Tag: pubmed

J Am Acad Orthop Surg Glob Res Rev. 2024 Dec 8;8(12). doi: 10.5435/JAAOSGlobal-D-24-00346. eCollection 2024 Dec 1.

ABSTRACT

BACKGROUND: In the surgical treatment of Haglund syndrome, combining a flexor hallucis longus (FHL) tendon transfer with Achilles tendon may improve plantarflexion strength and reduce strain on the repaired Achilles tendon. However, there is limited research comparing complication rates between surgical approaches with or without concurrent FHL tendon transfer.

METHODS: This was retrospective study of patients who underwent surgical management for Haglund syndrome between January 2015 and December 2023. Surgical management included open central-splitting Achilles tendon débridement, Haglund prominence resection, and subsequent Achilles tendon reattachment, either with or without concurrent FHL tendon transfer. Patient demographics, comorbidities, and postoperative complications were collected. Statistical analysis was conducted to compare outcomes between the two groups.

RESULTS: Among the 390 patients who underwent surgical intervention for Haglund syndrome, 52 individuals received FHL tendon transfer. The average follow-up duration was 10.1 ± 12.9 months. Overall, complications included persistent pain (10.3%), wound breakdown (8.2%), infection (1.8%), plantar flexion weakness (1.5%), and Achilles tendon rupture (0.3%). No notable difference was observed in complication rates between the two groups. However, wound breakdown was higher in the FHL tendon transfer group compared with the non-FHL group (P = 0.5). No patients who received a FHL tendon transfer experienced a postoperative Achilles tendon rupture.

CONCLUSION: In the largest study of patients who underwent surgical treatment for Haglund syndrome, with or without FHL tendon transfer, the overall complication rate was comparable. However, the FHL tendon transfer group exhibited a higher tendency for wound breakdown.

PMID:39700482 | DOI:10.5435/JAAOSGlobal-D-24-00346

J Speech Lang Hear Res. 2024 Dec 19:1-16. doi: 10.1044/2024_JSLHR-23-00080. Online ahead of print.

ABSTRACT

PURPOSE: We investigate the extent to which automated audiovisual metrics extracted during an affect production task show statistically significant differences between a cohort of children diagnosed with autism spectrum disorder (ASD) and typically developing controls.

METHOD: Forty children with ASD and 21 neurotypical controls interacted with a multimodal conversational platform with a virtual agent, Tina, who guided them through tasks prompting facial and vocal communication of four emotions-happy, angry, sad, and afraid-under conditions of high and low verbal and social cognitive task demands.

RESULTS: Individuals with ASD exhibited greater standard deviation of the fundamental frequency of the voice with the minima and maxima of the pitch contour occurring at an earlier time point as compared to controls. The intensity and voice quality of emotional speech were also different between the two cohorts in certain conditions. Additionally, facial metrics capturing the acceleration of the lower lip, lip width, eye opening, and vertical displacement of the eyebrows were also important markers to distinguish between children with ASD and neurotypical controls. Both facial and speech metrics performed well above chance in group classification accuracy.

CONCLUSION: Speech acoustic and facial metrics associated with affect production were effective in distinguishing between children with ASD and neurotypical controls.

SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.28027796.

PMID:39700465 | DOI:10.1044/2024_JSLHR-23-00080

J Speech Lang Hear Res. 2024 Dec 19:1-13. doi: 10.1044/2024_JSLHR-24-00524. Online ahead of print.

ABSTRACT

PURPOSE: This study investigated the ecological validity of conventional voice assessments by comparing the self-perceived voice quality and acoustic characteristics of voice production during these assessments to those in a simulated environment with varying distracting conditions and noise levels.

