Final Criteria Research Articles

The GABAergic system in Alzheimer's disease: a systematic review with meta-analysis.

The γ-aminobutyric acid (GABA)ergic system is the primary inhibitory neurotransmission system in the mammalian brain. Its dysregulation has been shown in multiple brain conditions, but in Alzheimer's disease (AD) studies have provided contradictory results. Here, we conducted a systematic review with meta-analysis to investigate whether the GABAergic system is altered in AD patients compared to healthy controls (HC), following the PRISMA 2020 Statement. We searched PubMed and Web of Science from database inception to March 18th, 2023 for studies reporting GABA, glutamate decarboxylase (GAD) 65/67, GABAA, GABAB, and GABAC receptors, GABA transporters (GAT) 1-3 and vesicular GAT in the brain, and GABA levels in the cerebrospinal fluid (CSF) and blood. Heterogeneity was estimated using the I2 index, and the risk of bias was assessed with an adapted questionnaire from the Joanna Briggs Institute Critical Appraisal Tools. The search identified 3631 articles, and 48 met the final inclusion criteria (518 HC, mean age 72.2, and 603 AD patients, mean age 75.6). Random-effects meta-analysis [standardized mean difference (SMD)] revealed that AD patients presented lower GABA levels in the brain (SMD = -0.48 [95% CI = -0.7, -0.27], adjusted p value (adj. p) < 0.001) and in the CSF (-0.41 [-0.72, -0.09], adj. p = 0.042), but not in the blood (-0.63 [-1.35, 0.1], adj. p = 0.176). In addition, GAD65/67 (-0.67 [-1.15, -0.2], adj. p = 0.006), GABAA receptor (-0.51 [-0.7, -0.33], adj. p < 0.001), and GABA transporters (-0.51 [-0.92, -0.09], adj. p = 0.016) were lower in the AD brain. Here, we showed a global reduction of GABAergic system components in the brain and lower GABA levels in the CSF of AD patients. Our findings suggest the GABAergic system is vulnerable to AD pathology and should be considered a potential target for developing pharmacological strategies and novel AD biomarkers.

Paper 24: Reliability of Posterior Tibial Slope Measurement on Magnetic Resonance Imaging Versus Computed Tomography

Objectives: Increased posterior tibial slope (PTS) has been linked to higher rates of anterior cruciate ligament (ACL) injury and ACL graft failure post-reconstruction. In recent years, more specific investigations have delineated distinct roles of the medial tibial plateau (MTP) and lateral tibial plateau (LTP) geometries on anteroposterior and rotatory stability of the knee. While the diagnostic workup of patients with ACL insufficiency typically consists of radiographs and magnetic resonance imaging (MRI), computed tomography (CT), which is the gold standard for evaluating the osseous geometry of the proximal tibia, is not routinely obtained. With increased understanding of the roles of the MTP and LTP geometries on tibiofemoral kinematics, accurate sagittal slope measurements of both the MTP and LTP will be crucial for further defining the treatment algorithm for ACL insufficiency. It is currently unknown whether traditional MRI can be used to accurately measure PTS and how well these measurements correlate to those on CT. Therefore, the purpose of this study was to compare PTS measurements of the MTP and LTP on MRI versus CT. Methods: After Institutional Review Board approval was obtained, an institutional picture archiving and communication system imaging database was retrospectively queried for patients that received concurrent MRI and CT imaging of the same knee within a one-year interval. Knees with significant arthrosis (Kellgren-Lawrence grade &gt;2), deformity, proximal tibia fracture, or artifact that obscured visualization of proximal tibia landmarks were excluded. On paired MRI and CT studies, PTS of the MTP and LTP were measured using a previously described, validated method (Hudek et al, Clin Orthop Relat Res, 2009) by two independent raters (Figure 1). Interrater reliability of PTS measurements was assessed using the intraclass correlation coefficient (ICC). Intermethod agreement between MRI and CT measurements was assessed using the ICC and Bland-Altman analysis. Results: A total of 41 knees in 40 patients (mean age, 37.9±13.4 years, 78.0% male) met final inclusion criteria. Interrater reliability was moderate for MRI measurements (ICC = 0.62-0.73) and high for CT measurements (ICC = 0.83-0.86). Mean measurements of PTS at the MTP were 3.3±2.8° (range, -4.7-8.4°) and 3.7±3.1° (range, -3.8-10.4°) on MRI and CT, respectively. Mean measurements of PTS at the LTP were 4.5±3.8° (range, -8.0-10.6°) and 5.2±3.6° (range, -3.6-15.7°) on MRI and CT, respectively. The mean absolute differences in PTS measurements between MRI and CT were 2.6±2.1° and 2.6±2.6° at the MTP and LTP, respectively. Poor intermethod agreement between MRI and CT was observed at the MTP (ICC = 0.31-0.41), while moderate intermethod agreement was observed at the LTP (ICC = 0.61-0.62). Bland-Altman plots demonstrated high variability and minimal bias of PTS measurements on MRI compared to CT (-0.9° [95% Limit of Agreement (LOA) -7.5-5.6°] for MTP; -1.0° [95% LOA -7.2-5.2°] for LTP) (Figure 2). Conclusions: With increased understanding of the roles of the medial and lateral tibial plateau geometries on tibiofemoral stability in the setting of ACL insufficiency, accurate measurements of PTS are necessary to guide treatment decisions. In this study, PTS measurements on MRI demonstrated lower interrater reliability compared to PTS measurements on CT. Poor-to-moderate agreement was observed for measurements of PTS of the MTP and LTP between paired MRI and CT studies, with high variability and minimal bias. Therefore, measurements of medial and lateral PTS may not be reliable on traditional MRI.

