bluuebunny/crossref_metadata_2025 huggingface dataset:
An Audit of Venous Thromboembolism (VTE) Risk Assessment in an NHS Trust Mental Health Inpatient Setting
Authors: Atmakur Manjula , Ibrahim Sururat , Adedipe Oluwakemisola
Published: August 2024

Aims

To assess compliance with National Institute of Clinical Excellence (NICE) guidance (NG 89) recommendations on VTE risk assessment for mental health inpatients in Black Country Healthcare NHS Foundation Trust (BCHFT).

Methods

NICE guidance (NG89) set out recommendations on VTE risk assessment for adult psychiatric inpatients. It recommends that:

•

All adult psychiatric inpatients have their VTE risk assessed as soon as possible after admission or at the first consultant's review.

•

All patients have their VTE risk re-assessed at the point of consultant's review or if their clinical condition changes.

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Any patient found to be at VTE risk should be considered for prophylaxis with Low Molecular Weight Heparin III (LMWH III), if the thrombotic risk outweighs the bleeding risk. Fondaparinux sodium should be considered in those with contraindications to LMWH III.

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VTE pharmaco-prophylaxis should be continued until the patient is no longer at increased VTE risk.

Using these recommendations as standards, we retrospectively evaluated inpatient clerking charts and progress notes of 49 inpatients across all the 23 wards in the Trust. Data were collected using a standardised audit tool on concordance with these standards to check how many patients had VTE risk assessment within 24 hours of their admission, whether patients had VTE risk re-assessment at any point during admission, whether the patients found to have increased VTE risk at admission were commenced on pharmaco-prophylaxis. Data was also collected to see if the patients commenced on VTE pharmaco-prophylaxis were re-assessed for continued need of the prophylaxis.

Results

30 patients (59.2%) were risk assessed for VTE within 24 hours of admission. Only 2% of patients had VTE re-assessment while on admission, but there was no record of the indication for this. All the 3 patients (6.1%), found to be at VTE risk on admission, were prescribed pharmaco-prophylaxis, but none of them had a VTE re-assessment to determine the prophylaxis’ continued need.

Conclusion

The trust’s compliance with NICE recommendation for VTE risk assessment is below standard. We felt the trust's compliance is a reflection of the medical staff's awareness on the importance of VTE risk assessment in mental health settings, and also lack of Trust's policy on VTE risk assessment. Recommendations were suggested to include VTE risk assessment in the junior doctors’ induction programme and for the trust to have a VTE policy that factors in mental health risk factors.
Audit on Decisions Relating to Cardiopulmonary Resuscitation (CPR) in 2 Older Adult Inpatient Wards
Authors: Philip Joel , Cherian Vinu , Ford Jennifer
Published: August 2024

Aims

This audit aimed to understand the practice of advance care planning with regard to cardiopulmonary resuscitation (CPR) in an older adult inpatient setting and to ultimately improve practices to conform to nationally set standards.

The aims of the audit were:

(1) To determine the prevalence of advance care planning decisions relating to CPR in patients admitted to two older adult psychiatric wards at Thurrock Community Hospital.

(2) To confirm that the practice of discussion and documentation of ‘Do Not Attempt Cardiopulmonary Resuscitation' (DNA-CPR) decisions is consistent with current national standards.

Methods

First, we scrutinized whether the patient's preferences for CPR as a life-sustaining treatment were documented or known to the primary care physician at the time of admission, and whether there was a DNA-CPR order in place at the time of admission.

Next, we looked at whether a discussion about CPR was facilitated with the patient (or those close to the patient) during the admission, whether the patient was involved in the discussion surrounding CPR and the reasons for their exclusion (if excluded), and at what point in time during the admission this discussion was carried out and whether it was properly documented.

Finally, we assessed the level of completion of the DNA-CPR form itself.

Total sample: 38 patients.

Results

13 out of 38 patients (34.21%) had a DNA-CPR form in place.

10 out of 13 DNA-CPR forms (76.92%) were complete in all aspects.

Discussion relating to DNA-CPR was not carried out in 29 out of 38 patients (76.32%) during their current admission.

Mental Capacity Assessments and Best Interest meetings were not documented as having been carried out as was necessary in the 4 patients (0%) who did not have a designated Lasting Power of Attorney.

Conclusion

Discussions about advance care planning and DNA-CPR were not being carried out in a timely manner as per the national guidelines.
Delirium Audit Project of the Greenwich Older Adult Mental Health Liaison Service
Authors: Ustun Anil
Published: August 2024

Aims

Delirium poses a significant risk in hospitals, with a prevalence of 20–30%. Queen Elizabeth Hospital conducted an audit focusing on delirium cases referred to the Greenwich Mental Health Liaison Team for Older Adults (GMHLT OA) between January and April 2023.

The audit aimed to assess immediate and medium-term outcomes, identify improvement areas, and propose strategies for optimizing delirium treatment within GMHLT OA.

Methods

Patient referrals received by OAMHLT are meticulously recorded in a logbook. Among the referrals, 39 patients from the target population were identified through a manual review of the documentation. To augment the data collection process, electronic databases were also reviewed to ensure comprehensive data retrieval.

