bluuebunny/crossref_metadata_2025 huggingface dataset:
Proton radiotherapy as a treatment strategy to increase survival in locally advanced pancreatic cancer in the body and tail: a retrospective study
Authors: Ami Katsuya , Terashima Kazuki , Ishida Jun , Suga Masaki , Okawa Taisuke , Takahashi Daiki , Park SungChul , Matsuo Yoshiro , Nanno Yoshihide , Tokumaru Sunao , Okimoto Tomoaki , Toyama Hirochika , Fukumoto Takumi
Published: August 2023

Background

Long-term outcomes and prognostic factors of proton radiotherapy for locally advanced pancreatic cancer (LAPC) in the body and tail are still unknown. The aim of this study was to determine the prognostic factors after proton radiotherapy in a large group of patients with LAPC in the body and tail.

Methods

The medical records of 200 patients with LAPC in the body and tail who underwent proton radiotherapy between February 2009 and January 2021 at the Hyogo Ion Beam Medical Center were retrospectively reviewed to identify prognostic factors that contribute to long-term survival.

Results

The overall survival rate at 1- and 2-year after PT was 69.6% and 35.4% with a median overall survival of 18.4 months. The 1- and 2-year local progression-free, and progression-free survival rates were 84.3% and 68.0%, and 44.3% and 19.4%, respectively. In multivariate analysis, superior mesenteric artery (SMA) invasion (SMA only invasion vs. celiac artery only invasion; P = 0.049: SMA and celiac artery invasion vs. celiac artery only invasion; P = 0.017), carbohydrate antigen 19-9 (CA 19-9) level ≥ 231.9 U/mL (P = 0.001), anterior peripancreatic invasion (P = 0.006), and incomplete scheduled concurrent chemotherapy (P = 0.009) were statistically significant prognostic factors for overall survival. There was no significant difference in local progression-free survival; however, distant metastasis-free survival was statistically worse in patients with prognostic factors than in those without.

Conclusions

Proton radiotherapy for LAPC in the body and tail may be a valuable multidisciplinary treatment option. Patients with SMA invasion, higher pre-proton radiotherapy serum CA 19-9 level, anterior peripancreatic invasion, or incomplete scheduled concurrent chemotherapy had worse overall survival because of worse distant metastasis-free survival, suggesting that distant metastases have a significant impact on overall survival in such patients.

Trial registration: Retrospectively registered.
Enhancing acetabular reaming accuracy: optimal techniques and a novel reamer design
Authors: Karia Monil , Boughton Oliver , Mohan Sceyon Vishnu , Halewood Camilla , Wozencroft Rob , Clarke Susannah , Cobb Justin
Published: August 2023

Introduction

Successful press-fit implantation relies on an accurately reamed bone cavity. Inaccurate reaming can lead to a suboptimal press-fit risking fracture and cup deformation or excessive micromotion and loosening. Several factors may impact reaming accuracy including the reamer design, the surgeon’s technique and the bone quality. The aim of this study is to investigate the accuracy of reaming techniques and the accuracy of a novel reamer design.

Methods

Eighty composite bone models, half high density and half low density, were reamed with either a conventional or an additively manufactured reamer with a novel design employing either a straight or ‘whirlwind’ reaming technique. Reamed cavities were scanned using a 3D laser scanner and the median difference between achieved and expected diameters compared.

Results

The novel reamer design was more accurate than the unused conventional reamer, using both whirlwind (0.1 mm (IQR 0–0.2) vs. 0.3 mm (IQR 0.3–0.4); p < 0.001) and straight techniques (0.3 mm (IQR 0.1–1.0) vs. 1.2 mm (IQR 1–1.6); p = 0.001). Whirlwind reaming was more accurate than straight reaming using both conventional (0.3 mm (IQR 0.3–0.4) vs. 1.2 mm (IQR 1–1.6); p < 0.0001) and single use reamers (0.1 mm (IQR 0–0.2) vs. 0.3 mm (IQR 0.1–1.0); p = 0.007). Reaming errors were higher in low-density bone compared to high-density bone, for both reamer types and reaming techniques tested (0.6 mm (IQR 0.3–1.5) vs. 0.3 mm (IQR 0.1–0.8); p = 0.005).

Conclusion

We present a novel reamer design that demonstrates superior accuracy to conventional reamers in achieving the desired reaming diameter. Improved reaming accuracy was also demonstrated using both devices and in both bone models, using a ‘whirlwind’ technique. We recommend the use of this novel reamer design employing a ‘whirlwind’ technique to optimize reaming accuracy. Particular attention should be paid toward patients with lower bone quality which may be more susceptible to higher inaccuracies.
Unilateral biportal endoscopic technique combined with percutaneous transpedicular screw fixation for thoracolumbar burst fractures with neurological symptoms: technical note and preliminary report
Authors: Tian Dasheng , Zhong Huazhang , Zhu Bin , Chen Lei , Jing Juehua
Published: August 2023

Background

Previous studies on thoracolumbar fractures with neurological symptoms have focused on how to achieve satisfactory fracture reduction, adequate nerve decompression, and stable spinal alignment. With the development of the minimally invasive spine surgery technique, achieving satisfactory treatment results and reducing iatrogenic trauma at the same time has become a new goal of spinal surgery. This research used percutaneous transpedicular screw distraction to partially reduce the fractured vertebrae, followed by completing nerve decompression and reducing residual displacement bone fragments with the assistance of the unilateral biportal endoscopic (UBE) technique to achieve full protection of bone-ligament tissue and obtain good clinical efficacy.

