bluuebunny/crossref_metadata_2025 huggingface dataset:
Immunization coverage and associated factors among children age 12-23 months in Ethiopia: An Umbrella review of Systematic review and Meta-analysis 2024
Authors: Hadaro Tesfahun Simon , Kussia Begetayinoral , Bekele Merkin , Oshine Woldetsadik , Abebe Mesfin
Published: April 2024

Background
Full immunization coverage plays a vital role in public health by enhancing child survival and preventing morbidity and mortality from common childhood illnesses. However, there is a shortage of comprehensive studies providing conclusive evidence on full immunization coverage and associated factors in Ethiopia. Hence, the objective of this umbrella review and meta-analysis was to identify the pooled full immunization coverage and associated factors in Ethiopia.
Methods
This review used an umbrella review method, by incorporating numerous systematic reviews. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The method involved systematically synthesizing suitable systematic reviews and meta-analyses using the Assessment of Multiple Systematic Reviews (AMSTAR) tool. Medical Subject Heading (Mesh) terms and keywords were used to find pertinent review in various online databases, such as PubMed, Cochrane Library, Science Direct, Google Scholar, and HINARI. I-squared statistics were used to assess study heterogeneity. STATA version 17 software was used for statistical analysis, and the 95% CI was used to determine statistical significance.
Result
In this review, four studies were included. The pooled prevalence of immunization coverage was 60.21% (95% CI: 57.29–63.14). The umbrella review found that factors such as institutional delivery (AOR = 1.93, 95% CI 1.75–2.10), travel time to vaccination site (AOR = 2.39, 95% CI 1.89–2.89), receiving at least one antenatal care visit (AOR = 2.70, 95% CI 2.05–3.33), possessing good maternal knowledge (AOR = 3.77, 95% CI 3.07–4.14), maternal education level (AOR = 2.3, 95% CI 1.7–2.96), and residing in urban areas (AOR = 1.84, 95% CI 1.54–2.14) were significantly associated with achieving full immunization coverage.
Conclusion
The pooled prevalence of immunization coverage was found to be 60.21%, indicating a substantial gap that needs to be addressed. Factors such as institutional delivery, travel time to vaccination site, antenatal care visits, maternal knowledge, education level, and urban residence were significantly associated with higher immunization rates. These findings underscore the need for targeted interventions to improve access to vaccination services, enhance maternal education and knowledge, and promote institutional delivery. Addressing these factors can help increase immunization coverage and contribute to better overall public health outcomes.
Hard X-ray projection imaging below 5 nm resolution
Authors: Zhang Wenhui , Dresselhaus Jan Lukas , Fleckenstein Holger , Prasciolu Mauro , Zakharova Margarita , Ivanov Nikolay , Li Chufeng , Yefanov Oleksandr , Li Tang , Egorov Dmitry , Aquino Ivan De Gennaro , Middendorf Philipp , Hagemann Johannes , Shi Shan , Bajt Saša , Chapman Henry
Published: April 2024

High-resolution X-ray imaging of non-crystalline objects is often achieved through the approach of scanning coherent diffractive imaging known as ptychography. The imaging resolution is usually limited by the scattering properties of the sample, where weak diffraction signals at the highest scattering angles compete with background noise and parasitic scattering. Here we demonstrate that X-ray multilayer Laue lenses of high numerical aperture (NA) can be used to create a strong reference beam that holographically boosts that weak scattering from the sample over a large range of scattering angles, enabling high-resolution imaging that is tolerant to such noise. An imaging resolution of about 5 nm was achieved at a photon energy of 17.4 keV with lenses of 0.014 NA from a Siemens star test object and a sample of hierarchical nanoporous gold, recording projection holograms at a magnification of more than 30,000 directly on a pixel-array detector. A numerical study compared this approach to far-field ptychography, indicating significant advantages for using high-NA lenses in the presence of background noise. This imaging modality is particularly fast and efficient to record high-resolution transmission phase-contrast images over large fields of view in a facile manner.
Hybrid Billiards Archimedes optimization of Multi-kernel polar codesfor 5G communications
Authors: banda yamini pushpa , panda sunita
Published: April 2024

A series of error correcting codes is known as polar codes, able to provably achieve channel capacity for a large number of channels. Punctured and shortened codes are decoded by means of their mother polar codes, increasing the decoding latency with respect to the actual code length. To overcome this in this manuscript a Hybrid Billiards Archimedes optimization based Multi-kernel polar codes for 5G communications (MK hybrid-BAO) is proposed for 5G communications. The proposed method consists of three phases. At first the polar code is constructed, the construction phase includes encoding, tanner graph and decoding. In the second phase the polar codes are designed the design principles for multi-kernel polar codes are Reliability design, Distance design and hybrid design. And these design principlesare optimized with the help of Billiards Archimedes optimization. For distance design, maximizes the minimal distance of the code, and makes use of the minimum-distance spectra of the kernels. For hybrid design, generalized design based on a mix of both reliability and distance. The MK Hybrid-BAO is compared with punctured, shortened, MK, MK + KS, MK Hybrid polar codes. The proposed method attains performance gain in terms of BLER.
Modeling the frailty phenotype by using biochemical markers measured in blood samples and multiple regression analysis
Authors: ZAMUDIO FRANCISCO , Garcia Francisco , Palomo Ivan , Fuentes Eduardo
Published: April 2024

