bluuebunny/crossref_metadata_2025 huggingface dataset:
Educational inequalities in blood pressure across the adult life course: Evidence from a 20-year follow-up study
Authors: Gebreslassie Mihretab , Warolén Marie , Lager Anton , Fors Stefan
Published: August 2024

Aim:

High blood pressure (BP) is a key contributor to the burden of disease. This study aimed to assess: a) educational differences across the entire BP distribution, and b) educational differences in the trajectories of BP across the adult life course.

Method:

Longitudinal data from the Stockholm Diabetes Prevention Program was analysed using quantile regression and linear mixed effects models. Models were adjusted for age, sex, lifestyle, and BP medication.

Results:

Lower educational level was associated with higher systolic BP (SBP) at all follow-up periods. Age and sex adjusted mean SBP was 2.49 (95% confidence interval (CI) 1.10, 3.87), 3.95 (95% CI 2.45, 5.45) and 2.61 (95% CI 1.09, 4.13) mmHg higher for people with pre-secondary education compared with post-secondary at baseline, 10 years and 20 years follow-up, respectively. Quantile regressions revealed that the inequalities could be observed across the entire BP continuum. Longitudinally analysed, people with pre-secondary education had 3.01 (95% CI 1.91–4.11) mmHg higher SBP than those with post-secondary education, age and sex adjusted. No significant convergence or divergence of the educational gaps in SBP was observed. Educational differences remained even after adjusting for lifestyle and BP medication.

Conclusions:

These results imply that public health interventions should aim to bring about distributional shifts in blood pressure, rather than exclusively focusing on hypertensive people, if they are to effectively minimize the educational disparities in blood pressure and its consequences.
Predicting mortality amongst Jordanian men with heart attacks using the chi-square automatic interaction detection model
Authors: Bani Hani Salam , Ahmad Muayyad
Published: August 2024

Background: One of the most complicated cardiovascular diseases in the world is heart attack. Since men are the most likely to develop cardiac diseases, accurate prediction of these conditions can help save lives in this population. This study proposed the Chi-Squared Automated Interactive Detection (CHAID) model as a prediction algorithm to forecast death versus life among men who might experience heart attacks. Methods: Data were extracted from the electronic health solution system in Jordan using a retrospective, predictive study. Between 2015 and 2021, information on men admitted to public hospitals in Jordan was gathered. Results: The CHAID algorithm had a higher accuracy of 93.72% and an area under the curve of 0.792, making it the best top model created to predict mortality among Jordanian men. It was discovered that among Jordanian men, governorates, age, pulse oximetry, medical diagnosis, pulse pressure, heart rate, systolic blood pressure, and pulse pressure were the most significant predicted risk factors of mortality from heart attack. Conclusion: With heart attack complaints as the primary risk factors that were predicted using machine learning algorithms like the CHAID model, demographic characteristics and hemodynamic readings were presented.
Review on path planning methods for autonomous underwater vehicle
Authors: Mohanty Prases K , Chaudhary Vishnu , Prajapati Rahul
Published: August 2024

Autonomous Underwater Vehicles (AUVs) have obtained a significant role in recent years due to their potential in oceanographic and marine research, as well as in industries such as oil and gas exploration and environmental monitoring. Technology has evolved significantly since its inception in the 19th century, with modern AUVs capable of operating at great depths for extended periods. This review paper provides an overview of the latest advancements in the domain of AUVs path planning. One of the critical challenges for AUVs is navigation in the complex and unpredictable marine environment and AUVs must overcome obstacles such as reefs, rocks, and shipwrecks to reach their destination. The paper focuses on the difficulties AUVs face in the ocean environment, mainly related to path planning. It emphasizes path planning with an optimal solution from the origin point to the final point. The path planning method is classified into two parts, global and local, to handle static and known obstacles and dynamic and unknown obstacles, respectively. This review paper has discussed the several path-planning methods for AUV, and strategies deployed for validating them through experimentation and simulation. The paper ends with a recommendation for future research on the path planning of AUVs.
Alternative Splicing Landscape of Head and Neck Squamous Cell Carcinoma
Authors: Wu Kehan , Sun Qianhui , Liu Dongxu , Lu Jiayi , Wen Deyu , Zang Xiyan , Gao Li
Published: August 2024

Head and neck malignancies are a significant global health concern, with head and neck squamous cell carcinoma (HNSCC) being the sixth most common cancer worldwide accounting for > 90% of cases. In recent years, there has been growing recognition of the potential role of alternative splicing (AS) in the etiology of cancer. Increasing evidence suggests that AS is associated with various aspects of cancer progression, including tumor occurrence, invasion, metastasis, and drug resistance. Additionally, AS is involved in shaping the tumor microenvironment, which plays a crucial role in tumor development and response to therapy. AS can influence the expression of factors involved in angiogenesis, immune response, and extracellular matrix remodeling, all of which contribute to the formation of a supportive microenvironment for tumor growth. Exploring the mechanism of AS events in HNSCC could provide insights into the development and progression of this cancer, as well as its interaction with the tumor microenvironment. Understanding how AS contributes to the molecular changes in HNSCC cells and influences the tumor microenvironment could lead to the identification of new therapeutic targets. Targeted chemotherapy and immunotherapy strategies tailored to the specific AS patterns in HNSCC could potentially improve treatment outcomes and reduce side effects. This review explores the concept, types, processes, and technological advancements of AS, focusing on its role in the initiation, progression, treatment, and prognosis of HNSCC.
Influence of Age, Gender and Body Mass Index on Intravenous Pharmacokinetics of Buprenorphine in Children Undergoing Orthopedic Surgery
Authors: Rivera-Espinosa Liliana , Vicencio-Rosas Eréndira , Flores-Pérez Carmen , Flores-Pérez Janett , Lares-Asseff Ismael , Gándara Mireles Jesús Alonso , Solorio-López Edelmira , Chávez-Pacheco Juan Luis
Published: August 2024

