bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk, Resilience, and the Two-Track Model of Dementia Grief Among Spouses of People Living With Cognitive Decline
Authors: Manevich Alexander , Rubin Simon Shimshon , Katz Michael , Ben-Hayun Rachel , Aharon-Peretz Judith
Published: June 2023

Pre-death grief in the context of dementia caregiving is a significant risk factor for depression, burden, anxiety, and adjustment difficulties. The Two-Track Model of Dementia Grief (TTM-DG) provides a bifocal perspective addressing the nature of the emotional attachment to a loved one living with cognitive impairment, along with a medico-psychiatric perspective associated with stress, trauma, and change in life. The aims of the present study were to empirically validate the components of the model as to identify salutary and risk factors for maladaptive grief responses. Participants were 62 spouses of people living with cognitive impairment, and a control group of 32 spouses. All completed a battery of self-report questionnaires. Structural Equation Modeling yielded six variables consistent with the TTM-DG: partner’s behavioral disorders; caregiver’s burden; social support; physical health; attachment anxiety; and dementia grief as an outcome measure. Additional findings addressed participants at risk for grief difficulties. The findings provide empirical support for the utility of the TTM-DG in the identification of risk factors associated with maladaptive responses and pre-death grief following a spousal cognitive decline. The TTM-DG can assist in the formulation of evidence-based evaluations and interventions to assist spouses caring for their loved ones living with dementia.
Reversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) network: Study protocol and rationale of a multicentre research collaboration
Authors: Lange Kristin Sophie , Choi So Youn , Ling Yu-Hsiang , Chen Shih-Pin , Mawet Jérôme , Duflos Claire , Lee Mi Ji , Ducros Anne , Wang Shuu-Jiun , Pezzini Alessandro
Published: June 2023

Introduction:

Reversible cerebral vasoconstriction syndrome (RCVS) is a rare, but increasingly recognised cerebrovascular condition with an estimated annual age-standardised incidence of approximately three cases per million. Knowledge about risk factors and triggering conditions and information about prognosis and optimal treatment in these patients are limited.

Methods:

The REversible cerebral Vasoconstriction syndrome intERnational CollaborativE (REVERCE) project aims to elucidate the epidemiological and clinical characteristics of RCVS by collecting individual patient data from four countries (France, Italy, Taiwan and South Korea) in the setting of a multicentric study. All patients with a diagnosis of definite RCVS will be included. Data on the distribution of risk factors and triggering conditions, imaging data, neurological complications, functional outcome, risk of recurrent vascular events and death and finally the use of specific treatments will be collected. Subgroup analyses will be made based on age, gender, aetiology, ethnicity and geographical region of residence.

Ethics and dissemination:

Ethical approval for the REVERCE study will be obtained from national or local institutional review boards in the participating centres. When needed, a standardised data transfer agreement will be provided for participating centres. We plan dissemination of our results in peer-reviewed international scientific journals and through conference presentations. We expect that the results of this unique study will lead to better understanding of clinical and epidemiological characteristics of RCVS patients.
Thinking vulnerability infrastructurally: Interdependence and possibility in Lebanon’s overlapping crises
Authors: Baumann Hanna , Moore Henrietta L
Published: June 2023

The notion of ‘vulnerability’ has gained growing traction in a range of different fields, from disaster risk reduction to feminist theory. This increased academic use has been paralleled by a rise in the use of the term as an operational concept in humanitarian and development policy. Using the incongruent deployments of the term as a starting point, this article examines the assumptions underpinning definitions of vulnerability in humanitarian programming in Lebanon, with a particular focus on the links between Lebanon’s crisis of public services and the mass displacement from neighbouring Syria since 2011. We show that, in the international response to Lebanon’s overlapping crises, ‘vulnerability’ is operationalised in ways that fail to address underlying causes, and thus resist meaningful transformation while even bearing the potential of additional harm. Based on the finding that vulnerabilities emanating from Lebanon’s public service crisis and from mass displacement are deeply entangled, the article proposes that an ‘infrastructural’ approach to vulnerability may better be able to address precariousness and precarity linked to basic service provision. An infrastructural approach, we posit, foregrounds dynamic interdependency and relationality with the human and non-human environment. Such a view allows us to acknowledge the power relations at work in both the production and alleviation of vulnerability and ultimately may better enable us to ‘think otherwise’ in situations of seemingly perpetual crisis and disruption.
Role of Preschool Teachers in Early Childhood Care and Education: A Study of Anganwadis/Anganwadi Schools Located in Scheduled Caste Colonies of Telangana State
Authors: Anjaneyulu Parupally
Published: June 2023

In India, ICDS provides early childhood education to children (3–6 years) under the supervision of Anganwadi Teacher (AWT). The study concluded that out of 42 AWTs, the majority are Schedule caste (SC) teachers and have more than 10 years of experience and only half of the AWTs have an intermediate and above qualification. The study also revealed that three-quarters of preschool children were from the SC community, and the rest came from other communities. The vast majority of AWCs have building blocks, charts, picture books and carpets, but the vast majority (65%) lack a first aid box. As per the study, the most difficult challenges for SC AWTs in organizing preschool education are as follows: insufficient space for class activities, material storage and indoor games; children’s irregularities, other responsibilities; parental migration, English medium schools and a lack of basic amenities, all of which impede proper pre-school education implementation.
Multimorbidity in South Africa: Is the health system ready?
Authors: Roomaney Rifqah Abeeda , van Wyk Brian , Pillay-van Wyk Victoria
Published: June 2023

Background: Multimorbidity is likely to be a significant contributor to ill health and inequality in South Africa and yet has been largely overlooked.

