bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Pelvic Floor Muscle Training on Pelvic Floor Muscle Function and Symptoms of Dysfunction in Women Post Obstetric Anal Sphincter Injury (Oasis): Study Protocol for a Randomized Controlled Trial
Authors: de Amorim Amanda Cruz , Lima Talita Vasco de Oliveira , Frate Beatriz Nogueira de Carvalho , Sartori Marair Gracio Ferreira , Group GPAP Study
Published: July 2024

Background: Pelvic floor disorders encompass several problems resulting from inadequacies in the pelvic floor muscles (PFM), especially after childbirth. Obstetric Anal Sphincter Injury (OASIS) is a complication of vaginal birth that can significantly affect the quality of life of these women. Factors related to the pregnant woman, childbirth, and the newborn can increase the risk of developing OASIS. The primary physical therapy intervention for pelvic floor disorders is PFM training, created by Kegel in 1948.
Methods: This study encompasses a prospective, randomized clinical trial design with parallel groups. Women diagnosed with OASIS are recruited within 60 days of giving birth. The control group receives standard postpartum care, and the intervention group receives standard care plus a PFM training program for 12 weeks. Participants are assessed in three in-person and two online sessions throughout the study. The study is conducted at a single center.
Discussion: This study aims to investigate the effect of PFM training in postpartum women with OASIS on PFM function and pelvic floor disorder symptoms. PFM training is expected to improve PFM function, reduce pelvic floor disorder symptoms, and provide an effective therapeutic option for postpartum women with anal sphincter injuries. This study provides significant results on the effectiveness of PFM training as an intervention for women with OASIS, contributing to improving the quality of life of these patients. This research protocol aims to fill a gap in scientific knowledge regarding the treatment of women with OASIS by providing solid evidence on the effectiveness of PFM training in this specific population. Trial registration: Brazilian Registry of Clinical Trials (ReBEC) (registration number: RBR-32z6gw2, registered 4 April 2024). Study protocol version 1.
The potential use of plasma NfL as a diagnostic and prognostic biomarker of fatigue in early Parkinson’s disease
Authors: Shang Huifang , Che Ning-Ning , Huang Jingxuan , Wang Shichan , Jiang Qirui , Yang Tianmi , Xiao Yi , Lin Junyu , Fu Jiajia , Ou Ruwei , Li Chunyu , Wei Qianqian , Zhao Bi , Chen Xueping
Published: July 2024

Background Fatigue is a prevalent non-motor symptom that often appears in the early stages of Parkinson’s disease (PD). Plasma neurofilament light chain (NfL) was elevated in PD patients and may be considered a potential biomarker for both motor and cognitive progression. In this study, we explored the association between plasma NfL levels and various fatigue subtypes and the prediction of baseline plasma NfL levels for fatigue subtype conversion.
Methods Patients with PD were classified into four categories: persistent fatigue, never fatigue, non-persistent fatigue, and new-onset fatigue. They underwent detailed neurological evaluations at baseline and a two-year follow-up. Plasma NfL, GFAP, p-tau181, Aβ42, and Aβ40 levels in both PD patients and control subjects were measured using an ultrasensitive single molecule array.
Results The study enrolled 174 PD patients and 95 control subjects. Plasma NfL levels were significantly higher in the persistent fatigue group compared to the never fatigue group at the two-year follow-up (P＜0.05). Longitudinally, 45.16% of baseline fatigue patients converted to non-fatigue at two-year follow-up. Additionally, 22.12% of patients initially without-figure patients converted to fatigue patients at two-year follow-up. Baseline plasma NfL levels were significantly higher in both the persistent fatigue and new-onset fatigue groups compared to the never fatigue group (P＜0.05). Higher baseline plasma NfL levels were significantly associated with the conversion to the non-fatigue subtype (OR=1.127, P=0.034) after adjusting for confounders.
Conclusion Baseline plasma NfL levels may serve as a biomarker for predicting fatigue subtype conversion and the progression of fatigue in PD.
Parental knowledge, attitude, and practice on self-medication of antibiotics for children in Bandung, Indonesia: A questionnaire-based survey and module-based learning intervention
Authors: Pitaloka Dian Ayu Eka , Insyirah Ariani , Oktariani Anisa Nabilah , Mardhiyyah Cut Ainul , Alfarafisa Nayla Majeda
Published: July 2024

Background
Parents' role as primary decision-makers in medication administration is essential to ensuring proper antibiotic use. Despite its significance, only a few studies have delved into parental perspectives. Therefore, this study used a questionnaire-based survey and a module-based learning intervention to assess Indonesian parental knowledge, attitude, and practice related to antibiotic use in pediatric care.
Methods
Parents of children aged 0–11 attending postnatal healthcare centers in Arcamanik District, Bandung, Indonesia, participated in this study using a validated questionnaire. Additionally, we developed and implemented an education module using an on-site learning approach to assist parents in managing their children's use of antibiotics. We also conducted pre- and post-tests to evaluate the improvement in knowledge.
Results
The results showed that based on the questionnaire-based survey, about half of parents believed antibiotics were necessary for children's illness (50%), and 64.5% considered their use essential when other treatments failed. Based on their previous symptoms, approximately 17.7% of parents misused antibiotics as stand-alone treatments. A significant 94.5% expressed the need for comprehensive information from healthcare providers regarding prudent use. The significant mean difference (45.7912.33; P = 0.00) between pre- and post-test analyses showed improvement in parental knowledge following the intervention.
Conclusions
This study underscored a concerning lack of understanding among parents, leading to self-medication practices in Indonesia. Using the developed module, the educational intervention effectively increased parental awareness. This suggested the potential for tailored interventions to rectify misconceptions and promote responsible antibiotic use in pediatric care.
Overexpression of Plasmalemmal Vesicle-Associated Protein-1 in a Case of Cyanotic Nephropathy
Authors: Ushio Yusuke , Hirata So , Manabe Shun , Suyama Mayuko , Tanaka Ayano , Seki Momoko , Kato Haruka , Nomura Kana , Nakai Anna , Sumori Hitoko , Kawaguchi Yuki , Kobayashi Shizuka , Makabe Shiho , Kataoka Hiroshi , Itoh Naoko , Taneda Sekiko , Honda Kazuho , Hoshino Junichi
Published: July 2024

