bluuebunny/crossref_metadata_2025_split huggingface dataset:
Responsiveness and clinically important differences of the Western Ontario Rotator Cuff (WORC) Index in surgical and non-surgical treatment groups with different follow-up periods: A systematic review and meta-analysis
Authors: Farzad Maryam , Jafari Hassan , MacDermid Joy C , Ataeian Milad 
Published: August 2024

Background This study reviews and meta-analyzes the responsiveness and minimal clinically important difference (MCID) of the Western Ontario Rotator Cuff (WORC) Index for various patient populations and treatment durations. Methods A comprehensive search in PubMed, Embase, Web of Science, and CINAHL identified studies on the responsiveness or MCID of the WORC in shoulder conditions. Two authors independently screened articles. Study quality was appraised using COSMIN and GRADE guidelines. Responsiveness was evaluated using anchor-based MCID and distribution-based standardized mean differences (SMDs) computed with Hedges’ g. A random-effect model addressed study variability, and heterogeneity was assessed with the chi-squared test and I² statistic. Results The 12 studies yielded high-quality evidence supporting the WORC's responsiveness. A meta-analysis of 1326 observations revealed a significant overall effect size (SMD) of 0.91 (95% CI: 0.56 to 1.26; p < 0.0001), with high heterogeneity ( I² = 91.2%). Subgroup analyses showed larger effect sizes for long-term follow-ups (SMD = 1.28) and surgical treatments (SMD = 1.14). The average MCID was 17 for conservative treatments within six months, 26 for surgical procedures, and 29 for follow-ups over six months. Conclusion The WORC measures improvements in rotator cuff conditions, with varying MCID values for different treatments and durations.
Perioperative complications and readmission rates following total shoulder arthroplasty in patients aged 90 and older
Authors: Tobin Jacqueline G , Jacobson Skye , Vallabhaneni Nikhil , Vanderham Lawrence C , Guareschi Alexander S , Eichinger Josef K , Friedman Richard J 
Published: August 2024

Background Previous literature has cited age as an independent risk factor for surgical outcomes following total shoulder arthroplasty (TSA). The purpose of this study is to determine the short-term outcomes of nonagenarians following primary TSA and compare them to younger cohorts. Methods The Nationwide Readmission Database (NRD) was queried from 2010 to 2020 to identify patients who underwent a primary reverse or anatomic TSA (rTSA or aTSA). Cohorts were defined by those aged 70–74 (septuagenarians), 80–84 (octogenarians), or 90 and over (nonagenarians). The septuagenarians and octogenarians were matched 1:1 to the nonagenarians by the Charlson–Deyo Comorbidity Index (CCI), year of procedure, and sex. Length of hospital stay, readmission rate, and postoperative outcomes were collected. Results Length of hospital stay, in-hospital death, 180-day mortality, 180-day readmission, and rate of medical complications were highest in the nonagenarians. Rates of periprosthetic fracture were highest in the nonagenarians. The number of total surgical complications was not significantly different between cohorts. The rate of revision within 180 days and discharge to rehabilitation facility was not significantly different between the three groups. Discussion The nonagenarians are at an increased risk of medical complications, longer hospital stays, periprosthetic fractures, and death following TSA. Otherwise, nonagenarians have similar rates of total surgical complications to the septuagenarians and octogenarians.
Can Operating Room Design Make Orthopedic Surgeries Shorter, Safer, and More Efficient?: A Quasi-Experimental Study
Authors: Quan Xiaobo 
Published: August 2024

