bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Dendrobium Officinale on Radioactive Oral Mucositis of Nasopharyngeal Carcinoma and Changes of Oral Microecology
Authors: Yang Jiaying , Liu Yuancai , Yao He , Sun Mengying , Tong Yangbo , Ma Guanjun , Chen Zhuo , Qian Xiang , Zhang Aiqin
Published: January 2025

Objective:

To observe the clinical efficacy of Dendrobium officinale in the treatment of radiotherapy-induced oral mucositis in nasopharyngeal carcinoma patients, and to explore its regulating effect on immune function and oral microbiota by comparing immune-related factors and oral microbiota before and after the intervention.

Methods:

We conducted a randomized double-blinded controlled trial in Zhejiang Cancer Hospital. Sixty patients with nasopharyngeal cancer combined with radiotherapy-induced oral mucositis were randomly divided into a study group and control group, with 30 cases in each group The study group used compound vitamin B12 solution and Dendrobium tea drink, and the control group simply used compound vitamin B12 solution rinse. When the patients developed radiotherapy-induced oral mucositis (at the time of 10F radiotherapy), and after 1 month of Dendrobium treatment (at the end of radiotherapy), the salivary flow rate was measured without stimulation to evaluate the degree of oral mucositis and the clinical efficacy. We also detected the content of EGF in saliva and the content of IL-10 and IL-11 in serum, and analyzed the differences in microbial community structure. All patients consented before enrollment.

Results:

The salivary flow rate and oral mucosal fraction of the study group after treatment were significantly improved, which was better than that of the control group( P < .05). The content of IL-10 in the study group after treatment increased significantly compared with that before treatment( P < .05). There was a significant difference between the oral flora of the study group before and after treatment (Unique OTU counts: 5390 vs 3906), and there was also a difference between the oral flora of the study group and control group after treatment (Unique OTU counts: 5671 vs 5439). After treatment, Erysipelotrichales (Phylum Firmicutes, LDA score = 2.80, P = .034), Leptotrichiaceae (Fusobacteria,LDA score = 3.38, P = .030) and Campylobacteraceae (Proteobacteria, LDA score = 3.35, P = .026) were significantly enriched in the study group. The use of Dendrobium officinale in nasopharyngeal carcinoma patients with radiotherapy-induced oral mucositis showed little difference in microbial diversity and abundance, but there were significant differences among oral bacteria genera.

Conclusions:

Dendrobium officinale is effective in the treatment of radiotherapy-induced oral mucositis, which may be related to the improvement of salivary gland function and regulation of the oral microenvironment. Dendrobium officinale may reduce the symptoms of radiotherapy-induced oral mucositis by affecting the systemic cellular immune function. It may reduce the secretion of pro-inflammatory factors of the relevant flora by directly changing the oral flora and regulating the oral micro-ecology.
Zeatin Elicits Premature Erythrocyte Senescence Through Calcium and Oxidative Stress Mediated by the NOS/PKC/CK1α Signaling Axis
Authors: Alajeyan Iman A. , Alsughayyir Jawaher , Alfhili Mohammad A.
Published: January 2025

Objectives: Cytokinins are plant hormones that regulate cell growth and differentiation. In particular, zeatin (ZTN) delays cellular senescence of human fibroblasts and keratinocytes and exhibits anticancer activity. Chemotherapy-induced anemia is a major side effect of anticancer therapy secondary to premature senescence of red blood cells (RBCs). Herein, we investigated the biochemical and molecular mechanisms underlying ZTN action in human RBCs. Methods: Colorimetric assays were used to quantify hemolysis and related markers and flow cytometric analysis was applied to examine eryptosis through phosphatidylserine (PS) exposure by annexin-V-FITC, intracellular Ca2+ by Fluo4/AM, reactive oxygen species (ROS) by H2DCFDA, and cell size from forward scatter (FSC). Results: ZTN at 200 μM induced significant hemolysis and K+, Na+, AST, and LDH leakage. ZTN also caused a significant increase in annexin-V-positive cells along with increased Fluo4 and DCF fluorescence and reduced FSC. Importantly, L-NAME, staurosporin, D4476, urea, sucrose, and polyethylene glycol 8000 (PEG) significantly ameliorated ZTN cytotoxicity. Conclusion: ZTN stimulates PS exposure, intracellular Ca2+ elevation, oxidative stress, and cell shrinkage. The hemolytic potential of ZTN, mediated through nitric oxide synthase/protein kinase C/casein kinase 1α signaling axis, is sensitive to isosmotic urea, sucrose, and PEG availability. Altogether, the anticancer potential of ZTN must be reconsidered with prudence.
Dignity and the Drama of the Death Penalty
Authors: Menon Jisha
Published: January 2025

This article explores the relationship between the law and personhood, dispossession and dignity. It asks: How might we move beyond a conception of dignity as the bounded property of the liberal, autonomous agent, toward a more capacious understanding of dignity, as the affective relationality between persons? How does the negative force of the death penalty radiate beyond the condemned and exert its power over their loved ones, family, and even the staff of the prison? What might it mean lose one’s autonomy, a word that derives from the law (nomos) over the self (autos), in the face of the state’s management of life and death? Exploring the moral and legal staging of the death penalty in Chinonye Chukwu’s Clemency (2019) and Boo Junfeng’s Apprentice (2016) this article examines conceptions of personhood when “civility” meets capital punishment.
Therapeutic regimens against Helicobacter pylori infection without proton pump inhibitors in patients with corpus atrophic gastritis: a real-life single-centre longitudinal observational study
Authors: Dilaghi Emanuele , Mosciatti Lorenzo , Dottori Ludovica , Ligato Irene , Esposito Gianluca , Pilozzi Emanuela , Annibale Bruno , Lahner Edith
Published: January 2025

Background:

Efficacy of eradication regimens in Helicobacter pylori (Hp) infection is commonly reported with proton pump inhibitors (PPIs). In patients with corpus atrophic gastritis, characterized by impaired acid secretion, PPI treatment is questionable.

