bluuebunny/crossref_metadata_2025 huggingface dataset:
Anatomical Characterization and Topographic Mapping of the Distal Ulnar Nerve and Its Peripheral Branches: A Cadaveric Analysis
Authors: Pautler Benjamin , Marchese Charles , Swancutt Makayla , Beutel Bryan G.
Published: December 2024

Background:

Understanding peripheral ulnar nerve anatomy is necessary to refine surgical treatment of ulnar nerve injuries. This study topographically mapped the ulnar nerve and its distal branch points from a well-defined surgical landmark and assessed for variations in interfascicular motor arrangement and branch size.

Methods:

Fifty-four cadaveric upper extremities were dissected to expose the distal ulnar nerve and its branches (dorsal cutaneous (DCB), volar sensory (VSB), and motor branches). The motor branch underwent internal neurolysis to record the topographic orientation of abductor digiti minimi (ADM) and flexor pollicis brevis (FPB) fascicles and the combined intrinsic fascicle identified by its terminal branch (first dorsal interosseus (FDI)). Using a standardized grid system, the branch point location of each terminal branch was measured relative to the hook of the hamate. Diameters of VSB, DCB, and motor fascicles were also measured.

Results:

Mean branch point coordinates relative to the hook of the hamate for the FDI were 22.8 mm radial/32.1 mm distal, 13.6 mm radial/25.1 mm distal for FPB, 7.7 mm ulnar/5.2 mm proximal for ADM, and 15.7 mm ulnar/95.3 mm proximal for DCB. The diameters of the VSB, motor branch, and DCB had a mean of 2.3, 1.9, and 1.6 mm, respectively. Proximal to the hook of the hamate, the fascicular arrangement from radial-to-ulnar was VSB, FPB, FDI/intrinsics, ADM, and DCB.

Conclusions:

This study provides a complete characterization and mapping of the distal ulnar nerve and its branches to assist surgeons with treatment of ulnar nerve injuries, including nerve transfer.
Reevaluating the Need for Antibiotic Prophylaxis in Adult Upper Extremity Surgery With Hardware
Authors: Yan Yufan , Khabyeh-Hasbani Nathan , Abuqubo Rami Z. , Cohen Joshua M. , Robbins Victoria P. , Pothula Aravind , Koehler Steven M.
Published: December 2024

Background:

Although it is well established that antibiotic prophylaxis is not needed in soft tissue upper extremity cases, there is still no definitive consensus when hardware implantation is involved. We hypothesize that antibiotic prophylaxis is not necessary and there is no difference in postoperative surgical site infection rates regardless of preoperative antibiotic administration.

Methods:

A retrospective cohort analysis was performed on upper extremity surgical cases with hardware implantation performed at a single institution amongst 5 hand surgeons between November 2021 and November 2023. Implants included plates, screws, Kirschner wires, and suture anchors. Primary outcome measures were diagnosis of surgical site infection by 14 and 30 days postoperatively. Secondary outcomes included the type of management used to treat infection. Categorical variables were compared using Fisher exact test, and continuous variables were compared using Wilcoxon rank-sum test.

Results:

A total of 232 patients were included for analysis—152 received antibiotic prophylaxis and 80 did not. There were no differences between the 2 groups in terms of demographic factors, comorbidities, or smoking status. There was no difference in infection rates between the group who received antibiotic prophylaxis and the group who did not. Infection rate in the antibiotic prophylaxis group was 4.6% and in the sans antibiotics group was 2.5%. All infections were treated with antibiotics, and there were no differences in the rates of operative washout and hardware removal between the 2 groups.

Conclusions:

Antibiotic prophylaxis is not necessary in upper extremity surgical cases even when implantation of hardware is involved.
Identification, Characterization and Anti-inflammatory Activity of a New Flavonoid From Hibiscus mutabilis L.
Authors: Hu Pan , Ye Lei , Gong Yuanxiang , Yan Xin , Huang Ping , Shi Xiaoqing , Wang Xi
Published: December 2024

Hibiscus mutabilis L (Malvaceae) was a traditional Chinese medicine with significant anti-inflammatory activity. We isolated 3 compounds from the flowers of H mutabilis L , including a new flavonoid, (1″R)-8-(1-(3,4-dihydroxyphenyl)ethyl)-3,3',5,7-tetrahydroxy-4′-methoxyl flavone (1), and 2 known flavonoids (2-3). The structures of these compounds were elucidated by various spectroscopic methods. In addition, we evaluated the anti-inflammatory effect of compound 1. The bioactivity assay showed that 1 significantly inhibit the excessive production of IL-6, TNF-α and NO in LPS-induced RAW264.7 macrophages. Western blot analysis demonstrated that 1 inhibit the expressions of COX-2 and iNOS protein in the macrophages induced by LPS in a concentration-dependent manner. In addition, 1 also significantly suppress the expression of the key proteins P65 and p-P65 in the NF- κB signaling pathway. Our results revealed that 1 exert potential anti-inflammatory activity through inhibiting the activation of NF- κB signaling pathway.
Extreme Behaviors in Risk Measurement via Joint Tail-Based Cumulative Residual Entropy and Its Generalized Version
Authors: Ben Hssain Lhoucine , Lakhnati Ghizlane
Published: December 2024

