bluuebunny/crossref_metadata_2025 huggingface dataset:
Chlorogenic acid in green bean coffee on body weight: a systematic review and meta-analysis of randomized controlled trials
Authors: Kanchanasurakit Sukrit , Saokaew Surasak , Phisalprapa Pochamana , Duangjai Acharaporn
Published: September 2023

Background

Supplemental green bean coffee extract (GBCE) with caffeine has been shown to prevent weight gain. There are different dosages of GBCE that contain chlorogenic acid (CGA), and the data for their effectiveness in preventing weight gain (500 mg/day) is currently out of date. To better understand the effects of GBCE containing CGA on body weight, the present study sets out to perform a systematic review and meta-analysis of these studies.

Methods

Using electronic databases, including Scopus, Embase, PubMed, and Cochrane Library databases, literature was searched up to October 13, 2022. For the meta-analysis examining the impact of GBCE containing CGA (500 mg/day) on body weight with a random-effects model, the randomized controlled trials (RCTs) were considered. We calculated weighted mean differences and 95% confidence intervals (CIs). To gauge study heterogeneity, the Cochran Q statistic and I-squared tests (I2) were employed.

Results

The meta-analysis includes three RCTs with 103 individuals (case = 51, control = 52). The combined findings of GBCE with CGA at least 500 mg/day result in body weight reduction (WMD: − 1.30 and 95% CI: − 2.07 to − 0.52, p = 0.001) without study heterogeneity (I2 = 0%, p = 0.904) and without publication bias estimated using Egger’s and Begger’s test (p = 0.752 and p = 0.602, respectively).

Conclusions

According to the meta-analysis, GBCE with CGA 500 mg/day lowers body weight. Nevertheless, despite its limited sample size and short-term study, this study was successful. Long-term research on the effectiveness and safety of GBCE and CGA on body weight require more clinical trials.

Systematic review registration

PROSPERO CRD42021254916.
Implementing AIRM: a new AI recruiting model for the Saudi Arabia labour market
Authors: Aleisa Monirah Ali , Beloff Natalia , White Martin
Published: September 2023

One of the goals of Saudi Vision 2030 is to keep the unemployment rate at the lowest level to empower the economy. Prior research has shown that an increase in unemployment has a negative effect on a country’s Gross Domestic Product (GDP). This paper aims to utilise cutting-edge technology such as Data Lake (DL), Machine Learning (ML) and Artificial Intelligence (AI) to assist the Saudi labour market by matching job seekers with vacant positions. Currently, human experts carry out this process; however, this is time-consuming and labour-intensive. Moreover, in the Saudi labour market, this process does not use a cohesive data centre to monitor, integrate or analyse labour-market data, resulting in several inefficiencies, such as bias and latency. These inefficiencies arise from a lack of technologies and, more importantly, from having an open labour-market without a national data centre. This paper proposes a new AI Recruiting Model (AIRM) architecture that exploits DLs, ML and AI to rapidly and efficiently match job seekers to vacant positions in the Saudi labour market. A Minimum Viable Product (MVP) is employed to test the proposed AIRM architecture using a labour market dataset simulation corpus for training purposes; the architecture is further evaluated against three research collaborators who are all professionals in Human Resources (HR). As this research is data-driven in nature, it requires collaboration from domain experts. The first layer of the AIRM architecture uses balanced iterative reducing and clustering using hierarchies (BIRCH) as a clustering algorithm for the initial screening layer. The mapping layer uses sentence transformers with a robustly optimised BERT pre-training approach (RoBERTa) as the base model, and ranking is carried out using the Facebook AI Similarity Search (FAISS). Finally, the preferences layer takes the user’s preferences as a list and sorts the results using the pre-trained cross-encoders model, considering the weight of the more important words. This new AIRM has yielded favourable outcomes: This research considered accepting an AIRM selection ratified by at least one HR expert to account for the subjective character of the selection process when exclusively handled by human HR experts. The research evaluated the AIRM using two metrics: accuracy and time. The AIRM had an overall matching accuracy of 84%, with at least one expert agreeing with the system’s output. Furthermore, it completed the task in 2.4 min, whereas human experts took more than 6 days on average. Overall, the AIRM outperforms humans in task execution, making it useful in pre-selecting a group of applicants and positions. The AIRM is not limited to government services. It can also help any commercial business that uses Big Data.
Blood urea nitrogen to creatinine ratio and long-term survival in patients with chronic heart failure
Authors: Wang Yajiao , Xu Xia , Shi Shuqing , Gao Xiya , Li Yumeng , Wu Huaqin , Song Qingqiao , Zhang Bingxuan
Published: September 2023

Objectives

To explore the correlation between Blood urea nitrogen to creatinine ratio (BUN/Scr ratio) and prognosis of patients with chronic heart failure complicated with renal injury.

Methods

A retrospective analysis of 504 patients hospitalized in Guang 'anmen Hospital, Chinese Academy of Traditional Chinese Medicine from March 2006 to June 2014 was conducted. The baseline data were analyzed, and the cutoff value was obtained by receiver operator characteristic curve (ROC) analysis, according to the cutoff value, all the participants were divided into two groups, BUN/Scr < 19.37 group (280 cases) and BUN/Scr ≥ 19.37 group (224 cases). The main end point was defined as all-cause death. The long-term mortality of the two groups was evaluated, and Kaplan–Meier survival curve was drawn. Univariate analysis was performed on all the variables affecting the patient's prognosis, and the variables with P < 0.05 were put into Cox regression model, and subgroup analysis was performed on the variables that might affect the patient’s prognosis.

