bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluation and associated factors of public health emergency management among medical college students in a city in Southwest China: a cross-sectional study
Authors: Chen Xinrui , Zhang Meng , Bu Qingqing , Tan Bo , Deng Dan
Published: March 2024

Background

Colleges and universities face an increased risk of public health emergencies. Among them, medical colleges and universities deserve more attention as they serve as the play a fundamental role in providing public health emergency services and in cultivating medical professionals. Effectively managing infectious disease prevention and control, as well as responding to public health emergencies in medical colleges and universities, is of great importance for enhancing the capacity of social emergency governance and improving the completeness of the public health system. This study aims to understand the management of public health emergencies in medical colleges in a city in southwest China, explore the factors associated with medical college students’ evaluations, and provide recommendations for emergency management mechanisms in colleges and universities.

Methods

In total, 781 medical college students were selected through stratified random sampling and surveyed using a questionnaire. The main factors affecting students’ evaluation of emergency management were analyzed using multiple linear regression and structural equation modeling.

Results

The overall emergency management situation in medical colleges was relatively complete, with satisfactory results. Medical college students’ satisfaction with the timeliness of prevention measures was the highest, while the publicity and education were the lowest. Multiple linear regression analysis showed that grades, emergency education, -simulation training, -information reporting, and dynamic adjustment measures were associated with the evaluation of emergency management by medical students.

Conclusions

Although the evaluation of emergency management in medical colleges was generally positive, certain limitations still existed. To improve the development of the public health system, colleges and universities should constantly reform and innovate emergency management mechanisms according to the important links in the prevention and control processes.
Knowledge, attitudes, and practices of the ethics in medical research among Moroccan interns and resident physicians
Authors: Harch Ibtissam El , Benmaamar Soumaya , Tachfouti Nabil , Hida Moustapha , Belahsen Mohammed Faouzi , Houssaini Tarik Sqalli , Rhazi Karima El
Published: March 2024

Background

In Morocco, medical research ethics training was integrated into the medical curriculum during the 2015 reform. In the same year, a law on medical research ethics was enacted to protect individuals participating in medical research. These improvements, whether in the reform or in the enactment of the law, could positively impact the knowledge of these researchers and, consequently, their attitudes and practices regarding medical research ethics. The main objective of this work is to assess Moroccan physicians’ knowledge, attitudes, and practices at the beginning of their careers (interns and residents) in medical research ethics.

Patients and methods

This is a multicenter cross-sectional study conducted in 2021 among Moroccan physicians. Three scores were created and validated to assess physicians’ level of knowledge, attitudes, and practices regarding research ethics. A descriptive analysis was carried out, followed by a univariate analysis and a multivariate analysis using multivariate binary logistic regression to study the factors associated with the different calculated scores.

Results

A total of 924 physicians were included in the study, with an average age of 27.8 ± 2.2 years. 40.7% had a high medical research ethics knowledge score, and 68.8% had good attitudes. These two scores were positively associated with age and were statistically higher in residents and in physicians who had received training in medical research ethics during their medical curriculum. Only 29,9% of physicians who had participated in research studies had adequate practices with medical research ethics. This score was statistically higher in residents and in physicians who had heard about research ethics.

Conclusion

A genuine introduction to ethics in the medical curriculum is essential to enhance researchers’ knowledge, attitudes, and practices. This, in turn, can lead to an increase in both the quantity and quality of research conducted in Morocco.
Pharmacist-led medication reconciliation service for patients after discharge from tertiary hospitals to primary care in Singapore: a qualitative study
Authors: Griva Konstadina , Chua Zi Yang , Lai Lester Yousheng , Xu Sandra Jialun , Bek Esther Siew Joo , Lee Eng Sing
Published: March 2024

Background

Medication discrepancies commonly occur when patients are transferred between care settings. Despite the presence of medication reconciliation services (MRS), medication discrepancies are still prevalent, which has clinical costs and implications. This study aimed to explore the perspectives of various stakeholders on how the MRS can be optimized in Singapore.

Methods

This is a descriptive qualitative study. Semi-structured interviews with 30 participants from the National Healthcare Group, including family physicians (N = 10), pharmacists (N = 10), patients recently discharged from restructured hospitals (N = 7) and their caregivers (N = 3) were conducted. All transcribed interviews were coded independently by three coders and inductive thematic analysis approach was used.

Results

Five core themes were identified. (1) The MRS enhanced healthcare services in various aspects including efficiency and health literacy; (2) There were several challenges in delivering the MRS covering processes, technology and training; (3) Issues with suitable patient selection and follow-up; (4) Barriers to scaling up of MRS that involve various stakeholders, cross-sector integration and environmental restrictions; and finally (5) Role definition of the pharmacist to all the stakeholders.

Conclusion

This study identified the role of MRS in enhancing healthcare services and explored the challenges encountered in the provision of MRS from family physicians, pharmacists, patients and their caregivers. These findings supported the need for a shift of MRS towards a more comprehensive medication review model. Future improvement work to the MRS can be conducted based on the findings.
Adult dietary patterns with increased bean consumption are associated with greater overall shortfall nutrient intakes, lower added sugar, improved weight-related outcomes and better diet quality
Authors: Papanikolaou Yanni , Slavin Joanne , Fulgoni Victor L.
Published: March 2024

Background

Limited evidence is available that focuses on beans within American dietary patterns and health. The purpose of this study was to identify commonly consumed adult dietary patterns that included beans and compare shortfall nutrient intakes and diet quality, relative to adults whose typical dietary pattern did not include beans.

Methods

The analyses used data from the National Health and Nutrition Examination Survey, 2001–2018. Cluster analysis was used to identify bean patterns of consumption, while the USDA food coding system defined daily beans consumed. Five bean dietary patterns of consumption were identified, of which four patterns included both canned beans and dry beans, while one pattern had no bean consumption. Bean consumption was defined as those consuming kidney beans, black beans, chickpeas, and/or pinto beans.

