bluuebunny/crossref_metadata_2025 huggingface dataset:
The Los Angeles motor scale (LAMS) and ASPECTS score are independently associated with DSA ASITN collateral score
Authors: Wang Richard , Lakhani Dhairya A , Balar Aneri B , Sepehri Sadra , Hyson Nathan , Luna Licia P , Cho Andrew , Hillis Argye E , Koneru Manisha , Hoseinyazdi Meisam , Lu Hanzhang , Mei Janet , Xu Risheng , Nabi Mehreen , Mazumdar Ishan , Urrutia Victor C , Chen Kevin , Huang Judy , Nael Kambiz , Yedavalli Vivek S
Published: October 2024

Background

Mechanical thrombectomy (MT) is the treatment standard in eligible patients with acute ischemic stroke (AIS) secondary to large vessel occlusions (LVO). Studies have shown that good collateral status is a strong predictor of MT efficacy, thus making collateral status important to quickly assess. The Los Angeles Motor Scale is a clinically validated tool for identifying LVO in the field. The aim of this study is to investigate whether admission LAMS score is also associated with the American Society of Interventional and Therapeutic Neuroradiology (ASITN) collateral score on digital subtraction angiography (DSA).

Methods

We conducted a retrospective multicenter cohort study of consecutive patients presenting with AIS caused by LVO from 9/1/2017 to 10/1/2023 with diagnostically adequate DSA imaging. Demographic, clinical, and imaging data was collected through manual chart review. Both univariate and multivariate analysis were applied to assess associations. A p-value <0.05 was considered significant.

Results

A total of 308 patients (median age: 68, IQR: 57.5–77) were included in the study. On multivariate logistic regression analysis, we found that lower admission LAMS score (adjusted OR: 0.82, 95% CI: 0.68–0.98, p < 0.05) and higher ASPECTS score (adjusted OR: 1.21, 95% CI: 1.02–1.42, p < 0.05) were independently associated with good DSA ASITN collateral score of 3-4.

Conclusions

Admission LAMS and ASPECTS score are both independently associated with DSA ASITN collateral score. This demonstrates the capability of LAMS to act as a surrogate marker of CS in the field.
Practical Qualitative Data Analysis for Public Health Research: A Guide to a Team-Based Approach With Flexible Coding
Authors: Michelen Melina , Phan Madeleine , Zimmer Arianna , Coury Natalie , Morey Brittany , Montiel Hernandez Gloria , Cantero Patricia , Zarate Salvador , Foo Mary Anne , Tanjasiri Sora , Billimek John , LeBrón Alana M.W.
Published: October 2024

Qualitative research is important to advance health equity as it offers nuanced insights into structural determinants of health inequities, amplifies the voices of communities directly affected by health inequities, and informs community-based interventions. The scale and frequency of public health crises have accelerated in recent years (e.g., pandemic, environmental disasters, climate change). The field of public health research and practice would benefit from timely and time-sensitive qualitative inquiries for which a practical approach to qualitative data analysis (QDA) is needed. One useful QDA approach stemming from sociology is flexible coding. We discuss our practical experience with a team-based approach using flexible coding for qualitative data analysis in public health, illustrating how this process can be applied to address multiple research questions simultaneously or asynchronously. We share lessons from this case study, while acknowledging that flexible coding has broader applicability across disciplines. Flexible coding provides an approachable step-by-step process that enables collaboration among coders of varying levels of experience to analyze large datasets. It also serves as a valuable training tool for novice coders, something urgently needed in public health. The structuring enabled through flexible coding allows for prioritizing urgent research questions, while preparing large datasets to be revisited many times, facilitating secondary analysis. We further discuss the benefit of flexible coding for increasing the reliability of results through active engagement with the data and the production of multiple analytical outputs.
Hemoperitoneum Due to Dissection and Rupture of the Superior Mesenteric Artery in a Patient With COL3A1 Mutation
Authors: Tironi Fabio , Lakmali Wijesinghe , Herath Jayantha
Published: October 2024

Introduction: Vascular Ehlers-Danlos syndrome (vEDS) is an autosomal dominant disorder that results from mutations in the collagen type III gene. It is a risk factor for medium-sized artery aneurysms, dissections, and ruptures. We report a case of hemoperitoneum due to medial dissection and rupture of the superior mesenteric artery related to vEDS. Methods: A full body CT scan and full three cavity autopsy was performed in a 47-year-old man with a history of an intermittent abdominal cramping for one week rand complex past medical history that included a sigmoid bowel perforation at age 20, and previous popliteal artery pseudoaneurysm rupture. Histology and genetic testing were performed. Results: The postmortem computed tomography and autopsy showed a significant hemoperitoneum due to a ruptured dissection of the superior mesenteric artery and branches, and multiple splanchnic artery dissections with renal and small bowel infarctions. Genetic testing revealed a heterozygous COL3A1 gene variant associated with Ehlers-Danlos syndrome. Death was attributed to hemoperitoneum due to medial dissection and rupture of the superior mesenteric artery due to arteriopathy. Discussion: The relatively young age and medical history correlate with the autopsy findings and genetic testing towards the conclusion of an arteriopathy consistent with vEDS.
Technology acceptance of the video game-based swallowing function training system among healthcare providers and dysphagia patients: A qualitative study
Authors: Zhang Bohan , Ding Ping , Hui Vivian , Wong Ka Po , Liu Yue , Liu Zihan , Xiao Qian , Qin Jing
Published: October 2024

Objective

Dysphagia is highly prevalent worldwide, causing serious complications. Video-game based rehabilitation training can increase dysphagia patient motivation and adherence. However, the acceptance of video game systems by patients and healthcare providers is still not fully explored. This study aimed to explore the acceptance of the video game swallowing training system among potential users.

