bluuebunny/crossref_metadata_2025 huggingface dataset:
Hernia sac preservation in large incisional ventral hernia to prevent anterior component release
Authors: Saini Vikram , Lather Rahul , Alla Sonali , Verma Himanshi
Published: June 2024

Large ventral hernias require complex surgical techniques, such as component separation. We are presenting a case of an incisional hernia measuring 15×8 cm. The hernia was covered with an overlying thin layer of skin and hernia sac. The skin of this layer was densely adherent to the underlying hernial sac. Because of the thin hernial sac and adherent nature of the skin, approximately 3 cm of the hernial sac was preserved. We used this hernial sac as the anterior sheath ‘extension’ for a tension-free closure. Posterior component separation with transverse abdominis muscle release was done to close the posterior layer without tension and to place a 23×16 cm mesh in the retrorectus plane. By using the hernial sac in repair, we avoided anterior component separation and achieved tension-free closure of the anterior layer.
Cross-sectional evaluation of online direct-to-public calprotectin testing
Authors: Bishara Maria , Smith Rebecca , Roberts Christopher , Djouider Yousra , Bewshea Claire , Nice Rachel , Kennedy Nicholas A , Goodhand James R , Ahmad Tariq
Published: June 2024

Objective  

Why about a quarter of patients with inflammatory bowel disease (IBD) suffer symptoms for more than a year before their diagnosis made is unclear. Low public awareness, embarrassment and the apprehension of invasive tests are cited. The anonymity of direct-to-public calprotectin testing may overcome these barriers. We sought to characterise what calprotectin testing is available directly to the public in the UK.

Design/method 

We conducted a cross-sectional evaluation of the calprotectin assays available online in the UK. Collection kits were procured from eligible providers, and surplus stool tested to receive follow-up advice for known positive (>50–100 μg/g) and negative (<50 μg/g) stool samples. 

Results 

Half (54.5% (6/11)) of the available tests were home lateral flow tests and the remainder were laboratory-based ELISAs. The lateral flow tests were considerably cheaper than the laboratory-based tests (median (range) cost £14.20 (£7.85–21.00) vs £75.85 (£59–151), p<0.0001). The median turnaround time for the laboratory tests was 14 (range: 1–23) days. All but one provider used a positivity threshold of 50 μg/g. All tests included written and pictorial instructions with the testing kit. Contact with a physician was recommended for similar proportions of positive and negative calprotectin results (54.5% (6/11) vs 54.5% (6/11), p=1).

Conclusion 

In the UK, the public can choose between inexpensive home-based lateral flow tests or send stool samples for gold-standard laboratory testing of calprotectin. The low cost and rapid turnaround times suggest that direct-to-public calprotectin testing could be promoted to try to reduce the time to IBD diagnosis.
Pericapsular nerve group block: a 3D CT scan imaging study to determine the spread of injectate
Authors: Balocco Angela Lucia , Gautier Nicolas , Van Boxstael Sam , López Ana M , Carella Michele , Corten Kristoff , Sala-Blanch Xavier , Hadzic Admir , Gautier Philippe Emmanuel
Published: June 2024

Background

Current understanding of the mechanism of action of the pericapsular nerve group (PENG) block is primarily based on cadaver studies. We performed an imaging study in patients undergoing hip surgery to enhance the understanding of the analgesic mechanisms following a PENG block.

Materials and methods

10 patients scheduled for hip surgery received an ultrasound-guided PENG block with 18 mL of 0.5% ropivacaine mixed with 2 mL of a contrast agent. After completion of the block, a high-resolution CT scan was performed to obtain a three-dimensional reconstruction of the injectate’s dispersion.

Results

The CT imaging revealed that injectate was mainly confined to the epimysium of the iliacus and the psoas muscle, with a minor spread to the hip capsule. Contrast dye was detected within the iliacus and/or the psoas muscle in all patients. No observed spread to either the subpectineal plane or the obturator foramen was detected.

Conclusion

Our study suggests that the analgesic effect of the PENG block may be related to the block of the branches of the femoral nerve traveling within the iliopsoas muscle without a spread pattern commensurate with the block of the obturator nerve.

Trial registration number

ClinicalTrials.gov Registry (NCT06062134).
Subpectineal obturator nerve block reduces opioid consumption after hip arthroscopy: a triple-blind, randomized, placebo-controlled trial
Authors: Jessen Christian , Espelund Ulrick Skipper , Brix Lone Dragnes , Nielsen Thomas Dahl , Lund Bent , Bendtsen Thomas Fichtner
Published: June 2024

Background

Hip arthroscopy causes severe pain during the first few hours in the postoperative care unit. This is probably due to the intraoperative stretching of the hip joint capsule. Pain relief requires high doses of opioids which may prolong recovery and may cause opioid-related adverse events.

The majority of hip joint capsule nociceptors are located anteriorly. The obturator nerve innervates the anteromedial part of the hip joint capsule. We hypothesized that a subpectineal obturator nerve block using 15 ml bupivacaine 5 mg/mL with added epinephrine 5 μg/mL would reduce the opioid consumption after hip arthroscopy.

Methods

40 ambulatory hip arthroscopy patients were enrolled in this randomized, triple-blind controlled trial. All patients were allocated to a preoperative active or placebo subpectineal obturator nerve block. The primary outcome was opioid consumption for the first 3 hours in the postanesthesia care unit. Secondary outcomes were pain, nausea, and hip adductor strength.

