bluuebunny/crossref_metadata_2025 huggingface dataset:
Does Inclement Weather Increase the Risk of Cardioembolic Stroke in Kashmir Valley?
Authors: Dar Waseem , Wani Maqbool , Yaqoob Arjimand , Raina Adnan , Khwaja Zubair , Chandra Amit , Mir Feroze , Asmi Ravouf
Published: February 2024

Background

Cardioembolic strokes are a common cause of mortality and morbidity because they are usually big and multiple. Despite extensive advances in the determination and management of modifiable risk factors of these strokes, a significant proportion are attributed to non-modifiable factors. We wanted to test the hypothesis that cardioembolic strokes and no other subtypes of ischemic stroke are associated with inclement weather in Kashmir Valley where winter seasons have harsh weather.

Results

A total of 540 ischemic stroke patients were included in the study of which cardioembolic strokes were most common. Cardioembolic strokes were more common in the winter season and associated with lower minimum and maximum temperatures.

Conclusion

Evaluation and management of cardioembolic strokes during winter months may demand more attention, particularly in elderly individuals and those with risk factors for atrial fibrillation.
Modeling interconnected social and technical risks in open source software ecosystems
Authors: Schueller William , Wachs Johannes
Published: February 2024

Open source software ecosystems consist of thousands of interdependent libraries, which users can combine to great effect. Recent work has pointed out two kinds of risks in these systems: that technical problems like bugs and vulnerabilities can spread through dependency links, and that relatively few developers are responsible for maintaining even the most widely used libraries. However, a more holistic diagnosis of systemic risk in software ecosystem should consider how these social and technical sources of risk interact and amplify one another. Motivated by the observation that the same individuals maintain several libraries within dependency networks, we present a methodological framework to measure risk in software ecosystems as a function of both dependencies and developers. In our models, a library’s chance of failure increases as its developers leave and as its upstream dependencies fail. We apply our method to data from the Rust ecosystem, highlighting several systemically important libraries that are overlooked when only considering technical dependencies. We compare potential interventions, seeking better ways to deploy limited developer resources with a view to improving overall ecosystem health and software supply chain resilience.
Commentary: Addressing stigma through relational research design
Authors: Heyworth Melanie
Published: February 2024

The history of research on parenting autistic children is complicated by the inheritance of “mother-blaming,” which continues to occur, albeit indirectly or implicitly. Parents of autistic children often experience and internalize stigma, which arises from the messaging that suboptimal parenting can exacerbate a child's autistic traits. This stigmatization is echoed by parents of other neurodivergent groups, including ADHD. For neurodivergent parents of neurodivergent children, this stigma may be compounded, since stigma is experienced both as a neurodivergent individual, and as the parent of a neurodivergent individual. Researchers have an ethical duty to pay attention to experiences of stigma when we study any vulnerable group so that stigma does not become a barrier to participation. In this commentary, I critically reflect on a study I designed, which did not adequately address parents’ potential stigma or sufficiently anticipate the impact of experiences of stigma on participation. I then outline the steps I took to modify the design, framed within a relational ethics of care, to acknowledge and account for the stigma that might have otherwise excluded parents of autistic children—especially parents who are autistic and otherwise neurodivergent themselves—from participating.
Diagnostic challenges between takotsubo cardiomyopathy and acute myocardial infarction—where is the emergency?: a literature review
Authors: Scafa-Udriste Alexandru , Horodinschi Ruxandra-Nicoleta , Babos Miruna , Dinu Bogdan
Published: February 2024

Background

Takotsubo cardiomyopathy (TC) is an emergency cardiovascular disease, with clinical and paraclinical manifestations similar to acute myocardial infarction (AMI), but it is characterized by reversible systolic dysfunction of the left ventricle (LV) in the absence (most of the time) of obstructive coronary artery disease (CAD).

Management of patients with TC

TC seems to be more frequent in post-menopausal women and it is triggered by emotional or physical stress. The diagnosis of TC is based on the Mayo Clinic criteria. Initially, patients with TC should be treated as those with AMI and carefully monitored in intensive care unit. Urgent clinical and paraclinical distinction between TC and AMI is mandatory in all patients, because of the different therapeutical management between the two diseases. Chest pain and dyspnea are the most common symptoms in TC. Paraclinical diagnosis is based on cardiac biomarkers, electrocardiogram (ST-segment elevation/T wave inversion in precordial leads without reciprocal ST-segment depression in inferior leads and absence of Q waves), echocardiography (LV systolic dysfunction, regional wall motion abnormalities extended in more than one coronary territory), cardiac magnetic resonance and in most of the cases the positive diagnosis is established by performing CA to exclude obstructive CAD. The prognosis of patients with TC is considered benign in most cases, with a complete LV function recovery, but severe complications may occur, such as cardiogenic shock, LV free wall rupture, life-threatening arrhythmia, and cardiac arrest. Postoperative TC may develop after any type of surgical intervention due to acute stress and it should be differentiated from postoperative AMI. The management of patients with TC is medical and it is based on supportive care and the treatment of heart failure, while patients with AMI require myocardial revascularization.