Tail risk analysis plays a pivotal strategic role in risk management, particularly in light of economic crises. In this context, the purpose of this paper is to examine the asymptotic properties of Joint Tail-based Cumulative Residual Entropy ([Formula: see text]) in a bivariate setup involving two variables, [Formula: see text] and [Formula: see text]. In this setup, [Formula: see text] is considered the variable of interest, while [Formula: see text] serves as the benchmark variable. We provide a generalization of the Joint Tail-based Cumulative Residual Entropy to create a more flexible version that allows for a more comprehensive analysis of extreme risk. This generalization leads to a deeper understanding of the tail relationship between [Formula: see text] and [Formula: see text] and their respective impacts on a specific system. To illustrate our results, we conducted the study under both tail-dependent and tail-independent scenarios. We supplemented our research with practical examples and applied our findings to real-world financial data, employing our proposed non-parametric estimator of [Formula: see text] as the basis for our analysis.
Safety and efficacy of staged primary coiling followed by delayed flow diversion of ruptured intracranial aneurysms: A systematic review and meta-analysis
Authors: Alayli A. , Monsour M. , Schimmel S. , Pressman E. , Klocksieben F. , Mokin M. , Guerrero W.R. , Vakharia K.
Published: December 2024

Background

Ruptured intracranial aneurysms lead to significant mortality and morbidity. Recent advancements have suggested staged coiling with subsequent flow diverter stent placement may reduce the risk of hemorrhage with dual antiplatelet therapy (DAPT) or stent thrombosis in the acute inflammatory phase after aneurysm rupture while still appropriately mitigating risk of aneurysmal rehemorrhage.

Materials and Methods

A systematic review and single-arm meta-analysis was conducted. Studies reporting patients receiving coiling followed by delayed flow diverter placement on a separate day were included.

Results

Five studies, comprising 94 patients, were included for meta-analysis. Average time between procedures ranged from 9.8 to 169 days; 24% (95% CI: 10–41%) of patients had a poor functional neurologic outcome (modified Rankin Scale > 2) at discharge compared to 4% (0–11%) at last follow-up. There was one incidence of rehemorrhage between treatments, 0% (0–4%). Vasospasm after coiling was the most common adverse event, 16% (1–41%). There was low risk of ischemic complications [1% (0–8%) with coil placement and 5% (1–11%) with stent placement]. Intraprocedural intracranial hemorrhage was also rare (two patients during coil placement; no cases during stent placement). There were no significant differences if flow diversion was performed less than or greater than 100 days from coiling.

Conclusions

Our study highlights the benefit of primary coiling with staged flow diversion for the management of ruptured intracranial aneurysms with a low risk for complications. Namely, the rate of rebleeding between treatments was exceptionally low. We advocate for the greater consideration of this treatment combination in the treatment of ruptured intracranial aneurysms.
Defining the responsibilities of principals in promoting equity: Insights from the Israeli school system
Authors: Shaked Haim
Published: December 2024

Contemporary school principals are tasked with promoting equity within their schools. The importance of this endeavor is clear; however, there is a need for greater clarity regarding the specific responsibilities involved. Addressing this need is the goal of this study. Data were collected from 21 principals of elementary schools in Israel using semistructured interviews. Data analysis included four stages: sorting, coding, categorizing, and theorizing. The findings illustrate how the framework of strong equity, comprising the four Rs—redistribution, recognition, representation, and reframing—can be applied to school leadership to encompass the key responsibilities that principals have in promoting equity. Theoretical and practical implications are discussed.
Top-down and emotional attention in blind and sighted individuals
Authors: Zinchenko Artyom , Geyer Thomas , Gädeke Julia C , Föcker Julia
Published: December 2024

There is evidence that congenitally blind individuals possess superior auditory perceptual skills compared to sighted people. However, relatively little is known about the auditory-specific cortical correlates of spatial attention in the blind and how task-irrelevant emotional stimulus features could further modulate such neural processes. This study tested blind and sighted participants in a challenging auditory discrimination task. All participants were blindfolded and seated between loudspeakers at 45-degree angles, while pseudowords were randomly presented. The task was to identify target sounds from either the left or the right speaker while ignoring nontarget stimuli, the irrelevant loudspeaker, and irrelevant speaker identity. Emotional valence—neutral, happy, fearful, threatening—of pseudowords was task-irrelevant, focusing solely on syllable detection. Our focus was on measuring the moment-to-moment deployment of auditory-selective attention. This was achieved using the lateralized N2ac event-related potential component characterised by greater negativity at anterior electrodes on the side contralateral to an attended auditory stimulus and observed 75 to 250 ms after stimulus onset. We observed that blind individuals showed better behavioural performance and reduced N2ac amplitudes than sighted individuals. Furthermore, for both groups, N2ac amplitudes were increased for the target compared to nontarget stimuli and stimuli appearing at spatially relevant versus irrelevant locations. Our study highlights the superiority of auditory processing capabilities in blind individuals. The results also highlight the N2ac component’s sensitivity to top-down attentional engagement and emotional attention, offering new insights into how blind and sighted individuals process auditory information.
The effect of rotator cuff repair on sleep quality: Influencing factors and the impact of narcotic medication on postoperative sleep patterns: A systematic review and meta-analysis
Authors: Mozes Adam Daniel , Danilkowicz Richard M , Haichin Loren Stephany , Gonzalez Felipe , Yona Tzadok , Lindner Dror , Beer Yiftah , Garrigues Grant E , Gilat Ron
Published: December 2024

Background

Impaired sleep quality often drives patients with rotator cuff tears (RCT) to seek surgical intervention. This meta-analysis reviews the impact of arthroscopic rotator cuff repair (ARCR) on sleep quality beyond six months and identifies influencing factors, primarily narcotics, on sleep quality.

