bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding social justice in a changing sociopolitical context: The perspective of social workers in Hong Kong
Authors: Ngai Tsz Chung
Published: March 2023

Amid recent political conflicts and the implementation of the national security law, Hong Kong society has undergone tremendous changes. Among other effects, the new law has spawned controversial social discourses, including about social workers’ responsibility to uphold human rights and promote social justice per the Hong Kong Social Workers Registration Board’s Code of Practice. This article, based on an analysis of interviews with six social workers in Hong Kong, examines how social workers understand social justice according to those discourses. The findings and this article’s discussion of them offer insights into social workers’ roles in an increasingly turbulent sociopolitical context.
Intelligent dimming control and energy consumption monitoring system of tunnel lighting
Authors: Xu R , Ye H , Hu B , Jin S , Lu M , Huang Z , Chen L
Published: March 2023

To achieve energy saving and safe driving in a tunnel, this work proposes a tunnel intelligent dimming control and energy consumption monitoring system. Firstly, a dynamic predicted tunnel traffic volume is established to optimize the timeliness of the system tunnel traffic volume. Secondly, a backpropagation neural network-based dimming control model is constructed, in which the luminance outside the tunnel, traffic volume and vehicle speed serve as the input, and the luminance inside the tunnel is the output. This model is then combined with the established integrated closed-loop control model of the tunnel internal and external luminance to achieve continuous dimming control of the tunnel. Finally, an energy consumption monitoring system is designed with an energy monitoring unit. The designed system was implemented and tested for 63 days in the Yongtaiwen–Chayuanli (China) tunnel. Experiment results show that the designed system can automatically control the luminance of the tunnel lighting according to the luminance measured outside the tunnel, traffic volume and vehicle speed, thus achieving continuous dimming control. This significantly reduced the power consumption (by approximately 65%) whilst ensuring the safety of tunnel traffic.
Navigating Transfer “Pivotal Points” in Challenging Contexts: A Longitudinal Investigation of STEM Transfer Students’ Pathways During COVID-19
Authors: Thiry Heather , Harper Raquel , Zahner Dana Holland
Published: March 2023

Community colleges have long been touted as a pathway to increase social mobility through their transfer function, yet this promise has not always been realized. This study uses the lens of community cultural wealth, particularly the concepts of aspirational, social, and navigational capitals, to understand vertical transfer students’ experiences and outcomes during the pandemic. Longitudinal interviews were conducted with 27 students over a four-year period as they moved through the transfer pathway in STEM majors. Students who transferred to a university immediately prior to or during the pandemic experienced greater academic and navigational challenges and reported diminished access to social capital. Students employed multiple, informal navigational strategies and drew on social networks, when possible, to maintain their academic progress. Findings also reveal the importance of the transfer-receiving department, especially access to supportive institutional agents, in sustaining STEM transfer students’ progress during COVID-19.
A Space Expander of Laparoscopic Rectal Cancer Surgery for Overweight or Obese Patients
Authors: Chen Guofeng , Lu Yu , Zhu Jiyun , Huang Yi , Chen Jian , Chen Kaibo
Published: March 2023

Background/Need

Laparoscopic rectal cancer surgery (LRCS) has become a preferred approach for its minimal invasion and fast postoperative recovery. But it is challenging for the tumors of the middle and lower rectum, especially for overweight or obese patients.

Methodology

We present a space expander of laparoscopic rectal cancer surgery, which is a simple tool to widen the perirectal space, as to facilitate the procedure of total mesorectal excision (TME) during the rectal cancer surgery. It has several advantages of lower demand for an assistant, less risk of surgical complications and good feasibility.

Device Description

It is designed as a cylindrical shape, and it is the first invented device to help surgeons safely perform accurate TME on overweight or obese patients during LRCS. With this method, we are able to dissect the rectal wall circumferentially in a safe and quick way.

Preliminary Results

Our previous pig experiments indicated that the learning curve for this technique was as short as 10 minutes.

Current status

Further clinical trials will be conducted on its efficacy and safety in the future.
Endovascular treatment for anterior cerebral artery occlusions
Authors: Ozdemir Gokhan , Eren Fettah , Aygul Recep , Kizildag Nazım , Kocaturk Idris , Mammadi Azer , Ersoy Ayse Nur , Ildiz Omer Faruk , Gunduz Zehra Betul , Korez Muslu Kazım
Published: March 2023

Background

We sought to examine the feasibility, safety and preliminary efficacy of anterior cerebral artery (ACA) occlusions in patients undergoing endovascular treatment.

Methods

Four hundred five consecutive patients with large-vessel occlusion treated with endovascular treatment were analysed to identify all patients with acute ACA occlusion who underwent endovascular treatment.

Results

Twenty had ACA occlusion (primary ACA occlusion: 9, rescue ACA occlusion: 11), 395 patients had other occlusions (internal carotid artery and MCA). The median [IQR] mRS score in the third month was significantly higher in the ACA-rescue occlusion group versus the ACA-primary occlusion group. The rate of haematoma in patients with ACA-occlusions was significantly higher compared with the ACA-primary occlusion group. Moreover, the three-month mortality rate was higher in patients with ACA-rescue than the patients with ACA-primary.