Conclusions

TC leads to transient LV dysfunction that mimics AMI from which it should be differentiated for a good therapeutic approach. Patients with TC should be carefully monitored during hospitalization because they have a high recovery potential if optimally treated.
Advances in the insect industry within a circular bioeconomy context: a research agenda
Authors: Hamam Manal , D’Amico Mario , Di Vita Giuseppe
Published: February 2024

The agri-food industry is increasingly recognizing the environmental impact of the over-exploitation of natural resources and waste production, which has prompted a search for sustainable alternatives based on circular bioeconomy principles. Insects can efficiently transform food substrates into reusable biomass, thus making them valuable contributors to a circular bioeconomy system. However, the relationship between the circular bioeconomy and the insect industry has so far appeared relatively unexplored in the existing research. To address this gap, a meta-synthesis has been conducted through a systematic literature review. By identifying the state of the art and assessing the role of insects in the transition of closed-loop systems, the aim of this research has been to shed light on the opportunities and challenges of integrating insects in circular bioeconomy strategies. The research revealed three main topics: (1) waste management by insects, i.e., the use of insects as a tool for waste management and with which to create high-value substrates; (2) insect-based feeds, namely the use of insects as alternative food sources in farming systems; (3) insect-based food acceptance by consumers. The results underscore the significant potential of this market within the circular bioeconomy context, highlighting the obstacles that need to be addressed and future strategies that could be adopted.
Transcriptome profile of pecan scab resistant and susceptible trees from a pecan provenance collection
Authors: Brungardt Jordan , Alarcon Yanina , Shiller Jason , Young Carolyn , Monteros Maria J. , Randall Jennifer J. , Bock Clive H.
Published: February 2024

Pecan scab is a devastating disease that causes damage to pecan (Carya illinoinensis (Wangenh.) K. Koch) fruit and leaves. The disease is caused by the fungus Venturia effusa (G. Winter) and the main management practice for controlling the disease is by application of fungicides at 2-to-3-week intervals throughout the growing season. Besides disease-related yield loss, application of fungicides can result in considerable cost and increases the likelihood of fungicide resistance developing in the pathogen. Resistant cultivars are available for pecan growers; although, in several cases resistance has been overcome as the pathogen adapts to infect resistant hosts. Despite the importance of host resistance in scab management, there is little information regarding the molecular basis of genetic resistance to pecan scab.

The purpose of this study was to elucidate mechanisms of natural pecan scab resistance by analyzing transcripts that are differentially expressed in pecan leaf samples from scab resistant and susceptible trees. The leaf samples were collected from trees in a provenance collection orchard that represents the natural range of pecan in the US and Mexico. Trees in the orchard have been exposed to natural scab infections since planting in 1989, and scab ratings were collected over three seasons. Based on this data, ten susceptible trees and ten resistant trees were selected for analysis. RNA-seq data was collected and analyzed for diseased and non-diseased parts of susceptible trees as well as for resistant trees. A total of 313 genes were found to be differentially expressed when comparing resistant and susceptible trees without disease. For susceptible samples showing scab symptoms, 1,454 genes were identified as differentially expressed compared to non-diseased susceptible samples. Many genes involved in pathogen recognition, defense responses, and signal transduction were up-regulated in diseased samples of susceptible trees, whereas differentially expressed genes in pecan scab resistant samples were generally down-regulated compared to non-diseased susceptible samples.

Our results provide the first account of candidate genes involved in resistance/susceptibility to pecan scab under natural conditions in a pecan orchard. This information can be used to aid pecan breeding programs and development of biotechnology-based approaches for generating pecan cultivars with more durable scab resistance.
Metatranscriptome analysis of symptomatic bitter apple plants revealed mixed viral infections with a putative novel polerovirus
Authors: Ghorani Shahrbanou , Massumi Hossein , Farhangi Samin H. , Mansouri Mehdi , Heydarnejad Jahangir , Hosseinipour Akbar
Published: February 2024

Background

Next-generation Sequencing (NGS) combined with bioinformatic analyses constitutes a powerful approach for identifying and characterizing previously unknown viral genomes. In this study, leaf samples from bitter apple plants (Citrullus colocynthis (L.) Schrad) exhibiting symptoms such as dwarfing, leaf crinkling, and chlorosis were collected from the southern part of Kerman province, Iran.

Results

Putative infecting viruses were identified through de novo assembly of sequencing reads using various tools, followed by BLAST analysis. Complete genomes for Squash vein yellowing virus (SqVYV), Citrus-associated rhabdovirus (CiaRV), and a novel polerovirus-related strain termed Bitter apple aphid-borne yellows virus (BaABYV) were assembled and characterized. Additionally, a partial genome for Watermelon mosaic virus (WMV) was assembled. The genomic organization of the BaABYV was determined to be 5’-ORF0-ORF1-ORF1,2-ORF3a-ORF3-ORF3,5-ORF4-3’. Amino acid sequence identities for inferred proteins (P0 and P1, P1,2) with known poleroviruses were found to be the 90% species delineation limit, implying that BaABYV should be considered a new member of the genus Polerovirus. Recombination events were observed in the BaABYV and WMV strains; such events were not found in the CiaRV strain.

Conclusions

Molecular evidence from this study suggests that C. colocynthis is a reservoir host of several plant viruses. Among them, BaABYV is proposed as a new member of the genus Polerovirus. Furthermore, the CiaRV strain has been reported for the first time from Iran.
Effectiveness of perioperative low-dose esketamine infusion for postoperative pain management in pediatric urological surgery: a prospective clinical trial
Authors: Xie Yanle , Liang Zenghui , Chen Shuhan , Liu Jing , lv Huimin , Xing Fei , Mao Yuanyuan , Ren Yanling , Wei Xin , Wang Zhongyu , Xing Na , Yang Jianjun , Gu Xiyao , Yuan Jingjing
Published: February 2024

Background

Postoperative pain is common in pediatric urological surgery. The study assess the impact of perioperative intravenous infusion of low-dose esketamine on postoperative pain in pediatric urological surgery.