Methods

Guide wires were safely inserted into the fractured vertebra and adjacent upper and lower vertebra under the surveillance of anteroposterior and lateral X-ray fluoroscopy. Transpedicular screws were implanted via guide wires on the side with mild neurological deficits or bone fragment compression (the opposite side of the endoscopic operation). A titanium rod was installed and moderately distracted to reduce the fractured vertebra. Then, under the guidance of the endoscopic view, the laminectomy and ligamentum flavum resection were completed according to the position of the protruding bone fragment into the spinal canal, and the compressed dural sac or nerve root was fully exposed and decompressed. An L-shaped replacer was used to reduce residual bone fragments. The ipsilateral transpedicular screws and rod were installed and adjusted to match the contralateral side. The drainage tube was indwelled, and the incision was closed. The preoperative and postoperative images of the patients were evaluated, and the recovery of neurological symptoms was observed.

Results

Surgery was successfully completed on all six patients, and no intraoperative conversion to open surgery was performed. Postoperative images showed good reduction of the protruding bone fragment and good placement of all screws. At the last follow-up, the neurological symptoms of all patients returned to normal.

Conclusion

The UBE technique combined with percutaneous transpedicular screw fixation in the treatment of thoracolumbar fractures with neurological symptoms can effectively achieve the reduction of displaced bone fragments, improve damaged nerve function, stabilize spinal alignment, and protect the integrity of bone-ligament tissue.
Alteration of the N6-methyladenosine methylation landscape in a mouse model of polycystic ovary syndrome
Authors: Zou Lingxiao , Li Waixing , Xu Dabao , Zhu Shujuan , Jiang Bin
Published: August 2023

Objective

To explore the N6-methyladenosine (m6A) methylation abnormality of mRNAs and its potential roles in the mouse model of polycystic ovary syndrome (PCOS).

Methods

The mouse model of PCOS were induced by injecting dehydroepiandrosterone (DHEA), and confirmed by observing the morphological structures of ovarian follicles. Subsequently, m6A-tagged mRNAs were identified via m6A epitranscriptomic microarray and its potential functional pathways were predicted in KEGG database. The expression and modification levels of key mRNAs in the most enriched pathway were evaluated and compared using western blot and methylated RNA immunoprecipitation-quantitative PCR (MeRIP-qPCR).

Results

Compared with the control group, 415 hypermethylated and downregulated mRNAs, 8 hypomethylated and upregulated mRNAs, and 14 hypermethylated and upregulated mRNAs were identified in the PCOS group (Fold change ≥ 1.5). Those mRNAs were mainly involved in insulin signaling pathway, type II diabetes mellitus, Fc epsilon RI signaling pathway, inositol phosphate metabolism, and GnRH secretion. In insulin signaling pathway, the expression levels of phosphorylated protein kinase B (p-AKT) were decreased, whereas that of upstream phosphorylated phosphatidylinositol 3-kinase (p-PI3K) were increased in PCOS group. Moreover, skeletal muscle and kidney-enriched inositol polyphosphate 5-phosphatease (SKIP), one of PIP3 phosphatases, was verified to be overexpressed, and Skip mRNAs were hypermethylated in PCOS group.

Conclusion

The altered m6A modification of mRNAs might play a critical role in PCOS process. The PI3K/AKT pathway is inhibited in the mouse model of PCOS. Whether it is caused by the m6A modification of Skip mRNAs is worthy of further exploration.
Association between periodontitis and temporomandibular joint disorders
Authors: Wang Shaotai , Jiang Huan , Qi Huichuan , Luo Danfeng , Qiu Tianyuan , Hu Min
Published: August 2023

Background

Periodontitis (PD) may affect temporomandibular joint disorders (TMD) and TMD may influence PD in previous observational studies. Nevertheless, these studies were prone to confounders and reverse causation, leading to incorrect conclusions about causality and direction of association. This research investigates the associations between PD and TMD employing bidirectional two-sample Mendelian randomization (MR) analysis.

Methods

Single-nucleotide polymorphisms (SNPs) related to PD (p < 5 × 10−6) were selected from a genome-wide association study (GWAS) from the Gene-Lifestyle Interaction in the Dental Endpoints (GLIDE) consortium, and related these to SNPs from FinnGen and UK Biobank (UKB) consortia, and vice versa. We implemented the standard inverse variance weighted (IVW), weighted median (WM), MR-Egger regression, and MR-PRESSO methods to estimate the potential causality between PD and TMD. Sensitive tests were conducted using robust MR methods. Results from FinnGen and UKB were combined using the fixed model.

Results

PD did not appear to causally affect TMD. Additionally, the reverse MR analysis did not reveal a significant causal effect of TMD on PD. The results of other MR methods were similar to those of the IVW method. Sensitivity analyses addressed no potential pleiotropy in MR estimations. Results from the meta-analysis were consistent with the above-mentioned consequences.

Conclusion

This research does not support a causal relationship between PD and TMD. PD does not appear to worsen TMD directly, and vice versa.
Metanephric adenoma diagnosed on biopsy in an infant: a case report
Authors: Mosbahi S. , Ben Youssef S. , Zouaoui A. , Abdelali M. , Ben Fredj M. , Ben Abdejelil N. , Belhassen S. , Hidouri S. , Chabchoub I. , Ksia A. , Sahnoun L. , Mekki M. , Zakhama A. , Zrig A. , Belghith M.
Published: August 2023

Background

Metanephric adenoma is a rare benign renal tumor of the kidney, uncommonly observed in children. It is often misdiagnosed preoperatively as a malignant neoplasm, leading to an unnecessary nephrectomy. The challenge is to make the right diagnosis preoperatively and therefore manage it with conservative surgery. We report a case of a child with metanephric adenoma who underwent nephron-sparing surgery.