Conclusions

Although endovascular treatment can be considered in patients with primary ACA occlusions, our data suggest that future clinical trials are needed to determine the efficacy of endovascular treatment for ACA occlusions. Unfavourable outcomes in our study were considered to occur in the rescue ACA occlusions.
Systematic review of the relationship between Hollenhorst plaques and cerebrovascular events
Authors: Ghoneim Baker Moustafa , Westby Daniel , Elsharkawi Mohamed , Said Marwa , Walsh Stewart R
Published: March 2023

Background

Few studies have evaluated the association between asymptomatic cholesterol emboli on fundoscopy (known as Hollenhorst plaque) and the subsequent risk of stroke or death.1

Aim

To evaluate the association between the presence of asymptomatic cholesterol retinal emboli and the risk of cerebrovascular events, with assessment of the need for carotid intervention.

Methods

PubMed, Embase, and Cochrane Library databases were searched using appropriate terms. The systematic review was conducted according to PRISMA guidelines.

Results

Initial search revealed 43 in Medline and 46 in Embase databases. Twenty-four potentially eligible studies were included after duplicate and non-related studies were excluded based on title and abstract. Three more studies were identified from reference lists. Seventeen studies were included in the final analysis. Asymptomatic cholesterol emboli were present in 1343 patients. Approximately 17.8% ( n = 181) had history of either cerebro-vascular Accident (CVA) or transient ischaemic attacks (TIAs) at presentation (more than 6 months). Nine studies mentioned the incidence of cerebrovascular events during follow-up. Of 780 patients, 93 evolved to stroke, TIAs, or death from a major carotid event during the follow-up period (6–86 m), an incidence of about 12%. Death due to stroke was documented in 3 studies ( n = 12).

Conclusion

The presence of asymptomatic retinal emboli indicates a risk of a cerebrovascular event when compared to patients with no plaques seen on fundoscopy. The evidence suggests that these patients warrant referral for medical optimization of cardiovascular risk factors. Currently, there is no recommendation to support carotid endarterectomy in patients with Hollenhorst plaques, or retinal emboli, and further studies are needed to assess this.
Analysing the physical output of international field hockey players through the lens of the phase of play
Authors: Cunniffe Eoin , Connor Mark , Beato Marco , Grainger Adam , Mcconnell Walter , Blake Catherine
Published: March 2023

The purpose of this study was to describe the locomotor activity of men's hockey based on the phase of play and to identify if differences in locomotor activity exist between phases. Twenty-four players (age 26 ± 4) wore a 10 Hz Global Positioning System device to track locomotor activity during 10 international matches. The locomotor activity of players was allocated to five different phases: (1) established attack, (2) opposition counterattack, (3) established defence, (4) attacking counterattack and (5) offensive pressing, utilising a video analysis-based system. Linear mixed models and post-hoc pairwise comparisons, using estimated marginal means, were utilised to compare the locomotor activity in each phase of play within each position. Significant main effects were found for the phase of play on several locomotor activity metrics ( p ≤ 0.05). With respect to max speed and relative total distance across positions, counterattacks present a unique challenge compared to other phases. Established attack phases evoke lower max speed values than offensive pressing phases for all playing positions as well as compared to opposition counterattacks for defenders, midfielders, and forwards. Positional differences existed during attacking counterattack phases, with defenders producing lower values than both midfielders and forwards for high-speed running, high-speed running efforts, max speed and relative total distance. Depending on the metric, this approach captured 22%–70% of a player's locomotor activity providing valuable insight into the current dynamics of international hockey. This investigation demonstrated positional differences based on the phase of play, which may explain previous research findings regarding positional differences.
Development of a nomogram for predicting pathological complete response in luminal breast cancer patients following neoadjuvant chemotherapy
Authors: Garufi Giovanna , Carbognin Luisa , Sperduti Isabella , Miglietta Federica , Dieci Maria Vittoria , Mazzeo Roberta , Orlandi Armando , Gerratana Lorenzo , Palazzo Antonella , Fabi Alessandra , Paris Ida , Franco Antonio , Franceschini Gianluca , Fiorio Elena , Pilotto Sara , Guarneri Valentina , Puglisi Fabio , Conte Pierfranco , Milella Michele , Scambia Giovanni , Tortora Giampaolo , Bria Emilio
Published: March 2023

Background:

Given the low chance of response to neoadjuvant chemotherapy (NACT) in luminal breast cancer (LBC), the identification of predictive factors of pathological complete response (pCR) represents a challenge. A multicenter retrospective analysis was performed to develop and validate a predictive nomogram for pCR, based on pre-treatment clinicopathological features.

Methods:

Clinicopathological data from stage I–III LBC patients undergone NACT and surgery were retrospectively collected. Descriptive statistics was adopted. A multivariate model was used to identify independent predictors of pCR. The obtained log-odds ratios (ORs) were adopted to derive weighting factors for the predictive nomogram. The receiver operating characteristic analysis was applied to determine the nomogram accuracy. The model was internally and externally validated.