Methods

Pediatric patients (n = 80) undergoing urological surgery were randomized into four groups. Patients in the control group were administered an analgesic pump containing only hydromorphone at a dose of 0.1 mg/kg (Hydromorphone Group 1, H1) or 0.15 mg/kg (Hydromorphone Group 2, H2). Patients in the experimental group were injected intravenously with 0.3 mg/kg of esketamine (Esketamine group 1, ES1) or equal volume of saline (Esketamine Group 2, ES2) during anesthesia induction. Esketamine 1.0 mg/kg and hydromorphone 0.1 mg/kg were added to the analgesic pump. Face, Leg, Activity, Crying, and Comfort (FLACC) scale or the Numerical Rating Scale (NRS) and adverse effects were recorded at 2, 6, 24, and 48 h postoperatively. Additionally, total and effective PCA button presses were recorded.

Results

In comparison to the H1 group, the pain scores were notably reduced at all postoperative time points in both the ES1 and H2 groups. The ES2 group exhibited lower pain scores only at 24 and 48 h postoperatively. When compared to the H2 group, there were no significant differences in pain scores at various postoperative time points in the ES2 group. However, the ES1 group demonstrated significantly lower pain scores at 6, 24 and 48 h postoperatively, and these scores were also significantly lower than those observed in the ES2 group. The total and effective number of PCA button presses in the ES1, ES2 and H2 group were lower than that in the H1 group (P < 0.001). The incidence of adverse effects within 48 h after surgery was 15% in ES1, 22% in ES2, 58% in H1, and 42% in H2, respectively (P = 0.021).

Conclusions

The use of low-dose esketamine infusion in analgesia pump can effectively alleviates postoperative pain in pediatric urological patients, leading to a significant reduction in the number of analgesic pump button press. The combined approach of perioperative anesthesia induction and analgesia pump administration is recommended for optimal pain management in these patients.

Trial registration

Chinese Clinical Trial Registry-ChiCTR2300073879 (24/07/2023).
Developing a set of emergency department performance measures to evaluate delirium care quality for older adults: a modified e-Delphi study
Authors: Filiatreault Sarah , Kreindler Sara A. , Grimshaw Jeremy M. , Chochinov Alecs , Doupe Malcolm B.
Published: February 2024

Background

Older adults are at high risk of developing delirium in the emergency department (ED); however, it is under-recognized in routine clinical care. Lack of detection and treatment is associated with poor outcomes, such as mortality. Performance measures (PMs) are needed to identify variations in quality care to help guide improvement strategies. The purpose of this study is to gain consensus on a set of quality statements and PMs that can be used to evaluate delirium care quality for older ED patients.

Methods

A 3-round modified e-Delphi study was conducted with ED clinical experts. In each round, participants rated quality statements according to the concepts of importance and actionability, then their associated PMs according to the concept of necessity (1–9 Likert scales), with the ability to comment on each. Consensus and stability were evaluated using a priori criteria using descriptive statistics. Qualitative data was examined to identify themes within and across quality statements and PMs, which went through a participant validation exercise in the final round.

Results

Twenty-two experts participated, 95.5% were from west or central Canada. From 10 quality statements and 24 PMs, consensus was achieved for six quality statements and 22 PMs. Qualitative data supported justification for including three quality statements and one PM that achieved consensus slightly below a priori criteria. Three overarching themes emerged from the qualitative data related to quality statement actionability. Nine quality statements, nine structure PMs, and 14 process PMs are included in the final set, addressing four areas of delirium care: screening, diagnosis, risk reduction and management.

Conclusion

Results provide a set of quality statements and PMs that are important, actionable, and necessary to a diverse group of clinical experts. To our knowledge, this is the first known study to develop a de novo set of guideline-based quality statements and PMs to evaluate the quality of delirium care older adults receive in the ED setting.
The association of family doctor contract service and patient trust in doctor: evidence from twenty-five village clinics of three counties in rural China
Authors: Gu Linni , Wang Xiaoying , Tian Donghua
Published: February 2024

Background

China is implementing the family doctor (FD) system to reform the primary healthcare (PHC). The family doctor contract service (FDCS) policy plays a crucial role in this system implementation, aiming to transform the doctor-patient relationship and enhance PHC quality. This study aims to investigate the impact of FDCS on the doctor-patient relationship in PHCs using field research methodology.

Method

The field research methodology was employed to address the research questions. Quantitative methods were utilized for data collection and analysis. A structure questionnaire was used to collect data based on the research questions. Our investigation encompassed twenty-five village clinics across three counties in China. A total of 574 subjects helped us to finish this investigation in the study. The collected data was analyzed using statistical analysis including ordinary least squares (OLS) model and propensity scores matching model (PSM) to estimate the relationship.

Result

The findings from ordinary least squares (OLS) regression revealed that FDCS had a positive influence on patient trust in doctors within PHCs, with patients who participated the FDCS exhibiting higher levels of trust compared to those who did not participate. Propensity score matching (PSM) analysis further confirmed these results by accounting for selection bias.