Results

The baseline data of 504 patients were analyzed and found that the median follow up was 683. Through ROC analysis of 504 subjects, the cutoff value of BUN/Scr was 19.37. The results of Kaplan–Meier survival curve showed that the mortality rate of patients with ratio ≥ 19.37 was higher than that of patients with ratio < 19.37. After multivariate analysis, COX regression model showed that the mortality of patients with BUN/Scr ≥ 19.37 was 1.885 times that of patients with BUN/Scr < 19.37 [HR = 1.885 (1.298–2.737), P = 0.001]. Subgroup analysis showed that the relationship between BUN/Scr and the prognosis of CHF was influenced by NYHA and eGRF (P < 0.05).

Conclusions

BUN/Scr ratio is related to the poor prognosis of patients with CHF, and is an independent predictor of all-cause death.
A feminist approach to eating disorders in China: a qualitative study
Authors: Holmes Su , Ma Hua
Published: September 2023

Background

As women continue to be more at risk from eating disorders, gender has often been a focus of concern in transcultural research. Yet feminist, qualitative studies which prioritize the voices of women/girls remain rare within transcultural work suggesting the need for greater interaction between these fields. This article seeks to contribute to the exploration of the applicability of feminist paradigmslargely developed in the West—to experiences of EDs in non-western contexts.

Methods

This article draws on semi-structured interviews with 12 women from urban China with self-reported experience of Bulimia Nervosa (BN) and binge eating disorder (BED) in order to explore the complex ways in which gender may be implicated within eating/body distress from a transcultural point of view. The data is analysed through Reflexive Thematic Analysis.

Results

The data analysis suggested two broad themes: (1) Chinese versus Western codes for judging female appearance: from surveillance to liberation (2) Discipline, appetite and control: the gendered/cultural meanings of binging and purging. In terms of the first theme, many participants had spent time in the West which was understood as a less regulated context in terms of gendered body surveillance and eating. Complicating existing assumptions about the ‘Westernisation’ thesis, different communication codes and peer interactions across Chinese and Western contexts played a central role in how participants experienced their bodies. In the second theme, binging and purging emerged as a way to manage a number of contradictions surrounding Chinese femininity, including respecting familial food cultures, contradictory discourses on female ‘appetite’, and the need to display a female body which signified cultural imperatives of self-restraint and discipline.

Conclusions

The data emphasises the importance of examining the culturally specific meanings of eating problems and their gendered contexts, whilst there is clearly much that echoes Western feminist work on Western samples. Although limited, the study crucially points to the importance of examining how ED subcategories other than AN can be explored from a transcultural and feminist point of view.
Pharmacists' knowledge of drug food administration and their appropriate patient counseling a cross-sectional study from Palestine
Authors: Abualhasan Murad , Tahan Shahd , Nassar Roa’a , Damere Maysoon , Salameh Hadeel , Zyoud Hiba
Published: September 2023

Pharmacists have a responsibility in the treatment of patients. Interactions between food and drugs may lead to a loss of therapeutic effectiveness or drug toxicity. Our study's objectives were to assess pharmacists' knowledge of patient counseling with regard to informing the patient about taking the drug in relation to food, as well as community pharmacists' knowledge of any pharmaceutical instructions that must be given to patients when delivering the drug. The pharmacists were assessed using an interview questionnaire. The results showed a variation in the pharmacist's knowledge about the administration of the drug with food. The chief pharmacists had better knowledge of the proper food administration counseling than that of assistant pharmacists; the percentage of those who did not give the proper food counseling was 24 vs. 58%, respectively (P < 0.05). Only (21%) of pharmacists with more work experience provided proper counseling, while only 18.2 and 18.7% of pharmacists with moderate and low work experience provided proper counseling, respectively. The study showed the pharmacists’ limited knowledge of drug administration with food and outdated counseling information. It is highly recommended that a continuous education system be encouraged and enforced by the ministry of health to update pharmacist’s knowledge of dispensed drugs.
Seismic attribute analysis with a combination of convolutional autoencoder and random forest in a turbidite reservoir
Authors: Wang Qiannan , Wang Zhiguo , Gao Dengliang , Gao Zhaoqi , Jia Junxiong , Zhu Jianbing , Gao Jinghuai
Published: September 2023

Due to the complex depositional environment of a turbidite reservoir in the Niuzhuang Delta, China, the traditional seismic facies classification is a challenge to perform accurately and continuously. Due to the thin turbidite layers in the reservoir, machine-learning-based prediction of sandstone thickness is challenging. Inspired by the autoencoder, we develop an open-source deep-learning workflow that combines unsupervised and supervised learning with jointed latent eigenvalues of the convolutional autoencoder (CAE) and traditional seismic attributes for seismic facies classification and sandstone thickness prediction constrained by the facies distribution. First, we extract lower-dimensional latent eigenvalues as a category of novel seismic attributes from the seismic data using a CAE. To accurately and effectively extract lower-dimensional latent eigenvalues, we develop a hybrid loss function based on the mean-squared error loss and the smooth L1 loss in this CAE. Then, we use principal component (PC) analysis to extract the first four PCs of these seismic lower-dimensional latent eigenvalues. Using unsupervised K-means, we cluster the first four PCs to form seismic facies. Finally, we take the first four PCs with the traditional seismic attributes as input and the sandstone thickness as labels for the random forest to predict the sandstone thickness distribution. The results of seismic facies and sandstone thickness distribution confirm the potential and advantages of our workflow, which can speed up the identification of seismic facies with smoother boundaries, improve the prediction accuracy by 16% over than that of traditional seismic attributes, and provide more depositional insight for a turbidite reservoir of the Shahejie Formation in the Niuzhuang Delta, China.
Deep learning with soft attention mechanism for small-scale ground roll attenuation
Authors: Yang Liuqing , Fomel Sergey , Wang Shoudong , Chen Xiaohong , Chen Yangkang
Published: September 2023