Methods

The search spanned PubMed, Google Scholar, Embase, and the Cochrane Central Register, targeting articles evaluating rotator cuff injury and sleep quality. Information gathered included study features, bias risk assessment, evaluation of sleep quality using sleep-specific patient-reported outcomes, and the effects of opiates on sleep outcomes.

Results

Ten studies, including 445 patients who underwent ARCR were included. The preoperative mean Pittsburgh Sleep Quality Index (PSQI) varied from 6.6 to 15. Eight studies presented a mean PSQI score of 3.6–7.1 at 6 months postoperatively; two studies reported mean score of 4.2 and 5.4 at 12 months. Both were found to be statistically significant by this meta-analysis compared to preoperative scores. Three studies found narcotic use, RCT size, alcohol consumption, diabetes, and hypertension to negatively affect PSQI scores.

Discussion

Arthroscopic rotator cuff repair significantly improves sleep quality at 6 and 12 months following surgery. Perioperative narcotic use, RCT size, alcohol consumption, diabetes, and hypertension may negatively impact sleep quality.
Study protocol for the iMarkHD study in individuals with Huntington's disease
Authors: van Wamelen Daniel J , Martin Naomi H , Makos Orsolya , Badenoch James , Valera-Bermejo Jose Manuel , Hartmann Monika , Cristales Alay Rangel , Wood Tobias C , Veronese Mattia , Moretto Manuela , Zelaya Fernando , dell’Acqua Flavio , O’Daly Owen , Lythgoe David J , Ginestet Cedric , Turkheimer Federico , Palasits Nikki , Mrzljak Ladislav , Warner John H , Rabiner Eugenii A , Gunn Roger , Tabrizi Sarah J , Sampaio Cristina , Wood Andrew , Williams Steven CR
Published: December 2024

Background: Huntington's disease (HD) is still often defined by the onset of motor symptoms, inversely associated with the size of the CAG repeat expansion in the huntingtin gene. Although the cause of HD is known, much remains unknown about mechanisms underlying clinical symptom development, disease progression, and specific clinical subtypes/endophenotypes. Objective: In the iMarkHD study, we aim to investigate four discrete molecular positron emission tomography (PET) tracers and magnetic resonance imaging (MRI) markers as biomarkers for disease and symptom progression. Methods: Following MRI optimization in five healthy volunteers (cohort 1), we aim to recruit 108 participants of whom 72 are people with HD (PwHD) and 36 healthy volunteers (cohort 2). Pending interim analysis, these numbers could increase to 96 PwHD and 48 healthy controls. Participants will complete a total of 10 study visits, consisting of a screening visit followed by a clinical and MRI visit and PET visits at baseline, year 1, and year 2. PET targets include the cannabinoid 1, histamine 3, and serotonin 2A receptors, and phosphodiesterase 10A, whereas MRI will be multimodal, including, but not limited to, the assessment of cerebral blood flow, functional connectivity, and brain iron. Results: Recruitment is currently active and started in September 2022. Conclusions: By combining PET and multi-modal MRI assessments we expect to provide a comprehensive examination of the molecular, functional, and structural framework of HD progression. As such, the iMarkHD study will provide a solid base for the identification of treatment targets and novel outcome measures for future clinical trials.
Cognitive impairment in Huntington's disease and its impact on functioning: Concept elicitation and cognitive debriefing for the Huntington's Disease Everyday Functioning (Hi-DEF) scale
Authors: Petrillo Jennifer , Levine A Alex , Johannesen Jason , Lovell Teya , Rams Alissa , Cano Stefan , Anderson Karen , Klapper Jennifer , Koenig Aaron
Published: December 2024

Background

Cognitive impairment in Huntington's disease (HD) is a key driver of disability that can have deleterious impacts on everyday functioning. Currently available patient-reported outcome measures may not adequately capture the impact of HD-related cognitive impairment on daily life, particularly higher-order executive functioning (i.e., processing information, decision making, multi-tasking, planning, etc.).

Objective

To address the unmet need to better quantify the functional sequelae of HD-related cognitive impairment by developing the Huntington's Disease Everyday Functioning (Hi-DEF) scale.

Methods

Qualitative interviews were conducted in two adult cohorts (25–65 years) with early stages of HD (i.e., huntingtin [ mHTT] gene carriers with self-reported cognitive complaints but could still function independently). Cohort 1 included 10 dyads of participants with HD and their care partners, who completed concept elicitation interviews to identify cognitive challenges impacting everyday tasks, which was used to design a draft item-set. Cohort 2, which included 15 additional participants with HD, cognitively debriefed this item-set.

Results

In Cohort 1, issues with executive functioning were reported 32 times by participants with HD and 22 times by care partners, and challenges with functioning were reported 46 times by participants with HD and 20 times by care partners. Based on these reports, the Hi-DEF scale was developed and cognitive debriefing interviews evaluated its content validity, relevance, clarity, interpretation, and acceptability. Psychometric validation of the Hi-DEF scale is reported elsewhere.

