Radiographic Factors Associated with Painful Callosities After Forefoot Surgery in Patients with Rheumatoid Arthritis

ABSTRACT Objectives Operative procedures for rheumatoid forefoot deformities have gradually changed from arthrodesis or resection arthroplasty to joint-preserving surgery. Though joint-preserving arthroplasty has yielded good outcomes, painful plantar callosities may occur postoperatively. This study aimed to reveal the radiographic factors associated with painful callosities after joint-preserving surgery for forefoot deformities in patients with rheumatoid arthritis (RA). Methods We retrospectively evaluated 166 feet in 133 patients with RA who underwent forefoot joint-preserving arthroplasty, including proximal rotational closing-wedge osteotomies of the first metatarsal, between January 2012 and December 2015. Logistic regression analysis was performed with the objective variable set as the presence/absence of painful plantar callosities at the final observation and the explanatory variables set as several radiographic factors including postoperative relative first metatarsal length (RML), amount of dorsal dislocation of the fifth metatarsal (5DD), and arc failure of the lesser toes. Results At the final follow-up, forty-two of the 166 feet (25.3%) had painful callosities under the metatarsal heads postoperatively. Logistic regression analysis showed that the RML, 5DD, and lesser toes’ arc failure were significantly associated with painful callosities. Conclusions We identified RML, 5DD, and arc failure of the lesser toes were associated with painful plantar callosities after the surgery.

Pengaruh Penggunaan Metode Bercerita Story Reading terhadap Perilaku Sosial Anak

This research was conducted to determine the relationship between the use of the story reading method of children's social behavior. After being given treatment in the form of the story reading storytelling method in the experimental group, it showed an increase in social behavior of children aged 4-5. In the experimental group the results of the pre-test observation (Y1) were 2407 and the results of the final observation (post test) showed higher data 2639. Based on the results of the experimental group pre-test and post-test data, there is a difference in the score between the post-test and pre-test with a difference of 200. So it can be concluded that there are differences in social behavior of children aged 4-5 years before being given treatment, namely the storytelling method. story reading after being given the story reading storytelling method treatment. After being given the treatment, the results of the final observation showed that the data score increased and showed that the story reading method can improve the social behavior of children aged 4-5 years.

Effect of Offering Pneumococcal Vaccines During Specialty Care on Vaccination Rates in Patients Receiving Immunosuppressive

Purpose: To determine whether clinician-led immunization education with immediate onsite vaccination availability will increase pneumococcal immunizations during specialty care. Methods: We designed a controlled before and after QI project quasi-experimental design to retrospectively evaluate the QI effectiveness. The QI setting included two clinics. Clinic #1 was a part of the county hospital system and offered comprehensive care. Clinic #2 was a university clinic that hosted a private practice and a dermatology resident continuity clinic. 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit participated in the study. The intervention included clinician provided verbal immunization recommendations. Patients were then given the opportunity for immediate immunization. The main measure of outcome was pneumococcal immunization status after QI intervention. Results: Our analysis included 201 patients with planned or existing immunosuppressive medication regimens attending an initial or follow-up dermatology visit (aged 0-64 years [82.1%] ,aged ≥65 years [17.9%]; male [34.3%] female [65.6%%]). Of these, 146 [72.6%] were in the QI group and 55 [27.4%] in the comparison group. Our unadjusted analyses identified no significant group differences in immunization status at initial observation (p=0.329; Table 1). Of the 102 patients in the QI group with no pneumococcal immunizations at initial observation, 80.4% (95% CI: 71.4%, 87.1%) received at least one pneumonia vaccination by the final observation. For the 27 patients in the QI group with partial immunization at project initiation, 85.2% (95% CI: 65.9%, 94.5%) received at least one pneumonia vaccination. Overall, 81.4% (95% CI: 73.6, 87.3) of patients in the QI group without full immunization at initial observation received at least one vaccination by the final observation. Conclusion: These data demonstrate that immunization coverage in patients on immunosuppressive medications can be markedly improved by clinician recommendation with immediate availability of the pneumococcal vaccine during specialty care. Wider adoption of this model and its adaptation to other immunizations and settings is an important opportunity to reduce vaccine-preventable illness, including COVID-19, and improve population health.

