bluuebunny/crossref_metadata_2025 huggingface dataset:
Androgen Deprivation Therapy in Prostate Cancer: A Practical Approach to Complex Clinical Scenarios
Authors: Danks Rachel
Published: May 2024

Androgen deprivation therapy (ADT) has been a cornerstone in the treatment of advanced prostate cancer (PCa) for many years, and continues to form the basis of current therapeutic approaches. However, a recent dramatic upsurge in the number of treatment options available in this area creates a responsibility for healthcare professionals to carefully select optimal drugs and combinations of drugs, to ensure the best outcomes and greatest quality of life for all patients. This requires a thorough understanding of clinical trial data, and an ability to apply this knowledge to everyday clinical practice. This article summarises presentations delivered during a symposium held on 29ᵗʰ November 2023 at the Global Congress on Prostate Cancer (PROSCA) 2023 in Málaga, Spain, where three distinguished speakers described and explored practical approaches to the use of ADT in complex clinical scenarios. Nazareno Suardi, Associate Professor of Urology at the University of Brescia, Italy, described approaches to manage ADT prescription when a patient presents with cardiovascular (CV) risk factors. Matthias Saar, Director and Chairman of the Department of Urology and Uro-oncology at the University Hospital Aachen, Germany, explored whether intermittent ADT remains an alternative in the new era of hormonal therapy. Alison Birtle, Consultant Clinical Oncologist at the Rosemere Cancer Centre, Lancashire Teaching Hospitals NHS Trust, Preston, UK, investigated the importance of drug choice in triplet or doublet therapy in patients with metastatic hormone-sensitive PCa (mHSPC). The meeting was chaired by Antoni Vilaseca, Senior Specialist in the Urology Service at the Hospital Clinic, University of Barcelona, Spain, who introduced the symposium, and also co-ordinated a question and answer session to conclude the meeting.
The Role of Neutrophil/Lymphocyte Ratio in Ovarian Torsions
Authors: Büyük Musa , Karacar Büyük Nagihan , Suman Kamuran , Gök Ebru , Suman Murat , Kuşcu Havva
Published: May 2024

Aim: Ovarian torsion is among the gynecological emergencies. Laboratory and imaging methods are used for diagnosis. Symptoms are generally nonspecific, making it difficult to differentiate from other acute abdominal emergencies. This study aims to investigate the diagnostic value of neutrophil-lymphocyte ratio (NLR) in addition to imaging methods for the diagnosis of ovarian torsion.
Material and Methods: A total of 120 patients were included in the study. The study was planned retrospectively. The patients included in the study were analyzed in three different groups. Those with follicular cysts were in Group 1, those with simple cysts were in Group 2, and those with ovarian torsion were in Group 3. The groups were compared in terms of laboratory parameters and demographic characteristics.
Results: When the groups were compared in terms of mean age, it was found that the mean age of Group 3 was significantly lower than Group 1 (p
The Impact of the COVID-19 Pandemic on Urological Outpatient Patients
Authors: Başaranoğlu Mert , Erdem Erim , Akbay Erdem
Published: May 2024

Aim: This study aims to investigate the impact of the COVID-19 pandemic on patients' admission to the urology outpatient clinic. It aims to evaluate changes in the frequency and distribution of diagnosed diseases.
Material and Methods: Our study retrospectively examined patient records at the Mersin University Hospital Urology Clinic. The study period covers September 11, 2018, to September 11, 2021. Patient information, International Classification of Diseases (ICD-10) codes, age groups, and examination dates were obtained from the patient's files. Data of patients with duplicate records were not included in the study. Each code was analyzed as a separate data point for patients with multiple diagnosis codes.
Results: Following the detection of the pandemic in our country, a decrease of 12.52% in patient admissions to our urology clinic was observed during the 540 days. Furthermore, a significant reduction of 27.08% in newly diagnosed urology cases was identified. This decrease was observed across all disease groups except oncological diseases when overall admissions were evaluated. The general urology and andrology categories also followed a similar decrease in newly diagnosed cases. However, an increase in patient admissions was noted in the 25-34 and 35-54 age groups (p
The Impact of Pain in Individuals with Cerebral Palsy on Parents
Authors: Gözaçan Karabulut Demet , Tezcan Sezen
Published: May 2024

Aim: The aim of this study is to evaluate the pain seen in individuals with Cerebral Palsy (CP) and to investigate its impacts on the parents.
Material and Methods: The study included 66 individuals with Cerebral Palsy aged between 6-16, with a mean age of 8.83±3.17. The levels of the individuals included in the study were determined using the Gross Motor Function Classification System and the Manual Ability Classification System. The pain intensity of the individuals with Cerebral Palsy was assessed through a visual analog scale reported by the parents. The Impact on Family Scale was used to determine the state of the parents' impact.
Results: A significant positive correlation was found between the visual analog scale and sub-parameters of the Impact on Family Scale, excluding the coping parameter (p
Dekorsuz ve Dekorlu Akvaryumla Yapılan Balık Girişiminin Çocuklarda Ağrı, Kaygı ve Korku Üzerindeki Etkisi
Authors: Tuncay Suat , Sarman Abdullah
Published: May 2024