Background

Buprenorphine (BPN) is a widely used analgesic in the pediatric population, although there are few studies on the pharmacokinetics and pharmacodynamics of this drug.

Objective

The objective was to characterize the pharmacokinetics of BPN after intravenous administration and analyze the effect of age, gender, weight, height, body mass index (BMI), and drug-drug interactions as covariates.

Methods

Ninety-nine children (2-10 years), who underwent orthopedic surgery under regional, general, or combined anesthesia were included. Patients evaluated according to the American Society of Anesthesiologists Physical Status Classification, who received intravenous BPN 2 μg/kg were enrolled. Blood was collected from 1-240 min. Drug plasma concentrations were determined by LC-MS/MS. Population pharmacokinetic parameters were obtained with Monolix 2021R1 software. Pearson’s correlation and/or ANOVA were used for statistical analysis.

Results

Age was associated with changes in clearance and central compartment volume and the female gender was associated with lower intercompartmental clearance, while BMI modified clearance, central and peripheral compartment volume. Concomitant administration of BPN with fentanyl and dexamethasone produced decreases in clearance.

Conclusions

The covariates of sex, age, and BMI are directly related to the increase or decrease in BPN pharmacokinetic parameters.
Changes in blood biochemistry thrombosis parameters 24 hours after stent-assisted endovascular treatment of intracranial aneurysms
Authors: Cinar Celal , Oran Ismail , Ozdemir Halil Ibrahim , Kusbeci Mahmut , Kavakli Ramazan Kaan , Tobu Mahmut , Parildar Zuhal
Published: August 2024

Background and purpose

This study aims to elucidate the early changes in blood biochemistry thrombosis parameters following stent-assisted endovascular treatment of intracranial aneurysms.

Methods

Consecutive patients with unruptured aneurysms undergoing stent implantation during endovascular treatment were included in this prospective study with approval from the local ethics committee. Blood samples were collected immediately before and 24 h after the procedure for biochemical analysis, including basic thrombosis indicators, bleeding tests, and a complete blood count.

Results

The study included 80 patients (60 women, 20 men) with 134 aneurysms. A total of 135 stents (110 flow-diverting, 25 standard) were used. Additionally, intrasaccular coiling was utilized in 28 aneurysms among 27 patients. Following the procedure, there was a significant decrease in activated partial thromboplastin time, fibrinogen, hemoglobin, and platelet levels, and a significant increase in prothrombin time, D-dimer, von Willebrand factor (vWF) activity/antigen ratio, and leukocyte levels in all patients. Correlation analyses revealed significant positive associations between platelet and fibrinogen levels, and a negative association between D-dimer and fibrinogen levels in the coil (−) group. Additionally, there was a significant negative correlation between aneurysm volume and vWF activity/antigen ratio, and procedure duration and thrombocyte count, while a positive association was found between aneurysm number and leukocyte count in the coil (−) group.

Conclusions

Analysis of blood chemistry alterations indicates that intravascular thrombosis occurs in the intracranial circulation following stent-assisted endovascular treatment of intracranial aneurysms. This thrombotic process is more pronounced in patients whose aneurysms were left open (i.e. flow-diverting stent alone).
Inferences for the distribution of the duration of response in a comparative clinical study
Authors: Cui Ying , Huang Bo , Mao Lu , Uno Hajime , Wei Lee-Jen , Tian Lu
Published: August 2024

Duration of response is an important endpoint used in drug development. Prolonged duration for response is often viewed as an early indication of treatment efficacy. However, there are numerous difficulties in studying the distribution of duration of response based on observed data subject to right censoring in practice. The most important obstacle is that the distribution of the duration of response is in general not identifiable in the presence of censoring due to the simple fact that there is no information on the joint distribution of time to response and time to progression beyond the largest follow-up time. In this article, we introduce the restricted duration of response as a replacement of the conventional duration of response. The distribution of restricted duration of response is estimable and we have proposed several nonparametric estimators in this article. The corresponding inference procedure and additional downstream analysis have been developed. Extensive numerical simulations have been conducted to examine the finite sample performance of the proposed estimators. It appears that a new regression-based two-step estimator for the survival function of the restricted duration of response tends to have a robust and superior performance, and we recommend its use in practice. A real data example from oncology has been used to illustrate the analysis for restricted duration of response.
Statistical approaches for component-wise censored composite endpoints
Authors: Eaton Anne
Published: August 2024