METHOD: Forty-two university professors (26 women) participated in the study, where they were asked to produce loud connected speech by reading a 100-word text under four different conditions: a conventional assessment and three virtual classroom simulations created with 360° videos, each with different noise levels, played through a virtual reality headset and headphones. The first video depicted students paying attention in class (40 dB classroom noise); the second showed some students talking, generating moderate conversational noise (60 dB); and the third depicted students talking loudly and not paying attention (70 dB). The entire experiment was conducted in a sound-treated room, and the voice of each participant was recorded for acoustic analysis. In each condition, self-perception of voice quality (vocal effort and vocal ease), SPL, fundamental frequency, long-term average spectrum (L1-L0 ratio, alpha ratio, and the 1/5-5/8 ratio), and smooth cepstral peak prominence were measured.

RESULTS: Visual distraction and noise level significantly impacted both subjective and acoustic measures of voice production, as shown by numerous statistically significant differences across almost all conditions and variables examined. Specifically, all measures increased with higher levels of distraction and noise, except for the 1/5-5/8 ratio, which showed a decreasing trend.

CONCLUSION: These findings indicate that visual distraction and noise level significantly influence self-perceived and acoustic vocal characteristics and suggest that conventional assessments, typically conducted in silence and without visual distractors, may not accurately represent real-world performance, thus limiting their ecological validity.

PMID:39700458 | DOI:10.1044/2024_JSLHR-24-00524

Neurology. 2025 Jan 14;104(1):e210106. doi: 10.1212/WNL.0000000000210106. Epub 2024 Dec 19.

ABSTRACT

BACKGROUND AND OBJECTIVES: Hypotonia is a relatively common finding among infants in the neonatal intensive care unit (NICU). Consideration of genetic testing is recommended early in the care of infants with unexplained hypotonia. We aimed to assess the diagnostic yield and overall impact of exome and genome sequencing (ES and GS).

METHODS: Consecutive infants with hypotonia were identified from research and clinical databases across 5 teaching hospitals in United States, Canada, United Kingdom, and Australia. Inclusion criteria included NICU admission and genetic evaluation. Infants with a known explanation for hypotonia were excluded. Data regarding infant characteristics, genetic testing, and diagnoses were collected. The primary outcome was identification of a molecular diagnosis. Impact on care was a secondary outcome. The Fisher exact and Wilcoxon rank-sum tests were used for statistical analysis.

RESULTS: We identified 147 infants with unexplained hypotonia. The median gestational age was 39 weeks (interquartile range [IQR] 36-42 weeks), 77 (52%) were female, and the median age was 8 days at the time of evaluation (IQR 2-19 days). Eighty (54%) had hypotonia as the main clinical feature while 67 (46%) had additional multisystem involvement. Seventy-five (51%) underwent rapid ES, 44 (30%) rapid GS, 2 (1%) both ES and GS, and 26 (18%) were admitted before ES or GS became available. Of the 121 infants who underwent ES and/or GS, 72 (60%) had the primary outcome of a molecular diagnosis. In addition, 2 infants with mitochondrial genome variants were diagnosed by mitochondrial GS after negative ES, and one infant needed targeted testing to identify a short tandem repeat expansion missed by GS. The proportion diagnosed by ES and GS was not different between infants with hypotonia as the primary finding (37/56, 66%) and infants with multisystemic symptoms (35/65, 54%, odds ratio [OR] 1.7, CI 0.8-3.7, p value = 0.20). Testing was more likely to have an impact on care for infants receiving a genetic diagnosis (57/66 vs 14/33, OR 8.4, CI 2.9-26.1, p = 1.0E-05).

DISCUSSION: Rapid ES and GS provided a molecular diagnosis for most of the infants with unexplained hypotonia who underwent testing. Further studies are needed to assess the generalizability of these findings as increased access to genetic testing becomes available.

CLASSIFICATION OF EVIDENCE: This study provides Class IV evidence that in unexplained neonatal hypotonia, rapid ES or GS adds diagnostic specificity.

PMID:39700446 | DOI:10.1212/WNL.0000000000210106

JMIR Public Health Surveill. 2024 Dec 19;10:e63557. doi: 10.2196/63557.

