bluuebunny/crossref_metadata_2025 huggingface dataset:
Novel hot and cold spots of mental hospital deserts across China using 2019-2022 antidepressant procurement data
Authors: Xue Qingyuan , Xue Aoming , Zhang Qi , Fan Keye , Chen Weiqi , Zhao Yang , Kuang Yuanyuan , Chen Yingsong , Zhou Jifang , Jiang Bin
Published: May 2024

Depression imposes a significant disease burden globally, being considered the second leading cause of disability in China. Therefore, it is worth noting whether patients with depression have sufficient opportunities to access treatment during travel. The minimum-cost path analysis method was employed to calculate travel times from population points to the nearest hospitals providing psychiatric medications, and to distinguish population points as either within or outside hospital deserts. Lastly, Poisson spatial scan analysis was used to identify hot spots and cold spots of hospital deserts. This study elucidates the limited and unequal access to antidepressant medications in China, providing policymakers and stakeholders with valuable insights to formulate effective strategies.
Plaque-type syringoma of the ear and scalp: Case report
Authors: Ali Rajiv Yussuf , Zuriel Daniel , Njambi Stephanie
Published: May 2024

Introduction
Syringomas are benign adnexal tumors derived from eccrine sweat glands that typically present as small, skin-colored dome-shaped papules. They are commonly found in women and typically affect the periorbital area but can also occur in other areas of the face and body. The plaque type is a rare type of syringoma, and only 14 cases have been reported to date with syringomas of the scalp and ear being even rarer.
Case presentation
We report the case of a 36-year-old Kenyan male who was referred to our dermatopathology department for biopsy and histopathological evaluation, and presented with a plaque lesion on the right temporal aspect of the scalp. Microscopic examination revealed a tumor arising from eccrine coils, forming cysts and coma-shaped ducts. The tumor extended deep into the reticular dermis, with extensive fibrosis surrounding the lesion, confirming the diagnosis of plaque-type syringoma.
Conclusion
Plaque-type syringoma is uncommon, and its presentation as discrete flat plaques on the scalp is even rarer. To the best of our knowledge, this is the first report of a plaque-type syringoma presenting as flat, dusky, discrete plaques on the scalp and ears. Therefore, clinicians should consider the differential diagnosis of plaque-type syringoma to avoid unnecessary exposure of patients to surgical procedures. Because the lesion is benign, careful observation and monitoring may be a reasonable management strategy in many cases. Treatment decisions are usually based on the patient's symptoms, lesion characteristics, and aesthetic concerns.
‘Super’-ior Scheduling: A Novel Model for an Inpatient Internal Medicine Resident Service
Authors: Kunnath Paul V. , Sr Maria , Fritz Adam , Lunt Jason , Ahmed Zarir , Vaidyan Philip , Buckhold Fred
Published: May 2024

Background
Residency programs have adopted blocked scheduling to improve the learning climate yet more intensive rotations still impact resident wellness. The effect of changing the alignment of inpatient resident teams on patient care opportunities is not well known. We sought to evaluate the association of new daily schedule (dubbed ‘Mariokart’) compared to a traditional schedule on patient care opportunities, days off, and duty-hour violations.
Methods
A non-randomized pre - and post-intervention study examining the daily patient census for residents covering a general internal medicine inpatient service within an internal medicine residency program at a single academic medical center from July 2018 to June 2021. The main outcome was the median daily patient census per resident inpatient team before and after the implementation of the ‘Mariokart’ schedule. Secondary outcomes included days off in a 28-day cycle, patient-care opportunities, and resident-reported duty-hour violations. A two-sided t-test was used to determine differences between the groups.
Results
In comparing 20 months prior to implementation of the ‘Mariokart’ schedule to 15 months post-implementation, the median census of the resident service was 60 patients (IQR 53.0–67.0) for the traditional model and 54 (IQR 49.0–59.0) for the MarioKart model. The median census per team was 12 (IQR 10.0–15.0) for the traditional model and 13.5 (IQR 12.25–14.75) for the MarioKart model. Total patient days per team were 288 (IQR 254.4-321.6) for the traditional model and 303.8 (275.6-331.9) for the MarioKart model (p < 0.001). Under the MarioKart model, residents had an extra 1.5 days off per 28 days compared to the traditional model. Short break violations for the entire program and for the general inpatient service were significantly reduced.
Conclusions
In this nonrandomized study of an alternate day-to-day schedule that reduced days worked for residents in a general medicine inpatient service, there was no decline in patient-care opportunities. This alternate organization of residents suggests that residency programs can innovate at a systems level to adjust resident schedules to provide more time off without a detriment to patient care opportunities.
Immobilization of lipase on graphene oxide: A biocatalyst for Esterification of oleic acid
Authors: Kanimozhi S. , Nagarani S. , Chang Jih-Hsing
Published: May 2024

