bluuebunny/crossref_metadata_2025 huggingface dataset:
Telerehabilitation and telemonitoring interventions programs used to improving quality of life in people with cystic fibrosis: A systematic review
Authors: Ortiz Ortigosa Lucía , Vinolo-Gil María Jesús , Pastora Bernal José-Manuel , Casuso-Holgado María Jesús , Rodriguez-Huguet Manuel , Martín-Valero Rocío
Published: August 2023

Background

Cystic fibrosis causes mucus to build up in the lungs, digestive tract, and other areas. It is the most common chronic lung disease in children and young adults. It requires daily medical care. Before the COVID-19 pandemic, telerehabilitation and telehealth were used, but it was after this that there was a boom in these types of assistance in order to continue caring for cystic fibrosis patients.

Objective

The objective is to evaluate the effect of telemedicine programs in people with cystic fibrosis.

Methods

For the search, the PubMed, Scopus, Web of Science, PEDro, Cochrane, and CINAHL databases were used. Randomized controlled trials, pilot studies, and clinical trials have been included. The exclusion criteria have considered that the population did not have another active disease or that telemedicine was not used as the main intervention. This study follows the PRISMA statement and has been registered in the PROSPERO database (CRD42021257647).

Results

A total of 11 articles have been included in the systematic review. No improvements have been found in quality of life, forced expiratory volume, and forced vital capacity. Good results have been found in increasing physical activity and early detection of exacerbations. Adherence and satisfaction are very positive and promising.

Conclusions

Despite not obtaining significant improvements in some of the variables, it should be noted that the adherence and satisfaction of both patients and workers reinforce the use of this type of care. Future studies are recommended in which to continue investigating this topic.
Using machine learning to detect sarcopenia from electronic health records
Authors: Luo Xiao , Ding Haoran , Broyles Andrea , Warden Stuart J , Moorthi Ranjani N , Imel Erik A
Published: August 2023

Introduction

Sarcopenia (low muscle mass and strength) causes dysmobility and loss of independence. Sarcopenia is often not directly coded or described in electronic health records (EHR). The objective was to improve sarcopenia detection using structured data from EHR.

Methods

Adults undergoing musculoskeletal testing (December 2017–March 2020) were classified as meeting sarcopenia thresholds for 0 (controls), ≥1 (Sarcopenia-1), or ≥2 (Sarcopenia-2) tests. Electronic health record diagnoses, medications, and laboratory testing were extracted from the Indiana Network for Patient Care. Five machine learning models were applied to EHR data for predicting sarcopenia.

Results

Of 1304 participants, 1055 were controls, 249 met Sarcopenia-1 and 76 met Sarcopenia-2. Sarcopenic participants were older, with higher fat mass, Charlson Comorbidity Index, and more chronic diseases. All models performed better for Sarcopenia-2 than Sarcopenia-1. The top performing models for Sarcopenia-1 were Logistic Regression [area under the curve (AUC) 71.59 (95% confidence interval [CI], 71.51–71.66)] and Multi-Layer Perceptron [AUC 71.48 (95%CI, 71.00–71.97)]. The top performing models for Sarcopenia-2 were Logistic Regression [AUC 91.44 (95%CI, 91.28–91.60)] and Support Vector Machine [AUC 90.81 (95%CI, 88.41–93.20)]. For the best Logistic Regression Model, important sarcopenia predictors included diabetes mellitus, digestive system complaints, signs and symptoms involving the nervous, musculoskeletal and respiratory systems, metabolic disorders, and kidney or urinary tract disorders. Opioids, corticosteroids, and antihyperlipidemic drugs were also more common among sarcopenic participants.

Conclusions

Applying machine learning models, sarcopenia can be predicted from structured data in EHR, which may be developed through future studies to facilitate large-scale early detection and intervention in clinical populations.
Digital literacy among Korean older adults: A scoping review of quantitative studies
Authors: Kang Hun , Baek Jiwon , Chu Sang Hui , Choi JiYeon
Published: August 2023

Background

While digital literacy has become an essential competency for individuals across generations and sectors of society, supporting digital literacy in older adults is particularly challenging. South Korea is among the many countries undergoing rapid digitalization and population aging. Therefore, it is timely to identify the current understanding of digital literacy among older adults in South Korea.

Aim

To identify prior studies that quantitatively measure digital literacy among older adults in South Korea and to identify and evaluate how digital literacy was measured in the reviewed studies.

Methods

The study followed Arksey and O’Malley's scoping review framework, searching through four international (PubMed, CINAHL, Embase, and Cochrane Library) and four Korean (RISS, KISS, KCI, and KMBase) databases.

Results

Among 42 studies included in the final analysis, 38 were cross-sectional studies, and 21 employed primary data. Digital literacy was assessed in various scopes, including digital literacy, e-health literacy, Internet use, and smartphone use. Of the 25 identified measures, three were validated; the rest varied greatly, from using a few items from large surveys to employing investigator-developed measures. Based on the European Commission's Digital Competence Framework, the most commonly addressed components were “information and data literacy” and “communication and collaboration.”