Conclusions

These interviews revealed the impact of HD-related cognitive impairment on everyday functioning and supported the content validity, relevance, clarity, interpretation, and acceptability of the Hi-DEF scale.
Enhancing the Efficacy of Radiotherapy in Gastric Adenocarcinoma Cells by Gut Microbiota Metabolites: Implications for Urolithin Combination Therapy
Authors: Ahmadi Abdolreza , Hosseini Fatemehsadat , Ostadi Hassan , Gholamhosseinian Hamid , Iranshahy Milad , Rassouli Fatemeh B.
Published: December 2024

Background

Gastric adenocarcinoma (GA) ranks as the fourth leading cause of cancer-related mortality. The clinical effectiveness of radiotherapy in GA patients is often limited by the development of radiation resistance. Urolithins, which are metabolites produced by gut microbiota from ellagitannins, possess good bioavailability and exhibit beneficial pharmaceutical properties. The aim of present study was to determine whether urolithins can enhance the effects of ionizing radiation (IR) on GA cells for the first time.

Methods

Urolithins were synthesized and MKN-45 cells were pretreated with UroA, UroB, and mUroA for 24, 48 and 72 h, followed by 400, 600 and 800 cGy IR exposure. After recovery, the viability of the cells was evaluated by resazurin assay, and the mode of interaction between urolithins and IR was determined. Then, interactome mapping and gene set enrichment analyses were performed. Upon validating CHEK1 expression in GA tissues and MKN-45 cells, molecular docking was conducted to predict the interaction of urolithins with CHK1.

Results

Pretreatment with urolithins significantly decreased viability upon radiotherapy. The most considerable decrease in the cell viability was observed after 400 cGy IR exposure. In comparison to the control treatments, 24 h pretreatment with UroA and mUroA significantly ( p < .0001) reduced cell viability to 57.4% and 62.8%, respectively. In addition, 48 h pretreatment with UroA and mUroA significantly ( p < .001) reduced viability to 69.7% and 72.7% after exposure to 400 cGy IR, respectively. Upon 72 h pretreatment with urolithins, only mUroA induced synergistic effects with 400 cGy IR. In silico analyses highlighted CHK1 as one of the main proteins involved in the response to IR-induced DNA damage, showing overexpression in GA samples and MKN-45 cells. Additionally, molecular docking revealed favorable interactions between urolithins and CHK1.

Conclusion

Present study highlights the notable synergistic effects of urolithins in combination with IR, indicating their potential to improve therapeutic outcomes.
Risk of Chondral Fracture During Implantation of Distal Femur Osteochondral Autograft Plugs: A Human Cadaveric Comparison of Four Different Donor Regions
Authors: Massey Patrick A. , Hayward Daniel , Bonner Christian , Scalisi Wayne , Taylor Ryan , Vincent Elise , W. Rutz Robert , F. Solitro Giovanni
Published: December 2024

Introduction

Distal femoral cartilage lesions can be treated using osteochondral autograft transfer (OAT). When impacting plugs into a recipient site, the cartilage may fracture. This study aimed to analyze OAT donor regions and impaction energies to identify characteristics that lead to fracture.

Methods

Fifteen cadaver femurs were used with OAT plugs harvested from the following regions: lateral and medial trochlea (LT and MT), lateral and medial intercondylar notch (LIN and MIN). Plugs were impacted into a bone surrogate block using a custom anvil-type system with pre-determined impact heights; 30, 50, 70, and 90 mm. Each plug’s cartilage was examined and determined to be intact or fractured. Chi-square was used to compare the rate of chondral fracture for each region.

Results

In all, 221 plugs were included. The overall rate of chondral fracture was 45.7%. There was a significant difference in the rate of fracture between regions, with LIN, MIN, LT, and MT, having a fracture rate of 46.6%, 62.7%, 25.0%, and 51.9%, respectively ( P = 0.001). An impact height of 30 mm resulted in a fracture rate of 17.7%. Increasing the impact height from 30 to 50 mm resulted in significantly increased chondral fracture risk ( P = 0.001).

Conclusion

Different donor regions have varying rates of chondral fracture during OAT plug impaction, with the lateral and medial trochlea being the most resistant to chondral fracture at lower forces. Increased impact energy increases risk of chondral fracture. Surgeons should maintain caution and utilize lower impact energy when inserting OAT plugs.
Smartphone use and personality: Their effects on sleep quality across groups using mediation analysis
Authors: Rahman Tauseef Ur , Jan Zahoor , Alam Aftab , Ali Raian
Published: December 2024

Purpose

The rapid rise in smartphone use has led to declining sleep quality. Excessive internet use has been linked to negative impacts on physical and mental health, and individual personality traits (PT) may contribute to internet addiction and mitigate its harmful effects. This study aims to: (1) examine whether PT mediate the relationship between smartphone use and sleep quality, and (2) investigate whether the relationship between smartphone use and sleep quality varies across different gender and age groups.

Methods

There were 269 participants in the dataset. The daily averages for sleep duration, sleep distraction, and smartphone use were extracted from the usage data acquired through a dedicated smartphone application. Structural equation modeling was employed to investigate the mediating role of personality in the relationship of smartphone use and sleep quality.

