bluuebunny/crossref_metadata_2025 huggingface dataset:
Disease-Specific health literacy in Iranian patients with chronic obstructive pulmonary disease: A cross-sectional study
Authors: Raddadi Yasaman , Adib-Hajbaghery Mohsen
Published: October 2023

Background and Objective:
Chronic obstructive pulmonary disease (COPD) is a progressive and chronic illness with substantial somatic, emotional, and social magnitudes that negatively affect the patient’s quality of life. The purpose of this study was to assess the disease-specific health literacy (DSHL) of patients with COPD and some of the influencing factors.
Materials and Methods:
A descriptive correlational study was carried out from May to December 2019. A total of 270 patients with COPD were enrolled in this study from those who were referred to Shahid-Beheshti Hospital in Kashan, Iran. The Chronic Obstructive Pulmonary Disease Knowledge Questionnaire (COPD-Q) was used to collect data. Descriptive statistics, Pearson and Spearman correlation coefficient, analysis of variance, and linear regression analysis were employed for data analysis.
Results:
The average age of the patients was 59.48±13.31 years and they had COPD for an average of 3.47±3.85 years. The mean DSHL score was 4.32±1.89.
Conclusion:
DSHL of patients with COPD was at a low level. Healthcare workers are suggested to design and implement effective interventions to expand the DSHL of patients with COPD.
Statins, ACE/ARBs drug use and risk of pneumonia in hospitalized older patients: a retrospective cohort study
Authors: Franchi Carlotta , Rossio Raffaella , Mandelli Sara , Ardoino Ilaria , Nobili Alessandro , Peyvandi Flora , Mannucci Piermannuccio
Published: October 2023

Aims: To evaluate the association between angiotensin-converting enzyme inhibitor (ACE-I), angiotensin II receptor blocker (ARBs) and/or statin use with the risk of pneumonia, and with in-hospital and short-term outpatient mortality in hospitalized older patients with pneumonia.
Methods: Patients aged 65 years or older hospitalized in internal medicine and/or geriatric wards throughout Italy and enrolled in the REPOSI (REgistro POliterapuie SIMI - Società Italiana di Medicina Interna) register from 2010 to 2019 were screened to assess diagnosis of pneumonia and classified on whether or not they were prescribed with at least one drug among ACE-I, ARBs and/or statins. Further study outcomes were mortality during hospital stay and at 3 months after hospital discharge.
Results: Among 5717 cases included (of whom 18.0% with pneumonia), 2,915 (51.0%) were prescribed at least one drug among ACE-I, ARBs and statins. An inverse association was found between treatment with ACE-I or ARBs and pneumonia (OR= 0.79, 95%CI: 0.65-0.95). A higher effect was found among patients treated with ACE-I or ARBs in combination with statins (OR=0.67, 95% CI: 0.52-0.85).
Conclusion: This study confirmed in the real-world setting that these largely used medications may reduce the risk of pneumonia in older people, who chronically take them for cardiovascular conditions.
Pigmented Paravenous Retinochoroidal Atrophy (PPRCA): a systematic review
Authors: Phiri Peter , Sajid Sana , Delanerolle Gayathri , Shi Jian , De Salvo Gabriella
Published: October 2023

Background
Pigmented paravenous retinochoroidal atrophy (PPRCA) is an uncommon and under-researched eye condition. Although onset and development of the condition is often asymptomatic, PPRCA has very distinguishing features. These are predominantly retinochoroidal atrophy and pigment clumping along the retinal veins. There is no known cause to the condition and no conclusive treatment has been developed. This systematic review aims to provide a holistic account of symptomatology and treatments.
Methods
This systematic review was registered with PROSPERO (CRD42022346753). All epidemiology and observational studies published in English between the 1st of January 1980-1st of August 2022 will be included. The search criteria were developed based upon the research question using PubMed, ESBCOhost, ProQuest, Medline, TRIP database, ScienceDirect Embase, SciELO, The Cochrane Library, and PROSPERO databases. The Critical Appraisal Skills Programme Systematic Review Checklist was used to assess the risk of bias.
Results
The systematic review included 62 papers and a total of 150 participants (54% Female, aged 4 to 82). Only 29% of patients had their ethnicity recorded of which 16 patients were White. Most of the data extracted and analysed was qualitative. Three key themes were uncovered: Symptoms (2 subthemes), Clinical Pathways (4 sub-themes), and Symptom Measurement Tools (5 sub-themes).
Conclusions
PPRCA lacks standardised criteria for diagnosis and treatment, with clinical records and case study publications reporting presentations in an arbitrary manner. To improve patient care and develop a comprehensive understanding of the condition, a methodical and clear clinical pathway framework needs to be developed.
Systematic Review and Meta-Analysis of the Etiology of Menorrhagia in 2,770 adolescent females
Authors: Hall Erin M , Ravelo Ana E , Aronoff Stephen C , Vecchio Michael T Del
Published: October 2023