Conclusions

In recent years, attention toward digital literacy among South Korean older adults has grown rapidly. However, the level of digital literacy among older adults in South Korea remains inconclusive given measurement heterogeneity. Developing and validating more robust measures are warranted to evaluate digital literacy among older adults with diverse functions and circumstances.
Search Fluency Mistaken for Understanding: Ease of Information Retrieval from the Internet Inflates Internal Knowledge Confidence
Authors: Hamilton Kristy A. , Qi Li
Published: August 2023

Internet search engines boast material features (e.g., Google’s knowledge panels, Featured Snippets) that increase the speed with which users find answers to search queries—while reducing their effort—to create a seamless media experience. Yet, the ability to instantaneously retrieve answers through seamless digital search may come at a metacognitive cost. This experiment examines the effect of digital search fluency on internal (in the “brain”) knowledge confidence. In a question-answering task, participants report higher ratings of internal knowledge confidence accompanying immediate access to Featured Snippets than those with delayed or no access to Featured Snippets. The effects of immediate information access on knowledge confidence not only occur for specific topics for which relevant information has been retrieved but also for topics irrelevant to the retrieved information. When people have immediate access to explanations through features that enhance access to information, external retrieval fluency may serve as a heuristic for internal knowledge confidence. Search engines that contribute to the immediate retrieval of external information may inadvertently strain Internet users’ ability to distinguish between mind and machine as the source of their knowledge.
Fixation of patella fracture with non-metallic implant
Authors: Ho Tsz Ying Giselle , Lee Syn Yuk Michelle
Published: August 2023

Introduction

Patella fracture fixations were traditionally done using metal tension band wiring techniques. However, complications associated with metallic implants causing soft tissue irritation are not infrequent. Since 1998, there have been emerging case reports and series reporting the use of non-metallic implants, such as braided sutures, in the fixation of patella fractures 3. However, there is a limited clinical study on a direct comparison between metal and suture fixation in patella fractures. The aim of this study is to evaluate the outcome of all-suture fixation in patella fractures and to compare all-suture and metal fixation in mid-pole fractures.

Materials and method

A total number of 50 patients with operated fracture patella were retrospectively reviewed in a 2.5-year period. Primary outcomes included operation time, time for fracture union and postoperative knee function. Secondary outcomes include complications, need for secondary operations due to prominent implants, infection or loss of fixation.

Results

There was no statistically significant difference concerning time for fracture union, operation time and postoperative functional knee score between the three fixation methods. The rate of secondary operations was higher in the hybrid group (7 out of 11, 63.6%) and metal group (7 out of 13, 53.8%), and was lowest in an all-suture group (0 out of 28, 0%). Metal implant breakage and soft tissue irritation were the main reasons for secondary operations, which was significantly lower in the all-suture group ( p < 0.0003). Subgroup analysis for mid-pole patella fractures showed similar results in which all primary outcomes showed no statistically significant difference, while the need for secondary operations was higher in the metal group ( p < 0.003).

Conclusion

All-suture fixation for patella fractures is a feasible option not limited to distal pole fractures. In our series, this technique achieved similar outcomes when compared with traditional metal implants, with lower rates of secondary operations, and could be safely employed in mid-pole fractures as well.
Customer Satisfaction and Sustainable Purchasing Behaviour via QR Code with the Mediating Role of Perceived Flow Among Malaysian Shoppers
Authors: Abdullah Borhan Sareya , Nawi Noorshella Che , Zainuddin Siti Afiqah , Hassan Ariezal Afzan , Ibrahim Wan Suzanna Aafanii Adeeba Wan , Mohamed Amaal Fadhlini , Zin Mohd Zubir Md
Published: August 2023

Mobile advertising on smartphones shows potential as a marketing and advertising strategy, particularly for influencing consumer purchasing behaviour. Mobile technologies, including QR codes, have been recognized as an effective and strategic tool for bridging the knowledge gap between companies and customers regarding purchasing behaviour. The literature, however, provides scarce insights into the QR code factors that affect consumer satisfaction and purchase intention via perceived flow. This study aims to empirically examine the mediating effect of perceived flow on the relationship between QR code (usefulness, acceptability and feasibility) and customer satisfaction and purchase intention based on the stimulus–organism–response model. The study adopted the cross-sectional design from 386 online shoppers. The PLS-SEM second-generation statistical method was used to analyse the data. The findings revealed that QR code usefulness, acceptability and feasibility have a positive significant effect on perceived flow, which positively influences customer satisfaction and purchase intention. Therefore, perceived flow positively mediated the relationship between QR code factors and customer satisfaction and purchase intention. Based on the SOR paradigm, the study extends the application of QR code services to the online shopping context in Malaysia and validates the positive relationship of QR code factors, perceived flow, customer satisfaction and purchase intention.
Best-Fit Circle for the Replication of Humeral Head Anatomy in Total Shoulder Arthroplasty
Authors: Kim Kyungil , Ju Sunghun , Jeong Jinyoung
Published: August 2023

Background:

Anatomic restoration of the humeral head is critical for successful shoulder replacement. Accurate measurements of the humeral head are essential for anatomic substitution.

Purpose:

To evaluate whether a best-fit circle of the humeral head, as determined from different projections of plain radiographs, can predict the humeral head implant size for either the left or right shoulder.

Study Design:

Descriptive laboratory study.

