bluuebunny/crossref_metadata_2025 huggingface dataset:
Utilisation of traditional healers among older people living with HIV in South Africa: a WHO SAGE well-being of older people study
Authors: Okyere Joshua , Ayebeng Castro , Owusu Bernard Afriyie , Agbemavi Wonder , Amoako Joseph Kwarteng , Dickson Kwamena Sekyi
Published: June 2023

Background

Within the African region, there are an estimated 8 million people living with HIV (PLHIV) in South Africa. Seeking healthcare services from traditional healers (TH) is one of the alternative and complementary approaches to HIV/AIDS treatment. Identifying the associated factors of TH utilisation among older PLHIV is crucial in developing healthcare interventions that cater to the unique needs of this vulnerable group. This study investigated the factors associated with TH utilisation among older PLHIV.

Methods

We studied 516 older PLHIV using data from the WHO SAGE Well-Being of Older People Study (2011–2013). Chi-square, bivariate and multivariate logistic regression were computed in STATA Version 14. The results were presented with both crude and adjusted odds ratio (AOR) and at 95% confidence interval (CI).

Results

Of the 516 participants, 15.89% utilised TH. The major reason for TH utilisation among older PLHIV was the perception of receiving better healthcare services from TH (51.2%) and the flexibility to pay with goods instead of money (14.6%). The factors associated with TH utilisation were age [AOR = 0.05; CI  0.01, 0.37], being hypertensive [AOR = 2.07; CI  1.04, 4.11], and having more than four servings of fruits [AOR = 10.64; CI  2.95, 38.34]. TH utilisation was significantly lower among those who visited the clinic once or twice [AOR = 0.17; CI  0.05, 0.63], three to six times [AOR = 0.16; CI  0.05, 0.56], and more than 6 times [AOR = 0.09; CI  0.03, 0.34] compared to those who had no clinic visits.

Conclusion

In conclusion, a low proportion of TH utilisation was reported among older PLHIV in South Africa. TH utilisation is associated with age, hypertension status, frequency of clinic visits and fruit servings consumed. Our study suggests that being hypertensive was a motivating factor for older PLHIV to utilise TH. Therefore, it is imperative for the South African health department to integrate the services of TH into the mainstream health system to manage non-communicable diseases, particularly hypertension, among older PLHIV.
Prognostic model on overall survival in elderly nasopharyngeal carcinoma patients: a recursive partitioning analysis identifying pre-treatment risk stratification
Authors: Li Ying , Weng Youliang , Huang Zongwei , Pan Yuhui , Cai Sunqin , Ding Qin , Wu Zijie , Chen Xin , Lu Jun , Hu Dan , Qiu Sufang
Published: June 2023

Background

We aimed to evaluate the optimal management for elderly patients with nasopharyngeal carcinoma (NPC) with intensity-modulated radiotherapy (IMRT).

Methods

A total of 283 elderly patients with NPC diagnosed from 2015 to 2019 were enrolled in the study. Overall survival (OS) was the primary endpoint. Univariate and multivariate Cox regression analyses were preformed to identify potential prognostic factors. The recursive partitioning analysis (RPA) was used for risk stratification. Kaplan-Meier survival curves were applied to evaluate the survival endpoints, and log-rank test was utilized to assess differences between groups. The prognostic index (PI) was constructed to further predict patients’ prognosis displayed by nomogram model. The area under the receiver operating characteristic (ROC) curves (AUC) and the calibration curves were applied to assess the effectiveness of the model.

Results

Based on RPA-based risk stratification, we demonstrated that elderly NPC patients who were treated with IC followed by RT had similar OS as those with induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT) in the middle- (stage I-III and pre-treatment EBV > 1840 copies/ml) and high-risk groups (stage IVA). IMRT alone may be the optimal treatment option for the low-risk group (stage I-III with pre-treatment EBV ≤ 1840 copies/ml). We established an integrated PI which was indicted with stronger prognostic power than each of the factors alone for elderly NPC patients (The AUC of PI was 0.75, 0.80, and 0.82 for 1-, 3-, 5-year prediction of OS, respectively).

Conclusion

We present a robust model for clinical stratification which could guide individual therapy for elderly NPC patients.
Three techniques for the determination of perindopril through derivatization with 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole
Authors: Askar H. , Metwally Mohammed E.-S. , Tolba M. M. , Ali Fatma A. , Fathy M. E.
Published: June 2023