Objectives: The study aimed to fill the knowledge gap about how operating room (OR) design could reduce orthopedic surgery duration and contribute to surgical care safety and efficiency. Background: Long surgery duration may lead to delays and cancellations of surgeries, deteriorated patient experiences, postoperative complications, and waste of healthcare resources. The OR physical environment may contribute to the reduction of surgery duration by minimizing workflow disruptions and personnel movements during surgeries. Methods: Unobtrusive observations were conducted of 70 unilateral total knee or hip replacement surgeries in two differently designed ORs at a community hospital in the United States. A set of computer-based forms adapted from recent research was used to measure the surgery duration, environment-related disruptions, and ambulatory movements involving circulators. Potential confounding factors like surgery type were controlled in statistical analyses. Results: Significantly shorter surgery durations were recorded in the larger OR with more clearances on both sides of the operating table, a wider door located on the sidewall, more cabinets, and more clearance between the circulator workstation and the sterile field ( p =.019). The better-designed OR was also associated with less frequent disruptions and fewer movements per case ( p < .001). Significant correlations existed between surgery duration, the number of disruptions, and the number of movements ( rs = .576–.700, ps < .001). Conclusions: The study demonstrated the important role of OR physical environment in supporting the safe and efficient delivery of surgical care, which should be further enhanced through research and design innovations.
Endoplasmic Reticulum Stress Promotes Telomerase Reverse Transcriptase Expression Contributes to Development of Allergic Rhinitis
Authors: Liao Yun , Zhang Xiwen , Tao Shuang , Wang Shiqi , Huang Qinmiao , Tang Ping , Tang Aifa , Yang Pingchang , Yang Gui 
Published: August 2024

Background The Th2 cell polarization is a crucial factor in the pathogenesis of allergic diseases. The underlying mechanism requires further investigation. Telomerase has an immune-regulating ability. The aim of this study is to elucidate the association between telomerase and Th2 cell polarization in patients with allergic rhinitis (AR). Methods CD4+ T cells were isolated from blood samples collected from AR patients and healthy control subjects. RNA sequencing was employed to analyze RNA samples extracted from CD4+ T cells. An AR mouse model was established using the ovalbumin-alum protocol. Results High telomerase gene activity and high endoplasmic reticulum (ER) stress status were observed in CD4+ T-cells in patients with AR. Positive correlation between the telomerase reverse transcriptase (TERT) gene expression in CD4+ T cells and AR response in patients with AR. TERT facilitated the degradation of Foxp3 proteins in CD4+ T cells, resulting in the polarization of Th2 cells. Sensitization with the ovalbumin-alum protocol enhanced the Tert expression in CD4+ T cells by exacerbating ER stress. Conditional inhibition of the Tert or eukaryotic translation initiation factor 2-α (Eif2a) expression in CD4+ T cells effectively attenuated experimental AR in mice. Conclusions Elevated amounts of telomerase in CD4+ T cells were found in CD4+ T cells of subjects with AR. Telomerase promoted Th2 cell polarization by inducing Foxp3 protein degradation and promotes GATA3 activation. Inhibition of TERT or eIF2a alleviated experimental AR.
Sex differences in comorbidities associated with exclusion from thrombolytic therapy in ischemic stroke patients with heart failure: A retrospective data analysis
Authors: Joffe Jonah , Stepp Ryan , Faulkner Madisen , Imeh-Nathaniel Samuel , Imeh-Nathaniel Adebobola , Nathaniel Thomas I. 
Published: August 2024

Objective The objective of this study is to identify baseline risk factors in AIS-HF inclusion and exclusion from rtPA therapy and determine whether the baseline factors are different in male and female patients. Methods This is a retrospective data analysis of data from the PRISMA Health stroke registry. Logistic regression models were developed to generate odds ratios (OR) that predict risk factors that are associated with male and female AIS-HF patients excluded from rtPA. Results A total of 590 AIS-HF were identified. Of this, 76.78% were females while 23.22 were males. Male AIS-HF patients with carotid artery stenosis (CAS) (OR = 0.279, 95% CI, 0.083–0.944, P = 014), were more likely to be excluded from rtPA, while those with higher National Institutes of Health Stroke Scale (NIHSS) scores (OR = 1.096, 95% CI, 0.907–3.526, P < 0.001), were more likely to be included for rtPA. Female AIS-HF patients with chronic renal disease (CRD) (OR = 0.159, 95% CI, 0.050–0.503, P = 002), were likely to be excluded from rtPA therapy, while those on antidepressant use (OR = 5.322, 95%, CI 1.488–19.03, P < 0.001), that presents with higher NIHSS scores (OR = 3.336, CI 1.699–6.950, P < 0.001) were more likely to be included for rtPA. Conclusions Our results reveal that male AIS-HF patients with a history of CAS were more likely to be excluded from rtPA therapy, whereas, females who present with CRD were more likely to be excluded from rtPA. These findings indicate the need for the development of management strategies to improve the use of rtPA for male and female AIS-HF patients.
Feline dystrophin-deficient muscular dystrophy misdiagnosed as Toxoplasma myositis
Authors: Reynolds Rachel M , Marks Stanley L , Guo Ling T , Shelton G. Diane , Graham Karina J 
Published: August 2024