Conclusions

The implementation of family doctor contract service has brought about significant transformation in the doctor-patient relationship within rural Chinese PHCs. In essence, it has revolutionized the service model of doctor in PHC, playing a pivotal role in improving primary health quality and enhance the service capability of doctors in PHC. This transformative process has been crucial for carrying out hierarchical diagnosis and treatment policy, which aims to adjust the medical service structure and optimizing the health service system. Therefore, it is imperative for government authorities and health administration departments to ensure continuous support for this essential service through appropriate formulation.
Multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil: the analysis derived from the Brazilian national survey of school health 2019
Authors: da Silva Alanna Gomes , Souza Juliana Bottoni , Gomes Crizian Saar , da Silva Thales Philipe Rodrigues , Gomide Nogueira de Sá Ana Carolina Micheletti , Malta Deborah Carvalho
Published: February 2024

Background

Health risk behaviors often emerge or intensify during adolescence and tend to co-occur, exposing individuals to an even greater risk for the development of non-communicable diseases (NCDs). The likelihood of exhibiting multiple health risk factors also increases throughout life and is associated with sociodemographic characteristics contributing to their escalation and severity. In this context, the objective of this study was to analyze the association between sociodemographic characteristics and multiple behavioral risk factors for non-communicable diseases among the adolescent population in Brazil.

Methods

This cross-sectional study utilized data from the Brazilian National Survey of School Health 2019. The sample comprised 121,580 adolescents aged 13 to 17. The analyzed variables included irregular intake of fruits and vegetables, regular consumption of soft drinks and treats, insufficient physical activity, sedentary lifestyle, cigarette smoking, and alcohol consumption. To analyze MBRFs, a classification ranging from zero to five was created, and associations were estimated using Odds Ratio (OR) with the respective 95% confidence interval (CI). The Backward method was employed for the multivariate regression model, utilizing ordinal logistic regression.

Results

Adolescents without behavioral risk factors for NCDs constituted only 3.9% (95% CI 3.7–4.1). The most prevalent categories were two and three MBRFs, accounting for 28.3% (95% CI: 27.7–28.8) and 27.0% (95% CI: 26.5–27.5), respectively. Adolescents aged 16 and 17 (ORadj: 1.39; 95% CI: 1.32–1.48), residing in the Brazilian Southeast (ORadj: 1.66; 95% CI: 1.52–1.81), and those reporting poor or very poor self-rated health (ORadj: 2.05; 95% CI: 1.87–2.25) were more likely to exhibit multiple behavioral risk factors. Conversely, male adolescents (adjusted OR: 0.65; 95% CI: 0.62–0.69), those of mixed race (adjusted OR: 0.92; 95% CI: 0.87–0.97), and residents of rural areas (adjusted OR: 0.76; 95% CI: 0.70–0.84) were less likely to manifest MBRFs for NCDs.

Conclusion

The majority of adolescents displayed MBRFs for NCDs, positively associated with age, region, and perceived health status. This underscores the necessity for healthcare promotional interventions throughout the life cycle, as these behaviors may persist into adulthood.
Self-rated health and its determinants in patients with hypertension in Isfahan in 2019
Authors: Mansouri Asieh , Khosravi Farsani Alireza , Mohammadifard Noushin , Nouri Fatemeh , Jozan Mahnaz , Tabatabaei Ghazaal Alavi , Salehidoost Rezvan , Rafiee Hamed
Published: February 2024

Background and objectives

Self-rated health (SRH) serves as an assessment of contentment regarding one’s social, mental, and physical well-being and has been linked to both cardiovascular mortality and morbidity. Nonetheless, the relationship between SRH and medical outcomes in individuals with hypertension unsettled. This research endeavors to pinpoint the determinants that affect SRH in Iranian patients with hypertension.

Materials and methods

This cross-sectional study took place in Isfahan, Iran, from November 2018 to August 2019 and involved 886 patients with essential HTN. The data collection methods included a checklist for demographic information and risk factors, blood pressure measurements (systolic and diastolic), the Persian version of the 8-Item Morisky Medication Adherence scale, and a self-rated health questionnaire recommended by the World Health Organization. Independent sample T-test and chi squared test were used for comparison of variables between two groups of SRH. Additionally, multivariable logistic regression was used to analyze the factors influencing self-rated health status.

Results

Among 886 participants (mean age 57.8 ± 8.8 years, 71.9% women), 89.62% reported good SRH. Comorbid conditions were significantly associated with poorer SRH (p < 0.05). Notably, higher education (odd ratio (OR) = 1.88, 95% confidence interval (CI) = 1.13–3.11, p = 0.015) and increased income (OR = 4.34, 95% CI = 1.43–13.18, p = 0.010) were identified as positive determinants of good SRH.

Conclusion

We concluded that socioeconomic factors (education and income) and comorbid conditions (diabetes, hyperlipidemia, and pulmonary diseases) are risk factors for poor SRH among hypertensive patients. These findings could help planning of health enhancement initiative.
Prevalence of prediabetes and risk of CVD mortality in individuals with prediabetes alone or plus hypertension in Northeast China: insight from a population based cohort study
Authors: Yue Ling , Tian Yuanmeng , Ma Mingxi , Jing Li , Sun Qun , Shi Lei , Sun Jixu , Wang Weizhong , Li Guangxiao , Xing Liying , Liu Shuang
Published: February 2024

Background

To evaluate the current prevalence of prediabetes in northeast China, and further determine the association between prediabetes alone or coexistent with hypertension and cardiovascular disease (CVD) mortality.

