bluuebunny/crossref_metadata_2025 huggingface dataset:
Evaluating the sustainability of smart technology applications in healthcare after the COVID-19 pandemic: A hybridising subjective and objective fuzzy group decision-making approach with explainable artificial intelligence
Authors: Chen Tin-Chih Toly , Chiu Min-Chi
Published: November 2022

During the COVID-19 pandemic, some smart technology applications were more effective than had been expected, whereas some others did not achieve satisfactory performance. Consequently, whether smart technology applications in healthcare are sustainable is a question that warrants investigation. To address this question, a hybridising subjective and objective fuzzy group decision-making approach with explainable artificial intelligence was proposed in this study and then used to evaluate the sustainability of smart technology applications in healthcare. The contribution of this research is its subjective evaluation of the sustainability of smart technology applications followed by correction of the evaluation outcome on the basis of the applications’ objective performance during the COVID-19 pandemic. To this end, a fuzzy nonlinear programming model was formulated and optimised. In addition, the impact of several major global events that occurred during the pandemic on the sustainability of smart technology applications was considered. The proposed methodology was applied to evaluate the sustainability levels of eight smart technology applications in healthcare. According to the experimental results, three applications—namely healthcare apps, smartwatches, and remote temperature scanners—are expected to be highly sustainable in healthcare, whereas one application, namely smart clothing, is not.
Primary Care Providers’ Use of Genetic Services in the Southeast United States: Barriers, Facilitators, and Strategies
Authors: Seibel Erin , Gunn Gwen , Ali Nadia , Jordan Ellen , Kenneson Aileen
Published: November 2022

Introduction/Objectives:

Collectively, genetic diseases are not that rare, and with increasing availability of genetics-informed healthcare management, primary care providers (PCPs) are more often asked to screen for or provide genetic services. Previous studies have identified barriers that impact PCPs’ ability to provide genetic services, including limited knowledge, training, and time/resources. This study set out to identify specific barriers limiting genetics service provision by PCPs within the Southeastern Regional Genetics Network (SERN) and resources that would help eliminate those barriers.

Methods:

PCPs were recruited through provider networks and invited to participate in semi-structured interviews, conducted via Zoom, recorded, and transcribed verbatim. Interview transcripts were independently coded by 2 coders using MAXQDA software. Thematic analysis was conducted.

Results:

Eleven interviews were conducted. Three predominant themes emerged from the data regarding factors impacting use of genetic services: system-wide factors, provider-specific factors, and patient factors. System-wide barriers included a lack of genetics providers and logistic challenges, which led to some PCPs coordinating referrals with other specialists or independently managing patients. Regarding provider-specific barriers, PCPs reported lack of genetics knowledge making referrals challenging. When possible, many PCPs contacted genetics providers for assistance. When not possible, some PCPs reached out to other colleagues or specialists for guidance. Patient-specific barriers included concerns or lack of information regarding genetics and unmet social needs. Many PCPs provided additional education regarding genetics appointments or testing benefits to their patients. Assistance from genetic counselors, electronic medical record systems that support referral to genetics, prior experience referring to genetics, established communication channels with genetics professionals, and highly motivated patients all facilitated improved collaboration with genetic services. PCPs provided suggestions for future resources to support interactions with genetics, including clear referral guidelines, increased access to genetics providers, improved test ordering processes, increased access to genetic education, and communication systems.

Conclusions:

PCPs face barriers at 3 different levels when engaging with genetic services: systems, providers, and patients. This study identified strategies that PCPs use to address these barriers, which are dependent on individual resources and practice settings. These strategies demonstrate resourcefulness in working to incorporate genetics into clinics operating at maximum capacity. By targeting barriers that uniquely impact providers, systems, and patients, as well as building upon strategies that PCPs are already using, medical providers can support PCPs to help with the provision of genetic services.
The Ownership, Innovation, and Sustainable Development of Micro and Small Enterprises: Evidence of China
Authors: Chen Fuzhong , Li Haifeng , Wei Huini , Nelson Wani
Published: November 2022

This study aims to examine the impacts of ownership and innovation on the sustainable development of micro and small enterprises (MSEs). Using the dataset from the 2015 China Micro and Small Enterprise Survey, this study divides the ownership of MSEs into state ownership, collective ownership, private ownership, and foreign ownership. In this study, the sustainable development of MSEs is measured by four sets of variables, sustainable operation, sustainable profitability from operations, sustainable profit input, and sustainable production or operation input. The Result suggests negative associations between the ownership of state-owned enterprises as well as collective-owned enterprises and MSEs’ sustainable development. Furthermore, public ownership also negatively contributes to MSEs’ sustainable development. Concerning the ownership of non-public-owned enterprises, while private ownership enables MSEs to develop sustainably, foreign ownership is not conducive to MSEs’ sustainable development. Besides, the result also indicates that innovation positively contributes to the sustainable development of MSEs. Moreover, this study offers implications for policymakers to take measures in promoting reform of mixed ownership as well as innovation to enhance MSEs’ sustainable development.
What Radiographic and Clinical Factors Ultimately Necessitate a C2-Sacrum Instrumented Posterior Spinal Fusion?
Authors: Mathew Justin , Zuckerman Scott L , Marciano Gerard , Simhon Matthew , Lin Hannah , Cerpa Meghan , Lee Nathan J , Boddapati Venkat , Lehman Ronald A , Sardar Zeeshan M , Dyrszka Marc D , Lombardi Joseph M , Lenke Lawrence G
Published: November 2022

Objective

/Hypothesis: Patients undergoing C2-sacrum PSF have unique medical histories and multiple prior operations over an extended period.