Ground roll is a type of coherent noise with low frequency, low velocity, and high amplitude, which masks useful signals and decreases the quality of subsequent seismic data processing. It is a challenge for traditional signal processing methods to separate useful signals effectively when the ground roll and useful reflected signals overlap seriously in the low-frequency band. We develop a supervised-learning-based framework with soft attention residual learning mechanisms for suppressing the ground roll noise. To reduce the cost of manual labeling, the 2D patching technique is used to segment large-scale seismic data into a large number of small-scale patches for training. Our network includes a multibranch attention block that uses multiple branches with different kernel sizes to extract waveform features at different scales from input noisy patches. Then, we use the soft attention mechanism to select and fuse the feature maps of different branches. Our network can achieve encouraging ground roll attenuation performance by using a small number of training samples, which is demonstrated by synthetic and field data examples. Compared with one traditional method and two advanced deep-learning frameworks, our network has better abilities in preserving low-frequency useful signals and removing ground roll.
Computational pathology–based HER2 quantification to identify novel biomarkers in gastric cancer (GC).
Authors: Kapil Ansh , Failmezger Henrik , Spitzmüller Andreas , Chan Jessica , Haneder Susanne , Shumilov Anatoliy , Barkell Alice , Oguma Toshihiro , Inaki Koichiro , Suto Fumitaka , Allard John , Lee Jeeyun , Barrett J Carl , Schmidt Günter , Sade Hadassah , Carroll Danielle , Cecchi Fabiola
Published: September 2023

449

Background: Trastuzumab deruxtecan (T-DXd) is an antibody-drug conjugate (ADC) approved for treatment of HER2-positive GC/gastroesophageal junction adenocarcinoma (GEJA) after chemotherapy (Japan) and for advanced/metastatic GC/GEJA after a trastuzumab-containing regimen (US/Israel/Singapore). Conventional HER2 immunohistochemistry (IHC) scoring identifies potential responders to trastuzumab but may not be suitable for next-generation ADCs capable of bystander killing, such as T-DXd [Modi NEJM 2022]. Use of computational pathology–based tools enables precise and accurate quantification of HER2 expression and spatial analysis, which enables design of better scores to reflect the T-DXd mechanism of action. Methods: Quantitative continuous scoring (QCS) was performed to quantify HER2 expression and distribution per cell in digitized images of HER2-stained (IHC, Ventana 4B5) GC. A QCS-derived signature was identified, called the continuous spatial proximity score (cSPS), which considers spatial location of tumor cells in addition to HER2 expression level and can be used as a surrogate for potential bystander activity. We retrospectively stratified patients in DESTINY-Gastric01 (DG-01; NCT03329690; T-DXd arm: n=123a; standard of care [SOC] arm: n=59a) using cSPS to give a binary QCS biomarker positive (BM+) or negative (BM−) status. QCS cSPS signature was independently validated on the DESTINY-Gastric02 cohort (DG-02; NCT04014075; n=71a). Results: In the DG-01 cohort, enrolled per HER2-positive status by IHC using ASCO/CAP GC scoring guidelines, median progression-free survival (mPFS) was 5.5a mo with T-DXd and 2.8a mo with SOC. QCS-derived cSPS scores showed significant survival benefit for BM+ vs BM− in the DG-01 T-DXd arm ( P<0.0001; HR=0.37 [0.24-0.58]) and longer mPFS for BM+ (8.3 mo) vs BM− (3.9 mo). Within the SOC arm, this signature showed the inverse prognosis ( P=0.034; HR=2.17 [1.06-4.44]; mPFS, 2.8 mo for BM+ vs 4.9 mo for BM−), strongly suggesting the signature is predictive of T-DXd response. This signature was validated in the DG-02 cohort (mPFS, 5.5 mo on enrollment by IHC status, 10.1 mo for BM+ vs 3.7 mo for BM−; HR=0.24 [0.13-0.45]; P<0.0001). Conclusions: We established QCS, a novel scoring method for tissue biomarkers. Our validated data and results support possible future use of this quantitative approach against manual scoring for identification of patients with GC who may benefit from T-DXd therapy. Clinical trial information: NCT03329690 , NCT04014075 . [Table: see text]
Prevalence, Risk Factors, and Clinical and Biochemical Characteristics of Alemtuzumab-Induced Graves Disease
Authors: Ueland Grethe Åstrøm , Ueland Hans Olav , Stokland Ann-Elin Meling , Bhan Alok , Schønberg Anne , Sollid Stina T , Morgas Dina Edvarda , Holmøy Trygve , Lima Kari , Methlie Paal , Løvås Kristian , Torkildsen Øivind , Husebye Eystein S
Published: September 2023

Objective

Atypical Graves disease (GD) is a common complication in multiple sclerosis (MS) patients treated with alemtuzumab. We present epidemiological, clinical, and biochemical characteristics of alemtuzumab-induced GD.

Methods

Retrospective follow-up study of MS patients treated with alemtuzumab from 2014 to 2020, including clinical course of GD, pregnancy outcome, and thyroid eye disease (TED).

