Research Committee Research Articles

Adult Moyamoya Disease and Moyamoya Syndrome: What Is New?

Recent advances are in the genetics, diagnosis, pathophysiology, and management of moyamoya disease (MMD), and moyamoya syndrome (MMS), a term used to describe moyamoya-like vasculopathy associated with various systemic diseases or conditions. Ring finger protein (RNF213) has been reported to be a susceptibility gene not only for MMD but also for atherosclerotic intracranial arterial stenosis and ischemic stroke attributable to large artery atherosclerosis. The latest guidelines by the Research Committee on MMD of the Japanese Ministry of Health, Labor, and Welfare, removed limitations of the previous definition that required bilateral involvement of the intracranial carotid artery to make the diagnosis, given the increasing evidence of progression to bilateral involvement in unilateral MMD. 3-dimensional constructive interference in steady-state MRI is useful for the differential diagnosis of MMD from atherosclerosis. Recent advances in the pathophysiology of MMD suggest that genetic and environmental factors play important roles in vascular angiogenesis and remodeling via complex mechanisms. The latest Japanese Guidelines and American Scientific Statement described that antiplatelet therapy can be considered reasonable. Endovascular interventional stent placement fails to prevent ischemic events and does not halt MMD progression. In the Japan Adult Moyamoya trial, a randomized controlled trial for bilateral extracranial-intracranial direct bypass versus conservative therapy in patients with MMD, who had intracranial hemorrhage, recurrent bleeding, completed stroke, or crescendo transient ischemic attack was significantly fewer with direct bypass than with conservative care. This review presents updated information on genetics, diagnosis, pathophysiology, and treatment of adult MMD and MMS. Despite recent advances, many mysteries still exist in the etiologies of moyamoya vasculopathy. The diagnostic criteria and treatment guidelines have been updated but not yet been globally established. Ongoing and future studies investigating underlying pathophysiological mechanisms of MMD and MMS may clarify potentially effective medical, surgical, or endovascular treatments.

Serotype 3 Experimental Human Pneumococcal Challenge (EHPC) study protocol: dose ranging and reproducibility in a healthy volunteer population (challenge 3)

IntroductionSince the introduction of pneumococcal conjugate vaccines, pneumococcal disease rates have declined for many vaccine-type serotypes. However, serotype 3 (SPN3) continues to cause significant disease and is identified in colonisation...

Distortion Product Otoacoustic Emission and Tinnitus: Role of Outer Hair Cells in the Genesis of Tinnitus

Background: This study aims to detect outer hair cell (OHC) function in patients with tinnitus, by comparing the otoacoustic emissions (OAEs) in tinnitus patients with normal hearing and normal-hearing subjects without tinnitus, thereby revealing the role of OHC in the generation of tinnitus. Methods: After approval by the local research and ethics committee, this study was done in the department of otolaryngology and associated hospitals, from April 2022 to January 2023. Consent was obtained from all the participants in the present work after explaining the test procedure. The study group included 60 subjects with bilaterally normal hearing to participate. They were classified into two groups: Group 1, i.e., the control group, comprised 30 subjects who were unaffected by tinnitus, whereas Group 2, i.e., the study group, comprised 30 subjects who were suffering from tinnitus. Basic audiological tests and OAE test were done on the respondents of both the groups followed by a comparison of outcomes. Results: The authors of the present study found a statistically significant difference between the amplitude and signal-to-noise ratio (SNR) of distortion product OAE (DPOAE) in tinnitus patients and the control group without tinnitus, suggesting that OHCs have a role in the generation of tinnitus. Conclusion: It can be concluded that OHC activity was reduced in patients with tinnitus, as detected by reduced DPOAE amplitude and SNR, suggesting that the dysfunction of OHCs can be attributable to the generation of tinnitus.

