bluuebunny/crossref_metadata_2025 huggingface dataset:
Identifying factors in the provision of intravenous stroke thrombolysis in Malaysia: a multiple case study from the healthcare providers’ perspective
Authors: Hwong Wen Yea , Ng Sock Wen , Tong Seng Fah , Ab Rahman Norazida , Law Wan Chung , Wong Sing Keat , Puvanarajah Santhi Datuk , Mohd Norzi Aisyah , Lian Fiona Suling , Sivasampu Sheamini
Published: January 2024

Background

Translation into clinical practice for use of intravenous thrombolysis (IVT) for the management of ischemic stroke remains a challenge especially across low- and middle-income countries, with regional inconsistencies in its rate. This study aimed at identifying factors that influenced the provision of IVT and the variation in its rates in Malaysia.

Methods

A multiple case study underpinning the Tailored Implementation for Chronic Diseases framework was carried out in three public hospitals with differing rates of IVT using a multiple method design. Twenty-five in-depth interviews and 12 focus groups discussions were conducted among 89 healthcare providers, along with a survey on hospital resources and a medical records review to identify reasons for not receiving IVT. Qualitative data were analysed using reflective thematic method, before triangulated with quantitative findings.

Results

Of five factors identified, three factors that distinctively influenced the variation of IVT across the hospitals were: 1) leadership through quality stroke champions, 2) team cohesiveness which entailed team dynamics and its degree of alignment and, 3) facilitative work process which included workflow simplification and familiarity with IVT. Two other factors that were consistently identified as barriers in these hospitals included patient factors which largely encompassed delayed presentation, and resource constraints. About 50.0 – 67.6% of ischemic stroke patients missed the opportunity to receive IVT due to delayed presentation.

Conclusions

In addition to the global effort to explore sustainable measures to improve patients’ emergency response for stroke, attempts to improve the provision of IVT for stroke care should also consider the inclusion of interventions targeting on health systems perspectives such as promoting quality leadership, team cohesiveness and workflow optimisation.
Spotlight on therapeutic efficiency of green synthesis metals and their oxide nanoparticles in periodontitis
Authors: Kiarashi Mohammad , Mahamed Parham , Ghotbi Nader , Tadayonfard Azadeh , Nasiri Kamyar , Kazemi Parisa , Badkoobeh Ashkan , Yasamineh Saman , Joudaki Ali
Published: January 2024

Periodontitis, one of the most prevalent dental diseases, causes the loss of bone and gum tissue that hold teeth in place. Several bacteria, commonly present in clinically healthy oral cavities, may induce and perpetuate periodontitis when their concentration rises in the gingival sulcus. Antibacterial effect against various Gram-negative and Gram-positive bacteria, including pathogenic and drug-resistant ones, has been shown for several distinct transient metal and metal oxide NPs. Therefore, NPs may be used in biomedicine to treat periodontal problems and in nanotechnology to inhibit the development of microorganisms. Instead of using harmful chemicals or energy-intensive machinery, biosynthesis of metal and metal oxide nanoparticles (NPs) has been suggested. To produce metal and metal oxide NPs, the ideal technique is “Green” synthesis because of its low toxicity and safety for human health and the environment. Gold NPs (AuNPs) appear to be less toxic to mammalian cells than other nanometals because their antibacterial activity is not dependent on reactive oxygen species (ROS). AgNPs also possess chemical stability, catalytic activity, and superior electrical and thermal conductivity, to name a few of their other advantageous characteristics. It was observed that zinc oxide (ZnO) NPs and copper (Cu) NPs exhibited discernible inhibitory effects against gram-positive and gram-negative bacterial strains, respectively. ZnO NPs demonstrated bactericidal activity against the microorganisms responsible for periodontitis. Medications containing magnetic NPs are highly effective against multidrug-resistant bacterial and fungal infections. The titanium dioxide (TiO2) NPs are implicated in elevating salivary peroxidase activity in individuals diagnosed with chronic periodontitis. Furthermore, specific metallic NPs have the potential to enhance the antimicrobial efficacy of periodontitis treatments when combined. Therefore, these NPs, as well as their oxide NPs, are only some of the metals and metal oxides that have been synthesized in environmentally friendly ways and shown to have therapeutic benefits against periodontitis.

Graphical Abstract
Transcriptomic insights into UTUC: role of inflammatory fibrosis and potential for personalized treatment
Authors: Li Keqiang , Huang Zhenlin , Xie Guoqing , Huang Budeng , Song Liang , Zhang Yu , Yang Jinjian
Published: January 2024

Background

Upper tract urothelial carcinoma (UTUC) is a rare disease, belonging to the same category of urothelial cancers as bladder cancer (BC). Despite sharing similar non-surgical treatment modalities, UTUC demonstrates a higher metastasis propensity than BC. Furthermore, although both cancers exhibit similar molecular disease emergence mechanisms, sequencing data reveals some differences. Our study investigates the transcriptomic distinctions between UTUC and BC, explores the causes behind UTUC's heightened metastatic tendency, constructs a model for UTUC metastasis and prognosis, and propose personalized treatment strategies for UTUC.