Background:
Adolescent menorrhagia, heavy menstrual bleeding, or abnormal uterine bleeding commonly occur in adolescent woman. The differential diagnosis can be challenging. The pneumonic: PALM-COEIN(polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified), is commonly used but it does not stratify as to the likelihood of a disorder. We have sought to develop a probability-based differential diagnosis for Adolescent menorrhagia, heavy menstrual bleeding, or abnormal uterine bleeding
Methods:
A comprehensive literature search was conducted using PubMed, EMBASE, and SCOPUS databases. Case series describing adolescents from 10 to 21 years of age with menorrhagia, abnormal uterine bleeding (AUB), or heavy menstrual bleeding (HMB) were acceptable if: more than 10 patients were included; editorials, case reports, and secondary sources such as review articles, or book chapters were excluded. No language filter was used, but an English abstract was required. The etiology of menorrhagia, abnormal uterine bleeding, or heavy menstrual bleeding, and the country of origin was extracted from articles that met inclusion criteria. Cumulative rate estimates were determined by Bayesian probability modeling.
Results:
17 full text articles were reviewed in detail; 2,770 patients were included. The most frequent causes of menorrhagia were Ovarian Uterine Disorders (23.7%; 95% CredI 22-25.5%), Coagulation Disorders (19.4%; 95% CredI 17.8 - 21.1%), and Platelet Disorders (6.23%; 95% CredI 5.27-7.27%) with 45.9% (95% CredI 43.8 - 47.%9) of the cases of indeterminate origin.
Conclusions:
The leading causes of menorrhagia in healthy adolescent females were varied. The sub-analysis identified distinct etiologies, suggesting that multiple factors must be considered in the evaluation of menorrhagia. While PALM-COEIN (polyp, adenomyosis, leiomyoma, malignancy and hyperplasia, coagulopathy, ovulatory dysfunction, endometrial, iatrogenic, and not yet classified) provides us with a comprehensive picture of the possible causes of menorrhagia in females, this systematic review assigns probabilities to the etiologies of menorrhagia in adolescent females, providing physicians with a more focused and efficient pathway to diagnosis.
Suitability of cowpea sprouts to optimize rearing of biocontrol agents Phanerotoma syleptae and Liragathis javana
Authors: Agountcheme Pascal Setondji , Dannon Elie Ayitondji , Datinon Bejamin Dossa , Manbou Aubin , Sinzogan Antonio Alain , Sriniva Ramasamy , Pittendrigh Barry Robert , Tamò Manuele
Published: October 2023

The legume pod borer Maruca vitrata is a key insect pest of cowpea, Vigna unguiculata Walp. The present study was designed to optimize the efficiency of mass rearing two of its biological control agents, the larval parasitoid Liragathis javana and ovo-larval parasitoid Phanerotoma syleptae, by comparing their performance on M. vitrata hosts reared on sprouting grains of 10 different varieties of cowpea as feeding substrate. Thus, 25 M. vitrata larvae of 24 hours old, 25 M. vitrata eggs of 24 hours parasitized by P. syleptae and 25 larvae of 48 hours parasitized by L. javana were reared on sprouts of 10 cowpea varieties in laboratory at a relative humidity of 70–80% and a temperature ranging from 25 to 26°C till pupae stage. Fecundity of M. vitrata and the two parasitoids were assessed per variety. Experiments were replicated 3 times. Results revealed significant difference between varieties for the development of unparasitzed larvae of M. vitrata and L. javana or P. syleptae-parasitized larvae. The cumulative daily fecundity shows different patterns: higher in IT 84D-449 for M. vitrata and L. javana but higher in Kpodji for P. sylepatae. Mortality of parasitized (by L. javana and P. syleptae) larvae and unparasitized (M. vitrata larvae) was lower in Kpodji variety. No significant differences were observed between male and female proportions (sex-ratio), regardless of insect species and cowpea variety except the varieties Tawa and Vitoco in L. javana. Data were discussed with regard to the optimization of mass rearing of the three insect species for the biological control against M. vitrata using L. javana and P. syleptae.
Establishment of a risk prediction model for bowel preparation failure prior to colonoscopy
Authors: Zhang Na , Xu Miaomiao , Chen Xing
Published: October 2023

Background This study aimed to determine the factors that contribute to the failure of bowel preparation in patients undergoing colonoscopy and to develop a risk prediction model.
Methods A total of 1115 patients were included. Patients were randomly divided into two groups: the modeling group (669 patients) and the validation group (446 patients). In the modeling group, patients were further divided into two groups based on their success and failure in bowel preparation using the Boston bowel preparation scale.
Results After controlling for relevant confounders, multifactorial logistic regression results showed that age ≥60 years (OR= 2.246), male (OR= 2.449), body mass index ≥ 24 (OR= 2.311), smoking (OR= 2.467), chronic constipation (OR= 5.199), diabetes mellitus (OR= 5.396) and history of colorectal surgery (OR= 5.170) were influencing factors of bowel preparation failure. The area under the ROC curve was 0.732 in the modeling group and 0.713 in the validation group.
Conclusions According to the calibration plot, the predictive effect of the model and the actual results were in good agreement. Age ≥60 years, male, body mass index ≥ 24, smoking, chronic constipation, diabetes mellitus, and history of colorectal surgery are independent risk factors for bowel preparation failure. The established prediction model has a good predictive efficacy and can be used as a clinical screening tool.
Effect of low-dose esketamine on perioperative neurocognitive disorder and postoperative depressive symptoms in elderly patients undergoing major elective non-cardiac surgery for malignant tumors: A randomized clinical trial
Authors: Cuifang Huang , Xianlong Xie , Yubing Liang , Huijun Dai , Xiangren Chen , Linghui Pan
Published: October 2023