Design

Single center, retrospective cohort

Methods

Consecutive C2-sacrum PSF patients operated on by 4 surgeons at a single-center from 2015-2020 were reviewed. Demographics, comorbidities, indications, surgical history, and radiographic parameters were collected.

Results

23 patients underwent C2-sacrum PSF. 13 (57%) were male, and 21 (91.3%) were adults. Mean age at time of first spine surgery was 44 years (range 5-71) and 53 years (range 14-72) at the time of C2-sacrum PSF. Six patients (26%) had osteoporosis, and 6 patients (26%) had neurologic comorbidities—including Parkinson’s disease (4), cerebral palsy (1), and Brown Sequard syndrome (1). Four (17%) had connective tissue disease. Two patients underwent C2-sacrum PSF as an index procedure: (1) 67M with myelomatous fractures and 124° of cervicothoracic kyphosis; (2) 28F with severe Marfan syndrome with 140° thoracic scoliosis and 130° thoracic kyphosis. The remaining 21 (91%) underwent C2-sacrum PSF as a revision following prior spinal surgeries on average, 4 previous surgeries (range 1-13) over 10.5 years (range .3-37.4). Indications for the remaining 21 C2-sacrum PSF revision procedures included 17 (81%) for kyphosis (5 of whom also had significant coronal deformity), 1 (5%) for only coronal malalignment, 2 (10%) for instrumentation failure, and 1 (5%) for myelopathy.

Conclusions

91% (21/23) of patients requiring C2-sacrum PSF were treated as revisions of prior fusions, with a mean of 4 prior surgeries over 10 years. Over 80% of these patients underwent C2-sacrum PSF to address kyphosis. 26% had neurologic conditions, and 26% had osteoporosis.
Antibacterial multicomponent electrospun nanofibrous mat through the synergistic effect of biopolymers
Authors: Shahid Md. Abdus , Hasan Md. Mehedi , Alam Md Rubel , Mohebullah Md , Chowdhury Mohammad Asaduzzaman
Published: November 2022

The endeavor was to adopt a facile bi-layered approach to fabricate a novel PVA-chitosan-collagen-licorice nanofibrous mat (PCCLNM) with maintaining the spinning parameters and conditions to assess the synergistic antibacterial action of two biopolymers and having properties for repairing tissues. Bonding behavior, morphological orientation, antibacterial activity, and moisture management features of the electrospun nanofibrous mat were investigated using various characterization techniques. The FTIR analysis of the manufactured nanofibrous mat revealed characteristic peaks of licorice, chitosan, collagen, and PVA polymer, confirming the presence of all polymers in the sample. Additionally, a scanning electron microscopy (SEM) image attributes the development of nanofibers with an average diameter for top and bottom sides were 219 and 188 nm respectively. Furthermore, moisture management tests (MMT) confirm PCCLNM’s slow absorption and drying capabilities. Apart from that, a disk diffusion method was used to investigate antibacterial activity against the bacteria Staphylococcus aureus (S. aureus), which revealed a strong presence of antibacterial activity with a 20 mm zone of inhibition due to the chemical constituents of licorice and chitosan compound. The developed bio-nanocomposite could have a potential application as wound healing material.
Explaining the Racial School Climate Gap: Evidence From Georgia
Authors: Graham Jerome
Published: November 2022

Research documents positive associations between school climate and student outcomes, and, as such, many policymakers have positioned it among their chief priorities for school improvement. Despite this increased focus, extant research has offered mixed findings on the presence and magnitude of racial school climate disparities. The present study uses administrative data of middle and high schools in Georgia to examine disparities in school-climate perceptions and factors predicting them. I find that Black and “Other” students consistently report worse perceptions on nearly all measures of school climate compared to White students and that these disparities persist within school. Furthermore, Black teachers moderate Black students’ climate perceptions and are critical protective factors against the risks they face in school. Implications suggest that an increased focus on school climate is unlikely to yield equitable returns absent ancillary policy and practices that improve schooling conditions influencing disparities in students’ school climate perceptions.
Perceived Occupational Stressors and the General Health of Critical Care Nurses During COVID-19 Pandemic
Authors: Al-Ghabeesh Suhair Hussni , Al-Awayssa Raid Mahmmud , Rayan Ahmad Hussien , Assaf Enas A
Published: November 2022

Introduction

The COVID-19 situation is placing nurses under great stress which may negatively influence their health.

Objective

The purpose of this study was to examine the association between occupational stress and general health of critical care nurses during COVID-19 pandemic.

Methods

A descriptive, cross-sectional design was used. A convenience sample of 150 Jordanian critical care nurses completed the study.