Purpose: This paper focuses on the findings of a recent large study that highlighted emerging issues - namely (i) the high levels of multimorbidity among three key groups - older adults, women, and the wealthy; (ii) discordant and concordant disease clusters among the multimorbid.

Research Design: Narrative.

Study Sample and Data Collection: Not applicable.

Results: We discuss the implications of each emerging issue for health systems policy and practice.

Conclusion: Although key policies are identified, many of these policies are not implemented and are therefore not part of routine practice, leaving much space for improvement.
An equivalent damping ratio that accounts for ground-motion spectral shape for displacement-based design of flag-shaped hysteresis systems
Authors: Zhou Ying , Tian Wenbo , Xiao Yi , Eberhard Marc O , Stanton John F
Published: June 2023

Direct displacement–based design (DDBD) methodologies simplify the estimation of the seismic deformation demands of a nonlinear system by replacing it with an equivalent linear system that is characterized by an effective stiffness and equivalent damping ratio (EDR). The calculated EDR for flag-shaped hysteresis relationships vary greatly among existing DDBD methodologies, and these methodologies display a strong bias according to the shape of the ground-motion response spectrum. In the work reported here, the limitations of existing methods are demonstrated for three sets of ground-motions: a set of far-field ground-motions, a set of near-field ground-motions, and a set of physics-based simulated ground-motions that account for the effects of a deep sedimentary basin. The effect of spectral shape can be quantified by a new measure of spectral shape that is based on the spectral displacement ordinates between the system’s initial and equivalent periods. To address the limitations of existing methodologies, a new equation for calculating EDR was developed based on numerous nonlinear history analyses for all three sets of ground-motions and for a wide range of systems with flag-shaped hysteresis. In comparison with existing equations, the proposed equation for calculating EDR improves the accuracy of the DDBD methodology by lowering the bias and dispersion of the ratio between the displacement calculated by nonlinear analysis and the displacement calculated with the equivalent linear system. The usage of the new EDR equation in DDBD requires iteration, but neither numerical modeling nor analysis is needed. Specific steps of the application are demonstrated for a system with a flag-shaped hysteresis.
Comparison of mortality rate and septic and aseptic revisions in total hip arthroplasties for osteoarthritis and femoral neck fracture: an analysis of the German Arthroplasty Registry
Authors: Szymski Dominik , Walter Nike , Krull Paula , Melsheimer Oliver , Schindler Melanie , Grimberg Alexander , Alt Volker , Steinbrueck Arnd , Rupp Markus
Published: June 2023

Background

Indications for total hip arthroplasties (THA) differ from primary osteoarthritis (OA), which allows elective surgery through femoral neck fractures (FNF), which require timely surgical care. The aim of this investigation was to compare mortality and revisions in THA for primary OA and FNF.

Methods

Data collection for this study was performed using the German Arthroplasty Registry (EPRD) with analysis THA for the treatment of FNF and OA. Cases were matched 1:1 according to age, sex, body mass index (BMI), cementation, and the Elixhauser score using Mahalanobis distance matching.

Results

Overall 43,436 cases of THA for the treatment of OA and FNF were analyzed in this study. Mortality was significantly increased in FNF, with 12.6% after 1 year and 36.5% after 5 years compared with 3.0% and 18.7% in OA, respectively (p < 0.0001). The proportion for septic and aseptic revisions was significantly increased in FNF (p < 0.0001). Main causes for an aseptic failure were mechanical complications (OA: 1.1%; FNF: 2.4%; p < 0.0001) and periprosthetic fractures (OA: 0.2%; FNF: 0.4%; p = 0.021). As influencing factors for male patients with septic failure (p < 0.002), increased BMI and Elixhauser comorbidity score and diagnosis of fracture (all p < 0.0001) were identified. For aseptic revision surgeries, BMI, Elixhauser score, and FNF were influencing factors (p < 0.0001), while all cemented and hybrid cemented THA were associated with a risk reduction for aseptic failure within 90 days after surgery (p < 0.0001).

Conclusion

In femoral neck fractures treated with THA, a significant higher mortality, as well as septic and aseptic failure rate, was demonstrated compared with prosthesis for the therapy of osteoarthritis. Increased Elixhauser comorbidity score and BMI are the main influencing factors for development of septic or aseptic failure and can represent a potential approach for prevention measures.

