bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Sleep Moderate the Effects of Exercise Training or Complex Mental and Social Activities on Cognitive Function in Adults With Chronic Stroke? Secondary Analysis of a Randomized Trial
Authors: Falck Ryan S , Stein Ryan G , Davis Jennifer C , Eng Janice J , Middleton Laura E , Hall Peter A , Liu-Ambrose Teresa
Published: November 2024

Background

Exercise (EX) or cognitive and social enrichment (ENRICH) are 2 strategies for promoting cognition poststroke. Whether sleep moderates the effects of EX or ENRICH on cognition in adults with chronic stroke is unknown.

Methods

A 3-arm parallel randomized clinical trial among community-dwelling adults aged 55+ years with chronic stroke (ie, ≥12 months since stroke). Participants were randomized to 2× per week EX, ENRICH, or balance and tone control (BAT). At baseline, device-measured sleep duration and efficiency were measured using wrist-worn actigraphy; self-reported quality was measured by Pittsburgh Sleep Quality Index (PSQI). Participants were categorized at baseline as having good or poor device-measured duration, device-measured efficiency, or self-reported quality based on PSQI. The primary cognitive outcome was Alzheimer’s Disease Assessment Scale Plus (ADAS-Cog-Plus) measured at baseline, 6 months (end of intervention), and 12 months (6-month follow-up). We examined if baseline sleep categorizations (ie, good vs poor) moderated the effects of EX or ENRICH on ADAS-Cog-Plus.

Results

We enrolled 120 participants in the trial (EX = 34; ENRICH = 34; BAT = 52). Sleep quality (ie, device-measured sleep efficiency or self-reported sleep quality) categorization moderated effects of EX (but not ENRICH) on ADAS-Cog-Plus. Compared with BAT participants with poor sleep quality, EX participants with poor sleep quality had better ADAS-Cog-Plus performance at 6 months (estimated mean difference for those with poor device-measured sleep efficiency: −0.48; 95% CI [−0.85, −0.10]; p = .010); estimated mean difference for those with poor self-reported sleep quality: −0.38; 95% CI [−0.70, −0.07]; p = .014). There was no effect of EX on ADAS-Cog-Plus for participants with good sleep quality. Device-measured sleep duration did not moderate intervention effects.

Conclusions

Exercise is particularly beneficial in improving cognitive function in adults with chronic stroke and poor sleep quality.
Testing the unintended cost effects of health policies for generic substitutions: the case of China’s National Volume-Based Procurement (NVBP) policy
Authors: Zhao Boya , Wu Jing , Feng Xing Lin
Published: November 2024

Generic substitutions are globally considered to contain health expenditures. Yet it is uncertain whether the costs spill over to other medicines or health services. Contextualizing China’s National Volume-Based Procurement (NVBP) policy, which promoted generic substitution, this study tests the changes in patients’ utilization of generic medicines and whether the costs shift to other pharmaceutics or health services post-policy. This population-based, matched, cohort study uses claims data from Tianjin, China in 2018–2020. We focus on amlodipine, the most commonly used calcium channel blocker with the largest procurement volume. We build comparable post-policy cohorts: Non-switchers who kept using originator amlodipine, Pure-switchers who loyally switched to generic amlodipine, and Back-switchers who switched back-and-forth; and compare between each matched pair, respectively, their annual healthcare costs and that broken down by components, and patients’ use of and adherence to amlodipine post-policy. In all, 1185 Pure-switchers, 1398 Back-switchers, and 2330 Non-switchers were identified (mean age: 63.0 years; 58.5% men). For the matched pairs, Pure-switchers (n = 772) incurred annual total medical costs of CNY 9213.5, 12.2% lower than Non-switchers [n = 1544, absolute difference CNY −1309.3, 95% confidence interval (−2645.8, −19.6)]. The cost reduction only results from amlodipine prescriptions in outpatient encounters and are equally borne by health plans and the enrolees. The costs for Pure-switchers and Non-switchers are not different from other medicines, nor from other items including tests, surgeries, beds, and medical consumables for hypertension-related encounters/admissions. Pure-switchers also had higher daily dosage and better adherence to amlodipine than Non-switchers. The differences between Back-switchers and Non-switchers show similar trends but are less profound. China’s NVBP policy is effective in controlling pharmaceutical costs. No unintended cost effects have yet been identified in the short run. Other countries may learn from China on a comprehensive set of auxiliary policies, including listing, bidding, purchasing, and reimbursing, to better promote generic substitutions.
Torturing Environment in the Documentation of Human Rights Violations in the Case of the Indigenous Rama-Kreol Communities in Nicaragua
Authors: Perez-Sales Pau , Arrieta-Betancourt Mandy Tatiana , López-Neyra Gabriela , Galán-Santamarina Andrea , Fraile-Julián Esther
Published: November 2024

ABSTRACT∞

In transitional justice processes, retrospective documentation of complex repressive environments poses significant challenges. Documenting state repression in fragile environments is challenging, especially when relying on local sources and information from vulnerable populations. This study employs a mixed-methods approach to document the Nicaraguan State’s actions against Rama-Kriol communities aimed at coercing them into accepting the construction of an Inter Oceanic Canal in their ancestral territories. The article introduces the concept of torturing environments to shed light on the multifaceted nature of low-intensity warfare against indigenous communities. Six axes of coercive actions emerged from the analysis: (a) threats to community survival, (b) assaults on physical integrity, (c) measures hindering individual and community control over their life, (d) attacks on individual and collective identity and (e) erosion of community cohesion, culture and identity. The concept of torturing environments offers unique insights into the multifaceted strategies employed in low-intensity conflicts against indigenous populations. Its application is valuable in documenting intricate contexts, especially where information is fragile and volatile, thereby contributing significantly to the search for truth and historical clarification in transitional justice efforts.
Fifty Shades of Deprivation: Disaggregating Types of Economic Disadvantage in Studies of Terrorism
Authors: Hertog Steffen , Arellano Adrian , Hegghammer Thomas , Østby Gudrun
Published: November 2024

