bluuebunny/crossref_metadata_2025 huggingface dataset:
PSUN192 Therapeutic Benefit of GLP-1 Agonists in Patients with Type 1 Diabetes on Insulin Therapy: an Updated Systematic Review and Meta-analysis
Authors: Park Jeayoung , Ntelis Spyridon , Downton Katherine , Yip Cheuk Fung , Munir Kashif , Haq Nowreen
Published: November 2022

Introduction

Glucagon-like Peptide 1 (GLP-1) agonists are efficacious glycemic control and weight loss agents for obese patients with or without type 2 diabetes mellitus. Use of GLP-1 agonists for patients with type 1 diabetes mellitus (T1DM), on the other hand, is an evolving area of research. Our present meta-analysis aims to critically evaluate existing evidence and provide an estimated average therapeutic effect.

Methods

PubMed, Embase, and Cochrane libraries were searched for randomized controlled trials comparing major efficacy and safety endpoints for 12 weeks or longer administration of GLP-1 agonists compared to placebo in T1DM patients on insulin. Main endpoints for analysis included glycated hemoglobin (A1c) level, body weight, and change in total insulin dose. Study was done in accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) statement.

Results

Of 3736 reports identified on search, 8 studies involving liraglutide 1.8mg daily (total 1415 patients) and 5 studies involving any dosage of exenatide (total 221 patients) were included. Liraglutide 1.8mg overall produced greater decrease in A1c (MD = -0.28%, 95% CI -0.41 to -0.16, I2=42%), body weight (MD = -4.84kg, 95% CI -5.25 to -4.44, I2=0%), and total daily insulin per kilogram body weight (MD = -0.08u/kg, 95% CI -0.10 to -0.06, I2=55%) compared to placebo. Exenatide regimen as a whole also overall produced decreased A1c (MD = -0.17%, 95% CI -0.38 to -0.00, I2=0%), body weight (MD = -4.05kg, 95% CI -14.3 to -3.45, I2=0%), total daily insulin (MD = -0.08u/kg, 95% CI -0.15 to -0.01, I2=0%) compared to placebo. However, 3 out of 5 exenatide trials were open label and studies used multiple doses and formations (short-release and extended release), which limited the interpretation of results in clinical practice.

Conclusion

Our meta-analysis supports the therapeutic benefits of GLP-1 agonists for patients with T1DM. Daily 1.8mg liraglutide injections for at least 12 weeks appear to be a promising adjunct to insulin therapy for T1DM patients, resulting in decreased A1c levels, body weight, and total daily insulin requirements.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN219 Increasing Frequency of Hemoglobin A1c (Hba1c) Measurements in Hospitalized Patients With Diabetes: A Quality Improvement Project Using Lean Six Sigma
Authors: Khan Sara A , Demidowich Andrew P , Tschudy Megan M , Wedler Joyce , Lamy Wilson , Sidhaye Aniket , Alexander Lee Ann , Misra Isha , Zilbermint Mihail
Published: November 2022

Background

Studies have shown the predictive value of hemoglobin A1c (HbA1c) on inpatient glycemic control, and its value for discharge planning. There is little data on HbA1c testing adherence to American Diabetes Association (ADA) guidelines among inpatient providers, and anecdotal evidence suggests that most inpatient providers do not have a standardized approach to HbA1c measurement. The Lean Six Sigma method is a management system that originated in the automobile industry and has become widely used in healthcare to improve the efficiency of processes. The objective of this study was to determine the impact utilizing Lean Six Sigma methodology to increase frequency of HbA1c measurements among hospitalized patients with a known history of diabetes, in line with ADA guidelines.

Methods

This was a quality improvement study performed in a 240-bed community hospital, evaluating inpatients (≥16 years) consecutively admitted with a diagnosis of diabetes (ICD-10 code E8-E13 and O24) between January 2016-June 2021. Patients were excluded if they had a HbA1c in the health system electronic health record (EHR) in the prior 3 months. The Lean Six Sigma approach was utilized to define the problem and implement solutions. The intervention bundle delivered between November 2017 and February 2018 included 1) provider and nursing education on the utility of HbA1c in patient care, 2) change in laboratory protocols for more rapid turnaround of HbA1c, 3) modifications to the EHR including a glucose management tab and insulin order set that included HbA1c. Hospital encounter and patient-level data were extracted from the EHR via bulk query. Demographic characteristics were calculated. Frequency of HbA1c lab sent while inpatient was compared pre- (Jan 2016-Nov 2017) and post-intervention (March 2018-June 2021) using chi-square analysis.

Results

17,869 patients were included (7,332 pre- and 10,537 post-intervention). Demographics did not differ between pre and post intervention periods (mean age [range]: 78.1 [16-106] years, sex: 52.3% male, race: 52.1% White, 25.1% Black). Only 53.5% of patients who met criteria had a HbA1c measured during hospitalization before intervention. This frequency increased to 70.2% postintervention. The improvement in the frequency of HbA1c measurement was sustained more than two years following the initial interventions and continued to improve over time.

