bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of Statins on the Prognosis After Thoracic Endovascular Aortic Repair for Patients With Acute Type B Aortic Dissection
Authors: Cheng Jiaxin , Zhang Zhiqiang , Wang Yasong , He Houlin , Zhao Tinghao , Wang Xiaozeng
Published: December 2024

Objective:

To analyze the clinical efficacy of long-term statin therapy following thoracic endovascular aortic repair (TEVAR) in patients with acute type B aortic dissection (ATBAD).

Methods:

We retrospectively analyzed data from 645 patients treated between January 2005 and June 2022, dividing them into Statin Group (n=330) and Non-statin Group (n=315) based on whether they received long-term postoperative statin therapy. Patients were further categorized based on median admission low-density lipoprotein cholesterol (LDL-C) levels into High and Low LDL-C Groups to assess the effect of statins on the prognosis of ATBAD patients after TEVAR.

Results:

The cohort had an average age of 53.44±11.42 years old, and 81.71% were male. Statin therapy significantly reduced occurrences of all-cause death (3.03% vs 8.57%, p=0.002) and aorta-related death (0.91% vs 3.81%, p=0.015), particularly in patients with high admission LDL-C levels. In addition, patients with statin therapy had a lower incidence of aorta-related adverse events (ARAE) (4.24% vs 11.11%, p=0.001). Kaplan-Meier analysis indicated statins reduced 5-year cumulative incidence rates of all-cause death and ARAE (all Log-rank p<0.05). These trends were sustained after adjustment. Multivariate Cox analysis confirmed that statin therapy was associated with reduced risks of all-cause and aorta-related deaths, as well as ARAE.

Conclusion:

Long-term statin therapy appears to decrease the risk of all-cause and aorta-related death in ATBAD patients after TEVAR, particularly patients with high admission LDL-C levels. Patients with lower LDL-C levels at admission have a reduction of aorta-related death in the follow-up period. Statin therapy also was associated with a lower incidence of ARAE in follow-up. These findings suggest that statins might be crucial in improving long-term outcomes in this patient population.

Clinical Impact

Long-term statin therapy administered to patients with acute type B aortic dissection (ATBAD) following thoracic endovascular aortic repair (TEVAR) demonstrates a substantial reduction in both all-cause and aorta-related mortality. Notably, this therapeutic benefit is most evident in patients presenting with elevated low-density lipoprotein cholesterol (LDL-C) levels at admission. Furthermore, statin therapy is associated with a decreased incidence of aorta-related adverse events during follow-up. These findings underscore the pivotal role of statin therapy in enhancing long-term clinical outcomes for ATBAD patients undergoing TEVAR, thereby contributing to improved patient care and prognosis.
Immediate Postintervention Outcomes from a Randomized Trial that Sought to Enhance Access to Live Donor Kidney Transplant for Black and African Americans
Authors: Arriola Kimberly Jacob , Barrett D’Jata , Pastan Stephen , Perryman Jennie , DuBay Derek , Tresslar Courtney , De Abreu Sara Useche , Di Mengyu , Teunis Larissa , Montoya Miranda , Mangurenje Tatenda , Patzer Rachel E
Published: December 2024

Introduction

Eliminating racial inequities in access to kidney transplantation requires multilevel interventions that target both patients and health systems.

Research Question

The aim of this study was to determine whether adding culturally sensitive, web-based patient education to a transplant center-level intervention was associated with increased knowledge, motivation to pursue living donor kidney transplant, and confidence in the behavioral skills to discuss living donation among Black/African American patients with end-stage kidney disease.

Design

A total of 411 transplant candidates were randomized to intervention (N = 222) or control groups (N = 189) and completed measures at baseline and immediate follow-up during the transplant evaluation visit.

Results

Results indicated no significant change in knowledge across time or study condition. At immediate follow-up, participants of both study conditions exhibited a significantly higher motivation to pursue living donation (t = 3.066, P < .01) versus at baseline. Both study conditions demonstrated increased confidence in the behavioral skills to discuss living donation over time (t = 3.580, P < .001). Process evaluation findings demonstrated limited engagement with the online video content across both conditions.

Conclusion

Results suggest that the intervention did not perform better than control but raised important considerations for the delivery of transplant education targeting Black/African American patients in a busy clinical setting.
Association Between Systemic Immune-Inflammatory Index (SIRI) and Diabetic Foot Ulcers in Individuals with Diabetes: Evidence from the NHANES
Authors: Liu Bei , Wang Lin , He Yufeng
Published: December 2024

