bluuebunny/crossref_metadata_2025 huggingface dataset:
Gibraltar subduction zone is invading the Atlantic
Authors: Duarte João C. , Riel Nicolas , Rosas Filipe M. , Popov Anton , Schuler Christian , Kaus Boris J.P.
Published: February 2024

Subduction initiation is a cornerstone of the Wilson cycle. It marks the turning point in an ocean's lifetime, allowing its lithosphere to be recycled into the mantle. However, formation of new subduction zones in Atlantic-type oceans is challenging, given that it commonly involves the action of an external force, such as the slab pull from a nearby subduction zone, a far-field compression, or the impact of a plume. Notwithstanding, the Atlantic already has two subduction zones, the Lesser Antilles and the Scotia arcs. These subduction zones have been forced from the nearby Pacific subduction zones. The Gibraltar arc is another place where a subduction zone is invading the Atlantic. This corresponds to a direct migration of a subduction zone that developed in the closing Mediterranean Basin. Nevertheless, few authors consider the Gibraltar subduction to be still active because it has significantly slowed down in the past millions of years. Here, we use new gravity-driven geodynamic models that reproduce the evolution of the Western Mediterranean, show how the Gibraltar arc formed, and test if it is still active. The results suggest that the arc will propagate further into the Atlantic after a period of quiescence. The models also show how a subduction zone starting in a closing ocean (Ligurian Ocean) can migrate into a new opening ocean (Atlantic) through a narrow oceanic corridor. Subduction invasion is likely a common mechanism of subduction initiation in Atlantic-type oceans and a fundamental process in the recent geological evolution of Earth.
Rare encounter: facial vein thrombosis and thrombophlebitis as a complication of acute submandibular sialadenitis
Authors: Goebel Frieder , Knopf Katrin , Fiedler Lukas S
Published: February 2024

Thrombosis and thrombophlebitis of the facial vein represent exceptionally rare diagnoses, particularly when occurring as complications of acute sialadenitis of the submandibular gland. This case report details the experience of a middle-aged man initially presenting at a tertiary care ear, nose and throat department with right submandibular gland sialadenitis. Despite initiating outpatient treatment involving oral antibiotics and sialagogues, the patient returned after a week with persistent and worsening pain, accompanied by swelling of the right submandibular gland and cheek. Using ultrasound, the accurate diagnosis was promptly identified, revealing thrombosis in the facial vein.

The patient underwent a comprehensive treatment regimen involving anticoagulation and intravenous antibiotics. With a subsequent reduction in pain and swelling, the patient was discharged, continuing oral anticoagulation and antibiotics. Outpatient follow-up revealed a complete recovery 3 weeks later. This case underscores the importance of timely and precise diagnostic measures in managing rare complications associated with sialadenitis.
Association of non-alcoholic fatty liver disease with cardiovascular disease and all cause death in patients with type 2 diabetes mellitus: nationwide population based study
Authors: Kim Kyung-Soo , Hong Sangmo , Han Kyungdo , Park Cheol-Young
Published: February 2024

Objective

To investigate the risk of non-alcoholic fatty liver disease (NAFLD) for cardiovascular disease and all cause death in patients with type 2 diabetes mellitus (T2DM).

Design

Nationwide population based study.

Setting

Longitudinal cohort study in Korea.

Participants

7 796 763 participants in the National Health Screening Programme in 2009 were divided into three groups based on NAFLD status: no NAFLD (fatty liver index<30); grade 1 NAFLD (30≤fatty liver index<60); and grade 2 NAFLD (fatty liver index≥60). Median follow-up was 8.13 years.

Main outcome measures

The primary outcome was incident cardiovascular disease (myocardial infarction, ischaemic stroke) or all cause death.

Results

Of 7 796 763 participants, 6.49% (n=505 763) had T2DM. More patients with T2DM had grade 1 NAFLD (34.06%) and grade 2 NAFLD (26.73%) than those without T2DM (grade 1 NAFLD: 21.20%; grade 2 NAFLD: 10.02%). The incidence rate (per 1000 person years) of cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD, and the incidence rates in patients with T2DM were higher than those in patients without T2DM. The five year absolute risk for cardiovascular disease and all cause death increased in the order of no NAFLD, grade 1 NAFLD, and grade 2 NAFLD in patients without and with T2DM (no NAFLD, without T2DM: 1.03, 95% confidence interval 1.02 to 1.04, and 1.25, 1.24 to 1.26, respectively; grade 1 NAFLD, without T2DM: 1.23, 1.22 to 1.25, and 1.50, 1.48 to 1.51, respectively; grade 2 NAFLD, without T2DM: 1.42, 1.40 to 1.45, and 2.09, 2.06 to 2.12, respectively; no NAFLD, with T2DM: 3.34, 3.27 to 3.41, and 3.68, 3.61 to 3.74, respectively; grade 1 NAFLD, with T2DM: 3.94, 3.87 to 4.02, and 4.25, 4.18 to 4.33, respectively; grade 2 NAFLD, with T2DM: 4.66, 4.54 to 4.78, and 5.91, 5.78 to 6.05, respectively). Patients with T2DM and without NAFLD had a higher five year absolute risk for cardiovascular disease and all cause death than those without T2DM and with grade 2 NAFLD. Risk differences for cardiovascular disease and all cause death between no NAFLD and grade 1 or grade 2 NAFLD were higher in patients with T2DM than in those without T2DM.

