bluuebunny/crossref_metadata_2025 huggingface dataset:
Validation of the Learner Engagement Instrument for Continuing Professional Development
Authors: Cook David A. , Stephenson Christopher R.
Published: April 2024

Purpose

Learner engagement is the energy learners exert to remain focused and motivated to learn. The Learner Engagement Instrument (LEI) was developed to measure learner engagement in a short continuing professional development (CPD) activity. The authors validated LEI scores using validity evidence of internal structure and relationships with other variables.

Method

Participants attended 1 of 4 CPD courses (1 in-person, 2 online livestreamed, and 1 either in-person or livestreamed) in 2018, 2020, 2021, and 2022. Confirmatory factor analysis was used to examine model fit for several alternative structural models, separately for each course. The authors also conducted a generalizability study to estimate score reliability. Associations were evaluated between LEI scores and Continuing Medical Education Teaching Effectiveness (CMETE) scores and participant demographics. Statistical methods accounted for repeated measures by participants.

Results

Four hundred fifteen unique participants attended 203 different CPD presentations and completed the LEI 11,567 times. The originally hypothesized 4-domain model of learner engagement (domains: emotional, behavioral, cognitive in-class, cognitive out-of-class) demonstrated best model fit in all 4 courses, with comparative fit index ≥ 0.99, standardized root mean square residual ≤ 0.031, and root mean square error of approximation ≤ 0.047. The reliability for overall scores and domain scores were all acceptable (50-rater G-coefficient ≥ 0.74) except for the cognitive in-class domain (50-rater G-coefficient of 0.55 to 0.66). Findings were similar for both in-person and online delivery modalities. Correlation of LEI scores with teaching effectiveness was confirmed (rho=0.58), and a small correlation was found with participant age (rho=0.19); other associations were small and not statistically significant. Using these findings, we generated a shortened 4-item instrument, the LEI Short Form.

Conclusions

This study confirms a 4-domain model of learner engagement and provides validity evidence that supports using LEI scores to measure learner engagement in both in-person and livestreamed CPD activities.
Evaluating Chat Generative Pre-trained Transformer Responses to Common Pediatric In-toeing Questions
Authors: Amaral Jason Zarahi , Schultz Rebecca J. , Martin Benjamin M. , Taylor Tristen , Touban Basel , McGraw-Heinrich Jessica , McKay Scott D. , Rosenfeld Scott B. , Smith Brian G.
Published: April 2024

Objective:

Chat generative pre-trained transformer (ChatGPT) has garnered attention in health care for its potential to reshape patient interactions. As patients increasingly rely on artificial intelligence platforms, concerns about information accuracy arise. In-toeing, a common lower extremity variation, often leads to pediatric orthopaedic referrals despite observation being the primary treatment. Our study aims to assess ChatGPT’s responses to pediatric in-toeing questions, contributing to discussions on health care innovation and technology in patient education.

Methods:

We compiled a list of 34 common in-toeing questions from the “Frequently Asked Questions” sections of 9 health care–affiliated websites, identifying 25 as the most encountered. On January 17, 2024, we queried ChatGPT 3.5 in separate sessions and recorded the responses. These 25 questions were posed again on January 21, 2024, to assess its reproducibility. Two pediatric orthopaedic surgeons evaluated responses using a scale of “excellent (no clarification)” to “unsatisfactory (substantial clarification).” Average ratings were used when evaluators’ grades were within one level of each other. In discordant cases, the senior author provided a decisive rating.

Results:

We found 46% of ChatGPT responses were “excellent” and 44% “satisfactory (minimal clarification).” In addition, 8% of cases were “satisfactory (moderate clarification)” and 2% were “unsatisfactory.” Questions had appropriate readability, with an average Flesch-Kincaid Grade Level of 4.9 (±2.1). However, ChatGPT’s responses were at a collegiate level, averaging 12.7 (±1.4). No significant differences in ratings were observed between question topics. Furthermore, ChatGPT exhibited moderate consistency after repeated queries, evidenced by a Spearman rho coefficient of 0.55 (P = 0.005). The chatbot appropriately described in-toeing as normal or spontaneously resolving in 62% of responses and consistently recommended evaluation by a health care provider in 100%.

Conclusion:

The chatbot presented a serviceable, though not perfect, representation of the diagnosis and management of pediatric in-toeing while demonstrating a moderate level of reproducibility in its responses. ChatGPT’s utility could be enhanced by improving readability and consistency and incorporating evidence-based guidelines.

Level of Evidence:

Level IV—diagnostic.
The Top 100 Cited Articles on Cervical Disc Arthroplasty
Authors: Patel Shrey , Schupper Alexander J. , Ezzat Bahie , Asfaw Zerubabbel , Yuk Frank J. , Stein Alan , Choudhri Tanvir F.
Published: April 2024

Study Design:

Bibliometric analysis.

Objective:

Cervical disc arthroplasty (CDA) has emerged as an effective surgical intervention for degenerative cervical disc disease with potential advantages over traditional cervical fusion. This bibliometric analysis aimed to assess the current state of research on CDA by analyzing the relevant literature using bibliometric indicators.

Summary of Background Data:

Web of Science Core Collection.

Methods:

A comprehensive search was conducted using the Web of Science database, for articles related to CDA published in the last 19 years. The top 100 articles were reviewed using bibliometric analysis. Publication trends, citation patterns, authorship, and collaboration networks were analyzed using VOSviewer and the Bibliometrix package in RStudio.

