bluuebunny/crossref_metadata_2025 huggingface dataset:
Augmented reality in the operating room: a clinical feasibility study
Authors: Dennler Cyrill , Bauer David E. , Scheibler Anne-Gita , Spirig José , Götschi Tobias , Fürnstahl Philipp , Farshad Mazda
Published: May 2021

Background

Augmented Reality (AR) is a rapidly emerging technology finding growing acceptance and application in different fields of surgery. Various studies have been performed evaluating the precision and accuracy of AR guided navigation. This study investigates the feasibility of a commercially available AR head mounted device during orthopedic surgery.

Methods

Thirteen orthopedic surgeons from a Swiss university clinic performed 25 orthopedic surgical procedures wearing a holographic AR headset (HoloLens, Microsoft, Redmond, WA, USA) providing complementary three-dimensional, patient specific anatomic information. The surgeon’s experience of using the device during surgery was recorded using a standardized 58-item questionnaire grading different aspects on a 100-point scale with anchor statements.

Results

Surgeons were generally satisfied with image quality (85 ± 17 points) and accuracy of the virtual objects (84 ± 19 point). Wearing the AR device was rated as fairly comfortable (79 ± 13 points). Functionality of voice commands (68 ± 20 points) and gestures (66 ± 20 points) provided less favorable results. The greatest potential in the use of the AR device was found for surgical correction of deformities (87 ± 15 points). Overall, surgeons were satisfied with the application of this novel technology (78 ± 20 points) and future access to it was demanded (75 ± 22 points).

Conclusion

AR is a rapidly evolving technology with large potential in different surgical settings, offering the opportunity to provide a compact, low cost alternative requiring a minimum of infrastructure compared to conventional navigation systems. While surgeons where generally satisfied with image quality of the here tested head mounted AR device, some technical and ergonomic shortcomings were pointed out. This study serves as a proof of concept for the use of an AR head mounted device in a real-world sterile setting in orthopedic surgery.
Comparison of hamstring and quadriceps strength after anatomical versus non-anatomical anterior cruciate ligament reconstruction: a retrospective cohort study
Authors: Jiang Hai , Zhang Lei , Zhang Rui-Ying , Zheng Qiu-Jian , Li Meng-Yuan
Published: May 2021

Background

Strength recovery of injured knee is an important parameter for patients who want to return to sport after anterior cruciate ligament reconstruction (ACLR). Comparison of muscle strength between anatomical and non-anatomical ACLR has not been reported.

Purpose

To evaluate the difference between anatomical and non-anatomical single-bundle ACLR in hamstring and quadriceps strength and clinical outcomes.

Methods

Patients received unilateral primary single-bundle hamstring ACLR between January 2017 to January 2018 were recruited in this study. Patients were divided into anatomical reconstruction group (AR group) and non-anatomical reconstruction group (NAR group) according to femoral tunnel aperture position. The hamstring and quadriceps isokinetic strength including peak extension torque, peak flexion torque and H/Q ratio were measured at an angular velocity of 180°/s and 60°/s using an isokinetic dynamometer. The isometric extension and flexion torques were also measured. Hamstring and quadriceps strength were measured preoperatively and at 3, 6, and 12 months after surgery. Knee stability including Lachman test, pivot-shift test, and KT-1000 measurement and subjective knee function including International Knee Documentation Committee (IKDC) and Lysholm scores were evaluated during the follow-up.

Results

Seventy-two patients with an average follow-up of 30.4 months (range, 24–35 months) were included in this study. Thirty-three were in AR group and 39 in NAR group. The peak knee flexion torque was significant higher in AR group at 180°/s and 60°/s (P < 0.05 for both velocity) at 6 months postoperatively and showed no difference between the two groups at 12 months postoperatively. The isometric knee extension torque was significant higher in AR group at 6 months postoperatively (P < 0.05) and showed no difference between the two groups at 12 months postoperatively. No significant differences between AR group and NAR group were found regarding knee stability and subjective knee function evaluations at follow-up.

Conclusions

Compared with non-anatomical ACLR, anatomical ACLR showed a better recovery of hamstring and quadriceps strength at 6 months postoperatively. However, the discrepancy on hamstring and quadriceps strength between the two groups vanished at 1 year postoperatively.
Long-term follow-up of prophylactic mesh reinforcement after emergency laparotomy. A retrospective controlled study
Authors: Bravo-Salva A. , Argudo-Aguirre N. , González-Castillo A. M. , Membrilla-Fernandez E. , Sancho-Insenser J. J. , Grande-Posa L. , Pera-Román M. , Pereira-Rodríguez J. A.
Published: May 2021

Background

Prevention of incisional hernias with a prophylactic mesh in emergency surgery is controversial. The present study aimed to analyze the long-term results of prophylactic mesh used for preventing incisional hernia after emergency midline laparotomies.

Methods

This study was a registered (NCT04578561) retrospective analysis of patients who underwent an emergency midline laparotomy between January 2009 and July 2010 with a follow-up period of longer than 2 years. Long-term outcomes and risk factors for the development of incisional hernias between patients who received a prophylactic reinforcement mesh (Group M) and suture (Group S) were compared.