Amaç: Hastane veya sağlık hizmeti verilen yerlerde uygulanan intravenöz girişimler çocuklarda ağrı, kaygı ve korkuya neden olmaktadır. Bu çalışma pediatrik akut bakım ortamlarında dekorsuz ve dekorlu akvaryumla yapılan balık girişiminin çocuklarda ağrı, kaygı ve korku üzerindeki etkisini belirlemek amacıyla yapıldı.
Gereç ve Yöntemler: Günübirlik tedavi hizmetleri almak için hastaneye başvuruda bulunan 5-7 yaş grubu 120 çocuk blok randomizasyonla ağrı, kaygı ve korku düzeylerini belirlemek için 40 kişilik üç gruba (dekorlu balık, dekorsuz balık, kontrol) ayrıldı. Verilerinin toplanmasında Kişisel Bilgi Formu, Wong-Baker Ağrı Yüz Skalası, Çocuk Kaygı Ölçeği-Durumluluk ve Çocuk Korku Ölçeği kullanıldı. Değerlendirmeler; işlem öncesi-sırası-sonrası olarak yapıldı. Hemşirelik girişimi için Japon akvaryum balıkları kullanıldı. Veriler SPSS 26 paket programıyla değerlendirildi.
Bulgular: Dekorlu ve dekorsuz balık grubunun uygulama sırası ve sonrasında ağrı, kaygı ve korku seviyesi kontrol grubuyla karşılaştırıldığında önemli bir azalma oluştuğu belirlendi (p
Predictive Role of Hematological Markers on Pediatric Appendicitis: Still a Mystery
Authors: Öztürk Ayşe Betül , Kılıçaslan Cengizhan , Tuncer Sibel Çiğdem
Published: May 2024

Aim: The diagnosis of appendicitis may be challenging in the pediatric population. It can be very difficult to examine a child or to take a medical history. The role of laboratory findings is still unclear. Therefore, we aimed to evaluate the diagnostic value of hematological parameters such as white blood cell, neutrophil to eosinophil ratio, and neutrophil to lymphocyte ratio.
Material and Methods: We retrospectively analyzed patients who underwent surgery with suspected appendicitis between February 2018 and February 2020. Preoperative data were gathered from patient records. Histopathological assessment was accepted as the gold standard in the diagnosis of appendicitis.
Results: The study population consists of 368 patients with a mean age of 11.95±3.68 years, 56.25% (n=207) of whom were male. The pathological examination revealed that 63.6% (n=234) of the patients were acute appendicitis, 18.5% (n=68) phlegmonous, and 8.7% (n=32) perforated. White blood cells, neutrophil-eosinophil ratio, and neutrophil-lymphocyte ratio were not diagnostic in acute appendicitis. On the other hand, the same parameters are useful markers in differentiating phlegmonous and perforated appendicitis.
Conclusion: There is no established biomarker for acute appendicitis. Although the white blood cell count is a well-known parameter in scoring systems, it is not capable of guiding the surgeon. The neutrophil to eosinophil ratio may be a novel diagnostic index for phlegmonous and perforated appendicitis. Understanding whether a child is experiencing appendicitis is still a diagnostic challenge for the clinician. Although clinical symptoms, scoring systems, and imaging methods and laboratory tests are important in the diagnosis of appendicitis, there are not any specific markers helping the surgeon.
Çocukluk Çağı Konuşma Apraksisi (ÇÇKA) ve Gelişimsel Koordinasyon Bozukluğu (GKB)
Authors: Atila Çağlar Nazmiye , Noyan Erbaş Ayşın , Köse Ayşen
Published: May 2024

Çocukluk Çağı Konuşma Apraksisi (ÇÇKA) ve Gelişimsel Koordinasyon Bozukluğu (GKB) sıklıkla birlikte ortaya çıkabilen, pek çok ortak noktaları bulunan iki ayrı bozukluktur. Çocukluk çağı konuşma apraksisi; anormal refleksler, anormal tonus gibi nöromüsküler defisitlerin eşlik etmediği, konuşmanın temelini oluşturan hareketlerin doğruluğu ve tutarlılığındaki bozukluklar ile karakterize nörolojik bir konuşma sesi bozukluğudur. Gelişimsel Koordinasyon Bozukluğu ise çocuğun kronolojik yaşına göre beklentilerin altında motor koordinasyon göstermesi şeklinde tanımlanmaktadır. Çocukluk çağı konuşma apraksisi olan çocukların yaklaşık %85’i GKB kriterlerini karşılayabilmektedir. ÇÇKA tanılama, değerlendirme ve müdahale sürecinde birincil sorumlu uzmanlar olan dil ve konuşma terapistlerinin bu iki bozukluk hakkında bilgi sahibi olması, gerekli yönlendirmelerin ve erken müdahalenin yapılabilmesi için kritik öneme sahiptir. Bu nedenle bu derleme ile sıklıkla beraber görülebilen ÇÇKA ve GKB özelliklerini, benzerlikler ve farklılıklarını sunmak ve aynı zamanda uzmanlar arası iş birliğini vurgulamak amaçlanmaktadır.
THE RELATIONSHIP BETWEEN PARENTS' PRENATAL FETAL GENDER PREFERENCE AND PRENATAL ATTACHMENT: AN ANALYTICAL AND CROSS-SECTIONAL STUDY
Authors: Çitil Canbay Funda , Çitil Elif Tuğçe
Published: May 2024