Conclusions

NAFLD in patients with T2DM seems to be associated with a higher risk of cardiovascular disease and all cause death, even in patients with mild NAFLD. Risk differences for cardiovascular disease and all cause death between the no NAFLD group and the grade 1 or grade 2 NAFLD groups were higher in patients with T2DM than in those without T2DM.
Non-pharmacological therapies for pain management in paediatric intensive care units: a protocol for a scoping review
Authors: Alencar Isabele Gouveia Muniz de , Dantas Joyce Karolayne dos Santos , Matias de Araújo Sara Cristina , Fernandes Thatiane Evelyn de Lima , de Araújo Pedro Lucas Oliveira , da Costa Alex Batista , Takahashi Juliana A , Oliveira Jonas Sâmi Albuquerque de
Published: February 2024

Introduction

In critically ill children, pain management is complex owing to cognitive development and the nature of hospitalisation in paediatric intensive therapy units. Although there are many protocols and guidelines for pain control via pharmacological interventions, non-pharmacological practices should also be explored and disseminated for their potential benefit.

Methods and analysis

A systematic literature search will be performed using the following databases: Academic Search Premier, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Excerpta Medica Database, Virtual Health Library, Medical Literature Analysis and Retrieval System Online, ScienceDirect, Scopus, Web of Science Core Collection, Theses fromCoordenação de Aperfeiçoamento de Pessoal de Nível Superior, Dart Europe, Open Access Theses and Dissertations and grey literature from Google Scholar. The research will consider quantitative and qualitative studies, mixed-method studies, systematic reviews, text articles, opinion articles, letters to editors and editorials in any language and from any database. The following will be eligible for inclusion: (1) newborns, infants, children and adolescents; and (2) non-pharmacological therapies used for pain in paediatric intensive care.

Ethics and dissemination

This study does not require ethical approval. The results of this research will be disseminated through social media channels and podcasts about pain in children.

Trial registration number

This protocol has been registered with the Open Science Framework (DOI 10.17605/OSF.IO/DZHKT).
Non-communicable disease care in Sierra Leone: a mixed-methods study of the drivers and barriers to retention in care for hypertension
Authors: Dibba Yusupha , Kachimanga Chiyembekezo , Gassimu Joseph , Kulinkina Alexandra V , Bukhman Gene , Gilbert Hannah N , Adler Alma J , Mukherjee Joia S
Published: February 2024

Objective

To retrospectively analyse routinely collected data on the drivers and barriers to retention in chronic care for patients with hypertension in the Kono District of Sierra Leone.

Design

Convergent mixed-methods study.

Setting

Koidu Government Hospital, a secondary-level hospital in Kono District.

Participants

We conducted a descriptive analysis of key variables for 1628 patients with hypertension attending the non-communicable disease (NCD) clinic between February 2018 and August 2019 and qualitative interviews with 21 patients and 7 staff to assess factors shaping patients’ retention in care at the clinic.

Outcomes

Three mutually exclusive outcomes were defined for the study period: adherence to the treatment protocol (attending >80% of scheduled visits); loss-to-follow-up (LTFU) (consecutive 6 months of missed appointments) and engaged in (but not fully adherent) with treatment (<80% attendance).

Results

57% of patients were adherent, 20% were engaged in treatment and 22% were LTFU. At enrolment, in the unadjusted variables, patients with higher systolic and diastolic blood pressures had better adherence than those with lower blood pressures (OR 1.005, 95% CI 1.002 to 1.009, p=0.004 and OR 1.008, 95% CI 1.004 to 1.012, p<0.001, respectively). After adjustment, there were 14% lower odds of adherence to appointments associated with a 1 month increase in duration in care (OR 0.862, 95% CI 0.801 to 0.927, p<0.001). Qualitative findings highlighted the following drivers for retention in care: high-quality education sessions, free medications and good interpersonal interactions. Challenges to seeking care included long wait times, transport costs and misunderstanding of the long-term requirement for hypertension care.

Conclusion

Free medications, high-quality services and health education may be effective ways of helping NCD patients stay engaged in care. Facility and socioeconomic factors can pose challenges to retention in care.
Impact of intraosseous regional administration of tranexamic acid in total knee arthroplasty on perioperative blood loss: a protocol for a randomised controlled trial
Authors: Wei Zhanqi , Yu Muyang , Xu Yiming , Weng Xisheng , Feng Bin
Published: February 2024

Introduction

Total knee arthroplasty (TKA) is a common surgical intervention to treat joint diseases. However, TKA is associated with significant blood loss. Tranexamic acid (TXA) has been used to reduce perioperative bleeding and postoperative blood transfusion. This study aims to explore the effectiveness and safety of intraosseous regional administration (IORA) of TXA in TKA and compare differences in perioperative blood loss between IORA of TXA, intravenous infusion of TXA, and combined IORA and intravenous infusion of TXA.

Methods and analysis

This randomised controlled trial will enrol 105 patients with osteoarthritis who meet the inclusion criteria for unilateral TKA. Patients were randomly divided into three groups using the random number table method. Group A received 1.0 g of TXA via IORA, group B received 1.0 g of TXA via intravenous infusion 15 min prior to the tourniquet release, and group C received both IORA of 1.0 g of TXA and intravenous infusion of 1.0 g of TXA. The primary outcome measure is perioperative total blood loss. Secondary outcomes include bleeding events, venous thromboembolism events, inflammation reactions, other complications and knee function assessments.