Results

From an initial 266 emergency midline laparotomies, 187 patients were included. The median follow-up time was 64.4 months (SD 35). Both groups had similar characteristics, except for a higher rate of previous operations (62 vs. 43.2%; P = 0.01) and operation due to a revision laparotomy (32.5 vs.13%; P = 0.02) in the M group. During follow-up, 29.9% of patients developed an incisional hernia (Group S 36.6% vs. Group M 14.3%; P = 0.002). Chronic mesh infections were diagnosed in 2 patients, but no mesh explants were needed, and no patient in the M group developed chronic pain. Long-term risk factors for incisional hernia were as follows: smoking (HR = 2.47; 95% CI 1.318–4.624; P = 0.05), contaminated surgery (HR = 2.98; 95% CI 1.142–7.8; P = 0.02), surgical site infection (SSI; HR = 3.83; 95% CI 1.86–7.86; P = 0.001), and no use of prophylactic mesh (HR = 5.09; 95% CI 2.1–12.2; P = 0.001).

Conclusion

Incidence of incisional hernias after emergency midline laparotomies is high and increases with time. High-risk patients, contaminated surgery, and surgical site infection (SSI) benefit from mesh reinforcement. Prophylactic mesh use is safe and feasible in emergencies with a low long-term complication rate.

Trial registration: NCT04578561. www.clinicaltrials.gov
Safety profile of preoperative administration of low-molecular-weight heparin on minimally invasive lung cancer surgery: a randomized controlled trial
Authors: A-Lai Gu-Ha , Zhuo Ze-Guo , Li Gang , Song Tie-Niu , Xu Zhi-Jie , Shen Xu , Yao Peng , Lin Yi-Dan
Published: May 2021

Background

Venous thromboembolism remains a common but preventable complication for cancerous lung surgical patients. Current guidelines recommend thromboprophylaxis for lung patients at high risk of thrombosis, while a consensus about specific administration time is not reached. This study was designed to investigate the safety profile of preoperative administration of low-molecular-weight-heparin (LMWH) for lung cancer patients.

Methods

From July 2017 to June 2018, patients prepared to undergo lung cancer surgery were randomly divided into the preoperative LMWH-administration group (PRL) for 4000 IU per day and the postoperative LMWH-administration group (POL) with same dosage, all the patients received thromboprophylaxis until discharge. Baseline characteristics including demographics and preoperative coagulation parameters were analyzed, while the endpoints included postoperative coagulation parameters, postoperative drainage data, hematologic data, intraoperative bleeding volume and reoperation rate.

Results

A total of 246 patients were collected in this RCT, 34 patients were excluded according to exclusion criterion, 101 patients were assigned to PRL group and 111 patients belonged to POL group for analysis finally. The baseline characteristic and preoperative coagulation parameters were all comparable except the PRL group cost more operation time (p = 0.008) and preoperative administration duration was significantly longer (p < 0.001). The endpoints including postoperative day 1 coagulation parameters, mean and total drainage volume, drainage duration, intraoperative bleeding volume and reoperation rate were all similar between the two groups. Moreover, coagulation parameters for postoperative day 3 between the two groups demonstrated no difference.

Conclusion

Preoperative administration of low-molecular-weight-heparin demonstrated safety and feasibility for lung cancer patients intended to receive minimally invasive surgery.

Trial registration: ChiCTR2000040547 (www.chictr.org.cn), 2020/12/1, retrospectively registered.
Salidroside protects endothelial cells against LPS-induced inflammatory injury by inhibiting NLRP3 and enhancing autophagy
Authors: You Lijiao , Zhang Di , Geng Huan , Sun Fangyuan , Lei Ming
Published: May 2021

Background

Salidroside (SAL) is a bioactive compound extracted fromRhodiola roseawith various biological properties. This study was designed to explore the functions of SAL on the endothelial damage induced by lipopolysaccharide (LPS) and its related mechanisms.

Methods

Human umbilical vein endothelial cells (HUVECs) were pretreated with SAL (0, 10, 25, 50, 100 μM), and then incubated with LPS (10 μg/mL). Cell viability was evaluated by MTT assay, cell injury by lactate dehydrogenase (LDH) release, and inflammatory cytokines release by ELISA assay. Oxidative stress was evaluated by malondialdehyde (MDA) and superoxide dismutase (SOD) in cell lysate. Apoptosis was detected by flow cytometry and caspase-3 activity. Western blot were performed to determine expression levels of autophagy and NOD-like receptor protein 3 (NLRP3) related proteins.

Results

SAL at 50 μM concentration showed no toxicity on HUVECs, but attenuated LPS-induced injury, as evidenced by increased cell viability, reduction in LDH level and inflammatory cytokines in culture media. SAL also reduced MDA level and increased SOD activity in HUVECs, and inhibited apoptosis rate and caspase-3 activity. (P < 0.05). Moreover, LPS enhanced HUVECs autophagy, and SAL pretreatment further enhanced autophagy, with increased Beclin-1 protein and decreased P62 protein. SAL also attenuated LPS-induced activation of NLRP3 inflammasome, reduced the protein expression of NLRP3-related proteins, including ASC and caspase-1. Autophagy inhibition by 3-MA markedly reversed SAL-modulated changes in cell viability and NLRP3 expression in LPS-stimulated HUVECs.