Case presentation

A renal tumor was discovered fortuitously in an 18-month-old Caucasian girl with several congenital malformations. Investigations showed a 28 × 27 × 27 mm left renal mass centrally located, well defined, nonvascularized, with no calcifications and which compressed the adjacent renal tissue. Furthermore, there were no signs of metastasis. The decision of a multidisciplinary meeting was to perform a computed tomography (CT)-scan-guided biopsy. Histologic examination concluded it was a metanephric adenoma. We performed a left open partial nephrectomy via a flank retroperitoneal incision. The final histopathological examination confirmed the diagnosis. The postoperative course was uneventful.

Conclusion

Preoperative diagnosis of metanephric adenoma is challenging. Because of the high probability of unnecessary radical nephrectomy, preoperative biopsy can be safe and determining to guide a more conservative approach so nephron-sparing surgery can be performed.
Angiopoietin-2 is associated with capillary leak and predicts complications after cardiac surgery
Authors: Wollborn Jakob , Zhang Zilu , Gaa Julie , Gentner Moritz , Hausmann Christian , Saenger Felix , Weise Karina , Justice Samuel , Funk Jean-Luca , Staehle Hans Felix , Thomas Marie , Bruno Raphael R. , Saravi Babak , Friess Jan O. , Marx Markus , Buerkle Hartmut , Trummer Georg , Muehlschlegel Jochen D. , Reker Daniel , Goebel Ulrich , Ulbrich Felix
Published: August 2023

Background

Patients undergoing cardiac surgery are prone to numerous complications. Increased vascular permeability may be associated with morbidity and mortality due to hemodynamic instability, fluid overload, and edema formation. We hypothesized that markers of endothelial injury and inflammation are associated with capillary leak, ultimately increasing the risk of postoperative complications.

Methods

In this prospective, observational, multidisciplinary cohort study at our tertiary academic medical center, we recruited 405 cardiac surgery patients. Patients were assessed daily using body impedance electrical analysis, ultrasound, sublingual intravital microscopy, and analysis of serum biomarkers. Multivariable models, as well as machine learning, were used to study the association of angiopoietin-2 with extracellular water as well as common complications after cardiac surgery.

Results

The majority of patients underwent coronary artery bypass grafting, valvular, or aortic surgeries. Across the groups, extracellular water increased postoperatively (20 ± 6 preoperatively to 29 ± 7L on postoperative day 2; P < 0.001). Concomitantly, the levels of the biomarker angiopoietin-2 rose, showing a strong correlation based on the time points of measurements (r = 0.959, P = 0.041). Inflammatory (IL-6, IL-8, CRP) and endothelial biomarkers (VE-Cadherin, syndecan-1, ICAM-1) suggestive of capillary leak were increased. After controlling for common risk factors of edema formation, we found that an increase of 1 ng/mL in angiopoietin-2 was associated with a 0.24L increase in extracellular water (P < 0.001). Angiopoietin-2 showed increased odds for the development of acute kidney injury (OR 1.095 [95% CI 1.032, 1.169]; P = 0.004) and was furthermore associated with delayed extubation, longer time in the ICU, and a higher chance of prolonged dependence on vasoactive medication. Machine learning predicted postoperative complications when capillary leak was added to standard risk factors.

Conclusions

Capillary leak and subsequent edema formation are relevant problems after cardiac surgery. Levels of angiopoietin-2 in combination with extracellular water show promising potential to predict postoperative complications after cardiac surgery.

Trial registration number: German Clinical Trials Registry (DRKS No. 00017057), Date of registration 05/04/2019, www.drks.de

Graphical Abstract
Restoring gluconeogenesis by TEF inhibited proliferation and promoted apoptosis and immune surveillance in kidney renal clear cell carcinoma
Authors: Zhuang Wenyuan , Shi Xiaokai , Gao Shenglin , Qin Xihu
Published: August 2023

Background

Kidney renal clear cell carcinoma (KIRC) is the major histological subtype of kidney tumor which covers approximately 80% of the cases. Although various therapies have been developed, the clinical outcome remains unsatisfactory. Metabolic dysregulation is a key feature of KIRC, which impacts progression and prognosis of the disease. Therefore, understanding of the metabolic changes in KIRC is of great significance in improving the treatment outcomes.

Methods

The glycolysis/gluconeogenesis genes were analyzed in the KIRC transcriptome from the Cancer Genome Atlas (TCGA) by the different expression genes (DEGs) test and survival analysis. The gluconeogenesis-related miRNAs were identified by ImmuLncRNA. The expression levels of indicated genes and miRNAs were validated in KIRC tumor and adjunct tissues by QPCR. The effects of miR-4477b and PCK1 on cell proliferation and apoptosis were examined using the cell viability assay, cell apoptosis assay, and clone information. The interaction of miR-4477b with TEF was tested by the luciferase report gene assay. The different gluconeogenesis statuses of tumor cells and related signatures were investigated by single-cell RNA sequencing (scRNA-seq) analysis.