Results

Occupational stress was a significant predictor of nurses’ general health. Female gender, young, living with elderly or persons having chronic diseases, and little nursing experience were associated with worse general health, while living with elderly or persons having chronic diseases were associated with more occupational stress.

Conclusion

Providing psychological support services for critical care nurses is required to reduce the impact of occupational stress on nurses’ poor general health.
Exploring the role of accessibility in shaping retail location using space syntax measures: A panel-data analysis in Lisbon, 1995–2010
Authors: Colaço Rui , de Abreu e Silva João
Published: November 2022

Although location theory is now almost two centuries old, the firms' location choice processes areyet to be fully understood. And while accessibility, in some form, has long been used as an explanatory factor, spatial configuration measures (space syntax) have hardly been used in location models, and longitudinal analyses have also been infrequent. Therefore, a panel multinomial logit model is implemented in Lisbon to explore the role of this specific type of accessibility measures in shaping firm location, throughout a 15-year period, using data from 1995, 2002 and 2010. The analysis is focused on retail activity (five retail categories), restaurants and cafes. The results show that firm location can persistently be related to Local integration and Choice, although the magnitude of the relationship changes depending on the commercial category. These results reinforce the general idea that good urban design can potentially counteract information costs and help commerce locate in new areas of the city while allowing it to continue to succeed in the city’s older, more central areas.
Doing environmental justice: Prospects for sustainable engagement—From classroom to fieldwork
Authors: Butt Bilal
Published: November 2022

In response to national attention on questions of how racial justice is still unrealized, different academic institutes have sought to increase diversity and justice in their curricula, institutional practices, and immersive experiences for their students. This has normally taken the form of diversity, equity, and inclusion principles. Yet there remain significant obstacles to how inequities and lack of attention to power differential across race, class, and gender continue to create imbalances that affect the ability to conduct just research. In this piece, I describe six critical points of engagement for sustainable engagement for just research. These concerns range from the field to the classroom and identify how existing structures can reinforce dominant narratives and understandings linked to colonial histories of extraction and the exploitation of knowledge. I offer tangible and credible alternatives for grounding knowledge generation in ways that are less restrictive than the coercive practices of the past.
Experiences of trauma and alcohol and other drug use by domestic, family, and sexual violence offenders: A review of 6 months of sentencing remarks from the Supreme Court of the Northern Territory, Australia
Authors: Clifford Sarah , Wright Cassandra JC , Livingston Michael , Smith James A , Griffiths Kalinda E , Miller Peter G
Published: November 2022

The Northern Territory (NT) has the highest rates of domestic, family and sexual violence (DFSV) in Australia. Although we know that alcohol and other drug (AOD) use and trauma both contribute to DFSV in the NT, some specifics remain unknown. This paper aims to (a) describe the extent of AOD involvement in criminally serious DFSV, (b) describe the volume of trauma experienced by convicted criminally serious DFSV offenders, and (c) qualitatively explore the judicial recognition of the intersections between alcohol and trauma. To do this we reviewed Judicial Sentencing Remarks (JSRs) from the Supreme Court of the NT. A content analysis of all DFSV JSRs from July to Dec 2020 was undertaken ( n = 64). A structured coding instrument was developed to extract quantitative and qualitative variables through repeated reviews by multiple authors. Descriptive statistics regarding demographics, number of significant traumatic events experienced, and AOD involvement were generated. The qualitative data from which these statistics were generated was used to explore the interplay between trauma and AOD involvement. The majority of offenders had experienced at least one form of trauma. The social determinants of health underpinned a significant amount of this trauma, with housing, poverty, and unemployment frequently described. The use of alcohol as a maladaptive coping mechanism was explicitly recognised. There was frequent judicial recognition of the intersections between trauma, alcohol, and violence, however addressing trauma as an essential part of rehabilitation processes was rare. Trauma and AOD use were widespread among convicted DFSV offenders, with alcohol involved in the majority of incidents. Further research is required to understand the bio-psycho-social factors involved in the relationship between trauma, alcohol, and DFSV. Systematic piloting and trialling of interventions is necessary to determine what approaches are effective for preventing DFSV and reducing recidivism for people with intersecting experiences of trauma and AOD concerns.
Occupational asthma due to heated polypropylene
Authors: Malo JL , Cartier A , Pineault L , Dugas M , Desjardins A
Published: November 2022

A 35 year-old nonatopic woman was referred to the hospital for possible work-related asthma. She had worked as an operator, at a plant producing polypropylene bags, for the previous four yrs. Her main complaint was a productive cough with dyspnoea and wheezing, as well as rhinitis over the past 3 yrs. She had been absent from work for 6 months on maternity leave, and had improved greatly. She was on a beta 2-adrenergic agent and had to take it at least four times daily. Baseline spirometry whilst at work showed marked airflow obstruction (forced expiratory volume in one second (FEV1) of 43% predicted (pred). After two months away from work FEV1 improved to 89% pred; provocative concentration of histamine causing a 25% fall in FEV1 (PC20) was 3.6 mg.ml-1 (mild airway hyperresponsiveness). Return to work resulted in a marked deterioration in FEV1, and serial peak expiratory flow (PEFR) values. PC20 was 0.11 mg.ml-1 (severe airway hyperresponsiveness) one week after she had returned to work. Specific inhalation challenges with polypropylene heated to 250 degrees C resulted in a late asthmatic reaction. As formaldehyde is one of the degradation products of heating polypropylene, we exposed her to it for up to 2 h, but we elicited no bronchospastic reaction. We conclude that heated polypropylene should be listed as one of the agents that causes occupational asthma.
Can breeders prevent pathogen adaptation when selecting for increased resistance to infectious diseases?
Authors: Hulst Andries D. , Bijma Piter , De Jong Mart C. M.
Published: November 2022