Ethics and dissemination

This study has been approved by the Ethics Committee of Peking Union Medical College Hospital and registered in the Chinese Clinical Trial Registry. Informed consent will be obtained from all the patients before enrolment. The trial will be conducted in accordance with the principles of the Declaration of Helsinki and the International Conference on Harmonization Good Clinical Practice guidelines. The results of this study will be disseminated through peer-reviewed publications, conference presentations and social media platforms. The findings will provide valuable insights into the use of IORA of TXA in TKA and may lead to the development of new strategies for perioperative blood management in joint replacement surgery.

Trial registration number

The Ethics Committee of Peking Union Medical College Hospital (approval number: K2371); Chinese Clinical Trial Registry (trial registration number: ChiCTR2200066293).
Good School Toolkit-Secondary Schools to prevent violence against students: protocol for a pilot cluster randomised controlled trial
Authors: Devries Karen , Tanton Clare , Knight Louise , Nakuti Janet , Nanyunja Barbrah , Laruni Yvonne , Amollo Mathew , Apota John , Opobo Timothy , Pearlman Jodie , Allen Elizabeth , Bonell Chris , Naker Dipak
Published: February 2024

Introduction

No whole-school interventions which seek to reduce physical, sexual and emotional violence from peers, intimate partners and teachers have been trialled with adolescents. Here, we report a protocol for a pilot trial of the Good School Toolkit-Secondary Schools intervention, to be tested in Ugandan secondary schools. Our main objectives are to (1) refine the intervention, (2) to understand feasibility of delivery of the intervention and (3) to explore design parameters for a subsequent phase III trial.

Methods and analysis

We will conduct a pilot cluster randomised controlled trial, with two arms and parallel assignment. Eight schools will be randomly selected from a stratified list of all eligible schools in Kampala and Wakiso Districts. We will conduct a baseline survey and endline survey 18 months after the baseline, with 960 adolescents and 200 teachers. Qualitative data and mixed methods process data collection will be conducted throughout the intervention. Proportion of staff and students reporting acceptability, understanding and implementing with fidelity will be tabulated at endline for intervention schools. Proportions of schools consenting to participation, randomisation and proportions of schools and individual participants completing the baseline and endline surveys will be described in a Consolidated Standards of Reporting Trials diagram.

Ethics and dissemination

The ethical requirements of our project are complex. Full approvals have been received from the Mildmay Ethics Committee (0407-2019), the Uganda National Council for Science and Technology (SS 6020) and the London School of Hygiene & Tropical Medicine (16212). Results of this study will be published in peer-reviewed academic journals, and shared with public bodies, policy makers, study participants and the general public in Uganda.

Trial registration number

PACTR202009826515511.
Common practices for sociodemographic data reporting in digital mental health intervention research: a scoping review
Authors: Kirvin-Quamme Andrew , Kissinger Jennifer , Quinlan Laurel , Montgomery Robert , Chernenok Mariya , Pirner Maddison C , Pajarito Sarah , Rapoport Stephanie , Wicks Paul , Darcy Alison , Greene Carolyn J , Robinson Athena
Published: February 2024

Background

The ability of digital mental health interventions (DMHIs) to reduce mental health disparities relies on the recruitment of research participants with diverse sociodemographic and self-identity characteristics. Despite its importance, sociodemographic reporting in research is often limited, and the state of reporting practices in DMHI research in particular has not been comprehensively reviewed.

Objectives

To characterise the state of sociodemographic data reported in randomised controlled trials (RCTs) of app-based DMHIs published globally from 2007 to 2022.

Methods

A scoping review of RCTs of app-based DMHIs examined reporting frequency for 16 sociodemographic domains (eg, gender) and common category options within each domain (eg, woman). The search queried five electronic databases. 5079 records were screened and 299 articles were included.

Results

On average, studies reported 4.64 (SD=1.79; range 0–9) of 16 sociodemographic domains. The most common were age (97%) and education (67%). The least common were housing situation (6%), residency/location (5%), veteran status (4%), number of children (3%), sexual orientation (2%), disability status (2%) and food security (<1%). Gender or sex was reported in 98% of studies: gender only (51%), sex only (28%), both (<1%) and gender/sex reported but unspecified (18%). Race or ethnicity was reported in 48% of studies: race only (14%), ethnicity only (14%), both (10%) and race/ethnicity reported but unspecified (10%).

Conclusions

This review describes the widespread underreporting of sociodemographic information in RCTs of app-based DMHIs published from 2007 to 2022. Reporting was often incomplete (eg, % female only), unclear (eg, the conflation of gender/sex) and limited (eg, only options representing majority groups were reported). Trends suggest reporting has somewhat improved in recent years. Diverse participant populations must be welcomed and described in DMHI research to broaden learning and the generalisability of results, a prerequisite of DMHI’s potential to reduce disparities in mental healthcare.
Scoping review of HIV-related intersectional stigma among sexual and gender minorities in sub-Saharan Africa
Authors: Dada Debbie , Abu-Ba’are Gamji R , Turner DeAnne , Mashoud Ibrahim Wunpini , Owusu-Dampare Francis , Apreku Amos , Ni Zhao , Djiadeu Pascal , Aidoo-Frimpong Gloria , Zigah Edem Yaw , Nyhan Kate , Nyblade Laura , Nelson LaRon E
Published: February 2024

Objectives

Sexual and gender minority (SGM) populations in sub-Saharan Africa (SSA) are disproportionately impacted by HIV and often face multiple HIV-related stigmas. Addressing these stigmas could reduce SGM HIV vulnerability but little is known about how the stigmas operate and intersect. Intersectional stigma offers a lens for understanding the experiences of stigmatised populations and refers to the synergistic negative health effects of various systems of oppression on individuals with multiple stigmatised identities, behaviours or conditions. This review aims to (1) assess how often and in what ways an intersectional lens is applied in HIV-related stigma research on SGM populations in SSA and (2) understand how intersectional stigma impacts HIV risk in these populations.

