Integrating dermal substitutes in soft tissue repair: Insights from a case series and comprehensive literature review.

The use of dermal substitutes with subsequent skin graft application constitutes an alternative treatment option in situations that limit the use of other conventional approaches.

Early Identification of Sepsis-Induced Acute Kidney Injury by Using Monocyte Distribution Width, Red-Blood-Cell Distribution, and Neutrophil-to-Lymphocyte Ratio.

Sepsis-induced acute kidney injury (AKI) is a common complication in patients with severe illness and leads to increased risks of mortality and chronic kidney disease. We investigated the association between monocyte distribution width (MDW), red-blood-cell volume distribution width (RDW), neutrophil-to-lymphocyte ratio (NLR), sepsis-related organ-failure assessment (SOFA) score, mean arterial pressure (MAP), and other risk factors and sepsis-induced AKI in patients presenting to the emergency department (ED). This retrospective study, spanning 1 January 2020, to 30 November 2020, was conducted at a university-affiliated teaching hospital. Patients meeting the Sepsis-2 consensus criteria upon presentation to our ED were categorized into sepsis-induced AKI and non-AKI groups. Clinical parameters (i.e., initial SOFA score and MAP) and laboratory markers (i.e., MDW, RDW, and NLR) were measured upon ED admission. A logistic regression model was developed, with sepsis-induced AKI as the dependent variable and laboratory parameters as independent variables. Three multivariable logistic regression models were constructed. In Model 1, MDW, initial SOFA score, and MAP exhibited significant associations with sepsis-induced AKI (area under the curve [AUC]: 0.728, 95% confidence interval [CI]: 0.668-0.789). In Model 2, RDW, initial SOFA score, and MAP were significantly correlated with sepsis-induced AKI (AUC: 0.712, 95% CI: 0.651-0.774). In Model 3, NLR, initial SOFA score, and MAP were significantly correlated with sepsis-induced AKI (AUC: 0.719, 95% CI: 0.658-0.780). Our novel models, integrating MDW, RDW, and NLR with initial SOFA score and MAP, can assist with the identification of sepsis-induced AKI among patients with sepsis presenting to the ED.

A comparison of the learning effects between TGfU-SE and TGfU on learning motivation, sport enjoyment, responsibility, and game performance in physical education.

Background: Both the Sport Education (SE) model and Teaching Games for Understanding (TGfU) have been connected to the theory of situated learning, which is a game-centered curricular model. TGfU emphasizes tactical awareness, decision making, and skill execution. The SE model provides a complete season during physical education (PE) lessons. Therefore, it is worth exploring the integration of TGfU with SE (TGfU-SE) model in PE courses, and whether the hybrid TGfU-SE model can achieve better learning effects for students than the TGfU model alone. Purpose: The purpose of the study was to compare the difference in learning effects between the TGfU-SE model and the TGfU model on students' learning motivation, sport enjoyment, responsibility, and game performance. Methods: This study used a quasi-experimental design to compare different learning effects between the experimental group (TGfU-SE) and the control group (TGfU). The participants lived in Taiwan, including two junior high school PE teachers and four PE classes with a total of 90 students (TGfU-SE group, n = 46; TGfU group, n = 44). Each teacher taught two PE classes, one with an experimental group and one with a control group. This study used four research instruments, including the Responsibility Scale in Physical Education (RSPE), Learning Motivation Scale in Physical Education (LMSPE), Sport Enjoyment Scale in Physical Education (SESPE), and Game Performance assessment instrument (GPAI). Analysis of covariance (ANCOVA) and the independent t-test were used to analyze the data. Results: The results of this study showed that the TGfU-SE model had more positive learning effects on students' learning motivation, sport enjoyment, responsibility, and game performance than the TGfU model. Conclusion: we concluded that the TGfU-SE model had a more positive influence on students' learning performance than the TGfU model. It is suggested that the hybrid TGfU-SE model could be implemented effectively in the PE curriculum.

Development of a deep learning-based tool to assist wound classification.

