Ethical Approval Number Research Articles

Clinical outcome of guided endodontics versus freehand drilling: A controlled clinical trial, single arm with external control group.

High-quality, prospective clinical studies are needed to increase evidence for guided endodontics. This study aims to assess the clinical outcome of guided endodontics for treatment of teeth presenting with pulp canal obliteration (PCO) in comparison with freehand treatment. This trial was registered in the ISRCTN.com registry (ISRCTN75277265) and designed as a controlled clinical trial: Single arm trial, prospective, nonrandomized, single-centre study (ethical approval number S64630). Inclusion criteria were; tooth presenting with PCO and symptoms and/or signs of apical periodontitis (AP). An external control group was selected from clinical records of patients presenting the same criteria but treated freehanded. Guided root canal treatments were performed by the same operator on all patients. Freehanded treatments were performed by a specialist in endodontics under microscope with pre-operative CBCT available. Primary outcome for both groups was evaluated as: canal found, canal not found, or perforation. As secondary outcome, the qualitative accuracy of the drill path was assessed as: optimal precision, acceptable precision or technical failure. Patients were followed up yearly. Descriptive statistics on the study patient's demographics and healing outcome were performed and specific statistical analysis was performed on each outcome variable. A total of 133 teeth were included (n = 60 guided, n = 73 freehanded) from 128 patients (n = 59 guided, n = 69 freehanded). The primary outcome for the guided group was: 59 teeth canals found and 1 tooth canal not found. No perforations were recorded. In the freehanded group, the root canal was successfully found in 59 teeth, seven were not found, and seven had a perforation. An analysis of all data showed that guided endodontics presented statistically significant better outcome than freehand treatment (p < .05). Guided endodontics showed a statistically significant better outcome than freehanded treatment resulting in less technical failures. However, it is a complex procedure which should be carried out by an experienced endodontist with the aid of a dental microscope.

A protocol for a single center, randomized, controlled trial assessing the effects of spectacles or orthokeratology on dry eye parameters in children and adolescents

BackgroundThe prevalence of myopia among adolescents is increasing precipitously in China, and the popularity of orthokeratology (OK) lenses as an effective treatment for controlling myopia progression is rising. This protocol assessed and compared the clinical dry eye parameters in children and adolescents with myopia treated with spectacles or OK lenses. Methods and analysisThis single-masked randomized control trial will include 300 participants (aged 8–17 years) with myopia treated with OK lens (study group) or spectacles (control group). We will record the ocular surface disease index, visual analog scale score, noninvasive tear breakup time, tear meniscus height, meibomian gland score, ocular redness score, visual acuity, tear Matrix Metalloproteinase-9 concentration, tear Lymphotoxin alpha levels at baseline, and after 1-, 3-, 6-, and 12-month. DiscussionThis study will be a standardized, scientific, clinical trial designed to evaluate the dry eye parameters in children and adolescents with myopia treated with OK lenses for myopia control. Ethics and disseminationThis study has been approved by the Ethics Committee of He Eye Specialist Hospital [ethics approval number: IRB(2023)K024.01]. Before participating in the trial, written informed consent will be obtained from all patient's parents or guardians. The findings of this study will be showcased at both local and international conferences and will also be submitted for publication in reputable peer-reviewed journals. Trial registration numberClinicaltrials.gov: NCT06023108 {2a, 2b}

Clinical application research of intelligent monitoring system for knee rehabilitation: a randomized controlled trial