Background
Human frailty syndrome is a complex phenotypic trait and the result of multiple sources of influence. Its assessment is not a simple task; however, it is important to preventing disability in adult people. However, it requires retrieval of clinical data and calculations that are time-consuming, which may be unfeasible in routine clinical practice. We propose a diagnostic tool based on multiple regression analysis and aimed to have a preliminary assessment of the frailty condition in senior adults. Because it depends on blood sample analyzes, our predictive functions are less invasive, expensive, time consuming, and less physically and psychologically discomforting.
Method
Data came from the Toledo Study for Healthy Aging, a prospective cohort study designed for evaluating the determinants, and consequences, of the frailty syndrome in older people living in the province of Toledo, Spain. The Garcia´s Frailty Trait Scale (FTS12) was considered as the dependent variable in the statistical analyzes. Forty-six traits assessed from blood samples were included as independent variables to be tested. They included 15 variables from hemograms, 19 variables from biochemical profiles, and 12 extra biochemical characteristics (not included in standard biochemical profiles). The stepwise regression method was used in deciding which explanatory variables were to be included in the predictive models.
Results
Two predictive functions of the observed frailty for each gender were obtained: a “full model” and a “reduced model”. A range of 0.615 to 0.649 of moderately high Pearson's correlations was recorded between observed and predicted FTS12 values across the four equations. The correlation between all functions of risk factors and FTS12 was larger than 0.4 and highly significant in all four study cases. With single risk factors, the highest correlation coefficient was 0.283 (p-value < 0.0001).
Conclusions
The frailty syndrome can be moderately well predicted by using biochemical information. However, full models showed a narrow superior predictive capability. Albumin was present in all functions of risk factors selected by the modeling. It showed to be a risk factor that helps in predicting the frailty phenotype. We expect that exploring Albumin’s potential as part of a predictive equation might help to design anti-aging therapeutic measures.
The Synergistic Impact of Probiotic Supplementation and High-intensity Interval Training on Dyslipidemia and the Liver Longevity Genes in Ovariectomized Rats
Authors: Abbaspour Elahe , Karimzadhagh Sahand , Bayat Zeinab , Damirchi Arsalan , Hasannejad-Bibalan Meysam , Babaei Parvin
Published: April 2024

Objective: This study aimed to explore the synergistic impact of supplementing with local probiotic consumption and engaging in high-intensity interval training (HIIT) on liver health. The focus was particularly on targeting the revitalization genes Cisd2 and Hnf4α and improving dyslipidemia.
Methods: In this study, forty ovariectomized (OVX) Wistar rats were divided into five groups: one control, sham surgery, and four ovariectomized (OVX) groups receiving either 1 ml of synthesized local probiotic or engaged in HIIT at 90-95% VO2 max for eight weeks and finally co-treatment of exercise and probiotics. Following the interventions, protein expressions were measured using Western blotting, and assessments of lipid profiles were conducted using colorimetric analysis and enzyme-linked immunosorbent assay.
Results: Western blot analysis demonstrated a notable increase in Cisd2 and Hnf4a levels following the co-administration of HIIT and probiotics compared to the OVX + Vehicle group (P=0.001). Furthermore, the analysis revealed a significant decrease in weight, WC, visceral fat, BMI, TG, TC, and LDL-C concentrations, coupled with increased HDL-C (P = 0.001).
Conclusion: Our study indicates the efficacy of combined HIIT and lactobacillus probiotic treatment in elevating liver longevity markers of Cisd2 and Hnf4a and mitigating factors associated with obesity and dyslipidemia.
Policing Domestic Abuse: Are They Listening? Assessing Active Listening in Police Response to Domestic Abuse Callouts Through Structured Observation of Body-worn Video
Authors: Valentine Sebastian , Cole Terri
Published: April 2024

Purpose
This research investigated the use of active listening skills (ALS) by frontline police officers at domestic abuse (DA) calls and its effect on case outcomes. Two out of every five calls to police in England and Wales relate to DA. Despite the strengthening of legislation and policy, charge rates and victim satisfaction remain low. This research explores the role active listening plays in the effectiveness of the police response to DA by seeking to answer the following research questions: What is the general level of ALS employed by uniform officers responding to DA callouts in Surrey Police? Does the use of ALS by police when speaking to a DA victim at a callout improve the outcome of that investigation?
Methods
A retrospective correlation study was undertaken using structured observation of police body-worn video. N = 40 video clips from DA incidents were viewed, and active listening behaviours displayed by the officers were scored. Scores were compared to offence outcomes using binary logistic regression.
Results
The mean active listening score was low. No correlation was found between active listening scores and either the victims giving a statement, or the case being solved. Rates of solved outcomes, statements and active listening scores were all low.
Conclusion
This research indicates low levels of active listening skills among officers. Due to these low levels, and poor overall outcomes, the impact of ALS on outcomes was difficult to determine. The wider implications of poor listening skills on police performance and culture are discussed.
Identification of Exercise Signature Genes Potentially Associated with Major Depressive Disorder by Combining Bioinformatics, Machine Learning, and Mendelian Randomization Analysis
Authors: Jiang Hongke , Zhao Shanguang , Yang Gang
Published: April 2024