This study aimed to determine the relationship between the fetal sex preferences of pregnant women and fathers and their prenatal levels of attachment to the fetus. This analytical and cross-sectional study was carried out with 152 married couples between 07/01/2022 and 02/01/2023. The study data were collected using information forms prepared for pregnant women and prospective fathers, the Maternal-Fetal Attachment Inventory (MFAI) for pregnant women, and the Paternal Antenatal Attachment Scale (PAAS) for prospective fathers. In the study, it was determined that attachment related to some individual and fetal sex characteristics of pregnant women and prospective fathers was correlated and that male fetal sex increased the levels of prenatal attachment in both pregnant women and prospective fathers (p
Relasi Sosial Etnis Tionghoa dan Pribumi di Pasar Lama Kota Tangerang
Authors: Utami Niken , Haryono Haryono , Kudus Wahid Abdul
Published: May 2024

Social life of a diverse society requires a sense of respect to different customs, customs, religion or anything else, so that a shared identity is created in which good relations are established between members of community. Society must be able to understand different characteristics of existing phenomena as a means of maintaining relationships and minimizing conflict. This research describes the social relations of Chinese and Indigenous communities in Pasar Lama, Tangerang City. This research uses a qualitative approach with descriptive methods. Data collection was carried out through interviews, observation and documentation. The informants in this research were Chinese and Indigenous people in Pasar Lama, Sukasari Village, Tangerang City selected based on purposive techniques. Data validity was checked using source and technical triangulations and then analyzed using data reduction, data presentation and conclusion drawing. The theory used is Stafford and Canary's Relational Maintenance Theory consisting of positivity, openness, assurances, sharing tasks, and social networks. The result of research show that the openness of interaction between Chinese and Indigenous communities has been going on for a relatively long time, and finally being able to create adjustments amidst differences in culture, religion, traditions and habits. Positivity manifested in Chinese and Indigenous people’s open attitude in Pasar Lama was ultimately able to create positive relationships, influence each other and work well because of the tolerance between the two groups so that conflict could be minimized. Security (guaranty) appears in personal social relationships, namely marriage between Chinese and Native couples. Task Division is manifested into individual participation in various social activities such as mutual cooperation, community service, or national holiday activities. Social networks can be seen in open interactions leading to the formation of unity between them, creating relationships that occur in all aspects of life, including social, cultural, economic and educational. The conclusion drawn is that relationship maintenance strategies are related to social relations that occur between individuals or groups. Relationship maintenance strategies are effective for maintaining and developing positive and stable relationships in people's lives.
Menggali Manfaat Sosial dan Manfaat Ekonomi dari Tradisi Rewang
Authors: Widiyawati Ari
Published: May 2024

The rewang tradition is a tradition of helping neighbors, friends, or family who have an event or celebration. This research aims to explore the sosial benefits and economic benefits of the rewang tradition in the Yosomulyo village community. Analyzed for this research using Peter M. Blau’s sosial exchange theory and this research used descriptive qualitative method. The result of the research show that rewang tradition provides many benefits to event owner rather than the cost of providing food and rewards for the para rewang. The sosial benefits of the rewang tradition are to establish of sosial relationships, increasing sosial solidarity, as a sosial capital, and acts of mutual assistance. The economic benefits of the rewang tradition are support for borrowing tools, reducing costs in organizing event, potential investment in merchandise, and investment in energy.
Assimetrias e Intensidades Tecnológicas no Diálogo entre o Pós-keynesianismo e o Pensamento Cepalino: algumas evidências empíricas
Authors: Fernandes Ladeira Thiago , Bittes Terra Fábio Henrique
Published: May 2024

A magnitude das assimetrias tecnológicas pode ser fator determinante para o padrão de crescimento desigual entre os países. Sendo esta uma importante dimensão da reflexão econômica heterodoxa no contexto dos modelos de crescimento restrito pelo balanço de pagamentos, é oportuna uma investigação a respeito da dinâmica do gap e do nível de intensidade tecnológico observado entre países do Norte e do Sul. Este é o esforço empreendido neste ensaio para a totalidade de países da América Latina e do Caribe. Partindo de um modelo de regressão linear para dados em painel, foi possível observar que a dinâmica temporal do nível médio de intensidade tecnológica dos países avaliados tende para um equilíbrio próximo da intensidade observada em países como Portugal e Nova Zelândia. Apesar disso, os valores encontrados situam-se distantes de países no topo da classificação estabelecida pelo Índice de Complexidade Econômica (ECI), indicando a necessidade de intervenções públicas para aprimorar as capacidades produtivas de cada país ao longo do tempo.
Impactos da Financeirização sobre a Inovação: Um estudo para as empresas não-financeiras brasileiras de capital aberto no período de 2010 a 2018
Authors: Limeira Bittencourt Jamille , Miranda Bernardo Pádua Jardim de , Maria de Matos Cirlene
Published: May 2024

Em nível empresarial a financeirização pode ser expressa pelo princípio de maximização da riqueza do acionista, pelo aumento das atividades financeiras e pelo endividamento. Ao direcionar recursos para estas três esferas, a financeirização pode reduzir sua disponibilidade para inovações. O objetivo deste artigo é estudar os impactos da financeirização sobre as inovações das empresas não-financeiras de capital aberto no Brasil entre 2010 e 2018. Para tanto foi estimado um painel dinâmico por meio do GMM-System utilizando dados contábeis e financeiros. Os resultados mostraram que a maximização da riqueza do acionista e o aumento do endividamento das empresas prejudicaram sua inovação.
Acceptability of community health worker and peer supported interventions for ethnic minorities with type 2 diabetes: a qualitative systematic review
Authors: Grant Vivene , Litchfield Ian
Published: May 2024

Objective

Ethnic minority groups in high income countries in North America, Europe, and elsewhere are disproportionately affected by T2DM with a higher risk of mortality and morbidity. The use of community health workers and peer supporters offer a way of ensuring the benefits of self-management support observed in the general population are shared by those in minoritized communities.

