Group Mean Research Articles

The Association Between Weight Loss and Hepatitis B Surface Antigen Seroclearence in Chronic Hepatitis B Patients

Background: In chronic hepatitis B (CHB) patients, hepatitis B surface antigen (HBsAg) seroclearance is the main target of therapy and is rarely observed. Objectives: This study aimed to investigate the factors affecting HBsAg loss by focusing especially on the relationship between weight loss and HBsAg loss. Methods: This study was designed retrospectively to assess HBsAg status and clinical and laboratory findings in CHB patients, as well as cross-sectionally to evaluate lifestyle factors. A total of 5600 hepatitis B (HB) infection patients who were treated or followed between 2008 and 2020 were evaluated retrospectively. In the HBsAg loss group, 94 CHB patients were examined based on exclusion criteria, and 95 patients without HBsAg loss were matched as controls. Patient data and laboratory findings were retrieved from patient files. All participants were surveyed using a questionnaire developed by the authors, which inquired about the lifestyle characteristics of CHB patients. The questionnaire covered topics such as the use of herbal products, coffee consumption, medication history, antiviral treatment, concurrent diseases, weight changes, and patient demographics. Statistical analysis was performed using SPSS version 25.0. The Student's t-test was used to compare quantitative variables, while the chi-square test was used for categorical variables. A paired samples t-test was used to compare dependent samples. The statistical significance level was set at a p value less than 0.05. Results: The basal mean hepatitis B virus (HBV) DNA level was significantly lower in the HBsAg loss group (P < 0.001). The prevalence of hyperlipidemia comorbidity (P = 0.008) and moderate/severe hepatosteatosis (P < 0.05) was significantly higher in the HBsAg loss group compared to the non-HBsAg loss group. Prior to HBsAg loss, 44 (47%) patients in the HBsAg loss group experienced weight loss, whereas only 22 (23%) patients in the non-HBsAg group had a history of weight loss (P < 0.001). Conversely, the incidence of weight gain was significantly lower in the HBsAg loss group (P = 0.001). A paired samples t-test was conducted to compare the baseline and last period body mass index (BMI) means of the HBsAg loss group, revealing a statistically significant decrease in mean BMI in the last period (P < 0.001). Conclusions: Weight loss was significantly associated with HBsAg seroclearance in patients with CHB infection. Conversely, weight gain was associated with HBsAg persistence.

Convergence and divergence in Kawasaki disease and multisystem inflammatory syndrome in children: results from the COVASAKI survey.

To compare Kawasaki disease (KD) and multisystem inflammatory syndrome (MIS-C) in children. Prospective collection of demographics, clinical and treatment data. Assessment of type 1 interferon (IFN) score, CXCL9, CXCL10, Interleukin (IL)18, IFNγ, IL6, IL1b at disease onset and at recovery. 87 patients (43 KD, 44 MIS-C) were included. Age was higher in MIS-C compared to KD group (mean 31±23 vs. 94±50 months, p<0.001). Extremities abnormalities (p=0.027), mucosal involvement (p<0.001), irritability (p<0.001), gallbladder hydrops (p=0.01) and lymphadenopathy (p=0.07) were more often recorded in KD. Neurological findings (p=0.002), gastrointestinal symptoms (p=0.013), respiratory involvement (p=0.019) and splenomegaly (p=0.026) were more frequently observed in MIS-C. Cardiac manifestations were higher in MIS-C (p<0.001), although coronary aneurisms were more frequent in KD (p=0.012). In the MIS-C group, the multiple linear regression analysis revealed that a higher IFN score at onset was related to myocardial disfunction (p<0.001), lymphadenopathy (p=<0.001) and need of ventilation (p=0.024). Both CXCL9 and CXCL10 were related to myocardial disfunction (p<0.001 and p=0.029). IL18 was positively associated to PICU admission (0.030) and ventilation (p=004) and negatively associated to lymphadenopathy (0.004). IFNγ values were related to neurological involvement and lymphadenopathy (p<0.001), IL1b to hearth involvement (0.006). A negative correlation has been observed between IL6 values, heart involvement (p=0.013) and PICU admission (p<0.001). The demographic and clinical differences between KD e MIS-C cohorts confirm previous reported data. The assessment of biomarkers levels at MIS-C onset could be useful to predict a more severe disease course and the development of cardiac complications.

