bluuebunny/crossref_metadata_2025 huggingface dataset:
Late Endograft Migration After Thoracic Endovascular Aortic Repair: A Systematic Review and Meta-analysis
Authors: Skrypnik Denis , Kalmykov Egan , Bischoff Moritz S. , Meisenbacher Katrin , Klotz Rosa , Hagedorn Matthias , Kalkum Eva , Probst Pascal , Dammrau Rolf , Böckler Dittmar
Published: July 2022

Purpose:

The objective of this systematic review was to report the cumulative incidence of endograft migration (EM), as well as the morbidity, reintervention rates, and mortality related to EM. This study aimed to provide evidence-based data on patient-relevant sequelae of EM after thoracic endovascular aortic repair (TEVAR) performed using contemporary aortic endografts.

Materials and Methods:

A systematic electronic search of literature in MEDLINE (via PubMed), Web of Science, and Cochrane Central Register of Controlled Trials was performed. The pooled synthesis of outcomes was performed using the inverse variance method.

Results:

Seven prospective non-randomized and 4 retrospective studies, including a total of 1783 patients presenting 70 EMs, were considered for the quantitative analysis. The pooled rate of EM was 4% (95% CI, 2%–7%; range, 0.2%–11%; I2=82%); pooled morbidity rate was 31% (95% CI, 12%–59%; range, 0%–100%; I2=64%) and pooled reintervention rate was 32% (95% CI, 15%–56%; range, 0%–100%; I2=55%). The pooled mortality rate due to EM was 5% (95% CI, 1%–21%; range, 0%–40%; I2=24%).

Conclusion:

For the first time, this meta-analysis provides pooled reference estimates of EM after TEVAR. Thus, the results hold the potential to further characterize EM after TEVAR. The clinical relevance of EM is underlined by its association with high rates of endoleak-related morbidity, reintervention, and mortality. Close standardized surveillance after TEVAR for early detection of EM and prophylaxis of its sequelae is essential.
No Difference Could Be Detected in Clinical Outcomes of 5-Strand and Quadruple Hamstring Autografts of Similar Diameter in Anterior Cruciate Ligament Reconstruction: A Retrospective Cohort Study
Authors: Ignozzi Anthony J. , Moran Thomas E. , Werner Brian C.
Published: July 2022

Background: There are few studies examining the clinical outcomes of 5-strand autografts in anterior cruciate ligament reconstruction (ACL-R). Purpose: We aimed to compare the clinical outcomes of ACL-R using 5-strand (5HS) and 4-strand (4HS) hamstring autografts of similar graft diameter to study the potential effects of autograft strand number on clinical outcomes. Methods: Patients who underwent ACL-R from 2013 to 2018 at a single academic institution and received a 4HS or 5HS autograft were included. Exclusion criteria were less than 2-year follow-up and any additional ligamentous reconstruction. Revision ACL-R and cyclops lesions were assessed at a minimum 2 years of postoperative follow-up. Objective measures of ability to return to sport were assessed at 6 months. Results: The mean graft diameters for 4HS (n = 51) and 5HS (n = 23) autografts were 8.3 ± 0.7 mm and 8.4 ± 0.7 mm, respectively. The mean follow-up for the 4HS and 5HS cohorts was 3.0 ± 1.5 years and 3.3 ± 1.3 years, respectively. The 4HS and 5HS cohorts had revision ACL-R rates of 15.7% (8/51) and 8.7% (2/23), respectively. Cyclops lesions occurred in 5.9% of 4HS patients and 13.0% of 5HS patients. We found no statistically significant differences between groups on objective measures of ability to return to sport. Conclusion: This retrospective cohort study detected no difference in revision ACL-R rates, frequency of cyclops lesions, or objective measures of ability to return to sport in patients who received 4HS or 5HS autografts of similar diameter for ACL-R. Further comparative study with larger sample sizes is warranted.
Chained Animation: Collaborative Forms of Filmmaking in Education
Authors: Hagler Juergen , Rauscher Remo
Published: July 2022

This article discusses experimental forms of collaborative filmmaking in education and introduces the pedagogical concept of Chained Animation. Animation filmmaking usually involves teamwork; production pipelines are traditionally linear and hierarchically structured, separated into direction (or artistic direction) and production teams. By contrast, Chained Animations are non-linear and based on a large group of animators working together at various levels. This concept is particularly well suited to education as it integrates all participants equally, from the idea phase all the way through to its realization. In addition to teaching basic animation principles, this experimental form of education goes beyond established methods of practising those principles. The educational concepts for Chained Animations follow different strategies and range from professional workflows to playful, experimental forms that emphasize participatory and collaborative aspects within large groups. In this article, the authors first examine participatory art practices; then they discuss experimental forms of collaboration in animation and education, using examples from art, film and science. This article examines different experimental approaches, challenges and findings, which are based on three case studies undertaken at the University of Applied Sciences Upper Austria, Hagenberg Campus – Home (2016), Utopia Now (2017) and Draft One (2018) – ultimately presenting guidelines for Chained Animation in education.
Virtual Production and the Transformation of Cameras Mechanical, Virtual, and Actual
Authors: Bédard Philippe
Published: July 2022