Perception of vibration threshold potential with tuning fork and pure tone audiometry assessment for early detection of diabetic polyneuropathy

Background: Diabetes mellitus (DM), a multisystem disorder, is a known etiological entity, leading to several neurological disorders. Among them, nervous system is more commonly affected. In most of the diabetic polyneuropathy cases, sensory symptoms involving both general and special senses predominate. Due to gradual and non-homogenous manifestations, it is not easy to detect its onset. Till now no accepted gold standard has been available for its assessment and diagnosis. In this study, changes in vibration perception threshold (VPT) at different frequencies and auditory perception threshold have been investigated in diabetes patients and healthy controls. Aims and objectives: Determination of perception threshold of a general sense-vibration sense and a special sense-hearing in normal human subjects and patients of DM and evaluation of perception threshold of the human sensory system by VPT test and pure tone audiometry (PTA) as a diagnostic, prognostic and research tool for diabetic neuropathy. Materials and Methods: A case–control study, conducted in the department of physiology at medical college, Kolkata, after obtaining approval by the institutional research and ethics committee on 100 cases and 40 control subjects. Testing of vibration sensitivity was performed with the help of tuning forks of frequencies of 128 Hz, 256 Hz, and 512 Hz. Assessment of auditory perception threshold was done by Siemens SD 28 diagnostic audiometer. Results: All data obtained by the methods described here are tabulated. Graphs and charts are drawn and analyzed by standard statistical methods using Statistical Packages for the Social Sciences (version-16) and MATLAB (version-9). A P < 0.05 was considered as significant. A partial negative correlation was observed between the vibration sensitivity and fasting blood sugar and postprandial blood sugar level of the patient population of DM cases, with a “r” value (Pearson’s correlation coefficient was around −0.5. By PTA, it was found the percentage of rise in auditory threshold is around 92–93% in 8000 Hz frequency, and the results of the t-test yield a very highly significant difference (P < 0.0001) between cases and controls. It was found that 128 Hz and 256 Hz vibration stimuli applied over maxillary prominence are highly sensitive and efficient tools for perception analysis. Pure tone auditory threshold evaluation showed preservation of the right-sided advantage of auditory sensitivity and frequency-dependent loss of hearing in the diabetic study population. Conclusion: Determination of perception threshold of vibration sense by tuning fork and auditory perception by PTA may be used as an effective, easily performed, and low-cost bedside and also outpatient department-based diagnostic tool in patients with DM.

Conscious sedation in pediatric dental procedures: Experience from Usmanu Danfodiyo University Teaching Hospital, Sokoto, Northwestern Nigeria

Abstract Background: The management of fear and anxiety in children scheduled for dental procedures has been a great challenge to the operating dental surgeon. Despite several controversies regarding the effectiveness, and safety of conscious sedation in dental and minor oral surgical procedures, it is widely used nowadays in dental practice. This study aimed to present a retrospective analysis of pediatric dental patients managed under conscious sedation. Materials and Methods: This was a retrospective study conducted over 5 years. After obtaining ethical approval from the research and ethics committee of the institution, the case records of all patients from 15 years and below who had a dental procedure under conscious sedation were retrieved. The demographics, procedures performed, the drug and dosage used, and length of the procedure were also recorded. Data obtained were analyzed using a statistical package for social sciences (IBM SPSS) version 25. Results: A total of 196 patients were included, 92 (46.9%) males and 104 (53.1%) females in the age range of 1–14 years and mean ± SD of 6.79 ± 2.98 years. The age categories were analyzed against the gender which revealed more female children between 6 and 10 years with no statistically significant difference (χ 2 = 4.566; df = 2; P = 0.102). The conscious sedation was done with ketamine 1–2 mg/kg intravenously in 72 patients (36.7%) and 3–4 mg/kg intramuscularly in 124 patients (63.3%), and additional doses were given in 93 patients (47.4%). Pulpectomy only constitutes the highest procedure performed in 42 patients (21.4%). The range length of the procedures was 5–67 min. Multiple procedures were performed in 52 (26.5%) of the patients. All patients were monitored until complete recovery, and no complications were recorded. Conclusion: Conscious sedation with ketamine was found effective and safe during dental and minor oral surgical procedures. With good functional suction, conscious sedation can provide excellent patient cooperation in carrying out multiple procedures in pediatric dental patients.