Results:

In the training set, data from 539 patients were gathered: pCR rate was 11.3% [95% confidence interval (CI): 8.6–13.9] (luminal A-like: 5.3%, 95% CI: 1.5–9.1, and luminal B-like: 13.1%, 95% CI: 9.8–13.4). The optimal Ki67 cutoff to predict pCR was 44% (area under the curve (AUC): 0.69; p < 0.001). Clinical stage I–II (OR: 3.67, 95% CI: 1.75–7.71, p = 0.001), Ki67 ⩾44% (OR: 3.00, 95% CI: 1.59–5.65, p = 0.001), and progesterone receptor (PR) <1% (OR: 2.49, 95% CI: 1.15–5.38, p = 0.019) were independent predictors of pCR, with high replication rates at internal validation (100%, 98%, and 87%, respectively). According to the nomogram, the probability of pCR ranged from 3.4% for clinical stage III, PR > 1%, and Ki67 <44% to 53.3% for clinical stage I–II, PR < 1%, and Ki67 ⩾44% (accuracy: AUC, 0.73; p < 0.0001). In the validation set (248 patients), the predictive performance of the model was confirmed (AUC: 0.7; p < 0.0001).

Conclusion:

The combination of commonly available clinicopathological pre-NACT factors allows to develop a nomogram which appears to reliably predict pCR in LBC.
Bone fragility during the COVID-19 pandemic: the role of macro- and micronutrients
Authors: Moretti Antimo , Liguori Sara , Paoletta Marco , Migliaccio Silvia , Toro Giuseppe , Gimigliano Francesca , Iolascon Giovanni
Published: March 2023

Bone fragility is the susceptibility to fracture due to poor bone strength. This condition is usually associated with aging, comorbidities, disability, poor quality of life, and increased mortality. International guidelines for the management of patients with bone fragility include a nutritional approach, mainly aiming at optimal protein, calcium, and vitamin D intakes. Several biomechanical features of the skeleton, such as bone mineral density (BMD), trabecular and cortical microarchitecture, seem to be positively influenced by micro- and macronutrient intake. Patients with major fragility fractures are usually poor consumers of dairy products, fruit, and vegetables as well as of nutrients modulating gut microbiota. The COVID-19 pandemic has further aggravated the health status of patients with skeletal fragility, also in terms of unhealthy dietary patterns that might adversely affect bone health. In this narrative review, we discuss the role of macro- and micronutrients in patients with bone fragility during the COVID-19 pandemic.
Antiviral Effects of the Plant Family Amaryllidaceae
Authors: Nair Jerald J , van Staden Johannes
Published: March 2023

Background

In spite of the significant progress in modern medicine, viruses continue to be a formidable challenge to human health. The use of plants for the remediation of viral-borne diseases stretches back to the very dawn of mankind. Among bulbous plants, the Amaryllidaceae is one of the most popular families exploited in the traditional remediation of infectious diseases.

Methods

This account details the findings from a literature search carried out on the antiviral properties of the Amaryllidaceae. The keyword engaged in the search was “antiviral” in combination with the words “Amaryllidaceae,” “Amaryllidaceae specie,” and “Amaryllidaceae alkaloid.”

Results

Thirty-six taxa from 13 countries, notably in Africa and parts of Asia, have been cited as traditional remedies for viral diseases. Alcoholic bulb extracts of 18 species were evaluated against 23 different pathogens from 13 viral families. A wide range of activities was observed, with the whole-plant methanol extract of Zephyranthes candida seen to be the most striking (IC50 0.0019 µg/mL against poliovirus). The active principles in the main were isoquinoline alkaloids, of which lycorine impressed against the Avian influenza virus (strain H5N1). The mechanisms underlying the antiviral effects were seen to be related to the inhibition of DNA, RNA, and protein synthesis as well as inhibitory effects toward reverse transcriptase and protease enzymes.

Conclusion

Amaryllidaceae provides a richly diverse platform for antiviral drug research. Such endeavors have been fortified by the significant amounts of information emerging from indigenous knowledge systems. Ongoing studies will continue to target the active entities, particularly from taxa with verifiable ethnomedicinal backgrounds.
Quantitative evaluation for intravascular structures of vertebral artery dissection with a novel zoomed high-resolution black-blood MR imaging
Authors: Minakuchi Kiyomi , Fukuda Hitoshi , Miyake Hirohisa , Maeda Tomonori , Fukui Naoki , Moriki Akihito , Morimoto Masanori , Ueba Tetsuya
Published: March 2023

Background

Although non-stroke vertebral artery dissection (VAD) is diagnosed using MRI, detecting the subtle intravascular structure remains challenging. This study aimed to evaluate the validity of quantitative intravascular scanning based on novel zoomed high-resolution black blood (Z-HB) MRI for distinguishing VAD from other vessel pathologies.

Methods

Twenty-one patients with non-stroke VAD and 18 with symptomatic atherosclerotic plaques in their vertebral artery underwent Z-HB MRI and subsequent profile curve processing. Axial Z-HB imaging was obtained from dissected and normal segments in patients with VAD and atherosclerotic plaque in patients with ischemia. We investigated the qualitative categorization of the scanning patterns of the intravascular signals. We also evaluated the quantitative ability of each profile curve to discriminate multiple vessel pathologies by analyzing the receiver operating characteristics curves.