Graphene Oxide (GO) provides excellent support for lipase enzyme immobilization due to its oxygen-containing functional groups and large surface area. In this work, we synthesized Candida rugosa lipase-immobilized GO and used it as a catalyst for the esterification process of oleic acid for biodiesel production. Different concentrations of (50–200 mg) Candida rugosa lipase enzyme immobilized on GO were used as catalysts. Physicochemical methods like X-ray diffraction (XRD), Raman spectroscopy, thermogravimetric analysis (TGA), and DRS-UV visible spectroscopy were used to describe the catalysts. HR-TEM studies have examined the surface morphology of GO and Candida rugosa lipase-immobilized GO. The catalytic activity was determined by esterifying oleic acid with ethanol to produce ethyl oleate. Gas Chromatography was used to identify the compounds using an internal standard. The various reaction conditions were altered to achieve the highest yield of ethyl oleate by varying the reaction process temperature, reaction duration, different concentrations of Candida rugosa lipase immobilized in GO, and the quantity of catalyst. A maximum oleic acid conversion of 89% was achieved using 150 mg of Candida rugosa lipase-immobilized GO (150 CR/GO). Hence, Candida rugosa lipases immobilized in GO were a good choice for biodiesel production.
Analysis of droplet evaporation dynamics using computational singular perturbation and tangential stretching rate
Authors: Angelilli Lorenzo , Galassi Riccardo Malpica , Ciottoli Pietro Paolo , Hernandez-Perez Francisco E. , Valorani Mauro , Im Hong G.
Published: May 2024

Computational singular perturbation (CSP) has been successfully used in the analysis of complex chemically reacting flows by systematically identifying the intrinsic timescales and slow invariant manifolds that capture the essential subprocesses driving the dynamics of the system. In this article, the analytical and computational framework is applied for the first time to analyze the Lagrangian droplets undergoing evaporation and dispersion in the surrounding gases. First, a rigorous mathematical formulation is derived to adapt the CSP tools into the droplet dynamics equations, including the formal definition of the tangential stretching rate (TSR) that represents the explosive/dissipative nature of the system. A steady ammonia and a falling water droplet studies are then conducted to demonstrate the utility of the CSP methodology in identifying various physical mechanisms driving the evolution of the system, such as the distinction of thermal-driven and mass-driven regimes. Various definitions of the importance indices are also examined to provide in-depth analysis of different subprocesses and their interactions in modifying the droplet dynamics.
Synthesis of ZnO/MoS2 nanocomposite for photodegradation of Methylene blue
Authors: Moein Hossein Karimi
Published: May 2024

An effective way to boost ZnO's photocatalytic activity is to decorate it with MoS2 nanosheets, a transition metal dichalcogenide with a narrow band gap. Fewer studies, nevertheless, demonstrate how multilayers of MoS2 nanosheets affect ZnO/MoS2 photocatalytic activity. ZnO nanorods were adorned in this study with low-layer and multilayer MoS2 nanosheets (about 11 and 3 atomic layers), which were annealed for 4 and 8 hours, respectively. The breakdown of methyl blue was subsequently explained using this kind of heterostructure. Our findings demonstrate that the ZnO/MoS2 photocatalytic efficiency is not only less than that of pure ZnO but also declines by 11% as the length and number of MoS2 nanosheet layers increase. The reduction in adsorption capacity could be the cause of this effect. of the ZnO/MoS2 system's water molecules as the contact angle rises from 17o–23o to 73o–76o. Because the planar surface of the 2H-MoS2 phase is hydrophobic, or an inactive catalytic site, there is an increased contact angle for ZnO/MoS2.
Plasma amyloid-β biomarkers for predicting amyloid positivity in mild cognitive impairment: a prospective cohort study
Authors: Ataka Takuya , Kimura Noriyuki , Kaneko Naoki , Masuda Teruaki , Takeuchi Yosuke , Yabuuchi Kenichi , Mizukami Takeshi , Takeuchi Tsukasa , Ito Temmei , Tasai Hideaki , Miyagawa Takehiko , Hanai Shunya , Iwamoto Shinichi , Matsubara Etsuro
Published: May 2024

Background: This study aimed to determine the predictive accuracy of amyloid-β precursor protein 669-711/amyloid-β1-42, amyloid-β1-40/1-42, and their composite biomarkers for brain amyloid deposition or the development of Alzheimer’s disease (AD) dementia in community-dwelling older adults with mild cognitive impairment(MCI).
Methods: This was a prospective cohort study conducted from August 2015 to September 2019. Blood samples were collected from older adults aged ≥65 years with MCI without dementia at baseline. Cognitive function and amyloid deposition were evaluated annually. Positron emission tomography was used to evaluate amyloid deposition. Plasma amyloid-β biomarkers were analyzed using immunoprecipitation-mass spectrometry. The classification accuracy of plasma biomarkers for brain amyloid status was evaluated using receiver operating characteristic curve analysis. Associations of plasma biomarkers with clinical conversion to AD dementia were evaluated using Kaplan‒Meier curves. Associations of plasma biomarkers with body mass index, apolipoprotein E4 status, cortical amyloid uptake, medical history, and hepatic or renal dysfunction were examined using multiple linear regression analysis.
Results: The participants included 107 patients (57 [53.3%] females, median age: 76.00 [72.00–80.00] years). Plasma biomarkers correlated with cortical amyloid uptake. The composite biomarker had the best area under the curve (0.943) for predicting amyloid positivity. Participants with high levels of composite biomarkers at baseline had a greater rate of conversion to AD dementia. Apolipoprotein E4 status and hepatic disorders were significantly correlated with increased plasma amyloid biomarker levels.
Conclusions: Composite amyloid biomarkers may serve as a surrogate measure for amyloid deposition in a community-based cohort.
Trial Registration: UMIN000017442
The Embodied Experiences of Injured Ultra-Runners: A Body-Mapping Study
Authors: Hall Leanne , Rhodes Paul
Published: May 2024