Methods:

Bilateral shoulder radiographs of 200 patients without arthropathy or other abnormal findings of the humeral head were evaluated. The best-fit circle was obtained based on 3 points: the medial and lateral endpoints of the anatomic neck and the lateral cortex below the greater tuberosity. This circle was drawn on 5 different radiographic projections (shoulder anteroposterior [AP], glenoid AP, outlet, axillary, and 30° caudal tilt) of the left and right shoulders of each patient, and the radius of each circle was measured. Agreement in the best-fit circle radius between the left and right shoulders was statistically analyzed using the intraclass correlation coefficient (ICC). There were 2 independent blinded observers who performed each measurement twice to evaluate inter- and intraobserver reliability.

Results:

Overall agreement in the radius between the right and left shoulders was excellent (all ICCs ≥0.990). The ICCs according to the radiographic view were 0.990 (95% CI, 0.986-0.993) for shoulder AP, 0.992 (95% CI, 0.989-0.995) for glenoid AP, 0.996 (95% CI, 0.994-0.997) for outlet, 0.994 (95% CI, 0.991-0.996) for axillary, and 0.993 (95% CI, 0.990-0.995) for 30° caudal tilt. Interobserver ICCs demonstrated a high level of precision: 0.987 (95% CI, 0.978-0.993) for shoulder AP, 0.986 (95% CI, 0.974-0.992) for glenoid AP, 0.974 (95% CI, 0.954-0.985) for outlet, 0.991 (95% CI, 0.984-0.995) for axillary, and 0.987 (95% CI, 0.977-0.993) for 30° caudal tilt. Intraobserver ICCs demonstrated excellent test-retest reliability: 0.983 (95% CI, 0.970-0.991) for shoulder AP, 0.989 (95% CI, 0.980-0.994) for glenoid AP, 0.987 (95% CI, 0.978-0.993) for outlet, 0.985 (95% CI, 0.973-0.991) for axillary, and 0.970 (95% CI, 0.947-0.983) for 30° caudal tilt.

Conclusion:

The best-fit circle to calculate the ideal size of a humeral head implant was able to be determined from different projections of plain radiographs.

Clinical Relevance:

Anatomic restoration of a deformed humeral head can be achieved using the best-fit circle of the contralateral humeral head as obtained from plain radiographs. This method can facilitate preoperative planning and postoperative evaluation in the anatomic restoration of the shoulder to avoid the problems of overstuffing.
Communication Apprehension Among Autistic Professionals
Authors: Cardon Peter
Published: August 2023

Prior research has shown that stress and anxiety are commonly reported by autistic adults in social-communication situations in their personal and professional lives. Yet, little research exists to demonstrate the extent and nature of communication apprehension in the workplace among autistic professionals. This survey study of 324 autistic professionals showed that autistic professionals experience high communication apprehension, particularly in comparison to the general population. As communication situations become less predictable, autistic professionals tended to disproportionately experience higher communication apprehension.
The Evolution of Alternative Care in Bhutan over the Last Decade and Way Forward
Authors: Dolkar Tshering
Published: August 2023

The main objective of this article is to understand the full spectrum of alternative care, various aspects covered under this theme and its progress in the SAARC countries over a decade respective country. This article hopes to understand and address the issues that can influence policy reforms, decision-making and improve practices and standards of care in the country. In addition to this, it is also to learn and get diverse ideas of practices prevalent in other societies, which will help in to strengthen research, knowledge and counselling practices currently prevalent. It is to bring forth the best practices that other regions might have been practicing. This article explores the existing policies and services that are prevalent in the country enhancing childcare and protection. It also tries to bring forth the good practices that are currently in place and how it can be strengthened further by addressing challenges within the system. It also provides insight into history and evolution, and role of stakeholders involved in alternative care in the country.
Glimpses from the Anthropological Odyssey of B. R. Ambedkar Through the Caste System in India
Authors: Guha Abhijit
Published: August 2023

B. R. Ambedkar’s original research on the caste system in India is an unexplored area. In this article, an attempt has been made to appreciate the views of Ambedkar on the origin of the caste system in India and the relationship of the anthropological milieu of the United States of America during the time of Franz Boas in shaping his thoughts. Ambedkar gave importance on the endogamy of caste superimposed on tribal exogamy, and he maintained an academic detachment from his painful personal experiences, while presenting his seminar paper on caste at Columbia University, USA.
Multilevel resistive switching memory in lead-free double perovskite La$$_{2}$$NiFeO$$_{6}$$ films
Authors: Qin Yongfu , Gao Yuan , Lv Fengzhen , Huang Fangfang , Liu Fuchi , Zhong Tingting , Cui Yuhang , Tian Xuedong
Published: August 2023