In addition to its pure form, three accurate, rapid, and simple methods have been established for determining perindopril (PRD) in its tablet form. At pH 9.0 using a borate buffer, developing the three designated methods was successful according to the reaction between PRD and 4-chloro-7-nitrobenzo-2-oxa-1,3-diazole (NBD-Cl) and the formation of a chromogen (with a yellow color) measurable at 460 nm using the spectrophotometric method (Method I). In addition, the produced chromogen was assessed using the spectrofluorimetric method (Method II) at 535 nm following excitation at 461 nm. Afterward, the same reaction product was separated and determined using the HPLC method with fluorescence detection (Method III). A Promosil C18stainless steel column (Q7 5 mm particle size, 250–4.6 mm) has proven suitable for separation. The mobile phase adjustment was made at pH 3.0, with a 1.0 mL min−1flow rate; its composition was methanol-sodium dihydrogen phosphate, 0.02 M (60: 40, v/v). Through concentration ranges of 5.0–60.0, 0.5–6.0, and 1.0–10.0 μg mL−1, the calibration curves were rectilinear for Methods I, II, and III, respectively, with limits of quantification (LOQ) of 1.08, 0.16 and 0.19 μg mL−1as well as limits of detection (LOD) of 0.36, 0.05 and 0.06 μg mL−1. The developed methods were implemented to estimate PRD in tablets, and a comparison between the obtained outcomes utilizing the developed methods as well as obtained from the official method revealed that they were comparable. The official BP method was based on dissolving PRD in anhydrous acetic acid and titrating with 0.1 M perchloric acid, then the potentiometric determination of the end-point. The designated methods were also implemented in content uniformity testing with satisfying results. The reaction pathway proposal was speculated, and according to ICH Guidelines, the statistical evaluation of the data was performed. The three proposed methods were confirmed to be green, eco-friendly and safe to environment using Green Analytical procedure index (GAPI) method.
Metabolic Dysfunction-associated fatty liver disease and incident heart failure risk: the Kailuan cohort study
Authors: Wei Zhihao , Huang Zhe , Song Zongshuang , Zhao Wenliu , Zhao Dandan , Tan Yizhen , Chen Shuohua , Yang Peng , Li Yun , Wu Shouling
Published: June 2023

Background

Recently, metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed to replace non-alcoholic fatty liver disease (NAFLD) to emphasize the pathogenic association between fatty liver disease and metabolic dysfunction. Studies have found that MAFLD independently increases the risk of myocardial infarction and stroke. But the relationship between MAFLD and heart failure (HF) is not fully understood.

Objectives

This study aimed to explore the association between MAFLD and the risk of HF.

Methods

The study included 98,685 participants without HF selected from the Kailuan cohort in 2006. All participants were divided into non-MAFLD group and MAFLD group according to MAFLD diagnostic criteria. After follow-up until December 31, 2020, the Cox regression analysis model was used to calculate the effect of MAFLD on the risk of HF.

Results

During the median follow-up of 14.01 years,3260 cases of HF were defined, the HF incidence density of non-MAFLD group and MAFLD group was 2.19/1000pys and 3.29/1000pys, respectively. Compared with the non-MAFLD group, participants with MAFLD had an increased risk of HF (HR: 1.40, 95% CI: 1.30–1.50); in addition, an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. We also observed a higher risk of HF among the different metabolic dysfunction of MAFLD in people with both fatty liver disease and type 2 diabetes (HR, 1.95; 95% CI, 1.73–2.20).

Conclusions

Our findings suggest that the risk of HF was significantly increased in participants with MAFLD, and an exacerbation of fatty liver disease was associated with an increased risk of HF in people with MAFLD. In addition, we should pay more attention to people with MAFLD with type 2 diabetes.
Acrolein adducts and responding autoantibodies correlate with metabolic disturbance in Alzheimer’s disease
Authors: Sanotra Monika Renuka , Kao Shu-Huei , Lee Ching-Kuo , Hsu Chun-Hsien , Huang Wen-Chung , Chang Tsuei-Chuan , Tu Fang-Yu , Hsu I-Uen , Lin Yung-Feng
Published: June 2023

Background

Alzheimer’s disease (AD) is caused by many intertwining pathologies involving metabolic aberrations. Patients with metabolic syndrome (MetS) generally show hyperglycemia and dyslipidemia, which can lead to the formation of aldehydic adducts such as acrolein on peptides in the brain and blood. However, the pathogenesis from MetS to AD remains elusive.

Methods

An AD cell model expressing Swedish and Indiana amyloid precursor protein (APP-Swe/Ind) in neuro-2a cells and a 3xTg-AD mouse model were used. Human serum samples (142 control and 117 AD) and related clinical data were collected. Due to the involvement of MetS in AD, human samples were grouped into healthy control (HC), MetS-like, AD with normal metabolism (AD-N), and AD with metabolic disturbance (AD-M). APP, amyloid-beta (Aß), and acrolein adducts in the samples were analyzed using immunofluorescent microscopy, histochemistry, immunoprecipitation, immunoblotting, and/or ELISA. Synthetic Aß1-16 and Aß17-28 peptides were modified with acrolein in vitro and verified using LC–MS/MS. Native and acrolein-modified Aß peptides were used to measure the levels of specific autoantibodies IgG and IgM in the serum. The correlations and diagnostic power of potential biomarkers were evaluated.

Results

An increased level of acrolein adducts was detected in the AD model cells. Furthermore, acrolein adducts were observed on APP C-terminal fragments (APP-CTFs) containing Aß in 3xTg-AD mouse serum, brain lysates, and human serum. The level of acrolein adducts was correlated positively with fasting glucose and triglycerides and negatively with high-density lipoprotein-cholesterol, which correspond with MetS conditions. Among the four groups of human samples, the level of acrolein adducts was largely increased only in AD-M compared to all other groups. Notably, anti-acrolein-Aß autoantibodies, especially IgM, were largely reduced in AD-M compared to the MetS group, suggesting that the specific antibodies against acrolein adducts may be depleted during pathogenesis from MetS to AD.