The sport of Ultra-running has seen exponential growth over the past ten years. These athletes attempt to push beyond unknown human limits by running for many hours at a time, often multiple times a week across mountains and trails. While research has begun to consider how injury impacts these athletes, less is known about their subjective embodied experiences. In particular, the discourses they resist and submit to when they are suddenly unable to run. This study describes the use of body-mapping and narrative interviewing as two forms of research inquiry merged to explore the embodied experiences of eight ultra-runners who had recently experienced an injury. Plot lines were woven through the visual and textual material resulting in three master plots and eight sub plots. Stories of Body Self-transformation, Machina Carnis or the body-as-machine and senescence or the ageing body were layered by emplacing images and text onto life sized body maps creating vibrant art works. These art works were analysed alongside detailed narratives of endurance, strength, determination and loss. Through the art works participants were able to make visible the invisible, with the injury experience providing a window into former ways of being and current experiences of liminality and fear. This study provides insight into the shifting subjectivities of these extreme athletes brought about by pain and injury and highlights the importance of using power leveling and emancipatory arts-based research methods in accessing subjective experience.
Longevity of hybrid immunity against SARS-CoV-2 in adults vaccinated with an adenovirus- based COVID-19 vaccine
Authors: Mvula Memory , Mtonga Fatima , Mandolo Jonathan , Jowati Chisomo , Kalirani Alice , Chigamba Precious , Lisimba Edwin , Mitole Ndaona , Chibwana Marah G , Jambo Kondwani C
Published: May 2024

Background.
Hybrid immunity provides better protection against COVID-19 than vaccination or prior natural infection alone. It induces high magnitude and broadly cross-reactive neutralising anti-Spike IgG antibodies. However, it is not clear how long these potent antibodies last, especially in the context of adenovirus-based COVID-19 vaccines.
Methods.
We conducted a longitudinal cohort study and enrolled 20 adults who had received an adenovirus-based COVID-19 vaccine before a laboratory-confirmed SARS-CoV-2 infection. We followed up the study participants for 390 days post the initial breakthrough infection. We assessed the longevity and cross-reactive breadth of serum antibodies against SARS-CoV-2 variants of concern (VOCs), including Omicron.
Results.
The binding anti-Spike IgG antibodies remained within the reported putative levels for at least 360 days and were cross-neutralising against Beta, Gamma, Delta, and Omicron. During the follow up period, a median of one SARS-CoV-2 re-infection event was observed across the cohort, but none resulted in severe COVID-19. Moreover, the re-exposure events were associated with augmented anti-Spike and anti-RBD IgG antibody titres.
Conclusions.
This study confirms that hybrid immunity provides durable broadly cross-reactive antibody immunity against SARS-CoV-2 variants of concern for at least a year (360 days), and that it is further augment by SARS-CoV-2 re-exposure.
Psychometrics of the modified Family-Centered Care Assessment short version for childhood obesity
Authors: Simione Meg , Ferreira Paola , Luo Man , Hoover Clarissa , Perkins Meghan , Fiechtner Lauren , Taveras Elsie M.
Published: May 2024

Background: Incorporating principles of family-centered care into pediatric weight management interventions can improve the effectiveness and quality of treatment and reduce attrition rates. To assess the family-centeredness of interventions, reliable, valid, and easy-to-administer scales are needed. The purpose of the study was to develop a shortened version of the modified Family Centered Care Assessment (mFCCA) and assess its psychometric properties.
Methods: The mFCCA, a scale to assess the family-centeredness of interventions for childhood obesity, was administered to families following the Connect for Health randomized control trial evaluating the effectiveness of a primary care-based pediatric weight management intervention. We iteratively removed items from the mFCCA and used Rasch modeling to examine the reliability and validity of the shortened scale.
Results: We included data from 318 parents and the exploratory factor analysis showed the presence of a single factor. The results of the Rasch modeling demonstrated acceptable internal consistency of the scale (0.7) and strong validity as evidenced by the overall model fit and range of item difficulty. Following the psychometric analyses, we reduced the number of items from 24 to 8 items.
Conclusions: The mFCCA short version demonstrates good psychometrics and can be used to evaluate the family-centeredness of childhood obesity interventions with reduced participant burden, thereby improving outcomes for children with obesity.
Trial registration: Clinicaltrials.gov NCT02124460 registered on April 24, 2014
Molecular biomarkers of response to sintilimab combined with lenvatinib for locally advanced hepatitis B virus-associated hepatocellular carcinoma
Authors: Wang Lijun , Cui Yong , Huang Longfei , Wang Hongwei , Liu Ming , Jin Kemin , Wang Kun , Xing Baocai
Published: May 2024

