bluuebunny/crossref_metadata_2025 huggingface dataset:
How does cervical sagittal profile change after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion
Authors: Liu Chengxin , Zhu Weiguo , Li Yongjin , Li Xiangyu , Shi Bin , Kong Chao , Lu Shibao
Published: May 2024

Purpose

This study aimed to evaluate the cervical sagittal profile after the spontaneous compensation of global sagittal imbalance and analyze the associations between the changes in cervical sagittal alignment and spinopelvic parameters.

Methods

In this retrospective radiographic study, we analyzed 90 patients with degenerative lumbar stenosis (DLS) and sagittal imbalance who underwent short lumbar fusion (imbalance group). We used 60 patients with DLS and sagittal balance as the control group (balance group). Patients in the imbalance group were also divided into two groups according to the preoperative PI: low PI group (≤ 50°), high PI group (PI > 50°). We measured the spinal sagittal alignment parameters on the long-cassette standing lateral radiographs of the whole spine. We compared the changes of spinal sagittal parameters between pre-operation and post-operation. We observed the relationships between the changes in cervical profile and spinopelvic parameters.

Results

Sagittal vertical axis (SVA) occurred spontaneous compensation (p = 0.000) and significant changes were observed in cervical lordosis (CL) (p = 0.000) and cervical sagittal vertical axis (cSVA) (p = 0.023) after surgery in the imbalance group. However, there were no significant differences in the radiographic parameters from pre-operation to post-operation in the balance group. The variations in CL were correlated with the variations in SVA (R = 0.307, p = 0.041). The variations in cSVA were correlated with the variations in SVA (R=-0.470, p = 0.001).

Conclusion

Cervical sagittal profile would have compensatory changes after short lumbar fusion. The spontaneous decrease in CL would occur in patients with DLS after the spontaneous compensation of global sagittal imbalance following one- or two-level lumbar fusion. The changes of cervical sagittal profile were related to the extent of the spontaneous compensation of SVA.
Open surgery with a lateral neck approach in cases of foreign body impaction that penetrating the neck through the esophagus: a single-center experience
Authors: Xu Feng , Shen Na , Liu Danzheng , Zhu Ting , Xue Liang , Luo Xuemei , Zhou Xu
Published: May 2024

Background

Because the cases are quite scarce, we aimed to review cases of foreign body impaction penetrating the neck through the esophagus to analyze the characteristics of these cases. The open surgery skills of the surgeon, the treatment procedure and the surgeons’ experience in the rare diseases were analyzed.

Methods

We collected and analyzed all cases from 2015–2020 in our hospital. Surgical skills and procedures for fasting and anti-infection treatment were reviewed retrospectively. Follow-up was telephone communication.

Results

Our series included 15 cases. Tenderness in the pre-cervical site was a physical sign for screening. Thirteen cases underwent a lateral neck open surgery with the incision including the left side of neck and only two cases were incised from the right side of the neck. Pus was found 3 days after the impaction in one case, the shortest time observed in our series. The esophageal laceration was only sutured primarily in 5 cases (33.33%) among all fifteen cases. After sufficient drainage (average more than 9 days), antibiotic treatment and fasting (normally 2–3 weeks), patients gradually began to switch to solid foods from fluids after complete blood counts and confirmations from esophageal radiography result. No severe complications occurred, and all the patients have no swallowing dis-function and recovered well.

Conclusion

Surgery should be performed as soon as possible after impaction. Lateral neck approach surgery and the therapeutic procedure described in this article are safe and effective treatments.
Correlates of intention to screen for cervical cancer among adult women in Kyotera District, Central Uganda: a community based cross-sectional study
Authors: Kiconco Arthur , Kabanda Richard , Ronald Anguzu , Beyer Kirsten M. M. , John Steven A.
Published: May 2024

Introduction

Cervical cancer continues to pose a major public health challenge in low-income countries. Cervical cancer screening programs enable early detection and effectively reduce the incidence of cervical cancer as well as late-stage diagnosis and mortality. However, screening uptake remains suboptimal in Uganda. This study assessed correlates of intention to screen for cervical cancer among women in the Kyotera district of Central Uganda.

Methods

We analyzed cross-sectional data collected to determine the effectiveness of community audio towers (CATs) as a modality of health communication to support cervical cancer prevention. Women (n = 430) aged 21–60 years without a prior history of cervical cancer screening were surveyed about demographics, sources of health information and cervical cancer screening intentions in 2020. We used generalized linear modelling with modified Poisson regression and backwards variable elimination to identify adjusted prevalence ratios and 95% confidence intervals (CI) to determine factors associated with intention to screen for cervical cancer.

Results

Half (50.2%) of the participants had intentions to screen for cervical cancer within twelve months and 26.5% had moderate knowledge about cervical cancer. Nearly half (46.0%) considered themselves at risk of cervical cancer. Compared to residents who primarily received their health information from social media and radio, participants who received health information primarily from CATs (aPR:0.64, 95% CI:0.52–0.80, p < 0.001) and TV (aPR:0.52, 95% CI:0.34–0.82, p = 0.005) had a lower prevalence of intention to screen for cervical cancer. The prevalence of intentions to screen for cervical cancer in twelve months was higher among those resided in town councils (aPR:1.44, 95% CI:1.12–1.86, p = 0.004) compared to rural areas, and higher among those who considered themselves to be at risk of cervical cancer (aPR:1.74, 95% CI:1.28–2.36, p < 0.001) compared to those who did not.