Composite endpoints defined as the time to the earliest of two or more events are often used as primary endpoints in clinical trials. Component-wise censoring arises when different components of the composite endpoint are censored differently. We focus on a composite of death and a non-fatal event where death time is right censored and the non-fatal event time is interval censored because the event can only be detected during study visits. Such data are most often analysed using methods for right censored data, treating the time the non-fatal event was first detected as the time it occurred. This can lead to bias, particularly when the time between assessments is long. We describe several approaches for estimating the event-free survival curve and the effect of treatment on event-free survival via the hazard ratio that are specifically designed to handle component-wise censoring. We apply the methods to a randomized study of breastfeeding versus formula feeding for infants of mothers infected with human immunodeficiency virus.
Single-Task and Dual-Task Gait Performance After Sport-Related Concussion: A Machine Learning Statistical Approach
Authors: Murray Nicholas G. , Szekely Brian , Taylor Madison R. , Quigley Kristen G. , McCarley Joseph , Constantino Nora , Hashida Kumiko , Tamura Kaori
Published: August 2024

Background:

This study evaluated 2 different dual-task (DT) conditions during tandem gait (TG) to predict sport-related concussion (SRC) diagnosis.

Hypothesis:

The best (fastest) single-task (ST) gait will differ between groups (controls vs SRC; baseline vs SRC), with auditory pure switching task (APST) response rate being the most important behavioral variable to aid prediction of SRC.

Study Design:

Cohort design.

Level of Evidence:

Level 3.

Methods:

A total of 409 National Collegiate Athletic Association Division I student-athlete controls and 21 team-physician-diagnosed SRC participated. All data were collected at preseason physicals (baseline) and within 7 days of injury for SRC. Each participant completed 3 conditions of TG in a pseudorandomized order: (1) ST, (2) DT with serial-7s (SS) subtractions, and (3) DT with APST. Outcomes of time-to-complete for TG and behavioral (eg, responses per second) for SS and APST were recorded for each trial.

Results:

ST Trials 2 ( P = 0.03) and 3 ( P = 0.01) were significantly different between controls and SRC. ST Trial 3 ( P = 0.04) was significantly different between baseline and SRC. Average responses per second for APST were significantly different between- ( P < 0.01) and within- ( P = 0.01) group.

Conclusion:

The results suggest that ST is significantly slower after SRC. However, DT (both SS and APST) time-to-complete are also important variables when predicting the SRC diagnosis. It is advised that both ST and DT be administered when making clinical decisions regarding postural instability after SRC.

Clinical Relevance:

The best ST TG time to complete gait is an important objective marker of concussion while DT paradigms, specifically SS and APST, are highly variable. DT may be more useful for clinical observable signs of SRC. Both SS and APST have unique usefulness, but APST response rate per second can be relied upon numerically for clinical decisions.
From Spinal Ependymoma to Superficial Siderosis: A Bottom to Top Cause of Progressive Neurological Deterioration
Authors: Valente Diana , Gil Inês , Nzwalo Hipólito , Felix Catarina
Published: August 2024

Superficial siderosis (SS) is an infrequent condition characterized by hemosiderin deposition in the central nervous system, resulting from chronic subarachnoid hemorrhage, often linked to dural mater diseases. Through a case report of a 50-year-old male with severe sensorineural hearing loss and newly diagnosed epilepsy, we explore SS triggered by a spinal ependymoma, diagnosed via resonance magnetic imaging (MRI). This case highlights the necessity of comprehensive neuroaxis imaging to identify treatable etiologies. The complexity of SS, with its varied clinical presentations, necessitates early detection and a multidisciplinary treatment approach. Despite limited treatment options and the uncertain efficacy of therapies like deferiprone, early intervention is crucial for mitigating irreversible neurological damage and enhancing patient prognosis.
Shaping infrastructural futures: The International Telecommunication Union’s visions for mobile communications and the anticipatory politics of 5G standardization
Authors: Hegarty Kieran , Wilken Rowan , Meese James , Middleton Catherine
Published: August 2024

This article shows how dominant actors inscribe certain ideas, visions, and predictions of infrastructural futures for international mobile telecommunications through standardization. It argues that standard setting is a key avenue that brings different (and sometimes divergent) interests, groups, concerns, and activities into alignment around a certain vision of social and technological progress. To demonstrate this, two key stages in the 5G standardization process were examined. First, we explored the path to the release of IMT-2020—the standard for 5G networks, devices, and services released by the Radiocommunication Sector of the International Telecommunication Union. Through the standard setting process, two key visions of 5G—one “evolutionary”, the other “revolutionary”—became highly influential ideas of a future worth striving for. Second, we examined how one technical feature of the IMT-2020 standard—the capacity for network slicing—was realized through the work of partner organization the Third Generation Partnership Project (3GPP). In doing so, this article reveals the processes that define the infrastructural conditions that underpin international mobile telecommunications. It also draws attention to how standardization has the potential to redefine the parameters of mobile media and communication in significant ways.
What explains trust in online mental health therapy provision platforms? An online descriptive survey
Authors: Fomicheva Elizaveta , Jyrgalbek Jasmin , Mikhaylova Oxana
Published: August 2024

Background

Currently, there is an increased interest in providing mental health care through digital devices and services, and the demand for these services is growing.