BackgroundThis study investigates the effectiveness of a self-developed intelligent monitoring system for home-based knee rehabilitation following total knee arthroplasty (TKA).MethodsIn this randomized controlled trial, 120 patients undergoing TKA were divided using random digit allocation. Preoperative and one-month postoperative assessments of knee function, quality of life, and isometric knee extension strength were conducted with the Intelligent Monitoring System. Patients received group-specific rehabilitation instructions pre-discharge and performed exercises for one month.ResultsChanges in isometric knee extensor strength on the affected side within one month post-surgery for the brace-monitored rehabilitation group showed a significant decrease three days after surgery compared to one day before surgery. Subsequent measurements taken at postoperative days 5, 7, 14, and 21 indicated a gradual increase in strength, although these increases did not reach statistical significance when compared with previous measurements. One month post-surgery, all groups demonstrated significant improvements in knee joint function and mobility compared to pre-surgery levels. Notably, the brace-monitored group showed statistically significant improvements in 36-Item Short-Form Health Survey (SF-36) scores over the conventional rehabilitation group.ConclusionsThe Intelligent Monitoring System provides effective real-time monitoring and guidance for home-based knee rehabilitation post-TKA. It significantly enhances knee joint function, isometric knee extension strength, and quality of life shortly after surgery compared to traditional rehabilitation methods. This system offers a promising approach for improving postoperative recovery in TKA patients.Trial registrationThis study was approved by the Medical Ethics Committee of Xiangya Hospital, Central South University (Ethics Approval Number 202209008-2). It was registered with the China Clinical Trial Registry, a primary registry of the World Health Organization’s International Clinical Trials Registry Platform (Registration Number ChiCTR2300068852).

A self-assessment maturity matrix to support large-scale change using collaborative networks in the New Zealand health system

BackgroundA maturity matrix can be a useful tool for organisations implementing large-system transformation (LST) initiatives in complex systems. Insights from implementation of a local LST initiative using collaborative networks, known as Alliances, highlighted a tool was needed to help health system leaders prompt discussions on how and where to focus their change efforts. In the New Zealand (NZ) health system, Alliances were introduced to integrate the planning and delivery of health care between primary and hospital care.MethodsThe aim of this research was to use insights from Alliance members to develop a learning tool that collaborative networks could use to assess and improve their readiness for change. We constructed a maturity matrix using the knowledge of senior NZ health system leaders, in a workshop setting. The maturity matrix was empirically tested and refined with three Alliances and with feedback from the NZ Ministry of Health Māori Health Strategy and Policy team.ResultsThe maturity matrix described the 10 key elements that had been found to support successful implementation of LST initiatives in the NZ health system, along with success indicators and different stages of maturity from beginning to excellence. Testing of the maturity matrix with three Alliances suggested that it functioned as a learning tool and stimulated collective thinking and reflection. The Māori Health Strategy and Policy team commented on the importance of such a tool to increase health system leaders’ responsiveness to improving Māori health outcomes. Comparisons with similar international matrices revealed common elements with ours. A strength of our maturity matrix is that it is specific to the NZ context and is the first practical tool to implement large-scale change in the health system that incorporates principles of the Government’s treaty with Māori, the indigenous people of NZ.ConclusionsThrough a regular self-assessment process, use of the maturity matrix may create feedback loops to support deliberate learning and knowledge sharing for senior health system leaders and collaborative networks. The maturity matrix fills an important gap in the NZ health system and contributes to implementation science literature internationally.OtherThis study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Financial incentive interventions for smoking cessation among Chinese smokers: study protocol for a cluster randomised controlled trial

IntroductionThere is an urgent issue to relieve the burdens caused by tobacco use through feasible and effective smoking cessation interventions, particularly in a middle-income country with less accessible smoking cessation...

Effects of the Prolong Life With Nine Turn-Method Qigong on Fatigue, Insomnia, Anxiety, and Gastrointestinal Disorders in Patients With Chronic Fatigue Syndrome: Protocol for a Randomized Controlled Trial.

