bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for placental abruption
Authors: Nkwabong Elie , Tchomguie Moussi Olive Stella , Fouedjio Jeanne
Published: July 2022

Our case-control study, aiming at identifying the risk factors for placental abruption (PA), looked at variables including maternal age, daily transportation means, folic acid consumption, smoking, past-history of infertility, number of antenatal visits done, presence of pre-eclampsia and umbilical cord insertion. Significant risk factors for PA were frequent transportation by motorbikes, consumption of haematinic preparation not containing folic acid, passive smoking, past-history of infertility, pre-eclampsia and marginal cord insertion. Pregnant women should be counselled about the above-mentioned risk factors.
Conspiratorial Narratives on Facebook and Their Historical Contextual Associations: A Case Study from Cyprus
Authors: Kouros Theodoros , Papa Venetia , Ioannou Maria , Kapnisis Vyronas
Published: July 2022

Conspiracy theories and their effects have greatly proliferated during the COVID-19 pandemic crisis. As in various countries, so in Cyprus, a mobilization of anti-vaxxers organized mainly through Facebook, violently attacked the largest media group of the island, “Sigma”. Taking into consideration local peculiarities and historical contexts, a qualitative research was conducted on comments posted on Sigma Live's Facebook page, spanning between August 2020 and June 2021.The article illustrates how cultural, political, and historical peculiarities are instrumental in the formation of anti-vax movements, and how conspiracy theorizing in general is inextricably bound to such peculiarities. We demonstrate how new publics in social media platforms may dispute media outlets’ representations through using the official channels of these outlets, highlighting an understudied facet of participatory media. The paper advocates for more context-bound theoretical analyses of conspiracy theorizing, which delve deeper into the meaning-making, interpretative, and discursive practices of conspiracists against media outlets.
Changes in liver enzymes and association with prognosis in patients with COVID-19: a retrospective case–control study
Authors: Shaveisi-Zadeh Farhad , Nikkho Bahram , Khadem Erfan Mohamaad Bagher , Amiri Amir , Azizi Ali , Mansouri Nasrin , Tarlan Mitra , Rostami-Far Zahra
Published: July 2022

Objective

COVID-19 has recently emerged as a serious threat to global health. This study examined the laboratory investigations of patients with COVID-19, with an emphasis on liver enzymes.

Methods

This retrospective, single-center study was performed on patients with COVID-19 who were admitted to Imam Reza Hospital, Iran from March 2020 to February 2021. Laboratory tests included a complete blood cell count, white blood cell (WBC) count, neutrophil/lymphocyte ratio (NLR), platelet/lymphocyte ratio (PLR), lymphocyte/monocyte ratio, and levels of aspartate aminotransferase, alanine aminotransferase (ALT), and alkaline phosphatase. Patient survival was among the outcome measures investigated in association with laboratory findings.

Results

We enrolled 77 patients with COVID-19 and 63 healthy controls. In comparison with the control group, patients with COVID-19 showed COVID-19 increased ALT, WBC, neutrophils, NLR, and PLR, and decreased platelet counts and lymphocytes.

Conclusion

Although elevated levels of AST, NLR, PLR, and LMR were found in patients with COVID-19, they were not linked to mortality. Given the presence of AST in other tissues, the influence of SARS-CoV-2 on the liver should be interpreted with caution.
Outcomes of complex discharge planning in older adults with complex needs: a scoping review
Authors: Rameli Puteri Maisarah , Rajendran Nithya
Published: July 2022

In this scoping review, we aimed to evaluate the effectiveness of integrated multidisciplinary team discharge planning and identify common outcomes among older adults with complex needs, focusing on a safe transition from the hospital to the community. We performed a literature search for relevant articles using seven electronic databases and agreed search terms. Only articles published in English were included. In total, 23,772 articles were identified, with 27 articles meeting the inclusion criteria. A preponderance of patients aged ≥65 years and women was inferred based on population demographics. Initiatives on complex discharge planning were noted across most Western countries. Common outcomes of complex discharge planning were functionality (n = 11) including frailty (n = 4), quality of life (n = 11), and patient-centered factors including psychosocial needs (n = 9). Various outcomes from complex discharge planning initiatives and pathways were explored in this scoping review. None of the selected studies covered all nine domains of outcome assessment. Further research is needed involving follow-up studies after complex discharge planning interventions to assess their true effectiveness or value.
Assessment of serum dipeptidyl peptidase-IV levels in autoimmune thyroid disease
Authors: Zhang Yuanyuan , Fu Ying , Yang Yuxian , Ke Jing , Zhao Dong
Published: July 2022

Objective

Decreased serum dipeptidyl peptidase-IV (sDPPIV) levels have been reported in patients with autoimmune diseases. However, few studies have analyzed the association between sDPPIV levels and autoimmune thyroid disease (AITD). This study aimed to evaluate the association between sDPPIV levels and three types of AITD: Graves’ disease (GD), Graves’ ophthalmopathy (GO), and Hashimoto’s thyroiditis (HT).

Methods

Patients newly diagnosed with GD (n = 65), GO (n = 22), and HT (n = 27) and healthy individuals (n = 30) were recruited. Clinical characteristics and thyroid function data were collected. sDPPIV was measured using enzyme-linked immunosorbent assays.

