bluuebunny/crossref_metadata_2025 huggingface dataset:
Schools and Institutional Leadership in Action: A Systematic Literature Review
Authors: Coutet Karl
Published: April 2024

As institutions, schools hold a place of significant value for their stakeholders. Selznick (1957/1984) recognised that institutions require a particular type of leadership that is concerned with the promotion and protection of values. Although not a new theory, institutional leadership has not received much attention by both researchers and practitioners since its formation, which has given way to the more familiar concepts of transactional and transformational leadership. A systematic literature review was carried out to survey what enactments of institutional leadership are taking place in different institutions and what impact Selznick’s theories still have on leadership practice. A thematic analysis of the literature found institutional leaders acting in five areas: (1) managing institutional identity, (2) leading followers, (3) managing the external environment, (4) organisational management, and (5) management of the self. The findings could be useful to school leaders who seek to adopt a leadership style that ensures the survival of their institutions.
Working in the Crisis: Practitioners' perceptions of and responses to the COVID-19 Pandemic
Authors: Sutton Jesse , Cleave Evan , Casey Sadler Richard , Hutchenreuther John , Oosterbaan Catherine , Arku Godwin
Published: April 2024

The COVID-19 pandemic was one of many global challenges localities have contended with over the past few decades. In response to such global pressures, economic development practitioners are tasked with safeguarding their localities’ economic and social well-being. But little is known about how these types of shocks and challenges have influenced overall economic development practices and planning. To address this question, we conducted in-depth interviews with thirty-seven local economic development practitioners from Ontario, Canada. We find that practitioners, in their bounded autonomy, push back against global forces such as the COVID-19 pandemic in an attempt to safeguard their localities. Further, the findings show that over the last three years a shift occurred in nearly all parts of local economic development – from greater emphasis on human capital, to changes in what sectors of local economies are favored and targeted, to alterations in the day-to-day work occurring within local economic development offices.
Patterns of Protest in Contemporary Africa: An Empirical Investigation of Regional Trends Employing Multiple Imputation
Authors: Schmiedl Martin , Lioy Alberto
Published: April 2024

What kind of people choose to join protests in contemporary Africa? Aiming to reduce the existing uncertainty related to the impact of different factors on protest participation, this article tests several hypotheses about participation in Third Wave demonstrations across the African continent, related to democratic values, socioeconomic status, and corruption perceptions. To do so, it deploys an innovative regression model that corrects for missing value bias through multiple imputation and that separates the broad survey data into regional subsamples, dependent upon historical patterns of neopatrimonialism and democratization. Its results show for the first time the existence of different profiles of protester associated with North, West, East, Central, and Southern Africa. Its most surprising result is that across the board, responders open to considering alternatives to democracy were more prone to protesting, while corruption perceptions mattered only in Western African countries. The largest contrast then regards the urban–rural divide: city dwellers lead the way in Southern Africa, while the countryside takes the helm in the Western part of the continent. Finally, people who declare to have voted and those who have more frequent political conversations also fit the profile of the average protester.
Examining the Perceptions of mHealth on Racial and Ethnic Disparities in Postpartum Health for Black Women: A Scoping Review
Authors: Hernandez-Green Natalie , Davis Morgan V. , Beshara Merna S. , Hernandez-Spalding Kaitlyn , Francis Sherilyn , Parker Andrea , Farinu Oluyemi , Chandler Rasheeta
Published: April 2024

Background. Several disparities exist for Black mothers during the postpartum period, including but not limited to increased maternal mortality and morbidity rates, decreased access to care, and limited access to resources. Given the racial discrepancies in attention to postpartum care, coupled with the critical importance of the postpartum period for preventing adverse maternal health outcomes, research is warranted to explore how mobile health (mHealth) applications may help to alleviate maternal health disparities by optimizing postpartum care and addressing barriers to care for postpartum Black women. Thus, this review examines the perceptions of mHealth applications and their utility in health outcomes among postpartum Black women. Methods. We undertook a comprehensive literature search using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We included peer-reviewed articles published between 2010 and 2022 that were written in English, utilized mHealth as a primary intervention, and focused on postpartum health and access to resources, primarily among Black women in the United States. Results. A total of eight articles were included in our synthesis, encompassing mobile phone-based interventions for Black women. Cultural tailoring was included in five studies. Interventions that incorporated tailored content and fostered interactions reported high rates of follow-up. Conclusions. Tailored mHealth interventions can effectively promote behavior change and improve health care outcomes for Black women. However, there is a critical need for more research to assess user engagement and retention and whether these improvements indicate long-term sustainability.
Soccer Bubble: Is There a Speculative Bubble in the Price of International Soccer Players?
Authors: Pancotto Francesca , Addessi Giorgio , Auteri Nicola
Published: April 2024

An exponentially increasing trend of players’ registration prices has taken place since 2012, and we test the hypothesis that this may be a speculative bubble, using a structural break test (Chow test) on a data set of international soccer players' registration prices, that ranges from 2007 to 2019. The test confirms the presence of an abrupt change in the trend of these prices since the year 2012, both for the whole data set and for subgroups based on the types of competition considered (Champions League, Europa League, and residual) and on the age of the players. We surmise that a possible root at the base of this trend is the need for soccer teams to cope with the Fair Play regulation, which has taken place exactly in the same years, and caused an excess of players’ trading as a means to comply with the obligation for teams to balance their books over time.
Adaptation, Violence, and Storytelling in The Last of Us
Authors: Spence Steve
Published: April 2024