Methods

The in-depth interviews were conducted face-to-face between July and October 2023 at a rehabilitation center in China, with a sample size based on the principle of information saturation. Interviews were audio-recorded and transcribed verbatim, and the data were analyzed using theory-driven thematic analysis methods based on the technology acceptance model.

Results

A total of 19 participants participated in the interviews, which included 11 hospitalized dysphagia patients, three rehabilitation therapists, one doctor, and four nurses. Three themes and seven subthemes were identified. Sufficient training content, interesting interaction between the game and the rehabilitation training, intuitive page design, and efficient training modes were related to the usefulness of the system; user-friendly page design and simple interface could make it easier for participants to use the system. Overall, the availability of the video game system for use without geographical or time limitations led to a high level of participant intention to use the system, but it is still challenging to use it in the real world.

Conclusions

The results of the study showed that participants were generally accepted and willing to use the video game system for dysphagia rehabilitation training. The video game-based swallowing function training system can be helpful in assisting with dysphagia rehabilitation.
Artificial neural network–based model for sleep quality prediction for frontline medical staff during major medical assistance
Authors: Chen Qingquan , Chen Zeshun , Zhu Xi , Zhuang Jiajing , Yao Ling , Zheng Huaxian , Li Jiaxin , Xia Tian , Lin Jiayi , Huang Jiewei , Zeng Yifu , Fan Chunmei , Fan Jimin , Song Duanhong , Zhang Yixiang
Published: October 2024

Background: The sleep quality of medical staff was severely affected during COVID-19, but the factors influencing the sleep quality of frontline staff involved in medical assistance remained unclear, and screening tools for their sleep quality were lacking. Methods: From June 25 to July 14, 2022, we conducted an Internet-based cross-sectional survey. The Pittsburgh Sleep Quality Index (PSQI), a self-designed general information questionnaire, and a questionnaire regarding the factors influencing sleep quality were combined to understand the sleep quality of frontline medical staff in Fujian Province supporting Shanghai in the past month. A chi-square test was used to compare participant characteristics, and multivariate unconditional logistic regression analysis was used to determine the predictors of sleep quality. Stratified sampling was used to divide the data into a training test set ( n = 1061, 80%) and an independent validation set ( n = 265, 20%). Six models were developed and validated using logistic regression, artificial neural network, gradient augmented tree, random forest, naive Bayes, and model decision tree. Results: A total of 1326 frontline medical staff were included in this survey, with a mean PSQI score of 11.354 ± 4.051. The prevalence of poor sleep quality was 80.8% ( n = 1072, PSQI >7). Six variables related to sleep quality were used as parameters in the prediction model, including type of work, professional job title, work shift, weight change, tea consumption during assistance, and basic diseases. The artificial neural network (ANN) model produced the best overall performance with area under the curve, accuracy, sensitivity, specificity, precision, F1 score, and kappa of 71.6%, 68.7%, 66.7%, 69.2%, 34.0%, 45.0%, and 26.2% respectively. Conclusions: In this study, the ANN model, which demonstrated excellent predictive efficiency, showed potential for application in monitoring the sleep quality of medical staff and provide some scientific guidance suggestions for early intervention.
Exploring sources of patient dissatisfaction in mobile health communication: A text analysis based on structural topic model
Authors: Liu Jingfang , Ding Peng , Jiang Huihong
Published: October 2024

Understanding online patient dissatisfaction is essential for improving the quality of healthcare services, patient satisfaction, and physician career development. This study is the first to apply the structural topic model to patient satisfaction research based on patient online reviews from a mobile health communication platform, revealing eight negative topics of patient concerns. These topics include under-explored areas such as “go to the hospital for check-ups,” “incomplete counseling,” and “language expression.” Additionally, we incorporated the doctor's title as a covariate in the model to examine how specific topics varied across different conditions. The results indicated that higher-titled doctors were more likely to receive complaints about the cost of treatment and whether the question was answered, whereas lower-titled doctors were more likely to receive complaints related to physician's knowledge, incomplete counseling, and response speed. This study not only enhances our understanding of mobile health services but also provides targeted insights for healthcare providers to improve their services, thereby contributing to the advancement of patient-centered care.
Learning Curve of Endoscopic Lumbar Discectomy – A Systematic Review and Meta-Analysis of Individual Participant and Aggregated Data
Authors: Koh Chan Hee , Booker James , Choi David , Khan Danyal Zaman , Layard Horsfall Hugo , Sayal Parag , Marcus Hani J , Prezerakos George
Published: October 2024

Study Design

A systematic review and meta-analysis of individual participant and aggregated data.