Objective

In this study, we considered the phenomenon of trust in online consultations, and the factors affecting this trust, within a Russian context.

Methods

An online survey was conducted using Google Forms in May 2023 and the data were analyzed using SPSS. All the participants were students from Moscow universities aged from 18 to 35 years. The final sample consisted of 203 students, of which 154 (75.9%) were women, 44 (21.7%) were men, and five (2.5%) preferred not to specify their gender.

Results

We found that students had a high level of trust, which depended on personal factors, such as experience, socio-economic status, and age, and contextual factors, such as geographical and temporal independence, price of the session, availability of recommendations, popularity of the platform, and the level of technical equipment.
Hemodynamic evaluation of intracranial arteriovenous malformations: Pre- and post-treatment 2D phase-contrast MRI measurements
Authors: Correia de Verdier Maria , Ronne-Engström Elisabeth , Borota Ljubisa , Wikström Johan
Published: August 2024

Background

Hemodynamic changes are seen in the feeding arteries of arteriovenous malformations (AVMs). Phase-contrast MRI (PC-MRI) enables the acquisition of hemodynamic information from blood vessels. There is insufficient knowledge on which flow or velocity parameter best discriminates AVMs from healthy subjects.

Purpose

To evaluate PC-MRI-measured flow and velocity in feeding arteries of AVMs before and, when possible, also after treatment and to compare these measurements to corresponding measurements in healthy controls.

Materials and Methods

Highest flow (HF), lowest flow (LF), mean flow (MF), peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV) were measured in feeding arteries in patients with intracranial AVMs using 2D PC-MRI at 3 T. Measurements were compared to previously reported values in healthy individuals. Values in patients above the 95th percentile in the healthy cohort were categorized as pathological. Nidus volume was measured using 3D time-of-flight MR angiography.

Results

Ten patients with diagnosed AVMs were examined with PC-MRI. Among these, three patients also underwent follow-up PC-MRI after treatment. Pathological velocities (PSV, EDV, and MV) were seen in all five subjects with a nidus larger or equal to 5.7 cm3, whereas pathological flow values were not seen in all, that is, pathologic HF in three, pathologic LF in two, and pathologic MF in two. After treatment, there was a decrease in flow and velocity (all measured parameters). After treatment, velocities (PSV, EDV, and MV) were no longer abnormal compared to healthy controls.

Conclusion

Patients with a large AVM nidus show pathological velocities, but less consistent flow increases. Following treatment, velocities normalize.
Diversity in Visual Perception: How Cultural Variability in Face Processing Can Inform Policymakers
Authors: Blais Caroline , Fiset Daniel , Gingras Francis , Plouffe-Demers Marie-Pier , Charbonneau Isabelle
Published: August 2024

Psychology and behavioral sciences lack diversity in their participant samples. In visual perception, more specifically, common practice assumes that the processes studied are fundamental and universal. In contrast, cultural psychology has accumulated evidence of cultural variability in visual perception. In face processing, for instance, this cultural variability may sabotage intercultural relations. Policies aim to increase diversity in research, supporting cultural psychology, and to increase awareness among professional workforces, as well as the general population, concerning how cultural variability may influence their interpretation of another's behavior.
Birthing Parent Experiences of Postpartum at-Home Blood Pressure Monitoring Versus Office-Based Follow up After Diagnosis of Hypertensive Disorders of Pregnancy
Authors: Tully Kristin P. , Tharwani Sonum , Venkatesh Kartik K. , Lapat Laarni , Farahi Narges , Glover Angelica , Stuebe Alison M.
Published: August 2024

Hypertensive disorders of pregnancy are a leading cause of pregnancy-related morbidity and mortality. The primary objective of this study was to compare the frequency of documentation of postpartum blood pressure through remote blood pressure monitoring with text-message delivered reminders versus office-based follow-up 7–10 days postpartum. The secondary objective was to examine barriers and facilitators of both care strategies from the perspectives of individuals who experienced a hypertensive disorder of pregnancy. We conducted a randomized controlled trial at a tertiary care academic medical center in the southeastern US with 100 postpartum individuals (50 per arm) from 2018 to 2019. Among 100 trial participants, blood pressure follow-up within 7–10 days postpartum was higher albeit not statistically significant between postpartum individuals randomized to the remote assessment intervention versus office-based standard care (absolute risk difference 18.0%, 95% CI −0.1 to 36.1%, p = 0.06). Patient-reported facilitators for remote blood pressure monitoring were maternal convenience, clarity of instructions, and reassurance from the health assessments. These positive aspects occurred alongside barriers, which included constraints due to newborn needs and the realities of daily postpartum life.
HIV infection is associated with compromised tumor microenvironment adaptive immune reactivity in Hodgkin lymphoma
Authors: Chantziou Amanda , Brenna Cloe , Ioannidou Kalliopi , Chen Oliver Y. , Korkolopoulou Penelope , Antoniadou Anastasia , Psichogiou Mina , Papaioannou Maria , Tsirigotis Panagiotis , Foukas Periklis G. , de Leval Laurence , Petrovas Constantinos
Published: August 2024