Does economic deprivation fuel terrorist recruitment? A large empirical literature has explored this question, but the findings remain contradictory and inconclusive. We argue that this is due to inconsistencies in the way deprivation has been defined and measured. This article identifies these deficiencies and provides a roadmap toward more precise measurement of deprivation and consequently toward a better understanding of its potential impact on the emergence of terrorism. More specifically, we propose a conceptual framework that distinguishes three different dimensions of relative deprivation: individual vs. collective, objective vs. subjective, and synchronic vs. diachronic. Combining them yields eight different mechanisms that could link economic status to terrorist radicalization. Drawing inspiration from fields such as conflict studies, social psychology, and political behavior, we outline some measurement approaches that could capture the mechanisms in a targeted way. The findings have implications for how researchers should collect data and design studies as well as for how policymakers should interpret the statistical results.
Metabolic interactions of Limosilactobacillus reuteri ZJ625 and Ligilactobacillus salivarius ZJ614 in co-culture: implications for multi-strain probiotics
Authors: Kwoji Iliya Dauda , Okpeku Moses , Aiyegoro Olayinka Ayobami , Adeleke Matthew Adekunle
Published: November 2024

Aims

Limosilactobacillus reuteri ZJ625 and Ligilactobacillus salivarius ZJ614 are potential probiotic bacteria. The mechanisms of enhanced benefits by muti-strain probiotics are yet fully understood. We elucidated the influence of co-culturing on the metabolite profiles of Limosilactobacillus reuteri ZJ625 and Ligilactobacillus salivarius ZJ614 to decipher the impacts of co-culturing on metabolic interactions between the strains.

Methods and results

Limosilactobacillus reuteri ZJ625 and Ligilactobacillus salivarius ZJ614 were grown in single and co-cultures in defined media. Bacterial cell metabolites were extracted at the mid-stationary growth phase and analysed using two-dimensional gas chromatography–time-of-flight mass spectrometry (GC × GC–TOFMS). Mass-spectral data were preprocessed and analysed using unsupervised and supervised methods based on the group allocations. A total of 1387 metabolites were identified, with 18.31% significant metabolites (P < 0.05) and 10.17% differential metabolites (P < 0.05, variable importance on projection > 1). The differential metabolites identified include arabinofuranose, methyl-galactoside, N-acetylglutamic acid, phosphoric acid, and decanoic acid. The metabolites impacted carbohydrate and amino-sugar metabolism.

Conclusion

Co-culturing of Limosilactobacillus reuteri ZJ625 and Ligilactobacillus salivarius ZJ614 influenced the metabolite profiles of the strains and impacted metabolic/biosynthetic pathways, indicating cell-to-cell interactions between the strains.
Dipeptides from Lactiplantibacillus plantarum limit Pseudomonas aeruginosa pathogenesis
Authors: Narasimulu Jayanth , Baburajan Nandana , Saravanan Tamil Selvam , Raorane Chaitany Jayprakash , Vaidyanathan Vinoth Kumar , Ravichandran Vinothkannan , Rajasekharan Satish Kumar
Published: November 2024

Aims

Lactobacilli have drawn a great deal of attention due to the heterogeneity of their cells, as well as their remarkable ability to adapt to a range of harsh conditions. One such adaptation response by Lactiplantibacillus plantarum was forming a V-shaped cell structure in low acidic pH conditions. This study aims to identify low pH induced-biofilm formation in L. plantarum and Limosilactobacillus reuteri and their antagonistic interactions with an opportunistic pathogen, Pseudomonas aeruginosa PAO1.

Methods and results

Dual species bacterial interactions revealed a Lactobacilli biofilm-mediated suppression of PAO1 biofilms and pyocyanin pigment. Furthermore, filtrates from Lactobacilli grown at low acidic pH (pH 3.5) effectively arrest the pathogenesis of P. aeruginosa PAO1, including biofilm, swarming motility, and pyocyanin formation. Liquid chromatography-mass spectroscopy analysis revealed the presence of several Lactobacilli-secreted metabolites and dipeptides that exhibited strong LasR receptor antagonistic interactions in molecular docking analysis. Prolyl-tyrosine showed the best lasR antagonistic and PAO1 biofilm inhibitory activities of the identified dipeptides.

Conclusion

Overall, the results will contribute to the development of anti-infective drugs against P. aeruginosa using Lactobacilli secreted dipeptides. Furthermore, the investigation identifies several dipeptides that can be extracted from V-shaped Lactobacilli for antimicrobial protein therapy against P. aeruginosa and other pathogens.
Influence of endoxifen on mammographic density: results from the KARISMA-Tam trial
Authors: Hammarström Mattias , Gabrielson Marike , Bergqvist Jenny , Lundholm Cecilia , Crippa Alessio , Bäcklund Magnus , Wengström Yvonne , Borgquist Signe , Eliasson Erik , Eriksson Mikael , Tapia José , Czene Kamila , Hall Per
Published: November 2024

Background

Monitoring metabolites of tamoxifen, such as endoxifen, has been suggested as a strategy to ascertain therapeutic effect of tamoxifen therapy, but clinical guidelines are missing. Herein, we aim to investigate the outcome of endoxifen concentrations of low-dose tamoxifen, using change in mammographic breast density as a proxy for therapy response.