Conclusion

This novel approach was successful in improving adherence to guideline-based measurement of HbA1c in hospitalized patients. This is the first quality improvement project in a community hospital utilizing the Lean Six Sigma process for this purpose and may represent a valuable methodology for community hospitals to improve inpatient diabetes care.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN220 Audit on Variable Rate Intravenous Insulin Infusion (VRIII) in inpatients in Scarborough General Hospital
Authors: Abraham Santhosh , Pawlak Tadeusz , Humphriss David , Uddin Mohd , Singh Anjali , Aniq Sana
Published: November 2022

Introduction

A Variable Rate Intravenous Insulin Infusion (VRIII) is an infusion of insulin at an interchangeable rate. It involves taking regular capillary blood glucose levels, aiming to control the serum glucose levels with in a specific range and an infusion of glucose containing fluid to prevent insulin induced hypoglycaemia (1). A VRIII is used in patients with known diabetes or with hospital related hyperglycaemia who are unable to take oral fluids/food and for whom adjustment of their own insulin regime is not possible (1). The advantage of a VRIII is the fact is that it involves target driven glucose control for specified indications and avoids metabolic decompensation.

Aim

To test the compliance of the ward medical staff with VRIII protocol against the local trust policy and the Joint British Diabetes Society guidelines (JBDS).

Methodology

A retrospective audit on sample of 15 patients at Scarborough General Hospital receiving VRIII on medical and surgical wards. Data was collected over a period of a month. Data collection and analysis performed utilising Microsoft Excel. Audits standards based on trust guidelines and JBDS guidelines.

Results

Most patients were above age of 60 years, female and type 2 diabetic. 100% of patients had daily electrolytes monitoring, 27% had hypoglycaemia, 13% did not have long-acting insulin started before stopping the VRIII. In 40% of patients, blood glucose levels were not maintained between 6-12 mmol/L. Furthermore, in 13% of patients, blood glucose was not monitored hourly.

Conclusion

This audit showed a good compliance with daily electrolytes measurement, early referral to diabetic team as well as starting the VRIII with dextrose. It is concerning however that integral measures such as ruling out DKA, not prescribing the correct fluid, not checking blood glucose levels and lowering the incidence of hypoglycaemia were not always present. Overall, this audit has identified areas required for improvement to optimise our compliance with VRIII protocol against local and national guidelines. We hope this can be improved via spreading greater awareness of the VRIII protocol, to promote early recognition of DKA and ensure safety checks occur when applying the VRIII protocol.

References

George, S., 2022. JBDS-IP The use of Variable Rate Intravenous Insulin Infusion (VRIII) in medical patients. Joint British Diabetes Society.

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
PSUN231 Adoptive Cell Transfer for Type 1 Diabetes Reversal
Authors: Imam Shahnawaz , Jaume Alexa , Jaume Juan
Published: November 2022

We have discovered a way to cure type 1 diabetes in a mouse model that closely resembles the human disease. Specifically, we are able to genetically modify blood cells from affected individuals and re-infuse them back to rescue insulin-producing beta cells being destroyed by the immune system.When autoimmune diabetes affects the youth, it is known as Juvenile or type 1 diabetes (T1D). It is named Latent Autoimmune Diabetes of Adults (LADA) when it affects adults. T1D affects about 1 million people in the USA. LADA is estimated to affect at least 10% of the type 2 diabetes population (about 30 million patients in the USA). Combined, 4 million people live with the condition.Can you imagine reversing type 1 diabetes at once?Autoimmune diabetes as a whole is a disease without a cure that is chronically managed with insulin replacement. Even under best management, diabetes complications shorten life expectancy, including blindness, amputations, and kidney failure. These are the population that will benefit from our technology. Starting with new-onset diabetes, the technology can benefit almost any patient with autoimmune diabetes.Our group has developed two currently patented technologies that achieve the goal of reversing type 1 diabetes (our value proposition). One is a new spontaneous, humanized, transgenic mouse model of human T1D (1). The other one is an adoptive cell transfer (ACT) therapeutic approach for T1D (2). A 30-day pre-clinical study in which animals with diabetes were treated with this therapeutic approach provided the proof-of-concept that diabetes CAN BE CURED.Our technology involves a standard-of-care approach already Federal Drug Administration (FDA) approved for cancer treatment (ACT of Chimeric Antigen Receptor, CAR, T cells). We have the materials and know-how needed for the large-scale pre-clinical trial we are currently running. This will generate the necessary data for Investigational New Drug, IND, FDA filing so human clinical trials can be carried out.

References

1. Imam, S., Alfonso-Jaume, M., Jaume, J.C. (2019). Spontaneous Autoimmune Diabetes in Humanized Mice Carrying Human Type 1 Diabetes Susceptibility and Uses Therefor. United States Application No. 16530452, Publication Number. US20200037586. https://patentscope.wipo.int/search/en/detail.jsf?docId=US283198965&tab=NATIONALBIBLIO

2. Imam, S., Jaume, J.C. (2020). Immunosuppressive Antigen-Specific Chimeric Antigen Receptor Treg Cells for Prevention and/or Treatment of Autoimmune and Alloimmune Disorders. International Application No. PCT/US2019/060593, Publication Number WO/2020/097546. https://patentscope.wipo.int/search/en/detail.jsf?docId=WO2020097546&_cid=P10-KHXN2B-33433-1

Presentation: Sunday, June 12, 2022 12:30 p.m. - 2:30 p.m.
NEDD1-S411 phosphorylation plays a critical function in the coordination of microtubule nucleation during mitosis
Authors: Timón Pérez Krystal , Scrofani Jacopo , Vernos Isabelle
Published: November 2022