Results

34 patients were analyzed for the primary outcome. The mean intravenous morphine equivalent consumption in the subpectineal obturator nerve block group was 11.9 mg vs 19.7 mg in the placebo group (p<0.001). The hip adductor strength was significantly reduced in the active group. No other intergroup differences were observed regarding the secondary outcomes.

Conclusion

We found a significant reduction in the opioid consumption for patients receiving an active subpectineal obturator nerve block. The postoperative intravenous morphine equivalent reduction the first painful 3 hours was reduced by 40% for patients receiving a subpectineal obturator nerve block in this randomized, triple-blind trial.

Trial registration number

EudraCT database 2021-006575-42.
Precise Push Study of Sci-tech Journals Based on Knowledge Graph Reasoning
Authors: Liu Bing , Lv Zhijun , Zhu Nan , Chang Dongyu , Lu Mengxin
Published: June 2024

To effectively promote the efficient dissemination of sci-tech journals and improve the influence of sci-tech journals, a precise push method of sci-tech journals based on knowledge graph reasoning is proposed, using knowledge graph to build network to realize push reasoning of scientific and Technological Journals. Based on the one-way author relationship network diagram and the two-way keyword network diagram, the PageRank algorithm is used to calculate the weight of network vertices, quantitatively and accurately identify the research direction of push customers and predict customers, and realize the accurate push management of content, so as to obtain the basis for the construction of network diagram. Based on the previous article in the Journal of the information society of science and technology of China, this paper constructs a knowledge reasoning diagram, mines 52 co-author cases and 60 related papers as experimental data, and verifies the progressiveness method through customer value. According to the network diagram, the progressiveness of this method is verified. The experimental results show that the knowledge map network reasoning method proposed in this paper has high accuracy in identifying the push objects of scientific and technological journals and accurately predicting the research direction. The matching degree between the number of customers and the pushed content. Using knowledge map network can ensure the timeliness and accuracy of pushing scientific and technological journals.
Performance Limit: Fuzzy Logic Based Anti-Collision Algorithm for Industrial Internet of Things Applications
Authors: Zhong Dongbo , Cui Zhiyong , Xie Yufei
Published: June 2024

Passive RFID has the advantages of rapid identification of multi-target objects and low implementation cost. It is the most critical technology in the Industrial Internet of Things information-gathering layer and is extensively applied in various industries, such as smart production, asset management, and monitoring. The signal collision caused by the communication between the reader/writer and tags sharing the same wireless channel has caused a series of problems, such as the reduction of the identification efficiency of the reader/writer and the increment of the missed reading rate, thus restricting the further development of RFID. At present, many hybrid anti-collision algorithms integrate the advantages of Aloha and TS algorithms to optimize RFID system performance, but these solutions also suffer from performance bottlenecks. In order to break through such performance bottleneck, based on the ISE-BS algorithm, we combined the sub-frame observation mechanism and the Q value adjustment strategy and proposed two hybrid anti-collision algorithms. The experimental results show that the two algorithms proposed in this paper have obvious advantages in system throughput, time efficiency and other metrics, surpassing existing UHF RFID anti-collision algorithms.
A Rare Tick Tale: A Novel Case of the Australian Paralysis Tick Causing Multiple Cranial Neuropathies
Authors: Surendran Sujan A. , McNamara Philomena , Hyer Jonathan N. , Su Charles S.
Published: June 2024

The Australian paralysis tick (Ixodes holocyclus) is found along the east coast of Australia. Tick bites may result in paralysis ranging from muscular weakness to ascending paralysis requiring respiratory support. Ocular complications and facial nerve involvement are rare. We present a rare occurrence of tick‐bite‐associated visual loss, proptosis, and multiple cranial neuropathies not previously reported in the literature. The tick was removed, and the patient’s symptoms improved following treatment with steroids and oral doxycycline. The vision and sensory changes are not explained by the Ixodes toxin; thus, we hypothesize this is related to orbital apex inflammation.
Relaxation Oscillation in SEIR Epidemic Models with the Intrinsic Growth Rate
Authors: Zhang Yingying , Wang Ruohan , Cai Yanan
Published: June 2024

The periodic oscillation transmission of infectious diseases is widespread, deep understanding of this periodic pattern and exploring the generation mechanism, and identifying the specific factors that lead to such periodic outbreaks, which are of very importanceto predict and control the spread of infectious diseases. In this study, to further reveal the mathematical mechanism of spontaneous generation of periodic oscillation solution, we investigate a type of SEIR epidemic model with a small intrinsic growth rate. By utilizing the singular perturbation theory and center manifold theorem, we extend the relaxation oscillation of three‐dimensional SIR models to the four‐dimensional SEIR models and prove the existence of stable relaxation oscillation with a large amplitude in the model. Numerical simulations are performed to verify our theoretical results. The results presented in this study provide a new idea for the study of the intrinsic mechanism of periodic oscillation in epidemiology, enrich the dynamics of epidemic models, and deepen the understanding of the global dynamics of these models.
Difficulty Modelling in Mobile Puzzle Games: An Empirical Study on Different Methods to Combine Player Analytics and Simulated Data
Authors: Kristensen Jeppe Theiss , Burelli Paolo
Published: June 2024