Results

Adults consuming Bean Dietary Patterns 1, 2, 3 and 4 had significantly higher diet quality scores (as assessed by USDA’s Healthy Eating Index-2015) compared to the no-bean pattern (61.2 ± 0.5, 58.9 ± 0.5, 55.2 ± 0.4 and 56.5 ± 0.8 vs 48.8 ± 0.2 p’s < 0.0001). Bean consumers also had significantly higher intakes of several shortfall nutrients (choline, alpha-linolenic acid, folate, iron, magnesium and vitamin E) relative to non-consumers of beans. Similarly, intake of dietary fiber, potassium and calcium, all nutrients of public health concern were significantly higher in bean patterns compared to no-beans. Bean Dietary Pattern 1 (~ 13.5% of total daily kcal from beans or ~ 2 servings of beans/day) and 2 (~ 9.5% of total daily kcal from beans or ~ 1.7 servings of beans/day) were significantly associated with lower BMI, decreased body weight and improved waist circumference relative to no-beans.

Conclusions

Dietary patterns that are rich in canned and dry beans were associated with significantly higher diet quality scores and greater intake of shortfall nutrients, including nutrients of public health concern. Bean dietary patterns were also associated with improved weight-related outcomes. Dietary guidance should consider the nutrient and health benefits associated with the promotion of increased canned and dry bean consumption in American dietary patterns.
Liraglutide improved the reproductive function of obese mice by upregulating the testicular AC3/cAMP/PKA pathway
Authors: Qi Ruibing , Liang Yuzhen , Yu Jinming , Chen Bing , Jiang Jiaqin , Wu Xingye , Lu Wensheng , Li Zhengming
Published: March 2024

Background

The incidence of male reproductive dysfunction is increasing annually, and many studies have shown that obesity can cause severe harm to male reproductive function. The mechanism of male reproductive dysfunction caused by obesity is unclear, and there is no ideal treatment. Identification of effective therapeutic drugs and elucidation of the molecular mechanism involved in male reproductive health are meaningful. In this study, we investigated the effects of the GLP-1 receptor agonist liraglutide on sex hormones, semen quality, and testicular AC3/cAMP/PKA levels in high-fat-diet-induced obese mice.

Methods

Obese mice and their lean littermates were treated with liraglutide or saline for 12 weeks. Body weight was measured weekly. Fasting blood glucose (FBG) was measured using a blood glucose test strip. The serum levels of insulin (INS), luteinizing hormone (LH), follicle stimulating hormone (FSH), testosterone (T), free testosterone (F-TESTO), estradiol (E2), and sex hormone binding globulin (SHBG) were detected using ELISA. The sperm morphology and sperm count were observed after Pap staining. The mRNA and protein expression levels of testicular GLP-1R and AC3 were measured by RT-qPCR and Western blot, respectively. Testicular cAMP levels and PKA activity were detected using ELISA.

Results

Liraglutide treatment can decrease body weight, FBG, INS, HOMA-IR, E2 and SHBG levels; increase LH, FSH, T, and F-TESTO levels; increase sperm count; decrease the sperm abnormality rate; and increase GLP-1R and AC3 expression levels and cAMP levels and PKA activity in testicular tissue.

Conclusions

Liraglutide can improve the sex hormone levels and semen quality of obese male mice. In addition to its weight loss effect, liraglutide can improve the reproductive function of obese male mice, which may also be related to the upregulation of AC3/cAMP/PKA pathway in the testis. This work lays the groundwork for future clinical studies.
A computational approach to design a multiepitope vaccine against H5N1 virus
Authors: Dashti Fatemeh , Raisi Arash , Pourali Ghazaleh , Razavi Zahra Sadat , Ravaei Fatemeh , Sadri Nahand Javid , Kourkinejad-Gharaei Fatemeh , Mirazimi Seyed Mohammad Ali , Zamani Javad , Tarrahimofrad Hossein , Hashemian Seyed Mohammad Reza , Mirzaei Hamed
Published: March 2024

Since 1997, highly pathogenic avian influenza viruses, such as H5N1, have been recognized as a possible pandemic hazard to men and the poultry business. The rapid rate of mutation of H5N1 viruses makes the whole process of designing vaccines extremely challenging. Here, we used an in silico approach to design a multi-epitope vaccine against H5N1 influenza A virus using hemagglutinin (HA) and neuraminidase (NA) antigens. B-cell epitopes, Cytotoxic T lymphocyte (CTL) and Helper T lymphocyte (HTL) were predicted via IEDB, NetMHC-4 and NetMHCII-2.3 respectively. Two adjuvants consisting of Human β-defensin-3 (HβD-3) along with pan HLA DR-binding epitope (PADRE) have been chosen to induce more immune response. Linkers including KK, AAY, HEYGAEALERAG, GPGPGPG and double EAAAK were utilized to link epitopes and adjuvants. This construct encodes a protein having 350 amino acids and 38.46 kDa molecular weight. Antigenicity of ~ 1, the allergenicity of non-allergen, toxicity of negative and solubility of appropriate were confirmed through Vaxigen, AllerTOP, ToxDL and DeepSoluE, respectively. The 3D structure of H5N1 was refined and validated with a Z-Score of − 0.87 and an overall Ramachandran of 99.7%. Docking analysis showed H5N1 could interact with TLR7 (docking score of − 374.08 and by 4 hydrogen bonds) and TLR8 (docking score of − 414.39 and by 3 hydrogen bonds). Molecular dynamics simulations results showed RMSD and RMSF of 0.25 nm and 0.2 for H5N1-TLR7 as well as RMSD and RMSF of 0.45 nm and 0.4 for H5N1-TLR8 complexes, respectively. Molecular Mechanics Poisson-Boltzmann Surface Area (MM/PBSA) confirmed stability and continuity of interaction between H5N1-TLR7 with the total binding energy of − 29.97 kJ/mol and H5N1-TLR8 with the total binding energy of − 23.9 kJ/mol. Investigating immune response simulation predicted evidence of the ability to stimulate T and B cells of the immunity system that shows the merits of this H5N1 vaccine proposed candidate for clinical trials.
MR compatible detectors assessment for a 0.35 T MR-linac commissioning
Authors: Chea Michel , Croisé Mathilde , Huet Christelle , Bassinet Céline , Benadjaoud Mohamed-Amine , Jenny Catherine
Published: March 2024

Purpose

To assess a large panel of MR compatible detectors on the full range of measurements required for a 0.35 T MR-linac commissioning by using a specific statistical method represented as a continuum of comparison with the Monte Carlo (MC) TPS calculations. This study also describes the commissioning tests and the secondary MC dose calculation validation.

