLoCk) study, and (ii) apply them to published CLoCk findings showing the prevalence of shortness of breath and tiredness increased over time from baseline to 12-months post-baseline in both SARS-CoV-2 Positive and Negative CYP.

Methods

Logistic regression models were fitted to compute the probability of (i) Responding given envisioned to take part, (ii) Responding timely given responded, and (iii) (Re)infection given timely response. Response, timely response and (re)infection weights were generated as the reciprocal of the corresponding probability, with an overall ‘envisioned population’ survey weight derived as the product of these weights. Survey weights were trimmed, and an interactive tool developed to re-calibrate target population survey weights to the general population using data from the 2021 UK Census.

Results

Flexible survey weights for the CLoCk study were successfully developed. In the illustrative example, re-weighted results (when accounting for selection in response, attrition, and (re)infection) were consistent with published findings.

Conclusions

Flexible survey weights to address potential bias and selection issues were created for and used in the CLoCk study. Previously reported prospective findings from CLoCk are generalisable to the wider population of CYP in England. This study highlights the importance of considering selection into a sample and attrition over time when considering generalisability of findings.
Comparative safety assessment of nasogastric versus nasojejunal feeding initiated within 48 hours post-admission versus unrestricted timing in moderate or severe acute pancreatitis: a systematic review and meta-analysis
Authors: Wang Ming , Shi Haiyan , Chen Qianqian , Su Binbin , Dong Xiaoyu , Shi Hui , Xu Shiping
Published: June 2024

Background

The primary objective of this study is to comparatively assess the safety of nasogastric (NG) feeding versus nasojejunal (NJ) feeding in patients with acute pancreatitis (AP), with a special focus on the initiation of these feeding methods within the first 48 h of hospital admission.

Methods

Studies were identified through a systematic search in PubMed, EMbase, Cochrane Central Register of Controlled Trials, and Web of Science. Four studies involving 217 patients were included. This systematic review assesses the safety and efficacy of nasogastric versus nasojejunal feeding initiated within 48 h post-admission in moderate/severe acute pancreatitis, with a specific focus on the timing of initiation and patient age as influential factors.

Results

The results showed that the mortality rates were similar between NG and NJ feeding groups (RR 0.86, 95% CI 0.42 to 1.77, P = 0.68). Significant differences were observed in the incidence of diarrhea (RR 2.75, 95% CI 1.21 to 6.25, P = 0.02) and pain (RR 2.91, 95% CI 1.50 to 5.64, P = 0.002) in the NG group. The NG group also showed a higher probability of infection (6.67% vs. 3.33%, P = 0.027) and a higher frequency of multiple organ failures. Subgroup analysis for early intervention (within 48 h) showed a higher risk of diarrhea in the NG group (RR 2.80, P = 0.02). No significant differences were found in the need for surgical intervention, parenteral nutrition, or success rates of feeding procedures.

Conclusion

This meta-analysis highlights the importance of considering the method and timing of nutritional support in acute pancreatitis. While NG feeding within 48 h of admission increases the risk of certain complications such as diarrhea and infection, it does not significantly impact mortality or the need for surgical intervention.
A designathon to co-create HPV screening and vaccination approaches for mothers and daughters in Nigeria: findings from a community-led participatory event
Authors: Kpokiri Eneyi E , Wapmuk Agatha E , Obiezu-Umeh Chisom , Nwaozuru Ucheoma , Gbaja-Biamila Titilola , Obionu Ifeoma , Kokelu Ekenechukwu , Smith Jennifer , Azuogu Benedict N , Ajenifuja Kayode , Babatunde Abdulhammed O , Ezechi Oliver , Tucker Joseph D , Iwelunmor Juliet
Published: June 2024

Background

Oncogenic types of human Papillomavirus (HPV) infection cause substantial morbidity and mortality in Nigeria. Nigeria has low cervical cancer screening and vaccination rates, suggesting the need for community engagement to enhance reach and uptake. We organised a designathon to identify community-led, innovative approaches to promote HPV screening and vaccination for women and girls, respectively, in Nigeria. A designathon is a three-phase participatory process informed by design thinking that includes the preparation phase that includes soliciting innovative ideas from end-users, an intensive collaborative event to co-create intervention components, and follow-up activities.