Methods

In our research, we utilized differential gene expression analysis, interaction networks, and Cox regression to explore the enhanced metastatic propensity of UTUC. We formulated and validated a prognostic risk model using diverse techniques, including cell co-culture, reverse transcription quantitative polymerase chain reaction (rt-qPCR), western blotting, and transwell experiments. Our methodological approach also involved survival analysis, risk model construction, and drug screening leveraging the databases of CTRPv2, PRISM and CMap. We used the Masson staining technique for histological assessments. All statistical evaluations were conducted using R software and GraphPad Prism 9, reinforcing the rigorous and comprehensive nature of our research approach.

Results

Screening through inflammatory fibrosis revealed a reduction of extracellular matrix and cell adhesion molecules regulated by proteoglycans in UTUC compared with BC, making UTUC more metastasis-prone. We demonstrated that SDC1, LUM, VEGFA, WNT7B, and TIMP3, are critical in promoting UTUC metastasis. A risk model based on these five molecules can effectively predict the risk of UTUC metastasis and disease-free survival time. Given UTUC's unique molecular mechanisms distinct from BC, we discovered that UTUC patients could better mitigate the issue of poor prognosis associated with UTUC's easy metastasis through tyrosine kinase inhibitors (TKIs) alongside the conventional gemcitabine and cisplatin chemotherapy regimen.

Conclusions

The poor prognosis of UTUC because of its high metastatic propensity is intimately tied to inflammatory fibrosis induced by the accumulation of reactive oxygen species. The biological model constructed using the five molecules SDC1, LUM, VEGFA, WNT7B, and TIMP3 can effectively predict patient prognosis. UTUC patients require specialized treatments in addition to conventional regimens, with TKIs exhibiting significant potential.
(Pro)renin receptor mediates tubular epithelial cell pyroptosis in diabetic kidney disease via DPP4-JNK pathway
Authors: Xie Shiying , Song Shicong , Liu Sirui , Li Qiong , Zou Wei , Ke Jianting , Wang Cheng
Published: January 2024

Background

(Pro)renin receptor (PRR) is highly expressed in renal tubules, which is involved in physiological and pathological processes. However, the role of PRR, expressed in renal tubular epithelial cells, in diabetic kidney disease (DKD) remain largely unknown.

Methods

In this study, kidney biopsies, urine samples, and public RNA-seq data from DKD patients were used to assess PRR expression and cell pyroptosis in tubular epithelial cells. The regulation of tubular epithelial cell pyroptosis by PRR was investigated by in situ renal injection of adeno-associated virus9 (AAV9)-shRNA into db/db mice, and knockdown or overexpression of PRR in HK-2 cells. To reveal the underlined mechanism, the interaction of PRR with potential binding proteins was explored by using BioGrid database. Furthermore, the direct binding of PRR to dipeptidyl peptidase 4 (DPP4), a pleiotropic serine peptidase which increases blood glucose by degrading incretins under diabetic conditions, was confirmed by co-immunoprecipitation assay and immunostaining.

Results

Higher expression of PRR was found in renal tubules and positively correlated with kidney injuries of DKD patients, in parallel with tubular epithelial cells pyroptosis. Knockdown of PRR in kidneys significantly blunted db/db mice to kidney injury by alleviating renal tubular epithelial cells pyroptosis and the resultant interstitial inflammation. Moreover, silencing of PRR blocked high glucose-induced HK-2 pyroptosis, whereas overexpression of PRR enhanced pyroptotic cell death of HK-2 cells. Mechanistically, PRR selectively bound to cysteine-enrich region of C-terminal of DPP4 and augmented the protein abundance of DPP4, leading to the downstream activation of JNK signaling and suppression of SIRT3 signaling and FGFR1 signaling, and then subsequently mediated pyroptotic cell death.

Conclusions

This study identified the significant role of PRR in the pathogenesis of DKD; specifically, PRR promoted tubular epithelial cell pyroptosis via DPP4 mediated signaling, highlighting that PRR could be a promising therapeutic target in DKD.
The 4th NextGen therapies of SJIA and MAS, part 4: it is time for IL-18 based trials in systemic juvenile idiopathic arthritis?
Authors: Canna Scott W. , De Benedetti Fabrizio
Published: January 2024

Since IL-18 has recently emerged as a biomarker associated with refractory disease course in SJIA, the focus of the discussion was the feasibility of the biomarker-driven drug development to SJIA. Overall, there was broad agreement on the conclusion that IL-18 is a uniquely specific biomarker for many of the subsets of SJIA most in need of new therapies, and it may define a class of diseases mediated by IL-18 excess. The consensus was that leveraging IL-18 remains our most promising “lead” for use in refractory SJIA as it may mechanistically explain the disease pathophysiology and lead to more targeted therapies.
Production of recombinant HPV11/16 E6/E7-MBP-His6 fusion proteins and their potential to induce cytokine secretion by immune cells in peripheral blood
Authors: Xu Mei-nian , Zhong Mei-zhen , Feng Si-ning , Xu Yan-qin , Peng Xiao-ming , Zeng Kang , Huang Xiao-wen
Published: January 2024