This article examines the rising importance of ‘virtual production’ by focusing on one of its core components, the so-called ‘virtual camera’. Using the virtual camera as a focal point, the author highlights how a particular industrial model of film production has changed in response to the transformations brought about by digital technologies. More specifically, this article uses the notion of ‘virtualization’ introduced by Pierre Lévy in Becoming Virtual: Reality in the Digital Age (1998) to offer a unique point of view on films ‘shot’ with cameras that are ultimately all but virtual. Here, The Lion King (2019) serves as a prime example of virtual production, in general, and of the transformation undergone by the camera, in particular.
Discourses about independence: A corpus-based analysis of discourse prosodies in Spanish and Catalan newspapers
Authors: Giugliano Marcello
Published: July 2022

The present study is a corpus-assisted analysis of discourses on the Catalan movement of independence in the Catalan and Spanish press. A referendum for Catalan independence was held on 1 October 2017 but was not approved by the central Spanish government and was declared illegal. Spanish and Catalan newspapers differed considerably in their treatment and representation of the conflict, which also drew the attention of the international press to Catalonia. My analysis interconnects theoretical perspectives from linguistic critical discourse studies, cognitive linguistics, and media studies. The methodology is based on the analysis of two comparable corpora of journalistic texts (in Catalan, Spanish). My aim is to identify and compare different features of the semantic prosody of words describing the event of geopolitical separation and the different narratives on this sociopolitical conflict that these prosodies contribute to producing. More specifically, I focus on a selection of keywords, like independence, secession, and sovereignty, that seem to be indicative of different discursive strategies consciously, and possibly unconsciously, chosen by a selection of national Catalan and Spanish newspapers. By carrying out a contrastive analysis of the two corpora, I am able to describe certain similarities, like the similar frequent use of the word independence, and differences, like the more frequent use of the word secession in the Spanish corpus, that indicate different framings of the same event and can be related to different ideological positionings against or in favor of Catalonia’s independence from Spain.
Cabozantinib for the treatment of solid tumors: a systematic review
Authors: Maroto Pablo , Porta Camillo , Capdevila Jaume , Apolo Andrea B. , Viteri Santiago , Rodriguez-Antona Cristina , Martin Lidia , Castellano Daniel
Published: July 2022

Background:

Cabozantinib is approved, in various settings, for the treatment of renal cell carcinoma, medullary thyroid cancer, and hepatocellular carcinoma, and it has been investigated for the treatment of other cancers. With the available evidence and the real-world performance of cabozantinib compared with clinical trial data, we performed a systematic review of cabozantinib monotherapy as treatment for solid tumors in adults.

Methods:

This study was designed in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses and registered with PROSPERO (CRD42020144680). We searched for clinical and observational studies of cabozantinib monotherapy for solid tumors using Embase, MEDLINE, and Cochrane databases (October 2020), and screened relevant congress abstracts. Eligible studies reported clinical or safety outcomes, or biomarker data. Small studies ( n < 25) and studies of cabozantinib combination therapies were excluded. Quality was assessed using National Institute for Health and Care Excellence methodology, and study characteristics were described qualitatively.

Results:

Of 2888 citations, 114 were included (52 randomized studies, 29 observational studies, 32 nonrandomized phase I or II studies or pilot trials, and 1 analysis of data from a randomized study and a nonrandomized study). Beyond approved indications, other tumors studied were castration-resistant prostate cancer, urothelial carcinoma, Ewing sarcoma, osteosarcoma, uveal melanoma, non-small-cell lung cancer, Merkel cell carcinoma, glioblastoma, pheochromocytomas and paragangliomas, cholangiocarcinoma, gastrointestinal stromal tumor, colorectal cancer, salivary gland cancer, carcinoid and pancreatic neuroendocrine tumors, and breast, endometrial and ovarian cancers. The most common adverse events were hypertension, diarrhea, and fatigue.

Conclusion:

The identified evidence demonstrates the positive efficacy/effectiveness of cabozantinib monotherapy in various solid tumor types, with safety findings being consistent with those observed with other VEGFR-targeting tyrosine kinase inhibitors. When available, real-world findings were consistent with the data reported from clinical trials. A limitation of this review is the high proportion of abstracts; however, this allowed us to capture the most up-to-date findings.
Who Sociology Is
Authors: Borchard Kurt
Published: July 2022

C. Wright Mills said developing a sociological imagination meant considering the link between history and biography. Drawing stylistically from David Markson’s This is Not a Novel, this textual experiment presents biographical fragments without a coherent narrative or clear purpose. Questions that might emerge: how is sociology related to its creators and practitioners’ biographies? How do details on individual sickness, mortality, and character affect an understanding of others and the self? How might biographical fragments compel reading, pauses, and further reading? Who counts as part of a field, and why? What effect does sequence have on information? Whose contributions, and/or lives, are valorized, remembered, marginalized, or forgotten? What do people say, and what do they do? How does the selection, representation, and categorization of sociologist’s biographical and demographic details, and life histories (key elements in sociological research), help re-imagine those concerned with generalizing about others?
A 40-Year-Old Woman With COVID-19 and Bilateral Vision Loss
Authors: Jain Varun , Senetar Alexander J. , Maciel Carolina B , Remley William , Islam Shehla , Fredenburg Kristianna M. , Babi Marc A , Robinson Christopher P.
Published: July 2022