Purpose: Aberrant alterations in exercise-related genes can significantly increase the vulnerability to major depressive disorder (MDD). This study aimed to systematically screen and identify exercise genes associated with the onset of MDD.
Method: The Gene Expression Omnibus and GeneCards databases were jointly utilized to screen for exercise differentially expressed genes (DEGs) in the depression dataset GSE38206. Functional enrichment and immunological analyses of DEGs were performed subsequently. Following this, the identification of signature genes was carried out using the Least Absolute Shrinkage and Selection Operator and Random Forest analysis methods. These signature genes were then subjected to validation for diagnostic efficacy, genome enrichment analysis, and immunological characterization. Finally, a two-sample Mendelian randomization analysis was conducted to confirm the causal relationship between physical exercise and MDD.
Results: A total of 256 differentially DEGs were identified through variance analysis. GeneCards was used to screen 962 exercise-related genes, resulting in the identification of 23 exercise DEGs through intersection. Exercise DEGs are enriched in signaling pathways such as advanced glycosylation end-product-receptor, tumor necrosis factor, and nuclear factor-κB, and are involved in physiological processes like response to lipopolysaccharide-mediated signaling pathways, negative regulation of exogenous apoptosis, and regulation of leukocyte immunity. Machine learning identified two signature genes, SNORD15A and RMRP, with areas under the receiver operating characteristic curve of 0.994 and 0.998, respectively. Enrichment analysis results indicate that RMRP regulates signaling pathways such as endocytosis, pyrimidine metabolism, ribosomal and protein hydrolysis, and is responsible for macroautophagy, phospholipid biosynthesis, immunomodulation, and nucleic acid metabolism. SNORD15A exhibits enrichment in signaling pathways related to extracellular matrix and receptor interactions, glycerophospholipid metabolism, as well as ribosomal and toll-like receptors. It is intricately involved in regulatory mechanisms responding to bacterial-derived molecules, oxidative stress, and reactive oxygen species. CIBERSORT statistics showed that both SNORD15A and RMRP were significantly positively correlated with CD4 memory-activated T cells, and plasma cells, and negatively correlated with T cell regulation. Mendelian randomization analysis showed a negative association between exercise and the risk of depression (OR: 0.965, p = 0.005).
Conclusion: SNORD15A, RMRP in peripheral blood is negatively associated with the risk of MDD. The discovery of the signature exercise genes expands the understanding of the pathological mechanisms of MDD and opens up new perspectives on exercise therapy for MDD.
Rare variants in genes coding for components of the terminal pathway of the complement system in preeclampsia
Authors: Lokki A , Triebwasser Michael , Daly Emma , COHORT FINNPEC , Kurki Mrtja , Perola Markus , Auro Kirsi , Salmon Jane , Java Anuja , Daly Mark , Atkinson John , Laivuori Hannele , Meri Seppo
Published: April 2024

Preeclampsia is a common multifactorial disease of pregnancy. Dysregulation of the complement activation is among emerging candidates responsible for disease pathogenesis. In a targeted exomic sequencing study we identified 14 variants within nine genes coding for components of the membrane attack complex (MAC, C5b-9) that are associated with preeclampsia. We found two rare missense variants in the C5 gene that predispose to preeclampsia (rs200674959: I1296V, OR (CI95) = 24.13 (1.25–467.43), p-value = 0.01 and rs147430470: I330T, OR (CI95) = 22.75 (1.17–440.78), p-value = 0.01). In addition, one predisposing rare variant and one protective rare variant were discovered in C6 (rs41271067: D396G, OR (CI95) = 2.93 (1.18–7.10), p-value = 0.01 and rs114609505: T190I, 0.02 OR (CI95) = 0.47 (0.22–0.92), p-value = 0.02). The results suggest that variants in terminal complement pathway predispose to preeclampsia.
Pituitary adenylate cyclase-activating polypeptide (PACAP) in the paraventricular nucleus of the thalamus: Influence on binge-type eating in male and female mice
Authors: Barson Jessica , Curtis Genevieve , Carpenter Brody , Pirino Breanne , Hawks Annie , Li George
Published: April 2024

Binge eating disorder, characterized by the overconsumption of food in a discrete time period, is the most common eating disorder in the United States, but its neurological basis is not fully understood. The paraventricular nucleus of the thalamus (PVT) is a limbic brain region implicated in eating, and the anorexigenic neuropeptide, pituitary adenylate cyclase-activating polypeptide (PACAP), is densely expressed in the PVT. This study sought to examine the possible involvement of PACAP in the PVT in binge-type eating. First, a model of binge-type eating was established in mice. Male and female C57BL/6J mice were given limited access to Milk Chocolate Ensure Plus® or had access only to chow and water. Under this model, while males and females both engaged in binge-type eating with Ensure, females engaged in this behavior to a greater degree than males. Next, the role of PACAP in the PVT was defined in relation to binge-type eating. Using quantitative real-time PCR, females were found to have higher baseline levels of PVT PACAP mRNA than males, but only males showed an increase in levels of PACAP after a history of binge-type eating, and only males showed a reduction in levels of PACAP immediately prior to a binge session. Using chemogenetics in PACAP-Cre transgenic mice on a C57BL/6J background, activation of PVT PACAP+ cells with a Cre-dependent Gq-DREADD was found to reduce binge-type eating, significantly in male but not female mice. These results indicate that PVT PACAP is involved in binge-type eating in a sex-dependent manner, with a decrease in PVT PACAP levels preceding binge-type eating in male mice, and enhanced PVT PACAP+ cell activity suppressing binge-type eating in male mice. Together, these results suggest that the PACAP system could be targeted in specific patient populations to help treat binge eating disorder.
Effectiveness of Community Engagement Using M-Mama Champions in Improving Literacy of Obstetric Danger Signs, Birth Preparedness and Complication Readiness Among Pregnant Women in Bahi, Dodoma. A Community-Based, Cluster Randomized Controlled Trial
Authors: Sanga Alex , Kibusi Stephen , Kengia James Tumaini
Published: April 2024