Background: Research on the impact of small-dose esketamine on perioperative neurocognitive disorder and postoperative depressive symptoms in elderly patients is limited. This study aimed to assess whether administering perioperative small-dose esketamine intravenously would reduce the incidence of perioperative neurocognitive disorder and postoperative depressive symptoms in elderly patients with malignant tumors undergoing elective non-cardiac major surgery.
Methods: This trial included 209 patients aged 65 to 86 years undergoing tumor resection who received esketamine (Group E) or not (Group C) during and after surgery. Cognitive function was evaluated using neuropsychological tests as well as the telephone interview for cognitive status-modified (TICSm), and symptoms of depression were assessed using the 17-item Hamilton Depression Rating Scale (HAMD-17).
Results: There was no significant difference in postoperative delirium incidence between patients who received esketamine during surgery and those who did not at 1-5 days post-operation. Group E had 12.0% incidence (13 out of 108 patients), while Group C had 10.9% (11 out of 101). Group E showed significantly better results than group C regarding less time required for the trail making test (Part B) during neuropsychological testing, lower incidence of depression, and lower Hamilton depression score at 3, 7, and 90 days post-surgery.
Conclusions: Small doses of eketamine given perioperatively improved postoperative depression in elderly patients with malignant tumors. Adverse reactions were not significantly increased. It did not significantly affect postoperative delirium and cognitive function, but it facilitated the recovery of social executive abilities.
Trial registration: The study was registered on clinicaltrials.gov.cn on 10/3/2023 (NO. ChiCTR2300069249).
Phleum pratense-pollen adaptive variations and pollen microbiome investigation under different climatic regions and prospects of allergenicity
Authors: Humayun Muhammad , Naseem Saadia , Goodman Richard E , Ali Zahid
Published: October 2023

Phleum pratense is an allergenic grass that pollinates in spring. Databases Allergenonline.org and Allergen.org record ten P. pratense allergens and their isoforms. Phl P 1, Phlp 5 and Phl p 11 are major P. pratense-pollen allergens with demonstrated basophil activity and skin test reactivity. Little is known about P. pratense pollen adaptive variations in different climatic regions and pollen associated microbial diversity. In this study, we collected P. pratense-pollens in the spring season 2022, from three climatic regions (R1, R2 and R3) in Pakistan having difference in mean annual air temperature, mean annual precipitation and elevation. The morphology of pollens was observed by light microscopy, scanning electron microscopy (SEM), biochemical fingerprint analysis and composition of pollens were investigated by fourier-transform infrared spectroscopy (FTIR). The pollen-associated bacterium was identified through Biolog GEN III microplate system. The pollen water-soluble proteins were isolated and stabilized in phosphate buffer saline (PBS) and tested for allergenicity response through dot blots and western blots analysis. Morphological study found difference in pollen biochemical composition. Biolog identified Brevibacterium epidermidis from P. pratense pollens. Protein extracts quantification and sodium dodecyl sulfate-poly acrylamide gel electrophoresis (SDS-PAGE) gel found decreased protein expression in R1 region pollens in comparison to R2 and R3 regions pollens. Allergenicity studies found differential expression of beta-expansin and profilin (allergens) in pollens obtained from three regions. Beta-expansin and profilin were suppressed in R1 pollens, and expressed in R2 and R3 pollens. This is the first study to identify B. epidermidis growth on P. pratense pollen. A variable allergen expression in P. pratense pollens has also been observed in different regions. An increase in mean annual temperature and decrease in mean annual precipitation affected pollen biochemical composition, and inhibited beta-expansin and profilin expression involved in pollen growth and development. Therefore, the findings of the research are unique, which enhances basic knowledge and understanding of P. pratense-pollen associated microbiota and climate change impacts on the pollen allergen expression.
Patients’ experience during vaginal examination and transvaginal ultrasound in a tertiary hospital in Singapore- A Qualitative study
Authors: Lee Jean-Jasmin ML , Cheong Xinyi , Tan Tse Yeun , Zhong Yuting , Chua Caroline SL , Goy Raymond WL , Ang Seng Bin
Published: October 2023

Background
Vaginal digital examination and transvaginal ultrasound are routinely for clinical assessment. Many women find these procedures uncomfortable, embarrassing, and stressful. Negative experiences increase anxiety and discomfort experienced during subsequent examinations. Emotional distress and fear of pain result in women avoiding gynaecological screening and follow-up. This study uses qualitative methods to evaluate the experience of patients who have undergone both vaginal digital and transvaginal ultrasound examinations, collectively called pelvic examinations (PE) in the outpatient setting of a tertiary hospital in Singapore.
Methods
Qualitative semi-structured interviews were conducted on twelve participants aged 30–57 years. Interviews were audio-recorded, transcribed, audited, and analysed iteratively based on grounded theory. Emergent themes were first externally validated and finalized after rounds of deliberations amongst the investigators. This included descriptions and concepts reflecting the most important matters experienced by participants.
Results
Majority of participants found PE unpleasant and uncomfortable especially when providers were perceived to have poor communication and examination skills. Factors that improve their experience include a conducive environment i.e., privacy, dim lights, and warm lubricant. Having adequate information before and during the procedure was important especially for first time.
Conclusion
Patient-centred care ensures a positive experience in relation to the themes found in this study. Gaps in HCP training on communication and procedure skills should be addressed. Efforts should be made improve the clinic environment and provide adequate information to patients.
Visualization of cristae and mtDNA dynamics and interactions with super-resolution microscopy
Authors: Xi Peng , Ren Wei , Ge Xichuan , Li Meiqi , Sun Jing , Li Shiyi , Shan Chunyan , Gao Baoxiang
Published: October 2023