Conclusions

We found suboptimal prevalence of intentions to screen for cervical cancer among women in central Uganda. Additional research and implementation projects are needed to increase cervical cancer screening. Targeting risk perceptions and behavioral approaches to increase intentions could be effective in future intervention work. Based on urban-rural differences, additional work is needed to support equitable sharing of information to support cancer prevention messaging; CATs and TV may best help reach those with lower intentions to screen based on our research.
Urban people’s preferences for life-sustaining treatment or artificial nutrition and hydration in advance decisions
Authors: Wu Yi-Ling , Lin Tsai-Wen , Yang Chun-Yi , Wang Samuel Shih-Chih , Huang Sheng-Jean
Published: May 2024

Background

The Patient Right to Autonomy Act (PRAA), implemented in Taiwan in 2019, enables the creation of advance decisions (AD) through advance care planning (ACP). This legal framework allows for the withholding and withdrawal of life-sustaining treatment (LST) or artificial nutrition and hydration (ANH) in situations like irreversible coma, vegetative state, severe dementia, or unbearable pain. This study aims to investigate preferences for LST or ANH across various clinical conditions, variations in participant preferences, and factors influencing these preferences among urban residents.

Methods

Employing a survey of legally structured AD documents and convenience sampling for data collection, individuals were enlisted from Taipei City Hospital, serving as the primary trial and demonstration facility for ACP in Taiwan since the commencement of the PRAA in its inaugural year. The study examined ADs and ACP consultation records, documenting gender, age, welfare entitlement, disease conditions, family caregiving experience, location of ACP consultation, participation of second-degree relatives, and the intention to participate in ACP.

Results

Data from 2337 participants were extracted from electronic records. There was high consistency in the willingness to refuse LST and ANH, with significant differences noted between terminal diseases and extremely severe dementia. Additionally, ANH was widely accepted as a time-limited treatment, and there was a prevalent trend of authorizing a health care agent (HCA) to make decisions on behalf of participants. Gender differences were observed, with females more inclined to decline LST and ANH, while males tended towards accepting full or time-limited treatment. Age also played a role, with younger participants more open to treatment and authorizing HCA, and older participants more prone to refusal.

Conclusion

Diverse preferences in LST and ANH were shaped by the public’s current understanding of different clinical states, gender, age, and cultural factors. Our study reveals nuanced end-of-life preferences, evolving ADs, and socio-demographic influences. Further research could explore evolving preferences over time and healthcare professionals’ perspectives on LST and ANH decisions for neurological patients..
“Unless someone sees and hears you, how do you know you exist?” Meanings of confidential conversations – a hermeneutic study of the experiences of patients with palliative care needs
Authors: Stenman Tove , Rönngren Ylva , Näppä Ulla , Melin-Johansson Christina
Published: May 2024

Background

Patients with palliative care needs live with the reality of limited time due to illness or age, eliciting emotional and existential responses. A failure to address their existential needs can lead to significant suffering. A person-centred approach is paramount to effectively address these needs, emphasising holistic care and effective communication. Although existing communication models focus on predefined frameworks, a need exists to explore more spontaneous and confidential conversations between patients and nurses. Confidential conversations have the potential to build therapeutic relationships and provide vital emotional support, highlighting the need for further research and integration into palliative care practice. This study aims to more deeply understand the meaning of confidential conversations for patients with palliative care needs.

Methods

In-depth interviews were conducted with 10 patients in the context of specialised palliative care. A hermeneutic analysis was used to gain a deeper understanding of the meanings of the conversations.

Results

The patients had varying experiences and wishes concerning confidential conversations. They strived for self-determination in finding confidants, seeking trust and comfort in their interactions with nurses. Trust was crucial for creating a safe space where patients could express themselves authentically. In shared belonging, confidential conversations with a nurse provided validation and relief from life’s challenges. Experiences of feeling unheard or rejected by a nurse could intensify loneliness, prompting individuals to withdraw and remain silent. Regardless of the motives behind their choices, it was crucial that patients felt respect and validation in their decisions. Their autonomy could thus be recognised, and they felt empowered to make decisions based on their unique preferences.

Conclusions

Patients value trust and understanding, particularly in confidential conversations with nurses, which offer solace, validation and empowerment. However, indifference can increase patients’ suffering, fostering self-doubt and reluctance to engage further. To address this, health care can prioritise empathic communication skills, offer ongoing support to nurses, and promote continuity in care through investment in training and resources. Additionally, adopting a person-centred approach in confidential conversations is crucial, considering patients’ varying preferences.
Exposure to secondary traumatic stress and its related factors among emergency nurses in Saudi Arabia: a mixed method study
Authors: Alshammari Bushra , Alanazi Nada F , Kreedi Fatmah , Alshammari Farhan , Alkubati Sameer A. , Alrasheeday Awatif , Madkhali Norah , Alshara Ammar , Bakthavatchaalam Venkat , Al-Masaeed Mahmoud , Alshammari Sabah Kaied , Alshammari Nwair Kaied , Ansari Mukhtar , Hussain Arshad , Al-Sadi Ahmed K.
Published: May 2024

Background

Emergency department (ED) nurses are exposed to the risk of secondary traumatic stress (STS), which poses a threat not only to nurses’ health and psychological well-being but also adversely affects the execution of their professional duties. The quality and outcome of their nursing services are negatively affected by STS.