Human papillomavirus (HPV) infection poses a significant threat to public health worldwide. Targeting the function of HPV E6 and E7 proteins and activating the host immune response against these proteins represent promising therapeutic strategies for combating HPV-related diseases. Consequently, the efficient production of soluble, high-purity E6 and E7 proteins is crucial for function and host immune response studies. In this context, we selected the pMCSG19 protein expression vector for Escherichia coli to produce soluble MBP-His6 tagged HPV11/16 E6/E7 proteins, achieving relatively high purity and yield. Notably, these proteins exhibited low toxicity to peripheral blood mononuclear cells (PBMCs) and did not compromise their viability. Additionally, the recombinant proteins were capable of inducing the secretion of multiple cytokines by immune cells in peripheral blood, indicating their potential to elicit immune responses. In conclusion, our study offers a novel approach for the production of HPV11/16 E6/E7 fusion proteins with relatively high purity and yield. The fusing HPV11/16 E6/E7 proteins to MBP-His6 tag may serve as a valuable method for large-scale protein production in future research endeavors.
Systematic evaluation of the degree of joint amnesia in patients after total hip arthroplasty with direct anterior approach (DAA) compared with posterior approach (PA)
Authors: Zhang Fukang , Zhang Zhuangzhuang , Fan Hua , Cheng Qinghao , Guo Hongzhang
Published: January 2024

Objective

A comparative study of joint amnesia in patients undergoing total hip arthroplasty with the direct anterior approach and posterior approach was conducted through a comprehensive evaluation.

Methods

The literature on joint amnesia in postoperative patients who underwent total hip arthroplasty by the direct anterior approach and the posterior approach was systematically searched in PubMed, Embase, Web of Science, Cochrane Library, CNKI, CBM, Wanfang, and VIP databases from the time of library construction until February 13, 2023. Meta-analysis was performed using RevMan 5.3 software after independent searching, screening of the literature, data extraction, and quality assessment of the included studies by two investigators in strict accordance with the guidelines for conducting meta-analyses.

Results

A total of one RCT and six cohort studies were included in this meta-analysis. Meta-analysis results indicated that at 1 month postoperatively (MD = 2.08, 95% CI (0.20, 3.96), P = 0.03), 3 months (MD = 10.08, 95% CI (1.20, 18.96), P = 0.03), and 1 year (MD = 6.74, 95% CI (1.30, 12.19), P = 0.02), DAA total hip arthroplasty was associated with better FJS compared to PA at 1 year postoperatively. However, there was no statistical significance in FJS between the two groups at 5 years postoperatively (MD = 1.35, 95% CI (− 0.58, 3.28), P = 0.17).

Conclusion

Current evidence suggests that the degree of joint amnesia after THA for DAA was not found to be superior to that of PA. Further, these findings require confirmation by including a larger number of high-quality randomized controlled studies.

Study design

Systematic review; Level of evidence, 3.
Combination of mangiferin and T0901317 targeting autophagy promotes cholesterol efflux from macrophage foam cell in atherosclerosis
Authors: Chen Qian , Wang Sijian , Bao Ruixia , Wang Dan , Wu Yuzheng , Zhang Yi , Liu Mengyang , Wang Tao
Published: January 2024

Background

The synthetic liver X receptor ligand (LXR) T0901317 (T0) has been reported to attenuate atherosclerosis (AS) without hyperglyceridemia due to innovative drug combination or nano-sized drug delivery. Given the key roles of mangiferin (MGF) in lipid metabolism and atherogenesis, it is critical to investigate progression of atherosclerotic lesion after combined treatment of MGF and T0.

Methods

Atherosclerotic plaque formation and hepatic lipid accumulation were compared in Apoe−/− mice among T0 and/or MGF treatment. The in vitro functions of MGF and T0 were analyzed by Oil-red O staining, cholesterol efflux assay, transmission electron microscopy and western blot analyses with or without acetylated low density lipoprotein.

Results

The combination therapy are effective regulators for atherosclerotic plaque formation in Apoe−/− mice, due to upregulation of ABCA1 and ABCG1 induced by LXR activation. Subsequently, we identified autophagy promoted by MGF and T0 treatment establishes a positive feedback loop that increases cholesterol efflux, resulted from LXRα activation. Under atherogenic conditions, the autophagy inhibitor CQ abolished the enhancement effect on cholesterol outflow of MGF and T0. Mechanically, MGF and T0 promotes LXRα and mTOR/AMPK signaling cascade in macrophage, and promotes AMPK signaling cascade in hepatocyte, leading to lipid metabolic homeostasis.

Conclusions

Altogether, our findings reveal that MGF and T0 engages in AS therapy without side effects by activating AMPK-dependent autophagy to promote macrophage cholesterol efflux, and MGF might serve as a natural compound to assist T0 in AS via targeting autophagy.
Targeting tumor–stromal interactions in triple-negative breast cancer using a human vascularized micro-tumor model
Authors: Hachey Stephanie J. , Hatch Christopher J. , Gaebler Daniela , Mocherla Aneela , Nee Kevin , Kessenbrock Kai , Hughes Christopher C. W.
Published: January 2024