Results

Compared with controls (786.3 ± 46.95), patients with GD and GO had significantly lower sDPPIV levels (662.2 ± 38.81 and 438.4 ± 31.78). Additionally, sDPPIV levels were negatively associated with antithyroid peroxidase antibody (r = −0.20) and antithyroglobulin antibody (r = −0.19), but there was no significant relationship between thyroid hormone and sDPPIV levels. GO cases were divided by proptosis with and without muscle thickening; sDPPIV levels were lower in the muscle thickening group than those in the without muscle thickening group. Logistic regression analysis showed that sDPPIV was negatively correlated with GO and GD.

Conclusions

sDPPIV concentrations were abnormal in patients with GD and GO, and reduced sDPPIV expression may be involved in the progression of GO and GD.
Left ventricular venting in veno-arterial extracorporeal membrane oxygenation: A computer simulation study
Authors: Jelenc Matija , Jelenc Blaž , Novak Robert , Poglajen Gregor
Published: July 2022

Introduction:

Veno-arterial extracorporeal membrane oxygenation (V-A ECMO) is the fastest way to restore circulation in refractory cardiogenic shock, however it cannot unload the failing left ventricle. There is a lack of consensus regarding optimal approach to left ventricular venting in V-A ECMO patients with severely depressed or absent left ventricular function.

Methods:

A computer model was developed in Matlab Simulink R20016b (MathWorks, Inc., Natick, MA, USA) to analyze different venting options as well as atrial septostomy in the setting of cardiogenic shock and V-A ECMO.

Results:

The model has shown an inverse linear relationship between left atrial pressure and either vent, Impella or atrial septum defect flow rate. The minimum vent flow required to prevent pulmonary edema in complete loss of left ventricular function needed to be higher than the bronchial blood flow. Atrial septostomy restored normal pulmonary blood flow with low left atrial pressure but induced stasis in the left ventricle. Venting the pulmonary artery induced stasis in the entire pulmonary circulation as well as left atrium and left ventricle. Venting the left ventricle directly with a cannula or Impella device avoided blood stasis.

Conclusion:

Our data suggest that reduction of left atrial pressure is linearly related to the vent, Impella or atrial septal defect flow rate. The preferred vent location is the left ventricle as it avoids stasis in the pulmonary circulation and cardiac chambers.
I never promised you a rose garden.… When landscape architecture becomes a laboratory for the Anthropocene
Authors: Steiner Henriette
Published: July 2022

In the summer of 2017, wildflower seeds were spread on a large, empty open space close to a motorway flyover just outside Copenhagen, Denmark. This was an effort to use non-mechanical methods to prepare the soil for an ‘urban forest’ to be established on the site, since the flowers’ roots would penetrate the ground and enable the planned new trees to settle. As a result, the site was transformed into a gorgeous meadow, and all summer long Copenhageners were invited to come and pick the flowers. In this article, I critically examine different aspects of this project – including the role of design, the perception of nature–culture relationships, climate change, and flower-picking as an event – in relation to my personal experience of visiting this meadow both on-site and on social media. The different temporalities that clash at the site give rise to conflicting interpretations, and I suggest that the meadow can be seen as a living plant archive of the Anthropocene, both physically and digitally. In doing so, I introduce and critique key conceptual pairs, including archive/death and bloom/decay, suggested by Lee Edelman’s queer cross-reading of Jacques Derrida’s ‘Archive Fever’ and Shakespeare’s Hamlet. I thereby contrast flower motifs pertaining to the cycles of blooming, decay, and nature’s (failed) eternal return in the meadow with the expansive futurity of the digitally mediated archive.
Event-triggered fuzzy control for vehicle nonlinear suspension systems with time delay
Authors: Jia Junru , Zhang Xinge , Zheng Liming , Zhang Zhen
Published: July 2022

This article investigates the adaptive event-triggered fuzzy control problem for vehicle suspension systems with nonlinear characteristics and time delay. First, to describe the vehicle suspension system with nonlinear components, a Takagi-Sugeno fuzzy suspension model is established via local linear regression method. Second, considering that the communication bandwidth is limited, an adaptive event-triggered strategy is employed to acquire a higher efficiency in terms of saving the transmission resource. Third, based on a time-delay principle and Lyapunov stability theory, a co-design method is proposed to obtain the event generator and the fuzzy controller simultaneously. The proposed event-triggered fuzzy control method is effective to improve performances of the suspension system and guarantee the limits of suspension travel and tire deflection. Finally, compared with the existing method, the effectiveness of the proposed method is verified by simulation tests with various road disturbances.
Process optimisation for enzymatic clarification of indigenous wild watermelon (Citrullus lanatus) juice
Authors: Mamabolo Moselo Maureen , Tabit Frederick Tawi
Published: July 2022