Conclusion

SAL protects endothelial cells against LPS-induced injury through inhibition of NLRP3 pathways and enhancing autophagy.
A new family with spastic paraplegia type 51 and novel mutations in AP4E1
Authors: Winkler Izabela , Miotła Paweł , Lejman Monika , Pietrzyk Aleksandra , Kacprzak Magdalena , Kubiak Marcin , Sobczyńska-Tomaszewska Agnieszka , Skrzypczak Maciej , Jaszczuk Ilona
Published: May 2021

Background

Autosomal recessive mutations in the AP-4 (adaptor protein complex 4) complex subunit ϵ − 1 (AP-4E1) gene on chromosome 15q21.2 are known to cause spastic paraplegia 51 (SPG51). The exact phenotype of SPG51 remains poorly characterized, because only a few families have been reported as carriers of the mutation. In addition, a previous study identified an autosomal dominant mutation in the AP4E1 gene as being associated with persistent stuttering. The aim of the current study was to characterize the phenotype of a paediatric patient with an identified novel AP4E1 mutation presenting with significant psychomotor retardation, intellectual disability and paraplegia.

Methods

Magnetic resonance imaging was used to identify hypoplasia of the corpus callosum. The DNA sample was tested using multiplex ligation-dependent probe amplification (MLPA) and array comparative genomic hybridization (aCGH). In addition, next-generation sequencing (NGS) was performed using the patient’s DNA, and Sanger sequencing was performed using that of his family members.

Results

The phenotype was identified to be associated with a novel pathogenic variant c.942_943 + 3delinsCC in the AP4E1 gene. The patient manifested severely delayed psychomotor development, impaired global physical development and general illness. Movement disorders were evident during the neonatal period.

Conclusions

The present study identifies a previously unknown disease-inducing AP4E1 gene mutation.
Rethinking pioglitazone as a cardioprotective agent: a new perspective on an overlooked drug
Authors: Nesti Lorenzo , Tricò Domenico , Mengozzi Alessandro , Natali Andrea
Published: May 2021

Since 1985, the thiazolidinedione pioglitazone has been widely used as an insulin sensitizer drug for type 2 diabetes mellitus (T2DM). Although fluid retention was early recognized as a safety concern, data from clinical trials have not provided conclusive evidence for a benefit or a harm on cardiac function, leaving the question unanswered. We reviewed the available evidence encompassing both in vitro and in vivo studies in tissues, isolated organs, animals and humans, including the evidence generated by major clinical trials. Despite the increased risk of hospitalization for heart failure due to fluid retention, pioglitazone is consistently associated with reduced risk of myocardial infarction and ischemic stroke both in primary and secondary prevention, without any proven direct harm on the myocardium. Moreover, it reduces atherosclerosis progression, in-stent restenosis after coronary stent implantation, progression rate from persistent to permanent atrial fibrillation, and reablation rate in diabetic patients with paroxysmal atrial fibrillation after catheter ablation. In fact, human and animal studies consistently report direct beneficial effects on cardiomyocytes electrophysiology, energetic metabolism, ischemia–reperfusion injury, cardiac remodeling, neurohormonal activation, pulmonary circulation and biventricular systo-diastolic functions. The mechanisms involved may rely either on anti-remodeling properties (endothelium protective, inflammation-modulating, anti-proliferative and anti-fibrotic properties) and/or on metabolic (adipose tissue metabolism, increased HDL cholesterol) and neurohormonal (renin–angiotensin–aldosterone system, sympathetic nervous system, and adiponectin) modulation of the cardiovascular system. With appropriate prescription and titration, pioglitazone remains a useful tool in the arsenal of the clinical diabetologist.
Efficiency of fine scale and spatial regression in modelling associations between healthcare service spatial accessibility and their utilization
Authors: Gao Fei , languille Clara , karzazi Khalil , Guhl Mélanie , Boukebous Baptiste , Deguen Séverine
Published: May 2021

Background

Healthcare accessibility, a key public health issue, includes potential (spatial accessibility) and realized access (healthcare utilization) dimensions. Moreover, the assessment of healthcare service potential access and utilization should take into account the care provided by primary and secondary services. Previous studies on the relationship between healthcare spatial accessibility and utilization often used conventional statistical methods without addressing the scale effect and spatial processes. This study investigated the impact of spatial accessibility to primary and secondary healthcare services on length of hospital stay (LOS), and the efficiency of using a geospatial approach to model this relationship.

Methods

This study focused on the ≥ 75-year-old population of the Nord administrative region of France. Inpatient hospital spatial accessibility was computed with the E2SFCA method, and then the LOS was calculated from the French national hospital activity and patient discharge database. Ordinary least squares (OLS), spatial autoregressive (SAR), and geographically weighted regression (GWR) were used to analyse the relationship between LOS and spatial accessibility to inpatient hospital care and to three primary care service types (general practitioners, physiotherapists, and home-visiting nurses). Each model performance was assessed with measures of goodness of fit. Spatial statistical methods to reduce or eliminate spatial autocorrelation in the residuals were also explored.

Results

GWR performed best (highest R2and lowest Akaike information criterion). Depending on global model (OLS and SAR), LOS was negatively associated with spatial accessibility to general practitioners and physiotherapists. GWR highlighted local patterns of spatial variation in LOS estimates. The distribution of areas in which LOS was positively or negatively associated with spatial accessibility varied when considering accessibility to general practitioners and physiotherapists.