During mitosis, spindle assembly relies on centrosomal and acentrosomal microtubule nucleation pathways that all require the γ-Tubulin Ring Complex (γ-TuRC) and its adaptor protein NEDD1. The activity of these different pathways needs to be coordinated to ensure bipolar spindle assembly ( Cavazza et al., 2016) but the underlying mechanism is still unclear. Previous studies have identified three sites in NEDD1 (S377, S405 and S411) that when phosphorylated drive MT nucleation at the centrosomes, around the chromosomes and on pre-existing MTs respectively ( Lüders et al., 2006; Pinyol et al., 2013; Sdelci et al., 2012). Here we aimed at getting additional insights into the mechanism that coordinates the different MT nucleation pathways in dividing cells using a collection of HeLa stable inducible cell lines expressing NEDD1 phospho-variants at these three sites and Xenopus egg extracts. Our results provide further support for the essential role of phosphorylation at the three residues. Moreover, we directly demonstrate that S411 phosphorylation is essential for MT branching using TIRF microscopy in Xenopus egg extracts and we show that it plays a crucial role in ensuring the balance between centrosome and chromosome-dependent MT nucleation required for bipolar spindle assembly in mitotic cells.
Fuzzy Q-Learning interaction controller design for collaborative robot
Authors: Kaichen Ying , chin-yin Chen , Longxiang Wang
Published: November 2022

Background: In physical human-robot interaction (pHRI), admittance control is widely used. The most critical thing in admittance control is the configuration of admittance parameters, but a constant admittance value can not meet the needs of interactive indicators smoothness especially. Variable admittance control is a method to overcome this limitation by adjusting the admittance value in real time. This paper proposes a fuzzy Q-learning (FQL) variable admittance control system, which integrates the fuzzy system (FIS) and reinforcement learning method Q-learning. 

Methods: FIS is used to turn a continuous input state into fuzzy set and Q-learning is used to train the premise strength of fuzzy rules to get the optimal policy of variable admittance value. To verify the performance of this method, an experiment was performed using an AUBO i5 robot. Training trajectory is point-to-point (PTP) trajectory, several interaction variables before and after training by the algorithm are compared to show the validity of algorithm.

Results: Experimental results show that the reward converges to a smaller value in about 25 episodes, and the reward of the last five episodes reduces by 68%. The motion trajectory after algorithm training is closer to the ideal min-jerk trajectory and the deviation and mean value of interaction force become smaller.

Conclusions: The proposed FQL method can converge in a few episodes and can improve the performance of pHRI by minimizing the jerk based cost function.
The COVID-19 pandemic and mental health outcomes – A cross-sectional study among health care workers in Coastal South India
Authors: T Rekha , Kumar Nithin , Hegde Kausthubh , Unnikrishnan Bhaskaran , Mithra Prasanna , Holla Ramesh , Bhagawan Darshan
Published: November 2022

Background: Frontline health care workers (HCWs) are at increased risk of developing unfavourable mental health outcomes and burnout, especially during the COVID-19 pandemic. Recognizing the early warning signs of mental distress is very important to ensure the provision of quality patient care.

Methods: In this facility-based cross-sectional study, HCWs of the teaching hospitals affiliated to Kasturba Medical College, Mangalore were assessed regarding their mental health status using a semi-structured questionnaire. All doctors and nurses who were willing to participate from these teaching hospitals were included in the study. Data was collected over a period of four months (1st March -30th June 2021) till the required sample size was reached and analysed using IBM SPSS and expressed using mean (standard deviation), median (interquartile range), and proportions. Univariate analysis was done to identify the factors associated with mental health outcomes among the HCWs and the corresponding unadjusted odds ratio and 95% confidence interval were reported.

Results: A total of 245 HCWs [52.2% (n=128) doctors and 47.8% (n=117) nurses] were included in our study. The proportion of participants with depressive symptoms, anxiety, and insomnia assessed using PHQ-9, GAD-7, and ISI-7 scales were 49% (n=119), 38% (n=93), and 42% (n=102) respectively. Depression, anxiety, and insomnia were more likely to be experienced by HCWs aged > 27 years, females, and involved in COVID-19 patient care. (p>0.05)

Conclusions:  Our findings that 38% of the examined HCWs had clinically relevant anxiety symptoms and 49% had clinically relevant depression symptoms draws attention to the importance of systematically tracking the mental health of HCWs during this ongoing pandemic. HCWs should monitor their stress reactions and seek appropriate help both on a personal and professional level. Appropriate workplace interventions including psychological support should be provided to HCWs, to ensure provision of uncompromised quality patient care.
Health misinformation: protocol for a hybrid concept analysis and development
Authors: Pope Johanna , Byrne Paula , Devane Declan , Purnat Tina D. , Dowling Maura
Published: November 2022

Background: Misinformation represents a serious and growing concern in public health; and

has attracted much interest from researchers, media, and the public over recent years. Despite increased concern about the impacts of misinformation on health and wellbeing, however, the concept of health misinformation remains underdeveloped. In particular, there is a need to clarify how certain types of health information come to be designated as “misinformation,” what characteristics are associated with this classification, and how the concept of misinformation is applied in public health interventions.