Results

Results indicated that PT partially mediated the relationship, with a significant negative indirect impact of smartphone use on sleep quality. Age differences were observed, showing distinct patterns between younger and older participants, while no significant gender differences emerged.

Conclusions

This study found that excessive smartphone use, coupled with low personality indicators, leads to poor sleep quality. Positive personality traits improve sleep outcomes, with age influencing the impact of smartphone use on sleep. Our findings support and contribute to existing concerns about technology overuse and highlight the need for targeted interventions to promote more beneficial technology design and usage patterns.
The effectiveness of digital tools to maintain physical activity among people with a long-term condition(s): A systematic review and meta-analysis
Authors: Howes Sarah , Stephenson Aoife , Grimmett Chloe , Argent Rob , Clarkson Paul , Khan Ameera , Lait Emily , McDonough Leah Rose , Tanner Giorgia , McDonough Suzanne M
Published: December 2024

Objective

Given the well-accepted health benefits, it is important to identify scalable ways to support people with long-term conditions (LTCs) to remain physically active. This systematic review aimed to evaluate the effect of digital tools on the maintenance of physical activity (PA) amongst this population.

Methods

Electronic databases were searched for randomised controlled trials investigating the effect of digital tools on PA maintenance at least three months post-intervention compared with a non-digital control in participants with long-term conditions. Meta-analyses were conducted at post-intervention and longest maintenance timepoint; subgroup analyses explored the effect of the type of control. Prospero registration: CRD42022299967.

Results

Twenty-three studies ( n = 5350 participants) were included, with the majority at unclear/high risk of bias. Web-based tools were commonly used (18 studies), 10 monitored PA with a sensor, and digital interventions were often combined with supervised exercise/walks. The overall meta-analysis showed no significant difference in PA between digital interventions compared with any type of control (device-based outcomes: SMD = −0.07, 95% CI [−0.35, 0.21]; self-reported outcomes: SMD = 0.11, 95% CI [−0.01, 0.24]). However, this was moderated by type of control group with subgroup analyses suggesting that the effect of digital interventions on PA surpassed that of an inactive/minimal control at post-intervention (SMD = 0.29) and maintenance timepoints (SMD = 0.24).

Conclusions

This review provides preliminary evidence that interventions incorporating digital tools may be more effective than minimal controls at supporting people with LTCs to maintain PA. Given the quality of the evidence, confidence in these findings is very low and may change with future research.
Oxygen saturation for the prediction of acute mountain sickness
Authors: Burtscher Johannes , Faulhaber Martin , Kopp Martin , Burtscher Martin
Published: December 2024

We read with interest the paper on “Smartwatch measurement of blood oxygen saturation for predicting acute mountain sickness: Diagnostic accuracy and reliability” recently published by Zeng and colleagues in Digital Health. This study demonstrated good reliability and high precision for measuring peripheral oxygen saturation (SpO2) using Huawei smartwatches during a 1-wk high altitude exposure. In addition, SpO2 values recorded during the ascent to high altitude were predictive for the development of acute mountain sickness (AMS). Although these findings are valuable and in accordance with previous studies, some additional clarifications would be helpful to better understand the use of SpO2 and its clinical relevance as an AMS predictor.
Comparing Postoperative Outcomes of Isolated Anterior Cruciate Ligament Reconstruction and the “Terrible Triad” Anterior Cruciate Ligament Reconstruction With Medial Meniscus Ramp and Lateral Meniscus Root Repairs
Authors: Shoemaker Evan P. , Tollefson Luke V. , Kennedy Nicholas I. , McGaver Rebecca Stone , Homan Morgan , Sieffert Kayla J. , Shah Ayush D. , Wulf Corey A. , Larson Christopher M. , Bjerke Brian P. , LaPrade Robert F.
Published: December 2024

Background:

A new “terrible triad” has been reported to be an anterior cruciate ligament (ACL) tear with a concomitant medial meniscus ramp tear and lateral meniscus root tear. Patient-reported outcomes (PROs) for isolated ACL reconstruction (ACLR) versus an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs are not well known.

Purpose:

To compare postoperative outcomes between isolated ACLR and ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs.

Study Design:

Cohort study; Level of evidence, 3.

Methods:

An initial cohort of 1228 patients with ACLRs were retrospectively identified between April 2016 and November 2021. A total of 41 patients with isolated ACLR (isolated cohort) were age and sex matched to 41 patients who had an ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Patients in the triad cohort were identified consecutively by date of surgery. Preoperative and ≥2-year postoperative PROs were evaluated to compare the isolated cohort with the triad cohort. Statistical analysis was performed with unpaired t tests and chi-square tests.

Results:

Both the isolated cohort and triad cohort demonstrated significant differences between preoperative and postoperative PROs in all questionnaire categories assessed. Postoperative scores for the International Knee Documentation Committee (isolated, 88.8; triad, 86.2; P = .392), Cincinnati (isolated, 91.1; triad, 88.1; P = .295), and Lysholm (isolated, 92.1; triad, 90.1; P = .472) PROs demonstrated no significant differences between the cohorts. No significant difference was found between the isolated and triad cohorts for all preoperative questionnaire categories. Additionally, no significant difference was found in revision or reoperation rates between isolated and triad patients ( P = .733).