Background: Diabetic Foot Ulcer (DFU) is a common and challenging complication of diabetes mellitus, associated with high recurrence, hospitalization, disability, and mortality rates. The Systemic Immune Inflammatory Index (SIRI) based on complete blood counts has been shown to correlate with several diseases but has not been widely studied in DFU.This study aimed to explore the relationship between SIRI and the presence of DFU in individuals with diabetes using data from the National Health and Nutrition Examination Survey (NHANES). Methods: A cross-sectional analysis was conducted on 1246 individuals with diabetes from NHANES cycles 1999-2000, 2001-2002, and 2003-2004. DFUs were identified through patient self-reported data. Multivariate logistic regression models assessed the association between SIRI and DFU, adjusting for potential confounders. Subgroup and interaction analyses were also performed. Results: A total of 117 patients were identified as having DFU. Elevated SIRI levels were significantly associated with DFU presence. In fully adjusted models, a 1-unit increase in SIRI was associated with 24.0% higher odds of DFU prevalence (OR = 1.24; 95% CI: 1.07, 1.43) Subgroup analyses revealed consistent associations across different groups of age, gender, body mass index (BMI), HbA1c, blood glucose, and hemoglobin levels. Conclusion: The findings indicate a positive correlation between SIRI and DFUpresence. Further research is warranted to elucidate the mechanistic links and explore the clinical utility of SIRI in DFU management.
Intrinsic Capacity and Life Quality Among Taiwanese Older People: A Cross-Sectional Study
Authors: Chen Hung-Yu , Su Hui-Chen , Liu Chieh-Hsiu , Wu Yi-Lin , Li Chung-Yi , Hou Wen-Hsuan , Lin Chung-Ying , Yang Yi-Ching , Griffiths Mark D.
Published: December 2024

Intrinsic capacity (IC), an internal composite ability proposed by the World Health Organization, is fundamental to older people’s health. The present study examined potential models explaining the association between IC and quality of life (QoL) among older people in Taiwan. Frailty, basic activities of daily living (BADL), and instrumental activities of daily living (IADL) were hypothesized to be mediators in the association between IC and QoL. Older people aged 50 years or above from community or medical center ( N = 1,235; Mage = 72.63 years [ SD = 7.19]; 601 males [48.7%]) completed a series of self-report and functional measures assessing IC, frailty, ADLs, and QoL. Results showed that IC was significantly associated with frailty, BADL, IADL, and QoL in the mediation models. Frailty was found to be a significant mediator in the association between IC and QoL alone or together with IADL. The findings indicate that IC is an important factor for older people to maintain good health and live a fulfilling life.
Is it possible to diagnose mixed epithelial and stromal tumor of kidney prior to surgery? A case report
Authors: Nishiyama Hiroki , Tominaga Masaki , Ito Kozue , Hasegawa Go , Ishida Kyohei , Hara Noboru , Nishiyama Tsutomu
Published: December 2024

We present a case in which renal mixed epithelial and stromal tumor (MEST) was considered in the differential diagnosis based on preoperative imaging findings. A 38-year-old woman was found to have a right renal tumor during an abdominal ultrasound examination conducted as part of a health checkup. Contrast-enhanced computed tomography revealed a 50 × 40-mm mass in the middle of the right kidney. The possibility of papillary renal cell carcinoma was considered. However, given the patient’s age, sex, and characteristics of the mass, MEST was also considered a differential diagnosis. The patient underwent laparoscopic radical right nephrectomy. The tumor was diagnosed as MEST.
Effect of Anatomic Variations in the Anterior Tibial Artery on Risk of Injury During Orthopaedic Knee Surgeries
Authors: Frey Christopher , Bugarinovic George , Zhou Joanne , Sherman Seth , Abrams Geoffrey , Segovia Nicole , Cheah Jonathan W.
Published: December 2024

Background:

Injury to the posterior vasculature is a potential complication in orthopaedic knee surgery that may be associated with variations in its anatomy, such as the type II-A2 variant, which places the anterior tibial artery (ATA) in closer proximity to the tibia. However, how close surgical instrumentation comes to injuring the ATA is not well described.

Purpose:

To determine how the type II-A2 variant of the popliteal vasculature affects proximity of the ATA to instrumentation for orthopaedic knee procedures.

Study Design:

Cross-sectional study; Level of evidence, 3.

Methods:

A total of 222 knee magnetic resonance imaging (MRI) scans from a single academic tertiary referral center were evaluated, and ATA branching patterns were characterized. The distances from the ATA to simulated instrumentation of high tibial osteotomy (HTO), posterolateral corner anatomic reconstruction, posterior cruciate ligament (PCL) reconstruction, lateral meniscus posterior horn repair, and lateral meniscus posterior root repair on axial plane MRI scans were measured by 2 authors independently using imaging software. Intrarater and interrater reliability of the measurements was calculated using the intraclass correlation coefficient.

Results:

ATAs with the type II-A2 pattern passed anterior to the popliteus on 3.15% (n = 7) of the 222 MRI scans. The distance between the ATA and the simulated instrumentation was significantly closer in type II-A2 compared with normal (type I) knees for the lateral meniscus posterior root repair tunnel (11.1 vs 15.7 mm; P = .014), HTO cuts (0.6 vs 8.2 mm; P < .001), and PCL reconstruction tunnel (4.1 vs 11.7 mm; P < .001). Interrater reliability was good to excellent for all measurements, and intrarater reliability ranged from moderate to excellent.