Results

Profile curve processing of 140 Z-HB images categorized the intravascular signal patterns into luminal, asymmetrical, and omega types. The asymmetrical type included both dissecting and atherosclerotic vessels, and the omega type included dissecting and normal vessels. In the asymmetrical type, quantitative evaluation successfully distinguished intramural hematomas of VAD from atherosclerotic plaque with an area under the curve of 0.80. The intimal flap of the VAD was distinguished from the blood flow artifact of the normal vessel with an area under the curve of 0.93 in the omega type.

Conclusions

A combination of novel Z-HB MRI and profile curve processing provided an ultra-high-resolution analysis of the intravascular structure of non-stroke VAD and successfully distinguished VAD from normal vessels or atherosclerotic plaques.
The role of supporting and disruptive mechanisms of FT3 homeostasis in regulating the hypothalamic–pituitary–thyroid axis
Authors: Hoermann Rudolf , Pekker Mark J. , Midgley John E. M. , Dietrich Johannes W.
Published: March 2023

Background:

Thyroid hormones are controlled by the hypothalamic–pituitary–thyroid (HPT) axis through a complex network of regulatory loops, involving the hormones TRH, TSH, FT4, and FT3. The relationship between TSH and FT4 is widely used for diagnosing thyroid diseases. However, mechanisms of FT3 homeostasis are not well understood.

Objective:

We used mathematical modelling to further examine mechanisms that exist in the HPT axis regulation for protecting circulating FT3 levels.

Methods:

A mathematical model consisting of a system of four coupled first-order parameterized non-linear ordinary differential equations (ODEs) was developed, accounting for the interdependencies between the hormones in the HPT axis regulation. While TRH and TSH feed forward to the pituitary and thyroid, respectively, FT4 and FT3 feed backward to both the pituitary and hypothalamus. Stable equilibrium solutions of the ODE system express homeostasis for a particular variable, such as FT3, if this variable stays in a narrow range while certain other parameter(s) and system variable(s) may vary substantially.

Results:

The model predicts that (1) TSH-feedforward protects FT3 levels if the FT4 production rate declines and (2) combined negative feedback by FT4 and FT3 on both TSH and TRH production rates keeps FT3 levels insensitive to moderate changes in FT4 production rates and FT4 levels. The optimum FT4 and FT3 feedback and TRH and TSH-feedforward ranges that preserve FT3 homeostasis were found by numerical continuation analysis. Model predictions were in close agreement with clinical studies and individual patient examples of hypothyroidism and hyperthyroidism.

Conclusions:

These findings further extend the concept of HPT axis regulation beyond TSH and FT4 to integrate the more active sister hormone FT3 and mechanisms of FT3 homeostasis. Disruption of homeostatic mechanisms leads to disease. This provides a perspective for novel testable concepts in clinical studies to therapeutically target the disruptive mechanisms.
Theorising with urban China: Methodological and tactical experiments for a more global urban studies
Authors: Teo Shaun SK , Chung Calvin King Lam , Wang Zheng
Published: March 2023

Despite global academic interest, the field of urban China continues to be dominated by exceptionalist theorising. Given that the unique properties of Chinese urbanisation present rich cases for an engaged pluralism in urban studies, we argue for theorising with urban China based on two methodological grounds: ‘thinking cities through elsewhere’ and conjunctural analysis. This opens space for mid-level theorisation, which has the potential to contribute to the revision of existing theoretical frameworks and/or create new starting points for analysis and conceptualisation between urban China and a wider range of contexts. We propose three tactics for mid-level conceptualisation with urban China cases: generating concepts through bespoke comparisons between cases in urban China and elsewhere; conceptualising from a single urban China case by placing two theoretical frameworks into conversation; and launching concepts developed from inductive research in urban China to develop novel analytical frameworks. We conclude by arguing that theorising with urban China can benefit from collaborative research across borders, with the need to include researchers who are deeply embedded in the field.
Internet of Things in Telecommunications: From the Perspective of an Emerging Market
Authors: Jabeen Munazza , Ishaq Khurram
Published: March 2023

This paper presents an exploratory case study of the Internet of things in telecommunications to analyze IoT technology in the telecom sector. It examines the IoT value in telecom and discusses the role of telecom operators across the value chain. It also presents a case analysis of IoT adoption in an emerging market of Pakistan to explore the IoT landscape in Pakistan and analyzes the IoT market positioning among telecom operators. It presents the business models and strategies which the telecom operators are following and analyzes the cost and benefits of IoT technology. It also discusses the IoT challenges faced by telecom operators during the adoption of IoT. In an emerging country like Pakistan, telecoms are adopting Internet of things technology, a novel, and real-time phenomenon. They are considering IoT technology as a new business opportunity in emerging markets, with the potential to be utilized as a new source of revenue. Telecoms are focusing on testing their roles in different areas of the IoT value chain. Their primary focus still remains basic connectivity which is evolved into smart connectivity. Telecoms are embracing their resources and capabilities across the IoT value chain, from connectivity to partnership, with innovative, value-added services. They are moving up to the IoT value chain by evolving further as an enabler for devices and enterprise-to-enterprise (E2E) solutions. They are developing partnerships with enterprises for providing various applications, service delivery, and system integration.
Sexuality of adolescent girls born with HIV in Senegal: an anthropological analysis
Authors: Laborde-Balen Gabrièle , Diop Maimouna , Sow Khoudia , Ndiaye Ndeye Bineta , Diop Karim , Taverne Bernard ,   The ETEA-VIH Study Group
Published: March 2023