A focus on the work of adaptation illuminates narrative innovations in Naughty Dog's PlayStation 3 game The Last of Us, its sequel, The Last of Us Part II, and the original game's transcoding as a nine-episode season of “quality television” by the American cable network Home Box Office (HBO). HBO's showrunners employed the distinct affordances of television to adapt core game themes regarding both ludic and real-life violence. Close comparisons with the game shed light on the wellsprings of the show's success, and they also highlight distinctive qualities of videogames as a storytelling medium. Naughty Dog's sequel also adapted the first game, using its complex, recursive narration to amend and complicate key moments from the original story. This narrative strategy reveals the influence of quality television, and it also enables the sequel to extend the first game's critique of violence's pleasures and their enabling justifications.
Placing African Cities in Chinese Lives: A Comparative Study of Migrant Geographies
Authors: Xiao Allen Hai , Zi Yanyin
Published: April 2024

Based on ethnographic research on Chinese migrants in Nigeria, Botswana, and Namibia from 2011 to 2015, this article has three lines of argumentation and contribution. First, it proposes a framing of migrant geographies from a humanistic comparative perspective in order to complement the political economy approaches in geographies of migration. Second, lying in the intersection of urban studies and migration studies, it illustrates the different positionalities of cities in three aspects of migrant geographies – migrant space, network, and belonging – echoing the multiscalar analysis of city-making in migration processes. Third, specifically in the context of Chinese migrant geographies, three African cities, Lagos, Gaborone, and Windhoek, are placed in three migrants’ geographic worlds, not always according to their positions in multiscalar power structures, but partly through migrant experiences in which top-down power horizontally works.
Comparative Effectiveness of Hybrid Closed-Loop Automated Insulin Delivery Systems Among Patients with Type 1 Diabetes
Authors: Folk Sara , Zappe Janet , Wyne Kathleen , Dungan Kathleen M.
Published: April 2024

Background:

Clinical trials have demonstrated the efficacy and safety of hybrid closed-loop (HCL) systems, yet few studies have compared outcomes in the real-world setting.

Method:

This retrospective study analyzed patients from an academic endocrinology practice between January 1, 2018, and November 18, 2022. The inclusion criteria were diagnosis code for type I diabetes (T1D), >18 years of age, new to any HCL system [Medtronic 670G/770G (MT), Tandem Control IQ (CIQ), or Omnipod 5 (OP5)], and availability of a pump download within three months. The outcomes included %time in range (TIR) of 70 to 180 mg/dL, %time below range (TBR) <70 mg/dL at 90 days, and HbA1c for 91 to 180 days.

Result:

Of the 176 participants, 47 were MT, 74 CIQ, and 55 OP5. Median (25%, 75%) change in HbA1c was −0.1 (−0.8, 0.3), −0.6 (−1.1, −0.15), and −0.55 (−0.98, 0)% for MT, CIQ, and OP5, respectively, ( P = .04). TIR was 70 (57, 76), 67 (59, 75), and 68 (60, 76)% ( P = .95) at 90 days while TBR was 2 (1, 3), 1 (0, 2), and 1 (0, 1)%, respectively, ( P = .002). The %time in automated delivery was associated with TIR and change in HbA1c. After controlling other factors including %time in automated delivery, HCL type was not an independent predictor of change in HbA1c nor TIR but remained a significant predictor of TBR.

Conclusion:

There were significant reductions in HbA1c in CIQ and OP5. TIR was similar across pumps, but TBR was highest with MT. The %time in automated delivery likely explains differences in change in HbA1c but not TBR between HCL systems.
How Can Critique of Critique Create Possibilities for Critical Qualitative Inquiry?
Authors: Cheek Julianne , Costa Nathalia
Published: April 2024

This commentary is based on a presentation given at the annual meeting of the Coalition for Critical Qualitative Research at the 19th International Congress of Qualitative Inquiry. The focus of the presentation was to address the theme: “ What are your conceptualisations of reactions to critique of critiques, and possibilities for, critical qualitative inquiry?” The aim was to prompt the participants to critically reflect on the idea of critique, and critiques of such critique.
Incidence and Factors Associated With the Development of Calvarial Osteoradionecrosis in Patients Treated for Cutaneous Malignancies
Authors: Weerakkody Dumindu , Nguyen Kevin , Lok Evania , Khor Richard , Ng Sweet P. , Starvaggi Ben , Wada Morikatsu , Li Henry , Kiu-Huen Ng Sally
Published: April 2024

Study Design

Retrospective cohort study.

Objective

Calvarial osteoradionecrosis (ORN) is a rare but devastating complication of radiotherapy. The aim of this study was to describe the cumulative incidence of Calvarial ORN in patients in patients treated for cutaneous malignancy of the scalp.

Methods

Data was compiled from patient records of a large tertiary hospital Plastic Surgery department and radiotherapy records of an affiliated cancer Center. We included all patients that were treated for cutaneous malignancies of the scalp that received radiotherapy. Patient demographics, cancer stage, treatment modalities, intraoperative details, and patient outcome data were recorded. Patients with incomplete radiotherapy data were excluded.