Conclusion:

HTO cut, PCL reconstruction tunnel, and lateral meniscus posterior root tunnel instrumentation were significantly closer to the ATA in knees with type II-A2 anatomy compared with normal (type I) anatomy. Careful analysis of vasculature using MRI may be of utility for select surgery about the knee to guide surgical technique.
Are Community-College Students Increasingly Choosing High-Paying Fields of Study? Evidence from Massachusetts
Authors: Murnane Richard J. , Willett John B. , McDonough Aubrey , Papay John P. , Mantil Ann
Published: December 2024

The labor-market payoff to workers with associate degrees in healthcare and STEM occupations is very high in Massachusetts. We examine whether this induced a growing proportion of students in MA community colleges (MACCs) to earn an associate degree (AD) in one of these fields. We do this by using multinomial logit analysis to compare trends across 12 cohorts of MACC entrants in the proportion of students who earned an AD in a healthcare or STEM program within six years of entry.

We find a substantial increase across cohorts in the proportion of students who earned an AD in a STEM program, but not in the proportion who earned an AD in a healthcare program. We found differences in degree attainment by student gender, race/ethnicity, family income, and 10th-Grade mathematics score. Interviews with MACC program leaders revealed that supply constraints hinder expansion of many healthcare AD programs, but not STEM programs.
Neuropsychological Symptoms and Functional Capacity in Older Adults with Chronic Pain
Authors: Ord Anna S. , Coddington Kim , Maksad Genevieve P. , Swiatek Sophia R. , Saunders Joyelle , Netz David , Washburn Donna , Braud Susan , Holland Jamie , Eldridge Adrienne H. , Kuschel Shannon G. , Magnante Anna T. , Cooper Alicia , Sautter Scott W.
Published: December 2024

The impact of chronic pain on neuropsychological functioning of older adults is under-studied. The present study examined the relationship between chronic pain, depression, anxiety, cognition, and functional capacity in community-dwelling older adults (ages 60–89) who completed an outpatient neuropsychological evaluation ( N = 452). Psychometrically sound and validated measures were used to assess depression (Geriatric Depression Scale [GDS]), anxiety (Beck Anxiety Inventory [BAI]), cognitive functioning (the Mini Mental Status Exam [MMSE] and the Repeatable Battery for the Assessment of Neuropsychological Status [RBANS]), and functional capacity (Texas Functional Living Scale [TFLS] and Instrumental Activities of Daily Living Questionnaire [IADL]). Multivariate analyses of covariance (MANCOVA) were conducted to examine differences between individuals with and without chronic pain, adjusting for age, education, gender, marital status, and other medical conditions. Results indicated that participants endorsing chronic pain displayed significantly higher levels of depression and anxiety, as well as lower levels of cognitive functioning and functional capacity, than those without chronic pain. Additionally, results of hierarchical multiple regressions indicated that chronic pain explained unique variance in all outcome variables, beyond demographic characteristics and health status. Chronic pain management may be an important intervention target for clinicians to help address cognitive and psychological functioning in older adults.
Social, emotional, and behavioral skills can be integrated into existing dynamic personality models
Authors: Jayawickreme Eranda , Fleeson William
Published: December 2024

We are very excited by the recent work of Soto and colleagues (2021; 2022; 2023) integrating the Big 5 model with the growing literature on the determinants of success. We agree that their proposed taxonomy of skills is a good starting point, especially given that it complements the substantive research literature supporting the Big 5. However, we argue that the decision to sharply separate traits from skills does not do justice to the full implications of their model, and that pulling back on the integration between traits and skills obscures the dynamic processes underlying the Big 5. Existing dynamic accounts of personality such as Whole Trait Theory provide a model for understanding both how these skills are included as part of traits and their development as well as a framework for interventions focused on skill development. We hope that discovering the link between skills and traits will warm researchers up to dynamic accounts of the Big 5.
Exploring hearing people’s experiences of working with sign language interpreters in the workplace
Authors: Hockaday Tamsyn
Published: December 2024

This study explored hearing (non-deaf) people’s experiences of working with sign language interpreters in the workplace. Qualitative data were collected through one-to-one interviews with managers, colleagues, or subordinates of deaf people. Transcripts of the interviews were then analysed using a reflexive thematic approach to identify themes that capture the hearing person’s perspective on working with interpreters. These themes included the positive and negative aspects of working with interpreters, the workplace norms and etiquette that affect both their understanding of the interpretation and their relationship with deaf colleagues, the way the interpreter presents both the deaf and hearing people, and finally the professional boundaries of the interpreter. In addition, the research revealed the reasons for hearing people creating their own lists of preferred interpreters and how this intersects with the preferences of deaf persons. Finally, the study explored the concept of trust and the effect this has on all individuals in the workplace.
Pericapsular Nerve Group (PENG) Block on Cadavers: A Scoping Review
Authors: Margenfeld Felix , Zendehdel Adib , Poilliot Amélie , Tamborrini Giorgio , Beck Matthias , Müller-Gerbl Magdalena
Published: December 2024

Objective:

The implementation of sonography has revolutionized anesthesia, especially local anesthesia. High-resolution sonography as an essential, well-established, and versatile technique now makes it possible to perform targeted nerve blocks and therefore to anesthetize with increasing precision. Ultrasonographic (US)-guided nerve blocks on cadavers are often used as pilot studies to investigate new techniques. The aim of this review was to map out US-guided pericapsular nerve group (PENG) block in human cadavers.