Aim: Developing a shared understanding of what it means for health information to be “misinformation” is an important first step to accurately identifying at-risk groups, clarifying pathways of vulnerability, and agreeing goals for intervention. It will also help to ensure that misinformation interventions are accessible, acceptable, and of benefit to the populations to which they are directed. We will therefore examine the characteristics, measurement, and applications of misinformation in public health.

Methods: We will undertake a hybrid concept analysis, following a framework from Schwartz-Barcott & Kim (2000). This framework comprises three phases: a theoretical phase, fieldwork phase, and final analysis phase. In the theoretical phase, a search of seven electronic citation databases (PsycInfo, socINDEX, JSTOR, CINAHL, Scopus, PubMed, and ScienceDirect) will be conducted in order to identify original research, review, and theoretical papers, published in English between 2016 and 2022, which examine “health misinformation.” Data from the literature will be synthesised using evolutionary concept analysis methods from Rodgers (2000). In the fieldwork phase, a purposive sampling strategy will be employed to recruit stakeholders for participation in semi-structured interviews. Interviews will be analysed using thematic analysis. The final phase will integrate findings from the theoretical and fieldwork analyses.
Identifying entrepreneurial discovery processes with weak and strong technology signals: a text mining approach
Authors: Bzhalava Levan , Kaivo-oja Jari , Hassan Sohaib S. , Gerstlberger Wolfgang Dieter
Published: November 2022

This study aims to propose methods for identifying entrepreneurial discovery processes with weak/strong signals of technological changes and incorporating technology foresight in the design and planning of the Smart Specialization Strategy (S3). For this purpose, we first analyse patent abstracts from 2000 to 2009, obtained from the European Patent Office and use a keyword-based text mining approach to collect weak and strong technology signals; the word2vec algorithm is also employed to group weak signal keywords. We then utilize Correlation Explanation (CorEx) topic modelling to link technology weak/strong signals to invention activities for the period 2010-2018 and use the ANOVA statistical method to examine the relationship between technology weak/strong signals and patent values. The results suggest that patents related to weak rather than strong signals are more likely to be high-impact innovations and to serve as a basis for future technological developments. Furthermore, we use latent Dirichlet allocation (LDA) topic modelling to analyse patent activities related to weak/strong technology signals and compute regional topic weights. Finally, we present implications of the research.
Design and Analysis of Switchback Experiments
Authors: Bojinov Iavor , Simchi-Levi David , Zhao Jinglong
Published: November 2022

Switchback experiments, where a firm sequentially exposes an experimental unit to random treatments, are among the most prevalent designs used in the technology sector, with applications ranging from ride-hailing platforms to online marketplaces. Although practitioners have widely adopted this technique, the derivation of the optimal design has been elusive, hindering practitioners from drawing valid causal conclusions with enough statistical power. We address this limitation by deriving the optimal design of switchback experiments under a range of different assumptions on the order of the carryover effect—the length of time a treatment persists in impacting the outcome. We cast the optimal experimental design problem as a minimax discrete optimization problem, identify the worst-case adversarial strategy, establish structural results, and solve the reduced problem via a continuous relaxation. For switchback experiments conducted under the optimal design, we provide two approaches for performing inference. The first provides exact randomization-based p-values, and the second uses a new finite population central limit theorem to conduct conservative hypothesis tests and build confidence intervals. We further provide theoretical results when the order of the carryover effect is misspecified and provide a data-driven procedure to identify the order of the carryover effect. We conduct extensive simulations to study the numerical performance and empirical properties of our results and conclude with practical suggestions.

This paper was accepted by George Shanthikumar, big data analytics.

Funding: The authors thank the Massachusetts Institute of Technology (MIT)-IBM partnership in Artificial Intelligence and the MIT Data Science Laboratory for support.

Supplemental Material: Data and the online appendix are available at https://doi.org/10.1287/mnsc.2022.4583 .
Acute toxicity evaluation of methanol, ethanol and aqueous extracts of Balanophora latisepala (V.Tiegh.) Lec.
Authors:   School of Education, Can Tho University, Can Tho 900000, Vietnam, Phuc Nguyen Trong Hong , Hai Pham Dong ,   College of Natural Sciences, Can Tho University, Can Tho 900000, Vietnam, Dat Phan Thanh ,   Can Tho Medical College, Can Tho 900000, Vietnam, Yen Lan Nguyen Thi ,   Phan Van Tri High School, Can Tho 900000, Vietnam, Hang Phung Thi ,   School of Education, Can Tho University, Can Tho 900000, Vietnam, Minh Quan Dang Minh Quan ,   School of Education, Can Tho University, Can Tho 900000, Vietnam
Published: November 2022