Results

Key Findings:

39 cases audited, predominantly females (62%).

Most affected age group: 71–80 years.

Infective causes (49%) and low mood (30%) were common.

Antipsychotic treatment administered in 56% of cases.

36% required institutionalization post-discharge.

Conclusion

The audit underscores the complexity of delirium care, aligning with epidemiological data. It provides a foundation for targeted improvements to enhance patient outcomes within GMHLT OA. Based on the results the following recommendations and action plan were made:

Implement multifaceted interventions and non-pharmacological approaches.

Strengthen collaboration between departments for diverse referral sources.

Explore regional resource allocation and establishment of care pathways based on local implications.
PANDAS Among the Lake District
Authors: Khokar Rehaan
Published: August 2024

Aims

Paediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infection (PANDAS) is an inflammatory brain disorder characterised by a new onset of obsessive-compulsive disorder, triggered by streptococcal infection likely inducing molecular mimicry of antistreptococcal antibody action within brain tissue. PANDAS is perhaps considered controversial in the field of psychiatry due to debates over the validity of the diagnosis, controversy surrounding aggressive antibiotic and immunomodulatory treatment and limited well-controlled case studies.

Methods

A 13-year-old boy, X, presented with new onset worsening confusion, on a background of autism, to a child psychiatric clinic in the Lake District. During the summer, he developed a fixation with Harry Potter and began to act on confabulating beliefs that his mother is (and always has been) Lord Voldemort. X's behaviour became increasingly violent and aggressive and he now only spoke in ‘parseltongue’, refusing to communicate with anyone in any other way. A new personality change was identified as his usual routine behaviours and fixations had dissipated, such as a decrease in his ritualistic behaviours, a loss of his usual inquisitive nature, and an increased fascination with wearing sunglasses due to beliefs that the sun was poisoned by his mother, ‘Lord Voldemort’. Additionally, X's eating habits had markedly changed and now refused all forms of food. Clinically, X also developed a new and sustained tic and was tremulous in clinics, despite no evidence of focal neurological signs. Due to the relatively acute onset of symptoms, an organic cause was queried, which eventually led to the presumed diagnosis of PANDAS.

Results

Extensive investigations, such as an MRI of the brain, autoantibody testing for anti-AQP4, MOG-Ab, and other serological testing, showed no specific cause could be identified other than evident inflammatory changes in the brain. A ‘three-pronged’ treatment approach was adopted: increased psychotherapeutic intervention, antibiotic treatment and IV immunoglobulin therapy.

Conclusion

This case illustrates the importance of recognition of PANDAS and, more pertinently, an appreciation of the biological aspect of the biopsychosocial approach to psychiatry. From the minimal evidence available, there is a suggestion of a relatively good prognosis for patients with suspected PANDAS when intervened timely; however, repeated infections or a chronic course of illness is more difficult to treat. PANDAS remains a diagnostic challenge and perhaps a mystery, with complicated impacts on not only the patient and their families but also the psychiatrist and wider teams involved in the management of care.
Navigating Complexity: A Case Report on Interplay of Intellectual Disability (ID), Schizophrenia, Clozapine Treatment and Chemotherapy
Authors: Marconi Alexandra , Martin Alaa
Published: August 2024

Aims

The use of Clozapine treatment requires rigorous and mandatory monitoring due to the side effects profile of Clozapine. Certain clinical situations may pose a dilemma for clinicians such as concomitant use of clozapine during myelosuppressive chemotherapy. There is limited evidence-based data regarding Clozapine and chemotherapy. We report on a case of a clozapine-stabilized, Schizophrenia patient with Mild ID who was diagnosed with High Grade B-cell Non-Hodgkin's Lymphoma (NHL) requiring chemotherapy. The challenges of this complex case are detailed in this paper.

Methods

A 56-year old man with a diagnosis of Mild ID, Schizophrenia and OCD. The patient has been taking Clozapine since 2001 daily dose of 600-400 mg for the past 20 years. Unfortunately, he was diagnosed with High Grade NHL in 2023. The decision was reached to continue Clozapine while undergoing chemotherapy sessions with frequent blood monitoring. Towards the end of his chemotherapy his bloods showed dangerously low (Clozapine red alert) requiring stopping Clozapine. The patient started showing signs of relapse in his mental state and subsequently commenced on Olanzapine. He continued to show signs of relapse and didn't recover to his previous baseline; the treatment plan is adding another antipsychotic or considering re challenging Clozapine.

Results

This report contributes to a very limited literature on the concurrent use of clozapine with chemotherapy and the use of Clozapine “outside license”. The main treatment options facing clinician is stopping or continuing clozapine during chemotherapy. The dilemma of taking the path of withdrawing a medication on which a patient is stabilized may compromise psychiatric stability, yet there is a valid argument that such inconvenience would present more favourable outcome than facing the serious haematological risks of neutropenia. There is a need for robust and close liaison between psychiatrists, oncologist, and haematologist on the various clinical considerations.