Background

Recent research shows that genetic selection has high potential to reduce the prevalence of infectious diseases in livestock. However, like all interventions that target infectious diseases, genetic selection of livestock can exert selection pressure on pathogen populations. Such selection on the pathogen may lead to escape strategies and reduce the effect of selection of livestock for disease resistance. Thus, to successfully breed livestock for lower disease prevalence, it is essential to develop strategies that prevent the invasion of pathogen mutants that escape host resistance. Here we investigate the conditions under which such “escape mutants” can replace wild-type pathogens in a closed livestock population using a mathematical model of disease transmission.

Results

Assuming a single gene that confers sufficient resistance, results show that genetic selection for resistance in livestock typically leads to an “invasion window” within which an escape mutant of the pathogen can invade. The bounds of the invasion window are determined by the frequency of resistant hosts in the population. The lower bound occurs when the escape mutant has an advantage over the wild-type pathogen in the population. The upper bound occurs when local eradication of the pathogen is expected. The invasion window is smallest when host resistance is strong and when infection with the wild-type pathogen provides cross immunity to infection with the escape mutant.

Conclusions

To minimise opportunities for pathogens to adapt, under the assumptions of our model, the aim of disease control through genetic selection should be to achieve herd-level eradication of the infection faster than the rate of emergence of escape mutants of the pathogen. Especially for microparasitic infections, this could be achieved by placing animals into herds according to their genetic resistance, such that these herds stay completely out of the invasion window. In contrast to classical breeding theory, our model suggests that multi-trait selection with gradual improvement of each trait of the breeding goal might not be the best strategy when resistance to infectious disease is part of the breeding goal. Temporally, combining genetic selection with other interventions helps to make the invasion window smaller, and thereby reduces the risk of invasion of escape mutants.
Design and feasibility of an implementation strategy to address Chagas guidelines engagement focused on attending women of childbearing age and children at the primary healthcare level in Argentina: a pilot study
Authors: Klein Karen , Roberti Javier , Rouvier Mariel , Belizan Maria , Cafferata Maria Luisa , Berrueta Amanda Mabel , Alonso Juan Pedro
Published: November 2022

Background

Chagas is a public health problem, especially in Latin America, exacerbated by migratory movements and increasing urbanization. Argentina is among the countries with the highest estimated prevalence in the region, with 1,500,000 people infected, with mother to child as the main mode of transmission. Vertical transmission has been significantly reduced by treating women of childbearing age; several guidelines in the region recommend treatment as a primary prevention strategy for the child and a secondary prevention strategy for women and their families. Despite recommendations, women of childbearing age are not always treated, and children do not receive timely diagnosis and treatment. The objective of this research was to design an implementation strategy to improve using Chagas guidelines focused on attending women of childbearing age and children at the primary healthcare level and pilot it in three primary health care centers in Argentina.

Methods

We conducted a pilot feasibility study using the Consolidated Framework for Implementation Research. A qualitative process evaluation was conducted using semi-structured interviews with health care providers and observations in primary health care centers.

Results

We developed a multifaceted implementation strategy including training, flowcharts and reminders, a register of suspected and confirmed cases, and the selection of a management facilitator. The pilot study took place between September 2019 and May 2020. The implementation level was heterogeneous and varied depending on the components, being the facilitating factors, the simplicity of the intervention, professionals’ willingness to expand the indication of serologic tests, and staff commitment to the adoption of intervention components. The main barriers found were the change of authorities at the local level, some professionals´ reluctance to administer etiological treatment, staff shortages, lack of diagnostic supplies, and the health emergency caused by the COVID-19 pandemic.

Conclusions

Behavioral change strategies should be applied to improve implementation to address some of the main barriers, including support actions offered by opinion leaders, medical experts, and local health authorities. Rapid diagnostic tests should be readily available to maintain behavior changes. We suggest further refinement of the strategy and its implementation in more centers to assess outcomes prospectively with a hybrid implementation research design.
Reproducibility and repeatability of a semi-automated pipeline to quantify trapeziometacarpal joint angles using dynamic computed tomography
Authors: Kuczynski Michael T. , Wang Kendra , Tse Justin J. , Bugajski Tomasz , Manske Sarah L.
Published: November 2022

Background

The trapeziometacarpal (TMC) joint is a mechanically complex joint and is commonly affected by musculoskeletal diseases such as osteoarthritis. Quantifying in vivo TMC joint biomechanics, such as joint angles, with traditional reflective marker-based methods can be difficult due to the joint’s location in the hand. Dynamic computed tomography (CT) can facilitate the quantification of TMC joint motion by continuously capturing three-dimensional volumes over time. However, post-processing of dynamic CT datasets can be time intensive and automated methods are needed to reduce processing times to allow for application to larger clinical studies. The purpose of this work is to introduce a fast, semi-automated pipeline to quantify joint angles from dynamic CT scans of the TMC joint and evaluate the associated error in joint angle and translation computation by means of a reproducibility and repeatability study.