Difficulty is one of the key drivers of player engagement, and it is often one of the aspects that designers tweak most to optimise the player experience; operationalising it is, therefore, a crucial task for game development studios. A common practice consists of creating metrics out of data collected by player interactions with the content; however, this allows for estimation only after the content is released and does not consider the characteristics of potential future players. In this article, we present a number of potential solutions for the estimation of difficulty under such conditions, and we showcase the results of a comparative study intended to understand which method and which types of data perform better in different scenarios. The results reveal that models trained on a combination of cohort statistics and simulated data produce the most accurate estimations of difficulty in all scenarios. Furthermore, among these models, artificial neural networks show the most consistent results.
Psychological Scars of COVID‐19 Pandemic: An Analysis of the Impact on a Cross‐Sectional Sample from Romania
Authors: Mitrea Adriana , Hăisan Anca , Enache Rodica Gabriela , Danteș Elena
Published: June 2024

Background. The worldwide COVID‐19 pandemic has impacted the physical and psychosocial health of the population, with consequences that stretch beyond the initial outbreak. In this context, our aim was to evaluate the psychological effects of the pandemic on individuals in Romania. Methods. We conducted a cross‐sectional survey to compare the severity of psychological distress, encompassing anxiety, stress, and depression, in the general population, using DASS‐21 questionnaire. Results. Among the 521 valid responses, the experience of illness has broadened the perception of all DASS indicators compared to individuals who have not encountered the disease. Moderate cases of the illness have notably increased anxiety and stress levels, while severe cases of COVID‐19 have led to elevated levels of depression. Women exhibit all the assessed variables in a more pronounced manner compared to men. Among the surveyed population, individuals aged over 65 have shown a significant increase in DASS values in response to the COVID‐19 pandemic. Conclusion. As we have navigated through the pandemic, it has become clear that varying degrees of psychosocial scars remain in its wake. Within Romania’s sociocultural context, it is apparent that women and the elderly demonstrate unique psychological susceptibilities. Urgent action is required to proactively address and reduce the adverse effects of the pandemic on these vulnerable groups.
Tumor-Agnostic Genomic and Clinical Analysis of BRAF Fusions Identifies Actionable Targets
Authors: Chen Monica F. , Yang Soo-Ryum , Tao Jessica J. , Desilets Antoine , Diamond Eli L. , Wilhelm Clare , Rosen Ezra , Gong Yixiao , Mullaney Kerry , Torrisi Jean , Young Robert J. , Somwar Romel , Yu Helena A. , Kris Mark G. , Riely Gregory J. , Arcila Maria E. , Ladanyi Marc , Donoghue Mark T.A. , Rosen Neal , Yaeger Rona , Drilon Alexander , Murciano-Goroff Yonina R. , Offin Michael
Published: June 2024

Purpose:

Even though BRAF fusions are increasingly detected in standard multigene next-generation sequencing panels, few reports have explored their structure and impact on clinical course.

Experimental Design:

We collected data from patients with BRAF fusion–positive cancers identified through a genotyping protocol of 97,024 samples. Fusions were characterized and reviewed for oncogenic potential (in-frame status, non-BRAF partner gene, and intact BRAF kinase domain).

Results:

We found 241 BRAF fusion–positive tumors from 212 patients with 82 unique 5′ fusion partners spanning 52 histologies. Thirty-nine fusion partners were not previously reported, and 61 were identified once. BRAF fusion incidence was enriched in pilocytic astrocytomas, gangliogliomas, low-grade neuroepithelial tumors, and acinar cell carcinoma of the pancreas. Twenty-four patients spanning multiple histologies were treated with MAPK-directed therapies, of which 20 were evaluable for RECIST. Best response was partial response (N = 2), stable disease (N = 11), and progressive disease (N = 7). The median time on therapy was 1 month with MEK plus BRAF inhibitors [(N = 11), range 0–18 months] and 8 months for MEK inhibitors [(N = 14), range 1–26 months]. Nine patients remained on treatment for longer than 6 months [pilocytic astrocytomas (N = 6), Erdheim–Chester disease (N = 1), extraventricular neurocytoma (N = 1), and melanoma (N = 1)]. Fifteen patients had acquired BRAF fusions.

Conclusions:

BRAF fusions are found across histologies and represent an emerging actionable target. BRAF fusions have a diverse set of fusion partners. Durable responses to MAPK therapies were seen, particularly in pilocytic astrocytomas. Acquired BRAF fusions were identified after targeted therapy, underscoring the importance of postprogression biopsies to optimize treatment at relapse in these patients.
Computational Model Predicts Patient Outcomes in Luminal B Breast Cancer Treated with Endocrine Therapy and CDK4/6 Inhibition
Authors: Schmiester Leonard , Brasó-Maristany Fara , González-Farré Blanca , Pascual Tomás , Gavilá Joaquín , Tekpli Xavier , Geisler Jürgen , Kristensen Vessela N. , Frigessi Arnoldo , Prat Aleix , Köhn-Luque Alvaro
Published: June 2024

Purpose:

Development of a computational biomarker to predict, prior to treatment, the response to CDK4/6 inhibition (CDK4/6i) in combination with endocrine therapy in patients with breast cancer.

Experimental Design:

A mechanistic mathematical model that accounts for protein signaling and drug mechanisms of action was developed and trained on extensive, publicly available data from breast cancer cell lines. The model was built to provide a patient-specific response score based on the expression of six genes (CCND1, CCNE1, ESR1, RB1, MYC, and CDKN1A). The model was validated in five independent cohorts of 148 patients in total with early-stage or advanced breast cancer treated with endocrine therapy and CDK4/6i. Response was measured either by evaluating Ki67 levels and PAM50 risk of relapse (ROR) after neoadjuvant treatment or by evaluating progression-free survival (PFS).