Results

We enrolled 183 of 203 patients (90%, 68% women) treated with alemtuzumab at 4 hospitals in Norway. Seventy-five (41%) developed thyroid dysfunction, of whom 58 (77%) had GD. Median time from the first dose of alemtuzumab to GD diagnosis was 25 months (range, 0-64). Twenty-four of 58 GD patients (41%) had alternating phases of hyper- and hypothyroidism. Thyrotropin receptor antibodies became undetectable in 23 of 58 (40%) and they could discontinue antithyroid drug treatment after a median of 22 (range, 2-58) months. Conversely, 26 (44%) had active disease during a median follow-up of 39 months (range, 11-72). Two patients (3%) received definitive treatment with radioiodine, 6 (10%) with thyroidectomy. Nine developed TED (16%), 7 had mild and 2 moderate to severe disease. Four patients completed pregnancy, all without maternal or fetal complications. Patients who developed GD had a lower frequency of new MS relapses and MRI lesions than those without.

Conclusion

GD is a very common complication of alemtuzumab treatment and is characterized by alternating hyper- and hypothyroidism. Both remission rates and the prevalence of TED were lower than those reported for conventional GD. Pregnancies were uncomplicated and GD was associated with a lower risk of subsequent MS activity.
Ropinirole for the Treatment of Hyperprolactinemia: A Dose-Escalation Study of Efficacy and Tolerability
Authors: Heneghan Liam J , Tsang Amanda , Dimino Cara , Khandji Alexander G , Panigrahi Sunil K , Page-Wilson Gabrielle
Published: September 2023

Context

Treatment of hyperprolactinemia with ergoline dopamine agonists (DAs) can be complicated by intolerance and resistance.

Objective

This study examines the efficacy and tolerability of the nonergot DA ropinirole for the long-term treatment of hyperprolactinemia.

Methods

Twelve hyperprolactinemic women were treated with ropinirole in a 6-month, open-label, dose-escalation trial; 7 of the 12 continued treatment in an extension study for up to 17 months. Ropinirole doses were uptitrated to achieve normal prolactin (PRL) levels, restore menses, and eliminate galactorrhea.

Results

Two of the 12 participants were DA naive; 6 of 12 were ergot DA intolerant; and 1 of 12 had known ergot DA resistance. Baseline PRL levels were 126.2 ± 41.4 ng/mL (SEM). Ropinirole was uptitrated from 0.125 to 0.25 mg/h to a median total daily dose (TDD) of 2 mg/d (1-4 mg/d [interquartile range]). PRL normalization was achieved in 50% of the participants (5 with microadenomas and 1 with idiopathic hyperprolactinemia) at a median effective TDD of 1 mg/d. Of the patients achieving PRL normalization, 83% were ergot DA intolerant. A persistent partial biochemical response (PRL reduction >50% from baseline) was achieved in 17% of the participants. During treatment, menses resumed in 67% of amenorrheic patients; galactorrhea resolved in 67%. Mild adverse effects were reported in 92% of participants; however, ropinirole was not discontinued because of intolerance even among the 50% of individuals with a prior history of ergot DA intolerance and resultant medication discontinuation.

Conclusion

These data demonstrate the efficacy and tolerability of ropinirole for the treatment of hyperprolactinemia in patients with microprolactinomas and idiopathic hyperprolactinemia and suggest ropinirole may represent a novel therapeutic alternative for treating hyperprolactinemic disorders in patients with ergot DA intolerance.
Comparative Effectiveness of Therapeutic Interventions in Pregnancy and Lactation-Associated Osteoporosis: A Systematic Review and Meta-analysis
Authors: Anagnostis Panagiotis , Lampropoulou-Adamidou Kalliopi , Bosdou Julia K , Trovas Georgios , Galanis Petros , Chronopoulos Efstathios , Goulis Dimitrios G , Tournis Symeon
Published: September 2023

Context

The optimal management of pregnancy and lactation-associated osteoporosis (PLO) has not been designated.

Objective

To systematically review the best available evidence regarding the effect of different therapeutic interventions on bone mineral density (BMD) and risk of fractures in these patients.

Methods

A comprehensive search was conducted in PubMed/Scopus databases until December 20, 2022. Data were expressed as weighted mean difference (WMD) with 95% CI. The I2 index was employed for heterogeneity. Studies conducted in women with PLO who received any antiosteoporosis therapy were included. Studies including women with secondary causes of osteoporosis or with transient osteoporosis of the hip were excluded. Data extraction was independently completed by 2 researchers.

Results

Sixty-six studies were included in the qualitative analysis (n = 451 [follow-up time range 6-264 months; age range 19-42 years]). The increase in lumbar spine (LS) BMD with calcium/vitamin D (CaD), bisphosphonates, and teriparatide was 2.0% to 7.5%, 5.0% to 41.5%, and 8.0% to 24.4% at 12 months, and 11.0% to 12.2%, 10.2% to 171.9%, and 24.1% to 32.9% at 24 months, respectively. Femoral neck (FN) BMD increased by 6.1% with CaD, and by 0.7% to 18% and 8.4% to 18.6% with bisphosphonates and teriparatide (18-24 months), respectively. Meta-analysis was performed for 2 interventional studies only. Teriparatide induced a greater increase in LS and FN BMD than CaD (WMD 11.5%, 95% CI 4.9-18.0%, I2 50.9%, and 5.4%, 95% CI 1.2-9.6%, I2 8.1%, respectively).

Conclusion

Due to high heterogeneity and lack of robust comparative data, no safe conclusions can be made regarding the optimal therapeutic intervention in women with PLO.
Regulation of the Cortisol Axis, Glucagon, and Growth Hormone by Glucose Is Altered in Prediabetes and Type 2 Diabetes
Authors: Lundqvist Martin H , Pereira Maria J , Almby Kristina , Hetty Susanne , Eriksson Jan W
Published: September 2023

Context

Insulin-antagonistic, counter-regulatory hormones have been implicated in the development of type 2 diabetes (T2D).