A Comparison of the Smile Esthetic Understanding of Periodontists, Orthodontists, General Dentists, and Dental Students

Objective: The aim of this study was to evaluate smile esthetics among periodontists, orthodontists, general dentists, and dental students. Methods: The study consisted of five groups: periodontists, orthodontists, general dentists, fifth-year dental students, and fourth-year dental students. The evulaters used the Smile Esthetics Index (SEI) consisting of 10 items to analyze the natural smile photographs of 15 different individuals. One-way ANOVA was performed for the comparison of group means. The Duncan multiple comparison test was also used to identify different groups. Non-linear principal component analysis was performed to determine the configuration of the relationship between categories of variables in two-dimensional space. Results: The group with the highest reliability coefficient among the groups was the fourth-year dental students (Cronbach's Alpha = 0.89). This was followed by general dentists, periodontists, fifth-year dental students, and orthodontists. According to the evaluation of the total score averages of the fifteen pictures, a statistically significant difference was observed between the groups (p = 0.041). Accordingly, the fourth-year dental students (5.78 ±1 .13) had a lower total score than the fifth-year dental students (6.56 ± 0.88), and this difference was statistically significant. However, no significant difference was observed between the fourth-year dental students and the general and specialized dentists and between the fifth-year dental students and graduated and specialized dentists in terms of the total score given to the pictures. Conclusion: It was observed that the reliability coefficient was high in all groups evaluated with SEI. It can be concluded that esthetic perception is formed by actively performing the profession of dentistry, and this situation does not change according to specialization.

Assessing the impacts of crop production on climate change: An in-depth analysis of long-term determinants and policy implications.

This research investigates the long-term determinants of carbon emissions in three diverse regions-Europe and Central Asia (ECA), Sub-Saharan Africa (SSA), and the Middle East and North Africa (MENA)-spanning 1990 to 2020. Utilizing advanced econometric models and analyses, including the Regularized Common Correlated Effects Estimator (rCCE), Common Correlated Effects Estimator (CCE), and Mean-Group (MG) approach, the study explores the intricate relationships between carbon emissions, crop production, emissions per agricultural production, energy consumption, renewable energy consumption, per capita GDP, and population. Region-specific nuances are uncovered, highlighting the varying dynamics: ECA exhibits intricate and non-significant relationships, SSA showcases significant effects of population dynamics and green technology adoption, and the MENA region reveals a nuanced interplay between emissions per agricultural production.The findings underscore the universal efficacy of green technology adoption for mitigation. Strategies for mitigating carbon emissions in the agricultural sector require diversified energy transition approaches, emphasizing efficiency enhancements, green technology adoption, and tailored population management strategies based on regional intricacies. Counterfactual simulations indicate the potential efficacy of strategic measures targeting crop production to reduce carbon emissions, while acknowledging the nuanced relationship between economic growth and emissions. Policymakers are urged to recognize the persistence in emission patterns, emphasizing the importance of targeted interventions to transition towards more sustainable trajectories. Overall, the research provides essential insights for crafting effective policies at both regional and global scales to address the complexities of climate change mitigation in the agricultural sector.

The effect of craniocervical flexors endurance training on suprahyoid muscle activation in healthy adults: A randomised controlled trial.

Cervical posture affects swallowing function through contractile and non-contractile structures. Craniocervical flexor endurance training (CCFET), which focuses on the activation of deep cervical muscles, is used to ensure cervical posture stability. The aim of this study was to investigate the effect of CCFET on the suprahyoid muscles (SH), which play an important role in swallowing function. Eighty healthy individuals (52 female and 28 male, mean age 21.77 ± 1.81 years) were recruited and randomly assigned to groups that underwent either deep cervical flexor (DCF) training with a pressure biofeedback unit (CCFET group, n = 41) or no intervention (control group, n = 39). The intervention was applied for 4 weeks (five sessions per week). Static endurance and activation of DCF muscles (Craniocervical Flexion Test, CCFT), tragus-wall distance (TWD) for forward head posture and surface electromyographic (sEMG) activation of suprahyoid muscles were evaluated. The endurance and activation of the DCF muscles were significantly increased in the CCFET group (p = <.001). In the CCFET group, TWD significantly lower than the control group (p = <.001) Peak SH amplitude and mean SH amplitude were lower in the CCFET group compared to the control group (p = .013, p = .003). The study shows that 4 weeks of CCFET reduced SH muscle activation, allowing the same work to be done with fewer motor units. CCFET can be included in rehabilitation programs as an additional method that has an effect on the muscles involved in swallowing by providing cervical motor control.