Background
Cyanotic nephropathy (CN) is a known complication of cyanotic congenital heart disease (CCHD). However, many aspects of its pathophysiology remain unclear.
Case presentation
We report the case of a 29-year-old male with a history of tetralogy of Fallot. Renal biopsy revealed glomerular hypertrophy and focal segmental glomerulosclerosis. Electron microscopy revealed extensive endothelial cell damage. For investigate the etiology of endothelial cell damage, PAL-E staining was conducted, revealing staining along the glomerular capillary wall.
Conclusion
This is the first report of PAL-E staining in CN, suggesting potential overexpression of PV-1. Previous studies have linked PV-1 expression to endothelial cell damage, implicating it in the pathogenesis of CN.
Efficacy and safety of Pemafibrate administration in patients with dyslipidemia: A Systematic Review and Updated Meta-analysis of Randomized Controlled Trials.
Authors: Elbahloul Mohammed A. , Elgadi Ammar , Fayed Hossam , Ramadan Mohamed , Kasser Mohamed E. , Hussein Ahmed , Labieb Fatma
Published: July 2024

Background:Patients with dyslipidemia are at risk for cardiovascular diseases. Lowering levels of lipid decreases morbidity. Pemafibrate is a selective peroxisome proliferator-activated receptor α modulator (SPPARMα) that works better at lowering serum triglycerides.
Methods: Clinical trials investigating the effect of pemafibrate on lipid biomarkers in patients with dyslipidemia were searched in PubMed, Ovid Medline, SCOPUS, Web of Science (WOS), and the Cochrane Library from inception till December 31, 2023. The data were pooled as mean difference, odds ratio (OR), and 95% confidence interval (CI).
Results: 14 clinical trials were eligible involving 12451 patients showed favorable triglyceride level change (MD: -49.60 [-62.64, -36.55] P<0.00001) for pemafibrate compared to placebo. Pemafibrate showed a significant increase in HDL-C levels (MD: 14.57 [10.14, 19.01] P<0.00001) but showed a concurrent increase in LDL-C levels (MD: 10.99 [6.10, 15.88] P <0.00001). It also showed non-HDL-C, total cholesterol level, Apo B, Apo C-II, and Apo C-III to be significantly reduced in pemafibrate groups. Also, in pemafibrate groups, hepatic adverse events were reported less frequently than in placebo groups. No significant difference was found in the frequency of total adverse effects, adverse drug reactions, or serious adverse events between the pemafibrate and placebo groups.
Conclusion:Pemafibrate improved the overall lipid biomarkers compared to placebo groups, demonstrating a significant reduction in triglycerides, non-HDL-C, and total cholesterol while increasing in HDL-C. Moreover, there was no significant difference in adverse effects.
Metabolic adaptations of Escherichia coli to extended zinc exposure: Insights into tricarboxylic acid cycle and trehalose synthesis
Authors: Rihacek Martin , Kosaristanova Ludmila , Fialova Tatiana , Rypar Tomas , Sterbova Dagmar Skopalova , Adam Vojtech , Zurek Ludek , Cihalova Kristyna
Published: July 2024

Balanced bacterial metabolism is essential for cell homeostasis and growth and can be impacted by various stress factors. In this study, we investigated the impact of extended exposure of Escherichia coli to zinc oxide (ZnO40) and zinc oxide nanoparticles (ZnONPs40) on the major metabolic pathways of E. coli with the aim to simulate long-term stress conditions. Transcriptomic and proteomic analyses along with quantification of intermediates of tricarboxylic acid (TCA) were employed to monitor and study the bacterial responses. Multi-omics analysis revealed that extended zinc exposure induced mainly oxidative stress and elevated expression/production of enzymes of carbohydrate metabolism, especially enzymes for synthesis of trehalose. After the zinc withdrawal, E. coli metabolism returned to a baseline state. These findings shed light on the alteration of TCA and on importance of trehalose synthesis in metal-induced stress and its broader implications for bacterial metabolism and defense.
Types and hospital manifestation of the risk-treatment paradox in non-ST-elevation acute coronary syndrome: the Regional Vascular Centre experience
Authors: Nesova Anastasiia K. , Vorobeva Darya A. , Ryabov Vyacheslav V.
Published: July 2024