Objectives:

The current study aimed to assess in clinical practice the tolerability and eradication rate of modified eradication regimens without PPI as first-line treatment in patients with histologically Hp-positive corpus atrophic gastritis.

Design:

Real-life longitudinal observational study.

Methods:

Overall, 76 patients (77.6% females, age 58.5 (26–88) years) with histologically Hp-positive corpus atrophic gastritis were consecutively diagnosed (2001–2022). First-line eradication treatment was prescribed without PPIs: concomitant or sequential amoxicillin-based therapy (ABT) until 2016 ( n = 30), then single-pill bismuth treatment (SPBT; n = 46). Treatment adherence and adverse events were clinically evaluated and treatment efficacy was assessed by histopathology (updated Sydney system) at 6 ± 3 months after treatment.

Results:

Only mild adverse events not requiring medical treatment were observed in four patients treated with SPBT without PPIs (vomiting, self-limiting diarrhoea, nausea, abdominal discomfort) and in two treated with ABT without PPIs (vomiting and abdominal discomfort). Overall, 71/76 (93.4%) corpus atrophic gastritis patients completed the treatment: 43/46 (93.5%) SPBT without PPIs and 28/30 (93.3%) ABT without PPIs. Successful cure of Hp was observed in 64/71 patients: overall eradication rate 90.1%, 95%CI 69.4%–115.1%. 42/43 corpus atrophic gastritis patients treated with SPBT without PPIs were successfully cured against 22/28 of those treated with ABT without PPIs. The eradication rate was higher for SPBT than ABT: 97.7%, 95%CI 70.4%–132.0% vs 78.6%, 95%CI 49.2%–118.9%, p = 0.013.

Conclusion:

In clinical practice, Hp cure can be achieved without PPIs as first-line treatment in about 90% of patients with corpus atrophic gastritis.
mHealth-assisted expiratory muscle strength training in Parkinson's disease patients: A proof-of-concept study
Authors: Srp Martin , Ferro Álvaro Sánchez , Ferreira Joaquim , Cacho Ricardo , Antunes Laura , Bouça-Machado Raquel , Gál Ota , Hoskovcová Martina , Kliment Radim , Mužík Jan , Mestre Tiago A , Rangel Daniel Pérez , Růžička Evžen , consortium iCARE-PD
Published: January 2025

Background

Expiratory muscle strength training (EMST) is acknowledged for its therapeutic benefits in Parkinson's disease (PD), yet long-term adherence remains a challenge.

Objective

The primary aim of this study was to assess the preliminary effects of EMST coupled with a mobile health app (SpiroGym) on self-efficacy and exercise adherence in PD patients. The secondary aim was to assess the usability of the SpiroGym app.

Methods

This single-group, multicenter, multinational proof-of-concept study involved 63 PD patients across four tertiary PD centers. Participants were enrolled in either a 1-week (n = 35) or 24-week (n = 28) EMST program coupled with SpiroGym app. Self-efficacy was assessed using the Self-Efficacy for Home Exercise Program scale (SEHEPS) and exercise adherence was monitored by SpiroGym app. Usability was evaluated using the System Usability Scale.

Results

Post-intervention, significant improvements in SEHEPS were observed in 1-week group (d = 0.48; p = 0.02) and 24-week group (d = 0.57; p = 0.002). Adherence rates in the 24-week PD patient group were high throughout the course of the study. Post-training SEHEPS was found to correlate (rho = 0.55; adjusted p = 0.016) with adherence to EMST during the non-supervised maintenance phase. The SpiroGym app exhibited high usability (>85th percentile score), with no significant differences noted between short-term and long-term use, indicating sustained user satisfaction.

Conclusions

The results of our study suggest a promising role for SpiroGym app in supporting adherence to home-based EMST in PD patients. Nevertheless, future comparative studies are required to confirm SpiroGym's effectiveness.
Rethinking ‘rare’ PINK1 Parkinson's disease: A meta-analysis of geographical prevalence, phenotypic diversity, and α-synuclein pathology
Authors: Yin Eden Paige , Dieriks Birger Victor
Published: January 2025