Triple-negative breast cancer (TNBC) is highly aggressive with limited available treatments. Stromal cells in the tumor microenvironment (TME) are crucial in TNBC progression; however, understanding the molecular basis of stromal cell activation and tumor–stromal crosstalk in TNBC is limited. To investigate therapeutic targets in the TNBC stromal niche, we used an advanced human in vitro microphysiological system called the vascularized micro-tumor (VMT). Using single-cell RNA sequencing, we revealed that normal breast tissue stromal cells activate neoplastic signaling pathways in the TNBC TME. By comparing interactions in VMTs with clinical data, we identified therapeutic targets at the tumor–stromal interface with potential clinical significance. Combining treatments targeting Tie2 signaling with paclitaxel resulted in vessel normalization and increased efficacy of paclitaxel in the TNBC VMT. Dual inhibition of HER3 and Akt also showed efficacy against TNBC. These data demonstrate the potential of inducing a favorable TME as a targeted therapeutic approach in TNBC.
Vitamin E-enriched medium cross-linked polyethylene in total knee arthroplasty (VIKEP): clinical outcome, oxidation profile, and wear analysis in comparison to standard polyethylene—study protocol for a randomized controlled trial
Authors: Maier Kristin , Selig Marius , Haddouche Andréa , Haunschild Martin , Hauschild Oliver , Khalili Iman , Kirschberg Julia , Lutter Christoph , Menges Michael , Mertl Patrice , Niemeier Andreas , Rubens-Duval Brice , Mittelmeier Wolfram
Published: January 2024

Background

The gliding surface of total knee endoprostheses is exposed to high loads due to patient weight and activity. These implant components are typically manufactured from ultra-high molecular weight polyethylene (UHMWPE). Crosslinking of UHMWPE by ionizing radiation results in higher wear resistance but induces the formation of free radicals which impair mechanical properties after contact with oxygen. Medium-crosslinked UHMWPE enriched with vitamin E (MXE) provides a balance between the parameters for a sustainable gliding surface, i.e., mechanical strength, wear resistance, particle size, and oxidation stability. Therefore, a gliding surface for knee endoprostheses made up from this material was developed, certified, and launched. The aim of this study is to compare this new gliding surface to the established predecessor in a non-inferiority design.

Methods

This multicenter, binational randomized controlled trial will enroll patients with knee osteoarthritis eligible for knee arthroplasty with the index device. Patients will be treated with a knee endoprosthesis with either MXE or a standard gliding surface. Patients will be blinded regarding their treatment. After implantation of the devices, patients will be followed up for 10 years. Besides clinical and patient-related outcomes, radiological data will be collected. In case of revision, the gliding surface will be analyzed biomechanically and regarding the oxidative profile.

Discussion

The comparison between MXE and the standard gliding surface in this study will provide clinical data to confirm preceding biomechanical results in vivo. It is assumed that material-related differences will be identified, i.e., that the new material will be less sensitive to wear and creep. This may become obvious in biomechanical analyses of retrieved implants from revised patients and in radiologic analyses.

Trial registration

ClinicalTrials.gov, NCT04618016. Registered 27 October 2020, https://clinicaltrials.gov/study/NCT04618016?term=vikep&checkSpell=false&rank=1.

All items from the World Health Organization Trial Registration Data Set can be found in Additional file 1.
Effects of including a dog on treatment motivation and the therapeutic alliance in child and adolescent psychotherapy: study protocol for a randomized controlled trial
Authors: Arnskötter Wanda , Martin Suzanne , Walitza Susanne , Hediger Karin
Published: January 2024

Background

Motivation and a therapeutic alliance are crucial for successful therapy. It is assumed that dogs can increase motivation and help support therapeutic relationships. This is one of the reasons for including dogs in psychotherapy. While the positive effects of psychotherapy with dogs have been documented over the past years, little is known about the underlying mechanisms of animal-assisted psychotherapy. This study therefore aims to investigate whether and how the presence of a dog affects motivation and the therapeutic alliance in child and adolescent psychotherapy.

Methods

The study is a randomized controlled trial assessing motivation and the therapeutic alliance during the first five sessions of psychotherapy attended by children and adolescents with different psychiatric disorders. We will recruit 150 children and adolescents and randomly assign them to one of three conditions: (a) a dog is present but not integrated in the therapeutic narrative, (b) a dog is actively integrated in the therapeutic narrative, and (c) no dog is present. The children’s and adolescents’ evaluations of the therapeutic alliance and of their motivation will be assessed as the primary outcomes using standardized questionnaires before and after the first five therapy sessions as well as at follow-up. Further outcomes include the therapists’ evaluations of the therapeutic alliance and their motivation, treatment adherence of the children and adolescents, and treatment satisfaction of the children and adolescents, their parents, and of the therapists. Interventions are conducted by experienced therapists who regularly work with their dogs. Outcomes will be analyzed using general linear models, with the treatment group as a fixed factor and the baseline values as covariates.

Discussion

This study provides information on the possible motivation and alliance-enhancing effects of integrating a dog into child and adolescent psychotherapy. This is relevant for practice, as these two components are strong predictors of therapy outcome. Moreover, the study will contribute to a better understanding of how a dog should be incorporated into psychotherapeutic settings. This can lead to a more purposeful inclusion of dogs in psychotherapy for children and adolescents.

Trial registration

The trial was registered on ClinicalTrials.gov, NCT05384808, on 20 May 2022.
Macrophage activation syndrome with acute hepatitis in a patient with adult-onset immunodeficiency with anti-interferon gamma antibodies: a case report
Authors: Hirsch William , Megna Bryant , Adeyi Oyedele , Lim Nicholas
Published: January 2024

Background

Macrophage activation syndrome is a rare disorder leading to unregulated immune activity manifesting with nonspecific constitutional symptoms, laboratory abnormalities, and multiorgan involvement. We report the case of a patient who presented with acute hepatitis secondary to macrophage activation syndrome diagnosed by liver biopsy and successfully treated with intravenous immune globulin, anakinra, and rituximab.