Does a blended learning implementation package enhance HIV index case testing in Malawi? A protocol for a cluster randomised controlled trial

IntroductionIndex case testing (ICT) is an evidence-based approach that efficiently identifies persons in need of HIV treatment and prevention services. In Malawi, delivery of ICT has faced challenges due to...

Dynamics of motor and functional disorders in the early recovery period after ischemic stroke

To study the dynamics and degrees of motor and functional disorders in patients with hemiparesis during the first 6 months after ischemic stroke under the impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation. Motor disorders and functional limitations were assessed using validated scales (Fugl-Meyer, Medical Research Committee Scale, Modified Ashworth Scale of muscle spasticity, Modified Frenchay scale, Wolf Motor Function Test, Action Research Arm Test, Rivermead mobility index, Hauser ambulation index, Functional Independence Measurement). Diagnostic and therapeutic transcranial magnetic stimulation was performed using the «Neuro-MS/D» magnetic stimulator. The dynamics of types and degrees of motor and functional disorders were evaluated in 113 patients with hemiparesis in the first 6 months after ischemic stroke. Severe disorders of the tone and strength characteristics of paretic muscles and limitation of movement in the joints of paretic extremities have been found in 2/3 of patients. The balance function (it is difficult to maintain a vertical position of the body) was impaired in 1/2 of patients. The correlations of electrophysiological indicators (diagnostic transcranial magnetic stimulation and surface electromyography) with clinical ones (degree of paresis, tone of paretic muscles, motor abilities and motor skills of the paretic hand, independence in daily living) have been determined. Positive impact of medical rehabilitation, including kinesiotherapy, physiotherapy and transcranial magnetic stimulation, on the strength of paretic muscles of the hand and leg, mobility of patients, walking function, activity of the paretic hand (transfer by the hands, manipulation of extremities' segments and objects) has been revealed. Electrophysiological investigation has shown that the functional activity of the paretic muscles increased. Severe motor and functional disorders, most pronounced in distal segments of the extremities (lack of movements in 14-26% of cases), are prevalent in the first six months after ischemic stroke in the carotid system. The regression of motor disorders leads to an enhancement of functional abilities (use of the paretic extremities for the realization of various motor actions) under the impact of rehabilitation.

Checklist of vascular plant species in Huangshui River Basin of Qinghai Province, China.

The Huangshui River Basin is one of the most important water sources in the Qinghai Province and is of great importance for ecological protection measures, agricultural irrigation and tourism. Based on previous studies and fieldwork related to plant species in China, this study presents comprehensive data on vascular plants distributed in the Huangshui River Basin of Qinghai Province.Ethical Compliance: All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.Data Access Statement: Research data supporting this publication are available from the repository at located at https://www.scidb.cn/en/anonymous/QUpuZVEz.Conflict of Interest declaration: The authors declare that they have NO affiliations with or involvement in any organisation or entity with any financial interest in the subject matter or materials discussed in this manuscript. The checklist of plants includes ferns, gymnosperms and angiosperms, covering three phyla, five classes, 49 orders, 139 families, 709 genera and 2,382 species. It includes numerous Asteraceae, Gramineae, Rosaceae and Fabaceae along with statistical data on the number of species distributed in different regions. The dataset presented in this article provides important background information on vascular plants in the Huangshui River Basin and, therefore, plays a crucial role in the protection and management of plant resources in this region.

Annual Report 2023 Research Committee on Wind-induced Disaster

Annual Report 2023 Research Committee on Wind-induced Disaster

Disease-modifying therapy initiation patterns in multiple sclerosis in three large MS populations.