A fundamental step in improving the quality and consumer acceptability of wild watermelon ( Citrullus lanatus) is the process of juice clarification. The aim of this research was to investigate the physicochemical properties of crude wild watermelon ( Citrullus lanatus) juice and to optimise the processing conditions, incubation time, incubation temperature and enzyme concentration for the enzymatic clarification of the crude juice. Crude wild watermelon juice samples were treated with pectinase enzyme in different concentrations (0.05 to 0.15 w/w%), at different incubation temperatures (30–50 oC) and for different incubation durations (60–180 min). The effects of the different treatments on turbidity, clarity, viscosity, lightness, and brix were determined. The response models adequately predicted turbidity, clarity, and viscosity at R2 > 0.5, but not lightness considering that R2 < 0.5. The model was statistically significant in predicting turbidity (R2 = 0.86), clarity (R2 = 0.81), viscosity (R2 = 0.97) and brix (R2 = 0.94) – but not lightness (R2 = 0.24) at p < 0.05. The enzyme concentration did not significantly affect turbidity, clarity, and lightness, but it did significantly affect brix positively (p < 0.05). Response surface methodology software was used to determine optimal clarification conditions. In conclusion, the optimum conditions for crude watermelon juice clarification were 0.15 w/w% enzyme concentration, 60 min incubation time and 60 oC incubation temperature. The optimum output parameters were 14.18 NTU for turbidity, 0.04 Abs for clarity, 52.30 L* value for lightness, 1.96 cps for viscosity and 3.08% for Brix.
Impact of cultural proximity on destination image and tourists’ perceptions: The case of the Portuguese cultural festival Lusofonia in Macao
Authors: Xu Ye
Published: July 2022

Festivals showcase cultural heritage, popularise travel destinations, and generate economic benefits. Additionally, studies have shown that participating in the festivals of a destination whose culture is proximate to their own helps tourists resonate with the destination better. Thus, this study investigates the impact of cultural proximity on destination image and tourists’ festival perception. It also examines the mediating roles of festival perception and cognitive destination image. Lusofonia festival, an annual Portuguese cultural festival of Macao, was chosen for the questionnaire-based data collection. I employed factor and correlations analyses and tested the hypotheses using structural equation modelling. The results consolidated the relationship between cognitive destination image and affective image, provided insight into the role of cultural events in enhancing destination image, and identified the attributes of parity in terms of home-destination culture that steer festival perception and cognitive destination image positively. The study indicates that tourism managers should align destination branding with tourists’ expectations and experiences.
The day program multiple: Noncoherence and ontological politics
Authors: Symonds-Brown Holly , Ceci Christine
Published: July 2022

Globally, day programs are increasingly proposed in policy as one way to address the support needs of people living at home with dementia and their families. Day programs represent a kind of space that can meet multiple interests and ideologies concerned with sustaining care at home for people living with dementia. In this paper, we draw on findings from an ethnographic study of how day programs work as care in the community for people living with dementia to argue that day programs’ ontological status in research as a “simple location” of care contributes to the ambiguous outcomes and limited evidence available for improving their design and delivery. Using one program as an illustrative case, we demonstrate the multiplicity of a day program and the ontological politics through which the potentialities for care emerge. Robert Cooper’s proximal analysis of organizing’s and Annemarie Mol’s work on ontological politics inform this analysis. Of note in this analysis are the different enactments of a day program and their modes of coordination. We show when these enactments hang together well and when they do not and consider the effects of these politics for care. Of particular concern is how some versions of a day program are easily displaced by the interests of administrative versions and managerial logics. We argue for approaches to research and planning that acknowledge the “day program multiple” and precarious nature of care.
Isatuximab in the Treatment of Multiple Myeloma: A Review and Comparison With Daratumumab
Authors: Shen Fei , Shen Weidong
Published: July 2022

Multiple myeloma (MM) is a hematologic malignancy characterized by the proliferation of clonal plasma cells. Although advances in treatment have markedly improved survival outcomes for patients with MM, this disease is still considered incurable owing to its high incidence of relapse and refractoriness. Isatuximab is an anti-CD38 monoclonal antibody that can induce apoptosis in myeloma cells through a variety of mechanisms. Many clinical studies have demonstrated the efficacy and efficiency of isatuximab in both relapsed/refractory multiple myeloma (RRMM) and newly diagnosed multiple myeloma, leading to its approval for the treatment of adults with RRMM in combination therapies. In this review, the structure, mechanisms of action, pharmacokinetics, pharmacogenetics, and safety profile of isatuximab in MM are summarized. Additionally, isatuximab is compared with daratumumab in terms of mechanism and efficacy.
A Comparative Study of the Right and Left Carotid Arteries in Relation to Age for Patients With Diabetes and Hypertension
Authors: Al-Sabbagh Ahmed Abduljabar , Essa Samar I. , Saleh Anmar Z
Published: July 2022

Introduction:

Age, hypertension, and diabetes can cause significant alterations in arterial structure and function, including changes in lumen diameter (LD), intimal-medial thickness (IMT), flow velocities, and arterial compliance. These are also considered risk markers of atherosclerosis and cerebrovascular disease. A difference between right and left carotid artery blood flow and IMT has been reported by some researchers, and a difference in the incidence of nonlacunar stroke has been reported between the right and left brain hemispheres. The aim of this study was to determine whether there are differences between the right and left common carotid arteries and internal carotid arteries in patients with hypertension and diabetes for 2 age groups.

Methods:

We studied 250 patients with both diabetes and hypertension. Patients were divided into 2 age groups with the old age group being 56 to 75 years and the young age group 35 to 55 years. The bilateral common carotid and internal carotid arteries were evaluated with B-mode ultrasound and Doppler examinations. The LD and IMT were measured for both common carotid arteries, and spectral waveform parameters and indices were recorded for both internal carotid arteries.

