bluuebunny/crossref_metadata_2025 huggingface dataset:
Medium-Term Survival After Unrepaired Ruptured Abdominal Aortic Aneurysm
Authors: Tham Sarah , Aw Darius , Vijaykumar Kalpana , Cheng Shin Chuen , Tay Jia Sheng , Choke Edward
Published: August 2022

Purpose:

Ruptured abdominal aortic aneurysm (AAA) is almost always considered fatal without open surgical or endovascular repair. We report a case that has defied this norm and explore the possible factors involved in this exceedingly rare outcome.

Case Report:

An 87 year old gentleman presented with an acute ruptured AAA with left retroperitoneal hematoma. He was counseled for emergent repair, but opted for conservative management instead. He has remained well at the time of writing, 13 months from the rupture, with clinical resolution of symptoms along with radiological resolution of the hematoma.

Conclusion:

Timely repair remains the mainstay of management for ruptured AAA, although this rare case highlights that it is possible for ruptured AAA to seal spontaneously with patient surviving up to 13 months. We have sought to hypothesize the factors in this case that may have contributed to prolonged survival following untreated ruptured AAA.

Clinical Impact Statement

While the overwhelming evidence is that a ruptured AAA left unrepaired is fatal, our case report illustrates a rare case that shows it is possible for ruptured AAA to seal spontaneously, with patient surviving up to 13 months. We seek to hypothesize the factors that may contribute to such prolonged survival.
Integrating Mindfulness and Acceptance Into Traditional Cognitive Behavioral Therapy During the COVID-19 Pandemic: A Case Study of an Adult Man With Generalized Anxiety Disorder
Authors: Garner Alisa R. , Stuart Gregory L.
Published: August 2022

Generalized Anxiety Disorder (GAD) can be chronic and impairing, highlighting the need for effective treatments. Although Cognitive Behavior Therapy (CBT) is an effective treatment for GAD, a number of patients continue to report GAD symptoms treatment. Integrating evidenced-based treatment components into CBT treatments, such as mindfulness- and acceptance-based treatment components found in Acceptance and Commitment Therapy (ACT), may help improve the efficacy of treatment. Emerging interventions and research suggest that the cognitive restructuring aspect of CBT and acceptance stance of ACT (e.g., cognitive defusion) can be implemented into treatment concurrently from a stance of increasing a patient’s coping skills repertoire and psychological flexibility. This systemic case analysis examined the efficacy and clinical utility of integrating ACT into a manualized CBT treatment for GAD. Furthermore, this study examined treatment efficacy and therapeutic alliance as the treatment rapidly and unexpectedly transitioned from in-person to telehealth due to the COVID-19 pandemic. Pre- to post-treatment and time-series analyses showed significant decreases in anxiety symptoms, worry, depressive symptoms, and emotion dysregulation. Although there was an initial increase in depressive and anxiety symptoms, worry, and emotion dysregulation following the switch from in-person to telehealth services, these quickly subsided and resumed a downward trend. The therapeutic relationship did not deteriorate during the transition to telehealth. This case study provides evidence of feasibility and efficacy of an integrated CBT/ACT approach in treating GAD. It also suggests that despite some temporary increase in symptoms, therapeutic alliance and treatment efficacy were not impacted by the switch to telehealth.
Cell cycle disturbances in mucopolysaccharidoses: Transcriptomic and experimental studies on cellular models
Authors: Brokowska Joanna , Gaffke Lidia , Pierzynowska Karolina , Cyske Zuzanna , Węgrzyn Grzegorz
Published: August 2022

Mucopolysaccharidoses (MPS) are a group of lysosomal storage diseases caused by defects in genes coding for proteins involved in degradation of glycosaminoglycans (GAGs). These complex carbohydrates accumulate in cells causing their serious dysfunctions. Apart from the physical GAG storage, secondary and tertiary changes may contribute significantly to the pathomechanism of the disease. Among processes which were not systematically investigated in MPS cells to date there is the cell cycle. Here, we studied perturbances in this crucial cellular process in majority of MPS types. Transcriptomic analyses indicated that expression of many genes coding for proteins involved in the cell cycle is dysregulated in all tested MPS cells. Importantly, levels of transcripts of particular genes were changed in the same manner (i.e. either up- or down-regulated) in most or all types of the disease, indicating a common mechanism of the dysregulation. Flow cytometric studies demonstrated that the cell cycle is disturbed in all MPS types, with increased fractions of cells in the G0/G1 phase in most types and decreased fractions of cells in the G2/M phase in all types. We found that increased levels of cyclin D1 and disturbed timing of its appearance during the cell cycle may contribute to the mechanism of dysregulation of this process in MPS. Reduction of GAG levels by either a specific enzyme or genistein-mediated inhibition of synthesis of these compounds improved, but not fully corrected, the cell cycle in MPS fibroblasts. Therefore, it is suggested that combination of the therapeutic approaches devoted to reduction of GAG levels with cyclin D1 inhibitors might be considered in further works on developing effective treatment procedures for MPS.
Can coproduction change the perceived outcome of rural public services? Evidence from the “New Socialist Countryside” initiative in China
Authors: Zheng Li
Published: August 2022