Background: Maternal mortality remains a global public health issue, Sustainable Development Goal 3 targets to reduce it to less than 70 for every 100,000 live births by 2030. Maternal mortality whose peak is during intrapartum and the first day post-partum, 75% of it is accounted for by obstetric danger signs complications. Tanzania’s maternal mortality ratio stands at 104 for every 100,000 live births higher than the SDG target. Innovations that include M-MAMA Champions as facilitators in women groups are necessary to improve the literacy level of obstetric danger signs, birth preparedness, and complication readiness among pregnant women and enhance obstetric emergency response and service utilization, for essential interventions in healthcare facilities alone haven’t been able to reduce maternal mortality due to poor services utilization.
Methods: In a community-based, parallel-group cluster randomized controlled trial (cRCT) design, a total of 120 first and second-trimester pregnant women will be randomized at a ratio of 1:1 to the intervention and control groups. The sensitizing pregnant women on Obstetric danger signs, birth preparedness, and complication readiness by the empowered M-MAMA Champions to the intervention arm will be done for a period of one month, each two-hour session will be delivered in an interval of two weeks, using participatory learning and action model. The effect of the intervention will be determined using repeated ANOVA analysis, of which the effect of M-MAMA Champions on literacy level and practice between arms will be determined.
Discussion; Implementation fidelity of the intervention will be ensured through implementation observation by the researcher, research assistants, and the community health workers.
Ethics approval and consent to participate; The University of Dodoma Research Ethics Committee approved this study (Ref. No. MA.84/261/02/1/115). The study will ensure the protection of the participants’ values, dignity, and integrity per the Helsinki Declaration by the World Medical Association.
Applications of Generative Artificial Intelligence (AI) in Medical Education: A Current Application and Future Prospects in Saudi Arabia
Authors: Al-Qahtani Ali S , Al-Garni Abdulaziz M , Almohaya Abdullah Y.
Published: April 2024

Background: The integration of Artificial Intelligence (AI) into medical education has transformative potential, yet systematic evidence regarding its adoption and impact remains limited. This study aims to evaluate the knowledge, attitude, practice and perception related to AI integration among health staff in Saudi Arabian health colleges.
Methods: A cross-sectional design was employed, utilizing an online questionnaire distributed to faculty, clinicians, and administrative personnel across Saudi health colleges. The questionnaire, developed based on expert input and literature review, assessed knowledge and perception regarding AI integration. Validity was ensured through expert review, pilot testing, and cognitive interviews. The questionnaire consisted of 6 domains (academic leadership, academic quality, generative AI in curriculum design and development, teaching methods, assessment and evaluation, and ethics, and challenges).
Results: A total of 313 participants were included in this survey, of the respondents, 73.31% were male, with assistant professors comprising nearly half of them (48.55%). Regarding AI use, 37.94% report that they never use general AI, while 30.55% use it sometimes, and 21.86% use it rarely. Significant differences in AI familiarity were observed according to academic rank (p = 0.028). Academic leadership, academic quality, and generative AI received the highest mean scores (4.29±0.64, 4.16±0.70, and 4.16±0.71 respectively), while ethics and challenges scored the lowest (3.80±0.76). Users of AI consistently reported higher mean scores across domains compared to non-users, with statistically significant differences observed for all domains except ethics and challenges. There was a statistically significant correlation between all domains.
Conclusions: The study highlights the importance of strategic AI integration in Saudi Arabian medical education to effectively address healthcare challenges and enhance learning methodologies and practices.
Cardiac safety after AstraZeneca COVID-19 vaccination: A cohort observational study
Authors: Karem Khalid , Barsoum Mina , Sabet Sameh , William Viola
Published: April 2024

Background
Vaccination is a well-established part of preventive and public health medicine but is not without risk. Most of the side effects related to COVID-19 vaccines are minor including local symptoms at the injection site and some systemic symptoms, such as fatigue, headache, and fever. Some preliminary reports mentioned a more serious side effect; myocarditis seen after certain COVID-19 vaccines. The purpose of this study was to reveal any decrease in left ventricular systolic function in patients receiving the AstraZeneca COVID-19 vaccine compared to healthy individuals who did not receive the vaccine.
Methods
This study included 150 people divided into two equal groups; the case group included individuals who received AstraZeneca COVID-19 vaccines, and the sex- and age-matched control group included healthy individuals who did not receive any of the COVID-19 vaccines. Echocardiographic parameters for assessment of systolic function were evaluated after full vaccination.
Results
By the end of the study, no difference was found between the case and control groups regarding the left ventricular ejection fraction (LVEF), the S' wave of the mitral valve, or the global longitudinal strain (GLS).
Conclusions
AstraZeneca COVID-19 vaccination was not associated with myocardial damage, as evaluated by 2D echocardiography, tissue Doppler, and speckle tracking echocardiography.
Post-traumatic Talus Avascular necrosis. Designing and additive manufacturing of talus implant as an alternative for leg amputation
Authors: Antounian Francois , Avagyan Hayk , Ghaltaghchyan Tsovinar , Holovenko Yaroslav , Khachatryan Hayk , Aghayan Marina
Published: April 2024

