bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparison of endoscopic breast-conserving surgery versus conventional breast-conserving surgery for the treatment of early-stage breast cancer: a meta-analysis
Authors: Li Liwen , Liang Yiwen , Li Chunyan , Huang Miaoyan , Liang Weiming , Qin Tian
Published: August 2024

Introduction

This meta-analysis seeks to evaluate the efficacy and safety of endoscopic breast-conserving surgery (E-BCS) compared to conventional breast cancer surgery (C-BCS) in patients diagnosed with early-stage breast cancer.

Materials and methods

Four databases (Medline, Embase, Web of Science and CENTRAL) were searched published from establishment of database to January 30,2024, for articles studying E-BCS compared to C-BCS in patients diagnosed with early-stage breast cancer. Meta-analyses of procedure time, blood loss, length of incision, drainage duration, total postoperative drainage volume, average duration of hospital stay, positive rate of margin, complication rate, recurrence rate, metastasis rate and cosmetic scoring were performed.

Results

Totally 11 studies were included for meta-analysis. Compared with C-BCS, E-BCS exhibited significantly reduced incision length (WMD = -6.44, 95%CI: -10.78 to -2.11, P=0.004, I2 = 99.0%) and superior cosmetic scoring (WMD = 2.69, 95%CI: 1.46 to 3.93, P=0.001, I2 = 93.2%), but had significantly longer operation time (WMD = 34.22, 95%CI: 20.89~47.55, P=0.000, I2 = 90.7%) and blood loss (WMD = 3.65, 95%CI: -3.12 to 10.43, P=0.291, I2 = 86.8%). There was no significant difference in terms of recurrence rate, metastasis rate, positive rate of tumor resection margins, drainage duration, drainage volume, complication rate and hospital days.

Conclusions

Our research findings indicate that E-BCS is a viable and secure method for treating breast cancer in its early stages. E-BCS provides distinct advantages in terms of the length of the incision and the aesthetic result, without demonstrating an elevated recurrence rate or metastasis rate.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024535164, identifier CRD42024535164.
Hyperthermia and radiotherapy: physiological basis for a synergistic effect
Authors: Righini Michael F. , Durham André , Tsoutsou Pelagia G.
Published: August 2024

In cancer treatment, mild hyperthermia (HT) represents an old, but recently revived opportunity to increase the efficacy of radiotherapy (RT) without increasing side effects, thereby widening the therapeutic window. HT disrupts cellular homeostasis by acting on multiple targets, and its combination with RT produces synergistic antitumoral effects on specific pathophysiological mechanisms, associated to DNA damage and repair, hypoxia, stemness and immunostimulation. HT is furthermore associated to direct tumor cell kill, particularly in higher temperature levels. A phenomenon of temporary resistance to heat, known as thermotolerance, follows each HT session. Cancer treatment requires innovative concepts and combinations to be tested but, for a meaningful development of clinical trials, the understanding of the underlying mechanisms of the tested modalities is essential. In this mini-review, we aimed to describe the synergistic effects of the combination of HT with RT as well as the phenomena of thermal shock and thermotolerance, in order to stimulate clinicians in new, clinically relevant concepts and combinations, which become particularly relevant in the era of technological advents in both modalities but also cancer immunotherapy.
Understanding the Cryptosporidium species and their challenges to animal health and livestock species for informed development of new, specific treatment strategies
Authors: Rideout Hannah , Cook Alasdair J. C. , Whetton Anthony D.
Published: August 2024

Cryptosporidium species are parasitic organisms of vertebrates with a worldwide distribution. They have an important impact globally upon human and animal health, and livestock productivity. The life cycle of these species is complex and difficult to disrupt to improve human health, animal health, food security and economic growth. This may contribute to the fact that no new treatment strategy has been widely accepted or applied in livestock for years. Here we consider the natural history of these parasites, their biochemistry and economic impact. Using recent developments in understanding these parasites we then consider viable and affordable approaches to enhancing control of their effects on livestock. These are based on advances in drug discovery, omics research and artificial intelligence applications to human and veterinary medicine that indicate putative new therapeutic approaches.
The effect of the antibiotic stewardship program (ASP) on community-acquired pneumonia (CAP): a before–after study
Authors: Fésüs Adina , Baluku Phiona , Sipos Éva , Somodi Sándor , Berczi-Kun Enikő , Lekli István , Bácskay Ildikó , Benkő Ria , Vaskó Attila
Published: August 2024

Background: Community-acquired pneumonia (CAP) is one of the leading causes of death worldwide. Antibiotic stewardship program (ASP) has been implemented to improve rational and responsible antibiotic use by encouraging guideline adherence.

Objective: This retrospective observational before–after study aimed to evaluate whether the ASP may improve guideline adherence, antibiotic exposure, and clinical outcomes in patients hospitalized due to CAP in Hungary.

Methods: The study was conducted at a pulmonology department of a tertiary care medical center in Hungary. The ASP implementation consisted of written and published guidelines available to all professionals, continuous supervision, and counseling services on antibiotic therapies at an individual level, with the aim of ensuring compliance with CAP guidelines. Overall guideline adherence (agent selection, route of administration, and dose), clinical outcomes (length of stay and 30-day mortality), antibiotic exposure, and direct costs were compared between the two periods. Fisher’s exact test and t-test were applied to compare categorical and continuous variables, respectively. P-values below 0.05 were defined as significant.

