Just Noticeable Difference Research Articles

Malreduction of Syndesmosis and Outcomes Following Trans-Syndesmotic Screw vs Suture Button Fixation Under Direct Visualization and Reduction Technique: A Prospective Randomized Controlled Study

Category: Trauma; Ankle Introduction/Purpose: Syndesmotic injury commonly accompanies rotational ankle fractures, with malreduction significantly affecting outcomes. While suture button fixation has demonstrated efficacy in reducing malreduction rates compared to trans-syndesmotic screw fixation, it incurs higher implant costs. However, the introduction of a direct visualization and reduction technique offers the possibility to mitigate the difference. This study aims to compare the syndesmotic malreduction rate and outcomes between trans-syndesmotic screw fixation and suture button fixation, utilizing the direct syndesmotic visualization technique. Methods: One hundred patients with unstable rotational ankle fractures and arthroscopically-confirmed syndesmotic injury who underwent open reduction and internal fixation were prospectively randomized into two parallel groups, receiving either trans-syndesmotic screw (SS) fixation (n=50) or suture button (SB) fixation (n=50). All syndesmoses were reduced under direct visualization at the anterior tibiofibular line. The primary outcome was the syndesmotic malreduction rate, evaluated by bilateral post-operative CT scan with a 2-mm side-to-side difference threshold. Secondary outcomes included visual analog scale (VAS), Short Form-36 (SF-36), and Foot and Ankle Ability Measure (FAAM) scores, as well as complications. Results: The malreduction rate was higher in the SS group (14%) compared to the SB group (4%), but it did not reach statistical significance (p = 0.160). Both groups showed significant improvement in pain VAS, FAAM scores, and SF-36, without a significant difference between the groups. The complication rate was not significantly different. Conclusion: The syndesmotic malreduction rates and post-operative outcomes were comparable between trans-syndesmotic screws and suture button fixation under direct visualization and reduction technique. Direct visualization and reduction of the syndesmosis with screw fixation can be a useful technique for better adjustment, potentially reducing malreduction to levels closer to those achieved with suture button fixation.

Safety and efficacy of adipose-derived mesenchymal stem cell therapy in elderly Parkinson's disease patients: an intermediate-size expanded access program

ObjectiveThis intermediate-size expanded access program aimed to evaluate safety and clinical efficacy of multiple intravenous infusions of autologous, Hope Biosciences adipose-derived mesenchymal stem cell (HB-adMSC) therapy in elderly patients with Parkinson's disease (PD). MethodsTen eligible participants (aged 76–95 years) received six intravenous infusions each with 200MM autologous HB-adMSCs over 18 weeks, with the end of study (EOS) at week 26. Safety was assessed through adverse events (AEs) and serious adverse events (SAEs). Efficacy was measured through improvements in both motor and non-motor symptoms, utilizing scales including Movement Disorder Society Unified Parkinson's Disease Rating Scale (MDS-UPDRS) parts I-IV, Parkinson's Disease Questionnaire-39 (PDQ-39), Parkinson's disease Fatigue Scale (PFS-16), Patient Health Questionnaire-9 (PHQ-9), and Visual Analog Scale (VAS). Analysis employed paired t-tests and Minimal Clinically Important Difference (MCID) thresholds for the patient-reported outcomes. ResultsMost AEs (37 out of 46) were mild in severity, with 5 SAEs reported, none attributed to the drug. No deaths occurred. Despite lack of statistical significance across the efficacy endpoints, modest yet clinically meaningful improvements with effect size > 0.3 were observed in several secondary efficacy endpoints (MDS-UPDRS part I & III, PDQ-39, and PHQ-9) at the EOS, nearing or surpassing the established MCID values. ConclusionsThe administration of autologous 200MM HB-adMSCs was found to be safe and well-tolerated in the elderly PD population. Although not achieving statistical significance, modest clinical improvements were noted across multiple secondary endpoints. These findings underscore the safety profile of the treatment in elderly patients and highlight the importance of evaluating clinical relevance alongside statistical measures for meaningful patient outcomes. Further investigation with a larger, randomized, placebo-controlled design is warranted to validate these observations.

The impact of smoking on patient-reported outcomes following lumbar decompression: an analysis of the Quality Outcomes Database.