Objectives

To define the learning curves of endoscopic discectomies using unified statistical methodologies.

Methods

Searches returned 913 records, with 118 full-text articles screened. Studies of endoscopic lumbar spine surgery reporting outcomes by case order were included. Mixed-effects nonlinear, logistic, and beta meta-regressions prdwere conducted to define the learning curves.

Results

13 studies involving 864 patients among 15 surgeons were included in total. For transforaminal endoscopic discectomy, the estimated operating time for the first case was 95 min [CI: 87-104], and the estimated plateau was 66 minutes [CI: 51-81]. An estimated 21 cases [CI: 18-25] were required to overcome 80% of this deficit, but near-plateau performance was expected only after 59 cases [CI: 51-70]. The estimated risk of surgical complications on the first case was 25% [CI: 11%-46%], with an 80% reduction in relative risk requiring an estimated 41 cases. The expected postoperative VAS leg pain score after the first case was 2.7 [CI: 1.8-3.8], with an 80% improvement requiring an estimated 96 cases. Similar numbers were required to overcome the learning curves in interlaminar and biportal endoscopic discectomies.

Conclusions

Approximately 60 cases are required to achieve proficiency in endoscopic lumbar spine surgery, although the greatest part of the learning curve can be overcome with 20 cases. This should be considered when designing implementation programmes for surgeons and service providers that wish to incorporate endoscopic spinal surgery into their practice.
FOUNTAIN: a modular research platform for integrated real-world evidence generation
Authors: Oberprieler Nikolaus G. , Pladevall-Vila Manel , Johannes Catherine , Layton J. Bradley , Golozar Asieh , Lavallee Martin , Liu Fangfang , Kubin Maria , Vizcaya David
Published: October 2024

Background

Real-world evidence (RWE) plays a key role in regulatory and healthcare decision-making, but the potentially fragmentated nature of generated evidence may limit its utility for clinical decision-making. Heterogeneity and a lack of reproducibility in RWE resulting from inconsistent application of methodologies across data sources should be minimized through harmonization.

Methods

This paper’s aim is to describe and reflect upon a multidisciplinary research platform (FOUNTAIN; FinerenOne mUlti-database NeTwork for evidence generAtIoN) with coordinated studies using diverse RWE generation approaches and explore the platform’s strengths and limitations. With guidance from an executive advisory committee of multidisciplinary experts and patient representatives, the goal of the FOUNTAIN platform is to harmonize RWE generation across a portfolio of research projects, including research partner collaborations and a common data model (CDM)–based program. FOUNTAIN’s overarching objectives as a research platform are to establish long-term collaborations among pharmacoepidemiology research partners and experts and to integrate diverse approaches for RWE generation, including global protocol execution by research partners in local data sources and common protocol execution in multiple data sources through federated data networks, while ensuring harmonization of medical definitions, methodology, and reproducible artifacts across all studies. Specifically, the aim of the multiple studies run within the frame of FOUNTAIN is to provide insight into the real-world utilization, effectiveness, and safety of finerenone across its life-cycle.

Results

Currently, the FOUNTAIN platform includes 9 research partner collaborations and 8 CDM-mapped data sources from 7 countries (United States, United Kingdom, China, Japan, The Netherlands, Spain, and Denmark). These databases and research partners were selected after a feasibility fit-for-purpose evaluation. Six multicountry, multidatabase, cohort studies are ongoing to describe patient populations, current standard of care, comorbidity profiles, healthcare resource use, and treatment effectiveness and safety in different patient populations with chronic kidney disease and type 2 diabetes. Strengths and potential limitations of FOUNTAIN are described in the context of valid RWE generation.

Conclusion

The establishment of the FOUNTAIN platform has allowed harmonized execution of multiple studies, promoting consistency both within individual studies that employ multiple data sources and across all studies run within the platform’s framework. FOUNTAIN presents a proposal to efficiently improve the consistency and generalizability of RWE on finerenone.
Association between different patterns of social participation and loneliness among the Chinese older people: is there a local-migrant gap?
Authors: Chen Rui , Liu Guangwen , Li Shixue , Kong Fanlei
Published: October 2024

Background

Little empirical evidences were provided on the disparity in the level of loneliness between the migrant older with children (MOC) and their local counterpart in China. This study aimed to explore the association between social participation and loneliness and verify whether there was a local-migrant difference in this association.

Methods

A total of 1332 older people (60 +) were included in this study with 656 MOC and 676 natives. Loneliness was assessed by the University of California Los Angeles Loneliness Scale with eight items (ULS-8). Social participation was evaluated by three kinds of social activities concerning sports activities, hobby activities and community resident interaction. Univariate analysis was conducted to compare the local-migrant disparity as well as the level of loneliness between different subgroups. Hierarchical multiple linear regression analysis was used to examine the proposed relationship and the moderating influence of migration status.

