bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of vitamin status; A, E and D in Egyptian neonates with IUGR: a cross sectional study
Authors: Abdallah Hanaa Reyad , Abdelrazek Abderahman A. , Youness Eman Refaat , Orban Hisham A. , Mahmoud Marwa A. , El Sayed Ahmed Helal , Zaki Moushira
Published: February 2024

Background

Neonates with intrauterine growth retardation (IUGR) may present with fatal complications and permanent serious consequences. Vitamin status may influence fetal development. In this study we assessed vitamin A, E and D concentrations in umbilical cord blood in newborns with IUGR.

Methods

Maternal data were obtained. Neonatal assessment included; age of gestation calculated from last menstrual period, Ultrasound (U/S), new Ballard, Apgar scores and anthropometric measurements including; Head circumference, length and weight. WHO growth percentile curves were used. Vitamin A, E and D in cord blood samples were measured by high performance liquid chromatography (HPLC) and ELISA consecutively.

Results

A total of 86 full term newborns were enrolled in this study, 42 (48.8%) with IUGR with gestational age (33.59 ± 1.20) week by U/S and 44 (51.2%) appropriate for gestational age neonates with gestational age (38.70 ± 1.50). Ballard and Apgar scores (p < 0.05) and Z scores for weight, length and head circumference (p < 0.001) at birth were significantly lower in neonates with Intrauterine growth retardation (IUGR) than appropriate for gestational age (AGA) neonates. The levels of Vitamin A, E and D were significantly lower in the IUGR group than the AGA (p < 0.05) for all. Significant positive correlations of weight with vitamin A, and E cord blood levels were found (p < 0.05), while length was significantly positively correlated only with vitamin A (p < 0.05). Head circumference showed significant positive correlations with the three vitamins (p < 0.05) for all.

Conclusion

Neonates with IUGR had significantly lower levels of Vitamin A, E and D than AGA neonates. Significant positive correlations of weight with vitamin A, and E cord blood levels was detected, while neonatal length was associated only with vitamin A level. The present study highlights the significance of nutritional policies for inhibiting deficiency of these vitamins during pregnancy and childhood.
Machine learning-based decision support system for orthognathic diagnosis and treatment planning
Authors: Du Wen , Bi Wenjun , Liu Yao , Zhu Zhaokun , Tai Yue , Luo En
Published: February 2024

Background

Dento-maxillofacial deformities are common problems. Orthodontic–orthognathic surgery is the primary treatment but accurate diagnosis and careful surgical planning are essential for optimum outcomes. This study aimed to establish and verify a machine learning–based decision support system for treatment of dento-maxillofacial malformations.

Methods

Patients (n = 574) with dento-maxillofacial deformities undergoing spiral CT during January 2015 to August 2020 were enrolled to train diagnostic models based on five different machine learning algorithms; the diagnostic performances were compared with expert diagnoses. Accuracy, sensitivity, specificity, and area under the curve (AUC) were calculated. The adaptive artificial bee colony algorithm was employed to formulate the orthognathic surgical plan, and subsequently evaluated by maxillofacial surgeons in a cohort of 50 patients. The objective evaluation included the difference in bone position between the artificial intelligence (AI) generated and actual surgical plans for the patient, along with discrepancies in postoperative cephalometric analysis outcomes.

Results

The binary relevance extreme gradient boosting model performed best, with diagnostic success rates > 90% for six different kinds of dento-maxillofacial deformities; the exception was maxillary overdevelopment (89.27%). AUC was > 0.88 for all diagnostic types. Median score for the surgical plans was 9, and was improved after human–computer interaction. There was no statistically significant difference between the actual and AI- groups.

Conclusions

Machine learning algorithms are effective for diagnosis and surgical planning of dento-maxillofacial deformities and help improve diagnostic efficiency, especially in lower medical centers.
Preparing healthcare facilities in sub-Saharan Africa for future outbreaks: insights from a multi-country digital self-assessment of COVID-19 preparedness
Authors: Gómez-Pérez Gloria P. , de Graaff Aafke E. , Dekker John T. , Agyei Bonifacia B. , Dada Ibironke , Milimo Emmanuel , Ommeh Marilyn S. , Risha Peter , Rinke de Wit Tobias F. , Spieker Nicole
Published: February 2024

Background

Despite previous experience with epidemics, African healthcare systems were inadequately prepared and substantially impacted by the coronavirus disease 2019 (COVID-19) pandemic. Limited information about the level of COVID-19 preparedness of healthcare facilities in Africa hampers policy decision-making to fight future outbreaks in the region, while maintaining essential healthcare services running.

Methods

Between May–November 2020, we performed a survey study with SafeCare4Covid − a free digital self-assessment application − to evaluate the COVID-19 preparedness of healthcare facilities in Africa following World Health Organization guidelines. The tool assessed (i) COVID-19-related capabilities with 31 questions; and (ii) availability of essential medical supplies with a 23-supplies checklist. Tailored quality improvement plans were provided after assessments. Information about facilities’ location, type, and ownership was also collected.