Smoking has been shown to negatively impact spinal health, as well as the outcomes of spinal fusion. Published reports show conflicting data regarding whether smoking negatively impacts patient outcomes following lumbar decompression. The objective of this study was to investigate whether smoking affects the outcomes of patients undergoing lumbar decompression for spinal stenosis or herniated disc. The Quality Outcomes Database was queried for patients with spinal stenosis or lumbar disc herniation who underwent one- or two-level lumbar decompression without fusion. All patients had preoperative and 12-month outcome measures and were divided into groups of nonsmokers and current smokers. Outcomes were compared between the two groups, as well as the percentage of patients reaching the minimal clinically important difference (MCID) threshold for numeric rating scale (NRS) back and leg pain scores and the Oswestry Disability Index (ODI). Of 17,271 patients, 14,233 were nonsmokers and 3038 were current smokers. Smokers had worse baseline NRS back and leg pain, ODI, and EQ-5D scores and experienced slightly less improvement in all measures following lumbar decompression (p ≤ 0.009), although changes were largely similar, and a high percentage of patients achieved the MCID thresholds for NRS back pain (78% nonsmokers vs 75% smokers), NRS leg pain (79% nonsmokers vs 73% smokers), and ODI (74% nonsmokers vs 68% smokers). Comparison of propensity-matched cohorts did not identify any difference in outcomes in smokers versus nonsmokers. In patients undergoing lumbar decompression for spinal stenosis or herniated disc, smokers demonstrated slightly less improvement in outcomes compared with nonsmokers, and a high proportion of both groups achieved meaningful improvement with surgery. While smoking cessation should be strongly encouraged in all patients, lumbar decompression procedures for spinal stenosis and herniated disc should not be denied to smokers.

Neighborhood Socioeconomic Disadvantage May Influence 1-Year Patient-Reported Outcome Measures After Total Hip Arthroplasty

BackgroundThe impact of socioeconomic status on achievement of clinically relevant patient-reported outcome measure (PROM) improvements and satisfaction after total hip arthroplasty (THA) is unknown. Area Deprivation Index (ADI) is a metric that can be used as a proxy for a patient’s neighborhood socioeconomic status. This study aimed to assess the association between ADI and failure to achieve: (1) clinically relevant improvements in PROMs; and (2) self-reported satisfaction at 1 year following THA. MethodsA prospective cohort of 7,506 patients who underwent primary unilateral THA from January 2016 to July 2021 was included. The ADI was stratified into quintiles based on their distribution in our sample. Multivariable logistic regression models were created to investigate the effect of ADI on 1-year PROMs. The included PROMs were the Hip Disability and Osteoarthritis Outcome Score (HOOS) Pain, Physical Function Shortform (PS), and Joint Replacement (JR). Clinically relevant improvements were assessed through minimal clinically important difference and patient acceptable symptom state threshold achievement. ResultsThere was no significant association between ADI and failure to achieve minimal clinically important difference for HOOS pain (P = 0.42), PS (P = 0.91), or JR (P = 0.20). However, higher ADI scores were independently associated with increased odds of failing to achieve patient acceptable symptom state for HOOS Pain (P = 0.002), PS (P = 0.003), and JR (P = 0.017). The ADI was not associated with failure to achieve patient satisfaction at 1 year (P = 0.93). ConclusionsGreater neighborhood socioeconomic disadvantage was associated with decreased odds of achieving clinically relevant improvement in patient-perceived symptomatic state, but not associated with patients’ perception of their overall pain and function 1 year after THA. Targeted interventions to address access and care pathways for low socioeconomic status patients may present an opportunity to improve patient-perceived outcomes following THA. Level of EvidenceLevel III.

Establishment of Minimum Clinically Important Difference and Patient Acceptable Symptom State Thresholds in Foot and Ankle Ability Measure and Visual Analogue Scale Scores After Hallux Valgus Surgery

Category: Bunion Introduction/Purpose: The purpose of this study was to determine the minimal clinically important difference (MCID) and the patient acceptable symptom state (PASS) threshold for the Visual Analogue Scale (VAS) and Foot and Ankle Ability Measure (FAAM) Scores after Hallux Valgus surgery. Methods: A retrospective review of prospective collected data was performed in patients undergoing hallux valgus surgery at a single institution from January 2021 through December 2022. Patient-reported outcome measures (PROMs) were collected pre-operatively and 1 year post-operatively. The specific PROMs utilized were the FAAM- Activities of Daily Living (FAAM-ADL), Single Assessment Numeric Evaluation (SANE), and VAS scale. The study measured change in PROMs from before surgery to one year after surgery to determine delta. Two methods were used to calculate MCID and PASS thresholds: A distribution-based approach and an anchor-based approach using responses to a one-year postoperative satisfaction question. The analysis identified optimal cut-off points that maximized sensitivity and specificity based on the Youden index. The percentage of patients reaching these optimal MCID and PASS thresholds was also determined. Results: Overall, 86% (136/158) completed baseline PROMs, and 72.7% (99/136) completed 1-year PROMs. The distribution-based MCID for FAAM-ADL, FAAM-ADL-SANE, , and VAS were calculated to be 10.8, 14.1, and 1.2 respectively. The rate of patients who achieved MCID thresholds was 54% for FAAM-ADL, 42% for FAAM-ADL-SANE, and 95.8% for VAS. The PASS threshold for FAAM-ADL, FAAM-ADL-SANE, and VAS were ≥78.5, ≥85, and ≤ 2, respectively. The rate of patients who achieved PASS thresholds was 77.5% for FAAM-ADL, 71.4% for FAAM-ADL-SANE, and 68.7% for VAS. Conclusion: This study identified useful values for the MCID and PASS thresholds at 1-year follow-up for patient undergoing hallux valgus surgery of FAAM-ADL, FAAM-ADL-SANE, and VAS scores.