Materials and methods

The major databases were searched for existing qualitative evidence of participants’ experiences and perspectives of self-management support for type 2 diabetes delivered by community health workers and peer supporters (CHWPs) in ethnically minoritized populations. The data were analysed using Sekhon’s Theoretical Framework of Acceptability.

Results

The results are described within five domains of the framework of acceptability collapsed from seven for reasons of clarity and concision: Affective attitude described participants’ satisfaction with CHWPs delivering the intervention including the open, trusting relationships that developed in contrast to those with clinical providers. In considering Burden and Opportunity Costs, participants reflected on the impact of health, transport, and the responsibilities of work and childcare on their attendance, alongside a lack of resources necessary to maintain healthy diets and active lifestyles. In relation to Cultural Sensitivity participants appreciated the greater understanding of the specific cultural needs and challenges exhibited by CHWPs. The evidence related to Intervention Coherence indicated that participants responded positively to the practical and applied content, the range of teaching materials, and interactive practical sessions. Finally, in examining the impact of Effectiveness and Self-efficacy participants described how they changed a range of health-related behaviours, had more confidence in dealing with their condition and interacting with senior clinicians and benefitted from the social support of fellow participants and CHWPs.

Conclusion

Many of the same barriers around attendance and engagement with usual self-management support interventions delivered to general populations were observed, including lack of time and resource. However, the insight of CHWPs, their culturally-sensitive and specific strategies for self-management and their development of trusting relationships presented considerable advantages.
Risk stratification and survival time of patients with gram-negative bacillary pneumonia in the intensive care unit
Authors: Liao Qiu-Xia , Feng Zhi , Zhuo Hui-Chang , Zhou Ye , Huang Peng , Lin Hai-Rong
Published: May 2024

Introduction

Pneumonia is a common infection in the intensive care unit (ICU), and gram-negative bacilli are the most common bacterial cause. The purpose of the study was to investigate the risk factors for 30-day mortality in patients with gram-negative bacillary pneumonia in the ICU, construct a predictive model, and stratify patients based on risk to assess their short-term survival.

Methods

Patients admitted to the ICU with gram-negative bacillary pneumonia at Fujian Medical University Affiliated First Hospital between January 2018 and September 2020 were selected. Patients were divided into deceased and survivor groups based on whether death occurred within 30 days. Multifactorial logistic regression analysis was used to identify independent risk factors for 30-day mortality in these patients, and a predictive nomogram model was constructed based on these factors. Patients were categorized into low-, medium-, and high-risk groups according to the model's predicted probability, and Kaplan-Meier survival curves were plotted to assess short-term survival.

Results

The study included 305 patients. Lactic acid (odds ratio [OR], 1.524, 95% CI: 1.057-2.197), tracheal intubation (OR: 4.202, 95% CI: 1.092-16.169), and acute kidney injury (OR:4.776, 95% CI: 1.632-13.978) were identified as independent risk factors for 30-day mortality. A nomogram prediction model was established based on these three factors. Internal validation of the model showed a Hosmer-Lemeshow test result of X2=5.770, P=0.834, and an area under the ROC curve of 0.791 (95% CI: 0.688-0.893). Bootstrap resampling of the original data 1000 times yielded a C-index of 0.791, and a decision curve analysis indicated a high net benefit when the threshold probability was between 15%-90%. The survival time for low-, medium-, and high-risk patients was 30 (30, 30), 30 (16.5, 30), and 17 (11, 27) days, respectively, which were significantly different.

Conclusion

Lactic acid, tracheal intubation, and acute kidney injury were independent risk factors for 30-day mortality in patients in the ICU with gram-negative bacillary pneumonia. The predictive model constructed based on these factors showed good predictive performance and helped assess short-term survival, facilitating early intervention and treatment.
Improved cure rate of periprosthetic joint infection through targeted antibiotic therapy based on integrated pathogen diagnosis strategy
Authors: Wang Qijin , Chen Yongfa , Chen Yang , Lv Jianhua , Ding Haiqi , Huang Jiagu , Huang Jiexin , Huang Zida , Yang Bin , Zhang Wenming , Fang Xinyu
Published: May 2024

Objectives

This study aimed to determine whether combined of pathogen detection strategies, including specimen acquisition, culture conditions, and molecular diagnostics, can improve treatment outcomes in patients with periprosthetic joint infections (PJI).

Methods

This retrospective study included suspected PJI cases from three sequential stages at our institution: Stage A (July 2012 to June 2015), Stage B (July 2015 to June 2018), and Stage C (July 2018 to June 2021). Cases were categorized into PJI and aseptic failure (AF) groups based on European Bone and Joint Infection Society (EBJIS) criteria. Utilization of pathogen diagnostic strategies, pathogen detection rates, targeted antibiotic prescription rates, and treatment outcomes were analyzed and compared across the three stages.