Design

Scoping review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews.

Data sources

Public health and regional databases were searched in 2020 and 2022.

Eligibility criteria

Articles in French and English on HIV-related stigma and HIV outcomes among men who have sex with men, women who have sex with women and/or transgender individuals in SSA.

Data extraction and synthesis

Articles were screened and extracted twice and categorised by use of an intersectional approach. Study designs and stigma types were described quantitatively and findings on intersectional stigma were thematically analysed.

Results

Of 173 articles on HIV-related stigma among SGM in SSA included in this review, 21 articles (12%) applied an intersectional lens. The most common intersectional stigmas investigated were HIV and same-sex attraction/behaviour stigma and HIV, same-sex attraction/behaviour and gender non-conformity stigma. Intersectional stigma drivers, facilitators and manifestations were identified across individual, interpersonal, institutional and societal socioecological levels. Intersectional stigma impacts HIV vulnerability by reducing HIV prevention and treatment service uptake, worsening mental health and increasing exposure to HIV risk factors.

Conclusion

Intersectional approaches are gaining traction in stigma research among SGM in SSA. Future research should prioritise quantitative and mixed methods investigations, diverse populations and intervention evaluation.
Overall survival of homebound patients without cancer receiving inpatient respite care in a hospital ward in Japan: a retrospective observational study
Authors: Miura Hisayuki , Goto Yuko
Published: February 2024

Objectives

This study aimed to investigate the relationship between the use of inpatient respite care and the overall survival of homebound patients without cancer admitted to a hospital ward in order to assess the potential impact of inpatient respite care on the duration of home care.

Design

This was a single-centre, hospital ward-based retrospective observational study.

Setting and participants

From March 2011 to September 2018, 393 cancer-free older patients (median age, 84.0 years; 53.9% women) receiving continuous medical care at home through clinics were enrolled upon admission to a hospital ward.

Primary outcome measures

Continuous cumulative survival curves were generated using the Kaplan-Meier method for two groups: inpatient respite care users and non-users. Additionally, prognostic factors associated with all-cause mortality were assessed using the Cox proportional hazards model.

Results

The Kaplan-Meier curves for inpatient respite care users without cancer admitted to the hospital ward demonstrated a longer median survival time than non-users. Subgroup analyses for patients with or without neurological disorders yielded similar results. The HR for inpatient respite care use, after adjusting for age, sex and other confounding variables, was 0.480 (95% CI: 0.328 to 0.703, p<0.001).

Conclusions

Homebound patients without cancer receiving inpatient respite care during the study period in Japan demonstrated higher overall survival than those who did not receive respite care. Subgroup analysis of patients with neurological disorders yielded similar results. Further studies are needed to investigate the benefits of inpatient respite care, including the exploration of appropriate methods for its use.
Physician and nurse well-being, patient safety and recommendations for interventions: cross-sectional survey in hospitals in six European countries
Authors: Aiken Linda H , Sermeus Walter , McKee Martin , Lasater Karen B , Sloane Douglas , Pogue Colleen A , Kohnen Dorothea , Dello Simon , Maier Claudia B Bettina , Drennan Jonathan , McHugh Matthew D
Published: February 2024

Objectives

To determine the well-being of physicians and nurses in hospital practice in Europe, and to identify interventions that hold promise for reducing adverse clinician outcomes and improving patient safety.

Design

Baseline cross-sectional survey of 2187 physicians and 6643 nurses practicing in 64 hospitals in six European countries participating in the EU-funded Magnet4Europe intervention to improve clinicians’ well-being.

Setting

Acute general hospitals with 150 or more beds in six European countries: Belgium, England, Germany, Ireland, Sweden and Norway.

Participants

Physicians and nurses with direct patient contact working in adult medical and surgical inpatient units, including intensive care and emergency departments.

Main outcome measures

Burnout, job dissatisfaction, physical and mental health, intent to leave job, quality of care and patient safety and interventions clinicians believe would improve their well-being.

Results

Poor work/life balance (57% physicians, 40% nurses), intent to leave (29% physicians, 33% nurses) and high burnout (25% physicians, 26% nurses) were prevalent. Rates varied by hospitals within countries and between countries. Better work environments and staffing were associated with lower percentages of clinicians reporting unfavourable health indicators, quality of care and patient safety. The effect of a 1 IQR improvement in work environments was associated with 7.2% fewer physicians and 5.3% fewer nurses reporting high burnout, and 14.2% fewer physicians and 8.6% fewer nurses giving their hospital an unfavourable rating of quality of care. Improving nurse staffing levels (79% nurses) and reducing bureaucracy and red tape (44% physicians) were interventions clinicians reported would be most effective in improving their own well-being, whereas individual mental health interventions were less frequently prioritised.