Objective

In this cross-sectional study, we investigated whether glucose-dependent regulation of such hormones differ in individuals with T2D, prediabetes (PD), and normoglycemia (NG).

Methods

Fifty-four individuals with or without T2D underwent one hyperinsulinemic-normoglycemic-hypoglycemic and one hyperglycemic clamp with repeated hormonal measurements. Participants with T2D (n = 19) were compared with a group-matched (age, sex, BMI) subset of participants without diabetes (ND, n = 17), and also with participants with PD (n = 18) and NG (n = 17).

Results

In T2D vs ND, glucagon levels were higher and less suppressed during the hyperglycemic clamp whereas growth hormone (GH) levels were lower during hypoglycemia (P < .05). Augmented ACTH response to hypoglycemia was present in PD vs NG (P < .05), with no further elevation in T2D. In contrast, glucagon and GH alterations were more marked in T2D vs PD (P < .05).

In the full cohort (n = 54), augmented responses of glucagon, cortisol, and ACTH and attenuated responses of GH correlated with adiposity, dysglycemia, and insulin resistance. In multilinear regressions, insulin resistance was the strongest predictor of elevated hypoglycemic responses of glucagon, cortisol, and ACTH. Conversely, fasting glucose and HbA1c were the strongest predictors of low GH levels during hypoglycemia and elevated, i.e. less suppressed glucagon levels during hyperglycemia, respectively. Notably, adiposity measures were also strongly associated with the responses above.

Conclusions

Altered counter-regulatory hormonal responses to glucose variations are observed at different stages of T2D development and may contribute to its progression by promoting insulin resistance and dysglycemia.
Persistently Decreased Quality of Life and its Determinants in Previous Illicit Androgen Users
Authors: Bulut Yeliz , Brandt-Jacobsen Niels , Buhl Laust , Schou Morten , Frystyk Jan , Kistorp Caroline , Rasmussen Jon Jarløv
Published: September 2023

Background and Objectives

Quality of life (QoL) has never been assessed in previous illicit users of androgens years following androgen cessation. Therefore, the objective of this study was to assess QoL in previous illicit androgen users compared with current illicit androgen users and controls who had never used androgens.

Methods

Cross-sectional study including men involved in recreational strength training grouped according to their history of androgen use. We used the RAND Short-Form-36 questionnaire to assess physical and mental health-related QoL.

Results

We included 77 previous and 118 current androgen users and 39 healthy nonusers. The mean (SD) age of all participants was 33 (8) years. The elapsed duration since androgen cessation, geometric mean (95% CI), was 2.0 (1.5-2.6) years in former users. Median (25th-75th percentiles) serum total testosterone was lower in former users than controls, 14 (11-17) vs 19 (16-21) nmol/L, P < .001. Previous users displayed lower mean (SD) across both mental and physical (PCS) component summary scores, 48 (10) vs 54 (4) (P = .004) and 48 (9) vs 53 (3) (P = .002) compared with controls.

Using multivariate linear regressions, evaluating physical and mental component scores as dependent variables, lower serum total testosterone, longer duration since androgen cessation, study recruitment from an endocrine outpatient clinic, and established chronic diseases were all independently associated with reduced QoL in previous users, P < .05.

Conclusions

Previous illicit androgen users exhibited reduced QoL 2 years after androgen discontinuation, which may be a persistent condition.
Toward Optimized and Cost-Efficient Protocols for Inferior Petrosal Sinus Sampling in the Diagnosis of Cushing Disease
Authors: Abdallah Hussein M. , Gersey Zachary C. , Plute Tritan , Remick Madison , Abou-Al-Shaar Hussam , Fazeli Pouneh K. , Mahmud Hussain , Lang Michael J. , Gardner Paul A. , Zenonos Georgios A. , Gross Bradley A.
Published: September 2023

BACKGROUND AND OBJECTIVE:

Conventional protocols for inferior petrosal sinus sampling (IPSS) during the workup of hypercortisolemia require adrenocorticotrophic hormone (ACTH) measurement at multiple time points with corticotropic-releasing hormone (CRH) used as a stimulator. Modernized evidence-based protocols must also reflect the increased utilization of desmopressin (DDAVP) for ACTH stimulation as the manufacturing shortage of traditionally used CRH continues. We model the diagnostic accuracy and potential economic savings of DDAVP utilization and reduced time point sampling.

METHODS:

A single-institution, retrospective review of patients undergoing IPSS between 2007 and 2021 was performed. A computational search for the minimal set of time points which preserves conventional diagnostic accuracy was performed by testing all 1 through 5-point combinations generated using a binomial expansion. Economic savings were modeled using a publicly available hospital chargemaster.

RESULTS:

A total of 50 patients qualified for inclusion, 47 of whom were diagnosed with Cushing disease and 3 with ectopic Cushing syndrome. Single-point diagnostic accuracy for DDAVP-stimulated tests was 71.4%–92.9%, and seven 2-point combinations (5-25 procedural minutes) were found, which preserved conventional diagnostic accuracy. Single-point accuracy for CRH-stimulated tests was 67.9%–89.3%, and two 2-point combinations (t = −15, t = +2 and t = −15, t = +10) preserved accuracy. For every time point removed, the cost of ACTH laboratory tests was reduced by $507 from $3042 for 6-point IPSS). The shortest and most economical stimulator and time point combination that preserved conventional accuracy was DDAVP sampling at t = 0 and t = +5 or t = +2 and t = +5 minutes, which cost $2028 total compared with the most expensive 6-point IPSS option with CRH ($6392).