This study presents the design and development of a meshed implant intended for talus replacement surgery. Our focus was on a young adult patient who had sustained severe damage to the talus, resulting in avascular necrosis (AVN) and subsequent bone collapse. This condition caused persistent and debilitating pain, leading the medical team to consider amputation of the left foot at the ankle level as a last resort. Instead, we proposed an innovative approach involving the fabrication of a patient-specific implant specifically designed for pan-talar fusion. The implant was created using selective laser melting technology, which allowed for precise and accurate construction of the unique mesh structure. To ensure its mechanical integrity, we conducted uniaxial compression experiments, which confirmed that the proposed structure met all essential mechanical requirements, including compressive loading. The patient underwent regular monitoring for a period of 12 months. The meshed implant exhibited excellent osteoconductive properties, as evidenced by the successful ingrowth of bone into the mesh pores, resulting in a fusion between the implant and the surrounding bones.
The prognostic value of lymph node to primary tumor standardized uptake value ratio in cancer patients: A meta-analysis
Authors: Yap Wing-Keen , Hsu Ken-Hao , Wang Ting-Hao , Lin Chia-Hsin , Kang Chung-Jan , Huang Shih-Ming , Lin Huan-Chun , Hung Tsung-Min , Chang Kai-Ping , Tsai Tsung-You
Published: April 2024

Objective: The lymph node to primary tumor standardized uptake value ratio (NTR) is an innovative parameter derived from positron emission tomography (PET) scans that captures the intricate relationship between primary tumors and associated lymph nodes. This meta-analysis aimed to investigate the prognostic value of NTR in cancer patients.
Methods: A systematic search of PubMed, Cochrane, and Embase databases was conducted to identify studies investigating the association between NTR and survival outcomes in cancer patients. The pooled adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) were calculated using a random-effects model.
Results: Twelve studies comprising a total of 2037 patients were included in the meta-analysis. Elevated NTR was significantly associated with worse overall survival aHR (2.21, 95% CI 1.63 to 2.99), disease-free survival aHR (3.27, 95% CI 2.12 to 5.05), and distant metastasis-free survival aHR (2.07, 95% CI 1.55 to 2.78) in cancer patients. Subgroup analyses by cancer type showed consistent results across various malignancies, including head and neck squamous cell carcinoma, endometrial carcinoma, lung cancer, breast cancer, and nasopharyngeal carcinoma.
Conclusions: This meta-analysis provides evidence for a significant association between elevated NTR and worse survival outcomes in cancer patients. Elevated NTR may serve as a useful prognostic biomarker for cancer patients, and could potentially be used to guide treatment decisions and monitor disease progression. Future studies should aim to validate these findings in larger and more diverse patient populations, and investigate the underlying mechanisms for the observed association between NTR and survival outcomes.
‘I am a father but not pregnant’—a qualitative analysis of the perspectives of pregnant couples on male partner role during pregnancy care in Bamenda, Cameroon
Authors: Foglabenchi Lily Haritu , Stöckl Heidi , Marchant Tanya
Published: April 2024

Background
The reduction of maternal mortality has stagnated globally. Estimates project a rise to 140.9 deaths per 100,000 live births by 2030, which is double the Sustainable Development Goal target. Male involvement in pregnancy care has been proposed as an intervention to improve maternal and child health outcomes. However, there is limited understanding of how communities view the role of men beyond the instrumentalist approach that only targets men as accompanying partners without altering the underlying gender and socio-cultural determinants that shape their involvement in pregnancy care. This study broadens existing research by exploring and and contextualising the role of male partners during pregnancy in Bamenda, Cameroon.
Methods
This study employed a qualitative design underpinned by symbolic interactionism. We conducted 68 semi-structured interviews (SSIs) and three focus group discussions (FGDs) with purposively selected pregnant women(n= 38 SSIs; n=6, FGD) and male partners (n= 30 SSIs; n=6, FGD) in an urban hospital in the North West Regional capital—Bamenda. Nvivo was used for data management and subsequently, we performed thematic analysis using a critical discourse lens to generate manifest and latent interpretations of study findings.
Results
The role of male partners reflected hegemonic masculinity and was broadly conceptualised in three categories: breadwinner, protector/comforter, and ‘sender’ for antenatal care. Perceptions of men’s role differed between male and female participants. While women sought male involvement for pragmatic reasons like joint attendance of antenatal care, psychosocial support (affirmation) and assistance with domestic chores, men limited their involvement to roles that matched gendered preconceptions of masculinity like financial support for antenatal fees, maternal nutrition and birth supplies. Nonetheless, the perceived benefits for antenatal attendance was expressed by some men in terms of the direct access it gives them to pregnancy-related education from experts, paternal bonding and the appeal of fast-track services for couples.
Conclusion
Male involvement in maternal and child health in Bamenda Health District is an extension and reflection of how patriarchal norms on masculinity are constructed and adapted in this setting. To address gaps in male involvement, intervention designers and implementers will need to take into account prevailing culture-specific norms while deconstructing and leveraging masculine ideals to situate male involvement in the prenatal context.
Neurotoxicity post-epidural anesthesia in a patient with Vitamin B12 deficiency: a case report
Authors: Ibrahim Christelle , Maalouf Nancy
Published: April 2024