Results:

The model showed significant association with patient’s outcomes in all five cohorts. The model predicted high Ki67 [area under the curve; AUC (95% confidence interval, CI) of 0.80 (0.64–0.92), 0.81 (0.60–1.00) and 0.80 (0.65–0.93)] and high PAM50 ROR [AUC of 0.78 (0.64–0.89)]. This observation was not obtained in patients treated with chemotherapy. In the other cohorts, patient stratification based on the model prediction was significantly associated with PFS [hazard ratio (HR) = 2.92 (95% CI, 1.08–7.86), P = 0.034 and HR = 2.16 (1.02 4.55), P = 0.043].

Conclusions:

A mathematical modeling approach accurately predicts patient outcome following CDK4/6i plus endocrine therapy that marks a step toward more personalized treatments in patients with Luminal B breast cancer.
Supplementary Figure 8 from Transcriptome Deconvolution Reveals Absence of Cancer Cell Expression Signature in Immune Checkpoint Blockade Response
Authors: Guo Yu Amanda , Kulshrestha Tanmay , Chang Mei Mei , Kassam Irfahan , Revkov Egor , Rizzetto Simone , Tan Aaron C. , Tan Daniel S.W. , Tan Iain Beehuat , Skanderup Anders J.
Published: June 2024

Area under the receiver operating curve (AUC) of the cancer-DEG model on 6 test datasets.
Supplementary Figure 10 from Transcriptome Deconvolution Reveals Absence of Cancer Cell Expression Signature in Immune Checkpoint Blockade Response
Authors: Guo Yu Amanda , Kulshrestha Tanmay , Chang Mei Mei , Kassam Irfahan , Revkov Egor , Rizzetto Simone , Tan Aaron C. , Tan Daniel S.W. , Tan Iain Beehuat , Skanderup Anders J.
Published: June 2024

Association between model prediction and overall survival.
A Phase II Trial of the WEE1 Inhibitor Adavosertib in SETD2
-Altered Advanced Solid Tumor Malignancies (NCI 10170)
Authors: Maldonado Edward , Rathmell W. Kimryn , Shapiro Geoffrey I. , Takebe Naoko , Rodon Jordi , Mahalingam Devalingam , Trikalinos Nikolaos A. , Kalebasty Arash R. , Parikh Mamta , Boerner Scott A. , Balido Celene , Krings Gregor , Burns Timothy F. , Bergsland Emily K. , Munster Pamela N. , Ashworth Alan , LoRusso Patricia , Aggarwal Rahul R.
Published: June 2024

We sought to evaluate the efficacy of WEE1 inhibitor adavosertib in patients with solid tumor malignancies (cohort A) and clear cell renal cell carcinoma (ccRCC; cohort B). NCT03284385 was a parallel cohort, Simon two-stage, phase II study of adavosertib (300 mg QDAY by mouth on days 1–5 and 8–12 of each 21-day cycle) in patients with solid tumor malignancies harboring a pathogenic SETD2 mutation. The primary endpoint was the objective response rate. Correlative assays evaluated the loss of H3K36me3 by IHC, a downstream consequence of SETD2 loss, in archival tumor tissue. Eighteen patients were enrolled (9/cohort). The median age was 60 years (range 45–74). The median duration of treatment was 1.28 months (range 0–24+). No objective responses were observed in either cohort; accrual was halted following stage 1. Minor tumor regressions were observed in 4/18 (22%) evaluable patients. Stable disease (SD) was the best overall response in 10/18 (56%) patients, including three patients with SD > 4 months. One patient with ccRCC remains on treatment for >24 months. The most common adverse events of any grade were nausea (59%), anemia (41%), diarrhea (41%), and neutropenia (41%). Nine patients (50%) experienced a Grade ≥3 adverse event. Of eight evaluable archival tissue samples, six (75%) had a loss of H3K36me3 by IHC. Adavosertib failed to exhibit objective responses in SETD2-altered ccRCC and other solid tumor malignancies although prolonged SD was observed in a subset of patients. Combination approaches may yield greater depth of tumor response.

Significance:

WEE1 inhibition with adavosertib monotherapy demonstrated limited clinical activity in patients with SETD2-altered solid tumors despite compelling preclinical data indicating a synthetic lethal effect, which did not translate into robust tumor regression. Loss of the H3K36me3 trimethylation mark caused by SETD2-deficiency was confirmed in the majority of evaluable tumors. A subset of patients derived clinical benefit as manifested by minor tumor regressions and prolonged SD.
As três grandes refutações: a crítica pessoana de Eduardo Lourenço pelo prisma da ironia
Authors: Gagliardi Caio
Published: June 2024

The purpose of this study is to outline the image of Eduardo Lourenço as a critic of Fernando Pessoa, taking into account the totality of Lourenço's texts about the writer, collected in the two volumes of the Complete Works. As a working hypothesis, we analyze the three major refutations of Lourenço's Pessoan criticism: the psychobiography of João Gaspar Simões; José Augusto Seabra's Barthesian thesis related to Caeiro; and the genesic exaltation of Walt Whitman. Along this path, we seek, concomitantly, to highlight, in all these refutations, the recurrence of Pessoa's irony as a fundamental analytical assumption.
First record of albinism in Lesser Woolly Horseshoe Bat Rhinolophus beddomei (Chiroptera: Rhinolophidae) with an updated list of chromatic aberrations in bats in India
Authors: Sail Pratiksha , Borkar Manoj R.
Published: June 2024