Conclusion:

No significant differences in PROs were found at minimum follow-up of 2 years postoperatively between the patients who underwent isolated ACLR (isolated cohort) and those who underwent ACLR with concomitant medial meniscus ramp and lateral meniscus root repairs (triad cohort). Inferior outcomes were not observed in the triad cohort when revision rates, reoperation rates, and postoperative PROs were compared. Given the optimistic short-term outcomes for isolated versus triad ACLR patients and the known biomechanical consequences of these untreated meniscal injuries, medial meniscus ramp and lateral meniscus root repairs should be performed when encountered concurrently with an ACL tear when possible.
Antiangiogenic therapy combined with immune checkpoint blockade in urothelial cancer: Systematic review and meta-analysis
Authors: Moussa Mohammad Jad , Kovalenko Iuliia , Crupi Emanuele , Proskuriakova Ekaterina , Geng Yimin , Fallara Giuseppe , Benkhadra Raed , Raggi Daniele , Campbell Matthew T. , Msaouel Pavlos , Alhalabi Omar
Published: December 2024

Background

Antiangiogenic therapy had been tested in urothelial cancer (UC) without reaching the clinic.

Objective

We provide a systematic review and meta-analysis of trials to assess efficacy of immune checkpoint inhibitors (ICI) combined with antiangiogenic agents in UC.

Methods

Following PRISMA guidelines, we searched for trials with at least one arm of patients with UC treated with ICI plus antiangiogenics. Data were analyzed with the “meta” package from R using a one-staged frequentist meta-analysis.

Results

After screening 13,708 titles and abstracts, 9 studies were selected for analysis with 14 identified cohorts comprising 621 patients: 448 were ICI-naïve (ICI-N) and 173 were ICI-exposed (ICI-E). The estimated objective response rate (ORR) in all patients was 27% (21–35). In the ICI-N group, ORR was 34% (28–41). Conversely, the ICI-E group had a lower ORR of 16% (9–28). This difference was mainly driven by a higher partial response rate of 27% (23–31) in ICI-N group compared to 13% (8–20) in the ICI-E group. Disease control rate was 72% (66–77) ICI-N group vs. 71% (64–78) in ICI-E group. Median overall survival ranged from 6.4 to 24.9 months in the ICI-N group, and 8.2 to 10.4 months in ICI-E group. Median progression free survival ranged from 1.9 to 10.1 months and from 3 to 3.9 months in both groups, respectively.

Conclusion

ORR with ICI plus antiangiogenics was lower after prior ICI exposure, with substantial variability estimates among included trials, either due to differences among antiangiogenic agents used or trial-related factors. Future exploration of ICI combined with antiangiogenics in UC, especially in ICI-refractory setting, will benefit from better patient selection.
Husband's Contributions to Stimulate Wife's Confidence Experiencing Role Transition: Cross-Sectional Study
Authors: Wahyuni Sri , Arief Yuni Sufyanti , Triharini Mira , Nursalam Nursalam
Published: December 2024

Introduction

Pregnancy can cause various physical and physiological changes. It affects confidence, resulting in depression and disturbing health not only for a mother but also for her fetus. These will also determine the ability of the mother to take care of her baby after delivery.

Objectives

To analyze the husband's contributions to stimulate the wife's confidence in experiencing role transition.

Methods

This research used a quantitative method with a cross-sectional design. The research was conducted in Central Java. There were 150 respondents of pregnant mothers. The variables of this study were the husband's factors and the wife's self-confidence, which were collected by demographic questionnaire and spiritual well-being scale questionnaire (SWBS) with a total sampling technique. The data were analyzed using a multinominal regression Test.

Results

Husbands were 58% at the age of early adult (26–35 years old), 76% graduating from secondary school level, 61.3% working as private employees, and 70% well supporting their wives. Most respondents (48.7%) had good self-confidence shown by the relationship of all husband's characteristics covering age, education, occupation, and support with the wife's self-confidence in facing role transition and had a value of <0.05.

Conclusion

The husband's age in a productive period with a good husband's education and occupation level could make the husband have mature thoughts, and he can calm his wife based on correct knowledge so that the wife is not worried about facing them and feels confident. Nurses can motivate and educate husbands to always provide support to their wives in facing pregnancy.
Exploring the Feasibility of a Caregiver Burden-Mastery Hybrid Assessment Tool With Decision Matrix in a Memory Clinic: A Multimethod Study
Authors: Chan Ee Yuee , Ong Zhi Lei , Glass George Frederick , Ang Siew Ling , Lim Jun Pei , Ali Noorhazlina Binte , Lim Wee Shiong
Published: December 2024

Introduction

Family members caring for a person living with dementia (PWD) can experience caregiver burden, leading to psychological distress if unmanaged. It's essential for healthcare professionals, especially nurses to identify caregivers at risk of stress and depression, triggering prompt management during their contact with caregivers of PWD. The study team developed an evidence-based caregiver burden-mastery hybrid assessment and intervention decision matrix (CHAT-MI) for caregivers of PWD and examined its feasibility of use.

Objective

To determine the feasibility and usability of implementing the CHAT-MI assessment-decision matrix tool in an outpatient setting in Singapore.

