bluuebunny/crossref_metadata_2025 huggingface dataset:
‘I feel like they’re actually listening to me’: a pilot study of a hospital discharge decision-making conversation guide for patients with injection drug use–associated infections
Authors: Thakarar Kinna , Kohut Michael , Stoddard Henry , Burris Deb , Chessa Frank , Sikka Monica K. , Solomon Daniel A. , Kershaw Colleen M. , Eaton Ellen , Hutchinson Rebecca , Fairfield Kathleen M. , Friedmann Peter , Stopka Thomas J.
Published: April 2023

Background:

The prevalence of injection drug use (IDU)-associated infections and associated hospitalizations has been increasing for nearly two decades. Due to issues ranging from ongoing substance use to peripherally inserted central catheter safety, many clinicians find discharge decision-making challenging. Typically, clinicians advise patients to remain hospitalized for several weeks for intravenous antimicrobial treatment; however, some patients may desire other antimicrobial treatment options. A structured conversation guide, delivered by infectious disease physicians, intended to inform hospital discharge decisions has the potential to enhance patient participation in decisions. We developed a conversation guide in order to: (1) investigate its feasibility and acceptability and (2) examine experiences, outcomes, and lessons learned from use of the guide.

Methods:

We interviewed physicians after they each piloted the conversation guide with two patients. We interviewed patients immediately after the conversation and again 4–6 weeks later. Two analysts indexed transcriptions and used the framework method to identify and organize relevant information. We conducted retrospective chart review to corroborate and contextualize qualitative data.

Results:

Eight patients and four infectious disease physicians piloted the conversation guide. All patients ( N = 8) completed antimicrobial treatment. Nearly all participants believed the conversation guide was important for incorporating patient values and preferences. Patients reported an increased sense of autonomy, but felt post-discharge needs could be better addressed. Physician participants identified the guide’s long length and inclusion of pain management as areas for improvement.

Conclusions:

A novel conversation guide to inform hospital discharge decision-making for patients with IDU-associated infections was feasible, acceptable, and fostered the incorporation of patient preferences and values into decisions. While we identified areas for improvement, overall participants believed that this novel conversation guide helped to improve patient care and autonomy.
Segmental Darier’s disease: A case report
Authors: Pastukhova Elena , LaBerge Lauren
Published: April 2023

Segmental Darier’s disease is an uncommon subtype of Darier’s genodermatosis, resulting from a mutation in the ATPase type 2 during early embryogenesis. It typically presents as a persistent, pruritic papular eruption following the lines of Blaschko. Histopathology of Darier’s disease demonstrates acantholysis, dyskeratosis, and corps ronds. First-line treatment includes topical retinoids, calcineurin inhibitors, and synthetic vitamin D analogues. Severe disease may require systemic therapy with oral retinoids, immunomodulators, magnesium, and low-dose naltrexone. Segmental Darier’s disease is important to recognize both clinically and histologically as it may resemble other acantholytic Blaschkolinear dermatoses and should be considered in individuals presenting with a chronic localized papular eruption in a Blaschkoid distribution. Herein, we present a case of a 48-year-old male with segmental Darier’s disease who improved significantly following acitretin treatment.
Age-group identity and political participation
Authors: Trachtman Samuel , Anzia Sarah F , Hill Charlotte
Published: April 2023

In many ways, American democracy seems to work better for older citizens than younger citizens, and one explanation is that young adults vote at much lower rates than their older counterparts. Yet while the existence of the age gap in turnout is well established, there remains uncertainty as to what drives it. In this paper, we explore age as a potentially important group identity and evaluate whether strength of age-group identity predicts political participation. Adapting established measures in the social identity literature, we surveyed a representative sample of American adults to gauge how strongly they identified with others in their age group. We find that, on average, younger adults identify less strongly than senior citizens with others their age. However, for young adults, age-group identity is as strong as another form of group identity that has gotten considerable attention in the literature: political party identity. The strength of age-group identity also predicts both voting and participating in climate change protests, especially for young adults. Age-group identity is a stronger predictor of climate protest participation for young Republicans than young Democrats—suggesting there may be potential for a bipartisan coalition of young people active on the issue of climate change.
Involuntary, Limited, and Contiguously Repeating Musical Imagery (InLaCReMI): Reconciling Theory and Data on the Musical Material Acquired by Earworms
Authors: Schubert Emery
Published: April 2023

“Earworms” have been proposed as a particular type of involuntary musical imagery (INMI) where musical material is repeated in the mind. The structure of the repetition is investigated by proposing a spreading activation model (SAM), where mental experience consists of priming and activation of nodes that represent objects, events, and relationships, including music. Music consists of chaining together nodes representing small music segments within hierarchical structures. Listening to music at a point in time activates the music's represented segment, which then primes the node representing the segment that follows. Repeating musical segments are coded recursively, with an additional layer of “context” nodes tracking global, structural location. From this basis, two hypotheses were proposed: H1 “Contiguous repetition at encoding” and H2 “Low environmental focus.” H1 predicts that when an INMI episode is a contiguously repeating segment, it must be based on music that contains contiguous repetition: it will be perceived as a subset of INMI – involuntary, limited, and contiguously repeating musical imagery (InLaCReMI). H1 challenges current views about preferred segments for looping, such as the “hook” of a tune. H2 predicts that InLaCReMI occurs when an individual is not focused on the immediate environment. In such a state there is less social imperative to activate high attentional-demand contextual information and so adherence to contextual integrity in thought is relaxed, leading to looping of recurrently activated nodes that were encoded with contiguous repetition. Additional predictions were made using SAM, demonstrating the potential for SAM to provide a unifying understanding of INMI. InLaCReMI is proposed as a frequently occurring species of INMI and confirmation of this phenomenon through more structured empirical investigation will provide novel insights into mental operation, and the nature of INMI.
Feature on Teaching and Technology: Teaching MBA Students Business Report Writing Using Social Media Technologies
Authors: Mehra Payal
Published: April 2023