There have been worldwide reports of chromatic aberrations in bats, most striking among which is albinism. Albinism is an inherited, hypo-pigmentary state characterised by a complete lack of melanin. Albinistic individuals have pale skin, white fur, and pinkish-red eyes. Here we report the first record of albinism in Lesser Woolly Horseshoe Bat Rhinolophus beddomei. During a bat survey in Goa, India; a single individual of albino Lesser Woolly Horseshoe Bat was recorded along with a normally coloured conspecific individual from a small shelter with tiled roof. We confirm the species identity of this bat based on its morphology, and acoustic characteristics of its echolocation call. We further update the list of colour aberrations in bats reported from India.
The Influence of Immersion on Situational Awareness in a Virtual Environment
Authors: Hébert-Lavoie Maxence , Ozell Benoît , Doyon-Poulin Philippe
Published: June 2024

Researchers have pointed out the need to find an alternative to subjective questionnaires to measure presence in a virtual environment. Situational awareness has been proposed to objectively measure the concept of presence. However, the link between situational awareness and specific factors of presence has not been established. To study this relationship, 60 participants executed a driving task in a virtual environment under different visual conditions while we measured their situational awareness with the situational awareness global assessment technique (SAGAT), and their presence with the presence questionnaire (PQ). During the driving task, we objectively and meaningfully manipulated immersion, a factor of presence, by varying our participants' contrast sensitivity, size of the field of view, and visual acuity. The meaningful manipulation of presence also allowed us to evaluate the functional thresholds of the three aforementioned visual qualities for a driving task, which were previously measured from a multidirectional selection test. Our results indicated a significant positive correlation between SAGAT and PQ. They also showed that SAGAT was sensitive to an immersion's degradation and brought a good diagnosticity on the effect of an immersion's manipulation. Consequently, we conclude that it could represent an objective alternative to subjective questionnaires to measure presence in a virtual environment. Moreover, our assessment of the functional thresholds allowed us to confirm that they were context dependent. Our results indicated that only the contrast sensitivity functional threshold was valid in both a multidirectional selection test and a driving task.
The Attribution of February Extremes over North America: A Forecast-Based Storyline Study
Authors: Lee Donghyun , Sparrow Sarah , Leach Nicholas , Osprey Scott , Lee Jinah , Allen Myles
Published: June 2024

The importance of extreme event attribution rises as climate change causes severe damage to populations resulting from unprecedented events. In February 2019, a planetary wave shifted along the U.S.–Canadian border, simultaneously leading to troughing with anomalous cold events and ridging over Alaska and northern Canada with abnormal warm events. Also, a dry-stabilized anticyclonic circulation over low latitudes induced warm extreme events over Mexico and Florida. Most attribution studies compare the climate model simulations under natural or actual forcing conditions and assess probabilistically from a climatological point of view. However, in this study, we use multiple ensembles from an operational forecast model, promising statistical as well as dynamically constrained attribution assessment, often referred to as the storyline approach to extreme event attribution. In the globally averaged results, increasing CO2 concentrations lead to distinct warming signals at the surface, resulting mainly from diabatic heating. Our study finds that CO2-induced warming eventually affects the possibility of extreme events in North America, quantifying the impact of anthropogenic forcing over less than a week’s forecast simulation. Our study assesses the validity of the storyline approach conditional on the forecast lead times, which is hindered by rising noise in CO2 signals and the declining performance of the forecast model. The forecast-based storyline approach is valid for at least half of the land area within a 6-day lead time before the target extreme occurrence. Our attribution results highlight the importance of achieving net-zero emissions ahead of schedule to reduce the occurrence of severe heatwaves.
Exercise-based interventions targeting balance and falls in people with COPD: a systematic review and meta-analysis
Authors: Loughran Kirsti J. , Emerson Jonathan , Avery Leah , Suri Sophie , Flynn Darren , Kaner Eileen , Rapley Tim , Martin Denis , McPhee Jamie , Fernandes-James Caroline , Harrison Samantha L.
Published: June 2024

Introduction

This review quantifies the mean treatment effect of exercise-based interventions on balance and falls risk in people with COPD.

Methods

A structured search strategy (2000–2023) was applied to eight databases to identify studies evaluating the impact of exercise-based interventions (≥14 days in duration) on balance or falls in people with COPD. Pooled mean treatment effects (95% confidence intervals (CIs), 95% prediction intervals (PIs)) were calculated for outcomes reported in five or more studies. Inter-individual response variance and the promise of behaviour change techniques (BCTs) were explored.

Results

34 studies (n=1712) were included. There were greater improvements in balance post intervention compared to controls for the Berg Balance Scale (BBS) (mean 2.51, 95% CI 0.22–4.80, 95% PI −4.60–9.63), Timed Up and Go (TUG) test (mean −1.12 s, 95% CI −1.69– −0.55 s, 95% PI −2.78–0.54 s), Single-Leg Stance (SLS) test (mean 3.25 s, 95% CI 2.72–3.77 s, 95% PI 2.64–3.86 s) and Activities-specific Balance Confidence (ABC) scale (mean 8.50%, 95% CI 2.41–14.58%, 95% PI −8.92–25.92%). Effect on falls remains unknown. Treatment effects were larger in maleversusmixed-sex groups for the ABC scale and SLS test, and in balance trainingversusother exercise-based interventions for the BBS and TUG test. Falls history was not associated with changes in balance. Meta-analysis of individual response variance was not possible and study-level results were inconclusive. Eleven promising BCTs were identified (promise ratio ≥2).