Chronic fatigue syndrome (CFS) is a debilitating multisystem disorder that can lead to various pathophysiological abnormalities and symptoms, including insomnia, gastrointestinal disorders, and anxiety. Due to the side effects of currently available drugs, there is a growing need for safe and effective nondrug therapies. The Prolong Life With Nine Turn (PLWNT) Qigong method is a system of mind-body exercise with restorative benefits that can alleviate the clinical symptoms of CFS and impart a significant inhibitory effect. Various studies have proven the treatment efficacy of PLWNT; however, the impact on insomnia, gastrointestinal disorders, and anxiety in patients with CFS has not yet beeninvestigated. This study aims to evaluate the efficacy and safety of the PLWNT method in terms of its effects on fatigue, insomnia, anxiety, and gastrointestinal symptoms in patients with CFS. We will conduct a randomized, analyst-blinded, parallel-controlled trial with a 12-week intervention and 8-week follow-up. A total of 208 patients of age 20-60 years will be recruited. The patients will be randomly divided into a PLWNT Qigong exercise group (PLWNT Group) and a control group treated with cognitive behavioral therapy at a ratio of 1:1. Participants from the treatment groups will be taught by a highly qualified professor at the Shanghai University of Traditional Chinese Medicine once a week and will be supervised via web during the remaining 6 days at home, over 12 consecutive weeks. The primary outcome will be the Multidimensional Fatigue Inventory 20, while the secondary outcomes include the Pittsburgh Sleep Quality Index, Gastrointestinal Symptom Rating Scale, Hospital Anxiety and Depression Scale, functional magnetic resonance imaging, gut microbiota, and peripheral blood. The study was approved by the ethics committee of Shanghai Municipal Hospital of Traditional Chinese Medicine in March 2022 (Ethics Approval Number 2022SHL-KY-05). Recruitment started in July 2022. The intervention is scheduled to be completed in December 2024, and data collection will be completed by the end of January 2025. Over the 3-year recruitment period, 208 participants will be recruited. Data management is still in progress; therefore, data analysis has yet to be performed. This randomized trial will evaluate the effectiveness of the PLWNT method in relieving fatigue, insomnia, anxiety, and gastrointestinal symptoms in patients with CFS. If proven effective, it will provide a promising alternative intervention for patients with CFS. China Clinical Trials Registry ChiCTR2200061229; https://www.chictr.org.cn/showproj.html?proj=162803. PRR1-10.2196/53347.

Evaluation of Nurse Workload in Patient Units

The inpatient room at a tertiary referral eye hospital includes eye surgery services and infection treatment for adult and pediatric patients. Nurse workload greatly influences the quality of service in the inpatient unit. However, data regarding the workload of nurses in inpatient units at tertiary referral eye hospitals is still limited. Objective: To determine the workload of nurses in the inpatient ward of a tertiary referral eye hospital. Method: This research is a quantitative descriptive study, which provides an overview of the workload of nurses in the inpatient ward of a tertiary referral eye hospital. The research was carried out from March to May 2023. The total sampling of research respondents was 25 nurses in inpatient treatment rooms for class 2 and 3 patients. Data collection used a workload questionnaire. Data analysis uses cross tabulation. The validity test was declared valid using the Pearson product moment correlation with results for the physical aspect of 0.396, the psychological aspect of 0.396 and the time aspect of 0.396 (0.396 &gt; 0.312). Reliability test usingCronbach's alphawith a coefficient of more than 0.6, it is declared reliable, where the physical aspect is 0.945, the psychological aspect is 0.903 and the time aspect is 0.906. This research has received ethical approval number: LB.02.01/2.3/5440/2023. Results: research shows that the workload of nurses on the physical aspect is high, namely 76%, and the workload of nurses on the psychological aspect is high, namely 96%. Discussion: Several factors causing the high workload of nurses include the large number of patients entering the inpatient room, the bed management system which is not yet optimal, and the limited treatment space but continuous use of beds. Conclusion: The high workload of nurses has an impact on the quality of nursing services.