Data-driven decision making has now moved beyond its traditional domains—operations research, business economics, computer sciences, and business statistics—to “softer subjects,” such as human resource management, organization behavior, and business communication. In this context, teaching with technology encourages students to systematically apply domain knowledge to communicate across a wide variety of stakeholders. In the era of multimodal forms of communication and multiple data sources, management students must be analytical when writing compelling reports and giving persuasive presentations. They should be well versed in using both quantitative and qualitative techniques for report writing and presentation. Drawing on authentic user-generated comments on social media, this article presents two case studies on (a) crisis communication by 30 CEOs and (b) culture shock experienced by foreign tourists sojourning in India, China, and the United Arab Emirates, to demonstrate how master’s in business administration (MBA) students could derive insights from the online comments to make strategic decisions for organizational benefit and make reports based on those findings. The article asserts that this could help to cultivate a data-analytic mindset among the students by preparing them to communicate small (and big) data-driven analysis to relevant stakeholders. It attempts to suggest ways to develop MBA students’ ability to analyze their potential audiences as well as to generate meaningful insights from the available information on social media websites. Finally, it hopes to nudge business communication instructors to embrace multidisciplinary perspectives for planning a technology-based business communication assignment involving the social media landscape. Instructors can not only use the two case studies to illustrate ways to integrate technology with teaching but also create their own mini cases to improve the decision-making, report-writing, and business report presentation skills of their students.
Medical imaging and nano-engineering advances with artificial intelligence
Authors: Utaibi Khalid Al , Ahmad Usama , Sait Sadiq M , Iqbal Sohail
Published: April 2023

Medical imaging is a broad field of research and artificial intelligence used to explore such images is termed as AI-Imaging. AI-imaging is further divided into sub-branches including the computational, theoretical and practical experiments in wet and dry labs. The current research focuses on the background of medical imaging, recent advances in the field of medical imaging for oncology, challenges and possible solutions. During this research, some computational and programing tools are outlined. The process of image segmentation is important as it can help to explore the medical images in more detail. During this research, the steps involved in image segmentation are outlined and the numerical experiments are performed on a set of breast cancer medical images. It is concluded during this research that the achievements in this domain are always credited by the smart programing & computational tools and computer vision. The current research also outlines the step-wise protocols of deep learning, designed for different types of medical imaging such as X-rays, CT-scan and MRI are documented to provide a comprehensive understanding, that can help in bridging the two domains of medicine and computer vision, in a reliable and fruitful manner.
Evaluation of parafoveal and peripapillary vascular densities using optical coherence tomography angiography in children with thalassemia major
Authors: Dursun Mehmet Emin , Hazar Leyla , Karahan Mine , Erdem Seyfettin , Ava Sedat , Üzel Veysiye Hülya , Dursun Birgül , Keklikçi Uğur
Published: April 2023

Background:

Thalassemia major (TM) is an inherited anaemia caused by faulty haemoglobin synthesis. Reducing serum iron levels using iron chelating agents is an important step in the treatment of TM, and the effects on the eye of both the disease and these agents can be determined by regular eye examination.

Objectives:

We evaluated macular and optic nerve vascular densities in children with TM and compared the results with healthy controls using optical coherence tomography angiography (OCTA).

Design:

This is a prospective study.

Methods:

A total of 30 children with TM and 30 healthy controls were included in the study. The area of the foveal avascular zone (FAZ) and the vascular densities (VD) of the optic nerve head (ONH), radial peripapillary capillary (RPC) and deep and superficial retinal vascular networks were measured using OCTA.

Results:

A statistically significant decrease in VD was observed in the whole image and the parafovea, superior hemi, superior and inferior parts of the superficial capillary plexus and in the whole image and the superior regions of the deep capillary plexus in the TM patient group compared with the control group ( p < 0.05). A significant decrease in VD was also observed in the whole image and the inside disc, peripapillary, nasal, inferonasal and temporal regions of the ONH and in the whole image and the inside disc, peripapillary and inferonasal regions of the RPC network in patients with TM ( p < 0.05). A significant positive correlation was observed between both serum ferritin levels and deferasirox dosage, on one hand, and both the superficial ( p = 0.023 and p = 0.002, respectively) and deep FAZs ( p = 0.015 and p = 0.045, respectively), on the other hand. A negative correlation was also found between the deferasirox dosage and the VDs of the superficial ( p = 0.010) and deep ( p = 0.001) foveal plexuses.