Results

The average ULS-8 scores were 11.73 ± 4.02 for local subjects and 12.82 ± 4.05 for MOC respectively, indicating a lower level of loneliness among local older people. Participating in hobby activities (β = -0.092, P = 0.003) and interacting with residents (β = -0.216, P = 0.001) more frequently were related to lower level of loneliness while participating in square dancing was related to higher level of loneliness (β = 0.087, P = 0.001). The negative relationships between hobby activities as well as resident interaction and loneliness were more profound in migrants than natives.

Conclusions

Only two types of social participation could help alleviate loneliness. More attention to older migrants’ loneliness and extending the scale and types of social activities were recommended for policymakers.
A preventive care approach for oral health in nursing homes: a qualitative study of healthcare workers’ experiences
Authors: Bellander Lisa , Angelini Eva , Andersson Pia , Hägglin Catharina , Wijk Helle
Published: October 2024

Background

Oral health problems are common among care-dependent older adults living in nursing homes. Developing strategies to prevent the deterioration of oral health is therefore crucial to avoid pain and tooth loss. A standardized work widely used in nursing homes in Sweden is the quality register Senior Alert (SA), which assesses age-related risks concerning e.g. pressure sores, falls, malnutrition and oral health. The oral health assessment is performed with the Revised Oral Assessment Guide-Jönköping (ROAG-J), which also includes planning and implementation of preventive oral care interventions with the goal of achieving good quality care. However, what facilitates and hinders healthcare workers in working with oral health in SA remains unexplored. The aim of this study was to describe healthcare workers’ experiences of assessing oral health with the ROAG-J, planning and performing preventive oral health care actions in accordance with SA in nursing homes.

Methods

Healthcare workers (n = 28) in nursing homes in two Swedish municipalities participated and data was collected through six focus group interviews. Reflexive thematic analysis was used to identify patterns of meaning in the data.

Results

Themes generated in the analysis were:

A structured process promotes communication and awareness and stresses the importance of oral health;

Oral care for frail older adults is challenging and triggers ethical dilemmas;

Unclear responsibilities, roles and routines in the organization put oral health at risk;

Differences in experience and competence among healthcare staff call for educational efforts.

Conclusions

The structured way of working increases staff awareness and prioritization of oral health in nursing homes. The main challenges for the healthcare workers were residents’ reluctance to participate in oral care activities and oral care being more complicated since most older adults today are dentate. Organizational challenges lay in creating good routines and clarifying staff roles and responsibilities, which will require continuous staff training and increased management involvement.
Navigating trust and health in India: the influence of social status and neighbourhood environment
Authors: Saha Shrestha
Published: October 2024

Background

The research on the relationship between interpersonal trust and health has primarily focused on Western contexts, with scarce attention in developing contexts. Addressing this gap, the study examines the association between interpersonal trust (both generalised and particularised) and health outcomes (self-rated health /SRH, and depression) among Indian adults, considering the moderating roles of social statuses (gender and caste) and macro-level factors like district-level income inequality.

Methods

The study draws on data from the World Health Organization's (WHO) Study on global AGEing and adult health (SAGE) Wave-1, collected between 2007 and 2010. This dataset provides a comprehensive overview of health outcomes, including self-rated health (SRH) and depression, socio-cultural status of adults aged 18 and above in India. Additionally, district-level data on income inequality, quantified through the Gini index, were incorporated to examine the influence of contextual socioeconomic influence on the trust-health relationship. Multilevel regression analysis with interaction effects with social statuses and income inequality at district was employed in the analysis to investigate the intricate relationship between interpersonal trust (both generalised and particularised) and health outcomes.

Results

The study reveals that while generalised trust does not directly influence depression or SRH, particularised trust acts as a protective factor for both health outcomes. Gender-specific interaction effect shows that generalised trust reduces depression among males and improves SRH among females. Notably, caste does not significantly moderate the trust-health relationship. High district-level income inequality, however, modifies these associations: generalised trust is associated with improved SRH in areas of high inequality, whereas particularised trust correlates with increased depression in these districts.

Conclusion

The findings highlight the complex dynamics between interpersonal trust, social status, and income inequality in shaping health outcomes in India. Generalised trust emerges as a potential buffer against the health-detrimental effects of income inequality, providing crucial insights for developing targeted health interventions. These results offer valuable guidance for global health policymakers and practitioners in effectively allocating development aid to enhance health outcomes, especially among the most marginalised groups.
Healthcare system navigation difficulties among informal caregivers of older adults: a logistic regression analysis of social capital, caregiving support and utilization factors
Authors: Kim Boah , Wister Andrew , Mitchell Barbara , Li Lun , Kadowaki Laura
Published: October 2024

Background

Informal caregivers of older adults play a vital role in improving the degree to which older adults access community and healthcare services in a seamless and timely manner. They are fulfilling important navigation and support roles for their older care recipients. However, there is still little knowledge of the most significant facilitators and barriers to effective and efficient system navigation among caregivers. This paper aims to fill these knowledge gaps through investigation of the key factors (i.e., social capital/cohesion, caregiving supports, and utilization factors) affecting navigation difficulties faced by informal caregivers of older adults.