Treatment guidelines recommend early disease-modifying therapy (DMT) initiation after diagnosis of multiple sclerosis (MS). Multinational comparative studies that assess time to DMT initiation in MS may allow detection of barriers inherent to healthcare systems to explain potential adverse systematic delays in commencing DMTs. To investigate and compare the time to first DMT and its association with sociodemographic and clinical variables after MS diagnosis in three large MS registries. This observational study was conducted using data from the German MS Registry (GMSR), the North American Research Committee on MS Registry (NARCOMS, US data only), and the United Kingdom MS Registry (UKMSR, both self- and clinician-reported). Data from relapsing people with MS (PwMS), with a diagnosis of MS between 2014 and 2019, and available DMT and disability status were pooled using a meta-analytic approach. A total of 5395 PwMS were included in the analysis (GMSR: n = 2658; NARCOMS: n = 447; UKMSR: n = 2290). Kaplan-Meier estimates for the time to first DMT [median months (95% CI)] were 2.0 (1.9-2.0), 3.0 (2-4), and 9.0 (7.7-10.6) for GMSR, NARCOMS, and UKMSR, respectively. Pooled multivariable Cox regression demonstrated shorter time to first DMT for PwMS diagnosed after 2017 [1.65 (1.42-1.92), p < 0.01], and longer time to DMT when a higher-efficacy DMT was selected (0.69 (0.54-0.90), p < 0.0001]. Time to DMT initiation differs across the populations studied, indicating that barriers may exist in early access to DMT, particularly in the United Kingdom. However, a consistent decrease in time to DMT initiation was noted since 2017 across all registries. Further studies are warranted comparing the effects of time to DMT and time to higher-efficacy DMT on long-term outcome.

Consensus on clinical application of immunoglobulin G4

IgG4 is a subclass of IgG. Elevated serum IgG4 levels are an important serological feature of IgG4 related diseases and serve as a serological marker for assessing disease activity and severity. The harmonization of IgG4 detection is crucial for its clinical application. National Clinical Research Center for Dermatologic and Immunologic Diseases (Peking Union Medical College Hospital), Experimental Diagnosis Research Committee, Rheumatology and Immunology Physicians Committee of Chinese Medical Doctor Association, Autoantibodies Detection Committee, and Chinese Rheumatism Data Center have organized clinical and laboratory experts to draft this consensus, aiming to standardize IgG4 detection and provide guideline for clinician and laboratory experts to appropriate utility and interpret IgG4 results in China.

Integrated health system intervention aimed at reducing type 2 diabetes risk in women after gestational diabetes in South Africa (IINDIAGO): a randomised controlled trial protocol

IntroductionSouth Africa has a high prevalence of gestational diabetes mellitus (GDM; 15%) and many of these women (48%) progress to type 2 diabetes mellitus (T2DM) within 5 years post partum....

Willingness and skills among students from non-health academic fields in providing efficient basic life support

Education in basic life support is widely proposed to increase survival in out-of-hospital sudden cardiac arrest. The authors aimed to assess knowledge, skills, and attitudes, including willingness to help, regarding myocardial infarction and sudden cardiac arrest among university students of all fields of knowledge. MethodsAn Ethical Research Committee approved this cross-sectional study. An electronic survey “KIDS SAVE LIVES BRAZIL” was sent to 58,862 students of 82 disciplines in three universities, aged ≥ 18 years. The survey covered three categories: knowledge, skills, and attitude. Each category was graded between 0 and 10 points (the highest). ResultsAmong students, 4,803 undergraduates (8.2 %) answered the survey, and were divided into three groups of disciplines: medicine (219, ∼21.7 years, 38 % male), other-healthcare (n = 1,058; ∼22.9 years; 36 % male), and non-health-care (n = 3,526; ∼22.9 years; 35 % male). All three groups showed significant differences between them (p < 0.001). The non-health-care compared with medicine and other healthcare groups showed, respectively, the lowest median scores (25 %‒75 %) in knowledge (4.0 [0.0‒9.3], 4.0 [4.0‒8.0], and 4.0 [4.0‒4.7]), skills (2.4 [1.2‒3.3], 6.4 [4.0‒8.3], 4.0 [2.4‒6.2]), and attitude (5.9 [5.9‒6.8], 7.3 [5.9‒7.3], and 7.3 [5.9‒7.3]). ConclusionUniversity students who answered the e-survey have the willingness to help victims suffering from myocardial infarction or sustaining sudden cardiac arrest. However, non healthcare students markedly lack the knowledge and skills to perform cardiopulmonary resuscitation and automated external defibrillation. These findings reveal a stark difference in basic life support competencies between students in related healthcare fields and those in non-health fields, emphasizing the need for universal basic life support training.