Results

The 11 gluconeogenesis genes were found to be suppressed in KIRC (referring as PGNGs), and the less suppression of PGNGs indicated better survival outcomes. Among the 11 PGNGs, we validated four rate-limiting enzyme genes in clinical tumor patients. Moreover, restoring gluconeogenesis by overexpressing PCK1 or TEF through miR-4477b inhibition significantly inhibited tumor cell proliferation, colony formation, and induced cell apoptosis in vitro. Independent single-cell RNA sequencing (scRNA-seq) data analysis revealed that the tumor cells had high levels of PGNG expression (PGNG + tumor cells) represented a phenotype of early stage of neoplasia and prompted immune surveillance.

Conclusions

Our study suggests that the deficiency of gluconeogenesis is a key metabolic feature of KIRC, and restoring gluconeogenesis could effectively inhibit the proliferation and progression of KIRC cells.
Concerns over colour durability in the nineteenth-century industrial revolution: insights from John Ruskin’s teaching collection
Authors: Ghigo Tea , Occhipinti Michele , Beeby Andrew , Domoney Kelly , Bone Daniel
Published: August 2023

The numerous new pigments that gradually became available to artists during the nineteenth-century Colour Revolution were received with contrasting attitudes. The initial enthusiasm for new chromatic possibilities was soon nuanced by concerns about the stability and performance of industrial materials. This study focuses on the work of John Ruskin, the famous art critic of Victorian England, whose artistic production was as impressive as his penmanship. Archival research into nineteenth-century literature is combined with material analyses with macro-XRF, XRD and FORS on a group of watercolours by Ruskin preserved at the Ashmolean Museum to determine his attitude towards pigment stability. The results show that he was very concerned with colour durability and chose his materials carefully, using the treatise Chromatography by the chemist George Field (first edition 1835) as guidance. The material analyses also provided new insight into the composition of specific pigments, revealing the use of a hitherto unreported cobalt-based blue.
A systematic review of demographic and background factors associated with the development of children’s aquatic competence
Authors: Duke Charlotte , Calverley Hannah , Petrass Lauren , Peters Jacqui , Moncrieff Kate , Konjarski Loretta , Matthews Bernadette
Published: August 2023

Background

Globally, drowning is a leading cause of unintentional injury and death among children. Teaching aquatic competencies (swimming skills and water safety knowledge) to children has been proposed as a prevention strategy. In Australia, however, many children are not meeting standard aquatic competency benchmarks. Exploration of the connection between demographic and background factors and aquatic competencies could provide insight into why differences in acquisition of aquatic knowledge and skills occur.

Main body

A systematic literature review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses was performed to identify studies that reported on the association between demographic and background factors and aquatic competencies. Nine databases were searched for English language peer-reviewed studies published since 2000. Fourteen studies fulfilled all inclusion criteria. Studies were quasi-experimental or cross-sectional in design, which is considered quality level III-2 or IV, respectively, on the National Health and Medical Research Council Evidence Hierarchy. Study quality was moderate, and risk of bias was high. While aquatic competencies can be taught, this review found that factors including age, gender, geographic residence, medical conditions/disabilities, socioeconomic status, and swimming frequency were significantly associated with the demonstration and/or acquisition of aquatic competencies.

Conclusion

This review provides insight into demographic and background factors that are significantly associated with the development of aquatic competence. Whilst further investigation is required to increase the evidence base, these findings may assist in tailoring swimming and water safety programs to accommodate those at-risk of not achieving age-appropriate aquatic competencies.
Differentiating brain metastasis from glioblastoma by time-dependent diffusion MRI
Authors: Kamimura Kiyohisa , Kamimura Yoshiki , Nakano Tsubasa , Hasegawa Tomohito , Nakajo Masanori , Yamada Chihiro , Akune Kentaro , Ejima Fumitaka , Ayukawa Takuro , Ito Soichiro , Nagano Hiroaki , Takumi Koji , Nakajo Masatoyo , Uchida Hiroyuki , Tabata Kazuhiro , Iwanaga Takashi , Imai Hiroshi , Feiweier Thorsten , Yoshiura Takashi
Published: August 2023

Background

This study was designed to investigate the use of time-dependent diffusion magnetic resonance imaging (MRI) parameters in distinguishing between glioblastomas and brain metastases.

Methods

A retrospective study was conducted involving 65 patients with glioblastomas and 27 patients with metastases using a diffusion-weighted imaging sequence with oscillating gradient spin-echo (OGSE, 50 Hz) and a conventional pulsed gradient spin-echo (PGSE, 0 Hz) sequence. In addition to apparent diffusion coefficient (ADC) maps from two sequences (ADC50Hz and ADC0Hz), we generated maps of the ADC change (cADC): ADC50Hz − ADC0Hz and the relative ADC change (rcADC): (ADC50Hz − ADC0Hz)/ ADC0Hz × 100 (%).

Results

The mean and the fifth and 95th percentile values of each parameter in enhancing and peritumoral regions were compared between glioblastomas and metastases. The area under the receiver operating characteristic curve (AUC) values of the best discriminating indices were compared. In enhancing regions, none of the indices of ADC0Hz and ADC50Hz showed significant differences between metastases and glioblastomas. The mean cADC and rcADC values of metastases were significantly higher than those of glioblastomas (0.24 ± 0.12 × 10−3mm2/s vs. 0.14 ± 0.03 × 10−3mm2/s and 23.3 ± 9.4% vs. 14.0 ± 4.7%; all p < 0.01). In peritumoral regions, no significant difference in all ADC indices was observed between metastases and glioblastomas. The AUC values for the mean cADC (0.877) and rcADC (0.819) values in enhancing regions were significantly higher than those for ADC0Hz5th (0.595; all p < 0.001).