The impact of HIV infection on the tumor microenvironment (TME) of classic Hodgkin lymphoma (cHL), one of the most common comorbidities after HIV infection, is not well understood. Here, we have used multiplexed immunofluorescence and spatial transcriptomic analysis to dissect the impact of viral infections (Epstein-Barr virus [EBV] and HIV/EBV) on cHL TME. HIV−EBV+ cHL TME was characterized by higher cell densities of CD8high T cells coexpressing inhibitory receptors (PD-1 and TIGIT), macrophage subsets, and an in situ inflammatory molecular profile associated with increased expression of T-cell receptor (TCR) and B-cell receptor cell signaling pathways than HIV−EBV− cHL TME. Compared with HIV−EBV+, HIV+EBV+ cHL TME was characterized by significantly less CD8high T cells coexpressing PD-1 and TIGIT, a profile concomitant with significantly increased cell densities of CD155high neoplastic cells. Significant downregulation of in situ TCR signaling and upregulation of extracellular matrix reorganization pathways were found in HIV+EBV+ cHL TME, in line with an altered topological organization of CXCL13 and heparan sulfate, an extracellular matrix glycosaminoglycan. Our data reveal the complexity of the cellular and molecular composition of cHL TME in the presence of viral infections, with possible implications for combinatorial immunotherapies. Furthermore, the data suggest specific molecular targets and pathways for further investigation that could improve our understanding of possible mechanistic links between HIV and lymphomagenesis.
Salivary polyreactive antibodies andHaemophilus influenzaeare associated with respiratory infection severity in young children with recurrent respiratory infections
Authors: Koenen Mischa H. , de Steenhuijsen Piters Wouter A.A. , de Jonge Marien I. , Langereis Jeroen D. , Nierkens Stefan , Chu Mei Ling J.N. , van der Woude Roosmarijn , de Vries Robert P. , Sanders Elisabeth A.M. , Bogaert Debby , van der Vries Erhard , Boes Marianne , Verhagen Lilly M.
Published: August 2024

Background

Recurrent respiratory tract infections (rRTIs) are a common reason for immunodiagnostic testing in children, which relies on serum antibody level measurements. However, because RTIs predominantly affect the respiratory mucosa, serum antibodies may inaccurately reflect local immune defences. We investigated antibody responses in saliva and their interplay with the respiratory microbiota in relation to RTI severity and burden in young children with rRTIs.

Methods

We conducted a prospective cohort study including 100 children aged <10 years with rRTIs, their family members and healthy healthcare professionals. Total and polyreactive antibody concentrations were determined in serum and saliva (ELISA); respiratory microbiota composition (16S rRNA sequencing) and respiratory viruses (quantitative PCR) were characterised in nasopharyngeal swabs. Proteomic analysis (Olink) was performed on saliva and serum samples. RTI symptoms were monitored with a daily mobile phone application and assessed using latent class analysis and negative binomial mixed models.

Results

Serum antibody levels were not associated with RTI severity. Strikingly, 28% of salivary antibodies and only 2% of serum antibodies displayed polyreactivity (p<0.001). Salivary polyreactive IgA was negatively associated with recurrent lower RTIs (adjusted OR 0.80, 95% CI 0.67–0.94) and detection of multiple respiratory viruses (adjusted OR 0.76, 95% CI 0.61–0.96).Haemophilus influenzaeabundance was positively associated with RTI symptom burden (regression coefficient 0.05, 95% CI 0.02–0.08).

Conclusion

These results highlight the importance of mucosal immunity in RTI severity and burden, and suggest that the level of salivary polyreactive IgA andH. influenzaeabundance may serve as indicators of infection severity and burden in young children with rRTIs.
Supplementary oxygen efficacy for chronic pulmonary disorders and exertion desaturation
Authors: Archontakis Barakakis Paraschos , Wolfe Adam , Schwartz Andrei , Hernandez Romero Gabriel J. , Gidwani Vipul , Chauhan Shaylika , Arizono Shinichi , Panos Ralph J. , Fortis Spyridon
Published: August 2024

Introduction

Exertion-induced desaturation (EID) is a common complication of numerous pulmonary disorders and often treated with supplementary oxygen during exertion. We performed a systematic review and meta-analysis of randomised clinical trials (RCTs) to evaluate the efficacy of supplementary oxygen for EID in pulmonary disorders.

Material and methods

Medline and Embase were systematically searched from July 2022 to June 2023 following PRISMA guidelines. RCTs that met predefined inclusion criteria were included. Means and standard deviations were extracted and standardised mean differences (SMDs), the difference in means between groups divided by the standard deviation, and 95% confidence intervals were calculated. Exercise capacity was the primary outcome; exercise dyspnoea, baseline dyspnoea and quality of life were secondary objectives. The immediate, post-rehabilitation, short-term and ambulatory effects of oxygen supplementation were evaluated.