Methods

In the randomized KARISMA-Tam (Karolinska Mammography project for risk prediction of breast cancer -Intervention Study with Tamoxifen) trial, including 5 doses of tamoxifen, measurements of plasma endoxifen concentrations, determination of CYP2D6 metabolizer status, and mammographic breast density change over the trial period were carried out. Association between endoxifen concentrations and relative mammographic breast density change after 6 months treatment was analyzed using linear regression in a spline model.

Results

A total of 824 women (335 premenopausal, 489 postmenopausal) were included. In analyses of premenopausal women, a spline model described a mammographic breast density decrease, equivalent to the mean (−18.5%) seen in women exposed to 20 mg tamoxifen, at endoxifen concentrations of 2-3 ng/mL. The mammographic breast density decrease reached a nadir at endoxifen levels of 3 ng/mL and did not decrease further at higher endoxifen concentrations. Most intermediate and normal tamoxifen metabolizers (about 90% of all participants) reached an endoxifen concentration of more than 2 ng/mL at tamoxifen doses of 5 and 10 mg. No mammographic breast density decrease was seen in the postmenopausal group.

Conclusions

We have identified a possible window of effect on mammographic breast density at endoxifen concentrations of 2-3 ng/mL in premenopausal women, which corresponds to the doses of 5 and 10 mg tamoxifen. Because mammographic breast density change was used as a surrogate marker for therapy response, results should be confirmed using clinically established outcomes measures.
Context and Background
Authors: Wolanski Adam , Simon-Shore Victoria
Published: November 2024

This introductory chapter considers the development and scope of the law of privacy in this jurisdiction. The chapter opens with a concise summary of the impact that the Human Rights Act 1998 (HRA) had on the common law development of the law of privacy. Section B provides a brief overview of the various pre-HRA reviews and proposals commissioned by former governments in relation to the historic absence of a free-standing right to privacy. In Section C, the authors set out the pre-HRA piecemeal protections of privacy in common law and equity, namely: trespass, wrongful interference with goods, nuisance, breach of confidence, defamation, malicious falsehood, privilege of witnesses, and the principle of necessity. This section also looks at the protections of privacy found in the Family Courts, the Court of Protection, and criminal law. Section D provides a detailed analysis of the impact of the HRA on media cases where Articles 8 and 10 ECHR are engaged. Section E sets out other legislative protections for privacy and confidentiality and Section F briefly considers the Codes of Practice which apply to the media. Finally, in Section G, the chapter considers the future of privacy law in the context of social media and the internet.
Remedies
Authors: Moreham N A , Speker Adam
Published: November 2024

This chapter examines the remedies available for threatened or actual breaches of privacy by the media. After the introduction in Section A, Section B considers s 12 HRA, which applies whenever a remedy is considered which might affect the exercise of freedom of expression. Section C discusses injunctive relief in privacy cases under various heads of claim. In misuse of private information, an injunction is often the primary remedy sought (frequently at the interim stage) bringing s 12 HRA into play. Final injunctions are also discussed in this section. Section D addresses damages, including their availability in principle, the different considerations which apply to pecuniary and non-pecuniary losses, the availability of aggravated and exemplary damages, and mitigation of damage. Remedies of less general application are considered in Section E, especially the availability of restitutionary remedies across the various types of privacy claim. 
Planet migration in windy discs
Authors: Wu Yinhao , Chen Yi-Xian
Published: November 2024

Accretion of protoplanetary discs (PPDs) could be driven by magnetohydrodynamic disc winds rather than turbulent viscosity. With a dynamical prescription for angular momentum transport induced by disc winds, we perform 2D simulations of PPDs to systematically investigate the rate and direction of planet migration in a windy disc. We find that the the strength of disc winds influences the corotation region similarly to the ‘desaturation’ effect of viscosity. The magnitude and direction of torque depend sensitively on the hierarchy between the radial advection time-scale across the horseshoe due to disc wind $\tau _{\rm dw}$, the horseshoe libration time-scale $\tau _{\rm lib}$ and U-turn time-scale $\tau _{\rm U-turn}$. Initially, as wind strength increases and the advection time-scale shortens, a non-linear horseshoe drag emerges when $\tau _{\rm dw} \lesssim \tau _{\rm lib}$, which tends to drive strong outward migration. Subsequently, the drag becomes linear and planets typically still migrate inward when $\tau _{\rm dw} \lesssim \tau _{\rm U-turn} \sim \tau _{\rm lib}h$, where h is the disc aspect ratio. For a planet with mass ratio of ${\sim} 10^{-5}$, the zone of outward migration sandwiched between inner and outer inward migration zones corresponds to $\sim$10–100 au in a PPD with accretion rates between $10^{-8}$ and $10^{-7}\, \mathrm{ M}_\odot \text{yr}^{-1}$.
Mineralocorticoid receptor antagonism attenuates arteriovenous fistula stenosis by modulating the phenotype of vascular smooth muscle cells
Authors: Liu Yamin , Chen Bohan , Chen Kai , Wang Yufei , Zhou Chunyu , Liang Xianhui , Wang Kai , Wang Pei
Published: November 2024

Background

Fistula stenosis is a primary contributor to arteriovenous fistula (AVF) failure in maintenance hemodialysis patients. Emerging data indicated excessive fibrotic remodeling was the primarily contributor to fistula stenosis during AVF remodeling. The mineralocorticoid receptor (MR) has been implicated in vascular remodeling across various cardiovascular pathologies. However, its role in AVF remodeling, particularly concerning fibrotic remodeling, remains elusive.