This paper presents a deep learning-based wound classification tool that can assist medical personnel in non-wound care specialization to classify five key wound conditions, namely deep wound, infected wound, arterial wound, venous wound, and pressure wound, given color images captured using readily available cameras. The accuracy of the classification is vital for appropriate wound management. The proposed wound classification method adopts a multi-task deep learning framework that leverages the relationships among the five key wound conditions for a unified wound classification architecture. With differences in Cohen's kappa coefficients as the metrics to compare our proposed model with humans, the performance of our model was better or non-inferior to those of all human medical personnel. Our convolutional neural network-based model is the first to classify five tasks of deep, infected, arterial, venous, and pressure wounds simultaneously with good accuracy. The proposed model is compact and matches or exceeds the performance of human doctors and nurses. Medical personnel who do not specialize in wound care can potentially benefit from an app equipped with the proposed deep learning model.

A Novel Dressing Composed of Adipose Stem Cells and Decellularized Wharton's Jelly Facilitated Wound Healing and Relieved Lymphedema by Enhancing Angiogenesis and Lymphangiogenesis in a Rat Model.

Lymphedema causes tissue swelling due to the accumulation of lymphatic fluid in the tissue, which delays the process of wound-healing. Developing effective treatment options of lymphedema is still an urgent issue. In this study, we aim to fabricate tissue-engineered moist wound dressings with adipose stem cells (ASCs) and decellularized Wharton's jelly (dWJ) from the human umbilical cord in order to ameliorate lymphedema. Rat ASCs were proliferated and an apparent layer was observed on dWJ at day 7 and 14. A rat tail lymphedema model was developed to evaluate the efficacy of the treatment. Approximately 1 cm of skin near the base of the rat tail was circularly excised. The wounds were treated by secondary healing (control) (n = 5), decellularized Wharton's jelly (n = 5) and ASC-seeded dWJ (n = 5). The wound-healing rate and the tail volume were recorded once a week from week one to week five. Angiogenesis and lymphangiogenesis were assessed by immunochemistry staining with anti-CD31 and anti-LYVE1. The results showed that the wound-healing rate was faster and the tail volume was lesser in the ASC-seeded dWJ group than in the control group. More CD31+ and LYVE-1+ cells were observed at the wound-healing area in the ASC-seeded dWJ group than in the control group. This proves that tissue-engineered moist wound dressings can accelerate wound-healing and reduce lymphedema by promoting angiogenesis and lymphangiogenesis.

A novel scoring system combining Modified Early Warning Score with biomarkers of monocyte distribution width, white blood cell counts, and neutrophil-to-lymphocyte ratio to improve early sepsis prediction in older adults.

OBJECTIVES: This study aims to investigate whether combining scoring systems with monocyte distribution width (MDW) improves early sepsis detection in older adults in the emergency department (ED). METHODS: In this prospective observational study, we enrolled older adults aged ≥60 years who presented with confirmed infectious diseases to the ED. Three scoring systems-namely quick sepsis-related organ failure assessment (qSOFA), Modified Early Warning Score (MEWS), and National Early Warning Score (NEWS), and biomarkers including MDW, neutrophil-to-lymphocyte ratio (NLR), and C-reactive protein (CRP), were assessed in the ED. Logistic regression models were used to construct sepsis prediction models. RESULTS: After propensity score matching, we included 522 and 2088 patients with and without sepsis in our analysis from January 1, 2020, to September 30, 2021. NEWS ≥5 and MEWS ≥3 exhibited a moderate-to-high sensitivity and a low specificity for sepsis, whereas qSOFA score ≥2 demonstrated a low sensitivity and a high specificity. When combined with biomarkers, the NEWS-based, the MEWS-based, and the qSOFA-based models exhibited improved diagnostic accuracy for sepsis detection without CRP inclusion (c-statistics=0.842, 0.842, and 0.826, respectively). Of the three models, MEWS ≥3 with white blood cell (WBC) count ≥11 × 109/L, NLR ≥8, and MDW ≥20 demonstrated the highest diagnostic accuracy in all age subgroups (c-statistics=0.886, 0.825, and 0.822 in patients aged 60-74, 75-89, and 90-109 years, respectively). CONCLUSIONS: Our novel scoring system combining MEWS with WBC, NLR, and MDW effectively detected sepsis in older adults.

Sedentary Time, Physical Activity Levels and Physical Fitness in Adults with Intellectual Disabilities.