The recent research on citizen participation in the provision of public services represented by coproduction has become a hot topic in public management. Coproduction studies propose that citizens can directly or indirectly participate in the process of public services to help improve the quality and legitimacy of public services. Very little, however, has been written in the existing coproduction literature on the outcome of public services provision. Based on the “One-Hundred Villages” Survey in 2020, this article analyzes and evaluates the impact of coproduction on the perceived outcome of public service in rural China. A series of statistical analysis results show that both co-planning and co-delivery have significant and positive impacts on how one views the outcome of rural public service provision. This research provides new evidence in rural China that citizen participation plays a crucial role in the state-led “New Socialist Countryside” campaign.
The Reaching Phase of Feeding and Self-Care Actions Optimizes Action Observation Effects in Chronic Stroke Subjects
Authors: Franceschini Marco , Ottaviani Marco , Romano Paola , Goffredo Michela , Pournajaf Sanaz , Lofrumento Margherita , Proietti Stefania , Sterpi Irma , Tricomi Enrica , Tropea Peppino , Corbo Massimo , Fadiga Luciano , Infarinato Francesco
Published: August 2022

Background

The Action Observation Therapy (AOT) is a well-established post-stroke rehabilitation treatment based on the theoretical framework of the Mirror Neuron System (MNS) activation. However, AOT protocols are still heterogeneous in terms of video contents of observed actions.

Objective

The aim of this study was to analyze electroencephalographic (EEG) recordings in stroke patients during the observation of different videos of task-specific upper limb movements, and to define which category of actions can elicit a stronger cortical activation in the observer’s brain.

Methods

Signals were analyzed from 19 chronic stroke subjects observing customized videos that represented 3 different categories of upper limb actions: Finalized Actions, Non-Finalized Actions, and Control Videos. The Event-Related Desynchronization in the µ and β bands was chosen to identify the involvement of the cerebral cortex: the area of the normalized power spectral density was calculated for each category and, deepening, for the reaching and completion sub-phases of Finalized Actions. For descriptive purposes, the time course of averaged signal power was described. The Kruskal–Wallis test ( P < .05) was applied.

Results

The analysis showed a greater desynchronization when subjects observed Finalized Actions with respect to Non-Finalized in all recorded areas; Control videos provoked a synchronization in the same areas and frequency bands. The reaching phase of feeding and self-care actions evoked a greater suppression both in µ and β bands.

Conclusions

The observation of finalized arm movements seems to elicit the strongest activation of the MNS in chronic stroke patients. This finding may help the clinicians to design future AOT-based stroke rehabilitation protocols.

Clinical Trial Registration:

Clinical Trial Registration—URL: http://www.clinicaltrials.gov . Unique identifier: NCT04047134.
Citizenship education to promote civic engagement among Arabic speaking student teachers in Israel
Authors: Zuzovsky Ruth , Guberman Ainat , Amasha Marcel
Published: August 2022

This study explores how teacher educators promoted Israeli Arab student teachers’ civic engagement through a multifaceted service-learning program. They worked on a project named ‘Challenges’ that supported service-learning, and provided knowledge about societal issues and Palestinian heritage. Qualitative interviews were conducted with 17 teacher educators. Additionally, 1608 freshmen students answered a questionnaire about their level of agreement with different reasons for, and objections to, volunteering, which was used as a measure of civic engagement. Among the students, 853 participated in the project, and 755 were not exposed to it yet. Scholarships were awarded to 399 students for their service and 109 expected one. Working as a team, the teacher educators achieved a system-wide change within the Arab teacher education curriculum. Participating students’ knowledge and civic engagement increased. Their level of agreement with reasons for volunteering was higher than that of students who were not exposed to the project yet and were not expecting a scholarship.
Criterion validity and reliability of a new algorithm to detect jump performance in women’s volleyball players
Authors: García-de-Alcaraz Antonio , Rico-González Markel , Pino-Ortega José
Published: August 2022

The limitation of tracking systems to assess short high intensity efforts has led to an exponential growth of inertial measurement units (IMU), capable of recording jumps at a very high sampling rate. However, the validity and reliability of each of them should be tested. This study aimed to assess the criterion validity and reliability of a new algorithm to detect jump performance in professional women’s volleyball players during training using an IMU. A total of 1581 jumps performed by 13 players (17.31 ± 7.34 years’ experience, and 6.77 ± 7 years playing in the first league) were video recorded during two volleyball training sessions. Data were recorded with Realtrack Systems IMU (WIMU PRO™, RealTrack Systems, Almeria, Spain), and extracted data were compared against a video system (Sony HDR-CX240 high-definition camera, Sony Corporation, Tokyo, Japan) using an observational procedure (ICC = 0.99). The results showed that WIMU PRO™ identified 1569 from the total of 1581 jumps performed (i.e. 99.24%). Therefore, this wearable device proved to have excellent jump count accuracy in top-level women’s volleyball players, making its use feasible in this sport context. This finding supports the use of this IMU as a valid method to guide the monitoring of jump training load.
Varieties of international pluralism
Authors: Hjorth Ronnie
Published: August 2022