Mucormycosis is a fast-spreading angioinvasive fungal infection with a very high mortality rate. It is associated with immunodeficiency, diabetes mellitus, iron overload, stem cell transplantation and the use of steroids. As cultures and histopathological biopsy may have low yield in invasive fungal infections, new generation sequencing of cfDNA (cell free deoxyribonucleic acid) has become a cornerstone for diagnosis. Over the past 18 months, increasing reports of COVID-19 associated Mucormycosis have emerged, most specifically in India and other nearby developing countries. Awareness and knowledge of this newly discovered association is of high importance and clinical relevance as the global COVID-19 pandemic continues. Herein, we present a case of a patient who was treated with steroids for COVID-19 in the outpatient setting and presented with unilateral periorbital pain and blurry vision. She progressively developed bilateral vision loss, fixed bilateral mydriasis, ophthalmoplegia and coma. Imaging findings included leptomeningeal, vascular, and subcortical enhancement accompanied with multifocal infarction. Subsequent biopsy of the paranasal sinuses revealed broad type fungal elements and cfDNA sequencing identified the pathogen as Rhizopus species. She was treated with intravenous amphotericin B, but succumbed to the infection.
Ethnicity, Social Determinants of Health, and Pediatric Primary Care During the COVID-19 Pandemic
Authors: David Pyone , Fracci Sarah , Wojtowicz Jennifer , McCune Erin , Sullivan Katyln , Sigman Garry , O’Keefe Julie , Qureshi Nadia K.
Published: July 2022

This study assessed the relationship between ethnicity, social determinants of health (SDH), and measures of health outcomes for children during the COVID-19 pandemic. This retrospective study reviewed electronic medical records of 1234 in-person well child visits (WCVs for age <18 years) at a single academic primary care clinic in a Chicago suburb for the results of SDH screening in the domains of food, financial, and transportation insecurity. The association between ethnicity, unmet SDH domains, routine medical care delay, vaccine delays, and utilization of acute and emergency department (ED) visits were evaluated. Patients with unmet SDH were more likely to be non-White ( P < .001), ≥3 years of age ( P < .001) and have Medicaid coverage ( P < .001). Unmet social needs were also associated with more acute visits ( P < .001), ED visits ( P < .001), and WCV delays ( P < .001). The results suggest that the COVID-19 pandemic has disproportionately affected patients with unmet SDH in obtaining routine pediatric well child care.
Bilateral Cerebral Infarctions Secondary to Unilateral ICA Stenosis
Authors: Gupta Dhananjay , Sharma Karan , Thakkar Dhaval , Jain Nishchint , Parthasarathy Rajsrinivas , Gupta Vipul
Published: July 2022

A 76-year-old diabetic man presented to us with complaints of sudden-onset right-sided weakness for the last 4 days. On evaluation, he was found to have right hemiparesis (Modified Medical Research Council grade 4-/5) along with left leg weakness (4+/5). Neuroimaging revealed acute infarcts in the right anterior cerebral artery (ACA) territory and left cerebral external watershed territory. Magnetic resonance (MR) angiogram of the brain showed a hypoplastic right A1-ACA with bilateral A2-ACA arising from the left A1-ACA (bi-hemispheric A1-ACA). MR angiogram of the neck revealed significant left internal carotid artery (ICA) origin stenosis. It was concluded that the origin of right A2-ACA from left ACA was the probable because of right ACA infarcts, along with left cerebral watershed infarcts (embolic phenomenon). This represents a very important variation, as in these cases, even a unilateral ICA stenosis can lead to bilateral ACA stroke and thus necessitates urgent revascularization.
Complications of Pediatric Mandibular Distraction Osteogenesis Hardware: A 10-Year Retrospective Analysis of the Food and Drug Administration Manufacturer and User Facility Device Experience Database
Authors: Jinka Sanjay K.A. , Coombs Demetrius M. , Murthy Ananth S.
Published: July 2022

Background:

The United States Food and Drug Administration’s (FDA) Manufacturer and User Facility Device Experience (MAUDE) database provides access to device related adverse event reports. This database mandates national reporting of complications that lead to “death and serious injury” by manufacturers, importers, and device user facilities. This study used MAUDE to conduct post-market surveillance of pediatric mandibular distraction osteogenesis (MDO) hardware.

Methods:

A MAUDE database search with terms related to mandibular distraction was performed for report dates between October 1st, 2011, and October 1st, 2021. Duplicate reports, reports from literature reviews, and vague reports were removed. Manufacturers were contacted to establish which devices were pediatric-use-only. Adult-use and mixed-use devices were excluded. Each remaining report was manually reviewed/categorized to compile summative data.

Results:

Seventy pediatric-use-only device reports were identified. The damaged/non-functioning part of the device included the distractor itself (57.14% of reports), footplate(s) (37.14%), or screw(s) (5.71%). Intraoperative and postoperative complications made up 15.71% and 84.29% of reports, respectively. Twenty percent of complications occurred during the activation phase and 1.43% occurred during device removal. The most common report was failure of the device to advance (37.14% of total complications). Some form of operative treatment or explantation was performed for 51.43% and 34.29% of complications, respectively. External distractors and related hardware made up 8.6% of reports and the most common complication in this group was the screw backing out at 33.3% of all reports.