Dense and flat La$$_{2}$$

2

NiFeO$$_{6}$$

6

(LNFO) films were fabricated on the indium tin oxide-coated glass (ITO/glass) substrate by sol–gel method. The bipolar resistive switching behavior (BRS) could be maintained in 100 cycles and remained after 30 days, indicating that the LNFO-based RS device owned good memory stability. Surprisingly, the multilevel RS characteristics were firstly observed in the Au/LNFO/ITO/glass device. The high resistance states (HRSs) and low resistance state (LRS) with the maximum ratio of $$\sim$$
∼
 500 could be remained stably in 900 s and 130 cycles, demonstrating the fine retention and endurance ability of this LNFO-based RS device. The BRS behavior of Au/LNFO/ITO/glass devices primarily obeyed the SCLC mechanism controlled by oxygen vacancies (OVs) dispersed in the LNFO layer. Under the external electric field, injected electrons were captured or discharged by OVs during trapping or detrapping process in the LNFO layer. Thus, the resistive state switched between HRS and LRS reversibly. Moreover, the modulation of Schottky-like barrier formed at the Au/LNFO interface was contributed to the resistive states switchover. It was related to the change in OVs located at the dissipative region near the Au/LNFO interface. The multilevel RS ability of LNFO-based devices in this work provides an opportunity for researching deeply on the high density RS memory in lead-free double perovskite oxides-based devices.
Meta-analysis of African ancestry genome-wide association studies identified novel locus and validates multiple loci associated with kidney function
Authors: Kintu Christopher , Soremekun Opeyemi , Machipisa Tafadzwa , Mayanja Richard , Kalyesubula Robert , Bagaya Bernard S. , Jjingo Daudi , Chikowore Tinashe , Fatumo Segun
Published: August 2023

Despite recent efforts to increase diversity in genome-wide association studies (GWASs), most loci currently associated with kidney function are still limited to European ancestry due to the underlying sample selection bias in available GWASs. We set out to identify susceptibility loci associated with estimated glomerular filtration rate (eGFRcrea) in 80027 individuals of African-ancestry from the UK Biobank (UKBB), Million Veteran Program (MVP), and Chronic Kidney Disease genetics (CKDGen) consortia.

We identified 8 lead SNPs, 7 of which were previously associated with eGFR in other populations. We identified one novel variant, rs77408001 which is an intronic variant mapped to the ELN gene. We validated three previously reported loci at GATM-SPATA5L1, SLC15A5 and AGPAT3. Fine-mapping analysis identified variants rs77121243 and rs201602445 as having a 99.9% posterior probability of being causal. Our results warrant designing bigger studies within individuals of African ancestry to gain new insights into the pathogenesis of Chronic Kidney Disease (CKD), and identify genomic variants unique to this ancestry that may influence renal function and disease.
Use of heart failure medications in older individuals and associations with cognitive impairment
Authors: Abramsson Linnea , Backman Annica , Lövheim Hugo , Edvardsson David , Gustafsson Maria
Published: August 2023

Background

To achieve the best treatment of heart failure, it is important to use all recommended drugs at their target doses. Given that underuse of medications can occur in individuals with cognitive impairment, we investigated the filled prescriptions and target doses of heart failure medication for older individuals with and without cognitive impairment as well as associated factors.

Methods

The study was based on two separate datasets. The first dataset, which was based on data from questionnaires sent to nursing homes in Sweden, included 405 individuals with heart failure. The data were linked with the Swedish Prescribed Drug Register and the National Patient Register to obtain information regarding filled prescriptions of heart failure medications and heart failure diagnoses among the population. In the second dataset, medical records of individuals aged 75 years or older admitted to a hospital in northern Sweden were reviewed and individuals with heart failure were identified. Target doses of heart failure medications were evaluated in 66 individuals who lived at home.

Results

Filled prescriptions of mineralocorticoid receptor antagonists and loop diuretics were significantly more common in individuals without cognitive impairment (OR 1.087; 95% CI 1.026–1.152, p < 0.05) and (OR 1.057; 95% CI 1.017–1.098, p < 0.05), respectively. There were no significant differences between individuals with and without cognitive impairment in terms of achieving target doses for any of the drug classes. A higher age was associated with fewer filled prescriptions and less ability to reach the target doses of beta blockers (OR 0.950; 95% CI 0.918–0.984, p < 0.05) and (OR 0.781; 95% CI 0.645–0.946, p < 0.05), respectively.

Conclusions

Our results suggest that individuals with cognitive impairment are partly undertreated for heart failure in that they had fewer filled prescriptions of important heart medications. Separately, the relatively low proportion of older individuals reaching target doses is an important observation and indicates that treatment of heart failure could be further optimised among older individuals.
CDK4/6 inhibitors, PI3K/mTOR inhibitors, and HDAC inhibitors as second-line treatments for hormone receptor-positive, HER2-negative advanced breast cancer: a network meta-analysis
Authors: Ji Danyang , Luo Yang , Wang Jiayu , Chen Shanshan , Lan Bo , Ma Fei , Xu Binghe , Fan Ying
Published: August 2023

Background

This study sought to compare the benefits and safety of agents including Cyclin-dependent kinase 4/6 (CDK4/6) inhibitors, phosphoinositide 3-kinase (PI3K)/mammalian target of rapamycin (mTOR) inhibitors, and histone deacetylase (HDAC) inhibitors as second-line treatments for these patients by conducting a comprehensive systematic review and network meta-analysis.

Methods

The Medline, Embase and Cochrane Library databases were searched for randomized trials comparing CDK4/6 inhibitors, PI3K/mTOR inhibitors, or HDAC inhibitors vs. placebo with the addition of exemestane or fulvestrant as second-line treatments in patients with HR + advanced breast cancer up to December 16, 2021. Outcomes of interest were progression-free survival (PFS), overall response rate (ORR), overall survival (OS), clinical benefit rate (CBR), and grade 3–4 adverse drug events (ADEs). The present study was conducted according to the Cochrane Collaboration and PRISMA statements. The overall effect was pooled using the random effects model.