This paper shows that while there seems to be more or less a general acceptance for plurality as a condition of world politics and at least a vague commitment to a pluralist ideal, the challenge remains to formulate a fruitful account of international pluralism. While dominating approaches to international theory present international pluralism as essentially a by-product and instrumental, this paper suggest an alternative way to conceive of international pluralism when defending the ancient concept variety as a better guide to approach both the understanding of plurality as the human condition and the notion of international pluralism. The paper concludes that it is preferable to accept a variety of pluralist conceptions rather than go on searching for a theoretical conception standing above the controversy; accepting pluralism in a sense involves rejecting just one version of pluralism.
The relation between lifestyles and positive mental health in Portuguese higher education students
Authors: Valentim Olga , Vilelas José , Carvalho José C. , Andrade Carmen M. Silva Maciel , Tomás Catarina , Costa Patrício Soares , Sequeira Carlos
Published: August 2022

Healthy lifestyles are commonly associated with improved physical and mental health. Sleep patterns, nutrition, physical exercise, consumption of psychoactive substances, among others, can strongly influence positive mental health. The aims are: characterize lifestyles based on positive mental health clusters, considering the cross-sectional cohort sample of higher education students, and analyse the lifestyles associated with positive mental health. A cross-sectional, descriptive, correlational and multicentric study of quantitative approach was conducted. The Positive Mental Health Questionnaire was applied. Through the k-means method, four clusters were obtained based on positive mental health levels. The sample of 3647 higher education students was mostly female (78.8%), single (89.5%), with an average age of 23 years (SD = 6.68). Differences were found between clusters based on the sociodemographic characteristics and lifestyles. Findings in Cluster 1 were highlighted because they included students with a higher level of positive mental health, which was associated with greater satisfaction in affective relationships, higher recreational and sports activities, better sleep quality, a healthy diet, and lower medication and illicit drugs consumption. These key findings emphasize the promotion of healthy lifestyles and highlight the importance of positive mental health in promoting the health of higher education students.
Successful health promotion, its challenges and the way forward in Nepal
Authors: Koirala Dhital Madhu , Dhital Shalik Ram , KC Bhakta Bahadur , Owens Vickie , Khadka Hem Raj , Gyawali Prajwal
Published: August 2022

Health promotion is the most favorable approach and process to achieve a positive health outcome of the population. Several countries across the world are committed to achieving positive health for their people with the best health promotion strategies. Health promotion, in fact, shares a large portion of health care economy and resources in many countries. A low-income country like Nepal, however, lacks the implementation of rigorous health care strategies on a large scale and is deficient in evidence of the potential scope of health promotion. Nepal has adopted the global health promotion declaration on paper; however, health care providers and authorities are still working in a traditional way using existing health policies and strategies. This paper aims to explore some of the global best practices of health promotion, including the challenges and opportunities by adopting such practices in Nepal, and provides some recommendations as a way forward.
Patient perceptions after the operative and nonoperative treatment of shoulder instability: A qualitative focus group study
Authors: van Iersel Theodore P , Tutuhatunewa Eric D , Kaman Ithri , Twigt Bas A , Vorrink Sigrid NW , van den Bekerom Michel PJ , van Deurzen Derek FP
Published: August 2022

Background

Little evidence is available regarding patient perceptions of the treatment of shoulder instability. The aim of this study is to investigate patient perceptions regarding the operative and nonoperative treatment of anterior shoulder instability.

Methods

Patients who presented to the emergency department or outpatient clinic between 2016 and 2020 were retrospectively selected using diagnosis and procedure codes. Online focus groups and semistructured interviews were conducted, systematically recorded and subsequently transcribed to MaxQDA 2007 for qualitative analysis. Coded transcripts of all focus groups were subjected to a grounded theory–based analysis.

Results

Six focus groups and two semistructured interviews were hosted with 35 included patients. The mean age of included patients was 34.1 years (±11.5). Eight patients were female (23%), and 27 patients were male (77%). Fear of (recurrent) dislocation, preoperative counseling, communication between surgeon and physiotherapists and need for a consistent postoperative rehab protocol turned out to be important patient perceptions. The most crucial factor for discontent was a lack of communication from the surgeon.

Discussion

This patient-centered focus group study revealed that fear of (recurrent) dislocation, preoperative counseling, communication between surgeons and physiotherapists and the need for a consistent postoperative rehabilitation protocol was the most frequently discussed themes.
Transcriptome Analysis Reveals the Mechanism of dill Seed Essential oil Against Sclerotinia sclerotiorum
Authors: Chen Yu-Xin , Li Wei , Zeng Hong , Zhou Gao , Cai Qiang
Published: August 2022

Sclerotinia sclerotiorum is a notorious fungal pathogen with a broad host range, including many important crops. A previous study showed dill seed essential oil (DSEO) could inhibit S sclerotiorum pathogenicity and protect canola production. However, the molecular basis of DSEO anti-fungal activity is still not well studied. To investigate the mechanism of DSEO anti-fungal activity, RNA-sequencing was employed to identify differentially expressed genes (DEGs) of S sclerotiorum in response to DSEO treatment. A total of 2470, 3218, and 3793 DEGs were identified in S sclerotiorum after being treated by DSEO for 0.5, 1, and 2 h, respectively. These genes that express changes in the early stage are more likely affected directly by DSEO. Gene Ontology (GO) analysis revealed that these genes were mainly related to transmembrane transport, cell membrane, ribosome biogenesis, and proteasome complex. DSEO treatment primarily affected the membrane part of the fungal cell, particularly the endoplasmic reticulum (ER) membrane at 0.5 and 1-hour treatment. In addition, a bunch of DEGs associated with the proteasome pathway was markedly enriched at 2 h of treatment. It is speculated that DSEO achieves antifungal effects by influencing these targets or pathways. The information obtained in this study expanded the understanding of the antifungal mechanism of DSEO and enriched the resources available for interpreting its mechanism at molecular level.
Mapping early tumor response to radiotherapy using diffusion kurtosis imaging**
Authors: Goryawala Mohammed , Mellon Eric A , Shim Hyunsuk , Maudsley Andrew A
Published: August 2022

Purpose

In this pilot study, DKI measures of diffusivity and kurtosis were compared in active tumor regions and correlated to radiologic response to radiotherapy after completion of 2 weeks of treatment to derive potential early measures of tumor response.