Objectives:

In Senegal, the dominant social norm upholds virginity before marriage and edifies abstinence for adolescents as a cardinal moral value. Currently, sex outside of marriage remains socially condemned. The onset of sex for adolescent girls born with HIV in Senegal brings up several challenges. In Dakar, initiatives, especially through digital applications, are being developed to support these young people. These programs are much rarer in rural settings. A study conducted in 2021 explored how adolescent girls born with HIV who live outside of Dakar experience sexuality, what socio-health constraints they face, and what support they receive from the healthcare system.

Method:

An anthropological study titled ‘Treatment Failure among Children and Adolescents Living with HIV in Senegal, Outside Dakar’ (ETEA-VIH, ANRS 12421) was conducted in 2021 in 14 regional hospitals and health centers. Semi-structured interviews were conducted with 87 HIV-positive children and adolescents, 95 parents/guardians, and 47 health care workers. Adolescent girls’ onset of sexuality was specifically analyzed for 40 adolescent girls age 12–19 years old.

Results:

Generally, parents feign oblivion about their children’s sexual lives. Mothers dread a pregnancy out of marriage because they are responsible for overseeing sex education and would be ‘blamed’ for the transgression. The occurrence of an unintended pregnancy can lead to exclusion from the family and a risk of transmitting HIV to the child due to the lack of medical and social support. HIV remains a stigmatizing disease that families keep secret. The risk of disclosure is a major concern. Despite sexual and reproductive health (SRH) programs, most healthcare workers are reluctant to discuss sexuality or to offer contraception to adolescent girls. Information spaces have been set up in some regional hospitals by associations trained in SRH. They are rarer in health centers. Accessibility to digital applications and discussion forums is limited due to the lack of smartphones and Internet access.

Conclusion:

In rural settings, HIV-positive adolescent girls are confronted with the silence that surrounds sexuality and HIV. An individualized approach and confidential access to contraception should be prioritized to support them with assistance from PLHIV associations.
Prevalence of leftover medicines, disposal practices, and associated factors in Arba Minch Town, Southern Ethiopia
Authors: Asmamaw Getahun , Agedew Tewodros , Tesfaye Besrat , Sasamo Samrawit , Gena Saude , Argeta Melkamu , Adio Aynoshe
Published: March 2023

Objective:

The increased prevalence of leftover medicines in the community is currently a global concern due to the detrimental effects on the environment and health. However, several developing countries have failed to give sufficient consideration to the issue. The primary purpose of this study was to describe the prevalence of leftover medicines, disposal practices, and the factors affecting those in households in Arba Minch Town, Southern Ethiopia.

Methods:

A community-based, descriptive cross-sectional study was conducted among households in Bere Edigetber and Nech Sar of Arba Minch town, from June 25 to August 27, 2022. Data were gathered through face-to-face interviews with revalidated structured questionnaires. A multistage sampling technique was utilized to select each household.

Results:

Three hundred forty-eight households agreed to participate in a study, resulting in a 94.8% response rate. Of the study participant, 172 (49.4%) of the households had leftover medicines, with antibiotics being the most common (64% of 172). Subsidy of symptoms and saving for later use were two frequently cited reasons for the presence of leftover medicines in the house. Throwing leftover medicines in household garbage was the preferred method of disposal (>60%). Only 0.1% of respondents considered returning leftover medicines to healthcare facilities or professionals. A binary regression analysis identified four predictors for having leftover medicines. Medicines obtained without prescription were the strongest predictor (odds ratio = 3.7; p < 0.001), followed by higher family monthly income (odds ratio = 2.5; p = 0.005), those waived paying for medicine (odds ratio = 0.294; p = 0.049), and those used medications for acute diseases ( p = 0.048; odds ratio = 0.450). Respondents who had prior information on safe medicine disposal were 2.3 ( p = 0.04) more likely to dispose of possessed leftover medicines rather than keep them for future use.