Conclusion

Evidence for the effect of exercise-based interventions eliciting clinically important improvements in balance for people with COPD is weak, but targeted balance training produces the greatest benefits. Future exercise interventions may benefit from inclusion of the identified promising BCTs.
Analysis of the aging-related biomarker in a nonhuman primate model using multilayer omics
Authors: Liu Yunpeng , Lu Shuaiyao , Yang Jing , Yang Yun , Jiao Li , Hu Jingwen , Li Yanyan , Yang Fengmei , Pang Yunli , Zhao Yuan , Gao Yanpan , Liu Wei , Shu Pengcheng , Ge Wei , He Zhanlong , Peng Xiaozhong
Published: June 2024

Background

Aging is a prominent risk factor for diverse diseases; therefore, an in-depth understanding of its physiological mechanisms is required. Nonhuman primates, which share the closest genetic relationship with humans, serve as an ideal model for exploring the complex aging process. However, the potential of the nonhuman primate animal model in the screening of human aging markers is still not fully exploited. Multiomics analysis of nonhuman primate peripheral blood offers a promising approach to evaluate new therapies and biomarkers. This study explores aging-related biomarker through multilayer omics, including transcriptomics (mRNA, lncRNA, and circRNA) and proteomics (serum and serum-derived exosomes) in rhesus monkeys (Macaca mulatta).

Results

Our findings reveal that, unlike mRNAs and circRNAs, highly expressed lncRNAs are abundant during the key aging period and are associated with cancer pathways. Comparative analysis highlighted exosomal proteins contain more types of proteins than serum proteins, indicating that serum-derived exosomes primarily regulate aging through metabolic pathways. Finally, eight candidate aging biomarkers were identified, which may serve as blood-based indicators for detecting age-related brain changes.

Conclusions

Our results provide a comprehensive understanding of nonhuman primate blood transcriptomes and proteomes, offering novel insights into the aging mechanisms for preventing or treating age-related diseases.
Primary care doctors in acute call-outs to severe trauma incidents in Norway – variations by rural-urban settings and time factors
Authors: Myklevoll Kristian Rikstad , Zakariassen Erik , Morken Tone , Baste Valborg , Blinkenberg Jesper , Bondevik Gunnar Tschudi
Published: June 2024

Background

A severely injured patient needs fast transportation to a hospital that can provide definitive care. In Norway, approximately 20% of the population live in rural areas. Primary care doctors (PCDs) play an important role in prehospital trauma care. The aim of this study was to investigate how variations in PCD call-outs to severe trauma incidents in Norway were associated with rural-urban settings and time factors.

Methods

In this study on severe trauma patients admitted to Norwegian hospitals from 2012 to 2018, we linked data from four official Norwegian registries. Through this, we investigated the call-out responses of PCDs to severe trauma incidents. In multivariable log-binomial regression models, we investigated whether factors related to rural-urban settings and time factors were associated with PCD call-outs.

Results

There was a significantly higher probability of PCD call-outs to severe trauma incidents in the municipalities in the four most rural centrality categories compared to the most urban category. The largest difference in adjusted relative risk (95% confidence interval (CI)) was 2.08 (1.27–3.41) for centrality category four. PCDs had a significantly higher proportion of call-outs in the Western (RR = 1.46 (1.23–1.73)) and Central Norway (RR = 1.30 (1.08–1.58)) Regional Health Authority areas compared to in the South-Eastern area. We observed a large variation (0.47 to 4.71) in call-out rates to severe trauma incidents per 100,000 inhabitants per year across the 16 Emergency Medical Communication Centre areas in Norway.

Conclusions

Centrality affects the proportion of PCD call-outs to severe trauma incidents, and call-out rates were higher in rural than in urban areas. We found no significant difference in call-out rates according to time factors. Possible consequences of these findings should be further investigated.
Prognostic Role of Tumor-Infiltrating Lymphocytes in Oral Squamous Cell Carcinoma
Authors: Wongpattaraworakul Wattawan , Choi Allen , Buchakjian Marisa R. , Lanzel Emily A. , KD Anand Rajan , Simons Andrean L.
Published: June 2024

Background

In oral squamous cell carcinoma (OSCC), the tumor-node-metastasis (TNM) staging system is a significant factor that influences prognosis and treatment decisions for OSCC patients. Unfortunately, TNM staging does not consistently predict patient prognosis and patients with identical clinicopathological characteristics may have vastly different survival outcomes. Host immunity plays an important role in tumor progression but is not included in the TNM staging system. Tumor-infiltrating lymphocytes (TILs) are part of the host immune response that recognizes tumor cells; and the presence of TILs has emerged as potential candidates for prognostic markers for many types of cancers. The present study aims to determine the association of T cell-specific markers (CD3, CD4, CD8, and FOXP3) with clinicopathological characteristics and survival outcomes in OSCC patients. The prognostic value of CD3, CD4, and CD8 will also be evaluated based on tumor stage.