Conclusion:

Retinal VD and FAZ are affected in patients with TM. OCTA, which can noninvasively measure retinal VD in patients with TM, may be a useful tool for the early detection of retinal microvascular changes that may occur during the course of the disease.
I am a research-based practitioner, not a practice-based researcher: A laudation of the everyday and the in-between
Authors: Pollmann Alexa
Published: April 2023

This essay addresses multimodal researchers thinking of working with practitioners or artists/researchers looking to use prototypes for research and identifies the struggles of positioning such research, as well as highlighting principles and benefits of practice when treated as main methodology. While the importance of practice in research areas related to artistic creation is acknowledged, I observe a culture where practice is analysed and narrated to underpin it as research. I studied Fashion (BA) and Design Interactions (MA) and have worked commercially in both fields before starting my own studio. Today, my work aligns to what commonly is considered design practice, but it also caters to the scientific analysis and data gathering of research. Rather than resulting in either products or new conclusions however, the work explores, tinkers, dares and tries, and sometimes fails. This sitting in between applied practice and more formal forms of research has great advantages, some of which I will discuss in the following. The dualism established between practice and research when treated as separate processes however sits uncomfortably with me. It feels like a return to the mind-body dualism. This text is a reflection and an account of the commonalities I detect throughout working with other practitioners and in my own rites and patterns of creating, directing, or producing. I identify underlying principles and concerns of practice that the discussion around practice would benefit from engaging with.
Patellar Tendon Rupture with Transosseous Tunnel Repair
Authors: Horner Nolan S. , Fenn Thomas W. , Ephron Chris , Nho Shane J.
Published: April 2023

Background:

Patellar tendon rupture is an injury most often occurring in adults and commonly caused by tensile overload to the extensor mechanism of the knee or direct trauma to the tendon. Early diagnosis and timely surgical repair lead to good functional outcomes and high rates of return to activity.

Indications:

In patients with impaired knee extensor mechanisms, inability to perform a straight leg raise, or evidence of complete tendon rupture on imaging, surgical tendon repair is indicated.

Technical Description:

The surgical technique demonstrated here presents a standard patellar tendon repair with transosseous tunnels of a 32-year-old man. Briefly, dissection was performed down to the retinacular layer, and the patellar tendon stump was identified. Any devitalized soft tissue was removed from the inferior pole of the patella and the proximal tendon stump by a rongeur. Two locking Krackow sutures were placed along the medial and lateral aspect of the patellar tendon. Then, a drill bit was used to create 3 transosseous tunnels in the patella and a nitinol basket was used to pass sutures through each tunnel. The retinacular layer was closed by figure-of-eight stiches, followed by layered closure of the subcutaneous layer, and finally, the skin.

Results:

Early surgical repair of the patellar tendon leads to good functional outcomes and return to sport rates. In a retrospective study of 38 knees, at average of 9.3 years follow-up, 96% of patients reported they were satisfied/very satisfied, with a 100% returning to work. High rates of return to sports have been reported from a retrospective study, with a 94.4% and 83.3% rate of return to sport and rate of return to sport at the same level, respectively.

Discussion:

In this surgical technique video, we review the common presentation, indications of surgical repair, key steps and technique pearls for a case of a ruptured patellar tendon. Furthermore, we review complications and postoperative rehabilitation guidelines, postoperative clinical outcomes, and return-to-sport rates existing in the literature. Finally, we assess key differences between 2 commonly used surgical techniques, knotless suture anchors versus transosseous tunnels, in patellar tendon repair.

Patient Consent Disclosure Statement:

The author(s) attests that consent has been obtained from any patient(s) appearing in this publication. If the individual may be identifiable, the author(s) has included a statement of release or other written form of approval from the patient(s) with this submission for publication.
Commentary on the EU Commission's proposal for amending the Water Framework Directive, the Groundwater Directive, and the Directive on Environmental Quality Standards
Authors: Backhaus Thomas
Published: April 2023

The EU Commission published on the 26th of October 2022 its proposal for amending three central water management Directives, the Water Framework Directive, the Groundwater Directive, and the Directive on Environmental Quality Standards. The proposal introduces a series of amendments and changes to remedy shortcomings that were identified in the previous fitness check of the European water legislation and to align the legal framework with the scientific and technical progress of the last decades. This commentary briefly summarizes and evaluates the new elements that are most relevant from a toxicological and ecotoxicological perspective.

The Commission proposal substantially extends the list of WFD priority substances and now includes 68 substances and substance groups. It also identifies five substances and substance groups as a priority for groundwater management. In several instances, generic sum-EQS values are suggested for selected substance groups, an approach that lacks scientific underpinning and might not always be sufficiently protective. EQS values for substances groups are certainly needed, but are better set using relative potency factors or other implementations of the Concentration Addition concept. The Commission proposal employs this approach for setting groupwise EQS values for PFAS chemicals and PAHs and it should be systematically applied also to other groups of priority substances.

Effect-based methods (EBMs) are now included in the legal text of the WFD, which is highly welcome. However, the Commission proposal limits EBMs to explorative studies and does not include the setting of EQS values based on EBM-methods.