Methods

MR expression and the phenotypes of vascular smooth muscle cells (VSMC) were assessed in dysfunctional AVF. The effects of MR on VSMC phenotypic switching were examined in vitro, and the protective effects of MR antagonists on AVF outcome were evaluated in a rat AVF model.

Results

Dysfunctional fistula exhibited significant medial fibrosis and extracellular matrix deposition, alongside markedly increased MR activity. In the dysfunctional fistula vessels, VSMC displayed reduced expression of the contractile marker SMMHC and features characteristic of a synthetic phenotype, including increased osteopontin expression and heightened proliferation. In vitro studies with cultured VSMC revealed that MR overactivity induced by aldosterone led to phenotypic switching from contractile to synthetic state, concomitant with EGFR-ERK1/2 pathway overactivation. These effects were largely abolished by the MR antagonist finerenone. Knockdown of EGFR expression abrogated ERK1/2 phosphorylation and inhibited the VSMC phenotypic switching. Conversely, ectopic overexpression of EGFR in VSMC diminished the protective effect of finerenone. In rat AVF models, pharmacologic targeting of MR with finerenone significantly improved AVF outcomes, characterized by increased luminal diameters and flow volume, reduced medial fibrosis, and inhibited VSMC phenotypic switching. These beneficial outcomes were likely attributable to a restrained activity of the EGFR-ERK1/2 pathway in VSMC.

Conclusions

Our study demonstrated that therapeutic targeting of MR may improve AVF outcome by modulating VSMC phenotypic switching. These findings offer promising avenues for further clinical investigations aimed at optimizing AVF outcomes in the hemodialysis population.
Integrative study of lung cancer adeno-to-squamous transition in EGFR TKI resistance identifies RAPGEF3 as a therapeutic target
Authors: Wang Hua , Tang Shijie , Wu Qibiao , He Yayi , Zhu Weikang , Xie Xinyun , Qin Zhen , Wang Xue , Zhou Shiyu , Yao Shun , Xu Xiaoling , Guo Chenchen , Tong Xinyuan , Han Shuo , Chou Yueh-Hung , Wang Yong , Wong Kwok-Kin , Yang Cai-Guang , Chen Luonan , Hu Liang , Ji Hongbin
Published: November 2024

Although adeno-to-squamous transition (AST) has been observed in association with resistance to epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor (TKI) in clinic, its causality, molecular mechanism and overcoming strategies remain largely unclear. We here demonstrate that squamous transition occurs concomitantly with TKI resistance in PC9-derived xenograft tumors. Perturbation of squamous transition via DNp63 overexpression or knockdown leads to significant changes in TKI responses, indicative of a direct causal link between squamous transition and TKI resistance. Integrative RNA-seq, ATAC-seq analyses and functional studies reveal that FOXA1 plays an important role in maintaining adenomatous lineage and contributes to TKI sensitivity. FOXM1 overexpression together with FOXA1 knockout fully recapitulates squamous transition and TKI resistance in both PC9 xenografts and patient-derived xenograft (PDX) models. Importantly, pharmacological inhibition of RAPGEF3 combined with EGFR TKI efficiently overcomes TKI resistance, especially in RAPGEF3high PDXs. Our findings provide novel mechanistic insights into squamous transition and therapeutic strategy to overcome EGFR TKI resistance in lung cancer.
α/β hydrolase domain-containing protein 1 acts as a lysolipid lipase and is involved in lipid droplet formation
Authors: Torres-Romero Ismael , Légeret Bertrand , Bertrand Marie , Sorigue Damien , Damm Alicia , Cuiné Stéphan , Veillet Florian , Blot Carla , Brugière Sabine , Couté Yohann , Garneau Matthew G , Kotapati Hari K , Xin Yi , Xu Jian , Bates Philip D , Thiam Abdou R , Beisson Fred , Li-Beisson Yonghua
Published: November 2024

Lipid droplets (LDs) are the major sites of lipid and energy homeostasis. However, few LD biogenesis proteins have been identified. Using model microalga Chlamydomonas, we show that ABHD1, an α/β-hydrolase domain-containing protein, is localized to the LD surface and stimulates LD formation through two actions: one enzymatic and one structural. The knockout mutants contained similar amounts of triacylglycerols (TAG) but their LDs showed a higher content of lyso-derivatives of betaine lipid diacylglyceryl-N,N,N-trimethylhomoserine (DGTS). Over-expression of ABHD1 increased LD abundance and boosted TAG content. Purified recombinant ABHD1 hydrolyzed lyso-DGTS, producing a free fatty acid and a glyceryltrimethylhomoserine. In vitro droplet-embedded vesicles showed that ABHD1 promoted LD emergence. Taken together, these results identify ABHD1 as a new player in LD formation by its lipase activity on lyso-DGTS and by its distinct biophysical property. This study further suggests that lipases targeted to LDs and able to act on their polar lipid coat may be interesting tools to promote LD assembly in eukaryotic cells.
Searching for Immunocompromising Conditions in Low-risk Adults After Invasive Pneumococcal Disease: An Opportunity to Uncover Multiple Myeloma Early
Authors: Maestro de la Calle Guillermo , Mateo Flores Javier , Brañas Patricia , Viedma Esther , Lumbreras Bermejo Carlos
Published: November 2024