Conclusions

Burnout, mental health morbidities, job dissatisfaction and concerns about patient safety and care quality are prevalent among European hospital physicians and nurses. Interventions to improve hospital work environments and staffing are more important to clinicians than mental health interventions to improve personal resilience.
PERSIAN traffic safety and health cohort: a population-based precrash cohort study
Authors: Golestani Mina , Razzaghi Alireza , Rezaei Mehdi , Vahedi Leila , Pourasghar Faramarz , Farahbakhsh Mostafa , Shafiee-kandjani Alireza , Meshkini Mohammad , Jahanjoo Fatemeh , Yazdani Mir Bahador , Davtalab Esmaeili Elham , Jafari-Khounigh Ali , Ahmadi Sajjad , Mohammadi Reza , Ghojazadeh Morteza , Sadeghi-Bazargani Homayoun
Published: February 2024

Purpose

Despite to high burden of road traffic injuries (RTIs), the RTI epidemiology has received less attention with rare investments on robust population cohorts. The PERSIAN Traffic Safety and Health Cohort (PTSHC) was designed to assess the potential causal relationships between human factors and RTI mortality, injuries, severity of the injury, hospitalised injury, violation of traffic law as well as offer the strongest scientific evidence.

Participants

The precrash cohort study is carried out in four cities of Tabriz, Jolfa, Shabestar and Osku in East Azerbaijan province located in northwest Iran. The participants were people who sampled among the general population. The cluster sampling method was used to enrol the households in this study. The PTSHC encompasses a wide and comprehensive range and types of data. These include not only the common cohort data collections such as medical examination measures, previous medical history, bio assays and behavioural assessments but also includes data obtained using advanced novel technologies, for example, electronic travel monitoring, driving simulation and neuro-psycho-physiologic laboratory assessments specifically developed for traffic health field.

Findings to date

A total of 7200 participants aged 14 years and above were enrolled at baseline, nearly half of them being men. The mean age of participants was 39.2 (SD=19.9) years. The majority of participants (55.4%) belonged to the age group of 30–56 years. Currently, approximately 1 200 000 person-measurements have been collected.

Future plans

PSTHC will be used to determine the human-related risk factors by adjusting for the vehicle and land-use-related factors. Therefore, a lot of crashes can be prevented using effective interventions. Although this cohort provides valuable data, it is planned to increase its size to achieve the highest level of evidence with higher generalisability. Also, according to the national agreement this cohort is going to be extended to several geographical regions in second decade.
Outcomes following surgical interventions for hypothalamic hamartomas: protocol for a systematic review and individual patient data meta-analysis
Authors: Goel Keshav , Niazi Farbod , Chen Jia-Shu , Hadjinicolaou Aristides , Keezer Mark , Gallagher Anne , Fallah Aria , Weil Alexander G
Published: February 2024

Introduction

Hypothalamic hamartomas (HHs) are deep-seated congenital lesions that typically lead to pharmacoresistant epilepsy and a catastrophic encephalopathic syndrome characterised by severe neuropsychological impairment and decline in quality of life. A variety of surgical approaches and technologies are available for the treatment of HH-related pharmacoresistant epilepsy. There remains, however, a paucity of literature directly comparing their relative efficacy and safety. This protocol aims to facilitate a systematic review and meta-analysis that will characterise and compare the probability of seizure freedom and relevant postoperative complications across different surgical techniques performed for the treatment of HH-related pharmacoresistant epilepsy.

Methods and analysis

This protocol was developed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Individual Participant Data guidelines. Three major databases, PubMed, Embase and Scopus, will be systematically searched from database inception and without language restrictions for relevant articles using our predefined search strategy. Title–abstract and full text screening using inclusion and exclusion criteria created a priori will be performed by two independent reviewers to identify eligible articles. Conflicts will be resolved via discussion with a third team member. Following data extraction of both study-level and individual patient data (IPD), a study-level and IPD meta-analysis will be performed. Study-level analysis will focus on assessing the degree of heterogeneity in the data and quantifying overall seizure outcomes for each surgical technique. The IPD analysis will use multivariable regression to determine perioperative predictors of seizure freedom and complications that can guide patient and technique selection.

Ethics and dissemination

This work will not require ethics approval as it will be solely based on previously published and available data. The results of this review will be shared via conference presentation and submission to peer-reviewed neurosurgical journals.

PROSPERO registration

CRD42022378876.
Interventional embolisation for patients with cirrhosis and recurrent or persistent hepatic encephalopathy related to spontaneous portosystemic shunts: protocol for a prospective, non-randomised controlled study
Authors: Ke Qiao , Lin Ting , Lei Xiaojuan , Weng Xiadi , He Jian , Huang Xinhui , Li Ling , Guo Wu-Hua
Published: February 2024

Introduction

The presence of spontaneous portosystemic shunts (SPSS) has been identified to be associated with hepatic encephalopathy (HE) in patients with cirrhosis. Nevertheless, the role of interventional embolisation in managing such patients remains poorly defined. Consequently, this prospective controlled study aims to assess the efficacy and safety of interventional embolisation as a therapeutic approach for patients with cirrhosis and recurrent or persistent HE related to SPSS.

Methods and analysis

Cirrhotic patients diagnosed with recurrent or persistent HE associated with SPSS will be recruited for this study, and assigned to either the interventional embolisation group or the standard medical treatment group. The efficacy endpoints encompass the evaluation of postoperative alleviation of HE symptoms and the incidence of overt HE recurrence during the follow-up period, as well as the duration and frequency of hospitalisations for HE, alterations in liver function and volume, and overall survival. The safety endpoints encompass both immediate and long-term postoperative complications.

Ethics and dissemination

This study will be conducted in strict adherence to the principles of good clinical practice and the guidelines outlined in the Declaration of Helsinki. Ethical approval for the trial has been obtained from the Ethics Committee of Mengchao Hepatobiliary Hospital of Fujian Medical University (2023_013_02). Written informed consent will be obtained from all the participants by the treating physician for each patient prior to their enrolment. The documented informed consent forms will be retained as part of the clinical trial records for future reference. The study findings will be disseminated through publication in peer-reviewed journals and will be presented at international conferences.

