bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of Segmental Hepatic Fat Distribution using Magnetic Resonance Proton Density Fat Fraction MR-PDFF in Non-alcoholic Fatty Liver Disease (NAFLD)
Authors:   Department of Radiology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan, Rafique Muhammad Salman , Ayub Ayesha ,   Department of Gastroenterology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan., Malik Ahmad Karim ,   Department of Gastroenterology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan., Malik Tahir ,   Department of Radiology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan., Kundi Sana ,   Department of Radiology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan., Saeed Abdullah ,   Department of Radiology, Pakistan Kidney and Liver Institute and Research Center, Lahore, Pakistan.
Published: July 2023

Abstract: Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a significant healthcare challenge. MR proton density fat fraction (MR-PDFF) is a quantitative imaging parameter that allows a precise estimation of hepatic steatosis. Determination of segmental and lobar fat distribution is also important since underestimation or overestimation may lead to hurdles in patient management and may also alter outcomes during liver donor assessment for living donor liver transplant. Objective: To determine the heterogeneity of hepatic fat distribution across different liver segments and both lobes in patients with non-alcoholic fatty liver disease (NAFLD). Materials and Methods: This cross-sectional descriptive study included 35 patients of NAFLD. MR-PDFF sequence was performed, two regions of interest (ROI) were drawn at the periphery of each hepatic segment and their mean was taken. We calculated mean values, ranges, and standard deviations for individual segments, both lobes and the entire liver. Pearson’s correlation was used to assess the relation between MR-PDFF and MR-PDFF variability. Paired sample t-test was utilized to compare the means of the right and the left lobe of the liver. Results: The fat fraction in segment I was the lowest and in segment VII the highest. The right and left lobes showed a significant difference in fat fraction with values of 14% and 11.4% respectively (paired sample t-test, p<0.005). The left lobe showed a greater MR-PDFF variability than the right lobe (1.9 vs 1.6%). Conclusion: In patients with NAFLD, segments VII and VIII show the greatest while segments I and IV show the least fat infiltration. Hepatic fat preferentially gets deposited more in the right lobe of the liver.
Benefits of Ferric Carboxymaltose Administration for Enhanced Hemoglobin Levels in Urban Population of Sindh: BOFERIN® Observational Study
Authors:   Department of Obstetrics & Gynecology, Dow University of Health Sciences, Karachi, Pakistan., Ainuddin Jahanara , Majid Nasreen ,   Department of Obstetrics & Gynecology, Memon Medical Institute, Karachi, Pakistan., Aslam Azra ,   Department of Obstetrics & Gynecology, Shah Bhitai Government Hospital, Hyderabad, Pakistan., Sikander Raheel ,   Department of Obstetrics & Gynecology, Liaquat University of Health Sciences, Hyderabad, Pakistan., Iqbal Sarmad ,   Department of Pharmacy Practice, University of Karachi, Sindh, Pakistan., Hussain Syed Saad ,   Department of Pharmacy, Iqra University, Karachi, Pakistan.
Published: July 2023

Abstract: Background: Iron deficiency anemia is a major public health issue in developing countries, especially among women of reproductive age. Anemia is a major public health problem in women of reproductive age in rural Pakistan and a large proportion of women were found to have low levels of serum iron. Materials and Methods: A multicenter observational cohort study was conducted at Karachi & Hyderabad from 8th February 2022 to 30th April 2022. Women with low hemoglobin level and age 18-45 years were included in this study. Patients were grouped according to 1-week assessment and 3-week assessment of hemoglobin concentration. A single dose of a generic substituent ferric carboxymaltose (Boferin®) was administered to the patients over 15 minutes infusion. Baseline hemoglobin levels were compared at 1 week and 3 weeks after administration of Ferric Carboxymaltose. Results: A total of 104 patients were enrolled in this study. The mean hemoglobin levels at baseline were 9.22 ± 0.175 g/dl and 7.55 ± 0.329 g/ dl for 1-week and 3-week, respectively. The mean hemoglobin increases after 1 week and 3 week was reported as 1.4211± 0.169 g/dl (p< 0.001) and 2.321± 0.335 g/dl (p< 0.001) respectively. Only three patients presented with mild to moderate adverse effect which included abdominal discomfort and nausea. Conclusion: This is a first in class study has shown statistically significant increase in hemoglobin at 1-week and 3-week interval with minimal side effects. It is concluded that Boferin® is efficacious in increasing hemoglobin levels in patients with iron deficiency anemia with its safety being documented in pregnant Pakistani population as well.
Barriers and Beliefs Related to Covid-19 Vaccine in a Rural Area of Peshawar, Pakistan
Authors:   Department of Prosthetics, Sardar Begum Dental College & Hospital, Gandhara University, Peshawar, Pakistan., Khan Abdul Adil , Gillani Syed Imran ,   Department of Community and Preventive Dentistry, Sardar Begum Dental College & Hospital, Gandhara University, Peshawar, Pakistan, Wadan Qazi Haris ,   Department of Prosthetics, Sardar Begum Dental College & Hospital, Gandhara University, Peshawar, Pakistan., Ali Syed Ibne ,   Department of Oral and Maxillofacial Surgery, Lady Reading Hospital, Peshawar, Pakistan.
Published: July 2023