Conclusions:

The MAUDE database is a useful tool in evaluation of MDO device-related incidents. Most complications occur in the postoperative period, during the distraction phase, and often require device removal. The most common complication in external distractors was screws backing out. Mindful activation of the distractor, careful device/screw handling, technical improvement of the devices, and thorough preoperative planning may minimize these untoward events.
Transformer Networks and Their Real-World Business Applications
Authors: Gupta Divam , Gupta Param , Goyal Medha
Published: July 2022

Recent advances in deep learning models have presented many opportunities for businesses. This article focuses on the possible game changing development of transformer networks which have enabled self-supervised learning. These advances provide encouraging opportunities for business applications. The article discusses the different types of learning paradigms and the similarities and dissimilarities between them. The article also discusses how transformer networks enable self-supervised learning. The article finally discusses real-life business applications with data from text, audio and images.
Crystal chemistry and Raman spectroscopy study of bennesherite, Ba2Fe2+Si2O7, and rare accessory Ba minerals from Caspar quarry, Bellerberg volcano, Germany
Authors: Juroszek Rafał , Ternes Bernd
Published: July 2022

Barium melilite – bennesherite, Ba2Fe2+Si2O7, known only from pyrometamorphic rocks of the Hatrurim Complex in Israel, has been recognised in a carbonate–silicate xenolith from the Bellerberg volcano area in Germany. The empirical formula of the German specimen is as follows: (Ba1.32Ca0.43Sr0.23Na0.05K0.02)Σ2.05(Fe2+0.79Ti0.06Mg0.05Al0.04Mn0.03Zn0.01)Σ0.98Si1.97O7. The Raman spectrum of bennesherite exhibits the presence of the main vibrations related to Fe2+O4 tetrahedra and disilicate Si2O7 groups at the T1 and T2 sites, at 589 cm–1 and in the range 618–673 cm–1, respectively. Detailed spectroscopic analyses performed for bennesherite in two different and random orientations confirm the reduction of bands intensity and the number of some components in several spectral ranges. Moreover, the presence of a heavy Ba atom indicates a decrease in band frequencies compared to melilites with Ca at the X position. A single-crystal X-ray diffraction experiment, despite attempts, could not be carried out due to the poor quality and small size of the bennesherite crystals however, a combination of composition and Raman data allowed for accurate phase identification. Detailed mineralogical investigations distinguished rare Ba minerals in association with bennesherite, such as walstromite, fresnoite and celsian, along with various ferrous melilites. Some of the detected phases are described from xenoliths of the Bellerberg volcano for the first time. The uniqueness of the Bellerberg volcano mineralisation is reflected in the interaction of alkaline magma with xenoliths of different compositions, which suggests that this locality still deserves attention as a source of new and unique minerals.
Reference equations for oscillometry and their differences among populations: a systematic scoping review
Authors: Deprato Andy , Ferrara Giovanni , Bhutani Mohit , Melenka Lyle , Murgia Nicola , Usmani Omar S. , Lacy Paige , Moitra Subhabrata
Published: July 2022

Respiratory oscillometry is gaining global attention over traditional pulmonary function tests for its sensitivity in detecting small airway obstructions. However, its use in clinical settings as a diagnostic tool is limited because oscillometry lacks globally accepted reference values. In this scoping review, we systematically assessed the differences between selected oscillometric reference equations with the hypothesis that significant heterogeneity existed between them. We searched bibliographic databases, registries and references for studies that developed equations for healthy adult populations according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A widely used Caucasian model was used as the standard reference and compared against other models using Bland–Altman and Lin's concordance correlational analyses. We screened 1202 titles and abstracts, and after a full-text review of 67 studies, we included 10 in our analyses. Of these, three models had a low-to-moderate agreement with the reference model, particularly those developed from non-Caucasian populations. Although the other six models had a moderate-to-high agreement with the standard model, there were still significant sex-specific variations. This is the first systematic analysis of the heterogeneity between oscillometric reference models and warrants the validation of appropriate equations in clinical applications of oscillometry to avoid diagnostic errors.
Impact of pulmonary embolism response teams on acute pulmonary embolism: a systematic review and meta-analysis
Authors: Fleitas Sosa Derlis , Lehr Andrew L. , Zhao Huaqing , Roth Stephanie , Lakhther Vlad , Bashir Riyaz , Cohen Gary , Panaro Joseph , Maldonado Thomas S. , Horowitz James , Amoroso Nancy E. , Criner Gerard J. , Brosnahan Shari B. , Rali Parth
Published: July 2022

Background

The impact of pulmonary embolism response teams (PERTs) on treatment choice and outcomes of patients with acute pulmonary embolism (PE) is still uncertain.

Objective

To determine the effect of PERTs in the management and outcomes of patients with PE.

Methods

PubMed, Embase, Web of Science, CINAHL, WorldWideScience and MedRxiv were searched for original articles reporting PERT patient outcomes from 2009. Data were analysed using a random effects model.