Background. There is reason to believe that unfavourable outcomes of non-ST-elevation acute coronary syndrome (NSTE-ACS) is due to the «risk-treatment» paradox (RTP). However, the true prevalence, types and causes of RTP have not been studied, and data from previous studies have shown an equivocal effect of RTP on outcomes of NSTE-ACS. Methods. The retrospective analysis included 600 patients with an initial diagnosis of NSTE-ACS. All patients were re-stratified into four groups according to their risk of adverse ischaemic events on admission to hospital. RTP was defined as situations where the risk did not match the recommended timing of invasive treatment strategy. Results. RTP identified in 321 cases (53.5%), was most characteristic of the intermediate risk (74%), and was least common in high-risk patients (28.5%). In a generalised comparison across all risk categories, no effect of RTP was found on hospital outcomes, length of hospital stay and incidence of adverse cardiovascular events during hospital follow-up. After adjusting for RTP in each risk group, only the high-risk group showed increase in adverse outcomes in the presence of RTP (5.4% mortality vs. 2.9% (OR 1. 9 (95% CI 0.5–8.9), p = 0.037) and a negative effect of RTP on the risk of recurrent myocardial ischaemia (RMI) after 24 hours (7.1% vs. 0.7%, OR 10.7 (95% CI 1.2–97.9), p = 0.01). Conclusions. RTP in relation to the timing of invasive treatment is common in patients with NSTE-ACS (53.5%). For high-risk patients, RTP worsened in-hospital outcome and influenced the risk of RMI after 24 hours. Clinical Trial Number This research is a retrospective observational study, which does not require mandatory registration as defined by the ICMJE.
Energy generation drives gut colonization by Bilophila wadsworthia
Authors: Sayavedra Lizbeth , Yasir Muhammad , Goldson Andrew , Brion Arlaine , Gall Gwen Le , Moreno-Gonzalez Mar , Altera Annalisa , Paxhia Michael D , Warren Martin , Turner Arthur , Beraza Naiara , Narbad Arjan
Published: July 2024

High-fat diets alter the gut microbiota composition and stimulate proliferation of the sulfidogenic bacterium Bilophila wadsworthia (Bw). Proliferation of B. wadsworthia is linked to gut inflammation, dysfunction of the intestinal barrier and bile acid metabolism but the genetic basis for its colonization of the gut remains largely unknown.
In this study, we identified genes that facilitate gut colonization by B. wadsworthia under a high-fat diet, either with or without a simplified humanized microbial consortium (SIHUMI), by using a combination of ‘omics’ approaches, including genome-wide transposon mutagenesis, metatranscriptomics and untargeted metabolomics. Comparisons between mutants present in culture and mutants in the gut revealed 32 genes essential for gut colonization. These included two gene clusters related to bacterial microcompartment (BMC) formation and function, and a NADH dehydrogenase (hdrABC-flxABCD) important for energy metabolism in anaerobes. BMCs allow B. wadsworthia to metabolise the organosulfonate compounds taurine and isethionate (abundant in the mammalian gut) releasing H2S, acetate and possibly ethanol. Although the H2S concentration and B. wadsworthia abundance were at their highest in the absence of the SIHUMI, detrimental impacts on the host were exacerbated in the presence of the SIHUMI, based on gut permeability, the abundance of pro-inflammatory cytokines (IL-1a, IFN-G) and increased infiltration of macrophages in the liver. More genes were required by B. wadsworthia for gut colonization when they were grown with the SIHUMI consortia compared with growth in monoculture; the same was true for their ability to synthesise nucleotides and histidine. This suggests that microbial community composition plays a key role in modulation of the activity of this pathobiont.
A genetic study of immunity in depression and interactions with childhood maltreatment
Authors: Herrera-Rivero Marisol , McCartney Daniel , Whalley Heather , Berger Klaus , McIntosh Andrew , Baune Bernhard
Published: July 2024

Genetic and environmental factors contribute to depression. Among the latter, early life adversity and immune dysregulation have been consistently linked with depression. Childhood maltreatment (CM) is believed to induce immune dysregulation later in life. However, it is not known how CM might interact with genetic immune factors to contribute to the occurrence of depression. We investigated how genetic variability in 2,370 genes from 20 immune pathways associates with lifetime depression at gene- and pathway-level, and how this variability interacts with CM. The depression analysis was carried out in 13,309 individuals (1,867 cases) from the Generation Scotland (GS) Study. The CM interaction analysis was carried out in a subset of 749 individuals (99 cases) from GS and an independent sample of 509 individuals (96 cases) from the German BiDirect (BD) Study for which both genetic and CM data was available. Interactions with different types of CM were tested using the subscales of the childhood trauma questionnaire (CTQ). These results were meta-analyzed to obtain general gene-CM interactions. We found association of the GHR gene (false discovery rate –FDR– =0.03, z = 4.2) and Reactome “RUNX1-regulated transcription of genes involved in myeloid cell differentiation pathway” (FDR = 0.016, beta = 1.2) with depression in GS. After meta-analysis, 56 immune gene-CM interactions were associated with depression (FDR < 0.05) in both GS and BD. These exert functions in hematopoiesis, pathogen recognition and stress responses, among others. Network analysis suggested macrophages as main expressing cell types. Our results underscore the involvement of hematopoietic alterations and immune gene-CM interactions in the development of depression.
Shear wave elastography for upper limb muscle stiffness assessment in patients with rigidity-dominant Parkinson's disease
Authors: Zhang Dihui , Meng Lingcui , Jiang Yanhui , Wu Xiaoxi , Cheng Fenghua , Liu Jia , Li Minying , Fu Wenbin , Zhou Peng , Zhang Jianxing
Published: July 2024