Results: Significant improvement in overall CAP guideline adherence (30.2%), sequential therapy (10.5%), and a significant reduction in the total duration of antibiotic therapy (13.5%) were observed. Guideline non-adherent combination therapies with metronidazole decreased significantly by 28.1%. Antibiotic exposure decreased by 7.2%, leading to a significant decrease in direct costs (23.6%). Moreover, the ASP had benefits for clinical outcomes, and length of stay decreased by 13.5%.

Conclusion: The ASP may play an important role in optimizing empirical antibiotic therapy in CAP having a sustained long-term effect.
Efficacy and safety of levetiracetam for migraine prophylaxis in children: a systematic review and meta-analysis
Authors: Peng Jing , Liu Linhui , Li Qiaoling , Liu Maochang , Zhou Rong , Chen Li , Liu Zhisheng
Published: August 2024

Background

Levetiracetam (LEV), an antiepileptic drug, has been effective in adult migraine prevention but lacks extensive research in children. This study evaluates LEV’s efficacy and safety for pediatric migraine prophylaxis.

Methods

We reviewed randomized controlled trials (RCTs) and non-RCTs in major databases through 8 January 2024, focusing on four efficacy endpoints and adverse drug reactions (ADRs). Data synthesis involved pooled relative risks or odds ratios for dichotomous outcomes and mean differences for continuous outcomes, using fixed- or random-effects models as appropriate.

Results

Eight studies with 190 participants showed that after taking LEV, the mean headache frequency decreased 5.19 per month (MD: −5.19, 95% CI: −7.11 to −3.27, p < 0.00001) and improved headache-free rates to 28% (95% CI: 0.17–0.41). More than 83% experienced a >50% reduction in monthly headache frequency. The migraine disability score decreased by 33.51 points (MD: −33.51, 95% CI: −38.46 to −28.55, p < 0.00001). ADR incidence did not significantly differ between LEV and control groups (RR: 1.06, 95% CI: 0.39 to 2.85, p = 0.91), with an overall ADR rate of 18% (95% CI: 0.13–0.24). The most common ADR was irritability (12%), leading to treatment discontinuation in 13% of cases (95% CI: 0.05–0.30).

Conclusion

LEV has shown good efficacy in preventing pediatric migraines. However, its safety requires further confirmation through more extensive and well-designed RCTs.

Systematic Review Registration

Identifier PROSPERO CRD42024497643.
Women have a higher risk of hospital admission associated with hyponatremia than men while using diuretics
Authors: Hendriksen L. C. , Mouissie M. S. , Herings R. M. C. , van der Linden P. D. , Visser L. E.
Published: August 2024

Background

Hyponatremia is a common electrolyte disturbance and known adverse drug reaction of diuretics. Women tend to be more susceptible for diuretic associated hyponatremia. The aim of this study was to find more evidence whether women have a higher risk of diuretic associated hyponatremia than men measured at hospital admission for specific diuretic groups and whether there is a sex difference in risk of severity of hyponatremia.

Methods

All patients using a diuretic and admitted for any reason to Tergooi MC and Haga Teaching hospital in the Netherlands between the 1st of January 2017 and the 31st of December 2021, with recorded sodium levels at admission were included in this study. Cases were defined as patients with a sodium level <135 mmol/L, while control patients had a sodium level ≥135 mmol/L at admission. Logistic regression analysis was used to calculate odds ratios (OR) with 95% CIs for women versus men and adjusted for potential confounding covariables (age, body mass index, potassium serum level, systolic and diastolic blood pressure, estimated glomerular filtration rate, number of diuretics, comedications and comorbidities). Stratified analyses were conducted for specific diuretic groups (thiazides, loop diuretics and aldosterone antagonists), and adjusted for dose. Furthermore, stratified analyses were performed by severity of hyponatremia (severe: <125 mmol/L), mild: 125–134 mmol/L).

Results

A total of 2,506 patients (50.0% women) were included, of which 516 had hyponatremia at admission (20.6%, 56.2% women). Women had a statistically significantly higher risk for hyponatremia at admission than men (OR 1.37; 95% CI 1.12–1.66) and after adjustment for potential risk factors (ORadj 1.55; 95% CI 1.22–1.98). Stratified analyses showed increased odds ratios for thiazides (ORadj 1.35; 95% CI 1.00–1.83) and loop diuretics (ORadj 1.62; 95% CI 1.19–2.19) among women. Use of aldosterone antagonists was also increased but not statistically significant (ORadj 1.15; 95% CI 0.73–1.81). Women had a statistically higher risk to develop mild and severe hyponatremia than men (ORadj 1.36; 95% CI 1.10–1.68 and ORadj 1.96; 95%CI 1.04–3.68, respectively).

Conclusion

Women have a higher risk of a hospital admission associated with hyponatremia while using diuretics than men. Further research is necessary to provide sex-specific recommendations.
Update: factors influencing heart rate variability–a narrative review
Authors: Sammito Stefan , Thielmann Beatrice , Böckelmann Irina
Published: August 2024

Objective

Heart rate variability (HRV) is an important non-invasive marker for the assessment of an organism’s autonomic physiological regulatory pathways. Lower HRV has been shown to correlate with increased mortality. HRV is influenced by various factors or diseases. The aim of this narrative review is to describe the current state of knowledge on factors influencing HRV and their significance for interpretation.