Preoperative patient-reported outcome measures predict minimal clinically important difference and patient-acceptable symptomatic state following arthroscopic Bankart repair.

The aims of this study were to validate the minimal clinically important difference (MCID) and patient-acceptable symptom state (PASS) thresholds for Western Ontario Shoulder Instability Index (WOSI), Rowe score, American Shoulder and Elbow Surgeons (ASES), and visual analogue scale (VAS) scores following arthroscopic Bankart repair, and to identify preoperative threshold values of these scores that could predict the achievement of MCID and PASS. A retrospective review was conducted on 131 consecutive patients with anterior shoulder instability who underwent arthroscopic Bankart repair between January 2020 and January 2023. Inclusion criteria required at least one episode of shoulder instability and a minimum follow-up period of 12 months. Preoperative and one-year postoperative scores were assessed. MCID and PASS were estimated using distribution-based and anchor-based methods, respectively. Receiver operating characteristic curve analysis determined preoperative patient-reported outcome measure thresholds predictive of achieving MCID and PASS. MCID thresholds were determined as 169.6, 6.8, 7.2, and 1.1 for WOSI, Rowe, ASES, and VAS, respectively. PASS thresholds were calculated as ≤ 480, ≥ 80, ≥ 87, and ≤ 1 for WOSI, Rowe, ASES, and VAS, respectively. Preoperative thresholds of ≥ 760 (WOSI) and ≤ 50 (Rowe) predicted achieving MCID for WOSI score (p < 0.001). Preoperative thresholds of ≤ 60 (ASES) and ≥ 2 (VAS) predicted achieving MCID for VAS score (p < 0.001). A preoperative threshold of ≥ 40 (Rowe) predicted achieving PASS for Rowe score (p = 0.005). Preoperative thresholds of ≥ 50 (ASES; p = 0.002) and ≤ 2 (VAS; p < 0.001) predicted achieving PASS for the ASES score. Preoperative thresholds of ≥ 43 (ASES; p = 0.046) and ≤ 4 (VAS; p = 0.024) predicted achieving PASS for the VAS. This study defined MCID and PASS values for WOSI, Rowe, ASES, and VAS scores in patients undergoing arthroscopic Bankart repair. Higher preoperative functional scores may reduce the likelihood of achieving MCID but increase the likelihood of achieving the PASS. These findings provide valuable guidance for surgeons to counsel patients realistically regarding their expectations.

Incidence of revision surgery and patient-reported outcomes within 5 years of the index procedure for grade 1 spondylolisthesis: an analysis from the Quality Outcomes Database spondylolisthesis data.

Some patients treated surgically for grade 1 spondylolisthesis require revision surgery. Outcomes after revision surgery are not well studied. The objective of this study was to determine how revision surgery impacts patient-reported outcomes (PROs) in patients undergoing decompression only or decompression and fusion (D+F) for grade 1 spondylolisthesis within 5 years of the index surgery. Patients in the 12 highest Quality Outcomes Database (QOD) enrolling sites with a diagnosis of grade 1 spondylolisthesis were identified and the incidence of revision surgery between the decompression-only and D+F patients were compared. PROs were compared between cohorts requiring revision surgery versus a single index procedure. Of 608 patients enrolled, 409 had complete 5-year data available for this study. Eleven (13.3%) of 83 patients underwent revision in the decompression-only group as well as 32 (9.8%) of 326 in the D+F group. For the entire cohort, patients requiring revision had significantly worse PROs at 5 years: Oswestry Disability Index (ODI) 27.4 versus 19.4, p = 0.008; numeric rating scale for back pain (NRS-BP) 4.1 versus 3.0, p = 0.013; and NRS for leg pain (NRS-LP) 3.4 versus 2.1, p = 0.029. In the decompression-only group, the change in 5-year PROs was not impacted by revision status: ODI 31.9 versus 24.2, p = 0.287; NRS-BP 1.9 versus 2.9, p = 0.325; and NRS-LP 6.2 versus 3.7, p = 0.011. In the D+F group, the change in 5-year PROs was diminished if patients required revision: ODI 19.1 versus 29.1, p = 0.001; NRS-BP 3.0 versus 4.0, p = 0.170; and NRS-LP 2.3 versus 4.6, p = 0.001. The most common reasons for reoperation within 5 years in the decompression-only group were repeat decompression and instability, whereas in the D+F group the most common reason was adjacent-segment disease. The need for revision resulted in modestly diminished benefit compared with patients with no revisions. These differences were greater in the fusion cohort compared with the decompression-only cohort. The mean PRO improvement still far exceeded minimal clinically important difference thresholds for all measures for patients who underwent a revision surgery.