Level of evidence: Level III, Prognostic.
Peroneal muscle response to single-leg drop-jump and unexpected leg-drop in young and middle-aged adults before and after one session of neuromuscular training
Authors: Hayek Roee , Gottlieb Uri , Gutman Itai , Springer Shmuel
Published: June 2023

Background

Changes in neuromuscular ability in middle age (MA) may lead to deterioration of postural control. The aim of this study was to investigate the anticipatory response of the peroneus longus muscle (PL) to landing after a single-leg drop-jump (SLDJ), and its postural response after an unexpected leg-drop in MA and young adults. A second aim was to investigate the influence of neuromuscular training on PL postural responses in both age groups.

Methods

Twenty-six healthy MA (55.3 ± 4 years) and 26 healthy young adults (26.3 ± 3.6 years) participated in the study. Assessments were performed before (T0) and after (T1) PL EMG biofeedback (BF) neuromuscular training. Subjects performed SLDJ, and PL EMG activity in preparation for landing (% of flight time) was calculated. To measure PL time to activation onset and time to peak activation in response to an unexpected leg-drop, subjects stood on a customized trapdoor device that produced a sudden 30° ankle inversion.

Results

Before training, the MA group showed significantly shorter PL activity in preparation for landing compared to the young adults (25.0% vs. 30.0%, p = 0.016), while after training there was no difference between the groups (28.0% vs. 29.0%, p = 0.387). There were no differences between groups in peroneal activity after the unexpected leg-drop before and after training.

Conclusions

Our results suggest that automatic anticipatory peroneal postural responses are decreased at MA, whereas reflexive postural responses appear to be intact in this age group. A short PL EMG-BF neuromuscular training may have an immediate positive effect on PL muscle activity at MA. This should encourage the development of specific interventions to ensure better postural control in this group.

Trial registration

ClinicalTrials.gov NCT05006547.
The Poisson distribution model fits UMI-based single-cell RNA-sequencing data
Authors: Pan Yue , Landis Justin T. , Moorad Razia , Wu Di , Marron J. S. , Dittmer Dirk P.
Published: June 2023

Background

Modeling of single cell RNA-sequencing (scRNA-seq) data remains challenging due to a high percentage of zeros and data heterogeneity, so improved modeling has strong potential to benefit many downstream data analyses. The existing zero-inflated or over-dispersed models are based on aggregations at either the gene or the cell level. However, they typically lose accuracy due to a too crude aggregation at those two levels.

Results

We avoid the crude approximations entailed by such aggregation through proposing an independent Poisson distribution (IPD) particularly at each individual entry in the scRNA-seq data matrix. This approach naturally and intuitively models the large number of zeros as matrix entries with a very small Poisson parameter. The critical challenge of cell clustering is approached via a novel data representation as Departures from a simple homogeneous IPD (DIPD) to capture the per-gene-per-cell intrinsic heterogeneity generated by cell clusters. Our experiments using real data and crafted experiments show that using DIPD as a data representation for scRNA-seq data can uncover novel cell subtypes that are missed or can only be found by careful parameter tuning using conventional methods.

Conclusions

This new method has multiple advantages, including (1) no need for prior feature selection or manual optimization of hyperparameters; (2) flexibility to combine with and improve upon other methods, such as Seurat. Another novel contribution is the use of crafted experiments as part of the validation of our newly developed DIPD-based clustering pipeline. This new clustering pipeline is implemented in the R (CRAN) package scpoisson.
Indirect regeneration in Ficus lyrata Warb. and metabolite profiles influenced by nitric oxide and Plant growth regulators
Authors: Abdolinejad Ruhollah , Salmi Mohamadreza Salehi
Published: June 2023

Background

To establish an indirect regeneration protocol in Ficus lyrata, a three-phase experiment (callus induction, morphogenic callus induction, and plant regeneration) based on auxin, cytokinin, and nitric oxide interactions was designed and implemented using leaf explants. The metabolite profiles (amino acid profile, total phenolic content, total soluble sugars, and total antioxidant activity) alteration patterns were also investigated to determine the metabolites contributing to the progress of each phase.

Results

Results demonstrated that 11 out of 48 implemented treatments resulted in morphogenic callus induction (morphogenic treatments), and nitric oxide played a key role in increasing efficiency from 13 to 100%. More importantly, nitric oxide cross-talk with cytokinins was necessary for shoot regeneration from morphogenic calli. Only 4 out of all 48 implemented treatments were capable of shoot regeneration (regenerative treatments), and among them, PR42 treatment led to the highest shoot regeneration rate (86%) and maximum mean number of shoot/explant (10.46). Metabolite analyses revealed that the morphogenic and regenerative treatments followed similar metabolite alterations, which were associated with increased biosynthesis of arginine, lysine, methionine, asparagine, glutamine, histidine, threonine, leucine, glycine, serine amino acids, total soluble sugars content, and total antioxidant activity. On the contrary, non-morphogenic and non-regenerative treatments caused the accumulation of a significantly greater total phenolic content and malondialdehyde in the explant cells, which reflexed the stressful condition of the explants.