Background: The efficacy of combining immune checkpoint inhibitors with anti-angiogenic drugs in advanced hepatocellular carcinoma (HCC) varies, and the predictive biomarkers for this therapy remain unclear.
Methods: In this single-center study in China, patients with HCC ineligible for traditional resection were administered sintilimab on day 1 of a 21-day cycle, accompanied by daily oral lenvatinib. Treatment responses were assessed using the modified Response Evaluation Criteria in Solid Tumors (mRECIST). Tumor biopsies underwent RNA sequencing (RNA-seq), immune microenvironment analysis, and whole-exome sequencing (WES). Survival analyses also incorporated data from The Cancer Genome Atlas (TCGA), and a multivariate Cox regression analysis was conducted to identify potential therapeutic factors.
Results: From August 1, 2018, to November 25, 2021, 33 patients with hepatitis B virus (HBV)-associated HCC were enrolled. By January 30, 2024, 13 patients had undergone potentially curative surgery or radiofrequency ablation. RNA-seq identified 94 differentially expressed genes (DEGs) between the 22 patients in the response group and the 11 in the non-response group. High expression levels of LINC01554 and WHRN were linked to prolonged progression-free survival (PFS).
The analysis of immune microenvironment differences and correlation with DEGs showed a positive association with patient responses for cell types such as pro-B, class-switched memory B, plasma, CD4+ Tcm, Th1, and NKT cells. However, only the status of CD4+ Tcm approached statistical significance (P < 0.10); other immune cells did not. In the WES analysis, a significant FANCD2 mutation (P < 0.05) was found, and a CUX1 mutation was associated with shorter PFS. Neither mutation correlated with liver cancer survival in the TCGA-liver cancer dataset. The Cox regression analysis indicated that a single tumor (P = 0.02, hazard ratio (HR) = 0.31, 95% confidence interval (CI) = 0.11-0.85), high LINC01554 expression level (P = 0.01, HR = 0.16, 95% CI = 0.05-0.49) and higher CD4+ Tcm score (P = 0.05, HR = 0.29, 95% CI = 0.08-0.98) were independent predictors of prolonged PFS.
Conclusions:Treatment with sintilimab plus lenvatinib can lead to varied responses in HCC patients. High levels of lncRNA LINC01554 and CD4+ Tcm, along with a single tumor, suggest improved disease control.
Predictive Value of Preoperative Serum Prealbumin Levels for Postoperative Complications and Survival Outcomes in Patients Undergoing Surgery for Malignant Bowel Obstruction: A Comprehensive Analysis
Authors: Weng Zongqi , Lai Jinhong , Wang Kangmei , Chen Zishan , Chen Hongbin , Yu Hongxi , Chen Xianqiang , Lin Yuyuan , Lin Mengxin , Pan Jie
Published: May 2024

Background Malignant bowel obstruction (MBO) is a common complication in advanced abdominal cancer patients, characterized by a high overall incidence and poor prognosis. Postoperative complications are particularly frequent, with a low postoperative survival rate. The preoperative nutritional status of patients, especially the prealbumin (PA) levels, is significantly correlated with postoperative issues and long-term prognosis. This study aimed to assess the predictive value of the preoperative prealbumin (PA) concentration for postoperative complications and long-term survival in patients with malignant bowel obstruction (MBO). Methods Single-factor and multifactor logistic regression analyses were performed to identify independent risk factors for severe complications and infectious complications. Moreover, univariate and multivariate stratified Cox regression analyses were employed to identify independent risk factors for overall survival (OS), and corresponding nomograms were created. Kaplan-Meier survival curves were generated for grouped data with statistically significant differences. The area under the curve (AUC) was compared to assess the testing efficacy of different nutritional indicators for severe postoperative complications. Results There was a statistically significant difference in the comparison of overall complications and infectious complications between the two groups for different Clavien-Dindo (CD) grades (p < 0.001). Specifically, the incidence of complications with CD grade ≥ 3 in the superlow PA group was higher (p<0.001), and a gradual increase in the severity of overall and postoperative infectious complications was observed with decreasing PA levels (p < 0.001). PA (p < 0.001) and intestinal stent placement (p = 0.015) were identified as independent influencing factors for early postoperative severe complications (CD grade ≥ 3), while PA was identified as an independent influencing factor for postoperative infectious complications (p < 0.001). Cox regression analysis stratified by TNM stage revealed that age, sex, surgical method, and postsurgical chemotherapy were independent predictors of OS. Compared to indicators such as the FPR and AFP, PA demonstrated the highest testing efficiency (AUC = 0.888). Conclusion Preoperative PA has significant predictive value for early postoperative complications and overall survival in patients with MBO, providing new insights into perioperative nutritional intervention and surgical approach selection for these patients.
The Global, Regional, and National Patterns of Change in the Burden of Pyoderma from 1990 to 2019 and the Forecast for the Next Decade
Authors: Wang Hao , Bai Zihao , Shen Chong , Kou Jiaxi , Zhu Yanqing , Xie Huaxia , Chen Chen , Mo Ran
Published: May 2024