Results:

The results revealed a significant increase in the number of publications related to CDA over the past 2 decades, with most of the articles being published in orthopedic and spine surgery journals. The most frequently cited articles were related to clinical outcomes, complications, and biomechanical studies of CDA. Co-authorship analysis identified influential authors and collaborative networks, highlighting the multidisciplinary nature of CDA research involving neurosurgeons, orthopedic surgeons, and engineers. Overall, this bibliometric analysis provides a comprehensive overview of the current state of research on CDA, highlighting the key research themes, influential authors, and collaborative networks in the field.

Conclusion:

These findings can serve as a guide for researchers, clinicians, and policymakers to identify knowledge gaps, research trends, and future directions in the field of CDA.
Comprehensive Molecular Analyses of an M2-Like Tumor-Associated Macrophage for Predicting the Prognosis and Immunotherapy in Breast Cancer
Authors: Chang Kexin , Yue QingFang , Jin Long , Fan Pengyu , Liu Yi , Cao Fei , Zhang Yuan
Published: April 2024

The involvement of M2-like tumor-associated macrophages (TAMs) in the advancement and treatment of cancer has been widely documented. This study aimed to develop a new signature associated with M2-like TAMs to predict the prognosis and treatment response in individuals diagnosed with breast cancer (BC). Weighted gene co-expression network analysis (WGCNA) was used to identity for M2-like TAM-related modular genes. The M2-like TAM-related modular subtype was identified using unsupervised clustering. WGCNA identified 722 M2-like TAM genes, 204 of which were associated with recurrence-free survival (RFS). Patients in cluster 1 exhibited upregulated cancer-related pathways, a higher proportion of triple-negative breast cancer (TNBC) subtypes, lower expression of immune checkpoints, and worse prognosis. Cluster 2 was characterized by upregulated immune-related pathways, a higher proportion of luminal A subtypes, and higher expression of immune checkpoints. A prognostic signature was created and confirmed using an independent dataset. A well-built nomogram can accurately forecast the survival outcomes for every individual. Furthermore, patients classified as low-risk exhibited a more favorable outlook, elevated tumor microenvironment (TME) score, and superior reaction to immunotherapy. In conclusion, we discovered 2 different types of M2-like TAMs and developed a prognostic signature revealing the diversity of M2-like TAMs in BC and their correlation with immune status and prognosis. This feature can predict the prognosis and immunotherapeutic effects of BC and offer novel concepts and approaches for tailoring BC treatment.
Macrophage hitchhiking for systematic suppression in postablative multifocal HCC
Authors: Li Xuehan , Zhang Yan , Li Shun , Shi Jiaqi , Liu Caiqi , Li Xianjun , Li Yingjing , Luo Shengnan , Wang Yuan , Lai Shihui , Li Mingwei , Zhang Meng , Sun Linlin , Du Xiaoxue , Zhou Meng , Xing Fan , Zhang Qian , Wu Zhiguang , Zheng Tongsen
Published: April 2024

Background and Aims:

HCC, particularly the multifocal HCC, features aggressive invasion and dismal prognosis. Locoregional treatments were often refractory to eliminate tumor tissue, resulting in residual tumor cells persisting and subsequent progression. Owing to problematic delivery to the tumor tissue, systemic therapies, such as lenvatinib (LEN) therapy, show limited clinical benefit in preventing residual tumor progression. Therefore, more advanced strategies for postablative multifocal HCC are urgently needed.

Approach and Results:

Motivated by the chemotaxis in tumor penetration of macrophages, we report a strategy named microinvasive ablation–guided macrophage hitchhiking for the targeted therapy toward HCC. In this study, the strategy leverages the natural inflammatory gradient induced by ablation to guide LEN-loaded macrophages toward tumor targeting, which increased by ~10-fold the delivery efficiency of LEN in postablative HCC in vivo. Microinvasive ablation–guided macrophage hitchhiking has demonstrated significant antitumor activity in various HCC models, including the hydrodynamic tail vein injection multifocal HCC mouse model and the orthotopic xenograft HCC rabbit model, systematically inhibiting residual tumor progression after ablation and prolonging the median survival of tumor-bearing mice. The potential antitumor mechanism was explored using techniques such as flow cytometry, ELISA, and immunohistochemistry. We found that the strategy significantly suppressed tumor cell proliferation and neovascularization, and such enhanced delivery of LEN stimulated systemic immune responses and induced durable immune memory.

Conclusions:

The macrophage hitchhiking strategy demonstrates exceptional therapeutic efficacy and biosafety across various species, offering promising prospects for clinical translation in controlling residual tumor progression and improving outcomes following HCC ablation.
OPTICAL COHERENCE TOMOGRAPHY FINDINGS IN PRESUMED VETERINARY ANTHELMINTIC DRUG-INDUCED RETINAL TOXICITY
Authors: Guan Wen-Xue , Zhao Xu-Feng , Yu Wei-Hong , Peng Xiao-Yan
Published: April 2024

Purpose:

To report optical coherence tomography findings of presumed veterinary anthelmintic drugs (VADs)-induced retinal toxicity that may aid in understanding potential pathogenic mechanisms.