Revising the major legislative frameworks offers opportunities to streamline water pollution management in the spirit of the “one substance, one assessment” idea. Further details on how substance evaluations performed in the context of water management can be harmonized with those performed by EFSA, ECHA and EMA during substance registration and authorization would have been welcome.
Assessment of cecal microbiota modulation from piglet dietary supplementation with copper
Authors: Paganin Ana Carolina Laureano , Monzani Paulo Sérgio , Carazzolle Marcelo Falsarella , Araujo Raquel Bighetti , Gonzalez-Esquerra Ricardo , Haese Douglas , Kill João L , Rezende Graziela Silva , de Lima César Gonçalves , Malavazi Iran , de Melo Freire Caio César , da Cunha Anderson Ferreira
Published: April 2023

Background

Swine production expanded in the last decades. Efforts have been made to improve meat production and to understand its relationship to pig gut microbiota. Copper (Cu) is a usual supplement to growth performance in animal production. Here, two performance studies were conducted to investigate the effects of three different sources of Cu on the microbiota of piglets. A total of 256 weaned piglets were randomly allocated into 4 treatments (10 replicates per treatment of 4 piglets per pen in Trial 1 and 8 replicates of 3 piglets per pen in Trial 2). Treatments included a control group (fed 10 mg/kg of Cu from CuSO4), a group fed at 160 mg/kg of Copper (II) sulfate (CuSO4) or tri-basic copper chloride (TBCC), and a group fed with Cu methionine hydroxy analogue chelated (Cu-MHAC) at 150, 80, and 50 mg/kg in Phases 1 (24–35 d), 2 (36–49 d), and 3 (50–70 d), respectively. At 70 d, the cecum luminal contents from one pig per pen were collected and polled for 16 S rRNA sequencing (V3/V4 regions). Parameters were analyzed in a completely randomized block design, in which each experiment was considered as a block.

Results

A total of 1337 Operational Taxonomic Units (OTUs) were identified. Dominance and Simpson ecological metrics were statistically different between control and treated groups (P < 0.10) showing that different Cu sources altered the gut microbiota composition with the proliferation of some bacteria that improve gut health. A high abundance of Prevotella was observed in all treatments while other genera were enriched and differentially modulated, according to the Cu source and dosage. The supplementation with Cu-MHAC can modify a group of bacteria involved in feed efficiency (FE) and short chain fatty acids (SCFA) production (Clostridium XIVa, Desulfovibrio, and Megasphera). These bacteria are also important players in the activation of ghrelin and growth hormones that were previously reported to correlate with Cu-MHAC supplementation.

Conclusions

These results indicated that some genera seem to be directly affected by the Cu source offered to the animals. TBCC and Cu-MHAC (even in low doses) can promote healthy modifications in the gut bacterial composition, being a promising source of supplementation for piglets.
Uncovering early transcriptional regulation during adventitious root formation in Medicago sativa
Authors: Ai Ye , Qian Xu , Wang Xiaoqian , Chen Yinglong , Zhang Tiejun , Chao Yuehui , Zhao Yan
Published: April 2023

Background

Alfalfa (Medicago sativa L.) as an important legume plant can quickly produce adventitious roots (ARs) to form new plants by cutting. But the regulatory mechanism of AR formation in alfalfa remains unclear.

Results

To better understand the rooting process of alfalfa cuttings, plant materials from four stages, including initial separation stage (C stage), induction stage (Y stage), AR primordium formation stage (P stage) and AR maturation stage (S stage) were collected and used for RNA-Seq. Meanwhile, three candidate genes (SAUR, VAN3 and EGLC) were selected to explore their roles in AR formation. The numbers of differentially expressed genes (DEGs) of Y-vs-C (9,724) and P-vs-Y groups (6,836) were larger than that of S-vs-P group (150), indicating highly active in the early AR formation during the complicated development process. Pathways related to cell wall and sugar metabolism, root development, cell cycle, stem cell, and protease were identified, indicating that these genes were involved in AR production. A large number of hormone-related genes associated with the formation of alfalfa ARs have also been identified, in which auxin, ABA and brassinosteroids are thought to play key regulatory roles. Comparing with TF database, it was found that AP2/ERF-ERF, bHLH, WRKY, NAC, MYB, C2H2, bZIP, GRAS played a major regulatory role in the production of ARs of alfalfa. Furthermore, three identified genes showed significant promotion effect on AR formation.

Conclusions

Stimulation of stem basal cells in alfalfa by cutting induced AR production through the regulation of various hormones, transcription factors and kinases. This study provides new insights of AR formation in alfalfa and enriches gene resources in crop planting and cultivation.
Non-thyroidal Illness Syndrome (NTIS) is no independent predictor for mortality in ICU patients
Authors: Krug Natalie , Bercker Sven , Busch Thilo , Friese Steffen , Jahn Nora , Voelker Maria Theresa
Published: April 2023

Background

Low T3-(/T4-) syndrome, also known as non-thyroidal Illness Syndrome (NTIS) describes a decrease in free serum thyroid hormones without a concomitant increase in TSH, frequently observed in critically ill patients. However, whether NTIS is only a metabolic adaption to stress in critically ill or plays a crucial role as an independent risk factor for ICU mortality, remains unknown. Our study aimed to evaluate NTIS as an independent risk factor for increased ICU mortality.