Conclusions

It could be concluded that the proper interactions of auxin, cytokinins, and nitric oxide could result in metabolite biosynthesis alterations, leading to triggering cell proliferation, morphogenic center formation, and shoot regeneration.
Cerebral embolic protection during transcatheter aortic valve replacement: a systematic review and meta-analysis of propensity score matched and randomized controlled trials using the Sentinel cerebral embolic protection device
Authors: Wolfrum Mathias , Handerer Immanuel Justus , Moccetti Federico , Schmeisser Alexander , Braun-Dullaeus Ruediger C. , Toggweiler Stefan
Published: June 2023

Background

The Sentinel cerebral embolic protection device (CEP) aims to reduce the risk of stroke during transcatheter aortic valve replacement (TAVR). We performed a systematic review and meta-analysis of propensity score matched (PSM) and randomized controlled trials (RCT) investigating the effect of the Sentinel CEP to prevent strokes during TAVR.

Methods

Eligible trials were searched through PubMed, ISI Web of science databases, Cochrane database, and proceedings of major congresses. Primary outcome was stroke. Secondary outcomes included all-cause mortality, major or life-threatening bleeding, major vascular complications and acute kidney injury at discharge. Fixed and random effect models were used to calculate the pooled risk ratio (RR) with 95% confidence intervals (CI) and absolute risk difference (ARD).

Results

A total of 4066 patients from 4 RCTs (3′506 patients) and 1 PSM study (560 patients) were included. Use of Sentinel CEP was successful in 92% of patients and was associated with a significantly lower risk of stroke (RR: 0.67, 95% CI: 0.48–0.95, p = 0.02. ARD: -1.3%, 95% CI: -2.3 – -0.2, p = 0.02, number needed to treat (NNT) = 77), and a reduced risk of disabling stroke (RR: 0.33, 95% CI: 0.17–0.65. ARD: -0.9%, 95% CI: -1.5 – -0.3, p = 0.004, NNT = 111). Use of Sentinel CEP was associated with a lower risk of major or life-threatening bleeding (RR: 0.37, 95% CI: 0.16–0.87, p = 0.02). Risk for nondisabling stroke (RR: 0.93, 95% CI: 0.62–1.40, p = 0.73), all-cause mortality (RR: 0.70, 95% CI: 0.35–1.40, p = 0.31), major vascular complications (RR: 0.74, 95% CI: 0.33–1.67, p = 0.47) and acute kidney injury (RR: 0.74, 95% CI: 0.37–1.50, p = 0.40) were similar.

Conclusions

The use of CEP during TAVR was associated with lower risks of any stroke and disabling stroke with an NNT of 77 and 111, respectively.
Comprehensive analysis identifies cuproptosis-related gene DLAT as a potential prognostic and immunological biomarker in pancreatic adenocarcinoma
Authors: Zhang Xiaoling , Zhou Yuxin , Hu Jiahe , Yu Xuefeng , Xu Haitao , Ba Zhichang , Zhang Haoxin , Sun Yanan , Wang Rongfang , Du Xinlian , Mou Ruishu , Li Xuedong , Zhu Jiuxin , Xie Rui
Published: June 2023

Background

Cuproptosis is a regulated cell death form associated with tumor progression, clinical outcomes, and immune response. However, the role of cuproptosis in pancreatic adenocarcinoma (PAAD) remains unclear. This study aims to investigate the implications of cuproptosis-related genes (CRGs) in PAAD by integrated bioinformatic methods and clinical validation.

Methods

Gene expression data and clinical information were downloaded from UCSC Xena platform. We analyzed the expression, mutation, methylation, and correlations of CRGs in PAAD. Then, based on the expression profiles of CRGs, patients were divided into 3 groups by consensus clustering algorithm. Dihydrolipoamide acetyltransferase (DLAT) was chosen for further exploration, including prognostic analysis, co-expression analysis, functional enrichment analysis, and immune landscape analysis. The DLAT-based risk model was established by Cox and LASSO regression analysis in the training cohort, and then verified in the validation cohort. Quantitative reverse transcriptase polymerase chain reaction (RT-qPCR) and immunohistochemistry (IHC) assays were performed to examine the expression levels of DLAT in vitro and in vivo, respectively.

Results

Most CRGs were highly expressed in PAAD. Among these genes, increased DLAT could serve as an independent risk factor for survival. Co-expression network and functional enrichment analysis indicated that DLAT was engaged in multiple tumor-related pathways. Moreover, DLAT expression was positively correlated with diverse immunological characteristics, such as immune cell infiltration, cancer-immunity cycle, immunotherapy-predicted pathways, and inhibitory immune checkpoints. Submap analysis demonstrated that DLAT-high patients were more responsive to immunotherapeutic agents. Notably, the DLAT-based risk score model possessed high accuracy in predicting prognosis. Finally, the upregulated expression of DLAT was verified by RT-qPCR and IHC assays.

Conclusions

We developed a DLAT-based model to predict patients’ clinical outcomes and demonstrated that DLAT was a promising prognostic and immunological biomarker in PAAD, thereby providing a new possibility for tumor therapy.
Association of full blood count findings with risk of mortality in children with Klebsiella pneumoniae bloodstream infection at a south african children’s hospital
Authors: Shapaka Johanna T , Muloiwa Rudzani , Buys Heloise
Published: June 2023

Background

Bloodstream infection (BSI) caused by Klebsiella pneumoniae (KP), is a leading cause of hospital-associated childhood mortality. There are limited data on how poor outcomes of KPBSI can be predicted in poorly resourced areas. This study aimed to assess if the profile of differential counts from full blood counts (FBC) taken at two time points in children with KPBSI could be used to predict the risk of death.