Abstract: Background: After the corona virus outbreak, a new challenge has presented itself in the form of vaccine hesitancy, a decision which stems from personal beliefs and perceptions, which may lead to the prevalence of a disease that can otherwise easily dealt with. Objectives: This study aimed to determine the barriers and beliefs related to COVID-19 vaccine in a rural area of Peshawar, Pakistan. Materials and Methods: An analytical cross-sectional study was conducted from May 2021 to October 2021 on a population from rural areas of Peshawar with a non-probability convenience sampling technique. An interview based self-administered questionnaire was used with questions regarding beliefs and about the COVID-19 vaccine as well as their vaccination status. An SPSS software was used to analyze the data for descriptive as well as inferential statistics. Results: A total of 526 people from the rural area participated in our study with 73% males (n = 384) and 27% females (n = 142). Only 23.6% got vaccinated voluntarily, 8% agreed that there was enough information available regarding the vaccine to trust, around 17.5% agreed the vaccine does not cause adverse reactions, only 15.6% believed that the vaccine had no unknown side effects, 22.1% trusted the vaccine to be effective in combating the coronavirus while 54.4% believed it to be a conspiracy. Conclusion: Vaccine hesitancy was quite profound which was caused by the amalgamation of many negative beliefs based on claims that had no sound basis. A great confusion surrounds the COVID-19 vaccine for the people of the rural area who are concerned about various aspects of the vaccine.
Giant Lipoma of Unusual Regions: A Case Series of Two Unfortunate Adults
Authors:   Department of Orthopedics, Unit II, Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan., Sahito Badaruddin , Qamar Javeria ,   Department of Orthopedics, Dow University of Health Sciences, Baba e Urdu Road, Saddar, Karachi, Pakistan., Ahmed Sajjad ,   Department of Orthopedics, Unit II, Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan, Khan Muhammad Waqas ,   Department of Orthopedics, Unit II, Dr. Ruth KM Pfau Civil Hospital Karachi, Pakistan.
Published: July 2023

Abstract: Lipomas are prevalent, benign, asymptomatic mesenchymal tumors that can develop in various areas where adipose tissue is present. However, when lipomas reach sizes larger than 10 cm in width or exceed 1 kilogram in weight, they are classified as giant lipomas [1-3]. These oversized lipomas can lead to functional restrictions, aesthetic concerns, and compression-related injuries, all of which can negatively impact an individual’s quality of life. They are usually surgically removed to avoid injury to major neurovascular structures; however, they have a predisposition for recurrence and the risk of malignancy following surgery. This case series discusses the clinical findings and surgical treatment of two patients who had enormous, deformable, fatty tumors of buttocks and thigh, respectively.
Estado de micronutrimentos en niños, niñas y mujeres mexicanas: análisis de la Ensanut Continua 2022
Authors: De la Cruz-Góngora Vanessa , García-Guerra Armando , Shamah-Levy Teresa , Villalpando Salvador , Valdez-Echeverría Raymundo , Mejía-Rodríguez Fabiola
Published: July 2023

Objetivo. Describir las deficiencias de micronutrientes en la población mexicana participante de la Encuesta Nacional de Salud y Nutrición 2022 (Ensanut 2022). Material y métodos. La Ensanut 2022 es probabilística y de representatividad nacional. Se recolectó sangre venosa en una submuestra de niños de 1-11 años (48%) y de mujeres de 12-49 años (37%). Se separó el suero in situ para analizar ferritina, vitamina B12, folato y 25[OH]D, definiendo deficiencias según criterios de la Organización Mundial de la Salud. Se realizaron análisis descriptivos en niños/as preescolares, escolares y mujeres (12-49 años), utilizando el diseño de la encuesta. Resultados. Las prevalencias de deficiencia de hierro, niveles bajos de vitamina B12 y deficiencia de vitamina D fueron 30.6, 17.4 y 4.7% en preescolares; 17.2, 20 y 37.1% en escolares; y 39.7, 34.0 y 37.7% en mujeres, respectivamente. Conclusión. La deficiencia de hierro en preescolares y de micronutrientes en mujeres fueron altamente prevalentes. Es necesario un llamado a la acción para realizar intervenciones focalizadas en grupos con mayor desventaja social.
Lesiones no intencionales en México. Ensanut Continua 2022
Authors: Hidalgo-Solórzano Elisa , Martínez-Nolasco Manuel Alejandro , Martínez-Dávalos Araczy , Híjar Martha
Published: July 2023

Objetivo. Estimar la prevalencia de lesiones no intencionales (LNI) y sus consecuencias no fatales en población mexicana. Material y métodos. Estudio transversal con la Encuesta Nacional de Salud y Nutrición Continua 2022 (Ensanut Continua 2022), diseñada con muestreo probabilístico, polietápico y estratificado. Se estimó la prevalencia de LNI, por grupo de edad, sexo, región, estrato de residencia e índice de bienestar. Resultados. La prevalencia de LNI fue 5.74% (IC95%: 5.31,6.21); 30.5% reportó consecuencias permanentes en salud y 62% requirió atención en servicios de salud públicos. Las regiones Península, Pacífico-Sur y Pacífico-Centro presentaron prevalencias más altas (6.69, 6.43 y 6.36% respectivamente), en hombres (6.8%) y en población de 10-19 años (6.51%). Las caídas fueron la causa más frecuente con 57.6%; vía pública (39.5%) y hogar (29%) los principales sitios de ocurrencia. Conclusiones. Las LNI no fatales afectan de manera diferenciada a hombres y población joven; caídas y lesiones de tránsito causan importante demanda en servicios de salud y discapacidad.
Conducta suicida en México: análisis comparativo entre población adolescente y adulta
Authors: Valdez-Santiago Rosario , Villalobos Hernández Aremis , Arenas-Monreal Luz , Benjet Corina , Vázquez García Alejandro
Published: July 2023