Background
Myotonia is the central clinical symptom of Parkinson's disease(PD), and myotonic conditions can be used to assess the severity of PD.Therefore, the aim of this study was to characterize the stiffness of limb muscles using ultrasound shear-wave elastography (SWE), and the validity of this method in assessing myotonia in PD.
Methods
From April 2019 to January 2020, SWE of the longitudinal biceps brachii and brachioradialis was performed on 60 PD patients and 30 healthy controls. The stiffness of the limb muscles, as measured by quantitative Young's modulus (YM), was compared between the remarkably symptomatic and mildly symptomatic sides of PD, as well as between PD patients and controls. The correlation between YM of the biceps brachii and brachioradialis with age, duration, and motion scores assessed by the unified PD Rating scale (UPDRS) part III was analyzed by Pearson's correlation coefficient. The reliability of SWE was tested using the intraclass correlation coefficient (ICC).
Results
(1) YM of the long axis of the biceps brachii and brachioradialis in PD patients were higher than in the control group (P<0.05), and were higher on the remarkably symptomatic side than on the mildly symptomatic side (P<0.05). The ICC for interobserver and intraobserver variations in measuring YM were 0.86 (95% confidence interval 0.54–0.96) and 0.93 (95% confidence interval 0.70–0.98), respectively, for biceps brachii and 0.84 (95% confidence interval 0.47–0.96) and 0.91(95% confidence interval 0.64–0.98), respectively, for brachioradialis. (2) A positive linear correlation was found between YM of longitudinal biceps brachii and brachioradialis on the remarkably symptomatic side in PD patients with the motion scores (r=0.462, P<0.001; r༝0.356, P<0.05), but no significant correlation was found between YM with age and duration in PD patients (P>0.05).
Conclusions
SWE can be used as a quantitative assessment of muscle stiffness in patients with PD.
Efficacy of Simulator-Based Direct Ophthalmoscopy Training using New Refractive Adjustment Fundoscopic Examination Simulator for Medical Students – ICEye Model: A Comparative Randomized Crossover Study
Authors: Chokchaitanasin Ratima , Vongkulsiri Sritatath , Choontanom Raveewan
Published: July 2024

Background: The use of simulators for ophthalmology training is growing globally. However, all developed simulators have certain limits based on different circumstances. The study aims to assess
the efficacy and satisfaction of the new refractive adjustment simulator "ICEyeModel" compared to a traditional simulator for direct ophthalmoscopy training in medical students.
Methods: This is a comparative, randomized cross-over study. Our study enrolled fifty participants from a 6-year medical student training program at Phramongkutklao Hospital. They required a refreshment lecture on primary direct ophthalmoscopy usage and a short course on common retinal disease review. They were randomized into two training sequence groups: Training sequence 1 started with a traditional film photograph simulator followed by the ICEyeModel. Training sequence 2 started with the ICEyeModel, followed by a traditional simulator. Both groups were asked to complete a fundoscopic description test and satisfaction questionnaires.
Results: Medical students training with the ICEye Model achieved significantly higher fundoscopic examination scores (14.42±2.34) compared to those training with traditional simulators (11.30±6.43), with p<0.001. For the ICEyeModel, 86% of participants can correctly adjust the direct ophthalmoscope power match to the refractive state from the trial lens placed in the simulator. ICEyeModel has a higher satisfaction score regarding picture quality, enhancing motivation and confidence than a traditional simulator.
Conclusion: The ICEye Model is the first combination of fundoscopic examination training and refraction practicing simulators that significantly improves fundoscopic examination skills and increases medical students' motivation and confidence in practicing direct ophthalmoscopy. In the future, it can be used to practice with indirect ophthalmoscopes and retinoscopes.
Survival Benefits of Asymptomatic Primary Tumor Resection After Bevacizumab Plus FOLFIRI as First-Line Therapy for Patients with Metastatic Colorectal Cancer with Synchronous Unresectable Metastasis
Authors: Chen Yen-Cheng , Chang Tsung-Kun , Su Wei-Chih , Yeh Yung-Sung , Chen Po-Jung , Huang Peng-Jen , Yang Po-Hsiang , Tsai Hsiang-Lin , Wang Jaw-Yuan , Huang Ching-Wen
Published: July 2024

Background
Metastatic colorectal cancer (mCRC) poses a clinical challenge and requires a combination of systemic therapy and conversion surgery. Although first-line chemotherapy and targeted therapy are considered the standard treatments for mCRC, the role of primary tumor resection (PTR) in asymptomatic synchronous mCRC with unresectable metastatic lesion after initial therapy remains relatively underexplored.
Materials
A retrospective review was conducted from January 2015 to January 2021, involving 74 patients with synchronous mCRC who received bevacizumab plus FOFIRI as first-line systemic therapy. All 74 patients had unresectable metastatic lesions confirmed through multidisciplinary team discussion. Patient characteristics, PTR data, and radiotherapy (RT) and overall survival (OS) outcomes were analyzed. The patients were categorized into a “PTR” group and a “No PTR” group and then further stratified into “4A,” “4B,” and “4C” subgroups based on the initial mCRC stage. Additionally, four subgroups—namely “PTR(+)/RT(+),” “PTR(+)/RT(−),” “PTR(−)/RT(+),” and “PTR(−)/RT(−)”—were formed to assess the combined effects of PTR and RT.
Results
The median OS for all the patients was 23.8 months (20.5–27.1 months). The “PTR” group exhibited a significantly higher median OS of 25.9 months (21.3–30.5 months) compared with 21.4 months (15.8–27.1 months) in the “No PTR” group (p = 0.048). Subgroup analyses revealed a trend of improved survival with PTR in patients with stage IVA and IVB; however, the results were not statistically significant (p = 0.116 and 0.493, respectively). A subgroup analysis of PTR and RT combinations revealed no significant difference in median OS rates.
Conclusion
For asymptomatic mCRC with synchronous unresectable distant metastasis, PTR following first-line therapy with bevacizumab plus FOLFIRI can provide a survival benefit, particularly in stage IVA/IVB patients compared with stage IVC patients. Additionally, RT for primary tumor did not provide an additional OS benefit in mCRC with unresectable metastasis. A prospective randomized trial with a larger sample size is essential to further elucidate the role of PTR in this context.
A worldwide assessment of the mechanical ventilation in patients with acute exacerbations of chronic obstructive pulmonary disease. Analysis of the VENTILAGROUP over time. A retrospective, multicenter study.
Authors: Peñuelas Oscar , Campo-Albendea Laura del , Morales-Quinteros Luis , Muriel Alfonso , Nin Nicolás , Thille Arnaud , Du Bin , Pinheiro Bruno , Ríos Fernando , Marín María Carmen , Maggiore Salvatore , Raymondos Konstantinos , González Marco , Bersten Andrew , Amin Pravin , Cakar Nahit , Suh Gee Young , Abroug Fekri , Jibaja Manuel , Matamis Dimitros , Zeggwagh Amine Ali , Sutherasan Yuda , Artigas Antonio , Anzueto Antonio , Esteban Andrés , Frutos-Vivar Fernando , Sorbo Lorenzo Del
Published: July 2024