Purpose: This cross-sectional study assessed the associations of gender, age, level of intellectual disabilities (IDs) and of daily sedentary and physical activity (PA) time with physical fitness in adults with ID. Materials and methods: Sixty adults (mean age = 39.19 ± 11.70 years) with ID participated in this cross-sectional study. PA was monitored for 7 days using an ActiGraph GT3X monitor. Physical fitness was measured with a 6-min walking test, isometric push-up test, modified curl-up test, handgrip strength test, and back-saver sit-and-reach test. Results: (a) An age of ≥39 years and female gender were associated with lower performance in multiple aspects of physical fitness. (b) More moderate-to-vigorous PA (MVPA) was associated with greater muscular strength and endurance (modified curl-ups: ß = 0.36, p < 0.01; handgrip strength: right, ß = 0.52, p < 0.01; left, ß = 0.52, p < 0.01). (c) More light-intensity PA (LPA) was associated with greater upper-body muscular endurance (ß = 0.42, p < 0.01) and greater flexibility (right leg: ß = 0.36, p < 0.01; left leg: ß = 0.38, p < 0.01). Conclusion: LPA may be as beneficial as MVPA to the physical fitness of adults with ID. Future studies should focus on developing effective PA interventions for adults with ID, especially for women and individuals aged ≥39 years, by incorporating both LPA and MVPA.

Moral Disengagement and Student Misbehavior in Physical Education.

This study examined how mechanisms of moral disengagement (MD) were related to students' self-reported misbehaviors. Participants were 282 and 336 high school students enrolled in physical education classes. In Stage 1, results of regression analysis showed that advantageous comparison and non-responsibility positively predicted four misbehaviors (i.e., low engagement, failure to follow directions, poor self-management, and distracting behavior). In Stage 2, results of the structural equation modeling confirmed that advantageous comparison and non-responsibility were the significant predictors of student misbehavior in physical education. It is suggested that prevention and intervention programs should address students' advantageous comparison (e.g., compared to skipping class, it is not a big deal to be shirking in class) and non-responsibility (e.g., no one is taking the class seriously; I am just one of them) to reduce misbehaviors in the physical education context.

Student Misbehavior in Physical Education: The Role of 2 × 2 Achievement Goals and Moral Disengagement.

This study aimed to determine whether goal orientations were related to students' self-reported misbehaviors in physical education and to examine whether the effects were mediated by moral disengagement. A two-study project employing structural equation modeling was conducted with high school students (Study 1, n = 287; Study 2, n = 296). In Study 1, the results showed that mastery-avoidance goals were unable to predict five misbehaviors (i.e., aggressive behavior, low engagement, failure to follow directions, poor self-management, and distracting behavior). Mastery-approach goals negatively predicted low engagement, failure to follow directions, and poor self-management. Performance-approach goals positively predicted aggressive and distracting behaviors, while performance-avoidance goals positively predicted all five misbehaviors. In Study 2, the results indicated that the positive relationships between performance-approach goals and misbehaviors and between performance-avoidance goals and misbehaviors were mediated by moral disengagement. These results are discussed in terms of the model of achievement goals, and implications for physical education are also highlighted.

A Study of Shuttlecock's Trajectory in Badminton.

The main purpose of this study was to construct and validate a motion equation for the flight of the badminton and to find the relationship between the air resistance force and a shuttlecock's speed. This research method was based on motion laws of aerodynamics. It applied aerodynamic theories to construct motion equation of a shuttlecock's flying trajectory under the effects of gravitational force and air resistance force. The result showed that the motion equation of a shuttlecock's flight trajectory could be constructed by determining the terminal velocity. The predicted shuttlecock trajectory fitted the measured data fairly well. The results also revealed that the drag force was proportional to the square of a shuttlecock velocity. Furthermore, the angle and strength of a stroke could influence trajectory. Finally, this study suggested that we could use a scientific approach to measure a shuttlecock's velocity objectively when testing the quality of shuttlecocks. And could be used to replace the traditional subjective method of the Badminton World Federation based on players' striking shuttlecocks, as well as applying research findings to improve professional knowledge of badminton player training. Key pointsThe motion equation of a shuttlecock's flying trajectory could be constructed by determining the terminal velocity in aerodynamics.Air drag force is proportional to the square of a shuttlecock velocity. Furthermore, the angle and strength of a stroke could influence trajectory.