Conclusions

The time-dependent diffusion MRI parameters may be useful for differentiating brain metastases from glioblastomas.
Stakeholder engagement in the development of an upper extremity outcome measure for children with rare musculoskeletal conditions
Authors: Elfassy Caroline , Wagner Lisa , Higgins Johanne , Montpetit Kathleen , Snider Laurie , Dahan-Oliel Noémi
Published: August 2023

Background

Upper extremity (UE) involvement is prevalent in 73% of individuals with arthrogryposis multiplex congenita (AMC), yet no AMC-specific outcome measure exists. When developing a measure specific to a population with a rare musculoskeletal condition, clinicians’ and patients’ perspectives and involvement is a crucial and necessary step. This study sought to determine the most clinically useful items for an outcome measure of UE function for children with AMC as defined by caregivers and clinicians.

Methods

To ensure the perspectives and needs of caregivers of children with AMC and clinicians were considered in the development of the UE measure for AMC, a Nominal Group technique (NGT) with caregivers of children with AMC (phase 1) followed by a three-round survey with clinicians (phase 2) were carried out.

Results

Phase 1: Eleven individuals participated in the nominal group technique and identified 32 items. The most important items were Picking up an object (n = 11), Eating (n = 10), Reaching mouth (n = 10), Getting out of bed (n = 10). Phase 2: Invitations to participate to an online survey was sent to 47 experts in the field of AMC, 20 participants completed round 1, 15 completed round 2 and 13 completed round 3. Throughout the survey, participants were asked about movement required to screen the UE, essential domains to be included in the measure, establishing a scoring guide and identifying tasks associated with joint motion and position.

Conclusion

A preliminary version of an UE AMC-specific outcome measure was developed with the help of caregivers’ perspectives and expert opinions.
Cognitive perspectives on maintaining physicians’ medical expertise: IV. Best practices and open questions in using testing to enhance learning and retention
Authors: Fraundorf Scott H. , Caddick Zachary A. , Nokes-Malach Timothy J. , Rottman Benjamin M.
Published: August 2023

Although tests and assessments—such as those used to maintain a physician’s Board certification—are often viewed merely as tools for decision-making about one’s performance level, strong evidence now indicates that the experience of being tested is a powerful learning experience in its own right: The act of retrieving targeted information from memory strengthens the ability to use it again in the future, known as the testing effect. We review meta-analytic evidence for the learning benefits of testing, including in the domain of medicine, and discuss theoretical accounts of its mechanism(s). We also review key moderators—including the timing, frequency, order, and format of testing and the content of feedback—and what they indicate about how to most effectively use testing for learning. We also identify open questions for the optimal use of testing, such as the timing of feedback and the sequencing of complex knowledge domains. Lastly, we consider how to facilitate adoption of this powerful study strategy by physicians and other learners.
Sternomental displacement and neck circumference: a new look for the neck as a difficult airway predictor in obese surgical patients—a cohort study
Authors: Gorgy Antony , Ahmed Abeer , Atef Mohamed , Mekawy Nevan , Sami Wael , Nagy Heba
Published: August 2023

Background

Sternomental displacement (SMDD) is a surrogate indicator for cervical spine (C-spine) mobility. SMDD revealed good potential to predict difficult airway, but its validity in obese patients is not evident. Therefore, this study assessed the performance of SMDD with neck circumference (NC) in predicting difficult airway in obese surgical patients. The study involved 135 adult patients with body mass index (BMI) ≥ 35 kg/m2 scheduled for elective surgeries under general anesthesia with endotracheal tubes (ETT) inserted using Macintosh laryngoscopes. The airway was assessed using SMDD, NC, and modified Mallampati test (MMT). Difficult laryngoscopy view (DLV) was defined as Cormack–Lehane (C-L) grade ≥ 3. The accuracy of the SMDD in predicting DLV was set as the primary endpoint, while the accuracy of the SMDD compared to that of NC, MMT, and NC/SMDD ratio in predicting difficult airway was set as the secondary endpoint.

Results

The DLV cases were 28 of 135 (20.7%), with a mean BMI of 41.1 ± 3.3 kg/m2. SMDD  < 5cm and NC > 43 cm could predict DLV with an area under the receiver operating characteristic curve (AUROC) of 0.97 and 0.83 respectively. SMDD and NC had a good negative correlation (r =  − 0.6; 95% CI = 0.7 to 0.4; p = 0.0001). The NC/SMDD ratio had the best prediction for DLV (AUROC of 0.98 at a cut-off value  > 7.8).

Conclusions

In obese surgical patients, SMDD and NC/SMDD ratios are excellent predictors for DLV when the cut-off values are  < 5cm and  > 7.8, respectively.

Trial registration

ClinicalTrials.gov, NCT04524546. Registered in August 2020.
Combining ability and gene action studies for yield and fibre traits in Gossypium arboreum using Griffings numerical and Haymans graphical approach
Authors: SUKRUTHA Bhimireddy , RAJESWARI Sivakami , PREMALATHA N. , BOOPATHI Narayana Manikanda , THIRUKUMARAN K. , MANIVANNAN A.
Published: August 2023

Background

For the purpose of utilising hybrid vigour to produce possible hybrids with a suitable level of stability, the knowledge of gene activity and combining ability is a crucial prerequisite before choosing desirable parents. The present study was carried out with six parents crossed in full diallel fashion and generated 30 F1 hybrids. These hybrids were evaluated in two replications in Randomized Block Design at Department of Cotton, TNAU for combining ability and gene action. Diallel analysis was carried out according to Griffing’s method-I (parents + F1 + reciprocals) and model-I and Hayman’s graphical approach by using INDOSTAT software.