Preoperative Osteoporosis Is Associated With Increased Health Care Utilization and Compromised Pain and Function Improvement After Primary Total Hip Arthroplasty: A Prospective Cohort Analysis

BackgroundOsteoporosis (OP) has been linked to complications after total hip arthroplasty (THA), but its impact on health care utilization and patient-reported outcomes remains unclear. This study aimed to evaluate the association between: 1) pre-THA OP and health care utilization as well as patient-reported pain and function outcome measures; and 2) dual energy X-ray absorptiometry (DEXA) scan-based T-scores and the aforementioned outcomes. MethodsA retrospective analysis of prospectively collected data of primary THA (2015 to 2018) was performed (n = 5,321) from a validated academic institutional database of a large North American tertiary health care system; of which 4,074 (76.6%) completed 1-year follow-up. Outcomes included prolonged length of stay [LOS] > three days, discharge disposition, 90-day readmission, and 1-year reoperation, as well as Hip Disability and Osteoarthritis Outcome Score (HOOS]) Pain, HOOS-function (PS), and minimal clinically important difference thresholds (MCID), and satisfaction. ResultsThe prevalence of OP pre-THA was 56.9%, of which 39.8% were not prescribed OP medications and 15.3% had a DEXA scan. Compared to those who did not have OP, those who had OP were independently associated with higher odds of prolonged LOS, nonhome discharge, 90-day readmission, and 1-year reoperation (P < 0.005). Furthermore, they had significantly higher odds of failing to achieve MCID (odds ratio: 1.41 (95% confidence interval: 1.06 to 1.89)) for HOOS-PS and satisfaction (odds ratio: 1.5 (95% confidence interval: 1.16 to 1.93)) at one year. Higher T-scores were associated with lower odds of prolonged LOS, nonhome discharge, failure to achieve MCID in HOOS-Pain, and HOOS-PS. ConclusionsOver half of patients had OP; however, only 15.3% of patients had a DEXA scan before THA. Patients who had OP were at higher risk of prolonged LOS, nonhome discharge, 90-day readmission, and 1-year reoperation in addition to poor pain/function improvement and dissatisfaction one year after THA.

Differences between uncapping and removal behaviors in Apis cerana from the perspective of long non-coding RNAs

BackgroundHygienic behavior, a specialized form of immune response evolved in social insects, plays a crucial role in safeguarding colonies from disease spread. In honeybee colonies, such behavior typically entails the dual steps of uncapping and removal of unhealthy and deceased brood. Although in recent years, numerous studies have examined the development of hygienic behavior, the mechanisms underlying the division in the performance of uncapping and removal have yet to be sufficiently elucidated. In this regard, long non-coding RNAs (lncRNAs) have been evidenced to be engaged in regulating the physiological activities of honeybees; however, whether lncRNAs are likewise involved in the uncapping and removal tasks has not been clarified.ResultsIn this study, the strong hygienic Apis cerana worker bees were used and the processes of uncapping and removal behaviors in three colonies were assayed with freeze-killed brood in the field. We then sequenced the antennal RNAs of honeybees to identify differentially expressed lncRNAs and performed lncRNA-mRNA association analysis to establish the differences between uncapping and removal. We detected 1,323 differentially expressed lncRNAs in the antennae, and the findings of lncRNA-mRNA association analyses revealed that the target genes of differentially expressed lncRNAs between uncapping and removal worker bees were predominantly linked to response to stimulus, receptor activity, and synapse. Notably, among the lncRNAs enriched in cellular response to stimulus, XR_001766094.2 was exclusively expressed in the uncapping worker bees. Based on these findings, we hypothesize that XR_001766094.2 plays a key role in distinguishing uncapping from removal behaviors by responding to external stimulus, thereby suggesting that the division of hygienic behaviors is governed by differential thresholds of responsiveness to environmental cues.ConclusionWe characterized differences in the uncapping and removal behaviors of worker bees from a perspective of lncRNAs. Uncapping bees may be equipped with a more rapid stimulatory response and more acute olfactory sensitivity, contributing to the rapid hygienic behavior in honeybee colonies. Our results thus establish a foundation for potential lncRNA-mediated gene expression regulation in hygienic behavior.