Conclusions

Our findings suggest that spatial regressions could be useful for analysing the relationship between healthcare spatial accessibility and utilization. In our case study, hospitalization of elderly people was shorter in areas with better accessibility to general practitioners and physiotherapists. This may be related to the presence of effective community healthcare services. GWR performed better than LOS and SAR. The identification by GWR of how these relationships vary spatially could bring important information for public healthcare policies, hospital decision-making, and healthcare resource allocation.
Novel mechanism for OSM-promoted extracellular matrix remodeling in breast cancer: LOXL2 upregulation and subsequent ECM alignment
Authors: Dinca Simion C. , Greiner Daniel , Weidenfeld Keren , Bond Laura , Barkan Dalit , Jorcyk Cheryl L.
Published: May 2021

Background

Invasive ductal carcinoma (IDC) is a serious problem for patients as it metastasizes, decreasing 5-year patient survival from > 95 to ~ 27%. The breast tumor microenvironment (TME) is often saturated with proinflammatory cytokines, such as oncostatin M (OSM), which promote epithelial-to-mesenchymal transitions (EMT) in IDC and increased metastasis. The extracellular matrix (ECM) also plays an important role in promoting invasive and metastatic potential of IDC. Specifically, the reorganization and alignment of collagen fibers in stromal ECM leads to directed tumor cell motility, which promotes metastasis. Lysyl oxidase like-2 (LOXL2) catalyzes ECM remodeling by crosslinking of collagen I in the ECM. We propose a novel mechanism whereby OSM induces LOXL2 expression, mediating stromal ECM remodeling of the breast TME.

Methods

Bioinformatics was utilized to determine survival and gene correlation in patients. IDC cell lines were treated with OSM (also IL-6, LIF, and IL-1β) and analyzed for LOXL2 expression by qRT-PCR and immunolabelling techniques. Collagen I contraction assays, 3D invasion assays, and confocal microscopy were performed with and without LOXL2 inhibition to determine the impact of OSM-induced LOXL2 on the ECM.

Results

Our studies demonstrate that IDC patients with high LOXL2 and OSM co-expression had worse rates of metastasis-free survival than those with high levels of either, individually, and LOXL2 expression is positively correlated to OSM/OSM receptor (OSMR) expression in IDC patients. Furthermore, human IDC cells treated with OSM resulted in a significant increase in LOXL2 mRNA, which led to upregulated protein expression of secreted, glycosylated, and enzymatically active LOXL2. The expression of LOXL2 in IDC cells did not affect OSM-promoted EMT, and LOXL2 was localized to the cytoplasm and/or secreted. OSM-induced LOXL2 promoted an increase in ECM collagen I fiber crosslinking, which led to significant fiber alignment between cells and increased IDC cell invasion.

Conclusions

Aligned collagen fibers in the ECM provide pathways for tumor cells to migrate more easily through the stroma to nearby vasculature and tissue. These results provide a new paradigm through which proinflammatory cytokine OSM promotes tumor progression. Understanding the nuances in IDC metastasis will lead to better potential therapeutics to combat against the possibility.
Outbreaks of clinical toxoplasmosis in humans: five decades of personal experience, perspectives and lessons learned
Authors: Dubey Jitender P.
Published: May 2021

Background

The protozoan parasite Toxoplasma gondii has a worldwide distribution and a very wide host range, infecting most warm-blooded hosts. Approximately 30% of humanity is infected with T. gondii, but clinical toxoplasmosis is relatively infrequent. Toxoplasmosis has a wide range of clinical symptoms involving almost all organ systems. In most persons that acquire infection postnatally, symptoms (when present) are mild and mimic other diseases such as flu, Lyme disease, Q fever, hematological alterations, or mumps. It is likely that clinical disease is more common than reported. The ingestion of infected meat or food and water contaminated with oocysts are the two main modes of postnatal transmission of Toxoplasma gondii. The infective dose and the incubation period of T. gondii infection are unknown because there are no human volunteer experiments.

Methods

Here, I have critically reviewed outbreaks of clinical toxoplasmosis in humans for the past 55 years, 1966–2020. Information from oocyst-acquired versus meat-acquired infections was assessed separately.

Results

Most outbreaks were from Brazil. There were no apparent differences in types or severity of symptoms in meat- versus oocyst-acquired infections. Fever, cervical lymphadenopathy, myalgia, and fatigue were the most important symptoms, and these symptoms were not age-dependent. The incubation period was 7–30 days. A genetic predisposition to cause eye disease is suspected in the parasites responsible for three outbreaks (in Brazil, Canada, and India). Only a few T. gondii tissue cysts might suffice to cause infection, as indicated by outbreaks affecting some (but not all) individuals sharing a meal of infected meat.

Conclusions

Whether the high frequency of outbreaks of toxoplasmosis in humans in Brazil is related to environmental contamination, poor hygiene, socioeconomic conditions, or to genotypes of T. gondii needs investigation.