Methods

We organised a three-phase designathon for women (30-65yrs) and girls (11-26yrs) in Nigeria. First, we launched a national crowdsourcing open call for ideas on community-driven strategies to support HPV screening among women and vaccination among girls. The open call was promoted widely on social media and at in-person gatherings. All eligible entries were graded by judges and 16 exceptional teams (with 4-6members each). All six geo-political zones of Nigeria were invited to join an in-person event held over three days in Lagos to refine their ideas and present them to a panel of expert judges. The ideas from teams were reviewed and scored based on relevance, feasibility, innovation, potential impact, and mother-daughter team dynamics. We present quantitative data on people who submitted and themes from the textual submissions.

Results

We received a total of 612 submissions to the open call from mother-daughter dyads. Participants submitted ideas via a website designated for the contest (n = 392), in-person (n = 99), email (n = 31), or via an instant messaging application (n = 92). Overall, 470 were eligible for judging after initial screening. The average age of participants for daughters was 19 years and 39 years for mothers. Themes from the top 16 proposals included leveraging local leaders (5/16), faith-based networks (4/16), educational systems (4/16), and other community networks (7/16) to promote awareness of cervical cancer prevention services. After an in-person collaborative event, eight teams were selected to join an innovation training boot camp, for capacity building to implement ideas.

Conclusions

Innovative strategies are needed to promote HPV screening for mothers and vaccination for girls in Nigeria. Our designathon was able to facilitate Nigerian mother-daughter teams to develop cervical cancer prevention strategies. Implementation research is needed to assess the effectiveness of these strategies.
Spatiotemporal epidemiology of substance-related accidental acute toxicity deaths in Canada from 2016 to 2017
Authors: Howard-Azzeh Mohammad , Wasfi Rania , Kakkar Tanya , Flynn Mallory , Rotondo Jenny , Schleihauf Emily , Bowes Matthew , Rees Erin E.
Published: June 2024

Objectives

In Canada, substance-related accidental acute toxicity deaths (AATDs) continue to rise at the national and sub-national levels. However, it is unknown if, where, when, and to what degree AATDs cluster in space, time, and space–time across the country. The objectives of this study were to 1) assess for clusters of AATDs that occurred in Canada during 2016 and 2017 at the national and provincial/territorial (P/T) levels, and 2) examine the substance types detected in AATD cases within each cluster.

Methods

Two years of person-level data on AATDs were abstracted from coroner and medical examiner files using a standardized data collection tool, including the decedent's postal code and municipality information on the places of residence, acute toxicity (AT) event, and death, and the substances detected in the death. Data were combined with Canadian census information to create choropleth maps depicting AATD rates by census division. Spatial scan statistics were used to build Poisson models to identify clusters of high rates (p < 0.05) of AATDs at the national and P/T levels in space, time, and space–time over the study period. AATD cases within clusters were further examined for substance types most present in each cluster.

Results

Eight clusters in five regions of Canada at the national level and 24 clusters in 15 regions at the P/T level were identified, highlighting where AATDs occurred at far higher rates than the rest of the country. The risk ratios of identified clusters ranged from 1.28 to 9.62. Substances detected in clusters varied by region and time, however, opioids, stimulants, and alcohol were typically the most commonly detected substances within clusters.