Material and methods

Plans were created on the Viewray TPS to generate MC reference data. Absolute dose points, PDD, profiles and output factors were extracted and compared to measurements performed with ten different detectors: PTW 31010, 31021, 31022, Markus 34045 and Exradin A28 MR ionization chambers, SN Edge shielded diode, PTW 60019 microdiamond, PTW 60023 unshielded diode, EBT3 radiochromic films and LiF µcubes. Three commissioning steps consisted in comparison between calculated and measured dose: the beam model validation, the output calibration verification in four different phantoms and the commissioning tests recommended by the IAEA-TECDOC-1583.

Main results

The symmetry for the high resolution detectors was higher than the TPS data of about 1%. The angular responses of the PTW 60023 and the SN Edge were − 6.6 and − 11.9% compared to the PTW 31010 at 60°. The X/Y-left and the Y-right penumbras measured by the high resolution detectors were in good agreement with the TPS values except for the PTW 60023 for large field sizes. For the 0.84 × 0.83 cm2 field size, the mean deviation to the TPS of the uncorrected OF was − 1.7 ± 1.6% against − 4.0 ± 0.6% for the corrected OF whereas we found − 4.8 ± 0.8% for passive dosimeters. The mean absolute dose deviations to the TPS in different phantoms were 0 ± 0.4%, − 1.2 ± 0.6% and 0.5 ± 1.1% for the PTW 31010, PTW 31021 and Exradin A28 MR respectively.

Conclusions

The magnetic field effects on the measurements are considerably reduced at low magnetic field. The PTW 31010 ionization chamber can be used with confidence in different phantoms for commissioning and QA tests requiring absolute dose verifications. For relative measurements, the PTW 60019 presented the best agreement for the full range of field size. For the profile assessment, shielded diodes had a behaviour similar to the PTW 60019 and 60023 while the ionization chambers were the most suitable detectors for the symmetry. The output correction factors published by the IAEA TRS 483 seem to be applicable at low magnetic field pending the publication of new MR specific values.
Interpapillary muscle distance independently predicts recurrent mitral regurgitation
Authors: Gambardella Ivancarmine , Spadaccio Cristiano , Singh Sanjeet S. A. , Shingu Yasushige , Kunihara Takashi , Wakasa Satoru , Nappi Francesco
Published: March 2024

Objective

Ischaemic secondary mitral regurgitation (ISMR) after surgery is due to the displacement of papillary muscles resulting from progressive enlargement of the left ventricle end-diastolic diameter (LVEDD). Our aim was to prove that if the interpapillary muscle distance (IPMD) is surgically stabilized, an increase in LVEDD will not lead to a recurrence of ischaemic mitral regurgitation (MR).

Methods

Ninety-six patients with ISMR, who underwent surgical revascularisation and annuloplasty, were randomly assigned in a 1:1 ratio to undergo papillary muscle approximation (PMA). At the 5-year follow-up, we assessed the correlation between PMA and echocardiographic improvements, the effect size of PMA on echocardiographic improvements, and a prediction model for recurrent MR using inferential tree analysis.

Results

There was a significant correlation between PMA and enhancements in both the α and β angles (Spearman’s rho > 0.7, p < 0.01). The α angle represents the angle between the annular plane and either the A2 annular-coaptation line or the P2 annular-coaptation line. The β angle indicates the angle between the annular plane and either the A2 annular-leaflet tip line or the P2 annular-leaflet tip line. PMA led to substantial improvements in LVEDD, tenting area, α and β angles, with a large effect size (Hedge’s g ≥ 8, 95% CI ORs ≠ 1). The most reliable predictor of recurrent MR grade was the interpapillary distance, as only patients with an interpapillary distance greater than 40 mm developed ≥ 3 + grade MR. For patients with an IPMD of 40 mm or less, the best predictor of recurrent MR grade was LVEDD. Among the patients, only those with LVEDD greater than 62 mm showed moderate (2+) MR, while only those with LVEDD less than or equal to 62 mm had absent to mild (1+) MR.

Conclusion

Prediction of recurrent ischaemic MR is not independent of progressive LVEDD increase. PMA-based surgical procedure stabilises IPMD.
Choosing and evaluating randomisation methods in clinical trials: a qualitative study
Authors: Bruce Cydney L. , Iflaifel Mais , Montgomery Alan , Ogollah Reuben , Sprange Kirsty , Partlett Christopher
Published: March 2024

Background

There exist many different methods of allocating participants to treatment groups during a randomised controlled trial. Although there is research that explores trial characteristics that are associated with the choice of method, there is still a lot of variety in practice not explained. This study used qualitative methods to explore more deeply the motivations behind researchers’ choice of randomisation, and which features of the method they use to evaluate the performance of these methods.

Methods

Data was collected from online focus groups with various stakeholders involved in the randomisation process. Focus groups were recorded and then transcribed verbatim. A thematic analysis was used to analyse the transcripts.

Results

Twenty-five participants from twenty clinical trials units across the UK were recruited to take part in one of four focus groups. Four main themes were identified: how randomisation methods are selected; researchers’ opinions of the different methods; which features of the method are desirable and ways to measure method features.