Graphical Abstract
Dynamical features of pine wilt disease through stability, sensitivity and optimal control
Authors: Khan Riaz Ahmad , Hussain Takasar , Ozair Muhammad , Tasneem Fatima , Faizan Muhammad
Published: May 2021

This work investigates the dissemination mechanism of pine wilt disease. The basic reproduction number is computed explicitly, and an ultimate invariable level of contagious hosts and vectors, without and with disease, is discussed by using this number. Highly effective techniques, Lyapunov functional and graph theoretic, are utilised to obtain the ultimate constant level of the whole population. The idea of complete disease eradication and reduction of endemic level is explored through the utilisation of two efficient methods. Using sensitivity analysis approach, necessary control measures are suggested to overcome the disease. Using the literature data, the robustness of control strategies is shown graphically.
Numerical simulation of the experimental behavior of RC beams at elevated temperatures
Authors: Issa Camille A. , Izadifard Ramezan A.
Published: May 2021

The danger of fire is present always and everywhere. The imminent danger depends upon the actual type and length of fire exposure. Reinforced concrete structural members are loadbearing components in buildup structures and are therefore at high risk, since the entire structure might potentially collapse upon their failure. Thus, it is imperative to comprehend the behavior of reinforced concrete members at high temperatures in case of fire. In this study, the mechanical properties of concrete exposed to high temperatures were experimentally determined through the testing of 27 concrete cylinder starting at room temperature and increasing up to 260 °C. The concrete material behavior was implemented into the ABAQUS software and a finite simulation of reinforced concrete beams exposed to actual fire conditions were conducted. The finite element models compared favorably with the available experimental results. Thus, providing a valuable tool that allows for the prediction of failure in case of a fire event.
Preferences for pre-exposure prophylaxis among U.S. military men who have sex with men: results of an adaptive choice based conjoint analysis study
Authors: Gutierrez José I. , Dubov Alex , Altice Frederick L. , Vlahov David
Published: May 2021

Background

Pre-exposure prophylaxis (PrEP) prevents human immunodeficiency virus (HIV) infection, but its use remains low among U.S. military men who have sex with men (MSM), likely due to mis-matching with personal preferences. We conducted a study to characterize preferences to PrEP measures within this population.

Methods

HIV-negative military MSM were recruited through a closed, Lesbian, Gay, Bisexual, and Transgendered (LGBT) military social media group. The survey was anonymous, and consisted of five experimentally varied attributes in service delivery: dosing method, provider type, visit location, lab work evaluation location, and dispensing venue. Relative importance and part-worth utility scores were generated using hierarchical bayes (HB) estimation, and the randomized first choice model was used to examine participation interest across eight possible PrEP program scenarios.

Results

A total of 429 participants completed the survey. Among the eight scenarios with varying attributes, the most preferred scenario featured a daily tablet, PrEP injection or implant, along with a military provider, smartphone/telehealth visit, and on-base locations for lab evaluation and medication pick-up. The results also emphasized the importance for providers to be familiar with PrEP prescription knowledge, and to provide interactions sensitive to sexual identity and mental health.

Conclusion

A PrEP program consisting of daily tablet is preferred in military healthcare settings is preferred. Long-acting implants and injections are also desired.
Preparing accessible and understandable clinical research participant information leaflets and consent forms: a set of guidelines from an expert consensus conference
Authors: Coleman Eleanor , O’Sullivan Lydia , Crowley Rachel , Hanbidge Moira , Driver Seán , Kroll Thilo , Kelly Aoife , Nichol Alistair , McCarthy Orlaith , Sukumar Prasanth , Doran Peter
Published: May 2021

Background

In line with Good Clinical Practice and the Declaration of Helsinki, it is the investigator’s responsibility to ensure that research participants are sufficiently informed, to enable the provision of informed consent. The Participant Information Leaflet/Informed Consent Form is key to facilitating this communication process. Although studies have indicated that clinical research Participant Information Leaflets/Informed Consent Forms are not optimal in terms of accessibility, there is little or no specific guidance available. The aim of this research was to propose and agree a set of guidelines for academic researchers and sponsors for preparing accessible and understandable Participant Information Leaflets/Informed Consent Forms.

Methods

A literature review identified guidance for the preparation of patient-facing documents. Following critical appraisal, key recommendations were extracted and a set of recommendations which can be applied to clinical research Participant Information Leaflets/Informed Consent Forms were prepared. These recommendations were evaluated and amended by an Expert Consensus Conference consisting of a group of key stakeholders. The stakeholders included members of a Research Ethics Committee (both lay and expert), a patient advocate, experienced clinical researchers, a plain English editor and a Data Protection Officer. Consensus was reached regarding a final set of recommendations.

Results

44 recommendations were agreed upon and grouped into five categories: Layout, Formatting, Content, Language and Confirming Readability. These recommendations aimed to maximize accessibility for lay participants, including readers with dyslexia, literacy or numeracy challenges, thereby improving the quality of the consent process.