The dynamic interaction between the mitochondrial inner membrane (IM) and mitochondrial DNA (mtDNA) remains elusive due to the limitations in spatiotemporal resolution offered by conventional microscopy and the absence of suitable in vivo probes specifically targeting the IM. Here, we have developed a novel fluorescence probe called IMMBright660, characterized by exceptional photostability, fluorogenicity within lipid membranes, and low saturation power. Leveraging these features, we successfully employed time-lapse stimulated emission depletion microscopy (STED) at low power to visualize the IM, despite that mitochondria is highly photo-sensitive. By utilizing dual-color imaging of the IM and mtDNA, we have uncovered that mtDNA tends to habitat at mitochondrial tips or branch points, exhibiting an overall spatially uniform distribution. Notably, the dynamics of mitochondria are intricately associated with the positioning of mtDNA, and mitochondrial fusion consistently occurs in close proximity to mtDNA to minimize pressure during cristae remodeling. In healthy cells, >66% of the the mitochondria are Class III (with lengths longer than 5 μm or more than 12 cristae), while it dropped to <18% in ferroptosis. Mitochondrial dynamics, orchestrated by cristae remodeling, foster the even distribution of mtDNA. Conversely, in conditions of apoptosis and ferroptosis where the cristae structure is compromised, mtDNA distribution becomes irregular. These findings, achieved with unprecedented spatiotemporal resolution, reveal the intricate interplay between cristae and mtDNA and provide insights into the driving forces behind mtDNA distribution and expansion.
A novel technique for one-lung ventilation in children with unilateral atelectasis
Authors: Bai Ke , Zhou Fang , Huo Junming , Wan Rui , Liu Chengjun
Published: October 2023

It is very difficult to perform differential lung ventilation (DLV) in children with unilateral atelectasis, especially small children. We aimed to introduce a novel technique, one-lung ventilation with a single-lumen tube with a side hole (SH-SL-OLV), to perform DLV in this setting. This retrospective, observational, and analytic study enrolled 21 children with unilateral atelectasis admitted to the PICU. The children were treated with one-lung ventilation with a single-lumen tube (SL-OLV) or SH-SL-OLV.A total of 8 children underwent 45 SL-OLV sessions, and 13 children underwent 23 SH-SL-OLV sessions. Before treatment, no significant between-group difference was present in FiO2, P/F ratio, and PCO2. However, during OLV, FiO2 and PCO2 were significantly lower, while the P/F ratio and the duration hours of OLV were significantly higher in the SH-SL-OLV group than in the SL-OLV group. SH-SL-OLV is an innovative technique for the treatment of unilateral atelectasis in children. SH-SL-OLV can improve atelectasis and reduce the risk of hypoxemia and hypercapnia during OLV.
Communication barriers faced by pharmacists when managing patients with hypertension in a primary care team: A qualitative study
Authors: Tan Reuben , Kawaja Ariffin , Ooi Swee Phaik , Ng Chirk Jenn
Published: October 2023

Background
As primary care pharmacists take on an increasingly important and collaborative role in managing patients with chronic diseases, communication barriers with patients and healthcare colleagues have emerged. This study aimed to explore the communication barriers faced by pharmacists when managing patients with hypertension in a primary care team.
Methods
Twelve pharmacists working in five government primary care clinics were interviewed by a researcher using a topic guide. The interviews were audio-recorded, transcribed verbatim and subjected to thematic analysis.
Results
Pharmacists’ management of patients with hypertension was found to be affected by communication challenges at three different levels: between pharmacists and patients, pharmacists and doctors, and doctors and patients. Barriers to communication between pharmacists and patients include language barrier, physical disabilities, medication brand changes, and specific challenges faced during video consultations. Barriers to communication between pharmacists and doctors include lack of access to patient information across institutions on the electronic medical records (EMR), inadequate and inappropriate documentation by doctors, and disruptive and ineffective phone calls by pharmacists to doctors. Barriers to communication between doctors and patients had a spillover effect on pharmacists; these barriers included language barrier, patients not discussing medication nonadherence with doctors, and conflicting advice given by doctors and pharmacists.
Conclusions
The communication barriers pharmacists faced when managing patients with hypertension involved multiple stakeholders. Many of the challenges resulted in patients having difficulty understanding and adhering to their management plan. Effective interventions to foster stronger interprofessional relationships and create a conducive platform of communication should be developed to address these communication barriers.
Accumulation of docosapentaenoic acid (n-3 DPA) in a novel isolate of the marine ichthyosporean Sphaeroforma arctica
Authors: Yan Qiang , Liu Yingchun , Barrett Christa , Ryan Kelly , Seeler Daniel , May Oliver , Zirkle Ross
Published: October 2023

The n-3 long-chain polyunsaturated fatty acids (LC-PUFAs) are important for human nutrition as structural components of cell membranes as well as functioning in various cell signaling pathways. Currently, docosapentaenoic acid (n-3 DPA, C22:5) is not considered in the omega-3 index and is less studied than its counterparts eicosapentaenoic acid (EPA, C20:5) and docosahexaenoic acid (DHA, C22:6) due in part to a lack of a consistent, highly enriched source. In this work, we screened microorganisms in our culture collections with the goal to isolate a strain with high levels of n-3 DPA. We isolated a strain of Sphaeroforma arctica that produces up to 11% n-3 DPA in total fatty acid and has a high n-3 DPA to DHA/EPA ratio. The cell growth of the isolated strain was characterized using microscopy imaging and flow cytometer technologies to confirm the coenocytic pattern of cell divisions previously described in S. arctica. Our novel isolate of S. arctica grew more robustly and produced significantly more n-3 DPA compared to previously isolated and described strains indicating the uniqueness of the discovered strain. Overall, this work reports a first isolate n-3 DPA producing microorganism and establishes the foundation for future strain improvement and elucidation of the physiological function of this LC-PUFA for human nutrition and health.
Doping Prevalence Among Elite U.S. Athletes
Authors: Davoren Ann Kearns , Rulison Kelly , Milroy Jeff , Grist Pauline , Fedoruk Matthew , Lewis Laura , Wyrick David
Published: October 2023