Results

Four hundred seventy-one facilities in 11 African countries completed the capability assessment; 412 also completed the supplies checklist. The average capability score on a scale of 0–100 (n=471) was 58.0 (interquartile range 40.0–76.0), and the average supplies score (n=412) was 61.6 (39.0–83.0). Both scores were significantly lower in rural (capability score, mean 53.6 [95%CI:50.3–57.0]/supplies score, 59.1 [55.5–62.8]) versus urban facilities (capability score, 65.2 [61.7–68.7]/supplies score, 70.7 [67.2–74.1]) (P<0.0001 for both comparisons). Likewise, lower scores were found for public versus private clinics, and for primary healthcare centres versus hospitals. Guidelines for triage and isolation, clinical management of COVID-19, staff mental support, and contact tracing forms were largely missing. Handwashing stations were partially equipped in 33% of facilities. The most missing medical supply was COVID-19 specimen collection material (71%), while 43% of facilities did not have N95/FFP2 respirators and 19% lacked medical masks.

Conclusions

A large proportion of public and private African facilities providing basic healthcare in rural areas, lacked fundamental COVID-19-related capabilities and life-saving personal protective equipment. Decentralization of epidemic preparedness efforts in these settings is warranted to protect healthcare workers and patients alike in future epidemics. Digital tools are of great value to timely measure and improve epidemic preparedness of healthcare facilities, inform decision-making, create a more stakeholder-broad approach and increase health-system resilience for future disease outbreaks.
P80 natural essence spray and lozenges provide respiratory protection against Influenza A, B, and SARS-CoV-2
Authors: Zaderer Viktoria , Diem Gabriel , Posch Wilfried , Jakschitz Thomas , Bonn Günther K. , Bellmann-Weiler Rosa , Huber Lukas A. , Wilflingseder Doris
Published: February 2024

Seasonally circulating viruses, such as Influenza, as well as newly emerging viruses and variants thereof, and waning immunity urge the need for safe, easy-to-use and inexpensive drugs to protect from these challenges. To prevent transmission of these viruses and subsequent excessive inflammatory reactions on mucous membranes, we tested the efficacy of the natural essence P80 as spray and in form of lozenges against respiratory infections caused by SARS-CoV-2 variants of concern (VoCs), influenza A (H3N2) and influenza B (Victoria). P80 natural essence, a Dimocarpus longan extract, shielded highly differentiated human airway epithelia from SARS-CoV-2 wildtype and Omicron variant as well as Influenza A and B infection and dampened inflammation by down-modulating pro-inflammatory cytokine and anaphylatoxin secretion. A single application of P80 natural essence spray maintained tissue integrity long-term. This also significantly reduced the release of infectious viral particles and the secretion of IP10, MCP1, RANTES and C3a, all of which mediate the migration of immune cells to the sites of infection. Even P80 lozenges dissolved in distilled water or non-neutralizing saliva efficiently prevented SARS-CoV-2 and Influenza-induced tissue destruction. Consequently, our in vitro data suggest that P80 natural essence can act as antiviral prophylactic, both in form of nasal or oral spray and in form of lozenges, independent of circulating respiratory challenges.
Ethnobotanical study of traditional medicinal plants used by the local Gamo people in Boreda Abaya District, Gamo Zone, southern Ethiopia
Authors: Zemede Juhar , Mekuria Tegenu , Ochieng Clintone Onyango , Onjalalaina Guy Eric , Hu Guang-Wan
Published: February 2024

Background

Medicinal plants have been used for centuries and are still relied upon by over 80% of the Ethiopian population. The people of Gamo, southern Ethiopia, have a rich cultural and traditional lifestyle with a long history of using plant resources for various uses including traditional herbal medicine. However, their traditional knowledge of traditional medicinal plants in Boreda Abaya District has not been explored Ethnobotanically yet, despite preserving diverse indigenous traditional medicinal plants. Hence, the study aimed to document and analyze traditional medicinal plants and associated traditional knowledge and practices used by local people.

Materials and methods

Quantitative ethnobotanical data were collected via semi-structured interviews, face-to-face conversations, group discussions, and guided field trips between September 2022 and February 2023. In total, 92 informants participated, of which 25 were key informants. Quantitative data indices (informant consensus factor—ICF—and use report—Ur) were computed by MS Excel spreadsheet software. Scientific names of medicinal plants were checked via World Flora Online.

Results

In the present study, we recorded 188 traditional medicinal plant species belonging to 163 genera and 73 plant families. Lamiaceae (16 species), Asteraceae (16 species), Fabaceae (11 species), and Euphorbiaceae (8 species) contributed highest number of species and were found to be predominant family in the area. Leaves and seeds were most frequently used plant parts, and pounding (46%) was the main method to prepare remedies. The sudden sickness disease category scored the highest consensus (ICF: 0.35), followed by blood and circulatory-related disease categories (ICF: 0.33). The highest number of plant taxa (61 species) used to treat dermal disease has a 71-use report score, while fewer plant taxa (21 species) were utilized to treat genitourinary system-related disease category, having 25 use reports. Ocimum lamiifolium (Ur:56) and Moringa stenopetala (Ur:51) are widely used species and received highest use report value.