Conclusions

Metabolic disturbance may induce acrolein adduction, however, neutralized by responding autoantibodies. AD may be developed from MetS when these autoantibodies are depleted. Acrolein adducts and the responding autoantibodies may be potential biomarkers for not only diagnosis but also immunotherapy of AD, especially in complication with MetS.
PFDI: a precise fruit disease identification model based on context data fusion with faster-CNN in edge computing environment
Authors: Dhiman Poonam , Manoharan Poongodi , Lilhore Umesh Kumar , Alroobaea Roobaea , Kaur Amandeep , Iwendi Celestine , Alsafyani Majed , Baqasah Abdullah M. , Raahemifar Kaamran
Published: June 2023

Fruits significantly impact everyday living, i.e., Citrus fruits. Numerous fruits have a solid nutritious value and are packed with multivitamins and trace components. Citrus fruits are delicate and susceptible to many diseases and infections. Many researchers have suggested deep and machine learning-based fruit disease detection and classification models. This research presents a precise fruit disease identification model based on context data fusion with Faster-CNN in an edge computing environment. The goal is to develop an accurate, efficient, and trustable fruit disease detection model, a critical component of autonomous food production in a robotic edge platform. This research examines and explores four different diseases of Citrus fruits using CNN deep learning models to be adopted as edge computing solutions. Identification of citrus diseases such as cankers black spot, greening, scab, melanosis, and healthy citrus fruits are implemented using the proposed sequential model without pruning, with pruning having different sparsity levels followed by post quantization. Through the transfer learning method, this model is optimized for the assignment of fruit disease detection employing visuals from two patterns: Near-infrared (NIFR) and RGB. Early and late data fusion techniques for integrating multi-model (NIFR and RGB) facts are evaluated. The accuracy obtained from the proposed model for the canker disease is 97%, scab 95%, melanosis 99%, Greening 97%, Black spot 97% and healthy 97%. In this paper, the results of the proposed model are compared and evaluated with the sparsity levels of 50–80%, 60–90%, 70–90%, and 80–90% pruning and also obtained the results of post-quantization on each level. The results show that the model size with 60–90% pruning can be counteracted to the 47.64 of the baseline model without significant loss of accuracy. Moreover, post-quantization can reduce the 60–90% pruning from 28.16 to 8.72. In addition to enhanced precision, the above initiative is much faster to implement for new fruit diseases because it needs bounding box annotation instead of pixel-level annotation.
Realist review of community coalitions and outreach interventions to increase access to primary care for vulnerable populations: a realist review
Authors: Welch Vivian , Pottie Kevin , Gaudet Caroline , Thuku Micere , Mallard Ryan , Spenceley Shannon , Amjed Nida , Wadhwani Arpana , Ghogomu Elizabeth , Scott Cathie , Dahrouge Simone ,   The IMPACT Team
Published: June 2023

Background

There are meaningful gaps in equitable access to Primary Health Care (PHC), especially for vulnerable populations after widespread reforms in Western countries. The Innovative Models Promoting Access-to-Care Transformation (IMPACT) research program is a Canadian-Australian collaboration that aims to improve access to PHC for vulnerable populations. Relationships were developed with stakeholders in six regions across Canada and Australia where access-related needs could be identified. The most promising interventions would be implemented and tested to address the needs identified. This realist review was conducted to understand how community coalition and outreach (e.g., mobile or pop-up) services improve access for underserved vulnerable residents.

Objective

To inform the development and delivery of an innovative intervention to increase access to PHC for vulnerable populations.

Methods

A realist review was conducted in collaboration with the Local Innovative Partnership (LIP) research team and the IMPACT research members who conducted the review. We performed an initial comprehensive systematic search using MEDLINE, EMBASE, PsycINFO, and the Cochrane Library up to October 19, 2015, and updated it on August 8, 2020. Studies were included if they focused on interventions to improve access to PHC using community coalition, outreach services or mobile delivery methods. We included Randomized Controlled Trials (RCTs), and systematic reviews. Studies were screened by two independent reviewers and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework was used for data extraction and framework analysis to obtain themes. The LIP research team was also allowed to suggest additional papers not included at screening.

Results

We included 43 records, comprising 31 RCTs, 11 systematic reviews, and 1 case control study that was added by the LIP research team. We identified three main themes of PHC interventions to promote access for vulnerable residents, including: 1) tailoring of materials and services decreases barriers to primary health care, 2) services offered where vulnerable populations gather increases the “reach” of the interventions, 3) partnerships and collaborations lead to positive health outcomes. In addition, implementation designs and reporting elements should be considered.

Conclusion

Realist reviews can help guide the development of locally adapted primary health care interventions.
Exploring the effects of gender and sexual orientation on disordered eating: an EFA to CFA study of the Eating Disorder Examination Questionnaire
Authors: Knight Ruth , Preston Catherine
Published: June 2023

Several problems limit our understanding of the ways that gender and sexual orientation influence disordered eating. These include the reliance on measures that have been developed and validated in samples of cisgender heterosexual women, and the lack of confirmed measurement invariance that allows us to meaningfully compare these experiences between groups. This study was an EFA to CFA exploration of the Eating Disorder Examination Questionnaire in a group of heterosexual, bisexual, gay, and lesbian men and women. In total 1638 participants were recruited via adverts in traditional and social media to complete an online survey. A 14-item, three-factor model of the EDE-Q was confirmed as best fitting the data and measurement invariance between groups was ascertained. Sexual orientation influenced disordered eating and muscularity-related thoughts and behaviours in men but not women. Heterosexual men reported more muscularity-related concerns and behaviours, whereas gay men showed more thinness-related concerns and behaviours. Bisexual participants showed a different pattern, highlighting the importance of treating this group individually and not collating all non-heterosexual participants together. Small but significant effects of sexual orientation and gender have an impact on the kinds of disordered eating thoughts and behaviours one might experience, and could influence prevention and treatment. Clinicians may be able to provide more effective and tailored interventions by taking into account gender and sexual orientation in sensitive ways.
Human VDAC pseudogenes: an emerging role for VDAC1P8 pseudogene in acute myeloid leukemia
Authors: Pappalardo Xena Giada , Risiglione Pierpaolo , Zinghirino Federica , Ostuni Angela , Luciano Daniela , Bisaccia Faustino , De Pinto Vito , Guarino Francesca , Messina Angela
Published: June 2023

Background

Voltage-dependent anion selective channels (VDACs) are the most abundant mitochondrial outer membrane proteins, encoded in mammals by three genes, VDAC1, 2 and 3, mostly ubiquitously expressed. As 'mitochondrial gatekeepers', VDACs control organelle and cell metabolism and are involved in many diseases. Despite the presence of numerous VDAC pseudogenes in the human genome, their significance and possible role in VDAC protein expression has not yet been considered.