Results:

The difference in LD between the left and right common carotid arteries for the old age group was 11.64% and for the young age group was 6.42%, with significant P values of <.05 for both age groups. The difference in IMT between the left and right common carotid arteries was 18.27% in the old age group compared with 15.38% in the young age group, with significant P values of <.05. There was a difference in peak systolic velocity between the left and right internal carotid arteries of 4.85% in the old age group which was not significant, compared with 14.28% in the young age group with a significant P value <.05, whereas the difference in end-diastolic velocity between the left and right internal carotid arteries was not significant for both age groups. Differences between the right and left internal carotid arteries for resistive index, pulsatility index, and pressure gradient were significant only in the young age group.

Conclusion:

We found significant differences between the right and left common carotid and internal carotid arteries in patients with diabetes and hypertension which were more prominent in the young age group. Values for common carotid IMT and LD were significantly higher in the left common carotid artery versus the right common carotid artery in both age groups. Differences between the 2 carotid sides may be attributed to anatomic variations in the common carotid artery origins which lead to differences in stress between the 2 sides.
Vibration signal modeling of planetary gearbox based on dynamics and finite element method for tooth crack diagnosis
Authors: Hu Jiao , Hu Niaoqing , Zhang Lun , Yang Yi , Luo Peng
Published: July 2022

Planetary gear set contains many kinds of nonlinear factors, such as time-varying meshing stiffness, bearing support, backlash, and comprehensive transmission error, which will deeply affect the gearbox response behaviors and vibration characteristics. During the operation of planetary gear set, there are several gear pairs meshing simultaneously, which will lead to multiple vibration sources and complicate vibration transmission. The revolution of the planet gears makes the meshing force of the gear pairs vary periodically, and the continuous motion of the meshing point also changes the length of vibration transmission path. This study aims to establish a hybrid model that can simulate the vibration signals of gearbox measuring points through fusing the dynamic model of planetary gear set and the transmission path model. Through the simulation analysis, the vibration characteristics of the measuring point signal of the planetary gearbox are revealed, and the crack fault of the planet gear tooth is effectively isolated. Finally, the availability and validity of the presented model are experimentally verified, and the magnitude match is up to 78%. The model can not only provide a theoretical basis for data-driven fault diagnosis methods, but also solve the pain point of diagnostic samples scale and balance by simulation means.
Feeling fixes: Mess and emotion in algorithmic audits
Authors: Keyes Os , Austin Jeanie
Published: July 2022

Efforts to address algorithmic harms have gathered particular steam over the last few years. One area of proposed opportunity is the notion of an “algorithmic audit,” specifically an “internal audit,” a process in which a system’s developers evaluate its construction and likely consequences. These processes are broadly endorsed in theory—but how do they work in practice? In this paper, we conduct not only an audit but an autoethnography of our experiences doing so. Exploring the history and legacy of a facial recognition dataset, we find paradigmatic examples of algorithmic injustices. But we also find that the process of discovery is interwoven with questions of affect and infrastructural brittleness that internal audit processes fail to articulate. For auditing to not only address existing harms but avoid producing new ones in turn, we argue that these processes must attend to the “mess” of engaging with algorithmic systems in practice. Doing so not only reduces the risks of audit processes but—through a more nuanced consideration of the emotive parts of that mess—may enhance the benefits of a form of governance premised entirely on altering future practices.
Patient Age and Surgical Intervention as Risk Factors for the Development of Osteoarthritis After Posterior Shoulder Instability: A Population-Based Study
Authors: Till Sara E. , Reinholz Anna K. , Lee Julia , Woodmass Jarret M. , Wu Isabella T. , Keyt Lucas K. , Krych Aaron J. , Dahm Diane L. , Camp Christopher L.
Published: July 2022

Background:

Diagnosis and treatment of posterior shoulder instability (PSI) has improved with advances in imaging and surgical technique. However, the relationship between PSI and osteoarthritis (OA) remains unclear.

Purpose:

To evaluate a population-based cohort to (1) determine the rate of symptomatic OA, (2) identify patient characteristic risk factors for OA, and (3) evaluate the effect of posterior capsulolabral repair on OA progression.

Study Design:

Case-control study; Level of evidence, 3.

Methods:

After review of 324 patient records, we included 115 patients (14 female, 101 male) diagnosed with PSI between January 1994 and July 2012 with an average follow-up of 12.5 years (range, 5-23 years). Medical records were reviewed for patient characteristics, injury characteristics, surgical details (if any), and radiographic progression of OA. Kaplan-Meier survival was used to estimate survival free of OA; characteristics associated with OA progression were determined via univariate Cox regression models, and associated 95% CIs and hazard ratios (HRs) are presented.

Results:

Overall, 14% (16/115) of patients had radiographic progression of symptomatic glenohumeral arthritis, with 5-year survival of 88.3% (95% CI, 79.7%-97.3%). Older age at the time of instability diagnosis was associated with arthritis progression (10-year unit HR, 1.95; 95% CI, 1.26-3.03). Patients who underwent surgery demonstrated increased radiographic progression of OA (HR, 4.03; 95% CI, 1.23-13.23). There was a trend of increased OA in patients treated with labral debridement compared with repair despite lower baseline levels of OA; however, this difference was not statistically significant ( P = .09).