Conclusion

In summary, both clozapine and chemotherapy are known to cause neutropenia and agranulocytosis. The clinical decision to continue clozapine during chemotherapy could be challenging. Clinicians should be aware that psychotic decompensation in such patients would inevitably increase morbidity and perhaps mortality due to nonadherence to all proposed treatment, including chemotherapy. In the absence of guidelines and given the nature of treatment-resistant symptoms, clinicians should work in a multidisciplinary approach and carefully weigh the risks and benefits of continuing clozapine during chemotherapy.
A Case of Overlapping Extrapyramidal Side Effects and Neuroleptic Malignant Syndrome
Authors: Phan Jun Hua , Ugwu Kainechukwu , Er Fong Sally Li
Published: August 2024

Aims

Neuroleptic malignant syndrome (NMS) is a rare, life-threatening idiosyncratic reaction to medications, specifically dopamine receptor antagonists. We report a case of a patient who initially developed extrapyramidal side effects (EPSE) and subsequently developed NMS after being treated with flupentixol depot.

Methods

A 64-year-old woman with an underlying recurrent depressive disorder with psychotic symptoms presented to a psychiatric hospital in June 2023. She exhibited self-neglect, low mood, paranoid delusions, and non-concordance to oral psychiatric medications.

In the first week, she declined all oral medications and was subsequently started on flupentixol decanoate (Depixol) depot injection at 40 mg once every 2 weeks. While showing good improvements in her mental state, she began complaining of akathisia and dystonia since July 2023, consistent with extrapyramidal side effects secondary to flupentixol.

The symptoms improved by lowering flupentixol to 30 mg every 2 weeks and adding procyclidine 5 mg twice daily and propranolol 20 mg three times daily.

In early September 2023, she experienced severe restlessness, stiffness, muscle weakness and felt hot and clammy over 36 hours. Physical observations showed fever, tachycardia, and hypertension. Examination revealed diaphoresis, rigidity in both upper and lower limbs, lower limb weakness, and normal reflexes. Blood tests indicated acute kidney injury (AKI) stage 1, deranged liver function tests, and a creatinine kinase (CK) level of 9405.

She was promptly admitted to the medical hospital for NMS and received extensive intravenous fluid rehydration along with oral Dantrolene. She made a complete recovery, and Depixol was discontinued. Two weeks later, she was started on quetiapine and gradually titrated to 50 mg once daily.

Results

EPSE and NMS are associated with dopamine receptor blockade and commonly occur during the initiation or dosage increment of neuroleptic medications.

NMS is rare but life-threatening, presenting with manifestations of muscle rigidity, pyrexia, altered mental status, sympathetic nervous system lability and elevated CK.

In our case, our patient, who recently started taking neuroleptic medication, experienced EPSE and later deteriorated acutely, raising a high suspicion of NMS. It is essential to consider other possible diagnoses, including serotonin syndrome, malignant hyperthermia, malignant catatonia and electrolyte disturbances.

The commonly used diagnostic criteria include Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5) and Levenson's criteria but diagnosis of NMS remains clinical.

The crucial step after identifying NMS is to immediately stop the neuroleptic agent, followed by supportive medical treatment.

Conclusion

Early recognition and prompt treatment of NMS in our patient led to a full recovery.
Identifying digital biomarkers of illness activity and treatment response in bipolar disorder with a novel wearable device (TIMEBASE): protocol for a pragmatic observational clinical study
Authors: Anmella Gerard , Corponi Filippo , Li Bryan M. , Mas Ariadna , Garriga Marina , Sanabra Miriam , Pacchiarotti Isabella , Valentí Marc , Grande Iria , Benabarre Antoni , Giménez-Palomo Anna , Agasi Isabel , Bastidas Anna , Cavero Myriam , Bioque Miquel , García-Rizo Clemente , Madero Santiago , Arbelo Néstor , Murru Andrea , Amoretti Silvia , Martínez-Aran Anabel , Ruiz Victoria , Rivas Yudit , Fico Giovanna , De Prisco Michele , Oliva Vincenzo , Solanes Aleix , Radua Joaquim , Samalin Ludovic , Young Allan H. , Vergari Antonio , Vieta Eduard , Hidalgo-Mazzei Diego
Published: August 2024

Background

Bipolar disorder is highly prevalent and consists of biphasic recurrent mood episodes of mania and depression, which translate into altered mood, sleep and activity alongside their physiological expressions.

Aims

The IdenTifying dIgital bioMarkers of illnEss activity and treatment response in BipolAr diSordEr with a novel wearable device (TIMEBASE) project aims to identify digital biomarkers of illness activity and treatment response in bipolar disorder.

Method

We designed a longitudinal observational study including 84 individuals. Group A comprises people with acute episode of mania (n = 12), depression (n = 12 with bipolar disorder and n = 12 with major depressive disorder (MDD)) and bipolar disorder with mixed features (n = 12). Physiological data will be recorded during 48 h with a research-grade wearable (Empatica E4) across four consecutive time points (acute, response, remission and episode recovery). Group B comprises 12 people with euthymic bipolar disorder and 12 with MDD, and group C comprises 12 healthy controls who will be recorded cross-sectionally. Psychopathological symptoms, disease severity, functioning and physical activity will be assessed with standardised psychometric scales. Physiological data will include acceleration, temperature, blood volume pulse, heart rate and electrodermal activity. Machine learning models will be developed to link physiological data to illness activity and treatment response. Generalisation performance will be tested in data from unseen patients.