Results

16 studies comprising 3827 PERT patients and 3967 controls met inclusion criteria. The PERT group had more patients with intermediate and high-risk PE (66.2%) compared to the control group (48.5%). Meta-analysis demonstrated an increased risk of catheter-directed interventions, systemic thrombolysis and surgical embolectomy (odds ratio (OR) 2.10, 95% confidence interval (CI) 1.74–2.53; p<0.01), similar bleeding complications (OR 1.10, 95% CI 0.88–1.37) and decreased utilisation of inferior vena cava (IVC) filters (OR 0.71, 95% CI 0.58–0.88; p<0.01) in the PERT group. Furthermore, there was a nonsignificant trend towards decreased mortality (OR 0.87, 95% CI 0.71–1.07; p=0.19) with PERTs.

Conclusions

The PERT group showed an increased use of advanced therapies and a decreased utilisation of IVC filters. This was not associated with increased bleeding. Despite comprising more severe PE patients, there was a trend towards lower mortality in the PERT group.
Recent advances in the management of pulmonary hypertension with interstitial lung disease
Authors: Waxman Aaron B. , Elia Davide , Adir Yochai , Humbert Marc , Harari Sergio
Published: July 2022

Pulmonary hypertension (PH) is known to complicate various forms of interstitial lung disease (ILD), including idiopathic pulmonary fibrosis, the interstitial pneumonias and chronic hypersensitivity pneumonitis. Pathogenesis of PH-ILD remains incompletely understood, and probably has overlap with other forms of pre-capillary pulmonary hypertension. PH-ILD carries a poor prognosis, and is associated with increased oxygen requirements, and a decline in functional capacity and exercise tolerance. Despite most patients having mild–moderate pulmonary hypertension, more severe pulmonary hypertension and signs of right heart failure are observed in a subset of cases. Clinical suspicion and findings on pulmonary function, computed tomography and echocardiography are often the initial steps towards diagnosis. Definitive diagnosis is obtained by right heart catheterisation demonstrating pre-capillary pulmonary hypertension. Drugs approved for pulmonary arterial hypertension have been investigated in several randomised controlled trials in PH-ILD patients, leading to discouraging results until the recent INCREASE study. This review provides an overview of the current understanding, approach to diagnosis and recent advances in treatment.
scDLC: a deep learning framework to classify large sample single-cell RNA-seq data
Authors: Zhou Yan , Peng Minjiao , Yang Bin , Tong Tiejun , Zhang Baoxue , Tang Niansheng
Published: July 2022

Background

Using single-cell RNA sequencing (scRNA-seq) data to diagnose disease is an effective technique in medical research. Several statistical methods have been developed for the classification of RNA sequencing (RNA-seq) data, including, for example, Poisson linear discriminant analysis (PLDA), negative binomial linear discriminant analysis (NBLDA), and zero-inflated Poisson logistic discriminant analysis (ZIPLDA). Nevertheless, few existing methods perform well for large sample scRNA-seq data, in particular when the distribution assumption is also violated.

Results

We propose a deep learning classifier (scDLC) for large sample scRNA-seq data, based on the long short-term memory recurrent neural networks (LSTMs). Our new scDLC does not require a prior knowledge on the data distribution, but instead, it takes into account the dependency of the most outstanding feature genes in the LSTMs model. LSTMs is a special recurrent neural network, which can learn long-term dependencies of a sequence.

Conclusions

Simulation studies show that our new scDLC performs consistently better than the existing methods in a wide range of settings with large sample sizes. Four real scRNA-seq datasets are also analyzed, and they coincide with the simulation results that our new scDLC always performs the best. The code named “scDLC” is publicly available at https://github.com/scDLC-code/code.
Spatial correction improves accuracy of catheter positioning during ablation of premature ventricular contractions: differences between ventricular outflow tracts and other localizations
Authors: Nies M. , Schleberger R. , Dinshaw L. , Klatt N. , Muenkler P. , Jungen C. , Rottner L. , Lemoine M. D. , Reißmann B. , Rillig A. , Metzner A. , Kirchhof P. , Meyer C.
Published: July 2022

Background

Hybrid activation mapping is a novel tool to correct for spatial displacement of the mapping catheter due to asymmetrical contraction of myocardium during premature ventricular contractions (PVC). The aim of this study is to describe and improve our understanding of spatial displacement during PVC mapping as well as options for correction using hybrid activation mapping.

Methods and results

We analyzed 5798 hybrid mapping points in 40 acquired hybrid maps of 22 consecutive patients (age 63 ± 16 years, 45% female) treated for premature ventricular contractions (PVCs). Median PVC-coupling interval was 552 ms (IQR 83 ms). Spatial displacement was determined by measuring the dislocation of the catheter tip during PVC compared to the preceding sinus beat. Mean spatial displacement was 3.8 ± 1.5 mm for all maps. The displacement was 1.3 ± 0.4 mm larger for PVCs with non-outflow-tract origin compared to PVCs originating from the ventricular outflow tracts (RVOT/LVOT; p = 0.045). Demographic parameters, PVC-coupling-interval and chamber of origin had no significant influence on the extent of spatial displacement.