Effect of simulation-based zoom learning on clinical decision-making among undergraduate nursing students and experiences of students and instructors: A mixed methods study

AimTo determine the effect of simulation-based Zoom learning (SBZL) on perceived capabilities and clinical decision-making skills among undergraduate nursing students and to explore experiences of the instructors and students participating in SBZL. BackgroundNursing is a practice profession and students acquire clinical decision-making skills in clinical settings. However, the COVID-19 pandemic has disrupted conventional clinical learning activities. In this study, the outcomes of implementing SBZL in an undergraduate programme to support students’ clinical learning were examined. DesignA mixed methods design was employed. MethodsThis study recruited 195 final-year students to participate in the SBZL programme, which was developed based on the NLN Jeffries Simulation Theory to guide its design, implementation and evaluation. Case scenarios were developed and simulated through Zoom. Students’ perceived capabilities, perceptions of the learning environment and clinical decision-making skills were assessed before and after SBZL. A historical control group of 226 previous final year students who had received a clinical practicum was included for comparison. Semi-structured interviews were conducted with 11 instructors and 19 students to explore their experiences of participating in SBZL. ResultsA total of 102 students completed the post-SBZL questionnaire. An increase in perceived creative thinking (mean difference = 0.24, p < 0.001) was observed post-SBZL. After SBZL, the perceptions of the learning environment were significantly improved. However, the SBZL group demonstrated lower perceived problem-solving capability than the control group (mean difference = 0.14, p = 0.007). Clinical decision-making was significantly improved in the SBZL group than in the control group (p < 0.001). Both the instructors and students reported positive experiences with SBZL, and highlighted challenges and factors for improving its implementation. ConclusionsSBZL showed improvement in perceived creative thinking, perceptions of the learning environment and clinical decision-making. This innovative teaching and learning method can be valuable for nursing education in various regions to prepare students for real-life roles. Tweetable abstractSimulation-based Zoom learning is better than traditional teaching in improving clinical decision-making skills among undergraduate nursing students.

OUTCOMES OF ACUTE ANKLE DISTRACTION FOR INTRA-ARTICULAR DISTAL TIBIAL AND PILON FRACTURES

IntroductionIntra articular distal tibia fractures can lead to post-traumatic osteoarthritis. Joint distraction has shown promise in elective cases. However, its application in acute fractures remains unexplored. This pilot study aims to fill this knowledge gap by investigating the benefits of joint distraction in acute fractures.Materials &amp; MethodsWe undertook a restrospective cohort study comprising patients with intra-articular distal tibia and pilon fractures treated with a circular ring fixator (CRF) at a single center. Prospective data collection included radiological assessments, Patient-Reported Outcome Measures (PROM), necessity for additional procedures, and Kellgren and Lawrence grade (KL) for osteoarthritis (OA).137 patients were included in the study, 30 in the distraction group and 107 in the non-distraction group. There was no significant difference between the groups.ResultsMean follow-up was 3.73 years. There was no significant difference between the groups in overall complications or need for further procedures. There was no significant difference in progression of KL between the groups (1.81 vs 2.0, p=0.38) mean follow up 1.90 years.PROM data was available for 44 patients (6 distraction, 38 non-distraction) with a mean follow-up of 1.71 years. There was no significant difference in EQ5D (p=0.32) and C Olerud-H Molander scores (p=0.17).ConclusionsThis pilot study suggests that joint distraction is safe in the acute setting. However, the study's impact is constrained by a relatively small patient cohort and a short-term follow-up period. Future investigations should prioritise longer-term follow-ups and involve a larger patient population to more comprehensively evaluate the potential benefits of joint distraction in acute fractures.