ABSTRACT

BACKGROUND: In-flight medical emergencies (IMEs) can have severe outcomes, including the deaths of passengers and aircraft diversions. Information is lacking regarding the incidence rate and characteristics of IMEs in most countries, especially in mainland China.

OBJECTIVE: The objective of this study was to investigate the incidence, patterns, and associated risk factors of IMEs in mainland China and to provide medical suggestions for the evaluation and management of IMEs.

METHODS: This population-based retrospective study examined electronic records for all IME reports between January 1, 2018, and December 31, 2022, from a major airline company in mainland China. Outcome variables included the medical category of the IMEs, the outcomes of first aid, and whether or not the IMEs led to a flight diversion. We calculated the incidence rate and death rate of IMEs based on the number of passengers and flights, respectively. A logistic regression model was used to investigate the factors associated with aircraft diversions.

RESULTS: A total of 199 IMEs and 24 deaths occurred among 447.2 million passengers, yielding an incidence rate of 0.44 (95% CI 0.39-0.51) events per million passengers and 66.56 (95% CI 50.55-86.04) events per million flights, and an all-cause mortality rate of 0.05 (95% CI 0.03-0.07) events per million passengers and 7.50 (95% CI 4.81-11.16) events per million flights. From 2018 to 2022, the highest incidence and mortality rates were observed in 2019 and 2020, respectively, while the lowest were in 2020 and 2021, respectively. Additionally, the highest incidence and mortality rates were observed between 6 PM to 6 AM and noon to 6 PM, respectively. There was a higher incidence rate of IMEs in the winter months. Moreover, the highest case-fatality rates were observed in 2019 (12/74, 16.2%), on flights traveling ≥4000 km (9/43, 20.9%), and on wide-body planes (10/52, 19.2%). Seizures (29/199, 14.6%), cardiac symptoms (25/199, 12.6%), and syncope or presyncope (19/199, 9.6%) were the most common medical problems and main reasons for aircraft diversion. The incidence of aircraft diversion was 42.50 (95% CI 37.02-48.12) events per million flights. Narrow-body planes (odds ratio [OR] 5.69, 95% CI 1.05-30.90), flights ≥4000 km (OR 16.40, 95% CI 1.78-151.29), and the months of December to February (OR 12.70, 95% CI 3.09-52.23), as well as the months of March to May (OR 23.21, 95% CI 3.75-143.43), were significantly associated with a higher risk of diversion.

CONCLUSIONS: The occurrence of and deaths associated with IMEs are rare in mainland China, but a temporal trend shows higher incidence rates at night and in winter. The leading IMEs are cardiac symptoms, seizures, and syncope. The establishment of a unified reporting system for IMEs and ground-to-air medical support are of great value for reducing IMEs and deaths in the global community.

PMID:39700443 | DOI:10.2196/63557

J Clin Oncol. 2024 Dec 19:JCO2401121. doi: 10.1200/JCO.24.01121. Online ahead of print.

ABSTRACT

This randomized phase III trial aimed to determine whether treatment with cisplatin and volume-directed radiation followed by carboplatin and paclitaxel for four cycles (chemoradiotherapy [C-RT]) increased recurrence-free survival (RFS) and overall survival (OS) when compared with carboplatin and paclitaxel for six cycles (chemotherapy [CT]) in locally advanced endometrial cancer (UC). Previously reported results showed that C-RT did not improve RFS compared with CT. Here we report the final OS analysis. Patients with International Federation of Gynecology and Obstetrics (FIGO) 2009 stage III-IVA UC or stage I/II serous or clear cell UC and positive cytology were enrolled. The primary objective was RFS. Secondary objectives were OS, toxicity, and quality of life. Cumulative probabilities of OS were estimated using the Kaplan-Meier method. Subgroup analyses of treatment effect for FIGO stage, age, race, gross residual disease, histology, lymph-vascular space invasion, and body mass index were performed. In total, 813 patients were randomly assigned (407 C-RT and 406 CT). The median follow-up was 112 months. Median OS was not achieved in either arm. The stratified hazard ratio for death comparing C-RT versus CT was 1.05 (95% CI, 0.82 to 1.34, log-rank two-sided P value = .72). None of the factors analyzed predicted OS benefit from C-RT. Although C-RT reduced the rate of local recurrence compared with CT, it did not increase OS or RFS in stage III/IVA UC.