Methods

Tissue microarrays were constructed containing 231 OSCC cases and analyzed by immunohistochemical staining for the expression of CD3, CD4, CD8, and FOXP3. The expression scores for each marker were correlated with clinicopathological parameters and survival outcomes. The prognostic impact of CD3, CD4 and CD8 were further analyzed based on tumor stage (early or advanced).

Results

CD3, CD4, and CD8 were found to be significantly associated with both overall survival and progression-free survival using univariate analysis. However, none of these markers were found to independently predict the survival outcomes of OSCC using multivariate analysis. Only conventional factors such as nodal status, tumor differentiation and perineural invasion (PNI) were independent predictors of survival outcomes, with nodal status being the strongest independent predictor. Additionally, low CD4 (but not CD3 or CD8) expression was found to identify early-stage OSCC patients with exceptionally poor prognosis which was similar to that of advanced staged OSCC patients.

Conclusions

TIL markers such as CD3, CD4, CD8, and FOXP3 can predict the survival outcomes of OSCC patients, but do not serve as independent prognostic markers as found with conventional factors (i.e. nodal status, tumor differentiation and PNI). CD4 expression may assist with risk stratification in early-stage OSCC patients which may influence treatment planning and decision making for early-stage OSCC patients.
Brain and the whole-body bone imaging appearances in Menkes disease: a case report and literature review
Authors: Zhu Juncheng , Liao Yi , Li Xuesheng , Jia Fenglin , Ma Xinmao , Qu Haibo
Published: June 2024

Background

Menkes disease (MD) is a rare, inherited, multisystemic copper metabolism disorder. Classical Menkes disease is characterized by low serum copper and ceruloplasmin concentrations, leading to multiple abnormalities in the whole-body, especially in connective tissue and central nervous system. However, serum copper and ceruloplasmin levels are not reliable diagnostic biomarkers due to the low concentrations in healthy newborns either. The featured imaging manifestations play an important role in diagnosing Menkes disease. To our knowledge, there are few reports on the systemic imaging manifestations of Menkes disease.

Case presentation

A 4-month-old male patient presented with recurrent seizures. He had cognitive, intellectual, growth, gross motor, precision movement, and language developmental lags. The patient’s hemoglobin and serum ceruloplasmin level were low. On MRI, increased intracranial vascular tortuosity, cerebral and cerebellar atrophy, white matter changes, and basal ganglia abnormalities were observed. Plain radiograph revealed wormian bones, rib flaring, metaphyseal spurring, and periosteal reactions in the long bones of the limbs. A pathogenic variant in ATP7A gene was identified in the patient, so he was confirmed the diagnosis of Menkes disease. His symptoms did not improve despite symptomatic and supportive treatment during his hospitalization. Unfortunately, the infant died 3 months after leaving hospital.

Conclusion

A comprehensive and intuitive understanding of the disease’s imaging manifestations can help clinicians to identify the disease and avoid delays in care.
Autologous rib grafts for craniocervical junction surgery in children: a clinical application
Authors: Deng Chenfu , Zou Xiaobao , Yang Haozhi , Fu Suochao , Chen Junlin , Ma Rencai , Xia Hong , Ma Xiangyang
Published: June 2024

Objective

Autologous iliac bone is commonly used as a bone graft material to achieve solid fusion in craniocervical junction (CVJ) surgery. However, the developing iliac bone of children is less than ideal as a bone graft material. The matured rib bone of children presents a potential substitute material for iliac bone. The aim of this study was to evaluate the efficacy of autologous rib grafts for craniocervical junction surgery in children.

Methods

The outcomes of 10 children with abnormalities of the craniocervical junction who underwent craniocervical junction surgery between January 2020 and December 2022 were retrospectively reviewed. All patients underwent posterior fusion and internal fixation surgery with autologous rib grafts. Pre- and post-operative images were obtained and clinical follow-ups were conducted to evaluate neurological function, pain level, donor site complications, and bone fusion rates.

Results

All surgeries were successful. During the 8- to 24-month follow-up period, all patients achieved satisfactory clinical results. Computed tomography at 3–6 months confirmed successful bone fusion and regeneration of the rib defect in all patients with no neurological or donor site complications.

Conclusion

Autologous rib bone is a safe and effective material for bone grafting in craniocervical junction fusion surgery for children that can reduce the risks of donor site complications and increase the amount of bone graft, thereby achieving a higher bone fusion rate.
Factors associated with frozen shoulder in adults: a retrospective study
Authors: Abudula Xiarepa , Maimaiti Palida , Yasheng Ailiyaer , Shu Jiaojiao , Tuerxun Asiguli , Abudujilili Halimire , Yang Ruiqi
Published: June 2024

Objective

This study aims to explore the risk factors associated with frozen shoulder patients and further analyze the relationship between gender and diabetes with frozen shoulder.

Method

We have reviewed the data of 1205 frozen shoulder patients in China's Xinjiang region from 2018 to 2023. The collected information included patients' gender, occupation, place of origin, marital status, age, the season of disease onset, duration of illness, etiology, surgical history, hypertension, diabetes, respiratory diseases, knee joint disease, hyperlipidemia, cardiovascular diseases, cervical spondylosis, lumbar disc herniation, rheumatoid arthritis, hyperuricemia, sleep quality, smoking and alcohol consumption, and constipation. We have used multifactor logistic regression analysis to identify the risk factors for a frozen shoulder.