Conclusion

Ectopic activation of the ventricular myocardium during PVCs results in spatial displacement of mapping points that is significantly larger for PVCs with non-outflow-tract origin. The correction for spatial displacement may improve accuracy of radiofrequency current (RFC)-application in catheter ablation of PVCs.
Barriers and facilitators for therapeutic drug monitoring of beta-lactams and ciprofloxacin in the ICU: a nationwide cross-sectional study
Authors: Ewoldt Tim M. J. , Abdulla Alan , van den Broek Puck , Hunfeld Nicole , Bahmany Soma , Muller Anouk E. , Gommers Diederik , Polinder Suzanne , Endeman Henrik , Spronk Inge , Koch Birgit C. P.
Published: July 2022

Background

Recent studies demonstrated that failure of achieving pharmacodynamic targets of commonly used antibiotics is common in critically ill patients. Therapeutic drug monitoring (TDM) can contribute to optimize the exposure of beta-lactams and ciprofloxacin. While evidence for TDM of these antibiotics is growing, translation into clinical implementation remains limited. Therefore, perceived barriers and facilitators are important for implementing TDM in this population. The primary aim of this study was to identify healthcare professionals’ barriers and facilitators for the implementation of TDM of beta-lactams and ciprofloxacin in Dutch intensive care units (ICU).

Methods

We conducted a nationwide cross-sectional online survey among healthcare professionals (HCPs) involved in antibiotic treatment of ICU patients. An adapted version of the Measurement Instrument for Determinants of Innovations was sent out. Items were considered barriers when ≥ 20% of participants responded with a negative answer. If ≥ 80% of the participants responded with a positive answer, the item was considered a facilitator.

Results

Sixty-four HCPs completed the survey, of which 14 were from academic hospitals, 25 from general hospitals, and 25 from teaching hospitals. Most participants were hospital pharmacists (59%) or medical specialists (23%). Eleven barriers and four facilitators for implementation of TDM of beta-lactams were identified; 17 barriers for TDM of ciprofloxacin and no facilitators. The most important barriers were a lack of conclusive evidence, organizational support, and low availability of assays. Additional barriers were a lack of consensus on which specific patients to apply TDM and which pharmacodynamic targets to use. Identified facilitators for beta-lactam TDM implementation are low complexity and high task perception, combined with the perception that TDM is important to prevent side effects and to adequately treat infections. Twenty-eight percent of participants reported that flucloxacillin could be analyzed in their hospital. Assay availability of other beta-lactams and ciprofloxacin was lower (3–17%).

Conclusion

Several barriers were identified that could obstruct the implementation of TDM of beta-lactams and ciprofloxacin in the ICU. In particular, education, clear guidelines, and organizational support should be considered when creating tailored implementation strategies. Finally, evidence of beneficial clinical outcomes on TDM of beta-lactams and ciprofloxacin can enhance further implementation.
Risk factors influencing cerebral venous infarction after meningioma resection
Authors: Cai Qing , Wang Shoujie , Zheng Min , Wang Xuejiao , Liu Rong , Liu Liqin , Qin Huaizhou , Feng Dayun
Published: July 2022

Background

Cerebral venous infarction (CVI) is a serious complication after meningioma resection. The risk factors of postoperative cerebral venous infarction after surgical resection of meningioma can be determined through large samples and this study can add evidence to the literature.

Methods

The clinical and imaging data of 1127 patients with intracranial meningiomas who underwent resection in our hospital were retrospectively collected and analyzed. CVI was evaluated by postoperative imaging and clinical manifestations. Univariate and multivariate analyses were performed to identify risk factors associated with CVI.

Results

Overall, 4.7% (53/1127) of patients experienced CVI after meningioma resection. Multivariate analysis revealed superficial meningioma, moderate to severe peritumoral edema, peritumoral critical vein and WHO grade II-III as independent predictors of a postoperative CVI. After timely intervention, the symptoms were clearly alleviated in one month, and the prognosis was good, but injury to key veins could cause irreversible neurological disorders.

Conclusions

Intraoperative protection of veins is the primary way to prevent CVI. The present study identified several significant and independent risk factors for postoperative venous infarction, thereby enabling the identification of high-risk patients who require special attention during clinical and surgical management.
Changes in prenatal care and vaccine willingness among pregnant women during the COVID-19 pandemic
Authors: Erchick Daniel J. , Agarwal Smisha , Kaysin Alexander , Gibson Dustin G. , Labrique Alain B.
Published: July 2022

Introduction

Concerns about SARS-CoV-2 infection risk in health care settings have resulted in changes in prenatal care and birth plans, such as shifts to in-person visits and increased Cesarean delivery. These changes may affect quality of care and limit opportunities for clinicians to counsel pregnant individuals, who are at higher risk of severe COVID-19 disease and adverse pregnancy outcomes, about prevention and vaccination.

Methods

We conducted a cross-sectional online survey of United States adults on changes in prenatal care, COVID-19 vaccine willingness, and reasons for unwillingness to receive a vaccine. We summarized changes in access to care and examined differences in vaccine willingness between pregnant and propensity-score matched non-pregnant controls using chi-squared tests and multivariable conditional logistic regression.