Methods

The narrative review only included reviews, meta-analyses, and cohort studies which were published until 2021. HRV confounders were grouped into four categories (non-influenceable physiological factors, diseases, influenceable lifestyle factors and external factors).

Results

The review found that HRV was decreased not only in non-influenceable physiological factors (e.g., age, gender, ethnicity) but also in connection with various number of acute and chronic diseases (e.g., psychiatric diseases, myocardial infarction, heart failure), influenceable lifestyle factors (e.g., alcohol abuse, overweight, physical activity), and external factors (e.g., heat, noise, shift work, harmful- and hazardous substances).

Conclusion

In order to improve the quality of HRV studies and to ensure accurate interpretation, it is recommended that confounders be taken into account in future diagnostic measurements or measurements in the workplace (e.g., as part of health promotion measures) in order to counteract data bias.
Soil drought sets site specific limits to stem radial growth and sap flow of Douglas-fir across Germany
Authors: Niessner Armin , Ehekircher Stefan , Zimmermann Reiner , Horna Viviana , Reichle Daniel , Land Alexander , Spangenberg Göran , Hein Sebastian
Published: August 2024

Introduction

Soil drought during summer in Central Europe has become more frequent and severe over the last decades. European forests are suffering increasing damage, particularly Norway spruce. Douglas-fir (Pseudotsuga menziesii (Mirbel) Franco), a non-native tree species, is considered as a promising alternative to build drought-resilient forests. The main goal of this study was to investigate the intraannual radial stem growth and sap flow performance of Douglas-fir along a precipitation gradient across Germany under severe drought.

Material and methods

Sap flow and stem radial changes of up to ten trees each at four sites with different precipitation regimes were measured in combination with volumetric soil water content during the growing season of 2022. Measurements of stem radial changes were used to calculate the trees’ stem water deficit, a proxy for tree water status and drought stress.

Results

The severe summer drought of 2022 led to an early growth cessation and a significant reduction in daily sap flow at all four sites monitored. We could identify a site-specific threshold in soil water availability ranging between 21.7 and 29.6% of relative extractable water (REW) under which stem water reserves cannot be replenished and thereby inhibiting radial growth. We could also demonstrate that at this threshold, sap flow is heavily reduced to between 43.5 and 53.3%, and for a REW below 50%, sap flow linearly decreases by 1.1–2.0% per 1% reduction in REW. This reduction tends to follow the humidity gradient, being more pronounced at the most oceanic characterized site and suggesting an adaptation to site conditions. Even though Douglas-fir is considered to be more drought stress resistant than Norway spruce, growth and sap flow are greatly reduced by severe summer drought, which became more frequent in recent years and their frequency and intensity is likely to increase.

Conclusions

Our results suggest that timber production of Douglas-fir in Central Europe will decline considerably under projected climate change, and thus pointing to site specific growth constraints for a so far promising non-native tree species in Europe.
Initiation of rest-grazing during soil thawing improves interspecific relationships and stability of plant communities on alpine grassland
Authors: Ma Kaikai , Hou Qingqing , Xu Changlin , Chen Yanzhu , Yang Hang , Xu Jingjing , Yu Xiaojun
Published: August 2024

Introduction

Grazing management is essential to maintain the stability of grassland ecosystems.

Methods

To determine the optimal rest-grazing period of alpine meadow, five rest-grazing periods were set based on soil thawing and plant re-greening in this study. The niche, interspecific relationships, and stability of plant communities at different rest-grazing periods were investigated.

Results

Rest-grazing during soil thawing resulted in a small niche width and niche overlap of plants, overall positive interspecific associations, and a high stability of plant communities. Delayed rest-grazing time to plant re-greening resulted in a large niche width and niche overlap of plants, overall negative interspecific associations, and a low stability of plant communities.

Discussion

Rest-grazing in alpine meadows should begin as soon as possible to promote healthy and sustainable utilization of grasslands.
Comparing time-series transcriptomes between chilling-resistant and -susceptible rice reveals potential transcription factors responding to chilling stress
Authors: Zhang Rui , Xi XiaoHui , Chen XinYi , Wang Yi , Zhou Ming
Published: August 2024

Low temperature is one of the most important environmental factors that inhibits rice growth and grain yield. Transcription factors (TFs) play crucial roles in chilling acclimation by regulating gene expression. However, transcriptional dynamics and key regulators responding to low temperature remain largely unclear in rice. In this study, a transcriptome-based comparative analysis was performed to explore genome-wide gene expression profiles between a chilling-resistant cultivar DC90 and a chilling-susceptible cultivar 9311 at a series of time points under low temperature treatment and recovery condition. A total of 3,590 differentially expressed genes (DEGs) between two cultivars were determined and divided into 12 co-expression modules. Meanwhile, several biological processes participating in the chilling response such as abscisic acid (ABA) responses, water deprivation, protein metabolic processes, and transcription regulator activities were revealed. Through weighted gene co-expression network analysis (WGCNA), 15 hub TFs involved in chilling conditions were identified. Further, we used the gene regulatory network (GRN) to evaluate the top 50 TFs, which might have potential roles responding to chilling stress. Finally, five TFs, including a C-repeat binding factor (OsCBF3), a zinc finger-homeodomain protein (OsZHD8), a tandem zinc finger protein (OsTZF1), carbon starved anther (CSA), and indeterminate gametophyte1 (OsIG1) were identified as crucial candidates responsible for chilling resistance in rice. This study deepens our understanding in the gene regulation networks of chilling stress in rice and offers potential gene resources for breeding climate-resilient crops.
A single amino acid substitution in the AAA-type ATPase LRD6-6 activates immune responses but decreases grain quality in rice
Authors: Yin Junjie , Zhang Cheng , Zhang Qianyu , Long Feiyan , Hu Wen , Zhou Yi , Mou Fengying , Zhong Yufeng , Wu Bingxiu , Zhu Min , Zou Lijuan , Zhu Xiaobo
Published: August 2024