Methods:

This is a retrospective observational case series analysis of patients with vision abnormalities following the accidental or intentional consumption of veterinary anthelmintic drugs. All cases underwent a thorough ophthalmological examination. Moreover, medical records, as well as the initial and follow-up optical coherence tomography images, were thoroughly scrutinized.

Results:

Four patients were identified (3 men; mean [range] age, 36.5 [22–52] years). Each patient overdosed on one or two of the following VADs: closantel, triclabendazole, praziquantel, pyrantel pamoate, and niclofolan. The most characteristic optical coherence tomography finding was diffuse, granular, hyperreflective lesions throughout the outer retina, which were initially identified in the ellipsoid zone in two cases. At follow-up, optical coherence tomography exhibited regression of hyperreflective lesions and extensive loss of the outer retinal elements in two patients. In addition, the subfoveal outer retinal layers may be partially preserved.

Conclusion:

Some veterinary anthelmintic drugs could be detrimental to the human retina if overdosed, resulting in visual disturbances. Optical coherence tomography revealed the mitochondria-enriched ellipsoid zone where outer retinal damage first appeared on, implying that these medications may harm the retina by inhibiting mitochondrial energy metabolism, as they do to eliminate parasites.
CHANGES IN SCLERAL THICKNESS IN THE ACUTE PHASE OF VOGT–KOYANAGI–HARADA DISEASE
Authors: Oshiro Ayano , Imanaga Naoya , Terao Nobuhiro , Koizumi Hideki
Published: April 2024

Purpose:

To evaluate changes in scleral thickness in Vogt-Koyanagi-Harada (VKH) disease.

Methods:

This study included 34 eyes of 17 treatment-naïve patients with acute-phase VKH disease. Scleral thickness and the presence of ciliochoroidal effusion were examined using anterior segment optical coherence tomography at baseline and 1 week, 2 weeks, and 12 weeks after the start of corticosteroid treatment. Scleral thickness was measured 6 mm posterior to the scleral spur in four directions.

Results:

Twenty-eight eyes (82.4%) initially had ciliochoroidal effusion, but this rapidly decreased to nine eyes (26.5%) after 1 week. The sclera with ciliochoroidal effusion became thinner from baseline to 1 week at the superior (400.2 ± 46.9–353.5 ± 47.9 µm), temporal (428.4 ± 53.6–387.8 ± 56.1 µm), inferior (451.5 ± 71.0–400.5 ± 50.5 µm), and nasal (452.4 ± 78.0–407.6 ± 62.9 µm) points (P < 0.01 for all), and no further changes were observed. The sclera without ciliochoroidal effusion remained unchanged.

Conclusion:

In VKH disease, eyes with ciliochoroidal effusion exhibited the maximum scleral thickness during the acute phase. This thickening responded rapidly to treatment and became thinner within 1 week. Inflammation in VKH disease may affect not only the choroid but also the sclera.
Building Interprofessional Competency Through A Virtual Cardiopulmonary Case Collaboration
Authors: Pathare Neeti , Loder Rayne , Washington Rosanne
Published: April 2024

Introduction

Interprofessional education (IPE) experiences are prioritized as a key component of physician assistant (PA) and Doctor of Physical Therapy (DPT) education programs’ curricula to reflect contemporary practice. Virtual IPE is reported to facilitate clinical decision making and teamwork in students. However, limited studies exist on its effectiveness to promote the IPE Collaborative's (IPEC) core competencies. As we aim to increase IPE in our curriculum, virtual IPE offers several advantages. The purpose of this study was to evaluate whether a case-based, virtual IPE improved students' knowledge and attitudes of collaborative team skills using the Interprofessional Collaborative Competencies Attainment Scale (ICCAS).

Methods

This study used a retrospective pretest-posttest design. Students in first-year PA and DPT programs (n = 130, PA = 48, DPT = 82) completed the ICCAS survey before and after attendance of a mandatory virtual IPE event. The virtual IPE session centered on designing a collaborative plan of care for an individual with congestive heart failure in an outpatient setting. To assess skill attainment, students completed the ICCAS survey. t Tests with Bonferroni's correction (P < .01) were conducted for analyses.

Results

One hundred twenty-two students (PA = 46, DPT = 76) provided complete survey data. Statistically significant improvement was noted for all 20 questions (P < .001). Large pre/post-IPE event effect sizes were observed for all 20 statements in the ICCAS. No statistically significant differences between the 2 disciplines were noted.

Discussion

Our findings suggest that a virtual case-based IPE experience may offer benefits to improve the student's attitude and knowledge related to IPEC during the initial year of PA and DPT programs. These data are encouraging as integration of virtual IPE experiences may affect teamwork competencies in healthcare programs.
Exploring Patient–Clinician Trust During Pregnancy Care
Authors: Molina Rose L. , Bazan Maria , Rivera Casul Giuliana , Pazos Herencia Yessamin , Alegría Margarita , Fernandez Leonor , Edelen Maria , Kaimal Anjali J. , Hacker Michele R. , Guise Jeanne-Marie
Published: April 2024

OBJECTIVE:

To explore patient experiences and perspectives regarding trust in clinicians during pregnancy care among Latine patients, focusing on those with Spanish as their preferred language.