Results

Between December 15–23, 2020, 8481 participants completed the survey, of which 233 were pregnant. Three-quarters of pregnant women (n = 186) experienced a change in prenatal care, including format of care (n = 84, 35%) and reduced visits (n = 69, 24%). Two-thirds experienced a change in birth plans, from a hospital birth to home birth (n = 45, 18%) or vaginal birth to a Cesarean delivery (n = 42, 17%). Although 40% of pregnant women (n = 78) were unwilling to receive COVID-19 vaccination, they had higher, though non-significant, odds of reporting willingness to receive vaccination compared to similar non-pregnant women (aOR 1.38, 95% CI: 0.95, 2.00).

Conclusion

To support pregnant women through the perinatal care continuum, maternity care teams should develop protocols to foster social support, patient-centered education around infection prevention that focuses on improved risk perception, expected changes in care due to COVID-19, and vaccine effectiveness and safety.
Recovery and the use of postoperative physical therapy after total hip or knee replacement
Authors: Groot L. , Latijnhouwers D. A. J. M. , Reijman M. , Verdegaal S. H. M. , Vliet Vlieland T. P. M. , Gademan M. G. J. ,   on behalf of the Longitudinal Leiden Orthopaedics Outcomes of Osteoarthritis Study (LOAS) Group, Nelissen R. G. H. H. , van der Linden H. M. J. , Kaptein B. L. , Damen P. J. , Kaptijn H. H. , Vehmeijer S. B. W. , Marijnissen W. J. C. M. , Onstenk R.
Published: July 2022

Background

Total hip or knee arthroplasties (THA/TKA) show favorable long-term effects, yet the recovery process may take weeks to months. Physical therapy (PT) following discharge from hospital is an effective intervention to enhance this recovery process. To investigate the relation between recovery and postoperative PT usage, including the presence of comorbidities, 6 months after THA/TKA.

Methods

Multicenter, observational study in primary THA/TKA patients who completed preoperative and 6 months postoperative assessments. The assessments included questions on PT use (yes/no and duration; long term use defined as ≥ 12 weeks), comorbidities (musculoskeletal, non-musculoskeletal, sensory comorbidities and frequency of comorbidities). Recovery was assessed with the HOOS/KOOS on all 5 subdomains. Logistic regression with long term PT as outcome was performed adjusted for confounding including an interaction term (comorbidity*HOOS/KOOS-subdomain).

Results

In total, 1289 THA and 1333 TKA patients were included, of whom 95% received postoperative PT, 56% and 67% received postoperative PT ≥ 12 weeks respectively. In both THA and TKA group, less improvement on all HOOS/KOOS domain scores was associated with ≥ 12 weeks of postoperative PT (range Odds Ratios 0.97–0.99). In the THA group the impact of recovery was smaller in patient with comorbidities as non- musculoskeletal comorbidities modified all associations between recovery and postoperative PT duration (Odds Ratios range 1.01–1.05). Musculoskeletal comorbidities modified the associations between Function-in-Daily-Living-and Sport-and-recreation recovery and postoperative PT. Sensory comorbidities only had an effect on Sport-and-recreation recovery and postoperative PT. Also the frequency of comorbidities modified the relation between Function-in-Daily-Living, pain and symptoms recovery and postoperative PT. In the TKA group comorbidity did not modify the associations.

Conclusion

Worse recovery was associated with longer duration of postoperative PT suggesting that PT provision is in line with patients’ needs. The impact of physical recovery on the use of long-term postoperative PT was smaller in THA patients with comorbidities.

Trial registration

Registered in the Dutch Trial Registry on March 13, 2012. TRIAL ID NTR3348; registration number: P12.047. https://www.trialregister.nl/trial/3197.
Effect of vitamin B6 on pain, disease severity, and psychological profile of fibromyalgia patients; a randomized, double-blinded clinical trial
Authors: Ghavidel-Parsa Banafsheh , Naeimi Arvin , Gharibpoor Faeze , Sattari Nazila , Jafari Atefeh , Masooleh Irandokht Shenavar , Montazeri Ali
Published: July 2022

Background

Given the role of vitamin B6 on pronociceptive/antinociceptive neurotransmitters balance, metabolic reactions, and inflammation, it is important to clarify the effect of vitamin B6 on pain and psychological disturbance in fibromyalgia (FM). This study aimed to evaluate whether an 80-mg daily dose of vitamin B6 improves pain, disease severity and psychological symptoms of FM compared to a placebo.

Methods

This randomized, double-blinded, placebo-controlled trial was performed on the FM patients whose diagnosis was confirmed by a rheumatologist based on the 2016 American College of Rheumatology (ACR). 90 Patients were randomized to receive either vitamin B6 (80 mg daily) or placebo in a 1:1 ratio, with a permuted block size of 30 stratified by disease severity. Primary outcomes included the Revised Fibromyalgia Impact Questionnaire (FIQR), Hospital Anxiety and Depression Scale (HADS), 12-item short-form health survey (SF-12), and pain visual analog scale (pain-VAS)). The mean differences in outcomes (before and after treatment) were compared between the vitamin B6 and placebo groups using an independent T-test. An ANCOVA model adjusted for baseline outcome value was also provided to compare the outcomes between the two groups.