Case summary A 6-month-old male entire domestic shorthair cat presented for presumptive Toxoplasma myopathy that was non-responsive to antiprotozoal therapy. Clinical features included marked macroglossia, dysphagia, regurgitation, truncal muscle hypertrophy, pelvic limb gait abnormalities and megaoesophagus. Relevant diagnostics included serial creatine kinase activity, cardiac troponin I, fluoroscopic swallow study and routine muscle histopathology. Ultimately, post-mortem histopathology with immunostaining demonstrated markedly decreased or absent staining for the rod and carboxy terminus of dystrophin, confirming a dystrophin-deficient muscular dystrophy (MD). The misdiagnosis of toxoplasmosis was based on an increased IgG titre and muscle histopathology submitted to a local laboratory. Treatment for megaoesophagus included vertical feeding of wet food only, sildenafil and omeprazole. Dysphagia and regurgitation improved moderately. Presumptive hyperaesthesia and muscle pain were managed with anti-inflammatory doses of prednisolone. The patient was ultimately euthanased as a result of progressive MD signs and uraemia at 2 years of age. Relevance and novel information This case report highlights the collective clinical features of MD, as they could be considered pathognomonic for this rare condition and must be differentiated from other myopathies via specific immunostaining of muscle biopsies. This is crucial to obtain a correct and early diagnosis, allowing instigation of potentially valuable treatments. Megaoesophagus is an inconsistent feature in feline MD in addition to the more commonly observed oropharyngeal dysphagia. Management with a canned diet, sildenafil, omeprazole and upright feeding was beneficial with moderate improvement in the frequency of regurgitation. Prednisolone was thought to minimise the presumptive myalgia.
Surgical management of a lumbar far lateral intervertebral disc extrusion in a cat
Authors: Fefer Gilad , Bynum Lauren , Early Peter 
Published: August 2024

Case summary A 9-year-old male castrated domestic shorthair cat was presented with a 2-week history of acute, progressive left pelvic limb lameness. Gait evaluation revealed a grade 3/5 left pelvic limb lameness with no apparent orthopedic cause for the lameness based on orthopedic examination or radiographs. The neurological examination was otherwise normal. MRI revealed a left-sided L6–7 far lateral intervertebral disc extrusion with possible secondary neuritis of the L6 spinal nerve. A left-sided L6–7 foraminotomy was performed to remove the extruded disc material and provide additional space for the significantly enlarged nerve root. An L6–7 fenestration was also performed. The patient made an excellent recovery with near-complete resolution of lameness at 26 days postoperatively. Relevance and novel information This case report contributes to the growing body of literature on lateral intervertebral disc extrusion as an etiological factor in pelvic limb lameness in cats, particularly when neurological deficits are absent. Furthermore, the case report highlights the diagnostic utility of cross-sectional advanced imaging for cats with lameness for which an orthopedic or radiographic cause cannot be identified. Finally, this case underscores the efficacy of surgical intervention as a treatment option for cats with lumbar far lateral intervertebral disc extrusions that do not improve with medical management alone. This finding could have implications for future surgical approaches in cats with similar findings.
Case management in a web-based cognitive and motor treatment for patients with mild cognitive impairment: A study protocol of a multicentric, randomized, two parallel arms controlled clinical trial
Authors: Gallucci Alessia , Tuena Cosimo , Bruni Francesca , Fedecostante Massimiliano , Rossi Lorena , Greco Antonio , Tettamanti Mauro , Lattanzio Fabrizia , Stramba-Badiale Marco , Giunco Fabrizio , Trimarchi Pietro Davide 
Published: August 2024