Most researchers agree that the randomisation method should be selected based on key trial characteristics; however, for many, a unit standard is in place.

Opinions of methods were varied with some participants favouring stratified blocks and others favouring minimisation. This was generally due to researchers’ perception of the effect these methods had on balance and predictability.

Generally, predictability was considered more important than balance as adjustments cannot be made for it; however, most researchers felt that the importance of these two methods was dependent on the design of the study.

Balance is usually evaluated by tabulating variables by treatment arm and looking for perceived imbalances, predictability was generally considered much harder to measure, partly due to differing definitions.

Conclusion

There is a wide variety in practice on how randomisation methods are selected and researcher’s opinions on methods. The difference in practice observed when looking at randomisation method selection can be explained by a difference in unit practice, and also by a difference in researchers prioritisation of balance and predictability. The findings of this study show a need for more guidance on randomisation method selection.
The Diaphragmatic Initiated Ventilatory Assist (DIVA) trial: study protocol for a randomized controlled trial comparing rates of extubation failure in extremely premature infants undergoing extubation to non-invasive neurally adjusted ventilatory assist versus non-synchronized nasal intermittent positive pressure ventilation
Authors: Matlock David N. , Ratcliffe Sarah J. , Courtney Sherry E. , Kirpalani Haresh , Firestone Kimberly , Stein Howard , Dysart Kevin , Warren Karen , Goldstein Mitchell R. , Lund Kelli C. , Natarajan Aruna , Demissie Ejigayehu , Foglia Elizabeth E.
Published: March 2024

Background

Invasive mechanical ventilation contributes to bronchopulmonary dysplasia (BPD), the most common complication of prematurity and the leading respiratory cause of childhood morbidity. Non-invasive ventilation (NIV) may limit invasive ventilation exposure and can be either synchronized or non-synchronized (NS). Pooled data suggest synchronized forms may be superior. Non-invasive neurally adjusted ventilatory assist (NIV-NAVA) delivers NIV synchronized to the neural signal for breathing, which is detected with a specialized catheter. The DIVA (Diaphragmatic Initiated Ventilatory Assist) trial aims to determine in infants born 240/7–276/7 weeks’ gestation undergoing extubation whether NIV-NAVA compared to non-synchronized nasal intermittent positive pressure ventilation (NS-NIPPV) reduces the incidence of extubation failure within 5 days of extubation.

Methods

This is a prospective, unblinded, pragmatic, multicenter phase III randomized clinical trial. Inclusion criteria are preterm infants 24–276/7 weeks gestational age who were intubated within the first 7 days of life for at least 12 h and are undergoing extubation in the first 28 postnatal days. All sites will enter an initial run-in phase, where all infants are allocated to NIV-NAVA, and an independent technical committee assesses site performance. Subsequently, all enrolled infants are randomized to NIV-NAVA or NS-NIPPV at extubation. The primary outcome is extubation failure within 5 days of extubation, defined as any of the following: (1) rise in FiO2 at least 20% from pre-extubation for > 2 h, (2) pH ≤ 7.20 or pCO2 ≥ 70 mmHg; (3) > 1 apnea requiring positive pressure ventilation (PPV) or ≥ 6 apneas requiring stimulation within 6 h; (4) emergent intubation for cardiovascular instability or surgery. Our sample size of 478 provides 90% power to detect a 15% absolute reduction in the primary outcome. Enrolled infants will be followed for safety and secondary outcomes through 36 weeks’ postmenstrual age, discharge, death, or transfer.

Discussion

The DIVA trial is the first large multicenter trial designed to assess the impact of NIV-NAVA on relevant clinical outcomes for preterm infants. The DIVA trial design incorporates input from clinical NAVA experts and includes innovative features, such as a run-in phase, to ensure consistent technical performance across sites.

Trial registration

www.ClinicalTrials.gov, trial identifier NCT05446272, registered July 6, 2022.
A cluster-randomized study to evaluate the effectiveness and cost-effectiveness of the Assessment of Burden of Chronic Conditions (ABCC) tool in South Tyrolean primary care for patients with COPD, asthma, type 2 diabetes, and heart failure: the ABCC South Tyrol study
Authors: Wiedermann Christian J. , Marino Pasqualina , Mahlknecht Angelika , Barbieri Verena , Piccoliori Giuliano , Engl Adolf , Gidding-Slok Annerika H. M.
Published: March 2024

Background

Chronic diseases, such as chronic obstructive pulmonary disease (COPD), asthma, type 2 diabetes, and heart failure, often coexist and contribute to a significant burden on individuals and health systems. The Assessment of Burden of Chronic Conditions (ABCC) tool, already in routine clinical use in the Netherlands, aims to comprehensively assess and visualize disease burden, stimulate self-management, and encourage shared decision-making. This study aims to validate the German and Italian versions of the ABCC tool and evaluate its effectiveness and cost-effectiveness in the South Tyrolean Primary Care setting.

Methods

This is a cluster-randomized study involving approximately 400 patients with COPD, asthma, type 2 diabetes, and heart failure who received care from the South Tyrolean General Practices. Initially, the ABCC tool will be translated into German and Italian and validated. Subsequently, half of the participants will use the validated ABCC tool for patient-reported outcome measurement assessments, while the other half will receive usual care. The primary outcome measure is the change in the patients’ perception of the quality of care after 18 months. The secondary outcomes included changes in quality of life, self-management behavior, and healthcare utilization. The missing data will be managed using multiple imputations. Additionally, a cost-effectiveness analysis that considers the direct medical costs reimbursed by the National Health Service will be conducted.

Discussion

This study provides insights into the application, validation, and efficacy of the ABCC tool in the South Tyrolean healthcare context. The tool’s potential to enhance person-centered care, improve the quality of life, and possibly reduce healthcare costs could greatly contribute to sustainable healthcare. The challenges of implementation, such as software integration and the use of an EU data platform, will provide lessons for future international patient care data management.