Results

We investigated the relevance of processed pseudogenes of human VDAC genes, both in physiological and in pathological contexts. Using high-throughput tools and querying many genomic and transcriptomic databases, we show that some VDAC pseudogenes are transcribed in specific tissues and pathological contexts. The obtained experimental data confirm an association of the VDAC1P8 pseudogene with acute myeloid leukemia (AML).

Conclusions

Our in-silico comparative analysis between the VDAC1 gene and its VDAC1P8 pseudogene, together with experimental data produced in AML cellular models, indicate a specific over-expression of the VDAC1P8 pseudogene in AML, correlated with a downregulation of the parental VDAC1 gene.
Maxillary labial peri-implant hard and soft tissue alteration observed on cross-sectional dimension: a 2-year prospective observational study
Authors: Yamada Shuhei , Nakano Tamaki , Kobayashi Tomoyuki , Ishigaki Shoichi
Published: June 2023

Objectives

To evaluate how peri-implant hard and soft tissue height (BH, MH) alter after final prostheses placement related to labial hard and soft tissue thickness (BW, MW).

Materials and methods

Forty-five platform-switched implants were classified into four groups according to BW and MW: type 1 (thick BW and thick MW), type 2 (thick BW and thin MW), type 3 (thin BW and thick MW), type 4 (thin BW and thin MW). Tissue resorption was evaluated on cone-beam CT images taken at final prostheses placement, at 1-year follow-up, and at 2-year follow-up. Kruskal–Wallis test and post hoc Mann–Whitney test were applied; significance was set to 0.05.

Results

BH resorption was 0.13 ± 0.12 mm in type 1, 0.26 ± 0.17 mm in type 2, 0.09 ± 0.09 mm in type 3, 0.94 ± 0.19 mm in type 4. Differences between type 1 and 4, type 2 and 4, and type 3 and 4 were statistically significant (p < 0.001, p = 0.005, p < 0.001, respectively). MH resorption was 0.10 ± 0.09 mm in type 1, 0.36 ± 0.16 mm in type 2, 0.12 ± 0.12 mm in Type 3, 0.79 ± 0.23 mm in type 4. Differences between type 1 and 2, type 1 and 4, type 2 and 3, type 2 and 4 and type 3 and 4 were statistically significant (p < 0.001).

Conclusions

Significantly less BH/MH resorption occurs around implants with thick BW/MW than those with thin BW/MW in 2 years. Implants with thick peri-implant soft tissue resulted in significantly less tissue resorption in second year after final prostheses placement.
Utilization of growth monitoring and promotion services and undernutrition of children less than two years of age in Northern Ghana
Authors: Baguune Benjamin , Aminu Dramani Mahama , Bekyieriya Emmanuel , Adokiya Martin Nyaaba
Published: June 2023

Background

Child undernutrition is a major public health problem and an important indicator of child’s health. Adequate nutrition is critical for a child’s growth and development. Growth monitoring and promotion (GMP) services is a nutrition intervention aimed at improving the nutritional status of children. We assessed the utilization of growth monitoring and promotion services and nutritional status of children less than two years of age in northern Ghana.

Methods

This was a descriptive cross-sectional study that involved face-to-face interviews among 266 mothers with children < 2 years of age attending child welfare clinics (CWC). We also collected anthropometric measurements. Descriptive statistic was performed and data presented as percentage. The nutritional status of children was classified as underweight (weight-for-age z score < -2 standard deviations), stunted (length-for-age Z score < − 2) and wasted (weight-for-length z score < -2) while utilization of GMP services was based on attendance to CWC and ability to interpret different growth curves. Chi square test was used to determine the relationship between utilization of GMP services and nutritional status of children at an alpha of 0.05.

Results

The prevalence of undernutrition shows that, 18.6% of the children were underweight, 14.7% were stunted and 7.9% were wasted. About 60% of the mothers accessed GMP services regularly. Less than half of the mothers were able to interpret the children’s growth curve correctly: falling growth curve (36.8%), flattening growth curve (35.7%) and rising growth curve (27.4%). In combining children < 6 and 6–23 months of age, only one-third (33.1%) of mothers practiced appropriate infant and young child feeding. Regular GMP services was found to have a statistically significant relationship with underweight (P < 0.001), stunting (P = 0.006) and wasting (P = 0.042).