There is a paucity of data on the prevalence of newly diagnosed immunosuppressive conditions following a first invasive pneumococcal infection (IPI) in adults considered to be at low risk for it. A total of 352 IPIs were reviewed over a 7-year period, with 39 (11.1%) ultimately analyzed. A 3.4-year follow-up period revealed that 4 patients (10.3%) had been diagnosed with immunosuppressive conditions. Of these, 3 had been diagnosed with multiple myeloma (MM). These findings indicate that in adults who experience a first IPI and are at low risk for it, MM should be strongly considered and addressed as early as possible.
Epigenetic memory of temperature sensed during somatic embryo maturation in 2-yr-old maritime pine trees
Authors: Trontin Jean-François , Sow Mamadou Dia , Delaunay Alain , Modesto Ines , Teyssier Caroline , Reymond Isabelle , Canlet Francis , Boizot Nathalie , Le Metté Claire , Gibert Audrey , Chaparro Cristian , Daviaud Christian , Tost Jörg , Miguel Celia , Lelu-Walter Marie-Anne , Maury Stéphane
Published: November 2024

Embryogenesis is a brief but potentially critical phase in the life cycle of a tree for adaptive phenotypic plasticity. Using somatic embryogenesis in maritime pine (Pinus pinaster Ait.), we found that temperature during the maturation phase affects embryo development and postembryonic tree growth for up to 3 yr. We examined whether this somatic stress memory could stem from temperature- and/or development-induced changes in DNA methylation. For this, we developed a 200 mb custom sequence capture bisulfite analysis of genes and promoters to identify differentially methylated cytosines (DMCs) between temperature treatments (18, 23, and 28 °C) and developmental stages (immature and cotyledonary embryos, shoot apical meristem of 2-yr-old plants) and investigate if these differences can be mitotically transmitted from embryonic to postembryonic development (epigenetic memory). We revealed a high prevalence of temperature-induced DMCs in genes (8% to 14%) compared to promoters (<1%) in all 3 cytosine contexts. Developmental DMCs showed a comparable pattern but only in the CG context and with a strong trend toward hypomethylation, particularly in the promoters. A high percentage of DMCs induced by developmental transitions were found memorized in genes (up to 45%–50%) and promoters (up to 90%). By contrast, temperature-induced memory was lower and confined to genes after both embryonic (up to 14%) and postembryonic development (up to 8%). Using stringent criteria, we identified 10 genes involved in defense responses and adaptation, embryo development, and chromatin regulation that are candidates for the establishment of a persistent epigenetic memory of temperature sensed during embryo maturation in maritime pine. Here, we provide evidence that DNA methylation marks established during the embryonic phase are transmitted to the postembryonic plant development phase.
Risk factors of severe Chlamydia trachomatis pneumonia in children: a retrospective case-control study
Authors: Chen Wenfeng , Dong Hongba , Yang Xiaoqing
Published: November 2024

This study explored the clinical characteristics of Chlamydia trachomatis (C. trachomatis) pneumonia in children and the risk factors for severe C. trachomatis pneumonia. This retrospective case-control study included children with C. trachomatis pneumonia who were admitted to the Department of Pediatrics, Women and Children’s Hospital, School of Medicine, Xiamen University (Xiamen, China) between January 2018 and December 2021. Among 117 children, 33 (28.2%) had severe C. trachomatis pneumonia and 84 children had mild-to-moderate C. trachomatis pneumonia. According to the results of the binary logistic regression analysis, congenital heart disease [odds ratio (OR) = 0.09, 95% confidence interval (CI): 0.01–0.74, P-value = .024], mixed infection (OR = 0.17, 95%CI: 0.05–0.51, P-value = .002), white blood cell count greater than 15 000 cells/dl (OR = 1.20, 95%CI: 1.03–1.40, P-value = .022), and partial pressure of carbon dioxide (PaCO2) (OR = 1.14, 95%CI: 1.02–1.26, P-value = .016) were found as independent predictive factors for severe C. trachomatis pneumonia in children. This study explored key risk factors for severe C. trachomatis pneumonia, a condition underreported in tropical regions where pediatric respiratory infections are a leading cause of morbidity and mortality. By identifying risk factors, such as congenital heart disease, mixed infections, and elevated PaCO2, this research may guide early intervention strategies in resource-limited settings, potentially reducing pediatric pneumonia deaths.
Perception and preparedness of physicians in public-sector hospitals of LMICs during the COVID-19 pandemic: a phenomenology-based qualitative study
Authors: Khadka Sitaram , Hashmi Furqan K. , Gupta Ravi P. , Aryal Pallav
Published: November 2024

Background:

Amid such a global chaotic scenario generated by the COVID-19 pandemic, physicians hold a significant frontline position in the health care system. The current study was designed to explore the perception and preparedness of physicians toward the COVID-19 pandemic and their patient assessment and management aspects.

Methods:

A total of 11 physicians were purposively interviewed. All the interviews were audio-taped, transcribed verbatim, and subjected to thematic content analysis.

Results:

Thematic content analysis yielded six major themes: familiarity with COVID-19, perceptions and attitudes toward COVID-19, preparedness for safety against COVID-19, case assessment, barriers to lifestyle, and psychological perspectives. Even in resource-limited settings with the scarcity of sufficient protective equipment and first-line medicines, the physicians provided patient care. They demonstrated intact self-esteem and better understanding and preparedness for COVID-19.