Plant spotted leaf (spl) mutants are useful to reveal the regulatory mechanisms of immune responses. Thus, in crop plants, their agronomic traits, especially the grain quality are usually ignored. Here, we characterized a rice spl mutant named spl-A (spotted leaf mutant from A814) that shows autoimmunity, broad-spectrum disease resistance and growth deterioration including decreased rice quality. A single nucleotide mutation of C1144T, which leads to change of the 382nd proline to serine, in the gene encoding the ATPases associated with diverse cellular activities (AAA)-type ATPase LRD6-6 is responsible for the phenotype of the spl-A mutant. Mechanistically, this mutation impairs LRD6-6 ATPase activity and disrupts its interaction with endosomal sorting complex required for transport (ESCRT)-III subunits OsSNF7.1/7.2/7.3. And thus, leading to compromise of multivesicular bodies (MVBs)-mediated vesicle trafficking and accumulation of ubiquitinated proteins in both leaves and seeds of spl-A. Therefore, the immune response of spl-A is activated, and the growth and grain quality are deteriorated. Our study identifies a new amino acid residue that important for LRD6-6 and provides new insight into our understanding of how MVBs-mediated vesicle trafficking regulates plant immunity and growth, including grain quality in rice.
Variations in the intensity of the securitization narratives at the EU level: securitizing the European refugee crisis
Authors: Stivas Dionysios
Published: August 2024

This paper examines the narratives of the European Council, European Commission, and European Parliament regarding the European refugee crisis. Although the relevant scholarly research suggests that the EU Institutions held different perspectives about the refugee crisis, this paper argues that there was no such a clash of perspectives. This paper builds on the Copenhagen School’s securitization framework as complemented with subsequent methodological tools to support the author’s arguments. The findings suggest that despite the similarity in the views held by the main EU Institutions considering the refugees’ influx, there was a variation in the intensity of their securitizing narratives. Theoretically, this study develops an understanding of the importance of the securitization narratives’ intensity. Methodologically, this study introduces the Securitization Narratives Continuum, a research tool that facilitates the assessment of securitization. Empirically, this is the first study to interview and take into account the opinions of the securitizing actors.
The impact of teachers’ perceived competence in information and communication technology usage, and workplace anxiety on well-being, as mediated by emotional exhaustion
Authors: Chen Bo-Ching , Wu Yu-Tai , Chuang Ya-Ting
Published: August 2024

Introduction

The 2030 Sustainable Development Goals (SDGs) were adopted by the United Nations in 2015, emphasizing the importance of achieving peace, prosperity, and well-being for all people. With the outbreak of the COVID-19 pandemic, sustainable health has become an important issue. Teachers were forced to adopt distance teaching, necessitating rapid upgrading of their ICT skills and integration into e-learning, which caused tangible and intangible pressures on teachers and impacted their well-being. This study examined the effects of ICT competence on teachers’ workplace anxiety, emotional exhaustion, and well-being during the pandemic from the perspective of Social Cognitive Theory (SCT).

Methods

A quantitative research methodology and a questionnaire survey with a total of 21 questions were used as the primary research design. The snowball method was employed as a sampling method for online questionnaires from September to October 2021. A total of 216 questionnaires were collected, of which four incomplete questionnaires were excluded, leaving 212 valid questionnaires, with a valid questionnaire recovery rate of 98.1%. The valid questionnaires were analyzed using Smart Pls 4.0 Partial Least Square Method Structural Equation Modeling (PLS-SEM).

Results

The study found that teachers’ ICT competence could significantly reduce emotional exhaustion and enhance teachers’ well-being. However, there was no significant effect on workplace anxiety. Additionally, well-being was not directly affected by workplace anxiety, and teachers’ well-being needs to be mediated by emotional exhaustion to be indirectly affected. Emotional exhaustion plays an important mediating role between teachers’ ICT competence and workplace stress, both of which are important mediators of well-being.

Discussion

From a practical point of view, to achieve the Sustainable Development Goals (SDGs) 2030, it is ideal to have good health and well-being for the whole person. This study facilitates the development of strategies to improve the well-being of teachers, which provides an empirical basis for the enhancement of mental health and well-being of educators.
An advanced Artificial Intelligence platform for a personalised treatment of Eating Disorders
Authors: Monaco Francesco , Vignapiano Annarita , Piacente Martina , Pagano Claudio , Mancuso Carlo , Steardo Luca , Marenna Alessandra , Farina Federica , Petrillo Gianvito , Leo Stefano , Ferrara Emanuela , Palermo Stefania , Martiadis Vassilis , Solmi Marco , Monteleone Alessio Maria , Fasano Alessio , Corrivetti Giulio
Published: August 2024

Introduction

Eating Disorders (EDs) affect individuals globally and are associated with significant physical and mental health challenges. However, access to adequate treatment is often hindered by societal stigma, limited awareness, and resource constraints.