Methods

All patients admitted to the interdisciplinary intensive care unit (ICU) at the University Hospital of Leipzig between 2008 and 2014 were retrospectively analyzed for thyroidal function. Baseline data, information on additional thyroid function tests, disease progression, hospital and ICU length of stay (LOS) and patient outcome were retrospectively analyzed from the hospitals digital information system. For statistical evaluation, univariate analysis, matched pairs analysis and multivariate logistic regression were conducted.

Results

One thousand, seven hundred ninety patients were enrolled in the study, of which 665 showed NTIS. Univariate analysis revealed a positive association of NTIS with ICU- and hospital-LOS, need for mechanical ventilation, incidence of sepsis, acute respiratory distress syndrome, acute liver failure and increased ICU mortality. Results of matched pair analysis confirmed these findings. In multivariate logistic regression, NTIS was associated with an increased ICU-LOS, increased duration of mechanical ventilation, acute kidney injury and liver failure, but showed no independent association with increased ICU-mortality.

Conclusion

Duration of mechanical ventilation as well as incidence of acute kidney injury, sepsis and acute liver failure were detected as independent predictors of mortality in patients with NTIS. NTIS itself was no independent predictor of increased ICU-mortality.
Low blood carotenoid status in dementia and mild cognitive impairment: A systematic review and meta-analysis
Authors: Wang Lin , Zhao Tie , Zhu Xu , Jiang Qinghua
Published: April 2023

Background

Given their potent antioxidation properties, carotenoids play a role in delaying and preventing dementia and mild cognitive impairment (MCI). However, observational studies have found inconsistent results regarding the associations between blood carotenoid levels and the risk of dementia and MCI. We conducted this systematic review and meta-analysis to investigate the relationship between blood carotenoid levels and the risk of dementia and MCI.

Methods

A systematic search was performed in the Web of Science, PubMed, Embase, and Cochrane Library electronic databases to retrieve relevant English articles published from their inception until February 23, 2023. Study quality was assessed by the Newcastle-Ottawa scale. Standardized mean differences (SMDs) and 95% confidence intervals (CIs) were pooled using random-effect meta-analyses. Ultimately, 23 studies (n = 6610) involving 1422 patients with dementia, 435 patients with MCI, and 4753 controls were included.

Results

Our meta-analysis showed that patients with dementia had lower blood lycopene (SMD: -0.521; 95%CI: -0.741, -0.301), α-carotene (SMD: -0.489; 95%CI: -0.697, -0.281), β-carotene (SMD: -0.476; 95%CI: -0.784, -0.168), lutein (SMD: -0.516; 95%CI: -0.753, -0.279), zeaxanthin (SMD: -0.571; 95%CI: -0.910, -0.232) and β-cryptoxanthin (SMD: -0.617; 95%CI: -0.953, -0.281) than the controls. Our results indicated that blood carotenoid levels were significantly lower in patients with dementia than in controls, despite high heterogeneity across the studies. Owing to insufficient data, we did not observe a similar and stable relationship between blood carotenoid levels and MCI.

Conclusions

Our meta-analysis indicated that lower blood carotenoid levels may be a risk factor for dementia and MCI.
Prevalence and the affecting factors on depression, anxiety and stress (DASS) among elders in Qazvin City, in the Northwest of Iran
Authors: Raeisvandi Abouzar , Amerzadeh Mohammad , Hajiabadi Fatemeh , Hosseinkhani Zahra
Published: April 2023

Background

Depression, anxiety, and stress are among the most common mental health disorders of the elderly that affect the health of individuals and society. Considering the growing trend of the elderly population in Iran, this study aimed to determine the prevalence of these disorders and to identify the factors affecting them in the elderly.

Methods

We conducted this cross-sectional study using cluster random sampling on 301 elderly people referred to Qazvin health centers. Data was collected using the Depression, Anxiety, Stress Scale 21 (DASS-21) questionnaire and analyzed through univariate and multivariate linear regression tests with the interaction between variables in STATA Version 14 software. A P-value of less than 0.05 was significant.

Results

The prevalence of depression was 45.5%, anxiety 35.5%, and stress 40.2%. Our findings showed that 22.9%, 7.9%, and 14.3% of people had severe and very severe levels of depression, anxiety, and stress. The variables of age, comorbidity, living status and job status had a significant relationship with the DASS score (p < 0.05). There was an interaction between the variables of comorbidity and income status influencing the DASS score (β = 0.68, 95% CI 0.15, 1.22).

Conclusion

The prevalence of depression, anxiety and stress in the elderly was high, indicating the inappropriate status of their mental health. Therefore, it is necessary to take operational steps to reduce some problems in the elderly, prioritize the elderly suffering from concurrent diseases, the unemployed elderly, those who do not have a certain income, and the elderly who live alone.
The role of medication adherence in the association between depressive symptoms and quality of life in older adults with type 2 diabetes mellitus
Authors: Yang Hao , Wu Fangtuan , Gui Mingdong , Cheng Yuwei , Zhang Li
Published: April 2023

Background

At present, the role of medication adherence in the association between depressive symptoms and quality of life (QOL) in older adults with type 2 diabetes mellitus (T2DM) was unclear. The purpose of this study was to explore the associations among depressive symptoms, medication adherence and QOL in older adults with T2DM.