Objective The growing attention towards the psychosocial characteristics of mild cognitive impairment (MCI), a possible prodromal stage of dementia, contributed to the spread of patient-centered approaches to the care of age-related cognitive decline. Within these new care models, including Case-Management approaches, technology-based treatments showed to improve quality of life and psychosocial functioning of people with MCI. However, studies testing technologies to treat functional well-being of MCI patients are still few. Moreover, whether Case Manager supervised or unsupervised technological interventions lead to comparable results is so far unexplored. This study protocol aims to test the superiority of a 1-year physical and cognitive training treatment supervised by a Case Manager in improving the quality of life, functional decline, treatment adherence, cognitive impairment of MCI patients and the mental well-being of informal caregivers compared to the same yet unsupervised treatment. Methods In a multicentric, randomized, two parallel arms controlled clinical trial MCI patients ≥65 year-old will be randomized to receive a technology-based treatment either supervised or unsupervised by a Case Manager. Regardless of the study group, patients will perform cognitive and motor exercises with the monitoring of a specialist only during the first 6 weeks of intervention. Three and two assessment points will be considered during the intervention and follow-up period, respectively. The quality of life will be measured as primary outcome at 6 months after baseline. Conclusions The results of this study will provide an evidence base to use Case Management as an adjuvant approach for technology-based treatments of psychosocial characteristics of MCI.
An AI-based prognostic model for postoperative outcomes in non-cardiac surgical patients utilizing TEE: A conceptual study
Authors: Zhu Yu , Liang Renrui , Zhou Cheng-Mao 
Published: August 2024

Objective The primary objective of this study was to assess the potential of artificial intelligence techniques, in conjunction with transthoracic echocardiography (TEE) examinations, to forecast postoperative mortality outcomes in patients undergoing moderate-to-high-risk noncardiac surgeries. Methods This is a second retrospective analysis using the BioStudies public database. This dataset includes data from two medical centers. We partitioned the dataset utilizing a 7:3 ratio. This model seamlessly integrated diverse algorithms, encompassing both machine learning and deep learning methodologies such as logistic regression, gradient boosting decision tree, XGBoost, LightGBM, CatBoost, linear support vector classification, multilayer perceptron classifier, Gaussian Naive Bayes, Adaboost, recurrent neural network, convolutional neural network, Bayesian neural network, and probabilistic Bayesian neural network. To thoroughly evaluate the model's performance, we employed multiple metrics, including the receiver operating characteristic curve, accuracy, precision, F1 score, recall, calibration curve, and clinical decision curve. Results The present study included a total of 1453 patients. The Gbdt algorithm ranks the variable importance, and the top five important results are creatinine (Cr), creatinine exceeding twice the upper limit (Cr > 2), creatinine clearance, left ventricular end-diastolic internal diameter, and hemoglobin. Among these algorithms, only Gbdt algorithm yielded satisfactory results both in the training and test groups. In the training group, Gbdt had an area under the curve (AUC) value of 0.904, accuracy of 0.984, and precision of 1; In the testing group, Gbdt had an AUC value of 0.835, accuracy of 0.984, and precision of 0.5. However, the Gbdt algorithm demonstrated suboptimal performance in terms of recall rate and F1 score. Finally, we successfully developed an online intelligent prediction webpage that utilizes the Gbdt algorithm and TEE. Conclusions Gbdt represents an optimal approach for predicting postoperative mortality among patients undergoing non-cardiac surgery with moderate-to-high risk.
Co-designing a new digital mental health platform, ‘Momentum’, with caregivers of young people aged 7–17
Authors: Ludlow Kristiana , March Sonja , Russell Jeremy K , Ryan Brooke , Brown Renee L , Hides Leanne , Donovan Caroline , Spence Susan H , Saxby Joseph , Cobham Vanessa E 
Published: August 2024