The effect of peer mentoring program on clinical academic progress and psychological characteristics of operating room students: a parallel randomized controlled trial

BackgroundOne of the new educational systems is the mentorship method. This study aimed to investigate the effect of peer mentoring program on clinical academic progress and psychological characteristics of operating room students.MethodsThis research was a randomized controlled trial that was conducted on undergraduate students in the operating room department of Khomein Faculty of Medical Sciences, Markazi Province in Iran. The number of operating room students were 70 that were divided into intervention and control groups by random allocation using Permuted Block Randomization. Inclusion criteria included all operating room students who were in internship, and exclusion criteria included failure to complete the questionnaires. The data collection tools were the demographic questionnaire, Depression Anxiety Stress Scale, Rosenberg Self-Esteem Scale and Situational Motivational Scale. In the control group, clinical training was done in the traditional way. In the intervention group, training was done by peer mentoring method. The obtained data were analyzed using descriptive statistics, independent t-test, paired t-test, chi-square test, ANCOVA, univariable and multivariable linear regression.ResultsThe study revealed significant differences between the intervention and control groups. Post-intervention, the intervention group demonstrated substantial increases in self-confidence (mean difference = 5.97, p < 0.001) and significant reductions in stress levels (mean difference = -3.22, p < 0.001). Conversely, minimal changes were noted in the control group for both self-confidence (mean difference = 0.057, p = 0.934) and stress levels (mean difference = 0.142, p = 0.656). Although both groups experienced decreases in anxiety and depression levels, these changes were not statistically significant (p > 0.05). Furthermore, the intervention significantly enhanced academic progress in the intervention group compared to the control group (mean difference = 20.31, p < 0.001).ConclusionThe results showed that the implementation of the peer mentoring program was effective in improving academic progress, self-confidence, and reducing the stress of operating room students. Therefore, this educational method can be used in addition to the usual methods to improve the education of operating room students.

Influence of a Concomitant Medial Meniscus Injury on Knee Joint Function and Osteoarthritis Presence after Anterior Cruciate Ligament Reconstruction.

(1) Background: The aim of this study was to investigate how a medial meniscus injury accompanying an anterior cruciate ligament rupture affects the clinical outcome 10 years after ACL reconstruction. (2) Methods: A total of 37 patients who received anterior cruciate ligament reconstruction (ACLR) were included in this retrospective study. Two groups were analyzed at a single follow-up of 10 years: (i) "isolated (ACLR)" (n = 20) and (ii) "ACLR with medial meniscal injury" (n = 17). The following clinical scores were recorded: International Knee Documentation Committee (IKDC), the Knee Injury and Osteoarthritis Outcome Score (KOOS), Lysholm Score and Tegner Activity Score. To determine the degree of osteoarthritis the Kellgren-Lawrence score was used. (3) Results: The "isolated ACLR" study group scored significantly higher (p < 0.05) on the IKDC subjective questionnaire (mean: 88.4) than the "ACLR with medial meniscus injury" group (mean: 81). The KOOS category "activities of daily living" showed significantly better results in the isolated ACLR group (p < 0.05). The "ACLR with medial meniscus injury" group had significantly higher degree of osteoarthritis (p < 0.05). No significant differences were found in all the other clinical scores. (4) Conclusions: The results of this study further indicate that patients with a concomitant medial meniscus injury have slightly more discomfort in everyday life and increased risk of developing osteoarthritis 10 years after surgery.

Effects of Co-Curricular Activities on Academic Performance of Elementary School Students

Background: Co-curricular activities (CCAs) have been increasingly recognized for their pivotal role in enhancing both academic performance and overall student development. These activities complement traditional learning by fostering a range of skills crucial for personal and academic growth. Objective: This study aims to evaluate the effects of co-curricular activities on the academic performance of sixth-grade students at Government Girls High School Bharth, Sialkot, providing insights into how these activities influence educational outcomes. Methods: A quantitative, experimental design was employed involving 98 sixth-grade students who were randomly assigned to either the experimental (n=36) or control group (n=36). The intervention included various CCAs such as drama, quiz, painting, and sports over two months. Data were collected using pre- and post-tests from the Urdu textbooks, with the results analyzed using SPSS version 25 to conduct t-tests and calculate means and standard deviations. Results: The pre-test results showed no significant difference between the groups (experimental group mean=14.97, SD=2.560; control group mean=14.03, SD=2.667; p=.131). Post-intervention, the experimental group exhibited a significant improvement in scores (mean=16.69, SD=2.806) compared to the control group (mean=12.69, SD=3.206), with p&lt;.0001 indicating a substantial impact of CCAs on student performance. Conclusion: The study confirms that engagement in co-curricular activities significantly boosts academic performance among students, suggesting that such activities should be integral to educational curricula to promote comprehensive student development.