Methods

In this cross-sectional study, 300 older adults with T2DM from the First Affiliated Hospital of Anhui Medical University were enrolled. Among them, 115 patients had depressive symptoms and 185 had no depressive symptoms. Univariate linear regression analysis was conducted to identify possible covariates. Univariate and multivariable linear regression analyses were performed to explore the associations between depressive symptoms and medication adherence or QOL in older adults with T2DM. Multiplicative interaction analysis was evaluated whether there was interaction effect between medication adherence and depressive symptoms on QOL of patients. Mediating effect analysis was used to analyze the medication effect of medication adherence on depressive symptoms and QOL in older adults with T2DM.

Results

Decreased medication adherence was observed in patients with depressive symptoms (β = -0.67, 95%CI: -1.10, -0.24) after adjusting for covariates. Depressive symptoms were associated with decreased QOL in older adults with T2DM (β = -5.99, 95%CI: -7.56, -4.42). The mediating analysis revealed that depressive symptoms were associated with decreased medication adherence (β = -0.67, 95%CI: -1.09, -0.25). Medication adherence was linked with increased QOL of older adults with T2DM (β = 0.65, 95%CI: 0.24, 1.06). Depressive symptoms were correlated with decreased QOL of older adults with T2DM (β = -5.56, 95%CI: -7.10, -4.01). The percentage mediated by medication adherence on depressive symptoms and QOL in older adults with T2DM was 10.61%.

Conclusion

Medication adherence might mediate depressive symptoms and QOL of older adults with T2DM, which might provide a reference for the improvement of QOL of these patients.
Education program promoting report of elder abuse by nursing students: a pilot study
Authors: Park Dahye , Ha Jeongmin
Published: April 2023

Background

Elder abuse is an important public health concern that requires urgent attention. One main barrier to active responses to elder abuse in clinical settings is a low level of relevant knowledge among nurses. This study aims to develop an educational program to promote an intent to report elder abuse among nursing students and assess its effectiveness, with a focus on the rights of older adults.

Methods

A mixed method design was used with the Analyze, Design, Develop, Implement, and Evaluate model. Twenty-five nursing students from Chungbuk Province participated in the study. Attitude toward older adults and knowledge of, awareness of, attitude towards, and intent to report elder abuse were assessed quantitatively and analyzed using paired t-test. The feasibility of the program and feedback were collected qualitatively through group interviews and analyzed using content analysis.

Results

After the education program, attitude toward older adults (Cohen’s d = 1.08), knowledge of (Cohen’s d = 2.15), awareness of (Cohen’s d = 1.56), attitude towards (Cohen’s d = 1.85), and intent to report elder abuse (Cohen’s d = 2.78) increased, confirming the positive effects of this program. Overall, all participants were satisfied with the contents and method of the program.

Conclusions

The method of program delivery should be improved and tailored strategies to boost program engagement among nursing students should be explored to implement and disseminate the program.
Impact of race-independent equations on estimating glomerular filtration rate for the assessment of kidney dysfunction in liver disease
Authors: Stämmler Frank , Derain-Dubourg Laurence , Lemoine Sandrine , Meeusen Jeffrey W. , Dasari Surendra , Lieske John C. , Robertson Andrew , Schiffer Eric
Published: April 2023

Background

Altered hemodynamics in liver disease often results in overestimation of glomerular filtration rate (GFR) by creatinine-based GFR estimating (eGFR) equations. Recently, we have validated a novel eGFR equation based on serum myo-inositol, valine, and creatinine quantified by nuclear magnetic resonance spectroscopy in combination with cystatin C, age and sex (GFRNMR). We hypothesized that GFRNMRcould improve chronic kidney disease (CKD) classification in the setting of liver disease.

Results

We conducted a retrospective multicenter study in 205 patients with chronic liver disease (CLD), comparing the performance of GFRNMRto that of validated CKD-EPI eGFR equations, including eGFRcr (based on creatinine) and eGFRcr-cys (based on both creatinine and cystatin C), using measured GFR as reference standard. GFRNMRoutperformed all other equations with a low overall median bias (-1 vs. -6 to 4 ml/min/1.73 m2for the other equations;p < 0.05) and the lowest difference in bias between reduced and preserved liver function (-3 vs. -16 to -8 ml/min/1.73 m2for other equations). Concordant classification by CKD stage was highest for GFRNMR(59% vs. 48% to 53%) and less biased in estimating CKD severity compared to the other equations. GFRNMRP30 accuracy (83%) was higher than that of eGFRcr (75%;p = 0.019) and comparable to that of eGFRcr-cys (86%;p = 0.578).