Methods

Ten cadaveric hands were scanned with dynamic CT using a passive motion device to move thumbs in a radial abduction–adduction motion. Static CT scans and high-resolution peripheral quantitative CT scans were also acquired to generate high-resolution bone meshes. Abduction–adduction, flexion–extension, and axial rotation angles were computed using a joint coordinate system. Reproducibility and repeatability were assessed using intraclass correlation coefficients, Bland–Altman analysis, and root mean square errors. Target registration errors were computed to evaluate errors associated with image registration.

Results

We found good repeatability for flexion–extension, abduction–adduction, and axial rotation angles. Reproducibility was moderate for all three angles. Joint translations exhibited greater repeatability than reproducibility. Specimens with greater joint degeneration had lower repeatability and reproducibility. We found that the difference in resulting joint angles and translations were likely due to differences in segment coordinate system definition between multiple raters, rather than due to registration errors.

Conclusions

The proposed semi-automatic processing pipeline was fast, repeatable, and moderately reproducible when quantifying TMC joint angles and translations. This work provides a range of errors for TMC joint angles from dynamic CT scans using manually selected anatomical landmarks.
Ertapenem-induced neurotoxicity in an end-stage renal disease patient on intermittent haemodialysis: a case report
Authors: Shahar Shamira , Arimuthu Durga A. , Mazlan Sadanah Aqashiah
Published: November 2022

Background

Carbapenem-induced neurotoxicity is an unusual side effect, with seizure being the most commonly reported symptom. Among the carbapenems, imipenem-cilastin is classically associated with the most severe neurotoxicity side effects. Carbapenem is mainly excreted by the kidney and its half-life is significantly increased in patients with chronic kidney disease (CKD). Therefore, dose adjustment is necessary in such patients. Ertapenem-associated neurotoxicity is increasingly being reported in CKD patients, but rarely seen in patients with recommended dose adjustment.

Case presentation

We report a case of a 56-year-old male patient with chronic kidney disease 5 on dialysis(CKD 5D). The patient presented with a history of fever, chills and rigours during a session of haemodialysis (HD). He was diagnosed with Enterobacter cloacae catheter-related blood stream infection and was started on ertapenem. After 13 days of ertapenem, he experienced an acute confusional state and progressed to having auditory and visual hallucinations. His blood investigations and imaging results revealed no other alternative diagnosis. Hence a diagnosis of ertapenem-induced neurotoxicity was made. He had complete resolution of symptoms after 10 days’ discontinuation of ertapenem.

Conclusion

Our case draws attention to the risk of potentially serious toxicity of the central nervous system in HD patients who receive the current recommended dose of ertapenem. It also highlights that renal dosing in CKD 5D patients’ needs to be clinically studied to ensure antibiotic safety.
The effects of pregnancy discrimination on postpartum depressive symptoms: a follow-up study
Authors: Kachi Yuko , Fujiwara Takeo , Inoue Akiomi , Baba Sachiko , Eguchi Hisashi , Ohta Hiroshi , Tsutsumi Akizumi
Published: November 2022

Background

Pregnancy discrimination in the workplace is prevalent worldwide. However, few studies have examined the effects of pregnancy discrimination on mothers’ perinatal mental health. We aimed to investigate the association between pregnancy discrimination and postpartum depressive symptoms, and the mediation effects of prenatal depressive symptoms on this association.

Methods

Our sample consisted of 285 Japanese women employed during pregnancy who completed a baseline online survey in May 2020 and a follow-up mail survey two months postpartum. Pregnancy discrimination was defined as exposure to any of 16 forms of disadvantageous treatment or harassment related to pregnancy, prohibited by national guidelines. Prenatal (assessed at baseline) and postpartum (assessed at follow-up) depressive symptoms were measured using the Edinburgh Postnatal Depression Scale. Multiple linear regression and mediation analyses were performed overall and stratified by regular (permanent) and non-regular (precarious) employees.

Results

Overall, 23.9% of participants experienced pregnancy discrimination during pregnancy. After adjusting for potential confounders, pregnancy discrimination was significantly associated with postpartum depressive symptoms (coefficient 1.76, 95% confidence interval [CI] 0.65–2.88). When stratified by employment type, these effects were observable among non-regular employees (coefficient 2.51, 95% CI 0.45–4.57) but not regular employees. Mediation analysis showed that prenatal depressive symptoms mediated 57.1% (95% CI 20.1–94.1%) of the association between pregnancy discrimination and postpartum depressive symptoms among all participants, with a greater effect among non-regular employees (64.1% [95% CI 18.5–109.8%]).