Objetivo. Estimar la prevalencia nacional de conductas suicidas en población adolescente y adulta, por características sociodemográficas, con los datos de la Encuesta Nacional de Salud y Nutrición (Ensanut 2022). Material y métodos. A partir de la Ensanut 2022 se analizan preguntas similares en adolescentes y adultos relacionadas con pensamiento e intento de suicidio alguna vez en la vida y en los últimos 12 meses. Resultados. El 7.6% de la población adolescente y 7.7% de la población adulta pensó alguna vez en suicidarse. La prevalencia de intento de suicidio alguna vez en la vida fue de 6.5% en adolescentes y 3.5% en adultos, y 3.1% en adolescentes y 0.6% en adultos para los últimos 12 meses. Las mujeres reportaron la mayor prevalencia en comparación con los hombres, tanto en pensamiento como en intentos de suicidio. Conclusión. Los hallazgos refuerzan la importancia de establecer la prevención del suicidio en jóvenes como una prioridad en la agenda nacional de salud.
La Encuesta Nacional de Salud y Nutrición 2022
Authors: Robledo Aburto Zoé
Published: July 2023

¿Qué pasaría si tuviéramos la capacidad de enviar en un solo evento a todo un país para una revisión con el médico? ¿Qué información obtendríamos? ¿Para qué nos serviría? Lo obtenido de este maratónico esfuerzo sería crucial para saber por qué los mexicanos enfermamos y de qué enfermamos, conoceríamos más sobre cómo hacer frente a los factores [...]
A hybrid attention generative adversarial network for Chinese Landscape Painting
Authors: Lyu Qiongshuai , Zhao Na , Liu Xiaoman , Zhou Gaiyun , Yang Yu
Published: July 2023

Landscape painting is one of the unique paintings in China, mainly depicting the natural scenery of mountains and rivers. However, it is very difficult for ordinary people to master the creative skill of landscape painting, such as painting methods, painting theory, and composition. In this paper, we propose HA-GAN to transform sketches into Chinese landscape paintings, a new GAN-based framework that builds upon a hybrid attention generator and a discriminator. To generate more realistic landscape paintings, we design a hybrid attention module containing style attention, spatial attention, and channel attention. Moreover, a novel loss function is proposed to constrain the training process of the model. Experimental results show that the proposed method can generate realistic landscape paintings similar to those created by human artists.
Effect of Environmental Decentralization on Pollution Reduction: Positive or Negative?
Authors: Yi Ming , Liu Yafen , Wang Yue , Xu Shujing , Wu Ting
Published: July 2023

This study investigates the impact of environmental decentralization on pollution mitigation based on the panel data across 30 Chinese provinces from 2004 to 2019. Different from previous studies, this study uses a spatial dynamic panel Durbin model and panel threshold model, considering both time and spatial lag factors of pollution mitigation and the possibility of non-linear impact of environmental decentralization on pollution mitigation. We conclude with four main findings. Firstly, environmental decentralization is not helpful to pollution mitigation at the national level. Secondly, the environmental decentralization shows a positive spatial spillover effect and non-linear effect, that is, the local environmental decentralization affects its neighbouring area’s pollution mitigation. In other words, when the environmental decentralization is at a low level, the negative impact on pollution mitigation is relatively large; while when the environmental decentralization is at a high level, the negative impact is relatively small. Thirdly, the impact of environmental decentralization on pollution mitigation appears regional heterogeneity, where the impact is positive to central and eastern regions, but negative to the western areas. Lastly, although the decentralization of environmental administration and supervision helps mitigate pollution, decentralized environmental monitoring negatively affects pollution reduction. Therefore, we suggest promoting the structural reform of environmental decentralization, setting a proper decentralization degree in different regions, and establishing a collaborative regulation mechanism across regions.
The application value of high-frequency ultrasound in the feasibility assessment of endoscopic retrograde appendicitis therapy in children with appendicitis
Authors: Guo Xiaoya , Yang Hengli , Zhao Ping , Li Jinghua , Zeng Lingchao , Wang Chunhui , Yang Yilin , Yang Ruijing
Published: July 2023