Conclusion

The level of undernutrition remains high and child feeding practices is poor. Maternal utilization of GMP services is also low in the study area. Similarly, ability to interpret the child’s growth curve appropriately persist as a challenge among women. Thus, attention is needed to improve utilization of GMP services to address child undernutrition challenges.
Varicose Vein Education and Informed coNsent (VVEIN) study: a randomised controlled pilot feasibility study
Authors: Kiernan Aoife , Boland Fiona , Moneley Daragh , Doyle Frank , Harkin Denis W.
Published: June 2023

Introduction

Doctors have a legal requirement and duty of care to ensure patients are enabled to make an informed decision about their treatment, including discussion of the benefits, risks and alternatives to a procedure. A patient-centred approach to consent has been firmly established in Ireland, and fundamental to this is the ability to engage in a dialogue that offers comprehensible information to patients. Telemedicine has revolutionised the way we can deliver care to patients in the modern era of computers, tablets, and smartphones, and its use has been rapidly expanded. Novel digital strategies to improve the informed consent process for surgical procedures have been increasingly under investigation over the last 10–15 years and may offer a low cost, accessible and tailored solution to consent for surgical interventions. Within vascular surgery, superficial venous interventions have been associated with a high number medicolegal claims and also represents an area within the specialty with rapidly evolving technology and techniques. The ability to communicate comprehensible information to patients has never been greater. Thus, the author’s aim is to explore whether it is feasible and acceptable to deliver a digital health education intervention to patients undergoing endovenous thermal ablation (EVTA) to supplement the consent process.

Methods

This is a prospective, single centre, randomised controlled, feasibility trial recruiting patients with chronic venous disease deemed suitable to undergo EVTA. Patients will be randomised to receive either standard consent (SC) or a newly developed digital health education tool (dHET). The primary outcome is feasibility; assessing the recruitment and retention rate of participants and assessing acceptability of the intervention. Secondary outcomes include knowledge retention, anxiety and satisfaction. This feasibility trial is designed to recruit 40 patients, which will allow for a moderate dropout rate. This pilot study will inform the authors of the appropriateness of an adequately powered multicentre trial.

Discussion

To examine the role of a digital consent solution for EVTA. This may improve and standardise the consent dialogue with patients and may have the potential to reduce claims related to poor consent processes and disclosure of risks.

Ethical committee reference

Ethical approval has been sought and received from both the Bon Secours Hospital and RCSI (202109017), on 14 May 2021 and 10 October 2021, respectively.

Trial registration

ClinicalTrials.gov Identifier: NCT05261412, registered on 1 March 2022
Persistent bilateral pneumothorax after robotic-assisted inguinal hernia repair: possible relevance to recent esophageal cancer surgery — a case report
Authors: Ishikawa Seiji , Shirakawa Kaori , Kuroda Yui , Yube Yukinori , Mine Shinji , Hayashida Masakazu , Kawagoe Izumi
Published: June 2023

Background

Postoperative pneumothorax is a well-known but relatively rare complication after laparoscopic surgery. There has been no report describing pneumothorax that persisted for a week or more after laparoscopic surgery. Herein, we report a case of bilateral pneumothorax after laparoscopic surgery, which appears to have occurred by a different mechanism than previously described.

Case presentation

A 65-year-old male, with a past history of esophagectomy and retrosternal gastric tube reconstruction 4 months earlier, underwent a robotic-assisted inguinal hernia repair. Postoperative chest x-rays revealed the development of bilateral pneumothorax, which became worse on postoperative day (POD) 1 and took more than 9 days to resolve spontaneously. We assumed that intra-abdominal gas replaced by the air after pneumoperitoneum might have migrated into thoracic cavities through an opened esophageal hiatus or along the retrosternal route.

Conclusions

Laparoscopic surgery after radical esophagectomy may be associated with an increased risk of postoperative pneumothorax.
Multiple cerebral microinfarcts: an uncommon presentation of Cerebral Amyloid Angiopathy-related inflammation
Authors: Theodorou Aikaterini , Tsibonakis Athanasios , Pateras Ioannis S , Kaloudi Georgia , Bakola Eleni , Chondrogianni Maria , Andreadou Elissavet , Panayiotides Ioannis G , Tsivgoulis Georgios
Published: June 2023

Background

Cerebral Amyloid Angiopathy-related inflammation (CAA-ri) is a distinct but rare subset of CAA. The greater availability of high resolution Magnetic Resonance Imaging (MRI) has currently allowed the increasing recognition and diagnosis of this entity, without the risk of a brain biopsy. However, in rare cases with typical clinical characteristics but uncommon neuroimaging findings at presentation, the brain-biopsy is required for an early and reliable diagnosis.

Case description

A 71-year-old man with arterial hypertension presented due to 1-week history of headache, vomiting, disorientation and impaired consciousness. Brain MRI revealed multiple acute cortical/subcortical microinfarcts, scarce microbleeds, extensive right parietooccipital and left frontotemporal leptomeningeal enhancement. After an extensive diagnostic work-up, excluding infectious, neoplastic and autoimmune etiologies, the patient underwent brain-biopsy. Histology disclosed amyloid deposition in an arteriolar wall and the patient fulfilled diagnostic criteria for probable CAA-ri with supporting pathology. He received intravenous methylprednisolone, followed by oral tapering with steroids showing clinical and radiological improvement with complete resolution of gadolinium enhancement. Follow-up MRI revealed an increase of cerebral microbleeds and the patient fulfilled CAA-ri neuroimaging criteria.