Conclusions

More empirical research is needed to further improve the informed consent process for research participants. However, these recommendations are informed by the current literature and have been ratified by expert stakeholders. It is hoped that these recommendations will help investigators and sponsors to consistently and efficiently produce more accessible clinical research Participant Information Leaflets/Informed Consent Forms.
Conducting invasive urodynamics in primary care: qualitative interview study examining experiences of patients and healthcare professionals
Authors: Milosevic Sarah , Joseph-Williams Natalie , Pell Bethan , Cain Elizabeth , Hackett Robyn , Murdoch Ffion , Ahmed Haroon , Allen A. Joy , Bray Alison , Clarke Samantha , Drake Marcus J. , Drinnan Michael , Hood Kerenza , Schatzberger Tom , Takwoingi Yemisi , Thomas-Jones Emma , White Raymond , Edwards Adrian , Harding Chris
Published: May 2021

Background

Invasive urodynamics is used to investigate the causes of lower urinary tract symptoms; a procedure usually conducted in secondary care by specialist practitioners. No study has yet investigated the feasibility of carrying out this procedure in a non-specialist setting. Therefore, the aim of this study was to explore, using qualitative methodology, the feasibility and acceptability of conducting invasive urodynamic testing in primary care.

Methods

Semi-structured interviews were conducted during the pilot phase of the PriMUS study, in which men experiencing bothersome lower urinary tract symptoms underwent invasive urodynamic testing along with a series of simple index tests in a primary care setting. Interviewees were 25 patients invited to take part in the PriMUS study and 18 healthcare professionals involved in study delivery. Interviews were audio-recorded, transcribed verbatim and analysed using a framework approach.

Results

Patients generally found the urodynamic procedure acceptable and valued the primary care setting due to its increased accessibility and familiarity. Despite some logistical issues, facilitating invasive urodynamic testing in primary care was also a positive experience for urodynamic nurses. Initial issues with general practitioners receiving and utilising the results of urodynamic testing may have limited the potential benefit to some patients. Effective approaches to study recruitment included emphasising the benefits of the urodynamic test and maintaining contact with potential participants by telephone. Patients’ relationship with their general practitioner was an important influence on study participation.

Conclusions

Conducting invasive urodynamics in primary care is feasible and acceptable and has the potential to benefit patients. Facilitating study procedures in a familiar primary care setting can impact positively on research recruitment. However, it is vital that there is a support network for urodynamic nurses and expertise available to help interpret urodynamic results.
A review on SARS-CoV-2 and stroke pathogenesis and outcome
Authors: Roushdy Tamer , Hamid Eman
Published: May 2021

Severe acute respiratory syndrome corona virus 2 hit strongly and hardly the entire globe for more than 1 year with a morbidity exceeding 139 million and a mortality approaching 3 million worldwide since its emergence in China in December 2019 until April 2021.

Although being termed after its ancestor the acute respiratory syndrome corona virus that emerged in 2002. Yet, the current corona virus has its unique devastating presentations being pulmonary and extra pulmonary.

In the current review, a highlight on the role played by corona virus 2 on pathogenesis and outcome of stroke is presented with an attempt to point to the most approved ways through which the corona virus induce stroke being disturbance in renin angiotensin system and angiotensin-converting enzyme 2 receptors downregulation, endothelial cell damage with coagulopathy, cytokine storm, and platelet as well as outcome and risks in patients who are suffering stroke with modifiable vascular risk factors and catching the severe acute respiratory syndrome corona virus 2.
Effect of mandibular complete dentures relining on occlusal force distribution using T-scan system
Authors: Ibraheem Eman M. , ElGabry Hisham S.
Published: May 2021

Background

This study aimed to evaluate the effect of mandibular complete dentures relining using soft relining material on the distribution of various occlusal forces using T-Scan system. Fifty completely edentulous patients having their conventional complete dentures earlier fabricated and utilized were selected for this study. Patients were controlled diabetics, characterized by having their residual alveolar ridges moderately developed and lined with firm mucoperiosteum. Mandibular complete dentures were relined with soft denture liner and T-Scan device was used for occlusal force distribution measurement prior to denture relining and three months thereafter the relinning procedure.

Results

Comparison between occlusal forces percentages before and after denture relining revealed that occlusal forces percentages was significantly lower after denture relining in anterior area, significantly higher after denture relining in right posterior area, where it was insignificantly higher after relining in left posterior area.

Conclusions

Our findings revealed that the use of soft denture liner for mandibular complete denture relining significantly improved the occlusal load distribution.

Clinical trial registration Trial registration NCT, NCT04701970. Registered 23/11/2020—Retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT04701970
A record of deglaciation-related shifting of the proximal zone of a sandur — a case study from the Gwda sandur, NW Poland (MIS 2)
Authors: Mleczak Mateusz , Pisarska-Jamroży Małgorzata
Published: May 2021

The study analyses a 7.5-m-thick sedimentary succession deposited in the largest sandur (the Gwda sandur, a glacial outwash plain) in NW Poland, during the late Weichselian (MIS 2). Although the study site is located in the distal zone of the sandur, its sedimentological features and palaeohydrological parameters reflect the presence of an energetic, powerful environment typical of the proximal zone. Three sedimentary units were recognized in the studied sedimentary succession: (1) lower unit — fine-grained sands with ripple cross-lamination and horizontal lamination; (2) middle unit — gravelly coarse-grained sands and sandy gravels with planar cross-stratification; and, (3) upper unit — sands and gravelly sands with trough cross-stratification. Although the age of deposition of the sandur is accepted to be convergent with that of end-moraines of the same phase, the sediments in the distal zone of the Gwda sandur correlate with an earlier glaciation phase/subphase. Our findings hint at a complex problem: large sandurs such as the Gwda sandur were probably deposited over a long time, and their successions might record the textural and structural features of the proximal subenvironment, even in their distal parts due to deglaciation-related shifting of the proximal zone of a sandur. This paper presents a new approach to analysing the depositional processes in large sandurs, shows a new light on glaciofluvial water supply dynamics of distal parts of sandurs, and may solve several fundamental problems related to the sandur deposition.
Prevalence and risk factors of delirium and subsyndromal delirium in older adults
Authors: Ibrahim Maha Hosam El-Din , Elmasry Manal , Nagy Fady , Abdelghani Ahmed
Published: May 2021