Methods

The project aims to utilize the power of Artificial Intelligence (AI), particularly Machine Learning (ML) and Deep Learning (DL), to improve EDs diagnosis and treatment. The Master Data Plan (MDP) will collect and analyze data from diverse sources, utilize AI algorithms for risk factor identificat io n, treatment planning, and relapse prediction, and provide a patient-facing chatbot for information and support. This platform will integrate patient data, support healthcare professionals, and empower patients, thereby enhancing care accessibility, personalizing treatment plans, and optimizing care pathways. Robust data governance measures will ensure ethical and secure data management.

Results

Anticipated outcomes include enhanced care accessibility and efficiency, personalized treatment plans leading to improved patient outcomes, reduced waiting lists, heightened patient engagement, and increased awareness of EDs with improved resource allocation.

Discussion

This project signifies a pivotal shift towards data-driven, patient-centered ED care in Italy. By integrat ing AI and promoting collaboration, it seeks to redefine mental healthcare standards and foster better well- being among individuals with EDs.
Head circumference growth in children with Autism Spectrum Disorder: trend and clinical correlates in the first five years of life
Authors: Cirnigliaro Lara , Clericò Luisa , Russo Lorenza Chiara , Prato Adriana , Caruso Manuela , Rizzo Renata , Barone Rita
Published: August 2024

Background

Macrocephaly is described in almost 15% of children with Autism Spectrum Disorder (ASD). Relationships between head growth trajectories and clinical findings in ASD children show a high degree of variability, highlighting the complex heterogeneity of the disorder.

Objectives

The aim of this study was to measure differences of the early growth trajectory of head circumference (HC) in children with ASD and macrocephaly compared to ASD normocephalic children, examining clinical correlates in the two groups of patients.

Methods

HC data were collected from birth to 5 years of age in a sample of children with a confirmed diagnosis of ASD. Participants were classified into two groups: ASD macrocephaly (ASD-M, Z-scores ≥1.88 in at least two consecutive HC measurements), and ASD non-macrocephaly (ASD-N). Based on the distribution of HC measurements (Z-scores), five age groups were identified for the longitudinal study. Developmental and behavioral characteristics of the ASD-M children compared to the ASD-N group were compared by using standardized scores.

Results

20,8% of the children sample met criteria for macrocephaly. HC values became indicative of macrocephaly in the ASD-M group at the age range from 1 to 6 months, and persisted thereafter throughout the first five years of age. ASD-M children showed significantly higher developmental quotients of Griffiths III B and D subscales compared to ASD-N group. No significant differences in the severity of ASD symptoms assessed by ADOS-2 were observed between ASD-M and ASD-N groups.

Conclusion

In this study HC size from birth to 5 years links to accelerated HC growth rate as early as the first 6 months of age in children with ASD and macrocephaly, preceding the onset and diagnosis of ASD. We found that in early childhood, children with ASD-M may exhibit some advantages in language and social communication and emotional skills without differences in autism severity, when compared with age-matched normocephalic ASD children. Longitudinal analyses are required to catch-up prospectively possible relationships between head size as proxy measure of brain development and neuro-developmental and behavioral features in children with ASD.
Assessment of epidemic risk state and its change trend of public hospital in underdeveloped area in different stages
Authors: Yang Ming , Miao Jingjing , Li Tiebing , Jiang Rong , Jiang Min
Published: August 2024

Objective

Epidemics are sudden and rapidly spreading. Hospitals in underdeveloped areas are particularly vulnerable in case of an outbreak. This paper aims to assess the epidemic risk state and its change trend of hospitals in different epidemic stages, identify the key factors affecting hospital epidemic risk change, provide priority reference for hospital epidemic risk control, and enhance the hospital's ability to respond to sudden epidemics.

Methods

Based on Grounded theory, the epidemic risk indicators that affect hospital safety are summarized. The concept of epidemic risk state and its random state space is proposed according to Markov chain theory. The impact of each indicator on the random risk state and its change is comprehensively assessed from two aspects: risk occurrence probability and risk loss. Finally, the assessment of the hospital epidemic risk state and its change at different stages is achieved.

Results

The stable risk states of public hospitals in underdeveloped areas in non-epidemic stage t0, early epidemic stage t1, and outbreak stage t2 are P^t0(Sn)={0.142,0.546,0.220,0.093}, P^t1(Sn)={0.025,0.364,0.254,0.357}, and P^t2(Sn)={0.020,0.241,0.191,0.548}, respectively. In non-epidemic stage, the key factor in improving the hospital epidemic risk state is emergency funding. In early epidemic stage, the key factors in improving the hospital epidemic risk state are the training of medical staff in epidemic prevention skills and the management of public health. In outbreak state, the key factor in improving the hospital epidemic risk state is the training of medical staff in epidemic prevention skills and psychological awareness.