Background
The trend overtime and across different geographical areas of outcomes and management with noninvasive ventilation or invasive mechanical ventilation in patients admitted for acute exacerbations of chronic obstructive pulmonary disease and treated with ventilatory support is unknown. The purpose of this study was to describe outcomes and identify variables associated with survival for patients admitted to an intensive care unit (ICU) with acute exacerbation of chronic obstructive pulmonary disease [aeCOPD] that received noninvasive or invasive mechanical ventilation worldwide.
Methods: Retrospective, multi-national and multicenter study, including four observational cohort studies carried out in 1998, 2004, 2010, 2016 for the VENTILAGROUP following the same methodology.
Reesults: A total of 1,848 patients from 1,253 ICU in 38 countries admitted for aeCOPD and need of ventilatory support were identified in the four study cohorts and included in the study. The overall incidence of aeCOPD as cause for ventiltory support at ICU admission significantly decreased over time and varied widely according to the gross national income. The mortality of patients admitted to ICU for aeCOPD and ventilatory support significantly decreased over time regardless of the geographical area and gross national income; however, there is a remarkable variability in ICU mortality according to geographical area and gross national income. The use of NPPV as first attempt of ventilatory support has significantly increased over time, with a parallel reduction of invasive mechanical ventilation regardless of gross national income.
Conclusions: in this worldwide observational study including four different sequential cohorts of patients over a time span of 18 years from 1998 to 2016, the mortality of patients admitted to ICU for aeCOPD and ventilatory support significantly decreased regardless of the geographical area and gross national income. Future research will need to investigate reason for the remarkable variability in ICU mortality according to geographical area, gross national income and methods to select patients for the appropriate ventilatory support.
Graphene-Infused Terracotta Acoustic Sound Amplifiers
Authors: TR Rajalekshmi , Pavithran Shilpa , Das Rinku Rani , James Alex
Published: July 2024

This work introduces a novel approach for enhancing mobile audio performance by incorporating graphene-infused terracotta as an acoustic amplifier. Leveraging the high thermal conductivity and mechanical strength of graphene, this study demonstrates the design, fabrication, and acoustic characterization of terracotta amplifiers. We demonstrate the significant impact of graphene-infused terracotta amplifiers on improving sound amplification in addition to mechanical strength. A graphene-based dispersion is prepared for incorporation in clay to make the amplifier. Testing is carried out on normal and graphene-dispersion-incorporated terracotta amplifiers. The experimental results illustrate a substantial improvement in audio quality with increased volume compared to conventional terracotta-based mobile speakers. The frequency-dependent variation of the output signal, SNR, and the influence of submerging in water have also been studied. This work contributes to the field of acoustic materials and offers new possibilities for augmenting the auditory experience of mobile device users while also presenting sustainable and aesthetically appealing acoustic accessories.
Early distinction of Alagille syndrome and biliary atresia in infants: A Comparative Study
Authors: Zhou Shuyuan , Zhan Xue , Li Shuyuan
Published: July 2024

Background and aims: Alagille syndrome (ALGS) is a multisystem disorder that is often confused with biliary atresia (BA) shortly after birth. This study aimed to identify criteria for early distinction between these two diseases.
Methods: Patients with confirmed ALGS and BA were retrospectively enrolled in this study. Clinical data, biochemical results, ultrasound findings, and genetic testing results were analyzed.
Results: A total of 14 patients with ALGS under 3 months of age were included in this study, and compared with 28 age- and sex-matched patients with BA. (1) Clinical features: significant differences in cardiac structural abnormalities and distinctive facial features were observed. (2) Biochemical indicators: both groups showed increased lactate dehydrogenase (LDH) and gamma-glutamyl transferase (GGT) levels; the GGT level of the ALGS group (304.75 U/L) was lower than that of the BA group (515.00 U/L), while the LDH level was higher; Fibrinogen (FIB) and prothrombin time (PT), though normal, showed significant differences. (3) Ultrasonography: ALGS patients had a lower gallbladder abnormality rate (64.3%, 9/14) than BA patients (96.4%, 27/28) (p < 0.05); the incidence of hepatomegaly and splenomegaly in ALGS patients was significantly lower than that in BA (p < 0.05).
Conclusion: For infants less than three months of age with high GGT cholestasis, attention should be paid to whether there are facial features, hepatomegaly, splenomegaly, gallbladder abnormality, and skeletal and heart abnormalities, which combined with GGT, LDH, FIB, and PT, can serve as criteria for early distinction of the two diseases.
Effectiveness of Selective Antibiotics Use in Esbl-Related UTIs.
Authors: Aththanayaka Kasun Prabuddha , Weerasinghe Yasoda Hansani , Weerakkody Nimsha Sevwandika , Samarasinghe Gayani Geethika , Priyadarshana Upul
Published: July 2024