Results

We included 15 studies in our analysis. Oxygen supplementation to treat adult EID had been investigated for COPD and idiopathic pulmonary fibrosis (IPF) only. Oxygen supplementation was superior to placebo for its immediate effect on exercise capacity for COPD (SMD 0.42, 95% CI 0.15–0.69, I2=3%) and IPF (SMD 0.41, 95% CI 0.08–0.75, I2=57%) and exercise dyspnoea for COPD (SMD −0.40, 95% CI −0.76–−0.04, I2=31%). Sensitivity analysis revealed similar results.

Conclusions

Our study revealed the efficacy of supplemental oxygen for EID and only a positive immediate effect on exercise capacity and dyspnoea, but no improvement in other short-term or long-term measures.
Advances in medical polyesters for vascular tissue engineering
Authors: Mi Chen-Hui , Qi Xin-Ya , Zhou Yan-Wen , Ding Yan-Wen , Wei Dai-Xu , Wang Yong
Published: August 2024

Blood vessels are highly dynamic and complex structures with a variety of physiological functions, including the transport of oxygen, nutrients, and metabolic wastes. Their normal functioning involves the close and coordinated cooperation of a variety of cells. However, adverse internal and external environmental factors can lead to vascular damage and the induction of various vascular diseases, including atherosclerosis and thrombosis. This can have serious consequences for patients, and there is an urgent need for innovative techniques to repair damaged blood vessels. Polyesters have been extensively researched and used in the treatment of vascular disease and repair of blood vessels due to their excellent mechanical properties, adjustable biodegradation time, and excellent biocompatibility. Given the high complexity of vascular tissues, it is still challenging to optimize the utilization of polyesters for repairing damaged blood vessels. Nevertheless, they have considerable potential for vascular tissue engineering in a range of applications. This summary reviews the physicochemical properties of polyhydroxyalkanoate (PHA), polycaprolactone (PCL), poly-lactic acid (PLA), and poly(lactide-co-glycolide) (PLGA), focusing on their unique applications in vascular tissue engineering. Polyesters can be prepared not only as 3D scaffolds to repair damage as an alternative to vascular grafts, but also in various forms such as microspheres, fibrous membranes, and nanoparticles to deliver drugs or bioactive ingredients to damaged vessels. Finally, it is anticipated that further developments in polyesters will occur in the near future, with the potential to facilitate the wider application of these materials in vascular tissue engineering.
Cardiopulmonary exercise testing in long covid shows the presence of dysautonomia or chronotropic incompetence independent of subjective exercise intolerance and fatigue
Authors: Mustonen Timo , Kanerva Mari , Luukkonen Ritva , Lantto Hanna , Uusitalo Arja , Piirilä Päivi
Published: August 2024

Background

After COVID-19 infection, 10–20% of patients suffer from varying symptoms lasting more than 12 weeks (Long COVID, LC). Exercise intolerance and fatigue are common in LC. The aim was to measure the maximal exercise capacity of the LC patients with these symptoms and to analyze whether this capacity was related to heart rate (HR) responses at rest and during exercise and recovery, to find out possible sympathetic overactivity, dysautonomia or chronotropic incompetence.

Methods

Cardiopulmonary exercise test was conducted on 101 LC patients, who were admitted to exercise testing. The majority of them (86%) had been treated at home during their acute COVID-19 infection. Peak oxygen uptake (VO2peak), maximal power during the last 4 min of exercise (Wlast4), HRs, and other exercise test variables were compared between those with or without subjective exercise intolerance, fatigue, or both.

Results

The measurements were performed in mean 12.7 months (SD 5.75) after COVID-19 infection in patients with exercise intolerance (group EI, 19 patients), fatigue (group F, 31 patients), their combination (group EI + F, 37 patients), or neither (group N, 14 patients). Exercise capacity was, in the mean, normal in all symptom groups and did not significantly differ among them. HRs were higher in group EI + F than in group N at maximum exercise (169/min vs. 158/min, p = 0.034) and 10 min after exercise (104/min vs. 87/min, p = 0.028). Independent of symptoms, 12 patients filled the criteria of dysautonomia associated with slightly decreased Wlast4 (73% vs. 91% of sex, age, height, and weight-based reference values p = 0.017) and 13 filled the criteria of chronotropic incompetence with the lowest Wlast4 (63% vs. 93%, p < 0.001), VO2peak (70% vs. 94%, p < 0.001), the lowest increase of systolic blood pressure (50 mmHg vs. 67 mmHg, p = 0.001), and the greatest prevalence of slight ECG-findings (p = 0.017) compared to patients without these features. The highest prevalence of chronotropic incompetence was seen in the group N (p = 0.022).

Conclusions

This study on LC patients with different symptoms showed that cardiopulmonary exercise capacity was in mean normal, with increased sympathetic activity in most patients. However, we identified subgroups with dysautonomia or chronotropic incompetence with a lowered exercise capacity as measured by Wlast4 or VO2peak. Subjective exercise intolerance and fatigue poorly foresaw the level of exercise capacity. The results could be used to plan the rehabilitation from LC and for selection of the patients suitable for it.
The Leicester, Leicestershire and Rutland quality improvement project and integrated chronic kidney disease system: implementation within a primary care network
Authors: Rizvi Fahad , Lakhani Niraj , Omuri Lydia , Roshan Simran , Kapasi Tariq , White Samuel J. , Wilson Philippe B.
Published: August 2024

Background

The optimisation of patients in primary care is a prime opportunity to manage patient care within the community and reduce the burden of referrals on secondary care. This paper presents a quality improvement clinical programme taking place within an NHS Primary Care Network as part of the wider Leicester Leicestershire Rutland integrated chronic kidney disease programme.