Balanophora latisepala has been used in traditional medicine in Vietnam for many years with both proven and unproven scientific proofs. This study aimed to evaluate the acute toxicity effects of B. latisepala by testing safety parameters of hot water, ethanol and methanol extracts of B. latisepala in Mus musculus. The acute toxicity was studied according to the World Health Organisations guideline for the evaluation of the safety and efficacy of herbal medicines. During study, a single dose of 1000, 2000 and 5000 mg/kg of each extract was orally administered to Swiss mice. To determine the median lethal dose, experimental mice were observed in behavior and mortality for 72 hours. Data of organ weight, histopathology,biochemical and hematology were also collected. The results showed that hot water, ethanol and methanol extracts at a dose of 5000 mg/kg did not induce mortality in experimental mice; therefore, LD50 is not determined. Insignificant changes were found in relative organ weight at dose 5000 mg/kg for all of the extracts. Similarly, no significant differences were observed in biochemical indices and organ histology. However, changes in hematological indices in both male and female mice were noticed. In male mice, it is likely that all B. latisepala extracts induced anemia. Moreover, clotting or bleeding abnormalities were also observed in female mice. Methanol extracts had the highest effect to hematology indices (p<0.05). Therefore, B.latisepala in different doses was shown its safety under acute toxicity studies with promising applications in drug therapy.
Prevalence of Marek’s disease virus in unvaccinated healthy backyard chickens in Cantho city, Vietnam and genetic characterization of meq gene
Authors:   Department of Veterinary Medicine, College of Agriculture, Can Tho University, Can Tho 900000, Vietnam, Huynh Ngoc Trang , Nguyen Tran Phuoc Chien ,   Department of Veterinary Medicine, College of Agriculture, Can Tho University, Can Tho 900000, Vietnam, Ho Thị Viet Thu ,   Department of Veterinary Medicine, College of Agriculture, Can Tho University, Can Tho 900000, Vietnam
Published: November 2022

An investigation was carried out to survey the prevalence of Marek’s disease virus serotype 1 (MDV-1) on unvaccinated healthy backyard chicken flocks from four districts in Cantho city and to analyze the genetic characterization of the meq gene. A total of 353 feather follicle samples were collected from 50 unvaccinated chicken flocks for Marek’s disease to investigate prevalent MDV-1 by polymerase chain reaction (PCR). The four represent strains were chosen for meq gene sequencing. The results revealed that 26 out of 353 samples were positive for MDV-1 accounting for 7.37%. There were significant differences in the prevalence of MDV-1 on chickens among districts (P<0.05). The Meq protein of the four strains (VT, CD, PD, and TL) contained 20.14% proline and three regions of proline repeats. Besides, all four strains occurred with amino acid point mutations. These strains had only a substitution of proline at position 217 as well as interruption of consecutive proline at site 2. Phylogenetic analysis indicated that these strains were within a group relating to virulent Italian isolates.
Detection of Japanese encephalitis virus and its specific antibody in abnormal swine litters in Vietnam
Authors:   Department of Veterinary Medicine, College of Agriculture, Can Tho University, Can Tho 900000, Vietnam, Ho Thị Viet Thu , Trang Huynh Ngoc ,   Department of Veterinary Medicine, College of Agriculture, Can Tho University, Can Tho 900000, Vietnam, Nguyen Duc Hien ,   Department of Veterinary Medicine, College of Agriculture, Can Tho University, Can Tho 900000, Vietnam,   Department of Animal Health of Can Tho 900000, Vietnam
Published: November 2022

Japanese encephalitis is considered an essential disease-causing swine reproductive failure in Asian countries; however, significant knowledge gaps remain about this problem in actual cases. This study examined 55 cases of reproductive failure in sows, including one abortion and 54 full-term farrowing litters, to find the Japanese encephalitis virus (JEV) and specific antibodies against JEV. Haemagglutination test was used to detect specific antibodies against JEV from 63 samples of fetal thoracic fluids and newborn un-suckling piglet sera (54 thoracic fluid samples of dead fetuses, two thoracic fluid samples of abortion fetuses, seven sera samples of weakly newborn un-suckling piglets), viral isolation and RT- PCR technique was attempted from 60 brains of fetuses and newborn un-suckling piglets, histopathology sections of fetal brains which were positive with JEV confirmed by HI test and RT-PCR were also made. The results showed that 17.46% (11/63) of thoracic fluids and sera were positive for JEV. No JEV isolation was found from 60 brain samples of dead fetuses and piglets, but RNA of JEV were detected from 5 of them (8.33%). Our results suggest that JEV should be considered the important cause of swine reproductive failure in Viet Nam.
Distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children
Authors: Chowdhury James M. Y. , Ahmadi Milad , Prior Christopher P. , Pease Felicity , Messner Juergen , Foster Patrick A. L.
Published: November 2022

Aims

The aim of this retrospective cohort study was to assess and investigate the safety and efficacy of using a distal tibial osteotomy compared to proximal osteotomy for limb lengthening in children.

Methods

In this study, there were 59 consecutive tibial lengthening and deformity corrections in 57 children using a circular frame. All were performed or supervised by the senior author between January 2013 and June 2019. A total of 25 who underwent a distal tibial osteotomy were analyzed and compared to a group of 34 who had a standard proximal tibial osteotomy. For each patient, the primary diagnosis, time in frame, complications, and lengthening achieved were recorded. From these data, the frame index was calculated (days/cm) and analyzed.

Results

All patients ended their treatment with successful lengthening and deformity correction. The frame index for proximal versus distal osteotomies showed no significant difference, with a mean 48.5 days/cm (30 to 85) and 48.9 days/cm (28 to 81), respectively (p = 0.896). In the proximal osteotomy group, two patients suffered complications (one refracture after frame removal and one failure of regenerate maturation with subsequent valgus deformity) compared to zero in the distal osteotomy group. Two patients in each group sustained obstacles that required intervention (one necessitated guided growth, one fibula lengthening, and two required change of wires). There was a similar number of problems (pin-site infections) in each group.