Acute appendicitis is one of the common acute abdominal diseases in pediatrics. However, the implementation of radiological examination guided endoscopic retrograde appendicitis therapy (ERAT) in adults is limited in children. Our previous research explored the non-invasive guidance of high-frequency ultrasound(HFUS) for ERAT and achieved good therapeutic effects. This study mainly focuses on exploring the application value of HFUS in the feasibility assessment of ERAT in children with appendicitis. 163 children with appendicitis received ERAT guided by HFUS were analyzed retrospectively. According to the parameters evaluated by HFUS before and during ERAT, the results indicated that the distance between the appendix orifice and the ileocecal valve significantly affected the time required for the guidewire to enter the appendix cavity ( P < 0.05). The diameter and the texture of the ficalith, the thickness of the intestinal wall of the appendiceal orifice all had significant effects on the successful removal of the ficalith (P < 0.05). The success rate, treatment time and final flushing effect of the guidewire to reach the blind end of the appendix were significantly affected by the tortuosity of the appendix and whether there was adhesion with surrounding tissues (P < 0.05). HFUS can accurately assess the feasibility of ERAT in children with appendicitis.
Environmental Regulation, Institutional Distance and China's Outward Foreign Direct Investment in the Belt and Road Countries
Authors: Yang Lihua , Chen Qi
Published: July 2023

Recent trends in green development have led to a proliferation of studies examining the relationship between environmental regulation and outward foreign direct investment (OFDI). However, there has been little discussion about the role of institutional distance in the impact of environmental regulation on OFDI. This study aims to explore the direct impact of environmental regulation on OFDI, and the moderating role of institutional distance in the relationship between the two. The results showed that environmental regulation has a significant positive effect on China’s OFDI, while institutional distance has a significant negative impact. Further analysis found that before the Belt and Road Initiative (BRI), environmental regulation positively affects OFDI, while after BRI, it does not have a significant impact on the OFDI. Furthermore, a positive moderating effect was detected after the BRI, and a negative moderating effect was found in host countries with worse institutions than China. The findings have significant implications for understanding how China’s OFDI responds to the environmental regulation of host countries, considering the impact of institutional distance at the same time. This study will help provide further implications for the development of foreign direct investment strategy and the formulation of government policies.
Safety and feasibility of esophagectomy after neoadjuvant immunotherapy combined with chemotherapy or chemoradiotherapy for locally advanced esophageal squamous cell cancer: Analysis of two phase 2 clinical trials
Authors: Shen Dijian , Chen Runzhe , Wu Qing , Ji Yongling , Chen Qixun , Chen Ming
Published: July 2023

Background: Although preoperative chemotherapy (CT) or chemoradiotherapy (CRT) show survival benefit in patients with locally advanced esophageal squamous cell cancer (ESCC), ESCC still has a dismal prognosis. With the potential benefit of combining immune checkpoint inhibitors (ICIs) neoadjuvantly, we initiated 2 phase II single-armed clinical trials which assessed the efficacy, feasibility and safety of esophagectomy after the combination of preoperative CT or CRT and PD-1 inhibitor in ESCC.
Methods: A total of 55 patients with histologically confirmed ESCC (clinical stage II-IVA according to the American Joint Committee on Cancer 8th staging system from two phase 2, single-arm trials underwent neoadjuvant ICIs combined with chemotherapy (nICT) (n=38) (NCT04506138) or chemoradiotherapy (nICRT) (n=17) (NCT03940001) between May 2019 and June 2022 were enrolled. Patients received 2 doses of intravenous PD-1 inhibitor every 3 weeks, combined with 2 cycles of CT or CRT. Data on the pathological complete response (pCR) rates, operative time, blood loss volume, 30-day complications, hospital stay and 30-day mortality were collected and assessed between these two groups using a multivariable log-binomial regression model to obtain adjusted relative risk ratios. The primary endpoints of the studies were safety and feasibility of esophagectomy after the combination of preoperative CT or CRT and PD-1 inhibitor. We also evaluated the pCR, primary tumor pCR, operation time, postoperative stay and 30-day mortality.
Results: All the included patients successfully completed neoadjuvant therapy. Age, sex, performance status, clinical stage, histologic subtype, procedure type, operative time and blood loss volume were similar between the two groups. The primary tumor pCR rates were 52.9% in nICRT and 21.6% in nICT group respectively (p=0.03), while the postoperative pCR rates were 41.2% in nICRT group and 21.6% in nICT group respectively (p=0.19). Minimally invasive surgery was performed 89.2% (33/37) in nICT group and 94.1% (16/17) in nICRT group. The risk of developing pulmonary, anastomotic, or other complications were similar in the two groups.
Conclusions: Esophagectomy was safe after the addition of PD-1 inhibitor to preoperative CT or CRT in ESCC neoadjuvant therapies. Follow-up and the exploratory endpoints including biomarkers analyses are ongoing.
Trial registration: These researches are registered under clinicaltrials.gov (NCT03940001, 07/05/2019, NCT04506138, 10/08/2020).
Systematic disease-agnostic identification of therapeutically actionable targets using the genetics of human plasma proteins.
Authors: Karim Mohd Anisul , Ariano Bruno , Schwartzentruber Jeremy , Roldan-Romero Juan Maria , Mountjoy Edward , Hayhurst James , Buniello Annalisa , Mohammed Elmutaz Shaikho Elhaj , Carmona Miguel , Holmes Michael V , Robins Chloe , Surendran Praveen , Haddad Stephen , Scott Robert , Leach Andrew , Ochoa David , Maranville Joseph , McDonagh Ellen M , Dunham Ian , Ghoussaini Maya , Ghoussaini Maya
Published: July 2023