Trial registration number

ChiCTR2300072189.
Intensive care unit interventions to promote sleep and circadian biology in reducing incident delirium: a scoping review
Authors: Wilcox M Elizabeth , Burry Lisa , Englesakis Marina , Coman Briar , Daou Marietou , van Haren Frank MP , Ely E Wes , Bosma Karen J , Knauert Melissa P
Published: February 2024

Rationale/Objectives

Despite plausible pathophysiological mechanisms, research is needed to confirm the relationship between sleep, circadian rhythm and delirium in patients admitted to the intensive care unit (ICU). The objective of this review is to summarise existing studies promoting, in whole or in part, the normalisation of sleep and circadian biology and their impact on the incidence, prevalence, duration and/or severity of delirium in ICU.

Methods

A sensitive search of electronic databases and conference proceedings was completed in March 2023. Inclusion criteria were English-language studies of any design that evaluated in-ICU non-pharmacological, pharmacological or mixed intervention strategies for promoting sleep or circadian biology and their association with delirium, as assessed at least daily. Data were extracted and independently verified.

Results

Of 7886 citations, we included 50 articles. Commonly evaluated interventions include care bundles (n=20), regulation or administration of light therapy (n=5), eye masks and/or earplugs (n=5), one nursing care-focused intervention and pharmacological intervention (eg, melatonin and ramelteon; n=19). The association between these interventions and incident delirium or severity of delirium was mixed. As multiple interventions were incorporated in included studies of care bundles and given that there was variable reporting of compliance with individual elements, identifying which components might have an impact on delirium is challenging.

Conclusions

This scoping review summarises the existing literature as it relates to ICU sleep and circadian disruption (SCD) and delirium in ICU. Further studies are needed to better understand the role of ICU SCD promotion interventions in delirium mitigation.
Boundary-Aware Abstractive Summarization with Entity-Augmented Attention for Enhancing Faithfulness
Authors: Li Jiuyi , Liu Junpeng , Ma Jianjun , Yang Wei , Huang Degen
Published: February 2024

With the successful application of deep learning, document summarization systems can produce more readable results. However, abstractive summarization still suffers from unfaithful outputs and factual errors, especially in named entities. Current approaches tend to employ external knowledge to improve model performance while neglecting the boundary information and the semantics of the entities. In this article, we propose an entity-augmented method (EAM) to encourage the model to make full use of the entity boundary information and pay more attention to the critical entities. Experimental results on three Chinese and English summarization datasets show that our method outperforms several strong baselines and achieves state-of-the-art performance on the CLTS dataset. Our method can also improve the faithfulness of the summary and generalize well to different pre-trained language models. Moreover, we propose a method to evaluate the integrity of generated entities. Besides, we adapt the data augmentation method in the FactCC model according to the difference between Chinese and English in grammar and train a new evaluation model for factual consistency evaluation in Chinese summarization.
A Study for Enhancing Low-resource Thai-Myanmar-English Neural Machine Translation
Authors: San Mya Ei , Usanavasin Sasiporn , Thu Ye Kyaw , Okumura Manabu
Published: February 2024

Several methodologies have recently been proposed to enhance the performance of low-resource Neural Machine Translation (NMT). However, these techniques have yet to be explored thoroughly in the low-resource Thai and Myanmar languages. Therefore, we first applied augmentation techniques such as SwitchOut and Ciphertext Based Data Augmentation (CipherDAug) to improve NMT performance in these languages. Second, we enhanced the NMT performance by fine-tuning the pre-trained Multilingual Denoising BART model (mBART), where BART denotes Bidirectional and Auto-Regressive Transformer. We implemented three NMT systems: namely, Transformer+SwitchOut, Multi-Source Transformer+CipherDAug, and fine-tuned mBART in the bidirectional translations of Thai-English-Myanmar language pairs from the ASEAN-MT corpus. Experimental results showed that Multi-Source Transformer+CipherDAug significantly improved Bilingual Evaluation Understudy (BLEU),
Character n-gram F-score (ChrF)
, and
Translation Error Rate (TER)
scores over the first baseline Transformer and second baseline Edit-Based Transformer. The model achieved notable BLEU scores: 37.9 (English-to-Thai), 42.7 (Thai-to-English), 28.9 (English-to-Myanmar), 31.2 (Myanmar-to-English), 25.3 (Thai-to-Myanmar), and 25.5 (Myanmar-to-Thai). The fine-tuned mBART model also considerably outperformed the two baselines, except for the Myanmar-to-English pair. SwitchOut improved over the second baseline in all pairs and performed similarly to the first baseline in most cases. Last, we performed detailed analyses verifying that the CipherDAug and mBART models potentially facilitate improving low-resource NMT performance in Thai and Myanmar languages.
Platelet Indices and Hypertension: Results from Shahedieh Cohort Study, Yazd, Iran
Authors: Shakeri Shamsi Fateme , Taheri Soodejani Moslem
Published: February 2024