PTEN-induced kinase 1 ( PINK1)-related Parkinson's disease (PD) is traditionally considered a rare autosomal recessive form of early-onset PD (EOPD), lacking classical Lewy body pathology. However, this characterization underestimates and oversimplifies PINK1-PD, largely due to a lack of extensive studies in diverse ethnic populations. This review and meta-analysis explores considerable variations in PINK1 variant rates and the wide heterogeneity influenced by patient- and variant-specific factors, delineating a more precise disease profile. Our findings reveal that PINK1-PD is more common than previously thought, with geographic ‘hotspots’ where up to 9% of EOPD cases are linked to PINK1 variants, including the pathogenic p.Leu347Pro variant affecting 1 in 1300 West Polynesians. Homozygous PINK1-PD typically manifests around age 35, predominantly affecting the lower limbs, with an excellent response to levodopa. Heterozygous PINK1-PD presents an ‘intermediate’ phenotype, with a later onset age (around 43 years) than homozygous PINK1-PD but earlier than idiopathic PD (typically after age 65). The severity of the phenotype is influenced by variant zygosity and pathogenicity, interacting with genetic and environmental factors to push some individuals beyond the disease threshold. Notably, females with PINK1-PD have earlier onset age than males, particularly in homozygous cases and when variants occur in the first half of PINK1's kinase domain. Contrary to traditional views, α-synuclein pathology is present in 87.5% of PINK1-PD postmortem cases across ages and variants. We challenge conventional views on PINK1-PD, highlighting distinct phenotypes influenced by zygosity, sex, and a role for α-synuclein pathology, urging for increased recognition and research of this not-so-rare disease.
Addressing the need for standardization of symptomatic medication documentation in Parkinson's disease clinical research: A call to action
Authors: Spott Mikayla , Javidnia Monica , Pedata Anne , Müller Martijn , Carrillo Laura , Simuni Tanya , Pagano Gennaro , Kwok Kevin , Romero Klaus , Stephenson Diane
Published: January 2025

People with Parkinson's disease (PD) are prescribed a variety of medications to mitigate symptoms and improve their quality of life. These symptomatic therapies cover a range of pharmacological classes, including classical dopaminergic treatments, other antiparkinsonian agents, and pharmacotherapies for non-PD conditions. Often, medications are prescribed for concomitant use and in increasing doses, particularly as the disease progresses. Documentation of these interventions in clinical trials is necessary to accurately capture medication usage, compare medication utilization across different studies, understand factors contributing to experimental therapeutic response, and analyze clinical trial data in a precise manner. At the present time, there is no current international standard for how these medications are documented within clinical trials. As a case example, we will highlight medication use documentation in a large international multicenter observational study commonly used as a reference for design of clinical trials. This review aims to raise awareness within the scientific community of the importance of proper medication documentation and the need for standardization to harmonize prescriptive practices, improve treatment interpretability, and perform consistently robust analyses from clinical trials data.
Proposed biological definitions of Parkinson's disease confuse understanding without delivering meaningful advances
Authors: Cardoso Francisco , Schmidt Peter
Published: January 2025

This article reflects on two proposals to classify and stage Parkinson's disease (PD) and related conditions based on the presence of aggregated alpha-synuclein (ASN) detected by alpha-synuclein aggregation assay (SAA). The authors highlight the significant shortcomings of the proposals: detection of ASN by SAA is not specific of PD or other well-established clinical conditions; they do not allow prediction of clinical course and prognosis; and they are not suitable as an endpoint for clinical trials. To move forward with proposals reflecting so many uncertainties and unknowns will just sow confusion and misunderstanding within the PD community.
Learning to Share Gendered Military Experiences: An Autoethnographic Exploration of Expressive Writing in Transforming Military Cultures
Authors: Taber Nancy
Published: January 2025

This article discusses the analytic-evocative autoethnographic exploration of my learning experiences planning for, facilitating, participating in, and reflecting on a series of expressive writing workshops for women-identifying Canadians who have served in the military. I explore how the intersection of expressive writing, adult education, and feminist antimilitarism can inform understandings of individual military service, the collective institution of the military, and transforming military cultures. I detail my methodology of autoethnography, including a discussion of method and analysis, which demonstrates how the core elements of expressive writing and autoethnography are at odds with those of military cultures. For these reasons, expressive writing and autoethnography hold great potential for transforming military cultures, which is why I chose to combine these creative forms of writing and exploration in my research. I explain my thematic findings of: reclaiming military identity, memories, and story through imagination; and, building community through story-telling inspired by shared gendered military experiences. I present a found poem created from my writing during the workshop series that emerged from my thematic findings. I conclude with implications for adult education and autoethnographers in the context of working toward transforming military cultures.
Early Impact of Hip Arthroscopy on the Resolution of Symptom Burden in Athletes With Femoroacetabular Impingement
Authors: Filan David , Mullins Karen , Carton Patrick
Published: January 2025

Background:

Coexisting symptoms can confound outcomes after arthroscopic correction of femoroacetabular impingement (FAI). Symptom burden (SB) represents the cumulative load of patient-reported symptoms.

Purpose:

To quantify the prevalence of symptoms in athletes before and after arthroscopic correction of FAI and evaluate the impact of independent and cumulative SB resolution on outcomes.

Study Design:

Case series; Level of evidence, 4.

Methods:

Included were 509 hips of 386 athletes (89% men; age, 26.4 ± 6.1 years) who underwent primary hip arthroscopy for FAI between 2011 and 2020. Symptom prevalence was assessed preoperatively and 1 year postoperatively using a 15-item SB survey, with the total number of symptoms reported as the SB score. Minimal clinically important difference (MCID-SB) and substantial clinical benefit (SCB-SB) thresholds according to the proportional pre- to postoperative resolution of SB were calculated, and 1- and 2-year postoperative patient-reported outcome measures (PROMs)—including the modified Harris Hip Score and 36-Item Short Form Survey—were compared relative to MCID-SB and SCB-SB achievement. Multivariable stepwise regression was used to evaluate the ability of individual symptom resolution for MCID and SCB achievements on PROMs.