The effect of guided imagery pre-cesarean section on the perceived preoperative anxiety, surgical fear, and physiological parameters of women: A randomized controlled trial

IntroductionGuided imagery (GI) helps patients feel happy, relaxed, calm, and safe while ensuring positive thinking. This study was conducted to investigate the impact of GI applied before cesarean section (CS) on preoperative anxiety, surgical fear, and physiological parameters. MethodsParticipants were randomized into the GI (n = 29) or control (n = 28) groups in this randomized controlled trial. Participants in the GI group were given a 15-minute GI audio recording three days before their CS and were allowed to listen to it every night for 3 days until the CS. Finally, they listened on the day of the CS, immediately after preparing for the CS. Anxiety levels were evaluated using the State Anxiety Inventory-S (STAI-S) 3 days before the CS (STAI-S1) and 15 min after the preparations on the CS morning (STAI-S2); while surgical fear was evaluated using the Surgical Fear Questionnaire (SFQ) 3 days before the CS (SFQ1-Total) and 15 min after the preparations on the CS morning (SFQ2-Total). Blood pressure, temperature, heart rate, respiratory rate, and fetal heart rate were also evaluated. ResultsA significant difference in the mean STAI-S scores was observed 15 min after the preparations for the CS between the GI and control groups (mean difference (MD) -4.51, 95 % confidence intervals (CIs) [-7.71, -1.31]). However, no significant difference was found in the mean SFQ scores between the groups (MD -5.53, 95 %CIs [-16.69, 5.63]). In the within group comparison of GI and the control group, no statistically significant difference was observed in the score means of the GI group (STAI-S1 with STAI-S2 and SFQ1-Total with SFQ2-Total). However, the score means of the control groups STAI-S2 was higher than STAI-S1 (MD -5.82, 95 %CIs [-8.16, -3.48]), and SFQ2-Total was higher than SFQ1-Total (MD -6.71, 95 %CIs [-10.97, -2.46]). No significant difference was found in physiological parameters between the groups. ConclusionThis study revealed the effectiveness of GI during the period before CS in reducing preoperative anxiety and keeping surgical fear under control. Nurses and other healthcare professionals involved in preoperative care can utilize GI to reduce preoperative anxiety and manage surgical fear before a CS. Clinical trial registrationNCT05790954

Impact of economic growth and financial development on renewable energy use in selected oil-exporting countries

The aim of this study is to explore the influence of economic growth and financial development on renewable energy consumption. For the purpose of analysis, this investigation uses annual data on renewable energy consumption, economic growth, financial development, consumer price index, domestic investment, and foreign direct investment for 13 major oil-exporting countries, including Algeria, Guinea, Gabon, Iran, Libya, Nigeria, Congo, Republic of Venezuela, Saudi Arabia, Mexico, Malaysia, Sudan, and Russia, during the period 1990-2020. The study employs the Pooled Mean Group (PMG) method and Dumitrescu-Hurlin panel causality test to conduct the empirical analysis. The Hausman test determines the PMG estimator as the most suitable among the Mean Group (MG), Dynamic Fixed Effect (DFE), and PMG estimators. This research shows that economic growth and financial development have a positive and significant long-term impact on renewable energy consumption. This suggests that as the economy grows and financial systems develop, there is a potential for an increase in the use of renewable energy. The Dumitrescu-Hurlin causality test and the panel dynamic ordinary least squares (DOLS) method support these findings. From a policy standpoint, promoting economic growth and financial development could lead to greater use of renewable energy and contribute to sustainable development in oil-exporting countries.

Alterations in white matter integrity in Egyptian youth with smartphone dependence: does DTI have a role?