Conclusion

Gamo people possess extensive traditional knowledge of ethnomedicine. The region's vegetation hosts diverse medicinal species, but deforestation, agriculture, and droughts threaten them. Local conservation practices require scientific support, prioritizing species having higher use reports (Ur), and in-depth investigations of promising species for drug development are essential.
Gender, marginalised groups, and young people’s mental health: a longitudinal analysis of trajectories
Authors: Lereya Suzet Tanya , Norton Sam , Crease Maddison , Deighton Jessica , Labno Angelika , Ravaccia Giulia Gaia , Bhui Kamaldeep , Brooks Helen , English Cara , Fonagy Peter , Heslin Margaret , Edbrooke-Childs Julian
Published: February 2024

Background

Individuals from marginalised groups experience higher levels of mental health difficulties and lower levels of wellbeing which may be due to the exposure to stress and adversity. This study explores trajectories of mental health over time for young women and girls and young people with other marginalised identities.

Methods

We conducted a secondary analysis on N = 14,215 children and young people (7,501 or 52.8% female, 6,571 or 46.2% male, and 81 or 0.6% non-binary or questioning) who completed a survey at age 11 to 12 years and at least one other annual survey aged 12 to 13 years and/or aged 13 to 14 years. We used group-based trajectory models to examine mental health difficulties.

Results

Except for behavioural difficulties, young women’s and girls’ trajectories showed that they consistently had higher levels of mental health difficulties compared to young men and boys. A similar pattern was shown for non-binary and questioning children and young people. Children and young people with economic disadvantage and/or special education needs, and/or for whom there were welfare concerns, were generally more likely to experience higher levels of mental health difficulties.

Conclusions

This information could inform public policy, guidance and interventions.
Interaction models matter: an efficient, flexible computational framework for model-specific investigation of epistasis
Authors: Batista Sandra , Madar Vered Senderovich , Freda Philip J. , Bhandary Priyanka , Ghosh Attri , Matsumoto Nicholas , Chitre Apurva S. , Palmer Abraham A. , Moore Jason H.
Published: February 2024

Purpose

Epistasis, the interaction between two or more genes, is integral to the study of genetics and is present throughout nature. Yet, it is seldom fully explored as most approaches primarily focus on single-locus effects, partly because analyzing all pairwise and higher-order interactions requires significant computational resources. Furthermore, existing methods for epistasis detection only consider a Cartesian (multiplicative) model for interaction terms. This is likely limiting as epistatic interactions can evolve to produce varied relationships between genetic loci, some complex and not linearly separable.

Methods

We present new algorithms for the interaction coefficients for standard regression models for epistasis that permit many varied models for the interaction terms for loci and efficient memory usage. The algorithms are given for two-way and three-way epistasis and may be generalized to higher order epistasis. Statistical tests for the interaction coefficients are also provided. We also present an efficient matrix based algorithm for permutation testing for two-way epistasis. We offer a proof and experimental evidence that methods that look for epistasis only at loci that have main effects may not be justified. Given the computational efficiency of the algorithm, we applied the method to a rat data set and mouse data set, with at least 10,000 loci and 1,000 samples each, using the standard Cartesian model and the XOR model to explore body mass index.

Results

This study reveals that although many of the loci found to exhibit significant statistical epistasis overlap between models in rats, the pairs are mostly distinct. Further, the XOR model found greater evidence for statistical epistasis in many more pairs of loci in both data sets with almost all significant epistasis in mice identified using XOR. In the rat data set, loci involved in epistasis under the XOR model are enriched for biologically relevant pathways.

Conclusion

Our results in both species show that many biologically relevant epistatic relationships would have been undetected if only one interaction model was applied, providing evidence that varied interaction models should be implemented to explore epistatic interactions that occur in living systems.
The first Cyclida from the Triassic of Italy
Authors: Pieroni Vittorio
Published: February 2024

A well-preserved carapace of the crustacean Halicyne is here described. The finding comes from the Sostegno Basin (Piedmont, Italy). This is the first occurrence of a well-preserved arthropod from the Middle Triassic San Salvatore Formation of the Biellese area and the first report of a Triassic Cyclida from Italy. Cyclida often occurs in shallow marine environments with rapidly changing salinity conditions. The finding from the Sostegno area suggests a hypersaline paleoenvironment similar to that of Monte San Salvatore (Ticino, Switzerland) upper levels, where the same taxon was previously documented. These fossiliferous localities are shortly compared with that of Rasa di Varese (Lombardy, Italy).
Recognition of warheads by range-profile matching with automatic threshold
Authors: Tan Donglin , Wang Junfeng
Published: February 2024

In this paper, a novel algorithm is presented for warhead recognition in the defense of ballistic missiles. The range profiles from the warheads of interest in typical illumination directions form a dataset. First, each range profile in the dataset is compared to the range profile of the target under observation, and the most similar range profile is found. Then, the observed target is considered as a warhead if the deviation of its range profile from the most similar range profile is less than or equal to a threshold. The threshold is chosen such that the detection rate is a constant. The simulation results verify the effectiveness of the proposed algorithm. Since the threshold is automatically calculated according to the detection rate, this algorithm has a larger applicability than the current methods based on range-profile matching.
Determinants of financial distress: evidence from insurance companies in Ethiopia
Authors: Kebede Tekalign Negash , Tesfaye Getahun Deribe , Erana Obsa Teferi
Published: February 2024