Conclusions:

The findings demand timely and adequate provision of personal protection equipment, availability of first-line medicines, as well as development and implementation of occupational health surveillance measures that ensure mental health well-being.
Effectiveness of individualized counseling in reducing leave against medical advice among neurosurgical patients in the emergency department
Authors: Mishra Aakash , Pokhrel Bibesh , Thapa Amit
Published: November 2024

Objective:

Leave against medical advice (LAMA) in the emergency department (ED) is a significant challenge in low- and middle-income countries, often leading to higher rates of readmission, increased mortality, and disrupted continuity of care. This study aimed to evaluate the effectiveness of individualized counseling in reducing LAMA incidents among neurosurgical patients in the ED.

Materials and Methods:

This quality improvement study employed a prospective case-control design to compare LAMA rates between patients who received individualized counseling and those who did not. A “nursing-coordinator program” was introduced, focusing on patient communication and engagement. Trained staff followed a standardized checklist to address the concerns of patients and their caregivers, providing “individualized counseling.” Data collected after the intervention were compared with retrospective pre-intervention data, and the results were analyzed.

Results:

A total of 554 patients, ranging from 1 to 94 years of age, were included in the study, with 60.5% being male. Among the 353 patients who received the “individualized counseling” intervention, 60 opted for LAMA (study group), compared to 49 LAMA cases out of 201 patients who did not receive counseling (control group). The LAMA rate significantly decreased from 24.4% to 16.9% post-intervention (P = 0.035). The “individualized counseling” intervention effectively reduced LAMA due to factors such as misinformation about disease severity (P = 0.009), economic constraints (P < 0.001), and poor prognosis (P < 0.001). However, it was less effective for reasons like proximity to home (P = 0.007), inadvisable transfers for personal reasons (P = 0.023), and family problems (P = 0.293).

Conclusions:

This study demonstrates that individualized counseling is an effective intervention for reducing LAMA among neurosurgical patients in the ED. By addressing non-medical factors often overlooked due to inadequate counseling, this quality improvement strategy can help prevent vulnerable patients from prematurely terminating their treatment.
Utilizing T-Line Mesh for Periumbilical Hernia Repair: Evaluation of Short-term Outcomes
Authors: Lu Charles , Cassidy Jillian , Embel Veysel , Ouellette Taylor , Arumugam Dena , Kipnis Seth
Published: November 2024

Background:

Abdominal periumbilical hernias are prevalent within the adult population. When symptomatic, quality of life may be affected. This case series of 10 patients evaluates the short-term outcomes of using the T-Line mesh in periumbilical hernia repair.

Methods:

A retrospective review of adult patients with symptomatic periumbilical abdominal hernia treated with open repair with T-Line mesh was performed at a tertiary referral center. Ten patients with an average age of 51 years were offered surgical treatment. Measures of postoperative outcomes included readmission within the 30-day postoperative period; recurrence; surgical site infection; development of seroma and hematoma; and the presence of pain, numbness, or bloating. Descriptive statistics were computed in Microsoft Excel.

Results:

All 10 patients reported improvement in symptoms. All repairs were elective and classified as clean (100%). Hernias included 40% primary umbilical, 50% ventral, and 10% incisional. The average defect size was 10 cm2, with a range from 1 to 25 cm2. The T-Line mesh was placed in a sublay manner, with an average mesh size of 36 cm2. No patients were readmitted in the 30-day postoperative period. There were no occurrences of surgical site infection or hernia recurrence. No hospital readmissions and no follow-up visits with hernia recurrence were noted at 3 months.

Conclusions:

We present a case series of 10 patients presenting with symptomatic periumbilical hernias who underwent repair with the T-Line hernia mesh without short-term surgical occurrences. Long-term studies are required to accurately reflect safety and efficacy.
Religiosity, Spirituality, Meaning-Making, and Suicidality in Psychiatric Patients and Suicide Attempters: A Systematic Review and Meta-Analysis
Authors: van den Brink Bart , Roodnat Rianne , Rippe Ralph C.A. , Cherniak Aaron D. , van Lieshout Kenny , Helder Sanne G. , Braam Arjan W. , Schaap-Jonker Hanneke
Published: November 2024

Learning Objective

After participating in this CME activity, the psychiatrist should be better able to:

• Explain current understanding of how religiosity, spirituality, and meaning-making (R/S/M) affect patients with psychiatric diagnoses.

Introduction

R/S/M generally protect against suicidality and suicide. Thus far, reviews on the topic have largely been descriptive, and there are no meta-analyses focused on psychiatric patients. This study systematically evaluates all empirical evidence on R/S/M’s potential influences on suicidality for psychiatric patients and recent suicide attempters.

Methods

A systematic PROSPERO preregistered search following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol was performed in MEDLINE and PsycInfo. Quantitative studies until 31 December 2022 on R/S/M and suicidality in psychiatric populations and recent suicide attempters were selected; psychological autopsy studies were excluded.

Results

The search identified 4,374 studies for screening. This resulted in 108 eligible studies for the systematic review and 75 studies for the meta-analysis, including 231 effect sizes (ES) and 17,561 subjects. Research focused mainly on the emotional, moral, and ritual aspects of R/S/M. Most research was cross-sectional; repeated R/S/M assessments were rarely reported. A combined significant and negative ES (Fisher Z = -0.13, p = .006, equivalent to Cohen's d = -0.26) was found for all good- and fair-quality studies.