Conclusion:

Symptomatic glenohumeral arthritis is not seen routinely in patients with PSI. Although uncommon, an age of at least 30 years at the time of diagnosis and surgical intervention were identified as risk factors for developing symptomatic arthritis at long-term follow-up.
A biomedical event extraction method based on fine-grained and attention mechanism
Authors: He Xinyu , Tai Ping , Lu Hongbin , Huang Xin , Ren Yonggong
Published: July 2022

Background

Biomedical event extraction is a fundamental task in biomedical text mining, which provides inspiration for medicine research and disease prevention. Biomedical events include simple events and complex events. Existing biomedical event extraction methods usually deal with simple events and complex events uniformly, and the performance of complex event extraction is relatively low.

Results

In this paper, we propose a fine-grained Bidirectional Long Short Term Memory method for biomedical event extraction, which designs different argument detection models for simple and complex events respectively. In addition, multi-level attention is designed to improve the performance of complex event extraction, and sentence embeddings are integrated to obtain sentence level information which can resolve the ambiguities for some types of events. Our method achieves state-of-the-art performance on the commonly used dataset Multi-Level Event Extraction.

Conclusions

The sentence embeddings enrich the global sentence-level information. The fine-grained argument detection model improves the performance of complex biomedical event extraction. Furthermore, the multi-level attention mechanism enhances the interactions among relevant arguments. The experimental results demonstrate the effectiveness of the proposed method for biomedical event extraction.
Foliar application of procyanidins enhanced the biosynthesis of 2-acetyl-1-pyrroline in aromatic rice (Oryza sativa L.)
Authors: Luo Haowen , Duan Meiyang , Xing Pipeng , Xie Huifang , Tang Xiangru
Published: July 2022

Background

Procyanidins is a polyphenolic compound with multiple properties. However, the application of exogenous procyanidins in crops has not been reported. Aromatic rice is a high-quality rice with a special aroma and popular with consumers. The 2-acetyl-1-pyrroline (2-AP) is a key compound of aromatic rice aroma. In the current study, aromatic rice plants were sprayed with procyanidins solutions at 0.25 (Pr0.25), 0.50 (Pr0.50), 1.00 (Pr1.00), 2.00 (Pr2.00) g L−1, respectively and treatment sprayed with distilled water was taken as control (CK). The effects of exogenous procyanidins on growth and 2-AP biosynthesis of aromatic rice plants were explored.

Results

Compared with CK, Pr1.00 and Pr2.00 treatments significantly increased 2-AP content by 16.67% and 37.68%, respectively. Higher proline, 1-pyrroline-5-carboxylic acid (P5C), 1-pyrroline, methylglyoxal contents, and lower γ- aminobutyric acid (GABA) content were recorded in Pr1.00 and Pr2.00 treatments than CK. Compared with CK, Pr1.00 and Pr2.00 treatments significantly improved the activities of P5CS and OAT and diminished the activity of BADH. Furthermore, compared with CK, Pr1.00 and Pr2.00 treatments significantly up-regulated the transcript levels of P5CS2, P5CR, OAT, DAO4 and down-regulated the transcript levels of BADH2. Exogenous procyanidins had no substantial effects on plant height, stem diameter, fresh weight, and dry weight of aromatic rice plants.

Conclusions

In conclusion, our findings reported the increment of 2-AP content in aromatic rice under exogenous procyanidins. Our results indicated that the application of exogenous procyanidins enhanced 2-AP biosynthesis by improving proline biosynthesis and inhibiting GABA formation.
Surgical treatment of patients with infective endocarditis: changes in temporal use, patient characteristics, and mortality—a nationwide study
Authors: Jensen Andreas Dalsgaard , Østergaard Lauge , Petersen Jeppe K. , Graversen Peter , Butt Jawad H. , Bundgaard Henning , Moser Claus , Smerup Morten H. , Modrau Ivy S. , Iversen Kasper , Bruun Niels E. , Torp-Pedersen Christian , Gislason Gunnar , Wang Andrew , Ragnarsson Sigurdur , Povlsen Jonas A. , Køber Lars , Fosbøl Emil L.
Published: July 2022

Background

Valve surgery guidelines for infective endocarditis (IE) are unchanged over decades and nationwide data about the use of valve surgery do not exist.

Methods

We included patients with first-time IE (1999–2018) using Danish nationwide registries. Proportions of valve surgery were reported for calendar periods (1999–2003, 2004–2008, 2009–2013, 2014–2018). Comparing calendar periods in multivariable analyses, we computed likelihoods of valve surgery with logistic regression and rates of 30 day postoperative mortality with Cox regression.