Purpose

The purpose of this study is to comprehensively investigate the prevalence and intensity of Secondary Traumatic Stress (STS) among Emergency Department (ED) nurses. It aims to identify and analyze the socio-demographic, occupational, and psychological factors that influence the severity and variation of STS experienced by these nurses.

Methods

The study utilized a sequential explanatory mixed methods approach, including two phases. Phase 1 employed a cross-sectional study design, utilizing a convenience sample of 181 nurses to explore the levels of STS and the factors associated with it. Following this, Phase 2 was structured as a qualitative descriptive study, which involved conducting semi-structured interviews with a purposefully selected group of ten ED nurses. Data collection took place at three major hospitals in Saudi Arabia during the period from January to June 2022.

Results

A total of 181 participants were included in the study. The mean STSS score reported by the nurses was 51 (SD = 13.23) out of the maximum possible score of 85, indicating severe STS among ED nurses. Factors associated with an increase in the levels of STS among ED nurses included being female, older in age, married, possessing higher education and experience, having a positive relationship with colleagues, receiving organisational support, and dealing with a higher number of trauma cases. Several themes emerged from the qualitative interviews including: ED Characteristics: Dual Impact on STS, Emotional Resonance and Vulnerability, Personal Life Stressors, The Ability to Cope, and Social Support.

Conclusion and implications for practice

Future strategies and interventions targeting STS should be prioritized to effectively manage its impact on ED nurses. It is crucial to develop targeted interventions that address the specific factors contributing to STS, as identified in this study. Additionally, these findings aim to enhance awareness among nursing administrators, managers, and supervisors about the critical factors associated with STS. This awareness is essential for accurately assessing and developing interventions that mitigate STS among nursing staff.
Determinants of appropriate antibiotic and NSAID prescribing in unscheduled outpatient settings in the veterans health administration
Authors: Ward Michael J. , Matheny Michael E. , Rubenstein Melissa D. , Bonnet Kemberlee , Dagostino Chloe , Schlundt David G. , Anders Shilo , Reese Thomas , Mixon Amanda S.
Published: May 2024

Background

Despite efforts to enhance the quality of medication prescribing in outpatient settings, potentially inappropriate prescribing remains common, particularly in unscheduled settings where patients can present with infectious and pain-related complaints. Two of the most commonly prescribed medication classes in outpatient settings with frequent rates of potentially inappropriate prescribing include antibiotics and nonsteroidal anti-inflammatory drugs (NSAIDs). In the setting of persistent inappropriate prescribing, we sought to understand a diverse set of perspectives on the determinants of inappropriate prescribing of antibiotics and NSAIDs in the Veterans Health Administration.

Methods

We conducted a qualitative study guided by the Consolidated Framework for Implementation Research and Theory of Planned Behavior. Semi-structured interviews were conducted with clinicians, stakeholders, and Veterans from March 1, 2021 through December 31, 2021 within the Veteran Affairs Health System in unscheduled outpatient settings at the Tennessee Valley Healthcare System. Stakeholders included clinical operations leadership and methodological experts. Audio-recorded interviews were transcribed and de-identified. Data coding and analysis were conducted by experienced qualitative methodologists adhering to the Consolidated Criteria for Reporting Qualitative Studies guidelines. Analysis was conducted using an iterative inductive/deductive process.

Results

We conducted semi-structured interviews with 66 participants: clinicians (N = 25), stakeholders (N = 24), and Veterans (N = 17). We identified six themes contributing to potentially inappropriate prescribing of antibiotics and NSAIDs: 1) Perceived versus actual Veterans expectations about prescribing; 2) the influence of a time-pressured clinical environment on prescribing stewardship; 3) Limited clinician knowledge, awareness, and willingness to use evidence-based care; 4) Prescriber uncertainties about the Veteran condition at the time of the clinical encounter; 5) Limited communication; and 6) Technology barriers of the electronic health record and patient portal.

Conclusions

The diverse perspectives on prescribing underscore the need for interventions that recognize the detrimental impact of high workload on prescribing stewardship and the need to design interventions with the end-user in mind. This study revealed actionable themes that could be addressed to improve guideline concordant prescribing to enhance the quality of prescribing and to reduce patient harm.
Drug release profile of a novel exenatide long-term drug delivery system (OKV-119) administered to cats
Authors: Klotsman Michael , Anderson Wayne H. , Gilor Chen
Published: May 2024

Beneficial weight-loss properties of glucagon-like peptide-1 receptor agonists (GLP-1RA) in obese people, with corresponding improvements in cardiometabolic risk factors, are well established. OKV-119 is an investigational drug delivery system that is being developed for the long-term delivery of the GLP-1RA exenatide to feline patients. The purpose of this study was to evaluate the drug release characteristics of subcutaneous OKV-119 implants configured to release exenatide for 84 days. Following a 7-day acclimation period, five purpose-bred cats were implanted with OKV-119 protypes and observed for a 112-day study period. Food intake, weekly plasma exenatide concentrations and body weight were measured. Exenatide plasma concentrations were detected at the first measured timepoint (Day 7) and maintained above baseline for over 84 Days. Over the first 28 days, reduced caloric intake and a reduction in body weight were observed in four of five cats. In these cats, a body weight reduction of at least 5% was maintained throughout the 112-day study period. This study demonstrates that a single OKV-119 implant can deliver the GLP-1RA exenatide for a months long duration. Results suggest that exposure to exenatide plasma concentrations ranging from 1.5 ng/ml to 4 ng/ml are sufficient for inducing weight loss in cats.
Neutrophils in Cancer immunotherapy: friends or foes?
Authors: Huang Xueqin , Nepovimova Eugenie , Adam Vojtech , Sivak Ladislav , Heger Zbynek , Valko Marian , Wu Qinghua , Kuca Kamil
Published: May 2024