Results

Seventeen studies with a total of 9,100 participants were included in the current study. Compared with placebo plus fulvestrant, PFS was significantly improved by CDK4/6 inhibitor plus fulvestrant, mTOR inhibitor plus fulvestrant, mTOR inhibitor plus exemestane, and PI3K inhibitor plus fulvestrant, but not HDAC inhibitor plus exemestane. While mTOR inhibitor plus exemestane was the best regimen (SUCRA value 89.5%), the mTOR inhibitor plus exemestane regimen induced more severe adverse events (SAEs) than the HDAC inhibitor plus exemestane regimen [OR, 95% CI: 2.40 (1.40–4.10)].

Conclusion

mTOR inhibitor and CDK4/6 inhibitor-based regimens demonstrated superior clinical efficacy and comparable safety profiles as second-line treatment in patients with HR-positive, HER2-negative advanced breast cancer.
Diagnosis of thoracic outlet syndrome with the lower trunk compression of brachial plexus by high-frequency ultrasonography
Authors: Chen Dingzhang , Gong Wenqing , Wang Jing , Hao Jikun , Zhao Rui , Zheng Minjuan
Published: August 2023

Background

Thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus (BP) is difficult to diagnosis. This study aimed to summarize the features of thoracic outlet syndrome (TOS) with the lower trunk compression of brachial plexus observed on high-frequency ultrasonography (HFUS).

Methods

The ultrasound data of 27 patients who had TOS with the lower trunk compression of brachial plexus were collected and eventually confirmed by surgery. The imaging data were compared, and the pathogenesis of TOS was analyzed on the basis of surgical data.

Results

TOS occurred predominantly in females (70.4%). Most cases had unilateral involvement (92.6%), mainly on the right side (66.7%). The HFUS features of TOS can be summarized as follows: (1) Lower trunk compression. HFUS revealed focal thinning that reflected compression at the level of the lower trunk; furthermore, the distal part of the nerve was thickened for edema (Affected side: 0.49 ± 0.12 cm vs. Healthy side: 0.38 ± 0.06, P = 0.009), and the cross-sectional area of brachial plexus cords was markedly greater on the injured side than on the healthy side (0.95 ± 0.08 cm² vs. 0.65 ± 0.11 cm², P = 0.004). (2) Hyperechoic fibromuscular bands behind the compressed nerve (mostly the scalenus minimus muscle). (3) Abnormal bony structures: cervical ribs or elongated transverse processes of the 7th cervical vertebra (C7). Surgical results showed that the etiological factors contributing to TOS were (1) muscle hypertrophy and/or fibrosis (100%) and (2) cervical ribs/elongated C7 transverse processes (20.7%).

Conclusion

TOS with the lower trunk compression of brachial plexus can be diagnosed accurately and reliably by high-frequency ultrasound.
Pseudoarthrosis after anterior cervical discectomy and fusion: rate of occult infections and outcome of anterior revision surgery
Authors: Calek Anna-Katharina , Winkler Elin , Farshad Mazda , Spirig José Miguel
Published: August 2023

Background

Pseudoarthrosis after anterior cervical discectomy and fusion (ACDF) is relatively common and can result in revision surgery. The aim of the study was to analyze the outcome of patients who underwent anterior revision surgery for pseudoarthrosis after ACDF.

Methods

From 99 patients with cervical revision surgery, ten patients (median age: 48, range 37–74; female: 5, male: 5) who underwent anterior revision surgery for pseudoarthrosis after ACDF with a minimal follow up of one year were included in the study. Microbiological investigations were performed in all patients. Computed tomography (CT) scans were used to evaluate the radiological success of revision surgery one year postoperatively. Clinical outcome was quantified with the Neck Disability Index (NDI), the Visual Analog Scale (VAS) for neck and arm pain, and the North American Spine Society Patient Satisfaction Scale (NASS) 12 months (12–60) after index ACDF surgery. The achievement of the minimum clinically important difference (MCID) one year postoperatively was documented.

Results

Occult infection was present in 40% of patients. Fusion was achieved in 80%. The median NDI was the same one year postoperatively as preoperatively (median 23.5 (range 5–41) versus 23.5 (7–40)), respectively. The MCID for the NDI was achieved 30%. VAS-neck pain was reduced by a median of 1.5 points one year postoperatively from 8 (3–8) to 6.5 (1–8); the MCID for VAS-neck pain was achieved in only 10%. Median VAS-arm pain increased slightly to 3.5 (0–8) one year postoperatively compared with the preoperative value of 1 (0–6); the MCID for VAS-arm pain was achieved in 14%. The NASS patient satisfaction scale could identify 20% of responders, all other patients failed to reach the expected benefit from anterior ACDF revision surgery. 60% of patients would undergo the revision surgery again in retrospect.

Conclusion

Occult infections occur in 40% of patients who undergo anterior revision surgery for ACDF pseudoarthrosis. Albeit in a small cohort of patients, this study shows that anterior revision surgery may not result in relevant clinical improvements for patients, despite achieving fusion in 80% of cases.