Materials and Methods:

A systematic scoping review following PRISMA-ScR guideline. A systematic literature review has been carried out, with relevant studies discovered in the following databases: MEDLINE, EMBASE, CENTRAL, BIOSIS Previews, and Web of Science Core Collection. The publishing year was not subject to any extra limitations. Only sonography studies on human cadavers were included. The article was included if the PENG block was the subject of the study.

Results:

The search found 9821 matches, from which 291 investigated nerves. Four studies investigated the PENG block. A total volume of 2396 ml dye was injected with an average volume of 19.01 ml for each PENG block. 126 US-guided PENG blocks were performed on human cadavers.

Conclusion:

Based on our assessment, this study is the first review to screen US-guided PENG blocks on human cadavers. US-guided labeling techniques in human cadavers are a widespread tool to examine new nerve block techniques through staining targeted nerves by dye and investigating staining quality and quantity by dissecting. These results suggest that PENG block should be further investigated on cadavers to determine the MEV90 for the targeted nerves of the PENG block and to test possible novel injection pathways of these nerves.
Introduction to a review series on high-risk aggressive lymphoma
Authors: Sehn Laurie H. , Hallek Michael
Published: December 2024

Edited by Associate Editor Michael Hallek and Podcast Editor Laurie H. Sehn, this Review Series highlights the biologic features of, clinical phenotype of, and therapeutic approaches to high-risk lymphoid malignancies, namely, lymphomas that exhibit rapid growth, present acutely, and require timely therapy. Although many patients are cured with chemotherapy, a subset of patients have treatment resistance and inferior outcomes. This timely set of state-of-the-art reviews addresses the challenges of defining and treating high-risk patients with lymphoma.
A critical multi-parameter analysis of the densification process on the dimensional stability and bending performance of densified timber
Authors: Cabral John Paul , Subhani Mahbube , Ashraf Mahmud , Kafle Bidur , Reiner Johannes
Published: December 2024

Timber densification is a process wherein various parameters can affect the physical and mechanical properties of the final product. Therefore, it is vital to understand the effects of these parameters to fully exploit the benefits of densification such as improved density, stiffness, and strength. The purpose of this study is to improve on the mechanical properties of Radiata pine (Pinus radiata) and to determine the influence of the process parameters. The densification process and the bending properties of the densified timber were investigated using a fractional factorial experimental design to determine the influence of various parameters (compression ratio, moisture content, compression temperature, heating time, setting temperature, and setting time) on the final product. Among the six process parameters, the compression ratio was the most significant factor with respect to bending properties of the densified timber, while the effect of the other parameters does not show a specific trend with respect to the load–displacement behaviour of the test specimens. A predictive model has been proposed herein to determine the properties of densified timber based on a reduced number of process parameters, with examples based on different design applications.
Elucidation of molecular function of phage protein responsible for optimization of host cell lysis
Authors: Kim Jinwoo , Kim Joonbeom , Ryu Sangryeol
Published: December 2024

Background

Bacteriophages (or phages) replicate by utilizing bacterial resources and destroy their host cells at the end of the replication cycle. Phages employ multiple proteins to optimize host cell lysis, thereby maximizing the production of phage particles. However, elucidating the entire lysis process is challenging due to the abundance of uncharacterized genes in the phage genome.

Results

In this study, we identified a gene orf52 from BSPM4 phage genome that showed antibacterial activity in Salmonella. Investigation of physiological role of ORF52 in the phage replication revealed that ORF52 could modulate the holin function to fine-tune a cell lysis, providing replication advantages to phages under high phage population density.

Conclusions

We concluded that ORF52 may optimize phage replication by modulating the timing of phage-mediated cell lysis. This study provides a unique example of a phage protein involved in fine-tuning lysis timing.
Molecular characterization and safety properties of multi drug-resistant Escherichia coli O157:H7 bacteriophages
Authors: Oluwarinde Bukola Opeyemi , Ajose Daniel Jesuwenu , Abolarinwa Tesleem Olatunde , Montso Peter Kotsoana , Njom Henry Akum , Ateba Collins Njie
Published: December 2024