Background: Determining the prevalence of doping within an elite athlete population is challenging due to the extreme sensitivity of the topic, however understanding true doping prevalence is important when designing anti-doping programs and measuring their effectiveness. The objective of this study was to estimate the prevalence of doping among Olympic, Paralympic, World and National-level competitive athletes in the United States subject to the World Anti-Doping Agency (WADA) Prohibited List. This study used a web-delivered survey and direct questioning approach to collect data from athletes in the United States Anti-Doping Agency (USADA) Registered Testing Pool or Clean Athlete Program. For the first time, a prevalence survey of elite athletes used the WADA Prohibited List to assess prevalence in each specific category of banned substance / method.
Results: Of 1,425 respondents, overall doping prevalence among U.S. elite athletes in the 12 months prior to survey administration ranged from an estimated 6.7-9.2% depending on the method of calculation. Specific doping prevalence rates for each individual substance category ranged from 0.1% (diuretics or masking agents) to 4.1% for cannabinoids (in-competition).
Conclusion: By measuring doping prevalence down to specific performance enhancing substances and methods, as well as coupling with individual athlete personality characteristics such as attitudes, motivators and norms, a clearer picture of the use of specific prohibited substances in- and out of-competition, attitudes toward doping, beliefs about testing and most effective deterrents can be identified. By understanding doping prevalence, anti-doping programs can be tailored to increase deterrence and overall program effectiveness.
Attention-deficit/hyperactivity symptoms, mental health, and the strengths of the healthy adult self: an investigation of Bernstein’s Strengths Scale using a network approach
Authors: Miklósi Mónika , Vajsz Kornél , Oláh Stella , Nagy Vivien , Szabó Brigitta
Published: October 2023

Background
Bernstein’s heuristic model of personal strengths describes 16 positive attributes of the healthy adult self, grouped into four higher-order factors: self-directedness (identity, self-reflection, self-confidence, self-assertion, imagination/creativity), self-regulation (emotional balance, resilience, self-control, self-care, reality testing), connection (empathy, compassion, humour, responsibility), and transcendence (gratitude and wisdom). The study aimed to explore the factorial validity of Bernstein’s Strengths Scale developed for the assessment of these constructs. Furthermore, we explored the association of strengths with attention-deficit hyperactivity (ADHD) symptoms and mental health in a nonclinical sample using a network approach.
Methods
Five hundred and twenty-eight adults filled out an online questionnaire, including Bernstein’s Strengths Scale (BSS), the Mental Health Continuum – Short Form (MHC-SF), and the Adult ADHD Self-Report Scale (ASRS).
Results
After leaving out two items, our data showed an acceptable fit to the 16-factor model (CFI = 0.912, RMSEA = 0.050 [0.047–0.053], SRMR = 0.050). Because of low internal consistency, the Self-control subscale was excluded from further analyses. Principal component analysis revealed three instead of four second-order factors. In the network model, Self-confidence and Wisdom emerged as the most influential nodes. ADHD symptoms were negatively connected to responsibility, self-care, identity, emotional balance, self-confidence, and mental health, while they had positive edges with humor, self-reflection, and imagination/creativity. Mental health was positively related to several strengths, with the highest value of the edge connecting mental health with gratitude. Imagination/creativity, emotional balance, self-care, self-confidence, and identity bridged ADHD symptoms and mental health.
Conclusion
The BSS has acceptable factorial validity and is a reliable tool for assessing the personal strengths of the healthy adult self. ADHD symptoms in adults may be associated with deficits in personal strengths, but protective factors could also be identified. Addressing personal strengths in psychosocial interventions for ADHD in adults may improve patients’ emotional well-being and everyday functioning.
Arsenic Treatment of Acute Promyelocytic Leukaemia Affects Neutrophil Function in a Compensatory Manner
Authors: Thunström Anna , Urban Constantin Felix
Published: October 2023

Background: Arsenic (ATO) and retinoic acid (ATRA) are successfully used as chemotherapy-free regimens to treat acute APL. Compared to traditional chemotherapy approaches, this therapy evokes fewer haematological side effects, such as severe neutropenia and thrombocytopenia, but little is known about the impact of the treatment on neutrophil function.
Methods: We included three patients undergoing consolidation treatment for APL. To evaluate the functionality of neutrophils, we assessed chemotaxis and ROS production during different time points of the treatment and compared them with neutrophils from healthy donors.
Results: We revealed that the chemotactic ability of neutrophils isolated from APL patients was decreased before starting each cycle of treatment. However, there was an increase in chemotactic ability in the first week of treatment compared to other time points. Additionally, we observed increased ROS production at the start of the treatment cycle. In vitro exposure of isolated neutrophils from healthy donors to ATO led to decreased chemotaxis at high ATO concentrations exceeding those achieved in vivo, while ROS production was not affected. Chemotaxis and ROS production were not altered by exposure to ATRA in vitro.
Conclusions: Our study suggests that ATO and ATRA therapy alter neutrophil function by increasing chemotaxis and reducing ROS production. The effect on neutrophil function does not, however, seem to impact infection susceptibility in our patients, indicating that the enhanced functionality might compensate for the lowered neutrophil count.
Antifungal Activity of Human Antibodies against Candida albicans germ tubes (CAGTA) in Invasive Candidiasis: Implications for Diagnosis and Immunization
Authors: Carrano Giulia , Arrieta-Aguirre Inés , Díez-Villalba Ander , Bregón-Villahoz Marta , Fernandez-de-Larrinoa Iñigo , Moragues María-Dolores
Published: October 2023