Methods

In the prospective study, 15,557 participants without diabetes among aged ≥40 years in northeast China, were followed for a median of 5.5 years. Following the American Diabetes Association, prediabetes was defined as fasting plasma glucose (FPG) range of 5.6-6.9 mmol/L or glycated hemoglobin (HbA1c) range of 5.7-6.4% in people without diabetes.

Results

The prevalence of prediabetes was 44.3% among population aged ≥40 years in northeast China. Prediabetes alone did not promote risk of CVD mortality. However, when the subgroups were stratified by hypertension, the CVD mortality risk in prediabetes plus hypertension subjects increased significantly compared with population without prediabetes and hypertension. Multivariate-adjusted hazard ratios for CVD mortality in prediabetes subgroups plus hypertension were 2.28 (95% CI: 1.50, 3.47) for those diagnosed by FPG < 5.6 mmol/L & HbA1c 5.7-6.4%, 2.18 (95% CI: 1.53, 3.10) for those diagnosed by FPG 5.6-6.0 mmol/L & HbA1c < 6.5% and 2.35 (95% CI: 1.65, 3.35) for those diagnosed by FPG 6.1-6.9 & HbA1c < 6.5% compared with the reference group. Moreover, the percentage of hypertension in prediabetes subjects was high (60.4%), but the awareness, treatment and control rates were far from satisfactory (45.3, 35.1 and 4.8%, respectively).

Conclusions

The prevalence of prediabetes remains high in northeast China, and the CVD mortality was elevated significantly in prediabetes coexistent with hypertension. Considering the high percentage and low control rate of hypertension in prediabetes, strategies focused on HbA1c screening, FPG lowering and blood pressure management should be emphasized in northeast China.
The effect of incentive spirometry in perioperative patients with lung cancer—a systematic review and meta-analysis
Authors: Liang Yan , Chen Shaolin , Song Jiamei , Deng Ting , Yang Jinfen , Long Yangyang , Suen Lorna Kwai Ping , Luo Xu
Published: February 2024

Background

Incentive spirometry (IS) as a routine respiratory therapy during the perioperative period has been widely used in clinical practice. However, the impact of IS on patients with perioperative lung cancer remains controversial. This review aimed to evaluate the efficacy of IS in perioperative pulmonary rehabilitation for patients with lung cancer.

Methods

Cochrane Library, PubMed, Web of Science, Ovid, CINAHL, Chinese National Knowledge Infrastructure, Weipu, and Wanfang Databases were searched from inception to 30 November 2023. Only randomized controlled trials were included in this systematic review. The PRISMA checklist served as the guidance for conducting this review. The quality assessment of the included studies was assessed by the Cochrane risk-of-bias tool. The meta-analysis was carried out utilizing Review Manager 5.4. Furthermore, sensitivity analysis and subgroup analysis were also performed.

Results

Nine studies recruited 1209 patients met our inclusion criteria. IS combined with other respiratory therapy techniques was observed to reduce the incidence of postoperative pulmonary complications, enhance pulmonary function, curtail the length of hospital stay, and lower the Borg score. Nevertheless, no improvements were found in the six-minute walk distance or quality of life score.

Conclusions

Although IS demonstrates benefits as a component of comprehensive intervention measures for perioperative patients with lung cancer, it proves challenging to determine the precise impact of IS as a standalone component within the comprehensive intervention measures. Therefore, further researches are required to better understand the effectiveness of IS isolation and its interactions when integrated with additional respiratory therapies for these patients.

Clinical trial registration

PROSPERO, https://www.crd.york.ac.uk/prospero/, registry number: CRD42022321044.
Influence of leg axis alignment on MRI T2* mapping of the knee in young professional soccer players
Authors: Dalos D. , Marshall P. R. , Lissy M. , Maas K. J. , Henes F. O. , Kaul M. G. , Kleinertz H. , Frings J. , Krause M. , Frosch K. H. , Welsch G. H.
Published: February 2024

Background

Investigation of the association between leg axis alignment and biochemical MRI in young professional soccer players in order to identify a potential influence of the leg axis on cartilage regions at risk.

Methods

Sixteen professional soccer players (21 ± 3 years) underwent static and dynamic leg axis analysis via radiation free DIERS formetric 4 D as well as 3-T MRI examination of both knees. Quantitative T2* mapping of the knee cartilage was performed and T2* values were evaluated as 144 regions of interest. Subgroup analysis was performed in players with severe varus alignment (> 6°).

Results

Analysis of the leg axis geometry revealed a mean static alignment of 6.6° ± 2.5 varus and a mean dynamic alignment of 5.1° ± 2.6 varus. Quantitative T2* mapping showed significantly increased T2* values in the superficial cartilage layer compared to the deeper region (p < 0.001) as well as a significant increase in relaxation times in the femoral cartilage from anterior to intermediate to posterior (p < 0.001). Combination of both methods revealed a significant correlation for the degree of varus alignment and the femoral, posterior, deep region of the medial knee compartment (r = 0.4; p = 0.03). If severe varus alignment was present this region showed a significant increase in relaxation time compared to players with a less pronounced leg axis deviation (p = 0.003).

Conclusion

This study demonstrates that varus alignment in young soccer players is associated with elevated T2* relaxation times in the deep cartilage layer of the medial, posterior, femoral compartment and might therefore be a contributing factor in the early pathogenesis of manifest cartilage lesions. Therefore, these findings should be considered in the development of preventive training programs.
Perioperative corticosteroids for reducing postoperative complications following esophagectomy: an updated systematic review and meta-analysis
Authors: Zou Wan-wan , Mok Hsiao-Pei , Zhu Qi-kun , Luo Jing , Yang Song , Cen Jian-zheng , Gao Qiang
Published: February 2024

Background

This updated systematic review and meta-analysis aims to evaluate the efficacy and safety of perioperative corticosteroid administration versus placebo for esophageal cancer patients following scheduled esophagectomy.