Conclusion

Our findings are the first in Canada to reveal the geographic disparities in AATDs at national and P/T levels using spatial scan statistics. Rates associated with substance types within each cluster highlight which substance types were most detected in the identified regions. Findings may be used to guide intervention/program planning and provide a picture of the 2016 and 2017 context that can be used for comparisons of the geographic distribution of AATDs and substances with different time periods.
Unpacking the impact of COVID-19 on child immunization: evidence from Ghana
Authors: Durizzo Kathrin , Awoonor-Williams Koku , Harttgen Kenneth , Günther Isabel
Published: June 2024

Background

With the onset of the COVID-19 pandemic, governments implemented social distancing regulations to limit the spread of the disease. Some health experts warned that these measures could negatively affect access to essential health services, such as routine childhood immunizations. Others noted that without these regulations, COVID-19 cases would increase, leading to overburdened health systems.

Methods

We analyze four years (2018–2021) of monthly administrative data on childhood immunizations in all administrative districts in Ghana and exploit variations in social distancing regulations across districts. Given variations in social distancing regulations across Ghanaian districts, we can further differentiate between the effect of public lockdowns and the effect of the pandemic.

Results

We find that child immunizations in Ghana declined by 6% during the public lockdown in April 2020, but the country compensated with higher vaccination rates starting in June, and immunization services recovered to pre-pandemic growth levels by 2021. Time-critical vaccines, such as polio, were not affected at all. We do find a substantially larger disruption in April 2020 (14%) and a slower recovery in 2020 in the 40 lockdown-affected districts. Interestingly, vaccination rates already decreased in February and March by about 5% before the public lockdown and before the pandemic had reached Ghana, but with the pandemic already spreading globally and in the news.

Conclusion

Our results indicate that the negative effect on child immunization was less severe and shorter than predicted by experts. Fear of COVID-19 and delayed vaccination campaigns had a substantial impact on childhood immunization while rising COVID-19 cases and moderate social distancing regulations did not seem to affect immunization rates.
Surgical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with ankylosing spondylitis
Authors: Ye Zhi-Yuan , Bai Jin-Yu , Ye Zhi-Min , Zhao Xu-Shen , Song Fang-Long , Zhou Zhen-Tao , Shan Bing-Chen , Zhou Xiao-Zhong
Published: June 2024

Background

Spinal fractures in patients with ankylosing spondylitis (AS) mainly present as instability, involving all three columns of the spine, and surgical intervention is often considered necessary. However, in AS patients, the significant alterations in bony structure and anatomy result in a lack of identifiable landmarks, which increases the difficulty of pedicle screw implantation. Therefore, we present the clinical outcomes of robotic-assisted percutaneous fixation for thoracolumbar fractures in patients with AS.

Methods

A retrospective review was conducted on a series of 12 patients diagnosed with AS. All patients sustained thoracolumbar fractures between October 2018 and October 2022 and underwent posterior robotic-assisted percutaneous fixation procedures. Outcomes of interest included operative time, intra-operative blood loss, complications, duration of hospital stay and fracture union. The clinical outcomes were assessed using the visual analogue scale (VAS) and Oswestry Disability Index (ODI). To investigate the achieved operative correction, pre- and postoperative radiographs in the lateral plane were analyzed by measuring the Cobb angle.

Results

The 12 patients had a mean age of 62.8 ± 13.0 years and a mean follow-up duration of 32.7 ± 18.9 months. Mean hospital stay duration was 15 ± 8.0 days. The mean operative time was 119.6 ± 32.2 min, and the median blood loss was 50 (50, 250) ml. The VAS value improved from 6.8 ± 0.9 preoperatively to 1.3 ± 1.0 at the final follow-up (P < 0.05). The ODI value improved from 83.6 ± 6.1% preoperatively to 11.8 ± 6.6% at the latest follow-up (P < 0.05). The average Cobb angle changed from 15.2 ± 11.0 pre-operatively to 8.3 ± 7.1 at final follow-up (P < 0.05). Bone healing was consistently achieved, with an average healing time of 6 (5.3, 7.0) months. Of the 108 screws implanted, 2 (1.9%) were improperly positioned. One patient experienced delayed nerve injury after the operation, but the nerve function returned to normal upon discharge.