Results:

The SB score was 6 ± 2.9 preoperatively, improving to 2.8 ± 2.7 at 1 year postoperatively ( P < .001). A proportional reduction in symptoms by 48.5% and 70.3% defined the MCID-SB and SCB-SB, respectively; this was achieved by 63.6% and 43.8% of the hips, respectively. Postoperatively, PROMs were superior where clinically meaningful SB resolution thresholds were achieved ( P < .001). A significantly higher proportion of these cases returned to their main sport (79.4% vs 63.1% achieved MCID-SB; 83.8% vs 65.2% achieved SCB-SB) ( P < .001). Odds ratios for symptoms associated with achieving the MCID on PROMs included resolution of groin pain (2.6-5.5), side hip pain (3.4), pain during (3.1) and after (2.6-3.5) activity, hamstring tightness (2.6), and limping after activity (2.6). Symptom resolution associated with achieving SCB included groin pain (3.0-3.1), pain during (3.3) and after (2.7-4.2) activity, and limping after activity (3-6.8).

Conclusion:

Achieving thresholds of clinically important SB resolution was associated with superior postoperative PROM scores and higher rates of return to sports for this athletic cohort. Resolution of groin pain, pain during/after activity, hamstring tightness, and limping after activity increased the odds of achieving clinically important improvement on PROMs.
Developing a Psychiatry Residency Program in a Low- and Middle-Income Country: Botswana’s Experience
Authors: Opondo Philip R. , Olashore Anthony A. , Ayugi James O. , Kebaetse Masego B. , Molebatsi Keneilwe
Published: January 2025

Like many other low- and middle-income countries, Botswana has struggled to address the shortage of doctors, particularly specialists. In 2009, the country’s first medical school offering an undergraduate medical program was established. A needs and feasibility assessment was conducted with relevant stakeholders to explore the need for specialty training programs in all medical school departments. As a result, three residency programs were established a year after the undergraduate program, but psychiatry was not included in this first crop of residency programs. Existing strengths in the university and healthcare systems were leveraged to successfully establish a four-year Master of Medicine residency program in psychiatry, which began in January 2020. The program aims to produce psychiatrists who are familiar with the local mental health needs. The first batch of students completed their training in December 2023. This paper reflects on and describes the development of a psychiatry residency program in Botswana and contributes a process grounded in educational program development models and educational theories that others can utilize. Botswana’s experience may be helpful to other low- and middle-income countries, particularly in sub-Saharan Africa, that want to establish and run a locally developed residency program in psychiatry.
Cadaveric Study Evaluating the Potential for Hindfoot Endoscopy and Flexor Hallucis Longus Tendoscopy Using a 1.9-mm Diameter Needle Arthroscope
Authors: Shimozono Yoshiharu , Arai Ryuzo , Kuroda Yutaka , Ito Hiromu , Matsuda Shuichi
Published: January 2025

Background:

Hindfoot endoscopy is an effective treatment for posterior ankle impingement syndrome (PAIS) and flexor hallucis longus (FHL) tendon disorders. However, FHL tendoscopy, especially from the posteromedial portal, carries a risk of tibial nerve damage. A needle-arthroscopic system with a 1.9-mm-diameter arthroscope, a semirigid frame, and a 0-degree direction of view has been introduced. This study aimed to evaluate the efficacy and safety of this system in visualizing and reaching significant structures in hindfoot endoscopy and FHL tendoscopy through the posteromedial and posterolateral portals using a cadaveric model.

Methods:

The 1.9-mm-diameter arthroscopic system (NanoScope, Arthrex) was used to perform hindfoot endoscopy in 6 human donor ankles (3 pairs). The arthroscope tube is 9.5 cm long, semirigid, and has an outer diameter of 1.9 mm, a 0-degree direction of view, and a 120-degree field of view. Posteromedial and posterolateral portals were established. Visualization and operative reach were recorded, including the posterolateral talar process, posterior talofibular ligament, intermalleolar ligament, subtalar joint, and FHL tendon. The neurovascular bundle and FHL tendon were examined for kinks or damage.

Results:

All significant structures were successfully visualized in all specimens. The wide 120-degree field of view facilitated adequate visualization of all structures. In all specimens, the FHL tendon was visualized from the ankle joint to the knot of Henry (zones 1 and 2), and the flexor digitorum longus tendon was observed via both portals. There were no signs of neurovascular damage from either the posterolateral or posteromedial portals.

Conclusion:

In this cadaver experiment without known pathology, use of a 1.9-mm-diameter needle-arthroscopy with a 0-degree direction of view provided effective visualization of all significant structures in treating PAIS and FHL tendon disorders. It appears that FHL tendoscopy can be performed from the level of the ankle joint to the knot of Henry via both the posterolateral and posteromedial portals.
A numerical study on the seismic retrofit of Haitian reinforced concrete building frames
Authors: Laguerre Marc-Ansy , Salehi Mohammad , DesRoches Reginald
Published: January 2025