The increase in multi drug resistance (MDR) amongst food-borne pathogens such as Escherichia coli O157:H7, coupled with the upsurge of food-borne infections caused by these pathogens is a major public health concern. Lytic phages have been employed as an alternative to antibiotics for use against food-borne pathogens. However, for effective application, phages should be selectively toxic. Therefore, the objective of this study was to characterise lytic E. coli O157:H7 phages isolated from wastewater as possible biocontrol agents and access their genomes for the absence of genes that denotes virulence, resistance, toxins, and lysogeny using whole genome sequencing. E. coli O157:H7 bacteriophages showed clear plaques ranging in size from 1.0 mm to 2.0 mm. Spot test and Efficiency of plating (EOP) analysis demonstrated that isolated phages could infect various environmental E. coli strains. Four phages; vB_EcoM_EP32a, vB_EcoP_EP32b, vB_EcoM_EP57, and vB_EcoM_EP69 demonstrated broad lytic spectra against E. coli O157:H7 strains. Transmission Electron Microscopy (TEM) showed that all phages have tails and were classified as Caudoviricetes. Growth parameters showed an average latent period of 15 ± 3.8 min, with a maximum burst size of 392 PFU/cell. The phages were stable at three distinct temperatures (4 °C, 28 °C, and 37 °C) and at pH values of 3.5, 5.0, 7.0, 9.0, and 11.0. Based on their morphological distinctiveness, three phages were included in the Whole Genome Sequencing (WGS) analysis. WGS results revealed that E. coli O157:H7 phages (vB_EcoM_EP32a, vB_EcoP_EP32b, and vB_EcoM_EP57) were composed of linear double-stranded DNA (dsDNA) with genome sizes 163,906, 156,698, and 130,723 bp and GC contents of 37.61, 37, and 39% respectively. Phages vB_EcoM_EP32a and vB_EcoP_EP32b genomes were classified under the class Caudoviricetes, Straboviridae family, and the new genus “Phapecoctavirus”, while vB_EcoM_EP57 was classified under the class Caudoviricetes, Autographiviridae family. Genome analysis revealed no lysogenic (integrase), virulence, or antimicrobial resistance sequences in all three Escherichia phage genomes. The overall results provided evidence that lytic E. coli O157:H7 bacteriophages in this study, are relatively stable, can infect diverse E. coli strains, and does not contain genes responsible for virulence, resistance, toxins, and lysogeny. Thus, they can be considered as biocontrol candidates against MDR pathogenic E. coli O157:H7 strains in the food industry.
General practitioners experience multi-level barriers to implementing recommended care for hip and knee osteoarthritis: a qualitative study
Authors: Gibbs Alison J. , Barton Christian J. , Taylor Nicholas F. , Kemp Joanne L. , Wallis Jason A. , Manski-Nankervis Jo-Anne , Ezzat Allison M.
Published: December 2024

Background

General practitioners (GPs) play a key role in managing osteoarthritis, including referring to appropriate management services. Physiotherapist-led osteoarthritis management programs and advanced practice triage services are effective, but GPs views on them are largely unknown. This study aimed to explore general practitioner perspectives on: (1) managing patients with hip and knee osteoarthritis, and (2) physiotherapy-led osteoarthritis care and referral pathways.

Methods

Interview topic guides were developed based on the theoretical domains framework. Twenty-five semi-structured interviews with GPs were conducted. All data were coded independently by at least two researchers and analysed inductively using thematic analysis, with barrier themes mapped to the socioecological model.

Results

Two interrelated themes were identified: (i) GPs had good general knowledge of recommended osteoarthritis care, but (ii) they faced multi-level challenges facilitating or directly providing evidence-based care. Nearly all GPs identified exercise as first-line care and surgery as a last resort. Most were aware imaging was not required to diagnose osteoarthritis, yet reported often referring for imaging. Many GPs expressed challenges facilitating patient engagement in physiotherapy due to patient, environmental/social and system level barriers. Key barriers included: perceived patient expectations and lack of motivation to attend physiotherapy, a lack of knowledge of available physiotherapy services, a lack of affordable physiotherapy services, and lengthy waiting times for public orthopaedic appointments. Having private health insurance was perceived as an enabler.

Conclusions

Despite having good knowledge of guideline-recommended care, GPs in our study experienced multi-level barriers to implementing this care in practice. Public health information and strategies to address patient’s beliefs and lack of motivation to exercise may help reduce barriers to engaging in appropriate care. Urgent health system funding reforms are needed to allow GPs to appropriately manage patients with hip and knee osteoarthritis.
Evaluating the effectiveness and acceptability of two positive body image media micro-interventions among children aged 4–6 years old – a study protocol
Authors: Smith H. G. , Garbett K. M. , White P. , Williamson H. , Craddock N.
Published: December 2024

Background

Children’s online media perpetuates appearance idealised images and can negatively impact the way children feel about their own and other people’s bodies (e.g., weight bias) at a young age. The development and evaluation of body image interventions for young children to counteract this, are scarce. There is a need for prevention efforts to nurture the development of positive body image among this group to help mitigate potential body image concerns in later childhood. Media-based approaches promoting positive body image messages have shown preliminary efficacy. In collaboration with industry partners, we have developed two positive body image media micro-interventions (a 15-minute episode and a music video) to be evaluated in a fully powered RCT.

Methods

We aim to recruit 440 children between the ages of 4 and 6 years to be randomised into one of four conditions: (i) 15-minute episode intervention, (ii) 15-minute episode control, (iii) 3-minute music video intervention, or (iv) 3-minute music video control. This study will be conducted face-to-face, whereby children and a parent attend a media screening session and children complete pre-and post-intervention measures of positive body image and weight bias. Both the child and parent will watch their assigned media, together on a tablet device. Due to their age, children will complete outcome measures with a trained moderator in a play-based interview pre-intervention (T1), immediately post-intervention (T2) and one-week follow up (T3). A corresponding parent will complete a questionnaire on intervention acceptability at T2, and re-watch of their assigned media at T3. The primary outcome will be the change in body appreciation, and secondary outcomes include change in functionality appreciation and weight bias. Exploratory analyses will determine any effect of gender (girls vs. boys), year group (reception vs. year 1) dosage or delayed effects. Moderator fidelity will be also assessed.