Methods

We conducted a retrospective study of a cohort of children admitted to hospital between 2006 and 2011 with KPBSI. FBC collected within 48 h (T1) of blood culture and 5–14 days later (T2), were reviewed. Differential counts were classified as abnormal if they were higher or lower than laboratory ranges for normal results. The risk of death was assessed for each category of differential counts. Risk ratios adjusted (aRR) for potential confounders were used to estimate the effect of cell counts on risk of death using multivariable analysis. Data were stratified by HIV status.

Results

Of 296 children, median age 5 (IQR:2–13) months, 82 were HIV -infected. Ninety-five (32%) children with KPBSI died. Mortality in HIV-infected and uninfected children was 39/82 (48%) and 56/214 (26%), respectively (p < 0.001). Independent associations with mortality were observed with leucopenia, neutropenia and thrombocytopenia. Risk of mortality in HIV-uninfected children with thrombocytopenia at T1 and T2 was aRR 2.5 (95% CI: 1.34–4.64) and 3.18 (95% CI: 1.31–7.73) respectively, whereas the mortality risk in the HIV-infected group with thrombocytopaenia at T1 and T2 was aRR 1.99 (95% CI: 0.94–4.19) and 2.01 (95% CI: 0.65–5.99) respectively. Neutropenia in the HIV-uninfected group at T1 and T2, showed aRR 2.17 (95% CI: 1.22–3.88) and aRR 3.70 (95% CI 1.30-10.51) respectively, while in the HIV-infected group, they were aRR 1.18 (95% CI 0.69–2.03) and aRR 2.05 (95% CI 0.87–4.85) at similar time points. Leucopenia at T2 was associated with mortality in HIV-uninfected and HIV-infected patients, aRR 3.22 (95%CI 1.22–8.51) and aRR 2.34 (95% CI 1.09–5.04) respectively. Persistent high band cell percentage at T2 in HIV-infected children indicated a risk of mortality of aRR 2.91 (95% CI 1.20–7.06).

Conclusion

Abnormal neutrophil counts and thrombocytopenia are independently associated with mortality in children with KPBSI. In resource-limited countries haematological markers have the potential to predict KPBSI mortality.
The clinical course and outcomes of SARS-CoV-2 virus infection in children: a 24-week follow-up study in Sulaimaniyah, Iraq
Authors: Sedik Rozhan Nabaz Mohammed
Published: June 2023

Most children infected with the SARS-CoV-2 virus have asymptomatic or mild disease with a short clinical course and excellent outcome; meanwhile, some children experienced persisting symptoms lasting > 12 weeks from the COVID-19 infection diagnosis. This study aimed to define the acute clinical course of SARS-CoV-2 virus infection and outcomes in children after recovery. This prospective cohort study was conducted on 105 children (aged < 16 years) with confirmed COVID-19 infection at Jamal Ahmed Rashid Teaching Hospital, Sulaimaniyah, Iraq, from July to September 2021. The symptomatic and suspicious cases of COVID-19 infection in children were confirmed by real-time reverse transcriptase-polymerase chain reaction (RT-PCR) on nasopharyngeal swabs. About 85.6% of children fully recovered at ≤ 4 weeks from initial COVID-19 infection diagnosis, 42% were hospitalized, while 15.2% reported long COVID-19 infection symptoms. The most commonly reported symptoms were fatigue (7.1%), hair fall (4.0%), lack of concentration (3.0%), and abdominal pain (2.0%). Children aged 11–16 showed a greater risk of long-term COVID-19 infection symptoms. We also observed a higher risk of long COVID infection symptoms in those who reported ongoing symptoms at 4–6 weeks of follow-up assessment (p = 0.01). Despite mild disease and complete recovery in most children, many suffered from long COVID infection symptoms.
Paediatric family activation rapid response (FARR) in tertiary healthcare organisations: Protocol for an online, multi-lingual, application (app) intervention development study
Authors: Marufu Takawira C. , Taylor Nicola , Fox Shannon Cresham , Boardman Rachel , Manning Joseph C.
Published: June 2023

Introduction

At least 85% of unplanned admissions to critical care wards for children and young people (CYP) are associated with clinical deterioration. CYP and their families play an integral role in the recognition of deterioration. The Paediatric Critical Care Outreach Team (PCCOT) supports the reduction of avoidable harm through earlier recognition and treatment of the deteriorating child, acting as a welcome conduit between the multiprofessional teams, helping ensure that CYP gets the right care, at the right time and in the right place. This positions PCCOT well to respond to families who call for help as part of family activation.

Aim

This protocol details the methods and process of developing a family activation rapid response online application.