The issue of financial distress has received much attention of scholars because it harms firm financial and operational systems which could lead to insolvency. The objective of this study is to examine the determinants of financial distress in Ethiopian insurance companies. A panel dataset was obtained from 11 insurance companies which range from 2010 to 2021. The study used the “Altman’s Z”-score model as a measure for financial distress. The pooled OLS regression results revealed that profitability (ROA), liquidity levels, insurers’ size, earnings growth, diversification have negative and significant effect on financial distress. Moreover, inflation rate, claims ratio, leverage, and asset tangibility have positive significant impact on financial distress. The study will have implications for different stakeholders, such as managers, policy makers, shareholders, etc., in that firm-specific and macro-economic factors are essential for managing the status of financial distress.
Prevalence of colistin resistance in clinical isolates of Acinetobacter baumannii: a systematic review and meta-analysis
Authors: Bostanghadiri Narjess , Narimisa Negar , Mirshekar Maryam , Dadgar-Zankbar Leila , Taki Elahe , Navidifar Tahereh , Darban-Sarokhalil Davood
Published: February 2024

Introduction

The development of colistin resistance in Acinetobacter baumannii during treatment has been identified in certain patients, often leading to prolonged or recurrent infections. As colistin, is the last line of therapy for A. baumannii infections that are resistant to almost all other antibiotics, colistin-resistant A. baumannii strains currently represent a significant public health threat, particularly in healthcare settings where there is significant selective pressure.

Aim

The aim of this study was to comprehensively determine the prevalence of colistin resistance in A. baumannii from clinical samples. Regional differences in these rates were also investigated using subgroup analyses.

Method

The comprehensive search was conducted using “Acinetobacter baumannii”, “Colistin resistant” and all relevant keywords. A systematic literature search was performed after searching in PubMed, Embase, Web of Science, and Scopus databases up to April 25, 2023. Statistical analysis was performed using Stata software version 17 and sources of heterogeneity were evaluated using I2. The potential for publication bias was explored using Egger's tests. A total of 30,307 articles were retrieved. After a thorough evaluation, 734 studies were finally eligible for inclusion in the present systematic review and meta-analysis.

Result

According to the results, the prevalence of resistance to colistin among A. baumannii isolates was 4% (95% CI 3–5%), which has increased significantly from 2% before 2011 to 5% after 2012. South America had the highest resistance rate to this antibiotic. The broth microdilution method had the highest level of resistance, while the agar dilution showed the lowest level.

Conclusions

This meta-analysis found a low prevalence of colistin resistance among A. baumannii isolates responsible for infections worldwide from 2000 to 2023. However, there is a high prevalence of colistin-resistant isolates in certain countries. This implies an urgent public health threat, as colistin is one of the last antibiotics available for the treatment of infections caused by XDR strains of A. baumannii.
Development of fermented beverage with citrus fruit extract using probiotics: impact on antioxidant activity and in vitro digestibility
Authors: Kim Doyoung , Oh Imkyung
Published: February 2024

Redhyang (Citrus hybrid ‘Kanpei’,CHK) is a subtropical citrus species introduced in Korea due to climate change. To enhance the nutritional value and usability of CHK as a processed food product, CHK extract was fermented with four types of commercial starters (YoFlex Harmony 1.0 (YFH), ABY-3 (ABY), YC-X11 (YXC), and YC-180 (YC)), and their antioxidant activities and changes in chemical properties during fermentation were investigated. The consumer acceptance of probiotic beverages containing fermented CHK extracts and their viability and antioxidant activity through in vitro digestion were also elucidated. The enumeration of lactic acid bacteria (LAB) in all samples after fermentation was above 7.60 log colony-forming units (CFU)/mL, with YC exhibiting the highest number after 24 h. Fermented CHK extracts containing higher levels of organic acids, total polyphenols, and flavonoids tended to exhibit higher antioxidant activities. YFH, ABY, and YC showed maximum antioxidant activity at 24 h, whereas YXC showed differences in the types of LAB at 12 h. After in vitro digestion, YXC showed higher antioxidant activity and LAB viability than the control. This result indicates that CHK extract fermented with YXC can increase antioxidant activity, bioactive ingredients, and sensory preference and positively impact the production of probiotic beverages.
Microplastic contamination, an emerging threat to the freshwater environment: a systematic review
Authors: Bhardwaj Laxmi Kant , Rath Prangya , Yadav Poornima , Gupta Urvashi
Published: February 2024

Microplastics have been noticed as widespread in an aquatic environment at the microscale. They have nonstop increased due to the increase in the production of synthetic plastics, population and poor waste management. They are ubiquitous in nature and slowly degrade in water and soil. They are emerging pollutants that have received interest from public audiences and research communities. They have great stability and can adsorb various other pollutants like pesticides, heavy metals, etc. After entering the freshwater environment, microplastics can be stored in the tissue of organisms and stay for a long time. They can generate a serious threat to freshwater ecosystems and can cause physical damage to organisms. Visual identification, Raman spectroscopy, pyrolysis–gas chromatography–mass spectrometry (Pyro–GC–MS), Fourier-transform infrared spectroscopy (FTIR), scanning electron microscopy (SEM) and combined methods are the commonly known methods for the quantification and identification of microplastics. The detected concentration of microplastics depends on the sampling method, locations and identification techniques. The authors assessed the sources, transport, impacts, identification and characterization, and treatment of microplastics in freshwater environments in detail. The authors are also giving some recommendations for the minimization of the MPs from the freshwater environment. This review article will provide the baseline facts for the investigators to do more research on microplastic pollution in the future.