BackgroundSmartphones provide various functions that facilitate our communication, organization, and entertainment in different situations. Diffusion tensor imaging (DTI) is a method measuring tissue microstructure as well as white matter integrity of the brain and detecting early changes. Several research studies recently aim to utilize conventional MRI for assessing brain structural alterations among smartphone users, but our study was aimed at identifying the DTI value while assessing white matter alterations in Egyptian youth with smartphone dependence.ResultsOur prospective case–control study involved fifty-three individuals with smart phone dependence (SPD group) as well as twenty-five volunteers who represented the control group. SPD individuals and controls were right-handed. The SPD group mean age exhibited 20.54 ± 1.56 years, while controls exhibited 26.8 ± 15.1 years. When utilizing smart phone addiction scale-short version, SPD group median total score exhibited 33. The diagnostic performance of fornix (fractional anisotropy) FA and external capsule fractional anisotropy (EC FA) regarding area under curve (AUC) exhibited significant increase as opposed to all other tested regions, with a sensitivity of 90.6% as well as a specificity of 96%. While regarding the mean diffusivity (MD), the greatest (AUC) was for EC (0.927, p < 0.001), in which the MD value = 0.825 was the cutoff value and able to diagnose the smart phone dependency with a sensitivity of 92.5% as well as a specificity of 76%.ConclusionsQuantitative DTI parameters (FA, MD) in different white matter regions can diagnose and detect white matter changes in excessive smartphone users even when conventional MRI data are normal. This study demonstrates the recent noninvasive MRI technique value while revealing covered brain white matter alterations in Egyptian youth due to smartphone overuse.

It’s hard to be loved by idiots.Fred Perry’s troubled relationship with the Proud Boys

Research methodology For the design of this case study, the authors used primary sources of information from the shops visited by them in preparation of the case and website of Fred Perry and secondary sources of information from both academic and journalistic publications. Case overview/synopsis Fred Perry is a premium clothing brand, well-known for its polo shirts. It was created by Mr Fred Perry, a British tennis player. The brand’s stated values are integrity, personality and individuality. Throughout its history, the brand has been adopted by different British subcultures but recently it has faced a challenge because of the brand appropriation by the Proud Boys, a US far-right white supremacy group and other extremist groups as Antifa and hooligans. The nature and actions of the group mean that Fred Perry runs the risk of losing control over its brand equity. This brand hijack means that Fred Perry risks alienating some of its customers by openly opposing the group but also by embracing this subculture’s appropriation. Practically, the brand opposed the appropriation in a press release and by putting an end to the sale of the black and yellow polo shirts in the USA and Canada. Fred Perry has also made a lot of efforts to reposition the brand away from extremist groups while maintaining its strong historical and cultural roots. Through this case study, students will have the opportunity to discuss this topic and explore solutions for brands that face this type of dilemma. Complexity academic level This case is designed to be used in a marketing management, brand strategy or consumer behavior/culture course, especially in the subfield of market segmentation in the telecommunications sector. Specifically, this case is designed for college seniors or master students with basic strategic marketing training. This case will help students understand the difference between the brand identity that the brand owners intend and the brand image that consumers actually perceive. It provides the basis of discussions on the topics of brand management, consumer culture, consumers-brands relationships, brand architecture, brand equity, brand appropriation and repositioning strategy.

Impact of subjective and objective language function and psychological distress on quality of life in glioma patients awaiting surgery

ABSTRACT Background Maintaining quality of life (QoL) and identifying contributing factors is an important aspect of treatment for glioma patients. Little is known about to what extent language function and psychological distress impact QoL before surgery. Aims The aim of the present study was to investigate the impact of subjective and objective language function, as well as psychological distress on domains of QoL before surgery. Methods and procedures Twenty-seven patients (52% female) with a suspected glioma, grade 1‒3 based on symptoms and MRI imaging diagnostics were assessed pre-surgery. Subjective language concerns, psychological distress and QoL were investigated with self-reported questionnaires. A Subjective language index was calculated, based on items addressing word-finding, expression of thoughts, reading and writing. Objective language function was assessed with tasks of naming (The Boston Naming Test), verbal comprehension (Vocabulary and Similarities), verbal fluency (Semantic and Phonemic fluency) and verbal short-term and working memory (Digit span forward and backward). The strength of associations was determined using Spearman’s rho correlations. Linear regression analyses were used to examine predictors for QoL. Outcomes and Results Clinically significant reductions in QoL were found in 48% of the sample. Subjective language concerns were highly common, with 85% reporting some degree of difficulty. Group means on objective language tests were within normative range on the included measures. The Subjective language index correlated significantly with several QoL domains, whereas objective performance mainly correlated with functional well-being. Psychological distress was a strong predictor for QoL. Conclusions The findings demonstrate that reductions in QoL may occur during the diagnostic phase, even before glioma treatment starts. Subjective language concerns and psychological distress contributed to all aspects of QoL and highlight the importance of acknowledging patient-reported information. The results suggest a comprehensive multi-modal assessment of glioma patients pre-surgery, to establish a base-line and facilitate patient-centered treatment planning.