Comparative Analysis of Liver Enzyme Changes Before and After Korean Medicine Treatment in People with Obesity: A Retrospective, Multicenter, Observational Study

This retrospective, multicenter, observational study aimed to evaluate the effects of herbal medicine treatment on liver function in obese patients exhibiting elevated liver enzymes. Conducted from May 2023 to April 2024 at various Korean medicine clinics, the study included 84 patients who underwent herbal treatments for obesity. All participants had at least one liver function test (LFT) showing elevated levels of aspartic amino transferase (AST), alanine amino transferase (ALT), or gamma glutamyl transferase (GGT), and a subsequent LFT performed after a minimum of 90 days. The study excluded patients with potential confounding factors such as hepatitis, antibiotic usage, or recent surgeries.&lt;/br&gt;The study showed significant reductions in AST, ALT, and GGT levels, with AST and ALT improving to within the normal range and GGT approaching normal levels. Patients also experienced statistically significant reductions in weight and BMI, meeting the minimum clinically important difference threshold.&lt;/br&gt;These findings suggest that herbal treatments for obesity are not only safe for patients with obesity-related liver enzyme abnormalities but also effective in improving liver function. This study shows that herbal treatment is effective in the management of obesity-related liver disease and confirms the safety and efficacy of an obesity treatment herbal formula containing ephedra. Larger prospective studies are needed to confirm these findings.

Federated learning data protection scheme based on personalized differential privacy in psychological evaluation

Federated learning enables multi-party model training by utilizing shared models instead of raw data, allowing for effective use of user data while ensuring privacy protection. However, the training process still has potential threats. Guided by the safe sharing and analysis of data in psychological evaluation, a federated learning data protection scheme based on differential privacy FL-PDP is proposed. First, local model parameters are perturbed using personalized differential privacy techniques to provide varying levels of privacy protection. Second, the privacy configuration selected by the user is divided into multiple levels and uploaded to the server after encryption to avoid targeted attacks in the uplink channel. Third, a probability-based selection method is employed for model aggregation to mitigate the impact of high privacy protection requirements on the model aggregation process. Finally, after aggregation is completed on the server side, noise that meets the global differential privacy threshold is added to quantify the level of global privacy protection. Experimental results indicate that this algorithm achieves high model accuracy, low communication latency, and scalability while ensuring privacy protection.

Quaternion attention-based JND model for macrophotography image watermarking

With the advancement of imaging technology, macrophotography images (MPIs) have become a popular research topic. Unlike natural images, MPIs often feature sharp foregrounds and blurred backgrounds, leading to distinct perceptual characteristics in estimation. As the number of MPIs grows rapidly, concerns over image quality and security increase. Robust watermarking techniques have been introduced to address these challenges. Just Noticeable Difference (JND) has been widely used in quantization-based watermarking frameworks. However, existing JND models handle each image area with a single-level perceptual attention. Visual attention in Quaternion Discrete Wavelet Transform (QDWT), which can reflect the Multi-level perceptual attention feature. Therefore, we propose a new method called Quaternion Attention-based Just Noticeable Difference model for MPIs Watemarking (QAJnd-MW) for watermarking MPIs. This method uses visual attention mechanisms, recognizing that the HVS is more sensitive to attention regions. We generate a masking effect in the JND field. The input image undergoes QDWT to explore multi-scale features. The multi-scale feature maps, with multi-directional luminance and multi-channel color, help create local and global attention maps, which are fused to form the final attention map. Specifically, considering both attention-based masking effects, the quaternion attention-guided JND model is designed for a robust MPI watermarking framework, aiming to further improve MPI security. Extensive experiments on the MP2020 and Blur Detection datasets show that the proposed model significantly improves robustness against JPEG compression attacks, reducing the bit error rate (BER) by up to 12%. Additionally, the model performs well against other attacks, such as those in online social networks, with lower BER than current state-of-the-art techniques.