The Impact of Reference Standard on Diagnostic Testing Characteristics for Carpal Tunnel Syndrome: A Systematic Review.

A systematic review was performed following PRISMA guidelines to investigate diagnostic modalities used in CTS. A literature search of Embase, PubMed, and Cochrane Reviews was conducted for the years of 2010-2021 for primary data, and 113 studies met final inclusion criteria. Studies were stratified based on the reference standard utilized and diagnostic modality assessed, and the weighted means of the sensitivities and specificities were calculated. Thirty-five studies used clinical diagnosis alone as a reference standard, and 78 studies used electrodiagnostic study (EDS). The specificity for MRI and ultrasound (US) were substantially lower when EDS was used as the reference standard. MRI was the test most affected by the reference standard used, showing increased sensitivity when using EDS as the reference compared to clinical diagnosis (77.1% versus 60.9%) and decreased specificity (87.6% versus 99.2%). Regardless of the reference standard used, all tests had anticipated false-positive and/or false-negative rates of at least 10%. Testing characteristics vary greatly based on the choice of reference standard, with the sensitivity of MRI most affected. Regardless of reference standard used, EDS, US, and MRI each had false-positive and/or false-negative rates too great to be appropriate for use as a screening examination.

Health Disparities among Rural Individuals with Mental Health Conditions: A Systematic Literature Review.

There is growing concern about the availability of healthcare services for rural patients. This systematic literature review evaluates original research on health disparities among rural and urban populations with mental health conditions in North America. Using PRISMA guidelines, we used four electronic databases (Pubmed, Cochrane, PsychInfo, Web of Science) and hand searches and included original research conducted in the United States or Canada before July 2021 that compared health outcomes of patients with any mental health disorder in rural versus non-rural areas. Both qualitative and quantitative data were extracted including demographics, mental health condition, health disparity measure, rural definition, health outcome measures/main findings, and delivery method. To evaluate study quality, the modified Newcastle Ottawa Scale was used. Our initial search returned 491 studies and 17 studies met final inclusion criteria. Mental health disorders included schizophrenia (4 studies), PTSD (10), mood disorders (9), and anxiety disorders (6). Total sample size was 5,314,818 with the majority being military veterans. Six studies (35.2%) showed no significant rural-urban disparities while eleven (64.7%) identified at least one. Of those, nine reported worse outcomes for rural patients. The most common disparities were diagnostic differences, increased suicide rates and access problems. This review found mixed results regarding outcomes in rural patients with mental health disorders. Disparities were found regarding risk of suicide and access to services. Telehealth in addition to in person outreach to these rural communities may be alternatives to impact these outcomes.

Poster 259: Delayed Care and Clinical Outcomes of Medicaid Patients versus Commercially Insured Patients Treated with Arthroscopic Meniscus Repair