PMID:39700442 | DOI:10.1200/JCO.24.01121

J Natl Cancer Inst. 2024 Dec 19:djae338. doi: 10.1093/jnci/djae338. Online ahead of print.

ABSTRACT

BACKGROUND: Racial and ethnic minorities remain underrepresented in gynecologic cancer clinical trials despite disproportionately worse oncologic outcomes. Research shows differential racial enrollment patterns due to comorbidity-based exclusion criteria (CEC). Our objective was to evaluate contemporary trends in CECs among NCI-sponsored gynecologic cancer clinical trials and protocol adherence to broadened eligibility criteria guidelines as an assessment of equitable enrollment access.

METHODS: The ClinicalTrials.gov registry was queried for NCI-sponsored gynecologic cancer clinical trials (1994-2021). Study characteristics and CECs were abstracted from protocols. Descriptive statistics and temporal trends were calculated using chi-square testing with STATA v17 software.

RESULTS: Among 279 clinical trials identified, 65% completed enrollment, 53% were Phase II, and 48% focused on ovarian cancer. Pharmaceutical agents (85%) were the primary therapeutic interventions.Several inequitably restrictive exclusion criteria increased over time such as hepatitis infection (17% in 1994-2000 vs 49% in 2015-2021, p < .001) and cardiovascular disease (47% in 1994-2000 vs 66% in 2015-2021, p = .002). A previously rare exclusion, “mental illness/social situations,” dramatically increased from 5% to 51% (p < .001) over three decades.Adherence to broadened eligibility criteria recommendations was mixed. Renal function, cardiovascular disease, and performance status criteria were not broadened but HIV, prior/concurrent malignancies, and brain metastasis criteria were.

CONCLUSIONS: Some, but not all, of the known restrictive CECs have increased in gynecologic cancer clinical trial design, despite calls for improving racial and ethnic minority representation. While exclusion criteria are critical for trial safety, they must be carefully considered given the differential racial impact on eligibility.

PMID:39700440 | DOI:10.1093/jnci/djae338

Rheumatology (Oxford). 2024 Dec 19:keae690. doi: 10.1093/rheumatology/keae690. Online ahead of print.

ABSTRACT

OBJECTIVES: Salivary gland ultrasound (SGUS) has an interest in primary Sjögren’s disease (pSD) for diagnosis, but the evolution of parenchymal lesions over time is unknown. The objective of this study was to assess the severity of ultrasound abnormalities in relation to pSD duration from the time of buccal dryness onset.

METHODS: In this cross-sectional international multicentre study, patients with pSD according to the 2002 or 2016 ACR/EULAR classification criteria were included. Parenchymal abnormalities were classified according to the semiquantitative score as defined by OMERACT. Patients were separated into 4 groups (Group A: < 5 years, Group B: 5-9 years, Group C: 10-20 years, and Group D: > 20 years from the onset of buccal dryness). The association between disease duration groups and SGUS lesions was quantified in terms of odds ratios and 95% confidence intervals.

RESULTS: A total of 247 patients were consecutively included between May 2019 and February 2022. Eighty-nine percent of patients had a focus score ≥1/4 mm2, and 85% had positive anti-Ro/SSA. pSD duration was associated with a pathological OMERACT score (score 2 or 3): OR for 5-year duration: 1.23 [95% CI 1.04; 1.47], p= 0.0383). Considering each US item, the only statistical association with pSD duration was found regarding the presence of hyperechoic bands (25% or more): OR for five-year duration 1.18 [95% CI 1.03; 1.36], p= 0.038), independent of an older age.