Objective validation of alternative speech test sources for person-to-person speech intelligibility assessments

A sound source that mimics the acoustics characteristics of a human talker is required in objective assessments of speech intelligibility in person-to-person speech communications (PP) scenarios. The few special speech test sources available that meet the strict specifications of the relevant standards are costly and can be inaccessible to practitioners. This can prevent investigations or can lead to non-special and more affordable loudspeakers to be used as alternative sources without knowledge of their suitability. This study evaluates the validity of non-special loudspeakers in PP assessments and supplements a previous preliminary examination by consolidating and expanding early findings. Speech Transmission Index Public Address (STIPA) assessments were conducted employing three representative non-special loudspeakers and one standardized reference speech test source under laboratory conditions. Absolute errors of STIPA measurements were analysed and evaluated against two just perceivable difference (JND) threshold levels. The mean absolute errors obtained for all non-special loudspeakers for almost all scenarios were within one JND of any of the two JND levels. The striking and consistent low level of error found validated the proposition that non-special and affordable loudspeakers may be used as suitable speech sources in pilot or survey-grade speech intelligibility assessments in place of a special standardized speech source when that source is not available, or in full investigations when the relevant standard to adhere to allows the use of those alternative speech sources.

The minimal important difference in obsessive-compulsive disorder: An analysis of double-blind SSRI trials in adults.

The change in symptoms necessary to be clinically relevant in obsessive-compulsive disorder (OCD) is currently unknown. In this study, we aimed to create an empirically validated threshold for clinical significance or minimal important difference (MID). We analyzed individual participant data from short-term, double-blind, placebo-controlled registration trials of selective serotonin reuptake inhibitors in adult OCD patients. Data were collected from baseline to week 12. We used equipercentile linking to equate changes in the Clinical Global Impression (CGI) scale to changes in the Yale-Brown Obsessive-Compulsive Scale (YBOCS). We defined the MID as the YBOCS change linked to a CGI improvement of 3 (defined as "minimal improvement"). We included 7 trials with a total of 1216 patients. The CGI-scores and YBOCS were moderately to highly correlated. The MID corresponded to 4.9 YBOCS points (95% CI 4.4-5.4) for the full sample, or a 24% YBOCS-decrease compared to baseline. The MID varied with baseline severity, being lower in the group with mild symptoms and higher in the group with severe symptoms. By linking the YBOCS to the CGI-I, this is the first study to propose an MID in OCD trials. Having a clearly defined MID can guide future clinical research and help interpretation of efficacy of existing interventions. Our results are clinician-based; however, there is further need for patient-reported outcomes as anchor to the YBOCS.

Comparison between a Novel Knee Arthrometer and Simultaneous Stress Radiography for the Diagnosis of Complete and Partial Acute Anterior Cruciate Ligament Tears.

The type of ligamentous tear and the degree of knee laxity have important guiding significancefor the diagnosis and management of anterior cruciate ligament (ACL) tears. Instrumental measurement is necessary for ACL tears since physical examination and magnetic resonance imaging (MRI) cannot provide an objective and quantitative assessment of knee laxity. This study aimed to compare the application of a novel knee arthrometer and simultaneous stress radiography in differentiating between complete and partial acute ACL tears, and further assess the correlation between the two measurements. A total of 106 patients with complete acute ACL tears and 52 patients with partial acute ACL tears were included in the study. Preoperative arthrometry and simultaneous stress radiography were performed using the Ligs arthrometer at 90, 120, and 150 N to assess side-to-side difference (SSD) in anterior knee laxity. The optimal threshold was determined using the receiver operating characteristic (ROC) curve. The area under the ROC curve (AUC) was used to assess the diagnostic value of the measurement. Pearson's correlation coefficient was used to assess the correlation between the two measurements. The optimal differential SSD thresholds in the Ligs arthrometer were 2.7 mm at 90 N, 3.8 mm at 120 N, and 4.6 mm at 150 N. Similarly, the optimal differential SSD thresholds in simultaneous stress radiography were 3.8 mm at 90 N, 5.1 mm at 120 N, and 5.6 mm at 150 N. The AUC analysis revealed that the Ligs arthrometer was fairly informative at 90 N (AUC = 0.851), 120 N (AUC = 0.878), and 150 N (AUC = 0.884), and simultaneous stress radiography was highly informative at 90 N (AUC = 0.910), 120 N (AUC = 0.925), and 150 N (AUC = 0.948). Moreover, the AUC of the combined measurements was 0.914 at 90 N, 0.931 at 120 N, and 0.951 at 150 N. A significantly strong correlation was found between the two measurements at 90 N (r = 0.743, p < 0.001), 120 N (r = 0.802, p < 0.001), and 150 N (r = 0.823, p < 0.001). The Ligs arthrometer and simultaneous stress radiography proved to be valid diagnostic tools to differentiate between complete and partial acute ACL tears, with a strong correlation between the two measurements in SSD values. Compared with single instrumental measurement, the combination of the two measurements can further improve the diagnostic value in this regard.