Conclusion

Posterior robotic-assisted percutaneous internal fixation can be used as an ideal surgical treatment for thoracolumbar fractures in AS patients. However, while robot-assisted pedicle screw placement can enhance the accuracy of pedicle screw insertion, it should not be relied upon solely.
Evaluation of the re-bond strength of debonded metal and ceramic brackets following Er: YAG laser treatment
Authors: Zheng Xiaowan , Huang Xiaofeng
Published: June 2024

Background

Failure of orthodontic bracket bonds is a common occurrence during orthodontic treatment. This study investigated the impact of Er: YAG laser-based removal of adhesive from the bases of metal and ceramic brackets for re-bonding.

Methods

A total of 168 extracted premolars were collected from patients. 84 metal brackets were used to be bonded on the buccal surface of the premolars in Groups 1, 2, 3 and 4, while 84 ceramic brackets were applied in Groups I, II, III and IV. Group 1/I represented the initial bonding group, with Group 2/II being the re-bonding group with new brackets, while Groups 3/III and 4/ IV received recycled brackets treated by Er: YAG laser or flaming respectively. Both the first and second de-bonding were performed in all samples using a universal testing machine to determine the shear bond strength (SBS). The adhesive remnant index (ARI) was evaluated using a stereo-microscope. The new and the treated bracket bases were evaluated using scanning electron microscopy (SEM). Differences in initial bonding and re-bonding ability were analyzed through one-way ANOVAs, and differences in ARI were assessed with the Kruskal–Wallis test.

Results

Greater amounts of adhesive residue were observed on ceramic brackets treated by laser. The SBS values for recycled metal brackets in Group 3 (26.13 MPa) were comparable to Group 1 (23.62 MPa) whereas they differed significantly from Group 4 (12.54 MPa). No significant differences in these values were observed when comparing the 4 groups with ceramic brackets. ARI score in Group 4 (2–3 points) differed significantly from the three other groups (P < 0.05). For Group I, II, III and IV, similar ARI scores were observed (P > 0.05). SEM analysis didn’t show apparent damage of bracket bases consisting of either metal or ceramic material treated by Er: YAG laser.

Conclusions

Er: YAG laser treatment was superior to flame treatment as a means of removing adhesive without damaging the brackets. SBS values and ARI scores following Er: YAG laser treatment were similar to those for new brackets, offering further support for Er: YAG laser treatment as a viable means of recycling debonded brackets.
Effect of acupuncture on tic disorder: a randomized controlled clinical trial based on energy metabolomics and infrared thermography
Authors: Fan Yi-ming , Li Ying-xin , Zhang Yi , Chen Dong , Yuan Meng-qian , Li Yan-cai , Teo Elsie Sin May , Xu Ming-hui , Zhou Yang-yang , Yang Pan-feng , Zhao Cheng-mei , Zheng Jing-jing , Li Jian-bing , Bao Chao
Published: June 2024

Background

Acupuncture is a method for treating tic disorder. However, there is a lack of sufficient clinical objective basis in regards of its treatment efficacy. Indeed, there are structural abnormalities present in energy metabolism and infrared thermography in children with tic disorder. Therefore, this study proposes a clinical trial scheme to explore the possible mechanism of acupuncture in treating tic disorder.

Methods

This randomized controlled trial will recruit a total of 90 children, in which they will be divided into non-intervention group and intervention group. The non-intervention group consists of 30 healthy children while the intervention group consists of 60 children with tic disorder. The intervention group will be randomly allocated into either the treatment group or the control group, with 30 children randomly assigned in each group. Children either received acupuncture treatment and behavioral therapy (treatment group) or sham acupuncture treatment and behavioral therapy (control group), 3 treatment sessions per week for a period of 12 weeks, with a total of 36 treatment sessions. Outcome measures include YGTSS, urinary and fecal metabolomics, infrared thermography of body surface including governor vessel. For the intervention group, these outcome measures will be collected at the baseline and 90th day prior to intervention. Whereas for the non-intervention group, outcome measures (excluding YGTSS) will be collected at the baseline.