Background: Neurotoxicity have been reported after central neuraxial block. Some metabolic disturbances (thiamine deficiency, diabetes) were identified as contributing factor.
Case presentation: We describe a young woman with vitamin B12 deficiency who developed persistent lower extremity weakness and hypoesthesia for weeks after epidural anesthesia. Initial examination revealed bilateral distal lower extremities weakness and decreased sensations. Serial neurologic examinations showed improved motor and sensory findings. An injected lumbosacral MRI was unremarkable. Vitamin B12 level was very low. The patient received physiotherapy and Vitamin B12 supplementation. Nerve conduction study and electromyography on day-23 post-epidural anesthesia revealed evidence of peripheral nerve injury.
Conclusion: This case is the first to recognize vitamin B12 deficiency as a predisposing factor for the development of neurotoxicity following epidural anesthesia, it also emphasizes the importance of timely identification of vitamin deficiencies in patients developing neurotoxicity following central neuraxial blocks.
Neurosurgical Management of Myelomeningocele in Premature Infants: A Case Series
Authors: Stewart Addison , Hale Andrew T. , Saccomano Benjamin W. , Barkley Ariana S. , Hopson Betsy D. , Arynchyna-Smith Anastasia , Johnston James M. , Rocque Brandon G. , Blount Jeffrey P. , Rozzelle Curtis J.
Published: April 2024

Introduction
Myelomeningocele (MMC) is the most common neural tube defect, but rarely seen in premature infants. Most centers advocate for closure of MMC within 24 hours of birth. However, this is not always possible in severely premature infants. Given the rarity of this patient population, we aimed to share our institutional experience and outcomes of severely premature infants with MMC.
Methods
We performed a retrospective, observational review of premature infants (≤ 32 weeks gestational age) identified through our multidisciplinary spina bifida clinic (1995–2021) and surgical logs. Descriptive statistics were compiled about this sample including timing of MMC closure and incidence of adverse events such as sepsis, CSF diversion, meningitis, and death.
Results
Eight patients were identified (50% male) with MMC who were born ≤ 32 weeks gestational age. Mean gestational age of the population was 27.3 weeks (SD 3.5). Median time to MMC closure was 1.5 days (IQR = 1–80.8). Five patients were taken for surgery within the recommended 48 hours of birth; 2 patients underwent significantly delayed closure (107 and 139 days); and one patient’s defect epithelized without surgical intervention. Six of eight patients required permanent cerebrospinal fluid (CSF) diversion (2 patients were treated with ventriculoperitoneal shunting (VPS), three were treated with endoscopic third ventriculostomy (ETV) with choroid plexus cauterization (CPC) and 1 patient treated with ETV; mean of 3 years after birth, ranging from 1 day to 16 years). Two patients required more than one permanent CSF diversion procedure. Two patients developed sepsis (defined as meeting at least 2/4 SIRS criteria), and 2 patients had intraventricular hemorrhage (both grade III). No patients developed meningitis (defined as positive CSF cultures) prior to MMC closure. Median follow up duration was 9.7 years. During this time epoch, 3 patients died: Two before 2 years of age of causes unrelated to surgical intervention. One of the two patients with grade III IVH died within 24 hours of MMC closure.
Conclusions
In our institutional experience with premature infants with MMC, some patients underwent delayed MMC closure. The overall rate of meningitis, sepsis, and mortality for preterm children with MMC was similar to MMC patients born at term.
Cerebral venous sinus thrombosis with head trauma and unclassifiable myeloproliferative neoplasm: a case report
Authors: Chu Qiongxian , Zhou Zhiwei , Du Xingyu , Pan Chunhua , Zhou Hongyan , Xu Zucai , Xu Ping , Xu Zhongxiang
Published: April 2024

Background
Cerebral venous sinus thrombosis (CVST) is a rare and special type of cerebrovascular disease characterized by complex etiology, diverse forms of onset, non-specific clinical manifestations, and difficult to diagnosis. Myeloproliferative neoplasm-unclassifiable (MPN-U) refers to clinical manifestations, laboratory findings, and morphological features that are consistent with the diagnosis of myeloproliferative neoplasms, but do not meet further specific classification criteria, or have overlapping features of two or more MPNs. Here, we report a case of CVST with MPN-U and a history of head trauma.
Case presentation:
A 52-year-old male was admitted the hospital due to paroxysmal visual impairment for 1 year and worsening for 2 months with a history of head trauma. His increased hemoglobin was resulted from was the MPN-U, with bilateral papilledema, impaired visual field, intracranial hypertension and elevated D-dimer, the diagnosis of superior sagittal sinus thrombosis was confirmed by brain CTV and MRI. Therefore, anticoagulant treatment with low molecular weight heparin were administered in hospital, then rivaroxaban was given after discharge. the blurred vision of this patient had significantly improved after treatment.
Conclusion
It is unique that CVST with blurred vision as the main clinical manifestation and two possible causes including head trauma and MPN-U. For patients with CVST, in addition to anticoagulant therapy, it is also necessary to identify the etiologies.
Tirzepatide cardiovascular benefits and adverse events assessment: a Bayesian network meta-analysis
Authors: gong xuyang , cheng panpan , han yahui , li qianshuai , song chunhua , zhao yanyan
Published: April 2024