METHODS:

We conducted a qualitative focus group study to explore trust in pregnancy care clinicians. Eligible participants self-identified as Hispanic/Latine, reported Spanish or English as their preferred language, were pregnant or had given birth in the previous year, and were at least 18 years old. Participants completed a brief demographic survey. We report descriptive statistics for survey responses. A semistructured discussion guide was developed from a literature review and feedback from a patient advisory panel. We report emerging themes using a modified grounded theory approach with an analysis of focus group transcripts. We mapped themes to the five dimensions of trust according to the Building Trust Initiative—communication, caring, comfort, cost, and competency—and barriers to trust.

RESULTS:

We conducted eight focus groups (five in Spanish, three in English) through Zoom between July and September 2023. Cost was not discussed in any of the focus groups. Rather, there was an emerging theme around acompañamiento (accompaniment is a distinct form of companionship in which there is shared power during a shared journey), particularly in the Spanish focus groups. Barriers to building trust exist at the interpersonal and health system levels, including miscommunication, lack of continuity, and brevity of appointments.

CONCLUSION:

This study explores how trust is conceptualized in pregnancy care according to the perspectives of Latine patients. We found that acompañamiento is a unique and crucial dimension of trust among Spanish-speaking patients.
What Gets Measured Gets Managed
Authors: Lalji Rahim , Muñoz Laguna Javier , Kauth Jael , Hofstetter Léonie , Kurmann Astrid , Adams Jon , Kongsted Alice , von Wyl Viktor , Puhan Milo A. , Hincapié Cesar A.
Published: April 2024

Musculoskeletal conditions are often managed in primary care settings. To facilitate research and healthcare quality, practice-based research networks offer sustained collaborations between clinicians and researchers. A scoping review was conducted to describe characteristics of practice-based research networks used for musculoskeletal research and musculoskeletal research conducted through practice-based research networks. Practice-based research networks were identified from 1) musculoskeletal-studies identified in OVID Medline, CINAHL, and Embase databases from inception to 5 February 2023 and in ClinicalTrials.gov and 2) from practice-based research network registries and websites. Among active musculoskeletal-focused practice-based research networks (i.e., currently recruiting and conducting research), an assessment of practice-based research network research good practices was performed. After screening 3025 records, 85 studies from 46 unique practice-based research networks met our eligibility criteria. Common conditions studied were low back pain (28%), musculoskeletal conditions not otherwise specified (25%), and osteoarthritis (19%). Thirty-two practice-based research networks (70%) were deemed to be active. Among active musculoskeletal-focused practice-based research networks, best practice data management information was retrievable for most (53%). Because of the scarcity of publicly available information, a large proportion of practice-based research network research good practice items was not assessable. Practice-based research networks have provided an avenue to assess clinical practice and patient outcomes related to musculoskeletal conditions. Further work to increase the transparency of musculoskeletal practice-based research network research practices is warranted.
Pittsburgh Impairment Testing Tool for Spina Bifida Can Predict Ambulation and Transfer Ability in Adults With Spina Bifida
Authors: Dicianno Brad E. , Pearson Elise M. , Mesoros Matthew , Houtrow Amy J. , McKernan Gina
Published: April 2024

Objective

The aim of this study was to evaluate the predictive accuracy of the Pittsburgh Impairment Testing Tool. It was hypothesized that the Pittsburgh Impairment Testing Tool would have a good overall accuracy (≥80%) for predicting both ambulation and transfer ability and that overall accuracy of the Pittsburgh Impairment Testing Tool would be higher than that of other scales.

Design

A retrospective chart review was used to classify 409 adults with spina bifida according to seven neurological scales. A Naïve Bayes classifier was used to obtain accuracy estimates for predicting both ambulation and transfer ability as a function of each scale.

Results

The Pittsburgh Impairment Testing Tool was the only scale demonstrating >80% overall accuracy for predicting both ambulation and transfer ability. While several scales demonstrated ≥80% overall accuracy in predicting transfer ability, none were useful in predicting inability to transfer. Inability to transfer was difficult for all tools to predict.

Conclusions

The Pittsburgh Impairment Testing Tool demonstrated good overall accuracy for predicting both ambulation and transfer ability. Sensory and anatomic levels were less useful than motor level in predicting functional ability.
Relationship Between 2 Years of Muscle Strength Decrease and Volume Loss of Menisci and Cartilage According to Knee Pain in Mild and Moderate Knee Osteoarthritis
Authors: Zhang Hui , Shuai Tao , Wang Junqing , Li Kang , Nie Yong
Published: April 2024

Objective

The aim of the study is to explore the relationship between 2-yr changes in muscle strength and cartilage according to knee pain in mild and moderate knee osteoarthritis.

Design

Two hundred seventy-nine participants were retrospectively obtained from the Osteoarthritis Initiative. Western Ontario McMaster University and Knee Injury and Osteoarthritis Outcome Score were used to assess pain and function. Five muscles strength (maximum extensor and flexor, normalized maximum extensor and flexor, and extensor/flexor ratio) were measured from isometric strength test. Menisci and cartilage volumes were measured from magnetic resonance imaging to assess 2 yr of osteoarthritis progression.

Results

Mild and moderate knee osteoarthritis progression was characterized by patellofemoral cartilage loss and meniscal degeneration. For WOMAC pain >2 participants, decrease in extensor strength and normalized extensor strength were positively correlated with medial meniscus volume loss (r = 0.261, P = 0.021; r = 0.232, P = 0.041, respectively). The extensor/flexor ratio changes were positively associated with Western Ontario McMaster University function changes (r = 0.291, P = 0.013) over 2 yrs.