Objectives: Medicaid patients with meniscal tears experience delays in care from delayed initial presentation to an orthopaedic surgeon to increased overall time from injury to surgery. While it has been previously established that medicaid patients may have delays in surgery, little is know about how this affects clinical outcomes. The goal of this study was to evaluate the time from injury to surgery and the clinical outcomes of Medicaid compared to commercially insured patient populations undergoing meniscus repair. Methods: A retrospective review of patient records with the meniscus repair codes CPT 29882 and 29883 from October 2014 to October 2018 was conducted. Patients over the age of 21 years old, with a fracture, grade 3 or 4 chondromalacia, or Worker’s Compensation payer type were excluded. The remaining patients’ insurance at the date of surgery was categorized as either commercial or Medicaid payer type. Time from initial injury to surgery, pain level, IKDC, Lysholm Knee Score and Tegner Activity Score were compared across the two patient categories. Statistical analysis was performed with 2 sample t-test to compare numerical data between the two groups. Results: In total, 98 patients met the final inclusion criteria with 57 patients in the Medicaid group and 41 patients in the commercial group. The average age of the commercial group was 16.9 and the average age of the Medicaid group was 15.1 (p&lt;.001). There was an increase in the average time from injury to surgery from the commercial group to the Medicaid group (p=.04). The average time from injury to surgery was 112 days for the commercial group versus 187 days for the Medicaid patients, an average difference of 75 days or roughly 2.5 months. There was no significant difference in the one-year outcomes between the commercial and Medicaid groups for pain level, IKDC, Lysholm or Tegner level (p=.69, p=.15, p=.09, p=.75, respectively). Conclusions: Young Medicaid insured patients with meniscus tears experienced on average 2.5 month longer delays until surgery than their commercially insured counterparts. This result is consistent with previous studies in the literature. When meniscus tears are treated with surgical repair, both young Medicaid insured patients and commercial insured patients had excellent outcomes with no significant difference between the two groups. While this study found no difference in post-operative outcomes, the discrepancy in time from injury to surgery is still an inequality that deserves to be addressed. Medicaid patients may experience prolonged discomfort and functional limitations during their 2.5- month average longer delays until surgery. Therefore, further work is needed to determine adequate solutions to reducing discrepancies in different payer type patient populations awaiting much needed surgical repair. [Table: see text][Table: see text][Table: see text]

EN İYİ-EN KÖTÜ YÖNTEMİ KULLANILARAK BİLGİ TEKNOLOJİLERİ TEDARİKÇİ İZLEME KRİTERLERİNİN BELİRLENMESİ: BİR HAVAYOLU İŞLETMESİ ÖRNEĞİ

Supplier monitoring, one of the critical steps of the supplier development process in organizations, is the formal evaluation of suppliers' performance at regular intervals. Industry-specific criteria need to be developed to evaluate IT suppliers that provide organizations with information technology such as software, hardware, maintenance, data center and cloud technologies. In this study, it is aimed to create a set of performance monitoring criteria specific to the IT supplier segment for an airline company and to weight each criterion according to the degree of importance. The analysis of the research was carried out in three stages. In the first stage, 41 criteria were determined by expert interviews and literature review. In the second stage, a consensus of experts was made and a total of 27 final criteria were determined under the dimensions of financial, operational, supplier abilities, strategic and relationship. In the third stage, weights were assigned to each criterion using the best and worst method. Among all the criteria, the flexibility of the supplier, the ability of the supplier to adapt the buyer company to the changing technology and the completeness of the quality of the offered product/service emerged as the most important criteria. Özet kısmında amaç, yöntem, bulgular, araştırmanın sınırları ve makalenin orijinalliği ile ilgili bilgiler içermeli. Özet en çok 150 kelimeden oluşmalıdır.

Elements and Definitions of Continuing Professional Development Leadership: A Scoping Review.

Leaders are being asked to transform the way that continuing professional development (CPD) is delivered to focus on better, safer, and higher quality care. However, there is scarce literature on CPD leadership. We set out to study what CPD leadership means and describe the competencies required for CPD leadership. A scoping review following Preferred Reporting Items for Systematic Reviews and Meta-analyses extension guidelines for scoping reviews guidelines was conducted. With librarian support, four databases were searched for publications related to leadership, medical education, and CPD. Publications were screened by two reviewers and three reviewers extracted data. Among 3886 publications, 46 were eligible for a full-text review and 13 met the final inclusion criteria. There was no agreed upon definition of CPD leadership and variable models and approaches to leadership in the literature. Contextual issues shaping CPD (eg, funding, training, and information technology) are evolving. We identified several attitudes and behaviors (eg, strategic thinking), skills (eg, collaboration), and knowledge (eg, organizational awareness) important to CPD leadership, but no established set of unique competencies. These results offer the CPD community a foundation on which competencies, models, and training programs can build. This work suggests the need to build consensus on what CPD leadership means, what CPD leaders do, and what they will need to create and sustain change. We suggest the adaptation of existing leadership frameworks to a CPD context to better guide leadership and leadership development programs.

Secondary autoimmune immune ear disease (AIED): a systematic review and meta-analysis on vestibular manifestations of systemic autoimmune and inflammatory disorders.