Conclusion

This paper proposes the concept of epidemic risk state, providing an effective assessment method for the epidemic risk state and its change trend in public hospitals. According to the assessment, public hospitals in underdeveloped areas in different epidemic stages should adopt different risk control strategies to improve their current risk state. Blind risk control is inefficient and may even cause the epidemic risk to transition toward a more dangerous state.
Simultaneous vaccination against seasonal influenza and COVID-19 among the target population in Italy
Authors: Sansone Vincenza , Miraglia del Giudice Grazia , Della Polla Giorgia , Angelillo Italo Francesco
Published: August 2024

Introduction

Annual influenza and COVID-19 vaccinations are effective tools for reducing the disease burden. The goals of the present cross-sectional survey were to investigate attitudes and behaviors toward the simultaneous vaccination against seasonal influenza and COVID-19 and the factors associated.

Methods

Questionnaires were self-administered or researcher-administered between October 2023 and February 2024 in an immunization center in the southern part of Italy.

Results

All 151 subjects eligible for influenza and COVID-19 vaccinations who attended the center agreed to participate. A total of 59.9% of respondents received concurrent seasonal influenza and COVID-19 vaccinations. Those who perceived that the simultaneous vaccination was safer and those who have been infected by SARS-CoV-2 fewer times were more likely to have simultaneously received both vaccinations. Regarding the reasons reported, half of the sample stated that the simultaneous vaccination was safe and that they were adequately informed. This was more likely indicated by the respondents who had received at least four doses of the COVID-19 vaccination. Among those who had not received the simultaneous vaccination, 70.7% and 29.3% had received only seasonal influenza and COVID-19.

Conclusion

Educational health communication campaigns are necessary to improve compliance with simultaneous administration of seasonal influenza and COVID-19 vaccinations and to increase the unsatisfactory coverage.
Safety assessment of high doses of vaporized oxalic acid on honey bee worker health and queen quality
Authors: Tellarini Prieto Emilio Enrique , Pietropaoli Marco , Camus Ylona , Polizel Camilli Marcelo , Raza Muhammad Fahim , Jose Midhun Sebastian , Obshta Oleksii , Bezerra da Silva Marina Carla , Kozii Ivanna , Moshynskyy Igor , Edirithilake Thanuri L.K. , Baril Erin , Glavinic Uros , Simko Elemir , Wood Sarah C.
Published: August 2024

Introduction

The honey bee ectoparasitic mite, Varroa destructor, is one of the main causes of honey bee colony loss worldwide. Synthetic acaricides are the most commonly used strategy for varroa control, however, resistance to these acaricides has emerged. Consequently, the use of organic acids for varroa control is gaining more interest among beekeepers. For example, oxalic acid (OA) is a natural compound that has been shown to be an effective acaricide against varroa mites, however, the potential toxicity of OA to adult bees and queens is poorly understood. The objective of the study was to evaluate the toxicity of incremental doses of vaporized OA on honey bee workers and queens.

Methods

We exposed 32 colonies to incremental doses (0, 5, 10 or 20 g per colony) of vaporized OA once per week over four consecutive weeks and we monitored the acute and long-term toxicity. We investigated the short-term effects of OA administration by evaluating adult bee mortality, brood production, and population size. Next, we evaluated the long-term effects of OA application on both worker bees and queens. Regarding workers, we investigated their ability to rear new queens. As for queens, we measured acceptance, performance, and sperm quality.

Results

We found that colonies treated with 20 g OA (20 times the label dose) had a statistically significant increase in worker bee mortality, with a non-significant, 23% decrease in brood relative to controls. No significant differences were observed in queen performance nor sperm quality.

Discussion

We found that repeated application of vaporized OA, at up to 20 times the label dose, had no significant short-term nor long-term, negative effects on colony or queen health, with the exception of a short-term increase in adult bee mortality in the 20 g OA-treated group. The results of this study support the safety of higher-than-label doses of OA for honey bee colonies. The observed increase in adult bee mortality in the 20 g OA dose group in this study suggests that OA doses should be maintained below 20 g per brood chamber.
Exploring the need and potential of ambulatory pharmacy practice for empowering patient and care delivery in India
Authors: Choudhary Ravindra P. , Siddalingegowda Srikanth M.
Published: August 2024

In recent years, rapidly changing disease profile patterns, shortage & uneven utilization of healthcare professionals contributed massive burden on the Indian healthcare system, which resulted in varying, fragmented, inconsistent healthcare delivery to the patients and poor patient management. Patients often face and experience many challenges like lack of accessibility, poor patient–healthcare provider relationships, and inadequate quality of care, resulting in unnecessary economic burden in managing their health conditions. Thus Indian healthcare reform is essential in enhancing its capacity to fulfill patients' health needs that can be addressed by focusing on key sustainable strategies and initiatives meant for enhancing coordination of care, expanding services accessibility, redeveloping healthcare infrastructure, implementing workforce innovation and strong governance with the incorporation of core principles such as patient-centeredness, integrated care and collaborative care approaches. The clinical and ambulatory pharmacy practice are fragment of the healthcare delivery which delivers pharmaceutical care and fulfils the needs of patients across healthcare settings. This paper focuses on the present & future perspectives of ambulatory pharmacy practice in India and the factors to be considered for implementing it in patient care.
A Model for Estimating the Burden of Disease of Transfusion-Transmitted Infection
Authors: Riley William , Love Kailey , Saxon Mary , Tobian Aaron , Bloch Evan M. , Kasirye Ronnie , Lubega Irene , Musisi Ezra , Dhabangi Aggrey , Kyeyune Dorothy , McCullough Jeffrey
Published: August 2024

Objectives

Blood transfusion is an important mode of infectious disease transmission in low- and middle-income countries (LMICs). This study describes a model to determine the prevalence of transfusion-transmitted infections (TTIs) and the associated burden of disease.