Invasive candidiasis (IC) is a fungal infection caused by yeasts of the Candida genus, being Candida albicans the most frequently isolated species. These infections are associated with high mortality rates due to challenges in diagnosis, and pose a significant problem, especially for critically ill patients and those with immunosuppression or undergoing transplantation. To evaluate the activity of antibodies produced by patients with IC, particularly focusing on CAGTA that recognize specific antigens located on the cell wall surface of C. albicans germ tubes. We used sera from 29 patients with IC caused by either C. albicans or non-albicans Candida species. Whole serum IgG antibodies were divided into various fractions: anti-blastospores, CAGTA-enriched and purified CAGTA. The effect of these antibodies on C. albicans was assessed by XTT colorimetric assay to evaluate metabolic activity, CFU counts for viability assessment, and microscopy for growth, viability and morphological analysis. Compared with the anti-blastospores, the CAGTA-enriched IgG fraction was mainly responsible for reducing the metabolic activity and viability of C. albicans cells. Purified CAGTA (20 µg/ml) altered the cell wall surface of germ tubes, and DiBAC fluorescent staining revealed that they were fungicidal. In conclusion, antibodies produced in response to invasive candidiasis have antifungal activity against Candida albicans. Purified CAGTA altered the cell wall structure and induced cell death. These findings suggest the potential use of CAGTA and related antigens as diagnostic markers and the development of immunization protocols for protection against Candida infections.
Impact of healthcare-associated infections within 7-days of acute stroke on health outcomes and risk of care-dependency: a multi-centre registry-based cohort study
Authors: Fluck David , Fry Christopher h , Robin Jonathan , Affley Brendan , Kakar Puneet , Sharma Pankaj , Han Thang S
Published: October 2023

Healthcare-associated infections (HCAIs) in patients admitted with acute conditions remain a major challenge to healthcare services. Here, we assessed the impact of HCAIs acquired withing 7-days of acute stroke on indicators of care-quality outcomes and dependency. Data were prospectively collected (2014–2016) from the Sentinel Stroke National Audit Programme for 3,309 patients (mean age = 76.2 year, SD = 13.5) admitted to four UK hyperacute stroke units (HASU). Associations between variables were assessed by multivariable logistic regression (odds ratios, 95% confidence intervals), adjusted for age, sex, co-morbidities, pre-stroke disability, swallow screening, stroke type and severity. Within 7-days of admission, urinary tract infection (UTI) and pneumonia occurred in 7.6% and 11.3% of patients. Female (UTI only), older age, underlying hypertension, atrial fibrillation, previous stroke, pre-stroke disability, intracranial haemorrhage, severe stroke, and delay in swallow screening (pneumonia only) were independent risk factors of UTI and pneumonia. Compared to patients without UTI or pneumonia, those with either or both of these HCAIs were more likely to have prolonged stay (> 14-days) on HASU: 5.1 (3.8–6.8); high risk of malnutrition: 3.6 (2.9–4.5); palliative care: 4.5 (3.4–6.1); in-hospital mortality: 4.8 (3.8–6.2); disability at discharge: 7.5 (5.9–9.7); activity of daily living support: 1.6 (1.2–2.2); and discharge to care-home: 2.3 (1.6–3.3). In conclusion, HCAIs acquired within 7-days of an acute stroke led to prolonged hospitalisation, adverse health consequences and risk of care-dependency. These findings provide valuable information for timely intervention to reduce HCAIs, and minimising subsequent adverse outcomes.
Poisson Inverted Shifted Gompertz Distribution with Applications to Engineering and Medical Data
Authors: Sapkota Laxmi Prasad , Kumar Vijay , Tekle Getachew , Alrweili Hleil , Mutairi Aned Al , Mustafa Manahil SidAhmed , Yusuf M.
Published: October 2023

A novel distribution is introduced herein, termed the "Poisson Inverted Shifted Gompertz Distribution," achieved by employing the Poisson-Generating family of distributions with the inverted shifted Gompertz distribution as its base. This distribution exhibits notable statistical properties, with explicit expressions derived for its survival function, hazard rate function, average residual life function, moments, quantile function, entropy, order statistics, skewness, and kurtosis. To estimate the distribution's parameters, we employ three different methods: Maximum Likelihood Estimation (MLE), Least-Square Estimation (LSE), and Cramer-Von-Mises Estimation (CVME). To comprehensively evaluate the performance of MLE, a simulation experiment is conducted. Furthermore, the applicability of our proposed model is demonstrated using real-world data from both engineering and medical domains. The goodness-of-fit of the Poisson Inverted Shifted Gompertz distribution is rigorously examined through various statistical tests and graphical methods. Compared to a selection of commonly used lifetime distributions, our proposed distribution exhibits superior fitting capabilities and greater flexibility. In addition, we explore the Bayesian perspective of the proposed model by employing Hamiltonian Monte Carlo (HMC) simulation techniques. This comprehensive analysis provides a holistic understanding of the Poisson Inverted Shifted Gompertz distribution's potential and applicability in various fields.
Mathematical Subject Classification 2020: 62F10, 62F40, 62E10, 62E15
Association between pulse pressure and carotid plaque in elderly patients with uncontrolled hypertension: Results from a community-based screening Hangzhou, China
Authors: Yu Zhecong , Yang Haifeng , Shou Biqi , Cheng Zongxue , Jiang Caixia , Xu Jue
Published: October 2023