Neutrophils play a Janus-faced role in the complex landscape of cancer pathogenesis and immunotherapy. As immune defense cells, neutrophils release toxic substances, including reactive oxygen species and matrix metalloproteinase 9, within the tumor microenvironment. They also modulate the expression of tumor necrosis factor-related apoptosis-inducing ligand and Fas ligand, augmenting their capacity to induce tumor cell apoptosis. Their involvement in antitumor immune regulation synergistically activates a network of immune cells, bolstering anticancer effects. Paradoxically, neutrophils can succumb to the influence of tumors, triggering signaling cascades such as JAK/STAT, which deactivate the immune system network, thereby promoting immune evasion by malignant cells. Additionally, neutrophil granular constituents, such as neutrophil elastase and vascular endothelial growth factor, intricately fuel tumor cell proliferation, metastasis, and angiogenesis. Understanding the mechanisms that guide neutrophils to collaborate with other immune cells for comprehensive tumor eradication is crucial to enhancing the efficacy of cancer therapeutics. In this review, we illuminate the underlying mechanisms governing neutrophil-mediated support or inhibition of tumor progression, with a particular focus on elucidating the internal and external factors that influence neutrophil polarization. We provide an overview of recent advances in clinical research regarding the involvement of neutrophils in cancer therapy. Moreover, the future prospects and limitations of neutrophil research are discussed, aiming to provide fresh insights for the development of innovative cancer treatment strategies targeting neutrophils.
Three-dimensional DNA nanomachine biosensor coupled with CRISPR Cas12a cascade amplification for ultrasensitive detection of carcinoembryonic antigen
Authors: Yao Shuo , Liu Yi , Ding Yukun , Shi Xuening , Li Hang , Zhao Chao , Wang Juan
Published: May 2024

The detection of carcinoembryonic antigen (CEA) holds significant importance in the early diagnosis of cancer. However, current methods are hindered by limited accessibility and specificity. This study proposes a rapid and convenient Cas12a-based assay for the direct detection of CEA in clinical serum samples, aiming to address these limitations. The protocol involves a rolling machine operation, followed by a 5-min Cas12a-mediated cleavage process. The assay demonstrates the capability to detect human serum with high anti-interference performance and a detection limit as low as 0.2 ng/mL. The entire testing procedure can be accomplished in 75 min without centrifugation steps, and successfully reduced the limit of detection of traditional DNA walking machine by 50 folds. Overall, the testing procedure can be easily implemented in clinical settings.

Graphical Abstract
HHLA2 deficiency inhibits pancreatic cancer progression and THP-1 macrophage M2 polarization via EGFR/MAPK/ERK and mTOR/AKT pathway
Authors: Zhou Siqi , Wang Zhangding , Zhao Dian , Fu Yao , Zhang Shu , Wang Zhiping , Zou Xiaoping
Published: May 2024

Background

Human endogenous retrovirus subfamily H long terminal repeat associating protein 2, (HHLA2), a member of B7 family, exhibits heightened expression in various malignant tumors. However, the exact functions of HHLA2 in pancreatic cancer (PC) remain incompletely elucidated.

Methods

We initially conducted an analysis of the B7 family members’ expression pattern in pancreatic tumor samples and adjacent normal tissues using The Cancer Genome Atlas (TCGA) database. Subsequently, immunohistochemistry, RT-qPCR and western blot methods were used to assess HHLA2 expression levels in PC tissues and cell lines. Furthermore, after silencing HHLA2 in PC cell lines, cell migration and proliferation of PC cells were detected by wound healing and CCK-8 assays, and cell invasion of PC cells was detected by transwell assays. We also investigated the regulation of epithelial-mesenchymal transition (EMT) markers and levels of EGFR, MEK, ERK1/2, mTOR and AKT via western blot analysis. Finally, the correlation between HHLA2 expression and immune infiltration was further explored.

Results

Silencing of HHLA2 resulted in the inhibition of PC cell proliferation, migration and invasion, potentially through the suppression of the EGFR/MAPK/ERK and mTOR/AKT signaling pathway. Additionally, silencing HHLA2 led to the inhibition of M2-type polarization of tumor associated macrophages (TAMs).

Conclusion

The knockdown of HHLA2 was observed to inhibit the migration and invasion of PC cells through the regulation of the EMT process and EGFR/MAPK/ERK and mTOR/AKT pathway. Furthermore, silencing HHLA2 was found to modulate M2 polarization of TAMs. These finding suggest that HHLA2 could be a promising therapeutic target for Pancreatic cancer.
Chemokine receptor 7 contributes to T- and B-cell filtering in ageing bladder, cystitis and bladder cancer
Authors: Zhao Jiang , Luo Xing , Yang Chengfei , Yang Xiao , Deng Min , Sun Bishao , Zhu Jingzhen , Dong Zongming , Wang Yangcai , Li Jia , Yang Xingliang , Li Benyi , Wang Xiangwei , Zheng Ji
Published: May 2024

Background

Research has suggested significant correlations among ageing, immune microenvironment, inflammation and tumours. However, the relationships among ageing, immune microenvironment, cystitis and bladder urothelial carcinoma (BLCA) in the bladder have rarely been reported.