Methods

The Behavioural-Ecological Framework of Healthcare Access and Navigation (BEAN) model is used to frame the study. Using the General Social Survey on Caregiving and Care Receiving 2018, we analyzed 2,733 informal caregivers whose primary care recipients were aged 65 or older. Hierarchical logistic regression was conducted to identify the relationship between system navigation difficulties among informal caregivers and four sequentially ordered blocks of predictors: (1) sociodemographic (2), social capital/cohesion (3), caregiving supports, and (4) healthcare demand.

Results

The fully adjusted model showed that the probability of reporting navigation difficulties was lower for caregivers with social capital/cohesion compared to those without social capital/cohesion. In comparison, the probability of reporting navigation difficulties was higher among caregivers with caregiving support and among caregivers whose care receivers use a higher amount of health service use. Several sociodemographic covariates were also identified.

Conclusion

Our findings support certain aspects of the BEAN model. This study extends our understanding of potential facilitators and barriers that informal caregivers of older adults face while navigating complex community and health systems. There is a need to implement coordinated schemes and health policies especially for older adults with mental/neurological issues to address the challenges of their caregivers given the specific vulnerability identified in this study. The need for further research using different approaches to examine the disproportionate impact of COVID-19 on caregivers’ system navigation experience is crucial.
Association between the non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) and cardiovascular outcomes in patients undergoing percutaneous coronary intervention: a retrospective study
Authors: Liu Jiuling , Oorloff Melysze Deanne , Nadella Adithya , Guo Ping , Ye Min , Wang Xiaoqing , Zhao Hang
Published: October 2024

Background

Dyslipidemia is prominently associated with adverse outcomes in patients with coronary artery disease (CAD). The non-high-density lipoprotein cholesterol to high-density lipoprotein cholesterol ratio (NHHR) is a novel comprehensive lipid index. However, limited evidence exists on the relationship of the NHHR with the risk of adverse outcomes in patients with CAD. This study aimed to explore the associations between the NHHR and adverse outcomes and identify the optimal NHHR ranges linked to the lowest adverse outcome risk in patients with CAD undergoing percutaneous coronary intervention (PCI).

Methods

Among 2253 patients with CAD undergoing PCI, 2251 with available total cholesterol and HDL-C levels were analyzed. Furthermore, all patients were classified into quintiles based on the NHHR. The primary outcome was the incidence of MACCEs, comprising cardiac mortality, acute myocardial infarction, stroke, and repeat revascularization. Multivariable logistic regression analysis was used to assess the relationship between the NHHR and MACCEs. Moreover, restricted cubic spline (RCS) analysis was performed to quantify nonlinearity. Lastly, the consistency between these associations was confirmed by conducting subgroup and interaction analyses.

Results

A total of 270 patients experienced MACCEs over a median follow-up of 29.8 months (interquartile range, 25.6–34 months). After adjustment for confounding variables, the adjusted ORs (95% CIs) of the patients in quintiles 2, 3, 4, and 5 were 0.79 (0.52–1.20), 0.64 (0.42–0.99), 1.00 (0.67–1.48), and 1.17 (0.74–1.64), respectively (reference group: quintile 1). Additionally, RCS analysis demonstrated a U-shaped relationship between the NHHR and MACCEs, with an inflection point at an NHHR of 3.119 using a two-piecewise regression model. This relationship was consistent across the various subgroups, while significant interactions were not observed in these associations.The ORs and 95% CIs to the left and right of the inflection point were 0.734 (0.551–0.978) and 1.231 (1.038–1.460), respectively.

Conclusions

This study reveals a U-shaped association between baseline NHHR and MACCE incidence in patients with CAD undergoing PCI.
Chronic stroke survivors underestimate their upper limb motor ability in a simple 2D motor task
Authors: Sporn Sebastian , Coll M. , Bestmann S. , Ward N. S.
Published: October 2024

Background

Stroke survivors can exhibit a mismatch between the actual motor ability of their affected upper limb and how much they use it in daily life. The resulting non-use of the affected upper limb has a negative impact on participation in neurorehabilitation and functional independence. The factors leading to non-use of the affected upper limb are poorly understood. One possibility is that non-use comes about through inappropriately low confidence in their own upper limb motor abilities.

Objective

We asked whether chronic stroke survivors underestimate the motor ability of their affected upper limb.

Methods

20 chronic stroke survivors (Mean FM: 28.2 ± 10.5) completed a 2D reaching task using an exoskeleton robot. Target sizes were individually altered to ensure success rates were similar for both upper limbs. Prior to each reaching movement, participants rated their confidence about successfully hitting the target (estimated upper limb motor ability).

Results

Confidence ratings were significantly lower for the affected upper limb (estimated ability), even though it was equally successful in the reaching task in comparison to the less affected upper limb (actual ability). Furthermore, confidence ratings did not correlate with level of impairment.