Conclusion

Our data show that distal tibial osteotomies can be safely employed in limb lengthening for children using a circular frame, which has implications in planning a surgical strategy; for example, when treating a tibia with shortening and distal deformity, a second osteotomy for proximal lengthening is not required. Cite this article: Bone Joint J 2022;104-B(11):1273–1278.
Assessing the influence of modifiable patient-related factors on complication rates after adult spinal deformity surgery
Authors: Williamson Tyler K. , Passfall Lara , Ihejirika-Lomedico Rivka , Espinosa Annie , Owusu-Sarpong Stephane , Lanre-Amos Tomi , Schoenfeld Andrew J. , Passias Peter G.
Published: November 2022

Aims

Postoperative complication rates remain relatively high after adult spinal deformity (ASD) surgery. The extent to which modifiable patient-related factors influence complication rates in patients with ASD has not been effectively evaluated. The aim of this retrospective cohort study was to evaluate the association between modifiable patient-related factors and complications after corrective surgery for ASD.

Methods

ASD patients with two-year data were included. Complications were categorized as follows: any complication, major, medical, surgical, major mechanical, major radiological, and reoperation. Modifiable risk factors included smoking, obesity, osteoporosis, alcohol use, depression, psychiatric diagnosis, and hypertension. Patients were stratified by the degree of baseline deformity (low degree of deformity (LowDef)/high degree of deformity (HighDef): below or above 20°) and age (Older/Younger: above or below 65 years). Complication rates were compared for modifiable risk factors in each age/deformity group, using multivariable logistic regression analysis to adjust for confounders.

Results

A total of 480 ASD patients met the inclusion criteria. By two years, complication rates were 72% ≥ one complication, 28% major, 21% medical, 27% surgical, 11% major radiological, 8% major mechanical, and 22% required reoperation. Younger LowDef patients with osteoporosis were more likely to suffer either a major mechanical (odds ratio (OR) 5.9 (95% confidence interval (CI) 1.1 to 36.9); p = 0.048) or radiological complication (OR 7.0 (95% CI 1.9 to 25.9); p = 0.003). Younger HighDef patients were much more likely to develop complications if obese, especially major mechanical complications (OR 2.8 (95% CI 1.1 to 8.6); p = 0.044). Older HighDef patients developed more complications when diagnosed with depression, including major radiological complications (OR 3.5 (95% CI 1.1 to 10.6); p = 0.033). Overall, a diagnosis of depression proved to be a risk factor for the development of major radiological complications (OR 2.4 (95% CI 1.3 to 4.5); p = 0.005).

Conclusion

Certain modifiable patient-related factors, especially osteoporosis, obesity, and mental health status, are associated with an increased risk of complications after surgery for spinal deformity. Surgeons should look for these conditions when assessing a patient for surgery, and optimize them to the fullest extent possible before proceeding to surgical correction so as to minimize the prospect of postoperative morbidity. Cite this article: Bone Joint J 2022;104-B(11):1249–1255.
Mode-locked laser oscillation with spectral peaks at molecular rovibrational transition lines
Authors: Okazaki Daiki , Song Wenqing , Morichika Ikki , Ashihara Satoshi
Published: November 2022

We demonstrate spectral peak formation in a mode-locked solid-state laser that contains a gas cell inside the cavity. Symmetric spectral peaks appear in the course of sequential spectral shaping through resonant interaction with molecular rovibrational transitions and nonlinear phase modulation in the gain medium. The spectral peak formation is explained as that narrowband molecular emissions triggered by an impulsive rovibrational excitation are superposed on the broadband spectrum of the soliton pulse by constructive interference. The demonstrated laser, which exhibits comb-like spectral peaks at molecular resonances, potentially provides novel tools for ultrasensitive molecular detection, vibration-mediated chemical reaction control, and infrared frequency standards.
Three-dimensional programming of nanolaser arrays through a single optical microfiber
Authors: Song Da In , Yu Aran , Samutpraphoot Polnop , Lee Jungmin , Kim Moohyuk , Park Byoung Jun , Sipahigil Alp , Kim Myung-Ki
Published: November 2022

Efficient programming of
integrated small optical sources is a key component of photonic
technologies. However, as the density of laser arrays increases, the
miniaturization and scalability of laser control using an electric
drive are pushed to the limit. This study presents an all-optical
drive scheme for complete programming of nanolaser arrays through a
single waveguide port. Three photonic crystal nanolasers, printed
three-dimensionally on the sides of a 2-µm-diameter fiber with
an 18 µm laser spacing, were entirely controlled by
modal interference, adjusted by the polarization and pulse width of
the pump beam through the same fiber. Our approach is applicable to
various small optical sources coupled to a single waveguide, and it
will lay the foundation for applications in high-density optical
integrated circuits, biosensing, and quantum network technologies.
The microbiota promotes social behavior by modulating microglial remodeling of forebrain neurons
Authors: Bruckner Joseph J. , Stednitz Sarah J. , Grice Max Z. , Zaidan Dana , Massaquoi Michelle S. , Larsch Johannes , Tallafuss Alexandra , Guillemin Karen , Washbourne Philip , Eisen Judith S.
Published: November 2022