Key elements and contextual factors that influence successful implementation of large-system transformation initiatives in the New Zealand health system: a realist evaluation

BackgroundDespite three decades of policy initiatives to improve integration of health care, delivery of health care in New Zealand remains fragmented, and health inequities persist for Māori and other high priority populations. An evidence base is needed to increase the chances of success with implementation of large-system transformation (LST) initiatives in a complex adaptive system.MethodsThis research aimed to identify key elements that support implementation of LST initiatives, and to investigate contextual factors that influence these initiatives. The realist logic of enquiry, nested within the macro framing of complex adaptive systems, formed the overall methodology for this research and involved five phases: theory gleaning from a local LST initiative, literature review, interviews, workshop, and online survey. NVivo software programme was used for thematic analysis of the interview, workshop, and the survey data. We identified key elements and explained variations in success (outcomes) by identifying mechanisms triggered by various contexts in which LST initiatives are implemented.ResultsThe research found that a set of 10 key elements need to be present in the New Zealand health system to increase chances of success with implementation of LST initiatives. These are: (i) an alliancing way of working; (ii) a commitment to te Tiriti o Waitangi; (iii) an understanding of equity; (iv) clinical leadership and involvement; (v) involved people, whānau, and community; (vi) intelligent commissioning; (vii) continuous improvement; (viii) integrated health information; (ix) analytic capability; and (x) dedicated resources and time. The research identified five contextual factors that influenced implementation of LST initiatives: a history of working together, distributed leadership from funders, the maturity of Alliances, capacity and capability for improvement, and a continuous improvement culture. The research found that the key mechanism of trust is built and nurtured over time through sharing of power by senior health leaders by practising distributed leadership, which then creates a positive history of working together and increases the maturity of Alliances.DiscussionTwo authors (KMS and PBJ) led the development and implementation of the local LST initiative. This prior knowledge and experience provided a unique perspective to the research but also created a conflict of interest and introduced potential bias, these were managed through a wide range of data collection methods and informed consent from participants. The evidence-base for successful implementation of LST initiatives produced in this research contains knowledge and experience of senior system leaders who are often in charge of leading these initiatives. This evidence base enables decision makers to make sense of complex processes involved in the successful implementation of LST initiatives.ConclusionsUse of informal trust-based networks provided a critical platform for successful implementation of LST initiatives in the New Zealand health system. Maturity of these networks relies on building and sustaining high-trust relationships among the network members. The role of local and central agencies and the government is to provide the policy settings and conditions in which trust-based networks can flourish.OtherThis study was approved by the Victoria University of Wellington Human Ethics Committee (Ethics Approval Number 27,356). The research was supported by the Victoria University of Wellington research grant (222,809) and from the University of Auckland Department of Medicine research fund (H10779).

Stereotactic radiosurgery of brain metastases: a retrospective study

BackgroundSingle-fraction stereotactic radiosurgery (SRS) is an established standard for radiation therapy of brain metastases although recent developments indicate that multi-fractionated stereotactic radiotherapy (FSRT) results in lower radiation necrosis especially for larger metastases, and the same or even better local control in comparison to SRS.MethodsSeventy-two patients with 111 brain metastases received SRS with a single dose of 18 Gy between September 2014 and December 2021. The dose prescription was either 18 Gy given to the enclosing 80% isodose with a normalization to Dmax = 100% of 22.5 Gy (part I) or 18 Gy = D98, while D0.03 cc of 21.6–22.5 Gy was accepted (part II). The study retrospectively evaluated local progression-free survival (LPFS), response on the first follow-up magnetic resonance imaging (MRI), and radiation necrosis.ResultsMelanoma brain metastases (n = 44) were the most frequent metastases. The median gross tumor volume (GTV) was 0.30 cm³ (IQR, 0.17–0.61). The median follow-up time of all patients was 50.8 months (IQR, 30.4–64.6). Median LPFS was 23.5 months (95%CI 17.2, 29.8). The overall LPFS rates at 12-, 18-, 24- and 30 months were 65.3%, 56.3%, 46.5%, and 38.8%. Brain metastases with radioresistant histology (melanoma, renal cell cancer, and sarcoma) showed a 12-month LPFS of 60.2%, whereas brain metastases with other histology had a 12-month LPFS of 70.1%. The response of brain metastases on first follow-up MRIs performed after a median time of 47 days (IQR, 40–63) was crucial for long-term local control and survival. Eight brain metastases (7.2%) developed radiation necrosis after a median time of 18.4 months (IQR, 9.4–26.5). In multivariate analyses, a GTV > 0.3 cm³ negatively affected LPFS (HR 2.229, 95%CI 1.172, 4.239). Melanoma, renal cell cancers, and sarcoma had a lower chance of LPFS in comparison to other cancer types (HR 2.330, 95%CI 1.155, 4.699).ConclusionsOur results indicate a reasonable 1-year local control of brain metastases with radiosensitive histology. Radioresistant metastases show a comparatively poor local control. Treatment refinements merit exploration to improve local control of brain metastases.Trial registrationThis study is retrospectively registered (ethics approval number 23-3451-104).