Methods

Bladder single-cell and transcriptomic data from young and old mice were used for immune landscape analysis. Transcriptome, single-cell and The Cancer Genome Atlas Program datasets of BLCA and interstitial cystitis/bladder pain syndrome (IC/BPS) were used to analyse immune cell infiltration and molecular expression. Bladder tissues from mice, IC/BPS and BLCA were collected to validate the results.

Results

Eight types of immune cells (macrophages, B-cells, dendritic cells, T-cells, monocytes, natural killer cells, γδ T-cells and ILC2) were identified in the bladder of mice. Aged mice bladder tissues had a significantly higher number of T-cells, γδ T-cells, ILC2 and B-cells than those in the young group (P < 0.05). Three types of T-cells (NK T-cells, γδ T-cells and naïve T-cells) and three types of B-cells (follicular B-cells, plasma and memory B-cells) were identified in aged mice bladder. Chemokine receptor 7 (CCR7) is highly expressed in aged bladder, IC/BPS and BLCA (P < 0.05). CCR7 is likely to be involved in T- and B-cell infiltration in aged bladder, IC/BPS and BLCA. Interestingly, the high CCR7 expression on BLCA cell membranes was a prognostic protective factor.

Conclusions

In this study, we characterised the expression profiles of immune cells in bladder tissues of aged and young mice and demonstrated that CCR7-mediated T- and B-cell filtration contributes to the development of bladder ageing, IC/BPS and BLCA.
Spontaneous retroperitoneal haemorrhage after pulmonary endarterectomy surgery
Authors: Divya Aabha , Chia Alicia , Jenkins David
Published: May 2024

Spontaneous retroperitoneal hematoma (SRH) is a rare complication of anticoagulation therapy. Presentation may vary from limb paresis to hypovolemic shock due to blood loss. The optimal treatment is controversial. It can be managed conservatively or surgically. We report a case of a 73-year-old man presenting with progressively worsening abdominal pain and severe pain radiating to his left lower limb twenty-five days after his pulmonary endarterectomy (PEA) surgery. He was on anticoagulation per our institutional protocol for PEA patients. Investigations revealed a large, spontaneously occurring iliopsoas hematoma. Our patient was treated conservatively, and the SRH stabilised.
Development and validation of the tic score for early detection of traumatic coagulopathy upon hospital admission: a cohort study
Authors: Brac Louis , Levrat Albrice , Vacheron Charles-Hervé , Bouzat Pierre , Delory Tristan , David Jean-Stéphane
Published: May 2024

Background

Critically injured patients need rapid and appropriate hemostatic treatment, which requires prompt identification of trauma-induced coagulopathy (TIC) upon hospital admission. We developed and validated the performance of a clinical score based on prehospital resuscitation parameters and vital signs at hospital admission for early diagnosis of TIC.

Methods

The score was derived from a level-1 trauma center registry (training set). It was then validated on data from two other level-1 trauma centers: first on a trauma registry (retrospective validation set), and then on a prospective cohort (prospective validation set). TIC was defined as a PTratio > 1.2 at hospital admission. Prehospital (vital signs and resuscitation care) and admission data (vital signs and laboratory parameters) were collected. We considered parameters independently associated with TIC in the score (binomial logistic regression). We estimated the score’s performance for the prediction of TIC.

Results

A total of 3489 patients were included, and among these a TIC was observed in 22% (95% CI 21–24%) of cases. Five criteria were identified and included in the TIC Score: Glasgow coma scale < 9, Shock Index > 0.9, hemoglobin < 11 g.dL−1, prehospital fluid volume > 1000 ml, and prehospital use of norepinephrine (yes/no). The score, ranging from 0 and 9 points, had good performance for the identification of TIC (AUC: 0.82, 95% CI: 0.81–0.84) without differences between the three sets used. A score value < 2 had a negative predictive value of 93% and was selected to rule-out TIC. Conversely, a score value ≥ 6 had a positive predictive value of 92% and was selected to indicate TIC.

Conclusion

The TIC Score is quick and easy to calculate and can accurately identify patients with TIC upon hospital admission.
The impact of incident stroke on cognitive trajectories in later life
Authors: Vishwanath Swarna , Hopper Ingrid , Cloud Geoffrey C. , Chong Trevor T-J , Shah Raj C. , Donnan Geoffrey A. , Williamson Jeff D. , Eaton Charles B. , Wolfe Rory , Reid Christopher M. , Tonkin Andrew M. , Orchard Suzanne G. , Fitzgerald Sharyn , Murray Anne M. , Woods Robyn L. , Nelson Mark R. , Sood Ajay , Steves Claire J. , Ryan Joanne
Published: May 2024

Background

Cognitive impairment is common after stroke, and a large proportion of stroke patients will develop dementia. However, there have been few large prospective studies which have assessed cognition both prior to and after stroke. This study aims to determine the extent to which incident stroke impacts different domains of cognitive function in a longitudinal cohort of older community-dwelling individuals.