Background

Delirium is a common geriatric problem associated with poor outcomes. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium yet, not satisfying the definition of full-blown delirium, defined by categorical elements, and is usually referred to as the presence of one or more symptoms in the confusion assessment method (CAM). This study aimed to investigate the prevalence and risk factors of delirium and SSD in older adults admitted to the hospital. Five hundred eighty-eight elderly (above 65 years) Egyptian patients were recruited from January 2019 to February 2020. After explaining the purpose of the study and assuring the confidentiality of all participants, an informed consent was obtained from the participant or a responsible care giver for those who were not able to give consent. All patients were subjected ‘on admission’ to thorough history taking, clinical examination, and comprehensive geriatric assessment including confusion assessment tools, mini-mental state examination, and functional assessment using Barthel index score.

Results

The current study showed that 19.6% of patients had delirium and 14.1% of patients had SSD with combined prevalence of 33.7%. Most common causes included metabolic, infection, organic brain syndrome, and dehydration. The current study reported significant proportionate relation between cognitive assessment and functional ability, so patients with a score of 23 MMSE had good functional ability, while cognitive assessment using mini-mental score shows inversed relation to delirium and SSD using CAM score.

Conclusion

Delirium is independently associated with adverse short-term and long-term outcomes, including an increase in mortality, length of hospital stay, discharge to an institution, and functional decline on discharge. Subsyndromal delirium (SSD) is characterized by the presence of certain symptoms of delirium, not yet satisfying the definition of full-blown delirium but it can identify patients with early cognitive and functional disabilities, and because of high prevalence of delirium and SSD. Efforts to prevent or early detection may identify patients who warrant clinical attention.
A study of voice quality in obese Egyptian children
Authors: Abdel Hamid Asmaa , Soliman Hend , Abdelhalim Rasha
Published: May 2021

Background

Obesity is considered a health problem that affects many systems of the body among which the respiration and voice. The objective of the study was to analyze the impact of obesity in children on quality of their voice. Thirty obese children were included in this cross-sectional study and compared to 30 age- and sex-matched healthy children as a control group. Voice of cases and controls were assessed subjectively by auditory perceptual assessment and objectively by studying acoustic parameters using Computerized Speech Lab. Flexible laryngoscopy was done for cases with dysphonia.

Results

Dysphonia perceived in 60% of cases, voice analysis revealed increased jitter and noise to harmonic ratio with significant difference than controls.

Conclusion

The voice of children with morbid obesity reveals significant modifications pertaining to vocal characteristics in comparison to non-obese persons, so voice hygiene and voice therapy could be added to their therapy program as prophylactic or therapeutic management of voice disorder.
Probing water partitioning in unsaturated weathered rock using nuclear magnetic resonance
Authors: Zhang Fan , Zhang Chi
Published: May 2021

”Rock moisture” (exchangeable water stored in weathered bedrock beneath the soil) is a key and yet overlooked component in hydrologic cycles. It can be partitioned to free water and capillary-bound water. Determining dynamic partitioning of rock moisture is crucial for conceptualizing critical zone functions and climate and hydrologic modeling. However, the quantification of rock moisture partitioning is challenging, especially in rocks with complex pore structures and weathering patterns. Laboratory nuclear magnetic resonance (NMR) measurements are performed on heterogeneous bedrock samples from a merokarst vadose zone to quantify the dynamics of rock moisture partitioning during the drying process. By fitting a multi-Gaussian function, NMR [Formula: see text] distributions are autodecomposed into multiple [Formula: see text] peaks representing different pore sizes and environments. This spectral analysis enables us to track the change of position, width, and area of peaks at any given saturation stage, shedding light on water depletion rates and patterns, water residence time, and partitioning and redistribution of the water in drying rocks. The changes in [Formula: see text] peaks associated with drying among our samples show strong correspondence with mineralogy, and [Formula: see text]-[Formula: see text] measurements indicate that rock moisture depletion and redistribution are closely related to the pore structures. Limestone with well-connected macropores shows a sequential water loss from large to small pores, whereas limestone with poorly connected macropores simultaneously loses water from all pore sizes. The [Formula: see text] peak decomposition analysis can be extended to the field scale to track rock moisture partitioning in the pore network. This capability has implications for documenting critical zone processes, including quantifying water storage dynamics, estimating plant available water, and monitoring weathering processes.
Radar imaging of fractures and voids behind the walls of an underground mine
Authors: Abbasi Baghbadorani Amin , Hole John A. , Baggett Jonathan , Ripepi Nino
Published: May 2021