Method

Patients are optimised to guidelines from the National Institute for Health and Care Excellence, by a primary care clinical team who are supported by nephrology consultants and nephrology pharmacists. Multidisciplinary team meetings take place with secondary care specialists and primary care staff. Learning is passed to the community clinicians for better patient treatment locally.

Results

A total of 526 patients were reviewed under this project.The total number of referrals to secondary care which were discharged following first outpatient appointment, reduced from 42.9% to 10%. This reduction of 32.9% represents the optimisation of patient cases through this quality improvement project. Patients can be optimised and managed within the community, reducing the number of unnecessary referrals to secondary care.

Conclusion

This programme has the potential to offer significant improvement in patient outcomes when expanded to a larger patient base. Medicine management and the use of clinical staff are optimised in both primary and secondary care.
Longitudinal associations between exclusive, dual and polytobacco use and respiratory illness among youth
Authors: Zavala-Arciniega Luis , Cook Steven , Hirschtick Jana L. , Xie Yanmei , Mukerjee Richa , Arenberg Douglas , Barnes Geoffrey D. , Levy David T. , Meza Rafael , Fleischer Nancy L.
Published: August 2024

Background

The health consequences of polytobacco use are not well understood. We evaluated prospective associations between exclusive, dual, and polytobacco use and diagnosed bronchitis, pneumonia, or chronic cough among US youth.

Methods

Data came from Waves 1–5 of the Population Assessment of Tobacco and Health Study. We categorized time-varying past 30-day tobacco use into seven categories: (1) non-current use; exclusive use of 2) cigarettes, 3) e-cigarettes, and 4) other combustible products (OC; pipes, hookah, and cigars); dual use of 5) e-cigarettes + cigarettes or e-cigarettes + OC, and 6) cigarettes + OC; and 7) polyuse of all three products. The outcome was parent-reported diagnosis of bronchitis, pneumonia, or chronic cough among youth. We conducted weighted multilevel Poisson models (person n = 17,517, 43,290 observations) to examine the longitudinal exposure-outcome relationship, adjusting for covariates: sex, age, race and ethnicity, parental education, body mass index, secondhand smoke exposure, and household use of combustible products.

Results

Compared to nonuse, exclusive cigarette use (Risk Ratio (RR) = 1.83, 95% CI 1.25–2.68), exclusive e-cigarette use (RR = 1.53, 95% CI 1.08–2.15), combustible product + e-cigarette dual use (RR = 1.90, 95% CI 1.18–3.04), cigarettes + OC dual use (RR = 1.96, 95% CI 1.11–3.48), and polytobacco use (RR = 3.06 95% CI 1.67–5.63) were associated with a higher risk of bronchitis, pneumonia, or chronic cough. In additional analyses, we found that the risk ratio for polytobacco use was higher compared to exclusive e-cigarette use (RR 2.01 CI 95% 1.02–3.95), but not higher compared to exclusive cigarette use (RR 1.67 CI 95% 0.85–3.28).

Conclusion

We found that exclusive, dual, and poly tobacco use were all associated with higher risk of bronchitis, pneumonia, or chronic cough compared to non-current use.
Preventive effects of probiotics on dental caries in vitro and in vivo
Authors: Zhang Jingyan , Wang Qian , Duan Zhi
Published: August 2024

Background

Dental caries is a common disease in the oral cavity, and the microorganisms in the cavity are colonized in the form of dental plaque biofilm. Streptococcus mutans is the main pathogen causing dental caries. Using probiotics to inhibit the growth and colonization of pathogenic bacteria, regulate mucosal immunity and improve oral microecological balance is an effective way to prevent or treat dental caries. The aim of this study was to evaluate the caries-prevention of probiotics in vitro and in rat caries models.

Methods

The probiotics used in this study are a combination of 4 strains of bacteria. After the fermentation of 4 strains (L. plantarum, L. salivarius, L. rhamnosus, and L. paracasei) was completed, they were mixed in equal volume proportions and used as samples to be tested. The mixture was then assessed the ability to inhibit the growth of S. mutans in vitro and in vivo. SPSS Statistics 22.0 (SPSS, Inc., Chicago, IL, USA) was used for analysis.

Results

In vitro the probiotics mixture could inhibit the growth of S. mutans and was able to remove biofilms formed by S. mutans. In a 42-day in vivo experiment, the probiotics group significantly reduced the level of S. mutans on the tooth surface of rats, reducing more than half the bacterial quantities compared with the caries model group (P < 0.05). The amount of S. mutans in the antagonist group was low and highly significant compared with the caries model group. Moreover, the mixture of 4 strains significantly reduced the caries scores (modified Keyes scoring method) in both the probiotic and antagonist groups (p < 0.05).