Background –
Urinary tract infections (UTIs) are the second most common infection, affecting 150 million people each year worldwide. Enterobacteriaceae species expressing extended-spectrum β-lactamases (ESBLs) are on the rise across the globe and are becoming a severe problem in the therapeutic management of clinical cases of urinary tract infection. Knowledge of the prevalence and antibiogram profile of such isolates is essential to develop an appropriate treatment methodology. This study aimed to investigate the prevalence of Enterobacteriaceae isolates exhibiting ESBL and their selective oral antibiogram profile at the district general hospital, Polonnaruwa.
Results -
A total of 4386 urine specimens received to the Microbiology Laboratory during the study period. Among them, 1081 (25%) showed positive results for urine culture while 200/1081 specimens showed ESBL isolates. Out of the selected 200 specimen’s majority (72%) of samples received from the In-Patient Department. There were 200 patients and reported that 115 (58%) were females and 85 (42%) were males. The majority (51%) of the patients belong to the age group of 55–74 years. Among the ESBLs positive specimens, the majority 74.5% (n = 149) identified organisms were E. coli followed by Klebsiella spp.17.5% (n = 35), Enterobacteriaceae 7% (n = 14) and only1% (n = 2) isolate of Proteus spp. Mecillinam (86.30%) and Nitrofurantoin (83.56%) showed higher effectiveness against E. coli. Nitrofurantoin showed the highest effectiveness against Klebsiella spp. (31.58%), other Enterobacteriaceae spp. (79%). Proteus spp. showed 100% effectiveness and resistance respectively against Ciprofloxacin, Cotrimoxazole and Nitrofurantoin.
Conclusion -
The most predominant ESBLs producing uro-pathogen was the E. coli in the study setting and E. coli had higher sensitivity rate against Mecillinam. Among currently used oral antibiotics Nitrofurantoin was the best choice for UTIs caused by ESBL producers.
The Impact of Selection Bias on Genetic Prediction Using the Bipolar Polygenic Risk Score in First-Admission Psychosis
Authors: Jonas Katherine , Asim Amna , Yang Yuan , Heilbronner Urs , Schulze Thomas , Lencz Todd , Vassos Evangelos , Clouston Sean , Kotov Roman
Published: July 2024

Polygenic risk scores (PRS) have potential utility as biomarkers of psychiatric disorders. However, while the schizophrenia (SZ) PRS has been consistently associated with case-control status and a more severe course of illness, the associations between the bipolar (BP) PRS and markers of bipolar disorder vary considerably between studies, with studies of population and case-control samples identifying many effects that cannot be replicated in case-only analyses. These analyses demonstrate that the heterogeneity in studies of the BP PRS is driven by selection bias. Specifically, selecting samples on the basis of diagnostic status or other phenotypes associated with genetic risk attenuates the correlation between the BP and SZ PRS. In such high-severity samples, while the SZ PRS predicts poor outcomes, the BP PRS predicts better outcomes. These findings highlight the importance of understanding the impact of selection bias in translational research evaluating PRS as biomarkers of psychiatric disorders, particularly when the intended application is populations enriched for high levels of genetic risk.
The Magnitude of Early Discontinuation of Intrauterine Contraceptive Device Use and Associated Factors among Clients at Marie Stopes Maternal and Child Health Center, Adama, Ethiopia
Authors: Girma Daniel , Aman Haji , Ejara Daba
Published: July 2024

Background
Intrauterine contraceptive devices are cost-effective, convenient, safe, and highly effective methods designed to be used for 10–12 years. However, the discontinuation of such long-acting reversible contraceptives is becoming a public health concern in Ethiopia. The practices may lead to program failures that cause significant health and economic impacts.
Objective
To assess the magnitude of early discontinuation of intrauterine contraceptive devices and associated factors among clients who received the method at Marie Stopes Maternal and Child Center in Adama town in Ethiopia, 2024.
Methods
Institutional-based cross-sectional study was conducted among 413 clients who received the service from January 1, 2017, to March 2022. A systematic random sampling technique was used to select the study participants. Data were collected from medical records and telephone interviews. The collected data were entered into Epi-Info version 7.1 and analyzed using SPSS version 25. The associations between dependent and independent variables were assessed by using binary logistic regression analysis. Adjusted odds ratio with its 95% CI was used to estimate the strength of associations. P –value < 0.05 was considered to declare statistical significance.
Result
The magnitude of early discontinuation of intrauterine contraceptive devices accounts for 20.6% (95% CI:16.7–24.9). In multivariate analysis, lack of formal education [AOR = 12.5, 95% CI: 4.97, 31.5)] and primary level of education [AOR = 3.5, 95% CI:1.6, 7.99)], giving birth to a male child in the last delivery[AOR = 0.317,95% CI:0.18, 0.55)], having two and lower number of children [AOR = 3.97,95% CI: 1.8, 8.95)], not counseled on methods [AOR = 16.5,95% CI;5.8,47.1)], having pelvic pain [AOR = 7.4, 95% CI:2.678,20.3)], pelvic infection[AOR = 8.67, 95% CI: 2.7,27.7)], heavy bleeding [AOR = 15.5,95% CI: 3.3,73.7)] and history of vaginal discharge[AOR = 5.9,95% CI: 2.1,16.88)] were associated with early discontinuation of intrauterine contraceptive devices.
Conclusion
The magnitude of early discontinuation of intrauterine contraceptive devices was high. Lack of counseling was the strongest factor associated with early discontinuation of intrauterine contraceptive devices. It is essential to provide counseling and early screening for clients to ensure that clients who choose intrauterine contraceptive devices have a lower risk of side effects and complications.
Robotic-Assisted Transcranial Doppler Monitoring in Acute Neurovascular Care: a Feasibility and Safety Study
Authors: Salimbeni Alvise Fattorello , Kulyk Caterina , Favruzzo Francesco , De Rosa Ludovica , Viaro Federica , Pieroni Alessio , Mozzetta Stefano , Vosko Milan R , Baracchini Claudio
Published: July 2024