Results

We analyzed 105 radiotherapy treatments to the scalp administered to 84 patients and recorded 7 cases of calvarial ORN resulting in a gross incidence of 6.67% per radiotherapy treatment. The parietal bone was the most frequently targeted site of radiotherapy and accordingly the most common site of ORN (85.7%). Median time from radiotherapy dose to the development of ORN was 846 days. Higher number of radiotherapy fractionation ( P = .038), cumulative radiotherapy dose ( P = .035), prolonged radiotherapy duration ( P = .022) and skin grafting ( P = .003) were associated with the development of ORN.

Conclusions

Our findings suggest radiotherapy variables, such as prolonged radiotherapy duration, increased cumulative dose and higher radiotherapy fractions were strongly associated with the development of ORN. In addition, skin grafting following surgical resection was associated with the development of ORN. Further studies with larger sample sizes are required to further explore this relationship.
A review of histopathologic and radiologic features of non-atherosclerotic pathologies of the extracranial carotid arteries
Authors: Larson Anthony S , Bathla Girish , Brinjikji Waleed , Lanzino Giuseppe , Cheek-Norgan Elizabeth Heidi , Aubry Marie C , Huston John , Benson John C
Published: April 2024

Diseases of the carotid arteries can be classified into different categories based on their origin. Atherosclerotic carotid disease remains the most encountered arterial wall pathology. However, other less-common non-atherosclerotic diseases can have detrimental clinical consequences if not appropriately recognized. The underlying histological features of each disease process may result in imaging findings that possess features that are obvious of the disease. However, some carotid disease processes may have histological characteristics that manifest as non-specific radiologic findings. The purpose of this manuscript is to review various non-atherosclerotic causes of carotid artery disease as well as their histologic-radiologic characteristics to aid in the appropriate recognition of these less-commonly encountered pathologies.
Appropriate Inclusion: A Novel Framework for the Development of China's Special Education
Authors: Shen (沈光银) Guangyin , Yin (尹弘飚) Hongbiao
Published: April 2024

Purpose

This study examines the Action Plan for the Development and Improvement of Special Education (hereinafter, the Action Plan) of the 14th Five-Year Plan, a national blueprint for special education forwarded by the General Office of the State Council of the People's Republic of China in December 2021.

Design/Approach/Methods

This is an analytical policy review.

Findings

In analyzing the policy highlights and characteristics of the Action Plan, this policy review identifies four factors motivating the policy: the United Nations’ Convention on the Rights of Persons with Disabilities, the Outline of the People's Republic of China 14th Five-Year Plan for National Economic and Social Development and Long-Range Objectives for 2035, educational equity, and the high-quality development of special education. In addition to proposing three developmental requirements in line with China's national conditions, the Action Plan establishes eight implementation strategies and three support systems for the initial development of high-quality special education.

Originality/Value

The findings of this article will enhance leaders’ and relevant stakeholders’ understanding of new directions in and future paths of the high-quality development of special education in China.
Assembly and comparative analysis of the initial complete mitochondrial genome of Primulina hunanensis (Gesneriaceae): a cave-dwelling endangered plant
Authors: Chen Lingling , Dong Xiang , Huang Hang , Xu Haixia , Rono Peninah Cheptoo , Cai Xiuzhen , Hu Guangwan
Published: April 2024

Background

Primulina hunanensis, a troglobitic plant within the Primulina genus of Gesneriaceae family, exhibits robust resilience to arid conditions and holds great horticultural potential as an ornamental plant. The work of chloroplast genome (cpDNA) has been recently accomplished, however, the mitochondrial genome (mtDNA) that is crucial for plant evolution has not been reported.

Results

In this study, we sequenced and assembled the P. hunanensis complete mtDNA, and elucidated its evolutionary and phylogenetic relationships. The assembled mtDNA spans 575,242 bp with 43.54% GC content, encompassing 60 genes, including 37 protein-coding genes (PCGs), 20 tRNA genes, and 3 rRNA genes. Notably, high number of repetitive sequences in the mtDNA and substantial sequence translocation from chloroplasts to mitochondria were observed. To determine the evolutionary and taxonomic positioning of P. hunanensis, a phylogenetic tree was constructed using mitochondrial PCGs from P. hunanensis and 32 other taxa. Furthermore, an exploration of PCGs relative synonymous codon usage, identification of RNA editing events, and an investigation of collinearity with closely related species were conducted.

Conclusions

This study reports the initial assembly and annotation of P. hunanensis mtDNA, contributing to the limited mtDNA repository for Gesneriaceae plants and advancing our understanding of their evolution for improved utilization and conservation.
Mining key circRNA-associated-ceRNA networks for milk fat metabolism in cows with varying milk fat percentages
Authors: Feng Xiaofang , Tong Lijia , Ma Lina , Mu Tong , Yu Baojun , Ma Ruoshuang , Li Jiwei , Wang Chuanchuan , Zhang Juan , Gu Yaling
Published: April 2024

Background

Cow milk fat is an essential indicator for evaluating and measuring milk quality and cow performance. Growing research has identified the molecular functions of circular RNAs (circRNAs) necessary for mammary gland development and lactation in mammals.