Graphical Abstract
Electrochemical random-access memory: recent advances in materials, devices, and systems towards neuromorphic computing
Authors: Kwak Hyunjeong , Kim Nayeon , Jeon Seonuk , Kim Seyoung , Woo Jiyong
Published: February 2024

Artificial neural networks (ANNs), inspired by the human brain's network of neurons and synapses, enable computing machines and systems to execute cognitive tasks, thus embodying artificial intelligence (AI). Since the performance of ANNs generally improves with the expansion of the network size, and also most of the computation time is spent for matrix operations, AI computation have been performed not only using the general-purpose central processing unit (CPU) but also architectures that facilitate parallel computation, such as graphic processing units (GPUs) and custom-designed application-specific integrated circuits (ASICs). Nevertheless, the substantial energy consumption stemming from frequent data transfers between processing units and memory has remained a persistent challenge. In response, a novel approach has emerged: an in-memory computing architecture harnessing analog memory elements. This innovation promises a notable advancement in energy efficiency. The core of this analog AI hardware accelerator lies in expansive arrays of non-volatile memory devices, known as resistive processing units (RPUs). These RPUs facilitate massively parallel matrix operations, leading to significant enhancements in both performance and energy efficiency. Electrochemical random-access memory (ECRAM), leveraging ion dynamics in secondary-ion battery materials, has emerged as a promising candidate for RPUs. ECRAM achieves over 1000 memory states through precise ion movement control, prompting early-stage research into material stacks such as mobile ion species and electrolyte materials. Crucially, the analog states in ECRAMs update symmetrically with pulse number (or voltage polarity), contributing to high network performance. Recent strides in device engineering in planar and three-dimensional structures and the understanding of ECRAM operation physics have marked significant progress in a short research period. This paper aims to review ECRAM material advancements through literature surveys, offering a systematic discussion on engineering assessments for ion control and a physical understanding of array-level demonstrations. Finally, the review outlines future directions for improvements, co-optimization, and multidisciplinary collaboration in circuits, algorithms, and applications to develop energy-efficient, next-generation AI hardware systems.
Lung- and diaphragm-protective strategies in acute respiratory failure: an in silico trial
Authors: Ratano Damian , Zhang Binghao , Dianti Jose , Georgopoulos Dimitrios , Brochard Laurent J. , Chan Timothy C. Y. , Goligher Ewan C.
Published: February 2024

Background

Lung- and diaphragm-protective (LDP) ventilation may prevent diaphragm atrophy and patient self-inflicted lung injury in acute respiratory failure, but feasibility is uncertain. The objectives of this study were to estimate the proportion of patients achieving LDP targets in different modes of ventilation, and to identify predictors of need for extracorporeal carbon dioxide removal (ECCO2R) to achieve LDP targets.

Methods

An in silico clinical trial was conducted using a previously published mathematical model of patient–ventilator interaction in a simulated patient population (n = 5000) with clinically relevant physiological characteristics. Ventilation and sedation were titrated according to a pre-defined algorithm in pressure support ventilation (PSV) and proportional assist ventilation (PAV+) modes, with or without adjunctive ECCO2R, and using ECCO2R alone (without ventilation or sedation). Random forest modelling was employed to identify patient-level factors associated with achieving targets.

Results

After titration, the proportion of patients achieving targets was lower in PAV+ vs. PSV (37% vs. 43%, odds ratio 0.78, 95% CI 0.73–0.85). Adjunctive ECCO2R substantially increased the probability of achieving targets in both PSV and PAV+ (85% vs. 84%). ECCO2R alone without ventilation or sedation achieved LDP targets in 9%. The main determinants of success without ECCO2R were lung compliance, ventilatory ratio, and strong ion difference. In silico trial results corresponded closely with the results obtained in a clinical trial of the LDP titration algorithm (n = 30).

Conclusions

In this in silico trial, many patients required ECCO2R in combination with mechanical ventilation and sedation to achieve LDP targets. ECCO2R increased the probability of achieving LDP targets in patients with intermediate degrees of derangement in elastance and ventilatory ratio.
Cardiac tamponade complicating esophagectomy and retrosternal gastric tube reconstitution in a patient with an abnormal ascending aorta position: a case report
Authors: Aoyama Shu , Miyazaki Yasuhiro , Motoori Masaaki , Hirota Masashi , Itami Takefumi , Matsumoto Sayaka , Hirano Masataka , Aomatsu Michihiro , Goto Takasumi , Kitahara Mutsunori , Ozato Yuki , Nishizawa Yujiro , Komatsu Hisateru , Inoue Akira , Kagawa Yoshinori , Tomokuni Akira , Iwase Kazuhiro , Nishi Hiroyuki , Fujitani Kazumasa
Published: February 2024

Background

Cardiac tamponade is a rare postoperative complication of esophageal cancer surgery, which leads to rapid hemodynamic changes and can be fatal if not treated properly and promptly. Herein, we report a case of cardiac tamponade after thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution for esophageal cancer that was successfully treated with surgical drainage.