Conclusions

Pregnancy discrimination has adverse effects on postpartum depressive symptoms, partially through prenatal depressive symptoms, especially among non-regular employees. To prevent perinatal depression in female workers, employers should comply with legislation and take preventive measures against pregnancy discrimination, while considering vulnerable employees.
Two cases of infantile-onset primary generalized glucocorticoid hypersensitivity and the effect of mifepristone
Authors: Zhao Xiu , Xu Zhongwei , Su Huiping , Zheng Rongfei , Zhan Min , Huang Yuge , Su Zhe
Published: November 2022

Background

Primary generalized glucocorticoid hypersensitivity (PGGH) is a very rare disease caused by terminal organ hypersensitivity to glucocorticoids for which the aetiology is unknown. The incidence of PGGH is extremely rare, especially in children. To date, the literatures about the etiology, prognosis and treatment of PGGH are scarce. Aim of the study is describing the cases of two Chinese children with infantile-onset PGGH in one family, one of whom died and one who was treated with mifepristone. They are the two youngest children with PGGH reported in the literature.

Case presentation

Two siblings with infantile-onset PGGH were affected in this family. The main manifestations of patient 1 were typical Cushing’s syndrome-like manifestations, significantly aggravated symptoms after physiological doses of glucocorticoids and very low levels of serum cortisol and adrenocorticotropin hormone (ACTH) during attacks. After being diagnosed with PGGH, he was given guidance to avoid glucocorticoids and took mifepristone therapy for 5 months, and his symptoms improved. Patient 2 was the younger brother of patient 1, with similar manifestations to his brother at the age of 4 months. Patient 2 ultimately died at the age of 9 months.

Conclusion

PGGH is a very rare disease that can lead to death if not diagnosed and treated in a timely manner. This article describes the cases of the two youngest children with PGGH reported in the literature, one of whom improved after mifepristone treatment, and increases the knowledge of the clinical manifestations of and the treatment experience in PGGH.
Registration based assessment of femoral torsion for rotational osteotomies based on the contralateral anatomy
Authors: Hoch Armando , Hasler Julian , Schenk Pascal , Ackermann Jakob , Ebert Lars , Fürnstahl Philipp , Zingg Patrick , Vlachopoulos Lazaros
Published: November 2022

Background

Computer-assisted techniques for surgical treatment of femoral deformities have become increasingly important. In state-of-the-art 3D deformity assessments, the contralateral side is used as template for correction as it commonly represents normal anatomy. Contributing to this, an iterative closest point (ICP) algorithm is used for registration. However, the anatomical sections of the femur with idiosyncratic features, which allow for a consistent deformity assessment with ICP algorithms being unknown. Furthermore, if there is a side-to-side difference, this is not considered in error quantification.

The aim of this study was to analyze the influence and value of the different sections of the femur in 3D assessment of femoral deformities based on the contralateral anatomy.

Material and methods

3D triangular surface models were created from CT of 100 paired femurs (50 cadavers) without pathological anatomy. The femurs were divided into sections of eponymous anatomy of a predefined percentage of the whole femoral length. A surface registration algorithm was applied to superimpose the ipsilateral on the contralateral side. We evaluated 3D femoral contralateral registration (FCR) errors, defined as difference in 3D rotation of the respective femoral section before and after registration to the contralateral side. To compare this method, we quantified the landmark-based femoral torsion (LB FT). This was defined as the intra-individual difference in overall femoral torsion using with a landmark-based method.

Results

Contralateral rotational deviation ranged from 0° to 9.3° of the assessed femoral sections, depending on the section. Among the sections, the FCR error using the proximal diaphyseal area for registration was larger than any other sectional error. A combination of the lesser trochanter and the proximal diaphyseal area showed the smallest error. The LB FT error was significantly larger than any sectional error (p < 0.001).

Conclusion

We demonstrated that if the contralateral femur is used as reconstruction template, the built-in errors with the registration-based approach are smaller than the intraindividual difference of the femoral torsion between both sides. The errors are depending on the section and their idiosyncratic features used for registration. For rotational osteotomies a combination of the lesser trochanter and the proximal diaphyseal area sections seems to allow for a reconstruction with a minimal error.
Fatal overdose from injection of human growth hormone; a case report and review of the literature
Authors: Erfanifar Azam , Mahjani Mahsa , Gohari Sepehr , Hassanian-Moghaddam Hossein
Published: November 2022

Background

Human growth hormone (HGH) is a categorized as a performance-enhancing substance. HGH has been abused by athletes for doping purposes.

Case presentation

We present a first lethal case of HGH acute toxicity. A young-agitated-athlete with a history of somatropin for the past 2-year, who had hallucinations referred to the emergency department reporting to have abused of 300 mg subcutaneous injections of HGH. He was tachycardic with mild hypertension. Lab data revealed hypernatremia (157 mEq/L), hyperkalemia (5.3 mEq/L), high LDH (1448 U/L), and CPK (2620 U/L), in favor of rhabdomyolysis. Routine drug screening tests were negative for all substances. He was intubated due to low O2 saturation and progressive loss of consciousness. After several episodes of hyperthermia, hypertension, and possibly pulmonary embolism, he died subsequent to somatropin overdose.