Methods

A five-step model was developed to determine the TTI-related burden of disease measured by disability-adjusted life years (DALYs). Uganda was selected as the study country.

Results

Approximately 298,266 units of blood were transfused in Uganda in 2019, yielding an estimated TTI incidence of 6,858 new TTIs (2.3% of transfused units) and prevalence of 19,141 TTIs (6.4% of transfused units). The total burden of disease is 2,903 DALYs, consisting of approximately 2,590 years of life lost (YLLs), and 313 years lived with disability (YLDs).

Conclusion

The incidence and prevalence of TTIs and the associated burden of disease can be calculated on a local and national level. The model can be applied by health ministries to estimate the impact of TTIs in order to develop blood safety strategies to reduce the burden of disease.
Intraoperative pyloric drainage is unnecessary during esophagectomies: a meta-analysis and systematic review of randomized controlled trials
Authors: Csontos Armand , Németh Dávid , Szakó Lajos , Berke Gergő , Sindler Dóra Lili , Berki Dávid , Papp Csenge , Hegyi Péter , Vereczkei András , Papp András
Published: August 2024

Objective: The topic of this meta-analysis is the comparison of gastric conduit esophageal reconstructions with or without pyloroplasty.

Background: Surgical procedures, especially minimal invasive esophagectomy (MIE) can be a curative treatment in the early stages of esophageal cancer. Previously, intraoperative pyloroplasty was routinely performed, but nowadays it became debated again in the light of minimally invasive esophagectomy.

Methods: A comprehensive search was performed in multiple databases to identify randomized controlled trials investigating the topic. Two independent authors performed the selection based on predefined criteria. Statistical analysis was performed to assess any significant difference, then the bias and quality of the data were estimated.

Results: Nine relevant RCTs consisting of 529 patients with esophageal cancer were identified. No significance was found in mortality [odds ratio (OR): 0.85; p = 0.642], anastomosis leakage (OR: 0.57; p = 0.254), respiratory morbidity (OR: 0.51; p = 0.214) and vomiting (OR: 0.74; p = 0.520), however the results about gastric emptying time (GET) were controversial (weighted mean difference (WMD): −67.71; p = 0.009, OR: 2.75; p = 0.072). Significant heterogeneity was not detected except for GET. Trial sequential analyses (TSA) show that a certain conclusion would require more data except in the binary variables of GET.

Conclusion: We conclude that the pyloric drainage procedure is not routinely necessary, but further well-designed studies would be needed, especially in Europe.
Effects of Wire-Wrapping Patterns and Low Temperature on Combustion of Propellant Embedded with Metal Wire
Authors: Wu Qiu , Zhao Jiangong , Ren Quanbin
Published: August 2024

Incorporating silver wires into propellant has emerged as a highly effective strategy for enhancing propellant burning rates, a technique extensively deployed in the construction of numerous fielded sounding rockets and tactical missiles. Our research, employing a multi-faceted approach encompassing thermogravimetric-differential scanning calorimetry measurements (TG-DSC), combustion diagnoses, burning rate tests, and meticulous collection of condensed combustion products, sought to elucidate how variations in silver wire quantity and winding configuration impact the combustion properties of propellants. Our findings underscore the remarkable efficacy of double tightly twisted silver wire in significantly boosting propellant burning rates under ambient conditions. Moreover, at lower temperatures, the reduced gap between the propellant and silver wire further magnifies the influence of silver wire on burning rates. However, it is noteworthy that the relationship between burning speed and combustion efficiency is not deterministic. While a smaller cone angle of the burning surface contributes to heightened burning rates, it concurrently exacerbates the polymerization effect of vapor phase aluminum particles, consequently diminishing propellant combustion efficiency. Conversely, propellants configured with sparsely twinned silver wires exhibit notable enhancements in combustion efficiency, despite a less pronounced impact on the burning rate attributed to the larger cone angle of the burning surface. Remarkably, these trends persist at lower temperatures. Based on the principle of heat transfer balance, a theoretical model for the combustion of propellants with wire inserts is developed. The reliability of this theoretical model is validated through a comparison of calculated values with experimental data. Our research outcomes carry significant implications for guiding the application and advancement of the silver wire method in solid propellants for solid rocket motors, offering valuable insights to inform future research and development endeavors in this domain.
Automatic Age and Gender Recognition Using Ensemble Learning
Authors: Yücesoy Ergün
Published: August 2024