Methods

CHAT-MI was developed through earlier research, research evidence, clinical guidelines, and expert opinion. A multimethod study was conducted in a Singapore outpatient memory clinic from November 2020 to January 2021. Caregivers of PWD who attended the clinic self-administered the assessment tool to determine their burden and personal mastery levels. Clinicians used a decision matrix to guide interventions based on the assessments. Feedback was gathered from both caregivers and clinicians through surveys and semistructured interviews.

Results

Thirty-four caregivers and six clinicians participated in the study. Caregivers found the burden-mastery assessment tool relatively easy to use and understand and helpful. Clinicians found the assessment-decision matrix tool acceptable, feasible, and useful, enhancing standard care by providing insights into caregivers’ current coping capabilities. Clinicians shared that junior clinicians could benefit from CHAT-MI to better detect caregiving stress and deliver interventions. Nevertheless, more can be done to train clinicians in the understanding of the concept of mastery (i.e., perceived control over life events) to help clinicians better engage and support caregivers.

Conclusion

CHAT-MI was found to be relatively brief and can aid the outpatient clinic setting. This suggests that such an evidence-based assessment cum intervention can be considered for use in a real-world clinical setting to aid both caregivers and clinicians.
Customer Value and Profit: Modelling in an Economic Approach
Authors: Heruwasto Ignatius
Published: December 2024

Customer value (CV) is a central concept in marketing; most research hypotheses are developed through conceptual discussions in positive linear relationships. This article explores the relationship between CV and profits using mathematical and economic substitution methods. Two models of CV to profits are benefit-based (Model-1) and price-based (Model-2), which reveal the relationship between CV and profits can be positive or negative, quadratic or concave. There is a CV paradox expressed in propositions intended to warn of possible threats to profitability. A three-dimensional graphical CV surface is depicted to facilitate understanding of the results and then used to develop guidelines for avoiding paradoxes. This article also explains several important strategies and practices in creating CV and company profits.
Review of the gastric physiology of disgust: Proto-nausea as an under-explored facet of the gut–brain axis
Authors: Alladin Sameer N. B. , Judson Ruth , Whittaker Poppy , Attwood Angela S. , Dalmaijer Edwin S.
Published: December 2024

Humans feel visceral disgust when faced with potential contaminants like bodily effluvia. The emotion serves to reject potentially contaminated food and is paired with proto-nausea: alterations in gastric rhythm in response to disgust. Here, we offer a narrative synthesis of the existing literature on the effects of disgust on the stomach as measured through electrogastrography, a non-invasive technique that measures stomach activity with electrodes placed on the abdominal skin surface. After identifying and assessing 368 studies for eligibility and inclusion based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses process, we reviewed a final sample of only 10 articles that employed electrogastrography to assess gastric responses to unpleasant stimuli, including disgust elicitors. Reviewed findings illustrate that changes in gastric rhythm are associated with negatively valenced emotions, and most reliably with visceral disgust elicitors. This rhymes with recent evidence for a causal role of gastric state in reductions in visceral disgust avoidance. Because limitations in the reviewed body of work come from the low number of studies and relatively small sample sizes, we strongly encourage studies of proto-nausea in designs with higher statistical power, ideally paired with experimental manipulations of gastric state.
A Literature Review Exploring Time to Re-Rupture after Functional Rehabilitation Treatment of Achilles Tendon Rupture
Authors: Bosse Jordan , Homere Andrew , Belle Parker Emily , Smith Jeremy T. , Bluman Eric M. , Martin Elizabeth A. , Chiodo Christopher P.
Published: December 2024

Category:

Ankle; Trauma

Introduction/Purpose:

Achilles tendon rupture is a common ankle injury. Patients who suffer a rupture may be treated operatively or nonoperatively. Nonoperative treatment with functional rehabilitation has grown in popularity over the last decade. However, re-rupture remains a known complication with this treatment. The current literature review explored time to re-rupture (TTR) in patients treated with functional rehabilitation for an Achilles tendon rupture. So that orthopaedists can optimally counsel patients with regard to return to activity, our primary goal was to investigate the time from initial injury to re-rupture. Secondary endpoints included the mechanism of re-rupture as well as the age, athletic status, and sex of patients who re-ruptured.

Methods:

A literature search was performed using PubMed. Articles examining functional rehabilitation published in English after 2010 with data on TTR were included. Mechanism of re-rupture, athletic status, and treatment method were collected. Studies where patients were immobilized for longer than four weeks were excluded. When TTR was reported as a range, authors were contacted, and data were used only if specific TTR was available.

Results:

Eleven articles were included. Of the 1,653 patients, 78 sustained a re-rupture (4.7%). The average TTR was 9 weeks (range, 2 to 28 weeks). Seventy-seven of the patients (98.7%) re-ruptured at or prior to 20 weeks (4.6 months), with a single re-rupture at 28 weeks. Most patients were male (77.5%). There was no significant difference in TTR by re-rupture mechanism (high energy vs low energy, p=0.09), age (≥40 vs < 40, p=0.35), sex (male vs female, p=0.53), and athlete status (non-athlete/unknown vs athlete, p=0.42). Re-rupture was more often treated operatively than nonoperatively (72.5% vs 27.5%).

