Clinical Outcomes of Intraoperative Contrast-Enhanced Ultrasound Compared with Intraoperative Neurophysiological Monitoring During Circumferential Decompression for Myelopathy Associated with Thoracic-Ossification of the Posterior Longitudinal Ligament.

BACKGROUND Circumferential decompression (CD) is an essential treatment option for myelopathy associated with thoracic-ossification of the posterior longitudinal ligament (T-OPLL) when laminectomy cannot achieve sufficient ventral decompression. Although intraoperative neurophysiological monitoring (IONM) is widely used, the operation has a relatively high risk. This study is the first to describe the use of contrast-enhanced ultrasound (CEUS) to evaluate the spinal cord blood flow (SCBF) during thoracic spine surgery in humans. The objective of this study was to compare clinical outcomes between intraoperative CEUS and IONM during CD. MATERIAL AND METHODS Sixty-eight T-OPLL patients who received CD from 2007 to 2014 were reviewed. All patients underwent IONM. CEUS was used on the following 2 occasions on 18 patients to evaluate SCBF: the first measurement was performed after laminectomy and the second after ventral decompression. Outcomes were evaluated by the Hirabayashi recovery rate (HRR). RESULTS The overall HRR of all patients was 56.7%. Regarding CEUS, the HRR was 20.0% in Group A (SCBF decreased) and 63.6% in Group B (SCBF increased), indicating a significantly poorer neurological outcome in Group A (P<0.01). Regarding IONM, the HRR did not significantly differ between Groups C (no meaningful change in potential), D (potential changed up to alert criteria), and E (potential improved). CONCLUSIONS IONM is relatively effective in detecting impending spinal cord dysfunction. Intraoperative CEUS is a safe and reliable method for assessing SCBF changes, which may be used as a supplement to IONM, thus reducing the incidence of false-negative results.

A global perspective: characteristics of infertility-related randomized clinical trials.

BACKGROUND: Infertility is a prevalent global condition, and emerging reproductive technologies may enhance its evaluation and treatment. Understanding the current features of randomized clinical trials in infertility is crucial for improving study design and ensuring the translation of results for patient benefits. OBJECTIVES: To investigate the primary characteristics of randomized clinical trials related to infertility and areas where require improvement. MATERIALS AND METHODS: We conducted a search on the International Clinical Trials Registry platform for eligible infertility trials between 2003 and 2022. The distribution ratio of various characteristics uploaded by infertility-related studies on the platform was analyzed and compared according to sex and registration year. RESULTS: Out of the total trials, 85.3% (1,906) included only women, 8.6% (192) included only men, and 6.1% (136) included couples. The majority of retrieved trials followed a parallel arm design (91.0%) and were non-industry-funded (92.2%), with a median planned sample size of 131 patients (interquartile range 75-270). Among these trials, 54.5% (1,217) were conducted in Asia. The most common primary purpose of infertility-related trials was treatment (88.8%), with over half of the investigated interventions focusing on medication (57.9%). DISCUSSION: Asia is the leading region for research, and the drug therapy is still widely used and updated. However, support care for infertile couples has also received some preference. Areas that require improvement and promotion include addressing male infertility and focusing on underserved regions like Africa. The results also highlight deficiencies in trial registration and masking methods, emphasizing the need for better regulation and facilitation of infertility trials in the post-COVID-19 era. CONCLUSION: Based on the current status of infertility RCT studies, greater attention should be paid to infertile men and populations in underdeveloped regions like Africa in future studies, together with a standardized registration and implementation procedures.

Acceptance of a Third Dose of COVID-19 Vaccine and Associated Factors in China Based on Health Belief Model: A National Cross-Sectional Study.

COVID-19 infections are returning to many countries because of the emergence of variants or declining antibody levels provided by vaccines. An additional dose of vaccination is recommended to be a considerable supplementary intervention. We aim to explore public acceptance of the third dose of the COVID-19 vaccine and related influencing factors in China. This nationwide cross-sectional study was conducted in the general population among 31 provinces in November, 2021. We collected information on basic characteristics, vaccination knowledge and attitudes, and vaccine-related health beliefs of the participants. Univariable and multivariable logistic regression models were used to assess factors associated with the acceptance of a third COVID-19 vaccine. A total of 93.7% (95% CI: 92.9-94.6%) of 3119 Chinese residents were willing to receive a third dose of the COVID-19 vaccine. Individuals with low level of perceived susceptibility, perceived benefit, cues to action cues, and high level of perceived barriers, old age, low educational level, low monthly household income, and low knowledge score on COVID-19 were less likely to have the acceptance of a third dose of COVID-19 (all p < 0.05). In the multivariable logistic regression model, acceptance of the third dose of COVID-19 vaccine was mainly related to previous vaccination history [Sinopharm BBIP (aOR = 6.55, 95% CI 3.30-12.98), Sinovac (aOR = 5.22, 95% CI:2.72-10.02), Convidecia (aOR = 5.80, 95% CI: 2.04-16.48)], high level of perceived susceptibility (aOR = 2.48, 95% CI: 1.48-4.31) and high level of action cues (aOR = 23.66, 95% CI: 9.97-56.23). Overall, residents in China showed a high willingness to accept the third dose of COVID-19 vaccines, which can help vaccine manufacturers in China to manage the vaccine production and distribution for the huge domestic and international vaccine demand. Relevant institutions could increase people's willingness to booster shots by increasing initial COVID-19 vaccination rates, public's perception of COVID-19 susceptibility and cues to action through various strategies and channels. Meanwhile, it also has certain reference significance for other countries to formulate vaccine promotion strategies.