Secondary autoimmune inner ear disease (AIED) is often bilateral and asymmetric in patients presenting with audiovestibular symptoms due to a systemic autoimmune disease. This systematic review and meta-analysis are aimed at identifying and highlighting patterns in prevalence of vestibular dysfunction, symptom presentation, and diagnostic methods in extant literature by combining clinical context from case reports with quantitative analyses from cohort studies. Screening of articles by title, abstract, and full text was completed by four reviewers (K.Z., A.L., S.C., and S.J.). In this study, we grouped secondary AIED and systemic autoimmune diseases by pathophysiologic mechanism: (1) connective tissue disease (CTD), (2) vasculitides (VAS), (3) systemic inflammatory disorders (SID), and (4) other immune-mediated disorders (OIMD). The search for AIED disease identified 120 articles (cohorts and case reports) that met the final inclusion criteria. All 120 were included in the qualitative review, and 54 articles were included for meta-analysis. Of these 54 articles, 22 included a control group (CwC). Ninety individual cases or patient presentations from 66 articles were included for analysis in addition to the 54 cohort articles. Secondary AIED does not have a diagnostic algorithm for managing vestibular symptoms. The management of audiovestibular symptoms requires close collaboration between otolaryngologists and rheumatologists to preserve end-organ function of the ear. To improve our ability to understand the impact on the vestibular system, vestibular clinicians need to develop a standardized reporting method. Clinical presentation should frequently be paired with vestibular testing to contextually investigate symptom severity and provide higher quality care.

Application of a novel metaheuristic algorithm based two-fold hysteresis current controller for a grid connected PV system using real time OPAL-RT based simulator

Grid connected photovoltaic (GCPV) rooftop systems have been considered as fast development and promising renewable energy sources due to low maintenance cost, secure investment, noise-free and do not require additional space for installation. Various factors considered for the installation of GCPV are mathematical models of PV module, sizing methods based on techno-economic objectives, PV panels and configurations, selection of the final optimum configuration and environmental criteria. Selection of appropriate controller and its optimal design for power electronic based converters also plays a crucial role in the performance of GCPV. Therefore in this article, a two-fold hysteresis current controller (TFHCC) based on an Improved Arithmetic Optimization Algorithm (IAOA) is introduced and investigated for the first time, for a GCPV system to minimize the switching loss and total harmonic distortion (THD). A novel multi-objective function considering switching frequency and current error is proposed by assigning appropriate weights to obtain the optimal values of duty cycle and hysteresis bands using IAOA, AOA, Forensic Based Investigation (FBI), Differential Evolution (DE) and Particle Swarm Optimization (PSO) algorithms. TFHCC utilizes zero level of the inverter by properly switching it on for a half cycle only and either on or off for the other cycle. Comparative performance analysis of the optimal TFHCC obtained with different algorithms is presented and it is proved that IAOA based TFHCC exhibits substantial reductions in variation and magnitude of the average switching frequency by 2.82 kHz and THD by 0.65%. Initially, the study is carried out with MATLAB Simulink environment and then experimentally validated with real time simulator based on OPAL-RT 4510.

Criteria to evaluate efficacy of biologics in asthma: a Global Asthma Association survey

ABSTRACT Background Currently, there are no universally accepted criteria to measure the response to biologics available as treatment for severe asthma. This survey aims to establish consensus criteria to use for the evaluation of response to biologics after 4 months of treatment. Method Using Delphi methodology, a questionnaire including 10 items was validated by 13 international experts in asthma. The electronic survey circulated within the Interasma Scientific Network platform. For each item, five answers were proposed graduated from ‘no importance’ to ‘very high importance’ and by a score (A = 2 points; B = 4 points; C = 6 points; D = 8 points; E = 10 points). The final criteria were selected if the median score for the item was ≥7 and > 60% of responses according ‘high importance’ and ‘very high importance’. All selected criteria were validated by the experts. Results Four criteria were identified: reduce daily systemic corticosteroids dose by ≥50%; decrease the number of asthma exacerbations requiring systemic corticosteroids by ≥50%; have no/minimal side effects; and obtain asthma control according validated questionnaires. The consensual decision was that ≥3 criteria define a good response to biologics. Conclusions Specific criteria were defined by an international panel of experts and could be used as tool in clinical practice.