Background
Pyoderma, commonly known as impetigo, is a bacterial skin infection causing pus formation, prevalent globally, especially in resource-poor areas. It affects both children and adults, including those with conditions like diabetes. Despite its significant impact and economic burden, research on its global epidemiology is limited. This study aims to address this gap by analyzing pyoderma trends from 1990 to 2019 using GBD data.
Objectives
The study aims to analyze global trends in pyoderma epidemiology from 1990 to 2019 using GBD data. Specifically, it investigates Age-Standardized Incidence Rate (ASIR), Mortality Rate (ASMR), and Disability-Adjusted Life Years Rate (ASDR) across 204 countries. Additionally, it provides insights into demographic and socioeconomic factors influencing pyoderma prevalence. Furthermore, it forecasts pyoderma's development trends for the next decade to inform public health strategies.
Methods
Data were sourced from the GBD 2019 database, comprising various sources such as censuses, surveys, and registries. Estimates for pyoderma incidence, mortality, and DALYs, along with their 95% uncertainty intervals (UI), were retrieved. The Sociodemographic Index (SDI) was used to assess socioeconomic status, and statistical calculations were performed using the WHO Health Equity Assessment Toolkit and R software (v4.3.2).
Results
From 1990 to 2019, the Age-Standardized Incidence Rate (ASIR) and Age-Standardized Mortality Rate (ASMR) of impetigo increased, while the Age-Standardized Disability-Adjusted Life Years Rate (ASDR) declined. Significant global geographical heterogeneity persists, closely associated with the Sociodemographic Index (SDI). Children under 5 and the elderly are particularly at risk, with lower SDI nations bearing higher burdens. Population growth and aging contribute to this rise, with disparities in impetigo trends persisting among countries and regions with varying SDI levels, expected to continue until 2030.
Conclusions
Pyoderma exhibits significant heterogeneity across age, gender, and geography, with pronounced disparities evident in underdeveloped regions or countries. Therefore, prioritizing policy formulation and implementing tailored prevention and treatment strategies for high-risk populations are imperative to alleviate the disease burden effectively. Such targeted approaches are crucial in addressing the global impact of pyoderma.
Increased levels of antibodies to synaptopodin and annexin 1 in patients with primary podocytopathies
Authors: NV Chebotareva , EA Charionovskaya , EA Biryukova , AA Vinogradov , II Alentov , NS Sergeeva , AS Kononikhin , EN Nikolaev , SV Moiseev , Chebotareva Natalia
Published: May 2024

Circulating anti-podocyte antibodies have been proposed as potential factors contributing to increased permeability in primary podocytopathies, such as Minimal Change Disease (MCD) and Focal Segmental Glomerulosclerosis (FSGS). The aim of the study was to to assess the levels of antibodies targeting synaptopodin and annexin 1 in the blood serum of patients diagnosed with nephrotic syndrome, with the aim of evaluating their potential utility in diagnosing primary podocytopathies and predicting therapeutic response. Methods: The study included a total of 72 patients diagnosed with nephrotic syndrome, alongside 21 healthy subjects for comparison. Among the patients, 38 were diagnosed with FSGS, 12 with MCD, and 22 with MN. The levels of anti-synaptopodin and anti-annexin-1 antibodies were quantified using Enzyme-Linked Immunosorbent Assay. Results: The levels of antibodies to annexin 1 and anti-synaptopodin in the blood were found to be higher in patients diagnosed with MCD and FSGS compared to those with MN and healthy individuals. The elevated levels of antibodies to annexin 1 and synaptopodin showed area under the curve values of 0.826 (95% CI 0.732–0.923) and 0.827 (95% CI 0.741–0.879), respectively. However, a model incorporating both antibodies demonstrated higher sensitivity (80.9%) and specificity (81.3%) with an AUC of 0.859 (95% CI 0.760–0.957). Notably, serum levels of annexin 1 and anti-synaptopodin antibodies did not predict the response to prednisolone and/or CNI therapy. Conclusion. Levels of antibodies targeting synaptopodin and annexin 1 were notably elevated in patients diagnosed with MCD and FSGS compared to those with MN and healthy controls. A panel comprising both antibodies demonstrated moderate to high sensitivity and specificity for diagnosis MCD or FSGS.
A Dynamic Flow Fetal Membrane Organ-on-a-Chip System for Modeling the Effects of Amniotic Fluid Motion
Authors: Kim Sungjin , Lam Po Yi , Richardson Lauren , Menon Ramkumar , Han Arum
Published: May 2024

Fetal membrane(amniochorion), the innermost lining of the intrauterine cavity, surround the fetus and enclose amniotic fluid. Unlike unidirectional blood flow, amniotic fluid subtly rocks back and forth, and thus, the innermost amnion epithelial cells are continuously exposed to low levels of shear stress from fluid undulation. Here, we tested the impact of fluid motion on amnion epithelial cells (AECs) as a bearer of force impact and their potential vulnerability to cytopathologic changes that can destabilize fetal membrane functions. An amnion membrane (AM) organ-on-chip (OOC) was utilized to culture human fetal amnion membrane cells. The applied flow was modulated to perfuse culture media back and forth for 48 hours flow culture to mimic fluid motion. Static culture condition was used as a negative control, and oxidative stress (OS) condition was used as a positive control for pathophysiological changes. The impacts of fluidic motion were evaluated by measuring cell viability, cellular transition, and inflammation. Additionally, scanning electron microscopy (SEM) imaging was performed to observe microvilli formation. The results show that regardless of the applied flow rate, AECs and AMCs maintained their viability, morphology, innate meta-state, and low production of pro-inflammatory cytokines. E-cadherin expression and microvilli formation in the AECs were upregulated in a flow rate-dependent fashion; however, this did not impact cellular morphology or cellular transition or inflammation. OS treatment induced a mesenchymal morphology, significantly higher vimentin to CK-18 ratio, and pro-inflammatory cytokine production in AECs, whereas AMCs did not respond in any significant manner. Fluid motion and shear stress, if any, did not impact AEC cell function and did not cause inflammation. Thus, when using an amnion membrane OOC model, the inclusion of a flow culture environment is not necessary to mimic any in utero physiologic cellular conditions of fetal membrane-derived cells.
The prevalence of metabolic syndrome and associated factors among adults on antiretroviral therapy in Dar es Salaam, Tanzania
Authors: Yusufu Innocent , Nagu Tumaini , Ottaru Theresia A. , Sando Mary Mmwanyika , Kaaya Sylvia , Mbugi Erasto , Hirschhorn Lisa R , Hawkins Claudia
Published: May 2024