Level of evidence

Retrospective study, level III.
Modified hindfoot alignment radiological evaluation and application in the assessment of flatfoot
Authors: Liang Jing-Qi , Zhang Yan , Liu Liang , Wen Xiao-Dong , Liu Pei-Long , Yang Xin-Quan , Liang Xiao-Jun , Zhao Hong-Mou
Published: August 2023

Background

Alignment is indispensable for the foot and ankle function, especially in the hindfoot alignment. In the preoperative planning of patients with varus or valgus deformity, the precise measurement of the hindfoot alignment is important. A new method of photographing and measuring hindfoot alignment based on X-ray was proposed in this study, and it was applied in the assessment of flatfoot.

Methods

This study included 28 patients (40 feet) with flatfeet and 20 volunteers (40 feet) from January to December 2018. The hindfoot alignment shooting stand independently designed by our department was used to take hindfoot alignment X-rays at 10 degree, 15 degree, 20 degree, 25 degree, and 30 degree. We measured the modified tibio-hindfoot angle (THA) at the standard hindfoot aligment position (shooting at 20 degree) and evaluated consistency with the van Dijk method and the modified van Dijk method. In addition, we observed the visibility of the tibiotalar joint space from all imaging data at five projection angles and evaluated the consistency of the modified THA method at different projection angles. The angle of hindfoot valgus of flatfoot patients was measured using the modified THA method.

Results

The mean THA in the standard hindfoot aligment view in normal people was significantly different among the three evaluation methods (P < .001). The results from the modified THA method were significantly larger than those from the Van Dijk method (P < .001) and modified Van Dijk method (P < .001). There was no significant difference between the results of the modified THA method and the weightbearing CT (P = .605), and the intra- and intergroup consistency were the highest in the modified THA group. The tibiotalar space in the normal group was visible in all cases at 10 degree, 15 degree, and 20 degree; visible in some cases at 25 degree; and not visible in all cases at 30 degree. In the flatfoot group, the tibiotalar space was visible in all cases at 10 degree, visible in some cases at 15 degree and 20 degree, and not visible in all cases at 25 degree and 30 degree. In the normal group, the modified THA was 4.84 ± 1.81 degree at 10 degree, 4.96 ± 1.77 degree at 15 degree, and 4.94 ± 2.04 degree at 20 degree. No significant differences were found among the three groups (P = .616). In the flatfoot group, the modified THA of 18 feet, which was visible at 10 degree, 15 degree and 20 degree, was 13.58 ± 3.57 degree at 10 degree, 13.62 ± 3.83 degree at 15 degree and 13.38 ± 4.06 degree at 20 degree. There were no significant differences among the three groups (P = .425).

Conclusions

The modified THA evaluation method is simple to use and has high inter- and intragroup consistency. It can be used to evaluate hindfoot alignment. For patients with flatfeet, the 10 degree position view and modified THA measurement can be used to evaluate hindfoot valgus.
Risk factors for postoperative acute ischemic stroke in advanced-aged patients with previous stroke undergoing noncardiac surgery: a retrospective cohort study
Authors: Xiao Wei , Yang Shuyi , Feng Shuai , Wang Chunxiu , Huang Hao , Wang Chaodong , Zhong Chonglin , Zhan Shubin , Yao Dongxu , Wang Tianlong
Published: August 2023

Background

The current study aimed to investigate the incidence and risk factors for postoperative acute ischemic stroke (PAIS) in advanced-aged patients (≥ 75 years) with previous ischemic stroke undergoing noncardiac surgery.

Methods

In this single-center retrospective cohort study, all advanced-aged patients underwent noncardiac surgery from 1 January, 2019, to 30 April, 2022. Data were extracted from hospital electronic medical records. Multivariable logistic regression analysis was performed to determine predictors of PAIS. Multivariable linear or logistic regression analysis was performed to determine predictors of outcomes due to PAIS.

Results

Twenty-four patients (6.0%) of the 400 patients developed PAIS. Carotid endarterectomy (CEA), length of surgery and preoperative Modified Rankin scale (mRS) ≥ 3 were significant predictors of PAIS. CEA was associated with increased risk of PAIS (OR 4.14; 95%CI, 1.43–11.99). Each additional minute in length of surgery had slightly increased the risk of PAIS (OR, 1.01; 95%CI, 1.00-1.01). Compared with reference (mRS < 3), mRS ≥ 3 increased odds of PAIS (OR, 4.09;95%CI, 1.12–14.93). Surgery type and length of surgery were found to be significant predictors of in-hospital expense (P < 0.001) and hospital stays (P < 0.05).

Conclusions

CEA, length of surgery and preoperative mRS ≥ 3 may increase the development of PAIS in advanced-aged patients (≥ 75 years) with previous stroke undergoing noncardiac surgery. PAIS increased in-hospital mortality and prolonged hospital stay.
PIWIL2 restrains the progression of thyroid cancer via interaction with miR-146a-3p
Authors: Lu Xiaoxiao , Zhu Qingyun , Du Hong , Gu Mingjun , Li Xiangqi
Published: August 2023

Objective

The classical role of PIWIL2 is to regulate reproduction by binding to piRNA, but its tumor-related function has received increasing attention in recent years. This study aims to explore its role in the progression of thyroid cancer (TC).

