bluuebunny/crossref_metadata_2025_split huggingface dataset:
Echocardiographic Evaluation of Postoperative Coaptation Geometry of Left AV Valve in Complete Atrioventricular Septal Defect
Authors: Kinami Hiroo , Morita Kiyozo , Shinohara Gen , Uno Yoshimasa 
Published: December 2022

Background: We sought to determine the difference in geometric parameters in the left atrioventricular valve (LAVV) postoperative complete atrioventricular septal defect (CAVSD) compared to the normal heart, and the correlation between geometric and functional parameters for detecting the mechanism of LAVV regurgitation (LAVVR) in CAVSD. Methods: LAVV geometric parameters based on complete and acceptable quality echocardiograms of 18 patients with repaired CAVSD compared with 17 normal controls. LAVVR severity was also quantified by indexed vena contracta (I-VC) (mm) and % jet area/left atrium area (% Jet/LA), and the correlation with LAVV parameters in the CAVSD group was investigated. Results: In the CAVSD group, the posterior closing angle (Pc) was nearly the same as the anterior closing angle (Ac), yet in the normal heart, the Pc angle was double the Ac angle. The anterior opening angle (Ao) and posterior-to-anterior leaflet diameter ratio (a/p) in the CAVSD group was also significantly smaller. The CAVSD group also had a shorter indexed coaptation length (I-CL) and indexed tenting height (I-TH). Displacement length (ΔD) differed completely between the CAVSD and Normal groups, and also showed a strong positive correlation to the functional parameters of LAVVR (% Jet/LA: r = .70, P = .02; I-VC: r = .60, P = .02). Conclusions: The parameters in this study were applicable to CAVSD AV valve coaptation characteristics. We introduced 2 novel measures that may provide important insights into the differences in geometry and performance of the LAVV in repaired CAVSD as compared to normal hearts.
Lifetime economic potential of mobile stroke units in acute stroke care: A model-based analysis of the drivers of cost-effectiveness
Authors: Rink Johann S , Froelich Matthias F , Nour May , Saver Jeffrey L , Szabo Kristina , Hoyer Carolin , Fassbender Klaus C , Schoenberg Stefan O , Tollens Fabian 
Published: December 2022

Background and purpose To simulate patient-level costs, analyze the economic potential of telemedicine-based mobile stroke units for acute prehospital stroke care, and identify major determinants of cost-effectiveness, based on two recent prospective trials from the United States and Germany. Methods A Markov decision model was developed to simulate lifetime costs and outcomes of mobile stroke unit. The model compares diagnostic and therapeutic pathways of ischemic stroke, hemorrhagic stroke, and stroke mimic patients by conventional care or by mobile stroke units. The treatment outcomes were derived from the B_PROUD and the BEST-mobile stroke unit trials and further input parameters were derived from recent literature. Uncertainty was addressed by deterministic and probabilistic sensitivity analyses. A lifetime horizon based on the US healthcare system was adopted to evaluate different cost thresholds for mobile stroke unit and the resulting cost-effectiveness. Willingness-to-pay thresholds were set at 1x and 3x gross domestic product per capita, as recommended by the World Health Organization. Results In the base case scenario, mobile stroke unit care yielded an incremental gain of 0.591 quality-adjusted life years per dispatch. Mobile stroke unit was highly cost-effective up to a maximum average cost of 43,067 US dollars per patient. Sensitivity analyses revealed that MSU cost-effectiveness is mainly affected by reduction of long-term disability costs. Also, among other parameters, the rate of stroke mimics patients diagnosed by MSU plays an important role. Conclusion This study demonstrated that mobile stroke unit can possibly be operated on an excellent level of cost-effectiveness in urban areas in North America with number of stroke mimic patients and long-term stroke survivor costs as major determinants of lifetime cost-effectiveness.
How much paediatric major trauma is truly paediatric? Experience from a level 1 urban Major Trauma Centre
Authors: Sanchez-Thompson Natalia , Platt Esther , Aylwin Christopher , Rees Clare , Alexander Nicholas , Hettiaratchy Sheehan 
Published: December 2022