Objective
To comprehensively assess the cardiovascular benefits and adverse events of tirzepatide (including different control groups, different dosages and different patients).
Method
A systematic search was conducted on PubMed, Web of Science,The Cochrane Library and ClinicalTrials.gov. Randomized controlled trials (RCTs) of at least 26 weeks that compared tirzepatide (TZP) at doses of 5mg, 10mg, and 15 mg once weekly with another antihyperglycemic drug or placebo in adults with obesity or type 2 dabetes mellitus(T2DM) were included. Data Synthesis was performed using R 4.2.2 and Stata 18.0 software. Each outcome was presented as a relative risk (RR) with a 95% confidence interval (CI). The results were also displayed using network plots, the surface under the cumulative ranking curve value (SUCRA), league table and forest plot.
Results
A total of 14 RCTs with 14654 participants with T2DM or obesity were included inthis study. Generally, compared to placebo, insulin and glucagon-like peptide-1 receptor agonists (GLP-1RAs), TZP did not increase the risk of four-component major adverse cardiovascular events (MACE-4) (RR [95% CI], 0.54[0.25 to 1.06], 0.85 [0.45 to 1.81], 1.00 [0.34 to 2.92], respectively) and significantly increased total adverse events(TAEs)(RR[95% CI], 1.09[1.01,1.19], 1.22 [1.11,1.35], 1.03 [0.91,1.16], respectively). Compared to placebo, TZP 5mg, TZP 10mg and TZP 15mg all reduced the incidence of MACE-4 (RR [95% CI], 0.47 [0.23 to 1.12], 0.46 [0.15 to 1.48], 0.38 [0.17 to 0.84], respectively) and increased the risk of TAEs (RR[95% CI] 1.04[0.96,1.13], 1.07[0.99,1.16], 1.10[1.02,1.19], respectively). Compared to GLP-1 RAs, TZP 5 mg, TZP 10 mg, and TZP 15 mg all increased the risk of TAEs(RR [95% CI], 1.01[0.91,1.11], 1.04[0.94,1.14], 1.07[0.97,1.17], respectively) and TZP 15mg reduced the risk of MACE-4 (0.82 [0.31 to 2.22]). Compared to obesity, patients with T2DM experienced greater benefits of MACE-4 (RR[95% CI], 0.44[0.04 to 2.65])and lower risk of TAEs (RR [95% CI], 0.95 [0.77 to 1.24]). Additionlay, TZP reduced all-cause death (ACD) and serious adverse events(SAEs) but increased the risk of DAEs. And these benefits were not superior to those of GLP-1RAs, while the risk of adverse events leading to discontinuation of study treatment (DAEs) was higher than that of GLP-1RAs. TZP 15mg was more effective in reducing ACD and SAEs, but also increased the risk of discontinuation. among patients who use TZP, T2DM patients had greater benefits in ACD and less risk of SAEs and DAEs compared to obeity patients.
Conclusions
TZP is not inferior to GLP-1 RAs in reducing cardiovascular events. The effect is greater with TZP 15mg, but there are also more adverse events. Additionally, the use of TZP in T2DM patients may have a greater effect and fewer adverse events than in obesity patients.
Virtual simulation for the surgical remove of impacted teeth in practice teaching
Authors: Zhang Yushi , Chi Ming
Published: April 2024

Background
To explore the teaching quality of the virtual simulation practice teaching system for the surgical remove of the impacted teeth in oral and maxillofacial surgery.
Methods
A total of 60 undergraduate interns majoring in stomatology of China Medical University were selected as the research objects and randomly divided into two groups: VRLG and TLG, with 30 students in each group. After completing all the study plans, the students will take the theoretical and practical examination uniformly. In addition, a self-made questionnaire was distributed at the end of the practical class.
Results
The theoretical course scores of the VRLG were significantly higher than those of the TLG (89.77 ± 4.11 vs. 87.20 ± 4.82, P < 0.05), and the practical course scores of the VRLG were significantly higher than those of the TLG (88.50 ± 4.11 vs. 84.77 ± 5.20, P < 0.05), and the difference was statistically significant; 86.67% students think that the virtual simulation practice teaching system can assist learning, and 83.33% think that it is easier to understand the learning quality.
Conclusion
The virtual simulation practice teaching system can stimulate the learning interest and improve the learning effect.
Exposure to normobaric hypoxia shapes the acute inflammatory response in human leukocytes in vivo
Authors: Schönberger Tina , Jakobs Marie , Friedel Anna-Lena , Hörbelt-Grünheidt Tina , Tebbe Bastian , Witzke Oliver , Schedlowski Manfred , Fandrey Joachim
Published: April 2024

Cells of the immune defence, especially leukocytes, often have to perform their function in tissue areas that are characterized by oxygen deficiency, so called hypoxia. Physiological hypoxia significantly affects leukocyte function and controls the innate and adaptive immune response mainly through transcriptional gene regulation via the hypoxia-inducible factors (HIFs). Multiple pathogens including components of bacteria, such as lipopolysaccharides (LPS) trigger the activation of leukocytes. HIF pathway activation enables immune cells to adapt to both, hypoxic environments in physiological and inflammatory settings and modulates immune cell responses through metabolism changes and crosstalk with other immune-relevant signaling pathways. To study the mutual influence of both processes in vivo, we used a human endotoxemia model, challenging participants with an intravenous LPS injection post or prior to a 4-hour stay in a hypoxic chamber with normobaric hypoxia of 10.5 % oxygen. We analyzed changes in gene expression in whole blood cells and determined inflammatory markers to unveil the crosstalk between both processes. Our investigations showed differentially altered gene expression patterns of HIF and target genes upon in vivotreatment with LPS and hypoxia. Further, we found evidence for effects of hypoxic priming upon inflammation in combination with immunomodulatory effects in leukocytes in vivo. Our work elucidates the complex interplay of hypoxic and inflammatory HIF regulation in human immune cells and offers new perspectives for further clinical research.
Assessing the influence of macroalgae and micropredation on the early life success of the echinoid Diadema africanum
Authors: Cano Iván , Ugena Aitor , González-González Estefanía , Hernández José Carlos
Published: April 2024