Results

We included 8804 patients with first-time IE; 1981 (22.5%) underwent surgery during admission, decreasing by calendar periods (N = 360 [24.4%], N = 483 [24.0%], N = 553 [23.5%], N = 585 [19.7%], P = < 0.001 for trend). For patients undergoing valve surgery, median age increased from 59.7 to 66.9 years (P ≤ 0.001) and the proportion of males increased from 67.8% to 72.6% (P = 0.008) from 1999–2003 to 2014–2018. Compared with 1999–2003, associated likelihoods of valve surgery were: Odds ratio (OR) = 1.14 (95% CI: 0.96–1.35), OR = 1.20 (95% CI: 1.02–1.42), and OR = 1.10 (95% CI: 0.93–1.29) in 2004–2008, 2009–2013, and 2014–2018, respectively. 30 day postoperative mortalities were: 12.7%, 12.8%, 6.9%, and 9.7% by calendar periods. Compared with 1999–2003, associated mortality rates were: Hazard ratio (HR) = 0.96 (95% CI: 0.65–1.41), HR = 0.43 (95% CI: 0.28–0.67), and HR = 0.55 (95% CI 0.37–0.83) in 2004–2008, 2009–2013, and 2014–2018, respectively.

Conclusions

On a nationwide scale, 22.5% of patients with IE underwent valve surgery. Patient characteristics changed considerably and use of valve surgery decreased over time. The adjusted likelihood of valve surgery was similar between calendar periods with a trend towards an increase while rates of 30 day postoperative mortality decreased.
Clinical features of patients with septic shock-triggered Takotsubo syndrome: a single-center 7 case series
Authors: Jing Chengqiao , Wang Yan , Kang Chunmiao , Dong Daoran , Zong Yuan
Published: July 2022

Background

Myocardial dysfunction is common in septic shock and has long been recognized. Takotsubo syndrome is an acute and usually reversible myocardial injury without evidence of an obstructive coronary artery disease, yet little is known about this syndrome in septic shock patients.

Case presentation

Among 84 septic shock patients admitted to the ICU over a period of 8 months, 7 patients (8.3%) were diagnosed with Takotsubo syndrome. The percentage of men was 71%, and the mean age was 58 (19–87) years. Sudden hemodynamic deterioration and/or dyspnea were the presenting symptoms in 6 patients. T-wave inversion was the major ECG anomaly in 5 patients. The mean left ventricular ejection fraction was 31.8% (20.0–53.0). Mild elevation of cardiac troponin disproportionate to the extent of regional wall motion abnormalities was present in all patients. Cardiac complications occurred in 6 patients. The mean time to recover the cardiac function was 6.5 (3–11) days. In-hospital death was observed in 2 patients.

Conclusions

Takotsubo syndrome is not uncommon in septic shock patients and may be the cause of some patients with sepsis-induced myocardial dysfunction. New-onset hemodynamic and respiratory worsening could arouse the suspicion of Takotsubo syndrome and prompt the screening for this syndrome using echocardiography in this clinical context.
Evaluating the impact of stay-at-home and quarantine measures on COVID-19 spread
Authors: Zhang Renquan , Wang Yu , Lv Zheng , Pei Sen
Published: July 2022

Background

During the early stage of the COVID-19 pandemic, many countries implemented non-pharmaceutical interventions (NPIs) to control the transmission of SARS-CoV-2, the causative pathogen of COVID-19. Among those NPIs, stay-at-home and quarantine measures were widely adopted and enforced. Understanding the effectiveness of stay-at-home and quarantine measures can inform decision-making and control planning during the ongoing COVID-19 pandemic and for future disease outbreaks.

Methods

In this study, we use mathematical models to evaluate the impact of stay-at-home and quarantine measures on COVID-19 spread in four cities that experienced large-scale outbreaks in the spring of 2020: Wuhan, New York, Milan, and London. We develop a susceptible-exposed-infected-removed (SEIR)-type model with components of self-isolation and quarantine and couple this disease transmission model with a data assimilation method. By calibrating the model to case data, we estimate key epidemiological parameters before lockdown in each city. We further examine the impact of stay-at-home and quarantine rates on COVID-19 spread after lockdown using counterfactual model simulations.

Results

Results indicate that self-isolation of susceptible population is necessary to contain the outbreak. At a given rate, self-isolation of susceptible population induced by stay-at-home orders is more effective than quarantine of SARS-CoV-2 contacts in reducing effective reproductive numbers $$R_e$$

R
e

. Variation in self-isolation and quarantine rates can also considerably affect the duration of outbreaks, attack rates and peak timing. We generate counterfactual simulations to estimate effectiveness of stay-at-home and quarantine measures. Without these two measures, the cumulative confirmed cases could be much higher than reported numbers within 40 days after lockdown in Wuhan, New York, Milan, and London.

Conclusions

Our findings underscore the essential role of stay-at-home orders and quarantine of SARS-CoV-2 contacts during the early phase of the pandemic.
Clinical features and 18F-FDG PET/CT for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients
Authors: Chen Donghe , Zhu Yunqi , Chen Yunbo , Zhu Danhua , Liu Zhengfeng , Li Tiancheng , Liu Yinuo , Zhao Kui , Su Xinhui , Li Lanjuan
Published: July 2022

Background

It is vital to distinguish between inflammatory and malignant lymphadenopathy in human immunodeficiency virus (HIV) infected individuals. The purpose of our study was to differentiate the variations in the clinical characteristics of HIV patients, and apply 18F-FDG PET/CT parameters for distinguishing of malignant lymphoma and inflammatory lymphadenopathy in such patients.