Results

Recruitment is ongoing.

Conclusions

This project should contribute to understanding the pathophysiology of affective disorders. The potential digital biomarkers of illness activity and treatment response in bipolar disorder could be implemented in a real-world clinical setting for clinical monitoring and identification of prodromal symptoms. This would allow early intervention and prevention of affective relapses, as well as personalisation of treatment.
Trends in Presentation, Management, and Survival of Women With Breast Cancer in a Multiethnic, Middle-Income Asian Setting
Authors: Jaya-Prakason Sharminii , Kong Yek-Ching , Yip Cheng-Har , See Mee-Hoong , Taib Nur Aishah , Abdul Satar Nur Fadhlina , Jamaris Suniza , Teoh Li Ying , Ibrahim Rose Irnawaty , Bhoo-Pathy Nirmala
Published: August 2024

PURPOSE

Granular data on breast cancer (BC) are pertinent for surveillance, planning, and monitoring of cancer care delivery. We determined the trends in clinical presentation, management, and survival of women with BC in a multiethnic middle-income Asian setting over 15 years.

METHODS

Data of 7,478 Malaysian women newly diagnosed with invasive BC between 2005 and 2019 from three hospital-based cancer registries were included. Trends in demographic, tumor, and treatment characteristics were compared across period 1 (P1): 2005-2009, period 2 (P2): 2010-2014, and period 3 (P3): 2015-2019. Overall survival and net survival were determined.

RESULTS

More women in P3 than P1 were older than 60 years at diagnosis. Only a marginal increase in proportion of women with stage I disease was observed (23.7% v 27.2% in P1 and P3, respectively, P = .004). Nonetheless, patients were increasingly presenting with smaller tumors, fewer axillary node involvement, well-differentiated tumors, and hormone receptor expression in recent times. Proportion of women with human epidermal growth factor receptor 2 (HER2)–overexpressed tumors significantly decreased. Among indicated patients, receipt of anticancer therapies was somewhat similar over the calendar periods, except for neoadjuvant chemotherapy and anti-HER2 therapy, where increases in administration were noted. Significant improvements in survival were observed over the 15 years, particularly for HER2-overexpressed BCs.

CONCLUSION

Although the improvements in BC survival that we have observed validate ongoing cancer control efforts and treatment advances, study findings suggest that more could be done for earlier detection and improved access to effective therapies in our settings.
The Association Between Telomere Length and Diabetes Mellitus: Accumulated Evidence From Observational Studies
Authors: He Xinxin , Cao Lu , Fu Xueru , Wu Yuying , Wen Hongwei , Gao Yajuan , Huo Weifeng , Wang Mengdi , Liu Mengna , Su Yijia , Liu Ge , Zhang Ming , Hu Fulan , Hu Dongsheng , Zhao Yang
Published: August 2024

Objective

In order to assess the associations between telomere length (TL) and diabetes mellitus (DM), especially type 2 diabetes (T2DM), we performed this systematic review and meta-analysis.

Methods

PubMed, Embase, and Web of Science were thoroughly searched up to July 11, 2023. The pooled standardized mean difference (SMD) and the 95% confidence interval (CI) were evaluated using the random-effects model. Age, sex, study design, duration of diabetes, region, sample size, and body mass index (BMI) were used to stratify subgroup analyses.

Results

A total of 37 observational studies involving 18 181 participants from 14 countries were included in the quantitative meta-analysis. In this study, patients with diabetes had shorter TL than the non-diabetic, whether those patients had T1DM (−2.70; 95% CI: −4.47, −0.93; P < .001), T2DM (−3.70; 95% CI: −4.20, −3.20; P < .001), or other types of diabetes (−0.71; 95% CI: −1.10, −0.31; P < .001). Additionally, subgroup analysis of T2DM showed that TL was significantly correlated with age, sex, study design, diabetes duration, sample size, detection method, region, and BMI.

Conclusion

A negative correlation was observed between TL and DM. To validate this association in the interim, more extensive, superior prospective investigations and clinical trials are required.
Developmental analysis of Spalt function in the Drosophila prothoracic gland
Authors: Ostalé Cristina M. , Pulido Diego , Vega-Cuesta Patricia , López-Varea Ana , de Celis Jose F.
Published: August 2024

The Spalt transcriptional regulators participate in a variety of cell fate specification processes during development, regulating transcription through interactions with DNA AT-rich regions. Spalt proteins also bind to heterochromatic regions, and some of their effects require interactions with the NuRD chromatin remodeling and deacetylase complex. Most of the biological roles of Spalt proteins have been characterized in diploid cells engaged in cell proliferation. Here, we address the function of Drosophila Spalt genes in the development of a larval tissue formed by polyploid cells, the prothoracic gland, the cells of which undergo several rounds of DNA replication without mitosis during larval development. We show that prothoracic glands depleted of Spalt expression display severe changes in the size of the nucleolus, the morphology of the nuclear envelope and the disposition of the chromatin within the nucleus, leading to a failure in the synthesis of ecdysone. We propose that loss of ecdysone production in the prothoracic gland of Spalt mutants is primarily caused by defects in nuclear pore complex function that occur as a consequence of faulty interactions between heterochromatic regions and the nuclear envelope.
Interpretation of the Smithing Process of Donghae Mangsangdong Site through Hammerscale of Restoration Experiment
Authors: Kwak Byeong Moon , Kim Su Kyoung , Hong Ju Hyeon , Kim Eun Ji
Published: August 2024