Host-associated microbiotas guide the trajectory of developmental programs, and altered microbiota composition is linked to neurodevelopmental conditions such as autism spectrum disorder. Recent work suggests that microbiotas modulate behavioral phenotypes associated with these disorders. We discovered that the zebrafish microbiota is required for normal social behavior and reveal a molecular pathway linking the microbiota, microglial remodeling of neural circuits, and social behavior in this experimentally tractable model vertebrate. Examining neuronal correlates of behavior, we found that the microbiota restrains neurite complexity and targeting of forebrain neurons required for normal social behavior and is necessary for localization of forebrain microglia, brain-resident phagocytes that remodel neuronal arbors. The microbiota also influences microglial molecular functions, including promoting expression of the complement signaling pathway and the synaptic remodeling factor c1q. Several distinct bacterial taxa are individually sufficient for normal microglial and neuronal phenotypes, suggesting that host neuroimmune development is sensitive to a feature common among many bacteria. Our results demonstrate that the microbiota influences zebrafish social behavior by stimulating microglial remodeling of forebrain circuits during early neurodevelopment and suggest pathways for new interventions in multiple neurodevelopmental disorders.
From months to minutes: Creating Hyperion, a novel data management system expediting data insights for oncology research and patient care
Authors: Snyder Eric , Rivers Thomas , Smith Lisa , Paoni Scott , Cunliffe Scott , Patel Arpan , Ramsdale Erika
Published: November 2022

Here we describe the design and implementation of a novel data management platform for an academic cancer center which meets the needs of multiple stakeholders. A small, cross-functional technical team identified key challenges to creating a broad data management and access software solution: lowering the technical skill floor, reducing cost, enhancing user autonomy, optimizing data governance, and reimagining technical team structures in academia. The Hyperion data management platform was designed to meet these challenges in addition to usual considerations of data quality, security, access, stability, and scalability. Implemented between May 2019 and December 2020 at the Wilmot Cancer Institute, Hyperion includes a sophisticated custom validation and interface engine to process data from multiple sources, storing it in a database. Graphical user interfaces and custom wizards permit users to directly interact with data across operational, clinical, research, and administrative contexts. The use of multi-threaded processing, open-source programming languages, and automated system tasks (normally requiring technical expertise) minimizes costs. An integrated ticketing system and active stakeholder committee support data governance and project management. A co-directed, cross-functional team with flattened hierarchy and integration of industry software management practices enhances problem solving and responsiveness to user needs. Access to validated, organized, and current data is critical to the functioning of multiple domains in medicine. Although there are downsides to developing in-house customized software, we describe a successful implementation of custom data management software in an academic cancer center.
Weight-normative messaging predominates on TikTok—A qualitative content analysis
Authors: Minadeo Marisa , Pope Lizzy
Published: November 2022

Tiktok is a social media platform with many adolescent and young adult users. Food, nutrition, and weight-related posts are popular on TikTok, yet there is little understanding of the content of these posts, and whether nutrition-related content is presented by experts. The objective was to identify key themes in food, nutrition, and weight-related posts on TikTok. 1000 TikTok videos from 10 popular nutrition, food, and weight-related hashtags each with over 1 billion views were downloaded and analyzed using template analysis. The one-hundred most viewed videos were downloaded from each of the ten chosen hashtags. Two coders then coded each video for key themes. Key themes included the glorification of weight loss in many posts, the positioning of food to achieve health and thinness, and the lack of expert voices providing nutrition information. The majority of posts presented a weight-normative view of health, with less than 3% coded as weight-inclusive. Most posts were created by white, female adolescents and young adults. Nutrition-related content on TikTok is largely weight normative, and may contribute to disordered eating behaviors and body dissatisfaction in the young people that are TikTok’s predominant users. Helping users discern credible nutrition information, and eliminate triggering content from their social media feeds may be strategies to address the weight-normative social media content that is so prevalent.
Systematic review the efficacy and safety of cilostazol, pentoxifylline, beraprost in the treatment of intermittent claudication: A network meta-analysis
Authors: Liang Xinyu , Wang Yuzhen , Zhao Cheng , Cao Yemin
Published: November 2022

Objective

To evaluate the efficacy and safety of cilostazol, pentoxifylline, beraprost for intermittent claudication due to lower extremity arterial occlusive disease.

Methods

Randomized controlled clinical trials were identified from PubMed, Scopus, EMbase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, SinoMed, Wanfang and Chongqing VIP databases, from the database inception to 31/12/2021. The outcome measures were walking distance measured by treadmill (maximum and pain-free walking distance), ankle-brachial index and adverse events. The quality of included studies was assessed by the Cochrane bias risk assessment tool. A network meta-analysis was carried out with Stata 16.0 software.