Protocol for a parallel assignment prospective, randomised, double-blinded, placebo-controlled trial to evaluate the efficacy of 0.01% atropine for near work-induced transient myopia and myopic progression in China

IntroductionAssessment of near work-induced transient myopia (NITM) is important for permanent myopia development and progression. Atropine eye drop has been reported to be beneficial in reducing initial NITM and slowing...

A Compilation of Experiences in Utilizing CAR-T Cell Therapy for Richter's Transformation

Objective:Even with Bruton tyrosine kinase inhibitors (BTKis) and BCL2 inhibitors, the prognosis for Richter's Transformation (RT) remains dismal, with a median overall survival (OS) of only 9-12 months from initial diagnosis. Although there are reports on CAR-T therapy for RT, the sample size is small and the conclusions vary greatly. Methods: We conducted a retrospective investigation of the efficacy of CAR-T cell therapy in treating RT at our center. Each participant provided their informed consent to partake in the “Phase II Clinical Trial of Sequential CAR-T Cell Therapy Targeting Different B-Cell Epitopes for Recurrent, Refractory Aggressive B-Cell Lymphoma”(Protocol number: BR-XG-CART-II, ChiCTR2100055062, Ethical Approval Number 20191225-PJ-003). Before lymphocyte collection, chemotherapy regimen without fludarabine/ Bendamustine is first used to reduce peripheral blood tumor load if peripheral blood tumor cells are higher than 10%. Patients with extramedullary tumor loads of 5cm or larger were treated with tumor reduction chemotherapy between lymphocyte collection and CART cell transfusion. The pretreatment scheme based on Bendamustine or FC scheme was adopted before CAR-T cells were infused. The efficacy and safety of CART cells were observed. Results: Between Feb 1, 2020 and Feb 28, 2023, our center administered CAR-T cell therapy to 16 patients diagnosed with RT, all of whom developed into diffuse large B-cell lymphoma. The patient population had a median age of 59 years (range: 42-69 years), consisting of 62.5% (10/16) males and 37.5% (6/16) females. The ECOG scores varied between 0 and 3. The median number of prior treatment lines was 5 (2-7). 93.8% failed previous BTKis treatment and 75% failed BCL2 inhibitor treatment; 93.8% had undergone chemotherapy (median 6 courses). 1 patient had previously failed universal CAR-T cell therapy, and another relapsed after autologous transplantation. 90% had at least one TP53 abnormality detected by either FISH or second-generation gene sequencing. Extramedullary masses were found in 87.5% (14/16) of patients, with a median maximum diameter of 42.5mm (18-144mm). Masses larger than 5cm were found in 25% (4/16) of cases, marrow involvement was noted in 62.5% (10/16), and cerebrospinal fluid was affected in 18.75% (3/16). None of the patients had central masses observed in their MRIs. During lymphocyte collection, 58.3% of patients showed positivity for peripheral blood tumor cells, with a maximum tumor cell proportion of 5.69%. The median infused CAR-T cell dose was 1.37×10 6/kg. 12 of them were injected with mouse CD19CAR-T, 2 with human CD20CART, and 2 with human CD19CART. CRS occurred in 81.3%of patients, of which, 68.8%were grade 1-2 and 12.5%were grade 3. Central CRS occurred in 6.3% (1/16) of patients. The complete response (CR) rate at the 3-month mark stood at 56.3% (9/16), with an overall response rate (ORR) of 68.8% (11/16). As of July 6, 2023, the median follow-up time was 10.6 months (4.4-33.6m), the 1-year OS was 73.4%, and the 1-year PFS was 68.8%. Median OS and PFS were not reached. One of the five patients who did not respond later underwent allogeneic hematopoietic stem cell transplantation and is still alive. The other four, despite attempts at salvage treatment including second CAR-T cell therapy, all died, with a median OS of only 5.6 months (4.4-8.9m). None of the four patients with extramedullary masses larger than 5cm achieved ORR despite tumor-reducing chemotherapy prior to CAR-T infusion. Only 1 of 3 patients with central involvement achieved CR and experienced grade 3 CRS along the way, while the other 2 did not respond to CAR-T therapy. Among all patients, only one experienced central CRS, and his cerebrospinal fluid showed no signs of tumor cells prior to the administration of CAR-T treatment. A patient who was in CR succumbed to an acute coronary event 19 months following infusion, despite remaining in CR. Conclusion: Even in the presence of TP53 gene abnormalities, resistance to BTK/BCL2 inhibitors, and unsuccessful previous chemotherapy regiments, A single CAR T cell therapy can result in CR in more than half of RT patients. Nonetheless, the prognosis remains bleak for patients presenting with large tumor masses and central nervous system involvement, despite having received chemotherapy aimed at reducing tumor size. The outlook is particularly dismal for those patients who fail to respond to CAR-T cell therapy.