Background
Adults living with HIV (ALHIV) are at increased risk of developing metabolic syndrome (MetS). Several factors are associated with an increase in MetS in these individuals, including certain antiretroviral therapies (ART). There is limited data on the prevalence of MetS among ALHIV in sub-Saharan Africa following scale up of newer integrase inhibitor-containing ART regimens.
Objective
We assessed the prevalence and correlates of MetS among ALHIV patients receiving tenofovir, lamivudine, and dolutegravir (TLD) in Tanzania.
Methods
We conducted a retrospective cross-sectional analysis of ALHIV aged >18 enrolled in a cardiovascular health study at six HIV Care and Treatment Clinics from 11/2020-1/2021 in Dar es Salaam, Tanzania. MetS was defined according to the National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III). Descriptive statistics were used to summarize the results, and logistic regression was used to assess demographic, behavioral, and HIV-related risk factors associated with MetS. Covariates with a p-value <0.2 at the univariate level were included in the multivariate model.
Results
Three hundred and eighty nine participants were included in the analysis. The mean age (SD) was 43 years (±11) years, and 286 (73.5%) were female. The prevalence of MetS in this population was 21%. In univariate analysis, MetS components that were significantly higher among women vs. men included abdominal obesity (27.3% vs. 4.9%), reduced HDL (77.9% vs. 53.4% ), and elevated glucose (18.5% vs. 14.6%), all p< 0.05. Age> 50 yrs [AOR 3.25; (95% CI 1.80-5.84), p < 0.01] and BMI [AOR 0.16; (95% CI 0.09-0.30), P < 0.01] were both associated with an increased odds of MetS in multivariate analyses.
Conclusion
MetS. is prevalent among Tanzanian ALHIV on TLD. Routine screening for MetS and healthy lifestyle promotion, particularly among women and those aging, should be a priority to prevent against cardiovascular disease. Further studies are needed to monitor the long-term impact of these newer ART regimens on MetS and CVD.
Exploring the Educational Journey: Perspectives of Ethnic Minority GP- Trainees in Dutch GP-Specialty Training - A Qualitative Interview Study
Authors: Moppes N.M. van , Nasori M. , Jorissen A.C. , Es J.M. van , Bont J. , Visser M.R.M. , Muijsenbergh M.E.T.C. van den
Published: May 2024

Background:
Previous research highlights persistent differential attainment by ethnicity in medical education, wherein the perceived inclusiveness significantly influences ethnic minority students’ and trainees’ outcomes. Biased organizational practices and microaggressions exacerbate the challenges faced by ethnic minorities, leading to lower academic performance and higher dropout rates. Consequently, understanding ethnic minority GP-trainees’ experiences and perspectives regarding relevant educational aspects is crucial for addressing these disparities and cultivating a more inclusive environment within medical education.
Research question:
We aimed to investigate the experiences of minority GP-trainees throughout their educational journey in Dutch GP-specialty training, emphasizing their challenges, sources of support, and suggestions for enhancing their learning environment.
Method:
We conducted semi-structured, in-depth interviews with minority GP trainees, employing purposive convenience sampling to ensure diversity across multiple dimensions. These included gender, age, ethnicity, social background, migration generation, educational stage, encountered challenges, sources of support, and the GP training institute attended. The analysis involved iterative, open coding, axial coding, and thematic analysis.
Results:
All fourteen ethnic minority interviewees had faced educational barriers stemming from misunderstandings and stereotyping in a predominantly 'white' organization. These barriers impacted various aspects of their education, including professional identity formation, application, admission, assessment procedures, social networks, course content, and expert guidance. Microaggressions permeated throughout their educational journey, hindering their full expression and potential. Their ideal GP-specialty training emphasized uniqueness of all trainees, comprehensive staff engagement in inclusivity, robust diversity, equity, and inclusion (DEI)-policies, individual mentorship, transparent standards, concise language usage in test questions, and bias elimination through mandatory DEI staff training.
Conclusion:
Ethnic minority GP-trainees in the Netherlands face significant challenges like biased assessment and admission, stereotyped course content, inadequate support networks, and microaggressions, putting them at risk for underperformance outcomes. They emphasize the need for inclusive training with robust DEI-policies to eliminate bias.
Effects of BMI on prognosis , disease-free survival and overall survival of breast cancer
Authors: Zangouri Vahid , Balaneji Souzan Soufizadeh , Golmoradi Roya , Kafili Ehsan , Bologhi Saleh , Mousavi Seyed Amin , Hesar Ataollah Ahmadi , Amestejani Morteza
Published: May 2024