Results

A total of 165 PJI cases and 38 AF cases were included in this study. With the progressive implementation of the three optimization approaches across stages A, B and C, pathogen detection rates exhibited a gradual increase (χ2 = 8.282, P=0.016). Similarly, utilization of targeted antibiotic therapy increased stepwise from 57.1% in Stage A, to 82.3% in Stage B, and to 84% in Stage C (χ2 = 9.515, P=0.009). The 2-year infection control rate exceeded 90% in both stages B and C, surpassing stage A (71.4%) (χ2 = 8.317, P=0.011). Combined application of all three optimized protocols yielded the highest sensitivity of 91.21% for pathogen detection, while retaining higher specificity of 92.11%.

Conclusion

The utilization of combined pathogen diagnostic strategies in PJI can increase pathogen detection rates, improve targeted antibiotic prescription, reduce the occurrence of antibiotic complications, and achieve better treatment outcomes.
Significance of extracellular vesicles in orchestration of immune responses in Mycobacterium tuberculosis infection
Authors: Alipoor Shamila D. , Elieh-Ali-Komi Daniel
Published: May 2024

Mycobacterium tuberculosis (M.tb), the causative agent of Tuberculosis, is an intracellular bacterium well known for its ability to subvert host energy and metabolic pathways to maintain its intracellular survival. For this purpose, the bacteria utilize various mechanisms of which extracellular vehicles (EVs) related mechanisms attracted more attention. EVs are nanosized particles that are released by almost all cell types containing active biomolecules from the cell of origin and can target bioactive pathways in the recipient cells upon uptake. It is hypothesized that M.tb dictates the processes of host EV biogenesis pathways, selectively incorporating its molecules into the host EV to direct immune responses in its favor. During infection with Mtb, both mycobacteria and host cells release EVs. The composition of these EVs varies over time, influenced by the physiological and nutritional state of the host environment. Additionally, different EV populations contribute differently to the pathogenesis of disease at various stages of illness participating in a complex interplay between host cells and pathogens. These interactions ultimately influence immune responses and disease outcomes. However, the precise mechanisms and roles of EVs in pathogenicity and disease outcomes remain to be fully elucidated. In this review, we explored the properties and function of EVs in the context of M.tb infection within the host microenvironment and discussed their capacity as a novel therapeutic strategy to combat tuberculosis.
Unlocking the potential of peatlands and paludiculture to achieve Germany’s climate targets: obstacles and major fields of action
Authors: Wichmann Sabine , Nordt Anke
Published: May 2024

Greenhouse gas emissions from drained peatlands must be substantially reduced to meet climate mitigation targets. In Germany, annual peatland emissions of 53 Mt CO2e account for more than 7% of total national GHG emissions. Peatland drainage and reclamation is traditionally considered as a symbol of progress and technical achievement, where agriculture has been the major driver. In Germany, an area of 1.3 million ha of drained peatlands used for agriculture ought to be rewetted by 2050 to meet the 1.5°C target of the Paris Agreement. Paludiculture allows a productive use of wet peatlands instead of abandonment following rewetting. This approach might therefore pave the way for voluntary large-scale peatland rewetting. However, implementation remains scarce. The long history and large extent of peatland drainage has shaped the political and legal framework as well as perceptions and attitudes, thus impeding rewetting and climate-friendly peatland use. This policy and practice review investigates the political, legal, economic and social aspects that hinder the implementation in Germany and derives approaches to overcome multifold restrictions. Finally, three major fields of action are identified: (1) To increase and accelerate rewetting, a consistent peatland mainstreaming approach is needed that overcomes structural barriers and adapts the policy and legal framework, e.g., the Common Agricultural Policy, planning law, water law and nature conservation law. (2) To motivate for a rapid transition, a system of immediate, comprehensive and attractive positive incentives is needed. This should be accompanied by early announcement and gradual introduction of negative incentives to set a clear course and provide planning certainty for farmers and landowners. (3) A just transition depends on empowering local communities to develop and pursue perspectives tailored to their peatland region. Future research of peatlands as social-ecological systems can help to identify region-specific drivers for sustainable peatland management.
Changes in the investigation and management of suspected myocardial infarction and injury during COVID-19: a multi-centre study using routinely collected healthcare data
Authors: Chammas Lara , Yuan Kevin , Little Stephanie , Roadknight Gail , Varnai Kinga A. , Chang Shing Chan , Sze Shirley , Davies Jim , Tsui Andrew , Salih Hizni , Glampson Ben , Papadimitriou Dimitri , Mulla Abdulrahim , Woods Kerrie , O’Gallagher Kevin , Shah Anoop D. , Williams Bryan , Asselbergs Folkert W. , Mayer Erik , Lee Richard , Herbert Christopher , Johnson Tom , Grant Stuart , Curzen Nick , Shah Ajay M. , Perera Divaka , Patel Riyaz S. , Channon Keith M. , Kaura Amit , Mayet Jamil , Eyre David W. , Squire Iain , Kharbanda Raj , Lewis Andrew , Wijesurendra Rohan S.
Published: May 2024

Objective

The COVID-19 pandemic was associated with a reduction in the incidence of myocardial infarction (MI) diagnosis, in part because patients were less likely to present to hospital. Whether changes in clinical decision making with respect to the investigation and management of patients with suspected MI also contributed to this phenomenon is unknown.

Methods

Multicentre retrospective cohort study in three UK centres contributing data to the National Institute for Health Research Health Informatics Collaborative. Patients presenting to the Emergency Department (ED) of these centres between 1st January 2020 and 1st September 2020 were included. Three time epochs within this period were defined based on the course of the first wave of the COVID-19 pandemic: pre-pandemic (epoch 1), lockdown (epoch 2), post-lockdown (epoch 3).