Many countries with moderate and high seismic risk have upgraded their building design standards and have developed techniques to strengthen their seismically deficient buildings. However, very limited research has been conducted on the seismic evaluation and retrofit of Haiti’s existing buildings. In an effort toward filling this gap, after reviewing the reinforced concrete (RC) building construction practices in Haiti, this article numerically evaluates the seismic performances of four different non-ductile RC building frames typical of Haiti and five different techniques to retrofit those. Specifically, the selected RC building frames are of one to three stories and of residential and non-residential functions. The examined retrofit techniques include using RC shear walls, using steel braces, using buckling-restrained braces (BRBs), using prestressed high-strength steel cables, and RC jacketing. To examine the damage of the columns and the beam-to-column joints of the original frame archetypes, their detailed three-dimensional finite element models are initially developed and analyzed via the software LS-DYNA. Subsequently, each frame is retrofitted through three of the above-mentioned techniques. A suite of 11 ground motions is selected and scaled to evaluate the effectiveness of the retrofits by performing time-history analysis on calibrated models on OpenSees. The analysis indicated that these techniques can efficiently retrofit the prototypes of Haitian structures. All the retrofits significantly reduce the interstory drift demand, and the RC jacket significantly increases the moment and shear capacity of the columns.
A qualitative systematic review of umbilical cord care practices in Nigeria
Authors: Anyakorah Precious Ebube , Aguna Florence Chinelo , Innocent David Chinaecherem , Uwandu-Uzoma Anthony Chinonso , Ekeleme Uzochukwu Godswill , Obasi Chidera Chisom , Eneh Stanley Chinedu , Ahunam Chidinma Peace , Dike Ihuoma Chimdimma , Maduekwe Vivian Chidimma , Ayando Oluwaseunayo Deborah , Duruji Chinazaekpere Oguguo , Innocent Rejoicing Chijindum , Uwaezuoke Princess Chidiebube , Adenuga Oluwafunmilayo Opeyemi , Emerole Chiagoziem Ogazirilem
Published: January 2025

Background

Umbilical cord care is an important aspect of newborn health, and different practices exist around the world, often influenced by cultural, healthcare infrastructure, and socioeconomic factors. The objective of this systematic review is to synthesize current literature on umbilical cord care practices in Nigeria, with an emphasis on the impact of cultural beliefs, healthcare infrastructure, and socioeconomic factors.

Methods

A comprehensive search for literature was performed across PubMED, MEDLINE and Google scholar for studies published between 2010 and 2023. The preferred reporting items for systematic reviews and meta-analysis (PRISMA) guidelines was followed for the execution of this study. Eligibility criteria included only English studies investigating umbilical cord care practices in Nigeria, with outcomes connected to cultural, healthcare, or socioeconomic factors. Critical Appraisal Skills Programme (CASP) checklist was used to critically appraise the quality and rigor of selected studies. Due to the heterogeneity of the studies (qualitative and quantitative), qualitative narrative synthesis was used to synthesize the studies in a textual format for comprehensive understanding.

Results

A total of 11 included studies were found out of 1532 studies. The findings reveal a range of cord care practices, emphasizing the use of various methods such as methylated spirit, hot compresses, and indigenous substances. Cultural beliefs, a lack of healthcare infrastructure, and socioeconomic circumstances all have a big impact on cord care decisions. Disparities in knowledge and adherence to evidence-based procedures are noticeable, particularly in the use of chlorhexidine gel. Infections continue to be a problem, highlighting the significance of appropriate therapies.

Conclusion

This systematic review offers a comprehensive perspective of Nigerian umbilical cord care practices, emphasizing the importance of culturally responsive educational interventions, enhanced healthcare infrastructure, and targeted legislative measures. Despite its limitations, the study is an important resource for guiding future research, policy creation, and interventions to improve maternal and newborn health outcomes in Nigeria.
Tibial tubercle transfer SurgeRy and physiothErapy Versus physIotherapy only for chronic paTellofemorAL paIn: study protocol for a randomiSed controllEd trial (REVITALISE)
Authors: van de Ven Myrthe P. F. , Ophey Martin , van de Graaf Victor , van de Groes Sebastiaan A. W. , Sinkeldam Marijn , Wijers Charlotte H. W. , Koëter Sander
Published: January 2025

Background

Patellofemoral pain (PFP) is a common musculoskeletal disorder resulting in anterior knee pain. Physiotherapy is the current standard treatment, while surgical intervention (tibial tubercle transfer [TTT]) is reserved for chronic cases when nonoperative treatment has failed. TTT can result in clinically meaningful improvement in patients with patellofemoral maltracking without instability. However, to date, no randomised controlled trials (RCT) have compared TTT combined with a physiotherapy (PT) programme to PT alone as the initial treatment for PFP.

Methods

A single-centre nonblinded RCT in 40 patients with chronic PFP (> 1 year) and tibial tubercle-trochlear groove (TT-TG) > 15 mm will be randomised to either TTT followed by PT or to PT alone in a 1:1 ratio in a concealed manner. The primary outcome is knee pain at 18 weeks for the TTT group (6 weeks splint phase + 12 weeks PT) and at 12 weeks for the PT group, measured by the visual analog scale (VAS). Secondary outcomes include Patient-Reported Outcome Measures (PROMs) using the Kujala score, International Knee Documentation Committee (IKDC) ‘Subjective Knee Form’, Tegner Activity score and EuroQol 5D-5 L for quality of life. Range of motion (ROM) is measured using the decline step-down test (DSDT). Between-group differences will be analysed using multivariable linear regression analysis, while longitudinal differences will be assessed with linear mixed models for repeated measures. The difference in direct medical costs will also be assessed.

Discussion

The REVITALISE study is the first randomised study to compare surgical intervention (TTT) followed by PT to PT alone in patients with chronic PFP. This study will generate level-1 evidence on the most effective treatment for chronic PFP, which can be integrated into the national guideline to aid orthopaedic surgeons and physiotherapists in their decision-making and ultimately improve our care for patients with chronic PFP.