BMI Trajectories During the First 2 Years, and Their Associations With Infant Overweight/Obesity: A Registered Based Cohort Study in Taizhou, China

Objective: The purpose of this study was to identify trajectories of body mass index (BMI) in toddlers from birth to 2 years old and examine their association with infantile overweight/obesity.Methods: Data were collected from 19,054 children born in any hospital or community healthcare center in Taizhou, China from 2018 to 2019 with at least three BMI measurements after birth. The Latent Class Growth Mixture Model was used to identify distinct BMI trajectories during the first 2 years of infants. Multiple logistic regression models were conducted to explore the associated factors of different BMI trajectories, and log-binomial regression was performed to assess the association between the trajectories and overweight/obesity.Results: Three heterogeneous BMI trajectories were identified and labeled as “lower” (36.21%, n = 6,899), “middle” (53.15%, n = 10,128) and “upper” (10.64%, n = 2,027), respectively. Several characteristics of infants and their corresponding mothers were found to be correlated with infant BMI trajectories, including infant sex, mode of delivery and weight at birth, as well as maternal parity, early pregnancy BMI and status of gestational diabetes mellitus. Furthermore, compared with those in the lower trajectory, infants in the middle [prevalence ratio (PR) = 2.63, 95% confidence interval (95%CI) = 2.17–2.63] or upper (PR = 2.98, 95%CI = 1.51–2.98) trajectory groups were prone to be overweight/obesity at their final observation.Conclusion: Heterogeneous BMI trajectories were observed in our study. Characteristics of both infants and their corresponding mothers could be potential determinants of infant growth. Moreover, infants in the middle and upper trajectory groups were more likely to suffer overweight/obesity.

EFEKTIVITAS MODEL EVALUASI PENDIDIKAN KARAKTER PADA RUMPUN PEMBELAJARAN EKONOMI

Abstrak: Tujuan dari penelitian ini akan melakukan implementasi Model Evaluasi Pendidikan Karakter pada Rumpun Pembelajaran Ekonom. Penelitian menggunakan pendekatan Research & Development yang dikembangkan Borg and Gall. Subjek penelitian adalah mahasiswa di Fakultas Ekonomi yang sedang mengambil matakuliah rumpun ekonomi dengan jumlah responden sebanyak 186 mahasiswa yang terdiri empat prodi S1 yang ada di Fakultas Ekonomi. Teknik analisis data yang digunakan adalah uji manova. Hasil dari penelitian ini ada dua. Pertama, asesmen karakter mahasiswa dalam pembelajaran ekonomi menyatakan bahwa pada awal semester (pengamatan awal) karakter mahasiswa cenderung rendah tetapi setelah pengimplementasian pendidikan karakter pada pertengahan semester (pengamatan akhir) karakter mahasiswa cenderung sedang ke tinggi. Kedua, Pembelajaran ekonomi yang menerapkan model evaluasi pendidikan karakter dapat dikatakan efektif dalam meningkatkan karakter mahasiswa. Terbukti dengan adanya rata- rata antara pretest dan posttest yang signifikan. Abstract: This research aims to implement the Character Education Evaluation Model in the Economist Learning Cluster. The study used the Research & Development approach developed by Borg and Gall. The research subjects were students at the Faculty of Economics. They were taking economic classes with 186 students as respondents consisting of four undergraduate study programs in the Faculty of Economics. The data analysis technique used was the Manova test. The results of this study are twofold. First, the assessment of student character in economic learning states that at the beginning of the semester (initial observation), the character of the student tends to be low, but after the implementation of character education in the middle of the semester (final observation) the character of the student tends to be high. Second, economic learning that applies the character education evaluation model can be effective in improving student character. It is proven by the significant mean between pretest and posttest.