Background: At its inception, there was no formal provision for children within the English major trauma network. There are now combined and stand-alone centres, but the scarcity of paediatric trauma facilities in some regions can result in long patient transfers and impact patient outcomes. The objective of this study was to determine the proportion of paediatric trauma patients who may benefit from input by adult services or may be safely managed within the local adult MTC, either because of patient physiology or injury patterns. Methods: All trauma presentations to our urban MTC aged ≤16 over a 3-year period were retrospectively identified and grouped, based on age and weight. ‘Young adult’ mechanisms of trauma and patient destinations (whether paediatric or adult wards) were determined. Results: There were 847 paediatric trauma cases recorded with a mean age of 9 and a male preponderance. Based on age and weight, 10–45% of cases could be considered physiologically adult-like, and 22–28% pubertal. Almost all penetrating trauma occurred in males, increasing with age. 14% of all admissions were managed on adult wards, with frequency increasing with patient age and with mechanism of actions (MOIs) relating to interpersonal violence. Conclusion: In this dataset, nearly half of paediatric trauma was ‘pubertal’ or ‘adult’ in their physiology and of these most presented with ‘young adult’ MOIs. These children likely benefit from combined paediatric and adult trauma services; where these do not exist, some older patients may be safely managed within local adult MTCs.
Development and evaluation of a regional diabetes service App for patient education, self-management and clinic engagement
Authors: Griffin Kirstin E , Jabbal Monu , Turtle Emma J 
Published: December 2022

Background: We created a free NHS App to deliver all patient information on type 1 diabetes to help promote self-management. This became an invaluable way of getting information to patients during the pandemic when all face-to-face clinics were suspended. The aim of this study is to investigate patient perceptions of the App. Methods: A questionnaire-based cross-sectional study was designed by the diabetes team to obtain quantitative data. Results: The mean score of patient accessibility to diabetes information and services before using the App was 5.1, and after using the App was 8.8 ( p < 0.001). Among the patients, 91% would recommend the App, 57.2% agree the App helps them schedule and attend their screening appointments and 73.7% agree the App has improved their self-management of type 1 diabetes. Conclusion: Patients agree the App has improved accessibility to diabetes information and services and has helped with self-management of their condition. Patients are likely to recommend the App to friends and family who have diabetes.
Double-Cuff Bidirectional Branch in Endovascular Aortic Repair: A New Way of Increasing the Flexibility of Inner Branch Endografting
Authors: Dias Nuno V. , Karelis Angelos , Oderich Gustavo S. , Sonesson Björn 
Published: December 2022

Purpose: The purpose of the study was to describe the design and implantation of a branched stent-graft during endovascular aortic repair incorporating double-cuff bidirectional inner branch. Technique: A new double-cuff bidirectional antegrade and retrograde inner branched stent-graft with large diamond-shaped fenestration was designed for incorporation of a splenic artery. The inner cuffs of the branch were accessible using brachial and/or femoral access. The splenic artery was originating from an aortic segment with narrow inner aortic luminal diameter in a patient with extent IV thoracoabdominal aortic aneurysm with bilobed configuration. The retrograde, more distal inner cuff of the branch was extended into the splenic artery using a self-expandable bridging stent-graft from the femoral approach, whereas the antegrade, more proximal inner cuff of the branch was intentionally occluded using an endovascular plug. The recovery was uneventful and a computed tomography angiography 30 days postoperatively showed patency of all the target vessels without signs of endoleaks. Conclusion: This is the first design of a double-cuff bidirectional inner branched stent-graft. The technique can potentially expand the applications of directional branches to patients with more difficult anatomy in the thoracoabdominal or aortic arch segments. Potential indications are patients with target arteries that are not ideally suited for caudally-oriented branches, patients with accessory vessels, or targets with early branch bifurcations. Clinical Impact This report describes the use of a branched endograft with a new double-cuff bidirectional branch that can potentially address many of the limitations of current BEVAR solutions, such as early bifurcations, double arteries with adjacent origins and arteries with less favorable trajectories for the traditional caudally-oriented branches.
The Impact of Maternal Depression on Internet-Parent–Child Interaction Therapy for Child Attention-Deficit/Hyperactivity Disorder: A Case Study
Authors: Druskin Lindsay R. , Victory Erinn J. , Han Robin C. , Phillips Sharon T. , Aman Emily , McNeil Cheryl B. 
Published: December 2022