Conclusions:

This study revealed a high prevalence of leftover medicines and their improper disposal in Arba Minch town. The preferred methods of leftover medicine disposal in this study deviate from conventional standards. Significant factor variables that predict having leftover medicines are attributed to purchasing medicine without a prescription, higher family monthly income, those waived paying for medicine, and those who used medications for acute diseases. Prior knowledge of proper disposal practices predicated the decision to dispose of on-hand leftover medicines or keep them for future use. These findings would be critical in developing strategies to reduce leftover medicines and promote proper disposal practices.
Medication sparing after medical cannabis initiation: A case study of a chronic pain patient in Project Twenty21
Authors: Sunderland Peter , Nutt David J , Schlag Anne Katrin
Published: March 2023

Prescribed cannabinoids are legal in the UK and are increasingly being used for a variety of conditions, with one of the most frequent conditions being chronic pain. Within this cohort, there is developing evidence that cannabis-based medicinal products are associated with opioid and other medication sparing. However, at present, the National Institute for Health and Care Excellence (NICE) does not recommend the prescription of cannabis-based medicinal products to treat chronic pain due to the lack of randomised controlled trial evidence for this condition. Here we present a case study of a 61-year-old woman with idiopathic small fibre neuropathy, who was prescribed the gabapentinoid pregabalin, in combination at different times with various other agents including amitriptyline, duloxetine, lamotrigine, meloxicam and topical capsaicin, over a 17-year period for the associated neuropathic pain. Although her pain was relatively well controlled, the patient reported hearing loss, sleepiness, tinnitus, confusion and worsening anxiety possibly as a result of prolonged pregabalin use. Efforts were made to reduce the pregabalin dose but any attempts to reduce below a total daily dose of 350 mg resulted in unacceptable pain for the patient. In 2021, the patient was enrolled in Project Twenty21, the UK's first medical cannabis registry, and prescribed full plant extract delta-9-tetrahydrocannabinol 10 mg: cannabidiol 15 mg/mL of oil, prescribed at a dose range of 0.1–0.5 mL twice daily. As a result, the patient managed to reduce her pregabalin down to 37.5 mg total daily dose. The patient now feels she has ‘been given a second chance at life’ and her husband describes her as ‘a new woman’. This patient feels that she is in a position to finally stop treatment with pregabalin, as a result of medical cannabis controlling her pain. Highlighting the potential benefits of cannabis-based medicinal products to treat chronic pain, our case study indicates the value of including real-world evidence when assessing the benefits and safety of cannabis-based medicinal products.
Risk Factors and Exit Strategy of Intraoperative Neurophysiological Monitoring Alert During Deformity Correction for Adolescent Idiopathic Scoliosis
Authors: Lee Choon Sung , Hwang Chang-Ju , Lee Dong-Ho , Cho Jae Hwan , Park Sehan
Published: March 2023

Study Design

Retrospective cohort study.

Objective

To elucidate the risk factors of intraoperative neurophysiological monitoring (IONM) alert during deformity correction surgery for adolescent idiopathic scoliosis (AIS) and to describe the outcomes of patients who underwent staged correction surgery due to IONM alert during the initial procedure.

Methods

We reviewed 1 024 patients with idiopathic scoliosis who underwent deformity correction and were followed-up for ≥1 year. The pre-and postoperative Cobb angle of the major structural curve, operative time, estimated blood loss (EBL), number of levels fused, event that caused the IONM alert, and intervention required for the recovery of the signal were recorded. Patients who received IONM alerts (alert group) and those who did not (non-alert group) during the operation were compared.

Results

Compared to the non-alert group, the alert group had a significantly greater preoperative Cobb angle of the major structural curve ( P < .001), number of levels fused ( P = .003), operative time ( P < .001), and EBL ( P < .001). The percentage of correction did not significantly differ between the 2 groups ( P = .348). Eight patients (.8%) underwent a staged operation because the IONM signal alert hindered correction of the deformity. The percentage of correction of patients who underwent staged operation was 64.9 ± 15.1%, and no permanent neurologic deficits occurred.

Conclusion

A greater magnitude of preoperative deformity and surgical extent increases the risk of cord injury identified by IONM alerts during correction of deformities in patients with AIS. However, in patients in whom the IONM alert cannot be recovered or reproduced by proceeding with deformity correction, surgeons can minimize the risk by aborting the initial procedure and completing the correction using staged operations.
Severe Central Airway Obstruction Secondary to a Giant Endobronchial Hamartoma: A Case Report
Authors: Fernandez-Trujillo Liliana , Castrillón Ana I. , Morales Eliana I. , Diaz Yesid , Sua Luz F.
Published: March 2023

Central airway obstruction refers to the occlusion of more than 50% of the trachea, main stem bronchi, or lobar bronchus. It can potentially become a life-threatening condition. Pulmonary hamartomas (PH) are rare tumors with an incidence of 0.25%, constituting about 8% of all benign lung neoplasms. Only 10% of PH occur endobronchially, while the remaining appear peripherally. We present the case of a women with an endobronchial hamartoma that required emergent resection by bronchoscopy. This is 44-year-old woman, with a history of an endobronchial mass on the right main stem bronchus (RMSB) without histopathological diagnosis or surgical management. She presented with a history of chronic cough and expectoration. Upon admission, a chest X-ray was performed, showing opacities of the right lung and amputations of the RMSB. Bronchoscopy was performed and a tumor-like mass that occludes the RMSB was found, with valve effect causing intermittent occlusion. In anesthetic induction, she presents severe airway obstruction and cardiorespiratory arrest. During resuscitation maneuvers, the lesion that was obstructing the light is seen and resection was performed with electrocautery and cryotherapy probes. Histopathological report described an endobronchial chondromesenchymal hamartoma, with no signs of malignancy. The control X-ray showed adequate re-expansion of the right lung. In conclusion, although endobronchial hamartoma has a low incidence and has a slow growth rate, it can manifest as severe airway obstruction. To achieve a complete resection of an endobronchial lesion, both rigid and/or flexible bronchoscopy plus multimodal interventions are recommended.
‘The beauty and the less beautiful’: exploring the meanings of dying at ‘home’ among community and practitioner representatives and advocates across Canada
Authors: Funk Laura , Krawczyk Marian , Cherba Maria , Cohen S. Robin , Dujela Carren , Nichols Camille , Stajduhar Kelli
Published: March 2023