The characteristics of the hammerscale, by process were confirmed by identifying the microstructure, appearance, and chemical composition characteristics of the hammerscale recovered in the restoration experiment. Based on this, it was attempted to understand the characteristics of the smithing furnace operation at the Mangsangdong site in Donghae, and further examine an effective classification method for the excavated hammerscales. In the case of the experiment hammer scale, changes in external characteristics were confirmed, with thickness and diameter decreasing as the refining, forging, and shaping processes progressed. According to the change process, the microstructure was divided into type I composed of Fayalite and Wüstite, type II dominated by coarse Wüstite, and type III with a three-layer structure(Hematite-Magnetite-Wüstite). In addition, through analysis of composition, differences in composition appeared as the process progressed, confirming the possibility of classification of hammerscales. Excavated hammer scales were confirmed to have type II, III microstructures at a rate of 88%, it is believed that process of the forging and shaping rather than refining. In addition, differences in composition were not clearly evident, which is considered to be because the scope of process of the Mangsangdong sites was not wide. As a result of checking the distribution of microstructure by dividing it into 4 mm or more, 2∼4 mm, and 0.5∼2 mm based on diameter of the hammerscale, there was a tendency for the proportion of microstructure of subsequent types to increase as the diameter decreased, confirming the possibility of effective process classification through diameter.
Identification of Paint by ER-FT-IR: Analysis of Paint Binder and Extender in Paint
Authors: Lee Na Ra , Kim Jung Heum , Lim Sung Jin
Published: August 2024

Identifying the types of paints in artworks with uncertain painting materials is very important in conservation science and art history. However, it is difficult to distinguish the type of paint diluted in a solvent with the naked eye because the diluted paint lost its characteristic texture and gloss. Accordingly, an analysis method that can interpret the type of paint is being studied, and in particular, a non-destructive analysis method that can be analyzed without sampling is required. This study attempted to supplement the limitations of the existing artwork analysis method by examining the applicability of ER-FT-IR, a non-destructive and non-contact analysis method. As a result of the analysis, it was possible to distingu ish between oil paint and a crylic paint through a carbonyl band with high detection sensitivity. In the case of watercolors and gouache paints which use the same binding medium, it was possible to distinguish them by comparing the detection intensity of extender in ATR mode, but it was difficult to compare the detection intensity of extender o f the two paints as the overall detection intensity decreased in ER mode. Therefore, it is recommended that cross-analysis through microscopic observation and XRF analysis is necessary when analyzing artworks.
A Study on the Classification of the Production Country of Korean and Chinese Traditional White Porcelain Using Machine Learning Models: Based on the Chemical Analysis Data of White Porcelain
Authors: Cho Ye Eun , Ahn Sangdoo
Published: August 2024

The objective of this study is to investigate the applicability of machine learning techniques in discriminating the production origins of pottery. 732 data sets analyzing the chemical composition of traditional white porcelain from Korea and China were collected, and models for determining the production country were developed by applying various machine learning algorithms. Upon applying these models to 146 test samples, the statistical analysis, principal component analysis-line discriminant analysis yielded a prediction accuracy of 87.7%, while machine learning techniques such as decision tree, K-nearest neighbor, and support vector machine models demonstrated relatively high prediction accuracies of 96.6%, 98.6%, and 99.3%, respectively. Additionally, feature importance analysis confirmed that rubidium is consistently the most critical variable for determining the origin in machine learning techniques that exhibit superior performance in classifying complex data structures. These findings underscore the potential of machine learning techniques in effectively discerning the production origins of white porcelain from Korea and China.
A study on the precision of voxel- and surface-based mandibular superimposition
Authors: Lin Gengbing , Chen Xue-ting , Shi Xie
Published: August 2024

Objective: To apply the more accurate technique for mandibular superimposition and provide a valuable reference for the assessment of mandibular tooth movement and condylar remodeling before and after orthodontic treatment.
Methods: This retrospective study involved 38 adult patients who underwent two cone beam computer tomography (CBCT) scans at different stages of treatment at Fujian Provincial People’s Hospital between September, 2020 and December, 2022. The software Dolphin was used for mandible segmentation, enabling voxel‐based mandibular superimposition with the mandibular ramus as the reference region. The Geomagic Wrap software was employed to process surface‐based mandibular superimposition with the mandibular ramus as a reference. Additionally, the voxel and surface‐based methods were compared for precision, with the mandibular ramus being the reference.
Results: After voxel‐based mandibular superimposition using the mandibular ramus as a reference, with all measurement errors (< 0.20 mm). In contrast, the results of surface‐based mandibular superimposition with the same reference, and the measurement errors were all less than 0.10 mm. The Wilcoxon signed‐rank test revealed statistically significant differences between AS1 and BS1, AS2 and BS2, AS3 and BS3, and AS4 and BS4 (all r< 0.05). Moreover, the absolute mean distances of AS1-AS4 were all greater than those of BS1-BS4.
Conclusion: All mandibular superimposition procedures, including the voxel‐ and surface‐based ones using the mandibular ramus as a reference, have acceptable surface errors (< 0.20 mm), indicating the good reliability of these techniques. Under the specified conditions, surface‐based mandibular superimposition appears to yield a higher degree of precision compared with the voxel‐based technique.
doi: https://doi.org/10.12669/pjms.40.8.8441
How to cite this: Lin G, Chen X, Shi X. A study on the precision of voxel- and surface-based mandibular superimposition. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.8441
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Retrospective analysis of efficacy and safety of recombinant human Rh-endostatinstatin combined with concurrent radiotherapy for cervical cancer
Authors: Zhang Xin , Li Qian , Liu Kuan , Shi Hong-yun
Published: August 2024