Method

The present study analyzed circRNA expression profiling data in mammary epithelial cells (MECs) from cows with highly variable milk fat percentage (MFP) using differential expression analysis and weighted gene co-expression network analysis (WGCNA).

Results

A total of 309 differentially expressed circRNAs (DE-circRNAs) were identified in the high and low MFP groups. WGCNA analysis revealed that the pink module was significantly associated with MFP (r = − 0.85, P = 0.007). Parental genes of circRNAs in this module were enriched mainly in lipid metabolism-related signaling pathways, such as focal adhesion, ECM-receptor interaction, adherens junction and AMPK. Finally, six DE-circRNAs were screened from the pink module: circ_0010571, circ_0007797, circ_0002746, circ_0003052, circ_0004319, and circ_0012840. Among them, circ_0002746, circ_0003052, circ_0004319, and circ_0012840 had circular structures and were highly expressed in mammary tissues. Subcellular localization revealed that these four DE-circRNAs may play a regulatory role in the mammary glands of dairy cows, mainly as competitive endogenous RNAs (ceRNAs). Seven hub target genes (GNB1, GNG2, PLCB1, PLCG1, ATP6V0C, NDUFS4, and PIGH) were obtained by constructing the regulatory network of their ceRNAs and then analyzed by CytoHubba and MCODE plugins in Cytoscape. Functional enrichment analysis revealed that these genes are crucial and most probable ceRNA regulators in milk fat metabolism.

Conclusions

Our study identified several vital circRNAs and ceRNAs affecting milk fat synthesis, providing new research ideas and a theoretical basis for cow lactation, milk quality, and breed improvement.
Impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery
Authors: Yin Lu , Wang Heng , Yin Xiaorong , Hu Xiuying
Published: April 2024

Background

This study aimed to investigate the impact of intraoperative hypothermia on the recovery period of anesthesia in elderly patients undergoing abdominal surgery.

Methods

A prospective observational study was conducted based on inclusion and exclusion criteria. A total of 384 elderly patients undergoing abdominal surgery under general anesthesia were enrolled in a grade A tertiary hospital in Chengdu, Sichuan Province from October 2021 and October 2022. After anesthesia induction, inflatable warming blankets were routinely used for active heat preservation, and nasopharyngeal temperature was monitored to observe the occurrence of intraoperative hypothermia. Patients were divided into hypothermia group and nonhypothermia group according to whether hypothermia occurred during the operation. Anesthesia recovery time and the incidence of adverse events or unwanted events during anesthesia recovery between the two groups were compared.

Results

The numbers (percentage) of 384 patients who underwent abdominal surgery developed intraoperative hypothermia occurred in 240 (62.5%) patients, all of whom had mild hypothermia. There were statistically significant differences between mild hypothermia after active warming and nonhypothermia in the occurrence of shivering (χ2 = 5.197, P = 0.023) and anesthesia recovery time (Z = -2.269, P = 0.02) in elderly patients undergoing abdominal surgery during anesthesia recovery, and there were no statistically significant differences in hypoxemia, nausea or vomiting, hypertension, hypokalemia, hypocalcemia, analgesic drug use,postoperative wound infection or postoperative hospitalization days.

Conclusions

The incidence of intraoperative mild hypothermia after active warming was high in elderly patients who underwent abdominal surgery. Mild hypothermia increased the incidence of shivering and prolonged anesthesia recovery time in elderly patients undergoing abdominal surgery.
The effect of glycopyrrolate vs. atropine in combination with neostigmine on cardiovascular system for reversal of residual neuromuscular blockade in the elderly: a randomized controlled trial
Authors: Wang Yanping , Ren Liyuan , Li Yanshuang , Zhou Yinhui , Yang Jianjun
Published: April 2024

Background

Glycopyrrolate-neostigmine (G/N) for reversing neuromuscular blockade (NMB) causes fewer changes in heart rate (HR) than atropine-neostigmine (A/N). This advantage may be especially beneficial for elderly patients. Therefore, this study aimed to compare the cardiovascular effects of G/N and A/N for the reversal of NMB in elderly patients.

Methods

Elderly patients aged 65–80 years who were scheduled for elective non-cardiac surgery under general anesthesia were randomly assigned to the glycopyrrolate group (group G) or the atropine group (group A). Following the last administration of muscle relaxants for more than 30 min, group G received 4 ug/kg glycopyrrolate and 20 ug/kg neostigmine, while group A received 10 ug/kg atropine and 20 ug/kg neostigmine. HR, mean arterial pressure (MAP), and ST segment in lead II (ST-II) were measured 1 min before administration and 1–15 min after administration.

Results

HR was significantly lower in group G compared to group A at 2–8 min after administration (P < 0.05). MAP was significantly lower in group G compared to group A at 1–4 min after administration (P < 0.05). ST-II was significantly depressed in group A compared to group G at 2, 3, 4, 5, 6, 7, 8, 9, 11, 13, 14, and 15 min after administration (P < 0.05).