Conclusions

The study showed that the combination of the four strains can reduce the cavity scores, and the four strains can be used as products in oral care products. At the same time, the study also suggests that probiotic therapy can be an effective way to prevent dental caries.
Medical students’ experience and learning outcomes of overseas community involvement project: a qualitative study
Authors: Nadarajan Gayathri Devi , Rasappan Kumaran , Ng Jonathan Shen You , Junchen Melvin Lim , Yoon Sungwon
Published: August 2024

Background

Medical students in Singapore engage in short term medical missions, locally known as Overseas Community Involvement Projects (OCIPs). Little is known about the learning outcomes of an OCIP and how this complements their medical education back home. Understanding this can help the medical educators structure the OCIP to optimise its learning value.

Objectives

This study aims to gain an in-depth understanding of the experiences and learning outcomes of the medical students who participated in the OCIP.

Methods

This was a qualitative study involving Singaporean students from one medical school travelling to Nepal. Data was collected from reflective journals, overall group reflections and two focus group discussions. The data was thematically analysed using the Accreditation Council for Graduate Medical (ACGME) core competencies for medical professionals.

Results

The data could be classified under various themes within the six domains of the ACGME framework. The study revealed themes of: humanism, socioeconomic and cultural determinants of health under the domain of patient care, application of medical knowledge, investigating and evaluating the needs of a population and feedback to drive improvement under the domain of practice-based learning and improvement, use of non-verbal cues and communicating across language barriers under the domain of interpersonal and communication skills, healthcare systems and delivery, resourcefulness and adaptability, health equity and accessibility under the domain of systems-based practice, ethics, role-modelling, teamwork and leadership skills, interprofessional skills and resilience under the domain of professionalism. Understanding the students’ motivations, utilising reflections, and following the patients’ journey facilitated attainment of these outcomes.

Conclusions

This OCIP experience translated to learning outcomes aligned with the ACGME framework. There is great potential for the experiential learning from a well-structured OCIP to help with personal and professional development and global health education.
Sildenafil-induced priapism in a dog : an unusual case report
Authors: Nam Hyo-Seung , Oh Ye-In
Published: August 2024

Background

Priapism is defined as erection that lasts for more than 4 h without sexual stimulation. There are various causes of priapism, but there are no reports of sildenafil-induced priapism in dogs. In human medicine, there were no pre-marketing reports of priapism caused by sildenafil, but post-marketing surveillance has shown that it is rare. In cases of pulmonary hypertension in dogs, sildenafil is the first-line drug of choice for symptomatic relief.

Case presentation

An 11-year-old neutered male Maltese dog that presented with tachypnea and cough was diagnosed with myxomatous mitral valve disease, American College of Veterinary Internal Medicine (ACVIM) stage C, and was treated medically. Eighteen months after the diagnosis, severe pulmonary hypertension occurred due to left heart disease. At 20 months postdiagnosis, pleural effusion occurred, and sildenafil (2 mg/kg twice daily) was added to the existing treatment. Two weeks later, the dyspnea recurred, confirming pleural fluid recurrence, and sildenafil was increased to 2 mg/kg thrice daily. One day later, the patient developed persistent erections and penile pain. Penile amputation and urethrostomy were recommended but were refused; therefore, analgesia and palliative care were provided. The patient died of acute dyspnea 22 months after the first presentation, with no specific priapism recurrence at the time of death.

Conclusion

To the best of our knowledge, this is the first report of sildenafil-induced priapism in a dog with pulmonary hypertension.
Bimetallic MOF-based electrochemical sensor for determination of paracetamol in spiked human plasma
Authors: Mouhamed Aya A. , Nadim Ahmed H. , Mahmoud Amr M. , Mostafa Nadia M. , Eltanany Basma M.
Published: August 2024

Metal-organic frameworks (MOFs) with their exceptional properties have the potential to revolutionize the field of electrochemistry and pave the way for new and exciting applications. MOFs is an excellent choice as an active electrocatalyst component in the fabrication of electrochemical sensors. Here, bimetallic NiCo-MOFs, monometallic Ni-MOFs, and Co-MOFs were fabricated to modify the carbon paste electrode. Moreover, the ratio between Co and Ni within the bimetallic MOFs was optimized. Our aim in this work is to synthesize different compositions from bimetallic MOFs and systematically compare their catalytic activity with mono-metallic MOFs on paracetamol. The structure and properties of the 2D NiCo-MOFs were characterized by scanning electron microscope, X-ray photoelectron spectroscopy, Fourier transform infrared, and electrochemical method. Bimetallic Ni0.75Co0.25-MOFs modified carbon paste sensor displayed the optimum sensing performance for the electrochemical detection of paracetamol. A linear response over the range 6.00 × 10− 7 to 1.00 × 10− 4 M with a detection limit of 2.10 × 10− 8 M was obtained. The proposed method was applied to detect paracetamol in spiked human plasma and to determine paracetamol in the presence of its major toxic impurity, p-aminophenol. These findings suggest the considerable potential use of the newly developed sensor as a point-of-care tool for detecting paracetamol and p-aminophenol in the future.