Hybrid Closed Wedge High Tibial Osteotomy Maintains the Leg Length After Surgery Compared With Open Wedge High Tibial Osteotomy.

This study aimed to assess the changes in leg length following open wedge high tibial osteotomy (OWHTO) and hybrid closed wedge high tibial osteotomy (h-CWHTO) and whether the change in leg length was associated with preoperative radiographic factors and the change in planned opening or closing width. We retrospectively evaluated the data of patients who underwent OWHTO (n=57) and h-CWHTO (n=31) between 2016 and 2019. Standing full-length anteroposterior radiographs were obtained preoperatively and one year postoperatively. Changes in the lower leg and tibial length were measured using radiography, and the planned opening or closing width was decided via operative planning. Flexion contracture was examined preoperatively and one year postoperatively using a goniometer, and the correlation factors and changes in leg length were analyzed using Spearman's rank correlation. In the OWHTO group, the lower leg was significantly longer by a mean of 6.0±8.7 mm compared to that preoperatively (p<0.01); however, no significant difference was observed in the h-CWHTO group (mean, -0.56±11.6 mm) (p=0.788). In the OWHTO group, flexion contracture did not improve after surgery, however, in the h-CWHTO group, flexion contracture significantly improved from -7.1±7.0 degrees to -4.7±6.2 degrees postoperatively (p<0.01). No radiographic factors or bone opening or closing width were associated with changes in leg length in both groups. OWHTO led to a significant elongation of the lower leg while leg length was maintained post-h-CWHTO. However, the changes in leg length following both OWHTO and h-CWHTO were not predictable from preoperative radiographic factors or changes in bone width.

Application of double plate fixation combined with Masquelet technique for large segmental bone defects of distal tibia: a retrospective study and literature review.

There is no effective consensus on the choice of internal fixation method for the Masquelet technique in the treatment of large segmental bone defects of the distal tibia. Thus, the study aimed to investigate the outcomes of the Masquelet technique combined with double plate fixation in the treatment of large segmental bone defects. This was a retrospective study involving 21 patients with large segmental bone defects of the distal tibia who were treated between June 2017 and June 2020. The length of bone defect ranged from 6.0cm to 11cm (mean, 8.19cm). In the first stage of treatment, following complete debridement, a cement spacer was placed to induce membrane formation. In the second stage, double plate fixation and autologous cancellous bone grafting were employed for bone reconstruction. Each patient's full weight-bearing time, bone healing time, and Iowa ankle score were recorded, and the occurrence of any complications was noted. All patients were followed up for 16 to 26months (mean, 19.48months). The group mean full weight-bearing time and bone healing time after bone grafting were 2.41 (± 0.37) months and 6.29 (± 0.66) months, respectively. During the treatment, one patient had a wound infection on the medial side of the leg, so the medial plate was removed. The wound completely healed after debridement without any recurrence. After extraction of iliac bone for grafting, one patient had a severe iliac bone defect, which was managed by filling the gap with a cement spacer. Most patients reported mild pain in the left bone extraction area after surgery. The postoperative Iowa ankle score range was 84-94 (P < 0.05). In this cohort, 15 cases were rated as "excellent", and 6 cases as "good" on the Iowa ankle scoring system. The Masquelet technique combined with double plate fixation is a safe and effective method for the treatment of large segmental bone defects of the distal tibia.

Home-Based Titration with Duodenal Infusion of Levodopa-Carbidopa Intestinal Gel in People with Parkinson's Disease: An Observational Feasibility Study.