Results

During the study period, 10,670 unique patients attended the ED with chest pain or dyspnoea, of whom 6,928 were admitted. Despite fewer total ED attendances in epoch 2, patient presentations with dyspnoea were increased (p < 0.001), with greater likelihood of troponin testing in both chest pain (p = 0.001) and dyspnoea (p < 0.001). There was a dramatic reduction in elective and emergency cardiac procedures (both p < 0.001), and greater overall mortality of patients (p < 0.001), compared to the pre-pandemic period. Positive COVID-19 and/or troponin test results were associated with increased mortality (p < 0.001), though the temporal risk profile differed.

Conclusions

The first wave of the COVID-19 pandemic was associated with significant changes not just in presentation, but also the investigation, management, and outcomes of patients presenting with suspected myocardial injury or MI.
Enhancing public health in developing nations through smartphone-based motor assessment
Authors: Souza Givago Silva , Furtado Brena Karoline Ataíde , Almeida Edilson Brabo , Callegari Bianca , Pinheiro Maria da Conceição Nascimento
Published: May 2024

Several protocols for motor assessment have been validated for use on smartphones and could be employed by public healthcare systems to monitor motor functional losses in populations, particularly those with lower income levels. In addition to being cost-effective and widely distributed across populations of varying income levels, the use of smartphones in motor assessment offers a range of advantages that could be leveraged by governments, especially in developing and poorer countries. Some topics related to potential interventions should be considered by healthcare managers before initiating the implementation of such a digital intervention.
Comparison of balanced crystalloids versus normal saline in patients with diabetic ketoacidosis: a meta-analysis of randomized controlled trials
Authors: Liu Yuting , Zhang Jianfeng , Xu Xiaoya , Zou Xiaoyun
Published: May 2024

Purpose

The optimal resuscitative fluid for patients with diabetic ketoacidosis (DKA) remains controversial. Therefore, our objective was to assess the effect of balanced crystalloids in contrast to normal saline on clinical outcomes among patients with DKA.

Methods

We searched electronic databases for randomized controlled trials comparing balanced crystalloids versus normal saline in patients with DKA, the search period was from inception through October 20th, 2023. The outcomes were the time to resolution of DKA, major adverse kidney events, post-resuscitation chloride, and incidence of hypokalemia.

Results

Our meta-analysis encompassed 11 trials, incorporating a total of 753 patients with DKA. There was no significant difference between balanced crystalloids and normal saline group for the time to resolution of DKA (MD -1.49, 95%CI -4.29 to 1.31, P=0.30, I2 = 65%), major adverse kidney events (RR 0.88, 95%CI 0.58 to 1.34, P=0.56, I2 = 0%), and incidence of hypokalemia (RR 0.80, 95%CI 0.43 to 1.46, P=0.46, I2 = 56%). However, there was a significant reduction in the post-resuscitation chloride (MD -3.16, 95%CI -5.82 to -0.49, P=0.02, I2 = 73%) among patients received balanced crystalloids.

Conclusion

Among patients with DKA, the use of balanced crystalloids as compared to normal saline has no effect on the time to resolution of DKA, major adverse kidney events, and incidence of hypokalemia. However, the use of balanced crystalloids could reduce the post-resuscitation chloride.

Systematic review registration

https://osf.io, identifier c8f3d.
Impact of stress hyperglycemia ratio on mortality in patients with cardiac arrest: insight from American MIMIC-IV database
Authors: Lian Li-You , Xue Wei-Hao , Lu Jia-Jia , Zheng Ru-Jie
Published: May 2024

Background

Stress hyperglycemia ratio (SHR) has shown a predominant correlation with transient adverse events in critically ill patients. However, there remains a gap in comprehensive research regarding the association between SHR and mortality among patients experiencing cardiac arrest and admitted to the intensive care unit (ICU).

Methods

A total of 535 patients with their initial ICU admission suffered cardiac arrest, according to the American Medical Information Mart for Intensive Care (MIMIC)-IV database. Patients were stratified into four categories based on quantiles of SHR. Multivariable Cox regression models were used to evaluate the association SHR and mortality. The association between SHR and mortality was assessed using multivariable Cox regression models. Subgroup analyses were conducted to determine whether SHR influenced ICU, 1-year, and long-term all-cause mortality in subgroups stratified according to diabetes status.

Results

Patients with higher SHR, when compared to the reference quartile 1 group, exhibited a greater risk of ICU mortality (adjusted hazard ratio [aHR] = 3.029; 95% CI: 1.802-5.090), 1-year mortality (aHR = 3.057; 95% CI: 1.885-4.958), and long-term mortality (aHR = 3.183; 95% CI: 2.020-5.015). This association was particularly noteworthy among patients without diabetes, as indicated by subgroup analysis.

Conclusion

Elevated SHR was notably associated with heightened risks of ICU, 1-year, and long-term all-cause mortality among cardiac arrest patients. These findings underscore the importance of considering SHR as a potential prognostic factor in the critical care management of cardiac arrest patients, warranting further investigation and clinical attention.
Non-causal relationship of polycystic ovarian syndrome with homocysteine and B vitamins: evidence from a two-sample Mendelian randomization
Authors: Su Nianjun , Li Jinsheng , Xia Yubing , Huang Cuiyu , Chen Lei
Published: May 2024

Objective

Previous observational studies have identified a correlation between elevated plasma homocysteine (Hcy) levels and polycystic ovary syndrome (PCOS). This study aimed to determine whether a causal relationship exists between Hcy and PCOS at the genetic level.