Conclusions

Our results demonstrate that chronic stroke survivors can underestimate the actual motor abilities of their affected upper limb, independent of impairment level. Low confidence in affected upper limb motor abilities should be considered as a therapeutic target to increase the incorporation of the affected upper limb into activities of daily living.
Metastatic prostate adenocarcinoma to the brain – a clinicopathologic analysis of 21 cases
Authors: Ajmal Namra , Deng Yutao , Kenyon Lawrence C. , Curtis Mark T. , Dispagna Mauro , Izes Joseph , Li Li
Published: October 2024

Background

Brain metastasis from prostate adenocarcinoma (PCa) is rare, often leading to death within a year. Its infrequent occurrence and atypical histopathologic features contribute to lower consideration in the differential diagnosis of tumor brain metastasis. This study aims to assess the clinical characteristics and distinctive histopathologic features of metastatic PCa in the brain for timely and enhanced diagnostic accuracy.

Design

A retrospective search spanning 20 years (2003–2022) was conducted on our archives and identified 21 cases diagnosed as “metastatic prostate adenocarcinoma (mPCa)” in brain biopsies and resections. All existing slides were thoroughly reviewed to evaluate the histopathology of the mPCa.

Result

The mean age at presentation for brain metastasis was 70 years. Of 21 cases, 5 were dural-based lesions, 16 were true intraparenchymal metastases, including 2 sellar/suprasellar masses, 3 frontal, 3 temporal, 3 occipital, 1 cerebellum, and 4 involving multiple brain lobes. The average interval between initial diagnosis and brain metastasis was 90.75 months. Notably, brain metastasis was the initial presentation for one patient, while another patient, initially diagnosed with prognostic grade group (GG) 2 PCa in 1/12 cores, presented with isolated brain metastasis two years later. Architecturally, tumor cells were arranged in sheets or nests in most cases; however, four cases showed histologic cribriform patterns, and five displayed papillary architecture. Cytohistology varied from uniform monomorphic to highly pleomorphic cells with prominent nucleoli (8/19) and high mitotic activity. Interestingly, 1 case showed small round blue cell morphology, another had focal areas of rhabdoid and spindle cell differentiation, and 6 had cytoplasmic clearing. Almost half of the cases (47%) showed necrosis.

Conclusion

mPCa to the brain can present with variable histomorphology. Therefore, consideration of mPCa in the differential diagnosis of metastatic brain lesions, even with non-suggestive imaging, is imperative in male patients with or without a history of primary disease. Accurate and prompt diagnosis is crucial, given the recent advancements in treatment that have improved survival rates.
The path to sustainable cardiac surgery in Rwanda: analysis of costs for consumables used during cardiac surgery for a non-governmental organization
Authors: Rando Hannah , Musoni Maurice , Greenwood Bonnie C. , Ingabire Lambert , Van Hook Sam , Bolman Ceeya Patton , Bolman R. Morton , Lin Yihan
Published: October 2024

Background

Until local healthcare infrastructure is strengthened, cardiac surgical care in low- and middle-income countries is often provided by non-governmental organizations by way of visiting healthcare teams. This is generally considered to be a cost-effective alternative to transporting patients to high income countries for surgical care, but the costs of cardiac surgery consumables under this model are poorly understood. Our objective was to identify the per-patient cost of cardiac surgery consumables used in single and double valve replacements performed by a non-governmental organization in Rwanda.

Methods

Financial data from 2020 were collected from Team Heart, a non-governmental organization that supports cardiac surgical care in Rwanda. A comprehensive list of consumables was generated, including surgical, perfusion, anesthesia, and inpatient supplies and medications. Acknowledging the variability in perioperative needs, the quantities of consumables were calculated from an average of six patients who underwent single or double-valve replacement in 2020. Total costs were calculated by multiplying purchasing price by average quantity per patient. Costs absorbed by the local hospital were excluded from the calculations.

Results

The total cost per patient was estimated at $9,450. Surgical supplies comprised the majority of costs ($6,140 per patient), with the most substantial cost being that of replacement valves ($3,500 per valve), followed by surgical supplies ($1,590 per patient).

Conclusions

This preliminary analysis identifies a cost of just over $9,000 per patient for consumables used in cardiac valve surgery in Rwanda, which is lower than the estimated costs of transporting patients to centers in high income countries. This work highlights the relative cost effectiveness of cardiac surgical care in low- and middle- income countries under this model and will be instrumental in guiding the allocation of local and international resources in the future.
Prevalence and correlates of disordered eating at a large state university before and after the onset of the COVID-19 pandemic
Authors: Pacanowski Carly R , Skubisz Christine , Borton David , Ryding Rachel
Published: October 2024

Background

Emerging adulthood is a transitory period in which disordered eating (DE) manifests; collecting data on the prevalence of DE among this population as well as demographic and behavioral correlates are important public health goals.