Trial registration

Study Identifier NCT06227806, registered on 26 Jan 2024 on ClinicalTrials.gov. The study underwent independent peer review and received approval from the ethical review board (number NL80956.091.22).
Opioid-related harms and experiences of care among people in justice settings in New South Wales, Australia: evidence from the National Ambulance Surveillance System
Authors: Beard Naomi , McGrath Michael , Lai Harry M. X. , Wilson James , Hew Anthony , Labiano Amaya Muñoz , Lubman Dan I. , Ogeil Rowan P.
Published: January 2025

Background

People in justice settings experience higher rates of psychiatric morbidity, including alcohol and drug use disorders, compared with the general population. However, our understanding of opioid-related harms in justice settings is limited. This study used ambulance data to examine opioid-related harms and experiences of care in New South Wales (NSW), Australia, during periods of incarceration or detention.

Methods

This mixed-methods study used data from the National Ambulance Surveillance System (NASS) for patients aged 18 and older with an opioid-related ambulance attendance between December 2020 and April 2023. People in justice settings were identified using ambulance billing codes and manual review of paramedic case notes. Descriptive statistics described the patterns and modalities of opioid-related harms in justice settings, and a qualitative thematic analysis of paramedic case notes was used to contextualise findings. Results Over the study period, 328 opioid-related ambulance attendances for people in justice settings were identified (51% heroin; 41% opioid agonist therapy (OAT) medication). Symptoms of opioid withdrawal were noted in 35% of attendances, most commonly for heroin (51%) and withdrawal from OAT medications (48%). Three interconnected themes were identified using qualitative analysis: trust and mistrust in justice settings, systemic barriers to providing OAT, and other harm reduction strategies, and experiences of withdrawal in justice settings.

Conclusion

Our study demonstrated the utility of ambulance data in identifying opioid-related harms for people in justice settings in NSW. Qualitative findings highlight current barriers to effective opioid care in justice settings and identify opportunities for intervention, including targeted harm reduction programs, as well as policies that promote continuity of care particularly during transitions in and out of justice settings.
Seismic Strength Evaluation of Corroded Reactor Containment Building
Authors: Azad Md Samdani , Nguyen Duy-Duan , Thusa Bidhek , Lee Tae-Hyung
Published: January 2025

The purpose of this study is to investigate the effects of the corrosion phenomenon on the seismic strength of a reactor containment building (RCB) in nuclear power plants (NPPs). A corrosion degradation model is proposed based on the rationale of NPP structures and applied to the reinforcements near the base mat of RCB. Three corrosion levels associated with the service life of the structure up to 60 years are considered in this study. Seven different cases are considered depending on the location of corrosion. A series of pushover analyses are performed to evaluate the seismic responses of the corroded RCB, considering all cases with different levels of damage due to corrosion. The results are obtained in terms of global responses, in which capacity curves, base shear at different limit states, demand–capacity ratios, and reserve strength ratios (RSR) are quantified. The findings of this study demonstrate that corrosion can cause a reduction in structural capacity in terms of base shear of up to 19.5% during its service life of 60 years and that is dependent on how the corrosion is propagated within RCB. The results also illustrate that corrosion in the elements in the tension zone increases the sensitivity of the responses subjected to seismic loads.
Psychotherapy boosting future risk research: the role of radical masculinities in social polarisation from a trauma-informed perspective
Authors: Tóth Erzsébet Fanni , Midor Kamila , Darabos Enikő
Published: January 2025

This paper examines the potential integration of trauma-informed practices and Critical Studies on Men and Masculinities (CSMM) into global and European risk research, with a focus on foresight methodologies. It explores how the complex interplay between untreated trauma, rapid resource loss, radicalisation, and rigid masculine norms can potentially escalate societal risks. The study argues for the adoption of a more holistic approach in risk assessment and future planning, incorporating insights from trauma studies, masculinity research, and psychotherapy. The paper discusses the value of participatory foresight methods in capturing diverse perspectives and lived experiences, particularly those affected by toxic masculinity and radicalisation. We highlight the importance of considering intersectionality and the compounded traumas that may arise from the interaction of extremist masculine norms with other social factors. Current findings suggest that including psychotherapy scientists and practitioners in risk research could provide valuable insights into the psychological mechanisms underlying trauma, meaning-making, and identity formation. By adopting this interdisciplinary approach, the paper proposes that risk researchers may develop more comprehensive and nuanced understandings of societal risks, leading to more effective strategies for addressing the complex challenges posed by radicalisation, radical masculinity/ies, and the associated traumas in an increasingly uncertain world.
Efficacy and safety of home-based transcranial direct current stimulation as adjunct treatment for cognitive improvement in major depressive disorder: A double-blind, randomized, multi-site clinical trial
Authors: Lee CW , Park K , Ahn JE , Jang Y , Park YS , Yu H , Lee D , Ihm HK , Lee J , Kim J , Lee YI , Lim S-E , Kwon SS , Park HY , Ha TH , Yoon I-Y , Myung Woojae , Baek Ji Hyun
Published: January 2025

Background

Transcranial direct current stimulation (tDCS) is a promising treatment for major depressive disorder (MDD). This study evaluated its antidepressant and cognitive effects as a safe, effective, home-based therapy for MDD.