Conclusions

Addition of myo-inositol and valine to creatinine and cystatin C in GFRNMRfurther improved GFR estimation in CLD patients and accurately stratified liver disease patients into CKD stages.
Functional connectivity of the language area in migraine: a preliminary classification model
Authors: Gou Chen , Yang Shuangfeng , Hou Qianmei , Rudder Peter , Tanglay Onur , Young Isabella , Peng Tingting , He Weiwei , Yang Liuyi , Osipowicz Karol , Doyen Stephane , Mansouri Negar , Sughrue Michael E. , Wang Xiaoming
Published: April 2023

Background

Migraine is a complex disorder characterized by debilitating headaches. Despite its prevalence, its pathophysiology remains unknown, with subsequent gaps in diagnosis and treatment. We combined machine learning with connectivity analysis and applied a whole-brain network approach to identify potential targets for migraine diagnosis and treatment.

Methods

Baseline anatomical T1 magnetic resonance imaging (MRI), resting-state functional MRI(rfMRI), and diffusion weighted scans were obtained from 31 patients with migraine, and 17 controls. A recently developed machine learning technique, Hollow Tree Super (HoTS) was used to classify subjects into diagnostic groups based on functional connectivity (FC) and derive networks and parcels contributing to the model. PageRank centrality analysis was also performed on the structural connectome to identify changes in hubness.

Results

Our model attained an area under the receiver operating characteristic curve (AUC-ROC) of 0.68, which rose to 0.86 following hyperparameter tuning. FC of the language network was most predictive of the model’s classification, though patients with migraine also demonstrated differences in the accessory language, visual and medial temporal regions. Several analogous regions in the right hemisphere demonstrated changes in PageRank centrality, suggesting possible compensation.

Conclusions

Although our small sample size demands caution, our preliminary findings demonstrate the utility of our method in providing a network-based perspective to diagnosis and treatment of migraine.
Autoimmune glial fibrillary acidic protein astrocytopathy associated with breast cancer: a case report
Authors: Yaguchi Tomonori , Kimura Akio , Takekoshi Akira , Matsuo Mikiko , Tomita Hiroyuki , Shimohata Takayoshi
Published: April 2023

Background

Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy (GFAP-A) is an autoimmune inflammatory central nervous system disorder characterized by the detection of autoantibodies that recognize GFAP in CSF. The pathogenesis of GFAP-A is poorly understood. Some patients had a neoplasm detected and GFAP expressed by neoplasms is plausible as immunogen triggering paraneoplastic neurological autoimmunity.

Case presentation

We report a case of 76-year-old female patient with GFAP-A complicated with breast cancer. She presented with altered consciousness, nuchal rigidity, speech disturbances, and weakness. Her clinical symptoms were improved by immunotherapy and cancer treatments. Immunohistochemical analysis showed that the restricted tumor expressed GFAP. The infiltration of CD3 + T cells were observed in the peritumoral and intratumoral areas. The most common infiltrating lymphocytes were CD8 + T cells. CD4 + T cells and CD20 + B cells were also observed in the predominant peritumoral area.

Conclusions

These results suggest that GFAP-A may occur in a paraneoplastic neurological syndrome associated with breast cancer.
Effect of serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte ratio on pregnancy and neonatal outcomes in women undergoing ICSI cycle
Authors: Huang Li-Juan , Wan Qi , Li Tian , Lv Xing-Yu , Geng Li-Hong , He Qi-Qi , Zhong Zhao-Hui , Li Yuan , Tang Xiao-Jun
Published: April 2023

Background

The serum progesterone on human chorionic gonadotropin trigger day / metaphase II oocyte (P/MII) ratio might be a more predictable indicator of pregnancy and neonatal outcomes as compare to P/estradiol (E2) or P alone. Hence, we conducted a larger population study to compare the pregnancy and neonatal outcomes in the low and high P/MII ratio.

Methods

A retrospective, single-center, larger population cohort study between January 2015 and August 2021. Calculate the threshold effect of P/MII ratio on clinical pregnancy rate according to the construct smooth curve fitting. Divide data into two groups by threshold for comparison.

Results

3566 fresh ICSI-ET cycles were included, in which 929 singleton delivery and 676 twin deliveries. Compare to P/MII ≤ 0.367 group, it indicated that the P/MII > 0.367 group had a lower clinical pregnancy rate and live birth rate, furthermore, a significantly higher rate of LBW and SGA were observed in the singleton and twin deliveries. No deleterious impact of high P/MII ratio on embryo quality and undesirable pregnancy outcomes was shown.

Conclusions

When P/MII is higher than 0.367, may have adverse impacts on pregnancy and neonatal outcomes for ICSI cycle.
Prognostic value of CYFRA 21 − 1 and Ki67 in advanced NSCLC patients with wild-type EGFR
Authors: Li Tao , Xie Qi , Fang Yang-Yang , Sun Yi , Wang Xiao Ming , Luo Zhu , Yan Gui-Ling , He Jian-Bo , Zheng Xiao-Qun
Published: April 2023

Background

The prognostic value of cytokeratin 19 fragment (CYFRA 21 − 1) and Ki67 in advanced non-small cell lung cancer (NSCLC) patients with wild-type epidermal growth factor receptor (EGFR) remains to be explored.

Methods

In this study, 983 primary NSCLC patients from January 2016 to December 2019 were retrospectively reviewed. Finally, 117 advanced NSCLC patients with wild-type EGFR and 37 patients with EGFR mutation were included and prognostic value of CYFRA 21 − 1 and Ki67 were also identified.