Antidiabetic properties of analog rice from local raw materials: a systematic review

Type 2 diabetes mellitus (T2DM) is a common disease, where about 90% of Indonesians suffer from high white rice consumption. According to various reports, analog rice from many raw materials has benefits for T2DM. This review aimed to identify nutritional content that can be found in various local raw materials for T2DM. In addition, this review explained the antidiabetic effects and mechanisms of the nutritional content. PRISMA guidelines were utilized as the basis of this systematic review. Relevant and related studies were determined by databases such as PubMed, Google Scholar, and Garuda. The identification process in those databases resulted in 284 articles, with only 56 articles included based on the final paper criteria. The primary keywords for the identification process include analog rice, T2DM, antidiabetic, glycemic index (GI), and fiber. Meanwhile, the secondary keywords are based on the review's local raw materials, such as purple yam, corn, banana, sorghum, and cassava. As a result, studies found nutritional compounds with antidiabetic properties inside analog rice made from different local raw materials. which each of them has different mechanisms to overcome T2DM. Therefore, the consumption of analog rice from purple yam, corn, banana, sorghum, and cassava has the potential to prevent T2DM.

Effects of mobile apps intervention on medication adherence and type 2 diabetes mellitus control: A systematic review and meta-analysis.

The prevalence of non-adherence to antidiabetic treatment remains high despite various efforts. Thus, the positive effects of the antidiabetic treatment cannot be optimised and the disease progresses to complications. This present systematic review and meta-analysis aimed to evaluate the effects of mobile applications (apps) intervention on medication adherence and type 2 diabetes mellitus (T2DM) control. This research was conducted following the PRISMA guidelines. The databases that had been searched included Web of Science, PubMed, Scopus, Cochrane Library and Ovid from 2017 to 2022. Study characteristics were retrieved and study outcomes such as adherence status and diabetes control were extracted and quantitatively analysed through meta-analysis. Eight studies met the final inclusion criteria and were included in the analysis, contributing to a total of 884 subjects. The methodological quality of the included studies was variable. Three studies reported statistically significant improvement in medication adherence through mobile apps intervention. Additionally, the mobile apps intervention proved effective in reducing glycaemic outcomes. As compared to non-mobile apps users, glycated haemoglobin (HbA1c) significantly decreased by 0.36% (95% CI -0.47% to -0.25%), whereas fasting plasma glucose (FPG) significantly decreased by 16.75 mg/dL (95% CI -17.60 mg/dL to -15.80 mg/dL). Mobile apps intervention had beneficial impacts on medication adherence and glycaemic parameters. Future research should explore the best practical approach for real-world settings.

The McKenzie Method Is an Effective Rehabilitation Paradigm for Treating Adults With Moderate-to-Severe Neck Pain: A Systematic Review With Meta-Analysis.

Neck pain is a common musculoskeletal condition frequently managed with numerous conservative interventions. The McKenzie method of mechanical diagnosis and therapy (MMDT)is a form of physical therapy evaluation and treatment that aims to improve pain and disability in patients with musculoskeletal pain, including neck pain. To date, no systematic review with meta-analysis has examined the use of the McKenzie MMDT for neck pain. This study aimed to examine the effectiveness of the McKenzie MMDT in adult patients with neck pain. A systematic review and meta-analysis were performed using PubMed, ScienceDirect, MEDLINE, CINAHL, Web of Science, and Google Scholar. Full search terms were "McKenzie method" OR "McKenzie approach" OR "McKenzie treatment" AND "neck pain." Inclusion criteria were the use of the McKenzie MMDT, level I randomized control trials (RCTs), adults, and outcomes of pain (0-10 scale) and disability (neck disability index). A total of 11 RCTs met the final selection criteria from 1,955 articles on initial search with 289 patients receiving the McKenzie MMDT out of 677 total patients. For meta-analysis, there was a clinically insignificant but statistically significant improvement in pain (1.14/10 points) in patients receiving the McKenzie MMDT versus control interventions (p<0.02). There was no significant improvement in the neck disability index score between the McKenzie MMDT versus control interventions (p=0.19). For severity of pain, there was a clinically and statistically significant improvement in moderate or severe pain (2.06/10 points; p<0.01), but not in mild-to-moderate pain (p=0.84) when comparing the McKenzie MMDT to control interventions. Overall, the McKenzie MMDT provides very small but statistically significant improvements in neck pain of all severity compared to control interventions. However, the McKenzie MMDT does provide clinically and statistically significant pain improvement in moderate-to-severe neck pain. Use of the McKenzie MMDT did not provide any significant improvement in disability compared to control interventions. This study is the first systematic review with meta-analysis on the effectiveness of the McKenzie MMDT for adult patients with neck pain.

A bibliometric analysis of global publication trends on rTMS and aphasia.