Methods

MRI and Magnetic Resonance Spectroscopic Imaging (MRSI) data were acquired before the beginning of RT (pre-RT) and 2 weeks after the initiation of treatment (during-RT) in 14 glioblastoma patients. The active tumor region was outlined as the union of the residual contrast-enhancing region and metabolically active tumor region. Average and standard deviation of mean, axial, and radial diffusivity (MD, AD, RD) and mean, axial, and radial kurtosis (MK, AK, RK) values were calculated for the active tumor VOI from images acquired pre-RT and during-RT and paired t-tests were executed to estimate pairwise differences. Receiver operating characteristic (ROC) curve analysis was conducted to evaluate the predictive capabilities of changes in diffusion metrics for progression-free survival (PFS).

Results

Analysis showed significant pairwise differences for AD ( p = 0.035; Cohen’s d of 0.659) and AK ( p = 0.019; Cohen’s d of 0.753) in diffusion measures after 2 weeks of RT. ROC curve analysis showed that percentage change differences in AD and AK between pre-RT and during-RT scans provided an Area Under the Curve (AUC) of 0.524 and 0.762, respectively, in discriminating responders (PFS>180 days) and non-responders (PFS<180 days).

Conclusion

This pilot study, although preliminary in nature, showed significant changes in AD and AK maps, with kurtosis derived AK maps showing an increased sensitivity in mapping early changes in the active tumor regions.
A Scoping Review of Non-Pharmacological Health Education Provided to Families of Children With Idiopathic Childhood Constipation Within Primary Health Care
Authors: Houghton Davina , Arabiat Diana , Ireson Deborah , Mörelius Evalotte
Published: August 2022

Objectives:

Idiopathic childhood constipation is a prevalent condition that initially brings the child under the care of the primary health care team. Although it is acknowledged that health education is crucial to reducing chronicity, the range of evidenced-based non-pharmacological health education provided to families has not previously been reviewed. For this scoping review, 4 research questions sought to identify papers that provide information on the utilization of guidelines, the range of health education, who provides it, and whether any gaps exist.

Methods:

Following a registered protocol and using the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews, searches of 10 online databases, reference lists, Google Scholar, and book chapter references were made. Eligible papers were original research published in English between January 2000 and December 2022.

Results:

Twelve worldwide studies (2 qualitative and 10 quantitative) reported that: evidence-based guidelines are not consistently used by primary care providers; the range of non-pharmacological health education provided is inconsistent; the non-pharmacological health education is provided by doctors, nurses, and pharmacists; and that gaps exist in non-pharmacological health education provision.

Conclusion:

This review demonstrates that rather than a lack of guideline-awareness, decreased specific idiopathic childhood constipation knowledge (and possibly time) may be responsible for inconsistent non-pharmacological health education. Inappropriate treatment and management of some children escalates risk for chronicity. Improving health education provision however, may be achieved through: increased collaboration; better utilization of nurses; and through developing the child’s health literacy by involving both child and family in all aspects of health education and decision-making.
Extending the Indications for Direct Transcutaneous Lower Blepharoplasty With an Infraorbital Incision to Tear Trough Deformities, Suborbicularis Oculi Fat, Festoons, and Revision Blepharoplasty
Authors: Ziegler Ulrich E. , Schäfer Ruth C. , Daigeler Adrien , Zeplin Philip H.
Published: August 2022

Introduction: Treatment of high-grade lower eyelid deformities with massive skin laxity and retroseptal fat pads can be challenging. Common techniques such as the transconjunctival approach and transcutaneous technique performed through a subciliary incision are associated with increased complication rates. Direct excision of the lower eyelid through an infraorbital incision is an alternative technique that allows safe treatment of dermatochalasis and pigmentation and correction of tear trough deformities, suborbicularis oculi fat, and festoons. This study aimed to determine whether direct transcutaneous blepharoplasty with an infraorbital incision could be indicated for these conditions instead of the established operative methods. Methods: A retrospective study of 21 patients with Fratila grades 9 or 10, Hirmand grade 3, and Barton grade 3 who underwent direct transcutaneous lower eyelid blepharoplasty via an infraorbital incision under local anesthesia was performed. All patients underwent surgery during a 9-year period from January 2010 to December 2018. The follow-up period was 12 months. Results were rated postoperatively using Barton grading. Results: Of 21 consecutive patients (13 women and 8 men), 18 required retroseptal fat pad removal, 3 had laxity of the skin and orbicularis muscle, and 5 had triangular cheek festoons. Combined lower and upper blepharoplasty was performed for 12 patients. All patients were satisfied with their surgical results and major improvements were observed. Scar quality was considered good by all patients. Conclusion: Direct transcutaneous lower blepharoplasty of the orbital rim can be indicated for different tear trough deformities, suborbicularis oculi fat laxity, and festoons.
Topical Tranexamic Acid (TXA) Decreases Time to Drain Removal, Wound Healing Complications, and Postoperative Blood Loss in Autologous Breast Reconstruction: A Retrospective Study
Authors: Rose Katherine , Edalatpour Armin , Gunderson Kirsten A. , Michelotti Brett F. , Poore Samuel O. , Gast Katherine
Published: August 2022