Introduction. Hypertension is one of the most important diseases worldwide. In this study, we aim to demonstrate the relationship between platelet indices and hypertension. Materials and Methods. We studied 9448 people in the age range of 30 to 70 years. We assessed their hypertension status, platelet count (PLT), mean platelet volume (MPV), platelet distribution width (PDW), smoking, cardiovascular disease history, diabetes status, body mass index, and creatinine levels. Hypertension status was assessed qualitatively. All platelet indices were categorized by quartiles. We then used logistic regression to predict the relationship between these indices and hypertension. Results. PDW index and hypertension had a statistically significant relationship in the second quartile (16.2 fL < PDW ≤ 16.7 fL) in 30 to 40 years old (AOR: 0.225, 95% CI: 0.063–0.806), in the fourth quartile in 50 to 60 years old (AOR = 1.532, 95% CI: 1.048–2.238), and in all the quartiles of the age range of over 60 years. PLT index had a positive relationship (AOR = 3.147, 0.95% CI: 1.163–8.516) in 30 to 40 years old in the fourth quartile vs. the first quartile. A positive relationship was obtained in the third and fourth quartiles of PLT and the age range of 40 to 50 years, respectively (AOR = 2.063, 0.95% CI: 1.162–3.662) and (AOR = 2.204, 0.95% CI: 1.220–3.981). Conclusion. According to the results of this study, some platelet indices could be correlated with hypertension, so we may be able to reduce the burden of this disease.
The Association of the Pulmonary Artery Pulsatility Index and Right Ventricular Function after Cardiac Surgery
Authors: Wei Johnny , Kee Abigail , Dukes Rachel , Franke Jack , Leonardo Vincent , Flynn Brigid C.
Published: February 2024

Background. The pulmonary artery pulsatility index (PAPi) has been shown to correlate with right ventricular (RV) failure in patients with cardiac disease. However, the association of PAPi with right ventricular function following cardiac surgery is not yet established. Methods. PAPi and other hemodynamic variables were obtained postoperatively for 959 adult patients undergoing cardiac surgery. The association of post-bypass right ventricular function and other clinical factors to PAPi was evaluated using linear regression. A propensity-score matched cohort for PAPi ≥ 2.00 was used to assess the association of PAPi with postoperative outcomes. Results. 156 patients (16.3%) had post-bypass right ventricular dysfunction defined by visualization on transesophageal echocardiography. There was no difference in postoperative PAPi based on right ventricular function (2.12 vs. 2.00, p=0.21). In our matched cohort (n = 636), PAPi < 2.00 was associated with increased incidence of acute kidney injury (23.0% vs 13.2%, p<0.01) and ventilator time (6.0 hours vs 5.6 hours, p=0.04) but not with 30-day mortality or intensive care unit length of stay. Conclusion. In a general cohort of patients undergoing cardiac surgery, postoperative PAPi was not associated with postcardiopulmonary bypass right ventricular dysfunction. A postoperative PAPi < 2 may be associated with acute kidney injury.
Blindness in Right Eyes after Enema: A Case of Klebsiella pneumoniae-Related Invasive Liver Abscess Syndrome with Endophthalmitis-Caused Blindness as the First Symptom
Authors: Jin Qi , Zhang Xinrui , Yang Huifen , Zhao Bo , Wang Yubao
Published: February 2024

We report a case of Klebsiella pneumoniae invasive liver abscess syndrome (KPILAS) with endophthalmitis-caused blindness as the first symptom after enema. The patient had diabetes, and his blood glucose was poorly controlled. She developed hematuria after four enemas for cosmetic purposes and later became blind. The eye discharge was cultured, which revealed a Klebsiella pneumoniae infection. B ultrasound did not show liver lesions, but computed tomography exhibited abscesses in the right lobe of the liver. Magnetic resonance imaging of the head indicated abscesses. These confirmed the diagnosis of invasive liver abscess syndrome. The patient was given ophthalmic and systemic anti-infection treatments, and her condition was effectively controlled. Unfortunately, the diseased eye still needed to be removed. This case underlines the necessity of avoiding unnecessary risky procedures (such as enemas) in vulnerable populations, the importance of early detection of invasive liver abscess syndrome, and the advantage of computed tomography in detecting liver abscesses.
Supplementary Table 2 from EZH2 Inhibition Promotes Tumor Immunogenicity in Lung Squamous Cell Carcinomas
Authors: DuCote Tanner J. , Song Xiulong , Naughton Kassandra J. , Chen Fan , Plaugher Daniel R. , Childress Avery R. , Gellert Abigail R. , Skaggs Erika M. , Qu Xufeng , Liu Jinze , Liu Jinpeng , Li Fei , Wong Kwok-Kin , Brainson Christine F.
Published: February 2024

Supplementary Table 2 shows Gene Set Enrichment Analysis on genes with mRNA up-regulated and H3K27me3 peaks lost in combination treatment vs IFN-gamma alone in human lung squamous cell carcinoma tumoroids.
Supplementary Figure 5 from EZH2 Inhibition Promotes Tumor Immunogenicity in Lung Squamous Cell Carcinomas
Authors: DuCote Tanner J. , Song Xiulong , Naughton Kassandra J. , Chen Fan , Plaugher Daniel R. , Childress Avery R. , Gellert Abigail R. , Skaggs Erika M. , Qu Xufeng , Liu Jinze , Liu Jinpeng , Li Fei , Wong Kwok-Kin , Brainson Christine F.
Published: February 2024

Supplementary Figure 5 shows additional analysis of tumors from EZH2 inhibition and anti-PD1 treated mice.
FIGURE 2 from EZH2 Inhibition Promotes Tumor Immunogenicity in Lung Squamous Cell Carcinomas
Authors: DuCote Tanner J. , Song Xiulong , Naughton Kassandra J. , Chen Fan , Plaugher Daniel R. , Childress Avery R. , Gellert Abigail R. , Skaggs Erika M. , Qu Xufeng , Liu Jinze , Liu Jinpeng , Li Fei , Wong Kwok-Kin , Brainson Christine F.
Published: February 2024