Pelvic floor muscle training in women with urinary incontinence and pelvic organ prolapse: A protocol study.

To evaluate the effectiveness of pelvic floor muscle training (PFMT) on pelvic floor muscle (PFM) function and quality of life (QoL) in women with stress urinary incontinence (SUI) and pelvic organ prolapse (POP). This study will be a randomized, controlled, parallel, and blinded clinical trial. The final sample will consist of 32 women diagnosed with SUI and cystocele (stage I and II). All volunteers will be assessed and reassessed using the same protocol: assessment form, gynecological examination, functional evaluation of PFM, and questionnaires to assess quality of life, urinary function, and sexual function. All volunteers will be evaluated for satisfaction levels post-treatment. The intervention will be PFMT, totaling 16 sessions to be conducted twice a week. Reevaluation will take place at the end of treatment and 1 month after completion of PFMT. Descriptive analysis and repeated measures ANOVA will be used for result analysis. A significance level of p<0.05 will be considered for all statistical tests. This study has been submitted to the Ethics in Research Committee of the Federal University of Rio Grande do Norte and approved under protocol number 5.826.563. It has been registered with the Brazilian Clinical Trials Registry ReBec (RBR-49p6g3t). It is expected that these studies will provide a deeper understanding of the efficacy of PFMT in women with SUI and cystocele. Additionally, it aims to provide more insights into the efficacy of PFMT prior to surgery.

Activity of Research Committee on Wind Loads and Wind Resistant Performance of Photovoltaic Systems

Activity of Research Committee on Wind Loads and Wind Resistant Performance of Photovoltaic Systems

An outreach strategy to increase uptake of vaginal self-sampling for cervical cancer screening in older French women: The RIDECA interventional research protocol.

In France, approximately 40% of women, including menopausal women, do not participate in cervical cancer screening. Many studies and meta-analyses have shown that self-sampling devices for high-risk human papillomavirus (HR-HPV) testing are valuable tools to increase participation. The success of self-sampling screening strategies depends on several factors, including the manner and circumstances in which the women are invited to participate. The acceptability and effectiveness of these strategies should be evaluated before further implementation. The primary objective is to evaluate the uptake of cervical cancer screening in under-screened women, based on a direct offer of a vaginal self-sampling device by a midwife. RIDECA is an interventional research project located in the South of France. Six hundred women aged 50-65 with no cervical smear or HR-HPV test for 3 years or more will be recruited at two sites. The device will be offered to enrolled women to utilize at home and return to the Montpellier Hospital laboratory for HR-HPV testing. Completion of self-sampling by women who have accepted the device and follow-up of those with positive HR-HPV DNA tests will be monitored. During recruitment, participants will complete questionnaires on their socio-economic environment and motivational factors based on the psychosocial I-Change model. Semi-structured interviews will be conducted with a sub-group to identify barriers and levers to participation. Statistical analyses will be conducted for the full research sample and for each recruitment site. The project was approved by the Ethical Research Committee Ile de France VI and by the French Data Protection Authority. The results will provide useful information on the effectiveness (acceptability, efficiency) of this outreach strategy and identify barriers and levers that facilitate its implementation. ClinicalTrials.gov (NCT04716127), January 20, 2021.