Introduction Digital mental health interventions (DMHIs) can offer affordable, accessible and anonymous delivery of mental health treatment as an alternative or complement to face-to-face services. To enhance acceptability of, and treatment engagement with, youth DMHIs, they should be co-designed with young people and their caregivers. This study focuses on co-design with caregivers. Objective To explore caregivers’ perspectives, preferences, and ideas to inform the co-design of a digital youth mental health platform for anxiety and depression: ‘Momentum’. Methods and Measures Six group discussions were conducted with 16 caregivers of young people aged 7–17 years. In relation to Momentum, and DMHIs more broadly, participants’ views were sought on purpose and acceptability, access, assessments and feedback, information sharing, caregiver involvement and engagement. Data were thematically analysed using an inductive codebook approach, guided by template analysis. Results Seven themes were identified: (1) providing therapeutic and educational resources; (2) promoting shared and positive communication about mental health; (3) enhancing user experience and understanding; (4) facilitating personalisation and offering customisation of platform features; (5) encouraging end-user engagement through interactivity, incentives, relatability and attracting and maintaining attention; (6) enabling caregivers to provide support while promoting young people's independence; and (7) reducing concerns about, and enhancing trust in, DMHIs. Conclusions Participants expressed favourable views towards DMHIs and Momentum. They shared design ideas for a user-friendly, engaging, interactive, trustworthy, personalised and transparent platform that offered educational resources and mental health treatment. Two sets of recommendations were derived from the study findings: (1) recommendations for co-designing DMHIs with caregivers and (2) recommendations for the design of youth DMHIs.
Comparing virtual reality vs. augmented reality in promoting COVID-19 self-testing, vaccination, and preventive behaviors
Authors: Xu Zhan , Dam Linda 
Published: August 2024

ObjectiveVirtual Reality (VR) and Augmented Reality (AR) are innovative technologies that can serve as effective tools for creating health interventions by altering psychological distance. Based on construal level theory and the reality-virtuality continuum, we designed, tested, and compared VR and AR campaigns to encourage proactive measures against COVID-19.Methods143 participants were randomly assigned to one of three messages: VR, AR, and a CDC video, and completed surveys before, immediately, and one week following message exposure.ResultsVR and AR increased preventive intentions and behaviors against COVID-19 both in the short and long run. VR was particularly effective as it also increased risk perceptions, more preventive intentions in the short term, and more preventive behaviors, including social distancing and mask wearing, in the long term. VR was more efficient than AR in enhancing risk perceptions and preventive intentions right after being exposed to the messages as well as promoting behaviors such as avoiding crowds, maintaining social distance from others, and wearing a mask in indoor public areas one week later. Moreover, among the three conditions, VR was the only intervention that generated actual behavior change after one week, which indicated potential long-term advantages of VR compared to other mediums. VR decreased social, spatial, and hypothetical distances to a greater degree than AR. VR was more effective than video. However, AR was not more persuasive than video.ConclusionsInsights gained from the findings extend beyond the pandemic phase, offering practical applications for employing VR and AR technologies in health campaigns.
Comparison of Surgical Site Infection After Instrumented Spine Surgery in Patients With High Risk of Infection According to Different Antibiotic Prophylaxis Protocols: A Cohort Study of 132 Patients With a Minimum Follow-Up of 1 year
Authors: Ferrer Pomares Pierre , Duque Santana Pablo , Moreno Mateo Fernando , Mengis Palleck Charles L. , Tomé Bermejo Felix , Álvarez Galovich Luis 
Published: August 2024

Study Design Observational Study. Objectives Surgical site infections (SSIs) are one of the major complications in spine surgery. Numerous factors that increase the risk of SSI have been widely described. However, clinical guidelines on antibiotic prophylaxis are usually common for all patients. There are no specific guidelines for patients with a high risk of infection. The aim of this paper is to create a specific protocol for patients at high risk of SSI. Methods This is a three-cohort study using a prospective database. Risk patients are those who meet at least two of the following criteria: obesity, diabetes, reoperation and immunosuppression. Between October 2021 and April 2023, 132 patients were recruited. They were divided into three cohorts: cohort A, 46 patients, standard prophylaxis with cefazolin 2 g/8 h for 24 h; cohort B, 46 patients, cefazolin 2 g/8h and amikacin 500 mg/12 h for 24 h; cohort C, 40 patients, cefazolin 2 g/8h and amikacin 500 mg/12 h for 72 h. Results There was a significant decrease in the infection rate depending on the prophylaxis (23.9% in cohort A, 8.7% in cohort B, and 2.5% in cohort C). When logistic regression models were applied and cohorts B and C were compared with A, the following results were obtained: OR of 0.30 (CI: 0.08 – 0.97; P = 0.057) and 0.08 (IC: 0.00 – 0.45; P = 0.019), respectively. Conclusions Prophylaxis with prolonged double antibiotic therapy with cefazolin and amikacin is associated with a statistically significant decrease in the rate of SSI in patients with a high risk of infection.