Introduction: Drain placement is commonplace after many plastic surgery procedures to evacuate excess blood and fluid. Tranexamic acid (TXA) is an antifibrinolytic that has been shown to decrease bleeding and fluid production at surgical sites and can be administered orally, intravenously, and topically. The purpose of this study is to evaluate the effect of topical TXA on drain removal in abdominally based autologous breast reconstruction (ABABR). Methods: A retrospective chart review was performed on patients who underwent ABABR from August 2018 to November 2019. In 1 cohort, a 2.5% TXA solution was topically applied to the abdominal wall prior to closure. Drains were removed when output was less than 30 mL/day for 2 consecutive days. The primary outcome was days to drain removal. Secondary outcomes include daily inpatient drain output, postoperative hemoglobin levels, blood transfusions, and complications within 30 days postoperatively. Results: Eighty-three patients were included, with 47 in the control group and 36 in the TXA group. Drains were removed significantly earlier in patients who received TXA (16 days vs 23 days, P = .02). Additionally, significantly fewer patients required postoperative blood transfusions in the TXA group (2 vs 14, P = .005). Abdominal complications were fewer in the TXA group with significantly less wound healing complications (22% vs 49%, P = .01). There was no difference in flap loss or systemic thromboembolic events. Conclusion: Topical TXA use in ABABR results in earlier abdominal drain removal, less blood transfusions, and lower abdominal wound complications without an increased risk of flap loss or adverse patient outcomes.
Correlation Between Anatomic Landmarks and Bony Trough Position in Lateral Meniscal Allograft Transplant
Authors: Choi Nam-Hong , Yang Bong-Seok , Lee Dong-Min , Lee Jong-Seok , Victoroff Brian N.
Published: August 2022

Background:

Determining the rotational axis of the bony trough during lateral meniscal allograft transplant (MAT) is difficult. The use of anatomic landmarks may help a surgeon determine the rotational alignment of the graft during the procedure.

Purpose:

To investigate the association between the knee's anatomic landmarks and the position of the bony trough to prevent extrusion after lateral MAT.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

Enrolled were 44 patients who underwent lateral MAT between July 2000 and February 2011. The patients’ mean age at the time of surgery was 30.8 years. Extrusion was measured on magnetic resonance imaging (MRI) scans at a mean of 3.6 months postoperatively, and patients were divided into an extrusion group (n = 15) and a no-extrusion group (n = 29). Three coronal MRI scans from each patient were selected, each from the region at the level of the tibial tuberosity (TT), the anterior bony trough, and the posterior bony trough. We measured the distance between the center of the anterior bony trough and the center of the TT (the TT distance) and the distance between the center of the posterior bony trough and the medial border of the lateral femoral condyle (LFC) (the LFC distance).

Results:

The mean center of the anterior bony trough was in a more medial position relative to the center of the TT in the no-extrusion group (–2.9 ± 4.8 mm) compared with the extrusion group (1.3 ± 4.9 mm; P = .010). The mean center of the posterior bony trough was in a more medial position relative to the medial border of the LFC in the no-extrusion group (–1.7 ± 3.9 mm) compared with the extrusion group (1.0 ± 3.2 mm; P = .027). Both TT distance and LFC distance were significantly correlated with extrusion ( P = .005 and .025, respectively). The cutoff value was –0.24 mm for the anterior bony trough and –0.58 mm for the posterior bony trough (negative values indicate that the trough was medial to the respective landmarks).

Conclusion:

To prevent extrusion of the allograft, the center of the anterior bony trough needs to be aligned with the center of the TT, and the center of the posterior bony trough needs to be aligned with the medial border of the LFC.
Do Age, Demographics, and Tear Characteristics Affect Outcomes After Rotator Cuff Repair? Results of Over 2000 Rotator Cuff Repairs at 5-Year Follow-up
Authors: Maher Anthony , Leigh Warren , Young Simon , Caughey William , Hoffman Thomas , Brick Matthew , Caughey Michael
Published: August 2022

Background:

The New Zealand Rotator Cuff Registry represents the largest prospective cohort of rotator cuff repairs. Despite this, there are limited medium- to long-term data of rotator cuff repair outcomes.

Purpose:

To (1) analyze the pain and functional outcomes of a large cohort of primary rotator cuff repairs and (2) evaluate the effect of patient factors and tear characteristics on medium-term outcomes.

Study Design:

Cohort study; Level of evidence, 2.

Methods:

This was a multicenter, multisurgeon prospective cohort study of rotator cuff repairs from March 2009 until December 2010. Surgical data were collected by the operating surgeon. Primary outcome measures were the Flexilevel Scale of Shoulder Function (FLEX-SF) and a pain score, collected at baseline, 6, 12, and 24 months, and 5 years. Univariate and multivariate analyses were carried out.