Conclusion:

This data adds to our understanding of re-rupture following functional rehabilitation for Achilles tendon rupture. Orthopaedists can counsel patients that the vast majority of re-ruptures occur within 20 weeks of injury and are rarely seen after 6 months. Summary of Included Patients Experiencing Re-Rupture After Functional Rehabilitation
A Radiographic Comparison between Successful and Failed Total Contact Casted Patients with Charcot Neuroarthropathy
Authors: Chopra Avani , Koroneos Zachary A. , Benedict Christian , Pitcher Michaela D. , Pitcher Michaela D. , Aynardi Michael
Published: December 2024

Category:

Midfoot/Forefoot; Hindfoot

Introduction/Purpose:

This study aims to evaluate the influence of foot deformity severity, as assessed by radiographic measurements, on the efficacy of total contact casting (TCC) in patients with Charcot neuroarthropathy. TCC is a common treatment in this patient population that aims to immobilize the foot and ankle to mitigate trauma, preventing additional damage, and safeguard the foot structure. There is limited data on the optimal radiographic measurement in predicting which patients will be successfully treated with TCC (Griffiths et al., 2021). By comparing radiographic outcomes between patients who were successfully treated with TCC and those who required surgical intervention following TCC failure, we seek to clarify the role of anatomical deformity in treatment prognosis.

Methods:

We retrospectively analyzed a cohort of Charcot neuroarthropathy patients treated within a single healthcare system. Patients with radiographs of the affected foot within 2 years prior to or 1 year after the initiation of TCC. Patients were divided into two groups: those successfully managed with TCC (n=10) and those necessitating surgery due to TCC failure (n=16). Ten measurements of standard radiographic parameters used for quantifying the level of deformity in Charcot (Wukich et al., 2014) were included in this study. These measurements were Meary’s angle, Calcaneal pitch, medial and lateral column height, calcaneal 5th metatarsal angle, talar declination, tibiotalar angle, Kite’s angle, hindfoot-forefoot angle, and talonavicular coverage angle. All measurements were collected using Phillips PACS Software (Release 4.7) by three trained evaluators with two evaluators assigned per scan. Differences in the average [value] between groups were assessed using an unpaired t-test.

Results:

The cohort was comprised of 26 patients (16 males, 10 females). Our analysis revealed that lateral column height was the only parameter with a statistically significant difference in the height measurement (p< 0.05) between the groups. There were no other significant differences detected amongst any of the 9 other measurements.

Conclusion:

This study revealed that there is a lack of significant differences in most radiographic measurements between patients successfully treated with TCC and those requiring surgical intervention. This may suggest that standard radiographic measurements used for characterizing foot deformity does not help to predict the outcomes of TCC for CN. These findings emphasize the need for a more comprehensive understanding of treatment success predictors beyond anatomical considerations.
A Retrospective, Comparative Study on Infinity Ankle Replacements vs Ankle Fusions
Authors: Steyn John , Penner Murray J. , Younger Alastair S.E. , Wing Kevin , Veljkovic Andrea , Sadr Hooman , Gagne Oliver
Published: December 2024

Category:

Ankle Arthritis; Ankle

Introduction/Purpose:

End-stage ankle arthritis (EAA) can diminish quality of life and handicap one’s daily activities. Ankle fusion or Total ankle arthroplasty (TAA) are two surgeries used to treat EAA. While ankle fusion has traditionally been the treatment of choice, it often impairs ankle functionality, and can increase the development of painful hindfoot arthritis. TAA typically has shorter recovery time and wider range of motion. Historically, TAA prostheses were inadequate due to frequent failures. Modern design and techniques have improved outcomes, decreased failure rates, allowed more normalized gait, and reduced adjacent joint arthritis development, but long-term performance remains ill-defined. The INFINITY® Total Ankle System (Stryker Inc.) is a 2-component fixed-bearing, bone-sparing design that this study aims to compare to ankle fusion through patient reported outcomes.

Methods:

Patients at least 19 years old at the time of index procedure were selected. We compared 100 patients who had the INFINITY® TAA between 2013- August 1st, 2021, with 200 ankle fusion patients from 2008 -August 1st, 2021, all with minimum 1 year of follow up. The primary outcome was the Ankle Osteoarthritis Scale (AOS). Secondary outcomes were the MODEMS, and SF-36 scores. Revision fusion and revision INFINITY® patients were excluded.

Results:

At 1 year follow up, Ankle Fusion AOS scores improved from a preoperative average of 55.25±19.31, to 26.01±21.64, vs 52.37±19.09 to 22.33±21.41 for INFINITY® TAA. At the last follow up after surgery (LFU), mean AOS scores in the Infinity cohort were significantly lower after linear regression for baseline variables with a mean difference of -6.76 (-12.52, -0.99 95% CI) p-value 0.02. The difference remained significant after removing 1-year follow up, and 9-14 year follow up, at -6.58 (-12.89, -0.27 95% CI), p-value 0.041. The revision rate for ankle fusion was 3.5%, while revision rate for INFINITY® TAA was 2%.

Conclusion:

Patients undergoing INFINITY® TAA had significantly lower mean AOS scores than patients undergoing ankle fusion at their last follow up after surgery, both before and after linear regression for baseline variables. This remained significant after excluding earlier (1-year) follow up, and later (9-14 year) follow up that only had fusion cohort data.