Case presentation

An 86-year-old man with lower thoracic esophageal cancer underwent thoracoscopic subtotal esophagectomy and retrosternal gastric tube reconstitution. No intra-operative complications were observed. On the first postoperative day, tachycardia and hypotension were observed, and pericardial effusion was identified on computed tomography images. The patient was diagnosed with obstructive shock secondary to cardiac tamponade. As percutaneous puncture drainage was not possible due to the presence of a retrosternal gastric tube, pericardiotomy with a small left anterior thoracotomy was performed, and a large amount of hematogenous fluid was drained, which instantly improved circulation. On the second postoperative day, the patient showed decreased pulse pressure, and computed tomography revealed a residual and enlarged hematoma around the right ventricle. The patient underwent surgical drainage and another pericardiotomy with a small right anterior thoracotomy was performed to drain the hematoma. At this time, multiple injuries to the fatty tissue, epicardium, and myocardium with active bleeding were observed on the anterior surface of the right ventricle near the root of the pulmonary artery. In this patient, the ascending aorta ran further to the right and dorsal sides than usual, causing the anterior wall of the right ventricle near the root of the pulmonary artery to be closer to the back of the sternum. This abnormality may have contributed to injury during the creation of the retrosternal pathway, leading to cardiac tamponade.

Conclusions

Cardiac tamponade after esophagectomy can occur because of manipulation during creation of the retrosternal route, with an anomaly in the aortic position being present in this case. Gentle manipulation and selection of the reconstruction route according to the patient’s condition are necessary in cases with such anatomical abnormalities.
Dietary assessment of type 2 diabetic patients using healthful plant-based diet score in the Eastern Province of Saudi Arabia
Authors: Alali Rudaynah A. , Alateeq Suad A. , Almuhanna Afnan F. , Al Elq Abdulmohsen H. , Albaker Waleed I. , Habara Alawi , Alrubaish Fatima A. , Vatte Chittibabu , Loza Bao-Li , Al-Muhanna Fahad A. , Al-Ali Amein K.
Published: February 2024

Background

Diabetes mellitus is a chronic disease characterized by a wide range of metabolic problems. The current study sought to assess nutritional habits of Saudi patients with type 2 diabetes (T2D) and to propose recommendations to improve these patients’ dietary habits and delay possible disease complications.

Methods

Over a period of three years, (2017–2019) 577 patients with T2D attending the outpatient’s diabetic clinics at King Fahd Hospital of the University, Al Khobar, Saudi Arabia were invited to participate in this study. Data of dietary intake were collected by trained nurses using a pretested structured validated semi quantitative food frequency questionnaire. The dietary data were collected using 7-day dietary recall questionnaire. A modified score system that associates dietary habits with glycemic control and lipid profile was used.

Results

Overall, a high healthful plant-based diet score was associated with a significant (P = 0.018) reduction in triglycerides (TG) level (mean difference − 3.78%; 95% CI, -0.65% to -6.81%) and a statistically non-significant (P = 0.06) increase in high density lipoprotein (HDL) levels (mean difference 1.87%; 95% CI -0.06–3.84%) in T2D patients from the Eastern Province of Saudi Arabia. Additionally, in our patient group, the prevalence of coronary artery disease, stroke, peripheral artery disease, and chronic kidney disease in T2D patients was 11.3%, 6.2%, 3.3%, and 8.4%, respectively and were higher when compared to the prevalence in the general population.

Conclusion

The present study showed that adherence to a healthful plant-based diet, when compared to high glycemic index diet, is associated with a favorable outcome in glycemic control and lipid profile in T2D patients. Prior assessment of total diet quality may be beneficial when giving nutritional advice to T2D patients with the possibility of improving glycemic control and lipid profile.
Outcomes of treatment with short dental implants compared with standard-length implants: a retrospective clinical study
Authors: Bérczy Kinga , Göndöcs György , Komlós György , Shkolnik Tatiana , Szabó György , Németh Zsolt
Published: February 2024

Background

The size of dental implants is a key success factor for appropriate osseointegration. Using shorter implants allows the possibility of avoiding complex surgical procedures and reduces the morbidity of treatment. Shorter implants also enable implant-prosthetic rehabilitation after maxillofacial reconstructions where only limited bone is available. In this study, the success rates of short implants were examined and compared to those of standard-sized implants.

Methods

Patients who received dental implants between 2007 and 2016 at the Department of Oro-Maxillofacial Surgery and Stomatology Semmelweis University were enrolled in the study. Several clinical parameters were recorded and supplemented with radiological examinations. The data were statistically analysed.