The sea urchinDiadema africanumhas a significant influence on subtidal rocky reef communities on the Canary Islands, facilitating transitions between macroalgal beds and barren grounds. Barren grounds in the archipelago are characterized by a dominance of crustose coralline algae and a lack of invertebrates and fishes compared to macroalgal beds, which are mainly dominated by brown algae. To assess the impact of these benthic community states on the early life success ofD. africanuma manipulative study was conducted during September 2022 in four sites of the eastern coast of Tenerife Island, 'Añaza' (28.4204060 N–16.2954172 W), 'Boca Cangrejo' (28.4061537 N–16.27429 W), 'Las Caletillas' (28.3814250 N – 16.3552938 W), and 'La Jaca' (28.12087153 N – 26.46111758 W. For this purpose, modified experimental larval collectors were employed to examine sea urchin settlement rates in response to two dominant macroalgal species,Lobophora schneideri, in algal beds and encrusting corallines (CCA) in barren grounds. Statistical analysis revealed significant spatial differences in sea urchin settlement and the interaction between site and treatment response. Specifically, the site with higher sea urchin recruitment exhibited lower numbers ofD. africanumsettlers in treatments containingL. schneiderithan in the Control and CCA treatments. Three decapod species (Alpheus macrocheles, Lophozozimus incisus, andPachygrapsus marmoratus) negatively correlated withD. africanum settlers. These results suggest that larval supply,L. schneideribeds, and micropredator abundance play a role in the early life success of this species. This may imply a community stability mechanism that helps prevent shifts between alternative stable states.
METTL14 attenuates cancer stemness by suppressing ATF5/WDR74/β-catenin axis in gastric cancer
Authors: Zhang Peiling , Xiang Hong , Peng Qian , Ma Lujuan , Weng Chengyin , Liu Guolong , Lu Lin
Published: April 2024

Purpose
Stemness is one of the leading causes of treatment failure in gastric cancer (GC). Methyltransferase-like 14 (METTL14) participates in several malignancies. But the precise mechanisms of METTL14 in regulating GC stemness are still unclear.
Methods
Expression of METTL14 in GC was assessed by public datasets and clinical specimens. The roles of METTL14 in proliferation, metastasis and stemness were examined by using both in vitro and in vivo experiments. The m6A RNA immunoprecipitation (MeRIP) and luciferase reporter assays were performed to verify the target of METTL14. Rescue assays were used to explore the impaired stemness by METTL14 overexpression. The downstream mechanisms of ATF5 and upstream modification of METTL14 were studied by Chromatin immunoprecipitation (ChIP) and westernblot.
Results
Decreased expression of METTL14 was correlated with poor survival in GC. Functionally, METTL14 knockdown promoted GC cell stemness. Mechanically, METTL14 mediated m6A modification and facilitated ATF5 mRNA degradation. Furthermore, the deleterious effects subdued by the overexpression of METTL14 were restored following ATF5 overexpression, which facilitated the transcription of WDR74, thereby enhancing β-catenin translocation from the cytoplasm to the nucleus. Moreover, lactylation modification that occurred on the histone H3 (Lys18) of METTL14 could promote the expression of METTL14.
Conclusions
Our results demonstrate that METTL14 knockdown-mediated m6A modification of ATF5 mRNA promotes GC stemness by activating the WDR74/β-catenin axis.
Nursing graduates' perceived future career pathway and career shift tendency in Egypt: A cross sectional study
Authors: khalafalla Mohamed H. , Awad Hasan A. , Aly Mohamed A. , Ismail Hossam A. , Elmoaty Aliaa E. Abd
Published: April 2024

Purpose
The aim of this study was to explore perceived future Career pathway, as well as career shift tendency among nursing graduates in Egypt. This study also investigated factors influencing career shift tendency and examine the relation between career pathway perception and career shift tendency.
Methods
A descriptive cross-sectional study was used, with an online distributed questionnaire for study participants from different nursing graduates’ categories (technical institute, bachelor's degree, postgraduate degrees practicing in clinical settings (staff nurses, nurse educators, and nurse leaders), academic settings. That included demographic characteristics, a section that measured nursing graduates’ future career pathway perception, and career shift tendency.
Results
Nursing graduates in Egypt were having a positive perception regarding their future career pathway. However, more than one quarter of them were considering career shift represents potential workforce instability and dissatisfaction within the nursing profession and financial factors was one of the main provoking drivers for career shift tendency. In addition, nursing graduates’ perception of career pathway had a significant effect on their career shift tendency in future.
Conclusion
Based on the findings of this study, further efforts should be made to confront nursing shortage in Egypt, implementing targeted interventions to support nursing graduates in navigating their career pathways. Additionally, proactive measures should be taken to address the identified factors driving intentions to leave the profession, such as improving workplace conditions, fostering intergenerational collaboration, and offering mentorship programs. These strategies are essential for fostering a resilient and satisfied nursing workforce and ensuring the delivery of high-quality patient care in the healthcare sector.