Conclusion

Overall, R/S/M was associated with lowering suicidality. Maladaptive-distressing dimensions of R/S/M correlated with higher rates of suicidality (e.g., religious struggles). The explanatory value was limited by the predominantly cross-sectional nature of ESs.

Registration and funding

PROSPERO registration 2023 CRD42023398692; there was no funding involved.
Challenges and outcomes of cataract surgery after vitrectomy
Authors: Lee Bryanna J. , Jun Jong Hwa , Afshari Natalie A.
Published: November 2024

Purpose of review

This review examines the challenges and outcomes of cataract surgery after pars plana vitrectomy (PPV), focusing on surgical techniques, timing, and complication management.

Recent findings

Cataract formation remains the primary complication post-PPV, affecting approximately 80–100% of patients within two years. Nuclear sclerotic cataracts are most common, occurring in 60–100% of patients over 50, followed by posterior subcapsular cataracts (4–34%), which primarily affect younger and diabetic patients. PPV disrupts the normal oxygen gradient in the vitreous, resulting in a more uniform oxygen distribution and accelerating cataract formation.

Post-PPV eyes present unique surgical challenges due to anatomical alterations, including zonular instability and capsular changes characterized by increased fragility, the potential for tears, and altered elasticity. Newer intraocular lens power calculations show promise, but unexpected refractive outcomes may occur. The choice between combined phacovitrectomy and sequential surgeries remains debated, with patient-specific factors guiding the approach. Visual outcomes vary depending on preexisting vitreoretinal pathologies and baseline vision before PPV. Further randomized controlled trials are needed to establish treatment guidelines and improve predictive models.

Post-PPV cataract surgery presents unique challenges, including anatomical alterations and an increased risk of capsular complications. These necessitate careful consideration of the surgical approach and highlight the need for further research to optimize outcomes and establish treatment guidelines.
A comprehensive update on over the counter artificial tears
Authors: Simon Lilla , Murillo Brian A. , Sabater Alfonso L.
Published: November 2024

Purpose of review

Artificial tears play a critical role in the management of dry eye disease (DED), providing patient symptomatic relief and improving ocular surface health. Its clinical importance has driven pharmaceutical innovation in terms of its formula and ingredients. The following article is an overview of the artificial tear products on the market.

Recent findings

The artificial tears on the market vary in terms of their active ingredients, inactive ingredients, preservatives, and formulation. The particular chemical composition of ingredients and formulation plays a clinical role in treating ocular pathology. Conversely, certain ingredients can cause more ocular damage than other ingredients.

Upon review of the artificial tears on the market, the authors conclude that clinicians should consider the products’ composition when designating a treatment for DED. Different artificial tear composition may benefit specific causes of DED such as evaporative, aqueous-deficient, glaucoma, ocular surface tumors, corneal ulcers, and viral conjunctivitis.
SpaceOAR Persistence on MRI at 59 Weeks Postplacement in a Patient With Stage IV CKD
Authors: Driscoll Conor B. , Lee Ziho , Ross Ashley , Kundu Shilajit
Published: November 2024

External beam radiation therapy is commonly used to treat prostate cancer, and gel spacers such as SpaceOAR Hydrogel (Boston Scientific, Marlborough, MA) are approved to limit local rectal radiation toxicity. SpaceOAR is usually reabsorbed in 12 to 24 weeks and excreted renally. It has a known low rate of rectourethral fistula that is usually associated with ectopic placement into the rectal wall. We present a case of a SpaceOAR Hydrogel insert persisting in a patient with chronic kidney disease on serial MRI scans for 59 weeks after placement with colovesical fistula development 81 weeks after placement of unclear association.
Congenital Cytomegalovirus Infection and Hearing Loss: It’s Time to Screen
Authors: Nishikawa Javier K. , Sánchez Pablo J.
Published: November 2024

Congenital CMV infection is the leading nongenetic cause of sensorineural hearing loss worldwide, yet most parents have never heard of it. The majority of infected newborns have no clinical signs of infection, although a substantial proportion may have hearing loss at birth or develop it later in life. As antiviral treatment with ganciclovir or valganciclovir initiated in the first month of age improves audiologic outcomes, there is an urgent need for timely identification of infected neonates. A targeted approach that tests neonates who refer on the newborn hearing screen has been implemented in many states and hospital programs, but it fails to identify about 40% of children who experience CMV-related hearing loss. A universal screening approach is optimal given the prevalence of congenital CMV infection, its associated sequelae, the availability of a simple saliva screening tool, the available antiviral treatment, and the directed therapies for hearing impairment.
Assessment of Electrically Evoked Stapedius Reflex Threshold (eSRT) for Auditory Mapping in Pulse Width Modulation Cochlear Implants: The Effect of Multielectrode Stimulation
Authors: Martins Pedro Goiana , Luís Leonel , Segovia-Martinez Manuel , Molaee-Ardekani Behnam
Published: November 2024

Objective

This study assesses the electrically evoked stapedius reflex threshold (eSRT) as an objective method for generating auditory maps in individuals with pulse-width-modulation cochlear implants (CIs). It investigates the impact of both single- and multiple-electrode stimulations on eSRT detection rates and their association with patients' comfort loudness levels (C-levels). Despite eSRT exploration by several CI brands incorporating pulse-amplitude-modulation stimulation technology, there is a lack of information on systems using pulse-width modulation.

Approach

The eSRT was measured in 19 ears ipsilaterally and contralaterally in response to stimulations in groups of 1, 3, and 5 electrodes across five distinct cochlear regions, spanning from apical to basal. For each group, the eSRT detection rate and its correlation with the C-levels were analyzed both regionally and overall.