Conduct disorders and attention-deficit/hyperactivity disorder (ADHD) are highly comorbid, with an estimated prevalence rate of 51.5% for children between 2–17 years of age (Centers for Disease Control and Prevention, 2020). Parent–Child Interaction Therapy (PCIT) is an empirically supported behavioral parent training program for children with disruptive behavior. PCIT research consistently demonstrates decreases in disruptive behaviors and increases in positive parenting strategies among families of young children with ADHD; however, PCIT has yet to become widely recognized as a treatment for ADHD. This case study presents the treatment of a 6-year-old boy with ADHD and severe behavior problems. The case was further impacted by the single mother’s depressive symptoms and internet delivery of PCIT during the COVID-19 pandemic. Findings from this case report documented an improvement in disruptive child behaviors and emotion regulation and increased positivity during parent–child interactions, despite worsening maternal depressive symptoms. This case study highlights the utility of PCIT to improve child disruptive behaviors and ADHD symptoms in the midst of several complicating factors.
First-line treatments for advanced hepatocellular carcinoma: a network meta-analysis and cost-effectiveness analysis in China and the United States
Authors: Sun Ke-Xin , Cao Shan-Shan , Shi Feng-Hao , Guan Yue , Tang Meng , Zhao Mei-na , Jian Yu-Fan , Cui Bin , Li Zhi-Yan , Wang Jing-Wen , Yu Feng , Ding Yi 
Published: December 2022

Background: Various therapeutic strategies are available for the first-line treatment of patients with advanced hepatocellular carcinoma (aHCC). But which approach is the most cost-effective remains uncertain. Objectives: This study aims to evaluate the cost-effectiveness of first-line strategies in aHCC patients from the perspective of Chinese and US payers. Design: A network meta-analysis (NMA) and cost-effectiveness study. Data sources and methods: A NMA was conducted to collect all first-line strategies with aHCC from 1 October 1 2018 until 1 January 2022. The relevant randomized controlled trial literature in PubMed, Embase, and Cochrane Library for the last 3 years were searched. The abstracts of meetings of the American Society of Clinical Oncology, European Society of Medical Oncology, and American Association for Cancer Research were also reviewed. A Markov model that included three states was developed. One-way sensitivity and probabilistic sensitivity analysis were performed to investigate the uncertainty of the economic evaluation. Scenario analysis was conducted to explore the economic benefits of treatment strategies in low-income populations. Results: Base-case analysis in China included 1712 patients showed that atezolizumab combined with bevacizumab, sintilimab combined with bevacizumab, lenvatinib (LEVA), and sorafenib (SORA) added 0.46, 1.25, 0.77, and −1.08 quality-adjusted life-years (QALYs), respectively, compared with donafenib, resulting in an incremental cost-effective ratio of $85607.88, $12109.27, and $1651.47 per QALY at a willingness-to-pay (WTP) of $11101.70/QALY. In the United States, only the incremental cost-effectiveness ratios (ICERs) of SORA was higher that were lower than the WTP threshold ($69375/QALY), and LEVA was the most cost-effective strategy with the ICERs were 25022.13/QALY. Conclusion: The NMA and cost-effectiveness analysis revealed that LEVA is the favorite choice in the first-line treatment of Chinese aHCC patients and US payers’ perspective when the WTP was $11101.70/QALY in China and $69375.0/QALY in the United States. Registration: This study has been registered on the PROSPERO database with the registration number CRD42021286575.
Preserved T-cell response in anti-CD20-treated multiple sclerosis patients following SARS-CoV-2 vaccination
Authors: Faissner Simon , Heitmann Neele , Rohling Ricarda , Ceylan Ulas , Bongert Marielena , Plaza-Sirvent Carlos , Marheinecke Corinna , Pedreiturria Xiomara , Ayzenberg Ilya , Hellwig Kerstin , Schmitz Ingo , Pfaender Stephanie , Gold Ralf 
Published: December 2022