Conclusions

In comparison to A/N, G/N for reversing residual NMB in the elderly has a more stable HR, MAP, and ST-II within 15 min after administration.
Double trouble - dual outflow tract obstruction in congenital heart disease: a case report
Authors: Maggo Kanchan , Bhayana Aanchal , Gupta Pranav , Gupta Vidushi , Verma Animesh , Malik Amita
Published: April 2024

Background

Double chambered right ventricle is a rare congenital heart disease that is characterised by the presence of an anomalous muscle bundle that divides the right ventricle into a low pressure superior (distal) chamber and a high pressure inferior (proximal) chamber. It is found in association with a ventricular septal defect in 90% cases with other associations being tetralogy of Fallot, transposition of great vessels, atrial septal defect and Ebstein’s anomaly. On the other hand, subaortic membrane is a form of discrete subaortic stenosis that is characterised by a membranous diaphragm in the subvalvular location of the left ventricular outflow tract. Both of these entities are responsible for causing subvalvular outflow tract obstruction. The occurrence of double chambered right ventricle in association with subaortic membrane is an extremely rare entity with only a few case reports available in the literature.

Case report

A 13-year-old male child with history of chest pain and palpitations presented to the outpatient department of a tertiary care center. Transthoracic echocardiography revealed a subaortic membrane producing a pressure gradient across the left ventricular outflow tract with dilatation of the right atrium and right ventricle which could not be fully evaluated on echocardiography. Cardiac computed tomography was then performed which additionally revealed an anomalous muscle bundle coursing across the right ventricle from the septum to the subinfundibular region creating a double chambered right ventricle. The patient was then taken up for reconstruction of right ventricular outflow tract and resection of subaortic membrane.

Conclusion

Right and left outflow tract obstructions are rare congenital lesions which when seen in combination, become even more infrequent. Echocardiography is a robust tool that detects turbulent flow to identify such lesions. However, poor acoustic window may sometimes result in missing these lesions and computed tomography in such situations can play an important role in detection as well as complete preoperative imaging evaluation.
Endoscopic diagnosis of gastric and oesophageal cancer in Lusaka, Zambia: a retrospective analysis
Authors: Kayamba Violet , Mubbunu Malambo , Kelly Paul
Published: April 2024

Introduction

There are uncertainties surrounding the spectrum of upper gastrointestinal (UGI) diseases in sub-Saharan Africa. This is mainly due to the limitations of data collection and recording. We previously reported an audit of UGI endoscopic diagnoses in Zambia spanning from 1977 to 2014. We now have extended this analysis to include subsequent years, in order to provide a more comprehensive picture of how the diagnoses have evolved over 4 decades.

Methods

We combined data collected from the endoscopy unit at the University Teaching Hospital (UTH) in Lusaka during a previous review with that collected from the beginning of 2015 to the end of 2021. Since 2015, an electronic data base of endoscopy reports at the UTH was kept. The electronic data base was composed of drop-down menus that allowed for standardised reporting of findings. Collected data were coded by two experienced endoscopists and analysed.

Results

In total, the analysis included 25,849 endoscopic records covering 43 years. The number of endoscopic procedures performed per year increased drastically in 2010. With the exception of the last 2 years, the proportion of normal endoscopies also increased during the time under review. In total, the number of gastric cancer (GC) cases was 658 (3%) while that of oesophageal cancer (OC) was 1168 (5%). The number of GC and OC diagnoses increased significantly over the period under review, (p < 0.001 for both). For OC the increase remained significant when analysed as a percentage of all procedures performed (p < 0.001). Gastric ulcers (GU) were diagnosed in 2095 (8%) cases, duodenal ulcers (DU) in 2276 (9%) cases and 239 (1%) had both ulcer types. DU diagnosis showed a significantly decreasing trend over each decade (p < 0.001) while GU followed an increasing trend (p < 0.001).

Conclusions

UGI endoscopic findings in Lusaka, Zambia, have evolved over the past four decades with a significant increase of OC and GU diagnoses. Reasons for these observations are yet to be established.
Cytomegalovirus colitis as intestinal obstruction in an immunocompetent adolescent: a case report and literature review
Authors: Ge Jiongshan , Li Yan , Shi Di , Wei Jiaxin , Wang Jing , Liu Jihai
Published: April 2024

Background

Cytomegalovirus infection manifests varying clinical characteristics and severity in diverse populations with different immune statuses. The signs and symptoms of gastrointestinal involvement are nonspecific. Here, we present a case of cytomegalovirus colitis in an immunocompetent adolescent, which manifested as intestinal pseud-obstruction.

Case presentation

A 15-year-old man who had contracted novel coronavirus infection one month earlier was admitted to our hospital with fever, abdominal pain, and hematochezia. His abdomen was distended, and laboratory evaluation revealed a decrease in the blood count, an increase in inflammatory indicators and hepatic impairment. Imaging shows bowel wall thickening and dilatation of the colon. A diagnosis of intestinal infection combined with acute intestinal pseud-obstruction was made. Diarrhea persisted despite conservative treatment with empirical antibiotics. A colonoscopy was performed. Pathology confirmed cytomegalovirus infection. Ganciclovir therapy was initiated, and subsequent review showed a good recovery.