Main results

In both contralateral and ipsilateral sides, higher electrically evoked stapedius reflex (eSR) detection rates were obtained for multielectrode (67%, 47%) than for single-electrode (41%, 23%) stimulation. Invoking eSR in the apical and basal regions was easier than in the middle region. The multiple stimulation just increased slightly the correlation coefficients between eSRT and C-levels from 0.73 to 0.77 and from 0.77 to 0.85 (p < 0.05) for the contralateral and ipsilateral ears, respectively.

Significance

Our research indicates that using a multielectrode stimulation approach enhances the detection rate of eSRT and slightly improves the correlation coefficient between eSRT and C-levels. It is found preferable to obtain measurements from the contralateral side due to its higher detection rate, although the ipsilateral side yields a marginally higher correlation coefficient. The findings suggest that eSRTs obtained from pulse width modulation implants could aid audiologists in programming the device.
Intraoperative Acoustic Monitoring Using Threshold and Suprathreshold Pure Tone Audiometry during Cochlear Implantation Under Local Anesthesia: A Simple and Novel Method to Potentially Enhance Hearing Preservation Cochlear Implant Surgery
Authors: Khandalavala Karl R. , Ostlie Sarah E. , Wallerius Katherine P. , Lohse Christine M. , Lohmann Amanda R. , Ladsten Max M. , Carlson Matthew L.
Published: November 2024

Objective

To report the feasibility and potential utility of monitoring acoustic hearing on awake patients using intraoperative behavioral responses to threshold and suprathreshold stimuli while undergoing cochlear implantation (CI) under local anesthesia, without any form of sedation.

Study Design

Retrospective review of the first five cases performed by one surgeon.

Setting

Tertiary care academic medical center.

Patients

Adult patients with residual acoustic hearing undergoing CI.

Interventions

CI under local anesthesia, without any form of sedation.

Main Outcome Measures

Procedural tolerance, reliability of intraoperative pure tone threshold and suprathreshold audiometry, and correlation of intraoperative findings with early postoperative residual hearing.

Results

Five ears in four patients underwent CI, including three males and one female, with a median age of 61 years. Intraoperatively, patients reported reliable behavioral responses to pure tone threshold and suprathreshold stimuli and provided real-time feedback on perceived stimulus change to the surgeon just prior to, during, and immediately following electrode insertion. All patients were able to complete the operation under local anesthesia. During electrode insertion, three cases reported no change and two cases reported diminished stimulus perception that reversed with limited electrode pull back near terminal insertion. Immediate postoperative audiograms demonstrated preservation of bone conduction thresholds within 10 dB of their preoperative baseline for all cases, suggesting hearing preservation. Three-month postoperative AzBio in quiet scores were available for two patients, measuring 45% and 94%, respectively.

Conclusions

This report describes the feasibility of intraoperative behavioral audiometry during CI under local anesthesia, using patient feedback during electrode insertion to optimize hearing preservation surgery. Akin to other surgical subspecialties that use real-time patient feedback where objective intraoperative measures of neurofunction are imperfect, we demonstrate feasibility and potential utility of live acoustic monitoring during CI.
Progress in dysphagia management in older patients
Authors: Lueg Gero , Pourhassan Maryam , Wirth Rainer
Published: November 2024

Purpose of review

The review summarizes current knowledge, recent findings and knowledge gaps about the pathophysiology and therapy of oropharyngeal dysphagia in older persons.

Recent findings

Oropharyngeal dysphagia is a major yet underrecognized health problem in older persons. Due to its high prevalence, its multifactorial etiology and multimodal treatment it has been classified as a geriatric syndrome. Although the knowledge of its pathophysiology and the effective diagnostic approach increased substantially during the last years, there is still minor evidence on how to effectively manage and treat dysphagia. However, treatment should be a multicomponent approach, combining swallowing training, nutritional therapy and oral hygiene. Emerging new fields are neurostimulation and chemical sensory stimulation which may be added in selected patients and indications. The individual components to be chosen should be based on the individual dysphagia pattern and severity as well as the capabilities of the patient. Frequently, the competing risks of inadequate nutrition and unsafe swallowing represent a challenge in determining the individual relevance of each component.

The understanding of the pathophysiology of oropharyngeal dysphagia increased substantially during recent years. However, due the multifaceted appearance of dysphagia, which requires an individualized treatment, the evidence for therapeutic approaches increases rather slowly.
Protein requirement in obesity
Authors: Weijs Peter J.M.
Published: November 2024

Purpose of review

The combined obesity and ageing pandemic require action to avoid a total health system infarct. Obesity is largely challenged with caloric restriction and endurance exercise, likely to be assisted by drugs. The older adults with the highest obesity levels may face extreme loss of muscle mass and increased risk of sarcopenic obesity.

Within this context the question of what is the protein requirement is extremely urgent.

Recent findings

While the topic is essential, no trials have directly assessed protein requirements for obesity. Therefore, we will have to deal with more indirect evidence. Several systematic reviews have appeared for obesity treatment involving protein and a few randomized controlled trials during weight loss are worth mentioning considering the amount of protein needed, especially with increasing age.

Protein requirements are hard to derive for obesity defined by BMI over 30 perse. During weight loss the rebuilding of the body is likely to need at least 1.2 g/kg body weight/d with a maximum weight of BMI 30, especially in the aged. Obesity might increase protein requirements, however being obese with a healthy and active lifestyle might result in normal protein requirements.