Methods

This retrospective cross-sectional study included 59 consecutive HIV-infected patients who underwent whole-body 18F-FDG PET/CT. Of these patients, 37 had biopsy-proven HIV-associated lymphoma, and 22 with HIV-associated inflammatory lymphadenopathy were used as controls. The determined parameters were the maximum of standard uptake value (SUVmax), SUVmax of only lymph nodes (SUVLN), the most FDG-avid lesion-to-liver SUVmax ratio (SURmax), laboratory examinations and demographics. The optimal cut-off of 18F-FDG PET/CT value was analyzed by receiver operating characteristic curve (ROC).

Results

Considering the clinical records, the Karnofsky Performance Status (KPS) scores in patients with inflammatory lymphadenopathy were obviously higher than those in patients with malignant lymphoma (P = 0.015), whereas lymphocyte counts and lactate dehydrogenase (LDH) were obviously lower (P = 0.014 and 0.010, respectively). For the 18F-FDG PET/CT imaging, extra-lymphatic lesions, especially digestive tract and Waldeyer’s ring, occurred more frequently in malignant lymphoma than inflammatory lymphadenopathy. Furthermore, the SURmax and SUVLN in malignant lymphoma were markedly higher than those in inflammatory lymphadenopathy (P = 0.000 and 0.000, respectively). The cut-off point of 3.1 for SURmax had higher specificity (91.9%) and relatively reasonable sensitivity (68.2%) and the cut-off point of 8.0 for the SUVLN had high specificity (89.2%) and relatively reasonable sensitivity (63.6%).

Conclusion

Our study identified the distinctive characteristics of the clinical manifestations, the SURmax, SUVLN and detectability of extra-lymphatic lesions on 18F-FDG PET, and thus provides a new basis for distinguishing of malignant lymphoma from inflammatory lymphadenopathy in HIV-infected patients.
Predicting coronary artery calcified plaques using perivascular fat CT radiomics features and clinical risk factors
Authors: Hu Guo-qing , Ge Ya-qiong , Hu Xiao-kun , Wei Wei
Published: July 2022

Objective

The purpose of this study was to develop a combined radiomics model to predict coronary plaque texture using perivascular fat CT radiomics features combined with clinical risk factors.

Methods

The data of 200 patients with coronary plaques were retrospectively analyzed and randomly divided into a training group and a validation group at a ratio of 7:3. In the training group, The best feature set was selected by using the maximum correlation minimum redundancy method and the least absolute shrinkage and selection operator. Radiomics models were built based on different machine learning algorithms. The clinical risk factors were then screened using univariate logistic regression analysis. and finally a combined radiomics model was developed using multivariate logistic regression analysis to combine the best performing radiomics model with clinical risk factors and validated in the validation group. The efficacy of the model was assessed by a receiver operating characteristic curve, the consistency of the nomogram was assessed using calibration curves, and the clinical usefulness of the nomogram was assessed using decision curve analysis.

Results

Twelve radiomics features were used by different machine learning algorithms to construct the radiomics model. Finally, the random forest algorithm built the best radiomics model in terms of efficacy, and this was combined with age to construct a combined radiomics model. The area under curve for the training and validation group were 0.98 (95% confidence interval, 0.95–1.00) and 0.97 (95% confidence interval, 0.92–1.00) with sensitivities of 0.92 and 0.86 and specificities of 0.99 and 1, respectively. The calibration curve demonstrated that the nomogram had good consistency, and the decision curve analysis demonstrated that the nomogram had high clinical utility.

Conclusions

The combined radiomics model established based on CT radiomics features and clinical risk factors has high value in predicting coronary artery calcified plaque and can provide a reference for clinical decision-making.
Safety and efficacy of low-dose rt-PA with tirofiban to treat acute non-cardiogenic stroke: a single-center randomized controlled study
Authors: Liang Zhigang , Zhang Junliang , Huang Shuangfeng , Yang Shaowan , Xu Luyao , Xiang Wei , Zhang Manman
Published: July 2022

Background and purpose

The recanalization rate after intravenous thrombolysis (IVT) is not enough and there is still the possibility of re-occlusion. We aim to investigate the effectiveness and safety of infusing tirofiban after IVT.

Methods

We performed a prospective controlled study of 60 patients with acute non-cardiogenic ischemic stroke who were hospitalized in Yantai Yuhuangding Hospital from January 2018 to December 2019. The patients were divided into 2 groups: those who received tirofiban for 24 h after IVT (rt-PA + T group) and those who did not receive postprocedural intravenous tirofiban (rt-PA group). The rt-PA + T group received low-dose rt-PA (0.6 mg/kg). The rt-PA group received standard dose rt-PA (0.9 mg/kg). The main outcome measure were safety, included the symptomatic intracranial hemorrhage (sICH), any ICH, severe systemic bleeding, and mortality. The secondary outcome measure is curative efficacy which were evaluated by the 7d-NIHSS score and functional outcomes at 90 days. During hospitalization, the deterioration of neurological function was recorded.

Results

All patients completed the follow-up with complete data, there were 30 patients in each of groups. The general characteristics between the two group patients had no statistically significant differences. Compared with the rt-PA + T group and the rt-PA group, in terms of safety, the rates of the sICH, severe systemic bleeding, and mortality in both groups were 0, and there was no statistically significant difference in the rates of any ICH between the two groups (10.0% vs. 3.3%, P = 0.306). In terms of efficacy, the rate of the early neurological deterioration events (END) was no statistical significance (0 vs. 6.6%, P = 0.246). There was no significant difference in the NIHSS score between the two groups before the IVT, and also at 24 h, however, the 7d-NIHSS score was lower in the rt-PA + T group compared with the rt-PA group (2.33 ± 1.85 vs. 4.80 ± 4.02, P = 0.004). At 90 days, 83.3% of patients in the rt-PA + T group had favorable functional outcomes compared with 60.0% of patients in the rt-PA group (P = 0.045).