Conclusions

Complications of HGH misuse can be life-threatening and athletes should be warned of its deleterious effects.
Trend changes and factor analysis of endometrial hyperplasia in patients with polycystic ovarian syndrome based on the Korean National Health Insurance Database
Authors: Park Bora , Lee Hakmo , Park Suyeon , Lee Eun Sil , Lee Jeong Jae , Lee Young , Seo Je Hyun
Published: November 2022

Background

Polycystic ovary syndrome (PCOS) is a common endocrine disorder associated with an increased risk of other gynecological disorders, such as endometrial hyperplasia (EH). However, substantial factors in the comorbidity of EH and PCOS remain to be investigated. We analyzed trend changes in PCOS and factors related to the comorbidity of PCOS and EH using data from the Korea National Health Insurance (KNHI) claims database.

Methods

The data for this population-based study of people diagnosed with PCOS or EH in Korea from 2009 to 2016 were collected from the KNHI claims database between 2007 and 2017. We conducted a trend analysis of the prevalence and incidence of PCOS and EH. In addition, we performed a logistic regression analysis to identify risk factors associated with EH incidence in people with PCOS using the matched case-control methodology.

Results

The average annual growth rate of the incidence of PCOS was 14.1% from 2009 to 2016, whereas the EH rate increased by only 3.4% annually. Comorbidities, type 2 diabetes, obesity, hypertension, hyperlipidemia, and infertility, increased the risk of EH in PCOS patients. Additionally, the cumulative duration of oral contraceptive & progestin treatment for PCOS correlated highly with the comorbidity of EH and PCOS.

Conclusions

We confirmed the relationship between PCOS and EH using big data suitable for time series analyses of the diagnosis and treatment of diseases. Endometrial evaluation should be done with more caution if oral contraceptives & progestins have been used for a long time.
Risk factors for natural menopause before the age of 45: evidence from two British population-based birth cohort studies
Authors: Peycheva Darina , Sullivan Alice , Hardy Rebecca , Bryson Alex , Conti Gabriella , Ploubidis George
Published: November 2022

Background

Menopause that occurs before the age of 45 and is not medically induced (referred to here as ‘early natural menopause’) affects around one in 10 women and has serious health consequences. These consequences include increased risk of all-cause mortality, cardiovascular disease, osteoporosis, and type 2 diabetes.

Methods

We investigate risk factors for the onset of natural menopause before the age of 45 in two population-based prospective cohort studies in Britain: the 1958 cohort following 8959 women and the 1970 cohort following 8655 women. These studies follow women from birth to adulthood, and we use harmonized data on birth and early life characteristics, reproductive health, health behaviour, and socioeconomic characteristics for 6805 women who were pre-menopausal, peri-menopausal or had undergone natural menopause. Of these 6805 women, 3614 participated in the 1958 cohort (of which 368 had early menopause) and 3191 participated in the 1970 cohort (of which 206 had early menopause). Taking a life course approach, we focus on three distinct life stages - birth/early life, childhood, and early adulthood - to understand when risk factors are most harmful. Respecting the temporal sequence of exposures, we use a series of multivariable logistic regression models to estimate associations between early menopause and each potential risk factor adjusted for confounders.

Results

We find that early menopause is influenced by circumstances at birth. Women born in lower social class families, whose mother smoked during the pregnancy or who were breastfed 1 month or less were more likely to undergo early menopause. Early menopause is also associated with poorer cognitive ability and smoking in childhood. Adult health behaviour also matters. Smoking is positively correlated with early menopause, while regular exercise and moderate frequency of alcohol drinking in women’s early thirties are associated with reduced risk of early menopause. The occurrence of gynaecological problems by women’s early thirties is also linked to early menopause.

Conclusions

We demonstrate that characteristics at different periods of life are associated with early menopause. Some of these associations relate to modifiable behaviours and thus the risks of early menopause and the adverse health outcomes associated with it may be preventable.
The relationship between menopausal syndrome and gut microbes
Authors: Liu Yaqian , Zhou Ying , Mao Ting , Huang Yanmei , Liang Jingtao , Zhu Min , Yao Peixun , Zong Yun , Lang Jianying , Zhang Yingxuan
Published: November 2022

Background

Gut microbes were closely related to women’s health. Previous studies reported that the gut microbes of premenopausal women were different from those of postmenopausal women. However, little was known about the relationship between gut microbiota dysbiosis and menopausal syndrome (MPS). The aim of this study was to explore the relationship between MPS and gut microbes.

Methods

Patients with MPS (P group,n = 77) and healthy women (H group,n = 24) at menopause were recruited in this study. The stool specimen and clinical parameters (demographic data, follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2), et al) of participants’ were collected. We evaluated the differences in gut microbes by 16S ribosomal RNA gene sequencing. We used LEfSe to identify gut microbes with varying abundances in different groups. The Spearman correlation coefficients of clinical parameters and gut microbes were calculated. PICRUSt was used to predict the potential KEGG Ortholog functional profiles of microbial communities.