Discussion

This study will evaluate two positive body image micro-interventions among children 4–6 years old. These interventions have the potential to bolster children’s positive body image and reduce weight bias. A dissemination plan is in place with project stakeholders such that the interventions can reach millions of children worldwide.

Trial registration

The trial is registered with Clinical Trial.gov, Ref number: NCT06146647.
Revisiting cost-effectiveness of folic acid supplementation in primary stroke prevention in China: considering vitamin B12 deficiency masking issue
Authors: Chen Xiyin , Bishai David
Published: December 2024

Objectives

To identify the cost-effectiveness of four policy options related to folic acid supplements after considering the side effects of masking vitamin B12 (B12) deficiency in primary stroke prevention for hypertensive patients in China.

Study Design

A cost-effectiveness analysis.

Methods

Four policies were considered: Policy A, Do nothing to address folate status in hypertensive patients at risk for stroke; Policy B, Folate supplementation without pre-screening for vitamin B12 deficiency; Policy C, Folate supplementation with pre-screening all patients for B12 deficiency and add B12 supplements if B12 is deficient; and Policy D, Folate supplementation only for those whose folate is deficient, pre-screen all patients for both B12 and folate deficiencies and add B12 supplements if B12 is deficient. A decision tree with a five-year period of intervention based on the China Stroke Primary Prevention Trial (CSPPT) from the Chinese healthcare system perspective estimated incremental cost-effectiveness ratio (ICER) for Policy B, Policy C and Policy D vs. Policy A.

Results

At a willingness to pay (WTP) threshold of 3 times the national GDP per capita ($38,198), Policy B was not cost-effective compared to Policy A, with an ICER of $47,968 per QALY due to QALYs lost introduced by the delayed diagnosis of B12 deficiency and the potentially underestimated costs associated with treating neuropathy. However, Policy C and Policy D were cost-effective compared to Policy A, with an ICER of $32,615 and $20,287 per QALY, respectively. A probabilistic sensitivity analysis showed that there would be a 72.7% and 83.5% chance that the additional cost of Policy C and Policy D, compared with Policy A, was at or below the WTP threshold.

Conclusions

Folate supplementation with integrated screening for B12 and folate deficiencies is considered the most cost-effective strategy for primary stroke prevention in hypertensive elderly patients in China. Future research should focus on advancing precision medicine to assess the feasibility and cost-effectiveness of nationwide implementation across diverse sub-populations within the context of integrated screening, ensuring efficient and tailored public nutrition strategy delivery.
The effect of lysophosphatidic acid on myometrial contractility and the mRNA transcription of its receptors in the myometrium at different stages of endometrosis in mares
Authors: Piotrowska-Tomala Katarzyna Karolina , Szóstek-Mioduchowska Anna , Jonczyk Agnieszka Walentyna , Drzewiecka Ewa Monika , Wrobel Michał Hubert , Hojo Takuo , Ferreira-Dias Graca , Skarzynski Dariusz Jan
Published: December 2024

Background

Endometrosis (chronic degenerative endometritis) results in morphological changes in the equine endometrium and impairs its secretory function. However, the effect of this condition on the myometrium remains unclear. Lysophosphatidic acid (LPA) may affect female reproductive function and embryo transport by influencing uterine contractility through its receptors (LPARs). The objective of this study was to determine myometrial LPAR1–6 mRNA transcription, and the effects of LPA on myometrial contractions in mares with endometrosis during the mid-luteal and follicular phases of the estrous cycle.

Results

A reduction in myometrial LPAR1 mRNA transcription was observed in mares with endometrosis during the mid-luteal phase, in comparison to those with category I endometria (P < 0.05). While, upregulation of myometrial LPAR3 or LPAR6 mRNA transcription was observed in mares with category III or IIB endometria; respectively (P < 0.05). An increase in myometrial LPAR1, LPAR3 and LPAR5 mRNA transcription was observed during the follicular phase in mares with category IIA endometrium in comparison to their expression in category I endometrium (P < 0.05). During endometrosis progression LPA reduced the force of myometrial contractions in both phases of the estrous cycle (P < 0.05). However, in mares with category IIA endometrium during the follicular phase, LPA was found to increase the force of contraction of myometrial strips in comparison to mares with category I endometrium (P < 0.01).

Conclusion

In the course of endometrosis in mares, a disruption in the myometrial mRNA transcription of LPARs has been observed. This is the first study to examine the impact of LPA on myometrial contractility at diffrent stage of endometrosis. However, it is essential to consider that multiple factors may contribute to this process. Alternations in contractile activity and changes in myometrial LPARs mRNA transcription may indicate impaired LPA-signaling mechanisms in equine myometrium during endometrosis.
The Australian clinical trial landscape: Perceptions of rural, regional and remote health service capacity and capability
Authors: Graffini Jenna , Johnston Karen , Farrington Alison , McPhail Steven M. , Larkins Sarah
Published: December 2024

Background

Access to clinical trials is limited for rural, regional and remote Australians, adding to the current health inequity between rural and metropolitan populations. The Australasian Teletrial Model was developed to bring clinical trials “closer to home”. In 2020, the Australian Teletrial Program was funded to expand and support the uptake of the model across six Australian states and territories. The aim of this study was to explore and describe the clinical trial landscape in Australia prior to the implementation of the Australian Teletrial Program with a particular focus on rural, regional and remote health services.