Methods

First, we measured and analyzed the levels of PIWIL2 and miR-146a-3p in TC tissue and adjacent tissues as well as several TC cell lines. We demonstrated the clinical significance of PIWIL2 and miR-146a-3p through the survival rate. Based on these results, we selected TPC-1 and KTC-3 cell lines for our cell experiments. We treated these cell lines with PIWIL2 lentivirus, PIWIL2 siRNA, miR-146a-3p mimic, or miR-146a-3p inhibitor and measured cell proliferation, cell cycle, apoptosis, migration, and invasion. We used PCR and Western blot to quantify the mRNA and protein levels of PIWIL2, while we used luciferase reporter assay and RNA binding protein immunoprecipitation to explore the relationship between miR-146a-3p and PIWIL2. Finally, we developed a xenograft tumor model to confirm the effects of the miR-146a-3p/PIWIL2 axis on TC progression in vivo.

Results

We identified that PIWIL2 and miR-146a-3p exhibit opposite expression alterations in TC tissues and that PIWIL2 serves as a ‘sponge’ by adsorbing miR-146a-3p. Up-regulating PIWIL2 decelerated the proliferation, metastasis, and cell cycle progression of TPC-1 and KTC-3 cells, but accelerated the apoptosis of TC cells, while miR-146a-3p exhibited opposite effects. Finally, overexpressing PIWIL2 restrained the progression of TC in nude mice, which can be reversed by increasing miR-146a-3p expression. Inhibiting PIWIL2, on the other hand, promoted the progression of TC in vivo, which can be reversed by inhibiting miR-146a-3p.

Conclusion

PIWIL2 may inhibit the progression of TC by sponging miR-146a-3p, providing new insights into the early treatment, recrudescence treatment, and metastasis treatment of TC.
Fertility-enhancing hysteroscopic surgery; multi-center retrospective cohort study of reproductive outcome
Authors: Al-Husban Naser , Odeh Omar , AlRamahi Muataz , Qadri Sara , Al-Husban Hedaieh
Published: August 2023

Introduction

Hysteroscopic surgery and assisted reproduction technology are feasible ways to improve the reproductive outcome. Our aim was to study hysteroscopic septoplasty and myomectomy’s effect on infertility and reproductive performance.

Methods

Retrospective cohort of patients who had unexplained infertility and/or recurrent miscarriages and had myomectomy or septoplasty in the period September 2016-october 2021 with a total of 18 months’ follow up. The main outcome measures were spontaneous pregnancy, term pregnancy and miscarriage. For analysis, we used Statistical Package for Social Sciences (SPSS) version 20.

Results

One hundred and sixty-five patients were included. The mean age of patients was 39 years. 40 patients had septum resection and 125 patients had hysteroscopic myomectomy. A spontaneous pregnancy rate after surgery was achieved in 46 patients (27.9%). Out of the 64 patients who had failed IVF preoperatively, 32 patients (50%) had a successful IVF post-hysteroscopic surgery and there were more successful cases in the patients who had fibroid resection but this difference did not reach a statistical significance (P value 0.055). In the 79 pregnancies after surgery, preterm birth and miscarriage were seen in 10 patients (12.7%), similarly, respectively after septal or fibroid resection. Miscarriages were less post-operatively. Hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy rate (63.0% Vs 37.0%, P value 0.018), more term pregnancies (87.5% vs. 12.5%, P value 0.001) and less miscarriage rate (40%vs 60%, P value 0.003). Pregnancy post-operatively in patients with primary infertility was more statistically significantly associated with hysteroscopic myomectomy than with hysteroscopic septoplasty (95.8% vs. 4.2%, p value 0.030). In patients who got pregnant postoperatively there was no statistically significant difference in the mode of delivery.

Conclusion

In carefully selected patients with unexplained infertility and recurrent miscarriage, hysteroscopic myomectomy, compared with hysteroscopic metroplasty, was significantly associated with higher spontaneous pregnancy, more term pregnancies and less miscarriage rates. More than metroplasty, hysteroscopic myomectomy led to higher spontaneous pregnancies in patients with primary infertility.

Trial registration

NCT05560295.
Assessment of lipoedema awareness among polish women- online survey study
Authors: Hansdorfer-Korzon Rita , Czerwińska Monika , Teodorczyk Jacek , Szamotulska Jolanta
Published: August 2023

Background

Lipoedema is an adipose tissue disorder that is still not fully understood. The primary purpose of this study is to explore the state of knowledge and understanding of lipoedema among Polish women. The secondary aim is to investigate the possible association between knowledge and factors such as BMI, self-reported symptoms, and age.

Methods

One hundred seventy polish women took part in an online survey study that was posted to social media groups and forums in January 2022. The survey consisted of 12 questions and aimed at assessing the basic knowledge about lipoedema.

Results

The least proportion of participants (4%) could correctly indicate the methods of lipoedema treatment. The accurate definition of lipoedema was indicated only by 7% of women, 12% identified characteristic features of lipoedema, and 37% correctly evaluated lipoedema curability. The greatest proportion of respondents knew the differences between obesity and lipoedema (50%).

Conclusions

Awareness of lipoedema among women is deficient. A significant proportion of the respondents report the occurrence of lipoedema symptoms. In order to improve the situation of lipoedema patients, it is crucial to increase the knowledge about this condition both among medical professionals and the general public.
Development and pilot study of “Smart Cancer Care”: a platform for managing side effects of chemotherapy
Authors: Sin Cheolkyung , Kim Hyeyeong , Im Hyeon-Su , Ock Minsu , Koh Su-Jin
Published: August 2023

Background

As outpatient chemotherapy treatment increases, cancer patients receiving chemotherapy spend more time at home. In addition, since the types of chemotherapy are gradually expanding, it will be essential to prepare patient self-management strategies for various chemotherapy-related side effects. This study aimed to develop a platform (called Smart Cancer Care) to implement a chemotherapy side effect management program and to evaluate its feasibility.