Case presentation

A 42-year-old Laotian woman with adult-onset immunodeficiency with anti-interferon gamma antibodies presented with a fever, headache, generalized myalgia, dark urine, and reduced appetite in the setting of family members at home with similar symptoms. Her laboratory workup was notable for evidence of acute hepatitis without acute liver failure. After an unrevealing comprehensive infectious and noninvasive rheumatologic workup was completed, a liver biopsy was performed ultimately revealing the diagnosis of macrophage activation syndrome. She was successfully treated with intravenous immune globulin, anakinra, and rituximab.

Conclusion

This case highlights the importance of maintaining macrophage activation syndrome on the differential of a patient with acute hepatitis of unknown etiology in the correct clinical context and the value of a liver biopsy in making a diagnosis when noninvasive testing is unrevealing.
Impact of health system strengthening interventions on child survival in sub-Saharan Africa: a systematic review protocol
Authors: Agula Caesar , Bawah Ayaga A. , Asuming Patrick O. , Kyei Pearl , Biney Adriana
Published: January 2024

Background

Strengthening healthcare systems is a practical approach to enhance healthcare delivery and services. Although there has been a rise in the number of health systems strengthening (HSS) interventions in sub-Saharan Africa (SSA), there is limited evidence on the causal effect of these activities on child survival. Furthermore, the findings reported so far have been varied, and how they relate to each other remains unclear. This systematic review study aims to assess all available evidence to understand the impact of HSS activities on child survival in SSA.

Methods

We developed a search strategy to retrieve all relevant studies from electronic databases such as PubMed/MEDLINE, Web of Science, and African Journals Online. We will use a combination of search terms such as “under-five mortality,” “child mortality,” “infant mortality,” “neonatal mortality,” “child survival,” and “health systems strengthening.” The review will include studies that establish a causal relationship between HSS interventions and child survival. This will include studies with designs such as randomized controlled trials and quasi-experimental and methods like difference-in-difference. Two reviewers will independently screen all citations, abstracts, and full-text data and a third reviewer will act as a tiebreaker in case of disagreements. The primary outcome of interest is the impact of HSS activities on under-five survival. We will evaluate the quality of each study using the Bradford Hill criteria for causation.

Discussion

Our systematic review will identify and evaluate all relevant evidence that establishes a causal relationship between HSS activities and the survival of children under five years in SSA. The review’s findings regarding the impact of HSS activities on child survival could be of significant interest to the donor community and policy actors in the region. We also anticipate that the review’s conclusions could serve as a valuable guide for the development of future health system interventions and strategies in SSA.

Systematic review registration

PROSPERO CRD42022333913.
BGNBA-OCO based privacy preserving attribute based access control with data duplication for secure storage in cloud
Authors: Pavithra M. , Prakash M. , Vennila V.
Published: January 2024

Cloud computing technology offers flexible and expedient services that carry a variety of profits for both societies as well as individuals. De-duplication techniques were developed to minimize redundant data in the cloud storage. But, one of the main challenges of cloud storage is data deduplication with secure data storage.To overcome the issue, we propose Boneh Goh Nissim Bilinear Attribute-based Optimal Cache Oblivious (BGNBA-OCO) access control and secure de-duplication for data storage in cloud computing in this paper. The proposed method achieves fne-grained access control with low computation consumption. We design Boneh Goh Nissim Privacy Preserving Revocable Attribute-based Encryption that reinforces attribute revocation and averts the discharge of sensitive information. Furthermore, we utilize Optimal Cache Oblivious algorithm to prevent disclosure of access patterns to hide the access patterns in cloud storage via rand pattern matching. We support updating both encrypted data and access control policies to minimize communication and computation overhead of data duplication and encryption processes concurrently. We perform secure data sharing to achieve higher data confidentiality and integrity. Finally, we conducted the extensive experiments in cloud and the results illustrated that our proposed BGNBA-OCO method is more efficient than related works.
28-day perioperative pediatric mortality and its predictors in a tertiary teaching hospital in Ethiopia: a prospective cohort study
Authors: Molla Misganew Terefe , Anley Nebiyu Shitaye , Zewdie Bekalu Wubshet , Endeshaw Amanuel Sisay , Kumie Fantahun Tarekegn
Published: January 2024

Background

Perioperative pediatric mortality is significantly higher in low-resource countries due to a scarcity of well-trained professionals and a lack of well-equipped pediatric perioperative services. There has been little research on pediatric mortality in low-income countries. Therefore, this study aimed to assess the incidence of perioperative pediatric mortality and its predictors in 28-day follow-up.

Methods

The data were collected using REDCap, an electronic data collection tool, between June 01, 2019 and July 01, 2021. This study includes pediatric patients aged 0 to 17 years who underwent surgery in Tibebe Ghion Specialized Hospital over 28 days with a total of 1171 patients. STATA version 17 software was used for data analysis. Log-rank tests were fitted to explore survival differences. After bivariable and multivariable Cox regression analysis, an Adjusted Hazard Ratio (AHR) with a 95% Confidence Interval (CI) was reported to declare the strength of association and statistical significance.