Two- and three-dimensional rock-penetrating-radar data were acquired on the wall of a pillar in an underground limestone mine. The objective was to test the ability of radar to image fractures and karst voids and to characterize their geometry, aperture, and fluid content, with the goal of mitigating mining hazards. Strong radar reflections in the field data correlate with fractures and a cave exposed on the pillar walls. Large pillar wall topography was included in the steep-dip Kirchhoff migration algorithm because standard elevation corrections are inaccurate. The depth-migrated 250 MHz radar images illuminate fractures, karst voids, and the far wall of the pillar up to approximately 25 m depth into the rock, with a spatial resolution of <0.5 m. Higher frequency radar improved the image resolution and aided in the interpretation, but at the cost of shallower depth of penetration and extra acquisition effort. Due to the strong contrast in physical properties between the rock and the fracture fluid, fractures with apertures as thin as a 50th of a radar wavelength were imaged. Water-filled fractures with mm-scale aperture and air-filled fractures with cm-scale apertures produce strong reflections at 250 MHz. A strong variation in the reflection amplitude along each fracture is interpreted to represent the variable fracture aperture and the nonplanar fracture structure. Fracture apertures were quantitatively measured, but distinguishing water from air-filled fractures was not possible due to the complex radar wavelet and fracture geometry. Two conjugate fracture sets were imaged. One of these fracture sets dominates the rock mass stability and water inrush challenges throughout the mine. All of the detected voids and a large cave are at the intersection of two fractures, indicating preferential water flow and dissolution along conjugate fracture intersections. Detecting, locating, and characterizing fractures and voids prior to excavation can enable miners to mitigate potential collapse and flood hazards before they occur.
Marchenko redatuming, imaging, and multiple elimination and their mutual relations
Authors: Wapenaar Kees , Brackenhoff Joeri , Dukalski Marcin , Meles Giovanni , Reinicke Christian , Slob Evert , Staring Myrna , Thorbecke Jan , van der Neut Joost , Zhang Lele
Published: May 2021

With the Marchenko method, it is possible to retrieve Green’s functions between virtual sources in the subsurface and receivers at the surface from reflection data at the surface and focusing functions. A macro model of the subsurface is needed to estimate the first arrival; the internal multiples are retrieved entirely from the reflection data. The retrieved Green’s functions form the input for redatuming by multidimensional deconvolution (MDD). The redatumed reflection response is free of internal multiples related to the overburden. Alternatively, the redatumed response can be obtained by applying a second focusing function to the retrieved Green’s functions. This process is called Marchenko redatuming by double focusing. It is more stable and better suited for an adaptive implementation than Marchenko redatuming by MDD, but it does not eliminate the multiples between the target and the overburden. An attractive efficient alternative is plane-wave Marchenko redatuming, which retrieves the responses to a limited number of plane-wave sources at the redatuming level. In all cases, an image of the subsurface can be obtained from the redatumed data, free of the artifacts caused by internal multiples. Another class of Marchenko methods aims at eliminating the internal multiples from the reflection data, while keeping the sources and receivers at the surface. A specific characteristic of this form of multiple elimination is that it predicts and subtracts all orders of internal multiples with the correct amplitude, without needing a macro subsurface model. Like Marchenko redatuming, Marchenko multiple elimination can be implemented as an MDD process, a double dereverberation process, or an efficient plane-wave oriented process. We have systematically examined the different approaches to Marchenko redatuming, imaging, and multiple elimination using a common mathematical framework.
Development and Evaluation of a Real-World Outcomes-Based Tool to Support Informed Clinical Decision Making in the Palliative Treatment of Patients With Metastatic NSCLC
Authors: Cramer-van der Welle Christine M. , Kastelijn Elisabeth A. , Plouvier Bram C. , van Uden-Kraan Cornelia F. , Schramel Franz M. N. H. , Groen Harry J. M. , van de Garde Ewoudt M. W.
Published: May 2021

PURPOSE

To develop and evaluate a tool for patients with stage IV non–small-cell lung cancer and their thoracic oncologists (TOs) that provides insight into real-world effectiveness of systemic treatments to support informed clinical decision making in the palliative setting.

METHODS

A participatory design approach was used to acquire insights from patients and TOs into preferences regarding the content and design of the web-based tool. Implementation was investigated by means of an adoption and usage rate. The appreciation of the tool was evaluated through a telephone survey with patients and a questionnaire for TOs.

RESULTS

From clinical data of 2,989 patients with stage IV non–small-cell lung cancer diagnosed in one of the Santeon hospitals, an interface was developed to show treatments plus both real-world outcomes and clinical trial results after selecting patient characteristics (patients like me). This prototype of the tool was finalized after discussion in a focus group with four TOs and semi-structured interviews with six patients. The tool was implemented and used by TOs in three of six Santeon hospitals (50% adoption rate). The tool was used in 48 patients (29% usage rate), of which 17 participated in the telephone survey. Ten TOs responded to the questionnaire. The responses varied from positive reactions on the clear overview of treatment outcomes to statements that the tool rarely changed treatment decisions. Overall, the majority of patients and TOs scored the tool as of added value (71% and 83%, respectively).

CONCLUSION

Our real-world data tool in metastatic lung cancer was appreciated in clinical practice by both patients and TOs. However, the efficacy of the implementation can be improved.