CONCLUSION: pSD duration was associated with the presence of hyperechoic bands, but not with hypoechoic areas, suggesting a progressive fibro-adipose evolution.

PMID:39700419 | DOI:10.1093/rheumatology/keae690

G3 (Bethesda). 2024 Dec 19:jkae280. doi: 10.1093/g3journal/jkae280. Online ahead of print.

ABSTRACT

Amplicon panels using genotyping by sequencing methods are now common, but have focused on characterizing SNP markers. We investigate how microhaplotype (MH) discovery within a recently developed Pacific oyster (Magallana gigas) amplicon panel could increase the statistical power for relationship assignment. Trios (offspring and two parents) from three populations in a newly established breeding program were genotyped on a 592 locus panel. After processing, 92% of retained amplicons contained polymorphic MH variants and 85% of monomorphic SNP markers contained MH variation. The increased allelic richness resulted in substantially improved power for relationship assignment with much lower estimated false positive rates. No substantive differences in assignment accuracy occurred between SNP and MH datasets, but using MHs increased the separation in log-likelihood values between true parents and highly related potential parents (aunts and uncles). A high number of Mendelian incompatibilities among trios were observed, likely due to null alleles. Further development of a MH panel, including removing loci with high rates of null alleles, would enable high-throughput genotyping by reducing panel size and therefore cost for Pacific oyster research and breeding programs.

PMID:39700397 | DOI:10.1093/g3journal/jkae280

J Glob Health. 2024 Dec 20;14:04246. doi: 10.7189/jogh.14.04246.

ABSTRACT

BACKGROUND: Postpartum family planning (PPFP) is an essential component of birth care that helps avert maternal and newborn health hazards by preventing short-spaced births. Many Asian and African studies found PPFP counselling during antenatal care (ANC) and postnatal care (PNC) effective in increasing PPFP uptake. Studies in Bangladesh, however, provided limited evidence of the feasibility and effectiveness of integrating PPFP in maternal health services. The national action plan integrated PPFP services (counseling and providing methods) in maternal health care and immunisation programmes. However, no study has examined the availability of PPFP counselling, an essential component of PPFP, in maternity care points and its effectiveness in increasing PPFP initiation. We explore the prevalence and correlates of PPFP counselling during ANC and PNC and investigate whether PPFP counselling during ANC and PNC increases PPFP initiation.

METHODS: We used nationally representative data from the 2017-18 Bangladesh Demographic and Health Survey to analyse whether women having the last live birth in the past three years received PPFP counselling during ANC or PNC visits. We included women’s other characteristics as covariates in a multivariable logistic regression. Finally, we analysed the 12-month PPFP initiation by PPFP counselling during ANC and PNC visits. The PPFP initiation analysis used self-reported contraceptive calendar data, a life table technique, and a proportional hazards model.

RESULTS: The prevalence of PPFP counselling was 12% during ANC and 22% during PNC. Women with higher education, higher birth order, upper household wealth quintiles, and living in the Khulna division compared to Chattogram (i.e. the division with the lowest PPFP counselling prevalence) were more likely to receive PPFP counselling during ANC and PNC. Three-fourths of the women initiated FP within 12 months postpartum. PPFP initiation was higher for women receiving PPFP counselling during PNC than those who did not receive it during PNC. We did not find evidence of increased PPFP initiation among women receiving PPFP counselling during ANC.

CONCLUSIONS: The higher PPFP initiation among women receiving PPFP counselling during PNC is encouraging. Although we did not find evidence supporting increased PPFP initiation among women receiving PPFP counselling during ANC, further investigation on the quality of PPFP counselling during ANC may guide this necessary intervention’s implementation and scale-up.

PMID:39700387 | DOI:10.7189/jogh.14.04246