Results

Thirty-four patients with a total of 60 implants were included. The average time after prosthetic loading was 39.33 ± 21.96 months in the group with 8-mm implants and 41.6 ± 27.5 months in the group with > 8-mm implants. No significant differences were observed between the two groups in terms of probing depth (short implants, 2.84 ± 0.09 mm; standard implants, 2.91 ± 0.35 mm) or mean marginal bone loss (short implants, 1.2 ± 1.21-mm mesially and 1.36 ± 1.47-mm distally; standard implants: 0.63 ± 0.80-mm mesially and 0.78 ± 0.70-mm distally).

Conclusions

In this study, the success rate of short dental implants was comparable to that of standard-sized implants. Consequently, it can be claimed that the long-term success of short dental implants does not differ significantly from the long-term success of standard implants.
Recommendations for diabetic macular edema management by retina specialists and large language model-based artificial intelligence platforms
Authors: Choudhary Ayushi , Gopalakrishnan Nikhil , Joshi Aishwarya , Balakrishnan Divya , Chhablani Jay , Yadav Naresh Kumar , Reddy Nikitha Gurram , Rani Padmaja Kumari , Gandhi Priyanka , Shetty Rohit , Roy Rupak , Bavaskar Snehal , Prabhu Vishma , Venkatesh Ramesh
Published: February 2024

Purpose

To study the role of artificial intelligence (AI) in developing diabetic macular edema (DME) management recommendations by creating and comparing responses to clinicians in hypothetical AI-generated case scenarios. The study also examined whether its joint recommendations followed national DME management guidelines.

Methods

The AI hypothetically generated 50 ocular case scenarios from 25 patients using keywords like age, gender, type, duration and control of diabetes, visual acuity, lens status, retinopathy stage, coexisting ocular and systemic co-morbidities, and DME-related retinal imaging findings. For DME and ocular co-morbidity management, we calculated inter-rater agreements (kappa analysis) separately for clinician responses, AI-platforms, and the “majority clinician response” (the maximum number of identical clinician responses) and “majority AI-platform” (the maximum number of identical AI responses). Treatment recommendations for various situations were compared to the Indian national guidelines.

Results

For DME management, clinicians (ĸ=0.6), AI platforms (ĸ=0.58), and the ‘majority clinician response’ and ‘majority AI response’ (ĸ=0.69) had moderate to substantial inter-rate agreement. The study showed fair to substantial agreement for ocular co-morbidity management between clinicians (ĸ=0.8), AI platforms (ĸ=0.36), and the ‘majority clinician response’ and ‘majority AI response’ (ĸ=0.49). Many of the current study’s recommendations and national clinical guidelines agreed and disagreed. When treating center-involving DME with very good visual acuity, lattice degeneration, renal disease, anaemia, and a recent history of cardiovascular disease, there were clear disagreements.

Conclusion

For the first time, this study recommends DME management using large language model-based generative AI. The study’s findings could guide in revising the global DME management guidelines.
Low temperature vaporized hydrogen peroxide sterilization of 3D printed devices
Authors: Eveland Randal , Antloga Kathleen , Meyer Ashley , Tuscano Lori
Published: February 2024

Background

Low temperature vaporized hydrogen peroxide sterilization (VH2O2) is used in hospitals today to sterilize reusable medical devices. VH2O2 sterilized 3D printed materials were evaluated for sterilization, biocompatibility and material compatibility.

Materials & methods

Test articles were printed at Formlabs with BioMed Clear™ and BioMed Amber™, and at Stratasys with MED610™, MED615™ and MED620™. Sterilization, biocompatibility and material compatibility studies with 3D printed materials were conducted after VH2O2 sterilization in V-PRO™ Sterilizers. The overkill method was used to evaluate sterilization in a ½ cycle. Biocompatibility testing evaluated the processed materials as limited contact (< 24-hours) surface or externally communicating devices. Material compatibility after VH2O2 sterilization (material strength and dimensionality) was evaluated via ASTM methods and dimensional analysis.

Results

3D printed devices, within a specific design window, were sterile after VH2O2 ½ cycles. After multiple cycle exposure, the materials were not cytotoxic, not sensitizing, not an irritant, not a systemic toxin, not pyrogenic and were hemo-compatible. Material compatibility via ASTM testing and dimensionality evaluations did not indicate any significant changes to the 3D printed materials after VH2O2 sterilization.

Conclusion

Low temperature vaporized hydrogen peroxide sterilization is demonstrated as a suitable method to sterilize 3D printed devices. The results are a subset of the data used in a regulatory submission with the US FDA to support claims for sterilization of 3D printed devices with specified materials, printers, and device design 1.
Use of patient-reported outcome measures after breast reconstruction in low- and middle-income countries: a scoping review
Authors: Malapati Sri Harshini , Hyland Colby J. , Liang George , Edelen Maria O. , Fazzalari Amanda , Kaur Manraj N. , Bain Paul A. , Mody Gita N. , Pusic Andrea L.
Published: February 2024

Background

Patient-reported outcome measures (PROMs) are increasingly administered in high-income countries to monitor health-related quality of life of breast cancer patients undergoing breast reconstruction. Although low- and middle-income countries (LMICs) face a disproportionate burden of breast cancer, little is known about the use of PROMs in LMICs. This scoping review aims to examine the use of PROMs after post-mastectomy breast reconstruction among patients with breast cancer in LMICs.