Methods

Data from an annual survey of undergraduate students at a large state university from 2019 to 2022 were analyzed, allowing researchers to compare prevalence and correlates before and after the onset of the COVID-19 pandemic using two brief screeners: the SCOFF and Eating Disorder Screener for Primary Care (ESP). We hypothesized that rates of DE would be greater after the onset of COVID-19 as compared to before. We also hypothesized that those identifying as women, reporting higher alcohol or drug use, and contemplating suicide would have greater odds of reporting symptoms consistent with DE.

Results

DE was significantly lower in pre-pandemic years compared to pandemic years: ESP pre = 38.01%(n = 704), pandemic = 48.79%(n = 645), p < 0.001; SCOFF pre = 22.82%(n = 422), pandemic = 31.46%(n = 414), p < 0.001. Logistic regressions showed women and students who contemplated suicide reported significantly greater DE, regardless of screener or time period. Inconsistent relationships were found between DE and current substance use.

Conclusion

These findings may inform targeted interventions for those most vulnerable to disordered eating.
Dynamic DeFi-G7 stock markets interactions and their potential role in diversifying and hedging strategies
Authors: Esparcia Carlos , Fakhfakh Tarek , Jareño Francisco , Ghorbel Achraf
Published: October 2024

This study examines the link between stocks and decentralized finance (DeFi) in terms of returns and volatility. Major G7 exchange-traded funds (ETFs) and various highly traded DeFi assets are considered to ensure the robustness of the empirical experiment. Specifically, this study applies the vector autoregression generalized autoregressive conditional heteroskedasticity (VAR-GARCH) model to examine the information transmission of these two markets on a two-way basis and the dynamic conditional correlation (DCC)-GARCH model to assess the bivariate correlation structure between each DeFi and ETF pair. The volatility spillover analysis proves a contagion effect occurred between different geographic markets, and even between markets of different natures and typologies, during the most turbulent moments of the COVID-19 crisis and the war in the Ukraine. Our results also reveal a weak positive correlation between most DeFi and ETF pairs and positive hedge ratios that approach unity during turbulent times. In addition, DeFi assets, except for the Bazaar (BZR) Protocol, can offer diversification gains when included in financial investment portfolios. These results are particularly relevant for portfolio managers and policy-makers when designing investment strategies, especially during periods of financial crisis.
Chronic periodontal disease is related with newly developing hypertension: a nationwide cohort study
Authors: Park Jung-Hyun , Kang Min Kyoung , Leem Gwang Hyun , Kim Jin-Woo , Song Tae-Jin
Published: October 2024

Background

Periodontal disease (PD) is a condition that can be treated and managed. This study aimed to determine if chronic PD status is associated with the risk of developing hypertension, utilizing data from the National Health Insurance Database of Korea.

Methods

Participants who received oral health examinations both in 2003 and in 2005–2006 were included. Those with a history of hypertension were excluded. Hypertension was defined as at least one outpatient or inpatient claim diagnosis (primary or secondary) of hypertension (International Classification of Diseases (ICD)-10 codes I10-I11) with prescription for antihypertensive medication or at least one incident of systolic blood pressure greater than 140 mmHg or diastolic blood pressure greater than 90 mmHg during a health examination. Changes of PD status was determined during two oral examinations. Study participants were divided into 4 groups according to the changes of PD status: PD-free (those consistently free of disease in both exams), PD-recovered (individuals with disease initially but not in the second exam), PD-developed (no disease initially, but present in the second exam), and PD-chronic (disease throughout both exams). The incidence of hypertension after the second oral health examination (index date) was monitored. Participants were observed from the index date until the earliest occurrence of hypertension onset, mortality, or December 2020.

Results

The study comprised 706,584 participants: 253,003(35.8%) in the PD-free group, 140,143(19.8%) in the PD-recovered group, 132,397(18.7%) in the PD-developed group, and 181,041(25.6%) in the PD-chronic group. Over a median follow-up duration of 14.3 years, 239,937 (34.0%) cases of hypertension were recorded. The PD-recovered group had a lower risk of hypertension compared to the PD-chronic group, while the PD-developed group had a higher risk of hypertension compared to the PD-free group.

Conclusion

Chronic PD is associated with an increased risk of developing hypertension. Although the increase in risk is modest, recovery from PD may have beneficial effects in reducing hypertension risk. Further studies are needed to confirm the importance of regular dental examinations and effective management of PD to reduce hypertension risk.
Real-world efficacy of fimasartan vs. other angiotensin receptor blockers in combination with calcium channel blockers: a nationwide cohort study
Authors: Lee Huijin , Park Chan Soon , Kim Bongseong , Rhee Tae-Min , Lee Heesun , Kim Yong-Jin , Han Kyungdo , Kim Hyung-Kwan
Published: October 2024

Background

The antihypertensive efficacy of fimasartan was assessed based on the transition rate from a combination of calcium channel blockers (CCB) and angiotensin receptor blockers (ARB) to three-drug combination therapy, as compared to other ARBs.