Methods

This is a single-centre, sequential, multiple methods study design. Firstly, a systematic review of the international literature on rapid response interventions in paediatric family activation was conducted. Findings from the review aimed to inform the content for next stages; interviews/ focus groups and experience-based co-design (EBCD) workshops. Participants: parents / caregivers whose children have been discharged or admitted to an acute care hospital and healthcare professionals who care for paediatric patients (CYP). During interviews and workshops participants’ opinion, views and input will be sort on designing a family activation rapid response online-app, detailing content, aesthetics, broad functionality and multi-lingual aspects. Further areas of discussions include; who will use the app, access, appropriate language and terminology for use.

A suitable app development company will be identified and will be part of the stakeholders present at workshops. Data obtained will be used to develop a multi-lingual paediatric family activation rapid response web based application prototype.

Ethics and dissemination

Full ethical approval was received from the Wales Research Ethics Committee 2.

Cardiff; REC reference: 22/WA/0174. The findings will be made available to all stakeholders.
School-based peer-led diabetes intervention among female adolescents: a cluster randomized trial
Authors: Ameneh Pooresmaeil Dorosteh , Mohtasham Ghaffari , Sakineh Rakhshanderou , Yadollah Mehrabi , Ali Ramezankhani
Published: June 2023

Background

The prevalence of type 2 diabetes is increasing among adolescents and clear strategies are needed to prevent it. The aim of this study was to determine the effect of peer education on knowledge, health beliefs and preventive behaviors of type 2 diabetes in female adolescents.

Methods

In this cluster randomized trial study, 168 students (84 people in each group) were enrolled. The data collection instrument was a questionnaire of knowledge (30 questions), health beliefs (16 questions) and behavior (20 questions) whose validity and reliability were confirmed. Then eight capable students were chosen as peer educators after being trained. The intervention group received 8 sessions of 90-min education through training, lectures, question and answer, and group discussion and with teaching aids such as pamphlets, educational clips and text messages. The post-test was administered two months after the treatment. Data collected using software SPSS16 and Chi-Square and ANCOVA test were used.

Results

The result showed that the mean and standard deviation of general knowledge, disease symptoms, behavioral risk factors, mid-term outcomes and long-term outcomes, perceived self-efficacy, behavioral beliefs, perceived susceptibility, perceived severity, prevention of stress, healthy food/healthy diet, unhealthy food/unhealthy diet, high-risk behavior, and self-care in the intervention group has increased significantly 2 months after intervention compared of control group (P < 0.001).

Conclusions

Peer education increased knowledge and improved adolescents' health beliefs and behaviors. Therefore, training in adolescence in order to prevention of diabetes can be considered as an effective step, and the use of peer-led education in this field is recommended.

Trial registration

Trial registration number IRCT20200811048361N1 from School of Public Health & Neuroscience Research Center—Shahid Beheshti University of Medical Sciences. Date applied: 30/12/2020. Date assigned: 01/12/2020.
Predictive factors for docking site procedure in bone transport for large lower extremity segmental defects
Authors: Omar Pacha T. , Aktas G. , Graulich T. , Stübig T. , Clausen J. D. , Liodakis E. , Omar M. , Sehmisch S. , Mommsen P.
Published: June 2023

Background

Segmental bone transport is a common technique for treating large segmental bone defects. However, a docking site procedure is often necessary in segmental bone transport. To date, no prognostic factors for the need of docking site procedure have been reported. Thus, the decision is often made at random, based on the surgeon’s subjective judgment and experience. The aim of this study was to identify prognostic factors for the need of docking site operation.

Methods

Patients with segmental bone transport in lower extremity bone defects were included regardless of age, aetiology, and defect size. We excluded patients undergoing treatments that were not yet completed, and those who discontinued therapy by any reason. The need for docking site operation was modelled with logistical and linear regression as well as univariate analysis of variances (ANOVA). Receiver operating characteristics (ROC) curve analysis was also performed.

Results

Twenty-seven patients from age 12 to 74 years (mean age: 39.07 ± 18.20 years) were included. The mean defect size was 76.39 ± 41.10 mm. The duration of transport (days) showed a significant influence (p = 0.049, 95%CI: 1.00–1.02) on the need for docking site operation. No other significant influences were detected.

Conclusion

A link between the duration of transport and the need for docking site operation was detected. Our data showed that if a threshold of about 188 days is exceeded, docking surgery should be considered.
Symptoms and coping of patients with dysphagia after anterior cervical spine surgery: a qualitative study
Authors: Yu Chen , Chunmei Luo , Caiping Song
Published: June 2023

Aim

To explore the subjective symptoms, psychological characteristics and coping strategies of patients with dysphagia after anterior cervical spine surgery, so as to provide the basis for formulating strategies to help patients with dysphagia solve clinical practice problems and to improve their quality of life after surgery.

Methods

Using the phenomenological research method and the purpose sampling method, semi-structured interviews were conducted with 22 participants with dysphagia at 3-time points after anterior cervical spine surgery (7 days, 6 weeks, and 6 months).

Results

A total of 22 (10 females and 12 males) patients, with years old ranging between 33 and 78 years were interviewed. When analysing the data, the following 3 categories were extracted from the participant interviews: “Subjective symptoms, Coping style and impact on social life”. The 3 categories consist of 10 sub-categories.