Agreement between manual and automatic ultrasound measurement of the velocity-time integral in the left ventricular outflow tract in intensive care patients: evaluation of the AUTO-VTI® tool.

Transthoracic echocardiography is widely used in intensive care unit (ICU) to manage patients with acute circulatory failure. Recently, automated ultrasound (US) measurement applications have been developed but their clinical performance has not been evaluated yet. The aim of this study was to assess the agreement between automated and manual measurements of the velocity-time integral in the left ventricular outflow tract (VTI-LVOT) using the auto-VTI® tool. This prospective, single-center, interventional study included ICU patients with acute circulatory failure. The examination involved two successive manual measurements of VTI-LVOT (mean of 3 consecutive heartbeats in regular sinus rhythm, and 5 heartbeats in irregular rhythm), followed by a measurement using auto-VTI® software. In patients receiving a fluid challenge, trending ability in detecting fluid responsiveness was also evaluated. Seventy patients were included between January 19, 2020, and September 24, 2020, at the Nîmes University Hospital. The feasibility of the auto-VTI® was 94%. The mean difference between the two methods was 11% with limits of agreement from - 19% to 42%. The proportion of agreement at the 15% difference threshold was 68% [58%; 80%]. The precision and least significant change measured for the manual measurement of VTI were 7.4 and 10.5%, respectively, and by inference for the automated method 28% and 40%. The new auto-VTI® tool, despite interesting feasibility, demonstrated an insufficient agreement with a systematic bias and an insufficient precision limiting its implementation in critically ill patients.Clinical trial registration: ClinicalTrials.gov identifier: NCT04360304.

Composting Cow Dung Enriched with Vivianite (Phosphocompost) for Agricultural Use in the Balaza Lawane Locality (Far North, Cameroon)

Aims: Soils in the Far North of Cameroon are deficient in organic matter and available phosphorus, making it difficult to intensify agricultural production. This affects the yield of several crops. With this in mind, a study has been carried out to produce cow dung compost enriched with vivianite, to improve soil quality in terms of organic matter and available phosphorus, and boost agricultural production. Study Design: A study was carried out to produce cow dung compost enriched with rock phosphate (Vivianite). Place and Duration of Study: Balaza Lawane in Far North Region of Cameroon. The sowing was done on January 15, 2021 until 20 april 2021. Methodology: To this end, we produced 3 organic amendments based on cow dung (a compost and two phospho-composts containing 10 and 20% of vivianite, respectively). Monitoring and chemical characterization of each of the three was carried out. A seed germination test was also carried out, on petri dishes in a completely randomized block design repeated three times. Results: Physico-chemical analyses reveal that the soil at the Balaza Lawane site has a Sandy clay loam granulometry and an acid pH (6.8); it is low in organic matter and available phosphorus. The monitoring of the amendments showed that the temperature, the pH, and even the moisture content of the amendments changed in the same way over time. The application of vivianite powder improved the nitrogen, potassium, and phosphorus content of the phosphocomposts compared to the compost. Phytotoxicity tests showed that our various amendments had no phytotoxic effects. The 20 and 10% phosphocomposts showed higher germination index than the other treatments (157.33±16.32% and 157.01±15.32% respectively). An analysis of variance revealed a significant difference (p &lt; 0.05) threshold. Conclusion: Compost enriched with 20% vivianite produced more available phosphorus, and showed no phytotoxicity. This phosphocompost is proving to be the most effective crop amendment on Balaza Lawane soil.

Experimental Study of the Influence of Occupants on Speech Intelligibility in an Automotive Cabin

Adding occupants to an enclosed space often leads to perceptible changes in the sound field and, therefore, speech intelligibility; however, this issue has not yet been examined in automotive cabins. This study investigated the effect of occupants in an automotive cabin on SI. Binaural room impulse responses (BRIRs) were measured in an automotive cabin with an artificial mouth and dummy head under different speaker–listener position configurations and occupancy modes. Based on the measured BRIRs, the speech transmission index (STI) was determined, and subjective speech–reception thresholds (SRTs) in Mandarin Chinese were assessed. The results indicate that speech intelligibility mostly decreased slightly after adding additional occupants. In most cases, the occupants did not significantly affect speech intelligibility, with STI variations of no more than the just-noticeable difference and SRT variation within 1 dB. When the listener was in the back-right seat, the effect of the occupants on speech intelligibility could not be ignored, with STI variations of up to 0.07 and an SRT variation of 2 dB under different occupancy modes. In addition, the influence of front-row passengers on the speech intelligibility of rear-row listeners was extremely small, and vice versa. Furthermore, altering the distribution of occupants had an effect comparable to changing the number of occupants.