Methods

This double-blind, sham-controlled, randomized trial divided participants into low-intensity (1 mA, n = 47), high-intensity (2 mA, n = 49), and sham (n = 45) groups, receiving 42 daily tDCS sessions, including weekends and holidays, targeting the dorsolateral prefrontal cortex for 30 minutes. Assessments were conducted at baseline and weeks 2, 4, and 6. The primary outcome was cognitive improvement assessed by changes in total accuracy on the 2-back test from baseline to week 6. Secondary outcomes included changes in depressive symptoms (HAM-D), anxiety (HAM-A), and quality of life (QLES). Adverse events were monitored. This trial was registered with ClinicalTrials.gov (NCT04709952).

Results

In the tDCS study, of 141 participants (102 [72.3%] women; mean age 35.7 years, standard deviation 12.7), 95 completed the trial. Mean changes in the total accuracy scores from baseline to week 6 were compared across the three groups using an F-test. Linear mixed-effects models examined the interaction of group and time. Results showed no significant differences among groups in cognitive or depressive outcomes at week 6. Active groups experienced more mild adverse events compared to sham but had similar rates of severe adverse events and dropout.

Conclusions

Home-based tDCS for MDD demonstrated no evidence of effectiveness but was safe and well-tolerated. Further research is needed to address the technical limitations, evaluate broader cognitive functions, and extend durations to evaluate its therapeutic potential.
Effect of Sodium-glucose Transporter 2 Inhibitors on Cardiovascular Outcomes in Type 1 Diabetes Mellitus: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Authors: Wang Songwei , Zhang Yueqi , Balati Abudunaibi , Li Bing , Dai Lei , Yu Dan
Published: January 2025

Background

Cardiovascular disease is a major cause of increasing morbidity and mortality in type 1 diabetes mellitus (T1DM). Although insulin therapy is the cornerstone of T1DM, its difficult use and narrow therapeutic index make it difficult for patients to reach glycated hemoglobin targets, increasing the risk of cardiovascular events. Therefore, the combination of sodium-glucose transporter 2 inhibitors (SGLT2i) can likely improve or provide more cardiovascular benefits to patients with T1DM.

Methods

This study conducted a systematic review and meta-analysis of randomized controlled trials published in PubMed, Scopus, Cochrane Library, Web of Science, and Embase up to June 30, 2024. The data from eligible trials were summarized as mean difference (MD) and SD for continuous methods and 95% CI and risk ratio (RR) for dichotomous approaches.

Results

There were 16 articles that met the inclusion criteria. Compared with placebo, SGLT2i significantly reduced glycated hemoglobin levels (MD: −0.40%, 95% CI, −0.44 to −0.36; P < .00001, I2 = 37%), and body weight (MD: −3.31 kg, 95% CI, −3.67 to −2.96; P < .00001, I2 = 70%) in insulin-using patients with T1DM, and did not significantly increase the risk of hypoglycemia and severe hypoglycemia. It should be noted that SGLT2i significantly increased the risk of diabetic ketoacidosis acidosis (RR: 4.45, 95% CI, 2.81-7.05, P < .00001, I2 = 0%).

Conclusion

SGLT2i not only significantly improved glycated hemoglobin and body weight in patients with T1DM but also significantly increased the risk of diabetic ketoacidosis acidosis.
Approach to the Patient with Achondroplasia—New Considerations for Diagnosis, Management, and Treatment
Authors: Merchant Nadia , Hoover-Fong Julie , Carroll Ricki S
Published: January 2025

Achondroplasia is the most common disproportionate short-stature skeletal dysplasia. Features associated with achondroplasia are rhizomelia, macrocephaly, midface hypoplasia, and typical cognition. Potential medical complications include foramen magnum stenosis, hydrocephalus, middle ear dysfunction, obstructive and central sleep apnea, spinal stenosis, and genu varum. Recently, vosoritide, a C-type natriuretic peptide analogue, was approved by the Food and Drug Administration with the primary indication of increasing linear growth in all children with achondroplasia and open growth plates. Due to this, pediatric endocrinologists suddenly are encountering infants and children with achondroplasia in their clinic whose families are seeking treatment with vosoritide. There is an urgent need to provide practical guidance pertaining to the diagnosis, management, and surveillance of these patients. Specific to current clinical use of vosoritide and other growth-modulating therapies in development for patients with achondroplasia, it is important to recognize that 1. some children and their families do not automatically desire such treatment, 2. not all treated children exhibit a response in linear growth, and 3. treatment does not negate the necessity of actively surveilling for the potential complications of achondroplasia that are part of its natural history. The goal of this paper is to provide probable, contemporary clinical scenarios of infants and children with achondroplasia who may present to an endocrinologist. This information is especially crucial to the endocrinologist when there is no specialized skeletal dysplasia center near the family.
Eldecalcitol Add-on to Risedronate Reduces Bone Loss From Aromatase Inhibitors in Postmenopausal Breast Cancer Patients
Authors: Imanishi Yasuo , Imai Takumi , Fujii Hisako , Aida Rei , Nagata Yuki , Shoji Tetsuo , Kashiwagi Shinichiro , Takashima Tsutomu , Emoto Masanori
Published: January 2025

Context

Aromatase inhibitors (AIs) cause bone loss and increase fracture risk in women with hormone receptor-positive early-stage breast cancer (HR + EBC). Bone antiresorptive agents are recommended for patients at risk of fragility fractures. Eldecalcitol, combined with bisphosphonate, increases bone mineral density (BMD) in primary osteoporosis.