Introduction: Transcranial Color Doppler (TCD) is currently the only non-invasive bedside tool capable of providing real-time information on cerebral hemodynamics. However, being operator dependent, TCD monitoring is not feasible in many institutions. Robotic assisted TCD (ra-TCD) was recently developed to overcome these constraints. The aim of this study was to evaluate the safety and feasibility of cerebral monitoring with a novel ra-TCD in acute neurovascular care.
Methods: This is a two-center prospective study conducted between August 2021 and February 2022 at Padua University Hospital (Padua, Italy) and Kepler University Hospital (Linz, Austria). Adult patients with conditions impacting on cerebral hemodynamics or undergoing invasive procedures affecting cerebral hemodynamics were recruited for prolonged monitoring (> 30 minutes) of the middle cerebral artery (MCA) with a novel ra-TCD (NovaGuideTM Intelligent Ultrasound, NeuraSignal, Los Angeles, CA, USA). Manual TCD was also performed for comparison by an experienced operator. Feasibility and safety rates were recorded.
Results: 92 patients [age: mean 68.5 years, range 36-91; gender: male 57 (62%)] were enrolled in the two centers: 54 in Padua, 38 in Linz. The exam was feasible in the majority of patients (85.9%); the head cradle design and its radiopacity hindered its use during carotid endarterectomy and mechanical thrombectomy. Regarding safety, only one patient (1.1%) reported a minor local edema due to prolonged probe pressure. Velocity values resulted similar between ra-TCD and manual TCD.
Discussion: This novel ra-TCD showed an excellent safety and feasibility, and proved to be as reliable as manual TCD in detecting blood flow velocities. These findings support its wider use for cerebral hemodynamics monitoring in acute neurovascular care. However, further technical improvements are needed to expand the range of applicable settings.
Predation of Two Species of Columbidae by the Burrowing Owl Athene Cunicularia (Strigiformes, Strigidae) in Urban Environment
Authors: Mendes Gabriela Carlos , Esclarski Priscilla , Zawadzki Cláudio Henrique
Published: July 2024

The burrowing owl Athene cunicularia is a species known for its adaptation to urban environments, being able to adjust their behaviors according to environmental conditions. This work reports the records of predation of two species of columbids by Athene cunicularia. 63 burrowing owl nests were monitored in the state of Paraná between June 2022 and July 2023. The identification of predated species occurred through direct observation at the time of predation and by comparison between wings and feathers found in the owls’ nests with pictures of the suspected species. Both Columba livia and Zenaida auriculata were registered, counting seven records. Six occurred in different points of the study area, while one occurred in the state of Roraima. The predation of these birds by Athene cunicularia should not be isolated cases, as they cohabit urban areas. Our data highlights the species' adjustment to the urban environment since the domestic pigeon is not part of its known diet and has about 146.1% of the owl’s body mass, reinforcing the importance of Athene cunicularia in urban environments as it controls the populations of species that can be harmful to humans.
Analysis of Msimbazi River Banks Erosion with Regards to Soil Erodibility
Authors: Alexander Augustina C. , Izdori Fides J. , Mulungu Deogratias M.M. , Mugisha Lucius R.
Published: July 2024

River bank erosion has become increasingly detrimental to most urban rivers around the world. One of the well-established factors influencing river bank failure especially during a rainy season is the soil erodibility. Msimbazi River is facing severe river banks erosion hazard at different section of the lower basin that have had significant impacts on the population along the Msimbazi River. The study analysed the river banks soil composition from three sections of lower Msimbazi River basin, Kinyerezi, Kigogo and Jangwani, to establish the risk of erosion with regards to soil erodibility. The Results indicated that river banks along the lower Msimbazi River basin are at risk of erosion hazard due insufficient clay content, which is crucial for soil strength against erosion. The ROslan and Mazidah (ROM) Erodibility Index (EIROM) painted that more than 80% of the river banks in the study area are at “high” to “critical” risk of erosion. The banks along Kinyerezi stretch were found to be more prone to erosion while Kigogo and Jangwani ones suffer from overburden deposit of sediment supplied from upstream. River banks characterization presented parameters that can exacerbate river banks erosion thus, aggregate of soil composition with other key parameters is important for effective banks protection.
The association between non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio with serum uric acid levels and hyperuricemia risk
Authors: Huang Jingjing , Chen Chunyong
Published: July 2024