Conclusions

The study observed a positive correlation between quadriceps strength decrease and medial meniscus degeneration in mild and moderate knee osteoarthritis patients with Western Ontario McMaster University pain >2. These findings suggested quadriceps-hamstrings balance possibly plays a protective role in knee function for participants with weaker quadriceps and severe pain.

To Claim CME Credits

Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME

CME Objectives

Upon completion of this article, the reader should be able to: 1): Determine the effect of knee extensor muscle strength changes on the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage over 2 yrs in mild to moderate knee osteoarthritis patients; 2): Describe the correlation of knee extensor strength with the medial and lateral meniscus, tibia, and medial and lateral femoral cartilage at different WOMAC-pain levels; and 3): Discuss the relationship between changes in muscle strength and changes in meniscus and cartilage volume and WOMAC pain scores over 2 yrs in mild to moderate knee osteoarthritis patients.

Level

Advanced

Accreditation

The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
A Case Report of Becker Muscular Dystrophy and Stroke Who Successfully Regained Mobility With Robot-Assisted Gait Training
Authors: Tay San San , Zainul Abideen Abbas Bin , Neo Jin Rui Edmund , Ho Esther Kye Ning , Visperas Christine Alejandro
Published: April 2024

A 30-yr-old patient with Becker muscular dystrophy presented with stroke. Background issues of proximal weakness, dilated cardiomyopathy, and reduced endurance challenged the usual goal-setting and formulation of a stroke rehabilitation plan. We discuss the holistic rehabilitation program that this patient underwent, with a focus on the utilization of robot-assisted gait training that eventually led him to successfully regain mobility.
Core Training for Pain Management and Functional Improvement in Patients With Patellofemoral Pain Syndrome
Authors: Wang Yongshen , Li Hongpeng , Zhang Di , Zhao Tianyu , Liu Zhixiang , Chen Jia , Gong Meng , Pan Juanhong , Lu Li , Jin Song
Published: April 2024

Objective

The aim of the study is to investigate the effects of core strengthening exercises on pain, mobility, and lower limb muscle strength in patients with patellofemoral pain syndrome.

Design

Six databases were searched from inception until August 11, 2023. Pain, function, and muscle strength-related outcomes were extracted and the quality of the studies was assessed using the PEDro scale and the level of evidence was assessed using the GRADE.

Results

Nineteen studies involving 1138 patients were included. Very low-grade evidence supported the short-term pain-relieving effect of core training (standardized mean difference = −0.60, 95% confidence interval [−0.95, −0.25]), high-grade evidence supported the short-term functional improvement effects of core training (weighted mean difference = 3.61, 95% confidence interval [1.44, 5.78]), which was similarly significant within 3–12 mos of follow-up. The results of the subgroup analyses suggested that hip-knee training was most advantageous in relieving pain and enhancing motor function.

Conclusions

Although training that includes trunk core is clearly superior to knee strengthening alone, the effectiveness of hip-knee training, which is also a core training program for pain and function, is more pronounced. The available evidence supports that hip-knee training is the most valuable treatment option for patients with patellofemoral pain syndrome.
Long-Term Impact of Psychological Rehabilitation on Isolated Hospitalization Patients With COVID-19
Authors: Jung Jae Hyu , Jeon Eun Hui , Ko Jin Young
Published: April 2024

Objective

This study aimed to investigate the long-term effects of a psychological rehabilitation program that was effective on anxiety, depression, and quality of sleep in hospitalized COVID-19 patients.

Design

This is longitudinal study. Thirteen patients in the experimental group who received a psychological rehabilitation program during hospitalization and 16 patients in the control group who received conservative treatment completed the questionnaire 6 mos after discharge. Questionnaires are the Zung Self-Rating Anxiety Scale, Zung Self-Rating Depression Scale, Patient Health Questionnaire-9, Visual Analysis Scale, and the Korean version of the Insomnia Severity Index.

Results

The Visual Analysis Scale for depression significantly improved in the experimental group compared with control group at discharge (E = −2.40, P < 0.001) and follow-up (E = −3.36, P < 0.001). The Zung Self-Rating Depression Scale and Patient Health Questionnaire-9 scores significantly improved at discharge (E = −4.05, P = 0.01 and E = −2.29, P = 0.01) but not at follow-up (E = −4.64, P = 0.12 and E = −1.81, P = 0.22). There are no significant interactions for Visual Analysis Scale for anxiety (E = −0.27, P = 0.79), Zung Self-Rating Anxiety Scale scores (E = −1.48, P = 0.51), and insomnia (E = −0.69, P = 0.63) scores during the follow-up.

Conclusions

Psychological rehabilitation showed a significant long-term reduction in depression, but not in anxiety. Therefore, continuous intervention and management of mental health are required after discharge.
Comparative Effects of Exercise Interventions and Mindfulness-Based Interventions for Cognitive Impairment and Quality of Life in Breast Cancer Survivors During or After Cancer Treatment
Authors: Zeng Qing , Li Caiyue , Yu Tana , Zhang Hongchen
Published: April 2024

Objective

The aim of this network meta-analysis was to compare the improvement effects of various exercise interventions and mindfulness-based interventions to determine the best interventions for the improvement of cognitive impairment.

Design

Seven databases were searched to screen randomized controlled trials of exercise interventions and mindfulness-based interventions to improve cognitive impairment. The network meta-analysis was performed using Revman 5.3, R 4.2.1 and ADDIS 1.16.8 software.