CONCLUSION:

DDAVP is a cost-efficient and effective alternative to CRH during IPSS. Our results encourage prospective evaluation of potentially fewer sampling time points in the interest of time and cost efficiency balanced with preserved accuracy.
General Versus Nongeneral Anesthesia for Spinal Surgery: A Comparative National Analysis of Reimbursement Trends Over 10 Years
Authors: Ghaith Abdul Karim , Akinduro Oluwaseun O. , El-Hajj Victor Gabriel , De Biase Gaetano , Ghanem Marc , Rajjoub Rami , Faisal Umme Habiba , Saad Hassan , Abdulrahim Mostafa , Bon Nieves Antonio , Chen Selby G. , Pirris Stephen M. , Bydon Mohamad , Abode-Iyamah Kingsley
Published: September 2023

BACKGROUND AND OBJECTIVES:

Nongeneral anesthesia (non-GA) spine surgery is growing in popularity and has facilitated earlier postoperative recovery, reduced cost, and fewer complications compared with spine surgery under general anesthesia (GA). Changes in reimbursement policies have been demonstrated to correlate with clinical practice; however, they have yet to be studied for GA vs non-GA spine procedures. We aimed to investigate trends in physician reimbursement for GA vs non-GA spine surgery in the United States.

METHODS:

We queried the ACS-NSQIP for GA and non-GA (regional, epidural, spinal, and anesthesia care/intravenous sedation) spine surgeries during 2011–2020. Work relative value units per operative hour (wRVUs/h) were retrieved for decompression or stabilization of the cervical, thoracic, and lumbar spine. Propensity score matching (1:1) was performed using all baseline variables.

RESULTS:

We included 474 706 patients who underwent spine decompression or stabilization procedures. GA was used in 472 248 operations, whereas 2458 operations were non-GA. The proportion of non-GA spine operations significantly increased during the study period. Operative times (P < .001) and length of stays (P < .001) were shorter in non-GA when compared with GA procedures. Non-GA lumbar procedures had significantly higher wRVUs/h when compared with the same procedures performed under GA (decompression; P < .001 and stabilization; P = .039). However, the same could not be said about cervicothoracic procedures. Lumbar decompression surgeries using non-GA witnessed significant yearly increase in wRVUs/h (P < .01) contrary to GA (P = .72). Physician reimbursement remained stable for procedures of the cervical or thoracic spine regardless of the anesthesia.

CONCLUSION:

Non-GA lumbar decompressions and stabilizations are associated with higher and increasing reimbursement trends (wRVUs/h) compared with those under GA. Reimbursement for cervical and thoracic surgeries was equal regardless of the type of anesthesia and being relatively stable during the study period. The adoption of a non-GA technique relative to the GA increased significantly during the study period.
Perioperative Infection After Aneurysmal Subarachnoid Hemorrhage: Risk Factors, Causative Pathogens, and Long-Term Outcomes
Authors: Kilgore Collin B. , Ran Kathleen R. , Kalluri Anita L. , Nair Sumil K. , Kim Jennifer E. , Caplan Justin M. , Jackson Christopher M. , Gonzalez L. Fernando , Huang Judy , Tamargo Rafael J. , Xu Risheng
Published: September 2023

BACKGROUND AND OBJECTIVES:

Nosocomial infections are the most common complication among critically ill patients and contribute to poor long-term outcomes. Patients with aneurysmal subarachnoid hemorrhage (aSAH) are highly susceptible to perioperative infections, yet it is unclear what factors influence infection onset and functional recovery. The objective was to investigate risk factors for perioperative infections after aSAH and relate causative pathogens to patient outcomes.

METHODS:

Clinical records were obtained for 194 adult patients with aSAH treated at our institution from 2016 to 2020. Demographics, clinical course, complications, microbiological reports, and outcomes were collected. χ2, univariate, and multivariate logistic regression analyses were used to analyze risk factors.

RESULTS:

Nearly half of the patients developed nosocomial infections, most frequently pneumonia and urinary tract infection. Patients with infections had longer hospital stays, higher rates of delayed cerebral ischemia, and worse functional recovery up to 6 months after initial hemorrhage. Independent risk factors for pneumonia included male sex, comatose status at admission, mechanical ventilatory use, and longer admission, while those for urinary tract infection included older age and longer admission. Staphylococcus, Klebsiella, and Enterococcus spp. were associated with poor long-term outcome. Certain pathogenic organisms were associated with delayed cerebral ischemia.

CONCLUSION:

Perioperative infections are highly prevalent among patients with aSAH and are related to adverse outcomes. The risk profiles for nosocomial infections are distinct to each infection type and causative organism. Although strong infection control measures should be universally applied, patient management must be individualized in the context of specific infections.
Time-Efficient, High-Resistance Inspiratory Muscle Strength Training Increases Exercise Tolerance in Midlife and Older Adults
Authors: CRAIGHEAD DANIEL H. , FREEBERG KAITLIN A. , HEINBOCKEL THOMAS C. , ROSSMAN MATTHEW J. , JACKMAN RACHEL A. , MCCARTY NARISSA P. , JANKOWSKI LINDSEY R. , NEMKOV TRAVIS , REISZ JULIE A. , D’ALESSANDRO ANGELO , CHONCHOL MICHEL , BAILEY E. FIONA , SEALS DOUGLAS R.
Published: September 2023

Purpose

This study aimed to determine if time-efficient, high-resistance inspiratory muscle strength training (IMST), comprising 30 inhalation-resisted breaths per day, improves cardiorespiratory fitness, exercise tolerance, physical function, and/or regional body composition in healthy midlife and older adults.