The use of speech-based recognition technologies in human–computer interactions is increasing daily. Age and gender recognition, one of these technologies, is a popular research topic used directly or indirectly in many applications. In this research, a new age and gender recognition approach based on the ensemble of different machine learning algorithms is proposed. In the study, five different classifiers, namely KNN, SVM, LR, RF, and E-TREE, are used as base-level classifiers and the majority voting and stacking methods are used to create the ensemble models. First, using MFCC features, five base-level classifiers are created and the performance of each model is evaluated. Then, starting from the one with the highest performance, these classifiers are combined and ensemble models are created. In the study, eight different ensemble models are created and the performances of each are examined separately. The experiments conducted with the Turkish subsection of the Mozilla Common Voice dataset show that the ensemble models increase the recognition accuracy, and the highest accuracy of 97.41% is achieved with the ensemble model created by stacking five classifiers (SVM, E-TREE, RF, KNN, and LR). According to this result, the proposed ensemble model achieves superior accuracy compared to similar studies in recognizing age and gender from speech signals.
Molecular Features and Treatment Paradigms of Acute Myeloid Leukemia
Authors: Shukla Mihir , Abdul-Hay Maher , Choi Jun H.
Published: August 2024

Acute myeloid leukemia (AML) is a common hematologic malignancy that is considered to be a disease of aging, and traditionally has been treated with induction chemotherapy, followed by consolidation chemotherapy and/or allogenic hematopoietic stem cell transplantation. More recently, with the use of next-generation sequencing and access to molecular information, targeted molecular approaches to the treatment of AML have been adopted. Molecular targeting is gaining prominence, as AML mostly afflicts the elderly population, who often cannot tolerate traditional chemotherapy. Understanding molecular changes at the gene level is also important for accurate disease classification, risk stratification, and prognosis, allowing for more personalized medicine. Some mutations are well studied and have an established gene-specific therapy, including FLT3 and IDH1/2, while others are being investigated in clinical trials. However, data on most known mutations in AML are still minimal and therapeutic studies are in pre-clinical stages, highlighting the importance of further research and elucidation of the pathophysiology involving these genes. In this review, we aim to highlight the key molecular alterations and chromosomal changes that characterize AML, with a focus on pathophysiology, presently available treatment approaches, and future therapeutic options.
Therapeutic Application and Structural Features of Adeno-Associated Virus Vector
Authors: Matsuzaka Yasunari , Yashiro Ryu
Published: August 2024

Adeno-associated virus (AAV) is characterized by non-pathogenicity, long-term infection, and broad tropism and is actively developed as a vector virus for gene therapy products. AAV is classified into more than 100 serotypes based on differences in the amino acid sequence of the capsid protein. Endocytosis involves the uptake of viral particles by AAV and accessory receptors during AAV infection. After entry into the cell, they are transported to the nucleus through the nuclear pore complex. AAVs mainly use proteoglycans as receptors to enter cells, but the types of sugar chains in proteoglycans that have binding ability are different. Therefore, it is necessary to properly evaluate the primary structure of receptor proteins, such as amino acid sequences and post-translational modifications, including glycosylation, and the higher-order structure of proteins, such as the folding of the entire capsid structure and the three-dimensional (3D) structure of functional domains, to ensure the efficacy and safety of biopharmaceuticals. To further enhance safety, it is necessary to further improve the efficiency of gene transfer into target cells, reduce the amount of vector administered, and prevent infection of non-target cells.
New Oncologic Drugs from 2008 to 2023—Differences in Approval and Access between the United States, Europe and Brazil
Authors: Barreto Rafael Balsini , Izidoro Andressa Moretti , Miranda Mario Henrique Furlanetto
Published: August 2024

Introduction: Advancements in oncology have revolutionized cancer treatment, with new drugs being approved at different rates worldwide. Our objective was to evaluate the approval of new oncological drugs for solid tumors by the Food and Drug Administration (FDA), the European Medicines Agency (EMA), and the Brazilian Health Regulatory Agency (ANVISA) since 2008. Methods: Data were collected from public and online databases by searching for the date of submission, the date of the procedure, the date of approval, clinical indication, and drug characteristics. The distribution was tested using the Shapiro–Wilk, test and comparisons were made using the Mann–Whitney U test; the data are reported using median days and interquartile range (IQR1–IQR3). Results: In total, 104 new oncologic drugs for the treatment of solid tumors were approved by the three agencies: 98 by the FDA, 90 by the EMA, and 68 by ANVISA. The cancer types with the highest number of first indications were lung cancer (n = 24), breast cancer (n = 15), and melanoma (n = 15). Most approvals were for oral medications (n = 63) and tyrosine–kinase inhibitors or other small-molecule inhibitors (n = 54). Time to approval after submission was as follows: the FDA—224 days (167–285); the EMA—364 days (330–418); and ANVISA—403 days (276–636) (p < 0.00001 for the FDA to the EMA and the FDA to ANVISA). The difference between submission dates among the agencies was as follows: EMA–FDA: 24 days (0–85); ANVISA–FDA: 255 (114–632); and ANVISA–EMA: 260 (109–645). The difference in approval dates between the agencies was as follows: EMA–FDA: 185 days (59–319); ANVISA–FDA: 558 (278–957); and ANVISA–EMA: 435 days (158–918). Conclusions: New oncologic drugs are submitted to the FDA and EMA for approval on similar dates; however, the longer appraisal period by the EMA pushes the approval date for Europe to approximately 6 months later. The same steps at ANVISA delay the approval by 1.5 years. Such procedures cause a significant difference in available medications between these regions.