Background:

Significant structural and normative pressures privilege the ideal of dying at home in Canada. At the same time, the social complexities and meanings associated with dying in particular locations remain critically unexamined.

Objective:

The aim of this study is to explore how diverse community members, including health and social care stakeholders, talk about preferences for locations of dying, with a particular focus on meanings of dying at home.

Design:

Semi-structured virtual interviews were conducted with 24 community and practitioner representatives and advocates across Canada during the Covid-19 pandemic. This included compassionate community advocates, palliative care professionals and volunteers, bereaved carers, and members of queer, rural, and immigrant communities. Participants were asked about their own preferences for location of dying and elaborated on these aspects with regard to their client population or community group.

Results:

Our analysis illuminates how meanings of dying at home are connected to previous experiences and perceptions of institutional care. As such, participants’ perspectives are often framed as a rejection of institutional care. Dying at home also often signals potential for preserving ontological security and relational connection in the face of life-threatening illness. However, participants’ expertise simultaneously informs a sense that dying at home is often unattainable. At times, this awareness underpins interpretations of both preferences and choices as contingent on considerations of the nature and type of illness, concerns about impacts on families, and available resources.

Conclusion:

The ideal of dying at home is nuanced by identity, relational, and structural contexts. Knowledge from this study can inform realistic and practical person-centered planning across care settings. It can also help create more representative public policy and health system quality indicators regarding a ‘good death’ that do not rely on or perpetuate undeveloped and unrealistic assumptions about dying, home, and family care.
Reversible interventions for menstrual management in adolescents and young adults with gender incongruence
Authors: Roden Rosemary Claire
Published: March 2023

The newly released World Professional Association for Transgender Health Standards of Care, 8th Edition specify that adolescents should be offered menstrual suppression as part of their treatment plans to suppress menses and alleviate dysphoria, provide contraception, or improve irregular bleeding on testosterone therapy. This is a review of current evidence-based options for reversible interventions for menstrual suppression in adolescents with gender dysphoria or incongruence. Shared decision-making should be used by the clinician at all times, and the clinician should be intentional in prioritizing the patient’s stated needs and desires when offering interventions. No method should be withheld due to the experience of gender incongruence alone. Contraceptive options offering menstrual suppression include depot-medroxyprogesterone acetate, levonorgestrel intrauterine systems, progestin-only contraceptive pills, and combined hormonal contraceptives. Non-contraceptive options include norethindrone acetate, oral medroxyprogesterone acetate, gonadotropin-releasing hormone analogues/agonists, and danazol. Certain patients may also benefit from non-pharmacologic interventions, such as specialty menstrual underwear.

Plain language summary

Using medicine to stop Menstrual periods in teens with gender incongruence Summary: Newly released recommendations for the care of teens and young adults with gender dysphoria or incongruence specifically recommend using medications to get rid of menstrual periods if desired or medically necessary. Patients may ask for this to help improve dysphoria, as a feature they want in birth control, or simply because they do not want to have periods. Because temporarily getting rid of periods is something that doctors can do for any patient old enough to have periods, patients with gender dysphoria should also be able to have their periods temporarily stopped using medications if requested. Doctors should ensure that they always help the patient make a decision that is right for them instead of prescribing what they think is right without considering the patient’s input. Options for temporarily getting rid of periods can include birth control, such as oral contraceptive pills, patches, or rings; intrauterine devices; or shots, and it can also be done with things that are not birth control, such a progesterone pills or puberty blockers. Finally, some patients may only need improved period hygiene with period underwear to feel better in their bodies.
Effects of Ag3Sn nanoparticles and isothermal aging on IMC layer growth, mechanical properties, and life prediction of SAC305/Cu solder joints
Authors: Yuan Peng , Chen Dongdong , Qin Junhu , Bai Hailong , Zhang Xin , Gan Guoyou , Leng Chongyan , Yan Jikang
Published: March 2023