Results

Analysis of variance for combining ability indicated that mean square values of GCA, SCA and reciprocals were highly significant for all the traits except for the uniformity index. RG763 and K12 showed highly positively significant GCA effects for most of the yield traits while PA838 and K12 for fibre quality traits, so they were found as best general combiners. PAIG379 × K12 and PDB29 × K12 for yield traits, and PDB29 × PA838, RG763 × PA838, and CNA1007 × RG763 cross combinations for fibre quality traits could be recommended for future breeding programms.

Conclusion

The results of both Griffing’s and Hayman’s approaches showed that non-additive gene action predominates as SCA variance was bigger than GCA variance, so heterosis breeding is thought to be a more fruitful option for enhancing GCA of many traits.
Telmisartan versus EnalapRil In heart failure with redUced ejection fraction patients with Moderately impaired kidney Functions; randomized controlled trial: “TRIUMF trial”
Authors: Samir Ahmad , Aboel-Naga Salma , Shehata Ahmed , Abdelhamid Magdy
Published: August 2023

Background

When heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) co-exist, Renin angiotensin-aldosterone system inhibitors (RAASi) are often underutilized for the fear of worsening renal function (WRF). Telmisartan is a RAASi characteristic for a favorable renal profile, although data on its utility in HFrEF is limited. This study aimed to compare efficacy and tolerability of Telmisartan versus Enalapril in patients with HFrEF and CKD.

Results

This study randomized 107 patients with HFrEF and CKD to either Telmisartan (10–80 mg) or Enalapril (5–40 mg) daily. The achieved RAASi dose, dose reductions (DR) or dis-continuation (DC), death/Heart failure rehospitalization (HFH), NYHA class and 6MWT were compared at 3- and 6-months. At 3- and 6-months, 93.5% versus 68.6% and 95.2% versus 72.9% were maintaining ≥ 50% of the target dose in the Telmisartan- versus Enalapril-group, respectively. Despite the higher achieved dose by 3- and 6-months, Telmisartan versus Enalapril was associated with less WRF (6.4% vs. 22.9%, p = 0.022 and 7.3% vs. 13.6%, p = 0.28) and fewer episodes of DR-DC (31.9% vs. 55.1%, p = 0.018 and 35.7% vs. 56.5%, p = 0.041), respectively. By the end of the study, there were 5 deaths in each group, yet, HFH occurred in 34.1% versus 55.3%, p = 0.035, and NYHA class changed by − 1 [− 2, 0] versus 0 [− 1, 1], p = 0.017 in Telmisartan- versus Enalapril patients, respectively. Within-group results showed improvement in 6MWT in Telmisartan-, and increase in diuretic requirements in Enalapril-group.

Conclusions

In patients with HFrEF and CKD, Telmisartan was better tolerated to uptitrate, caused less WRF, less HFH and showed better functional improvement compared to Enalapril.

Clinical trial registration This study was prospectively registered on clinicaltrials.gov, with registration number (NCT04736329).
Arterial spin-labeled magnetic resonance perfusion imaging in prediction of pediatric brain tumors grading: inter-observer agreement
Authors: Elmansy Maha Mohammed Hassan , Zaki Samia Mounir , Elbakry Magda Ali Hany , Abdelwahab Rihame Mohamed
Published: August 2023

Background

Pediatric brain tumors are a major concern with many variable management options. Arterial spin-labeled magnetic resonance perfusion imaging is a relatively new and noninvasive technique that can help in predicting tumor grades and provide us with physiological data about the tumors which significantly aids in all stages of tumor care, including diagnosis, therapy, and follow-up.

Aim of the study

To determine agreement between independent observers in the assessment and prediction of brain tumor grading in pediatrics by arterial spin-labeled (ASL) magnetic resonance perfusion imaging.

Methods

Thirty-two patients (21 boys and 11 girls; mean age of (10.28 ± 4.31) years) with brain tumors were evaluated by ASL MRI perfusion. Image analysis was performed by two reviewers for quantifying absolute and relative tumoral blood flow (aTBF and rTBF) as well as qualitative assessment of the tumors in ASL color map images.

Results

The inter-observer agreement for the mean aTBF and the mean rTBF values of the studied lesions was almost perfect (inter-class correlation coefficient (ICC) = 0.978, 0.997). There was substantial agreement between both observers for the qualitative assessment of the studied lesions in color ASL images (Kappa = 0.779, with % of agreement = 87.0%). The mean aTBF for grade I tumors was (24.64 ± 3.45 ml/100 g/min), for grade II tumors it was (33.81 ± 3.59 ml/100 g/min), while for high-grade tumors (grade III and IV tumors) it was (75.60 ± 20.0 ml/100 g/min) with (p < 0.001). The mean rTBF of grade I, II, and III/IV tumors was (1.01 ± 0.17); (1.07 ± 0.31); and (3.12 ± 0.24) with (p < 0.001).

Conclusions

Arterial spin-labeled perfusion MRI can help in the challenge of prediction of brain tumor grading in pediatrics with accurate quantitative and semi-quantitative measurements of perfusion parameters of the tumors as well as qualitative and visual assessment of the tumors.
Applying machine learning methods to predict operative mortality after tricuspid valve surgery
Authors: Arafat Amr A. , Alamro Sultan , AlRasheed Maha M. , Adam Adam I. , Ismail Huda , Pragliola Claudio , Albabtain Monirah A.
Published: August 2023

Background

EuroSCORE stratifies surgical risk in cardiac surgery; however, it is not explicitly for tricuspid valve surgery. Therefore, we aimed to apply machine learning (ML) methods to predict operative mortality after tricuspid valve surgery and compare the predictive ability of these models to EuroSCORE.