Conclusions

This case highlights the importance of continuous vigilance from clinical neurologists to detect CAA-ri diagnosis and the diagnostic value of brain-biopsy in CAA-ri patients with atypical neuroimaging presentation, such as acute microinfarcts. The early diagnosis and the prompt treatment initiation can improve the prognosis and the evolution of this rare disorder.
Prognostic and diagnostic anthropometric biomarkers of sarcopenia in a cohort of Egyptian patients with hepatitis C-induced liver cirrhosis
Authors: Abbasy Amany Nabil , Abdel-Naby Hoda Mohamed , Ellakany Walid Ismail
Published: June 2023

Background

Chronic hepatitis C (HCV) infection is a leading cause of liver cirrhosis (LC) worldwide with decompensation-related clinical sequelae. Sarcopenia is currently recognized as a fundamental complication of LC owing to various mechanisms. This study aimed to assess the role of anthropometric measures of sarcopenia in predicting the outcome of LC as assessed by the Child-Turcotte-Pugh (CTP) grade.

Results

A cross-sectional study was carried out on 80 patients with HCV-related LC with different CTP grades. The diagnosis of sarcopenia was based on the 2018 definition of sarcopenia according to the European Working Group on Sarcopenia in Older People (EWGSOP). Muscle strength was assessed by hand grip strength (HGS) and lower leg extension strength (LES). Assessment of muscle mass was performed by measuring mid-calf circumference (MCC) and mid-arm muscle circumference (MAMC). HGS varied significantly between the different CTP grades, being highest in CTP grade C. Additionally, the number of patients diagnosed with “definitive sarcopenia” using either HGS/MCC or LES/MCC varied significantly between CTP grades, being highest in CTP grade C.

Conclusions

HGS is a better predictor of worse outcomes of liver cirrhosis than LES. The combination of MCC and HGS or LES is a potentially promising noninvasive prognostic biomarker of liver disease.
A suggested dynamic soil – structure interaction analysis
Authors: Shehata Osama E. , Farid Ahmed Fady , Rashed Youssef F.
Published: June 2023

In this paper, a new methodology for time domain analysis of buildings on raft foundations considering soil – structure interaction is proposed. Sub-structuring technique is used to separate the building as super-structure and the underneath soil as sub-structure. The super-structure can be modeled using any numerical method. However, in this paper the super-structure is modeled via the BEM to consider the real interaction area between column and slabs. The dynamic load is considered as an earthquake acceleration record that can be transformed to equivalent dynamic loads acting on the super-structure floors. The sub-structure is analyzed using the dual reciprocity boundary element method as closed domain. New iterative coupling technique is proposed between the super and sub-structures to reduce the computational effort and required storage. An example is presented to demonstrate the strength and the practicality of the proposed methodology.
The Disproportionate Impact of Fear of Negative Evaluation on First-Generation College Students, LGBTQ+ Students, and Students with Disabilities in College Science Courses
Authors: Busch Carly A. , Wiesenthal Nicholas J. , Mohammed Tasneem F. , Anderson Shauna , Barstow Margaret , Custalow Cydney , Gajewski Jas , Garcia Kristin , Gilabert Cynthia K. , Hughes Joseph , Jenkins Aliyah , Johnson Miajah , Kasper Cait , Perez Israel , Robnett Brieana , Tillett Kaytlin , Tsefrekas Lauren , Goodwin Emma C. , Cooper Katelyn M.
Published: June 2023

Fear of negative evaluation (FNE) is the primary factor causing student anxiety in active learning. This study of 566 undergraduates establishes that LGBTQ+, first-generation, and disabled students disproportionately experience FNE, which causes students to overthink their responses and reduces their participation in class.
Acceptability of a Chinese version of volitional help sheet to prevent self-harm repetition: qualitative study
Authors: Hwang I-Ting , Chen Yi-Chun , Armitage Christopher J. , Hsu Chia-Yueh , Chang Shu-Sen
Published: June 2023

Background

Individuals who self-harm have increased suicide rates. Brief interventions are associated with reduced repeated suicide attempts. However, very few previous studies investigated the acceptability of brief interventions before implementing new trials.

Aims

We aimed to explore the perceptions of individuals who self-harm toward a brief intervention, the Chinese version of the volitional help sheet (VHS-C), which encourages people to link a critical situation with an appropriate response.

Method

Fourteen participants who presented to hospitals with self-harm were interviewed about their perspectives regarding the acceptability of the paper- and web-based VHS-C. Data were analysed with the framework method.

Results

The participants could understand the intended goal of the VHS-C by reading the written instructions, but indicated that having verbal instructions would also help. They shared the reasons why they felt the VHS-C was helpful (e.g. relatable contents, useful coping strategies and appropriate instructions that made them feel understood) or unhelpful (e.g., being not specific enough, not useful during the crisis and triggering negative emotional responses). Some indicated that the VHS-C might not be applicable to people experiencing ongoing distress in emergency departments. Most participants preferred the web-based to the paper-based VHS-C, and suggested that the format and frequency of follow-up reminders could leave the patient to decide.