Conclusions

The case was diagnosed as cytomegalovirus colitis. We reviewed the reports of 9 cases of bowel obstruction, including our own, and found that the majority of the adult patients were elderly with underlying disease. Clinical and endoscopic manifestations are typically nonspecific, and imaging shows typical signs of intestinal obstruction. The final diagnosis was confirmed by pathology. Most of them have a good prognosis. We suggest that cytomegalovirus colitis can also lead to intestinal obstruction and that viral reactivation in immunocompetent individuals may be associated with inflammatory conditions and viral coinfection, particularly with the novel coronavirus.
Imbalance of gut microbiota in gestational diabetes
Authors: Shen Weiyi , Chen Qianyi , Lin Renbin , Hu Zhefang , Luo Man , Ren Yanwei , Huang Keren , Wang Li , Chen Shujie , Wang Lan , Ruan Yu , Feng Lijun
Published: April 2024

Aim

To investigate the differences in gut microbiota composition among nonpregnant women of reproductive age, healthy pregnant women, and gestational diabetes (GD) patients.

Methods

A total of 45 outpatients were enrolled and divided into three groups: nonpregnant women of reproductive age (control group, n = 23), healthy pregnant women (normal group, n = 10), and GD patients (GD group, n = 12). Faecal samples were collected and sequenced using 16S rRNA gene sequencing to analyse the microbial composition.

Results

(1) Pregnant patients exhibited an increase in the abundance of Streptococcus (Pnormal = 0.01286, PGD = 0.002965) and Blautia (Pnormal = 0.0003924, PGD = 0.000246) but a decrease in the abundance of Roseburia (Pnormal = 0.0361, PGD = 0.007075), Phascolarctobacterium (Pnormal = 0.0003906, PGD = 0.02499) and Lachnoclostridium (Pnormal = 0.0003906, PGD = 0.03866). (2) Compared with healthy pregnant women, GD patients had an excessive increase in Streptococcus abundance and decrease in Roseburia abundance. The increase in Blautia abundance and the decrease in Phascolarctobacterium and Lachnoclostridium abundance in GD patients were less than those in healthy pregnant women. (3) The abundance of Faecalibacterium prausnitzii decreased significantly in GD patients (PGD = 0.02985) but not in healthy pregnant patients (Pnormal = 0.1643).

Conclusions

Abnormal increases and decreases in the abundances of gut microbiota components, especially Faecalibacterium prausnitzii, were observed in GD patients.

Trial registration

The cross-sectional research was conducted in accordance with the Declaration of Helsinki, and approved by Sir Run Run Shaw Hospital Clinical Trials and Biomedical Ethics Committee. The study has been registered in the Chinese Clinical Trial Registry (ChiCTR1900026164, 24/09/2019, http://www.chictr.org.cn/showproj.aspx?proj=43,455).
Analysis of related factors for pathological upgrading of cervical biopsy from CIN3 to cancer after conical resection
Authors: Li Zhifang , Zhou Guiju , Jiang Longfan , Wang Mengjie
Published: April 2024

Background

To investigate related factors for postoperative pathological upgrading of cervical biopsy to cervical cancer (CC) in patients with cervical intraepithelial neoplasia (CIN)3 after conical resection.

Methods

This retrospective study collected data from patients diagnosed with CIN3 by cervical biopsies at the author’s Hospital between January 2012 and December 2022. The primary outcome was the pathological results of patients after conical resection. The pathological findings were categorized into the pathological upgrading group if postoperative pathology indicated CC, while those with normal, inflammatory, or cervical precancerous lesions were classified into the pathological non-upgrading group. The factors associated with upgrading were identified using multivariable logistic regression analysis.

Results

Among 511 patients, there were 125 patients in the pathological upgrading group (24.46%). The patients in the upgrading group were younger (47.68 ± 9.46 vs. 52.11 ± 7.02, P < 0.001), showed a lower proportion of menopausal women (38.40% vs. 53.02%, P = 0.0111), a lower proportion of HSIL (40.00% vs. 57.77%, P = 0.001), a higher rate of HPV-16/18 positive (25.60% vs. 17.36%, P = 0.011), a higher rate of contact bleeding (54.40% vs. 21.50%, P < 0.001), lower HDL levels (1.31 ± 0.29 vs. 1.37 ± 0.34 mmol/L, P = 0.002), higher neutrophil counts (median, 3.50 vs. 3.10 × 109/L, P = 0.001), higher red blood cell counts (4.01 ± 0.43 vs. 3.97 ± 0.47 × 1012/L, P = 0.002), higher platelet counts (204.84 ± 61.24 vs. 187.06 ± 73.66 × 109/L, P = 0.012), and a smaller platelet volume (median, 11.50 vs. 11.90 fL, P = 0.002).The multivariable logistic regression analysis showed that age (OR = 0.90, 95% CI: 0.86–0.94, P < 0.001), menopausal (OR = 2.68, 95% CI: 1.38–5.22, P = 0.004), contact bleeding (OR = 4.80, 95% CI: 2.91–7.91, P < 0.001), and mean platelet volume (OR = 0.83, 95% CI: 0.69–0.99, P = 0.038) were independently associated with pathological upgrading from CIN3 to CC after conical resection.