Tofacitinib in the treatment of primary Sjögren’s syndrome-associated interstitial lung disease: study protocol for a prospective, randomized, controlled and open-label trial

IntroductionTofacitinib, a selective inhibitor of JAK1 and/or JAK3, is considered to alleviate the pulmonary condition of primary Sjögren’s syndrome (pSS)-associated interstitial lung disease (ILD) through its anti-inflammatory and antifibrotic effects.Methods and analysisThis is a single-center, prospective, randomized, open-label trial. The trial will compare a 52-week course of oral tofacitinib with traditional therapy cyclophosphamide (CYC) combined with azathioprine (AZA) in the treatment of pSS-ILD. A total of 120 patients will be randomly assigned into two treatment groups with a 1:1 ratio and followed for 52 weeks from the first dose. The primary endpoint of the study is the increase of forced vital capacity (FVC) at 52 weeks. Secondary endpoints include high-resolution computed tomography (HRCT), diffusion capacity for carbon monoxide of the lung (DLCO), the Mahler dyspnea index, the health-related quality of life (HARQoL) score, the cough symptom score, EULAR Sjögren's syndrome disease activity index (ESSDAI), and safety.DiscussionThis study will be the first randomized controlled trial to investigate tofacitinib compared to the traditional regimen of CYC in combination with AZA in the treatment of pSS-ILD, which will provide data on efficacy and safety and further elucidate the role of the JAK-STAT signaling pathway in the development of pSS-ILD.Ethics and disseminationBefore starting the experiment, the research proposal, informed consent (ICF) and relevant documents in accordance with the ethical principles of the Helsinki Declaration and the relevant requirements of the local GCP rules for ethical approval shall be submitted to the ethics committee of the hospital. The ethical approval of this study is reviewed by the Ethics Committee of Tongji Hospital and the ethical approval number is 2021-LCYJ-007. When the experiment is completed, the results will also be disseminated to patients and the public through publishing papers in international medical journals.Trial registrationThe study was registered on the Chinese Clinical Trial Registry, www.chictr.org.cn; ID ChiCTR2000031389.