Methods

MEDLINE, Embase, Web of Science, CINAHL, and PsycINFO were searched in August 2022 for English-language studies using PROMs after breast reconstruction among patients with breast cancer in LMICs. Study screening and data extraction were completed. Data were analyzed descriptively.

Results

The search produced 1024 unique studies, 33 of which met inclusion criteria. Most were observational (48.5%) or retrospective (33.3%) studies. Studies were conducted in only 10 LMICs, with 60.5% in China and Brazil and none in low-income countries. Most were conducted in urban settings (84.8%) and outpatient clinics (57.6%), with 63.6% incorporating breast-specific PROMs and 33.3% including breast reconstruction-specific PROMs. Less than half (45.5%) used PROMs explicitly validated for their populations of interest. Only 21.2% reported PROM response rates, ranging from 43.1 to 96.9%. Barriers and facilitators of PROM use were infrequently noted.

Conclusions

Despite the importance of PROM collection and use in providing patient-centered care, it continues to be limited in middle-income countries and is not evident in low-income countries after breast reconstruction. Further research is necessary to determine effective methods to address the challenges of PROM use in LMICs.
Psychometric performance of the CFQ-R-8D compared to the EQ-5D-3L and SF-6D in people with cystic fibrosis
Authors: Mukuria Clara , Rowen Donna , Acaster Sarah , McGarry Lisa J. , Lou Yiyue , Sosnay Patrick R. , Quittner Alexandra L.
Published: February 2024

Objective

This study aimed to compare the psychometric performance of the Cystic Fibrosis Questionnaire–Revised–8 Dimensions (CFQ-R-8D), a new, condition-specific, preference-based measure, with that of generic preference-based measures EQ-5D-3L and Short Form 6 dimensions (SF-6D).

Methods

Data from three trials of participants with CF aged ≥ 14 years who completed the CFQ-R and EQ-5D-3L or SF-6D were used. Analyses were undertaken to evaluate convergent validity based on correlations with CFQ-R domain scores. Known-group validity was assessed based on percent predicted forced expiratory volume in one second and pulmonary exacerbations. Responsiveness was based on correlation of change and sensitivity to change based on change in symptom severity. Effect sizes and standardized response means were estimated.

Results

CFQ-R-8D utilities and dimensions were strongly correlated with most of the overlapping CFQ-R domain scores (ρ > 0.5); EQ-5D-3L and SF-6D utilities and dimensions had moderate (ρ > 0.3) to strong correlations in dimensions capturing similar concepts. All measures showed evidence of known-group validity (P < 0.05). Change correlations were strong for CFQ-R-8D utilities and dimensions and CFQ-R, but they were moderate for SF-6D and mostly weak ((ρ > 0.1) for EQ-5D-3L. The SF-6D had the largest mean change over time and effect sizes, followed by CFQ-R-8D and then EQ-5D-3L. Neither CFQ-R-8D or SF-6D utility scores had ceiling effects (< 9% responses in full health) compared with those of EQ-5D-3L (61-62%). In participants classified as being in full health by EQ-5D-3L, CFQ-R-8D captured CF-specific health problems, particularly cough, abdominal pain, and breathing difficulty.

Conclusions

The CFQ-R-8D reflected known-group differences and changes over time with stronger evidence of good psychometric performance than EQ-5D-3L and similar evidence as SF-6D. Additionally, the CFQ-R-8D captured more condition-specific symptoms than EQ-5D-3L or SF-6D, which are important determinants of health-related quality of life for people with CF.
The diagnostic yield of a 2-h versus a 30-min electroencephalogram for patients with altered mental status in neurological intensive care unit
Authors: Mounir Nesma , Belal Ehab Shaker , Abozeina Mahmoud Fathi , Tawfeek Aliaa Ali
Published: February 2024

Background

The continuous electroencephalogram (cEEG) monitoring is recommended for critical ill patients with altered mental status, The cEEG detects seizure activity and nonconvulsive status epilepticus (NCSE) more efficiently than routine electroencephalogram (rEEG). Yet, cEEG is not widely available in many neurological intensive care units (NICU) in limited resource countries. Ideal study duration, and whether cEEG is useful and cost-effective in terms of patient outcome compared to (rEEG), is still questions under research. The main objective in our study was the relative diagnostic yield of the 2 h, prolonged EEG recording, compared to the 30-min rEEG recording in the NICU.

Results

There was no significant diagnostic yield for the 2-h electroencephalogram (EEG) over the 30-min EEG for patient with altered mental status in the NICU. Being with altered mental state in an NICU carries a poor outcome, we found that death occurred in 68.9% of patients. Acute ischemic stroke is the most common cause of altered mental status in NICU by about 53.3% of patients. Less than half of the patients (42.2%) were receiving anti-seizure medications (ASM).

Conclusions

As long as the cEEG is not available in the NICU, the 30-min EEG has a good diagnostic yield and it is almost equivalent to the prolonged 2-h EEG, and if the EEG is recommended for a longer duration, we recommend a long-term EEG more than 2 h.