Conclusions

Low-dose rt-PA combined with tirofiban in acute non-cardiogenic ischemic stroke did not increase the risk of ICH, and mortality, and it was associated with neurological improvement.

Trial Registration

The trial has been registered at the ChiCTR and identified as ChiCTR1800014666 (28/01/2018).
Women’s use of non-conventional herbal uterotonic in pregnancy and labour: evidence from birth attendants
Authors: Sumankuuro Joshua , Baatiema Leonard , Crockett Judith , Young Jeanine
Published: July 2022

Background

Over the years, governments and stakeholders have implemented various policies/programmes to improve maternal health outcomes in low-middle-income countries. In Ghana, Community Health Officers were trained as midwives to increase access to skilled maternal healthcare. The government subsequently banned traditional birth attendants from providing direct maternal healthcare in 2000. Despite these, there is an unprecedented utilisation of TBAs’ services, including herbal uterotonics. This has attempted to defeat stakeholders’ campaigns to improve maternal health outcomes. Thus, we explored and highlighted herbal uterotonic consumption in pregnancy and birth and the implications on maternal and newborn health outcomes in North-Western Ghana.

Methods

This was an exploratory qualitative study that investigated traditional birth attendants (n = 17) and healthcare providers' (n = 26) perspectives on the intake of herbal uterotonics in pregnancy and childbirth in rural Ghana, using in-depth interviews. A combination of convenience, purposive and snowball sampling procedures were employed in selecting participants.

Results

Findings were captured in two domains: (1) perceived rationale for herbal uterotonic intake, and (2) potential adverse impacts of herbal uterotonic intake in pregnancy and labour, and nine topics: (i) confidence in unskilled attendance at birth, (ii) cost and a shortage of essential medicines, (iii) herbal uterotonics as a remedy for obstetric problems, (iv) herbal uterotonics facilitate birth, (v) attraction of home birth for cultural reasons, (vi) affordability of herbal uterotonics, (vii) unintended consequences and adverse outcomes, (viii) risks using herbal uterotonics to manage fertility and (ix) risks using herbal uterotonics to facilitate home birth.

Conclusion

The findings have suggested that the intake of non-conventional herbal uterotonic is widespread in the study area, although the constituents of the herb are unknown. However, complex and multiple factors of healthcare cost, desire for homebirth, unawareness of the negative effects of such substances, perceived way of addressing obstetric problems and cultural undertones, among others, accounted for herbal uterotonics consumption. We also encourage research into the constituents of ‘mansugo’ and the potential benefits and adverse effects. We recommend qualitative studies involving previous users of this herbal uterotonic to inform policy and healthcare provision.
Patient, primary care provider, and stakeholder perspectives on mammography screening frequency: lessons learned from a qualitative study
Authors: Ro Vicky , Jones Tarsha , Silverman Thomas , McGuinness Julia E. , Guzman Ashlee , Amenta Jacquelyn , Kukafka Rita , Crew Katherine D.
Published: July 2022

Background

U.S. professional organizations have provided conflicting recommendations on annual vs. biennial mammography screening. Potential harms of more frequent screening include increased anxiety and costs of false positive results, including unnecessary breast biopsies and overdiagnosis.

Objective

To characterize current practices and beliefs surrounding mammography screening frequency and perspectives on using risk-based screening to inform screening intervals.

Design

Semi-structured interviews informed by the Consolidated Framework for Implementation Research (CFIR).

Participants

Patients, primary care providers (PCPs), third-party stakeholders (breast radiologists, radiology administrators, patient advocates).

Main measures

Qualitative data, with a codebook developed based upon prespecified implementation science constructs.

Key results

We interviewed 25 patients, 11 PCPs, and eight key stakeholders, including three radiologists, two radiology administrators, and three patient advocates. Most patients reported having annual mammograms, however, half believed having mammograms every two years was acceptable. Some women were worried early breast cancer would be missed if undergoing biennial screening. PCPs were equally split between recommending annual and biennial mammograms. Although PCPs were interested in using breast cancer risk models to inform screening decisions, concerns raised include time burden and lack of familiarity with breast cancer risk assessment tools. All breast radiologists believed patients should receive annual mammograms, while patient advocates and radiology administrators were split between annual vs. biennial. Radiologists were worried about missing breast cancer diagnoses when mammograms are not performed yearly. Patient advocates and radiology administrators were more open to biennial mammograms and utilizing risk-based screening.

Conclusions

Uncertainty remains across stakeholder groups regarding appropriate mammogram screening intervals. Radiologists recommend annual mammography, whereas patients and PCPs were evenly split between annual vs. biennial screening, although both favored annual screening among higher-risk women. Breast cancer risk assessment tools may help facilitate decisions about screening intervals, but face barriers to widespread implementation in the primary care setting. These results will inform future implementation strategies to adopt risk-stratified breast cancer screening.