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has tremendous implications for the management of patients with autoimmune conditions such as multiple sclerosis (MS) under immune therapies targeting CD20+ B cells (aCD20). Objectives: Here, we investigated humoral and cellular immune responses, including anti-spike titers, neutralization against SARS-CoV-2 wild-type (WT), delta, and omicron variant and T cell responses of aCD20-treated relapsing–remitting MS patients following SARS-CoV-2 vaccination compared with healthy controls. Methods: Blood samples were collected within 4–8 weeks following the second vaccination against SARS-CoV-2. Sera were analyzed for anti-SARS-CoV-2 spike antibodies and neutralization capacity against pseudovirus for wild-type (WT), delta, and omicron variant. Peripheral blood mononuclear cells (PBMCs) were stimulated with a SARS-CoV-2 peptide pool and analyzed via flow cytometry. Results: The aCD20-treated MS patients had lower anti-SARS-CoV-2-spike titers, which correlated with B cell repopulation. Sera of aCD20-treated patients had reduced capacity to neutralize WT, delta, and omicron pseudoviruses in vitro. On the contrary, PBMCs of aCD20-treated patients elicited higher frequencies of CD3+ T cells and CD4+ T cells and comparable response of cytotoxic T cells, while Th1 response was reduced following restimulation with SARS-CoV-2. Conclusion: In summary, aCD20-treated patients have a reduced humoral immune response, depending on B cell repopulation, in accordance with preserved cellular immune response, suggesting partial cellular protection against SARS-CoV-2.
Harvest Technique Does Affect the Quality of Osteochondral Grafts: Histologic Evaluation Comparing Commercial Standards versus Scalpel Blade Technique
Authors: Merkely Gergo , Leite Chilan B.G. , Farina Evan M. , Gomoll Andreas H. , Lattermann Christian 
Published: December 2022

Objective While the percentage of viable cells is a major determinant of graft performance during osteochondral allograft (OCA) transplantation, the baseline chondrocyte viability at the periphery of osteochondral plugs is defined at the time of harvest. In this laboratory study, we aimed to determine the optimal technique for OCA plug harvest by evaluating commercial standard techniques compared to sharp blade harvest technique. Design Osteochondral explants were harvested from bovine and human samples using 3 different techniques: (1) standard OATS manual punch device (Osteochondral Autograft Transplant System OATS; Arthrex, Naples, FL), (2) powered trephine device, and (3) fresh scalpel blade. Chondrocyte viability and the dead area at the periphery of the tissue were evaluated by LIVE/DEAD staining. Safranin-O and fast-green were performed for structural evaluation. Results For both bovine and human samples, the dead area at the periphery of the explant was significantly smaller after scalpel blade preparation compared to harvest with OATS ( P < 0.001) and powered trephine devices ( P < 0.001). In addition, while powered device had a smaller remaining dead area compared to the OATS device ( P < 0.001), there was significantly greater tissue loss and peripheral contour change for plugs harvested with the powered trephine device. Conclusion Our study demonstrated that OCA plugs harvested with OATS and powered device lead to a significant mechanical injury at the periphery of the explants compared to a scalpel. We propose that the optimal technique for OCA harvest utilizes a combined approach incorporating a scalpel blade/circular scalpel to prepare the chondral surface and a powered trephine to prepare the osseous surface.
An immersive virtual reality-based application for treating ADHD: A remote evaluation of acceptance and usability
Authors: Zangiacomi Andrea , Flori Valeria , Greci Luca , Scaglione Arianna , Arlati Sara , Bernardelli Giuseppina 
Published: December 2022