Objective

To determine the effect of eldecalcitol (0.75 ug/day) add-on therapy to risedronate (17.5 mg/week) on bone quantity and quality in women treated with AI.

Design

Open-label randomized control trial.

Setting

Postmenopausal women with HR + EBC (TNM stage 0-3A) treated with risedronate for more than 12 months.

Patients

Two hundred patients were enrolled; 196 patients were eligible for the full analysis set after excluding those without follow-up BMD data. Participants were advised to take vitamin D and calcium, yet many were vitamin D deficient or insufficient.

Intervention

Participants were randomly assigned in a 1:1 ratio to receive either eldecalcitol add-on therapy or risedronate monotherapy.

Main Outcome Measure

The primary outcome was the group difference in the change of lumbar spine (LS)-BMD in 24 months. Secondary outcomes included femoral neck (FN)-BMD, total hip (TH)-BMD, trabecular bone score (TBS), and the incidence of vertebral and nonvertebral fractures.

Results

The increase at LS-, FN-, and TH-BMD at 24 months was larger in the add-on therapy group than in the monotherapy group, with a group difference (add-on therapy minus monotherapy) estimate of 0.020 g/cm2 [95% confidence interval (CI): 0.010-0.029 g/cm2, P < .001] for LS-BMD. The incidence rate ratio (add-on therapy/monotherapy) for morphometric vertebral fractures was 0.292 (95% CI: 0.080-1.061, P = .061). No group difference was detected in the change in TBS.

Conclusion

Eldecalcitol add-on therapy increased LS-BMD in osteopenic to osteoporotic postmenopausal women treated with an AI and risedronate.
“Women Should Become Thinner When They Are Pregnant”: Corpulency and Women's Reproductive Health in the Long Eighteenth Century
Authors: Goodge Charlotte
Published: January 2025

In the long eighteenth century, medical writers were quick to condemn “corpulence” or “corpulency” (the Georgian equivalent terms for “obesity”) in potential or actual mothers. Medical writing from the period criticizes the influence of corpulence on the reproductive health of women, claiming that corpulence's impact on female fertility is either obstructive, or eventually results in abortive maternity. However, this article's examination of fictional “fat” women, alongside contemporary medical opinions on corpulence's effect on female health, reveals that the medical condemnation of the fat woman was as much influenced by social expectations of female reproductiveness as it was made on scientific grounds. By examining a variety of fictional fat women, I hope to demonstrate how popular eighteenth-century works interacted with medical opinion, sometimes reinforcing but just as often probing, disputing, and rejecting the condemnation with which medical writers treated corpulent women. I will look at several such women in literary and visual culture: James Gillray's caricature of Albinia Hobart, Countess of Buckinghamshire (1737/38 – 1816), Rachel Hodges from Maria Edgeworth's “Angelina: or, L'aime Inconnue” (1801), and Miss Groves from Charlotte Lennox's The Female Quixote (1752). As Hobart, Hodges, and Groves show, concerns over female fatness are seldom exclusively health related. These characters underscore how the fat woman is not simply a point of satire, or a pathologized and useless body, but can also be fertile, autonomous, and even healthy. Ultimately, I will claim that the fat woman is more than just a cypher of medical opinion: she is also a discordant figure of criticism too.
Phase I/II Study of Neoadjuvant Chemoradiotherapy Consisting of S-1 and Cisplatin for Patients with Clinically Resectable Type 4 or Large Type 3 Gastric Cancer (OGSG1205)
Authors: Shinkai Masayuki , Imano Motohiro , Yokokawa Masaki , Tanaka Ryo , Matsuyama Jin , Shimokawa Toshio , Kawakami Hisato , Satoh Taroh , Yasuda Takushi , Furukawa Hiroshi
Published: January 2025

Background

To improve the prognosis of clinically resectable type 4 or large type 3 gastric cancer (GC), we performed a phase I/II study of neoadjuvant-radiotherapy combined with S-1 plus cisplatin.

Patients and Methods

Phase I, with a standard 3 + 3 dose-escalation design, was performed to define the recommended phase II dose. Efficacy and safety were evaluated in phase II. The three dose levels were as follows: level 0, S-1 60 mg/m2 on days 1–14 plus cisplatin 60 mg/m2 on day 1; level 1, S-1 80 mg/m2 on days 1–14 plus cisplatin 60 mg/m2 on day 1; and level 2, S-1 80 mg/m2 on days 1–14 and 22–35, plus cisplatin 60 mg/m2 on days 1 and 22. The starting dose was level 1. Radiotherapy was delivered at a total dose of 40 Gy in fractions for 4 weeks.

Results

A total of six patients were enrolled in the phase I study. Dose-limiting toxicity was observed at level 2; level 1 was established as the recommended phase II dose. In phase II, 20 patients were enrolled from November 2012 to April 2018. Grade 3/4 leukopenia and nonhematologic adverse events occurred in 35% and 5% of the patients, respectively. In total, 19 patients underwent the protocol surgery; 2 (10.5%) achieved a pathological complete response. There were no treatment-related deaths; 3- and 5-year overall survival rates were 70.0 and 50.0%, respectively.

Conclusions

Neoadjuvant chemoradiotherapy with S-1 plus cisplatin is a safe and promising treatment for clinically resectable type 4 or large type 3 GC.