Testing and titration of the right levodopa equivalent dose are usually performed during a hospital admission. However, optimal dose titration in people with Parkinson's disease (PwPs) may depend on home environment, emotional stress, and physical activity of everyday life. Firstly, to evaluate the feasibility and safety of a home-based LCIG titration program and patients'/caregivers' satisfaction. Secondly, to identify barriers and facilitators for home-based titration. This study assesses the feasibility and safety of home-based titration of levodopa duodenal infusions with the use of self-reported evaluation questionnaires with open-ended questions included, registration of total time used, and number of contacts/visits. A telemedicine solution was used to remotely monitor the patients, adjust treatment, and provide support and guidance to patients and caregivers. Ten of 12 PwPs (5 females and 7 males) completed the total titration program. Eight of the 12 PwPs were dependent on help. These 8 PwPs also had a high burden of nonmotor symptoms (NMS). Cognitive impairments varied in severity (range 16-30). Time spent with home visits was on average 93.4 minutes (ranging from 35 to 180 minutes), and the length of the total titration (LCIG initiation to termination of titration) was on average 3.4 days with 2-5 (mean 3.2) contacts/visits with PD team members. The average score on the satisfaction evaluation questionnaires was lower in the caregiver group (mean 31.8) than the PwP outcome (mean 36.2). Telehealth-assisted home-based titration programs are feasible due to the length of the titration period, number of contacts, and time spent in PwPs' private homes, are rated satisfactory and safe by PwPs and caregivers, and may be a substitute for in-hospital treatment. Clinical recommendations including facilitators and barriers from a patient/caregiver perspective are displayed. This trial is registered with NCT4196647.

Effectiveness of an articulating laparoscopic needle holder for cesarean scar defect repair.

To evaluate the efficacy of an articulating laparoscopic needle holder in laparoscopic surgery for cesarean scar defect. We performed a retrospective case-control study at the Shiga University of Medical Science. Patients who underwent laparoscopic uterine scar repair were divided into an articulating laparoscopic needle holder (ArtiSential®) group and a rigid needle holder (conventional) group to compare the suture and total operative times. Uterine myometrial suturing involves a double-layer interrupted suture, including a modified Gambee suture for the first layer. We measured the residual myometrial thickness using magnetic resonance imaging preoperatively and at 3 months postoperatively. Both groups comprised 10 patients each. The time per stitch for the first and second layers was significantly shorter in the ArtiSential group than in the conventional group (median 208 s vs. 403 s, p < 0.0001 and median 17 s vs. 29 s; p < 0.0001, respectively). The total operating time was significantly shorter in the ArtiSential group (mean 188 min vs. 240 min, p = 0.0015). The postoperative residual myometrial thickness (mean 9.1 mm in the ArtiSential group and 9.6 mm in the conventional group) was significantly higher than the preoperative residual myometrial thickness (mean 1.6 mm in the ArtiSential group and 1.6 mm in the conventional group) (p < 0.0001 in both groups). An articulating needle holder is useful in laparoscopic surgery for cesarean scar defect, especially when a modified Gambee suture is required.

Tranexamic acid reduces intraoperative red blood cell transfusion rates in craniosynostosis surgery: a 6-year retrospective analysis

Surgery for craniosynostosis in children is associated with substantial intraoperative bleeding and the need for blood transfusions. Recent studies have supported the efficacy of tranexamic acid (TXA) in reducing blood loss and transfusion requirements. The records of 72 patients under 18 months of age who had undergone 113 surgeries for non-syndromic craniosynostosis in a single institution for 6 years were retrospectively analyzed. The transfusion requirements in infants with and without TXA administration were compared. The concept of patient blood management before and after TXA implementation in practice was also examined. The rate of intraoperative packed red blood cells (PRBC) transfusion was significantly lower in the TXA than in the non-TXA group (26.7% vs. 83%, p < 0.001). The volume of intraoperatively transfused PRBC was also lower in the TXA group compared to the non-TXA group (mean 68.25 mL vs. 101.91 mL, p < 0.001), as was the weight-adjusted volume (mean 11.2 mL/kg vs. 15 mL/kg, p = 0.002). There were no significant differences in the rate and volumes of postoperative PRBC transfusion between groups. The volume of intraoperatively transfused PRBC was dependent on TXA administration, but not on the affected suture and type of intervention. We found that while in the pre-TXA period all patients were transfused intraoperatively, the frequency of intraoperative transfusions in the post-TXA period was reduced by 40.9% even in the patients who had not received TXA. TXA seems to effectively reduce the intraoperative transfusion requirements in children undergoing craniosynostosis surgery. The optimal blood management in this patient population remains to be further evaluated.