Discussion

The main outcome will be to observe the changes of the severity of tic condition, the secondary outcome will be to observe the changes of structural characteristic of infrared thermography of body surface/acupoints along the governor vessel and to evaluate the changes of urinary and fecal metabolomics at the end of the treatment, so as to analyze the relationship between them and to provide further knowledge in understanding the possible mechanism of acupuncture in improving the clinical symptoms via regulating and restoring the body metabolomics network, which in future it can develop as a set of clinical guideline (diagnosis, treatment, assessment, prognosis) in treating tic disorder. ChiCTR2300075188(Chinese Clinical Trial Registry, http://www.chictr.org.cn, registered on 29 August 2023).
“Out of the frying pan and into the fire” – the UKFPO’s recent changes are a short-sighted response to a complicated problem
Authors: Skan Oliver , Saini Kiran , Armstrong Edward
Published: June 2024

In June 2023, the UK Foundation Programme Office announced that the previous method of ranking students based on their educational performance measure and situational judgement test performance would be superseded by a preferencing algorithm that disregards academic merit. We outline our strong objections to this policy.
Healthcare utilisation in people with long COVID: an OpenSAFELY cohort study
Authors: Lin Liang-Yu , Henderson Alasdair D. , Carlile Oliver , Dillingham Iain , Butler-Cole Ben F. C. , Marks Michael , Briggs Andrew , Jit Mark , Tomlinson Laurie A. , Bates Chris , Parry John , Bacon Sebastian C. J. , Goldacre Ben , Mehrkar Amir , MacKenna Brian ,   The OpenSAFELY Collaborative, Eggo Rosalind M. , Herrett Emily
Published: June 2024

Background

Long COVID potentially increases healthcare utilisation and costs. However, its impact on the NHS remains to be determined.

Methods

This study aims to assess the healthcare utilisation of individuals with long COVID. With the approval of NHS England, we conducted a matched cohort study using primary and secondary care data via OpenSAFELY, a platform for analysing anonymous electronic health records. The long COVID exposure group, defined by diagnostic codes, was matched with five comparators without long COVID between Nov 2020 and Jan 2023. We compared their total healthcare utilisation from GP consultations, prescriptions, hospital admissions, A&E visits, and outpatient appointments. Healthcare utilisation and costs were evaluated using a two-part model adjusting for covariates. Using a difference-in-difference model, we also compared healthcare utilisation after long COVID with pre-pandemic records.

Results

We identified 52,988 individuals with a long COVID diagnosis, matched to 264,867 comparators without a diagnosis. In the 12 months post-diagnosis, there was strong evidence that those with long COVID were more likely to use healthcare resources (OR: 8.29, 95% CI: 7.74–8.87), and have 49% more healthcare utilisation (RR: 1.49, 95% CI: 1.48–1.51). Our model estimated that the long COVID group had 30 healthcare visits per year (predicted mean: 29.23, 95% CI: 28.58–29.92), compared to 16 in the comparator group (predicted mean visits: 16.04, 95% CI: 15.73–16.36). Individuals with long COVID were more likely to have non-zero healthcare expenditures (OR = 7.66, 95% CI = 7.20–8.15), with costs being 44% higher than the comparator group (cost ratio = 1.44, 95% CI: 1.39–1.50). The long COVID group costs approximately £2500 per person per year (predicted mean cost: £2562.50, 95% CI: £2335.60–£2819.22), and the comparator group costs £1500 (predicted mean cost: £1527.43, 95% CI: £1404.33–1664.45). Historically, individuals with long COVID utilised healthcare resources more frequently, but their average healthcare utilisation increased more after being diagnosed with long COVID, compared to the comparator group.