Results:

Overall, 2533 primary rotator cuff repairs were analyzed with 81% follow-up at 5 years. The mean age of the cohort was 56 years. In the 2052 patients with final follow-up data, improvement on the FLEX-SF continued until 24 months postoperatively and remained high at 5 years. Mean improvement in FLEX-SF from baseline to 5 years was 15 points. Patients aged >70 years had lower FLEX-SF scores but no significant difference in improvement compared with patients ≤70 years. The mean anteroposterior tear size was 2.2 cm, and on multivariate analysis, tears >4 cm had worse 5-year FLEX-SF scores. If the affected tendon was easily reducible, there was no difference in FLEX-SF score for retracted or larger tears compared with smaller tears. The reoperation rate was 6.2%.

Conclusion:

Results indicated that rotator cuff repairs provide a sustained clinical improvement out past 5 years. Most functional improvement and pain relief occurred within the first 6 months, but improvement continued out to 24 months. Most population groups did well after rotator cuff repairs, including those >70 years. Tear size >4 cm and tendon reducibility correlated with outcome. Even patients with large tear sizes had clinically significant improvement in FLEX-SF scores after repair.
A Plan to Exclude Ethnic Groups and Implement Partial Development Programme Under ‘Pradhan Mantri Ujwala Yojana’ in the Indian Subcontinent: A Case Based on Madurai District in Tamil Nadu
Authors: Amose T. , Sreedevi N. , Jeyakumar KR.
Published: August 2022

Madurai district in Tamil Nadu consists of three forestry regions such as Kurinji Nagar, Alagammalpuram and Mokathanparai as the residence of ethnic groups. The central scheme Pradhan Mantri Ujjwala Yojana (PMUY) found that it has no beneficiaries from the regions, and as usual the ethnic groups consume firewood with several difficulties. Hence, the study focuses on cooking energy consumers among ethnic groups as beneficiaries in detail under PMUY. A total of 108 households were chosen for the analysis which is the actual total number of households of ethnic groups in the district. Collected data have been tested by statistical tools, such as Chi-square and ANOVA, to know the relationship and the efficiency of factors, which influences the results that a majority of ethnic groups are expected to benefit under PMUY with free of cost, and they face climatic difficulties in traditional energy consumption.
How Long is Long Enough? A Closer Look at Proximal Margin Length for Esophageal Adenocarcinoma
Authors: Alvarado Christine E. , Luo Xun , Linden Philip A. , Towe Christopher W. , Sarode Anuja L. , Argote-Greene Luis M. , Perry Yaron , Worrell Stephanie G.
Published: August 2022

Background:

Esophagectomy approach for patients with esophageal adenocarcinoma (EAC) is determined by location of tumor and surgeon preference. Furthermore, type of esophagectomy affects the proximal margin length able to be achieved. Current guidelines for proximal margin length do not exist. We hypothesized that shorter proximal margin length would be associated with increased recurrence among EAC patients.

Methods:

A retrospective review of adult patients undergoing esophagectomy for EAC at a single institution (2007-2020) was performed. Primary outcome of interest was risk of disease recurrence based on proximal margin length. Spline term of proximal margin length was determined by locally weighted smoothing exploration. Cox regression was used to assess time to recurrence and overall survival based on proximal margin length.

Results:

In total, 165 patients met inclusion criteria with 72 (43.6%) recurrences. After adjustment, longer proximal margin was associated with significantly lower risk of recurrence when proximal margin length was >3.5 cm. At 5 years, recurrence was 64.7% for proximal margins <3.5 cm versus 47.6% for proximal margins ≥3.5 cm. For proximal margin length <3.5 cm, risk of recurrence did not decrease with longer margins (HR = 1.01, P = .95). When proximal margin length was ≥3.5 cm, every additional 1 cm was associated with lower risk of recurrence (HR = 0.90, P = .02). Proximal margin was not associated with survival (HR 0.97, P = 0.30).

Conclusions:

Patients with EAC have high risk of recurrence. Shorter proximal margins were significantly associated with increased recurrence. Proximal margins <3.5 cm are inadequate and additional margin >3.5 cm is associated with favorable reduction in disease recurrence.
Genomic profiling for clinical decision making in lymphoid neoplasms
Authors: de Leval Laurence , Alizadeh Ash A. , Bergsagel P. Leif , Campo Elias , Davies Andrew , Dogan Ahmet , Fitzgibbon Jude , Horwitz Steven M. , Melnick Ari M. , Morice William G. , Morin Ryan D. , Nadel Bertrand , Pileri Stefano A. , Rosenquist Richard , Rossi Davide , Salaverria Itziar , Steidl Christian , Treon Steven P. , Zelenetz Andrew D. , Advani Ranjana H. , Allen Carl E. , Ansell Stephen M. , Chan Wing C. , Cook James R. , Cook Lucy B. , d’Amore Francesco , Dirnhofer Stefan , Dreyling Martin , Dunleavy Kieron , Feldman Andrew L. , Fend Falko , Gaulard Philippe , Ghia Paolo , Gribben John G. , Hermine Olivier , Hodson Daniel J. , Hsi Eric D. , Inghirami Giorgio , Jaffe Elaine S. , Karube Kennosuke , Kataoka Keisuke , Klapper Wolfram , Kim Won Seog , King Rebecca L. , Ko Young H. , LaCasce Ann S. , Lenz Georg , Martin-Subero José I. , Piris Miguel A. , Pittaluga Stefania , Pasqualucci Laura , Quintanilla-Martinez Leticia , Rodig Scott J. , Rosenwald Andreas , Salles Gilles A. , San-Miguel Jesus , Savage Kerry J. , Sehn Laurie H. , Semenzato Gianpietro , Staudt Louis M. , Swerdlow Steven H. , Tam Constantine S. , Trotman Judith , Vose Julie M. , Weigert Oliver , Wilson Wyndham H. , Winter Jane N. , Wu Catherine J. , Zinzani Pier L. , Zucca Emanuele , Bagg Adam , Scott David W.
Published: August 2022