Objective: Retrospective study and analysis of the safety and efficacy of Rh-Rh-endostatinstatin combined with simultaneous radiotherapy in the treatment of cervical cancer.
Methods: A retrospective study was used to enroll cervical cancer patients who received Rh-endostatin combined with simultaneous radiotherapy (observation group) or radiotherapy alone (control group) from January 2019 to December 2022 in the Affiliated Hospital of Hebei University, and RECIST 1.1 criteria were used to evaluate the recent efficacy, and the WHO Adverse Reaction Scale for Anti-cancer Drugs to evaluate the toxic and side effects.
Results: The difference between PR, SD, PD, ORR and DCR of the two groups was not statistically significant (P>0.05), and the CR of the observation group was significantly higher than that of the control group (P<0.05). The proportion of neutropenia, hypertension, arrhythmia, hemoglobin reduction in the observation group was significantly higher than that in the control group, and the proportion of nausea and vomiting was significantly lower than that in the control group(P<0.05), and there was no significant difference in other adverse reactions (P>0.05). After intervention, the CD3+, CD3-CD19+, CD16+CD56+, CEA, CY211 of both groups were significantly lower than before treatment(P<0.05). After treatment, CD3+, CD3-CD19+, CD16+CD56+ were significantly higher in the observation group than in the control group, and WBC and PLT were significantly lower than before treatment(P<0.05). The HPV conversion rate of the observation group was significantly higher than that of the control group(P<0.05).
Conclusions: Our finding revealed that Rh-endostatinstatin combined with simultaneous radiotherapy showed better clinical outcomes and favorable toxic profile than that of radiotherapy alone in the treatment of cervical cancer.
doi: https://doi.org/10.12669/pjms.40.8.8770
How to cite this: Zhang X, Li Q, Liu K, Shi H. Retrospective analysis of efficacy and safety of recombinant human Rh-endostatinstatin combined with concurrent radiotherapy for cervical cancer. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.8770
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Translation process of the tested Rome IV diagnostic questionnaire for functional gastrointestinal disorders into Saudi-Arabian Arabic: A mixed-methods approach
Authors: Aljaaly Elham A. , Khatib Mai A.
Published: August 2024

Objective:  A report on the cross-cultural adaptation and validation process of the Rome IV Diagnostic Questionnaire for children aged four years and over into Saudi-Arabian Arabic for use in assessing the prevalence of functional gastrointestinal disorders in children in Saudi Arabia.
Method: A mixed-methods approach was used in translating the 60-item original English version of the questionnaire. The process included four steps followed by a cognitive debriefing and was guided by the Rome Foundation. The questionnaire was tested for practicability with 10 participants of children aged four years and older. The whole study took place between October 2020 and April 2021.
Results: The original questionnaire repeated information on areas of pain experienced by children, which did not show up in the backward, English, translation. The back-translated version occasionally provided medical expressions that were then explained between parentheses in plain English, for example, dyspepsia (burning feeling). The expert panel indicated that all questionnaire items reached the set 90% agreement level, confirming that the questionnaire is fully understandable and valid for use. Preliminary testing with 10 participants (four years and older) revealed functional constipation to have the highest prevalence among the participants (40%, n=4), followed by irritable bowel syndrome (20%) and abdominal migraine (20%).
Conclusion: This study provides a detailed report on the translation process of the tested ROME- IV Diagnostic Questionnaire for children aged four years and over into Saudi Arabic following Rome Foundation guidelines. The results of the preliminary test should encourage researchers and clinicians in Saudi Arabia to utilize the tool for non-invasive diagnosis of functional gastrointestinal disorders in children.
Abbreviations: DQ: Diagnostic questionnaire, FGIDs: Functional gastrointestinal disorders, RF: Rome Foundation, TT: Translation team.
doi: https://doi.org/10.12669/pjms.40.8.9126
How to cite this: Aljaaly EA, Khatib MA. Translation process of the tested Rome IV diagnostic questionnaire for functional gastrointestinal disorders into Saudi-Arabian Arabic: A mixed-methods approach. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.9126
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Breast Cancer Screening in Transgender Population: Review of literature
Authors: Tareen Saffa , Mooghal Mehwish , Shaikh Kulsoom , Zeeshan Sana
Published: August 2024