Results

There were 29 RCTs included in the study, covering total 5352 patients. Cilostazol was ranked first for both maximum and pain-free walking distance, followed by beraprost and pentoxifylline. For cilostazol, pentoxifylline and beraprost, maximum walking distance increased by 62.93 95%CI(44.06, 81.79), 32.72 95%CI(13.51, 55.79) and 43.90 95%CI(2.10, 85.71) meters, respectively relative to placebo, and pain-free walking distance increased by 23.92 95%CI(11.24, 36.61), 15.16 95%CI(2.33, 27.99) and 19.78 95%CI(-3.07, 42.62) meters. For cilostazol, pentoxifylline, beraprost and cilostazol combined with beraprost, ankle-brachial index increased by 0.06 95%CI(0.04, 0.07), -0.01 95%CI(-0.08, 0.05), 0.18 95%CI(0.12, 0.23) and 0.23 95%CI(0.18, 0.27), respectively relative to placebo. The pentoxifylline and cilostazol was associated with a lower ratio of adverse events than beraprost and cilostazol combined with beraprost.

Conclusion

Cilostazol, pentoxifylline and beraprost were all effective treatments for intermittent claudication; cilostazol with good tolerance was likely to be the most effective in walking distance, while beraprost and cilostazol combined with beraprost were more prominent in the ankle-brachial index.
An investigation of movement dynamics and muscle activity during traditional and accentuated-eccentric squatting
Authors: Armstrong Richard , Baltzopoulos Vasilios , Langan-Evans Carl , Clark Dave , Jarvis Jonathan , Stewart Claire , O’Brien Thomas
Published: November 2022

Introduction

Accentuated-eccentric loading (AEL) takes advantage of the high force producing potential of eccentric muscle contractions, potentially maximising mechanical tension within the muscle. However, evidence is lacking on how AEL squatting may load the involved musculature, limiting scientifically justified programming recommendations. The purpose of this study was to investigate the effects of concentric and eccentric loads on joint loading and muscle activity of the lower limbs.

Methods

Resistance trained males performed traditional squatting (20–100% of concentric one-repetition maximum [1RM]) and AEL squatting with eccentric loads (110–150% of 1RM) provided by a novel motorised isotonic resistance machine (Kineo). Kinetics and kinematics of the hip, knee, and ankle joints were collected, with electromyography from the gluteus maximus, vastus lateralis, biceps femoris, and gastrocnemius medialis. A secondary cohort underwent a kinematic and electromyography analysis of squatting technique to compare Kineo and back and front barbell squatting.

Results

Knee joint peak eccentric moments occurred at 120% 1RM (P = 0.045), with no further increase thereafter. As eccentric load increased, the time course of moment development occurred earlier in the eccentric phase. This resulted in a 37% increase in eccentric knee extensor work from the 80% 1RM trial to the 120% 1RM trial (P<0.001). Neither hip nor ankle joints displayed further change in kinetics as eccentric load increased above 100% 1RM. Electromyographic activity during traditional squatting was ~15–30% lower in all eccentric trials than in concentric trials for all muscles. EMG plateaued between a load of 80–100% 1RM during the eccentric trials and did not increase with AEL. No significant differences in kinematics were found between Kineo and barbell squatting.

Conclusions

The knee extensors appear to be preferentially loaded during AEL squatting. The greater work performed during the eccentric phase of the squat as eccentric load increased suggests greater total mechanical tension could be the cause of adaptations from AEL. Our data suggest that AEL should be programmed with a load of 120% of 1RM. Further studies are needed to confirm the longer-term training effects of AEL.
Diagnostic and prognostic performance of the ratio between high-sensitivity cardiac troponin I and troponin T in patients with chest pain
Authors: Eggers Kai M. , Hammarsten Ola , Aldous Sally J. , Cullen Louise , Greenslade Jaimi H. , Lindahl Bertil , Parsonage William A. , Pemberton Christopher J. , Pickering John W. , Richards A. Mark , Troughton Richard W. , Than Martin P.
Published: November 2022

Background

Elevations of high-sensitivity cardiac troponin (hs-cTn) concentrations not related to type 1 myocardial infarction are common in chest pain patients presenting to emergency departments. The discrimination of these patients from those with type 1 myocardial infarction (MI) is challenging and resource-consuming. We aimed to investigate whether the hs-cTn I/T ratio might provide diagnostic and prognostic increment in this context.

Methods

We calculated the hs-cTn I/T ratio in 888 chest pain patients having hs-cTnI (Abbott Laboratories) or hs-cTnT (Roche Diagnostics) concentrations above the respective 99th percentile at 2 hours from presentation. All patients were followed for one year regarding mortality.

Results

The median hs-cTn I/T ratio was 3.45 (25th, 75th percentiles 1.80–6.59) in type 1 MI patients (n = 408 ☯46.0%]), 1.18 (0.81–1.90) in type 2 MI patients (n = 56 ☯6.3%]) and 0.67 (0.39–1.12) in patients without MI. The hs-cTn I/T ratio provided good discrimination of type 1 MI from no type 1 MI (area under the receiver-operator characteristic curve 0.89 ☯95% confidence interval 0.86–0.91]), of type 1 MI from type 2 MI (area under the curve 0.81 ☯95% confidence interval 0.74–0.87]), and was associated with type 1 MI in adjusted analyses. The hs-cTn I/T ratio provided no consistent prognostic value.

Conclusions

The hs-cTn I/T ratio appears to be useful for early diagnosis of type 1 MI and its discrimination from type 2 MI in chest pain patients presenting with elevated hs-cTn. Differences in hs-cTn I/T ratio values may reflect variations in hs-cTn release mechanisms in response to different types of myocardial injury.