Methods

We searched databases through June 30, 2023. We included articles on randomized controlled trials (RCTs) comparing perioperative corticosteroid administration with placebo in esophageal cancer patients with esophagectomy. The outcomes were the death rate during hospitalization, length of hospital stay, and short-term complications. Risk ratios (RRs) and corresponding 95% confidence interval (CIs) for each estimated effect size were applied for dichotomous outcomes, and the mean difference (MD) and corresponding 95% CIs for each estimated effect size were applied for continuous outcomes. We used GRADE to evaluate the quality of each of the outcome and the level of recommendations.

Results

Nine RCTs with 508 participants were included in this study. Severe outcomes, including the length of hospital stay, leakage, mortality during the hospitalization period in the corticosteroid group was comparable to that in the control group, but positive effects of corticosteroid administration were observed on the length of intensive care unit stay (MD -3.1, 95% CI − 5.43 to − 0.77), cardiovascular disorders (RR 0.44, 95% CI 0.21–0.94) and other general complications (RR 0.49, 95% CI 0.29–0.85).

Conclusions

Peri-operative intravenous corticosteroid administration may reduce cardiovascular disorders, other general complications and the length of ICU stay without carrying severe outcomes. More high quality RCTs are warranted to further investigate the effects of corticosteroids on postoperative mortality and complications for esophageal cancer patients with esophagectomy.

Systematic review registration

Cochrane, registration number: 196.
Characteristics and outcomes of patients with do-not-resuscitate and physician orders for life-sustaining treatment in a medical intensive care unit: a retrospective cohort study
Authors: Lee Song-I , Ju Ye-Rin , Kang Da Hyun , Lee Jeong Eun
Published: February 2024

Background

In the intensive care unit (ICU), we may encounter patients who have completed a Do-Not-Resuscitate (DNR) or a Physician Orders to Stop Life-Sustaining Treatment (POLST) document. However, the characteristics of ICU patients who choose DNR/POLST are not well understood.

Methods

We retrospectively analyzed the electronic medical records of 577 patients admitted to a medical ICU from October 2019 to November 2020, focusing on the characteristics of patients according to whether they completed DNR/POLST documents. Patients were categorized into DNR/POLST group and no DNR/POLST group according to whether they completed DNR/POLST documents, and logistic regression analysis was used to evaluate factors influencing DNR/POLST document completion.

Results

A total of 577 patients were admitted to the ICU. Of these, 211 patients (36.6%) had DNR or POLST records. DNR and/or POLST were completed prior to ICU admission in 48 (22.7%) patients. The DNR/POLST group was older (72.9 ± 13.5 vs. 67.6 ± 13.8 years, p < 0.001) and had higher Acute Physiology and Chronic Health Evaluation (APACHE) II score (26.1 ± 9.2 vs. 20.3 ± 7.7, p < 0.001) and clinical frailty scale (5.1 ± 1.4 vs. 4.4 ± 1.4, p < 0.001) than the other groups. Solid tumors, hematologic malignancies, and chronic lung disease were the most common comorbidities in the DNR/POLST groups. The DNR/POLST group had higher ICU and in-hospital mortality and more invasive treatments (arterial line, central line, renal replacement therapy, invasive mechanical ventilation) than the other groups. Body mass index, APAHCE II score, hematologic malignancy, DNR/POLST were factors associated with in-hospital mortality.

Conclusions

Among ICU patients, 36.6% had DNR or POLST orders and received more invasive treatments. This is contrary to the common belief that DNR/POLST patients would receive less invasive treatment and underscores the need to better understand and include end-of-life care as an important ongoing aspect of patient care, along with communication with patients and families.
Medical students’ attitudes and perceived competence regarding medical cannabis and its suggestibility
Authors: Denneler Tatjana , Mahling Moritz , Hermann Sabine , Stengel Andreas , Zipfel Stephan , Herrmann-Werner Anne , Festl-Wietek Teresa
Published: February 2024

Introduction

The global trend of legalizing medical cannabis (MC) is on the rise. In Germany, physicians have prescribed MC at the expense of health insurers since 2017. However, the teaching on MC has been scant in medical training. This study investigates medical students’ attitudes and perceived competence regarding MC and evaluates how varying materials (videos/articles) impact their opinions.

Methods

Fourth-year medical students were invited to participate in the cross-sectional study. During an online session, students viewed a video featuring a patient with somatoform pain discussing her medical history, plus one of four randomly assigned MC-related materials (each an article and a video depicting a positive or negative perspective on MC). Students’ opinions were measured at the beginning [T0] and the end of the course [T1] using a standardized questionnaire with a five-point Likert scale. We assessed the influence of the material on the students’ opinions using paired-sample t-tests. One-way analysis of variance and Tukey post-hoc tests were conducted to compare the four groups. Pearson correlations assessed correlations.