Aphasia is one of the most devastating cognitive disorders caused by brain injury and seriously hinders patients' rehabilitation and quality of life. Repetitive transcranial magnetic stimulation involves the repeated application of extracranial pulsed magnetic fields to the local central nervous system to alter the membrane potential of cortical nerve cells, generating induced currents that affect brain metabolism and electrical activity. As one of the most popular noninvasive brain stimulation techniques, it has been used to treat aphasia. However, only a few bibliometric studies have examined the research direction and main findings in the field. To obtain an in-depth understanding of the research status and trend in this area, a bibliometric analysis based on the Web of Science database was conducted. VOSviewer (Leiden University, Leiden, Netherlands) and Microsoft Excel (Microsoft, Redmond, USA) were used to extract bibliometric information. Analysis of global distribution was conducted using the webpage mapping implement GunnMap2 (http://lert.co.nz/map/). Publications in this field were retrieved from the Web of Science Core Collection database, and 189 articles met the final inclusion criteria. The most influential authors, institutions, journals, and countries were Ralph MA from the University of Manchester, Harvard University, Neuropsychologia, and the USA, respectively. This study revealed publication patterns and emerging trends in the literature, providing a detailed and objective overview of the current state of research on repetitive transcranial magnetic stimulation for the treatment of aphasia. This information will be of great benefit to anyone seeking information about this field and can serve as a reference guide for researchers aiming to conduct further research.

Utilization of Non-Transecting Pyeloplasty Techniques for Management of Recurrent Ureteropelvic Junction Obstruction

Introduction: Cases of recurrent ureteropelvic junction obstruction (UPJO) in patients who underwent a prior failed pyeloplasty may pose a difficult challenge for urologists. The increased findings of periureteral fibrosis and scarring in a reoperative field may increase the risk of ureteral devascularization and stricture recurrence. The goal of this study is to demonstrate three robotic non-transecting pyeloplasty techniques for patients in this setting. Methods: We conducted a retrospective review of our Collaborative of Reconstructive Robotic Ureteral Surgery (CORRUS) database for all consecutive patients between April 2012 and September 2019 who underwent a secondary pyeloplasty for management of a recurrent UPJO after prior failed pyeloplasty. Transecting (dismembered) and non-transecting pyeloplasty (YV plasty, buccal mucosa graft ureteroplasty onlay, or Heineke–Mikulicz) were the techniques used for secondary pyeloplasty. YV plasty was utilized in patients with high insertion UPJO without a redundant renal pelvis. A buccal mucosa graft ureteroplasty onlay was utilized for patients with nonobliterative long-segment UPJO and/or significant peri-ureteropelvic junction fibrosis. The Heineke–Mikulicz technique was utilized in patients with short-segment (≤1.5 cm) UPJO. Symptomatic absence of flank pain and radiographic obstruction (computed tomography urogram, renal scan, and/or renal ultrasound) were measures used to assess for postoperative success. Using a p < 0.05 for statistical significance, we used nonparametric independent sample median tests and chi-square tests to compare perioperative variables between transecting and non-transecting pyeloplasty. Results: Twenty-eight patients met the final inclusion criteria. Regarding preoperative variables, there was no difference in median operative time (p = 0.26) and estimated blood loss (p > 0.99) between both groups. In the non-transecting group, near-infrared fluorescence with indocyanine green was utilized more frequently (85.7% vs. 50.0%, p = 0.04). The non-transecting group also had a longer median stricture length (2.8 cm vs. 1.1 cm, p = 0.04). There was no difference in surgical success rates between both groups (85.7% for both groups, p > 0.99). Two patients who underwent a non-transecting buccal mucosa graft ureteroplasty onlay required postoperative management with percutaneous nephrostomy tubes caused by recurrent obstruction. Regarding postoperative variables, there was no difference in surgical success rates between both groups (p > 0.99). Conclusions: In patients with recurrent ureteropelvic junction obstruction after prior failed pyeloplasty, non-transecting pyeloplasty techniques, including YV plasty, buccal mucosa graft ureteroplasty onlay, and Heineke–Mikulicz pyeloplasty, are safe and feasible options. Given the potential technical challenges involved with secondary repair, non-transecting pyeloplasty techniques may offer benefits in reducing the risk of ureteral devascularization and preserving the fragile ureteral blood supply. J.J., M.L., J.K., and L.C.Z. have no conflicts of interest to disclose. M.D.S. is on the Scientific Advisory Board for Intuitive, a consultant for VTI Medical, and performs educational activities for Ethicon. D.D.E. is a paid speaker, consultant, and proctor for Intuitive Surgical, consultant for Johnson and Johnson, and founder/part owner of Melzi Corp. Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. The study was approved by the Institutional Review Board at Temple University (protocol number 20793). Runtime of video: 7 mins 15 secs This material was presented at the American Urological Association Conference in 2021 (https://doi.org/10.1097/JU.0000000000002052.04).