Trial registration

ISRCTN registry, ISRCTN13531607. Registered on August 23, 2023.
Lifestyle intervention in children with obesity and nonalcoholic fatty liver disease (NAFLD): study protocol for a randomized controlled trial in Ningbo city (the SCIENT study)
Authors: Zhang Ping-ping , Wang You-xin , Shen Fang-jing , Xing Yun-fei , Gu Jia-ying , Li Xue-ying , Jin Han , Jin Shi-feng , Xu Miao , Wang Hai-jun , Wang Hui , Li Li
Published: March 2024

Background

The increasing prevalence of childhood obesity has become an urgent public health problem, evidence showed that intervention for childhood obesity bring enormous health benefits. However, an effective individualized intervention strategy remains to be developed, and the accompanying remission of related complications, such as nonalcoholic fatty liver disease (NAFLD), needs to be assessed. This study aimed to develop an m-Health-assisted lifestyle intervention program targeting overweight/obese children and assess its effectiveness on indicators of adiposity and NAFLD.

Methods

This is a cluster-randomized controlled trial that conducted in children with overweight/obesity in Ningbo city, Zhejiang Province, China. Students in Grade 3 (8–10 years old) were recruited from six primary schools, with three be randomized to intervention group and three to usual practice group. The intervention program will last for one academic year and consists of health education, dietary guidance, and physical activity reinforcement. This program is characterized by encouraging four stakeholders, including School, Clinic, famIly, and studENT (SCIENT), to participate in controlling childhood obesity, assisted by m-Health technology. Assessments will be conducted at baseline and 3 months, 9 months, 24 months, and 36 months after baseline. The primary outcome will be the differences between the two groups in students’ body mass index and fatty liver index at the end of the intervention (9 months after baseline). During the implementation process, quality control methods will be adopted.

Discussion

The program will test the effectiveness of the m-Health-assisted lifestyle intervention on children with obesity and NAFLD. The results of this study will provide evidence for establishing effective lifestyle intervention strategy aimed at childhood obesity and NAFLD and may help develop guidelines for the treatment of obesity and NAFLD in Chinese children.

Trial registration

Clinicaltrials.gov NCT05482191. Registered on July 2022.
On the existence, uniqueness, stability, and numerical aspects for a novel mathematical model of HIV/AIDS transmission by a fractal fractional order derivative
Authors: Wu Yanru , Nosrati Sahlan Monireh , Afshari Hojjat , Atapour Maryam , Mohammadzadeh Ardashir
Published: March 2024

In this study, we explore a mathematical model of the transmission of HIV/AIDS. The model incorporates a fractal fractional order derivative with a power-law type kernel. We prove the existence and uniqueness of a solution for the model and establish the stability conditions by employing Banach’s contraction principle and a generalized α-ψ-Geraghty type contraction. We perform stability analysis based on the Ulam–Hyers concept. To calculate the approximate solution, we utilize Gegenbauer polynomials via the spectral collocation method. The presented model includes two fractal and fractional order derivatives. The influence of the fractional and fractal derivatives on the outbreak of HIV is investigated by utilizing real data from the Cape Verde Islands in 1987–2014.
Dual-energy computed tomography in a multiparametric regression model for diagnosing lymph node metastases in pancreatic ductal adenocarcinoma
Authors: Li Sheng , Jiang Dongping , Jiang Linling , Yan Shumei , Liu Lizhi , Ruan Guangying , Zhou Xuhui , Zhuo Shuiqing
Published: March 2024

Objective

To investigate the diagnostic value of dual-energy computed tomography (DECT) quantitative parameters in the identification of regional lymph node metastasis in pancreatic ductal adenocarcinoma (PDAC).

Methods

This retrospective diagnostic study assessed 145 patients with pathologically confirmed pancreatic ductal adenocarcinoma from August 2016–October 2020. Quantitative parameters for targeted lymph nodes were measured using DECT, and all parameters were compared between benign and metastatic lymph nodes to determine their diagnostic value. A logistic regression model was constructed; the receiver operator characteristics curve was plotted; the area under the curve (AUC) was calculated to evaluate the diagnostic efficacy of each energy DECT parameter; and the DeLong test was used to compare AUC differences. Model evaluation was used for correlation analysis of each DECT parameter.

Results

Statistical differences in benign and metastatic lymph nodes were found for several parameters. Venous phase iodine density had the highest diagnostic efficacy as a single parameter, with AUC 0.949 [95% confidence interval (CI):0.915–0.972, threshold: 3.95], sensitivity 79.80%, specificity 96.00%, and accuracy 87.44%. Regression models with multiple parameters had the highest diagnostic efficacy, with AUC 0.992 (95% CI: 0.967–0.999), sensitivity 95.96%, specificity 96%, and accuracy 94.97%, which was higher than that for a single DECT parameter, and the difference was statistically significant.

Conclusion

Among all DECT parameters for regional lymph node metastasis in PDAC, venous phase iodine density has the highest diagnostic efficacy as a single parameter, which is convenient for use in clinical settings, whereas a multiparametric regression model has higher diagnostic value compared with the single-parameter model.
Tumor suppression effect of ultrasound-sensitive nanoparticles with focused ultrasound in a pancreas cancer xenograft model
Authors: Kim Soojin , Lee Jae Young , Park Eun-Joo , Ahn Yun Deok , Cheon Yuri , Sim Wonchul , Lee Hak Jong
Published: March 2024

Background

We investigated the tumor suppression effect of an ultrasound-sensitive doxorubicin-loaded liposome-based nanoparticle, IMP301, to enhance the synergistic effect with focused ultrasound (FUS) in an animal model of pancreatic cancer.

Methods

Thirty nude mice with xenografts of PANC-1 human pancreatic cancer cells were randomly and prospectively allocated to 6 different groups (5 per group) each for Study-1 (dose–response test) and Study-2 (synergistic effect test). Study-1 consisted of control, gemcitabine, Doxil with FUS, and three different doses of IMP301 (2, 4, 6 mg/kg) with FUS groups. Study-2 consisted of control, FUS only, gemcitabine, Doxil with FUS, and IMP301 (4 mg/kg) with or without FUS groups. Differences in tumor volume and growth rate were evaluated by one-way ANOVA and Student–Newman–Keuls test.