Results

150 students participated in the course, the response rate being 75.3% [T0] and 72.7% [T1]. At T0, students felt a little competent regarding MC therapy (M = 1.80 ± 0.82). At T1, students in groups 1 (positive video) and 3 (positive article) rated themselves as more capable in managing MC therapy $$ (\text{t}\left(28\right)=-3.816,\text{p}<0.001; \text{t}\left(23\right)=-4.153,\text{p}<0.001)$$, and students in groups 3 (positive article) and 4 (negative article) felt more skilled in treating patients with chronic pain $$ (\text{t}\left(23\right)=-2.251,\text{p}=0.034;\text{t}\left(30\right)=-2.034;\text{p}=0.051)$$. Compared to the other groups, group 2 students (negative video) felt significantly less competent. They perceived cannabis as addictive, hazardous and unsuitable for medical prescription.

Discussion

This study showed that medical students lack knowledge and perceived competence in MC therapy. Material influences their opinions in different ways, and they seek more training on MC. This underlines that integrating MC education into medical curricula is crucial to address this knowledge gap.
Multicentric lymphoma in a donkey with intestinal and bone marrow involvement
Authors: Paraschou Georgios , Xue Cynthia , Egan Rebecca , Bolfa Pompei
Published: February 2024

Background

Lymphoma is a common neoplasm in horses but is reported much less commonly in donkeys. In this case report, we describe the macroscopic, microscopic and immunohistochemical features of a multicentric lymphoma with intestinal and bone marrow involvement.

Case presentation

A geriatric female donkey with history of chronic lameness was found dead. Post-mortem examination revealed advanced emaciation, periodontal disease, left front foot laminitis and multiple, soft, white to yellow tan intestinal transmural masses, up to 12 cm in diameter. Cytology suggested a round cell intestinal neoplasm. The femur of the left hint limb was double the size of the normal contralateral, with suspected neoplastic infiltration and replacement of bone marrow and bone. Histologically we diagnosed a lymphoma in the intestine and left femur. Immunohistochemically, the neoplastic cells showed CD3 immunolabelling, supporting a diagnosis of a multicentric T-cell lymphoma.

Conclusions

To the authors’ knowledge, this is the first time multicentric lymphoma is diagnosed in donkeys. Further studies of the genetic background, clinical, laboratory, histopathologic, and immunohistochemical, as well as the pathogenesis of lymphoma, is needed to better understand the uniquely low frequency of this neoplasm in donkeys.
Efficacy and safety of enavogliflozin vs. dapagliflozin as add-on therapy in patients with type 2 diabetes mellitus based on renal function: a pooled analysis of two randomized controlled trials
Authors: Lyu Young Sang , Hong Sangmo , Lee Si Eun , Cho Bo Young , Park Cheol-Young
Published: February 2024

Background

We assessed the efficacy and safety of enavogliflozin (0.3 mg), a newly developed SGLT-2 inhibitor, in patients with type 2 diabetes mellitus based on kidney function via pooled analysis of two 24-week, randomized, double-blind phase III trials.

Methods

Data from 470 patients were included (enavogliflozin: 0.3 mg/day, n = 235; dapagliflozin: 10 mg/day, n = 235). The subjects were classified by mildly reduced (60 ≤ eGFR < 90 mL/min/1.73 m², n = 247) or normal eGFR (≥ 90 mL/min/1.73 m², n = 223).

Results

In the mildly reduced eGFR group, enavogliflozin significantly reduced the adjusted mean change of HbA1c and fasting plasma glucose levels at week 24 compared to dapagliflozin (− 0.94% vs. −0.77%, P = 0.0196). Enavogliflozin exhibited a more pronounced glucose-lowering effect by HbA1c when combined with dipeptidyl peptidase-4 inhibitors than that observed in their absence. Enavogliflozin showed potent blood glucose-lowering effects regardless of renal function. Conversely, dapagliflozin showed a significant decrease in the glucose-lowering efficacy as the renal function decreased. Enavogliflozin showed a higher urinary glucose excretion rate in both groups. The homeostatic model assessment showed that enavogliflozin markedly decreased the insulin resistance. The blood pressure, weight loss, or homeostasis model assessment of beta-cell function values did not differ significantly between enavogliflozin and dapagliflozin. Adverse events were similar between both drugs.

Conclusions

The glucose-lowering efficacy of enavogliflozin is superior to that of dapagliflozin in patients with type 2 diabetes mellitus with mild renal function impairment; this is attributed to its potent urinary glucose excretion-promoting ability. The emergence of new and potent SGLT-2 inhibitors is considered an attractive option for patients with inadequate glycemic control and decreased renal function.

Trial registration

Not applicable (pooled analysis).
N-terminal truncation of PhaCBP-M-CPF4 and its effect on PHA production
Authors: Neoh Soon Zher , Tan Hua Tiang , Trakunjae Chanaporn , Chek Min Fey , Vaithanomsat Pilanee , Hakoshima Toshio , Sudesh Kumar
Published: February 2024

Background

Among the polyhydroxyalkanoate (PHA), poly[(R)-3-hydroxybutyrate-co-(R)-3-hydroxyhexanoate] [P(3HB-co-3HHx)] is reported to closely resemble polypropylene and low-density polyethylene. Studies have shown that PHA synthase (PhaC) from mangrove soil (PhaCBP-M-CPF4) is an efficient PhaC for P(3HB-co-3HHx) production and N-termini of PhaCs influence its substrate specificity, dimerization, granule morphology, and molecular weights of PHA produced. This study aims to further improve PhaCBP-M-CPF4 through N-terminal truncation.