Conclusions

The results showed that swallowing-related symptoms may occur after anterior cervical spine surgery. Many patients had developed compensatory strategies to manage or reduce the burden of these symptoms, but lacked professional guidance from health care professionals. Moreover, dysphagia after neck surgery has its unique characteristics, involving the interaction of physical, emotional and social factors, which requires early screening.Healthcare professionals should provide better psychological support in the early or late postoperative period to ensure the improvement of health outcomes and patients’ quality of life.
The role of Roux-en-Y hepaticojejunostomy for the management of biliary complications after living donor liver transplantation
Authors: Wen Tzu-Cheng , Hsieh Chia-En , Hsu Ya-Lan , Lin Kuo-Hua , Hung Yu-Ju , Chen Yao-Li
Published: June 2023

Introduction

Post living donor liver transplantation (LDLT) biliary complications can be troublesome over the post-operative course of patients, especially those with recurrent cholangitis or choledocholithiasis. Thus, in this study, we aimed to evaluate the risks and benefits of Roux-en-Y hepaticojejunostomy (RYHJ) performed after LDLT as a last option to deal with post-LDLT biliary complications.

Methods

Retrospectively, of the 594 adult LDLTs performed in a single medical center in Changhua, Taiwan from July 2005 to September 2021, 22 patients underwent post-LDLT RYHJ. Indications for RYHJ included choledocholithiasis formation with bile duct stricture, previous intervention failure, and other factors. Restenosis was defined if further intervention was needed to treat biliary complications after RYHJ was performed. Thereafter, patients were categorized into success group (n = 15) and restenosis group (n = 4).

Results

The overall success rate of RYHJ in the management of post-LDLT biliary complications was 78.9% (15/19). Mean follow-up time was 33.4 months. As per our findings, four patients experienced recurrence after RYHJ (21.2%), and mean recurrence time was 12.5 months. Three cases were recorded as hospital mortality (13.6%). Outcome and risk analysis presented no significant differences between the two groups. A higher risk of recurrence tended to be related to patients with ABO incompatible (ABOi).

Conclusion

RYHJ served well as either a rescue but definite procedure for recurrent biliary complications or a safe and effective solution to biliary complications after LDLT. A higher risk of recurrence tended to be related to patients with ABOi; however, further research would be needed.
Restoring black triangle with bioclear matrix versus conventional celluloid matrix method: a randomized clinical trial
Authors: Hussien Aya Omar Tawfik , Ibrahim Shereen Hafez , Essa Mona El Saied , Hafez Randa Mohamed
Published: June 2023

Background

Open gingival embrasures form complex aesthetic and functional problems. This clinical trial assessed the bioclear matrix using injection molding technique against conventional celluloid matrix technique in management of black triangle.

Methods

A total of 26 participants were randomly divided into two groups (13 participants each) according to the technique used. In group (A) celluloid conventional matrix method was used, while in group (B) bioclear matrix with injection molding technique was used. The different outcomes (Esthetic evaluation, marginal integrity and patient satisfaction) were evaluated following the FDI criteria by two blinded examiners. The evaluation was done at (T0) (immediate after restoration); (T6) after 6 months; and (T12) after 12 months. Statistical analysis was done as categorical and ordinal data were presented as frequency and percentage values. Categorical data were compared using fisher’s exact test. Intergroup comparisons for ordinal data were analyzed utilizing the Mann–Whitney U test, while intragroup comparisons were analyzed using Friedman’s test followed by the Nemenyi post hoc test. The significance level was set atp ≤ 0.05 within all tests.

Results

Regarding radiographic marginal integrity and marginal adaptation, the bioclear matrix group revealed superior results when compared to celluloid matrix group with a significant difference between both groups at all intervals (p < 0.05); however no significant difference was detected at different intervals. While for proximal anatomical form and esthetic anatomical form, as well as phonetics and food impaction, all cases in both groups were successful with no statistical significant difference between groups. For the periodontal response, there was no significant difference between groups. However, there was a significant difference between scores measured at different intervals, with T0 being significantly different from other intervals (p < 0.001). Marginal staining revealed that there was no significant difference between groups. While, a significant difference between scores measured at different intervals.

Conclusions

The restorative management of the black triangle with both protocols was able to deliver superior aesthetic and good marginal adaptation; suitable biological properties; with adequate survival time. Both techniques were almost equally successful, however they are depending on the operator skills.

Trial registration

The clinical trial was registered in the (www.clinicaltrials.gov/) database in 23/07/2020; with the unique identification number NCT04482790.
Identification of necroptosis-related gene TRAF5 as potential target of diagnosing atherosclerosis and assessing its stability
Authors: Peng Zhanli , Wang Kangjie , Wang Shenming , Wu Ridong , Yao Chen
Published: June 2023

Background

Atherosclerosis (AS) is a leading cause of morbidity and mortality in older patients and features progressive formation of plaques in vascular tissues. With the progression of atherosclerosis, plaque rupture may occur and cause stroke, myocardial infarction, etc. Different forms of cell death promote the formation of a necrotic core of the plaque, leading to rupture. Necroptosis is a type of programmed cell death that contributes to the development of cardiovascular disease. However, the role of necroptosis in AS has not yet been investigated.