Results

In Study-1, 4 mg/kg or greater IMP301 with FUS groups showed lower tumor growth rates of 14 ± 4 mm3/day (mean ± standard deviation) or less, compared to the control, gemcitabine, and Doxil with FUS groups with rates exceeding 28 ± 5 (p < 0.050). The addition of FUS in Study-2 decreased the tumor growth rate in the IMP301-treated groups from 36 ± 17 to 9 ± 6, which was lower than the control, FUS only, gemcitabine, and Doxil with FUS groups (p < 0.050).

Conclusions

IMP301 combined with FUS exhibited higher tumor growth suppression compared to the use of a conventional drug alone or the combination with FUS. The present study showed the potential of IMP301 to enhance the synergistic effect with FUS for the treatment of pancreatic cancer.

Relevance statement

This article aims to evaluate the synergistic effect of FUS and ultrasound-responsive liposomal drug in tumor growth suppression by using xenograft mouse model of pancreatic ductal adenocarcinoma. FUS-induced ultrasound-sensitive drug release may be a potential noninvasive repeatable treatment option for patients with locally advanced or unresectable pancreatic cancer.

Key points

• Modification of conventional drugs combined with FUS would maximize tumor suppression.

• IMP301 with FUS had higher tumor suppression effect compared to conventional chemotherapy.

• This image-guided drug delivery would enhance therapeutic effects of systemic chemotherapy.

Graphical Abstract
Germline variants in the Von Hippel-Lindau tumor suppressor gene in Cuban patients
Authors: Esperón Álvarez Antonio Alejandro , Noa Hechavarría Inés Virginia , López Reyes Ixchel , Collazo Mesa Teresa
Published: March 2024

Background

Von Hippel-Lindau (VHL) syndrome is an autosomal dominantly inherited disorder that predisposes to multiple neoplasms. Patients may develop hemangioblastomas of the central nervous system and retina, multiple cysts in the pancreas and kidneys, renal carcinoma, and pheochromocytomas, among other lesions. This disease is caused by germline genetic variants in the VHL gene. The regulation of the alpha subunit of hypoxia-inducible factor-1 is the key tumor suppressor function of the VHL protein. To date, more than seven hundred variants have been reported in VHL gene. This study aimed to investigate the molecular etiology of VHL syndrome in Cuban patients.

Results

DNA samples from twenty-two individuals were analyzed by Sanger sequencing or enzymatic restriction. The analysis identified four novel pathogenic variants for the Cuban population: c.463 + 2T > C, C162W, R167W, and S183X, in addition to D121G and R161X, previously described in another work. The diagnosis was confirmed in seven patients with clinical manifestations and family history. Two at-risk family members without clinical signs were positive for presymptomatic diagnosis.

Conclusions

The spectrum of germinal point mutations of VHL gene in Cuban patients was updated. The presence of genetic variants was ruled out in eight asymptomatic relatives, which is a psychological relief for these individuals. The results allow for offering other at-risk relatives the presymptomatic diagnosis and the possibility of receiving genetic counseling.
Role of multi-parametric magnetic resonance imaging in preoperative staging of cervical carcinoma in females
Authors: Sadec Hoda Mohamed Helmy Ahmed , Awadallah Shrouk Mohamed , Ibrahim Ahmed Mohamed , Abdel-Aziz Amany Mohamed Rashad , Sheha Aliaa Sayed
Published: March 2024

Background

In cervical cancer, accurate diagnosis of parametrial invasion (PMI) helps in determining the next step in management, either surgical resection or neoadjuvant therapy. Cervical cancer staging is still determined according to the clinical findings. But it is widely recognized that there are differences between clinical evaluation and the actual disease extent, particularly for PMI. In this prospective study, we investigate the relationship between clinical staging and magnetic resonance imaging (MRI) staging with post-management findings among patients with cervical cancer who underwent pre-treatment MRI, using fused T2-weighted image/diffusion-weighted imaging (T2/DWI).

Results

Based on examination under anesthesia (EUA), 80% of patients showed PMI, while fused T2/DWI was positive for PMI in 77.5% of patients. In all analyzed cases (40 females), MRI had sensitivity, specificity, and accuracy of 91%, 75%, and 87.5% compared to EUA. In the operated patients (24 females), MRI likewise had sensitivity, specificity, and accuracy of 81.3%, 87.5%, and 83%, respectively. In comparison with the postoperative results, the EUA showed higher sensitivity and accuracy than MRI (92.9% vs. 81.3%) and (83.3% vs. 79.2%), respectively, in the detection of PMI in operated cases. However, MRI was more specific in the PMI detection in cases with cervical cancer than EUA (75% vs. 70%).

Conclusion

MRI (with the aid of fused T2/DWI) improves the diagnostic performance for the PMI assessment in cases with cervical carcinoma. Therefore, MRI is helpful in choosing surgical candidates.
The blue pill of matriX
Authors: Σέβτσοβ Αλεξάντρ
Published: March 2024