Proteome-wide Mendelian randomization (MR) has emerged as a promising approach in uncovering novel therapeutic targets. However, genetic colocalization analysis has revealed that a third of MR associations lacked a shared causal signal between the protein and disease outcome, raising questions about the effectiveness of this approach. The impact of proteome-wide MR, stratified by cis-trans status, in the presence or absence of genetic colocalization, on therapeutic target identification remains largely unknown.
In this study, we conducted genome-wide MR and cis/trans-genetic colocalization analyses using proteomic and complex trait genome-wide association studies. Using two different gold-standard datasets, we found that the enrichment of target-disease pairs supported by MR increased with more p-value stringent thresholds MR p-value, with the evidence of enrichment limited to colocalizing cis-MR associations.
Using a phenome-wide proteogenetic colocalization approach, we identified 235 unique targets associated with 168 binary traits at high confidence (at colocalization posterior probability of shared signal > 0.8 and 5% FDR-corrected MR p-value). The majority of the target-trait pairs did not overlap with existing drug targets, highlighting opportunities to investigate novel therapeutic hypotheses. 42% of these non-overlapping target-trait pairs were supported by GWAS, interacting protein partners, animal models, and Mendelian disease evidence. These high confidence target-trait pairs assisted with causal gene identification and helped uncover translationally informative novel biology, especially from trans-colocalizing signals, such as the association of lower intestinal alkaline phosphatase with a higher risk of inflammatory bowel disease in FUT2 non-secretors.
Beyond target identification, we used MR of colocalizing signals to infer therapeutic directions and flag potential safety concerns. For example, we found that most genetically predicted therapeutic targets for inflammatory bowel disease could potentially worsen allergic disease phenotypes, except for TNFRSF6B where we observed directionally consistent associations for both phenotypes.
Our results are publicly available (https://mk31.shinyapps.io/mr_app2/), enabling others to use proteogenomic evidence to appraise therapeutic targets.
Far from Home: Tracing the non-native origin of water frogs (genus Pelophylax) in Malta by molecular markers
Authors: Papežík Petr , Sciberras Arnold , Benovics Michal , Sciberras Jeffrey , Deidun Alan , Mikulíček Peter
Published: July 2023

One of the most frequently translocated species outside their native range in Europe are water frogs of the genus Pelophylax. Recently, water frogs belonging to the same genus have also been recorded on the island of Gozo in Malta. To trace their origin, we genetically examined 17 individuals from three Gozitan localities where water frogs have been recorded recently. We analysed one mitochondrial gene (ND2) and one nuclear (SAI-1) gene to identify the geographic origin of the frogs and a set of microsatellite markers to determine their population-genetic structure and the predicted number of source populations. Based on the ND2 and SAI-1 markers, the water frogs on the island of Gozo originate from southern Anatolia, Turkey. According to sequence variation in ND2, they were assigned to a caralitanus mtDNA clade, which is endemic to southern Anatolia and taxonomically represents either an evolutionary lineage within P. cf. bedriagae or a separate species P. caralitanus. All Gozo water frogs had only one haplotype in the ND2 and one allele in the SAI-1 gene, indicating a recent and single introduction event. These results are supported by microsatellite analysis, which revealed low genetic variability and the absence of any population-genetic structure, suggesting that Gozo water frogs originate from only one source population.
Barriers and Facilitators to a Task-Shifted Stroke Prevention Program for Children with Sickle Cell Anemia in a Community Hospital: A Qualitative Study
Authors: Bello-Manga Halima , Haliru Lawal , Ahmed Kudirat , Ige Samuel , Musa Hayatu , Muhammad-Idris Zainab Kwaru , Monday Binshak , Sani Abdulrashid M. , Bonnet Kemberlee , Schlundt David G. , Varughese Taniya , Tabari Abdulkadir M. , DeBaun Michael R. , Baumann Ana A. , King Allison A.
Published: July 2023

Background
Children with sickle cell anemia (SCA) are at high risk for stroke. Protocols for stroke prevention including blood transfusions, screening for abnormal non-imaging transcranial Doppler (TCD) measurements, and hydroxyurea therapy are difficult to implement in low-resource environments like Nigeria. This study aimed to examine the contextual factors around TCD screening in a community hospital in Nigeria using qualitative interviews and focus groups.
Methods
We conducted focus groups with health care providers and interviews with administrative leadership of the community hospital. Interview guides and analysis were informed by the Consolidated Framework for Implementation Research (CFIR) framework. Transcripts were coded and analyzed using an iterative deductive (CFIR)/Inductive (transcribed quotes) qualitative methodology.
Results
We conducted two focus groups and five interviews with health care workers (nurses and doctors) and hospital administrators, respectively. Themes identified key elements of the inner setting (clinic characteristics, resource availability, implementation climate, and tension for change), characteristics of individuals (normative, control, and behavioral beliefs), and the implementation process (engage, implement, and adopt), as well as factors that were influenced by external context, caregiver needs, team function, and intervention characteristics. Task shifting, which is already being used, was viewed by providers and administrators as a necessary strategy to implement TCD screening in a clinic environment that is overstressed and under-resourced, a community stressed by poverty, and a nation with an underperforming health system.
Conclusion
Task shifting provides a viable option to improve health care by making more efficient use of already available human resources while rapidly expanding the human resource pool and building capacity that is more sustainable.
Trial registration:
NCT05434000
Game-Based Educational Experience in Clinical Simulation and Academic Achievement in Medical Students
Authors: Salafia-Recupero Maria Amalia , Perez-Ochoa María Elena
Published: July 2023