Methods

We performed a double-blind, randomized, sham-controlled clinical trial (NCT03266510) testing 6 wk of IMST (30 breaths per day, 6 d·wk−1, 55%–75% maximal inspiratory pressure) versus low-resistance sham training (15% maximal inspiratory pressure) in healthy men and women 50–79 yr old. Subjects performed a graded treadmill exercise test to exhaustion, physical performance battery (e.g., handgrip strength, leg press), and body composition testing (dual x-ray absorptiometry) at baseline and after 6 wk of training.

Results

Thirty-five participants (17 women, 18 men) completed high-resistance IMST (n = 17) or sham training (n = 18). Cardiorespiratory fitness (V̇O2peak) was unchanged, but exercise tolerance, measured as treadmill exercise time during a graded exercise treadmill test, increased with IMST (baseline, 539 ± 42 s; end intervention, 606 ± 42 s; P = 0.01) but not sham training (baseline, 562 ± 39 s; end intervention, 553 ± 38 s; P = 0.69). IMST increased peak RER (baseline, 1.09 ± 0.02; end intervention, 1.13 ± 0.02; P = 0.012), peak ventilatory efficiency (baseline, 25.2 ± 0.8; end intervention, 24.6 ± 0.8; P = 0.036), and improved submaximal exercise economy (baseline, 23.5 ± 1.1 mL·kg−1⋅min−1; end intervention, 22.1 ± 1.1 mL·kg−1⋅min−1; P < 0.001); none of these factors were altered by sham training (all P > 0.05). Changes in plasma acylcarnitines (targeted metabolomics analysis) were consistently positively correlated with changes in exercise tolerance after IMST but not sham training. IMST was associated with regional increases in thorax lean mass (+4.4%, P = 0.06) and reductions in trunk fat mass (−4.8%, P = 0.04); however, peripheral muscle strength, muscle power, dexterity, and mobility were unchanged.

Conclusions

These data suggest that high-resistance IMST is an effective, time-efficient lifestyle intervention for improving exercise tolerance in healthy midlife and older adults.
Intrapelvic Kirschner wire Migration following Developmental Dysplasia of Hip Surgery and Laparoscopic Removal
Authors: Muhammad Abdul Basit  , Shams Ahmed , Qureshi Shahzad Anver , Hussain Mumtaz
Published: September 2023

Salter innominate osteotomy remains the most commonly performed pelvic osteotomy for the Developmental Dysplasia of Hip in children after 18 months of age up to six years. Kirschner wire (K- wire) is used to fix the bone graft across the osteotomy site. Of the several complications of the pelvic osteotomy, K- wire migration into the pelvis is rare and only a few case reports are reported. We present a case of a 2-year-old girl with Right sided Developmental Dysplasia of Hip who underwent Femoral shortening and Salter innominate osteotomy, presented three months later with intrapelvic migration of k-wire. Paediatric Surgery consult was obtained and K-wire was removed laparoscopically without any complications successfully.

doi: https://doi.org/10.12669/pjms.39.6.7413

How to cite this: Basit MA, Shams A, Qureshi SA, Hussain M. Intrapelvic Kirschner wire Migration following Developmental Dysplasia of Hip Surgery and Laparoscopic Removal. Pak J Med Sci. 2023;39(6):---------. doi: https://doi.org/10.12669/pjms.39.6.7413

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Case Report: Atypical presentation of non-functional gonadotropinoma
Authors: Oommen Suresh , Rice Sam
Published: September 2023

Gonadotropinoma is the most common non-functional pituitary adenoma comprising 10%–30% of all pituitary adenomas. They are benign slow-growing tumours originating from adenohypophysis and rarely become malignant. Its presentation can be atypical, such as visual disturbance, and most patients presenting to an ophthalmologist for visual correction are eventually found to have a field defect. Here, we report a case of a 59-year-old patient who presented with a left-sided visual disturbance, which progressed over the years due to a left temporal hemianopia. The patient was referred to us by an ophthalmologist and was diagnosed with a giant non-functional gonadotropinoma. The patient was surgically treated. Postoperative follow-up magnetic resonance imaging after 3 months showed near complete resection of the tumour.
Extracorporeal cardiopulmonary resuscitation as a standard of care in the future: a literature review
Authors: Patel Vashistha , Patel Shreya , Saab Rayan , Prudhvi Kalyan , Cobia Miles , Rogers Allison , Cole Alanna
Published: September 2023

Background: The use of extracorporeal cardiopulmonary resuscitation (ECPR) is limited generally to situations where traditional CPR failed to restore a patient's heart rhythm. Although ECPR is not regarded as the standard of care for cardiac arrest patients, it might be a more effective treatment for some forms of cardiac arrest. This literature review explores the efficacy of ECPR as a potential standard of care for cardiac arrest in the future.

Methods: English language publications fulfilling eligibility criteria from 2010 to 2023 were found through a literature search using four electronic databases (PubMed, Google Scholar, Cochrane, and IEEE Explore). Articles were included in this literature review for fulfilling following criteria: empirical primary studies evaluating ECPR in human subjects with either IHCA or OHCA; articles published in English between 2010 and 2023; articles exploring ECPR in cardiac arrest across all ages of patients.

Results: 12 studies out of 1,092 search results met the inclusion criteria for data extraction and synthesis. Data extracted included the efficacy of ECPR in both IHCA and OHCA patients based on the PICO framework. The quality of study done by NOS (Newcastle-Ottawa Quality Assessment Scale for Cohort Studies) resulted in three studies with moderate quality while nine were of high quality.