Results

The N-terminal truncated mutants of PhaCBP-M-CPF4 were constructed based on the information of the predicted secondary and tertiary structures using PSIPRED server and AlphaFold2 program, respectively. The N-terminal truncated PhaCBP-M-CPF4 mutants were evaluated in C. necator mutant PHB−4 based on the cell dry weight, PHA content, 3HHx molar composition, molecular weights, and granule morphology of the PHA granules. The results showed that most transformants harbouring the N-terminal truncated PhaCBP-M-CPF4 showed a reduction in PHA content and cell dry weight except for PhaCBP-M-CPF4 G8. PhaCBP-M-CPF4 G8 and A27 showed an improved weight-average molecular weight (Mw) of PHA produced due to lower expression of the truncated PhaCBP-M-CPF4. Transformants harbouring PhaCBP-M-CPF4 G8, A27, and T74 showed a reduction in the number of granules. PhaCBP-M-CPF4 G8 produced higher Mw PHA in mostly single larger PHA granules with comparable production as the full-length PhaCBP-M-CPF4.

Conclusion

This research showed that N-terminal truncation had effects on PHA accumulation, substrate specificity, Mw, and granule morphology. This study also showed that N-terminal truncation of the amino acids that did not adopt any secondary structure can be an alternative to improve PhaCs for the production of PHA with higher Mw in mostly single larger granules.
RhoB expression associated with chemotherapy response and prognosis in colorectal cancer
Authors: Kopsida Maria , Liu Na , Kotti Angeliki , Wang Jing , Jensen Lasse , Jothimani Ganesan , Hildesjo Camilla , Haapaniemi Staffan , Zhong Wen , Pathak Surajit , Sun Xiao-Feng
Published: February 2024

Purpose

To examine the role of RhoB expression in relation to chemotherapy response, clinical outcomes and associated signaling pathways in colorectal cancer patients.

Materials and methods

The study included 5 colon cancer cell lines, zebrafish embryos and 260 colorectal cancer patients treated with 5-fluorouracil (5-FU) and oxaliplatin (OXL). The methods consisted of CRISPR/Cas9, reactive oxygen species (ROS), caspase-3 activity, autophagy flux, in-silico RNA sequencing and immunohistochemistry. Gene expression analysis and pathway analysis were conducted using RNA-seq data.

Results

All cancer lines tested, including SW480, SW480-KO13 (RhoB knockout), SW480-KO55 (RhoB knockout), HCT116 and HCT116-OE (RhoB overexpressed), exhibited cytotoxicity to 5-FU and OXL. RhoB knockout cell lines demonstrated significantly reduced migration compared to the control cell lines. Furthermore, RhoB played a role in caspase-3-dependent apoptosis, regulation of ROS production and autophagic flux. The mRNA sequencing data indicated lower expression levels of oncogenes in RhoB knockout cell lines. The zebrafish model bearing SW480-KO showed a light trend toward tumor regression. RhoB expression by immunohistochemistry in patients was increased from normal mucosa to tumor samples. In patients who received chemotherapy, high RhoB expression was related to worse survival compared to low RhoB expression. Furthermore, the molecular docking analysis revealed that OXL had a higher binding affinity for RhoB than 5-FU, with a binding affinity of -7.8 kcal/mol and HADDOCK predicted molecular interactions between RhoB and caspase 3 protein. Gene-set enrichment analysis supported these findings, showing that enrichment of DNA damage response pathway and p53 signaling in RhoB overexpression treatment group, while the RhoB knockout treatment group exhibited enrichment in the negative regulation pathway of cell migration.

Conclusion

RhoB was negatively associated with chemotherapy response and survival in colorectal cancers. Therefore, RhoB inhibition may enhance chemotherapeutic responses and patient survival.
StairNet: visual recognition of stairs for human–robot locomotion
Authors: Kurbis Andrew Garrett , Kuzmenko Dmytro , Ivanyuk-Skulskiy Bogdan , Mihailidis Alex , Laschowski Brokoslaw
Published: February 2024

Human–robot walking with prosthetic legs and exoskeletons, especially over complex terrains, such as stairs, remains a significant challenge. Egocentric vision has the unique potential to detect the walking environment prior to physical interactions, which can improve transitions to and from stairs. This motivated us to develop the StairNet initiative to support the development of new deep learning models for visual perception of real-world stair environments. In this study, we present a comprehensive overview of the StairNet initiative and key research to date. First, we summarize the development of our large-scale data set with over 515,000 manually labeled images. We then provide a summary and detailed comparison of the performances achieved with different algorithms (i.e., 2D and 3D CNN, hybrid CNN and LSTM, and ViT networks), training methods (i.e., supervised learning with and without temporal data, and semi-supervised learning with unlabeled images), and deployment methods (i.e., mobile and embedded computing), using the StairNet data set. Finally, we discuss the challenges and future directions. To date, our StairNet models have consistently achieved high classification accuracy (i.e., up to 98.8%) with different designs, offering trade-offs between model accuracy and size. When deployed on mobile devices with GPU and NPU accelerators, our deep learning models achieved inference speeds up to 2.8 ms. In comparison, when deployed on our custom-designed CPU-powered smart glasses, our models yielded slower inference speeds of 1.5 s, presenting a trade-off between human-centered design and performance. Overall, the results of numerous experiments presented herein provide consistent evidence that StairNet can be an effective platform to develop and study new deep learning models for visual perception of human–robot walking environments, with an emphasis on stair recognition. This research aims to support the development of next-generation vision-based control systems for robotic prosthetic legs, exoskeletons, and other mobility assistive technologies.