BACKGROUND: In recent years, medical education has increasingly embraced gamification as a method for teaching clinical skills. In Peru, social isolation resulting from the COVID-19 pandemic forced universities and academic institutions to restructure their teaching methods. Therefore, this work aims to determine whether a game-based strategy is associated with the achievement of clinical skills of students from a Peruvian medical school.
METHOD: We conducted a retrospective and cross-sectional study on medical students’ users of the Full Code Medical Simulation platform. We retrieved qualification data from selected cases of clinical courses with an appropriate number of users [Clinical Medicine (CM) I (7 cases), CM II (17 cases), Surgery I (6 cases) and Surgery II (6 cases). cases)]. We also evaluate correlation between academic performance levels and quantitative variables obtained in the Full Code platform were determined using the Kruskal-Wallis test.
RESULTS: A total of 590 students were enrolled. We found a direct correlation between the student's course grade and Full Code score in all courses (CM I: p<0.001, CM II: p<0.05, Surgery I: p<0.05 and Surgery II: p < 0.05). CM II course students who dedicated more time to case development received better grades (p < 0.05). There was no relationship between the percentage of correctly diagnosed cases and having better grades.
CONCLUSION:The use of gamification in clinical simulation positively influenced the learning outcomes of students in clinical courses. However, the guidance and commitment of the teachers were crucial to motivate and improve the skills of the students.
How to measure digital public health system maturity on a national level: An international multidisciplinary Delphi study
Authors: Maaß Laura , Zeeb Hajo , Rothgang Heinz
Published: July 2023

Unlocking the full potential of digital public health (DiPH) systems requires a comprehensive tool to assess their maturity. While the World Health Organization and the International Telecommunication Union released a toolkit in 2012 covering various aspects of digitalizing national healthcare systems, a holistic maturity assessment tool has been lacking ever since. To bridge this gap, we conducted a pioneering Delphi study, including 82 experts from diverse continents and academic fields. Our research aimed to gather indicators from multiple domains to evaluate the maturity of DiPH systems. Over three survey panels, participants collaborated to develop and establish consensus on these indicators, with a threshold of 70% agreement on indicator importance. Eventually, 96 indicators were identified and agreed upon by experts. Notably, 48% of these indicators were found to align with existing validated tools, highlighting their relevance and reliability. However, further investigation is required to assess the suitability and applicability of all the suggestions put forward by our participants. Nevertheless, this Delphi study is an essential initial stride toward a comprehensive measurement tool for DiPH system maturity. By working towards a standardized assessment of DiPH system maturity, we aim to empower decision-makers to make informed choices, optimize resource allocation, and drive innovation in healthcare delivery. The results of this study mark a significant milestone on the path to advancing DiPH on a global scale. Introduction
Regeneration of collecting lymphatic vessels following injury
Authors: Razavi Mohammad S. , Lei Pin-Ji , Amoozgar Zohreh , Leartprapun Nichaluk , Nadkarni Seemantini , Baish James , Padera Timothy , Munn Lance
Published: July 2023

Secondary lymphedema is a debilitating condition driven by impaired regeneration of lymphatic vasculature following lymphatic injury, surgical removal of lymph nodes in cancer patients or infection. However, the extent to which collecting lymphatic vessels regenerate following injury remains unclear. Here, we employed a novel mouse model of lymphatic injury in combination with state-of-the-art lymphatic imaging to demonstrate that the implantation of an optimized fibrin gel following lymphatic vessel injury leads to the growth and reconnection of the injured lymphatic vessel network, resulting in the restoration of lymph flow to the draining node. Intriguingly, we found that fibrin implantation elevates the tissue levels of CCL5, a potent macrophage-recruiting chemokine. Notably, CCL5-KO mice displayed a reduced ability to reconnect injured vessels following fibrin gel implantation. These novel findings shed light on the mechanisms underlying lymphatic regeneration and suggest that enhancing CCL5 signaling may be a promising therapeutic strategy for enhancing lymphatic regeneration.
Alpha-Fetoprotein and APRI as a Predictive Marker for Patients with Type C Hepatitis B-Related Acute-on-Chronic Liver Failure: A retrospective study
Authors: Li Chunyan , Hu Hao , Bai Chengzhi , Xu Huaqian , Liu Lin , Tang Shanhong
Published: July 2023