Results

Thirty-four randomized controlled trials involving 14 interventions were included in the study. In terms of cognitive function, except for mindfulness-based stress reduction, all interventions showed significantly greater improvement in cognitive function compared with conventional therapy. Physical activity and Qigong showed better effect in improving executive function. In terms of improving verbal memory, compensatory cognitive training, neurofeedback training, Qigong, and sham Qigong were more effective than other interventions. On performing surface under the cumulative ranking curve analysis, acceptance and commitment therapy, neurofeedback training, Qigong, and mediation had the best effects on cognitive function, quality of life, executive function, and processing speed, respectively.

Conclusions

Mindfulness-based interventions were found to be more effective than exercise interventions for alleviating cognitive impairment. More robust randomized controlled trials focusing on acceptance and commitment therapy for cognitive impairment are required to support the current evidence.
Neural Interconnections of Extracranial Nerves in Headache Surgery: Anatomical Landmarks and Clinical Implications: A Review of the Literature
Authors: Knoedler Samuel , Frank Konstantin , Muehlberger Thomas , Safi Ali-Farid , Cotofana Sebastian , Perozzo Filippo A. G. , Panayi Adriana C. , Guyuron Bahman , Janis Jeffrey E. , Alfertshofer Michael
Published: April 2024

Headache disorders (HDs) remain a nationwide challenge for the US health care system, affecting nearly 60% of the US population. Surgical deactivation of the peripheral trigger site, also referred to as headache surgery, represents an effective treatment for patients with refractory HD pain or nonresponse to pharmacologic regimens. Research stemming from other surgical specialties has underlined the clinical relevance of neural interconnections in refining diagnostic algorithms, adapting surgical techniques, and improving overall patient outcomes. Different HD trigger points have been identified, but there is a paucity of studies discussing the mostly sensory neural interconnections between these trigger points in a comprehensive fashion. The authors provide an overview of the specific nerves involved in HD and synthesize the literature on HD nerve interconnections to deduce clinical implications. Overall, this line of research may help refine the perioperative workflow and enhance HD patient care.
Homolateral Embolic Stroke After Emergency Ligation of the Common Carotid Artery to Stop Heavy Bleeding Caused by Carotid Blowout Syndrome
Authors: Finsterer Josef , Mehri Sounira
Published: April 2024

Emergency common carotid artery (CCA) ligation for bleeding control during carotid blowout syndrome with consecutive embolic stroke has been reported rarely. The patient is a 70-year-old man, who was suffering from acute profuse bleeding from the left superior thyroid artery into the piriformis sinus, which was not controlled other than by ligation of the left CCA. The cause of the bleeding remained unclear but was suspected to be related to his history of being positive for squamous cell carcinoma of the left hypopharynx with ari and postcricoid infiltration, diagnosed at age 58. Squamous cell carcinoma was treated with local resection, chemotherapy (docetaxel, carboplatin, and cetuximab), and radiotherapy. Neurological examination 4 days after CCA ligation revealed multiple subacute embolic strokes in the territory of the left middle cerebral artery, macroangiopathy of the extra and intracranial cerebral arteries, and hypoplasia of the left vertebral artery. This case demonstrates that carotid blowout syndrome may require CCA ligation when external carotid artery ligation is not possible, and that ligation can be complicated by an asymptomatic embolic stroke.
Feasibility of 2-Point Fixation by Absorbable Plates Using the Transoral Approach in Management of the Zygomatic Complex Fractures
Authors: Diarra Drissa , Zhang Ze-Xing , Wang Hang , Li Zhi
Published: April 2024

Purpose:

The purpose of this study was to retrospectively evaluate the feasibility of 2-point fixation using absorbable plates by the transoral approach in the management of the zygomatic complex (ZMC) fractures.

Methods:

Twenty-five patients (15 male and 10 female, age range 16 y to 55 y) with Knight and North Group Ⅲ zygomatic fractures were included in this case series. Open reduction by intraoral approach was performed on these patients, and the fractures were fixed using absorbable plates placed at the zygomaticomaxillary buttress and infraorbital rim. Postoperatively, follow-up was undertaken to evaluate the fracture healing, mouth opening, facial asymmetry, diplopia, and paresthesia.

Results:

Postoperatively, all patients achieved uneventful healing; facial symmetry and wound healing were achieved, along with sensory recovery involving the infraorbital nerve. Complications such as sensory disturbances, infection, diplopia, malunion, and nonunion were not encountered in these patients.

Conclusions:

Two-point fixation using absorbable plates by transoral approach can provide sufficient stabilization for Knight and North Group III zygomatic fractures.
Aging-Related Changes of the Historical Japanese Beauty, Ono no Komachi (小野小町, 825–900 AD)
Authors: Jung Sung Gyun , Hwang Kun , Hwang Young Joong
Published: April 2024