EZH2 inhibition allows upregulation of MHCI and MHCII in human LSCC PDTs. A, H&E staining of primary squamous cell carcinoma tissue, xenograft tissue from primary patient tissue, and tumoroids generated from xenografts, scale bars = 100 µm. B, qRT-PCR in two unique PDT cultures treated for 11 days with 5 µmol/L EZH2 inhibition with 20 ng/mL IFNγ added on day 9 for the genes HLA-A, B2M, CIITA, and HLA-DRA; mean ± SEM is graphed; n = 4; *, P < 0.03; **, P < 0.005; ***, P < 0.0008; ****, P < 0.0001 by one-way ANOVA with multiple comparisons and Holm-Šídák post hoc test. C, Flow cytometry analysis of both PDTs treated for 11 days with 5 µmol/L EZH2 inhibition with 20 ng/mL IFNγ added in on day 9 for cell surface proteins HLA-A,B,C and HLA-DR; mean ± SEM is graphed; n = 4 biological replicates; *, P = 0.043; **, P < 0.004; ***, P < 0.0009; ****, P < 0.0001 by one-way ANOVA with multiple comparisons and Holm-Šídák post hoc test. Representative histograms for Patient 1 are shown, G = GSK126, E = EPZ6438, I = IFNγ, I+G = IFNγ+GSK126, and I+E = IFNγ+EPZ6438. See also Supplementary Fig. S2.
Data from EZH2 Inhibition Promotes Tumor Immunogenicity in Lung Squamous Cell Carcinomas
Authors: DuCote Tanner J. , Song Xiulong , Naughton Kassandra J. , Chen Fan , Plaugher Daniel R. , Childress Avery R. , Gellert Abigail R. , Skaggs Erika M. , Qu Xufeng , Liu Jinze , Liu Jinpeng , Li Fei , Wong Kwok-Kin , Brainson Christine F.
Published: February 2024

Abstract
Two important factors that contribute to resistance to immune checkpoint inhibitors (ICI) are an immune-suppressive microenvironment and limited antigen presentation by tumor cells. In this study, we examine whether inhibition of the methyltransferase enhancer of zeste homolog 2 (EZH2) can increase ICI response in lung squamous cell carcinomas (LSCC). Our in vitro experiments using two-dimensional human cancer cell lines as well as three-dimensional murine and patient-derived organoids treated with two inhibitors of the EZH2 plus IFNγ showed that EZH2 inhibition leads to expression of both MHC class I and II (MHCI/II) expression at both the mRNA and protein levels. Chromatin immunoprecipitation sequencing confirmed loss of EZH2-mediated histone marks and gain of activating histone marks at key loci. Furthermore, we demonstrate strong tumor control in models of both autochthonous and syngeneic LSCC treated with anti-PD1 immunotherapy with EZH2 inhibition. Single-cell RNA sequencing and immune cell profiling demonstrated phenotypic changes toward more tumor suppressive phenotypes in EZH2 inhibitor–treated tumors. These results indicate that EZH2 inhibitors could increase ICI responses in patients undergoing treatment for LSCC.
Significance:
The data described here show that inhibition of the epigenetic enzyme EZH2 allows derepression of multiple immunogenicity factors in LSCC, and that EZH2 inhibition alters myeloid cells in vivo. These data support clinical translation of this combination therapy for treatment of this deadly tumor type.
Cannabidiol-Derived Cannabinoids: The Unregulated Designer Drug Market Following the 2018 Farm Bill
Authors: Zawatsky Charles N. , Mills-Huffnagle Sara , Augusto Corinne M. , Vrana Kent E. , Nyland Jennifer E.
Published: February 2024

Background: In this review, we summarize current scientific knowledge on psychoactive cannabinoids synthesized from cannabidiol (CBD) and sold in the semi-legal market established in response to the passage of the US Agriculture Improvement Act of 2018, commonly known as the 2018 Farm Bill. The discussion focuses on recent developments that suggest this unregulated market may be fertile ground for a potential health crisis. Summary: Current research into CBD-derived cannabinoids is mainly limited to Δ8-tetrahydrocannabinol (Δ8-THC) products, with some recent publications beginning to explore O-acetyl-THC, a term describing the acetate ester of Δ8-THC or Δ9-THC, and its potential pulmonary toxicity. We advance the discussion on the CBD-derived cannabinoid market, shedding light on the introduction and associated dangers of novel cannabinoids, likely produced via fully synthetic routes using sidechain variants of CBD, with purportedly greater agonist activity at the human cannabinoid receptor 1 (as a source of euphorigenic activity) than Δ9-THC. We discuss the expanded incorporation of the acetate ester motif into other THC analogues. We also discuss the lack of regulatory oversight for the production of CBD-derived cannabinoids and the unlabeled presence of under-researched cannabinoids formed as reaction side products in the CBD-derived cannabinoid products being sold. Accordingly, we suggest approaches to monitoring the CBD-derived cannabinoid market and investigating the pharmacology of the cannabinoids being consumed. Finally, important epidemiological findings are discussed and future directions for research are suggested to call investigators to this critically understudied field. Key Messages: The CBD-derived cannabinoid market is growing internationally, and the market has diversified to include potent synthetic cannabinoids. The products sold on this unregulated market are under-researched despite growing availability and consumer interest. Ernest investigation of the pharmacology of these novel cannabinoids and the contents of CBD-derived cannabinoid products is critical for monitoring this potential source of another vaping-related epidemic.