Background
Obese breast cancer patients have worse prognosis than normal weight patients, but the level at which obesity is prognostically unfavorable is unclear. This study aimed to investigate different effects of Body Mass Index (BMI) on prognosis disease-free survival and overall survivor of breast cancer patients.
Method
This retrospective cohort study analyzed the medical records of breast cancer patients who sought treatment at Namazi hospital in Shiraz, Iran between 2014 and 2019. Three groups of patients were divided according to BMI. Menopausal status, BMI status, clinicopathological characteristics, treatment, and overall survival (OS), and disease free survival (DFS) were comprehensively evaluated.
Results
Of the 7134 breast cancer patients, the majority (42.6%) were in 25–30 kg/m2. Menopausal status significantly were associated with obesity (P <0 .001). The majority of patients were categorized as grade 2 and stage 2 according to the BMI categories (P = 0.12, P = 0.08, respectively). BMI categories regardless of menopausal status displayed increased 1, 3, and 5-year DFS and 5- year OS in stage 1 and increased 1, 3, and 5-year OS and 1 and 3-year DFS in stage 2. In stage 3, the risks of relapse and death were significantly decreased in all three groups of BMI patients with post-menopausal period.
Conclusion
Obesity leads to worse DFS and OS in patients with BC and the effects of obesity on the breast cancer prognosis seem to be clinically related to menopausal status. Once validated, these results should be considered in the development of prevention programs.
Individual empowerment and community norm effects of engaging young husbands in reproductive health in rural India: findings from a pilot study
Authors: Diamond-Smith Nadia , Vaishnav Yogesh , Choudhary Usha , Sharma Payal , Kachhwaha Ankur , Panjalingam Tamera , Vallin Janelli , Das Debangana , Gopalakrishnan Lakshmi
Published: May 2024

Background: Despite decades of a call to action to engage men in reproductive health, men are often left out of programs and interventions. In India, where half of pregnancies are reported as unintended, patriarchal gender norms and still dominant patterns of arranged marriages make engaging men in family planning and strengthening couples communication critical in increasing reproductive autonomy and helping young couples meet their reproductive goals. This study explores the feasibility and acceptability from the men’s perspective of the pilot of a gender transformative intervention for newly married couples in India.
Methods: A pilot study was conducted of TARANG, a 4-month intervention for newly married women, with light touch engagement of husbands (4 sessions). A total of 41 husbands participated in the pilot, and we collected baseline knowledge and endline feasibility and acceptability data from them, along with in depth qualitative interviews with 13 men. The study was conducted in June-January, 2023.
Results: Men had low levels of knowledge about biology, family planning, with the majority of men reporting that no one had provided them information about these topics. Most men wanted to delay the first birth by at least 2 years, yet less than a quarter had discussed childbearing plans with their partner or engaged in family planning methods. While all men reported high acceptability (satisfaction and usefulness), feasibility (participation) was low, with only 43% attending 2 or more sessions. Main barriers to participation included commitments due to work and migration. Men reported that the intervention led to improvements in their relationships with their wives, gave them a sense of empowerment, and led them to become resources for other men in their community.
Conclusions: Men in these rural communities are not receiving the information that they need to meet their reproductive goals, however, they greatly desire this information and ways to improve relationships with their new wives. Such an intervention appears to have the potential to help change norms and spread information in the community and provide men with positive, life affirming feelings. Providing information through technology could address barriers to in-person engagement.
Trial registration: clinicaltrials.gov (NCT06320964), 03/13/24
Radiological signs of stone impaction add no value in predicting spontaneous stone passage
Authors: Popiolek Marcin , Lidén Mats , Georgouleas Petros , Sahlén Klara , Sundqvist Pernilla , Jendeberg Johan
Published: May 2024

Stone size and location are key factors in predicting spontaneous stone passage (SSP), but little attention has been paid to the influence of radiological signs of stone impaction (RSSI). This research aims to determine whether RSSI, alongside stone size, can predict SSP and to evaluate the consistency of ureteral wall thickness (UWT) measurements among observers. In this retrospective study, 160 patients with a single upper or middle ureteral stone on acute non-enhanced computed tomography (NECT) were analysed. Patient data were collected from medical records. Measurements of RSSI, including UWT, ureteral diameters, and average attenuation above and below the stone, were taken on NECT by four independent readers blind to the outcomes. The cohort consisted of 70% males with an average age of 51 ± 15. SSP occurred in 61% of patients over 20 weeks. The median stone length was 5.7 mm (IQR: 4.5–7.3) and was significantly shorter in patients who passed their stones at short- (4.6 vs. 7.1, p < 0.001) and long-term (4.8 vs. 7.1, p < 0.001) follow-up. For stone length, the area under the receiver operating characteristic curve (AUC) for predicting SSP was 0.90 (CI 0.84–0.96) and only increased to 0.91 (CI 0.85–0.95) when adding ureteral diameters and UWT. Ureteral attenuation did not predict SSP (AUC < 0.5). Interobserver variability for UWT was moderate, with ± 2.0-mm multi-reader limits of agreement (LOA). The results suggest that RSSI do not enhance the predictive value of stone size for SSP. UWT measurements exhibit moderate reliability with significant interobserver variability.
Community: component based differential cell communication analysis in large multi-sample case-control scRNAseq datasets
Authors: Solovey Maria , Celik Muhammet , Salcher Felix , Abdelfattah Mohamed , Ismail Mostafa , Scialdone Antonio , Ziemann Frank , Colomé-Tatché Maria
Published: May 2024