This literature review explores breast cancer screening practices among transgender individuals globally, emphasizing the overlooked population in Pakistan. With an overview of intersex and transgender terminology, the study delves into screening guidelines for transfeminine and transmasculine patients, considering hormone therapy and surgery. Worldwide statistics on transgender and intersex populations are provided, highlighting the unique challenges they face, particularly in Pakistan, where societal discrimination and healthcare barriers persist.
Databases searched included PubMed, Scopus, and Google Scholar from the Year 2000 till todate.The review synthesizes breast cancer screening recommendations in transgender population from ACR, WPATH, UCSF, and the Canadian Cancer Society, revealing variations in guidelines. It concludes with a call for tailored screening protocols for Pakistan’s transgender community and recommends a comprehensive study due to the absence of data in Southeast Asia. The unstructured abstract underscores the need for nuanced, personalized screening strategies and emphasizes the critical gap in knowledge specific to breast cancer in this marginalized population.
doi: https://doi.org/10.12669/pjms.40.8.9132
How to cite this: Tareen S, Mooghal M, Shaikh K, Zeeshan S. Breast Cancer Screening in Transgender Population: Review of literature. Pak J Med Sci. 2024;40(8):---------. doi: https://doi.org/10.12669/pjms.40.8.9132
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Nuclear lifetime measurements around Z=50
Authors: Efstathiou Margarita , Vasileiou Polytimos , Mertzimekis Theodoros , Zyriliou Aikaterini , Karadimas Angelos , Chalil Achment , Koseoglou Pavlos , Mărginean Nicolae , Mihai Constantin , Costache Cristian , Lică Razvan , Mihai Radu , Turturica Andrei , Borcea Ruxandra , Florea Nicoleta
Published: August 2024

In the present work, a dedicated experimental study of the lifetimes of in Te and Sb isotopes was undertaken at the 9 MV Tandem accelerator at the IFIN-HH. Beams of 11B at 35 MeV impinged on a natAg target to populate the nuclei of interest and study their decay using the activation method. The emitted gamma rays and charged particles were detected by the ROSPHERE and SORCERER arrays. Lifetimes of the decaying isomeric and ground states in 117Te and 115,117Sb were measured. The present results update existing literature data from half a century ago employing a new reaction mechanism to populate the states of interest along with a more advanced array of detectors
Constraining the hypothetical X17 boson from compact objects observations
Authors: Moustakidis Charalampos , Alkiviadis Kanakis-Pegios  , Vlassios Petousis  , Martin Veselsky  , Jozef Leja
Published: August 2024

We investigate the hypothetical X17 boson on neutron stars and Quark Stars (QSs) using various hadronic Equation of States (EoSs) with phenomenological or microscopic origin. Our aim is to set realistic constraints on its coupling constant and the mass scaling, with respect to causality and various possible upper mass limits and the dimensionless tidal deformability Λ1.4. In particular, we pay special attention on two main phenomenological parameters of the X17, the one is related to the coupling constant g that it has with hadrons or quarks and the other with the in-medium effects through the regulator C. Both are very crucial concerning the contribution on the total energy density and pressure.In the case of considering the X17 as a carrier of nuclear force in Relativistic Mean Field (RMF) theory, an admixture into vector boson segment was constrained by 20% and 30%.In our investigation, we came to the general conclusion that the effect of the hypothetical X17 both on neutron and QSs constrained mainly by the causality limit, which is a specific property of each EoS, and it  depends on the interplay between the two main parameters, the interaction coupling g and the in-medium effects regulator C. These effects are more pronounced in the case of QSs concerning all the bulk properties.
Neutron dosimetry at HK-1 beam line of LVR-15 reactor for biomedical sample irradiations
Authors: Kalamara Antigoni , Georgiou Sofia , Stefanopoulos Konstantinos L. , Stamatelatos Ion E. , Kalef-Ezra John A. , Vinš Miroslav , Klupák Vit , Rabochová Michaela , Šoltés Jaroslav , Theodossiou Theodossis
Published: August 2024

The HK-1 neutron beam line at the LVR-15 reactor in ÚJV Řež, Czech Republic, was used for in vitro cell studies carried out in the framework of the FRINGE project, aiming on the development of a novel neutron capture therapy technique using Gd containing compounds. The neutron fluence rate close the HK-1 beam exit was experimentally assessed. Neutron fluence rate data were combined with Monte Carlo simulations performed using the MCNP 6.1 code, to model a well-type vial containing a thin layer of cells, with and without Gd, as well as the supporting media. Aim of the study was to evaluate the energy deposited by the neutrons in the cell monolayers and delineate the contribution of the various dose components in an attempt to interpretate the findings of the in vitro studies.
The ELISA spectrometer at the JRC-Geel: development, achievements and future plans
Authors: Gkatis Georgios , Pirovano Elisa , Diakaki Maria , Noguere Gilles , Nyman Markus , Oprea Andreea , Paradela Carlos , Plompen Arjan
Published: August 2024