Conclusions

The contents of the VHS-C were acceptable for people who presented to hospitals with self-harm. The VHS-C may be more helpful before individuals encounter suicidal thoughts than when they have an ongoing crisis.
Gender Inequality Reinforced: The Impact of a Child's Health Shock on Parents' Labor Market Trajectories
Authors: Vaalavuo Maria , Salokangas Henri , Tahvonen Ossi
Published: June 2023

This article employs a couple-level framework to examine how a child's severe illness affects within-family gender inequality. We study parental labor market responses to a child's cancer diagnosis by exploiting an event-study methodology and rich individual-level administrative data on hospitalizations and labor market variables for the total population in Finland. We find that a child's cancer negatively affects the mother's and the father's labor income. The effect is considerably larger for women, increasing gender inequality beyond the well-documented motherhood penalty. We test three potential moderators explaining the more negative outcomes among mothers: (1) breadwinner status, (2) adherence to traditional gender roles and conservative values, and (3) the child's care needs. We find that mothers who are the main breadwinner experience a smaller reduction in their household income contribution than other mothers. Additionally, working in a gender-typical industry and a child's augmented care needs reinforce mothers' gendered responses. These findings contribute to the literature by providing new insights into gender roles when a child falls ill and demonstrating the effects of child health on gender inequality in two-parent households.
District Sales Managers
Authors: McCarthy Anna
Published: June 2023

This is a brief personal reflection on Stanley Aronowitz's contributions to our understanding of academic labor and management.
Gender and Violence: The Multivalent Voices of a Cannibalized Concubine in Late Imperial Chinese Literature
Authors: Wang Guojun , Yingde Guo
Published: June 2023

Recent studies of Chinese history and literature have revealed the important role of violence—actual and representational—in constructing gendered subjectivities in late imperial China. This article investigates the relationship between violence and female agency through a case study of literary representations of a concubine who was cannibalized during the defense of Suiyang amid the An Lushan Rebellion (755–763) in the Tang dynasty. As a result of that event, the ethically questionable act of cannibalism engendered an assortment of writings down through late imperial China. Although historical writings before the Ming dynasty frequently praise the concubine's husband for sacrificing her, a series of dramatic works starting in the Ming feature the concubine character in contention with her husband. This paper parses those materials to reveal vastly different characterizations of the cannibalized woman—as a loyal concubine, a female knight-errant, an independent state subject, and a maternal deity. We suggest that authorship, generic traditions, family-state dynamics, ethnic relations, and religions together influenced the representations of the concubine. In particular, moving further away from the literati writing tradition, literature and performance derived from the story ascribed increasingly potent agency to the concubine character in late imperial China.
Endoscopic Endonasal Transtuberculum Approach for Pediatric Tuberoinfundibular Craniopharyngioma: 2-Dimensional Operative Video
Authors: Vigo Vera , Chang Jose E. , Nunez Maximiliano A. , Prolo Laura M. , Hwang Peter H. , Fernandez-Miranda Juan C.
Published: June 2023

INDICATIONS: CORRIDOR AND LIMITS OF EXPOSURE

The endoscopic endonasal transtuberculum approach grants access to suprasellar and retrochiasmatic lesions with hypothalamic involvement. Here, we present a case of a 13-year-old boy with a history of stunted growth, decreased vision, headaches, and low energy with a tuberoinfundibular craniopharyngioma. The patient consented to the procedure.

ANATOMIC ESSENTIALS: NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT

Evaluation of the sphenoid sinus pneumatization, internal carotid artery disposition, presence of clinoidal rings, variations of the infrachiasmatic corridor (optic chiasm location, height of dorsum sella), and location of the pituitary stalk are crucial for surgical strategy.

ESSENTIALS STEPS OF THE PROCEDURE

Harvesting of nasoseptal flap and access to the sphenoid sinus; drilling the sella, tuberculum, and chiasmatic sulcus up to the limbus sphenoidalis and laterally exposing the clinoidal carotid artery segment; wide dural opening to the level of distal rings inferolaterally and falciform ligaments superolaterally; identification and coagulation of superior hypophyseal branches providing tumor supply; intracapsular dissection and debulking and subpial sharp dissection at the hypothalamic tumor interface to achieve complete removal; and reconstruction with inlay collagen, fascia lata, and nasoseptal flap.

PITFALLS/AVOIDANCE OF COMPLICATIONS

Preservation of the superior hypophyseal arteries and stalk is essential for preventing pituitary dysfunction. Preoperative reckoning of hypothalamic invasion and identification of adequate interface aids in avoiding complications. To reduce CSF leak risk, multilayer reconstruction was performed and lumbar drain placed postoperatively.

VARIANTS AND INDICATIONS FOR THEIR USE

For retroclival extension, intradural pituitary transposition should be considered to expand the corridor; in patients with preoperative hypopituitarism, pituitary sacrifice is most effective to increase retroclival access.
Subcranial Approach: A Straightforward Approach to the Anterior Fossa Floor: 2-Dimensional Operative Video
Authors: Aversa Antonio , Godoy Bruno , de Mello Rafael , Nogueira Janio
Published: June 2023

INDICATIONS: CORRIDORS AND LIMITS OF EXPOSURE:

Subcranial approach is a versatile keyhole approach mainly indicated to the tumors of the anterior fossa and midline invasive tumors from the nasal cavity and paranasal sinus.
1-5
Endoscopic endonasal video assistance enhances the exposure and the safety of the approach.

ANATOMIC ESSENTIALS: NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT:

Preoperative images depicted the size of the frontal sinuses and the relations of the lesions with frontal, ethmoid, and orbits.

ESSENTIAL STEPS OF THE PROCEDURE:

After performing a bifrontal scalp flap and a pericranial flap, periorbits are dissected from the superior and medial orbital rims. After frontonasal osteotomy, we drill the posterior wall of the frontal sinus.

PITFALLS/AVOIDANCE OF COMPLICATIONS:

Avoiding disruption of the cantal ligaments prevents telecantus. Watertight closure of the dura with temporal fascia graft and reinforcement with the pericranial flap makes cerebrospinal fluid leak occurrence very rare.