Methods

This qualitative study provides a descriptive exploration of the clinical trial landscape across rural, regional and remote Australia. Data were obtained from semi-structured interviews (n = 33) and one focus group (n = 5) involving clinical trial stakeholders between August 2022 and May 2023. Deductive then inductive thematic analysis used the broad topic areas of the interview schedule as a framework, as follows: education and training, workforce, equipment and services, clinical trial sites, participant recruitment and clinical trial approval process.

Results

This study identified barriers that are generalizable to the Australian clinical trial landscape and those specific to the rural, regional and remote health service context. The main barriers to conducting clinical trials in rural, regional and remote areas were lack of investment and engagement on the part of health service executives, workforce limitations, inconsistent training, lack of physical infrastructure and competing clinical priorities. Despite these challenges, clinicians reported enthusiasm for conducting clinical trials, and opportunities were reported for these health services to partner with larger metropolitan/regional health services, regional universities and communities to support the growth of clinical trial capability and capacity.

Conclusions

The clinical trial landscape in Australian health services varies in terms of quality and availability of training, workforce capacity, executive support, site capability and approval processes. The Australian Teletrial Program has an immense opportunity to overcome some of the reported challenges by supporting capacity and capability building. Ultimately, however, sustainable reform to bring trials closer to home requires a collaborative approach that considers implementation strategies across all levels of the health service and government, alongside other initiatives.
The clinical and biochemical effectiveness and safety of cholic acid treatment for bile acid synthesis defects: a systematic review
Authors: Polak Yasmin , van Dussen Laura , Kemper E. Marleen , Vaz Frédéric M. , Klouwer Femke C. C. , Engelen Marc , Hollak Carla E. M.
Published: December 2024

Background

Bile acid synthesis defects (BASDs) can be severely disabling involving the liver and nervous system, potentially due to elevated levels of toxic C27-bile acid intermediates. Cholic acid (CA) supplementation is hypothesized to decrease bile acid production, stimulate bile secretion and -flow, and slowing down disease progression. This systematic review assesses the clinical and biochemical effectiveness, and safety of CA in BASDs patients.

Methods

A systematic review of MEDLINE, Embase and clinical trial registries (ClinicalTrials.gov, ICTRP registry) using controlled MeSH- and Emtree terms.

Results

From 526 articles 70 publications were deemed eligible for inclusion based on title and abstract. 14 publications were included after full-text assessment comprising case reports and -series with 1–35 patients (162 patients in total) receiving 1 week to 16,5 years of CA treatment. All presented data on effectiveness, 8 studies also presented data on safety. The included population concerned patients with Zellweger spectrum disorders (n = 73), 3β-Hydroxy-Δ5-C27-steroid oxidoreductase deficiency (n = 62), cerebrotendinous xanthomatosis (n = 22), Δ4-3-oxosteroid 5β-reductase deficiency (n = 13), and α-methylacyl-CoA racemase deficiency (n = 3). Main outcomes concerned liver disease (12 studies), general physical examinations, biochemical outcomes, and safety (9 studies), and fat-soluble vitamin absorption (7 studies). The overall risk of bias score was considered to be critical (1 study), serious (4 studies), and moderate (9 studies). Major issues were missing data (10 studies), generalized data (8 studies), and no wash-out between treatments (4 studies).

Conclusion

More controlled studies are required as the available data is insufficient to draw definite conclusions on the effectiveness and safety of CA treatment in BASD patients. Establishing an independent international disease registry could better utilize existing real-world data.
Rationale and design of a large trial of perioperative ketamine for prevention of chronic post-surgical pain
Authors: Peyton Philip J. , Braat Sabine , De Silva Anurika , Story David , Evered Lisbeth , Myles Paul S. , Chan Matthew , Schug Stephan , Hogg Malcolm , Holmes Alex , Sidiropoulos Sofia , Leslie Kate
Published: December 2024

Background

Chronic post-surgical pain (CPSP) is recognised as one of the most common and debilitating complications of major surgery. Progression from acute to chronic pain after surgery involves sensitisation of central nervous system pathways with the N-methyl-D-aspartate (NMDA) receptor having a central role. Ketamine is a potent, non-selective NMDA antagonist commonly used for management of acute postoperative pain. Inconsistent but largely supportive evidence from small trials of a preventative effect of perioperative ketamine on CPSP risk suggests that a confirmative large trial is needed.

Methods

The ROCKet (Reduction Of Chronic Post-surgical Pain with Ketamine) Trial is a multicentre, double-blind, placebo-controlled, individually randomised superiority trial conducted in 36 hospitals across Australia, New Zealand, and Hong Kong. The trial aims to recruit 4884 patients undergoing abdominal, thoracic, or major orthopaedic surgery. Eligible participants are randomised equally to perioperative intravenous ketamine or placebo for up to 72 h. Incidence of pain in the area of the index surgery is measured by structured telephone interview at 3 months (primary trial endpoint) and 12 months. Pain severity, nature, and associated psychological and quality of life indices are measured using the modified Brief Pain Inventory short form, Neuropathic Pain Questionnaire, Kessler K-10 Psychological Distress Scale, Pain Catastrophising Scale, EQ-5D-3L, and measures of healthcare utilisation and costs. The trial is being conducted by the Department of Critical Care, University of Melbourne, and the Australian and New Zealand College of Anaesthetists Clinical Trials Network. The trial is funded by the Australian National Health and Medical Research Council.