Methods

A two-sample Mendelian Randomization (TSMR) study was implemented to assess the genetic impact of plasma levels of Hcy, folate, vitamin B12, and vitamin B6 on PCOS in individuals of European ancestry. Independent single nucleotide polymorphisms (SNPs) associated with Hcy (n=12), folate (n=2), vitamin B12 (n=10), and vitamin B6 (n=1) at genome-wide significance levels (P<5×10-8) were selected as instrumental variables (IVs). Data concerning PCOS were obtained from the Apollo database. The primary method of causal estimation was inverse variance weighting (IVW), complemented by sensitivity analyses to validate the results.

Results

The study found no genetic evidence to suggest a causal association between plasma levels of Hcy, folate, vitamin B12, vitamin B6, and PCOS. The effect sizes, determined through random-effect IVW, were as follows: Hcy per standard deviation increase, OR = 1.117, 95%CI: (0.842, 1.483), P = 0.442; folate per standard deviation increase, OR = 1.008, CI: (0.546, 1.860), P = 0.981; vitamin B12 per standard deviation increase, OR = 0.978, CI: (0.808, 1.185), P = 0.823; and vitamin B6 per standard deviation increase, OR = 0.967, CI: (0.925, 1.012), P = 0.145. The fixed-effect IVW results for each nutrient exposure and PCOS were consistent with the random-effect IVW findings, with additional sensitivity analyses reinforcing these outcomes.

Conclusion

Our findings indicate no causal link between Hcy, folate, vitamin B12, vitamin B6 levels, and PCOS.
Causal association between type 2 diabetes mellitus and acute suppurative otitis media: insights from a univariate and multivariate Mendelian randomization study
Authors: Kui Lihong , Dong Cheng , Wu Junyu , Zhuo Feinan , Yan Bin , Wang Zhewei , Yang Meiling , Xiong Canhai , Qiu Peng
Published: May 2024

Background

Type 2 diabetes mellitus (T2DM) and hearing loss (HL) constitute significant public health challenges worldwide. Recently, the association between T2DM and HL has aroused attention. However, possible residual confounding factors and other biases inherent to observational study designs make this association undetermined. In this study, we performed univariate and multivariable Mendelian Randomization (MR) analysis to elucidate the causal association between T2DM and common hearing disorders that lead to HL.

Methods

Our study employed univariate and multivariable MR analyses, with the Inverse Variance Weighted method as the primary approach to assessing the potential causal association between T2DM and hearing disorders. We selected 164 and 9 genetic variants representing T2DM from the NHGRI-EBI and DIAGRAM consortium, respectively. Summary-level data for 10 hearing disorders were obtained from over 500,000 participants in the FinnGen consortium and MRC-IEU. Sensitivity analysis revealed no significant heterogeneity of instrumental variables or pleiotropy was detected.

Results

In univariate MR analysis, genetically predicted T2DM from both sources was associated with an increased risk of acute suppurative otitis media (ASOM) (In NHGRI-EBI: OR = 1.07, 95% CI: 1.02-1.13, P = 0.012; In DIAGRAM: OR = 1.14, 95% CI: 1.02-1.26, P = 0.016). Multivariable MR analysis, adjusting for genetically predicted sleep duration, alcohol consumption, body mass index, and smoking, either individually or collectively, maintained these associations. Sensitivity analyses confirmed the robustness of the results.

Conclusion

T2DM was associated with an increased risk of ASOM. Strict glycemic control is essential for the minimization of the effects of T2DM on ASOM.
Exploring the causal relationships between rheumatoid arthritis and oral phenotypes: a genetic correlation and Mendelian randomization study
Authors: Shen Jindan , Lou Yimei , Zhang Liping
Published: May 2024

Background

Rheumatoid arthritis (RA) frequently presents with oral manifestations, including gingival inflammation, loose teeth, and mouth ulcers; however, the causal connections between these conditions remain unclear. This study aims to explore the genetic correlations and causal relationships between RA and prevalent oral phenotypes.

Methods

Using summary data from genome-wide association studies of European populations, a cross-trait linkage disequilibrium score regression was conducted to estimate the genetic correlations between RA and six oral phenotypes. Subsequently, a two-sample Mendelian randomization (MR) approach was employed to assess the causal relationships, corroborated by various sensitivity analyses. Heterogeneity was addressed through the RadialMR method, while potential covariates were corrected using the multivariable MR approach.

Results

A significant negative genetic correlation was detected between RA and denture usage (rg = −0.192, p = 4.88 × 10−8). Meanwhile, a heterogenous causal relationship between RA and mouth ulcers was observed (OR = 1.027 [1.005–1.05], p = 0.016, Pheterogeneity = 4.69 × 10−8), which remained robust across sensitivity analyses. After excluding outlier variants, the results demonstrated robustly consistent (OR = 1.021 [1.008–1.035], p = 1.99 × 10−3, Pheterogeneity = 0.044). However, upon adjusting for covariates such as smoking, alcohol consumption, body mass index, and obesity, the significance diminished, revealing no evidence to support independent genetic associations.