Conclusions:  ECPR was associated with neurologically intact survival with favorable neurological outcomes compared to a standard CRP for cardiac arrest patients. This study also demonstrates that, at the moment, ECPR is the most successful in centers with a well-trained multidisciplinary ECMO team of experts. On the other hand, cardiac arrest patients in semi-rural areas and underdeveloped locations are likely to benefit less from ECPR interventions due to the lack of necessary ECPR expertise and infrastructure. Those individuals eligible for ECPR benefit from better neurological outcomes and associated higher survival rates.
Exploring the Use of Metadata Record Graphs for Metadata Assessment
Authors:   , Phillips Mark Edward
Published: September 2023

Cultural heritage institutions, including galleries, libraries, museums, and archives are increasingly digitizing physical items and collecting born-digital items and making these resources available on the Web. Metadata plays a vital role in the discovery and management of these collections. Existing frameworks to identify and address deficiencies in metadata rely heavily on count and data-value based metrics that are calculated over aggregations of descriptive metadata. There has been little research into the use of traditional network analysis to investigate the connections between metadata records based on shared data values in metadata fields such as subject or creator. This study introduces metadata record graphs as a mechanism to generate network-based statistics to support analysis of metadata. These graphs are constructed with the metadata records as the nodes and shared metadata field values as the edges in the network. By analyzing metadata record graphs with algorithms and tools common to the field of network analysis, metadata managers can develop a new understanding of their metadata that is often impossible to generate from count and data-value based statistics alone. This study tested application of metadata record graphs to analysis of metadata collections of increasing size, complexity, and interconnectedness in a series of three related stages. The findings of this research indicate effectiveness of this new method, identify network algorithms that are useful for analyzing descriptive metadata and suggest methods and practices for future implementations of this technique.
On Habit and Organizing: A Transactional Perspective Relating Firms, Consumers, and Social Institutions
Authors: Farjoun Moshe , Mahmood Nudrat
Published: September 2023

Habits and routines are foundational to several organizational theories. Considering organizational members to be predominately employees, established habit-based models recognize how these members’ habits help build organizations and are shaped by them. Departing from this traditional, internal focus, our paper highlights an important aspect of organizing, which has been relatively overlooked by established habit-based models, namely, how firms engineer consumer habits to their advantage and, by extension, strategically shape the habits of other key resource providers. To better theorize consumer habits and their engineering, and to integrate these phenomena within extant organizational theory, we develop a new habit-based perspective relating firms, consumers, and social institutions. Inspired by Dewey’s transactional approach and drawing on modern habit science, our transactional framework helps illuminate habit engineering, promotes a richer and more integrated view of organizing, and opens new possibilities for habit-based organizational theories. Our paper also offers several implications for firms’ managers, individual consumers, and broader society.
Bespoke Engineering
Authors: Fortune Kyle
Published: September 2023

With a limited to an edition only 270, the Polestar 2 BST Edition 270 is an enthusiast-orientated car in the BEV marketplace. It underlines company's desire to create cars that people like to drive, to the point that it can even be adjusted to suit individual needs
Iğdır’da Oynanan Köse Oyununun Köy Seyirlik Oyunları Bağlamında İncelenmesi
Authors: KOCABIYIK Yiğit
Published: September 2023

Kırsal bölgelerde oynanan ve yılın önemli günlerinde ya da özel günlerde organize edilen tiyatro geleneği olarak tanımlanabilen köy seyirlik oyunları, Anadolu halkının kültürel birikiminin yansımalarını barındırmaktadır. Ayrıca bu oyunlar, köy yaşantısının tiyatro ve eğlence ihtiyacını karşılamaya da katkı sağlamaktadır. Geleneksel Türk tiyatrosu üzerine çalışmalar yapmış uzmanlara göre, Türkiye'deki tiyatro kültürünün evrensel bir niteliği ulaşması için köy seyirlik oyunları üzerine araştırmalar yapmak oldukça önemlidir. Ayrıca yapılan bu araştırmalar köy seyirlik oyunlarının nesilden nesle doğru bir şekilde aktarımına ve unutulmamasına da katkı sağlayabilir. Bu nedenlerle yapılan araştırma, Iğdır ilinde icra edilen Köse oyununu köy seyirlik bağlamında incelemeyi amaçlamaktadır. Nitel araştırma yöntemlerinden doküman incelemenin kullanıldığı araştırmada toplanan materyaller, Iğdır İl Halk Kütüphanesi ve Iğdır İl Kültür ve Turizm Müdürlüğü’nün arşivinden alınmıştır. Veriler Iğdır ilinde Köse oyununun nasıl oynandığına odaklanarak yatay seviyede ortaya konmuş, ardından Metin And’ın köy seyirlik oyun incelemeye dair önerileri dikkate alınarak analiz yapılmıştır. Yapılan analiz sonucunda Köse oyununun, baharın başlangıcını işaret eden Nevruz kutlamalarının bir parçası olarak 21 Mart tarihinde oynandığı görülmüştür. Ayrıca oyunda doğanın canlanması ve ölüp yeniden dirilme motiflerinin yer alması, Köse oyununun törensel özellikler taşıdığına işaret etmektedir. Oyunun son zamanlarda çocuklar tarafından oynandığı ve önemli motifleri içermediği tespit edilmiştir. Ancak Iğdır merkezinde İl Kültür ve Turizm Müdürlüğü tarafından organize edilen Nevruz etkinlikleri içeriğinde amatör oyuncular tarafından oyuna dair motifler korunarak oynanmaya devam edilmektedir. Oyunda dekor, ışıklandırma ya da kukla gibi ögelerin yer almadığı görülürken, başrolleri canlandıracak kişilerde giysi açısından çeşitli belirgin özelliklerin var olduğu tespit edilmiştir.