Conclusions

Long COVID increases healthcare utilisation and costs. Public health policies should allocate more resources towards preventing, treating, and supporting individuals with long COVID.
Late gestation fetal hypothyroidism alters cell cycle regulation across multiple organ systems
Authors: Smith Alyssa A. , Vesey Alexa , Helfrich Caden , Pasternak J. Alex
Published: June 2024

Background

Hypothyroidism is a common endocrine disruption observed in utero that adversely affects fetal growth and maturation leading to long-term impacts on health; however, the exact molecular mechanisms by which these deleterious effects occur are unknown. We hypothesize that fetal hypothyroidism during late gestation will disrupt cell cycle regulation in a tissue-specific manner. To evaluate this, eight pregnant gilts were dosed with either methimazole or an equivalent negative control during days 85–106 out of 114 days of gestation (n = 4/group). Following treatment, the gilts were humanely euthanized, and tissue samples of fetal heart, ileum, kidney, lung, liver, muscle, spleen, and thymus taken from two male and two female fetuses (n = 32) from each gilt.

Results

The relative expression of three cell cycle promoters (CDK1, CDK2, and CDK4), and one cell cycle inhibitor (CDKN1A) was compared in each tissue to determine the effect of hypothyroidism on the developing fetus. All of the eight tissues examined experienced at least one significant up- or downregulation in the expression of the aforementioned genes as a result of treatment with methimazole. Substantial changes were observed in the liver and muscle, with the latter experiencing significant downregulations of CDK1, CDK2, and CDK4 as a result of treatment. In addition, all tissues were examined for changes in protein content, which further elucidated the impact of hypothyroidism on the fetal liver by the observation of a marked increase in protein content in the methimazole-treated group. Finally, the heart and liver were histologically examined for evidence of cellular hyperplasia and hypertrophy by measuring average nuclei density and size in each tissue, with the results showing a significant decrease in average nuclei size in the liver of hypothyroid fetuses.

Conclusions

Collectively, these findings indicate the occurrence of organ-specific disruptions in cell cycle progression as a result of in utero hypothyroidism, which may explain the long term and widespread effects of hypothyroidism on fetal development.
Combined SERS-Raman screening of HER2-overexpressing or silenced breast cancer cell lines
Authors: Spaziani Sara , Esposito Alessandro , Barisciano Giovannina , Quero Giuseppe , Elumalai Satheeshkumar , Leo Manuela , Colantuoni Vittorio , Mangini Maria , Pisco Marco , Sabatino Lina , De Luca Anna Chiara , Cusano Andrea
Published: June 2024

Background

Breast cancer (BC) is a heterogeneous neoplasm characterized by several subtypes. One of the most aggressive with high metastasis rates presents overexpression of the human epidermal growth factor receptor 2 (HER2). A quantitative evaluation of HER2 levels is essential for a correct diagnosis, selection of the most appropriate therapeutic strategy and monitoring the response to therapy.

Results

In this paper, we propose the synergistic use of SERS and Raman technologies for the identification of HER2 expressing cells and its accurate assessment. To this end, we selected SKBR3 and MDA-MB-468 breast cancer cell lines, which have the highest and lowest HER2 expression, respectively, and MCF10A, a non-tumorigenic cell line from normal breast epithelium for comparison. The combined approach provides a quantitative estimate of HER2 expression and visualization of its distribution on the membrane at single cell level, clearly identifying cancer cells. Moreover, it provides a more comprehensive picture of the investigated cells disclosing a metabolic signature represented by an elevated content of proteins and aromatic amino acids. We further support these data by silencing the HER2 gene in SKBR3 cells, using the RNA interference technology, generating stable clones further analysed with the same combined methodology. Significant changes in HER2 expression are detected at single cell level before and after HER2 silencing and the HER2 status correlates with variations of fatty acids and downstream signalling molecule contents in the context of the general metabolic rewiring occurring in cancer cells. Specifically, HER2 silencing does reduce the growth ability but not the lipid metabolism that, instead, increases, suggesting that higher fatty acids biosynthesis and metabolism can occur independently of the proliferating potential tied to HER2 overexpression.