Methods

Smart Cancer Care comprises an application for patients and a dashboard for medical staff. Thirty-two symptoms to be managed using Smart Cancer Care were summarized through a literature review and Delphi. Management guidelines were developed based on the severity of each symptom (3 stages), and installed in Smart Cancer Care according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0 guidelines. To evaluate the feasibility of the developed application and medical dashboard, cancer patients and cancer treatment medical staff used Smart Cancer Care for 2 to 3 weeks and subsequently reported the experience of using them.

Results

The patient application provided a list of symptoms according to the cancer type and anticancer drug enabling presence and severity of each symptom to be evaluated. Patients received management guidelines for symptoms based on the symptom evaluation results. On the medical staff dashboard, administrators and authorized medical personnel could access and assess information regarding side effects and symptom severity submitted by the patient. The feasibility and usefulness of Smart Cancer Care were confirmed through a pilot test targeting 30 patients and 24 chemotherapy-related medical staff. For patients, the evaluation score for the “The program will be helpful when seeing medical staff” item was the highest. For medical staff, the score for the “By checking the patient’s symptoms using the program, it helps to take appropriate measures for the patient” item was the highest. Although minor corrections were raised, most patients and medical staff expected that Smart Cancer Care would help their treatment.

Conclusions

The configuration of the application and dashboard of Smart Cancer Care detailed in this study could be used for the development of a widely accepted platform to implement a chemotherapy side effect management program.
Association of housing adaptation services with the prevention of care needs level deterioration for older adults with frailty in Japan: a retrospective cohort study
Authors: Tsuchiya-Ito Rumiko , Hamada Shota , Iwagami Masao , Ninomiya Ayako , Ishibashi Tomoaki
Published: August 2023

Background

Housing adaptations are aimed at minimizing the mismatch between older adults’ functional limitations and their building environments. We examined the association of housing adaptations with the prevention of care needs level deterioration among older adults with frailty in Japan.

Methods

The subjects comprised individuals who were first certified as having care support levels (defined as frail, the lowest two of seven care needs levels) under the public long-term care insurance systems between April 2015 and September 2016 from a municipality close to Tokyo. The implementation of housing adaptations was evaluated in the first six months of care support certification. Survival analysis with Cox proportional hazards model was performed to examine the association between housing adaptations and at least one care needs level deterioration, adjusting for age, sex, household income level, certified care support levels, cognitive function, instrumental activities of daily living, and the utilization of preventive care services (designed not to progress disabilities). We further examined the differences in the association of the housing adaptation amount by categorizing the subjects into the maximum cost group (USD 1,345–1,513) or not the maximum cost group (< USD 1,345). All the subjects were followed until the earliest of deterioration in care needs level, deaths, moving out of the municipality, or March 2018.

Results

Among 796 older adults, 283 (35.6%) implemented housing adaptations. The incidence of care needs level deterioration was 19.3/1000 person-month of older adults who implemented housing adaptations, whereas 31.9/1000 person-month of those who did not. The adjusted hazard ratio (aHR) of care needs level deterioration was 0.69 (95% confidence interval (CI): 0.51–0.93). The aHRs were 0.51 (95% CI: 0.31–0.82) and 0.78 (95% CI: 0.57–1.07) in the maximum and not maximum cost groups, respectively.

Conclusions

Housing adaptations may prevent care needs level deterioration of older adults with frailty. Policymakers and health professionals should deliver housing adaptations for older adults at risk of increasing care needs.
Implementing a resilience coach program to support first year housestaff during the COVID-19 pandemic: early pilot results and comparison with non-housestaff sessions
Authors: Stewart Rebecca E. , Wislocki Katherine , Wolk Courtney B. , Bellini Lisa , Livesey Cecilia , Kugler Kelley , Kwon Nayoung , Cardamone Nicholas C. , Becker-Haimes Emily M.
Published: August 2023

Background

In response to the COVID-19 pandemic, we launched the Penn Medicine Coping First Aid program to provide psychosocial supports to our health system community. Our approach leveraged lay health worker volunteers trained in principles of Psychological First Aid to deliver coaching services through a centralized virtual platform.

Methods

We emailed all (n = 408) first year housestaff (i.e., residents and fellows) with an invitation to schedule a session with a resilience coach. We compared the mental health concerns, symptoms, and Psychological First Aid techniques recorded in (n = 67) first year housestaff sessions with (n = 91) sessions of other employees in the health system.

Results

Between June and November 2020, forty-six first year housestaff attended at least one resilience coaching session. First year housestaff most commonly presented with feelings of anxiety and sadness and shared concerns related to the availability of social support. Resilience coaches most frequently provided practical assistance and ensured safety and comfort to first year housestaff. First year housestaff reported fewer physical or mental health symptoms and held shorter sessions with resilience coaches than non-housestaff.

Conclusions

This work offers insights on how to address psychosocial functioning through low-intensity interventions delivered by lay personnel. More research is needed to understand the efficacy of this program and how best to engage housestaff in wellness and resilience programs throughout training, both during and beyond COVID-19.