Background
The relationship between the non-high-density lipoprotein cholesterol (non-HDL-C) to high-density lipoprotein cholesterol (HDL-C) ratio (NHHR), serum uric acid levels, and hyperuricemia risk remains unclear. This study evaluated the association between NHHR with serum uric acid levels, and hyperuricemia risk in US adults.
Methods
The data from the National Health and Nutrition Examination Survey (NHANES) spanning from 2005 to 2018 were analyzed cross-sectionally using weighted linear regression, weighted logistic regression, restricted cubic splines, and threshold effects analysis. Additionally, subgroup analyses were performed to investigate the relationships between NHHR, serum uric acid levels, and the risk of hyperuricemia.
Results
Among 9439 individuals (mean age: 48 ± 14 years), the mean NHHR was 2.56 ± 0.71, and the mean uric acid level was 5.40 ± 0.90. The overall prevalence of hyperuricemia was 21%, increasing significantly with NHHR quartiles (Q1: 13%, Q2: 17%, Q3: 24%, Q4: 31%, P < 0.01). Each unit increase in NHHR was associated with a 20% higher risk of hyperuricemia (95% confidence interval [CI]: 1.09–1.33, P < 0.01) and a 0.13 increase in uric acid levels (95% CI: 0.09–0.18, P < 0.001). Subgroup analyses confirmed these findings across various demographics. A non-linear relationship was found between NHHR and uric acid levels/hyperuricemia risk, with breakpoints at 4.33 and 3.91, respectively (P for nonlinear < 0.001).
Conclusions
Elevated NHHR is significantly correlated with higher uric acid levels and hyperuricemia risk in US adults. Early intervention and management of NHHR may help mitigate hyperuricemia.
Psychometric Properties of the Chinese Version of the Self-Injurious Thoughts and Behaviors Interview in Adolescent Outpatients
Authors: Huang Hui-Chun , Huang Yu-Hsin , Liu Hui-Ching , Huang Chiu-Rong , Sung Ming-Ru , Sun Fang-Ju , Liu Shen-Ing
Published: July 2024

Background:
The Self-Injurious Thoughts and Behavior Interview (SITBI) has been widely used in Western countries, but its use in Chinese culture is limited. Based on the scarcity of standardized Chinese interviews to assess self-injurious thoughts and behaviors, this study aimed to validate the SITBI Chinese version (SITBI-C).
Methods:
The psychometric properties of the SITBI-C were tested in 195 outpatient adolescents with various levels of suicidality. The test-retest, interrater and concurrent validity were investigated in this study.
Results:
The analysis of the SITBI-C showed perfect test-retest reliability within one week. The interrater agreement was also excellent, ranging across SITB-C items. The validity indices were good when comparing the responses to the SITBI-C and other interview-based and self-reported measures, suggesting strong convergent validity.
Conclusions:
Overall, the results of this research suggested that the SITBI-C demonstrated good psychometric properties. The SITBI-C is appropriate for assessing suicidality in the Chinese adolescent population and can be used to assess adolescent suicidality to determine the risk for suicidal behavior.
Can Virtual Reality Technology be Used for Empathy Education in Medical Students: A Randomized Case-control Study
Authors: Lin Huang-Li , Huang Man-Lin , Wang Yu-Ching , Yu Nan-Wen , Tang I , Hsu Yu-chen , Huang Yu-Shu
Published: July 2024

Background
Empathy is an important factor in the doctor-patient relationship, but mental illness is more difficult to understand than other diseases. Besides traditional skills, virtual reality (VR) has been identified as a promising tool in empathy education. This study aimed to investigate the ability of empathy enhancement, the feasibility of depression education, and the changes in thoughts and attitudes in medical students through a single VR experience.
Methods
We recruited medical students and randomly assigned them to two groups based on their completed Interpersonal Response Index scores. Two sets of VR systems were provided; the intervention group experienced the daily life of the depressed medical student, while the control group experienced the general medical student scenario. The improvement of empathy was assessed using the Jefferson Scale of Empathy-Health Professional Students (JSE-HPS), and the change of attitude was assessed through the Implicit Association Test. In addition, other questionnaires were used to evaluate the user experience of this VR system, and correlation analysis was conducted to examine the association between the use of VR and changes in the JSE and IAT scores.
Results
A total of 59 medical students were enrolled in this study. The intervention group showed a significant increase in the perspective-taking (pre: mean 5.817, SD 0.536; post: mean 5.947, SD 0.620; P = .03) and compassionate care (pre: mean 5.546, SD 0.581; post: mean 5.721, SD 0.629; P = .01) domains of the JSE score and a significant decrease in the empathy (SP) domain (pre: mean 3.583, SD 1.253; post: mean 2.967, SD 1.252; P = .002). The Pearson correlation analysis found a significant positive correlation between the JSE score with immersion aspect (r = 0.308, P = .049) and presence aspect (r = 0.415, P = .01), and we also found a significant negative correlation between the IAT score and presence aspect (r=-0.333, P = .04).
Conclusions
This study is the first randomized case-control study to investigate the effect of two different versions of VR on empathy development toward depression for medical students. Although the single VR experience was unable to induce a great improvement in empathy or attitude, the VR system could help medical students enhance their understanding of depressive disorders.
Trial Registration:
Australian New Zealand Clinical Trials Registry (ANZCTR): ACTRN12624000297527; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386683&isReview=true