Results

There were 35 deaths in the cohort of 1171 pediatric patients. Twenty of the deaths were in neonates. The overall perioperative mortality among pediatric patients was 2.99%, with an incidence rate of 1.11 deaths per 1000 person day observation (95% CI 0.79, 1.54). The neonatal age group had an AHR = 9.59, 95% CI 3.77, 24.3), transfusion had an AHR = 2.6, 95% CI 1.11, 6.09), and the America Society of Anesthesiology physical status classification III and above had an AHR = 4.39, 95% CI 1.61, 11.9 were found the significant predictors of perioperative pediatric mortality.

Conclusions

In this study, the perioperative mortality of pediatric patients was high in the 28-day follow-up. Neonatal age, transfusion, and America Society of Anesthesiology physical status III and above were significant predictors of pediatric mortality. Therefore, perioperative surgical teams should give special attention to neonates, the America Society of Anesthesiology physical status III and above, and transfusion to reduce pediatric mortality.
Analysis of solar energy potentials of five selected south-east cities in nigeria using deep learning algorithms
Authors: Ikemba Samuel , Song-hyun Kim , Scott Temiloluwa O , Ewim Daniel R. E. , Abolarin Sogo M. , Fawole Akeeb Adepoju
Published: January 2024

This study presents a meticulous examination of the solar energy potential of five selected metropolitan cities (Abakaliki, Awka, Enugu, Owerri, and Umuahia) in Eastern part of Nigeria using deep learning algorithm, specifically the Long Short-Term Memory (LSTM) model. These cities, despite being characterized by extended rainy seasons and a high level of cloudiness, are suitable environment for solar power generation and investment opportunities. The employed methodology capitalized on the LSTM deep learning approach to analyze and predict energy generation, utilizing comprehensive hourly weather data from the National Airspace Agency (NASA). The data set comprised various parameters, such as date/time, solar azimuth angle, temperature, humidity, wind speed, wind direction, cloud cover, and power, enabling a thorough analysis of each city. To ensure accuracy, energy prediction capabilities were benchmarked against real-time datasets from a solar power plant in Ulsan, South Korea, thereby training and fine-tuning the model for precision. The LSTM model's performance metrics were maintained at a learning rate of 0.07, a batch size of 150, and a train-test split ratio of 0.8 to 0.2. Data validation exhibited a mean square error (MSE) of 0.01, demonstrating the model’s reliability. Results showed Enugu as having the highest solar energy potential, averaging 6.25 kWh/day, while Awka registered the most substantial electricity demand across various sectors. These findings highlight the substantial potential for photovoltaic (PV) power systems and advocate for the immediate implementation of renewable energy policy in the selected cities. These are expected to bring about significant implications for future renewable energy environmentally friendly investments in Nigeria and globally.
Impact of green digital finance on sustainable development: evidence from China’s pilot zones
Authors: Xiao Yubo , Lin Muxi , Wang Lu
Published: January 2024

To investigate the impact of Green Digital Finance (GDF) policies on sustainable regional development goals, this study exploits the implementation of China’s green finance reform and innovation pilot zones as a quasi-natural experiment to examine the theory and impact of policy channels on sustainable development. A difference-in-differences model was applied to evaluate the impact of policies in these zones based on data from 285 cities in China from 2014 to 2020. Research has shown that the GDF is conducive to achieving sustainable development goals through the effects of financial inclusion and energy transitions, which promote the transformation and upgrading of industrial structures. The impact of the GDF pilot-zone policies on the sustainable development of cities at different levels, locations, resource endowments, and green total factor productivity is heterogeneous. This study provides accurate empirical evidence of the effects of the extensive implementation of the policies adopted in the pilot zones and the expansion of the scale of these zones, and it provides policy recommendations for the GDF.
Application of probiotics as a constituent element of non-surgical periodontal therapy for cases with chronic periodontitis
Authors: Robo Ilma , Heta Saimir , Ostreni Vera , Hysi Joana , Alliu Nevila
Published: January 2024

Background

Non-surgical periodontal therapy includes not only the local curettage of tartar and bacterial plaque, but also aims to remove "bubbling" bacteria in saliva or gingival fluid, which cause the creation of bacterial plaque and therefore also chronic periodontitis. In the final stage, the indication for giving or not prescribing antibiotics depends on the clinical course of the disease. Probiotics can serve as helpers in the "fight" against the causative pathogenic bacteria, but with the specificity of application in the intermediate stages and not in the final stage of non-surgical periodontal treatment.

Main body of the abstract

The study is of the review type with the aim of selecting articles published in PubMed in a period of 5 years about the topic of probiotics and their application in non-surgical periodontal therapy for the treatment of chronic periodontitis. The selection of articles was carried out based on the combination of key words. The selected articles were 23 and then classified based on the clinical periodontal parameters that have been studied and the positive, positive/negative or negative attitude about the application or not of probiotics for the treatment of chronic periodontitis as a companion to non-surgical periodontal therapy. Non-concrete well-defined results are observed on the type of dosage and method of application of probiotics, being accompanied by non-concrete results both locally in the affected periodontal areas, but also systemic in the patient's serum.