THE USE OF AN ULTRASONIC TOOL TO CUT HUMAN BONE: CUTTING SPEED AND FORCES OF ORTHOPAEDIC SURGEONS

AbstractBackgroundUltrasonic cutting of bone boasts many advantages over alternatively powered surgical instruments, including but not limited to: elimination of swarf, reduced reaction forces, increased precision in cutting and reduced adjacent soft tissue damage, reduced post-operative complications such as bleeding and bone fracture, reduced healing time, reduced intra-operative noise and ease of handling. Despite ultrasonic cutting devices being well established in oral and maxillofacial surgery, applications in orthopaedic surgery are more niche and are not as well understood. The aim of this study was to investigate the cutting speed (mm/s) and cutting forces (N) of orthopaedic surgeons using a custom-designed state of the art ultrasonic cutting tool to cut fresh human bone samples.MethodsA setup based on the Robot Operating System (ROS) and AprilTag was designed to track and to record the real time position of the ultrasonic cutting tool in space. Synchronised load cell axial force readings of three separate orthopaedic surgeons during ultrasonic cutting were recorded. Each surgeon was asked to find a comfortable position that reflects as close as possible their clinical handling of a cutting instrument used in surgery, and to perform two cuts in each of three samples of human cortical bone. Bone samples were obtained following ethical approval from an institutional review board (ethics approval number: SR1342) and prior informed consent was obtained from all patients. Bone samples were extracted from the femoral neck region of three hip osteoarthritis patients. During cutting, surgeons were allowed a total cutting time of one minute and cutting was conducted using an ultrasonic tool with frequency of a 35kHz (35.7 µm peak to peak displacement amplitude) under constant irrigation using a MINIPULS® 3 Peristaltic pump (38 revolutions per minute) using Phosphate-Buffered Saline (PBS) at 25°C. From the recorded data, the average instantaneous cutting velocity was calculated and the maximum cutting force was identified.ResultsAll surgeons assumed a back-and-forth cutting motion, variation in the applied cutting force was observed. The average vertical cutting speed, axial cutting force and cutting depth across all surgeons and all samples was 1.64 mm/s, 1.91 N and 0.73 mm, respectively. While increasing the axial cutting force resulted in a deeper cut, overloading of the ultrasound transducer occurred when the tool advanced too quickly into the bone tissue during cutting. The exact force threshold, or the optimal speed at which the surgeon can maintain a constant force during cutting, requires further investigation.ConclusionsIn this study, all surgeons cut using a back-and-forth cutting motion, with variation in the applied cutting force which may ultimately inform which clinical applications in orthopaedic engineering are most suitable for this technology. Applying too much force caused overloading of the ultrasound transducer, which is a limitation with the current cutting tool. The results from this study may facilitate the eventual uptake of ultrasonic cutting tools for application in orthopaedic surgery.Declaration of Interest(b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Is there structural change on MRI in gluteal tendinopathy after treatment? Single outcome measure extension of an RCT

BackgroundThe etiology of tendinopathy remains controversial and it is unknown whether degenerative structural changes in tendinopathies are reversible.HypothesisThere will be no structural change on magnetic resonance imaging (MRI) taken > 2-years after treatment for gluteal tendinopathy.Study DesignExtension of a single site, double-blind, prospective randomized-controlled trial to analyze the additional outcome measure; MRI changes.MethodsUniversity of Melbourne ethics approval number: 1852900, trial registration: ACTRN12613000677707. Participants with gluteal tendinopathy who had previously received a leukocyte-rich platelet-rich plasma injection (LR-PRP) or a corticosteroid injection (CSI) had a post treatment MRI between at least 2-years and up to 7 years following trial completion. A blinded, senior musculoskeletal radiologist graded all de-identified MRI scans using the Melbourne Hip Score (MHIP). The primary outcome measure was the change in overall pre- and post-treatment score.ResultsParticipants (n = 20) underwent MRI at mean time of 4.15 (SD 1.11; range 2–7) years after their initial treatment. There was no change in the overall mean MHIP score for the CSI group (Pre 4.3 (SD 2.3) Post 4.3 (SD 1.1), p = 1.00). Although there was an improvement in the LR-PRP group mean MHIP score (Pre 5.3 (SD 3.0) Post 4.77 (SD 2.5), p = 0.56) it was not statistically significant. However, in the LR-PRP intervention group, five out of nine of participants’ MHIP score improved, with four of these improving by 2–4 points.ConclusionThe hypothesis that there would be no improvement in MHIP scores following treatment of gluteal tendinopathy was supported. Findings of improvement in the LR-PRP group at 4 years would support further studies powered to look for structural improvement. These findings suggest that structural change following treatment for tendinopathy may be possible supporting the inclusion of MRI as a core outcome for future studies.Clinical relevanceThe study suggests that degenerative structural changes in tendons may be reversible.