Nursing workload: use of artificial intelligence to develop a classifier model.

to describe the development of a predictive nursing workload classifier model, using artificial intelligence. retrospective observational study, using secondary sources of electronic patient records, using machine learning. The convenience sample consisted of 43,871 assessments carried out by clinical nurses using the Perroca Patient Classification System, which served as the gold standard, and clinical data from the electronic medical records of 11,774 patients, which constituted the variables. In order to organize the data and carry out the analysis, the Dataiku® data science platform was used. Data analysis occurred in an exploratory, descriptive and predictive manner. The study was approved by the Ethics and Research Committee of the institution where the study was carried out. the use of artificial intelligence enabled the development of the nursing workload assessment classifier model, identifying the variables that most contributed to its prediction. The algorithm correctly classified 72% of the variables and the area under the Receiver Operating Characteristic curve was 82%. a predictive model was developed, demonstrating that it is possible to train algorithms with data from the patient's electronic medical record to predict the nursing workload and that artificial intelligence tools can be effective in automating this activity.

The NAON Research Committee: We Are Here to Serve.

The NAON Research Committee: We Are Here to Serve.

A Study on Variations in Size and Shape of Left Atrial Appendage from Formalin-fixed Cadavers

Introduction: Atrial appendages were once considered vestigial structures with no significant role in atrial function. However, they are now recognized as significantly impacting various pathophysiological conditions, including cardiac thromboembolism and arrhythmias. The left atrial appendage (LAA), in particular, has been found to have significant variations in shape and size, and its relationship with nearby structures, such as the pulmonary veins (PVs), is crucial in planning interventional and surgical procedures in and around the LAA. Although most studies examining variations in the LAA are image-based, few have focused on anatomical studies. Materials and Methods: In this study, we examined heart specimens from 54 cadavers for anatomical dissection at a tertiary care teaching hospital. After removing the heart from the pericardial cavity, we opened the left atrium and examined its interior. Observations were made regarding the LAA orifice and PV orifices, and measurements were taken. Subsequently, we removed the LAA along with a portion of the left atrial wall, observed its shape and number of lobes, and took measurements. To classify the shape, we used a system proposed by Wang et al. based on resemblance to familiar objects. Categorical variables were expressed as percentages and continuous as mean and standard deviation. The institutional research committee and the institutional ethics committee approved the study. Results: The most common shape variant observed was the Chicken Wing type, followed closely by the Windsock type. Specimens with Cauliflower or Cactus morphology were rare, with the Cactus variant being the least common. The LAA orifice was round or oval shaped in most cases. In most cases, the LAA orifice was at the same or lower level as the left superior PV orifice, with a prominent ridge between the two orifices in most patients. We observed most of the appendages to be trilobed, with considerable variations in length and diameter. We found two specimens with unusual morphologies but no specimens with accessory appendages. Conclusions: Based on our study, there are significant differences in findings compared to some of the previous studies reporting the shape variations of LAA. However, our findings are matching with those of some other earlier studies. The variations in the shape and size of LAA orifices and their relationship to PV orifices are similar to those reported in earlier studies. The distribution of variations in the size of LAA was also similar to those reported in earlier studies. Conducting larger studies to explore these variations could aid in designing and developing therapeutic interventions in the LAA.

Apendicite aguda em um adolescente com situs inversus totalis: relato de caso

Appendicitis is the most common surgical emergency in pediatrics, being present in 1% to 8% of children with acute abdominal pain. The classical clinical presentation is characterized by the presence of acute migrating abdominal pain in the right iliac fossa. However, in patients with situs inversus totalis, the pain manifests in the left iliac fossa, which may delay the diagnosis and predispose to the development of complications. Thus, the aim of this study is to report a case of appendicitis in an adolescent with situs inversus totalis. METHODS: This study is case report of appendicitis in an adolescent with situs inversus totalis. The research was submitted to the Ethics in Human Research Committee and approved under CAAE number 53591321.0.0000.5237. RESULTS: The incidence of appendicitis in patients with situs inversus totalis is 0.016% to 0.024%. Due to the atypical clinical presentation in these patients, there is a tendency to delay the diagnosis of appendicitis, especially when the situs inversus totalis was not previously identified. Thus, there is a greater risk of developing severe complications such as intestinal perforation and sepsis, which considerably increases morbidity and mortality. CONCLUSIONS: We emphasize the importance of listing appendicitis as a possible diagnosis in patients with acute abdominal pain in the left iliac fossa because of the possibility of situs inversus totalis.