The aim of this study was to determine how the aging-related changes of a beautiful woman were described in Japanese literature. A poem written by Ono no Komachi was reviewed. Images of her were also searched through Google search. Komachi’s poem in Hyakunin Isshu reads: “How the color has faded from the flowers. As I gaze in reverie at the falling rain, I find my beauty, too, has fallen in this world’s esteem.” Tamatsukuri Komachiko’s Death Book describes: “She became thin and looked tired. Her hair looks like a lotus with frost. Her skin resembles a frozen pear. Her bones stick out and her tendons are visible. Her face is dark, and her teeth are yellow”. Color woodblock print shows an old woman: She retains her intelligence and beauty even in her advanced years. Her posture was stooped, with a pronounced forward curvature of the spine, resulting as “turtle neck.” Her hair was long and gray. Visible signs of aging included forehead wrinkles, crow’s feet, deepened nasolabial folds, and marionette lines. Her upper jaw appeared retracted, a “witch’s chin.” She exhibited neck wrinkles as well as on her hands and wrists, which grasped a bamboo walking stick. Her eyes were sunken, accompanied by a drooping of the upper eyelids. We think that the narrative of her transformation into an ugly and poor woman was intended to convey to men the fleeting nature of women’s beauty, and to women that the power of beauty is not ultimately of major significance.
Graph convolutional network learning model based on new integrated data of the protein-protein interaction network and network pharmacology for the prediction of herbal medicines effective for the treatment of metabolic diseases
Authors: Kim Tae-Hyoung , Yu Ga-Ram , Lim Dong-Woo , Park Won-Hwan
Published: April 2024

Chronic metabolic diseases constitute a group of conditions requiring long-term management and hold significant importance for national public health and medical care. Currently, in Korean medicine, there are no insurance-covered herbal prescriptions designated primarily for the treatment of metabolic diseases. Therefore, the objective of this study was to identify herbal prescriptions from the existing pool of insurance-covered options that could be effective in treating metabolic diseases. This research study employed a graph convolutional network learning model to analyze PPI network constructed from network pharmacology, aiming to identify suitable herbal prescriptions for various metabolic diseases, thus diverging from literature-based approaches based on classical indications. Additionally, the derived herbal medicine candidates were subjected to transfer learning on a model that binarily classified the marketed drugs into those currently used for metabolic diseases and those that are not for data-based verification. GCN, adept at capturing patterns within protein-protein interaction (PPI) networks, was utilized for classifying and learning the data. Moreover, gene scores related to the diseases were extracted from GeneCards and used as weights. The performance of the pre-trained model was validated through 5-fold cross-validation and bootstrapping with 100 iterations. Furthermore, to ascertain the superior performance of our proposed model, the number of layers was varied, and the performance of each was evaluated. Our proposed model structure achieved outstanding performance in classifying drugs, with an average precision of 96.68%, recall of 97.18%, and an F1 score of 96.74%. The trained model predicted that the most effective decoction would beJowiseunggi-tangfor hyperlipidemia,Saengmaegsanfor hypertension, andKalkunhaeki-tangfor type 2 diabetes. This study is the first of its kind to integrate GCN with weighted PPI network data to classify herbal prescriptions by their potential for usage on certain diseases.
Streptococcus pneumoniae: Nasal influenza vaccination, carriage density and transmission in families
Authors: Metz J. , Qian G. , Morales-Aza B. , Oliver J. , Oliver E. , Rice H. , Duale K. , Heath P. , Faust S.N. , Snape M.D. , Hughes S. , Hole L. , Mann R. , Shackley F. , Rudd P. , Ludman S. , Gessner BD. , Danon L. , Finn A.
Published: April 2024

The live attenuated influenza vaccine (LAIV) is offered in the United Kingdom to young children, protecting against influenza for those vaccinated and indirect protection for the wider community. It has also been shown to increase carriage density of Streptococcus pneumoniae, to an extent, in children. This study therefore investigates whether the vaccine leads to an increase in density in children and, if so, whether this augments transmission to household contacts.

We implemented a randomised control study involving 405 two-year-old children and 958 household contacts. Nasopharyngeal swabs from all participants were taken over 5 visits, each two weeks apart, and tested for pneumococcal carriage. LAIV was given to 205 children at visit 1, and to 200 children at visit 2.

We developed regression models to analyse the association between vaccination and whether an increase in pneumococcal density 14 and 28 days later was observed, as well as an increase in the odds of transmission to household members after administering LAIV.

From regression analyses, there was a 2.5-fold (95%CI:1.3-4.3, p<0.001) increase in the odds of vaccinated children to have increased pneumococcal density 2 weeks later, compared with unvaccinated children, and a 2.1-fold (95%CI:1.2-3.6, p=0.011) increase in the odds of presumed transmission from children to their household contacts.

Our results provide evidence that an attenuated influenza virus infection transiently increases the likelihood of pneumococcal transmission from children who are colonised with the bacterium to their contacts and that this increase is driven by an increase in bacterial abundance triggered by the vaccine.
Chromosomal-level genome of fish mintHouttuynia cordataThunb. (Saururaceae)
Authors: Law Sean T.S. , Nong Wenyan , Tsang Stacey S.K. , Lau David T.W. , Shaw Pang Chui , Hui Jerome H.L.
Published: April 2024