Antitumor effects and potential mechanisms of aconitine based on preclinical studies: an updated systematic review and meta-analysis.

Background: Herbs originating from the Aconitum L. (Ranunculaceae), such as Aconitum carmichaelii Debeaux. (Wutou), Aconitum pendulum Busch. (Tiebangchui), and Aconitum kusnezoffii Reichb. (Caowu), etc. are highly valued for their medicinal properties. The roots and tubers of these herbs are commonly used to treat an array of ailments, including joint pain and tumors. The alkaloids present in them are the primary active components, with aconitine being the most notable. Aconitine has gained attention for its exceptional anti-inflammatory and analgesic properties, as well as its potential as an anti-tumor and cardiotonic agent. However, the exact process through which aconitine hinders the growth of cancerous cells and triggers their programmed cell death remains unclear. Therefore, we have undertaken a comprehensive systematic review and meta-analysis of the current research on the potential antitumor properties of aconitine. Methods: We conducted a thorough search of relevant preclinical studies in databases including PubMed, Web of Science, VIP, WanFang Data, CNKI, Embase, Cochrane Library, and National Center for Biotechnology Information (NCBI). The search was conducted up until 15 September 2022, and the data were statistically analyzed using RevMan 5.4 software. The number of tumor cell value-added, tumor cell apoptosis rate, thymus index (TI), and Bcl-2 gene expression level were the main indicators to be analyzed. Results: After applying the final inclusion criteria, a total of thirty-seven studies, comprising both in vivo and in vitro research were analyzed. The results showed that treatment with aconitine led to a significant reduction in tumor cell proliferation, a noteworthy increase in the rate of apoptosis among tumor cells, a decrease in the thymus index, and a reduction in the expression level of Bcl-2. These results suggested that aconitine could inhibit the proliferation, invasion, and migration abilities of tumor cells by regulating Bcl-2 etc., thereby enhancing the anti-tumor effects. Conclusion: In summary, our present study demonstrated that aconitine effectively reduced tumor size and volume, indicating a strong anti-tumor effect. Additionally, aconitine could increase the expression levels of caspase-3, Bax and other targets. Mechanistically, it may regulate the expression levels of Bax and Bcl-2 through the NF-κB signaling pathway, ultimately inhibiting tumor cell proliferation through autophagy.

Predictors of tropical cyclone-induced urban tree failure: an international scoping review

BackgroundTrees are critical components of rural and urban ecosystems throughout the world. While they have adapted to the historic conditions of their native environments, climate change, urbanization, and human-assisted range expansion may test the storm resiliency of many tree species.ObjectiveIn this global multilingual scoping review, we investigate a range of intrinsic (i.e., tree characteristics) and external (i.e., environmental and management) factors which have been used to predict tree failure during tropical cyclones.DesignWe searched online databases and journals in English, Chinese, French, Japanese, Portuguese, and Spanish to find peer-reviewed papers and dissertations. We retained papers that used ground-based methods to study tree damage following a tropical cyclone and conducted a statistical analysis of factors that influence tree resistance to damage. From each paper we extracted details of study methods, and the relationships between damage and predictors.ResultsOur efforts generated 65 peer-reviewed papers and dissertations that met our final criteria for inclusion (i.e., data on the relative proportion of trees failed/intact as assessed no more than a year after the storm event). Of these papers 37 independent variables were assessed to predict tree failure. Research in both urban and rural settings tends to be concentrated in regions frequently impacted by tropical cyclones. Characteristics of species such as wood density have been studied in rural environments and are also relevant predictors for tree failure in urban trees. Environmental characteristics unique to urban settings such as planting areas surrounded by pavement need further research. Several urban studies demonstrate that risk assessment methods can predict tree failure during a storm.ConclusionResults can be used by future storm researchers to identify both predictors may warrant inclusion in their models as well as predictors which have yet to be tested. Results can also inform planning and activities that can mitigate tropical cyclone damage to the urban forest.

The Incidence of Postoperative Shoulder Stiffness After Arthroscopic Rotator Cuff Repair: A Systematic Review.