This retrospective analysis included 1161 consecutive patients who underwent tricuspid valve surgery at a single center from 2009 to 2021. The study outcome was operative mortality (n=112), defined as mortality occurring within 30 days of surgery or the same hospital admission. Random forest, LASSO, elastic net, and logistic regression were used to identify predictors of operative mortality.

Results

EuroSCORE was significantly higher in patients who had operative mortality [8.52 (4.745–20.035) vs.4.11 (2.29–6.995), P<0.001] [AUC=0.73]. Random forest identified eight variables predicting operative mortality with an accuracy of 92% in the test set (age≥70 years, heart failure, emergency surgery, chronic kidney disease grade IV, diabetes mellitus, tricuspid valve replacement, hypertension, and redo surgery). The classification error rate in the training data was 9%, and in the testing data, it was 4.8%. Logistic regression identified eight variables with an AUC of 0.76. LASSO identified 13 variables with an AUC of 0.78, and elastic net identified 17 variables (AUC=0.795). The AUCs of the elastic net (P=0.048) and random forest (P<0.001) models were significantly higher than that of EuroSCORE.

Conclusions

ML effectively predicted TV surgery mortality more accurately than the traditional risk-scoring method. Incorporating ML in cardiac surgery risk scoring with comprehensive inclusion of all possible variables is recommended.
Assessing for autism in adult psychiatry
Authors: Tromans Samuel , Desarkar Pushpal
Published: August 2023

This editorial discusses a study by Nyrenius and colleagues in which they investigated rates of co-occurring psychiatric conditions and functioning in a population of adults referred to a Swedish psychiatric out-patient clinic, comparing those meeting DSM-5 diagnostic criteria for autism with their non-autistic peers.
‘Main the gap!’ The view of healthcare professionals on gains and pitfalls of traditional and innovative models for providing mental health care to imprisoned persons with a severe mental illness in Spain
Authors: Antón Basanta J. , Paz Ruiz S. , Estévez Closas V. P. , López López Á. , Barrios L. F. , Calcedo-Barba A.
Published: August 2023

Introduction

Different mental health care provision models coexist in prisons in Spain. The Ministry of Interior applies a traditional model to secure mental health care to 83% of the country imprisoned population. Three autonomous regions with acquired competencies for health care provision (17% of the imprisoned population) are implementing innovative care models.

Objectives

To explore the views of healthcare professionals on models of mental health care provision for imprisoned persons with a serious mental illness (SMI) in Spain.

Methods

21 healthcare professionals (13 physicians, 5 nurses, 3 pharmacists) working in prisons, penitentiary psychiatric hospitals and a psychiatric in-prison unit took part in 5 online, 2 hours focus groups and one in-deep interview between 31st May and 20th July 2022. The moderator used open-ended questions to research into the characteristics of mental health care models and on the challenges for implementation. Focus groups were audiotape recorded and transcribed. Transcripts were analysed applying thematic analysis.

Results

Healthcare professionals reported that within the traditional model of healthcare provision, the psychiatric care of SMI imprisoners relies on correctional general practitioner physicians (GP). Psychiatrists act as external care providers. There are two psychiatric penitentiary hospitals with a strong correctional character for in-hospital care. Acute psychiatric care happens in prisons or at the local general hospital. Healthcare records remain within the penitentiary organization and outside the accesible healthcare information system. In consequence, there is fragmentation and delocalization of mental health care. An innovative approach consists of a dedicated mental healthcare unit within the prison with continuous psychiatric supervision of imprisoners with SMI and good quality psychiatric care. Schizophrenia and hyperactive attention deficit disorder persons benefit the most. Continued mental health care in the community remains a challenge. Another model of care is centred in the SMI imprisoned person. Acute and rehabilitation psychiatric penitentiary units operate within a network of mental health and social care resources in the community, coordinated by a liaison nurse. Individualised care plans keep SMI persons in their social environment. Costs of implementation are high. Clear definition of roles; investment in dedicated staff and shared information systems are challenges to overcome.

Conclusions

Innovative models of mental health care are needed to benefit imprisoned persons with a SMI in Spain. A decided national and regional will is paramount to overcome challenges.

Disclosure of Interest

None Declared
Social cohesion in psychiatry training in the UK More than a number game? – a secondary review
Authors: Sathyanarayanan V. , Azeem M. W.
Published: August 2023

Introduction

With the growing mental health concerns in the United Kingdom, it is undisputable that there will be a need for more mental health professionals, particularly psychiatrists. It has been estimated that there is 1 consultant psychiatrist per 12,567 people in England. The Royal College of Psychiatrists continue to call for a long term plan to address the mental health crisis by investing in psychiatric training and education.

Objectives

To analyze the socio-demographic profile of doctors in training in psychiatry and change in demand over the last decade (2012-2021)

Methods

We carried out secondary review of the state of medical education and practice in the UK in 2021 report. We analyzed reference tables in the report pertaining to doctors in training in psychiatry by age group; gender; by ethnicity; and by place of primary medical qualification. The report included data for the period 2012-13 to 2020-21, which was analyzed. In addition, 5-year (2017-2021) and 10-year (2012-2021) trends were also available and included in our analysis.