Background: Type C hepatitis B-related acute-on-chronic liver failure (HBV-ACLF), which based on decompensated cirrhosis, have different laboratory tests, precipitating events, organ failure and clinical outcome. The predictors of prognosis for the type C HBV-ACLF patients are different from other subgroups. This study aimed to construct a novel, short-term prognostic score that applied serological indicators of hepatic regeneration and noninvasive assessment of liver fibrosis to predict outcomes in patients with type C HBV-ACLF.
Method: Patients with type C HBV-ACLF were observed for 90 days. Demographic information, clinical examination, and laboratory test results of the enrolled patients were collected. Univariate and multivariate Logistic regression was performed to identify independent prognostic factors and develop a novel prognostic scoring system. And a receiver operating characteristic (ROC) curve was used to analyze the performance of the model.
Results: A total of 224 patients with type C HBV-ACLF were finally incorporated. The overall survival rate within 90 days was 47.77 %. Age, total bilirubin (TBil), international normalized ratio (INR), alpha-fetoprotein (AFP), white blood cell (WBC), serum natrium (Na), and Aspartate aminotransferase/platelet ratio index (APRI) were found to be independent prognostic factors. According to the results of the Logistic regression analysis, a new prognostic model (we named it the A3Twin score) was established. The area under the curve (AUC) of the receiver operating characteristic curve (ROC) was 0.851[95% CI（0.801-0.901）], the sensitivity of 78.8%, and specificity of 71.8%,which was significantly higher than that of the MELD, IMELD,MELD-Na, TACIA and COSSH‐ACLF II scores (all P < 0.001).Patients with lower A3Twin scores (<-9.07) would survive longer.
Conclusions: A new prognostic scoring system for patients with type C HBV-ACLF based on seven routine indexes was established in our study, and can accurately predict short-term mortality and might be used to guide clinical management.
Formulations containing Artemisia afra Jacq. Ex Willd for topical delivery
Authors: Olivier Duné , Kooy Frank Van der , Gerber Minja
Published: July 2023

Artemisia afra (A. afra) is an herbal medicine, traditionally prepared as a tea infusion, used for centuries in African countries to treat a vast number of ailments. This herb contains an ample amount of known and unknown compounds and has antibacterial, anti-viral and anti-fungal properties; hence, topical treatment was considered. A liquid chromatography mass spectrometry (LC-MS/MS) method was developed and validated to detect the six selected marker compounds used during this study: two organic acids (4,5-dicaffeoylquinic acid (DCQA) and chlorogenic acid (CGA), two flavonoids (luteolin and quercetin) and two coumarins (scopoletin and scopolin). The formulations selected had to accommodate the hydrophilic nature of the A. afra infusion; therefore, there was an infusion, hydrogel and emulgel selected. The hydrogel and emulgel contained a gelling agent, xanthan gum, whereas the emulgel additionally contained a chemical penetration enhancer, evening primrose oil (EPO), to improve penetration through the lipophilic stratum corneum. The characterisation of the semi-solid formulations was to ensure skin application suitability. Membrane release studies confirmed sufficient release of the different markers from the formulations. During the in vitro skin diffusion studies, the discovery was that the infusion had the highest median flux and amount per area diffused compared to the other formulations. Thereafter, there was tape stripping performed, and established that there were markers present in the stratum corneum-epidermis (SCE) and epidermis-dermis (ED). The testing of cytotoxicity was to determine the safety of topical delivery, and the finding was that A. afra showed no cytotoxicity at the levels tested.
Spatially resolved immune exhaustion within the alloreactive microenvironment predicts liver transplant rejection.
Authors: Barbetta Arianna , Rocque Brittany , Bangerth Sarah , Street Kelly , Weaver Carly , Chopra Shefali , Kim Janet , Sher Linda , Gaudilliere Brice , Akbari Omid , Kohli Rohit , Emamaullee Juliet
Published: July 2023

Allograft rejection is a frequent complication following solid organ transplantation, but defining specific immune subsets mediating alloimmunity has been elusive due to the scarcity of tissue in clinical biopsy specimens. Single cell techniques have emerged as valuable tools for studying mechanisms of disease in complex tissue microenvironments. Here, we developed a highly multiplexed imaging mass cytometry panel, single cell analysis pipeline, and semi-supervised immune cell clustering algorithm to study archival biopsy specimens from 79 liver transplant (LT) recipients with histopathological diagnoses of either no rejection (NR), acute T-cell mediated rejection (TCMR), or chronic rejection (CR). This approach generated a spatially resolved proteomic atlas of 461,816 cells derived from 98 pathologist-selected regions of interest relevant to clinical diagnosis of rejection. We identified 41 distinct cell populations (32 immune and 9 parenchymal cell phenotypes) that defined key elements of the alloimmune microenvironment (AME), identified significant cell-cell interactions, and established higher order cellular neighborhoods. Our analysis revealed that both regulatory (HLA-DR+ Treg) and exhausted T-cell phenotypes (PD1+CD4+ and PD1+CD8+ T-cells), combined with variations in M2 macrophage polarization, were a unique signature of TCMR. TCMR was further characterized by alterations in cell-to-cell interactions among both exhausted immune subsets and inflammatory populations, with expansion of a CD8 enriched cellular neighborhood comprised of Treg, exhausted T-cell subsets, proliferating CD8+ T-cells, and cytotoxic T-cells. These data enabled creation of a predictive model of clinical outcomes using a subset of cell types to differentiate TCMR from NR (AUC = 0.96 ± 0.04) and TCMR from CR (AUC = 0.96 ± 0.06) with high sensitivity and specificity. Collectively, these data provide mechanistic insights into the AME in clinical LT, including a substantial role for immune exhaustion in TCMR with identification of novel targets for more focused immunotherapy in allograft rejection. Our study also offers a conceptual framework for applying spatial proteomics to study immunological diseases in archival clinical specimens.
Prediction of Surface Residual Stress in Grinding Process
Authors: Lyu Yu-Ting , Ay Herchang , Huang Yu-Chun , Hung Tsung-Pin , Jang Kevin , Lee Rong-Tsong , Hong Zheng-Han , Tseng Po-Han
Published: July 2023