Results

Single-factor logistic regression analysis showed that the number of females, patients with diabetes, knee joint disease, constipation, and patients with poor sleep quality in the observation group are higher than in the control group (P < 0.05). There were no statistically significant differences between the two groups in terms of occupation, place of origin, marital status, age, season of disease onset, duration of illness, etiology, surgical history, hypertension, respiratory diseases, hyperlipidemia, cardiovascular diseases, cervical spondylosis, lumbar disc herniation, rheumatoid arthritis, hyperuricemia, smoking, and alcohol consumption history (P > 0.05).

Multivariate analysis showed that the final model included four variables: gender, diabetes history, sleep, and constipation. Among them, the OR values of gender and diabetes history were more significant than 1, indicating that they were independent risk factors for frozen shoulder, while the OR values of sleep and constipation were less than 1, suggesting that they were negatively associated with the occurrence of frozen shoulder.

Conclusion

The results of this study suggest that gender and diabetes are independent risk factors for frozen shoulder. Additionally, poor sleep quality and constipation also can be correlated with the occurrence of a frozen shoulder.
Chronic endometritis multiplies the recurrence risk of endometrial polyps after transcervical resection of endometrial polyps: a prospective study
Authors: Huang Jing , You Xiao , Zhao Zijun , Jiang Xiaorui , Qu Dacheng
Published: June 2024

Background

To investigate the impact of chronic endometritis (CE) on the recurrence of endometrial polyps (EPs) in premenopausal women after transcervical resection of endometrial polyps (TCRP).

Methods

This prospective study enrolled 507 women who underwent TCRP between January 1, 2022 and December 31, 2022. The patients were divided into a CE group (n = 133) and non-CE group (n = 374) based on the expression of CD138 in the endometrium. The EP recurrence rate at 1 year after TCRP was compared between the CE and non-CE groups and between groups with mild CE and severe CE. The impact of CD138 expression by resected EPs on EP recurrence also was investigated.

Results

The EP recurrence rate at 1 year post-TCRP was higher in the CE group than in the non-CE group (25.6% vs. 10.4%) and also higher in the severe CE group than in the mild CE group (34.5% vs. 18.7%). Additionally, the EP recurrence rate was higher among patients with CD138-expressing EPs than among those with EPs lacking CD138 expression (30.5% vs. 6.5%). The odds ratio (OR) for EP recurrence in the CE cohort compared with the non-CE cohort was 3.10 (95% confidence interval [CI] 1.84–5.23) after adjustment for EP number and precautions against EP recurrence. The ORs for EP recurrence in patients with mild CE and severe CE were 2.21 (95%CI 1.11–4.40) and 4.32 (95%CI 2.26–8.26), respectively. Similarly, the OR for EP recurrence in cases with CD138-expressing EPs relative to cases with EPs lacking CD138 expression was 6.22 (95%CI 3.59–10.80) after adjustment for EP number and precautions against EP recurrence.

Conclusions

CE multiplied the recurrence rate of EPs in premenopausal women after TCRP, and this effect positively correlated with CE severity. CD138 expression by EPs also was associated with a higher risk for EP recurrence.
Empagliflozin’s role in reducing ventricular repolarization heterogeneity: insights into cardiovascular mortality decline from the EMPATHY-HEART trial
Authors: Lauretti Cristiane , Antonio Graziella L. , Fernandes Ariana E. , Stocco Fernando G. , Girardi Adriana C. C. , Verrier Richard L. , Caramelli Bruno
Published: June 2024

Background

The incidence of myocardial infarction (MI) and sudden cardiac death (SCD) is significantly higher in individuals with Type 2 Diabetes Mellitus (T2DM) than in the general population. Strategies for the prevention of fatal arrhythmias are often insufficient, highlighting the need for additional non-invasive diagnostic tools. The T-wave heterogeneity (TWH) index measures variations in ventricular repolarization and has emerged as a promising predictor for severe ventricular arrhythmias. Although the EMPA-REG trial reported reduced cardiovascular mortality with empagliflozin, the underlying mechanisms remain unclear. This study investigates the potential of empagliflozin in mitigating cardiac electrical instability in patients with T2DM and coronary heart disease (CHD) by examining changes in TWH.

Methods

Participants were adult outpatients with T2DM and CHD who exhibited TWH > 80 µV at baseline. They received a 25 mg daily dose of empagliflozin and were evaluated clinically including electrocardiogram (ECG) measurements at baseline and after 4 weeks. TWH was computed from leads V4, V5, and V6 using a validated technique. The primary study outcome was a significant (p < 0.05) change in TWH following empagliflozin administration.

Results

An initial review of 6,000 medical records pinpointed 800 patients for TWH evaluation. Of these, 412 exhibited TWH above 80 µV, with 97 completing clinical assessments and 90 meeting the criteria for high cardiovascular risk enrollment. Empagliflozin adherence exceeded 80%, resulting in notable reductions in blood pressure without affecting heart rate. Side effects were generally mild, with 13.3% experiencing Level 1 hypoglycemia, alongside infrequent urinary and genital infections. The treatment consistently reduced mean TWH from 116 to 103 µV (p = 0.01).

Conclusions

The EMPATHY-HEART trial preliminarily suggests that empagliflozin decreases heterogeneity in ventricular repolarization among patients with T2DM and CHD. This reduction in TWH may provide insight into the mechanism behind the decreased cardiovascular mortality observed in previous trials, potentially offering a therapeutic pathway to mitigate the risk of severe arrhythmias in this population.

Trial registration

NCT: 04117763.