Results

While in 2012, there were 1,370 doctors in training in psychiatry, the number had dropped marginally to 1,352 in 2021. While there has been an overall decline of 1.3% in the decade (2012-21), there has been a 11.1% increase (2017-21) in the last 5 years. A big change was noticed with respect to gender. While there were 670 male doctors in training in psychiatry in 2012, the number dwindled to 522 in 2021 (22.1% decline). A deeper analysis of the decline in the male psychiatry trainees reveals that the steepest decline has happened among male international medical graduates (389 to 131 or 58.1% to 25.1%). However, the 5-year trend for male doctors has been more favorable with a 10.6% increase between 2017 and 2021. Among female doctors on the other hand, there was a 18.6% increase from a baseline of 700 in 2012 to 830 in 2021. From an ethnicity perspective, there has been a sharp decline in the proportion of Asian or Asian British trainees, down by 33.9% (555 to 367) between 2012 and 21, compensated largely by White trainees, where a 50.1% increase (511 to 767) has been seen. There has been a significant fall in the proportion of international medical graduates taking up psychiatry training (down 53.5% from 677 to 315) in the UK. This has been compensated by a 58.2% (607 to 960) increase in those who had primary qualification from the UK.

Conclusions

The theme of the 31ST European Congress of Psychiatry: ‘social cohesion, a common goal of psychiatry’ blends well with what is needed in today’s psychiatry teaching and practice in the UK. With the role of culture and society well established in psychiatry, the pursuit for popularizing the profession should not be a ‘one size fits all’ approach but a more targeted approach to ensure that there is greater diversity among the available psychiatrists for patients to choose and benefit from.

Disclosure of Interest

None Declared
Four Days Exposure And Reprocessing Therapy For PTSD
Authors: Duek O. , Levy I. , Harpaz-Rotem I.
Published: August 2023

Introduction

Post-traumatic stress disorder (PTSD) is a debilitating disorder affecting approximately 6% of the population. Current treatments have been shown to efficaciously reduce symptom burden between 30%-50%. However, due to the high intensity of treatment over a long period of time. drop-out rates are as high as 50%.

Objectives

Assess the effect of one-time ketamine infusion in subanasthetic dosage on PTSD psychotherapy

Assess feasibility and effect of massed, four days, esposure focused psychotherapy for PTSd

Methods

Here, we tested the efficacy of a four-day exposure and processing-focused psychotherapy at reducing PTSD severity. Twenty-seven participants with chronic PTSD were randomized to two groups, one receiving a one-time infusion of ketamine in a subanesthetic dose (0.5mg/kg for 40 minutes), the other receiving midazolam. Both groups underwent four 90-120 minutes of daily psychotherapy sessions a day after infusion, followed by in-vivo exposure practice. The severity of PTSD was assessed with the PCL-5 before and at the end of treatment, and at 30 and 90 days follow-up. Brain reactivation to the trauma reminders was measured using fMRI

Results

PTSD severity in both treatment groups decreased by 13, 16, and 15 points on the PCL-5 at the end of treatment, 30 days follow-up, and 90 days respectively, surpassing the minimum clinical difference of 7.9 points. There was no significant difference in symptom reductions between the treatment groups. However, brain reactivation to trauma stories differed between the groups, with the ketamine group showing a decline in the amygdala and hippocampus reactivation compared to the midazolam group, at the end of treatment.

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Conclusions

Our results imply comparable efficacy of this short-term intervention to standard trauma-focused psychotherapies, emphasizing its clinical usefulness as a short and effective intervention.

Disclosure of Interest

None Declared
A randomized controlled trial on the effect of parenting intervention through “Care for Child Development guideline” on early child development and behaviors
Authors: Kelishadi R. , Yaghini O.
Published: August 2023

Introduction

It is suggested that parenting intervention programs can play a core component in early child development. Given the limited healthcare resources in developing countries, a group design intervention might be cost-effective.

Objectives

Our objective was to assess the effect of parenting interventions in a cost-effective setting through group sessions CCD interventions on children’s development and behaviors in a non-Western, low/middle income country.

Methods

This randomized controlled trial was conducted in a public Pediatrics clinic in Isfahan, Iran. We included 210 pregnant women in their third trimester, and then followed their children for 18 months. The intervention group underwent 5 educational group sessions. The main outcomes were the children’s development and behaviors based on Bayley Scales of Infant and Toddler Development-III (BSCID-III) at 12 months and Children Behavior Checklist (CBCL) at 18-month of age.

Results

Data of 181 children were analyzed (80 in the intervention group and 101 controls. The adjusted median differences were significantly lower in the intervention group than in controls for attention problems (-3.38; SE=1.59; P=0.035), anxiety problems (-2.28; SE=1.03; P=0.007) and pervasive developmental problems (-5; SE= 1.16; P<0.001) based on CBCL results. However, the difference of proportions was not significant in none of the BSCID-III domains in the intervention and control groups.Table 1-

Results of BSID-III in intervention and control groups at 12 months of age a

Intervention
(n=80)
Median (IQR)Control
(n=101)
Median (IQR)PAdjusted median differencesbCoefficientSECognitive score105 (100-115)110 (100-120)0.099-4.222.510.095Language score112(103-118)112(103-118)0.444-1.922.520.446Motor score103(97-110)107(91-112)0.957-1.092.410.652

Conclusions

We found that parenting interventions through CCD group sessions were significantly effective on several child’s behavior domains, but not on children’s development. Future longitudinal studies are necessary in this field.

Disclosure of Interest

None Declared