Short conclusion

Correct application protocols of probiotics for treatment of chronic periodontitis, but also of other periodontal pathologies, have “the advantage” of avoiding the prescription of systemic antibiotics, in the conditions of increased resistance to them. The effects of probiotics when applied even in the first stages of non-surgical therapy are mainly visible in the reduction of infection inflammation, the most mentioned and most visible results, based on the data published in the literature. More data are required in this regard.
A study protocol for implementing Canadian Practice Guidelines for Treating Children and Adolescents with Eating Disorders
Authors: Couturier Jennifer L. , Kimber Melissa , Ford Catherine , Coelho Jennifer S. , Dimitropoulos Gina , Kurji Ayisha , Boman Jonathan , Isserlin Leanna , Bond Jason , Soroka Chelsea , Dominic Anna , Boachie Ahmed , McVey Gail , Norris Mark , Obeid Nicole , Pilon David , Spettigue Wendy , Findlay Sheri , Geller Josie , Grewal Seena , Gusella Joanne , Jericho Monique , Johnson Natasha , Katzman Debra , Chan Natalie , Grande Chloe , Nicula Maria , Clause-Walford Drew , Leclerc Anick , Loewen Rachel , Loewen Techiya , Steinegger Cathleen , Waite Elizabeth , Webb Cheryl , Brouwers Melissa
Published: January 2024

Background

Eating disorders have one of the highest mortality rates among psychiatric illnesses. Timely intervention is crucial for effective treatment, as eating disorders tend to be chronic and difficult to manage if left untreated. Clinical practice guidelines play a vital role in improving healthcare delivery, aiming to minimize variations in care and bridge the gap between research and practice. However, research indicates an active guideline implementation approach is crucial to effective uptake.

Methods

Mixed methods will be used to inform and evaluate our guideline implementation approach. Semi-structured focus groups will be conducted in each of the eight provinces in Canada. Each focus group will comprise 8–10 key stakeholders, including clinicians, program administrators, and individuals with lived experience or caregivers. Qualitative data will be analyzed using conventional content analysis and the constant comparison technique and the results will be used to inform our implementation strategy. The study will then evaluate the effectiveness of our implementation approach through pre- and post-surveys, comparing changes in awareness, use, and impact of the guidelines in various stakeholder groups.

Discussion

Through a multifaceted implementation strategy, involving the co-creation of educational materials, tailored training, and context-specific strategies, this study intends to enhance guideline uptake and promote adherence to evidence-based practices. Our study will also contribute valuable information on the impact of our implementation strategies.
Classification of COVID-19 patients from HRCT score prediction in CT images using transfer learning approach
Authors: Tembhurne Jitendra
Published: January 2024

COVID-19 had a huge impact on patients and medical systems all around the world. Computed tomography (CT) images can effectively complement the reverse transcription-polymerase chain reaction testing (RT-PCR) and offer results much faster than RT-PCR test which assists to prevent spread of COVID-19. Various deep learning models have been recently proposed for COVID-19 screening in CT scans as a tool to automate and help the diagnosis, but consisting of some benefits and limitations. Some of the reasons for this are: (i) training the data with largely unbalanced dataset and (ii) training the models with datasets having all similar CT images which leads to overfitting. In this work, we proposed a method to use multiple models to classify COVID-19 positive or negative which are trained using transfer learning techniques. In addition to classifying, if a person is COVID-19 positive or negative, we have also calculated the high-resolution computed tomography (HRCT) score or CT score to find the severity of infection with the help of image segmentation techniques, which assist in identifying the preliminary prognosis of the patient, and take necessary preventive measures.
Integrating in silico molecular docking, ADMET analysis of C.verticillata with diabetic markers and in vitro anti-inflammatory activity
Authors: A. Maheswari , DE Salamun
Published: January 2024

Background

Over the past decade, various research studies have proved the interconnection between the inflammatory pathways and diabetes complication in clinical condition. The present study evaluated the anti-inflammatory and antioxidant activity. Further, the sample was tested for its pharmacokinetics properties and the best compounds were docked with the diabetic markers (DPP IV (PDB-ID: IJ2E) and SGLT2 (PDB-ID: 7VSI)).

Results

C.verticillata showed a good hydrogen peroxide (78.3 ± 0.34%, IC50 = 287.81 µg/ml) and superoxide scavenging activity (52.7 ± 1.26%, IC50 = 796.15 µg/ml). In addition, the sample was checked for its anti-inflammatory activity with protein denaturation (57.4 ± 0.19%, IC50 = 471.5 µg/ml) and proteinase inhibition assay (68.3 ± 0.48%, IC50 = 213.42 µg/ml). Further, the bioactive compounds detected from HPLC-ESI-MS/MS analyzed sample were checked for its drug likeliness by checking its ADME properties and toxicological parameters. It has been observed that except Loliolide, all the other compounds have followed the physicochemical parameters and proved to exhibit drug likeliness characteristics. The bioactive compounds that follow the Lipinski’s rule were taken further for in silico molecular docking analysis with the diabetic protein markers (DPP IV and SGLT2). Docking results revealed that Pyro pheophorbide a with DPP IV and Dihydromonacolin L acid with SGLT2 have recorded a maximum docking score of (− 9.4 kcal/mol) and (− 9.2 kcal/mol), respectively.