VARIANTS AND INDICATIONS FOR THEIR USE:

Subcranial approach is our preferred approach for the tumors of the anterior fossa floor and the midline paranasal invasive tumors. This keyhole approach through a relatively small frontoethmoidal craniotomy combines the advantages of the regular craniotomies but with no manipulation of the frontal lobes. An advantageous inferior angle of view similar of the pure endonasal endoscopical approach is achieved, but better than in the pure endoscopical approaches, the subcranial approach allows a direct wider exposure and a superior watertight reconstruction of the anterior fossa floor.

The patients consented to the procedure and to the publication of his/her image.
Endoscopic Endonasal Transpterygoid Approach: Technical Lessons
Authors: Finger Guilherme , Gun Ramazan , Wu Kyle C. , Carrau Ricardo L. , Prevedello Daniel M.
Published: June 2023

INDICATIONS: CORRIDOR AND LIMITS OF EXPOSURE

The endoscopic endonasal transpterygoid approach (EETPA) provides direct access to the petrous apex, lateral clivus, inferior cavernous sinus compartment, jugular foramen, and infratemporal fossa.
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In the coronal plane, it provides exposure far beyond a traditional sphenoidotomy.

ANATOMIC ESSENTIALS: NEED FOR PREOPERATIVE PLANNING AND ASSESSMENT

The pterygoid process of the sphenoid bone forms the junction between the body and greater sphenoid wing before bifurcating because it descends into medial and lateral plates. The key to this exposure lies in the region's bony foramina: the palatovaginal canal, vidian canal, and foramen rotundum.
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ESSENTIALS STEPS OF THE PROCEDURE

After performing a maxillary antrostomy, stepwise exposure of these foramina leads to the pterygopalatine fossa. The sphenopalatine artery is cauterized as it becomes the posterior septal artery at the sphenopalatine foramen, and the maxillary sinus' posterior wall is opened to expose the pterygopalatine fossa. After mobilizing and retracting the contents of the pterygopalatine fossa, the pterygoid process is removed, improving access in the coronal plane.
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PITFALLS/AVOIDANCE OF COMPLICATIONS

Vidian neurectomy causes decreased or absent lacrimation. Injury to the maxillary nerve or its branches results in facial, palatal, or odontogenic anesthesia or neuralgia. In addition, the EEPTA precludes the ability to raise an ipsilateral nasal septal flap, making it crucial to plan reconstruction preoperatively.
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VARIANTS AND INDICATIONS FOR THEIR USE

There are 5 variants of the EEPTA: extended pterygopalatine fossa, lateral recess of the sphenoid sinus, petrous apex, infratemporal fossa and petrous carotid artery, and middle and posterior skull base.
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The patient consented to the procedure.

Images in the video used with permission as follows: images at 0:33 and 1:15 reused from Bozkurt et al,
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© Georg Thieme Verlag KG; image at 0:39 from Prosser et al,
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© John Wiley and Sons; images at 0:54, 9:03, and 9:38 from Kasemsiri et al,
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© John Wiley and Sons; images at 1:07 and 9:44 from Falcon et al,
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© John Wiley and Sons; image at 1:15 from Sandu et al,
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© Springer Nature.
Percutaneous Vertebroplasty and Upper Instrumented Vertebra Cement Augmentation Reducing Early Proximal Junctional Kyphosis and Failure Rate in Adult Spinal Deformity: Case Series and Literature Review
Authors: Gassie Kelly , Pressman Elliot , Vicente Angel Chinea , Flores-Milan Gabriel , Gordon Jonah , Alayli Adam , Lockard Gavin , Alikhani Puya
Published: June 2023

BACKGROUND AND OBJECTIVES:

One of the risks involved after long-segment fusions includes proximal junctional kyphosis (PJK) and proximal junctional failure (PJF). There are reported modalities to help prevent this, including 2-level prophylactic vertebroplasty. In this study, our goal was to report the largest series of prophylactic cement augmentation with upper instrumented vertebra (UIV) + 1 vertebroplasty and a literature review.

METHODS:

We retrospectively reviewed our long-segment fusions for adult spinal deformity from 2018 to 2022. The primary outcome measures included the incidence of PJK and PJF. Secondary outcomes included preoperative and postoperative Oswestry Disability Index, visual analog scale back and leg scores, surgical site infection, and plastic surgery closure assistance. In addition, we performed a literature review searching PubMed with a combination of the following words: “cement augmentation,” “UIV + 1 vertebroplasty,” “adjacent segment disease,” and “prophylactic vertebroplasty.” We found a total of 8 articles including 4 retrospective reviews, 2 prospective reviews, and 2 systematic reviews. The largest cohort of these articles included 39 patients with a PJK/PJF incidence of 28%/5%.

RESULTS:

Overall, we found 72 long-segment thoracolumbar fusion cases with prophylactic UIV cement augmentation with UIV + 1 vertebroplasty. The mean follow-up time was 17.25 months. Of these cases, 8 (11.1%) developed radiographic PJK and 3 (4.2%) required reoperation for PJF. Of the remaining 5 patients with radiographic PJK, 3 were clinically asymptomatic and treated conservatively and 2 had distal fractured rods that required only rod replacement.

CONCLUSION:

In this study, we report the largest series of patients with prophylactic percutaneous vertebroplasty and UIV cement augmentation with a low PJK and PJF incidence of 11.1% and 4.2%, respectively, compared with previously reported literature. Surgeons who regularly perform long-segment fusions for adult spinal deformity can consider this in their armamentarium when using methods to prevent adjacent segment disease because it is an effective modality in reducing early PJK and PJF that can often result in revision surgery.