In this paper, Ag3Sn nanoparticles were prepared by chemical method and added into SAC305 solder in different proportions to explore the effects of the Ag3Sn on the wettability, melting performance, metallographic structure, and mechanical property of the solder. The results show that a small amount of Ag3Sn nanoparticles were able to reduce the wetting time, increase the maximum wetting force, and expand the spreading area. The melting performance was also improved. Ag3Sn nanoparticles were also found to significantly refine the solder structure in the metallographical. The best comprehensive performance was achieved with the addition of 0.5% Ag3Sn nanoparticles. These Ag3Sn nanoparticles effectively improved the morphology of the IMC at the interface and effectively reduced the thickness of the IMC layer. The addition of nano Ag3Sn increased the diffusion activation energy and stabilized the interface. Moreover, the growth of the IMC layer was inhibited by 0.5% Ag3Sn, as indicated by aging results. The addition of Ag3Sn nanoparticles increases the tensile strength and Vickers hardness of the solder joint. When the amount of Ag3Sn nanoparticles was 0.5 wt%, the tensile strength reached the maximum of 17.45 MPa. The microhardness value of the solder is greatly increased, which reaches 311 HV. Finite element simulation showed that the service life of the solder was prolonged by adding the appropriate amount of Ag3Sn nanoparticles. The paper demonstrates a method of “nano” solder paste preparation. Results show that the addition of Ag3Sn nanoparticles plays an important role in the interfacial reaction and mechanical properties between the SAC solder and Cu substrate.
Scapulothoracic Arthroscopy for Snapping Scapula Syndrome
Authors: Nammour Michael , Arner Justin , Murray Ryan , Bradley James
Published: March 2023

Background:

Snapping scapula syndrome (SSS) is a disruption of the normal smooth motion of the scapulothoracic joint leading to clicking or “snapping” which can be painful or painless. There are a variety of etiologies with first-line treatment being conservative. If patients fail extensive nonoperative treatments, then surgery may be considered. Although technically challenging, arthroscopic treatment is recommended due to its decreased morbidity and improved cosmesis.

Indications:

We present a 21-year-old man with a 2-year history of mechanical popping and crepitus with overhead and scapulothoracic motion of his left arm. After failing an extensive trial of conservative therapy, the patient underwent scapulothoracic arthroscopy with bursectomy and partial resection of the superomedial border of the scapula.

Technique Description:

The patient is positioned prone with the operative arm behind the back to elevate the medial border off the chest wall. The scapula is outlined. Two arthroscopic portals are used; the superior portal is 3 cm medial to the medial border of the scapula at the level of the scapular spine and the inferior portal is 4 cm inferior to this at the inferomedial angle of the scapula. Viewing is typically done from the inferior portal, and the superior portal is used for resection of the bursa and superomedial border of the scapula. A shaver and ablator are used to perform a bursectomy and expose the superomedial border of the scapula. An arthroscopic bur is used to partially resect the superomedial border of the scapula at approximately 3.5 cm wide and 2 cm deep.

Results:

Although there are limited studies examining outcomes after scapulothoracic arthroscopy, the current literature suggests that scapulothoracic arthroscopy is effective in improving crepitus, pain, and clinical outcome scores.

Discussion/Conclusion:

In cases of SSS which have failed exhaustive conservative therapy, arthroscopic bursectomy and partial bony resection can be an effective treatment option with minimal invasiveness, improved cosmesis, and early return to activities. Proper patient positioning and careful portal placement are critical to avoid iatrogenic injury, particularly to neurologic structures.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Impact of triple therapy on mortality in COPD
Authors: Soumagne Thibaud , Zysman Maeva , Karadogan Dilek , Lahousse Lies , Mathioudakis Alexander G.
Published: March 2023

Only a few therapies have been shown to prolong survival in specific patients with COPD. In recent years, the IMPACT and the ETHOS trials suggested that triple therapy (a combination of inhaled corticosteroid (ICS), long-acting muscarinic antagonist (LAMA) and long-acting β2-agonist (LABA) given in a single inhaler) may reduce mortality compared with dual bronchodilation.

These results need however to be interpreted with caution. These trials were not powered by design to evaluate the impact of triple therapy on mortality as mortality was a secondary outcome. In addition, mortality reduction has to be put in perspective with the low mortality rate in both studies (<2%). Furthermore, a key methodological issue is that up to 70–80% of patients had ICS withdrawal at the enrolment in the LABA/LAMA arms, but none in the ICS-containing treatment arms. It is possible that ICS withdrawal may have contributed to some early death events. Finally, the inclusion and exclusion criteria of both trials were designed to select patients likely to respond to ICS.

There are no conclusive data yet that triple therapy reduces mortality in COPD. Future, well-designed and -powered trials are needed to validate the findings on mortality.
Respiratory complications of obesity: from early changes to respiratory failure
Authors: Shah Neeraj M. , Kaltsakas Georgios
Published: March 2023

Obesity is a significant and increasingly common cause of respiratory compromise. It causes a decrease in static and dynamic pulmonary volumes. The expiratory reserve volume is one of the first to be affected. Obesity is associated with reduced airflow, increased airway hyperresponsiveness, and an increased risk of developing pulmonary hypertension, pulmonary embolism, respiratory tract infections, obstructive sleep apnoea and obesity hypoventilation syndrome. The physiological changes caused by obesity will eventually lead to hypoxic or hypercapnic respiratory failure. The pathophysiology of these changes includes a physical load of adipose tissue on the respiratory system and a systemic inflammatory state. Weight loss has clear, well-defined benefits in improving respiratory and airway physiology in obese individuals.