Results

Of 90 eligible patients, 60 patients (31 patients in vitamin B6 and 29 in the placebo group) completed the trial. Overall, the FIQR, pain-VAS, and HADS-anxiety scores improved after treatment in both vitamin B6 and placebo groups; However, there was no statistically significant intergroup difference regarding primary outcomes. ANCOVA model also showed no difference in the treatment effects.

Conclusions

Our results showed no priority for vitamin B6 over placebo in FM patients. Considering the potential ameliorating role of vitamin B6 on pain and psychological symptoms, acknowledgment of vitamin B6 as a relatively safe adjuvant treatment needs larger future studies.

Trial registration

Iranian Registry of Clinical Trials:IRCT20200920048782N2on 2021/10/04.
Improving the communication skills of medical students ——A survey of simulated patient-based learning in Chinese medical universities
Authors: Ge Yurong , Takeda Yuko , Liang Peifeng , Xia Shilin , Nealy Marcellus , Muranaka Yoko , Sun Shishu , Okada Takao
Published: July 2022

Background

It is useful to advance simulated patient (SP) participation in teaching to improve the communication skills of medical students, so this study aims to explore the current state of Chinese mainland SP education.

Methods

A cross sectional survey was designed utilizing well defined quantitative research methods and descriptive statistics. The questionnaire sought information which elucidated the current status of SP-based education, the origin of SP-based learning, SP training, challenges of this learning strategy and future developments. Questionnaires were distributed to 79 medical colleges in mainland China, and 68 were returned. Of these, 64 constituted valid responses (81%).

Results

The number of SP-based education activities in medical colleges offering 5-year、7-year and 8-year clinical medicine programs was significantly higher than that in medical colleges which offered only a single 5-year program (p < 0.01). Communication skills training accounted for 73% of the content of SP-based learning activities, and was expected to rise in the future to 90%, in response to a need to improve doctor-patient relationships. Persons recruited as ‘simulated patients’ included students (21% of the total), residents (49%), medical staff (15%) and teaching staff (14%).

Colleges, planning a SP-based education program, preferred teachers (80%) and students (55%) to assume ‘simulated patient’ roles. In objective structured clinical education (OSCE) scenarios, co-scoring by both SPs and teachers featured more highly in the ‘consultation’ station and ‘doctor-patient communication’ station. A number of factors were identified as hindering future development and implementation of SP-based learning including budget restraints, SP selection and training.

Conclusions

SP-based learning programs offer clear benefits for improving the clinical education of medical students and their communication skills. The main obstacles to achieving more widespread and higher quality SP-based education are insufficient funding and the lack of standardized training and performance evaluation processes for simulated patients. Medical colleges should consider reducing the proportion of students and teachers acting as SPs, and attract more citizens to participate in SP-based learning activities. Formalised training and evaluation of SPs performance are necessary to establish a ‘standard simulated patient’ for a particular medical discipline, thus improving SP-based activities and student learning.
Cost-effectiveness of medical migration for chronic kidney disease: a national cross-sectional study in China
Authors: Ao Yumeng , Yang Chao , Li Pengfei , Wang Fulin , Peng Suyuan , Wang Huai-Yu , Wang Jinwei , Zhao Ming-Hui , Zhang Luxia , Yuan Ye , Qin Xuezheng
Published: July 2022

Background

The phenomenon of medical migration is common in China. Due to the limited capacity and substantial geographical variation in medical practice, patients with chronic kidney disease (CKD) travel more frequently to seek medical care. We aimed to assess the cost-effectiveness of medical migration for CKD patients in China and provide real-world evidence for the allocation of CKD resources.

Methods

Records of patients with CKD between January 2014 and December 2018 were extracted from a large national database. A patient is defined as a medical migrant if she travelled across the provincial border to a non-residential province to be admitted for inpatient care. The propensity score matching method is used to estimate the effect of medical migration on medical expenditure, length of hospital stay, and in-hospital mortality. The cost-effectiveness is evaluated by comparing the estimated cost per life saved with contemporaneous estimates of the value of a statistical life.

Results

Among 4,392,650 hospitalizations with CKD, medical migrants accounted for 4.9% in 2018. Migrant patients were estimated to incur a 26.35% increase in total medical expenditure, experience a 0.24-percentage-points reduction in in-hospital mortality rates, and a 0.49-days reduction in length of hospital stay compared to non-migrant patients. Overall, medical migration among CKD patients incurred an average of 1 million yuan per life saved, which accounted for 20–40% of contemporaneous estimates of the value of a statistical life. Compared with migrant patients with self-payment and commercial insurance, migrant patients with public health insurance (urban basic medical insurance and new rural co-operative medical care) incurred lower cost per life saved. Cost per life saved for CKD patients was similar between female and male, lower among older population, and varied substantially across regions.

Conclusions

The medical care seeking behaviors of CKD patients was prominent and medical resources of kidney care were unevenly allocated across regions. Medical migration led to a reduction in mortality, but was associated with higher medical expenditure. It is imperative to reduce the regional disparity of medical resources and improve the clinical capacity. Our study shows that it is imperative to prioritize resource allocation toward improving kidney health and regional health care planning.