Lagrange principle and its regularization as a theoretical basis of stable solving optimal control and inverse problems

The paper is devoted to the regularization of the classical optimality conditions (COC) — the Lagrange principle and the Pontryagin maximum principle in a convex optimal control problem for a parabolic equation with an operator (pointwise state) equality-constraint at the final time. The problem contains distributed, initial and boundary controls, and the set of its admissible controls is not assumed to be bounded. In the case of a specific form of the quadratic quality functional, it is natural to interpret the problem as the inverse problem of the final observation to find the perturbing effect that caused this observation. The main purpose of regularized COCs is stable generation of minimizing approximate solutions (MAS) in the sense of J. Warga. Regularized COCs are: 1) formulated as existence theorems of the MASs in the original problem with a simultaneous constructive representation of specific MASs; 2) expressed in terms of regular classical Lagrange and Hamilton–Pontryagin functions; 3) are sequential generalizations of the COCs and retain the general structure of the latter; 4) “overcome” the ill-posedness of the COCs, are regularizing algorithms for solving optimization problems, and form the theoretical basis for the stable solving modern meaningful ill-posed optimization and inverse problems.

Syphilis in the practice of doctors of related specialties

The article presents clinical cases of syphilitic infection from our own practice, which were not recognized by doctors of related specialties at the early stages of the development of the disease. In the first observation, the manifestations of syphilis were regarded as a surgical pathology in the patient, which entailed surgical intervention, which was not necessary as such. The following clinical case demonstrates lesions of the mucous membranes in syphilis, mistakenly recognized by the therapist as streptococcal angina. The atypical hard chancre in the final observation disorientated the surgeon, that led to a delay in the correct diagnosis and, accordingly, in the appointment of adequate treatment. Regardless of the specialty, everyone should not forget about the variety of manifestations of syphilis in all periods. The lack of alertness among doctors of related specialties contributed to the delayed diagnosis and the appointment of specific anti-syphilitic therapy.

A short-segment fusion strategy using a wide-foot-plate expandable cage for vertebral pseudarthrosis after an osteoporotic vertebral fracture

OBJECTIVEVarious surgical treatments have been reported for vertebral pseudarthrosis after osteoporotic vertebral fracture (OVF). However, the outcomes are not always good. The authors now have some experience with combined anterior-posterior short-segment spinal fusion (1 level above and 1 level below the fracture) using a wide-foot-plate expandable cage. Here, they report their surgical outcomes with this procedure.METHODSBetween June 2016 and August 2018, 16 consecutive patients (4 male and 12 female; mean age 75.1 years) underwent short-segment spinal fusion for vertebral pseudarthrosis or delayed collapse after OVF. The mean observation period was 20.1 months. The level of the fractured vertebra was T12 in 4 patients, L1 in 3, L2 in 4, L3 in 3, and L4 in 2. Clinical outcomes were assessed using the lumbar Japanese Orthopaedic Association (JOA) scale and 100-mm visual analog scale for low-back pain. Local kyphotic angle, intervertebral height, bone union rate, and instrumentation-related adverse events were investigated as imaging outcomes. The data were analyzed using the Wilcoxon signed-rank test.RESULTSThe mean operating time was 334.3 minutes (range 256–517 minutes), and the mean blood loss was 424.9 ml (range 30–1320 ml). The only perioperative complication was a superficial infection of the posterior wound that was cured by irrigation. The lumbar JOA score and visual analog scale value improved from 11.2 and 58.8 mm preoperatively to 20.6 and 18.6 mm postoperatively, respectively. The mean local kyphotic angle and mean intervertebral height were 22.6° and 28.0 mm, respectively, before surgery, −1.5° and 40.5 mm immediately after surgery, and 7.0° and 37.1 mm at the final observation. Significant improvement was observed in both parameters immediately after surgery and at the final observation when compared with the preoperative values. Intraoperative endplate injury occurred in 8 cases, and progression of cage subsidence of 5 mm or more was observed in 2 of these cases. Proximal junctional kyphosis was observed in 2 cases. There were no cases of screw loosening. No cases required reoperation due to instrument-related adverse events. Bone union was observed in all 14 cases that had CT evaluation.CONCLUSIONSThis short-segment fusion procedure is relatively minimally invasive, and local reconstruction and bone fusion have been achieved. This procedure is considered to be attempted for the surgical treatment of osteoporotic vertebral pseudarthrosis after OVF.