Sex Differences in Patient-Reported Depression Following Vascular Surgery Procedures

IntroductionFemale patients frequently experience worse clinical outcomes than male patients after undergoing vascular surgery procedures. However, it is unclear whether these sex-based disparities also impact mental health outcomes. This study was designed to investigate sex differences in patient-reported outcome measures of depression for patients undergoing vascular surgery. MethodsWe retrospectively analyzed 107 patients (73 males and 34 females) who underwent vascular surgery procedures between January 2016 and April 2023. These patients completed a Patient-Reported Outcome Measurement Information System (PROMIS) Item Bank v1.0-Depression assessment 90 d before surgery and at least once after surgery. After stratifying patients by sex, we analyzed changes in PROMIS depression scores using a multiple mixed-effects linear regression model. Then, logistic regression was used to compare the proportion of patients who achieved a clinically meaningful difference in PROMIS depression score within 15 mo after surgery. ResultsThere was no significant difference between female and male patients among rates of complications, length of hospital stay, or rates of nonhome discharge. However, female sex was associated with significantly improved PROMIS depression scores after surgery compared to male sex (P = 0.034). Furthermore, female patients were over 3-fold more likely than male patients to reach the minimal clinically important difference threshold for improvement in PROMIS depression scores (odds ratio 4.66, 95% confidence interval 1.39-15.61). ConclusionsThese results suggest that female sex is associated with improved patient-reported measures of depression after undergoing vascular surgery. Clinicians should consider these mental health benefits when evaluating female patients for vascular interventions.

Reaffirmation of Mechanistic Proteomic Signatures Accompanying SGLT2 Inhibition in Patients With Heart Failure: A Validation Cohort of the EMPEROR Program

BackgroundSodium-glucose cotransporter 2 (SGLT2) inhibitors exert a distinctive pattern of direct biological effects on the heart and kidney under experimental conditions, but the meaningfulness of these signatures for patients with heart failure has not been fully defined. ObjectivesWe performed the first mechanistic validation study of large-scale proteomics in a double-blind randomized trial of any treatment in patients with heart failure. MethodsIn a discovery cohort from the EMPEROR (Empagliflozin Outcome Trial in Patients With Chronic Heart Failure and Reduced Ejection Fraction) program, we studied the effect of randomized treatment with placebo or empagliflozin on 1,283 circulating proteins in 1,134 patients with heart failure with a reduced or preserved ejection fraction. In a validation cohort, we expanded the number to 2,155 assessed proteins, which were measured in 1,120 EMPEROR participants who had not been studied previously. ResultsIn the validation cohort, 25 proteins were the most differentially enriched by empagliflozin (ie, ≥15% between-group difference and false discovery rate <1% at 12 weeks with known effects on the heart or kidney): 1) 13 proteins promote autophagy and other cellular quality-control functions (IGFBP1, OTUB1, DNAJB1, DNAJC9, RBP2, IST1, HSPA8, H-FABP, FABP6, ATPIFI, TfR1, EPO, IGBP1); 2) 12 proteins enhance mitochondrial health and ATP production (UMtCK, TBCA, L-FABP, H-FABP, FABP5, FABP6, RBP2, IST1, HSPA8, ATPIFI, TfR1, EPO); 3) 7 proteins augment cellular iron mobilization or erythropoiesis (TfR1, EPO, IGBP1, ERMAP, UROD, ATPIF1, SNCA); 4) 3 proteins influence renal tubular sodium handling; and 5) 9 proteins have restorative effects in the heart or kidneys, with many proteins exerting effects in >1 domain. These biological signatures replicated those observed in our discovery cohort. When the threshold for a meaningful between-group difference was lowered to ≥10%, there were 58 additional differentially enriched proteins with actions on the heart and kidney, but the biological signatures remained the same. ConclusionsThe replication of mechanistic signatures across discovery and validation cohorts closely aligns with the experimental effects of SGLT2 inhibitors. Thus, the actions of SGLT2 inhibitors—to promote autophagy, restore mitochondrial health and production of ATP, promote iron mobilization and erythropoiesis, influence renal tubular ion reabsorption, and normalize cardiac and renal structure and function—are likely to be relevant to patients with heart failure. (EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Preserved Ejection Fraction [EMPEROR-Preserved], NCT03057951; EMPagliflozin outcomE tRial in Patients With chrOnic heaRt Failure With Reduced Ejection Fraction [EMPEROR-Reduced], NCT03057977)