Methods

19,114 older individuals without cardiovascular disease or major cognitive impairment were recruited and followed over a maximum 11 years. Stroke included ischaemic and haemorrhagic stroke and was adjudicated by experts. Cognitive function was assessed regularly using Modified Mini-Mental State Examination (3MS), Hopkins Verbal Learning Test–Revised (HVLT-R), Symbol Digit Modalities Test (SDMT), and Controlled Oral Word Association Test (COWAT). Linear mixed models were used to investigate the change in cognition at the time of stroke and decline in cognitive trajectories following incident stroke.

Results

During a median follow-up period of 8.4 [IQR: 7.2, 9.6] years, 815 (4.3%) participants experienced a stroke. Over this time, there was a general decline observed in 3MS, HVLT-R delayed recall, and SDMT scores across participants. However, for individuals who experienced a stroke, there was a significantly greater decline across all cognitive domains immediately after the event immediately after the event (3MS: -1.03 [95%CI: -1.45, -0.60]; HVLT-R: -0.47 [-0.70, -0.24]; SDMT: -2.82 [-3.57, -2.08]; COWAT: -0.67 [-1.04, -0.29]) and a steeper long-term decline for three of these domains (3MS -0.62 [-0.88, -0.35]; COWAT: -0.30 [-0.46, -0.14]); HVLT-R: -0.12 [95%CI, -0.70, -0.24]). However individuals with stroke experienced no longer-term decline in SDMT compared to the rest of the participants.

Conclusions

These findings highlight the need for comprehensive neuropsychology assessments for ongoing monitoring of cognition following incident stroke; and potential early intervention.
Health and wellbeing status of the long-lived individuals of the Spanish LONGECYL cross-sectional study
Authors: Vega-Alonso Tomás , Lozano-Alonso José , Estévez-Iglesias Lorena , Ordax-Díez Ana , Arrieta-Antón Enrique , Díaz-Rodríguez Ángel , Yañez-Ortega José-Luis , Santos-Lozano Alejandro , Nuñez-Torres Rocío , Perez-Caro María , Pita Gillermo , Pinto-Labajo Rosa , Alonso Ramos María-Jesús , Álamo-Sanz Rufino , García-Montero Andrés-C , Gonzalez-Neira Anna
Published: May 2024

Background

The increase in life expectancy and long-lived individuals is a challenge for public health and provides an opportunity to understand the determinants of longevity. However, few studies have addressed the factors associated with the health status and quality of life in a long-lived individual population. We described the perceived health, clinical status, quality of life, and dependency for activities of daily living in a representative population in Castile and Leon, Spain.

Methods

A sample of 759 long-lived individuals aged 95 years and older was studied by the Health Sentinel Network of Castile and Leon (Spain) through a health examination and a structured questionnaire covering quality of life (EQ-5D-3), lifestyle habits, diet, working life and family health. A blood sample was taken for the study of biological and genetic markers. Chi Square and logistic regression OR with 95% confidence intervals were used to analyze the determinants of the long-lived individuals’ health status. The significant level for the bivariate analysis was established at 0.05.

Results

Perceived health was good, very good or excellent in 64.2%, while only 46.0% had a quality-of-life index above 0.5 (ranging from 0 to 1) and 44.1% maintained acceptable independence for activities of daily living. Quality-of-life index was higher in the oldest, (OR 7.98 [2,32-27.41]) above 100 years compared to those under 98, and men had better values for independence than women (OR 2.43 [1.40–4.29]). Cardiovascular diseases were the most prevalent (85.5%), but neurological and mental diseases and vision problems had the highest impact on quality of life and independence.

Conclusion

The long-lived individuals of Castile and Leon have a relatively well-preserved health status, although the perception of health is higher than that describing their quality of life and dependence. The quality of life was higher in the oldest age group and showed differences according to sex, with a better quality of life in men. Public health policies and programs should take in account the differences by sex and age as well as the prevention and control of the main conditions related with poor quality of life or dependence. Future research must include the interaction among genetic, socioeconomic, environmental, and other clinical factors in the quality of life and disability of long-lived individuals.
25 years recording of the long-base fluid tiltmeter installed at 2.850 m a.s.l. observatory of Pizzi Deneri on Etna volcano
Authors: Bonaccorso Alessandro , Falzone Giuseppe , Ferro Angelo , Gambino Salvatore , Laudani Giuseppe , Privitera Laura
Published: May 2024

Etna is a highly active volcano with frequent eruptions and is closely observed with different monitoring techniques. One of the monitoring methods is a network of short-base tiltmeters that provides continuous control of ground deformation. Since 1996, this network has been integrated with a long-base fluid tiltmeter installed in two 80 m long connected tunnels at the high-altitude (2850 m a.s.l.) volcanological observatory of Pizzi Deneri (PDN) located on the volcano’s summit. The instrumentation was devised with an innovative configuration composed of mercury, free to move along the entire length of the tiltmeter in response to the ground tilt, and laser sensors to measure the changes in the mercury levels. In this study, for the first time, we present the entire 25-year series of data recorded by this instrumentation. During this long interval, the Etna volcano was characterized by numerous major eruptions due to dyke intrusions. The tilt variations recorded in the short-term during the rapid intrusive phases are presented and discussed. These signals contributed both to the modeling of eruptive processes, and in particular in the case of the 2002–2003 eruption, to the real-time understanding of the ongoing eruptive phenomenon, supporting the correct hazard assessment. In the medium-long term (years to decades), we show and discuss that the PDN signal is mainly related to the marked sliding of the entire eastern sector of the volcano.