With the introduction of large-scale molecular profiling methods and high-throughput sequencing technologies, the genomic features of most lymphoid neoplasms have been characterized at an unprecedented scale. Although the principles for the classification and diagnosis of these disorders, founded on a multidimensional definition of disease entities, have been consolidated over the past 25 years, novel genomic data have markedly enhanced our understanding of lymphomagenesis and enriched the description of disease entities at the molecular level. Yet, the current diagnosis of lymphoid tumors is largely based on morphological assessment and immunophenotyping, with only few entities being defined by genomic criteria. This paper, which accompanies the International Consensus Classification of mature lymphoid neoplasms, will address how established assays and newly developed technologies for molecular testing already complement clinical diagnoses and provide a novel lens on disease classification. More specifically, their contributions to diagnosis refinement, risk stratification, and therapy prediction will be considered for the main categories of lymphoid neoplasms. The potential of whole-genome sequencing, circulating tumor DNA analyses, single-cell analyses, and epigenetic profiling will be discussed because these will likely become important future tools for implementing precision medicine approaches in clinical decision making for patients with lymphoid malignancies.
Does pulmonary rehabilitation address treatable traits? A systematic review
Authors: Holland Anne E. , Wageck Bruna , Hoffman Mariana , Lee Annemarie L. , Jones Arwel W.
Published: August 2022

Background

There is growing interest in a “treatable traits” approach to pulmonary rehabilitation in chronic airways disease. The frequency with which pulmonary rehabilitation programmes address treatable traits is unknown.

Methods

Randomised controlled trials of pulmonary rehabilitation compared to usual care in patients with stable chronic airways disease were included. The components of pulmonary rehabilitation delivered were extracted and mapped to treatable traits in pulmonary, extrapulmonary and behavioural/lifestyle domains. Meta-analysis was used to evaluate the impact of addressing >1 treatable trait on exercise capacity and health-related quality of life (HRQoL).

Results

116 trials were included (6893 participants). Almost all pulmonary rehabilitation programmes addressed deconditioning (97% of trials). The most commonly addressed extrapulmonary traits were nutritional status (obesity and cachexia, 18% each) and mood disturbance (anxiety and depression, 10% each). Behavioural/lifestyle traits most frequently addressed were nonadherence (46%), poor inhalation technique (24%) and poor family/social support (19%). Exercise capacity and HRQoL outcomes did not differ between studies that addressed deconditioning alone and those that targeted additional traits, but heterogeneity was high.

Conclusion

Aside from deconditioning, treatable traits are infrequently addressed in existing trials of pulmonary rehabilitation. The potential of the treatable traits approach to improve pulmonary rehabilitation outcomes remains to be explored.
The 6-min walk test as a primary end-point in interstitial lung disease
Authors: Harari Sergio , Wells Athol U. , Wuyts Wim A. , Nathan Steven D. , Kirchgaessler Klaus-Uwe , Bengus Monica , Behr Jürgen
Published: August 2022

There is a need for clinical trial end-points to better assess how patients feel and function, so that interventions can be developed which alleviate symptoms and improve quality of life. Use of 6-min walk test (6MWT) outcomes as a primary end-point in interstitial lung disease (ILD) trials is growing, particularly for drugs targeting concurrent pulmonary hypertension. However, 6MWT outcomes may be influenced differentially by interstitial lung and pulmonary vascular components of ILD, making interpretation complicated. We propose that using 6MWT outcomes, including 6-min walk distance or oxygen desaturation, as primary end-points should depend upon the study population (how advanced the ILD is; whether vasculopathy is significant), the degree of disease progression, and, importantly, the effect of study treatment expected. We argue that the 6MWT as a single outcome measure is suitable as a primary end-point if the treatment goal is to improve functional performance or prevent disease progression within a study population of patients with advanced ILD or those with ILD and co-existent vasculopathy. In addition, we discuss the potential of composite primary end-points incorporating 6MWT outcomes, outlining important considerations to ensure that they are appropriate for the study population and treatment goals.
A Green Approach for High Oxidation Resistance, Flexible Transparent Conductive Films Based on Reduced Graphene Oxide and Copper Nanowires
Authors: Lin Ya-Ting , Huang Da-Wei , Huang Pin-Feng , Chang Li-Chun , Lai Yi-Ting , Tai Nyan-Hwa
Published: August 2022