Herbaceous flowering plants in the family Saururaceae, or commonly known as the lizard’s tail family, are native to Southeast Asia and North America. Fish mintHouttuynia cordatais native to Southeast Asia and widely cultivated as culinary herb and medicinal plant in traditional medicine. Here, using a combination of PacBio HiFi long-read sequencing and Omni-C data, we present the chromosomal-level genome assembly ofH. cordata(genome size 499.6 Mb). The genome has high sequence contiguity (scaffold N50 = 64.3 Mb) and completeness (BUSCO score of 94.6 %). 40,451 protein coding genes were also predicted using two transcriptomes generated in this study. The fish mint genome provides a valuable resource for further understanding the bioactive compounds and evolution of plants in the Saururaceae more widely.
Combined in vitro differentiation and cell sorting-based isolation of highly pure mouse bone marrow-derived basophils
Authors: Gambardella Adriana Rosa , Tirelli Valentina , Andreone Sara , Mancini Jacopo , Mattei Fabrizio , Schiavoni Giovanna
Published: April 2024

Basophils constitute a rare population of granulocytes with key functions in allergies, immunodeficiencies and cancer. The scarcity of basophils in the human blood and tissues constitutes a considerable limit for the study of these cells. Interleukin-3 (IL-3) is a cytokine that stimulates both the differentiation and the expansion of basophils from bone marrow (BM) precursors by positively regulating the expression of the IL3Ra receptor. We have standardized anin vitrodifferentiation protocol of mouse basophils (mBaso) from BM precursors through culture in presence of IL-3 for 10 days followed by cell sorting. At the end of the 10-day differentiation, a considerable number of mBaso can be obtained and cell sorting procedures further improved the isolation of an extraordinarily pure (>98%) and vital FcεR1+CD11c-c-kit-mBaso population. Phenotypic analysis revealed that terminally differentiated (day 10) unsorted mBaso cultured for 24 hours showed a decrease in basophilic lineage (c-kit-) and an increase of mastocytic lineage (c-kit+) and reduced the expression of basophil markers FcεRI, CD49b and CD200R either in absence of stimuli or following activation with the alarmin IL-33, indicating cell dedifferentiation. In contrast, terminally differentiated and FcεR1+CD11c-c-kit-sorted mBaso do not dedifferentiate in mast cells when placed in culture, and responded to IL-33 stimulation by up-regulating the activation marker CD63 without down-modulation of FcεRI and CD200R3. These evidences highlight thatin vitrodifferentiation followed by cell sorting is a useful method to obtain elevated numbers of highly pure mBaso that preserve their lineage markers and thus are suitable for conducting the desired functional studies.
Detection of hemagglutinin H5 influenza A virus sequence in municipal wastewater solids at wastewater treatment plants with increases in influenza A in spring, 2024
Authors: Wolfe Marlene K. , Duong Dorothea , Shelden Bridgette , Chan Elana M. G. , Chan-Herur Vikram , Hilton Stephen , Paulos Abigail Harvey , Zulli Alessandro , White Bradley J. , Boehm Alexandria B.
Published: April 2024

Prospective influenza A (IAV) RNA monitoring at 190 wastewater treatment plants across the US identified increases in IAV RNA concentrations at 59 plants in spring 2024, after the typical seasonal influenza period, coincident with the identification of highly pathogenic avian influenza (subtype H5N1) circulating in dairy cattle in the US. We developed and validated a hydrolysis-probe RT-PCR assay for quantification of the H5 hemagglutinin gene. We applied it retrospectively to samples from three plants where springtime increases were identified. The H5 marker was detected at all three plants coinciding with the increases. Plants were located in a state with confirmed outbreaks of highly pathogenic avian influenza, H5N1 clade 2.3.4.4b, in dairy cattle. Concentrations of the H5 gene approached overall influenza A virus gene concentrations, suggesting a large fraction of IAV inputs were H5 subtypes. At two of the wastewater plants, industrial discharges containing animal waste, including milk byproducts, were permitted to discharge into sewers. Our findings demonstrate wastewater monitoring can detect animal-associated influenza contributions, and highlight the need to consider industrial and agricultural inputs into wastewater. This work illustrates wastewater monitoring’s value for comprehensive influenza surveillance for diseases with zoonotic potential across human and animal populations.
Clinically feasible liver tumour cell size measurement through histology-informedin vivodiffusion MRI
Authors: Grussu Francesco , Bernatowicz Kinga , Palombo Marco , Casanova-Salas Irene , Navarro-Garcia Daniel , Barba Ignasi , Simonetti Sara , Serna Garazi , Grigoriou Athanasios , Macarro Carlos , Voronova Anna , Garay Valezka , Corral Juan Francisco , Vidorreta Marta , García Pablo García-Polo , Merino Xavier , Mast Richard , Rosón Núria , Escobar Manuel , Vieito Maria , Toledo Rodrigo , Nuciforo Paolo , Mateo Joaquin , Garralda Elena , Perez-Lopez Raquel
Published: April 2024

Innovative diffusion Magnetic Resonance Imaging (dMRI) models enable the non-invasive measurement of cancer biological propertiesin vivo. However, while cancers frequently spread to the liver, models tailored for liver application and easy to deploy in the clinic are still sought. We fill this gap by delivering a practical, clinically-viable dMRI framework for liver tumour imaging, informing its design through histology. By comparing dMRI and histological data from mice and cancer patients, we select a dMRI signal model of restricted intra-cellular diffusion with negligible extra-cellular contributions, maximising radiological-histological correlations. The model enables non-invasive liver cancer phenotyping, providing cell size and density estimates that i) correlate with their histopathology counterparts, ii) are associated to cell proliferation and tumour volume, and iii) that distinguish tumour types. By delivering metrics that are biologically meaningful, our approach may complement standard-of-care radiology, and become a new tool for enhanced cancer characterisation in precision oncology.