Graphical Abstract
Seeing the truck, but missing the cyclist: effects of blur on duration thresholds for road hazard detection
Authors: Guidi Silvia , Kosovicheva Anna , Wolfe Benjamin
Published: May 2024

Drivers must respond promptly to a wide range of possible road hazards, from trucks veering into their lane to pedestrians stepping onto the road. While drivers’ vision is tested at the point of licensure, visual function can degrade, and drivers may not notice how these changes impact their ability to notice and respond to events in the world in a timely fashion. To safely examine the potential consequences of visual degradation on hazard detection, we performed two experiments examining the impact of simulated optical blur on participants’ viewing duration thresholds in a hazard detection task, as a proxy for eyes-on-road duration behind the wheel. Examining this question with older and younger participants, across two experiments, we found an overall increase in viewing duration thresholds under blurred conditions, such that younger and older adults were similarly impacted by blur. Critically, in both groups, we found that the increment in thresholds produced by blur was larger for non-vehicular road hazards (pedestrians, cyclists and animals) compared to vehicular road hazards (cars, trucks and buses). This work suggests that blur poses a particular problem for drivers detecting non-vehicular road users, a population considerably more vulnerable in a collision than vehicular road users. These results also highlight the importance of taking into account the type of hazard when considering the impacts of blur on road hazard detection.
Surgical management of caesarean scar disorder using different techniques: a scoping review and case series
Authors: Harjee Rahana , Devji Jalila , Barrett-Chan Ella Katelyn , Khinda Jas , Bedaiwy Mohamed A.
Published: May 2024

Background

Caesarean scar disorders (CSDi) are an increasingly recognized consequence of caesarean sections, which can present with secondary infertility. Currently, there is limited data on the management of CSDi, and the subsequent fertility and pregnancy outcomes. Our aim was to examine different treatment methods and outcomes in a cohort of women with secondary infertility.

Study design

This study involved a retrospective case series for patients (n = 26) diagnosed with and treated for a CSDi between 2008 and 2019 at a tertiary care centre in British Columbia, Canada, by one of three gynecologists with expertise in CSDi repair. Surgical repair was performed via laparoscopy for residual myometrial thickness (RMT) < 3.0 mm, and via hysteroscopy otherwise. Postoperative pregnancy rates and reproductive outcomes are reported. This study also included a search of the literature to gain an overview of the indications, outcomes, advantages, disadvantages, and risks associated with four surgical approaches (hysteroscopic, laparoscopic, vaginal, abdominal) used in the management of CSDi. A Medline and manual searches of referenced articles were conducted for this purpose.

Results

Twenty-six patients with CSDi were diagnosed with secondary infertility (mean age = 36.4 years) during the study period. Twenty of these patients underwent surgical management, with 12 receiving hysteroscopic resection or ablation, and 8 receiving laparoscopic repair. Six patients had no treatment or are still awaiting management at this time. Postoperatively, 11/20 patients (55%) were able to successfully conceive at least once. 8/11 patients were from the hysteroscopy group (66% pregnancy rate) and 10/11 pregnancies resulted in live births at term. In the laparoscopy group, there were 3 pregnancies (37.5% pregnancy rate), including 2 term live births, and 1 preterm live birth at 26 weeks. With respect to our review of the literature, a total of 49 articles were included in our final review of surgical techniques used in the management of CSDi.

Conclusions

This study suggests that surgical repair can improve pregnancy rates in patients with secondary infertility in the context of a confirmed CSDi.
Breaking barriers: supporting hematopoietic stem cell transplant program through collaborative radiation therapy service from a physically distant center
Authors: Pandit Subhas , Sapkota Simit , Adhikari Abish , Karki Prakriti , Shrestha Roshani , Jha Deepak Suman , Prajapati Rajan , Nyaichyai Kanchan Sarga , Poudyal Bishesh Sharma , Poudel Bishal , Jha Anjani Kumar
Published: May 2024

Background

Total body irradiation (TBI) for hematopoietic stem cell transplant (HSCT) has certain distinct advantages, such as uniform dose distribution and lack of drug resistance, but it is not widely available in resource-constrained settings. To overcome the limitations of in-house radiotherapy services in hematology centers, we evaluated the feasibility of conducting HSCT programs in coordination with two physically distant centers using a reduced-intensity TBI protocol.

Methods

Thirty-two patients with a median age of 20.5 years were included in the study. Fifteen patients were diagnosed with aplastic anemia, 10 patients with acute myeloid leukemia (AML), 3 patients with acute lymphocytic leukemia (ALL), and 4 patients with other hematological conditions. Conditioning regimens used were fludarabine plus cyclophosphamide in 29 cases, fludarabine-cytarabine ATG in 2 cases, and busulfan plus fludarabine in 1 case. The TBI dose was 3 Gy in 28 cases and 2 Gy in 4 cases. Patients were followed monthly after TBI, and the major toxicities were recorded.