Results

The abundance of 14 species differed substantially between the MPS and menopausal healthy women (LDA significance threshold > 2.0) according to LEfSe analysis. Using Spearman’s correlation analysis, it was discovered that E2 had a positive correlation with Aggregatibacter segnis, Bifidobacterium animalis, Acinetobacter guillouiae(p< 0.05, these three species were enriched in menopausal healthy women), while FSH and LH had a negative correlation with them (p< 0.05). KEGG level3 metabolic pathways relevant to cardiovascular disease and carbohydrate metabolism were enriched in the MPS (p< 0.05), according to functional prediction by PICRUST and analyzed by Dunn test.

Conclusion

There was gut microbiota dysbiosis in MPS, which is reflected in the deficiency of the abundance ofAggregatibacter segnis,Bifidobacterium animalisandAcinetobacter guillouiaerelated to the level of sex hormones. In MPS individuals, species with altered abundances and unique functional pathways were found.
Effects of qigong exercise on the physical and mental health of college students: a systematic review and Meta-analysis
Authors: Lin Jianping , Gao Yi fang , Guo Yue , Li Ming , Zhu Yuxiang , You Ruoshi , Chen Shaoqing , Wang Shizhong
Published: November 2022

Background

Physical and mental health problems are becoming more serious among college students due to lifestyle changes and increased academic stress. Qigong exercise has been regarded as a potentially effective intervention to improve the physical and mental health of college students.

Methods

Eleven databases were searched from their respective inception dates to April 2022. Relevant randomized controlled trials (RCTs) were included. Physical and psychological conditions, including limb muscle strength, flexibility, cardiorespiratory endurance, vital capacity, blood pressure and heart rate, as well as depression, anxiety and mood, were evaluated. The risk of bias was assessed with the Cochrane Collaboration tool.

Results

Sixteen randomized controlled trials were included in the meta-analysis. Significant improvements in cardiorespiratory endurance (MD = 3.83, 95% CI: 0.99 to 6.67, P = 0.008) and flexibility (MD = 3.01, 95% CI: 1.21 to 4.81, P = 0.001) were observed. We also observed that Qigong exercise significantly reduced depression and anxiety symptoms (SMD=-0.89, 95% CI: -1.17 to -0.61, P < 0.00001; SMD=-0.78, 95% CI: -1.31 to -0.25, P = 0.004). Nevertheless, no significant effects on muscle strength, vital capacity, blood pressure, heart rate or mood were found.

Conclusion

Qigong exercise was advantageous for college students in terms of improving flexibility and cardiorespiratory endurance and alleviating depression and anxiety to some extent. However, due to the limited number of eligible trials and the low methodological quality, more well-designed RCTs are needed in the future.
Association of maternal levothyroxine use during pregnancy with offspring birth and neurodevelopmental outcomes: a population-based cohort study
Authors: Ge Grace Mengqin , Cheung Edmund C. L. , Man Kenneth K. C. , Ip Patrick , Leung Wing Cheong , Li Gloria H. Y. , Kung Annie W. C. , Cheung Ching-Lung , Wong Ian C. K.
Published: November 2022

Background

The influence of maternal levothyroxine treatment during pregnancy remains unclear. This study aimed to evaluate the associations of maternal levothyroxine treatment during pregnancy with the birth and neurodevelopmental outcomes in offspring.

Methods

This population-based cohort study was conducted among pregnant women using the Hong Kong Clinical Data Analysis and Reporting System. Mother-child pairs in Hong Kong from 2001 to 2015 were included and children were followed up till 2020. We defined the exposure group as mothers who were exposed to levothyroxine during pregnancy. Preterm birth and small for gestational age (SGA) were included as birth outcomes. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) were included as neurodevelopmental outcomes. Odds ratios (OR) or hazard ratios (HRs) with a 95% confidence interval (CI) were evaluated to assess the association of gestational levothyroxine use with offspring birth and neurodevelopmental outcomes respectively, using propensity score fine-stratification weighting and a Cox proportional hazards regression model.

Results

Among 422,156 mother-child pairs, 2125 children were born from mothers exposed to levothyroxine during pregnancy. A significantly increased risk of preterm birth was observed in children with maternal levothyroxine exposure during pregnancy, when compared to mothers who had no history of thyroid-related diagnoses or prescriptions (weighted OR [wOR]: 1.22, 95% CI: 1.07, 1.39). Similarly, an increased risk of preterm birth was found among children of gestational levothyroxine users, when compared to children of mothers who had used levothyroxine before but stopped during pregnancy (wOR: 2.16, 95% CI: 1.09, 4.25). Sensitivity analysis, by excluding mothers exposed to psychotropic or antiepileptic medications before or during pregnancy, also indicated a similar increased risk of preterm birth regarding the gestational use of levothyroxine (wOR: 1.26, 95% CI: 1.10, 1.45). No significant association was observed for the risk of SGA, ADHD, and ASD.

Conclusions

There is no evidence that gestational use of levothyroxine is associated with SGA, ADHD, or ASD in offspring. Gestational levothyroxine treatment is associated with a higher risk of preterm birth. Such risk might be confounded by the underlying maternal thyroid disease itself, however, we cannot completely exclude the possible effect of gestational L-T4 treatment on offspring preterm birth. Our findings provided support to the current guidelines on the cautious use of levothyroxine treatment during pregnancy.