The ELISA (ELastic and Inelastic Scattering Array) setup, currently installed at the GELINA (Geel Electron Linear Accelerator) facility of the EC-JRC (European Commission – Joint Research Centre) in Geel (Belgium), is a unique instrument in Europe, used for the production of high-resolution neutron elastic and inelastic scattering cross-section data, relevant for nuclear physics applications. The setup features 32 liquid organic scintillators for the detection of the scattered neutrons coupled with a 235U ionization chamber for the measurement of the neutron flux. This paper outlines a brief history of the development of the setup, the measurements that have been performed so far, and the future experimental plans.
More foreign-accented but more comprehensible: Attrition and amelioration of L1 speech in proficient L2 learners
Authors: Yazawa Kakeru , Konishi Takayuki , Pérez-Ramón Rubén , Kondo Mariko
Published: August 2024

Background There is an increasing interest in cross-linguistic influences of the second language (L2) on the first (L1), but its communicative impact remains to be elucidated. This study investigates how L2 learners’ L1 pronunciation is perceived as foreign-accented and (in) comprehensible as a function of their L2 learning experience and proficiency levels. Methods Read speech of 154 L1 Japanese learners of L2 English in the J-AESOP corpus was examined, where approximately one-third of them had lived in English-speaking countries and the rest had never lived outside of Japan. Their L1 speech was rated by another group of native Japanese listeners for accentedness and comprehensibility (from October 25, 2022 to August 20, 2023), while their L2 speech was previously rated by native American English listeners for nativelikeness or proficiency. The speakers’ vowel acoustics were also examined. Results More proficient L2 speakers were perceived as more foreign-accented in their L1, but only if they had lived overseas; their length of residence abroad predicted the degree of perceived accentedness. In contrast, more proficient L2 speakers were consistently perceived as more comprehensible in the L1, regardless of prior overseas experience. Acoustic analyses indicated that perceived accentedness is associated with a clockwise chain shift of all vowel categories in the vowel space. It was also revealed that the dispersion, rather than compactness, of vowel production contributed to perceived comprehensibility, although the degree of L1 vowel dispersion did not predict L2 proficiency. Conclusions The overall results suggest two main conclusions. First, perceptible L1 foreign accent likely results from L1 disuse rather than L2 interference, thereby L1 pronunciation differs from native norms at a system-wide rather than category-specific level. Second, L2 learning has a positive influence on perceived L1 comprehensibility, rather than individuals with clearer and more comprehensible L1 speech being inherently better L2 learners.
IoT-Driven Hybrid Deep Collaborative Transformer with Federated Learning for Personalized E-Commerce Recommendations: An Optimized Approach
Authors: Alqhatani Abdulmajeed , Khan Surbhi Bhatia
Published: August 2024

Recommender systems are already being used by several biggest e-commerce websites to assist users in finding things to buy. A recommender system gains knowledge from a consumer and suggests goods from the available goods that will find most value. In this deep learning technique, the Hybrid Deep Collaborative Transformer (HDCT) method has emerged as a promising approach. However, it is crucial to thoroughly examine and rectify any potential errors or limitations in the optimization process to ensure the optimal performance of the HDCT model. This study aims to address this concern by thoroughly evaluating the HDCT method uncovering any underlying errors or shortcomings. By comparing its performance against other existing models, the proposed HDCT with Federated Learning method demonstrates superior recommendation accuracy and effectiveness. Through a comprehensive analysis, this research identifies and rectifies the errors in the HDCT model, thereby enhancing its overall performance. The findings of this study provide valuable insights for researchers and practitioners in the field of e-commerce recommendation systems. Data for the RS is collected from the Myntra fashion product dataset. By understanding and addressing the limitations of the HDCT method, businesses can leverage its advantages to improve customer satisfaction and boost their revenue. Ultimately, this research contributes to the ongoing advancements in e-commerce recommendation systems and paves the way for future improvements in this rapidly evolving domain. The suggested model’s efficacy is assessed using metrics for MSE, MSRE, NMSE, RMSE, and MAPE. The suggested values in metrics are 0.2971, 0.2763, 0.4013, 0.3222, 0.2911 at a 70% learn rate and 0.2403, 0.2234, 0.3506, 0.2025, 0.2597 at an 80% learn rate, and the proposed model outperformed with the least amount of error.
E-commerce Data Mining Analysis based on User Preferences and Association Rules
Authors: Zhang Yun
Published: August 2024

With the development of network technology, online shopping is becoming more and more convenient. But the increasing number of products also makes it difficult for consumers to make the right decision. When there is no apparent market demand, how to recommend products with commercial potential to customers has become an urgent problem for businesses to solve. This paper proposes e-commerce product recommendation based on user preference and association rule algorithm aiming at the problems existing in e-commerce product recommendation. Firstly, this paper constructs a user interest modeling method. Through analyzing users’ interests and preferences, to provide users with timely and accurate personalized services. Then, the FP_Growth algorithm is optimized and improved. A more effective CTE-MARM algorithm is designed, and an association rules database based on user benefit items is constructed and analyzed jointly. Analyze products with strong correlations. According to consumers’ interest levels, TOP-N is the best product choice. Experiments show that the algorithm has higher prediction accuracy. The research results of this project can not only improve enterprises’ ability to analyse data and provide data support for enterprises to carry out effective marketing management.