Conclusion

Genetically predicted RA increases the risk of mouth ulcers, and a negative genetic correlation is identified between RA and denture use. The observed heterogeneity suggests that shared immunological mechanisms and environmental factors may play significant roles. These findings highlight the importance of targeted dental management strategies for RA patients. Further clinical guidelines are required to improve oral health among vulnerable RA patients.
Genetically predicted major depression causally increases the risk of temporomandibular joint disorders
Authors: Wu Shiqian , Chen Zhuo , Zhao Yawen , He Qiang , Yin Zhongxiu , Yao Hailiang , Liu Huili , Yan Lihui
Published: May 2024

Objective

Observational studies have reported that mental disorders are comorbid with temporomandibular joint disorder (TMD). However, the causal relationship remains uncertain. To clarify the causal relationship between three common mental illnesses and TMD, we conduct this Mendelian Randomization (MR) study.

Methods

The large-scale genome-wide association studies data of major depression, bipolar disorder and schizophrenia were retrieved from the Psychiatric Genomics Consortium. The summary data of TMD was obtained from the Finn-Gen consortium, including 211,023 subjects of European descent (5,668 cases and 205,355 controls). The main approach utilized was inverse variance weighting (IVW) to evaluate the causal association between the three mental disorders and TMD. Five sensitivity analyses including MR-Egger, Maximum Likelihood, Weighted median, MR. RAPS and MR-PRESSO were used as supplements. We conducted heterogeneity tests and pleiotropic tests to ensure the robustness.

Results

As shown by the IVW method, genetically determined major depression was associated with a 1.65-fold risk of TMD (95% CI = 1.10–2.47, p < 0.05). The direction and effect size remained consistent with sensitivity analyses. The odds ratios (ORs) were 1.51 (95% CI = 0.24–9.41, p > 0.05) for MR-Egger, 1.60 (95% CI = 0.98–2.61, p > 0.05) for Weighted median, 1.68 (95% CI = 1.19–2.38, p < 0.05) for Maximum likelihood, 1.56 (95% CI = 1.05–2.33, p < 0.05) for MR. RAPS, and 1.65 (95% CI = 1.10–2.47, p < 0.05) for MR-PRESSO, respectively. No pleiotropy was observed (both P for MR-Egger intercept and Global test >0.05). In addition, the IVW method identified no significant correlation between bipolar disorder, schizophrenia and TMD.

Conclusion

Genetic evidence supports a causal relationship between major depression and TMD, instead of bipolar disorder and schizophrenia. These findings emphasize the importance of assessing a patient’s depressive status in clinical settings.
Advances in non-coding RNA in tendon injuries
Authors: Wang Bin , Chen Qiang , Zou Xiaodi , Zheng Ping , Zhu Jie
Published: May 2024

Tendons serve as important weight-bearing structures that smoothly transfer forces from muscles to skeletal parts, allowing contracted muscle movements to be translated into corresponding joint movements. For body mechanics, tendon tissue plays an important role. If the tendons are damaged to varying degrees, it can lead to disability or pain in patients. That is to say, tendon injuries havea significant impact on quality of life and deserve our high attention. Compared to other musculoskeletal tissues, tendons are hypovascular and hypo-cellular, and therefore have a greater ability to heal, this will lead to a longer recovery period after injury or even disability, which will significantly affect the quality of life. There are many causes of tendon injury, including trauma, genetic factors, inflammation, aging, and long-term overuse, and the study of related mechanisms is of great significance. Currently, tendon there are different treatment modalities, like injection therapy and surgical interventions. However, they have a high failure rate due to different reasons, among which the formation of adhesions severely weakens the tissue strength, affecting the functional recovery and the patient’s quality of life. A large amount of data has shown that non coding RNAs can play a huge role in this field, thus attracting widespread attention from researchers from various countries. This review summarizes the relevant research progress on non-coding RNAs in tendon injuries, providing new ideas for a deeper understanding of tendon injuries and exploring new diagnostic and therapeutic approaches.
Association between protein intake, serum albumin and blood eosinophil in US asthmatic adults
Authors: Wen Jun , Xia Jing , He Qingliu , Giri Mohan , Guo Shuliang
Published: May 2024

Background

Presently, numerous studies have indicated that protein consumption and levels of blood albumin serve as important biomarkers for a range of respiratory illnesses. However, there have been few investigations into the correlation between protein consumption, serum albumin, and asthma.

Methods

Our analysis incorporated 2509 asthmatics from the 2011–2018 NHANES dataset. The investigation employed three linear regression models and XGBoost model to investigate the potential link between protein intake, serum albumin levels, and blood eosinophil counts (BEOC) in patients with asthma. The trend test, generalized additive model (GAM), and threshold effect model were utilized to validate this correlation. As well, we undertook stratified analyses to look at the correlation of serum albumin with BEOC among distinct populations.

Results

In the univariable regression model, which did not account for any covariates, we observed a positive correlation between protein intake and BEOC. However, univariable and multivariable regression analyses all suggested a negative connection of serum albumin with BEOC in asthma populations. In Model C, which took into account all possible factors, BEOC dropped by 2.82 cells/uL for every unit increase in serum albumin (g/L). Additionally, the GAM and threshold effect model validated that serum albumin and BEOC showed an inverted U-shaped correlation.

Conclusion

Our investigation discovered there was no independent link between asthmatics’ protein intake and BEOC. However, we observed an inverted U-shaped relationship between serum albumin levels and BEOC, suggesting a possible relationship between the overall nutritional status of asthmatics and immune system changes. Our findings provide new directions for future research in the field of asthma management and therapy.