This study mainly constructs a finite element analysis model. The temperature, energy partition and changes of FC300 gray cast iron workpiece during dry grinding are investigated. Thermal load and mechanical deformation of workpiece during grinding can leave residual stress on the surface, which has a considerable impact on the fatigue properties of the workpiece. In the experimental part, different grinding wheel speeds (1200, 900, 600, 400 rpm), workpiece speeds (1000, 3000, 5000, 10000 mm/min), and grinding depths (10, 20 mm/min) were measured μm) Changes in residual stress under conditions. A moving heat source model and a multi abrasive model are established to simplify the condition of the grinding wheel contacting the workpiece. The comparison of material residual forces measured by X-ray diffraction measurements shows that the finite element analysis model proposed in this paper has good reliability. Finally, this model is used to analyze the effects of grinding wheel speed, workpiece speed, and grinding depth on the residual stress on the workpiece surface, and to understand the possible causes of residual stress during grinding.
Translation and Validation of Iranian Version of Nursing Professional Values Scale-3 (NPVS-3) among Nursing Students: A Psychometric Analysis
Authors: Talebian Fateme , Yaghoubi Tahere , Nia Hamid Sharif , Haghighat Sahar
Published: July 2023

Background
The development pillars of a profession’s identity are the values of that profession. It’s highly critical to recognize and honor those professional values in nursing since nurses are in the frontline of the health system. In order to validate the 28-item scale of nursing professional value (NPVS-3), it was executed among nursing students. To conduct a Persian translation and validation of the nursing professional values scale-3 (NPVS-3).
Method
A methodological design was performed using convenient sampling method with a 400-subject sample size. As prescribed by the World Health Organization protocol, the NPVS-3 was translated.
Results
Removing 3 items, the exploratory factor analysis revealed a 3-factor structure (profession, activity, care), respectively, with 25 remaining items for the NPVS-3. These 3 factors overall accounted for 24.48% of the total variance of the NPVS-3 in this sample. Regarding the findings of the confirmatory factor analysis, all the fitness indices were appropriate and the fitness of the model was confirmed. As surveying the convergent and divergent validity displayed, all 3 factors are of befitting convergent and divergent validity. McDonald's Omega(ꙍ), CR and Cronbach's alpha, 3 factors extracted from the 25-item NPVS-3 were greater than 0.7.
Conclusions
The current research findings reported that the validity and reliability of the 25-item version of the NPVS-3 has been verified. This scale can be utilized to measure the awareness about the values of the nursing profession and the adherence and compliance level among the nursing students.
Expression of inflammatory mediators in biofilm samples and clinical association in multiple sclerosis patients in remission – a pilot study of case series
Authors: Fehlhofer Jakob , Ries Jutta , Nickel Florian Tobias , Rothhammer Veit , Schwab Stefan , Kesting Marco , Buchbender Mayte
Published: July 2023

Background: Multiple sclerosis (MS) is a chronic inflammatory autoimmune disease of unknown etiology that affects the central nervous system and can lead to neurological impairment. Our aim was to determine whether MS patients also show inflammatory changes in the oral cavity more frequently than healthy individuals.
Material and Methods: We examined plaque samples for various mediators and their correlation with clinical findings. A study group (MS) and a control group were examined and compared. The plaque samples were analyzed for the expression of interleukins (IL-2, -6, -10), matrix metalloproteinases (MMP-7, MMP-9) and a surface antigen CD90 by quantitative real-time PCR. Clinical parameters examined were the Mombelli plaque index (MPI), bleeding on probing (BOP) index, gingival pocket depth (PD) and Decayed, missing and filled tooth (DMFT) index.
Results: The expression of MMP9 was significantly (p=0.035) higher in the control group. The expression of IL-2 was increased 4-fold in the MS group, but this difference was not statistically significant. The mean PD (p<0.001) and BOP index (p=0.029) were increased in the study group.
Conclusion: The clinical parameters of the BOP index and PD were significantly amplified in the MS patients. However, no causal relationship between the investigated inflammatory mediators and the clinical findings could be established in this case series.
The study was registered in the German clinical trial registry (DRKS00022956,registered 28/08/2020).
New perspectives on Australian hydroclimate and population dynamics during Last Glacial Maximum and terminal Pleistocene
Authors: Cadd Haidee , Williams Alan , Saktura Wanchese , Cohen Timothy , Mooney Scott , He Chengfei , Turney Chrisitan , Otto-Bliesner Bette
Published: July 2023

Long-standing interpretations of the Last Glacial Maximum (LGM; 21,000 ± 2,000 years ago) in Australia suggest that the period was one of extreme cold and aridity, during which the Indo-Australian summer monsoon (IASM) system collapsed, and human populations declined and retreated to ecological refuges to survive. Here, we use transient iTRACE simulations, combined with palaeoclimate proxy records and archaeological data to re-interpret the late LGM and terminal Pleistocene (21,000–11,000 yrs) in Australia. The models suggest climates during the peak LGM were cooler than present (-4 to -6°C), but there is no evidence of IASM collapse or substantial precipitation decreases in northern Australia. Kernel Density Estimates (KDE) of archaeological ages show relatively stable and persistent human activity across most regions throughout the late LGM and terminal Pleistocene, consistent with genetic evidence. Spatial coverage of archaeological sites steadily increased across the terminal Pleistocene; however population collapse is not evident.