Methods

This nationwide cohort study used data obtained from the Korean National Health Insurance Service database. Patients who had received national health checkups within 2 years prior to January 1, 2017, and were concurrently prescribed ARBs and CCBs for > 30 days during the 6 months from January 1, 2017, to June 30, 2017 were included in the study. Patients were categorized into the ‘fimasartan group’ (those prescribed fimasartan) and the ‘non-fimasartan group’ (those prescribed ARBs other than fimasartan). The index date was set as the last day of a 30-day prescription period for ARBs and CCBs, with a subsequent 2.5-year follow-up to observe the potential addition of a third drug, such as beta-blockers or diuretics.

Results

The study included 34,422 patients with a mean age of 60.3 years and 58.3% being male. The fimasartan group constituted 2.7% (n = 928) of the total, and the non-fimasartan group, 97.3% (n = 33,494). During the follow-up period, 38 patients in the fimasartan group (14.3 per 1,000 person-years) and 3,557 patients in the non-fimasartan group (42.8 per 1,000 person-years) required additional antihypertensive medications. After multivariate adjustment for age, sex, diabetes mellitus, dyslipidemia, cancer, heart failure, systolic blood pressure, and diastolic blood pressure, the fimasartan group showed a significantly lower rate of adding a third medication (hazard ratio 2.68, 95% confidence interval 1.95–3.69) compared to that of the non-fimasartan group.

Conclusions

Fimasartan is associated with a lower need for additional antihypertensive drugs compared to other ARBs. This implies its greater effectiveness in hypertension management, potentially enhancing cardiovascular outcomes, and minimizing polypharmacy.
Who is affected by parental leave reforms? Women’s selection into different parental leave lengths across recent policy reforms in Germany
Authors: Bister Lara , Eibich Peter , Rutigliano Roberta
Published: October 2024

Public parental leave schemes aim to facilitate women’s reconciliation of family and employment after their transition into motherhood. While parental leave policies underwent several reforms over the past decades, adapting to changing female labour market participation and family cultures, the available entitlements are not tailored to women’s individual circumstances and needs. It remains unclear how these affect the women’s parental leave uptake, particularly the leave length. In this paper, we followed an exploratory and descriptive approach to study the selection of women into different parental leave lengths with changing public parental leave entitlements in Germany and according to their individual characteristics. We use data from the German Statutory Pension Fund on 29,001 women born between 1955 and 1984 who had their first child between 1991 and 2016 at the ages 20–39. We estimate linear regression and discrete-time proportional hazard models to examine associations between women’s characteristics and their length of leave. We identify the effects of two major parental leave reforms in Germany in 1992 and 2007 in a Regression Discontinuity Design. Our results show that the general extension of available parental leave entitlements in 1992 increased the likelihood of women’s parental leave uptake between 25 and 36 months. For women who became mothers at an older age, had a high income before transitioning into motherhood, or with higher education; however, the likelihood of parental leave uptake of 2 months increased. The reform of 2007 led to an increased likelihood of leave uptake longer than 2 months for these women. These findings suggest that women with a higher labour market attachment have responded more strongly to the changes in parental leave benefits in Germany.
Unveiling the dynamics of intraoperative contamination in total hip arthroplasty: the discrepancy between particulate and microbial contamination in surgical site infection risk
Authors: Tateiwa Toshiyuki , Masaoka Toshinori , Takahashi Yasuhito , Ishida Tsunehito , Shishido Takaaki , Yamamoto Kengo
Published: October 2024

Background

Surgical site infection (SSI) is a major problem following total hip arthroplasty (THA). This study investigated the impact of a standard intraoperative routine where the surgical team wears full-body exhaust suits (space suits) within a laminar airflow (LAF)-ventilated operating room (OR) on environmental contamination. Our primary objective was to identify potential modifiable intraoperative factors that could be better controlled to minimize SSI risk.

Methods

We implemented an approach involving simultaneous and continuous air sampling throughout actual primary cementless THA procedures. This method concurrently monitored both airborne particle and microbial contamination levels from the time the patient entered the OR for surgery until extubation.

Results

Airborne particulate and microbial contamination significantly increased during the first and second patient repositionings (postural changes) when the surgical team was not wearing space suits. However, their concentration exhibited inconsistent changes during the core surgical procedures, between incision and suturing, when the surgeons wore space suits. The microbial biosensor detected zero median microbes from draping to suturing. In contrast, the particle counter indicated a significant level of airborne particles during head resection and cup press-fitting, suggesting these procedures might generate more non-viable particles.

Conclusions

This study identified a significant portion of airborne particles during the core surgical procedures as non-viable, suggesting that monitoring solely for particle counts might not suffice to estimate SSI risk. Our findings strongly support the use of space suits for surgeons to minimize intraoperative microbial contamination within LAF-ventilated ORs. Therefore, minimizing unnecessary traffic and movement of unsterile personnel is crucial. Additionally, since our data suggest increased contamination during patient repositioning, effectively controlling contamination during the first postural change plays a key role in maintaining low microbial contamination levels throughout the surgery. The use of sterile gowns during this initial maneuver might further reduce SSIs. Further research is warranted to investigate the impact of sterile attire on SSIs.