Conclusions

Our results clearly demonstrate the efficacy of the combined SERS and Raman approach to definitely pose a correct diagnosis, further supported by the data obtained by the HER2 gene silencing. Furthermore, they pave the way to a new approach to monitor the efficacy of pharmacologic treatments with the aim to tailor personalized therapies and optimize patients’ outcome.
Repair spinal cord injury with a versatile anti-oxidant and neural regenerative nanoplatform
Authors: Zhou Heng , Li Ziwei , Jing Shuili , Wang Ben , Ye Zhifei , Xiong Wei , Liu Yonghao , Liu Ye , Xu Chun , Kumeria Tushar , He Yan , Ye Qingsong
Published: June 2024

Spinal cord injury (SCI) often results in motor and sensory deficits, or even paralysis. Due to the role of the cascade reaction, the effect of excessive reactive oxygen species (ROS) in the early and middle stages of SCI severely damage neurons, and most antioxidants cannot consistently eliminate ROS at non-toxic doses, which leads to a huge compromise in antioxidant treatment of SCI. Selenium nanoparticles (SeNPs) have excellent ROS scavenging bioactivity, but the toxicity control problem limits the therapeutic window. Here, we propose a synergistic therapeutic strategy of SeNPs encapsulated by ZIF-8 (SeNPs@ZIF-8) to obtain synergistic ROS scavenging activity. Three different spatial structures of SeNPs@ZIF-8 were synthesized and coated with ferrostatin-1, a ferroptosis inhibitor (FSZ NPs), to achieve enhanced anti-oxidant and anti-ferroptosis activity without toxicity. FSZ NPs promoted the maintenance of mitochondrial homeostasis, thereby regulating the expression of inflammatory factors and promoting the polarization of macrophages into M2 phenotype. In addition, the FSZ NPs presented strong abilities to promote neuronal maturation and axon growth through activating the WNT4-dependent pathways, while prevented glial scar formation. The current study demonstrates the powerful and versatile bioactive functions of FSZ NPs for SCI treatment and offers inspiration for other neural injury diseases.
Multifunctional nano-in-micro delivery systems for targeted therapy in fundus neovascularization diseases
Authors: Liu Xin , Huang Keke , Zhang Fuxiao , Huang Ge , Wang Lu , Wu Guiyu , Ren Hui , Yang Guang , Lin Zhiqing
Published: June 2024

Fundus neovascularization diseases are a series of blinding eye diseases that seriously impair vision worldwide. Currently, the means of treating these diseases in clinical practice are continuously evolving and have rapidly revolutionized treatment opinions. However, key issues such as inadequate treatment effectiveness, high rates of recurrence, and poor patient compliance still need to be urgently addressed. Multifunctional nanomedicine can specifically respond to both endogenous and exogenous microenvironments, effectively deliver drugs to specific targets and participate in activities such as biological imaging and the detection of small molecules. Nano-in-micro (NIM) delivery systems such as metal, metal oxide and up-conversion nanoparticles (NPs), quantum dots, and carbon materials, have shown certain advantages in overcoming the presence of physiological barriers within the eyeball and are widely used in the treatment of ophthalmic diseases. Few studies, however, have evaluated the efficacy of NIM delivery systems in treating fundus neovascular diseases (FNDs). The present study describes the main clinical treatment strategies and the adverse events associated with the treatment of FNDs with NIM delivery systems and summarizes the anatomical obstacles that must be overcome. In this review, we wish to highlight the principle of intraocular microenvironment normalization, aiming to provide a more rational approach for designing new NIM delivery systems to treat specific FNDs.

Graphical Abstract