Practices, perceptions and trust of the public regarding online drug purchasing: a web-based survey from Jordan

ObjectivesOnline purchasing, including drugs, increased dramatically in the last decade especially through the COVID-19 pandemic. The aim of this study was to investigate the frequency and attitudes of consumers concerning...

Association between Chinese herbal medicine (CHM) treatment and depression among cancer patients in China: An outpatient-based cross-sectional study.

Depression is a prevalent condition among cancer patients and significantly impacts their quality of life. Traditional Chinese Medicine, particularly Chinese Herbal Medicine (CHM), has shown potential in both anti-tumor and anti-depressive effects. However, there is a dearth of scientific literature exploring the association between CHM treatment and depression in cancer patients. This study aims to investigate the relationship between CHM treatment and depression in cancer patients. A cross-sectional study was conducted among cancer outpatients at Longhua Hosiptal, Shanghai University of Traditional Chinese Medicine, from June 2020 to April 2021 (Ethical approval number: 2020LCSY057). All patients signed informed consent and completed The European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30). Hamilton depression scale was evaluated depression by psychiatrists. The power of the sample size was determined using Gpower statistical and SPSS were used for statistical analysis. A total of 809 completed the study. Gender, medical insurance, the classification of time since diagnosis, ECOG, cancer stage, metastasis, gene mutation, treatment plan and CHM treatment were an important factor affecting depression (P < .05). Further analysis investigated the impact of CHM treatment on depression. There were 374 enrolled in CHM group and 435 enrolled in Non-CHM group. The assessment results of Hamilton depression scale and EORTC QLQ-C30 in CHM group were superior to those in Non-CHM group. The morbidity of depression is 50.27% in CHM group and 66.44% in Non-CHM group. After adjusting for potential confounders (gender, medical insurance, cancer stage, etc.), CHM treatment indicated negative correlation with depression (Odds ratio (OR) = 0.7, 95% confidence interval (CI): 0.5-0.9, P = .020). The interaction effects within each subgroup were no significantly affect the relationship between CHM treatment and depression (P > .05). CHM treatment was an independent protective factor for depression in cancer patients, and lead to better quality of life for cancer patients.

Melodic intonation therapy for non-fluent aphasia after stroke: A clinical pilot study on behavioral and DTI findings

Music-based melodic intonation therapy (MIT) has shown promise as a treatment for non-fluent aphasia after stroke. This trial compared the efficacy of music-based MIT and speech therapy (ST) in aphasia, focusing on arcuate fasciculus connectivity in brain structural and language ability scores. A total of 62 patients were enrolled, of whom 40 completed the trial. The experimental group received MIT for 30min/d, five days per week for four weeks, while the control group received ST with the same dose. The BDAE and fMRI-DTI were performed at T0 and T1. The music-based MIT group demonstrated better language levels. DTI showed that FA, FN, and path length of the MIT group in the right hemisphere were significantly increased. Music-based MIT had positive effects on reorganization and activation of arcuate fasciculus in aphasia after stroke. This research is funded by NSFC No. T2341003 and No.2020CZ-10. Clinical Trials ChiCTR2000037871. Ethics approval number: 2020-013-1.

Protocol for a parallel assignment prospective, randomised, comparative trial to evaluate the safety and efficacy of intense pulsed light (IPL) combined with 3% diquafosol (DQS) ophthalmic solution in dry eye syndrome

IntroductionEvaporative dry eye (EDE) is common and can lead to ocular pain, decreased visual quality and reduced quality of life. Intense pulsed light (IPL) and 3% diquafosol ophthalmic solution have...

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

Erratum: Eyestalk Ablation to Increase Ovarian Maturation in Mud Crabs.

Differences in stress levels between junior high school students and college students during online learning

Differences in stress levels between junior high school students and college students during online learning