Conclusion

The observed results suggest that the identified and selected bioactive compounds from C.verticillata can be considered as a potential target molecule for the management of oxidative stress induced diabetic condition. Furthermore, the study also provides an insight on the effectiveness of the compounds on reducing the inflammation as well.
Synthesized complex-frequency excitation for ultrasensitive molecular sensing
Authors: Zeng Kebo , Wu Chenchen , Guo Xiangdong , Guan Fuxin , Duan Yu , Zhang Lauren L. , Yang Xiaoxia , Liu Na , Dai Qing , Zhang Shuang
Published: January 2024

Sensors have emerged as indispensable analytical tools across a wide range of important fields, encompassing environmental monitoring, food safety, and public health. They facilitate early disease diagnosis, personalized medicine, and rapid detection of toxic agents. However, detecting trace molecules remains a significant challenge. Surface-enhanced infrared absorption (SEIRA) based on plasmonic nanostructures, particularly graphene, has emerged as a promising approach to enhance sensing sensitivity. While graphene-based SEIRA offers advantages such as high sensitivity and active tunability, intrinsic molecular damping weakens the interaction between vibrational modes and plasmons. Here, we demonstrate ultrahigh-sensitive molecular sensing based on synthesized complex-frequency waves (CFW). Our experiment shows that CFW can amplify the molecular signals (silk protein monolayer) detected by graphene-based sensor by at least an order of magnitude and can be universally applied to molecular sensing in different phases. Our approach is highly scalable and can facilitate the investigation of light-matter interactions, enabling diverse potential applications in fields such as optical spectroscopy, biomedicine and pharmaceutics.
Supervised machine learning-based salp swarm algorithm for fault diagnosis of photovoltaic systems
Authors: Hichri Amal , Hajji Mansour , Mansouri Majdi , Nounou Hazem , Bouzrara Kais
Published: January 2024

The diagnosis of faults in grid-connected photovoltaic (GCPV) systems is a challenging task due to their complex nature and the high similarity between faults. To address this issue, we propose a wrapper approach called the salp swarm algorithm (SSA) for feature selection. The main objective of SSA is to extract only the most important features from the raw data and eliminate unnecessary ones to improve the classification accuracy of supervised machine learning (SML) classifiers. Subsequently, the selected features are used to train supervised machine learning (SML) techniques in distinguishing between various operating modes. To evaluate the efficiency of the technique, we used healthy and faulty data from GCPV systems that have been injected with frequent faults, 20 different types of faults were introduced, including line-to-line, line-to-ground, connectivity faults, and those affecting the operation of bay-pass diodes. These faults present diverse conditions, such as simple and multiple faults in the PV arrays and mixed faults in both arrays. The performances of the developed SSA-SML are compared with those using principal component analysis (PCA) and kernel PCA (KPCA) based SML techniques through different criteria (i.e., accuracy, recall, precision, F1 score, and computation time). The experimental findings demonstrated that the proposed diagnosis paradigm outperformed the other techniques and achieved a high diagnostic accuracy (an average accuracy greater than 99%) while significantly reducing computation time.
Regularity of bedtime, wake-up time, and time in bed in mid-life: associations with cardiometabolic health markers with adjustment for physical activity and sedentary time
Authors: Nauha Laura , Farrahi Vahid , Jurvelin Heidi , Jämsä Timo , Niemelä Maisa , Ala-Mursula Leena , Kangas Maarit , Korpelainen Raija
Published: January 2024

Background

Insufficient sleep has been linked to the accumulation of cardiometabolic risks while physical activity acts as a protective factor. Also, sleep regularity may play a critical role in maintaining optimal cardiometabolic health. This cross-sectional study examined the association between device-based sleep regularity, waking activity behaviors, and cardiometabolic health markers, including blood pressure level; abdominal adiposity level; and blood glucose, insulin, and cholesterol.

Methods

We included 3698 members of the Northern Finland Birth cohort 1966 who participated in the follow-up study at the age of 46 years between 2012 and 2014 (women 61%). We used seven-day standard deviations of device-based bedtime, wake-up time, and time in bed to reflect sleep regularities. As covariates in linear regression models, we used commonly known potential risk factors in (gender, education, marital status, work schedule, smoking status, alcohol risk use, seven-day time in bed mean, chronotype). In addition to the previous, we used either sedentary time or total physical activity as a covariate (B coefficients with 95% confidence intervals CI).

Results

When we considered sedentary time with other covariates, irregularities in bedtime, wake-up time, and time in bed were associated with unfavorable cardiometabolic health markers, such as higher body mass index (bedtime regularity: 0.194, 95% CI [0.072, 0.316], p = 0.002); higher diastolic blood pressure levels (time in bed regularity: 0.175, 95% CI [0.044, 0.306], p = 0.009); and higher 2-h glucose levels (wake-up time regularity: 0.107, 95% CI [0.030, 0.184], p = 0.006). When we considered total physical activity with other covariates, only irregular bedtime was associated with higher waist circumference (B 0.199, 95% CI [0.042, 0.356], p = 0.013). Irregularities in bedtime and wake-up time were not associated with higher diastolic blood pressure, higher visceral fat area or higher fasting insulin level after considering sedentary time or total physical activity with other covariates (in all, p > 0.05).

Conclusions

In middle-aged, physical activity appears to weaken the adverse relationship between irregular sleep and cardiometabolic health markers, although the interpretation of the impact of sedentary time remains less conclusive. The clinical significance and extent of the observed associations warrant further investigation.