Conclusion

Age, menopausal, contact bleeding, and mean platelet volume are risk factors of pathological upgrading from CIN3 to CC after conical resection, which could help identify high risk and susceptible patients of pathological upgrading to CC.
The podoplanin-CLEC-2 interaction promotes platelet-mediated melanoma pulmonary metastasis
Authors: Sheng Minjia , Sun Ran , Fu Jianxin , Lu Gao
Published: April 2024

Background

Podoplanin (PDPN) expressed on tumour cells interacts with platelet C-type lectin-like receptor 2 (CLEC-2). This study aimed to investigate the role of the PDPN-platelet CLEC-2 interaction in melanoma pulmonary metastasis.

Methods

Murine melanoma B16-F0 cells, which have two populations that express podoplanin, were sorted by FACS with anti-podoplanin staining to obtain purified PDPN + and PDPN- B16-F0 cells. C57BL/6J mice transplanted with CLEC-2-deficient bone marrow cells were used for in vivo experiments.

Results

The in vivo data showed that the number of metastatic lung nodules in WT mice injected with PDPN + cells was significantly higher than that in WT mice injected with PDPN- cells and in WT or CLEC-2 KO mice injected with PDPN- cells. In addition, our results revealed that the platelet Syk-dependent signalling pathway contributed to platelet aggregation and melanoma metastasis.

Conclusions

Our study indicates that the PDPN-CLEC-2 interaction promotes experimental pulmonary metastasis in a mouse melanoma model. Tumour cell-induced platelet aggregation mediated by the interaction between PDPN and CLEC-2 is a key factor in melanoma pulmonary metastasis.
The impact of non-pharmaceutical interventions on community non-SARS-CoV-2 respiratory infections in preschool children
Authors: Klee Bianca , Diexer Sophie , Horn Johannes , Langer Susan , Wende Marie , Ortiz Diego , Bielecka Agata , Strowig Till , Mikolajczyk Rafael , Gottschick Cornelia
Published: April 2024

Background

Effects of non-pharmaceutical interventions during the pandemic were mainly studied for severe outcomes. Among children, most of the burden of respiratory infections is related to infections which are not medically attended. The perspective on infections in the community setting is necessary to understand the effects of the pandemic on non-pharmaceutical interventions.

Methods

In the unique prospective LoewenKIDS cohort study, we compared the true monthly incidence of self-reported acute respiratory infections (ARI) in about 350 participants (aged 3–4 years old) between October 2019 to March 2020 (pre-pandemic period) and October 2020 to March 2021 (pandemic period). Parents reported children’s symptoms using a diary. Parents were asked to take a nasal swab of their child during all respiratory symptoms. We analysed 718 swabs using Multiplex PCR for 25 common respiratory viruses and bacteria.

Results

During the pre-pandemic period, on average 44.6% (95% CI: 39.5–49.8%) of children acquired at least one ARI per month compared to 19.9% (95% CI: 11.1–28.7%) during the pandemic period (Incidence Rate Ratio = 0.47; 95% CI: 0.41–0.54). The detection of influenza virus decreased absolute by 96%, respiratory syncytial virus by 65%, metapneumovirus by 95%, parainfluenza virus by 100%, human enterovirus by 96% and human bocavirus by 70% when comparing the pre-pandemic to the pandemic period. However, rhinoviruses were nearly unaffected by NPI. Co-detection (detection of more than one virus in a single symptomatic swab) was common in the pre-pandemic period (222 of 390 samples with viral detection; 56.9%) and substantially less common during the pandemic period (46 of 216 samples; 21.3%).

Conclusion

Non-pharmaceutical interventions strongly reduced the incidence of all respiratory infections in preschool children but did not affect rhinovirus.
Factors associated with damages and repair costs of reusable flexible bronchoscopes in pediatrics in China
Authors: Hu Ruixue , Chen Yanhua , Jiang Sixin , Hu Ting , Huang Juanli , Zhang Lu , Pan Wei , Yi Liangying , Huang Yan
Published: April 2024

Background

Frequent repairs of pediatric flexible bronchoscopes can lead to a huge financial burden for the hospital. This study aimed to investigate the common causes of the failures in pediatric flexible bronchoscopes and propose the measures to prevent the failures.

Methods

This was a retrospective study. We collected repair information of the pediatric flexible bronchoscopes reprocessed in the Department of Sterile Processing at a hospital between September 1, 2018 and September 1, 2022 in order to investigate the causes and possible factors associated with the failures in pediatric flexible bronchoscopes.

Results

The Department of Sterile Processing staff reprocessed the pediatric flexible bronchoscopes 4280 times. A total of 29 failures were identified. The failure rate was 0.678%. The average repair cost was USD7246.60. The common failures in the pediatric flexible bronchoscopes included dim video image, black dots, improper video image display or no image during angulation adjustment, and pressure marks in the insertion tube. The failure rates in flexible electronic bronchoscopes and small-diameter flexible bronchoscopes were 65.5% and 93.1%, respectively. The failure rate in the pediatric flexible bronchoscopes reprocessed by the staff members with less work experience was 75.9%.