Objectives: There is a wider pulse pressure (PP) and a higher prevalence of carotid plaques in the elderly. Previous studies indicated PP is strongly associated with carotid plaques formation. This study aimed to explore this association in elderly patients with uncontrolled hypertension.
Materials and Methods: 1671 hypertensive patients aged ≥ 60 years with uncontrolled hypertension were enrolled from a community-based screening in Hangzhou, China. Carotid plaques were assessed using ultrasonography. Logistic regression models were used to estimate the association between PP and carotid plaques by odds ratios (ORs) and 95% confidence intervals (CIs).
Results: Carotid plaques were detected in 780 (46.7%) of subjects. Of them, plaques ≥ 2 was found in 415 (53.1%). There was a significant positive association between the PP tertile levels and the prevalence of carotid. After adjustment for traditional risk factors, compared to patients within the lowest tertile of PP, those within the highest tertile had an increased risk of carotid plaques (OR 1.641, CI 1.152–2.337). For each 1-SD increase, the risk increased by 38.4% (OR 1.384, CI 1.134–1.688). There was a non-linear association between PP and carotid plaques (P-nonlinearity= 0.029). The risk increased rapidly after the predicted PP level reached at around 70 mmHg.
Conclusions: Our findings suggested that PP was independently associated with carotid plaques in elderly patients with uncontrolled hypertension who have an increased risk of atherosclerosis.
The causal relationship between flatfoot, BMI and iliotibial bundle syndrome: A Mendelian randomization analysis
Authors: Li Wenjia , Yao Chen , Zhou Jihong , Pang Ruiming
Published: October 2023

Background
An increasing number of patients with iliotibial bundle syndrome have been found to be clinically. To investigate the putative causal link between flatfoot and BMI, and the development of iliotibial bundle syndrome, employing a Mendelian randomization approach.
Method
Utilizing extensive GWAS data, MR analysis was conducted, primarily employing random-effects inverse variance weighting, MR-Egger regression, and weighted median method.
Results
The Mendelian randomization (MR) findings regarding the association between flatfoot and iliotibial bundle syndrome indicated that the MR-Egger regression yielded an odds ratio (OR) of 2.26 (95% CI: 0.99–5.14) with a p-value of 0.067, the weighted median method yielded an OR of 1.35 (95% CI: 0.92–1.98) with a p-value of 0.110, and the inverse variance weighting method yielded an OR of 1.43 (95% CI: 1.10–1.87) with a p-value of 0.008. The MR analysis of the relationship between BMI and iliotibial bundle syndrome demonstrated that the MR-Egger regression, inverse variance weighting method, and weighted median method had p-values greater than 0.05, and the difference was not statistically significant.
Conclusion
The risk of iliotibial bundle syndrome in individuals with flat feet is 43% higher than that in persons with normal foot structure. There is no significant association between BMI and the risk of iliotibial bundle syndrome.
Assessment of water quality of the Narmada River (India) using fuzzy water quality index method.
Authors: Rahi Dal Chand , Chandak Rajeev , Vishwakarma Amit
Published: October 2023

This study aims to assess the water quality of the Narmada River utilizing the fuzzy water quality index method. In this context, samples of water were gathered from six sampling stations for various parameters like turbidity, pH, dissolved oxygen (DO), bio-chemical oxygen demand (BOD5), total dissolved solids (TDS), total suspended solids (TSS), chemical oxygen demand (COD), electrical conductivity (EC), total hardness (TH), total alkalinity (TA) and chlorides in 2021-22. Due to contamination from domestic wastewater, dairy industrial activities, and agricultural activity, water quality assessment has become essential. To address this requirement, the water quality index (WQI) was developed which incorporates various water quality parameters and expresses total water quality into a single value. Nowadays, to get around WQI, the fuzzy water quality index (FWQI) method has been developed. To develop FWQI, eleven input, single output, Mamdani method, And operators, fuzzy inference rules, and centroid methods for defuzzification have been used. Results of FWQI revealed that Station Third was adversely affected by urban activities, Station First was influenced by tributaries, and Station Six was impacted by agricultural activities. According to the rating scale, the value of FWQI revealed that water quality was poor at the first four stations and good at the last two stations. Comparing the result of FWQI with WQI have found a five percent variation for the same water samples. This new index could serve as an alternative approach to assessing water quality.
Is survival after transanal total mesorectal excision (taTME) worse than that after traditional total mesorectal excision? A Retrospective Propensity Score-Adjusted Cohort Study
Authors: Ammann Yanic , Warschkow Rene , Schmied Bruno , De Lorenzi Diego , Reißfelder Christoph , Brunner Walter , Marti Lukas
Published: October 2023