Cell-cell communication is essential for physiological tissue function. In disease, communication often gets disbalanced by changes in the tissue cell type composition, fraction of cells engaged in communication, and changes in expression levels of ligands, receptors and adhesion molecules. Single cell RNAseq analyses allow to measure these parameters in healthy and diseased tissues. Here we present community, an R-based tool that is designed to perform differential communication analysis using scRNAseq data between large cohorts of cases and controls. Community performs differential analysis to identify communication channels affected in disease by reconstructing the communication between different cell types using three components: cell type abundance, fraction of active cells, and ligand/receptor expression levels, both in cases and controls. This approach allows to not only identify up- or down-regulated interactions, but also detect cases of compensation, where a shift in one component gets compensated by a counter-shift in another component, keeping the levels of communication stable. The component analysis enables us to better understand the underlying biological processes leading to changes in communication. We demonstrate the performance of community by using two disease entities, ulcerative colitis and acute myeloid leukemia. We compared the performance of our tool to other differential communication pipelines, which community outperformed in robust identification of up- and down-regulated interactions, as well as its unique feature of identifying compensated communication shifts. Overall, community is a fast, well-scalable, user-friendly R tool to assess differential cell-cell communication using large case-control scRNAseq datasets, and disentangle the driving mechanisms of communication shifts in disease.
Deep Learning Model to Differentiate Intracranial Germ Cell Tumors Subtypes and Predict Survival
Authors: Li Yanong , Zhuo Zhizheng , Weng Jinyuan , Haller Sven , Bai Harrison X. , Li Bo , Liu Xing , Zhu Mingwang , Wang Zheng , Li Jane , Qiu Xiaoguang , Liu Yaou
Published: May 2024

Background Pretherapeutic differentiating subtypes of primary intracranial germ cell tumors (iGCTs), including germinomas (GEs) and non-germinomatous germ cell tumors (NGGCTs) is essential for clinics because of their distinct treatment strategies and prognosis profiles. This study aimed to develop a deep learning model, iGNet, to assist in differentiation of iGCT subtypes by employing pretherapeutic MR images.Methods The iGNet model was developed using a retrospective dataset of 280 pathology-confirmed iGCT patients, including 83 GE and 117 NGGCTs in train dataset, and 31 GEs and 49 NGGCTs in the retrospective internal test dataset. The model's diagnostic performance was then tested through area under the receiver operator characteristics curve (AUC) in a prospective internal dataset (n = 22) and two external datasets (n = 22 and 20). Next, we compared the diagnostic performance in six neuroradiologists with or without the assistance of iGNet. Lastly, the predictive ability of the iGNet outputs for progression-free and overall survival was assessed in comparation with pathological diagnosis.Results iGNet achieved high diagnostic performance with AUCs between 0.869 and 0.950 across the four test datasets. With the assistance of iGNet, neuroradiologists' diagnostic AUCs (average of the four test datasets) were increased by 9.22–17.90% across six neuroradiologists. The iGNet output can predicting the progression-free and overall survival, comparable to that based on pathological diagnosis (P = .889).Conclusions The iGNet, leveraging pretherapeutic MR imaging, accurately differentiates iGCT subtypes, thereby facilitating clinical stratified treatment and prognostic evaluation.
The development of a duplex RT-qPCR assay for the simultaneous detection of cycas necrotic stunt virus and lychnis mottle virus in Paeonia lactiflora
Authors: Soeng Chandara , Kean Chanchota , Yoon Ju-Yeon , Ju Ho-Jong
Published: May 2024

In this study, a duplex probe based reverse transcription quantitative polymerase chain reaction (RT-qPCR) assay was utilized to simultaneously detect cycas necrotic stunt virus (CNSV) and lychnis mottle virus (LycMoV) in Paeonia lactiflora collected from various locations in South Korea. CNSV and LycMOV infections were verified by using conventional reverse transcription polymerase chain reaction (RT-PCR) using gene-specific primers. Due to peony’s high secondary metabolites, multiple standard templates in the form of both DNA and RNA were evaluated. The circular plasmid was observed to produce the finest results and was used in dye-based qPCR to select the best-performing primers characterized by their ability to yield a low threshold cycle (Ct) and high fluorescence. The high precision quantification duplex probe-based qPCR assay was conducted and then optimized. The combination of primer concentration of 5 pmol/µl coupled with probe concentration of 4 pmol/µl at the annealing temperature of 57 ℃ produced stable and consistent amplification plots and standard curves. This combination demonstrated the capability to simultaneously detect plasmid DNA of both CNSV and LycMoV at concentrations as low as 10-6 ng/µl. These primer sets and optimum conditions were applied in RT-qPCR to detect total RNA of peony leaves co-infected with CNSV and LycMoV. Successful detection occurred with a slightly weaker sensitivity, having a detection limit of 10-3 ng/µl. The use of duplex probe-based RT-qPCR assay demonstrated in this study should improve the virus screening process of CNSV and LycMoV, leading to a reduction of the spread of these two plant viruses.