Copper nanowires (CuNWs)-based thin film is one of the potential alternatives to tin-doped indium oxide (ITO) in terms of transparent conductive films (TCFs). However, the severe problem of atmospheric oxidation restricts their practical applications. In this work, we develop a simple approach to fabricate highly stable TCFs through the dip-coating method using reduced graphene oxide (rGO) and CuNWs as the primary materials. Compared with previous works using toxic reduction agents, herein, the CuNWs are synthesized via a green aqueous process using glucose and lactic acid as the reductants, and rGO is prepared through the modified Hummers’ method followed by a hydrogen-annealing process to form hydrogen-annealing-reduced graphene oxide (h-rGO). In the rGO/CuNWs films, the dip-coated graphene oxide layer can increase the adhesion of the CuNWs on the substrate, and the fabricated h-rGO/CuNWs can exhibit high atmospheric oxidation resistance and excellent flexibility. The sheet resistance of the h-rGO/CuNWs film only increased from 25.1 to 42.2 Ω/sq after exposure to ambient atmosphere for 30 days and remained almost unchanged after the dynamic bending test for 2500 cycles at a constant radius of 5.3 mm. The h-rGO/CuNWs TCF can be not only fabricated via a route with a superior inexpensive and safe method but also possessed competitive optoelectronic properties with high electrical stability and flexibility, demonstrating great opportunities for future optoelectronic applications.
Complementary support in later life: investigating the gender disparities in patterns and determinants among older adults in South-Western Nigeria
Authors: Mobolaji Jacob Wale , Akinyemi Akanni Ibukun
Published: August 2022

Old-age needs are multifaceted and require multiple support sources, yet caregiving roles for older Nigerians are largely shifted to adult children. However, the children also declining capacity to respond. The extent to which older adults access support from other sources remains under-researched. This study investigates the patterns and determinants of access to complementary supports among older adults in South-Western Nigeria, taking Oyo State as the case study. The study is cross-sectional and utilized primary data of 827 older adults aged ≥ 65 years selected using a multi-stage sampling design. Box plot was used to determine the patterns while multiple ordinary least square regression was used to predict the determinants of access to complementary support. Expressed in percentage, the median complementary support score of older adults in Oyo State was 30 (interquartile range [IQR] = 24) with a slightly higher score for men (median = 32, IQR = 24) compared to women (median = 28, IQR = 20). Access to complementary support was lower for the widow(er)s, the lower socioeconomic group and self-dependent older adults across genders, and for urban women with secondary/higher education compared to the otherwise groups. Increased access to complementary support was significantly associated with primary/no education (β = 4.365; p < 0.01 95% C.I. = 1.511–7.218), affiliation to Islamic/Traditional religion (β = 5.100; p < 0.001; 95% C.I. = 3.000–7.200), rich wealth status (β = 3.315; p < 0.05; 95% C.I. = 0.667–5.963) and depending on both self and children/family for income (β = 5.510; p < 0.05; 95% C.I. = 1.710–9.309) with some gender disparities. However, reduced complementary support was associated with ages 80 years or over (β = -3.649; p < 0.05; 95% C.I. = -6.460 – -0.838) and widowhood (β = -6.285; p < 0.001; 95% C.I. = -8.556 – -4.015). The study suggests the need for welfare plans among professional, social, and religious groups, institutionalised social support systems, and community engagement to escalate welfare support for older adults. It also recommends intensified attention on the more vulnerable groups, especially the widows, childless and lower socioeconomic groups.
Long-term outcomes of laparoscopic Extralevator Abdominoperineal excision with modified position change for low rectal Cancer treatment
Authors: Sun Shaowei , Sun Shengbo , Zheng Xiangyun , Yu Jiangtao , Wang Wenchang , Gong Qing , Zhao Guowei , Li Jing , Zhang Huanhu
Published: August 2022

Background

Extralevator abdominoperineal excision (ELAPE) has been recommended for treating low rectal cancer due to its potential advantages in improving surgical safety and oncologic outcomes as compared to conventional abdominoperineal excision (APE). In ELAPE, however, whether the benefits of intraoperative position change to a prone jackknife position outweighs the associated risks remains controversial. This study is to introduce a modified position change in laparoscopic ELAPE and evaluate its feasibility, safety and the long-term therapeutic outcomes.

Methods

Medical records of 56 consecutive patients with low rectal cancer underwent laparoscopic ELAPE from November 2013 to September 2016 were retrospectively studied. In the operation, a perineal dissection in prone jackknife position was firstly performed and the laparoscopic procedure was then conducted in supine position. Patient characteristics, intraoperative and postoperative outcomes, pathologic and 5-year oncologic outcomes were analyzed.

Results

The mean operation time was 213.5 ± 29.4 min and the mean intraoperative blood loss was 152.7 ± 125.2 ml. All the tumors were totally resected, without intraoperative perforation, conversion to open surgery, postoperative 30-day death, and perioperative complications. All the patients achieved pelvic peritoneum reconstruction without the usage of biological mesh. During the follow-up period, perineal hernia was observed in 1 patient, impaired sexual function in 1 patient, and parastomal hernias in 3 patients. The local recurrence rate was 1.9% and distant metastasis was noted in 12 patients. The 5-year overall survival rate was 76.4% and the 5-year disease-free survival rate was 70.9%.

Conclusions

Laparoscopic ELAPE with modified position change is a simplified, safe and feasible procedure with favorable outcomes. The pelvic peritoneum can be directly closed by the laparoscopic approach without the application of biological mesh.