Methods

The Gene Expression Omnibus (GEO) database was used to obtain gene expression profiles. Differentially expressed genes (DEGs) and necroptosis gene sets were used to identify necroptosis-related differentially expressed genes (NRDEGs). The NRDEGs were used to construct a diagnostic model and were further screened using least absolute shrinkage selection operator (LASSO) regression and random forest (RF) analysis. The discriminatory capacity of the NRDEGs was evaluated using receiver operating characteristic (ROC) curves. Immune infiltration levels were estimated based on CIBERSORTx analysis. The GSE21545 dataset, containing survival information, was used to determine prognosis-associated genes. Univariate and multivariate Cox regression analyses combined with survival analysis determined gene prognostic values. RNA and protein levels were detected by RT-qPCR and western blotting in arteriosclerosis obliterans(ASO) and normal vascular tissues. Vascular smooth muscle cells (VSMCs) were treated with oxidized low-density lipoprotein (ox-LDL) to develop cell models of advanced AS. The effects of protein knockdown on necroptosis were assessed by western blotting and flow cytometry. EdU and Cell Counting Kit-8 assays were used to examine cell proliferation.

Results

TNF Receptor Associated Factor 5 (TRAF5) was identified as a diagnostic marker for AS based on the AUC value in both the GSE20129 and GSE43292 datasets. According to differential expression analysis, LASSO regression analysis, RF analysis, univariate analysis, multivariate analysis, and gene-level survival analysis, TRAF5 was markedly associated with necroptosis in AS. Silencing TRAF5 promotes necroptosis and attenuates the proliferation of ox-LDL-induced cell models of advanced AS.

Conclusions

This study identified a diagnostic marker of necroptosis-related atherosclerosis, TRAF5, which can also be used to diagnose and assess atherosclerotic plaque stability. This novel finding has important implications in the diagnosis and assessment of plaque stability in atherosclerosis.
Heterogeneity of weight gain after initiation of Elexacaftor/Tezacaftor/Ivacaftor in people with cystic fibrosis
Authors: Gramegna Andrea , Majo Fabio , Alicandro Gianfranco , Leonardi Gloria , Cristiani Luca , Amati Francesco , Contarini Martina , Aliberti Stefano , Fiocchi Alessandro Giovanni , Blasi Francesco
Published: June 2023

Background

The introduction of the novel therapy, Elexacaftor/Tezacaftor/Ivacaftor (ETI) has been effective in improving weight gain in both clinical trials and real-world studies. However, the magnitude of this effect appears to be heterogeneous across patient subgroups. This study aims to identify potential determinants of heterogeneity in weight gain following 6-month ETI therapy.

Methods

We conducted a multicenter, prospective cohort study enrolling 92 adults with CF at two major CF centers in Italy with follow-up visit at one month and six months from ETI initiation. The treatment’s effect on weight changes was evaluated using mixed effect regression models that included subject-specific random intercepts and fixed effects for potential predictors of treatment response, time and a predictor-by-time interaction term.

Results

The mean weight gain at six months from the start of treatment was 4.6 kg (95% CI: 2.3–6.9) for the 10 patients with underweight, 3.2 kg (95% CI: 2.3-4.0) for the 72 patients with normal weight, and 0.7 kg (95% CI: -1.6-3.0) for the 10 patients with overweight. After six months of ETI treatment, 8 (80%) of the patients with underweight transitioned to the normal weight category, while 11 (15.3%) of the normal-weight patients became overweight. The major determinants of heterogeneity in weight gain were the baseline BMI and the presence of at least one CFTR residual function mutation, explaining 13% and 8% of the variability, respectively.

Conclusions

Our results indicate that ETI is highly effective in improving weight gain in underweight subjects with CF. However, our data also suggests the need for close monitoring of excess weight gain to prevent potential cardiometabolic complications.
Alveolar macrophages from EVALI patients and e-cigarette users: a story of shifting phenotype
Authors: Warren Kristi J. , Beck Emily M. , Callahan Sean J. , Helms My N. , Middleton Elizabeth , Maddock Sean , Carr Jason R. , Harris Dixie , Blagev Denitza P. , Lanspa Michael J. , Brown Samuel M. , Paine Robert
Published: June 2023

Exposure to e-cigarette vapors alters important biologic processes including phagocytosis, lipid metabolism, and cytokine activity in the airways and alveolar spaces. Little is known about the biologic mechanisms underpinning the conversion to e-cigarette, or vaping, product use-associated lung injury (EVALI) from normal e-cigarette use in otherwise healthy individuals. We compared cell populations and inflammatory immune populations from bronchoalveolar lavage fluid in individuals with EVALI to e-cigarette users without respiratory disease and healthy controls and found that e-cigarette users with EVALI demonstrate a neutrophilic inflammation with alveolar macrophages skewed towards inflammatory (M1) phenotype and cytokine profile. Comparatively, e-cigarette users without EVALI demonstrate lower inflammatory cytokine production and express features associated with a reparative (M2) phenotype. These data indicate macrophage-specific changes are occurring in e-cigarette users who develop EVALI.