Results

The patients age, smoking history and the Eastern Corporative Oncology Group (ECOG) performance scores were significantly different between CYFRA21-1 positive and negative groups (p < 0.05), while no significant differences were found in Ki67 high and low groups. The results of over survival (OS) demonstrated that patients with CYFRA21-1 positive had markedly shorter survival time than CYFRA21-1 negative (p < 0.001, For whole cohorts;p = 0.002, For wild-type EGFR). Besides, patients with wild-type EGFR also had shorter survival times than Ki67 high group. Moreover, In CYFRA 21 − 1 positive group, patients with Ki67 high had obviously shorter survival time compared to patients with Ki67 low (median: 24vs23.5 months;p = 0.048). However, Ki67 could not be used as an adverse risk factor for patients with EGFR mutation. Multivariate cox analysis showed that age (HR, 1.031; 95%CI, 1.003 ~ 1.006;p = 0.028), Histopathology (HR, 1.760; 95%CI,1.152 ~ 2.690;p = 0.009), CYFRA 21 − 1 (HR, 2.304; 95%CI,1.224 ~ 4.335;p = 0.01) and Ki67 (HR, 2.130; 95%CI,1.242 ~ 3.652;p = 0.006) served as independent prognostic risk factor for advanced NSCLC patients.

Conclusions

Our finding indicated that CYFRA 21 − 1 was an independent prognostic factor for advanced NSCLC patients and Ki67 status could be a risk stratification marker for CYFRA 21 − 1 positive NSCLC patients with wild-type EGFR.
Comparison of post-treatment recurrence between ranibizumab injection and laser photocoagulation for type 1 retinopathy of prematurity
Authors: Cao Jing-Ke , Han Tao , Tang Hong-Yi , Zhang Sheng , Wang Zong-Hua , Feng Zhi-Chun , Li Qiu-Ping
Published: April 2023

Objective

To compare post-treatment recurrence between ranibizumab injection and laser photocoagulation (LP) for type 1 retinopathy of prematurity (ROP), and explore the associated risk factors.

Methods

The clinical data of ROP infants treated with LP or ranibizumab in a NICU of China from October 2007 to November 2021 were retrospectively analyzed and compared, such as general condition, degree of ROP, therapeutic effectiveness and post-treatment recurrence. The dependent variable was recurrence after ROP treatment. Univariate and regression analysis of risk factors was performed.

Results

Of the 298 ROP infants (556 eyes), 58% of the eyes were treated with LP and the other 42% with ranibizumab. There was no significant difference in gestational age at birth, birth weight, sex, delivery mode, prenatal corticosteroids, ROP diagnosed before admission or after admission, and the duration of oxygen therapy between the two groups. However, the ratio of type 1 ROP and aggressive retinopathy of prematurity (A-ROP) in ranibizumab group was higher than that in LP group. The number of treatments, recurrence rate and recurrence interval in ranibizumab group were higher than those in LP group. However, there was no difference in the recurrence rate between the two groups after stratified analysis by the lesion area and the presence or absence of A-ROP. There was no significant difference in the final lesion regression between the two groups. Regression analysis showed that plus disease and ROP located in zone I were independent risk factors for post-treatment recurrence.

Conclusion

There is no significant difference in the recurrence rate of ROP between ranibizumab injection and LP, and recurrence is mainly related to the severity of ROP. In half of our patients treated with A-ROP recurrences occur.
Management of neonatal pulmonary hypertension-a survey of neonatal intensive care units in India
Authors: Singh Pari , Deshpande Sujata , Nagpal Rema , Garegrat Reema , Gupta Samir , Suryawanshi Pradeep
Published: April 2023

Background

Persistent pulmonary hypertension of the newborn (PPHN) is a common neonatal condition associated with significant morbidity and mortality. First-line diagnostic and treatment options such as echocardiography and inhaled nitric oxide (iNO) are not routinely available in resource limited settings and alternative treatment modalities need to be utilized. This study was conducted to assess current diagnostic and management strategies used for PPHN in Indian neonatal intensive care units (NICUs).

Methods

A questionnaire in multiple choice question format was sent to practising neonatologists in India via an online survey tool between July to August 2021. Information pertaining to demographic data, diagnostic criteria and management strategies of PPHN was requested. The responses were collated and information processed.

Results

There were 118 respondent NICUs (response rate 74%). The majority of neonatal units (65%) admitted an average of 1–3 patients of PPHN per month. Targeted neonatal echocardiography (TnECHO) was practised in 80% of the units. Most common management strategies being followed were pulmonary vasodilators (88.1%), inotropes (85.6%), conventional ventilation (68.6%) and high frequency ventilation (59.3%). The most preferred pulmonary vasodilator was sildenafil (79%) and inotropic agent was milrinone (32%). Only 25% of respondents reported use of iNO. None of the participating units used extracorporeal membrane oxygenation.

Conclusion

We found wide variability in management practices of PPHN across Indian NICUs. Non-selective pulmonary vasodilators are more widely used than iNO. There is an urgent need for structured TnECHO training programs and evidence based national guidelines for standardized management of PPHN as per availability of resources in India. Additional research on low cost alternative therapies to iNO in Indian settings might be helpful.