Conclusion

The failure rate in the pediatric flexible bronchoscopes was not high but the repair costs were extremely high. The types and size of the flexible bronchoscopes and work experience of the staff members responsible for bronchoscope reprocessing were the possible factors associated with the failure rate in the pediatric flexible bronchoscopes. It is advisable to further optimize the central workflow and management mode for reprocessing the pediatric flexible bronchoscopes, thereby extending their useful life and reducing costs.
Clinical features of intussusception in children secondary to small bowel tumours: a retrospective study of 31 cases
Authors: Wang Li , Zhang Hanwen , Wang Dayong , Shen Qiulong , Huang Liuming , Liu Tingting
Published: April 2024

Background

Summarizing the clinical features of children with intussusception secondary to small bowel tumours and enhancing awareness of the disease.

Methods

Retrospective summary of children with intussusception admitted to our emergency department from January 2016 to January 2022, who underwent surgery and were diagnosed with small bowel tumours. Summarize the types of tumours, clinical presentation, treatment, and prognosis.

Results

Thirty-one patients were included in our study, 24 males and 7 females, with an age of onset ranging from 1 m to 11y 5 m. Post-operative pathology revealed 4 types of small intestinal tumour, 17 lymphomas, 10 adenomas, 4 inflammatory myofibroblastomas and 1 lipoma. The majority of tumours in the small bowel occur in the ileum (83.9%, 26/31). Abdominal pain, vomiting and bloody stools were the most common clinical signs. Operative findings indicated that the small bowel (54.8%, 17/31) and ileocolic gut were the main sites of intussusception. Two types of procedure were applied: segmental bowel resection (28 cases) and wedge resection of mass in bowel wall (3 cases). All patients recovered well postoperatively, with no surgical complications observed. However, the primary diseases leading to intussusception showed slight differences in long-term prognosis due to variations in tumor types.

Conclusions

Lymphoma is the most common cause of intussusception in pediatric patients with small bowel tumours, followed by adenoma. Small bowel tumours in children tend to occur in the ileum. Therefore, the treatment of SBT patients not only requires surgeons to address symptoms through surgery and obtain tissue samples but also relies heavily on the expertise of pathologists for accurate diagnosis. This has a significant impact on the overall prognosis of these patients.
Effects of scapular treatment on chronic neck pain: a systematic review and meta-analysis of randomized controlled trials
Authors: Chen Yin , Yang Chunlan , Nie Kailu , Huang Jiapeng , Qu Yun , Wang Tingting
Published: April 2024

Background

Chronic neck pain (CNP) is a common public health problem that affects daily living activities and quality of life. There is biomechanical interdependence between the neck and scapula. Studies have shown that shoulder blade function might be related to chronic neck pain. We therefore evaluated the effects of scapular targeted therapy on neck pain and function in patients with CNP.

Methods

Databases, including MEDLINE (via PubMed), EMBASE (via Ovid), Ovid, Web of Science, and Scopus, were systematically searched for randomized controlled trials published in English investigating treatment of the scapula for CNP before July 16, 2023.

Results

A total of 313 participants were included from 8 RCTs. Compared with those in the control group, the intervention in the scapular treatment group exhibited greater improvement in pain intensity (standardized mean difference (SMD) = 2.55; 95% CI = 0.97 to 4.13; P = 0.002), with moderate evidence. Subgroup analysis for pain intensity revealed a significant difference between the sexes, with only the female population (SMD = 6.23, 95% CI = 4.80 to 7.65) showing better outcomes than those with both sexes (SMD = 1.07, 95% CI = 0.57 to 1.56) (p < 0.00001). However, moderate evidence demonstrated no improvement in neck disability after scapular treatment (SMD of 0.24[-0.14, 0.62] of Neck Disability Index or Northwick Park Neck Pain Questionnaire). No effect of scapular treatment was shown on the pressure pain threshold (PPT). The cervical range of motion (CROM) and electromyographic activity of neck muscles could not be conclusively evaluated due to limited support in the articles, and further study was needed. However, the patient’s head forward posture appeared to be corrected after scapular treatment.

Conclusion

Scapular therapy was beneficial for relieving pain intensity in patients with CNP, especially in women. Head forward posture might also be corrected with scapular therapy. However, scapular therapy may have no effect on the PPT or neck disability. However, whether scapular therapy could improve CROM and cervical muscle activation in patients with CNPs had not been determined and needed further study.
Harnessing ResNet50 and SENet for enhanced ankle fracture identification
Authors: Wang Hua , Ying Jichong , Liu Jianlei , Yu Tianming , Huang Dichao
Published: April 2024

Background

Ankle fractures are prevalent injuries that necessitate precise diagnostic tools. Traditional diagnostic methods have limitations that can be addressed using machine learning techniques, with the potential to improve accuracy and expedite diagnoses.

Methods

We trained various deep learning architectures, notably the Adapted ResNet50 with SENet capabilities, to identify ankle fractures using a curated dataset of radiographic images. Model performance was evaluated using common metrics like accuracy, precision, and recall. Additionally, Grad-CAM visualizations were employed to interpret model decisions.

Results

The Adapted ResNet50 with SENet capabilities consistently outperformed other models, achieving an accuracy of 93%, AUC of 95%, and recall of 92%. Grad-CAM visualizations provided insights into areas of the radiographs that the model deemed significant in its decisions.

Conclusions

The Adapted ResNet50 model enhanced with SENet capabilities demonstrated superior performance in detecting ankle fractures, offering a promising tool to complement traditional diagnostic methods. However, continuous refinement and expert validation are essential to ensure optimal application in clinical settings.