Results

The median follow-up was 22 months. The most common acute complication was acute graft-versus-host disease (GVHD), which occurred in 15.6% of patients. The major late complications were chronic GVHD (9.3%), Cytomegalovirus (CMV) infection (34.3%), and CMV-induced secondary graft failure (6.2%). Seventy-five percent of patients were alive, 21.9% were dead, and 1 patient was lost to follow-up.

Conclusions

HSCT based on TBI is feasible even if the center lacks a radiotherapy facility by coordinating with a remote radiotherapy facility. without compromising the patient's outcome.
A formative mixed methods evaluation of a new Ross program: why context matters
Authors: Bilodeau Kyle S. , Yang Frank F. , Shang Michael , Mossman Audrey , Mauchley David C. , DeRoo Scott , Burke Christopher R.
Published: May 2024

Background

The Ross procedure is a technically complex operation to address the pathology of the aortic valve. Prior attempts at widespread implementation have been plagued with variations in effectiveness. We report our initial programmatic outcomes using dissemination and implementation (D&I) science frameworks, with an aim to define both programmatic efficacy and effectiveness. The study design was a single center, explanatory sequential mixed methods evaluation of a Ross surgery program from June 2020 to April 2023. Quantitative measures for baseline patient characteristics and postoperative outcomes were summarized. Qualitative measures were obtained using semi-structured interviews and characterized using implementation science frameworks.

Results

A total of 71 patients underwent the Ross procedure at a single academic center. Mean age was 40 years (± 13). There were no perioperative deaths or valve-related reinterventions (0%). During the follow-up period, 2 (2.8%) patients required re-operation and 2 (2.8%) required balloon dilation of the pulmonary homograft. Qualitative measures noted communication and prospective self-audit facilitated measures of effectiveness, as dichotomy within expected vs. observed outcomes led to program modifications. Collaboration across hospital systems promoted adoption and implementation, which led to the incorporation of the Ross procedure into accepted organizational practice.

Conclusions

In this formative evaluation, limited-efficacy outcomes demonstrated similar programmatic success to data from other established centers. With the prerequisite center volume and case selection, the Ross procedure is a safe and efficacious treatment for aortic valvular disease. Implementation science can be used both in real-time and retrospectively to guide organizational efforts to improve outcomes and to improve the translation of results across centers.
Numerical analysis of a protective coating for mining industry feed chute
Authors: Kalala Michael , Kisula Patrick , Muheme Innocent , Tartibu Lagouge
Published: May 2024

The selection of materials for the protective coating of a crusher’s feed chute significantly influences the mean time between failures (MTBF) and operational costs associated with the mass production of sulfuric acid at MMG/Kinsevere. Neglecting the condition of the protective coating can pose a serious challenge to production efficiency and result in increased downtime. This study focuses on enhancing industrial productivity in Sulfuric Acid production with minimal maintenance. The investigation explores the quality and type of materials used for the protective coating of the feed chute in the mining industry, particularly at MMG/Kinsevere, utilizing Ansys Fluent and SOLIDWORKS Software for analysis. The paper proposes a Ceramic protective liner for the crusher feed chute due to its superior resistance to erosion compared to other liners. Different feed chute models, constructed with materials like halogenated butyl rubber, 316 stainless steel, and ceramic, underwent analysis. The evaluation of the potential impact on the mean time between failures (MTBF) for different materials used in a protective coating, considering the rate of erosion through computational fluid dynamics (CFD) with ANSYS FLUENT software, is a central aspect of this study. The detailed modeling and simulation reveal that the ceramic material exhibits the most favorable protective coating characteristics, with an erosion rate density of 06.636753 kg/m2s, outperforming halogenated butyl rubber (3.326576 kg/m2s) and 316 stainless steel (2.186633 kg/m2s). The simulation yielded results corresponding to flow rates of 284.19 kg/s for the solid phase and 123.14 kg/s for the liquid phase.
Acute Interstitial Nephritis and Oxalate Nephropathy After Rapid Pasireotide Response in Treatment-resistant Acromegaly
Authors: Hayes Annabelle G , Penny Mark J , Aivazian Karina , Greenfield Jerry R
Published: May 2024

We report a case of interstitial nephritis, likely secondary to oxalate nephropathy, due to the development of pancreatic exocrine dysfunction after commencement of pasireotide for acromegaly. Pasireotide is known to impair insulin secretion but can also impair pancreatic exocrine function, hypothezised to result from high-affinity binding of somatostatin receptors 1, 2, 3, and 5. This has been an advantage in postoperative tissue anastomoses after pancreatic surgery, but exocrine insufficiency has not been reported when used for the treatment of acromegaly. A 73-year-old woman, diagnosed with acromegaly, was unable to achieve biochemical control despite 2 surgical resections of an invasive mammosomatotroph pituitary tumor and treatment with cabergoline and maximal-dose lanreotide. The tumor expressed somatostatin receptor type 5 but not somatostatin receptor type 2, predicting good response from pasireotide, which was commenced at 40 mg every 4 weeks. IGF-1 rapidly normalized, but the patient presented with nausea, anorexia, and acute kidney injury. Renal biopsy revealed acute-on-chronic interstitial nephritis, with numerous oxalate crystals. Increased fecal fat globules were noted on fat stain (3+), supporting malabsorption as an etiology of secondary enteric hyperoxaluria. Renal function recovered to near baseline over months following pasireotide withdrawal and high-dose glucocorticoids.