Rotator cuff tear (RCT) is a common shoulder condition frequently treated with arthroscopic rotator cuff repair (ARCR) after conservative interventions have failed. Postoperative shoulder stiffness (POSS) is a common complication after ARCR. The purpose of this study is to determine the incidence of POSS after ARCR in total and based on tear extent prior to ARCR. A systematic review was performed using PubMed, Cumulative Index of Nursing and Allied Health Literature (CINAHL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and ScienceDirect databases. The search terms were "rotator cuff repair" AND "arthrofibrosis" OR "postoperative shoulder stiffness." Articles were selected based on ARCR and the presence of POSS documentation. Twenty-five articles out of 284 articles met the final selection criteria after reviewing for patients who received ARCR. Out of all patients (n=9,373), 597 had POSS (6.4%). Out of the 2,424 patients with a specified tear pattern, 96 out of 1,862 (5.2%) patients with full-thickness tearsand 58 out of 562 (10.3%) patients with partial-thickness tears had POSS after ARCR. Partial-thickness tears are associated with higher rates of POSS after ARCR as compared to full-thickness tears (p<0.001). Overall, POSS is a common complication after ARCR with an incidence of 6.4%, regardless of tear type. POSS is more common in patients who receive ARCR for partial-thickness RCT (10.3%) as compared to patients who receive ARCR for full-thickness RCT (5.2%). More research is needed to determine other factors impacting the incidence of POSS after ARCR.

Alternatives to DEXA for the assessment of bone density: a systematic review of the literature and future recommendations.

Osteoporosis has significant implications in spine fusion surgery, for which reduced spinal bone mineral density (BMD) can result in complications and poorer outcomes. Currently, dual-energy x-ray absorptiometry (DEXA) is the gold standard for radiographic diagnosis of osteoporosis, although DEXA accuracy may be limited by the presence of degenerative spinal pathology. In recent years, there has been an evolving interest in using alternative imaging, including CT and MRI, to assess BMD. In this systematic review of the literature, the authors assessed the use and effectiveness of MRI, opportunistic CT (oCT), and quantitative CT (qCT) to measure BMD. In accordance with the PRISMA guidelines, the authors conducted a systematic search for articles posted on PubMed between the years 2000 and 2022 by using the keywords "opportunistic CT, quantitative CT, MRI" AND "bone density" AND "spine." Inclusion criteria consisted of articles written in English that reported studies pertaining to human or cadaveric subjects, and studies including a measure of spinal BMD. Articles not related to spinal BMD, osteoporosis, or spinal surgery or reports of studies that did not include the use of spinal MRI or CT were excluded. Key study outcomes were extracted from included articles, and qualitative analysis was subsequently performed. The literature search yielded 302 articles. Forty-two articles reported studies that met the final inclusion criteria. Eighteen studies utilized MRI protocols to correlate spinal BMD with vertebral bone quality scores, M-scores, and quantitative perfusion markers. Eight studies correlated oCT with spinal BMD, and 16 studies correlated qCT with spinal BMD. With oCT and qCT imaging, there was consensus that Hounsfield unit (HU) values > 160 demonstrated significant reduction in risk of osteoporosis, whereas HU values < 110 were significantly correlated with osteoporosis. Osteoporosis is increasingly recognized as a significant risk factor for complications after spinal fusion surgery. Consequently, preoperative assessment of BMD is a critical factor to consider in planning surgical treatment. Although DEXA has been the gold standard for BMD measurement, other imaging modalities, including MRI, oCT, and qCT, appear to be viable alternatives and may offer cost and time savings.

35. Sublingual Versus Oral Captopril for Blood Pressure Reduction in Hypertensive Urgency: A Systematic Review

Background: Hypertensive emergencies are distinguished from hypertensive urgencies by the presence of immediately escalating target organ damage. The treatment of emergency hypertension should focus on bringing the blood pressure down gradually in 24 hours. Well known Guidelines recommend intravenous antihypertensive in this clinical setting. However, in some cases such as rural areas, oral antihypertensives are the one and only available option. Objective: To evaluate the which Captopril intake - the widely available oral anti-hypertensive agent in rural areas - that would have better outcome in Emergency Hypertension. Method: This review was conducted in accordance with the requirements outlined in the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) 2020 guidelines. The search for studies to be included in the systematic review was carried out from December, 28nd 2022 using the PubMed and SagePub databases by inputting the words: “sublingual”, “oral”, “captopril”, “blood pressure reduction” and “hypertension urgency”. Result: After identifying 1.254 PubMed and 897 SagePub articles, the total article that met publishing time criteria (2012 and after) are 190 articles. After performing tittle screening, 37 articles were chosen and when final exclusion criteria were applied, we have 4 articles left. The study showed that patients who received captopril subligual 25 mg experienced the greatest reduction in systolic blood pressure, while DBP and MAP were better in the oral group. Conclusion: Since the MAP reduction is the main therapy target in emergency hypertension, oral captopril intake is better than sublingual to achieve this goal.