Introduction Virtual reality (VR) is a digital technology currently considered to implement rehabilitation programs for children with ADHD, a disorder characterised by inattention, overactivity and impulsiveness. This study presents the results of the acceptance and usability of a VR application developed for children with ADHD aiming to provide an environment capable of supporting the development of the different attentional components. Due to COVID-19 restrictions, this study had the secondary aim of assessing whether a remote evaluation was feasible and meaningful. Methods A sample of 20 clinical experts (neuro and psychomotor therapists of the developmental age) was involved in assessing the proposed environment. Two different tools have been applied: the Technology Acceptance Model (TAM-3) questionnaire and a semi-structured interview were self-administered. Six sessions were planned in total, and each one lasted 30 min. Results With respect to the acceptance of the system, the mean of the answers given is for most of the constructs greater than 4, showing agreement among experts. Cronbach alpha and correlations of subscales seem to confirm the reliability of measures. According to results from the interviews, the developed application has shown versatility in being able to be applied to the heterogeneity of the disorder and it was also possible to obtain valuable insights on possible additional features and functionalities. Regarding the secondary aim, the collected outcomes were positive: all the participants were satisfied with what they could perceive about the application. Conclusions The results of this work pave the way for a future validation study with children due to the active participation of clinicians and their unanimous positive judgement confirming that the application was considered user-friendly and well accepted.
Making Sense of Interdisciplinary General Education Curriculum Design: Case Study of Common Core Curriculum at the University of Hong Kong
Authors: Lam (林文灏) Adrian Man-Ho 
Published: December 2022

Purpose This research is an interview-based study that captures the academics’ perspectives toward the planning and design of an interdisciplinary General Education Curriculum for undergraduate students in the Chinese context, using the Common Core Curriculum at the University of Hong Kong as a case study. Design/Approach/Methods A total of 28 academics with various levels of academic ranking, disciplinary context, proven teaching excellence, and research productivities were individually invited for and consented to a semi-structured and face-to-face interview. Findings This article suggests four fundamental and interrelated dimensions for consideration when structuring an interdisciplinary General Education Curriculum, namely, how to design, what is worth learning, how to learn and teach, and how to know students have learned. It is suggested that the ideal curriculum should remain coherent and coordinated, broad and balanced, as well as open and flexible, ensuring the capture of knowledge, skills, and attitudes, with the facilitation of active, authentic, and contextualized pedagogies and assessments. Originality/Value This article has the potential of providing insight for policymakers and educators around the world to better structure an interdisciplinary General Education Curriculum by creating an overall springboard for future discussion. They can also integrate these evidence-based elements and strategies into their everyday practices.
Guidelines on the Diagnosis and Treatment of Lateral Meniscal Lesions: A Consensus Statement by the Chinese Society of Sports Medicine
Authors: Zhang Shurong , Chen Gang , Li Ruixin , Yang Chunxi , Zheng Jiapeng , Wang Cheng , Lu Jun , Zhang Zhengzheng , Shang Xiliang , Zhang Hui , Wang Weiming , Li Weiping , Huang Jingmin , Zhang Yadong , Wang Jianquan , Wang You , Zheng Xiaofei , Chen Shiyi , Li Jian , Hua Yinghui 
Published: December 2022

Background: The lateral meniscus is a unique structure of the knee joint, and its anatomy, function, pathological process, and treatment are distinct from those of the medial meniscus. To date, no consensus on the management of lateral meniscal lesions has been published, and clinical decision-making is challenging. To facilitate this, consensus and practice guidelines for lateral meniscal lesions were developed and endorsed by the Chinese Society of Sports Medicine. Study Design: Consensus statement. Methods: This project followed the Delphi approach to the consensus process, involving steering, rating, and peer review groups. A total of 61 experts in the fields of sports medicine and arthroscopic surgery were invited to participate in the compilation of a consensus statement on lateral meniscal lesions. (The discoid lateral meniscus was addressed by separate consensus.) To begin, the steering group drafted a set of questions and replies regarding lateral meniscal lesions. An online panel discussion was then held to provide initial agreement and comments on the statements, followed by a round of anonymous voting. Results and feedback were sent to the steering group for a second draft. A second round of voting was then held, and each statement was discussed during a combined meeting of the steering and rating groups. Finally, a consensus draft was evaluated by a review group. Results: Fifty-three questions and answers addressing lateral meniscal lesions were drafted, and 20 statements were excluded because of redundant information during the first round of voting. Ultimately, 33 statements were completed, 9 of which were unanimous. Conclusion: This expert consensus process focused on the anatomy, function, pathological processes, and treatment of lateral meniscal lesions. Accepted recommendations in these areas can assist doctors and therapists in standardizing the management of related pathology. The consensus statement indicates that certain types of lateral meniscal tears that were previously considered irreparable can be repaired. Preservation of the lateral meniscus should be the first-line treatment whenever possible, because the long-term clinical and radiological outcomes are worse after partial meniscectomy.