Την τελευταία δεκαετία, οι πλατφόρμες κοινωνικής δικτύωσης αποτελούν πλέον την κύρια πηγή πληροφόρησης για δισεκατομμύρια ανθρώπους παγκοσμίως επιτυγχάνοντας την άμεση μετάδοση της. Ωστόσο, το περιεχόμενο των κοινωνικών δικτύων έχει εγείρει ανησυχίες σχετικά με τη διάδοση ψευδών ειδήσεων και την παραπληροφόρηση των χρηστών. Οι κακόβουλοι χρήστες, γνωστοί ως bot accounts, εκμεταλλεύονται τις πλατφόρμες κοινωνικής δικτύωσης προς χειραγώγηση της κοινής γνώμης μέσω της διάδοσης ψεύτικων ή μεροληπτικών πληροφοριών με πειστικό τρόπο. Λόγω της δημοτικότητας του Twitter και της πολιτικής πρόσβασης σε δεδομένα μέσω API, έχει γίνει δημοφιλές στους κακόβουλους χρήστες. Κατά την τελευταία δεκαετία, οι ερευνητές έχουν αποδείξει περιπτώσεις προπαγάνδας, χειραγώγησης γνώμης και επιρροής κατά τη διάρκεια πολιτικών γεγονότων στο Twitter μέσα από την βιβλιογραφία. Η μέτρηση του άμεσου αντίκτυπου της δραστηριότητας των bots στις ανθρώπινες αποφάσεις είναι μια πρόκληση. Ωστόσο, η έρευνα έχει δείξει έμμεσες συσχετίσεις μεταξύ της δραστηριότητας των bots και των γεγονότων, όπως στις προεδρικές εκλογές του 2016 στις ΗΠΑ και στις τιμές των μετοχών του χρηματιστηρίου. Προκειμένου να διατηρηθεί η ακεραιότητα των πλατφορμών κοινωνικής δικτύωσης, απαιτούνται αποτελεσματικές μέθοδοι ανίχνευσης των bots. Οι τρέχουσες μεθοδολογίες και λύσεις στερούνται της αποτελεσματικής ανίχνευσης των bots στη γενική περίπτωση και ως επί το πλείστον προσφέρουν υψηλή απόδοση σε πολύ συγκεκριμένα σενάρια περιπτώσεων, καθιστώντας τις, μη πρακτικές σε πραγματικές καταστάσεις. Σε αυτή τη διατριβή, διερευνούμε την εξέλιξη και τις προκλήσεις των τεχνικών ανίχνευσης, προς τη δημιουργία μιας νέας γενικής μεθόδου ανίχνευσης των bots (BotArtist). Αυτή η μέθοδος ελαχιστοποιεί τη χρήση του Twitter API και ξεπερνά τις υπάρχουσες μεθόδους ανίχνευσης των bots. Αρχικά επικεντρωθήκαμε στην ανίχνευση των κοινοτήτων botnet που μοιράζονται πολύ παρόμοιο περιεχόμενο σχεδόν την ίδια χρονική στιγμή. Με βάση τα ευρήματα μας αναλύσαμε τις διαφορές στα χαρακτηριστικά μεταξύ φυσιολογικών και bot λογαριασμών. Στην συνέχεια, εφαρμόσαμε την προηγούμενη γνώση για την ανάπτυξη μοντέλων μηχανικής μάθησης ικανών για τον εντοπισμό των bots κατά την διάρκεια της συζήτησης των προεδρικών εκλογών στην Αμερική 2020. Επιπλέον, πραγματοποιήσαμε μια εκτενή αξιολόγηση διαφόρων χαρακτηριστικών λογαριασμών όσον αφορά την προβλεπτική τους δύναμη σε σύντομα και μακροχρόνια χρονικά διαστήματα.Αυτή η συνολική προσέγγιση οδήγησε στη δημιουργία του BotArtist, που αυτήν τη στιγμή αποτελεί την πιο ευέλικτη μέθοδο εντοπισμού λογαριασμών των bots. Το BotArtist επέτυχε εντυπωσιακά αποτελέσματα, με μέσους όρους F1 83.19 για συγκεκριμένες εφαρμογές συνόλων δεδομένων και 68,5 για γενικές περιπτώσεις χρήσης. Αυτό αντιπροσωπεύει μια συνολική αύξηση απόδοσης κατά σχεδόν 10% σε σύγκριση με τις υπάρχοντες τεχνικές.
Ανδρικοί χαρακτήρες και ανδρικές ταυτότητες στην Αλεξάνδρα του Λυκόφρονα
Authors: Κριτσαντώνης Ηλίας
Published: March 2024

Η διδακτορική διατριβή έχει αντικείμενο μελέτης το έργο του ελληνιστικού ποιητή Λυκόφρονα, Αλεξάνδρα. Οι μυθολογικές αναφορές ως κυρίαρχο γνώρισμα, που διατρέχει το συγκεκριμένο ποίημα, γίνονται αφορμή για την αφήγηση της δράσης των προσώπων της Αλεξάνδρας. Η εστίαση της μελέτης γίνεται συγκεκριμένα στη δράση των αρρένων και των ποικίλων πτυχών της. Με τη βοήθεια των νεωτερικών αρχών της κοινωνιολογίας και του κλάδου των «σπουδών του φύλου» (gender studies) οι ταυτότητες των ανδρικών χαρακτήρων διακρίνονται στην ηγεμονική, την υποτακτική, τη συνεργατική ή συνενοχική και την περιθωριακή. Οι ίδιοι ανδρικοί χαρακτήρες αποδεικνύουν την πολλαπλότητα των κοινωνικών τους αντιδράσεων σύμφωνα με τις περιστάσεις, αξιολογούνται και κατανέμονται σε κάθε μια από τις παραπάνω ταυτότητες. Η παραπάνω διάκριση και ταξινόμηση βοηθά στην ερμηνεία των δράσεων τους με μια πιο επιστημονική, αλλά και πιο διεισδυτική ματιά. Ο Ηρακλής, ο Αχιλλέας, ο Έκτορας, ο Διομήδης, ο Αίαντας ο Λοκρός, ο Αίαντας ο Τελαμώνιος, ο Φιλοκτήτης, ο Αινείας, ο Μενέλαος, αλλά και ο Μέγας Αλέξανδρος ως το μοναδικό ιστορικό ανδρικό πρόσωπο, γίνονται το αντικείμενο της ενασχόλησης στη διδακτορική διατριβή σε μια δημιουργική αφομοίωση της αρχαϊκής, κλασικής, ελληνιστικής και σύγχρονης εποχής αποδεικνύοντας την ενότητα των ανδρικών δράσεων των διαφορετικών εποχών, αλλά και τη διαφορετικότητα των κοινωνικών συμβάσεων.
Μέτρηση της κάτω κοίλης φλέβας με διαθωρακικό υπερηχογράφημα στην επίπτωση της υπότασης απο υπαραχνοειδή αναισθησία σε ηλικιωμένους ασθενείς που υποβάλλονται σε ορθοπεδική επέμβαση
Authors: Σπηλιωτάκη-Φραγκουλάκη Ελένη
Published: March 2024