Purpose:Transanal total mesorectal excision (taTME) was developed to provide better vision during resection of the mesorectum. Conflicting results have shown an increase in local recurrences and shorter survival after taTME. This study compares the outcomes of taTME and abdominal (open, laparoscopic, robotic) total mesorectal excision (abTME).
Methods:Patients who underwent taTME or abTME for stage I-III rectal cancer and received an anastomosis were included. A retrospective analysis of a prospectively conducted database was performed. The primary endpoints were overall survival (OS), cancer-specific survival (CSS), and disease-free survival (DFS). Risk factors were adjusted by propensity score matching (PSM). The secondary endpoints were local recurrence rates and combined poor pathological outcomes.
Results: From 2012 to 2020, a total of 189 patients underwent taTME, and 119 underwent abTME; patients were followed up for a median of 53.3 [IQR 35.9-71.8] and 84.0 [IQR 50.2-107.9] months, respectively (p<0.001). The 5-year survival rates after taTME and abTME were not significantly different after PSM: OS: 78.2% vs. 88.6% (p=0.073); CSS: 87.4% vs. 92.1% (p=0.359); and DFS: 69.3% vs. 80.9%, respectively (p=0.104). No difference in the local recurrence rate was observed (taTME n=10 (5.3%), abTME n=10 (8.4%); p=0.280). Combined poor pathological outcomes were more frequent after abTME (n=36, 34.3%) than after taTME (n=35, 19.6%) (p=0.006); this difference was nonsignificant in multivariate analysis (p=0.404).
Conclusion: The findings reveal that taTME is a good treatment option for rectal cancer; it likely does not significantly affect survival or local recurrence, and it might have a positive influence on specimen quality.
RETRACTED: Evaluating the Relationship between DMFT Index and Quality of Life of Pregnant Women in Hamadan
Authors: Tiznobaik Azita , Taheri Safoura , Momenimovahed Zohre , Roshanaei Ghodratollah , Ghaleeiha Ali , Shirinzad Mehdi , Ahmadian Mohammad Amir
Published: October 2023

The authors have requested that this preprint be removed from Research Square.
Early brain microstructural development among preterm infants requiring caesarean section versus those delivered vaginally
Authors: Bobba Pratheek S. , Weber Clara F. , Malhotra Ajay , Bahtiyar Mert O. , Copel Joshua , Taylor Sarah N. , Ment Laura R. , Payabvash Seyedmehdi
Published: October 2023

It is known that the rate of caesarean section (C-section) has been increasing among preterm births. However, the relationship between C-section and long-term neurological outcomes is unclear. In this study, we utilized diffusion tensor imaging (DTI) to characterize the association of delivery method with brain white matter (WM) microstructural integrity in preterm infants. We retrospectively analyzed the DTI scans and health records of preterm infants without neuroimaging abnormality on pre-discharge term-equivalent MRI. We applied both voxel-wise and tract-based analyses to evaluate the association between delivery method and DTI metrics across WM tracts while controlling for numerous covariates. We included 68 preterm infants in this study (23 delivered vaginally, 45 delivered via C-section). Voxel-wise and tract-based analyses revealed significantly lower fractional anisotropy values and significantly higher diffusivity values across major WM tracts in preterm infants delivered via C-section when compared to those delivered vaginally. These results may be partially, but not entirely, mediated by lower birth weight among infants delivered by C-section. Nevertheless, these infants may be at risk for delayed neurodevelopment and could benefit from close neurological follow up for early intervention and mitigation of adverse long-term outcomes.
Neutrophil-to-lymphocyte ratio (NLR) predicts mortality in hospitalized geriatric patients independent of the admission diagnosis: a multicenter prospective cohort study.
Authors: Rosa Mirko Di , Sabbatinelli Jacopo , Soraci Luca , Corsonello Andrea , Bonfigli Anna Rita , Cherubini Antonio , Sarzani Riccardo , Antonicelli Roberto , Pelliccioni Giuseppe , Galeazzi Roberta , Marchegiani Francesca , Iuorio Salvatore , Colombo Daniele , Burattini Maurizio , Lattanzio Fabrizia , Olivieri Fabiola
Published: October 2023

Background The Neutrophil-to-lymphocyte ratio (NLR) is a marker of poor prognosis in hospitalized older patients with different diseases, but there is still no consensus on the optimal cut-off value to identify older patients at high-risk of in-hospital mortality. Therefore, in this study we aimed at both validating NLR as a predictor of death in older hospitalized patients and assess whether the presence of specific acute diseases can modify its predictive value.Methods this prospective cohort study included 5,034 hospitalizations of older patients admitted to acute care units in the context of the ReportAge study. NLR measured at admission was considered as the exposure variable, while in-hospital mortality was the outcome of the study. ROC curves with Youden’s method and restricted cubic splines were used to identify the optimal NLR cut-off of increased risk. Cox proportional hazard models, stratified analyses, and Kaplan-Meier survival curves were used to analyse the association between NLR and in-hospital mortality.Results both continuous and categorical NLR value (cut-off ≥ 7.95) predicted mortality in bivariate and multivariate prognostic models with a good predictive accuracy. The magnitude of this association was even higher in patients without sepsis, congestive heart failure, and pneumonia, and those with higher eGFR, albumin, and hemoglobin (p < 0.001). A negative multiplicative interaction was found between NLR and eGFR (p = 0.001).Conclusions NLR at admission is a readily available and cost-effective biomarker that could improve identification of geriatric patients at high risk of death during hospital stay independent of admitting diagnosis, kidney function and hemoglobin levels.