Discussion

The ROCKet trial will clarify the effectiveness of ketamine in primary prevention of CPSP. In addition, it will provide high-quality, prospective data on the epidemiology of CPSP which will better inform further research into prevention and management of CPSP.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN12617001619336) on the date of 12/11/2017.
Process-based therapy vs. routine-CBT for difficult-to-treat mood and anxiety disorders: study protocol for a randomized controlled trial
Authors: Stangier Ulrich , Kohl Viktoria , Görg Nora , Sendig Lucie , Hufschmidt Bettina , Bonarius Desiree , Nemani Arwin , Ebert Mareike , Hofmann Stefan G.
Published: December 2024

Background

Process-based therapy (PBT) is a new framework to intervention planning, based on the use of ecological momentary assessment (EMA) data and dynamic and idiographic network analyses. Support for its applicability has been reported from a single-case studies. Here, we examine the feasibility and effectiveness of PBT in a larger clinical sample. We have translated a training manual of PBT and modified for delivery of CBT in mental health service. The aim of this study is to test the relative efficacy of PBT compared to traditional CBT delivered in routine practice (r-CBT) for difficult-to-treat mood and anxiety disorders.

Methods

The study is a randomized controlled trial (RCT) of PBT vs r-CBT for difficult-to-treat unipolar depression and anxiety disorders. In total, 80 patients are recruited at an outpatient clinic and included in two intervention arms.

Primary outcome is emotional distress; secondary outcomes include psychological well-being and quality of life, adaptive behavior, psychological flexibility, and reflective functioning. Assessments of outcome variables are conducted before and after therapy and at 6 months follow-up. Weekly patient-rated outcomes are collected for every session to investigate process of change. Outcome assessors, blind to treatment allocation, will perform the observer-based symptom ratings, and adherence with manual will be monitored using self-report.

Discussion

The current study will be the first RCT of PBT in a health care setting. The planned moderator and mediator analyses will clarify the mechanisms of change in psychotherapy and the association between personalized assessment based on dynamic network analysis and treatment effect.

Trial registration

ClinicalTrials.gov NCT06517589. Registered 24 July 2024.
Cave-dwelling phlebotomine sand flies (Diptera: Psychodidae: Phlebotominae) in Thailand: population composition and pathogen detection of Bartonella and Trypanosoma
Authors: Sunantaraporn Sakone , Somwang Puckavadee , Khositharattanakool Pathamet , Unchanam Isaraporn , Saenchaiban Nattiya , Wongkhut Wilai , Sanum Pinpinat , Pataradool Thanapat , Boonserm Rungfar , Depaquit Jérôme , Siriyasatien Padet
Published: December 2024

Background

Leishmaniasis is an emerging vector-borne disease that occurs in Thailand. Although Leishmania (Mundinia) parasites, the causative agents of the disease have been identified, the vectors of the disease remain unidentified. In the present study, we collected sand flies from three caves located in endemic areas of leishmaniasis, including Lampang and Chiang Rai in northern Thailand, and Songkhla in southern Thailand.

Methods

Female sand flies were identified on the basis of morphological characteristics and confirmed by cytochrome c oxidase subunit I (COI) sequencing. Sand fly DNA samples were screened for Leishmania, Trypanosoma, and Bartonella DNA by polymerase chain reaction (PCR) on the basis of the ITS1 region of the ribosomal RNA (rRNA), SSU rRNA, and gltA genes, followed by phylogenetic relationships and haplotype diversity analysis.

Results

A total of 557 sand flies were identified, comprising four genera (Sergentomyia, Phlebotomus, Grassomyia, and Idiophlebotomus) and 11 species. Molecular detection of pathogens demonstrated that Leishmania DNA was not detected. However, Trypanosoma DNA was detected in 11 samples of Phlebotomus mascomai from Lampang (7 for T. noyesi), Se. anodontis from Chiang Rai (1 each for T. noyesi and Trypanosoma sp.), and Se. khawi from Songkhla (2 for Trypanosoma sp.). Bartonella DNA was detected in 16 samples of Se. anodontis and Se. barraudi s.l. from Chiang Rai, Se. anodontis from Lampang, and Se. khawi from Songkhla. The novel Bartonella sp. detected in Thai sand flies was phylogenetically related to Bartonella sp. from bats. Genetic diversity analysis showed high haplotype diversity in both Trypanosoma parasites and Bartonella bacteria.

Conclusions

The data from the present study indicate that phlebotomine sand flies could be potential vectors of zoonotic diseases caused by Trypanosoma sp. and Bartonella sp. To our knowledge, this is the first report of the natural infection of Bartonella associated with bats in Thailand, and the presence of T. noyesi and amphibian trypanosomes. However, further investigation is required to elucidate and enhance the understanding of potential vectors and transmission dynamics of pathogens in Thailand, particularly with regard to different seasonality, habitats, and host ranges.

Graphical abstract