Σκοπός: Ο σκοπός της μελέτης ήταν να μελετήσουμε αναδρομικά τα διαγνωστικά χαρακτηριστικά συγκεκριμένων υπερηχοκαρδιογραφικών μετρήσεων, σε ηλικιωμένους ασθενείς, που υποβάλλονται σε χειρουργικές επεμβάσεις κάτω άκρου, υπό υπαραχνοειδή αναισθησία. Δόθηκε έμφαση σε δύο δείκτες, την IVCCI και τον λόγο dIVCmax προς IVCCI, όπου dIVCmax είναι η μέγιστη διάμετρος της κάτω κοίλης φλέβας στην εκπνοή και IVCCI είναι ο δείκτης συμπιεσιμότητας της κάτω κοίλης φλέβας. Υλικό και μέθοδος: Σε 70 ασθενείς διενεργήθηκε διαθωρακική υπερηχοκαρδιογραφική μελέτη πριν την εφαρμογή της υπαραχνοειδούς αναισθησίας, βάσει συγκεκριμένων κριτηρίων και πρωτοκόλλου. Οι υπερηχοκαρδιογραφικές μετρήσεις που πραγματοποιούνταν συμπεριελάμβαναν την IVCCI και τον λόγο dIVCmax προς IVCCI, το κλάσμα εξώθησης, την ολική μέγιστη επιμήκη συστολική παραμόρφωση, την συστολική μετακίνηση του δακτυλίου της τριγλώχινας, τον λόγο της μέγιστης ταχύτητας της ροής του αίματος διαμέσου της μιτροειδούς βαλβίδας προς το μέσο όρο των μεγίστων ταχυτήτων κίνησης του δακτυλίου της μιτροειδούς στο πλάγιο τοίχωμα και στο μεσοκοιλιακό διάφραγμα στην αρχή της διαστολής, τον όγκο παλμού και την μάζα της αριστερής κοιλίας. Υποτασικοί, θεωρήθηκαν οι ασθενείς οι οποίοι, διεγχειρητικά εμφάνισαν μέση αρτηριακή πίεση κάτω από 65 mmHg ή 25% μείωση της προεγχειρητικής τους αρτηριακής πίεσης. Αποτελέσματα: 28 από τους 70 ασθενείς εμφάνισαν υπόταση που αποδόθηκε στην υπαραχνοειδή αναισθησία. Ο λόγος dIVCmax προς IVCCI είχε την μεγαλύτερη διαγνωστική αξία. Συγκεκριμένα, η μέτρηση του λόγου dIVCmax προς IVCCI κάτω από 43 είχε σημαντικά μεγαλύτερη διαγνωστική ισχύ σε σχέση με τη μέτρηση της IVCCI πάνω από 0.3. Η ανάλυση λογιστικής παλινδρόμησης ανέδειξε ότι ο λόγος dIVCmax/IVCCI και η ηλικία είναι οι καλύτεροι προβλεπτικοί παράγοντες της υπότασης έπειτα από υπαραχνοειδή αναισθησία. Συμπεράσματα: Η προεγχειρητική μέτρηση του λόγου dIVCmax/IVCCI ,σε ηλικιωμένους ασθενείς, μπορεί να προβλέψει την υπόταση έπειτα από υπαραχνοειδή αναισθησία καλύτερα από την IVCCI και άλλες υπερηχοκαρδιογραφικές μετρήσεις. Ο λόγος dIVCmax/IVCCI και η ηλικία του ασθενούς, μπορούν να προβλέψουν με σημαντική ακρίβεια την υπόταση έπειτα από υπαραχνοειδή αναισθησία σε ηλικιωμένους ασθενείς.
Plant fiber-reinforced green composite: A review on surface modification, properties, fabrications and applications
Authors: Molla Anik , Moyeen Abdullah Al , Mashfiqua Mahmud Raiyana , Haque Md. Jahidul
Published: March 2024

Plastic pollution has become a persistent challenge globally. The extensive production of disposable plastics overwhelms the world's ability to cope with. These non-biodegradable plastics accumulating in landfills, rivers, and seas cause severe damage to wildlife and the environment. The utilization of biopolymer is a possible alternative to petroleum-based plastics. Polybutylene succinate (PBS), polyhydroxyalkanoates (PHA), polylactic acid (PLA), poly(ε-caprolactone) (PCL), cellulose, chitin, and thermoplastic starch are mostly used biopolymers with promising properties. There are challenges too. Properties including brittleness, low thermal stability, low strength, and poor chemical barrier properties are the challenges to replacing plastics material. Reinforcing natural fibers as an alternative to non-biodegradable synthetic fiber with biopolymer matrices improves the properties of the material significantly. Flax, kenaf, jute, ramie, and hemp are a few agro-based fibers that are generally reinforced with biopolymer matrices. These composites are known as green composites. In order to create an interfacial bond between hydrophilic fiber and hydrophobic biopolymer surface modification of natural fiber is needed. There are many physical and chemical methods of surface medication which enhance roughness, wettability as well as hydrophilicity, lowers moisture absorption, improve the interfacial bond, and also enhance the tensile properties of natural fiber. The review is on the classification of biopolymers, natural fibers and their properties as well as the surface modification techniques for plant fibers. Moreover, the fabrication, mechanical and chemical properties including biodegradation of different green composites and the application of green composites, are also discussed here.